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internal medicine ishani > infections > Flashcards

infections Flashcards

1
Q

lyme ds causes by

A

borrelia burgdorferi

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2
Q

lyne ds transmitted by

A

tick

should be present in body for 24 hrs

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3
Q

characteristic lesion of lyme ds

A

erythema migrans

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4
Q

wht is erythma migrans

A

characteristic expanding skin lesion in lyme ds
red macule papule at the site of tick bite
annular lesion with partial central clearing target center
not often painful

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5
Q

stages of lyme ds

A

stage 1 localised infection
erythema migrans
stage 2 disseminated inf
secondary annular skin lesion
meningitis ,cranial neuritis ,carditis ,AV block
migratory musculoskeletal pain
stage 3 persistent inf
intermittent or persistent arrthris
polyneuropathy
acrodermatiits chronica atrophicans

post lyme syndrome / chronic lyme ds
subjective pain due to cognitive manisfestations , fatigue syn confusion with chronic fatigue syn and fibromyalgia

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6
Q

acrodermatiits chronica arophicans

A

late skin manifeststions of lyme ds stage 3
acral surface of arms and legs
red violaceous discolouration becomes atrophic or sclerotic

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7
Q

drug of choic of lyme ds

A

skin jt heart and some nervous involvement
doxycycline if > 9 yrs
amoxicillin if < 9yrs

some nervous , 3rd degree av block
iv ceftrixone

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8
Q

characteristic feature of relapsing fever

A

2 or more fever episodes varying periods of well being

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9
Q

cause of relapsing fever

A

antigenic variations of spirochetal surface

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10
Q

spirochetes gram behaviour

A

gram - ve but not seen under gram staining easily

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11
Q

endoflagella seen in

A

spirochetes

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12
Q

vector for relapsing fever

A

tick / louse
•tick- bites
•louse - rubbing of feces into bite site with fingers in response irritation
inoculation into conjuctiva or into open wound

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13
Q

clinical manifestations of relapsing fever

A

•sudden onset fever ends in crisis
due to killing be antibodies
for 15-30 min rigor increase in temp and dec in BP followed by profuse diaphoresis dec in temp and hypotension
• headache , neck stiffness , arthragia , myalgia

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14
Q

drug of choice for relapsing fever

A

tick borne 10 days treatment
louse borne single dose

less than 9yrs erythromycin
more than 9yrs doxycycline

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15
Q

weils ds caused by

A

leptospira

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16
Q

which spirochete has hooked ends

A

leptospira

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17
Q

transmission of leptospira

A

reservior rodents ( rats )
transmission direct contact with urine , blood, tissue from infected animal , environmental contamination
bacreria enters through cuts abraded skin , mucous membrane ( conjuctiva , oral mucosa )

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18
Q

phases of leptospiroses

A

biphasic
• leptospiremic phase 3-10 dys oraganism cultured from blood
• immune phase resolution of symptoms appearence of antibody

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19
Q

clinical manifestations of leptospiroses

A

mild leptospiroses flu like symptoms

severe leptospiroses weils syndrome

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20
Q

weils syndrome

A

severe form of leptospiroses triad

hemorrage
jaundice
acute kidney injury

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21
Q

loss of Mg is associated with ____ nephropathy

leptospira

A

nonoliguric hypokalemic renal insufficiency is characteristic of early leptospiroses

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22
Q

typical characteristic electrolyte disturbance of leptospiroses

A

hypokalemia hypomagnesimia hyponatremia

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23
Q

typical characteristic electrolyte disturbance of leptospiroses

A

hypokalemia hypomagnesimia hyponatremia

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24
Q

spirochetes include ___

A 
4 genera
leptospira 
borrelia 
treponema 
brachyspira
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25
Q

clinical manifestations of syphilis

A 
•primary syphilis  
       typical primary chanchre + regional inguinal lymphadenopathy painless 
•secondary syphilis 
          mucocutaneous lesion ( CONDYLOMATA LATA )
 generalised non tender lymphadenopathy 
  constitutional symptoms 
•latent syphilis 
      absent of clinical manifestations + positive serolgy + normal CSF  
•tertiary syphilis  
        ▪cardiovascular 
        ▪GUMMA 
•congenital syphilis
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26
Q

neurosyphilis

A

can occur at stage
•symptomatic meningeal , meningiovascular , stroke , parenchymal involvement ( paresis) tabes dorsalis charcot joints ,Argyll robertson pupil

• asymptomatic

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27
Q

tabes dorsalis

A

syphlitic myelopathy
late manifestations of syphilis
demylination of dorsal column and root ganglia

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28
Q

charcot joints

A

trophic joint degeneration due to loss of pain

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29
Q

linaer calcifiation of aorta on chest xray seen in

A

syphlitic aortits

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30
Q

cardiovascular syphilis

A

endarteritis obliterans of vasa vasorum which

complete it

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31
Q

mnemonic paresis

A 
p personality
a affect
r reflexes hyperactive 
e eye arygyl robertson 
s sensorium ( illusion , delusions 
i intellect ( memory, orienration, calculations, judgement)
s speech

SEEN IN PARENCHYMAL DAMAGE OF NEUROSYPHILIS

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32
Q

GUMMA ?

A

granulomatous inflammation with central necrosis due to endarterits obliteratans
can occur at any site
most common skin and skeleton

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33
Q

congential syphilis

A

early ( within 2yrs ) are infectious resemble secondary syphilis in result
rhinitis snuffles mucocutaneous lesions
bone lesions osteitis osteochondritis periostetis
hepatosplenomegaly

late 8th nerve deafness , keraitis
cluttons joint bilateral knee effusion

classic stigmata hutinchon teeth
mulberry molars
saddle nose saber shin

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34
Q

hutchinson teeth

A

seen in congenital syphilis
residual stigmata
centrally notched widely spaced peg shaped upper central incisors

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35
Q

test for syphilis

A

treponemal test for syphilis FTA ABS flourescent treponemal absorption test
TPPA TREPONEMAL particle agglutination , EIA/CIA treponemal enzyme immunoassays

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36
Q

initial test for examing csf for syphilis

A

VDRL

RPR easy to perform no heating required

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37
Q

principle of non treponemal and treponemal tests

A

igG and igM against cardiolipin lecithin cholesterol antigen conplex

treponemal test - ??

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38
Q

?

A

as treponemal test r likely to remain reactive even after adequate treatment

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39
Q

features of syphilis test

A

RPR / VDRL screening , diagnosis
quantitative measurement of ab to assses clinical syphilis activity to monitor response to therapy

FTA ABS TPPA EIA/CIA Confirmation of syphilis dx in a patient with reactive ?

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40
Q

test used to monitor therapy in syphilis

A

?

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41
Q

treatment of syphilis

A

primary, sec , early latent PENICILLIN G ( if allergic tetracycline)

late latent PENICILLIN G ( if allergic tetracycline)
neurosyphilis PENICILLIN G if allergic desentization and then penicillin
pregnancy same as neurosyphilis

is csf abnormal in any phase treat as neurosyphilis

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42
Q

ghons focus

A

lesion of lung parenchyma after initial infection usually perifery

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43
Q

ghons complex

A

ghons focus + regional lymphadenopathy

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44
Q

why post latent inf of tb localise to apical and posterior segments of upper lobes

A

due higher mean oxygen tension favors aerobic mycobacterial growth

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45
Q

areas most common involved primary tb

A

because most inspired air is to middle and lower lung lobe

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46
Q

lymph nodes tb

A

painless swelling most common cervical and supraclavicular
discrete initially matted later
nontender may develop fistulous tract
draining caseous material

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47
Q

meningeal invovlement in tb is pronunced in which region

A

base of brain

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48
Q

most common gi involved site in tb

A

terminal ileum and caecum

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49
Q

ACID FAST ORGANISMS

A 
mycobacteria
nocardia 
rhodococcus 
leigonella
isospora 
cryptosporidium
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50
Q

whipple ds caused by

A

trophyrema whippli

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51
Q

classic whipple ds manifestations as

A

combinations of arthalgia arthiritis , weigt loss, abdominal pain , fever

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52
Q

gram behaviour of trophyrema whippli

A

weakly gram +ve

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53
Q

clinical manifestations of whipples ds

A 
intestinal 
rheumatogic  arthritis 
others neurological cardial endocarditis pulmonary lymphatic ( mesentric retropeeitoneal if intestinal mediastinal in pulmonary 
ocular uveitis 
dermatologic hyperpigmentation
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54
Q

clinical manifestations of actinomycetes

A 
actinomycosis 
orocervical    orocervical facial sites       
thoracic 
abdominal 
cns brain abscess 
musculoskeletal 
soft tissue
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55
Q

lesions of actinomycosis

A

????
chronic indolent face lesions multiple lesions
central necrosis consisting of neutrophils
fibrotic walls over time sinus tract to skin adjacent organ or bone

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56
Q

mode of infections of actinomycosis

A

colonize mouth colon vagina

mucosal disruption may lead to infection at any site

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57
Q

bisphonates r associated with ___ inf

A

actinomycosis

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58
Q

DOC for actinomycosis

A

PENICILLIN

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59
Q

clinical manifestations of nocardiosis

A

pneumonia most common

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60
Q

actinomycetoma

A

begins as nodular swelling
most common at feet and hands
nodules break fistula appears fistulas tend to come and go with new one forming as old one disppeaes discharge serous or purulent may be bloody andoften contains white granules

systemic symptoms minimal

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61
Q

granules in nocardiosis

A

these r microcolonies extendendung radially from central core found in actinomycetoma but never in discharges in lesion of other form nocardiosis

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62
Q

actinomycetoma caused by

A

nocardia not actinomycetes

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63
Q

clinical manifestations of catscratch ds

A

numerous extranodal involving various

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64
Q

transmission of catscratch ds

A

major reservior cats

inoculation via contaminated flea feces usually result from cat scratch , bite

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65
Q

clinical manifestations of typical cats scratch ds

A

primary lesion small painless erythematosus papule or pustule at inoculation site
lymphadenopathy- enlarged painful granuloma formation overlying erythema suppration axillary epitrochlear most common ( head and neck , inguinal, femoral also)
constitutional- fever malaise anorexia night sweats

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66
Q

cause of trnch fever

A

bartonell qintana

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67
Q

5 day fever

A

trench fever / quintan fever

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68
Q

vector for trench fever

A

human body louse

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69
Q

ds by louse

A

trench fever

relapsing fever ??????

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70
Q

clinical manifestations of classical trench fever

A

fever is often periodic lasting 4-5 days
(range 3- 8 days )interval bw episodes
other symptoms HEADACHE back and limb pain
profuse sweating shivering myalgia arthralgia
spelnomegaly

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71
Q

___ r most common organisms in culture-ve endocarditis

A

coxiella burnetti

bartonella

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72
Q

bacillary angimatosis and peliosis

A

bartonella

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73
Q

wht bacillary angiomatosis & peliosis

A

bacillary angiomatosis lobular proliferation of small blood vessels lined by larged endothelial cells interspersed with mixed infiltration of neutro and lympho
peliosis small blood filled cystic space partially lined by endothelial cells mainly liver
both r ds of immunocompromised

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74
Q

orya fever by

A

bartonella

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75
Q

carrion ds consist of

A

oroya fever initial febrile bactremic phase with/ without sudden onset anaemia ( due to erythrocyte hemolysis due to bartonella reinvasion )
verruga peruana red hemangioma like cuteneus lesion

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76
Q

carrion ds vector

A

sandfly

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77
Q

ds by tick

A 
relapsing fever ( also by louse )
lyme ds ????
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78
Q

ds caused by bartonela

A 
catscratch 
trench fever 
endocarditis 
carrion ds ( oroya veruga peruana)
bacillary angiomatosis 
peliosis
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79
Q

F1 ANTIGEN found in

A

yersenia pestis

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80
Q

vector for plague

A

xenopsella cheopsis ratflea

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81
Q

clinical manifestations of plaque

A

•bubonic replication of bacteria inregional lymph nodes depending on site of bite
tense tender swelling most common inguinal ( due to bite )
•primary septicemic (due to bite ) without preceding LDN
pneumonic
PRIMARY - Inhalation
SECONDARY- hematogenous
meningitis
pharyngitis meat inhaltion

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82
Q

morphology of yersenia

A

GRAM - VE
bipolar coccobacilli
close safety pin APPEARANCE

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83
Q

clinical manifestations of nocardiosis

A

respiratory tract : pneumonia

extrapulmonary ds : due to dissemination
MC site is brain but can involve any site or organ
typical manifestations is in form of subacute abscess

following transcutaneus inoculation
cellulitis
lymphocutaneous ds
Actinomycetoma

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84
Q

clinical manifestations of tularemia

A

oropharyngeal( ingestion)
acute exudative membranous pharygnitis
ulcerative intestinal lesion
pulmonary (inhaltion)
ulceroglandular (tick bite )
skin lesion - ulcer at site erythematosus indurated punched out black base
regional lymphadenopathy depending on the site of inoculation
oculoglandular ( eyes contamination) purulent conjuctivitis with regional lymphadenopathy depending

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85
Q

doc of tularemia

A

gentamycin

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86
Q

clinical manifestations of cholera

A 
sudden onset of watery diarrhoea 
vomit 
fever absent 
muscle cramps due to electrolyte disturbances 
stool rice water stool 
 nonbilious gray slighly cloudy with flecks of mucus 
no blood
somewht fishy inoffensive odour 
r
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87
Q

doc of cholera

A

erythromycin/ azithromycin

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88
Q

vibro parahemolyticus

A

halophilic marine environment
consumption of improper cooked sea food or food contaminated with sea water cause gastroenteritis - watery diaarhoea
dysentery
less commonly wound infection
normal individual r at risk can be infected

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89
Q

vibrio vulnificus

A

halophilic sea water marine environment
cause
primary sepsis in immunocompromised with underlying liver ds / hemochromatosis
primary wound infection even in healthy

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90
Q

selective medium for vibrio

A

taurocholate tellurite gelatin

thiosulfate citrate bile salt sucrose tcbs

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91
Q

___ cause HEMOLYSIS on wagatsuma agar

A

vibrio parahemolyticus

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92
Q

kanagawa phenomenon

A

hemolysis on wagtsuma agar by vibrio parahemolyticus linked to its enteropathogenicity

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93
Q

darting motility seen in

A

campylobacter

vibrio

94
Q

clinical manifestations of campylobacter jejuni

A

gastroenteritis contaminated food and water
prodrome fever arthrits myalgia malaise
intestinal phase loose stools to grossely bloody
abdominal pain

95
Q

___ inf mimic ulcerative colitis and chrons ds

A

•campylobacter jejuni
biopsy finding same
• shigella

96
Q

doc campylobacter

A

erythromycin/ ciprofloxacin

97
Q

transport medium of vibrio

A

cary blair

alkaline peptone water

98
Q

clinical manifestations of shigella

A

4 phases
incubation period
watery diarrhoea
dysentry small volume of bloody mucopurulent stools with increased tenesmus and abdominal cramps
cause acute colitis mailnly distal colon and rectum
can cause toxic megacolon inflammation extending to smooth muscle layer
postinfectious phase

99
Q

ekiri syndrome

A

toxic encephalopathy with bizzare posturing , cerebral edema, fatty

100
Q

complications of shigella inf

A

toxic megacolon

HUS

101
Q

HUS CAUSED BY

A

ecoli enterohamerragic

shigella dysentry type 1 shiga toxin

102
Q

?

A

shigella dysentry shigatoxin

103
Q

doc of shigella

A

ciprofloxacin

104
Q

enteric fever caused by

A

salmonella typhi

salmonella parathphi

105
Q

clinical manifestations of enteric fever

A

fevr + gastrointestinal symptoms
fever
•most prominent prolonged fever can continue upto 4 wks

headache, chils , cough sweating , myalgia malaise arthralgia anorexia abdominal pain, nausea,vomiting, diarrhoea,
rose spots

physical examination 
coated tongue 
rose spots
neurological disorders  
hepatosplenomegaly 
abdominal tenderness 
relative bradycardia at peak of fever
106
Q

rose spots

A

faint salmon colored blanching maculopapular on trunk and chest

107
Q

doc of enteric fever

A

azithromycin

ciprofloxacin

108
Q

colonic character of pseudomonas

A

pigment production yellow green blue
shiny gun metal appearance
fruity odour

109
Q

ds caused by pseudomonas aeroginosa

A

effect anysite
rarely initiate infection in absence of host compromise
most commonly cause respiratory inf
most common cause of ventilator associated pneumonia
chronic infection in structural lung ds cystic fibrosis bronchiectasis due to altered mucociliaery clearence

110
Q

ecthyma gangrenosum

A

it is distinctive skin lesion by pseudomonas painful reddish maculopapular black necrotic
differentiates pseudo sepsis from other gram - ve sepsis
occur exclusively in neutopenic or AIDS

111
Q

pathogenesis of duodenal ulceration , gastric ulceration

A

•duodenal ulceration dec in somato producing D cells no inhibition of gastrin inc gastrin inc acid
(from a relatively spared gastic corpus )
•gastric ulceration and adenocarcinoma
inflammation in corpus + acid less despite hypergastrinemia ulcer at antral corpus junction

112
Q

clinical manifestations of h pylori

A

peptic ulcer ds
gastric adenoca
lymphoma

113
Q

test for hpylori

A

endoscopy
biospsy urease test
histology culture

non invasisve
urea breath test
stool antigen test

114
Q

treatment for hyplori

A

1 PPI + 2/3 antimicrobial for 7- 14 days

115
Q

regimens for hpylori

A

TOMS
metronidazole+ omeprazole +TETRACYCLINE + bismuth subsalicylate

COAT
CLATHIROMYCIN + OMEPRAZOLE +AMOXICILLIN +TINIDAZOLE

OMEPRAZOLE +AMOXICILLIN
OMEPRAZOLE + CLATHIROMYCIN + METRONIDAZOLE

116
Q

acenitobacter infections

A

???

117
Q

ds caused by ecoli

A

intestinal and extraintestinal

intesstinal 
mneumonic STIPA 
EXTRAINTESTINAL 
UTI
•pneumonia mostly in hospital acquired 
• abdominal and pelvic inf 
•meningitiis one of leading cause of neonatal meningitis other being streptococcus 
cellulitis 
musculoskeletal 
bactremial
118
Q

STIPA MNEMONIC? INTESTINAL PATHOGENIC ECOLI

A

STEC/EHEC/STEAEC shiga toxin producing
enterohamerragic/ shiga toxin producing enetroaggregative
causes HUS / hemolytic colitis
ETEC ENTEROTOXIGnic
causes travellers diarrhoea
EPEC enteropathogenic
causes watery diarrhoea , persistent diarrhoea
EIEC enteroinvasive
cause dysentry
EAEC enteroaggregative
causes travellers diarrhoea, acute diarrhoea, persistent diarrhoea

STEC AND EIEC bloody stools
STEC no fever
EIEC mucus blood inflammatory cells , abdominal pain, tenesmus , fever

119
Q

STEC

A

enterohamerragic ecoli

120
Q

HUS and hemorragic colitis caused by

A

EHEC

121
Q

mechanism of enterohamerragic ecoli enterotoxin

A

consist of heat labile toxin LT
activates adenylate cyclase inc cyclic AMP
consist of 2 subunits A and B subunit
A cause ribosylation of adp
B binds to GM1 ganglioside receptors for entry of subunit A
AND heat stable ST
activates guanylate cyclase inc cyclic GMP

122
Q

antibiotic not recommended for EHEC WHY?

A

may increase incidence of increased production of shiga toxin

123
Q

doc of ecoli

A

floroquinolones

azithromycin

124
Q

?

A

•klebsiella oxytoca hospital setting
•klebsiella pneumonie subsps rhinoscleromatous causes rhinoscleroma
granilomatous mucosal uri tht progresses slowly cause necrosis and obstruction of nasal pathway

klebsiella ozeane - atrophic rhinitis

PNEUMONIA
UTI
ABDOMINAL INFECTION
HPKP common cause of monomicrobial community acquired pyogenic liver abscess

125
Q

swarming motility on agar plate seen by

A

proteus

126
Q

ds caused by proteus

A

produce urease hydrolyse urea to ammonia alkanization of urine
stones struvite
formation of biofilm on catheters

127
Q

medium of bordetella

A

bordet gengue

regenlowe

128
Q

clinical manifestations of pertusis

A

•catarrhal indistinguishable from common cold
coryza , lacrimation, mild cough, low grade fever , malaise after 1-2 wks whooping cough
•paroxymal whooping cough associated with protuding tongue , cyanosis , post tussive vomiting
•convulsant after 2-4 wks gradual resolution of coughing episodes

complications 
subconjuctival hrges 
abdominal hernia
hemothorax
facial truncal petechiae
129
Q

clinical manifestations of pertusis

A

•catarrhal indistinguishable from common cold
coryza , lacrimation, mild cough, low grade fever , malaise after 1-2 wks whooping cough
•paroxymal whooping cough associated with protuding tongue , cyanosis , post tussive vomiting
•convulsant after 2-4 wks gradual resolution of coughing episodes

130
Q

doc of bordetella

A

macrolide

131
Q

leignellosis

A

consist of 2 clinical syndrome
pontaic fever acute febrile self limiting fever
leegionnairs ds ( pneumonia )
abdominal pain , nausea ,vomiting

132
Q

BCYE MEDIUM IS FOR

A

legionella

buffered charcoal yeast extract

133
Q

mode of transmission of leigonella

A

aquatic reservoir ie water distribution systems
devices filled with tap water
nebulizer humidifier
mist machine
aerosolization and direct instillation
most common aspiration
from oropharyngeal colonisation or drinking of contaminated water

134
Q

pontaic fever

A

acute febrile self limited fever caused by leigonella

135
Q

leigonella ds

A

diffrential diagnosis of atypical pneumonia

136
Q

doc of leigonella

A

macrolide

respiratory flouroquinolones

137
Q

most common bacterial cause of exacerbation of COPD

A

h influenzae

moraxella catarrhalis

138
Q

clinical manifestations of moraxella

A

nasal manifestations common in children
otitis media
sinusitis
COPD exacerbation

139
Q

hemophilus ducryi

A

characterised by genital ulceration + inguinal adeniits
painful nonindurated ulcer
bleeds easily
inguinal adeniits is tender suppurate

140
Q

hockey puck sign

A

used to differntiate moraxella catarrhalis from commensal neisseral colonies tht r part of upper airways
moraxella colonies can slid across agar surface without disruption

141
Q

ribosyl ribitol phosphate is found in

A

capsule of h influenzae

142
Q

clinical manifestations of h influenzae

A

meningitis manifests at <2yrs
epiglottis at 2-7 yrs
cellulitis not so important
pneumonia

143
Q

most common cause of childhoods otitis media

A

hinfluenzae
strep pneumonie
moraxella catarrhalis

144
Q

drugs for hemophilus

A

ceftrixone CEPHALOSPORIN

145
Q

pathogenesis of neisseria meningitis

A 
endothelial injury  can lead 
increased vascular permeability 
loss of resistance 
intravascular 
myocardilal dysfunction 
?
146
Q

clinical manifestations of neisseria meningitis

A

meningitis
meningiococcal septicemia
rash - initially blanching in nature then becomes petechial and then finally purpuric

147
Q

common causes of petechial or purpuric rash

A 
enterocviris
measeles
EBV 
parvovirrus 
deficiency of protein C and S 
platelet disorders 
connective tissue disoreders
pneumococcal
streptococcal
staphylocca
148
Q

identification of neisseria on thoraot swab not of value because ?

A

component of normal flora

149
Q

traumatic gas gangrene caused by?

A

clostridium perferngis due to anaerobic environment?

150
Q

pathogenesis of gas gangrene

A

extracellular toxin
alpha - occlusion of blood vsels by herotopic aggreagetes of lympho and ?
theta toxin - form ring like spores

151
Q

treatment of gas gangrene

A

penicillin and clindamycin

152
Q

histopathalogy of gas gangrene

A

paucity of leumocytes in infected tissue

accumulation of leulocytes in adjacent vsels

153
Q

doc for listeria

A

ampicillin

154
Q

clinical manifestations of listeria

A

gastroenteritis and septicemia most common
bacteremia
meningitis
aseptic meningitis
in older and debeliated
meningioencephalitis
focal abscess
inf in pregnant and neonate
nonspecific acute or subacute febrile illness
with myalgia malaise arthralgia backache
preterm
granulomatosis infantiseptica ( listerial fetal infection with military microabsess and granulomas in skin, liver,spleen)

155
Q

mode of transmission of listeria

A

food borne contamination

156
Q

bacteria seen in form of clusters of parallel rays

A

corynebacterium refereed to as chinese letter appearence

157
Q

corynebacteriophage

A

responsible for toxigenic conversion of tox- ve coryne into tox+ coryne

158
Q

mechanism of action of diphteria toxin

A

A and B fragment
delivery of A fragment into cell cytosol result in irreversible inhibition of protein synthesis by NAD dependant ADP Ribosylation of elongation factor 2

159
Q

inhibtion of ef-2 done by

A

diptheria

160
Q

characteristic finding od diptheria

A

mucosal ulcer with pseudomembranous coating
it is composed of inner band of fibrin and luminal band of neutrophils
mucosal ulcers result from necrosis of epithelium

161
Q

why call pseudomembrane in diptheria

A

because tightly adhrent and attempt to dislodge cause bleeding

162
Q

leading causes of pharyngitis

A 
viral 
   rhinovirius 
   influenza 
   parainfluenza
    corona 
    adeno 
stereptococcal 
atypical mycoplasma pneumonie 
chlamydia pneumonie
163
Q

clinical manifestations of diptheria

A 
respiratory  
    sore throat 
    low grade fever 
     pseudomembranous 
 bulls neck ( massive edema of submamdibular and paratracheal region)
cutaneus  
  punched out ulcerative lesion 
systemic manifestations
164
Q

complications of diptheria

A

airway obstruction
polyneuropathy
myocarditis

165
Q

treatment of diptheria

A

procaine PENICILLIN G/ PENICILLIN V
OR
ERTHROMYSIN

166
Q

most common cause of bacterial endocarditis

A

streptococcus viridans

167
Q

leading causes of bacterialsepsis and meningitis in new born

A

grp b strep

168
Q

lancefield grp

A

A STREP PYOGENUS beta hemolytic
B strep agalactiae beta hemolytic
C,G STREP DYSGALACTiae beta hemolytic
D enterococci e. faecium ; e faecalis non hemolytic
variableor nongrpable ,
strep viridans alpha hemolytic
anaerobivlc

169
Q

alpha hemolytic strep

A

streptococcus viridans

170
Q

major surface protein of GAB

A 
M PROTEIN 
resist phagaocitic killing by binding ok fibrrinogen to m protein 
polysaccharide capsule 
stretolysin Sand O 
sterptokinase, DNASES 
SOME ERYTHROGENIC TOXIN
171
Q

clinical manifestations of GAS

A 
pharyngitis 
cellulitis 
scarlet fever 
impetigo 
nectrotising fasicitis
172
Q

scarlet fever

A

due to streptococcus pyrogenic exotoxin
rash upper trunk spread to involve extremities
spares palm and soles
minute papules giving sand paper feeling
circumoral pallor
strawberry tongue ( enlarged papillae coated tongue which becomes denuded)
pastia line ( accentuation of rash in skin folds )
subsidence of rash in 1 week followed by desquamation later on sparing pams aoles

173
Q

inpetiga

A

begin as red papules which form veasiclethen pusular tht break down and colalese to for honeycomb
painless
no fever
also caused by staph but more extensive thn it

174
Q

? erysipelas

A

?
warm to touch
may be tender
shiny swollen
peud orange cluster involvement of superficial lymphatics
fever and chills
occur over malar area of face and extremities

175
Q

grp b sterp?

A

s agalctiae

176
Q

CAMP FACTOR BY?

A

streptococcus agalactiae

phospholipase tht cause synergistic hemolysis with b lysin prodeuced by staph

177
Q

typical inf caused by GBS

A

neonatal sepsis due to colonisation of maternal genital tract or rectum
neonatal meningitis
purpureal infection causes uti
endocarditis

178
Q

grp d sterep

A

enterococcus

strep gallolyticus

179
Q

strep galolyticus endocarditis

A

often association with malignalcy of gi tract

most common colon or polyp

180
Q

clinical manifestations of strep viridans

A

endocarditis
brain absesces
dental abscess ?
liver abscess

181
Q

difference bw enterococcus and strep gallolyticus

A

enterococcus hydrolyse PYR

181
Q

difference bw enterococcus and strep gallolyticus

A

enterococcus hydrolyse PYR

182
Q

clinical manifestations of enterococcal infection

A 
uti 
prostatities 
bactremia 
endocarditis 
meningitis
183
Q

most common cause of septic arthritis in native joints

A

staph aureus

184
Q

most common cause of surgical wound infection

A

staph aureus

185
Q

toxin mediated ds by staph

A

enterotoxin - food poisoning
heat stable, short incubation period , vomiting
diffrential diagnosis is bacillus cerus
fever is less
toxic shock syn- toxic shock syn
exfolitive toxin - staphylococcal scalded skin syndrome

186
Q

organisms responsible for rht sided tricuspid valvular endocarditis in iv drug absures

A

staph aureus

187
Q

pressence of staph aureus in urine generally suggests

A

hematogenous as staph infrequent cause of uti

188
Q

anterior nares and is primary site of colonisation by

A

staph aureus

can colonise damaged skin , vagina, groin, oropharynnmx

189
Q

difference between staph aureus and other staph species

A

coagulase enzyme tht convert fibrinogen to fibrin

190
Q

colonies of staph aureus

A

golden beta hemolytic but

CONS white non hemolytic

191
Q

clinical manifestations of staph aureus

A 
skin and soft tissue 
      folliculitis
       faruncle 
       carbuncle 
       cellulitis 
       masitiis 
      surgical wound ( most common cause)
musculoskeletal 
   septic arthritis 
    pyomyositis 
    osteomyleitis 
   HEMATOGENOUS OSTEOMYLEITIS 
         IF ADULT -- VERTEBRA 
     IF CHILD     -- LONG BONES
psoas abscess 
respiratory 
  ventillator 
  postviral
   empyema 
    septic pulmonary emboli 
bactremia 
   sepsis , septic shock 
infective endocarditis
   iv drug use 
  native valve
  prosthetic 
  nisocomial 
device related infection 
toxin mediated 
 toxic shock syn 
 food poisoning 
  SSS
invasive infection 
necrotizing fascitis
 waterhouse friderichsen syn
 necrotizing pneumonia 
 purpura fulminans
192
Q

alpha hemolytic strep

A

sterp virians

strep pneumonie

193
Q

quelling reaction showm by

A

strep pneumonie ie capsule swell in p ressence of specific antiserum

194
Q

clinical manifestations of streptococcus pneumonia

A

otitis media
sinusitis
pneumonia
meningitis

195
Q

capsular polysaccharide vaccine of streptococcus pneumonia

A

capsular polysaccharide ppsv 23
23 valent
2-64 yrs of age who hve underlying medical condition

polysaccharide protein conjugate vaccine
for infants and young children

196
Q

rickettsial ds

A 
RMSF by rickettsia ricketsse 
LOUSE BORNE TYPHUS 
SCRUB TYPUS ORIENTIA psupsugamushi
MURINE TYPUS R typhi 
Mediterranean fever R conorii 
rickktisial pox  mite borne by mites 
epidemic typus louse borne by R prowazekii 
endemic typhus  flea borne by R typhi
197
Q

RMSF TRANSMISSION BY

A

tick

198
Q

fundamental basis for tissue and organ injury of in rmsf

A

increased vascular permeability resulting in edema, hypovolemia, ischemia
consumption of platelets result in thrombocytopenia

199
Q

clinical manifestations of RMSF

A

rash tht first appears wrist and ankles and then appears on remainder of extremities and the trunk
involvement of palms and soles tht r diagnostically important
hypovolemia
???

200
Q

scrub typhus caused by

A

orientia tsutsugamushi

201
Q

louse borne typhus

A

epidemic typhus

202
Q

brill zinsser ds

A

recrudescent ds occuring yrs after acute epidemic typhus
prowaskii remains latent for yrs its reactivation result in ds
leading sporadic cases in louse free populations or epidemic in louse infested populations

203
Q

endemic fever rash skin lesion lack necrotic area or crust surrounded by erythema

A

rickettsial spotted fever

204
Q

doc for rickettsia

A

doxycycline

205
Q

HME AND HGA

A

human monocytotropic ehrlichosis
tick borne

human granulocytotropic anaplasmosis
tick borne

both effects haematopoeitic cells

206
Q

erythema migrans seen in

A

HGA

207
Q

morulae seeen in?

A

HGA
HME
intracellular inclusion

208
Q

q fever caused by

A

coxiella burnetti

209
Q

mode of transmission of q fever

A

inhaltion or ingestion of contaminated milk
parturiation
percutaneous transmissiom

210
Q

clinical manifestations of q fever

A

acute fever fever , headache , fatigue etc
post q fever fatigue noninfective afyer q fever
chronic q fever always impleis endocardities

211
Q

vegetation of q fever

A

different from infective endocarditis

manifesting as endothelium covered nodules on valves

212
Q

most common chronic manifestations of q fever

A

endocarditis

213
Q

clinical manifestations of mycoplasma

A

respiratory infections myco pneumonie

genitourinary infections by mycoplasma others

214
Q

most common bacterial cause atypical pneumonia

A

mycoplasma pneumonia

leigonella

215
Q

treatment for mycoplasma

A

macrolides

doxycycline

216
Q

clinical spectrum of herpes simplex virus

A

mucocutaneous
orofacial gingivostomatoties
pharyngitis
herpes labialis most common manifestations of reactivation
•genital infections- multiple extremly painful punched out various stages
confluent shallow ulceres on edematous base
•herpetic whitlow- finger infection from oro/ genital herpes or direct inoculatiom
CNS
encephalitis especially temporal lobe
autonomic radiculopaythy
neonatal
acquired perinatelly
infected secretion of genitalia
visceral
esophagiits ( diret speard of oropharyngeal or reactivation and spread via vagus )
lung , liver
disseminated
erythema multiforme
eyes - keratitis
most xause of corneal blindness in US

217
Q

treatment of HSV

A

acyclovir
valcyclovir
famcyclovir

218
Q

treatment of infection of acyclovir resistant hsv

A

foscarnet

219
Q

clinical manifestations of varicella zoster

A 
infectious 48hrs before the onset of rash 
during the period of vesicle formation 
untill all vesicles r crusted 
4-5 days 
•rash
    maculopapular vesicles scabs in various
 stages of evolutiom
lesion also in mucosa pharynx vaginal
older chilren more vesicles 
•low grade fever

•malaise

220
Q

complications of varicella

A

sec bacterial superinfection of skin
cns meningitis, encephalitis
varicella pneumonie most serious complications onset 3- 5 days
perinatal varicella 5 days before the delivery within 2 days thereafter
congenital varicella
skin - streptococcus pyogenous
staph aureus on scratch

221
Q

clinical manifestations of herpes zoster

A

•rash
unilateral, vesicular dermatomal
mostly in thoracic and opthalmic divisions of mandibular nerve
pain in dermatomal region 2- 3 days before
•zoster sine hepatica– localised dermatomal pain + serological evidence but no rash
•ram say hunt – geniculate ganglia of sensory branch of facial nerve
pain and vesicles on ext auditory canal, loss of taste sensation in ant2/3 of tongue with ipsilateral facial paralysis
•post herpetic neuralgia some degree of pain in involved dermatome for mnths after resolutio
cns

222
Q

ramsay hunt syn

A

triad of ipsilateral , facial paralysis , ear pain , vesicles in ext auditory canal and auricle
due to reactivation of herpes zoster in geniculate ganglia
lower motor neuron lesion of facial nerve
inabilty to move some muscle of face

223
Q

treatment of varicella

A

acyclovir
famcyclovir
valcyclovir

224
Q

characteristic of EBV

A 
hetrophile +ve 
fever 
sore thorat 
lymphadenopathy 
atypical lymphocytosis
225
Q

mode of transmission of ebv

A

salivary secretion s via kissing

226
Q

clinical manifestations of ebv

A 
•fever low grade  
fatigue 
•myalgia 
•malaise 
•lymphadenopathy posterior cervical or generalised tender symmetrical not fixed 
•pharyngitis or tonsillitis
•splenomegaly 
• hepatomegaly 
•rash 
           papular or morbiliform
227
Q

atypical lymphocytes found in which inf

A 
ebv 
enlarged lymphocytes 
abdundant cytoplasm 
vacuoles 
indentation of cell membrane
228
Q

complications of ebv

A
  • cns – meningitis and encephalitis
  • blood autoimmune hemolytic anaemia, cytopenial
  • spleen rupture
229
Q

oral hairy leukoplakia caused by ebv in hiv adults

A

ebv in hiv adults white corrogative lesion on tongue

internal medicine ishani (9 decks)

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