163.3 🩺 內科專科考前版

163.3.0.1 1⃣ Hib Vaccine Schedule (Taiwan)

  • 2/4/6 mo + booster 18 mo
  • 公費 (NIP)
  • ç„¡è„Ÿ, immunocompromise — booster 埌幎霡 if not previously vaccinated
  • Catch-up to 5 yr if unvaccinated

163.3.0.2 2⃣ Post-Vaccine Era Epiglottitis

  • Adult > child now (incidence shifted)
  • 涵蓋 broader pathogens: GAS, S. aureus, S. pneumo, NTHi
  • Empirical: ceftriaxone + vanco (community), broaden if hospital risk
  • 即䜿 vaccinate 埌 NTHi 可胜

163.3.0.3 3⃣ COPD Exacerbation Microbiology

  • ~ 50% bacterial cause; remaining viral / non-infectious
  • NTHi most common (~ 30%), M. catarrhalis (~ 15%), S. pneumoniae (~ 15%)
  • Pseudomonas in severe COPD with FEV1 < 50%, frequent abx, hospitalize
  • Treatment: amox-clav, FQ, macrolide (Anthonisen criteria)

163.3.0.4 4⃣ HACEK IE Update

  • Gone from “culture-negative” to identifiable
  • 5-7 day automated systems detect most
  • ESC 2023 / AHA 2024: ceftriaxone 2 g q24h × 4 wk (native) — once-daily, often OPAT
  • 替代: amp-sulbactam, FQ
  • Endocarditis general workup: TEE, surgical consult if vegetation > 10 mm, abscess, HF

163.3.0.5 5⃣ Chancroid + HIV

  • Genital ulcers (chancroid, HSV, syphilis) → HIV transmission risk ↑
  • HIV ↑ chancroid prevalence + slower healing
  • 倚 ulcer / atypical → think HIV co-infection
  • Always test HIV + syphilis + HSV + Chlamydia/LGV

163.3.0.6 6⃣ Moraxella catarrhalis 鑑別 Neisseria

項目 Moraxella catarrhalis Neisseria
Sugar fermentation None Glucose ± maltose
DNase + -
Growth 22°C + -
Tributyrin hydrolysis + -

163.3.0.7 7⃣ Streptobacillus moniliformis + Rat-bite Fever

  • (Not Haemophilus but related差別 fastidious gram-)
  • Rat bite / contact / unpasteurized milk
  • Fever + 玅疹 + polyarthralgia (Haverhill fever)
  • PCN G or doxycycline × 7-14d