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3rd Year (Step 2) > ID 3b > Flashcards

ID 3b Flashcards

1
Q

Infectious Diarrhea: Bloody – Dx?

Poultry

A

Salmonella

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2
Q

Infectious Diarrhea: Bloody – Dx?

Most common cause

A

Campylobacter

ass’d w/ GBS

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3
Q

Infectious Diarrhea: Bloody – Dx?

Hemolytic Uremic Syndrome (HUS)

A
  1. E. coli O157:H7

2. Shigella (2nd most common w/ HUS)

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4
Q

Infectious Diarrhea: Bloody – Dx?

Shellfish & cruiseships

A

Vibrio parahaemolyticus

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5
Q

Infectious Diarrhea: Bloody – Dx?

Shellfish, Hx of liver disease, skin lesions

A

Vibrio Vulnificus

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6
Q

Infectious Diarrhea: Bloody – Dx?

High affinity for iron, hemochromatosis, blood transfusions

A

Yersinia

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7
Q

Infectious Diarrhea: Bloody – Dx?

White & red cells in stool

A

Clostridium dificile

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8
Q

Best initial test in infectious diarrhea?

A

Blood &/or fecal leukocytes

Stool lactoferrin has greater sensitivity & specificity than stool leukocytes

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9
Q

Nonbloody infectious diarrhea ass’d w/ vomiting – organism(s)?

A

Bacillus cereus & Staphylococcus

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10
Q

Infectious diarrhea – Tx of mild & sever disease?

A

Mild = Oral fluid replacement

Severe = Fluid replacement & oral ABX like Ciprofloxacin

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11
Q

“Severe” infectious diarrhea means what?

A

Hypotension, Tachycardia, Fever, Abdominal pain, Bloody diarrhea, Metabolic acidosis

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12
Q

Cryptosporidiosis – Tx?

A

Treat underlying AIDS

- Nitazoxanide

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13
Q

Most common causes of acute hepatitis?

A

Hepatitis A or B

Hep C rarely presents as acute hepatitis, usually “silent” infection that presents later w/ cirrhosis

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14
Q

Acute Hepatitis presentation Sx?

A
  • Jaundice
  • Fever, weight loss, fatigue
  • Dark urine
  • Hepatosplenomegaly
  • Nausea, vomiting, abdominal pain
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15
Q

Acute Hepatitis Dx tests?

A

Increased:

  • Direct Bilirubin
  • ALT:AST ratio
  • Alkaline Phosphatase
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16
Q

Acute Hepatitis marker that correlates best w/ inc’d likelihood of mortality?

A

Prothrombin time

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17
Q

Best initial Dx test to differentiate type of hepatitis?

A

Hep A, B, D, & E: IgM antibody for acute infection, IgG for resolution of infection

Hep C: PCR to assess RNA level

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18
Q

Serology marker of Hepatitis B vaccination?

A

Positive Surface Antibody

surface- & e-antigen negative, core-Ab negative

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19
Q

Serology marker of resolved/past Hepatitis B infection

A

Positive IgG Core antibody & Surface antibody

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20
Q

Serology marker of acute or chronic Hepatitis B infection?

A

Positive surface antigen, e-antigen, core antibody (IgG or IgM)

(negative surface antibody)

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21
Q

Serology marker of “window period” of Hepatitis B infection?

A

Positive IgM, then IgG Core antibody

antigens & surface antibody all negative

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22
Q

What does positive e-antigen mean in hepatitis B?

A

High level of DNA polymerase activity — viral replication occurring

e-antigen is the best indication of the need for Tx in chronic disease

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23
Q

Acute Hepatitis C – Tx?

A

Interferon (injection), Ribavirin, & Boceprevir or Telaprevir

(dec likelihood of developing chronic infection w/ Hep C)

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24
Q

Definition: “Chronic” Hepatitis B

A

Presence of Surface antigen > 6 months

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25
Interferon -- AEs?
- Arthralgia/myalgia - Leukopenia & Thrombocytopenia - Depression & flu-like symptoms
26
Chronic Hepatitis w/ elevated e-antigen -- Tx?
Entecavir, Adefovir, Lamivudine, Telbivudine, Interferon, or Tenofovir (interferon is injection & has most side effects -- not best 1st choice)
27
Goal of Chronic Hepatitis therapy?
- Reduce DNA polymerase to undetectable levels | - Convert those patients w/ e-antigen to having anti-hepatitis e-antibody
28
Acute Hepatitis B -- Tx?
None. Hep B becomes chronic in 10% of patients & no Tx has been shown to alter this.
29
Role of Liver Biopsy in chronic Hepatitis management?
Fibrosis on biopsy = start Tx for Hep B or C right away - if there's active viral replication, fibrosis will progress to cirrhosis, which is irreversible
30
Are ALT levels a good indication of activity of chronic hepatitis?
No, you can have significant infection w/ normal transaminase levels
31
Ribavirin -- AEs?
- Hemolytic Anemia | - Severe Teratogen
32
Goal of Hep C therapy?
Achieve an undetectable viral load
33
Urethritis vs. Cystitis presentation?
Both: Dysuria w/ urinary frequency & burning | Urethritis = Urethral discharge cystitis does not give this
34
Urethritis -- Tx?
Cefexime or Ceftriaxone (gonorrhea) + Azithromycin or Doxycycline (chlamydia)
35
Urethritis -- best initial test?
Urethral swab for Gram stain
36
Causes of Urethritis other than Gonorrhea/Chlamydia?
Mycoplasma genitalium & Ureaplasma
37
Cervicitis -- presentation?
Cervical discharge & inflamed "strawberry" cervix on PE
38
Cervicitis -- Tx?
``` - Testing & Tx are identical to Urethritis Tx = Cefexime or Ceftriaxone (gonorrhea) + Azithromycin or Doxycycline (chlamydia) ```
39
Pelvic Inflammatory Disease (PID) -- presentation?
- Lower abdominal tenderness - Lower abdominal pain - Fever - Cervical motion tenderness - Leukocytosis
40
PID -- best 1st step?
Exclude pregnancy!
41
Dx? | Painless genital ulcer
Syphilis
42
Dx? | Painful genital ulcer
Chancroid (Haemophilus ducreyi)
43
Dx? | Lymph nodes tender & suppurating + genital ulcer
Lymphogranuloma venereum
44
Dx? | Painful vesicles, leading to ulcer
Herpes simplex
45
Syphilis -- Dx tests?
Dark-field microscopy - CDRL or RPR (75% sensitive in primary syphilis) - FTA or MHA-TP (confirmatory)
46
Chancroid (H. ducreyi) -- Dx tests?
Stain & culture on specialized media
47
Lympogranuloma venereum -- Dx tests?
- Complement fixation titers in blood | - Nucleic acid amplification testing on swab (PCR)
48
Herpes simplex -- Dx tests?
- Tzanck prep = best initial test | - Viral culture = most accurate test
49
Syphilis -- Tx?
Single dose of intramuscular benzathine penicillin - Doxycycline in penicillin allergy (ulcers resolve on their own, Tx is to prevent further stages)
50
Chancroid (H. ducreyi) -- Tx?
Azithromycin (single dose)
51
Lymphogranuloma venereum -- Tx?
Doxycycline
52
Primary syphilis -- presentation?
- Painless genital ulcer w/ heaped-up INDURATED EDGES (becomes painful if secondarily infected w/ bacteria) - Painless adenopathy
53
Secondary syphilis -- presentation?
- Rash (palms & soles) - Alopecia areata - Mucous patches - Condylomata lata
54
Tertiary syphilis -- presentation?
Neurosyphilis: - Meningovascular (stroke from vasculitis) - Tabes dorsalis (loss of P & V sense, incontinence, cranial nerve) - General paresis (memory & personality changes) - Argyll Robertson pupil (reacts to accommodation but not light) - Aortitis (aortic regurge & aneurysm) - Gummas (skin & bone lesions)
55
Syphilis Tx: If PCN-allergic, when do you desensitize to PCN instead of switching to Doxycycline
If neurosyphilis exists or if the patient is pregnant
56
Condyloma Acuminata -- what is it?
Genital warts (papillomavirus)
57
Condyloma Acuminata -- Dx test(s)?
Visual appearance alone
58
Condyloma Acuminata -- Tx?
Remove w/ Cryotherapy w/ liquid nitrogen, surgery, laser, or "melting" w/ podophyllin or tricloroacetic acid - Imiquimod is a locally applied immunostimulant that leads to the sloughing off of the lesion
59
Pediculosis
Crabs - found on hair bearing areas (axial, pubis) - Visible on surface - Causes itching
60
Pediculosis -- Tx?
Permethrin | Pediculosis = Crabs
61
Scabies -- Dx test(s)?
Must scrape them out of the skin & magnify to Dx | b/c they burrow beneath the skin but leave a visible trail
62
Scabies -- Tx?
Permethrin
63
Scabies -- where is it found?
Web spaces between fingers & toes or @ elbows or genitalia
64
Pyelonephritis -- Tx?
- Ceftriaxone (1st), Ertapenem - Ampicillin & Gentamicin (if cultures are known) - Ciprofloxacin (oral for outpatient) ** any drug for gram-negative rods would be effective **
65
Prostatitis -- Tx?
- Ceftriaxone (1st), Ertapenem - Ampicillin & Gentamicin (if cultures are known) - Ciprofloxacin (oral for outpatient) ** any drug for gram-negative rods would be effective **
66
Chronic Prostatitis -- Tx?
TMP/SMX x 6-8 wks
67
Isoniazid -- AEs?
- Neurotoxicity (prevented by pyridoxine, B6) - Hepatotoxicity - Lupus-like syndrome
68
Rifampin -- AEs?
- Minor hepatotoxicity & drug interactions (inc's P450) | - Orange body fluids (nonhazardous)
69
Pyrazinamide -- AEs?
- Hyperuricemia | - Hepatotoxicity
70
Ethambutol -- AEs?
Optic neuropathy (red-green color blindness)
71
What type of drugs end in "navir"?
Protease inhibitors
72
What type of drugs end in "vudine"?
NRTIs | though not all of these end in "vudine"

3rd Year (Step 2) (44 decks)

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