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Clinical Medicine > ID 1 > Flashcards

ID 1 Flashcards

1
Q

what are 2 common causes of acute viral rhinosinusitis

A

rhinovirus
parainfluenza virus
coronavirus
some bacterial

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2
Q

tx of acute viral rhinosinusitis

A

supportive: NSAIDs, saline washes, fluids, decongestants
*s/s>10 days, abx indicated

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3
Q

spread and incubation of influenza

A

spread- droplet
incubation- 1-4 days

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4
Q

influenza s/s include…

A

fever, chills, malaise, myalgia, URI s/s, non-productive cough
GI symtoms- influenza B

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5
Q

influenza dx

A

rapid tests
PCR- most sensitive
CBC
low O2

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6
Q

influenza tx

A

supportive
antivirals within 48 hrs
neuraminidase inhibitors (A&B)

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7
Q

if exposed to influenza, may tx with this within 48 hrs of exposure

A

chemoprophylaxis: oseltamivir or baloxavir

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8
Q

this syndrome is associated with giving aspirin with acute viral illnesses and may lead to progressive liver failure and encephalopathy

A

reye syndrome

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9
Q

s/s of this disease include grouped vesicles on erythematous base

A

HSV-1 and HSV-2

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10
Q

primary infection of HSV-1

A

Adults-tonsillopharyngitis
Children- gingivostomatitis
most asymtpomatic

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11
Q

HSV-2 primary infection s/s

A

dysuria
tender lymphadenopathy
systemic symptoms- fever, HA

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12
Q

Dx of HSV 1 and 2

A

PCR
serology
Tzanck smear
clinical

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13
Q

tx of HSV-1 and HSV-2

A

oral antivirals- valacylovir, acyclovir, famicilovir

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14
Q

varicella zoster transmission and incubation

A

transmission- contact, droplet, airborne
incubation- 10-21 days

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15
Q

when is chickenpox contagious

A

48 hrs before rash onset–> crusting of lesions

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16
Q

s/s of varicella zoster

A

fever, malaise, headache
rash:
- pruritic
- face–> trunk
- variable stages at once
- dew drop on rose petal

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17
Q

dx of varicella

A

clinical
PCR
serology
Tzanck smear

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18
Q

tx of varicella zoster

A

<12- supportive
>12- acyclovir

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19
Q

herpes zoster s/s

A

rash- unilateral vesicular dermatomal
erythematous papules–> grouped vesicles/ bullae–> pustular

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20
Q

this complication of shingles affects the facial nerve and leads to:
auditory and oral lesions
loss of taste
ipsilateral facial palsy
HL, tinnitus, vertigo

A

Ramsey Hunt syndrome

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21
Q

tx of ramsey hunt syndrome

A

antivirals and prednison

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22
Q

tx of herpes zoster

A

antivirals
analgesics
corticosteroids

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23
Q

tx of PHN

A

gabapentin
lidocaine
tricyclic antidepressants
capsaicin cream

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24
Q

HPV transmission and incubation

A

transmission- direct contact
incubation- 2-18 mo

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25
Q

what are 3 presentations of HPV

A

common wart (verruca vulgaris)
genital wart (condyloma)
plantar wart (verruca plantaris)

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26
Q

tx of HPV

A

common and plantar- cryotherapy, salicylic acid
genital- podophyllum resin, imiquimod, sinecatechins, cryotherapy, removal

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27
Q

Epstein-Barr virus (HHV-4) transmission and incubation

A

transmission- saliva, genital secretions
incubation- 30-50 days

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28
Q

s/s of epstein-barr (HHV-4)

A
  • enlarged tonsils and exudates
  • pharyngeal petechiae
  • lymphadenopathy (cervical)
  • Hoagand sign- transient upper lid edema
  • splenomeagly and hepatomeagly
  • maculopapular rash
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29
Q

dx of epstein barr virus (HHV-4)

A

heterophile antibody
EBV specific antibodies (IgM and IgG)
periopheral smear–> downey cells

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30
Q

tx of epstein-barr (HHV-4)

A

supportive- steroids for airway, fluid, analgesics

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31
Q

erythema infectiosum (5th disease) cause

A

parovirus B19

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32
Q

erythema infectiosum (5th disease) transmission and incubation

A

transmission- respiratory secretions and blood transfusions
incubation- 4-14 days

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33
Q

s/s of erythema infectiosum

A

prodrome- pharyngitis, conjunctivitis, fever, myalgias
rash- 2-5 later
* “slapped cheek” appearance
* symmetric maculopapular rash
* lacy reticulated rash

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34
Q

tx of erythema infectiosum

A

supportive- antipyretics, hydration

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35
Q

mumps cause

A

paramyxovirus

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36
Q

spread and incubation of mumps

A

transmission- repiratory secretions, droplets, saliva
incubation- 12-25 days

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37
Q

s/s of this disease includes:
* parotid tenderness/ facial edema
* orchitis- testicular swelling
* oophrotitis- lower abd pain
* pacreatitis- esp in children

A

mumps

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38
Q

mumps dx

A

leukopenia
lymphocytosis
elevated serum amylase
elevated IgM

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39
Q

tx of mumps

A

supportive- cold compress, analgesics, BR

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40
Q

what is the cause of rubeola (measles)

A

paramyxovirus

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41
Q

what is the transmission and incubation of rubeola (measles)

A

transmission- droplet and airborne
* contagious: 5 days before s/s- 4 days after rash

incubation- 6-21 days

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42
Q

s/s of rubeola

A

prodrome- 3 Cs: cough, coryza, conjunctivitis
enanthem- Koplik spots
exanthem- brick red starts at neckline and moves down and out

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43
Q

tx of rubeola

A

supportive- antipyretics, hydration, vit A, isolation

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44
Q

cause of rubella

A

togavirus

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45
Q

rubella incubation time

A

14-21 days
* contagious- 1 wk before rash–> 15 days after rash

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46
Q

rubella s/s

A

prodrome
* lymphadenopathy, fever, malaise

enanthem
* forchheimer spots

exanthem
* pink rash starts on face and spreads to trunk and extremities

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47
Q

rubella tx

A

supportive- anitpyretics, hydration

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48
Q

roseola (6th disease) cause

A

HHV-6 or HHV-7

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49
Q

s/s of roseola (6th disease)

A

prodrome
* high fever, OM, conjunctivitis

enanthem
* nagayama spots

exanthem
* rose colored rash starts on tunk and spreads toward face

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50
Q

tx of roseola

A

supportive- antipyretics, hydration

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51
Q

this is common s/s of primary infection of what disease?
mononucleosis- exudative tonsillopharyngitis and cervical lymphadenopathy

A

CMV (HHV-5)

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52
Q

CMV (HHV-5) secondary s/s

A

colitis
* diarrhea, n/v, abd pain

retinitis
* fluffy, yellow/ white retinal lesions, granular appearance, intraretinal hemorrhage

esophagitis
* odynophagia, dysphagia, large superifical ulcers

pneumonitis
* common post transplant

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53
Q

dx of CMV

A

tissue biopsy
serology (IgM, IgG)

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54
Q

CMV (HHV-5) tx

A

primary- supportive
* pregnancy- high dose valacylovir

severe or reactivation- antiviral therapy (ganciclovir)

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55
Q

s/s of congenital CMV

A

SNHL
eye involvement- cataracts, glaucoma
heart defects
blueberry muffin like hemorrhagic purpuric eruptions

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56
Q

dx of congenital CMV

A

PCR

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57
Q

tx of congenital CMV

A

life threatening- IV ganciclovir
non-life threatening- valganciclovir

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58
Q

rabies cause

A

rhabdovirus–> encephalitis of gray matter

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59
Q

s/s of this disease includes:
* prodrome- aerophobia, hydrophobia, pain, fever, n/v
* CNS stage- encephalitic or paralytic
* coma, ANS dysfunction, death

A

rabies

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60
Q

dx of rabies

A

PCR
skin biopsy
after death–> negri bodies

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61
Q

rabies tx

A

wound care
post exposure prophylaxis- HDCV on days 0, 3, 7, and 14 + immune globulin day 0

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62
Q

west nile virus cause and incubation

A

arbovirus/ flavivirus
arthropod borne
2-14 days

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63
Q

s/s of this viral illness include:
* fever and flu like s/s
* meningitis
* encephalitis: AMS, tremor, seizure, CN palsy

A

west nile virus

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64
Q

dx of west nile virus

A

serology- IgM ELISA in serum or CSF

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65
Q

west nile virus tx

A

supportive
if severe–> hospitalize

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66
Q

ebola cause

A

filoviridae

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67
Q

transmission and incubation of ebola

A

transmission- contact with bodily fluids and skin
incubation- 2-21 days

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68
Q

these s/s describe what disease?
stage 1/ nonspecific febrile illness
* HA
* weakness, dizziness
* fatigue
* myalgia or arthralgia

stage 2
* abd pain, n/v, diarrhea
* ecephalitis
* hypovolemic shock
* hemorrhagic symptoms

A

ebola

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69
Q

ebola dx

A

PCR
IgM ELISA

70
Q

ebola tx

A

supportive

71
Q

zika cause

A

flavivirus

72
Q

zika virus transmission and incubation

A

transmission- mosquitoes, maternal-fetal, sexual, blood
incubation- 2-14 days

73
Q

these are s/s of what viral illness?
* pruritic rash on face, trunk, extremities, palms and soles
* arthralgia and myalgia
* conjunctivitis
* HA
* hyperreflexia

A

zika

74
Q

dx of zika

A

PCR- if 7 days post-exposure
serology IgM- if 7+ days after exposure

75
Q

tx of zika

A

supportive

76
Q

what kind of shock is sepsis?

A

distributive

77
Q

list the qSOFA criteria

A
  1. BP- systolic < or equal to 100 mmHg
  2. AMS
  3. RR- > or equal to 22 breaths/ min

(at least 2 of the following)

78
Q

list the SIRs criteria

A
  1. temp- >100.4 (38) or <96.8 (36)
  2. HR- >90 bpm
  3. RR- >20 breaths/min or PaCO2 <32 mmHg
  4. WBC- >12,000 or <4,000
    (at least 2 of the following)
79
Q

sepsis management steps

A
  1. fluids
  2. vasopressives- NE, vasopressin, epi
  3. broad spectrum abx
  4. 2 sets of blood cultures from 2 different sites
80
Q

these conditions are complications of GAS pharyngitis

A

scarlet fever/ rheumatic fever

81
Q

this condition leads to a rash that is diffusely erythematous with red papules with a sandpaper consistency. Strawberry tongue may be present.

A

scarlet fever

82
Q

dx of rheumatic fever

A

Jones criteria

83
Q

what are the requirements of the jones criteria?

A

major
* polyarthritis
* carditis
* chorea
* rash

minor
* fever
* arthralgia
* inflammatory markers
* PR segment prolongation

84
Q

tx of scarlet fever/ rheumatic fever

A

penicillin
recurrent- prophylaxis for 5 yrs

85
Q

skin and soft tissue infection progression

A

folliculitis–> furuncles–> carbuncle–> deep abscess involving muscle or fascia–> necrotizing fascitis

86
Q

dx of skin and soft tissue infection

A

culture of wound
blood cultures (if systemic infection s/s)
* bactremia–> blood cultures every 24-48 hrs

87
Q

tx of purulent skin and soft tissue infection

A

I&D
oral dicloxacillin or clindamycin
MRSA-clindamycin, bactrim, doxycycline

88
Q

tx of nonpurulent skin and soft tissue infection

A

oral abx- amoxicillin, cephalexin, clindamycin
IV abx- nafcillin, cefazolin, vancomycin, daptomycin

89
Q

what are the 3 main causes of osteomyelitis

A
  1. hematogenous (bactremia)
  2. contiguous focus (trauma/ injury)
  3. vascular insufficiency
90
Q

RFs for hematogenous osteomyelitis

A

injection drug user
sickle cell anemia
older pts

91
Q

s/s of this type of osteomyelitis include:
* sudden onset of high fever
* chills
* pain
* tenderness of involved bone

A

hematogenous (bacteremia)

92
Q

s/s of this type of osteomyelitis include:
* localized signs of inflammation
* absent fever or signs of toxicitiy

A

contiguous focus

92
Q

s/s of this type of osteomyelitis include:
* absent bone pain
* absent fever

A

vascular insufficiency

93
Q

bedside signs of vascular insufficiency osteomyelitis include…

A
  1. probe advances to the bone
  2. ulcer area > 2cm x 2 cm
94
Q

dx of osteomyelitis

A
  • definitive- isolation from sample
  • initial- x-ray
  • most sensitive- CT
  • epidural abscess- MRI
95
Q

if vertebral osteomyelitis, suspect _________

A

epidural abscess

96
Q

tx of osteomyelitis

A

prolonged IV abx- cefazolin, nafcillin, oxacillin
MRSA- IV vancomycin or daptomycin

97
Q

staphylococcal bacteremia may suggest _______

A

endocarditis

98
Q

dx of staphylococcal bacteremia

A

transesophageal echocardiogram to r/o endocarditis

99
Q

tx of staph bacteremia

A

IV vancomycin or daptomycin

100
Q

s/s of this disease include:
* acute onset high fever
* n/v, watery diarrhea
* sore throat, myalgia, HA
* macular erythematous rash, desquamation of palms and soles
* nonpurulent conjunctivitis
* hypotension

A

toxic shock syndrome

101
Q

dx of toxic shock

A

blood cultures- will be negative since it is due to toxins, not infection

102
Q

tx of toxic shock syndrome

A
  1. remove source
  2. rapid rehydration
  3. anti-staph therapy
  4. manage organ failure
  5. IV clindamycin, IV immune globulin
103
Q

this infection is typically due to intravascular devices, prosthetic devices, or wound infection following cardiothoracic surgery

A

coagulase-negative staphylococci

104
Q

s/s of coagulase-negative staphylococci

A

purulent serosanguineous drainage
erythema
pain at site of foregin body

105
Q

tx of coagulase- negative staphylococi

A

remove device

106
Q

cause of tetanus

A

clostridium tetani–> neurotoxin tetanospasmin

107
Q

tetanus incubation

A

5 days- 15 weeks

108
Q

eary s/s of tetanus

A

pain and tingling
spasticity of nearby muscles
jaw or neck stiffness
dysphagia
irritability

109
Q

late s/s of tetanus

A

hyperreflexia,
asphyxia and apnea
spasms of jaw muscles–> trismus
fascial muscle spasm–> risus sardonicus
spasm of muscles of abd, neck and back–> opisthotonos

110
Q

tx of tetanus

A

IM human tetanus immune globulin within 24 hrs
debride wound
IV or PO metronidazole (or PCN)
BR, no light or noise, sedation, paralysis, nutrition

111
Q

botulism cause

A

clostridium botulinum–> botulism toxin

112
Q

3 common souces of botulism

A
  1. foodborne- canned, smoked, vacuum packed
  2. infant ingestion of honey
  3. wound- injection drug users
113
Q

s/s of this condition includes:
* symmetric descending flaccid paralysis–> respiratory failure or death
* visual disturbances- ptosis, dipolpia, ect..
* dry mouth, dysphagia, dysphonia

A

botulism

114
Q

dx of botulism

A

toxin found in serum

115
Q

tx of botulism

A

contact state health department
airway
equine serum heptavalent botulism antitoxin
fluids

116
Q

diphtheria cause

A

corynebacterium diphtheria

117
Q

s/s of this condition includes:
* tenacious gray membrane that covers tonsils and pharynx (appears stuck on)
* laryngeal infection
* nasal drainage
* myocarditis and neuropathy

A

diphtheria

118
Q

dx of diphtheria

A

clinical
culture
PCR

119
Q

prevention of diphtheria

A

if exposed… get booster

120
Q

tx of diphtheria

A

removal of membrane and antitoxin from horse serum from CDC
PCN or erythromycin

121
Q

listeriosis cause

A

listeria monocytogenes
contaminated foods- unpaseurized dairy, hot dogs, deli meat, cantaloupes, soft cheeses

122
Q

5 types of listeriosis

A
  1. pregnancy infections
  2. granulomatosis infantisepticum
  3. bacteremia
  4. meningitis
  5. focal infections
123
Q

dx of listeriosis if suspecting meningitis

A

lumar puncture–> elevated neutrophils and proteins

124
Q

tx of listeriosis

A

IV ampicillin

125
Q

cause of pertussis (whooping cough)

A

bordetella perussis

126
Q

transmission and incubation of pertussis

A

transmission- respiratory droplets
incubation- 7-17 days

127
Q

what are the 3 stages of pertusis?

A
  1. catarrhal stage
  2. paroxysmal stage
  3. convalescent stage
128
Q

s/s of catarrhal stage of pertussis

A

insidious cough
lacrimation
sneezing
coryza
anorexia and malaise
night cough (diurnal)

129
Q

s/s of paroxysmal stage of pertussis

A

rapid consecutive coughing
deep high pitched inspiration (whoop)

130
Q

s/s of convalescent stage of pertussis

A

decrease in frequency and severity of paroxysms of cough

131
Q

dx of pertussis

A

isolating organism from nasopharyngeal culture

132
Q

prevention of pertussis post-exposure

A

prophylaxis with oral macrolide (erythromycin)

133
Q

tx of pertussis

A

azithromycin, clarithromycin, bactrim

134
Q

tx of sinusitis, otitis, or resp. infections due to h. flu

A

oral amoxicillin or augmentin

135
Q

tx of epiglottitis (due to h flu)

A

IV ceftriaxone
PCN allergy–> fluoroquinolone

136
Q

what causes salmonellosis?

A

ingestion of s enterica

137
Q

dx of typhoid fever

A

blood culture

138
Q

s/s of typhoid fever

A

abd pain and constipation
fever- ascends in stepwise fashion
splenomeagly, bradycaria and meningismus
rash- rose spots during second wk

139
Q

tx of typhoid fever

A

azithromycin or ceftriaxone

140
Q

what are 3 presentations of salmonellosis?

A

typhoid fever
acute enterocolitis
septicemic

141
Q

what is the MC form of salmonellosis?

A

acute enterocolitis

142
Q

dx of acute enterocolitits

A

culture from stool

143
Q

tx of acute enterocolitis

A

self limited
if complications–> ciprofloxacin or levofloxacin

144
Q

transmission of shigellosis

A

fecal-oral
ingestion of contaminated foods
person to person

145
Q

s/s of this illness include:
stool mixed w/ blood and mucus
abrupt onset diarrhea
tenesmus (cramping rectal pain)

A

shigellosis

146
Q

tx of shigellosis

A

self-limited
tx dehydration and hypotension
severe- fluoroquinolones or ceftriaxone

147
Q

s/s of cholera

A

*rice water stool
turbid, gray, watery, large volume stools
may have blood or pus
dehydration and hypotension

148
Q

dx of cholera

A

stool culture

149
Q

tx of cholera

A

fluid replacement via oral or IV fluids
antimicrobials- tetracyclines, macrolides, fluoroquinolones

150
Q

tx of campylobacter jejuni

A

self limited
hydration and electrolytes
severe- azithromycin, ciprofloxacin, levofloxacin

151
Q

incubation of plague

A

2-8 days

152
Q

s/s of plague

A

buboes, pneumonia, meningitis
high fever, delirium, severe myalgias
purpuric spots

153
Q

dx of plague

A

smears from buboes

154
Q

tx of plague

A

fluoroquinolones, aminoglycosides or doxycycline

155
Q

s/s of what disease cause:
penile- dysuria, milky discharge, yellow discharge
rectal- proctitis (men who have sex w/ men)
pharynx infections
cervicovaginal infections- dysuria, inflammation of bartholin glands, increased vaginal discharge

A

gonococcal infections

156
Q

dx of gonoccocal infections

A

nucleic acid amplification tests

157
Q

disseminated gonococcal infection s/s

A
  1. purulent arthritis
  2. triad- rash, tenosynovitis, polyarthralgia (arthtitis dermatitis syndrome)
  3. bacteremia, meningitis, endocarditits
  4. conjunctivitis
158
Q

tx of gonococcal infection

A

IM ceftriaxone
chlamydia- add doxycycline
pregnant- azithromycin

159
Q

cause of chancroid

A

haemophilys ducreyi (G- bacillus)

160
Q

s/s of chancroid

A
  1. vesiculopustule–> painful soft ulcer w/ necrotic base and erythema
  2. unilateral lymphadenitits
  3. fever, chills, malaise
161
Q

tx of chancroid

A

azithromycin or ceftriaxone

162
Q

cause of cat scratch disease

A

bartonella henselae

163
Q

tx of cat scratch disease

A

self limited
lymphadentitis- azithromycin

164
Q

what are 2 common presentations of chlamydia?

A
  1. lymphogranuloma venereum
  2. urethritis and cervicitis
165
Q

s/s of this presentation of chlamydia include:
* papular or ulcerative lesion
* 1-4 wks post-exposure- inguinal or femoral buboes, may have sinuses
* proctocolitits- MC in pts receiving anal sex

A

lymphogranuloma venereum

166
Q

dx of lymphogranuloma venereum chlamydia

A

nucleic acid amplification test (NAAT)

167
Q

tx of lymphogranuloma venereum chlamydia

A

doxycycline
pregnant- erythromycin or azithromycin

168
Q

s/s of this type of chlamydia include:
* less painful and more watery discharge
* cervicitis, PID, salpingitis, abd pain w/ sex, bleeding between periods

A

urethritis and cervicitis

169
Q

dx of urethritis and cervicitis chlamydia

A

highly sensitive nucleic acid amplification test (NAAT)

170
Q

tx of urethritis and cervicitis

A

doxycycline
pregnant- azithromycin or levofloxacin
screen for HIV, gonorrhea and syphilis

Clinical Medicine (8 decks)

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