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Peds Boards ID

Green C2- MedStudy Board Review 2011, Infectious Disease

#1 cause of osteomyelitis in patients with sickle cell Salmonella
#1 cause of osteomyelitis in patients without sickle cell Staph aureus
In the stem is a patient with hx of flu and new-onset pneumonia... bacteria? Staph pneumonia, staph sepsis
MRSA in the blood... drug of choice? Vancomycin
Treatment of non-MRSA staph toxic shock syndrome _______. Oxacillin + Clinda +/- IVIG
Treatment of strep toxic shock syndrome ______. High dose IV PCN + Clinda +/- IVIG
Child with temp >102, Hypotension, Rash with desquamation (esp palms/soles), >3 organ systems Toxic Shock Syndrome
#1 bacterial cause of Otitis Media = ____. Strep pneumoniae
#1 bacterial cause of Meningitis, pneumonia, occult bacteremia without focus = _____. Strep pneumoniae
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.
Skin infection, very tender, well-demarcated line between infected and uninfected skin, "leading edge" cultures Strep pyogenes (group A) - Erysipelas
Treatment of necrotizing fasciitis (remember very fast, severe pain and swelling) IV PCN and IV clinda +/- IVIG
Major cause of newborn pneumonia, meningitis, bacteremia, UTIs in pregnant mothers Strep agalactiae (Group B Strep)
Early onset GBS from ____ hours to ____ days. Most common serotypes _____. 1hour to 6 days; 1a, 1b, II, III, V most common.
Early onset GBS: Which is more common: Meningitis or Sepsis/Pneumonia? Sepsis (45%)/Pneumonia (40%) more common. Meningitis only 10%.
Late onset GBS: ____ days to ___ days. Most common serotypes ____. 7 days to 90 days. Serotype III causes 90%.
Late onset GBS: Which is more common: Meningitis/Bacteremia or Osteo/Cellulitis Meningitis (40%)/Bacteremia without focus (50%). Osteo/cellulitis <10%.
Late-late onset GBS: Usually preterm or term infants? Usually pretermers with hx of or currently with IV lines. "bacteremia without a focus"
Gold standard for diagnosis of GBS: Blood cultures (serum or CSF only! NOT URINE).
True or False. You can get rheumatic fever only from pharyngeal strains of GAS. True. You dont get it from impetigo or the like.
True or False. You can get post-strep glomerulonephritis only from skin strains of GAS. False. Can get from skin or pharyngeal strains.
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
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.
Adolescent with Listeria: potential environmental or food sources? Sheep/goats/poultry. Contaminated milk, soft cheese, pate, uncooked hotdogs
Unvaccinated child, hoarse, sorethroat, low grade fever, myocarditis/polyneuritis: ____ diphtheria: Cornyebacterium; grey-white pharyngeal membrane
TX of diphtheria: Erythro or PCN + antitoxin
6 year old, sore throat, "scarlet fever like" rash, strep negative: Bacteria? _____ , Treatment? _____ Arcanobacterium haemolyticum, treat with Erythromycin, tetracycline, PCN
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
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.
Main toxin in all species of Clostridium? Alpha toxin
Dirty wound: Concern of tetanus. What 2 Indications for TIG + vaccine? 1.) unknown vacccine history. 2.) Less than 3 tetanus immunizations
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.
Clean wound: Concern of tetanus. Treatment plan? If uptodate and <10yrs, no treatment. If uptodate and >10yrs, give Tdap if >7yr, DTaP if <7.
Nail puncture wound through a tennis shoe. Pseudomonas
Hot tub rash Pseudomonas
Round, indurated black lesion with central ulceration Pseudomonas
3rd most common cause OM, sinusitis. Cause? Treatment? Moraxella catarralis. Tx with amox, amox-clav, eryhtro, Tmp/smx, cefuroxime
Pet iguana, baby chicks, turtles, kids collecting eggs Salmonella Non-typhi.
Treatment of salmonella typhi- typhoid fever: TMP/SMX, cipro, ceftriaxone
Rose spots, 1 week into fever, on trunk, low WBCs, contaminated food/milk/water Salmonella typhi
Daycare, contaminated pool/lake, diarrhea, rectal prolapse, bandemia, seizures. Cause? Tx? Shigella. Tx with IV 3rd gen ceph or PO Azith.
regional adenopathy, FUO, cat at home. Cause? Treatment? Bartonella henselae. TX: none or Azith (shrinks nodes faster). dont aspirate the nodes!
Neonate with fever; citrobacter in blood. What 2 tests order next? Spinal tap and CT of head. worry about brain abscess.
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
N. meningitidis treatment? PCN G
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
What is the finding of gonorrhea on gram stain? Gram neg diplococci; in males = diagnostic, in females = suggestive but need culture
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
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)
Newborn eye ointments are given to prevent what infection? Gonococcal. not chlamydia.
cause and treatment of "traveler's diarrhea"? ETEC: enterotoxigenic E coli: watery diarrhea: Tx with TMP/SMX
Hemolytic uremic syndrome : Which E coli, common causes EHEC (enterohemorrhagic) or STEC: O157:H7 induces HUS: undercooked beef, unpasteurized milk, apple juice
Hemolytic uremic syndrome : which agar, antibiotics? Sorbitol-enhanced agar, NO ANTIBIOTICS.
Hemolytic uremic syndrome: triad of symptoms Renal failure, thrombocytopenia with purpura, hemolytic anemia
3 yr old with fever >103, dysphagia, drooling, "cherry red" epiglottis :diagnosis? cause? treatment? Epiglottitis: H. influenzae, 3rd gen cephalosporin
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 +
Most common sequelae to bacterial meningitis? Hearing loss
Plauge: caused by? transmitted by? Yersinia pestis, wild rodents - transmitted by fleas
Plague: name the 2 types Bubonic: lymphadenopathy that suppurates. Pulmonic: very contagious by coughing (remember anthrax pneumonia not contagious to others)
Plague: diagnosis? treatment? Dx: aspirate the lymph nodes; Tx: streptomycin, chloramphenicol, doxycycline
Tularemia: found in? mode of spread? Rabbits, deer, ticks; tickbite, eating infected animals, inhalation, self inoculation
Tularemia: diagnosis? Tx? Dx: serology: DONT aspirate; tx: streptomycin, gentamicin, tetracycline
Rocky Mountain Spotted Fever: cause, mode of spread? Rickettsia, tick exposure
Rocky Mtn Spotted Fever: sy/sx? Rash (distal plams, soles) maculopapules to petechiae, fever, arthralgias, hyponatremia
Rocky Mtn Spotted Fever: Dx? Treatment? Dx: serology (specific IFA assay), immunofluorescent staining of biopsy of lesion. Tx: doxycycline, chloramphenicol
Ehrlichia: where, mode, dx, tx Tick borne; Southeast, south central, midwest, flu-like, pancytopenia, dx: serology; tx: doxy
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.
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
TB Memingitis most common in what age? MRI findings? 6months to 4 yrs, basal ganglia or posterior enhancement on MRI, SIADH common
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
Skin testing in TB is positive in a healthy 12yr old at what mm? 15mm
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)
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.
Tx of active TB disease? INH/RIF/PZA +/- ethambutol or streptomycin
What bacteria can cause draining facial lesions (cervicofacial swelling from dental source) or PID if IUD present? tx? Actinomyces PCN/amp or tetracycline
And afebrile 3 mos old with "persistant staccato" cough. Dx? Tx? Chlamydia pneumonia, tx: oral erythromycin
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.
Name 3 predisposing conditions to invasive Malassezia > LBW (<1000g), IV catheter, Lipid hyperalimentation
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
Dx of Malassezia blood cultures require what special addition? Olive oil overlay on Sabourauds medium
Treatment of Malassezia? Remove catheter, stop lipids, AmphoB (1mg/kg/day)
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.
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.
Tx of extracutaneous sporotrichosis? Ampho B or itraconazole.
Cat litter box Toxoplasma
Maltese cross Babesia microti (intra RBC protozoan)
Citywide outbreak of diarrhea Cryptosporidium
Expected course of crypto in immunocompetent patient? Watery, self-limited, lasts 1-2 weeks, 3 day course of nitazoxanide
Expected course of crypto in immunosuppressed patient? persists indef, paromomycin + azith then paromomycin alone
South Texas to Central America. Raspberries. Dx/Tx Dx: Cyclospora, tx: TMP/SMX
Transmitted by Anopheles mosquito Plasmodia.
Recent travel, on blood smear see banana shaped gametocytes, many infected RBCs on slide. Dx ? P. falciparum, most fatal type
Which Plasmodium has widespread chloroquine resistance? P. falciparum
Duffy RBC antigen P. vivax
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.
Prophylaxis of malaria that can increase sun exposure risk. Doxycycline: daily for 1-2 days before arrival and continue 4 weeks after
Prophylaxis of malaria, shorter course of treatment than others Atovaquone/proguanil (malarone) daily 1-2 days before and 7 days after.
Child in Nantucket in the late summer, develops hemoglobinuria, emotial lability. Dx/carrier? Babesia microti, Ixodes tick from rodents/deer. febrile hemolytic anemias,
Tx of mild and severe Babesia microti Mild: clinda + quinine or atovaquone + aztih Severe: Exchange transfusion then abx.
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
Tx of Entamoeba histolytica Metronidazole followed by iodoquinol or paromomycin
Difference in acute and chronic Giardia? Acute: Watery,smelly diarrhea, flatulence. Chronic: Flatulence, sulfuric belching, soft stools
Dx of Giardia? Fresh stool O&P, Giardia-specific antigen on stool, string test
Tx of Giardia? Metronidazole, Nitazoxanide, Furazolidone, tinidazole
Increased risk of Giardia? Campers, travelers, daycare, IgA deficiency
New onset heart block in an adoptee Lyme dz or chagas dz
CXR with infiltrate, later CXR with infiltrate in different spot, high eos count Roundworm (ascaris), Loffler syndrome: shifting infiltrates, 30-35% eos.
Test for, tx of Pinworms symptoms: rectal itching, test: scotch tape test, tx: mebendazole, albendazole.
Child is diarrhea, abdominal pain, rectal prolapse: top 2 diagnoses? Shigella, Whipworms
The only helminthic organism that replicates in the body Nematodes/Strongyloides (3% of kids positive), Eosinophilia, persist decades, Tx Ivermectin, thiabendazole
Kid seizes, MRI = cyst Cestodes: cysticercosis, ingested pork, eggs hatch, oncospheres into blood to CNS/eye, form cysticerci, when cysts die, CNS- seizures
Tx of Flatworms (cestodes) Albendazole, praziquantel with steroids if neuro
Shistosomiasis Dx, tx Dx: eggs in stool. liver dz but no ascites, no hx alcohol. Tx with Praziquantel
Incubation period of varicella? 10-21 days (up to 28days if VariZIG was given)
Most common complication of varicella? secondary bacterial infection with S aureus or S pyogenes (TSS or Nec Fasc!)
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.
If seronegative pregnant exposed: VariZIG or vaccine or both or neigther? VariZIG if within 4 days exposure. NEVER give vaccine (give before become pregnant!!).
If mother within 5 days prior to or within 2 days after delivery develop varicella: HIGH risk for severe infection, give VariZIG
Tx of chickenpox in children Acyclovir 20mg/kg/dose 4x/day for 5 days
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
Tx of chickenpox in Immunocompromised: Acyclovir 10mg/kg IV q 8 hrs
CMV: Serious dz in 2 circumstances: 1. transplacental infection of fetus, 2. Immunocompromised patients (AIDS, organ/bone marrow transplant)
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
EBV associated with which -omas? African Burkitt lymphoma, B-cell lymphoma, nasopharyngeal carcinoma
After infection virus persists in which cells for life? B lymphocytes
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
Cause of roseola HHV-6
Cause of Kaposi sarcoma in AIDS pts HHV-8
Child with large postauricular lymph node, fever, red rash. German measles-rubella. Forchheimer spots- in mouth
1st trimester rubella 90% risk infection with cataracts, cardiac, glaucoma, hearing loss, neuro
2nd trimester rubella 25-30% risk infection, hearing or neuro problems
3rd trimester rubella 60-100% risk but no sequelae
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
Nonimmunized kid with cough, coryza, conjunctivitis. Measles
Describe measles rash starts at hairline, spreads caudally, red maculopapular, Koplik spots,
Increased risk of intussusception in diarrhea due to which virus? Adenovirus 40 & 41
Hematuria, not post-strep GN, which virus potentially? Acute hemorrhagic cystitis due to Adenovirus 11/21.
Fever, sore throat, conjunctivitis, runny nose, cervical adenitis Adenovirus 3
Recent travel to Asia, fever, chills, myalgia, headache. SARS- coronavirus- resp symptoms 2-7 days after start of illness (SOB, cough)
Which viruses cause the most croup? Parainfluenza virus 1 -4
Which viruses cause hand-foot-mouth? Coxsackievirus A16, A5, A10, also enterovirus type 71
Difference in CNS onset of polio vs GBS? Guillan Barre Synd (GBS) starts distal and goes proximal, polio starts proximal and goes distal.
Asymmetric, flaccid paralysis without reflexes, and aseptic meningitis Polio
15-35% of postpubertal males with mumps get ___ epididymoorchitis (unilateral)
31% of adolescent females get _____ and 7% get ___________ in polio 31% get mastitis and 7% get oophritis
Adolescent in New Mexico with thrombocytopenia, increased HCT, hemorrhagic pneumonia Hantavirus, cotton rat is reservoir
What bacteria should you think of in a patient with prior head trauma and meningitis S. pneumoniae
Think of complement deficiencies, think of what cause of meningitis? N. meningitidis
Think of splenectomy, think of what cause of meningitis? S. pneumoniae, H. influenzae, N. meningitidis, Enterovirus
Think of sickle cell disease, think of what cause of meningitis? S. pneumoniae, H. influ
Think of HIV, think of what cause of meningitis? Cryptococcus, Toxoplasma gondii, Histoplasma, TB, syphilis
CSF findings of bacterial meningitis? 500-10,000 WBC, >90% neutro, <40 glucose, >150 protein
CSF findings of aseptic/viral meningitis 10-500 WBC, Early= >50% neutrophils, Late= < 20% neutrophils, Normal glucose, <100 protein
CSF findings of TB meningitis 50-500 WBC, Early= >50%neutrophils, Late=<50% neutrophils, <30 glucose, >150 protein
CSF findings of syphilitis meningitis 50-500 WBC, <10% neutrophils, <40 glucose, <100 protein
>1 month of
CSF findings of aseptic/viral meningitis 10-500 WBC, Early= >50% neutrophils, Late= < 20% neutrophils, Normal glucose, <100 protein
CSF findings of TB meningitis 50-500 WBC, Early= >50%neutrophils, Late=<50% neutrophils, <30 glucose, >150 protein
CSF findings of syphilitis meningitis 50-500 WBC, <10% neutrophils, <40 glucose, <100 protein
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
Treatment for meningitis, gram stain shows gram positive diplococci: 3rd gen ceph and VANC until sensitivities known (if PCN sensitive, change to IV PCN)
Treatment for meningitis, gram stain shows gram negative diplococci: IV PCN or 3rd gen ceph
Treatment for meningitis, gram stain shows gram negative "pleomorphic" rods Dexamethasone followed by 3rd gen ceph
Treatment for meningitis, gram stain shows gram positive rods: Amp and gent
Treatment for meningitis, gram stain shows gram negative rods 3rd gen ceph
N. meningitidis has lower or higher mortality rates? Lower (10%)
Most common sequela of bacterial meningitis survivors? Deafness (6-10%)
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.
Majority of viral etiology of aseptic meningitis is what family of viruses? Enteroviruses (also could be arbovirus, mumps, HSV)
Swimming in cow pond, now with meningitis Amebic meningitis
Chronic neutrophilic meningitis Nocardia, Actinomyces, fungal
TB meningitis- which nerve palsy? 6th
Lyme meningitis Bells Palsy or foot drop
What is empiric therapy for brain abscesses? Ceftriaxone + metronidazole (add vanco if MRSA suspected)
Most common cause of bacterial diarrhea? E coli (think no blood, no WBCs, children in and travelers to developing countries)
12 yr old with underlying liver disease, scratched by crab... cause? Vibrio vulnificus
Cholera pandemics, crab/oyster outbreaks Vibrio cholerae
Shellfish outbreaks Vibrio parahaemolyticus
Turkey on thanksgiving... diarrhea for next few days... Yersinia enterocolitica
Test for C.dif colitis? Stool for WBCs, Stool toxin with one of 3 available assays: PCR, EIA, cytotoxicity assay
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
describe complicated C dif colitis complicated: hypotension, shock, partial ileus, megacolon
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
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
If first recurrence of C dif colitis how treat? Same drug as 1st time, only if first recurrence.
If severe recurrent relapses of C dif colitis? Vanc in pulsed doses over 42 days or Vanc x14days then rifampin x 14days
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
Who should be treated for Salmonella diarrhea? Do not treat unless severe immunocompromised or infant <3 mos
Who should be treated for asymptomatic bacteruria? Pregnant, Neutropenic, Transplant patients
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)
Puncture wound in a tennis shoe Pseudomonas
Osteomyelitis in a sickle cell patient Salmonella, S. aureus
Osteomyelitis in a neonate GBS, gram negatives, S. aureus
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.
Treatment of septic arthritis? Drain, IV abx 3-6 weeks
Treatment of Osteo- acute hematogenous IV abx x 5-14 days then oral abx for 4-8 weeks total therapy
Rabbit for a pet Tularemia
5 diseases you can get from mice/rats Plague, Typhus, Babesiosis, Hantavirus, Leptospirosis
2 disease you can get from gerbils Salmonella, Leptospirosis
6 diseases you can get from guinea pigs, hamsters LCM = lymphocytic choriomeningitis, salmonella, Yersinia, Campylobacter, pasteurella, Leptospirosis
Turtles Salmonella
Iguanas, snakes, lizards Salmonella
6 yr old with ferret for a pet: fever, diarrhea Campylobacter (also salmonella, rabies, influenza, cryptosporidosis, tuberculosis)
14 year old, lives on a dairy farm, fevers, headaches, chills, pneumonia, enlarged spleen Q fever- coxiella burnetti
Describe microscopic findings in Q fever gram negative pleomorphic coccobacillus, intracellular pathogen
how to treat Q fever? most resolve without tx, tetracycline or doxycycline
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)
Treatment of Psittacosis Tetracycline
60-75% of normal cats carry what in their mouth (answer is not dead mice) Pasteurella
Top two organisms in cat wound infections Pasteurella, S. aureus
How to treat cat bites? Treat ALL cat bites: Amox/Clav + cipro or TMP/SMX (if PCN allergy- clinda + TMP/SMX)
Cause of cat-scratch disease Bartonella henselae
Toxoplasma gondii host? cats
How Dx toxoplasma? Acute IgM antibody positive.
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
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)
Newborn with microcephaly, purpura, scattered cerebral calcifications on MRI Toxoplasma
Tx of newborn with toxoplasma? Pyrimethamine, sulfadiazine, leucovorin
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
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)
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
Treatment of toxocariasis Albendazole or mebendazole
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
Treatment for West Nile virus? Supportive
18 yr old, visiting from Europe, develops dementia Think of CJD - remember Bovine Spongiform Encephalopathy
Is oral PCN effective for Pseudomonas? NO - NOT even Amox/Clav
Best treatment for Ehrlichia Doxycycline or tetracycline
Abx for infected central line Vanco - if gram negative suspected, add Pseudomonas coverage (ceftaz, pip-tazo, aminoglycoside--- not ceftriaxone
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
Treatment of patient with Lyme disease and 3rd degree heart block Ceftriaxone and pacemaker
Swimming in a pond with a dog- what abx of choice if spirochete? Likely leptospirosis - Doxycycline or PCN
When see Listeria, think of what antibiotic? Ampicillin
When see Enterococci, think of what antibiotic? Amp or vanc with/without aminoglycoside if severe
Can you treat pneumococcal pneumonia with Cipro> no.
Which can you use Ketoconazole? Itraconazole? Fluconazole? Fluconazole. Both others need acid environment in stomach to be absorbed.
Aztreonam treats: Gram Positives or gram negatives? Gram negative aerobic infections
Created by: KTClimbs