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105 Cards in this Set
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- Back
Meningitis in 0-6 mos
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GBS
E.coli/Gram neg rods Listeria |
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Meningitis in 6 mo - 6 yo
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S. pneumonie
H. influenza B Neisseria meningitis Enterovirus |
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Meningitis in 6 -60yo
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S. pneumonie
N. meningitis Enterovirus HSV |
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Meningitis in elderly >60yo
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S. pneumonie
N. meningitis Listeria Gram neg rods |
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Diagnostic test for legionella
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urine legionella antigen
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diagnostic test for mycoplasma
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serum cold agglutinins and serum mycoplasma antigen
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diagnostic test for strep pneumo
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urine pneumococcal antigen
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UTI
(Main organism and empirical Abx to tx) |
E. coli
TMP-SMZ, nitrofurantoin, amoxicillin, quinolones |
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Bronchitis
(Main organism and empirical Abx to tx) |
Virus: no abx
Haemophilus influenza: Azithromycin/Erythromycin (macrolides "-mycin") Moraxella: either watchful waiting, quinolone (ciprofoxacin, "-floxacin"), erythromycin |
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Classic pneumonia
(Main organism and empirical Abx to tx) |
Strep pneumo, H.influenza
azithromycin, 3rd gen cephalosporin (ceftriaxone,etc) |
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Atypical pneumonia
(Main organism and empirical Abx to tx) |
Mycoplasma, Chlamydia
Macrolide (azithromycin, "-mycin"), doxycycline |
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Osteomyelitis
(Main organism and empirical Abx to tx) |
Staph aureus, Salmonella
Oxacillin, cefazlin, vancomycin |
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Cellulitis
(Main organism and empirical Abx to tx) |
Stretococci, staphyloccoci
Cephalexin, dicloxacillin If suspect MRSA: clindamycin or TMP-SMZ |
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Meningitis in neonate
(Main organism and empirical Abx to tx) |
Group B Strep, E.coli, Listeria
Ampicillin + aminoglycoside (streptomycin/amikacin/gentamicin/tobramicin), cefotaxime |
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Meningitis in child/adult
(Main organism and empirical Abx to tx) |
Strep pneumoniae, Neisseria meningitidis
*H. influenza if the child is NOT VACCINATED Cefotaxine or ceftriaxone + vancomycin |
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Endocarditis
(Main organism and empirical Abx to tx) |
Staphylcocci and streptococci
Dicloxacillin/methicillin (antistaph penicillin) or vancomycin + aminoglycoside (strepomycin/amikacin/gentamicin/tobramicin) |
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Sepsis
(Main organism and empirical Abx to tx) |
Gram-negative organisms, streptococci, staphylococci
3rd gen cephalosporin (ceftriaxone) or 3rd gen penicillin (ticarcillin/carbicillen) + aminoglycoside (strepomycin/amikacin/gentamicin/tobramicin), or imipenam |
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Septic arthritis (monogamous/nonsex vs sexually active young pt)
(Main organism and empirical Abx to tx) |
monogamous pt: staph aureus
sexually active pt: n. gonorrhea Vancomycin Ceftazidime/ceftriaxone: for gram neg Gonococci: ceftrixone, ciprofloxacin, or spectinomycin |
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Empiric abx for:
Strep A or B |
Penicillin, cefazolin
Alt: Erythromycin |
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Empiric abx for:
S. pneumoniae |
3rd gen cephalosporin + vancomycin
Alt: Fluoroquinolone |
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Empiric abx for:
Enterococcus |
Penicillin/ampicillin + aminoglycoside (amikacin/strepomycin/gentamicin/tobramicin)
Alt: Vancomycin + aminoglycoside |
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Empiric abx for:
Staph Aureus |
Methicillin
Alt: Vancomycin if MRSA |
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Empiric abx for:
Gonococcus +Additional step? |
Ceftriaxone or cefixime
Alt: Spectinomycin ADDITIONALLY, tx for chlamydia: doxycycline |
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Empiric abx for:
Meningococcus |
Ceftriaxone or cefotaxime
Alt: Pencillin G (if susceptible to pencillin) or chloramphenicol |
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Empiric abx for:
Haemophilus |
2nd gen cephalosporin (cefoxitin, ceflaclor) or 3rd gen (ceftriaxone/cefixime)
Alt: ampicillin |
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Empiric abx for:
Pseudomonas |
Ticarcillin/pipercillin + clavulanate/tazobactam (beta lactamase inhibitor)
Alt: ceftazidime, cefepime (4th gen), imipenemm, cipro |
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Empiric abx for:
Bacteroides |
Metronidazole
Alt: Clindamycin |
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Empiric abx for:
Mycoplasma |
Erythromycin, azithromycin
Alt: doxycycline |
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Empiric abx for:
Treponema pallidum |
Penicillin
Alt: Doxycycline |
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Empiric abx for:
Chlamydia |
Doxycycline, azithromycin
Alt: erythromycin, ofloxacin |
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Empiric abx for:
Lyme disease/Borrelia burgdorfei |
Doxycycline, amoxicillin, cefuroxime (2nd gen)
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Gram stain blue/purple = ?
Gram stain red = ? |
Blue/purple = gram positive
Red = gram neg |
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Gram + cocci in chains
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Streptococci
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Gram + cocci in clusters
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Staphyloccoci
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Gram + cocci in pairs (diplococci)
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Strep pneumoniae
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Gram neg coccobacilli (small rods)
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Haemophilus
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Gram neg diplococci
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Neisseria (STD, septic arthritis, meningitis)
Moraxella (lungs, sinusitis) |
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Gram neg rod with thick capsule (mucoid appearance)
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Klebsiella
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Gram + rods that form spores
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Clostridium
Bacillus |
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Pseudohyphae
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Candida
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Acid fast organism
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Mycobacterium (usually M. tuberculosis)
Nocardia (weakly acid fast) |
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Gram + with sulfur granules
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Actinomyces (PID in IUD users, rarely case neck mass or cervical adenitis)
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Silver staining
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Pneumocystis jirovecii
Cat scratch dz (bartonella henselae) |
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Positive India ink (thick capsule)
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Cryptococcus neoformans
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Spirochete
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Treponema (syphilis)
Leptospira [above 2 seen on dark field microscopy] Borrelia (seen on regular light microscope) |
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Stuck with thorn/gardening
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Sporothrix schenckii
Tx with ketoconazole or oral potassium (K) iodide |
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Aplastic crisis in sickle cell dz
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Parvovirus B19
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Sepsis after splenectomy
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SHiN
S. pneumoniae H. influenzae N. meningitis (encapsulated bugs) |
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Pneumonia in southwest (CA, arizona)
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Coccidioides immits
Tx: itraconazole or fluconazole Amphotericin B if severe |
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Pneumonia in Ohio/mississippi river
Or after cave exploring/bird droppings |
Histoplasma capsulatum
Tx: Mild pulm dz: itraconazole or supportive Chronic pulm dz (cavitation on CXR): itraconazole x >1yr Disseminated dz (HSM, palatal ulcers, pancytopenia): Liposomal amphotericin B x 2 yrs, then itraconazole x life |
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Pneumonia after exposure to parrot/exotic bird
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Chlamydia psittaci
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Fungus ball/hemopytsis after TB or cavitary lung dz
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Aspergillus sp
Tx: voriconazole |
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Pneumonia in miner/sandblaster (silicosis)
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TB
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Diarrhea after hiking/drinking from a stream
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Giarda lamblia
Dx: stool cysts Tx: metronidazole |
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Pregnant woman with cats
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Toxoplasma gondii
Dx: peripheral blood smear shows trophozoites Tx: spiramycin |
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B12 deficiency and abd sx
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Diphyllobothrium latum
Could tx with praziquantal |
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Seizures with ring-enhancing brain lesions on CT
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Taenia solium (cysticercosis)
Tx: albendazole or praziquantel + steroids Also toxoplasmosis; tx with pyrimethamine or clindamycin Tx: anticonvulsants |
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Squamous cell bladder cancer in Middle east or Africa
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Schistosoma haematobium
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Worm infxn in children
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Enterobius
Dx: positive tape test; pt complains of perianal itching Tx: mebendazole or albendazole |
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Fever + muscle pain + eosinophilia + periorbital edema after eating raw meat
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Trichinella spiralis (pork worm)
Dx: muscle bx Tx: mebendazole or albendazole if serious, usually self-resolves |
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Gastroenteritis in young kids
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Rotavirus
Norwalk virus |
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Food poisoning after eating reheated rice
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Bacillus cereus
self-limited |
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Food poisoning after eating seafood
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Vibrio parahaemolyticus
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Diarrhea after travel to Mexico
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E.coli
Tx: ciprofloxacin (entertoxic e.coli is the usual cause of traveler's diarrhea) |
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Tx for clostridium difficle
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Metronidazole or vancomycin
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Baby paralyzed after eating honey
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Clostridium botulinum
Tx: antitoxin |
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Genital lesions on kid without sexual abuse/activity
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Molluscum contagiosum (spread from hand to peepee bc they touch it)
(By DNA poxvirus); warts, self-resolves |
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Cellulitis after cat/dog bites
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Pasteurella multicoda
Ppx tx: amoxicillin-clavulanate |
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Slaughterhouse worker with fever
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Brucellosis
Tx: streptomycin and doxycycline |
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Pneumonia after being in hotel/cruise ship/air conditioner/water tower
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Legionella pneumophilia
Tx: azithromycin or levofloxacin |
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Burn wound infxn with blue/green color
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Pseudomonas
(S. aureus also in burn but not blue/green) |
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Tx for acute pharyngitis with 3/4 Centor criteria
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Center criteria for group A beta-hemolytic strep pyogenes:
1. fever 2. tonsillar exudate 3. tender anterior cervical LAD 4. lack of cough Tx with penicillin x 10 days |
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Lemierre's syndrome
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complication of group A strep pharyngitis
thrombophlebitis of the jugular vein |
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Sinusitis dx and tx
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Dx: CT scan
Tx: - usually self-limited if viral - acute bacterial: amoxicillin/clavulanate or TMP-SMZ |
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Postviral/influenza pneumonia organism
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Staph aureus
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Meningitis vs encephalitis sx
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meningitis: fever, HA, neck stiffness, photophobia
encephalitis: fever, HA, seizures, AMS |
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ppx for close contacts of pt with meningococcal meningitis
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rifampin
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pt with encephalitis sx with RBCs in CSF with h/o trauma
what will be on MRI? |
HSV encephalitis
increased temporal lobe signaling start IV acyclovir asap |
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CMV encephalitis tx
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IV ganciclovir +/- foscarnet
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young male pt with paranasal sinusitis, then with brain abscess, what is the organism?
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strep miller
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empiric tx for bacterial meningitis in <1 mo
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ampicillin + cefotaxime/gentamicin
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empiric tx for bacterial meningitis in 1-3 mo
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IV vancomycin + ceftriaxone /cefotaxime
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empiric tx for bacterial meningitis in 3 mos - adulthood
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IV vancomycin + ceftriaxone/cefotaxime
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empiric tx for bacterial meningitis >60 yo/alcoholism/chronic illness
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Ampicillin + vancomycin + ceftriaxone/cefotaxime
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HIV ppx levels
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<200, against PCP; 1x TMP-SMZ
<100, against MAC; weekly azithromycin <50, against toxoplasma; 2x TMP-SMZ |
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AIDS pathogens
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The Major Pathogens Concerning Complete T-Cell Collapse
(Toxic MAC PCP Canada Crypt neo, TB CMV, crypt parvo) Toxoplasma gondii MAC PCP Cryptococcus neo CMV TB Candidasis Crypt parvum |
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Tx for candida
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Esophagitis: fluconazole
Oral: nystatin swish and swallow |
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S. pneumoniae ppx in AIDS pt
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Pneumovax q5yrs when CD4>200
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Pseudohyphae + budding yeast
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Candida
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45 angle branching septae hyphae + rare fruiting bodies
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Aspergillus
fruity ass at a cute (45) angle |
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Yeasts with wide capular halo, narrow-based unequal budding
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Cryptococcus
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Irregular broad, nonseptate, hyphae, wide-angle branching
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Mucor
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AIDS + pigeon droppings; HA/fever without meningitis signs
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Dx: CSF cryptococcal antigen, or India stain
Tx: IV amphotericin B + flucytosine x2 wk, fluconazole for life |
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HIV pt with nonproductive cough + dyspnea
also check what else? |
Pneumocystis carinii pneumonia (PCP)
check for PaO2 (it will be very low) Tx: high dose TMP-SMZ x 3 wks + predisone taper if PaO2 <70 |
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Disseminated dz in HIV pts CD4<50; fever weight loss and HSM/LAD in pts not on HAART therapy
clinical lab findings |
MAC
Lady windermere syndrome: the pulmonary form in healthy nonsmokers Lab: increased alk phos and LDH foamy macrophages with acid-fast bacilli Tx: clarithromycin if not in HAART |
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Lyme dz vs Rocky Mt Spotted Fever
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Lyme: target ("bull's eye"; erythema migrans); can get Bell's palsy and arthritis and encephalitis
- mostly in Wisconsin and the northeast states near Maine Rocky mt (by Rickettsia rickettsii): macular (spotty) rash at wrists and ankles and become itchy and spread centrally - midsouth states like Alabama/OK Tx both with doxycycline |
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CXR finding for inhaling anthrax
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Widened mediastinum
tx: ciprofloxacin |
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Pathogen in swimmer's ear (otitis externa)
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Pseudomonas
Ear drops of strepmycin/amikacin/tobramicin (aminoglycosides) |
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Osteomyelitis in pt with no risk factors
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S. aureus
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Osteomyelitis in IV drug user
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Pseudomonas or S. aureus
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Osteomyelitis in sickle cell dz
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Salmonella
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Osteomyelitis in hip replacement
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Staph epidermis
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Osteomyelitis in foot puncture wound
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Pseudnomonas
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Chronic osteomyelitis
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S. aureus, pseudomonas, Enterbacteriaecae
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Diabetic with osteomyelitis
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Polymicrobial, pseudomonas, S. aureus, streptococci, anaerobes
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