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132 Cards in this Set
- Front
- Back
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UTI: common bug? DOC?
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1. E. coli
2. TMP/SMX, nitrofurantoin, amoxicillin, quinolones |
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bronchitis: common bug? DOC?
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1. virus, H. influenzae, Moraxella spp.
2. amoxicillin, erythromycin |
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pneumonia (classic): common bug? DOC?
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1. Streptococcus pneumonia, H. influenzae
2. 3rd gen cephalosorin, azithromycin |
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pneumonia (atypical): common bug? DOC?
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1. Mycoplasma, Chlamydia spp.
2. Macrolide antibiotic, doxycycline |
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osteomyelitis: common bug? DOC?
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1. Staphylococcus aureus, Salmonella spp.
2. anti-Staph penicillin (dicloxacillin, methicillin), vancomycin |
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cellulitis: common bug? DOC?
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1. Streptococci, staphylococci
2. anti-Staph penicillin covers both (dicloxacillin, methicillin) |
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meningitis (neonate): common bug? DOC?
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1. Streptococci B, E. coli, Listeria spp.
2. ampicillin + aminoglycoside, 3rd generation cephalosporin |
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meningitis (child/adult): common bug? DOC?
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1. S. pneumoniae, Neisseria meningitidis
2. 3rd gen cephalosporin, meropenem + vancomycin + dexamethasone |
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is H. influenzae a common cause of meningitis in children?
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No, due to widespread vaccination
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in a child who hasn't been vaccinated, what is most likely cause of meningitis?
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H. influenzae
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sepsis: common bug? DOC?
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1. gram negative bugs, streptococci
2. 3rd gen penicillin/cephalosporin staphylococci + aminoglycoside, imipenem |
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septic arthritis (monogamous or not sexually active pts): common bug? DOC?
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1. S. aureus
2. anti-staphylococcal penicillin, vancomycin |
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common cause of septic arthritis in young adults who are sexually active?
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gonorrhea
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endocarditis: common bug? DOC?
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1. Gonococci, staphylococci, streptococci
2. Gonococci -> Ceftriaxone, penicillin, spectinomycin; streptococci -> Antistaphylococcal penicillin (or vancomycin) + aminoglycoside |
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Strep A or B: empiric abx?
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first: penicillin, cephazolin
second: erythromycin |
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S. pneumoniae: empiric abx?
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first: 3rd gen cephalosporin
second: fluoroquinolone (eg. levofloxacin) |
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Enterococcus: empiric abx?
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first: penicillin or ampicillin + aminoglycoside
second: vancomycin + aminoglycoside |
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Staphylococcus aureus: empiric abx?
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first: Anti-Staph Penicillin (eg. methicillin)
second: Vancomycin (MRSA) |
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Gonococcus: empiric abx?
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first: ceftriaxone or fluoroquinolone
second: spectinomycin |
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Meningococcus: empiric abx?
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first: penicillin/ampicillin
second: cefotaxime, chloramphenicol |
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Haemophilus: empiric abx?
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first: 2nd or 3rd gen cephalosporin
second: ampicillin |
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Pseudomonas: empiric abx?
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first: antipseudomonal penicillin + aminoglycoside
second: aztreonam, imipenem |
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Bacteroides: empiric abx?
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first: metronidazole
second: clindamycin |
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Mycoplasma: empiric abx?
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first: erythromycin, azithromycin
second: doxycycline |
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Treponema pallidum: empiric abx?
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first: penicillin
second: doxycycline |
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Chlamydia: empiric abx?
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first: doxycycline, azithromycin
second: erythromycin, fluoroquinolone |
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Lyme disease: empiric abx?
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first: ceftriaxone, doxycycline
second: erythromycin, amoxicillin |
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with genital infections, always treat for a presumed co-infection with what bug? what do you treat with?
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1. Chlamydia
2. azithromycin or doxycycline |
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gram stain: blue/purple color. bug?
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Gram-positive
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gram stain: red color. bug?
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Gram-negative
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gram stain: gram + cocci in chains. bug?
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Streptococci
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gram stain: gram + cocci in clusters. bug?
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Staphylococci
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gram stain: gram + cocci in pairs (diplococci). bug?
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Streptococcus pneumoniae
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gram stain: gram neg. coccobacilli (small rods). bug?
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Haemophilus sp.
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gram stain: gram neg. diplococci. bug?
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STD, septic arthritis, meningitis: Neisseria sp.
lungs, sinusitis: Moraxella |
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gram stain: plump gram neg. rod with thick capsule (mucoid appearance). bug?
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Klebsiella sp.
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gram stain: gram + rods that form spores. bug?
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Clostridium sp., Bacillus sp.
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gram stain: pseudohyphae. bug?
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Candida sp.
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gram stain: acid fast organisms. bug?
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Mycobacterium (usually M. tuberculosis), Nocardia sp.
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gram stain: gram + with sulfur granules. bug?
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Actinomyces sp. (pelvic inflammatory disease in intra-uterine device users; rare cause of neck mass/cervical adenitis)
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gram stain: silver staining. bug?
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Pneumocystis carinii and cat-scratch disease
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gram stain: positive Indian ink preparation (thick capsule). bug?
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Cryptococcus neoformans
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gram stain: spirochete. bug?
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Treponema sp., Leptospira sp. (both seen only on darkfield microscopy); Borrelia sp. (seen on regular light microscope)
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gold standard for pneumonia diagnosis? what do you think about?
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sputum culture; get it before starting abx; get blood cx too because of possible bacteremia in pneumonia
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most common cause of pneumonia?
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Streptococcus pneumoniae
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classic presentation of S. pneumoniae pneumonia?
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rapid onset, shaking chills after 1-2d of URI sx (sore throat, runny nose, dry cough), followed by fever, pleurisy, productive cough (yellowish green or rust-colored from blood), especially in older adults.
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what is shown on CXR and CBC in S. pneumoniae pneumonia?
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lobar concentration
WBC count is high c large % of neutrophils |
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how do you treat S. pneumoniae pneumonia?
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1. 3rd gen cephalosporin (ceftriaxone)
2. macrolide (azithromycin) 3. broad spectrum floroquinolone (levofloxacin) |
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best prevention against S. pneumoniae?
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vaccination
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who should get the S. pneumoniae vaccine?
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1. children and adults>65yrs
2. splenectomized pts 3. sickle-cell disease pts (autosplenectomy) 4. pts with splenic dysfunction 5. immunocompromised pts (HIV, malignancy, organ transplant) 6. pts with chronic disease (DM, cardiac, pulm, renal, liver) |
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how do you recognize Haemophilus influenze pneumonia?
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2nd most common cause
this is more common in kids than adults presents clinically like S. pneumoniae pneumonia; but it's a gram negative coccobacilus on sputum Gram stain |
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what are 3 different ways you could treat H. influenza pneumonia?
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1. ampicillin/amoxicillin
2. cephalosporin 3. TMP/SMX |
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empyema and lung abscesses are more common in what type of pneumonia?
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Staph aureus pneumonia
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what are hallmarks of Staph aureus pneumonia?
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1. tend to be nosocomial pneumonia
2. CF pts often get it (that, or Pseudomonas) 3. IV drug useres 4. pts c chronic granulomatous disease (recurrent lung abscess) |
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how do you treat gram neg. pneuonias?
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3rd gen penicillin/cephalosporin plus an aminoglycoside
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in what clinical situations do you get gram-negative pneumonias?
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pseudomonas -> CF
Klebsiella -> 'skid-row' alcoholics and homeless people (currant jelly sputum) enteric gram neg. organisms (E. coli) -> aspiration, neutropenia, nosocomial pneumonia |
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pneumonia common in adolescents, young adults; classically a college student or soldier in dormitory. what is the bug?
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Mycoplasma pneumonia
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how is atypical pneumonia different than typical in presentation?
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long prodrome with gradual worsening of malaise, headaches, dry, non-productive cough and sore throat; low grade fever
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CXR in atypical pneumonia?
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patchy, diffuse bronchopneumonia, classically looks terrible, but pt doesn't feel that bad
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what in atypical pneumonia can cause hemolysis or anemia?
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cold-agglutinin antibody titers
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DOC in atypical pneumonia?
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macrolid abx (azithromycin) or broad spectrum fluoroquinolone (levofloxacin)
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2 common bugs that cause atypical pneumonia in adolescents and young adults?
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1. Mycoplasma sp.
2. Chlamydia sp. |
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in what setting do you see Pneumocystis carinii (PCP) and cytomegalovirus (CMV) pneumonia
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HIV positive pts with CD4 counts <200/mm3 (AIDS); other severely immunocompromised pts (organ transplant pts, CA pts)
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how do you diagnose and treat Pneumocystis carinii pneumonia?
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dx: bronchoalveolar lavage; silver stain and bilateral interstitial lung infiltrates
rx: TMP/SMX or pentamidine |
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what is particular about the diagnosis of CMV pneumonia? how do you treat?
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intracellular inclusion bodies
ganciclovir; foscarnet is an alternative |
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when do you think about PCP prophylaxis in an HIV pt? what do you give?
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when CD4 < 200/mm3
TMP/SMX or pentamidine |
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buzz: stuck with thorn or gardening. bug? rx?
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Sporothrix schenckii
oral potassium iodide or ketoconazole |
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buzz: aplastic crisis in sickle cell disease. bug?
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parvovirus B19
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buzz: sepsis after splenectomy. bugs?
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S. pneumoniae, H. influenzae, N. meningitidis (encapsulated bugs)
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buzz: pneumonia in the southwest. bug? rx?
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Coccidioides immitis
itraconazole, fluconazole, or amphotericin B for severe disease |
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buzz: pneumonia after cave exploring or exposure to bird droppings in Ohio and Mississippi River valleys. bug?
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Histoplasma capsulatum
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pneumonia after exposure to parrot or exotic bird. bug?
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Chlamydia psittaci
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fungus ball/hemoptysis after TB or cavitary lung disease. bug?
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Aspergillus sp.
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pneumonia in pt with silicosis. bug?
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TB
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diarrhea after hiking/drinking from a stream. bug? findings and rx?
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Giardia lamblia
stool cysts; tx with metronidazole |
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pregnant woman with cats gets infection. bug?
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Toxoplasma gondii
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B12 deficiency with abdominal sx. bug?
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Diphyllobothrium latum
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seizures with ring-enhancing lesion on CT. bug?
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Taenia solium (cysticercosis) or toxoplasmosis
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squamous cell bladder CA in Middle East or Africa. bug?
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Schistosoma haematobium
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worm infection in children. bug? findings?
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Enterobius sp.
positive tape test, perianal itching |
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fever, muscle pain, eosinophilia, and periorbital edema after eating raw meat. bug?
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Trichinella spiralis (trichinosis)
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gastroenteritis in young kids. bugs?
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rotavirus, Norwalk virus
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food poisoning after eating reheated rice. bug?
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Bacillus cereus
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food poisoning after eating raw seafood. bug?
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Vibrio parahemolyticus
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diarrhea after travel to Mexico. bug?
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E. coli (Montezuma's revenge)
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baby paralyzed after eating honey. bug? mxn?
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Clostridium botulinum
toxin blocks Ach release |
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genital lesions in children in absence of sexual abuse or activity. bug?
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Molluscum contagiosum
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cellulitis after cat/dog bites. bug? rx?
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Pasteurella multocida
prophylactic ampicillin |
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slaughterhouse worker with fever. bug?
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Brucellosis
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pneumonia after being in hotel or near air conditioner or water tower. bug? rx?
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Legionella pneumophila
azithromycin or levofloxacin |
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burn wound infx with blue/green color. bug?
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Pseudomonas sp.
S. aureus is also a common burn infx, but lacks blue/green color |
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ring enchancing brain lesion as a complication of AML and immune compromise. bug?
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Asperigillus spp.
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how do you screen for syphilis?
how do you confirm a positive screen? |
1. RPR (rapid plasma reagin) or VDRL (Venereal Disease Research Laboratory) test
2. confirm with FTA-ABS (fluorescent treponemal antibody absorbed) or microhemagglutination (MHA-TP) |
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2 tests remain positive for life in syphilis patients after a cure. which are they?
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FTA-ABS and MHA-TP
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if you scrape the base of a genital chancre or conyloma lata, what do you see under dark-field microscopy?
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spirochetes
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what group of pts should always be screened for syphilis?
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pregnant women; prevent birth defects
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how do you treat syphilis?
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penicillin
use doxycycline for penicillin allergic pts |
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describe the 3 stages of syphilis.
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1*) painless chancre resolves spontaneously w/in 8 wks
2*) 6 to 18wks after infection, look for condyloma lata, maculopapular rash (palms and soles of feet), lymphadenopathy -- latent phase -- 3*) gummas (granulomas in many different organs), neurologic sx and signs (neurosyphilis, Argyll-Robertson pupil, dementia, paresis, tabes dorsalis, Charcot joints), and/or thoracic aortic aneurysms |
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how do you recognize measles (rubeola) infx in a child?
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- lack of immunization
- Koplik's spots (tiny white spots on buccal mucosa) seen 3 days after high fever, cough runny nose, and conjuctivitis with or without photophobia - on the next day, a maculopapular rash begins on head and neck, spreading down to cover trunk |
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what are the complications of measles?
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- giant cell pneumonia in very young or immunocomprimised pts
- otitis media - encephalitis (either acute or late - subacute sclerosing panencephalitis can occur years later) |
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why is rubella infx (German measles) an important disease?
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- infx in pregnant moms can cause severe birth defects in the fetus
- must screen and immunize all women of reproductive age w/o evidence of rubella antibodies before pregnancy * the vaccine is contraindicated in pregnant women * |
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how do you recognize rubella infection in kids? complications?
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1. rubella is milder than measles; sx include low-grade fever, malaise, tender swelling of suboccipital and postauricular nodes, arthralgias
after 2 to 3 day prodrome, faint maculopapular rash appears on face and neck and then spreads down to trunk (like measles) complications include encephalitis and otitis media |
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how do you recognize roseola infantum (exanthum subitum)? what causes it?
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- distintive progression: high fever with no apparent cause for 4d (possible febrile sz's), abrupt return to normal temp as diffuse macular/maculopapular rash appears on chest and abdomen
disease is rare in kids older than 3yrs caused by human herpesvirus type 6 (DNA herpes family virus) |
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what disease is caused by the human herpesvirus type 6 (DNA herpes virus)?
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roseola infantum (exanthum subitum)
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how do you recognize erythema infectiosum (fifth disease) in kids? cause?
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- classic 'slapped cheek' appearance
- mild constitutional sx (low fever, malaise) - one day later, maculopapular rash appears on arms, legs and trunk caused by parvovirus B19, the same virus that causes aplastic crisis in sickle cell |
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how do you recognize chicken pox? what virus causes it?
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progression of the disease: discrete macules (usually on trunk) turn to papules, which turn to vesicles that crust over; happens in crops, so different patches with different stages of progression
all this happens within 1 day varicella virus |
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how do you make the definitive dx of chicken pox? when is a pt no longer infectious
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Tzanck smear of tissue from base of a vesicle shows multinucleated giant cells
when last lesion crusts over |
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complications of chickenpox?
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infection of lesions with streptococci or staphylococci which cause erysipelas, cellulitis and/or sepsis
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can a child get chickenpox from someone with shingles?
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yes
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what is tx and ppx for chickenpox?
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tx: supportive care c acetominophen, fluids, don't infect others; acyclovir in severe cases
routine vaccination for all kids in U.S. |
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what do you give pts with debilitating illness within 4 days of exposure to someone with chickenpox?
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Varicella-zoster immunoglobulin
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what is scarlet fever?
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febrile illness with rash caused by certain Streptococcus spp.
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describe the hx of someone with scarlet fever.
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- hx of untreated streptococcal pharyngitis
- only streptococcal spp. that produce erythrogenic toxin can cause scarlet fever - pharyngitis followed by sandpaper-like rash on abdomen and trunk with classic circumoral pallor and strawberry tongue - rash desquamates once fever subsides |
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how do you treat streptococcal pharyngitis? what do you want to prevent?
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- penicillin
- rheumatic fever |
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what is another name for Kawasaki's syndrome?
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mucocutaneous lymph node syndrome
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what are the diagnostic criteria for Kawasaki's syndrome?
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- seen in pts under 5yrs old
- fever for more than 5 days - bilateral conjunctival injection - changes in lips, tongue, oral mucosa (strawberry tongue, fissuring, injection) - changes in extremities (eg. skin desquamation, edema, erythema) - polymorphous truncal rash, beginning one day after the fever starts - cervical lymphadenopathy |
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what disease must you include in the ddx of a child with MI?
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Kawasaki's syndrome
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what is the most feared complication of Kawasaki's disease?
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heart problems:
- coronary artery aneurysms - CHF - arrhythmias - myocarditis - MI |
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what do you give to kids with Kawasaki's syndrome to reduce risk of cardiac lesions?
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aspirin and IV immunoglobulins
Kawasaki's syndrome is one of the FEW indications for aspirin in children |
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what is an important ddx of EBV infection?
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acute HIV infection; it can cause a mononucleosis-type syndrome
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what is the link between EBV and CA?
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- nasopharyngeal CA
- African Burkitt's lymphoma - posttransplant lymphoproliferative d/o |
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what are the classic findings of EBV infection (infectious mononucleosis)?
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Fatigue
Fever Pharyngitis Cervical lymphadenopathy all in a young adult |
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what do you see in EBV infx that don't appear in streptococcal pharyngitis?
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- splenomegaly (could lead to splenic rupture)
- hepatomegaly - atypical lymphocytes with lymphocytosis, anemia, or thrombocytopenia - positive serology (heterophile antibodies [Monospot test], specific EBV antibodies) |
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vignette:
- hx of tick bite in pt on East Coast - severe HA, malaise about a week before high fever and chills - rash appears 4d later on palms/wrists and soles/ankles and spreads rapidly to trunk and face diagnosis? |
Rocky Mountain spotted fever
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what bug causes Rocky Mountain spotted fever? treatment?
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Rickettsia rickettsii
tetracycline; chloramphenicol is 2nd choice |
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describe typical lesions of impetigo caused by Streptococcus and Staphylococcus spp. where do they typically present on the body?
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- look for hx of break in the skin (eg. prior chickenpox, insect bite, scabies, cut)
- rash starts as thin-walled vesicles that rupture and form yellowish crusts - classically described as 'weeping' skin - typically present on face and tend to be localized; rash is infectious |
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how do you treat impetigo caused by Streptococcal and Staphylococcal spp?
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tx with oral antistaphylococcal penicillin (eg. methicillin) to cover both Streptococcus and Staphylococcus spp.
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what are the 2 types of endocarditis? how do they present?
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1. acute or fulminant: affects normal heart valves
2. subacute: insidious onset and typically affects previously damaged or mechanical valves |
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what do you think about if Streptococcus bovis shows up on culture in someone with endocarditis?
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suspect colon CA
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what bug is most common cause of acute endocarditis? subacute?
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acute: Staphylococcus aureus
subacute: Streptococcus viridans (and others: S. bovis, S. epidermis, S. faecalis) |
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what is another term for S. faecalis?
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enterococci
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how is endocarditis diagnosed? what is empiric treatment?
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1. diagnose with blood cultures
2. third generation penicillin or cephalosporin plus and aminoglycoside |
