Infectious Disease Flashcards
1
Q
Gram stain results for strep?
A
G+, catalase -, cocci in chains
2
Q
Clinical findings of strep throat
A
sudden onset fever/chills difficulty swallowing tender anterior cervical adenopathy red, swollen throat purulent exudate in pharynx
3
Q
strep throat + rash =
A
Scarlet Fever
4
Q
Clinical findings of Scarlet Fever
A
- strep throat sx’s
- Rash:
Blanches
Fine papules that feel like “sandpaper”
Starts on neck, face, chest
Circumoral pallor
Key Word: bright red swollen strawberry tongue
5
Q
Erysipelas is skin infection caused by ________.
A
Group A strep
6
Q
Clinical findings of Erysipelas
A
- Painful/itchy rash with raised borders, well demarcated, historically on face (currently common on legs)
- Fever
- H/o sore throat
7
Q
Antibiotic of choice for streptococci infections
A
penicillin
8
Q
honey crusted lesions
A
impetigo
9
Q
epidemiology of impetigo
A
young children or demented person who has runny nose and can’t wipe; poor hygiene
10
Q
Most common cause of cellulitis in U.S.
A
Strep A
11
Q
Tx impetigo
A
topical Mupirocin (Bactroban) gentle washing of area several time per day
12
Q
Clinical findings of cellulitis
A
Local pain/tenderness, erythema, and sharp distinct borders
13
Q
Cellulits tx
A
abx (penicillin)
severe cases may need debridement
14
Q
Deep subcutaneous infection that results in destruction of fascia and fat
A
necrotizing fasciitis
15
Q
_______ can occur 2-3 weeks after strep pyogenes infection, commonly in children 6-15 yo.
A
Rheumatic Fever
16
Q
How is Rheumatic Fever diagnosed?
A
Jones’ Criteria for acute RF; pt must have either 2 major or 1 major + 2 minor
Major criteria: carditis, erythema marginatum, subcutaneous nodules, Sydenham chorea, arthritis
Minor criteria: fever, polyarthralgias, reversible prolongation of PR interval, elevated CRP, h/o rheumatic fever
17
Q
Rheumatic Fever TX
A
- aspirin for pain and fever
- penicillin if strep infection present
- corticosteroids for joint sx’s if aspirin not enough
18
Q
Complications of rheumatic fever
A
Valvular defects (mostly mitral) CHF Rheumatic pneumonitis Arrhythmias (a-fib) Pericarditis with effusion
19
Q
Most common presentation of Salmonella. One of the most common type of food poisoning (under-cooked chicken, eggs)
A
gastroenteritis
20
Q
3 presentations of Salmonella
A
Gastroenteritis/enterocolitis
Bacteremia
Typhoid Fever
21
Q
How does gastroenteritis caused by Shigella present?
A
8-48 hrs after ingestion
abd pain, F/C, N/V
bloody diarrhea
22
Q
Tx of diarrhea from Shigella
A
fluid and electrolyte replacement
sx last 2-5 days
23
Q
_______ bacteria attack the mucous of intestines and begins to replicate in Typhoid Fever.
A
Salmonella typhi
24
Q
“Typhoid Mary”
A
some people can be asx carriers and pass bacteria in their stool for years
25
Clinical presentation of Typhoid Fever
```
progressive fever reaching over 103
abd pain/distention/tenderness
delirium
rose spots = small pink spots on belly and chest that blanch
bradycardia
splenomegaly
```
26
Tx of Typhoid Fever
Fluid and lyte replacement
Ampicillin, Chloramphenicol, and Bactrim
Tx of carriers typically ineffective
27
Complications of Typhoid Fever
30% of untreated cases will have some complication
intestinal hemorrhage, intestinal perforation, nephritis, myocarditis, pneumonia, peritonitis
28
Viral signs of pharyngitis
rhinorrhea, cough, hoarseness
29
Bacterial signs of pharyngitis
fever, tonsillopharyngeal erythema, exudates, beefy red swollen uvula, tender anterior cervical lymphadenopathy, petechiae on palate
30
How is strep throat dx'd?
rapid antigen test
| throat culture
31
Strep throat tx
abx only for confirmed cases
Penicillin x 10 days is 1st line
Amoxicillin x 10 days - tastes better and easier to give kids
32
8 yo comes to clinic with fever, weird involuntary movements, and joint pain
Rheumatic fever
33
Why no honey during first year of life?
infant botulism
34
Why does botulism cause neurological symptoms?
Clostridium botulinum makes toxins that inhibit release of ACh at NMJ
35
3 types of botulism
Infant botulism - honey
Food borne botulism - canned food
Wound botulism - soil
36
Neuro symptoms in botulism
symmetric muscle weakness or paralysis, diplopia, dilated pupils, ptosis, trouble breathing
37
Botulism tx
- Antitoxin available from CDC
- Breathing assistance (mechanical ventilator)
- Rehab for paralysis
38
Most common sexually transmitted disease
Chlamydia
39
Labs and dx studies for Chlamydia
G stain negative
| Swab for culture and PCR (cervix for female, urethra for male)
40
Chlamydia tx
1 g Azithromycin (or doxy)
Prevention: abstinence, barrier protection, few partners
Screening: women under 25, pregnant women
41
Toxin produced by vibrio cholerae results in hyper secretion of what?
water and chloride
42
Cholera on gram stain
G-, comma shaped with single flagellum
43
Hallmark of cholera
"rice water" diarrhea
| 3-5 gallons per day!!!!
44
Epidemiology of cholera
people in crowded places with poor sanitation
45
Treatment of cholera
FLUIDS!!! (IV if severe)
Electrolyte replacement
Self-limiting but abx speed up recovery (doxycycline, azithromycin)
46
Characteristics of diphtheria on microscope
G+, facultative anaerobic
47
Hallmark sign of diptheria infection
grey pseudomembrane covering pharynx/tonsils
48
Treatment of diptheria
```
antitoxin
abx: penicillin, erythromycin
Laryngoscopy to remove pseudomembrane
Intubation prn
Isolation and tx of contacts, report to CDC
```
49
Where in the body does Neisseria gonorrhoeae attack?
mucous membrane of reproductive tract (cervix, uterus, fallopian tubes, urethra)
may also affect mouth, throat, eyes, anus
50
Signs/Sx of gonorrhea
- yellow, creamy purulent discharge from penis or vagina (maybe blood-tinged)
- painful/freq urination
- painful intercoarse
eye infection, septic arthritis
51
Dx of gonorrhea
```
PCR
culture
Gram stain (G-, diplococci)
UA
pelvic U/S
```
52
Tx of gonorrhea
1 g IM Cefriaxone
53
How to get infected with Salmonellosis?
ingest contaminated food or water
54
Stain characteristics of Salmonellosis
G- rod
55
Why does patient with Salmonellosis come to clinic?
```
Enteric fever (typhoid)
- high fever
abd pain/distention
- constipation/diarrhea
- elevated HR
- pink papular rash on trunk
```
Gastroenteritis
- crampy abd pain
- fever
- N/V
- bloody diarrhea
56
how to treat Salmonella
Enteric fever
- Fluoroquinolones (Cipro)
- 3rd generation cephalosporin (ceftriaxone)
Gastritis
- Self limiting
- Bactrim or Cipro may be used
57
Stain characteristics of Shigellosis
G-, facultative anaerobe, rod
58
Shigella mode of transmission
fecal-oral route
59
Epidemiology of Shigella
day care centers, nursing homes, refugee camps; places where conditions are crowded and sanitation is poor
60
Signs/sx of Shigella
abd discomfort/cramps
diarrhea with blood, pus, or mucus
fever
rectal tenesmus
61
Shigella treatment
Fluids and electrolytes!
| Meds: Bactrim, Cipro, Ampicillin
62
Organism characteristics of Tetanus
G+, obligate anaerobe, rod
63
Effects of Tetanus neurotoxins
uncontrollable muscle spasm
64
signs/sx of tetanus infection
```
pain and spasticity at site
trismus (lockjaw)
risus sardonicus (facial spasms)
difficulty swallowing
stiffness of neck and abd
spasm of respiratory muscles
```
65
Tetanus treatment
Vaccination with a booster every 10 years
Mild cases: tetanus immunoglobulin, Metronidazole, diazepam
Tracheostomy and mechanical ventilation prn
Mg2+ to prevent muscle spasm
66
Where can Candidiasis infect in body?
skin and/or mucous membranes of mouth, intestines, or vagina
67
Sx's of thrush
- sore/painful/burning mouth
- dysphagia
- white patches on oral mucosa (cheek, throat, tongue, gums)
68
Sx's of vulvovaginal candidiasis
- erythematous vagina and labia
- thick, curd-like discharge (cottage cheese)
- burning urination
69
How is Candidiasis dx'd?
- KOH prep: pseudohyphae and budding yeasts
| - Gram stain
70
Candidiasis tx?
Topical, oral azoles (IV Amphotericin B if severe)
Good hygiene
71
Cryptococcosis usually affects who?
immunocompromised
72
How is Cryptococcus spread?
inhalation of airborne fungi
73
Cryptococcus on microscope
encapsulated yeast
74
Different types of Cryptococcus
Wound or cutaneous
Pulmonary
Meningitis
75
signs/sx's of Cryptococcus
Pulm: productive cough, pleuritic chest pain
Meningitis: HA, confusion, lethargic, N/V, fever, stiff neck, vision changes, seizures, etc.
76
How is Cryptococcus dx'd?
- Cutaneous lesions: biopsy and cultures
- Blood: culture, antigen testing
- CSF fluid: India ink smear, culture, antigen testing
77
Cryptococcus treatment
Antifungals: IV amphotericin B
78
How is Histoplasmosis spread?
Inhaled spores often found in bird and bat droppings
79
signs/sx's of Histoplasmosis infection
```
Chest pain
Chills
Cough
Fever
Joint pain and stiffness
Muscle aches and stiffness
Extreme weakness
```
80
How is Histoplasmosis diagnosed?
- Medical and travel history
- Labs: blood and urine antigen detection (systemic disease), CBC (mild anemia, pancytopenia), Alk phos (elevated), Sputum culture, Complement-fixing antibodies, Immunoprecipitating antibodies
- Chest x ray shows MILIARY INFILTRATES
- CT Scan of lungs
81
Tx of Histoplasmosis
Symptoms may go away w/o treatment
Meds:
Antifungals - Itraconazole for several months is 1st line
Amphotericin B
Corticosteroids - for acute respiratory distress sx's
82
Most common opportunistic infection in HIV/AIDS
Pneumocystis jirovecii pneumonia (PJP)
83
Diagnostic studies for Pneumocystis jirovecii pneumonia?
```
CXR: diffuse interstitial infiltrates
Hypoxia
Sputum induction or bronchoscopy for sputum sample
Bronchoalveolar lavage
Biopsy to confirm dx
```
84
Treatment of Pneumocystis jirovecii pneumonia?
Bactrim (TMP-SMX) is given as empiric treatment to all immunocompromised patients who present with a cough
Steroids also used
85
What component of Bactrim are patients often allergic to?
sulfa
86
How would you treat a vaginal candida infection?
Fluconazole one time dose of 150 mg
