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Infectious diseases > diseases and DDX > Flashcards

diseases and DDX Flashcards

1
Q

Common vaginal infections - types and bugs

A
  1. Bacterial vaginosis (Gardnerella vaginalis)
  2. Thrichomoniasis (trichomonas vaginalis)
  3. Candida vulvovaginitis (Candida)
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2
Q

Common vaginal infections - treatment

A
  1. Bacterial vaginosis –> metronidazole/clinddamycin
  2. Thrichomoniasis –> metronidazole (also treat sexual partner)
  3. Candida vulvovaginitis –> -azoles
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3
Q

Common vaginal infections - labs

A
  1. Bacterial vaginosis –> clue cells, ph>4.5, amine whiff test (mixing discharge with 10% KOH enhance, fishy odor
  2. Thrichomoniasis –> motile trichomonas, ph>4.5
  3. Candida vulvovaginitis –> pseudohyphae, ph normal (4-4.5)
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4
Q

Common vaginal infections - signs and symptoms

A
  1. Bacterial vaginosis –> no inflammation, thin white discharge with fishy odor
  2. Thrichomoniasis –> inflammation (strawberry cervix), frothy, grey geen, foul smeeling discharge
  3. Candida vulvovaginitis –> inflammation, thick white cottage cheese discharge
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5
Q

Rashes in childhood - bugs and disease

A
  1. Coxsackievirus type A –> Hand-foot-mounth disease
  2. HHV-6 (Less commonly HHV-7)–> Roseola (exannthem subitum or 6th disease)
  3. Measles virus –> Measles (rubeola)
  4. B19 –> Erythema infectiosum (Slapped cheek, 5th disease)
  5. Rubella virus –> Rubella (German measles)
  6. S. pyogenes –> Scarlet fever
  7. VZV –> chickenpox
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6
Q

Congenital infections - bugs

A

ToRCHeS infections: (+ other)

  1. Toxoplasma gondi
  2. Rubella
  3. CMV
  4. HIV
  5. HSV-2
  6. Syphilis
  7. S. agalactiae 8. E.coli 9. Listeria, 10. B19
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7
Q

Toxoplasma gondi - neonatal manifestation

A

classic triad: 1. chorioretinitis 2. hydrocephalus 3. intracranial calcifications
+/- blueberry muffin rash

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8
Q

Rubella - neonatal manifestation

A

classic triad: 1. PDA (or pulmonary artery stenosis, or septal defects)
2. Hearing loss 3. Deafness
+/- blueberry muffin rash

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9
Q

CMV - neonatal manifestation

A
  1. hearing loss
  2. seizures
  3. petechial rash
  4. blueberry muffin rash
  5. periventricular calcifications
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10
Q

HSV -2 neonatal manifestation

A
  1. encephalitis

2. herpetic (vesicular) lesions

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11
Q

Congenital infections - definition / transmission

A

microbes that may pass from mother to fetus:

1. transplacental (MC) 2. delivery

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12
Q

Non-specific signs of congenital infection

A
  1. hepatosplenomegaly
  2. jaundice
  3. thrombocytopenia
  4. growth retardation
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13
Q

Scarlet fever is caused by? clinical presentation

A

Streptococcus pyogenes

Erythematus sandpaper-like rash with fever and sore throat

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14
Q

Serratia marcescens - special features (2)

A
  1. red pigment (some stains)

2. often nosocomial and drug resistance

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15
Q

Pseudomonas aeruginosa - - special features (2)

A
  1. Bleu-green pigment and fruity odor

2. often nosocomial and drug resistance

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16
Q

Chlamydia trachomatis serotypes D-K causes

A
  1. Urethritis/PID
  2. ectopic pregnancy
  3. neonatal pneumonia (staccato cough) with eosinophilia
  4. neonatal conjunctivitis
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17
Q

common skin infections - types

A
  1. erysipelas
  2. cellulitis (nonpurulent)
    cellulitis (purulent)
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18
Q

erysipelas - organisms and manifestation

A
  • S. pyogenes
  • superficial dermis + lymphatics
  • raised, sharply demarcated edges
  • rapid spread + onset
  • fever early in course
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19
Q

nonpurulent cellulitis - organisms and manifestation

A 
S. pyogenes + MSSA
- deep dermis + subcutaneous fat
- flat edges with poor demarcation
- indolent (over days)
localized (fever later in course)
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20
Q

purulent cellulitis - organism and manifestation

A
  • MMSA + MRSA
  • Purulent drainage
  • folliculitis: infected hair follicle
  • Furuncles: Folliculitis –> dermis –> abcess
  • Carbuncle: muutluple furuncles
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21
Q

infectious genital ulcers - DDX

A

painful: HSV. Haemophilus ducrei (chancroid)
painless: Clamydia trachomatis (L1-L3) (lymphogranuloma venereum), syphilis

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22
Q

infectious genital ulcer - HSV

A
  • painful
  • small vesicles or ulcers on erythematus base
  • mild lymphadenopathy
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23
Q

infectious genital ulcer - Haemophilus ducreyi (chancroid)

A
  • painful
  • large, deep ulcer with gray, yellow exudate
  • WELL-demarcated borders + soft, friable base
  • sever lymphadenopathy that my suppurate
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24
Q

infectious genital ulcer - lymphogranuloma venereum

A
  • painless
  • small shallow ulcers (often missed)
  • can progress to painful, fluctant adenitis (buboes)
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25
Q

MC opportunistic infections in patients received solid organ transplant

A

CMV and PCP

For sure TMP-SXM in the beginning for 1/2-1 year, maybe ganciclovir as well

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26
Q

most reliable sign for spinal osteomyelitis

A

tenderness to gentle percussion over the spinous process of the involved vertebra
- FEVER AND LEYKOCYTOSIS ARE UNRELIABLE

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27
Q

osteomyelitis - fever

A

less than 50%

  • ESR slightly elevated
  • normal leukocytes
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28
Q

solid organ transplant with systemic illness (pneumonitis, hepatitis, GI) - test for

A

CMV viremia

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29
Q

C. difficile - diagnosis and treatment

A

diagnosis: stool PCR or enzyme immunoassay –> if (-) –> consider colonoscopy and biopsy)
treatment: oral metronidazole or vancomycin

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30
Q

C. difficile - diagnosis and treatment

A

diagnosis: stool PCR or enzyme immunoassay –> if (-) –> consider colonoscopy + biopsy
treatment: oral metronidazole or vancomycin

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31
Q

meningococcal vaccination - when

A
  • primary vaccination preferebly at age 11-12
  • booster at age 16-21
  • if high risk (complement def, asplenia, collage, military, travel to endemic, outbreaks): vaccinate even after 18
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32
Q

anti-TNF - vaccination

A

avoid live-attenuated

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33
Q

contraindications for yellow fever vaccination

A
  1. allergy to vaccine components (eg. eggs)
  2. AIDS (CD less than 200), certain immunodef,
  3. immunosuppressive therapy (anti-TNF, high dose cortisol)
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34
Q

another symptom of meningococcal meningitis

A

severe myalgias

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35
Q

meningogcoccal mening - treatment

A

3rd gener + vancomycin

  • steroids not helpful
    chrmoprophylaxis: rifampin, cipro, ceftriaxone to all resp contacts
36
Q

N. gonor - screening

A

men are alwasy symptomatic
women can be asymptomatic: indications: sexually active before 25, no condoms, history of multiple partners or other STD, pregnancy

37
Q

Evaluation of suspected ventilator-associated pneumonia

A

abnormal X-ray –> Lower resp tract endotracheal tube samle (culture, microscopy) –> Empiric antibiotics:

  • (-) cultures: stop antibiotics and evaluate other causes
  • (+) with clinical improvement: narrow antibiotics according to culture
  • (+) cultures without clinical improvement –> consider changing antibiotcs, assess for VAP complications (abcess, empyema), consider other causes –> CT
38
Q

ventilator-associated pneumonia - what to cover empirically

A
  • Gram (+)
  • pseudomonal and gram (-)
  • MRSA
39
Q

ventilator-associated pneumonia - onset

A

48 or more hours after incubation

40
Q

Recommenced vaccines for adults - influenza

A

annually

41
Q

Recommended vaccines in adults - Tdap?

A

Tdap once as substitute for Td booster (as adult), then Td every 10 years

42
Q

PCV - recommended vaccines for adults

A
  • if 65 or older: 1 dose of PCV13 followed by PPSV23 at 6-12 months later
  • 19-64: PPSV23 alone in heart or liver disease, DM, smoker, alcoholic
    OR both (LIKE OLDER THAN 65) in very high risk: CSF leak, cochlear implants, SCD, aspenia, immne, kidney disease, HIV
43
Q

chronic liver disease - vaccination

A
  1. Tdap/Td
  2. infl: annually
  3. HAV: 2 doses with 6 months apart with initial (-) serologies)
  4. HBV: 3 doses at 0 months. 1 month + 4 months
  5. PPSV23 alone, followed by sequential PCV13 + PPSV 23 at age 65
44
Q

Liver disease - pneumococcal vaccination

A

PPSV23 alone, followed by sequential PCV13 + PPSV 23 at age 65

45
Q

Hospital acquired pneumonia treatment

A

vancomycin + tazosin

46
Q

urethritis in men - etiology

A
  1. N. gonor (MC)
  2. Chlamydia trachomatis
  3. Mycoplasma genitalum
  4. Trichomonas (rare)
47
Q

urethritis in men - diagnosis

A
  • urinalysis
  • gram stain + culture
  • PCR
48
Q

urethritis in men - treatment

A
  • azythromycin or doxycycline

- PLUS ceftriaxone if gonococcus suspected or not ruled out

49
Q

indication for CT scan in acute pyelonephritis

A
  1. not improvement despite 49-72 hours of therapy
  2. history of nephrolythiasis
  3. complicated
  4. unusual urinary findings (eg. gross hematuria, suspicion for urinary obstruction)
50
Q

clinical features of toxic shock syndrome

A
  1. fever higher than 38.9
  2. hyptotension
  3. Diffuse macular erythroderma
  4. skin desquamation (including palms and soles (1-2 weeks after illness onset)
  5. multisystem involvement (3 or more)
51
Q

Ludwig angina?

A

rapidly progressive cellulitis (polymicrobial) of the submandibular + sublingual spaces –> the source of infection is most commonly an infected mandibular molar

  • early intervention with IV antibiotics prevents airway compromise
  • local compressive + systemic symptoms + crepitus
  • CT to confirm and rule out abscess
52
Q

medications that can cause pill esophagitis

A
  1. potassium chloride
  2. tetracyclines
  3. biphosphonates
  4. NSAID
53
Q

MRSA pneumonia - people?

A

superinfection in young people with inf infection

  • rapidly progressive necrotizing pneumonia, often fatal
  • malitlobular cavitary infiltrates
  • often causes leukopenia
54
Q

clindamycin - covers

A 
anaerobic and gram (+)
NOT GRAM (-)
55
Q

anaerobic coverage in lungs

A
  • metronidazole + amoxicillin
  • clindamycin
  • augmentin
  • carbapenem
56
Q

TMP - SXM - oral or IV

A

both

57
Q

TMP-SXM SE

A

rash neutropenia, hyperkalemia, elevated transaminases

58
Q

initial management for neutropenic fever

A

monotherapy with antipseudomonal: cefepime, tazosin, meropenem

59
Q

another symptom of mycoplasma infection

A

macular/vesicular rash / nonexudative pharyngitis

60
Q

test to diagnose dengue fever

A

turniquet test

61
Q

Tetanus prophylaxis - clean or minor wound

A
  1. if received 3 or more tetanus toxoid doses: tetanuus toxoid-containing vaccine only if last dose more than 10 years ago, NO TIG
  2. unimmunized or less than 3 doses: tetanus toxoid vaccine only, NO TIG
62
Q

Tetanus prophylaxis in dirty or sever wound

A
  1. if received 3 or more tetanus toxoid doses: vaccine only if last dose 5 or more years before, NO TIG
  2. unimmunized or less than 3 doses: vaccine PLUS TIG
63
Q

Evaluation of vertebral osteomyelitis

A

fever, back pain, focal spinal tenderness –> blood cultures, ESR, CRP, plain spinal x-rays –> if high ESR/CRP but normal x-ray –> MRI –> CT guided needle aspiration/biopsy

64
Q

infection in diabetic foot - mechanism and type of microorganism

A

polymicrobial with gram (-), gram (+), and anaerobic
osteomyelitis due to continuous extension
(superficial can be monomicrobial, but deeper infections are always polymicrobial

65
Q

foot infectons in diabetics foot start with localized skin erythema, warmth, tenderness and edema - suspect deeper infection when

A
  1. long standing wounds (more than 1-2 weeks)
  2. systemic symptoms
  3. large ulcers (more than 2 cm)
  4. elevated ESR
  5. presence of bone in the ulcer base
66
Q

patients with puncture wound and osteomyelitis - organism

A

pseudomonas

67
Q

splenic abscess - manifestation / RF / treatment / causes

A

triad: 1. fever 2. LUQ pain 3. leukocytosis
- Left pleural effusion, possible splenomegaly
- RF: invective endocarditis, hemoglobinopathies, immunosuppression, IV drugs, trauma
- CT scan
- treatment: antibiotics + splenectomy (if not candidate: percuteneous: drainage)
causes: STREP, STAPH, SALMONELLA

68
Q

upper resp illnesses - types

A
  1. viral upper resp syndrome
  2. influenza
  3. Strep pharyng
69
Q

upper resp illnesses - onset of symptoms

A
  1. viral upper resp syndrome: slow stepwise, migrator or evolving
  2. influenza: abrupt
  3. Strep pharyng: variable
70
Q

upper resp illnesses - upper resp symptoms

A
  1. viral upper resp syndrome: rhinorrhea, coryza, sneezing, mild pharyngitis
  2. influenza: usually mild
  3. Strep pharyng: predominantly pharyngeal symptoms
71
Q

upper resp illnesses - systemic symptoms

A
  1. viral upper resp syndrome: usually mild
  2. influenza: prominent with possible high fever, myalgias, headache
  3. Strep pharyng: variable with possible fever and myalgias
72
Q

upper resp illnesses - examination signs

A
  1. viral upper resp syndrome: nasal edema with normal or slightly erythematous pharynx
  2. influenza: variable but often unremarkable
  3. Strep pharyng: pharyngeal erythema, tonsillar hypertrophym exudates, tender cervica; lymphnodes
73
Q

human bite - treatment

A

polymicrobial (aerobic and anaerobic) –> augmentin
+ Tetanus vaccination
- maybe surgical debridement and left open

74
Q

major pathologic mechanism of foodborne illness (and organisms)

A
  1. enterotoxin ingested: S/ aureus, Bacillus cereus) –> Usually vomiting
  2. Entertoxin made in intestine: Clost perringens, ETEC, STEC, V. cholera –> watery/bloody diarrhea
  3. Bacterial epithelial invasion: C.jujuni, Nontyphoidal salmonella, Listeria –> watery/bloody diarrhea
75
Q

an effective measure to reduce the risk for catheter associated UTI

A

clean intermittent cathetirzation (periodic insertio and removal every 4-6 hours)

76
Q

superinfection to inf - orgnanisms and empiric treatment

A

S. aureus (rapid onset, necrotizing pneumornia)
S. pneum
- multibroad empiric antibiotics (vanco, Tazosin, levofloxacin)

77
Q

MCC of bloody diarrhea in the absent of fever

A

E. coli

78
Q

MCCs of bloody diarrhea

A
  1. E. coli
  2. campylobacter
  3. shigella
79
Q

bacterial mengitis empiric therapy in older than 50 … (common organisms)

A

S. pneum, N. menig, Listeria

vancom + 3rd gener ceph + Ampicillin

80
Q

bacterial mengitis empiric therapy in immonocompromised … (common organisms)

A

S. pneum, N. menig, Listeria, gram (-) robs
vancom + Ampicillin + cefepime
alternative to cefepime: meropenem or ceftazidime

81
Q

bacterial mengitis empiric therapy in neurosurgery/penetrating skull trauma … (common organisms)

A

Gram (-) robs, MRSA, coagulase (-) staph

Vancom + cefepime

82
Q

alternative to ampicillin in bacterial meningitis

A

TMP-SXM

83
Q

3rd generation cephalosporins for bacterial meningitis

A

ceftriaxone or cefotaxime

84
Q

routine blood and pustule cultures in disseminated gonoccocal infection

A

could be negative (65%) –> do PCR

85
Q

(+) test for N. gonor - next steps beside treatment

A

screen for other STD (including chlamydia, HIV, syphilis, HBV)

86
Q

disseminated gonococcal infection - treatment

A

IV ceftriaxone, switch to oral (cefixime) when clinically improved)

  • empiric azithromyzn or doxyxycline for concomitant chlamydial infection
  • joint drainage for purulent arthritis

Infectious diseases (13 decks)

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