Infectious diseases Flashcards
1
Q
Immunosuppressed states
A
Chronic kidney disease
Diabetes
HIV
Hematologic malignancies
Chronic immunosuppression
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)
3
Q
Bacterial endocarditis prophylaxis
- High-risk conditions
- Indicated procedures and appropriate coverage
A
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)
5
Q
Post-infectious complication of impetigo (group A strep)
A
Poststreptococcal glomerulonephritis
6
Q
Post-infectious complication of group A strep pharyngitis
A
Rheumatic fever
7
Q
Measles (rubeola)
- Clinical presentation
- Diagnosis
- Prevention
- Treatment
- Complications
A
8
Q
A
Erythema infectiosum (fifth disease)
Caused by Parvovirus B19
9
Q
Pharyngoconjunctival fever
A
Caused by adenovirus
Pharyngitis
Non-prurulent conjunctivitis
Fever
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
11
Q
Live attenuated vaccines
- Which ones
- Recommendations for HIV patients
A
Varicella
Zoster
Measles-Mumps-Rubella
Can be safely given to individuals with CD4 counts >200
12
Q
A
Septic pulmonary emboli
In an IV drug user with infective endocarditis, likely due to staph aureus
13
Q
Infective endocarditis in IV drug users
A
Tricuspid regurg
Holocystolic murmur increases with inspiration indicating tricuspid involvement
14
Q
A
Miliary tuberculosis
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
16
Q
HIV in infancy
- Risk factors
- Clinical features
- Diagnosis
- Treatment
A
17
Q
X-linked agammaglobulinema (XLA)
A
Low B cell concentrations
Recurrent bacteriopulmonary sinus infections
Absent lymphoid tissue
Low serum immunoglobulin levels
18
Q
Ciliary dyskinesia
A
Recurrent ear, nasal, and sinus infections
Bacterial pneumonia
19
Q
Adenosine deaminase deficiency
A
Causes severe combined immunodeficiency
Profound lymphopenia
Recurrent infections
Failure to thrive
20
Q
Chronic granulomatous disease
A
Impaired phagocytosis
Recurrent, severe infections due to catalase-positive organisms (Staph aureus, Serratia) and fungal organisms (Aspergillus)
21
Q
Toxoplasma encephalitis
- Clinical
- Diagnostic
- Therapeutic
A
22
Q
Neurocysticercosis
Treatment
A
Associated with pork consumption or travel to endemic areas (Central or South America)
Causes seizures
Albendazole
23
Q
Cryptococcal meningitis
Treatment
A
Fever, malaise, ring-enhancing lesions on MRI
Amphotericin B and flucytosine
24
Q
Mycobacterium avium complex (MAC)
Treatment
A
Clarithromycin and ethambutol
25
CMV encephalitis
treatment
Confusion, focal neurologic deficits with micronodules or ventricular enhancement
## Footnote
**Gancyclovir**
26
Reducing risk of infection in neurogenic bladder requiring catheterization
Clean intermittent catheterization
27
Infectious mononucleosis
1. Etiology
2. Clinical features
3. Diagnostic findings
4. Management
28
Syphilis treatment (First-line, second line)
1. Primary
2. Secondary
3. Latent
4. Tertiary
A 4-fold decrease in antibody titers in 6-12 months indicates treatment success.
29
Chlamydia & Gonorrhea
1. Risk factors
2. Manifestations
3. Diagnosis
4. Treatment
5. Complications
30
Pertussis
1. Clinical phases
2. Diagnosis
3. Treatment
4. Prevention
31
Enterobius life cycle
32
Enterobus vermacularis
1. Symptoms
2. Diagnosis
3. Treatment
33
Strongyloids stercoralis
1. Symptoms
2. Lifecycle
3. Treatment
1. Symptoms: Urticaria, abdominal pain, respiratory symptoms
2. Treatment: Ivermectin
34
Onchocerciasis
1. Symptoms
2. Treatment
"River blindness"
1. Symptoms: Ocular lesions, dematitis
2. Treament: Ivermectin
35
Treatment for protozoan infections
Amebiasis (acute dysentery, liver abscess)
Metronidazole
36
Congenital toxoplasmosis
1. Risk factors
2. Clinical features
3. Diagnosis
4. Treatment
37
Chorioretinitis
Occurs in adults who have reactivation of congenital toxoplasmosis
38
Patterns of necrotizing fasciitis
1. Microbiology
2. Pathogenesis
3. Clinical manifestations
4. Treatment
39
Preseptal versus orbital cellulitis
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.
40
Cavernous sinus thrombosis
Headache
Periorbital edema
Exopthalmos
CHemosis
Papilledema and dilated tortuous retinal veins
Involvment of CN III, IV, V, VI
41
Clues for increasing index of suspicion for Legionella pneumonia
1. Exposure to possibly contaminated water
2. Clinical clues
3. Laboratory clues
4. Diagnosis
4. Test urine for legionella antigen
42
Regions in US where Lyme disease is Endemic
Northeast and upper midwest
43
Treatment for Lyme disease in children \< 8 and women who are pregnant or lactating
Amoxicillin
44
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
6. 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**
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
45
Serologic markers in acute HBV infection
46
Prosthetic joint infection (early, delayed, late onset)
1. Time to onset after surgery
2. Presentation
3. Most common organisms
47
Congenital rubella syndrome
1. Clinical triad
2. Diagnosis
3. Prevention
First trimester maternal-fetal transmission of rubella is teratogenic
48
Disseminated histoplasmosis
1. Epidemiology
2. Symptoms
3. Diagnosis
4. Treatment
Immunocompromised patients (HIV with CD4+ count \< 100) are at high risk for disseminated disease
49
Treatment for disseminated histoplasmosis in patients with HIV
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
Approach to odynophagia and dysphagia in patients with HIV
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
Herpes simplex virus esophagitis
Multiple, small, and well-circumscribed ulcers with a small and deep appearance.
52
Early Lyme disease
1. Epidemiology
2. Manifestations
3. Diagnosis
4. Treatment
Lyme disease is caused by a spirochete
53
What is the most likely organism responsible?
*Streptococcus pneumoniae*
54
Clinical features of splenic abscess
1. Risk factors
2. Clinical presentation
3. Treatment
55
Isoniazid-induced peripheral neuropathy
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
Acute rheumatic fever
1. Epidemiology
2. Clinical features
3. Late sequelae
4. Prevention
Jones criteria
Treat with intramuscular benzathine penicillin G
57
Isonizid hepatitis
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
Pill esophagitis
Acute odynophagia due to direct effects of a medication on esophageal mucosa
Common offenders:
Potassium chloride
Tetracyclines
Bisphosphonates
NSAIDs
59
Common causes of esophagitis in HIV
1. Causes
2. Typical features
60
*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
Treatment options for patients with latent TB
62
Patients to treat based on PPD area of induration
1. \>= 5 mm
2. \>= 10 mm
3. \>= 15 mm
63
Common skin infections
1. Infection
2. Organism
3. Manifestations
64
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
Influenza
1. Clinical presentation
2. Treatment
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
Human monocytic ehrlichiosis
1. Epidemiology
2. Clinical manifestations
3. Laboratory findings
4. Diagnosis
5. Treatment
67
Stages of Lyme Disease
Early localized
Early disseminated
Late
Ceftriazone used for the treatment of neurologic and cardiac manifestations of Lyme disease
68
Vaccine types
1. Live attenuated
2. Non-live
69
Adalimumab
Tumor necrosis factor antagonist
Patients on TNF antagonists should avoid live attenuated vaccines
70
Meningococcal vaccination
1. Regular schedule
2. High-risk patients
Endemic environments: sub-Saharan Africa and Muslim hajj pilgrimage to Mecca, Saudi Arabia
71
Patients with Wolff-Parkinson-White syndrome who develop atrial fibrillation with a rapid ventricular rate
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
Foodborne disease
1. Vomiting predominant
2. Watery diarrhea predominant
3. Inflammatory diarrhea predominant
4. Non-GI symptoms
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
Mucormycosis
Most commonly seen in DKA
Surgical debridement + amphotericin B
74
Rhino-orbital-cerebral mucormycosis
1. Risk factors
2. Manifestations
3. Diagnosis
4. Treatment
75
Sporotrichosis
1. Epidemiology
2. Manifestations
3. Diagnosis
4. Treatment
76
Human rabies
1. Pathogenesis
2. Reservoir
3. Clinical features
4. Postexposure prophylaxis
5. Prognosis
77
Causes of meningitis in children
| (3 age categories)
78
HIV screening indications
1. Initial screening
2. Annual (or more frequent) screening
3. Additional screening
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
Varicella (chickenpox)
Varicella-zoster virus (VZV)
80
Varicella infection
1. Clinical features
2. Prognosis
3. Prevention
Breakthrough infection in vaccinated children is most common in children who have received only a single dose of VZV vaccine.
81
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
Secondary syphilis
Diffuse maculopapular rash that begins on the trunk, extends to extremities and involves palms and soles
83
Epitrochlear lymphadenopathy
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
Clinical findings of congenital infections
1. All
2. Cytomegalovirus
3. Toxoplasmosis
4. Syphilis
5. Rubella
85
Condyloma accumulata
Secondary to HPV
86
Leukoclastic vasculitis
Non-blanching, 1-3 mm violaceous papules that can cluster-coalesce into plaques
Due to infections. medications, infammatory conditions, or malignancy
87
Malignant melanoma
88
Neurofibromatosis Type I
89
Neurofibromatosis Type I
| (Cafe au lait spots)
90
Neurofibromatosis type 2
Vestibular schwannoma
Raised plaque-like lesions or subcutaneous nodules (from nerve swelling)
91
Managment of baby born to mother with active hepatitis B infection
1. Passive immunization at birth with Hepatitis B immune globulin (HBIG)
2. Active immunization with recombinant HBV vaccine.
92
Nummular dermatitis
Treat with corticosteroids
93
Tinea corporis
94
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*)
95
Jarisch-Herzheimer reaction
1. Epidemiology
2. Clinical presentation
3. Treatment
96
Bacteria most commonly responsible for unilateral cervical lymphadenitis
Staphylococcus aureus
97
Neonatal conjunctivitis
(Type, Onset age, Findings, Treatment)
1. Chemical
2. Gonococcal
3. Chlamydial
Topic treatments for chlamydial conjunctivitis are not effective. (Although they can be used as prophylaxis)
98
Cervicofacial Actinomyces
1. Risk factors
2. Manifestations
3. Diagnosis
4. Treatment
Presence of prurulent discharge with "sulfur granules" is pathognomonic
99
Antiobiotic options for anaerobic coverage
Metronidazole with amoxicillin
Amoxicillin-clavulanate
Clindamycin
100
Pneumocystis jirovecii pneumonia
1. Clinical
2. Workup
3. **Treatment**
4. Prevention
Use prednisone if O2 sat is low
101
Recommended vaccines for adults
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
Neisseria gonorrhea
103
Prophylaxis for neonatal conjunctivitis
Topical erythromycin ointment within 1 hour of birth, to prevent gonococcal infection
104
Culture negative urethritis
Chlamydia
105
Hydatid cyst
(Cystic hepatic cyst with eggshell calcification)
Echinococcus granulosus
106
Cat bites
Microbiology:
Pasteurella multocida
Anaerobic bacteria
Management:
Copious irrigation and cleaning
Prophylactic amoxicillin/clavulanate
Tetanus booster as indicated
Avoid closure
107
Cocciodes
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
Cryptococcal meningoencephalitis
1. Presentation
2. Diagnosis
3. Treatment
109
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**
110
Blastomycosis
1. Epidemiology
2. Clinical features
3. Diagnosis
4. Treatment
111
Miliary tuberculosis
Diffuse reticolunodular pattern (milelt seed) on x-ray
Most common risk factor: Substance abuse
112
1. Epidemiology
2. Clinical
3. Diagnosis
4. Treatment
113
Bacillary angiomatosis
Caused by Bartonella in HIV patients
114
Opportunistic infections in HIV (Infection, Risk Factors, Prophylaxis)
115
Key respiratory tract infections in children
Diagnosis
Classic pathogen
Presentation
