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Infectious Disease Flashcards

1
Q

Bacterial CSF finding

  1. Opening pressure
  2. Leukocyte count
  3. Leukocyte differential
  4. Glucose
  5. Protein
  6. Gram stain
  7. Culture
A
  1. Opening pressure- 200-500 mm H2O
  2. Leukocyte count- 1000-5000/μL
  3. Leukocyte differential- Neutrophils
  4. Glucose- <40 mg/dL
  5. Protein- 100-500 mg/dL
  6. Gram stain- Positive in 60%-90%
  7. Culture- Positive in 70%-85%
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2
Q

Viral CSF finding

  1. Opening pressure
  2. Leukocyte count
  3. Leukocyte differential
  4. Glucose
  5. Protein
  6. Gram stain
  7. Culture
A
  1. Opening pressure- ≤250 mm H2O
  2. Leukocyte count- 50-1000/μ
  3. Leukocyte predominance- Lymphocytes
  4. Glucose- >45 mg/dL
  5. Protein- <200 mg/dL
  6. Grams stain- Negative
  7. Culture- Negative
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3
Q

Most common causes of bacterial meningitis

A

Streptococcus pneumoniae and Neisseria meningitidis

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4
Q

Tx for Immunocompetent host with community acquired bacterial meningitis

A

IV ceftriaxone or cefotaxime plus IV vancomycin

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5
Q

Tx meningitis in Patient >50 years or those with altered cell mediated immunity

A

IV ampicillin (Listeria coverage) plus IV ceftriaxone or cefotaxime plus IV vancomycin

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6
Q

Tx meningitis in Allergies to β-lactams

A

IV moxifloxacin instead of cephalosporin

IV trimethoprim-sulfamethoxazole instead of ampicillin

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7
Q

Hospital-acquired bacterial meningitis treatment

A

IV vancomycin plus either IV ceftazidime, cefepime, or meropenem

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8
Q

Neurosurgical procedures meningitis tx

A

IV vancomycin plus either IV ceftazidime, cefepime, or meropenem

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9
Q

when to give dexamethasone in meningitis

A

In patients with suspected or confirmed pneumococcal meningitis- 15 minutes before administration of antimicrobial agents and continued for 4 days.

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10
Q

viral meningitis tx

A

symptomatic and supportive. Empiric antimicrobial agents may be initiated in viral meningitis
until bacterial meningitis is excluded.

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11
Q

Brain abscess causes

A

ENT source, from penetrating trauma, or after neurosurgery

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12
Q

Testing for brain abscess

A

MRI is more sensitive than CT

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13
Q

tx for brain abscess

A

Empiric antimicrobial treatment should be based on the suspected source and Gram stain results. A narrowed regimen is based
on culture results and is continued for 4 to 8 weeks.

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14
Q

when should you drain brain abscess

A

Abscesses >2.5 cm should be excised or drained stereotactically.

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15
Q

should you do lp in suspected brain abscess

A

NO, because increased pressure and herniation risk

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16
Q

Herpes simplex encephalopathy test findings
CSF
CT and EEG

A

CSF testing shows lymphocytic pleocytosis and, when necrosis is extensive, erythrocytes.
Temporal lobe abnormalities on imaging and periodic lateralizing epileptiform discharges on EEG suggest HSE.

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17
Q

Bloodwork for HSE

A

HSV PCR of the CSF allows rapid diagnosis of HSE

- do not test csf culture or serologic tests for HSV

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18
Q

TX for HSE

A

High-dose IV acyclovir should be started within 24 hours of symptom onset and continued for 14 to 21 days.

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19
Q

season for West Nile

A

the summer and early fall

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20
Q

severe west nile symptoms

A

acute asymmetric flaccid paralysis and may progress to respiratory failure.

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21
Q

DX for west nile

A

Diagnosis is established by detecting serum and CSF IgM antibody to WNV. (never a viral culture)

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22
Q

west nile tx

A

Treatment is limited to supportive care. Monitor patients with significant muscle weakness for respiratory failure in an intensive
care setting

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23
Q

testing for autoimmune encephalitis

A

Anti-NMDA receptor antibody

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24
Q

what is associated with autoimmune encephalitis

A

ovarian teratoma

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25
Q

tx of autoimmune encephalitis

A

Treatment includes removal of the teratoma, when present, and immunosuppression with glucocorticoids, rituximab, cyclophosphamide, or IV immune globulin

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26
Q

Erysipelas character

A

affects the superficial skin layers, including the upper dermis and dermal lymphatics. It classically involves the malar
region. The key clinical finding is a sharply raised border and orange-peel texture. It is usually caused by streptococcal infection.

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27
Q

if Honey-colored, crusted pustules.. think

A

Impetigo caused by β-hemolytic Streptococcus or Staphylococcus

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28
Q

if Sepsis, cellulitis, and hemorrhagic bullae after exposure to
saltwater fish or shellfish in patients with cirrhosis or chronic
illnesses such as diabetes mellitus, rheumatoid arthritis, or CKD.. think

A

Vibrio vulnificus infection

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29
Q

if Skin ulcer with necrotic center in a patient with neutropenia think

A

Ecthyma gangrenosum from Pseudomonas or other bacterial infections

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30
Q

if Chronic nodular infection of distal extremities with exposure to fish tanks or marine environments.. think

A

Mycobacterium marinum

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31
Q

Chronic nodular infection of distal extremities with exposure to plants/soiL

A

Sporotrichosis and Nocardia

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32
Q

Sepsis following a dog bite in a patient with asplenia

A

Capnocytophaga canimorsus

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33
Q

Swelling and erythema with pain out of proportion to physical examination findings

A

Necrotizing (deep) soft tissue infection (surgical emergency)

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34
Q

Acute, tender, well-delineated, purulent lesions

A

Abscess caused by S. aureus

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35
Q

Follicle-centered pustules in the beard and pubic areas, axillae, and thighs

A

S. aureus folliculitis

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36
Q

Follicle-centered erythematous papules and pustules on the trunk, axillae, and buttocks 1-4 days after hot tub or whirlpool exposure

A

Pseudomonas folliculitis

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37
Q

Symmetric, pink-to-brown patches with thin scale in intertriginous areas (axillae, groin, inframammary)

A

Erythrasma caused by Corynebacterium minutissimum.

Erythrasma will fluoresce to a coral red color with a Wood lamp

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38
Q

Empiric treatment for β-hemolytic streptococci and MSSA Tx

A

Dicloxacillin, cephalexin, clindamycin (all oral); IV antibiotics for unsuccessful outpatient treatment or patients with signs of toxicity

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39
Q

Purulent cellulitis, mild to moderate severity Empiric treatment for MRSA tx

A

Clindamycin, trimethoprim-sulfamethoxazole, doxycycline

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40
Q

Purulent cellulitis with extensive disease or signs

of systemic toxicity tx

A

Vancomycin (IV) or linezolid (oral or IV), daptomycin, telavancin, ceftaroline

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41
Q

Impetigo tx

A

Extensive disease, treat as nonpurulent cellulitis; limited disease, mupirocin (topical)

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42
Q

Erysipelas tx

A 
With systemic symptoms, ceftriaxone (parenteral); if mild/asymptomatic, penicillin
or amoxicillin (oral)
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43
Q

Folliculitis (staphylococcal and pseudomonal) tx

A

Spontaneous resolution is typical. Topical mupirocin or clindamycin lotion can be used

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44
Q

Human bite (Clenched fist injury) tx

A

Ampicillin-sulbactam (IV)

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45
Q

Animal bites tx

A

Ampicillin-sulbactam (IV) or amoxicillin-clavulanate (oral)

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46
Q

Neutropenia infection tx

A

Vancomycin and cefepime

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47
Q

Necrotizing fasciitis, compartment syndrome,
myonecrosis on imaging, purple bullae, or
sloughing of skin tx

A

Imipenem, clindamycin, vancomycin, and prompt debridement

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48
Q

Erythrasma Tx

A

Topical erythromycin, clarithromycin, or clindamycin

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49
Q

Mild (nonpurulent) DM foot infection tx

A

Single oral antibiotic, such as cephalexin, dicloxacillin, amoxicillin-clavulanate, or clindamycin

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50
Q

Mild (purulent and at risk for MRSA) DM foot infection tx

A

Clindamycin, doxycycline, or trimethoprim-sulfamethoxazole

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51
Q

Moderate DM foot infection tx

A

Two-drug therapy, such as trimethoprim-sulfamethoxazole plus amoxicillin-clavulanate or
clindamycin plus ciprofloxacin, levofloxacin, or moxifloxacin

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52
Q

Severe DM Foot infection tx

A

β-lactam/β-lactamase inhibitor (e.g., ampicillin-sulbactam), a carbapenem (e.g., imipenem cilastin), and a fluoroquinolone (e.g., moxifloxacin) and surgical debridement

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53
Q

PNA cause Aspiration

A

Gram-negative enteric pathogens, oral anaerobes

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54
Q

PNA w/ Cough >2 weeks with whoop or posttussive vomiting

A

Bordetella pertussis

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55
Q

Lung cavity infiltrates

A

Community-associated MRSA, oral anaerobes, endemic fungal pathogens, Mycobacterium tuberculosis, nontuberculous mycobacteria

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56
Q

pna associated with etoh

A

S. pneumoniae, oral anaerobes, Klebsiella pneumoniae, Acinetobacter species, M. tuberculosis

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57
Q

pna associated with smoking/copd

A

Haemophilus influenzae, Pseudomonas aeruginosa, Legionella species, S. pneumoniae, Moraxella catarrhalis, C. pneumoniae

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58
Q

PNA in HIV (early)

A

S. pneumoniae, H. influenzae, M. tuberculosis

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59
Q

PNA in southwest usa

A

Coccidioides species, Hantavirus

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60
Q

pna in Travel or residence in Southeast and East Asia

A

Burkholderia pseudomallei (melioidosis)

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61
Q

Exposure to bat or bird droppings

A

Histoplasma capsulatum

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62
Q

Exposure to birds

A

Chlamydophila psittaci

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63
Q

Exposure to rabbits

A

Francisella tularensis

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64
Q

Exposure to farm animals or parturient cat

A

Coxiella burnetii

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65
Q

Exposure to rodent excreta

A

Hantavirus

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66
Q

prophylaxis for lyme

A

antibiotic prophylaxis with doxycycline only when the attached tick isidentified as an adult or nymphal deer tick, attachment is estimated at 36 hours or longer, prophylaxis is begun within 72 hours
of tick removal, the tick bite occurred in an endemic area

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67
Q

lyme endemic areas

A

northeast, mid-Atlantic, and Midwest United

States.

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68
Q

Lyme treatment if Within 30 days of exposure: erythema migrans, fever, fatigue, headache, arthralgia, myalgia

A

Treat without serologic confirmation`

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69
Q

Lyme tx if Weeks to months after exposure: multiple erythema migrans lesions, heart conduction block, cranial neuropathy, radiculoneuropathy, lymphocytic meningitis, acute attacks of monoarticular or oligoarticular arthritis

A

Treat if ELISA is positive Obtain Western blot if ELISA is

indeterminate

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70
Q

Lyme if Months to years after exposure: attacks of monoarticular or oligoarticular arthritis and/or chronic monoarthritis or oligoarthritis, peripheral neuropathy, or encephalomyelitis

A

Treat if ELISA is positive Obtain Western blot if ELISA is

indeterminate

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71
Q

early lime tx

A 
begin doxycycline (10-21 days,
preferred), amoxicillin, or cefuroxime for 14 to 21 days without laboratory confirmation
of Borrelia burgdorferi
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72
Q

Manage late carditis or neurologic disease with

A

h IV penicillin or IV ceftriaxone for 28 days, and manage arthritis and facial nerve palsy with
doxycycline

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73
Q

bebisiosis tick and endemic area

A

black-legged deer tick) malaria-like illness endemic to the northeast coast of the United States

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74
Q

signs of beibisiosis

A

myalgia, headache, and fatigue. Severe hemolytic anemia, jaundice, kidney failure, and death

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75
Q

testing for beibisiosis

A

A Wright- or Giemsa-stained
peripheral blood smear will show intraerythrocytic parasites in
ring, or more rarely, tetrad formations (Maltese cross shape).
Consider PCR for Babesia DNA in cases of low parasitemia

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76
Q

Babesiosis tx

A

monitor asymptomatic patients for 3 months. use Atovaquone plus azithromycin is the treatment of choice for patients with persistent parasitemia after 3 months and for mild-to-moderate symptomatic disease

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77
Q

erlichiosis and anaplasmosis pathogen, tick and demographic

A 
Ehrlichia chaffeensis (transmitted by the lone star tick and most prevalent in south central and southeastern United States) and
Anaplasma phagocytophilum (transmitted by the Ixodes tick) are rickettsia-like organisms that infect leukocytes
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78
Q

anaplasmosis and erlichosis signs and symptoms

A

The clinical syndromes of HME and HGA are very similar:
• fever, headache, and myalgia
• multiorgan failure (AKI, ARDS, meningoencephalitis)
• fever of unknown origin (symptoms can persist for months)
• elevated aminotransferases with normal alkaline phosphatase and bilirubin levels
• leukopenia and thrombocytopenia
• presence of morulae (clumps of organisms in the cytoplasm of the appropriate leukocyte)

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79
Q

testing and tx of erlichosis and anaplasmosis

A

Whole blood PCR and Doxy(IV or Oral)`

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80
Q

RMSF epidemiology

A

a tick-borne rickettsial infection most prevalent in the southeastern and south central states.
spring and summer months

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81
Q

RMSF rash

A

r rash starting on the ankles and

wrists and often affecting the palms and soles of the feet; lesions spread centripetally and become petechial.

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82
Q

Diagosiing RMSF

A

Thrombocytopenia and elevated aminotransferase levels are characteristic. Immunohistochemistry or PCR of a skin biopsy

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83
Q

tx of RMSF

A

Select doxycycline. In patients who are pregnant, choose chloramphenicol

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84
Q

when to screen or treat asymptomatic bacturia

A

pregnant or are about to undergo an invasive urologic procedure

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85
Q

when to obtain a urine culture

A
  • suspected pyelonephritis
  • complicated UTI
  • recurrent UTI
  • suspicion of an unusual or antimicrobial-resistant microorganism or a patient who is pregnant
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86
Q

best treatment for uncomplicated cystitis

A
  • 3 days of oral trimethoprim-sulfamethoxazole
  • 5 days of oral nitrofurantoin
  • single 3-g oral dose of fosfomycin
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87
Q

best tx patient at high risk for complicated UTI

A

obtain a urine culture and initiate empiric treatment for 7 to 14 days with a
fluoroquinolon

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88
Q

best tx for pregnant patient with complicated uti

A

choose 7 days of empiric therapy with amoxicillin-clavulanate, nitrofurantoin,
cefpodoxime, or cefixime. Obtain a urine culture after treatment.

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89
Q

r recurrent uncomplicated UTIs tx

A
  • postcoital antibiotic prophylaxis, particularly if UTIs are temporally associated with coitus
  • continuous antibiotic prophylaxis
  • self-initiated therapy for frequent recurrent episodes
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90
Q

when bactrim is contraindicated?

A

sulfa allergy or s taken in the preceding 3 months

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91
Q

Tx duration for pyelo

A

Treat uncomplicated infection for 5 to 7 days and complicated infection for 14 days.

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92
Q

tx of pyelo in long term care facilities

A

Patients admitted from a long-term care facility should also receive empiric coverage for vancomycin-resistant Enterococcus
and fluoroquinolone-resistant gram-negative rods.

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93
Q

when to obtain extra imaging for pyelo

A

Obtain ultrasonography or CT for persistent fever or continuing symptoms after 72 hours of antibiotics to evaluate for complications of pyelonephritis (e.g., perinephric abscess).

CT and MRI should be considered in patients with persistent or relapsing pyelonephritis despite a negative ultrasound.

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94
Q

tx for latent tb

A

: For patients without HIV, select daily isoniazid for 6 months or
daily rifampin for 4 months. In patients with HIV, select daily isoniazid for 9 months

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95
Q

tx for active tb

A

the core first-line agents are isoniazid, rifampin, pyrazinamide,
and ethambutol. These agents are administered for 8 weeks as part of the initiation phase, and then isoniazid and rifampin are continued for either 4 or 7
months as part of the continuation phase.

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96
Q

criteria that patient is no longer infectious from TB

A
  • adequate TB treatment >2 weeks
  • improvement of symptoms
  • three consecutive negative sputum smears
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97
Q

what to check for patients on pyrazinamide or ethambutol

A

uric acid levels or visual acuity and

color vision testing are recommended, respectively

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98
Q

two presentations of MAC

A
  1. middle-aged to older adult male smokers with underlying lung disease who clinically and radiographically resemble patients with TB.
  2. healthy white women presenting as right middle lobe or left lingular lobe lung infection. These women often have scoliosis, pectus excavatum, or MVP suggesting an underlying connective tissue defect.
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99
Q

when does disseminated mac occur

A

HIV who have CD4 cell counts less than 50/μL who are not receiving MAC prophylaxis

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100
Q

tx for mac

A

usually consists of clarithromycin or azithromycin with ethambutol and either rifampin or rifabutin.

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101
Q

which mycobacteria infections are associated with soft tissue esp after trauma, surgery or tattoo

A

Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae

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102
Q

when does aspergilloma occur

A

preexisting pulmonary cavities or cysts, or in areas of devitalized lung

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103
Q

aspergilloma symptoms

A

cough, hemoptysis, dyspnea, weight loss, fever, and chest pain

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104
Q

at risk for aspergillus infection

A

Neutropenic patients and organ transplant recipients

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105
Q

gold standard diagnostic test for Aspergillus infection

A

deep body specimen; galactomann in right clinical setting or to ensure resolution

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106
Q

tx for aspergilloma

A

surgical resection

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107
Q

tx of invasive aspergilosis

A

variconizole

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108
Q

allergic bronchopulmonary aspergillosis tx

A

oral glucocorticoids

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109
Q

tx for Patients with aspergilloma who are asymptomatic and have stable x-rays

A

no tx required

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110
Q

tx for cadedemia

A

caspafungin, micafungin

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111
Q

preventative tx against cadidemia

A

Fluconizole

112
Q

do you treat resp cadidemia

A

no likely contaminant

113
Q

do you tx asymptomatic candiduria

A

no unless yrological procedure or neutropenic

114
Q

most common form of meningitis in aids

A

crypto

115
Q

which HIV pt usually are susceptible to crypto

A

Most patients have a CD4 cell count of less than

100/μL

116
Q

dx of crypto

A

cryptococcal antigen in the CSF or culture of Cryptococcus neoformans in the
CSF. The opening CSF pressure is typically elevated.

117
Q

tx for crypto meningitis

A

amphotericin B plus flucytosine for induction treatment of meningitis followed by fluconazole maintenance therap

118
Q

blasto demographic and symptoms

A 
1. Midwestern, southeastern, and south
central United States (Mississippi,
Missouri, and Ohio river valleys)
2. onset 4-6w and Consider in patients with primary skin lesion or concurrent
pulmonary and skin or bone findings
119
Q

coccido demographic and symptoms

A
  1. Southern Arizona, south central California, southwestern New Mexico, west Texas
  2. Consider in patients with pulmonary symptoms and
    erythema nodosum or erythema multiforme
120
Q

histo demographic and symptoms

A
  1. Midwestern states in the Ohio and
    Mississippi River valley regions
  2. Consider in patients with complex pulmonary disease
    (nodular, cavitary, lymphadenopathy)
121
Q

sporotrichosis demographic and symptoms

A
  1. gardeners
  2. A papule appears days to weeks later at the inoculation site.
    Similar lesions then occur along lymphatic channels
    proximal to the inoculation site.
122
Q

tx for chlamydial infection

A

azithro or doxy

123
Q

signs of disseminated gonnorhea

A

sparse peripheral necrotic pustules
• monoarthritis or oligoarthritis (knees, hips, and wrists)
• tendon sheath inflammation

124
Q

Besides NAAT to test for gonorrhea what should you also get for arthritis and for disseminated disease

A

1 Joint aspiration

2. Blood culture

125
Q

Tx for gonorrhea epipdidmitis

A

ceftriaxone and azithromycin or doxycycline for 10 days

126
Q

tx for disseminated gonorrhea

A

Treat disseminated gonococcal infection with

a 7- to 14-day course of ceftriaxone.

127
Q

outpatient tx for pid

A

a single parenteral dose of ceftriaxone plus doxycycline with or without metronidazole for 14 days.

128
Q

when to admit for pid

A

no clinical improvement after 48 to 72 hours of antibiotic treatment
• inability to tolerate oral antibiotics
• severe illness with nausea, vomiting, or high fever
• suspected pelvic abscess
• pregnancy

129
Q

inpatient treatment for pid

A

Inpatients are treated with parenteral cefoxitin or cefotetan and doxycycline

130
Q

if patient is non-responsive to abx inpatient what is the next best step

A

nonresponsive to antibiotics in 48

to 72 hours, choose ultrasonography for evaluation of possible tubo-ovarian abscess.

131
Q

how to diagnose secondary syphilis

A

• fever and any type of rash (except vesicles), often with palmar or plantar involvement
• nontender generalized lymphadenopathy
• headache, cranial nerve abnormalities, altered mental status, or stiff neck
• mucous patches (a slightly elevated oval erosive lesion with surrounding inflammation) and condylomata lata lesions
(grey to white, raised, wart-like lesions on moist intertriginous surfaces)

132
Q

latent syphilis is..

A

involves the presence of serologic evidence of infection in the absence of clinical signs. Latent syphilis
is divided into early latent (infection ≤1 year in duration) or late-latent (infection >1 year

133
Q

Late syphilis classified as

A

meningitis and subarachnoid arteritis (a cause of stroke in a young patient)
• aortitis
• general paresis and tabes dorsalis
• gumma in any organ

134
Q

VDRL and RPR titers syphilis
primary
secondary
tertiary

A
  • often negative in primary infection
  • positive in high titers in secondary syphilis
  • lower titers are seen in latent and tertiary infection
135
Q

how should you confirm syphilis

A

fluorescent treponemal antibody absorption test

(FTA-ABS) or Treponema pallidum particle agglutination (TPPA) assay

136
Q

which test in syphils will remain +

A

e FTA-ABS and microhemagglutination assay for T. pallidum (MHA-TP) antibodies will remain positive indefinitely

137
Q

csf in neurosyphilis

A
  • CSF lymphocytes >5/μL
  • elevated CSF protein
  • positive CSF VDRL test
138
Q

Herpes (HSV type 1 or 2) rash character

A

Multiple 1- to 2-mm tender vesicles or erosions and tender lymphadenopathy

139
Q

Syphilis (T. pallidum) rash character

A

Single 0.5- to 1.0-cm painless indurated ulcers and nontender bilateral inguinal lymphadenopathy

140
Q

Chancroid (Haemophilus ducreyi) rash character

A

Ragged, purulent, painful ulcers with tender lymphadenopathy`

141
Q 
Lymphogranuloma venereum (Chlamydia
trachomatis) rash character
A

Single 0.2- to 1.0-cm ulcer, sometimes painful, with tender unilateral lymphadenopathy,
which may suppurate

142
Q

Fixed drug eruptions (NSAIDs,

phenobarbital, antibiotics) rash character

A

Single or multiple blisters or erosions, 1-3 cm, frequently on the glans penis

143
Q

Treat primary or secondary or early latent syphilis with

A

one dose of IM benzathine penicillin

144
Q

treat late latent or asymptomatic syphilis of unknown

duration

A

3 weekly doses of benzathine penicillin

145
Q

Treat late (tertiary) nonneurosyphilis

A

three weekly doses of IM benzathine penicillin.

146
Q

Treat neurosyphilis with

A

continuous penicillin G infusion

(or every 4 hours) for 10 to 14 days.

147
Q

Failure of treatment of syphilis or reaquisition is determined by

A

Failure of nontreponemal serologic test results to decrease

fourfold in the 6 to 12 months after treatment

148
Q

how to tx prego patient with penicillin allergy for syphilis

A

desensitized and treated with penicillin.

149
Q

what is e Jarisch-Herxheimer reaction

A

acute febrile illness occurring within 24 hours of treatment for any stage of
syphilis and is not an allergic reaction to penicillin

150
Q

where does herpes stay latent in the body

A

a latent state in nerve cell bodies in ganglion neurons

151
Q

most diagnostic sensitive modality for testing herpes

A

PCR testing of clinical specimens obtained from ulcers and mucocutaneous sites

152
Q

what does a positive HSV-2 antibody test indicate

A

indicates only previous infection and is not a useful diagnostic test.

153
Q

tx for oral or genital hsv

first and recurrent

A

first episode acyclovir, famciclovir, or valacyclovir 7-10 days recurrent 3-5 days

154
Q

Treat primary herpes keratoconjunctivitis

A

topical trifluorothymidine, vidarabine, or acyclovir. Ophthalmology referral is
mandatory.

155
Q

treatment for bells palsy

A

glucocorticoids may be beneficial. The role of antiviral therapy is unclear

156
Q

genital warts vaccine

A

The HPV4 and HPV9 vaccines are approved for both sexes and protect against HPV types that cause genital warts and cervical
cancer.

157
Q

which hpv resp for genital warts

A

6 and 11

158
Q

most commonly isolated pathogen causing hematogenous osteomyelitis and what about other causes of osteo

A

1 s aureus

2 polymicrobial

159
Q

pathogen of osteo caused by cat or dog bit

A

pasturella multicoda

160
Q

pathogen of osteo caused by foot puncture wound

A

psuedomonas, puncture through sole of foot

161
Q

what predisposes sickle cell patients to oseto

A

bone infarcts or bone marrow thrombosis

162
Q

pathogen of osteo in sickle cell patients

A

s aureus or salmonella (capsule)

163
Q

diagnostic imagining for osteo

A

mri or bone scan if contraindicated

164
Q

what is definitive study for osteomyelitis

A

bone biopsy

165
Q

do you need to get bone biopsy if osteo is negative

A

no

166
Q

do you start abx before bone biopsy in stable osteo

A

no get bone biopsy first

167
Q

most common pathogen in vertebral osteo

A

s. aureus or coagulase negative staph

168
Q

next step if imaging mri shows vertebral osteo but bcx negative

A

ct percutaneous biopsy

169
Q

empiric tx of osteo

A

Vancomycin or daptomycin plus ceftriaxone, ceftazidime, cefepime, or a fluoroquinolone are appropriate choices.

170
Q

tx for osteo with implanted device that cannot be removed

A

a prolonged course (3-6months) of fluoroquinolone and rifampin

171
Q

definition of FUO

A

a temperature >38.3 °C (100.9 °F) for at least 3 weeks that remains undiagnosed after 2 outpatient visits or 3 days of inpatient evaluation

172
Q

drugs that can cause fever

A

anticonvulsants (phenytoin, carbamaz- epine), antibiotics (β-lactams, sulfonamides, nitrofurantoin), and allopurinol.

173
Q

iga deficiency may present with

A

recurrent sinopulmonary infections, giardiasis, and have an increased risk for autoimmune disorders, including RA and SLE.

174
Q

what do you need to be cautious of if patient has iga deficiency

A

high risk for transfusion reactions because of the development of anti- IgA antibodies.

175
Q

what is CVID

A

most common symptomatic primary immunodeficiency and is characterized by low levels of one or more immu- noglobulin classes or subclasses

176
Q

diagnose cvid

A

Measure serum IgM, IgA, IgG (all low), and IgG subclasses (variably low), and measure the ability to mount an antibody response to tetanus toxoid (protein) and pneumococcal polysaccharide vaccine (polysaccharide) antigens.

177
Q

treatment for CVID

A

Choose IV immune globulin as first-line therapy for CVID. Most patients with selective IgA therapy do not require treatment.

178
Q

why is standard immunuglobulin therapy contraindicated in isolated iga deficiency

A

these patients may have IgG or IgE antibodies directed against the transfused IgA.

179
Q

what infection are pts at risk for with complement deficiency

A

neisseria (terminal deficiency test CH50 assay)

180
Q

treatment for patient with compliment deficiency

A

atients with complement deficiency respond to standard antibiotics. Patients should maintain currency of vaccinations, especially meningococcal, pneumococcal, and Haemophilus b conjugate vaccine.

181
Q

symptoms of small pox

A
  • fever>38.5°C (101.3°F), fatigue, and headache and backaches
  • rash beginning 2 to 3days after onset of fever
  • rash first appearing on buccal or pharyngeal mucosa, then the face and proximal arms and legs, and then spreading to the chest and distal extremities, including the palms and soles
  • rash in the same stage at any one time, in any one location of the body (all papules, all vesicles, all pustules, or all crusts)
182
Q

chickenpox symptoms

A
  • generally mild prodrome of fever and constitutional symptoms in children and adolescents, occurring simultaneously with rash
    • rash beginning on the trunk, then spreading to the face and extremities
  • rash in different stages(mix of papules,vesicles,pustules, and crusts) at any one time
183
Q

How long are patient still contagious with small pox

A

untilall scabs and crusts are shed

184
Q

tx of small pox

A

supportive maybe tecovirmat

185
Q

exposure to small pox treatment

A

post- exposure vaccination with vaccinia within 7 days of exposure and targeting close contacts of patients with smallpox (“ring vaccination”) is recommended.

186
Q

risk factors for anthrax

A

• travel to the Middle East, Africa , South America ,or Asia
• exposure to wool, hides, or animal hair from endemic
countries
• bioterrorism

187
Q

diagonses for enlarging, pain- less ulcer with black eschar surrounded by edema or large gram-positive bacilli on Gram stain

A

cutaneous anthrax

188
Q

inhalation anthrax

A

dyspnea, fever, chest pain, and a wid- ened mediastinum on chest x-ray or CT scan.

189
Q

post exposure prophylaxis for anthrax

A

postexposure vaccination and ciprofloxacin for 60 days or Raxibacumab

190
Q

tx for cutaneous anthrax vs inhalation anthrax

A

cutaneous: oral cipro

inhalation anthrax: IV Cipro and 2 other abx, Raxibacumab can be used to neutralize toxin

191
Q

how is yersinia pestis transmitted

A

by fleas

192
Q

bubonic plague vs septicemic plague vs pneumonic plague

A
  • Bubonic plague follows primary cutaneous exposure and is characterized by buboes (infected, swollen lymph nodes).
  • Septicemic plague is characterized by DIC and multiorgan system failure.
  • Pneumonic plague most often arises secondarily through hematogenous spread from a bubo or direct inhalation.
193
Q

how do patient’s with pneumonic plague present

A

en high fever, pleuritic chest discomfort, a productive cough, and hemoptysis. The chest x-ray is nonspecific.

194
Q

yersinia pestis gram stain

A

Sputum Gram stain (and possibly blood smear) may identify the classic bipolar gram-negative
staining or “safety pin” shape.

195
Q

tx of plague

A

gent or streptomycin

196
Q

Francisella tularensis gram stain

A

gram-negative coccobacillus

197
Q

Diagnose tularemia

A

A high index of clinical suspicion is necessary for diagnosis. Routine laboratory tests are nonspecific. Diagnosis is confirmed 2
or more weeks after infection with presence of IgM and IgG antibodies to Francisella tularensis.

198
Q

tx for tularemia

A

mild -oral cipro

severe- IV gent or streptomycin

199
Q

MOA of Clostridium botulinum

A

neurotoxin inhibits acetylcholine release at ganglia and neuromuscular junctions, causing bulbar
palsy and symmetric flaccid paralysis beginning 12 to 72 hours after exposure

200
Q

5 Ds of botulism

A
  • Diplopia
  • Dysphonia
  • Dysarthria
  • Dysphagia
  • Descending paralysis (starting with facial muscles)
201
Q

tx of botulism

A

respiratory support and trivalent (tequine serum antitoxin should be administered as early as
possible to prevent progression; it cannot reverse existing paralysis.

202
Q

Malaria clinical clues

A 
Paroxysmal fever (every 48 or 72 hours, depending on the species and
may be continuous with Plasmodium falciparum), intraerythrocytic
parasites, thrombocytopenia
203
Q

Dengue fever clinical clues

A

Acute onset of fever with chills, biphasic fever pattern (“saddleback”),
frontal headache, lumbosacral pain, extensor surface petechiae

204
Q

Chikungunya fever clinical clues

A

Fever (abrupt onset up to 40 °C [104 °F] with rigors with recrudescent
episodes), rash, and small joint polyarthritis

205
Q

Zika virus clinical clues

A

Nonspecific symptoms of fever, rash, joint pain, and/or conjunctivitis
(asymptomatic in up to 80% of persons)

206
Q

Typhoid fever clinical clues

A

Prolonged fever, pulse-temperature dissociation, diarrhea or constipation,
faint salmon-colored macules on the abdomen and trunk (“rose spots”)

207
Q

Novel coronaviruses (severe acute respiratory syndrome clinical clues

A

Flu-like syndrome prodrome, diarrhea, dry cough with progressive
dyspnea, lymphopenia, thrombocytopenia, elevated lactate dehydrogenase

208
Q

Hemorrhagic fever viruses (Ebola, Marburg, and Lassa) clinical flu

A

Fever, malaise, myalgia, vomiting, diarrhea, coagulation disorders, and
bleeding

209
Q

Rabies clinical clues

A

Paresthesias or pain at wound site, fever, nausea and vomiting, hydrophobia, delirium, agitation

210
Q

zika virus effect on pregnancy

A

flavivirus that causes microcephaly and other congenital malformations

211
Q

how long after being in a zika endemic place should you wait to conceive

A

3 mo for men

8 weeks for women

212
Q

zika testing

A

initial 2 weeks reverse transcriptase pcr after that igM

213
Q

how long is incubation period for malaria

A

1 w to 3 months

214
Q

diagnosis for malaria by

A

thick and thin peripheral blood smears

215
Q

which malaria have >2% parasitemia

A

Parasitemia levels >2% are most consistent with P. falciparum or Plasmodium knowlesi

216
Q

tx for malaria

A

use chloriquine in areas that flaciproum is not prevelant otherwise use atovaquone-proguanil, mefloquine, and quinine-based regimens

217
Q

symptoms of leptospirosis

A

fever, rigors, myalgias, and headache. Kidney failure, uveitis, respiratory failure, myocarditis, and rhabdomyolysis can occur.

A key physical sign is conjunctival suffusion, infrequently found in
other infectious diseases.

218
Q

diagnosis and tx of leptospirosis

A

serological screening
Tx: Most cases are self-limited, but doxycycline and penicillin may
be helpful in severe disease or shortening the duration of mild
disease.

219
Q 
bacteria and tx 
Watery diarrhea, bloating,
flatulence, weight loss
HIV patients have more severe
illness with wasting
A

cyclospora

tx bactrim

220
Q 
parasite  and tx 
Watery diarrhea, bloating,
flatulence, weight loss
HIV patients have more severe
illness with wasting
A

cyclospora

tx bactrim

221
Q

parasite and tx

Watery diarrhea, abdominal
cramping, steatorrhea, weight loss
Prolonged infection with IgA
deficiency

A

Giardia

Metronidazole × 5-10 days

222
Q

virus and tx

Watery, noninflammatory
diarrhea; vomiting in >50% of
cases; highly transmissible;
frequent cause of outbreaks

A

norovirus

tx supportive

223
Q

bacteria and tx

Bloody stools (>25% of cases),
fever, vomiting (>50% of cases)
Severe infection with sepsis in
patients with hepatic dysfunction
or alcoholism
A

Vibrio cholerae

fluroquinolones

224
Q

bacteria and tx

Fever, diarrhea, RLQ pain (mimics
appendicitis), pharyngitis
Postinfectious reactive arthritis

A

yersenia

tx Fluoroquinolone; trimethoprimsulfamethoxazole

225
Q

bacteria and tx

Nonbloody, watery stools after traveling

A

Enterotoxigenic E. coli
(travelers’ diarrhea)

tx Fluoroquinolone, azithromycin, or
rifaximin

226
Q

bacteria and tx

Bloody stools in >80% of cases;
fever often absent; may be
associated with HUS

A

STEC including
Escherichia coli
O157:H7

Tx None (antibiotic treatment of STEC
may increase the risk of HUS)
227
Q

bacteria and tx

Fever, chills, diarrhea; bacteremia in
10%-25% of cases and may result in
endothelial infection, including
aortitis, arteritis, mycotic aneurysm;
osteomyelitis in sickle cell disease
A

Salmonella
(nontyphoidal)

Do not treat mild disease; this may
lead to prolonged shedding of
bacteria in stool
If significant comorbid illness or severe
illness, treat with fluoroquinolone
228
Q

bacteria and tx

Dysentery
Day-care center or nursing home
workers
Rare cause of HUS or reactive arthritis

A

Shigella

Usually self-limited
Fluoroquinolone; azithromycin for
severe symptoms or positive stool
cultures to reduce transmission

229
Q

bacteria and tx

Fevers, chills, bloody diarrhea,
abdominal pain
Postinfectious IBD, reactive
arthritis, Guillain-Barré

A

Campylobacter

tx
Azithromycin or erythromycin

230
Q

what infections are patient post transplant susceptible to in first 30 days

A

same as those
that develop postoperatively in patients who have undergone non–transplant-related surgery

neutropenia patient can be susceptible to

231
Q

what are patient’s post transplant susceptible to after the first 30 days

A

CMV esp in a CMV negative patient and CMV positive donor

232
Q

what is CMV infection posttransplant associated with

A
  • an increased risk for renal graft failure
  • GI perforations and significant bleeding
  • CMV-related pneumonia and respiratory failure
  • EBV, polyomavirus BK, polyomavirus JC, and hepatitis B and C reactivation
233
Q

Polyomavirus JC infection can progress to

A

progressive multifocal leukoencephalopathy

234
Q

what infection is almost always found in posttransplantation lymphoproliferative disease

A

EBV

235
Q

Kidney transplant patients with polyomavirus BK infection may develop

A

nephropathy, organ rejection, or ureteral strictures.

236
Q

HSCT recipients with BK infection may develop

A

hemorrhagic cystitis.

237
Q

Transplant ppx
ppx during Neutropenia
Pneumocystis and Toxoplasma prophylaxis.
CMV ppx solid vs hsct

A

neutropenia should include antifungal such as voriconazole.

PCP/Toxo- Bactrim

CMV solid valganciclovir
HSCT acycovir to avoid myelosupression

238
Q

what can cmv ppx in transplant patient also lower the occurance of

A

a lower incidence of polyomavirus BK and EBV

reactivation.

239
Q

tx for transplant cmv

A

immunosuppressive therapy may need to be reduced. IV ganciclovir,
oral valganciclovir, oral foscarnet, and IV cidofovir are used for treatment

240
Q

The only known effective treatment for polyomavirus

JC infection is to

A

reverse immunosuppressive therapy

241
Q

HAP VS VAP

A

HAP is defined as pneumonia that occurs ≥48 hours after admission. VAP, a subset of HAP, is defined as occurring >48 hours
after endotracheal intubation.

242
Q

how to reduce vap

A
  • following daily weaning protocols for timely extubation
  • keeping the head of the bed elevated >30 degrees
  • avoiding nasal intubation and nasogastric tubes
  • using chlorhexidine mouth rinse and subglottic suction catheters
243
Q

catheter related infections when should you remove line

A
  • tunnel or pocket infection
  • sepsis
  • metastatic infection (septic thrombosis, endocarditis, or osteomyelitis)
  • Staphylococcus aureus or Pseudomonas infection
  • fungemia
244
Q

is routine dressing changes beneficial in preventing line infection

A

no actually increases risk

245
Q

tx for line infection

A

MSSA is treated with either nafcillin (or oxacillin) or cefazolin
• MRSA is treated with vancomycin or daptomycin

For septic or neutropenic patients cover for psuedomonas.

246
Q

duration of tx in line infections

A

IV catheter-related S. aureus bacteremia that clears within 72 hours without evidence of endocarditis or metastatic infection
may be treated with 10 to 14 days of parenteral antibiotics.

Persistent S. aureus bacteremia >72 hours after the start of appropriate antimicrobial therapy suggests a complicated infection. Evaluate with echocardiography, preferably transesophageal. Treat complicated S. aureus bacteremia for 4 to 6 weeks.

247
Q

HIV testing protocol

A

• a fourth-generation combination immunoassay that includes an EIA for HIV antibody (HIV-1 and HIV-2) and HIV p24
antigen
• if combination immunoassay is positive, obtain immunoassay to differentiate HIV-1 from HIV-2
• detection of either HIV-1 or HIV-2 antibody confirms the diagnosis
• if differentiation immunoassay is inconclusive for either HIV-1 or HIV-2, obtain NAAT
• a positive NAAT in the setting of a negative antibody test indicates acute HIV infection

*if patient has postive saliva test still needs to go through algorhythm

248
Q

what diseases should warrent HIV testing

A
  • severe or treatment-refractory HSV infection
  • oral thrush or esophageal candidiasis
  • Pneumocystis jirovecii pneumonitis
  • cryptococcal meningitis
  • disseminated mycobacterial infection
  • CMV retinitis or GI disease
  • toxoplasmosis
  • severe seborrheic dermatitis, or new or severe psoriasis
  • recurrent herpes zoster infections
249
Q

what is the best indicator for predicting long term prognosis in HIV and what is the best indicator to determine risk of opportunisitic infection

A

viral load

CD4

250
Q

tx for iris

A

continue art, tx underlying infections, steroids and nsaids can assist

251
Q

HIV ppx for CD4<200

A

Pneumocystis -> bactrim

252
Q

HIV ppx for CD4< 100

A

Toxoplasmosis -> Trimethoprim-sulfamethoxazole

253
Q

HIV ppx for CD4 <50

A

MAC -> azithro

254
Q

can you give MMR and varicella to HIV patients

A

only if CD4>200

255
Q

when can you discontinue ppx for hiv opp infections

A

when cd4 count >200 and undetectable viral load for 3 mo

256
Q

how do you diagnose pjp

A

An elevated LDH level may be present in HIV-infected patients with P. jirovecii pneumonia. The diagnosis is established by immunofluorescent monoclonal antibody stain or silver stain examination of induced sputum or a bronchoscopic sample show- ing characteristic cysts.

257
Q

The most common cause of a pneumothorax in a patient with AIDS is

A

PJP

258
Q

tx for PJP

A

oral trimethoprim-sulfamethoxazole for mild to moderate pneumonia
• IV trimethoprim-sulfamethoxazole for moderate to severe pneumonia
• glucocorticoids within 72 hours for A-a ≥35 mm Hg or arterial P o2 <70 mm Hg
• IV pentamidine or IV clindamycin plus oral primaquine for patients with sulfa allergy

259
Q

signs of toxo

A
  • encephalitis, chorioretinitis, or pneumonitis in immunocompromised patients
  • any focal neurologic syndrome, acute or subacute
  • mononucleosis-like syndrome
260
Q

Lymphoma (primary CNS, B-cell lymphoma)

A

Often a solitary lesion is located in the periventricular or periependymal area or in the corpus callosum

Neither clinical nor neuroradiologic findings reliably distinguish lymphoma from toxoplasmosis

Brain biopsy is diagnostic

261
Q

imaging findings in toxo

A

Typical findings on imaging include multiple ring-enhancing lesions.

262
Q

Progressive multifocal leukoencephalopathy

A

Dementia is often the presenting symptom
CD4 cell counts are usually <50/μL and
PCR of CSF can show JC virus
Brain biopsy is diagnostic

263
Q

Cryptococcus neoformans

A

Headache, fever, and altered mental status are present CD4 cell counts are usually <100/μL

CSF culture for Cryptococcus or cryptococcal antigen tests on CSF and serum are diagnostic;
elevated CSF opening pressure is characteristic

264
Q

MTB in the brain characteristics

A

Basilar meningitis with cranial nerve abnormalities Culture and PCR of CSF are diagnostic

265
Q

CMV encephalitis

A

Diffuse encephalitis and fever are characteristic CD4 cell counts are <50/μL; CSF PCR is positive, and brain biopsy is diagnostic

266
Q

neurosyphilis

A

Atypical and accelerated neurosyphilis is seen in HIV infection
Lymphocytic pleocytosis and elevated CSF protein Positive serum RPR or VDRL test, FTA-ABS, and MHA-TP; positive CSF VDRL

267
Q

toxo tx

A

sulfadiazine, pyrimethamine, and folic acid in patients with multiple ring-enhancing lesions, positive T. gondii serologic test results (IgG), and immune suppression (CD4 cell count <200/μL). Treat patients with persistent immunosuppression indefinitely. Biopsy lesions that fail to respond to 2 weeks of empiric therapy.

268
Q

what do you do in setting of institutional outbreak of flu

A

vaccinate staff members and residents not already immunized and give chemoprophylaxis with zanamivir or oseltamivir for at least 2 weeks following immunization.

269
Q

most common complication of the flu

A

super imposed bacterial pna

270
Q

what should you test for in a young patient who gets shingles

A

HIV

271
Q

how does shingles occur

A

latent VZV within sensory ganglia, especially in adults >60 years or in immunosuppressed patients.

272
Q

what is postherpetic neuralgia

A

neuropathic pain lasting more than 1 month after resolution of the vesicular rash.

273
Q

what is ramsey hunt syndrome

A

vesicular rash in external ear associated with ipsilateral peripheral facial palsy and altered taste

274
Q

shingles vaccination guideline

A

recombinant zoster vaccine for all adults ≥50 years, including those who have previously had herpes zoster infection or have been vaccinated with the live attenuated vaccine.

275
Q

whos should get post exposure ppx for shingles

A

postexposure varicella vaccination is appropriate in immunocompetent persons, and varicella-zoster immune globulin should be used in immunocompromised adults and in pregnant women.

276
Q

tx for shingles

A

Antiviral therapy (acyclovir, valacyclovir, and famciclovir) speeds recovery and decreases the severity and duration of neuropathic pain if begun within 72 hours of VZV rash onset.

Intravenous acyclovir should be used for immunosuppressed or hospitalized patients and those with neurologic involvement.

277
Q

cancer association with ebv

A

B-cell lymphoma, T-cell lymphoma, Hodgkin lymphoma, and nasopharyngeal carcinoma. Another EBV manifestation is oral hairy leukoplakia

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