ID Flashcards by Mani Yavi

Headache, fever, Rash starts at wrists and ankles and then spreads to trunk, palms, soles

Rocky mountain spotted fever via Rickettsia rickettsii; rx Doxycycline

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Pt o/w inflamed oropharynx, vesicles on the tongue, buccal mucosa, posterior pharynx, gums; Maculopapular (vesicular or pustular) rash on hands fingers, feet

Hand-foot-and-mouth disease caused by coxsackie A virus

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AIDS pt p/w headache, subacute fever, N&V, stiff neck, sensitivity to light, mental status changes, increased intracranial pressure; dx? Csf stain?

India ink stain of CSF shows Cryptococcus blastocysts, high opening P, elevated protein, low glucose; rx Flucytosine and Amphotericin B; maintain on Fluconazole

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AIDs w/ blurred vision, “pizza-pie” pattern retinopathy with exudates and perivascular hemorrhage. Dx, rx?

CMV retinitis; oral valganciclovir and IV ganciclovir or foscarnet

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Sickle Cell pt w/ Howell Jowell bodies, increased infection risk by?

Encapsulated bacteria, Strep pneumoniae, Neisseria meningitidis, Haemophilus influenzae.

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AIDS pt w/ nonproductive cough, fever, and exertional dyspnea CD4 60; dx,rx?

PCP via Pneumocystis jiroveci, rx TMP-SMX, add Corticosteroids w/ PaO2<70, A-a gradient>35

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Regional painful lymphadenopathy suppurative, erythematous skin pruritis with vesicles, cats; dx/rx?

Cat scratch Dz, Bartonella Henselea, rx Azithromycin for 5 days

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HIV pt p/w cutaneous and visceral (liver) angioma-like blood vessels (contast enhance nodular on contast CT); dx?

Bartonella causes bacillary angiomatosis in immunocomprimised

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Pt p/w scratches on neck, 3 red papules (∼3 mm), two 3-cm lymph nodes in the anterior cervical chain. Dx? Associated tumor? Bx? Rx?

Cat scratch dz via Bartonella henselae; Bacillary angiomatosis w/ neutrophilic infl; bx clumps of bacilli on Warthin-Starry silver; rx Erythromycin, Doxycycline

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Febrile neutropenia def/rx?

ANC<1500 (<500 is severe); rx piperacillin-tazobactam (or meropinem, cefepime)

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The ToRCHes microbes that may pass from mother to fetus

Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex virus/HIV, and Syphilis

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Neonatal Classic triad: chorioretinitis, hydrocephalus, and intracranial calcifications

Toxoplasmosis; check IgM, PCR; rx Sulfadiazine + pyrimethamine; cat feces exposure

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Neonate Classic triad: PDA (or pulmonary artery hypoplasia), cataracts, hyperbilirubinemia, deafness, “blueberry muffin” rash; dx/rx?

Rubella; check maternal IgM, supportive care

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Neonate w Hearing loss, seizures, petechial rash, “blueberry muffin” rash

CMV; rx Ganiciclovir

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Neonate w Encephalitis, herpetic (vesicular) lesions, shock and DIC

HSV-2; Tzanck smear, PCR; rx Acyclovir

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Newborn w facial abnormalities (notched teeth, saddle nose, short maxilla), saber shins, CN VIII deafness; dx/rx?

Congenital Syphilis; penicillin

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Neonate w Cutaneous lesions occur on the palms and soles, HSM, jaundice, anemia, metaphyseal dystrophy and periostitis; dx/ workup?

Congenital Syphilis; VDRL or RPR first, FTA ABS or dark field most accurate

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Kid w/ strawberry tongue, sandpaper-like rash on the trunk which desquamates after a few days, cervical lymphadenopathy, circumoral pallor; dx, rx?

Scarlet fever, group A β-hemolytic streptococci w/ elevated ASO, CRP, ESR; penicillin to prevent rheumatic fever

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Infant w/ acute fever T>40° (seizures) 3-5days, painless maculopapular blanching rash begins as the fever breaks, spreads from trunk to face, extremities

Roseola (exanthema subitum or sixth disease) by HHV-6

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Child w/ 3-days mild fever, Cough, Coryza, Conjunctivitis (“3 C’s”), then Koplik’s spots (small white spots on reddned buccal mucosa), later HIGH fever ≥ 40°C w blanching, red maculopapular rash cranial-to-caudal fashion spares palms and soles?

Measles via Paramyxovirus; rx Vitamin A; prevented by live attenuated vaccine

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Child w/ mild fever, headache, URI sx, erythematous rash on the face rapidly spreads as a diffuse, erythematous, maculopapular to the trunk and proximal extremities

Parvovirus B19 causing erythema infectiosum (fifth disease),“slapped cheek” rash will clear centrally forming lacy reticular rash.

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Peds w/ erythematous, tender, pink maculopapular rash begins on the face and descends over the rest of the body, postauricular cervical lymphadenopathy, also coryza and conjunctivitis, low fever; dx?

Rubella; arthalgias common in adults, women

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2yo w/ severe bark cough, running nose, fever, coryza, inspiratory stridor, steeple sign on cxr; dx/rx?

Croup from Parainfluenza or RSV, hypoxia on presentation (v epiglottitis); rx (before ddx) racemic empinephrine (moderate), steroids (mild)

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2yo p/w fever, refusing to lie flat, muffled voice, drooling, cherry-red epiglottis, thumbprint sign on cxr; dx/rx?

Epiglottitis via haemophilus influenza type B; rx Intubate in OR (possible tracheostomy), ceftriaxone 7-10days, (rifampin to contacts)

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Child w/ cervical adenopathy, petechiae, T\>104, URI sx, dx/rx/complications?

Pharyngitis via group A beta-hemolytic strep, Rapid DNAse antigen; rx oral peniccilin (or macrolides); Rheumatic fever, glomerulonephritis

Most common Pneumonia in CF pt, age?

0-20 Staph Aureus (Vanco); \>20 Psudomonas (Ceftazidime, Ceftriaxone, Amikacin)

HIV pt ppd\>5mm; dx/rx?

TB prophylaxis treatment with Isoniazid 9months with pyridoxine

South american p/w dyspnea, S3, peripheral edema, JVD, cardiomegaly, hx of megacolon; dx?

Chagas dz Trypanosoma cruzi; rx Benznidazole or nifurtimox

Pt p/w Dilated cardiomyopathy, megacolon, megaesophagus; from South America

Chagas dz Trypanosoma cruzi; rx Benznidazole or nifurtimox

spiking fevers, hepatosplenomegaly, pancytopenia; Macrophages containing amastigotes; dx, rx?

Leishmania donovani; Amphotericin B, sodium stibogluconate

bloody diarrhea (dysentery), liver abscess (“anchovy paste” exudate), RUQ pain (histology shows flask-shaped ulcer if submucosal abscess of colon ruptures)

Entamoeba histolytica; rx Metronidazole; iodoquinol for asymptomatic cyst passers

Bloating, flatulence, foul-smelling, fatty diarrhea (often seen in campers/hikers); dx,rx?

Giardia; rx Metronidazole (think fat-rich Ghirardelli chocolates for fatty stools of Giardia)

Systemic mycosis rx?

Fluconazole or itraconazole for local infection; amphotericin B for systemic infection.

States east of Mississippi River and Central America. Causes inflammatory lung disease and can disseminate to skin and bone (lytic lesions). Forms granulomatous nodules. Broad-base budding

Blastomycosis; Blasto buds broadly; unique lytic bone lesions and ulcerated skin lesions

Mississippi and Ohio River valleys. Pulmonary inf. p/w Pneumonia, Hilar or Mediastinal nodes, arthalgia or Erythema Nodosum. Caseating (or Non-caseating) Granulomas. Macrophages filled with it

Histoplasmosis; Histo hides (within macrophages). Bird or bat droppings. Rx itraconazole or amphotericin B

SW US, CA; pneumonia, meningitis; can disseminate to bone and skin, w/ earthquakes, Spherule filled with endospores

Coccidioidomycosis; Coccidio crowds. “(San Joaquin) Valley fever” “Desert bumps” = erythema nodosum “Desert rheumatism” = arthralgias

Budding yeast with “captain’s wheel” formation; Latin America

Paracoccidio parasails with the captain’s wheel all the way to Latin America.

Heavily encapsulated yeast. Not dimorphic. Soil, pigeon droppings, via inhalation, hematogenous dissemination to meninges. Culture Sabouraud agar. Stains India ink, mucicarmine. “Soap bubble” lesions in brain.

Cryptococcus neoformans; Cryptococcal meningitis, cryptococcosis.

Ketoacidotic diabetic, leukemic pt; Fungi proliferates in blood vessel walls via cribriform plate to brain. Rhinocerebral, frontal lobe abscesses. Headache, facial pain, black necrotic eschar

Mucormycosis. Rx amphotericin B.

Pt p/w dysuria, urethral discharge, swollen red painful knee

Septic monarthritis is Gonorrhea until proven otherwise; rx Ceftriaxone or ciprofloxacin

Dysuria, urethral discharge, (or PID), negative gram stain; dx, rx?

Chlamydia; rx doxycycline 7days or azithromycin single dose; also treat Gonorrhea w/ ceftriaxone unless nucleic acid test is negative

Foul-smelling, greenish discharge; itching and burning; higher pH “strawberry cervix”; dx, rx?

Trichomonas Vaginitis; rx Metronidazole for patient and partner

small, painless ulcers on genitals, swollen, wks later painful inguinal lymph nodes that ulcerate (“buboes”); dx, rx?

Lymphogranuloma venereum via Chlamydia trachomatis L1,L2, L3; rx doxycycline.

Jones Criteria for acute rheumatic fever post Group A Strep (penicillin rx)? 2major or 1 major+2minor

Major: JONES Joint (migratory arthritis), carditis, Nodules (subq), Erythema marginatum (sharp margins), Sidenham chorea; Minor: Fever, arthalgia, prolonged PR, elevated CRP/ESR

Painful erythematous edematous rash w/ well demarcated raised borders on the face, fever; dx/rx?

Erysipelas via Group A beta-hemolytic strep (Strep Pyogenes); rx penicillins, clindamycin or erythromycin

Recent Bone marrow transplant, p/w cough and diffuse patchy pulmonary infiltrates in cxr; dx?

CMV pneumonitis

8yo p/w bilateral sub-acute lymphadenopathy, fever, pharyngitis, HSM; dx?

Ebstein Barr Virus

Child w/ acute unilateral lymphadenopathy, tender, swollen, erythematous; dx?

Staph Auerus lymphadenitis most common (also group A step)

Pt p/w fever, headache, confusion, myalgias, chills, recent outdoors hx, thrombocytopenia, leukopenia, elevated lactate dehydrogenase, ALT/LFT; dx/rx?

Ehrlichiosis, morulae in monocytes; rx Doxycycline

CURB-65 algorithm?

Confusion, Uremia (BUN\>20), RR\>30/min, BP\<90/60, Age\>65; 2 or more points admit inpatient, 4 or more ICU

Community acquire pneumonia rx? (commonly strep pneumo, h. influ, mycoplasma)

Healthy outpt - Doxycycline or macrolide; comorbid outpt or inpatient - Fluoroquinolone or betalactam + macrolide,

Tetanus prophylaxis?

Tetanus diphteria toxid vaccine for clean/minor wounds if\> 10 yrs vaccination or unimmunized, dirty large wounds \>5yrs post vaccine; Tetanus toxoid plus immunoglobulin for unimmunized w/ large dirty wounds

HIV pt w/ local neuro sx, multiple non-enhancing cortical lesions w/o mass effect on CT; dx?

PML Progressive multifocal leukoencephalopathy via JC virus

10 yo p/w dry cough following 2 wks of rhinorrhea, subconjuctival hemorrhages, clear lungs, lymphocytic leukocytosis; dx/rx?

Pertussis, hx of lack of immunization, inspiratory whoop, paroxysmal coughs, cyanosis in baby; rx azythromycin, clarithromycin (macrolides)

Alcoholic p/w fever, dysphagia, odynophagia, drooling, swollen tender submandible and sublingual areas with crepitus; dx/rx?

Ludwig's angina, rapidly spreading infection from molar tooth w Strep and anaerobes (crepitus); risk of asphyxiation; rx pull tooth and penicillins

HIV pt p/w immunocomprimised pt p/w fever dyspnea cough, pulmonary nodule w/ "halo sign" or air crescent; dx/rx?

Invasive aspergillosis;

Vaccinations reommended for asplenic pt? (given \>14 days either before or after spleen removal)

Meningococcus (quad, every 5 yrs), Pneumococcus (PCV13 then PPSV23 8wks and 5yrs later), H Influ (HiB) one time

Pt p/w urticaria rash, fever, arthalgias, lymphadenopathy, headache, elevated ESR/CRP, 2weeks after starting treatment for pharyngitis; dx?

Serum sickness-like reaction (type3 hypersensitivity) from beta-lactams (penicillins) or sulfa drugs (TMP-SMX)

Cat bite rx?

Amoxicillin/Clavulanate 5days for Pasteurolla Multocida

Febrile prostitute w/ migratory polyarthalgia without purulence, tenosynovitis (wrists, ankles, fingers), Dermatitis (pustules, macules, vesicles)

Dissemintated Gonorrhea (may also p/w purulent arthritis w/o skin lesions); IV ceftriaxone 7-14days, co treat for chlamydia (doxycycline or azythromycin)

HIV pt w/ bloody diarrhea, abd pain, colonoscopy shows mucosal ulcers and erosions, bx shows giant cells with inclusion bodies; dx/rx?

CMV colitis; rx Ganciclovir (or foscarnet)

HIV pt w/ solitary periventricular weak ring-enhancing lesion on MRI head, EBV virus on CSF PCR; dx?

Primary CNS lymphoma

SIRS criteria (2 of 4)?

HR\>90, RR\>20, T\>38.5 (101.3) or T\<35 (95), WBC\>1200 or \<4000 or \>10% Bands

Centor criteria for pharyngitis treatment Strep goup A?

Fever, Tonsillar Exudate, Tender anterior cervical LN, Absence of cough: all 4 rx empirically with Penicillin or Amoxicillin, 2-3 RapidStrepTest

Nail puncture wound in adult causing osteomyelitis; dx/rx?

Pseudomonas aeuroginosa; rx fluoroquinolone (ciprofoloxacin, levofloxacin)

Lyme dz rx?

Doxycycline or Amoxicylcine for pregnant/lactating women and children

Post viral-URI purulent pneumonnia w/ multiple cavitary lesions; dx?

Staph Aureus

Sx of severe rhinorrhea over 10 days, or T\>39 (102) w purulent nasal discharge and face pain \>3days, or worsening sx after initially improving URI \>5days; dx/ rx?

Acute bacterial rhinosinusitis, most commonly Strep Pneumo (amoxicillin-clavullinic acid), nontypable H. Influ, Moraxella Catarrhalis

HIV med SE: NRT

Lactic acidosis

HIV med SE: NNRT

Steven-Johnsons reaction

HIV med SE: Enfaavirenz (a NNRT)

Insomnia w/ vivid bizarre dreams

HIV med SE: Indinavir

Needle shaped crystal induced nephropathy w/ hamturia

HIV med SE: Didanosine

Pancreatitis

HIV med SE: Nevirapine

Liver failure

Abd pain, N&V, followed by triad of periorbital edema, myositis (CK) and eosinophilia (\>20%), also w/ fever, conjuctival or retinal hemorrage, subungal splinter hemorrhage; dx/rx?

Trichinellosis from ingested undercooked meat (pork) worm forms cyst in myosites; rx abendazole, mebendazole

RUQ pain, fever, leukocytosis, elevated alk phos, ALT/AST, recent travel to mexico followed by dysesntery, abscess liver lesion on CT; dx/rx?

Amoebic liver abscess (Entamoeba Histolytica); rx Metronidazole, plus Paromomycin

RUQ pain, elevated alk phos, ALT/AST, may have Eosinophilia, close contact w/ dogs, abscess liver lesion on CT; dx/rx?

Echinococcus Hydatid cyst; rx aspiration and Albendazole

Fever for a week, abd pain and salmon colored rash wk 2, third week HSM w/ abd complications (perforation, bleeds); dx?

Typhoid fever via Salmonella; rx azythromycin, fluoroquilnolone, or ceftriaxone

Polyarthalgia w/ leukopenia, thrombocytopenia, high fever, rash, peripheral edema, cervical lymphadenopathy, recent travelt to tropics; dx?

Chikungunya fever (mosquito borne); rx supportive

Febrile w/ warm erythematous tender joint, elevated WBC, ESR, CRP; dx/rx (age)?

Septic arthritis; 0-3months (Staph A., Group B Strep, G- bacilli) rx Nafcillin or Vanco + Gentamycin or Ceoftaxime; \>3months (Staph A., Group A Strep, Pseudomonas) rx Nafcillin, Vanco, Clindamycin or Cefazolin

Prosthetic joint infection acute vs. subacute dx?

Acute via Staph A or Pseudomonas; Subacute via Staph Epidermis (coagulase negative)

Insensate, hypopigmented patch on skin of arm w/ marked muscle atrophy; dx?

Leprosy tuberculoid form (mycobacterium leprae), confirm by skin biopsy showing acid-fast bacilli; chronic granulomatous w/ peripheral n damage and muscle atrophy; rx Dapsone and Rifampin

Child p/w Dysphagia, Drooling, Distress, "tripod positioning", inspiratory stridor, tachypnea, high fever, cyanotic; dx/rx?

Epiglottitis via H. influ B (or Staph, Strep, non-typable H.Infu) look for "thumb sign" on xray; rx Intubate in OR (possible tracheostomy), ceftriaxone 7-10days, (rifampin to contacts)

Pt p/w fever, sweats, malaise, dark urine (hemoglobinuria), jaundice (hemolytic anemia), thrombocytopenia, elevate ESR, ALT/AST, decreased complement, recent tick bite, pmh splenectomy; dx/rx?

Babesiosis via Ixodes Tick; rx Quinidine-Clindamycin or Atorvaquone-Azithromycin,

Kid w/ nocturnal anal itch, positive scotch tape test; dx/rx?

Enterobius vermicularis (pinworms); rx Albendazole, or pyrantel pamoate, or mebendazole

HIV pt w/ conjuctivitis followed by blindness, painful, keratitis and uveitis, fundoscopy shows peripheral pale regions and central retinal necrosis; dx?

HSV or VZV

HIV pt w/ non painful vision loss, fundoscopy shows hemorrhage and fluffy granular lesions around retinal vessels

CMV retinitis; oral valganciclovir and IV ganciclovir or foscarnet

Daycare/school teacher p/w 10days of b/l arthalgia/arthritis of PIP/MCP/wrists/knee/ankle, fatigue, intermittent diarrhea, mild itchy skin patches; dx?

Parvovirus B19 (B19 IgM), self resolves in 2-3 weeks

High fever \>39, SOB, diarrhea, non productive cough, headache, relative bradycardia for fever, hyponatremia, neutrophils on sputum but no organisms; dx/rx?

Legionella (look for water source/ recent travel); rx Levofloxacin (fluoroquinolone) or macrolides (IV erythromycin) or IV doxycycline