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1
Q

what is the standard for fever of unknown origin?

A

fever >38.3 (100.9),
3 days,
three outpatient visits,
3 week illness

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2
Q

what are the categories for FUO?

A

nosocomial,
neutropenic,
HIV,
Organ transplant

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3
Q

how do you define a nosocomial FUO?

A

> 38.3 (100.9)
3 days,
not at admission
initial culture neg

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4
Q

how do you define neutropenic FUO?

A

fever
neutrophil less than 400/microliter
unknown diagnoses after 3 days
inpatient/outpatient

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5
Q

how do you define HIV FUO?

A

fever 4 weeks duration outpatient, 3 days as an inpatient w/ 2 days of culture

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6
Q

what is an iatrogenic disease?

A

we did it, caused by medical treatment

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7
Q

what does equivocal diagnosis mean?

A

vague or ambiguous “best guess”, or working diagnosis

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8
Q

what is active immunity?

A

gained through exposure to an antigen

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9
Q

what is passive immunity

A

immunization using pre-formed antibody from another individual

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10
Q

what is partial immunity?

A

just a decreased immunity overtime

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11
Q

wht is non-sterile immunity

A

trace disease is left over, but not active

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12
Q

concomitant infection

A

2 infections at the same time, thnk staphy pneumonia and influenza, chlamydia and gonorrhea

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13
Q

what is sensitivity?

A

the portion of true positive it detects of all positives

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14
Q

what is specificity?

A

proportion of true negatives it detects of all the negatives. Measure of how accurately it identifies negatives

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15
Q

what does left shift mean?

A

increased number of immature neutrophils (band forms). suggests acture inflammation

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16
Q

what does an O & P not test for?

A

cryptosporidium, done w/ 3 stools each >24 hrs apart

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17
Q

obligate intracellular parasites?

A

virus

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18
Q

may be free living, obligate intracellular parasites, or obligate pathogens living outside of cells. They are prokaryotic w/ DNA. May or may not have a barbohydrate capsule, fimbriae, pili, or flagella. Reporduce using binary fission so 2 parent cells and 4 offspring.

A

bacteria

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19
Q

eukaryotic organism w/ lipid bilayer plasma membrane, DNA that makes RNA that makes proteins. They are unicellular, multicellular, or both. Usually are opportunistic, and can live freely in the environment (most of the time), but the ones that are on humans are extracellular. Reproduce sexually, or asexually.

A

fungi (yeast, filamentous, dimorphic)

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20
Q

unicellular eukaryotic organisms, sever life cycle stages, sexual or asexual reproduction, can live freely or be obligate.

A

protozoan parasites

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21
Q

macroscopic, multicellular w/ organs and sexual reproduction, live in humans and can live in intestines

A

helminth (worm) parasites

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22
Q

what would you see on CXR for anthrax?

A

widened mediastinum

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23
Q

what is the PEP for anthrax length and DOC?

A

60 days ciprofloxacin 500 mg PO BID, w/ vaccination AVA biothrax

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24
Q

what is the treatment for anthrax from an uncomplicated cutaneous disease, where the source is naturally occuring?

A

7-10 day course

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25
Q

what is the alternative medication for anthrax?

A

obiltoxaximab

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26
Q

what do you get from the hides of animals (cattle, sheep, goats, camels), ingestion of contaminated meat, or the inhalation of spores?

A

anthrax

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27
Q

where is one of the most common places on earth for plague?

A

madagascar

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28
Q

where is plague in the US and what animals is it associated w/?

A

south west, NM, AZ, CO. Cats and rats w/ fleas

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29
Q

what plague are fleas associated w/?

A

bubonic

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30
Q

what does the bubonic plague appear w/?

A

high fever, malaise, tender lymphnodes (buboes)

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31
Q

what do the labs for plague show?

A

DIC, inc. LFT, inc. WBC w/ L shift

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32
Q

what does microscope show for labs for plague?

A

gram negative coccobacillus, safety pin bipolar staining

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33
Q

what is the treatment for plague?

A

gentamicin or streptomicin

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34
Q

what is the PEP for plague?

A

doxycycline or septa

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35
Q

describe the small pox rash

A

starts on face, oropharynx, then moves trunk, arms, legs. Begins as a maculopapular rash, then 1-2 days later becomes ulceration or vesicles, then becomes pustules or pocks, then becomes a scab.

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36
Q

describe hemorrhagic small pox

A

dusty erythema, then petechiae, then hemorrhage

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37
Q

who is at risk of developing cowpox?

A

people w/ imported rodents as pets, horses, feral cats and dairy cows

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38
Q

how do you send in a suspected case of small pox?

A

send in a sealed vacutainer, then put vacutainer in second waterproof container, then send samples to high containment lab (BL-4) to be analyzed under electron microscopy

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39
Q

what is the treatment for small pox?

A

cidofovir, symptomatic care.

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40
Q

how long is the small pox vaccine good for?

A

10-15 years

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41
Q

explain small pox post exposure prophylaxis

A

w/ in 3 days ideal w/in 24 hrs, and give vaccinia immune globulin .6 ml/kg IM

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42
Q

what is described as vesicular on erythematous base?

A

varicella

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43
Q

– Clustered vesicles on an erythematous base
– Develops crust (5-7 days)
– Constitutional symptoms

A

herpes

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44
Q

what is the treatment for herpes?

A

something that ends in vir, specifically valacyclovir

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45
Q

what are the medical treatments for HPV?

A

imiquimod
podofilox
trichloroacetic acid

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46
Q

how are the HPV vaccines dosed?

A

IM, 1st stat, 2nd 2 mos., 3rd 6 mos

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47
Q

gram negative intracellular, diplococcus

A

gonorrhea

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48
Q

what can a woman develop if her gonorrhea or chlamydia is not treated.

A

PID same symptoms but cervical motion tenderness and adnexal tenderness

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49
Q

joint pain following gonnorhea

A

disseminated gonoccal infection, other weird arthritis stuff too

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50
Q

what is the diagnostic standard for detection of gonorrhea?

A

isolation through culture

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51
Q

who is most likely to have gonoccal strains w/ antimicrobial resistance?

A

MSM

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52
Q

what is the treatment for gonorrhea?

A

ceftriaxone (rocephin) 250 mg IM and azithromycin 1 gm PO for chlamydia

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53
Q

what is the alternate therapy for gonorrhea?

A

azithromycin 2 g PO

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54
Q

what is the treatment for treatment failure for gonorrhea?

A

ceftriaxone 500mg and azithromycin 2 gm, plus test of cure in one week

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55
Q

what is the most frequently reported infectious disease in the US?

A

chlamydia

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56
Q

what STD may be asymptomatic?

A

chlamydia

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57
Q

what is the treatment for chlamydia?

A

azithromycin 1 gm

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58
Q

what is the alternate treatment for chlamydia?

A

doxycycline 100 mg po q12 hrs x 7 days

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59
Q

where is lymphogranuloma venereum located?

A

india, africa, central america, southeast asia

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60
Q

what causes lymphogranuloma venereum?

A

c. trachomatis

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61
Q

what is a non painful herpetiform lesion associated w/?

A

lymphogranuloma venereum

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62
Q

what is the first stage of lymphogranuloma venereum associated w/?

A

a painless herpetiform ulcer that clears by itself

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63
Q

what is the second stage of lymphogranuloma venereum associated w/?

A

2-6 weeks after lesion, painful lymph buboes w/ groove sign

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64
Q

what is the third stage of lymphogranuloma venereum associated w/?

A

proctocolitis, weight loss, fever rectal pain, weight loss, perirectal fistulas, abcesses, strictures

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65
Q

what is the treatment for lymphogranuloma venereum?

A

needle aspirate and doxy for 2 weeks

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66
Q

what is the MC nongonoccal urethritis?

A

chlamydia

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67
Q

what does urethritis present w/?

A

urethral discharge, dyuria, orchalgia, foreign body sensation

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68
Q

what is the treatment for non-gonoccal urethritis?

A

azithromycin or doxy

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69
Q

what is the treatment for gonoccal urethriitis?

A

ceftriaxone and azithromycin

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70
Q

what are the signs and symptoms of primary syphilis?

A

painless sore and NONtender lymphadenopathy

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71
Q

what are the signs and symptoms of secondary syphilis?

A

2-10 weeks after primary lesion rash on palms and sole, could get warts too. remember great imitator, myalgias as well, and maybe constitutional signs

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72
Q

what is MC affected by cardiovascular syphilis?

A

ascending aorta

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73
Q

what is cutaneous gummas?

A

rubbery granulomas found on liver, skeleton and testes they are associated w/ tertiary

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74
Q

what are non treponemal tests and when are they most effective?

A

rapid plasma reagin, RPR, veneral disease research lab RPR secondary syphilis

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75
Q

how do you track efficacy of care for syphilis?

A

VDRL titers

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76
Q

what is the DOC for treating syphilis?

A

benzathine penicillin G

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77
Q

what can happen after treatment of syphilis?

A

jarisch-herxheimer reaction, just fever and chills from rapid death of spirochetes

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78
Q

what does bacterial vaginosis present with?

A

strong fish like odor, especially after intercourse,
white or gray thin discharge,
pH greater than 4.5,
clue cells

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79
Q

what are the is the treatment for bacterial vaginosis?

A

metronidazole, tinidazole, clindamycin

80
Q

what causes chancroid?

A

haemophilus ducreyi

81
Q

how does chancroid present?

A

small red papules that suppurate into ulcers w/ deep undermined edges and irregular borders. VERY PAINFUL, can have bubo

82
Q

what will a gram stain show and what is the definitive test to diagnose for haemophilus ducreyi?

A

school of fish, culture is definitive diagnosis

83
Q

what is the treatment for haemophilus influenza?

A

ceftriaxone, azithromycin

84
Q

how will granuloma inguinale present?

A

PAINLESS small beefy red pump that is elevated and velvety nodule. It will spread can eat the tissue through inguinal folds. it bleeds easily and will cause depigmentation

85
Q

what will you see on a punch biopsy for granuloma inguinale?

A

donovan bodies (donovanosis)

86
Q

what is the DOC and length for treatment of granuloma inguinale?

A

azithromycin for 3 weeks

87
Q

what do you give if the granuloma inguinale (donovanosis) is not clearing?

A

aminoglycoside

88
Q

how can you tell how long a pediculosis capitis infection has been going on?

A

the distance away from the scalp

89
Q

what is a test of pediculosis?

A

fluoresce under wood’s lamp

90
Q

what is the treatment for lice?

A

permethrin wash off after 10 min,
malathion 8-12 hrs then wash off,
ivermectin lotion 10 min for >6 mos for resistance

repeat 7-10 days later

91
Q

what is a key symptom in scabies?

A

nocturnal pruritis

92
Q

what is pathognomnic for scabies?

A

short elevated serpiginous (s shaped) tack

93
Q

what is the treatment for scabies?

A

permethrin cream wash after 8-14 hrs,

ivermectin PO

94
Q

what disease can bed bugs spread?

A

hepatitis B

95
Q

what do you have to be worried about with bed bugs?

A

anaphlactic reaction

96
Q

what are some signs of bed bugs?

A

pungent odor, papules/wheals/bullae, and hemorrhagic puncta

97
Q

what is an aversion to smoking associated w/?

A

viral hepatitis

98
Q

in advanced viral hepatitis what might you see?

A

dark urine- coca cola
jaundice
tender hepatomegaly

99
Q

what strands of hepatits become chronic?

100
Q

what are some physical signs of hepatitis?

A

icterus, jauindice, tender liver, signs of dehydration (tachycardia, dry mucous membranes, loss of skin turgor)

101
Q

what types of hepatitis are spread fecal to oral?

102
Q

what hepatitis is assoicated w/ day care centers and residential institutions?

A

hepatitis A

103
Q

what type of hepatitis is associated w/ raw shellfish and infected food handlers?

A

hep A and E

104
Q

how do you you diagnose acute hep a?

A

igM anti HAV from 5-10 days before to 6 months after

105
Q

what are the two Hepatitis A vaccines?

A

havrix and vaqta

twinRIX

106
Q

how are hep a vaccines dosed?

A

0, 6-12 mos >12 mos

twin rx 3 dose (0,1,6 mo) >18

107
Q

what would you give for immediate protection against hepatitis A?

A

immune serum globulin

108
Q

what group of people need to be worried about Hepatitis E?

A

pregnant females

109
Q

what is the treatment for E?

A

just avoidance, IG does not protect

110
Q

what age group normally develops chronic hep b infectin?

111
Q

what is the first serum marker for heptatis b?

112
Q

what is an indicator of immunity/immunization/ that shows up 4-6 months after infection in hep B?

113
Q

what are indicateors of chronic hep B?

A

continued HBsAg and/ or anti-HBc

114
Q

what is the treatment for chronic hepatitis B?

A

something that ends in VIR

115
Q

what is prevention for hep B?

A

Hep B IG w/in 7 days of exposure and immunization

116
Q

what is hep C usually coinfected w/?

117
Q

what transmission is Hep C associated w/?

A

intravenous drug use

118
Q

what populations have hep c?

A

veterans, prisoners

119
Q

hep C leads to cirrohsis, what will speed that up?

A

increased alcohol intake, age >40, HiV coinfection, male, chronic HBV coinfec

120
Q

what is the leading cause for liver transplants in the US?

A

chronic hep C

121
Q

how do you test for hep C?

A

EIA for anti-hcv, confirmed w/ RT-pcr for RNA, repeat if negative

122
Q

how do you stage a hep c patient?

A

assessment of liver, LFTs, and biopsy

123
Q

what is the treatment for chronic hep C?

A

pegylated interferon + ribavirin

or -vir

124
Q

what is something to consider when treating hep C?

A

the harsh side effects of interferon

125
Q

what is important to note about hep D?

A

it is a coinfection w/ hep B

126
Q

how quickly can you detect antibodies in the blood in HIV?

A

3-6 weeks post exposure and 3 months post exposure

127
Q

what is the screeing test for HIV?

128
Q

what is the confirmatory test for HiV?

A

western blot

129
Q

cd4 count is an indicator of what?

A

disease progression

130
Q

viral load indicates what?

A

amount of actively replicating virus

131
Q

susceptibility to opportunistic infections begins when?

132
Q

who is category A?

A

never a CD4 below 500

133
Q

who is category B?

A

t cells 500-200/ category defining disease (candidiasis, hairy leukoplakia, herpes, PID) and NEVER a category C disease

134
Q

who is category C?

A

less than 200 or aids defining illness

candidiasis-esophageal

135
Q

what are the aids defining illnesses?

A

candidiasis, esophagus, trachea, bronchi, lungs

cryptococcus, extrapulmonary

cryptosporidosis diarrhea >1 month

cytomegalovirus

HSV ulcers >1 month

kaposis <60

lymphoma brain

mycobacterium avium or kansasii

pneumocystis jiroveci

toxoplasmosis

136
Q

what is associated w/ 50 or fewer CD4?

A

cryptosporidosis, toxoplasmosis

137
Q

what is associated w/ cd4 100 or fewer?

A

aspergillosis, AIDS dementia, cytomegalovirus

138
Q

what is associated w/ cd4 200 or fewer?

A

candidiasis, kaposi’s sarcoma, p. joroveci penumonia

139
Q

what is the initial workup for HIV

A

CD4/viral loadPPD, CMV/toxo, std, ophthalmologic, hep panel

140
Q

what is not considered infectious for HIV unless visibly bloody?

A

feces, nasal secretions, saliva, sputum, sweat, tears, urine, vomitus

141
Q

what are the civilian PEP meds for HIV and how long?

A

tenofovir + emtricitabine (truvada) & raltegravir for 28 days w/in 72 hrs

142
Q

what are the military meds for PEP for HIV?

A

combivir, truvada, zarit + kaletra, evotraz for 28 days w/in 72 hrs.

143
Q

what time periods is somebody tested w/ EIA for seroconversion after exposure?

A

baseline, 6 weeks, 12 weeks, 6 months then to 12 months if develops Hep C

144
Q

what is the PrEP for HIV?

A

truvada (emtricabine + tenofovir)

145
Q

how long does it take for HIV PrEP to become effective?

146
Q

what do you have to do before giving PrEP HIV prophylaxis?

A

Neg HIV test, comprehensive STD screening, CrCl levels prior to initiation

147
Q

what influenza is most associated w/ school and military camps?

A

influenza B

148
Q

what flu is most associated w/ antigenic drift?

A

inflenza A

149
Q

what populatino has the highest attack rate for influenza?

150
Q

what population has the highest risk of complication for influenza?

151
Q

ifluenza presents w/ what?

A 
viral prodrome
high fever >104 4-5 days
chills
myalgia first 3 days
severe HA first 2 days
152
Q

what can you consider if a person has influenza less than 48 hrs?

A

antiviral -mivir A-H1N1

neuraminidase inhibitors influenza A or b

153
Q

what age groups can get flumist?

154
Q

who should get the flu vaccine

A

.65, nursing home resident, chronic disease, long term aspirin <18 y/o, health care workers,

155
Q

who shoulnt get the flu vaccine?

A

anaphylaxis to eggs, reaction to thimerosal contact solution, acute febrile illness, guillain barre

156
Q

what complications are associated w/ flu?

157
Q

what is the MC transplant pneumonia?

158
Q

what does HSV look like on x-ray?

A

small nodule on periphery

159
Q

what does cmV look like on X-ray

A

lower lobes

160
Q

what does RSV look like on x-ray

A

bilateral interstitial or patchy infiltrates

161
Q

what does varicella look like on x-ray

A

diffuse, fluffy, reticular, or nodular infiltrates

162
Q

what can you get from exposure to rodent/rodent feces specifically from a deer mice?

A

hanta virus

163
Q

what does not hantavirus look like on x-rays?

A

basilar or perihilar pattern

164
Q

what does hantavirus present w/?

A

from NM/CO, myslagia particularly in back and legs, tachypnea, fever tachycardia, abdominal tenderness, increased HCT, acidosis, myalgia

165
Q

what is the treatment for hantavirus?

166
Q

what is the MC common cause of community acquired pneumonia?

A

strep pneumoniae

167
Q

who is more susceptible to stroptococcus/pneumococcal pneumonia?

A

asplenic patients

168
Q

how may strep pneumo present?

A

after viral upper respiratory, acute, productive cough (rather than dry like viral), high fever, pleuritic chest pain

169
Q

what does strep pneumo look like on x-ray

A

alveolar pattern and the radiograph stays worse longer than the patient

170
Q

what labs will be changed for strep pneumo?

A

left shift and elevated ESR and CRP

171
Q

what is the treatment for strep pneumo?

A
  • cillin or
  • floxacin

until afebrile or a min of 5 days

172
Q

who should get the pneumococcal vaccine?

A

> = 65, high risk, before splenectomy, immunocrompromised

173
Q

what is the MC cause of CAP in health people 5-35

A

mycoplasma pneumoniae

174
Q

how will mycoplasma penumoniae present on x-ray?

A

fluffy infiltrates

175
Q

what is associated w/ mycoplasma pneumoniae?

A

bullous myringitis (fluid fill blisters on the ear drum)

176
Q

what can you consider treating mycoplasma pneumonia w/?

A

doxy or azithromycin

177
Q

who will get chlamydophila psittaci (psitacosis)?

A

people that work with psittacine birds like poultry workers and pet stores. Its from inhalation of dried bird droppings

178
Q

what will chlamydiophila psittaci present w/?

A

horder’s spots, splenomegaly, hemturia, exertional dypsnea, cough, and fever

179
Q

what do you use to treat chlamydophila psittaci?

A

doxy, erythromycin

180
Q

where are some places that you will find legionella?

A

cruise ship, showers, cooling systems

181
Q

what sign does legionella have that’s different?

A

a higher incidence of confusion

182
Q

what test can you do for legionella?

A

legionella urine antigen testing

183
Q

what is the treatment for legionionella?

A

azithromycin or levofloxacin

184
Q

what is likely the cause of a newborn with fever, tachypnea, ciculatory collapse, cough, and respiratory distress that had a preceding viral illness?

A

staphylococcus aureus

185
Q

if an adult gets influenze what are you worry about them potentially developing?

186
Q

what is the treatment for staph A?

A

vanc, nafcillin, drain effusion, chest tube

187
Q

what is treatment for kelbsiella?

188
Q

what is associated w/ klebsiella?

A

upper lobe caviation, alcoholics, and currant jelly sputum

189
Q

what causes bronchitis in a healthy person?

A

influenza A/B, adenovirus, RSV, rhinovirus

190
Q

why are smokers more likely to have bronchitis?

A

their ciliary action is paralyzed

191
Q

what do you treat bronchitis w/ in smokers

A

amoxicillin

192
Q

what is asociated w/ pertussis besides the whoop?

A

post-tussive gagging and/or vomiting. and apneic spells in infants, cough greater than 14 days in adults, FRENIC ULCER

193
Q

what might be coinfecting w/ pertussis?

194
Q

what do you treat bordettla w/?

A

azithromycin

195
Q

what causes severe acute respiratory syndrome?

A

coronavirus

infectious disease (18 decks)

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