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Internal Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Clinical Presentation of Acute HIV Infection?

A
  • Mucocutaneous Ulcerations (oral, anal, penis, esophagus)
  • Rash after fever
  • Adenopathy
  • Nausea, Diarrhea, Weight Loss
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2
Q

Clinical Presentation of Chronic HIV Infection?

A
  • Oropharyngeal/Vulvovaginal Candidiasis
  • Oral Hairy Leukoplakia
  • Seborrheic Dermatitis
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3
Q

AIDS defining maligancies?

A
  • Kaposi sarcoma
  • Cervical/ Anal Cancer
  • Non-Hodgkin Lymphomas/ CNS Lymphoma (EBV)
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4
Q

Initial test for HIV testing?

A

HIV 1/2 Immunoassay

detects HIV p24 antigen and HIV antibodies

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5
Q

Most common antibiotics that cause C. difficle? (4)

A
  • Clindamycin
  • Cephalosporins
  • Ciprofloxacin
  • Co-amoxiclav (Augmentin/Amoxicillin+Clavulanate)
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6
Q

Another pharmacologic group that causes C. difficle?

A

Gastric acid suppressors

  • PPIs
  • H2 receptor inhibitors
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7
Q

Clinical Presentation of C. Difficle?

A
  • Watery Diarrhea
  • Lower abdominal Pain
  • Fever
  • Leukocytosis
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8
Q

Criteria for Systemic Inflammatory Response Syndrome?

A
  • HR > 90
  • Hypo or Hyperthermia
  • High or Low WBCs
  • Tachypnea
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9
Q

Risk factors for Sepsis:

A
  • Bacteremia
  • Advanced age
  • Diabetes
  • Cancer
  • Immunosuppression
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10
Q

What is the differentiation separates Septic Shock from Sepsis?

A

Septic Shock requires Hypotension that is refractory to fluid resuscitation

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11
Q

Laboratory Findings of Sepsis?

A
  • Elevated Lactic Acid
  • Increased BUN/Cr Ratio
  • Elevated Liver Enzymes
  • Leukocytosis or Leukopenia
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12
Q

Important Diagnostic Tests for Sepsis?

A

Blood, Urine, Sputum cultures

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13
Q

Most common pathogens in Nosocomial Sepsis? And Treatment

A
  • MRSA (Vancomycin, Linezolid)
  • Pseudomonas (Piperacillin-Tazobactam)
  • E. coli (Ciprofloxacin)
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14
Q

Treatment for Sepsis?

A
  • Broad Spetrum Antibiotics
  • IV Fluids
  • Pressors (Norepinephrine)
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15
Q

Common Pathogens for UTI?

A

SSEEK PP

  • S. Saprophyticus (young sexually active women)
  • Serratiamarcescens(red pigment)
  • E. coli(most common) &Enterococci
  • Enterobacter cloacae
  • Klebsiella pneumonia
  • Proteus mirabilis(urine smells like ammonia)
  • Pseudomonas aeruginosa(blue-green pigment, usually nosocomial)
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16
Q

Clinical Presentation of UTIs?

A
  • Frequency
  • Dysuria
  • Urgency
  • Suprapubic Pain
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17
Q

When is a urine culture/analysis indicated in women?

A
  • Complicated Cystitis
  • Pyelonephritis
  • Pregnancy
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18
Q

Urinalysis results for a patient with a UTI?

A
  • Elevated Nitrites
  • Increased Leukocyte Esterase
  • WBCs
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19
Q

Complications of a UTI (cystitis)?

A
  • Pyelonephritis
  • Renal Failure
  • Abscesses
  • Sepsis
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20
Q

Treatment for Uncomplicated Cystitis?

A
  • TMP-SMX (3 days)
  • Nitrofurantoin (5 days)
  • Fosfomycin (single dose)
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21
Q

Treatment for Complicated Cystitis?

A

Flouroquinolones

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22
Q

Treatment for Asymptomatic Bacteremia or Cystitis in Pregnant Women?

A
  • Nitrofurantoin
  • Cephalexin
  • Amoxicillin-clavulanic acid
  • Fosfomycin
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23
Q

Pathogens of Pyelonephritis?

A
  • E. coli*
  • Klebsiella
  • S. saprophyticus
  • Proteus
  • Candida
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24
Q

Clinical Presentation of Pyelonephritis?

A
  • Flank pain
  • Costovertebral tenderness
  • Urinary symptoms (frequency, dysuria, urgency)
  • Chills
  • Nausea, vomiting
  • Fever
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25
Q

Urine Analysis Findings in Pyelonephritis?

A
  • WBC Casts

- 100,000 colony units

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26
Q

Other Lab Findings in Pyelonephritis?

A
  • Elevated ESR and C-reactive Protein

- Elevated WBCs

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27
Q

Complications of Pyelonephritis in Pregnant Women?

A
  • Premature Labor

- Low birth weight

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28
Q

Treatment of Pyelonephritis?

A

1-2 days of the following:

  • IV Flouroquinolones
  • IV Aminoglycosides
  • IV Cephalosporins
  • Oral Antibiotics

2-3 weeks in complicated Pyelonephritis

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29
Q

Layers of the skin affected in Cellulitis vs. Erysipleas?

A

Cellulitis: Deeper dermis & subcutaneous fat
Erysipleas: Upper dermis & superficial lymphatics

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30
Q

Clinical Presentation of cellulitis or erysipelas?

A
  • Erythema
  • Edema
  • Warmth
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31
Q

Distinguishing feature of erysipleas from cellulitis?

A

Erysipleas has a well-demarcated edge that is raised compared to the surrounding skin.

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32
Q

Treatment of Cellulitis?

A
  • Clindamycin
  • Amoxicillin plus TMP-SMX
  • Amoxicillin plus tetracycline
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33
Q

Treatment of Erysipleas with systemic symptoms (fever, chills)? Without?

A

With systemic symptoms:
- IV Ceftriaxone, Cefazolon

Without Systemic symptoms:
- Oral Penicillin/Amoxicillin

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34
Q

Lymphogranuloma venerum is caused by which pathogen?

A

C. trachomatis

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35
Q

Clinical Presentation of the first stage of Lymphogranuloma venerum?

A
  • Malaise
  • Headache
  • Fever
  • Papule formation at contact site that transforms to a painless ulcer, healing after a few days
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36
Q

Clinical Presentation of the Second Stage of Lymphogranuloma venerum?

A

Inguinal buboes (enlarged, painful lymph nodes)

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37
Q

Clinical Presentation of the Third Stage of Lymphogranuloma venerum?

A
  • Proctocolitis
  • Rectal stricture
  • Rectovaginal fistula
  • Elephantiasis (swelling due to lymphatic obstruction)
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38
Q

Treatment for Lymphogranuloma venerum?

A
  • Doxycycline
  • Azithromycin
  • Erythromycin
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39
Q

Granuloma inguinale is caused by which pathogen?

A

Klebsiella granulomatis

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40
Q

Clinical Presentation of Granuloma inguinale?

A

Genital nodule that turns into painless, friable ulcer (with beefy red base and irregular borders)

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41
Q

Diagnositic test for Granuloma inguinale?

A

Ulcer biopsy positive for Donovan bodies (red encapsulated intracellular bodies)

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42
Q

Treatment for Granuloma inguinale?

A

3 week course of:

  • Doxycycline or
  • Trimethoprim-SMX
43
Q

Clinical Presentation of Cervicitis?

A

Largely Asymptomatic

  • Purulent vaginal discharge
  • Cervical Friability
  • Dyspareunia
  • Dysuria
  • Vaginal Irritation
44
Q

Most common pathogens that cause Cervicitis?

A
  • Chlamydia

- Gonnorrhea

45
Q

Diagnostic tests for Chlamydia and Gonnorrhea?

A
  • NAAT
  • Gram stain (Gram neg. diplococci–> Gonnorrhea)
  • Culture on Thayer-Martin agar (Gonnorrhea)
46
Q

Complications of Cervicitis/ Chlamydia and Gonnorrhea Infections?

A
  • Pelvic Inflammatory Disease (PID)
  • Reactive Arthritis (Chlamydia)
  • Septic Arthritis (Gonnorrhea)
47
Q

Treatment of Cervicitis?

A
  • Ceftriaxone

- Azithromycin or Doxycycline

48
Q

Clinical Presentation of Pneumocystis jirovecii (PCP)?

A
  • Non-productive cough
  • Fatigue
  • Chills
  • Fever

Common in HIV patients with CD4 < 200

49
Q

Chest X-ray and CT findings in PCP?

A

Chest X-ray: Bilateral ground glass infiltrates

CT: Patchy or Nodule Ground Glass attenuation

50
Q

Diagnostic Test for PCP?

A

Bronchoalveolar lavage with Silver stain

51
Q

Complication of PCP?

52
Q

Treatment for PCP?

A

Trimethoprim-SMX

Add corticosteriods for severe disease

53
Q

Treatment for PCP in patients with a sulfa allergy?

A
  • Dapsone
  • Atovaquone — preferred for mild disease
  • Pentamidine — in severe disease
  • Clindamycin plus primaquine — in moderate or severe disease
54
Q

Clinical Presentation of Lyme Disease?

A

FACE

  • Facial Nerve Palsy
  • Arthritis
  • Cardiac Block
  • Erythema Migrans (Bull’s eye rash)
55
Q

Classic triad of neurologic symptoms in early disseminated Lyme Disease (Stage 2)?

A
  • Menigitis
  • Cranial nerve palsy
  • Radiculoneuropathy
56
Q

Clinical Presentation of Stage 3 Lyme Disease?

A
  • Large jointarthritis
  • Chronic synovitis
  • Subacute encephalopathy
  • Polyneuropathy
57
Q

Diagnostic tests for Lyme Disease?

A
  • ELISA/ Immunoassay

- Western Blot

58
Q

Treatment for Stage 1 (Early Localized) Lyme Disease?

A
  • Doxycycline* (Not for pregnancy or children)
  • Amoxicillin
  • Cefuroxime
    14 day regimen
59
Q

Treatment for Stage 2 (Early Disseminated) Lyme Disease?

A
  • Ceftriaxone
  • Cefotaxime
  • Pencillin D
60
Q

Endemic area of Blastomycosis?

A

Southeastern region of USA

Mississippi River Valley

61
Q

Clinical Presentation of Blastomycosis?

A
  • Acute/Chronic Pneumonia (Cough, hemoptysis, Chest pain)
  • Extrapulmonary disease (Verrucous gray/purple skin lesions w/ irregular borders)
  • Asymptomatic
62
Q

Diagnostic tests of Blastomycosis?

A

Broad-base budding yeast cells from Bronchial lavage

63
Q

Treatment for Blastomycosis?

A
  • Itraconazole

- Amphotericin B (for Severe Disease)

64
Q

Transmission of coccidiodes?

A

Through inhalation of spores through dust exposure

large spherule containing endospores

65
Q

Endemic area of Coccidiodes?

A

Desert areas in western USA, Mexica, and Central America

66
Q

Clinical presentation of Coccidiodes?

A
  • Community-acquired Pneumonia

- Erythema nodosum and multiforme

67
Q

Disseminated Coccidiodes can be found where in the body?

A
  • Skin, Soft tissue
  • Skeleton
  • Meninges
68
Q

Treatment for Coccidiodes?

A
  • Itraconazole

- Amphotericin B (severe infxn)

69
Q

Endemic areas for Histoplasmosis?

A

Missouri, Ohio, or Mississippi River Valleys

70
Q

Transmission of Histoplasmosis?

A

Dimorphic fungus with septate hyphae that is found inside macrophages. Transmitted through bat and bird droppings

71
Q

Clinical presentation of Histoplasmosis?

A
  • Flu-like symptoms
  • Pleuritic Chest Pain
  • Bronchopneumonia
72
Q

Diagnostic tests for Histoplasmosis?

A
  • Urine and serum antigen immunoassays (screening)

- Biopsy of lungs or lymph nodes showing granulomas

73
Q

Complications of Histoplasmosis?

A
  • Liver and Splenic Calcification
74
Q

Treatment of Histoplasmosis?

A
  • Itraconazole

- Amphotericin B (Severe infxn)

75
Q

Risk factors of TB in the US?

A
  • Immunosuppression (HIV, malnourishment, immunosuppressants, advanced age)
  • Underlying pulmonary disease (silicosis, COPD)
  • Substance misuse disorder (EtOH, tobacco, illicit drugs)
  • Systemic diseases (diabetes mellitus, hematologic malignancies, head & neck cancer)
76
Q

Complications of TB?

A
  • Spread to Bone (Pott’s Disease)

- Meningitis

77
Q

Clinical Presentation of TB?

A
  • Cough
  • Hemoptysis
  • Fever
  • Dyspnea
  • Weight loss
  • Night Sweats
78
Q

Diagnostic tests for TB besides PPD?

A
  • Acid Fast Stain

- Culture of sputum

79
Q

Chest X-ray findings in primary and reactivated TB infection?

A

Primary: Lower Lobe infiltrates
Reactivation: Upper Lobe Infiltrates with cavitations and fibronodular infiltrates

80
Q

Treatment for TB?

A

RIPE

  • Rifampin
  • Isoniazid (Give Vit B6)
  • Pyrazinamide
  • Ethambutol

R & I for 6 months
P & E for 2 months

81
Q

Complications of Varicella Simplex Virus in Immunocompromised patients?

A
  • Encephalopathy
  • Retinitis
  • VSV Pneumonia
82
Q

Treatment for Shingles?

A
  • Acyclovir
  • Analgesics
  • Corticosteriods
83
Q

At what age is the Shingles vaccine recommended?

A

50 yrs old and older

Recombinant Zoster vaccine is preferred

84
Q

Complications of Varicella in all patients?

A

Post-infectious Neuralgia- long lasting pain

85
Q

Main causes of Pelvic Inflammatory Disease?

A

Untreated STD infections

86
Q

Risk Factors of PID? (4)

A
  • Multiple partners
  • Recent history of douching
  • Prior history of PID
  • Cigarette smoking
87
Q

Clinical Presentation of PID?

A
  • Lower abdominal pain with adnexal tenderness
  • Cervical motion tenderness
  • Vaginal bleeding, foul smelling discharge
  • GI distress, Diarhhea
  • Painful Urination
88
Q

Complications of PID?

A
  • Infertility
  • Tubo-ovarian abscess
  • Peri-hepatitis (Fitz-Hugh Curtis syndrome)
89
Q

Ultrasound findings of PID?

A
  • Inflamed enlarged uterus
  • Abscess in fallopian tubes or the ovaries
  • Free fluid in the peritoneum
90
Q

Treatment for PID?

A
  • Ceftriaxone + Doxycycline

- Metronidazole

91
Q

Treatment for Severe PID and Tub-ovarian abscess?

A
  • IV Cefotetan +
  • PO Doxycycline or
  • IV clindamycin + gentamicin
92
Q

Most important risk factor post-partum endometritis?

A

Cesarean section

93
Q

Clinical Presentation of Post-partum endometritis?

A
  • Purulent lochia (discharge after childbirth)
  • Uterine tenderness
  • Midline lower abdominal pain
94
Q

Treatment for Post-partum endometritis?

A
  • IV Clindamycin + Gentamicin

- Vancomycin (For Pencillin allergy)

95
Q

Clinical Presentation of Primary Syphilis?

A
  • Painless nonexudative ulcer witha raised, indurated margin
  • Painlessbilateral inguinal lymphadenopathy
96
Q

Clinical Presentation of Second Syphilis?

A
  • Maculopapular rash on hands and soles
  • Condyloma lata (grey wart-like lesions)
  • Systemic Symptoms (fever, headache, malaise, myalgias)
  • Lymphoadenopathy
  • Hepatitis
  • Alopecia
97
Q

Clinical Presentation of Tertiary Syphilis?

A

Gummatous:
- Ulcers on skin, bone, viscera (mass lesion)

Cardiovascular:
- Endarteritis-> Aorta dilation and Aortic regurgitation

CNS:

  • Meningitis,
  • Tabes dorsalis (Dorsal column demyelination)
  • Argyll-Robertson pupils
  • Stroke w/o HTN
  • Charcot joints
  • Broad based ataxia and Propriaception issues
98
Q

Clinical Presentation of Early Congenitial Syphilis?

A
  • Hepatomegaly (Jaundice, Cholestasis)
  • Rhinitis
  • Maculopapular rash on palms and soles
  • Lymphadenopathy
  • Anemia, Thrombocytopenia
99
Q

Clinical Presentation of Late Congenital Syphilis?

A
  • Frontal bossing
  • Interstitial keratitis
  • Sensorineural hearing loss
  • Hutchinson teethandmulberry molars
  • Rhagadesandgummas
  • Intellectual disability
  • Saber shins
  • Paroxysmal cold hemoglobinuria
100
Q

TORCHES infections that can be transmitted transplacently?

A
  • Toxoplasmosis
  • Rubella
  • CMV
  • HIV
  • Herpes virus
  • Syphilis
101
Q

Diagnostic test for Syphilis?

A
  • Dark field microscopy
  • FTA-ABS (Direct Fluorescent Antibody testing)
  • Serology (RPR and VDRL)
102
Q

Conditions that result in a False Positive on VDRL tests?

A

PVDRL

  • Pregnancy
  • Viral infections (eg, EBV, hepatitis)
  • Drugs(eg, hydralazine, procainamide)
  • Rheumatic fever
  • Lupus, Leprosy
103
Q

Treatment for Syphilis?

A
  • IM Pencillin G
    (Single dose for Primary, Secondary, Latent)
    (1-3 wks for Teritary)
  • Doxycycline for Penicillin allergy*
104
Q

Treatment for Syphilis in pregnant patients with a penicillin allergy?

A

Penicillin desensitization

Internal Medicine (15 decks)

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