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*PANCE by subspecialty > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

IgM role in immunity

A

IgM = the first antibodies made against an infection

IgG = most prevalent immune globulin in the bloodstream - phagocytosis of invading pathogens & transplacental immunity

IgA = found in mucosal surfaces & secretory immunity

IgE = present in allergy & anthelminthic immunity

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2
Q

Candidial esophagitis - CP, DX, TX

A

Odynophagia, GERD, epigastric pain, nausea, vomiting, +/- thrush

Endoscopy - white linear plaques/erosions

KOH smear: Candida = budding yeast & pseudohyphae (spagetti & meatballs)

Tx: Fluconazole PO

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3
Q

Oral thrush

A

CP - friable white plaques - leave erythema/bleed if scraped

KOH smear: Candida = budding yeast & pseudohyphae (spagetti & meatballs)

Tx: Nystantin S&S

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4
Q

VAGINAL CANDIDIASIS

A

Vulvar pruritis, burning, vaginal itching

KOH smear: Candida = budding yeast & pseudohyphae (spagetti & meatballs)

Tx: Mizonazole, clotrimazole

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5
Q

Intertrigo - what is it? CP? TX?

A

Pruritic red beefy rash w/ discinct scalloped borders & satellite liesions

KOH smear: Candida = budding yeast & pseudohyphae (spagetti & meatballs)

Tx: Topical clotrimazole

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6
Q

Fungemia, endocarditis

A

Seen in immunocompromised pt +/- indwelling catheters

Tx:
IV amphotericin B
Caspofungin if severe

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7
Q

Cryptococcosis - etio, transmission

A

Cryptococcus neoformans or C. gattii - encapsulated budding round yeast

Found in PIGEON / IRD DROPPINGS

MC in immunocompromised pt

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8
Q

Cryptococcosis - CP

A

CP:
1. Meningoencephalitis - HA meningeal si (neck stiffness, N/V, photophobia)

or

  1. Pneumonia
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9
Q

Cryptococcosis - DX & TX

A

Dx:
LP - inc WBC (lymphocytes), dec glucose, inc protein, india ink stain = encapsulated yeast , cryptococcal antigen in CSF

Tx:
Amphotericin B + Flucytosine x 2 weeks followed by oral fluconazole x 10 weeks

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10
Q

Histoplasmosis - etio? a/w? where found? CP?

A

Etio: Histoplasma capsulatum = dimorphic oval yeast

A/w: Soil contaminated w/ bird/bat droppings in OH/MI river valley

CP: ASX, atypical PNA (fever, non-productive cough, myalgias)

Disseminates if immunocompromised = hepatosplenomegaly, fever, ulcers, blood diarrhea, & adrenal insufficiency

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11
Q

Dx - labs, imaging histoplasmosis

A

Labs - Inc ALP, LDH, pancytopenia

CXR - pulmonary infiltrates & hilar/mediastinal lymphadenopathy

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12
Q

Tx histoplamosis

A

Mild- mid: IV Itraconazole

Severe dz: Amphotericin B

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13
Q

Pneumocystis PNA - etio, CP,

A

Etio: pneumocystis jiroveccii

CP:
O2 desat w/ ambulation, fever, DOE, nonproductive cough

Dx:
CXR - diffuse b/l interstitial infiltrates - may be normal, increased LDH

w/ Pneumo, PaO2 drops w/ ambulation P=P

Tx:
BACTRIM x 21 days - prednisone if hypoxic
Dapsone if sulfa allergy

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14
Q

CD4 count less than ? you PPX for PCP

A

< 200

PPX w/ Bactrim

PPX b/c PCP is most common opportunistic infection

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15
Q

Aspergillus found in? MC affects which parts of body?

A

Garden & house plant soil & compost - transmission via inhalation

Mc affects lungs, sinuses, & CNA

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16
Q

Aspergillus releases which substance which increases risk of which cancer?

A

Releases alfatoxin B1 which is a/w inc risk of hepatocellular carcinoma

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17
Q

Allergic bronchopulmonary aspergillosis - MC in who? CP?

A

MC in asthma & CF

Airway type I hypersensitivity rxn to fungus (eosinophilia & inc IgE)

CP: Asthma sx, cough, thick brown sputum (mucus plugs), fever, pulmonary infiltrates

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18
Q

“Fungal ball” on CXR = ?

A

Aspergilloma - when fungus colonizes a pre-existin pulmonary cavitary lesion - can be asx or have couth + hemoptysis

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19
Q

Chronic sinusitis treated with several courses of abx that didn’t go away should make you think what?

A

FUNGAL infection like acute invasive aspergillus - fever, HA, toothache, epistaxis,

INVASIVE CHRONIC SINUSITIS - often fatal - pull out the big guns (voriconazole)

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20
Q

Tx allergic bronchopulmonary aspergillosis

A

Tapered corticosteroids - chest PT, itraconazole

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21
Q

Severe or invasive aspergilus sinusitis tx

A

Voriconazole

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22
Q

Symptomatic aspergilloma tx

A

Surgical resection

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23
Q

Infection found in men who work outdoors with decaying wood or around soil in close proximity to waterways

A

Blastomycosis - fungal infection caused by blastomyces dermatitidis = pyogranulamatous fungal infection

Tx: Itraconazole

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24
Q

What does disseminated blastomycossis look like?

A

Pulmonary = MC site –> MOST ARE ASYMPTOMATIC - if chronic - like the flu- cough with or without sputum, dyspnea, headache, fever,

Also cutaneous - verrucous crusted ulcerated lesions which expand - skin = MC extrapulmonary site

Look like little meteor blasts on the skin

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25
Q

Coccidiodomycosis - who gets it? CP?

A

FOund in arid/desert regions in SOUTHWEST US, me
Primary pulmonary dz = asx in 65%

If not sx = mild flu-like sx or valley fever

Disseminated =CNS Meningitis

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26
Q

Valley fever clinical syndrome

A

Fever, arthralgias (pain & swelling in knees & ankles), erythema nodosum, erythemamultiform, macropapular rash, flu-like sx

Kind of generic - hopefully will give hx of being in southwest - arid climates where coccidiodomycosis is (southwest US, mexico) or being in dirt

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27
Q

Tx coccidiodomycosis - “valley fever”

A

Most cases are asx and don’t need tx

Localized lung dz treated symptomatically

Fluconazole for CNS disease

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28
Q

Reiter’s syndrome

A

Is reactive arthritis 2/2 chlamydia infection - urethritis, uveitis, arthritis

+ HLA - B27

Cant see, pee, climb a tree or “B”e

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29
Q

Disseminated gonorrhea = ?

A

Arthritis & dermatitis

Septic arthritis of the knee!

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30
Q

Cat scratch disease - etiology, CP, tx

A

Bartonella henselae - after scratch or bite from flea-infested cat (2-4wk incubation )

Brown/red/papule - ulcer at inoculatio site - 1-7 weeks after = fever, headahe, malaise, LYMPHADENOPATHY!!

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31
Q

Etiology meningococcal meningitis

A

Neisseria meningitidis

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32
Q

CP meningiococcal meningitis

A

+ kernig sign (can’t straignten leg when knee flexed - stretching meninges hurts)

+ Brudzinski - neck flexion -= involuntary hip/knee flexion

Fever, headache, visual changes, photophobia, AMS, neck stiffness, purpuric rash (DIC)

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33
Q

Treatment meningococcal meningitis

A

Most people are treated empirically:
Adults: ceftiraxone & vanco Infant:Ampicillin & cefotaxime

Penicillin G is TOC if susceptible

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34
Q

Prevention of meningococcal meningitis

A

Meningococcal vaccine - given to patients > 55 YO & high risk patients (asplenia)

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35
Q

Chancroid etiology, characteristics

A

Etio: Haemophilus ducreyi

ChancO = Haem-O

STD - PAINFUL ulcer(s) - irregular border, erythema, fever, painful inguinal LAD

Treat H. flu w/ azithro, treat this with azithro! 1g x 1 dose

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36
Q

MCC epiglotitis

A

Haemophilus influenzae

Also 2nd MCC CAP

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37
Q

Which cause of CAP is a/w otitis media & sinusitis?

A

H. flu

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38
Q

Diseases with eschar formation

A

Tularemia, anthrax, leishmaniasis, coccidiomycosis, mucormycosis

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39
Q

Hot tub folliculitis - etio, description of rash, tx

A

Etio - Pseudomonas

CP - smal pink to red bumps - filled with pus or covered w/ scap - 1-4 d after exposure - itchy tender red bumps located around hair follicles

Management - Usually spontaneously resolves WITHOUT treatment

Ciprofloxacin orally if persistent

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40
Q

Bubonic plague presentation

A

Etio - yersinia pestis (GNR)

Acutely swollen extermely warm red painful nodes (buboes) - 2-10 cm in diameter int eh groin, axilla & cervical regions

Tx Streptomycin or gentamycin

PEP - doxy or tetra

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41
Q

Fournier’s gangrene - etio, pt it happens in, tx

A

Etio - MC GABHS (often polymicrobial)

Happens in MALES w/ impaired immunity or after trauma to the area

EXTREME PAIN OUT OF PROPORTION TO PHYSICAL EXAM - blue, hemorrhagic bullae (blisters) at site –> gangrene –> shock

Tx - surgical debridement and broard spectrum antibiotics (carbepenem, zosyn, unasyn etc)

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42
Q

Diptheria etio

A

Corynebacterium diptheriae

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43
Q

Clinical manifestations diptheria

A

Tonsillopharyngitis w/ PSEUDOMEMBRANE - friable gray/white membrane on pharynx that bleeds if scraped

Myocarditis rarely = arrhythmias & heart failure

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44
Q

Tx diptheria

A

Diptheria antitoxin - horse serum and erythromycin & Penicillin x 2 weeks

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45
Q

Prevention of diptheria

A

DTAP vaccination

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46
Q

Tetanus - how do you get it, patho, CP

A

Clostridium tetani (Gram positive rod) - anaerobe found in soil - germinates easily in crush and puncture wounds - make s

Make sure anyone w/ wound has had tetanus shot esp if dirty

Patho/CP: Tetanospasmin = neurotoxin that = severe muscle spasm = local muscle spasms, jaw & neck stiffness, TRISMUS (lock jaw) = MC presenting sx, dysphagia

PE: Inc DTR! autonomic dysfunction = tachy, hyperpyrexia

Tetanus = trismus!!!

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47
Q

Tx tetanus

A

Metronidazole - against the clostridium tetani anaerobe!

PLUS teatnus immunoglobulin

Benzos for spasms

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48
Q

Tetanus PPX - never previously vaccinated

A

Tetanus immunoglobulin (250)

Tetanus vaccine - first dose right away, 2nd in 4-8wk, 3rd in 6-12 mo

IF previously vaccinated - TDAP or Td vaccine q10 years or given again if major cut > 5 years since last booster

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49
Q

Gas gangrene (myonecrosis) - etio, MC scenario it happens in, CP, tx

A

Etio - Clostridium perfringens

Happens after traumatic injury, IV drug use - (where clostridium anaerobes get into anaerobic environment)

CP - sudden onset pain & edema in area of wound w/ systemic toxicity (shock)

Brown to blood-tinged watery exudates with skin discoloration of surrounding area

Crepitus / gas in the tissue palpated on physical exam

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50
Q

Dx gas gangrene (myonecrosis)

A

Radiographs - air in the soft tissues

Culture of smear of exudates = gram positive rods/bacilli that are spore-forming

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51
Q

Tx gas gangrene

A

IV penicillin + IV clinda + wound debridement

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52
Q

Botulism - etio, who gets it/how

A

Etio: Clostridium botulinum

Adults: from canned, smoked or vacuum-packed foods

Infants: Honey or dust w/ spores = active toxin in gut

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53
Q

CP Botulinism

A

Sx onset 12-36 hrs after ingestion, 6-8 hrs if <1YO

8D’s of botulism - 8 letters & 8 D’s =

Dilated, fixed pupils
Dry mouth
Dysphagia
Dysarthria
Dysphonia
Descending, decreased muscle strength = flaccid paralysis

(think of botox freezing muscles)

Infants = floppy baby syndrome - lethargy, weakness, flaccid paralysis, weak cry, FTT

54
Q

Tx botulism

A

Antitoxins (<1 human, >1 equine)

Intubation if respiratory failure

NO ANTIBIOTICS in food-borne type = more bacterial lysis = more toxin release!

Only abx in wound type (rare)

55
Q

Where is listeria found? Who does it cause significant disease burden in? Treatment?

A

Found in contaminated deli meats and unpasteurized dairy products (soft cheeses)

Infects: Children, elderly, pregnant patients

CP: Bacteremia (esp newborns), 3rd MCC meningitis

Tx: IV ampicillin

56
Q

Anthrax - found in? causes which manifestations?

A

Bacillis anthracis - found in livestock

Manifestations - on skin = painless black eschar = MC type.

Also if inhaled - flu-like sx –> dyspnea–> pleural effusions, hypoxia, shock –> think bioterrorism

57
Q

Dx inhaled anthrax on CXR

A

WIDENED mediastinum - b/c of hemorrhagic lymphadenitis

58
Q

Tx anthrax

A

CIpro for tx & exposure

59
Q

Syphilis etiology, transmission

A

Etio: Spirochete treponema pallidum - known as the “great immitator” b/c can present in many ways similar to other diseases

Transmission: Direct contact - sexual activity - forms chancre at innoculation site –> LN then disseminates

60
Q

Clinical manifestations syphillis

A

Primary - (3 days - 3 months after infection)- single pailnless chancre at innoculation site - raised, indurated edges w/ non-tender regional LAD

Secondary - (6 weeks to 6 months after initial sx)- think of it disseminating = systemic sx (fever, malaise, LAD, arthritis, HA), maculopapular rash on palms, soles, also - CONDYLOMATA LATA - wart-like lesions involving mm

Tertiary - (years after primary infection) = granulomatous gummas and spreads to brain = neurosyphilis (HA, dementia, vision & hearing loss, TABES DORSALIS, ARGYLL ROBERTSON PUPIL, AORTITIS

Each one has skin manifestations - chancre –> condylomata lata –> gummas

Secondary is spreading to body - so systemic sx, then tertiary spreads up to brain =

61
Q

Tabes dorsalis

A

Demyelination of posterior column leading to ataxia, areflexia, burning pain, weakness

Occurs in tertiary syphilis

62
Q

Argyll- robertson pupil - what is it? when does it occur?

A

Small irregular pupil that constricts normally to near accommocation but does not constrict/react to light

Occurs in tertiary syphilis

63
Q

Congenital syphilis causes….

A

Hutchinson teeth (notches on teeth)

Saddle-nose deformity

ToRCH syndrome

64
Q

ToRCH syndrome

A

TORCH syndrome is a cluster of symptoms caused by congenital infection with toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and other organisms including syphilis, parvovirus, and Varicella zoster.

Zika virus is considered the most recent member of TORCH infections

Sx: Hepatosplenomegaly (enlargement of the liver and spleen), fever, lethargy, difficulty feeding, anemia, petechiae, purpurae, jaundice, and chorioretinitis

65
Q

Dx of syphilis

A

Darkfield microscopy to directly visualize if have a chancre or condyloma lata

RPR - non-treponomal test - non-specific & must be confirmed if positive w/ treponemal test =

FTA-ABS - fluorescence treponemal antibody absorption (FTA-ABS) or microhemagglutinatino test for T. pallidum antibodies

66
Q

Tx syphilis

A

PENICILLIN G = ALWAYS THE TOC - even in penicillin allergic pt - try desensitizing

Primary, secondary, or early latent:
Pen G 2.4 mil units x 1 dose

Tertiary or late-latent:
If tertiary or late-latent then Pen G 2.4 mil units IM every week x 3 doses

If bad PCN allergy - can try doxy - but none are as effective as PCN

All pt follow up at 6 months & 12 months to see if cured - 4-fold dec in RPR titer = adequate management

67
Q

Lyme disease - etio, transmitted via?

A

Borellia burgdorferi - gram negative spirochete

Transmitted via lxodes scapularis tick in nymphal phase - MC source = white-tailed deer & white-footed mice - in SPRING, SUMMER (when the nymphs feed) - MC in northeast, midwest, id-atlantic

Highest rate of trans if tick engorged & has been attached for > 72 hours

68
Q

Clinical manifestations of early localized lyme

A

Erythema migrans

Expanding, warm, annular, erythematous macular rash - classically seen w/ central clearing but not always - appearance w/in 1 month of & around area of tick bite

May also have viral-like syndrome - headache, fever, malaise, LAD

69
Q

Clinical manifestations of early disseminated lyme

A

1-12 weeks after infection - rheumatologic - ARTHRITIS (large joints)

Neurologic - HA, meningitis, weakness, CN palsies (CNVII palsy!!! - think bells! Lyme = common cause! )

Cardiac - AV block, pericarditis

70
Q

Late lyme disease clinical manifestations

A

Persistent synovitis
Persistent neurological sx
Subacute encephalitis
Acrodermatitis chronic atrophicans - bluish discoloration of extremities seen in europe

71
Q

Lyme dx

A

Lyme = CLINICAL dx !!! - esp w/ early lyme - this is because people in erythema migrans rash stage are often SERONEGATIVE so no reason to test!!!

72
Q

Serology testing for lyme - when done, how?

A

ELISA –> if positive, or equivocal, it is followed up by a western blot

**Note - during time pt has erythema migrans rash, the serologic testing is often negative - that’s why it’s mainly a clinical diagnosis based on the rash & classic lyme sx along with hx exposure

73
Q

False positive for lyme- ELISA occurs in?

A

If have another spirochetal disease like syphilis

74
Q

Lyme tx

A

Early disease - doxy BID x 10-21 days - early disseminated do at least 14 days, if not 28

Amoxicillin = TOC in pregnancy, children <8 YO x 14-21d

Late/severe disease (AV heart block, sycnope, dyspnea, CP, CNS disease - other than CNVII palsy) –> IV ceftriaxone

75
Q

Which two diseases that the PANCE loves commonly cause CNVII palsy?

A

Lyme disease

Sarcoidosis (Sarco-NM = 7 letters)

76
Q

Lyme PPX

A

Doxycycline 200 mg x 1 dose within 72 hours of Ixodes tick removal that was on > 36 hours & > 20% of ticks in area infected

77
Q

RMSF

A

RMSF =
M - W = wood dog tick
S - seizures, V SICK (fever, chills, arthralgias, myalgias, HA, lethargy, N/V, seizures)
Rash

78
Q

Fever, maculopapular rash, tick bite =

A

Rocky mountain spotted fever = clinical dx based on fever, rash, hx tick bite = DX = TREAT

79
Q

Tx RMSF

A

Doxy (even in children) x 5-14 days - ideally w/in 5 days of sx onset to reduce mortality

Chloramphenicol = 3rd line = TOC in pregnancy (not in pregnancy)

80
Q

Describe the rash of RMSF

A 
Maculopapular 
Erythematous 
BLANCHING
FIRST on wrists/ankles --> 
then palms/ soles --> 
then centrally

Think of tick biting on wrist & crawling towards your center- rash spreads towards center

81
Q

Dx RMSF

A

CLINICAL - fever, rash, tick bite = dx right there- treat w/ doxy

Can do serologies - indirect immunofluorescent Av test for IgM and IG against rickettsia ricketsii - 4x increase in titers = acute disease

CSF - low glucose & pleocytosis (increased cell count)

82
Q

Amebiasis - etio, CP, dx, TX

A

Etio: Entamoeba histolytica - protozoan spread by fecal contamination of soil, water

CP: GI colitis, dysentery (bloody diarrehea), amebic liver abscess

Dx: Stool O&P, positive serologic tests (ELISA)

Tx:
Colitis - metronidazole followed by paromomycin (anti-parasitic aminoglycoside)

Abscesss - metronidazole, paromomycin, chloroquine +/- IR drainage if no improvement in 3 days

83
Q

Malaria - etio, who gets it, who **doesn’t get it

A

Etio: Plasmodium spp. - falciparum = worst

Anyone bit by anopheles mosquito w/ the protozoa in it

Sickle cell trait & thalassemia trait are protective vs malaria

84
Q

CP Malaria

A

CYCLICAL fever (2/2 cyle of plasmodium infecting RBC –> RBC lysis –> Fever)

Also chills –> fever –> diaphoresis –> chills –> fever –> etc

Hemolytic anemia
Thromgocytopenia
Leukopenia

P. falciparum = most dangerous b/c can cause cerebral malaria = coma and severe hemolysis + hemoglobinuria (dark urine) –> renal failure

85
Q

Dx malaria

A

Geisma stain peripheral smear (thin & thick) - parasites in RBCs, thrombocytopenia, increased LDH

86
Q

Tx malaria

A

Chloroquine - 1st line in sensitive areas

MDR area = atovaquone with doxy or clinda

87
Q

Babeiosis - etio, transmission, CP

A

Etio - babesia microti - malaria-like protozoa that attacks RBCs

CP: fever, chills, hemolytic anemia & jaundice, arthralgias, myalgias

Like the malarial version of lyme diease - b/c caused by same tick (Ixodes) & in same area (northease - LONG ISLAND, MASS), bite but infects RBC (it’s a protozoa) & = hemolysis like malaria

LYME FUCKED MALARIA = BABY- OSIS

88
Q

Dx babeiosis

A

Peripheral smear shows:

Pathognomonic TETRADS = MALTESE cross = the parasite that has infected the RBC

89
Q

Tx babeiosis

A

Atovaquone plus azithromycine or quinine plus clinda

90
Q

Toxoplasmosis - etio, CP, Dx, Tx

A

Etio: Toxoplasma gondii (protozoan) - transmitted by cats

Primary inf - usu asx in immunocompetent pt or may develop mono-like illness w/ cervical LAD

Immunocompromised pt (CD4 < 100) = ENCEPHALITIS & chorioentinitis - fever, cervical LAD, malaise, myalgias, headache, arthritis

Dx: PCR, Head CT/MRI w/ RING-enhancing lesions

Tx: Sulfadiazene (or clinda) + pyrimethamine (w/ folic acid/leucovorin) to prevent bone marrow suppression - spiramycin if pregnant

Toxoplasmosis - PS - pyrimethamine & sulfadiazene

91
Q

Contenital toxoplasmosis

A

One of ToRCH infections = BLUEBERRY MUFIN RASH (from TTP - thrombotic thrombo-cytopenic purpura), hepatosplenomegaly, hearing loss, mental development delays

92
Q

Pinworm - etio, transmission, tx

A

Etio: Enterobius vermicularis (sounds like worm)

Tranmission: Fecal-oral (esp in school-aged children!)

Dx: Scotch tape test

Tx: Albendazole - bend over to check & then give you albendazole

93
Q

African trypanosomiasis (african sleeping sickness)

A

Etio: Protozoa T. brucei rhodesiense & gambiense

Vector: Tsetse fly
Prevalent in: Sub-sarahan africa & central america

CP:
Early: Painless shancre at bite site - generalized LAD, fever, malaise, HA, joint pain, WINTERBOTTOM sign - POSTERIOR cervical LAD

Late: CNS infection = daytime sleepiness followed by nighttime insomnia

Dx: Peripheral blood smear or aspiration of an affected LN

Tx: Infectious disease consult

94
Q

Mycobacterium avium complex

A

Causes bronchiectasis/pulm infection in immunocompetent pt - cough w/ sputum, fever, weightloss

In immunocompromised (HIV) = disseminates = FUO, sweating, weight loss, fatigue, diarrhea, dyspnea, RUQ Pain

Dx: Acid fast bacillus staining & culture

Tx: Clarithromycin & Ethambutol for TWELVE MONTHS

95
Q

Leprosy - etio, where found, tx

A

Eito: Mycobacterium leprae

Affects: Superficial tissues (skin, peripheral nerves)

Dx: Acid fast bacillus smear on skin bx

Tx: Dapsone & rifampin & clofazimine x 2-3 years

96
Q

CMV = HHV#?,

A

Cytomegalo = 5 sylab = HHV 5

One of ToRCH infections
Most people have it (70%) but only causes disease in immunosuppressed pt

CP:
Primary dz - moast ASX, or mono-like illness

Reactivation (CD4<50)- retinitis (scrambled eggs/ketchup appearance), esophagitis (large superficial ulcers on endoscopy)

Tx: Gancyclovir

97
Q

Congenital CMV

A

One of ToRCH infections - cause blueberry muffin rash (TTP) & petechiae, sensorineural hearing loss, hepatosplenomegaly

98
Q

Dendritic ulcers on slit lamp exam =

A

Herpes keratitis

Tx: antiviral eye drops (trifluridine, vidarabine, ganciclovir) AND oral acyclovir

99
Q

HSV esophagitis on endoscopy?

A

SMALL DEEP ULCERS

CMV = large shallow ulcers

100
Q

Usual description of herpes ulcers on a test

A

Painful, grouped vesicles on an erythematous base

101
Q

Bells palsy a/w which herpes virus?

A

HSV 1

102
Q

MCC encephalitis? Tx?

A

HSV

Tx: IV acyclovir

103
Q

Dx HSV 1/2 in all forms

A

PCR is most sensitive & specific test, also a clinical dx

104
Q

What would a KOH for herpes show? What would a tzanck smear show?

A

KOH - show NOTHING - used for FUNGAL infections DUH

Tzanck smear - would show multinucleated giant cells & intranuclear inclusion bodies

105
Q

Varicella zoster virus - HHV#? clinical manifestations? management?

A

HHV3 - 3 words, #3

Clinical manifestations:
1. Chicken pox:
Primary inf - fever, malaise, begins on face, spreads down - in different stages of healing, vesicles on erythematous base (dew drops on rose petal)

  1. Herpes zoster (shingles) - VZV reactivation along ONE dermatome - UNILATERAL, can disseminate in HIV
  2. Herpes zoster ophthalmalicus- HHV3 infects first division of CN 5 (trigeminal). + HUTCHINSON’s SIGN - lesions on nose usu mean ocular involvement!!! + dendritic lesions on slit lamp if keratoconjunctivitis present
  3. Post-herpetic neuralgia - pain > 3 months, hyperesthesias, decreased sensation - GIVE antivirals w/ in 72 hours of sx onset in zoster to prevent PHN
106
Q

Epstein barr virus (mono) caused by HHV#? CP, Dx, Tx

A

Etio: HHV4 - mono = 4 letters, & is #4

“kissing disease” 80% adults are seropositive

CP: Fever, sore throat, & POSTERIOR cervical LAD, malaise, myalgias, splenomegaly

Dx: Heterophile (monospot) Ab test (positive w/in 4 weeks)

CBC w/ diff (or smear) will show > 10% atypical lymphocytes

Tx: Supportive, avoid trauma & contact sports

107
Q

Rabies

A

Def = life-threatening infection of the CNS (encephalitis of grey matter)

Infected saliva from bites of rabid animals - raccoons, bats, skunks, foxes, wolves dogs (NOT RODENTS)

108
Q

If person slept in room where later discovered a bat - do they receive rabies PPX?

A

YES - even if no visible bite mark seen - goes thru axons from peripheral to central nervous system w/ incubation 3-7 weeks so too late if don’t get PPX

109
Q

CP Rabies

A
  1. Prodrome - pain, itching, paresthesisas at initial site of bite is pathognomonic
  2. CNS phase - encephalitis, arophobia, hydrophobia, numbness, paralysis
  3. Respiratory phase - respiratory muscle paralysis = death

RABIES = PCR - prodrome, CNS infection, RESP paralysis

110
Q

Dx rabies

A

Quarantine the animal for 7-10 days if you can - NEGRI bodies in brain of dead animals

111
Q

Tx rabies

A

Once sx occur, you’re fucked - induce coma & give amantadine & ribavirin

112
Q

PEP Rabies, first episode

A 
PEP rabies = 
Rabies vaccine (HDCV) on days 0, 3, 7, 14 - HDCV = 4 letters, need 4 doses (immunocomp add one dose on day 28)

AND

Rabies immunoglobulin (1/2 in wound, 1/2 IM)

This is all ideally started w/in 6 days of exposure

113
Q

PEP for rabies if have already been bitten in past & received PEP once

A

Only need rabies vaccine, two doses, no immunoglobulin needed

114
Q

Smallpox classic presentation

A

Flu-like prodrome with SIMULTANEOUS SKIN eruptions - palmar and plantar lesions common - spreads TRUNK to extremities (varicella spreads head down & spares palms/soles)

Tx: supportive, isolate & vaccinate all contacts

115
Q

West nile fever - etio, CP, tx

A

Etio: Flavivirus (type of arbovirus)- birds = reservoir, mostquitos transmit to humans, homeless at increased risk

CP: Most ASX, flu-like - HA, fatigue, nausea, vomiting, stiff neck, AMS

Tx: Supportive

116
Q

SARS (severe, acute, respiratory syndrome) - etio, CP, tx

A

Coronavirus - respiratory droplet transmission

Causes: atypical PNA, non-specific flu-like symptoms, pharyngitis

Dx: TR-PCR for CARS-CoV in urine, stool & nasal secretions - STOOL is the first to be positive

Management: aggressive supportive management

117
Q

Creutzfeldt-jakob disease - etio? CP?

A

PRION - mediated degenerative grain disease that leads to rapidly-progressing dementia - fatal w/in 1 year

Patho: Prion enters cells = misfolding = holes in tissues = spongioform cortex

Myoclonus, marked gait abnormalities

118
Q

HIV acute seroconversion CP

A

Flu-like illness, fever, malaise, generalized rash, generalized LAD

119
Q

AIDS CP

A

Defined as CD4 count < 200 or the development of aids-defining illness with or without HIV testing

Recurrent & potentially severe life-threatening opportunistic infections or malignancies

HIV wasting syndrome (chronic diarrhea & weight loss)

AIDS-associated neurologic changes - encephalopathy or dementia

120
Q

Dx HIV

A

Antibody testing:
- ELISA (screening test) - if reactive, confirmed w/ western blot - person usu reactive w/in 3-6 mo

  • Rapid testing: blood or saliva

HIV RNA VIRAL LOAD - used mainly to monitor infectivity & treatment effectiveness in pt already dx w/ HIV

121
Q

CD4 200-500 HIV - opportunistic infections that start causing an issue

A

Tuberculosis!!! - treat w/ INH if latent TB

Kaposi sarcoma, thrush, lymphoma, zoster

122
Q

CD4 count < 200 in HIV ….worry about?

A

PCP - can initiate PPX with bactrim

123
Q

CD4 count < 150 in HIV …worry about?

A

HIstoplasmosis - PPX with Itraconazole

124
Q

CD4 count < 100 in HIV..worry about?

A
  • Toxoplasmosis - PPX w/ bactrim
    (Note: **Different than tx - tx = sulfaziazene w/ pyrimethazine - causes then ring-enhancing lesions on MRI)
  • Cryptococcus - PPX w/ fluconazole
125
Q

CD4 count < 50 in HIV…worry about?

A

MAC - Azithromycin

CMV retinitis - valganciclovir

126
Q

PEP to HIV

A

Used in pt w/ high risk of infection (occupational exposure) - best if started w/in 72 hours - earlier the better

We offer PEP to HCP with a percutaneous mucous membrane or nonintact skin exposure to blood or bloody body fluids of a patient with known HIV infection. If the HIV status of the source patient is unknown, we offer PEP while awaiting HIV testing, particularly if the source patient is at high risk for HIV infection (eg, injection drug users, men who have sex with men) or has symptoms suggesting HIV infection. If the source patient cannot be identified (ie, HIV testing not possible), we offer PEP if the exposure occurred in a high-risk setting (eg, a needlestick from a sharps container in an HIV clinic or a needle exchange program)

127
Q

HIV ARV treatments for naive patients

A

NNRTI + 2 NRTI or…
PI + 2 NRTI or…
INSTI + 2 NRTI

NRTI =
Zidovudine, Emtricitabine, abacavir, tenofivir

NNRTI =
Efevirenz, delavirdine, etravirine, nevirapine, rilpivirne

Proteas inhibitors (PI) - all end in - NAVIR: 
Atazanavir, indinavir

INSTI = integrase inhibitor =
Raltegravir, dolutegravir

128
Q

Measles vs German measles

A

O looks like a C & its in RubeOla - one L, measles = one word

Rubella = two L’s = two words (german measles) - german’s are tough, not as bad of an infection - just some post-cervical & post-auricular LAD & LIGHT pink rash. Measles you turn into a red brick as maculopapular rash convalesces

3 C’s - cough, conjunctivitis, coryza & Koplick spots - rubeOla - measles

Rubella - german measles - two LL’s = light pink rash, lighter sx - 3d rash & no long term sequelae - BUT congenital rubella = teratogenic (ToRCH infection)

Rubeola - measles = can have significant M&M if it causes PNA or encephalitis in kids

129
Q

Roseola - CP

A

Fever and rash, surprise surprise..

However Roseola = HIGH fever for 3 days - child is well-appearing during this time - pink maculopapular BLANCHING rash

Only childhood rash that STARTS ON TRUNK - then goes to face

Measles = starts on hair line & spreads to face extremities

Chicken pox - starts on face & descends - spreads down

RMSF - starts on wrists & spreads centrally

130
Q

Erythema infectiosum

A

AKA 5th disease - caused by PARVO (5 letters) virus

Red flushed face - “slapped cheek” like been slapped by hand w/ 5 fingers - also lacy reticular rash on the body - ALL OTHERS ARE maculopapular - so if see “lacy reticular” then think erythema infectiosum

131
Q

Hand, foot & mouth disease

A

Coxsackie A virus

Fever, URI - vesicular lesions w/ erythematous base w/ an erythematous halo in oral cavity - vesicles on hands, feet, mouth, genitals

Seen more in summer

132
Q

Scalded skin syndrome

A

S. aureus exotoxin

Kids < 6 YO

+ NIKOLSKY SIGN = sloughing of skin with gentle pressure

PAINFUL diffuse red rash begins centrally

*PANCE by subspecialty (22 decks)

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