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ID Flashcards

1
Q

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

A

Rocky mountain spotted fever via Rickettsia rickettsii; rx Doxycycline

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2
Q

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

A

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

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3
Q

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

A

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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4
Q

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

A

CMV retinitis; oral valganciclovir and IV ganciclovir or foscarnet

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5
Q

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

A

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

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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

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

A

Bartonella causes bacillary angiomatosis in immunocomprimised

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9
Q

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?

A

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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10
Q

Febrile neutropenia def/rx?

A

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

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11
Q

The ToRCHes microbes that may pass from mother to fetus

A

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

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12
Q

Neonatal Classic triad: chorioretinitis, hydrocephalus, and intracranial calcifications

A

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

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13
Q

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

A

Rubella; check maternal IgM, supportive care

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14
Q

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

A

CMV; rx Ganiciclovir

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15
Q

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

A

HSV-2; Tzanck smear, PCR; rx Acyclovir

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16
Q

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

A

Congenital Syphilis; penicillin

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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

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

A

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

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20
Q

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?

A

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

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21
Q

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

A

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

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22
Q

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?

A

Rubella; arthalgias common in adults, women

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23
Q

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

A

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

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24
Q

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

A

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

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25
Q

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

A

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

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26
Q

Most common Pneumonia in CF pt, age?

A

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

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27
Q

HIV pt ppd>5mm; dx/rx?

A

TB prophylaxis treatment with Isoniazid 9months with pyridoxine

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28
Q

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

A

Chagas dz Trypanosoma cruzi; rx Benznidazole or nifurtimox

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29
Q

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

A

Chagas dz Trypanosoma cruzi; rx Benznidazole or nifurtimox

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30
Q

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

A

Leishmania donovani; Amphotericin B, sodium stibogluconate

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31
Q

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

A

Entamoeba histolytica; rx Metronidazole; iodoquinol for asymptomatic cyst passers

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32
Q

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

A

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

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33
Q

Systemic mycosis rx?

A

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

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34
Q

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

A

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

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35
Q

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

A

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

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36
Q

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

A

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

37
Q

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

A

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

38
Q

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.

A

Cryptococcus neoformans; Cryptococcal meningitis, cryptococcosis.

39
Q

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

A

Mucormycosis. Rx amphotericin B.

40
Q

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

A

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

41
Q

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

A

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

42
Q

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

A

Trichomonas Vaginitis; rx Metronidazole for patient and partner

43
Q

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

A

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

44
Q

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

A

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

45
Q

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

A

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

46
Q

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

A

CMV pneumonitis

47
Q

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

A

Ebstein Barr Virus

48
Q

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

A

Staph Auerus lymphadenitis most common (also group A step)

49
Q

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

A

Ehrlichiosis, morulae in monocytes; rx Doxycycline

50
Q

CURB-65 algorithm?

A

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

51
Q

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

A

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

52
Q

Tetanus prophylaxis?

A

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

53
Q

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

A

PML Progressive multifocal leukoencephalopathy via JC virus

54
Q

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

A

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

55
Q

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

A

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

56
Q

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

A

Invasive aspergillosis;

57
Q

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

A

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

58
Q

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

A

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

59
Q

Cat bite rx?

A

Amoxicillin/Clavulanate 5days for Pasteurolla Multocida

60
Q

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

A

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

61
Q

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

A

CMV colitis; rx Ganciclovir (or foscarnet)

62
Q

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

A

Primary CNS lymphoma

63
Q

SIRS criteria (2 of 4)?

A

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

64
Q

Centor criteria for pharyngitis treatment Strep goup A?

A

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

65
Q

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

A

Pseudomonas aeuroginosa; rx fluoroquinolone (ciprofoloxacin, levofloxacin)

66
Q

Lyme dz rx?

A

Doxycycline or Amoxicylcine for pregnant/lactating women and children

67
Q

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

A

Staph Aureus

68
Q

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?

A

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

69
Q

HIV med SE: NRT

A

Lactic acidosis

70
Q

HIV med SE: NNRT

A

Steven-Johnsons reaction

71
Q

HIV med SE: Enfaavirenz (a NNRT)

A

Insomnia w/ vivid bizarre dreams

72
Q

HIV med SE: Indinavir

A

Needle shaped crystal induced nephropathy w/ hamturia

73
Q

HIV med SE: Didanosine

A

Pancreatitis

74
Q

HIV med SE: Nevirapine

A

Liver failure

75
Q

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?

A

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

76
Q

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

A

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

77
Q

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

A

Echinococcus Hydatid cyst; rx aspiration and Albendazole

78
Q

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

A

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

79
Q

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

A

Chikungunya fever (mosquito borne); rx supportive

80
Q

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

A

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

81
Q

Prosthetic joint infection acute vs. subacute dx?

A

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

82
Q

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

A

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

83
Q

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

A

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)

84
Q

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?

A

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

85
Q

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

A

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

86
Q

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

A

HSV or VZV

87
Q

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

A

CMV retinitis; oral valganciclovir and IV ganciclovir or foscarnet

88
Q

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?

A

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

89
Q

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

A

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

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