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Clinical Medicine II > Infectious Disease: Bacterial Infections II > Flashcards

Infectious Disease: Bacterial Infections II Flashcards

1
Q

Most common STI in the US ?

A

Chlamydia Trachomatis

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2
Q

How does Chlamydia pneumoniae spread?

A

Respiratory Tract

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3
Q

How does Chlamydia Psittaci spread?

A

Bird transmission

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4
Q

What are the two transmissions routes of Chlamydia Trachomatis

A

1) Sexual contact

2) During birth

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5
Q

Chlamydia Trachomatis is
highly transmissible?

T of F

A

True

  • Incubation period
    7–21 days
  • Significant asymptomatic reservoir
  • Reinfection is common
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6
Q

Common S&S for women with Chlamydia Trachomatis?

A
  • Urethritis
  • Asymptomatic
  • Dysuria, frequency
  • “sterile” pyuria
  • Cervicitis
  • Mucopurulent endocervical discharge
  • Edematous cervix with erythema and friability
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7
Q

Common S&S for Men with Chlamydia Trachomatis?

A
  • Urethritis
  • Asymptomatic (>50%)
  • Mucopurulent or clear discharge
  • Dysuria
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8
Q

Complications for women with Chlamydia Trachomatis?

A
  • Pelvic Inflammatory Disease (PID)
  • Perihepatitis (Fitz-Hugh-Curtis Syndrome)
  • Reactive arthritis
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9
Q

Complications for Men with Chlamydia Trachomatis?

A
  • Epididymitis

- Reactive arthritis

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10
Q

How do you Dx Chlamydia Trachomatis?

A

1) Clinical Dx

2) Nucleic acid amplification tests (NAATs)

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11
Q

T or F

Cultures are the gold standard for Chlamydia Trachomatis Dx?

A

False

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12
Q

What are the treatment medications for Chlamydia Trachomatis?

A

1) Azithromycin

2) Doxycyline

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13
Q

What is the treatment medication for Chlamydia Trachomatis in a pregnant woman?

A

Erythromycin

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14
Q

What is Inclusion Conjunctivitis and how is it caused?

A

Direct contact with the epithelial cells of the conjunctiva (Eye) with infected Chlamydia Trachomatis genital secretions

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15
Q

Inclusion Conjunctivitis pt’s present with what S&S?

A
  • Non purulent Unilateral conjunctivitis
  • Eye Lids sticking together
  • Cobblestoning
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16
Q

Inclusion Conjunctivitis pt’s are treated with ?

A

Azithromycin 1 gram Po

Treat partners too

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17
Q

Chlamydia pneumoniae occurs mostly in what age group?

A

Children

Asymptomatic or only mild symptoms

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18
Q

Can Adults and Elderly get Chlamydia pneumoniae?

A

Yes

Slow development over weeks

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19
Q

What are some S&S of Chlamydia pneumoniae in adults and elderly?

A
  • Nonproductive cough
  • Nasal congestion
  • Sore throat
  • Hoarseness
  • HA
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20
Q

What are PE findings of Chlamydia pneumoniae in adults and elderly?

A
  • Localized pulmonary crackles or rhonchi
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21
Q

Can Pt’s with Chlamydia pneumoniae be co infected with other pathogens?

A

Yes

1) S. pneumoniae
2) M. pneumoniae

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22
Q

Pharyngitis caused by Chlamydia (STI) is tested using ?

A

Nucleic Acid Amplified Testing (NAAT)

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23
Q

What is the #1 and #2 most common STI in the US?

A

1 Chlamydia

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24
Q

T of F Gonorrhea is gram negative?

A

True

Gram Negative Diplococci

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25
Ages of M/W of high prevalence of Gonorrhea
15 - 29
26
T of F Women are usually asymptomatic with Gonorrhea?
True
27
True of False, Men are usually asymptomatic with gonorrhea
False - Urethritis - Purulent discharge with dysuria
28
What are some complications of Gonorrhea in women?
- Bartholin gland infection - Pelvic inflammatory disease - Disseminated gonococcal infection - Conjunctivitis
29
Complications of Gonorrhea in men?
- Epididymitis: Infrequent but most common local complication - Disseminated gonococcal infection - Conjunctivitis
30
Dx of Gonorrhea includes?
- Gram stain of urethral discharge may show gram-negative intracellular diplococci - Culture - Nucleic acid amplification testing
31
Tx of Gonorrhea?
- IM Ceftriaxone or oral Cefixine PLUS - Doxycycline or Azithromycin All partners should be treated *Reportable infection in most states*
32
What are Disseminated Gonococcal Infections DGI?
Bacteremic spread of N. gonorrhea M > W
33
What sex is more at risk of Gonorrhea?
Women Usually no symptoms of genital gonorrhea
34
T of F there is a prodomal period with Gonorrhea?
- False - No prodromal period - Feel well up to the time symptoms start
35
What are the two separate groups of clinical manifestations with Gonorrhea?
1) Arthritis Dermatitis Syndrome (Tenosynovitis, Dermatitis, and Polyarthralgias) 70% of Pt's Spontaneously resolve or evolves into overt septic arthritis 2) Purulent arthritis (< 50% of pt's present with actual arthritis
36
PE findings associated with Gonorrhea and Arthritis Dermatitis Syndrome?
- Tenosynovitis (Multiple joints, Wrist, Fingers, Ankles, Toes) - Dermatitis 75% of Pt's (Painless, Pustular or Vesiculopustular)
37
PE findings associated with Gonorrhea and Purulent Arthritis?
- Abrupt onset of mono-or oligarthritis - Pain and swelling in one or more joints - Gonococcal arthritis (Distal joints Knees, Wrist, and Ankles) - afebrile
38
What are some lab test done to help Dx DGI?
- Blood Cultures (2 Sets) - Swabs (Urogenital, Rectal, Pharyngeal) - Synovial fluid
39
Initial treatment of DGI?
- Ceftriaxone 1gm IM or IV every 24 hours IV for those who have septic arthritis - Azithromycin 1gm in a single dose
40
What organism causes Syphilis?
Treponema pallidum (Spirochete)
41
Who is at higher risk of Syphillis?
- Gay Men | - 90% of cases of primary and secondary case occur in men
42
Primary Syphilis S&S?
- Painless chancre or ulcer (site of inoculation) - Most commonly the Genitals and Anus - Associated with regional lymphadenopathy
43
Secondary Syphilis S&S?
- Constitutional symptoms - Generalized lymphadenopathy - Rash - Alopecia - Renal issues - GI Hepatitis - Muscular - Neurological (HA, Meningitis)
44
What disease is called the great pretender?
Syphilis
45
Secondary Syphilis classic sign?
- Rash - Vesicular lesion is most common - Diffuse symmetric maculopapular - Trunk and Extremities - MC Palms & Soles - Mouth / Mucous membranes
46
S&S of tertiary (Late) Syphilis?
- Gumma (granuloma) body trying to fight infection - Cardiac (Dilated thoracic aorta) - CNS (Tabes Dorsalis) - Argyll Robertson Pupil - Broad Based Ataxia
47
T of F Syphilis can be cultured in a lab?
False Organism can not be cultured
48
Most common Dx test for Syphilis?
FTA-ABS: Fluorescent treponemal antibody absorption test
49
Problem with using VDRL and RPR test for Syphilis?
- Only accurate after 4 - 6 weeks after infection - Will only catch Primary and Secondary syphilis - Negative in Tertiary Syphilis
50
Treatment of Primary Syphilis?
- Benzathine Penicillin G | - Single dose
51
Treatment of Secondary and Tertiary Syphilis?
- Benzathine Penicillin G | - 3 weekly injections
52
True of False Syphilis should be followed up with HIV testing?
- True | - Must be reported to local health Dept.
53
What is a classic finding on XRay for a pt with a Mycobacterial disease?
- Cavitary infiltrate of the upper lobe
54
What are the two forms of Mycobacterium?
- Tuberculous | - Nontuberculous
55
How is tuberculosis spread?
- Inhalation of organisms contained within the aerosolized droplets from an infected individual
56
Most pt's will be able to clear Tuberculosis True of False?
- True - 90% will clear disease - 10% will develop TB Pneumonia (TB seeds in lung hilum)
57
What population is at higher risk of TB?
- Pt's on immunosuppressants - HIV - Chronic kidney disease - DM - Infants & Elderly
58
What are the phases of TB?
- Primary - Latent - Reactivated
59
S&S of primary TB in a pt?
- Asymptomatic - Local bacterial replication - Host able to fight off infection - Progressive TB in small percent of patients within 2 years - In immunocompetent becomes “latent”
60
S&S of latent TB?
- Pt is noncontagious - Asymptomatic - Persistent state of immune response to M. tuberculosis
61
S&S of Reactivated TB?
- After latent phase 5-10% - Typically pulmonary manifestations - > 2 years after primary infection
62
Primary TB clinical symptoms?
- Cough most common - Dry then Wet - Hemoptysis (bloody cough) - Pleuritic chest pain - 2 to 3 weeks - Fever/Chills - Night sweats - Anorexia - Weight loss
63
Most common finding TB Xray findings?
- Hilar Adenopathy - Pulmonary cavitation upper lobe - Infiltrates (Right side) Perihilar
64
Treatment of TB?
- Multi drug Tx (Gold Standard) - 10 drugs (FDA Approved) - HUGE ISSUE Drug resistance - Seek expert advice when treating TB
65
TB can develop into Pneumonia and then spread where?
- Cervical lymphadenopathy - Meningitis - Pericarditis - Millary dissemination
66
Non-tuberculosis clinical manifestations?
- Disseminated disease - Pulmonary disease - Cervical lymph nodes - Skin and soft tissue
67
Best way to Dx Non-Tuberculosis?
- PPD (Fast and Easy) gold standard - Interferon assays - CXR may be normal
68
Prevention of Non-Tuberculosis is pt's with HIV?
Prophylaxis HIV and CD4 count < 50K - Azithromycin - Clarithromycin - Rifabutin
69
Treatment of Non-Tuberculosis ?
- Multidrug therapy 1st line: Macrolide (clarithromycin or azithromycin), ethambutol, rifampin or rifabutin - 18 months of therapy (must continue 12 months after culture conversion) - May need to refer to Infectious Disease specialist
70
Two types of Tick Borne illnesses?
- Lyme disease (spirochete) | - Rockey Mountain Spotted Fever
71
Lyme Disease is caused by ?
- Spirochete Borreila burgdorferi | - Wooded areas up north
72
Vector for Lyme disease in the US?
- Spread from the bite of the Ixodes tick - Ixodes Scapularis - Lxodes Pacificus
73
What are some reservoirs for lyme disease?
- Black Legged Tick - Rodents or the White foot mouse - Ticks feed on the rodents - Ingest the spirochete - Tick feeds on deer (obtain a blood meal) fall off - Deer are important for survival but not a reservoir for the spirochete
74
Primary reservoir for B burgdorferi (Cause of lyme Disease)
Rodents, White foot mouse
75
Primary vector for lyme disease?
Black legged tick - Ixodes Scapularis - Lxodes Pacificus
76
How long must the tick be attached to a human for transmission?
24 to 36 hours
77
Lyme disease three stages?
- Early localized - Early disseminated - Late disease
78
Hallmark sign of the Tick bite?
- 75% Erythema Migrans Bulls Eye Rash - 25% do not exhibit a rash or recall having a rash
79
When does the bull eye rash usually develop?
- 7 to 14 days after bite | - Range 3 to 30 days
80
Erythema migrans rash most common locations?
- Axilla, groin, popliteal fossa, or belt line
81
T of F Erythema migrans is painful and hurts?
False Painless, may burn or itch
82
Early localized lyme disease S&S?
- Fatigue - Anorexia - Headache - Neck stiffness - Myalgias - Arthralgias - Regional lymphadenopathy - Fever
83
What lab will be elevated in a pt with early localized lyme disease?
ESR levels elevated
84
Early disseminated lyme disease S&S?
- Acute Neurological or Cardiac involvement - Ocular manifestations - Weeks to months after bite
85
Most common neurological Early disseminated lyme disease S&S?
- Unilateral or bilateral cranial nerve palsies (facial nerve most common) - Bells palsy
86
Early disseminated lyme disease cardiac S&S?
- Carditis | - Av Blocks
87
Early disseminated lyme disease ocular manifestations S&S?
- Conjunctivitis - Keratitis - Optic neuritis - Uveitis
88
Late disseminated lyme disease S&S?
- Months to years after exposure - Arthritis - Large joints (knees) - Joint swelling and Pain
89
Gold Standard to confirm Dx of Lyme Disease?
- Western blot is the confirmatory test
90
Can an Immunofluorescent Assay or ELISA technique test be used to test for antibodies in lyme disease?
Yes, but Antibodies can wax and wane in the first several months
91
What is the prophylaxis TX of lyme disease?
- Tick attached for > 36hrs - Began within 72 hours of removing the engorged tick - Doxycycline not contraindicated
92
How is Rocky Mountain Spotted Fever transmitted?
- Wood ticks - American dog tick - Brown dog tick
93
Classic S&S of Rocky mountain spotted fever?
- Abrupt onset - Fever - Headache - Myalgias - Red macular rash Starts on wrists and ankles - Rash spreads centrally, Petechiae develops
94
How do you Dx rocky mountain spotted fever?
- PCR of the skin Bx | - Serology antibodies confirms
95
T of F All pt's remember the tick bite in rocky mountain spotted fever?
- False | - 40% do not remember
96
Treatment of Rocky mountain spotted fever?
- Doxycycline | - Risk factors for Elderly and Comorbidities
97
What causes Tetanus?
Caused by contamination of wounds from the bacteria Clostridium tetani or The spores they produce that live in the soil, and animal feces, - ubiquitous
98
True of False Tetanus can be transmitted from person to person ?
False
99
How does Tetanus enter the body?
- Puncture wounds - Burns / wounds - IV drug access
100
Characteristics of Clostridium Tetani?
- Anaerobic | - Gram positive Rod
101
What is the incubation period of Tetanus?
5 days to 15 weeks
102
S&S of Tetanus?
- Pain & tingling at site of inoculation - Dysphagia - Drooling - Excess sweating - Uncontrolled urination and defecation - Fever - Risus sardonicus (raised eyebrows, grin) - Muscle spasms
103
How is Tetanus Dx?
Clinically - Cultures and Serology have low Sen and Spe
104
Treatment of Tetanus?
- Protect the Airway - Benzo's - Human Tetanus Immunoglobulin (Flown in from CDC) - Wound debridement - Metronidazole or Penicillin
105
Vaccinations for Tetanus are 100% effective True of False
True - 100% effective - Booster every 10 years

Clinical Medicine II (9 decks)

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