Green C2- MedStudy Board Review 2011, Infectious Disease
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| #1 cause of osteomyelitis in patients with sickle cell | Salmonella
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| #1 cause of osteomyelitis in patients without sickle cell | Staph aureus
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| In the stem is a patient with hx of flu and new-onset pneumonia... bacteria? | Staph pneumonia, staph sepsis
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| MRSA in the blood... drug of choice? | Vancomycin
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| Treatment of non-MRSA staph toxic shock syndrome _______. | Oxacillin + Clinda +/- IVIG
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| Treatment of strep toxic shock syndrome ______. | High dose IV PCN + Clinda +/- IVIG
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| Child with temp >102, Hypotension, Rash with desquamation (esp palms/soles), >3 organ systems | Toxic Shock Syndrome
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| #1 bacterial cause of Otitis Media = ____. | Strep pneumoniae
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| #1 bacterial cause of Meningitis, pneumonia, occult bacteremia without focus = _____. | Strep pneumoniae
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| 2yr old with low grade fever, decreased feeding, abdominal pain or vomiting, thick purulent nasal discharge _______. | Streptococcosis AKA "strep fever" due to Group A Strep pyogenes.
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| Skin infection, very tender, well-demarcated line between infected and uninfected skin, "leading edge" cultures | Strep pyogenes (group A) - Erysipelas
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| Treatment of necrotizing fasciitis (remember very fast, severe pain and swelling) | IV PCN and IV clinda +/- IVIG
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| Major cause of newborn pneumonia, meningitis, bacteremia, UTIs in pregnant mothers | Strep agalactiae (Group B Strep)
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| Early onset GBS from ____ hours to ____ days. Most common serotypes _____. | 1hour to 6 days; 1a, 1b, II, III, V most common.
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| Early onset GBS: Which is more common: Meningitis or Sepsis/Pneumonia? | Sepsis (45%)/Pneumonia (40%) more common. Meningitis only 10%.
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| Late onset GBS: ____ days to ___ days. Most common serotypes ____. | 7 days to 90 days. Serotype III causes 90%.
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| Late onset GBS: Which is more common: Meningitis/Bacteremia or Osteo/Cellulitis | Meningitis (40%)/Bacteremia without focus (50%). Osteo/cellulitis <10%.
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| Late-late onset GBS: Usually preterm or term infants? | Usually pretermers with hx of or currently with IV lines. "bacteremia without a focus"
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| Gold standard for diagnosis of GBS: | Blood cultures (serum or CSF only! NOT URINE).
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| True or False. You can get rheumatic fever only from pharyngeal strains of GAS. | True. You dont get it from impetigo or the like.
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| True or False. You can get post-strep glomerulonephritis only from skin strains of GAS. | False. Can get from skin or pharyngeal strains.
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| Describe treatment of GBS for: 1.) Pneumonia/sepsis. 2.) Meningitis 3.) Septic arthritis/osteo | IV PCN/AMP +gent initially: then:
1.) pneumonia/sepsis: 10 days total PCN G. 2.) Meningitis: minimum 14days PCN G. 3.) osteo/arthritis: 3-4 weeks generally
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| Newborn, + bld cx with "diptheroid": contaminant or concern? | Listeria! NOT a contaminant.
-Highest incidence in newborn period, colonized from mother. TX: Amp or PCN +/- gent if severe. or TMP/SMX if PCN allergic.
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| Adolescent with Listeria: potential environmental or food sources? | Sheep/goats/poultry. Contaminated milk, soft cheese, pate, uncooked hotdogs
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| Unvaccinated child, hoarse, sorethroat, low grade fever, myocarditis/polyneuritis: ____ | diphtheria: Cornyebacterium; grey-white pharyngeal membrane
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| TX of diphtheria: | Erythro or PCN + antitoxin
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| 6 year old, sore throat, "scarlet fever like" rash, strep negative: Bacteria? _____ , Treatment? _____ | Arcanobacterium haemolyticum, treat with Erythromycin, tetracycline, PCN
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| Painless papule to painless ulcer to painless black eschar, nonpitting edema, induration, swelling. Cause? | Bacillus anthracis. 95% are cutaneous. usually from handling hids and wool
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| True or false, anthrax pneumonia is spread human to human. Treatment? Typical xray finding? | FALSE. (smallpox and pneumonic plague ARE). Tx with Cipro or doxy. WIDENED MEDIASTINUM on Xray.
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| Main toxin in all species of Clostridium? | Alpha toxin
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| Dirty wound: Concern of tetanus. What 2 Indications for TIG + vaccine? | 1.) unknown vacccine history.
2.) Less than 3 tetanus immunizations
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| Dirty wound: Concern of tetanus but vaccines are uptodate. If less than 5yrs since last, what to do? If greater than 5yrs, then what to do? | If <5yrs, no treatment.
If >5yrs, give Tdap if over 7yrs if hasnt had booster, if did, Td. ONLY GIVE DTaP IF <7yrs of age.
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| Clean wound: Concern of tetanus. Treatment plan? | If uptodate and <10yrs, no treatment.
If uptodate and >10yrs, give Tdap if >7yr, DTaP if <7.
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| Nail puncture wound through a tennis shoe. | Pseudomonas
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| Hot tub rash | Pseudomonas
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| Round, indurated black lesion with central ulceration | Pseudomonas
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| 3rd most common cause OM, sinusitis. Cause? Treatment? | Moraxella catarralis. Tx with amox, amox-clav, eryhtro, Tmp/smx, cefuroxime
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| Pet iguana, baby chicks, turtles, kids collecting eggs | Salmonella Non-typhi.
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| Treatment of salmonella typhi- typhoid fever: | TMP/SMX, cipro, ceftriaxone
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| Rose spots, 1 week into fever, on trunk, low WBCs, contaminated food/milk/water | Salmonella typhi
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| Daycare, contaminated pool/lake, diarrhea, rectal prolapse, bandemia, seizures. Cause? Tx? | Shigella. Tx with IV 3rd gen ceph or PO Azith.
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| regional adenopathy, FUO, cat at home. Cause? Treatment? | Bartonella henselae. TX: none or Azith (shrinks nodes faster). dont aspirate the nodes!
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| Neonate with fever; citrobacter in blood. What 2 tests order next? | Spinal tap and CT of head. worry about brain abscess.
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| N. meningitidis prophylaxis for who ? With what? | Rifampin: household contacts, day care, "significant others", healthcare worker with close contact (intubate, mouth-mouth)
Ceftriaxone: pregnant in categories above
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| N. meningitidis treatment? | PCN G
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| Who should receive the conjugated, MCV4 vaccine? | Age 2-55, at 11-12r visit, or entry to high school or 15yr (whichever first); dorm residents, asplenia, complement def
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| What is the finding of gonorrhea on gram stain? | Gram neg diplococci; in males = diagnostic, in females = suggestive but need culture
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| What is seen with gonoccocal ophthalmia? (when, symptoms, workup, treatment) | 2-7 days post delivery; bloody/green/serosang discharge; gram stain discharge then septic workup; treat with Ceftriaxone 125mg x1 if eye only
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| If baby develops eye discharge at days 7-14 life what is the usual cause? | Chlamydia trachomatis (Less than 2 days usu chemical reaction, 2-7 usu gonococcal)
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| Newborn eye ointments are given to prevent what infection? | Gonococcal. not chlamydia.
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| cause and treatment of "traveler's diarrhea"? | ETEC: enterotoxigenic E coli: watery diarrhea: Tx with TMP/SMX
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| Hemolytic uremic syndrome : Which E coli, common causes | EHEC (enterohemorrhagic) or STEC: O157:H7 induces HUS: undercooked beef, unpasteurized milk, apple juice
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| Hemolytic uremic syndrome : which agar, antibiotics? | Sorbitol-enhanced agar, NO ANTIBIOTICS.
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| Hemolytic uremic syndrome: triad of symptoms | Renal failure, thrombocytopenia with purpura, hemolytic anemia
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| 3 yr old with fever >103, dysphagia, drooling, "cherry red" epiglottis :diagnosis? cause? treatment? | Epiglottitis: H. influenzae, 3rd gen cephalosporin
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| H. influ occult bacteremia: 30-50% risk of ?. If only one + blood cx do you treat? | 30-50% risk of meningitis or deep, focal infection, ALWAYS TREAT even if only 1 +
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| Most common sequelae to bacterial meningitis? | Hearing loss
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| Plauge: caused by? transmitted by? | Yersinia pestis, wild rodents - transmitted by fleas
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| Plague: name the 2 types | Bubonic: lymphadenopathy that suppurates. Pulmonic: very contagious by coughing (remember anthrax pneumonia not contagious to others)
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| Plague: diagnosis? treatment? | Dx: aspirate the lymph nodes; Tx: streptomycin, chloramphenicol, doxycycline
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| Tularemia: found in? mode of spread? | Rabbits, deer, ticks; tickbite, eating infected animals, inhalation, self inoculation
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| Tularemia: diagnosis? Tx? | Dx: serology: DONT aspirate; tx: streptomycin, gentamicin, tetracycline
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| Rocky Mountain Spotted Fever: cause, mode of spread? | Rickettsia, tick exposure
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| Rocky Mtn Spotted Fever: sy/sx? | Rash (distal plams, soles) maculopapules to petechiae, fever, arthralgias, hyponatremia
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| Rocky Mtn Spotted Fever: Dx? Treatment? | Dx: serology (specific IFA assay), immunofluorescent staining of biopsy of lesion. Tx: doxycycline, chloramphenicol
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| Ehrlichia: where, mode, dx, tx | Tick borne; Southeast, south central, midwest, flu-like, pancytopenia, dx: serology; tx: doxy
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| Difference in the xray of pulmonary TB disease in primary infection vs months to years after initial infection? | Primary initial infection occurs as lower-lobe disease, disease occuring months to yrs more commonly upper and apical lobes.
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| TB Pleural effusions: high or low glucose? elevated or decreased protein? AFB smear negative or positive? | TB pleural effusions low glucose, elevated protein and LDH, almost always AFB smear negative
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| TB Memingitis most common in what age? MRI findings? | 6months to 4 yrs, basal ganglia or posterior enhancement on MRI, SIADH common
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| Skin testing TB: 5mm is postive in what 5 conditions? | 1. HIV or cell-mediated dysfunction 2.fibrotic changes on CXR 3.close contact with documented case 4.organ transplant recipient 5. on >15mg/day prednisone x 1 month
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| Skin testing in TB is positive in a healthy 12yr old at what mm? | 15mm
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| Skin testing in TB is positive in a healthy 3 yr old at what mm? | 10mm (10mm positive in <4yrs, diabetics, recent immigrants, prednisone <15mg/day, healthcare workers, etc)
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| Skin testing in TB is positive in a healthy 5 month old at what mm? | Trick question. Skin testing not reliable in kids < 6months of age.
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| Tx of active TB disease? | INH/RIF/PZA +/- ethambutol or streptomycin
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| What bacteria can cause draining facial lesions (cervicofacial swelling from dental source) or PID if IUD present? tx? | Actinomyces PCN/amp or tetracycline
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| And afebrile 3 mos old with "persistant staccato" cough. Dx? Tx? | Chlamydia pneumonia, tx: oral erythromycin
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| A teenager goes swimming with his dog... in Hawaii. Dx? How to Dx? Tx? | Leptospirosis. In early dz (<7days): blood culture. In late dz (>7days): urine culture. Tx with PCN or doxycycline.
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| Name 3 predisposing conditions to invasive Malassezia > | LBW (<1000g), IV catheter, Lipid hyperalimentation
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| A NICU baby (950g) becomes septic, increased WBCs, decreased plts, increased vent settings, on TPN with lipids. Think of: | Invasive Malassezia. -- sometimes asymptomatic. Fever, resp distress, thrombocytopenia, HSM, increased WBCs
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| Dx of Malassezia blood cultures require what special addition? | Olive oil overlay on Sabourauds medium
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| Treatment of Malassezia? | Remove catheter, stop lipids, AmphoB (1mg/kg/day)
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| A child is out picking berries with his family. 3 weeks later nodular lesion that ulcerates on his hand. Dx? | Sporotrichosis, dx by culturing the organism. single lesion ulcerates 1-12 weeks later, then subQ nodules over days to weeks.
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| Tx of lymphocutaneous sporotrichosis? | Potassium iodine 5 drops tid PO increased by 1drop/day to daily 120-150drops/day for 4 weeks after lesion healed. Or itraconazole.
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| Tx of extracutaneous sporotrichosis? | Ampho B or itraconazole.
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| Cat litter box | Toxoplasma
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| Maltese cross | Babesia microti (intra RBC protozoan)
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| Citywide outbreak of diarrhea | Cryptosporidium
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| Expected course of crypto in immunocompetent patient? | Watery, self-limited, lasts 1-2 weeks, 3 day course of nitazoxanide
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| Expected course of crypto in immunosuppressed patient? | persists indef, paromomycin + azith then paromomycin alone
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| South Texas to Central America. Raspberries. Dx/Tx | Dx: Cyclospora, tx: TMP/SMX
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| Transmitted by Anopheles mosquito | Plasmodia.
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| Recent travel, on blood smear see banana shaped gametocytes, many infected RBCs on slide. Dx ? | P. falciparum, most fatal type
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| Which Plasmodium has widespread chloroquine resistance? | P. falciparum
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| Duffy RBC antigen | P. vivax
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| Prophylaxis of malaria that can have side effects of crazy dreams. | Mefloquine (or chloroquine if sensitive area) 1/week for 3 weeks prior and 4 weeks after.
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| Prophylaxis of malaria that can increase sun exposure risk. | Doxycycline: daily for 1-2 days before arrival and continue 4 weeks after
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| Prophylaxis of malaria, shorter course of treatment than others | Atovaquone/proguanil (malarone) daily 1-2 days before and 7 days after.
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| Child in Nantucket in the late summer, develops hemoglobinuria, emotial lability. Dx/carrier? | Babesia microti, Ixodes tick from rodents/deer. febrile hemolytic anemias,
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| Tx of mild and severe Babesia microti | Mild: clinda + quinine or atovaquone + aztih
Severe: Exchange transfusion then abx.
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| Entamoeba histolytica- Do a liver aspirate or no for diagnosis with liver abscess? | Liver aspirate of liver abscess shows no ameba or WBCs, Diagnosis: serology for liver abscesses
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| Tx of Entamoeba histolytica | Metronidazole followed by iodoquinol or paromomycin
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| Difference in acute and chronic Giardia? | Acute: Watery,smelly diarrhea, flatulence. Chronic: Flatulence, sulfuric belching, soft stools
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| Dx of Giardia? | Fresh stool O&P, Giardia-specific antigen on stool, string test
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| Tx of Giardia? | Metronidazole, Nitazoxanide, Furazolidone, tinidazole
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| Increased risk of Giardia? | Campers, travelers, daycare, IgA deficiency
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| New onset heart block in an adoptee | Lyme dz or chagas dz
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| CXR with infiltrate, later CXR with infiltrate in different spot, high eos count | Roundworm (ascaris), Loffler syndrome: shifting infiltrates, 30-35% eos.
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| Test for, tx of Pinworms | symptoms: rectal itching, test: scotch tape test, tx: mebendazole, albendazole.
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| Child is diarrhea, abdominal pain, rectal prolapse: top 2 diagnoses? | Shigella, Whipworms
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| The only helminthic organism that replicates in the body | Nematodes/Strongyloides (3% of kids positive), Eosinophilia, persist decades, Tx Ivermectin, thiabendazole
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| Kid seizes, MRI = cyst | Cestodes: cysticercosis, ingested pork, eggs hatch, oncospheres into blood to CNS/eye, form cysticerci, when cysts die, CNS- seizures
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| Tx of Flatworms (cestodes) | Albendazole, praziquantel with steroids if neuro
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| Shistosomiasis Dx, tx | Dx: eggs in stool. liver dz but no ascites, no hx alcohol. Tx with Praziquantel
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| Incubation period of varicella? | 10-21 days (up to 28days if VariZIG was given)
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| Most common complication of varicella? | secondary bacterial infection with S aureus or S pyogenes (TSS or Nec Fasc!)
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| Varicella and pregnancy: weeks of most worry? What defects? | Birth defects if infected with primary varicella during 8-20 weeks. Limp atrophy, microceph, cortical atrophy, SZs, chorioretinitis, cicatricial skin scarring.
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| If seronegative pregnant exposed: VariZIG or vaccine or both or neigther? | VariZIG if within 4 days exposure. NEVER give vaccine (give before become pregnant!!).
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| If mother within 5 days prior to or within 2 days after delivery develop varicella: | HIGH risk for severe infection, give VariZIG
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| Tx of chickenpox in children | Acyclovir 20mg/kg/dose 4x/day for 5 days
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| Tx of chickenpox in adolescent/adult, pregnant, pneumonia: | Acyclovir 800mg po 5x/day for 7 days, Acyclovir 10mg/kg IV TID for 5 days, Valacyclovir 1g TID for 5 days
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| Tx of chickenpox in Immunocompromised: | Acyclovir 10mg/kg IV q 8 hrs
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| CMV: Serious dz in 2 circumstances: | 1. transplacental infection of fetus, 2. Immunocompromised patients (AIDS, organ/bone marrow transplant)
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| Mother with 1st CMV infection during pregnancy: severe form | "Blueberry muffin" baby, microcephaly, cerebral atrophy, chorioretinitis, hearing loss, intracerebral calcifications that circumvent ventricles, IUGR, HSM
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| EBV associated with which -omas? | African Burkitt lymphoma, B-cell lymphoma, nasopharyngeal carcinoma
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| After infection virus persists in which cells for life? | B lymphocytes
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| EBV Serology: IgM VCA+ = ____. EBNA + = ____. IgG VCA+ = ____. | IgM VCA+ = acute primary or very recent past infection. EBNA+ = convalescent or post-EBV infection. IgG VCA+ = positive for life
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| Cause of roseola | HHV-6
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| Cause of Kaposi sarcoma in AIDS pts | HHV-8
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| Child with large postauricular lymph node, fever, red rash. | German measles-rubella. Forchheimer spots- in mouth
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| 1st trimester rubella | 90% risk infection with cataracts, cardiac, glaucoma, hearing loss, neuro
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| 2nd trimester rubella | 25-30% risk infection, hearing or neuro problems
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| 3rd trimester rubella | 60-100% risk but no sequelae
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| Child with hx of congenital rubella- increased risk of ___? | IDDM 4x normal by age 10, IDDM 10-20x normal by adulthood, increased risk of thyroiditis
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| Nonimmunized kid with cough, coryza, conjunctivitis. | Measles
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| Describe measles rash | starts at hairline, spreads caudally, red maculopapular, Koplik spots,
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| Increased risk of intussusception in diarrhea due to which virus? | Adenovirus 40 & 41
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| Hematuria, not post-strep GN, which virus potentially? | Acute hemorrhagic cystitis due to Adenovirus 11/21.
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| Fever, sore throat, conjunctivitis, runny nose, cervical adenitis | Adenovirus 3
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| Recent travel to Asia, fever, chills, myalgia, headache. | SARS- coronavirus- resp symptoms 2-7 days after start of illness (SOB, cough)
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| Which viruses cause the most croup? | Parainfluenza virus 1 -4
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| Which viruses cause hand-foot-mouth? | Coxsackievirus A16, A5, A10, also enterovirus type 71
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| Difference in CNS onset of polio vs GBS? | Guillan Barre Synd (GBS) starts distal and goes proximal, polio starts proximal and goes distal.
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| Asymmetric, flaccid paralysis without reflexes, and aseptic meningitis | Polio
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| 15-35% of postpubertal males with mumps get ___ | epididymoorchitis (unilateral)
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| 31% of adolescent females get _____ and 7% get ___________ in polio | 31% get mastitis and 7% get oophritis
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| Adolescent in New Mexico with thrombocytopenia, increased HCT, hemorrhagic pneumonia | Hantavirus, cotton rat is reservoir
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| What bacteria should you think of in a patient with prior head trauma and meningitis | S. pneumoniae
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| Think of complement deficiencies, think of what cause of meningitis? | N. meningitidis
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| Think of splenectomy, think of what cause of meningitis? | S. pneumoniae, H. influenzae, N. meningitidis, Enterovirus
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| Think of sickle cell disease, think of what cause of meningitis? | S. pneumoniae, H. influ
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| Think of HIV, think of what cause of meningitis? | Cryptococcus, Toxoplasma gondii, Histoplasma, TB, syphilis
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| CSF findings of bacterial meningitis? | 500-10,000 WBC, >90% neutro, <40 glucose, >150 protein
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| CSF findings of aseptic/viral meningitis | 10-500 WBC, Early= >50% neutrophils, Late= < 20% neutrophils, Normal glucose, <100 protein
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| CSF findings of TB meningitis | 50-500 WBC, Early= >50%neutrophils, Late=<50% neutrophils, <30 glucose, >150 protein
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| CSF findings of syphilitis meningitis | 50-500 WBC, <10% neutrophils, <40 glucose, <100 protein
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| >1 month of |
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| CSF findings of aseptic/viral meningitis | 10-500 WBC, Early= >50% neutrophils, Late= < 20% neutrophils, Normal glucose, <100 protein
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| CSF findings of TB meningitis | 50-500 WBC, Early= >50%neutrophils, Late=<50% neutrophils, <30 glucose, >150 protein
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| CSF findings of syphilitis meningitis | 50-500 WBC, <10% neutrophils, <40 glucose, <100 protein
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| meningitis treatment for child >1 month of age and no organism seen on gram stain and for empiric therapy | 3rd gen ceph: ceftriaxone, cefotaxime, etc. AND VANCOMYCIN
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| Treatment for meningitis, gram stain shows gram positive diplococci: | 3rd gen ceph and VANC until sensitivities known (if PCN sensitive, change to IV PCN)
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| Treatment for meningitis, gram stain shows gram negative diplococci: | IV PCN or 3rd gen ceph
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| Treatment for meningitis, gram stain shows gram negative "pleomorphic" rods | Dexamethasone followed by 3rd gen ceph
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| Treatment for meningitis, gram stain shows gram positive rods: | Amp and gent
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| Treatment for meningitis, gram stain shows gram negative rods | 3rd gen ceph
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| N. meningitidis has lower or higher mortality rates? | Lower (10%)
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| Most common sequela of bacterial meningitis survivors? | Deafness (6-10%)
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| Drug of choice for PROPHYLAXIS of contacts with meningitis due to H. influenzae? what if pregnant? | rifampin for children <18yrs, Ceftriaxone if pregnant. Cipro is acceptable alternative to rifampin in nonpreg adults.
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| Majority of viral etiology of aseptic meningitis is what family of viruses? | Enteroviruses (also could be arbovirus, mumps, HSV)
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| Swimming in cow pond, now with meningitis | Amebic meningitis
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| Chronic neutrophilic meningitis | Nocardia, Actinomyces, fungal
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| TB meningitis- which nerve palsy? | 6th
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| Lyme meningitis | Bells Palsy or foot drop
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| What is empiric therapy for brain abscesses? | Ceftriaxone + metronidazole (add vanco if MRSA suspected)
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| Most common cause of bacterial diarrhea? | E coli (think no blood, no WBCs, children in and travelers to developing countries)
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| 12 yr old with underlying liver disease, scratched by crab... cause? | Vibrio vulnificus
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| Cholera pandemics, crab/oyster outbreaks | Vibrio cholerae
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| Shellfish outbreaks | Vibrio parahaemolyticus
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| Turkey on thanksgiving... diarrhea for next few days... | Yersinia enterocolitica
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| Test for C.dif colitis? | Stool for WBCs, Stool toxin with one of 3 available assays: PCR, EIA, cytotoxicity assay
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| Difference in C dif colitis severity? | Mild/Mod: <15,000 WBC and Cr <1.5 x normal ; Severe >or= 15000 WBC and Cr >or= 1.5 x normal
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| describe complicated C dif colitis | complicated: hypotension, shock, partial ileus, megacolon
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| Treatment of C dif colitis if mild/mod or severe? | Mild/Mod: metronidazole 500mg TID x 10-14days; Severe: vancomycin 125mg QID po x 10-14 days
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| Treatment of C dif colitis if complicated? if complicated with complete ileus? | Complicated: Vanc 500mg QID PO or NG + IV metronidazole 500mg TID x 10-14days. If complete ileus add rectal vanc
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| If first recurrence of C dif colitis how treat? | Same drug as 1st time, only if first recurrence.
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| If severe recurrent relapses of C dif colitis? | Vanc in pulsed doses over 42 days or Vanc x14days then rifampin x 14days
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| Diarrhea on cruise ship with widespread outbreak? what if limited to only a few that ate the buffet? | widespread: norovirus/norwalk if only a few: salmonella
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| Who should be treated for Salmonella diarrhea? | Do not treat unless severe immunocompromised or infant <3 mos
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| Who should be treated for asymptomatic bacteruria? | Pregnant, Neutropenic, Transplant patients
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| 5 yr old boy fell off his bike, stitches on his knee, now with osteo- which bacteria? | S. aureus (acute, most common boys <6yr, history trauma or intercurrent URI)
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| Puncture wound in a tennis shoe | Pseudomonas
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| Osteomyelitis in a sickle cell patient | Salmonella, S. aureus
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| Osteomyelitis in a neonate | GBS, gram negatives, S. aureus
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| 5 yr old boy fell off his bike 3 days ago, stitches on his knee, now with suspected osteo- if you dont see on xray should you treat | yes- takes 10-14 days to see plain xray findings. if negative bone scan, would exclude osteo.
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| Treatment of septic arthritis? | Drain, IV abx 3-6 weeks
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| Treatment of Osteo- acute hematogenous | IV abx x 5-14 days then oral abx for 4-8 weeks total therapy
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| Rabbit for a pet | Tularemia
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| 5 diseases you can get from mice/rats | Plague, Typhus, Babesiosis, Hantavirus, Leptospirosis
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| 2 disease you can get from gerbils | Salmonella, Leptospirosis
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| 6 diseases you can get from guinea pigs, hamsters | LCM = lymphocytic choriomeningitis, salmonella, Yersinia, Campylobacter, pasteurella, Leptospirosis
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| Turtles | Salmonella
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| Iguanas, snakes, lizards | Salmonella
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| 6 yr old with ferret for a pet: fever, diarrhea | Campylobacter (also salmonella, rabies, influenza, cryptosporidosis, tuberculosis)
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| 14 year old, lives on a dairy farm, fevers, headaches, chills, pneumonia, enlarged spleen | Q fever- coxiella burnetti
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| Describe microscopic findings in Q fever | gram negative pleomorphic coccobacillus, intracellular pathogen
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| how to treat Q fever? | most resolve without tx, tetracycline or doxycycline
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| How do humans acquire Psittacosis? | by inhalation of aerosols of dried avian excreta, or handling sick birds (NOT by food borne transmit of eating infected poultry)
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| Treatment of Psittacosis | Tetracycline
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| 60-75% of normal cats carry what in their mouth (answer is not dead mice) | Pasteurella
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| Top two organisms in cat wound infections | Pasteurella, S. aureus
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| How to treat cat bites? | Treat ALL cat bites: Amox/Clav + cipro or TMP/SMX (if PCN allergy- clinda + TMP/SMX)
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| Cause of cat-scratch disease | Bartonella henselae
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| Toxoplasma gondii host? | cats
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| How Dx toxoplasma? | Acute IgM antibody positive.
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| name 4 types of Toxoplasma | 1.)asymptom/mild: self limited. 2.)Pregnancy acquired 3.) CNS disease- multiple mri lesions 4.) Ocular: yellow/white cotton patches
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| Fetal risk of infection with Toxoplasma increases or decreases as progress along in pregnancy? | Increases - 3rd trimester 65%. However the severity decreases as fetus is older (the inverse)
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| Newborn with microcephaly, purpura, scattered cerebral calcifications on MRI | Toxoplasma
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| Tx of newborn with toxoplasma? | Pyrimethamine, sulfadiazine, leucovorin
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| Postexposure to rabies: | Rabies immunoglobulin: 20IU/kg with as much as possible into the wound, Rabies vaccine 1ml IM into delt on days 0,3,7,14
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| Teenager working on a ranch cleaning out stalls, conjunctival suffusion, jaundice | Leptospirosis, skin or mucous membranes come in contact with contaminated urine of infected animal (rats, dogs, livestock, wild mammals, cats)
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| 3 yr old with hx of pica, have pets at home, on CBC eosinophils of 40-50%, fever, cough | Toxocara - intestinal roundworms of dogs/cats, eggs excreted found in dust, cracks of floors, under rugs: visceral larva migrans
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| Treatment of toxocariasis | Albendazole or mebendazole
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|
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| Dog that sleeps in the same bed with boy, found to have fleas, now child with abdominal pain, diarrhea | Tapeworm (Dipylidium), tx with praziquantel or niclosamide
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| Treatment for West Nile virus? | Supportive
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|
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| 18 yr old, visiting from Europe, develops dementia | Think of CJD - remember Bovine Spongiform Encephalopathy
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|
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| Is oral PCN effective for Pseudomonas? | NO - NOT even Amox/Clav
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| Best treatment for Ehrlichia | Doxycycline or tetracycline
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|
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| Abx for infected central line | Vanco - if gram negative suspected, add Pseudomonas coverage (ceftaz, pip-tazo, aminoglycoside--- not ceftriaxone
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|
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| After vancomycin, patient develops flushing- can patient receive again | Red man syndrome- not a true allergy, can use again, slow down dose and give benadryl
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| Treatment of patient with Lyme disease and 3rd degree heart block | Ceftriaxone and pacemaker
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| Swimming in a pond with a dog- what abx of choice if spirochete? | Likely leptospirosis - Doxycycline or PCN
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| When see Listeria, think of what antibiotic? | Ampicillin
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| When see Enterococci, think of what antibiotic? | Amp or vanc with/without aminoglycoside if severe
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|
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| Can you treat pneumococcal pneumonia with Cipro> | no.
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|
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| Which can you use Ketoconazole? Itraconazole? Fluconazole? | Fluconazole. Both others need acid environment in stomach to be absorbed.
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| Aztreonam treats: Gram Positives or gram negatives? | Gram negative aerobic infections
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|
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