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Internal Medicine > Infectious > Flashcards

Infectious Flashcards

1
Q

Tuberculosis cause

A

mycobacterium tuberculosis; inhaled aerosol droplets via coughing; primary, active/progressive primary, latent phases

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2
Q

Tuberculosis s/s

A

cough (dry -> progressive) >3 weeks with or without hemoptysis; fever, drenching night sweats, anorexia, weight loss; pleuritic chest pain, dyspnea, hemoptysis, post-tussive rales; ill appearing/malnourished

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3
Q

Tuberculosis dx

A

DNA sputum culture (acid-fast bacilli); biopsy (caseating granulomas); tuberculin skin test/PPD (positive w/ active/latent, induration >15mm); CXR (primary, reactivated, healing primary)
■ Primary CXR: homogeneous infiltrates, hilar/paratracheal lymph node enlargement, segmental atelectasis, cavitations w/ progressive disease
■ Reactivation CXR: fibrocavitary apical disease, nodules, infiltrates, posterior and apical segments of the right upper lobe, apical-posterior segments of left upper lobe, superior segments of the lower lobe
■ Healed Primary CXR: Ghon complexes (calcifications), Ranke complexes (calcifications w/ hilar lymph nodes)

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4
Q

Tuberculosis tx

A

Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), Ethambutol (EMB); BCG vaccine (high risk)
■ LTBI: INH x9mos or RIFx4mos or RIF + PZA x2mos
■ Active TB: INH + RIF + PZA + EMB x2mos
■ ADEs: INH (give pyridoxine for neuropathy, hepatitis), RIF (orange fluid), EMB (optic neuritis)

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5
Q

Atypical Mycobacterial Disease cause

A

mycobacterium marinum, mycobacterium avium-intracellulare; contaminated water, injections, surgical procedures, trauma, cockroaches, immunosuppression (emphysema, DM, leukemia, lung cancer, CKD, SLE)

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6
Q

Atypical Mycobacterial Disease s/s

A

lymphadenitis, multiple/isolated skin nodules in linear distribution; pulmonary consolidation, cavitation, fibrosis, nodules, bronchiectasis, adenopathy

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7
Q

Atypical Mycobacterial Disease dx

A

tissue culture; electrophoresis, polymerase chain, CXR (centrilobular nodules isolated in lingual and middle lobe)

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8
Q

Atypical Mycobacterial Disease tx

A

antibiotics (clarithromycin); surgical drainage/debridement/prolonged treatment w/ antimicrobial agents

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9
Q

Human Immunodeficiency Virus cause

A

retrovirus integrating into DNA, attacking CD4 T-cells (helper T cells); sexual transmission, IV drug use, occupational injury, blood products, mom-to-baby

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10
Q

Human Immunodeficiency Virus s/s

A

mono-like/flu-like illness for 2 weeks, rash, mucocutaneous ulcers, myalgias, fever, sore throat, adenopathy, N/V/D, HA (early HIV); asymptomatic, LAD lasts 10 years (clinical latency); LAD, tissue damage, fever, night sweats, weight loss, oral hairy leukoplakia, thrush, skin disorders (molluscum) (symptomatic infection)

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11
Q

Human Immunodeficiency Virus dx

A

HIV positive antigen/antibody testing, CBC, CMP, toxoplasma IgG, Hep A/B/C, RPR, STDs, PPD, pap (initial screen); Viral load >100K, elevated LFTs, leukopenia, anemia, thrombocytopenia (early); Viral load decreases to “set point” then rises, CD4 count declines (clinical latency); Viral load increase, CD4 count decreases (symptomatic infection); CD4 <200 or HIV + AND 1/27 AIDS defining conditions (PCP pneumonia, toxoplasmosis, mycobacterium avium complex, CMV, candidiasis, Kaposi’s sarcoma, cervical cancer, etc);

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12
Q

Human Immunodeficiency Virus tx

A

viral load <50 then treat opportunistic infections; antiretroviral therapy (3 drugs from 2 classes; NNRTIs, NRTIs, PIs, integrase inhibitor, fusion inhibitors); non-occupational HIV exposure (begin <72hrs); occupational exposure (being w/in hrs, treat x4wks)

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13
Q

Pneumocystis Jiroveci Pneumonia (PCP) cause

A

pneumocystis jiroveci (fungi)

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14
Q

Pneumocystis Jiroveci Pneumonia (PCP) s/s

A

fever, cough, SOB; severe hypoxemia

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15
Q

Pneumocystis Jiroveci Pneumonia (PCP) dx

A

sputum sample culture, elevated LDH; CXR (diffuse perihilar infiltrates); CD4 <200

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16
Q

Pneumocystis Jiroveci Pneumonia (PCP) tx

A

Bactrim DS, supportive

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17
Q

Toxoplasmosis cause

A

encephalitis by toxoplasma gondii; ingestion of cat feces, raw foods

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18
Q

Toxoplasmosis s/s

A

HA, focal neurological deficits, seizures, AMS, retinitis, pneumonitis

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19
Q

Toxoplasmosis dx

A

CT/MRI (multiple contrast-enhancing lesions), seropositive for toxoplasmosis; CD4 <100

20
Q

Toxoplasmosis tx

A

Bactrim DS

21
Q

Mycobacterium Avium Complex cause

A

mycobacterium avium, mycobacterium intracellulare; found in soil and inhaled/ingested dust

22
Q

Mycobacterium Avium Complex s/s

A

night sweats, weight loss, abdominal pain, diarrhea, anemia, pulmonary infection

23
Q

Mycobacterium Avium Complex dx

A

sputum culture (acid-fast bacillus); positive blood cultures; CD4 <50

24
Q

Mycobacterium Avium Complex tx

A

Zithromax (azithromycin), clarithromycin

25
Q

Cytomegalovirus retinitis cause

A

CMV, herpes virus; blood, sexually transmitted, perinatally

26
Q

Cytomegalovirus retinitis s/s

A

visual disturbances, blindness

27
Q

Cytomegalovirus retinitis dx

A

perivascular hemorrhages, white fluffy exudates (cotton wool spots) on fundoscopic exam; seropositive for CMV

28
Q

Esophageal Candidiasis/Recurrent Vaginal Candidiasis cause

A

candida albicans

29
Q

Esophageal Candidiasis/Recurrent Vaginal Candidiasis s/s

A

white cottage cheese-like patches on esophagus or in vaginal canal; more invasive candidiasis, lower CD4 count

30
Q

Esophageal Candidiasis/Recurrent Vaginal Candidiasis dx

A

clinical; endoscopy; CD4 count low

31
Q

Esophageal Candidiasis/Recurrent Vaginal Candidiasis tx

A

Diflucan

32
Q

Kaposi’s Sarcoma cause

A

vascular neoplasm; homosexual transmission

33
Q

Kaposi’s Sarcoma s/s

A

multifocal/widespread lesions, LAD

34
Q

Kaposi’s Sarcoma dx

A

clinical; CD4 count low

35
Q

Hepatitis cause

A

viral (A, B, C, D, E); alcohol, acetaminophen, drugs; Wilson’s disease, a-antitrypsin deficiency; autoimmune
■ Hep A, E: fecal oral transmission
■ Hep B, C, D: parenterally or mucous contracted

36
Q

Hepatitis s/s

A

fatigue, malaise, anorexia, tea colored urine, abdominal discomfort, scleral icterus, jaundice

37
Q

Hepatitis dx

A

liver biopsy; aminotransferase elevations, bilirubin >3, antibody/antigen testing
■ Acute Hep A (anti-HAV)
■ Hep B infection (HBsAg), past infection/immunity (HBsAb), acute infection (HBcAg), highly infectious (HBeAg), low titer (HBcAb), high DNA load
■ Chronic infection (ALT, AST, increase, hepatocellular damage on biopsy)

38
Q

Hepatitis tx

A

supportive (avoid alcohol, meds, toxins); adenofovir, lamivudine (Hep B); pegylated inferno a2 + ribavirin (Hep C); vaccinate against Hep A,B

39
Q

Influenza cause

A

orthomyxovirus; mucous droplets

40
Q

Influenza s/s

A

abrupt, fever, chills, malaise, muscle aches, substernal chest pain, headache, nasal stiffness, nausea (onset 18-72hrs after infection); fever (1-7 days), coryza, nonproductive cough, photophobia, eye pain, sore throat, pharyngeal injection, flushed facies, wheezes, rhonchi; pneumonia, Reye syndrome (fatty liver w/ encephalopathy)

41
Q

Influenza dx

A

viral cultures vs rapid flu; CXR (bilateral diffuse infiltrates); leukopenia, proteinuria

42
Q

Influenza tx

A

supportive (rest, analgesics, cough suppressants); oseltamivir (Tamiflu); fluids; vaccine

43
Q

Varicella-Zoster (Shingles) cause

A

Varicella-zoster virus (herpes family)

44
Q

Varicella-Zoster (Shingles) s/s

A

abrupt painful, erythematous macules and papules lesions (dew drops on rose petal) with a crust in a centripetal pattern on the dermatome; low grade fever, malaise, muscle aches, arthralgias, headache; Hutchinson sign (tip of nose and trigeminal pattern)

45
Q

Varicella-Zoster (Shingles) dx

A

clinically; fluorescent microscopy

46
Q

Varicella-Zoster (Shingles) tx

A

supportive (pain medication, acyclovir); Varicella-zoster immunoglobulin (immunocompromised); Zostavax vaccine

Internal Medicine (9 decks)

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