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STEP 3 > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

Small papules with central umbilication and central necrosis in an HIV + patient

A

Cutaneous cryptococcosis
Dx w/ biopsy
Treat with ampho B + flucytosine for 2 or more weeks, then oral fluconazole for a year

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2
Q

Pt with meningoencephalitis with mosquito bites on arms

A

West Nile virus
Dx: West Nile IgM in CSF
Tx: supportive

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3
Q

Perinatal hep B infection

A

Tx: immunoglobulin and vaccine within 12 hours of birth
Routine vaccine series: 0, 2 and 6 months
Serology ~3 months after 3rd vaccine dose

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4
Q

Active tuberculosis

A

Dx with sputum acid-fast bacilli smear and culture
Smear has low sensitivity
Wait for culture or nucleic acid amplification (NAA) testing for definitive results

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5
Q

Infectious mononucleosis

A

Caused by EBV
Fever, fatigue, exudative pharyngitis/tonsillitis (“white exudate”, posterior cervical lymphadenopathy
Atypical reactive lymphocytes on smear

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6
Q

Streptococcal pharyngitis

A

Caused by S. pyogenes
Sudden fever, sore throat. No URI symptoms.
Tx: amoxicillin for 10 days
Alternatives: IM penicillin if unable to tolerate oral, cephalosporin if mild penicillin allergy, azithromycin x5d if severely allergic

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7
Q

What does a positive antibody test to HCV mean?

A

Active ongoing infection
Past infection that has resolved
False positive
F/u test with HCV RNA

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8
Q

Chlamydia in pregnancy

A

Screen at first visit and 3rd trimester if risk factors present
Tx w/ azithromycin
Complications if left untreated include PPROM, preterm labor and postpartum endometritis

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9
Q

HIV-associated lipodystrophy

A

Lipoatrophy: loss of subQ fat in arms, legs, buttocks; seen with NRTIs (zidovudine)
Fat accumulation: buffalo hump, visceral abdominal fat
Also insulin resistance, dyslipidemia and incr. CV risk
Tx w/ statin

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10
Q

Screening test for HIV

A 
HIV antigen (p24) and HIV-1/HIV-2 antibodies
Cautious use during window period (first 4 weeks), can repeat test
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11
Q

What conditions should you screen for prior to initiating antiretroviral therapy?

A

Hep B (some antiretroviral meds have dual activities)
Hep C
TB
STDs

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12
Q

Syphilis testing

A

Screen with RPR

Confirm with FTA-ABS or VDRL

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13
Q

Tx of syphilis

A

Primary, Secondary or early latent <12mo: benzathine penicillin IM x1
Late latent >12mo or unknown duration, gummatous/CV syphilis: benzathine penicillin IM weekly x3
Neurosyphilis: aqueous penicillin G IV q4h for 2 weeks
Congenital syphilis: similar to neurosyphilis
No prevention for Jarisch-Herxheimer reaction

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14
Q

Dx and Tx of latent TB

A

Dx: positive IFB-g assay w/o symptoms or CXR findings
Tx: isoniazid for 9mo, alternative is rifampin for 4-6 months

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15
Q

Tx of chlamydia

A

Azithromycin

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16
Q

Tx of gonorrhea

A

Ceftriaxone (+azithromycin to cover chlamydia)

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17
Q

Persistent urethritis despite tx for chlamydia/gonorrhea

A

Repeat urethral swab and gram stain

Often due to infections caused by Mycoplasma genitalium or Trichomonas vaginalis

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18
Q

Which patients should you give oseltamivir regardless of symptom duration?

A

Age 65 or more
Women who are pregnant and up to 2 weeks postpartum
Underlying chronic medical illness (cardiac, pulmonary, hepatic or renal)
Immunosuppressed
Morbidly obese
Native Americans
Nursing home or care facility residents

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19
Q

Tx of human bites

A

Augmentin

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20
Q

Lactational mastitis

A

Fever, breast pain and focal inflammation

Tx with dicloxacillin or cephalexin

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21
Q

Post-exposure management of Hep B

A

Healthcare worker immune: NTD
Healthcare worker not immune and source patient:
-Positive for Hep B -> hep B immunoglobulin and vaccinate
-Negative for Hep B -> vaccinate

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22
Q

Tuberculous meningitis

A

Choroidal tubercles (yellow-white nodules near the optic disc)
Basilar meningeal enhancement on imaging
CSF with low glucose, high protein, WBC count 100-500
Dx with CSF AFB staining and culture
Tx with 4-drug therapy for 2 mo and 9-12mo of continuation therapy

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23
Q

Tx of acute cystitis and asymptomatic bacteriuria

A

Cephalexin, amoxicillin-clavulanate, fosfomycin

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24
Q

Cervical and preauricular adenopathy with unilateral conjunctivitis

A 
Oculoglandular syndrome (Parinaud syndrome) due to catscratch disease
Can treat with azithromycin and needle aspiration to prevent lymph node suppuration
25
Q

Side effect of isoniazid

A

Hepatotoxicity

Ok to continue unless LFTs >5x ULN and asymptomatic or >3x ULN and symptomatic

26
Q

Disseminated gonococcal infection triad

A

Dermatitis: 2-10 painless pustules on distal extremities
Tenosynovitis: swelling and pain with passive extension
Polyarthralgia: asymmetric small and large joints
Dx: NAAT of urinary specimen

27
Q

Hand-foot-mouth disease

A

Caused by coxsackievirus

28
Q

Sporotrichosis

A

Painless papule which ulcerates and drains nonpurulent, odorless fluid
Proximal lesions form along lymphatic chain
Dx: culture
Tx: 3-6mo of oral itraconazole

29
Q

1st line agents for acute uncomplicated cystitis

A

TMP-SMX for 3 days or nitrofurantoin for 5 days

30
Q

1st line for uncomplicated pyelonephritis

A

Ciprofloxacin

31
Q

Organism responsible for concurrent otitis media and purulent conjunctivitis (otitis-conjunctivitis syndrome)

A

Nontypeable H. influenzae

Tx with augmentin if received amoxicillin alone in last month

32
Q

Tx of infectious mono with imminent airway obstruction

A

IV corticosteroids

33
Q

Man w/ 3 months of pelvic pain and dysuria, bacteriuria and urine leukocytes on UA

A

Chronic prostatitis

Tx: 6 weeks of ciprofloxacin or TMP-SMX (shorter courses result in tx failure)

34
Q

Ecthyma gangrenosum

A

Immunosuppressed pt, central catheter
Painless red macules that rapidly develop into bullae and then quickly evolve into gangrenous ulcers with raised violaceous margins
Tx w/ anti-pseudomonal beta lactam (pip-tazo) and aminoglycoside (gentamicin)

35
Q

Indications for corticosteroid use in the ICU

A

Alveolar-arterial oxygen gradient 35mmHg or more

Arterial oxygen tension (PaO2) <70

36
Q

Dx and Tx of PJP

A

Dx: sputum culture or bronchoalveolar lavage
Tx: TMP-SMX +/- corticosteroids

37
Q

Dx and Tx of cryptococcal meningitis

A

Markedly elevated opening pressures >250, low WBC count <50 with lymphocytic predominance
Positive india ink stain or cryptococcal antigen test

Tx with ampho B and flucytosine (at least 2w), then high dose fluconazole for 8 weeks then low dose for ~1 year. Can be complicated by high ICPs requiring serial lumber punctures

38
Q

Antibiotics for pediatric sepsis

A

<28 days: ampicillin + gentamicin or cefotaxime
(caused by E. coli and GBS)
>28 days: ceftriaxone or cefotaxime + vanco if meningeal involvement suspected (S. pneumo or N. meningitidis)

39
Q

TB tx in pregnancy

A 
3-drug therapy for 2 months (no pyrazinamide), the ONH + RIF for 7 additional months
Give pyridoxine (B6) supplementation
40
Q

Tx sinusitis

A

1st line: augmentin

2nd line: doxycycline or fluoroquinolones

41
Q

Management of pediatric pneumonia

A

Preschool/focal findings: amoxicillin for strep pneumo

School/bilateral diffuse: azithromycin for Mycoplasma

42
Q

Name the source of the following oral lesions in childrem:

  • Recurrent ulcers on anterior oral mucosa, no fever or systemic symptoms
  • Vesicles and ulcers on posterior oropharynx
  • Vesicles and ulcers on anterior oral mucosa and around mouth with fever
  • Tonsillar exudate with diffuse lymphadenopathy, fever +/1 hepatosplenomegaly
  • Tonsillar exudate with fever and anterioc cervical lymphadenopathy
A 
Aphthous ulcers
Herpangina (Coxsackie A virus)
Herpes gingivostomatitis
Infectious mononucleosis
Group A strep
43
Q

Pulmonary aspergillosis

  • Classic triad
  • Dx
  • Tx
A

Triad: cough, pleuritic chest pain, hemoptysis
Dx: CT chest with nodule w/ ground-glass opacities and/or cavitations with air-fluid levels; galactomannan and beta-d-glucan serum levels, sputum for fungal culture
Tx: voriconazole (surgery if needed)

44
Q

What is immune reconstitution inflammatory syndrome?

A

When someone is started on antiretroviral therapy for HIV, rapid improvement in immune function can cause a paradoxical worsening of infectious symptoms
Treat symptomatically w/ NSAIDs or with short course of steroids

45
Q

Croup vs epiglottitis

A

Croup: barking cough, parainfluenza, steeple sign, use racemic epinephrine/IM corticosteroids

Epiglottitis: respiratory distress, drooling, high fever, H. influenzae type b (vaccine preventable), thumb sign, intubate + IV abx

46
Q

Tx vaginitis

  • Bacterial vaginosis
  • Trichomoniasis
  • Candida vaginitis
A
  • Metronidazole or clindamycin
  • Metronidazole, treat partner
  • Fluconazole
47
Q

Most specific and sensitive tests for osteomyelitis

A

Specific: probe-to-bone (91%)
Sensitive: MRI (90%)

48
Q

Most common complication from diptheria

A

Toxin-mediated myocarditis

49
Q

Tx of salmonella

A

Supportive

Use ciprofloxacin, Bactrim, or ceftriaxone for at risk individuals

50
Q

Presentation of subphrenic abscess

A

2-3 weeks after abdominal surgery, swinging fever and leukocytosis. Dx w/ ultrasound

51
Q

Indications for dialysis catheter removal in setting of infection

A

Severe sepsis
Hemodynamic instability
Evidence of metastatic infection (endocarditis)
Pus at the exit site of the catheter
Continued symptoms 72h after initiation of antibiotics
Long-term catheter (>14 days) with evidence of S. aureus, P. aeruginosa or fungi on blood cx

52
Q

Headache, myalgia, arthralgia

Macular, erythematous rash and few petechiae on bilateral wrists and ankles

A

Rocky Mountain Spotted Fever
Labs: low platelets and sodium, increased transaminases
Dx: Rickettsia serology, skin biopsy
Tx: doxycycline

53
Q

Pt with fever after travelling, after BP cuff is applied, diffuse petechiae noted on skin underneath

A

Hemorrhagic dengue fever, at risk for circulatory collapse

54
Q

Congenital infections

A

Toxoplasmosis: calcification, hydrocephalus, hearing impairment, chorioretinitis
Rubella: heart defects, eye abnormalities and hearing impairment, symptomatic illness (fever, maculopapular rash) in mother

55
Q

Tx of intestinal helminths

A

Albendazole

56
Q

Tx of shingles (HSV)

A

Valacyclovir

57
Q

Abx tx for necrotizing fasciitis

A

Vancomycin
Pip/tazo or carbapenem
Clindamycin

Usu. caused by group A strep

58
Q

Tx for vibrio vulnificus

A

IV ceftriaxone and doxycycline

59
Q

How to diagnose Lyme disease

A

Serum enzyme-linked immunosorbent assay and Western Blot

STEP 3 (12 decks)

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