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step 2 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Active Hep B infection

A
  1. Start with surface antigen
  2. Then IgM CORE antibody becomes positive (actual infection)
  3. e-antigen POSITIVE–>indicates active viral REPLICATION (this is what determines vertical transmission to baby)

Chronic when surface ANTIGEN positive greater than 6 mo

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2
Q

Resolved past Hep B infection

A
  • IgG CORE antibody positive (actual infection)
  • Surface antiBODY positive (past infection
  • e-antigen negative (viral replication no longer active)
  • surface antiGEN negative–NO longer infectious
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3
Q

Hep B vaccination

A

-surface antiBODY positive

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4
Q

Treatment of n. gonorrhea

A

Cefixime/ceftriaxone PLUS azithromycin or doxycycline (also cover chlamydia)

same for urethritis, cervicitis (strawberry cervix), and PID

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5
Q

Treatment of chlamydia

A

azithromycin or doxycycline

same for urethritis, cervicitis, and PID

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6
Q

Primary syphilis

A

painLESS genital ulcer
painLESS lymphadenopathy
Tx: IM penicillin

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7
Q

Secondary syphilis

A

rash on PALMS and SOLES
alopecia areata
condylomata lata

Tx: IM penicillin

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8
Q

Tertiary syphilis

A

neurosyphilis-meningovascular stroke from vasculitis
tabes dorsalis (loss of position and vibratory sense, incontinence)
Argyll robertson pupil (loss of light rxn, but accomodates)
Aortitis
Gummas

Tx: IV penicillin
risk: Jarisch Herschheimer-fever/worse symptoms after tx-give apsipirn/antipyretic-it will pass

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9
Q

Treatment of crabs (pediculosis) or scabies

A

permethrin

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10
Q

Pregnant woman UTI or asymptomatic bacteriuria

A

Nitrofurantoin or amoxicillin (3 days if uncomplicated)

NOOOOOO!!!!! to bactrim and fluoroquinolones (cipro)

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11
Q

Strep bovis

A

endocarditis in person with colon cancer

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12
Q

Endocarditis

A

either abnormal valves (regurg/stenosis/prosthetic) OR injecting drug use (STAPH aureus)

fever + murmur or change in murmur and/or positive blood cultures

splinter hemorrhages, Janeway lesions (flat, painless), Osler nodes( raised, painful), mycotic aneurysms in brain, conjunctival petechiae, splenomegaly, septic emboli to lungs

best dx: blood culture, TEE more sensitive but also TTE

best empiric therapy: vancomycin + gentamicin
SURGERY only: valve rupture, chordae tendonae rupture, CHF, prosthetic

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13
Q

Culture negative endocarditis

A

most common-coxiella and bartonella
HACEK- Haemophilus aphrophilus, Haemophilus parainfluenzae, Actinobacillus, Cardiobacterium, Eikenella, Kingella

  • oscillating vegetation on Echo
  • prosthetic valve or injection drug use
  • evidence of emboli

Tx: ceftriaxone

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14
Q

Prophylaxis with endocarditis

A

required if:
1- significant cardiac defect (prosthetic valve, unrepaired cyanotic lesion, transplant, previous endocarditis)
AND
2-Risk for bacteremia (dental work with BLOOD, resp tract surgery)

NOT for endoscopies, ob/gyn, prostate biopsy
NOT for mitral valve prolapse, mitral regurg, mitral stenosis, aortic stenosis, ASD

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15
Q

Lyme

A 
Borrelia burgdorfi 
carried by Ixodes scapularis tick
target lesion (erythema migrans), fever, oligoarthritis (esp knee), Bell palsy (7th CN), myocarditis, ventricular arrhythmia,

Dx: if rash consistent-no test, serolgy for other manifestations

Tx: doxycycline unless cardiac or more severe neuro–> ceftriaxone

Prophylaxis-single dose doxycycline ONLY when:

  • endemic area
  • tick attached for 24-48 hours
  • definitely ixodes scapularis

Otherwise NO tx for asymptomatic tick

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16
Q

HIV- important CD4 levels

A

normal- 600-1000
start treatment: 200: TB HSV, varicella, Kaposi sarcoma
200-PCP
opportunistic infections-mostly at

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17
Q

Best initial HIV treatment

A

emtricitatbine, tenofovir, efavirenz

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18
Q

HIV transmission risk

A

anal>needle stick>oral>vaginal

25-30% maternal child without treatment

19
Q

Prevention of Perinatal transmission

A

either continue existing treatment or start treatment (not teratogenic efavirenz)

mom may stop treatment following delivery if CD4 count high and viral load low

baby given intrapartum zidovudine and for 6 weeks following delivery

delivery: can do vaginal but MUST be C-section if
- CD4 below 350
- very high viral load (>1,000)

20
Q

Disease prevention in HIV

A

New dx–> PPD with threshold of 5mm and chest x-ray if positive, if negative CXR–>latent–>INH 9 months
PCP prophylaxis with bactrim when

21
Q

Meningitis-Bacterial Treatment

A

Treatment based on CELL COUNT
Thousand of neutrophils-start with ceftriaxone, vancomycin and steroids
add ampicillin for listeria if elderly/immunocompromised/pregnant etc

22
Q

Meningitis-Viral treatment

A

suspect when lesions in temporal lobe, olfactory hallucinations, seizures
CELL COUNT–high lymphocytes in CSF
–>IV acyclovir

23
Q

Rocky Mountain Spotted Fever

A

Rickettsia rickettsiae

fever, maculopapular rash on hands and feet, myalgias, headache, nausea

transmitted by dermacanter ticks-in US mostly south central and southeastern states

24
Q

Most common overall cause meningitis (18-60 and 60+)

A

strep pneumo

other: n. meningitidis, listeria
gram - rods in elderly over 60

25
Q

Most common cause meningitis in adolescents/young adults (2-18)

A

N. meningitides

other: s. pneumo, listeria

26
Q

Most common cause meningitis newborn to 3 mo

A

Group B strep

other: e. coli, listeria, H influenza

27
Q

Most common cause meningitis 1 mo-2 yr

A

strep pneumo and n. meningitidis

other: group B strep, Listeria, H. influenza

28
Q

Community acquired pneumonia with comorbidity

A

fluoroquinolone alone (such as moxifloxacin) or beta lactam plus azithromycin

klebsiella suspected–>fluoroquinolone and cefuroxime cover

ex. alcoholic with pneumonia– azithromycin + cefuroxime

29
Q

Onchomycosis treatment of toenails

A

oral terbinafine best

30
Q

Shingles

A

Herpes zoster
treat within 72 hours of rash with antiviral-acyclovir, famciclovir
Plus if pain very pain- neuropathic pain like TCA desripramine or gabapentin

31
Q

Oral candidiasis treatment

A

clotrimazole or nystatin swishes

test for underlying condition-HIV, DM, etc.

32
Q

Otitis externa organisms

A

pus out of ear
common in swimmers , divers, and immunocompromised

most common-pseudomonas and staph

33
Q

Numerous calcificed lesions on CT

A

headache plus lesions on CT-taenia solium= neurocysticercosis
tx: albendazole

34
Q

TB dx and treatment

A

PPD for screening:

Diagnosis:

35
Q

Red-orange urine, sweat, tears on TB treatment

A

rifampin

36
Q

First gen cephalosporins

A

cefazolin, cephalexin, cephradine, cefadroxyl

37
Q

Second gen cephalosporins

A

cefotetan, cefoxitin, cefaclor, cefprozil, cefuroxime

38
Q

Third gen cephalosporins

A

ceftriaxone, cefotaxime, ceftazidime

39
Q

Fourth gen cephalosporins

A

cefepime

40
Q

Fifth gen cephalosporins

A

ceftaroline-MRSA coverage

41
Q

Histoplasmosis

A

esp in HIV patients

test for URINE ANTIGEN
treat with itraconazole if moderate
if severe-IV amphotericin B followed by itraconazole

42
Q

Tinea corporis

A

treat with terbinafine

43
Q

Septic arthritis in children

A

often staph/strep following respiratory infection
first step-labs etc
second-arthrocentesis
MRI to check for osteo only if persistent in spite of empiric antibiotic treatment

44
Q

Cervical lymphadenitis

A

fever, swollen node in neck (isolated)
often in children due to staph/strep
treat with clindamycin

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