block 44, 45: ID Flashcards
Who gets HIV screening?
15-65 regardless of risk factors
Preferred HIV screening test
4th generation assay
- confirmatory test: HIV-1/HIV-2 antibody differentiatio immunoassay
- HIV RNA if first test is negative
Why do we not routine screen for syphilis
false positives
do guidelines recommend screening asymptomatic patients for HSV
no
what are 3 things to look for in an HIV patient with CMV? What is the CD4 count below
CD less than 50
- retinitis
- esophagitis
- colitis
Diagnostic test for CMV colitis in HIV patient
colonoscopy with biopsy
clinical feature of HIV patient with cryptosporidium
chronic, profuse watery diarrhea
Malaria chemoprophylaxis in areas of high rate of chloroquine resistance
atovaquone-proguanil
Doxycycline
Mefloquine
Postexposure HIV prophylaxis treatment
3-drug antiretroviral therapy for 4 weeks
- prefer to start treatment in first few hours
Atypical community-acquired pneumonias with GI and central nervous system problems? what bug do I have
Legionnaries
how can staph. aureus cause lung problems
- IV drug user
- tricuspid endocarditis
- fragments of vegetation can embolize to lungs (cavitary lesions)
where is Chloroquine sensitive
Argentina Mexico Turkey Iraq Central America Caribbean
What is Streptococcus gallolyticus ( S bovis biotype I) is associated with what
colonic neoplasms
In humans hepatic hydatid cysts are due to infection with?
Echinococcus granulosus
CT of c hepatic hydatid cyst shows
eggshell calcification
cutaneous blastomycosis manifests as ?
well- circumscribed verrucous nodules and plaques that progress to microabscesses
Patient with diabetes mellitus on INH (isoniazid) is at what risk
pyridoxine deficiency: get peripheral neuropathy
Eikenella Corrodens? type of bacteria and where it is found
gram-negative anaerobe
normal human oral flora
Enterococi are a common cause of endocarditis associated with
nosocomial urinary tract infection
when is 13-valent pneumococcal conjugate vaccine recommended
all adults 65 and older followed later by 23-valent pneumococcal polysaccharide vaccine
when is 23-valent pneumococcal polysaccharide vaccine recommended
- less than 65
- smoker, chronic medical condition, heart/lung disease, diabetes, chronic liver disease
what vaccine is given every 10 years
Td vaccine
when is Tdap given
one-time dose in place of Td for adults
when do you usually test for HSV
with patient has active symptoms
Difference between janeway lesions and osler nodes
Janeway: vascular, nontender
Osler: Immunologic, painful
Laboratory studies for infective endocarditis
normocytic anemia
increase ESR
adult still disease
- high fevers
- arthritis/arthralgias
- salmon-colored macular rash
when is PPD test considered positive in an HIV-infected patient
induration is greater than or equal to 5mm
how are HIV patients with no manifestations of active TB treated for latent TB?
Isoniazid and pyridoxine
how is Babesiosis diagnosed
peripheral blood smear
“Maltese cross”
treatment for influenza
most adults without risk factors ( age greater than 65, chronic medical condition) treat symptoms
What is the most common secondary complication of influenza and should be suspected in any patient who develops worsening fever or pulmonary symptoms after initial improvment
secondary bacterial pneumonia
- Streptococcus pneumoniae
- staphylococcus aureus
Clinical features of Staph aureus pneumonia? X-ray?
rapid-onset, severe, necrotizing pneumonia with high risk of death
- lobar
what is the heterophile antibody test for CMV?
negative
- CMV IgM serology is positive
What antibiotic covers virulent oral bacteria ( aerobic and anaerobic oral organisms)
Amoxicillin-Clavulanate
what does ampicillin cover
gram-positive and gram-negative
What does clindamycin cover
gram-positive bacteria and anaerobes
What does Ciprofloxacin cover
gram-negative
some gram-positive organisms
PE for vertebral osteomyelitis
tenderness to gentle percussion overs spinous process
what lab values are elevated in vertebral osteomyelitis
platelets
ESR
Miliary tuberculosis Chest-Xray shows
diffuse reticulonodular pattern (millet seed)
Most common behavioral risk factor for TB in the US
substance abuse
- other: incarceration
causes of toxic shock syndrome
- Menstruation
- nasal packing
- post surgery infection
lab values for toxic shock syndrome
immature neutrophils
thrombocytopenia
when is 13-valent pneumococcal conjugate vaccine recommended
- all over 65 followerd by 23-valent pneumococcal polysaccharide vaccine at least 6-12 months later
when is PPSV23 recommended
younger 65 with chronic medical condition and smoker
- one time
when is tetanus immune globulin given
patients with significant or dirty wounds who have not previously received at least 3 doses of tetanus vaccine or vaccine is uncertain
Patients with significant puncture wounds who have not received revaccination for tetanus within how many years should be vaccinated?
5 years
lab values for malaria
anemia and thrombocytopenia
when can you give live attenuated varicella and MMR vaccines to HIV patients
CD count greater than 200
titers must be low
Lab values for disseminated histoplasmosis? X-ray?
pancytopenia
elevated LFTs
-reticulonodular infiltrates
Treatment for disseminated histoplasmosis in HIV
Amphotericin B
- 1-2 weeks of clinical improvement transition to oral itraconazole for 1 year maintenance
cause of epididmyitis for age 35 and older
E. Coli
cause of epdidmytis for age less than 35
Chlamydia or Neisseria
when do you get imaging for pyelonephritis
no clinical symptoms improvement for 48-72 horus
Proteus mirabilis increases the solubility of element in the urine
phosphate
- struvite stones ( magnesium ammonia phosphate)
treatment for infective endocarditis for viridans group streptococci
IV aqueous Penicillin G OR
IV ceftriaxone
for 4 weeks
what does ultrasound for Echinococcus granulosus look like
hepatic cyst with daughter cysts ( internal separations)
warm, tender, erythematous rash with raised, well-demarcated borders
Erysipelas
What causes erysipelas
Group A streptococcus
What area of the body suggests erysipelas as this skin lacks lower dermic level
external ear
Difference between Td and Tdap
Td: booster
Tdap: one-time dose in place of Td
For adults age less than 65, with other chronic medical conditions that increase the risk of invasive pneumococcal disease should get what vaccine
PPSV23 alone, followed by sequential PCV13 and PPSV23 at age 65
most common cause of community-acquired bacterial meningitis
Streptococcus pneumonia
An effective measure for reducing the risk of catheter-associated urinary tract infection in patients with neurogenic bladder
clean intermittent catheterization
