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Boards Infectious Dz

Stuff I should know

Normal body temperature range 97-99.5F
Maximum body temperature before risking irreversible brain damage 106.8F
Definition of fever of unknown origin Temp of >101.8 for 3 weeks with no discernible cause
Most common causes (2) of fever of unknown origin Infection, multisystem disease (autoimmune, neoplasm)
Aspirin products should be avoided in children because of what syndrome? Reyes syndrome
Streptococci: gram type Gram positive
Distinguishing microbiological tests of streptococci Catalase positive, and alpha/beta/gamma hemolytic
Most common type of streptococci? Group A Beta hemolytic
S&S of strep pharyngitis Sore throat, painful swallowing, fever, chills, cervical lymph node enlargement, pharyngeal mucosa edema and hypertrophy, erythema and exudates
Description of scarlet fever Strep throat + rash. Face flushing, circumoral pallor, strawberry tongue
Description of scarlet fever rash "Sunburn with goosebumps". Diffuse erythema that blanches with fine red papules that may be appreciated only by touch (sandpaper rash)
Cause of Scarlet fever Streptococci
Cause of Erysipelas Group A Strep
Description of Erysipelas Painful macular rash with well defined margins, usually confined to the face, abrupt onset with rapid progression, desquamates in 5-10 days
Causes of Impetigo (2)? Strep pyoderma and staph
Thick, crusted golden "honey" yellow lesions indicates what diagnosis? Impetigo
Most common cause of cellulitis? Group A Strep
Cellulitis is common in what patient population (3 conditions/diseases)? Lymphedema, venous stasis, venous grafts
Causes of necrotizing fasciitis? Polymicrobial (GAS, clostridium, bacteroides, E.coli, Klebsiella, Enterobacter, Proteus)
Description of cellulitis? Local swelling, erythema, and pain. Skin is pink and indurated
Treatment of cellulitis? Vancomycin vs. Cefotaxime vs. Gentamicin vs. surgical debridement
Description of necrotizing fasciitis? Swelling, heat, erythema, pain spreading proximal to distal. The skin darkens, and blisters and bullae with clear yellow fluid form
Cause of toxic shock syndrome? Streptococci
S&S of toxic shock syndrome? Abrupt onset of severe pain, fever/hypothermia, confusion, combativeness, coma, shock, and multiorgan failure
What is an ominous sign of toxic shock syndrome? Violaceous/blue vesicular or bullous rash
Lab findings of toxic shock syndrome? Leukocytosis with severe left shift, low platelets, hemoglobinuria, elevated serum creatinine, low albumin, low calcium
Acute rheumatic fever follows infection from what organism? Strep (pharyngitis)
Possible complications of acute rheumatic fever (3)? CHF, rheumatic pneumonitis, rheumatic heart disease
Most common complication of acute rheumatic fever? Valvular defects
Are prophylactic antibiotics recommended before invasive procedures in patients with a history of rheumatic heart disease? No
The Centor criteria is used for what type of infection? Strep pharyngitis
The Centor critera involves what 4 conditions? Tonsillar exudates, absence of a cough, tender anterior lymphadenopathy, history of fever
Treatment for group A strep? Penicillins, cephalosporins, macrolides if PCN allergy
Distinguishing microbiological tests of Clostridium botulinum? Anaerobic, spore-forming bacillus
What is the physiological effect of botulinum toxin when ingested in humans? Inhibits Acetylcholine release at the neuromuscular junction
Initial clinical symptoms of botulinum toxin poisoning? Visual changes: diplopia, loss of accomodation
Clinical manifestations of botulinum toxin poisoning? Visual changes, ptosis, impaired EOMs, fixed dilated pupils, cranial nerve palsies, dysphonia, dry mouth, dysphagia, nausea, and vomiting. Respiratory paralysis
Labs for botulinum toxin poisoning? Antiserum after mouse inoculation with the patient's serum
Botulinum toxin poisoning treatment? Antitoxin
Gram type of Bacillus anthracis? Gram positive
Distinguishing microbiological tests of Bacillus anthracis? Spore-forming, gram positive, aerobic rod
Populations at high risk of Bacillus anthracis/ anthrax? Farmers, veterinarians, tannery workers, wool workers
Transmission route of Bacillus anthracis? Inoculation of broken skin, mucous membranes, inhalation.
Where is Bacillus anthracis naturally found? In sheep, cattle, horses, goats, and swine
Dermatologic S&S of anthrax? Erythematous papule at site of inoculation, becomes vesicular with purple-to-black center that necroses and sloughs. Regional adenopathy, fever, malaise, HA, nausea and vomiting may occur. Sepsis and hemorrhagic meningitis may also occur.
Pulmonary S&S of anthrax? Fever, HA, malaise, dyspnea, cough, congestion. Later pneumonia and mediastinitis within hours or days.
GI S&S of anthrax? Ingestion of contaminated meat may cause fever, diffuse abdominal pain, rebound tenderness, vomiting, change in bowel habits, ulcerations and associated complications.... GI manifestations not reported in US.
Labs for bacillus anthracis? Sputum/blood/CSF/skin lesion cultures; CXR
Treatment for Bacillus anthracis? Fluoroquinlone/ Ciprofloxacin. Alternative is doxycycline
Prognosis for the 3 types of anthrax poisoning (cutaneous, GI, inhalation)? Cutaneous: excellent. GI and inhalation: poor
What is the physiological effect of Vibrio cholerae toxin? It activates adenylyl cyclase in the small intestine = hypersecretion of water and chloride ion = massive diarrhea
Sudden onset of severe, frequent "rice water" diarrhea warrants suspect of what causative organism? Vibrio cholera
S&S of cholera? Sudden onset of severe/frequent "rice water" diarrhea (gray, turbid, without odor/blood/pus), dehydration, hypotension, electrolyte imbalance
Lab tests for cholera? Stool cultures
Treatment for cholera? Rehydration, electrolyte replacement, Tetracycline/ampicillin/chloramphenicol/ TMP-SMX/fluoroquinolones
How often are boosters needed for cholera vaccine? Every 6 months
Where are Clostridium tetani spores found naturally? In the soil
What is the physiological effect of Clostridium tetani? Bacteria produce a neurotoxin that interferes with neurotransmission at spinal synapses of inhibitory neurons = uncontrolled spasm and exaggerated reflexes
What type of wounds are most susceptible to Clostridium tetani inoculation? Puncture wounds
S&S of tetanus? Pain/tingling at site of inoculation with muscle spasticity nearby, jaw and neck stiffness, dysphagia, irritability, hyperreflexia, muscle spasms, painful tonic convulsions, spasm of glottis and respiratory muscles, asphyxia.
Treatment for tetanus? IM tetanus immune globulin, followed by tetanus toxoid once recovered. Bed rest, sedation, and mechanical ventilation + Penicillin
When should tetanus boosters be given? Every 10 years or after a major injury if it has been more than 5 years since last booster
A patient presents with history of stepping on a nail. They report their last tetanus shot was given 7 years ago. Should they be given a booster? Yes; boosters should be administered after a major injury if last booster was more than 5 years ago
Causative organism of typhoid fever? Salmonella
Incubation period of Salmonella-induced enteric fever/ typhoid fever 5-14 days
S&S of typhoid fever? Insidious onset, Prodrome of malaise, HA, cough and sore throat. Abdominal pain, distention, constipation, and "pea soup" diarrhea with increasing fever. A pink papular rash develops during 2nd week on trunk
Pt presents with 7 day history of abdominal pain, pea soup diarrhea and increasing fever. A pink papular rash appeared on the trunk during day 9 as fever began to subside. What diagnosis should be suspected? Typhoid fever/ Enteric fever by Salmonella
Physical exam findings of typhoid fever? Splenomegaly, abdominal distention and tenderness, bradycardia, pink papular rash on trunk
Lab tests for typhoid fever? Blood culture if obtained during first week of illness only.
Complications of typhoid fever (10)? Intestinal hemorrhage, urinary retention, pneumonia, thrombophlebitis, myocarditis, psychosis, cholecystitis, nephritis, osteomyelitis, meningitis
Treatment for typhoid fever? Ampicillin/chloramphenicol/TMP-SMX (but resistance is increasing). Alternative: Ceftriaxone/ fluoroquinolones. Treat for 2 weeks
Three patterns of Salmonella infection? Enteric fever/typhoid fever, Gastroenteritis, Bacteremia
Most common form of Salmonella infection? Gastroenteritis
Lab test for Salmonella-induced gastroenteritis? Stool culture
Salmonella bacteremia is most common in what patient population? Immunocompromised
S&S of Salmonella bacteremia? Prolonged/recurrent fever, local infection of bone/joints/pleura/pericardium/lungs etc.
Treatment for Salmonella bacteremia? Ampicillin/chloramphenicol/TMP-SMX (but resistance is increasing). Alternative: Ceftriaxone/ fluoroquinolones. Treat for 2 weeks
Causative organism of dysentery? Shigella
Pt presents with abrupt onset of bloody-mucus diarrhea, lower abdominal cramps, and tenesmus, accompanied by fever, chills, anorexia, HA, and malaise. What is a likely diagnosis? Dysentery- Shigella
Describe the S&S of dysentery? Abrupt onset of bloody-mucus diarrhea, lower abdominal cramps, and tenesmus, accompanied by fever, chills, anorexia, HA, and malaise.
Lab studies for dysentery/Shigella? Stool culture, stool positive for leukocytes/RBCs
Treatment for dysentery/Shigella? Fluid replacement, TMP/SMX. May substitute cipro/fluoroquinolone.
Transmission route of Corynebacterium diphtheriae? Respiratory secretions
What is the physiological effect of Corynebacterium diphtheriae? The bacteria produces an exotoxin that causes myocarditis and neuropathy of cranial nerves
S&S of diphtheria- nasal infection? Nasal discharge
S&S of diphtheria- laryngeal infection? Upper airway and bronchial obstruction
S&S of diphtheria- pharyngeal infection? Gray membrane covering tonsils and pharynx, mild sore throat, fever, and malaise
What is the most common form of diphtheria? Pharyngeal infection
Lab study for diphtheria? Culture
Treatment for diphtheria? Horse serum antitoxin + Penicillin/Erythromycin. Isolate patient until 3 negative pharyngeal cultures are documented.
Diphtheria prophylaxis? DTaP or Td
Microbiological characteristics of Pertussis? Gram negative pleomorphic bacillus
Reservoir for Bordetella pertussis? Humans only
Populations of highest Bordetella pertussis infection? Premature infants, and pt's with cardiac/ pulmonary/neuromuscular disorders
3 stages of Bordetella pertussis infection? Catarrhal, Paroxysmal, Convalescent
Describe the Catarrhal stage of Bordetella pertussis infection? 1st stage; Most infectious stage; insidious onset of sneezing, coryza, loss of appetite, malaise, hacking cough worse at night
What is the most infectious stage of Bordetella pertussis? The 1st stage- Catarrhal
Describe the Paroxysmal stage of Bordetella pertussis? Spasms of rapid coughing followed by deep high pitched inspiration (the whoop). Paroxysms may last several minutes
Infants with Bordetella pertussis are at risk of what respiratory condition? Apnea
Describe the convalescent stage of Bordetella pertussis infection? Paroxysms decrease in frequency and severity. Begins 4 weeks after onset of cough, may last for weeks
A pt presents with a cough lasting more than 2 weeks. What diagnosis should be considered? Bordetella pertussis
Lab tests for Bordetella pertussis? Culure, lymphocytosis
Treatment for Bordetella pertussis? Erythromycin is DOC
Pertussis vaccine for adults? Tdap
Pertussis vaccine for children? DTap
Epstein-Barr Virus transmission route? Saliva
Cause of mononucleosis? Epstein-Barr Virus
Burkitt's lymphoma (rare and aggressive form of non-hodgkin's lymphoma) is associated with what common virus? Epstein Barr
S&S of mononucleosis (5)? Fever, sore throat, exudative pharyngitis/ tonsillitis/ gingivitis, soft palate petechiae, posterior cervical lymph node enlargement
Serious, common, unique sign of mononucleosis? Splenomegaly (50% of cases)
Most common complications (2) of mononucleosis? Bacterial (commonly strep) pharyngitis, splenic rupture
A false positive VDRL or RPR test for syphilis may occur with what viral illness? Epstein Barr
Labs (8) in Epstein Barr infection? Early granulocytopenia followed by lymphocytic leukocytosis, +/- hemolytic anemia, +/- thrombocytopenia, heterophile antibodies and mononucleosis positive test within 4 weeks, increased hepatic aminotransferases, increased bilirubin
Epstein Barr virus treatment Symptomatic; non-aspirin antipyretics and anti-inflammatories
Treatment for thrombocytopenia, hemolytic anemia, or airway obstruction secondary to enlarged lymph nodes in mononucleosis? Steroids
Cause of common skin warts? HPV types 1 and 4
Cause of condyloma accuminata (anogenital warts)? HPV types 6 and 11
Cancer likelihood with condyloma accuminata? Rare unless immunocompromised
Cause of cervical warts? HPV types 16 and 18
Vaccine for HPV (Gardasil) protects against which types? 6, 11, 16, and 18
Recommended age to initiate Gardasil vaccine? 11-12 y.o. females
Approved ages to receive Gardasil vaccine? 9-26 y.o. females
Labs for HPV? Histologic sampling
Definitive diagnostic lab for HPV? Histologic sampling
Treatment options (7) for HPV (for persistent lesions or cosmetically bothersome or in immunocompromised pt's)? Liquid nitrogen, salicylic acid, podophyllum, topical interferon (Imiquimod/Aldara), dissection, electrocautery, CO2 laser
Transmission route of HSV type 1? Saliva
Precipitating factors (5) of HSV outbreaks? Sun exposure, surgery, stress, fever, viral infection
Cause of genital herpes lesions? HSV Type 2
Transmission route of HSV type 2? Sexual contact or mother's genital tract during delivery
Common dorsal root ganglia in which HSV1 remains latent? Trigeminal nerve
Common dorsal root ganglia in which HSV2 remains latent? Sacral root
Cause of acute herpetic gingivostomatitis? HSV1
Common age of herpetic gingivostomatitis? 6mo-5yrs
A 3 yo boy presents with history of fever and anorexia, with painful red, swollen vesicles and ulcers on oral mucosa, tongue, and lips. What is the most likely diagnosis? Acute herpetic gingivostomatitis?
Cause of acute herpetic pharyngotonsillitis? HSV1
Common age of herpetic pharyngotonsillitis? Adults
A 32 yo male presents with history of fever, malaise, HA, and sore throat with painful vesicles and shallow ulcers on posterior pharynx and tonsils. What is the most likely diagnosis? Herpetic pharyngotonsillitis
A 32 yo male presents with history of fever, malaise, HA, and sore throat with painful vesicles and shallow ulcers on posterior pharynx and tonsils. You suspect herpetic pharyngotonsillitis. What other feature do you expect to find on oral exam? Grayish exudate over posterior mucosa
HSV2-induced genital herpes is more severe in males/females? Females tend to have more severe disease with higher rates of complication
Typical location for HSV1? Vermillion border
Typical locations (4) for HSV2? Genital area (penile shaft, labia, perianal area, buttocks)
Average recurrence rate of HSV1? Twice per year, episodes decrease with time
Maximum shedding of HSV1 occurs within what time frame of eruption? First 24 hours
Herpes infection near eye warrants further evaluation from who/ what are you concerned about? Ophthalmology; concerned about blindness via optic nerve infection... keratoconjunctivitis
Maternal concerns if initial genital herpes infection? Disseminated infection and maternal mortality
Infant concerns if initial genital herpes infection of mom? Visceral and CNS infection, high mortality and sequelae rates
Labs for herpes infection? Culture/stain of vesicular fluid (Tzank smear), serum PCR for antibodies
Test of choice for herpes and results seen? Tzank smear shows multinucleated giant cells
Treatment for herpes? Antivirals- Acyclovir/Valacyclovir
S&S of influenza (17)? Fever lasting 1-7 days, chills, malaise, muscle aches, substernal chest pain, headache, nasal stuffiness, +/- nausea, coryza, nonproductive cough, photophobia, eye pain, sore throat, pharyngeal injection, flushed facies, +/- wheezes and rhonchi
Strains of influenza (3)? A, B, C
Definition of Reye's syndrome? Fatty liver with encephalopathy
Peak age of Reye's syndrome? 5-14 years
Clinical manifestations (9) of Reye's syndrome? Vomiting, lethargy, jaundice, seizures, hypoglycemia, increased liver enzymes, increased ammonia levels, prolonged PT, AMS
Mortality rate of Reye's syndrome? 30%
Inducing factors for Reye's syndrome? Influenza A or Varicella infection + ASA ingestion in children (5-14 yo)
Labs for influenza? Leukopenia, proteinuria, viral cultures- nasal or throat, diffuse infiltrates on CXR if pneumonia
Timeframe for most accurate influenza viral cultures? First few days of illness
Treatment for influenza? Supportive: Rest, analgesics, cough suppressants PRN. Relenza/Tamiflu (Oseltamivir) if given within 48 hours of sx onset
Tamiflu (Oseltamivir) or Relenza are effective against which influenza strains? A and B
Cause of most influenza fatalities? Pneumonia
Timeframe for influenza vaccination? October- November
Patient populations for which influenza vaccination is recommended (6)? Age >65, kids/teens on chronic ASA therapy, nursing home residents, chronic heart/lung disease patients, all health care workers
Contraindications to flu vaccination (2)? Egg allergy, thrombocytopenia
Time until immunity for flu vaccine? 2 weeks
Time when varicella zoster is most contagious? Day before rash appears
Common season(s) for varicella zoster? Late winter and spring
Clinical findings of Varicella Zoster? Generalized eruption of erythematous macules/papules in a centripetal pattern that form superficial vesicles and crust over. Lesions appear in crops so several morphologies are observed.
Treatment of Varicella Zoster? Supportive. Prevent bacterial infection with good hygiene and trimming fingernails.
Treatment of Varicella Zoster in immunocompromised patients? Acyclovir and Varicella-zoster Ig.
Pharm intervention to prevent postherpetic neuralgia in varicella zoster? Steroids
Vaccine for Varicella Zoster- peds age? 1-2 yo
Should varicella zoster vaccine be given in pregnancy? No
Most common site for Varicella Zoster eruption? Thoracic and Lumbar
Contraindications to Zostavax vaccine for shingles? Gelatin and neomycin allergy, pregnancy, immunocompromised, untreated TB
Patient population recommended for Zostavax? Age 60 and older
Cause of rabies? Rhabdovirus
Transmission route of rabies? Infected saliva from animal bite or open wound
Vectors of rabies (6)? Dogs, bats, skunks, foxes, raccoons, and coyotes
Incubation period for rabies? 10 days- years. Typically 3-7 weeks
Clinical findings of rabies (12)? Pain & paresthesia of inoculation site (hx of animal bite not always apparent), skin sensitive to temp and wind, restless, muscle spasms, bizarre behavior, convulsions, paralysis, thick saliva, H2Ophobia (painful spasms w/ H20 drink), +/- ascend paralysis
Labs for humans with rabies? CSF PCR, MRI
Treatment for rabies? Mechanical ventilation, O2 therapy, Rabies Ig, human diploid cell vaccine (HDCV), monoclonal antibodies, ribavirin, interferon alpha, ketamine
Prognosis of rabies? Almost universally fatal within 7 days, likely from respiratory failure
Rabies prevention strategies Control bat populations, immunize household pets, immunize patients with regular exposure- vets, park rangers
HIV technique for replication? Reverse transcription
Primary antigen and cell type HIV attacks T4 antigen of CD4 helper lymphocytes
Transmission route for HIV? Bodily fluids- sexual contact, parenteral exposure via blood or blood products, perinatal exposure
Average time from HIV infection to symptomatic disease? 10 years but variable
Nonspecific initial finding of HIV infection? Generalized lymphadenopathy
Systemic manifestations (4) of HIV? Fever, night sweats, weight loss, muscle wasting due to increased metabolic rate and decreased protein synthesis
Common sites of infection/malignancy with HIV (9)? Lungs, upper respiratory system, lymph system, CNS, PNS, mouth, GI tract, eyes, skin
AIDS definition? CD4 count less than 200 cells/uL or AIDS indicator disease (Kaposi's sarcoma, etc.)
Labs for HIV? 2 ELISA tests + 1 Western Blot... positive within 6 months, anemia, leukopenia, thrombocytopenia, hypercholesterolemia
Chance of contracting HIV from needlestick injury? 0.3%
Timeframe to begin HIV post-exposure prophylaxis treatment? 72 hours
Should HIV+ pregnant/breastfeeding women be treated for HIV? Yes; it reduces chance of transmission to infant.
Goal of HIV treatment? Suppression of viral load
Patient population that experiences symptoms with CMV? Immunocompromised patients
Clinical findings of CMV (10)? Fever, malaise, arthralgias, jaundice, hepatosplenomegaly, thrombocytopenia, periventricular CNS calcifications, mental retardation, motor disability, purpura
Transmission route of CMV (4)? Sexual contact, breast milk, blood transfusion, respiratory droplet
Lab studies for CMV? Lymphocytosis, leukopenia, Antigens in blood/ urine/ CSF via PCR, tissue biopsy reveals "owls eyes" (intracytoplasmic inclusions)
A pt presents with complaints of fever, malaise, arthralgias, jaundice, purpura, mental retardation and motor disability. Tissue biopsy reveals "owls eyes"? Most likely diagnosis? Cytomegalovirus
Treatment for CMV? Ganciclovir, valganciclovir, foscarnet, cidofovir
Risk factors (3) for Candida albicans disease? Broad spectrum abx therapy, Diabetes mellitus, immunocompromised
Common cause of diaper dermatitis? Candida
Characteristic sign of Candidal dermatitis? Satellite lesions
Common areas of candidal dermatitis in adults? Dark moist areas: axillae, under breasts, large pannus
Cause of thrush? Candida
Treatment for cutaneous candida infection? Topical antifungals
S&S of thrush? White plaques that reveal red mucosa when scraped off. Denture-wearers may only have painful red palates. Odynophagia, painful swallowing
Treatment of thrush? Oral fluconazole/ itraconazole/ amphotericin B
Risk factors of candidal vulvovaginal disease? Age extremes, pregnancy, uncontrolled DM, corticosteroids, HIV disease
S&S of candidal vulvovaginal disease? Pruritis, burning, dyspareunia, white cottage cheese/ curd-like discharge, white plaques on vaginal walls
Treatment for candidal vulvovaginal disease? Topical azole or oral fluconazole
Common cause of candidal fungemia? Ill patients with indwelling catheters
Treatment for candidal fungemia? IV amphotericin B
Patient population in which hepatosplenic candidiasis occurs? Very low WBC count as in leukemia
Potential complication of candidal fungemia? Death
Pt presentation with hepatosplenic candidiasis? Leukemia- on chemotherapy with onset of fever, RUQ pain, nausea
Labs for hepatosplenic candidiasis? Diagnostic = biopsy. Increased alkaline phosphatase, low density liver/ spleen/ kidneys
Treatment for hepatosplenic candidiasis? Amphotericin B
Causes of candidal endocarditis (3)? Direct inoculation during surgery, IV drug users, late-stage HIV disease
S&S of candidal endocarditis? Splenomegaly, petechiae, murmur, large vessel embolization
Treatment for candidal endocarditis? Amphotericin B + valve replacement + lifelong fluconazole
Transmission route of Histoplasma (histoplasmosis)? Inhalation
Natural location of Histoplasma? Soil infested with bird or bat droppings
Most common S&S of histoplasmosis? Asymptomatic
Progressive disseminated histoplasmosis S&S? Fever, dyspnea, cough, weight loss, prostration, oral/pharyngeal/liver/splenic/ adrenal etc. ulcers
Chronic progressive pulmonary histoplasmosis occurs in what patient population? Older patients with COPD
Pulmonary changes with chronic progressive pulmonary histoplasmosis? Calcified nodes and pericarditis
Lab studies for histoplasmosis? Anemia of chronic disease, increased alkaline phosphatase, LDH, ferritin, +/- pancytopenia
Lab test to confirm disseminated histoplasmosis? Urine antigen assay
Treatment for histoplasmosis? Itraconazole
Natural location of cryptococcus? Soil contaminated with dried pigeon dung
Transmission route of cryptococcus? Inhalation
Patient population that becomes symptomatic with cryptococcus infection? Immune deficient
Pulmonary S&S of cryptococcal infection? Common in COPD/ chronic steroid use/post-transplant: fever, cough, dyspnea, Nodules/pneumonitis on CXR
CSF findings in cryptococcus infection? Increased opening pressure, increased protein, decreased glucose, cryptococcal antigen
Treatment for cryptococcal infection in non-immunocompromised pt's? Amphotericin B
Most common opportunistic infection in HIV? Pneumocystis jiroveci pneumonia
Clinical findings of pneomocystis jiroveci pneumonia? Fever, SOB, nonproductive cough, fatigue, weak, wt loss, disproportionate physical exam findings, heterogeneous/ miliary/ patchy interstitial infiltrates on CXR or normal CXR, +/- spontaneous pneumothorax,
Labs of pneomocystis jiroveci pneumonia? Sputum/ bronchoalveolar lavage stains for organism, hypoxia, hypocapnia, reduced CO2, high LDH, low WBC
DOC for pneomocystis jiroveci pneumonia? TMP/SMX vs. Dapsone + steroids of PaO2 is <70 mmHg
Natural location of Entamoeba histolytica? Soil and water
Transmission route of Fecally contaminated food or water, fly droppings, human-to-human contact
Common location of Entamoeba histolytica-induced ulcers? Large intestine or terminal ileum
S&S of Entamoeba histolytica? Cyclic abdominal cramps, fatigue, weight loss, and increased flatulence, abdominal distention, hyperperistalsis, generalized abdominal tenderness
Complications of Entamoeba histolytica (5)? Appendicitis, bowel perforation, fulminant colitis, massive mucosal sloughing, hemorrhage
Labs for Entamoeba histolytica? Stool specimens (cysts/trophozoites), sigmod/colonoscopy reveals ulcers, elevated WBC, U/S/ CT/ MRI for hepatic abscesses
Treatment for Entamoeba histolytica? Luminal amebicide (diloxanide furoate, iodoquinol, paromomycin), metronidazole, tinidazole
Most endemic areas of hookworm infection? Moist tropics/subtropics
Life cycle of hookworm? Eggs passed in stool and hatch in moist soil; Larvae penetrate skin, migrate via bloodstream to pulmonary capillaries, destroy alveoli, carried by cilia to mouth, swallowed, attach to small bowel mucosa, suck blood, release eggs once mature
S&S of hookworm infection? Pruritis at site of penetration followed by erythematous dermatitis: maculopapular/vesicular rash, cough/ wheeze/ blood-tinged sputum, low fever, diarrhea, anemia if severe infxn- malabsorption
Labs for hookworm infection? Eggs in feces, Positive stool occult blood, hypochromic microcytic anemia, eosinophilia
Treatment for hookworm infection? Mebendazole
Most common patient population for pinworm infection? Children
Transmission route of pinworm infection? Hands, foods, drink, fomites
Life cycle of pinworm? Females pass through anus to lay eggs on perianal skin.. eggs transmitted and swallowed, hatch in duodenum, larvae pass to cecum and mature
S&S of pinworm infection? Perianal pruritis, crawling sensation worse at night, insomnia, wt loss, enuresis, irritability, night exam reveals worms in anus or stool
Labs for pinworm infection? Eggs trapped in cellophane tape over perianal skin
Treatment for pinworm infection? Albendazole/ Mebendazole/ Pyrantel. Treat all family members
Cause of malaria? Plasmodium: vivax, malariae, ovale, falciparum from Anopheles mosquito
Malaria is endemic to what geographic areas? Tropics/ subtropics
Transmission route of malaria? Bite of Anopheles mosquito
S&S of malaria? Shaking chills, then fever, then diaphoresis. Fatigue, HA, dizzy, GI complaints, myalgias, arthralgias, backache, dry cough, +/- hepato/splenomegaly
Labs for malaria? Blood samples stained with Giemsa/Wright stain, leukocytosis/leukopenia, hepatic changes, hemolytic jaundice, thrombocytopenia, anemia, reticulocytosis, antibodies after 8-10 days
Treatment/Prophylaxis of malaria? Chloroquine
Causative organism of syphilis? Treponema pallidum
Transmission route of syphilis? Sexual contact, blood contact, congenital
Syphilic chancre occurs during which stage of syphilis? Primary
Pt presents with a painless ulcer with a clean base and firm, indurated margins. There is regional lymphadenopathy- nontender. Likely diagnosis? Syphilis-Primary
Presentation of primary syphilis? Painless chancre
Presentation of secondary syphilis? Secondary lesions of the skin, mucous membranes, eye, bone, kidneys, CNS, or liver
Presentation of tertiary/late syphilis? Gummatous lesions of skin, bones, viscera, cardiovascular disease, nervous system, and ophthalmic lesions.
Manifestations of neurosyphilis (3)? Chronic meningitis, generalized paresis, tabes dorsalis (chronic progressive degeneration of parenchyma)
Manifestations of untreated congenital syphilis in infants (5)? Interstitial keratitis, Hutchinson's teeth, saddle nose, deafness, CNS abnormalities
Labs for syphilis? VDRL, RPR for primary and secondary syphilis; lumbar puncture/ joint fluid analysis/ biopsy in tertiary syphilis
DOC for syphilis? Penicillin G + antipyretics
Causative organism of gonorrhea? Neisseria gonorrhoeae
S&S of gonorrhea in men? Burning urination, milky-yellow discharge
Complications of untreated gonorrhea in men? Prostatitis, epididymitis, urethrl strictures, periurethral gland inflammation
S&S of gonorrhea in women? Asymptomatic/ dysuria, urinary frequency and urgency, purulent urethral discharge, vaginitis, cervicitis
Complications of untreated gonorrhea in women? Pelvic inflammatory disease, infertility
Labs for gonorrhea? Culture and gram stain of discharge
Treatment of gonorrhea? Ceftriaxone. Also treat for Chlamydia and treat partners
Cause of lymphogranuloma venereum? Chlamydia
S&S of lymphogranuloma venereum? A vesicular or ulcerative lesion that may go unnoticed, spreads to lymph nodes causing inguinal buboes that may fuse and break down, resulting in multiple draining sinuses and scarring
S&S of chlamydia in men? Urethritis, watery discharge, less pain than gonorrhea
S&S of chlamydia in women? Asymptomatic/ cervicitis/ salpingitis/ PID
Complication of untreated chlamydia in women? Infertility
Labs for chlamydia? Often dx clinically, ELISA, DNA probe
Treatment of chlamydia? Doxycycline/ Azithromycin
DOC of chlamydia in pregnant women? Erythromycin
What would you see on a wet mount positive for Trichomonas? Motile flagellates
S&S of Trichomonas? Pruritis, maladorous, frothy yellow-green discharge, diffuse vaginal erythema, macular lesions on cervix
Female presents with vaginal pruritis, and a maladorous, frothy yellow-green discharge. Likely diagnosis? Trichomonas
Treatment for Trichomonas? Metronidazole
Causative organism of Lyme disease? Borrelia burgdorferi
Borrelia burdorferi causes what disease? Lyme disease
Transmission route of lyme disease? Tick feeding for more than 24-36 hours
Most common vector-borne disease in U.S? Lyme disease
Erythema migrans is a sign of what disease? Lyme disease
Early S&S of lyme disease(2)? Erythema migrans commonly of the groin, thigh, or axilla, flu-like symptoms
S&S of Lyme Disease stage 2? Hx of erythema migrans, flu-like sx; HA, stiff neck, fatigue, malaise, musculoskeletal sx, +/- cardiac (pericarditis, arrhythmias, heart block) or neuro (aseptic meningitis, Bell's palsy, encephalitis)
S&S of Lyme Disease stage 3? Joint pain, arthritis, chronic synovitis, encephalopathy (memory loss, mood changes), polyneuropathy (paresthesias, encephalopathy), leukoencephalitis (cognitive changes, paraparesis, ataxia, bladder dysfunction)
Labs for Lyme disease? ELISA and Western blot
DOC for Lyme disease? Doxycycline, NSAIDs PRN
Causative organism of Rocky Mountain spotted fever? Rickettsia rickettsii
Rickettsia rickettsii causes what disease? Rocky Mountain spotted fever
Transmission route of Rocky Mountain Spotted Fever? Wood tick, common in eastern US
S&S of Rocky Mountain Spotted Fever? Fever, chills, HA, N/V, myalgias, restless, indomnia, irritable, flushed face, injected conjunctiva, faint macules/ maculopapules/ petechiae on wrists and ankles, spreading to extremities and trunk.
Pt presents with complaints of fever, chills, HA, N/V, myalgias, restless, indomnia, irritable, flushed face, injected conjunctiva, faint macules/ maculopapules/ petechiae on wrists and ankles, spreading to extremities and trunk. Likely diagnosis? Rocky Mountain Spotted Fever
Labs for rocky mountain spotted fever? Leukocytosis, thrombocytopenia, hypoNa, proteinuria, hematuria, CSF: pleocytosis and hypoglycorrhachia, antibody titers after 2nd week
Treatment for Rocky Mountain Spotted Fever Doxycycline or Chloramphenicol for quicker recovery, otherwise supportive
Created by: mccullough87