ID: Block 1 Flashcards by brandon lovin

Define Iatrogenic Dz

Define Virulence

Latros: greek for physician
Genic: derived from

Degree/availability of pathogenic organism to cause Dz

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Define Virulence factors

Normal flora is AKA ?

Diagnosis is AKA ?

Features that enhance ability of microbe to cause Dz

Microbiome

Equivocal- vague, ambiguous

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For an infection to be Dx as a nosocomial infection, it occurs within ? hrs of admission

Define Active Immunity

Define Passive Immunity

48hrs

Immunity from exposure and response to an Ag

Immunity from pre-formed Ab from another individual

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Re-immunization of PTs is needed due to loss of ?

Nosocomial infections are usually due to ? 6 microbes

Partial immunity

Staph A
Pseudomonas
E coli
Klebsiella
Serratia Marc.
Proteus mirabillis

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Define Non-Sterile Immunity

Define Concomitant Infection

Define Empirical Tx

Traces of organism present, no presence of Dz

Two or more infections a the same time (Staph A + influenza, Ghon + Chlamyd)

Tx based off of experience

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Define Sensitivity

Define Specificity

What type of microbe is a virus

Proportion of true positives

Proportion/accuracy of true negatives

Obligate intracellular parasite

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Define Left Shift

O&P requires ? samples ? hrs apart

O&P doesn’t detect ? microbe

Increased number of immature neutrophils (band forms) suggesting acute inflammation

3 samples, 24hrs

Cryptosporidium

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Purpose of ELISA test

Purpose of IFA test

Ab/Ag is linked to an enzyme to detect matches

IDs specific Abs/Ags
Abs tested w/ serum

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Purpose of Immunohistochemistry

Purpose of Western Blot Tests

ID’s cellular/tissue Ags

Detection specific protein in a mixture (HIV)

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What is the four standard criteria for FOUO

Fever > 38.3/100.9*
Three days of hospitalization w/out Dx
Three OutPT visits
Illness of 3wks of duration

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What are the categories of FOUO

Nosocomial- hospitalized w/ fever 38.3*
Not at admission
Initial cultures will be negative

Neutropenic- neutrophil -500 and unknown Dx after 3 days

HIV- fever for 4wks OutPT or,
3 days InPT w/ 2 days of culture incubation in a known HIV Dx PT

Organ transplant- specific and unique DDx

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If PT from long term care facility and is mostly bed ridden presents w/ FOUO, what 3 areas need to be examined for broken skin?

What are the 5 classifications of causes of FOUO

Occipital region
Sacral region
Heels

Infection
Neoplasm- MC lymphoma and leukemia
Autoimmune
Miscellaneous
Undiagnosed- factitious d/o

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What lab tests are done when working up FOUO

All PTs w/ FOUO have ? image ordered?

Blood cultures prior to ABX w/ acute/convalescent titers
CBC
CRP/ESR

CXR

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What are 4 types of biopsys that may be done when assessing FOUO

How are FOUO Tx

What Tx is considered controversial and may be avoided

LP
Lymph nodes
Skin
Bone marrow aspirate

Empiric ABX

Steroids

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Anthrax

Bacillus Anthracis

Infected hides, meat
Inhaled spores that can remain viable in soil x 40yrs

No person to person transmission

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S/Sxs of different forms of Antrhax

Cutaneous- Malignant Pustule w/ outer ring of non-tender Brawny-edema followed by black eschar

Inhaled- malaise, lymphadenopathy; two phases: Initial- w/ VRI, rhinorrhea and pharyngitis
Later- dyspnea, hemoptysis

Intestinal- GE Sxs, hematemesis, sepsis, massive ascites

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What labs are ordered for suspected anthrax?

How is anthrax Tx

CXR- widened mediastinum
Rapid ELISA test
Nasal swab- identifies outbreak
Gram stain

Cipro + Linezolid or Clinda IV

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What meds are used for post-anthrax exposure Tx

What is the name of the vaccine used for prevention?

Cipro or Doxy
In conjunction w/ vaccine

AVIP vaccine

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Aerosolized anthrax treatment use is recommended for ? days and the recommended vaccine has ? doses in the series

Cutaneous anthrax from hides is Tx for ? days w/ ? med

60 days regardless of vaccination status
3 doses

7-10 days w/ Cipro

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What are the two meds approved for post-anthrax exposure that is used if other therapies are not available

Obiltoxaximab

Biothrax

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Plague

Yersinia Pestis

Still present in NM, AZ and CO, gives temporary immunity after infection

3 types:
Bubonic- rats
Primary septicemic
Pneumonic- aerosolized

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How do the different forms of plague present

What will be seen on lab results in these PTs?

Pneumonic: F/C, HA, toxic
Bubonic: buboes primarily in inguinal region, legs MC flea bitten
Septicemia- no buboes, involves CNS and lungs

WBC +20K w/ inc bands
Inc fibrin split products
Inc liver function test
Gram neg w/ safety pin staining

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How is Plague Tx

What is used for post-exposure prophylaxis?

What is the name of the virus that causes small pox?

Streptomycin or Gentamycin

Doxy or Cipro
No vaccine

Variola

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What are the two types of smallpox

How is it transmitted

Major: hemorrhagic (MC in pregnancy), malignant (flat type)
Minor

Person to person by respiratory droplet

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What is the sequence of smallpox seen on the skin How long are these PTs contagious

``` Synchronus: Maculopapular Vesicles/oral ulcers Tense embedded pustules Crusts/scabs Scars w/ sebaceous gland destruction ``` Until last scab crusts and falls off

What is the difference in S/Sxs of Hemorrhagic and Malignant smallpox

Hemorrhagic: dusky erythema, petechia, hemorrhage Malignant: confluence, flat/velvet vesicles w/ reddish grain coloration No formation of pustules or scabs

How are suspected smallpox samples shipped to ? type of lab How is it Tx How often is re-vaccination needed

Vacutainer w/ tape top in water proof container to BL-4, ID under electron microscope Tecovirimat Cidofovir- covers Tx of Monkey Pox 10-15yrs

How are PTs post-exposure Tx for smallpox What is the natural reservoir of Cow Pox

Vaccine if exposure within 4 days and no VaccHx CDC guidance if Vaccinia Immune Globulin can be given within 3 days but best if w/in 24hrs Wild rodents

Hemorrhagic smallpox is uniformly fatal by day ? Why would lamb skin condoms be recommended and not recommended?

6 of rash + pregnancy prevention - STD/HIV prevention

HSV can cause rare but serious illnesses in ? two PT populations? How does the initial outbreak present?

Pregnant ImmSupp GALT Gingivitis Anorexia Lymphdenopathy Temp Sxs gone in 2wks, shedding x 3wks

Once HSV goes dormant, where does it hide? What type and PT have worse outbreaks?

Dorsal ganglia Females w/ Type 2

In words, what does HSV look like What form of HSV has an immediate referral to an ophthalmologist

Clustered vesicles on erythematous base that pustulate and ulcerate Auto inoculated keratoconjunctiviits

How is HSV Dx How is it confirmed

Clinically Viral culture Tzanck smear- multi nucleated giant cells PCR Punch biopsy

How is HSV Rx managed Which med is most effective for decreasing HSV 2 transmission between couples What are the topical forms that can be used?

FAV-clovir Valacyclovir Penciclovir Acyclocir- no real efficacy Doconasol

How are perinatal transmissions avoided? What needs to be avoided

Highest risk during primary infection near delivery time, consider c-section Scalp electrodes

What drug is recommended for HSV pos mothers that are not already on suppressive therapy When working up a suspected STD, what tests are included in an STD panel?

Acyclovir at 36wks Hepatitis HIV Syphilis G/C

Genital warts are AKA ? What are the two most common forms What are the two most serious

Condyloma Acuminata HPV HPV 6 or 11 HPV 16 and 18

How are Condyloma cases Tx surgically or medicinally

Cyrotherapy Carbon-dioxide or electro laser for internal lesions on female Podofilox Imiquimod Trichloroacetic

What medication is used for Condyloma prevention What is the dosing scheudle?

Gardasil 9 for M/F 9-45y/o, prevents cervical cancer in seronegative PTs 3 doses at Dx, 2mon and 6mon

# Define JORRP What is the triad

Juvenile Onset Recurrent Respiratory Papillomatosis- vertical transmission of HSV 6 or 11 during pregnancy 1st born Vaginal delivery Mother under 20y/o

What is AKA the Clap? What type of microbe is it

Gonorrhea Gram neg, intracellular aerobic diplococcus

What are the S/Sxs of Gonorrhea What is the name of the disseminated form and what are the Sxs

M>F, a lot of F will be ASx M: discharge, dysuria, epididymis tenderness F: CMT, discharge/bleeding, dysparunia, dysuria Both: fever, mucous membrane tissue infection ``` Arthritis Dermatitis Syndrome- Septic arthritis Tenosynovitis Endocarditis Meningitis Polyarthrlagia in knees, elbows, distal joints ```

What is the Dx standard for gonorrhea How is it Tx

Isolation through culture Transcription mediated acid test- UA test replaced bore punch CDC recommendation: culture and susceptibility testing Ceftriaxone and Azith Alt: Azithromycin Tx failure: Ceftriax and Azith PLUS test of cure in 1wk

What is the fear/risk behind a Gonorrhea infection Chlamydia is AKA ? This is the MC ?

Female develops PID (acute salpingitis) and inc risk for ectopic pregnancy Non-gonococcal urethritis Reported IDz in US

Chlamydia has the highest prevalence in ? PT population and results in ? if UnTx How is it Dx? How is it Tx

<25y/o PID TMA Azith Alt: Doxy

What microbe causes Lymphogranuloma Venereum What are the stages?

C trachomatis, part of chlamydia family Primary: painless papule Secondary: unilateral painful lymph nodes (buboes) Tertiary: genitoanorectal syndrome; more common in female

What is the classic finding of lymphogranuloma venereum that leads to men being Dx? Why are most women PTs not Dx? What PE finding is characteristic for this Dz

Groove sign Lack of inguinal lymphadenopathy Proctocolitis Fever Rectal pain/tenesmus

What lab finding is considered diagnostic for lymphogranuloma venereum How is it Tx

Complement fixation 1:64 Needle aspirate/I&D for relief Doxy for Tx

How is NGU Urethritis Tx How is GU Urethritis Tx

Azithromycin Doxy Ceftriaxone and Azithromycin

How does syphilis present What is this AKA ?

Painless chancre 3wks w/ regional non-tender lymphadenopathy Great Imitator/Imposter

What are the 2* Sxs of syphilis When is syphilis considered non-infectious and what is it AKA

Rash Malaise, HA, Fever, myalgia 2-10wks after primary lesion Tertiary- gummatous syphili

What is the test for any suspected syphilis Time range for Dx of early or late congenital syphilis

RPR test Early: first 2yrs of life Late: after 2yrs old

What parts of the body are commonly affected by gummatous syphilis What cardio finding may e seen

Liver Skeleton Testes Cardiovascular syphilis- 10yrs after primary affecting ascending aorta

When does neurosyphilis present? How can it present

Any stage Argyle robertson- accommodate but not react CN8 deafness Dec DTRs

Congenital syphilis can affect fetus if mother acquires Dz ? far prior CDC recommends that all pregnant women delivering still born at __wks or more of gestation are tested for syphilis

4yrs 20wks

How would an older PT w/ congenital syphilis present

``` Prominant frontal bone Depressed nasal area Pronounced mandible Hutchinson incisors- arched teeth Mullberry molars- too many cusps ```

What are 4 conditions that could cause a false-pos on a RPR test What test is ordered to follw and evaluate the efficacy of care

``` Lupus Viral/bacterial illness Recent Imms Pregnancy Marijuana use ``` VDRL Titers Don't use confirmatory tests

How is syphilis Tx How is neurosyphilis Tx How is congenital syphilis under 30 days Tx?

Benzathine PCN G- DOC Alt: Doxy/Tetra/Ceftriaxone Aqueous crystaline Pen G or Procaine Pen G w/ Probenicid Aqueous Pen G

What is the physiological response seen post-syphilis Tx Bacterial vaginosis is common in ? PT population but rare in ? one

Fever/chills called Jarisch-Herxheimer reaction Common: adult Rare: pre-puberty

Female PT w/ green d/c has ? infection Female PT w/ cottage chees d/c has ? Female PT w/ true BV has ? d/c

Trichomoniasis Candidiasis Gray w/ fish

What are the 4 criteria used for Dx BV What is the most reliable sign/indicator of Dx?

``` 3 of: White d/c Vag pH higher than 4.5 Fishy odor Clue cell w/ KOH ``` >20% are clue cells

What additional Dx test can be done for BV on top of pH, and KOH How is BV Tx

Amine test (whiff test) Clindamycin Tinidazole Metronidzaole

Chancroids are rare but common coinfect w/ ? STDs What microbe causes it?

HSV2 Syphillis Haemophilus Ducreyi

How does Chancroid present What appearance does it have on gram stain What is the definitive Dx method

Malaise HA Anorexia Painful genital ulcer w/ regional lymphandenitis (bubo) School of fish Culture

3 Dzs present w/ Bubos in DDx How is Chancroid Tx

LGB Chancroid Plague Ceftriaxone Azithromycin

How does Granuloma Inguinale present What happens w/ this Dz the longer it goes un-Tx

Small beefy red bump that's painless but bleeds easily Erosion and destruction of genital tissue Spread to inguinal folds and depigmentation

How is Granuloma Inguinale (Donovanosis) Dx How is this Tx

Punch biopsy to locate donovan bodies (speckled raw egg) ``` Azithromycin Add Gentamicin (aminoglycoside) if ulcers don't respond in first few days) ```

Pediculosis encompasses ? 3 infections Bed bugs belong to ? species

Head, Body, Pubic louse Climex

Where are P Capitus infections seen on PE? Where are P Corpis infections seen on PE? Where are P Pubis infections seen on PE?

Postauricular/occipital area Distance of nits from scalp= duration of infestation Anywhere but nits not in hair Perineum/pubic area Eyebrow/lashes

How are pediculosis infections Tx w/ topical meds? When would a pediculosis infection be suspicious of sexual abuse?

Permethrin 1% If resistant, Ivermectin 0.5% Malathion 0.5% (8-12hr wait time) Child w/ pubis infection

Unique fun fact about scabies? Who is it usually seen in?

First human dz proven to be caused by pathogen Younger than 15y/o w/ sexual activity

What is the most likely presenting Sx of Scabies? How do scabies present on PE that is also pathognomoic for a Dx

Crescendo nocturnal pruritis The Burrow: Serpiginous (s-shaped) tract in web spaces or flexors of wrist If PT is ImmSupp: Bullous lesion

How are scabies Dx How are they Tx

Skin scrapings Permethrin cream 5% Ivermectin

Bed bugs can be a carrier for Hepatitis ? and ? reactions Although Tx is not required, what meds may be used?

B Anaphylactoid reactions Cream w/ CCS PO antihistamine

Lect 3 video

59:25 ROS shotgun questions | Re-listen

What are the fecal/oral forms of hepatitis What are the serum forms?

Hep A, E Hep B C D G

What is a unique presenting of an acute hepatitis Dz What may be seen in an advanced case?

Aversion to smoking Coca cola urine Juandice Tender hepatomegaly

Viral hepatitis can progress into what 2 Dzs

Fulminant hepatic failure- failure w/ hepatic encephalopathy Chronic Hep- CA, cirrhosis

What types of hepatitis can progress to Fulminant or Chronic? How is viral hepatitis D

Ful: Hep E in Asia or Hep C if co-infected w/ A Chronic: B and C, not A or E UA: for bilirubin Liver enzyme panel Serum bilirubin: elevated= infectious hepatitis Higher than 30mg= severe

What type of renal reaction can indicate fulminant hepatitis What meds can induce hepatitis

Dec renal function -azoles Acetaminophen

Hep A is more common where? All military get vaccines for Hep ? and ?

Endemic in underdeveloped Western US A and B

Hep A can infect through ? food especially if PT is ? or ? What two modes of transmission can occur but are uncommon?

Shellfish Pregnant ImmComp Blood exposure Sexual contact

What Hep A Sx severity increases w/ age How is Hep A Dx

Jaundice IgM anti-HAV, present 5-10 days before Sxs, gone in 6mon

When are Hep A vaccines given What is the Hep A and B combo vaccine and when is it given?

0, 6-12mon Twinrix- 3 dose series at 0, 1mon, 6mon

Hep E transmission is same as A, F/o in undeveloped countries, but is typically benign except for in ? How can this infection be dx?

Pregnant PTs, 25% mortality rate IgM/IgG anti HEV HEV RNA in serum/stool

What infection is 100x more infectious than HIV

Hep B from blood/sexual or perinatal exposure

What is the link between age and severity for Hep B What is the first lab result seen that would indicate infection?

Younger PT- ASx chronic Older PT- acute infection w/ recovery HBsAg- first serum marker IgM anti-HBc- first Ab seen

What lab result would be seen later in a Hep B PT and indicates immunity What lab results indicate a PT is a carrier or has chronic Hep B

Anti-HBs (HBsAb) HBsAg and or Anti-HBc

What can be given for acute Hep B Tx if within 7 days of exposure What is the goal of Tx of chronic Hep B

HBIG and Hep B vaccine Inhibit viral replication w/ Tenofovir, Entecavir or PEG-IFN 2nd/3rd line: Adefovir, Lamivudine

What lab result is used to monitor and plan Tx for chronic Hep B What is the MC and less common transmission methods of Hep C

HBV DNA MC: IVD abuse Less w/ sexual transmission

What risk factors may increase the progression time for Hep C induced cirrhosis How is Hep C Dx

Inc alcohol intake +40y/o when infected Hep B/HIV infected Male EIA for anti-HCV Confirm w/ RT-PCR for HCV RNA Repeat 1mon if neg

Since there are 6 genotypes of Hep C, which ones have better prognosis Depending on the genotype, what meds may be used for Tx

2 and 3 4 is rare and hard to Tx Pegylated Interferon + Ribavirin

Hep D is rare like E, but can infect 5% of ? carriers How is it transmitted?

HBsAg IVD abuse Sexual contact

What's the best way to prevent Hep D infection other than common sense? HIV infection is highest occurrence in ? PT populations

Hep B vaccine Hep C Young gay/bi men

Where does HIV replicate in the body? The initial presenting Sxs of HIV after infection are similar to ? infection

CD4 surface receptor Mono and Sxs self resolve

HIV Abs are detectable ? long after exposure What is the name of the phase when the virus is in the body and slowly replicating/building in numbers

3mon Eclipse

What test is used to screen and confirm HIV infections What may be seen on a CBC in a PT w/ a HIV infection

ELISA- screen Western Blot- confirm Thrombocytopenia Anemia Neutropenia

What lab result is the predictor of HIV progression What is the newer screening test that may not be avail everywhere?

Absolute CD4 lymphocyte count p24 Ag test

What are the top 3 S/Sx of a primary HIV infection

Fever Fatigue Pharyngitis