ID Flashcards
What’s herpetic whitlow
Herpes of the hand, often due to hand jobs or dental work. Have focal area of grouped vesicles on an erythematous base.
In pts with widespread molluscum contagiosum, consider testing for
Hiv
Side effect of ethambutol
Optic neuritis
Side effect of isoniazid
Peripheral neuropathy And hepatitis
If pt in septic shock doesn’t respond to abx and fluid resus, whAt should you do
Administer vasopressors and admit to icu
Ppx meds of choice for close contacts of pts with meningococcal meningitis
Rifampin and cipro
Rbcs jn csf without hx of trauma is highly suggestive of
Hsv encephalitis
Two most common causes of encephalitis
Hsv and adenovirus
Tx of cmv encephalitis
Iv ganciclovir and possiby foscarnet
Most common postviral pneumonia bug in elderly
S aureus
Tx of brain abscess
Broad spec iv abx and surgical drainage
Triad of headache, fever, and focal neuro deficit, think
Brain abscess
Hiv destroys what cells
Cd4+ t lymphocytes
Dx of hiv
Elisa and then western blot to confirm
If Elisa is neg and pt had acute exposure do hiv rna pcr
Rapid hiv test also available
Babes of hiv positive moms should receive ___ six weeks postpartum
Zidovudine
Which are the only live vaccines that should be given to hiv pts
Mmr and Varicella
Should you give oral polio vaccine to aids pts
No
Mac in aids pts occurs when cd4 count is under
50
In Mac, serum alk phos and ldh Are
High
Biopsy of bone marrow, intestine or liver in Mac reveals
Foamy macrophages with acid fast bacilli
Ppx against Mac in aids pts
Azithromycin
Tx of gonorrhea
Ceftriaxone Im and azithro P.O. (for chlamydia tx)
Primary Syphillis occurs ___ after infection and presents with a ___
10-90 days
Painless ulcer
Secondary Syphillis occurs ___ after chancre and presents with a ___
4-8 wks
Low grade fever, headache, lymphadenopathy, maculopapular rash on soles and palms and condyloma lata
Tertiary Syphillis appears ___ after initial infection
1-20 years
What is tabes dorsalis
Posterior column degeneration seen in tertiary Syphillis
treatment of Syphillis can result in acute flulike illness (headache, fever, chills, myalgias) known as ___, which results from ___
Jarisch-herxheimer reaction, release of endotoxins by the killed organisms
Criteria of sirs
- temp below 36 or over 38
- tachypnea >20 breaths per minute
- tachycardia
- leukocytosis or leukopenia
Uncomplicated malaria can be treated with
Chloroquine
In cases of p vivax, p ovale or unknown species, how do you treat malaria
Chloroquine plus primaquine
Ppx against chloroquine resistant malaria
Atovaquone-proguanil
Tx of neutropenic fever
Empiric antibiotic therapy with anti-pseudomonal agent (cefepime, pip-tazo)
Admit if high risk
Most common causes of otitis externa (swimmers ear)
Pseudomonas and enterobacter
Pain with movement of the tragus/pinna, think
Otitis externa
Infective endocarditis in an iv drug user is due to
S aureus
Infective endocarditis in pts just having undergone dental procedure is due to what bug
Strep viridans
S bovis endocarditis is associated with
Gi malignancy
Presentation of endocarditis
From Jane Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Nail hemorrhage Emboli
Noseptate dangerous fungi
Mucormycosis
Most common organism for osteomyelitis? How about in scd pts?
Normally s aureus
For scd salmonella
Long standing chronic osteomyelitis with a draining sinus may lead eventually to
Squamous cell carcinoma (marjolin ulcer)
Labs in acute rheumatic fever
High esr and Crp
Clinical features of acute rheumatic fever
Jones Joints Carditis Nodules (subcutaneous) Erythema marginatum Sydenham chorea
Demographic in acute rheumatic fever
Age 5-15, girls>boys
Condylomata acuminata are caused by
Hpv
Verrucous papilliform lesions that are pink or skin colored
Condylomata acuminata
Preseptal cellulitis is usually due what
Break in periorbital skin eg abrasion or insect bite
Orbital cellulitis is an infection of what space
Space posterior to orbital septum
How can preseptal cellulitis be differentiated from orbital cellulitis
Preseptal cellulitis does not have:
- painful or impaired eom
- proptosis (no orbital fat involvement)
Inability to extend neck and widened prevertebral space in a kiddo suggests a diagnosis of
Retropharyngeal abscess
Name three viruses that can cause thrombocytopenia
Ebv
Hep c
Hiv
all pts with presumed itp should be tested for what viruses
Hiv and hep c
If preggo has hep c what should you do
Give hep a and b vaccines ; ribavirin is teratogenic
Most common viruses causing myocarditis (2)
Coxsackie b and adenovirus
Viral prodrome preceding worsening resp distress from acute left heart failure and pulm edema, possibly with a holosystolic murmur and hepatomegaly. Think
Viral myocarditis
Treatment of viral myocarditis
Supportive measures eg diuretics and inotropes
What is asymptomatic bacteruria
Growth of > 10,000 colony units from a clean catch without uti sx
First line treatments for asymptomatic bacteriuria
Cephalexin, augmentin, nitrofurantoin
Bactrim is ___ in first tri and ___ in second tri
Contraindicated
Safe
Fluoroquinolones are __ in preg
Contraindicated
What age do you get mmr
1 and 4
Measles is spread by
Respiratory particles
Tx of Lyme dz in preggos and kids under 8
Amoxicillin
Do you get fever and leukocytosis with osteomyelitis
Sometimes not always
Are most cases of vertebral osteo chronic and insidious
Yes
Old man with mild leukocytosis, and bilateral diffuse reticular infiltrates on cxr likely has pneumonia due to
Influenza
Old man with sig leukocytosis, high fever and lobar infiltrates on cxr likely has pneumonia due to
S pneumo, s aureus or pseudomonas
Parvo presents with __ arthralgias in adults
Symmetric polyarticular
Positive anti-hbs and negative all other hep b markers means
Person has been immunized against hep b
Tic that causes flu-like sx, anemia, thrombocytopenia, dark urine, increased bili/ldh/lfts
Babesiosis
Causes of meningitis in babes under three months (4)
GBs
E Coli
Listeria
Hsv
Causes of meningitis in kids 3 months to 10 years
S pneumo
N meningitidis
Causes of meningitis in Children over eleven
N meningitis
Fever headache focal neuro deficits and seizure, plus rfs of congenital heart disease and or recurrent sinusitis. Think
Brain abscess
Sporotrichosis is due to ___ infection
Fungal
How do you treat Syphillis in a pt with a penicillin allergy
Doxy
Is cmv retinitis painful?
No
Fundoscopy in cmv retinitis shows
Fluffy/glandular retinal lesions near retinal vessels and associated hemorrhage
Describe presentation of mumps
Viral infection that presents with fever and parotitis after nonspecific prodrome in school aged children.
Two complications of mumps
Aseptic meningitis and orchitis
How do you rule out septic arthritis
Synovial fluid analysis
Bartonella is gram __ and is seen with ___ stain
Negative
Warthrin starry stain
Presentation of cat scratch disease
Fever
Regional lymphadenopathy esp in axilla or groin
Localized papules or nodular skin lesion
Tx of cat scratch disease
Usually self limiting but can be treated with azithromycin
Most common causes of pneumonia in copd (2)?
H flu and klebsiella
Are s pneumo, s aureus and h flu encapsulated
Yes
Can you give neonates ceftriaxone? Justify
No
Risk of biliary sludging and kernicterus
Tx of confirmed chlamydia
Azithromycin
Tx of confirmed gonorrhea
Azithro + cef
Cysts, msm, liver abscess and ruq pain think
Entamoeba histolytica
Anchovy paste consistency of liver abscess. What am I?
Entamoeba histolytica
Dx of entamoeba histolytica
Trophozoite with endocytosed rbcs on stool o&p
Tx of entamoeba histolytica
Metronidazole
Pertussis is associated with ___cytosis
Lymphocytosis
Catarrhal phase of pertussis sx
Injected conjunctiva and lacrimation
What causes whooping cough
Pertussis
Tx of pertussis
Azithromycin
Pertussis vaccine is what kind of vaccine
Acellular
Pneumocystis pjiroveci is associated with cd count under
200
What kind of pneumonia does Pneumocystis pjiroveci cause
Diffuse interstitial causing dyspnea and fever but not productive cough
What do you see on cxr in Pneumocystis pjiroveci
Sometimes nothing otherwise ground glass infiltrate with crushed ping pong balls
Dx of Pneumocystis pjiroveci
Bronchoalveolar lavage then methamine silver stain
Ppx against and tx of Pneumocystis pjiroveci
Bactrim or pentamidine
How many doses of vzv vaccine do you need
Two
Age 1 and 4
If you suspect endocarditis what do you do
Serial blood cultures BEFORE starting antibiotics
HbsAg indicates
Antibody to hbsag; immunity (eg immunized)
What does IgM HBcAb indicate
Antibody to hbcag; igM positive in window period between when antigen disappears and antibody arrives
What does IgG HBcAb indicate
Indicates prior or current hep B infection
HBsAb and HBcAb positive means
Person has hep b and is now immune
Positive HBsAb and neg HBcAb means
Immunized against hep b
Pp with solid organ transplants on immunosuppression are at risk for what two opportunistic infections
Pcp and cmv
Triad of congenital rubella
Pda, hearing loss, cataracts
What do you see on ct of nec fas?
Air in the deep tissue
Tx of aspiration pneumonia
Anaerobic coverage including metronidazole with amoxicillin, augmentin and clinda
Abx for human bite wounds
Augmentin
Most common bacterial colonization in cf patients under twenty? Over twenty?
Under: staph aureus
Over: pseudomonas
Who gets legionella pneumonia?
Those in the hospital or have traveled (eg cruise)
Hyponatremia, diarrhea and pneumonia, think
Legionella
Dx of legionella
Urine legionella antigen
Tx of legionella
Fluoroquinolone or macrolide
Ldh level in pc pneumonia?
Very high
Pcp is seen in hiv pts with cd4 counts under
200
Can autoimmune hemolytic anemia and thrombocytopenia be seen in mono pts
Yes
Can you get a maculopapular rash with ebv
Yes, If mistakenly given amoxicillin or ampicillin
What is bacillary angiomatosis
Friable papules and plaques in immunocompromised pts as a result of Bartonella species, often associated with fever and other systemic sx
Types of strep viridans
Momms
Mitis Oralis Mutans Sanguinis Milleri
Viral esophagitis is more common than candida esophagitis in pts who have what sx
Severe odynophagia (pain with swallowing) but no dysphagia
Infant botulism is caused by
Botulism spores
Food borne botulism is caused by
Ingestion of preformed botulinum toxin
Can rpr be negative in early Syphillis infection
Yes
Confirm dx of genital herpes with what test?
Pcr
