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ID Flashcards

1
Q

The following is the general “criteria” for what?

  • Fever >38.3degC (100.9F)
  • At least 3wks duration
  • No dx after 3 outpt visits or 3 days of hospitalization
A

Fever of unknown origin

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2
Q

What are the 3 MC etiologies of Fever of Unknown Origin (FUO)?

A
  1. Infection
  2. Malignancy
  3. Connective Tissue Disease
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3
Q

What is the #1 MC malignancy to cause FUO (fever of unknown origin)?

A

Lymphoma, especially non-hodgkins

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4
Q

What is the main site of colonization of staphylococcal infections?

A

Nose

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5
Q

Is staph aureus coagulase negative or positive

A

positive

(Staph epidermidis and staph saprophyticus are both coag neg)

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6
Q
  • Which staphylococcal strain is a frequent skin contaminant of blood cultures?
  • What do you do to confirm whether a contaminant or a true cause of bacteremia?
A
  • Staph epidermidis
  • May have to draw from 2 sites
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7
Q

Which bacteria causes infections of:

  • Urine catheters
  • IV lines
  • Prosthetic joints/heart valves
  • Dialysis catheters
A

Staph epidermidis

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8
Q

Which staphylococcal strain is coagulase negative and is a leading cause of UTIs?

A

Staphylococcus saprophyticus

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9
Q

What is the etiology of TSS?

A

Staph aureus

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10
Q

Clinical presentation of what?

  • Abrupt onset high fever
  • Vomiting & watery diarrhea
  • Sore throat, myalgias, h/a
  • Hypotension with kidney and heart failure
  • Diffuse macular erythematous rash and nonpurulent conjunctivitis
  • Desquamation, esp. of palms & soles (late finding)
A

TSS

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11
Q

Lab findings in TSS are consistent with what?

A

shock and organ failure

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12
Q

What is empiric antibiotic tx for TSS?

A

Clindamycin + Vanco

(Also needs rapid rehydration–> 3L)

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13
Q

What condition is caused by Staph aureus and is primarily in neonates 3-15 days old?

A

Staph Scalded Skin Syndrome (SSSS)

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14
Q

Clinical presentation of which condition?

  • Prodrome: fever, irritability
  • Erythematous patches with large superficial fragile blisters
  • When blisters rupture, skin appears red and scalded
  • Nikolsky sign (only the first layer)
A

Staph Scalded Skin Syndrome (SSSS)

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15
Q

Diagnosis of what?

  • Clinical with cultures
  • Skin biopsy shows intraepidermal cleavage without necrosis**
A

Staph Scalded Skin Syndrome (SSSS)

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16
Q

What type of abx should be used to tx SSSS? If there is no response, what 2 meds should you consider?

A
  • Penicillinase-resistant beta-lactam agents (Nafcillin)
  • If no response, consider MRSA & tx with vancomycin
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17
Q

Etiology of Anthrax?

A

Bacillus anthracis

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18
Q

T/F: there has been bioterrorism w/ anthrax spores

A

True

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19
Q

Hallmark of what condition?

  • Painless eschar with extensive surrounding edema

(will be on exam)

A

Cutaneous clinical syndrome of Anthrax

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20
Q

What causes:

  • hemorrhagic mediastinitis
  • occasionally necrotizing pneumonia
  • Bacteremia
A

Inhalation clinical syndrome of Anthrax (the most dangerous form)

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21
Q

Which clinical syndrome has a prodrome including sxs like hemoptysis and dyspnea and can resultmin death within days

A

INHALATION clinical syndrome of Anthrax

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22
Q

What is seen on CXR of the inhaled form of Anthrax?

(will be on exam)

A

Widened mediastinum

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23
Q

What is the GI form of Anthrax from?

A

consumptom of undercooked, infected meat from animals infected with anthrax

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24
Q

Which infectious disease causes:

  • Necrotic ulcers surrounded by extensive edema of infected intestinal segment and adjacent mesentery
  • Can cause GI hemmorrhage
A

GI tract clinical syndrome of Anthrax

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25
Q

How do you tx anthrax if it is systemic w/ meningitis?

A
  • Report/consult public health department
  • Cipro + meropenem + Linezolid
  • Antitoxin
  • etc.
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26
Q

How do you tx Anthrax that is systemic WITHOUT meningitis?

A
  • Report/consult public health department
  • Cipro + Clinda
  • Antitoxin
  • etc.
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27
Q

How do you treat cutaneous Anthrax?

A
  • Report/consult public health department
  • _Ciprofloxacin**_
  • Antitoxin
  • etc.

***definitely know abx- will be on exam***

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28
Q

Which type of anthrax has the highest mortality rate? (cutaneou, injection, GI, inhalation or anthrax meningitis)

A
  • Anthrax meningitis- even with treatment, mortality is 100%
  • Inhalation is also very deadly with mortality rate of 45%
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29
Q

What is post-exposure prophylaxis for patients exposed to aerosolized B. anthracis (anthrax)?

A

Start Cipro w/in 48hrs- treat for 60 days

+

3 dose series of Anthrax vaccine

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30
Q

What is usually transmitted by the infected saliva of a bat, raccoon or skunk?

A

Rabies (caused by rhabdovirus)

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31
Q

Which infectious disease?

  • Virus travels in nerves to the brain, multiplies in brain, then travels along efferent nerves to salivary glands
  • Forms cytoplasmic inclusion bodies – site of viral transcription & replication
A

Rabies

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32
Q

What infectious disease causes percussion myoedema (mounding of the muscle at the percussion site)?

A

Rabies

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33
Q

What are the two types of CNS presentations of Rabies? What do both forms progress to?

A

•“furious” – encephalitic

•“dumb” – paralytic

*both forms progress to coma, ANS dysfunction, death

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34
Q

“Furious” (encephalitic) or “dumb” (paralytic) form of rabies?

  • MC
  • paranoia, terror
  • Hydrophobia
  • unquenchable thirst
  • oversalivating
  • Death by cardiac arrest
A

Furious (Encephalitic) rabies

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35
Q

“Furious” (encephalitic) or “dumb” (paralytic) form of rabies?

  • gradual coma
  • NO hydrophobia
  • paralysis
  • muscle weakness and loss of sensation
  • death
A

Paralytic rabies

(this is less dramatic and usually longer course than furious rabies)

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36
Q

How do you diagnose rabies? (4)

A
  • test animal if possible
  • PCR of saliva
  • viral culture of saliva
  • Full thickness skin biopsy from posterior region of neck at hairline
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37
Q

How do you prevent rabies? (this is the main tx)

A

Immunize household pets and ppl w/ signifcant animal exposure

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38
Q

What is PEP and PrEP for rabies?

A

PEP= Human rabies immune globulin, Rabies vaccine

PrEP= Human diploid cell vaccine

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39
Q

Which infectious disease?

  • Aedes mosquito
  • Sexual, vertical or blood transmission
  • Sxs: Acute onset fever, maculopapular pruritic rash, nonpurulent conjunctivitis, arthralgias
  • most are asymptomatic
A

Zika

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40
Q

How do you dx Zika virus?

A
  • Viral RNA or IgM
  • real-time RT-PCR of blood or urine for Zika virus RNA
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41
Q

When is it important to test someone for Zika virus even if they are asymptomatic?

A

Test asymptomatic pregnant women for IgM 2-12 weeks after:

  • travel to endemic area OR
  • sex w/ person with confirmed Zika
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42
Q

If you have a pregnant woman with Zika virus, what is the management?

A

Ultrasounds every 3-4wks looking for:

  • Congenital microcephaly
  • Also may see arthrogryposis (club foot) and spontaneous abortions
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43
Q

What are 3 complications of Zika virus?

A
  • Guillain-Barré syndrome
  • Myelitis
  • Meningoencephalitis
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44
Q

What is tx for Zika virus?

A

rest

symptomatic tx

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45
Q

How do you prevent zika virus? (4)

A
  • Mosquito control
  • Avoidance of travel to affected areas when pregnant
  • Abstinence from sexual intercourse or barrier protection
  • No blood donations
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46
Q

Which infectious disease is due to Water reservoir contamination and transmission is never person-to-person

A

Legionella

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47
Q

What are 5 risk factors for Legionella?

(you can be exposed without getting sick)

A
  • smoking
  • chronic lung disease
  • older age
  • transplant recipient
  • biologic therapy
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48
Q

Which infectious disease has a cough that is initially mild and slightly productive and then develops blood-streaked sputum (rarely gross hemoptysis)

A

Legionella

49
Q

What is seen on CXR for legionella?

A

•Patchy unilobar infiltrate that progresses to consolidation

•Pleural effusions common

50
Q

The following lab findings are seen in which infectious disease?

  • Renal/hepatic dysfunction
  • Thrombocytopenia
  • Leukocytosis
  • Hypophosphatemia
  • Hyponatremia
  • Hematuria/proteinuria
  • Elevated serum ferritin
A

Legionella

51
Q

what form of legionella is more mild and has the following:

•Fever, malaise, chills, fatigue, h/a

•No respiratory complaints

•Self-limited

A

Pontiac fever

52
Q

How do you diagnose Legionella?

A

sputum culture

Urinary antigen tests

53
Q

How do you tx legionella?

A

Azithromycin or clarithromycin or levofloxacin x10-14days

No isolation needed

54
Q

How do you tx pontiac fever?

A

symptomatic tx

55
Q

Which infectious disease blocks release of acetylcholine at the neuromuscular junction

A

Botulism

56
Q

How do alduts typically get botulism? infants?

A

Adults= canned, smoked or vacuum-packed food

Infants= honey

57
Q

Clinical presentation of which infectious disease?

  • Descending weakness
  • NO fever
  • Visual- blurred vision, diplopia, nystagmus, ptosis
  • urinary retention & constipation
  • _***Paralysis may progress to respiratory failure***_
A

Botulism

58
Q

How do you dx botulism?

A

Clinical dx

Toxin in serum, stool, etc

59
Q

How do you tx Botulism?

A
  • Equine serum heptavalent botulism antitoxin w/in 24 hrs
  • intubation
  • IV fluids
60
Q

Which infectious disease has a gray membrane covering tonsils & pharynx?

A

Diphtheria

61
Q

The exotoxin from Coryneybacterium diphtheriae causes what 2 things?

A

Myocarditis

neuropathy

62
Q

What are the 2 complications of Diphtheria?

A

•Myocarditis complication – arrhythmias, heart block, heart failure

•Neuropathy complication – diplopia, slurred speech, dysphagia

63
Q

How do you dx diphtheria?

A

Clinical dx

confirmed w/ culture and + toxin assay

64
Q

How do you treat diphtheria? (4)

A
  • Diphtheria equine antitoxin
  • Penicillin or erythromycin x14 days
  • Remove membrane by laryngoscopy
  • ISOLATION until neg culture x3
65
Q

What is PEP for diphtheria?

A

Booster + penicillin or erythromycin

66
Q

Pathology of which infectious disease?

  • Retrograde axonal transport within motor neuron
  • Blocks neurotransmission, inactivating inhibitory neurotransmission causing:
    • increased muscle tone
    • painful spasms
    • widespread autonomic instability
A

Tetanus

67
Q

Which infectious disease?

  • Trismus (“lock jaw”)
  • tonic/spastic muscle contraction in 1 EXTREMITY OR BODY REGION
  • intermittent intense spasms
A

Tetanus

68
Q

The following is a later finding of which infectious disease?

  • profuse sweating
  • cardiac arrhythmias
  • labile HTN or hypotension
  • fever
A
  • profuse sweating
  • cardiac arrhythmias
  • labile HTN or hypotension
  • fever
69
Q

How do you dx tetanus?

A

clinical dx in setting of tetanus prone injury and hasn’t had tetanus booster in last 5 yrs

70
Q

How do you tx tetanus? (7 most important)

A
  • ICU
  • Metronidazole
  • Tetanus immune globin
  • Tetanus immunization x3
  • Benzos
  • airway management
  • neuromuscular blocking agents
71
Q

What causes lyme dz?

A

Borrelia Burgdorferi

transmitted by deer tick and blacklegged tick

72
Q

Which disease has a bimodal distribution (5-10 and 35-55)

A

Lyme disease

73
Q

For someone to get lyme disease: ticks need to feed for ___ to ___ hours to transmit infection

A

24-36 hours

74
Q

Presentation of which disease?

  • Erythema migrans (target lesion) 1 week after bite
  • Viral like illness (myalgias, headache, fatigue,etc)
A

Lyme Disease

75
Q

How do you dx early lyme?

A

clinical diagnosis

76
Q

How do you dx late lyme? (intermittent or persistent arthritis, subtle encephalopathy, polyneuropathy)

A

Clinical dx + lab evidence

77
Q

How do you tx Lyme Disease? Alternative tx for pregnant women?

A

Doxycycline x10-14 days

Amoxicillin for pregnant/lactating women

78
Q

What are the complications of Lyme Disease in pregnancy?

A

•spontaneous abortion, still birth, preterm birth

79
Q

What are 3 things that people with chronic lyme complain of?

A
  1. fatigue
  2. Arthralgias
  3. Memory impairment
80
Q

T/F: the following is some of the diagnostic for chronic lyme disease:

  • H/o lyme treatment
  • onset of nonspecific sxs (fatigue, arhtralgias, memory disturbances, etc) w/in 6 months
A

True

81
Q

Criteria that must be met for you to give prophylactic antibioticcs for lyme disease:

  • Tick attached for at least ____ hours
  • Prophylaxis within ____ hours of the time the tick was removed
  • More than 20% of ticks in the area are known to be infected with B burgdorferi
  • No contraindication to the use of doxycycline
A
  • Tick attached for at least 36 hours
  • Prophylaxis within 72 hours of the time the tick was removed
82
Q

What causes rocky mountain spotted fever?

A

Rickettsia rickettsia

(tick borne illness)

83
Q

Which infectious disease:

  • MC men, <10y/o and 40-64y/o
  • Fever, severe h/a, malaiase, myalgias, arthralgias
  • Rash on day 3-5: blanching erythematous rash w/ macules–> petechiae
    • ​rash starts on ankles/wrists–> trunk–> palms/soles
A

Rocky mountain spotted fever

84
Q

Which infectious disease?

•Normal WBC count with immature bands

  • Thrombocytopenia
  • Hyponatremia
  • Elevated LFTs
A

Rocky Mountain Spotted Fever

85
Q

How do you dx Rocky mountain spotted fever?

A

•Serologic testing with IFA (indirect fluorescent antibody) for R. rickettsia antigen

86
Q

How do you tx Rocky Mountain Spotted fever?

A

Doxycycline w/in 5 days of onset

87
Q

Complications of which infectious disease?

  • Renal failure
  • Sepsis
  • Encephalitis
  • Noncardiogenic pulmonary edema
  • ARDS
  • Cardiac arrhythmias
  • Coagulopathy/DIC
  • GI bleeding
  • Skin necrosis
A

Rocky Mountain Spotted Fever

88
Q

Which infectious disease?

  • 90-95% serum positive
  • Transmitted through intimate contact w/ saliva
  • Persists asymptomatically for life, reactivation uncommon
  • Associated w/ B cell lymphomas, etc
A

Epstein Barr Virus (EBV)

89
Q

The following is classic sxs of which disease?

  • tonsillitis/pharyngitis, cervical LAD, fever
  • Nausea, vomiting, anorexia (mild hepatitis in 90%)
  • Splenomegaly (50-60%)
  • Resolves in 1-2wks; fatigue persists x months
A

Infectious mononucleosis caused by EBV

90
Q

Treatment of infective mononucleosis caused by EBV with ______ results in a morbiliform rash

A

Ampicillin

91
Q

What is a good marker of acute infection of infectious mononucleosis (caused by EBV)

A

IgM and IgG antibodies against viral capsid antigen (VCA)

92
Q

Infectious mono caused by EBV:

Early presence of what excludes acute infeciton?

A

IgG antibodies to EBV nuclear antigen (EBNA)

*this indicates latent infection

93
Q

What are the top 3 complications of infectious mononucleosis caused by Epstein Barr Virus?

A
  1. Pneumonia
  2. Hepatitis
  3. Myocarditis
94
Q

What are the 2 main treatments of infectious mononucleosis caused by EBV?

A
  • Supportive care- NO ABX (Amox)
  • Sports restrictions- no contact b/c of splenomegaly
95
Q

What is the MC presentation of Cytomegalovirus?

A

CMV mono

96
Q

The following is caused by what virus?

  • Transmission: sex, close contact (daycare), blood, perinatal
  • usually asymptomatic but sxs in transplant pt
A

Cytomegalovirus

97
Q

T/F: CMV can be vertically transmitted and is associated w/ syndrome of congenital CMV in newborns

A

True

98
Q

How do you dx CMV?

A

Quantitative DNA PCR

99
Q

How do you tx cytomegalovirus

A

strong antivirals (ex: ganciclovir)

100
Q

Which disease?

  • Caused by cat feces or eating poorly cooked contaminated meat
A

Toxoplasmosis

101
Q

Which disease is usually asymptomatic in immunocompetent patients but can have:

  • b/l symmetrical nontender cervical or occipital adenopathy
  • Chorioretinitis – visual loss or floaters
A

Toxoplasmosis

102
Q

Which 4 things can be vertically transmitted? (TORCH)

A

T- Toxoplasmosis

O- Other (Syphilis)

R- Rubella

C- CMV

H- Herpes

103
Q

Which disease can cause encephalitis with multiple necrotizing brain lesions in immunocompromised pts

A

Toxoplasmosis

(this is the most concerning presentation)

104
Q

Toxoplasmosis in pregnancy can cause what 3 things

A
  • Spontaneous abortion
  • still-birth
  • neonatal disease (neurologic & ophthalmic disorders)
105
Q

How do you dx Toxoplasmosis

A

Serology- ELISA

106
Q

Although most pts with Toxoplasmosis don’t need treatment, If someone has severe/prolonged infection, or are immunocompromized/pregnant?

A
  • Pyrimethamine + sulfadiazine OR pyrimethamine + clindamycin + leucovorin
  • Tx minimum of 2-4 weeks
  • Ophthalmology
107
Q

What is prophylactic treatment of Toxoplasmosis?

A

Trimethoprim- sulfamethoxazole

108
Q

Which disease?

  • Pigeon dung
  • transmitted by inhalation
  • usually asymptomatic
    • Immunocomp- progressive lung disease and dissemination
A

Cryptococcosis

109
Q

Presentation of what?

  • Nodules, widespread infiltrates leading to respiratory failure
  • Dissemination:
    • CNS - Meningitis, AMS, CN abnormality
    • Skin – papules, plaques, abscesses, sinus tracts
    • MSK – osteolytic lesions
A

Cryptococcosis - presentation above is seen in immunodeficient patients

110
Q

What 4 things are used to dx Cryptococcosis?

A

•Respiratory secretion or pleural fluid culture

  • LP with CSF analysis
  • MRI
  • Antigen testing
111
Q

How do you treat Cryptococcosis?

A
  • Amphotericin B x 14 days
  • Follow with fluconazole x 8 weeks
112
Q

Which disease?

  • Unilateral vesicular eruption in a dermatomal distribution
  • old people (>50)
A

VZV- Herpes Zoster

113
Q

How do you dx VZV

A

clinical diagnosis

114
Q

When would you treat VZV and what would you tx with?

A

Acyclovir w/in 72 hrs of onset

>72 hrs if still getting new lesions

if immunocompromised

115
Q

How would you tx a pt w/ VZV with mild pain

A

NSAIDs and acetaminophen

116
Q

How would you tx a pt w/ VZV with mod-severe pain

A

Stronger opioid (Oxycodone, morphine)

117
Q

The following are complications of what?

•Postherpetic neuralgia (90d of pain)

  • Ocular complications – uveitis, keratitis
  • Aseptic meningitis
  • Encephalitis

•Herpes zoster oticus (Ramsay Hunt syndrome)- facial palsy w/ vesicles in ear

•Myelitis

A

VZV

118
Q

When do you give the Herpes Zoster Vaccine?

A

50+

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