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2CK Smartbook > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

a healthy individual must have a PPD over what size limit to be considered positive

A

greater than or equal to 15mm

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2
Q

which patients are considered to have a positive PPD when it is greater than or equal to 5mm

A

HIV, immunocompromised, known recent TB exposure/contact

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3
Q

which patients are considered to have positive PPD when it is greater than or equal to 10mm

A

living in high risk areas (

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4
Q

major contraindications to rotavirus vaccine

A

SCID, history of intussisception, congenital malformations of GI tract (Meckel’s), anaphylaxis to vaccine contents

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5
Q

how do you treat a pregnant woman for lyme disease

A

oral amoxicillin (doxycycline contraindicated due to teratogenicity, skeletal abnormalities and teeth discoloration)

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6
Q

treatment of cellulitis with systemic signs?

A

nafcillin or cefazolin

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7
Q

multiple ring enhancing lesions with edema seen in the brain of a patient with HIV is ___________
what is the treatment?

A

toxoplasmosis; treat with sulfadiazine-pyrimethamine

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8
Q

what are the main symptoms of infection with Bordatella pertusis, how is diagnosis confirmed and what is the treatment

A

starts with cough and rhinorrhea, eventually becomes “100 day cough” with coughing fits and posttussive emesis, inspiratory whoop, can cause apnea in infants, subconjunctival hemorrhages; confirm with culture or PCR; treat with macrolides

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9
Q

when a rapid-onset gastroenteritis follows ingestion of meat or mayonnaise-containing foods (potato salad, tuna salad) what organism should you suspect

A

staph aureus (preformed toxin causes rapid onset)

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10
Q

treatment of choice for uncomplicated Lyme disease in age > 8 years vs. age

A

oral amoxicillin or cefuroxime for age 8 years

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11
Q

what is the classic triad of congenital rubella

A

leukocoria (white pupillary reflex from cataracts), patent ductus arteriosus, sensorineural deafness

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12
Q

name two common organisms that cause pneumonia in cystic fibrosis patients and which is more common in children vs. adults

A

staph aureus (more common in children) and pseudomonas (more common adults)

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13
Q

what fungal disease do cystic fibrosis patients get

A

aspergillus

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14
Q

what is the classic triad of congenital toxoplasmosis

A

chorioretinitis, hydrocephalus, intracranial calcifications (can also cause microcephaly, hepatosplenomegaly and thrombocytopenia)

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15
Q

which childhood infection commonly causes leukopenia

A

measles (rubeola) causes leukopenia via a T-cell cytopenia

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16
Q

what vitamin is beneficial for reducing morbidity and mortality in measles

A

vitamin A decreases morbidity and mortality in measles via immune enhancement and GI/respiratory epithelium regeneration

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17
Q

ring-enhancing lesions in an HIV patient should make you think these two things…

A

toxoplasmosis and CNS lymphoma

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18
Q

what is the prophylaxis for toxoplasma and when would you administer it

A

prophylactic bactrim is given to HIV patients with AIDS who have positive antibodies to toxo because reactivation is common

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19
Q

should you vaccinate an HCV infected pregnant woman against HBV and HAV?

A

Yes. The inactivated vaccines against HBV and HAV are safe in pregnancy

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20
Q

how can you differentiate between fungal (Candida) and viral (CMV, HSV) esophagitis based on presentation?

A

Candida esophagitis usually involves thrush and has mild to no odynophagia
Viral esophagitis usually involves severe odynophagia and does not have thrush

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21
Q

what does kaposi’s sarcoma look like

A

pink, red, brown or purple plaques or globular growths with high vascularity

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22
Q

what two organisms cause painful genital ulcers and how can you differentiate them on physical exam

A

HSV and H. ducreyi (chancroid): HSV ulcers have a shallow, erythematous base, chancroid tends to have a friable, exudative base

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23
Q

what three organisms cause painless genital ulcers

A

chlamydia, primary syphilis, klebsiella granlumatis (granuloma inguinale)

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24
Q

what hematologic complications are associated with EBV infectious mononucleosis

A
  • cold autoimmune hemolytic anemia (due to cross-reactivity with red blood cells and platelets leading to complement-mediated RBC and platelet destruction)
  • Burkitt/Hodgkin’s lymphoma
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25
Q

a patient infected with a hydatid cyst in the liver or lung (round, fluid filled cyst with daughter cysts) was probably infected by what organism and how

A

Echinococcus granulosus

via sheep or dog exposure

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26
Q

infectious endocarditis in a patient with recent UTI is likely due to what organism

A

Enterococci

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27
Q

how does one contract Q fever (Coxiella burnetti)

A

inhaled aerosols from livestock or unpasturized milk

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28
Q

a patient with sudden, continuous writhing and jerked movements in addition to pericarditis and nodules on hands should make you think of what condition and what organism

A

acute rhematic fever (JONES: joint pain, carditis, nodules, erythema marginatum, sydenham’s chorea)

caused by strep pyogenes

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29
Q

what is the most common infectious cause of bloody diarrhea in an afebrile patient

A

enterohemorrhagic E. coli

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30
Q

how should enterohemorrhagic E. coli be treated

A

supportive; NO abx because they aren’t helpful and can increase the risk of HUS

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31
Q

what is the best way to test for histoplasmosis

A

urine or serum antigen (fastest and very sensitive and specific)

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32
Q

what is the treatment for disseminated histoplasmosis if severe vs. not severe

A

severe: amphotericin B for 2 weeks, then itraconazole
non-severe: itraconazole
(NOT fluconazole due to poor coverage)

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33
Q

pulmonary infiltrates showing partially acid-fast, gram positive filamentous branching rods is likely what organism?
how is it treated?

A

Nocardia

treat with bactrim

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34
Q

how are actinomyces and nocardia similar and different

A

both are filamentous gram positive rods

Actinomyces is anaerobic, not acid-fast and contains sulfur granules

Nocardia is aerobic, partially acid-fast

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35
Q

how is pertussis infection confirmed

A

pertussis culture or PCR

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36
Q

what is the treatment for cervicofacial actinomycosis

A

penicillin (use clinda if allergic)

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37
Q

what is the treatment for pinworm (enterobius vermicularis)

A

albendazole or pyrantel pamoate

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38
Q

how can you differentiate between measles and rubella (german measles)

A

measles tends to have a high-grade fever and Koplik spots

rubella has a low-grade fever and lymphadenopathy and Forschheimer spots

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39
Q

what should a patient do if he/she finds a tick attached to the skin

A

remove ASAP via tweezers grasped as close to skin as possible and with upward pressure applied

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40
Q

what four things allow you to distinguish orbital cellulitis from preseptal cellulitis?

A
  1. opthalmoplegia (eye pain)
  2. pain with extraocular muscle movements
  3. vision impairment
  4. proptosis (protrusion of eyeball)
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41
Q

renal dysfunction, thrombocytopenia and anemia after a diarrheal illness is likely what (and what organism is implicated)

A

Hemolytic uremic syndrome

enterohemorrhagic E. coli, O157:H7

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42
Q

what criteria should you use to determine whether to perform a rapid strep test

A

2 or more Centor criteria

  1. tonsillar exudates
  2. fever
  3. tender cervical adenopathy
  4. absence of cough
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43
Q

what are the most common causes of acute bacterial rhinosinusitis and what is the treatment of choice

A

Step pneumo and nontypable H. influenzae (Moraxella catarrhalis less commonly)
treat with amoxicillin-clavulanate (due to beta-lactamase resistance)

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44
Q

what are 3 ways to clinically diagnose acute bacterial rhinosinusitis

A
  1. 10 or more days of persistent symptoms without improvement
  2. severe symptoms (high fever, purulent nasal discharge, facial tenderness)
  3. onset of symptoms 5 or more days after an improving URI
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45
Q

what are the three main drugs you can use to treat HBV

A
  1. interferon alpha (not for decompensated cirrhotics)
  2. entecavir
  3. tenofovir
    (lamivudine is less favored now due to resistance)
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46
Q

how can you tell the difference between CMV esophagitis and HSV esophagitis on endoscopy

A

CMV esophagitis produces linear ulcers

HSV esophagitis produces round ulcers and vesicles

47
Q

what antibiotics are used to treat septic arthritis (after joint aspiration and cultures return of course)

A

3 months: nafcillin, vanc, cefazolin, clindamycin

48
Q

what is the treatment of PCP?

what should you add if the disease is severe (PaO2 35)?

A

bactrim

add steroids if severe to reduce inflammation

49
Q

which species of strep most commonly causes infective endocarditis in patients with prosthetic valves or catheters, etc.

A

Strep epidermidis

50
Q

what are the characteristic symptoms of croup and what organism causes croup

A

barky cough, whistling sound on inspiration

parainfluenza causes croup

51
Q

what antibiotics are given for acute bacterial meningitis for:

  • ages 2-50
  • ages > 50
  • immunocompromised
  • skull injury/surgery
A

-ages 2-50: vancomycin (pneumococcus) + 3rd gen cephalosporin (meningococcus)
-ages > 50: vanc + 3rd gen cephalosporin + add ampicillin for Listeria
-immunocompromised: vanc + cefepime + ampicillin
-skull injury: vanc + cefepime
note steroids should be started in adults and continued if cx comes back as pneumococcus

52
Q

eggshell calcifications of a liver cyst suggest what organism and what potential sources

A

Echinoccocus granulosus; contracted from dogs or sheep

53
Q

what is the treatment for cat scratch disease

A

5 days of azithromycin to clear Bartonella henselae

54
Q

which antibiotic should you use for pneumonia occurring after an endoscopic procedure

A

clindamycin (for suspected anaerobes in aspiration pneumonia)

55
Q

how do you differentiate between gonococcal and chlamydial conjunctivitis and how are each treated

A

gonococcal: profuse mucopurulent discharge, marked eyelid swelling and corneal ulceration; ppx with topical erythromycin and treat with IV ceftriaxone or cefoxatime
chlamydial: scant watery, bloody or mucopurulent discharge, chemosis; treat with oral erythromycin

56
Q

what organisms cause acute epididymitis

  • in young men?
  • in older men?
A
  • young men: STDs (gonorrhea and chlamydia)

- older men: E.coli (most common), Pseudomonas (less common)

57
Q

a flu-like illness, neurologic changes, thrombocytopenia, leukopenia, transaminitis and elevated LDH after a tick bite should make you think what organism?
how should you treat?

A

Erhlichiosis (lone star tick in Southern US)

treat with doxycycline

58
Q

what antibiotics are good against Pseudomonas

A

pip/tazo, cefepime (4th gen), gentamicin, tobramycin, amikacin, imipenem/cilastin, aztreonam, ciprofloxacin

59
Q

what are the characteristic symptoms of histoplasma capsulatum (and where is it endemic to)

A
  1. pulmonary granulomas (mimics sarcoidosis)
  2. mediastinal/hilar lymphadenopathy
  3. arthralgias
  4. erythema nodosum
    Histoplasma capsulatum is endemic to Ohio/Mississippi river basins
60
Q

how is histoplasma diagnosed

A

fungal stain/culture and urine antigen

61
Q

what parts of the world have endemic chloroquine-resistant P. falciparum and what are the recommended prophylactic antimalarials?

A

southern and southeast Asia, sub-saharan Africa, Amazon

ppx: mefloquine (best in pregnancy), atovaquone-proguanil, doxycycline

62
Q

what areas have more endemic P. ovale and vivax rather than falciparum?
what antimalarials can you use for ppx?

A

Korean peninsula, Mexico, parts of South America

ppx: primaquine

63
Q

state the algorithm for working up suspected vertebral osteomyelitis

A

patient has fever, back pain and FOCAL spinal tenderness –> blood cx, ESR/CRP, plain x-ray
–> if ESR/CRP is elevated, but x-ray neg then get MRI –> CT-guided needle biopsy

64
Q

what are the symptoms of acute HIV infection

A

mono-like syndrome (LAD, fever, night sweats, sore throat, arthralgias); generalized macular rash; GI symptoms (diarrhea, abdominal pain)

65
Q

what is the appropriate prophylaxis for household members of a pertussis infected person

A

macrolid ppx for all household contacts (regardless of vaccination status) as pertussis is highly contagious (note, only azithromycin for infants

66
Q

a unilateral cervical lymphadenitis (swelling, erythema and warmth of the node) is most likely caused by what organism

A

staph aureus is the most common cause of cervical lymphadenitis

67
Q

vulvar pruritus in a young child which is experienced mostly at night is suspicious for what organism

A

pinworm (enterobius vermicularis) can occur as anal pruritus or vulvovaginitis

68
Q

what can be used to distinguish EBV mononucleosis from Group A strep pharyngitis

A

EBV has diffuse cervical lymphadenopathy while GAS has anterior cervical chain LAD
if a patient is treated with amoxicillin, and soon after develops a maculopapular rash then the infection is likely EBV instead

69
Q

why shouldn’t ASO antistreptolysin antibodies be tested in acute pharyngitis

A

ASO titers peak ~1 month after streptococcal infection so they aren’t useful in acute pharyngitis

70
Q

meningococcus vaccine and booster is especially important to what populations

A

soldier’s living quarters, travel to sub-Saharan desert

71
Q

when should meningicoccus vaccine be given (initial dose, booster and special considerations)

A 
all children 11-12, or 13-18 if missed
give booster for ages 16-21
optional for ages 19-21
give to high risk adults >21
high risk= military, college, sub-saharan Africa
72
Q

what are the symptoms of a necrotizing surgical infection and how do you treat it

A

sx: intense pain, edema or erythema beyond/around the site; parasthesia or anesthesia at the wound edges; cloudy grey drainage (“dishwater drainage”); fever, hypotension or tachycardia; subcutaneous gas or crepitus
Tx: parenteral abx and surgical exploration for debridement

73
Q

what are the sx; dx method and tx of babesiosis

A

sx: fever, hemolytic anemia (jaundice, hemoglobinuria, renal failure) after tick bite in northeastern US
dx with Giemsa thin and thick blood smear
tx: atovaquone-azithromycin or quinine-clindamycin

74
Q

a patient on isoniazid develops mild elevations in AST and ALT (

A

nothing! observe and continue to monitor LFT’s; isoniazid can cause a mild subclinical hepatic injury in young, healthy pts. that is self-limited

75
Q

presentation of epiglotitis?

A

abrupt onset fever, sore throat, dysphagia, drooling, relief with hyperextension of the neck, eventually dyspnea, sometimes stridor

76
Q

pumonary nodules with halo sign or air crescent is likely

A

invasive aspergillosis

77
Q

A child with meningitis suddenly develops hypotension and dies. What is the likely cause of death and its pathophysiology?

A

Waterhouse-Friederichsen syndrome is associated with meningococcal meningitis; it is caused by adrenal gland hemorrhage

78
Q

what is the difference between symptoms and treatment of echinoccocus and entamoeba

A

both cause liver cysts: echinococcus generally has no fever and is commonly asymptomatic, while entamoeba causes dysuntery and fever
Tx for echinococcus=bendazole and aspiration
Tx for entamoeba=oral metronidazole (usually no drainage needed)

79
Q

maculopapular rash involving the palms and soles along with generalized lymphadenopathy should make you think of what condition

A

secondary syphilis

80
Q

a post-bone marrow transplant patient with lung infiltrates and diarrhea should make you think of what organism

A

CMV pneumonitis and colitis

81
Q

what is erythema multiform and what causes it

A

multiple small target-shaped lesions all over the body that can become confluent; caused by drug reaction, mycoplasma or herpes

82
Q

what is the presentation of chikunguya

A

fever, malaise, lymphadenopathy, symmetric polyarthralgias, thrombocytopenia and leukocytopenia in a patient who was recently in the Caribbean

83
Q

which HIV patients should not receive live vaccines

A

patients with AIDS (CD4

84
Q

what is erysipelas? what is the associated organism?

A

a type of cellulitis involving the superficial dermis (vs. deep dermis of cellulitis) characterized by sharp demarcation and prominent swelling of the erythematous area; commonly caused by Group A Strep

85
Q

how do you treat bullous vs. non-bullous impetigo

A

bullous: oral cephalexin, dicloxacillin or clindamycin

non-bullous: topical mupirocin

86
Q

what three situations predispose to toxic shock syndrome

A

nasal packing, tampon use, and surgical packing

87
Q

what are some characteristic features of dengue fever

A

fever, myalgia, arthralgia, headaches, retro-orbital pain, leukopenia

88
Q

how should you address a minor cat bite

A

treat with prophylactic amox/clavulanate for 5 days (cat bites are usually deep, despite cleanliness and Pasturella is a feared complication)

89
Q

crystal induced nephropathy is a complication of which antiretroviral

A

indinavir (a protease inhibitor)

Think “Crystals from India”

90
Q

which antiretrovirals are known to cause lactic acidosis

A

NRTI’s

91
Q

which antiretrovirals are known to cause Steven-Johnson Syndrome

A

N-NRTI’s

92
Q

which antiretroviral is associated with liver failure

A

nevirapine

93
Q

swelling, tenderness and crepitus in the submandibular and sublingual spaces is what condition and how is it acquired

A

Ludwig angina: cellulitis of the submandibular and sublingual glands; acquired from tooth (molar) infection that spreads to submandibular and sublingual spaces; usually strep or oral anaerobes

94
Q

what is the treatment for acute unilateral cervical adenitits

A

clindamycin (covers the most common causes=strep and staph aureus)

95
Q

what is the side effect of giving an infant oral erythromycin

A

pyloric stenosis

96
Q

a neonate with a staccato cough likely has what infection and what is the treatment

A

chlamydial pneumonia; treat with oral erythromycin

97
Q

most common cause of viral meningitis

A

enteroviruses like echovirus and coxsackie

98
Q

what are the symptoms and treatment of nocardiosis

A

pulmonary nodules and symptoms resembling TB, CNS involvement, skin rash
Tx=bactrim (+ a penem or linezolid if severe)

99
Q

bilateral parotid enlargement and fever/malaise in an unvaccinated child should make you think of what disease and what other organ is commonly affected

A

mumps parotitis

also affects the testes: mumps orchitits
can also cause aseptic meningitis and encephalitis

100
Q

what is the treatment for latent TB (positive PPD with negative CXR and no sx)

A

INH + pyridoxine for 9 months (alternative = INH for 6 months or rifampin for 4 months)

101
Q

what is the treatment of choice for a human bite

A

amoxicillin-clavulanate

102
Q

a patient being treated for syphilis suddenly develops worsening of symptoms; what is the reason?

A

Jarish-Herxheimer reaction: rapid death of spirochetes leads to release of antibody-antigen complexes and massive immunologic reaction

103
Q

fever, cough, diarrhea, night sweats, hepatosplenomegaly and alkaline phosphatase elevation in an HIV patient with CD4

A

disseminated Mycobacterium avium complex

104
Q

when a patient who is sick with a respiratory infection suddenly develops subcutaneous crepitus what test must you order right away

A

and emergent CXR for possible pneumothorax

105
Q

what are the neurologic complications of AIDS (mnemonic and causative organisms)?

A

DREAM=dementia (HIV), retinitis (CMV), encephalopathy (PML from JC virus), abscess (toxoplasma), meningitis (cryptococcus)

106
Q

increased intracranial pressure (papilledema) is characteristic of what AIDS-associated infection

A

cryptococcus neoformans meningitis (cryptococci occlude CSF flow leading to increased intracranial pressure)

107
Q

in a patient with croup whose respiratory status is deteriorating what should your first intervention be? then after that fails?

A

racemic epinephrine;

if epi fails then intubate (note: starting racemic epinephrine can decrease rates of intubation)

108
Q

a diabetic develops necrotizing infection of the nasal turbinates and periorbital space with chemosis and proptosis; what is the organism and treatment

A

mucormycosis due to rhizopus

Tx: surgical debridement and amphotericin B

109
Q

pneumonia in diabetics and alcoholic and with current jelly sputum is likely what organism

A

klebsiella pneumoniae

110
Q

LUQ pain, leukocytosis, splenomegaly and splenic fluid collection suggests what condition and how is it acquired

A

splenic abscess; can be caused by left-sided infective endocarditis (septic emboli to spleen), immunosuppression, IVDU, trauma, hemoglobinopathies

111
Q

explain post-exposure prophylaxis for chicken pox

A

immunocompetent, unvaccinated: VZ vaccine
immunosuppressed, unvaccinated: VZ immunoglobulin
vaccinated: observation

112
Q

in an HIV patient what is the difference in terms of presentation between PJP pneumonia and pneumococcus pneumonia (most common cause of pneumonia in HIV patients)

A

PJP pneumonia presents as dry cough and dyspnea with diffuse bilateral infiltrates on CXR; pneumococcus presents with high fever, productive cough, pleural effusion and unilateral consolidated infiltrate on CXR

113
Q

erysipelas is most commonly caused by what organism

A

Group A strep

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