Infectious Diseases Flashcards

Question 1

Q

Evaluation of suspected ventilator-associated pneumonia

Answer

A

Suspect for Ventilator-associated pneumonia (VAP)
- abnormal chest X-ray
Lower respiratory endotracheal tube sample
- culture
- microscopy
Empiric antibiotics
- gram (+)
- antipseudomonal & gram (-)
- MARSA (methicillin-resistance Staph. aureus)

—-
3.1 negative culture:
- discontinue antibiotics + evaluate for other causes

3.2 positive culture & clinical improvement
- narrow antibiotics (according to the culture result)

3.3. Positive culture without clinical improvement:
- likely VAP
- Consider changing antibiotics
- assess for VAP complication ( abscess, empyema)
- consider evaluating for other causes

Question 2

Q

Ventilator-associated pneumonia

Answer

A

Feature:
- occurs after 48 hours of endotracheal tube incubation
- associated with:
1. Gram (-) bacilli ( pseudomonas, E.coli, Klebsiella)
2. Gram (+) cocci ( MRSA, Streptococcus)

Signs:
- fever
- leukocytosis ( increase WBC)
- purulent secretion
- difficulty with ventilation ( increase RR, decrease Tidal volume)

Question 3

Q

Meningococcal meningitis

Answer

A

Epidemiology:
- Neisseria Meningitis
- most common in young children & young adult

Feature:
- initially: non-specific fever, headache, vomiting, myalgia, sore throat
- within 12-24 hours: petechiae/purpura, meningeal signs (stiff neck), altered mental status

Diagnosis:
-blood culture (before starting antibiotics)
- lumbar puncture

Treatment:
- ceftriaxone ( ± vancomycin for coverage of PRSP)
-treatment should not be delayed for lumbar puncture

Complication:
- shock
- DIC
- adrenal hemorrhage

Prevention:
- droplet precautions
- chemoprophylaxis ( Rifampin, ciprofloxacin, or ceftriaxone) —> for close contacts

Question 4

Q

Tularemia ( rabbit fever, or deer fly fever )

Answer

A

typically attacks the skin, eyes, lymph nodes and lungs
infection with: Francisella Tularensis

LEAD TO:
- unilateral conjunctivitis with ipsilateral pre-auricular lymphadenopathy ( parinaud oculoglandular syndrome) —-> this is also seen with Bartonella henselae (catscratch), & herpes simplex virus

Epidemiology:
- transmission from:
1. Wild animals ( hare, rabbit) hunting
2. Tick/mosquito bite
3. Bioterrorism agent

Feature:
1. Nonspecific symptoms ( fever, malaise)
2. Ulcero-glandular disease ( tender lymphadenopathy)
3. Pneumonia

Microbiology:
- poorly staining, gram (-) coccobacillus
- most strains require cysteine for growth
- evade most immune defenses & replicate within macrophages/ neutrophils

Question 5

Q

Adenovirus

Answer

A

Lead to:
- pneumonia
-regional lymphadenopathy
-Conjunctivitis (minimal or no purulence)

Question 6

Q

Candida Albican

Answer

A

seen in:
1. People with compromised immunity ( prolonged neutropenia)
2. Recent eye trauma or surgery
3. Indwelling central catheters
4. Not seen in healthy people

Question 7

Q

Yersinia Pestis

Answer

A

transmitted by fleas from rodents & wild/domestic animals
exposure can occur from hunting/trapping
lead to very painful suppurative lymphadenitis

Question 8

Q

Entamoeba histolytica ( Protozoal infestation )

Answer

A

Risk factors:
- resource limited regions (contaminated food/water)

Clinical:
- prolonged blood/mucoid diarrhea
- RUQ pain + fever
- complication: pleural effusion + rupture to peritoneum/pleural space
—> dysentery: abdominal pain + diarrhea + bloody stools
Diagnosis:
- stool PCR antigen

Treatment:
- Metronidazole or tinidazole
PLUS
- intraluminal antibiotics (paramomycin)

Question 9

Q

Creutzfeldt-Jackob (Mad Cow disease) ( prion)

Answer

A

Hx:
- rapidly progressive dementia
- handling brain (autopsy)

PE:
- ataxia
- cerebellar dysfunction
- myoclonic jerks

Etiology:
- ingestion or contact of infected brain or cattle causes brain shrinkage & deterioration
- transmitted by: surgical instrument, EEG electrodes, corneal transplantation, dura mater graft, human pituitary hormones

Epidemiology:
- most common prion disease
- rare
- medical examiner
- forensic pathologist
- mortician

DX:
- diagnosis of exclusion

TX:
- death within 8 months
- supportive care

Question 10

Q

Cryptococcal

(Fungal disease)
(More neurological symptoms)

Answer

A

Hx:
- neurologic ( fever, headache)
- respiratory ( non-productive cough, pleuritic chest pain)

PE:
- neurologic ( papilledema, nuchal rigidity)
-respiratory ( rales )
- pustular rash

Etiology:
- inhaled spores of cryptococcus neoforman yeast In birds & bat feces
- causes meningitis (most common presentation )
- or pulmonary disorder

Epidemiology:
- immunocompromised
- farmers
- demotition Crew
- pacific coast (colonize in eucalyptus trees)

Dx:
- lumbar puncture (if neurologic)
- sputum culture (if respiratory)
- cryptococcal antibody titer
- lesion biopsy

Tx:
- oral antifungal ( Amphotericin B)

Question 11

Q

Histoplasmosis

(Fungal disease)
(More respiratory symptoms)

Answer

A

Hx:
- asymptomatic (90%) (if solve resolve within 4 weeks)
- night sweat
- mainly respiratory symptoms ( dyspnea, dry or productive cough, hemoptysis)

PE:
- maculopapular rash

Etiology:
- Histoplasma Capsulatum Fungus in soil with bird or bat feces
- is inhaled & grows into yeast

Epidemiology:
- ohio, Missouri, Mississippi River Valley
- ( ideal soil composition & moisture)
- immunocompromised

Dx:
- sputum + blood cultures
- antibody titer
- chest X-ray ( hilar masses)

Tx:
- most cases self resolve within 4 weeks
- if longer than 4 weeks, consider Amphotericin B

Question 12

Q

Pneumocystis Jirovecii Pneumonia (PJP)

(Fungal disease)

Answer

A

Hx:
- weight loss, dyspnea, severe dry cough (sputum is too thick to be expectorated)

PE:
- tachypnea, fever, decrease oxygen saturation (SPO2)

Etiology:
- fungal pneumocystitis jirovecii spores ( formerly called, Pneumocystitis Carinii, but this species was found to only infect rats)

Epidemiology:
- most common infection in AIDS & immunocompromised

Dx:
- sputum culture
- positive Beta -D- Glucan ( assay detects fungal cell wall)
- Chest X-ray: diffused perihilar infiltrates
- CT: ground glass

Tx:
- TMP/SMX (Bactrim)
- steroids
- mortality 20%

Question 13

Q

Pinworms (helminth)

(Helminthic/worm disease)

Answer

A

Hx:
- nocturnal perianal pruritus

PE:
- Anal excoriations
- less than 1 cm perianal white worms

Etiology:
- Enterobius Vermicularis
- fecal-oral route
- female lay eggs outside of anus at night & cause itching

Epidemiology:
- most common Helminth infection
- 30% of children ages (5-14)
- daycare
- crowded living situation

Dx:
- scotch tape test (over anus shows eggs or worms)

Tx:
- mebendazole (vermox)

albendazole ( albenza)
treat household contacts ( clean linens in hot water, frequent hand wash) —> highly contagious

Question 14

Q

Helminth intestinal infestation

Answer

A

Hookworm:
- Ancylostoma duodenale, Necator Americanus
- eggs in animal feces/soil absorbed through skin, walking barefoot
- reside in intestine
- lead to iron deficiency anemia

Tapeworm:
- raw or uncooked pork (Taenia Solium), Beef (Taenia Saginata), rarely fish (Taenia latem)
- reside in intestine
- cause weight loss & malnutrition
- treat with: praziquantel

Ascarids:
- Ascaris Lumbricoides
- Contaminated soil on food/hands, ingested
- roundworms grow & multiply in intestine
-cause malnutrition & intestinal obstruction

Flukes:
- Clonorchis sinensis, opisthorchis viverrini
- contaminated water —> burrow in skin
- undercooked seafood
- reside in intestine, blood, liver, lung

Trichinosis:
- Trichinella worms ( Trichinella spiralis)
- raw or undercooked pork
- encapsulates in muscle & brain tissue ( difficult to treat)

Question 15

Q

Helminth Infestation

Answer

A

Filariasis (Elephantiasis)
- Wuchereria Bancrofti (most common)
- Filariid worms transmitted by mosquitos
- reside in lymphatic system, skin
- causes lymphatic pooling, skin breakdown

Guina worm ( Dracunculiasis)
- Dracunculus medinensis
- contaminated water
- reside in skin, head will emerge
- removed small amount at a time, breakage can cause secondary infection

Loa loa worm (loiasis)
- filariid worm transmitted by bite of Chrysops Fly (mango or deer fly)
- migrates to and reside in eye

Question 16

Q

Tropical viral fevers ( Dengue, Yellow )

(Viral diseases)

Answer

A

Hx:
- 80% of Dengue fever are asymptomatic
- Myalgia + malaise + headache

PE:
- both have fever & petechial rash
1. Dengue: usually mild mucosal bleeding
2. Yellow: 15% develop jaundice (yellow), mucosal & GI bleed —> hypotension —> death

Etiology:
- both are spread by Aedes mosquito, incubation of 1 week
1. Dengue: dengue virus, 5% develop Hemorrhagic GI bleeding
2. Yellow: Flavivirus, 15% develop liver failure

Epidemiology:
- Latin America, Southeast Asia, Africa

Dx:
- CBC ( neutropenia, thrombocytopenia)
- PCR
- ELISA

TX:
- IV fluid
- Acetaminophen
- Fresh frozen plasma ( if bleed)
- prevent with vaccine
- Dengue: resolves in 10 days; Mortality with GI bleeding is 25%, without is 1%
- Yellow: resolves in 5 days. Mortality with Jaundice 20-50%, without is 7%

Question 17

Q

Ebola Virus ( viral hemorrhagic fever)

( viral disease)

Answer

A

Hx:
- headache, diarrhea, vomiting, abdominal pain, travel to endemic area

PE:
- High fever, rash, ciliary injection, internal & external bleeding.
- in lateral stages, liver & renal failure, bleeding in eyes, ears, nose

Etiology:
- infected primate ( hunting & eating)
- virus transmitted through any body fluid
- incubation 2-21 days

Epidemiology:
- Africa, healthcare worker

DX:
- CBC ( thrombocytopenia)
- coagulation panel ( prolonged PT, PTT, Bleeding time)
- PCR
- ELISA

TX:
- IV Fluid
- oxygen
- supportive
- 50-90% mortality within 6-16 days of symptoms onset
- Remdesivir is experimental

Question 18

Q

Zika virus

(Viral diseases)

Answer

A

Hx:
- 80% asymptomatic
- arthralgia, headache, travel to endemic area within 2 weeks

PE:
- rash, fever

Etiology:
- flavivirus transmitted by Aede mosquito
- sexually transmitted

Epidemiology:
- Africa, Southeast Asia, South America, Virgin Island, Puerto Rico

Dx:
- urine PCR

TX:
- self resolved (7 days)
- teratogenic if pregnant (microcephaly, eye deformity)

Question 19

Q

Hantavirus

(Viral disease)

Answer

A

Hx:
- prodrome (3-5 days of GI): vomiting, diarrhea, abdominal pain
- cardiopulmonary phase (1-2 days of respiratory): dyspnea, dry cough

PE:
- Rales, dehydration ( sunken eyes, decreased skin turgor, dry mucous membrane)

Etiology:
- inhaled Sin Nombre Virus in rodent waste

Epidemiology:
- arid, dusty climate (desert)

Dx:
- smear ( atypical lymphocytosis)
- PCR
- ELISA ( elevated IgM & IgG)

TX:
- supportive
- ventilation

Question 20

Q

Infectious Mononucleosis

(Viral disease)

Answer

A

Hx:
- extreme fatigue, pharyngitis, sharing drinks, kissing

PE:
- cervical lymphadenopathy, tonsillar exudates, splenomegaly, fever, jaundice, faint transient rash, petechiae on soft palate.

Etiology:
- Epstein- Barr Virus infection of B lymphocyte

Epidemiology:
- young adult

Dx:
- CBC (leukocytosis)
- smear (atypical lymphocytes)
- heterophiles (mono-spot)
- screening test
- elevated EBV IgM

Tx:
- NSAIDS & rest
- self resolve 10 days- 3 months
- no contact sport ( lead to splenic rupture)
- may get rash if given Penicillin antibiotics ( amoxicillin)

Question 21

Q

Cytomegalovirus

(Viral disease)

Answer

A

Hx:
- flu-like symptoms + sore throat

PE:
- fever, cervical lymphadenopathy

Etiology:
- HHV5 transmitted by bodily fluid
- in immunocompromised: can cause hepatitis, retinitis, colitis, pneumonitis, esophagitis, encephalitis

Epidemiology:
- 90% of human can get it during lifetime

Dx:
- smear ( Owl’s eye infected cells)
- PCR
-ELISA

TX:
- IVIG ( if severe)
- antiviral in immunocompromised (reduce mortality; ganciclovir; foscarnet)
- teratogenic if pregnant ( cognitive & motor defects)

Question 22

Q

HIV & AIDS

(Viral disease)

Answer

A

Hx:
- unprotected sex ( #1 receptive anal), multiple partners, other STDs, IV drug use, transfusion
- prodrome ( 2-4 weeks): flu-like illness, truncal rash, neuropathy, diarrhea
- clinical latency (3-20 years): fever, weight loss, lymphadenopathy
- If untreated, 50% will develop AIDS 10 years after exposure: opportunistic infection ( Kaposi sarcoma, Burkitt lymphoma, thrush, PJP, TB, toxoplasmosis, shingles, dementia).

Etiology:
- HIV-1 (common), HIV-2 (rare)
- blood borne ( mother to child, IV needle, needle stick, genital ulcers, rough sex)

Epidemiology:
- Sub-saharan Africa
- men have sex with men ( anal sex)
- IV drug users

Dx:
- PCR
-ELISA
- antibody test
- CD4 T cell count ( CD4 < 200 = AIDS)

TX:
- highly active antiretroviral therapy (HAART) = normal life expectancy ( without it = 10 years)
- condom use, antiviral vaginal gel
- pre-exposure prophylaxis: tenofovir/ emtricitabine
- post-exposure (48-72 hours): 3 antiviral drug combo

Question 23

Q

Rabies
( viral disease)

Answer

A

Hx:
- aggressive animal bite patient 1-3 months before symptoms.
- triads ( paresthesia, pain, intense itching at bite site)
- malaise, headache, fever, insomnia

PE:
- furious type (80%): agitation, delirium, hydrophobia & aerophobia ( attempting to drink or having air blown in the face cause pharyngeal spasms), excessive salivation, convulsion, autonomic dysfunction —> arrhythmia, hypotension —> death

paralytic type (20%): priapism, anisocoria, facial palsy, progressive paralysis —> death

Etiology:
- CNS- acting Lyssavirus
- dog/cat, bat, skunk, coyote, wolf…

Epidemiology:
- 2 human death annually

Dx:
- nuchal skin biopsy of patient ( rabies virus in cutaneous nerve)
- test questionable animal
- salivary PCR

TX:
- debride wound,
- rabies vaccine at bite site
- IVIG
- 100% mortality due to respiratory failure within 1 week of emergence of neurologic symptoms —> prevent with vaccine

Question 24

Q

Influenza
( viral disease)

Answer

A

Hx:
- myalgia, fever/chills, headache, sinus pressure, fatigue, dry cough
- exposure to sick contact, no flu shot

PE:
- ill appearing, fever, clear fluid behind tympanic membrane, pharyngeal erythema ( post-nasal drip)

Etiology:
- Type A: severe, peak Nov/Dec
- type B: mild, peak Jan/Feb
- H1N1 ( swine flu): severe variant of type A

Epidemiology:
- highly contagious, common, may lead to pneumonia

Dx:
- nasopharyngeal swab rapid flu test
- PCR for H1N1

TX:
- flu vaccine ( prevent)
- inactivated (IM) shot for older than 6 months & pregnant women.
- live-attenuated for ages 2-49
- may cause flu-like symptoms & injection site reaction.
-Within 48 hours of symptoms onset: oseltamivir, zanamivir

Question 25

Q

Common Cold

( viral disease)

Answer

A

Hx:
- headache, pharyngitis, sneezing, rhinorrhea, malaise, dry cough
- mild fever or myalgia
- exposure to sick contact

PE:
- Clear fluid behind tympanic membrane, pharyngeal erythema (postnasal drip)

Etiology:
- spread through respiratory droplet, fomites, direct contact.
- Rhinovirus, coronavirus, parainfluenza, respiratory syncytial virus, enterovirus, metapneumovirus

Epidemiology:
- highly contagious, common, adult have 2-3 a year, children have 6-8 a year

Dx:
- clinical

Tx:
- self resolve in 7- 10 days
- NSAID, cough suppressant, nasal decongestion, zinc supplement (shorten duration)
- may develop secondary infection of otitis media, sinusitis

Question 26

Q

Erythema infectiosum (5th disease)

(Viral disease)

Answer

A

Hx:
- 3 days of low fever before pruritic rash
- 2-3 days of malaise

PE:
- slapped cheek rash + truncal lucy rash + lymphadenopathy

Etiology:
- parvovirus B19

Epidemiology:
- under age 15 ( most common)

Dx:
- clinical, serum IgM

TX:
- self-resolve (weeks)
- acetaminophen (for fever) + fluid ( for dehydration) + diphenhydramine, hydroxyzine, topical camphor/menthol ( for rash )

Question 27

Q

Exanthema subitum ( roseola infantum, 6th disease)

Answer

A

Hx:
- 3 days high fever, febrile seizure ( 15%)
- rash starts as fever resolves

PE:
- non- pruritic morbilliform rash over entire body, erythematous papule on the soft palate & base of the uvula ( Nagayama spots)

Etiology: herpes virus 6

Epidemiology:
- under age 3

Dx:
- clinical, serum IgM

TX:
- self-resolve (weeks)
- acetaminophen (for fever) + fluid ( for dehydration) + diphenhydramine, hydroxyzine, topical camphor/menthol ( for rash )

Question 28

Q

Measles ( Rueola)

( viral disease)

Question 29

Q

German Measles ( Rubella)
(Viral disease)

Question 30

Q

Mumps

( viral disease)

Question 31

Q

Condylomata Acuminata

(Viral disease)

Question 32

Q

Herpes simplex virus ( type 1 oral ; type 2 genital)

Question 33

Q

Antiretroviral therapy (ART)

Answer

A

indicated for all patients with HIV (regardless of CD4 count)
to reduce HIV- related mortality & death

Question 34

Q

Leprosy (Hansen Disease)

Answer

A

hypo-pigmented + anesthesia (no sensation to pinprick) patch with nerve nodularity/ pain

Epidemiology:
-mycobacterium leprae ( acid fast bacillus)
- primary developing world ( Asia, Africa, south america)
-transmutation via: respiratory droplets/ nine banded armadillo
- low infectivity

Manifistation:
- macule, anesthetic skin lesions with raised borders
- nodular, painful nearby nerves with loss of sensory/motor function

Diagnosis:
- full thickness biopsy of skin lesion edge (active edge)
- M leprae is not culturable

Treatment:
- Dapsone + Rifampin ( for paucibacillary: minimal lesion)
- Dapsone + Rifampin + clofazimine —> if severe (multibacillary)

Question 35

Q

Lyme disease

Answer

A

manifest as: erythema migrans ( slowly spreading erythematous lesion with central clearing = bull’s eye lesion)
sensory & motor neuropathy may sometimes occur early disseminated disease

Question 36

Q

Primary syphilis

Answer

A

-characterized by painless chancre ( shallow, non-purulent ulcer with raised, well demarcated borders.

Question 37

Q

Tertiary syphilis

Answer

A

cause skin gummas ( soft, ulcerative masses with necrotic centers)

Question 38

Q

Common cause of diarrhea in patient with AIDS

Answer

A

Cryptosporidium ( CD4 < 180)
- Severe watery diarrhea + low grade fever + weight loss
Micro-sporidium / Isosporidium ( CD4 < 100)
- watery diarrhea + crampy abdominal pain + wight loss + fever is rare
Macro-bacterium Avium complex ( CD4 < 50)
- watery diarrhea + high fever > 39.0 + weight loss + cough
Cytomegalovirus (CD4 < 50)
- frequent, small volume diarrhea + hematochezia + abdominal pain + low grade fever + weight loss

Question 39

Q

Legionella pneumonia

Answer

A

exposure to possibly contaminated water
- recent travel (cruise + hotel stay) within previous 2 weeks
-contaminated potable water in hospital/nursing homes

Clinical:
-fever >39
- bradycardia related to high fever
-confusion
- diarrhea
- unresponsive to beta-lactam & amino-glycoside antibiotics

Laboratory:
1. hyponatremia
2. hepatic dysfunction
3. hematuria & proteinuria
4. sputum gram stain shows many neutrophils ( & no microorganisms)
5. Chest x-ray: lobar infiltrates

Treatment:
- respiratory fluoroquinolone ( levofloxacin)
or
- newer macrolide ( azithromycin)

Question 40

Q

Infectious genital ulcers

Answer

A

Painful ulcers:

HSV:
- pustules, vesicles, or small ulcers on erythematous base
- tender lymphadenopathy
- systemic symptoms common
Haemophilus Ducreyi (chancroid):
- larger, deep ulcers with gray/yellow exudate
- well-demarcated borders & soft, friable base
- papule —> pustule —> ulcer ( conversion) + inguinal lymphadenitis
- sexually transmitted + gram (-) rod
- in Africa, Southeast Asia + Latin America
- trade sex for drugs
- treat with: Azithromycin ( new macrolide)

Painless ulcers:
1. Treponema pillidum ( Syphilis)
-usually single ulcer (chancre)
- indurated borders & hard, non-purulent base

Chlamydia Trachomatis serovars L1-L3 ( Lymphogranuloma venereum)
- initial small, shallow ulcers (often missed)
- then painful & fluctuant adenitis (buboes)

Note:
- gonorrhea: most common STD. Causes cervicitis or urethritis

Question 41

Q

Diagnostic serology for Syphilis

Answer

A

Non- treponemal ( RPR, VDRL):
- Antibody to Cardiolipin- Cholestrol-Lecithin (CCL) Antigen
- Quantitative ( titer; ####)
- Possible negative result in early infection
- decrease in titer confirm treatment

Treponema ( FTA- ABS, TP-EIA)
- antibody to trepanema antigen
- Qualitative ( present, or not)
- Greater sensitivity in early infection
- positive even after treatment

Note:

RPR: rapid plasma reagin
VDRL:
FTA-ABS: fluorescent trepanomal antibody absorption —> best for primary syphilis, particularly early in the disease course
TP-EIA: trepanema pallidum enzyme immunoassay

Question 42

Q

Community-acquired Pneumonia (CAP)

Answer

A

Treat with:
- Amoxicillin - clavulanate
- these medication works against —> beta-lactamase hemophilus & maroxella

Note:
- Drugs treat: otitis media, sinusitis

Question 43

Q

Pneumococcus + Haemophilus + Moraxella

Answer

A

Treat with
- Ceftriaxone

Question 44

Q

Aspiration pneumonia + lung abscess

Answer

A

Treat with:
- clindamycin ( type of macrolide)

Question 45

Q

Nosocomial Pneumonia ( when risk MRSA is high) —> ventilator acquired pneumonia ( VAP)

Answer

A

Treat with:
- vancomycin

Question 46

Q

Post-Exposure to HIV

Answer

A

Determine if high risk ( urgent Tx) or low risk ( no need for tx)
Urgent treatment (WITHIN FIRST FEW HOURS) & continue for 4 weeks
Regimen of combination of 3 drugs:

two nucleotide/nucleoside reverse transcriptase inhibitor ( tenofovir, emtricitabine)

PLUS

Integrase strand transfer inhibitor (raltegravir), protease inhibitor, or non-nucleoside reverse transcriptase inhibitor

Question 47

Q

Malaria prevention

Answer

A

initiate chemoprophylaxis ( before, during, & after) traveling
drugs:
1. Atovaquone-proguanil

Mefloquine ( 2 weeks before traveling, & continued 4 weeks after travel)
Doxycycline
Tafenoquine

Question 48

Q

Neisseria Gonorrhea

Answer

A

Symptoms:
- cervecitis or urethrasitis
- conjunctivitis + pharyngitis + arthritis

Question 49

Q

Major pathologic mechanisms of food-brone illness

Answer

A

Enterotoxin Ingestion:
- Staph. Aureus + Bacillus Cereus ( reheated rice)
- symptoms:
1. Quick onset: 1-6 hours
2. Vomiting predominant

Enterotoxin made in intestine:
- Clostridium perfringens ( ETEC/STEC) + Vibrio cholerae
- symptoms:
1. Delayed onset: > 1 day
2. Watery/bloody diarrhea

Bacterial epithelial Invasion:
- Campylobacter jejuni + Nontyphoidal salmonella + Listeria Monocytogenes
- symptoms:
1. Variable onset
2. Watery/bloody diarrhea
3. Fever
4. Systemic illness ( Listeria)

Note:
- ETEC: Enterotoxigenic E.coli
- STEC: shiga toxin- producing E.coli

Question 50

Q

Entamoeba Histolytica

Answer

A

liver abscess ( after episode of dysentery)+ lived or travelled to developing country
syx: fever/ RUQ pain/ anorexia/ increase liver enzymes / increase WBC

-Treat with:
1. Metronizadole or tinidazole
Or
2. Paromomycin

Question 51

Q

Sexually transmitted infection screening

Answer

A

All patients:
1. Neisseria Gonorrhea ( via NAAT)
2. Chlamydia Trachomatis ( via NAAT)
3. Syphilis ( via RPR, VDRL, AFB-ABS, TP-EIA)
4. HIV ( via 4th generation antigen/antibody)

Additional testing for certain populations:

women only: Trichomonas vaginalis ( wet mount)
HSV screening ( serology) only when history of characteristic lesions

Question 52

Q

Febrile neutropenia (FN)

Answer

A

Febrile with normal chest x-ray & urinalysis

Defined as:
- neutrophil count < 1500/ mm3
- severe neutropenia < 500/ mm3

are at higher risk for overwhelming bacterial infection due to blunted/absence of neutrophil mediated inflammatory response

Approach
- start on empiric broad-spectrum antibiotic ( as soon as possible) after blood culture is obtained

empiric mono-therapy with anti-pseudomonal agent:
1. Cefepime
2. meropenem
3. piperacillin-tazobactam

Question 53

Q

Cefepime
meropenem
piperacillin-tazobactam

Answer

A

To treat:
- pseudomonal aureginosa that can lead to febrile neutropenia

Question 54

Q

Acyclovir

Answer

A

Treat:
-herpes simplex virus

Question 55

Q

Ceftriaxone

Question 56

Q

Ciprofloxacin

Question 57

Q

Linezolid

Question 58

Q

Vancomycin

Answer

A

has no gram (-) activity

To treat:
- MRSA
- catheter-related infection
- skin/soft tissue infection
- pneumonia
- hemodynamic instability

Question 59

Q

Variconazole

Answer

A

anti fungal
recommended in patients with:

Neutropenic patient + Persistence fever after 4-7 days of initial therapy

Question 60

Q

HIV is associated with TB reactivation

Answer

A

Syx:
- weeks of fever, weight loss, cough, night sweat, fatigue
- productive/bloody cough in the early morning
- lung upper lobe cavity lesion (chest x-ray)

Question 61

Q

Treatment for TB

Answer

A

RIPE:
1. Rifampin
2. Isoniazid (INH) ( develop mild elevated aminotransferase; minor hepatic injury; self-resolve)
- adverse effect: hepatotoxicity (± hepatitis)
3. Pyrazinamide
4. Ethmabutol

Note:
- viral hepatitis (similar to INH hepatitis): fatigue, nausea, flu-like symptoms, jaundice, aminotransferase > 10 times upper limit
- severe hepatitis (due to daily alcohol, liver disease, or age > 50):

Question 62

Q

Syphilis treatment

Answer

A

Primary (chancre)+ secondary (diffuse rash: start at trunk and spread: lymphadenopathy: oral lesion)
- 1st: penicillin G (IM) * 1
-2nd: Doxycycline * 14 days

Tertiary ( cardiovascular; gummata)
- 1st: penicillin G (IM) * 3
-2nd: Doxycycline * 28 days

Neurosyphilis ( meningitis, ocular)
- 1st: penicillin G (IV) * 10-14 Days
-2nd: Ceftriaxone (IV) * 14 Days

Note:
- ( RPR= rapid plasma reagin): a 4-fold decrease in antibody titer at 6-12 months indicates treatment success
( Example: 100 titer ——> 25 titer)

Question 63

Q

Toxoplasma encephalitis

Answer

A

Syx:
- headache, confusion, fever, focal neurologic deficits/seizure

Dx:
- AIDS with CD4 count < 100
- positive toxoplasma gondii (IgG)
- Multiple ring-enhancing brain lesions (MRI)

Trx:
- sulfadiazine & pyrimethamine ( plus leucovorin)
- anti-retroviral initiated within 2 weeks
- prophylaxis: TMP-SMX ( CD4 count < 100)

Question 64

Q

Post-exposure prophylaxis of Hepatitis B infection

Answer

A

unvaccinated individuals should receive both HB vaccine & HB immune globulin as soon as possible

Answer 57

A

Feature:
- fever
- tonsillitis/pharyngitis ± Exudates
- cervical lymphadenopathy
- significant fatigue
- hepatospelnomegaly
- rash after amoxicillin

Complication:
- acute airway obstruction
- autoimmune hemolytic anemia & thrompocytopenia
- splenic rupture

Answer 58

A

-Penicillin —> syphilis

amino-penicillin ( beta-lactamase sensitive) —> fight gram (-)
1. Amoxicillin
2. Ampicillin
—> when adding beta-lactamase inhibitor to Amox or Amp: they extend to cover gram (+):
1. Amoxicillin- clavulanate ( strap. & gram -)
2. Ampicillin - sulbactam
—-> anti-pseudomonal penicillin (+ beta-lactamase Inhibitor) to extend to cover gram (+) :
1. Piperacillin-tazobactam ( cover everything, but Staph)
2. Ticarcillin-sulbactam

—->
1. Carbapenem: ( 1. meropenem)
2. Monobactam: (1. Aztreonam) —> only with severe penicillin allergy or beta-lactam allergey that are anaphylactic

Beta-lactamase penicillin —>

-

Answer 59

A

Penicillin —>

Methicillin- sensitive staph. Aureus ( MSSA):
1. Nafcillin
2. Dicloxacillin ( oral form)
Methicillin- resistance Staph Aureus ( MRSA):
1. Vancomycin
2. Daptomycin (Treat Bloodstream infection)
3. Linezolid ( treat lung infection; PO/IV forms)

Answer 60

A

1st Gen: ( treat gram positive) ( cover Strep. & MSSA)
1. Cephalaxin (Keflex): PO; prophylaxis & surgery for skin infection
2. Cephazolin (Ancef): IV; cellulitis, UTI, pneumonia, endocarditis, joint infection, biliary tract infection

2nd Gen:
- don’t matter

3rd Gen: ( treat gram negative & Strep. ) ( does not cover Staph) ( can’t treat pseudomonas)

Ceftriaxone:

4th Gen: ( anti-pseudomonal) ( no gram positive activity) ( good gram negative coverage)
1. Cefepime:

Note:
1st: Gram (+)/ Strep. —> 3rd: Strep./ gram (-) —> 4th: gram (-)/ pseudomonas

Answer 61

A

( cephalexin & cefazolin)

Answer 62

A

Gram (-) coverage:
- urinary fluoroquinolone ( treat UTI bugs) ( double coverage of pseudomonas)
Ciprofloxacin:
Gram (+) coverage:
- respiratory Fluoroquinolone ( treat Strep. That cause pneumonia)
Moxifloxacin
Levofloxacin

Answer 63

A

Metronidazole: in gut & vagina
Clindamycin: used everywhere else

Addition of: beta-lactames & fluoroquinolone

Answer 64

A

If sick go broad ( ex: moxifloxacin IV form NPO, once a day)
Escalate quickly ( patient is deteriorating on antibiotic —> add bunch)
Deescalate slowly-> remove one coverage a day

—-add bunch at once & remove once per day——

Target cultures. Sensitization ( when you have a known bug & drug —> pick the antibiotic the bug is sensitive to that is lowest in the ladder)
Use empiric therapy ( should be lowest on the ladder)

Answer 65

A

-inpatient: Ceftriaxone + azithromycin

Or

outpatient: Azithromycin

—————

Patient with CAP & life threatening Beta-lactamase allergy:

Moxifloxacin ( PO & IV form) is the respiratory fluoroquinolone

Answer 66

A

( vancomycin) or ( Linezolid)

Plus

(Piperacillin-tazobactam) or ( meropenem)

NOTE:
- treatment can take > 6 weeks

Answer 67

A

vancomycin
ceftriaxone ( 2 gram, twice a day)
steroids ( methylprednisolone)
ampicillin ( if they are immunocompromised)

Answer 68

A

Outpatient: amoxicillin
If beta-lactame allergic —> nitrofurantoin

Or

TMP-SMX ( alternative)

Or

ciprofloxacin ( should not be used for urinary tract infection…..not you cant use it !!!!)

Examples:

pyelonephritis —> ceftriaxone

Answer 69

A

From

strep
1. Outpatient: amoxicillin (PO)
2. Inpatient: ceftriaxone (iv)
staph
1. Outpatient: Clindamycin ( IV or PO)
2. Inpatient: vancomycin

Note:
1. Strep: The infection is often accompanied by an extremely sore throat with white patches, difficulty swallowing, and a fever.
2. Staph: is a skin infection that is most often the result of surgery or an open wound.

Answer 70

A

Less than 3 months:
- staph. aureus + Pseudomonas aeruginosa

3- 12 months:
-Staph. Epidermis

Answer 71

A

lead to bacillary angiomatosis in advanced HIV
cat scratch or homeless or shelter living

TREATMENT:
- doxycycline or erythromycin
- antiretroviral therapy

Answer 72

A

Etiology:
- Niesseria Ghonnorhea
-chalamedya trecomatis
-Mycoplasma Genitalium
-Trichomatus Vagenalis

Feature:
-dysuria
-discharge

Diagnosis:
-stain & culture
- NAAT

Treatment:
- gonococcucal urethritis: ceftriaxone
- gonococcal urethritis + chalamydia: ceftriaxone + doxycycline
- chlamydia + mycoplasma: azithromycin
-trichomanus: metronidazole

Answer 73

A

penicillin G, penicillin V
gram positive
syphilis, strep pharyngitis, dental procedure, rheumatic fever

Answer 74

A

naficillin, oxacillin, dicloxacillin
gram positive (staph)
MSSA ( bacteremia, osteomyelitis, cellulitis, endocarditis)

Answer 75

A

amoxicillin, ampicillin
gram positive, gram negative
acute otitis media, step pharyngitis, listeria

Answer 76

A

amoxicillin-clavulanate (augmenten—> severe diarrhea)
ampicillin-sulbactam
gram positive, gram negative, anaerobes
aspiration pneumonia, animal bites, acute sinusitis

Answer 77

A

piperacillin- tazobactam
ticarcillin-clavulanate
gram positive, gram negative (pseudomonas), anaerobes
hospital acquired pneumonia

Answer 78

A

GI (diarrhea)
hypersensitivity reaction
hematologic reaction

Answer 79

A

First generation:
- cephalaxen (PO)
- Cefazolin (IV)

gram positive (strep, staph)
skin infection (MSSA)
surgical prophylaxis ( cefazolin)
———————————————————

Second generation: ( 2 furry foxes drinking tea on the floor)
- cefoxitin, cefuroxime, cefaclor, cefotetan
- gram positive, gram negative, anaerobes

intra-abdominal/ pelvic-infection
———————————————————

Third generation: (you can TRI TAXing me, but i wont give you a DIME)
- ceftriaxone, cefotaxime, ceftazidime

gram negative (including pseudomonas with ceftaxime)
gonococcal infection
meningitis
community acquired pneumonia ( hospitalization)

—————————————————

4th generation:
- cefepime
- covers gram negative ( including pseudomonas)

—————————-

5th generation:

ceftaroline
covers MRSA

Answer 80

A

aztreonam
covers gram negative ( including pseudomonas)
-no cross reactivity with other beta lactam antibiotics (except ceftazidime)
— can be used in patient with renal insufficiency

Answer 81

A

Impinem-cilastin
meropenem
ertapenem (does not cover pseudomonas)
covers: extremely broad-spectrum antibiotic ( covers gram positive, gram negative-ESBL, Pseudomonas-, anaerobes
reserved for severe infection
adverse drug reaction:
lower seizure threshold = causes CNS toxicity ( particularly imipenem)

Answer 82

A

for treatment of Covid infection

Answer 83

A

(Infectious origin strep coccus —> soft tissue infection )
- merapenm ( start with this )
- vancomycin ( continue with this)

for
MRSA —> tx for 4 weeks
osteomyelitis tx. for 4 weeks to 6 weeks —> 2 weeks of iV, & 2 weeks of oral
endocarditis (Tx. For 4 weeks)

Answer 84

A

Fosfomycin used for treatment of UTI of kliebsiella or E.coli

Answer 85

A

Treat: bacterial infections, such as pneumonia and other chest infections, skin infections and urinary tract infections (UTIs).

Answer 86

A

Lobar (typical):
- strep pneumo

Atypical
Kliebsiella
Legionella
Clamydia

Answer 87

A

Chlamydia
Legionella
Mycoplasma pneumoniae

Answer 88

A

Strep pneumo
H. influenza
Moraxella

Answer 89

A

E.coli
Pseudomonas
Staph aureus

Answer 90

A

Predispose to aspiration pneumonia —> usually in the right lower lobe —> see air/fluid level that indicates abscess formation

X-ray:
1. Multiple cavities, fluid level, aspiration lung abscess

Answer 91

A

Typical pneumonia :
1. Amoxicillin

Atypical pneumonia:
2. Azithromycin

Answer 92

A

Fluoroquinolone

Aspiration pneumonia:
1. Clindamycin (to cover for anaerobes)

Hospital-acquired pneumonia: (Cover for pseudomonas)
1. Zosyn = pipercillin-tazobactem
2. Cefepime

Answer 93

A

Positive PPD test:

Healthy person & > 15 mm —> positive
10-15 mm —> positive, if Incarcerated or health care worker or foreigner
> 5 mm —> positive, If with HIV or got in contact to TB.

Chest X-ray:

positive finding:
- upper lobe cavitation + B symptoms ( fever,
  weight loss, night sweat) + hemoptysis
  —> treat with: RIPE ( rifampin, isoniazid/vitamin B-6, Pyrazinamide, ethanbutenol
  —> Treatment duration: RIPE (for 2 months) + RI ( extra 4 months)
Negative finding:
- treat with: isoniazid for 9 months

Note:
—> Purified protein derivative (PPD)

—> if patient got TB (BCG) vaccine & have a positive PPD test & negative chest x-ray —> still be treated with isoniazid for 9 months

Answer 94

A

RIPE:
1. Rifampin —> lead to hepatotoxicity + orange sweat/tears
2. Isoniazid —> lead to hepatotoxicity + neuropathy + hepatitis
3. Pyrazinamide —> lead to hepatotoxicity + gout
4.Ethambetol —> hepatotoxicity + visual defect/vision loss/retrobulbar neuritis

All TB med —> lead to hepatotoxicity
only stop taking RIPE —> if LFT are greater than 3 times the normal

Answer 95

A

present with headache, fever, neck stiffness, photophobia, Brudzinski neck sign
Laboratory:
- Viral infection—> high WBC, high protein, normal glucose —> lymphocyte predominant

bacterial infection—> high WBC, high protein, low glucose —> neutrophil predominant
fungal infection —> high WBC, high protein, low glucose —> lymphocytes predominant

Note:
1. Brudzinski neck sign—> passive flexion of the neck lead to flexion of both the thigh & leg

fungal infection —> mainly in immunocompromised patients; AIDS: cryptococcus neoforman —> india ink positive stain; Treated with amphotericin B)
Viral infection —> most common—> herpes ( affect temporal lobe, seizure, lumbar puncture has blood), echo, enterovirus
Bacterial infection—> TB—> has the basilar enhancement &

Answer 96

A

Less than 3 months & elderly
Common organism:
- strep pneumo
- H. Influenza
- Neisseria meningitidis —> will cause a rash

If less than 3 months:
1. Group B strep
2. E. Coli
3. Listeria

Treatment empirically above 3 months old :
1. Vancomycin ( cover strep pneumonia)
&
2. ceftriaxone ( cover Neisseria)

Treatment empirically less than 3 months old, elderly or immunocompromised :
1. Vancomycin
&
2. Ceftriaxone
&
3. Ampicillin (Covers for liesteria)

Answer 97

A

usually treated empirically without urinalysis
first line treatment:
1. Nitrofurantoin
2. TMP-SMX
2. Fluoroquinolone
if pregnant women:
1.Nitrofurantoin
2. Amoxicillin
3. Cephalosporin
** avoid fluoroquinolone ( tendinopathy)
** avoid TMP-SMX ( neural tube defect)
In complicated UTI: ( diabetic, pregnant , male, immunosuppressed pt.)
1. Order Urine culture
if patient have 2 UTI per year—> give them TMP-SMX as prophylaxis

Answer 98

A

Young patient:
1. Chlamydia
2. Gonorrhea
- treat with:
1. Ceftriaxone
2. azithromycin

Old patient:
1. E.coli
- treat with:
1. Fluoroquinolone

Answer 99

A

Do C-section —>
- if viral load is greater than 1000
Deliver vaginally—>
- if viral load is below 1000

Note:
1. HIV is contraindication to breastfeeding

HIV prodrome —> sore throat, malaise, fever, LAD, Rash, diarrhea
- (smilier to mono prodrome except for diarrhea, rash)
Prophylaxis starts at CD4 OF 200 OR LESS:
- TMP-SMX —> prevents pneumocystis pneumonia ( caused by pneumocystis Jirovecii)
If CD4 drops below 50, prophylaxis with:
- Azithromycin —> covers for mycobacterium avium complex ( causes fever, diarrhea, weight loss)

Answer 100

A

Cryptococcus meningitis
- treated with: Amphotericin
- associated with pigeon exposure
Cytomegalovirus (CMV)
- causes colitis, esophagitis, retinitis, bloody diarrhea

Answer 101

A

Cryptosporidium
- a lot of watery diarrhea
CMV
- bloody diarrhea
MAC
- fever + diarrhea

Answer 102

A

people with HIV gets three vaccines:

Pneumovax
influenza
HAPPY

Answer 103

A

Lymphogranuloma venereum

Type of chlamydia ( L1 to L3)
Painless Genital ulcer + inguinal lymph adenopathy
Has Buboes (big painful hard red inguinal nodes)

Granuloma inguinale
1. Caused by Klebsiella Granulomatis
2. Painless Genital ulcer + inguinal lymph adenopathy
3. Nodes ulcerates & turn into granulomas

Answer 104

A

-Treatment with —> benzadezapen (penicillin)

-Left arterial uveitis ( sign of neurosyphilis)

-ENT —> otitis media & osteomestatitis ( use audiogram investigation with ENT —> for speech assistance)

-

Answer 105

A

-Blast injury

fever + tachycardia ( several days maybe due to pain) —> look at infectious causes —>
mixed organisms: enterococcus fecalis, candida, bactrem, klebsiella, pseudomonas, staph aureus —> treated with tegacyclin ( to cover entercocus & staph aureus) , merapenem ( pseudomunas coverage)
PEG line inserted —> ( 85% burn patient ) —> send culture, if positive change PEG LINE
Note: if use tazosyn instead of meropenem & sos instead of tegacyclin—-> will by time for patient
HA
candida aureus can stay at line —->

Answer 106

A

young + pakistan + 10 days history of rash all over his body at extremity + vesicle with different stages + headache + No recent travel + no cough + good appetite
vesicle are fluid filled some are crusted and some are not /// no ulcers
lymph node at peripheral
is it monkey pox ? Is it veresella ? IgG & IgM & PCR for diagnosis of the vesicle
chicken pox (in adults manifistation as: 1. Pneumonitis , 2. CNS: ENCEPHALITIS, meningitis , or meningeal encephalitis ) ( in children manifistation of CNS within 10 days & treat with steroid)
DANGI manifistation is 3 weeks —>

Answer 107

A

46 year old + somali + 3 months ago abdomenal & back pain —> descitis at x-ray + Now: lower limb swelling & immobilization

Down syndrome, diabetes , HTN
admit as cellulitis ( foroproxicellin for treatment )
plan: do MRI for spine & leg to look for descitis —> check for brucella —> drain if needed
the mother died and had TB
DESCITIS can be possibly due to TB IN THE patient
## staph aureus can present with descitis

Answer 108

A

MRSA = use vancomycin
Plan TEE
covid infection —>
septic arthritis —>

Answer 109

A

changes in CT scan is rapid —> inflammatory of autoimmune response —> could be miliary TB
NITROFURANTOIN FOR UTI

Answer 110

A

58 year old women, diabetes HTN dyslipedemia
LIVE IN INDIA
COME TO uae 10
fever, body pain ( a week ago)
cefexeme initially treatment …ECG, ECHO, Blood tests —> are not remarkable, mild elevation in LFT enzyme, negative covid
stop tazosyn treatment Are replace it with ceftriaxone +…..
——-
Approach:

Fever not improving after 7 days & tachycardia & desaturating ( very hypoxic; require High flow O2), no cough, no diarrhea, no rash,no history of sick contact —>
CTPE is done —-> no PE, but suggest congestion—>
Could be due to cardiac issue —>
Rexicia & dingi & malaria send in serology —>

Answer 111

A

The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may first show up on the chest, back, and face, and then spread over the entire body, including inside the mouth, eyelids, or genital area.

Answer 112

A

Bangladish + smoking + present with fever & fatigue for 3 months +
fever, pancytopenia, no lymph node, mild hepatosplenomegaly + weight loss in last + no night sweat
EBV pcr —> 700,000
diagnosis : hematologic malignancy ( pancytopenia)
order bone marrow biopsy

Answer 113

A

Hx:
-Bacterecemia + scrotal abscess + MRSA managed
- scrotal enlargement + abscess —> order ultrasound to look for
- patient on vancomycin & tazo
-blood culture shows —> polymicrobial (pseudomonas, epidermatis)
—> stop vancomycin
—>

Answer 114

A

## bacteremia with MSSA

Answer 115

A

1.Syphilis
- well-circumscribed chancre (ulcer)
- painless genital ulcer & painless LAD
- caused by: treponema pallidum
- treated with:
1. penicillin G
2. Doxycycline, if allergy to penicillin
3. Desensitize than treat with penicillin, if pregnant women or patient with patient with syphilis involving CNS
4. Ceftriaxone: if tertiary syphilis
5. Note: patient treated with penicillin —> treponema pallidum can release endotoxin that lead to fever, myalgia & chills ( Jerish Herxheimer Rxn) —> prevented with prednisolone —> treated with: NSAID & IV fluid

LGV
- small & shallow ulcer —> forms buboes
- painless genital ulcer & painful LAD
- caused by: Chlamydia trachomatis ( L1 to L3)
- inclusion bodies within the cytoplasm of epithelial cells & leukocytes
- treated with:
Doxycycline
Granuloma inguinale
- extensive granulation tissue
- Painless genital ulcer & no LAD
- shows Donovan bodies ( gram negative intracytoplasmic cysts)
- caused by: Klebsiella granulomatis
- treated with: doxycycline
Genital herpes
- group of ulcer with shallow & erythromatous (red) base
- painful genital ulcer & mild LAD
- cowdry type A & multinucleated giant cells in biopsy
- caused by: Herpes simplex virus
- treat with: acyclovir
Chancroid
- deep ulcer with grey base
- painful genital ulcer & painful LAD/ with puss
- bacteria is seen in clumps within the chancroid
- caused by: Haemophilus Ducreyi
- treat with: azithromycin

Answer 116

A

Primary syphilis
- start as a painless chancre ( on genital mostly)

Secondary syphilis
- rash on the palms/soles + chomdyloma lata over the genital

Late phase:
- present with Gummatous leison that has ulcerated ( seen on forehead)

Tabes dorsalis:
- affects the dorsal column + meningitis

Tertiary syphilis
Neurosyphilis

Answer 117

A

strep pyogene ( group A streptococcus)
gradual onset
deep border

Symptoms:
1. Irritated area of skin that tends to expand
2. Red, swelling, painful, warm, tender to touch + fever + chills
2. Like “ peel of orange”

Answer 118

A

caused by strep pyogene
rapid onset
clear distinct borders

Answer 119

A

caused by staph aureus

Answer 120

A

caused by:
1. Strep pyogene (most common)
2. Clostridium perfringen (if, gas bubbles or gas gangrene presents)

Found in:
1. Alcoholics, diabetes, insect bites, post surgery

Symptoms:
1. Erythema & swelling at the affected site
2. Irritated area expands fast
3. When barely touched, patient screams in pain
4. Severe pain disproportionate to a local findings
5. Sign of severe sepsis ( tachycardia, hypotension, metabolic acidosis)

Answer 121

A

Ask yourself:

More than 3 vaccines Or Less than 3 vaccines
Clean wound Or dirty wound ?

If,

More than 3 vaccines & clean would (superficial, no dirt)
- give vaccine, if last vaccine was more than 10 years ago
Less than 3 vaccines & clean wound:
- give vaccine
More than 3 vaccine & dirty wound:
- give vaccine, if last vaccine was more than 5 years ago
Less than 3 vaccine & dirty wound:
- give vaccine & antibodies
If patient have tetany —> add diazepam to minimize muscle spasm

Note:
- tetany —> involuntary muscle contraction/spasm——> is caused by hypocalcemia ( low Ca level)

Answer 122

A

both have common bugs:

Staph aureus
Salmonella ( if, sickle cell disease)
Pseudomonas (if, IV drug user)

Any swollen, red, painful joint —> next step is to aspirate or do arthrocentesis for analysis —> suspect septic arthritis

Answer 123

A

Hospital acquired or nosocomial acquired
Abscess
Septic arthritis
Osteomyelitis
Toxic shock syndrome (TSS)

Answer 124

A

Common bugs:
- staph aureus
- salmonella (if, sickle cell disease)
- pseudomonas (if, Iv drugs users)

Symptoms:
- fever, leukocytosis, inability to bear weight on the joint or move it at all + swelling/red joint

Diagnosis:
- aspiration —> shows > 50,000 WBC

Answer 125

A

caused by: Borrelia burgdorferi
starts as erythema migrans rash ( target rash) —> red center surrounded with clear area than surrounded with red border—> forming (bull’s eye pattern) —> can spread & warm

Treatment:
1. Doxycycline (if, patient is older than 8 years)
2. Amoxicillin ( if, patient is younger than 8 years)

Note:
1. Doxycycline can cause teeth coloration as side effect which is not good for little kids

Answer 126

A

Plasmodium falciparum
- constant fever
- treatment: mefloquine
Plasmodium vivax/ovale
- q 48 hours fever (fever every 2 days)
- treatment: mefloquine + primaquine (kills hypnozoites in liver)
Plasmodium malariae
- q 72 hours fever (fever every 3 days)
- treatment: mefloquine

Note:
- if cyclic fever + recent travel history (india or africa) —> think of malaria

Answer 127

A

Treatment:
- irrigate the wound + give antibodies + vaccine

Symptoms:
- hydrophobia + encephalopathy + afraid to drink water (too late stage, can be fetal)

Caused by:
- when infected saliva gets into open wound, exposure to bat or getting bitten by animal

Answer 128

A

caused by:
1. Bartonelle hanselae

Symptoms:
- present with distal cat scratch + proximal lymphadenitis

Treatment:
1. Macrolide (azithromycin)
2. Doxycycline

Answer 129

A

Allergic bronchpulmonary aspergillosis (ABPA)
- asthma & eosinophilia
Aspirgilloma
- hemoptysis with chronic cough
- x-ray shows fungus ball on upper lobe of lung
Invasive aspirgillosis
- affect immunosuppressed patients (recent transplant)
- systemic symptoms ( fever, leukocytosis, hemoptysis with classic halo signs, which is pulmonary nodule with surrounding ground glass opacity

Treatment:
- Amphotericin

Answer 130

A

Symptoms:
- similar to TB, but differentiated based on location
- B-symptoms (fever, night sweat, weight loss) + hemoptysis

Mnemonic —> His Coc Blasts Spores

Histoplasma
- associated with bats & caves
- x-ray shows bilateral hilar lymphadenopathy
Coccidiodes
- west coast ( Arizona or California) (Valley Fever)
- unilateral hilar adenopathy + respiratory symptoms
Blastomyces
- Chicago disease (a person from midwest, Iowa, Illinois)
- purple skin lesion + pneumonia
Sporothrix
- hand is cut by a thorn + lymphadenitis that follows a trail up their arm

Treatment:

itraconazole ( by moth 3-6 months)
potassium iodide

Note:
- found in the environment as mold, infect human as yeast

Answer 131

A

HIV with severe watery diarrhea

Answer 132

A

Mnemonic —> SANd

Ancylostoma deudenale
Nector americanus

Path:
- walking bare foot —> penetrate—> go to lung —> cough it out —> swallow it —> go to GI

Symptoms:
1. Itchy, localized rash, abdominal pain, diarrhea + eosinophilia

Answer 133

A

snail
person from middle-east with hematuria & eosinophilia

Note:
- snail releases trematode, which penetrates skin —> invades circulation —> adult deposits eggs in bladder wall —> inflammation —> hematuria

Answer 134

A

Caused by:
1. Staph aureus —> Exotoxin hyper-activates T-cells, which release a lot of cytokines & lead to shock

Symptoms:
- Shock + nosebleed ( leave a tissue/tampon inside nose for a while) + desquamation (skin peeling)

Treatment:
1. Iv fluid + vancomycin

Answer 135

A

-Neutrophil count is less than 1500

Neutropenic fever:

Treat empirically at first (culprit pseudomonas)
Treat with zosyn (piperacillin-Tazobactem) to cover pseudomonas

Answer 136

A

bloody or watery diarrhea

Most common bloody diarrhea (SEECSY) —> fever + bloody diarrhea
- Salmonella
- E.coli (EHEC)
- Entamoeba (protozoa)
- Campylobacter
- shigella
- Yersinia Enterocolitica
Most common watery diarrhea

Norovirus ( begins 12-48 hours after contact & lasts 1-3 days)
Rotavirus ( begins 2 days after contact, lasts 3-8 days)
ETEC (if, recent travel to south American)

Note:
1. Best next step is stool analysis for WBC
2. If positive WBC (from stool analysis)—> do stool culture

Treatment:
1. Most bloody diarrhea treated symptomatically

Give antibiotics ( if, really young/old, or immunosuppressant)
Avoid antibiotics for EHEC ( predispose to hemolytic uremic syndrome—> HUS)

Answer 137

A

N/V + diarrhea within 1-6 hours:
- Staph aureus
- Bacillus cereus ( heated rice)
Abdominal cramps + diarrhea within 8-16 hours:
- Clostridium perfrinogens
- bacillus cereus
Diarrhea only ( water or bloody) after 16 hours:
- vibro cholera ( watery)
- E.coli (EHEC; Bloody), ETEC; watery)
- salmonella ( bloody)
- campylobacter ( bloody)
- shigella ( bloody)

Answer 138

A

patient taking antibiotics and developed diarrhea afterwards

Investigation:
- look for C.difficile toxin

Answer 139

A

rickettsia infection
transmitted by tick bite
peak in summer

Symptoms:
1. Constitutional symptoms (headache, fever, myalgia, arthralgia)
2. Rash
3. Complication: encephalitis, pulmonary edema, bleeding, shock

Laboratory:
1. Low platelets
2. Low sodium
3. High AST & ALT

Diagnosis:
1. Rickettsia serology
2. Skin biopsy

Treatment:
Doxycycline

Answer 140

A

is a tick-borne illness caused by Rickettsia

-classic symptoms include a few days of fever & headache

followed by maculopapular or petechial rash that involves the palm & soles.
without emperic treatment (doxycycline), noncardiogenic pulmonary edema & shock can occur

Answer 141

A

gram negative coccobacilli
1/2 weeks of rhinitis & cough
2/8 weeks of severe dry cough & vomit

Diagnosis:
1. Pertussis PCR
2. Pertussis culture

Prevention:
1. Acellular pertussis Vaccination (immunity wane off after 5-10 years)
2. Macrolide (azithromycin) for close contact

Answer 142

A

Enterococci (enterococcus facalis)—> common cause of endocarditis associated with nosocomial Urinary Tract Infection
Staph aureus & epidermidis —> endocarditis due to prosthetic valves & intravascular catheter
Viridin (strep sanguinis)—> endocarditis due to dental care
Candida —> endocarditis due to prolonged antibiotic use
Strep. Gallolyticus ( Bovis) —>bacteremia+ endocarditis associated with colon cancer —> require colonoscopy to evaluate for occult malignancy

Answer 143

A

worsen fever & pulmonary after initial improvement
usually age > 65
but, MRSA occurs in younger patients

Answer 144

A

food-borne pathogen (contaminated beef) —> inflammatory diarrhea ( stool initially watery, then becomes bloody)

Answer 145

A

Shiga-producing toxin E.coli
- bloody diarrhea only + associated with contaminated beef
Rotavirus:
- nonbloody diarrhea + associated with unvaccinated children
Listeria:
- watery diarrhea + self-limited lasting 3 days + associated with immunocompetent patient
Clostridium perfringen:
- nonbloody diarrhea + abdominal pain + associated with contaminated & undercooked meat + symptoms resolve in 1-2 days

Answer 146

A

most common cause of bacterial meningitis in elderly patient ( followed by: H.influenza, Neisseria)
in children ( Group B strep, E.coli, Listeria)

Answer 147

A

fever+ flank pain + dysuria
lead to urinary tract infection

Brainscape's Knowledge GenomeTM

Infectious Diseases Flashcards

Brainscape's Knowledge Genome^TM