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Residency > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What are risk factors for true bacteremia?

A

Old age Lines and catheters Steroid use Immune suppression Chronic liver and kidney disease Neutropenia Parenteral nutrition

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2
Q

What are the most common bacterial contaminants in blood cultures?

A

Skin flora: Bacillus Coag negative staph Propionibacterium Strep viridans

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3
Q

What bacteria is the leading cause of hospital infections? What are common infections that it causes?

A

Pseudomonas Ventilator associated pneumonia Catheter associated UTI’s Most common pathogen isolated from cystic fibrosis patients

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4
Q

What are some pathogens that when isolated in blood cultures are likely true positives?

A

S. aureus S. pneumo Pseudomonas Candida Enterobacteriaceae (E. coli, shigella, klebsiella, salmonella)

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5
Q

Which antibiotics provide coverage for P. aeruginosa?

A

Cefepime Ceftazidime (3rd gen. Ceph.) Zosyn Ciprofloxacin

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6
Q

Which foodbourne illness is associated with an increased risk of pre-term labor?

A

Listeria monocytogenes

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7
Q

Listeria infection is most commonly associated with what activity?

A

Eating unpasteurized dairy and deli products

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8
Q

What is the treatment of choice for Listeria?

A

Ampicillin or Pen G

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9
Q

Listeria infection Source, presentation, associations, treatment

A

Unpasteurized dairy and deli Fever, myalgia, vomiting, non-bloody diarrhea Causes pre-term labor, and sepsis/meningitis in elderly or immune compromised Treated only in severe cases with ampicillin or Pen G

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10
Q

What bacteria cause foodbourne illness through pre-formed toxins?

A

B. cereus and S. aureus

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11
Q

When empirically treating meningitis, when do you need to provide coverage for Listeria?

A

Immune compromised and >50 years

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12
Q

What are the broad classifications of the stages of Syphilis?

A

Primary, Secondary, Latent, Tertiary

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13
Q

What are the defining features of primary syphilis? What happens if not treated?

A

Painless chancre If untreated, can develop secondary syphilis weeks to months later

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14
Q

What are the defining features of secondary syphilis?

A

Weeks to months after primary infection develop: Generalized lymphadenopathy Diffuse maculopapular rash classically involving the palms and soles Mucus membrane lesions Systemic symptoms Condyloma lata (moist, flat, broad based papular lesions of the anogenital region)

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15
Q

What are the features of tertiary syphilis?

A

Cardiovascular involvement including aortitis and aortic aneurysms Gummatous disease: unique granulomatous disease forming gumma in the liver (most common), heart, brain, skin, bone, testis and other tissues

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16
Q

Which STI’s cause a rash on the palms and soles?

A

Secondary Syphilis and Gonococcemia

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17
Q

A patient is noted to have a diffuse macular rash and moist broad-based papular lesions on her external genitalia. What STI is possible?

A

Syphilis Condyloma lata

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18
Q

Explain the diagnostic tests for syphilis

A

Dark field microscopy: best in primary stage, but limited by performer and collector RPR/VDRL: decreased sensitivity in early and late syphilis therefore best for secondary, positive 4-6 weeks after infection, only 70–80% sensitive, must be followed by a more sensitive and specific test, many false positives Treponemal specific: EIA, TPHA, FTA-abs: used to confirm diagnosis after positive VDRL/RPR

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19
Q

What is the treatment for syphilis?

A

Primary/Secondary: IM benzathine pen G X 1 dose Tertiary: IM benzathine pen G qweek X 3 weeks

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20
Q

What disease process is this and what is the treatment?

A

Toxoplasmosis as suggested by the ring enhancing lesions. AIDS-defining illness. Caused by toxoplasmosis gondii, a parasite that is common and best known to be in cat feces.

Treated with IV pyrimethamine and sulfadiazine (must also give leukovorin (folinic acid) to prevent toxic effects of methotrexate and pyrimethamine)

Neurocysticercosis also has ring enhancing lesions in the brain, but the rings tend to be grape-like in size and are more symmetrically round

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21
Q

The most common CNS infection of untreated AIDS patients?

A

Toxoplasmosis

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22
Q

An AIDS patient that has not been treated presents with headache, fever, and new-onset seizure. What should you suspect?

A

Toxoplasmosis infection of the CNS

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23
Q

What are two AIDS-defining CNS infections and how are they different?

A

Toxoplasmosis: CD4 counts less than 100, ring enhancing lesions on head CT

Cryptococcal meningitis: CD4 counts less than 50, no CT head findings

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24
Q

What is the treatment for cryptococcal meningitis?

A

Amphotericin B and oral flucytosine

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25
Q

What is the common imaging finding for neurocysticercosis and what other disease has a similar finding?

A

Round, ring-enhancing lesions of the brain

Toxoplasmosis also has ring-enhacing brain lesions, but they are larger and more irregularly shaped

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26
Q

What is the treatment for neurocysticercosis and what is the source of this disease?

A

Praziquantel

Tapeworm in the brain from undercooked pork

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27
Q

What is the prophylactic medication for toxoplasmosis in HIV patients and when is it given?

A

sulfamethoxazole-trimethoprim (Bactrim) after CD4 counts are less than 100

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28
Q

Who are the patients that the CDC recommends treating with Tamiflu?

A

Patients at higher risk of complications:

>65yr, <2yr, pregnant or up to 2 weeks postpartum, immune compromise, residents of nursing homes, individuals with chronic illnesses including pulmonary disease, significant cardiac disease not including hypertension, malignancy, renal insufficiency, liver disease, diabetes, sickle cell disease, immunosuppression, and any neurological condition that compromises respiratory function, morbidly obese patients, and Native Americans

Better if within 48 hours of onset, but still administer at anytime if otherwise indicated

Patients who report improvement in symptoms are not likely to benefit from treatment

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29
Q

What are the most common symptoms of the flu?

A

Fever, Headache, myalgias, cough, sore throat, fatigue/malaise, GI symptoms

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30
Q

What is the most common cause of viral pneumonia in adults?

A

Influenza

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31
Q

Antiviral treatment has been shown to be beneficial in which type of flu?

A

Type A (pandemic type)

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32
Q

In herpes, lesions on what part of the face have a higher risk of ophthalmic involvement and why?

A

Vesicular lesions on the tip of the nose carry a higher risk of eye involvement because of the nasociliary branch of the trigeminal nerve that innervates both the nose and the globe. Called Hutchinson’s sign.

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33
Q

What is the treament for herpes ophthalmicus?

A

Oral antivirals and topical steroids. If immunecompromised or other severe disease, IV antivirals should be given.

Ophthalmology consult urgent/emergently

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34
Q

Patient has left sided facial paralysis, left ear pain and tinitus and is found to have vesicles in the left ear canal. What could be causing this?

A

Herpes zoster infection of the left middle/inner ear.

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35
Q

What is the first-line vasopressor in septic shock and why is it better compared to the other options? (Epinephrine, Dopamine, Phenylephrine, Dobutamine, Vasopressin)

A

Norepinephrine

Has B1 and A1 activity increasing cardiac output and vascular resistance.

Dopamine has more cardiac and less vessel effects and causes more dysrhythmias than NE

Phenylephrine doesn’t increase cardiac output

Vasopressin can be used as an adjunct, but not alone in sepsis

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36
Q

When are vasopressors used in sepsis?

A

After failure of fluid resuscitation of 30cc/kg bolus given rapidly and MAP<65

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37
Q

What are the 3 most common ways of getting botulism and what are the presenting symptoms?

A

Infant: most common, from honey or corn syrup

Food ingestion: poorly preserved foods, canned foods

Wound: contamination, iatrogenic from ingections

Symptoms: symmetric descending paralysis, cranial nerve defecits causing diplopia, dilated and non-reactive pupils, ptosis, dysphonia, dysphagia, dysarthria, poor gag reflex, decreased muscle strength and DTR’s but intact sensation, respiratory failure, parasympathetic blockade

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38
Q

What is the treatment for botulism?

A

Infants<1yr give human derived immune globulin

>1yr give equine derived immune globulin

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39
Q

How might botulism and an ischemic stroke be differentiated?

A

Stroke causes assymetrical weakness and sensation loss

Botulism is symmetrical and causes non-reactive pupils

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40
Q

What is one big difference between the symptoms of botulism vs myasthenia gravis?

A

Botulism causes non-reactive pupils whereas pupils are normal in MG

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41
Q

What is the most common cause of infectious food-bourne illness?

A

Viruses, with Norovirus causing more than 50%

Foodbourne illness is usually from fecally contaminated foods…, but viral enteritis can also come from person-person contact and aerosolization

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42
Q

What are the symptoms of viral enteritis?

A

diarrhea, nausea, vomiting, loss of taste

Viral courses are more mild than bacterial enteritis

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43
Q

What is the most common extra-pulminary presentation of tuberculosis?

A

Scrofula (painless lymphadenitis)

Cervical is most common

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44
Q

What are these tender nodules and the most common causes?

A

Erythema Nodosum

Thought to be a delayed hypersensitivity reaction causing inflammatory and painful nodules of the subcutaneous fat

Most common cause is strep throat, but also caused by tuberculosis, mycoplasma pneumo, histoplasma capsulatum, EBV, cat scratch, valley fever, autoimmune disorders such as sarcoidosis, and many others

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45
Q

When is a PPD test positive for TB?

A

15mm induration for those with no increased risk of disease

10mm for homeless, healthcare workers, IVDU, foreign-born

5mm for immune compromised, recent TB contact, steroid use, positive CXR

46
Q

What is the name for the lesions seen in the lungs in TB?

A

Ghon focus

It is a calcified lesion if a cavitary lesion has not healed

47
Q

How is TB diagnosed?

A

Primary or latent: PPD

Active/reactivated: Sputum looking for acid-fast bacilli

48
Q

What is the treatment for TB?

A

Latent TB: INH for 6 or 9 months, rifampin for 4 months, or INH/rifapentine for 3 months

Active/reactivation TB: rifampin, INH, pyrazinamide, ethambutol (RIPE)

49
Q

What are the most common encapsulated bacteria?

A

mnemonic: SHiNE SKiS

Strep. pneumo

H. flu B

Neisseria meningitidis

E.coli

Salmonella

Klebsiella pneumo

Strep (group B)

50
Q

Kids with sickle cell disease are most likely to be bactermic from what organism?

A

Strep. pneumo

51
Q

Young patient with sickle cell disease presents with a fever. What should you do?

A

Any patient with sickle cell disease that presents with a fever should be assumed to be bacteremic and septic and treated very aggressively as they are 100’s of time more susceptible to bacteremia.

Obtain blood and urine cultures immediately and start empiric antibiotics until cultures are negative.

52
Q

What is the treatment for uncomplicated chlamydia infection?

A

Azithromycin

53
Q

What is the treatment for gonoccocal infection?

A

Ceftriaxone 250mg IM

54
Q

What is the treatment for syphilis?

A

Primary and secondary: single dose of pen g

Tertiary: IM pen g once weekly for 3 weeks

55
Q

Describe the VZV virus and herpes zoster and the diseases they cause and why the virus is named the way it is.

A

Varicella = chicken pox

Zoster = shingles

Single herpes virus causes both conditions and it is called the Varicella-Zoster Virus (VZV)

Herpes Zoster is the disease known as shingles that this virus causes

56
Q

How are acyclovir and valacyclovir related?

A

valacyclovir is a prodrug form and is converted into acyclovir in the body and apparently is more potent.

57
Q

How toxic is acyclovir/valacyclovir?

A

Apparently virtually non-toxic to normal cells with little to no adverse effects

IV administration has more side-effects of nausea, diarrhea and headache

58
Q

Can acyclovir and valacyclovir be used in pregnancy?

A

Yes

59
Q

What diseases are acyclovir and valacyclovir most effective against?

A

Herpes infections

Less effective for zoster but still some activity

60
Q

What is the drug of choice for treating CMV infection?

A

IV therapy with ganciclovir

Oral therapy with valganciclovir

These drugs have more toxic side-effects than acyclovir but are much more effective in this case.

61
Q

What disease is this and what are the primary features of the rash?

A

Herpes

Grouped vesicles on an erythematous base

62
Q

What disease is this and what is the causative agent and treatment?

A

Impetigo

Staph aureus and sometimes Strep A

Isolated lesions treated with topical mupirocin

Keflex if MRSA not suspected

If MRSA: bactrim, doxy or clinda

63
Q

What disease and causative agent?

A

Hand-foot-mouth disease

Caused by coxackie virus

64
Q

Which agents are active against MRSA?

A

Mupirocin (topical and uncomplicated)

Doxycycline, Vancomycin, Bactrim, Daptomycin, Linezolid

Clindamycin has some activity

65
Q

Patient returns from travel to south america with mild fever, red maculopapular rash on trunk and face that is pruritic, joint pain in hands and feet, and conjunctival injection. What viral infection may she have? What are the complications of this disease?

A

Zika

Notable symptoms are: mild fever, pruritic rash, small joint pain, conjunctival involvement

Complications: microcephaly, pregnancy loss, Guillain-Barre syndrome

66
Q

Pt returns from south america with a cyclical fever, anemia, nausea, and muscle aches. What is a likely illness?

A

Malaria

67
Q

Pt returns from south america with high fever, severe myalgias, and a headache. What is a likely cause?

A

Dengue fever

Known for high fever and severe myalgias

Zika is different for more mild symptoms and conjunctival involvement

68
Q

What are the common features of Yellow Fever and where in the world is it endemic?

A

Hepatic and renal failure with coagulopathy

South america and sub-saharan Africa

69
Q

18 month old child, had high fever near 104, fussy, but otherwise doing well, fever breaks and macular rash appears that blanches and is non-pruritis or painful. What is the likely cause?

A

Roseola Infantum

Common disease of children less than 2 years.

High fevers that can lead to seizures. Fever then rash after fever breaks. Kids usually appear well. Disease is self-limiting requiring support only with tylenol.

Caused by HHV 6

70
Q

What are the classic features of scarlet fever and what is the treatment?

A

Pharyngitis, macular rash that is sandpaper like, and a fever.

Treated with penicillin

71
Q

What are the defining criteria of SIRS?

A

2 of the following:

Heart rate >90

Temperature >38C or less than 36C

Respiratory rate >20 or pCO2<32

WBC >12,000 or <4,000

72
Q

What is the definition of sepsis?

Severe sepsis?

Septic shock?

A

Sepsis = SIRS + source

Severe = sepsis + organ dysfunction, lactic acidosis, hypotension (SBP<90)

Shock = severe + unresponsive to fluids

73
Q

What is the regimen for post-rabies exposure prophylaxis?

A

Rabies Ig injected at the wound lite + the vaccine on days 0, 3, 7, 14

If previously vaccinated, give just the vaccine on days 0, 3

74
Q

Describe tetanus prophylaxis

A

Clean wounds: Tdap if never vaccinated or more than 10 yeara ago

Dirty wound: Tdap if vaccine >5yr; Tdap + Ig if never immunized

75
Q

What are the “atypical” bugs that require special agents for coverage and which agents are used?

A

Mycoplasma pneumoniae, Legionella, rickettsia

Doxycycline, Azithromycin, Cipro and Levofloxacin

76
Q

What is the treatment for newborn chlamydia conjunctivitis?

A

Oral erythromycin (topical does not work)

77
Q

What is a side effect of giving erythromycin to infants <2weeks old?

A

Hypertrophic pyloric stenosis

78
Q

What is the treatment for mucormycosis and the causative agent?

A

Rhizopus-oryzae fungal infection

Amphotericin B is the only treatment

Hyphae get into vasclature causing necrosis

79
Q

Elevated serum levels of what substance promote fungal growth in serum and tissues and increases the risk of mucormycosis?

A

Iron

80
Q

What diseases can cause non-tender lymphadenitis like this in children?

A

Nontuberculous mycobatcterium

Cat scratch disease

Brucellosis

Mononucleosis

Toxoplasmosis

Tularemia

Lymphoma

81
Q

What are the different stages of Lyme Disease?

A

Early Localized: 7–14 days after infection, local erythema migrans, non-specific symptoms of fever, fatigue, anorexia, headache, myalgias, neck stiffness

Early Disseminated: multiple sites of erythema migrans, delayed neurologic and cardic sequelae including peripheral neuropathies, cranial nerve palsies, bilateral Bell’s palsy, heart block and myopericarditis

Late Lyme: large joint arthritis and mild encephalopathy

82
Q

What are the treatments for early Lyme disease for all populations?

A

Doxycycline is the drug of choice for 10–21 days

Amoxicillin is used for kids under 8 and pregnant women due to teeth side effects

83
Q

What are the most common side effects of doxycycline treatment for Lyme?

A

Teeth discoloration for kids under 8 and pregnant women

Photosensitivity, prevented with sunscreen

84
Q

What is a common reaction that happens in the first 24 hours when treating spirochete infections?

A

Jarisch-Herxheimer reaction

As spirochetes die they release their inner contents and the patient feels worse at first with fever and other symptoms

85
Q

Patient has been traveling to countries along the equator and complains of cough, intermittent fevers, nausea, lethargy, and chills. What is the likely diagnosis?

A

Malaria

Suspect anytime there is a travel history and irregular fevers

86
Q

How is malaria diagnosed?

A

Thick and thin blood smears

87
Q

What is the cause of malaria? What are the types and which is the most severe?

A

Parasite infection transmitted most commonly by mosquito

Plasmodium falciparum (most severe)

P. vivax

P. ovale

P. malariae

88
Q

What are common complaints with malaria? What severe symptoms are possible with P. falciparum?

A

intermittent fevers, upper respiratory symptoms, anemia, lethargy, nausea, abdominal pain, headache (fevers are every other day, or every third day)

P. falciparum can cause severe organ failure and death, encephalopathy, hypoglycemia, metabolic acidosis, severe anemia, renal failure, pulmonary edema, disseminated intravascular coagulation

89
Q

What are the treatments for malaria?

A

Uncomplicated and in areas that are not resistant: chloroquine

Complicated or in areas of resistance: doxycycline + quinidine

90
Q

Bilateral facial nerve palsy is virtually pathognomonic for…?

A

Lyme disease

91
Q

How is the facial paralysis of Bell’s palsy differentiated from a central cause of paralysis?

A

Forehead muscles are involved with bell’s palsy (peripheral cause) and spared in a stroke

This is because the forehead has bilateral innervation from both sides of the brain so only a peripheral lesion can disrupt fibers from both sides of the brain

92
Q

What are the signs/symptoms, source, treatment of hantavirus infection?

A

Hantavirus comes from rodents—feces, urine, saliva that is aerosolized and inhaled

Causes a prodromal viral illness followed by a cardiopulmonary phase with bilateral pleural edema that progresses rapidly with hypoxia

Hemorrhagic fever with renal syndrome, oliguria and diuresis

Treat with supportive care including mechanical ventilation, ICU care, and possibly ECMO

93
Q

What is the treatment for the different stages of syphilis?

A

Primary and secondary: one dose of IM PenG

Tertiary: IM penG once a week for 3 weeks

94
Q

What is the most common finding for septic arthritis?

A

Pain with joint motion

95
Q

What is the most common bacteria in septic arthritis and how does the bacteria get in the joint?

A

Staph aureus

Hematogenous spread

96
Q

How is syphilis treated in pregnant patients who are allergic to penicillin?

A

Penicillin is the only treatment, so patients have to be admitted for desensitization prior to treatment

97
Q

What is the pattern of paralysis progression in botulism? What effects does botulism have on the GI and GU tracts?

A

Descending paralysis starting with the cranial nerves

Causes ileus and urinary retention (parasympathetic blockade from prevention of Ach release)

98
Q

What CXR findings are highly suggestive of TB?

A

Upper lobe cavitary lesions with hilar or mediastinal lymphadenopathy

Hilar adenopathy is the most common CXR finding

The most common symptom is fever

99
Q

How is TB diagnosed?

A

Latent/primary: PPD

Active/reactivation: sputum smears or culture

100
Q

Which causes of food-bourne illness are more likely to cause watery diarrhea?

A

Vibrio, shiga-toxin producing E. coli, shigella, Staph aureus, B cereus, C. perfringens, viral

101
Q

What bugs cause hemorrhagic diarrhea?

A

salmonella, campylobacter, enteroinvasive E. coli

102
Q

What bug is associated with traumatic myonecrosis, or gas gangrene?

A

Clostridium perfringens

Clostridium septicum causes spontaneus clostridial myonecrosis

103
Q

What is the treatment for campylobacter and salmonella enterocolitis?

A

Treatment is supportive, even with bloody diarrhea.

Treatment for salmonella with antibiotics may be considered in immunecompromised, and those over 50 or under 3 months or in severe disease

104
Q

Which cause of food-bourne illness causes a pseudoappendicitis?

A

Campylobacter

105
Q

What is a potential late complication of campylobacter enteritis?

A

reactive arthritis

Guillain barre

106
Q

What CBC lab finding is associated with Coccidioides immitis?

A

Eosinophilia

107
Q

Describe the spectrum of activity of fluoroquinolones

A

In general, known for activity against gram negative enterobacteriacieae with Cipro as the first. Also great against Haemophilus and M. catarrhalis making it good for respiratory infections.

Levo and Moxi have increased effect on gram positives including S. pneumo

Moxi covers anaerobes somewhat

Only Cipro covers pseudomonas

108
Q

What is the primary use of macrolides and what antibiotics are in this class?

A

Erythromycin, Azithromycin, Clarithromycin

Azithro and Clarithro used commonly for respiratory infections

109
Q

What is the spectrum of activity of Azithromycin and CLarithromycin? How does this differ from erythromycin?

A

Used best for upper respiratory infections

Activity against: S. pneumo, M. catarrhalis, Haemophilus

And also against atypicals: Chlamydia, Mycoplasma, Legionella

Also usually active against strep and staph aureus

Erythro does not cover H. flu and the newer agents have enhanced gram negative activity

110
Q

Why is azithro chosen over clarithro or erythromycin for treating respiratory infections?

A

Azithromycin has the best activity against H. influenzae

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