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vutobeyi's version from 2015-07-12 03:05

Section 1

Question Answer
Meningitis in immunocompromised (S pneumo, N mening, Listeria, GNRs)vanc + ampicillin + cefepime/ceftazadime/meropenem
Meningitis age 2-50 (N meningitides, S pneumo)vanc + ceftriaxone/cefotaxime
Meningitis >50 (S pneumo, N mening, Listeria)vanc + ampicillin + ceftriaxone/cefotaxime
Meningitis in neurosurg/shunt (GNRs, S aureus, coag-neg Staph)vanc + cefepime/ceftazadime/meropenem
Meningitis with penetrating skull trauma (S aureus, coag-neg Staph, GNRs)vanc + cefepime/ceftazadime/meropenem
alternative abx for Listeriaampicillin or trimethoprim/sulfamethoxazole
normal CSF (WBC, glucose, prot)WBC 0-5; glucose 40-70; prot <40
bacterial meningitis CSF (WBC, glucose, prot)WBC >1000; glucose <40; prot >250
viral meningitis CSF (WBC, glu, prot)WBC 100-1000; glucose 40-70; prot <100
tuberculous meningitis CSFWBC 5-1000; glucose <10; prot >250
guillain-barre CSFWBC 0-5; glucose 40-70; prot 45-1000

Section 2

Question Answer
vaccines in chronic liver diseaseTdap q10, Influenza q fall, HAV (2 doses), HBV (3 doses), pneumococcal (PPSV23 --> age 65 PCV13 --> PPSV23)
HIV screening (p24 + antigen)first-time 15-65 yo; high risk activities; with each pregnancy; homeless shelter/incarceration; tx for TB or another STD
post-influenza PNAstaph aureus
vaccines for new HIV dxTdap q10, influenza qfall, pneumococcus PCV13 --> PPSV23 2 mos later then q5y, HBV, HAV if risks, HPV 9-26yo, meningococcus if teen or group living or asplenia. MMR, VZV, & LAV are okay if CD4 >200 and no AIDS-defining illness
AIDS-defining illnessesPCP, KS, Mycobacterium Avium Complex, Cytomegalovirus esophagitis
Live vaccinesBCG, anthrax, oral typhoid, oral polio, yellow fever
CD4 count for PCP, Histoplasma, Toxoplasma, MACPCP <200; Histoplasma <150; Toxoplasma <100; MAC <50
Prophylaxis in HIV (based on CD4 count)TMP-SMX for PCP & Toxoplasma; Itraconazole for Histoplasma; Azithromycin/clarithromycin for MAC
Friable, exophytic nodules in HIV pt; or visceral angioma-like growths (org, tx)bacilliary angiomatosis, usually caused by Bartonella. Tx oral erythromycin.

Section 3

Question Answer
osteomyelitis in SCDSalmonella and S aureus
sepsis in SCD 2/2 functional aspleniaencapsulated orgs: S pneumo, H flu B, N mening, Salmonella. Penicillin prophylaxis until 5yo
trichinosis triadmyositis, periorbital edema, eosinophilia
empiric abx in CF PNA<20 yo: S aureus most likely - vanc for MRSA. >20 yo - cover for Pseudomonas: ticar/piper + clav/tazo, cipro, imipenem, aztreonam, ceftazadime, cefepime.
Bartonella (cat-scratch dz) txAzithromycin
disseminated gonococcal infection: s/s, dx, txs/s: either purulent arthritis OR tenysinovitis + migratory polyarthralgia + pustulent dermatitis. blood cx may be neg, try body cx. tx IV ceftriaxone, --> oral cefixime after 1-2 wk. empiric azithro or doxy for concurrent chlamydia.

Section 4

Question Answer
UTI or asymptomatic bacteriuria in pregnancynitrofurantoin, amox/clav, cephalexin
UTI/bacteriuria contraindicated in pregnancyFluoroquinolones (cipro), tetracyclines, trimethoprim/sulfamethoxazole
Pertussis txazithromycin, erythromycin clarithromycin (macrolides)
lyme disease, regular & prg/nursing/peds <8doxycycline; amoxicillin/cefuroxime
Peds sinusitis: strep pneumo, h flu, moraxellaamox/clav
HACEK - what are they, what organisms, txfastidious oropharyngeal GNRs that are a cause of culture-negative endocarditis. Hemophilus, Aggregatibacter (prev Actinobacillus), Cardiobacterium, Eikenella, Kingella. Tx ampicillin-sulbactam
Trachoma - what is it, organism, txchlamydia serotype A-C; follicular conjunctivitis, neovascularization of cornea. giemsa dx. topical tetracycline/oral azithro.

Section 5

Question Answer
endocarditis in IVDU (septic pulmonary emboli, peripheral): org, txS aureus, vanc
PCP: CD4 count, prophylaxis, txCD4 <200. Proph TMP-SMX oral. Tx TMP-SMX IV + corticosteroids (alternates: dapsone, atavoquone, pentamidine, clinda + primaquine)
what TMP/SMX is prophylactic forPCP, nocardia, toxoplasmosis, ?UTIs.
prophylaxis for CMVgancyclovir, valganciclovir
MAC in HIV: CD4 count, prophylaxis, txCD4<50, proph azithromycin/clarithromycin, tx
Ventilator-associated pneumonia common organismsgram+ cocci (MRSA, streptococcus); aerobic gram-neg bacilli (pseudomonas, klebsiella, E coli).
CAP and PNA in nursing homes: most common org, txS pneumo, ceftriaxone/cafotaxime +/- vanc, cipro/levo