Infectious disease Flashcards

1
Q

Acute HIV meningitis

A

seroconversion syndrome. alertness/cognition preserved. Normal LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lyme disease Dx/Rx

A
CNS sxs? IV rocephin or Penicillin B x 2-4 weeks.
-B/l facial nerve palsy.  
-Cardiac conduction block in stage II
-Encephalitis, dementia stage III
No CNS sxs? doxycycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mucormycosis

A

angioinvasive. zygomycosis. non-septated. cavernous/venous sinus thrombosis. Risk factors include immunosuppression, DM, DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HIV associated dementia

A

etiology of this condition is the retrovirus itself rather than an opportunistic infection. Progressive cognitive decline and prominent psychomotor dysfunction are the main clinical manifestations. CSF analysis is nonspecific. Late stage of HIV. Rx HAART therapy/adherence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

West Nile encephalitis

A

asymptomatic sxs include fever. 20% can progress to encephalitis or WNV can also invade the anterior horn cells leading to flaccid weakness with arreflexia, similar to poliomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cryptococcus meningitis

A

CD4 counts fall below 100 cells/μL. LP w/increased opening pressure, mononuclear lymphocytosis with increased protein, low glucose levels. India ink smear is not very sensitive; Cryptococcal antigen detection in the CSF is rapid, sensitive and specific.
Rx amphotericin plus flucytosine for 2 to 3 weeks followed by PO fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Toxoplasma gondii

A

intracellular protozoan, encysted bradyzoite.CD4 < 100/μL. Dx brain bx, typically treated empirically. sulfadiazine plus pyrimethamine w/folate supplementation. Alternative agent is clindamyin. Trimethoprim-sulfamethoxazole is used for prophylaxis less than 100/μL with positive IgG antibodies to toxoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

primary CNS lymphoma

A

subacute focal neurologic manifestations, Associated with Epstein–Barr virus, positive CSF PCR to help make dx. Flow cytometry showing monoclonal B lymphocytes. MRI showing periventricular and deep regions of the brain with contrast enhancement, surrounding edema, and produce a mass effect.
Rx Corticosteroids, however s/p brain bx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Progressive multifocal leukoencephalopathy (PML)

A

Polyomavirus. demyelinating. presents with a gradually progressive course of multiple focal neurologic manifestations, with visual field deficits and hemiparesis, sensory deficits.
Dx MRI findings and CSF JC virus DNA PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HIV neuropathy

A

distal sensory neuropathy more frequently as the CD4 count drops 2/2 direct effects of the virus and cytokine upregulation. sensory, axonal length-dependent symmetric polyneuropathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nucleoside analog-associated neuropathy

A

occurs over weeks following the initiation of therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PML MRI findings?

A

multiple white matter nonenhancing lesions that tend to coalesce and predominate in the parieto-occipital regions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HIV myositis

A

induces major histocompatibility complex I expression with autoimmune muscle fiber injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

lepromatous variant

A

occurs in patients with impaired cell-mediated immunity, making it possible for the organism to spread to the skin and peripheral nerves. sensory loss predominantly in the coolest regions of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

tuberculoid variant

A

occurs in patients with good cellular immunity, in which the disease is less disseminated. ulnar nerve is commonly affected, and the syndrome may resemble mononeuritis multiplex.

Dx inflammatory granulomas with epithelioid and mononuclear infiltrates and acid-fast organisms.
Rx rifampin, dapsone, and clofazimine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Brain abscesses evolution

A

initial cerebritis in the first few days, then the formation of central necrosis with surrounding vasogenic edema, and the subsequent formation of a capsule
Rx third-generation cephalosporin (for streptococci and gram-negative bacilli), metronidazole (for anaerobes), and vancomycin (for staphylococci). The IV antibiotic regimen is continued for 6 to 8 weeks,

17
Q

cavernous sinus thrombosis

A

proptosis, compromise of the cranial nerves (CNs) traveling within the sinus (CNs V1 and V2, III, IV, and VI), retinal vein engorgement with retinal hemorrhages, and papilledema. Superior sagittal or the transverse sinuse thrombosis.

18
Q

tuberculous (TB) meningitis

A

granulomatous inflammatory response with multinucleated giant cells and caseating necrosis
Dx CSF demonstrates elevated protein level, low glucose level, and lymphocytic pleocytosis. AFB/cultures are poor tests, use PCR

19
Q

Whipple disease

A

Tropheryma whippelii. Presents with dementia, supranuclear ophthalmoplegia, ataxia, oculomasticatory myorhythmia and neuropathy, myopathy.
Dx duodenal bx showing PAF + macrophages
Rx IV ceftriaxone for 2 weeks, followed by a prolonged course of trimethoprim-sulfamethoxazole

20
Q

Treatment of neurosyphilis

A

CSF VDRL is very specific. penicillin G 4 million units every 4 hours for 14 days

21
Q

CJD

A

cellular prion protein (PrPC) to scrapie prion protein (PrPSc), which has an increased β-sheet content. PrPSc has the ability to bind to PrPC and induce its conformational change, therefore making this agent infective.
EEG repetitive sharp and wave periodic pattern.
MRI hockey-stick and pulvinar signs

22
Q

HSV diagnosis and treatment?

A

intravenous acyclovir 10 mg/kg every 8 hours x 2 weeks. FLAIR T2 hyperintensities and restricted diffusion in the temporal regions and PLEDs on EEG

23
Q

fatal familial insomnia

A

prion disorder characterized by progressive intractable insomnia and symptoms of sympathetic hyperactivity such as hypertension, tachycardia, hyperthermia, and hyperhidrosis. Patients may also have cognitive impairment, tremor, ataxia, hyperreflexia, and myoclonus.
Dx neuron loss/gliosis of the thalamus

24
Q

Gerstmann–Straussler–Scheinker

A

inherited prion disease that progresses slowly over years. Presents with cerebellar ataxia and dysarthria, sometimes extrapyramidal features followed by dementia

25
Q

Subacute sclerosing panencephalitis (SSPE)

A

late complication of measles: Acute encephalitis. Postviral encephalomyelitis. Measles inclusion body encephalitis and SSPE.
first 2 years of life are the ones at the greatest risk for SSPE

26
Q

SSPE symptoms

A

behavioral and personality changes, later causing seizures, myoclonus, spasticity, ataxia, choreoathetoid movements, optic atrophy, quadriparesis, autonomic instability, akinetic mutism, and eventually coma.

27
Q

Arbovirus

A

transmitted RNA viruses exist, including Saint Louis encephalitis virus, West Nile virus, La Crosse encephalitis virus, Japanese encephalitis virus, and Eastern and Western Equine encephalitis viruses.

28
Q

Aspergillus fumigatus

A

neutropenic patients, immunocompromised patients. invading blood vessels, causing stroke-like syndromes, infarcts, and hemorrhagic transformation. A vasculitis-type phenomenon. Forms granulomas in brain. septate hyphae that branch at acute angle

29
Q

Cryptococcus vs aspergillus vs histoplasmosis?

A

Cryptococcus causes meningitis and not typically a vasculitis-type syndrome. Histoplasmosis causes basilar meningitis, focal cerebritis, or granulomas

30
Q

Amebic meningoencephalitis

A

free-living amebae, such as Naegleria fowleri, Acanthamoeba, and Balamuthia mandrillaris

31
Q

Ramsay–Hunt syndrome

A

facial palsy combined with herpetic rash in the external auditory meatus, sometimes with vertigo, tinnitus, and deafness. This syndrome is secondary to geniculate ganglion involvement.

32
Q

VZV vasculopathy

A

Small and large intracranial vessels are involved, leading to ischemic strokes, TIAs, and sometimes aneurysmal dilatations with resulting subarachnoid or intracranial hemorrhages.
Dx Angio- showing multifocal segmental narrowing with poststenotic dilatation and anti-VZV IgG in the CSF has been demonstrated to be superior to the detection of VZV DNA

33
Q

VZV vasculopathy treatment?

A

should be treated with acyclovir 10 to 15 mg/kg IV three times a day for at least 2 weeks. Steroids may be required

34
Q

mycotic aneurysms

A

usually very distal in the arterial tree, and commonly seen in distal bifurcations. secondary to septic emboli involving distal vessels, affecting their vasa vasorum, with destruction and weakening of the arterial wall and subsequent aneurysmal dilatation. SAH is cortical and superficial, and is not generally associated with vasospasm.

35
Q

Rabies

A

cytoplasmic eosinophilic inclusions known as Negri bodies, which are found mainly in Purkinje cells and pyramidal cells of the hippocampus.
Rx s/p exposure HDCV (human diploid cell vaccine) and human rabies immunoglobulin (20 IU/kg) a