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U World Step 2 > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Immunosuppressed states

A

Chronic kidney disease

Diabetes

HIV

Hematologic malignancies

Chronic immunosuppression

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2
Q

Exam findings for mitral valve prolapse

A

Late systolic murmur over cardiac apex

Prolongs (occurs earlier in systole) with Valsalva (decreases left ventricular blood volume)

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3
Q

Bacterial endocarditis prophylaxis

  1. High-risk conditions
  2. Indicated procedures and appropriate coverage
A
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4
Q

Community Acquired bacterial meningitis in adults

A

Organisms

Streptococcus pneumoniae (70%)

Neisseria meningitidis (12%)

Group B Strep

Haemophilus influenzae

Agents

Ceftriaxone (everything)

Vancomycin (S. pneumo resistant to beta lactams)

Ampicillin (Listeria in immunocompromised patients or patients > 50)

Dexamethasone (S. pneumo)

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5
Q

Post-infectious complication of impetigo (group A strep)

A

Poststreptococcal glomerulonephritis

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6
Q

Post-infectious complication of group A strep pharyngitis

A

Rheumatic fever

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7
Q

Measles (rubeola)

  1. Clinical presentation
  2. Diagnosis
  3. Prevention
  4. Treatment
  5. Complications
A
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8
Q
A

Erythema infectiosum (fifth disease)

Caused by Parvovirus B19

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9
Q

Pharyngoconjunctival fever

A

Caused by adenovirus

Pharyngitis

Non-prurulent conjunctivitis

Fever

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10
Q
A

Sandpaper-like, erythematous rash

Associated with scarlet fever

Caused by Streptococcus pyogenes (GAS)

Fever, toxicity, pharyngitis, rash, circumoral pallor and strawberry tongue.

Penicilline A is the drug of choice

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11
Q

Live attenuated vaccines

  1. Which ones
  2. Recommendations for HIV patients
A

Varicella

Zoster

Measles-Mumps-Rubella

Can be safely given to individuals with CD4 counts >200

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12
Q
A

Septic pulmonary emboli

In an IV drug user with infective endocarditis, likely due to staph aureus

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13
Q

Infective endocarditis in IV drug users

A

Tricuspid regurg

Holocystolic murmur increases with inspiration indicating tricuspid involvement

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14
Q
A

Miliary tuberculosis

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15
Q
A

Pneumocystis pneumonia

More common in HIV patients with CD4 counts <200

Subacute symptoms, diffuse infiltrates on chest X ray, increased A-a gradient

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16
Q

HIV in infancy

  1. Risk factors
  2. Clinical features
  3. Diagnosis
  4. Treatment
A
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17
Q

X-linked agammaglobulinema (XLA)

A

Low B cell concentrations

Recurrent bacteriopulmonary sinus infections

Absent lymphoid tissue

Low serum immunoglobulin levels

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18
Q

Ciliary dyskinesia

A

Recurrent ear, nasal, and sinus infections

Bacterial pneumonia

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19
Q

Adenosine deaminase deficiency

A

Causes severe combined immunodeficiency

Profound lymphopenia

Recurrent infections

Failure to thrive

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20
Q

Chronic granulomatous disease

A

Impaired phagocytosis

Recurrent, severe infections due to catalase-positive organisms (Staph aureus, Serratia) and fungal organisms (Aspergillus)

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21
Q

Toxoplasma encephalitis

  1. Clinical
  2. Diagnostic
  3. Therapeutic
A
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22
Q

Neurocysticercosis

Treatment

A

Associated with pork consumption or travel to endemic areas (Central or South America)

Causes seizures

Albendazole

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23
Q

Cryptococcal meningitis

Treatment

A

Fever, malaise, ring-enhancing lesions on MRI

Amphotericin B and flucytosine

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24
Q

Mycobacterium avium complex (MAC)

Treatment

A

Clarithromycin and ethambutol

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25
Q

CMV encephalitis

treatment

A

Confusion, focal neurologic deficits with micronodules or ventricular enhancement

Gancyclovir

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26
Q

Reducing risk of infection in neurogenic bladder requiring catheterization

A

Clean intermittent catheterization

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27
Q

Infectious mononucleosis

  1. Etiology
  2. Clinical features
  3. Diagnostic findings
  4. Management
A
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28
Q

Syphilis treatment (First-line, second line)

  1. Primary
  2. Secondary
  3. Latent
  4. Tertiary
A

A 4-fold decrease in antibody titers in 6-12 months indicates treatment success.

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29
Q

Chlamydia & Gonorrhea

  1. Risk factors
  2. Manifestations
  3. Diagnosis
  4. Treatment
  5. Complications
A
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30
Q

Pertussis

  1. Clinical phases
  2. Diagnosis
  3. Treatment
  4. Prevention
A
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31
Q

Enterobius life cycle

A
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32
Q

Enterobus vermacularis

  1. Symptoms
  2. Diagnosis
  3. Treatment
A
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33
Q

Strongyloids stercoralis

  1. Symptoms
  2. Lifecycle
  3. Treatment
A
  1. Symptoms: Urticaria, abdominal pain, respiratory symptoms
  2. Treatment: Ivermectin
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34
Q

Onchocerciasis

  1. Symptoms
  2. Treatment
A

“River blindness”

  1. Symptoms: Ocular lesions, dematitis
  2. Treament: Ivermectin
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35
Q

Treatment for protozoan infections

Amebiasis (acute dysentery, liver abscess)

A

Metronidazole

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36
Q

Congenital toxoplasmosis

  1. Risk factors
  2. Clinical features
  3. Diagnosis
  4. Treatment
A
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37
Q
A

Chorioretinitis

Occurs in adults who have reactivation of congenital toxoplasmosis

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38
Q

Patterns of necrotizing fasciitis

  1. Microbiology
  2. Pathogenesis
  3. Clinical manifestations
  4. Treatment
A
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39
Q

Preseptal versus orbital cellulitis

A

Preseptal cellulitis is a mild infection of the eyelid anterior to the orbital septum

Orbital cellulitis is a serious infection of the tissues posterior to the orbital septum

Dangerous complications of orbital cellulitis include orbital abscess, intracranial infection, and cavernous sinus venous thrombosis.

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40
Q

Cavernous sinus thrombosis

A

Headache

Periorbital edema

Exopthalmos

CHemosis

Papilledema and dilated tortuous retinal veins

Involvment of CN III, IV, V, VI

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41
Q

Clues for increasing index of suspicion for Legionella pneumonia

  1. Exposure to possibly contaminated water
  2. Clinical clues
  3. Laboratory clues
  4. Diagnosis
A
  1. Test urine for legionella antigen
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42
Q

Regions in US where Lyme disease is Endemic

A

Northeast and upper midwest

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43
Q

Treatment for Lyme disease in children < 8 and women who are pregnant or lactating

A

Amoxicillin

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44
Q

Markers of hepatitis B infection over time

  1. HBsAg
  2. HBeAg
  3. IgM anti-HBc
  4. IgG anti-HBc
  5. Anti-HBs
  6. Anti-HBe
  7. HBV DNA

Acute HBV

Early phase

Window phase

Recovery phase

Chronic HBV carrier

Acute flare of chronic HBV

Vaccinated for HBV

Immune form natural HBV infection

A

Response to acute hepatitis B infection depends heavily on when in life a patient becomes infected.

  1. Neonatal period progress almost universally to chronic infection
  2. Children 1-5 have a 50-80% chance of clearing the infection
  3. Among healthy adults, acute HBV infection is cleared in 95% of cases
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45
Q

Serologic markers in acute HBV infection

A
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46
Q

Prosthetic joint infection (early, delayed, late onset)

  1. Time to onset after surgery
  2. Presentation
  3. Most common organisms
A
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47
Q

Congenital rubella syndrome

  1. Clinical triad
  2. Diagnosis
  3. Prevention
A

First trimester maternal-fetal transmission of rubella is teratogenic

48
Q

Disseminated histoplasmosis

  1. Epidemiology
  2. Symptoms
  3. Diagnosis
  4. Treatment
A

Immunocompromised patients (HIV with CD4+ count < 100) are at high risk for disseminated disease

49
Q

Treatment for disseminated histoplasmosis in patients with HIV

A
  1. Amphotericin B (fungicidal; for 1-2 weeks)
  2. Oral itraconazole (fungistatic; for >= 1 year of maintenace therapy)
  3. Antiretroviral therapy in all patients with HIV who develop disseminated histoplasmosis (usually 2 weeks after antigunal treatment)
50
Q

Approach to odynophagia and dysphagia in patients with HIV

A

Acyclovir is not useful against CMV because the virus does not encode the thymidine kinase enzyme needed to convert acyclovir to its active form.

51
Q
A

Herpes simplex virus esophagitis

Multiple, small, and well-circumscribed ulcers with a small and deep appearance.

52
Q

Early Lyme disease

  1. Epidemiology
  2. Manifestations
  3. Diagnosis
  4. Treatment
A

Lyme disease is caused by a spirochete

53
Q

What is the most likely organism responsible?

A

Streptococcus pneumoniae

54
Q

Clinical features of splenic abscess

  1. Risk factors
  2. Clinical presentation
  3. Treatment
A
55
Q

Isoniazid-induced peripheral neuropathy

A

Due to pyrodixine (B6) deficiency

Patients with malnutrition, pregnancy, or comorbid conditions (e.g., diabetes) should be started on pyridoxine supplementation when treated for latent or active TB with isoniazid

56
Q

Acute rheumatic fever

  1. Epidemiology
  2. Clinical features
  3. Late sequelae
  4. Prevention
A

Jones criteria

Treat with intramuscular benzathine penicillin G

57
Q

Isonizid hepatitis

A

10-20% of patients on isoniazid will develop mild aminotransferase elevations within the first few weeks of treatment. The hepatic injury is self-limited and will resolve without intervention.

58
Q

Pill esophagitis

A

Acute odynophagia due to direct effects of a medication on esophageal mucosa

Common offenders:

Potassium chloride

Tetracyclines

Bisphosphonates

NSAIDs

59
Q

Common causes of esophagitis in HIV

  1. Causes
  2. Typical features
A
60
Q
A

Pneumocystis pneumonia (PCP)

Bilateral, diffuse interstitial infiltrates

Diagnosis requires identification of P jirovecii organisms in respiratory secretions using microscopy with specialized stains.

Samples are obtained using induced sputum, or, if this is unrevealing, bronchoscopy with bronchoalveolar lavage

61
Q

Treatment options for patients with latent TB

A
62
Q

Patients to treat based on PPD area of induration

  1. >= 5 mm
  2. >= 10 mm
  3. >= 15 mm
A
63
Q

Common skin infections

  1. Infection
  2. Organism
  3. Manifestations
A
64
Q
A

Erysipelas

Superficial skin infection that manifests with acute onset of fever, chills, regional lymphadenitis, and a warm, tender, erythematous rash with raised, sharply demarcated borders.

Majority of cases caused by Group A Strep

65
Q

Influenza

  1. Clinical presentation
  2. Treatment
A

APproximately 1-5 days after inoculation, patients abruptly develop systemic (fever, malaise, myalgias, headache) and upper/lower respiratory (rhinorrhea, sore throat, nonproductive cough) symptoms.

For adults with suspected or confirmed influenza:

Those rwith no risk factors for complications do not require diagnostic testing.

Patients with risk factors (age >=65, chronic medical problems, pregnancy) should receive oseltamavir

Patients without risk factors may receive oseltamavir for symptom reduction within 48 hours of symptom onset.

66
Q

Human monocytic ehrlichiosis

  1. Epidemiology
  2. Clinical manifestations
  3. Laboratory findings
  4. Diagnosis
  5. Treatment
A
67
Q

Stages of Lyme Disease

Early localized

Early disseminated

Late

A

Ceftriazone used for the treatment of neurologic and cardiac manifestations of Lyme disease

68
Q

Vaccine types

  1. Live attenuated
  2. Non-live
A
69
Q

Adalimumab

A

Tumor necrosis factor antagonist

Patients on TNF antagonists should avoid live attenuated vaccines

70
Q

Meningococcal vaccination

  1. Regular schedule
  2. High-risk patients
A

Endemic environments: sub-Saharan Africa and Muslim hajj pilgrimage to Mecca, Saudi Arabia

71
Q

Patients with Wolff-Parkinson-White syndrome who develop atrial fibrillation with a rapid ventricular rate

A

Treat with cardioversion of antiarrhythmics such as procainamide.

AV nodal blockers (beta blockers, CCB, digoxin, and adenosine) should be avoided bc they can cause increased conduction through the accessory pathway.

72
Q

Foodborne disease

  1. Vomiting predominant
  2. Watery diarrhea predominant
  3. Inflammatory diarrhea predominant
  4. Non-GI symptoms
A

Staph aureus causes foodborne illness due to ingestion of preformed toxins.

Vomiting begins 1-6 hours after exposure.

Food containing mayonnaise is often implicated in staphylococcal food poisoning.

73
Q
A

Mucormycosis

Most commonly seen in DKA

Surgical debridement + amphotericin B

74
Q

Rhino-orbital-cerebral mucormycosis

  1. Risk factors
  2. Manifestations
  3. Diagnosis
  4. Treatment
A
75
Q

Sporotrichosis

  1. Epidemiology
  2. Manifestations
  3. Diagnosis
  4. Treatment
A
76
Q

Human rabies

  1. Pathogenesis
  2. Reservoir
  3. Clinical features
  4. Postexposure prophylaxis
  5. Prognosis
A
77
Q

Causes of meningitis in children

(3 age categories)

A
78
Q

HIV screening indications

  1. Initial screening
  2. Annual (or more frequent) screening
  3. Additional screening
A

Preferred HIV screening test is a 4th generation assay that detects both the HIV p24 antigen and HIV antibodies

Men with gonorrhea usually develop urethritis with significant symptoms (no need to screen?)

79
Q
A

Varicella (chickenpox)

Varicella-zoster virus (VZV)

80
Q

Varicella infection

  1. Clinical features
  2. Prognosis
  3. Prevention
A

Breakthrough infection in vaccinated children is most common in children who have received only a single dose of VZV vaccine.

81
Q
A

Eczema herpeticum

Caused by herpes virus infection of areas of skin affected by atopic dermatitis, leading to painful vesicular rash, fever, and possibly viral dissemination.

82
Q
A

Secondary syphilis

Diffuse maculopapular rash that begins on the trunk, extends to extremities and involves palms and soles

83
Q

Epitrochlear lymphadenopathy

A

Pathognomonic for syphilis

Sailors would perform a 2-handed “sailor’s handshake” (with one hand on the elbow) to determine if potential partners had epitrochlear nodes prior to engaging their company.

84
Q

Clinical findings of congenital infections

  1. All
  2. Cytomegalovirus
  3. Toxoplasmosis
  4. Syphilis
  5. Rubella
A
85
Q
A

Condyloma accumulata

Secondary to HPV

86
Q
A

Leukoclastic vasculitis

Non-blanching, 1-3 mm violaceous papules that can cluster-coalesce into plaques

Due to infections. medications, infammatory conditions, or malignancy

87
Q
A

Malignant melanoma

88
Q
A

Neurofibromatosis Type I

89
Q
A

Neurofibromatosis Type I

(Cafe au lait spots)

90
Q

Neurofibromatosis type 2

A

Vestibular schwannoma

Raised plaque-like lesions or subcutaneous nodules (from nerve swelling)

91
Q

Managment of baby born to mother with active hepatitis B infection

A
  1. Passive immunization at birth with Hepatitis B immune globulin (HBIG)
  2. Active immunization with recombinant HBV vaccine.
92
Q
A

Nummular dermatitis

Treat with corticosteroids

93
Q
A

Tinea corporis

94
Q

Microbiology & clinical associations of infective endocarditis: Associations

  1. Staphylococcus aureus
  2. Viridans group streptococci
  3. Staphylococcus epidermidis
  4. Enterococci
  5. Streptococcus gallolyticus
  6. Fungi (e.g., Candida)
A
95
Q

Jarisch-Herzheimer reaction

  1. Epidemiology
  2. Clinical presentation
  3. Treatment
A
96
Q

Bacteria most commonly responsible for unilateral cervical lymphadenitis

A

Staphylococcus aureus

97
Q

Neonatal conjunctivitis

(Type, Onset age, Findings, Treatment)

  1. Chemical
  2. Gonococcal
  3. Chlamydial
A

Topic treatments for chlamydial conjunctivitis are not effective. (Although they can be used as prophylaxis)

98
Q

Cervicofacial Actinomyces

  1. Risk factors
  2. Manifestations
  3. Diagnosis
  4. Treatment
A

Presence of prurulent discharge with “sulfur granules” is pathognomonic

99
Q

Antiobiotic options for anaerobic coverage

A

Metronidazole with amoxicillin

Amoxicillin-clavulanate

Clindamycin

100
Q

Pneumocystis jirovecii pneumonia

  1. Clinical
  2. Workup
  3. Treatment
  4. Prevention
A

Use prednisone if O2 sat is low

101
Q

Recommended vaccines for adults

A

If the patient has not received Tdap as an adult, or if the patient’s prior vaccine history is unknown, the CDC recommends that Tdap be given followed by Td every 10 years thereafter.

102
Q
A

Neisseria gonorrhea

103
Q

Prophylaxis for neonatal conjunctivitis

A

Topical erythromycin ointment within 1 hour of birth, to prevent gonococcal infection

104
Q

Culture negative urethritis

A

Chlamydia

105
Q
A

Hydatid cyst

(Cystic hepatic cyst with eggshell calcification)

Echinococcus granulosus

106
Q

Cat bites

A

Microbiology:

Pasteurella multocida

Anaerobic bacteria

Management:

Copious irrigation and cleaning

Prophylactic amoxicillin/clavulanate

Tetanus booster as indicated

Avoid closure

107
Q

Cocciodes

A

Endemic mycosis of southwest desert

Community acquired pneumonia

Arthralgias

Erythema nodosum

Erythema multfom

Ketoconazole of fluconazole for patients with high risk for dissemination (immunocompromise)

108
Q

Cryptococcal meningoencephalitis

  1. Presentation
  2. Diagnosis
  3. Treatment
A
109
Q

Bacterial causes of diarrhea (Organism, Features)

  1. Bacillus cereus
  2. Staphylococcus aureus
  3. Clostridium difficile
  4. Clostridium perfringens
  5. Salmonella
  6. Vibrio vulnificus

7. Escherichia coli

8. Shigella

9. Campylobacter species

A
110
Q

Blastomycosis

  1. Epidemiology
  2. Clinical features
  3. Diagnosis
  4. Treatment
A
111
Q
A

Miliary tuberculosis

Diffuse reticolunodular pattern (milelt seed) on x-ray

Most common risk factor: Substance abuse

112
Q
  1. Epidemiology
  2. Clinical
  3. Diagnosis
  4. Treatment
A
113
Q
A

Bacillary angiomatosis

Caused by Bartonella in HIV patients

114
Q

Opportunistic infections in HIV (Infection, Risk Factors, Prophylaxis)

A
115
Q

Key respiratory tract infections in children

Diagnosis

Classic pathogen

Presentation

A

U World Step 2 (22 decks)

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