Systems Review Combo – Flashcards
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| Name the layers of infection from skin to bone. |
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| impetigo, erysipelas, cellulitis, fasciitis, myositis, osteomyelitis |
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| 2 common causes of cellulitis? |
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| S. aureus and S. pyogenes (GAS) |
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| Cause of cellulitis in pts with diabetes? |
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| GBS (maybe pseudomonas) |
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| Who gets a pseudomonas cellulitis? |
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| netropenics, diabetics, steroid use, water exposure |
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| Liver disease will make you susceptible to what kinds of infections? |
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| Neisseria b/c of complement deficiency and V. vulnificans because of increased iron |
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| What mycobacterium is acquired from exposure to water? |
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| M. Marnium |
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| T/F You can get toxic shock from a VZV infection. |
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| true |
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| What are the endemic fungi that can cause ulcers? |
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| blastomyces, crytococcus, and histoplasma |
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| Blood cultures are often contaminated with... |
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| coag. neg staph |
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| Likely cause of celulitis d/t trauma in brakish water in the summertime? |
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| V. vulnificans |
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| T/F Yersinia enterolytica is an iron lover. |
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| true |
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| What is a cause of cellulitis in Crohn's disease? |
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| gram negative organisms and anaerobes |
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| Lupus or complement deficiency can predispose you to a cellulitis caused by... |
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| S. pneumoniae (in lupus, necrotizing fasciitis is more common than S. pneumo) |
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| IUD with chronic pelvic abscess is likely d/t... |
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| actinomycosis |
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| Complement deficiency puts you at risk for infection with... |
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| neisseria and encapsulated bacteria |
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| Sun burn rash is a ____ mediated phenomena. |
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| toxin |
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| Exposure to conga drums put you at risk for... |
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| anthrax |
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| Treat cellulitis empirically with.. |
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| vancomycin + clindamycin because vanc will increase the amount of toxin (Daptomycin or linezolid would work) |
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| What are the pros and cons of treating cellulitis with TMP/SMX? |
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| can tx MRSA and MSSA but not strep |
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| What is a D test for? |
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| determine susceptibility to clindamycin |
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| Cellulitis is toxin mediated so you should treat it with antibioitcs that.. |
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| .inhibit ribosomes (clindamycin and linezolid) |
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| Why is Daptomycin particularly good for cellulitis? |
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| kills organism quickly to decrease the amount of toxin produced |
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| Staph can be differentiated from Strep infection clinically by... |
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| presence of abscesses is characteristic of staph infeciton |
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| What is the gold standard treatment for strep cellulitis? |
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| Penicillin V or amoxicillin or 1st generationo cephalosporin (ceftalaxin + anti-MRSA) |
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| Why is staph catalase +? |
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| prevents being killed by ROS |
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| What is the most important mode of transmission for GAS? |
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| droplet transmission from nasopharnyx (also peuperal fever from not washing hands) |
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| What type of pneumonia has a high incidence of peluritic chest pain? |
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| GAS |
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| T/F Empyemas are common in GAS pneumonia. |
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| true |
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| What is the MC GAS infection? |
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| pharyngitis |
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| What is the most common precursor to GAS bacteremia? |
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| skin/soft tissue infection |
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| What is the most common precursor to GAS bacteremia? |
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| skin/soft tissue infection |
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| What is the most common precursor to GAS bacteremia? |
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| skin/soft tissue infection |
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| What is the most common precursor to GAS bacteremia? |
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| skin/soft tissue infection |
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| GAS in urine means the patient also has... |
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| bacteremia (hematogenous spread is the only way GAS gets to the UT) |
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| What are the symptoms/signs associated with Scarlet fever? |
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| strawberry tongue, circumoral pallor, desquamation of skin during healing and sore throat |
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| T/F Scarlet fever can present with a papulovesicular rash. |
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| false erythema marginatum is not vesicular |
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| What type of GAS infection will more likely predispose you to PSGN over ARF? |
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| pyoderma |
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| T?F Serious GAS infection should be treated with penicillin. |
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| false |
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| T/F Doxycycline has poor strep coverage. |
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| true |
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| Where is the most important reservoir for asymptomatic carriage of s. aureus? |
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| nasopharynx |
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| What is the most important mode of transmission of S. aureus? |
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| direct person to person contact |
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| What types of precautions must be taken with GAS to prevent transmission? |
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| droplet precaution |
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| How is N. meningitidis transmitted? |
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| droplets |
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| T/F It is possible to transmit S. Aureus via sexual intercourse. |
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| true |
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| Does S. aureus cause pharyngitis? meningitis? |
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| NOT pharyngitis, meningitis is uncommon |
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| 50% of osteomyelitis is caused by... |
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| S. aureus |
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| What are the 2 MC organisms of IE? |
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| S. aureus and viridans strep |
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| What are some symptoms of staph TSS? |
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| V/D at onset, desquamation of palms and soles, hyperemia of mucous membranes, thrombocytopenia |
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| You are unlikely to have (+) blood cultures if you have ___ TSS. |
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| staph |
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| What are the laboratory findings of staph TSS? |
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| azotemia, increased CK ( d/t rhabdomyolysis), pyuria and thrombocytopenia |
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| Staph TSS disease is not invasive but causes systemic diases by the way of... |
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| toxemia |
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| Can you get a positive blood culture in a patient with TSS? |
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| staph is usually negative (toxemia) but strep is usually positive (like in necrotizing fasciitis) |
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| NBT test is used for. |
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| CGD |
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| Agammaglobulinemia puts you at risk for infection with.. |
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| extracellular encapsulated bacteria |
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| Hyper IgE (Job's syndrome) puts you at risk for what kind of infection? |
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| recurrent staph infection |
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| What causes IE? |
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| S. viridans and S. aureus, S. lugdenensis, HACEK (haemophilus, aggregatibacter, cardiobacterium, Eikenella, Kingella) |
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| What mycobacteria can cause IE? |
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| atypical and fast growing ones like M. fortuitum |
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| What is the emperic treatment for IE? |
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| vancomycin for 4-6 weeks + aminoglycoside |
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| What bacteria cause sinusitis? |
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| S. pneumo, H. flu, other haemophilus, M. Catarrhalis, GAS, S. aureus, anaerobes |
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| What is pott's puffy tumor? |
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| pus infection breaks into orbit and eye pops out |
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| When is it appropriate to use antibiotics for a respiratory tract infection? |
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| if symptoms last for more than 7 days you are increasing the cure rate from 60-80% |
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| What antibiotics do you give for sinusitis? |
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| high doses of amoxicillin |
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| What common organism is not covered by standard antibiotic tx for sinusitis? |
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| M. Catarrhalis (produces a beta lactamase) |
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| If amoxicillin doesn't treat sinusitis switch to a... |
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| macrolide or beta lactam inhibitor combo like augmentin (amoxicillin + clavulanate) |
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| What would you use for a pseudomonas sinusitis infection? |
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| piperacillin or tazobactam |
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| Different microscopy of aspergillus and zygomyces? |
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| aspergillus= septate hyphae with acute angle branching (tx with voriconazole) zygomyces= nonseptate hyphae with 90 degree branching (Tx with amphotericin B) |
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| Chronic means the infection has lasted for more than... |
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| 2 weeks |
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| What causes a necrotizing pneumonia? |
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| pseudomonas, S. aureus, Klebsiella |
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| What is farmer's lung? |
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| allergic bronchopulmonary aspergillosis |
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| Bacteria from Winn DIxie produce misters= |
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| legionella |
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| T/F COxiella is associated with a rash. |
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| true |
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| What causes a pulmonary meningitis syndrome? |
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| S. pneumo, H. influenzae, and legionella |
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| What is a major symptome of tularemia? |
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| weightloss |
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| What are the most common causes of pneumonia? |
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| mycoplasma, chlamydia, S. pneumo, H. flu, M cat and legionella |
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| What is the necrotizing pneumonia you get from eating raw crawfish? |
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| paragonimus |
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| Proton pump inhibitor can increase you risk of what nonGI infection? |
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| pneumonia |
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| Smokers have an increase risk of pneumonia by what specific organism/ |
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| S. pneumo |
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| What are the causes of community acquired pneumonia? |
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| S. pneumo, mycoplasma, and chlamydia |
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| How do you treat legionella? |
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| moxifloxacin IV, azithromycin + ceftriazone |
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| What are bacterial causes of encephalitis? |
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| S. pneumo, H. influenzae, Listeria, N. meningitidis, gram negative enteric |
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| What are the advantages to treating encephalitis with ceftriaxone? |
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| CSF penetration, covers H. flu, N. men and most penicillin resitant pneumococci (but NOT LISTERIA which is why you add amphicillin) Also could use vancomycin to cover penicillin resistant pneumococci |
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| Which;organisms are common causes of diarrhea in HIV patients? |
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| cryptosporidium, salmonella |
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| Name some toxin mediated causes of diarrhea? |
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| B. cereus, C. difficile, S. aureus |
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| What are some causes of diarrhea that require the actuall presence of the bacteria (not just toxin)? |
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| V. choelra, shigella, salmonella, campylobacter, H. pylori, ETEC, EHEC; EIEC, EAggEC, MTB, MAC, Yersinia, Plesiomonas, aeromonas |
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| How sensitive is the stool culture for routine pathogens? |
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| 30-50% |
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| What are the GIroutine pathogens? |
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| shigella, salmonella, campylobacter, yersinia and EHEC |
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| What treats C diff? |
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| metronidazole (vanc if severe) |
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| What is the MC cause of diarrhea in day care workers? |
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| shigella (cryptosporidia, giardia and salmonella) |
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| How do you test for EHEC? |
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| Shiga-like toxin ELISA |
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| What is a complication of EHEC? |
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| Hemolytic Uremic synrome= anemia, thrombocytopenia and renal problems d/t endothelial injury, fibrin stranding, schistocytes |
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| How do you get EHEC? |
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| cow manure, petting zoos, public pools |
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| How do you treat EHEC? |
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| NO ANTIBIOTICS, supportive |
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| What bacteria can cause hepatitis? |
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| leptospira, legionella, ricketsia, ehrlichia, salmonella |
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| How do you treat most spirochetes? |
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| penicillin or doxy, watch out for jarisch herxheimer reaction |
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| How do you prevent Hep B? |
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| HBIG or vaccination |
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| Which hepatitis virus has HIV synergy? |
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| hep C |
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| How do you treat hep C? |
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| pegylated IFN, ribavirin, protease inhibitor (boceprevir or telaprevir, esp if genotype I or AA) |
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| How do you differentiate pyelonephritis from cystitis? |
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| flank pain and fever |
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| Why is it important to distinguish whether a patient ahs cystitis or pyelonephritis? |
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| pyelo is treated longer and can lead to bacteremia |
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| What allows ecoli to be a good UTI pathogen? |
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| motility and adhesion (EHEC, ETIC and most GI commensals do not cause UTIs because they do not have adhesions which is CRUCIAL to causing a UTI) |
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| What are the UTI natural host defenses? |
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| acid, peristalsis, psuedovalves of ureter and flwo |
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| What are the risk factors for UTI? |
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| female, sexual trama, not being hydrated, diaphragm use, urethral reflux, DM |
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| What is the most resistant UTI pathogen? |
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| new delhi metallo-carbapenemase (NMD1) from pakistan |
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| What is the #3 MC TB site? |
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| kidney |
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| What is the significance of casts in urine? |
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| WBC casts implicate pyelonephritis, RBC casts indicate glomerularnephritis |
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| What are the most common cuases of UTI? |
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| GN= Ecoli and Klebsiella pneumonia GP= Staph saprophyticus, beta hemolytic strep (strep agalactiae), alpha hemolytic strep, and gamma hemolytic strep (enterococcus faecalis), mycoplasma hominis |
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| What Urinary pathogen can also cause IE? |
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| Strep agalactiae (GBS) |
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| Whata re the pros and cons to using nitrofurantoin for UTI |
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| concentrates in urine (not suitible for systemic disease) proteas is resistant |
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| What are the pros/cons to using fosfomycin to cover UTIs? |
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| covers everything but is expensive and induces vomiting |
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| What is S. saprophyticus resistant to? |
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| very susceptible to everything |
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| What is E coli resistant to? |
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| 60% to ampicillin, 20% to cefazolin 5% to genatmycin and 2% to ceftriazone |
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| What are teh pros and cons to using ceftriaxone to treat a UTI? |
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| causes less GI changes and will cover Ecoli |
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| Whata re the pros and cons of using gentamycin to treat ecoli UTI/ |
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| renal failure is a side effect |
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| What is the best treatment for ecoli UTI? |
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| ceftriazone |
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| When do you treat asymptomatic bacteruria? |
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| if pregnant |
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| How long do you treat for UTI? |
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| if flouroquinolone susceptible you treat for 7 days if nonflouroquinolone suceptible you treat for 14 days |
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| Why does pregnancy increase your risk of UTI? |
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| decrease flow because of mechanical pressure on ureters and increase estrogen which decreases peristalsis of the ureters |
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| What MUST YOU NOT USE to treat asymptomatic bactiuria in a pregnant patient? |
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| TMP-SMX or cipro |
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| What do you use to treat asymptomatic bactiuria during pregnancy? |
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| ampicillin, gentamycin, nitrofuratoin |
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| UTI with kidney stones and high pH is likely d/t-> |
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| proteaus |
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| Parasite Dracunculus medinensis is aka... |
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| guinea worm |
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| What are the symptoms of sarcoidosis? |
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| skin lesion, arthritis, erythema nodosum and lung disease |
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| What disease causes calcification of skin? |
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| dermatomyositis |
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| What bacteria are common in the feces? (What bacteria were present in teh skin lesions of the 19 yo morman girl)? |
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| Ecoli, bacteroides, enterococcus, clostridium |
