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Infectious disease Flashcards

1
Q

Define mild asthma:

A

speak sentences, wheezing only on exhalation, POx >95%, PEFR >70%

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2
Q

Define moderate asthma:

A

speak phrases, wheezing on exhalation and inhalation, POx 90-95%, PEFR 40-69%

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3
Q

Define severe asthma:

A

speak only words, wheezing on exhalation/inhalation or quiet, POx <90%, PEFR <40%

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4
Q

Indication for starting controller

A

2+ exacerbations in 6mo requiring oral CS

>4 episodes of wheezing/year that last at least 1 day, interfered with sleep, has positive asthma predictive index

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5
Q

What are signs of atopic disease (positive asthma predictive index?

A

1 major - parenteral asthma, atopic dermatitis

2 minor - allergen sensitization, eosinophilia >4%, wheeze without URI

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6
Q

Describe criteria for intermittent asthma

A

symptoms or use of SABA <2days/wk, nightime awakenings <2x/month in 5-11yr, no interference with activity, baseline FEV1 >80%, steroids 1x/year for exacerbation

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7
Q

Rx for intermittent asthma

A

SABA

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8
Q

Rx for mild persistent

A

Add low dose ICS or LTRA for 0-4

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9
Q

Rx for moderate persistent

A

0-4y medium dose ICS

Older pt low-dose ICS and LABA or stay on low dose ICS+LTRA

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10
Q

Escalation of therapy for moderate persistent

A

Medium dose ICS + LABA or LTRA

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11
Q

Rx for severe persistent

A

High dose ICS + LABA/LTRA

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12
Q

Escalation for severe persistent

A

HD ICS + LABA/LTRA and oral CS

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13
Q

What are indications for oral steroid use?

A

Does not respond to initial albuterol, mod to severe exacerbation, hx of recent oral steroid use, optimal albuterol therapy at home, hx of life-threatening episode, anti-inflammatory 2-4hr, improve SABA in 1-2hr

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14
Q

When do you have to taper steroid use?

A

if >10 days of usage

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15
Q

What are indications of well-controlled asthma?

A 
symptoms/SABA usage <2/week
oral CS use <1/year
night waking <1/mo
FEV1 or PEFR normal
activity normal
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16
Q

Indication for long-acting B2-agonists

A

Poor control on low to moderate doses of ICS, control of nocturnal symptoms, exercise-induced asthma

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17
Q

Can you develop antibody to LABA

A

yes

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18
Q

What are SE of Mg sulfate

A

flushing, malaise, hypotension and bradycardia

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19
Q

What is atrovent, SE, and function

A

ipratropim, smooth muscle relaxant, can cause pupillary dilation

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20
Q

First choice Rx for allergic rhinitis in young kids

A

oral antihistamine

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21
Q

First choice Rx for allergic rhinitis in older kids

A

intranasal CS

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22
Q

Define anaphylaxis precisely

A

acute skin + respiratory/decreased BP
2 or more (skin/mucous membranes, respiratory, cardiac GI)
Decreased BP exposed to known allergen

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23
Q

Pattern: IUGR, sepsis, sensorineural, periventricular calcification, pneumonitis, hepato-splenomegaly, thrombocytopenia, dental defects

A

CMV

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24
Q

Pattern: rash, IUGR, senosrineural hearing loss, cataracts/microphthalmia, PDA, pulm stenosis, myocarditis, T cell dysfunction

A

Rubella

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25
Q

Which viral infection is less likely transmitted in 3rd trimester?

A

rubella

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26
Q

Which virus is more often periparum transmitted

A

HepB

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27
Q

When is highest infectivity for varicella?

A

if mom ets it 5 dys before delivery to unwith 48hrs after delivery

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28
Q

Pattern: encephalitis, low birth weight, paralysis with muscular atrophy limb, increased susceptibility to infection, rudimentary digits, chorioretinitis, microophthalmia, cataracts, clubfoot

A

varicella

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29
Q

Pattern: high fever, cough, coryza, conjunctivitis, Koplik spots 2 days after onset, rash last 7 days, appears 4 days, brawny-coppery appearance

A

measles

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30
Q

Pattern: parotitis with pain and fever, epididymo-orchitis, encephalities in males, deafness

A

Mumps

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31
Q

Complications of measles

A

reactivation of TB, bacterial PNA, severe otitis media, appendicitis, laryngotracheitis, stomatitis, fatal neuro subacute sclerosing panencephalitis

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32
Q

Pattern: generalized rash, HA, lympadenopathy, fever, polyarthralgia, and polyarthritis, encephalitis

A

rubella

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33
Q

Pattern: rash, papules, centrally and peripherally, high vaccine failure, can have associated superinfection of staph A or group A strep

A

Varicella

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34
Q

Pattern: mild 7-10 days of symptoms before rash appears

A

Erythema infectiosum - Parvo19

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35
Q

Rx for Parvo19 chronic

A

IVIg for chronic

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36
Q

Complications of Parvo19

A

polyarthropathy, transient aplastic crisis, myocarditis, acute fulminant hepatitis

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37
Q

Pattern: high fever, rapid deferevescence –> papular rash, high seizure risk because of fever curve

A

HHV-6

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38
Q

Pattern: fever, exudative pharyngitis, lymphadenopathy, hepatosplenomegaly

A

EBV

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39
Q

Rash appear with ampicillin or penicllin exposure

A

EBV (can see with CMV)

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40
Q

Traveler’s diarrhea

A

Ecoli enterotoxigenic

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41
Q

Rice water diarrhea

A

vibrio

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42
Q

shellfish, and salad in winter

A

rotavirus

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43
Q

Summer, water in wilderness, foreign travel, day care centers, flatulence, foul-smelling stools, prolonged infection with soft stools, weight loss

A

giardia

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44
Q

Prolonged 1-2 weeks of diarrhea or longer

A

cryptosporidium

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45
Q

Crampy, watery diarrhea toxin producing in mexican food, meat, poultry

A

C. perfringens

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46
Q

Voluminous diarrhea

A

vibrio

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47
Q

Fever/pulse dissociation

A

typhoid fever

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48
Q

Petting zoo, farm animals

A

shiga-toxin producing, STEC, cryptosporidium

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49
Q

Swimming

A

shiga-toxin, cryptosporidium

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50
Q

Petting zoo, farm animals

A

shiga-toxin, cryptosporidium

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51
Q

Animals

A

cryptosporidium, campylobacter, yersinia, nontyphoid salmonella

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52
Q

Chicken

A

nontyphoid salmonella, campylobacter, c. perfringens

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53
Q

Hamburger

A

STEC +/- HUS

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54
Q

Pork

A

Yersinia

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55
Q

Shellfish/salad

A

Norovirus

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56
Q

Raw fruits/vegetables

A

STEC, nontyphoid

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57
Q

Unpasteurized milk

A

campylobacter, nontyphoid

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58
Q

Picnic, banquet

A

S aureus, b. cereus, clostridium perfringens

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59
Q

Travel

A

Enterotoxigenic, S. typhi, shigella, vibrio cholera, giardia, cryptosporidium, entamoeba histolytica

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60
Q

fall-winter

A

rota, noro

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61
Q

summer

A

giardia, crypto, STEC

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62
Q

Hemoglobinopathy

A

nontyphoid salmons

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63
Q

Iron overload

A

yersinia

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64
Q

HIV infection

A

cyrptosporidium, nontyphoid salmonella

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65
Q

Day-care center

A

Rota, crypto, giardia, campylobacter, STEC

66
Q

Pattern: gradual onset, fever, HA, malaise, abdominal pain, HSM, rose spots, fever/pulse dissociation

A

salmonella typhi

67
Q

Pattern: 7-10 days incubation

A

salmonella typhi

68
Q

Pattern: from eggs, chicken, red meat, reptiles, unpasteurized milk, ice cream, raw fruits, vegetables

A

non-typhoid salmonella

69
Q

Which bacterial infection has complication of bacteremia, osteomyeltis, meningitis, abscesses in infants, sickle-cell, asplenia, HIV-infected

A

non-typhoid salmonella

70
Q

Pattern: from farm animals, day care centers, intestinal cramping

A

campylobacter

71
Q

Pattern: mesenteric adenitis, pseudoappendicitis, arthritis, excessive iron storage, bactermia, meningist, osteomyelitis

A

yersinia

72
Q

Pattern: hematochezia, severe abdominal pain that mimics intussception, fever, blood diarrhea

A

stec

73
Q

Pattern: gradual onset, abdominal cramps, diarrhea, blood and mucus, tenesmus (mimic IBD) lower quad pain, liver abscess, brain abscess

A

entabmoeba histolytic

74
Q

Pattern: bacteremia, osteomyelitis, meningitis

A

non-typhoid, yersinia

75
Q

Pattern: arthritis

A

yersinia

76
Q

liver abscess

A

ent histolytica

77
Q

prominent cramping

A

campylobactor, clostridium perfringens

78
Q

pseudoappendicitis

A

yersinia

79
Q

IBD like presentation

A

entabmoeba histolyica

80
Q

bacterial culture

A

salmonella, shigella, campylobacter

81
Q

Toxin detection

A

STEC, C. difficile

82
Q

Antigen detection

A

rotavirus, campylobacter, c. difficile

83
Q

PCR

A

norovirus, c. difficile

84
Q

Rx E.coli

A

azith, ceftriaxone, cipro

85
Q

Rx vibrio cholera

A

azith, doxycycline

86
Q

Rx giardia

A

metronidazole, mitazoxanide, tinidazole

87
Q

Rx crytosporidium

A

nitazoxanide

88
Q

Rx shigella

A

azithro, ceftriaxone, cipro,

89
Q

Rx salmonella typhi

A

ceftriaxone, azithro, quinolone

90
Q

Rx non-typhoid salmonlla

A

Rx is not indicated if uncomplicated

91
Q

Antibiotics may prolong carrier state

A

non-typhoid salmonella

92
Q

Rx campylobacter

A

azithro

93
Q

Rx ent histolytica

A

metronidazole

94
Q

rose spots

A

typhoid fever or enteric

95
Q

petechiae/purpura

A

meningococcal disease

96
Q

ecthymus grangrenosum

A

pseudomonas in immunocompromised pt

97
Q

pustule and skin abscess

A

s aureus

98
Q

macular –> petechiae –> necrosis

A

RMSF

99
Q

With which maternal infection would you need to stop breastfeeding period?

A

HIV, brucellosis, HTLV-1, 2, HepC

100
Q

With which maternal infection can you breastfeed, but most pump

A

Varicella, CMV, untreated TB, active HSV lesions on breast

101
Q

Malnutrition impairs what arm of immune system?

A

Both innate and adaptive

102
Q

Malnutrition puts you at risk particularly of which disease?

A

Higher risk for TB

103
Q

How do you test for congenital CMV?

A

Stool, urine, respiratory tract or CSF within 2-4 weeks of birth or PCR

104
Q

How is CMV transmitted beyond neonatal period?

A

urine, respiratory secretions, blood, organ or hematopoietic stem cell transplantation

105
Q

Pattern: blueberry muffin, thrombocytopenia, IUGR, microcephaly, cerebral atrophy, periventricular intracerebral calcification, hepatosplenomegaly, jaundice, chorioretinitis, sensorineural hearing loss

A

CMV

106
Q

What cause oral hairy leukoplakia as early manifestion of HIV?

A

EBV

107
Q

What is EBV associated with?

A

X-linked lymphoproliferative syndromes, Burkitt lymphoa, nasopharyngeal carcinoma in southeast Asia

108
Q

What is the incubation period for EBV?

A

1-2 months

109
Q

Pattern: <4yo, rash, hepatosplenomegaly, prolonged fever

A

EBV

110
Q

What are the compliciations of EBV infection?

A

Airway obstruction, neurologic complications, severe hepatitis, myocarditis or hemolytic anemia

111
Q

What antibiotic can cuase rash in mono patients?

A

ampicillin

112
Q

What is the management for mono?

A

supportive care

113
Q

Pattern: transplant recipient, fever, rash, hepatitis, bone marrow suppression, PNA, encephalitis and graft rejection

A

HHV-6

114
Q

Most sensitive test and most commonly used test for rotavirus

A

PCR - most sensitive

ELISA most commonly used

115
Q

Reservoir for west nile virus

A

avian-mosquito-avian

116
Q

Season for west nile

A

summer or early fall

117
Q

Risk factors for HepC virus

A

Infected mother, recipients of blood before 1992, international adoptees and refugees, HIV-infected children, adolescnts with IV drug use, multiple sex prtners, victims of sexual assault, unintentional needle stick

118
Q

Whenshould you evaluate newborn suspected of HCV?

A

RNA between 2 and 6 months, antibodies after 15 months

119
Q

Agent: brain abscesses, oral nd dental infections, deep neck, intra-abdominal, pelvic, necrotizing soft tissue

A

anaerobic

120
Q

Two bacteria most common causes of pharyngitis

A

Strept and arcanobacterium haemolyticum

121
Q

Difference in testing for strept and a. hemolyticum

A

A hemolyticum - grows on sheep blood agar, colonies are smll, have narrow hemolysis

122
Q

Rx for Arcanobacterium

A

erythromycin

123
Q

What must you think of with FUO >8 days

A

Brucella

124
Q

How can you get Brucella?

A

unpasteurized dairy products, inoculation of infected animal fluids, inhalation

125
Q

What are symptoms of brucella?

A

fever, sweating, osteoarticular, hepatosplenomegaly, transaminitis, arthritis (monoarticular) affecting knee and hip, bone marrow suppression

126
Q

What is unique about treatment of brucella?

A

Prolonged treatment because of intracellular pathogen

127
Q

Pattern: microabscesses in hepatosplenic cat scratch

A

bartonell

128
Q

Rx for mild to mod c difficile

A

metronidazole

129
Q

Rx for severe c difficile

A

oral vancomyocin

130
Q

How is severity measured for c difficile infection?

A

presence of ileus, megacolon or shock

131
Q

Pattern: cericovaginal discharge, intermenstrual bleeding, lower abdominal pain, cervical friability

A

gonorrhoeae

132
Q

Rx for N gono

A

Ceftriaxone x 1 shot and 1 dose of azithromycin or doxy for 7 days BID

133
Q

Pattern: viral from URI, mouth sores, respiratory then goes to bones

A

kingella kingae

134
Q

Rx for kingella

A

penicillins and cephalosporins

135
Q

Who should receive ppx for individuals exposed to N meningitidis

A

rifampin, ceftriaxone, ciprofloxacin for household members, daycare, childcare center , contact occurred at any time during 7 days before symptom onset, direct exposure to oral secretions

136
Q

Cat bite

A

pasteurella

137
Q

Rx pasteurella

A

Penicillin or azithro

138
Q

Pattern: fever, chills, malaise, headache, myalgias, vomiting/diarrhea, rash, DIC, respiratorydistress syndrome, renal failure and encephalopathy

A

Rocky Mountain spotted fever

139
Q

Pattern: cellulitis, impetigo, uruncles, abscesses, lymphadenitis, more invasive (bacteremia, pneumonia, pyomyositis, osteo)

A

staph aureus

140
Q

Rx for staph aureus

A

mild, incision/drainage, obtain specimen for culture and oral antibiotics
Severe - empiric vancomycin+nafcillin

141
Q

Suspect what bacteria with IV cath in place for >3 days

A

S epi

142
Q

Pattern: acute pharyngotonsillitis and impetigo develops 7 to 10 days after

A

GAS (pyogenes)

143
Q

Pattern: hepatosplen, snuffles, cutaneous lesions, edema lymphadenopathy, steochondritis, PNA, pseudoparalysis, hemolytic anemia, thrombocytopenia

A

congenital syphilis

144
Q

Pattern: 8th CN deafness, interstitial keratitis, peg-shaped incisors, mulberry molars, frontal bossing, saddle nose, tibial bowing, swelling of knees, ulceration, desquamation, palpable lesions

A

syphillis

145
Q

Syphillis treatment

A

IV penicillin

146
Q

Pattern: malaise, fever, cough, chest pain, headache, and myalgias (Valley fever) unilateral pulmonary infiltrate, hilar adenopathy or pleural effusion, erythema nodosum, erythema multiforme, erythematous maculopapular rash

A

coccidioides

147
Q

Dx for coccidiodes

A

CXR

148
Q

Pattern: hydrocephalus, cerebral calcifications, and chorioretinitis

A

Toxo

149
Q

Pattern: sequelae learning disability, mental retardation, hearing loss or vision impairment later in life

A

Toxo

150
Q

Rx for tox

A

pyrimehtamine plus sulfadiazine

151
Q

Which plasmodium?

Indian and subcontinent and central america

A

P vivax

152
Q

Which plasmodium?

AFrica, Papua New Guinea, Haiti, DR

A

P falciparum

153
Q

Which plasmodium? West Africa

A

P ovale

154
Q

Which plasmodium?

worldwide

A

malariae

155
Q

Pattern: fever, chills, rigors, HA, paroxysmal, nausea, vomiting, diarrhea, abdominal pain, arthralgias, myalgias, and respiratory symptoms can occur, H/P

A

malari

156
Q

Which plasmodium? hepatic infection

A

vivax and ovale

157
Q

Which plasmodium? nephrotic

A

malariae

158
Q

Pattern: blood stools, severe abdominal pain and fever

A

entabmoeba histolytica

159
Q

rx for e histolytica

A

metronizdazole or tinidazole

160
Q

Pattern: chlorine tolerant associated with contaminated drinking and recreational water, nonbloody diarrhea but watery lasting 1 to 2 weeks

A

crypto

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