ID Flashcards
What are the signs/symptoms of early sepsis and septic shock?
Early sepsis: fever, vasodilation, warm flushed skin, +/- visible source of infection
Septic shock: organ hypoperfusion, pulmonary edema (ARDS), AMS, acute renal failure, GI bleeding, angina, DIC
When working a pt up for sepsis and running a blood culture, how many sites should you get blood from?
2
How do you treat sepsis?
IV fluids
Vasoconstrictive agents
Broad spectrum abx (until culture comes back)
Insulin (BS 80-110)
Corticosteroids
What do you monitor in pts with sepsis?
Serum lactate, base deficit, & pH to evaluate progression
Toxic shock syndrome is commonly seen in what population?
90% of cases are in women of childbearing age
What is the most common toxin that causes toxic shock syndrome?
TSST-1
What are the signs/symptoms of toxic shock syndrome?
Fever
Macular rash
Systemic hypotension
Vomiting/diarrhea
Myalgias
Disorientation
Lethargy
How do you treat toxic shock syndrome?
Supportive care
Abx: nafcillin or oxacillin (for staph), PenG + clindamycin (for strep)
Monitor cardiac, renal, & pulm
Aside from menstruation products, what other things can cause toxic shock syndrome?
Diaphragm use
IV drug use
Osteomyelitis
Pilonidal abscess
Septic arthritis
Cellulitis
Burns
What is the definition of a fever of unknown origin?
Fever that persists > 3 weeks without expected response to treatment
What temp meets the criteria for fever of unknown origin along with the > 3 week duration?
100.9F (38.3C)
To be diagnosed with a fever of unknown origin, must the fever be consistent?
No, it can be intermittent, relapsing sustained, or temperature-pulse disparity
What causes lyme disease?
Spirochete borrelia burgdorferi carried by the blacklegged tick (deer tick)
What are the signs/symptoms of lyme disease?
Early (3-30 days post bite): fatigue, fever, chills, muscle/joint aches, erythema migrans (rash @ site of bite) “target like” or “bulls-eye” shape
Late (days - months post bite): severe HA, stiff neck, numbness/tingling of the face/hands/feet, rashes at sites other than initial bite, heart palpitations
How long after a tick bite can you test for lyme disease?
Lyme antibody testing 4-6 weeks after tick bite
How do you treat lyme disease?
Early: 7-14 days of PO doxy or amoxicillin or cefuroxime
Late w/neuro symptoms: 14-21 days of PO or IV doxy or ceftriaxone
Late w/carditis: 14-21 days of PO or IV doxy or amoxicillin or cefuroxime
Late w/arthritis: 28 days of PO doxy or amoxicillin or cefuroxime
When can you provide prophylactic treatment for lyme disease?
Tick bite occurred in area w/high incidence
Tick was removed in last 72 hrs
Tick was engorged
Tick was blacklegged type
Pt has no contraindications to doxy
What causes Rocky Mountain Spotted Fever?
Rickettsia rickettsii carried by american dog tick, rocky mountain wood tick, or the brown dog tick
What is the classic triad of symptoms of rocky mountain spotted fever?
Fever
Tick exposure
Rash
What are symptoms of rocky mountain spotted fever?
Fever/chills/malaise
HA
Myalgias
Vomiting
Rash 2-4 days after fever (macules that transition to petechiae that moves from wrists/ankles to trunk to palms/soles)
What can occur in pts w/rocky mountain spotted fever later in the disease?
Amputations (2/2 vascular inflammation & damage)
Hearing loss
Paralysis
Mental disability
What is the 1st line treatment for rocky mountain spotted fever?
Doxy (100mg q12 hrs for adults, 2.2mg/kg BID for kids) x 5-7 days
What mosquito carries malaria?
Female anopheles
How do you test for malaria?
Microscopic exam of thick & thin blood smears repeated every 12-24 hrs OR
Antigen detection test (BinaxNOW)
How many sets of negative blood smears are needed to rule out malaria?
3
What is the treatment for malaria?
Chloroquine OR
Hydroxychloroquine
What are the signs/symptoms of malaria?
High fever
Shaking chills
HA
N/V/D
Neuro complaints
Myalgias
Flu-like general appearance
What is almost always fatal once signs/symptoms appear and only has < 20 documented cases of human survival?
Rabies
What are signs/symptoms of rabies?
Early: may be asymptomatic, fever, HA, prickling/itching at bite site
Late: delirium, abnormal behavior, hallucinations, hydrophobia, insomnia
What is the treatment for rabies?
Supportive if signs/symptoms present & confirmed diagnosis
Post-bite prophylaxis w/rabies immune globulin & vaccination in pts bitten by an animal known or assumed to have rabies
What med is commonly used to prophylactically treat an animal bite?
Augmentin
How is typhus fever typically spread?
Body lice, chiggers, or fleas
What are common symptoms of typhus fever?
Fever
HA
Rash
How do you treat typhus fever?
Doxy (100mg BID for adults, 2.2mg/kg BID in kids) for at least 3 days after fever stops & evidence of improvement
Arboviral disease, West Nile virus, and yellow fever are all treated with what?
Supportive care
What is the 1st & 2nd most common STI in the US?
1st: chlamydia
2nd: gonorrhea
Both chlamydia and gonorrhea may have what type of symptoms?
Asymptomatic
Abdominal/pelvic pain
Dyspareunia
Dysuria
Urinary urgency
Penile/vaginal discharge
Breakthrough vaginal bleeding
Which STI (gonorrhea or chlamydia) has an unremarkable physical exam in 90% of men and 70-95% of women?
Chlamydia
Where do you obtain a sample for the nucleic acid amplification test when working a pt up for gonorrhea or chlamydia?
Sample must come from symptomatic area (urine, oropharyngeal, vaginal, rectal)
What is the treatment of choice for gonorrhea?
Ceftriaxone 500mg IM (if pt < 150kg) (100mg if pt > 150kg) x 1 dose
What is the treatment of choice for chlamydia?
Doxy 100mg PO BID x 7 days
What is a primary sign of pelvic inflammatory disease (PID)?
Cervical motion tenderness (chandelier sign)
What can having a PID affect in the future?
Fertility
What is the treatment of choice for PID?
Ceftriaxone 1g IV q24 hrs PLUS doxy 100mg PO or IV q12 hrs PLUS metronidazole 500mg PO or IV q12 hrs
What are the signs/symptoms of trichomoniasis?
Thin, frothy, malodorous vaginal discharge
Strawberry cervix
What test is used to diagnose trichomoniasis?
Wet mount/prep
What is the treatment for trichomoniasis?
Metronidazole 2g x 1 dose OR
Tinidazole 2g x 1 dose OR
Metronidazole 500mg BID x 7 days
What should you caution pts about when prescribing Metronidazole?
Cannot take with alcohol
What are the signs/symptoms of primary syphilis?
Primary (10-90 days post exposure): painless/indurated ulcer
What bug causes syphilis?
T. pallidum
What are the signs/symptoms of secondary and tertiary syphilis?
Secondary (2-8 weeks after chancre disappears w/concurrent multiple systemic manifestations): condyloma lata, alopecia, papulosquamous rash
Tertiary (months-year post infx): cardiovascular syphilis, neurosyphilis, gummatous syphilis
What is the first test that is performed when diagnosing syphilis?
Rapid plasma reagin (RPR)
What is the treatment for primary/secondary syphilis?
Benzathine penicillin G 2.4 million units IM x 1 dose
What is the treatment for neurosyphilis and tertiary syphilis in pts with HIV?
Neuro: Pen G aqueous 18-24 million units IV QD x 14 days
Tertiary w/HIV: benzathine pen G 2.4 million units IM weekly x 3 weeks
What are common signs/symptoms of Hep B & C?
Anorexia
N/V
Abdominal pain
Jaundice
Signs of liver damage
What is the treatment for Hep B?
Virus usually clears on its own
No cure if it doesn’t clear
Vaccine for prevention
What does the CDC recommend for screening for Hep B?
Once per lifetime in any adult over 18 yo with no known risk factors
What is the treatment for Hep C?
Can clear on its own or lead to chronic infection
Oral direct acting antivirals (DAA) x 12 weeks
Who does Medicare require screening for Hep C?
Pts > 60 yo
What are the signs/symptoms of herpes simplex virus?
Painful oral or genital ulcer (herpes hurt)
Pruritus
Dysuria
Fever
HA
Localized lymphadenopathy
What test is used when diagnosing HSV?
Nucleic acid amplification test (NAAT) from ulcer (if recently ruptured vesicle)
What is the initial treatment for the first episode of HSV?
Acyclovir 400mg TID x 7-10 days OR
Valacyclovir 1g BID x 7-10 days
What is the treatment for an acute flair/recurrent episode of HSV?
Acyclovir or valacyclovir at higher doses & shorter durations
What is the suppressive treatment for HSV?
Acyclovir 400mg BID OR
Valacyclovir 500mg - 1g QD
What is the difference between HSV-1 and HSV-2?
HSV-1: classically associated with orolabial (now leading cause of genital herpes in young/homosexual pts)
HSV-2: classically associated with genital infections
(1 mouth, 2 balls)
What are most cases of HPV caused by?
HPV 6, 11, 16, & 18
What are the signs/symptoms of HPV?
Genital/anogenital warts
Cauliflower-like growth (condylomata acuminata) to external genital region, perineum, or perianal region
What is the treatment for HPV that presents w/an anogenital wart w/o malignancy?
Surgical removal
Cryotherapy
Laser vaporization
Topicals (imiquimod, podofilox)
What is the treatment for HPV that presents w/high-grade/persistent cervical dysplasia?
Cryotherapy
Loop electrosurgical excision
Cold knife cone resection
Is HPV an STI that gets reported to the health department?
No
How are hookworms transmitted/make people sick?
Infested soil through skin
Skin penetration –> migrate to vascular system –> migrate to R side of heart & pulm circulation –> migrate to pharynx –> migrate to GI tract
What are signs/symptoms of a hookworm infection?
Pulm: cough, sneezing, wheezing, hemoptysis
GI: abd. pain & distention, diarrhea, maybe melena
May have keloids from hookworm tract
What diagnostic test is done to test for hookworms?
Stool sample microscopy
How do you treat a hookworm infection?
Single-dose albendazole OR
Multi-dose mebendazole
What presents with perianal itching that gets worse at night?
Pinworms
What test is done in suspected pinworm infection?
Tape test
What is the treatment for pinworms?
Vermox OR
Mebendazole
What is commonly seen in people who live in tropical areas w/decreased sanitation & increased fecal contamination of water supplies, and can present with GI symptoms?
Amebiasis
What is the treatment for amebiasis?
Metronidazole 500mg PO q6-8 hrs x 7-14 days OR
Tinidazole 2g PO QD x 3 days
What is a common protozoan infection in the US that is spread via a fecal-oral route that peaks from early summer to early fall?
Giardia
What are the signs/symptoms of giardia?
Foul-smelling diarrhea
Greasy stools
Abdominal bloating/cramping
Increased flatulence
What is the gold standard test for giardia?
Microscopic identification of pathogen in stool sample collected over several days
What other tests for giardia may be used in place of the stool sample collection?
Direct fluorescence immunoassay (DFA)
Enzyme immunoassay (EIA)
Duodenal aspirate
What is the treatment for giardia?
Current 1st line for pts > 3 yo: tinidazole
Classic 1st line: metronidazole
What is a common opportunistic infection that can cause significant disease in immunocompromised pts?
Toxoplasmosis
What is seen on a brain CT or MRI in a pt with toxoplasmosis?
Multiple hypodense areas with ring-enhancing lesions
What is the treatment for toxoplasmosis?
Empirical therapy if suspected & waiting on test results
Pyrimethamine & sulfadiazine combo for 4-6 weeks beyond resolution of symptoms, prolonged course (6 months) for immunocompromised pts
How long do AIDS pts usually have to be on a pyrimethamine & sulfadiazine combo for toxoplasmosis treatment?
Lifelong
What commonly presents with pts saying they “feel like I’ve been hit by a truck”, fever, chills, & fatigue?
Influenza
What is the general treatment for influenza?
Prevent w/annual vaccine
Supportive care
What pts can get anti-viral treatment for the flu?
High risk groups if within 48 hours of symptom onset
What antivirals are used to treat influenza?
Flu A & B: neuraminidase inhibitors (oseltamivir, zanamivir, peramivir)
Flu A only: adamantane antivirals (amantadine, rimantadine)
What are the stages of HIV?
Acute HIV infection
Chronic HIV w/o AIDS: CD4 count > 200 w/goal > 500
Chronic HIV w/AIDS: CD4 count < 200 or AIDS defining illness
Advanced HIV: CD4 count < 50
What is the gold standard treatment for HIV?
Highly active retroviral therapy (HAART) regardless of CD4 count
May include: NRTI, NRTI fixed-dose combo, integrase inhibitors, NNRTIs, or protease inhibitors
What CD4 count gets a prophylactic treatment and what agent is used?
CD4 < 200 prophylaxis w/Bactrim
If a healthcare provider is exposed to HIV infection, what is the treatment?
PEP within 72 hrs of exposure
What is used as prophylactic treatment for people who have a partner that is HIV positive?
PrEP
What is the criteria for diagnosing AIDS?
CD4 count < 200 AND
1 or more of the following:
TB, CMV, candidiasis, cryptococcal meningitis, toxoplasmosis, kaposi sarcoma, kidney disease, neuro complications (AIDS dementia)
What is the classic triad for TB?
Fever
Night sweats
Hemoptysis
What may be seen on CXR in a pt with TB?
Perihilar infiltrates
What is the treatment for TB?
6 month RIPE regimen: 2 months w/4 drugs (rifampin, isoniazid, pyrazinamide, ethambutol) & 4 months w/2 drugs (rifampin, isoniazid) OR 4 months rifapentine-moxifloxican
What constitutes a positive skin TB test?
Healthy pt: > 15mm induration
Healthcare or high-risk setting: > 10mm
HIV, close contact w/known TB, or immunosuppressed: > 5mm
