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Clin Med 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Name the most common bacterial STI in the US

A

Chlamydia

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2
Q

Name two common antibiotics used to treat atypical bacteria like chlamydia and mycoplasma

A
  • Azithromycin
  • Doxycycline
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3
Q

Which bacteria causes nongonococcal urethritis?

A

Chlamydia trachomatis

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4
Q

Name the most common chlamydial infection in men

A

Nongonococcal urethritis

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5
Q

Most common symptoms of nongonococcal urethritis

A
  • Dysuria
  • Subtle urethral discharge (maybe only with milking)
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6
Q

Diagnostic test for nongonococcal urethritis

A

NAAT
- urine is test of choice for men
- vaginal swab for females (not urine, since STI)

Patient are recommended to be tested for gonorrhea and HIV too

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7
Q

Treatment for nongonococcal urethritis

A

Doxycycline or azithromycin
- treat partners too
- add ceftriaxone for gonorrhea if present

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8
Q

Which organism is the most common cause of epidiymitis?

A

Chlamydia trachomatis

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9
Q

Symptoms of epididymitis

A
  • Fever
  • Unilateral scrotal pain
  • Palpable swelling of epididymis
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10
Q

The Prehn sign is performed on physical exam to confirm this condition

A

Epididymitis

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11
Q

Diagnostic test for epididymitis

A

NAAT (urine)

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12
Q

Treatment for epididymitis

A

Ceftriaxone and doxycycline

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13
Q

Women with this condition are most often (85%) asymptomatic, but may have yellow/green cervical discharge or intermenstrual/postcoital bleeding.
Physical exam is often normal (80-90%), but you may see a friable endocervix.

A

Mucopurulent cervicitis

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14
Q

Diagnostic test for mucopurulent cervicitis

A

Vaginal/cervical swab

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15
Q

Treatment for mucopurulent cervicitis

A

Doxycycline or azithromycin

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16
Q

Where is the most common location for chlamydia infection in women?

A

Cervix

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17
Q

Which organism causes mucopurulent cervicits?

A

Chlamydia trachomatis

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18
Q

Which organism causes acute proctitis?

A

Chlamydia trachomatis

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19
Q

This condition is associated with anal intercourse in men

A

Acute proctitis

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20
Q

Acute proctitis symptoms

A
  • Rectal pain
  • Rectal discharge
  • Rectal bleeding
  • Tenesmus

(usually asymptomatic in women)

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21
Q

Diagnostic testing for acute proctitis

A

Anoscopy and NAAT

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22
Q

Treatment for acute proctitis

A

Doxycycline and ceftriaxone

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23
Q

Which organism causes lymphogranuloma venereum?

A

Chlamydia trachomatis serovar

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24
Q

Where in the world is lymphogranuloma venereum most common?

A

Tropical regions

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25
Q

Diagnostic testing for lymphogranuloma venereum

A

NAAT (urine or urethral swab)

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25
Q

Symptoms of lymphogranuloma venereum

A
  • Painless genital ulcer that heals in a few days
  • Followed by suppurative regional lymphadenopathy 6 weeks later
  • Rectal pain/bloody-purulent discharge
  • Fever and malaise
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26
Q

Treatment for lymphogranuloma venereum

A

Doxycycline

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27
Q

Perinatal infections of a child born to a mother with chlamydia usually present as …

A

Either conjunctivitis or pneumonia

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28
Q

In a child born to a mother with chlamydia who develops a perinatal infection, would you expect to see them develop conjunctivitis or pneumonia first?

A
  • Conjunctivitis first
  • Pneumonia later (4-8 weeks)
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29
Q

Diagnostic testing for perinatal infections caused by chalmydia

A
  • NAAT or culture
  • Screen (and treat) all pregnant women <25)
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30
Q

Treatment for perinatal infections due to chlamydia

A
  • Oral azithromycin
  • not doxycycline since age <9
    (topicals medication often ineffective)
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31
Q

What is trachoma?

A

Chronic conjunctivitis caused by recurrent infection with certain chlamydia trachomatis serovars

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32
Q

What is the leading infectious cause of blindness worldwide?

A

Trachoma

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33
Q

How is trachoma transmitted?

A

Via ocular/nasal secretions (hands, fomites)

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34
Q

This conditions caused by chlamydia trachomatis serovars is known as a cicatricial disease

A

Trachoma

(cicatricial = scarring)

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35
Q

Average age of patients with active trachoma infections

A

Under 10 years old

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36
Q

Diagnostic testing for trachoma

A

NAAT (if available)

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37
Q

Treatment for trachoma

A

Topical tetracycline
(ok in kids since topical)

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38
Q

This infection caused by Neisseria is associated with spread in college dorms

A

Neisseria meningitidis

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39
Q

What are the number one and two causes of bacterial meningitis in the general population

A
  1. Strep pneumoniae
  2. Neisseria meningitidis

(Neisseria is most common cause in children and young adults)

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40
Q

How is Neisseria meningitidis transmitted?

A
  • Prolonged intimate contact
  • Respiratory/oral secretions
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41
Q

What condition is associated with the classic triad of:
1. Fever
2. Stiff neck
3. Altered mentation

A

Meningitis
- 58% if caused by Strep pneumoniae
- 27% if caused by Neisseria meningitidis

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42
Q

Symptoms for Neisseria meningitidis

A
  • Fever
  • Headache
  • Nausea/vomiting
  • Decreased concentration
  • Myalgias

Seen in a previously healthy patient

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43
Q

A college student comes to the dormitory nurses station complaining of flu-like symptoms with body aches and stated “this is the sickest I’ve ever felt”.

What is a must not miss diagnosis?

A

Neisseria meningitidis

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44
Q

What condition is associated with physical exam findings of petechiae near belts/elastic straps?

A

Neisseria meningitidis

(1/2 of patients will have petechiae somewhere)

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45
Q

Diagnostic testing for Neisseria meningitidis

A

Culture blood and CSF (lumbar puncture)

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46
Q

Treatment for Neisseria meningitidis

A

Ceftriaxone

(treat on suspicion, don’t wait for confirmation)

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47
Q

This gram negative diplococci most often causes urethral discharge in men and endocervical infection in women and can cause arthritis-dermatitis syndrome when disseminated (spread through the body)

A

Neisseria gonorrhoeae

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48
Q

Complications of Neisseria gonorrhoeae

A
  • Cervicitis
  • Urethritis
  • PID
  • Proctitis
  • Arthritis-dermatitis syndrome
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49
Q

Most common symptoms of Neisseria gonorrhoeae

A

Men
- Discharge most common
- Dysuria second

Women
- Endocervical infection primarily
- Discharge, vaginal pruritis, menorrhagia, dyspareunia

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50
Q

Diagnostic testing for Neisseria gonorrhoeae

A

NAAT
- urine or swab in men
- swab in women

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51
Q

Treatment for Neisseria gonorrhoeae

A

Ceftriaxone

(give doxycycline too if chlamydia hasn’t been ruled out by NAAT)

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52
Q

Which atypical bacteria can cause pneumonia?

A

Mycoplasma

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53
Q

What is the most common cause of walking pneumonia?

A

Mycoplasma pneumoniae

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54
Q

Symptoms of mycoplasma pneumoniae

A
  • 50% have: fever, nonproductive cough, dyspnea, sore throat, and headache
  • 25% have: vomiting, erythema multiforme
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55
Q

Treatment for mycoplasma pneumoniae

A

Azithromycin or doxycycline

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56
Q

Diagnostic testing for mycoplasma pneumoniae

A

Only treat if encephalitis/life-threatening illness!

(CXR, sputum testing, cold agglutinins)

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57
Q

Risk factors for sinusitis

A

Anatomic
- block sinus drainage
- deviated septum etc

Environmental
- impair ciliary action
- smoking, cocaine, topical decongestants

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58
Q

75% of sinusitis cases are caused by these two pathogens

A

S. pneumoniae and H. influenzae

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59
Q

Is frontal and maxillary sinusitis more common in children or adults?

A

Adults

(frontal sinus doesn’t develop until age 7)

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60
Q

Is ethmoid and maxillary sinusitis more common in children or adults?

A

Children

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61
Q

Symptoms of bacterial sinusitis typically begin this many days after initial mucosal inflammation

A

7-10 days after initial mucosal inflammation

(facial, tooth, eye pain, purulent discharge)

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62
Q

Physical exam signs of sinusitis

A
  • Facial tenderness
  • Opacity with transillumination (low sens and spec.)
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63
Q

Sinusitis is typically a clinical diagnosis.
However, chronic sinusitis mucosal thickening, sinus opacification, and air-fluid levels can be evaluated with these imaging methods

A

X-ray and/or CT

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64
Q

Treatments for sinusitis

A
  • Sinus rinse followed by intranasal steroids
  • Humidifier
  • Intranasal saline

Antibiotics if moderate/severe infection or failed above treatments
- Amoxicillin/Augmentin
- Doxycycline or Bactrim if allergy

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65
Q

Otitis media is most commonly caused by these three pathogens

A
  • H. influenzae
  • M. catarrhalis
  • S. pneumoniae
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66
Q

Otitis media is most common in this age group

A

Young children

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67
Q

Symptoms of otitis media

A
  • Ear pain/rubbing, hearing loss
  • Low-grade fever

In young children:
- nonspecific fussiness
- disturbed sleep
- poor feeding
- GI symptoms

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68
Q

Physical exam signs of otitis media

A
  • Purulence
  • Visibly dilated vessels on and around TM
  • Impaired mobility with pneumatic otoscopy
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69
Q

On physical exam, how will otitis media with effusion look different from acute otitis media?

A

Acute otitis media
- bulging, red, inflamed

Otitis media with effusion
- bubbly, fluid level
- less red/inflamed/vascular

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70
Q

Treatment for acute otitis media

A
  • Ibuprofen/acetaminophen

Don’t have to give antibiotics, 81% recover without
Give antibiotics if very young/old/ill/immunocompromised

  • Amoxicillin (Augmentin if b-lactam in last 30 days or history of recurrent AOM unresponsive to amoxicillin)
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71
Q

Otitis externa infections are often precipitated by …

A

Moisture/trauma in external auditory canal

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72
Q

Risk factors for otitis externa

A
  • Swimming
  • Trauma (cotton buds)
  • Occlusive devices
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73
Q

Symptoms of otitis externa

A
  • Pruritus and pain in ear
  • May have discharge
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74
Q

Physical exam signs of otitis externa

A
  • Pain with movement of external ear/tragus
  • Inflamed ear canal
  • Drainage
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75
Q

Treatment for otitis externa

A
  • Clean ear canal with hydrogen peroxide

Mild symptoms:
- acetic acid and hydrocortisone

Mod/severe symptoms:
- polymyxin B + neomycin
OR
- ciprofloxacin + hydrocortisone (ofloxacin = safest if can’t see TM)

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76
Q

Which, bacterial or viral, is the more common kind of pharyngitis?

A

Viral much more common

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77
Q

Treatment for viral pharyngitis

A
  • Analgesics (NSAIDs preferred)
  • Warm tea with honey (only age 1+)
  • Salt water gargles
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78
Q

Which condition is associated with the Centor criteria? And what are the four components of the Centor criteria?

A

Streptococcal pharyngitis
- Fever
- Absence of cough
- Cervical lymphadenopathy
- Tonsillar exudates

(FACT)

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79
Q

Diagnosis for streptococcal pharyngitis

A
  • Rapid Ag test in office
  • Follow up with throat culture for children (need to be sure, risk of complications)
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80
Q

Treatment for streptococcal pharyngitis

A
  • Penicillin or amoxicillin
  • Erythromycin or azithromycin if allergy

(change toothbrush!)

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81
Q

Describe Quinsy

A

Peritonsillar abscess

  • Collection of pus between capsule of tonsil and pharyngeal mm. (membrane?)
  • Complication of group A strep tonsilitis in young patient
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82
Q

Symptoms of peritonsillar abscess (Quinsy)

A
  • Muffled “hot potato” voice
  • Sore throat
  • Fever
  • Dysphagia with drooling
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83
Q

Physical exam findings in peritonsillar abscess (Quinsy)

A
  • Tonsil is displaced towards midline
  • Uvula often deviated
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84
Q

Diagnostic tools for peritonsillar abscess (Quinsy)

A
  • Ultrasound (need experienced technician)
  • CT neck
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85
Q

Treatment for peritonsillar abscess (Quinsy)

A

Penicillin and drainage

(prompt surgery if airway compromised)

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86
Q

Retropharyngeal abscess symptoms

A
  • Tripod/sniffing position
  • Fever
  • Toxicity
  • Neck pain
  • Dysphagia
  • Muffled voice
  • Drooling
  • Stridor
  • Anxiety
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87
Q

Physical exam findings in retropharyngeal abscess

A
  • Erythema and bulging of posterior pharyngeal wall
  • Pain with neck extension
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88
Q

Diagnostic tool for retropharyngeal abscess

A

CT

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89
Q

Treatment for retropharyngeal abscess

A

Hospitalization and ENT consultation

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90
Q

Acute epiglottitis is most common in this age group

A

Age 2-8

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91
Q

Acute epiglottitis is most commonly caused by these three pathogens

A
  • H. influenzae
  • Pneumococci
  • Streptococci

having problems swallowing

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92
Q

Symptoms of acute epiglottitis

A
  • Severe sore throat
  • Fever
  • Dysphagia
  • Drooling
  • Respiratory distress

Do not use tongue blade!

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93
Q

Diagnostic tool for acute epiglottitis

A

Lateral neck x-ray
- Thumbprint sign

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94
Q

Treatment for acute epiglottitis

A

Nasotracheal intubation + antibiotic therapy (e.g. cefuroxime)

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95
Q

The common cold is most often caused by this pathogen

A

Rhinovirus

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96
Q

Symptoms of the common cold

A
  • Sneeze
  • Cough
  • Sore throat
  • Nasal drainage
  • Minimal lymphadenopathy, lungs clear to auscultation
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97
Q

Common colds typically self resolve in [time period], but is longer in [these types of patients]

A
  • Usually resolves in 5-7 days
  • Longer in smokers/underlying lung disease
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98
Q

Common cold treatments

A
  • Acetaminophen/NSAIDs for symptoms
  • Saline helps clearance, promotes vasoconstriction
  • Hydration, thins secretions
  • Avoid OTC cold meds in children <6/12
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99
Q

Symptoms of acute bronchitis

A

Severe/prolonged cough (productive or non-productive)

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100
Q

Acute bronchitis can be treated without antibiotics because it will typically self resolve in this time period

A

1-3 weeks

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101
Q

Physical exam signs of acute bronchitis

A
  • Ronchi that clears with coughing
  • Maybe wheezing
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102
Q

Treatment for acute bronchitis

A

Antibiotics are not indicated

  • Lozenges, hot tea, honey
  • Cough suppressants: benzonatate, DM
  • Albuterol/steroids only if wheezing/underlying lung disease

Avoid codeine

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103
Q

Influenza symptoms

A
  • Rapid onset of fever, nonproductive cough, myalgias, chills, headache, sore throat, congestion
  • Nausea, vomiting, diarrhea suggest influenza B

Symptoms more subtle in elderly/immunocompromised:
- Weakness
- Dizziness
- Altered mental status

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104
Q

Diagnostic tools for influenza

A
  • Real time PCR (high sens/spec. best test if available)
  • Rapid molecular test
  • Rapid antigen test
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105
Q

Treatments for influenza

A
  • Rest
  • Hydration
  • Antipyretics
  • Antitussives

Antivirals only given if risk factors
(very young/old/fat/sick/pregnant)
- Neuraminidase inhibitors (oseltamivir)
- Give within 48 hours of symptom onset

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106
Q

An influenza patient who improves initially from the virus, then has a relapse of fever with the addition of a productive cough most likely has pneumonia secondary to influenza that is most often caused by this pathogen

A

S. pneumoniae

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107
Q

Primary influenza pneumonia has this appearance on chest x-ray

A

Bilateral reticulo-nodal opacities

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108
Q

Inflammation of the subglottic airway is known as …

A

Croup (viral layngotracheitis)

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109
Q

Croup (viral layngotracheitis) is most common in this age group

A

6 months to 3 years of age

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110
Q

Symptoms of croup (viral layngotracheitis)

A
  • Barking/seal-like cough
  • Inspiratory stridor
  • Hoarseness

Symptoms often worse at night

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111
Q

Diagnostic tools for croup (viral layngotracheitis)

A
  • Clinical
  • Check vitals, mental status, hydration status
  • X-rays not often done, but would show steeple sign if performed
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112
Q

Treatment for croup (viral layngotracheitis)

A
  • Single dose oral dexamethasone or prednisolone

(epinephrine + IV steroids if severe)

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113
Q

Respiratory syncytial virus is the most common cause of this respiratory condition

A

Bronchiolitis - acute inflammation of the bronchioles

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114
Q

Bronchiolitis is usually seen in patients aged [blank] and is most dangerous between ages [blank]

A
  • Usually seen in patient under 2 years old
  • Most dangerous between ages 2 and 6 months
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115
Q

Symptoms of bronchiolitis

A
  • Low fever (<101f) and rhinorrhea for 1-3 days
  • Followed by wheezing, cough, and maybe respiratory distress (RR>70, retractions, rales, cyanosis)
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116
Q

Diagnosis for bronchiolitis

A
  • Clinical
  • Rapid antigen test only if results will alter management
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117
Q

Bronchiolitis treatment

A

Hospitalization if respiratory distress

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118
Q

Coronavirus symptoms

A
  • Nonproductive cough
  • Congestion and rhinorrhea
  • Myalgia/malaise
  • Sore throat
  • Headache
  • Diarrhea
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119
Q

If you administer a rapid COVID test in office too early, are you more likely to get a false positive or false negative result?

A

False negative: virus hasn’t replicated enough yet

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120
Q

Viral pneumonia from COVID most commonly appears 10-12 days after symptom onset and has this appearance on chest x-ray

A

Ground-glass opacities

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121
Q

Differentiate between these stages of COVID severity:
- Mild
- Moderate
- Severe
- Critical
- Cytokine storm

A
  • Mild: minimal symptoms
  • Moderate: fever with signs of pneumonia
  • Severe: Respiratory distress
  • Critical: Respiratory failure, shock, organ failure
  • Cytokine storm: Hyperinflammation leading to multiple organ failure
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122
Q

COVID treatment

A

Only treat if high risk:
- 65+, immunocompromised, severe disease, 65+ and unvaccinated

  • Paxlovid
  • Remdesivir
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123
Q

Tuberculosis is caused by this pathogen

A

Mycobacterium tuberculosis

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124
Q

Risk factors for tuberculosis

A
  • Men
  • Poor
  • Immigrants
  • Immunosuppressed
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125
Q

Symptoms of acute tuberculosis infection

A
  • Fever
  • Chest pain
  • Nonproductive cough
  • Night sweats
  • Weight loss (consumption)
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126
Q

Chest x-ray findings in acute symptomatic tuberculosis infection

A

Hilar lymphadenopathy

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127
Q

After catching tuberculosis and passing through the acute asymptomatic infection phase, a patient will enter the [blank] phase

A

Latent phase

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128
Q

A patient with asymptomatic latent TB will have these results:
- Chest x-ray: [normal/abnormal]
- TB skin test: [positive/negative]

A
  • Chest x-ray: Normal
  • TB skin test: Positive
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129
Q

True or false.
Latent tuberculosis is transmissable

A

False

  • Can only catch active TB (fever, symptoms)
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130
Q

When is reactivation of latent tuberculosis most likely to occur?

A

Anything that suppresses immune system, TB gets out from sequestration
- HIV
- Organ transplant
- Silicosis
- TNF-a blockers
- Dialysis

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131
Q

Does reactivation of latent tuberculosis have an abrupt or insidious onset?

A

Slow and insidious

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132
Q

Symptoms of latent tuberculosis reactivation

A
  • Weight loss
  • Night sweats
  • Fever (diurnal)
  • Hemoptysis
  • Chest pain
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133
Q

Are cavitations on chest x-ray more likely to be seen in a primary tuberculosis infection or a reactivation of latent disease?

A

Reactivation of latent disease

  • Cavitation rare in primary TB infection
  • Hasn’t had enough time for immune system to build walls around
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134
Q

What is “miliary” tuberculosis?

A
  • Hematogenous dissemination
  • TB spreading around the body through the blood
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135
Q

Most common presentation of extrapulmonary tuberculosis

A

Lymphadenitis (scrofula)

  • A big lymph node full of TB
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136
Q

What methods of tuberculosis screening are available for latent disease in cases of known exposure, health care workers, etc

A
  • Interferon-gamma release assay (IGRA) is preferred if available (WBC test)
  • Tuberculin (Mantoux) test (skin test)
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137
Q

How would you interpret the following measurements of induration 2-3 days after administration of a tuberculin skin test:
- 5mm
- 10mm
- 15mm

A

5mm
- Positive if HIV or known close contact

10mm
- Positive if immigrant, prisoner, homeless, IV drug user, nursing home resident, chronic illness

15mm
- Anyone with this much induration is considered positive

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138
Q

If an asymptomatic patient has a positive screening (TST or IGRA) for tuberculosis, what is the next test to confirm?

A

Chest x-ray
- Looking for mediastinal lymphadenopathy, consolidation, effusion, cavitation

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139
Q

Patient who have signs of active tuberculosis OR who have a positive screening + chest x-ray findings should have this testing done next …

A

Collect sputum and perform any of the following
- Acid-fast bacilli smear (AFB) - fastest and cheapest
- Nucleic acid amplification testing (NAAT) = better sens. than AFB
- Culture

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140
Q

Treatment for latent tuberculosis disease

A

Isoniazid for 6-9 months

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141
Q

Side effects of isoniazid

A
  • Can develop peripheral neuropathy (preventable with pyridoxine = vitamin B6)
  • Liver toxicity
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142
Q

Side effects of rifampin

A
  • Orange discoloration of urine/sweat/tears/saliva
  • Liver toxicity
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143
Q

Pyrazinamide side effects

A
  • Liver toxicity
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144
Q

Ethambutol side effects

A
  • Ocular toxicity
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145
Q

Name two diseases (not tuberculosis) caused by mycobacteria

A
  • Mycobacterium avium complex (MAC)
  • Mycobacterium leprae (leprosy)
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146
Q

What is the #1 opportunistic bacterial infection in AIDS patients?

A

Mycobacterium avium

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147
Q

Mycobacterium avium is thought to be acquired from …

A

Municipal water

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148
Q

Symptoms of mycobacterium avium

A
  • Fever
  • Chills
  • Night sweats
  • Profound weight loss
  • Diarrhea
  • Malabsorption

(can also cause pulmonary disease)

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149
Q

Diagnostic tools for mycobacterium avium

A

Cultures and smears

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150
Q

Treatments for mycobacterium avium

A
  • Antiretroviral therapy (keep helper T cells up in HIV patients)
  • Azithromycin or clarithromycin
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151
Q

Mycobacterium leprae primarily affects these parts of the anatomy

A

Skin and peripheral nerves

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152
Q

Symptoms of mycobacterium leprae

A
  • Hypopigmented/reddish patches on skin
  • Paresthesia on hands/feet
  • Painless wounds/burns on hands/feet
  • Tender, enlarged peripheral nerves

Late findings:
- Weakness and deformities

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153
Q

How is a diagnosis of mycobacterium leprae confirmed?

A

Biopsy

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154
Q

How is herpes simplex virus transmitted?

A

Direct contact of secretions with mucosal surfaces/breaks in skin

(not respiratory droplets or fomites)

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155
Q

Which of the following is more common with HSV 1 or 2?
- Orofacial disease
- Genital disease

A
  • Orofacial disease = HSV-1
  • Genital disease = HSV-2
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156
Q

Herpes simplex virus is neurovirulent. Which nerves do HSV-1 and HSV-2 live in?

A
  • HSV-1: Trigeminal ganglia
  • HSV-2: S2-S5 ganglia
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157
Q

Common causes of dormant herpes infection reactivation

A
  • Fever
  • Trauma
  • Emotional stress
  • Sunlight
  • Menstruation
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158
Q

Which, HSV-1 or HSV-2, is more common in newborns due to maternal spread?

A

HSV-2 from vaginal delivery (or across placenta - rare)

159
Q

How does the presentation of primary oral-labial herpes differ from reactivation?

A
  • Primary: gingivostomatitis or pharyngotonsillitis
  • Reactivation: cold sores

Generally, more likely to see abrupt onset, intra-oral ulcers, and systemic symptoms with first infection

160
Q

Oral-labial herpes typically first occurs between these ages

A

6 months to 5 years

161
Q

What are the prodromal symptoms of herpes labialis?

A

Pain, burning, tingling

162
Q

Ocular herpes is usually due to [HSV-1/HSV-2]

163
Q

Symptoms of ocular herpes

A
  • Unilateral conjunctivitis, blepharitis, or corneal opacities
  • Pain, photophobia
  • Blurry vision
  • Tearing, redness
164
Q

The most common corneal cause of blindness in the US is …

A

HSV keratitis

165
Q

Symptoms of genital herpes

A
  • Painful vesicular genital lesions
  • Fever, malaise, inguinal lymphadenopathy

Recurrent episodes are milder and shorter

166
Q

Perianal and anal herpes is most commonly seen in …

167
Q

Symptoms of perianal and anal herpes

A
  • Pain
  • Itching
  • Tenesmus
  • Rectal discharge
  • Fever, chills
  • Sacral paresthesia
  • Headache
  • Dysuria
168
Q

Differentiate between localized and disseminated neonatal herpes infections

A

Localized:
- Skin, eye, mucous membrane disease (SEM disease) presents at 10-12 days old
- Good outcome with prompt antiviral therapy

Disseminated:
- Severe disease with hepatic/pulm/neuro failure
- High mortality if not promptly treated

Possibility of sepsis or CNS infection (encephalitis) at 2-3 weeks of age (lethargy, irritability, seizures)

169
Q

Is there a higher risk of neonatal transmission of herpes in a primary or recurrent infection of the mother?

A

Primary (50% vs 5% for recurrence)

170
Q

Herpes infections are often diagnosed clinically. However, this lab test is the best

171
Q

How to prevent neonatal herpes transmission if a pregnant mother has active lesions

172
Q

Treatment for (neonatal, ocular, genital) herpes

173
Q

How is varicella-zoster virus transmitted?

A
  • Aerosolized respiratory droplets
  • Direct contact with vesicular fluid
  • Contagious from 48 hours before rash, until lesions are crusted
174
Q

Symptoms of varicella zoster (chicken pox)

A
  • Prodrome of fever, malaise, pharyngitis
  • Subsequent generalized vesicular rash
175
Q

Herpes zoster (shingles) typically occurs in these kinds of patients

A
  • Older
  • Immunocompromised
176
Q

Postherpetic neuralgia, Ramsay Hunt syndrome, and segmental myelitis are potential complications of this condition

A

Herpes zoster (shingles)

  • Need to treat shingles asap!
177
Q

Diagnosis of herpes zoster (shingles) is often clinical. But this lab test is best if confirmation is needed

A

PCR testing

(culture too slow, don’t have time)

178
Q

Symptoms of herpes zoster (shingles)

A

Pain in a dermatome followed by vesicular eruption in a dermatome

179
Q

Treatment for varicella-zoster (shingles)

A

Acyclovir - within 3 days of onset

(if immunocompromised, give IV acyclovir)

180
Q

Symptoms of postherpetic neuralgia

A
  • Pain persisting >3 months after shingles rash started
  • Burning, itching, or sharp pain localized to a dermatome
  • Usually thoracic, cervical, or trigeminal
181
Q

Risk factors for postherpetic neuralgia

A
  • Age >60
  • Severe pain/rash with previous acute herpes zoster (shingles) episode
182
Q

How is cytomegalovirus transmitted?

A
  • Blood, respiratory secretions, saliva, urine, semen, cervical mucus, tears, breast milk

(anything wet)

183
Q

Cytomegalovirus is most commonly seen in these patients

A
  • Transplant patients (immunosuppressed)
184
Q

Symptoms of cytomegalovirus

A
  • Usually asymptomatic or mild mono-like symptoms (sore throat, fatigue, fever)

Immunocompromised = multiple organs affected
- GI manifestations (colitis)
- Neurologic, ocular, CV complications

185
Q

What would be seen in the peripheral blood smear of a patient with cytomegalovirus?

A

Lymphocytosis with atypical T lymphocytes

186
Q

What is the best lab test for cytomegalovirus?

A

PCR

(only test immunocompromised/transplant patients though)

187
Q

Treatment for cytomegalovirus

A

Ganciclovir or valganciclovir

188
Q

This virus has a long incubation time (1-2 months), is asymptomatic in young children, but can cause fever, pharyngitis, lymphadenopathy, fatigue, and splenomegaly

A

Epstein-Barr virus (mono)

189
Q

Symptoms of infectious mononucleosis

A
  • Fever
  • Pharyngitis (exudative or non-exudative)
  • Lymphadenopathy
  • Fatigue
  • Splenomegaly

(body attacks infected b-cells)

190
Q

Diagnostic tools for Epstein-Barr virus

A
  • Monospot: detect heterophile antibodies
  • CMP: elevated LFTs
  • Peripheral blood smear: lymphocytosis with atypical lymphocytes
191
Q

Treatment for Epstein-Barr virus

A
  • Supportive
  • Steroids for airway obstruction/severe thrombocytopenia/hemolytic anemia
192
Q

How long after an episode of infectious mononucleosis can a patient return to sports?

A

Four weeks at the earliest

193
Q

How is measles (rubeola) spread?

A

Respiratory aerosol droplets (very contagious)

194
Q

Symptoms of measles (rubeola)

A
  • Koplik spots on buccal mucosa and conjunctiva
  • Fever, malaise
  • Eye problems (conjunctivitis, photophobia, periorbital edema)
  • Cough
  • Coryza (congestion)
  • Rash starting at hairline, spreading downwards
195
Q

Which, measles (rubeola) or rubella (German measles) has a rash that lasts longer (6-7 days)?

A

Measles (rubeola)

196
Q

These lesions that appear in the buccal mucosa and conjunctiva are described as “small grains of sand on a red background”

A

Koplik spots - seen in rubeola (measles)

197
Q

Symptoms of mumps

A
  • Parotid tenderness/swelling within 48 hours
  • Fever, headache, malaise
198
Q

Diagnostic tools for mumps

A
  • PCR (buccal swab)
  • Serum IgM
199
Q

This condition has potential complications of epididymo-orchitis in postpubertal males, pancreatitis, oophoritis, and hearing loss

200
Q

Symptoms of rubella (German measles)

A
  • Prodrome of fever, headache, malaise, mild conjunctivitis
  • Rach beginning on face/forehead, spreads to trunk and extremities

(NO Koplik spots, NO cough, NO coryza)

201
Q

Symptoms of erythema infectiosum (parovirus B19/fifth disease)

A
  • Fiery-red rash on both cheeks (slapped cheek disease)
  • Pallor around mouth
  • Extremity rash later, spreads to trunk
  • Arthritis/arthralgia
202
Q

Symptoms of molluscum contagiosum

A
  • Multiple painless, pearly white 2-5mm nodules with central umbilication
  • Appear everywhere except soles and palms
  • NO symptoms other than rash
203
Q

Both gonorrhea and chlamydia are often asymptomatic. But which one, if symptomatic, is generally more purulent and aggressive?

204
Q

Symptoms of urethritis/cervicitis

A
  • Urethral discharge
  • Dysuria
  • Itching at distal urethra
205
Q

What kind of organism is Neisseria Gonorrhea?

A

Gram negative diplococci bacteria

206
Q

Best test for gonorrhea diagnosis

A

Nucleic acid amplification test (NAAT)

207
Q

Which patients are recommended to get three site testing when screening for gonorrhea?

A

Men who have sex with men and other high risk populations

208
Q

Treatment for gonorrhea

A
  • Ceftriaxone 500-1000mg (weight based) IM

(if chlamydia not excluded add doxycycline/azithromycin)

209
Q

Between chlamydia and gonorrhea, which one is more likely to cause a clear discharge?

210
Q

What is the number one reported bacterial infectious disease in the US?

211
Q

Prevalence of chlamydia is highest in this age group

212
Q

Symptoms of chlamydia

A
  • Most often asymptomatic
  • Dysuria
  • Discharge
  • Dyspareunia
  • Abdominal/testicular pain
  • Breakthrough bleeding
213
Q

All women diagnosed with chlamydia during pregnancy should be tested for reinfection in [time period]

A

Three months

214
Q

Both chlamydia and gonorrhea have the potential to cause conjunctivitis. But which one is more likely to be beefier and more red?

A

Gonorrhea (gonococcal conjunctivitis)

215
Q

Treatment for chlamydia

A
  • Doxycycline 100mg PO BID x7
    OR
  • Azithrmoycin 1g PO single dose
216
Q

Treatment for chlamydia in pregnancy

A
  • Azithromycin 1g PO single dose
  • Safe in all trimesters

(Can’t give doxycycline)

217
Q

What is the most common cause of vaginal discharge in women of reproductive age?

A

Bacterial vaginosis

218
Q

Bacterial vaginosis is a polymicrobial condition but is mostly associated with this bacteria

A
  • Gardnerella vaginalis

(also anaerobes, prevotella, mobiluncus, and mycoplasma)

219
Q

What condition is associate with the Amsel diagnostic criteria and what is the criteria?

A

Bacterial vaginosis
- Homogenous, white, uniformly adherent discharge
- Vaginal pH >4.5
- Clue cells on wet mount
- Fishy odor with Whiff test
- Absence of WBCs

220
Q

Treatment for bacterial vaginosis

A

Must perform pelvic exam and lab testing to confirm before treating!

  • Metronidazole 500mg PO BID x7
221
Q

Topical, intravaginal treatments, such as clindamycin cream, for bacterial vaginosis are effective (if no upper GU involvement) with fewer side effects for pregnant women.
However, these types of creams should be used with caution as they can weaken condoms and diaphragms.

A

Oil-based creams

222
Q

This condition is associated with a sexually transmitted protozoan (parasite)

A

Trichomoniasis

223
Q

Risk factors for trichomoniasis

A
  • Black
  • Smoking
  • Incarceration
  • Poor
224
Q

Symptoms of trichomoniasis

A

70% are asymptomatic!

Men
- Itching/irritation inside penis
- Burning with urination/ejaculation
- Penile discharge

Women
- Copious frothy discharge
- Itching, burning, redness, sore genitals
- Discomfort with urination

225
Q

Diagnostic criteria of trichomonas vaginalis

A
  • Profuse, frothy green/yellow vaginal discharge
  • Vulvar itching
  • Motile trichomonads on microscopy
226
Q

Treatment for trichomoniasis

A
  • Metronidazole or tinidazole
  • Partners should be treated
227
Q

Which condition is associated with pseudohyphae seen on microscopy?

A

Vulvovaginal candidiasis

228
Q

Symptoms of vulvovaginal cadidiasis

A
  • Odorless cottage cheese discharge
  • Dysuria
  • Genital burning/pain
  • Erythema, fissures, edema
229
Q

Vulvovaginal candidiasis is usually caused by this pathogen

A

Candida albicans

230
Q

This pathogen, that can cause vulvovaginal candidiasis, is known to have a “snowman” appearance

A

Candida glabrata

231
Q

Treatment for vulvovaginal candidiasis

A

Fluconazole 150mg PO single dose

232
Q

In a patient with recurrent yeast infections, what underlying virus might you test for?

A
  • Look for undiagnosed HSV
  • Serologic testing for HSV-1 and HSV-2 IgM and IgG
233
Q

Symptoms of cytolytic vaginosis

A
  • Symptoms are CYCLIC, during luteal phase
  • Pruritus, dysuria, dyspareunia, white cheesy discharge
234
Q

In a patient with vaginal pruritus, dysuria, dyspareunia, white cheesy discharge you see lactobacilli, crenated epithelial cells, isolated nuclei on wet prep. You do not see WBCs, clue cells, flagellate protozoans, or pseudohyphae.
What is the likely diagnosis?

A

Cytolytic vaginosis

  • differentiate from lactobacillosis with presence of crenated epithelial cells or intracellular debris
235
Q

Treatment for cytolytic vaginosis

A
  • Baking soda sitz baths
  • Can be done prior to onset of symptoms (luteal phase)
236
Q

Describe the appearance of the lactobacilli seen on microscopy of a patient with lactobacilliosis

237
Q

Syphilis is caused by this pathogen

A

Treponema pallidum

238
Q

It is recommended to offer syphilis testing to all sexually active people between the ages of ….

239
Q

Symptoms of primary syphilis

A
  • Firm, round PAINLESS chancre
  • Raised border, red smooth base
  • Lasts 3-6 weeks
240
Q

Symptoms of secondary syphilis

A
  • 3-6 weeks after development of primary chancre
  • Rash with sores in mouth and other mucus membranes
  • Systemic symptoms: fever, headache, lymphadenopathy, fatigue, myalgias,
  • Maculopapular rash on palms and soles of feet
  • Condylomata lata = contagious weepy warts
241
Q

Symptoms of latent syphilis

A
  • No symptoms
  • Positive serologic testing though
242
Q

Symptoms of tertiary syphilis

A
  • Damage to the brain and nervous system, heart, and blood vessels
  • Gummatous (necrotic) lesions
  • May present as psychiatric illness (neurosyphilis)
243
Q

Which patients are most at risk of developing neurosyphilis in the tertiary phase?

A

Untreated HIV patients with low CD4 count

244
Q

Which patients are most at risk of developing ocular syphilis?

A

Men who have sex with men

245
Q

Physical exam signs and symptoms of ocular syphilis

A
  • Symptoms:
  • Eye pain, redness, bluriness, vision loss, flashing lights
  • PE signs
  • Small, irregular pupils
  • Do NOT constrict to light
  • DO constrict when focusing (accomodation)
246
Q

Which sexually transmitted disease can present as ADHD in children?

A

Syphilis

(can present as any psychiatric condition)

247
Q

Which sensory loss can present as the first sign of syphilis?

A

Hearing loss

  • Otosyphilis: irreversible hearing loss, tinnitus, vertigo
248
Q

What screening tests are performed when looking for syphilis?

A
  • VDRL, RPR, non-treponemal
  • If positive: treponemal-specific tests to confirm
249
Q

Treatment for syphilis

A
  • Penicillin benzathine IM single dose
  • Clinical and serologic follow-up at (3 in CM3) 6, 12 months
250
Q

Screening to prevent congenital syphilis

A
  • Screen all women in early pregnancy
  • Screen again twice in 3rd trimester if high risk community/population
251
Q

Symptoms of genital herpes

A
  • PAINFUL ulcers/vesicles
  • Undermined border
  • Lymphadenopathy
252
Q

Diagnostic test for genital herpes

A
  • Culture, Tzanck prep
253
Q

Herpes simplex virus treatment

A

Acyclovir 400mg TID x7-10

254
Q

A painful genital ulcer with ragged borders and buboes (suppurative lymphadenopathy), but no prodromal symptoms is most suggestive of this condition

A

Chancroid (h. ducreyi)

255
Q

Diagnostic tests for chancroid (h. ducreyi)

A
  • No available testing, clinical diagnosis
  • Suspicion based on painful lesion +/- regional lymphadenopathy
  • Negative for HSV, syphilis
256
Q

Treatment for chancroid (h. ducreyi)

A
  • Azithromycin 1g PO
    OR
  • Ceftriaxone 250mg IM
  • Lymph node aspiration for comfort
  • Confirm resolution 3-7 days later
257
Q

Symptoms of lymphogranuloma venereum

A
  • Unilateral tender inguinal or femoral lymphadenopathy
  • Painless, shallow ulcer
  • Proctocolitis if rectal exposure (may resemble IBS)
258
Q

Which condition is an invasive form of chlamydia that is associated with the “Groove sign” (matted inguinal lymph nodes)

A

Lymphogranuloma venereum

  • Groove due to unilateral lymph enlargement
259
Q

Which sexually transmitted disease can cause the complication of genital elephantiasis?

A

Lymphogranuloma venereum

260
Q

Treatment for lymphogranuloma venereum

A
  • Doxycycline 100mg PO BID x21
    OR
  • Azithrmoycin 1g weekly x 21
    OR
  • Erythromycin 500mg QID x21

(all 21 days)

261
Q

Symptoms of granuloma inguinale (Donovanosis)

A
  • Painless ulcerations that are highly vascularized and beefy red
  • Lesions bleed easily on contact
  • Lesions heal inwards from ulcer margins
  • NO regional lymphadenopathy
262
Q

Treatment for granuloma inguinale (Donovanosis)

A

Azithromycin 1g PO weekly x21

263
Q

Out of the following, which have PAINFUL lesions?
- Chancroid (h. ducreyi)
-Granuloma inguinale (Donovanosis)
Lymphogranuloma venereum
- Herpes simplex virus
- Non-sexually acquired genital ulcers (NSAGU

A
  • Chancroid (h. ducreyi)
  • Herpes simplex virus
  • NSAGU
264
Q

Symptoms of non-sexually acquired genital ulcers (NSAGU)

A
  • Painful genital ulcers
  • Yellow or black center due to necrosis
  • Often around menses
265
Q

Treatment for non-sexually acquired genital ulcers (NSAGU)

A
  • Analgesics
  • Corticosteroids

(both oral or topical)

266
Q

Symptoms/physical exam findings of pelvic inflammatory disease (PID)

A

Uterine/adnexal/cervical motion tenderness

267
Q

Treatment for pelvic inflammatory disease (PID)

A
  • Cetriaxone + doxycycline + metronidazole
268
Q

Define a UTI

A

An inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria

269
Q

Risk factors for getting a UTI

A
  • Female
  • Age
  • Hospitalization
  • Sexually active women
  • Diabetes
  • Anatomic and function abnormalities (VUR, stones, catheter, stent)
270
Q

Most UTIs are caused by this category of bacteria

A

Facultative anaerobes

271
Q

This bacteria is the most common cause of UTIs

272
Q

This gram negative bacteria causes UTIs and alkalizes the urine, so is associated with stones

273
Q

Risk factors for ascending UTIs

A
  • Post menopausal women (less estrogen = less lactobacilli = more room for e.coli)
  • Spermicide/diaphragm
  • Soilage of the perineum
274
Q

Symptoms of cystitis

A
  • Dysuria
  • Urinary frequency and urgency
  • Suprapubic pain
275
Q

Symptoms of pyelonephritis

A
  • Fever
  • Chills
  • Flank pain
276
Q

Cloudy and malodorous urine can most commonly be a sign of …

277
Q

Diagnostic tools for UTIs

A
  • Urinalysis
  • Microscopy (pyuria, hematuria, bacteriuria
278
Q

The presence of nitrite in the urine is suggestive of a UTI caused by this type of bacteria

A
  • Gram negative (typically e. coli)

(gram negatives convert nitrates to nitrites)

279
Q

The presence of squamous epithelial cells in a urinalysis are suggestive of …

A
  • Contamination (unclean catch)
280
Q

Urine culture with growth of 10^2 colony forming units (CFU) defines bacteriuria in [dysuric/asymptomatic] patients, whereas growth of 10^5 CFU is diagnostic in [dysuric/asymptomatic] patients

A
  • 10^2 CFU is diagnostic in DYSURIC patients (lower threshold if symptoms)
  • 10^5 CFU is diagnostic in ASYMPTOMATIC
281
Q

Physical exam sign for pyelonephritis

A
  • Costovertebral pain with percussion (CVAT) = kidney punch test
282
Q

White blood cell casts, pyuria, and bacteriuria are associated with this type of UTI

A

Pyelonephritis

283
Q

Renal and perirenal abscesses are mostly secondary to …

A
  • Ascending UTI with e. coli

(also often associated with renal stones/obstruction)

284
Q

Symptoms of renal and perirenal abscesses

A
  • Insidious onset
  • Chronic fever
  • Weight loss
  • Night sweats
  • Anorexia
  • Flank/back pain
285
Q

Diagnostic tools for renal and perirenal abscesses

A

Ultrasound or CT

286
Q

Symptoms of acute and chronic prostatitis

A
  • Acute: chills, dysuria, urinary frequency, urgency, perineal pain
  • Chronic: recurrent bacteriuria, low grade fever, back/pelvic pain
287
Q

Diagnostic tools for prostatitis

A
  • History and physical
  • Urinalysis
  • Urine culture
  • Residual urine determination (post void residual)
288
Q

Four common medications used to treat UTIs

A
  • Bactrim (most widely used)
  • Nitrofurantoin
  • Cephalosporins (Keflex) (good in pregnancy)
  • Fluoroquinolones (Cipro/Levo)
289
Q

Treatment for acute uncomplicated pyelonephritis

A
  • Bactrim or fluoroquinolones
  • Not nitrofurantoin (no tissue penetration)
290
Q

Which UTI medications should be avoided during pregnancy?

A
  • Bactrim (kernicterus + fetal toxicity)
  • Fluoroquinolones (tendons)

(also tetracyclines)

291
Q

True or false.
You should not treat a UTI in a patient with a foley catheter unless they are having symptoms

A

True

  • Only treat catheterized patients if they are having symptoms such as fever, pain, dysuria, urgency/incontinence, foul odor)
292
Q

What is the most common nosocomial infection?

A

Catheter associated UTI

293
Q

Asymptomatic bacteriuria should only be treated in patients who are …

294
Q

All febrile children with no obvious cause of infection in this age group should be evaluated for a UTI

A

2 to 24 months

295
Q

When assessing a child for a UTI use this type of urine sample

A

Catheter specimen

296
Q

This category of bacteria is found deep in layers of colon, between teeth and gums, or in tissue with damaged blood vessels/restricted blood flow

A

Anaerobes

(seen in abscesses, GI tract, penetration of foreign matter, and devitalized tissue)

297
Q

Clostridium, Bacteroides, and Actinomyces all fall into this category of bacteria

A

Anaerobes

CBA = can’t breathe air

298
Q

Histotoxic clostridia is associated with lowered host resistance. Give me two examples of this

A
  • Trauma: c. perfringes
  • Colon cancer: c. septicum

(skin is part of host resistance)

299
Q

Symptoms and physical exam findings of gas gangrene (myonecrosis)

A
  • Sudden, severe pain
  • Pale/purple/red skin
  • Induration
  • Destruction
  • Toxemia and shock
300
Q

Which bacteria most commonly causes gas gangrene (myonecrosis)?

A

Histotoxic clostridia

301
Q

Treatment for histotoxic clostridia

A
  • Irrigation, debridement
  • Zosyn (+) and Clindamycin (-)
302
Q

This bacteria is the second most common cause of foodborne infection after salmonella

A

Clostridium perfringes

303
Q

Risk factors for clostridium difficile

A
  • Recent use of clindamycin, fluoroquinolone, or beta-lactam
  • Age 65+
  • Recent hospitalization/nursing home
  • PPI use
304
Q

Most common symptoms of clostridium difficile

A
  • Diarrhea (3 or more episodes in 24 hrs)
  • Abdominal cramps
305
Q

Diagnostic tool for clostridium difficile

A

Liquid stool sample

306
Q

Treatments for clostridium difficile

A
  • Fidamoxicin, vancomycin, or bezlotoxumab
  • Fecal transplant (“live biotherapeutic products”)
307
Q

Which neurotoxic clostridia releases a toxin that blocks nervous system excitation?

A
  • C. botulinum
  • Targets cholinergic synapses
308
Q

Which neurotoxic clostridia releases a toxin that blocks nervous system inhibition?

A
  • C. tetani
  • Blocks inhibitory neurons
309
Q

Symptoms of tetanus (c. tetani)

A
  • Restlessness
  • Painful spasm/stiffness
  • Trismus (lockjaw)
  • Opisthotonos (arching of body due to extreme contraction)
310
Q

Treatment for tetanus (c. tetani)

A
  • Minimize stimuli (dark, quiet room)
  • Wound debridement
  • Metronidazole
  • Antitoxin
  • Muscle relaxants/sedatives
311
Q

What is the most common anaerobe isolated from intra-abdominal infections and bacteremia?

A

Bacteroides fragilis

312
Q

Treatment for bacteroides fragilis

A
  • Metronidazole or beta-lactam/beta-lactamase inhibitor/carbapenem
313
Q

Actinomyces is associated with infections on this area of the body

A
  • Cervicofacial (neck and jaw)
314
Q

Risk factors for actinomyces infections

A
  • Dental infections
  • Oromaxillofacial trauma
315
Q

Treatment for actinomyces

A
  • Penicillin G
316
Q

Traveler’s diarrhea is most commonly caused by this pathogen

A

E. coli (enterotoxigenic)

317
Q

Symptoms of traveler’s diarrhea

A
  • Watery diarrhea
  • Usually self-limited to 3-5 days
318
Q

Symptoms of infection with shiga toxin-producing E. coli

A
  • Painful, watery diarrhea
  • Progresses to bloody diarrhea
  • Hemolytic uremic syndrome
319
Q

Diagnostic tools for shiga toxin-producing E. coli

A
  • Stool sample
  • Rectal swab

(must send off quickly)

320
Q

Treatments to give and avoid in shiga toxin-producing E. coli

A
  • Treat dehydration
  • Do NOT give antibiotics - releases more toxin
  • Do NOT give NSAIDs - already dehydrated, will reduce kidney blood flow
  • Do NOT give opioids - don’t want to slow down excretion
  • Do NOT give IV ondansetron - increases risk of hemolytic anemia
321
Q

Risk factor for proteus mirabilis infection

A
  • Long term catheters
322
Q

Treatment for proteus mirabilis infection

A
  • Bactrim or fluoroquinolone
323
Q

Risk factors for klebsiella pneumoniae infections

A
  • Hospitalized/immunocompromised (weak)
  • Alcoholism
  • Diabetes
324
Q

Symptom associated with klebsiella pneumoniae infection

A
  • Currant jelly sputum
325
Q

Diagnostic tools for klebsiella pneumoniae infection

A
  • Culture sputum, blood, urine
326
Q

Name three types of gram-positive aerobic bacilli

A
  • Listeria
  • Bacillus
  • Corynebacterium
327
Q

Symptoms and physical exam findings of corynebacterium diphtheriae

A
  • Pharyngitis
  • Malaise
  • Low fevers
  • White/gray membrane in posterior pharynx that bleeds with scraping
328
Q

Diagnostic tools for corynebacterium diphtheriae

A
  • Culture the membrane, deep to the membrane, and nasal passage
  • Test for presence of toxin
329
Q

Treatment for corynebacterium diphtheriae

A
  • Monitor airway! - membrane can block
  • Hospitalization
  • Erythromycin or PCN G/V
  • Antitoxin
330
Q

Listeriosis is primarily a foodborne pathogen that most often causes self-limited gastroenteritis in healthy people.
However, listeria has the potential to spread to these two areas of concern

A
  • Brain: meningitis
  • Placenta: fetal infections
331
Q

Risk factors for severe disease from a listeria infection

A
  • Age 70+
  • Pregnant
  • Immunocompromised
332
Q

How to prevent listeriosis

A
  • Avoid unsterilized/undercooked foods
  • Hot dogs should be steaming hot!
333
Q

Treatment for listeriosis

A
  • Ampicillin +/- penicillin
334
Q

Risk factors for Nocardiosis

A
  • Immunosuppression:
  • Glucocorticoids
  • Diabetes, HIV, transplant, cancer
335
Q

Most common symptoms of Nocardiosis

A
  • Pulmonary nocardiosis most common:
  • Productive cough
  • Pleuritic chest pain
  • Dyspnea
  • Fever
  • Anorexia
  • Weight loss

(can spread to any organ though, brain abscesses, skin infections)

336
Q

Nocardiosis diagnosis tools

A
  • Sputum culture or skin biopsy
337
Q

Treatment for Nocardiosis

A
  • Bactrim, imipenem, ceftriaxone
338
Q

Apart from bioterrorism, how else might someone contract anthrax?

A
  • Industrial processing of animal hides
339
Q

Symptoms of anthrax

A
  • Papule > vesicle > eschar (black stuff in the middle)
  • Respiratory infection resembling influenza
340
Q

Treatment for anthrax

A
  • Ciprofloxacin or doxycycline
341
Q

Mean age of patients with endocarditis

342
Q

Definition of endocarditis

A

Infection of a cardiac valve or the endocardium caused by bacteria, fungi, rickettsia, or chlamydiae

343
Q

Risk factors for endocarditis

A
  • Prosthetic valves/devices (highest risk)
  • Congenital heart disease
  • Heart valve disease
  • Previous endocarditis
  • Skin abscess (biggest way bacteria gets in)
344
Q

Right sided endocarditis will embolize to the lungs and is most likely caused by …

A

IV drug use

345
Q

Emboli from left-sided endocarditis can spread to …

346
Q

Most common bacteria causing endocarditis

A
  • Staph aureus
  • Streptococci

(pseudomonas most common gram negative cause)

347
Q

Which, acute infective or subacute, endocarditis is more likely to respond to antibiotics?

A
  • Subacute endocarditis
348
Q

Which, acute infective or subacute, endocarditis is more likely to occur in a patient with previously healthy valves?

A
  • Acute infective endocarditis
349
Q

Compare and contrast symptoms of subacute and acute bacterial endocarditis

A

Subacute:
- “Sick and weirdly sick”
- Fever, sweats, weakness, myalgias, arthralgias, malaise, anorexia, fatigue

Acute:
- Abrupt onset
- Rigors
- Temp 103-105f
- Petechiae

350
Q

Which condition is associated with Osler’s nodes (tender) and Janeway lesions (non-painful)?

A
  • Subacute bacterial endocarditis
351
Q

Physical exam findings in subacute bacterial endocarditis

A
  • Osler’s nodes (tender)
  • Janeway lesions (non-painful)
  • Murmurs
  • Petechiae in conjunctivae, oropharynx, skin, legs
  • Linear subungual hemorrhages
352
Q

Which condition is associated with the Duke’s criteria?

A

Endocarditis

353
Q

Describe the diagnostic criteria for endocarditis

A

Duke’s criteria

Pathologic criteria:
- Proof of vegetation

Clinical criteria:
- 2 major OR
- 1 major + 2 minor OR
- 5 minor criteria

Major criteria:
- Positive blood culture x2
- Evidence of endocardial involvement (echo showing oscillating intracardiac mass or cardiac CT)

354
Q

Diagnostic imaging tools for endocarditis

A
  • Echocardiogram (TTE is first choice, unless prosthetic valves, then TEE)
  • Cardiac CT

(also scintigraphy and FDG-PET)

355
Q

Diagnostic lab tests for endocarditis

A
  • CBC with differential (neutrophilia)
  • ESR
  • CRP
  • Blood culture!
356
Q

Treatment for endocarditis

A
  • Parenteral antibiotics for at least six weeks
  • Empiric therapy should cover staphylococci, streptococci, and enterococci
  • High risk (prosthetic valve) patients get prophylactic antibiotics for dental procedures (ampicillin, cefazolin, azithromycin, doxycycline)
357
Q

HIV primarily affects these immune cells

A

CD4 (T cells)

358
Q

At what point can it be said that a HIV patient has advanced to full blown AIDS?

A
  • CD4 cell count below 200
    OR
  • CD4 less than 14%
    OR
  • Any CD4 count + opportunistic infection
359
Q

Risk factors for HIV

A
  • Men who have sex with men
  • Sex workers
  • Multiple partners
  • STDs
  • IV drug use
  • Vertical transmission (mother to fetus)
360
Q

What is the most common mode of HIV transmission

A

Receiving gay anal sex (being sodomized)

361
Q

Between what ages does the CDC recommend patients be screened for HIV?

A

13 to 64

(USPSTF 15 to 65)

362
Q

Which generation of HIV test can detect both antigens (Ag) and antibodies (Ab)?

A

4th generation

363
Q

At what CD4 count should antiretroviral therapy be started for a HIV patient?

A

Begin right away regardless of CD4 count

364
Q

For post exposure prophylaxis for HIV, within what time frame should antiretroviral therapy be started?

A

Within 72 hours of exposure

365
Q

What is the most common cause of sepsis?

366
Q

Which group of bacteria is most commonly found in patients with sepsis?

A

Gram positive (and opportunistic fungi)

367
Q

Definition of sepsis

A

Life-threatening organ dysfunction caused by a dysregulated response to infection

368
Q

Describe the severity stages of sepsis

A
  • Infection
  • Bacteremia
  • Sepsis
  • Septic shock
  • Multiple organ dysfunction syndrome (MODS)
  • Death
369
Q

Definition of septic shock

A

Sepsis plus failure to respond to fluid resuscitation/require vasopressors to maintain a MAP >65 mmHg

370
Q

What does the SIRS criteria measure?

A
  • Abnormal vital signs to estimate a systemic inflammatory response syndrome
371
Q

In what part of the body does sepsis most commonly originate?

A
  • Lungs (pneumonia)
372
Q

Risk factors for sepsis

A
  • Any patient with infection or bacteremia
  • Age >65
  • ICU admission/previous hospitalization
  • Immunosuppression
  • Diabetes
  • Obesity
  • Cancer
  • Community acquired pneumonia
373
Q

Early symptoms and physical exam signs of sepsis

A

Early:
- Subtle symptoms, confusion, decreased sensorium
- Unexplained decrease in urine output
- Sudden cholestatic jaundice
- Metabolic alkalosis
- Excess bleeding at venipuncture sites
- Early shock: high CO, low systemic vascular resistance (high HR, low BP)

374
Q

Symptoms and physical exam signs of established sepsis

A
  • Hypotension
  • Tachycardia
  • Fever
  • Leukocytosis
  • Organ dysfunction
  • Warm flushed skin, becomes cool/clammy
  • Decreased capillary refill/cyanosis/mottling
375
Q

Two most commonly used scores/criteria to diagnose/risk assess sepsis

A
  • qSOFA (quick sequential organ failure assessment)
  • NEWS (national early warning score)
376
Q

What are the three criteria of the qSOFA score for sepsis?

A
  • Respiratory rate >22
  • Altered mentation
  • Systolic blood pressure <100

(2 of 3 = worse prognosis)

377
Q

There is no single lab test that is sufficient to diagnose sepsis. However, these lab values are helpful and should be done on all patients with sepsis

A
  • CRP and/or procalcitonin suggest bacterial cause
  • Lactate - sign of organ hypoperfusion
  • CBC - low platelets
  • CMP - high creatinine
  • Blood cultures - get before giving abx, from two different sites
  • EKG
378
Q

Which condition is associated with MODS (multiple organ dysfunction syndrome)?

A

Sepsis

  • MODS = failure of 2 or more organ systems
379
Q

This syndrome is a common type of organ failure ins sepsis, contributing to MODS

A
  • ARDS (acute respiratory distress syndrome)
380
Q

Chest x-ray findings in ARDS (acute respiratory distress syndrome)

A

Bilateral, symmetrical alveolar opacities

381
Q

Treatment for sepsis

A

Fluid resuscitation:
- Urgent IV access, within first 3 hours
- 30 mL/kg of crystalloid fluid IV

Vasopressor:
- Start with Levophed to maintain MAP >65
- Can add epinephrine, phenylephrine, dopamine, vasopressin, dobutamine

Antibiotics:
- Start broad (Vancomycin/Zosyn)

  • Nutritional support
  • DVT prophylaxis
  • Ulcer prophylaxis (PPIs)
  • Management of blood glucose (<180)
  • Blood transfusion (Hgb >7)
  • Hydrocortisone IV if refractory shock
382
Q

Which, Hodgkin’s or non-Hodgkin’s lymphoma, is more common?

A

Non-Hodgkin’s lymphoma (85%)

383
Q

Non-Hodgkin’s lymphoma most commonly effects these types of cells in the body

384
Q

Risk factors for non-Hodgkin’s lymphoma

A
  • Males
  • Age
  • Immunosuppressive therapy
  • Autoimmune diseases
  • Family history
  • Agricultural pesticides
  • Agent orange
385
Q

Treatment for non-Hodgkin’s lymphoma

A
  • Watch and wait (if indolent)
  • Chemotherapy
  • Radiation
  • Immunotherapy
  • Targeted drugs
  • Hematopoietic stem cell transplant
386
Q

Which condition is associated with Reed-Sternberg cells?

A

Hodgkin’s lymphoma

387
Q

Treatment for Hodgkin’s lymphoma

A

Chemotherapy

388
Q

Most common physical exam sign of lymphoma

A
  • Lymphadenopathy

(palpable, rubber like, but painless)

389
Q

Pain in a patient’s lymph nodes immediately after drinking alcohol is a worrying symptom that could indicate this disease

A

Hodgkin’s lymphoma

390
Q

Symptoms of lymphoma

A
  • Palpable lump in lymph node most common
  • Cough, airway obstruction, cardiac tamponade, superior vena cava syndrome, spinal cord compression if aggressive
  • B-symptoms: drenching night sweats, fever >38c/100.4f, weight loss = likely more aggressive
391
Q

Which, Hodgkin’s or non-Hodgkin’s lymphoma, is more associated with:
- skip pattern/non-contiguous spread
- multiple lymph node involvement
- extra-nodal/organ involvement
- less predictable spread

A

Non-Hodgkin’s lymphoma

392
Q

Which, Hodgkin’s or non-Hodgkin’s lymphoma, is more associated with:
- contiguous spread pattern
- limited to one group of lymph nodes
- rarely has extra-nodal involvement
- Spreads predictably

A

Hodgkin lymphoma

393
Q

Which areas of the body should be assessed when doing a physical exam for lymphoma?

A
  • Lymphoid survey
  • Waldeyer’s ring (tonsils, base of tongue, nasopharynx)
  • Liver and spleen (hepatosplenomegaly)
394
Q

Which condition is classified in severity by the Ann Arbor scale?

A

Hodgkin’s or non-Hodgkin’s lymphoma

395
Q

Name the four stages on the Ann Arbor scale

A
    1. Single lymph node (LN) region
    1. Two or more LN regions on the same side of the diaphragm
    1. Involves LN regions on both sides of the diaphragm
    1. Disseminated extra-lymphatic disease involving one or more organs OR with distant, non-regional lymph node involvement
396
Q

Best diagnostic tool for the confirmation of lymphoma

A

Excisional biopsy

Clin Med 2 (6 decks)

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