IM-ID Flashcards
What test is used in primary syphilis that has the higher sensitivity (>97%)
Treponemal tests (Fluorescent treponemal antibody absorption- FTA-antibodies)
What is the bug and the treatment?
White plaques
- Candidia
- Fluconazole
What is the bug and the treatment?
Large linear ulcers
- CMV
- Ganciclovir
What is the bug and the treatment?
Vesicle and round/ovoid ulcers
- HSV
- Acyclovir
What is the bug and the treatment?
Aphthous ulcer
nonspecific canker sore
- for recurrent- use prednisone (if not responding to topical corticosteroids)
Aspiration pneumonia can expose pt with what organisms and the tx
- anaerobic
- clindamycin
foul-smelling sputum
anaerobic organisms
periodis febrile paroxysms, nonspecific malaise, headache, N/V, abd pain, myalgia, pallor, jaundice, petechiae, hepatosplenomegaly
Malaria
how do you diagnose Malaria
-Thin & thick peripheral blood smears
How does one gain protection from Malaria (not including medications) (2)
- Hemoglobinopathies (Hgb S, Hgb C, thalassemia)
- Partial immunity from previous malaria illness
The 5 antimalarial drugs are
- Atovaquone-proguanil
- Doxycycline
- Mefloquine
- chloroquine
- Hydroxychloroquine
What are the duration of the 3 stages for Lyme disease
- early localization (days-1month)
- early disseminated (weeks-months)
- Late (Months-years)
Clinical features for 1st stage (early localization) (5)
Erythema migrans Fatigue headache myalgias arthralgias
Clinical features for 2nd stage (early disseminated) (5)
Multiple erythema migrans unilateral/bilateral CN palsy ( CN VII) Meningitis Carditis (AV block) Migratory arthralgias
Clinica features for 3rd stage (late) (3)
Arthritis
Encephalitis
Peripheral neuropathy
Tx for Lyme disease
Doxcycline
4 bugs that can cause Urethritis in men
Neisseria gonorrhoeae (most common)
Chlamydia trachomatis
Mycoplasma genitalium
Trichomonas (rare)
Diagnosis used for Chlamydia trachomatis is
Nucleic acid amplification testing
Fever (>102.2), bradycardia related to fever, neurological symptoms, GI symptoms (diarrhea), unresponsive to beta-lactam and aminoglycoside, Cxray patchy infiltrates. Bug?
How do you treat (2)?
Legionella pneumophila
Macrolides or fluoroquinolones (levofloxacin)
Lab clue for Legionella PNA (5)
- Hyponatremia
- hepatic dysfunction
- Hematuria &
- proteinuria
- Sputum gram stain;- many neutrophils and few or no microorganisms
Infective endocarditis due to Eikenella corrodens (gram -) anaerobe is common in what settings (3)
- Poor dentition
- Periodonal infection
- dental procedures that manipulation of the gingiva or oral mucosa
Prolonged fever, malaise, exudative pharyngitis, hepatosplenomegaly, generalized lymphadenopathy, hemolytic anemia and thrombocytopenia
Dx? Organism? Diagnostic?
- Infectious mononucleosis
- EBV
- antiheterophile antibodies (monospot test), atypical lymphocytes on blood smear, & Coombs test
How to treat toxoplasma encephalitis and ppx?
Sulfadiazine and pyrimethamine
- antiviral initiations
and ppx TMP-SMX (CD4<100)
Slowly progressive confusion, paresis, ataxia, and seizure in HIV pt
Progressive multifocal leukoencephalopathy (PML)- JC virus reactivation with CD4 <200
The 3 PEP drugs (post-exposure prophylaxis) are
- 2 NRTI ( Tenofovir + Emtricitabine)
- 1 from intergrase inhibitor (raltegravir) or protease inhibitor or NNRTI
Most likely microb to cause infective endocarditis in patients with
Prosthetic valves, intravascular catheters, implanted devices, IV drug users
Staphylococcus aureus
Most likely microb to cause infective endocarditis in patients with
Gingival manipulation
Respiratory tract incision or biopsy
Viridans group streptococci (S. mutans, S. mitis, S. oralis, S. sanguinis)
Most likely microb to cause infective endocarditis in patients with
prosthetic valves, IV catheters, Implanted devices
Staphylococcus epidermidis
Most likely microb to cause infective endocarditis in patients with nosocomial UTI
Enterococci
Most likely microb to cause infective endocarditis in patients with colon carcinoma, IBD
Streptococcus gallolyticus (S. Bovis)
Most likely microb to cause infective endocarditis in patients with an Immunocompromised host, IV catheters, prolonged antibiotic therapy
Fungi (Candida species)
Common causes of diarrhea in pt with AIDS (4)
- Cryptosporidium parvum
- Microsporidium/Isosporidium
- Mycobactrium Avium complex (MAC)
- Cytomegalovirus (CMV)
The organism that causes Hydatid cyst? what is the definite host? what does the lesion look like on CT?
- Echinococcus granulosus
- Dogs definitive host
- eggshell calcification
Quick onset (1-6hrs), vomiting predominant. What bug? mechanism of foodborne illness
- Staph aureus & Bacillus cereus (reheated rice)
- Enterotoxin ingestion
Delayed onset (>1day), watery/bloody diarrhea, What bug? mechanism of foodborne illness
- Clostridium perfringens, ETEC/STEC, Vibrio cholera
- Enterotoxin made in intestine
Variable onset, watery/bloody diarrhea, fever, systemic illness, What bug? mechanism of foodborne illness
- Campylobacter Jejuni, nontyphoidal salmonella, Listeria monocytogenes (systemic illness)
- Bacterial epithelial invasion
Symptoms of UTI, with UA pH of 8.5, with urinary calculi. What is the bug?
Proteus mirabilis- urease-producing bacterium
with Struvite stones (mg ammonium phosphate)
Bright red, firm, friable, exophytic nodules in a HIV pt, is? cause? Tx (2)?
- Bacillar angiomatosis
- Bartonella (hensele/Quintana) (Gram neg bacillus)
- Oral erythromycin or doxycycline
who are the patient at risk for bartonella exposure?
- cat exposure
- homelessness (lice)
- Severe immunocompromise (advanced HIV-CD4<100)
Hx of tick bite, febrile illness with symptomatic symptoms, leukopenia and or thrombocytopenia, elevated aminotransferases and rash with pt in endemic region. What is the bug?
Ehrlichia chaffeensis and E ewingii- Enhrlichiosis
Tx for uncomplicated acute pyelonephritis (2)
- Oral fluoroquinolone
- Trimethrprim-Sulfamethoxazole
Tx for complicated acute pyelonephritis (3)
- IV fluoroquinolone
- Aminoglycoside
- Extended spectrum beta-lactam/cephalosporin
indolent headache, malaise, fever, persistent dry cough, pharyngitis (nonexudative), macular/vesicular rash. Bug?
Mycoplasma pneumoniae
dx for Mycoplasma pneumonia (3)
- Normal leukocyte count
- Subclinical hemolytic anemia (Cold agglutinins)
- Interstitial infiltrate (Cxray)
Tx for Mycoplasma pneumonia (2)
- Macrolide or respiratory fluoroquinolone
Headache, malaise, fever, exudative pharyngitis/tonsillitis, lymphadenopathy and splenomegaly. Bug?
Epsten-Barr virus (Infectious mononucleosis)
-Ingestion of undercooked meat (pork),
-from Mexico, china, Thailand, central Europe and Argentina
- Gastric acid releasing larvae (1 wk of ingestion) that invade small intestine and develop into worms
- Female worms release larvae that migrate and encyst in striated muscle
Bug?
Trichinellosis
Clinical presentation for Trichinellosis (8)
- abd pain,
- N/V,
- diarrhea
- Myositis
- fever,
- subungual splinter hemorrhages
- Periorbital edema
- Eosinophilia
An HIV patient should get HAV vaccine when? (3)
- Chronic liver disease (including HBV and HCV)
- Men who have sex with men
- IV drug users
An HIV patient should get HBV vaccine when?
All patient without documented immunity to HBV
An HIV patient should get HPV vaccine when?
All pt age 11-26
An HIV patient should get Influenza vaccine when?
Annually for all pt (inactivated formulation)
An HIV patient should get meningococcus (serogroups A, C, W, Y) vaccine when?
All patients
An HIV patient should get pneumococcus vaccine when? which one? (2)
- PCV13 once
- PPSV23 8 weeks later, 5 years later & at age 65
An HIV patient should get Tdap vaccine when? (2)
- Tdap once (repeat with each pregnancy in women)
- Td every 10 years
Which live vaccines are contraindicated if CD4 <200? (3)
- MMR
- Zoster
- Varicella
Who do you treat HIV pt with progressive disseminated histoplasmosis
Amphotericin B
Acute symmetric arthritis of the hands, knees and ankle joints, Bug? Dx?Tx?
- Parvovirus B 19
Anti-parvovirus B19 IgM
-self-limiting
Transient Pure red cell aplasia in pt with Sickle cell anemia
Parvovirus B 19
Fever, Nausea and rash (slapped check)
Erythema infectiousm (fifth disease) Parvovirus B 19
After your remove a tick with forceps/tweezers when do you prophylaxis for Lyme disease? It must meet all 5
- if >36hrs attached
- Ppx with in 72hr of tick removal
- No contraindication to doxycycline (pregnant or lactating)
- Attached tick is an adult or nymphal/Ixodes scapularis (deer tick)
- Local Borrelia burgodorferi infection rate >/= 20%
What are the work up needed for PCP (pneumocystic jiroveci PNA) (3)
- elevated LDH level
- Diffuse reticular infiltrates on imaging
- Induced sputum or BAL (stain)
Tx for PCP (pneumocystic jiroveci PNA) (2)
- TMP-SMX
- Prednisone if low oxygen level
Ppx for PCP (pneumocystic jiroveci PNA) in HIV pt
- TMP-SMX
- Antiretroviral
HIV pt with subacute cough and a cavitary, inflammatory upper lung lesion is likely to be
reactivataion TB
which bacterial likes to infect the lung apices due to high oxygen tensions and slower lymphatic elimination
Mycobacterium TB- causing reactivation TB at the site of latent infection (apical lobes)?
PPD testing is duration is __ for HIV pt
> /= 5mm at 48-72hrs
The most common behavioral risk factor for TB in USA is
Substance abuse
Diffused reticulonodular pattern on xray on HIV pt, with extrapulmonary disease in the lymph nodes, liver, bones and central nervous system
Miliary TB
Millet seed seen on cxray
frequent small volume diarrhea, hematochezia, abd pain, low-grade fever, weight loss in HIV pt. Bug?
cytomegalovirus, CMV
electric sensation that runs through the back and into the limbs. Name? Dx?
- Lhermitte’s phenomenon/barber chair phenomenon
- Multiple sclerosis
HIV pt, fever, cough, abd pain, diarrhea, night sweats, wt loss, CD4 <50. Dx? Tx(2)?
Mycobacterium avian complex (MAC)
Azithromycin (can be used ppt) and clarithromycin
Two genital ulcers that are painful
- HSV
- Haemophilus ducreyi (Chancroid)
Two Genital ulcers that are painless
- Treponema Pallidum (Sypilis)
- Chlamydia trachoma’s servers L1-L3 (lympogranuloma venereum)
Small, shallow genital ulcer-can progress to painful, fluctuant adenines (buboes)
Chlamydia trachoma’s L1-L3
Single ulcer, regular borders and hard base
Syphilis (chancre)
Action and SE of Levodopa + Carbidopa
- Dopamine precursor
- Somnolence, confusion, hallucinations, Dyskinesia, dizziness, headache, agitations
After many years of therapy- Involuntary movements
Small pruritic vesicles or ulcers on erythematous base
Mild lymphadenopathy? Tx?
HSV
Acyclovir
slowly progressive, non painful, indurated mass around the submandibular, sinus tracts with sulfur granules, thick yellow discharge, fever/lyphadenopathy
Dx? Tx?
Actinomyces
Penicillin 2-6 months , if sever surgery
Filamentous gram+ rods with rudimentary branching
Actinomyces
3 risk factors for Rhino-orbital-cerebral mucormycosis
- DM (ketoacidosis)
- Hematologic malignancy
- Solid organ or stem cell transplant
Treatment of r mucormycosis (Rhizopus) (2)
- Surgical debridement
- Liposomal amphotericin B
Sudden-onset server, stabbing pain along the V2 (maxillary) and V3 (mandibular) area. Dx? mechanism
Trigeminal neuralgia (usually unilateral and bilateral if it is with MS) - Demyelination of the nerve nuclei
Triad of tenosynovitis, dermatitis ( papule and pustules), asymmetric migratory polyarthralgias
or
- Purulent monoarthritis
Disseminated gonococcal infection
Neisseria gonorrheae
The most common secular transmitted disease causing septic arthritis
Disseminated gonococcal infection
Tx for viral (HSV) encephalitis
IV acyclovir
Culture media used for cryptococcal
Sabouraud agar
Tx for cryptococcal meningoencephalitis (2)
Amphoteric B with flucytosine (Initial)
Fluconazole (maintenance)
Common fungus in south/south-central states, Mississippi and Ohio river valleys, upper midwest states, great lakes step and Canadian provinces
Blastomycosis
low grade fever and violacoeous skin lesions with scrapings showing yeast, progressing to micro abscess
balstomyces dermatiditis
sore that, fever, muffled voice, drooling, stridor, and hoarseness
Infectious epiglottis (H Influenze type B)
Which microbiology gives those infective endocarditis associations?
Prosthetic valves
IV catheter
Implanted devices
IV drug users
Staphylococcus aureus
Which microbiology gives those infective endocarditis associations?
Gingival manipulation
Respiratory tract incision or biopsy
Viridans group streptococci
Which microbiology gives those infective endocarditis associations?
Prostatic valves
IV catheters
Implanted devices
Staphylococcus epidermidis
Which microbiology gives those infective endocarditis associations?
Nosocomial UTI
Enterococci
Which microbiology gives those infective endocarditis associations?
Colon carcinoma
Inflammatory bowel disease
Strptococcus gallolyticus (S. Bovis)
Which microbiology gives those infective endocarditis associations?
Immunocompromised host
IV catheters
Prolonged antibiotic therapy
Fungi (Candida species)
Tropical/Subtropical parts of central/south America, Africa, and Asia
A Aedes mosquito (that transmits dengue and Zika)
Chikungunya fever
Sever polyarthralgias, high fever, headache, myalgia, conjunctivitis, maculopapular rash, lymphopenia, thrombocytopenia, transaminitis
Chikungunya fever
Solid organ transplantations getting high-dose immunosuppressive medication are at risk for which two opportunistic infections?
- Pneumocystis pneumonia (PCP)
- Cytomegalovirus (CMV)
Systemic illness involving in patient with HIV/ Solid organ transplant with multiple organ systems symptoms like Pneumonitis, hepatitis, and GI-diarrhea should be tested for
CMV viremia
Abx used for lung abscesses, skin and soft-tissue infections, female URT infections- covers Gram+ and anaerobes
Clindamycin
Human bites have what kind of microbes? Tx?
- both aerobic and anaerobic
- Amoxicillin-Clavulanate (Augmentin)
fatigue, elevated transaminases, arthralgia, and kind findings with recurrent blisters on back of hand and forearm
Chronic hepatitis C infection with porphyria cutanea trarda (PCT)
HCV is strangely associated with
PCT (porphyria cutanea tarda)
Endemic mycosis of the desert southwest that causes community-acquried pneumonia,
often accompanied by arthralgia, erythema nodosum, and erythema multiforme.
Tx?
- Coccidioides
- Ketoconazole or fluconazole
Wt loss, fever, night sweats, Cxray- alveolar infiltrates and nodules with cavitation, immunocompromised host, finding on culture Gram+, partially acid-fast, filamentous, branching rods
Dissemintated disease include lung, brain and skin. Dx?
Tx?
Nocardia
- Trimethoprim-Sulfamethoxazole
When is one time PPSV23 alone recommended as a one time vaccine?
For adults <65, current smokers or
other conditions hearth or lung disease, DM, chronic liver disease
When is the PCV13 vaccine recommended
adults age > 65 followed by the PPSV23 at least 6-12 months later
Health care workers without previous HB vaccination or adequate antibody response, exposed to blood from HB patients should receive post-exposure prophylaxis with
-get complete HB vaccine series
1st dose within 12hrs
next doses with standard schedule
-Also they need to receive HB immune globulin as soon as possible (<24hrs)
Endomic to the nerowastern US, erythema migrant, carditis(AV block), and neurologic manifestations
Lyme disease
- Spirochete Borrelia burgdorferi
Skin infection of the upper dermis and superficial lymphatic system? Cause?
Erysipelas
group A Streptococcus
Individual with high-risk sexual intercourse should be screened for 2 viruses
HBV and HIV
Individual with use injection drugs, high-risk needle stick exposure or received blood transfusion before 1992 should be screened for what virus
HCV
electric sensation that runs through the back and into the limbs. Name? Dx?
Lhermitte’s phenomenon/barber chair phenomenon
-Multiple sclerosis
When overheated and elevated boy temperature worsts neurological symptoms (blurry or reduced vision…)Name?Dx?
Uhthoff’s phenomenon
-MS
The 4 disease pattern of MS are
- Relapsing-remitting
- Primary progression
- Secondary progressive
- Progressive relapsing
Diagnostic for MS (2)
- T2 MRI lesions
- Oligoclonal IgG bands
What part of the brain is affected in MS that is seen in MRI?
- Periventricular
- Juxtacortical
- Infratentorial
- Spinal cord
What type of gait disturbance does parkinsonism has
Shuffling gait
hyperkinetic gait
Action and SE of Levodopa + Carbidopa
- Dopamine precursor
- Somnolence, confusion, hallucinations, Dyskinesia
Action and SE of Trihexyphenidyl/benztropine
- Anticholinergic
- Dry mouth, blurred vision, constipation, Nausea and urinary retention
Action and SE of Amantadine
- Unclear mechanism
- Ankle edema and Lived reticulates
Action and SE of
Apomorphine, bromocriptine, pramiperxole, ropinorole
- Dopamine agonist
- Somnolence, hypotension and confusion, hallucinations
Action and SE of Entacapone or tolcapone
- COMPT inhibitor
- Dyskinesia, hallucinations, confusion, nausea, orthostatic hypotension
Action and SE of Selegiline
- MAO B inhibitor
- Insomnia and confusion
Sudden-onset server, stabbing pain along the V2 (maxillary) and V3 (mandibular) area
Trigeminal neuralgia (usually unilateral and bilateral if it is with MS)
Improperly canned foods (fruits and veg), aged seafood (cured fish), cause of the food borne disease
Clostridium botulism
-bilateral cranial neuropatheis, systemic descending muscle weakness, diaphragmatic weakness with respiratory failure
C. Botulisnum toxin
Tx of food-borne Botulism
Equine serum heptavalent botulism antitoxin
A brain dead person can have with central nervous system activities
Deep tendon reflexes
What are the two types of hearing loss
Sensorineural
Conductive
Disorder involving the inner ear, cochlea, or auditory nerve
Sensorineural hearing loss
any cause that limits sound from gaining access to the inner ear
Conductive hearing loss
The 5 sensorineural hearing loss disorders are
- Presbycusis
- Meniere disease
- Barotrauma
- Acoustic neuroma
- Cerebrovascular ischemia
The 5 causes of conductive hearing loss are
- Otitis external or media
- Cholesteatoma
- Trauma
- Cerumen
- Tympanic membrane perforation
Progressive bilaterally symmetric and predominantly high frequency sensorineural hearing loss that occurs over many years, tinnitus
Presbycusis (age related hearing loss)
What part tract in the UMN does pronator drift examine?
Pyramidal/corticospinal tract
The 5 abortive Migraine therapies are
- Triptans (sumatriptan)
- NSAIDS (naproxen)
- Acetaminophen
- Antiemetics (metoclopramide, prochlorperazine)
- ergotamine (dihydroergotamine)
The 4 preventives Migraine therapies
- Topiramate
- Divalproex sodium
- Tricyclic antidepressants
- Beta-blockers (propranolol)
Pt with lacunar stroke presents after weeks with paroxysmal burning pain over the affected area when light touched. Dx?
Thalamic pain syndrome
Allodynia
burning pain with light touch
Weakly ring-enhanced periventricular mass on MRI of HIV patient with EBV DNA in the CSF
Primary CNS lymphoma
Hx of HTN, HLD, DM2, sever dizziness, systolic bruit at the base of the neck above the clavicle on the Left side, 4th heart sound heard. cause and Dx?
Subclavian artery occlusion
Subclavian steal syndrome
