ID Uworld Flashcards
what causes bacillary angiomatosis
bartonella gram neg bacillus
tx for bacillary angiomatosis in HIV patient
oral erythromycin
most common secondary bacterial pneumonia
Staph, strep, H flu
blood streaked sputum with multiple midfield lung cavities on CXR
acute necrotizing pneumonia with secondary penumatoceles
what pathogen causes post viral URI necrotizing pulmonary bronchopneumonia
Staphylococcus aureus
severe watery diarrhea in AIDs patient with CD4
cryptosporidium
watery diarrhea in AIDs patient with high fever and CD4
MAC
small volume frequent diarrha
with hematochezia and abdominal pain in AIDs patient with CD4
CMV
what antibiotics can you use for UTI in pregnancy
nitrofurantoin
amoxicillin
augmentin
cephaexin
differene of preseptal and orbital cellulitis
preseptal there is no paint with eye movement or vision impairment
+HbsAg
+HbeAg
+antiHbcAg IgG
chronic hep B
Tx chronic hep B
entecavir and tenofovir
rubella
german measles
congenital rubella
sensorineural hearing loss
intellectual disability
cardiac anoamlies
cataracts, glaucoma (leukocoria)
congenital CMV
unilateral deafness, blindness from chorioretinitis
HSM purpura and jaundice
congenital toxo
chorioretinits, hydrocephalus, intracranial calcifications
empiric Tx for meningitis in immunocompromised
vanco, ampicillin cefepime
Tx meninigitis 2-50 years old
vanco and third generation cephalosporin
14 day old infant with spasms of whole body
poor suckling
no antenatal care
swollen and erythematous umbilical cord
tetanus
tx cat bites
augmentin
pathogen in cat bites
pasteurella multocida
complication meningococcemia
waterhouse friederichsens syndrome
what is waterhouse friederichsen syndrome
sudden vasomotor collapse and skin rash due to adrenal hemorrhage
most common ventilator associated pneumonias
Pseudomonas, E coli, klebsiella, MRSA and strep
pregnant lady with erythema migrans and Hx tick bite
amoxicillin
common extrapulmonary findings in coccidiomycosis
erythema multiforme and erythema nodosum
hep C in pregnancy, next step
hep A and B vaccinations
disseminated histo
lymphadenopathy, pancytopenia and HSM
how to Dx Histo
urinary antigen testing and careful fungal stains
Tx mucormycosis by rhizopus
debridement and IV amphotericin B
ludwig angina
rapidly progressive bilateral cellulitis of submandicular and sublingual spaces
arise in molars
pathogen for submanidbular cellulitis
strep and anaerobes
next step for HIV stick in healthcare setting
blood testing and triple therapy
Bone marrow transplant in AML patient now has abdominal pain, diarrhea and cry cough
CXR shows bilateral diffuse patchy infiltrates
cytomegalovirus
CMV infection in post bone marrow transplant patients
upper and lower GI ulcers bone marrow suppression arthralgias myalgias esophagitis
rash starting on trunk and spreads to whole body including palms and soles
syphilis
initial testing for syphilis
RPR and VDRL
Tx syphilis
IM benzathine penicillin
jarisch herxheimer reaction
acute febrile illness with HA and myalgias after IM penicillin for syphillis
immunocompromixed patient with dense consolidation on CXR
CT shows halo signs around pulmonary nodules
aspergillosis
aspergillosis pulmonary. cXR finding and CT finding
cavitary lesion on CXR
CT- pulm nodules with halo sign or lesions with air crescent
marked eyelid swelling in newborn with produse purulent discharge
gonococcal conjunctivitis
Tx for gonococcal conjunctivitis
IN or IM ceftriaxone or cefotaxime
when does chlamydial conjunctivitis occur in newborn
5-14 days
Signs chlamydial conjunctivits
welling, chemosis,
watery or bloody or mucopurulent eye discharge
Tx chlamydial conjunctivitis
Oral erythromycin
why is topical eye ointment erythromycin given
to prevent gonococcal
has no activity on chlamydial
progression of bordetella pertussis in kids
1-2 weeks mild cough and rhinitis 2-6 weeks coughing with inspiratory whoop vomiting after coughing spells apnea and cyanosis in infants weeks-months: resolve gradually
Tx bordetella pertussis
azithromycin, erythromycin, clarithromycin
labs in bordetella pertussis
marked lymphocytosis
Tx for PID
inpatient cefotetan and doxy
clinda or gentamicin IV
criteria for Dx PID
fever leukocytosis inc ESR purulent cervical discharge adenexal tenderness, cervical motion tenderness lower abdominal tenderness
complications untreated PID
tubo ovarian abscesses, abscess rupture, pelvic peritonitis, sepsis
when to Tx someone with PId inpatient?
when high fever, failure to respond to antibiotics, nausea and vomiting, pregnancy and those at risk for noncompliance
Dx CMV diarrhea in AIDs patient
colonoscopy
findings on colonoscopy for CMV in AIDs
esosinophilic, intranuclear and basophilic intracytoplasmic inclusions
Tx for disseminated histoplasmosis
Itraconazole
What are the HACEK organisms
H aphrophilus Aggregatibacter actinomycetemcomintans Cardiobacterium hominis E corrodens Kingella kingae
when do you see Eikenella corrodens
poor dentition and periodontal infection
colonic neoplasia and endocarditis
likely pathogen causeing IE
strep gallolyticus
S bovis biotype I
endocarditis caused by enterococci is usually spread how
UTI
unilateral acute lymphadenitis in child
staph or strep pyogenes
bartonella henselase
cat scratch
bilateral acute lymphadenitis
adenovirus or EBV
patient with CF and recurrent sinopulmonary infections
most common pathogen
staph aureus
what antibiotic is prioritized in CF patient with Hx recurrent hospitalizations
IV vanc for MRSA
congenital syphilis
intermittent fever
osteitis
osteochondritis
mucocutaneous lesions, lymphadenopathy, hepatomegaly and persistent rhinitis
congenital rubella syndrome
microcephaly, microphthalmia and meningoencephalitis
sensorinueral deafness, cardiac anomalies, congenital glaucoma and cataracts
congenital herpes simplex
enecephalitis, chorioretinits, disseminated disease
congenital toxo
chorioretinitis, hydrocephalus and intracranial calcifications
large painful lymphadenopathy in inguinal area
chlamydia trachomatis
frothy green discharge
trich vaginalis
worsening croup, next step
racemic epinephrine before intubation
pteterm infant neonatal sepsis pathogen
E coli > GBS
Tx neonatal sepsis
ampicillin and gentamicin
prophylaxis for MAC in AIDs
CD4
clinical features blastomycosis
lung: acute or chronic pneumonia
skin: wartlike lesions with violaceous hue and skin ulcers
bones: osteomyelitis
GU: prostatitis and epididymo-orchitis
CNS can have meningitis or abscesses
Tx blasto
ampho B
tularemia
acute unilateral cervical lymphadenopathy with fever chills, HA and mailaise
zoonosis- after contact with rabbits, hamsters or blocc sucking arthropods
Tx for H flu type B meningitis
dexamethasone
on CT see a cyst with invaginated sclex
neurocysticcercosis
when do you give meningitis booster
age 16-21
what are the live attenuated vaccines
MMR
varicella
yellow fever
intranasal influenza
clinical presentatoin of rash in german measles (rubella)
spreads head down rapidly
maculopapular blanching
arthritis
rash in measles
higher fever with head to toe rash that spreads gradually
no arthritis
rocky mountain spotted fever rash
over wrists and ankles involving palms and oles
spreads centrally
what helps with measles
Vit A
T cell cytopenia and thrombocytopenia
herpes viral esophagitis
herpetic lesions wit round ovoid ulcers
have concurrent oral HSC
CMV esophagitis
deep linear ulcers
distal esophagus
which pills cause pill esophagitis
K Cl
tetracyclines
bisphosphonates
NSAIDs
Echinococcus granulosus
hyatid cyst causer
from close contact wiht dogs and from tapeworm
CT liver shows what for hyatdid cysts
eggshell calcification
Tx of hyatid cyst
surgical resection with albendazole
risk of aspirating hyatid cyst
anaphylactic shock
Febrile neutropenia
medical EM
start empitic abitibiotic with pseudomonas coverage like pip taz, cefepime or meropenem
what causes scarlet fever
GAS that produce erythrogenic exotoxins
rash of scarlet fever
sand paper like
punctate or finely papular
Tx scarlet fever
Penicillin V
Dx amebic liver abscess
trophozoites in stool
serology
liver imaging
Tx for amebic liver abscess
metonidazole
if aspirate amebicliver abscess
usually sterile
atypical lymphocytes
large basophilic cells with vacuolated appearance
CMV
Triad disseminated gonorrhea
tenosynovitis
dermatitis
migratory asymmetric polyarthalgia without purulent arthritis
Tx disseminated gonorrhea
IV ceftriaxone for 1-2 weeks
then PO cefixime when clinically imporved
Tx azithro or doxy for chlamydia
Dx disseminated gonorrhea
2 sets blood cultures
synovial fluid
urethral cervical cultures
recurrent disseminated gonorrhea
check terminal complement activity
Prevent toxo in HIV
TMP SMX
inflammation of superficial dermaitis, raised well demarcated red rash
erysipelas- cellulitis
Group A beta hemolytic strep (pyogenes)
Tx for PCP pnuemonia
TMP SMX IV for acutely ill
can do pentamidine Iv
atovaquone oral
TMP SMX and dapsone
clinda and primaquine
presentation trichenellosis
intestinal is within 1 week ingestion: ASx or abdominal pain, n/v/d muscle stage (up to 4 weeks): myositis, fevere, subungal splinter hemorrhages, periorbital edema, eosinophilia
areas of trichenella
Mexico, China, Thailand, Central Europe and argentina
what type of food has trichenella
undercooked or raw meat. usually pork
presentation dengue
fever, HA, retro orbital pain, rash and myalgia and arthralgias
typhoid fever
fever in first week then abdominal pain and salmon colored rash in 2nd week
HSM and abdominal complications like bleeding in 3rd week
rash in rubella
german measles
very fast spread of rash head to toe
also will ahve forscheimer spots with is patchy erythema on soft palate
rash in measles
more severe disease
rash is head to toe but very gradual and darker
and have high fever
Tx enterobiu vermicularis
pinworm
albendazole or pyrantel pamoate
Tx all household contacts
ivermectin used for
strongyloidiasis
presentaiton stronglyoides
urticaria, abdominal pain and respiratory problems
can have river blindness (ocular lesions)
Tx trichmoniasis
metro for patient and partner
Tx for cerebral toxo
sulfadiazine and pyrimethamine
Tx actinomycosis
penicillin
risk factors actinomycosis
dental caries, extractions
gingivitis
DM
malnutrition
presentation actinomycosis
chronic slowly progressive non tender indurated mass
extends through tissue planes and makes fistulas and sinus tracts
mandible is most common spot
yellow granular puss in infected tissue of mandible
actinomycosis
sulfur granules make color and consistency
Dx actinomycosis
gram stain showing Gram + branching bacilli
prosthetic joint infection within 3 months or surgery
staph aureus
gram - rods
prosthetic joint infection after 3 months since surgery
staph epidermidis
propionibacterium
enterococci
bacterial vaginosis
thin off white discharge with fishy odor
gardnerella
pH>4.5
clue cells
Tx bacterial vaginosis
metro or clinda
chlamydial cervicitis
mucopurulent discharge
erythematous friable cervix
Tx chlamydial cervicitis
azithro
thing green grey discharge, malorodours
strawberry cervix
trichomonas
Dx chlamydial cervicitis
nuclein acid amplicficaiton testing
Tx impetigo
topical mupirocin
Tx extensive impetigo
oral antibiotics like cephalexin and clindamycin
common causes of AIDs diarrhea
cryptosporidium, MAC, microsporidia, giardia and isospora belli
HIV patient with profuse non bloody diarrhea, next step
stool sample to check for ova and parasites
diarrhea from CMV
bloody
how to Dx pertussis
PCR
mumps
parotitis, otchitis
congenial syphilis
cutaneous lesions on palsm and soles HSM jaundice anemia rhinorrhea
what to do for child non vaccinated exposued to chicken pox
administer vaccine
Pertussis post exposure prophlyaxis
azithromycin for all close contacts
what causes herpangina
coxsackie A
herpetic gingivostomatitis
herpes simplex 1
clusters of small vesicles on the anterior oropharynx
what to give infant born to mom with active Hep B
Hep B Ig and vaccine
common pathogen for spinal pyogenic osteomyelitis
staph aureus
best image for spinal osteomyelitis
MRI
what causes acute rheumatic fever
strep pyogenes
syndenham chorea
acute rheumatic fever by strep pyogenes
which diarrheal illnesses last longer than 2 weeks
cryptosporidium cystoisopora microsporidia cyclospora giardia
diarrhea from entamoeba histolytica
abdominal pain and bloody
cavitary inflammatory upper lung lesion
reactivation TB
man from SE asia has lesion on left forearm that is hypopigmented and no pinprick sensation
do a skin Bx for leprosy
acid fast bacilli
post influenza pneumonia pathogen
staph aureus
Tx for cryptococcal meningoencephalitis
amphotericin plus flucytosine
then fluconazole PO
what is grisefulvin used for
dermatophytosis and onychomycosis
chemoproph for chloroquine resistant malaria
mefloquine
what areas have chloroquine Resistant P falciparum
sub saharan africa
souther and southeast asia
areas without P falciparum malaria
south america
mexico
korean peninsula
what to use for chemoproph malaria without P falciparum
primaquine
common cause nail pncture osteomyeltiis in adults
pseudmonase
rubeola
measles
koplik spots
measles
Tx measles
vit A and supportive care
how to Dx measles
PCR
acute and convalescent serology for anti measles IgM and IgG
acute HIV
mono like syndrome with generalized macular rash and GI symptoms
crystal induced nephopathy is a side effect of what HIV Rx
indinavir a protease inhibitor
side effect didanosine
pancreatitis
side effect abacavir
related HS syndrome
which HIV med causes lactic acidosis
NRTIs
which HIV meds cause steven johnsons syndrome
NNRTIs
nevirapine side effect
liver failure
bit by dog w/o rabies vaccination but dog seems healthy
confine dog for 10 days and observe
no post exposure prophylaxis
most common pneumonia in HIV patient
strep pneumo
liver shows smooth round big cyst with daughter cysts in it
Echinococcus- tapeworm
usually from sheep
Hyatid cyst
HIV patient with 6 mm PPD induration
Isoniazid and pyridoxine for 9 months
when are live vaccines CI in HIV patients
CD4
drug used for aspiration pneumonia
clinda
nocardia gram stain
gram + rod branching
partially acid fast
aerobic
lcinical features nocardia
systemic Sx
pneumonia like TB
CNS abscess
cutaneous
Tx nocardia
TMP SMX
keys for legionella pneumonia
recent travel on cruise or hotel
how does legionella p spread
water
signs legionella
high fever bradycardia for high fever neuro Sx of confusion diarrhea does not respond to beta lactam or aminoglycoside
labs in legionella
hyponatremia
hepatic dysfunction
hematuria and proteinura
hwo to Dx legionella
urinary Ag
give what with isoniazid
pyridoxine to prevent neuropathy
pregnant woman + syphilis.
allergic to penicillin
Tx?
first do skin testing to confirm tru allergy
penicillin desensitization
CSF analysis in herpes encephalitis
inc WBC (lymphocytes
normal glucose
increased protein
Tx herpes encephalitis
IV acyclovir
findings in CSF for viral meningitis
WBC 100-1000
glucose 40-70
protein
CSF in TB meningitis
WBC 5-1000
250 protein
what viruses cause meningitis
non polio enteroviruses
echo and coxsackie
most common pathogen for acute bacterial parotitis
staph aureus
most common pathogen causing croup
parainfluenza
Tx for bacterial vaginosis
metronidazole
clue cells
bacterial vaginosis
best screening for HIV
p24 Ag and HIV Ab
causes of impetigo
staph aureus
GAS
s pyogenes
complications of impetigo
post strep glomerulonephritis
step to confirm IE
bacterial blood cultures
Tx nocardia
TMP SMX
Tx to prevent HIV transmission in pregnany
triple therapy
widened prevertebral space in little kid drooling in resp distress
retropharyngeal abscess
cutaneous larva migrans
hookworm
sandboxes and beaches
severely pruritic elevated serpinginous reddish brown lesions on the skin
vaccines for post splenectomy
Meningo, H flu and PCV13 in 2 weeks
Tx candidal esophagitis
oral fluconazole
patient with PID from gonorrhea. should test for
syphilis. Tx for chlamydia
what are the strep viridans group
mitis, oralis, mutans and sobrinus and milleri and saguinis
patient confirmed with syphilis, do what other screening?
HIV with ELISA
patients with mono are at risk for what complication
autoimmune hemolytic anemia
how to confirm autoimmune hemolytic anemia from mono
IgM col agglutinin Ab “anti-i Ab”
coombs +
HIv patient with fevers, HA and signs of ICP (papilledema)
cryptococcal meningitis
most predisposing factor for acute bacterial sinusitis
Viral URI
bacillary angiomatosis
bartonella
risk of Bc bacillary angiomatosis
bleeding
Tx pinwrom
mebendazole
Tx for human bite
augmentin
Tx for dog bite
augmentin
best testing for HIV in infant under 18 mo old
PCR because passage of maternal Ab will confound Ab test
CSF meningitis
inc WB
inc protein
dec glucose
can have peteichiae and purpura
fever, fatigue, pharyngitis, polymorphous rash after taking amoxicillin or amplicillin
mono
most common cause meningitis in 18 month old
N meningitis
pneumonia vaccines
immunocompromised or special population receive PPSV23 once
then PCV13 followed by PPSV23 at age 65
rash in mycoplasma pneumonia
erythema multiforme
IV drug use, pulmonary symptoms and cavitary lesions in lung on CT
septic emboli from IE
common pathogen of septic emboli from IE
Staph aureus
lesions usually in lung periphery
Tx for healthy young male except he has syphliis and is allergic to penicillin
oral doxy
Tx to person with tertiary syphilis allergic to penicillin
ceftriaxone
what can cause subcutneous empysema
severe coughing paroxysms
pneumothorax
ruptured esophagus
order CXR to rule out pneumo
which patienets are at higher risk IE
drug IV users
those with MVP and regurg
septic arthritis pathogens in
staph
GBS
gram - bacilli
septic arthritis if child > 3 mo
staph
GAS
strep pneumo
first step after determining septic arthritis
arthrocentesis
doxycycline is contraindicated in
pregnant women and children
lymes Tx for 7 year old
amoxicillin or cefuroxamine
pathogens of cellulitis
beta hemolytic strep and staph aureus
Tx for cellulitis with systemic Sx of fever, rigors, chills, fatigue, confusion
nafcillin or cefazolin
Disseminated MAC infection
fever, cough,a bdominal pain, diarrhea, night sweats, weight loss
splenomegaly
elevated alk phos
CD4
first line Tx for disseminated MAC
azithromycin or clarithromycin
trypanosomiasis
East africa
acute febrile illness with chancre, myocarditis and progression to CNS involvement
babesiosis
endemic area with tick bite
ixodes tick
NE USu
causes hemolysis of RBC
Sx babesiosis
jaundice, hemoglobinuria, renal failure and death
babesiosis usually in what paptients
without a spleen or immunocomprmoised
how to Dx babesiosis
giemsa stained thick and thin blood smear
Tx babesiosis
quinine-clindamycin
atovaquone-azithromycin
erlichiosis
spotless rocky mountian spotted fever
fever, maliase, HA, n/v
leukopenia and thrombocytopenia
Q fever
zoonosis coxiella burnetti cattle, goat sheep meat processing or vets flu like syndrome and hepatitis or pneumonia like
condyloma acuminata
anogenital warts from HPV
leukocytoclastic vasculitis
can be from meds, infections, malignancy or inflammation
non blanching 1-3 mm violaceous papules in cluster or plaques
NF2
acoustic neuromas
most common cause pneumonia in nursing homes
strep pneumo
msot common cause CAP in adults
S pneumo
which UTI pathogen causes increased urine pH
proteus mirabilis from urease that increases ammonia to decrease free H+
struvite stones
proteus
urease producing bacteria
klebsiella, morganella morganii, pseudomonas, providencia, staph, ureaplasma urealyticum
Tx amebic abscess
metro
Tx for strep viridans IE native valve
aqueous penicillin G
pathogen of acute epididymitis in older patient
E coli because likely from UTI
pathoegn of acute epididiymitis in someone sexuallya ctive
C tach
N gonorrhea
when do you use amantadine and rimantadine
Influenza A
when to Tx influenza
within 48 hours onset with oseltamivir
signs Sx TSS
fever, diffus emyalgias, vomiting, profuse diarrhea hypotension, diffuse macular erythroderma like sunburn
management TSS
supportive
broad spect anti staph antibiotics
progressive multifocal leukoencephalopathy
no mass effect
in cortical white matter
gradual onset
hemiparesis and distrubances in speech vision and gait
confirm PML encephalopathy
MRI- non enhancing lesions with no mass effects
when to screen for hep C
high risk needle stick exposure
IV drug use
received transfusions before 1992!!!
no Sx chalmydia but test is +
nuclemic amplification test gonorrhea is negative
Tx?
single dose azithromycin or 7 days doxy
labs in erlichiosis
leukopenia and thrombocytopenia
elevated LFTs and LDH
Dx erlichiosis
intracytoplasmic morulae in monocytes
PCR for E chaggeensis and E ewingii
where is erlichiosis
southwastern and south central US
is there a rash in erlichiosis
not usually
erythromycin kills what pneumonia-pathogens
legionella and mycoplasma
where is chikungunya
centra and south america, tropical africa
south asia
mosquito carryin chikungunya and dengue
aedes
clinical manifestations chikungunya
3-7 day incubation
high fevers, polyarthralgias
HA, myalgias, conjunctivitis, maculopapular rash
lymphopenia, thrombocytopenia, inc LFTs
Tx chikungunya
supportive
reactive arthritis
1-4 weeks most GI or GU infection with asymmetric oligoarthritis, conjunctivitis, and oral lesions
Tx legionella pneumo
fluoros or macrolides
when to Tx PPD >10 mm induration
recent immigrants IV drug users healthcare workers lab personnel in mycobacterium lab DM, immunsuppressed with corticosteroids, ESRD children
penicillin to precent S penumonia until age 5
most common cause osteomyelitis in adults and children
staph aureus
patients with splenic abscess present
fevers, chills, LUQ pain and splenic effusion
fever, leukocytosis splenomgealy
risk factors for splenic abscess
infective endocarditis, immunosuppression
IV drug use, trauma
hemoglobinopathies
pathogens causing splenic abscess
staph, strep and salmonella
Tx splenic abscess
splenectomy
gram - coccobacilli
H flue nontypeable
most common pathogens for pneumonia in CF
staph- most common
pseudomonas
H flue
strep pneumo