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Infectious disease

STEP 2 UWORLD notes

QuestionAnswer
What is most acute-onset, non-bloody diarrhea due to? Viral infection
How long does it take, on average, for viral gastroenteritis to resolve? 2-3 days
What is the management of mild and moderate viral gastroenteritis? Oral rehydration
How is mild dehydration clinically presented? ↑thirst, ↓ intake&/or loss of fluids
What are clinical associations of moderate dehydration? ↓skin turgor, dry mucous membranes, sunken eyes and fontanelles, and ↓↓urine output
What percentage of loss fluid indicates severe dehydration? >10%
What are clinical features seen in severe dehydration? Lethargy, unresponsiveness, skin tenting, no tears, ↑HR but weak, hypotension, and ↑HR, oliguria/anuria
What description of diarrhea often indicates or points toward bacterial etiology? Bloody or mucoid diarrhea
Why are empiric antibiotics not recommended in bacterial diarrhea? ↑↑↑risk of HUS associated w/ Shiga toxin-producing E. coli.
How is inflammatory diarrhea further divided in in assessing etiology? STEC vs non-STEC
STEC stands for Shiga toxin-producing E. coli
What are high-risk features for suspected infectious diarrhea? Bloody stools or high-grade fever Severe disease Elderly, immunocompromised Diarrhea > 7 days
What considerations are seen in non-inflammatory diarrhea and non-STEC inflammatory diarrhea? Antibiotics for: -severe disease -pathogens with low infectious dose (e.g., Shigella)
What neurological symptom is associated with Shigella-gastroenteritis in children? Seizures
What severe condition is associated with adrenal insufficiency and meningococcemia? Waterhouse-Friderichsen syndrome
What is the pathogenesis of Waterhouse-Friderichsen syndrome? Sudden vasomotor collapse and skin rash due to adrenal hemorrhage
How is the rash associated with Waterhouse-Friderichsen syndrome? Large purple lesions on the flanks; large petechiae and purpuric lesions
DOC for cat/dog bites Amoxicillin-Clavulanate
Why is Amoxicillin-Clavulanate the DOC in mammalian bites? Provides activity against skin flora (human), and cat oral flora (P. multicide, anaerobes)
What procedure is itself a risk for aspiration pneumonia? Upper endoscopy
What is the treatment of bacterial aspiration pneumonia, if the patient has NOT developed lung abscess or empyema? Same as for CAP
What is the treatment for CAP if pt can handle PCNs? Amoxicillin or amoxicillin-clavulanate + Macrolide (preferred) or doxycycline
What is the TX for CAP if pt is unable to tolerate Penicillins but has no problem with cephalosporins? 3rd gen cephalosporin + Macrolide (preferred) or doxycycline
If a pt is unable to tolerate PCNs and Cephalosporins, how is CAP managed pharmacologically? Respiratory fluoroquinolone
What is the treatment for bacterial aspiration pneumonia if pt has developed lung abscess and/or empyema? Ampicillin-sulbactam + CAP regimen, in order to cover for anaerobes
Common condition caused by a tick bite Ehrlichiosis
What is DOC for Ehrlichiosis? Doxycycline
What is the therapeutic indication for a woman in active labor and active genital herpes lesions? C-section to reduce vertical transmission of neonatal HSV
Why does HCV chronic infection require extra confirmation? HCV may spontaneously clear in some pts, thus need double confirmation
How is HCV DX confirmed? By having both, a (+) serologic Ab test and a confirmatory molecular test for circulating HCV RNA
AKA: pinworm AKA: Enterobius vermicularis
S/S: perianal pruritus in child, especially at night Enterobius vermicularis infection
What is the FLT for E. vermicularis infection? Pyrantel pamoate or Albendazole
Who needs to be treated for E. vermicularis infection? Patient and all household contacts
Created by: rakomi
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