IDS Flashcards
1
Q
Fever without a focus definition
A
Rectal temperature of 38C or higher as the sole presenting feature
2
Q
Common pathogens in late-onset neonatal bacterial disease
A
Group B streptococci
E. coli
Listeria monocytogenes
3
Q
Most common serious bacterial infection in 1-3 age group and most common pathogen
A
Pyelonephritis
E. coli
4
Q
Low risk criteria for child 1-3 mo old with fever
A
CBC <15,000-20,000 Band:total ratio <0.2, absolute band ≤1,500 Urine <9-10 WBC CSF <5-10 WBC Stool <5 WBC
5
Q
Pathogens that account for most cases of occult bacteremia in 3-36 mo age group
A
S. pneumoniae
N. meningitidis
Salmonella
6
Q
Classic FUO
A
> 38C
3 weeks as outpatient, >2 visits
1 week in the hospital
7
Q
Virulence factors:
slime layer, coagulase, Protein A, catalase, penicillinase, B-lactamase, Panton-Valentine leukocidin, exfoliatin A and B, TSST-1, altered PBP-2A
A
Staphylococcus aureus
8
Q
Produces a yellow or orange pigment and B-hemolysis on blood agar
A
Staphylococcus aureus
9
Q
Most common cause of osteomyelitis and suppurative arthritis in children
A
Staphylococcus aureus
10
Q
Virulence factor responsible for methicillin resistance of MRSA isolates
A
altered PBP-2A
11
Q
Common pathogens in cavitary pneumonia
A
S. aureus, M tuberculosis, K. pneumoniae
12
Q
Treatment of TSS
A
B-lactamase resistant antistaphylococcal antibiotic (nafcillin, oxacillin, first gen cephalosporin) PLUS clindamycin (to reduce toxin production
13
Q
Most common cause of nosocomial bacteremia
A
S. epidermidis
14
Q
Most common pathogen associated with CSF shunt meningitis
A
coagulase-negative staphylococci
15
Q
Gram-positive, lancet-shaped, diplococci
A
Streptococcus pneumoniae
16
Q
On solid media, forms unpigmented, umbilicated colonies surrounded by a zone of incomplete a hemolysis.
Bile soluble and Optochin-sensitive
A
Streptococcus pneumoniae
Average time to isolation is 14-15 hr
17
Q
Gram-positive coccoid-shaped bacteria that tend to grow in chains
Zone of complete hemolysis that surrounds colonies grown in blood agar
Sensitive to bacitracin
A
Group A b-hemolytic streptococcus (S. pyogenes)
18
Q
Rash appears 24-48 hours after onset of symptoms and begins to fade after 3-4 days
Starts around the neck and spreads over the trunk and extremities
Goose-pimple appearance
Strawberry tongue
A
Scarlet fever
19
Q
Pathogen in bullous impetigo
A
S. aureus
20
Q
Pathogen in nonbullous impetigo
A
GAS
21
Q
Most common cause of acute pharyngitis in children
A
viruses
22
Q
Most common cause of bacterial pharyngitis
A
GAS
23
Q
Treatment of perianal streptococcal disease
A
oral cefuroxime
24
Q
Latent period between GAS pharyngitis and poststreptococcal reactive arthritis
A
<10 days
Involves large joints, and small peripheral joints as well as the axial skeleton
Not migratory
25
Rheumatogenic GAS serotypes
M types 1, 3, 5, 6, 18, 29
26
Age of greatest risk for GAS pharyngitis
5-15 yr
| Also highest incidence of both initial attacks and recurrences of acute rheumatic fever
27
Antiinflammatory therapy for arthritis with carditis without cardiomegaly or CHF
aspirin 50-70 mkday in QID x 3-5 days
then 50 mkday QID x 3 weeks
then half that dose for 2-4 weeks
28
Antiinflammatory therapy for arthritis with carditis, cardiomegaly, CHF
```
prednisone 2 mkday QID x 2-3 weeks
then half the dose for 2-3 weeks
then taper by 5 mg/24 hr every 2-3 days
When tapering prednisone,
start asprin at 50 mkday QID x 6 weeks
```
29
Treatment for Sydenham chorea
phenobarbital 16-32 mg q6-8
If ineffective,
haloperidol 0.01-0.03 mkday BID pr
chlorpromazine 0.05 mkdose q4-6
30
Secondary prophylaxis for recurrences of ARF
Benzathine penicillin G 600,000 IU IM for ≤60 lb, 1,200,000 IU IM for >60 lb q21-28 days
or
Pen V 250 mg BI
or
Sulfadiazine or sulfisoxazole 0.5 g OD ≤60 lb or 1 g for >60 lb
31
Duration of secondary prophylaxis for ARF
1. Rheumatic fever without carditis
2. RF with carditis but without residual heart disease
3. RF with carditis and residual heart disease
1. RF w/o carditis: 5 years or until 21 yr
2. RF with carditis, no residual heart disease: 10 yr or until 21 yr
3. RF w/ carditis, with residual heart disease: 10 yr or until 40 yr, SOMETIMES FOR LIFE
32
Facultative anaerobic gram-positive cocci that form chains or diplococci in broth
Forms small gray-white colonies on solid medium
B-hemolytic, resistant to bacitracin and TMP-SMX
CAMP factor
Group B streptococcus
| S. agalactiae
33
Vaginorectal GBS screening should be performed for all pregnant women ___ gestation
35-37 wk
34
Gram-positive, catalase-negative, facultative anaerobes that grown in pairs or short chains
Nonhemolytic on sheep blood agar
Able to grow in bile and hyrolyze esculin
Can grow in 6.5% NaCl and hydrolyze L-pyrrolidonyl-B-naphthylamide
Enterococcus
35
Aerobic, nonencapsulated, non-spore-forming, nonmotile, pleomorphic, GRAM POSITIVE BACILLI
Isolated in cystine-tellurite blood agar or Tinsdale agar - gray-black colonies
Urease negative
Elek test
Corynebacterium diphtheriae
36
62-kDa polypetide exotoxin
Diphtheria virulence factor
| Inhibits protein synthesis and causes local tissue necrosis
37
Incubation period of diphtheria
2-4 days
38
The first evidence of cardiac toxicity occurs during the __ week of illness in diphtheria
2nd and 3rd
39
ECG findings in diphtheria toxic cardiomyopathy
prolonged PR interval
ST-T wave changes
dysrhythmias
40
In diphtheria, cranial neuropathies occur in the __ week, leading to oculomotor and ciliary paralysis
5th
41
Onset of symmetric polyneuropathy in diphtheria
10 days to 3 months after oropharyngeal infection
| Distal weakness with proximal progression
42
Antimicrobial therapy for diphtheria
erythromycin 40-50 mkday IV/PO q6, max 2g/d
OR Pen G 100-150T ukd IV q6
OR daily procaine penicillin
<10 kg 300T u/d IM; >10 kg 600T u/d x 14 d
43
Antimicrobial prophylaxis for case contacts of diphtheria
Benzathine penicillin G
<6 yr: 600T u IM, >6 yr 1.2M u IM
OR erythromycin 40-50 mkday WID x 10d
44
Facultative anaerobic, non-spore-forming, motile, gram-positive bacilli
Catalase positive
tumbling motility, umbrella-type formation
grows at cold temp 4-10C
Listeria
45
Iron overload syndromes have high risk for __ because of sideraphores that scavenge iron
Listeriosis
46
Differentiate two clinical presentations for neonatal listeriosis
Early onset <5 days, septicemic form
| Late-onset >5 days, mean 14 days, meningitic form
47
CBC findings in listeriosis
monocytosis or lymphocytosis
48
Treatment for listeriosis
ampicillin 100-200, up to 400 for meningitis mkday q6 alone or in combination with aminoglycoside 5-7.5 mkday q8
duration: 2-3 weeks
49
Actinomycosis in children suggests an underlying immunodeficiency, especially?
chronic granulomatous disease
50
Anaerobic, nonsporulating, gram-positive bacteria with a filamentous branching structure
Cultures in 24-48 hr
Forms loose masses of delicate branching filaments, with a characteristic spider-like growth
Does not stain with acid-fast stain
Actinomyces israelii
51
Sulfur granules - adherent mass of PMN attached to the radially arranged eosinophlic clubs of the granule on H&E staining - are characteristic of?
Actinomycosis
52
Chronic, granulomatous, suppurative disease characterized by direct extension to contiguous tissue across natural anatomic barriers with the formation of numerous draining fistulas and sinus tracts
actinomycosis
53
Lumpy jaw
actinomycosis
54
Chronic lower lobe pulmonary consolidation
Empyema
Wavy periostitis of the ribs
radiographic triad of thoracic actinomycosis
55
Treatment for actinomycosis
Penicillin G 250T ukday q4-6, max 18-24M u/day x 2-6 wk, followed by oral antibiotics for 3-12 mo
Penicillin V 100 mkday q6
56
Delicately branched, gram-positive, coccoid to bacillary bacteria that tend to fragment
Filamentous, obligate aerobe
Forms waxy, folded, or heaped colonies at the edges after 1-2 wk
Fragmented bacilli with stain concentrated in a beaded pattern along portions of the branching filaments with Kinyoun acid-fast staining
Nocardia
57
Treatment for nocardiosis
Trimethoprim-sulfamethoxazole
ampicillin and co-amox for N. brasiliensis
Superficial cutaneous 6-12 wk
6-12 mo for mycetoma, pulmonary, systemic
58
Gram-positive, fastidious, encapsulated, oxidase-positive, aerobic diplococus.
Neisseria meningitidis
59
Adrenal insufficiency caused by adrenal necrosis/hemorrhage in meningococcus
Waterhouse-Friedrichsen syndrome
60
Antibiotic treatment of meningococcemia
Penicillin G 300T umkday q4-6, max 12-14M
or ampicillin 200-400 mkday q6
or cefotaxime 200-300 mkday q6-8 (neonate)
or ceftriaxone 100 mkday q12-24
61
Most common complication of acute severe meningococcal septicemia
focal skin infarction
62
Antibiotic prophylaxis to prevent N. meningitidis infection
```
Rifampin
Infants <1 mo: 5 mkdose q12 x 2 days
Children >1 mo: 10 mkdose q12 x 2 days
Ceftriaxone
<15 yr: 125 mg IM x 1 dose
>15 yr: 250 mg IM x 1 dose
Ciprofloxacin
>1 mo: 20 mkdose x 1 dose
```
63
Nonmotile, aerobic, non-spore-forming, gram-negative, intracellular diplococcus with flattened adjacent surfaces
Thayer-Martin growth medium
Produces cytochrome oxidase
Neisseria gonorrhoeae
64
Most common sexually transmitted infection found in sexually abused children
Gonorrhea
65
Perihepatitis resulting from dissemination of gonococci from the fallopian tubes through the peritoneum to the liver capsule
Fitz-Hugh-Curtis syndrome
66
Two clinical syndromes of disseminated gonococcal infection
1. Tenosynovitis-dermatitis syndrome
| 2. Suppurative arthritis syndrome
67
Painful, discrete, 1-20 mm pink or red macules that progress to maculopapular, vesicular, bullous, pustular or petechial lesions are dermatologic lesions associated with what pathogen?
Neisseria gonorrhoeae
68
Necrotic pustule on an erythematous base, including the palmar and plantar surfaces, sparing the face and scalp, numbering between 5 and 40
Neisseria gonorrhoeae
69
Antibacterial treatment for uncomplicated gonorrhea
Ceftriaxone 250 mg IM
Infant and children: 50 mkdose, max 125 mg
plus azithromycin 1 g PO x 1 dose
or doxycycline 100 mg PO BID x 7 days
70
Treatment for disseminated gonococcal infection
ceftriaxone 1 g/day x 7-14 days
Infant and children: 50 mkday max 1g
plus azithromycin 1 g PO x 1 dose
or doxycycline 100 mg PO BID x 7 days
71
Fastidious gram-negative, pleomorphic coccobacillus
H. influenzae
72
Most important known element of host defense against H. influenzae
Anti-PRP antibody
73
Treatment for H. influenzae meningitis
Ampicilli, cefotaxime or ceftriaxone
for 7-14 days
Dexamethasone 0.6 mkday q6 x 2 days
74
Duration of treatment for H. influenzae
1. cellulitis
2. preseptal cellulitis
3. orbital cellulitis
4. Supraglottitis/acute epiglottitis
5. pneumonia
6. suppurative arthritis
1. cellulitis: 7-10 days, shift to oral once afebrile
2. preseptal cellulitis: 5 days IV, 10 days total
3. orbital cellulitis: 14 days IV
4. supraglottis/epiglottitis: 7 days, shift to oral once able to take fluids by mouth
5. pneumonia: 7-10 days
6. suppurative arthritis: 5-7 days IV, 3 wk total or until normal CRP
75
H. influenzae prophylaxis
rifampin 0-1 mo 10 mkdose OD x 4 days
| >1 mo 20 mkdose max 600 mg OD x 4 days
76
Small, fastidious, gram-negative coccobacilli
| Colonize only ciliated epithelium
Bordetella
77
Virulence factors: filamentous hemagglutinin, agglutinogens, pertactin, tracheal cytotoxin, dermonecrotic factor
B. pertussis
78
Incubation period of B. pertussis
3-12 days
79
Stages of pertussis
1. catarrhal stage (1-2 wk)
2. paroxysmal stage (2-6 wk)
3. convalescent stage (≥2 wk)
80
Cough of 14 days or longer
| At least 1 associated symptom of paroxysms, whoop or posttussive vomiting. Consideration?
Pertussis
81
Infant younger than 3 mo, with gagging, gasping, apnea, cyanosis, apparent life-threatening event. Consideration?
Pertussis
82
```
Features of a non-life-threatening paroxysm
1. duration
2. color change
3. HR, O2 sat
4.
5.
6.
```
1. Duration <45 sec
2. Red but not blue color change
3. tachycardia, bradycardia (not <60 in infants), or desaturation resolve spontaneously at the end of the paroxysm
4. Brisk self-rescue
5. Self-expectorated mucus plug
6. Posttusive exhaustion but not unresponsiveness
83
Antimicrobial treatment for pertussis, <1 mo
azithromycin 10 mkday OD x 5 days
84
Antimicrobial treatment for pertussis, 1-5 mo
azithromycin 10 mkday OD x 5 days
or erythromycin 40-50 mkday QID x 14d
or clarithromycin 15 mkday BID x 7d
or TMP-SMZ
85
Antimicrobial treatment for pertussis, ≥6 mo
azithromycin 10 mkday OD max 500 on D1
then 5 mkday max 250 on D2-5
or erythromycin 40-50 mkday QID x 14d
or clarithromycin or TMP-SMZ
86
Optimal time to give Tdap to pregnant women
26-37 w AOG, every pregnancy
87
Motile, nonsporulating, nonencapsulated, gram negative rods
| Resistant to many physical agents but can be killed by heating to 54.4C for 1 hr or 60C for 15 min
Salmonellae
88
Number of NTSbacteria to cause symptomatic disease in a healthy adult
Incubation period
10^6-10^8
| Incubation period 6-72 hr (mean 24 hr)
89
Children with what hematologic disorder are at increased risk for Salmonella septicemia and osteomyelitis
sickle cell disease
90
Treatment of Salmonella gastroenteritis
```
For <3 mo or immunocompromised
cefotaxime 100-200 mkday q6-8 x 5-14 days
or
ceftriaxone 75 mkday OD x 7 days
or
ampicillin 100 mkday q6-8 x 7 days
or
cefixime 15 mkday x 7-10 days
```
91
Nontyphoidal Salmonella is excreted in feces for a median of __
5 weeks
92
Virulence factor of S. Typhi that has a protective effect against the bactericidal action of the serum of infected patients
polysaccharide capsule Vi
93
Infecting dose of S. Typhi
| Incubation period
10^5-10^9
| Incubation period 4-14 days
94
Macular or maculopapular rash visible around the 7th-10th day of illness, appearing in crops of 10-15 on the lower chest an abdomen and last 2-3 days. Lesion? Diagnosis?
Rose spots
| Typhoid fever
95
Test that measures antibodies against O and H antigens of S. Typhi
Widal test
96
Treatment of uncomplicated typhoid fever
1. Fully sensitive
2. MDR
3. Quinolone-resistant
1. Fully sensitive: chloramphenicol 50-75 mkday x 14-21 days
or amoxicillin 75-100 mkday x14 days
2. MDR: fluoroquinolone 15 mkday x 5-7 days
or cefixime 15-20 mkday x 7-14 days
3. Quinolone-resistant: azithromycin 8-10 mkday x 7 days
or ceftriaxone 75 mkday x 10-14 days
97
Treatment of sever typhoid fever
1. Fully sensitive
2. MDR
3. Quinolone-resistant
1. Fully sensitive: fluoroquinolone 15 mkday x 10-14 days
2. MDR: fluoroquinolone 15 mkday x 10-14 d
3. Quinolone-resistant: cefriaxone 60 mkday x 10-14 days
or cefotaxime 80 mkday x 10-14 days
98
"Chronic carriers" are individuals who excrete S. Typhi for __
3 months or longer
99
Bacillary dysentery is caused by __ while amoebic dysentery is caused by __
Shigella; Entamoeba histolytica
100
Ability to invade colonic epithelial cells by turning on a series of temperature-regulated proteins is the shared virulence trait of __
Shigella
101
Syndrome of severe toxicity, convulsions, extreme hyperpyrexia and headache followed by brain edema following Shigellosis
Ekiri syndrome or lethal toxic encephalopathy
102
Treatment of Shigellosis
```
vitamin A 200,000 IU single dose
zinc 20 mg elemental x 14 days
ciprofloxacin 20-30 mkday BID
or ceftriaxone 50 mkday
or cefixime 8 mkday q 12-24
or nalidixic acid 55 mkday QID
or azithromycin 12 mkday D1, 6 mkday x 4 d
*5 day antibiotic course
```
103
Facultative, anaerobic, gram-negative bacilli
member of Enterobacteriaceae family
Usually ferments lactose
E. coli
104
Six major groups of diarrheagenic E. coli
1. Enterotoxigenic
2. Enteroinvasive
3. Enteropathogenic
4. Shiga toxin-producing/Enterohemorrhagic
5. Verotoxin producing/Enteroaggregative
6. Diffusely adherent
105
Most common cause of traveler's diarrhea
ETEC
| Self-limited, resolves in 3-5 days
106
E. coli that presents like bacillary dysentery
EIEC
107
E. coli that cause acute, prolonged and persistent diarrhea in children younger than 2
Histopath: attaching and effacing lesion
Causes bluting of villi, inflammatory changes and sloughing of superficial mucosal cells
EPEC
108
E. coli associated with HUS
STEC
E. coli O157:H7
Differs from shigellosis in that fever is uncommon
109
E. coli that causes acute and persistent diarrhea in HIV-infected individuals
Forms a biofilm on the intestinal mucosa
Stacked-brick-like pattern
EAEC
110
Antibiotics should not be given for this group of E. coli
STEC - can increase risk of HUS
111
Gram-negative, comma-shaped bacillus
Vibrio cholerae
112
Blood group at increased risk for cholera
O
113
Incubation period of cholera
1-3 days
114
Rice-water stools with a fishy smell is the hallmark of?
Cholera
115
Most severe form of cholera
Cholera gravis
| Purging of 500-1000 mL/hr
116
Dark field microscopy showing darting motility in wet mounts of stools
Cholera
117
Recommended antimicrobials for cholera
tetracycline 12.5 mkdose QID max 500 mg per dose x 3 days
| or erythromycin, ciprofloxacin, doxycycline
118
Dose of zinc
Started as soon as vomiting stops
<6 mo 10 mg oral zinc x 2 weeks
>6 mo 20 mg
119
Gram-negative, curved, thin, non-spore-forming rods with tapered ends
Variable morphology:
- short comma-shaped or S-shaped
- long, multispiraled, filamentous, seagull
Motile, with a flagellum at 1 or both poles
Microaerophilic, oxidase positive
Transform into coccoid forms under adverse conditions, especially oxidation
Campylobacter
120
Classic source of Campylobacter
chicken
| raw milk
121
Campylobacter species most likely to produce bacteremia
C. fetus
122
Most common late-onset complications of Campylobacter
reactive arthritis
Guillain-Barre syndrome
Also IgA nephropathy, hemolytic anemia
123
Onset of reactive arthritis after diarrhea
1-2 wk
124
Onset of GBS after diarrhea
1-12 wk
125
GBS variant more commonly affecting cranial nerves, characterized by ataxia, aeflexia, ophthalmoplegia
Miller-Fisher variant
126
Drug of choice for Campylobacter gastroenteritis
erythromycin or azithromycin
127
Drug of choice for Campylobacter sepsis
aminoglycosides, meropenem or imipenem
128
Conditions with iron overload are at an increased risk for?
Listeria
| Yersinia
129
Most common form of Yersinia transmission to humans
Consumption of contaminated food, especially pork
130
Manifestations of systemic Yersinia infection
splenic and hepatic abscess, osteomyelitis, septic arthritis, meningitis, endocarditis, mycotic aneurysms
131
Empirical treatment for Yersinia enterocolitis
TMP-SMX x5 days
132
Large, gram-negative coccobacillus
No bipolarity when stained with methylene blue and carbol fuschin
Ferments glucose and sucrose but not lactose
Oxidase negative
Reduces nitrate to nitrite
Facultative anaerobe, motile
Can grow at refrigerator temperature
Yersinia enterocolitica
133
Most common presentation of Yersinia pseudotuberculosis
pseudoappendicitis
134
Can present as Kawasaki disease-like illness
Yersinia pseudotuberculosis
135
Most common mode of transmission of Y. pestis to humans
flea bites (Xenopsylla cheopis)
136
3 clinical presentations of plague
1. Bubonic - most common (80-90%)
2. Septicemic
3. Pneumonic
137
Treatment for bubonic plague
Streptomycin 30 mkday max 2g/d, q12 IM x 10 days
Gentamicin 7.5 mkday q8
Doxycycline, ciprofloxacin or chloramphenicol
7-10 days
138
Postexposure prophylaxis for pneumonic plague
tetracycline, doxycycline or TMP-SMX x 7 days
139
Y. pestis incubation period
2-8 days
140
Gram-negative rod, strict aerobe
Does not ferment lactose, oxidase positive
B-hemolysis on blood agar
Produce pyocyanin, pyoverdin, pyorubrin
Pseudomonas aeruginosa
141
Quantitative culture value that differentiates Pseudomonas invasion from colonization
100,000 colony forming units/mL or g
142
Antimicrobial treatment for Pseudomonas
ceftazidime 150-250 mkday q6-8 or
piperacillin tazobactam 300-450 mkday q6-8
or meropenem, ciprofloxacin
143
Characteristic skin lesion of Pseudomonas
ecthyma gangrenosum
144
Antimicrobial treatment for Burkholderia
TMP-SMX
or doxycycline
or meropenem
145
Motile, gram-positive, spore-forming obligate anaerobe
| Drumstick or tennis racket appearance
Clostridium tetani
146
Most common form of tetanus
neonatal or umbilical tetanus
147
Treatment for tetanus
1. TIG 500 u IM x 1 dose
or tetanus antitoxin 50T-100T u, 1/2 IM, 1/2 IV
2. Pen G 100T ukday q4-6 IV x10-14 d
or metronidazole 500 mg IV q8
3. diazepam 0.1-0.2 mkdose q3-6. Sustain for 2-6 weeks before tapering
4. vecuronium or pancuronium
5. a- and/or b-blocking agents
148
Poor prognosis in tetanus
1. onset of trismus
2. onset of tetanic spasms
1. onset of trisumus <7 days after injury
| 2. onset of generalized spasms <3 days after onset of trismus
149
Schedule of tetanus vaccination
DTaP 2, 4, 6, and 15-18 mo
DTaP booster at 4-6 yr and Tdap at 11-12 yr
then Td at 10 year intervals
For pregnant women, 1 dose Tdap at 27-36 wk AOG of each pregnancy
150
Virulence factors: toxin A and toxin B
Clostridium difficile
151
Gram-positive, anaerobic, spore-forming, bacillus resistant to alcohol
Clostridium difficile
152
Antimicrobial treatment for C. difficile
oral metronidazole 20-40 mkday q6-8 x 7-10 days
| or oral vancomycin 40 mkday q6 x 7-10 d
153
Most common form of extrapulmonary tuberculosis in children
scrofula
154
Complication of HAART in children with HIV and TB
immune reconstitution inflammatory syndrome (IRIS)
155
Delicate, tightly spiraled, motile, spirochete with finely tapered ends
Treponema pallidum
156
Characterized by a painless but highly contagious ulcer with raised borders and regional lymphadenitis
Primary syphilis
| Appears 2-6 wk after inoculation
157
Gray-white to erythematous wart-like plaques
condyloma lata
158
```
Generalized nonprupritic maculopapular rash involving the palsm and soles
Condyloma lata
Mucous patches
Flu-like illness
meningitis in 30% of patients
```
secondary syphilis
| occurs 2-10 wk after chancre heals
159
Early latent period syphillis
1st year of latency
160
Marked by neurologic, cardiovascular, and gummatous lesions of the skin, bone, and liver resulting rom the host cytotoxic T-cell response
Tertiary syphilis
161
Metaphyseal demineralization of the medial aspect of the proximal tibia
Diagnosis?
Wimberger lines
| congenital syphilis
162
Painful osteochondritis resulting in irritability and refusal to move involved extremity
pseudoparalysis of Parrot
| congenital syphilis
163
Bony prominence of the forehead caused by persistent or recurrent periostitis
Olympian brow
| congenital syphilis
164
Unilateral or bilateral thickening of the sternoclavicular third of the clavicle
Clavicular or Higoumenakia sign
| congenital syphilis
165
Anterior bowing of the midportion of the tibia
Saber shins
| congenital syphilis
166
Convexity along the medial border of the scapula
Scaphoid scapula
| congenital syphilis
167
Peg-shaped upper central incisors; they erupt during the 6th yr of life with abnormal enamel, resulting in a notch along the biting surface
Hutchinson teeth
| congenital syphilis
168
Abnormal 1st lower (6 yr) molars characterized by small biting surface and excessive number of cusps
Mulberry molars
| congenital syphilis
169
Depression of the nasal root, a result of syphilitic rhinitis destroying adjacent bone and cartilage
saddle nose
| congenital syphilis
170
Linear scars that extend in a spoke-like pattern from previous mucocutaneous fissures of the mouth, anus and genitalia
Rhagades
| congenital syphilis
171
Latent meningovascular infection; it is a rare and typically occurs during adolescence with behavioral changes, focal seizures, or loss of intellectual function
Juvenila paresis
| congenital syphilis
172
Rare spinal cord involvement and cardiovascular involvement with aortitis
Juvenile tabes
| congenital syphilis
173
Hutchinson teeth, interstitial keratitis and 8th nerve deafness
Hutchinson triad
| congenital syphilis
174
Unilateral or bilateral painless joint swelling (usually involving knees) from synovitis with sterile synovial fluid; spontaneous remission usually occurs after several weeks
Clutton joint
| congenital syphilis
175
Manifests with intense photophobia and lacrimation, followed within weeks or months by corneal opacification and complete blindness
Interstitial keratitis
176
May be unilateral or bilateral, appears at any age, manifests initially as vertigo and high-tone hearing loss, and progresses to permanent deafness
8th nerve deafness
177
Antimicrobial therapy for congenital syphilis
aqueous crystalline penicillin G 100T-150T ukday; 50T ukdose q12 x 7 days, then q18 for total of 10 days
or Pen G procaine 50T ukday IM x 1 dose x 10 days
178
Antimicrobial therapy for syphilis in >1 mo
1. Congenital syphilis 200-300T ukday as 50T ukdose q4-q6 x 10 days
2. Primary, secondary and early latent
Pen G benzathine 50T ukdose IM max 2.4M x 1 dose
3. Late latent or unknown duration
Pen G benzathine 50T ukdose IM x 3 weekly doses
4. Neurosyphilis - aqueous crystalline pen G 200T-300T ukday q4-6 x 10-14 d
179
Persons exposed for __ preceding diagnosis of syphilis in a sex partner should be treated presumptiveley even if seronegative
90 days or less
180
Aerobic spiral bacterial with terminal hook at 1 or both ends
Leptspira
181
Gold standard diagnostic method for leptospirosis
microscopic agglutination test
182
Detected by Warthin-Starry silver stain
spirochetes
183
Leptospires can be recovered from the blood or CSF during __ and from the urine __
the first 10 days of illness;
| 2nd week
184
Treatment of leptospirosis
Penicillin, and tetracyclines
185
Prophylaxis for leptospirosis
doxycycline 200 g PO once a week
186
Obligate intracellular gram-negative organisms without detectable peptidoglycan
Chlamydia
187
Two morphologically distinct forms of Chlamydia
1. elementary body - infectious form
| 2. reticulate body - reproductive form
188
Antimicrobial treatment for chlamydia
erythromycin 40 mkday BID x 10 days
or clarithromycin 15 mkday BID x 10 days
or azithromycin 10 mkday x 1 day, then 5 mkday x 4 days
189
Diagnostic criteria for trachoma
2 of 4:
1. lymphoid follicles on upper tarsal conjunctivae
2. typical conjunctival scarring
3. vascular pannus
4. limbal follicles
190
Treatment of trachoma
azithromycin 20 mkdose max 1 g x 1 dose
191
First line treatment regimen for C. trachomatis genital infection
```
azithromycin 1 g PO x 1 dose
and doxycycline 100 mg PO BID x 7 days
For pregnant:
azithromycin 1 g PO x 1 dose
and amoxicillin 500 mg TID x 7 days
```
192
Treatment for lymphogranuloma venereum
doxycycline 100 mg PO BID x 21 days
193
3 morphologic forms of Candida
1. blastospores/yeast cells
2. chlamydospores
3. pseudomycelium - tissue phase
194
Germ tube test is used in the diagnosis of?
Candida albicans
195
Fluconazole is inactive against all strains of?
C. krusei
| and 5-25% of C. glabrata
196
Duration of systemic antifungal therapy
21 days from last positive Candida culture
197
Measles patients are infections from __ to __ after the onset of rash
3 days before to 4-6 days after the onset of rash
198
Warthin-Finkeldey giant cells are pathognomonic for?
Measles
199
Koplik spots are pathognomonic for?
Measles. Appear 1-4 days prior to the onset of rash
200
Most common complication of measles
otitis media
201
Characteristic EEG findings of SSPE
suppression-burst episodes
202
Dose of vitamin A
<6 mo: 50,000 IU
6-11 mo: 100,000 IU
≥12 mo: 200,000 IU
OD x 2 days
203
Period of highest communicability of rubella
5 days before to 6 days after the rash
204
Tiny, rose-colored lesions on the oropharynx of a patient with rubella
Forchheimer spots
205
Most common finding is nerve deafness
salt-and-pepper retinopathy
cataracts
Congenital Rubella Syndrome
206
Period of infectiousness of mumps
1-2 days before to 5 days after onset of parotid swelling
207
Salt-and-pepper retinopathy is the most common ocular abnormality in?
congenital rubella syndrome
208
Most frequent cause of hand-foot-and-mouth disease
coxsackievirus A16
209
Most common cause of viral meningitis in mumps-immunized population
Enteroviruses
210
Virus that can cause aplastic crisis in patients with hemolytic anemias
Can also cause fetal anemia and hydrops
Cell receptor is erythrocyte P antigen
Parvovirus B19
Erythema infectiosum
fifth disease
211
Slapped cheek appearance
Erythematous symmetric, maculopapular, truncal rash appears 1-4 days after, develops central clearing, becomes lacy, reticulated
Does not desquamate
Parvovirus B19
Erythema infectiosum
fifth disease
212
Recurrent asceptic meningitis
Mollaret meningitis
213
Treatment of acute mucocutaneous Herpes infection
acyclovir 15 mkdose 5x/day PO x 7 days
214
Treatment of CNS herpes infection
acyclovir 10 mkdose q8 IV x 14-21 days
215
Treatment of perinatal herpes infection
acyclovir 60 mkday q8 IV
SEM 14 days
CNS and disseminated 21 days
216
Incubation period of varicella
10-21 days
| Infective 1-2 days before the appearance of the rash
217
Infants whose mothers demonstrate varicella in the period from __ to __ are at high risk for severe varicella
5 days prior to delivery to 2 days after delivery
| Give 1 vial of VariZIG ASAP
218
Cicatricial skin scarring, limb hypoplasia, neurologic (microcephaly, cortical atrophy, seizures, mental retardation), eye (chorioretinitis, microphthalmia, cataracts), renal (hydroureter and hydronephrosis) and ANS (neurogenic bladder, swallowing dysfunction, aspiration pneumonia) abnormalities in newborn. Diagnosis?
Congenital varicella syndrome
219
Classic triad of primary EBV infection
fatigue, pharyngitis, generalized lymphadenopathy
220
Primary immunodeficiency associated with severe EBV infection
X-linked lymphoproliferative syndrome (Duncan syndrome)
221
"ampicillin rash", associated with?
EBV
222
Classic physical exam findings of EBV infection
generalized lymphadenopathy
splenomegaly
hepatomegaly
223
Symmetric rash on the cheeks with multiple erythematous papules, which may coalesce into plaques and persist for 15-50 days
Gianotti-Crosti syndrome
| EBV
224
Alice in Wonderland syndrome is associated with which pathogen
EBV
225
Transient heterophile IgM antibodies seen in infectious mononucleosis
Paul-Bunnel antibodies
226
SGA, microcephaly, thrombocytopenia, hepatosplenomegaly, hepatitis, intracranial calcifications, chorioretinitis, hearing abnormalities, blueberry muffin appearance
Diagnosis?
Congenital CMV infection
227
Nagayama spots (ulcers at the uvulopalatoglossal junction), fait pink or rose-colored, nonpuriritic, 2-3 mm morbilliform rash on the trunk, high fever 39.7C. Diagnosis?
Roseola infantum (exanthema subitum, sixth disease, HHV 6 & 7)
228
History of 3 days of high fever in an otherwise nontoxic 10 mo old with a blanching maculopapular rash on the trunk. Possible diagnosis?
Roseola
229
Passive immunoprophylaxis for RSV
palivizumab 15 mkdose IM once a month
230
Antiviral agent for RSV
ribavirin inhaled x 3-5 days
231
Principal vector of dengue virus
Aedes aegypti
| Stegomyia family
232
Incubation period of dengue
1-7 days
233
Dengue IgM disappears after?
6-12 weeks
234
Pathologic hallmark of rabies
Negri body
235
Incubation period for rabies
1-3 mo
236
Prophylaxis against cerebrovascular spasm in rabies
nimodipine
237
Incubation interval for development of AIDS-defining condition after vertical transmission is __ while after horizontal transmission is __
vertical transmission 5 mo
| horizontal transmission 7-10 yr
238
Diagnostic viral testing for HIV in neonates should be performed by __, __ and __
by 48 hours of age
at 1-2 mo
and at 3-6 mo
HIV infection is confirmed if positive on 2 separate occasions
239
Preferred virologic method for diagnosing HIV infection during infancy
HIV DNA PCR
240
Prophylaxis for vertical transmission of HIV
zidovudine to the mother started by 4 weeks AOG continued during delivery and to the newborn for the first 6 weeks of life
241
Benefit of CS delivery is negligible of HIV viral load of the mother is?
<500 copies/mL
242
Treatment of toxoplasmosis
Pyrimethamine
| Sulfadiazine
243
Detectable form of malaria
Trophozoite
| Ring form
244
Treatment of malaria
Chloroquine
Mefloquine for P. falciparum
Doxycycline for mefloquine resistant P. falciparum
245
Treatment for gastrointestinal ascariasis
Albendazole 400 mg PO x 1 dose
Or mebemdazole 100 mg BID x 3 days or 500 mg x 1 dose
Or ivermectin 150-200 mcg/kg PO x 1 dose
246
Treatment of choice for intestinal or biliary obstruction from ascariasis
Piperazine citrate 75 mkday x 2 days max 3.5 g/d
