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USMLE2 Medicine 14

Infectious Disease 03

Tx of uncomplicated cystitis 3d TMP/SMX
Tx of uncomplicated cystitis in DM 7d TMP/SMX
If cystitis in pregnancy, what drug do you not use? flouroquinolones
pts with pyelo who are immunosuppressed or have indwelling catheters -- what org caused the pyelo? Candida
Tx of pyelo 2 weeks of cipro
how to tx pregnant pt who has pyelo admit them
pt with presentation of pyelo but doesn't get better with tx consider perinephric abscess
how to tx perinephric abscess Abx (CTX) and drainage
If suspect pernephric abscess, how to dx? Initial test is U/S, then CT or MRI. Then need aspiration to get bacterial sensitivity.
Layers of skin layers CLoGS B skin: stratum Corneum, stratum Lucidum, stratum Granulosum, stratum Spinosum, stratum Basale.
child with pustular skin infection on arms, legs, face with oozing, crusting (golden yellow), and draining lesions - what is the disease and what is it caused by? impetigo by GAS or Staph aureus (called bullous impetigo if S aureus)
How to tx impetigo - mild and serious cases, PCN allergic? mild - topical bacitracin. Severe - oral keflex or oxacillin (cover GAS and S aureus). PCN allergic use azithromycin
pt with BL shiny red, indurated edematous tender lesions on face, arms, legs, sharply demarcated from surrounding skin. erysipelas (superficial cellulitis), caused by GAS.
How to tx erysipelas? If sure it's strep, use PCN. If not sure if erysipelas or cellulitis, use oxacillin to cover Staph.
Tx of tinea corporis/unguium (nails)/capitis oral itraconazole or terbinafine
Tx of tinea pedis/cruris topical clotrimazole or ketoconazole
How to tx systemic Candidal infection? amphotericin, fluconazole if less serious
How to tx Candida paronychia? (swelling around the nails) amphotericin
Spaghetti and meatballs under microscope hyphae and spores of malassezia furfur (pityrosporum orbiculare)
tan brown white scaling macular lesions that coalesce and don't tan (chest/abd/face) tinea versicolor - malassezia furfur (pityrosporum orbiculare)
How to tx tinea versicolor? Topical Selenium sulfide, clotrimazole, or ketoconazole. If lots of surface area affected, can use oral tx.
pruritis on flexor surfaces of wrists and finger webs Scabies (sarcoptes scabiei)
Scabies is associated with what type of pts? Down Syndrome
How to dx scabies? show parasite in skin scrapings! Ewww!
Tx for scabies permethrin
Tx for lice permethrin
Tx for Norwegian scabies a version of scabies that affects immunocompromised pts with crusting and malodorous discharge. Use permethrin and ivermectin
skin colored waxy umbilicated papules molluscum contagiosum, poxvirus
how to tx molluscum contagiosum freezing/curettage
osteomyelitis in children - where and what org? long bones - femur and tibia, S. aureus
osteomyelitis in adults - where and what org? vertebral bodies (lumbar) --> epidural abscess, S. aureus
risk factor for vertebral osteomyelitis IVDU
osteomyelitis in someone with prosthetic joint - what org? S. aureus
osteomyelitis in DM - where and what org? small bones of the lower extremity (repeated trauma), S. aureus
Best test for osteomyelitis MRI or technetium bone scan early on, but then definitive is the bone bx
how to tx acute hematogenous osteo in children? In adults? in children, abx (oxacillin OR [vanc if MRSA + CTX]) only; in adults, abx with drainage and debridement
how to tx chronic osteomyelitis? oxacillin or [vanc if MRSA + CTX], depending on sensitivities, for 12 weeks
Septic arthritis - what organisms? Gonorrhea --> S. aureus --> Strep
Difference between gonoccocal and non-gonoccocal septic arthritis Gonococcal is polyarticular mostly with petechiae or purpura and nongonococcal is monoarticular
How to dx Gonococcal vs. Non-gonococcal septic arthritis? Gonococcal culture cervix/pharynx/rectum/urethra. Nongonococcal culture the synovial fluid.
How to tx septic arthritis? joint aspiration and abx with CTX if gonococcal or oxacillin + CTX if non-gonococcal
soldier in Iraq with shrapnel injury and wound with brownish sweet-smelling discharge gas gangrene, C. perfringens
How to tx gas gangrene? high dose PCN or clindamycin PLUS debridement or amputation
most common org causing infective endocarditis S. aureus
manifestations of infective endocarditis Jane Osler Roth has a splinter in her pet. Janeway lesions painless, Osler nodes painful, Roth spots on retina, and petechiae
How to dx infective endocarditis? 2 MAJOR criteria: blood cx, echo (TEE) or 1 major and 3 minor. MINOR: fever, cardiac lesion, vascular phenomena, immuno phenoma, micro evidence.
Empiric of infective endocarditis vancomycin and gentamicin for native valve and IVDU; vanc, gent, and rifampin for prosthetic valves
In what circumstance would you prophylax for bacterial endocarditis? only with dental procedures - amoxicillin or clinda for PCN allergic
pulsus paradoxus cardiac tamponade
tx of viral pericarditis anti-inflammatory - indomethacin --> prednisone if no response
Tx for TB pericarditis TB meds and steroids
myocarditis - most common org coxsackie
EKG for myocarditis nonspecific STT changes
facial palsy Lyme
Tx for PCP PNA TMP/SMX. If severe (PO2<70 or A-a grad >35) then add steroids.
Prophylaxis for PCP PNA. When to start and stop prophylaxis? TMP/SMX. Start when CD4<200, stop when CD4>200 >6mo
Retinitis or esophagitis in HIV pt with shallow ulcers in distal esophagus. What is the CD4 count? CMV CD4<50
Tx of CMV in HIV+ pt Valganciclovir - retinitis and GI. Ganciclovir --> foscarnet for CNS infection.
Prophylaxis for CMV in HIV+ pt Valganciclovir
Tx of Mycobacteria avium in HIV+ pt Clarithromycin and ethambutol +/- rifabutin
Prophylaxis for Mycobacteria avium in HIV+ pt. When to stop prophylaxis? Azithromycin qweek. Stop when CD4>100 for a few months
ring enhancing lesion on contrast head CT toxoplasmosis CD4<100
Tx for toxoplasmosis in HIV+ pt pyrimethamine and sulfadiazine (sulfa allergic then clinda). Also add leucovorin to prevent bone marrow suppression
Prophylaxis for toxoplasmosis in HIV+ pt TMP/SMX
Vaccinations for HIV+ pt PIB Pneumococcus, influenza, hepatitis B
AIDS illness for CD4 <50 CMV, MAI, PML, CNS lymphoma
AIDS illness for CD4 <100 Toxoplasmosis, Herpes - disseminated, Cryptosporidiosis, Cryptococcus
AIDS illness for CD4 <100-200 PCP, Histo, Cocci, Dementia
AIDS illness for CD4 <200-500 thrush, Kaposi, TB, Zoster
How to know if HIV+ pt has adequate response to antiretrovial tx? goal is complete suppression of viremia with <50 to 70 copies of HIV-RNA; adequate response when drop of at least 50% of viral load in first month
When to start AIDS therapy when CD4 <350 or viral load >55K
What drugs to start in AIDS tx 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine OR AZT/Lamivudine) and one or two protease inhibitors (Ritonavir plus another -navir)
"boosted protease inhibitors" give protease inhibitor in combination with ritonavir --> synergystic, decreases the metab of the other PI and enables higher drug levels and increases chances of success
What to know about Efavirenz a non-nucleoside reverse transcriptase inhibitor, part of the single HAART pill, only antiretroviral that is contraindicated in pregnancy
When should HIV+ pregnant woman plan for a C-section? when viral load >1K
If HIV+ pregnant pt is not on treatment for her own disease, when should she start antiretroviral treatment for the pregnancy? 14 weeks of pregnancy
Post exposure prophy for needlestick from HIV+ AZT + lamivudine + nelfinavir (PI) for 4 weeks
undercooked meat (pork/lamb) Toxoplasmosis
Tx Q fever doxy
Tx for RMSF doxy
halo sign around nodular lesion on CXR or chest CT Aspergillus
Tx for aspergillus Voriconazole
Created by: christinapham



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