Day 7
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Normal flora: skin | Staph epidermidis
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| Normal flora: nose | Staph epidermidis; colonized by Staph aureus
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| Normal flora: oropharynx | Viridans group sterptococci
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| Normal flora: dental plaque | Stre mutans
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| Normal flora: colon | Bacteroides fragilis > E coli
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| Normal flora: vagina | Lactobacillus, colonized by E coli and group B strep
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| In which situation would a neonate have no flora? | Neonates delivered by C-section; they get rapidly colonized after birth
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| Bug assoc'd with contaminated seafood (shellfish, ocean water) | Vibrio parahaemolyticus and V vulnificus
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| Wound infections from contact with infected ocean water or shellfish | Vibrio vulnificus
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| Preformed toxin in meats, mayonnaise, and custard | S aureus (food poisoning happens and ends quickly)
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| Bug assoc'd with reheated rice | Bacillus cereus (food poisoning happens and ends quickly)
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| Bug assoc'd with reheated meat dishes | Clostridium perfringens
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| Bug assoc'd with undercooked meat | E coli O157:H7
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| Bug assoc'd with eating poultry, meat, and eggs, and touching reptiles or turtles b/f eating with unwashed hands | Salmonella
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| Lactose negative flagellar motility oranism causing bloody diarrhea | Salmonella (salmon swim)
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| Bug causing bloody diarrhea and pseudoappendicitis | Yersinia enterocolitica
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| Bug causing watery traveler's diarrhea | ETEC (T for Traveler's diarrhea)
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| Protozoan causing watery diarrhea | Giardia and Cryptosporidium (immunocompromised)
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| Which viruses are associated with watery diarrhea? | Rotavirus, adenovirus, and Norwalk virus (norovirus)
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| What are the MCC of pneumonia in neonates? | Group B strep and E coli (colonize vagina)
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| What are the MCC of pneumonia in children (4wks-18yo)? | RSV (viral), Mycoplasma, Chlamydia pneumoniae, Strep pneumo (Runts May Cough Sputum)
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| What are the MCC of pneumonia in adults 18-40yo? | Mycoplasma, Chlamydia pneumoniae, and Strep pneumo
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| What are the MCC of pneumonia in adults 40-65yo? | Strep pneumo, H flu, Anaerobes, viruses, mycoplasma
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| What are the MCC of pneumonia in the elderly? | Strep pneumo, influenza virus, anaerobes, H flu, gram negative rods (fecal matter due to poor hygiene)
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| What is the treatment for neonatal pneumonia? | Ampicillin and gentamycin
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| What is the treatment for pneumonia in adults 18-40yo? | Macrolides for Mycoplasma and Chlamydia pneumo, and penicillin or cefriaxone (3rd gen cephalosporin) for Strep pneumo
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| What is the treatment for pneumonia in adults 40-65yo? | Ceftriaxone (3rd gen ceph) for Strep pneumo, 2nd gen ceph for H flu, clindamycin for anaerobes, and Macrolides for Mycoplasma, Clindamycin for anaerobes,
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| What is the treatment for pneumonia in the elderly? | Ceftriaxone (3rd gen ceph) for strep pneumo, clindamycin for anaerobes, 2nd gen cephalosporin for H flu, and aminoglycosides (gentamycin) for gram neg rods; can also just use a big gun like imipenem/cilastatin or meropenem to cover everything
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| Cause of nosocomial pneumonia | Staph, enteric gram neg rods
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| Cause of penumonia in HIV | Pneumoncystis jiroveci
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| Cause of aspiration pneumonia (general) | Anaerobes
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| Cause of pneumonia in an alcoholic or IV drug user | Strep pneumo, Klebsiella, Staph
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| Pneumonia in CF patient | Pseudomonas
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| Post viral pneumonia | Staph, H flu
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| Cause of atypical pneumonia; what's the treatment? | Mycoplasma, Legionella, Chlamydia (pneumo and psittaci); treat with macrolides (azithromycin)
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| What is the MCC of meningitis in newborns? | Group B strep, E coli, and Listeria
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| What can be used to treat meningitis in neonates? | Ceftriaxone for Group B strep and E coli, and ampicillin for Listeria
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| What is the MCC of meningitis in children 6mos-6yo? | Strep pneumo, Neisseria meningitidis (life threatening purpura), H flu type B, Enteroviruses
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| What is the MCC of meningitis in people 6-60yo? | Enteroviruses, Strep pneumo, N meningitidis, and HSV (temporal lobe encephalitis)
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| What is the MCC of meningitis in people over 60yo? | Strep pneumo, gram neg rods, and Listeria
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| What should be administered prior to a dose of ceftriaxone to reduce neural sequelae in children and to decrease morbidity/mortality in adults during treatment for meningitis? | Dexamethasone (steroid)
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| What is used to treat meningitis caused by toxoplasmosis? | Pyrimethamine and sulfadiazine
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| Which viruses can cause meningitis? | enteroviruses (esp coxsackievirus and echovirus), HSV, HIV, West Nile virus, and VZV
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| AIDS patient with radiographic finding of ring-enhancing lesions in both cerebral hemispheres | Toxoplasmosis (brain abscess)
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| What are the CSF findings in bacterial meningitis? | Increased presure, increased neutrophils/PMNs, increased protein, decreased sugar (bacteria like to eat sugar)
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| What are the CSF findings in fungal or TB meningitis? | Increased pressure, increased lymphocytes, increased protein, decreased sugar (fungi like to eat sugar)
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| What are the CSF findings in viral meningitis? | Normal or slightly increased pressure, increased lymphocytes, normal or slightly increased protein, normal sugar
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| What is the treatment for staph aureus osteomyelitis? | Vancomycin (just assume that it's MRSA)
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| Osteomyelitis preferentially infects which part of the bone? | Metaphysis of the long bone
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| Osteomyelitis in sexually active | Neisseria gonorrhea (rare) or septic arthritis
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| Osteomyelitis in diabetics and drug addicts | Pseudomonas aeruginosa
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| Osteomyelitis in sickle cell patients | Salmonella
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| Osteomyelitis in prosthetic replacement | Staph aureus and Staph epidermidis
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| Osteomyelitis in vertebral bodies | Mycobacterium TB (Pott's disease)
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| Osteomyelitis after a dog or cat bite or scratch | Pasturella multocida
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| What test can rule out osteomyelitis? | Negative CRP
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| What tool is used to diagnose osteomyelitis? | Bone scan or MRI (X-rays are NOT sufficient to rule out osteomyelitis)
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| Osteomyelitis occurs most commonly in which population? | Children
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| Dysuria, frequency, urgency, suprpubic pain, and WBCs (no casts) in urine | UTI
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| Fever, chills, flank pain, CVA tenderness, hematuria,and WBC casts | Pyelonephritis (UTI that ascended to kidney)
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| Positive leukocyte esterase test | bacterial UTI; basically just means inflammation is somewhere in the urinary tract
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| Positive nitrite test | gram negative bacterial UTI; more specific than the positive leukocyte esterase test
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| Leading cause of UTI; shows metallic sheen on EMB (eosin methylene blue) agar | E coli
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| 2nd leading cause of community-acquired UTI in sexually active women | Staph saprophyticus
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| 3rd leading cause of UTI. Large mucoid capsule and viscous colonies | Klebsiella penumoniae
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| Motility causes swarming on agar; produces urease; associated with struvite stones; cause of UTI | Proteus mirabilis
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| Blue-green pigment and fruity odor; causes drug-resistant nosocomial UTIs | Pseudomonas aeruginosa
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| What is the treatment for UTIs? | TMP-SMX (treatment of choice), or fluoroquinolones or nitrofurantoin
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| What is the treatment for UTIs in pregnant women? | 1st or 2nd generation cephalosporins, aminopenicillin, or nitrofurantoin
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| Neonate with cotton-like yellow-white scars on retina visible by fundoscopy (chorioretinitis), hydrocephalus, and intracranial calcifications | Toxoplasma gondii (TORCH infection)
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| How is toxoplasma gondii transmitted? | Via aerosolized cat feces or ingestion of undercooked meat; transplacental transmission in first 6mos gestation
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| Neonate with PDA, cataracts, deafness, and bluberry muffin rash (I'm hungry already!) | Rubella (TORCH infection); in children causes mild illness called German measles; a togavirus
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| How is rubella transmitted? | Via respiratory droplets
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| Newborn with unilateral hearing loss, seizures, and petechial rash | CMV (TORCH infection); CMV is MCC of TORCH infections
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| How is CMV transmitted? | Sexual contact, organ transplant
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| Neonate with recurrent infections and chronic diarrhea | HIV (TORCH infection)
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| Name 3 ways to prevent HIV transmission to a neonate/fetus. | 1. Prophylax mom with zidovudine
2. Prophylax mom with HAART
3. Deliver infant via C-section
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| Neonate with vaginal deliver presents with temporal encephalitis and vesicular lesions; mother had vaginal vesicular lesions | HSV; vesicular lesions in mother are a contraindication for vaginal delivery due to easy transmissability through skin or mucous membrane contact intrapartum (during delivery)
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| Stillbirth or hydrops fetalis; if infant survives, presents with facial abnormalities (notched teeth, saddle nose, short maxilla) and saber shins | Syphilis
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| What other viral infection can cause hydrops fetalis? | Parvovirus (DNA virus)
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| What is the MCC of saddle nose deformity? | Wegener's granulomatosis! Gotcha!
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| Rash begins on trunk, spreads to face with lesions of differnt age | Chicken pox caused by VZV
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| Erythematous, sandpaper-like rash with fever and sore throat | Scarlet fever caused by Strep pyogenes
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| Vesicular rash on palms and soles; ulcers in oral mucosa | Hand-foot-mouth disease caused by Coxsackievirus type A
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| Urethritis, cervicitis, creamy purulent discharge | Gonorrhea caused by Neisseria gonorrhea
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| Painful genital ulcer, inguinal adenopathy | Chancroid caused by Haemophilus ducreyi
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| Ulcers, lymphadenopathy, rectal strictures (may be mistaken for IBD) | Lymphogranuloma venereum (Chlamydia trachomatis serotypes L1-L3)
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| Vaginitis, strawberry cervix, corkscrew motility on wet prep | Trichomoniasis caused by Trichomonas vaginalis
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| Noninflammatory, malodorous discharge (fishy smell), positive whiff test, clue cells | Bacterial vaginosis caused by Gardnerella vaginalis (also mobiluncus and various anaerobes)
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| What are the top 2 bugs that produce the infamous chandelier sign? | PID: Chlamydia trachomatis (subacute, often undiagnosed) and Neisseria gonorrhea (acute, fever); C trachomatis is the MC STD in the US
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| Infection of the liver capsule and violin string adhesions of parietal peritoneum to liver | Fitz-Hugh-Curtis syndrome; complication of PID
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| Nosocomial infection assoc'd with hyperalimentation (e.g, TPN feeding) | Candida albicans
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| Nosocomial infection assoc'd with urinary catheterization | E coli, proteus mirabilis
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| Nosocomial infection assoc'd with respiratory therapy equipment | Pseudomonas aeruginosa
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| Nosocomial infection assoc'd with work in a renal dialysis unit | HepB (also assoc'd with needle sticks)
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| What are the 2 most common causes of nosocomial infections? | E coli (UTI) and Staph aureus (wound infection)
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| HIV + adult: Low grade fevers, cough, and hepatosplenomegaly; oval yeast cells within macrophages | Histoplasma capsulatum (Histo hides in macrophages)
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| HIV + adult: Superficial vascular proliferation; biopsy of skin reveals neutrophilic infiltrate | Bacillary angiomatosis caused by Bartonella henselae
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| HIV + adult: Superficial neoplastic proliferation of vasculature; biopsy reveals lymphocytic inflammation | Kaposi's sarcoma caused by HHV8
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| HIV + adult: Chronic watery diarrhea; acid fast cysts seen in stool | Cryptosporidium
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| HIV + adult: Encephalopathy due to reactivation of a latent virus; results in demyelination | Progressive Multifocal Leukoencephalopathy (PML) caused by JC virus
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| HIV + adult: Abscesses in brain; many ring-enhancing lesions on imaging | Toxoplasmosis gondii
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| HIV + adult: Cotton wool spots on fundoscopic exam | CMV retinitis
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| HIV + adult: Intersitial pneumonia; biopsy reveals cells with intranuclear Owl's eye inclusion bodies | CMV
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| HIV + adult: Pleuritic pain, hemoptysis, infiltrates on imaging | Invasive aspergillosis caused by Aspergillus fumigatus
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| HIV + adult: TB-like disease of the lungs, especially with CD4 counts <50 | MAC (Mycobacterium avium-intracellulare)
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| A microbe that colonizes the nasopharynx and can lead to meningitis in children | H flu type B
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| Bug hints: Postive PAS stain | Tropheryma whippelii (Whipple's disease)
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| Bug hints: Chronic granulomatous disease | Catalase + organisms: staph aureus, nocardia, and aspergillus
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| Bug hints: Bilateral Bell's palsy | Borrelia burgdorferi (Lyme disease)
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| What is the correct tx for a woman who presents with purulent urethritis? | 3rd generation cephalosporin (ceftriaxone) to treat N gonorrhea and azithromycin or doxycycline to treat Chlamydia. Must alway treat for Chlamydia with a gonococcal PID b/c Chlamydia often co-infects with N gonorrhea.
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