Infectious Disease Flashcards
First Line Treatment Chlamydia?
If Prego?
Neonate Conjunctivitis?
- Doxy 100 mg BID x 7 days
- Prego = Azithromycin 1g
- Neonate = Erythromycin
What is Gonorrhea?
Gram Negative Diplocci
Yellow Green Discharge of anus/vagina/penis/pharynx?
Gonorrhea
Gonorrhea Arthritis Dermatitis Syndrome?
Disseminated Gonorrhea
- Tendon/Joint pain
- Rash
- Septic Arthritis (knee most common)
Tender Grey/Neurotic center Halo papules?
Gonorrhea gone Septic!!!
Treatment of Gonorrhea:
1st Line Healthy?
Septic?
What else should you give?
- I.M. Ceftriaxone
- Septic = I.V. Ceftriaxone
You should give DOXY to cover Chlamydia!
What is Cat Scratch Fever?
Bartonella Henselae
Describe onset of Cat Scratch Fever
Brown/red ulcers (2-4 weeks)
Fever (7 weeks)
Lymphadenopathy (2-4 months)
Treatment for Cat Scratch Fever
Moderate vs Severe
Moderate : Doxy
Sever : Rifampin
What is Clostridium Botulinum
Gram + anaerobe with spores
Clostridium Botulinum: with what prevents AcH release causing issues on Cranial Nerves
The Snare Protein Cleaver
Clostridium Botulinum Test:
Toxin Assay
Clostridium Botulinum Treatment
If immediate, Active Charcoal and Antitoxin A/G within 72 hours / Human Botulinum immunoglobulin
Which direction does Clostridium Botulinum move?
Head down to Feet
Describe Campylobacter Jejuni
Gram Negative Rod
Oxidase Postive
Flagella + Curved corkscrew shaped
Bloody Stool with Ascending paralysis?
Campylobacter Jejuni
Most Common Acute Bacteria : Campylobacter Jejuni, where to get it from? (4)
- Raw Chicken
- Unpastorized Milk
- Puppy Poop
- Pigs
D/X: Campylobacter Jejuni
Camp in the Heat (42 Degree Agar)
T/X: Campylobacter Jejuni? (2)
Fluoroquinolone or Azithromycin
Describe Vibrio Cholera
Gram Negative
Oxidase Postive
Comma Shaped (curved)
Glucose Fermenting
NonLactose
Rice Water Diarrhea?
Vibrio Cholera
D/X: Vibrio Cholera
Dipstick or Stool
T/X: Vibrio Cholera
Fluids + Doxy
Describe Diphtheria?
Gram + Rod Anaerobe
How does Diphtheria enter body?
Inhaled POOP
Diphtheria:
- Pseudomemberous?
- Lymphadenapathy?
- Myocarditis?
- Polyneuritis
- Patchy grey/white exudate that bleeds when scraped
- Bull Neck Cervical Lymph
- EKG + Enzymes
D/X: Diphtheria?
Elek Test
T/X: Diphtheria?
Antitoxin + Erythromycin
Describe a Boil/Pustule on skin with Methicillin Res. Staph A. (MRSA) patient?
Pustules w/erythematous base
D/X: MRSA
Normal Conditions?
OutBreak?
Normal - Chromogen Agar or PCR
Outbreak - PFGE
T/X MRSA: (Irrgate First)
Small:
Mod:
Severe:
Small: Mupirocin
Mod: Bactrim or Doxy
Severe: Vanco
Immune Response to Strep Pyrogens, my immune response mimics Anti-Strep-tolysin and fucks shit up?
Rheumatic Fever
Jones Criteria:
J.
O.
N.
E.
S.
Joints - (poly arthritis)
Heart - Carditis
Nodules
Erythema Marginatum
Sydenham Chorea
Involuntary hand/feet movement
Sydenham Chorea
Non-Puritic Trunk/Limb Rash
Erythema Marginatum
Rheumatic Fever:
- Common Valve Issue?
- Rhythm Issue?
- Found on Heart?
- Mitral Regurgitation
- A-Fib
- Aschoff Bodies
Direction of Joint Pain Rheumatic Fever?
Ankles/Knees moving up
Minor Criteria Jones?
C
A
F
P
CRP/ESR increased
Arthralgia
Fever
Prolonged PR Interval
T/X Rheumatic Fever:
1st Line:
Allergy:
PCN G or Amoxy
If Allergy - Erythromycin
Dermacentor Tick causes?
Rocky Mountain Fever - Rickettsia Rickettsii
D/X Rocky Mountain Fever?
Fever/HA
Wrist/Angle Rash that moves to Trunk
T/X: Rocky Mountain Spotted Fever
Doxy 200 mg x 7 Days
Describe Clostridium Tetani?
Gram + Rods Anaerobe
Clostridium Tetani, what does Tetanspasmin Exotoxin block on the pre synapse of motor nerves?
GABA and Glycine
S/S Clostridium Tetani
1.
2.
3.
- Lockjaw (trismus)
- Risus Sardonicus (raised eyebrow/grin)
- Opisthotunus (Head/Neck/Back Hyperextension)
Risus Sardonicus (raised eyebrow/grin)
Opisthotonus (Head/Neck/Back Hyperextension)
T/X: Clostridium Tetani
Metronidozol
Gram Neg
Oxidate Neg
NonLactose
White/HighPH (MaConkay)
H2S producing
Salmella
Gram Neg
Oxidate Neg
NonLactose
White/HighPH (MaConkay)
NOT H2S producing
Shigellosis
Salmonella from contaminated food
S. Typhi
Salmonella from fecal matter on food that cause Gastroenteritis?
S. Typh / S. Enteritis
Invades Pyer Patch with PeaSoup Diarrhea?
Another noticeable Sign?
What if Sickle Cell?
Salmella Typhi
Rose Spots (Trunk)
Sickle = osteomyelitis
D/X Salmella?
Culture (Increased WBC but Decreased Platelets)
T/X Salmella?
Fluids
DO NOT give ABX due to prolonging poop!
Inhibits 60s Ribosomes?
Shigellosis Sonnei (most common USA)
Flexneri (developing country)
Daycare kids, crowded areas that causes watery, mucus bloody painful diarrhea?
Shigellosis
S/S Shigellosis (4)
- Diarrhea (watery, mucus, bloody) painful
- Cramps
- Tenesmus
- High Fever and Chills
D/X Shigellosis?
Culture Stool
T/X Shigellosis?
1.
2. >18 y/o
3. <18 y/o
4. Caution
- Fluids
- Bactrim
- Azithromycin
- Don’t give meds that stop diarrhea
Four Areas for Candidiasis?
- Vaginal
- Esophageal
- Oral
- Intertrigo
Vaginal Candidiasis
1. Describe -
2. KOH -
3. T/X -
- Itchy, erythema, CURD discharge
- KOH - Hyphae Budding
- Miconazole cream 1-7 days or Fluconazole
Esophageal Candidiasis
1. Most common?
2. EGD shows?
3. T/X?
- AIDS
- Linear erosion
- Fluconazole
Dysphagia, Reflux, Nausea with or w/o pain. Patient is AIDs positive. What do you think it is?
Esophageal Candidiasis
T/X Oral Thrush (candidiasis)
Nystatin
Describe Intertrgo Candidiasis?
Pruritic BEEFY red rash w/distinct scalloped borders and satellite region
T/X Intertrigo Candidiasis:
1.
2.
*If in blood?
- Keep Dry
- Ketoconazole w/ Hydrocortisone 2.5%
If in blood, treat with I.V. AmpB
AIDs/immunocomprimised / Acne like ulcers
Cryptococcosis
How to contract Cryptococcosis?
Inhaled budding yeast in soil/bird poop
Cryptococcosis will cause what most of the time?
Meningoencephalitis
Meningoencephalitis Cryptococcosis symptoms? (3)
AMS
HA
meningismus
India Ink Cyst?
What does CSF tapping show?
1.
2.
Cryptococcosis
- increased pressure, protein, lymph
2.decreased glucose
T/X Cryptococcosis?
1.
2. If CD4 < 100 prophylaxis
3. Pneumonia
- AmpB + Flucytosine 2 week followed by Fluconazole 10 weeks
- Fluconazole
- Fluconazole
Caseous Necrosis granulmoa?
histoplasmosis capsulatum
S/S (4)
- Cough
- Low grade Fever
- Tongue Ulcerations
- Huge Spleen
D/X histoplasmosis capsulatum?
1. Takes long time but GOLD Standard
What would you see?
- Urine Cultures
Increasing Alkaline Phosphatase LDH postive
T/X histoplasmosis capsulatum:
1. Weeks/Months?
2. IF systemic?
Itraconazole weeks/months
If Systemic AmpB
Interstitial pneumonia with ground glass opacities HIV patient?
pneumocystis jiroveci pneumonia
pneumocystis jiroveci pneumonia 3 common symptoms
Dyspnea
Fever
Non-productive Cough
D/X pneumocystis jiroveci pneumonia?
Respiratory Tract tissue sample or Broncho alveoli levaage
T/X pneumocystis jiroveci pneumonia?
1.
2. If allergy?
- Bactrim
- Pentamidine
Atypical Mycrobacterials
1.
2.
3.
4.
- Mycobacterium avium complex MAC
- Mycobacterium avium intracellulare MAI
- Mycobacterium Kansasii
- Mycobacterium Marinum
Most common Atypical Mycobacterial?
Location most common?
Mycobacterium Avium complex
Lungs
Treatment:
1. MAC
2. Kensasii
3. TB
- Clarithromycin + Ethambutol 12 months
- Rifampin + Ethambutol
- R.I.P.E.
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
R.I.P.E. Adverse Effects
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Rifampin - Red/Orange Fluids
Isoniazid - I-so-numb = Peripheral Neuropathy GIVE Pyridoxine
Pyrazinamide - Pyramid = stones (hyperuicemia) and Sun rash (photo sensitive)
Ethambutol
Microbacterium Marinum
Aquarium = puncture = Fisherman/Seafood handlers
Enterobius
Pinworm
Nightime Anal itch?
T/X?
Enterobius (Pinworm)
Whole family Mebendazole or Albendazole
Nematods? (2)
Cestode?
Trematode?
Pinworm/Roundworm
Tapeworm
Flukes
Ascaris Lumbricoids
Roundworm
Ascaris Lumbricoids (RoundWorm) s/s:
Small amount?
Moderate Amount?
Large Amount?
T/X
Small = Asymptomic
Moderate = Vague Abdomen symptoms
Large = Pancreatic/Bile/Appendix issues
Mebendazole
Patient has vague GI symptoms and unexpected weight loss?
D/X
T/X
Tapeworm
Praziquantel
Treatment of Mammal Schistosomes Flukes (swimmers itch)?
Praziquantel
Describe Zika Virus?
Tropical Aedes Mosquito that is single RNA Flava virus that infect skin cell.
Most Zika virus resolves in 10 days, but what are two complications for a pregnant person needs to be concerned about?
Miscarriage
Congenital Microcephaly
Patient travels to a tropical area and developed a low grade fever, itchy rash and a mild case of watery eyes. She is pregnant and is concerned for her unborn baby. Describe what you would see if the baby has a congenital microcephaly of the disease above?
- Intercranial Calcifications
- Cerebral Malformations
A mosquito in Africa carries what type of Parasite?
Plasmodium Parasites
Once a Anopheles Mosquito from Africa injects a Plasmodium Parasite into a human, how does it feed and where does it live?
Feeds on RBC’s and lives in the Liver
S/S of M.A.L.A.R.I.A.?
Malaria
Anemia
Liver Failure
AMS
Round n Round Fever
Infant Death (miscarriage)
Abnormal Large Spleen
Malaria:
- Daily on/off fever?
- Every other day Fever?
- Every three days fever?
- Falciparum
- Vivax/Ovale
- Malariae
D/X Malaria?
Thick/Thin Smears and Blood cultures
T/X Malaria:
Normal:
Resistant:
Chemoprophylaxis:
Normal = Chloroquine
Resistant = ACT
prophylaxis follow above
Ring Enhanced Legions Aids Patient
Toxoplasmosis
Group of diseases that can be passed from mother to baby in womb? ToRCH
Toxoplasmosis
Rubella
Cytomegalovirus
Herpes
Inflammation of the brain, post-infection, that causes fever, headaches and neck pain?
Encephalitis
Inflammation of the (thin pigmented vascular coat of the eye) and the eye itself post-infection of Toxoplasmosis?
Chorioretinitis
S/S Toxoplasmosis?
1.
2.
3.
- Encephalitis
- Chorioretinitis
- Intercranial Calcifications
T/X Toxoplasmosis:
First Line Tx?
If CD4 < 100 then?
Pyrimethamine + Sulfadiasine
HIV CD4 <100 = Bactrim prophylaxis
Pregnant mother that was discovered to have Toxoplasmosis, baby was born,,, what would you notice if the baby has a congenital defect? (2)
Blue berry rash + hearing loss
Type of Tick that causes Lyme Disease?
Type of parasite that travel with tick to cause Lyme disease?
- Ixodes scapularis
- Borrelia Burgdorferi
Lyme Disease Stages:
Stage 1 (7-10 days):
Stage 2 (1-12 weeks): (3)
Stage 3 (Late): (3)
Stage 1: Bullseye Rash
Stage 2. Flu-Like, Bells palsy CN VII, AVBlock
Stage 3. Polyarthritis/polyneuropathy/encephalopathy
D/X Lyme disease Two Tiers?
Tier 1 = EIA or EFA
Tier 2 = Western blot IgG/IgM
T/X Lyme disease:
Normal?
Prego?
Late Stage?
- Doxy
- Amoxicillin
- 3rd Gen Cephalosporin or PCN G
Most common non-viral STD?
Trichomoniasis Vaginalis
S/S of Trichomoniasis Vaginalis? (3)
- Malodorous green/gray discharge
- Frothy petechiae cervix (strawberry)
- Burn/itch/pain sex
D/X Trichomoniasis Vaginalis smear shows?
pear-shaped protozoa with flagella and pH >4.5
T/X Trichomoniasis Vaginalis?
Metronidazole (also treat partner)
Congenital Varicella:
Fetus infect 8-28 weeks
30% fatal w/in 1 month of birth
15% Herpes w/in 4 years of life
S/X (5)
- Scars w/ dermatomal patterns
- Neuro/ocular deficits
- Limb deficits
- GI issues
- Decrease birth wt.
D/X Congenital Varicella?
PCR baby blood or amniotic fluid for VzV DNA
Congenital Varicella what not to give to mother? and what to do if the mother has immunity?
NO live vaccine
Reassurance that its going to be ok
You conduct a Direct viral test of a lesion from a pregnant mother testing positive for Herpes Virus. How should you treat?
New Onset?
To surpress?
If shedding?
Aclylovir 400 mg x 7 days
Acyclovir 400 mg TID
C-Section
Extremely rare to pass on this STD from mother to baby, and only c-section is recommended if obstruction?
Perinatal Human Papillomavirus (HPV)
D/X HPV Colposcopy will show?
2.
Colposcopy will show
1. Low-grade squamous
2. ASCUS HPV positive
HSV 1 - Oral Lesions (cold sore)
HSV 2 Genital Lesions
HSV 2 Genital Lesions
Most common form of herpes that leads to Viral Meningitis?
HSV 2 Genital Lesions
What?
Describe?
- HHV 3 - VZV Varicella Zoster Chicken Pox
- Dewdrop on a rose pedal
What?
Describe?
- HHV 3 - VZV Varicella Zoster Shingles
- Unilateral Dermatomal pattern
HHV 4 - EBV Epstein Barr
HHV 5 - CMV Cytomegalovirus
HHV 6 - Roseola Virus a.k.a. 6th disease
HSV - Herpetic Whitlow
Herpes Labials
Herpes of the mouth
Herpes Gladiaturum
Westler trunk Herpes
Blanching dendritic lesion around the Eye caused by herpes?
Keratoconjunctivitis Herpes
Herpes, why is PCR assay better than Tzank?
What would the Tzank test show?
Because PCR assay is better!
Multinucleated Giant Cells
Double stranded DNA virus that is leaner?
What is this pattern called?
Herpes Simplex Virus
Cowdry Bodies
Hutchinson Sign
Varicella Zoster Shingles
T/X Varicella Zoster:
- Normal and Prego
- < 12 y/o
- > 12 y/o
Bonus: What not to give if child has VZV? What should you give instead?
- Acyclovir
- Nothing
- Valacyclovir
DONT GIVE salicylate because risk of Reys Syndrom
Instead give them Acetaminophen
VSV Vaccine schedule:
1st dose at 12-15 months
2nd dose at 4-6 y/o
To prevent shingles if older than 50 y/o, give?
If active shingles give?
Shingrex 2 does 6 months apart
Valaclovir
If you have a 21 y/o pregnant women with not history of have vaccine or chickenpox, what should you do for her?
Give her Varcilla-Zoster immuneglobin
Classic Triad for the KISSING disease (Epstein Barr)?
Fever
Pharyngitis
Lymphadenopathy
Patient was complaining of symptoms that lead the Practitioner to give an antibiotic thinking it was a bacterial disease. The patent soon after developed a macular rash and now you believe the patient might have a virus instead. What virus and what antibiotic was given that caused the rash?
Epstein Barr Virus and the patient must have received Ampicillin
D/X Epstein Barr Virus EBV HHS 4? (2)
Blood Smear showing atypical lymph
Monospot showing heterophiles antibodies
T/X Epstein Barr Virus EBV HHS 4?
Support (fluids, gargle salt, no sport 4 week)
Why no sport for 4 weeks with a Epstein Barr Virus EBV HHS 4 patient?
Patients can develop splenomegaly
Cytomegalovirus CMV 5 (ToRCH):
Where does it go dormant?
Who does it develop in?
Dormant in B/T cells and macrophages
Immunocompromised
Most common Viral Fetal Infection?
Cytomegalovirus CMV 5 (ToRCH)
Describe congenital Cytomegalovirus CMV 5 (ToRCH)?
(5)
Blueberry rash
Jaundice
Seizures
Deaf
Perintercrainal calcifications
You received back a Tissue biopsy that shows Owls eye inclusion, what do you suspect it is?
Cytomegalovirus CMV 5 (ToRCH)
T/X Cytomegalovirus CMV 5 (ToRCH)?
Ganciclovir
Roseola Infantum HHV 6, occurs in?
Children less than 2 years old
S/S Roseola Infantum? (3)
- Extremly High Fever
- Lacy blanching body rash (trunk to arms)
- Nagayama’s Spots
Patients develops a rash that started at the trunk after a few days of a very high fever. The rash has now moved to the extremities. What disease?
Roseola Infantum HHV 6
Treatment?
Support (fluids, rest, NSAIDS)
Fifths Disease or Parvovirus B19?
Erythema Infectiosum (Slap Cheek)
Fun Fact about the rash for Roseola infantum HHV 6?
The only rash that start at the trunk and moves to the extremities
Patients has a low grade fever, then devlopes a rash that began in the face but has moved to the body. What do you expect this to be?
5ths Disease Erythema Infectiosum (slap cheek)
As a concerned practitioner, what type of patients can have a aplastic crisis with 5ths Disease Erythema Infectiosum (slap cheek)?
Sickle Cell
G6PD
Thalassemia
D/X and T/X for 5ths Disease Erythema Infectiosum (slap cheek)?
Clinical and Supportive care
- HPV Stereotype that causes Cutaneous Warts?
- HPV Stereotype that causes Genital Warts?
- HPV Stereotype that causes Cervical Cancer?
- Cutaneous = 1,2,4
- Genital = 6,11
- Cervical Cx = 16, 18 (USA)
Most patients never realize they have HPV, what test should you order if PAP smear came back showing Stage II dysplasia?
Colposcopy and HPV test
HPV Gardasil vaccine Schedule
2.
- 11-12 y/o x 2 doses
- 13-26 y/o to catch-up
Condyloma Acumination =
Condyloma Lata =
Condyloma Acumination = HPV genital warts
Condyloma Lata = Secondary Syphilis white lesions
Koilocytic squamous clumps
HPV Human Papillomavirus
Patient develops a rash that started at the trunk after a few days of a very high fever. The rash has now moved to the extremities. What disease?
Roseola Infantum HHV 6
Influenza Prophylaxis Vaccine Starts at what age?
> 6 months old
Influenza treatment:
- Neuraminidase inhibitors Dr. OZ P.hD
Oseltamivir, Zanamivir, and Peramivir
Gold Standard D/X influenza?
RT-PCR
- MMR vaccine protect against?
- Frist dose?
- Second dose?
- Measles, Mumps, RubeLLa
- 12 months
- 15-16 months
Macular-Papular blanching rash
Rubeola (Measles) virus
Bright Red spots w/blue/white center like GRAINS of Sand
Koplik Spots
Phases of Rubeola (Measles) Virus
Phase 1: 1-3 days … 3c’s
Phase 2: 48 hours later
Phase 3: 2-4 days later
Phase 1: Cough, Coryza, Conjunctivitis with Fever
Phase 2: Rash + Koplike spots
Phase 3: brick red rash maculopapular blanching rash face down
D/X Rubeola (measles)?
Fever x 3 days + Koplik spots + one of the 3 c’s
T/X Rubeola (measles)
Isolate for 1 week if Rash + support
Mumps
Mumps can cause whats in males?
Orchitis (swollen testes)
Mumps can make you testes as big as POP Poms
Parotitis
Orchitis
Mengitits (aseptic)
Pancreatitis
TX for Mumps
Isolate 5 days + Support
Pinpoint Red Macula’s on soft palate
Forchheimer spots
What is Rubella (German mumps) called the 3 day version of measles?
Rash in gone within 3 days
Patients comes in with a rash that started in the face and moved down the body. After 3 days, the rash was gone. You notice pinpoint red macula’s on the soft palate. What is you D/X?
Rubella (German mumps)
What can Rubella (German mumps) cause in the 1st Trimester of pregnancy?
Deaf, Dumb and Blind + PDA baby
T/X Rubella (German Mumps)?
Support
What virus most commonly in bats cause Rabies?
Ribonucleic RNA rhabdovirus
Incubation of RNA rhabdoviurs (Rabies)?
Symptoms?
1 to 3 months
Hydrophobia (can’t swallow water)
Fear of draft fresh air
Before rabies death, test?
After rabies death, test?
Before = RT-PCR + Skin + CSF
After = Negri Bodies
AIDS = CD4 counts <
200
Protocol for CD4 < 350 HIV patient?
HAART
- NNRTI + 2 NTRIs or PI + 2NTRIs
- INSTI + 2 NTRIs
CD4 < 250
Coccidioidomycosis = Annual Testing + Fluconazole
CD4 < 200
Pneumocystis = Bactrim
CD4 < 150
Histoplasmosis = test only
CD4 < 100
Toxoplasmosis/Cyptococcus
only treat Toxoplasmosis TMP-SMX (Bactrim)
CD4 < 50
MAC = ART treatment
Sepsis is life threatening, what 3 areas are disfunctioning?
Circulatory
Cellular
Metobolic
Indirect marker of tissue Perfusion?
Lactate
Most common cause of sepsis?
Pneumonia
Criteria for sepsis SIRS (old) SOFA and NEWS, what information does this give?
Mortality predicition
Gram + Septic shock? (2)
Gram - Septic Shock? (4) KEPP
Gram + : Staph/Strep
Gram - : Klesbella, E. coli, Proteus, Pseudomonas
Sepsis biomarkers (2)
Procalcitonin (increased w/in 4 hours)
Lactate (>18)
Treatment for Sepsis
1.
2.
3.
4.
5.
- Remove cause of infection!
- NormSaline fluids 30 ml/kg x 3 hours
- Empiric Antibiotics
- NoriEpi to get MAP > 65
- Remove all existing catheters