Gp-Mksap-Id-01

Front 1

=== CNS & PRIONS ====

Back 1

=== CNS & PRIONS ====

Front 2

test to dx enteroviral, HSV, and WNV meningitis?

Back 2

- Polymerase chain reaction is both sensitive and specific for diagnosing enteroviral meningitis and HSV

- WNV: IgM Ab in CSF

Viral cx are unreliable

Front 3

Meningitis Associations:

i. Strep pneumo

ii. Neisseria meningitis

iii. Listeria

iv group b strep

Back 3

i. pneumonia, sinusitis, otitis, immunocomp

ii. children, young adults, complemt def.

iii. extrems of age, immunocomp'd, TNF inh, contaminated food, iron overload, HIV

iv. Neonates

Front 4

Emperic tx, Comm-acq Meningitis

i. 2-50

ii. >50

iii. immunocompromisedd

Back 4

i. Vanc + 3G ceph

ii. Vanc + amp + 3G ceph

iii. vanc + amp + (cefepime or meropenem)

Front 5

Emperic tx, HC-acq Meningitis

i. skull fx

ii. post-neurosurg or head trauma

iii. ventricular catheters

Back 5

i. Vanc + 3G ceph

ii. Vanc + (ceftaz | cefepime | meropenem)

iii.

Front 6

Criteria for home IV abx tx of Meningitis?

Back 6

(1) completion of IP therapy for > 6d

(2) no fever > 24 - 48 hours; (3) no significant neurologic dysfunction, focal findings, or seizure activity; (4) clinical stability or improving infection; (5) ability to take fluids by mouth; (6) HHA / visiting nurse

Front 7

dx of brain abscess?

Back 7

- MRI

- lesion > 2.5 cm should be stereotactically aspirated or surgically excised

- culture and histopathologic analysis.

Front 8

Brain abscess, Emperic tx

i. Ear/sinus

ii. Dental

iii. trauma / neurosurgery

iv. lung inf

v. endocarditis

Back 8

i. Metro + 3G ceph

ii. Metro + PCN

iii. Vanco + 3G ceph

iv. metro + PCN + sulfonmide (TMP-SMX)

v. Vanc + gent

Front 9

brain abscess, length of tx

Back 9

- Abx 6-8 wks (3-4 if excised)

- repeat imaging biweekly up to 3 mo

Front 10

cranial subdural empyema, sx?

Back 10

rapidly progressive, with symptoms and signs related to increased intracranial pressure, meningeal irritation, or focal cortical inflammation

Front 11

cranial subdural empyema, dx/tx?

Back 11

dx: MRI > CT

tx: vanc / metro / 3-4gen ceph

- surgical decompression

Front 12

Spinal epidural abscess, indications for med vs surg tx?

Back 12

- abx alone can be considered if have localized pain and radicular symptoms without long-tract signs (do frequent neuro checks + serial MRI)

- surg in pt with increasing neurologic deficit, persistent severe pain, or increasing fever or peripheral leukocyte count, paralysis < 36 hrs

Front 13

HSV encephalitis, dx and tx?

Back 13

- dx: HSV PCR in CSF [may be neg 1st 3-7d].

- NOT serology/CSF viral cx

- tx: IV acyclovir 2-3wk

Front 14

WNV enceph, sx?

Back 14

fever, fatigue, EPS, tremors, bradykinesia, **focal weakness**

Front 15

CJD, presentation and dx

Back 15

- progressive dementia, myoclonus, death in 5 mo

- DX: Neural tissue evaluation demonstrating spongiform changes and histopathologic staining for prion protein (PrPsc)

- dx only after death and can spread infection

Front 16

Variant CJD?

Back 16

- young pt, psych sx

- from bovine spongiform encep

- PrPsc type 4, can do pre-mortem tonsil bx

Front 17

Treating bacterial meningitis, no improvement, what to do?

Back 17

Repeating the CSF analysis is indicated for patients who have not improved after 36 to 48 hours of appropriate therapy, especially for patients with pneumococcal meningitis who are also being treated with adjunctive dexamethasone.

Front 18

=== SKIN AND SOFT TISSUES ====

Back 18

=== SKIN AND SOFT TISSUES ====

Front 19

typical strep and staph skin infection appearances?

Back 19

The presence of lymphangitis and a “peau d’orange” appearance of the skin are more consistent with strep

- an abscess or drainage from an existing wound or site of previous penetrating trauma is more suggestive of staph

Front 20

treatment of community MRSA?

Back 20

Oral: clindamycin, trimethoprim-sulfamethoxazole, tetracyclines, and linezolid.

Hospitalized: vancomycin, daptomycin, telavancin, ceftaroline, and linezolid

Front 21

tx of necrotizing fasciitis

Back 21

surgical exploration (daily as indicated)

anti-MRSA+GP+GN+anaerobe coverage (+ pseudomonal)

vanco/dapto/linez +

(zosyn | cefepime + metro | carabpenem)

Front 22

tx for strep and staph TSS?

Back 22

Clinda, IVIG, Hyperbaric O2?

Front 23

Human bite on hand / punch to face treatment?

Back 23

clenched-fist injury to hand requires immediate prophylaxis (GP/GN/ anaerobe):

- Amox-clav

- Clina / Moxi (PCN allergic)

Front 24

indication for abx after dog or cat bite?

Back 24

- immunocompromised patient

- wounds on the hands or near a joint or bone,

- moderate or severe wounds at any site, significant crush injuries, or wounds with associated edema

Front 25

dog/cat bite abx?

Back 25

augmentin

if allergic: fluoroquin, doxy, TMP-SMX + clinda

Front 26

=== CAP ====

Back 26

=== CAP ====

Front 27

when to test for causative organism in CAP?

Back 27

Outpatient tx: optional

IP: yes if etOH, cavitary liver dz, failed OP tx

ICU: yes, blood cx, sptum, urine leigonella

Front 28

OP CAP tx and duration?

Back 28

5-7 days

Low risk: Xmycin or doxy

High rsk for drug resistant: resp fluor or beta lactam + (macrolide | doxy)

Front 29

When to do immediate thora in CAP?

Back 29

large associated pleural effusion (typically defined as an effusion occupying half or more of the hemithorax on an upright chest radiograph or a fluid level of more than 1 cm on lateral decubitus films)

Front 30

=== TICK DISEASE =====

Back 30

==== TICK DISEASE ======

Front 31

The initial clinical manifestation of Lyme disease?

Back 31

Erythema migrans, which is an erythematous skin lesion at the site of tick attachment 1-2 weeks after infection

Front 32

Lyme Stages & dx?

Back 32

Early localized (incu 3-30d) : Visualize EM

Early Disseminated (Incu 3-6wk): ELISA + W Blot

Late: (Months - years) : ELISA +WB or PCR of joint fluid

Post Lyme : none

Front 33

Lyme Stages & sx?

Back 33

Early localized (incu 3-30d) : E Migrans

Disseminated (Incu 3-6wk): Multiple EM, CN palsy, meningtis, myocarditis,fever

Late(Months - years) : Arthritis

post-lyme: neuralgia, HA, fatigue

Front 34

Lyme tx?

Back 34

All Oral 2-3 weeks

except Early Dess Stage + Meningitis / 2 deg AVB / CHB -> give IV

Late: 28 days oral [IV if relapse or enceph]

Post-Lyme (supportive, no abx)

Front 35

Infections carried by Ixodes tick?

Back 35

Babesia [only one that give hemolysis]

Lyme

Anaplasma

Front 36

babesiosis

i. dx

ii. tx

Back 36

tx all symptomatic pt and asymtomatic > 3 mo

i. hemolysis, macrocytic anemia, while blood PCR

ii. mild - atovaquone + azithro OR quinine + clinda

severe: quinine+clinda

exchange trf if > 10% parasitemia

Front 37

human monocytic ehrlichiosis and human granulocytic anaplasmosis

i. sx

ii. dx

iii. tx

Back 37

i. nonfocal febrile illness with frequent headache, myalgia, and fatigue, leukopenia

ii. Clusters of bacteria on buffy coat stain; serum antibodies appear 2-4 wks after

iii. doxy

Front 38

RMSF

i. lab findings / dx

ii. tx

Back 38

i. thrombocytopenia and elevated serum liver enzyme values. NORMAL leukocyte count (unlike ehrlic / anaplas). Serological testing lags. Can check skin bx

ii. doxy

Front 39

Leptospirosis

i. source

ii. sx

iii. dx

Back 39

i. tropics, animal urine, water/soil

ii. Conjunctival effusion, abrupt fever, rigor, kidney / resp failure, myocarditis

iii. self-limited, doxy / PCN shorten sx