ID Flashcards
What hematologic laboratory abnormality may be found in patients with infection by the organism Rickettsia ricketsii ?
This infection causes Rocky Mountain spotted fever, a disease which affects the vascular endothelium. Thrombocytopenia is a common lab abnormality found in these patient
what bug causes vomiting and diarrhea within hours of ingestion?
S. aureus can cause severe diarrhea and vomiting within hours of ingestion due to the toxin produced in the body as a consequence of ingesting this food.
what sexually transmitted dz would Intracytoplasmic inclusions be seen on dx testing?
found during diagnostic testing, would confirm the diagnosis of Chlamydia
Fungemia
yeast in the blood
tx of fungemia?
Amphotericin B, Flucytosine or Fluconazole
Cryptococcus Neoformans is found
soil from pigeon poop, pulmonary and CNS/visual symptoms, think immunocompromised
Cryptococcus Neoformans Dx
Crypotcoccal antigen in CSF or serum. India ink stain
Cryptococcus Neoformans tx
Amphotericin B or Fluconazole for 10 weeks
Histoplasmosis
Dimorphic fungus found in soil/bird poop/bat poop in mississippi and ohio
Histoplasmosis symptoms
Fever, cough, mouth ulcers, wt loss, retinal deposits
● Chronic progressive pulmonary and Calcified nodules
Histoplasmosis tx
Tx: Long term itraconazole, Amphotericin B
chest x ray for histoplasmosis will show?
CXR will show miliary infiltrates
Pneumocystis Jiroveci (PCP/PJP) x rays finding
diffuse interstitial infiltrates, “Bat wing pattern
Pneumocystis Jiroveci (PCP/PJP) dx
BAL or induced sputum
tx of Pneumocystis Jiroveci (PCP/PJP
TMP/SMX, steroids if PO2
Pneumocystis Jiroveci (PCP/PJP most common opportunistic infection of ______patients
HIV
Tx for Botulism
Botulinum antitoxin from CDC
rheumatic fever is caused by
Group A Streptococcus (S. pyogenes)
how long after strep hemolytic infection does rheumatic fever show up
2-3week
botulism symtoms Ds
double vision, droopy head, difficulty speaking, dilated pupils and dry mouth
Major Criteria Jones criteria
Polyarthritis, Carditis, Nodules, Chorea, Erythema
Marginatum
Minor Criteria:
Arthralgias, Fever, Leukocytosis, Elevated CRP/ESR,
prolonged PR interval
Risus sardonicus (spasm of the facial muscles causing a “joker smile”) and Opisthotonus (spasm causing body to go into extreme hyperextension)
tentanus
hypersecretion of water & chloride → massive diarrhea →
hypovolemia and metabolic abnormalities
Vibrio cholerae
tx cholerae
Oral rehydration, antibiotics shorten course (Tetracycline, Ampicillin, TMP/SMX, Quinolones)
Corynebacterium diptheriae
Transmitted by respiratory secretions (trachea)
Deadly for infants
complications of Corynebacterium diptheriae
Exotoxin causes myocarditis/neuropathy
Enteric fever (typhoid fever) is caused by
salmonella (pea like diarrhea and will have fever)
systemic symptoms of enteric fever?
splenomegaly, abdominal distension/tenderness, paradoxical bradycardia (low HR even with fever), rash in week 2 (faint pink papular rash on trunk that fades with pressure)
tx of Enteric fever (typhoid fever)
Ceftriaxone or Quinolones for 2 wks
Salmonella Bacteremia differs b/c of prolonged fever and what else
osteomyelitis
Shigella dysenteriae
Sudden onset diarrhea, abdominal cramps, tenesmus (feeling as if you constantly need to evacuate bowels), fever, malaise, headache, loose stools with
blood and mucous
tx Shigella dysenteriae
TMP/SMX (Bactrim)
tx of Diphtheria
Horse serum antitoxin from CDC,Antibiotics: Penicillin or Erythromycin/Azithromycin and vaccine
pseudomembrane or corn flake membrane
Diphtheria
pertussis is caused by
Bordetella pertussis
what stage is the Catarrhal
the first stage: hacking
cough (mostly at night) most infectious stage
Paroxysmal is what stage of pertussis
2nd stage: coughing spasms followed by high-pitched inspirations (whoops, gasping for air)
final third stage of pertussis
Convalescent: happens about 4 wks after the onset of cough; paroxysms improves; lasts another 2-3 wks
jones ( must have two major criteria) use JONES for rheumatic fever what are they?
JONES (major criteria): Joints (polyarthritis), O (imagine “O” is heart shaped for Carditis), Nodules (subcutaneous nodules on extensor surfaces), Erythema
Marginatum, Sydenham chorea (choreiform movements)
minor criteria for jones criteria (PEACE) or you can have one major and two minor to make dx
PEACE: PR, ESR, Arthralgias, CRP, Elevated temperature
LGV (lymphgranuloma venereum)
○ vesicular lesions or ulcers spreading to lymph nodes (inguinal buboes) and anorectal involvement possible
Chlamydia
dx Chlamydia
ELISA/DNA test to confirm (cervical or urethral swab, or urine sample)
tx for Chlamydia
Azithromycin (1gram PO x 1) or Doxycycline course
○ Erythromycin in pregnancy
more painful than Chlamydia
○ milky discharge and dysuria initially then days later have worsening
symptoms with profuse, yellow discharge
Gonorrhea
Conjunctivitis via direct inoculation
○ copious purulent discharge (pus pouring out of eye)
Gonorrhea
Bacteremia
○ skin lesions (small pustules, gun metal gray, hemorrhagic component and septic arthritis
Gonorrhea
dx of gonorrhea
Culture from infected area
● Infant gonococcus: gram stain of discharge (will see gram negative intracellular diplococci)
Name the other Mycobacterium that is not TB?
Mycobacterium avium intracellulare (MAC) ● Affects AIDS patients and immunosuppressed ● Causes lung disease and bone marrow suppression Mycobacterium marinum ● Affects fish handlers ● Causes skin infections Mycobacterium kansii ● lung disease Mycobacterium ulcerans
inhaled droplet to get TB everyone gets primary, how many will become latent?
95%
most common symptoms of TB
cough
Toxoplasmosis in the brain
brain lesions in patients with AIDS (ring enhancing
lesions on CT)
Toxoplasmosis tx
Pyrimethamine
Rickettsia Rickettsii
rocky mountain spotted fever
Borrelia Burgdorferi
lymes
Transmission by the Ixodes Tick
lyme dz
lyme dx
Dx by antibodies (ELISA – 50% are false negative so mostly a clinical diagnosis
lyme tx
Tx: Doxycylcine
Erythema Migrans
first stage of lyme (target lesion)
what MS, CNS and Cardiac complications does lyme dz have?
Musculoskeletal (arthralgias), CNS (bells palsy – can be bilateral), Cardiac (heart
block)
Transmitted by Wood Tick
rocky mountain spotted fever
Rash to wrists and ankles which
spreads to the trunk, hepatosplenomegally, ARDS, increased WBC’s,
thrombocytompenia, hyponatremia, hematuria
rocky mountain spotted fever
tx for rocky mountain fever
Treatment: Doxycycline
Treponema Pallidum
Syphilis
Syphilis test dx
RPR/VDRL confirm with FTA –ABS
Chancre – ulcer to inoculated site with raised edges, round, smooth base, painless, and lymphadenopathy
Syphilis
Gummatous lesions: skin/bones/viscera/cardiovascular/ aorta
syphillis
Neruosyphilis
Tabes Dorsalis - demyelination of dorsal columns→ impaired
proprioception/ loss of vibratory sense
Argyll Robertson Pupil (like prostitutes)
accommodation but don’t react (constrict with accommodation but not light)
tx syphilis
Tx: Benzathine Penicillin G 2.4million units in a single dose – if diagnosed late
give 3 doses 1 week apart
name 3 spirochetes
lyme, rocky mountain and syphillis
worse type of malaria
Falciparum is the worst
Anopheles mosquito
transmits malaria
dx malaria
Dx. by blood smear stains (not easy)
tx of malaria
Tx: chloroquine
HS family 1-8
- herpes 1
- herpes 2
- chicken poxes
4 Eb Barr - CMV
6&7 Roseola - Karposi
herpes cause what brain disorder
encephalitis
Varicella Zoster complications
Can involve lungs (PNA or superinfection PNA) or brain (encephalitis)
Herpes Ophthalmicus
Trigeminal nerve – may see Hutchinson’s sign:
herpetic lesion to tip of nose
Post-herpetic neuralgia
can’t be dx until months after zoster occurred months before, tx with chronic pain drugs
Pharyngitis, Lymphadenopathy, fever
Epstein Barr Virus
Epstein Barr Virus associated with
Burkitt’s lymphoma and nasopharyngeal carcinoma
difference between small poxes and chicken poxes
small poxes are all the same stage
Sudden high fevers then days later rash starts as the child is getting better
roseola (spread from truck to head)
Rash starts on Face and spreads to trunk and limbs
rubella
Congenital CMV
Primary CMV in pregnancy: 10% of babies will have low birth wt, microcephally, seizures, rash, hepatosplenomegally, jaundice,
pneumonia, retinal damage
symptoms of mono
Posterior lymphadenopathy, rash
what happens if you give amoxicillin and pt has mono
macularpapular/petechial rash
Dx
atypical lymphocytes on smear, hemolytic anemia,
thrombocytopenia, increased LFT’s, false + RPR/VDRL b/c of heterophilic antibodies
can you give aspirin for mono?
no Reyes symptoms
mono dx can give you a false positive for RPR- which is for
syphillis
CMV in AIDS below 50 CD count
Retinitis in AIDS pt’s with CD4
tx for CMV
Ganciclovir, Foscarnet
“Sixth disease” “Exanthem subitum” are other names for
roseola
why is rubella horrible
BAD in Pregnancy! – Congenital Rubella syndrome
a. Microcephaly
b. PDA (patent ductus arteriosum)
c. Cataracts
slapped cheeks 5th dz is caused by
parvovirus
most common flu
A
bigger mutation is shift or drift
shift
flu symptoms
FEVER, muscle aches, sore throat,
What signs or symptoms would you expect to find at the bite site of a patient infected with Rabies?
These symptoms have classically been described with a rabies infection and occur at the site of inoculation.
Which of the following organisms would appear red or pink upon application of a Gram stain?
Neisseria gonorrheae
Salmonellosis incubation peroid
8-48 hours after eating bad food
Which of the following is the most common vaginal infection?
BV
test for Gon and Chal
Nucleic acid amplification
pasteurella multocida organism is transfered in
dog bites
if the CD4 count is below 200 then HIV becomes AIDS or if
you have a AID related illness
if CD4 count is below 500
samonella or cdiff, herpes, zoster, TB
if CD4 count is below 200
PJP, treat with TMP-SMX
if CD4 count is below 100
toxo, tx with TMP-SMX and histo, tx with itraconazole
if CD4 count is below 50
CMV (retinitis =) and MAC (mycobacterium avium complex) tx with azthriomycin
A 10-year-old girl is brought to the office by her mother for human papilloma virus vaccination. The mother is concerned about what she reads on the internet linking causation between vaccines and medical conditions. The vaccine that her daughter is to receive contains an adjuvant, and the mother asks you to explain the purpose of this ingredient. Which of the following best describes the mechanism of adjuvant function?
It boosts the body’s immune response to a given antigen dose
Which of the following is a recommended therapy in the treatment of Hepatitis C?
Ribavirin & alpha-interferon
patient’s cellulitis and abscess are suspected to be caused by MRSA, which of the following is the best oral antibiotic choice?
bactrim
This is the chief pathogen of interest in dog bites.
Pasteurella multocida
Zidovudine is a medicine that treats HIV what are the SE
peripheral neuropathy and pancreatitis
What is the therapy of choice for a patient diagnosed with Coccidioidomycosis?
The first line drug of choice for Valley Fever is fluconazole.