ID pt 2 Flashcards
COVID dx
PCR/ NAAT
COVID tx
paxlovid
what are 4 types of polio?
- abortive
- nonparalytic
- paralytic
- post-poliomyelitis syndrome
s/s of abortive polio
nonspecific illness
- fever
- HA
- constipation
- sore throat
- n/v/d
s/s of nonparalytic polio
- nonspecific illness
- meningeal irritation and muscle spasms
- no paralysis
s/s of paralytic polio
- flaccid asymmtric paralysis affecting proximal muscles of lower extremities
- sensory loss is rare
- spinal- impacts spinal nerves
- bulbar- impacts CNs and can lead to respiratory paralysis
s/s of post-polio syndrome
- progressive muscle paresis and atrophy
- fasiculations and fibrillation
- restless leg syndrome
dx of poliomyelitis
PCR of washings, stools, CSF
tx of polio
suportive
polio vaccination schedule for children
4 doses
- 2 mo, 4 mo, 6-18 mo, 4-6 yrs old
polio adult vaccination scheudle
3 doses
- 1st dose, 2nd dose 1-2 mo later, 3rd dose 6-12 mo after 2nd
s/s of active TB
- fever
- night sweats
- weight loss
- hemoptysis
- productive cough
a primary TB infection can progress to what 3 stages?
- active/ primary progression
- latent TB
- termination
list a few s/s of disseminated TB/ miliary TB
- meningitis
- Addison’s disease
- Pott’s disease
- erythema nodosum
- hepatitis
CXR of primary or latent TB would show what finding?
Ghon focus/ complex
CXR or CT findings in active TB
cavitary lesions in lung apices
active TB tx
PIER
- pyrazinamide (PZA)
- isoniazid (INH)
- ethambutol (EMB)
- rifampin (RIF)
latent TB tx
INH or RIF
s/s of atypical tuberculosis
- skin and soft tissue findings: abscesses, arthritis
- lymphadenitis: MAC in children
- eyes: keratitis and retinal lesions
dx of atypical mycobacterial disease
culture of sputum, blood or urine
tx of MAC
azithromycin or clarithromycin
and
ethambutol
and
rifampin or rifabutin
syphilis cause
treponema pallidum
s/s of primary early/ infectious syphilis
painless chancre
non-tender regional lymphadenopathy
s/s of secondary early/ infectious syphilis
systemic symptoms- generalized lymphadenopathy
rash- non-pruritic, includes palms and soles
condyloma lata
lesions distant from site of inoculation
*most infectious stage
this stage of syphilis is highly infectious and lasts up to 1 yrear after initial infection. Infectious lesions may recur.
early latent stage
this stage of syphilis is noninfectious except transplacentally and occurs more than 1 yr after initial infection.
late latent
what are 2 types of late syphilis?
tertiary or neurosyphilis
major findings of tertiary late syphilis
gumma- infiltrative tumor with rapid onset
cardiac syphilis- aortitis and other heart findings
neurosyphilis findings
- meningitis, dementia, HL, psychosis
- tabes dorsalis–> loss of virbration and proprioception
- general paresis
- argyll robertson pupil
argyll robertson pupil
constricts with _______ but not to _____
accommodation
light
tx of syphilis
IM PCN G
neurosyphilis- IV PCN
lyme disease stage 1 (early localized) s/s
erythema migrans
viral like illness- myalgias, fatigue, HA
lyme disease stage 2 (early disseminated) s/s
aseptic meningitis
bilateral CN7 palsy
cardiac issues- AV block
lyme disease stage 3 (late persistent) s/s
MSK- joint pain/ swelling
neuro findings
AMS, mood changes, ect
diagnostic standards for lyme disease
1- exposure to endemic area
2- documented erythema migrans within 30 days OR one late manifestation
3- lab confirmation
lab confirmation of lyme disease
ELISA and western blot
elevated ESR and liver enzymes
tx of lyme disease
doxycycline
4 requirements for lyme disease prophylaxis
1- attached for 36 hrs or more
2- started within 72 hrs of removal
3- more than 20% of ticks in area infected
4- no doxy contradictions
relapsing fever s/s
abrupt onset fever, chills, tachy, severe HA, ect for 3-10 days, then relapse occurs 1-2 wks later
dx of relapsing fever
blood smear with wright or giemsa stains
PCR
tx of relapsing fever
IV PCN G or ceftriaxone
how long must the tick be attached for lyme disease to be transmitted?
24-36 hrs
how long does the tick need to be attached for rocky mountain spotted fever to be transmitted?
6-10 hrs
rocky mountain spotted fever s/s
abrupt onset fever and HA
rash- small blanching pink macules that spread into petechiae-> involvement of palms and soles
chills, malaise, hard palate lesions, conjunctival injection
dx of rocky mountain spotted fever
skin biopsy with immunohistology or PCR
tx of rocky mountain spotted fever
doxycycline
pregnancy- chloramphenicol
ehrlichisosis s/s
high fever
rigors
pleomorphic rash- many stages at once
tx of ehrlichiosis
doxycycline
pregnancy- rifampin
amebiasis s/s
dysentery- bloody diarrhea, colitis, abd pain
necrotizing colitis- hemorrhage, perforation
extraintestinal- liver abscess, hepatomegaly,** RUQ pain,** weight loss, high fever
amebiasis tx
metronidazole or tinidazole + luminal agent
- luminal agents: diloxanide, idoquinol, paromomycin
this protozoan disease is common in healthy pts who recently went swimming in lakes or heated swimming pools
naegleria fowleri
naegleria fowleri s/s
primary amebic meningoencephalitis (PAM)
- fever, neck stiffness, HA
- photophobia, 3, 4, and 6 CN palsies, AMS
- coma and death
tx of naegleria fowleri
amphotericin B
rifampin
miltegosine
azithromycin
steroids
probably won’t be on exam via Wil
this protozoan disease is common in pts with history of camping and lake water exposure
giardiasis
s/s of giardiasis
explosive, foul smelling nonbloody diarrhea
- stools are frothy/ greasy
- weight loss, malabsorption, vitamin deficiencies
dx of giardiasis
stool wet mount
stool antigen assays
tx of giardiasis
metronidazole or tinidazole
pregnancy- paromomycin
treat contacts
s/s of malaria
HA and fatigue
irregular paroxysms of fever and diaphoresis (sweats)
dx of malaria
giemsa stained blood smears
rapid antigen tests
tx of malaria
non-falciparum- chloroquine
* vivax or ovale- add primaquine
falciparum- ACTs: artemether-lumefantrin
severe-** IV artesunate**
toxoplasmosis s/s in healthy pts
asymptomatic
mono-like illness
* non-tender bilateral lymphadenopathy
* sore throat
toxoplasmosis s/s in immunocompromised
encephalitis
pneumonitis
chorioretinitis
necrotizing brain lesions
congenital infection of toxoplasmosis s/s
- chorioretinitis
- hydrocephalus
- intracranial calficiations
blueberry muffin rash
seizures
spontaneous abortion
this is the late manifestation of toxoplasmosis that may present years after congenital infection
retinochoroiditis
* eye pain
* photophobia
* glaucoma or blindness
what does CT scan show for toxoplasmosis
ring-enhancing lesions
toxoplasmosis tx
immunocompetent- self limited
immunocompromised/ congenital/ pregnancy >14 wks- pyrimethamine + sulfadiazine w/ folinic acid
pregnancy <14 wks- spiramycin
trichomoniasis s/s
copious, purulent malodorous frothy discharge
hemorrhages in vaginal walls
strawberry cervix
dysparenunia
males- minimal discharge
trichomoniasis dx
wet mount
NAAT
tx of trichomoniasis
metronidazole
2nd line- tinidazole
s/s of hookworm/ round worm
rash- pruritic at site of penetration, serpiginous tracts
lungs- cough, wheezing, low fever
GI- epigastric pain, diarrhea
nutritional def- iron deficiency (anemia) and protein loss (hypoalbuminemia, edema, ascites)
dx of hookworm/ roundworm
stool microscopy
CBC- eosinophilia, anemia, hypoalbuminemia
iron def
tx of hookworm/ roundworm
albendazole
iron supplements and vitamins
this type of tapeworm infection may lead to neurocysticercosis
pork- taenia solium
this type of tapeworm may lead to megoblastic anemia due to B12 def
fish- diphyllobothrium latum
this type of tapeworm may lead to pruritis ani, anorexia, weight loss and crampy abd pain and seizures
dwarf- hymenolepis nana
dx of non-invasive tapeworms
proglottids in stool
tx of non-invasive tapeworms
praziquantel
dwarf requires more than 1 dose
s/s of invasive taenia solium
neurocysticerosis
* increased ICP
* seizures
* AMS
* psych disease
extraneural cysticerosis- muscle and subcutaneous invovlement
dx of invasive taenia solium
imaging- CT and MRI
* parenchymal cysts and calcifications
lab
* CSF
* serology
tx cysticercosis
viable or degenerating parenchymal cysts- albendazole + corticosteroids
if more than 2- add praziquantel
echinococcosis s/s
abd pain, biliary obstruction, cholangitis, portal HTN, cirrhosis
CP and bronchial obstruction
tx of echinococcosis
albendazole
pinworm s/s
nocturnal pruritis ani
insomnia and restlessness
enuresis
severe- abd pain and n/v
tx of pinworms
albendazole, mebendazole or pyrantel
pregnancy- only treat if severe w/ pyrantel
