Term
| an immunocompetent host should receive Abx Tx only d/t a bite from which animal? |
|
Definition
|
|
Term
| what is the empirical Tx of cat bites? |
|
Definition
| one dose of IV ampicillin/sulbactam and the rest PO amoxicillin/clavulonate |
|
|
Term
| what organism can lead to overwhellming sepsis following a dog bite in the asplenic patient? |
|
Definition
| capnocytophaga canimorsus |
|
|
Term
| what is the Tx of a dog bite in the asplenic patient? what is the organism responsible? |
|
Definition
| 3rd generation cephalosporin, capnocytophaga canimorsus |
|
|
Term
| 3 conditions of dog bites where empirical Abx Tx should be given |
|
Definition
| elderly, deep, on the hand |
|
|
Term
| what is the maximal CD4 level underwhich a person can contract bacillary angiomatosis? |
|
Definition
|
|
Term
| what is the Tx of bacillary angiomatosis? |
|
Definition
| azithromycin or doxycyline |
|
|
Term
| how is the Dx of bacillary angiomatosis made? |
|
Definition
|
|
Term
| what is the MCC of culture negative endocarditis? |
|
Definition
|
|
Term
| what are the 2 MC organisms responsible for culture negative endocarditis? |
|
Definition
| Q fever (Coxiella bunetti) and Bartonella |
|
|
Term
| what is the Tx for Bartonella endocarditis? |
|
Definition
| Gentamycin and Doxycycline |
|
|
Term
| what is the empirical Tx for culture negative endocarditis |
|
Definition
| Ceftriaxone and Gentamycin +/- Doxycycline |
|
|
Term
| what are 2 clues for Bartonella Quintana infection? |
|
Definition
| homelessness and body louse |
|
|
Term
| Dx of Bartonella Quintana - 3 step |
|
Definition
1. blood cultures - sensitivity 25%
2. PCR from valvular material |
|
|
Term
| what is the prevalence of dermatologic manifestations among HIV+ patients? |
|
Definition
|
|
Term
| what is the MC dermatologic manifestation in HIV? |
|
Definition
|
|
Term
| Tx for P.Falciparum Malaria 2 lines |
|
Definition
1st line IV Artemisinin
2nd line Doxycycline and Quinine |
|
|
Term
| bacterial vaginosis is associated with acquisition of 4 organisms and 2 adverse outcomes |
|
Definition
HIV, chlamydia, gonorrhea, HSV2
preterm labor, subacute pelvic inflammatory disease |
|
|
Term
| 2 indications of Mefloquine |
|
Definition
1. prophylaxis
2. multi-drug resistant malaria |
|
|
Term
| what is the MCC of aseptic meningitis and how prevalent is it? |
|
Definition
|
|
Term
| what is the MC season to contract aspetic meningitis caused by enteroviruses? |
|
Definition
|
|
Term
| when is it MC to contract aseptic meningitis other caused by viruses other than enteroviruses? |
|
Definition
|
|
Term
| whats the mortality from properly treated Legionella pneumonia in the immunocompetent patient and what is it in the same patient who isn't treated properly? |
|
Definition
|
|
Term
what is the TOC of Legionella pneumonia?
what should you add in severe cases? |
|
Definition
a Macrolide or Quinolone
add Rifampin in severe cases |
|
|
Term
| clinical presentation of Katayama fever - Schistosoma mansonii contracted by bathing in inland rivers (3) |
|
Definition
1. serum sickness like illness - fever arthralgias, headaches
2. eosinophilia
3. 1 or 2 month following travel to the tropics |
|
|
Term
| 3 live-attenuated vaccines CI in the immunocompromised patient |
|
Definition
| oral Typhoid vaccine, smallpox, yellow fever |
|
|
Term
| 3 symptoms of Trichomoniasis in females |
|
Definition
1. vaginal pruritus
2. maloderous discharge
3. dyspareunia |
|
|
Term
| what is the MC symptom of Trichomoniasis in males? what 3 other possible organ-specific infections |
|
Definition
most males are asymptomatic
urethritis, epididymitis, prostatitis |
|
|
Term
| 3 Dx options for Trichomoniasis |
|
Definition
1. most sensitive - direct immunofluorescent antibody detection
2. wet mount to look for mobile forms - sensitivity 60%
3. culture - takes 3-7 days |
|
|
Term
| what is the most sensitive method of Dx Trichomoniasis |
|
Definition
| direct immunofluorescent antibody detection |
|
|
Term
| an important note on Tx of Trichomoniasis |
|
Definition
| all sexual partners must be treated |
|
|
Term
| 4 types of patients at increased risk of developing a severe case of Babesiosis |
|
Definition
1. immunocompetent
2. co-infection with Lyme disease
3. elderly
4. asplenic patients |
|
|
Term
| how is Babesiosis transmitted to humans? |
|
Definition
|
|
Term
| what is the most common manifestation of Babesiosis |
|
Definition
|
|
Term
| what are 4 possible complications of a severe case of babesiosis |
|
Definition
| hemolysis, high output heart failure, renal and pulmonary failure |
|
|
Term
|
Definition
| fever, shaking chills, myalgias, arthralgias |
|
|
Term
| 2 possible characteristics of the fever in Babesiosis |
|
Definition
1. constant at around 40c
2. intermittent |
|
|
Term
| 4 adverse effects of Vericonazole |
|
Definition
visual disturbances
photosensitivity
liver toxicity
drug interactions |
|
|
Term
| what does Voriconazole cover? |
|
Definition
| all species of Candida and Aspergillus |
|
|
Term
| 4 conditions (1 general) that cause Pure Red Cell Aplasia |
|
Definition
parvovirus B19
HIV
lymphoproliferative diseases
post transplantation |
|
|
Term
| what cells does parvo B19 infect |
|
Definition
|
|
Term
| what will the blood smear show on pure red cell aplasia (2)? |
|
Definition
1. normocytic anemia
2. absence of reticulocytes |
|
|
Term
| 3 types of patients at risk of legionella infection and the reason for it |
|
Definition
legionella is an intracellular organism - macrophages present antigens to T cells
so patient with 1. T cell immunodeficiency or innate immune deficiency 2. smokers 3. chronic lung disease are at a greater risk of developing legionella pneumonia |
|
|
Term
| 2 step Tx of cryptococcal meningoencephalitis in the immunocompetent patient |
|
Definition
1. about 10 wks of Tx with IV amphotericin and until clinical improvement, negative CSF cultures, decreasing antigen titer and normal CSF glucose
2. 6-12 months of fluconazole |
|
|
Term
| 3 step Tx of cryptococcal meningoencephalitis in the immunocompromised patient |
|
Definition
1. 2 wks of IV amphotericin
2. 8 wks of fluconazole
3. life long fluconazole prophylaxis ant reduced dose |
|
|
Term
| how is the goal of Cryptococcal meningoencephalitis Tx different in immunocompetent vs. immunocompromised patients |
|
Definition
| cure vs. alleviation of symptoms |
|
|
Term
| 5 infections associated with ataxia-telangiectasia |
|
Definition
| S. pneumoniae, H. influenzae, S. aureus, rubella virus, G. lamblia |
|
|
Term
| 5 immunodeficiencies associated with Mixed T/B disorders |
|
Definition
| ataxia telangiectasia, wiskott-aldrich, common variable hypogammaglobulinemia, severe combined immunodeficiency, x linked hyper IgM syndrome |
|
|
Term
| 3 types of patients may experience an acute infection w/o presenting with fever |
|
Definition
| elderly, liver disease, steroids/NSAIDs |
|
|
Term
| what is the MC etiology of brain abscess |
|
Definition
| polymicrobial - aerobes (strep.) and anaerobes |
|
|
Term
| subdural empyema - entry? etiology? |
|
Definition
| paranasal sinuses. strep./staph. |
|
|
Term
| septic cavernous sinus thrombosis. etiology? |
|
Definition
|
|
Term
| what is the MCC of meningitis in hosts with cell-mediated immune deficiency |
|
Definition
|
|
Term
| 8 factors of poor prognosis in meningitis |
|
Definition
| coma, hypotension, meningitis due to S. pneumoniae, respiratory distress, a CSF glucose level of <0.6 mmol/L (<10 mg/dL), a CSF protein level of >2.5 g/L, a peripheral white blood cell count of <5000/L, and a serum sodium level of <135 mmol/L |
|
|
Term
| MCC of meningitis in adults |
|
Definition
| S.pneumoniae followed by N.meningitides |
|
|
Term
| what % of patients with meningitis have bacteremia |
|
Definition
|
|
Term
| which 3 vaccines may cause Gullian-Barre syndrome a few wks after |
|
Definition
| influenza, meningococc, tetanus |
|
|
Term
| 5 organisms that cause prosthetic valve endocarditis less than 2 months after surgery |
|
Definition
| S. aureus, Coagulase neg Staph, facultative gram-negative bacilli, diphtheroids, and fungi |
|
|
Term
| what % of Coagulase neg staph strains which cause PVE are resistant to methicillin |
|
Definition
|
|
Term
| when does endocarditis occur after implantation of a deffibrilator or pacemaker? which organisms |
|
Definition
| wks. s.aureus, coag neg staph. |
|
|
Term
| 5 unusual organisms that cause left sided endocarditis in IV drug users |
|
Definition
| pseudomonas, candida, Bacillus, Lactobacillus, and Corynebacterium |
|
|
Term
| which organism causes an indolent, culture negative, afebrile form of endocarditis |
|
Definition
|
|
Term
| 2 mechanisms for the formation of nonbacterial thrombotic endocarditis |
|
Definition
| mechanical forces (valvular dysfunction), hypercoagulable states(APLA, malignancy) |
|
|
Term
| which element is required for S.Aureus to invade intact endothelium |
|
Definition
| fibronectin-binding proteins |
|
|
Term
| 3 organisms that cause an indolent course of endocarditis |
|
Definition
| C.Burnetti, T.Wipellii, Bartonella |
|
|
Term
| 6 cardiac complications of endocarditis |
|
Definition
| heart failure, abscesses, intracardiac fistula, pericarditis, coronary emboli/MI, conduction - heart block |
|
|
Term
| 3 risk factors for embolization in endocarditis |
|
Definition
| mitral valve vegitation, vegitation>10 mm, S.Aureus |
|
|
Term
| 5 CNS manifestations in endocarditis |
|
Definition
| stroke, intracranial hemorrhage, seizures, microabscesses, aspetic or purulent meningitis |
|
|
Term
| which mechanism in endocarditis causes renal dysfunction |
|
Definition
| immune complex deposition (and not septic emboli) |
|
|
Term
| 2 typical presenting symptoms in late-onset PVE |
|
Definition
| conduction problems and CHF |
|
|
Term
| how many criteria needed to establish definite Dx of endocarditis |
|
Definition
| 2 major, 1 major + 3 minor or 5 minor |
|
|
Term
| 3 situations where Dx of endocarditis should be rejected |
|
Definition
| alternative diagnosis, symptoms resolve and do not recur with ≤4 days of Abx, or if surgery or autopsy after ≤4 days of Abx yields no histologic evidence of endocarditis |
|
|
Term
| how many criteria (Duke's) required to establish a possible Dx of endocarditis |
|
Definition
| 1 major + 1 minor or 3 minor |
|
|
Term
| 3 conditions for the blood cultures criterion as part of the dukes criteria in case of organisms that may cause endocarditis and bacteremia in the absence of endocarditis |
|
Definition
| 2 positive cultures at least 12 hrs apart or 3 out of 3 first and last at least 1 hr apart or majority of at least 4 first and last at least 1 hr apart |
|
|
Term
| blood culture criteria as part of dukes for typical bacteria that cause endocarditis |
|
Definition
|
|
Term
| according to the dukes criteria of infective endocarditis, which 5 organisms are considered typical (and require only 2 cultures w/o a timeline) |
|
Definition
| Viridans streptococci, Streptococcus gallolyticus (Bovis) , HACEK group, Staphylococcus aureus, Community-acquired enterococci in the absence of a primary focus |
|
|
Term
| what is the major duke criterion for coxiella Burnetti infective endocarditis |
|
Definition
| single blood culture or serology |
|
|
Term
| 4 options for endocardial involvement as a major dukes criterion for infective endocarditis |
|
Definition
| mass, abscess, New partial dehiscence of prosthetic valve or new valvular regurgitation |
|
|
Term
| 5 groups of minor dukes criteria for infective endocarditis |
|
Definition
| fever, predisposition, vascular manifestations, immunologic manifestations, microbiological evidence not fulfilling the major criterion |
|
|
Term
| regarding the minor microbiological evidence criterion in dukes infective endocarditis, which 3 organisms should be excluded even as minor criterion |
|
Definition
| single culture: coag neg staph, and diphtheroids (common culture contaminants) and gram neg bacilli (rarely cause infective endocarditis) |
|
|
Term
| 4 immunologic phenomena considered a minor dukes criterion for infective endocarditis |
|
Definition
| glomerulonephritis, Osler's nodes, Roth's spots, rheumatoid factor |
|
|
Term
| how to obtain blood cultures in a patient with a suspected subacute infective endocarditis who is hemodynamically stable |
|
Definition
| if no prior Abx, 3 sets of cultures, each at least 1 hr apart, within the 1st 24 hours |
|
|
Term
| how to continue when all initial 3 blood cultures are negative after 48-72 hrs? |
|
Definition
| additional 3 sets of cultures and consult the lab |
|
|
Term
| how should blood cultures be taken in suspected acute infective endocarditis or those who are hemodynamically unstable |
|
Definition
| within several hrs, after which empirical Abx treatment will commence immediately |
|
|
Term
| which 5 organisms that may cause infective endocarditis are tough to culture and may require serology |
|
Definition
| Brucella, Bartonella, Legionella, Chlamydophila psittaci, and C. burnetii |
|
|
Term
| what are 5 non-blood culture methods of obtaining microbiological evidence of vegitation in infective endocarditis |
|
Definition
| PCR, direct fluorescence antibody technique, culture of vegitation Bx, microscopic visualization of vegitation Bx, serology |
|
|
Term
| 4 pitfalls of TTE for vegitation in infective endocarditis |
|
Definition
| cannot detect vegitations smaller than 2 mm, technically inadequate in 20% d/t habitus/emphysema, inadequate for prosthetic valves, inadequate for intracardiac complications |
|
|
Term
| what is the sensitivity of TTE in detecting the vegitation in definite infective endocarditis |
|
Definition
|
|
Term
| what is the sensitivity of TEE for vegitations in infective endocarditis |
|
Definition
|
|
Term
| what should be done in a patient who is very likely to suffer infective endocarditis but TEE is negative/ |
|
Definition
|
|
Term
| in suspected infective endocarditis, after initial TTE, in what situations would it be required to perform TEE? |
|
Definition
1. TTE negative but clinical course deteriorates
2. TTE positive and high risk features are identified |
|
|
Term
| 4 findings on TTE that are considered high risk in the evaluation of suspected IE, and require TEE follow up |
|
Definition
| large vegetations, valve insufficiency, paravalvular infection, or ventricular dysfunction |
|
|
Term
| in the evaluation of suspected IE, 2 conditions in which TTE would be sufficient (vs. TEE) |
|
Definition
| low initial patient risk and low clinical suspicion for IE |
|
|
Term
| in the evaluation of suspected IE, 3 conditions in which TEE should be the method of workup |
|
Definition
| high initial risk, high clinical suspicion, difficult imaging candidate |
|
|
Term
| 8 "high initial risk" items which indicate use of TEE in the patient suspected of IE |
|
Definition
new murmur, new ECG changes, new CHF, Prosthetic heart valves
Prior endocarditis
Unrepaired cyanotic congenital heart disease
Completely repaired congenital heart defects during the 6 months after repair,
Valvulopathy developing after cardiac transplantation |
|
|
Term
| what do you do if the initial TEE is negative in the workup of IE? |
|
Definition
| if clinical suspicion remains high, repeat TEE |
|
|
Term
| what do you do if the second TEE is negative in the workup of IE? |
|
Definition
| look for other cause of symptoms |
|
|
Term
| 4 antimicrobial treatment options for penicillin sensitive strep and strep gallolyticus (bovis) induced IE? |
|
Definition
| penicillin G, Ceftriaxone or vancomycin for 4 wks, penicillin G + aminoglycoside for 2+2 wks |
|
|
Term
| 3 antimicrobial treatment options for relatively penicillin resistant strep induced IE |
|
Definition
penicillin G or Ceftriaxone for 4 wks + Gentamycin for 2 wks
vancomycin for 4 wks |
|
|
Term
| 3 antimicrobial treatment options for Moderately penicillin-resistantg streptococci, nutritionally variant organisms, or Gemella morbillorum induced IE |
|
Definition
penicillin G or Ceftriaxone for 6 wks + Gentamycin for 6 wks
vancomycin for 4 wks |
|
|
Term
| 3 antimicrobial treatment options for Enterococci induced IE |
|
Definition
4-6 wks of:
1. vancomycin + Gentamycin
2. Ampicillin + Gentamycin
3. penicillin G + Gentamycin
Gentamycin can be replaced by Streptokinase if not resistant |
|
|
Term
| 4 antimicrobial treatment options for Methicillin-susceptible S. Aureus, infecting native valves (no foreign devices) |
|
Definition
| 4-6 wks of the following: nafcillin, oxacillin, cefazolin, vancomycin |
|
|
Term
| antimicrobial treatment for Methicillin-resistant S.Aureus, infecting native valves (no foreign devices) |
|
Definition
|
|
Term
| 2 antimicrobial treatment options for Methicillin-susceptible S.Aureus, infecting prosthetic valves |
|
Definition
| Nafcillin or Oxacillin for 6-8 wks + Gentamycin for 2 wks + Rifampin for 6-8 wks |
|
|
Term
| antimicrobial treatment for Methicillin-resistant S.Aureus, infecting prosthetic valves |
|
Definition
| Vancomycin and Rifampin for 6-8 wks + Gentamycin for 2 wks |
|
|
Term
| 2 antimicrobial treatment options for HACEK organisms induced IE |
|
Definition
Ceftriaxone for 4 wks or
Ampicillin/sulbactam for 4 wks |
|
|
Term
| what are the MIC values for penicillin susceptible, relatively resistant and moderately resistant strep |
|
Definition
| <0.1, 0.1-0.5, 0.5-0.8, respectively |
|
|
Term
| what should be the treatment in high-level resistance to beta-lactamase enterococci induced IE |
|
Definition
| ampicillin/sulbactam or vancomycin + gentamycin for 4-6 wks |
|
|
Term
| what should be the treatment in high-level resistance to both gentamycin and streptomycin in enterococci induced IE? |
|
Definition
| 8-12 wks of single cell-wall agent - e.g. Ceftriaxone |
|
|
Term
| what should be the treatment in high level resistance to both gentamycin and streptomycin in Enterococci Fecaelis induced IE? |
|
Definition
| high doses of ampicillin combined with ceftriaxone or cefotaxime |
|
|
Term
| what is the treatment of IE resistant to all antimicrobial therapy? |
|
Definition
|
|
Term
| what is the treatment of MRSA induced IE with vancomycin intermediate resistance (MIC 4-16, whether native or prosthetic) |
|
Definition
|
|
Term
| 2 treatment options for Methicillin-susceptible S. aureus endocarditis that is uncomplicated (fever less than 5 days and no multiple pulmonary septic emboli) and limited to the tricuspid or pulmonic valve—a condition occurring almost exclusively in injection drug users |
|
Definition
| 2 wks of nafcillin/oxacillin + Gentamycin |
|
|
Term
| in treatment of Staphylococcal PVE resistant to Gentamycin, what is a good substitute for gentamycine |
|
Definition
| another aminoglycoside or a fluoroquinolone |
|
|
Term
| what is the treatment of candida induced endocarditis |
|
Definition
| amphotericin B plus flucytosine and early surgery with later secondary prophylaxis by an azole |
|
|
Term
| what is the empirical treatment (right after cultures are taken) of infective endocarditis in IV drug users |
|
Definition
|
|
Term
| what is the empirical treatment of culture negative infective endocarditis in a patient w/o prior Abx use? |
|
Definition
| [ampicillin/sulbactam or ceftriaxone+gentamicin] + doxycycline if Bartonella is suspected |
|
|
Term
| 4 drugs that must be included in the empirical treatment of infective endocarditis involving a prosthetic valve inserted over a yr before |
|
Definition
| Vancomycin, gentamicin, cefepime, and rifampin |
|
|
Term
| what are 3 conditions to complete treatment for infective endocarditis in the outpatient setting |
|
Definition
| sterile blood cultures, no fever, and no clinical or echo findings that suggest an impending complication |
|
|
Term
| how many patients experience Abx toxicity or allergy during the treatment of infective endocarditis? when does this usually occur |
|
Definition
|
|
Term
| what should be the monitoring of antimicrobial therapy in IE |
|
Definition
| daily blood cultures until sterile, additional blood cultures if fever re-occurs, repeat 4-6 wks after therapy cessation |
|
|
Term
| when would cultures become sterile in IE caused by viridans streptococci, enterococci, or HACEK organisms? |
|
Definition
|
|
Term
| when would cultures become sterile in IE caused by methicillin susceptible S.Aureus |
|
Definition
|
|
Term
| when would cultures become sterile in IE caused by MRSA |
|
Definition
|
|
Term
| which 2 complications (and in what settings) benefit the most from surgical intervention in the treatment of infective endocarditis |
|
Definition
| NVE complicated by heart failure or myocardial abscess |
|
|
Term
| 6 situations where surgery must be done as part of the treatment of infective endocarditis |
|
Definition
Moderate to severe congestive heart failure due to valve dysfunction
Partially dehisced unstable prosthetic valve
Persistent bacteremia despite optimal antimicrobial therapy
Lack of effective microbicidal therapy (e.g., fungal or Brucella endocarditis)
S. aureus prosthetic valve endocarditis with an intracardiac complication
Relapse of prosthetic valve endocarditis after optimal antimicrobial therapy |
|
|
Term
| 3 indications for Emergent (same day) surgery for IE |
|
Definition
Acute aortic regurgitation plus preclosure of mitral valve
Sinus of Valsalva (aortic sinus) abscess ruptured into right heart
Rupture into pericardial sac |
|
|
Term
| 7 indications for urgent (1-2 days) surgery in IE |
|
Definition
Valve obstruction by vegetation
Unstable (dehisced) prosthesis
Acute aortic or mitral regurgitation with heart failure (NYHA III or IV)
Septal perforation
Perivalvular extension of infection
Lack of effective antibiotic therapy
Major embolus plus persisting large vegetation (>10 mm in diameter) |
|
|
Term
| 3 suggestive clues for perivalvular infection in IE |
|
Definition
| persistent unexplained fever, new ECG disturbances, and pericarditis |
|
|
Term
| 5 indications to consider (not obligated) surgery in IE |
|
Definition
Perivalvular extension of infection
Poorly responsive S. aureus endocarditis involving the aortic or mitral valve
Large (>10-mm diameter) hypermobile vegetations with increased risk of embolism
Persistent unexplained fever (10 days) in culture-negative native valve endocarditis
Poorly responsive or relapsed endocarditis due to highly antibiotic-resistant enterococci or gram-negative bacilli |
|
|
Term
| what is the trend in the consideration of performing surgery for IE in a large unstable vegetation prone to embolize? |
|
Definition
| usually it is not perform solely for this indication but when there is an additional indication for surgery |
|
|
Term
| what is the timing of indicated surgery for IE when neurologic indications are present |
|
Definition
| 3 wks after embolic stroke and 4 wks after cerebral hemorrhage |
|
|
Term
| who has better survival in S.Aureus induced IE, IV drug users or non-IV drug users |
|
Definition
|
|
Term
| who has better survival patients with early onset PVE or late onset? |
|
Definition
|
|
Term
| 6 High-Risk Cardiac Lesions for Which Endocarditis Prophylaxis Is Advised before Dental Procedures |
|
Definition
Prosthetic heart valves
Prior endocarditis
Unrepaired cyanotic congenital heart disease
Completely repaired congenital heart defects during the 6 months after repair
Incompletely repaired congenital heart disease with residual defects adjacent to prosthetic material
Valvulopathy developing after cardiac transplantation |
|
|
Term
| 8 Infections Associated with Vesicles |
|
Definition
| HSV, VZV, Coxsackievirus, smallpox, mullescum contangiosum, ricketssia, S.aureus, GAS |
|
|
Term
| what is the treatment of an animal bite prophylactic to infection |
|
Definition
|
|
Term
| what is the treatment of an animal bite that has developed into infection |
|
Definition
|
|
Term
| what is the treatment of bacillary angiomatosis |
|
Definition
|
|
Term
| what is the treatment of cellulitis (staph or strep) |
|
Definition
|
|
Term
| what is the treatment of necrotizing faciitis (group A strep) |
|
Definition
| clindamycin + penicillin G |
|
|
Term
| what is the treatment of Necrotizing fasciitis (mixed aerobes and anaerobes) |
|
Definition
| clindamycin + ampicillin + ciprofloxacin |
|
|
Term
| what is the treatment of Gas Gangrene (clostridium perfringens) |
|
Definition
| clindamycin + penicillin G |
|
|
Term
| what is the size limit for which over it Furuncles should be surgically drained? |
|
Definition
|
|
Term
| which organism is the MCC of osteomyelitis |
|
Definition
|
|
Term
| which organism is Usually associated with osteomyelitis in foreign material or implants |
|
Definition
|
|
Term
what family of organisms May become resistant to antibiotics during therapy
for osteomyelitis |
|
Definition
| enterobacteriacea (E.Coli, Klebsiella etc.) |
|
|
Term
| what is the MC fungal cause of osteomyelitis |
|
Definition
|
|
Term
| how long should Abx treatment take place in osteomyelitis |
|
Definition
|
|
Term
| when should follow up to determine success of therapy for osteomyelitis take place |
|
Definition
| 6 months after cessation of therapy |
|
|
Term
| primary (spontaneous) bacterial peritonitis is most commonly associated with which underlying disease |
|
Definition
|
|
Term
| what is the most common clinical manifestation of primary bacterial peritonitis |
|
Definition
|
|
Term
| how is the diagnosis of primary bacterial peritonitis done? |
|
Definition
| excluding any primary source of intraabdominal infection with CT and demonstrating over 250 PMNs in the aspirated fluid (doesn't apply to secondary peritonitis) |
|
|
Term
| what are the common organisms that cause primary bacterial peritonitis |
|
Definition
E.coli is the most common
ocassionaly enterococci and strep |
|
|
Term
| what are the common organisms that cause secondary peritonitis |
|
Definition
| mixed flora including anaerobes |
|
|
Term
| what should the treatment of primary bacterial peritonitis cover, what is the treatment |
|
Definition
| gram positive and negative bacteria - 3rd generation cephalosporins |
|
|
Term
| what is the role of secondary prevention in primary bacterial peritonitis |
|
Definition
| 70% of patients develop a second episode of PBP within a year of the first one - use Resprim or ciprofloxacin as secondary prophylaxis |
|
|
Term
| what is the MCC of intraabdominal infection and abscess |
|
Definition
|
|
Term
| what is the MC sign of a liver abscess |
|
Definition
|
|
Term
| 4 organisms requiring a very small inoculum size to cause diarrhea |
|
Definition
| Shigella, enterohemorrhagic Escherichia coli, Giardia lamblia, or Entamoeba |
|
|
Term
| People with blood group O show increased susceptibility to diarrheal disease due to which organisms |
|
Definition
| V. cholerae, Shigella, E. coli O157, and norovirus |
|
|
Term
| in the patient with acute diarrheal disease, blood in stool w/o leukocytes should alert the physician to what organism |
|
Definition
|
|
Term
| Tenesmus (painful rectal spasms with a strong urge to defecate but little passage of stool) in the settings of a acute diarrheal disease may point at what condition? by which organisms? |
|
Definition
| proctatitis - shigellosis or amebiasis |
|
|
Term
| what is the first and second questions a physician should ask himself regarding a patient coming in with acute diarrhea? |
|
Definition
| what is the severity? is it inflammatory or non-inflammatory? |
|
|
Term
| 2 basic methods of determining whether diarrhea is inflammatory or non-inflammatory |
|
Definition
|
|
Term
| 3 lab findings in the stool that suggest inflammatory diarrhea |
|
Definition
| blood, leukocytes, lactoferrin |
|
|
Term
| 2 MCC of travelers diarrhea |
|
Definition
| enterotoxigenic and enteroaggregative strains of E. coli |
|
|
Term
| MCC of diarrhea in children under 2 |
|
Definition
|
|
Term
| which organism has been identified as a cause of antibiotic-associated hemorrhagic colitis |
|
Definition
|
|
Term
| the following 6 organisms that cause diarrhea are more common in children than adults |
|
Definition
| enterotoxigenic, enteropathogenic, and enterohemorrhagic E. coli; Shigella;C. jejuni; and G. lamblia |
|
|
Term
| a patient with a cell-mediated immunodeficiency and diarrhea has an increased probability to be infected with what 3 organisms |
|
Definition
| cryptosporidium, listeria, salmonella |
|
|
Term
| a patient with a hypogammaglobulinemia and diarrhea has an increased probability to be infected with what 2 organisms |
|
Definition
|
|
Term
| which 2 organisms are capable of causing diarrhea within 1-6 hrs of ingestion |
|
Definition
|
|
Term
| which types of foods may be contaminated with S.Aureus to cause food poisoning |
|
Definition
| Ham, poultry, potato or egg salad, mayonnaise, cream pastries |
|
|
Term
| in which type of food would B.Cereus be found when causing diarrhea within 1-6 hrs of ingestion |
|
Definition
|
|
Term
| what is the treatment for traveler's diarrhea with over 2 unformed stools a day or dysentery |
|
Definition
adults: azithromycin or fluoroquinolones
children: azithromycin |
|
|
Term
| what are the components that should be included in oral rehydration solutions per litter of water |
|
Definition
| 2.6 g of sodium chloride, 2.9 g of trisodium citrate, 1.5 g of potassium chloride, and 13.5 g of glucose |
|
|
Term
| what is the effect of Abx therapy on the duration of traveler's diarrheal illness |
|
Definition
| it shortens it from 3 days to 1.5 days |
|
|
Term
| what is a prophylactic treatment for traveler's diarrhea? what are 2 side effects after 3 wks of use |
|
Definition
| Bismuth subsalicylate. darkening of the tongue and tinnitus |
|
|
Term
| when should you obtain stool for WBC examination? |
|
Definition
| when diarrhea occurs for over 24 hrs |
|
|
Term
| when should you obtain stool for parasite examination in the setting of diarrhea? |
|
Definition
| when diarrhea persists for over 10 days |
|
|
Term
| which Abx pose little risk for pseudomembanous colitis |
|
Definition
| Penicillin/-lactamase-inhibitor combinations such as ticarcillin/clavulanate and piperacillin/tazobactam |
|
|
Term
| what % of patients hospitalized for more than 1 wk are colonized by C.difficile? |
|
Definition
|
|
Term
| 6 risk factors for C.difficile infection |
|
Definition
| older age, greater severity of underlying illness, gastrointestinal surgery, use of electronic rectal thermometers, enteral tube feeding, and antacid treatment |
|
|
Term
| what is a protective factor for infection with C.difficile |
|
Definition
| colonization with C.difficile |
|
|
Term
| 2 criteria for the diagnosis of clostridium difficile infection |
|
Definition
| (1) diarrhea (3 unformed stools per 24 h for 2 days) with no other recognized cause plus (2) toxin A or B detected in the stool, toxin-producing C. difficile detected in the stool by polymerase chain reaction (PCR) or culture, or pseudomembranes seen in the colon |
|
|
Term
| which 2 drugs should be avoided in a severe case of pseudomembranous colitis |
|
Definition
| antiperistaltic agents and opiates |
|
|
Term
| which drug is superior in severe pseudomembranous colitis, metronidazole or vancomycin |
|
Definition
|
|
Term
| recurrence of clostridium difficile infection is associated with an increased risk of which 5 complications |
|
Definition
| shock, megacolon, perforation, colectomy, or death within 30 days |
|
|
Term
| how do you diagnose a patient with severe fulminant clostridium difficile infection w/o diarrhea |
|
Definition
|
|
Term
| what is the treatment of fulminant (associated with ileus) clostridium difficile infection |
|
Definition
1. nasogastric tube/enema of vancomycin
2. in no improvement - colectomy |
|
|
Term
| what is the marker that should be observed in medically treated fulminant clostridium difficile infection in order to decide if to progress to colectomy |
|
Definition
|
|
Term
| what is the initial treatment for males with urethritis? |
|
Definition
| IM ceftriaxone + (doxycycline for 7 days or azythromycin) |
|
|
Term
|
Definition
|
|
Term
| what is the treatment of epididymitis? |
|
Definition
| same as urethritis in the male |
|
|
Term
| what is the MC complication of burns |
|
Definition
|
|
Term
| 4 aerobic bacteria implicated in human bites |
|
Definition
| viridans streptococci, S. aureus, E. corrodens, and Haemophilus influenzae |
|
|
Term
| what is the initial treatment of dog, cat, human and monkey bites that develop into an infection? |
|
Definition
| Amoxicillin/clavulanate or ampicillin/sulbactam |
|
|
Term
| which animal bites require prophylaxis even if no infection has developed? |
|
Definition
|
|
Term
| in what transplant setting is there a higher risk of GVHD, sibling or parent |
|
Definition
|
|
Term
| risk of early infection is d/t depleted neutrophils. which type of transplantation carries the highest risk of early infection |
|
Definition
|
|
Term
| what is the prophylactic treatment given during the first month after HSC transplantation |
|
Definition
| Quinolones for gram negative bacteria |
|
|
Term
| what type of bacteria infect during the first few days after HSC transplantation |
|
Definition
| bacteria usually found on the skin, mucosal surfaces and IV catheters |
|
|
Term
| which 5 bacteria are responsible for infection beyond the first few days of neutropenia after HSC transplantation |
|
Definition
| nosocomial bacteria (VRE, Stenotrophomonas maltophilia, Acinetobacter species, and ESBL) and nocardia |
|
|
Term
| which organisms are responsible for infection 6 months after HSC transplantation |
|
Definition
|
|
Term
| the risk for which type of fungus is increased after HSC transplantation with the use of central venous catheters |
|
Definition
|
|
Term
| which is the MC fungal infection 1 wk after HSC transplantation |
|
Definition
|
|
Term
| resprim is given prophylactically for one year after HSC transplantation to protect against which 6 organisms |
|
Definition
| T.gondii, PCP, nocardia, listeria, pneumococc, H.flu |
|
|
Term
| HSV seropositive patients 2 wks after HSC transplantation should receive prophylaxis with acyclovir to prevent which 4 conditions? |
|
Definition
| oral lesions, esophagitis, pneumonia and anogenital lesions |
|
|
Term
| how long after HSC transplantation would herpes zoster occur |
|
Definition
|
|
Term
| what is the treatment of CMV pneumonia in HSC transplant patients |
|
Definition
|
|
Term
| 5 clinical CMV diseases in the post HSC transplant patient |
|
Definition
Associated with graft rejection
Fever, malaise, esophagitis, myalgia
Bone marrow failure
Pneumonitis
Gastrointestinal disease |
|
|
Term
| which CMV disease has the highest mortality in post HSC transplant patients |
|
Definition
|
|
Term
| when does clinical infection with CMV occur post HSC transplantation |
|
Definition
|
|
Term
| 3 clinical manifestations of HHV-6 post HSC transplantation? when does it occur? |
|
Definition
Fever
Delayed monocyte/platelet engraftment
Encephalitis (controversial)
2-4 wks post |
|
|
Term
| 3 clinical manifestations of EBV infection in post HSC transplants |
|
Definition
b cell lymphoproliferative disease
CNS lymphoma
hairy cell leukemia |
|
|
Term
| what is the treatment of b cell lymproliferative disease in the setting of HSC transplantation |
|
Definition
| Rituximab followed by chemotherapy if need be |
|
|
Term
| viruses which cause pneumonia in the post HSC transplant patient |
|
Definition
| CMV, influenza A and B viruses, RSV, parainfluenza virus (types 1–4), adenovirus, enterovirus, bocavirus, human metapneumovirus, coronavirus, and rhinovirus |
|
|
Term
| which 4 rejection phenomena are associated with CMV post solid organ transplantation |
|
Definition
| glomerulopathy in kidney transplant recipients, bronchiolitis obliterans in lung transplant recipients, vasculopathy in heart transplant recipients, and the vanishing bile duct syndrome in liver transplant recipients |
|
|
Term
| 3 infections that occur 1-4 months after Solid Organ Transplantation in the lung |
|
Definition
|
|
Term
| 2 types of infection that occur 6 months after Solid Organ Transplantation in the lung |
|
Definition
| PCP, reactivation of granulomatous disease (Nocardia, TB, Fungal) |
|
|
Term
| 3 infections that occur 1-4 months after kidney transplantation |
|
Definition
|
|
Term
| in which solid organ transplantation is infection with Toxoplasma gondii most prevalent |
|
Definition
|
|
Term
| what infection would occur as of 1 month after heart transplantation |
|
Definition
|
|
Term
| what is the prophylactic treatment given to kidney recipients until 6 months after transplantation |
|
Definition
|
|
Term
| what is the most prevalent infection 1-4 months after kidney transplantation |
|
Definition
|
|
Term
| rare bacteria causing mediastinitis post heart transplantation and its treatment |
|
Definition
| mycoplasma hominis, surgical flap treatment + clindamycin and tetracycline |
|
|
Term
| 4 organisms which cause CNS infection post heart transplantation |
|
Definition
| Listeria, Toxoplasma, Nocardia, and Aspergillus |
|
|
Term
| what prophylactic treatment is given to patients post heart transplantation |
|
Definition
|
|
Term
| 4 clinical signs included in CMV syndrome |
|
Definition
| fever, leukopenia, thrombocytopenia, and hepatic enzyme abnormalities |
|
|
Term
| in which organ transplant is mediastinitis MC after transplantation |
|
Definition
|
|
Term
| what is the most common organism to cause IV catheter site infection |
|
Definition
|
|
Term
| what is the most common organism to cause IV catheter induced bacteremia? |
|
Definition
|
|
Term
| what type of transplantation carries a higher risk of TB reactivation, HSC or SOT |
|
Definition
| solid organ transplantation |
|
|
Term
| when should MMR vaccination be given to patients who undergo HSC transplantation |
|
Definition
| 24 months after transplantation in the absence of GVHD |
|
|
Term
| when should empyema be suspected in a patient with pneumococcal pneumonia |
|
Definition
| when fever, leukocytosis and pleural fluid persist 4-5 days after appropriate therapy |
|
|
Term
| 3 findings on pleurocentesis that indicate the presence of empyema |
|
Definition
| pH<7.1, pus, bacteria seen on microscope |
|
|
Term
| what is the treatment of empyema |
|
Definition
|
|
Term
| which pneumococcal vaccination is used in infants and children, PPV or PCV |
|
Definition
|
|
Term
| what is the leading cause of nosocomial infections |
|
Definition
|
|
Term
| what is the MCC of native joint septic arthritis |
|
Definition
|
|
Term
| what is the leading cause of endocarditis worldwide? |
|
Definition
|
|
Term
| which 3 infections should be excluded by serology in the diagnosis of toxic shock syndrome |
|
Definition
| measles, leptospirosis and rocky mountain spotted fever |
|
|
Term
| 8 systems involved in toxic shock syndrome |
|
Definition
| hepatic, muscular, CNS, renal, hematologic, GI, cardiovascular, skin |
|
|
Term
| what is the hematologic manifestation in toxic shock syndrome |
|
Definition
|
|
Term
| what is the dermatological manifestation of toxic shock syndrome |
|
Definition
| Diffuse macular rash, with desquamation 1–2 weeks after onset (including the palms and soles) |
|
|
Term
| what is the cardiovascular manifestation of toxic shock syndrome |
|
Definition
| hypotension (systolic<90 or orthostatic) |
|
|
Term
| what is the most general finding in toxic shock syndrome |
|
Definition
|
|
Term
|
Definition
| the application of selected medical interventions in a sequence of prescribed steps |
|
|
Term
| 3 popular alternatives vancomycin in the treatment of MRSA |
|
Definition
| quinupristin/dalfopristin, daptomycin, linezolide |
|
|
Term
| which oral agents are effective against skin and soft tissue infection with MRSA |
|
Definition
| clindamycin, resprim, doxycycline, and linezolid |
|
|
Term
| 4 components of treatment for toxic shock syndrome (s.aureus) |
|
Definition
| fluids, vasopressors, clindamycin or linezolid and possibly IVIG |
|
|
Term
| 2 important infections caused by entrococci |
|
Definition
| nosocomial UTI (indwelling catheter), chronic prostatitis in the patient who has undergone GU/GI manipulations |
|
|
Term
| complications of corynebacterium diphtheria infection |
|
Definition
| airway obstruction, pulmonary embolism, polyneuropathy, stroke, myocarditis, renal failure |
|
|
Term
|
Definition
|
|
Term
| what is the role of Abx in diphtheria |
|
Definition
| to prevent transmission to other people |
|
|
Term
| which diagnosis should be considered in all older or chronically ill adults with "aseptic" meningitis |
|
Definition
|
|
Term
| 5 components of tetanus treatment |
|
Definition
| Metronidazole, antitoxin, IV magnesium, benzodiazepines, beta blockers |
|
|
Term
| 2 groups of conditions that predispose to spontaneous gas gangrene (clostridia) |
|
Definition
| GI portal of entery, immunosuppression |
|
|
Term
| MC manifestation of N.meningitides infection |
|
Definition
| asymptomatic colonization in the nasopharynx |
|
|
Term
| which bacteria develops resistance to Abx most rapidly |
|
Definition
|
|
Term
| what is the treament of choice for gonorrhea |
|
Definition
|
|
Term
| what type of arthritis is present in gonococcal arthritis (diffuse gonococcal infection) |
|
Definition
|
|
Term
| 3 etiologies of otitis media in children |
|
Definition
| M. catarrhalis, nontypable H.Flu, pneumococc |
|
|
Term
| what is the MC site of extrapulmonary legionellosis |
|
Definition
|
|
Term
| what is a common test to diagnose legionella pneumophila |
|
Definition
| legionella urine antigen test |
|
|
Term
| what is the chinese name of pertusis |
|
Definition
|
|
Term
| pertusis is implicated in 30% of cough that persists over 2 wks |
|
Definition
|
|
Term
| what is the duration of immunization for the pertussis vaccine |
|
Definition
|
|
Term
| specific lab sign of pertussis in children |
|
Definition
| extremely high lymphocytosis |
|
|
Term
| why is the diagnosis of Bordetella pertussis difficult |
|
Definition
| it has a short window of potential recovery of the organism from the nasopharynx that falls on the catarrhal phase that lacks the typical cough |
|
|
Term
| to which 3 major drugs are ESBL GNB resistant? and what is the treatment |
|
Definition
cephalosporins III, aztreonam, and (in some instances) cephalosporins IV
Tx: Carbapenems |
|
|
Term
| which 3 gram negative organisms most commonly present as ESBL |
|
Definition
| Klebsiella pneumoniae, K. oxytoca, and E. coli |
|
|
Term
| 2 leading causes of neonatal meningitis |
|
Definition
|
|
Term
| 3 conditions usually associated with klebsiella pneumonia |
|
Definition
| alcoholism, diabetes, or chronic lung disease |
|
|
Term
| klebsiella is usually associated with 3 underlying disease |
|
Definition
| alcoholism, diabetes, or chronic lung disease |
|
|
Term
| 3 treatment options for ESBL with carbapenemase (KPC, E.coli) |
|
Definition
| Tigecycline, polymyxin B, and polymyxin E (colistin) |
|
|
Term
| what type of infection is proteus mirabilis most commonly implicated |
|
Definition
| chronically catheterized UTI |
|
|
Term
| what type of infections do enterobacterae generate in general |
|
Definition
| hospital acquired, nosocomial |
|
|
Term
| what is the treatment of serious enterobacter infection resistant to beta lactamase and is ESBL |
|
Definition
| carbapenems, amikacin, and fluoroquinolones |
|
|
Term
| serretia and proteus should not be treated with which antibiotics |
|
Definition
| ampicillin, cephalosporins I, nitrofurantoin, and polymyxin B |
|
|
Term
| 4 clinical conditions in which acinetobacter baumennii must be considered |
|
Definition
| hospital-acquired pneumonia, central line–associated bloodstream infection, posttraumatic wound infection in military personnel returning from Iraq and Afghanistan, and postneurosurgical meningitis |
|
|
Term
| 3 noninvasive methods of determining H.pylori colonization |
|
Definition
| urea breath test, stool examination, serology |
|
|
Term
| what is the method to follow up on eradication of h.pylori and what is important to remember? |
|
Definition
urea breath test
unreliable if performed within 4 weeks of treatment with antibiotics or bismuth compounds or within 2 weeks of the discontinuation of PPIs |
|
|
Term
| p.aeroginosa is most commonly seen in what hospital setting |
|
Definition
|
|
Term
| which clinical manifestation is very specific to bacteremia caused by p.aeroginosa and in which 2 conditions does it exclusively occur |
|
Definition
ecthyma gangrenosum
neutropenia and AIDS |
|
|
Term
| 2 treatment options for all p.aeroginosa infections (except CNS and UTI) |
|
Definition
combination therapy:(Piperacillin/tazobactam, imipenem or meropenem) + amikacin + if in septic shock: aminoglycoside
monotherapy: cefepime (4th generation) |
|
|
Term
| 2 type of infections which are exclusive to iv drug users with pseudomonas |
|
Definition
| vertebral osteomyelitis and infective endocarditis |
|
|
Term
| 2 lifethreatening complications of enteric fever (salmonella) |
|
Definition
| intestinal perforation and GI bleeding |
|
|
Term
| 2 complications of particular importance in shigellosis |
|
Definition
|
|
Term
| 4 typical signs of brucellosis |
|
Definition
| fever, night sweats, monoarthritis (knee or hip) and apathetic |
|
|
Term
| a patient with fever and a limp (monoarthritis) is considered to have what infection in the middle east unless proven otherwise |
|
Definition
|
|
Term
| what is the treatment for brucellosis |
|
Definition
| IM streptomycin for 3 wks + doxycycline for 6 wks |
|
|
Term
| what is the 3 step clinical course of Tularemia |
|
Definition
1. fever, chills
2. ulcer
3. lymphadenopathy/necrosis |
|
|
Term
| what are the MC sites of lymphadenopathy d/t Tularemia in the adult and child |
|
Definition
adult: inguinal
child: cervical |
|
|
Term
| what is the treatment of typical cat scratch disease? |
|
Definition
| not indicated unless extensive lymphadenopathy and then azithromycin |
|
|
Term
| trench fever (Bartonella Quintana) is seen most often in which population |
|
Definition
|
|
Term
| what is the drug of choice for nocardiosis? |
|
Definition
|
|
Term
| 3 clinical features that should raise suspicion to the diagnostically challenging actinomyces |
|
Definition
(1) the combination of chronicity, progression across tissue boundaries, and mass-like features (mimicking malignancy, with which it is often confused);
(2) the development of a sinus tract, which may spontaneously resolve and recur; and
(3) a refractory or relapsing infection after a short course of therapy, since cure of established actinomycosis requires prolonged treatment |
|
|
Term
| 2 predisposing factors to actinomyces head and neck mass |
|
Definition
| radiation therapy and bisphosphonates |
|
|
Term
| what is a clinical clue differentiating anaerobes induced pleuropulmonary infections from strep pneumonia |
|
Definition
|
|
Term
| 6 co-morbidities associated with increased risk of reactivation of TB |
|
Definition
| hiv, diabetes, GI bypass surgery, immunosuppressive therapy, silicosis, chronic renal failure/hemodialysis |
|
|
Term
| what is the MC site of extrapulmonary TB |
|
Definition
|
|
Term
| scrofula, lymph node TB mass, is painless |
|
Definition
|
|
Term
| how do you monitor treatment response in TB |
|
Definition
| monthly sputum cultures - should be clean by 2nd month. if not clear at 3rd month - suspect drug resistance |
|
|
Term
| how to monitor hepatic toxicity during isoniazid treatment for TB |
|
Definition
all patients receive baseline LFTs
elderly, alcoholics and patients with liver disease are monitored monthly
if LFTs increase by 5-6 fold - stop izoniazide until they normalize |
|
|
Term
| adverse effect of pyrozinamide for the treatment of TB |
|
Definition
| hyperuricemia-arthralgia-gout |
|
|
Term
| what should be done in the case of arhtralgia d/t pyrozinamide in the setting of TB treatment |
|
Definition
| treat with aspirin. if gouty arthritis develops - stop pyrozinamide |
|
|
Term
| what is an important side effect of rifampin for the treatment of TB, what should be done in case it presents? |
|
Definition
autoimmune thrombocytopenia
in case - stop rifampin |
|
|
Term
| what is the important side effect of ethambutol for the treatment of TB |
|
Definition
|
|
Term
| what should be done if during treatment for TB cultures don't clear up by 3 months? |
|
Definition
| send drug susceptibility test for all the 1st and 2nd line drugs using the current culture and empirically add at least 2 drugs to the regimen |
|
|
Term
| what is the treatment of TB resistant to both rifampin and Isoniazide (MDR-TB) |
|
Definition
| fluoroquinolone, ethambutol, pyrazinamide, and streptomycin for at least 20 months |
|
|
Term
| what is the treatment of TB resistant to rifampin, isoniazid and streptomycin |
|
Definition
| fluoroquinolone, ethambutol, pyrazinamide, streptomycin and injectable amikacin |
|
|
Term
| 4 second line oral drugs in TB |
|
Definition
| para-aminosalicylic acid, cycloserine, ethionamide, or prothionamide |
|
|
Term
| what is the treatment for TB patients with resistance to all of the first-line agents |
|
Definition
| 4 2nd line drugs where one of them is injectable like amikacin |
|
|
Term
| what is the definition of MDR-TB? |
|
Definition
| resistance to at least rifampin and isoniazid |
|
|
Term
| what is the definition of XDR-TB |
|
Definition
| resistance to at least rifampicin and isoniazid as well as to any member of the quinolone family and at least one of the following second-line anti-TB injectable drugs: kanamycin, capreomycin, or amikacin |
|
|
Term
| how do you treat a pregnant women with TB |
|
Definition
| you exclude pyrazinamide from the standard treatment |
|
|
Term
| what is the standard treatment for TB |
|
Definition
2 months: isoniazid, rifampin, ethambutol and pyrazinamide
4 months: isoniazid and rifampin |
|
|
Term
| how do you treat TB relapse |
|
Definition
| add streptomycin to the standard regimen and treat for 3 months and then continue with izoniazid, rifampin and ethambutol for 5 months |
|
|
Term
| how do you treat TB resistance/intolerance to isoniazide |
|
Definition
| 6 months of rifampin, ethambutol and pyrazinamide |
|
|
Term
| how to treat TB with resistance/intolerance to rifampin |
|
Definition
| 12 to 18 months of isoniazid, ethambutol, pyrazinamide, and a quinolone |
|
|
Term
| what is the treatment of intolerance to pyrazinamide TB |
|
Definition
| isoniazide, rifampin, ethambutol - 2 months and isoniazide and rifampin for 7 months |
|
|
Term
| who should not receive BCG vaccination? |
|
Definition
| HIV patients and children |
|
|
Term
| what is the treatment for latent TB infection |
|
Definition
|
|
Term
| in what 3 conditions is the tuberculin skin test considered positive when over 5 mm |
|
Definition
| fibrotic lesions on CXR, close contacts of TB patients, HIV/immunosuppression |
|
|
Term
| in what 2 conditions is the tuberculin skin test considered positive when over 10 mm |
|
Definition
1. recent infection (2 yrs)
2. high risk medical conditions (5) - DM, Hematologic diseases, IV drug use, ESRD, and clinical situations associated with rapid weight loss |
|
|
Term
| 3 type of patients that should not receive a 6 months instead of a 9 months treatment with isoniazid for latent TB infection |
|
Definition
| HIV, children, signs on CXR |
|
|
Term
| 4 nerves most commonly enlarged in tuberculoid leprosy |
|
Definition
| ulnar, posterior auricular, peroneal, and posterior tibial nerves |
|
|
Term
| in lepratomous leprosy, where can the bacteria be found |
|
Definition
| skin lesions, blood, and anywhere else except the CNS and lungs |
|
|
Term
| 2 reactions to therapy of leprosy |
|
Definition
in BL: type one which includes inflammation of existing skin lesions
in LL: type 2 erythema nodosum leprosum |
|
|
Term
| 2 major complications in leprosy |
|
Definition
| orchitis (infetility), amyloidosis |
|
|
Term
| lepromatous leprosy is associated with hyperglobulinema and may cause which 3 false positive blood tests |
|
Definition
|
|
Term
| for the sake of treatment, leprosy is divided to paucibacillary and multibacillary - what is the distinction |
|
Definition
| patients with 6 or more skin lesions are considered multibacillary |
|
|
Term
| what is the treatment of paucibacillary leprosy |
|
Definition
| daily dapsone and monthly rifampin for 6 months |
|
|
Term
| what is the treatment of multibacillary leprosy |
|
Definition
| daily dapsone and clofazimine and monthly rifampin and clofazimine |
|
|
Term
| what adverse effect limits the use of dapsone in leprosy |
|
Definition
| sulfone syndrome (including high fever, anemia, exfoliative dermatitis, and a mononucleosis-type blood picture) |
|
|
Term
| when is clofazimine unacceptable by the patient for the treatment of leprosy |
|
Definition
| in pale skinned patients b/c it colors the lesions red or black |
|
|
Term
| what is lady windermere's syndrome |
|
Definition
| named after a tall and thin old lady character in one of oscar wilde's novels, is a non-tuberculous mycobaterial lung infection |
|
|
Term
| what is the typical presentation of non-tuberculous mycobacterial lung infection |
|
Definition
| persistent purulent cough for months to years |
|
|
Term
| which non tuberculous micobacteria may produce a lung infection resembeling TB |
|
Definition
|
|
Term
| 4 classical stigmata in congenital syphilis |
|
Definition
| Hutchinson's teeth (centrally notched, widely spaced, peg-shaped upper central incisors), "mulberry" molars (sixth-year molars with multiple, poorly developed cusps), saddle nose, and saber shins |
|
|
Term
| 3 optional criteria for the diagnosis of neurosyphilis |
|
Definition
| examination of CSF for pleocytosis (>5 white blood cells/L), increased protein concentration (>45 mg/dL), or VDRL reactivity |
|
|
Term
| 3 indications for CSF Examination in Adults with All Stages of Syphilis |
|
Definition
Signs or symptoms of nervous system involvement [e.g., meningitis, hearing loss, cranial nerve dysfunction, altered mental status, ophthalmic disease (e.g., uveitis, iritis, pupillary abnormalities), ataxia, loss of vibration sense], or
RPR or VDRL titer 1:32, or
Suspected treatment failure |
|
|
Term
| what is the treatment of primary, secondary and early latent syphilis |
|
Definition
| single dose IM penicillin G |
|
|
Term
| what is the treatment of late latent and tertiary syphilis |
|
Definition
| weekly dose of IM penicillin G for 3 wks |
|
|
Term
| how is efficacy of treatment monitored in syphilis |
|
Definition
| quantitative VDRL or RPR titer for a fourfold decline. early disease at 6 and 12 months and late disease at 6, 12, and 24 months |
|
|
Term
| which marker is most sensitive to neurosyphilis disease activity |
|
Definition
|
|
Term
| what is the major risk factor for leptospirosis |
|
Definition
|
|
Term
| signs/symptoms of leptospirosis |
|
Definition
| conjunctival suffusion (dilated conjunctival blood vessels in the absence of discharge); pharyngeal erythema without exudate; muscle tenderness; rales on lung auscultation or dullness on chest percussion over areas of pleural hemorrhage; rash; jaundice; meningismus; and hypo- or areflexia |
|
|
Term
| 4 typical clincial manifestations of Weil's disease (severe leptospirosis) |
|
Definition
| jaundice, acute kidney injury, hypotension, and hemorrhage |
|
|
Term
| what is the diagnostic mainstay in leptospirosis |
|
Definition
|
|
Term
| what is the average time of relapse in borrelia relapsing fever |
|
Definition
|
|
Term
| diagnosis of borrelia relapsing fever |
|
Definition
| visualization of organism under thick/thin smear microscopy |
|
|
Term
| 4 treatment options for borreliae relapsing fever |
|
Definition
| chloramphenicol, erythromycin, doxycycline and tetracycline |
|
|
Term
| what is the first stage of lyme disease |
|
Definition
| erythema migrans - erythematous expanding lesion with pronounce outer ring and central clearing |
|
|
Term
| manifestations of disseminated (stage 2) lyme disease |
|
Definition
| more erythema migrans lesions, neurological manifestations, cardiologic - AV block, myalgia, arthralgia etc. |
|
|
Term
| manifestations of persistent lyme disease infection (stage 3) |
|
Definition
| frank arthritis - usually involves the knee, chronic neurologic symptoms such as encephalopathy, |
|
|
Term
| what is the range of WBCs found in the aspirated joint affected with arthritis in the patient with persistent (stage 3) lyme disease |
|
Definition
|
|
Term
| what is post lyme syndrome |
|
Definition
| a clinical picture similar to chronic fatigue syndrome present in patients who have recovered from lyme disease |
|
|
Term
| how is the diagnosis of lyme disease made |
|
Definition
| clinical picture and serology |
|
|
Term
| how are serologic tests performed for the diagnosis of lyme disease |
|
Definition
| 2 step: elisa and western blotting |
|
|
Term
| what is the treatment for early lyme disease |
|
Definition
|
|
Term
| what is the initial clinical presentation of rocky mountain spotted fever? |
|
Definition
| first 3 days - flu-like illness |
|
|
Term
| after the flu like symptoms what is the symptom of RMSF that significantly elevates the suspicion during the first week of illness? |
|
Definition
| rash starting at the wrists and ankles spreading to palms and soles and proximally to the trunk |
|
|
Term
| a helpful diagnostic clinical sign of RMSF develops after the rash, no earlier than day 6, in 50% of patients |
|
Definition
|
|
Term
| what are the severe life thretening clinical manifestations of RMSF |
|
Definition
| azotemia, hypovolemia, hypotension, non-cardiogenic pulmonary edema, cardiac involvement - arrythmias, CNS involvement - encephalopathy |
|
|
Term
| when does death occur in RMSF |
|
Definition
8-15 days of onset if untreated
5 days in fulminant type seen in G6PD def |
|
|
Term
| the diagnosis of RMSF is very challenging during the acute phase, what is the most important clue |
|
Definition
| stay at an endemic area in the past 12 days |
|
|
Term
| what is the sensitivity and specificity of the indirect immunofluorescence assay in RMSF? why can't it be used for real time diagnosis |
|
Definition
| above 95%, but its positive no earlier than a week |
|
|
Term
| The only diagnostic test that is useful during the acute illness of RMSF? |
|
Definition
| immunohistologic examination of tissue from punch biopsy of the rash |
|
|
Term
| treatment of rocky mountain spotted fever should commence as early as possible, much before definitive diagnosis. what drugs? |
|
Definition
| doxycycline or tetracycline |
|
|
Term
| what is the typical presentation of Mediterranean spotted fever/Kenya tick typhus/Indian tick typhus/Israeli spotted fever/Astrakhan spotted fever that raises high suspicion |
|
Definition
| fever, rash, and/or a skin lesion consisting of a black necrotic area or a crust surrounded by erythema |
|
|
Term
| what ricketssial disease is endemic to new york city? |
|
Definition
|
|
Term
| what is the first clinical sign of ricketssialpox? |
|
Definition
| 1- to 2.5-cm painless black crusted eschar surrounded by an erythematous halo |
|
|
Term
| in ricketssialpox what clinical signs appear 10-17 days after onset of eschar? |
|
Definition
|
|
Term
| how is endemic typhus (R.prowesekii) transmitted? |
|
Definition
| by the human louse - Pediculus humanus corporis |
|
|
Term
| initial presentation of endemic typus (R.prowazekii) |
|
Definition
| fever, very severe myalgias and typical crouching posture in attempt to alleviate the pain |
|
|
Term
when does rash develop in endemic typhus?
which areas does it not affect? |
|
Definition
usually after 5 days
palms, soles, face |
|
|
Term
| what is a unique clinical manifestation of endemic typhus in comparison to the rest of the ricketssial diseases? |
|
Definition
|
|
Term
| Human Monocytotropic Ehrlichiosis is a very common tick borne disease in the USA with the undifferentiated clinical symptoms of the rest of those diseases. what is most helpful in honing down on this particular disease? |
|
Definition
| Laboratory findings are valuable in the differential diagnosis of HME; 61% of patients have leukopenia (initially lymphopenia, later neutropenia), 73% have thrombocytopenia, and 84% have elevated serum levels of hepatic aminotransferases. Despite low blood cell counts, the bone marrow is hypercellular, and noncaseating granulomas may be present |
|
|
Term
| which organism causes Human Monocytotropic Ehrlichiosis |
|
Definition
|
|
Term
| Human Granulocytotropic Anaplasmosis, a tick borne disease also prevalent in the northeastern USA - has some specific signs that help hone down on it as well? |
|
Definition
| same as in Human Monocytotropic Ehrlichiosis - lab signs of leukopenia, thrombocytopenia and elevated LFTs |
|
|
Term
| what is confusing about the Human Granulocytotropic Anaplasmosis? |
|
Definition
| Many HGA patients develop Lyme disease antibodies in the absence of clinical findings consistent with that diagnosis because they are both carried by the same tick -Ixodes |
|
|
Term
| extrapulmonary manifestations in mycoplasma pneumonia infection usually occur in the absence of lung infection |
|
Definition
|
|
Term
| what is the most significant skin manifestation in mycoplasma pneumonia infection |
|
Definition
| Erythema multiforme major (Stevens-Johnson syndrome) |
|
|
Term
| 3 of the MC neurological manifestations of mycoplasma pneumonia infection |
|
Definition
| encephalitis, Guillain-Barré syndrome, and aseptic meningitis |
|
|
Term
| hematologic manifestations in mycoplasma pneumonia infection |
|
Definition
| hemolytic anemia, aplastic anemia, cold agglutinins, disseminated intravascular coagulation |
|
|
Term
| 7 clinical manifestations in mycoplasma pneumonia infection besides the skin, neurological and hematologic manifestations |
|
Definition
| hepatitis, glomerulonephritis, pancreatitis, myocarditis, pericarditis, rhabdomyolysis, and arthritis |
|
|
Term
| what is the most sensitive and rapid approach to diagnosis of mycoplasma pneumonia respiratory infection? |
|
Definition
| The combination of PCR of respiratory tract secretions and serologic testing |
|
|
Term
| what 2 things should be done in a mycoplasma pneumonia infection empirically appearing to be resistant to macrolides? |
|
Definition
1. culture for sensitivities
2. empirically treat with a non-macrolide |
|
|
Term
| what is the recommended method of diagnosis for urogenital mycoplasma infections in contrast to respiratory infections |
|
Definition
| PCR or culture. serology should not be done |
|
|
Term
| only species of mycoplasma that may cause pyelonephritis |
|
Definition
|
|
Term
| what is the leading infectious cause of preventable blindness in the developing world? |
|
Definition
| ocular trachoma (Chlamydia trachomatis) |
|
|
Term
| what are the rates of asymptomatic chlamydia trachomatis carriers |
|
Definition
|
|
Term
| what serovars of chlamydia trachomatis most commonly cause genital infection |
|
Definition
|
|
Term
| what is the initial clinical manifestations of lymphogranulosa vernerum |
|
Definition
| small painless papule that tends to ulcerate at the site of inoculation - this usually goes un-noticed and is not the most common clinical presentation |
|
|
Term
| what is the most common clinical presentation of lymphogranulosa venerum (chlamydia trachomatis) |
|
Definition
| inguinal syndrome, which is characterized by painful inguinal lymphadenopathy beginning 2–6 weeks after presumed exposure. the overlying skin becomes inflammed. the sign of the groove in not specific nor very common |
|
|
Term
| what is the diagnostic method of choice for lymphogranulosa venerum (chlamydia trachomatis) |
|
Definition
| nucleic acids amplification assay NAATs |
|
|
Term
| what is the recommended site from which to attain specimens for diagnosis via NAAT in chlamydia trachomatis suspected patients |
|
Definition
| self administered vaginal swabs for females and urine samples for males |
|
|
Term
| what is the test of cure method in chlamydia trachomatis? and when should it be done |
|
Definition
| NAATs. should be done 3 weeks after cessation treatment b/c nucleic acids persist later than the actual organism |
|
|
Term
| what is the initial presentation of trachoma (ocular chlamydia trachomatis) |
|
Definition
| conjunctivitis characterized by small lymphoid follicles in the conjunctiva |
|
|
Term
| what is the more progressive presentation of trachoma |
|
Definition
inflammatory leukocytic infiltrations and superficial vascularization (pannus formation) of the cornea
conjunctival scarring eventually distorts the eyelids, causing them to turn inward so that the lashes constantly abrade the eyeball |
|
|
Term
| what is the reason that Communities with blinding trachoma often experience seasonal epidemics of conjunctivitis |
|
Definition
| concurrent infection with H.Flu intensify the inflammatory process |
|
|
Term
| 3 clinical manifestation that are potentially fatal in chlamydia psitacci |
|
Definition
| Endocarditis, hepatitis, and neurologic complications |
|
|
Term
| helpful finding on physical examination of suspected chlamydia psitacci |
|
Definition
|
|
Term
| gold standard diagnosis of chlamydia psitacci |
|
Definition
| microimmunofluorescence > 1:16 |
|
|
Term
| what unrelated medical condition has been found to be associated with Chlamydia pneumonia infection |
|
Definition
|
|
Term
| what is the correct way of performing serology for different infections? |
|
Definition
| demonstration of a fourfold rise in titer in paired (meaning both IgG and IgM) serum samples |
|
|
Term
| what is common about the clinical presentation of both chlamydia pneumonia and mycoplasma pneumoniae - pneumonias |
|
Definition
| leukocytosis is frequently lacking and patients often have prominent antecedent upper respiratory tract symptoms, fever, nonproductive cough, mild to moderate illness, minimal findings on chest auscultation, and small segmental infiltrates on chest x-ray |
|
|
Term
| what is the clinical impact of Zanamivir and Oseltamivir for the treatment of influenza A and B |
|
Definition
| When started within 2 days of onset in uncomplicated disease, zanamivir and oseltamivir reduce symptom duration by 1.0–1.5 and 1.3 d, respectively |
|
|
Term
| which drugs may be used for the prevention of influenza a and b |
|
Definition
| zanamivir and oseltamivir |
|
|
Term
| which virus is more likely to reactivate, HSV-1 or HSV-2? |
|
Definition
| HSV-2 - meaning genital symptoms of herpes recur more often than orolabial ones |
|
|
Term
| what is the most common 1st episode clinical manifestation of HSV-1 infection |
|
Definition
| pharyngitis and gingivostomatitis |
|
|
Term
| what is the most recurrent clinical manifestations of HSV-1 infections |
|
Definition
|
|
Term
|
Definition
| HSV (1 or 2) infection of the finger |
|
|
Term
| what is most the common cause of corneal blindness in the United States |
|
Definition
|
|
Term
| what is the diagnosis of HSV encephalitis vs. meningitis |
|
Definition
encephalitis: PCR for HSV DNA in CSF only
meningitis: HSV antibodies in CSF or PCR for HSV DNA in CSF |
|
|
Term
| which type of HSV is associated with encephalitis and which type with meningitis |
|
Definition
HSV-1 with encephalitis
HSV-2 with meningitis |
|
|
Term
|
Definition
|
|
Term
| visceral HSV infection of which 3 organs may occur w/o viremia? |
|
Definition
|
|
Term
| when are patients with chickenpox (VZV) infectious |
|
Definition
| 48 hrs before rash and until all vesicles have crusted |
|
|
Term
| what is the incubation time of VZV chickenpox |
|
Definition
|
|
Term
| which patients are likely to have more vesicles in chickenpox |
|
Definition
| older, secondary family members with the disease, immunocompromised |
|
|
Term
| what is the most common complication of chickenpox VZV? |
|
Definition
| bacterial skin superinfection |
|
|
Term
| what is the most common extracutaneous complication of chickenpox |
|
Definition
| CNS involvement - encephalopathy 0.1% of cases - no need for treatment |
|
|
Term
| what is the most dangerous complication of chickenpox in adults? |
|
Definition
| varicella pneumonia - 20% of cases |
|
|
Term
| which dermatomes are most frequently involved in herpes zoster |
|
Definition
|
|
Term
| VZIG to prevent VZV infection - who should it be given to and when |
|
Definition
had exposure: immunocompromised children, pregnant women, premies
give within 96 hrs of exposure |
|
|
Term
| who should receive treatment for VZV and for how long |
|
Definition
over 24 hrs of symptoms
give for 5-7 days |
|
|
Term
| where is the lymphadenopathy in EBV mononucleosis most prominent |
|
Definition
|
|
Term
| what is an early manifestation of HIV caused by EBV |
|
Definition
| hairy leukoplakia (on the tongue) |
|
|
Term
| how is the diagnosis of EBV mononucleosis made |
|
Definition
| clinical presentation + heterophile antibody test at least 1:44 positive + atypical lymphocytes on blood smear |
|
|
Term
| what is the sensitivity of the heterophile antibody test for EBV mono? |
|
Definition
first wk - 40%
2nd wk - 90% |
|
|
Term
| how is the monospot in comparison to the heterophile antibody test? |
|
Definition
| more sensitive and specific |
|
|
Term
| 4 conditions that may cause false positive results in the monospot for EBV |
|
Definition
| connective tissue disease, lymphoma, viral hepatitis, and malaria |
|
|
Term
| EBV specific serology is used in what cases of suspected EBV infection |
|
Definition
| atypical presentation or very typical presentation with negative heterophile antibody test |
|
|
Term
| when does EBNA seroconversion (development of EBNA antibodies) during the course of acute infectious mononucleosis |
|
Definition
|
|
Term
| 4 uses of prednisone in the treatment of infectious mononucleosis EBV |
|
Definition
| severe tonsillar hypertrophy, for autoimmune hemolytic anemia, for hemophagocytic lymphohistiocytosis, and for severe thrombocytopenia |
|
|
Term
| what is the treatment of oral hairy leukoplakia |
|
Definition
|
|
Term
| who is susceptible to congenital cmv infection? 3 MC manifestations |
|
Definition
newborns to mothers who have been infected during pregnancy.
Petechiae, hepatosplenomegaly, and jaundice |
|
|
Term
| 2 major complications occurring in children who were infected with CMV during pregnancy |
|
Definition
| hearing loss and intellectual deficiency |
|
|
Term
| what is the MC presentation of newborns who are infected with CMV perinataly |
|
Definition
|
|
Term
| what are the laboratory findings in CMV mononucleosis |
|
Definition
| atypical lymphocytes (no heterophile antibodies) |
|
|
Term
| what is the most sensitive method to detect CMV in body fluids |
|
Definition
|
|
Term
| what is the treatment of gancyclovir-resistant CMV |
|
Definition
|
|
Term
| when does Molluscum contagiosum usually regress |
|
Definition
|
|
Term
| 3 manifestation of B19 in adults |
|
Definition
| transient aplastic crisis, red cell aplasia, polyarthropathy syndrome |
|
|
Term
| diagnosis of B19 infection |
|
Definition
|
|
Term
| conditions that may cause false positive results in ELISA for HIV |
|
Definition
| antibodies to class II antigens (such as may be seen following pregnancy, blood transfusion, or transplantation), autoantibodies, hepatic disease, recent influenza vaccination, and acute viral infections |
|
|
Term
| in western blot for HIV what increases the suspicion that one might be dealing with a false positive test? |
|
Definition
| absence of the gp31 antigen b/c half of the positives who lack this antigen are actually false positives |
|
|
Term
| who is considered negative on western blot and who is considered positive |
|
Definition
negative - doesn't have any of the antigens
positive has at least 2 of the 3 antigens tested |
|
|
Term
| who is considered ideterminate on western blot for HIV |
|
Definition
| not positive nor negative - one antigen positive - usually d/t cross reactivity |
|
|
Term
| what do you do with a patient who is HIV positive on western blot but doesn't have antibodies to gp31? |
|
Definition
| obtain additional confirmation with an RNA-based test for HIV-1 and/or a follow-up Western blot |
|
|
Term
| what do you do with an indeterminate result on ELISA for HIV |
|
Definition
| repeat the test twice more and if negative in those time - assume negative |
|
|
Term
| does everyone get a confirmation test with western blot for HIV? |
|
Definition
| no people with negative results on ELISA and no clinical reason to suspect HIV don't |
|
|
Term
| what is the fastest HIV test out there |
|
Definition
OraQuick HIV-1 antibody test that can be run on blood or saliva
takes up to an hr to get results with very high sensitivity (negative result r/o infection) |
|
|
Term
| what % of HIV + patients present with an acute illness? how long after infection? |
|
Definition
| 50-70%, 3-6 wks after infection |
|
|
Term
| what is the median duration of the asymptomatic latent period of HIV infection |
|
Definition
|
|
Term
| what is the average decline in CD4 in HIV |
|
Definition
|
|
Term
| what is the CD4 threshold of cryptococcus neoformans infections in HIV |
|
Definition
|
|
Term
| what is the prophylaxis for cryptococcus neoformans and coccidiodomycosis immitis |
|
Definition
|
|
Term
| histoplasma capsulatum appears under what cd4? what is the prophylaxis |
|
Definition
|
|
Term
| what is the CD4 threshold for bartonella infection in HIV |
|
Definition
|
|
Term
| what is the CD4 threshold for CMV infection in HIV |
|
Definition
|
|
Term
| 5 vaccinations recommended to HIV patients |
|
Definition
| HBV, HAV, influenza, HPV, strep pneumoniae |
|
|
Term
| 2 infections in HIV that are recommended secondary prophylaxis |
|
Definition
| Herpes Simplex and candida |
|
|
Term
| 4 bacteria that cause pneumonia in HIV at increased numbers in comparison with the general population |
|
Definition
| s.pneumonia, h.flu, s.aureus, p.aeruginosa |
|
|
Term
| pneumonia in hiv usually occurs at what CD4? |
|
Definition
|
|
Term
| what is the recommended prevention of pneumonia in HIV |
|
Definition
| vaccination to s.pneumonia best given at CD4>200 and every 5 yrs. if CD4 below this should be repeated when above it |
|
|
Term
| what happens to the incidence of pneumonia when patients with HIV quit smoking |
|
Definition
|
|
Term
| what is the MCC of pneumonia in HIV |
|
Definition
|
|
Term
| what is the most common finding on CXR of a patient with PCP d/t HIV |
|
Definition
| normal or delicate bilateral interstitial infiltrates |
|
|
Term
| when should HIV + patients with PCP receive glucocorticoid therapy in conjunction with their Abx? |
|
Definition
| when PaO2<70% or A-a gradient>35 |
|
|
Term
| indications for PCP prophylaxis |
|
Definition
| CD4<200, history of PCP, unexplained fever for >2 weeks, and any patient with a history of oropharyngeal candidiasis |
|
|
Term
| condition for discontinuing primary and secondary prophylaxis for PCP in HIV |
|
Definition
| suppression of HIV (<50 copies per milliliter) and CD4+ T cell counts >200/L for 3–6 months |
|
|
Term
| what is the median CD4 of patients with HIV presenting with TB |
|
Definition
|
|
Term
| in the treatment of TB in HIV + patients what is the only change made from non-HIV patients |
|
Definition
| Rifabutin instead of Rifampin for patients on protease inhibitors or non-nucleoside reverse transcriptase inhibitors |
|
|
Term
| how do you treat a patient who presents simultaneously with TB and HIV |
|
Definition
| start TB treatment and 2-8 wks later start ART. otherwise patient has an increased risk of suffering immune reconstitution inflammatory syndrome |
|
|
Term
| what is the treatment of HIV patients with a PPD of over 5 mm or an IFN positive test? |
|
Definition
| isoniazid and pyridoxine for 9 months |
|
|
Term
| what is the treatment of MAC in HIV |
|
Definition
| ethambutol and clarithromycin |
|
|
Term
| 3 organisms that may cause a pulmonary infection in HIV - less mentioned in HIV |
|
Definition
| cryptococcus, coccidiodes immitis, aspergillosis |
|
|
Term
| what is a form of clinically insignificant pulmonary condition in HIV |
|
Definition
| lymphoid idiopathic pneumonitis - 1% of untreated cases |
|
|
Term
| what is the MCC cardiovascular manifestation in HIV |
|
Definition
|
|
Term
| which 2 oropharyngeal conditions are indicative of a significant immunologic decline in HIV |
|
Definition
| candidiasis and oral hairy leukoplakia. CD4<300, 59% develop AIDS within the year |
|
|
Term
| how is the diagnosis of oral candidiasis made in HIV? |
|
Definition
| direct examination of hyphae from sampled tissue (not culture - may be positive w/o disease) |
|
|
Term
| where does oral candidiasis begin in the mouth of the HIV patient |
|
Definition
|
|
Term
| oral hairy leukoplakia isn't premalignant |
|
Definition
|
|
Term
| what is an effective treatment of aphthous oral lesions in HIV |
|
Definition
|
|
Term
| esophagitis in HIV may be due to which 3 organisms |
|
Definition
|
|
Term
| 2 bacteria that cause GI infections seen more often in HIV patients |
|
Definition
|
|
Term
| 3 of the MC opportunistic protozoa that infect the GI tract and cause diarrhea in HIV-infected patients |
|
Definition
| Cryptosporidia, microsporidia, and Isospora belli |
|
|
Term
| how is the diagnosis of cryptosporidium diarrhea in the HIV infected patients made? |
|
Definition
| intestinal biopsy - noninflammatory, oocysts that stain with acid-fast |
|
|
Term
| 3 risk factors of obtaining a cryptosporidial GI infection in HIV |
|
Definition
| human and animal feces, untreated water from lakes or rivers, eating raw shellfish |
|
|
Term
| 3 organisms cause biliary disease in HIV |
|
Definition
|
|
Term
| how is the diagnosis of microsporidia GI infection in HIV made |
|
Definition
first, chromotrope-based stains of stool samples viewed under light microscopy
confirmation with electron microscopy |
|
|
Term
| what is the most effective treatment of microsporidia in HIV |
|
Definition
|
|
Term
| how do you treat isospora bellii GI infection in HIV |
|
Definition
|
|
Term
| viral cause of diarrhea in the untreated HIV patient? treatment? |
|
Definition
|
|
Term
| what is the first step (out of 3) in the diagnosis of diarrhea in HIV |
|
Definition
| stool examinations, including culture, examination for ova and parasites, and examination for Clostridium difficile toxin |
|
|
Term
| what is the second step (out of 3) in the diagnosis of diarrhea in HIV when stool examination was unrevealing |
|
Definition
|
|
Term
| what is implied by a non-revealing endoscopy in the diagnosis of diarrhea in HIV |
|
Definition
| HIV enteropathy (if symptoms have been persistent throughout at least a month) |
|
|
Term
| what are the rates of HIV co-infection with HCV in IV drug users in the USA? |
|
Definition
|
|
Term
| what is the effect of HIV on the co-infection of HBV |
|
Definition
| 3 fold decrease in inflammatory hepatitis |
|
|
Term
| what is an effective treatment of HBV co-infected with HIV? what's not? |
|
Definition
|
|
Term
| which virus that co-infects with HIV in 50% of HIV patients is associated with a decrease in progression to AIDS? |
|
Definition
|
|
Term
| which drug for the treatment of HIV has been associated with fulminant hepatitis, necrosis and failure |
|
Definition
|
|
Term
| what % of untreated HIV infected patients have microalbuminuria |
|
Definition
|
|
Term
| HIV associated nepropathy (HIVAN) - 3 treatment options, CD4? |
|
Definition
ART, ACEi, prednisone
CD4<200 usually |
|
|
Term
| 6 drugs for the treatment of HIV that may cause renal damage |
|
Definition
| pentamidine, amphotericin, adefovir, cidofovir, tenofovir, and foscarnet |
|
|
Term
|
Definition
| an ulcerating lesion of the skin caused by necrotizing vasculitis in patients with HIV co-infected with syphillis |
|
|
Term
| how is the diagnosis of syphilis made in a patient with HIV |
|
Definition
|
|
Term
| 5 endocrine abnormalities seen in lypodistrophy syndrome in HIV |
|
Definition
| elevations in triglycerides, total cholesterol, apolipoprotein B, hyperinsulinemia and hyperglycemia |
|
|
Term
| typical habitus changes in lypodystrophy syndrome of HIV |
|
Definition
| central obesity with peripheral wasting especially the face and buttocks, prominent veins in legs and buffalo hump |
|
|
Term
| what is the etiology of lypodystrophy seen in HIV |
|
Definition
|
|
Term
| what 6 factors are associated with an increased risk of osteonecrosis and avascular necrosis in HIV |
|
Definition
| lipid-lowering agents, systemic glucocorticoids, or testosterone; bodybuilding exercise; alcohol consumption; and the presence of anticardiolipin antibodies |
|
|
Term
| which ART drug may cause hypokalemia |
|
Definition
|
|
Term
| which ART drug can cause iatrogenic cushing's syndrome |
|
Definition
|
|
Term
| why are immediate hypersensitivity reactions more prevalent in HIV patients |
|
Definition
| as the CD4 drops the IgE increases |
|
|
Term
| which drug is associated with the most common allergic reaction in HIV |
|
Definition
|
|
Term
| which is the only ART drug that may not be reinstituted in HIV after an immediate hypersensitivity reaction has occured because of fatal outcomes |
|
Definition
|
|
Term
| what is the association of HIV with autoimmune diseases and autoimmune serology |
|
Definition
| less autoimmune disease (except for a sjogren-like disease called " diffuse infiltrative lymphocytosis syndrome"), but more commonly found serology |
|
|
Term
| what is the difference btwn the sjogren like syndrome of HIV, called "diffuse infiltrative lymphocytosis syndrome", and the real Sjogren's syndrome |
|
Definition
| in the sjogren like syndrome of hiv CD8 cells invade the salivary glands. where as in Sjogren syndrome it is CD4 cells |
|
|
Term
| what % of patients with HIV have some form of reactive arthritis or any other spondyloarthropathy |
|
Definition
|
|
Term
| what % of patients with HIV experience arthralgias |
|
Definition
|
|
Term
| what is "painful articular syndrome" in HIV |
|
Definition
| sudden monoarthralgia in the knee, hip or shoulder that lasts for 2-24 hours. 10% incidence in HIV |
|
|
Term
| what % of HIV infected patients started on ART experience immune reconstitution inflammatory syndrome? which ones are more susceptible? |
|
Definition
| 30%, those who start treatment with CD4<50 |
|
|
Term
| 5 conditions that cause bone marrow suppression in HIV infected patients |
|
Definition
HIV infection
Mycobacterial infections
Fungal infections
B19 parvovirus infection
Lymphoma |
|
|
Term
| 9 drugs that may cause bone marrow suppression in the treatment of HIV |
|
Definition
Zidovudine
Dapsone
Trimethoprim/sulfamethoxazole
Pyrimethamine
5-Flucytosine
Ganciclovir
Interferon
Trimetrexate
Foscarnet |
|
|
Term
| regarding lymphadenopathy how is it predictive of progression of HIV |
|
Definition
| when it is associated with HIV itself it does not predict progression, but when it remits w/o ART this is predictive of progression |
|
|
Term
| 4 conditions in the DD of lymphadenopathy in an HIV infected patient with a cd4>200 |
|
Definition
| KS, TB, Castleman's disease, and lymphoma |
|
|
Term
| 4 additional causes of lymphadenopathy in the hiv infected patient |
|
Definition
| atypical mycobacterial infection, toxoplasmosis, systemic fungal infection, or bacillary angiomatosis |
|
|
Term
| 3 indications for performing a lymph node biopsy in the case of lymphadenopathy in the HIV infected patient |
|
Definition
| cd4<200, associated B symptoms, become fixed or coalesce |
|
|
Term
| MGUS is seen in 3% of patients with HIV and is usually associated with the 3 following conditions |
|
Definition
| viral infections, non-Hodgkin's lymphoma, and plasma cell malignancy |
|
|
Term
| what is a laboratory sign associated with the anemia concurrent with zidovudine treatment in HIV |
|
Definition
|
|
Term
| what is the MC hematologic manifestation of HIV? |
|
Definition
|
|
Term
| what type of anemia in HIV infected patients is associated with poorer prognosis? |
|
Definition
| anemia that has no underlying cause but the HIV infection itself |
|
|
Term
| what is the treatment of anemia associated with parvovirus B19 infection in patients with HIV |
|
Definition
|
|
Term
| dvt is more prevalent in HIV. 4 risk factors amongst hiv patients |
|
Definition
| age over 45, history of an opportunistic infection, lower CD4 count, and estrogen use |
|
|
Term
| which skin condition is seen in 3% of the general population and in 50% of HIV infected patients |
|
Definition
|
|
Term
| what dermatological side effects are associated with the use of zidovudine |
|
Definition
| elongation of the eyelashes and bluish discoloration of the nails |
|
|
Term
| what side effects are associated with the use of clofazimine (leprosy) |
|
Definition
| orange discoloration of the skin and urine |
|
|
Term
| what % of patients with HIV on ART can be shown to suffer at least mild-to-moderate neurocognitive deterioration |
|
Definition
|
|
Term
| 4 CSF finding that (at least one of them) occur in virtually all HIV patients |
|
Definition
| pleocytosis (50–65% of patients), detection of viral RNA (75%), elevated CSF protein (35%), and evidence of intrathecal synthesis of anti-HIV antibodies (90%). |
|
|
Term
| HIV dementia can be earliest seen in what levels of CD4 |
|
Definition
|
|
Term
| what are the symptoms of HIV dementia/encephalopathy? |
|
Definition
| unlike alzheimer's (agnosia, anomia): impaired ability to concentrate, increased forgetfulness, difficulty reading, or increased difficulty performing complex tasks, motor and behavioral |
|
|
Term
| extra caution is needed in treating HIV infected patients with which psychiatric medications |
|
Definition
| neuroleptics - more sensitive to extrapyramidal side effects |
|
|
Term
| seizures in HIV occur most frequently with what concurrent infection |
|
Definition
|
|
Term
| standard treatment of toxoplasma CNS infection |
|
Definition
| sulfadiazine and pyrimethamine |
|
|
Term
| what concurrent infection does myelpathy and polyradiculopathy indicate in HIV |
|
Definition
|
|
Term
| The most common peripheral neuropathy in patients with HIV infection |
|
Definition
| distal sensory polyneuropathy (DSPN) also referred to as painful sensory neuropathy (HIV-SN), predominantly sensory neuropathy, or distal symmetric peripheral neuropathy |
|
|
Term
| 2 risk factors to HIV painful neuropathy |
|
Definition
| older age, taller stature |
|
|
Term
| what is The most common abnormal findings on funduscopic examination in HIV patients |
|
Definition
|
|
Term
| what is the difference btwn the ophthalmologic manifestations of CMV and those of VZV and HSV |
|
Definition
| CMV retinitis is painless, where as the other two cause painful retinitis |
|
|
Term
| what is generalized wasting in HIV |
|
Definition
| involuntary weight loss of >10% associated with intermittent or constant fever and chronic diarrhea or fatigue lasting >30 days in the absence of a defined cause other than HIV infection |
|
|
Term
| what 3 malignancies are considered to be AIDS defining |
|
Definition
| Kaposi, non-hodgkin's and cervical |
|
|
Term
| which AIDS defining malignancy did not show decrease incidence d/t the progress made in ART |
|
Definition
|
|
Term
| 2 forms of involvement of Kaposi sarcoma in the GI |
|
Definition
1. mucosal - bleeding obstruction
2. biliary disease |
|
|
Term
| 4 MC systems involved in Kaposi sarcoma |
|
Definition
| skin, the lymph nodes, GI tract, and lung |
|
|
Term
| what % of patients with Kaposi's sarcoma die of it? |
|
Definition
|
|
Term
| treatment approach to Kaposi sarcoma |
|
Definition
| people usually don't die of the disease so only very debilitating conditions should be treated like dysphagia, lesions over joints etc. |
|
|
Term
| what is the treatment of Kaposi sarcoma refractory to ART with single or limited number of lesions |
|
Definition
Radiation
Intralesional vinblastine
Cryotherapy |
|
|
Term
| what is the initial and subsequent treatment of extensive Kaposi sarcoma |
|
Definition
Interferon (if CD4+ T cells >150/ L)
Liposomal daunorubicin
Liposomal doxorubicin
Paclitaxel |
|
|
Term
| what % of AIDS patients develop lymphoma |
|
Definition
|
|
Term
| what is the MC type of lymphoma in AIDS patients accounting for 60% of cases |
|
Definition
|
|
Term
| Prevention of maternal-fetal HIV transmission |
|
Definition
| In pregnant women with CD4+ T cell count 200/L, AZT PO beginning at weeks 14–34 of gestation plus IV drug during labor and delivery plus PO AZT to infant for 6 weeks decreased transmission of HIV by 67.5% (from 25.5% to 8.3%) |
|
|
Term
| 11 side effects of zidovudine |
|
Definition
| Anemia, granulocytopenia, myopathy, lactic acidosis, hepatomegaly with steatosis, headache, nausea, nail pigmentation, lipid abnormalities, lipoatrophy, hyperglycemia |
|
|
Term
| 3 NRTIs that may cause flare up of HBV in co-infected patients on cessation of treatment |
|
Definition
| Tenofovir, Lamuvidine, Emtricitabine |
|
|
Term
| 3 NRTIs associated with peripheral neuropathy |
|
Definition
| didanosine, zalcitabine, stavudine |
|
|
Term
| 4 ART drugs (3 NRTIs + 1 PI) that cause pancreatitis |
|
Definition
| didanosine, zalcitabine, stavudine, ritanovir (Kaletra) |
|
|
Term
| 3 ARTs that may cause hypersensitivity reaction |
|
Definition
| Abacavir, Enfuvirtide, Etravirine |
|
|
Term
| ART which cause skin rash |
|
Definition
| all NNRTIs, Abacavir, Amprenavir Atazanavir, Tipranavir, Darunavir, Maraviroc |
|
|
Term
| in ART - how do you distinguish according to the name btwn NRTI, NNRTI, protease inhibitors and integrase inhibitors |
|
Definition
NRTI - vir in end of name
NNRTI - vir in middle of name
protease inhibitors - navir in end of name
integrase inhibitors - tegravir in end of name |
|
|
Term
| which ARTs have no effect over HIV-2 at all? |
|
Definition
| NNRTIs, enfuvirtide, variable sensitivity to protease inhibitors |
|
|
Term
| fever in viral gastroenteritis is common with which 2 viruses |
|
Definition
|
|
Term
| what is the MCC of mild gastroenteritis in adults |
|
Definition
|
|
Term
| what is the MCC of gastroenteritis in children |
|
Definition
|
|
Term
| what is the MCC of aseptic meningitis |
|
Definition
|
|
Term
what is pleurodynia (Bornholm disease)?
what is the etiology? |
|
Definition
Paroxysms of severe, knifelike pleural (chest) pain usually last 15–30 min and are associated with diaphoresis and tachypnea
etiology: Coxsackie B |
|
|
Term
| what is the leading cause of exanthems in children |
|
Definition
|
|
Term
| what is the cause of hand-foot-and-mouth disease |
|
Definition
| Coxsackie virus (an enterovirus) |
|
|
Term
| what is herpangina? what is the cause? |
|
Definition
fever, sore throat, odynophagia, and grayish-white papulovesicular lesions on the soft palate, anterior pillars of the tonsils, and uvula
Coxsackievirus A |
|
|
Term
| which 3 organisms cause hemorrhagic conjunctivitis? |
|
Definition
| chlamydia trachomatis, adenovirus, enterovirus |
|
|
Term
| what's special about the hemorrhagic conjunctivitis caused by enteroviruses |
|
Definition
| acute onset and quick remission |
|
|
Term
| what is the temporal relation btwn the koplik spots and the rash in measles |
|
Definition
| koplik spots appear 2 days before the rash |
|
|
Term
| 3 elements in the clinical diagnosis of measles |
|
Definition
1. fever over 38.3
2. diffuse rash
3. cough, coryza, or conjunctivitis |
|
|
Term
| how is the laboratory diagnosis of measles made |
|
Definition
| serology - IgM rises - detectable 4 days after onset of rash |
|
|
Term
| what is the treatment of measles |
|
Definition
| Vit A given on day 1 and 2 of the disease |
|
|
Term
| 2 MC bacterial complications of measles infection |
|
Definition
| strep pneumonia and H.flu causing bronchpneumonia and otitis media |
|
|
Term
| what is a treatment given to people who have been exposed to measles? what is its significance |
|
Definition
| human immunogloblunis which if given within 72 hrs of exposure will prevent clinical manifestations and if withing 6 days will attenuate them |
|
|
Term
| 4 groups of complications seen in congenital rubella syndrome |
|
Definition
| eyes, CNS, cardiac, hearing loss |
|
|
Term
| 2 cardiac complications seen in congenital rubella syndrome |
|
Definition
| patent ductus arteriosus, pulmonary arterial stenosis |
|
|
Term
| 3 CNS complications seen in congenital rubella syndrome |
|
Definition
| microcephaly, mental retardation and autism |
|
|
Term
| 2 ocular manifestatinos of congenital rubella syndrome |
|
Definition
|
|
Term
| clinical manifestations of mumps besides parotitis and orchitis |
|
Definition
| thyroiditis, nephritis, arthritis, hepatic disease, keratouveitis, and thrombocytopenic purpura, pancreatitis, myocarditis |
|
|
Term
| why is pancreatitis hard to diagnose in the setting of mumps |
|
Definition
| because the parotits also secretes amylase |
|
|
Term
| mumps causes aseptic meningitis in 50% of patients. what is sometimes the supporative treatment |
|
Definition
| lumbar puncture to relieve pressure and headache |
|
|
Term
| what is the next diagnostic step after identifying clinical signs of TB and on CXR? |
|
Definition
| 3 sputum cultures for acid-fast and one for culture on lowenstein jensen |
|
|
Term
| 3 situations where izoniazid should be discontinued from the treatment of TB d/t hepatotoxicity |
|
Definition
hepatitis symptoms
jaundice and an ALT level three times the upper limit of normal
asymptomatic with an ALT level five times the upper limit of normal |
|
|
Term
| 5 drug options for legionella (intracellular) |
|
Definition
| quinolones, macrolides, tetracyclines, rifampin, resprim |
|
|
Term
| what is the treatment of pertusis |
|
Definition
macrolides
allergic to macrolides - resprim |
|
|
Term
| 4 options for the treatment of acinetobacter |
|
Definition
carbapenems - resistance is developing fast
sulbactam, polymixins, colistin |
|
|
Term
| first choice treatment of salmonella and shigella |
|
Definition
|
|
Term
| what is the first line of treatment of cholera |
|
Definition
|
|
Term
| what is the treatment of choice for brucellosis? |
|
Definition
| streptomycin + tetracycline |
|
|
Term
| what is the treatment of choice for listeria |
|
Definition
|
|
Term
| 2 treatment options for diphtheria |
|
Definition
| penicillin G or erythromycin |
|
|
Term
| treatment of choice for nocardia |
|
Definition
|
|
Term
| what is the treatment of choice for actinomyces |
|
Definition
2-6 wks of IV penicillin +
6-12 months of PO penicillin or amoxicillin |
|
|
Term
|
Definition
| doxycycline or beta lactam |
|
|
Term
| treatment of choice for ureaplasma/mycoplasma |
|
Definition
| doxycycline or macrolides |
|
|
Term
| what is the treatment of pneumococcal meningitis |
|
Definition
|
|
Term
| what is the empirical treatment of meningitis in young previously healthy adults/adolescents |
|
Definition
| vancomycin + Ceftriaxone + acyclovir + doxycycline |
|
|
Term
| Ampicillin should be added to the empirical regimen of meningitis for coverage of L. monocytogenes in..... |
|
Definition
| individuals <3 months of age, those >55, or those with suspected impaired cell-mediated immunity because of chronic illness, organ transplantation, pregnancy, malignancy, or immunosuppressive therapy |
|
|
Term
| Metronidazole is added to the empirical regimen of meningitis to cover gram-negative anaerobes in.... |
|
Definition
| patients with otitis, sinusitis, or mastoiditis |
|
|
Term
| what is the treatment of listeria meningitis |
|
Definition
|
|
Term
| treatment of MAC in hiv infected individual |
|
Definition
|
|
Term
| how is the diagnosis of mycobacteria associated chronic infection in hiv infected patients made |
|
Definition
|
|
Term
| what type of TB is the most infectious? |
|
Definition
| cavitary TB or TB visible on microscopic examination of sputum |
|
|
Term
| what is the treatment of a patient with TB and HIV who starts ART and presents with IRIS? |
|
Definition
| add GCS, continue both ART and anti-TB medications |
|
|
Term
| what is pink on gram stain |
|
Definition
|
|
Term
| what is the immunedeficiency seen in N.meningitidis |
|
Definition
|
|
Term
| 10% of patients with brucellosis have epididymoorchitis |
|
Definition
|
|
Term
| 25% of patients with brucellosis have hepatosplenomegaly |
|
Definition
|
|
Term
| spinal osteophytes are common in brucellosis or TB? |
|
Definition
|
|
Term
| spinal diskitis and wedging and a psoas abscess are common in brucellosis or TB? |
|
Definition
|
|
Term
| how is the diagnosis of catheter infection in dialysis patients made? |
|
Definition
| peripheral + tip of catheter cultures |
|
|
Term
| effect of rifampin on P450 |
|
Definition
|
|
Term
| what effect do macrolides (erythropoietin) have on p450? |
|
Definition
|
|
Term
| adverse effects of quinolones |
|
Definition
| CNS toxicity, phototoxicity, cardiotoxicity, arthropathy, and tendon toxicity |
|
|
Term
|
Definition
|
|
Term
| painful laceration of arm, thrombocytopenia, hypotension, dyspnea - Dx? Tx? |
|
Definition
| streptococcal TSS, clindamycin |
|
|
Term
| fever with (paradoxical) bradycardia and rash |
|
Definition
| typhoid fever - salmonella |
|
|
Term
| treatment for malaria prohibited in G6PD deficient patients? |
|
Definition
|
|
Term
| which antimalarial drugs are effective against p.falciparum |
|
Definition
| Piperaquine, primaquine, Artemisinin |
|
|
Term
| which antimalarial drug causes major hypoglycemia |
|
Definition
|
|
Term
| which antimalarial drug may cause serious agranulocytosis and hepatitis |
|
Definition
|
|
Term
| which antimalarial drug may cause Neuropsychiatric reactions, convulsions, encephalopathy |
|
Definition
|
|
Term
| antimalarial of choice for eradication of hepatic malaria |
|
Definition
|
|
Term
| treatment of necrotizing faciitis d/t group A strep |
|
Definition
| clindamycin + penicillin G |
|
|
Term
| treatment of necrotizing faciitis d/t mixed aerobic and anaerobic flora |
|
Definition
| ampicillin, clindamycin and fluoroquinolones |
|
|
Term
| what is the empirical antibiotic treatment of necrotizing fasciitis |
|
Definition
| (1) clindamycin or metronidazole + (2) ampicillin or ampicillin/sulbactam + (3) gentamicin |
|
|
Term
| part cystic part calcified lesion in the liver |
|
Definition
|
|
Term
| in screening for HIV what is the next step after a positive elisa? |
|
Definition
|
|
Term
| if HIV negative on repeat elisa, what is the next step? |
|
Definition
|
|
Term
| what do you do if western blot test for HIV is indeterminate |
|
Definition
|
|
Term
| if western blot for HIV indeterminate for the second time |
|
Definition
|
|
Term
|
Definition
| should first r/o by stool culture, direct examination for ova/parasites and test for toxins. then, if suspect colitis, perform colonoscopy if not perform gastroscopy |
|
|
Term
| treatment of urethritis in pregnancy should consist of cetriaxone and azithromycin (and not doxycycline) |
|
Definition
|
|
Term
| pneumococcal strains are considered resistant to penicillin in levels... |
|
Definition
|
|
Term
| what drug do you add to the treatment of infective endocarditis with a prosthetic valve |
|
Definition
|
|
Term
| penicillin sensitivity - caution with cephalosporins and carbapenems. aztreonem is ok |
|
Definition
|
|
Term
| babesios in asplenic patients |
|
Definition
|
|
Term
|
Definition
|
|
Term
| post exposure prevention of meningococc |
|
Definition
|
|
Term
|
Definition
| pigs, periorbital edema, eosinophilia, CPK, myocarditis |
|
|
Term
| malaria from the far east - treatment |
|
Definition
|
|
Term
| salmonella typhi has a vaccine |
|
Definition
|
|
Term
| empirical treatment for patient with salmonella before culture returns sensitivities |
|
Definition
ceftriaxone
if sensitive to all - fluoroquinolones |
|
|
Term
| MCC of meningitis in adults<20 |
|
Definition
|
|
Term
|
Definition
| resprim + steroids + O2 (if low PaO2) |
|
|
Term
| when to stop izoniazid treatment in TB |
|
Definition
| עלייה א-סימפטומטית ב-ALT פי 5 מה-UNL או סימפטומי פי 3 מה-UNL |
|
|
Term
| treatment of mediteranean spotted fever (eschar, R.conorri) |
|
Definition
| דוקסילין, ציפרופלוקסצין, כלורמפניקול |
|
|
Term
| order of diagnostic tests to demonstrate PCP in HIV |
|
Definition
| bronchoscopy with BAL, transbronchial biopsy, open lung Bx, immunfluoroscense |
|
|
Term
| duration of treatment for meningitis according to pathogen |
|
Definition
| במנינגוקוק – שבוע, בפנאומוקוק – שבועיים, בליסטריה – 3 שבועות. בהרפס (או מקרים חמורים של EBV / VZV) נטפל באציקלוביר במשך 7-14 ימים |
|
|
Term
| treatment of choice for SBP |
|
Definition
| צפוטקסים, צפטריאקסון או piperacillin/tazobactam |
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Term
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Definition
• סיבוך מסכן חיים כמו קרע של מסתם
• אי ספיקת לב רפקטורית בינונית/קשה על רקע פגיעה חדשה או החמרה של פגיעה מסתמית. הכי נפוץ כסיבה לניתוח
• זיהום perivalvular- יותר שכיח בתותב. לחשוד כשיש פריקרדיטיס, הפרעת הולכה או חום פרסיסטנטי.
• זיהום בלתי נשלט –תרביות דם או חום למרות טיפול של שבועיים, או פתוגן שידוע שאין טיפול יעיל כמו פטריות, פסאודומונס, גרם שלילי עמידים, ברוצלה, לעיתים קוקסילה ברונטי
• אראוס על מסתם תותב- יש לשקול גם במסתם רגיל שמאלי עם וגיטציות ומהלך ספטי לאחר שבוע טיפול
• אמבולי סיסטמי –וגיטציה מעל 10 מ"מ עם סיכון לתסחיף |
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Term
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Definition
• אנמיה ב90-70 אחוז
• שקיעת דם מוחשת וCRP במעל ל90 אחוז
• ירידה ברמות משלים ב40 אחוז
• RF ב50 אחוז
• המטוריה מיקרוסקופית ב30-50 אחוז
• לויקוציטוזיס 20-30 אחוז |
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Term
| המוליזה של אגלוטינינים קרים במיקופסלזמה מכוונת כנגד אנטיגן I על ה-RBC |
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Definition
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Term
| מה הן בדיקות הסקר הטובות ביותר בשלב החריף של HIV |
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Definition
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Term
| דינמיקה של חום בTYPHOID/ENTERIC FEVER |
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Definition
| o הסימן הקלאסי הוא חום שעולה בהדרגה מספר ימים ואז מתייצב על כ39-41 מעלות למשך כ10-14 יום ומתחיל לאחר מכן לרדת בהדרגה. שיא החום הינו אחהצ |
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Term
| למי נעשה CT ראש לפני ניקור מותני במנינגיטיס |
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Definition
• דיכוי חיסוני
• טראומת ראש בעבר
• סימנים נוירולוגים פוקאלים כמו פפילאדמה, ירידה במצב הכרה
• גידול CNS |
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Term
| JARICH HERXHEIMER עשויה להופיע בזיהומים הבאים |
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Definition
• סיפליס-הכי שכיח
• בורליה –ליים וrelapsing fever
• לפטוספירה
• Q fever
• ברטונלה
• ברוצלה
• טיפואיד |
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Term
| מצבים בהם נטפל כאשר בבדיקת PPD תתקבל אינדורציה של 5 מ"מ |
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Definition
| מגע קרוב עם חולה, חולי HIV , מוחלשים חיסונית, או צלח שמתאים לTB |
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Term
| מצבים בהם נטפל כאשר בבדיקת PPD תתקבל אינדורציה של 10 מ"מ |
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Definition
| עובדי בריאות, חולי סכרת, מחלה המטולוגית, IVDU ESRD וירידה מהירה במשקל. זיהום חדש מתחת לשנתיים |
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Term
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Definition
| • כשל טיפול נחשד כשתרבית ליחה חיובית לאחר 3 חודשים או אסיד פאסט חיובי לאחר 5 חודשים |
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Term
| באילו מצבים של נוזל פלאורלי נכניס נקז |
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Definition
o נוזל מנורתק
o PH מתחת ל7.2
o גלוקוז מתחת ל60
o צביעת גרם חיובית או תרבית חיובית מנוזל פלאורלי
o נוכחות של מוגלה |
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Term
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Definition
| באמפוטריצין B ופלוקיטוזין לשבועיים או עד תרבית CSF סטרילית. לאחר מכן ממשיכים פלוקונאזול ל10 שבועות ואם לאחר מכן תרבית CSF סטרילית יש להפחית בהדרגה . באיידס נטפל כל חייהם |
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Term
| נבגים של קריפטוקוקוס נשאפים מ.... |
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Definition
| מאדמה מלוכלכת או צואת ציפורים |
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Term
| איך מטפלים מניעתית בחולה לאחר חשיפה לHIV |
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Definition
• בחשיפה קלה – טיפול בשילוב של שני nucleoside analogue RT inhibitors למשך 4 שבועות
• בחשיפה חמורה- כנל + תרופה שלישית ל4 שבועות
• במקרה של דקירה –שטיפה וחיטוי יסודי של הפצע |
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Term
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Definition
| מי שנחשף להפרשות מאורופארינקס-נשיקה, כוסות, אינטובציה . ריפמפין כל 12 שעות במשך יומיים + ציפרו, אזיתרומיצין או צפטריאקסון לשריר |
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Term
| Peginterferon combined with ribavirin (plus boceprevir or telaprevir in patients with genotype 1) is the standard treatment for patients with chronic HCV infection |
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Definition
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Term
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Definition
Major, uncontrolled depressive illness
A kidney, heart, or lung transplant
Autoimmune hepatitis or other conditions known to be exacerbated by interferon or ribavirin
Untreated thyroid disease
Severe concurrent disease such as severe hypertension, heart failure, significant coronary artery disease, poorly controlled diabetes, obstructive pulmonary disease
Known hypersensitivity to drugs used to treat HCV
Therapy is also contraindicated in patients who are:
Less than two years of age
Pregnant |
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Term
| preconditions to treatment for HCV |
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Definition
At least 18 years of age
HCV RNA detectable in the serum
Liver biopsy with chronic hepatitis and significant fibrosis (bridging fibrosis or higher)
Compensated liver disease
Total serum bilirubin <1.5 g/dL (25.7 micromol/L)
INR <1.5
Albumin >3.4 g/dL (34 g/L)
Platelet count >75,000 cells/mm3 (75,000 x 10(6)/L)
No evidence of hepatic encephalopathy or ascites
Acceptable hematological and biochemical indices
Hemoglobin >13 g/dL for men and >12 g/dL for women
Neutrophil count >1500 cells/mm3 (1500 x 10(6)/L)
Creatinine <1.5 mg/dL (133 micromol/L |
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