Infectious Disease Flashcards
k[Inf/Virus/Influenza]
High Risk age group for Influenza Complications
Thus Recommended for Antiviral Treatment of Suspected or
Confirmed Influenza
Children < ___ years old (Especially < ___ )
Children <5 (Especially <2)
[Inf/Bacteria/GI/C.Diff]
Treatment for C difficile infection
Mild to moderate: __
Severe (with fever and leukocytosis): __
Mild to Mod: Oral metronidazole (30 mg/kg per day) every 6 hours for 10 days
Severe: Oral vancomycin (40 mg/kg per day) every 6 hours for 10 days
[Inf/Bacteria/GI/C.Diff]
Complications of C difficile infection? (3)
Hypotension or shock
Pseudomembranous colitis on endoscopy
Ileus, or toxic megacolon
[Inf/Bacteria/Tick/Lyme]
Lyme disease
Indication of prophylaxis?
Choice of drug for tick bite?
- Indication:
When tick attached ≥ 36 hours and removed ≤ 72 hours - Choice of drug:
Doxycycline single dose for all ages and pregnant women
[Inf/Basic/Antibiotics]
Bacteriostatic agents?
E
C
S
T
Erythromycin
Clindamycin
Sulfonamide
Trimethoprim, Tetrachyclines
[Inf/Antibiotics/Cell Wall]
Antibiotics for cell wall synthesis inhibitor? (3)
- β-lactams: penicillin, cephalosporins, carbapenems, monobactams
- Vancomycin
- Daptomycin
[Inf/Antibiotics/Cell Wall/β-lactams]
Class of β-lactams antibiotics (4)?
Penicillin
Cephalosporin
Carbapenem
Monobactam
[Inf/Antibiotics/Cell Wall/β-lactams]
Which bacteria for natural penicillins (Pen G, Pen V) (3)?
- Streptococcus (Group A, Group B, Viridans, Pneumococcus)
- Listeria
- Treponema pallidum (syphilis)
[Inf/Antibiotics/Cell Wall/β-lactams]
Examples of cephalosporin groups?
1st generation (2): ___
2nd generation (3): ___
3rd generation (2): ___
4th generation (1): ___
1st generation (2): cefazolin, cephalexin
2nd generation (3): cefuroxime, cefoxitin, cefotetan
3rd generation (2): ceftriaxone, ceftazidme
4th generation (1): cefepime
[Inf/Antibiotics/Cell Wall/β-lactams]
1st generation cephalosporin (cefazolin, cephalexin)
Susceptable bacteria (3)?
Indication (2)?
- Bacteria:
Staphylococcus: MSSA
Streptococcus: most aerobic
Enterobacteriaceae (PEcK): Proteus, E. Coli, Klebsiella - Indication:
Skin and soft tissue infections
Most surgical prophylaxis (cefazolin)
[Inf/Antibiotics/Cell Wall/β-lactams]
Which bacteria for 3rd generation cephalosporin (ceftriaxone, ceftazidime) (4)?
S
H
E
N
Strep pneumococcus
Haemophilus
Enterobactericeae (PEcK): Proteus, E. Coli, Klebsiella
Neisseria
[Inf/Antibiotics/Cell Wall/β-lactams]
Pseudomonas covering antibiotics
Penicillin (1): ___
Cephalosporin (2): ___
Penicillin (1): piperacillin/tazobactam
Cephalosporin (2): ceftazidime (3rd), cefepime (4th)
[Inf/Antibiotics/Cell Wall/β-lactams/carbapenem]
Imipenem toxicity? (2)
Lowering seizure threshold
Nephrotoxicity
[Inf/Antibiotics/Protein Synthesis]
Class of antibiotics for protein synthesis inhibitor (5)?
Aminoglycoside: gentamicin, tobramycin, amikacin
Macrolides: erythromycin, clindamycin
Tetrachyclines: doxycycline, minocycline
Clindamycin
Oxazolidinones: Linezolid
[Inf/Antibiotics/Protein Synthesis]
Side effect of Oxazolidinones (Linezolid) (4)?
Reversible bone marrow suppression (anemia, thrombocytopenia)
Irreversible neuropathy (optic neuritis)
Lactic acidosis
Serotonin syndrome
[Inf/Antibiotics/DNA Synthesis]
Class of antibiotics for DNA synthesis inhibitor (4)?
Fluoroquinolone: ciprofloxacin, levofloxacin, ofloxacin,
Rifampin
Trimethoprim/Sulfamethoxaxole (TMP/SMX)
Nitrofurantoin
[Inf/Antibiotics/DNA Synthesis/Fluoroquinolone]
Side effect of fluoroquinolone (2)?
Akilles tendon rupture
QT-interval prolongation
[Inf/Antibiotics/DNA Synthesis/TMP/SMX]
Indications for TMP/SMX in pediatrics (2)?
UTI outpatient
Pneumocystis jiroveci pneumonia
[Inf/Antibiotics/DNA Synthesis/TMP/SMX]
Side effect of TMP/SMX (3)?
Bone marrow suppression
Hypersensitivity reactions (Stevens Johnson syndrome)
Jaundice in < 2 months
[Inf/Antibiotics/Lactation]
Safe antibiotics for lactating women (4)?
Amoxicillin
Cephalosporin
Macrolides: erythromycin, azithromycin
Aminoglycosides: gentamicin
[Inf/Fever without source]
Initial workup for up to 28 days
Regardless of appearance: ill-appearing, well-appearing
< 8 days: Full sepsis workup and early sepsis management
8 to 21 days: Full sepsis workup +/- HSV
22-28 days: Partial sepsis with UA +/- LP depending on risk factor and prelim workup
[Inf/Fever without source]
Initial workup for 29 days to 90 days
If ill-appearing: full sepsis workup
If well-appearing: Invasive Bacterial Infection (IBI) Risk factor
- Low risk
- 29-60 days: CBC, BCx, inflammatory markers, UA
- 60-90 days: UA and UCx
- With risk factor
- 29-60 days: Full sepsis workup
- 60-90 days: CBC, Blood culture, inflammatory markers, UA
[Inf/Fever without source]
Initial workup for 3 to 36 months
Incomplete, unimmunized, if fever > 102.2 F (39C)
CBC, procalcitonin
+/- UA and UCx depending on risk factor
Blood culture if procal ≥ 0.5, WBC ≥ 15K, ANC ≥ 10K
CXR if WBC ≥ 20K
Completely immunized (3 doses of PCV, complete Hib 2-3)
+/- UA and UCx depending on risk factor
[Inf/Fever without source]
Initial workup for 3 to 36 months
UTI risk factors for UA/UCx investigation (5)
Boys - Circumcised ≤ ___ months
Boys - Uncircumcised ≤ ___ months
Girls ≤ ___ months
Prolonged fever > ___ hours
Children with ___
Boys - Circumcised ≤ 6 months
Boys - Uncircumcised ≤ 12 months
Girls ≤ 24 months
Prolonged fever > 48 hours
Children with prior UTI, urogenital anomaly,
[Inf/Lymphadenopathy]
Bacterial cause?
Cat: ___
Rabbit: ___
Rose throne: ___
Marine: ___
Shellfish: ___
Fishermen/meat handlers: ___
Cat: Bartonella
Rabbit: Francisella
Rose throne: Sporothrix
Marine: Mycobacterium marinum
Shellfish: Vibrio
Fishermen/meat handlers: Erysipelothrix rhusiopathiae
[Inf/CNS infection]
Cause?
CSF finding:
Mild to moderate WBC elevation
Monocytic predominance
High protein
Low glucose
High opening pressure
CT scan: basilar enhancement
Tuberculous meningitis
[Inf/CNS infection]
Cause?
Treatment?
CN 7 (facial palsy)
Foot drop
Mild to moderate WBC elevation
Lymphocytic predominance
Lyme meningitis
- Treatment:
Ceftriaxone for 21 days
[Inf/CNS infection]
Cause?
Treatment?
Recent immigrant from latin America
New onset seizure
Ring enhancing lesion on CT scan
Neurocysticercosis
- Treatment:
Albendazole
+/- steroid
[Inf/GI infection]
Traveler’s diarrhea
Most common cause?
Treatment?
EnteroToxigenic E. Coli
- Treatment:
Azithromycin
(No treatment for EHEC, Shiga toxin)
[Inf/GI infection]
Treatment for Campylobacter (2)?
- Microlides: erythromycin, azithromycin
- TMP/SMX
[Inf/UTI]
Positive CFU for urine culture?
Bagged sample: ___
Clean void: ___
Catheter specimen: ___
Suprapubic: ___
Bagged sample: only rule out when negative
Clean void: > 100K CFU/mL
Catheter specimen: > 50K CFU/mL
Suprapubic: any growth of uropathogen
[Inf/Osteomyelitis]
Drug of choice for osteomyelitis?
Ceftriaxone + vancomycin
[Inf/Endocarditis]
Subacute bacterial endocarditis
HACEK organism?
Haemophilus
Aggregatilbacter actinomycetemcomitans
Cardiobacterium hominis
Eikenella
Kingella
[Inf/Endocarditis]
Modified duke criteria?
2 major, 1 major + 3 minor, 5 minor
Major (2)
Minor (5)
Major (2)
1. Positive blood culture, 2 separate, 12 hours apart
2. Abnormal echocardiogram
Minor (5)
1. Predisposing condition
2. Fever > 100.4 F
3. Vascular phenomena (Janeway lesions, conjunctival hemorrhages)
4. Immunologic phenomena (Osler nodes, Roth spots)
5. Positive blood culture (not meeting major criteria)
[Inf/Prevention/When to return]
When to return to school
Measles returns ____ after onset of rash
Mumps returns ____ after onset of parotid swelling
Rubella returns ____ after onset of rash
Varicella returns ____ after onset of rash
Hep A returns ____ after onset of illness
Measles returns 4 days after onset of rash
Mumps returns 5 days after onset of parotid swelling
Rubella returns 7 days after onset of rash
Varicella returns 6 days after onset of rash
Hep A returns 7 days after onset of illness
[Inf/Prevention/When to return]
When to return to school
Strep pharyngitis ___ after antibiotics started
Impetigo returns ___ after starting antibiotics
Pertussis returns ___ after antibiotics are completed
Strep pharyngitis 12 hours after antibiotics started
Impetigo returns 24 hours after antibiotics started
Pertussis returns 5 days after antibiotics are completed
[Inf/Prevention/Transmission]
Airborne transmission agents? (3)
Mycobacterium tuberculosis
Measles
Varicella
[Inf/Prevention/Transmission]
Infectious agents expressed in breast milk? (3)
HIV
HTLV (Human T cell lymphotropic virus)
Brucellosis
[Inf/Prevention/Transmission]
Mothers with ___ can express milk (3)
TB
HSV
Varicella
[Inf/Bacteria/G(+) Cocci]
Examples of Gram (+) Cocci and classification?
Staphylococcus
- Coagulase (-): S. aureus
- Coagulase (+): S. epidermidis, S. saprophyticus
Streptococcus
- α-hemolysis: S. pneumoniae, Viridans
- β-hemolysis: Group A (S. pyogenes), Group B (S. agalactiae)
- γ-hemolysis: Enterococci, S. bovis
[Inf/Bacteria/G(+) Cocci]
Treatment for Coagulase negative Staphylococci (CNS, S. epi) for prosthetic device infection?
Vancomycin +/- Rifampin
[Inf/Bacteria/G(+) Cocci]
Treatment for S. pneumoniae meningitis?
Vancomycin + Ceftriaxone till susceptibility
[Inf/Bacteria/G(+) Cocci]
Diangosis?
Mechanism?
Sandpaper rash, starting from neck and chest to palms and soles followed by desquamation
Acute pharyngitis with strawberry tongue, circumoral pallor
Pastia lines (petechial lines in folds)
Scalret fever
- Mechanism:
Pyrogenic exotoxin
[Inf/Bacteria/G(+) Cocci]
Treatment for streptococcal pharyngitis
Penicillin V potassium (PCN VK)
Or
Pen G IM, amoxicillin PO
[Inf/Bacteria/G(+) Rods]
Examples of Gram (+) Rods?
L
A
B
C
C
Listeria
Arcanobacterium (Corynebacterium) haemolyticum
Bacillus cereus, B. anthrax
Corynebacterium diphtheriae
Clostridium difficile, botulinum, tetani, perfringens
[Inf/Bacteria/G(+) Rods]
Which bacteria
Treatment?
Prophylaxis?
Low fever
Pharyngitis with whitish membrane
Cervical lymphadenitis (bull neck)
Conjunctivitis
Corynebacterium diphtheriae (Diphtheria)
- Treatment:
Equine antitoxin
PO Erythromycin or IV/IM PCN - Prophylaxis:
Close contacts, regardless immunization status
PO Erythromycin or IM PCN
[Inf/Bacteria/G(+) Rods]
Toxin-mediated effects for Corynebacterium diphtheriae (2)?
Myocarditis within the first week
Neural involvement: Guillain-Barre syndrome or peripheral nerve palsies
[Inf/Bacteria/G(+) Rods]
Which bacteria?
Treatment?
Acute pharyngitis
Scarlatiniform rash
Lymphadenopathy without palatal petechiae/strawberry tongue
similar to S. pharyngitis, Not improved with penicillin
Arcanobacterium haemolyticum
- Treatment:
Macrolides (Erythromycin, azithromycin)
[Inf/Bacteria/G(+) Rods]
Which bacteria?
Treatment?
Prophylaxis?
Painless pruritic papule becomes painless ulcer with black eschar
Fever, myalgia
Painful lymphadenopathy
Bacillus anthracis
(Cutaneous anthrax)
- Treatment:
Amoxicillin or ciprofloxacin
Plus Antitoxin - Prophylaxis for aerosol exposure:
Ciprofloxacin or doxycycline for 60 days
[Inf/Bacteria/G(+) Rods]
Gas gangrene treatment for Clostridium perfringens?
High dose penicillin G
[Inf/Bacteria/G(+) Rods]
Treatment for Clostridium tetani?
Human tetanus immunoglobulin TIG
Plus
Metronidazole (or Pen G)
[Inf/Bacteria/G(-) Cocci]
Examples of Gram (-) Cocci (2)?
Neisseria
Moroxella
[Inf/Bacteria/G(-) Cocci]
Indications for meningococcus prophylaxis (2)?
___ days prior of onset
7 days prior of onset
- Close contacts
Living together, flight > 8 hours,
Attending same child care - Direct exposure
Invasive procedure like intubation, suction
[Inf/Bacteria/G(-) Cocci]
Treatment options for meningococcus prophylaxis (3)?
Rifampin for 2 days
Ceftriaxone IM 1 dose
Ciprofloxacin 1 dose (>18 years old)
[Inf/Bacteria/G(-) Coccobacilli]
Examples of Coccobacilli (11)?
Haemophilus influenza
Camplyobacter
Ellas (except Kleb/Sal/Shi)
Bordetella pertusis
Kingella kingae
Yersinia pestis
Francisella tularensis
Legionella pneumophila
Coxiella burnetii
Brucella
Bartonella
Pasteurella
[Inf/Bacteria/G(-) Coccobacilli]
Treatment and prophylaxis for Bordetella pertussis?
Treatment:
Macrolide (Azithro for infants)
Prophylaxis:
Macrolide +/- Tdap (Eligible, infant, pregnancy)
[Inf/Bacteria/G(-) Coccobacilli]
For Haemophilus influenzae
Prophylaxis indication: ___
Prophylaxis options: ___
Prophylaxis:
Rifampin x 4 days
- Indication:
Close contacts, child care, unimmunized or incompletely immunized, immunocompromised
Child care center ≥ 2 patients within 60 days
[Inf/Bacteria/G(-) Coccobacilli]
Treatment options for Kingella kingae?
Penicillin
[Inf/Bacteria/G(-) Coccobacilli]
Diagnosis?
Which bacteria?
Exposed to cattle placenta/birth product
Fever, malaise, pneumonia
Infective endocarditis
Q fever
Coxiella burnetii
[Inf/Bacteria/G(-) Coccobacilli]
Which bacteria/disease?
Treatment?
GI: Diarrhea
CNS: Headache, delirium, confusion
Renal: azotemia, hematuria
Pulm: pneumonia
Legionella pneumophila
Legionellosis
(Pontanic fever for milder, without pneumonia)
- Treatment:
Azithromycin
[Inf/Bacteria/G(-) Coccobacilli]
Which bacteria/disease?
Treatment?
Unpasteurized milk
Heart: endocarditis
GU: orchitis, abortion
Endocrine: thyroiditis, adrenal insufficiency, SIADH
Lung/GI: pneumonia diarrhea
Brucella
Brucellosis
- Treatment:
Doxycycline + aminoglycoside
Or
Doxycycline + Rifampin
[Inf/Bacteria/G(-) Coccobacilli]
Which bacteria/disease?
Treatment?
Cat scratch or bite
If near eye: conjunctivitis, preauricular lymphadenopathy, ocular granuloma
Bartonella henselae
Catscratch disease
(Parinaud oculoglandular syndrome for near the eyes)
- Treatment:
Azithromycin
[Inf/Bacteria/G(-) Rods]
Examples of G(-) Rods (6)?
Pseudomonas aeruginosa
Helicobacter pylori
Klebsiella
Salmonella
Shigella
Escherichia coli
[Inf/Bacteria/G(-) Rods]
Which bacteria/disease?
Treatment?
Nail-puncture wound in the shoe
Endocarditis in IV drug user
Ecthyma gangrenosum (round black lesion, central ulceration)
Pseudomonas aeruginosa
- Treatment: pseudomonas covering antibiotics
Penicillin: Piperacillin/tazobactam
Cephalosporin: Ceftazidime, cefepime
Carbapenem: imipenem, meropenem
Aminoglycosides
Quinolones
[Inf/Bacteria/G(-) Rods]
Which bacteria/disease?
Slowly rising fever with relative bradycardia
Abdominal pain and constipation
Rose spots
Leukopenia
Salmonella Typhi
Typhoid fever
[Inf/Bacteria/Atypical]
Classes of atypical bacteria (4)?
Mycoplasma
Chlamydia
Spirochetes: syphilis, lyme, leptospirosis
Rickettsiae: Rickettsiae, Ehrlichia
[Inf/Bacteria/Atypical]
Which bacteria?
Treatment?
Exposed to birds (parrots, parakeets, pigeon)
High fever > 105F
Pneumonia
Splenomegaly
Chlamydia pisttaci
- Treatment:
Macrolides
[Inf/Bacteria/Atypical]
Which bacteria?
Treatment?
Exposure to ticks in Arkansas, Georgia, Oklahoma
Rash starting from wrists/ankles, spread to trunk, palms/soles
Petechial to purpuric
Myalgias, arthralgias, diarrhea, photophobia
Hyponatremia, thrombocytopenia
Rickettsia rickettsii
Rocky Mountain Spotted Fever
- Treatment:
Doxycycline (Even < 8 years old)
[Inf/Bacteria/Atypical]
Which bacteria?
Treatment?
Exposure to ticks in Arkansas, Oklahoma
+/- rash
Viral syndrome
Hepatitis
Pancytopenia
Morulae in WBC
Ehrlichia
(Human monocytic ehrlichiosis)
Or
Anaplasma
(Human granulocytic anaplasmosis)
- Treatment:
Doxycycline
[Inf/Bacteria/Gram-variable]
Example of gram variable bacteria (1)?
Gardnerella vaginalis
[Inf/Bacteria/Anaerobes]
Examples of anaerobes (4)?
Fusobacterium
Actinomyces
Peptostrepcoccus
Bacteroides
[Inf/Bacteria/Anaerobes]
Which bacteria?
Diangosis?
Treatment?
Pharyngitis
Internal jugular vein thrombophlebitis
Septic lung emboli
Fusobacterium necrophorum
Lemierre syndrome
- Treatment:
Ceftriaxone plus metronidazole
[Inf/Bacteria/Anaerobes]
Which bacteria/disease?
Treatment?
After dental procedure
Yellow sulfur granule/abscess
Actinomyces
(Actinomycosis)
- Treatment:
Penicillin
[Inf/Bacteria/Acid-Fast]
Examples of Acid-Fast bacteria (2)?
Mycobacterium (tuberculosis, leprae, avium complex)
Norcadia
[Inf/Bacteria/Acid-Fast]
Diagnostic test for TB by age?
< 2 years of age: Tuberculin skin testing
≥ 2 years of age or BCG recipients: Interferon gamma release assay (IGRA)
[Inf/Bacteria/Acid-Fast]
Tuberculin skin test reading
≥ 4 years of age without any risk factors
Positive when induration ≥ ___ mm
≥ 4 years of age without any risk factors
Induation ≥ 15 mm
[Bacteria/Acid-Fast]
Tuberculin skin test reading
< 4 years of age
Increased risk:
- Co-morbidities (DM, CKD)
- Travel to high prevalence regions
- Exposure to high risk adults (HIV, homeless)
Positive when induration ≥ ___ mm
Positive when induration ≥ 10 mm
< 4 years of age
Increased risk:
- Co-morbidities (DM, CKD)
- Travel to high prevalence regions
- Exposure to high risk adults (HIV, homeless)
[Inf/Bacteria/Acid-Fast]
Tuberculin skin test reading
Close contact with active case
HIV infection or immunosuppressive conditions
Clinical signs or positive CXR
Positive when induration ≥ ___ mm
Positive when induration ≥ 5 mm
Close contact with active case
HIV infection or immunosuppressive conditions
Clinical signs or positive CXR
[Inf/Bacteria/Acid-Fast]
Tuberculin skin test reading
Who is positive when induration < 5 mm (1)
HIV infection plus close contact of active case
(any reading is positive)
[Inf/Bacteria/Acid-Fast]
Latent TB infection treatment options (3)?
- Isoniazid and rifapentine 1/week for 3 months
- Isoniazid and rifampin daily for 3 months
- Rifampin daily for 4 months
(Discouraged isoniazid for 9 months due to compliance)
[Inf/Bacteria/Acid-Fast]
TB infection treatment?
RIPE for 2 months and RI for 4 months
R: Rifampin
I: Isoniazid
P: Pyrazinamide
E: Ethambutol or streptomycin
[Inf/Bacteria/Acid-Fast]
Side effects of TB antibiotics?
R: Rifampin: ___
I: Isoniazid: ___
P: Pyrazinamide: ___
E: Ethambutol: ___
R: Rifampin: Orange discoloration
I: Isoniazid: Liver toxicity
P: Pyrazinamide: N/V/abdominal pain, hypersensitivity
E: Ethambutol: decreased in visual acuity
[Inf/Bacteria/Atypical/Spirochetes]
Which bacteria?
Diagnosis?
Treatment?
Swim in the pond with dogs, rats
Fever, myalgia
Conjunctival suffusion
Hepatitis (disproportionally high bilirubin)
Renal failure
Leptospirosis
Weil disease
- Treatment:
PO doxycycline for mild
IV doxy or pen G, ceftriaxone for severe
[Inf/Bacteria/Atypical/Spirochetes]
Stages of lyme disease (3)?
- Early localized
erythema migrans - Early disseminated
heart block, nerve palsy - Late disseminated
arthritis
[Inf/Fungi]
Coccidioides vs Histoplasma vs Blastomyces
From Arizoma
Flu-like illness
Arthralgias, erythema multiforme/nodosum
Pulmonary coin lesion
Coccidioides
(Valley fever)
[Inf/Fungi]
Coccidioides vs Histoplasma vs Blastomyces
From Kansas, Missouri
Soil with bat and bird
Calcified granuloma, interstitial pneumonia
Splenomegaly
Pancytopenia
Histoplasma
[Inf/Fungi]
Coccidioides vs Histoplasma vs Blastomyces
From Minnesota, Michigan, Canada
Exposed to decaying wood
Fever, myalgia, cough, nonspecific symptoms
Blastomyces
[Inf/Fungi]
Which fungus?
Pricked by rose thorn
Sporotrichosis (Sporothrix)
[Inf/Parasite/Protozoa]
Protozoa classes and their examples (3)?
Protozoa: single cell, eukaryocyte
Helminth: multicells (worms)
Protozoa
1. Sporozoa:
Toxoplasma, Cryptosporidium, Cyclospora, Plasmodium, Babesia
2. Ameba:
Entamoeba
3. Flagellates:
Giardia, Trichomonas, Trypanosoma, Leishmania
[Inf/Parasite/Protozoa]
Which parasite?
Treatment?
Contaminated water park, swimming pool outbreaks
Watery diarrhea for 1-2 weeks
Stool O&P: small round oocytes
Cryptosporidium
- Treatment:
nitazoxanide
[Inf/Parasite/Helminth]
Helminth classes and their examples (2)?
Protozoa: single cell, eukaryocyte
Helminth: multicells (worms)
Helminth
1. Nematodes (Roundworms):
Pinworms, hookworms, whipworms, Trichinella, Strongyloides, Ascaris
2. Platyhelminths:
Cestodes (tapeworms), trematodes (flukes)
[Inf/Parasite/Protozoa]
Which parasite?
Fever, vomiting, myalgia
Jaundice, splenomegaly
Plasmodium falciparum (Malaria)
[Inf/Parasite/Protozoa]
Which parasite?
Especially in asplenic patients
Tick from rodents in Northeast (NH, Vermont)
Fever
Hemolytic anemia, hemoglobinuria
Babesiosis
[Inf/Parasite/Protozoa]
Which parasite and its treatment?
Especially in anal sex, IgA deficiency, cystic fibrosis patients
Watery, smelly diarrhea, flatulence
Giardia
Treatment: Metronidazole
[Inf/Parasite/Protozoa]
Which parasite?
Diagnosis?
From Mexico, South America
Heart block, heart failure
Achalasia, megacolon
Unilateral firm edema of the eyelids (Romana sign)
Generalized lymphadenopathy
Trypanosoma
T. Cruzi: Chagas disease
(T. brucei: sleeping sickness)
[Inf/Parasite/Protozoa]
Which parasite?
Cutaneous: cigarette paper scar
Mucosal: granulomatous inflamation
Visceral: hepatosplenomegaly
Leishmania
[Inf/Parasite/Helminth]
Which parasite?
Abdominal: diarrhea, anorexia
Respiratory: migratory infiltrates (Loffler syndrome), hemoptysis
Ascaris lumbricoides (round worm)
[Inf/Parasite/Helminth]
Which parasite?
Treatment?
Anal pruritus
Adhesive tape test
Enterobius vermicularis (Pinworm)
- Treatment:
Albendazol for all household members
[Inf/Parasite/Helminth]
Which parasite?
Walking barefoot
Cutaneous larva migrans
Necator americanus (Hookworm)
[Inf/Parasite/Helminth]
Which parasite?
Undercooked pig/bear meat
Muscle pain, calcification in x-ray
Myocarditis, periorbital edema, eosinophilia
Trichinella spiralis
[Inf/Parasite/Helminth]
Which parasite?
Pica
Migratory pneumonia
Hypergammaglobulinemia, eosinophilia
Visceral larva migrans, ocular larva migrans
Larva currens (Itchy, serpiginous, erythematous tracks)
Strongyloides stercoralis
[Inf/Parasite/Platyhelminths/Cestodes]
Which parasite?
Multiple cysts, calcified granulomas
Neurocysticercosis
[Inf/Parasite/Platyhelminths/Trematodes]
Which parasite?
Treatment?
Swimming in the contaminated water
Hematuria
After 2 months of inoculation, serum-sickness like symptoms (LAD, diarrhea, HSM)
Schistosoma haematobium (hematuria)
Acute schistosomias (Katayama fever)
- Treatment: praziquantel for 1 day
[Inf/Virus/Herpesviruses]
Which virus?
Neurologic: Alice in Wonderland syndrome
Skin: papular acrodermatitis (Gianotti-Croti syndrome)
Epstein-Barr virus (EBV)
[Inf/Virus/Herpesviruses]
Which virus and its disease?
Fever then erythematous rash
Febrile seizure with febrile stage
Erythematous papules in the soft palate, uvula (Nagayama spots)
Human Herpersvirus 6 (HHV-6)
Roseola, exanthem subitum, roseola infantum, sixth disease
(Parvo: Erythema infectiosum, fifth disease)
[Inf/Virus/Herpesviruses]
Which virus and its disease?
Children: Slapped cheek rash, Fever, Arthritis
Adolescents, adults: papular purpuric gloves and sock syndrome
Parvovirus B19
Erythema infectiosum, fifth disease
(HHV6: roseola infantum, sixth disease)
[Inf/Virus/Herpesviruses]
Which virus’s complication?
Subacute sclerosing panencephalitis:
Dementia, myoclonus, new-onset seizures at 10 years of age
Measles (Rubeola)
[Inf/Virus/Herpesviruses]
Which virus?
Floria, Puerto Rico
High fever, polyarthralgia, +/- maculopapular rash
Lymphopenia, thrombocytopenia, elevated LFTs, elevated Cr
Chikungunya virus
(Dengue: retro-orbital pain, saddle back fever, hemorrhage, shock)
[Inf/Virus/Herpesviruses]
Which virus?
Mexico, South America, Puerto Rico
Saddle back fever (biphasic)
Severe myalgias, arthralgias, headaches, conjunctivitis
Retro-orbital pain, macular rash
Hemorrhagic, or shock
Dengue virus
(Chikungunya: severe joint pain, conjunctivitis, no hemorrhage or shock)
[Inf/Virus/Herpesviruses]
Which virus?
Desert Southwest
Severe hemorrhagic pneumonia
Thrombocytopenia, increased hematocrit
Hantavirus
[Inf/Virus/Herpesviruses]
Which virus?
Congo
Fruit bats
Fever, myalgia, diarrhea, headache
Hiccups, conjunctival injection, dar red discoloration of the palate
Leukopenia, thrombocytopenia, elevated LFTs, coagulopathy, CKD
Ebola
[Inf/Virus/HIV/Complications]
Which causal organism?
Fever, cough, hypoxia
Elevated LDH, normal LFT
X-ray of diffuse bat-wing infiltrates
Pneumocystis jiroveci pneumonia (PJP)
[Inf/Virus/HIV/Prophylaxis]
Indications for PJP prophylaxis
- All HIV-infected asymptomatic infants until from ____ to ___ of age (until confirm negative)
- HIV-infected (1-5 years of age) if CD4 count is <___ cells/pL
- HIV-infected (> 6 years of age) if CD4 count is <___ cells/pL
- History of prior PJP infection
- All HIV-infected asymptomatic infants until 1 year of age
- HIV-infected (1-5 years of age) if CD4 count is <500 cells/pL
- HIV-infected (> 6 years of age) if CD4 count is <200 cells/pL
- History of prior PJP infection
[Inf/Virus/HIV/Immunization]
live vaccine candidates
extra immunization?
- Live vaccines:
1-13 years: CD4+ T-cell > 15%
>13 years: CD4+ T-cell > 200/µL - Rota vaccines: can be given regardless CD4 counts
- PCV23 after 24 months
- Menacwy after 2 months
[Inf/Virus/HIV/Treatment]
All infants born to mothers with HIV infection should receive ___ therapy for ___ weeks.
If an HIV-positive woman has not received antepartum antiretroviral therapy (ART) or received ART only at delivery, 3 doses of ___ is also given in the 1st week of life along with ZDV.
All infants born to mothers with HIV infection should receive zidovudine therapy for 4-6 weeks (before test results).
If an HIV-positive woman has not received antepartum antiretroviral therapy (ART) or received ART only at delivery, 3 doses of nevirapine is also given in the 1st week of life along with ZDV.
[Inf/Virus/exanthem]
Which virus?
Postauricular, suboccipital lymphadenopathy
Maculopapular rash, coming from face down
Soft palate petechiae and reddish spots (Forchheir sign)
Rubella (German measles, three day measles)
[Inf/Bacteria/Atypical]
Which bacteria and treatment??
Infant between 4 and 12 weeks of age
Staccato-like cough, nasal stuffiness
Afebrile, tachypnea, rales in the absence of wheezing
Eosinophilia
CXR Hyperinflation interstitial infiltration
Chlamydia trachomatis
Treatment: erythromycin (even for infants)
[Inf/Bacteria/G(-) Coccobacilli]
Which bacteria?
Immunocompromised hosts or excessive iron storage (sickle cell disease, β thalassemia)
Undercooked pork
Diarrhea, abdominal pain after 4-7 days
Yersinia enterocolitica gastroenteritis
Treatment:
Supportive
If severe, ciprofloxacin for adults, ceftriaxone for children
[Inf/Prevention/precuations]
Which precautions/isolation?
Contact/Droplet/Airborne
Multidrug-resistant bacteria, Shigella species, and Staphylococcus aureus (cutaneous infection or draining abscesses)
Herpes simplex virus, respiratory syncytial virus, parainfluenza virus, enteroviruses
Scabies
Contact precautions
[Inf/Prevention/precuations]
Which precautions/isolation?
Contact/Droplet/Airborne
Influenza, parvovirus B19 (before the onset of rash), rhinovirus, mumps, and adenovirus (pneumonia)
Pertussis, Neisseria meningitidis (invasive)
Droplet precautions
[Inf/Prevention/prophylaxis]
Indication for Varicella-zoster immune globulin (VZIG) (3)?
- Immunocompromised
- Pregnant ladies
- Newborns with mother infected 5 days before through 2 days after delivery
(If VZIG not available, give IVIG)
[Inf/Prevention/prophylaxis]
Hep A postexposure prophylaxis:
≥ 12 months: ___
< 12 months: ___
≥ 12 months: Hep A vaccine
< 12 months: Hep A immunoglobulin
(within 2 weeks of exposure)
[Inf/Prevention/prophylaxis]
TB postexposure prophylaxis indications (2)?
< 5 years old
Immunocompromised
(TB test first, start chemoprophylaxis, discontinue after 8-10 weeks of retest)
[Inf/Virus/EBV]
Serology early and/or past infection
EBV VCA IgM: ___
EBV VCA IgG: ___
EBV nuclear antigen (EBNA): ___
EBV VCA IgM: early infection
EBV VCA IgG: early and/or past infection
EBV nuclear antigen (EBNA): past infection
[Inf/Bacteria/G(+)]
Which disease?
Severe malabsorption, arthritis, polyserositis, CNS symptoms
PAS positive granules in the lamina propria
Gram positive Actinomycete
Whipple disease
(Tropheryma whipplei)