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Most common causes of community pneumonia
- Strep pneumonia
- H. influenza
- influenza virus
- Legionella
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Most common nosocomial causes of bacterial pneumonia
- gram negative rods
- staph aureus
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Symptoms of typical pneumonia
- Acute onset of fever and shaking chills
- Productive cough
- Pleuritic chest pain
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How can pneumonia be differentiated from acute bronchitis?
CXR
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Causes of atypical community pneumonia
- Mycoplasma pneumonia (most common)
- Clamydia pneumonia
- Clamydia psittaci
- Coxiella Burnetii (Q fever)
- Legionella
- Viruses (influenza, adeno, parainfluenza, RSV)
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Signs and symptoms of atypical pneumonia
- Headache, sore throat, myalgia
- Dry cough
- Fever (chills are uncommon)
- High fever with normal pulse
- Diffuse reticulonodular infiltrates on CXR, w/o consolidation
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Common cause of pneumonia in alcoholics
Klebsiella
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Cause of pneumonia in transplant recipients
Legionella
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Assay used to detect legionella
Urinary antigen assay
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First line antibiotics for pneumonia in a young, healthy patient
Macrolides, fluoroquinolones, or doxycycline (cover all the common organisms in healthy individuals under 60)
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Why are penicillin and cephalosporins not first line agents for pneumonia?
They don't cover atypicals such as mycoplasma and chlamydia
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First line antibiotic for pneumonia in an elderly patient or a patient with comorbidities
Second or third generation cephalosporins or amoxicillin plus clavulanic acid (these patients are more likely to have typical pneumonia)
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When should a pleural effusion be drained?
When it is larger than 1 cm on a lateral decubitus film
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Which lobe is most commonly affected by aspirated material?
right upper
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When is a person with TB contagious?
When the TB is active. Primary TB is not contagious
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Where is secondary (reactivated) TB most commonly found?
Lung apeces (primary TB is most commonly found in the lower lobes)
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Progressive primary TB
Development of the pulmonary and constitutional symptoms of active TB due to an incompetent immune response during primary infection (which is usually asymptomatic)
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Ghon complex
A calcified primary TB focus
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Ranke complex
A calcified primary TB focus plus a calcified hilar lymph node
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Upper lobe infiltrates with cavitations are seen in...
TB
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Size of induration needed for a positive PPD test in:
1. general population
2. health care workers
3. IC patients
- General population-15 mm
- Health care workers-10 mm
- IC patients--5 mm
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Treatment for positive TB exposure (positive PPD) but no active disease
INH only
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Causes of chronic meningitis
- mycobacteria
- fungi
- Lyme disease
- parasites
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Most common cause of acute meningitis in:
1. adults
2. the elderly
- Adults--S. pneumonia, N. meningitidis, H. influenza
- Elderly--S. pneumonia, N. meningitis, L. monocytogenes
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Most common cause of meningitis in IC patients
L. monocytogenes
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Patient presents with fever, nuchal rigidity, and maculopapular rash
Bacterial meningitis due to N. meningitidis
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Kernig's sign
- Inability to fully extend knees when patient is supine with flexed hips
- Present in 50% of patients with bacterial meningitis
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Brudzinski's sign
- Passive flexion of the neck triggers flexion of the legs and thighs
- Indication of bacterial meningitis
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What drug should be given, in addition to IV antibiotics, in a patient with meningitis and cerebral edema?
Steroids
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Viral causes of encephalitis
- HSV-1
- Arboviruses (Eastern equine, West Nile)
- Enteroviruses (polio)
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Most common lobe of the brain affected by HSV-1 encephalitis
Temporal
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Which virus is associated with PAN?
Hep B
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Which virus is associated with cryoglobulinemia?
Hep C
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Which HBV antigen indicates active viral replication?
HBeAg
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What is an indication of HBV infection during the window period?
HBcAB
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How is HCV diagnosed?
- PCR to detect viral load
- HCV antibodies indicate infection, but may not be detectible for several months, while PCR can detect viral mRNA 1-2 weeks after infection.
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ALT vs AST in viral and alcoholic hepatitis
- In viral hepatitis, ALT is more elevated
- In alcoholic hepatitis, AST is more elevated
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Symptoms of botulinum poisoning
- Abdo cramps, nausea, and diarrhea
- Symmetric, descending flacid paralysis, beginning with dry mouth, dysarthria, and diplopia
- Try not to confuse with Guillain-Barre, which is usually descending paralysis, but which has one variant (Fischer) which can manifest with ascending paralysis
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Most common causes of UTI
- E. coli
- Staph saprophyticus
- Enterococci
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Phenazopyridine (Pyridium)
Urinary analgesic, given to treat dysuria
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Complications of pyelonephritis
- Sepsis (10-25% of patients)
- Emphysematous pyelonephritis--caused by gas-producing bacteria in diabetic patients
- Chronic pyelonephritis and kidney scarring
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Acute v. chronic prostatitis
- Acute seen in younger men, presents with fever, chills, dysuria, frequency/urinary retention, lower back pain
- Chronic seen in older men, often asymptomatic
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What part of PE should be skipped in a patient with acute bacterial prostatitis?
DRE, to avoid causing bacteremia
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Treatment for chronic prostatitis
Fluoroquinolone
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Infection associated with Reiter's syndrome
Chlamydia
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Presentation of gonorrhea in women vs. men
- Usually asymptomatic in women (so goes undetected)
- Causes urethral discharge and dysuria in men
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Symptoms of disseminated gonoccocal infection
- Fever, arthralgias, tenosynovitis
- Migratory polyarthritis
- Endocarditis
- Skin rash, usually on distal extremities
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Complications of gonorrhea
- PID (infertility, chronic pelvic pain)
- Epididymitis, prostatitis
- Salpingitis, tubo-ovarian abscess
- Fitz-Hugh-Curtis syndrome (inflammation of liver capsule)
- Disseminated infection
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Treatment for gonorrhea
Ceftriaxone, plus azithromycin or doxycycline to cover chlamydia co-infection
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