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Infectious for step 2 > Infectious 2 > Flashcards

Infectious 2 Flashcards

1
Q

The patient started on empiric vancomycin and culture grow susceptible S.Mutans to penicillin what to do?

A

Change to penicillin V or ceftriaxone

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2
Q

Disseminated gonococcal infection?

A

Purulent Arthritis
Triads of tenosynovitis, dermatitis, and migratory polyarthralgia
NAAT: From genital area
Culture is less sensitive

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3
Q

Symptoms of CNS Toxo?

A

Headache
Confusion
Fever
Focal neurologic deficiet

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4
Q

Diagnosis?

A

AIDS with CD4<100
Positive Toxo IgG
Multiple ring-enhancing lesions on MRI

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5
Q

managment?

A

sulfadiazine & pyramitamine(lukovorine)
ART whithin 2 week
Prophaxis:TMP-SMX(CD4 < 100)

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6
Q

Progressive multifocal leukoencephalopathy?

A

JC virus reactivation(JC virus infect in childhood and remain dormant in kidney and lymphoid thishu, Reactivation in CD4 < 200 and cause oligodendrocyte damage in white matter)
In IC patient

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7
Q

Manifestation?

A 
Slowly progressive
Confusion
Paresis
Ataxia
Seizure
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8
Q

Diagnosis?

A

MRI: Asymmetric, hypodense, white matter lesion with no enhancement and edema.
LP: PCR JC virus
Biopsy: rarely needed

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9
Q

Treatment?

A

Often fatal
Antiretroviral
Most patients develop a neurologic complication

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10
Q

HIV-associated dementia imaging?

A

Cortical atrophy
Ventriculomegaly
Reduced attenuation of white matter

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11
Q

Fungal pneumonia and erythema nodusum?

A

Histoplasmosis

Especially people come from Mississippi and Ohio

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12
Q

Differential dignosis in same rigion(M & O)?

A

Blastomycosis But B: Skin ulcer, bone erosion, and prostatitis but In H: erythema nodusum and HL

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13
Q

When to consider meningitis?

A 
Presence of >=2 signs from 4 signs and symptoms
1-Headache
2-Fever >38
3-Nuchal rigidity
4-AMS
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14
Q

A common cause of bacterial meningitis in age >2?

A

S.pnumonia

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15
Q

hemophilus ducri(Chancroid) symptoms?

A

Large, deep ulcer with gray/yellow discharge
well-demarcated border with & soft friable mass
Severe, painful LDP that may be superlative
Diagnosis requires culture
azithromycin is curative

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16
Q

tissue invasive CMV infection?

A

Common inpatient with IC and not receiving Px(indicated in organ transplant patient)
manifestation
-Hepatitis
-gastroenteritis
–intersticilal pnumonia
-Meningoencephalitis
diagnose with blood/tissue biopsy(GS)– PCR
Manage with IV gancyclovir in severe cases and PO in mild

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17
Q

Gonnococal pharengitis?

A

In sexually active by orogenital contact
Bilateral non tender LD
Prharengial erythema and edema w/o exudate
Concomitant PID/STI

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18
Q

HIV prophylaxis recommended in?

A

High-risk exposure

  • mucosal, nonintact skin, and subcutaneous exposure
  • Blood, Semen, Vaginal fluid, and anybody secretion with blood content.
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19
Q

What and when to give?

A

Initiate urgently
Continue for a 28 day
>= 3 drug
2NRTI + 1 II/PI/NNRTI
even if the patient serostatus not known but at risk
De serostatus at a spot for a baseline then 6 weeks,3 months, and 6 month

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20
Q

Cryptosporidium?

A 
CD4 <180
animal contact, water, and person to person tm
Severe watery diarrhea
low-grade fever
wight loss
examine with modified acid-fast stain (3-6 um oocyst)
Treatment is supportive and ART
Infection persist until CD4 improve
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21
Q

Mirosporidium/isospora?

A

CD4 < 100
watery diarrhea
lower abdominal pain
wight loss
fever is rare
Microsporidia(spore in stool and treat with albenda)
Isospora Belli (oocyst and treat with TMP-SMX)

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22
Q

MAC?

A

CD4 < 50
Sever fever(>39)
watery diarrhea and fever

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23
Q

CMV?

A 
CD4 <50
frequent Bloody diarrhea
low-grade fever
Wt loss
Abdominal pain
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24
Q

Tetanus PEP?

A 
------Clean minor wound
Td/TDaP If
the last dose is given> 10 year
History of childhood Vx<3, uncertain or not Given
-----Dirty/sever wound
Td/TDaP If
the last dose is given> 5 year
With Tetanus immunoglobulin if History of childhood Vx<3, uncertain or not Given
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25
Q

Childhood vaccination?

A

2,4 and 6 month
15-18 month
Every 10 year Td

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26
Q

Why TD/TDaP?

A

Diphtheria and pertussis need booster

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27
Q

Babisiosis epidimology?

A

babesia microti
NE USA
Ixodus scapularis thick bite

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28
Q

Clinical menifestasion?

A

Flu-like symptom
sign of IV hemolysis
ARDS, CHF, DIC, and splenic rupture in severe case
mild hepatosplenomegaly
Anemia,thrombocytopenia,Elevated LDH/LFT/bilirubin

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29
Q

Diagnosis?

A

thin blood smear(intraerythrocytic ring(maltase cross)

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30
Q

treatment?

A

Atovaquone + azithromycin
sever: Quinine + clindamycin
7-10 days and up to 3 months until resolve

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31
Q

watery diarrhea in HIV patient approach?

A

microscopy/Culture stool for ova and parasite
Clostridium difficile AG
AFS: for cryptosporidium

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32
Q

Infectious mononucleosis etiology?

A

EBV

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33
Q

Clinical manifestation?

A 
Fever and fatigue
Tonsilitis/pharengitis +-exudate
Posterior cervical/diffiuse LDP
\+-Hepatosplenomegaly
\+-rash after amoxicillin
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34
Q

Diagnostic finding?

A

Hetrophile Ab(monospot test)–FN in first 1 week
Lymphocytosis
transient hepatitis

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35
Q

Managment?

A

Avoid sport for > 3 weeks and contact sport >4 week

36
Q

Varicella vaccine for HIV?

A

If CD4 >200–Since it is LAV
For Low anti varicella Ab on serology
immediately at diagnosis of HIV

37
Q

Pertussis clinical presentation?

A

cathera l(1-2 weeks): mild cough and rhinitis
paroxysmal(2-6)week: cough with an inspiratory whoop,posttusive vomiting, apnea in an infant
convalescent: weeks to month:resolve

38
Q

diagnosis?

A

Pertussis culture/PCR

Lymphocytosis

39
Q

treatment?

A

Macrolide

40
Q

what about allergic aspergillosis?

A

occur in patients with CF/Asthma
bronchial obstruction symptom
eosinophilia/not lymphocytosis

41
Q

Mycoplasma pneumonia symptom?

A

Respiratory droplet
winter/fall
close-quarter/young military and dorm

42
Q

CM?

A

indolent headche,fever,mailase
persistent dry cough
nonexudative pharengitis
vesicular/macular rash on extremity

43
Q

Diagnosis?

A 
Normal leukocyte count
intersticial pnumonia/infilitrate on CXR
subclinical hemolysis(Cold agglutinin)
44
Q

Treatment?

A

usually emperic

Macrolid or respiratory floouroquinolol

45
Q

Acute HIV infection CM?

A

Lasts 2-4 week
Mononucleosis like symptoms
Generalized macular rash(oral ulcer(painful), oval,pink macular lesion)–Transient and stay for a week
GI symptom

46
Q

Diagnosis?

A

High viral load(>100,000)
Normal CD4 count
Serology may be negative

47
Q

Managment?

A

Start HAART

Partner screening and secondary prophylaxis based on serology

48
Q

Prophylaxis should be given?

A

TMP-SMX–PCP
Gancyclovir–CMV(based on donor serostatus)
PCV and HBV vaccination prior to transplant–to make sure of immune response
IM influenza vaccine yearly
Antifungal prophylaxis for lung and liver transplant

49
Q

ehrlichiosis?

A

Transmitted by tick bite(Lonestar thick)

SE & Central USA

50
Q

clinical manifestation?

A 
Flue like illness
Nurologic symptom(AMS and Neck stiffness)
rash uncommon(<30 % RMSF like lesion w/o spot)
51
Q

Diagnosis?

A

Lukopnia and thrombocytopnia
Intracytoplasmic morula(on monocyte)
Elevated TA and LDH
PCR

52
Q

managment?

A

Doxycycline while waiting for the result

53
Q

S.pnumonia is common in what CD4 count?

A

If CD4 <200

54
Q

Indolent murmur can be seen in patients with fever?

A

Mid systolic, G2 murmur on left cost sternal –Due to high blood flow.

55
Q

UTI with alkaline urine indicates?

A

Urase producing bacteria infection

  • -proteus(MC)
  • -Klebsiella
56
Q

Neurocysticercosis epidemiology?

A

Tenia Solium(pork tapeworm) egg
feco-oral transmission
C & S America,Subsaharan Africa and asia

57
Q

CM?

A 
Prolonged incubation(month-years)
Seizure
ICH sign
cysticercosis can involve liver and muscle
Systemic sympoms are absent
58
Q

Diagnosis?

A

MRI/CT

cyst(hypodense/edema or enhancement)

59
Q

Treatment?

A

Seizure/ICH treatment
Antiparasitic therapy(Albendazole)
Corticosteroid

60
Q

Treatment of latent TB IN HIV?

A 
Positive PPD(Induration >=5 mm) or Positive INTY assay
Rule out active disease(Symptom + CXR)
( month of INH + pyridoxine)
61
Q

Microbiology of IE?

A

based on patient risk

62
Q

S.Aures?

A

IV drug user
Implanted devise
catheter
prosthetic valve

63
Q

Viridian streptococci(SM and SS)?

A

Gingival manipulation

Respiratory incision or biopsy

64
Q

streptococcus epidermidis?

A

Implanted devise
Iv catheter
prosthetic valve

65
Q

Enterococcus?

A

Nosocomial UTI

GU procedure

66
Q

Streptococcus gallolycoticus/bovis?

A

Colonic CA

IBD

67
Q

Fungi(candidia)?

A

IV drug
IC
prolonged antibiotic

68
Q

Parvovirus B-19 infection CM?

A 
Flu-like symptom
Slapped check rash in children and lacy in adult
Erythema infectiousum(fifth disease)
Acute, Symmetric arthritis
Transient pure cell aplasia
69
Q

diagnosis?

A 
Acute
IgM in Imunocompitent
NAAT in immunocompromise
Reactivation
IgG and NAAT
70
Q

Nocardia Tx when the brain is involved?

A

TMP-SMX + carbapenem

If possible drain abscess

71
Q

Fluconzole proflaxise in HIV?

A

Given as secondary prophylaxis

Pateint previous history with still low CD4 count

72
Q

Early HAART tx benefit?

A

early CD4 recovery
decrease inflammation related cardiac and renal complication
Decease oncogenic virus reactivation
Decrease public transmission risk

73
Q

IE treatment?

A

Acute; empiric vancomycin

Subacute; Based on culture result

74
Q

Syphilis diagnosis?

A

Non-treponemal

Treponemal

75
Q

Non-treponemal?

A 
RPR and VDRL
Ab to cardiolipin -cholesterol-lecitine Ag
Quantitative(tITER)
Possible -Ve in early disease
Decrease titer confirms treatment
76
Q

Treponemal?

A 
FTA-AB and TP-EIA
Ab to treponemal antigen
Qualitative(R/NR)
High sensitivity in early disease
Positive after  treatment
77
Q

HAV vaccination indication?

A

Chronic hepatitis
Gay
IV drug user

78
Q

Treatment of NG positive and CT negative urethritis by NAAT?

A

Ceftriaxone and azithromycin(dec resistance)

If azithromycin C/I substitute doxycycline

79
Q

ecthyma gangrenosum?

A

Typical pseudomonal skin infection
Occur in immunocompromised patients
Vascular invasion of media and adventitia–vascular obstruction–skin necrosis(gangrenous skin ulceration
fever

80
Q

Managment for patients with severe penicillin allergy and have syphilis?

A 
P-Doxyxycline 14 day
S-Doxyxycline 14 day
L-Doxyxycline 28 day
T-Ceftriaxone 14 day
Do NTAB titer after 6-12 month
81
Q

Travelers diarrhea cause?

A 
profuse watery diarrhea
Transmitted by water
Cryptosporidium
Giardiasis
Cyclospora
82
Q

Managment of pyelonephritis?

A

Complicated
oral FQ or TMP-SMX
complicated
IV cephalosporins,FQ, aminoglycoside or ESBL

83
Q

Complicated?

A 
DM
URT obstruction
Renal failure
Instrumentation
Immunosuppression
Hospital aquired
84
Q

Monospot test negative and strong suspicion for IM?

A

IgM and IgG for EBV

IgM for CMV

85
Q

Leprosy CM?

A

A macular anesthetic lesion with a raised border

Nodular, painfully nearby nerve with loss of sensory and motor function

86
Q

Diagnosis and managment?

A 
Full skin biopsy
Tubercloid
Dopson + rifampicin
Lepromatous 
Dapsone + Rifampcine + CFZ

Infectious for step 2 (3 decks)

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