ID Flashcards
Headache, fever, Rash starts at wrists and ankles and then spreads to trunk, palms, soles
Rocky mountain spotted fever via Rickettsia rickettsii; rx Doxycycline
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
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
AIDs w/ blurred vision, “pizza-pie” pattern retinopathy with exudates and perivascular hemorrhage. Dx, rx?
CMV retinitis; oral valganciclovir and IV ganciclovir or foscarnet
Sickle Cell pt w/ Howell Jowell bodies, increased infection risk by?
Encapsulated bacteria, Strep pneumoniae, Neisseria meningitidis, Haemophilus influenzae.
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
Regional painful lymphadenopathy suppurative, erythematous skin pruritis with vesicles, cats; dx/rx?
Cat scratch Dz, Bartonella Henselea, rx Azithromycin for 5 days
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
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
Febrile neutropenia def/rx?
ANC<1500 (<500 is severe); rx piperacillin-tazobactam (or meropinem, cefepime)
The ToRCHes microbes that may pass from mother to fetus
Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex virus/HIV, and Syphilis
Neonatal Classic triad: chorioretinitis, hydrocephalus, and intracranial calcifications
Toxoplasmosis; check IgM, PCR; rx Sulfadiazine + pyrimethamine; cat feces exposure
Neonate Classic triad: PDA (or pulmonary artery hypoplasia), cataracts, hyperbilirubinemia, deafness, “blueberry muffin” rash; dx/rx?
Rubella; check maternal IgM, supportive care
Neonate w Hearing loss, seizures, petechial rash, “blueberry muffin” rash
CMV; rx Ganiciclovir
Neonate w Encephalitis, herpetic (vesicular) lesions, shock and DIC
HSV-2; Tzanck smear, PCR; rx Acyclovir
Newborn w facial abnormalities (notched teeth, saddle nose, short maxilla), saber shins, CN VIII deafness; dx/rx?
Congenital Syphilis; penicillin
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
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
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
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
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.
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
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)
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)
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
