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Infectious Disease Flashcards

1
Q

When is Amphotericin indicated?

A

Fungal endocarditis
Cryptococcus meningitis
Mucormycosis in diabetics (black fungus)

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2
Q

DOC for MRSA?

A

IV Vancomycin

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3
Q

What 3 bugs is penicillin good against?

A

Strep pyogenes
Syphilis
Leptospira

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4
Q

Bugs covered by amoxicillin (pneumonic)?

A 
HELPS
H. influenzae
E. coli
Listeria
Proteus
Salmonella
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5
Q

What 2 bugs are resistant to ALL cephalosporins?

A

Listeria

Enterococcus

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6
Q

In regards to penicillin allergies, when can you give cephalosporins?

A

If penicillin allergy is RASH only!

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7
Q

Best initial therapy for PID?

A

Cefotetan or Cefoxitin
(2nd gen cephalosporins)

S/E: bleeding risk (decrease prothrombin), disulfiram-like rxn w/ EtOH

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8
Q

Why is ceftriaxone C/I in neonates?

A

Impaired biliary metabolism from underdeveloped biliary system

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9
Q

Uses for fluoroquinolones?

A

CA pneumonia
Cystitis & pyelonephritis
Diverticulitis (only Moxifloxacin used mono therapy - need to combine others w/ metronidazole to cover for anaerobes)

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10
Q

Side effects of fluoroquinolones?

A
  • Bone growth abnormalities in children & pregnant women

* Tendonitis & tendon rupture (Achilles, biceps)

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11
Q

What class of bug are aminoglycosides useless against?

What are side effects?

A

Anaerobes - need O2 to function

*Nephrotoxic & ototoxic

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12
Q

Uses for Doxycycline?

A 
Chlamydia (w/ Azithromycin)
Lyme
Rickettsia
Syphilis (w/ penicillin allergy)
Borrelia, Ehrlichia, Mycoplasma
*Rocky Mountain spotted fever in children
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13
Q

Side effects of doxycycline?

A 
tooth discoloration (children)
phototoxicity
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14
Q

Nitrofurantoin has one indication for use?

A

Cystitis, especially in pregnant women

Asymptomatic bactiuria also

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15
Q

Uses for TMP-SMX?

MOA?

A

Cystitis
Pneumocystis Pneumonia
MRSA of soft tissue & skin

Blocks folate metabolism in body

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16
Q

Side effects of TMP-SMX?

A

Rash
Hemolysis w/ G6PD deficiency
Bone marrow suppression

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17
Q

What drug helps stimulate gut motility?

A

Erythromycin

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18
Q

Why can’t daptomycin be used for respiratory infections?

A

It is metabolized by surfactant in lungs

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19
Q

What 4 drugs are used to treat minor MRSA skin infections?

A

TMP/SMX
Clindamycin
Doxycycline
Linezolid

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20
Q

What is most likely diagnosis:
Stiff neck, photophobia, meningismus?
Confusion?
Focal neuro deficits?

A

Meningitis
Encephalitis
Abscess

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21
Q

Best initial and most accurate test for meningitis?

A

LP

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22
Q

When is head CT indicated first?

A

Papilledema
Seizures
Focal neuro deficits
Confusion

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23
Q

Best initial treatment for bacterial meningitis?

A

Ceftriaxone
Vancomycin
Steroids
Ampicillin (if Listeria present)

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24
Q

In Neisseria meningitidis, what prophylaxis is given to close contacts?

A

Either rifampin, ciprofloxacin, or ceftriaxone

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25
Q

1) Signs of encephalitis?
2) Most common cause?
3) Best initial of choice?
4) Most accurate test?
5) Therapy of choice?

A

1) ACUTE onset FEVER & CONFUSION
2) Herpes simplex (temporal lobe)
3) Head CT
4) PCR of CSF
5) Acycovir - (famciclvir & valcyclovir for IV route)
Foscarnet for acyclovir-resistant strains

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26
Q

Key physical finding in OM?

Best initial/most accurate test?

Best therapy?

A

IMMOBILITY of TM

Tympanocentesis

Amoxicillin

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27
Q

What illness has initial high fever & appear much more ill than suggested by their complaints. On physical exam, you see a discrete pink, blanching lesions on the chest and back. What is it?

A

Typhoid fever

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28
Q

What illness is described by polyarthritis (multiple joints), tenosynovitis (pain along tendon sheaths), and rash (maculopapular, then hemorrhagic)? What other finding is common?

Most common cause?

Tx?

A

Disseminated gonococcal infection

Urethritis is common

MCC = septic arthritis in sexually active adults

Tx: ceftriaxone or cefotaxime

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29
Q

What presents with fever, pharyngitis w/ exudate, lymphadenopathy (NOT strep throat)?

What other 2 findings are unique to this?

If given Abx (ampicillin), what happens?

A

Mononucleosis –> EBV

Atypical lymphocytosis + enlarged spleen

RASH w/ Abx –> immune complex-related maculopapular rash

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30
Q

What 2 groups of people should NOT receive the smallpox vaccine?

A

Hx of eczema
Coronary artery disease

Eczema vaccinatum –> generalized infection of skin with severe disseminated, crusting, vesicular rash from smallpox vaccine

Higher incidence of MI w/ smallpox vaccine

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31
Q

Characteristic of Primary syphilis? Secondary? Tertiary?

Treatment of Primary syphilis? Secondary? Tertiary?

A

Characteristics:
Primary –> NON-tender chancre
Secondary –> maculopapular rash WITH PALMS + SOLES
Tertiary –> gummas, aortitis, neurosyphilis

Treatment
Primary –> Benzathine Penicillin G IM single dose
Sec –> Benzathine Penicillin G IM single dose
Tertiary –> Penicillin G benzathine 3 doses IM once a week
Neurosyphilis –> IV Penicillin G 10-14 days

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32
Q

What is prophylactic treatment for close contacts of someone with Neisseria meningiditis?

A

Rifampin
Cipro –> DONT give to kids
Ceftiraxone

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33
Q

Person with prolonged hospital stays that develop fever and high WBC count. Cultures reveal Gram (+) cocci in clusters. What is most appropriate treatment at this time?

A

Vancomycin (IV)

Prolonged hospital stay = higher incidence of resistant infections

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34
Q

People with prior rheumatic fever - what do they need?

A

Continuous Abx prophylaxis –> IM penicillin benzathine every 4 weeks

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35
Q

If syphilis is confirmed, what other screening test should be performed?

A

HIV antibodies by ELISA

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36
Q

What is hallmark of malaria?

What are other common s/s?

Lab findings?

What is best diagnostic test?

A

Hallmark: CYCLICAL fevers

Phases: Cold (chills/shivering) –> Fevers –> Sweating

Anemia (lysis of RBCs) and Thrombocytopenia

Blood smears

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37
Q

In person with Guillian Barre, what is most important test to determine severity?

What is CSF profile?

Tx?

A

PFT (assess resp function)

Normal glucose, LARGE increase in protein, normal opening pressure, clear yellow appearance

Tx: plasmaphresis (filters out antibodies from blood)

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38
Q

S/S of influenza?

Current guidelines for treatment of influenza?

A

Abrupt onset high-grade fever, HA, severe myalgias with other associated symptoms.

Tx of suspected influenza WITHIN 48 hours of symptom onset!

If greater than 48 hours after onset = symptomatic tx

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39
Q

Acute onset (

A

Herpes Simplex Virus-1 encephalitis

Lymphocytosis, increased RBCs

Temporal lobe lesions on CT

HSV PCR

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40
Q

What symptoms are you looking for with disseminated gonococcal infection?

A

Single joint arthritis (red, swollen)
Pustular rash
Tenosynovitis

Young, sexually active person

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41
Q

Boy presents with high-grade fever and rash for last 9 days. A brick-red, maculopapular rash appeared on face and spread to trunk and extremities. Before outbreak, he had cold s/s. What is it? What vitamin has shown to reduce morbidity and mortality rates in this infection?

A

Measles

Vitamin A

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42
Q

What are long term neurologic effects of bacterial meningitis?

A 
Hearing loss
Loss of cognitive fxn
Seizures
Mental retardation
Spasticity or paresis
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43
Q

If an adult gets chickenpox, what is a very dangerous complication?

A

Pneumonia secondary to chickpox

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44
Q

Patient with HIV has fever, cough, diarrhea and splenomegaly. Has elevated ALP. What do you suspect? Tx?

A

Mycobacterium avid complex (MAC)
*Seen when CD4 BELOW 50

  • Splenomegaly
  • High ALP

Tx: azithromycin prophylaxis when CD4

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45
Q

What bug is commonly confused for tuberculosis? What does it look like on gram stain?

Tx?

A

Nocardia
Gram (+), partially acid-fast, branching filamentous rod

*Can disseminate to the brain (abscesses)

Tx: TMP-SMX

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46
Q

Patient with HIV develops white plaques on the tongue that can be easily scraped off. He also has had substernal chest pain. What are you considering and what treatment?

A

Candida esophagitis –> if oral thrush = tx for this!

Empiric oral fluconazole

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47
Q

Defining features of HIV esophagitis?

Tx?

A

Candida = oral thrush, white plaques (easily removed)
Herpes (HSV) = ROUND, oval ulcers
CMV = deep, LINEAR

Candida = oral fluconazole
HSV = acyclovir
CMV = IV ganciclovir
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48
Q

What are signs/factors pointing to C. difficile colitis?

A

Recent hospital admission
Recent antibiotic use (flouors, penicillin, cephalo, clinda)
New onset diarrhea and/or abdominal pain

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49
Q

Woman with previous dental extraction develops an abscess below angle of mandible. There is serosanguinous draining from center of the lesion. Needle aspirate shows Gram (+), anaerobic branching bacteria. What is it and what’s the treatment?

A

Actinomyces –> look for “yellow granular pus”

Tx: Penicillin (12 weeks)

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50
Q

Describe herpetic whitlow?

What test is diagnostic?

What is method of spread?

A

Distal pulp space of finger is swollen, soft, and tender. Throbbing pain present and non-purulent vesicles on volar aspect of hands are pathognomonic.

Tzanck smear (multinucleated giant cells)

*Infected saliva or serum (women with genital herpes or children with herpetic gingivostomatitis)

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51
Q

20 yo develops HSV encephalitis and is treated with IV acyclovir. 2 days later he develops abdominal pain with increased creatinine. What is going on?

A

Crystal-induced AKI that cause obstruction

IV acyclovir has low urine solubility and can precipitate in tubules –> can cause obstruction and AKI

*acyclovir induced AKI = 2 days after treatment

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52
Q

What is the difference between herpangina and herpetic gingivostomatosis?

A

Herpangina: coxsackie virus

- 1mm gray vesicles on tonsillitis pillars and posterior pharynx --> become ulcerated
- lesions also on hands and feet
- seen in summer

Herpetic gingivostomatosis: HSV-1
- anterior oropharynx and lips

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53
Q

Person with HIV has dry cough, exertional dyspnea, and fever - what do you suspect? Tx?

When do you give corticosteroids?

A

PCP (esp when CD4 35

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54
Q

HIV (+) male presents with purple skin masses on his lower abdomen. He has hepatomegaly and CT scan shows nodular, contrast-enhanced intrahepatic lesions. Liver biopsy attempted but severe bleeding results. What is this?

A

Bacillary angiomatosis –> from Bartonella bacteria

BArtonella = Bacillary Angiomatosis

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55
Q

What is a concern with aminoglycosides, especially gentamicin?
What is the test specific to identify gentamicin toxicity?

A

Otoxicity (hearing loss) & damage to motion-sensitive hair cells in inner ear –> cause vestibulopathy

Look for oscillopsia –> sensation of objects moving around in visual field when looking in any direction

  • Head thrust test –> look at fixed target and rapidly move head away from the target –> if vestibulopathy present, the eyes can’t stay fixed on the target and they move away then move back to target with horizontal saccade
    • Specific for gentamicin-induced vestibulopathy
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56
Q

7 yo develops erythema migrans from a tick bite. What is the appropriate treatment?

A

Oral amoxicillin!

NEVER give tetracyclines (doxycycline) in children or pregnant women = slow bone growth and cause enamel hypoplasia and permanent teeth stains

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57
Q

“Muffled” voice (hot-potato voice) and deviation of the uvula suggest what?

Best initial tx?

A

Peritonsillar abscess secondary to tonsillitis

Tx: Needle peritonsillar aspiration

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58
Q

Cause of chronic diarrhea in AIDS patients?

A

Cryptosporidium parvum

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59
Q

Most common cause of multiple ring-enhancing lesions on CT in AIDS patients?

What is the treatment?

A

Toxoplasmosis

Tx: Sulfadiazine + pyrimethamine

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60
Q

Presentation of acute HIV?

A

*Mono-like syndrome (fever, sweats, arthalgias, lymphadenopathy) usually w/in 2-4 weeks after infection

61
Q

Where is Histoplasmosis found?

A

Mississippi, Ohio river valley
Central America

*Bird/bat guano

62
Q

45 yo man recently visited Mexico and shortly after returning developed bloody diarrhea. This resolved and 2 weeks later now has RUQ pain and pain on inspiration in this area. US of liver shows a single cyst in the liver. What is the cause?

A

Amebiasis –> Entamoeba histolytica

*bloody diarrhea followed by liver abscess

Tips to endemic areas

63
Q

Man steps on a rusty nail and his heel is now red and swollen. Foot Xray shows osteomyelitis. What is most common agent responsible?

A

Nail puncture wound causing osteomyelitis = Pseudomonas

64
Q

Empiric Abx regiment for immunocompromised person?

What bugs are you covering?

A

Vancomycin + Amoxicillin + Cefepime

Vanco - G(+)
Amox - Listeria
Cefepime - neisseria

65
Q

What 2 findings point towards secondary syphilis?

A
  • *Diffuse maculopapular rash - including PALMS and SOLES

* *Generalized lymphadenopathy

66
Q

Treatment of choice for cellulitis?

A

IV nafcillin or cefazolin

67
Q

Triad for toxoplasmosis?

A

Chorioretinitis
Hydrocephalus
Intracranial calcifications

68
Q

Lack of what antibody predisposes to Giardia infections?

A

IgA

**Look for B-cell deficiency

69
Q

Man who recently returned from a cruise develops shortness of breath with crackles b/l. He is also confused during the exam and has had recent diarrhea. What it the cause? Tx?

A

Legionnaire’s disease

Pneumonia + diarrhea + hyponatremia (confusion) + hepatitis

Tx: macrolides or fluoroquinolones

70
Q

What is a hydatid liver cyst indicative of?
Imaging findings?
Tx?

A

Echinococcus granulosus –> acquired from close contact w/ dogs
*Eggshell calcification on CT
Tx: Surgery for removal
*Do NOT aspiration b/c risk spilling cyst contents and triggering anaphylaxis rxn!

71
Q

TMP-SMX is used to prevent what 2 opportunistic infections in AIDS patients?

A 
Pneumocystis jiroveci (PCP)
Toxoplasmosis
72
Q

What do you suspect when patient has periorbital edema, muscle aches and pains, and eosinophilia with recent foreign travel?

A

Trichinellosis

  • Triad of
    1. Periorbital edema
    2. Myositis
    3. Eosinophilia

Also see splinter hemorrhages

73
Q

Woman has painful rash on R hand and enlarged, suppurative lymphadenopathy at elbows and axilla. What is the cause? Tx?

A

Cat-scratch disease –> Bartonella henselae
Look for cat exposure

Tx: azithromycin

74
Q

2 most common causes of acute bacterial rhino-sinusitis?

Tx?

A

Strep pneumoniae, Haemophilus influenzae

Amox-clavulanic acid (Augmentin)

75
Q

Patient develops sudden onset of skin and oral ulcers. He can’t drink due to pain in his mouth and throat. He was on TMP-SMX 5 days prior for sinusitis. On exam his conjunctivae are inflamed. He has red, blistering, and ulceration of oral mucosa with some involvement of trunk, hands, arms, and feet. What is the cause?

A

Stevens-Johnson syndrome

**Watch with Sulfa drugs, anticonvulsants, allopurinol

76
Q

Patient has gray, thin vaginal discharge and pear-shaped motile organisms seen on wet-mount. What must she avoid during treatment?

A

Alcohol use

**Metronidazole used for Trichomonas –> can cause disulfiram-like rxn

77
Q

65 yo diabetic woman has difficulty eating over past 2 days. She has discharge out of her L ear with granulations in the ear canal. Facial asymmetry is present and the angle of the jaw on the L is deviated downward. What is the causative organism?

Tx?

A

Pseudomonas!! (suspect in diabetics)

Malignant otitis externa –> can extend into bone and eat away at nerves (facial nerves)

Tx: IV ciprofloxacin (emipiric)

78
Q

Most common bug causing post-influenza pneumonia?

A

S. aureus

79
Q

Most common bug for pneumonia in alcoholics and diabetics?

A

Klebsiella pneumoniae

80
Q

Person has adrenal insuffiency suspected. A cosyntropin test (synthetic ACTH) is done and almost no cortisol is released. CT of the abdomen shows calcification of both adrenal glands. What is the cause?

A

Tuberculosis

Adrenal insuffienciy + calcifications in adrenals

Most common in developing countries

81
Q

Dome-shaped, flesh-colored, non-pruritic rash with central umbilication - what is it? What is it associated with?

A

Molluscum contagiosum

*It’s a virus –> cellular immunodeficiency increases risk of developing it (HIV)

82
Q

Woman has 7 day hx of fatigue and headache that worsened in intensity today. She had one episode of vomiting. Her current temp is 101 F. She has b/l papilledema and MRI of the brain is normal. Rapid HIV test is (+). What is the cause? What other physical exam finding is commonly present? Definitive test to confirm diagnosis? Tx?

A

Cryptococcal meningitis
Fever, HA, elevated ICP in HIV patient over 2-3 weeks

Thrush

Cryptococcal antigen testing of CSF

Tx: amphotericin B w/ flucytosine

83
Q

Person receiving chemotherapy for seminoma comes to ER with fever. His WBC count is extremely low. What is the best empiric Abx to start with? Besides Abx, what is additional step?

A

*Anti-pseudomonal agent
(Pip-Tazo, cefepime, meropenem)

Blood cultures

84
Q

What areas of the world require other anti-malaria treatment besides chloroquine?

What is the preferred treatment?

A

Amazon region in South America
Sub-Saharan Africa
India & Southeast Asia

Mefloquine, Doxy, or Atovaquone/proguanil

85
Q

DOC for malaria in pregnant women?

A

Mefloquine

86
Q

Most common cause of pneumonia in infants/children with CF?

A

S. aureus

87
Q

Most common cause of pneumonia in adults with CF?

A

Pseudomonas aeruginosa

88
Q

Treatment of choice of Lyme disease?

What about in children

A

Doxycycline

Amoxicillin

89
Q

What acute life-threatening reactions are associated with these HIV therapies?

1) Didanosine?
2) Abacavir?
3) Any NRTI?
4) Any NNRTI?
5) Neviapine?
6) Indinavir?

A

1) Didanosine = pancreatitis
2) Abacavir = hypersensitivity syndrome
3) Nucleoside reverse transcriptase inhibitor (NRTI) = lactic acidosis
4) Non-nucleoside RTI (NNRTI) = Stevens-Johnson synd
5) Nevirapine = liver failure
6) Indinavir (protease inhibitor) = crystal-induced nephropathy

90
Q

34 yo male has severely pruritic lesions on his hands. He remembers going to the beach 3 days ago. He initially remembered pruritic erythematous papules over his arm that progressed to serpiginous, red-brown elevated lesions. What is the cause?

A

Cutaneous larva migrans
- Dog/cat hookworm

*Sand exposure

91
Q

What prophylaxis is important in any organ transplant patients?

A

TMP-SMX –> prevent PCP infection

92
Q

Most common cause of bloody diarrhea withOUT fever?

Abx use?

A

E.coli (EHEC) –> starts out watery and becomes bloody

NO Abx –> may increase risk of HUS

93
Q

Best tx for acute, U/L cervical adenitis in children?

A

Clindamycin + I/D

94
Q

26 yo male from Mexico has 2 wk hx of persistent RUQ pain and low grade fevers. Several months ago, he had bloody diarrhea for several days that resolved spontaneously. CT of abdomen shows large solitary liver mass. What is the cause? Tx?

A

Entamoeba histolytica –> liver abscess + hx of bloody diarrhea

Tx: metronidazole

95
Q

Adenopathy in Strep vs EBV?

A 
Strep = anterior cervical
EBV = posterior cervical
96
Q

22 yo man comes to doc b/c his girlfriend wants him to be screened for STD’s. What is the most appropriate test for him?

A

HIV p24 antigen + HIV antibody testing

*Recommended testing once b/w ages 15-65

97
Q

How much induration is needed in a person with HIV to begin treatment for TB?

What is appropriate tx?

What needs to be added?

A

> 5mm induration

Isoniazid (9 months) + pyridoxine

*Pyridoxine helps prevent peripheral neuropathy from isoniazid –> does NOT help prevent liver damage

Need periodic LFT’s

98
Q

Person with HIV has pain and trouble swallowing. What is initial suspicion? What other finding is present? Tx?

A

Candadiasis
Oral thrush
Oral fluconazole

99
Q

Person with HIV has bright red, firm, friable, exophytic nodules - what is the diagnosis? Tx?

A

Bacillary angiomatosis (Bartonella)

Tx: erythromycin

100
Q

What drugs must you always avoid b/c of risk for kidney failure?

A

Aminoglycosides

101
Q

What is a common side effect to be aware of with fluoroquinolone use?

A

Achilles tendinopathy

102
Q

Prodrome of fever, tender lymphadenopathy, and malaise with a blanching, red, maculopapular rash that starts on the face and then spreads to the trunk and extremities (not on palms and soles) over next 24 hours. What is it?

A

Rubella

103
Q

What causes fatigue, fever, muscle aches, and arthalgias, splenomegaly. Peripheral smear shows large basophilic lymphocytes with a vacuolated appearance?

A

CMV mononucleosis

**Does NOT have pharyngitis and cervical lymphadenopathy

104
Q

Treatment for syphilis in person with severe penicillin allergy?

Pregnant women?

A

Doxycycline

Pregnancy –> desensitize before given penicillin

105
Q

Person treated for DKA 3 days ago now has fever, dull facial pain and bloody nasal discharge. He has R-sided nasal turbinates that are necrotic and R eye has chemises and proptosis. What is the bug and tx?

A

Rhizopus (Mucormycosis)

Surgical debridement and IV amphotericin

106
Q

TB test - what people qualify for induration of:

A
107
Q

34 yo Asian male has a 4x4cm hypo pigmented lesion on his L arm that has no sensation to pinprick. What is it and what test is indicated?

A

Leprosy

Skin biopsy for M. leprae –> acid-fast bacilli

108
Q

Most common vaccine-preventable disease among travelers and should be given when traveling to developing countries?

A

Hepatitis A

109
Q

What are CSF findings of Guillan-Barre syndrome?

A

High protein
NORMAL WBC, RBC, glucose

*Immune-related response to the initial bacterial infection –> not an active infection

110
Q

Why can’t Chlamydia be seen on Gram stain?

Best test to confirm?

A

Intracellular organism

Nucleic acid amplification test (NAAT)

111
Q

What type of deficits are seen in Guillan-Barre?

Most important next step in mgmt?

A

Ascending muscle weakness
Decreased reflexes
Distal paresthesias

Assess pulmonary function with Spirometry
FVC

112
Q

What 2 drugs are now commonly used to treat active Hepatitis B?

A

Entecavir

Tenofovir

113
Q

23 yo had an insect bite on his cheek 2 weeks ago and now has worsening headache over the past week. His R cheek and both eyelids are swollen. B/L extra ocular movements are restricted. Both sides of the forehead and mid-face are extremely tender to light palpation. What must you suspect?

A

Infectious cavernous sinus thrombosis

The veins that drain the face, sinuses, and orbits all lead to cavernous sinus

Look for severe HA, B/L periorbital edema, and CN III, IV, V, VI deficits

114
Q

Best test to confirm disseminated Histoplasmosis disease?

Tx?

A

Urine/serum assay for Histoplasmosis antigen

Itraconazole

115
Q

Tx for Cryptococcus and Candida?

A

Flucytosine

116
Q

What agent can cause heaped-up verrucous/nodular lesions (wart-like) w/ violaceous hue that can develop into micro abscesses, dry cough with malaise, prostate tenderness, and scrotal swelling?

What state most likely from?

A

Blastomycosis

Mid-west (Wisconsin, Illinois, MI, KY, TN)

117
Q

Child with meningococcemia, what are they most likely to die from?

A

Waterhouse-Friedrichsen syndrome –> adrenal hemorrhage (vasomotor collapse and flank skin rash)

118
Q

Commonly seen in gardeners with red nodules that later ulcerate and spread proximally?

A

Sporothrix schenickii

119
Q

Why is splenectomy such a big deal for encapsulated organisms?

A

Foreign antigens travel to spleen via splenic artery and are phagocytized by dendritic cells in white pulp of spleen –> then presented to T helper cells –> T helper cells travel to marginal zone and present to B cells –> germinal centers form with production of B cells

No spleen = no phagocytosis by dendritic cells

120
Q

In acute liver failure, what is most important prognostic factor?

Why will LFTs actually start to decrease?

A

PT

Decreased amt of functional liver tissue = decreased LFTs

121
Q

Tx for cat bites?

A

Prophylactic 5 day tx of amoxicillin-clavulanate

122
Q

Person with severe nasal bleeding develops diffuse, confluent erythematous macules on the trunk and extremities. The oropharynx is hyperemic and low platelet count. He has temp 102.2, BP 90/60, Pulse 120. What is the cause?

A

Toxic shock syndrome

**Look for menstruation (tampon use), surgical wound infections, sinusitis, or septorhinoplasty

123
Q

Tx for Chlamydia?

A

*Doxycycline, Azithromycin

Only symptomatic in 80% of women!

124
Q

Chronic exopsure to birds can result in what lung condition?

A

Pulmonary fibrosis (hypersensitivity pneumonitis)

125
Q

Person with AML receiving chemotherapy develops fever and his chest X-ray shows pulmonary nodule with the ‘halo sign’ in his upper R lung. What is the most likely cause?

A

Aspergillosis

**Immunocompromised + pulmonary nodule with ‘halo sign’ or lesions with air crescent

126
Q

Best agent for tx of aspiration pneumonia?

A

Clindamycin

**Look for fever, cough, foul-smelling sputum

127
Q

Scaly, red, mildly pruritic rash with red peripheral ring and central clearing. What is it? What is tx?

A

Tinea corporis

Topical antifungal –> terbinafine

128
Q

Person is currently on quad-therapy for infiltrative TB. They also have anemia with dimorphic RBC population, high serum Fe, and low TIBC. What is this and what’s the cause?

A

Sideroblastic anemia

 * Increased serum Fe
 * Decreased TIBC

*Seen with pyridoxine def from isoniazid –> pyridoxine is needed for early steps in heme synthesis (protoporphyrin synthesis)

129
Q

Tx for Enterobiasis?

A

Albendazole or pyrantel pamoate

  • Noctural perianal itching in children
  • Scotch tape test
130
Q

Differences between tick-borne paralysis and Guillan-Barre syndrome?

A

Tick-borne –> onset w/in HOURS, can be asymmetrical, NO fever/sensory abnormalities, NORMAL CSF

GBS –> onset days/weeks, autonomic dsyfxn, CSF abnormal (high protein)

131
Q

Important cause for traveler’s diarrhea that should be considered in patients with persistent ( > 2 wks), non-bloody, watery diarrhea?

A

Cryptosporidium parvum

132
Q

4 yo with inflamed R eye. Had nasal discharge for past 10 days. Follicles and inflammatory changes in conjunctiva of R eye are seen with neovascularization of the cornea. What is it?

A

Trachoma (from Chlamydia conjunctivitis)

- Follicular conjunctivitis with neovasc in the cornea
- Repeated scaring in cornea = blindness
  • Major cause of blindness worldwide
  • Look for conjunctivitis + cold s/s
133
Q

Most common middle ear pathology in patients with HIV/AIDS?

A

Serous otitis media –> non-infectious effusion behind TM due to auditory tube dysfxn from lymphadenopathy/obstructing lymphoma.

134
Q

DIfferences in immune response for PPSV23 and PCV13?

A

PPSV23: polysaccharide ONLY –> can’t be presented to T cells –> T-cell independent B-cell response

PCV13: polysaccharide+protein conjugate –> presented to T-cells –> T-cell dependent B-cell response

135
Q

45 yo man has 2 day hx of fever, dyspnea, abdominal pain, and diarrhea. He had bone marrow transplant 3 months ago for AML. He is febrile. Oropharynx shows thrush and lung exam shows B/L diffuse rales. Nonspecific tenderness is present in abdomen. CXR shows multifocal diffuse patchy infiltrates. What is the cause of current condition?

A

*CMV pneumonitis

Occur 45 days after transplant
GI ulcers –> cause diarrhea + abdominal pain

136
Q

Post bone marrow transplant recipient with pneumonitis and colitis?

A

CMV

137
Q

57 yo man has had intermittent joint pains for past 8 years. He has had transiently elevated LFTs in addition to vesicles and erosions on the dorsum of both hands. What is this?
What disorder is associated with underlying condition?

A

Chronic Hep C

  • Porphyria cutanea tarda –> fragile skin, photosensitivity, vesicles + erosions on dorm of hands
  • Hep C associated with essential mixed cryoglobulinemia
138
Q

What extra hepatic manifestations are seen with chronic Hep C?

A
  • Essential mixed cryoglobulinemia
  • Porphyria cutanea tarda
  • Glomerulonephritis
139
Q

Major criteria for acute rheumatic fever?

A 
JONES
Joint (migratory arthritis)
O (carditis)
N (subcutaneous nodules)
Erythema marginatum (red rash with cleared borders)
Syndenham chorea
140
Q

Signs of babesiosis?

A

Tick-borne
Hemolysis
Prior splenectomy

141
Q

Only oral agent approved for empiric treatment of pyelonephritis?

If bug is resistant to this agent, what is next best choice?

A

Fluoroquinolones (cipro)

IV ceftriaxone/gentamicin

142
Q

Best way to diagnose active Hep B infection in someone?

A

HBsAg + IgM anti-HBc

anti-HBc = only detectable marker present during window period in acute Hep B

143
Q

If you suspect EBV, what blood disorder must you monitor for?

A

Cold-agglutinin autoimmune hemolytic anemia
*IgM

2-3 weeks after initial onset

144
Q

What tick borne illness has low WBC and platelet counts and is common in southeast and southern US?

Tx?

A

Ehrlichiosis
*Low WBC + platelets + elevated LFTs

Tx: doxycycline

145
Q

What is most likely cause of CHILD with pneumonia who has CF?

A

S. aureus –> use IV vancomycin

146
Q

JC virus - when do you see it and what are s/s?

A

Immunocompromised patients

S/S:
Hemiparesis
Disturbances in speech, vision, gait

*Lesions in cortical white matter

Immunocompromised patient with focal neuro deficits = PML –> get MRI

147
Q

What live vaccines are ALLOWED to be given in HIV? What is the condition?

A

MMR + varicella –> ONLY if CD4 > 200

148
Q

How long after splenectomy should these patients receive vaccines? Which ones?

A

14 days after splenectomy

*PCV 13, meningococcal, HiB

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