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PSBIM > INFECTIOUS DISEASE > Flashcards

INFECTIOUS DISEASE Flashcards

1
Q

Triad for Weil’s syndrome (3):

A

a. Jaundice
b. Hemorrhagic diathesis
c. Renal dysfunction

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2
Q

Coiled, thin, highly motile organisms that have hooked ends and two periplasmic flagella, with polar extrusions from the cytoplasmic membrane that are responsible for motility

A

Leptospira sp.

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3
Q

Sex predilection of leptospirosis

A

Men

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4
Q

Most important reservoir of leptospirosis

A

Rodents (esp. rats)

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5
Q

Leptopirosa serovar associated with rats as reservoir (2):

A

a. Icterohaemorrhagiae

b. Copenhageni

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6
Q

Leptopirosa serovar associated with voles as reservoir:

A

Grippotyphosa

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7
Q

Leptopirosa serovar associated with cattle as reservoir:

A

Hardjo

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8
Q

Leptopirosa serovar associated with dogs as reservoir:

A

Canicola

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9
Q

Leptopirosa serovar associated with pigs as reservoir:

A

Pomona

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10
Q

Percentage of leptospirosis that lead to severe, potentially fatal complications

A

~1%

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11
Q

An independent risk factor for leptospirosis:

A

Swimming in the Segama River

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12
Q

Phase of leptospirosis wherein organisms proliferate, cross tissue barriers, and disseminate hematogenously to all organs

A

Leptospiremic phase

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13
Q

Phase of leptospirosis when organism can be isolated from the bloodstream

A

Leptospiremic phase

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14
Q

During leptospiremic phase, organisms are able to survive in the nonimmune host by evading complement-mediated killing by binding ____:

A

Factor H (a strong inhibitor of the complement system)

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15
Q

Phase of leptospirosis where the appearance of antibodies coincides with the disappearance of leptospires from the blood

A

Immune phase

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16
Q

Phase of leptospirosis where bacteria persist in various organs, including liver, lung, kidney, heart, and brain

A

Immune phase

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17
Q

Deregulation of the expression of several transporters along the nephron in leptospirosis causes these 3:

A

a. Impaired sodium absorption
b. Tubular potassium wasting
c. Polyuria

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18
Q

Thrombocytopenia in leptospirosis is most likely due to:

A

Platelet consumption

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19
Q

The only leptospiral virulence factor shown to satisfy Koch’s molecular postulates

A

Loa22

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20
Q

Hallmarks of fatal leptospirosis (2):

A

a. Bleeding

b. Multiorgan failure

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21
Q

Incubation period of leptospirosis:

A

1-2 weeks (may range from 1-30 days)

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22
Q

During immune phase, leptospires can be cultured in the:

A

Urine

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23
Q

Milder cases of leptospirosis do not always include this phase:

A

Immune phase

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24
Q

Mild leptospirosis usually spontaneously resolve within:

A

7–10 days

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25
Q

Case–fatality rate of severe leptospirosis:

A

1 to 50%

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26
Q

Risk factor for higher mortality rates in leptospirosis (6):

A

a. Age >40
b. Altered mental status
c. Acute renal failure
d. Respiratory insufficiency
e. Hypotension
f. Arrhythmias

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27
Q

Percentage of patients with leptospirosis who have jaundice:

A

5-10%

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28
Q

Jaundice in leptospirosis is usually associated with fulminant hepatic necrosis: True/False

A

False

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29
Q

Typical electrolyte abnormalities in leptospirosis (2):

A

a. Hypokalemia

b. Hyponatremia

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30
Q

Unique feature of leptospiral nephropathy

A

Loss of Mg in the urine

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31
Q

Characteristic of renal manifestation of early leptospirosis

A

Nonoliguric hypokalemic renal insufficiency

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32
Q

Most common radiographic finding in Leptospirosis:

A

Patchy bilateral alveolar pattern (due to scattered alveolar hemorrhage and predominantly affects the lower lobes)

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33
Q

Definitive diagnosis of leptospirosis (3):

A

a. Isolation of organism
b. Positive PCR
c. Seroconversion or a rise in antibody titer

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34
Q

Microscopic agglutination test (MAT) result required for diagnosis of leptospirosis in cases with strong clinical evidence of infection:

A

1:200 – 1:800

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35
Q

Has the capacity to confirm the diagnosis of leptospirosis with a high degree of accuracy during the first 5 days of illness

A

PCR

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36
Q

DOC for severe leptospirosis

A

IV penicillin

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37
Q

Alternative drugs for severe leptospirosis (3):

A

a. Ceftriaxone
b. Cefotaxime
c. Doxycycline

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38
Q

Recommended oral drugs for mild leptospirosis (4):

A

a. Doxycycline
b. Azithromycin
c. Ampicillin
d. Amoxicillin

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39
Q

DOC for leptospirosis in areas where rickettsial diseases are coendemic (2):

A

a. Doxycycline

b. Azithromycin

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40
Q

Rare reaction that occurs within hours after the initiation of antimicrobial therapy in leptospirosis:

A

Jarisch-Herxheimer reaction

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41
Q

Adjunct therapy for pulmonary involvement associated with severe leptospirosis (2)

A

a. Glucocorticoids

b. Desmopressin

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42
Q

Dose of doxycycline in mild leptospirosis:

A

100 mg BID x 7 days

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43
Q

Dose of Amoxicillin in mild leptospirosis:

A

500 mg TID x 7 days

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44
Q

Dose of ampicillin in mild leptospirosis:

A

500 mg TID x 7 days

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45
Q

Dose of Pen G in moderate/severe leptospirosis:

A

1.5M u IV or IM q6hrs x 7 days

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46
Q

Dose of Ceftriaxone in moderate/severe leptospirosis:

A

2 g/day IV x 7 days

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47
Q

Dose of cefotaxime in moderate/severe leptospirosis:

A

1g IV q6hrs x 7 days

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48
Q

Dose of doxycycline in moderate/severe leptospirosis:

A

LD 200 mg IV, then 100 mg IV q12h

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49
Q

The protypic lesion of IE

A

Vegetation

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50
Q

Analogous process of IE in AV shunts, AA shunts (i.e. PDA) or coarctation of the aorta

A

Infective endarteritis

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51
Q

A hectically febrile illness that rapidly damages cardiac structures, seeds to intracardiac sites

A

Acute Endocarditis

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52
Q

Has indolent course and causes structural cardiac damage only slowly, and rarely metastasizes

A

Subacute Endocarditis

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53
Q

Predisposing factors for IE (4):

A

 Congenital heart disease
 Illicit IV drug use
 Degenerative valve disease
 Intracardiac devices

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54
Q

Most common organisms causing IE (3):

A

 Viridans streptococci
 Staphylococci
 HACEK organisms

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55
Q

What are HACEK organisms?

A 
	Haemophilus species
	Aggregatibacter species
	Cardiobacterium hominis
	Eikenella corrodens
	Kingella kingae
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56
Q

Primary portals for IE (3):

A

 oral cavity
 skin
 upper respiratory tract

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57
Q

Organism from GIT, associated with polyps and colonic tumors, that can cause IE:

A

Streptococcus gallolyticus subspecies gallolyticus (formerly S. bovis biotype 1)

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58
Q

How many percent of IE have negative blood cultures

A

5-15%

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59
Q

Causes an indolent, culture-negative, afebrile form of endocarditis

A

Tropheryma whipplei

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60
Q

Early prosthetic valve endocarditis arises within how many months after valve surgery?

A

2 months

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61
Q

Delayed onset prosthetic valve endocarditis arises within how many months after valve surgery?

A

2-12 months

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62
Q

Late prosthetic valve endocarditis arises within how many months after valve surgery?

A

> 12 months

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63
Q

How many percent of coagulase-negative staphylococcus strain causing PVE are resitant to methicillin?

A

At least 68-85%

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64
Q

Most common cause of cardiovascular ICD endocarditis (2):

A

S. aureus

CoNS

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65
Q

Most commonly affected valve in injection drug-use-associated endocarditis? And the most common cause?

A

Tricuspid valve, S. aureus

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66
Q

Endocarditis with uninfected vegetations seen in patients with malignancy and chronic diseases

A

Marantic endocarditis

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67
Q

Adherence of gram positive bacteria in IE is facilitated by:

A

Fibronectin-binding proteins

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68
Q

Adherence of S. aureus in IE is facilitated by:

A

Clumping factor

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69
Q

Adherence of Enterococcus faecalis in IE is facilitated by (3):

A

Fibrinogen-binding surface proteins (Fss2)
Collagen-binding surface protein (Ace)
Ebp pili

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70
Q

Adherence of streptococcus in IE is facilitated by:

A

Glucans or FimA

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71
Q

Organisms deep in vegetations are metabolically active and relatively susceptible to killing by antimicrobial agents

A

Inactive, resistant to killing

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72
Q

How many % of IE patients will have CHF?

A

30-40%

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73
Q

Cause of CHF in IE (2):

A 
Valve dysfunction
Intracardiac fistulae (occasionally)
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74
Q

How many % of IE patients will have MI?

A

2%, due to emboli to a coronary artery

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75
Q

Classic nonsuppurative peripheral manifestation of IE that is related to prolonged infection

A

Janeway lesions

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76
Q

Arterial emboli in IE is increased in: (3)

A

 S. aureus endocarditis
 Mobile vegetations >10 mm in diameter
 Infection involving the mitral valve (esp anterior leaflet)

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77
Q

How many % of IE patients will have cerebrovascular emboli?

A

15-35%

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78
Q

Endocarditis of which side will more likely cause cerebrovascular emboli?

A

Left-sided endocarditis

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79
Q

Focal dilations of arteries occurring at points in the artery wall that have been weakened by infection in the vasa vasorum or where septic emboli have lodged

A

Mycotic aneurysms

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80
Q

The diagnosis of infective endocarditis is established with certainty only when

A

vegetations are examined histologically and microbiologically

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81
Q

A highly sensitive and specific diagnostic schem for IE

A

Modified Duke Criteria

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82
Q

Clinical diagnosis of definite endocarditis based on Modified Duke Criteria

A

two major criteria, or one major criterion and three minor criteria, or of five minor criteria

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83
Q

Diagnosis of endocarditis is rejected if (3):

A

 Alternative diagnosis is established
 Symptoms resolve and do not recur with ≤4 days of antibiotic therapy
 Surgery or autopsy after ≤4 days of antimicrobial therapy yields no histologic evidence of endocarditis

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84
Q

Possible IE

A

 One major and one minor criterion

 Three minor criteria

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85
Q

Modified Duke Critera: Major criteria (2)

A

 Positive blood culture
o Typical microorganism for IE in 2 separate blood culture
o Persistently positive blood culture, defined as recovery of microorganism consistent with IE from blood cultures drawn > 12 h apart, or all of 3 or a majority of >/= 4 separate blood culture with 1st and last drawn at least 1 h apart
o Single positive blood culture for Coxiella burnetti or phase I IgG antibody titer of >1:800
 Evidence of endocardial involvement
o Positive echocardiogram
o New valvular regurgitation

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86
Q

Positive echochardiogram findings of IE (3):

A

 Oscillating intracardiac mass on valve or supporting structures or in path of regurgitant jets or in implanted material, in the absence of an alternative anatomic explanation
 Abscess
 New partial dehiscence of prosthetic valve

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87
Q

Minor criteria of Modified Duke Criteria (5)

A

 Predisposing heart conditions or injection drug use
 Fever≥ 38C
 Vascular phenomena
 Immunologic phenomena
 Microbiologic evidence (positive blood culture not meeting major criteria, or serologic evidence)

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88
Q

Vascular phenomenon included in the modified duke criteria (6)

A 
	Major arterial emboli
	Septic pulmonary infarcts
	Mycotic aneurysm
	Intracranial hemorrhage
	Conjunctival hemorrhages
	Janeway lesions
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89
Q

Immunologic phenomena included in the modified duke criteria (4)

A

 Glomerulonephritis
 Osler’s nodes
 Roth’s spots
 Rheumatoid factor

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90
Q

How to obtain blood cultures for IE?

A

 Three 2-bottle blood culture sets, separated from one another by at least 2 h, should be obtained from different venipuncture sites over 24 h

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91
Q

Treatment of Candida endocarditis

A

Amphotericin B (3–5 mg/kg IV qd) plus flucytosine (25 mg/kg PO q6h)

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92
Q

Empirical therapy for culture-negative endocarditis injection drug user or health care-assocaited NVE

A

Vancomycin plus gentamicin or cefepime

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93
Q

Empirical therapy for NVE with subacute presentation

A

Vancomycin plus ceftriaxone

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94
Q

Empirical therapy for blood culture-pending PVE

A

 Vancomyci, gentamicin and cefepime if prothetic valve has been in place for ≤1 year
 Similar to NVE if prosthetic valves in place for >1 year

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95
Q

Duration of antibiotic therapy if with CIED endocarditis and bacteremia that persist even after removal

A

4- to 6-week course

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96
Q

Duration of antibiotic therapy for generator pocket infection without bacteremia

A

10- to 14-day course

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97
Q

Anticoagulation must be given for IE. True or false

A

False. Patients with IE are at risk for emboli, for hemorrhagic transformation of embolic strokes, and for intracerebral hemorrhage from septic arteritis or ruptured mycotic aneurysms

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98
Q

The most common indications for surgery in IE (2)

A

Intracardiac complications

CHF

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99
Q

Indications of surgery in IE (5):

A 
	Congestive Heart Failure
	Perivalvular Infection
	Uncontrolled Infection
	Prevention of Septic emboli
	CIED Endocarditis
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100
Q

Most commonly affected valve in the perivalvular infection complication of IE

A

Aortic valve

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101
Q

Test of choice to detect perivalvular abscesses

A

TEE with color Doppler

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102
Q

In CIED endocarditis, when can you reimplant CIED if necessary?

A

At a new site 10-14 days of antimicrobial therapy

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103
Q

If surgical indication is not urgent, cardiac surgery should be delayed for _______ after a large nonhemorrhagic embolic infarction and ______ after a cerebral hemorrhage

A

2-3 weeks

4 weeks

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104
Q

Extracardiac complications of IE (2):

A

Splenic abscess

Mycotic aneurysm

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105
Q

Salmonella sp. that are restricted to human hosts, causing enteric (typhoid) fever (2)

A

Salmonella typhi and paratyphi

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106
Q

Salmonella:
Gram negative or positive?
Spore forming or not?
Aerobe or unaerobe?

A

Gram negative bacilli, non-spore-forming, facultatively anaerobic bacilli

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107
Q

Family of Salmonella

A

Enterobacteriaceae

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108
Q

Salmonella produce what gas on sugar fermentation? Salmonella that does not form this gas?

A

H2S

Salmonella typhi

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109
Q

Serogroup of salmonella that cause ~99% of infections in humans and other warm-blooded animals

A

O-antigen serogroups

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110
Q

Infectious dose of salmonella

A

200 CFU to 106 CFU

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111
Q

Characterized by infiltration of mononuclear cells into the small bowel mucosa

A

Enteric fever

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112
Q

infectous disease that is characterized by massive PMN leukocyte infiltration into both the large and small bowel mucosa

A

NTS gastroenteritis

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113
Q

Etiologic agents of enteric fever

A

S. Typhi and S. Paratyphi serotypes A, B and C

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114
Q

Incubation period of enteric fever

A

average of 10-14 days but ranges from 5-21 days

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115
Q

Which is milder, S. parathyphi or typhi?

A

Paratyphi

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116
Q

Rash of typhoid fever and found in how any percentage?

A

Rose spots – 30%

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117
Q

Faint, salmon-colored, blanching, maculopapular rash primarily in the trunk and chest, and evident at the end of the 1st week of typhoid fever

A

Rose spots

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118
Q

ECG findings in typhoid fever seen in <50% of cases

A

Relative bradycardia at the peak of high fever

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119
Q

Disease that has neuropsychiatric symptoms of “muttering delirium” or “coma vigil”, and picking at bedclothes or imaginary objects

A

Typhoid fever

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120
Q

Up to ____ of untreated salmonellosis will excrete S. Typhi in the feces for up ______, and _____ will be a chronic carrier up to ____.

A

10% - 3 months

2-5% - >1 year

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121
Q

Concomittant infection with this organism is a risk factor for chronic asymptomatic carriage of Salmonella

A

S. haematobium

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122
Q

Chronic asymptomatic carriage of salmonella will increase risk of what cancer

A

Gallbladder CA

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123
Q

In salmonellosis, if blood, bone marrow, and intestinal secretions are all cultured, the yield is

A

> 90%

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124
Q

Serologic test for typhoid fever for febrile agglutinins

A

Widal serologic tests

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125
Q

Most effective class of agents for drug-susceptible typhoid fever

A

Fluoroquinolones

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126
Q

Preferred fluoroquinolones for typhoid fever

A

Ciprofloxacin

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127
Q

Treatment for DSC Typhoid fever (3)

A

Ceftriaxone
Azithromycin
High dose ciprofloxacin

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128
Q

Treatment for MDR salmonellosis

A

Ceftriaxone
Cefotaxime
Cefixime

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129
Q

Treatment of complicated enteric fever and duration of treatment

A

IV 3rd gen cephalosporin or fluoroquinolone up to at least 10 days or for 5 days after fever resolution

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130
Q

Glucocorticoid used for enteric fever (include dose and indication)

A

Dexamethasone initial dose of 3 mg/kg then 8 doses of 1 mg/kg every 6 h
severe enteric fever

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131
Q

Treatment of chronic salmonella carriage and duration of treatment

A

Oral ciprofloxacin or other fluoroquinolones x 4 weeks

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132
Q

2 typhoid vaccines

A

Ty21a – oral live attenuated S. Typhi vaccine

Vi CPS – parenteral vaccine consisting of purified Vi polysaccharide from the bacterial capsule

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133
Q

DOC for MDR – nontyphoidal salmonellosis (2)

A

extended spectrum cephalosporins and fluoroquinolones

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134
Q

An illness that mimics inflammatory bowel disease that is seen in NT salmonellosis

A

Pseudoappendicitis

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135
Q

Antibiotics is not usually recommended in NT salmonellosis. Why?

A

may prolong fecal carriage

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136
Q

Bacteremia is most common in what organism causing NTS (2)?

A

Salmonella Choleraesuis and Salmonella Dublin

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137
Q

Suspected in elderly patients with prolonged fever and back, chest or abdominal pain developing after an episode of gastroenteritis

A

NTS Arteritis

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138
Q

Preemptive antibiotic treatment for NTS is given only to these populations (6)

A
  • Neonates (up to 3 mos of age)
  • > 50 years of age
  • Athersosclerosis
  • Immunosuppressed
  • Cardiac valvular or endovascular abnormalities
  • Significant joint disease
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139
Q

Treatment for NTS endocarditis and arteritis with duration:

A
  • 6 weeks IV β-lactam antyibiotic (ceftriaxone or ampicillin)
  • May also be given with IV ciprofloxacin
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140
Q

2 forms of Rabies

A
  • Encephalitic

* Paralytic

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141
Q

Genus of rabies virus

A

Lyssavirus

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142
Q

Rabies virus is what kind of virus? DNA or RNA?

A

Single-stranded RNA virus, nonsegmented

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143
Q

Incubation period of rabies

A

20-90 days

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144
Q

In muscles, rabies bind to what receptor?

A

nicotinic Acetylcholine receptor on postsynaptic membranes at NMJ

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145
Q

Rabies virus spread centripetally along peripheral nerves toward the spinal cord or brainstem via _______. Virus then enters the CNS and rapidly disseminates to other regions of the CNS via ______ along neuroanatomic connections

A

retrograde fast axonal transport

fast axonal transport

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146
Q

T or F: Rabies virus prominently infect astrocytes

A

False. Neurons. Astrocytes infection is unusual

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147
Q

Pathologic changes in rabies include mononuclear inflammatory infiltration in the leptomeninges, perivascular regions, and parenchyma, including the microglial nodules called

A

Babes nodules

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148
Q

Most characteristic pathologic finding in rabies

A

Negri bodies

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149
Q

Eosinophilic cytoplasmic inclusions in brain neurons composed of rabies virus proteins and viral RNA

A

Negri bodies

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150
Q

T or F: neuronal death is responsible for the clinical disease in rabies

A

False. Neuronal dysfunction

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151
Q

Earliest specific neurologic symptoms that strongly suggest rabies (3):

A
  • Paresthesias near the site of the exposure
  • Pain near the site of the exposure
  • Pruritus near the site of the exposure
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152
Q

Encephalitic (furious) form and paralytic form are seen in how many percent of rabies patients respectively

A

80%

20%

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153
Q

T or F: Episodes of hyperexcitability in rabies are typically followed by periods of complete lucidity that become shorter as the disease progresses

A

True

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154
Q

Early brainstem involvement in rabies present as

A

Hydrophobia

Aerophobia

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155
Q

T or F: Paralytic forms of rabies generally survive a few days shorter than those with encephalitic rabies

A

False. Longer.

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156
Q

Highly sensitive and specific test for rabies (2)

A

RT-PCR

Direct fluorescent antibody (DFA) testing (can be performed quickly)

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157
Q

Difference between rabies encephalitis and other acute encephalitis

A

Early brainstem involvement with preservation of consciousness

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158
Q

T or F: rabies has 100% mortality rate

A

False. Aggressive management with supportive care in critical care units has resulted in the survival of more than 15 patients with rabies. But is an almost uniformly fatal disease.

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159
Q

T or F: Rabies is nearly always preventable after recognized exposures with appropriate postexposure therapy during the early incubation period

A

True

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160
Q

Active immunization of rabies

A

Four 1 mL doses of rabies vaccine given IM in the deltoid area or anterolateral aspect of the thigh (children) at day 0, 3, 7, 14 (5th dose on Day 28 no longer recommended)

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161
Q

T or F: Rabies vaccine is contraindicated in pregnancy

A

False

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162
Q

Who should receive the passive immunization of rabies?

A

To all previously unvaccinated persons

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163
Q

When should rabies Ig be administered

A

Should be administered within 7 days after the 1st vaccine dose

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164
Q

Dose of Rabies Ig

A

20 iu/kg, or 40iu/kg (purified ERIG) infiltrated at the site of bite then the remaining dose given IM at distant site; If exposure is through mucous membrane, entire dose must be given as IM

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165
Q

T or F: Rabies Ig may be given at the same site as the vaccine

A

False. Not same site

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166
Q

Preexposure rabies vaccination is given at how many doses?

A

3 doses. Day 0, 7, and 21 or 28

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167
Q

When a previously immunized individual is exposed to rabies, when will you give booster dose?

A

2 doses. Day 0 and 3.

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168
Q

most common and frequent infections in humans

A

Respiratory virus infection

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169
Q

mark the transition between the upper and lower respiratory tracts

A

Vocal cords

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170
Q

Parts of lower respiratory tract (5)

A
  • Trachea
  • Bronchi
  • Bronchioles
  • Alveolar spaces
  • Lung tissue
Upper respiratory tract
•	Sinuses
•	Middle-ear spaces
•	Eustachian tubes
•	Conjunctiva
•	Nasopharynx
•	Oropharynx
•	Larynx
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171
Q

Principal types of cells in the major airways (3)

A
  • Cilated or nonciliated epithelial cells
  • Goblet cells
  • Clara cells
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172
Q

Wheezing is the constriction of lumen size of smooth muscles at the level of

A

Bronchioles

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173
Q

With narrowest lumen diameter of the airways

A

Bronchioles

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174
Q

Difficulty in inspiration associated with barky cough

A

Croup

Inflammation or infection of the larynx, trachea, and bronchi

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175
Q

Most common viral causes of serious lower respiratory tract disease (3)

A
  • Influenza viruses
  • RSV
  • Human metapneumovirus
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176
Q

Most common cause of common colds

A

Rhinoviruses

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177
Q

Most common virus isolated in immunosuppressed patients with pneumonia during bronchoalveolar lavage

A

Cytomegalovirus

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178
Q

Influenza virus belong to what family?

A

Orthomyxoviridae

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179
Q

Influenza infection has high rate of complication with bacterial superinfection, most commonly with (2)

A

S. aureus and S. pneumoniae

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180
Q

Describe influenza virus

A

A single-stranded, segmented, negative-sense, RNA genome virus

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181
Q

Influenza virus that is most virulent for humans

A

Influenza A

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182
Q

Influenza that is composed of hemagglutinins and neuraminidase

A

Influenza A

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183
Q

Influenza that infect humans almost exclusively

A

Influenza B

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184
Q

A process that can make the zoonotic viruses (e.g avian or swine) more fit for replications in humans

A

Reassortment

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185
Q

RSV is from what genus and family?

A

Genus: Pneumovirus
Family: paramyxoviridae

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186
Q

Single-stranded, negative-sense, non-segmented, RNA virus that is one of the most common viral causes of severe lower respiratory tract illness in the elderly and in children

A

RSV

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187
Q

Infection with this virus early in life have strong association with subsequent asthma

A

RSV

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188
Q

Measles virus is from what genus and family?

A

Genus: Morbilivirus
Family: paramyxoviridae

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189
Q

Most contagious respiratory virus infection of humans

A

Measles virus

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190
Q

Clinical manifestations of measles (4)

A
  • ≥ 3 days of high fever
  • 3 Cs: cough, coryza and conjunctivitis
  • Diffuse maculopapular rash appears within days of fever onset
  • Koplik’s spots
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191
Q

Typical mucosal lesions in the mouth that appear briefly in measles

A

Koplik’s spots

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192
Q

Coxsackievirus belong to what family?

A

Picornaviridae

Enterovirus A

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193
Q

Causes hand-foot-and-mouth disease and herpangina

A

Coxsackievirus

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194
Q

Clinical syndrome of ulcers or small vesicles on the palate that often involves the tonsillar fossa associated with fever, difficulty swallowing, and throat pain

A

Herpangina

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195
Q

Clinical manifestation of epidemic pleurodynia

A

Acute illness characterized by sharp chest pain and fever

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196
Q

Epidemic herpangina is caused by

A

Echovirus 11

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197
Q

Describe structure of rhinovirus

A

Single-stranded, positive-sense RNA virus

Icosahedral and non-enveloped

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198
Q

Describe structure of adenovirus

A

Double-stranded DNA virus, non-segmented, <100 nm in diameter, non-enveloped, icosahedral morphology

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199
Q

Common in stressful or crowded living conditions and was first recognized among military recruits during WWII

A

Adenovirus

Most often associated with adenovirus types 4 and 7

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200
Q

When was the epidemic of SARS-CoV

A

Nov 2002 to July 2003

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201
Q

Mortality rate of SARS-CoV

A

10%

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202
Q

Mortality rate of MERS-Cov

A

35%

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203
Q

MERS-CoV may have emerged from what animals?

A

Bats

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204
Q

Herpes that mostly affects the oral cavity

A

HSV-1

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205
Q

Describe the structure of polyomaviruses

A

Small, double-stranded, DNA viruses, non-enveloped, icosahedral

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206
Q

Respiratory virus that may be oncogenic

A

Polyomavirus

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207
Q

Polyomavirus that can infect the respiratory system, kidney, or brain

A

JC virus

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208
Q

Polyomavirus that causes mild respiratory infection or pneumonia

A

BK virus

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209
Q

Major determinant of risk for symptomatic disease during respiratory virus infection

A

Age

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210
Q

T or F: Primary infection of respiratory virus is usually more severe than reinfection

A

True

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211
Q

Gold standard for diagnosing a respiratory viral infection

A

Virus isolation

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212
Q

Most sensitive and specific test for respiratory viral infection

A

RT-PCR

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213
Q

Neuraminidase inhibitors act on what influenza type

A

A and B

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214
Q

Neuraminidase inhibitors

A

Oseltamivir
Zanamivir
Peramivir
Laninamivir

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215
Q

Neuraminidase inhibitors that may cause bronchospasm in asthma and COPD

A

Zanamivir

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216
Q

Adamantanes are used for treatment of what influenza?

A

Influenza A

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217
Q

Nucleoside antimetabolite prodrug that is used as treatment for RSV infection

A

Ribavirin

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218
Q

Caused by point mutations in the H and N molecules of influenza

A

Antigenic drift

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219
Q

This is the reason why there is a need to produce new vaccines yearly

A

Antigenic drift

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220
Q

Reassortment of 2 viruses during co-infection of one individual or animal that may cause a pandemic

A

Antigenic shift

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221
Q

Most common cause of contact transmission of viruses

A

Poor hand hygiene

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222
Q

The basic level of infection control that is used in the care of all patients at all times

A

Standard precaution

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223
Q

The second level of infection control that is used and may require a single room for the patient when possible

A

Contact precaution

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224
Q

Range of large-particle droplets during transmission of virus

A

3 ft

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225
Q

T or F. Acute bacterial infection of joints typically involve multiple joints

A

False. single or a few joints only

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226
Q

Immunologic reaction of joints during course of endocarditis, rheumatic fever, disseminated neisserial infection, and acute hepatitis B

A

Acute polyarticular arthritis

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227
Q

Cell count in normal synovial fluid

A

<180 cells per microliter

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228
Q

Predominant cell in normal synovial fluid

A

mononuclear

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229
Q

Cell count in synovial fluid during acute bacterial infection

A

Cell count of 25,000 – 250,000/uL

> 90% neutrophils

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230
Q

Cell count in synovial fluid of crystal-induced, rheumatoid, and noninfectious inflammation

A

<30,000-50,000/uL

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231
Q

Cell count in synovial fluid during mycobacterial and fungal infection

A

10,000 – 30,000/uL

50-70% neutrophils and the remainder lymphocytes

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232
Q

Mode of transmission of acute bacterial arthritis

A

o Hematogenous infection

o Direct inoculation

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233
Q

Most mode of transmission of acute bacterial arthritis

A

Hematogenous route

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234
Q

Most common bacteria isolated in acute bacterial arthritis in young adults and adolescents

A

N. gonorrheae

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235
Q

Most common nongonococcal bacteria isolated in acute bacterial arthritis in adults

A

S. aureus

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236
Q

Most common bacteria isolated in acute bacterial arthritis that is post-surgical or trauma-induced

A

S. aureus

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237
Q

Penetration of a sharp object through a shoe will cause an arthritis in the foot caused by what organism

A

Pseudomonas aeruginosa

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238
Q

Highest incidence of infective arthritis occurs in patients with

A

Rheumatoid arthritis

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239
Q

Most common cause of infectious arthritis among patients with rheumatoid arthritis

A

S. aureus

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240
Q

Infectious arthritis that is most often seen in primary iimmunoglobulin deficiency

A

Mycoplasmal arthritis

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241
Q

treatment of mycoplasmal arthritis (2)

A

tetracycline and IV immunoglobulin

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242
Q

Most commonly involved joint in the acute bacterial arthritis

A

Knee

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243
Q

Most commonly involved joints in the acute bacterial arthritis among IV drug users (3)

A

Spine, sacroiliac joints, and sternoclavicular joints

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244
Q

On plain radiograph, this indicates advanced infection with poor prognosis

A

Narrowing of the joint space and bony erosions

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245
Q

T or F: Men are more likely to develop disseminated gonococcal infection (DGI) and arthritis than women

A

False. Women are more likely, especially during menses and pregnancy

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246
Q

Small number of papules that progress to hemorrhagic pustules in the trunk and extensor surfaces of the distal extremities associated with migratory arthritis and tenoxynovitis of the knees, hands, wrists, feet and ankles

A

Disseminated Gonococcal Infection

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247
Q

T or F. In true gonococcal septic arthritis, blood culture is almost always negative

A

True

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248
Q

Agar used to isolate organism in gonococcal arthritis

A

Thayer-Martin agar

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249
Q

This supports a clinical diagnosis of the disseminated gonococcal syndrome if cultures are negative

A

Dramatic alleviation of symptoms within 12-24 h after the initiation of appropriate antibiotic therapy

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250
Q

Treatment for gonococcal arthritis

A

Ceftriaxone 1g IV or IM every 24 h

Once local and systemic signs are clearly resolving, 7-day course of therapy can be completed with an oral fluoroquinolone such as ciprofloxacin 500 mg BID and Amoxicillin 500 mg TID

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251
Q

Aside from treating the gonococcal arthritis with ceftriaxone or ciprofloxaciin, what other antibiotic will you give and for what reason?

A

Azithromycin 1g single dose

they should be treated for Chlamydia trachomatis infection also

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252
Q

Cause of lyme disease

A

Borrelia burgdorferi

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253
Q

Lyme diseaseis transmitted by

A

Ixodes tick

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254
Q

Antibiotic treatment of lyme disease (3)

A

 Oral doxycycline 100 mg BID for 28 days
 Oral amoxicillin 500 mg TID for 28 days
 IV ceftriaxone 2g/day for 2-4 weeks

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255
Q

Periarticular swelling and immobilization of the involved limbs complicate osteochondritis of long bones in congenital syphilis

A

Parrot’s pseudoparalysis

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256
Q

Late joint manifestation of congenital syphilis caused by painless synovitis with effusions of large joints

A

Clutton’s joint

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257
Q

Joint deformity that result from sensory loss due to tabes dorsalis

A

Charcot joint

in tertiary syphilis

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258
Q

Most common presentation of mycobacterial arthritis

A

Chronic granulomatous monoarthritis

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259
Q

Unusual syndrome which is a reactive symmetric form of polyarthritis that affects persons with visceral or disseminated tuberculosis

A

Poncet’s disease

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260
Q

Most common cause of fungal arthritis (3)

A

Coccidioids immitis
Blastomyces dermatitidis
Histoplasma capsulatum

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261
Q

Treatment of fungal arthritis

A

amphotericin (IV and intraarticular)

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262
Q

T or F. In management of infections of prosthetic joints, prosthesis must be always replaced

A

False.

Prosthesis may not be removed if:
o In cases of streptococci or pneumococci
o Lack of radiologic evidence of loosening of the prosthesis
o Antibiotic therapy must be initiated within several days of the onset of infection
o Joint should be drained vigorously by open arthrotomy or arthroscopically

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263
Q

Therapy that has a high cure rate with retention of prosthesis in infections of prosthetic joints

A

Oral rifampin plus another antibiotic

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264
Q

Trematodes are also known as

A

flatworms

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265
Q

Trematodes belong to what phylum?

A

Platyhelminthes

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266
Q

All the trematodes are hermophriditic except for

A

Shistosomes

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267
Q

Definitive host of trematodes

A

mammal / humans

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268
Q

Infective stage of Schistosoma

A

Cercariae

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269
Q

Cercariae of the schistosomes penetrate intact human skin within a few minutes after attaching to the skin then transform to

A

shistosomula

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270
Q

Where does the schisosomes mature to adult males and females

A

portal vein

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271
Q

Final location of adult schistosomes (2)

A

mesenteric or pelvic venous plexus

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272
Q

Interval from schistosome cercarial penetration to sexual maturation and egg production

A

Prepatent period

5-7 weeks

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273
Q

Free-swimming larval stage of schistosomes

A

miracidium

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274
Q

Life cycle of schistosomes that penetrate the host snail then undergoes asexual multiplication

A

miracidium

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275
Q

The only stage of the schistosome that is detected in humans

A

egg

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276
Q

Schistosome egg that has terminal spine

A

S. haematobium eggs

277
Q

Schistosome egg that has lateral spine

A

S. mansoni eggs

278
Q

Schistosome egg that is smaller, rounder, with a small lateral spine or knob

A

S. japonicum eggs

279
Q

Body forms a groove or gynecophoric canal in which the mature adult female is held

A

Male schistosome

280
Q

Compared to male schistosome, female worm is

A

Longer, thinner, and rounded

281
Q

Humans are the most important definitive hosts for these schistosomes (3)

A

S. mansoni,
S. haematobium,
S. intercalatum

282
Q

Zoonotic schistosomes

A

S. japonicum and S. mekongi

283
Q

The most important of the neglected tropical diseases and is second only to malaria in public health impact

A

• Schistosomiasis

284
Q

T or F: Most manifestations of schistosomiasis are due to immunologic reactions to worms retained in host tissues

A

False. Eggs

Egg, and not the adult worms, induce the organ-specific morbidity

285
Q

Schistosome species that cause hepatosplenomegaly (2)

A

S. mansoni

S. japonicum

286
Q

Schistosome egg-induced granulomatous response leads to this severe periportal fibrosis

A

Symmers clay pipestem fibrosis

287
Q

S. haematobium has predilection to what veins

A

urogenital plexus

288
Q

This schistosome can cause intense egg-induced tissue inflammation leading to bladder wall thickening and development of masses and pseudopolyps

A

S. haematobium

289
Q

Swimmer’s itch is caused by

A

Schistosomes

290
Q

Cause of swimmer’s itch

A

cercarial penetration of the skin

291
Q

causes severe form of cercarial dermatitis

A

Avian schistosomes

Cannot complete development in humans and die in the skin leading to inflammatory allergic reaction

292
Q

Treatment of cercarial dermatitis

A

Systemic or topical antihistamines or glucocorticoids

to reduce symptom only

293
Q

Acute schistosomiasis is also known as

A

Katayama fever

294
Q

Onset of katayama fever is how many weeks/months after exposure?

A

2 weeks to 3 months

295
Q

Symptoms of Katayama fever (6)

A 
o	Fever
o	Myalgia
o	General malaise and fatigue
o	Headache
o	Nonproductive cough
o	Abdominal tenderness or pain
296
Q

Liver is enlarged (especially the left lobe) smooth, and firm with no hepatic fibrosis on USD is manifestation of what infection?

A

Hepatosplenic Schistosomiasis

Early inflammatory hepatosplenomegaly

297
Q

Left hypochondrial mass with discomfort and anorexia, and with USD of typical periportal fibrosis and dilation of the portal vein is manifestation of what infection?

A

Hepatosplenic schistosomiasis

Late hepatosplenic disease with periportal or Symmers fibrosis

298
Q

Most severe complication of hepatosplenic schistosomiasis

A

hematemesis

299
Q

Characteristic sign of active stage of urogenital schistosomiasis

A

Painless, terminal hematuria

300
Q

Manifests as nocturia, urinary retention, dribbling, and incontinence, and with cystoscopic findings of “sandy patches”

A

Chronic stage of urogenital schistosomiasis

301
Q

Schistosome that is classified as definitely carcinogenic to humans (group 1 carcinogen) and what cancer does to cause?

A

S. haematobium

May cause squamous cell carcinoma of the urinary bladder

302
Q

Schistosomes that can end up in the spinal venous plexus (2) and the condition that they cause

A

S. mansoni and S. haematobium

transverse myelitis

303
Q

Schistosome that causes granulomatous lesions in the brain

A

S. japonicum

304
Q

Rectal biopsies can detect what schistosomes (2)

A

S. mansoni and S. haematobium

305
Q

Serology that is used by CDC to detect schistosomiasis

A

Falcon assay screening test / enzyme-linked immunosorbent assay (FAST-ELISA)

Use S. mansoni adult microsomal antigen

306
Q

Drug of choice for all forms of schistosomiasis

A

Praziquantel

307
Q

Cornerstone of management and control

A

Praziquantel mass administration programs

308
Q

Most important liver flukes causing human infections (4)

A

o Opistorchis viverrini and Opistorchis felineus
o Clonorchis sinensis
o Fasciola hepatica
o Fasciola gigantica

309
Q

1st and 2nd intermediate hose of opistorchiasis and clonorchiasis

A

host snail

fresh water fish

310
Q

Infective stage of opistorchiasis and clonorchiasis

A

metacercariae

311
Q

Tretamatodes that may cause cholangiocarcinoma

A

Opistorchiasis

Clorchis sinensis

312
Q

2nd intermediate host of Fasciola hepatica

A

None

metacercariae adhere directly to aquatic plans such as watercress

313
Q

Intestinal fluke

A

Fasciolopsis buski

314
Q

Lung fluke

A

Paragonimus westermani

315
Q

2 intermediates host of paragonimus

A

o Freshwater snail

o Freshwater crustacean

316
Q

Infective stage of paragonimus westermani

A

metacercariae

317
Q

2 DOC for trematode infection

A

o Praziquantel

o Triclabendazole

318
Q

Based on RITM guidelines, what is Stage I, II and III of tetanus based on incubation period

A

I - > 14 days
II - > 10-14 days
III - <10 days

319
Q

Based on RITM guidelines, what is Stage I, II and III of tetanus based on period of onset

A

I - > 6 days
II - > 3-6 days
III - <3 days

320
Q

Based on RITM guidelines, what is Stage I, II and III of tetanus based on trismus

A

I - mild
II - moderate
III - severe

321
Q

An acute illness with muscle spasms or hypertonia in the absence of a more likely diagnosis than tetanus

A

Probable tetanus

322
Q

an illness occurring in a child who has the normal ability to suck and cry in the first 2 days of life but who loses this ability between days 3 and 28 of life and becomes rigid and has spasms

A

Neonatal tetanus

323
Q

Maternal tetanus occus during pregnancy or within _____ after the conclusion of pregnancy (whether with birth, miscarriage, or abortion) – WHO

A

6 weeks

324
Q

Describe C. tetani in terms of:

aerobic vs anaerobic
gram + vs -
spore-forming vs non-spore-forming
coccus vs bacilli

A

an anaerobic, gram-positive, spore-forming rod whose spores are highly resilient and can survive readily in the environment throughout the world

325
Q

In______% of cases of tetanus, no puncture entry wound is found.

A

20–30%

326
Q

the most common infection sites of tetanus in adults

A

Superficial abrasions to the limbs

327
Q

Difference between tetanospasmin and botulinum toxin in terms of transport to CNS

A

Tetanospasmin undergoes retrograde transport into the CNS (unlike the botulinum toxin) and thus produces clinical effects different from the botulinum toxin

Botulinum toxins remain at the NMJ

328
Q

Aim of management of tetanus infection (2)

A

o Neutralize remaining unbound toxin

o Support vital functions

329
Q

In generalized tetatnus,, which part is affected first most often?

A

muscles of the face and jaw

330
Q

Milder form of tetanus

A

Localized tetanus

331
Q

Difference between incubation period and period of onset in tetanus

A

o Incubation period – time from wound to first symptom

o Period of onset – time from first symptom to first generalized spasm

332
Q

T or F. In tetanus, shorter incubation period and/or period of onset has worse outcome

A

True

333
Q

The most common cause of death in tetanus without ventilatory support

A

Respiratory failure

334
Q

Labile BP with rapid fluctuations from high to low accompanied by tachycardia in tetanus is caused by

A

autonomic dysfunction

335
Q

Aside from labile BP, autonomic involvement of tetanus is evidenced by (4)

A

 Gastrointestinal stasis
 Sweating
 Increased tracheal secretions
 Acute (often high-output) renal failure

336
Q

Level of serum anti-tetanus IgG (measured by standard ELISA) that is protective and do not support the diagnosis of tetanus

A

> 0.1 IU/mL

337
Q

Preferred antibiotic therapy for tetanus (with dose)

A

Metronidazole 400 mg rectally or 500 mg IV every 6 h for 7 days

338
Q

Alternative antibiotic for tetanus (with dose)

A

Penicillin 100,000–200,000 IU/kg per day

339
Q

Theoretically, this drug may exacerbate spasms and in one study was associated with increased mortality in tetanus

A

Penicillin

340
Q

Preparation of choice of tetanus antitoxin (with dose)

A

Human tetanus immune globulin (TIG)

Single IM dose (3000–5000 IU) is given with a portion injected around the wound

341
Q

Dose of equine antitoxin for tetanus

A

10,000–20,000 U is administered IM as a single dose or as divided doses

342
Q

These drugs used in tetanus to control spasm by sedation (2)

A

Benzodiazepines

Propofol infusion

343
Q

T or F: In treating the cardiovascular instability in tetanus, long-acting drug are preferred

A

False. Short-acting drugs that allow rapid titration are preferred.

Longer-acting drugs such as β antagonists may cause hypotensive cardiac arrest

344
Q

Recovery from tetanus may take up to

A

4–6 weeks

345
Q

How do you give the “Catch-up” schedules for tetanus vaccination?

A

3-dose primary course with 4 weeks between doses followed by 2 boosters 6 months apart

346
Q

For persons who have received a complete primary course of tetanus vaccine in childhood but no further boosters, how many doses should you give?

A

Two doses at least 4 weeks apart are recommended

347
Q

T or F. Patients with incomplete or unknown tetanus vaccination or last booster given > 10 years of earlier must be vaccinated but may not be given with TIG.

A

False. Must also be given passive immunization with TIG

348
Q

WHO recommendation for prevention of maternal and neonatal tetanus

A

Administration of two doses of tetanus toxoid at least 4 weeks apart to previously unimmunized pregnant women

In high-risk areas: more intensive approach. All women of childbearing age must receive a primary course along with education on safe delivery and postnatal practices

349
Q 
Factors associated with a poor prognosis in adult tetanus in terms of:
Age
incubation period
time from onset to admission
entry site
period of onset
heart rate
SBP
spasms
temperatur
A 
Age >70 years
Incubation period <7 days
Short time from first symptom to admission
Puerperal, IV, postsurgery, burn entry site
Period of onset <48 h
Heart rate >140 beats/min
Systolic blood pressure >140 mmHg
Severe disease or spasms
Temperature >38.5°C
350
Q

Vibrio cholerae need ____ bacteria to cause disease

A

10^5-10^8

351
Q

Produces an adherence protein called colonization factor antigen necessary for colonization of the upper small intestine by the organism prior to production of enterotoxin

A

Enterotoxigenic E. coli

352
Q

3 exotoxins causing vomiting/diarrhea

A

Enterotoxins
Cytotoxins
Neurotoxins

353
Q

Prototypical enterotoxin

A

Cholera toxin

354
Q

Exotoxin that cause watery diarrhea by acting directly on secretory mechanisms in the intestinal mucosa

A

Enterotoxins

355
Q

Part of cholera toxin that contains the enzymatic activity of the toxin

A

A subunit

356
Q

Part of cholera toxin that binds holotoxin to the enterocyte surface receptor (GM1)

A

B subunits

357
Q

Cholera toxin causes diarrhea by

A

Increasing Cl secretion and decreasing Na absorption causing loss of fluid

358
Q

Exotoxin that cause inflammatory diarrhea

A

Cytotoxins

Cause destruction of mucosal cells

359
Q

This exotoxin produce syndrome of dysentery, with bloody stools containing inflammatory cells

A

Cytotoxins

Shigella dysenteriae type 1 and Shiga toxin producing E. coli strains

360
Q

More than 99% of the normal colonic microbiota is made up of

A

anaerobic bacteria

361
Q

T or F. Neutralization of gastric acid with antacids, PPIs, or H2 blockers increase risk of enteric colonization

A

True

362
Q

The major mechanism for clearance of bacteria from the proximal small intestine

A

Normal peristalsis

363
Q

Opiates can cause increased frequency of bacterial overgrowth and infection of the small bowel with enteric pathogens by

A

Impairing intestinal motility

As well as other antimotility drugs, anatomic abnormalities, or hypomotility states

364
Q

Blood group with increased susceptibility to disease due to V. cholerae, Shigella, E. coli O157, and norovirus

A

O Blood Group

365
Q

marker of fecal leukocytes

A

Fecal lactoferrin

366
Q

HUS syndrome follows infection with (3)

A

Shiga toxin-producing bacteria

Shigella dysebteriae type 1 and enterohemorrhagic E. coli

367
Q

GBS is commonly associated with what infection Shigella dysebteriae type 1 and enterohemorrhagic E. coli

A

Campylobacter infection

368
Q

most common travel-related infectious illness

A

Traveler’s diarrhea

369
Q

Single most important cause of Traveler’s diarrhea

A

Enterotoxigenic strains of E. coli

Enteroaggregative strain is also common

370
Q

Traveler’s diarrhea that is associated with cruise ship is often caused by

A

Novovirus

371
Q

Traveler’s diarrhea that is common among hikers and campers who drink from fresh water streams

A

Giardia lamblia

372
Q

Most common etiologic agent associated with outbreaks of AGE

A

Novovirus

373
Q

Predominant cause of nosocomial diarrhea among adults

A

C. difficile

374
Q

Caused more than ½ of cases of significant diarrheal illness in elderly patients in chronic-care institutions

A

C. difficile

375
Q

Identified as a cause of antibiotic-associated hemorrhagic colitis

A

Klebsiella oxytoca

376
Q

Most morbidity and mortality from enteric pathogens occurs at what age

A

< 5 years of age

377
Q

Bacteria that cause disease by enterotoxin elaborated outside the host (2)

A

S. aureus and B. cereus

378
Q

Incubation period and duration for bacterial disease caused by an enterotoxin elaborated outside the host

A

1-6 h

<12 h

379
Q

Outbreaks following picnics where potato salad, mayonnaise, and cream pastries have been served is commonly caused by

A

Staphylococcal food poisoning

380
Q

2 forms of B. cereus food poisoning

A

Emetic

Diarrhea

381
Q

Emetic form of B. cereus food poisoning is mediated by what toxin

A

staphylococcal type of enterotoxin (shorter incubation)

382
Q

Diarrheal form of B. cereus food poisoning is mediated by what toxin

A

enterotoxin resembling E. coli heat-labile toxin (longer incubation period)

(8-16 )

383
Q

Heat-resistant spores of this bacteria is found in inadequately cooked meat, poultry, or legumes

A

Clostridium perfringens

384
Q

T or F. All food poisoning has bacterial cause.

A

False. Not all food poisoning has bacterial cause.

Other causes:
Capsaicin
Toxins from fish and shellfish

385
Q

Mainstay of treatment of acute infectious diarrheal diseases

A

Adequate rehydration

386
Q

Per L water of ORS consists (4)

A
  • 2.6 g NaCl
  • 2.9 g trisodium citrate
  • 1.5 g KCl
  • 13.5 g glucose (or 27 g sucrose)
387
Q

T or F. Bloody diarrhea should be treated empirically with an antimicrobial agent

A

True. fluoroquinolone or macrolide

But, Enterohemorrhagic E. coli should NOT be treated with antimicrobial agents because it will increase by 20-fold the risk for HUS and renal failure

388
Q

Treatment of Campylobacter infection

A

Macrolide such as erythromycin or azithromycin

389
Q

Enterohemorrhagic E. coli should NOT be treated with antimicrobial agents because it will increase by 20-fold the risk for

A

HUS and renal failure

390
Q

Malaria is transmitted by the bite of

A

infected female Anopheles mosquitoes

391
Q

Most important of the parasitic diseases of humans

A

Malaria

392
Q

Almost all malaria deaths are caused by what sp

A

falciparum malaria

393
Q

Female anopheles mosquito inoculates this life stage of malaria to humans during blood meal

A

Sporozoites

394
Q

Asexual reproduction of malaria occurs in

A

Liver

intrahepatic or preerythrocytic schizogony

395
Q

During asexual reproduction of malaria, sporozoites produce

A

10,000->30,000 merozoites

396
Q

Stage of malaria that invade the RBC

A

Merozoites

397
Q

Once at the RBC, the malarial stage is called

A

Trophozoites

398
Q

When malaria reach densities of__________, symptomatic stage begins

A

~50/μL of blood (~100 million parasites)

399
Q

Dormant form of malaria parasite

A

hypnozoites

400
Q

A proportion of intrahepatic forms of these plasmodium sp do not divide immediately but remain inert for a period of 2 weeks to ≥1 year (2)

A

P. vivax and P. ovale

Hypnozoites - cause of the relapses in these species

401
Q

Blood group antigens that plays an important role in invasion of malaria

A

Duffy blood group antigens – Fya or Fyb

Duffy-negative FyFy phenotype – generally resistant to P. vivax malaria

402
Q

By the end of the intraerythrocytic life cycle, the plasmodium has consumed 2/3 of the RBC’s hemoglobin and has grown to occupy most of the cell. This is then called

A

Schizont

403
Q

When plasmodium-infected RBC ruptures, it release

A

6-30 daughter merozoite

404
Q

Malaria disease in human beings is caused by (2)

A
  • Direct effects of asexual parasite (RBC invasion and destruction)
  • Host’s reaction
405
Q

Sexual form of malaria

A

Gametocytes

406
Q

Life stage of malaria that are ingested by biting female anopheles mosquito

A

Gametocytes

407
Q

Malarial morphology: usually only ring-form, banana-shaped gametocytes

A

Falciparum

408
Q

Malarial morphology: irregularly shaped large rings and trophozoites, enlarged erythrocytes and Schuffner’s dots

A

P. vivax

409
Q

Malarial morphology: infected erythrocytes, enlarged and oval with tufted ends; Schuffner’s dots

A

P. ovale

410
Q

Malarial morphology: band or rectangular forms of trophozoites

A

P. malariae

411
Q

Pigment colors of the malarial species

A

Falciparum – black
Vivax – yellow-brown
Ovale – dark brown
Malariae – brown-black

412
Q

Malaria sp that may have relapse

A

Vivax and ovale

413
Q

Endemicity of malaria in Hypoendemic, Mesoendemic, Hyperendemic and Holoendemic

A
  • Hypoendemic - <10%
  • Mesoendemic – 11-50%
  • Hyperendemic – 51-75%
  • Holoendemic – >75%
414
Q

Characteristic of malarial transmission seen in hyper- and holoendemic areas

A

Stable transmission

constant, frequent, year-round infection

415
Q

Characteristic of malarial transmission seen in hypoendemic areas

A

Unstable tansmission

Transmission is low, erratic, or focal
Full protective immunity is not acquired
Malaria can behave like an epidemic disease
High mortality rates among all age group

416
Q

Principal determinants of epidemiology of malaria (3)

A
  • Number / density of anopheline mosquito
  • Human-biting habits of anopheline mosquito
  • Longevity of anopheline mosquito
417
Q

Number of sporozoite-positive mosquito bites per person per year is also called

A

Entomologic inoculation rate

418
Q

Most common measure of malaria transmission

A

Entomologic inoculation rate

419
Q

Effect of malaria to RBC

A

Alters the RBC membrane

RBCs become more irregular in shape, more antigenic, and less deformable

420
Q

Processes that are central to pathogenesis of P. falciparum infections (3)

A

Cytoadherence
Resetting
Agglutination

421
Q

This pathogenetic process of malaria refers to attachment to receptors on venular and capillary endothelium mediated by strain-specific erythrocyte membrane adhesive protein (PfEMP1)

A

Cytoadherence

422
Q

This pathogenetic process of malaria refers when infected RBCs adhere to uninfected RBCs

A

Resetting

423
Q

This pathogenetic process of malaria refers when infected RBCs adhere to other parasitized erythrocyte

A

Agglutination

424
Q

Plasmodium sp with marked predilection for young RBCs (2)

A

P. vivax and P. ovale

425
Q

Plasmodium sp with predilection to old RBCs

A

P. malariae

426
Q

Plasmodium sp that can invade RBCs of all ages (2)

A

P. falciparum

P. knowlesi

427
Q

Process when spleen removes damaged ring-form malarial parasites

A

Pitting

Spleen returns the once-infected RBC to the circulation  shortened survival

Rupture of schizont – happens to those cells escaping splenic removal

428
Q

This host response to malaria is defined by accelerated removal of both parasitized and uninfected RBCs

A

Augmented splenic immunologic and filtrative clearance

429
Q

Genetic disorders that confer protection against death from falciparum malaria (5)

A
  • Thalassemias
  • Sickle cell disease
  • Hemoglobins C and E
  • Hereditary ovalocytosis
  • G6PD deficiency
430
Q

Reason why thalassemia patients are protected against malarial death

A

α- thalassemia have frequent malaria in early years of life, hence, protection from severe disease

431
Q

Reason why sickle cell disease patients are protected against malarial death

A

HbA/S RBCs impair parasite growth at low oxygen tensions

6-fold reduction in the risk from of dying from severe falciparum malaria

432
Q

Reason why hereditary ovalocytosis patients are protected against malarial death

A

Rigid RBCs resist merozoite invation

433
Q

state of plasmodium infection without illness

A

Premunition

434
Q

Fever spikes, chills, and rigors at regular intervals is characteristic of

A

Malaria

Classic malarial paroxysms

435
Q

Generalized seizure occur to this malaria type

A

falciparum malaria

Herald the development of encephalopathy in cerebral malaria

436
Q

If malaria is appropriately and promptly treated, mortality rate is

A

< 0.1%

437
Q

Once vital-organ dysfunction occurs or total proportion of RBC infected by malaria increases to ____________, mortality risk rises steeply

A

> 2% (>10^12 parasites in adult)

438
Q

A characteristic and ominous feature of cerebral malaria caused by falciparum

A

Coma

Death rate: ~20% among adults and 15% among children

439
Q

Cerebral malaria manifest as what type of encephalopathy

A

diffuse symmetric encephalopathy

440
Q

Primitive reflexes that are common in cerebral malaria (2)

A

Bruxism and pout reflex

Other primitive reflexes are absent

441
Q

Hypoglycemia in malaria may be compounded by these antimalarial treatment

A

Quinine and quinidine

Powerful stimulant of pancreatic insulin, causes hyperinsulinemic hypoglycemia

442
Q

Conditions that compounds acidosis in adults and children with malaria

A

Renal impairment – adult

Ketoacidosis – children

443
Q

Best biochemical prognosticators in severe malaria (2)

A

Serum bicarbonate or lactate

444
Q

Mortality rate of noncardiogenic pulmonary edema in severe malaria

A

> 80%

445
Q

Renal impairment in malaria manifests as

A

acute tubular necrosis

446
Q

Description of anemia in malaria

A

Normocytic, normochromic

447
Q

Acute hemolytic anemia with massive hemoglobinuria seen in malaria

A

Blackwater fever

  • Hemoglobinuria may contribute to renal injury
  • May be seen in patients with G6PD deficiency
448
Q

Antimalarial treatment that may have sudden hemolysis many days after treatment

A

Artesunate

Due to synchronous loss of once-parasitized “pitted” RBCs

449
Q

T or F: Pregnant mothers in areas with stable malarial transmission are prone to severe infections

A

False.

In areas with stable transmission, pregnant mothers remain asymptomatic despite intense accumulation of parasitized erythrocytes in the placental microcirculation

In areas with unstable transmission, pregnant women are prone to severe infections

450
Q

T or F. Incubation period of transfusion malaria is longer

A

False. Incubation period is short – because there is no preerythrocytic stage

451
Q

Clinical features of hyperreactive malarial splenomegaly (3)

A
  • Abdominal mass
  • Dragging sensation in the abdomen
  • Perisplenitis
452
Q

Chronic or repeated infections with P. malariae (or other malarial species) may cause soluble immune complex injury to the renal glomeruli leading to nephrotic syndrome. This condition is called

A

Quartan malarial nephropathy

453
Q

Histology of quartan malarial nephropathy (2)

A

Focal or segmental glomerulonephritis

Splitting of capillary basement membrane

454
Q

Diagnosis of malaria is obtained by

A

demonstration of asexual forms of parasite in stained PBS

455
Q

Preferred Romanowsky stains used in malaria detection

A

Giemsa at pH 7.2

Other stains:
• Field’s
• Wright’s
• Leishman’s

456
Q

Diagnostic stain of malaria that is fixed and density of parasitemia is expressed by number of parasitized RBC per 1000 RBCs

A

Thin blood smears

457
Q

Diagnostic stain of malaria that is not fixed and number of parasites per unit volume is calculated from the total leukocyte count then converted to number of parasitized RBCs per microliter

A

Thick blood smear

458
Q

First-line treatment for uncomplicated falciparum malaria in malaria-endemic areas

A

Artemisinin-based combination therapy (ACT)

459
Q

Remains an effective treatment for P. vivax, P. ovale, and P. malariae

A

Chloroquine

460
Q

Tinnitus, high-tone hearing loss, nausea, vomiting, dysphoria, postural hypotension are manifestations of this ADR of antimalarial drugs. What is this ADR and what are the antimalarial drugs that may cause it?

A

cinchonism

Quinine and quinidine

461
Q

Antimalarial drug that has the ADR of agranulocytosis and hepatotoxicity

A

Amodiaquine

462
Q

Antimalarial drug that is contraindicated in G6PD patients

A

Primaquine

May actually be used by with lower dose

463
Q

Antimalarial drug that eradicates hepatic forms of P. vivax and P. ovale; kills all stages of P. falciparum gametocyte development; kills developing liver stages of all species

A

Primaquine

464
Q

Drug of choice for all patients with severe malaria

A

Parenteral artesunate

If unavailable, may use artemether, quinine or quinidine

465
Q

T or F. Fluid management of malaria is similar to that of sepsis

A

False.

Fluid boluses are potentially dangerous un severe malaria

466
Q

In severe malaria, this antimalarial drug must be avoided because it can increase risk of post-malaria neurologic syndrome

A

Mefloquine

467
Q

Artemisinin derivatives (3)

A
  • Artesunate
  • Artemether
  • Dihydroartemisinin
468
Q

Used for radical treatment of malaria

A

Primaquine

469
Q

Antimalarial drug that has adverse neuropsychiatric reaction

A

Mefloquine

470
Q

These antimalarial drugs exacerbate the orthostatic hypotension associated with malaria

A

Quinolines (chloroquine, mefloquine, and quinine)

471
Q

If the level of malarialparasitemia does not fall below ___ of the admission value in 72 h or if parasitemia has not cleared by____, drug resistance is likely and the regimen should be changed

A

25%

7 days

472
Q

Treatment of acute renal failure in malaria

A

Renal replacement therapy

Hemofiltration or hemodialysis

473
Q

Suspected when condition of any patient suddenly deteriorates for no obvious reason during antimalarial treatment

A

Sepsis

474
Q

Used in mass treatment of malaria for focal elimination of falciparum malaria

A

slowly eliminated antimalarials such as dihydroartemisinin-piperaquine

475
Q

Peak feeding times of anopheles

A

dusk to dawn

476
Q

Chemoprophylaxis for malaria (3).

A

Atovaquone-proguanil (Malarone)
Doxycycline
Mefloquine

Other drugs may also be used

477
Q

Once-daily chemoprophylaxis for malaria that is effective in ALL types of malaria including MDR falciparum malaria

A

Atovaquone-proguanil (Malarone)

478
Q

Only drug advised for pregnant women traveling to areas with drug-resistant malaria

A

Mefloquine

  • Choloroquine and proguanil – safe, but recommended in very few regions only
  • Doxycycline – safe until 15 weeks of pregnancy
479
Q

Duration of malarial chemoprophylaxis for travelers.

A

Antimalarial drugs 2 days to 2 weeks before departure, continued for 4 weeks after leaving an endemic area

Exceptions: Atovaquone-proguanil or primaquine – discontinued 1 week after departure from endemic area

480
Q

Have a “dewdrop” appearance and develop in crops randomly about the trunk, extremities, and face over 3–4 days

A

Varicella

481
Q

Occurs in a single dermatome and appearance of vesicles is preceded by pain for several days

A

Herpes zoster

482
Q

HSV found on or around the lips

A

HSV-1

483
Q

HSV found on the genitals

A

HSV-2

484
Q

Herpes infection in head and neck of young wrestlers

A

Herpes gladiatorum

485
Q

Herpes infection in the digits of health care workers

A

Herpetic whitlow

486
Q

Hands-foot-mouth disease is caused by

A

Coxsackievirus A16

487
Q

A painful, vesicular, localized S. aureus or group A streptococcal infection of the pulps of the distal digits of the hands.

A

Blistering dactylitis

488
Q

Infection caused by a toxin (exfoliatin) from phage group II S. aureus

A

Staphylococcal scalded-skin syndrome (SSSS)

489
Q

Impetigo contagiosa is caused by

A

S. pyogenes

490
Q

Bullous impetigo is caused by

A

S. aureus

491
Q

most common cause of localized folliculitis

A

S. aureus

492
Q

Inflammation of sweat glands that mimic infection of hair follicles, particularly in the axillae

A

Hidradinitis suppurativa

493
Q

Hot-tub folliculitis is caused by

A

Pseudomonas aeruginosa

494
Q

Cat-scratch disease and Bacillary angiomatosis are caysed by

A

Bartonella henselae

495
Q

Raised serpiginous or linear eruptions caused by burrowing larvae of dog or cat hookworms (Ancylostoma braziliense)

A

Cutaneous larva migrans

496
Q

This is transmitted mostly in persons bitten by Simulium flies in Africa that may cause blindness

A

Onchocerca volvulus

497
Q

Begins as a pruritic papule then develops within days into an ulcer with surrounding vesicles and edema and then into an enlarging ulcer with a black eschar. They may also cause chronic nonhealing ulcers with an overlying dirty gray membrane.

A

Cutaneous anthrax

498
Q

Painful ulcerated lesions on the genitals

A

Chancroid

499
Q

Ulcerated painless lesions on the genitals

A

Primary syphilis

500
Q

Cause of erysipelas

A

S. pyogenes

501
Q

An abrupt onset of fiery-red swelling of the face or extremities associated with intense pain

A

Erysipelas

Desquamation of the involved skin occurs 5–10 days into the illness

502
Q

Treatment of erysipelas

A

Penicillin

503
Q

Most common cause of purulent cellulitis

A

S. aureus

504
Q

Most common cause of nonpurulent cellulitis

A

S. pyogenes

More rapidly spreading, diffuse process that is frequently associated with lymphangitis and fever

505
Q

Elevated serum IgE is seen in patients with

A

Job syndrome

506
Q

Cellulitis acquired by cat bites is caused by

A

Pasteurella multocida

507
Q

P. aeruginosa causes three types of soft tissue infection, which are

A

 Ecthyma gangrenosum in neutropenic patients
 Hot-tub folliculitis
 Cellulitis following penetrating injury

508
Q

Necrotizing fasciitis is caused by

A

group A Streptococcus or mixed aerobic–anaerobic bacteria

509
Q

Necrotizing fasciitis associated with gas gangrene is caused by

A

Clostridium perfringens

510
Q

Necrotizing fasciitis may also be caused by strains of MRSA that produce this toxin

A

Panton-Valentine leukocidin (PVL) toxin

511
Q

Massive swelling of the scrotum and penis with extension into the perineum or the abdominal wall and the legs

A

Fournier’s gangrene

512
Q

Most common cause of pyomyositis

A

S. aureus

513
Q

Gas gangrene of the uterus is caused by

A

Clostridium sordellii

Uniformly fatal and death ensues rapidly

514
Q

Primary treatment of animal bite (prophylaxis or early infection)

A

Amoxicillin–clavulanate (875/125 mg PO bid)

Alternative: Doxycycline (100 mg PO bid)

515
Q

Primary treatment of animal bite with established infection

A

Ampicillin–sulbactam (1.5–3 g IV q6h)

Alternative: Clindamycin (600–900 mg IV q8h) plus Ciprofloxacin (400 mg IV q12h) or cefoxitin (2 g IV q6h)

516
Q

Primary treatment of herpex simplex infection

A

Acyclovir (400 mg PO tid for 10 days)

Alternative: Famciclovir (250 mg PO tid for 5–10 days) or valacyclovir (1000 mg PO bid for 10 days)

517
Q

Primary treatment of herpex zoster infection

A

Acyclovir (800 mg PO 5 times daily for 7–10 days)

Alternative: Famciclovir (500 mg PO tid for 7–10 days) or valacyclovir (1000 mg PO tid for 7 days)

518
Q

Primary treatment of Cellulitis (staphylococcal or streptococcalb,c)

A

Nafcillin or oxacillin (2 g IV q4–6h)

Alternative: Cefazolin (1–2 g q8h) or ampicillin/sulbactam (1.5–3 g IV q6h) or erythromycin (0.5–1 g IV q6h) or clindamycin (600–900 mg IV q8h)

519
Q

Primary treatment of MRSA skin infection

A

Vancomycin (1 g IV q12h)

Alternative: Linezolid (600 mg IV q12h)

520
Q

Primary treatment of Necrotizing fasciitis (group A streptococcal)

A

Clindamycin (600–900 mg IV q6–8h) plus penicillin G (4 million units IV q4h)

Alternative: Clindamycin (600–900 mg IV q6–8h) plus a cephalosporin (first- or second-generation)

521
Q

Primary treatment of Necrotizing fasciitis (mixed aerobes and anaerobes)

A

Ampicillin (2 g IV q4h) plus clindamycin (600–900 mg IV q6–8h) plus ciprofloxacin (400 mg IV q6–8h)

Alternative: Vancomycin (1 g IV q6h) plus metronidazole (500 mg IV q6h) plus ciprofloxacin (400 mg IV q6–8h)

522
Q

Primary treatment for gas gangrene

A

Clindamycin (600–900 mg IV q6–8h) plus penicillin G (4 million units IV q4–6h)

Alternative: Clindamycin (600–900 mg IV q6–8h) plus cefoxitin (2 g IV q6h)

523
Q

Infections are associated with relative bradycardia. Patients have a lower heart rate than might be expected for a given body temperature. What do you call this sign?

A

Faget’s sign

524
Q

For every 1°C (1.8°F) increase in core temperature, the heart rate typically rises by

A

15–20 beats/min

525
Q

Indirect measures of acute-phase response

A

Erythrocyte sedimentation rate (ESR)

Changes relatively slowly, and its measurement more often than weekly usually is not useful

526
Q

Direct measures of acute-phase response

A

C-reactive protein (CRP)

Change rapidly, and daily measurements can be useful

527
Q

Specific situations that might prompt an infectious disease consult include (4)

A

 Difficult-to-diagnose patients with presumed infections
 Patients who are not responding to treatment as expected
 Patients with a complicated medical history (e.g., organ transplant recipients, patients immunosuppressed due to autoimmune or inflammatory conditions)
 Patients with “exotic” diseases

528
Q

Prolonged febrile illnesses without an established etiology despite intensive evaluation and diagnostic testing

A

FUO

529
Q

Old definition of FUO: An illness of _____ duration with fever of _______ on ____ occasions and an uncertain diagnosis despite ____ of inpatient evaluation

A

> 3 weeks
≥38.3°C (≥101°F)
Two
1 week

530
Q

New definition of FUO

A

 Fever ≥38.3°C (≥101°F) on at least two occasions
 Illness duration of ≥3 weeks
 No known immunocompromised state
 Diagnosis that remains uncertain after a thorough history-taking, physical examination, and obligatory investigations

531
Q

Most common infectious cause of FUO

A

TB

532
Q

Most common solid tumor that causes fever (6)

A 
Breast
Colon
Hepatocellular
Lung
Pancreatic
Renal cell carcinoma
533
Q

T or F. FUO is far more often caused by an atypical presentation of a rather common disease than by a very rare disease

A

True

534
Q

A sterile thrombotic disease that occurs as a paraneoplastic phenomenon, especially with adenocarcinomas

A

Marantic endocarditis

535
Q

Uncommon disorder but can often be diagnosed easily in a patient with FUO who presents with urticaria, bone pain, and monoclonal gammopathy

A

Schnitzler syndrome

536
Q

Most common diagnosis of FUO among the neoplasms

A

Malignant lymphoma

537
Q

T or F. All drugs can cause fever, even that commencing after long-term use

A

True

538
Q

Fever artificially induced by the patient

A

Factitious fever

 For example, by IV injection of contaminated water
 More common among young women in health care professions

539
Q

The most common infectious disease associated with FUO in elderly patients

A

Tuberculosis

540
Q

Most common diseases with an atypical manifestation of FUO in elderly (2)

A

giant cell arteritis and polymyalgia rheumatica

541
Q

T or F. In conducting diagnostic tests for FUO, antibiotic and glucocorticoid treatment should still be continued as treatment of possible diseases

A

False. Before further diagnostic tests are initiated, antibiotic and glucocorticoid treatment, which can mask many diseases, should be stopped

542
Q

Which is a preferred obligatory test in FUO, abdominal ultrasound or CT?

A

Ultrasound

543
Q

If fever persists beyond ___ after discontinuation of suspected drug, it is unlikely that this drug is the cause of fever

A

72

544
Q

Noninvasive method allowing delineation of foci in all parts of the body on the basis of functional changes in tissues

A

Scintigraphy

CT and MRI routinely provide information on only part of the body, while scintigraphy readily allows whole-body imaging

545
Q

In FUO, if no diagnosis is reached despite scintigraphic and PDC-driven histologic investigations or culture, what is the next step?

A

Second-stage screening diagnostic tests

Screening abdominal and chest CT
Bone marrow aspiration
Temporal artery biopsy
Liver biopsy

546
Q

In FUO, when is empiric antibiotic indicated? (2)

A

Hemodynamic instability or neutropenia

547
Q

Highly effective in preventing attacks of familial Mediterranean fever but is not always effective once an attack is well under way

A

Colchicine

548
Q

NSAIDs has dramatic response in FUO of what disease?

A

adult-onset Still’s disease

549
Q

A key cytokine in local and systemic inflammation and the febrile response

A

Interleukin (IL) 1

550
Q

A recombinant form of the naturally occurring IL-1 receptor antagonist (IL-1Ra) and blocks the activity of both IL-1α and IL-1β

A

Anakinra

551
Q

Accounts for most FUO-related deaths

A

Malignancy

Non-Hodgkin’s lymphoma carries a disproportionately high death toll
In nonmalignant FUO, fatality rates are very low

552
Q

Body temperature is controlled by the

A

Hypothalamus

553
Q

Normal core body temperature

A

36.5–37.5°C

554
Q

Mean oral temperature

A

36.8° ± 0.4°C

Low levels at 6 am (max is 37.2°C)
Higher levels at 4-6 pm (max is 37.7°C)

555
Q

Rectal temperatures

A

generally 0.4°C (0.7°F) higher than oral

Oral: 36.8° ± 0.4°C

556
Q

Fever that most commonly occurs in patients with central nervous system (CNS) hemorrhages

A

Hyperpyrexia
>41.5°C

Can develop in patients with severe infections

557
Q

Uncontrolled increase in body temperature that exceeds the body’s ability to lose heat

A

Hyperthermia (heat stroke)

558
Q

T or F. Hyperthermia responds to antipyretics

A

False. Does not involve pyrogenic molecules

Can be rapidly fatal and characteristically does not respond to antipyretics

559
Q

Pyrogenic products of gram-positive organisms that are also called superantigens

A

Enterotoxins

560
Q

Pyrogenic cytokines (4)

A

IL-1, IL-6, tumor necrosis factor (TNF), and ciliary neurotropic factor

561
Q

the primary cell types that produce pyrogenic cytokines (2)

A

Myeloid and endothelial cells

562
Q

Distinct receptors for microbial products that are located on the hypothalamic endothelium and are similar in many ways to IL-1 receptors.

A

Toll-like receptors

563
Q

Fever lasting 3–10 days is followed by afebrile periods of 3–10 days and are classic for Hodgkin’s disease and other lymphomas

A

Pel-Ebstein pattern

564
Q

fevers occur every 21 days and accompany the neutropenia

A

Cyclic neutropenia

565
Q

Relapsing fever

A

Borrelia infection

566
Q

Blocks IL-1 activity and are useful in recurrent fever of autoimmune and autoinflammatory diseases (2)

A

Anakinra or Canakinumab

567
Q

T or F. Acitaminophen is more effective than aspirin in reducing fever in humans

A

False. Oral aspirin and acetaminophen are equally effective in reducing fever in humans

568
Q

Aspirin increases the risk of this condition in children

A

Reye’s syndrome

569
Q

Difference of sepsis, severe sepsis and septic shock

A
  • Sepsis is a systemic inflammatory response to infection
  • Severe sepsis – sepsis is complicated by acute organ dysfunction
  • Septic shock – sepsis complicated by hypotension despite adequate fluid resuscitation along with perfusion abnormalities
570
Q

a dysregulated host response to infection that leads to acute organ dysfunction

A

Sepsis

571
Q

Septic shock criteria includes sepsis plus (2) (despite adequate resuscitation):

A
  • Need for vasopressor to elevate MAP to ≥65mmHg

* Serum lactate concentration >2.0 mmol/L

572
Q

Most common source of sepsis

A

Pneumonia

573
Q

2nd most common source of sepsis

A

Intraabdominal and GU infections

574
Q

Most common gram positive isolates in sepsis (2)

A

S. aureus and S. pneumoniae

Gram positive > gram negative

575
Q

Most common gram negative isolates in sepsis (3)

A

E. coli, Klebsiella species, and P. aeruginosa

576
Q

Structures conserved across microbial species recognized by the receptors which will lead to upregulation of inflammatory gene transcripton and initiation of innate immunity

A

Pathogen-associated molecular patterns (PAMP)

Lipid A moiety of LPS – common PAMP

577
Q

Endogenous molecules released from the injured cells also recognized by the receptors that leads to inflammation

A

Damaged-associated molecular patterns (DAMPs)

Examples:
• High-mobility group protein B1
• S100 proteins
• Extracellular RNA, DNA and histones

578
Q

6-organ framework that assess primary physiologic manifestations of organ dysfunction

A

SOFA score

24 points

579
Q

Hypoxemia and bilateral infiltrates of noncardiac origin that arise within 7 days of the suspected infection

A

ARDS

580
Q

According to Berlin criteria, mild, moderate and severe ARDS is defined as

A
  • Mild – PaO2/FiO2 – 201-300 mmHg
  • Moderate – PaO2/FiO2 – 101-200 mmHg
  • Severe – PaO2/FiO2 – ≤100 mmHg
581
Q

Difference between hydrostatic edema and ARDS

A

Hydrostatic edema has elevated pulmonary capillary wedge pressure > 18 mmHg

582
Q 
Findings in sepsis in terms of:
HR
RR
SBP
O2 sat
WBC
A 
HR > 90 bpm
RR > 20 cpm
SBP ≤100 mmHg
O2 sat ≤90%
WBC < 4000/μL or > 12,000/μL
583
Q

Quick SOFA (qSOFA) score parameters (3)

A
  • Systolic hypotension ≤100 mmHg
  • Tachypnea ≥22 cpm
  • Altered mentation

Score of ≥ 2 points – sepsis

584
Q

Marker of tissue hypoperfusion in sepsis

A

Arterial lactate

Hyperlactemia and delayed lactate clearance – greater incidence of organ failure and death in sepsis

585
Q

For every 1-h delay among patients with sepsis, a ____ increase in the odds of in-hospital death is reported

A

3-7%

586
Q

Initial management bundle for sepsis (4)

A
  • Early administration of appropriate broad-spectrum antibiotics
  • Collection of blood for culture before antibiotic administration
  • Measurement of serum lactate levels
  • Cardiorespiratory resuscitation
587
Q

Initial management bundle of sepsis must be completed within ___ of presentation

A

3 h

588
Q

Management bundle of sepsis must be completed within

A

6 h

589
Q

Management bundle for sepsis

A
  • IV fluid bolus
  • Treatment with vasopressors for persistent hypotension or shock
  • Re-measurement of serum lactate levels
590
Q

Recommended as first line fluids for sepsis resuscitation

A

Crystalloids

591
Q

Primary goal of supportive treatment of sepsis

A

To improve delivery of oxygen to the tissues as quickly as possible

592
Q

Most widely used fluids in critically ill patients

A

Colloids

593
Q

First choice vasopressors in septic shock

A

Norepinephrine

594
Q

Trial that compared norepinephrine and dopamine and showed no difference observed in 28-day mortality, but arrhythmias are significantly higher with dopamine

A

SOAP II trial

595
Q

Indications of mechanical ventilatory support in sepsis (4)

A
  • Significant hypoxemia (PaO2 < 60 mmHg or SaO2 < 90%
  • Hypoventilation – rising PaCO2
  • Increased work of breathing
  • Inadequate or unsustainable compensation for metabolic acidosis (pH < 7.2)
596
Q

T or F. Most meta-analyses report no change in mortality but an increase in shock reversal with glucocorticoid treatment

A

True

International CPG suggest against the use of IV hydrocortisone to treat septic shock. If to be used, may give a dose of 200 mg/day

597
Q

Mortality rates for septic shock

A

~20%

598
Q

Rate of hospital re-admission within 90 days in sepsis

A

> 40%

599
Q

In patients with septic shock requiring vasopressors, the recommended target mean arterial pressure is

A

65 mmHg.

600
Q

______ should be used with the intent of reducing the norepinephrine dose.

A

Vasopressin

601
Q

In the management of sepsis, red blood cell transfusion is recommended only when the hemoglobin concentration decreases to _______ in the absence of acute myocardial infarction, severe hypoxemia, or acute hemorrhage.

A

<7.0 g/dL

602
Q

A protocol-based approach to blood glucose management should be used in ICU patients with sepsis, with insulin dosing initiated when two consecutive blood glucose levels are

A

> 180 mg/dL

603
Q

Cause of acute rheumatic fever

A

infection of the upper respiratory tract with group A streptococci

The potential role of skin infection and of groups C and G streptococci is currently being investigated

604
Q

The most common cause of heart disease in children in developing countries

A

RHD

A major cause of mortality and morbidity in adults

605
Q

Peak age of ARF

A

age 5–14 years

Initial episodes become less common in older adolescents and young adults and are rare in persons aged >30 years

606
Q

Peak age of RHD

A

25-40 years

More common in females

607
Q

Serotypes of group A strep that is associated with ARF

A

M-serotypes

It is now thought that any strain has the potential to cause ARF

608
Q

Human leukocyte antigen (HLA) class II alleles associated with susceptibility to ARF

A

HLA-DR7 and HLA-DR4

609
Q

Human leukocyte antigen (HLA) class II alleles associated with protection against ARF

A

HLA-DR5, HLA-DR6, HLA-DR51, HLA-DR52, and HLA-DQ

610
Q

The most widely accepted theory of rheumatic fever pathogenesis

A

Molecular mimicry

Alternative hypothesis: initial damage is due to streptococcal invasion of epithelial surfaces, with binding of M protein to type IV collagen allowing it to become immunogenic

611
Q

Latent period between the precipitating group A streptococcal infection and the appearance of the clinical features of ARF

A

~3 weeks (1–5 weeks)

Chorea and Indolent carditis – prolonged latent period of 6 months

612
Q

Most common clinical features of ARF

A
  1. Polyarthritis – 60-75%
  2. Carditis – 50-60%

Other features:
• Chorea - <2 – 30%
• Erythema marginatum – rare; <5%
• Subcutaneous nodules – rare; <5%

613
Q

Hallmark of rheumatic carditis

A

Valvular damage

614
Q

Valve that is almost always affected in RHD

A

Mitral valve

Aortic valve – often affected together with mitral valve

615
Q

The characteristic manifestation of rheumatic carditis in previously unaffected individuals

A

Mitral regurgitation

May be accompanied by aortic regurgitation

Stenosis – may occur over ensuing years due to recurrent episodes

616
Q

The most common form of joint involvement in ARF

A

Arthritis

Objective evidence of inflammation, with hot, swollen, red, and/or tender joints

617
Q

Characteristic of arthritis in ARF

A

Polyarthritis
Migratory
Large joints
Asymmetric

618
Q

Treatment of joint disease in ARF

A
  1. Salicylates
  2. NSAIDs

Joint involvement that persists for more than 1-2 days after starting salicylates is unlikely to be due to ARF

619
Q

Chorea of ARF

A

Sydenham’s chorea

Found mainly in females

620
Q

Characteristic of chorea in ARF

A

darting movements of the tongue
Affect particularly the head and upper limbs

Associated emotional lability or obsessive-compulsive traits
Usually resolve within 6 weeks but sometimes may take up to 6 months

621
Q

Essential in making the diagnosis of ARF

A

Evidence of a preceding group A streptococcal infection

622
Q

Most common serologic tests for ARF

A
  1. Antistreptolysin O (ASO) titer

2. Anti-DNAse B (ADB) titer

623
Q

Criteria for diagnosis of ARF

A

Jones criteria

624
Q

T or F. There is no treatment for ARF that has been proven to alter the likelihood of developing, or the severity of, RHD

A

True

625
Q

Drug of choice for ARF

A

Penicillin

  1. Phenoxymethyl penicillin, 500 mg (250 mg for children ≤27 kg) PO twice daily
  2. Amoxicillin, 50 mg/kg (maximum, 1 g) daily, for 10 days
  3. Benzathine penicillin G of 1.2 million units (600,000 units for children ≤27 kg) IM single dose
626
Q

DOC for the treatment of arthritis, arthralgia, and fever, once the diagnosis of ARF is confirmed

A

Aspirin 50–60 mg/kg per day, up to a maximum of 80–100 mg/kg per day (4–8 g/d in adults) in 4–5 divided doses

Fever, joint manifestations, and elevated acute- phase reactants sometimes recur up to 3 weeks after the medication is discontinued. This Does not indicate a recurrence and can be managed by recommencing salicylates for a brief period

Alternative drug: Naproxen

627
Q

Glucocorticoid is used by some clinicians in ARF as treatment of

A

Carditis

Prednisone or prednisolone 1–2 mg/kg per day (maximum, 80 mg), usually for a few days or up to a maximum of 3 weeks

628
Q

T or F. Long term bed rest is a cornerstone in the management of ARF

A

False. No longer widely practiced.

Should be prescribed as needed while arthritis and arthralgia are present and for patients with heart failure. Gradual mobilization can commence as tolerated once symptoms resolve

629
Q

Management of chorea in ARF

A
  1. Provide a calm environment – in milder cases
  2. Carbamazepine or sodium valproate – in severe cases
  3. Corticosteroids – in severe or refractory cases
  4. IVIg – in small studies
    Medications to control the abnormal movements do not alter the duration or outcome of chorea
630
Q

Untreated, ARF lasts on average of

A

12 weeks

631
Q

In ARF, Echocardiogram should be performed after _____ to determine if there has been progression of carditis

A

1 month

632
Q

The mainstay of controlling ARF and RHD

A

Secondary prevention

633
Q

Secondary prevention in ARF and RHD

A

Long-term penicillin prophylaxis

Patients with ARF are at dramatically higher risk than the general population of developing a further episode of ARF after a group A streptococcal infection

634
Q

The best secondary prophylaxis for ARF or RHD

A

Benzathine penicillin G 1.2 million units, or 600,000 units if ≤27 kg delivered every 4 weeks. Can be given every 3 weeks, or even every 2 weeks, to persons considered to be at particularly high risk

Other drugs – less effective
Oral penicillin V 250 mg twice daily
Erythromycin 250 mg BID

635
Q

According to the World Heart Federation Criteria for Echocardiographic Diagnosis of Rheumatic Heart Disease (RHD) in Individuals <20Years of Age, definite RHD is defined as (4)

A

(A) Pathologic MR and at least two morphologic features of RHD of the mitral valve

(B) MS mean gradient ≥4 mmHg (note: congenital MV anomalies must be excluded)

(C) Pathologic AR and at least two morphologic features of RHD of the AV (note: bicuspid AV and dilated aortic root must be excluded)

(D) Borderline disease of both the MV and AV

636
Q

According to the World Heart Federation Criteria for Echocardiographic Diagnosis of Rheumatic Heart Disease (RHD) in Individuals <20Years of Age, borderline RHD is defined as (4)

A
  1. At least two morphologic features of RHD of the MV without pathologic MR or MS
  2. Pathologic MR
  3. Pathologic AR
637
Q

Diagnosis of ARF based on Jones criteria is when the criteria fulfilled are

A
  1. 2 major
  2. 1 major + 2 minor
  3. 3 minor
638
Q

Jones major criteria (5)

A
  1. Carditis
  2. Arthritis
  3. Chorea
  4. Erythema marginatum
  5. SC nodules
639
Q

American Heart Association Recommendations for Duration of Secondary Prophylaxis for patients with Rheumatic fever without carditis

A

For 5 years after the last attack or 21 years of age (whichever is longer)

640
Q

American Heart Association Recommendations for Duration of Secondary Prophylaxis for patients with Rheumatic fever with carditis but no residual valvular disease

A

For 10 years after the last attack, or 21 years of age (whichever is longer)

641
Q

American Heart Association Recommendations for Duration of Secondary Prophylaxis for patients with rheumatic fever with persistent valvular disease, evident clinically or on echocardiography

A

For 10 years after the last attack, or 40 years of age (whichever is longer); sometimes lifelong prophylaxis

642
Q

A flat lesion that is due to bleeding into the skin that is <3 mm in diameter

A

Petechiae

643
Q

A flat lesion that is due to bleeding into the skin that is >3 mm in diameter

A

Ecchymoses

644
Q

A necrotic lesion covered with a black crust

A

Eschar

645
Q

Discrete lesions that become confluent as rash spreads from hairline downward, usually sparing palms and soles; lasts ≥3 days

A

Rubeola (measles)

Nonspecific because they also develop in infectious mononucleosis, scarlet fever, and Zika virus infection

646
Q

Palatal petechiase seen in Rubella

A

Forschheimer spots

647
Q

Bright-red “slapped-cheeks” appearance followed by lacy reticular rash that waxes and wanes over 3 weeks; rarely, papular-purpuric “gloves-and- socks” syndrome on hands and feet

A

Erythema infectiosum (fifth disease)

648
Q

Also known as 6th disease

A

Roseola

Exanthem subitum

649
Q

Exanthem subitum is caused by

A

Human herpesvirus 6

650
Q

Maculopapular eruption appearing in axillae, spreading to trunk and later to extremities; usually spares face, palms, soles; evolves from blanchable macules to confluent eruption with petechiae

A

Epidemic typhus

651
Q

Cause of Epidemic typhus

A

Rickettsia prowazekii

652
Q

Cause of endemic typhus

A

Rickettsia typhi

653
Q

Headache; musculoskeletal pain (“breakbone fever”); leukopenia; occasionally biphasic (“saddleback”) fever are symptoms of

A

Dengue

654
Q

Cause of erythema marginatum

A

Group A streptococcus

655
Q

Transient 2- to 5-mm erythematous papules appearing at height of fever on trunk, proximal extremities; lesions evanescent.. Other clinical manifestations are High spiking fever, polyarthritis, splenomegaly; erythrocyte sedimentation rate, >100 mm/h

A

Still’s disease

656
Q

Eastern African trypanosomiasis is caused by

A

T. brucei rhodesiense

657
Q

Western African trypanosomiasis is caused by

A

T. brucei gambiense

658
Q

African trypanosomiasis is transmitted by what vector

A

Tsetse fly

659
Q

Winterbottom’s sign is seen in

A

Western African trypanosoiasis

660
Q

Posterior cervical lymphadenopathy in Western African trypanosoiasis

A

Winterbottom’s sign

661
Q

Erythema multiforme is caused by (3)

A
  1. Herpes simplex virus
  2. Mycoplasma pneumoniae
  3. Drug intake
662
Q

Rat-bite fever

A

Haverhill fever

663
Q

Rat-bite fever is caused by

A

Streptobacillus moniliformis

664
Q

Scarlet fever is caused by

A

Group A streptococcus

665
Q

Diffuse blanchable erythemabeginning on face and spreading to trunk and extremities; circumoral pallor; “sandpaper” texture to skin; accentuation of linear erythema in skin folds (Pastia’s lines); enanthem of white evolving
into red “strawberry” tongue; desquamation in second week

A

Scarlet fever (second disease)

666
Q

Rash similar to scarlet fever (scarlatiniform) or EM; fissuring of lips, strawberry tongue; conjunctivitis; edema of hands, feet; desquamation later in disease

A

Kawasaki disease

667
Q

Streptococcal toxic shock syndrome is caused by

A

Group A streptococcus

668
Q

Macules (2–3 mm) evolving into papules, then vesicles (sometimes umbilicated), on an erythematous base (“dewdrops on a rose petal”); pustules then forming and crusting; lesions appearing in crops; may involve scalp, mouth; intensely pruritic

A

Varicella

669
Q

Difference of variola (smallpox) from varicella (2)

A
  1. Skin lesions in any given area are at same stage of development
  2. Prominent distribution of lesions on face and extremities (including palms, soles)
670
Q

Indurated plaque evolving into hemorrhagic bulla or pustule that sloughs, resulting in eschar formation; erythematous halo; most common in axillary, groin, perianal regions

A

Ecthyma gangrenosum

671
Q

Large, violaceous, nonulcerative subcutaneous nodules that are exquisitely tender; usually on lower legs but also on upper extremities

A

Erythema nodosum (septal panniculitis)

672
Q

Tender red or blue edematous nodules giving impression of vesiculation; usually on face, neck, upper extremities; when on lower extremities, may mimic erythema nodosum

A

Sweet syndrome (acute febrile neutrophilic dermatosis)

673
Q

Palpable purpuric lesions appearing in crops on legs or other dependent areas; may become vesicular or ulcerative

A

Cutaneous small-vessel vasculitis

674
Q

1- to 2-mm white or bluish lesions with an erythematous halo on the buccal mucosa

A

Koplik’s spots

675
Q

Pathognomonic for measles

A

Koplik’s spots

Generally seen during the first 2 days of symptoms

676
Q

Postauricular and suboccipital adenopathy and arthritis are usually seen in

A

Rubella

677
Q

Cause of erythema infectiosum (fifth disease)

A

human parvovirus B19

678
Q

Consists of 2- to 3-mm rose-pink macules and papules that coalesce only rarely, occur initially on the trunk and sometimes on the extremities (sparing the face), and fade within 2 days

A

Exanthem subitum (roseola)

679
Q

Rash of Lyme disease

A

Erythema migrans

680
Q

Rash of acute rheumatic fever

A

Erythema marginatum

681
Q

Target lesions (central erythema surrounded by area of clearing and another rim of erythema) up to 2 cm; symmetric on knees, elbows, palms, soles; spreads centripetally; papular, sometimes vesicular; when extensive and involving mucous membranes, termed EM major

A

Erythema multiforme

682
Q

Accentuated petechiae in body folds seen in scarlet fever

A

Pastia’s lines

683
Q

In the exfoliative stage of this disease, the skin can be induced to form bullae with light lateral pressure (Nikolsky’s sign)

A

Staphylococcal scalded-skin syndrome

684
Q

The skin can be induced to form bullae with light lateral pressure. This is called

A

Nikolsky’s sign

685
Q

Disseminated candidiasis is often due to

A

Candida tropicalis

686
Q

In immunocompromised hosts, nodular lesions often represent

A

disseminated infection

687
Q

Triad of disseminated candidiasis

A
  1. Fever
  2. Myalgias
  3. Eruptive nodules
688
Q

Distinctive, sparse, countable hemorrhagic pustules, usually located near joints

A

Disseminated gonococcemia

PSBIM (12 decks)

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