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Infectious disease
STEP 2 UWORLD notes
| Question | Answer |
|---|---|
| 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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