ID 2 - Ddx & treatment

  1. Ddx vaginal discharge
    • white - candida
    • yellow/green - trichomonas
    • watery - bacterial vaginosis
  2. Ddx dependent rubor / cellulitis
    • DR positional, blanches when raised
    • DR can be bilateral
    • DR cool skin, C warm skin
  3. Ddx stasis dermatitis / lipodermatosclerosis
    • both start above the medial malleolus and create red, hot skin with no defined borders, and can be bileteral
    • SD: pitting edema, blanches when elevated
    • L: woody, bowling pin shape
  4. Vasculitis
    • does not blanch
    • symmetrical distribution
    • subcutaneous nodules
    • ulcerations
    • hemorrhagic bullae
    • purpuric papules
  5. Fixed drug eruption
    • oval or ring shaped itchy burning painful red spots
    • can occur up to 2 weeks after exposure to a systemic drug
    • lesions can persist for weeks
  6. 4 types of pyoderma gangrenosum
    • Classic
    • pustular
    • peristomal
    • vegetative
  7. Ddx necrotizing fasciitis / cellulitis
    • NF pain out of proportion to exam
    • NF red/purple -> gray/blue
    • C skin is warm
  8. treatment for necrotizing fasciitis
    carbapenem + clindamycin + vancomycin
  9. pyoderma gangrenosum
    irregular purple border around wound, red and hard around the edges
  10. Acute febrile neutrophilic dermatosis
    • reactive.
    • fever
    • leukocytosis
    • papules/plaque/nodules
  11. Signs of lymphedema
    • localized, non-pitting edema
    • discoloration
    • hardening
    • wart-like appearance
    • hyperkeratosis
  12. risk factor for lymphedema
    obesity; weight compresses lymph drainage
  13. risk factors for orbital cellulitis
    • dental infection
    • NLD obstruction
    • bacterial sinusitis
  14. treatment of orbital cellulitis
    vancomycin and ceftriaxone
  15. signs of preseptal cellulitis
    • ocular pain
    • swelling of lid and conjunctiva
    • erythema
  16. treat preseptal cellulitis
    clindamycin
  17. sign of impetigo
    "honey" crusted lesions
  18. risk factors for impetigo
    • poor hygiene
    • malnutrition
  19. CAP drugs
    HSV lesions crust over after vesicular outbreak Impetigo starts as a crust
  20. nonpurulent cellulitis caused by what organism
    Group A streptococcus
  21. lymphangitic streaking is a sign of what
    nonpurulent cellulitis
  22. carbuncle vs abscess
    mass of infected hair follices vs pus collected in cavity
  23. symptoms of cellulitis
    • subjective fevers/chills
    • decreased appetite
    • malaise
    • pain
  24. appearance of cellulitis
    • hot, red, swollen
    • indurated
    • bullae
    • regional lymphadenopathy
    • "orange peel"
    • does not blanch on elevation
  25. stasis dermatitis is the result of
    venous insufficiency, venous hypertension
  26. which lower extremity afflictions blanch when the leg is raised
    • dependent rubor
    • stasis dermatitis
  27. which markings do not blanch when the affected limb is raised
    • cellulitis
    • vaculitis
  28. signs of necrotizing fasciitis
    • fever
    • tachycardia
    • hypotension
    • leukocytosis
    • lactic acidosis
    • red/purple skin -> gray/blue
  29. What can stop pseudomonas
    • piperacillin-tazobactam Zosyn
    • ceftazidime
    • 4th gen cephalosporins
    • carbapenem
    • quinolones
    • aminoglycosides
    • fosfomycin
    • colistin
  30. What to use against atypical agents
    • macrolides
    • tigecycline
    • tetracyclins
    • moxifloxacin
  31. what to use against anaerobes
    • Augmentin
    • Zosyn
    • cefoxitin
    • cefotetan
    • carbapenems
    • tigecycline
    • clindamycin
  32. what to use against MRSA
    Vancomycin & Linezolid
  33. Bacteriostatic drugs
    • Tetracyclines
    • macrolides
    • chloramphenicol

    clindamycin
  34. bacteriocidal drugs
    • penicillins
    • vancomycin
    • cephalosporins
    • fluoroquinolones
    • imipenem
    • aminoglycosides
  35. what bacterial lung infection is more common in smokers than non smokers
    Hemophilus influenza
  36. organisms found in the urine are frequently Gram...
    Gram Negative
  37. beta-lactam mechanism of action
    Weaken the cell wall. Works on Gram + organisms. Only bacteriocidal for growing, dividing cells.
  38. 1st generation cephalosporins: 2 examples and two types of infections it combats
    • Cephalexin, Cefazolin 
    • Gram +
    • staph/strep (2nd choice to PCN)
  39. 2nd generation cephalosporins: 2 examples, and what organisms it combats
    • cefotetan, cefoxitin
    • anaerobes, Gram +/-
  40. 3rd generation cephalosporins: 3 examples and infections it combats
    • Cefixime, ceftazidione, ceftriaxone (Rocephin)
    • Gram -
    • nosocomial infections 
    • ceftazidime - pseudomonas
  41. 4th generation cephalosporins: 2 examples, and coverage
    • Cefepime, ceftaroline
    • Pseudomonas
    • Gram - /+
  42. carbapenems: 2 examples
    Meropenem, imipenem
  43. What drug classes offer Gram +/- and pseudomonas coverage
    • carbapenems
    • 4th generation cephalosporins 
    • piperacillin-tazobactam (Zosyn)
  44. covers gram - and pseudomonas
    • Aztreonam
    • aminoglycosides
    • colistin

    also: 3rd & 4th gen c-sporins, Zosyn, carbapenems, quinolones, fosfomycin
  45. what covers Gram +/- and MRSA
    • 5th generation cephalosporins
    • TMP-SMX
    • tigecycline
  46. Tetracyclines are good for treating what infections?
    • chlamydia
    • rickettsia
    • cholera
    • h. Pylori
    • Lyme
    • CAP
  47. side effects and warnings of tetracyclines
    • Can’t be given with di- or trivalent minerals
    • causes UV hypersensitivity 
    • not for children <9 (teeth)
  48. azithromycin is good for treating what types of infections?
    Lungs. Has long t 1/2 in tissues, so not good for blood infections
  49. aminoglycosides are good choices against what microbes?
    • Pseudomonas
    • Gram -
  50. side effects and warnings of aminoglycosides
    Does not get absorbed in GI tract. Good for endocarditis. Ototoxic, nephrotoxic
  51. quinolones can cause what
    Prolonged QT interval
  52. What Antimicrobials can increase the action of warfarin?
    Ciprofloxacin, sulfonamides
  53. side effects and warnings of fluoroquinolones
    Avoid caffeine and cation supplements
  54. Which fluoroquinolone covers anaerobes
    moxifloxacin
  55. what drugs render pathogens unable to synthesize folic acid
    sulfonamides
  56. best choice for uncomplicated UTI
    Sulfonamide
  57. everything can cover Gram +s except...
    • Aminoglycosides
    • aztreonum
    • colistin
  58. most nosocomial PNA and UTI infections are Gram...
    gram negative
  59. sepsis protocol
    • Within first three hours
    • 1) measure lactate levels
    • 2) obtain blood cultures
    • 3) start broad-spectrum antibiotics
    • 4) give 30 mL/kg normal saline or lactate 
    • within first 6 hours
    • 5) vasopressors
    • 6) measure SpO2 and central venous pressure
    • 7) remeasure lactate level if originally high
  60. maintain arterial pressure
    65 or higher
  61. Primary signs of EBV
    Fever, sore throat
  62. 50% of EBV cases present with
    Splenomegaly
  63. EBV lymph nodes
    • Cervical posterior
    • Large, discrete, nonsupporative
  64. Test EBV vs CMV
    • CMV heterophile negative
    • EBV heterophile positive
  65. EBV exam findings
    • Exudative pharyngitis
    • Tonsillitis
    • Petechiae on soft palate
    • Possible maculopapular rash
  66. When should you give steroids for EBV?
    Thrombocytopenia, hemolytic anemia, airway obstruction
  67. Leukemia and lymphoma patients are more likely to get pneumonia from what pathogens?
    Fungus
  68. college students are more likely to get PNA from what pathogens, with gram stain and treatment
    • Mycoplasma - Gram positive,
    • chlamydia - Gram negative
    • Atypical PNA treated with macrolide or TCN
  69. COPD patients are more likely to get PNA from what pathogen, with gram stain and treatment
    • Haemophilus pneumoniae, Gram negative
    • macrolide (azithromycin) or fluoroquinolone (ciprofloxacin) if pt is at high risk
  70. alcoholics are more likely to get pneumonia from what pathogen, with gram stain
    Klebsiella Gram negative 
  71. elevated procalcitonin levels indicate what
    Bacterial infection (Rather than viral)
  72. how to treat PJP
    bactrim (TMP-SMX)
  73. real name of Bactrim
    trimethoprim-sulfamethoxazole
  74. PJP clinical presentation and treatment
    • fever, tachypnea, dyspnea, dry cough
    • TMP-SMX
  75. CXR of PJP
    • diffuse perihilar infiltrates, possibly bilateral
    • NO effusions
  76. s/s Kawasaki syndrome
    • Bilateral cervical lymphadenopathy
    • strawberry tongue
    • conjunctivitis
    • Fever
    • Peripheral extremity abnormalities eg desquamation
    • mucous membrane abnormalities
  77. Most common complication of Kawasaki syndrome
    Coronary artery aneurysm
  78. most common type of PNA in CF pts,
    Pseudomonas & Gram negative, aminoglycosides (if suspected drug resistant, or if hospitalized, add a beta lactam)
  79. Abx unsafe for pregnancy
    • Fluoroquinolones
    • tetracycline
  80. klebsiella presentation
    Rust colored sputum, currant jelly
  81. atypical PNA DDx
    • Mycoplasma: pharyngitis, wheezing, low grade fever, cough, possible bullous tympanic membrane - quinolone
    • Chlamydia: sore throat, hoarseness, sinusitis - azithromycin 
    • Legionella: nonspecific, diarrhea - azithromycin
  82. mycoplasma PNA PE findings and treatment
    • Low fever, cough, bullous myringitis, pharyngitis, wheezing
    • Quinolones
  83. clamydia PNA PE findings and treatment
    • Sore throat, dysphonia, sinusitis
    • Treat with azithromycin
  84. Legionella findings and treatment
    • Non specific symptoms
    • Azithromycin or other macrolide
  85. RIPE stands for what, and what are the most common side effects of treatment?
    • Rifampin - hepatitis, orange body fluids 
    • isoniazid - hepatitis
    • pyrazinamide
    • ethambutol - optic neuritis
    • Give B6 to reduce risk of peripheral neuropathy
  86. classic auscultation sign of TB
    Post tussive rales
  87. symptoms of TB
    • Progressive cough
    • night sweats
    • anorexia
    • weight loss
    • hemoptysis
  88. length of isolation for TB infection
    2 weeks after completion of treatment
  89. beta lactams with no Gram negative coverage
    • Penicillin
    • methicillin
  90. what beta lactams cover anaerobes?
    • Pip-tazo
    • augmentin
  91. Macrolide good for respiratory infections
    azithromycin
  92. vanco-resistant MRSA should be treated with what?
    Linezolid
  93. how do tetracyclines work?
    bind to ribosome and prevent tRNA binding
  94. tetracyclines are first line therapy for what diseases?
    • Rickettsial infections & Lyme
    • Rheumatoid arthritis
    • H. Pylori
    • mycoplasma PNA
    • Chlamydia
  95. treat chlamydia with what?
    tetracycline
  96. which tetracycline can treat MRSA?
    Doxycycline
  97. treat mycoplasma PNA with what?
    Tetracycline
  98. adverse effects of TCN
    • Gi irritation
    • teeth & bones
    • hepatotoxicity
    • renal toxicity
    • photosensitivity
  99. what 2 classes of antibiotics should not be given together
    • Fluoroquinolones 
    • macrolides
    • (additive effect of QT prolongation)
  100. What drugs prolong QT intervals
    • macrolides
    • fluoroquinolones
  101. 3 examples of macrolides
    • azithromycin
    • erythromycin
    • clarithromycin
  102. what macrolide is good for respiratory infections?
    Azithromycin
  103. most topical abx are in what category?
    Aminoglycosides: gentamicin, tobramycin, neomycin
  104. adverse effects of aminoglycosides
    • ototoxicity
    • nephrotoxicity
  105. three examples of fluoroquinolones
    • ciprofloxacin
    • levofloxacin
    • moxifloxacin-only one that can combat aerobes
  106. Adverse effects of ciprofloxacin
    • Candida infection,
    • seizures,
    • tendon rupture
  107. uncomplicated UTIs can be treated with what?
    Sulfonamides
  108. adverse effects of sulfonamides
    • Hemolytic anemia
    • Stevens-Johnson 
    • renal damage
  109. sulfonamides amplify what other drugs?
    • warfarin
    • phenytoin,
    • Oral hypoglycemic
  110. TMX-SMZ is first line treatment for what?
    • Whooping cough
    • brucellosis
    • otitis media
    • bronchitis
  111. what drug treats Protozoa and obligate anaerobes
    Metronidazole
  112. drug interactions of metronidazole
    ETOH
  113. nitrofurantoin brand name and what it’s used to treat
    • Macrobid
    • lower UTIs
  114. good for pseudomonas
    • Ceftazidime
    • pip-tazo
    • Carbapenems
    • quinolones
    • aminoglycoside
    • fosfomycin
    • colistin
  115. what two cephalosporins cover anaerobes?
    • cefoxitin
    • cefotetan
  116. CAP drugs
    • Levaquin
    • DCN
    • Moxifloxacin
Author
ketch22
ID
337906
Card Set
ID 2 - Ddx & treatment
Description
differential diagnosis and treatment of infectious disease
Updated