Opportunistic Infections
Hospital acquired infections
Organ based
Outpatient
100

Name 3 reasons a patient can be susceptible to opportunistic infection

uncontrolled diabetes, cancer, HIV, organ transplant patients, severely malnourished pt

100

What is the importance of monitoring vancomycin levels inpatient?

pharmacy measures the peaks and troughs to ensure the vancomycin levels are therapeutic and not nephrotoxic

100

Henry loves the hospital so much, he decides to build an entire wing so that he can live there. He remembers someone saying something about treatment for pneumonia. how does treatment differ from communiy acquired pneumonia to health care associated?

CAP: azithromycin /dozy

HCAP: multidrug resistant pathogens like Pseudomonas, klebsiella require cefepime, piperacillin/tazobactam, or respiratory fluoroquinolone

if MRSA, use vancomycin or linezolid

100

Raisa comes in with cough and muscle aches lasting 2 days. She denies any sick contacts. There are no exudates in her throat. What is the treatment and why

supportive care, likely viral

200

What is the treatment for recurrent C. Diff?

consider fecal transplant

Vancomycin orally 500mg QID for 10 days

consider cholestyramine

200

78 year old female with a BMI of 17 comes in from the nursing home with nonspecific fever, chills and FTT. Vitals 70/90, HR 100 and temp 96. After a few days of broad spectrum antibiotics, blood cultures are not back yet and patient remains on pressors. What is the next treatment?

Consider antifungals, get procal and fungitell.

200

Gus and Gul go on a trip to the caves in Mississippi. They both have a huge sweet tooth and refuse to listen to their endocrinologist, Dr. Jarugula. A few weeks later, they both notice red bumps on their shins. Name the sickness

Histoplasmosis!

200

Raad hasn't been feeling good the last few weeks. He goes to his favorite IM doctor Dr. Nathanson and is diagnosed with Pneumona. Name the first line treatment for pneumonia

Azithromycin, doxycycline, some may say moxifloxacin...

300

Arhum has been spending a lot of time working in the needle exchange program, trying to save the world. He's in line for the next nobel prize if you can name three opportunistic infections commonly associated with HIV/AIDS

PCP pneumonia, CMV, oral hairy leukoplakia, HSV encephalitis

300

Which organism commonly causes CLABSI?

Staph aureus / coagulase negative staph

300

Name two pathogens that can cause endocarditis and the valves they typically invade

Staph Aureus: mitral and aortic

Strep Viridans: mitral (dental procedures)

Enterococcus: mitral

Strep Bovis: tricuspid, can be from colonic tumors

Staph epi: Prosthetic valves


300

Outpatient treatment of cellulitis, when to hospitalize. include non-MRSA and MRSA

Staph: purulent, tx with cephalexan, dicloxacillin. Bactrim if allergy

MRSA: bactrim, amoxicillin, clindamycin, linezolid

pain out of proportion to exam findings, rapidly progressing, fever, chills, stiff muscle (compartment syndrome)

400

What is the primary antiretroviral class used in treatment of HIV?

Protease inhibitors and integrase inhibitors (emtricitabine, efavirenz, tenofovir, retrovir, epivir, doravirine)

400

Matt is a retired 99 year old man that has an infection that's being treated with cefepime. In his old, healthy age, what are the adverse effects of cefepime to look out for?

headache, dizziness, confusion

neutropenia, elevated BUN/Creatinine

Liver enzyme elevations

400

What are the types of necrotizing fascitis?

Type 1: Polymycrobial

Type 2:Group A strep 

Type IV: fungal cases (rare)

400

40 year old  Ronak presents with recurrent heartburn and has started having trouble swallowing. He takes omeprazole daily with no relief. What is the quadruple therapy he needs to be on? He is allergic to penicillin

PPI

Metronidazole

Clarithromycin

Bismuth Salicylate

500

Dr. Turfe, in his old age, is a 86 year old male with a recent A1C of 13 and undergoing systemic chemotherapy for colon cancer, diagnosed by his long time friend and colleague Dr. Dourra. He starts having black spots on his nose and face. What does he have and what is the treatment?

mucormycosis

tx: amphotericin B and RADICAL surgical debridement


40-50% mortality rate

500

Dr. Mansour is working on improving his 200 bed ICU. He asks, how can you prevent a CAUTI and CLABSI?

don't draw cultures on the line!

(just kidding)

500

22 year old female  Henna presents in the springtime with heart palpitations lasting about a day. She went camping recently and has a rash on her ankles, wrists, palms and soles. Pt also has a low grade fever, muscle aches and joint pain. Upon further questioning, she states she went camping in Toronto over a week ago. Name the diagnosis and treatment.

Rocky mountain spotted fever

Doxycycline

500

Describe the difference between Bacterial vaginosis and vaginitis. Please include features, microscopic findings and treatment.

BV: overgrowth of bacteria, with thin grayish white discharge "fishy". pH of >4.5, clue cells on microscopy. Tx with metronidazole 500mg oral twice daily for 7 days


Vaginitis: thick white discharge, itching, redness. Pseudohyphae on microscopic exam, tx with fluconazole 150mg orally as single dose.