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Clinical Medicine I > Fungal infections > Flashcards

Fungal infections Flashcards

1
Q

How do you treat tinea capitis?

A

oral terbinafine >4 yo, griseofulvin >2 yo

oral fluconazole or itraconazole are options

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2
Q

Do topical agents work on tinea capitis?

A

they can reduce transmission but cannot treat. Add on top of treatment!
-selenium sulfide, ketoconazole shampoo!

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3
Q

How do you treat a kerion formation in tinea capitis?

A

griseofulvin

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4
Q

How do you treat tinea barbae?

A

terbinafine, griseofulvin, fluconazole
+ topical agents

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5
Q

How do you treat tinea corporis?

A

topical terbinafine, butenafine, -zoles, and continue treatment 1-2 weeks post clearance

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6
Q

What if your patient has extensive lesions of tinea corporis?

A

oral regimen - itraconazole or terbinafine work!

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7
Q

How do you treat tinea cruris?

A

topical terbinafine or -zoles

severe - oral itraconazole or terbinifine

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8
Q

How do you treat tinea pedis in the macerated stage?

A

aluminum acetate solution soaks + topical cream (azoles/ciclopirox)
OR
terbinafine/butenafine

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9
Q

How do you treat tinea pedis in the dry/scaly stage?

A

broad spectrum antifungal cream (urea lotion)

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10
Q

How do you treat tinea pedis in the severe stage?

A

itraconazole or terbinafine + topical maintenance powders/creams

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11
Q

How do you treat onychomycosis in the fingernail?

A

griseofulvin, terbinafine, itraconazole, fluconazole

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12
Q

How do you treat onychomycosis in the toenail?

A

terbinafine or itraconazole

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13
Q

How do you treat tinea versicolor?

A

oral fluconazole + topical treatments for maintenance/ addition!

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14
Q

What’s the presentation of oropharyngeal candidiasis?

A

itching, burning/sore throat, dysphagia/odynophagia, possible pain at lips

Thick, white plaques on tongue that CAN be scraped away, beefy, red appearance

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15
Q

What should you test for when you see thrush in a healthy young person?

A

HIV

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16
Q

How do you treat oropharyngeal candidiasis?

A

fluconazole, ketoconazole, clotrimazole, nystatin mouth rinse

Nystatin powder for dentures

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17
Q

What is cheilitis?

A

cracked lips, red swollen corners of the mouth, white patches

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18
Q

How do you treat cheilitis?

A

nystatin, ketoconazole, clotrimazole

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19
Q

What’s vulvovaginal candidiasis?

A

white discharge, itching, irritation, dysuria dyspareunia

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20
Q

How do you treat vulvovaginal candidiasis?

A
  • single dose fluconazole
  • intravaginal clotrimazole
  • miconazole
  • terconazole
  • nystatin

Recurrent = itraconazole

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21
Q

What’s balanitis?

A

itching around glans penis, red swollen foreskin, white discharge
purulent - bacterial

22
Q

What’s the treatment for balanitis?

A

topical nystatin ointment
soaking with dilute aluminum acetate can help
Refer!

23
Q

REVIEW: intertrigo

A

beefy red, macerated plaques; scrape and double check, many causes – topical antifungal tx!

24
Q

What is a candidal cystitis?

A

UTI but cannot differentiate from symptoms on bacterial vs yeast –need to do a UA!
General UTI symptoms

25
Q

How do you manage recurrent candidal cystitis?

A

PO fluconazole
remove bladder catheter, discontinue abx!

26
Q

How does esophageal candidiasis present?

A

substernal odynophagia, gastroesophageal reflux, maybe thrush

27
Q

How do you diagnose esophageal candidiasis?

A

endoscopy with biopsy and culture

28
Q

How do you manage esophageal candidiasis?

A

swallow = fluconazole or itraconazole
severe = IV fluconazole, echinocandin or voriconazole

29
Q

What is invasive candidiasis?

A

candida in the blood - diagnose with blood culture, and treat with IV therapy

30
Q

What are the four types of histoplasmosis?

A
  1. acute pulmonary
  2. progressive disseminated
  3. chronic pulm
  4. complications of pulm
31
Q

What is acute pulmonary histoplasmosis?

A

mild influenza to severe PNA

32
Q

What is progressive disseminated histoplasmosis?

A

fever, multi-organ involvement w/ dyspnea, cough, weight loss, prostration (HIV, TNF) septic shock, hepatosplenomegaly, adrenal involvement, GI, CNS involvement
CT shows miliary pattern

33
Q

Where is histoplasmosis most common Hint hint for test?

A

eastern tennesse, eastern midwest - think high acidity and humidity in soil!

34
Q

What indicates histoplasmosis in labs?

A

low everything - all is effected

35
Q

What’s the best way to diagnose histoplasmosis?

A

combo of 1st morning urine + serum polysaccharide antigen assays

36
Q

How do you treat histoplasmosis?

A

mild-moderate = itraconazole
severe/meningitis = IV amphotericin B followed by oral itraconazole

37
Q

What is a lumbar puncture important for?

A

to check CNS

38
Q

What’s the clinical presentation of the cryptococcosis?

A

cough, sputum, hemoptysis, dyspnea, chest pain, fever, malaise, night sweats, weight loss

39
Q

What’s a risk with immunocompromised and cryptococcosis?

A

often develop tumors that spread to brain

40
Q

What’s the MCC of fungal meningitis?

A

cryptococcosis

41
Q

How do you diagnose cryptococcosis?

A

culture of respiratory secretions/pleural fluid, lumbar puncture
CXR & CT = pulmonary nodule

42
Q

How do you manage cryptococcosis?

A

depends on severity & comorbidities -> CNS involvement is essential to check

43
Q

What is coccidiodomycosis?

A

primary = fever, chills, headache, body aches
erythema nodosum 2-20 days after onset of symptoms

disseminated = verrucous skin lesions & abscesses, pulmonary findings pronounced, meningeal signs if CNS involvement

44
Q

Where is coccidiodomycosis found?

A

SW USA, south america

45
Q

What helps coccidiodomycosis diagnosis?

A

labs - CBC, ELISA, CSF
Imaging - variable findings, hilar lymphadenopathy

46
Q

How do you manage coccidiodomycosis?

A

symptomatic for limited disease
w/ progression - itraconazole, fluconazole
progressive = IV amphotericin B
meningitis = high dose fluconazole/amphotericin B

47
Q

In who is blastomycosis most common?

A

immunocompetent outdoor activity people

48
Q

What are the symptoms of blastomycosis?

A
  • abrupt onset fever
  • chills
  • body aches
  • pleuritic chest pain
  • cough
  • dysuria
  • headache and neck pain (CNS)
  • epididymitis, prostatitis
  • respiratory distress w/ tachypnea

cutaneous has verrucous lesions and bones are often involved

49
Q

Where is blastomycosis most common?

A

eastern midwest area; often presenting after failed abx therapy

50
Q

How can you diagnose blastomycosis?

A

CBC, sputum/tissue biopsy, culture, UA

Imaging - look for lobar consolidation (tumor?)

51
Q

How do you treat blastomycosis?

A

mild - itraconazole long-term
moderate/CNS/treatment failure = IV amphotericin B followed by oral -azoles

Clinical Medicine I (33 decks)

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