ID med Flashcards by Derin King

bitten by pet dog that hasnt been vaccinated for rabies. next step in management?

observe dog for 10 days and vaccinate patient and give immunoglobulin (together = pep) if dog has rabies signs

dog cat ferret. available = quarantine. unavailable = start PEP

Wild animal. available = euthanse test and start PEP if positive. unavailable = start PEP

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history of mitral stenosis. signs of Infective endocarditis after undergoing dental procedure. most likely pathogen?

strep mutans!!!!

or strep mitis, oralis or sanguinis.

Essentially a strep viridans group

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26 yo. fever malaise fatigue sore throat. pharyngeal erythema, mild spleenomegaly and amorbillifrom rash. no enlarged lymph nodes. labs show lymphocytosis. heterophile antibody testing is negative. blood smear showing atypical lymphocytes. most likely diagnosis?

Cytomegalovirus infection!!
CMV mononucleosis!!!

no lymphadenopathy although it could be present, points away from ALL. ALL would have thrombocytopenia

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when would you give corticosteroids in addition to TMPSMZ for PCP in HIV?

PAO2 </= 70!!!
sats <92%
A-A gradient >/= 35

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72 YO man. SOB, cough. fever, headache, sore throat, runny nose, anorexia, severe body aches.. bilateral crackles on auscultation. CXR shoes diffuse bilateral reticular opacities. most likely pathogen causing?

influenza virus!!

CXR findings are due to development of influenza pneumonia

rhinorrhea and myalgia are not typical of PCP or CMV. and CMV typically does not affect lungs.

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45 yo man, right sided chest pain and cough. at start of symptoms, he had malaise, nasal congestion runny nose. but today sudden onset severe right sided chest pain after coughing. lungs clear to auscultation. marked tenderness when palpating of 9th rib area. lymphocytic leukocytosis on labs. most likely diagnosis?

Pertussis

posttussive focal rib pain consistent with rib fracture - other signs seen in adults may be hernia, subconjuctival hemorrhage

normal non specific lung or cxr findings classic

not influenza as abrupt onset fever and myalgia would be expected

not TB as fever is common and nasal symptoms not. lung exam typically abnormal

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In neutropenic sepsis, what antibiotic is given?

PIP-TAZ!!
or cefepime!

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the presence of urinary alkalinization (ph >8) indicates what organism most likely responsible for UTI?

proteus

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Fever + new onset murmur in tricuspid region
6 months ago arm cellulitis and now showing picture of arm with track marks!!!! -> most likely IVDY

most appropriate therapy?

(V) Vancomycin!!

*staph aureus is also most common cause in I(V)DU

strep bovis seen in underlying cancer -> colonoscopy!!

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recent trip to asia.
1. purple skin ulcer on forearm
2. abdominal pain with multiple hyperechoic septate masses in liver and spleen = abscesses
3. cough and fever with CXR showing bilateral opacifications = pneumonia

gram negative bacilli in blood cultures

most likely diagnosis?

Meliodosis!!! With The abcesses

caused by burkholderia pseudomalllei and endemic to east asia

NOT listeria because it causes gi illness and meningoencephalitis when disseminated

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bacterial conjuctivitis can spread from 1 eye to the other and between people.

most likely causative pathogen?

staph aureus

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differential diagnosis for ulcerative skin lesion + regional lymphadenopathy?

Tularemia!!
sporotrichosis
cat scratch disease

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Live attenuated varicella vaccine can now be given in HIV as long as CD4 is >/200

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low grade fever, dry cough and right sided chest pain
right sided crackles
erythematus tender nodules on bilateral shines
achiness in knees and ankles but no swelling
just completed desert training in arizona
most likely cause?

coccidiodes immitis!!! - mycosis of desert southwest! that causes community acquired pneumonia, athralgias, erythema nodosum and erythema multiforme

if immunocompromised give ketoconazole or fluconazole

NOT legionella pneumophillia as causes GI symptoms vomiting diarrhea + pneumonia symptoms

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rapidly ascending paralysis. just returned from hiking trip. no recent illness or infection. normal sensation normal wbc count, normal CSF.
next step in management?

meticulous search for a tick!!!
tick borne paralysis
removal of tick results in improvement in most patients

GBS unlikley
also NOT MRI of spine + IV methylprednisolone as these are done if spinal tumour is suspected = days to weeks for symptom development and sensation typically abnormal

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hiv. red-purple papules that enlarge to nodules on face and extremeities that bleed easily with palpation. hepatospleenomegaly. hypodense liver lesions that enhance with iv contrast. most likely cause?

Bartonella species!! = bacillary angiomatosis!!

treat with antimicrobials - doxycycline or erythromycin

Not mycobacterium avium as it causes diarrhea

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In vertebral osteomyelitis, leukocyte count may be normal but ESR and CRP typically elevated. MRI spine -> CT guided bone biopsy

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In a patient with new HIV diagnosis at the first appointment its important to screen for latent tuberculosis!!! eg with IGRA test.

NOT CXR

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fever malaise sore throat, tonsilar exudates. lymphadenopathy

recently returned from honduras

spleenomegaly

jaundice and hemolytic anemia
thrombocytopenia
elevated lfts
leukocytosis

most likely diagnosis?

infectious mononucleosis!!!

can cause hemolytic anemia and thrombocytpenia due to cross reaction with EBV-induced antibodies!!!!

can cause transient hepatitis with elevated serum transaminases

can cause hepatospleenomegaly!!!

NOT acute hep A as tonsilitis, lymphadenopathy and spleenomegaly not expected. transaminases would be more severely elevated

NOT malaria as tonsilitis and lymphadenopathy not expected. and fevers would be cyclical

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recent tooth extraction
diabetic
slow growing mass
purulent discharge with sulfur granules
fine needle aspiration with culutre grows gram niegative rods (first step in diagnosis)

treatment?

penicillin!!!

actinomyces infection

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return from mexico
GI symptoms
followed by periorbital edema, myositis and eosinophilia.

fever, splinter hemorrhages may be present.

diagnosis?

Trichinellosis

NOT ascariasis as starts with a lung phase and non productive cough -> then migration to GI tract and gi symptoms + eosinophilia. periorbital edema and myositis not present

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tuberculin skin test is done to screen for latent tuberculosis.

induration size is 12mm

next step in management?

if the patient had HIV, what cut of would mean they had latent TB?

no additional intervention!!!

induration size <15 is negative

if at least 15 -> repeat testing, IGRA, CXR

with HIV, at least 5mm = Latent TB, so treat patient

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erisipelas of face described.
most likely causative organism?

group a streptococcus

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dirty wound, no tetanus vaccine in last 5 years -> vaccinate

significant or dirsty wound and not up to 3 doses in past -> add on tetanus immunoglobulin

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42 YO. last tdap at 31. chronic liver disease all childhood vaccines taken what vaccinations does she require.

hep A and Hep b + pneumococcus (not hep C) + tdap cause its every 10 years + influenza cause its an anual vaccine

the most common cause of community acquired bacterial meningitis is strep pneumonia

3 small ulcers on penis 2 cm no pain mild inguinal lymphadenopathy most likely diagnosis?

syphillis - mulitple ulcers can occur, particularly in those with HIV NOT chancroid = painful ulcer(s) with purulence and painful!!!!!! lymphadenopathy NOT lymphogranuloma venerum = multiple painless ulcers that are tiny <6mm and disappear within a few days then painful buboes (Chlamydia trachomatis)

fever chills, dyspnea on exertion 1 week SLE started taking pred CXR shows bilateral interstitial inflitrates most likely cause?

PCP!! chronic glucocorticoids ->must be on prophylaxis with TMP-SMX NOT pulmonary fibrosis as it takes time to develop and wont cause fever

Patients with pyelenephritis who are vomiting, of older age or septic or who have comorbifitiez like diabetes mellitus, urinary obstrucción requiere hosptialisation and IV antibiotics. If cultures come back and symptoms improve at 48 hours they can be moved to ORAL antibitoics based on culture results

A negative Hep A IgG means patient is not vaccinated against hep A

+ve treponemal in syph, negative VDRL = treated infection, early stage infection, late stage infection -ve treponemal, +vdrl = false positive, autoimmune disease, pregnancy, liver disease, IVDU, HIV

community acwuired pneumonia treatment? what if emyema or abscess present? treatment for community acquired pneumonia if patient has to be admitted to hospital???

amoxicillin/co-amoxiclav AND macrolide or doxycycline less preferred penicilline allergic: cephalosporin AND macrolide or doxy less preferred so if patient is on azithromycin and symptoms not resolving-> add co-amoxiclav empyema/abscess = add ampicillin sulbatam!!! admission to hospital = beta lactam + macrolide = ceftriaxone + azithromycin. OR fluoroquinolones like ciprofloxacin

leprosy is diagnosed via?

skin biopsy from edge of the lesion!!!!

TRIPLE drug anti-retroviral therapy recommended after needlestick with HIV patient, not single drug

esophagitis in patient with HIV but oral exam is normal most likely aetiology?

VIRAL!! CMV = linear ulcers, intranuclear inculsions HSV - vesicular ulcers, multinucleated giant cells no oral thrush makes candida unlikely pill esophagitis is a differential that happens with medications

watery diarrhea. no blood or mucus. swiming in local lakes on holiday most likely cause

cyrptospordium!!! not strongyloidis because skin and respiratory symptoms would be seen not entamoeba because it causes bloody or mucoid!!! diarrhea

high centor criteria score for pharyngitis -> strep rapid test -> penicillin or amoxicillin

ams fever, petechiae -> rocky mountain spotted fever -> doxycycline!

headache and nausea septic shock. bilateral rales in lungs diffuses macular rash with petechiae over body sexually active no nuchal ridgidity lumbar puncture shows minimal leukocytosis most likely diagnosis?

classic PETECHIAL rash pulmonary edema and shock ! = rocky mountain spotted fever (thrombocytopenia and hyponatremia typically seen) NOT HIV infection = diffuse lymphadenopthy, sore throat, mucocutaneous ulcers. shock would be atypical!!! NOT herpes simplex encephalitis - vesicular rash in mouth or genitals. significant rbcs on lumbar puncture

dry cough and sore throat macular rash cxr: interstitial infiltrates and small pleural effuion 19! no lymphadenopathy most likely diagnosis? treatment?

mycoplasma pneumonia - clarithromycin Not parvovirus as would have a malar rash instead and prulmonary symptoms not expected like interstitial infilitrates NOt legionella as would expect GI symptoms

heterophile antibodies, whilst specific for disease, can be negative early on in infectious mononucleosis NOT hodkins lymphoma as that does not have atypical lymphocytes or pharyngitis

warty heaped up skin lesion with a violaceous hue/ nodules that progress to microabscesses most likely diagnosis?

blastomycosis!

prophylaxis for toxoplasmosis in hIV+ve?

TMP-SMX also used to prevent PCP

bloody diarrhea + abdominal pain in an HIV+ve patient with low cd4 count. most likely cause?

CMV!!!! NOT cryptosporidium = severe watery diarrhea NOT mycobacterium avium = watery diarrhea + high fever over 39

on immunosuppressants for rhumatoid arthritis. night sweats, multiple pulmonary nodules. left temporal lobe abscess on brain scan and siezures. PARTIALLY acid fast rods next step in management?

TMP-SMX nocardia infection TB is completely acid fast and does not gram stain

fever, fatigue, myalgia ANEMIA! and thrombocytopenia dark urine recent tick bite history of spleenectomy!!! next step in investigation?

blood smear examination!! -> malteee cross babesiois!! -> a tick borne illness, aspleenia is a risk factor not ixs for rocky mountain fever as although presents similarly from tick bite, anemia is uncommon! and rash would be present.

fever weakness, glomerulonephritis, arthralgia, dyspnea, raised esr violaceous nodules on the fingertips and toes (oslers nodes) next step in management?

echo!

fevers myalgia hypotension diaphoresis after penicillin treatment for syphillis mechanism behind presentation?

rapid lysis of the spirochetes jarisch-herxheimer reaction

give VZV vaccine in HIV

if interferon gamma levels dont respond/rise significantly to control antigens what may be the cause?

HIV immunosuppressants ongoing inflammation or concurrent infection

painless lesion on penis a papule. inguinal lymphadenopathy ocassional bumps in mouth next step in treatment uses condoms consistently

penicillin!! ulcers in mouth likely canker sores/apthous stomatitia NOT herpes = cluster of painful vesicles.

epidydimits in man >35, most likely pathogen?

ecoli!!! <35 = STI

for cryptococcal meningitis, after initial treatment with amphotericin B and flucytosine, patients should be discharged with?

fluconazole

fever weight loss fatigue. diffuse reticulonodular pattern on cxr. recent incarceraiton, iv drug use. most likely diagnosis?

milliary tuberculosis

mississipi ohio wisconsin -> most likely blastomycosis vs south western us -> coccidiodyomycosis

test for goncooccal arthritis?

synovial fluid NAAT test

positive hep C antibody test. next step ?

Follow up with PCR

in a patient with hep a worried about passing it on to sexual partner, what does partner need?

hep a vaccination or immunoglobulin barrier contraception is not enough

(L)iegonella pnemonia is trated with which antibiotic?

levofloxacin!! or other fluoroquinolones

if a patients blood cultures show clostridium septicum bacteremia, next step in management?

colonoscopy!!! suggests underlying colon cancer also if bacteremia with strep bovis or group d streptococci not opthalmic evaluation -> for candidiemia not syctoscopy -> for ecoli or gram negative bacteremia not echo -> should be done if s aureus bacteremia and strep bovis

multidrug resistant pneumonia, MRSA, VRE highest level of precautions required?

gowns and gloves and single use stethoscope

punched out gangrenous ulcers in patient developing rapidly after chemo treatment. causative pathogen?

gram negative bacteremia!! (pseudomonas aueroginosa) not pyoderma gangrenosum as it occurs in IBD and arthropathies

solid organ transplant. now pneumonitis + gastroenteritis + hepatitis most likely cause?

CMV!! it is CMV and PCP that organ transplant patients mostly at risk of

fever abdominal pain rectal urgency diarrhea over 2 days now bloody diarrhea MSM most likely diagnosis?

shigella infection!!! acute onset diarrhe typically infectious = non inflammatory like norovirus or inflammatory like (ecoli, shigella, campylobacter, salmonella non typhi) inflammatory will have blood and or mucus, fever, rectal urgency non inflammatory = large volume watery diarrhea bacteria like shigella can be transmitted by receptive anal intercourse!! NOT gonorrhea as it can cause rectal bleeding and pain/ proctitis but NOT diarrhea. also you would expect purulent discharge.

polyarthralgia, PUSTULAR rash on body Sexually active recent sore throat in daughter most likely diagnosis?

disseminated gonoccola infection!! EITHER polyarthritis + pustular rash or monoarthritis NOT rhuematic fever as the rash is erythma marginatum NOT secondary syphilis = maculopapular rash

liver transplant 2 weeks ago RUQ pain on immunosuppressants 39.1 degrees C BP 85/55 leukocytes 28,800 most likely cause?

bacterial infection <1 week = hyperacute rejection <1 month since transplant = bacterial infections 1-6 month = opportunistic pathogens eg CMV NOT acute cellular rejection as would not expect hemodynamical instability , high fever and severe leukocytosis

chemo is a risk factor for c difficile

Central line associated blood stream infections caused by what type of organisms?

Coagulase negative staphylococci (CONS). Eg staph epidermis

Burn wound!! Sepsis specifically. What antibitics do you need?

Vancomycin!!! And cefepime!!! Have to cover for MRSA which typically affects burn wounds hence vancomycin (Ambos ppq) Other important points = enteral nurtution, stress ulcer prophylaxis with PPIs

Cdifd first line tx?

Oral vanc or oral fidaxomyxin!! *ambos ppq

ID med Flashcards

(71 cards)