IDz Flashcards
Criteria for FOUO
> 38.3/100.9*
3 days admitted w/out Dx
3 OutPT visits
Illness x 3wks
What are the categories of FOUO
Nosocomial- admitted PT w/ fever >38.3*C
Neutropenic- in/out PT w/ neutrophils <500 x 3 days no Dx
HIV- PT w/ HIV Dx and fever x 4wks (out) / 3 days (in) w/ 2 day incubation
Organ transplant
What labs are drawn when investigating FOUO
What images are ordered?
Culture prior to ABX, grown x 2wks
Titers
CBC
CRP/ESR
All PTs get CXR (TB risk)
What areas of the body can be biopsied when investigating FOUO?
Empiric ABX are used if DDx includes ?
What Tx is controversial and avoided
LP Lymph Marrow Skin
Infectious dz
Steroids
What biological warfare agents are classified as Category C
What agents are classified as “other important zoonotic” ?
Nipah
Hantavirus
West Nile
Hendra
Rift Valley
Spongiform encephalopathy
Anthrax
Gram + rod shaped Bacillus Anthracis
Contact w/ hides
Ingestion of meat
Inhalation of spores
NOT transmitted person to person
Cutaneous anthrax can be AKA ?
How does this present
Malignant pustule
PEV UB
Pustule Erythematous papul
Vesicle Ulcer Brawny edema
What are the S/Sxs of inhalation anthrax?
What are the two phases?
Malaise, Lymphdenopathy
Initial: viral URI, rhinorrhea, pharyngitis
Later: dyspnea, hemoptysis
S/Sxs of intestinal anthrax
How is anthrax Dx?
GASH
GE Ascites Sepsis Hematemesis/chezia
CXR- wide mediastinum
Rapid ELISA
Culture everything
Anthrax Dx
What is given for postexposure PO prophylaxis
Cipro + LInezolid or Clindamycin
Vaccine +
Cipro or Doxy x 60 days
How are PTs exposed to aerosolized anthrax managed?
How are non-complicated, naturally acquired cutaneous cases of anthrax Tx?
Regardless of vaccination Hx: 60 days of antimicrobial drugs
Cipro x 7-10 days
What are the names of the injection meds for anthrax post-exposure prophylaxis?
These two meds are also approved for use in ? scenarios
Obiltoxaximab, Biothrax
Prevent inhalation anthrax when alternative therapies are unavail/inappropriate
What are the complications that can occur after anthrax?
What are the three types of the ‘zoonotic dz of rodents’?
Scarring
Airway occlusion
Death
Plague:
Bubonic- fleas
Pneumonic- aerosol
Septicemic
S/Sxs of Pneumonic Plague
S/Sxs of Bubonic Plague
S/Sxs of Septicemia Plague
CHAFT Hemoptysis
Chills HA Fever Toxic
BMF
Buboe (inguinal) Malase Fever
CNS, lungs (no buboes)
What would be seen on lab results if plague is present
How is it Tx
What two meds are used for post-exposure prophylaxis
WBC 20K w/ inc bands
Inc split fibrin split (Low DIC)
Inc LFTs
Strepto/Gentamycin
Doxy/Cipro
What are the complications of plague
What are the initial and later rash locations of smallpox?
DIC ARDS Shock Superinfection
Initial: oropharynx, face, forearms
Later: trunk and legs
What is the sequence of a smallpox lesion
Synchronous: MVPSS Maculopapular Vesicle Pustule/pocks Scabs/scars w/ sebaceous destruction
Characteristics of Hemorrhagic Smallpox
Characteristics of Malignant Smallpox
Dusky erythema
Petechia
Hemorrhage of skin/membranes
Lesions
Velvet vesicles
Red fine grained skin
No formation of pustules/scabs
Tx for smallpox?
Tx for small and monkeypox?
How often are new vaccines needed?
Tecovirimat
Cidofovir
10-15yrs
How is post-smallpox exposure prophylaxis managed?
What is the natural reservoir of cow pox?
Vaccinate if within 4 days and no vaccine Hx
CDC guidance for eligibility of Vaccina Immune Globulin within 3 days (best within first 24hrs)
Small wild rodents
What form of variola is more deadly?
Hemorrhagic- uniformly fatal by day 6 of rash
Malignant- frequent fatal
Major- 30%
How long for HSV initial and recurrence Sxs/viral shedding to stop?
How is HSV described in words
Initial: 2wks, 3wks
Rec: 10 days, 5 days
Erythematous papule to vesicle to pustule to ulcer
How is HSV Dx
How is it Tx
Punch biopsy- ImmComp
Tzanck smears- MNG cells
PCR
Culture- CSF, serum
FAV-clovir
Topicals: PA-clovir, Doconasal
How is HPV Dx
Biopsy- ImmComp
PCR- 9 high risk types, 5 low risk types
Cervical Pap
STD panel: Hep HIV Syphillis G/C
How is HPV Tx surgically
How is HPV Tx w/ meds?
CO2 laser Electrosurgery LN2 cryotherapy Excision (laser therapy for inner lesions on females)
Podofilox
Imiquimod
Trichloroacetic acid
Gonorrhea is AKA ?
What type of microbe is it
Clap
Gram - intracellular aerobic diplococcus
S/Sxs of Gonorrhea
F: D/c CMT Dysuria/pareunia
M: D/c Epididymis pain Dysuria
Both: fever, infection of membrane tissue
What is the fear with gonorrhea in women that goes unTx
What is the form of disseminated gonorrhea infection?
PID: acute salpingitis leading to ectopic pregnancy
Arthritis Dermatitis Syndrome: Polyarthralgia Septic arthritis Tenosynovitis Endocarditis Meningitis
How is Gonorrhea Dx
What is the CDC’s recommendation for Dx
GT PUC
Gram stain TMA PCR US/CT
Culture isolation*
Culture and Susceptibility testing
What types of gonorrhea strains are more likely to exhibit antimicrobial resistance?
How is Gonorrhea Tx
MSM strains
Ceftriaxone and Azithromyin
Alt: Azithromycin 2g PO
Tx fail: Ceftriaxone + Azith + test for cure 7days
What is the MC reported IDz in the US
How is this infection Dx
Chlamydia, especially in PTs <25y/o
TMA
How is chlamydia Tx
What microbe is the cause of LGV and what family of microbe does it belong to
LGV occurs in 10% of PTs w/ ?
Azithromycin, Ceftriaxone
Alt: Doxy
C Trachomatis- Chlamydia family
Genital ulcer Dz
What are the three stages of an LGV infection
Primary: <30 days after infection w/ small/painless papule that rapidly heals
Secondary: 2-6wks after initial, painful unilateral bubo, systematic spread
M: Dx w/ groove sign: inguinal ligament raised over buboe
F: rarely dx, lack of adenopathy
Tertiary: genitoanorectal syndrome, usually in F PTs
How is LGV Dx
How are they Tx
Complement fixation 1:64
Therapeutic: aspiration
Tx: Doxy x 3wks
What organisms can cause Nongonococcal urethritis:
Non-G Urethritis: Mycoplasma genital: MSM, PID, labor Trichomonas Chlamydia* Ureaplasma Mycoplasma hominis
Rarely:
LGV HSV Syphillis
How is NG and G urethritis Tx
How does syphilis present?
NGU: Azith, Doxy
GU: Azith, Ceftriax
Round, demarcated borders, painless w/ regional adenopathy
What form of syphilis is considered non-infectious
What are the S/Sxs of congenital syphilis
Tertiary- Gummatous syphilis
Multiple organ involvement either early (first 2yrs) or late (older than 2yrs)
2* syphilis may present w/ ? derm finding
What parts of the body are commonly affected by gummas syphilis?
Alopecia
Liver Skeleton Testis
Cardiovascular syphilis can arise ? yrs later and usually affects ?
What may be found on PE?
10yrs after primary infection
Ascending aorta
Aortic valve insufficiency
When can neurosphylis develop?
How can they present
Any stage of syphilis
CN8 palsy
Argyle Robertson pupils
Tabes dorsalis
Stroke/meningitis Sxs
Syphilis can infect a fetus how long after an infection?
Why is this infection not caught during prenatal work ups?
4yrs prior
Late/limited prenatal care
Failure to adhere to screening
CDC recommends that all females delivering stillborn babies prior to ?wks are tested for syphilis?
What are the PE findings of a PT w/ late congenital syphilis?
20wks
Depressed facial bones
Hutchinson incisors
Mulberry molars- too many cusps
What lab result is used to monitor the efficacy of care for PTs Tx for syphilis
What other systemic Dzs/issus can trigger a false-pos for syphilis on a RPR test?
VDRL titers
Infection, viral/bacterial Lupus Immunizations Marijuana use (biological false pos) Pregnancy
What are the alternative meds for Tx syphilis?
What med is added to Pen G when Tx neurosyphilis
How is congenital syphilis under 30 days Tx?
CDT: Ceftriax Doxy Tetra
Probenicid
Aqueous Pen G
How is BV Tx
Chancroid infections are usually found in ? 2 countries and co-infect w/ ?
How does it present?
Clindamycin PO/cream
Tinidazole
Metronidazole*
Africa, Caribbean
HSV 2, Syphilis
HA Anorexia Painful ulcer
Bubo
How are chancroids definitively Dx
How are they Tx
Gram stain-unreliable
Culture- definitive
Ceftriaxone
Azithromycin
Granuloma inguinale is AKA ?
How does this present?
Donovanosis
Beefy red bump that is painLESS
Spreads w/ erosion, depigmentation
Which IDz has to be Dx w/ punch biopsy?
What is seen when viewed under microscope?
Donovanosis
Speckled round eggs
How is Granuloma Inguinale/Donovanosis Tx
Bed bugs belong to ? species
Azithromycin x 3wks
If ulcers don’t respond within few days, add Gentamicin (aminoglycoside)
Cimex
? term encompasses lice and what is the concern w/ these infestations
Where are the different types usually seen?
Pediculosis- secondary skin infections
Capitis- occipital, post-auricular
Distance of nits from scalp= duration of infestation (closer to scalp= newer infection)
Corpus: bites found anywhere but no nits in hair
Phithrius pubis: pubes, perienium, eyebrows and eyelashes
Pedicuosis infestations can quickly be visually Dx by ?
How are these Tx
Woods lamp
Permethirn 1%
Ivermectin 0.5% for resistance and PTs over 6mon old
Malathion 0.5% (8-12hrs)
REPEAT Tx in 7 days to kill nits
What type of pediculosis infestation is indicative of child abuse?
What are scabies eggs called?
Pediculosis pubis
Scybala
What was the first human Dz proven to be caused by a specific pathogen?
What PT populations is this infestation highest in?
Scabies
<15y/o
Sexually active
ImmComp
Debilitated
How do scabies present?
What PT population is this type of infestation rare in?
Crescendo pruritis, worse at night
Neonates
How do scabies appear on PE?
Where are they usually seen?
If PT that is ImmComp acquires scabies infestations, how do they present?
Serpinginous
Burrow- pathognomonic for scabies infestation
Webs of fingers
Flexors of wrist
AC space
Axilla
Bullous lesions
How is a scabies infestation Dx?
How are they Tx?
Skin scrapings for mite/eggs
Permethrin 5%- neck down
Ivermectin PO
Bed bugs are a vector for ? and ? adverse reaction is well described with their infestation
How do bed bug infestations present in clinic
Hep B
Anaphylactoid
Papule Bullae Wheal
Hemorrhagic puncta
How are bed bugs Tx
Which forms of hepatitis are transmitted through fecal/oral or through serum?
Creams w/ CCS
PO antihistamine
F/o: A E (acute only)
Serum: B C D G (acute and chronic)
Chronic hepatitis can lead to ? or ? and is caused by ? form
What labs are ordered and what will be seen on results for hepatitis?
Ca Cirrhosis
B and C
Urine/serum bilirubin
Elevated serum bilirubin= infectious hepatitis
+30mg= severe hepatitis
Prothrombin time
What weird food can carry Hep A?
What are the two more rare but possible transmission methods for this version?
Severity of the Dz increases due to ?
Shellfish
Blood
Sexual contact
Age
What lab results is Dx of acute Hep A
When can Twinrix be given?
IgM anti-HAV
Arrives 5 days before Sxs, gone by 6mon
0 1mon 6mon if PT is >18y/o
>12mon= Havrix
Vaccines offer ? type of immunity
What is used for post exposure Tx of Hep A exposure
Active
Immune serum globulin within 2wks of exposure
Hep E is usually a benign course infection except in ?
How is it Dx
Pregnant PTs
IgM and IgG anti-HEV
HEV RNA in serum/stool
? type of virus is Hep B
This form is more infective than ?
DNA virus
100x more than HIV through blood/sex contact
What is the odd relation between contracting Hep B and age
Chronic HEB is usually ?
Younger PTs- chronic
Older PTs- acute cases
ASx
What lab result would be the first indication of a Hep B infection
What would be the first Ab seen?
This first Ab is eventually replaced by ?
HBsAg
IgM and anti-HBc
IgG anti-HBc
What lab result is indicative of successful immunity from Hep B?
What results are indicative PT has chronic hepatitis and is a carrier?
Anti-HBs (HBsAb)
HBsAg and/or
anti-HBc
Hep B immunoglobulin and Hep B vaccine can be given for post-exposure within ? days
What is the goal when treating chronic Hep B?
7 days for Tx and prevention
Inhibiting viral replication
What meds are used for chronic Hep B
What meds are used as 2 or 3rd line options?
PEG-IFN Entecavir Tenofovir
Adefovir Lamivudine
What lab result is used to plan and monitor Hep B Tx?
Hep C infections usually also come with ?
HBV DNA
HIV
What is the MC cause of Hep C
This form has less transmission likelihood through ?
What is the median time for this form to lead to cirrhosis?
IVDA
Sexual contact
30yrs
What are 4 factors that can accelerate the progression of Hep C into cirrhosis?
What PTs are tested for Hep C
Inc alcohol
>40 when infected
Chronic Hep B/HIV infected
Male
Clotting Liver Injected Transplant Dialysis Injected illegal drugs Received clotting factors Blood/organ transplant Hemodialysis Liver dz
When do medical workers need to be screened for Hep C
When are babies tested?
? causes the greatest increase of HCV cases between ages 18-39?
+ HCV PT w/ + needle stick
HCV + mother
Opioid IVDA
How is Hep C Dx
Since there are more than 50 genotypes of Hep C, what two have favorable prognosis and which one has a poor prognosis?
What genotype is rare and harder to Tx
Screen: Anti-HCV
Confirmed: PCR- RNA
If neg, repeat in 1mon
2 and 3
1- more common
4
What are the s/e of using IFN for Hep C Tx
Hep D infects PTs that are carriers of ?
How does it present?
Neuropsychiatric
Marrow suppression
Flu-like
HBsAg
Severe acute presentation similar to Hep B, low risk for chronic infection
Hep D super infections have higher risk for ? and rapid progression to ?
How is Hep D transmitted
Chronic liver dz
Cirrhosis
IVDA, Sexual contact
How is Hep G transmitted
This form can co-infect w/ ? 2
Blood transfusion
Co-infect w/ Hep B
B and C
HIV replicates on the surface receptors of ? cells
This includes ? cells
CD4 surface receptor
Microglial cells Dendritic cells Monocytes Alveolar macrophages Macrophages
Initial HIV Sxs present ? wks after infection and resemble a ? infection
Abs would be almost 100% detectable by ?mon
2-4wks
Infetious mononucleosis
3mon post-exposure
? lab test is used for screening and ? is used for confirmation of HIV
What would be seen on a CBC result
Screen w/ ELISA
Confirm w/ Western blot
Thrombocytopenia
Anemia
Neutropenia
What lab result is used as the counter-predictor of progression of HIV?
Opportunistic pathogen and Cas are more likely when CD4 count drops below ?
CD4 lymphocyte %
<200/14%
What are the top 3 MC signs of HIVs Acute Retroviral Syndrome?
These Sxs indicate ? physiological process has occurred?
What opportunistic infections can occur when CD4 levels are below 200
Cytokine storm causing: Fever Fatigue Pharyngitis
Abs have just become detectable and becomes infectious
P jiroveci pneumonia- MC OI associated w/ AIDS
Kaposi sarcoma
Candidiasis
What opportunistic infections can occur when CD4 levels are below 100
What opportunistic infections can occur when CD4 levels are below 50
How often are CD4 counts measured in HIV PTs?
AIDS dementia
Aspergillosis
Cytomegalovirus
Crypto
Toxoplasmosis
M avium complex
Every month after initiating/changing Tx
Q3mon
How are AIDS PTs w/ HSV, Toxoplasmosis, M Avium or P jiroveci Tx
When is the likelihood of HIV transmission lowest?
Viral suppression is defined as less than ?
HSV- acyclovir
Toxo: pyrimethamine
M Avium: Clarythromycin
PJ- TMP/SMX
Viral load is undetectable
200-400 copies
What tools are used to measure AIDS treatment therapy?
Which tool is used to indicate when to start/change therpy?
Occupational exposure for HIV includes universal precautions that include ?
CD4 count
Viral loads
Clinical status- thrush
Viral load
Gloves Eye-pro Gown Booties
What fluids are NOT considered infectious w/ HIV as long as no blood is visible in them
Feces
Urine
Nasal secretions
Tears
Vomit
Saliva
Sputum
Sweat
What is a less/more severe type of HIV exposure?
HIV infection status of source are classified into ? 2
Less: solid needle, superficial
More: large, deep, bloody
Class 1: ASx, low viral load (<1,500 copies)
Class 2: Sxs, high viral load
What are the recommended HAART combos
? PT education has to happen and they achieve viral suppression within ?mon of starting
Recommend:
Lami Aba Dolut
Bic/Ten Ala/Emtri
Alt:
Ten Emtri Cobi Elvit
Efan/Ten/Emtri
Taken same time every day
6mon
What are the post-HIV/AIDS exposure meds
Basic:
Zido + Lami
Emi + Teno
Stav + Lami
Expanded:
Basic + Lopin or Atazan
x 28days, best started w/in 72hrs
Healthcare persons are f/u w EIA how often after an HIV/AIDS exposure
AD members w/ HIV/AIDS are medically retired when CD4 count reaches ?
What medication is recommended for pre-exposure prophylaxis against HIV?
6 and 12wks
6mon
Extend to 12mon if infected w/ Hep C
<300 or can’t perform job
Emtri TDF
What HIV pre-exposure med is used primarily?
What pre-exposure med is used for receptive anal intercourse safety against HIV?
Receptive form is not for use in ? population
Emtri TDF
Emtri Teno Afen
Vaginal intercourse
Define Antigenic Shift
Define Antigenic Drift
Major genetic change resulting in pandemics (1918 Spanish flu)
Minor mutation leading to epidemics
What is the difference between Influenza A, B and C
A: outbreaks due to antigenetic shifts=pandemic
B: antigenetic drifts, less variation than A; school/barracks outbreaks= epidemic
C: mild illness
What PT populations have the highest attack and complication rates w/ influenza
When are these PTs infective?
Kids: highest attack
Elderly: highest mortality and complication, lowest attack
1 day before Sx onset
What would be seen on CBC in PTs w/ influenza
Where can the virus be isolated from for ? Dx studies
Leukopenia
Mild leukocytosis
Nasopharyngeal, throat, sputum
Immunoassay
What meds are used for Sx Tx of influenza?
What meds can be given for influenza A or B if Sxs are present for <48hrs?
What med is given for A and B resistant strains?
Tylenol
Neuroaminidase inhibitors- Zana/Oseltamivir
Baloxavir Marboxil
Why do we avoid giving aslicylates to PTs < 16y/o w/ influenza
FluMist vaccines are given to PTs how old?
Reyes syndrome
2-49y/o
What are the indications to give the influenza vaccine?
What are the c/i to giving the vaccine
\+65y/o Chronic Dz Health workers Aspirin use under 18y/o Resident of nursing home
GBarre Syndrome
Acute febrile illnesses
Thimerosal allergy- contact solution
Egg allergy
What complications can arise from influenza infections
1* influenza pneumonia
2* bacterial pneumonia
Myositis/Rhabdo
Renal failure
Myocarditis
Tracheobronchitis
Neuro- Reyes/GBS
What are two specific viral causes of pneumonia in ImmComp PTs
What are the two respiratory infections seen in HIV/AIDS PTs
What type of pneumonia is rarely seen in kids?
HSV or CMV
M avian complex
P jiroveci
Varicella pneumonia
Varicella pneumonia is more common/severe in adults and ImmComp, how does it present?
How does CMV pneumonia in an ImmComp PT present
Pneumonia w/ rash
Couth and Tachy
Interstitial pulmonary infiltrates
What type of viral pneumonia is exclusive to ImmSupp PTs?
How are they Tx?
HSV pneumonia
MC cause of post transplant pneumonia
High dose IV Acyclovir
How do viral pneumonias look on x-ray according to their cause?
HSV: peripheral nodules, coalesce to infiltrates
CMV: lower lobes, possible interstitial involvement after organ transplant
RSV: bilateral interstitial/patchy infiltrate w/ consolidation/effusions
Varicella: fluffy/nodular infiltrates w/ possible calcification
Hanta virus is found in ? but cant be transmitted by ?
What are the MC S/Sxs of Hantavirus
What are the MC PE findings
Deer mice feces
Person to person
Fever CHills Myalgias in back/legs
Tachy Fever Tachy
What finding would NOT be seen on blood work of Hanta
What lab results may be seen in Hantavirus
The virus can cause a lot of lab results to be elevated except for ?
No petechiae even w/ thrombocytopenia
inc Hct
Acidosis
Dec albumin
What is the definitive Dx method for Hantavirus
How does this infection progress on CXRs
How is Hantavirus Tx
Serology
Mild pulmonary edema to base/perihilar pattern
Ribavirin
Bacterial pneumonia is AKA
Its MC caused by ?
It can be caused by ? atypicals
CAP
MC Streptococcus/ pneumococcal pneumonia
Atypicals: Legion Mycoplasma Chlamydia Klebsiella
Gram negs
Anaerobes
What type of cough w/ Strep Pneumo pneumonia
How does this appear on CXR but what caution is needed
Rusty blood sputum
Alveolar pattern*
Resolution lags behind clinical recovery
What will be seen on lab results in PTs w/ Strep/Pneumo pneumonia
What is the DOC for Tx for PTs w/ comorbid conditions
Leukocytosis w/ L shift
Inc ESR/CRP
Amoxicillin and Clavulanate
What drugs are used for PCN susceptible CAP?
What drugs are used for PCN resistant strains?
How long are the PTs Tx for?
Ampicillin
Amoxicillin
Pen G
Genifloxacin
levofloxacin
Moxifloxacin
Afebrile x 5 days
Prevention of Strep/Pneumo pneumonia is best w/ pneumococcal vaccine given when ?
Atypical pneumo can be caused by ? 3 microbes
+65y/o
High risk Dxs
2wks prior splenectomy
ImmComp
Mycoplasma Pnemo*
Legionella Pneumo
Chlamydia psittaci
What is the MC cause of CAP?
What unique Sx does it present with?
Since CAP is Dx w/ clinical presentation, what may be seen on CXR?
How is it Tx
Mycoplasms pneumo in PTs 5-35y/o
Acute ottitis media- (Bullous myringitis)
Fluffy infiltrates w/ diffuse lobular involvement
Doxy/Azithromycin
How is MAC Tx or prevented
How is Chlamydia Psittaci Dx
How is it Tx
Tx: Clarithromycin
Prev: Azithromyvin
CXR
LFTs
Serlogic testing w/ PCR
Azith
Doxy
What are the S/Sxs of Chlamydia Psittaci that are unique
What type of microbe is legionella and where is it harbored
Hematuria
Photophobia
Horder spots
Splenomegaly
Gram neg bacteria in cooling water systems
Who’s more likely to get Legionella
How is this different
Men Smoker Alcoholic ImmSupp DM
Confusion/neuro Sxs
GI Sxs
Liver/renal Dz
How is Legionella Dx
How is it Tx
Multi-lobar CXR w/ rapid deterioration
Urine Ag test for Serogroup 1
Sputum culture
Levofloxacin
Azithromycin
When can Staph A cause pneumonia in kids
What Sx will be absent in kids but is present in adults
How is this Dx
First 8wks of life preceding viral infection
Pneumatoceles
CXR
Blood culture
Sputum Gram stain
How is Staph A pneumonia Tx
Staph A is morel likely if ? pre-existing Dz is present
MSSA- nafcillin
MRSA- vancomycin
Abscess present= ventilator
Empyema= chest tube
Influenza
Adults w/ Staph A pneumonia needs to have what other Dx considered simultaneously
What other bacteria can cause CAP/
Influenza
Morazella Cat
Hemophilus influenza
What other bacteria can cause bacterial pneumaoni in hospitals or neutropenic acquired
How is Kelbsiella pneumonia Tx
Proteus
Psuedomonas
Providencia
Gram-neg rod microbes
Piperacillin/tazobactam
Bronchitis is the result of ?
What two atypicals can cause this
Respiratory Virus
Mycoplasma
Pertussis
What two microbes can be isolated from brnchitis sputum even if PT is ASx
Usually no ABX are given for bronchitis, but what two can be given it PT has mild/mod case and is smoker
Strep pneumo
H influenza
Amoxicillin
How does pertussis present in infants
What is PE finding/sign is Dx for pertussis
Apneic spells
Frenal ulcer
How is pertussis Dx
How is it Tx
What microbe causes ARDS
DFA or culture
Azithromycin
Corona virus- 6 types
What is the biggest risk factor for acquiring ARDS if PT is <50y/o
Herpes genitalis is characterized by ?
Obesity- inc inflammation
Ulcerative/Necrotic cervical mucosa
Blood cultures for FOUO work up are grown x ?wks
What type of microbe is plague
2wks
Plague- Gram - coccobacillus bipolar safety pin
What does JORRP stand for
PT presents w/ hemorrhagic mediastinitis, what is the next step
Juvenile Onset Recurrent Respiratory Papillomatosis
Vertical transmission HPV 6/11
CXR for wide mediastinum from anthrax
What is used for anthrax exposure prevention
This is also used for ?
DOD Avip vaccine/PrEP
Post exposure for unvaccinated PTs
What is recommended for immediate protection from anthrax?
Smallpox vaccine is ? type
Vaccine + 60 days antimicrobials
Intradermal inoculation w/ bifurcated needle
PTs that import pets into US from overseas may need ? vaccine
Drew drop on rose petal= ?
Cidofovir- small/monkey pox vaccine
Varicella
? STD has the largest reported numbers to the CDC for any reason
What are the constitutional Sxs seen w/ 2* Syphilis
Chlamydia
HA Malaise Sore throat Fever
? STD can present w/ a necrotic rash?
What part of this STD is contagious
2* syphilis
Mucous patches
What are the microbes causing BV and the color of d/c
Gardnerella: gray d/c
Trichomoniasis: green d/c
Candidiasis: white d/c
Clue cells may be AKA ?
PT education piece when using -azoles for BV
Epithelial clumping
Metallic taste
No ETOH consumption
? bug infestation may present as ASx in kids
? ectoparasite infestation is an epidemic in the US?
Pediculosis
Scabies
When do bed bug prevalence activity increase?
Use extreme caution or avoid cryofreezing HPV warts off of ?
Don’t freeze warts off of ?
Before dawn
Penile meatus
Urethra meatus
PT is “peeing fire” has ?
3 Dzs w/ buboes in DDx
Gonorrhea
Plague Chancroid LGV
PT w/ NG urethritis that either had MSM, has PID or experienced premature labor contracted ? microbe
Acute S/Sxs of viral hepatitis
3 S/Sxs of advanced Dz
Mycoplasma genitalium
FAM AND
Fever Anorexia Malaise
Aversion N/V Diarrhea
Coca cola urine
Jaundice
Tender hepatomegaly
Define Fulminant Hepatic Failure
What other body system will have decreased function w/ this form of hepatitis
LF w/ hepatic encephalopathy
Hep A/B- 1%
E in Asia
C if super infected w/ A
Renal function is decreased
What are the incubation time from shortest to longest of the hepatitis viruses?
? form of Hepatitis can be acquired from perinatal exposure?
A: 15-50, Avg- 28 days
E: 15-60, Avg- 40 days
B: 45-180, Avg 60-90 days
C: 49-56 days
Hep B
50% of Hep C PTs belong to what 4 PT populations
HIV co-infection w/ Hep C triples ? three risks
Hepatitis C Tx is controversial due to hepatotoxic meds + inflamed liver may dec ? production
Uninsured Veterans IVDU Prisoners
Liver Dz/failure/related death
Clotting factors
HIV replicates in/on ? cells?
This type of cell includes ? 5 types
CD4 surface receptor
Monocyte Macrophage Microglial Alveolar macrophage Dendritic
Define HIV eclipse phase
At ? level does HIV become detectable?
What is being measured for detection?
Infection establishes within lymphoid tissues, not at detectable levels
10K
HIV RNA
What physiological process indicated HIV infection has taken and is in the PT
Acute Retroviral Syndrome:
inflammatory response of cytokine storm
? 9 OIs are indicative of a definitive AIDS Dx w/ or w/out HIV dx/evidence
Candida
Crypto
Cytomegalo
HSV
Kaposi: HHV-8
Lymphoma, brain
Mycobacterium
Pneumocystis
Toxoplasmosis
? is the MC space occupying lesion in an AIDS infected PT
? is a common infection in ImmunoCOMPETENT PTs
What is the MC IO in AIDS PTs
Toxoplasmosis
Cytomegalovirus
Jiroveci pneumonia
What are AIDS Pts w/ CD-4 count below 50 given for protection against M. Avium infections
How are HSV, CMV, measles and varicella pneumonias Dx
Clarythromycin
Azithromycin
HSV: Ag detection IF/PCR
CMV: Ag detection IF/PCR
Measles: hemaglutination, culture
Varicella: Ag detection, IF
PTs w/ bowel resection in MedHx may contract ? type of respiratory issue
ImmunohistoHx
Bacterial pneumonia
Cell/tissue ID through Ag/Ab interactions
