IM-Infectious Flashcards
Painful, grouped vesicles on penis
Diagnosis?
Initial test?
Accurate test?
Drug of choice?
GENITAL HERPES (HSV 2)
Initial test: Tzank smear
Accurate test: PCR of DNA scrapings
Drug of choice: Acyclovir (IV in neonatal herpes and HSV enceph), Valacyclovir
Nontender ulcerated nodule with indurated border
Diagnosis? Etiologic agent? Initial test? Accurate test? Drug of choice?
PRIMARY SYPHILIS
Etiologic agent: Treponema pallidum
Initial test: RPR VDRL?
Accurate test: Dark-field microscopy in primary
Drug of choice: Single dose Penicillin
Differentiate stages of Syphilis
Most infectious stage?
1 Chancre
2 Macular rash on palms and soles, Condyloma lata
-most infectious
3 Tabes dorsaljs, Neurosyphilis, Gummas, Argyll-Robertson pupil
Yellowish mucopurulent vaginal discharge, dysuria, unprotected sex
Diagnosis? Etiologic agent? Initial test? Accurate test? Drug of choice?
MUCOPURULENT CERVICITIS
Etiologic agent? N. gonorrhea or C. Trachomatis
Initial test? Swab for gram stain
Accurate test? NAAT or culture (Thayer-Martin Agar)
Drug of choice? Ceftri/cefix single dose + Azith/Doxy single dose
Hypogastric pain, fever, cervical motion tenderness
Etiologic agent? Next best step? Initial test? Accurate test? Drug of choice?
PID
Etiologic agent:
Next best step? Preg test, Bhcg
Initial test? NAAT or culture
Accurate test? For salpingitis, laparoscopy
Drug of choice? Ceftri single dose + Doxy x 14 days + Metro
Vulvar itching, white clumped discharge
VULVOVAGINAL CANDIDIASIS
C. Albicans
Fluconazole single dose
Vulvar itching, profuse whitish-yellowish HOMOGENOUS discharge, strawberry cervix
TRICHOMONAL VAGINITIS
T. Vaginalis, trophozoite
Wet mount
Metronidazole single dose
Treat asymptomatic partner
Fishy odor with 10% KOH Clue cells (coccobacillary)
BACTERIAL VAGINOSIS
G. vaginalis
Metronidazole x 7 days
Loose blood stools
Potato, egg salad
Nausea, vomiting, cramping abdominal pain
Diagnosis? Etiologic agent? Initial test? Accurate test? Drug of choice?
BACTERIAL FOOD POISONING
Etiologic agent: S. aureus
Best next step: Hydration
Cornerstone of dx: Stool analysis
Duration
Acute diarrhea
Persistent
Chronic
<2wks
2-4wks
>4wks
Fried rice
Bacillus cereus
Loose blood stools, burgers fries spag, low grade fever
Anemia, thrombocytopenia
E. Coli (EHEC)
O157:H7 toxin
Shiga toxin
Hemorrhagic colitis - grossly bloody diarrhea
Hemolytic uremic syndrome
-ARF, thrombocytopenia, microangiopathic Hemolytic anemia
Sudden onset nausea, vomiting, rice water diarrhea
CHOLERA
V. Chilerae
Most important: water, electrolyte
May give: oral tetra or doxy
Watery, greasy, foul smelling diarrhea, from camping/hiking
GIARDIASIS
G. Lamblia
AIDS
Chronic diarrhea and malabsorption
Cryptosporidium
CD4 <100
Fever, right upper quadrant abdominal pain
Anchovy paste on aspiration
AMEBIC LIVER ABSCESS
Etiology: E. Histolytica
Usually in right lobe of liver
Tx: metro + iodoquinol
Amebic colitis
- definitive: trophoizoite with rbc in stool
- flask shaped ulcer
- metro + iodoquinol
Asymptomatic carrier: iodoquinol
Salmon-colored, maculopapular rash on trunk (rose spots)
Bradycardia at peak of fever
Muttering deliriun, coma vigil at the height of fever
HALLMARK: fever + abdominal pain
TYPHOID FEVER
S. typhi
Accurate test: blood culture (BUS)
Antibx: Ciprofloxacin
Most common manifestation: enterocolitis
Waded on flood waters, fever, body aches, conjunctival suffusio , abdominal pain, jaundice, no urine output
Diagnosis? Etiologic agent? Initial test? Accurate test? Drug of choice?
LEPTOSPIROSIS
Next best step: hydrate with PNSS
Gold standard: Culture and isolation
Drug of choice?
- mild: Doxy
- severe:m (Weil’s): Pen G
Pulmo hemorrhage: methylpred w/in 12h
Predict AKI ahead of Crea: Urine NGAL
Chills, fever spikes, sweating stages
Travel to endemic area
Diagnosis? Etiologic agent? Initial test? Accurate test? Drug of choice?
MALARIA
Plasmodium
Accurate: Thick and thin blood smears
Infective stage: Sporozoites
Relapse: Hypnozoites
Severe falciparum: Artesunate then ACT
Nonfalciparum: ACT or chloroquine + primaquine
Pregnant: Quinine + Clindamycin
Prophy: 2wks before travel up to 4 weeks after travel
From Samar
Weight loss, abdominal enlargement, coffee ground vomiting
Hepatosplenomegaly, lymphadenopathy
SCHISTOSOMIASIS
hooklike spine: S. Japonicum
Terminal spine: s. Hematobium
Lateral spine: s. Mansoni
Infective: cercaria
Tx: praziquantel
Skin: swimmers itch, cercarial dermatitis
Skin, Liver: Katayama syndrome/Acute (high degree eosinophilia)
GI: chronic
Fever
Eosinophilia
Freshwater
Schistosomiasis
Fever
Eosinophilia
Raw pork
Trichinella
High vasculature:
Skeletal muscles, EOM (periorbital edema), cardiac (tachyarrhyrhmia)
Fever
Eosinophilia
Larvae currens
Strongyloides
Punctured wound
Trismus
Difficulty talking
TETANUS
Etiologic agent: C. tetani
Toxin: tetanospasmin, blocks gaba and glycine
Most common site: superficial abrasion, limbs
Affected first: face, jaw
Tx: Metro, HTIG
HIV titers highest in? (Body fluid)
Most common neurologic sydrome in AIDS
Measures risk of getting opportunistic infection:
Long term prognosis:
Antiretroviral effectiveness:
Semen, blood
AIDS dementia complex
CD4
Viral load
Viral load
CD4<200
Dry cough
Dyspnea
Hypoxia
PCP
Cotri (+steroids if with hypoxemia) x 21 days
CD4 <200
Headache
Nausea, Vomiting
Focal neurologic deficit
TOXOPLASMOSIS
Pyrethamine
CD4 < 50
Blurring of vision (retinitis)
Diarrhea (colitis)
CMV
Gancyclovir
CD4<50
Fever
Headacve
Neck stiffness
Cryptococcus
Amphotericin B + Fluocytocin
CD4 < 50
Fever
Weight loss
Fatigue
MAC
Clarith + Ethambutol
Prophy: Azith
Preferred imaging in fever of unknown origin
Most common etiology
Most implicated etiology
Most common diagnosis among neoplasms
Abdominal utz over CT scan
Infection
TB
Malignant lymphoma
