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IPAP > ID: Block 1 > Flashcards

ID: Block 1 Flashcards

1
Q

Define Iatrogenic Dz

Define Virulence

A

Latros: greek for physician
Genic: derived from

Degree/availability of pathogenic organism to cause Dz

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2
Q

Define Virulence factors

Normal flora is AKA ?

Diagnosis is AKA ?

A

Features that enhance ability of microbe to cause Dz

Microbiome

Equivocal- vague, ambiguous

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3
Q

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

Define Active Immunity

Define Passive Immunity

A

48hrs

Immunity from exposure and response to an Ag

Immunity from pre-formed Ab from another individual

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4
Q

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

Nosocomial infections are usually due to ? 6 microbes

A

Partial immunity

Staph A
Pseudomonas
E coli
Klebsiella
Serratia Marc.
Proteus mirabillis
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5
Q

Define Non-Sterile Immunity

Define Concomitant Infection

Define Empirical Tx

A

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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6
Q

Define Sensitivity

Define Specificity

What type of microbe is a virus

A

Proportion of true positives

Proportion/accuracy of true negatives

Obligate intracellular parasite

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7
Q

Define Left Shift

O&P requires ? samples ? hrs apart

O&P doesn’t detect ? microbe

A

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

3 samples, 24hrs

Cryptosporidium

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8
Q

Purpose of ELISA test

Purpose of IFA test

A

Ab/Ag is linked to an enzyme to detect matches

IDs specific Abs/Ags
Abs tested w/ serum

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9
Q

Purpose of Immunohistochemistry

Purpose of Western Blot Tests

A

ID’s cellular/tissue Ags

Detection specific protein in a mixture (HIV)

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10
Q

What is the four standard criteria for FOUO

A

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

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11
Q

What are the categories of FOUO

A

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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12
Q

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

A

Occipital region
Sacral region
Heels

Infection
Neoplasm- MC lymphoma and leukemia
Autoimmune
Miscellaneous
Undiagnosed- factitious d/o
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13
Q

What lab tests are done when working up FOUO

All PTs w/ FOUO have ? image ordered?

A

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

CXR

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14
Q

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

A

LP
Lymph nodes
Skin
Bone marrow aspirate

Empiric ABX

Steroids

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15
Q

Anthrax

A

Bacillus Anthracis

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

No person to person transmission

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16
Q

S/Sxs of different forms of Antrhax

A

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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17
Q

What labs are ordered for suspected anthrax?

How is anthrax Tx

A

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

Cipro + Linezolid or Clinda IV

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18
Q

What meds are used for post-anthrax exposure Tx

What is the name of the vaccine used for prevention?

A

Cipro or Doxy
In conjunction w/ vaccine

AVIP vaccine

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19
Q

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

A

60 days regardless of vaccination status
3 doses

7-10 days w/ Cipro

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20
Q

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

A

Obiltoxaximab

Biothrax

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21
Q

Plague

A

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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22
Q

How do the different forms of plague present

What will be seen on lab results in these PTs?

A

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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23
Q

How is Plague Tx

What is used for post-exposure prophylaxis?

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

A

Streptomycin or Gentamycin

Doxy or Cipro
No vaccine

Variola

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24
Q

What are the two types of smallpox

How is it transmitted

A

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

Person to person by respiratory droplet

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25
Q

What is the sequence of smallpox seen on the skin

How long are these PTs contagious

A 
Synchronus: 
Maculopapular
Vesicles/oral ulcers
Tense embedded pustules
Crusts/scabs
Scars w/ sebaceous gland destruction

Until last scab crusts and falls off

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26
Q

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

A

Hemorrhagic: dusky erythema, petechia, hemorrhage

Malignant: confluence, flat/velvet vesicles w/ reddish grain coloration
No formation of pustules or scabs

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27
Q

How are suspected smallpox samples shipped to ? type of lab

How is it Tx

How often is re-vaccination needed

A

Vacutainer w/ tape top in water proof container to BL-4, ID under electron microscope

Tecovirimat
Cidofovir- covers Tx of Monkey Pox

10-15yrs

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28
Q

How are PTs post-exposure Tx for smallpox

What is the natural reservoir of Cow Pox

A

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

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29
Q

Hemorrhagic smallpox is uniformly fatal by day ?

Why would lamb skin condoms be recommended and not recommended?

A

6 of rash

+ pregnancy prevention
- STD/HIV prevention

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30
Q

HSV can cause rare but serious illnesses in ? two PT populations?

How does the initial outbreak present?

A

Pregnant ImmSupp

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

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31
Q

Once HSV goes dormant, where does it hide?

What type and PT have worse outbreaks?

A

Dorsal ganglia

Females w/ Type 2

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32
Q

In words, what does HSV look like

What form of HSV has an immediate referral to an ophthalmologist

A

Clustered vesicles on erythematous base that pustulate and ulcerate

Auto inoculated keratoconjunctiviits

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33
Q

How is HSV Dx

How is it confirmed

A

Clinically

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

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34
Q

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?

A

FAV-clovir

Valacyclovir

Penciclovir
Acyclocir- no real efficacy
Doconasol

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35
Q

How are perinatal transmissions avoided?

What needs to be avoided

A

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

Scalp electrodes

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36
Q

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?

A

Acyclovir at 36wks

Hepatitis
HIV
Syphilis
G/C

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37
Q

Genital warts are AKA ?

What are the two most common forms

What are the two most serious

A

Condyloma Acuminata
HPV

HPV 6 or 11

HPV 16 and 18

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38
Q

How are Condyloma cases Tx surgically or medicinally

A

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

Podofilox
Imiquimod
Trichloroacetic

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39
Q

What medication is used for Condyloma prevention

What is the dosing scheudle?

A

Gardasil 9 for M/F 9-45y/o, prevents cervical cancer in seronegative PTs

3 doses at Dx, 2mon and 6mon

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40
Q

Define JORRP

What is the triad

A

Juvenile Onset Recurrent Respiratory Papillomatosis- vertical transmission of HSV 6 or 11 during pregnancy

1st born
Vaginal delivery
Mother under 20y/o

41
Q

What is AKA the Clap?

What type of microbe is it

A

Gonorrhea

Gram neg, intracellular aerobic diplococcus

42
Q

What are the S/Sxs of Gonorrhea

What is the name of the disseminated form and what are the Sxs

A

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
43
Q

What is the Dx standard for gonorrhea

How is it Tx

A

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

44
Q

What is the fear/risk behind a Gonorrhea infection

Chlamydia is AKA ?

This is the MC ?

A

Female develops PID (acute salpingitis) and inc risk for ectopic pregnancy

Non-gonococcal urethritis

Reported IDz in US

45
Q

Chlamydia has the highest prevalence in ? PT population and results in ? if UnTx

How is it Dx?

How is it Tx

A

<25y/o
PID

TMA

Azith
Alt: Doxy

46
Q

What microbe causes Lymphogranuloma Venereum

What are the stages?

A

C trachomatis, part of chlamydia family

Primary: painless papule
Secondary: unilateral painful lymph nodes (buboes)
Tertiary: genitoanorectal syndrome; more common in female

47
Q

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

A

Groove sign

Lack of inguinal lymphadenopathy

Proctocolitis
Fever
Rectal pain/tenesmus

48
Q

What lab finding is considered diagnostic for lymphogranuloma venereum

How is it Tx

A

Complement fixation 1:64

Needle aspirate/I&D for relief
Doxy for Tx

49
Q

How is NGU Urethritis Tx

How is GU Urethritis Tx

A

Azithromycin
Doxy

Ceftriaxone and
Azithromycin

50
Q

How does syphilis present

What is this AKA ?

A

Painless chancre 3wks w/ regional non-tender lymphadenopathy

Great Imitator/Imposter

51
Q

What are the 2* Sxs of syphilis

When is syphilis considered non-infectious and what is it AKA

A

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

Tertiary- gummatous syphili

52
Q

What is the test for any suspected syphilis

Time range for Dx of early or late congenital syphilis

A

RPR test

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

53
Q

What parts of the body are commonly affected by gummatous syphilis

What cardio finding may e seen

A

Liver
Skeleton
Testes

Cardiovascular syphilis- 10yrs after primary affecting ascending aorta

54
Q

When does neurosyphilis present?

How can it present

A

Any stage

Argyle robertson- accommodate but not react
CN8 deafness
Dec DTRs

55
Q

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

A

4yrs

20wks

56
Q

How would an older PT w/ congenital syphilis present

A 
Prominant frontal bone
Depressed nasal area
Pronounced mandible
Hutchinson incisors- arched teeth
Mullberry molars- too many cusps
57
Q

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

A 
Lupus
Viral/bacterial illness
Recent Imms
Pregnancy
Marijuana use

VDRL Titers
Don’t use confirmatory tests

58
Q

How is syphilis Tx

How is neurosyphilis Tx

How is congenital syphilis under 30 days Tx?

A

Benzathine PCN G- DOC
Alt: Doxy/Tetra/Ceftriaxone

Aqueous crystaline Pen G or
Procaine Pen G w/ Probenicid

Aqueous Pen G

59
Q

What is the physiological response seen post-syphilis Tx

Bacterial vaginosis is common in ? PT population but rare in ? one

A

Fever/chills called Jarisch-Herxheimer reaction

Common: adult
Rare: pre-puberty

60
Q

Female PT w/ green d/c has ? infection

Female PT w/ cottage chees d/c has ?

Female PT w/ true BV has ? d/c

A

Trichomoniasis

Candidiasis

Gray w/ fish

61
Q

What are the 4 criteria used for Dx BV

What is the most reliable sign/indicator of Dx?

A 
3 of:
White d/c
Vag pH higher than 4.5
Fishy odor 
Clue cell w/ KOH

> 20% are clue cells

62
Q

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

How is BV Tx

A

Amine test (whiff test)

Clindamycin
Tinidazole
Metronidzaole

63
Q

Chancroids are rare but common coinfect w/ ? STDs

What microbe causes it?

A

HSV2
Syphillis

Haemophilus Ducreyi

64
Q

How does Chancroid present

What appearance does it have on gram stain

What is the definitive Dx method

A

Malaise HA Anorexia
Painful genital ulcer w/ regional lymphandenitis (bubo)

School of fish

Culture

65
Q

3 Dzs present w/ Bubos in DDx

How is Chancroid Tx

A

LGB
Chancroid
Plague

Ceftriaxone
Azithromycin

66
Q

How does Granuloma Inguinale present

What happens w/ this Dz the longer it goes un-Tx

A

Small beefy red bump that’s painless but bleeds easily

Erosion and destruction of genital tissue
Spread to inguinal folds and depigmentation

67
Q

How is Granuloma Inguinale (Donovanosis) Dx

How is this Tx

A

Punch biopsy to locate donovan bodies (speckled raw egg)

Azithromycin 
Add Gentamicin (aminoglycoside) if ulcers don't respond in first few days)
68
Q

Pediculosis encompasses ? 3 infections

Bed bugs belong to ? species

A

Head, Body, Pubic louse

Climex

69
Q

Where are P Capitus infections seen on PE?

Where are P Corpis infections seen on PE?

Where are P Pubis infections seen on PE?

A

Postauricular/occipital area
Distance of nits from scalp= duration of infestation

Anywhere but nits not in hair

Perineum/pubic area
Eyebrow/lashes

70
Q

How are pediculosis infections Tx w/ topical meds?

When would a pediculosis infection be suspicious of sexual abuse?

A

Permethrin 1%
If resistant, Ivermectin 0.5%
Malathion 0.5% (8-12hr wait time)

Child w/ pubis infection

71
Q

Unique fun fact about scabies?

Who is it usually seen in?

A

First human dz proven to be caused by pathogen

Younger than 15y/o w/ sexual activity

72
Q

What is the most likely presenting Sx of Scabies?

How do scabies present on PE that is also pathognomoic for a Dx

A

Crescendo nocturnal pruritis

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

73
Q

How are scabies Dx

How are they Tx

A

Skin scrapings

Permethrin cream 5%
Ivermectin

74
Q

Bed bugs can be a carrier for Hepatitis ? and ? reactions

Although Tx is not required, what meds may be used?

A

B
Anaphylactoid reactions

Cream w/ CCS
PO antihistamine

75
Q

Lect 3 video

A

59:25 ROS shotgun questions

Re-listen

76
Q

What are the fecal/oral forms of hepatitis

What are the serum forms?

A

Hep A, E

Hep B C D G

77
Q

What is a unique presenting of an acute hepatitis Dz

What may be seen in an advanced case?

A

Aversion to smoking

Coca cola urine
Juandice
Tender hepatomegaly

78
Q

Viral hepatitis can progress into what 2 Dzs

A

Fulminant hepatic failure- failure w/ hepatic encephalopathy

Chronic Hep- CA, cirrhosis

79
Q

What types of hepatitis can progress to Fulminant or Chronic?

How is viral hepatitis D

A

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

80
Q

What type of renal reaction can indicate fulminant hepatitis

What meds can induce hepatitis

A

Dec renal function

-azoles
Acetaminophen

81
Q

Hep A is more common where?

All military get vaccines for Hep ? and ?

A

Endemic in underdeveloped
Western US

A and B

82
Q

Hep A can infect through ? food especially if PT is ? or ?

What two modes of transmission can occur but are uncommon?

A

Shellfish
Pregnant
ImmComp

Blood exposure
Sexual contact

83
Q

What Hep A Sx severity increases w/ age

How is Hep A Dx

A

Jaundice

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

84
Q

When are Hep A vaccines given

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

A

0, 6-12mon

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

85
Q

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?

A

Pregnant PTs, 25% mortality rate

IgM/IgG anti HEV
HEV RNA in serum/stool

86
Q

What infection is 100x more infectious than HIV

A

Hep B from blood/sexual or perinatal exposure

87
Q

What is the link between age and severity for Hep B

What is the first lab result seen that would indicate infection?

A

Younger PT- ASx chronic
Older PT- acute infection w/ recovery

HBsAg- first serum marker
IgM anti-HBc- first Ab seen

88
Q

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

A

Anti-HBs (HBsAb)

HBsAg and or Anti-HBc

89
Q

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

A

HBIG and Hep B vaccine

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

90
Q

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

A

HBV DNA

MC: IVD abuse
Less w/ sexual transmission

91
Q

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

How is Hep C Dx

A

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

92
Q

Since there are 6 genotypes of Hep C, which ones have better prognosis

Depending on the genotype, what meds may be used for Tx

A

2 and 3
4 is rare and hard to Tx

Pegylated Interferon + Ribavirin

93
Q

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

How is it transmitted?

A

HBsAg

IVD abuse
Sexual contact

94
Q

What’s the best way to prevent Hep D infection other than common sense?

HIV infection is highest occurrence in ? PT populations

A

Hep B vaccine

Hep C
Young gay/bi men

95
Q

Where does HIV replicate in the body?

The initial presenting Sxs of HIV after infection are similar to ? infection

A

CD4 surface receptor

Mono and Sxs self resolve

96
Q

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

A

3mon

Eclipse

97
Q

What test is used to screen and confirm HIV infections

What may be seen on a CBC in a PT w/ a HIV infection

A

ELISA- screen
Western Blot- confirm

Thrombocytopenia
Anemia
Neutropenia

98
Q

What lab result is the predictor of HIV progression

What is the newer screening test that may not be avail everywhere?

A

Absolute CD4 lymphocyte count

p24 Ag test

99
Q

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

A

Fever Fatigue Pharyngitis

IPAP (212 decks)

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