Step 2 ID 2

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Anonymous
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27255
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Step 2 ID 2
Updated:
2010-07-18 18:34:43
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USMLE Step
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USMLE Step Infectious Disease
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  1. MCC of PNA in kids 6wks-18yrs
    • Viruses (RSV)
    • Mycoplasma
    • Chlamydia Pneumoniae
    • Strep pneumoniae
  2. MCC of PNA in adults 18-40 yrs
    • Mycoplasma
    • C. Pneumoniae
    • S. Pneumoniae
  3. MCC of PNA in adults 40-65 yrs
    • Strep. Pneumoniae
    • H. Influenza
    • Anaerobs
    • Viruses
    • Mycoplasma
  4. MCC of PNA in elderly
    • S. pneumoniae
    • Viruses
    • Anaerobes
    • H. Influenza
    • Gram + Rods
  5. PNA work up for
    1 Legionella
    2 Chlamydia Pneumo
    3 Mycoplasma
    4 strep Pneumo
    5 Viral
    • 1: Legionella urine antigen test
    • 2: chlamydia serologic testing, cuture, PCR
    • 3: Mycoplasma, serum cold agglutinis and serum Mycoplasma antigen
    • 4: Urine pneumococcal Ag test, culture
    • 5: nasopharyngeal aspirate, rapid tests, DFA, viral culture
  6. Out-pt comm-acquired PNA, pts <65 yrs of age, otherwise healthy
    Likely cause and Tx
    • S. pneumo
    • Mycoplasma
    • C. Pneumo
    • H. influenza
    • viral

    • Macrolide: azithromycin
    • Doxycycline
    • Flouroquinolones
  7. Pts >65 yrs or with comorbidity:
    COPD, CHF, DM, Renal Failure, Liver Dz, EtOH abuse
    Most common pathogens and Tx
    • Strep pneumo
    • H. influenza
    • Aerobic GNR: E.coli, Enterobacter, Klebsiella
    • Staph Aureus
    • Legionella
    • Viruses
  8. TX:
    • Macrolide (azithromycin)* or
    • Fluoroquinolones
    • *Consider adding 2nd Gen Cephalosporin or B-lactam to macrolide
  9. Comm-Acquired PNA requiring admission
    pathogens and Tx
    • Strep Pneumo
    • H. infu
    • Anaerobes
    • Aerobic GNRs
    • Legionella
    • Chlamydia

    • TX:
    • Extended spect Cephalosporin
    • B-lactam/B-lactamase inhibitor or
    • fluoroquinolone
    • add macrolide if atypical organisims suspected
  10. Comm-acquired PNA needing ICU care
    pathogens and Tx
    • Strep pneumo
    • H. Influ
    • Anaerobes
    • Aerobic GNRs
    • Mycoplasma
    • Legionella
    • Psudomonas

    • TX:
    • Fluoroquinolone or 3rd Gen Ceph or
    • B-lactam/B-lactamase inhibitor + macrolide
  11. Hospital acquired PNA
    Pathogens and TX
    • GNR's (includes Pseudomonas and Acinetobactor)
    • Staph Aureus
    • Legionella
    • Mixed Flora

    • TX:
    • 3rd Gen Ceph or
    • B-lactam with antipseudomonal activity or
    • Carbepenem
    • Might add aminoglycoside or Fluoroquinolones for coverage of resistant organisms (pseudomonas)
  12. PNA d/t MRSA, Tx
    Add Vanc or linezolid; broader gram neg coverage
  13. Tx of active and Latent TB
    • report all cases to local and state health departments
    • Respirator Isolation

    • Active TB: 4-drug tx, INH, Pyrazinamide, rifampin, ethambutol x 2mos
    • followed by 4 mos of INH+Rifampin

    • Latent TB:
    • +PPD w/o symptoms - INH x 9mos
    • alternative - INH x 6mos or rifampin x 4mos
  14. What should also be given to patients on INH therapy?
    • Vit B6 (Pyridoxine)
    • helps to minimize the peripheral neuropathy caused by INH
  15. Causes of Acute Pharyngitis
    Viral>Bacterial (90% of adults)

    Bacterial: GAS, N. gonorrhea, Corynebacteria, Mycoplasma

    Viral: Rhinovirus, Coronavirus, Adenovirus, HSV, EBV, CMV, Flu virus, coxsackie, acute HIV
  16. Centor's Criteria for Strep Pharyngitis
    • 3 of 4 criteria required
    • Fever
    • Sore throat
    • pharyngeal exudate
    • Lack of Cough***

    Others: cevical lymphadenopathy, palatal petechiae, HA, Vomiting, scarlatiniform rash
  17. Dx and Tx of Strep pharyngitis
    Dx: 3/4 Centor Criteria and +Rapid GAS antigen test

    Tx: Penicillin x 10 days

    Alternatives: Cephalosporins, amoxicillin, azythromycin
  18. Complications of Strep Pharyngitis
    Nonsupprative: Acute Rheumatic Fever and Poststrep GN

    • Supporative: cervical lymphadenopathy, mastoiditis, sinusitis, OM, retropharyngeal or peritonsillar abscess and
    • Lemierre's syndrome: thrombophebitis of jugular vein d/t Fusobacterium
  19. Gold Standard Dx of Sinusitis
    • Sinus tap and bacterial culture (not usually done)
    • Middle meatus endoscopy and cultures is gaining popularity
  20. Tx for Sinusitis
    • Since most are d/t virus and self limiting...
    • symptomatic: decongestants, antihistamines, pain relief
  21. Tx for Acute Bacterial Sinusitis
    Augmentin: amoxil/clavulanate 500mg PO TID x 10 days

    Alternatives: clarithromycin, azythromycin, TMP-SMX, Fluoroquinolone or 2nd gen ceph
  22. Tx for Chronic Sinusitis
    Adjuvant therapy with intranasal corticosteroids, decongestants, antihistamines

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