Infectious Disease Flashcards
Pathogen responsible for nail-puncture wound through tennis shoe?
Pseudomonas
Best treatment for Ecthyma Gangrenosum?
ABX
Best treatment for Pyoderma Gangrenosum?
Corticosteroids for treatment of underlying Crohn’s Disease
Lab result seen in Salmonella Typhi infection?
Leukopenia … (rather than leukocytosis)
Clinical presentation of Salmonella Typhi infection?
Truncal rose spots that appear ~1 week after fever
Etiology of non-typhoidal salmonella?
Consumption of chicken/eggs
Complication of non-typhoidal salmonella infection?
Atherosclerotic aortic aneurysm
Why should non-typhoidal salmonella NOT be treated with ABX?
Increased risk of carrier state
Vector for yersinia?
Flea
Reservoir of yersinia?
Rodents … (prairie dogs)
Appearance of yersinia on Gram stain?
Safety pin appearance … bipolar staining
2 DOC for yersinia infection?
Streptomycin, Tetracycline
Best treatment for bartonells henselae?
Azithromycin
Clinical presentation of Legionella infection?
PNA, diarrhea, hyponatremia, bradycardia
Treatment of Legionella infection?
Macrolide
Lab result seen in setting of Bordetella infection?
Lymphocytosis
Lab result seen in setting of Rickettsii infection?
Hyponatremia
Cardiac manifestation of Coxiella infection?
Signs of endocarditis
Aspect of HX that predisposes patients to Coxiella infection?
HX of heart valve damage … (murmur)
What is a rickettsial infection that is not caused by classic Rickettsia?
Coxiella
Should you order serology test for patient with suspected Lyme Disease?
No … (takes too long, need to start doxycycline before then)
If a patient discovers tick on body, know it has been there for > 48 hours – what is best management?
1 dose of doxycycline
If a patient discovers tick on body, know it has been there for < 48 hours – what is best management?
Observation
Clinical presentation of stage 2 Lyme disease?
Polyarthritis, Bell’s palsy, Cardiac conduction
Which Cardiac conduction abnormality is associated with stage 2 Lyme disease?
3rd degree heart block
Clinical presentation of stage 3 Lyme disease?
Polyarthritis, Encephalitis
Causative agent of Granuloma Inguinale?
Klebsiella
Appearance of Granuloma Inguinale on biopsy?
Donovan bodies
Description of Granuloma Inguinale?
Beefy red granulomatous ulcer
Appearance of lungs in Primary TB infection?
Calcified hilar LN
___ refers to Calcified hilar LN seen in Primary TB infection?
Gohn Complex
At what level of PPD induration should patients be treated with isoniazid if they have had recent TB contacts?
> 5mm induration
At what level of PPD induration should patients be treated with isoniazid if they have HIV?
> 5mm induration
How long should latent TB patients be treated with Isoniazid?
9 months
32 yo Indian immigrant presents for PPD test that showed 11mm of induration; Reports HX of BCG vaccination in home country – next step?
CXR + sputum culture
At what level of PPD induration should patients be treated with isoniazid if they have HX of BCG vaccination?
> 10mm induration
Next step of workup for patients with (+) PPD?
CXR + Sputum culture
Next step of workup for patients with (+) PPD; (-) CXR and (-) Sputum culture?
Isoniazid for 9 months
Next step of workup for patients with (+) PPD; (+) CXR and (+) Sputum culture?
RIPE therapy … 4 drugs for 2 months; 2 drugs for 4 months
What are the 2 TB drugs that should be given for 4 months?
Isoniazid + Rifampin
AEs of streptomycin?
Nephrotoxicity, Ototoxicity
Treatment of Coccidioidomycosis?
Amphotericin B
3 aspects of clinical presentation for Coccidioidomycosis?
Sarcoid-like … Pulmonary lesions + Arthralgias + Erythema nodosum
3 aspects of clinical presentation for Histoplasmosis?
Interstitial PNA, Splenomegaly, Pancytopenia
Appearance of spleen in Histoplasmosis?
Calcified
2 aspects of clinical presentation for Blastomycosis?
Skin + Bone involvement
Best treatment for aspergilloma (fungal ball)?
Surgical removal
Clinical presentation for aspergilloma (fungal ball)?
Massive hemoptysis
Aflatoxin (aspergillus flavus) is a risk factor for which type of CA?
Liver
Best treatment for allergic bronchopulmonary aspergillosis?
Steroids + Oral itraconazole
Which type of Aspergillus infection in most common in immunocompromised patients?
Invasive pulmonary aspergillosis
Clinical presentation of Schistosoma mansoni?
Cirrhosis, portal HTN, varices
Clinical presentation of Schistosoma hematobium?
Squamous cell bladder CA
Clinical presentation of Diphyllbothrium latum?
Megaloblastic anemia
Alternate name for Diphyllbothrium latum?
Fish tapeworm
Alternate name for Enterobius vermicularis?
Pinworm
50 yo male with AML presents with fever; Finished CTX 10 days ago; Indwelling catheter with no redness or discharge; Labs show PML = 250 – next step in workup?
Draw blood and start IV piperacillin/tazobactam + IV aminoglycoside … covering for Pseudomonas
50 yo male with AML presents with fever; Finished CTX 10 days ago; Indwelling catheter with no redness or discharge; Labs show PML = 250; Patient is started on IV piperacillin/tazobactam + IV aminoglycoside – fever does not resolve after 5-7 days … what is next step in management?
Add Amphotericin B
Which 4 pathogens are most likely to infect patients with humoral deficiency?
Encapsulated organisms … Strep pneumoniae, Haemophilus influenza, Neisseria meningitis, Giardia
2 bacteria that affect patients with T cell deficiency?
Listeria, Nocardia
2 fungi that affect patients with T cell deficiency?
Histoplasma, Cryptococcus
2 protozoa that affect patients with T cell deficiency?
Pneumocystis carinii, Toxoplasma, Strongyloides
2 viruses that affect patients with T cell deficiency?
CMV, Varicella, HSV
Best treatment for Gonococcal arthritis?
IV ceftriaxone for 7-10 days
Schedule for Hepatitis B vaccine?
Birth, 1-2 months, 6-18 months
Best treatment for infants born to mothers with (+) HBsAg?
Hep B IgG, Hepatitis B vaccine
What type of vaccine is Hepatitis B?
Inactivated
What type of vaccine is Rotavirus?
Live attenuated
Route of administration for Rotavirus?
Oral
Schedule for Rotavirus vaccine?
2 months, 4 months, 6 months
Rotavirus vaccination should not be started on infants older than the age of …
15 weeks
AE of Rotavirus vaccination?
Intussusception
Schedule for DTap vaccine?
2 months, 4 months, 6 months, 15-18 months, 4-6 years
AE of DTap vaccine?
Encephalopathy
Schedule for Haemophilus Influenzae vaccine?
2 months, 4 months, 6 months
When is Haemophilus Influenzae booster vaccine given?
12-15 months
Schedule for PCV13 pneumococcal vaccine?
2 months, 4 months, 6 months
When should PCV13 pneumococcal booster vaccine be administered?
12-15 months
Indication of PPSV23 pneumococcal vaccine?
Immunocompromised
Schedule for PPSV23 pneumococcal vaccine?
After completing PCV13 vaccine (2 yo), then 7 yo
Schedule of Polio vaccine?
2 months, 4 months, 6-18 months, 4-6 years
Schedule of MMR vaccine?
12-15 months, 4-6 years
What type of vaccine is MMR?
Live attenuated
Contraindication to MMR vaccine?
Immunodeficiency
Schedule of Varicella Zoster vaccine?
12-15 months, 4-6 years
Important consideration for patients 6 weeks after receiving VZV vaccine?
Avoid ASA … (risk for Reye Syndrome)
Schedule for Hepatitis A vaccine?
Given between 12-24 mo (with 6 months between doses)
When may intranasal flu vaccine be administered?
2+ yo
Important consideration for patients 6 weeks after receiving influenza vaccine?
Avoid ASA … (risk for Reye Syndrome)
When is Tdap virus first given?
11-12 yo
How often is Tdap given?
Every 10 years
Contraindication to Tdap vaccine?
HX of encephalopathy
Timing of first meningococcal vaccine?
11-12 yo
Timing of first meningococcal booster?
16 yo
Which group of patients should receive meningitis vaccine before 11 yo?
Travelling to endemic region, Asplenia, Complement deficiency
Medication that allows for patients should receive meningitis vaccine before 11 yo?
Eculizumab
MOA of Eculizumab?
C5 inhibitor
When should HPV vaccine be given?
11-12 yo (with 6 months between doses)
Coagulase (+) staphylococcus?
Staph aureus
Coagulase (-) staphylococcus?
Staph epidermidis, Staph saprophyticus
What type of toxin is TSST-1 in Toxic Shock Syndrome due to Staph aureus?
Exotoxin
Most common type of nosocomial infection?
UTI
What is best ABX for treatment of post-influenza Staph aureus PNA?
IV nafcillin … (this is MSSA)
3 outpatient treatments for MRSA?
Clindamycin, TMP-SMX, Doxycycline
Common pathogen responsible for post-partum endometritis?
GBS
Which virulence factor is responsible for Scarlet fever cause by Strep pyogenes?
Exotoxin A-B-C
Which virulence factor is responsible for Necrotizing Fasciitis cause by Strep pyogenes?
Exotoxin B
Which ABX is important to add to cases of Necrotizing Fasciitis?
Clindamycin
In a patient with Toxic Shock Syndrome (hypotension, desquamating rash, thrombocytopenia, prolonged PTT) – how can you tell between TSS due to Strep pyogenes vs. Staph aureus?
Strep pyogenes = (+) culture; Staph aureus = (-) blood culture
32 yo male develops dry cough for 2 days; No exudate, no fever, no LAD – next step?
Observe … strep pharyngitis = fever, no cough, LAD, exudate
Patient presents with mucopurulent urethral discharge, multiple sexual partners, absence of bacteria on UA – diagnosis?
Chlamydial urethritis
In addition to strep bovis, which bacteria is associated with colon CA?
Clostridium septicum
Most common pathogen responsible for subacute bacterial endocarditis in native valves in patients without drug use HX?
Streptococcus viridans
Strep pneumoniae is most common cause of which 2 conditions in adults?
Pneumonia, Meningitis
3 DOCs for treatment of bacterial meningitis?
vanComycin, Corticosteroids, Ceftriaxone
Leading cause of invasive bacterial respiratory disease in patients with HIV infection?
Strep pneumoniae … (not PCP)
Best treatment for suspected meningitis caused by Listeria (patient is on chronic steroids)?
Ampicillin + Ceftriaxone + Vancomycin
Best treatment for Cornyebacterium Diphtheria?
Erythromycin + Diphtheria toxin
Complication of Cornyebacterium Diphtheria infection?
Myocarditis
Clinical presentation of Cornyebacterium JK infection?
IV catheter infection in bone marrow transplant
Best treatment for Cornyebacterium JK infection?
Vancomycin
Toxin used by Clostridium perfringens in setting of necrotizing fasciitis?
Lecithinase … phopholipidase
Etiology of neonatal tetanus?
Umbilical stump infection
Does tetanus infection induce protective immunity?
No … need to give vaccine after tetanus infection
If patient is diagnosed with C. diff infection, but unable to take medications orally – what is DOC?
IV metronidazole
Cutaneous manifestation of Bacillus anthracis infection?
Painless black ulcers
Best treatment for Cutaneous Bacillus anthracis infection?
Ciprofloxacin
Pulmonary manifestation of Bacillus anthracis infection?
Hemorrhagic mediastinitis
Clinical presentation of Hemorrhagic mediastinitis in Bacillus anthracis infection?
Widened mediastinum
Best treatment for Pulmonary Bacillus anthracis infection?
Ciprofloxacin + Tetracycline
Route of transmission for Pulmonary Bacillus anthracis infection?
Spore inhalation … not person-to-person transmission like PNA
Best treatment for bacillus cereus gastroenteritis?
Supportive
Best treatment for bacillus cereus eye trauma?
Vancomycin
Oxygen requirement of Nocardia?
Aerobe
Oxygen requirement of Actinomyces?
Anaerobe
Which is acid-fast staining – Nocardia or Actinomyces?
Nocardia
In addition to dental procedures, what is another exposure that might lead to infection with Actinomyces?
IUD insertion
Clinical presentation of Nocardia infection?
Abscess in lungs + brain
Best treatment for Nocardia infection?
TMP
Most common infectious cause of blindness in developed world?
HSV-1 keratitis
Complication of HSV-1?
Encephalitis
Classic smell associated with HSV-1 encephalitis?
Smell of burning runner
Complication of HSV-2?
Meningitis
Structure of Sporotrichosis on tissue culture?
Cigar-shaped yeast
What should you NOT do in Franciscella infection?
Aspirate the LN
Patient presents with non-healing ulcer after working around fish tank – pathogen responsible?
M. marinum
Pathogen most likely to cause genital herpes?
HSV-2
Best treatment for pregnant female with genital lesions?
C-Section
AE of valacyclovir?
Nephrotoxicity
Complication of HHV-6 treated with ASA?
Reye Syndrome
Is hairy leukoplakia seen in patients with HIV infection pre-malignant?
No
How can you differentiate varicella (chickenpox) from smallpox?
Smallpox = same stage; Varicella chickenpox = all different stages
Which specific type of immunodeficiency results in Varicella-Zoster Virus reactivation?
T cell deficiency
Which branch of CN V1 accounts for Hutchinson sign in VZV reactivation?
Nasociliary
3 aspects of clinical presentation in Ramsay Hunt Syndrome?
Ear pain, ipsilateral facial weakness, Vesicular lesions on external ear
Ramsay Hunt Syndrome results from reactivation of VZV from within …
Geniculate ganglion
Appearance of Tzanck smear in VZV infection?
Multinucleated giant cells
2 DOC for post-herpetic neuralgia?
TCA, gabapentin
Value of treating herpes zoster infection with acyclovir?
Shortened course of illness, but does not decrease incidence of post-herpetic neuralgia
Which 2 medications can decrease the likelihood of post-herpetic neuralgia?
Famicyclovir, Valacyclovir
Which pathogen is most commonly responsible for ocular complications in HIV patients?
CMV
Ocular effect of CMV in HIV patients?
Chorioretinitis
AE of ganciclovir?
Granulocytopenia
Appearance of EBV infection on blood smear?
Atypical lymphocytes … indentation of cytoplasm (ballerina skirt)
3 malignancies associated with EVB infection?
Nasopharyngeal carcinoma, Burkitt lymphoma, Hodgkin Lymphoma
Flu vaccination decreases influenza mortality by about ___%
33
Amatidine is effective against Influenza A or Influenza B?
A
Oseltamivir is effective against Influenza A or Influenza B?
Both
MOA of Oseltamivir in treatment of Influenza A and B?
Neuraminidase inhibitor
Best treatment for patients in nursing home in which influenza infection is spreading?
Give oseltamivir to slow spread of infection … No point in giving influenza vaccination … Only effective in preventing spread of influenza on population basis
Antigenic ___ in influenza infection is responsible for minor spontaneous mutations of HA or NA
Drift
Antigenic ___ in influenza infection is responsible for major changes in viral RNA segments
Shift
Which is responsible for yearly flu endemic infections – drift or shift?
Drift
Which is responsible for yearly flu pandemic infections – drift or shift?
Shift
Which group of patients should receive pre-exposure rabies prophylaxis?
Veterinarians
Patient is attacked by animal (thinks it was a raccoon) – should you start with rabies IgG + vaccination?
Yes
Hint for West Nile infection?
Dead birds
Vector for West Nile infection?
Aedes mosquito
In addition to Parvovirus B19, what are 2 other causes of Red Cell Aplasia?
Diamond-Blackfan Anemia … Thymoma
Which cells are targeted by HIV?
CD4+ T cells
Acute retroviral syndrome in HIV infection mimics …
Infectious mononucleosis
Majority of HIV spread occurs in …
Heterosexual patients … but homosexual sexual behavior is higher risk
Is HIV or Hepatitis B more likely to be transferred via needle stick?
Hepatitis B … 1:3
Best management of needlestick from known HIV patient?
Begin HAART therapy for 1 month
Best test for diagnosis of HIV infection?
ELISA, confirm with Western Blot
4 infectious diseases that should be screened for in newly-diagnosed HIV patients?
Syphilis, toxoplasma, Hepatitis B + C
Which 3 vaccines are contraindicated in all HIV patients?
Polio, varicella, yellow fever
Which vaccine is contraindicated in HIV patients with CD4 < 200?
MMR
Best management of pregnant HIV patient?
Begin zidovudine after 10-12 weeks (regardless of CD4 count) + IV zidovudine during delivery + Zidovudine for infant for 6 weeks
CD4 count associated with CD4 < 200?
Pneumocystis jiroveci
Best prophylaxis for Pneumocystis jiroveci?
TMP-SMX
Best prophylaxis for Pneumocystis jiroveci in patient with TMP-SMX allergy?
Dapsone
CD4 count associated with CD4 < 100?
Toxoplasma
Best prophylaxis for Toxoplasma?
TMP-SMX
Best prophylaxis for Toxoplasma in patient with TMP-SMX allergy?
Dapsone
CD4 count associated with CD4 < 50?
Mycoplasma Avium Carinum (MAC)
Best prophylaxis for Pneumocystis jiroveci?
Macrolides
When should HAART therapy be started in HIV patient?
CD4 < 500
3 AEs of AZT therapy?
3 M’s … macrocytic anemia, myelosuppression, myopathy
HAART drug associated with HSN reaction?
Abacavir
3 AEs of Protease inhibitors?
Lipodystrophy, Inhibition of P450, DM
Which HAART drug should be avoided in patients with TB?
Rifampin … use Rifabutin instead
2 examples of Protease inhibitors?
Indinavir, Ritonavir
AE associated with indinavir?
Nephrolithiasis
AE associated with ritonavir?
Lipodystrophy
Most common pathogen causing invasive pulmonary disease in HIV patients?
Strep pneumoniae
Which pathogen is associated with CNS lymphoma in AIDs?
EBV
AE of pentamidine used in treatment of Pneumocystis Jiroveci?
Atypical PNX
3 ring-enhancing lesions of brain in HIV patients?
Toxoplasmosis, CNS lymphoma, Brain abscess
Best treatment for Cryptococcal meningitis?
Amphotericin B until CSF is negative + Oral fluconazole indefinitely
Special stain for Cryptococcal meningitis?
India ink
