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Step 2 CK > Infectious diseases (GI infections) > Flashcards

Infectious diseases (GI infections) Flashcards

1
Q

What organisms can lead to Blood and WBCs in stool? (8)

A 
Salmonella (poultry)
Campylobacter (most common cause)
E. coli 0157:H7 (HUS)
Shigella (2nd most common association w/ HUS)
Vibrio parahaemolyticus (shellfish and cruise ships)
Vibrio vulnificus
Yersinia (high affinity for iron)
Clostridium difficile
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2
Q

What is the best initial test for infectious diarrhea?

A

Stool lactoferrin (greatest sensitivity and specificity), Blood and/or fecal leukocytes

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3
Q

What is the most accurate test for infectious diarrhea?

A

Stool culture

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4
Q

What organisms cause infectious diarrhea w/ no blood or WBCs in stool?

A 
Viral
Giardia (camping/hiking)
Cryptosporidiosis (AIDS)
Bacillus cereus (vomiting)
Staphylococcus (vomiting)
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5
Q

Why do bacillus and staphylococcus lead to nausea/vomiting in addition to diarrhea?

A

Intake of preformed toxin

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6
Q

How are mild and severe infectious diarrhea treated?

A

Mild: Oral fluid replacement
Severe: Fluid replacement and oral antibiotics (Cipro)

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7
Q

How does “severe” infectious diarrhea present? (6)

A 
Hypotension
Tachycardia
Fever
Abdominal pain
Bloody diarrhea
Metabolic acidosis
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8
Q

How is Giardia treated?

How is Cryptosporidiosis treated?

A

Giardia: Metronidazole ,tinidazole
Cryptosporidiosis: Treat underlying AIDS, nitazoxanide

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9
Q

Hepatitis D exists exclusively in those who have active viral replication of ______ __

A

Hepatitis B

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10
Q

Which types of hepatitis are spread by sex, blood, or perinatal transmission?

A

Hepatitis B, C, and D

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11
Q

Which types of hepatitis are spread by food and water?

A

“You Ate hepatitis A; you Eat hepatitis E”

Hepatitis A and E

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12
Q

All forms of acute hepatitis present with…

A 
Jaundice
Fever, weight loss, and fatigue
Dark urine
Hepatosplenomegaly
Nausea, vomiting, abdominal pain
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13
Q

What diagnostic findings are seen with acute hepatitis? (3)

A

Increased direct bilirubin
Increased ratio of ALT to AST
Increased alkaline phosphatase

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14
Q

What is the presentation of a Scombroid infection?

How is it treated?

A

Rapid onset
Wheezing, flushing rash
Found in fish
Treat with antihistamines

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15
Q

What test correlates best with an increased likelihood of mortality in acute hepatitis?

A

Prothrombin time (increased risk of fulminant hepatic failure and death)

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16
Q

What is the best initial diagnostic test for hepatitis A, C, D, and E?

A

IgM antibody for the acute infection and IgG antibody to detect resolution of infection

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17
Q

How is disease activity of hepatitis C assessed?

A

PCR for RNA level (tells the amount of active viral replication)

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18
Q 
Describe the following for an acute or chronic hepatitis B infection...
Surface antigen:
E-Antigen:
Core antibody:
Surface antibody:
A

Surface antigen: Positive
E-Antigen: Positive
Core antibody: Positive IgM or IgG
Surface antibody: Negative

19
Q 
Describe the following for a resolved, old, past hepatitis B infection...
Surface antigen:
E-Antigen:
Core antibody:
Surface antibody:
A

Surface antigen: Negative
E-Antigen: Negative
Core antibody: Positive IgG
Surface antibody: Positive

20
Q 
Describe the following for someone vaccinated for hepatitis B infection...
Surface antigen:
E-Antigen:
Core antibody:
Surface antibody:
A

Surface antigen: Negative
E-Antigen: Negative
Core antibody: Negative
Surface antibody: Positive

21
Q 
Describe the following for someone in the window period of a hepatitis B infection...
Surface antigen:
E-Antigen:
Core antibody:
Surface antibody:
A

Surface antigen: Negative
E-Antigen: Negative
Core antibody: Positive IgM, then IgG
Surface antibody: Negative

22
Q

Which serologic marker becomes abnormal first after acquiring hepatitis B?

A

Surface antigen (measure of actual viral particles)

23
Q

Which serologic marker for hepatitis B most directly correlates with amount or quantity of active viral replication?

A

Hepatitis B e-antigen is directly correlated with the degree of DNA polymerase activity

24
Q

Lack of which serologic marker indicates that a patient is no longer at risk for transmitting hepatitis B infection?

A

Lack of surface antigen

25
Q

Which serologic marker in hepatitis B infection is the strongest indicator of active viral replication?

A

E-antigen

26
Q

What is the difference between testing for e-antigen and testing for DNA polymerase?

A

e-antigen is a qualitative test (it is simply positive or negative)
DNA polymerase is a quantitative test (gives a level that can have a lot of variability)

27
Q

What is the most common method of hepatitis B transmission worldwide?

A

Perinatal transmission

28
Q

What is the purpose of testing for viral load in hepatitis B and C?

A

Best test for determining whether there has been a response to therapy or a failure in therapy

29
Q

Hepatitis __ and __ resolve spontaneously over a few weeks

A

A and E

30
Q

Hepatitis B becomes chronic in __% of patients regardless of treatment

A

10%

31
Q

Acute hepatitis C should be treated with… (which decrease likelihood of developing chronic infection)

A

Interferon, ribavirin, and either boceprevir or telaprevir

32
Q

What is chronicity for hepatitis B defined as?

A

Persistence of surface antigen for more than 6 months

33
Q

If patients with chronic hepatitis B are positive for ________ with an elevated level of ____ __________ they should be treated

A

e-antigen; DNA polymerase

34
Q

Treatment for chronic hepatitis B is with any one of which 6 drugs?

A

Entecavir, adefovir, lamivudine, telbivudine, interferon, or tenofovir

35
Q

What adverse effects are associated with interferon? (5)

A 
Arthralgia/myalgia
Leukopenia
Thrombocytopenia
Depression
Flu-like symptoms
36
Q

Genotypes 2 and 3 of hepatitis C are treated with…

A

Oral sofosbuvir and ribavirin

37
Q

Genotype 1 of Hepatitis C is treated with…

A

Oral ledipasvir and sofosbuvir for 12 weeks

38
Q

What is the goal of chronic hepatitis therapy?

A

Reduce DNA polymerase to undetectable levels

Convert patients with e-antigen to having anti-hepatitis e-antibody

39
Q

The presence of ____ on liver biopsy is indication to begin therapy for either hepatitis B or C right away

A

fibrosis

40
Q

Why is there no way to determine duration of infection with hepatitis C?

A

No equivalent of the surface antigen test

41
Q

What is the only form of acute hepatitis that should be treated?

A

Hepatitis C

42
Q

Everyone born between ____ and ___ is tested for hepatitis C regardless of risk factors

A

1945-1965

43
Q

When should patients be treated for chronic hepatitis C (which minimized the need to perform liver biopsy)?

A

When there is an elevated PCR-RNA viral load

Step 2 CK (4 decks)

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