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Most common causes of community pneumonia
- Strep pneumonia
- H. influenza
- influenza virus
Most common nosocomial causes of bacterial pneumonia
- gram negative rods
- staph aureus
Symptoms of typical pneumonia
- Acute onset of fever and shaking chills
- Productive cough
- Pleuritic chest pain
How can pneumonia be differentiated from acute bronchitis?
Causes of atypical community pneumonia
- Mycoplasma pneumonia (most common)
- Clamydia pneumonia
- Clamydia psittaci
- Coxiella Burnetii (Q fever)
- Viruses (influenza, adeno, parainfluenza, RSV)
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
Common cause of pneumonia in alcoholics
Cause of pneumonia in transplant recipients
Assay used to detect legionella
Urinary antigen assay
First line antibiotics for pneumonia in a young, healthy patient
Macrolides, fluoroquinolones, or doxycycline (cover all the common organisms in healthy individuals under 60)
Why are penicillin and cephalosporins not first line agents for pneumonia?
They don't cover atypicals such as mycoplasma and chlamydia
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)
When should a pleural effusion be drained?
When it is larger than 1 cm on a lateral decubitus film
Which lobe is most commonly affected by aspirated material?
When is a person with TB contagious?
When the TB is active. Primary TB is not contagious
Where is secondary (reactivated) TB most commonly found?
Lung apeces (primary TB is most commonly found in the lower lobes)
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)
A calcified primary TB focus
A calcified primary TB focus plus a calcified hilar lymph node
Upper lobe infiltrates with cavitations are seen in...
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
Treatment for positive TB exposure (positive PPD) but no active disease
Causes of chronic meningitis
- Lyme disease
Most common cause of acute meningitis in:
2. the elderly
- Adults--S. pneumonia, N. meningitidis, H. influenza
- Elderly--S. pneumonia, N. meningitis, L. monocytogenes
Most common cause of meningitis in IC patients
Patient presents with fever, nuchal rigidity, and maculopapular rash
Bacterial meningitis due to N. meningitidis
- Inability to fully extend knees when patient is supine with flexed hips
- Present in 50% of patients with bacterial meningitis
- Passive flexion of the neck triggers flexion of the legs and thighs
- Indication of bacterial meningitis
What drug should be given, in addition to IV antibiotics, in a patient with meningitis and cerebral edema?
Viral causes of encephalitis
- Arboviruses (Eastern equine, West Nile)
- Enteroviruses (polio)
Most common lobe of the brain affected by HSV-1 encephalitis
Which virus is associated with PAN?
Which virus is associated with cryoglobulinemia?
Which HBV antigen indicates active viral replication?
What is an indication of HBV infection during the window period?
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.
ALT vs AST in viral and alcoholic hepatitis
- In viral hepatitis, ALT is more elevated
- In alcoholic hepatitis, AST is more elevated
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
Most common causes of UTI
- E. coli
- Staph saprophyticus
Urinary analgesic, given to treat dysuria
Complications of pyelonephritis
- Sepsis (10-25% of patients)
- Emphysematous pyelonephritis--caused by gas-producing bacteria in diabetic patients
- Chronic pyelonephritis and kidney scarring
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
What part of PE should be skipped in a patient with acute bacterial prostatitis?
DRE, to avoid causing bacteremia
Treatment for chronic prostatitis
Infection associated with Reiter's syndrome
Presentation of gonorrhea in women vs. men
- Usually asymptomatic in women (so goes undetected)
- Causes urethral discharge and dysuria in men
Symptoms of disseminated gonoccocal infection
- Fever, arthralgias, tenosynovitis
- Migratory polyarthritis
- Skin rash, usually on distal extremities
Complications of gonorrhea
- PID (infertility, chronic pelvic pain)
- Epididymitis, prostatitis
- Salpingitis, tubo-ovarian abscess
- Fitz-Hugh-Curtis syndrome (inflammation of liver capsule)
- Disseminated infection
Treatment for gonorrhea
Ceftriaxone, plus azithromycin or doxycycline to cover chlamydia co-infection