Step Up: infectious diseases I

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  1. Most common causes of community pneumonia
    • Strep pneumonia
    • H. influenza
    • influenza virus
    • Legionella
  2. Most common nosocomial causes of bacterial pneumonia
    • gram negative rods
    • staph aureus
  3. Symptoms of typical pneumonia
    • Acute onset of fever and shaking chills
    • Productive cough
    • Pleuritic chest pain
  4. How can pneumonia be differentiated from acute bronchitis?
  5. Causes of atypical community pneumonia
    • Mycoplasma pneumonia (most common)
    • Clamydia pneumonia
    • Clamydia psittaci
    • Coxiella Burnetii (Q fever)
    • Legionella
    • Viruses (influenza, adeno, parainfluenza, RSV)
  6. 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
  7. Common cause of pneumonia in alcoholics
  8. Cause of pneumonia in transplant recipients
  9. Assay used to detect legionella
    Urinary antigen assay
  10. First line antibiotics for pneumonia in a young, healthy patient
    Macrolides, fluoroquinolones, or doxycycline (cover all the common organisms in healthy individuals under 60)
  11. Why are penicillin and cephalosporins not first line agents for pneumonia?
    They don't cover atypicals such as mycoplasma and chlamydia
  12. 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)
  13. When should a pleural effusion be drained?
    When it is larger than 1 cm on a lateral decubitus film
  14. Which lobe is most commonly affected by aspirated material?
    right upper
  15. When is a person with TB contagious?
    When the TB is active. Primary TB is not contagious
  16. Where is secondary (reactivated) TB most commonly found?
    Lung apeces (primary TB is most commonly found in the lower lobes)
  17. 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)
  18. Ghon complex
    A calcified primary TB focus
  19. Ranke complex
    A calcified primary TB focus plus a calcified hilar lymph node
  20. Upper lobe infiltrates with cavitations are seen in...
  21. 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
  22. Treatment for positive TB exposure (positive PPD) but no active disease
    INH only
  23. Causes of chronic meningitis
    • mycobacteria
    • fungi
    • Lyme disease
    • parasites
  24. 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
  25. Most common cause of meningitis in IC patients
    L. monocytogenes
  26. Patient presents with fever, nuchal rigidity, and maculopapular rash
    Bacterial meningitis due to N. meningitidis
  27. Kernig's sign
    • Inability to fully extend knees when patient is supine with flexed hips
    • Present in 50% of patients with bacterial meningitis
  28. Brudzinski's sign
    • Passive flexion of the neck triggers flexion of the legs and thighs
    • Indication of bacterial meningitis
  29. What drug should be given, in addition to IV antibiotics, in a patient with meningitis and cerebral edema?
  30. Viral causes of encephalitis
    • HSV-1
    • Arboviruses (Eastern equine, West Nile)
    • Enteroviruses (polio)
  31. Most common lobe of the brain affected by HSV-1 encephalitis
  32. Which virus is associated with PAN?
    Hep B
  33. Which virus is associated with cryoglobulinemia?
    Hep C
  34. Which HBV antigen indicates active viral replication?
  35. What is an indication of HBV infection during the window period?
  36. 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.
  37. ALT vs AST in viral and alcoholic hepatitis
    • In viral hepatitis, ALT is more elevated
    • In alcoholic hepatitis, AST is more elevated
  38. 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
  39. Most common causes of UTI
    • E. coli
    • Staph saprophyticus
    • Enterococci
  40. Phenazopyridine (Pyridium)
    Urinary analgesic, given to treat dysuria
  41. Complications of pyelonephritis
    • Sepsis (10-25% of patients)
    • Emphysematous pyelonephritis--caused by gas-producing bacteria in diabetic patients
    • Chronic pyelonephritis and kidney scarring
  42. 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
  43. What part of PE should be skipped in a patient with acute bacterial prostatitis?
    DRE, to avoid causing bacteremia
  44. Treatment for chronic prostatitis
  45. Infection associated with Reiter's syndrome
  46. Presentation of gonorrhea in women vs. men
    • Usually asymptomatic in women (so goes undetected)
    • Causes urethral discharge and dysuria in men
  47. Symptoms of disseminated gonoccocal infection
    • Fever, arthralgias, tenosynovitis
    • Migratory polyarthritis
    • Endocarditis
    • Skin rash, usually on distal extremities
  48. Complications of gonorrhea
    • PID (infertility, chronic pelvic pain)
    • Epididymitis, prostatitis
    • Salpingitis, tubo-ovarian abscess
    • Fitz-Hugh-Curtis syndrome (inflammation of liver capsule)
    • Disseminated infection
  49. Treatment for gonorrhea
    Ceftriaxone, plus azithromycin or doxycycline to cover chlamydia co-infection
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Step Up: infectious diseases I

internal medicine infectious disease
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