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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
Urine Analysis Findings in Pyelonephritis?
- WBC Casts | - 100,000 colony units
26
Other Lab Findings in Pyelonephritis?
- Elevated ESR and C-reactive Protein | - Elevated WBCs
27
Complications of Pyelonephritis in Pregnant Women?
- Premature Labor | - Low birth weight
28
Treatment of Pyelonephritis?
1-2 days of the following: - IV Flouroquinolones - IV Aminoglycosides - IV Cephalosporins - Oral Antibiotics *2-3 weeks in complicated Pyelonephritis*
29
Layers of the skin affected in Cellulitis vs. Erysipleas?
Cellulitis: Deeper dermis & subcutaneous fat Erysipleas: Upper dermis & superficial lymphatics
30
Clinical Presentation of cellulitis or erysipelas?
- Erythema - Edema - Warmth
31
Distinguishing feature of erysipleas from cellulitis?
Erysipleas has a well-demarcated edge that is raised compared to the surrounding skin.
32
Treatment of Cellulitis?
- Clindamycin - Amoxicillin plus TMP-SMX - Amoxicillin plus tetracycline
33
Treatment of Erysipleas with systemic symptoms (fever, chills)? Without?
With systemic symptoms: - IV Ceftriaxone, Cefazolon Without Systemic symptoms: - Oral Penicillin/Amoxicillin
34
Lymphogranuloma venerum is caused by which pathogen?
C. trachomatis
35
Clinical Presentation of the first stage of Lymphogranuloma venerum?
- Malaise - Headache - Fever - Papule formation at contact site that transforms to a painless ulcer, healing after a few days
36
Clinical Presentation of the Second Stage of Lymphogranuloma venerum?
Inguinal buboes (enlarged, painful lymph nodes)
37
Clinical Presentation of the Third Stage of Lymphogranuloma venerum?
- Proctocolitis - Rectal stricture - Rectovaginal fistula - Elephantiasis (swelling due to lymphatic obstruction)
38
Treatment for Lymphogranuloma venerum?
- Doxycycline - Azithromycin - Erythromycin
39
Granuloma inguinale is caused by which pathogen?
Klebsiella granulomatis
40
Clinical Presentation of Granuloma inguinale?
Genital nodule that turns into painless, friable ulcer (with beefy red base and irregular borders)
41
Diagnositic test for Granuloma inguinale?
Ulcer biopsy positive for Donovan bodies (red encapsulated intracellular bodies)
42
Treatment for Granuloma inguinale?
3 week course of: - Doxycycline or - Trimethoprim-SMX
43
Clinical Presentation of Cervicitis?
Largely Asymptomatic - Purulent vaginal discharge - Cervical Friability - Dyspareunia - Dysuria - Vaginal Irritation
44
Most common pathogens that cause Cervicitis?
- Chlamydia | - Gonnorrhea
45
Diagnostic tests for Chlamydia and Gonnorrhea?
- NAAT - Gram stain (Gram neg. diplococci--> Gonnorrhea) - Culture on Thayer-Martin agar (Gonnorrhea)
46
Complications of Cervicitis/ Chlamydia and Gonnorrhea Infections?
- Pelvic Inflammatory Disease (PID) - Reactive Arthritis (Chlamydia) - Septic Arthritis (Gonnorrhea)
47
Treatment of Cervicitis?
- Ceftriaxone | - Azithromycin or Doxycycline
48
Clinical Presentation of Pneumocystis jirovecii (PCP)?
- Non-productive cough - Fatigue - Chills - Fever *Common in HIV patients with CD4 < 200*
49
Chest X-ray and CT findings in PCP?
Chest X-ray: Bilateral ground glass infiltrates | CT: Patchy or Nodule Ground Glass attenuation
50
Diagnostic Test for PCP?
Bronchoalveolar lavage with Silver stain
51
Complication of PCP?
SIADH
52
Treatment for PCP?
Trimethoprim-SMX *Add corticosteriods for severe disease*
53
Treatment for PCP in patients with a sulfa allergy?
- Dapsone - Atovaquone — preferred for mild disease - Pentamidine — in severe disease - Clindamycin plus primaquine — in moderate or severe disease
54
Clinical Presentation of Lyme Disease?
FACE - Facial Nerve Palsy - Arthritis - Cardiac Block - Erythema Migrans (Bull's eye rash)
55
Classic triad of neurologic symptoms in early disseminated Lyme Disease (Stage 2)?
- Menigitis - Cranial nerve palsy - Radiculoneuropathy
56
Clinical Presentation of Stage 3 Lyme Disease?
- Large joint arthritis - Chronic synovitis - Subacute encephalopathy - Polyneuropathy
57
Diagnostic tests for Lyme Disease?
- ELISA/ Immunoassay | - Western Blot
58
Treatment for Stage 1 (Early Localized) Lyme Disease?
- Doxycycline* (Not for pregnancy or children) - Amoxicillin - Cefuroxime 14 day regimen
59
Treatment for Stage 2 (Early Disseminated) Lyme Disease?
- Ceftriaxone - Cefotaxime - Pencillin D
60
Endemic area of Blastomycosis?
Southeastern region of USA | Mississippi River Valley
61
Clinical Presentation of Blastomycosis?
- Acute/Chronic Pneumonia (Cough, hemoptysis, Chest pain) - Extrapulmonary disease (Verrucous gray/purple skin lesions w/ irregular borders) - Asymptomatic
62
Diagnostic tests of Blastomycosis?
Broad-base budding yeast cells from Bronchial lavage
63
Treatment for Blastomycosis?
- Itraconazole | - Amphotericin B (for Severe Disease)
64
Transmission of coccidiodes?
Through inhalation of spores through dust exposure | large spherule containing endospores
65
Endemic area of Coccidiodes?
Desert areas in western USA, Mexica, and Central America
66
Clinical presentation of Coccidiodes?
- Community-acquired Pneumonia | - Erythema nodosum and multiforme
67
Disseminated Coccidiodes can be found where in the body?
- Skin, Soft tissue - Skeleton - Meninges
68
Treatment for Coccidiodes?
- Itraconazole | - Amphotericin B (severe infxn)
69
Endemic areas for Histoplasmosis?
Missouri, Ohio, or Mississippi River Valleys
70
Transmission of Histoplasmosis?
Dimorphic fungus with septate hyphae that is found inside macrophages. Transmitted through bat and bird droppings
71
Clinical presentation of Histoplasmosis?
- Flu-like symptoms - Pleuritic Chest Pain - Bronchopneumonia
72
Diagnostic tests for Histoplasmosis?
- Urine and serum antigen immunoassays (screening) | - Biopsy of lungs or lymph nodes showing granulomas
73
Complications of Histoplasmosis?
- Liver and Splenic Calcification
74
Treatment of Histoplasmosis?
- Itraconazole | - Amphotericin B (Severe infxn)
75
Risk factors of TB in the US?
- 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
Complications of TB?
- Spread to Bone (Pott's Disease) | - Meningitis
77
Clinical Presentation of TB?
- Cough - Hemoptysis - Fever - Dyspnea - Weight loss - Night Sweats
78
Diagnostic tests for TB besides PPD?
- Acid Fast Stain | - Culture of sputum
79
Chest X-ray findings in primary and reactivated TB infection?
Primary: Lower Lobe infiltrates Reactivation: Upper Lobe Infiltrates with cavitations and fibronodular infiltrates
80
Treatment for TB?
RIPE - Rifampin - Isoniazid (Give Vit B6) - Pyrazinamide - Ethambutol R & I for 6 months P & E for 2 months
81
Complications of Varicella Simplex Virus in Immunocompromised patients?
- Encephalopathy - Retinitis - VSV Pneumonia
82
Treatment for Shingles?
- Acyclovir - Analgesics - Corticosteriods
83
At what age is the Shingles vaccine recommended?
50 yrs old and older | *Recombinant Zoster vaccine is preferred*
84
Complications of Varicella in all patients?
Post-infectious Neuralgia- long lasting pain
85
Main causes of Pelvic Inflammatory Disease?
Untreated STD infections
86
Risk Factors of PID? (4)
- Multiple partners - Recent history of douching - Prior history of PID - Cigarette smoking
87
Clinical Presentation of PID?
- Lower abdominal pain with adnexal tenderness - Cervical motion tenderness - Vaginal bleeding, foul smelling discharge - GI distress, Diarhhea - Painful Urination
88
Complications of PID?
- Infertility - Tubo-ovarian abscess - Peri-hepatitis (Fitz-Hugh Curtis syndrome)
89
Ultrasound findings of PID?
- Inflamed enlarged uterus - Abscess in fallopian tubes or the ovaries - Free fluid in the peritoneum
90
Treatment for PID?
- Ceftriaxone + Doxycycline | - Metronidazole
91
Treatment for Severe PID and Tub-ovarian abscess?
- IV Cefotetan + - PO Doxycycline or - IV clindamycin + gentamicin
92
Most important risk factor post-partum endometritis?
Cesarean section
93
Clinical Presentation of Post-partum endometritis?
- Purulent lochia (discharge after childbirth) - Uterine tenderness - Midline lower abdominal pain
94
Treatment for Post-partum endometritis?
- IV Clindamycin + Gentamicin | - Vancomycin (For Pencillin allergy)
95
Clinical Presentation of Primary Syphilis?
- Painless nonexudative ulcer with a raised, indurated margin  - Painless bilateral inguinal lymphadenopathy
96
Clinical Presentation of Second Syphilis?
- Maculopapular rash on hands and soles - Condyloma lata (grey wart-like lesions) - Systemic Symptoms (fever, headache, malaise, myalgias) - Lymphoadenopathy - Hepatitis - Alopecia
97
Clinical Presentation of Tertiary Syphilis?
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
Clinical Presentation of Early Congenitial Syphilis?
- Hepatomegaly (Jaundice, Cholestasis) - Rhinitis - Maculopapular rash on palms and soles - Lymphadenopathy - Anemia, Thrombocytopenia
99
Clinical Presentation of Late Congenital Syphilis?
- Frontal bossing - Interstitial keratitis - Sensorineural hearing loss - Hutchinson teeth and mulberry molars - Rhagades and gummas - Intellectual disability - Saber shins - Paroxysmal cold hemoglobinuria
100
TORCHES infections that can be transmitted transplacently?
- Toxoplasmosis - Rubella - CMV - HIV - Herpes virus - Syphilis
101
Diagnostic test for Syphilis?
- Dark field microscopy - FTA-ABS (Direct Fluorescent Antibody testing) - Serology (RPR and VDRL)
102
Conditions that result in a False Positive on VDRL tests?
PVDRL - Pregnancy - Viral infections (eg, EBV, hepatitis) - Drugs (eg, hydralazine, procainamide) - Rheumatic fever - Lupus, Leprosy
103
Treatment for Syphilis?
- IM Pencillin G (Single dose for Primary, Secondary, Latent) (1-3 wks for Teritary) * Doxycycline for Penicillin allergy*
104
Treatment for Syphilis in pregnant patients with a penicillin allergy?
Penicillin desensitization

Internal Medicine (15 decks)

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