12. Infectious disease Flashcards
HIV infected + surrounded by bird/pigeon
Name/Transmission/2 type presentation/Dx/Tx
Name: Cryptococcosis
Transmission: inhalation of bird/pigeon dropping
2 type of presentation: fungal meningitis(MC cause of fungal menigitis) and PNA
Dx: lumbar punture (india ink stain)
Tx: Amphotericin B + Flucytosin
- Esophagitis - appearance/Tx
- Oral thrush - appearance/Tx
- Vaginal candidiasis - appearance/Tx
- Intertrigo(cutanous infection)- appearance/Tx
- Fungemia - cause/Tx
Pathogen/Dx
- white liner plaques - Tx: fluconazole PO
- friable white plaque able to scrap off - Tx: nystatin
- white thick curd like - Tx: Clotrimazole
- beefy red erthema (satellite lesions - underbreast) - Tx: clotrimazole
- Cause - indwelling catheters - Tx: IV Amp B
Pathoge: candida albican (MC opportunistic organism)
Dx: KOH
hx of living mississippi & ohio river valleys (IL, Missouri) + PNA like sx + X-ray BB-sized calcifications and hilar adenopathy
Name/Transmission/Dx/Tx
Name: histoplasmosis
Transmission: inhalation
Dx: CXR, culture
Tx: itraconazole, if severe amphotericin B
hx of HIV + PNA like sx + CD4 less than 200
Name/Transmission/Pathogen/Dx/Tx
Name: Pneumocystis Pneumonia
Transmission: inhalation
Pathogen: Pnemocystitis jirovecii
Dx: CD4 less than 200, X-ray shows bilateral interstitial
Tx: Bactram (TMX-SMX), add prednison if CO2 less than 70
hx of garden and houseplant soil work + chronic sinuses
Name/transmission/Pathogen/Dx/Tx
Hemoptysis + fungal ball on CXR
Name/Dx/Tx
Name: aspergillosis
Transmission: inhalation
Pathogen: aspergillus
Dx: biopsy - dusky, necrotic tissue (nose)
Tx: Voriconazole
Name: aspergilloma
Dx: biopsy
Tx: surgical remove
Black eschars on nose + hx of DM or HIV
Name/Dx/Tx
Name: Mucormycosis
Dx: biopsy
Tx: IV Amphotericin B
hx of immunosupressant + outdoor activities (soils or decaying wood) + PNA sx
Name/Transmission/Dx/Tx
Name: blastomycosis
Transmission: inhalation
Dx: culture
Tx: itraconazole, severe Amphotericin B
Hx of southwestern US or Mexico + Fever + arthralgias + EM
Name/Transmission/Dx/Tx
Name: coccidioidomycosis (valley fever)
Transmission: inhalation
Dx: IgM & IgG 1st, Culture Definitive
Tx: self limit
pruritus + purulent discharge + sexually active + PAINFUL
Name/Pahogen/type3/Dx/Tx/After care
Name: Chlamydia
Pathogen: Chlamydia trachomatis
Type 3
- Urethritis
- PID
- Reiter’s dz - urethritis, uveitis, arthritis
Dx: Nucleic acid amplification
Tx: AZA 1g x 1 dose or doxy 100mg bid x 10 days
Also tx for gonorrhea Ceftx IM 250mg x 1 dose
After care: retest in 3 weeks to make sure, treat sex partner as well
hx of cat scratch
Name/Pathogen/Tx
Name: Cat scratch
Pathogen: bartonella henselae
Tx: AZA
Purpuric rash + neck rigidity + fever
Name/2 PE sign/Dx/Tx/Prophylaxis
Name: Neisseria meningitidis (meningococcemia)
PE
- Kernig(hip flexed leg can’t straighten)
- Brudzinski (neck flexion cause hip/knee flexion)
Tx
- Adult: Ceftx + Vanco, Infant: Amp + cefo (empiric first)
- Drug of choice - Pen G
Prophylaxis - exposed - cipro 500mg 1 dose
PAINFUL Ulcer first + later inguinal lymph pain
Name/Pathogen/Tx
Name: Chancroid
Pathogen: Hemophilus Ducreyi
Tx: AZA 1g x 1 dose
Eschar + hx of around rabbits
Name/Related/transmission/Dx/Tx
Name: Tularemia
Related: Rabbits
Trasmission: by tick/insect or touching animal
Dx: serology
Tx: Streptomycin
hx of eating cheese and milk in Mexico + low grade fever
Name/Related/Dx/Tx
Name: Brucellosis
Related: goat/sheep/cattle hog
Dx: serology
Tx: rifampin + doxy
hx of use spa, hot tub which made of wood, or swimming pool + small pink to red bump
Name/Tx
Name: hot tub folliculitis
Tx: None, resolve in 7-14 days w/o tx
hx of exposure to sheep, cattle, and goat + flu like sx
Name/Dx/Tx
Name: Q fever
Dx: immunofluorescence IFA
Tx: Doxy
Acutely swollen extremely warm painful at groin, axilla, cervical region(neck)
Name/Pathogen/Dx/Tx
Name: Plague
Pathogen: yarsinia
Dx: Gram stain (safety pin appearance)
Tx: Streptomycin -> prophylaxis doxy or tetra
Pain out of proportion + develop grangrene + hemorrhagix bullae
Name/Pathogen/Tx
Name: Necrotizing fasciitis (flesh eating disease)
Pathogen: GABHS
Tx: Surgical debridement + broad spectrum abx
Friable gray/white membrane(pseudomembrane) on pharynx that bleed if scraped + bull neck + myocarditis
Name/Tx/Prevention/Prophylaxis for close contact
Name: Diphtheria
Tx: Diphtheria antitoxin + Penicillian or erythromycin x 2 weeks (airway protection)
Prevention: Dtap 5 dose 7 year old less, 11 yr with booster
Prophylaxis: erythomycin 7-10 days (No school)
hx of puncture wound from rawfish, shellfish + purplish erythema
Name/Tx
Name: Erysipeloid
Tx: Pen V
hx of puncture or crush wound + severe muscle spasm (neck stiffness, Trismus)
Name/Tx/Prophylaxis
Name: Tetanus
Tx: Metronidazole
Prophylaxis: Tdap Q10yrs
Sudden on set of pain & edema + gas in the tissue palpated on PE
Name/Dx/Tx
Name: Gas gangrene
Dx: X-ray - soft tissue air pocket
Tx: IV Pen + IV Clinda
hx of eating can/smoked/vacumm-packed food + dilated fixed pupil + descending decreased muscle strength
Name/MC/infant case/Occur time/Tx
Name: Botulism
MC type: infentile
Infant: ingested honey or dust
Occur time: 1-2 days
Tx: Antitoxin
hx of eating cold deli & unpasterized cheese, milk
Name/Risk/Tx
Name: listeriosis
Risk: infant <2month & elderly - bacteremia, Pregnancy - premature labor & stillbirth
Tx: IV Ampicilin
Painless black eschar
Name/Dx/Tx
Name: Anthrax
Dx: Clinical - if seen black eschar, X-ray widen midiastinum on CXR - inhalation case
Tx: cipro + exposure
Painless ulcer + sexually active
Name/Pathogen/3 types/Dx/Tx/Cotransmission
Name: syphilis
Pathogen: Treponema pallidum
Type
- Primary - painless ulcer
- Secondary - maculopapular rash (palms/soles), condyloma lata (wart like legion)
- Tertiary - argill-robertson pupil (doesn’t react to light)
Dx: Darkfield microscopy, RPR, VDAL, FTA ABS (confirming test)
Tx: Pen G IM 2.4 million dose, if tertiary or late latent - x 3 dose, if neuro IV 4 million dose
Allegic to Pen G then use doxy
Cotransmission: high rate of cotransmission with HIV infection
Central clearing or bull’s eye
Name/Pathogen/Early/disseminated/Dx/Tx(pregnancy, severe)/Prophylaxis
Name: Lyme disease
Pathogen: borrelia burgdorferi (tick)
Early: bulls eye (erythema migrans)
Disseminated: CN7/facialy nerve palsy
Dx: Elisa, if Disseminated: lumbar punture
Tx
- Doxy
- Pregnancy (amox)
- Late/severe - IV ceftx
- Prophylaxis - doxy 200mg x 1 dose in 72 hours
hx of camping + blaching erythematous rash wrist and ankles (lower extremities)
Name/Pathogen/Dx/Tx/Pregnancy
Name: Rocky Mountain Spotted fever
Pathogen: Rickettsia Ricketsii (tick)
Dx: clinical
Tx
- Doxy (even children) x 5- 14 days
- Pregnancy - chloramphenicol
Amebic liver abscess + fecal contamination
Name/Dx/Tx
Name: Amebiasis
Dx: Stool O&P
Tx: Metronidazole
hx of swimming with contact lens + keratitis
Name/PE
Name: Acanthamoeba Keratitis
PE: Corneal stromal ring infiltrate
Cold stage(chilld), Hot stage(fever), sweating stage every other or 3rd days
Name/Most dangerous type/Dx/Tx
Name: Malaria
Most dangerous: Malaria falciparum
Dx: Giemsa stain peripheral smear (thick and thin smear)
Tx: Chloroquine
hx of tick bite + smear appears pathognomonic tetrads
Name/Dx/Tx
Name: Babesiosis
Dx: Peripheral smear
Tx: Atovaquone + AZA
hx of cat owner + encephalitis + CD4 less than 100 + MRI shows ring enhancing lesion
Name/Dx/Tx/Prophylaxis
Name: Toxoplasmosis
Dx: MRI
Tx: Sulfadiazene + pyrimethamine
Prophylaxis: TMX-SMX
Perianal itching at night
Name/Dx/Tx
Name: Enterobiasis (pinworm)
Dx: Scotch tape
Tx: Albendazole
Fever + unilateral periorbital edema + CHF + Leading cause of latin america
Name/Risk/Dx/Tx
Name: Chagas disease
Risk: MC children
Dx: Echo for heart, Blood smear or culture
Tx: Benznidazole
hx of bite (Tsetse fly) + hx of visit afrian and south/central america + painless chancre
Name/Dx/Tx
Name: African trypanosomiasis
Dx: blood smear
Tx: infectious disease control
hx of eating raw pork + myositis
Name/Dx/Tx
Name: Trichonosis
Dx: Serology - eosinophilia
Tx: self limited, severe albendazole
eggs in feces or large worm coughed, vomited
Name/Tx/other possible
Name: Ascariasis
Tx: Albendazole, Pyrantel (if pregnant)
Other possible: Hookworm (Necator americanus) - egg in stool same tx as ascariasis
Difference
- Hookworm - infect upper intestine which lead to anemia
- Ascariasis - cough up large worm, do not lead anemia
hx of bite of a female sand fly
Name/Dx/Tx
Name: Leishmaniasis
Dx: Culture
Tx: Infectious disease consult
Grouped painful vesicles
Name/Resided/Related dz/Dx/Tx/Prevention
Name: Herpe simplex virus HHV1,2 (1 Oral, 2 genital)
Resided: doral root ganglion
Related dz: bell’s palsy, encephalitis
Dx: PCR
Tx: Acyclovir (IV for encephalitis)
Prevention:
vesicle on an erythematous base (dew drops on a rose pedal) in different stages
Name/Tx
Name: Varicella Zoster Virus (HHV3) (chicken pox)
Tx: Surppotive tx
Follow dermatome with painful legion
Name/Related spread to other organ/Special PE sign/Complication/Tx
Name: VZV HHV3 (Shingles)
Related spread to other organ: Eye - opthalmicus, Ear - oticus (Ramsay Hunt syndrome)
Special PE sign: Hutchinson’s sign - VZV on tip of nose possible eye infection
Complication: Herpetic nuerralgia
Tx: Acyclovir, Neuro pain - gabapentin
Fever + throat swelling + posterior cervical lymphadenopathy + splenomegaly
Name/Drug interaction/Dx/Tx/Prevention/complication
Name: Epstein-barr virus (mono,, kissing)
Drug interaction: Rash after Amox given (mono)
Dx: Monospot (heterophile) test
Tx: supportive but no aspirin
Prevention: no contact sport due to possible spleen rupture
Complication: Guillian barr
Fundus exam shows pizza pie legion (retinite) + CD4 less than 50
Name/Type/Dx/Tx
Name: Cytomegalovirus HHV-5
Type
- Congenital CMV - sensorineuro hearing loss
- CMV reactivation - retinitis (CD4<50), esophagitis
Dx: Fundus exam - pizza pie legion (scrambled egg/ketchup appearance), problem at esophagitis - endoscopy (large superfical ulcer)
Tx: ginciclovir
Sudden high fever + after few days fever gones rash start from trunk to neck and head
Name/Tx
Name: Roseola HHV 6-7
Tx: Supportive
Rash start from head to downward + usually goes away in 3 days
Name/Tx/Teratogenic
Name: Rubella
Tx: supportive
Teratogenic: 1st trimaster congenital syndrome occur - PDA, small head(microcephaly), loss hearing, cataract
Fever + cough + coryza + conjunctivitis
Name/PE/Tx/Complication
Name: Measles (Robeola)
PE: Koplik’s spot(red surround w/ white/blue centered), Rash starts from head to downward
Tx: supportive
Complication: diarrhea, OM
Coryza, fever + slapped cheek + age <10
Name/Pathogen/Tx/Complication
Name: erythema infectiosum (fifth disease)
Pathogen: paravovirus B19
Tx: supportive
Complication - aplastic crisis in pt with sickle cell disease
Parotid gland pain & swelling
NAme/Pathogen/Tx/Complication
Name: Mumps
Pathogen: Paramyxovirus
Tx: Supportive
Complication: Orchitis
Severe sudden on set of fever + severe arthalgia + non productive cough
Name/MC motality/Tx/Prevention/Post exposure
Name: Influenza
MC mortality: secondary to PNA (young or older population)
Tx: Oseltamivir (tamiflu) - must given within 48 hours
Prevention: vaccination yearly
Post Exposure: must provide tamiflu if within 48 hours
HIV explain
Virus type/transmission/Infected site/AIDS definition/Dx/Tx/Opportunistic dz
Virus type: Retrovirus
Transmission: Sex, IV drug
Infected site: HIV target T4 due deplete
AIDS definition: CD4 less than 200 or defining illness (see below)
Dx: Fourth generation combination HIV-1/2 immunoassay (1st), Western blot (confirmatory)
- Serum viral load is for monitor therapy status
Tx: HAART (NRTI 2 + 1 PI or NNRTI)
Opportunistic dz defined as AIDS
- CD4 <200 - PCP
- CD4 <100 - toxoplasmosis, cryptococcus
- CD4 <50 - MAC(GI sx), CMV(eye sx)
hx of bite of bats + hydrophbia (painful throat after drink H2O) + Paresthesias and fasciculations
Name/Related/Dx/Tx/Prior vaccinated with new bite
Name: Rabies
Related: bat, dog, racoon, skunks, foxes, wolves
Dx: Dead animal biposy - negri bodies
Tx: Rabies vaccine day 0,3,7,14 + Rabbies immune globulin 1/2 wound site, 1/2 IM at glut
*if immunisupressant person - need extra care 28 days of rabies vaccine
Prior vaccination with new bite: Immuno globin for once, Vaccination everytime new bite occur.
Small pox vs chicken pox
Small pox - one stage
Chicken pox - all different stage
inital fever 3-7 days + gone for 2 days + 1-2 days of fever again + break bone or joint pain
Name/Tx
Name: Dengue fever
Tx: acetaminophen
history of pain, tenderness, and itching of his glans penis and foreskin + curd-like exudate in the sulcus between the glans and foreskin
Name/Related/Tx
Name: Candidal balanitis
Related: DM - poorly controlled glucose lead infection candida
Tx: antifunfal (clotrimazole)
pruritus + mucopurulent discharge + sexually active + PAINFUL
Name/Pahogen/Disseminated/Dx/Tx/After care
Name: Gonorrhea
Pathogen: Neisseria Gonorrhea
Disseminated: arthrities + dermatitis (necrotic or hemorrhagic center at palm)
Dx: Nucleic acid amplification
Tx: AZA 1g x 1 dose or doxy 100mg bid x 10 days
Also tx for gonorrhea Ceftx IM 250mg x 1 dose
If disseminated gonorrhea Ceftx x 7 days
After care: retest in 3 weeks to make sure, treat sex partner as well
Fever 7-10 days gets btter after + bradycardia + rash + pea soup diarrhea
Name/Tx
Name: typhoid fever
Tx: Ceftx + quinolone x 2weeks
hx of picnic + on set 8 - 48 hours abd pain + diarrhea 3-5 days with fever
Name/Pathogen/Dx/Tx
Name: Gastrogenteritis
Pathogen: MC form of salmonella (caused by food)
Dx: stool culture
Tx: self-limited
severe rice water diarrhea + third world country visit
Name/Pathogen/Patho/Tx
Name: Cholera
Pathogen: Vibrio cholerae
Patho: toxin cause hypersecretion of water in small intestine
Tx: Oral rehydration + cipro
Prevention: Clean water and food supply for prevention
hx of food intake + sudden onset diarrhea + fever + loose stool with blood
Name/Dx/Tx
Name: Shigellosis
Dx: Fecal test, stool culture
Tx: bactram(TMP/SMX)
Painless ulcer + painful inguinal
Name/Pathogen/Travel site/Risk/Tx
Name: Lymphogranuloma venerum
Pathoge: Chlamydia trachomatis
Travel site: recent travel to tropical and subtropical areas of the world
Risk: homosexual
Tx: Doxy 100mg bid 21days
