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PANCE > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

When do you see pneumocytis jiroveci pneumocytosis?

A

Common in AIDS when <200 CD4 cells

most common opportunistic infection in AIDS patients

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2
Q

Presentation of pneumocytis jiroveci?

A

Subacute (more indolent) fever, dyspnea, tachypnea, nonproductive cough
-interstitial infiltrates

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3
Q

Dx of pneumocytis jiroveci?

A

PCR of sputum > DFA > more sensitive than silver stain

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4
Q

Tx of Pneumocytis jiroveci?

A

TMP-SMX

-add prednisone taper over 21 days if PaO2 <70

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5
Q

Tx of vaginal candidiasis

A

-conzaole cream x 1-7 days
OR
fluconazole 100-200mg PO x 1

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6
Q

What happens before esophageal candidiasis?

A

Usually ABX, steroid & or chemo exposure
-dx via EGD w/ biopsy
Tx = IV fluconazole

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7
Q

Most common causes of malaria?

A

(these two cause >90% of US cases)
-plasmodium vivax
**falciparum is most virulent
(transmitted by female mosquitos)

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8
Q

Presentation of Malaria

A

periodic chills, fever, sweats
headache, myalgia, splenomegaly possible
(travel history is vital)

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9
Q

How is malaria diagnosed?

A

Thick/thin blood microscopy smears

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10
Q

Malaria prophylaxis =

A

Nets & Repellants PLUS

  • Chloroquine or if resistance use atovaquone-proguanil
  • if endemic w/ p. vivax use Primaquine
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11
Q

How is varicella zoster virus transmitted

A

Mostly by respiratory secretions

less w/ direct contact of vesicular or pustular lesions

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12
Q

When does varicella-zoster virus present?

A

When adults age, cell mediated immunity wanes, or when they are stressed!
-so if <40-50 w/ flare you should ask more questions about HIV etc

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13
Q

Sequelae to varicella zoster virus?

A

increased CVA events within 6 mo of herpes zoster

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14
Q

Treatment of Herpes Zoster?

A

mild to mod = valcyclovir or famciclovir (PO)

severe/ disseminated = acyclovir (IV)

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15
Q

Who should get zostavax?

A

Single dose for all immunocompetent people > 50-60 years old INCLUDING those w/ previous episode of zoster (but lesions must be healed)

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16
Q

About Zostavax (type)

A

Live attenuated viral vaccine

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17
Q

HIV should be suspected in?

A

Anyone who is sexually active or injects drugs is at risk for HIV infection
HIV is a retrovirus

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18
Q

What is Acute HIV Syndrome?

A

An initial manifestation of HIV.

  • Mono-like illness usually more severe and needing hospitalization
  • rash in 40-80% (no exposure to aminopenicillins)
  • *mucocutaneous ulceration is a distinctive feature
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19
Q

Most common presentation of HIV?

A

Patient is asymptomatic and found via screening but not uncommon to find advanced disease

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20
Q

Routine screening for HIV =

A 
New = enzyme immunoassay (ELISA) then viral load test
Old = ELISA then confirm w/ western blot
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21
Q

HIV screening recommendation

A

Routine non-risk based opt-out HIV screening in all pts 13-64

  • all pts initiating tx for TB
  • all pts seeking tx for STDs
  • all pregos should be screened
  • Pts at high risk for HIV should be screened > or = 1 yr
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22
Q

Med Regimens for HIV

A

Regimen = 3 meds (2 NRTIs + 1NNRTI or 2NRTIS + 1 PI)

1) Nucleoside Reverse Transcriptase Inhibitors **these will always have ()
- Emtricibine (FTC)
- Tenofovir (TDF)
2) Non-nucleosdie Reverse Transciptase Inhibitors
- Efavirenz
3) Proteause Inhibitors
- fosamprenavir
- lopinavir
- atazanavir
- darunavir

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23
Q

Protease Inhibitor SE

A

Lipodystrophy and metabolic side effects

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24
Q

Prophylaxis when CD4 <200

A

for Pneumocystosis = TMP-SMX

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25
Q

Prophylaxis when CD4 <100

A

for Toxoplasmosis = TMP-SMX

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26
Q

Prophylaxis when CD4 <50

A

for Mycobacterium avium complex = Azithromycin

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27
Q

What causes lyme disease?

A

Borrelia burgdorferi spirochete
(the only two spirochetes are lyme dz and syphilis)
most common vector borne disease in US

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28
Q

Progression of Lyme Dz

A

1: (Early) constitutional symp + erythema migrans
(small red papule w/ centrifugal spread & central clearing)

2: (Disseminated)
- Cardiac symp (5% develop varying degrees of AV block)
- Neuro symp (Bell’s Palsy)

3: (Late)
- chronic arthritis may occur in up to 60% of people

(the longer the infection goes on, the harder it is to treat)

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29
Q

Screening tests in Lyme Dz

A

Antibody assay may take 4-6 weeks to turn positive after infection. Confirm w/ western blot if screen is positive or equivocal.

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30
Q

Tx of Lyme Dz

A

Doxycycline (if > 8 y/o)
Amoxicillin or cefuroxime (if < 8 y/o)
Ceftriaxone if more serious manifestations (i.e. neuro)

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31
Q

What causes Rocky Mountain Spotted Fever? Manifestation?

A

Rickettsia rickettsii
-presents as influenza prodrome and then red macular rash on 2nd-6th day of fever **1st on wrists/ankles and then spreading centrally (then turns petechial in 50%)

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32
Q

Tx of Rocky Mountain Spotted Fever

A

Treat w/ Doxycycline (EVEN KIDS)

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33
Q

Gonorrhea bacteria characteristics and presentation

A

Neisseria gonorrhoeae = gram NEG DIPLOcocci

yellow, creamy, profuse discharge (may be asymp)

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34
Q

Dx of gonorrhea

A

Nucleic acid amplification test NAAT of discharge or urine

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35
Q

Tx of gonorrhea

A

Ceftriaxone 250mg IM x 1 plus azithromycin 1g PO X1

use combo therapy even if NAAT is negative for chlamydia

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36
Q

Chlamydia characteristics & presentation

A
  • most common REPORTABLE sti
  • Men may be asymptomatic or urethritis or dysuria
  • Women commonly asymptomatic
  • **both sexes can present w/ reactive arthritis (Reiter’s)
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37
Q

Chylamdia Tx

A

Azithromycin 1g PO x 1 or Doxycyline 100mg PO BID x 7days

must retest for cure in pregnancy

38
Q

Syphilis bacteria characteristics

A

Treponema pallidum (corkscrew shaped spirochete)

39
Q

Syphilis Staging

A
  • *great imitator**
    1) Active
  • Primary = chancre
  • Secondary = generalized MP rash on palms and soles
  • Tertiary = neurosyphilis
    2) Latent
  • Early latent if < 1 yr
  • Late latent if > or = 1 yr
40
Q

Early syphilis dx

A

Darkfield exam of lesion exudates

41
Q

Later syphillis dx

A

1) Traditionally = RPR and confirm w/ fluorsecent treponemal antibody absorbed (FTA-ABS)
2) Reverse Seq = treponemal enzme immunoassay (EIA) if positive then do RPR w/ titer

42
Q

Tx of syphilis

A

Benzathine Penicillin G
(if PCN allergy = ceftriaxone or doxycycline)
**treatment failures occur though, so serologic testing should be repeated 6 and 12 mo after initial treatment. Follow-up is mandatory.

43
Q

Most common cause of genital ulcer in US

44
Q

OTHER Common clinical manifestations of HSV

A
  • meningoencephelitis
  • esophagitis/proctitis
  • *HSV-1 associated w/ Bell’s Palsy (facial muscle weakness; CN VII palsy)
45
Q

Diagnosis of HSV

A

Tzanck smear is the historical test = intranuclear inclusions and GIANT MULTINUCLEATED CELLS

Cell culture or PCR is preferred
**PCR is test of choice for detecting HSV in spinal fluid

46
Q

Low risk types primarily benign anogenital warts

47
Q

High risk types primarily anogenital cancers

48
Q

Most common non-reportable STI =

49
Q

Who should get Gardasil?

A

Boys and girls between age of 9-26y/o

prevents 6, 11, 16, 18

50
Q

Who should get cervarix?

A

Girls ONLY
between age 10-25
(prevents 16, 18)

51
Q

Most common cause of infectious arthritis

A

S. aureus
(transient bacteremia > other source of infection)
Tx: antistaph abx & joint drainage

52
Q

Most common cause of infectious arthritis in young sexually active people

A

n. gonorrhea

Tx: ceftriaxone + doxy

53
Q

What bacteria do you think of in acute presentation of endocarditis

54
Q

What bacteria do you think of in sub-acute presentation of endocarditis

A

strep and enterococci

55
Q

Gold Standard orders in endocarditis

A

Blood cultures X2-3

Echo

56
Q

Empiric Abx in Endocarditis

A

Vanco + ceftriaxone

Vanco + gentamicin

57
Q

Endocarditis prophylaxis abx =

A

Amoxicillin 2g PO 1hr BEFORE procedure

Cephalixin 2 g PO or clindamycin PO 1hr BEFORE procedure if penicillin allergy

58
Q

Bacterial Meningitis bugs in preterm to 1 mo

A

s. agalactiae

e. coli

59
Q

Bacterial Meningitis bugs in >1mo to 50yrs

A

s. pneumo
n. meningitidis
h. influenzae

60
Q

Bacterial Meningitis bugs in >50 y/o

61
Q

Aseptic Meningitis bugs

A

enteroviruses (coxsackie and echovirus common)

-usually in fall or summer

62
Q

Bacterial Meningitis CSF

A 
high opening pressure
increased cell count 100-1000
cell differentiation = PMNs usually
decreased glucose
increased protein
63
Q

Aseptic Meningitis CSF

A

normal or min elevated opening pressure
cell count 10-100s
cell differentiation = lymphs usually
glucose often normal

64
Q

Empiric therapy in meningitis pts 1mo to 50y

A

ceftriaxone + vanco +/- ampicillin (if concern for listeria)
**listeria is a rod that is not gram negative
Add dexamethasone

65
Q

Meningoencephalitis Causes

A 
Sporadic = HSV1 > Varicella zoster virus
Seasonal = est nile
66
Q

West nile virus meningoencephalitis presentation

A

muscle weakness, flaccid paralysis “polio like virus”

67
Q

Pathognomic for HSV meningoencephalitis

A

temporal lobe abnormalities on MRI

68
Q

Tx of Meningoencephalitis

A

Empiric Acyclovir

69
Q

Erysipelas cause, symp, tx

A

strep species (s. progenes)&raquo_space; staph
rapid onset red, glistening demarcated skin
Tx: anti staph abx (cefazolin, clindamycin, vanco)

70
Q

Cellulitis cause, symp, tx

A

step species&raquo_space; staph

erythema less intense than erysipelas; fever, chills, erythema, induration

71
Q

Furuncle cause, tx

A

s. aureus

Tx: warm compresses, I&D, anti-staph abx

72
Q

Necrotizing fascitis cause, symp, tx

A

Classically = group A strep (s. pyogenes)
but most are polymicrobial
presents like cellulitis but exam findings (systemic toxicity, pain) are out of proportion
Tx: surgical emergency (extensive debridement)

73
Q

Non-Inflammatory Diarrhea characteristics

A
  • large volume, watery stool
  • no blood or PMNs (mucus)
  • nausea/flu-like symp are common
74
Q

Differential Dx of non-inflammatory diarrhea

A
  • viral (norovirus)
  • bacterial (s. aureus, b. cereus, v. cholerae)
  • protozoal (giardia, cryptospordium)
  • *anti-peristaltics are usually ok**
75
Q

Inflammatory Diarrehea characteristics

A

small volume, frequent bloody/mucus stools
abdundant PMNs
Fever, chills, abdominal pain

76
Q

Differential dx for inflammatory diarrhea

A

e. coli, c. diff, shigella, campylobacter, salmonella

77
Q

Most common cause of gastroenteritis in US

78
Q

Food poisoning

A

Usually staph
N/V/D 1-6 hr later
Tx = supportive

79
Q

Bacteria if food poisoning from rice

A

bacillus cereus

80
Q

Cholera

A 
contaminated food or H20
caused by vibrio cholera
***rice water stool***
Dx w/ stool culture
Tx: lots of fluids; azithromycin or doxy decreases duration of dz
81
Q

Giardia

A 
Giardia Lamblia
-most common parasitic etiology of infectious diarrhea in US
-associated w/ camping/hiking
*most cases asymptomatic
Dx w/ stool antigen test
Tx: metronidazole or tinidazole
82
Q

Cryptospordiosis

A

fecal oral transmission
cholera-like diarrhea
Dx: stool antigen test

83
Q

E. coli diarrhea

A

initially associated w/ undercooked hamburger, now associated w/ almost any fresh food
often afebrile
**35% of blood diarrhea
Dx: stool culture and fecal toxin testing
Tx: supportive

84
Q

Complication of e.coli diarrhea

A

HUS

  • acute renal failure
  • thrombocytopenia
  • hemolytic anemia
85
Q

Tx of c. dif

A

metronidazole (if mild)
vancomycin (moderate to severe)
remember = barnyard smell

86
Q

Shigellosis

A

presents abruptly w/ bloody diarrhea, abd pain, tenesmus, systemic toxicity
associated w/ daycare centers
Tx: fluoroquinolone for adults; azithromycin for kids

87
Q

Campylobacter

A

gram negative s shaped rod
most common bacterial cause of infectious diarrhea
fever, watery-bloody diarrhea, and abdominal pain
Tx: Azithromycin

88
Q

Complications of campylobacter infection

A
  • Guillain Barre Syndrome

- Reactive arthritis

89
Q

Salmonellosis (Gastroenteritis pattern)

A

-raw egg or chicken ingestion
-presents like campylobacter
Tx: fluoroquinolone

90
Q

Slamonellosis (enteric fever)

A

any salmonella species can cause but most s. typhi is most common

91
Q

Typhoid fever=

A

enteric fever secondary to s. typhi
-Constitutional symp, HA, GI symp (constipation or diarrhea) and generally in a *returning traveler
-dx w/ stool culture
Tx: FQ or ceftriaxone (vaccine is available)

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