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Internal Medicine EOR > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What is botulism?

A

gram-positive bacteria associated with home canned food products

  • presents as muscle weakness and respiratory paralysis, “floppy babies”
  • exposure to moist heat at 120 C (248 F) for 30 min kills the spores
  • toxins, on the other hand, are readily destroyed by heat and cooking food at 80 C (176 F) for 30 min safeguards against botulism
  • honey (no honey for babies) - it is recommended that you wait until your baby is at least 12 moths before introducing honey
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2
Q

What is the the tx fo botulism?

A

botulinum antitoxin

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3
Q

What is vaginal candidiasis?

A
  • presents with vulvar itching, erythema and white curdy discharge
  • KOH shoes hyphae
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4
Q

What is the tx for vaginal candidiasis?

A

miconazole cream x 1-7 days or fluconazole 150 mg PO single dose

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5
Q

What is esophageal candidiasis?

A
  • very common in AIDS patients
  • may present with substernal dysphagia, GE reflux, or nausea with or without pain
  • diagnosis is by EGD with biopsy will demonstrate linear erosions on endoscopy
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6
Q

What is the tx of esophageal candidiasis?

A

treat with fluconazole

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7
Q

What is oral thrush?

A

friable white plaques that bleed if scraped

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8
Q

What is the tx for oral thrush?

A

treat with nystatin

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9
Q

What is intertrigo?

A

moist macerated areas, pruritic rash BEEFY RED ERYTHEMA with distinct scalloped borders and satellite lesions

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10
Q

What is the tx of intergtrigo?

A

treat with clotrimazole, ketoconaozle, miconazole, topical, keep the area dry

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11
Q

What is chlamydia?

A

the most common sexually transmitted infections

  • gram-negative rods, intracellular
  • asymptomatic, dysuria
  • diagnosis: NAAT
  • gram stain reveals no organisms
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12
Q

What is the tx for chlamydia?

A

(1) azithromycin 1 g PO x 1 (2) doxycycline 100 mg PO two times per days for 7 days
+ceftriaxone 250 mg IM x 1 to cover for gonorrhea
-alternative:
-erythromycin 500 mg QID x 7 days
-levofloxacin 500 mg P daily x 7 days
-in pregnancy: azithromycin 1 g PO single dose or amoxicillin 500 mg PO tid x 7 days

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13
Q

What is cholera?

A

an acute infectious disease of the small bowel caused by vibrio cholerae a gram-negative bacteria which secretes a toxin causes a life-threatening, rice water diarrhea

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14
Q

What are the characteristics of cholera?

A
  • typically through contaminated water or seafood
  • characteristics include severe “rice water” diarrhea with extreme fluid and electrolyte depletion, vomiting, muscle cramps, prostration, and potential death without replacement of fluids and electrolytes
  • diagnosis is confirmed by stool cultures
  • endemic areas: india, Southeast Asia, Africa, Middle East, southern europe, oceania, south, Central American
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15
Q

How do you tx cholera?

A

treat with oral rehydration + antibiotics (macrolides, fluoroquinolone, and tetracyclines

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16
Q

What is cryptococcus?

A

AIDS-defining illness, diagnose with CSF and serum serology

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17
Q

What are the charcterisitcs of cryptococcus?

A
  • tranmission is through inhalation, budding yeast found in soil contaminated with pigeon/bird droppings
  • India ink may be postive
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18
Q

What is the tx of cryptococcus?

A

treat with amphotericin B + flucytosine for two weeks followed by fluconazole for 10 weeks
-prophylaxis in HIV; fluconazole if CD4 <100

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19
Q

What is cytomegalovirus?

A

is an enveloped double-stranded linear DNA virus in the herpesvirus family

  • it is also called human herpevirus 5
  • it can cause infections that have a wide range of severity
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20
Q

What are the characteristics of cytomeglovirus?

A
  • CMV can cause a syndrome that is similar to infectious mononucleosis but lacks severe pharyngitis
  • CMV can cause pneumonia and inflammation of the retina (CMV retinitis) and esophagus in the immunosuppressed, especially in transplant recipients
  • associated with a CD4 count < 50
  • severe systemic disease can develop in neonates
  • it is one of the TORCHES infections and can cause hearing loss, seizures, and petechial rash in newborns
  • visulization of owl’s eye inclusions in a cell sightly specific for cytomegalovirus
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21
Q

What is the tx of cytomegalovirus?

A

treatment is with Ganciclovir, valganciclovir, foscarnet, and cidofovir

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22
Q

What is diptheria?

A

URI with thick gray psudomembrane in the throat that bleeds ifs capped in someone who wasn’t vaccinated

  • patient may have neck swelling due to enlarged cervical lymphadenopathy (bull neck)
  • rare in the US due to routine vaccination at 2, 4, 6, and 15-18 months with a booster at 4-6 years of age
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23
Q

What is the tx of diphtheria?

A

treat with antitoxin and antibiotic (penicillin or macrolide)

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24
Q

What is Epstein - Barr infection?

A

epstien barr mononucleosis is a viral illness characterized by a classic triad of fever + lymphadenopathy + pharyngitis

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25
Q

What are the characteristics of Epstein-Barr infection?

A
  • diagnosed with positive heterophiles antibody screen (mono spot) - may not appear early in the illness (positive within 4 weeks)
  • atypical lymphocytes with enlarged nuclei and prominent nucleoli
  • maculopapular rash develops in 80% of patients treated with ampicillin
  • left upper quadrant pain secondary to splenomegaly and are at risk for splenic rupture - athletes should avoid vigorous sports for at least the first three to four weeks of the illness
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26
Q

What is the tx for Epstein-Barr Infection?

A

supportive

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27
Q

What is gonococcal infections?

A

caused by neisseria gonorrhoeae - a gram-negative diplococcus

  • presentation:
  • women: often asymptomatic, prolonged infection can result in pelvic inflammatory disease when the bacterium travels into the pelvic peritoneum
  • men: yellow, creamy, profuse and purulent discharge
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28
Q

What is the tx of gonococcal infections?

A

-ceftriaxone 125 mg IM x 1 + treatment for chlamydia (azithromycin 1 g PO single dose or doxycycline 100 mg PO BID for 7 days)

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29
Q

What is gonococcal pharyngitis?

A

is usually asymptomatic but may cause a sore throat

  • neonatal conjunctitivits and pharyngitis
  • disseminated infections can occur resulting in septic arthritis, tenosynovitis, and pustules on the hands and feet
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30
Q

What is herpes simplex infection?

A

-prodromal symptoms > 24 hours prior (burning, tingling) followed by painful grouped vesicles on an erythematous base

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31
Q

What is herpes simplex virus type 1?

A

gingivostomatitis, Bell’s palsy, keratoconjunctivitis, cutaneous herpes, genital herpes, encephalitis, herpes lbialis, esophagitis, pneumonia, hepatitis

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32
Q

What is herpes simplex virus type 2?

A

gential herpes, cutaneous herpes, gingivostomatitis, neontal herpes, aseptic meningitis, disseminated infection, hepatitis

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33
Q

What is varicella-zoster virus?

A
  • human herpesvirus 3

- chickenpox, herpes zoster, disseminated herpes zoster

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34
Q

What is Epstein-barr virus?

A
  • human herpesvirus 4
  • infectious mononucleosis, hepatitis, encephalitis, nasopharyngeal carcinoma, hodkin lymphoma, burkitt lymphoma, lymphoproliferative syndromes, oral hairy leukoplakia
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35
Q

What is human herpesvirus 6?

A

roseola infantum, otitis media with fever, encephalitis

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36
Q

What is human herpesvirus 7?

A

roseola infantum

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37
Q

What is kaposi sacroma-associated herpesvirus?

A

not a known cause of acute illness but has a causative role in Kaposi sarcoma and AIDS-related non-hodgkin lymphomas that grow primarily in the pleural, pericardial, or abdominal cavities as lymphomatous effusions
-also linked with multi centric cattleman disease

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38
Q

What is histoplasmosis?

A

AIDS-defining illness, associated with soil containing birds and bat droppings in the Mississippi and Ohio river valleys

  • highest risk is with a CD4 <100, patients develop fever and mutliorgan failure, fulminant disease septic shock, and death are common
  • increased alkaline phosphatase and LDH, (+) blood cultures if disseminated
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39
Q

What is the tx of histoplasmosis?

A

treat with itraconazole orally for weeks to months or amphotericin B if severe or failed itraconazole
-in general antigunal prophylaxis with itraconazole is not administered to prevent primary infection with special indications

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40
Q

What is the treatment for human immunodeficiency virus with a CD4 count 700-1,500?

A

disease normal

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41
Q

What is the treatment for human immunodeficiency virus with a CD4 count >500?

A

lymphadenopathy

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42
Q

What is the treatment for human immunodeficiency virus with a CD4 count 500-200?

A
  • tuberculosis, kaposi sarcoma, thrush, lymphoma, zoster
  • primary prophylaxis: INH
  • secondary prophylaxis: rifampin
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43
Q

What is the treatment for human immunodeficiency virus with a CD4 count <200?

A
  • PJP, histoplasmosis
  • primary prophylaxis: TMP/SMX, itraconazole
  • secondary prophylaxis: dapsone, amphotericin B
44
Q

What is the treatment for human immunodeficiency virus with a CD4 count <100?

A
  • toxoplasmosis, cryptococcus
  • primary prophylaxis: TMP/SMX, fluconazole
  • secondary prophylaxis: pyrimethamine + sulfadiazine + colonic acid, amphotericin B
45
Q

What is the treatment for human immunodeficiency virus with a CD4 count <50?

A
  • MAC, CMV retinitis
  • primary prophylaxis: valganciclovir
  • secondary prophylaxis: Ganciclovir + foscarnet
46
Q

What is the post exposure prophylaxis of HIV?

A
  • PEP should be started within 72 hours of exposure
  • the chances of contracting HIV from a needle stick injury involving a patient with known HIV is <0.3%
  • testing should be done on worker and the patient - resting at 6 weeks, 3 months, and 6 months
  • can take antiretrovirals - combo therapy with drugs from different classes should be continued for at least 4 weeks, full course PEP reduced the chance of HIV transmission by up to 70%
47
Q

What is influenza?

A

everyone ages > 6 mo should receive annual influenza vaccination
-antiviral treatment reduces the duration of illness by about 1 day and should be specifically considered for high-risk patients

48
Q

What is the tx of influenza?

A

Oseltamivir and Zanamivir (neuraminidase inhibitors) treat A + B

49
Q

What is Lyme disease?

A

caused by borrelia burgdorferi (gram-negative spirochete) that is spread by lxodes (deer) tick
-transmission via tick bite (lxodes) - enters blood - spreads to tissues and organs; especially joints, heart, nervous system

50
Q

What are the three stages of Lyme disease?

A
  • locailzed disease (occurs 3-30 days after exposure) - non-painful, gradually expanding eythema mirgans (EM) “bull’s-eye” rash appearing at the site of tick bite; feels warm to palpation; may itch
  • constitutional: low-grade fever, chlls, headache, fatigue, myalgia, arthralgia, lymphadenopathy
  • disseminated disease (days to months after exposure; multisystem involvement): musculoskeletal, flu-like syndrome, consisting of malaise, fatigue, chills, fever, headache, stiff neck, myalgias, and arthralgia that may last for weeks, cardiac (AV block)
  • late/chronic disease (months to years after exposure): presence of nonspecific (e.g headaches, fatigue, joint pain) that persists after treatment for lyme disease
51
Q

How is Lyme disease dx?

A

CDC testing criteria - two-tiered testing for lyme disease

  • first test: enzyme immunoassay (EIA) or immunofluorescence assay (IFA)
  • the second test (as needed): IgM and/or IgG western blot
  • Other laboratory findings:
  • blood chemistry: increased ESR, serum creatine phosphokinase, aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT)
  • blood studies: anemia, leukocytosis, thrombocytopenia
52
Q

What is the tx of Lyme disease?

A
  • treat with doxycycline or amoxicillin (10-21 days) it started immediately after diagnosis
  • prophylaxis: doxycycline 200 mg x 1 dose within 72 hours if lxodes tick
53
Q

What is helminth infestations?

A
  • helminth infections are all intestinal infections
  • helminths are worm-like parasites that infect several species
  • those that infect humans include the following:
  • nematodes: roundworm (ascaris), hookworm, pinworm - cause GI symptoms and cough, treat with mebendazole
  • pinworm: anal pruritus in a child in the morning, scotch tape test - the parent will go in early in the morning before the child wakes and apply scotch tape on the rectum and present for exam, also with pinworm paddles
  • ascaris lumbricoides (roundworm) - most common internal helminth worldwide found in contaminated soil - small worm load will be asymptomatic, larger load may cause value abdominal symptoms, a high load may migrate to the pancreatin duct, bile duct, appendix, diverticula and cause symptoms at the site
  • cestodes: tapeworm - cause GI symptoms and weight loss, treat with praziquantel
  • trematodes: flukes, including Schistosoma, avian and mammal schistosomes (mercurial dermatitis or swimmer’s itch)
  • in any parasitic infection, eosinophilia may be presents
54
Q

What is the tx of helminth infestations?

A
  • pinworm and most other roundworms with mebendazole

- tapeworms and flukes with praziquantel

55
Q

What is the presentation of malaria?

A

presents with periods chills, fever and sweats (fever every 3 days)

  • caused by plasmodium vivax, p. malaria, p. oval, p. falciparum (most virulent)
  • transmitted by anopheles mosquito
  • splenomegaly typically after > 4 days of symptoms
  • diagnose with giemsa stain peripheral smear (thin and thick) - parasites in RBCs, thrombocytopenia, increased LDH
56
Q

What is the treatment of malaria?

A

treat with chlorquine or mefloquine for chloroquine-resistant p. falciparum

57
Q

What are pinworms?

A

pinworms infection, also known as enterobiasis vermicularis is a human parasitic disease caused by the pinworm (a type of roundworm)

  • the most common symptoms is itching in the anal area
  • this can make sleeping difficult
58
Q

What are the characteristics of pinworms?

A
  • perianal itching especially at night (eggs are laid at night)
  • eggs cling to the fingers while itching and are transmitted to other people either directly or through food or surfaces
  • the eggs can thrive for 2-3 weeks on an inanimate object
  • diagnosis is with a “scotch tape test” done in the early morning
  • can see the eggs under microscopy
59
Q

What is the tx fo pinworms?

A

treatment is with albendazole or mebendazole

60
Q

What is toxoplasmosis?

A

toxoplasma gondii is a parasitic protozoan that causes the disease toxoplasmosis

  • triad of encephalitis + chorioetinitis + intracranial calcifications in AIDS patients with a CD4< 100
  • pregnant females with exposure to cat feces: toxoplasmosis is the reason we tell pregnant mother not to change cat litter
  • CT of the brain shows ring-enchains lesions, Toxo Egg and IgM
  • congential toxoplasmosis is part of ToRCH syndrome
61
Q

What is the tx of toxoplasmosis?

A

prophylaxis for all HIB patients with CD4 count < 100 with Bactrim

62
Q

What is pertussis?

A 
Whooping cough (pertussis) is highly contagious respiratory tract infection marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like a whoop 
-gram-negative bacteria Bordetella pertussis - high contagious
63
Q

What are the characteristics of pertussis?

A
  • consider in adults with cough > 2 weeks, patients < 2 years
  • catarrhal stage: cold-like symptoms, poor feeding, and sleeping
  • paroxysmal stage: high-pitched “inspiratory whoop”
  • convalescent stage: residual cough (100 days)
64
Q

How is pertussis dx?

A

nasopharyngeal swab of nasopharyngeal secretions - culture

65
Q

What is the tx of pertussis?

A

macrolide (clarithromycin/azithromycin); supportive care with steroids/beta2 agonists

  • vaccinations 5 doses = 2, 4,6, 15-18 mo, 4-6 yrs (DTap)
  • 11-18 yo = 1 dose Tdap
  • expectant mothers should getT Tdap during each pregnancy, usually at 27-36 weeks
66
Q

What is pneumocystis?

A

AIDS-defining illness, associated with soil containing birds and bat droppings in the Mississippi and Ohio Rive Valleys

  • originally called pneumocystis carinii pneumonia, then renamed pneumocystis jirovecii but still referred to as PCP
  • most common opportunistic infection in patients with HIV especially if CD4 count <200
67
Q

How is pneumocystis dx?

A

chest x-ray characteristically shows diffuse, bilateral perihilar infiltrates

68
Q

What is the tx for pneumocystis?

A

trimethoprim-sulfamethoxazole (bactrim) and steroids

  • if sulphate allergen, pentamidine
  • prophylaxis with daily bactrim for high-risk patients with a CD4 count of less than 200 or with a history of PJP infection
69
Q

What is rabies?

A

caused by a ribonucleic acid (RNA) rhabdovirus affecting mammals, including humans

  • transmission via dogs, raccoons, skunks, bats, fox, coyote
  • hydrophobia (inability to swallow water) is a classic symptom, pharyngeal spasms, aerophobia (fear of drafts of fresh air) and hyperactivity
70
Q

How is rabies dx?

A

negri bodies (eosinophilic inclusion bodies in the cytoplasm of hippocampal nerve cells) are considered pathognomonic and are found in the brain of dead animals

71
Q

What is the tx of rabies?

A

post-exposure treatment: rabies immunoglobulin + inactiavted vaccine (4 doses over 14 days)
-fatal when there are neurological symptoms

72
Q

What is Rocky Mountain spotted fever?

A

caused by rickettsia rickettsia a species of bacterium that is spread to humans by the American dog tick (dermacentor variables)

73
Q

What are the characteristics of Rocky Mountain spotted fever?

A
  • 2-14 days after tick bit will develop flu-like symptoms: fevers and chills, myalgia, and headache
  • red maculopapular rash first on wrists and ankles (palms and soles) then spreading centrally over 2-3 days
  • face is usually spared
  • indirect fluorescent antibody (IFA) test remains the standard method of diagnosis of RMSF
74
Q

What is the tx of Rocky Mountain spotted fever?

A

treat with doxycycline or chloramphenicol second line

75
Q

What is salmonellosis?

A

although there are many types of salmonella, they can be divided into two broad categories: those the cause typhoid and enteric fever and those that primarily induce gastroenteritis:

76
Q

What is enteric fever?

A

(salmonella typhi): a flu-like bacterial infection characterized by fever, GI symptoms, and headache

  • transmitted via the consumption of fecally contaminated food or water
  • GI symptoms may be marked constipation or “pea soup diarrhea”
  • rose spots may be present (2-3 mm papule on trunk usually)
  • more common in the developing world (usually immigration cases)
77
Q

What is gastroenteritis?

A

(salmonella typhimurium, Enteritidis, and newport): results from improperly handled food that has been contaminated by animal or human fecal material
-it is estimated that 1 in 10,000 egg yolks is infected with salmonella Enteritidis

78
Q

What is the tx for salmonellosis?

A

treat with ceftriaxone or other medications based on the sensitivity

79
Q

What is shigellosis?

A

gram-negative bacteria shigella that results in watery diarrhea or dysentery (the frequent and often painful passage of small amounts of stool that contains blood, pus, and mucus)

80
Q

What are the characteristics of shigellosis?

A
  • the illness starts abruptly with diarrhea, lower abdominal cramps, and tenesmus accompanied by fever, chills, anorexia, headache, and malaise
  • stools are loose and mixed with blood and mucus
  • the abdomen is tender; dehydration is common
81
Q

What is the tx for shigellosis?

A

treat with TMP-SMX or ciprofloxacin

82
Q

What is syphilis?

A

is caused by the spirochete treponema palladium and has increased in incidence over the last 10 years; it is associated with risk-taking behavior such as drug use
-the disease has 3 phases, with an incubation of about 3 weeks

83
Q

What is primary syphilis?

A

presents as a painless chancre in the genital or groin region persisting 3 to 6 weeks

84
Q

What is secondary syphilis?

A

presents as an erythematous rash involving the palms and soles or a condyloma lata which is similar to lesions on primary syphilis in its infectivity but differs in appearance

85
Q

What is tertiary syphilis (latent)?

A

affects about 30% and is a representation of widespread systemic involvement and can present with major vessel changes, such as in the aorta, permanent CNS changes (neurosyphilis), or even benign mucosal growths called gummas

86
Q

How is syphilis dx?

A

diagnosis is by RPR/VDRL and confirmed by treponemal antibody-absorption test (FTA-ABS)
-lyme disease can cause a false positive

87
Q

What is the tx for syphilis?

A
  • IM benzathine penicillin for primary and secondary disease
  • IV penicillin G (for gummas) for congenital and late disease
88
Q

What is tetanus?

A

results from a toxin produced by the anaerobic bacteria Clostidium retain

  • the toxin makes muscles become rigid and contract involuntarily (spasm)
  • clostridium tetani spores are ubiquitous in soil
  • the spores germinate in wounds where the bacteria produce a neurotoxin (tetanospasmin), which interferes with neurotransmission at spinal synapses of inhibitory neurons
  • the result is uncontrolled spasm and exaggerated reflexes
  • puncture wounds are most susceptible
  • the elderly, migrant workers, newborns, and injection drug users are at particular risk
89
Q

What are the symptoms of tetanus?

A

first symptom is pain and tingling at the site of inoculation

  • later muscle spasms, respiratory muscle tetany, and lockjaw
  • gram postive organism
  • neurotoxin
  • transmission: rusty nail
90
Q

What is the tx of tetanus?

A

treat with immunoglobulin, wound debridement and penicillin

-prognosis: high mortality

91
Q

What is the vaccination for tetanus?

A
  • DTaP is usually given at 2, 4, 6, and 12 to 15 months, with an additional dose at 4 to 6 years
  • Tdap adolescent preparation is recommended at age 11 to 12 years for those who have completed the recommended childhood DTP/DTaP vaccination series and have not received tetanus and diphtheria toxoid (td) booster dose
  • subsequent boosters of Tdap are recommended every 10 years
92
Q

What is toxoplasmosis?

A

toxoplasma gondii is a parasitic protozoan that causes the disease toxoplasmosis

  • triad of encephalitis + chorioretinitis + intracranial calcifications in AIDS patients with a CD4 < 100
  • pregnant female with exposure to cat feces: toxoplasmosis is the reason we tell pregnant not to change cat litter
  • CT of the brain shows ring-enhancing lesions
  • toxo IgG and IgM
  • congential toxoplasmosis is part of ToRCH syndrome
93
Q

What is the tx for toxoplasmosis?

A

prophylaxis for all HIV patients with CD4 count < 100 with Bactrim

94
Q

What is tuberculosis?

A

organism: mycobacterium tuberculosis
- presentation: cough, night sweats, weight loss, post-tussive rales endemic area, immunocompromised
- xray: cavitary lesions, infiltrates, ghon complexes in the apex of lungs
- acid-fast bacilli stain
- biopsy: caveating granulomas

95
Q

When is the Mantoux skin test positive?

A
  • > 5 mm: patients at high risk of developing active TB if infected, such as those who have chest x-ray evidence of past TB, who are immunosuppressed because of HIV infection or drugs (eg TNF - alpha inhibitors, corticosteroid use equivalent to prednisone 15 mg/day for > 1 mo), or who are close contacts of patients with infectious TB
  • > 10 mm: patients with some risk factors, such as injection drug users, recent immigrants from high-prevalence areas, residents of high-risk settings (eg prisons, homeless shelters), patients with certain disorders (eg silicosis, renal insufficiency, diabetes, head or neck cancer), and those who have had gastrectomy or jejunoileal bypass surgery
  • > 15 mm: patients with no risk factors (who typically should not be tested)
96
Q

What is the treatment for latent TB?

A
  • rifampin (RIF) daily for four months (regiment abbreviations: 4R)
  • isoniazid (INH) and RIF daily for three months (regimen abbreviations: 3HR)
  • isoniazid 5 mg/kg (300 mg maximum) orally daily for 9 months
  • isoniazid 5 mg/kg (300 mg maximum) orally daily for 6 months
  • isoniazid 15 mg/kg (900 mg maximum) orally twice weekly for 9 or 6 months
97
Q

What is the treatment for active TB?

A
  • active treatment: quad therapy - isoniazid, rifampin, ethambutol, pyrazinamide for 8 weeks - peripheral neuropathy (give with B6)
  • rifampin - orange body fluids, hepatitis
  • ethambutol - optic neuritis, red-green blindness
  • pyrazinamide - hyperuricemia
98
Q

What is the prophylaxis treatment for household members of patients that have TB?

A

isoniazid for 1 year

99
Q

What is varicella (chickenpox)?

A

primary infections - cluster of vesicles on an erythematous base

  • dewdrops on a rose petal in different stages
  • it starts on the face and spreads down
  • acutely causes chickenpox - becomes latent in the Doral root ganglion
  • symptomatic treatment may use acyclovir in special populations
100
Q

What is Herpes zoster (shingles)?

A

varicella reactivation causing a maculopapular rash along one dermatome
-identified via tzanck smear with visualization of multinucleate giant cells

101
Q

What is zoster opthalmicus?

A

shingles involving CCN V, dendritic lesions on slit lamp exam if keratoconjunctivits is present

102
Q

What is zoster optics (Ramsay-hunt syndrome)?

A

facial nerve (CN VII) otalgia, lesions on the ar, auditory canal and TM, facial palsy auditory symptoms

103
Q

What is the tx of shingles?

A

acyclovir, valacyclovir, and famciclovir - given within 72 hours to prevent post-herpetic neuralgia

104
Q

What is postherpetic neuralgia?

A

pain > 3 months, paresthesia or decreased sensation

-treat with gabapentin or TCA, topical lidocaine gel, and capsaicin

105
Q

What are the characteristics of the shingles vaccine?

A

herpes zoster vaccine is a liver, attenuated virus vaccine - vaccination is recommend for immunocompetent adults > 60 years of age

Internal Medicine EOR (10 decks)

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