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Boards Infectious Dz
Stuff I should know
| Question | Answer |
|---|---|
| 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
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