Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
319 Cards in this Set
- Front
- Back
|
What organisms cause necrotizing fasciitis?
|
- Group A strep
- Haemolytic strep (B, C, G) - Staph aureus - Clostridium perferingens - Clostridium septicum - Vibrio vulnificus |
|
|
What historical clues point to vibrio vulnificus?
|
cur or puncture in hand after immersion in warm salt water. oysters, fish
|
|
|
What causes necrotizing fasciitis in "black tar heroin" users?
|
C. sordellii
|
|
|
What is the initial treatment for vibrio vulnificus?
|
tetracycline or third-generation cephalosporin
|
|
|
How do you treat necrotizing fasciitis?
|
Antibiotic therapy & aggressive surgical debridement.
- Vanco for MRSA, clinda for anaerobic |
|
|
Which antiretroviral should not be used in patients with asthma and suffering from Influenza?
|
zanamivir - may induce bronchospasm
|
|
|
What causes progressive multifocal leukencephalopathy (PML)? What is the treatment? What are the MRI findings?
|
polyomavirus JK
No treatment. If not severe and caught early, may consider stopping immunosuppressive medication. - lesions in the cortical areas of the left temporoparietal lobes and scattered throughout the deep white matter |
|
|
In patients status post transplant and mental status changes, which organism should be considered?
|
polymovirus JK
|
|
|
What does polymavirus BK cuase?
|
nephropathy and deteriorating renal function
|
|
|
How do you differentiate smallpox from chickenpox?
|
Lesions are on soles and palms and same stage with smallpox. Also, fever tends to precede rash with smallpox
|
|
|
Which virus causes vesicular lesions in hands, feet and mouth?
|
coxsackievirus
|
|
|
What sort of rash is associated with ebola?
|
petechial rash
|
|
|
How do you differentiate monkeypox from smallpox (variola) and varicella?
|
monkeypox is a centrifugal rash, sometimes associated with a hemorrhagic component and associated with LAD (not present w/ the other two)
|
|
|
How do you diagnose smallpox?
|
sending tissue obtained by skin biopsy, fluid from an unroofed lesion, a swab from the tonsils, or a blood specimen to a reference laboratory for one of several tests, including DNA sequencing, electron microscopy, and immunohistochemical studies
|
|
|
What vaccine can affect severity of monkeypox?
|
vaccinia vaccine
|
|
|
In whom is smallpox vaccine contraindicated? What should they be given?
|
- pregnant women and immunosuppressed patients
- specific immune globulin |
|
|
Should contacts of patients with smallpox be vaccinated?
|
yes, they should take their temperature twice daily for 17 days after exposure
|
|
|
Should patients suspected to have smallpox be isolated?
|
yes
|
|
|
Does vaccination provide protection against smallpox if already exposed?
|
yes, partially if given within 4 days
|
|
|
What can cause encephalitis post-tranfusion?
|
West Nile Virus, may remain in the circulation for 28 days
|
|
|
What are the most common manifestations of West Nile encephalitis?
|
Encephalitis, meningitis, flaccid paralysis, and fever
|
|
|
What antibiotics are most appropriate for treating ESBL-producing gram-negative baccilli empirically?
|
Carbapenems (imipenem, meropenem, ertapenem)
|
|
|
If a patient is HIV+ with CD4 count < 200 & evidence of chronic Hep B w/active liver inflammation, what retrovirals shouls be used in HAART therapy?
|
Lamivudine and Tenofovir - they have activity against chronic hepatitis B
|
|
|
Which chronic Hep B patients are candidates for treatment?
|
- active liver inflammation
- elevated serum alanine aminotransferase levels and - evidence of ongoing infection (positive HBeAg or HBV DNA >105 copies/mL ) |
|
|
What retrovirals can be used to treat chronic Hep B?
|
Lamivudine, tenofovir or adefovir. Increased resistance to monotherapy with lamivudine.
|
|
|
What infection is associated with hot tub exposure?
|
Mycobacterium avium complex hypersensitivity pneumonitis
|
|
|
What can be seen with Nocardia lung syndrome? Who is usually affected?
|
- Nodular 'coin' lesions
- Patients with reduced cell-mediated immunity, immunosuppressed, chronic steroid tx - usually caused by Nocardia asteroides |
|
|
In immunosuppressed or high risk individuals, what size induration is consdered positive for TB?
|
> 5 mm
|
|
|
Does a normal CXR rule out spinal TB?
|
NO
|
|
|
What is the most serious complication of spinal TB? How do you treat it?
|
- spinal cord compression
- emergent MRI and surgical decompression |
|
|
What are the classic symptoms for Dengue fever?
|
- fever
- myalgias - arthralgias - severe headache - leukopenia - thrombocytopenia |
|
|
What is the likely diagnosis for a patient that was recently in the caribbean and complaining of myalgias, fever, headache and thrombocytopenia?
|
Dengue fever (also S. America & Central America)
|
|
|
What is the treatment for dengue fever?
|
supportive
|
|
|
What would you see with Dengue hemorrhagic fever?
|
signs or symptoms of hemorrhage or capillary fragility, such as a petechial rash, pleural effusion, or peripheral edema
|
|
|
what clinical presentation strongly suggests underlying bronchiectasis?
|
Development of chronic cough and sputum production following a severe episode of pneumonia several years ago and a chest radiographic with nospecific increased markings
|
|
|
What organisms colonize bronchiectatic lungs?
|
Strep pneumonia
Haemophilus influenzae Staphylococcus aureus Pseudomonas aeruginosa |
|
|
What prophylaxis do post-transplant patients receive against CMV?
|
ganciclovir or valganciclovir
|
|
|
What is the diagnosis of a post-transplant patient presenting with abdominal pain, anemia, melena and ulcers on EGD if off of ganciclovir?
|
gastrointestinal CMV infection
|
|
|
How to differentiate HSV from CMV in patients presenting with GI complaints?
|
HSV causes ulcerated lesions in mouth & esophagus but rarely causes gastric or duodenal ulcers as does CMV.
|
|
|
Who should receive prophylaxis for meningococcal infection?
|
- Household contacts
- health care workers who have contact with respiratory secretions (intubation) |
|
Patient presents obtunded with signs of meningitis, history of middle ear infection and this gram stain. What is the diagnosis & treatment?
|
Strep pneumoniae
Vanco + ceftriaxone + dexamethasone |
|
|
A patient returns from Africa with fever, myalgias, lymphadenopathy, and a erythematous and papulovesicular cutaneous with a single eschar. What is the diagnosis, organism & treatment?
|
- African tick bite fever
- Rickettsia africae (carried by ticks) - doxycycline or fluoroquinolone |
|
|
With Creutzfeldt-Jakob disease, what does CSF examination show?
|
Normal except for an elevated protein level (14-3-3)
|
|
|
How do you difinitively diagnose Creutzfeldt-Jakob disease?
|
PrPsc in brain tissue obtained with biopsy or autopsy
|
|
|
What is the typical EEG tracing in a patient with CJD?
|
Sharp, or triphasic, waves occurring once every second (develops later in the disease)
|
|
|
What are the most commonly used probable criteria for diagnosing CJD?
|
presence of dementia (time course unspecified) with either “typical” electroencephalogram (EEG) findings or an elevated 14-3-3 protein level in the cerebrospinal fluid plus at least two of the following four symptoms:
1) visual/cerebellar signs 2) extrapyramidal/pyramidal signs 3) myoclonus, and 4) akinetic mutism |
|
|
Most common MRI finding for diagnosing sporadic CJD
|
hyperintensity in the cortical gyri and basal ganglia on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) MRI sequences
|
|
|
Diagnostic criteria for probable variant CJD
|
Presence of a progressive neuropsychiatric illness for at least 6 months and four of the five following findings:
1) early psychiatric symptoms 2) persistent painful paresthesias 3) ataxia 4) dementia 5) myoclonus, chorea, or dystonia (don't usually have typical EEG findings) |
|
|
What does MRI in patients with variant CJD show?
|
Pulvinar sign, in which the pulvinar (posterior thalamus) is brighter than the anterior putamen on T2-weighted MRI.
|
|
|
What is the prefered treatment for Listeria monocytogenes?
|
ampicillin or penicillin G combined with an aminoglycoside
|
|
|
What is the prefered treatment for Listeria monocytogenes in patients with PCN allergy?
|
trimethoprim–sulfamethoxazole
|
|
|
What is the recommended treatment for TB?
|
1) isoniazid, rifampin, and pyrazinamide
2) isoniazid, rifampin, pyrazinamide, and ethambutol 3) isoniazid, rifampin, pyrazinamide, and streptomycin |
|
|
What is the recommended empiric therapy for a patient admitted to a general medical floor with community-acquired pneumonia?
|
1) an intravenous β-lactam plus an intravenous or oral macrolide or doxycycline or
2) monotherapy with an intravenous fluoroquinolone |
|
|
What is the recommended empiric therapy for a patient admitted to the ICU with community-acquired pneumonia?
|
intravenous β-lactam (ceftriaxone or cefotaxime) plus either an intravenous macrolide (azithromycin) or an intravenous fluoroquinolone. If the patient is at risk for P. aeruginosa infection, an anti-pseudomonal β-lactam should be used.
|
|
|
Atypical organisms that typically cause community-acquired pneumonia?
|
Mycoplasma pneumoniae, Chlamydophila pneumoniae (formerly Chlamydia pneumoniae), and Legionella pneumophila
|
|
|
When does a chancre occur with primary syphillis?
|
3 weeks after exposure
|
|
|
When does seconday syphillis occur? How does it present?
|
- 2-8 wks after primary chancre.
- fever, rash ('nickels and dimes' and lymphadenopathy |
|
|
What should you think of when a young person presents with alopecia?
|
syphillis
|
|
|
What can you see with tertiary syphillis?
|
- aortitis (rupture is main cause of death)
- argyll-robertson pupil - tabes dordalis (sensory ataxia, foot slap, wide gait, lightening pains, autonomic dysfunction) |
|
|
Treatment for the different stages of syphillis. Primary, Secondary, Latent, late Latent, neurosyphilis?
|
*Primary, Secondary, early Latent: Benzathine PCN G 2.4 million IM x 1
*Late (> 1yr): PCN G 2.4 million IM weekly x 3 * Neuro: aqueous PCN G 4 million IV x 14 days |
|
|
What should you think of when a young person presents with alopecia?
|
syphillis
|
|
|
What type of infection are Immunosuppressed transplant recipients are at high risk for in their first month?
|
Bacterial (staph wound infection (coag+ or Coag-), aspiration pneumonia, etc
|
|
|
What should you think of when a young person presents with alopecia?
|
syphillis
|
|
|
What is superior to povidone-iodine for cleaning a catheter insertion site?
|
Chlorhexidine
|
|
|
What can you see with tertiary syphillis?
|
- aortitis (rupture is main cause of death)
- argyll-robertson pupil - tabes dordalis (sensory ataxia, foot slap, wide gait, lightening pains, autonomic dysfunction) |
|
|
What can you see with tertiary syphillis?
|
- aortitis (rupture is main cause of death)
- argyll-robertson pupil - tabes dordalis (sensory ataxia, foot slap, wide gait, lightening pains, autonomic dysfunction) |
|
|
Where is community-acquired MRSA endemic?
|
prisons and low-income housing populations
|
|
|
Treatment for the different stages of syphillis. Primary, Secondary, Latent, late Latent, neurosyphilis?
|
*Primary, Secondary, early Latent: Benzathine PCN G 2.4 million IM x 1
*Late (> 1yr): PCN G 2.4 million IM weekly x 3 * Neuro: aqueous PCN G 4 million IV x 14 days |
|
|
Treatment for the different stages of syphillis. Primary, Secondary, Latent, late Latent, neurosyphilis?
|
*Primary, Secondary, early Latent: Benzathine PCN G 2.4 million IM x 1
*Late (> 1yr): PCN G 2.4 million IM weekly x 3 * Neuro: aqueous PCN G 4 million IV x 14 days |
|
|
What type of infection are Immunosuppressed transplant recipients are at high risk for in their first month?
|
Bacterial (staph wound infection (coag+ or Coag-), aspiration pneumonia, etc
|
|
|
Prisoner presents with fever, hypotension, swollen arm, history of 'spider bite' & Gram+ org. What is the diagnosis & treatment?
|
necrotizing fasciitis from community-acquired MRSA & Vanco
|
|
|
What type of infection are Immunosuppressed transplant recipients are at high risk for in their first month?
|
Bacterial (staph wound infection (coag+ or Coag-), aspiration pneumonia, etc
|
|
|
What is superior to povidone-iodine for cleaning a catheter insertion site?
|
Chlorhexidine
|
|
|
What antibiotics, besides Vanco, are effective for treating MRSA?
|
Ampicillin–sulbactam
cefazolin oxacillin Clindamycin (do sensitivity testing 1st) |
|
|
What is superior to povidone-iodine for cleaning a catheter insertion site?
|
Chlorhexidine
|
|
|
a asymptomatic HIV patient presents with increasing viral load and missing doses of antiretrovirals. What should be done next?
|
Order HIV genotype resistance assay
|
|
|
Where is community-acquired MRSA endemic?
|
prisons and low-income housing populations
|
|
|
Where is community-acquired MRSA endemic?
|
prisons and low-income housing populations
|
|
|
Prisoner presents with fever, hypotension, swollen arm, history of 'spider bite' & Gram+ org. What is the diagnosis & treatment?
|
necrotizing fasciitis from community-acquired MRSA & Vanco
|
|
|
Prisoner presents with fever, hypotension, swollen arm, history of 'spider bite' & Gram+ org. What is the diagnosis & treatment?
|
necrotizing fasciitis from community-acquired MRSA & Vanco
|
|
|
What is the recommended treatment for latent tuberculosis?
|
isoniazid for 9 months
|
|
|
What antibiotics, besides Vanco, are effective for treating MRSA?
|
Ampicillin–sulbactam
cefazolin oxacillin Clindamycin (do sensitivity testing 1st) |
|
|
What antibiotics, besides Vanco, are effective for treating MRSA?
|
Ampicillin–sulbactam
cefazolin oxacillin Clindamycin (do sensitivity testing 1st) |
|
|
a asymptomatic HIV patient presents with increasing viral load and missing doses of antiretrovirals. What should be done next?
|
Order HIV genotype resistance assay
|
|
|
a asymptomatic HIV patient presents with increasing viral load and missing doses of antiretrovirals. What should be done next?
|
Order HIV genotype resistance assay
|
|
|
What is the recommended treatment for latent tuberculosis?
|
isoniazid for 9 months
|
|
|
What is Mishap Probability?
|
The probability that a hazard will result in a mishap or loss, based on an assessment of various factors.
|
|
|
What are alternative treatments for latent TB (in stead of isoniazid)?
|
-Rifampin and pyrazinamide for 2 months
OR -Rfampin alone for 4 months |
|
|
Do patients who received BCG vaccine have positive tuberculin skin test?
|
NO, occasional false +, but should treat for latent TB if positive
|
|
|
What tuberculin skin tests are considered positive?
|
* ≥15 mm of induration for persons at low or no risk of developing tuberculosis.
*10 to 14 mm of induration for recent immigrants from endemic areas, health care workers, injection drug users, and persons residing in long-term-care institutions. * 5 to 9 mm of induration for immunosuppressed patients, recent contacts of patients with active tuberculosis, and persons with suspicious findings on chest radiographs. |
|
|
Patient steps on a rusty nail and later develops osteomyelitis? What are the causative organisms & what antibiotics should be used?
|
- staphylococci, streptococci, anaerobes, and gram-negative bacilli
- Pseudomonas aeruginosa has been found between the layers of rubber soles of sneakers - Tx: vanco + piperacillin-tazobactam |
|
|
What antiretroviral is approved for treating CMV infection?
|
Cidofovir
|
|
|
Which medication is helpful in preventing reactivation of varicella zoster virus in stem-cell transplant recipients?
|
acyclovir
|
|
|
How can contact dermatitis be differentiated from other skin infections?
|
Usually pruritic, non-pustular vesicles without fever and leukocytosis
|
|
|
What is the most appropriate empiric therapy for a patient with purulent meningitis following neurosurgery?
|
Vancomycin plus cefepime
|
|
|
What can be given to immunosuppressed patients requesting influenza A & B prophylaxis?
|
oseltamivir (PLUS family members should be immunized)
|
|
|
What can be done for aymptomatic patients who received a tick bite in areas endemic for Lyme?
|
doxycycline - single dose
|
|
|
What increases a person's risk of developing Lyme disease?
|
If the tick is engorged with blood
|
|
|
Which organism causes Lyme disease? How is infection confirmed?
|
- Borrelia burgdorferi
- confirmation by Western blot analysis after detection of a positive enzyme-linked immunosorbent assay (ELISA), serology (not + in acute stage) |
|
|
What are early symptoms of Lyme disease?
|
rash (erythema migrans), headache, fever, lymph nodes
|
|
|
How can you treat Lyme disease?
|
* Early/facial nerve palsy: doxycycline 100mg BID x 21 days or amoxicillin 500 mg Q8 x 21 days
* Late/Meningitis/carditis: ceftriaxone 2g IV x 21 dys, PCN G 3-4 million IV Q4 hrs x 14 dys * Arthritis: doxy 100 mg BID x 21 dys, PCN G 3-4 million IV Q4 hrs x 14 dys |
|
|
What areas are endemic for Lyme disease?
|
CT, Martha's Vineyards
|
|
|
What is the treatment of choice for babesiosis?
|
Mild:
- Atovaquone plus azithromycin - quinine plus clindamycin Severe: -exchange transfusion, then antibiotics |
|
|
Where is babesiosis endemic?
|
New England states (Mass, Nantucket, CT, RI)
|
|
|
What organism causes babesiosis?
|
Babesia microti (tick infection)
|
|
|
What clinical findings, signs & symptoms of babesiosis?
|
- fever, sweats, myalgias, chills, emotional lability
- hemoglobulinemia (predominant sign) - FEBRILE HEMOLYTIC ANEMIA |
|
|
What do you see on peripheral blood smear?
|
- intraerythrocytic parasites
- Maltese cross (Malaria is circular) |
|
|
If a patient is low risk for HIV and has a positive ELISA and indeterminant Western, what should be offered?
|
repeat testing in 3 months and 6 months
|
|
|
What does an indeterminant HIV western blot indicate?
|
HIV seroconversion or the presence of cross-reactive antibodies
|
|
|
Should HIV RNA viral loads be tested in patients with indeterminant results?
|
NO, low-level abnormal values may simply be a laboratory artifact
|
|
|
What is a malodorous vaginal discharge with a high pH characteristic of?
|
trichomoniasis or bacterial vaginosis
|
|
|
What antibiotics can be used for candidemia?
|
Echinocandin:
- caspofungin - micafungin - anidulafungin - fluconazole once shown to be sensitive |
|
|
Which species of candida is fluconazole usually effective for?
|
C. albicans or C. tropicalis
|
|
|
In a patient with brain abscess, what empiric antibiotic should be used if had otitis media or mastoiditis?
|
ceftriaxone/cefotaxime + metronidazole.
** Use cefepime if suspect pseudomonas** |
|
|
In a patient with brain abscess, what empiric antibiotic should be used if had sinusitis?
|
Vanco + metronidazole + ceftriaxone/cefotaxime
|
|
|
In a patient with brain abscess, what empiric antibiotic should be used if had dental sepsis?
|
penicillin + metronidazole
|
|
|
In a patient with brain abscess, what empiric antibiotic should be used if had lung abscess, ampyema or bronchiectasis?
|
Vanco + ceftriaxone/cefotaxime \
** Use cefepime if suspect pseudomonas** |
|
|
In a patient with brain abscess, what empiric antibiotic should be used if had endocarditis?
|
PCN + metronidazole + sulfonamide (Bactrim if Nocardia suspected)
|
|
|
In a patient with brain abscess, what empiric antibiotic should be used if had
|
Vanco + gent
OR nafcillin + ampicillin + gent |
|
|
Which infections require respiratory precautions?
|
TB, measles, Varicella (chickenpox)
|
|
|
Which organisms cause brain abscesses from otitis media?
|
Strep (anaerobic & aerobic), Bacteroides, Provetella, Enterobacteriacae
|
|
|
What organisms cause toxic shock syndrome?
|
* Staph aureus
* Group A Step (strep pyogenes) |
|
|
Which organism is most likely to cause TSS if patient had prior viral infection (chickenpox)?
|
Strep
|
|
|
What is used to treat TSS?
|
Vanco + clindamycin
|
|
|
What are the signs and symptoms of TSS?
|
fever, hypotension, rash and must have 3 organ symptoms. Can have diarrhea & hypocalcemia.
|
|
|
How should staph epi (coag neg staph) be treated if cause of TSS?
|
Vanco +/- Rifampin +/- Gent
|
|
|
Which pneumococcus is diplococci?
|
H. influenzae
|
|
|
What should be used to treat H. influenzae if blood cultures positive?
|
IV nafcillin or Vanco.
|
|
|
In patients with severe combined immunodeficiency, what type of blood products must they receive?
|
- T cell depletion
- irradiated (to avoid CMV infection) - cannot receive live viruses |
|
|
What infections are patients with X-linked gammaglobulinemia susceptible to? How do you treat?
|
- encapsulated infections (pneumococcus, meningococcus)
- IVIG |
|
|
If a patient in their 20-30s presents with recurrent sinus and pulmonary infections, what should you suspect? How can you diagnose?
|
- common variable immunodeficiency
- CT scan/biopsy - noncaseating granulomas in the spleen & liver |
|
|
What infection are patients with IgA deficiency susceptible to?
|
giardia
|
|
|
What other conditions do patients with IgA deficiency have?
|
atopic dermatitis
asthma rhinitis |
|
|
What type of deficiency should be suspected in patients with recurrent sinuopulmonary infections by encapsulated bacteria?
|
Complement deficiency
- C2: most common - C3: severe bacterial infections |
|
|
What types of infections are prominent in patients with terminal complement deficiency (C5-9)? How do you screen?
|
- meningococcal, H. influenzae, pneumococci
- check CH 50 or CH 100 |
|
|
What condition can patients with C1 deficiency have?
|
- Hereditary angioedema
- suspect if another family member had it (even if on an ACEI - DON'T BE FOOLED) |
|
|
What causes infections 1-4 months following transplant?
|
CMV
Hepatitis B Nocardia |
|
|
What causes infections 2-6 months following transplant?
|
viruses (varicella)
|
|
|
How do you treat disseminated cryptococcus?
|
flucytosine & lipid-form of amphotericin B
|
|
|
Which organisms can reactivate in people with impaired immunity?
|
-Nocardia
-TB -Strongyloides (can stay 30-40 yrs) - Histoplasmosis - cryptococcus - blastomycosis - coccidiomycisis |
|
|
What organism should be suspected if patient has sepsis/endocarditis after TURP?
|
Enterococcus
|
|
|
What can be used to treat VRE?
|
-daptomycin
-linezolid - if sensitive, vanco, PCN + amp + gent |
|
|
What conditions does strep pyogenes cause?
|
-pharyngitis
- TSS - Rheumatic fever - erysipelas or scarlet fever |
|
|
What signs and symptoms to do see with strep pyogenes pharyngitis?
|
fever, leukocytosis, exudate tonsils (if hoarseness, think viral)
|
|
|
If patient presents with pharyngitis and rapid strep negative, what other causes should you consider?
|
- EBV (mono)
- acute retroviral syndrome |
|
|
What groups of patients get group B strep (agalactiae) wound infections?
|
-DM
-ETOH -very young or very old - pregnant women (UTI) - post-part endometritis/bacteremia |
|
|
How do you treat strep agalactiae?
|
- amp + gent
- amp + ceftriaxone (3rd gen ceph) |
|
|
What does group D strep causes & what other condition is it associated with?
|
-strep bovis
-bacteremia, endocarditis - colon cancer (30% cases) |
|
|
Who gets Listeria monocytogenes (think goat cheese)?
|
-pregnant women
- AIDS -lymphoma - Leukemia |
|
|
How do you treat listeria monocytogenes?
|
amp or PCN +/- aminoglycoside
|
|
|
Patient from Russia with URI, gray-white pharyngeal membrane, low fever. What is the likely diagnosis? How do you treat?
|
- corynebacterium diptheria
- ampicillin or PCN +/- aminoglycoside |
|
|
Patient with painless papule, ulcer and black eschar. Gram stain shows Gram-postive rods. What is the diagnosis & treatment?
|
- bacillus anthracis
- PCN G (if sensitive), tetracycline, erythromycin, quinolones. Can use Cipro until know sensitivities |
|
|
What do you see radiographically with b. anthracis pneumonia?
|
widened mediastinum
|
|
|
Do patients with b. anthracis need to be isolated?
|
NO
|
|
|
What are risks for infection with bacillus cereus?
|
fried rice
contact lens wearers IV catheters |
|
|
How do you treat bacillys cereus?
|
supportive
|
|
|
What is the early symptoms of infection with b. cereus? late symptoms?
|
- early: emesis (preformed in food)
- late: profuse watery diarrhea, non-bloody with cramping |
|
|
Which strain of clostridium is associated with food poisoning? What is the treatment?
|
-perferingens
- PCN |
|
|
Which strain of clostridium is associated with GI malignancy?
|
c. septicum
|
|
|
Which strain of clostridium is associated with tetanus? What is the treatment?
|
- c. tetani
- PCN |
|
|
Which strains of clostridium is associated with gas gangrene?
|
-c. septicum
-c. tetani -c. perferingens -c. noryi |
|
|
which organisms are associated with GI malignancy?
|
-strep bovis
-clostridium septicum |
|
|
Who should receive prophylaxis for neisseria (gram neg cocci)?
|
- people with intimate oral contact
- household contacts - daycare - significant others |
|
|
How do you treat Neisseria?
|
Fluoroquinolones (Cipro)
Ceftriaxone (child or pregnancy) |
|
|
What organism causes a hot tub rash?
|
pseudomonas
|
|
|
What organism is associated with ecthyma gangrenosum? describe lesion?
|
Pseudomonas
- round, black, indurated lesion with central ulceration |
|
|
Patient from Texas presents with large, localized lymphadenopathy and hemorrhagic pneumonia and fever. What is the likely diagnosis? Does this patient need to be isolated? How do you treat?
|
- yersinia pestis (plague). Diagnose with LN biopsy
- YES - stretomycin, chloramphenicol, doxycycline |
|
|
What is the differential diagnosis for hemorrhagic pneumonia?
|
Yersinia pestis and Haunta virus
- Haunta virus has renal failure |
|
|
Which organisms should be suspected if patient gets lymphadenopathy after hunting? How do you differentiate?
|
-Yersinia pestis & tulermia (francisella)
- Yersinia in SW states - Tuleremia in Ok, arkansas & missouri |
|
|
How do you diagnose and treat tuleremia?
|
Dx: serology for francisella
Tx: streptomycin, gent, tetracyclines |
|
|
How is tulermia transmitted?
|
ticks or eating infected meat (rabbits, dear)
|
|
|
Where is legionella (aerobic gram-neg baccilli) found?
|
in water
|
|
|
What symptoms can a patient have with legionella infection?
|
pneumonia, CNS and diarrhea
|
|
|
How do you treat legionella infection?
|
erythromycin, clarithromycin, azithromycin
|
|
|
If a hunter from Oklahoma, Missouri or arkansas presents with pneumonia and skin lesions, what is the likely diagnosis?
|
blastomycosis
|
|
|
If a hunter from Oklahoma, Missouri or arkansas presents with a cat scratch, no tick bite and lymphadenopathy, what is the likely diagnosis?
|
- bartonella henselae (gram-neg)
- Tx: azithromycin |
|
|
Patient from Georgia presents with maculopapular rash on palms & soles, abdominal pain, exposure to ticks and hyponatremia. What is the diagnosis, how do you confirm & what is the treatment?
|
- Rocky Mountain spotted fever
- serology - doxycycline, chlorampenicol (seen in midatlantic - delaware, NC, SC, GA) |
|
|
Patient presents after a tick bite with pancytopenia. What is the diagnosis, how do you confirm & what is the treatment?
|
- Ehrlichia (spotless RMSF)
- serology, Monila smear - Tx: doxycycline |
|
|
In what disease do you see PAS-foaming macrophages? What is the causative organism? How do you treat?
|
- Whipples Disease
- tropheryma whippelli - Ceftriaxone for 2 weeks, bactrim for 1 yr |
|
|
How do you treat actinomyces (sulfur granules)?
|
anaerobic
Tx: PCN, ampicillin 2nd line: tetracycline |
|
|
what is seen clinically with leptospirosis? Are urine/blood cultures positive early or late in disease? How do you treat?
|
- myalgias, fever, headache
- Weil's syndrome (hepatitis with renal symptoms, very elevated bilirubin) - blood: early, urine: late - Tx: PCN or doxy |
|
|
What organisms are the most common causes of nongonococcal septic arthritis in adults?
|
staphylococci and streptococci
** higher in patients with RA** |
|
|
Which antiviral agent for influenza would require dosage adjustment for renal insufficiecy?
|
Amantadine
**Although oseltamivir and zanamivir are excreted by the kidneys, dosage adjustment is not required in a patient with renal compromise** |
|
|
If traveling and at risk for Hepatitis A, when should vaccine be given?
|
2 weeks prior to exposure. If less than 2 weeks, may give serum immune globulin.
|
|
|
What is chronic granulomatous disease is characterized by? How is screening performed?
|
- invasive skin infections due to deficient neutrophil function
- nitroblue tetrazolium dye test |
|
|
What screening is recommended for patients with defective cellular immunity?
|
TB, mumps, candida antigens
|
|
|
What suggests deficiency in cellular immunity?
|
infections with viruses, intracellular pathogens, or fungi
|
|
|
What is a 'halo' sign on CT indicative of?
|
aspergillus
|
|
|
What is one of the most common fungal infections in transplant recipients and one of the leading causes of death in allogeneic transplant recipients?
|
Aspergillus, usually occurs within the first 3 months
|
|
|
What can be used to treat aspergillus infection?
|
- voriconazole (sign interaction with sirolimus)
- amphotericin B |
|
|
What are potential causative organisms for osteomyelitis in sickle cell patients?
|
staphylococci, streptococci, and Salmonella
|
|
|
what should a patient with sickle cell and osteomyelitis be treated with?
|
Vanco and ceftriaxone
|
|
|
What is the most appropriate therapy for a subdural empyema?
|
Antimicrobial therapy and neurosurgical drainage
|
|
|
Where is histroplasma capsulatum endemic? Who is at risk?
|
- Midwestern US (mississippi & Ohio valleys), central America
- construction workers (bat/bird droppings) |
|
|
What are the signs & symptoms of histoplasmosis?
|
- interstitial pneumonia, palate ulcers, splenomegaly
- 1/3 with anemia, neutropenia or pancytopenia |
|
|
What is used to treat histoplasmosis?
|
itraconazole or voriconazole
|
|
|
What is used to treat coccidioidomycosis?
|
fluconazole, occasionally with amphotericin
|
|
|
Where is coccidioidomycosis prevalent?
|
SW US & Mexico
|
|
|
Which fungal infection presents like sarcoid?
|
coccidioidomycosis
- flu-like with athralgias, erythema multiforme +/- erythema nodosum |
|
|
What is used to treat blastomycosis?
|
itraconazole
|
|
|
What causes hepatitis and meningoencephalitis in immunosuppressed patients?
|
Reactivation of human herpesviruses 6 and 7
|
|
|
What can be used to treat HHV-6 infection?
|
- ganciclovir & foscarnet
|
|
|
What diseases does HHV-8 cause and is associated with?
|
- Kaposi sarcoma
- Castleman's syndrime - primary effusion lymphoma |
|
|
What is the gold standard for diagnosing primary TB?
|
pistive sputum or tissue cultures and stains for acid-fast bacilli
|
|
|
What is used to treat disseminated gonoccal infection?
|
Ceftriaxone
|
|
|
How is disseminated gonococcal infection manifested?
|
dermatitis, tenosynovitis, and asymmetric arthritis
|
|
|
How do you diagnose disseminated neisseria gonorrhoeae?
|
swab the urethra, throat, and rectum for culture
|
|
|
Which genotype is the most common for Hep C infections? Is it responsive to treatment?
|
- Genotype 1
- NO |
|
|
What is the treatment of choice for hepatitis C?
|
combination of pegylated interferon and ribavirin.
|
|
|
How is penicillin resistance categorized?
|
- Intermediate-level resistance (minimal inhibitory concentration [MIC] between 0.1 and 1 μg/mL)
- High-level resistance (MIC >1 μg/mL). |
|
|
What other antibiotics can be used if strep pneumonia resistant to penicillin?
|
- fluoroquinolone
- Vanco - linezolid - Ceftriaxone (if MIC to PCN < 2 ug/ml) |
|
|
Which infection is associated with nephropathy and deteriorating renal function in renal transplant recipients?
|
Polyomavirus BK
|
|
|
What findings are highly indicative of polyomavirus BK?
|
intranuclear inclusions in tubular epithelial cells or transitional cells
|
|
|
What causes acute retinal necrosis in patients with HIV infection or AIDS?
|
varicella-zoster virus or possibly by herpes simplex virus
|
|
|
What is used to treat toxoplasmosis? How does it present?
|
- Intravenous pyrimethamine + oral sulfadiazine + leukovorin (need folinic acid)
- CNS & eye disease |
|
|
What is the preferred treatment for acute retinal necrosis?
|
acyclovir
|
|
|
What is used to treat cytomegalovirus retinitis? What is a characteristic finding?
|
- valganciclovir or Intravenous ganciclovir
- Cotton wool spots |
|
|
What is used to treat herpes zoster ophthalmicus?
|
corticosteroids
|
|
|
What symptoms does retinitis cause?
|
floaters and photopsia (flashing lights) in addition to blurring and loss of vision
|
|
|
Should a pregnant lady clean a cat litter? If not, what is she at risk for?
|
NO, toxoplasmosis
|
|
|
How does toxoplasmosis present in AIDS patients?
|
headache, seizures and MRI with multiple lesions
|
|
|
How do you diagnosis toxoplasmosis?
|
acute IgM antibody
|
|
|
How is toxoplasma gondii transmitted?
|
inhalation
|
|
|
What causes a city outbreak of watery, self-limited diarrhea in immunocompetent patients?
|
crytosporidium
|
|
|
How can cryptosporidium be treated in immunocompromised patients?
|
nitazoxamide
|
|
|
How do you treat bronchopulmonary aspergillosis?
|
prednisone & oral itraconazole
|
|
|
Which fungal infection increases risk for hematologic malignancy?
|
aspergillosis
|
|
|
What is used to treat aspergillus?
|
voriconazole
|
|
|
Patient presents with hemoptysis and serial CXR show varying locations of nodular mass. What is the likely diagnosis?
|
aspergillus
|
|
|
What are the types of aspergillosis?
|
1. asymptomatic
2. fungus ball (with cavitaries in lung, old TB) 3. Invasive pulmonary (neutropenic pt) - die within 7-21 days, can embolize 4. allergic bronchopulmonary aspergillosis (asthma patients, diffuse nodular infiltrates, wheezing, coughing) - tx with steroids 5. tracheobronchitis (rare) |
|
|
How do you treat aspergilloma?
|
surgical excision
|
|
|
HIV/AIDS patient with low CD4 count and meningitis. What is the likely diagnosis?
|
cryptococcus
|
|
|
How do you diagnose cryptococcus?
|
India ink or cryptococcal antigen
|
|
|
How can cryptococcus manifest?
|
pulmonary, cutaneous (pustular), meningitis
|
|
|
A gardener is pricked by a thorn and later develops a nodular lesion that ulcerates 1-2 wks later. What is the likely cause/diagnosis?
|
sporotrichum schenckii
|
|
|
How is sporotrichosis diagnosed? Treated?
|
culture
Itraconazole |
|
|
How does variant CJD vary from sporatic CJD in regards to patient population and presentation?
|
patients with the variant form of the disorder tend to be younger and have psychiatric symptoms rather than dementia early in the disease, more prominent sensory findings
|
|
|
The development of focal lymphadenitis in a patient with HIV infection is most commonly caused by what organisms?
|
Mycobacteria, Streptococcus species, or Staphylococcus species.
|
|
|
At what CD4 count does M. avium complex or M. kansasii infection occur in AIDS patients?
|
< 50/uL
|
|
|
What is the most commonly recommended initial treatment for cryptococcal infection?
|
Flucytosine and a lipid formulation of amphotericin B. (monotherapy with flucytosine is not recommended)
|
|
|
In post transplant patients, the presents of fever, decreased mental function & fungemia is suggestive of what?
|
cyrptococcal infection
|
|
|
What empiric antibiotic should be used for infections caused by clenched fist injury?
|
ampicillin-sulbactam
|
|
|
What is is the most appropriate antiviral agent for a patient with genital herpes simplex virus infection without systemic complications?
|
Oral valacyclovir
|
|
|
What is the classic clinical presentation of botulism?
|
prominent bulbar findings (including the four “D's” of diplopia, dysphonia, dysarthria, and dysphagia) with descending, symmetric flaccid paralysis that develops 12 to 72 hours after exposure
|
|
|
How do you distinguish botulism from Guillain–Barré syndrome?
|
In GB, ascending paralysis is a classic finding (vs decending flaccid paralysis)
|
|
|
What are some other signs seen with botulism besides paralysis?
|
No complaints of sensory deficits, NO fever, normal-slow HR
|
|
|
How is botulism distinguished from myasthenia gravis?
|
MG has bulbar symptoms but does not initially cause significant weakness at rest. It also progresses more slowly and does not involve genetically unrelated persons in a household.
|
|
|
What type of disease is fatal familial insomnia?
|
prion disease (very rare)
|
|
|
What are the signs & symptoms of fatal familial insomnia?
|
Insomnia is the predominant symptom, confusion, other signs of dementia, and signs of autonomic nervous system instability are also present
|
|
|
what are the MRI findings of fatal familial insomnia?
|
Diffusion-weighted imaging reveals slight hyperintensity of the cerebral cortex and basal ganglia
|
|
|
How is the diagnosis of anaplasmosis confirmed?
|
finding morulae in granulocytes
|
|
|
What is the treatment of anaplasmosis?
|
doxycycline
|
|
|
How is anaplasmosis infection characterized? Where is it endemic?
|
- Fever, flu-like symptoms, leukopenia, thrombocytopenia, and elevated liver chemistry test
- Virginia |
|
|
What should patients with anaplasmosis also be checked for?
|
lyme and babesiosis
|
|
|
If have a diabetic with a nosebleed & something black in the nose, what should you do?
|
call the surgeon and start amphotericin B (mucor)
|
|
|
Who is susceptible to giardia? How is it treated?
|
- IgA deficiency, campers, travelers
- metronidazole |
|
|
What will aspiration from entamoeba histolytica show? how do you diagnose?
|
NO amoeba or PMNs
Serology |
|
|
How do you treat entamoeba histolytica?
|
Metrinidazole
|
|
|
What organism is associated with 'anchovie paste' aspirate?
|
entamoeba histolytica
|
|
|
If pregnant patient is exposed to varicella and not previously vaccinated, what should be done?
|
Patient should be given immune globulin within 4 days. DO NOT GIVE VACCINE BC LIVE VACCINE
|
|
|
Which treatments decrease post-herpetic neuralgia for zoser?
|
famciclovir & valacyclovir
|
|
|
If patient presents with mono-like illness but negative monospot, what is the likely diagnosis?
|
CMV
|
|
|
How is CMV pneumonitis treated in post organ or bone marrow transplant patients?
|
ganciclovir & IVIG
|
|
|
What is the differential diagnosis for pharyngitis?
|
-strep pneumonia
-CMV -EBV -acute HIV |
|
|
With which infection do patients develop a rash when treated with ampicillin?
|
EBV (mono)
|
|
|
What diseases, besides mono, is EBV associated with?
|
-Burkitt's lymphoma
- b-cell lymphoma -Hairy leukoplasia in HIV pts |
|
|
A patient with a small child presents with arthritis of hands and knees that resolves over several weeks. What is the likely diagnosis?
|
Parvovirus 19 (diagnose with IgM)
|
|
|
What causes aplastic crisis in sickle cell patients?
|
parvovirus 19
|
|
|
Patient presents with rash, retroauricular/suboccipital LN & fever. What is the likely diagnosis?
|
rubella (German measles
|
|
|
What condition is associated with orchitis, swollen salivary glands and occasionally meningeal signs?
|
Mumps (no organisms on gram stain)
|
|
|
Patient presents with rash that started at the hairline, coryza, conjunctivitis, cough and whitish spots in pharynx. What is the diagnosis?
|
Measles (rubeola)
|
|
|
Patient from Japan presents with paresis, gait disturbances, incontinence and weakness/stiffness. What is the likely diagnosis?
|
HTLV-1 (spastic tropic paraparesis)
Also seen in Caribbean, S. America and Africa |
|
|
How do you treat HTLV-1 infection?
|
corticosteroids, danazol, interferon B1a
|
|
|
Patient from S. America or Mexico presents with achalasia, megaesophagus, megacolon, CNS symptoms and heartblock and CHF. What is the most likely diagnosis?
|
Chagas disease (T. cruzi)
|
|
|
Patient was serving in military in Iraq presents with abdominal pain, hepatomegaly, painless skin ulcers with heaped up margins that started after a small red papule. What is the diagnosis & treatment?
|
Leishmaniasas (from sand fly)
Tx: sidum stibugluconate, meglumine, amphotericin B |
|
|
Veteran from WWII started chemo and now has abdominal complaints and eosinophilia. What is the likely diagnosis & treatment
|
Strongyloides stercoralis
-can also have pulm or CNS symptoms Tx: thiabendazole |
|
|
When do you start chemo treatment for Kaposi sarcoma?
|
when develop extensive skin involvement or visceral involvement
|
|
|
What are the most common pathogens of dog or cat bites? what is the treatment?
|
- pastuerella multicoda, staphylococcus, strep pyogenes
- TMP-Clinda (if PCN allergy), otherwise amoxicillin-clavulate |
|
|
What helps prevent development of ventilator-associated pneumonia?
|
Keeping mechanically ventilated patients semi-recumbent (at a 45-degree angle)
|
|
|
what is a side effect of Linezolid?
|
bone marrow suppression if continued fro more than 2 wks
|
|
|
Which carbapenem is most convenient for outpatient treatment of ESBL infections and why?
|
Ertapenem because once daily dosing
|
|
|
What are patients with progressive massive fibrosis are at increased risk for developing?
|
Tuberculosis
|
|
|
What disease is surface mining associated with?
|
Silicosis - characterized by small nodular opacities distributed mainly in the upper lungs. When these nodules coalesce to form masses, the condition is known as progressive massive fibrosis. In this final stage of the disease, cavitation of the masses and hilar lymphadenopathy are usually present
|
|
|
What is the most common cause of diarrhea in travelers to developing countries?
|
Enterotoxigenic Escherichia coli.
|
|
|
What is the treatment for Enterotoxigenic Escherichia coli?
|
Usually self-limiting and doesn't require treatment
|
|
|
What is the most common bacterial cause of diarrhea in the United States?
|
Camplobacter jejuni
|
|
|
In whom is West Nile virus encephalitis is most likely to occur?
|
in patients 65 years of age and older
|
|
|
What are the findings in patients with West Nile virus encephalitis?
|
Fever, severe headache, marked muscle weakness involving the lower motor neurons, mental status changes, and possibly seizures
|
|
|
What is the most common cause of infectious esophagitis?
|
Candida species, followed by herpes simplex virus and cytomegalovirus
|
|
|
Patient presents with abdominal pain, diarrhea followed by renal failure and hemolytic anemia. what is the most likely diagnosis?
|
E. coli O157:H7 (prodcues shiga toxin)
|
|
|
What should be used to treat acyclovir-resistant herpes simplex virus infection?
|
foscarnet
|
|
|
What laboratory studies should be monitored with foscarnet treatment?
|
electrolytes
|
|
|
What is a side effect of cidofovir?
|
nephrotoxicity
|
|
|
A “halo sign” (a nodular lesion with a surrounding ground-glass appearance) on chest radiographs is characteristic of?
|
Aspergillus pneumonia
|
|
|
Patient presents with MRSA endocarditis and vanco treatment not successful. What should antibiotic be changed to?
|
Daptomycin
|
|
|
How should community-acquired pneumonia be treated?
|
third-generation cephalosporin + macrolide
|
|
|
What is the recommendation for HIV post-exposure prophylaxis?
|
two or three antiretrovirals (within 2 hrs if a deep puncture)
|
|
|
What can be used to treat CMV retinitis?
|
Oral valganciclovir or intravenous ganciclovir
|
|
|
How should patients with osteomyelitis and an epidural abscess who do not have focal neurologic deficits be treated?
|
antimicrobial therapy alone, but must be monitored carefully
|
|
|
How should patients with osteomyelitis and an epidural abscess who has focal neurologic deficits be treated?
|
emergency surgical decompression
|
|
|
Patient has 'watery' sputum that is blood-tinged. What is the diagnosis?
|
yersinia pestis
|
|
|
How does pneumonic plaque appear on chest xray?
|
patchy bronchopneumonia
|
|
|
What is is the most common cause of eosinophilic meningitis worldwide?
|
Angiostrongylus cantonensis (the rat lungworm)
|
|
|
Where is Angiostrongylus cantonensis endemic?
|
tropical areas
|
|
|
How do you treat Angiostrongylus cantonensis?
|
The meningitis is self-limited
|
|
|
What is the treatment of choice for patients with herpes zoster?
|
Famciclovir and valacyclovir
|
|
|
What infection is associated with fish tanks?
|
Mycobacterium marinum
|
|
|
How is the cutaneous form of mycobacterium marinum diagnosed?
|
biopsy for histologic, culture & acid fast
|
|
|
How does cutaneous Mycoplasma marinum?
|
chronic nodule or ulcer of a digit, and is often referred to as a “fish tank” or “swimming pool” granuloma
|
|
|
What is the preferred antimicrobial therapy for a patient with a brain abscess caused by Nocardia species?
|
Trimethoprim–sulfamethoxazole
|
|
|
What should Rocky Mountain spotted fever be treated with?
|
doxycycline
|
|
|
Besides genotype resistance assay, what is most important for determining a revised antiretroviral regimen?
|
history of use of antiretroviral agents
|
|
|
If unsure if infection is due to Aspergillus or Pseudallescheria, what can you treat with?
|
Voriconazole
|
|
|
Acute cellulitis in an immunosuppressed patient can be caused by?
|
cryptococcus neoformans
|
|
|
Which antiretroviral should not be used in pregnant HIV patients?
|
Efavirenz
|
|
|
Patient comes from Guatamala with copious diarrhea without fever, and a positive acid-fast smear of stool. What is the diagnosis & treatment/
|
- Cyclospora infection
- trimethoprim–sulfamethoxazole |
|
|
What antibiotic can be used for aspiration pneumonia?
|
Clindamycin
|
|
|
How should prosthetic joint infections be treated?
|
Remove prosthesis, treat with anitbiotic for 6 wks and then reimplant prosthesis
|
|
|
Which beta-lactam can be used safely in patients with PCN allergy?
|
aztreonam
|
