Infectious Disease - IM Quick Notes

arold001's version from 2015-12-30 17:58

Section 1

Question Answer
What are the 3 most common causes of community acquired pneumonia?strep pneumonia, H. influenza, Mycoplasma
Whats the inpatient vs outpatient tx for community acquired pneumoniainpatient: azithromycin +ceftriaxone (or levofloxacin)
outpatient: azithromycin or levofloxacin or doxycycline
what are 4 most common causes of hospital acquired pneumonia?GNR (pseudomonas, klebsiella, E. coli), staph aureus
whats the most common cause of ventilator associated pneumonia?pseudomonas
what 2 drugs used to tx for ventilator associated pneumoniacarbepenem + levofloxacin
whats the tx for aspiration pneumonia?ceftriaxone or levofloxacin
what 3 drugs are the empiric therapy for sepsis?ceftriaxone, gentamicin and metronidazole
whats the tx of acute bacterial endocarditis?vancomycin + gentamicin
whats the tx of SUBACUTE bacterial endocarditis?CEFTRIAXONE + gentamicin
whats the tx for acute and prosthetic valve endocarditis?vancomycin + gentamicin
whats the 2 tx options for osteomyelitis?oxacillin or vancomycin
what org causes osteomyelitis in diabetic pts?pseudomonas
what org causes osteomyelitis in sick cell ptssalmonella
what 4 organisms causes uncomplicated UTIs?E.coli, Proteus, Klebsiella, staph saprophyticus
whats the 2 treatment options for UTI?ciprofloxacin or TMP-SMX
what are 3 orgs that cause neutropenic fevers?pseudomonas, staph aureus, strep viridans
whats the tx of neutropenic fever?imipenem or piperacillin or cefepime) +/- vancomycin or ceftazidime +/- vancomycin

Section 2

Question Answer
whats the definition of health care-associated pneumonia (HCAP)?hospitalized >2 days within 90 days of pneumonia
whats the definition of hospital acquired pneumonia?pneumonia occurs 48 hours or more AFTER admission
whats ventilator associated pneumonia?pneumonia occuring 48 hours or more AFTER intubation
what is aspiration pneumonia?pneumonia occuring within 24-72 hours after aspiration event
2 most common causes of pneumonia in COPD pts?H. influenza and Moraxella catarrhalis
elderly pt presents with pneumonia, diarrhea and HYPONATREMIAlegionella (look for water source, smoker or immunocompromised)
pneumonia in alcoholics or elderly nursing home residentsklebsiella = currant jelly sputum
young healthy pt presents with mild sxs but CXR shows pneumoniaMycoplasma, chlamydia,
whats the most common cause of pneumonia in HIV pts?strep pneumonia (but consider PCP when CD4 <100)
what 3 orgs cause ACUTE bacterial endocarditis?staph aureus, group A strep, Strep pneumoniae
what org causes subacute bacterial endocarditis?strep viridans
whats the tx of endocarditis due to IV drug use?vancomycin
is strep viridans susceptible to penicillin?YES!
strep bovis endocarditis is a/w?colon cancer
what 2 viruses cause pericarditis and myocarditis?coxsackie or echovirus
how do you tx pericarditis and myocarditis?NSAIDs --> add colchicine

Section 3

Question Answer
CSF shows: increased neutrophil, increased proteins, decreased glucosebacterial meningitis
CSF shows: increased lymphocytes, inreased proteins, NORMAL glucoseviral meningitis
CSF shows: increase lymphocyte, normal to increased proteins, decreased glucosefungal meningitis
CSF shows increase lymphocytes, increased proteins, decreased glucoseTB meningitis
2 causes of RBCS after LPbloody tap or HSV encephalitis
whats the prophylactic tx of meningococcal meningitis?rifampin (or cipro or ceftriaxone)
whats the tx of CMV encephalitis??foscarnet
how do you diagnose UTI on UA?pyuria + bacteriuria +/- hematuria +/- nitrites
whats the tx for urethritis due to Neisseria and chlamydia?ceftriaxone + (doxycycline or azithromycin)
whats a common cause of UTI in young sexually active woman?staph saprophyticus
pt presents with fever, flank pain, CVA tenderness, pyuriapyelonephritis
whats the outpatient tx for pyelonephritis?ciprofloxacin or cephalosporin
whats the inpatient tx options for pyelonephritis?ceftriaxone, ciprofloxacin, gentamicin, or ampicillin/sulbactam

Section 4

Question Answer
whats the definition of AIDSHIV infection + CD4 <200 or opportunistic infection or malignancy
how test do you order to diagnose HIV?ELISA --> then confirm with western blot --> then PCR to follow viral load
how does PCP pneumonia present?CXR shows bilateral, diffuse infiltrates; may see elevated LDH
how do you tx PCP pneumonia?treat with bactrim (treat with steroids before if PaO2 <70 or A-a gradient >35)
what are the 3 most common causes of diarrhea in HIV patients?CMV colitis, MAC, cryptosporidium
what are 2 skin findings a/w HIV?Kaposi’s sarcoma (HHV-8), bacillary angiomatosis (Bartonella)
what org causes retinitis in HIV pts?CMV retinitis
whats a common cause of meningitis in HIV pts?cryptococcus meningitis
if HIV pt presents with oral thrush, whats his CD4 countCD4 <400
if HIV pt has CD4 <400, what is he susceptible to?oral thrush, tinea pedis, VZV reactivation, TB reactivation, other bacteria (H. influenzae, S. pneumoniae, Salmonella
if HIV pt presents with CD4 <200, what is he at risk for?HSV reactivation, cryptosporidiosis, Isospora, disseminated coccidioidomycosis, PCP, Bartonella, cryptococcus, histo, cocci
if HIV pt has PCP, whats his CD4 count?CD4 <200
if HIV pt has toxoplasmosis, whats his CD4 count?CD4 <100
if HIV pt presents with CD4 <100, what 3 things is he at risk for?Candidal esophagitis, toxoplasmosis, Nocardia brain abscess
if HIV pt presents with CD4 < 50, what is he at risk for?CMV retinitis and esophagitis, disseminated MAC, cryptococcal meningoencephalitis, invasive aspergillosis, bacillary angiomatosis, CNS lymphoma, PML
what toxicity is a/w HIV medication: didanosinepancreatitis
what toxicity is a/w HIV medication: abacavirhypersensitivity reaction
what toxicity is a/w HIV medication: any NRTILACTIC ACIDOSIS
what toxicity is a/w HIV medication: NNRTIsteven johnsons syndrome
what toxicity is a/w HIV medication: nevirapineliver failure
what toxicity is a/w HIV medication: indinavircrystal nephropathy
what toxicity is a/w HIV medication: protease inhibitorstruncal obesity and hyperlipidemia
what toxicity is a/w HIV medication: zidovudinebone marrow suppression
what toxicity is a/w HIV medication: efavirenzdepression and psychosis
in HIV pts, what prophylactic tx should you start when CD4 <200 vs cd4 <50 : CD4< 200: start TMP-SMX for PCP ppx
CD4 <50: start azithromycin for MAC ppx

Section 5

Question Answer
CXR of primary TB versus reactivation TBprimary TB: middle/lower lobe pneumonia. Reactivation TB: apical infiltrate
how do you tx ACTIVE TB?“4 for 2 then 2 for 4” – RIPE treatment (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) for 2 months then rifampin and isoniazid for 4 months
how do you tx positive PPD, but no active disease?isoniazid for 6-9 months
side effect of which TB medication: orange body fluidrifampin
side effect of which TB medication: hepatitisrifampin, isonizaid, pyazinamide
side effect of which TB medication: CYP450 inducerrifampin
side effect of which TB medication: peripheral neuropathyisoniazid
side effect of which TB medication: drug-induced lupusisoniazid
side effect of which TB medication: hepatitis and hyperuricemiapyrazinamide
side effect of which TB medication: optic neuritisethambutol
whats SIRS criteria?(need 2/4):
1) T >38 or <36,
2) HR >90,
3) RR >20 (or PaCO2 <32),
4) WBC >12,000 or <4,000 or >10% bands
whats sepsis?SIRS with suspected infection
whats severe sepsis?sepsis with end organ dysfunction
whats septic shock?sepsis with persistent hypotension despite fluid resuscitation
what are some antipseudomonal antibiotics?anti-pseudomonal penicillins (piperacillin), some 3rd and 4th generation cephalosporins (ceftazidime, cefepime), carbapenems (except ertapenem), aminoglycosides (gentamicin), aztreonam, fluoroquinolones
what are some anti-MRSA antibiotics?vancomycin, linezolid, daptomycin, tigacycline, cefteroline, synercid

Section 6

Question Answer
what are 5 causes of spherocytes?autoimmune hemolytic anemia, hereditary spherocytosis, ABO incompatibility, G6PD deficiency, hyperthermia
heinz bodies and bite cellsG6PD deficiency
dacrocrytes = teardrop RBCsmyelofibrosis
patient presents with what looks like iron deficiency anemia is not responding to iron therapy...diagnosis?thalassemia minor
severe anemia, elevated HbF and HbA2beta-thalassemia major = 2 mutated beta genes
whats the tx of beta-thalassemia minor vs major?beta thal minor = no tx!
beta thal MAJOR = transfusion dependent!
one mutated alpha genealpha thal carrier = silent!
two mutated alpha genesalpha thal minor = no tx!
3 mutated alpha genesHbH disease = transfusion dependent or splenectomy
4 mutated alpha genesHb Barts = not compatible with life
how do you definitively diagnose aplastic anemia?bone marrow biopsy = shows hypocellular marrow
alcoholic pt has what type of anemia?macrocytic anemia due to vitamin B12
what are 6 causes of macrocytic anemia due to vitamin B12 deficiency?pernicious anemia, gastrectomy, crohns diease, ileal resection, alcoholism, VEGAN
whats the tx of vitamin B12 deficiency?IM cyanocobalamin
what 2 drugs causes folate defiency?methotrexate and PHENYTOIN
High reticulocyte index, low haptoglobin, high LDH, unconjugated hyperbilirubinemia (leading to jaundice), hemoglobinuria (leading to dark urine)hemolytic anemia
name 4 encapsulated orgs strep pneumo, H. influenza, Neisseria, salmonella
whats the most common cause of osteomyelitis?staph
elevated MCHChereditary spherocytosis
spherocytes but direct combs test is NEGATIVEhereditary spherocytosis (NOT AIHA)

Section 7

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