Step 2 review: ID

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Step 2 review: ID
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2011-08-05 01:52:59
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  1. most common causes of pneumonia: children
    • 1. viruses
    • 2. mycoplasma
    • 3. C.pneumo
    • 4. S.pneumo
  2. most common causes of pneumonia: older adults
    • S.pneumo
    • H.flu
    • anaerobes
    • viruses
    • mycoplasma
  3. classic pneumonia treatment
    3G ceph, azithro
  4. atypical pneumonia organisms, tx
    • mycoplasma, legionella, chlamydia
    • macrolide, doxy, broad spec FQ (levo, moxi)
  5. most common causes of pneumonia: alcoholics
    • S. pneumo
    • Klebsiella
    • S. aureus
  6. most common causes of pneumonia: CF
    • Pseudomonas
    • Burkholderia
    • S. aureus
    • mycobacteria
  7. most common causes of pneumonia: neonate
    • GBS
    • E.coli
  8. When to hospitalize for pneumonia
    • CURB-65 > 1 [confusion, inc urea, RR > 30, BP <90/ <60, age > 65]
    • or any comorbidities, immunosuppression
  9. Pseudomonas: tx
    • (piperacillin +/- tazo) + tobramycin
    • or piperacillin + ceftazidime/cefepime
  10. TB: tx
    • Active TB: Rifampin, INH, pyrazinamide, ethambutol x 2 mo, then Rifampin, INH x 4 mo
    • Latent TB: INH x 9mo
  11. INH: side effects
    • peripheral neuritis- give with pyridoxine to prevent
    • hepatitis
  12. Centor criteria
    • used to ID strep pharyngitis
    • 3+ of - fever, tonsillar exudate, tender cervical LA, no cough
  13. Acute pharyngitis: complications
    • non-suppurative: rheumatic fever (mitral stenosis > aortic stenosis), PSGN
    • suppurative: mastoiditis, peritonsillar abscess, Lemierre's syndrome (thrombophlebitits of jugular vein)
  14. Corynebacterium: characteristics, complication, tx
    • GP, highly pleomorphic "chinese characters"
    • form pseudomembranes
    • complication- dilated cardiomyopathy
    • tx- erythromycin or PCN
  15. Sinusitis: acute vs chronic, tx
    • Acute < 1mo, bacteria cause symp < 1 wk
    • Chronic > 3mo, often dt obstruction or ongoing low grade anaerobe infx
    • Tx- mostly symptomatic
    • acute bacterial: Amox/Clavulanate (or macrolides, TMP-SMX, FQ)
    • Chronic: adjuvant intranasal steroids, decongestants, antihistamine, longer course abx
  16. Coccidiodomycosis: population affected, tx
    • consider in HIV+, Filipino, Af-Am, pregnant pt from SW US
    • tx- consider IV amphotericin B for severe pulm infx or disseminated disease. otherwise PO azole for mild
  17. Meningitis: common causes in children + tx
    • S.pneumo
    • N. meningitidis
    • Hib
    • Enterovirus
    • tx- Vanc + ceftriaxone/cefotaxime
  18. Meningitis: common causes in adults + tx
    • N. meningitidis
    • Enterovirus
    • S. pneumo
    • HSV
    • tx- Vanc IV + ceftraixone/cefotaxime
  19. Meningitis: common causes in HIV
    • Cryptococcus
    • CMV, HSV, VZV
    • TB
    • toxo
    • JC virus
  20. Meningitis: common causes in elderly + tx
    • S.pneumo
    • GNR
    • Listeria
    • N. meningitidis
    • tx- Amp + Vanc + cefotaxime/ceftriaxone
  21. Encephalitis: clinical features, dx
    • altered consciousness, HA, fever, seizures
    • CSF- lymphocytic pleocytosis, inc protein, poss dec glucose
    • obtain DSV gram stain, acid fast stain, India ink (cryptococcus), wet prep (amebae), Giemsa stain (trypanosomes), PCR
  22. Features of HSV encephalitis
    • RBCs in CSF without history of trauma
    • constrast-enhancing lesion in temporal lobe
  23. HIV: opportunistic infx
    • CD4 < 50: disseminated MAC, histo, CMV retinitis, CNS lymphoma
    • CD4 < 200: Pneumocystosis, toxo, cryptococcus, coccidioidomycosis, cryptosporidiosis
    • higher CD4 count- TB, HSV, HZ, vaginal cadidiasis, hairy leukoplakia, Kaposi's sarcoma
  24. HIV: when to initiate antiretrovirals
    • symptomatic regardless of CD4 of viral count
    • asympt with CD4 < 350
    • pregnant
    • specific HIV-related conditions
  25. HIV: prophylaxis for opportunistic infx
    • PCP- CD4 < 200, oral candidiasis, unknown fever x 2weeks
    • MAC- CD4 < 50-100
    • Toxo- CD4 < 100
    • TB- PPD or high risk
    • Candida, HSV- multiple recurr
    • MMR vaccine: only live vaccine given to HIV pts (give if CD4 > 200)
  26. Oropharyngeal candiasis: features, dx, tx
    • soft white plaques that can be rubbed off
    • budding yeast + pseudohyphae
    • local tx for thrush, PO azole for esophagitis
  27. Cryptococcal meningitis: features, dx, tx
    • exposure to pigeon droppings
    • LP- dec gluc, inc protein, leuk, opening pressure
    • + CSF cryptococcal antigen test
    • India ink stain- narrow based, unequal budding
    • tx- IV ampho B + flucytosine x 2 weeks. lifelong maintenance tx until CD4 > 200 for >6 mo
  28. Histoplasmosis: dx, tx
    • CXR, urine and serum polysaccaride antigen test, silver stain (yeast)
    • tx- itraconazole 1 yr for chronic cavitary lesions, ampho B followed by itraconazole for severe pulm or disseminated dz
  29. Pneumocystis jiroveci: dx, tx
    • silver stain
    • high dose TMP-SMX x 21d
    • alternate- clinda, primaquine, pentamidine
  30. CMV: transmission, manifestations
    • via sex, breast milk, resp droplets, blood transfusion
    • CMV retinitis
    • AIDS cholangiopathy
    • CMV pneumonitis- pts with heme malig
    • CNS- polyradiculopathy, transverse myelitis, encephalitis (periventricular calicification)
  31. Mycobacterium avium Complex: features, dx, tx
    • fever, weak, wt loss in pts not on HAART or prophylaxis
    • dx- blood cx, inc alk phos and LDH, bone marrow shows foamy macrophage with AFB
    • tx- clarithromycin + ethambutol +/- rifabutin. HAART
    • prevent- weekly azithromycin if CD4 < 50
  32. Toxoplasmosis: features, dx, tx
    • raw or undercooking meat, cat litter, France
    • dx- serology, PCR, CT scan if CNS involvement (multiple ring-enhancing lesions with predilection for basal ganglia)
    • tx- PO pyrimethamine, sulfadiazine + leukovorin, spiramycin (for preg)
  33. Chlamydia: presentation, dx, tx, complications
    • often asympt, urethritis, mucopurulent cervicitis, PID
    • lymphogranuloma venereum - affect LN then "anogenital syndrome"
    • clinical dx, culture is gold standard. GS may show PMNs but no bac
    • tx- doxy or azithro
    • Reiter's syndrome, Fitz-Hugh-Curtis syndrome
  34. Gonorrhea: presentation, dx, tx
    • GN intracell diplococus
    • green/yellow discharge, adnexal pain, in male purulent urethral discharge
    • monoarticular septic arthritis, tenosynovitis
    • GS and culture is gold standard
    • tx- ceftriaxone or cefepine x 1 dose
  35. Syphilis: presentation
    • primary: painless chancre
    • secondary: flu-like symp, macpap rash on soles and palms, condylomata lata
    • early latent < 1 yr
    • late latent > 1yr --> may progress to tertiary
    • tertiary: gummas, neurosyphilis (tabes dorsalis, Argyll Robertson pupil), cardiovasc (thoracic aortic aneurysm)
  36. Syphilis: dx, tx
    • dx- darkfield (1', 2'), VDRL/RPR (false positives, become neg when infx clears), FTA-ABS (remain positive for life)
    • tx- benzathine pcn x 1d (tetracycline or doxy). possible Jarisch-Herxheimer rxn
  37. UTI: tx
    • uncomplicated- TMP-SMX or FQ x 3d, nitrofurantoin x 7d
    • complicated- above x 7-14d
    • pregnant- nitrofurantoin or cephalosporin x 3-7d
  38. SIRS: definition
    2 or more of temp (< 36 or > 38), tachypnea, tachycardia, leukocytosis/leukopenia
  39. Sepsis: causes in neonates
    • GBS
    • E.coli
    • Listeria
    • H.flu
  40. Sepsis: causes in children
    • H.flu,
    • pneumococcus
    • meningococcus
  41. Sepsis: causes in adults
    • GPC
    • aerobic GNR
    • anaerobes
  42. Sepsis: causes in asplenic pt
    • pneumococcus
    • H.flu
    • meningococcus
  43. Malaria: tx
    • uncomplicated- chloroquine +/- primaquine for hypnozoites (P.vivax, P.ovale)
    • severe- IV quinidine or proguanil/atovaquone
  44. Infectious mono: compliations
    • CNS infection
    • splenic rupture
    • bac superinfx- strep pharyngitis
    • fuminant heaptic necrosis
    • autoimmune hemolytic anemia
  45. EBV associated cx
    • nasopharyngeal cx
    • African Burkitt lymphoma
    • posttransplant lymphoprolif d/o
  46. Lyme disease: presentation, tx
    • Borrelia burgdorferi carried by Ixodes tick
    • 1' (early local)- erythema migrans
    • 2' (early dissem)- migratory polyarthropathy, neurologic phenom, meningitis, conduction abnl
    • 3' (late)- arthritis, subacute enceph
    • tx- doxycycline for early dz, ceftriaxone for advanced
  47. Rocky Mountain Spotted Fever: presentation, tx
    • Rickettsia rikettsii carried by dermacentor dog tick
    • macular rash on wrists/ankles spread centrally as petechia/purpura
    • look very ill, DIC
    • tx- doxycycline (chloramphenicol 2')
  48. Endocarditis: etiologies + associations
    • S.aureus- IVDU
    • Viridans strep- left-sided subacute IE, native valve
    • Coag neg staph- prosthetic valve
    • Strep bovis- GI malig
    • Candida/aspergillis- immunocompromise, long-dwelling IV
    • HACEK- culture neg
    • Libman-Sacks- SLE
  49. Endocarditis: tx
    vancomycin (or pcn) + gentamicin/tobramycin
  50. Osteomyelitis: causative orgs, tx
    • S.aureus, Salmonella
    • oxacillin, cefazolin, vanc
  51. Cellulitis: causative orgs, tx
    • Strep, Staph
    • dicloxacillin, cephalexin
    • if MRSA, TMP-SMX or clinda
  52. Septic arthritis: causative orgs, tx
    • S.aureus- vanc
    • GNR- ceftazidime or ceftriaxone
    • N.gonorrhea- ceftriaxone, cipro, spectinomycin
  53. empiric antibiotics for Strep A/B
    • PCN, cefazolin (1G)
    • erythromycin
  54. empiric antibiotics for S.pneumo
    • macrolide, doxy
    • 3G ceph + macrolide or doxy
    • FQ c atypical coverage
  55. empiric antibiotics for enterococcus
    • PCN or amp+gent
    • Vanc + gent
  56. aminoglycoside types + uses
    • gentamicin, tobra, strptomycin
    • aerobic GNR, TB
    • endocarditis c stronger GPC abx (amp+gent)
  57. empiric antibiotics for gonococcus
    • ceftriaxone or cefixime (3G)
    • spectinomycin
  58. empiric antibiotics for meningococcus
    • ceftriaxone or cefotaxime (3G)
    • chloramphenicol or Pen G
  59. empiric antibiotics for Haemophilus
    • 2 or 3G ceph
    • ampicillin
  60. empiric antibiotics for mycoplasma
    • erythromycin, azithromycin
    • doxycycline
  61. macrolide: types and uses
    • azithromycin, erythromycin
    • GPC + mycoplasma, legionella, mycobacterium (think broader PCN)
  62. Antipseudomonal PCNs
    ticarcillin, pipercillin (think zosyn)
  63. Antistaph PCNs
    dicloxacillin, methicllin, oxacillin, nafcillin
  64. Pneumonia after exposure to exotic bird
    Chlamydia psittaci
  65. Seizures with ring-enhancing brain lesions on CT
    • Taenia solium- albendazole or praziquantel
    • Toxoplasmosis
  66. SCC in middle east or africa
    Schistosoma haematobium
  67. Worm infection in children: cause, dx, tx
    • Enterobius
    • dx- + tape test, perianal itching
    • tx- mebendazole or albendazole
  68. Measles: presentation, complication
    • fever, cough, runny nose, conjunctivitis
    • 3 days later, Koplik's spots
    • then macpap rash on head/neck c cephalocaudal progression
    • giant-cell pneumonia, subacute sclerosing panencephalitis (years later)
  69. Rubella: presentation, pregnancy
    • vaccine contraindicated in pregnant
    • milder than measles
    • 2-3d prodrome then rash on face, neck with cephalocaudal progression
  70. Roseola infantum: cause, presentation
    • HHV6
    • children > 3yo
    • high fever with no known cause x 4 d, then diffuse rash on chest/abd
  71. Erythema infectiosum (fifth disease): cause, presentation
    • parvovirum B19
    • "slapped cheek" rash on face, followed by rash on arms, legs, trunk
  72. Scarlet fever: cause, presentation, tx
    • GAS
    • pharyngitis then sandpaper-like rash on trunk, circumoral pallor, strawberry tongue
    • PCN V PO
  73. Kawasaki dz: presentation, complication
    • < 5 yo
    • fever > 5d, strawberry tongue, conj injection, skin desquamation, rash beginning 1d before fever, cervical LA, arthralgia
    • complic- coronary a aneurysm, arrhythmia, MI
  74. Kawasaki dz: tx
    IVIg, ASA
  75. Croup: cause, presentation, tx
    • Parainfluenza virus
    • 1-2 yo in fall/winter
    • viral URI --> "barking" cough, stridor
    • "steeple sign" on radiograph
    • tx- supportive, racemic epinephrine
  76. Epiglottitis: cause, presentation, tx
    • Hib >> S.aureus, S.pyogenes, S.pneumo
    • 2-5 yo
    • little/no prodrome c rapid progression to high fever, toxic appearance, drooling, resp distress c no cough
    • "thumb sign" on lateral radiograph
    • tx- estblish airway, oxacillin/cefazolin/clinda/vanc + cefotaxime/ceftriaxone
  77. Bronchiolitis: cause, presentation, tx
    • RSV
    • 0-18mo, fall/winter
    • viral URI then respiratory distress
    • tx- supportive, consider ribavirin if severe
  78. Congenital syphilis: presentation, tx
    • early- skin rash + lesions, HSM, "snuffles," jaundice, anemia, metaphyseal dystrophy, periostitis
    • late signs (> 2yo)- Hutchinson's triad (peg shapped teeth, interstitial keratitis, deafness. saddle nose, saber shins, CNS involvement
    • tx- PCN G IV
  79. Congential Toxoplasmosis: presentation
    • consumption of raw meat, contact cat feces
    • hydrocephalus, intracranial calcifications, chorioretinitis, ring-enhancing lesions on CT
  80. Congenital Rubella: presentation
    • "blueberry muffin" rash
    • PDA
    • cataract
    • MR
    • hearing loss
  81. Congenital CMV
    • the most common congenital infx
    • petechial rash (blueberry muffin like)
    • periventricular calcification
    • IUGR, microcephaly
    • HSM
    • chorioretinitis

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