Infectious & Dermatology Flashcards
Historical and physical “red flags” in a patient with an unknown rash
<ul><li>Fever</li><li>Toxic appearance</li><li>Hypotension</li><li>Mucosal lesions</li><li>Severe pain</li><li>Very old or young age</li><li>Immunosuppressed</li><li>New medication</li></ul>
DDX of Petichiae
Palpable:<br></br> Vasculitis<br></br> Infection<br></br>Non-palpable:<br></br> Low plt (ITP, DIC)
DDx of petichiae in a febrile patient:
<b>Palpable:</b><br></br> Meningococcemia<br></br> Disseminated GC<br></br> Endicarditis<br></br> RMSF<br></br> HSP<br></br><br></br><b>Non-palpable:</b><br></br> Purpura fulminans<br></br> DIC<br></br> TTP
DDx of erythematous Rash
Staphylococcal scalded skin syndrome<br></br>Toxic epidermal necrolysis<br></br>Toxic shock syndrome<br></br>Kawasaki dis<br></br>Anaphylaxis<br></br><br></br>Other DDx:<br></br>Scarlet fever<br></br>Alcohol flush<br></br><br></br>
<strong>Approach to the maculopapular rash</strong>
<b>Febrile/Toxic & Central:</b><br></br>Erythema migrans (Lyme dis)<br></br>Viral exanthem (measles, rubella)<br></br><br></br><strong>Febrile/Toxic & Peripheral:<br></br></strong>Erythema multiforme<br></br>Stevens-Johnson Syndrome<br></br>TEN<br></br><br></br><strong>Afebrile/Nontoxic:<br></br></strong>non life threatening<br></br>Drug reaction<br></br>Pitryasis<br></br>Scabies<br></br>Eczema<br></br>Psoriasis
<strong>Approach to the vesiculobullous rash</strong>
<b>Febrile and Diffuse:</b><br></br>Varicella<br></br>Smallpox<br></br>Disseminated GC<br></br>DIC<br></br><br></br><strong>Febrile and localized</strong>:<br></br>Necrotizing fasciitis<br></br>Hand foot mouth dis (Coxackie A)<br></br><br></br><strong>Afebrile and Diffuse:<br></br></strong>Bollous pemphigoid<br></br>Pemphigus vulgaris<br></br><br></br><strong>Afebrile and localized</strong>:<br></br>HZV<br></br>Contact dematitis
Malaria classic triad
Fever<br></br>Splenomegaly<br></br>TCP
Risk factors for TSS
Current menstruation (using tempones)<br></br>Postpartum/post abortion<br></br>Recent surgical procedure<br></br>Burns<br></br>Deep abscess<br></br><br></br><i>Sinusitis<br></br>IUD<br></br>Peritonsillar abscess<br></br>Nasal packing for epistaxis</i>
Commonly missed topics in Hx regarding infectious diseases
Immunocompromized<br></br>Age<br></br>Comorbidities<br></br>Travel Hx<br></br>ETOH<br></br>Substance abuse esp IVDU<br></br>Men sex with men<br></br>Endocarditis<br></br>Asplenia<br></br>Immunization status
Atypical causes of PUO
Meningitis<br></br>Endocarditis<br></br>TB<br></br>Malaria<br></br>HIV<br></br>Malignancy
DDx of Fever + ALOC (Hot and Altered)
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Features favoring encephalitis over meningitis
AMS<br></br>Focal signs<br></br>Altered behaviour and personality change<br></br>Speech changes<br></br>Seizures<br></br>CN palsies<br></br>Exaggerated DTRs
Meningitis Rx
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<div><b>Contraindications to lumbar puncture include:</b></div>
<div>1. Cellulitis over the proposed site of puncture, </div>
<div>2. Cardiopulmonary instability, </div>
<div>3. Bleeding diathesis, or platelet count below 50,000/μl, </div>
<div>4. Focal neurologic deficits, and </div>
<div>5. Signs of increased intracranial pressure, including papilledema</div>
<div><b>Pediatrics sepsis by age groups:</b></div>
<div>< 28 days</div>
<div>GBS, Listeria, E. Coli</div>
<div>1-3 months</div> <div>H.flu; pneumococcus, meningococcus, e coli</div> <div>3-36 months</div> <div>Same as above, less Hflu</div> <div>> 3 yr</div> <div>Same as above, but add in Group A Strep</div>
<div><b>CSF analysis is composed of:</b></div>
<div>1. Cell count and differential</div>
<div>2. Gram stain and Culture</div>
<div>3. Protein</div>
<div>4. Glucose</div>
<div>5. HSV PCR</div>
<div><b>What are risk factors for UTI in infants?</b></div>
<ul> <li>Age < 12 months</li> <li>Fever >24hours (boys) or >2 days (girls)</li> <li>Fever >39 degrees</li> <li>Absence of another source of infection</li> <li>Non-black race (boys) or white race (girls)</li> <li>Uncircumcised</li> </ul>
Dose of dexamethasone in meningitis
0.6 mg/kg/day in qid or<br></br>0.8 mg/kg/day in bid for 2-4 days
Who are the close contacts for meningitis?
Household contacts<br></br>HCW<br></br>Day care<br></br>Direct nose or mouth contamination (shared bottles,,,)
<p>Indications for primary closure of mammalian bite wounds</p>
<p>–Face or scalp</p>
<p>–Within 12 hours of injury (<24 hrs face)</p>
<p>–Simple wound, appropriate for single closure, no devitalized tissue</p>
<p>–Lack of underlying injury</p>
<p>–No systemic immunocompromising conditions</p>
<p>Indications for prophylactic antibiotics in bites</p>
<p>–Cat or human bite</p>
<p>–Livestock</p>
<p>–Monkey bites</p>
<p>–Deep puncture wounds</p>
<p>–Hand, foot, face, genital wounds</p>
<p>–Bites in immunosuppressed patients</p>
<p>–Wounds requiring surgical repair</p>
ABs for bites
Clavulin 875 mg bid x 3-5 days<br></br>in PCN allergy:<br></br>Doxy/septra/cipro/levo + flagyl/clinda<br></br>or<br></br>Moxifloxacin alone
<p>Tetanus prophylaxiss</p>
<ul> <li>Clean minor wounds</li> </ul>
<p>–< 3 or uncertain doses: Td</p>
<p>–Last dose within 5 years: None</p>
<p>–Last dose within 5 – 10 years: None</p>
<p>–Last dose > 10 years: Td</p>
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<ul> <li>All other wounds (> 6 hours, > 1 cm deep, gross contamination, saliva/feces, ischemic, infected, avulsions, crush)</li> </ul>
<p>–< 3 or uncertain: Td, TIG</p>
<p>–Last dose within 5 years: None</p>
<p>–Last dose within 5 – 10 years: Td</p>
<p>–Last dose > 10 years: Td</p>
Rabies vaccine
0,3,7,14<br></br>Post exp proph Human Rabies Ig day 0:<br></br>20 IU/kg around the wound, the remainder given im distal to vaccination site<br></br><br></br>Captured animal==> examine the brain<br></br>Pet==> quarantine<br></br><br></br>Previously vaccinated pt==> vaccines only 0 and 3
Possible infection agents in fight fist inj
<ul> <li>Eikenella</li> <li>Strep viridans</li> <li>S. aureus</li> <li>Bacterioides</li> <li>Corynebacterium</li> </ul>
Pathogen for Lyme dis
Borrelia Burgdorferi<br></br>Vector= Ixodes deer tick (black legged tick)
Complications of Lyme dis
Neuropathy<br></br>Encephalitis<br></br>Migraines<br></br>Heart block<br></br>Arthritis<br></br>Myopericarditis<br></br>Ataxia
Pathognomonic features of Lyme dis
Erytema migrans<br></br>B/L facial palsy
<div>When indicated, what is the recommended prophylaxis for preventing Lyme disease in asymptomatic patients with a tick bite?</div>
A single 200 mg dose of doxycycline given within 72 hours of the deer tick bite
Rx of Lyme dis
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Complications of HSV & HZV inf
Pneumonia<br></br>Encephalitis/meningitios<br></br>Hepatitis<br></br>Severe sepsis<br></br>Death
<ul> <li>List five risk factors which increase your risk of severe HSV disease</li> </ul>
<ul> <li>Patients 12 years or over</li> <li>Those with chronic skin disease (ie. Atopic dermatitis)</li> <li>Those with underlying pulmonary disease</li> <li>Patients receiving salicylate therapy</li> <li>Those receiving oral or inhaled corticosteroids</li> <li>Patients who are immunocompromised</li><li>Neonates</li><li>Pregnant</li> </ul>
<p>Indications for VZIG</p>
<ul> <li>Exposed while Pregnant</li> <li>Exposed while Immunosuppressed</li> <li>Neonates born to women who have chicken pox 5 days prebirth to 2 days after delivery</li> <li></li> <li>Timing?</li> <li>Up to 96 hours of exposure (can be given up to 10 days later)</li> </ul>
Complications of HZV (shingles)
Postherpetic neuralgis (most common)<br></br>Ramsy Hunt Syndrome<br></br>HZ ophthamicus<br></br>Pneumonitis<br></br>Meningitis<br></br>Hepatitis<br></br>Encephalitis<br></br>Sepsis