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IM Board Review > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

_______are the most common cause of viral meningitis, usually presenting with symptoms of headache, fever, nuchal rigidity, photophobia, nausea, vomiting, myalgias, pharyngitis, maculopapular rash, and cough between May and November

A

Enteroviruses

Herpesviruses can cause meningitis year round; herpes simplex virus 2 is the most common cause and can recur.

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2
Q

______ usually develops weeks after exposure, during the second phase of illness, and can present with uveitis, rash, conjunctival suffusion, sepsis, lymphadenopathy, kidney injury, and hepatosplenomegaly.

A

Leptospiral meningitis

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3
Q

Add listeria coverage as ampicillin after age _____

A

50

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4
Q

Other random causes of meningitis/encephalitis

A

Naegleria fowleri, brucella, aspetic meningitis (NSAID, IgG, SLE), chemical following procedures

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5
Q

Odd feature of TB meninitis_____

A

SIADH (Hyponatremia)

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6
Q

Most common causes of encephalitis: The most common known causes are viral (herpes simplex virus types 1 and 6, varicella-zoster virus, and West Nile virus) and autoimmune diseases.

A
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7
Q

Encephalitis in transplant patients __________________

A

CMV, HHV6

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8
Q

Varicella-zoster virus (VZV) is a treatable form of encephalitis and may present without vesicular rash, so polymerase chain reaction of the cerebrospinal fluid (CSF) or a serum-to-CSF anti-VZV IgG should be ordered in all patients with encephalitis.

A

WNV can cause meningitis, encephalitis, acute flaccid paralysis (similar to poliomyelitis), neuropathy, and retinopathy.

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9
Q

_______ is most common auto-immune encephalitis; it was initially described as a paraneoplastic syndrome affecting young women with ovarian teratomas, but it can be associated with other tumors (sex cord stromal tumors, small cell lung cancer) or occur without a tumor.

A

Anti-N-methyl-D-aspartate receptor encephalitis

Treatment includes intravenous glucocorticoids, intravenous immune globulin, tumor removal (if present), and, in some cases, plasmapheresis and rituximab

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10
Q

Treatment of toxic shock syndrome also involves use of ____ apart from standard staph/strepp coverage

A

Clindamycin 2/2 toxin

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11
Q

Pneumococcal antigen testing is not recommended in adults with community-acquired pneumonia (CAP), except in those with severe CAP;

A
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12
Q

Lyme disease (Morelia) spread by _______, treated with ____ only with 36hr attachment, high endemic rate of infection

A

Deer tick

Doxycycline, can also use ceftrioxone/penicillin for CNS penetration

Early Disseminated disease; he most common manifestation is a flu-like illness characterized by fevers, arthralgia, myalgia, and lymphadenopathy

Testing involves Serum ELISA, with confirmatory western blot for late infection signs, but can be clinical diagnosis without testing

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13
Q

____ and ___ and ____are spread by deer tick

A

Lyme, Babesiosis, Anaplasmosis

The hallmark of babesiosis is hemolysis, with anemia almost invariably present. With severe disease, thrombocytopenia, elevated liver enzyme levels, and acute kidney injury are possible.

Smear = Maltese cross tetrads

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14
Q

Treatment of Babesiosis

A

Atovaquone plus azithromycin are most appropriate for mild disease, whereas clindamycin plus quinine remains the regimen of choice for severe disease

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15
Q

Another tick born disease causing erythema migrans, but occurring in the southern states like Texas

A

STARI, treated with Doxy

spread by Lone star tick, so is Erlichiosis

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16
Q

Do you typically get a rash in Anaplasmosis _____

A

No

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17
Q

Petechia palms/soles, rash, as vector born disease_____

A

Rocky mountains spotted fever

Also called ricketsia rickets

Can be tested with skin serologies

Fever first then rash

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18
Q

Hallmark feature of Erlichiosis _______

A

Monocyte morula

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19
Q

Both ____ and anaplasmosis need PCR tests, will be negative serologies

A

erlichiosis,

Anaplasma/erlichiosis treated with doxycycline

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20
Q

Treatment of asymptomatic bacteriuria is indicated in pregnant women and __________

A

in patients scheduled to undergo an invasive procedure involving the urinary tract.

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21
Q

2nd line treatment for UTI_______

A

Floroquinolone

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22
Q

Recurrent UTI in women____

A

Prophylactic daily antimicrobial therapy is an option in women who have had three or more urinary tract infections in the previous 12 months or two or more in the previous 6 months; other options include postcoital antimicrobial prophylaxis and self-diagnosis with self-treatment

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23
Q

Treatment of acute bacterial prostatitis_____

A

Fluoroquinolone antibiotics are the preferred oral agents for treating acute bacterial prostatitis but should not be used if recent genitourinary instrumentation was performed because most E. coli strains are now resistant to fluoroquinolones.

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24
Q

Quantiferon gold not effected by BCG vaccine_______

A

True

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25
Q

If signs of extrapulmonary tuberculosis infection are present, samples from those areas should be obtained and sent for acid-fast bacilli staining, mycobacterial culture, and histopathology.

A
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26
Q

Latent TB treatments

1)Isoniazid/Rifapentine x3 months
2) Rifampin x 4 months
3) Isoniazid Rifapmin x 3 months
4) Isoniazid 6-9 months + pyridoxine (Pregnant)

A

Rifampin monotherapy has not been proven in HIV+ patients

Rifampin also used as post exposure prophylaxis for H/Influenza and meningitis

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27
Q

Active TB treatment______

A

6 to 9 months of treatment in patients with drug-susceptible active tuberculosis; a four-drug regimen is given daily for 2 months, followed by a continuation phase of isoniazid plus rifampin daily, usually for 4 months.

2 months = RIPE

4 months = Rifampin/Isoniazid (discontinue ethambutol, and pyrazinamide)

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28
Q

Treatment of drug resistant TB______

A

In patients with multidrug-resistant tuberculosis, at least a five-drug regimen should be provided for 5 to 7 months, followed by a four-drug regimen for a total treatment duration of 15 to 21 months.

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29
Q

You may delay ART initiation for HIV TB to prevent immune reconstitution (True/False)

A

True, 2 -12 weeks

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30
Q

Disseminated candida should not be treated with fluconazole, instead initiate____

A

micafungin (echinocandin), but does not work for candida neoformans

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31
Q

First-line treatment of invasive or chronic pulmonary Aspergillus infection is with _______

A

a triazole, such as voriconazole, posaconazole, or isavuconazole;

Azoles work for aspergillus, echinocandins work for candida

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32
Q

Treatment of Cryptococcus

A

In HIV patients, meningitis

ambisome + flucytosine

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33
Q

Treatment for disseminated Histo_______________

A

Ambisome

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34
Q

Treatment of coccidiomycosis______

Treatment of blastomycosis_______

A

Fluconazole

Itraconazole

35
Q

Test of cure is not recommended in patients with Chlamydia trachomatis infection except in pregnancy;

A
36
Q

painful ulcer with tender and suppurative regional lymphadenopath_____

Painless genital papule or ulcer with unilateral tender inguinal lymphadenopathy______

A

Chancroid, tx: Azithro/Ceftriox/Cipro

Lymphogranuloma Venereum, basically a complicated Chlymidia infection (Tx: Doxycycline)

37
Q

Treatment of symptomatic genital wards______

A

Patient-applied therapies include imiquimod, podofilox, and sinecatechins; provider-administered therapies include trichloroacetic acid or bichloroacetic acid, cryotherapy with liquid nitrogen or cryoprobe, or surgical removal.

Asymptomatic, dont treat

38
Q

Anti staph Abx and ______ is indicated for ortho hardware osteomyelitis

A

Rifampin + Cefazolin/Vanc

39
Q

Vaccination with complement deficiency______

A
40
Q

Repeated sinopulmonary infection, GI infection

A

IgA deficiency

41
Q

Live vaccines should be avoided in people with common variable immunodeficiency (T/F)

A

True

42
Q

Early component complement deficiency is associated with an increased rate of_______and risk of infection with encapsulated organisms; terminal complement defects can result in recurrent Neisseria infections.
Any defect in the classical complement pathway will result in low total hemolytic complement (CH50) level.

A

SLE

43
Q

Asymptomatic persons exposed to aerosolized Yersinia pestis and close contacts of infected patients within the previous 7 days warrant postexposure prophylaxis with levofloxacin or doxycycline.

A
44
Q

Clue to IgA deficiency __________

A

Anaphylaxis to blood products may occur because of the presence of anti-IgA antibodie

45
Q

Patients with common variable immunodeficiency can experience recurrent infections and are at increased risk of noninfectious complications, including autoimmune disease, inflammatory bowel disease, granulomatous disease, bronchiectasis, and malignancy.

A
46
Q

personal or family history of recurrent Neisseria infections is an indication to test the ____________because any defect in the classical complement pathway will result in a low total level.

A

total hemolytic complement (CH50) level

47
Q

Asymptomatic persons exposed to aerosolized Y. pestis and close contacts of infected patients within the previous 7 days warrant postexposure prophylaxis

A
48
Q

Botulism characterized by : Patients present with symmetric, _______ flaccid paralysis with prominent bulbar signs (the “4 Ds”: diplopia, dysarthria, dysphonia, and dysphagia), which may progress to respiratory failure.

A

descending, guillan barre is ascending

Botulism treatment includes supportive care and early administration of antitoxin, although this will not reverse existent paralysis.

49
Q

___________________

fever with headache, arthralgia, myalgia, pharyngitis, and anorexia follows a 1- to 2-week incubation period. Abdominal pain and tenderness can be accompanied by early-onset diarrhea, which may spontaneously resolve or become severe late in disease. One fifth of patients have constipation at diagnosis

During the second week of illness, discrete, blanching, 1- to 4-mm salmon-colored macules, known as rose spots (Figure 19) develop in crops on the chest and abdomen in about 20% of patients. Moderate hepatosplenomegaly, leukopenia, anemia, thrombocytopenia, and elevated aminotransferase levels are common

A

Salmonella typhi and Salmonella paratyphi (A, B, and C)

Ceftriaxone, fluoroquinolones, and azithromycin are preferred treatments for typhoid fever; dexamethasone decreases mortality in severe disease, such as patients with shock and encephalopathy.

50
Q

_____ characterized by acute febrile illness associated with frontal headache, retro-orbital pain, myalgia, and arthralgia, with or without minor spontaneous bleeding. Gastrointestinal or respiratory symptoms may predominate. Severe lumbosacral pain is characteristic. As the fever abates, a macular or scarlatiniform rash, which spares the palms and soles, may develop and evolve into areas of petechiae on extensor surfaces [tourniquets sign]

A

Dengue

51
Q

Symptoms of ___________ resemble dengue fever, including abrupt onset of fever (≥39.0 °C [102.2 °F]) and severe bilateral and symmetrical polyarthralgia, often involving the hands and feet; a maculopapular rash on the limbs and trunk is common

A

chikungunya

52
Q

When is Hep A immunoglobin indicated: _______

A

Serum immune globulin is indicated for persons aged 12 months or younger and for those who decline vaccination or are allergic to its components. It has also been recommended for immunocompromised persons (who are less responsive to hepatitis A vaccine) and patients with chronic liver disease.

53
Q

____________ characterized by fever, headache, malaise, conjunctivitis, and pharyngitis often accompanied by a maculopapular, vesicular, or petechial rash

A

Rickettsia typhus

54
Q

treatment of choice for uncomplicated brucellosis is a combination of doxycycline, rifampin, and streptomycin (or gentamicin), often given for several weeks; neurobrucellosis requires several months of combined ceftriaxone, doxycycline, and rifampin.

A

Brucella risk from abroad, unpasteurized products

55
Q

___________ osteomyelitis also can occur and is classically associated with sickle cell disease.

A

Salmonella

56
Q

EHEC: Enterohemorrhagic Escherichia coli strains produce a Shiga-like toxin that can cause hemorrhagic colitis; treatment is primarily supportive because antibiotics and antimotility agents may increase the risk of developing hemolytic uremic syndrome and do not appear to shorten the duration of infection.

A

For EHEC, you actually do not use antibiotics

57
Q

Severe C.Diff requires addition of IV Flagyl

A
58
Q

The protozoan ____________ is the most common cause of swimming pool–related outbreaks of diarrhea

A

Cryptosporidium

59
Q

Treatment of cyclospora___________

A

Bactrim

Symptoms can last for several weeks and may be more pronounced in HIV-infected patients.

60
Q

common viral early post transplant infection___________

A

HSV

61
Q

_____________ is the most significant viral infection after transplantation, with risk for infection depending on donor and recipient serology.

A

Cytomegalovirus

62
Q

______________ is a protozoan that can reactivate with immunosuppression after transplantation, usually causing encephalitis with fever, headache, and focal neurologic deficits and with multiple ring-enhancing brain lesions on imaging.

A

Toxoplasma gondii

63
Q

____________ is the most common fungal infection without prophylaxis; it is typically a more aggressive pneumonia in patients after transplantation than in those with AIDS

A

Pneumocystis pneumonia

64
Q

PREP regiment___________

A

tenofovir disoproxil fumarate (or tenofovir alafenamide, except in women engaging in receptive vaginal intercourse) plus emtricitabine; 90% effective

65
Q

post exposure prophylaxis_______________

A

A three-drug regimen is given for 4 weeks; the preferred regimen is tenofovir disoproxil fumarate and emtricitabine plus either raltegravir or dolutegravir

HIV usually takes 18-45 days to be detected on the assay

66
Q

__________, a very commonly used nucleoside analogue in HIV therapy, is associated with increased risks of tubular nephrotoxicity and worsening of bone mineral density

A

Tenofovir disoproxil fumarate (TDF)

tenofovir alafenamide should be used preferentially over TDF in patients with or at risk for bone or kidney disease.

67
Q

IRIS usually occurs within a few months of initiating effective antiretroviral therapy in patients with low pretreatment CD4 cell counts (<100/µL). Management of IRIS includes continuing antiretroviral therapy while treating the opportunistic infection

A
68
Q

HIV drugs to avoid in pregnancy_____________

A

1) bictegravir and tenofovir

69
Q

_______ encephalitis associated with teratomas

A

auto-immune (anti NMDA receptor) : steroids, rituximab

70
Q

In lyme disease, late presenting complicated presentation much be confirmed with ELISA/Western blot before treatment

A

Localized, acute disease maybe serologically negative, but you clinically treat with doxycycline

Late disease treated with IV ceftrioxone for 28 days

arthritis/facial nerve palsy = doxycycline

*pregancy cannot have doxy
*post lyme can be chronic lyme that is untreated, therefore have to serologically confirm first

71
Q

Treatment of rocky mountain spotted fever in pregnant patients___________

A

chloramphenicol, non pregnant = Doxycycline

Rash starting in lower extremities, affecting palms and soles

72
Q

Complicated UTI treated with____________

A

Cipro/Levo

Pregnant patient: augmentin, nitrofurantoin

73
Q

Latent TB Treatment

1)Normal: Rifampin 4 months or Isoniazid 6 months

2)HIV+ : Isoniazid 9 months

A
74
Q

Treatment of invasive aspergillosis______
Treatment of ABPA_______________

A

Voriconazole

Steroids —> Itraconazole

75
Q

Treatment of cryptococcus________________

A

Induction: Amphotericin + flucytosine

76
Q

PID not responding to antibiotics______

A

tubo-ovarian abscess

77
Q

neurosyphillis: have to be admitted for 14 days of IV penicillin

Pregnant patients will need de-sensitization, since Doxy cannot be used

Doxy/Tetracycline option for therapy for non-pregnant penicillin allergy

A
78
Q

Anthrax post exposure_________________

A

Cipro 60 days, vaccine, Raxibacumab

79
Q

Treatment of cryptosporidium_____________

A

Nitazoxanide for symptomatic patients

80
Q

Tenofovir cannot be used in pregnancy

A
81
Q

emtricitabine (FTC), lamivudine (3TC), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) have activity against both HIV and HBV,

A

But you cannot use tenofovir during pregnancy

82
Q

When can live vaccines be given for HIV+______

A

After CD4>200

83
Q

Treatment of Toxoplasma Gondiii_______

A

Sulfadiazine/Pyrimethamine, folic acid

84
Q

Varicella post exposure:__________

A

vaccine + Ig for immunocompromised

IM Board Review (13 decks)

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