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PANCE review > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Gram stain results for strep?

A

G+, catalase -, cocci in chains

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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
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3
Q

strep throat + rash =

A

Scarlet Fever

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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

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5
Q

Erysipelas is skin infection caused by ________.

A

Group A strep

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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
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7
Q

Antibiotic of choice for streptococci infections

A

penicillin

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8
Q

honey crusted lesions

A

impetigo

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9
Q

epidemiology of impetigo

A

young children or demented person who has runny nose and can’t wipe; poor hygiene

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10
Q

Most common cause of cellulitis in U.S.

A

Strep A

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11
Q

Tx impetigo

A 
topical Mupirocin (Bactroban)
gentle washing of area several time per day
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12
Q

Clinical findings of cellulitis

A

Local pain/tenderness, erythema, and sharp distinct borders

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13
Q

Cellulits tx

A

abx (penicillin)

severe cases may need debridement

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14
Q

Deep subcutaneous infection that results in destruction of fascia and fat

A

necrotizing fasciitis

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15
Q

_______ can occur 2-3 weeks after strep pyogenes infection, commonly in children 6-15 yo.

A

Rheumatic Fever

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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

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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
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18
Q

Complications of rheumatic fever

A 
Valvular defects (mostly mitral)
CHF
Rheumatic pneumonitis
Arrhythmias (a-fib)
Pericarditis with effusion
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19
Q

Most common presentation of Salmonella. One of the most common type of food poisoning (under-cooked chicken, eggs)

A

gastroenteritis

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20
Q

3 presentations of Salmonella

A

Gastroenteritis/enterocolitis
Bacteremia
Typhoid Fever

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21
Q

How does gastroenteritis caused by Shigella present?

A

8-48 hrs after ingestion
abd pain, F/C, N/V
bloody diarrhea

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22
Q

Tx of diarrhea from Shigella

A

fluid and electrolyte replacement

sx last 2-5 days

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23
Q

_______ bacteria attack the mucous of intestines and begins to replicate in Typhoid Fever.

A

Salmonella typhi

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24
Q

“Typhoid Mary”

A

some people can be asx carriers and pass bacteria in their stool for years

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25
Q

Clinical presentation of Typhoid Fever

A 
progressive fever reaching over 103
abd pain/distention/tenderness
delirium
rose spots = small pink spots on belly and chest that blanch
bradycardia
splenomegaly
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26
Q

Tx of Typhoid Fever

A

Fluid and lyte replacement
Ampicillin, Chloramphenicol, and Bactrim
Tx of carriers typically ineffective

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27
Q

Complications of Typhoid Fever

A

30% of untreated cases will have some complication

intestinal hemorrhage, intestinal perforation, nephritis, myocarditis, pneumonia, peritonitis

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28
Q

Viral signs of pharyngitis

A

rhinorrhea, cough, hoarseness

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29
Q

Bacterial signs of pharyngitis

A

fever, tonsillopharyngeal erythema, exudates, beefy red swollen uvula, tender anterior cervical lymphadenopathy, petechiae on palate

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30
Q

How is strep throat dx’d?

A

rapid antigen test

throat culture

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31
Q

Strep throat tx

A

abx only for confirmed cases

Penicillin x 10 days is 1st line
Amoxicillin x 10 days - tastes better and easier to give kids

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32
Q

8 yo comes to clinic with fever, weird involuntary movements, and joint pain

A

Rheumatic fever

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33
Q

Why no honey during first year of life?

A

infant botulism

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34
Q

Why does botulism cause neurological symptoms?

A

Clostridium botulinum makes toxins that inhibit release of ACh at NMJ

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35
Q

3 types of botulism

A

Infant botulism - honey
Food borne botulism - canned food
Wound botulism - soil

36
Q

Neuro symptoms in botulism

A

symmetric muscle weakness or paralysis, diplopia, dilated pupils, ptosis, trouble breathing

37
Q

Botulism tx

A
  • Antitoxin available from CDC
  • Breathing assistance (mechanical ventilator)
  • Rehab for paralysis
38
Q

Most common sexually transmitted disease

A

Chlamydia

39
Q

Labs and dx studies for Chlamydia

A

G stain negative

Swab for culture and PCR (cervix for female, urethra for male)

40
Q

Chlamydia tx

A

1 g Azithromycin (or doxy)

Prevention: abstinence, barrier protection, few partners
Screening: women under 25, pregnant women

41
Q

Toxin produced by vibrio cholerae results in hyper secretion of what?

A

water and chloride

42
Q

Cholera on gram stain

A

G-, comma shaped with single flagellum

43
Q

Hallmark of cholera

A

“rice water” diarrhea

3-5 gallons per day!!!!

44
Q

Epidemiology of cholera

A

people in crowded places with poor sanitation

45
Q

Treatment of cholera

A

FLUIDS!!! (IV if severe)
Electrolyte replacement
Self-limiting but abx speed up recovery (doxycycline, azithromycin)

46
Q

Characteristics of diphtheria on microscope

A

G+, facultative anaerobic

47
Q

Hallmark sign of diptheria infection

A

grey pseudomembrane covering pharynx/tonsils

48
Q

Treatment of diptheria

A 
antitoxin
abx: penicillin, erythromycin
Laryngoscopy to remove pseudomembrane
Intubation prn
Isolation and tx of contacts, report to CDC
49
Q

Where in the body does Neisseria gonorrhoeae attack?

A

mucous membrane of reproductive tract (cervix, uterus, fallopian tubes, urethra)

may also affect mouth, throat, eyes, anus

50
Q

Signs/Sx of gonorrhea

A
  • yellow, creamy purulent discharge from penis or vagina (maybe blood-tinged)
  • painful/freq urination
  • painful intercoarse

eye infection, septic arthritis

51
Q

Dx of gonorrhea

A 
PCR
culture
Gram stain (G-, diplococci)
UA
pelvic U/S
52
Q

Tx of gonorrhea

A

1 g IM Cefriaxone

53
Q

How to get infected with Salmonellosis?

A

ingest contaminated food or water

54
Q

Stain characteristics of Salmonellosis

A

G- rod

55
Q

Why does patient with Salmonellosis come to clinic?

A 
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
Q

how to treat Salmonella

A

Enteric fever

  • Fluoroquinolones (Cipro)
  • 3rd generation cephalosporin (ceftriaxone)

Gastritis

  • Self limiting
  • Bactrim or Cipro may be used
57
Q

Stain characteristics of Shigellosis

A

G-, facultative anaerobe, rod

58
Q

Shigella mode of transmission

A

fecal-oral route

59
Q

Epidemiology of Shigella

A

day care centers, nursing homes, refugee camps; places where conditions are crowded and sanitation is poor

60
Q

Signs/sx of Shigella

A

abd discomfort/cramps
diarrhea with blood, pus, or mucus
fever
rectal tenesmus

61
Q

Shigella treatment

A

Fluids and electrolytes!

Meds: Bactrim, Cipro, Ampicillin

62
Q

Organism characteristics of Tetanus

A

G+, obligate anaerobe, rod

63
Q

Effects of Tetanus neurotoxins

A

uncontrollable muscle spasm

64
Q

signs/sx of tetanus infection

A 
pain and spasticity at site
trismus (lockjaw)
risus sardonicus (facial spasms)
difficulty swallowing
stiffness of neck and abd
spasm of respiratory muscles
65
Q

Tetanus treatment

A

Vaccination with a booster every 10 years

Mild cases: tetanus immunoglobulin, Metronidazole, diazepam

Tracheostomy and mechanical ventilation prn

Mg2+ to prevent muscle spasm

66
Q

Where can Candidiasis infect in body?

A

skin and/or mucous membranes of mouth, intestines, or vagina

67
Q

Sx’s of thrush

A
  • sore/painful/burning mouth
  • dysphagia
  • white patches on oral mucosa (cheek, throat, tongue, gums)
68
Q

Sx’s of vulvovaginal candidiasis

A
  • erythematous vagina and labia
  • thick, curd-like discharge (cottage cheese)
  • burning urination
69
Q

How is Candidiasis dx’d?

A
  • KOH prep: pseudohyphae and budding yeasts

- Gram stain

70
Q

Candidiasis tx?

A

Topical, oral azoles (IV Amphotericin B if severe)

Good hygiene

71
Q

Cryptococcosis usually affects who?

A

immunocompromised

72
Q

How is Cryptococcus spread?

A

inhalation of airborne fungi

73
Q

Cryptococcus on microscope

A

encapsulated yeast

74
Q

Different types of Cryptococcus

A

Wound or cutaneous
Pulmonary
Meningitis

75
Q

signs/sx’s of Cryptococcus

A

Pulm: productive cough, pleuritic chest pain

Meningitis: HA, confusion, lethargic, N/V, fever, stiff neck, vision changes, seizures, etc.

76
Q

How is Cryptococcus dx’d?

A
  • Cutaneous lesions: biopsy and cultures
  • Blood: culture, antigen testing
  • CSF fluid: India ink smear, culture, antigen testing
77
Q

Cryptococcus treatment

A

Antifungals: IV amphotericin B

78
Q

How is Histoplasmosis spread?

A

Inhaled spores often found in bird and bat droppings

79
Q

signs/sx’s of Histoplasmosis infection

A 
Chest pain
Chills
Cough
Fever
Joint pain and stiffness
Muscle aches and stiffness
Extreme weakness
80
Q

How is Histoplasmosis diagnosed?

A
  • 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
Q

Tx of Histoplasmosis

A

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
Q

Most common opportunistic infection in HIV/AIDS

A

Pneumocystis jirovecii pneumonia (PJP)

83
Q

Diagnostic studies for Pneumocystis jirovecii pneumonia?

A 
CXR: diffuse interstitial infiltrates
Hypoxia
Sputum induction or bronchoscopy for sputum sample
Bronchoalveolar lavage
Biopsy to confirm dx
84
Q

Treatment of Pneumocystis jirovecii pneumonia?

A

Bactrim (TMP-SMX) is given as empiric treatment to all immunocompromised patients who present with a cough

Steroids also used

85
Q

What component of Bactrim are patients often allergic to?

A

sulfa

86
Q

How would you treat a vaginal candida infection?

A

Fluconazole one time dose of 150 mg

PANCE review (18 decks)

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