Infectious Disease

Question 1

WBC Interpretation
CBC:
Neutrophils \_\_\_\_ w/  BACTERIAL infection 
Monocytes: \_\_\_\_\_ 
Lymphocytes: \_\_\_\_
Eosinophils: \_\_\_\_\_
Basophils and Eosinophils: \_\_\_\_\_\_\_

Answer 1

WBC Interpretation
CBC:
Neutrophils increase w/ BACTERIAL infection
Monocytes: Bacterial
Lymphocytes: Viral
Eosinophils: worms, wheezes, weird diseases
Basophils and Eosinophils: DON’T RESPOND TO VIRAL or BACTERIAL

Question 2

what does cbc shift to left mean?

Answer 2

Left shift= Increase band cells (immature immunity cells)= acute infection happening now

Question 3

bacterial infection, causes by staph or strep Pyrogens, involving deeper layers of the tissue
warm, edema, pain, sharp demarcation
Systemic involvement; lymph, fevers, chills
Lymph streaking

Answer 3

Cellulitis

Question 4

Diagnostics for cellulitis

Answer 4

Lab: CBC, creatonon, bicarb, creatine phosphokinse, gram stain
Imaging: eval osteomyelitis, US
Dx: blood cultures, needle aspirate, culture

Question 5

managing cellulitis

Answer 5

Update tetanus
Meds: Kephlex

Regular people Antibiotics = Penicillin, Amox, Augmentin, Keflex (Class)

MRSA oriented - Doxycycline (class)

F:U 24-48 hours

Question 6

Non-purulent SSTI infection of upper demis to include lymphatics - superficial cellulitis

Erythema, edema, pain
Lymphatic streaking
LE most common location

Answer 6

Erysipelas (strep)- cellulitis but superficial

Question 7

How to tx Erysipelas (strep)- cellulitis but superficial

Answer 7

Pain- ibuprofen or tylenol
PCN first line

if allergies- macrolide/ cephalosporin

Question 8

diagnostics for Erysipelas (strep)

Answer 8

Labs: CBC, ESR, CRP

Imagine- r/o necrotizing fasciitis

Question 9

Honey crusted lesions
1-2mm lesions
Common in face and LE

Answer 9

Impetigo (bacterial)

Question 10

how to manage Impetigo ?

Answer 10

Mupirocin 2% topical TID x 10 days (for mild)

Severe: amoxicillin/clavulanate (augmentin) 500 Q8

Question 11

(oral) and (genital)- both can appear at any site
Stays on nerve roots and can reactivate infection
Risk Factors:
Stress, depression, anxiety, poor sleep

Answer 11

Herpes Simplex

Question 12

How to tx Herpes Simplex?

Answer 12

Acyclovir 1g BID 10 days; abreva (topical OTC)

antibiotics are only used if there is an infection
Oral acyclovir is just for adults/ severe pediatric cases
topical acyclovir is for genital herpes infection and doesn’t do much for symptom relief

Question 13

PAIN

Unilateral eruption within one dermatome

Answer 13

Herpes Zoster (chicken pox) shingles

Question 14

How to manage Herpes Zoster/ shingles ?

Answer 14

Meds:’Valtrex 1g BID x 10 days, gabapentin- nerve pain, lidocaine spray
-> Post herpatic neuralgia

VACCINE - shingrix (2 doses, 6 mo apart)
Should get new one if they had old

Question 15

highly contagious acute viral RR disease 
Flu a/ b 
1-4 days- incubation 
Fall and spring 
PE: Nuccal rigidity and lymph

Answer 15

Influenza (rapid onset)

Question 16

How to manage Influenza?

Answer 16

Flu shot
Tamiflu reduces sx by 1-2 days
No ASA- Reye’s syndrome
Supportive , hand washing

Question 17

acute viral syndrome caused by EBV
Spread by saliva
Common in college

Triad: fever, pharyngitis, adenopathy
Sore throat, cough, chills, photophobia, posterior cervical, splenic enlargement

Answer 17

Infectious mononucleosis

Question 18

Mono diagnostics? ‘

education/ management?

Answer 18

CBC- lymphocytes
Rapid step, LFTs

Education rest, no lifting, no ETOH and no sports due to enlarged spleen
Amoxicillin/ PCN- rash - Erythromycin if they have concurrent strep and mono

Question 19

Painless, itching, flesh-colored, shiny, pearly white, or waxy dome-shaped papules with CENTRAL dimple

Answer 19

Molluscum Contagiosum

Question 20

how to tx Molluscum Contagiosum?

Answer 20

Self-limiting in healthy… Watchful waiting -healthy

Immunocompromised- Cidofovir

Question 21

How to manage verruca?

1st line?
flat warts?
genital/ face?
Prevention ?

Answer 21

Salicylic acid for 1st line
Tretinoin cream for flat warts
Genital/ face - Imiquimod cream
Prevention- HPV vaccine

Question 22

On hands, feet and mouth
Fever, sore throat, malaise for 1-2 days, submandibular and vertical lymphadenopathy, oral lesions
Pathogen: Coxsackie - invades through GI tract
BENIGN but can cause problems

Answer 22

Hand-Foot-Mouth (Virus)

Question 23

Droplet Transmission: Fever, blanching rash (in later stages doesnt blanch), presents in hairline, forehead, and behind ears and spreads cephalocaudally and centrifugally
dx= 4x specific IgG antibody

Answer 23

Measles

Question 24

Abrupt onset of fever
Rash from trunk to extremity
Cold symptoms with it: dry cough, runny nose
… Afebrile before returning to daycare

Answer 24

Roseola (rose pink rash)

Question 25

Fungal caused by candida
Cottage cheese on tounge- thrush, angular cheliltie
Red moist patches surrounded by thin scale patches

Acts up if immunosuppression, obesity, abx, steroids, malnutrition

Answer 25

Candidiasis

Question 26

How to tx tinea capitis?

Answer 26

ketoconazole 2x / week for 4 weeks

Question 27

How to tx Onychomycosis (fungal nail infection) ?

Answer 27

terbinafine 250 mg daily

Question 28

spirochete borrelia ( cork screw bacteria- can affect any part of body) 
Not all ticks transmit the disease 

Tick bite
Incubation- 1-32days
Needs to be attached to human for 48 hrs to be transmitted
April- October

Answer 28

Lyme Disease

Question 29

Fatigue, HA, myalgias
Late: cardiac problems, neuro
PE:
Bulls eye

Answer 29

Lyme Disease

Question 30

How to tx / manage Lyme Disease ?

Reg? And with nuro sx?

Answer 30

Abx: Doxycycline, amoxicillin

Neurological manifestations: ceftriaxone 2g daily IV

Question 31

pruritic eruption often with linear burrows in the web spaces of the fingers.
Risk Factors: Crowded living conditions

Answer 31

Scabies