Infectious dz Flashcards
1
Q
dx? Difficulty swallowing and breathing. Double vision, drooping eyelids, blurry vision, difficulty moving the eyes. Slurred speech. Symmetrical weakness of both arms – proximally and distally. Descending paralysis that always includes cranial nerves. NO sensory component, only motor.
A
botulism
2
Q
MC bac cause of diarrheal illness in US
A
Campylobacter jejuni
3
Q
is Campylobacter jejuni
diarrhea bloody?
A
yes, usually
4
Q
Campylobacter jejuni
complications (4)
A
dehydration, electrolyte imbalances, reactive arthritis, GBS
5
Q
tx for chlamydia in preg
A
Pregnant: azithromycin 1g PO X 1 dose.
6
Q
f/u for chlamydia
A
Screen all F 3 months s/p infx bc reinfection rates are high
7
Q
dx? Fever, malaise, severe sore throat. Neck swelling, gray-white membrance covering tonsils, palate, uvula, and post pharynx.
A
diptheria
8
Q
gonorrhea tx for pt >150kg
A
Single dose Ceftriaxone 1g IM
9
Q
PSGN happens _____ after pharyngitis;_____ after impetigo
A
1-2 wks, 3-6 wks
10
Q
topical, PO, and IV tx for MRSA
A
Topical mupirocin 2%. PO bactrim, doxy, clinda. IV vanc, linezolid, daptomycin
11
Q
ped autoimmune neuropsychiatric disorder ASW strep infx
A
PANDAS
12
Q
consider what dx in peds w/ abrupt onset of OCD or tics
A
PANDAS
13
Q
tx for pertussis W/in 3 wks of cough onset or up to 6 wks in pregnancy, >65 y/o, chronic respiratory dz, or immunocompromised
A
Azithromycin or clarithromycin
14
Q
MC finding on exam of acute rheumatic fever
A
mitral regurg
15
Q
ask about what 3 sx in suspected ARF?
A
joint pain (polyarthritis in large joints), rash (erythema marginatum), bumps (subcutaneous nodules)
16
Q
classic triad of tetanus
A
rigidity, muscle spasm, and autonomic dysfunction
17
Q
most common mold to cause invasive fungal infx
A
aspergillosis
18
Q
CT showing cresent sign in lungs. dx?
A
aspergillosis
19
Q
Free-living fungal species distributed in soil of large section of midwest and SE US. Inhaled spores covert to yeasts and multiply in lungs
A
Blastomycosis (blastomyces dermatitidis)
20
Q
tx for OP candidiasis
A
PO fluconazole
21
Q
fungus dz from inhaling spores from soil of SW US , parts of Mexico, Central and S. America
A
Coccidioidomycosis (aka Valley Fever)
22
Q
elderly pt in MS river valley develops fever and cough after visiting bat cave. dx?
A
Histoplasmosis
23
Q
2nd most common opportunistic infx in HIV/AIDS
A
pneumocystis PJP
24
Q
most common opportunistic infx in HIV/AIDS
A
oral thrush
25
MC atypical mycobacterial dz
most common is Mycobacterium Avium Complex (MAC) closely related species of M. avium and M. intracellulare
26
pt w/ Fever, night sweats, weight loss and anorexia, cough, hemoptysis, CP. order what tests?
CXR, PPD
27
how to test for TB if pt had BCG
quantiferon
28
tx for active TB + timeframe
Rifampin, Isoniazid, Pyrazinomide, Ethambutol X 2 mo, then rifampin + isoniazid X 4 mo.
29
3 tx options for latent TB + timeframe
INH + rifapentine weekly X 3 mo (3HP). OR rifampin QD X 4 mo (4R). OR INH + rifampin QD X 3 mo (3HR)
30
for pt on RIPE, have them take what supplement?
vitamin B6 pyridoxine
31
rifamipin SE
red/orange body fluids
32
PZA SE
hyperuricemia
33
ethambutol SE
optic neuritis
34
baseline test to order before starting RIPE
LFTs
35
tx for most roundworms
mebendazole
36
tx for pinworms
mebendazole
37
pt w/ f/c every other day, recent travel
malaria
38
gold standard for dx of malaria
blood smear (Giemsa stain)
39
which malaria tx worsens psoriasis
chloroquine
40
which malaria med is ok in preg?
mefloquine
41
pathognomonic finding on Ct of brain for toxoplasmosis
ring enhancing lesions
42
how soon does lyme rash appear after tick bite?
avg 7-14 days (can be 3-30)
43
pt has rash suspicious for lyme. ask about what AS? (4)
f/c, weakness, myalgias/arthralgias, HA
44
stage 2 lyme can cause what arrhythmia
complete heart block
45
tx for lyme
1) doxy for age 8+ for 10-14 days, 2) amoxicillin / 2nd-3rd gen cephalosporins (cefuroxime) X 14 days (NOT cephalexin!)
46
when to give lyme prophylaxis after tick bite and dose
doxy 200mg PO X 1 dose (if >36 hrs attached)
47
which tick dz is not treateed w/ doxy, and what is the tx?
babesiosis, azith + atovaquone X 7-10d
48
for pt w/ f/c, myalgias, malaise, HA, consider what group of dz?
tick borne
49
which tick borne dz causes hemolysis?
babesiosis
50
RMSF is caused by what pathogen?
Rickettsia rickettsii
51
pt had flu like sx and now has blanchable 2-6mm macular or papular rash on ankles/wrists, palms, soles. dx?
RMSF
52
tx for RMSF in 5 y/o
doxy
53
what does the secondary syphillis rash look like
Diffuse rash of erythematous papules, typically including palms and soles
54
eye finding in tertiary syphillis
Argyll Robertson pupil (b/l small pupils that do NOT constrict when exposed to bright light, but DO constrict for near focus)
55
congenital syphillis finding
hutchinson teeth (scalloped edges)
56
tx for syphilis
Benzathine penicillin G 2.4 million units IM single dose (no alt for pregnancy / allergic)
57
MC dz cause of sepsis
PNA
58
MC sx of sepsis
fever
59
outpatient tx for high RF for COVID and timeframe
Paxlovid if high risk if w/in 5 days of onset (Check meds for interactions w/ Paxlovid (esp statins))
60
tx for inpatient COVID w/ no O2 req
Veklury/remdesivir - 200 mg IV on day one, followed by 100 mg IV x 5-10 days.
61
tx for inpatient COVID w/ O2 req
Remdesivir + dexamethasone 6mg QD X 10 days.
62
pharyngitis and LAD in CMV vs EBV
both less severe in CMV than EBV. EBV also generalisted as well as cervical LAD
63
tissue bx finding for CMV
Owl-eye basophilic inclusion bodies
64
MC viral infx in transplant pts
CMV
65
MC congenital infx
CMV
66
what will happen if pt w/ CMV or EBV is treated w/ amox or ampicillin
generalised rash
67
CBC-D finding in EBV
Atypical lymphocytosis on white blood cell differential
68
classic triad of EBV
Classic triad: severe sore throat, fever, lymphadenopathy.
69
besides constitutional and ENT AS, ask about what for EBV?
abd pain
70
counseling for pt w/ EBV
Avoid heavy lifting and contact sports for 4+ weeks after mono to prevent spleen rupture
71
pt w/ fever, fatigue, lymphadenopathy, sore throat, rash, myalgia/ arthralgia, HA, mucocutaneous ulcers, n/v/d, anorexia, weight loss. consider what do not miss dx?
HIV
72
AIDS = when CD4 count is <____
200
73
MC STI
HPV
74
fever timeline in flu
sudden onset; fever (38-40C) that peaks w/in 12-24 hours of onset, lasts 1-5 days
75
annual flu vax in all pts ____ or older if no CI
6 mo
76
antivirals for flu most effective if started <_____ of onset
48 hrs
77
measles pt should take vitamin ___
A
78
does the monkeypox rash involve palms/soles
yes
79
unvaxed kid w/ fever, swollen cheeks, swollen scrotum
mumps
80
#1 infectious common cause of acquired sensorineural deafness.
mumps
81
give MMR to preg?
no
82
classic sx in rabies
hydrophobia
83
rabies postmorten: __________ in brain cells are pathognomonic
Negri bodies
84
pt got bit by racoon. no preimmunisation. next steps (4)
clean wound, tetanus booster. HRIG – half at site and half in buttock, then vaccinate day 0,3,7,14
85
Where does roseola start?
Trunk and neck
86
viral exanthem that starts w/ abrupt high fever, then rash when fever goes away
roseola
87
differences between Rubella (German Measles) and measles rubeola in terms of severity, rash, and AS
Measles (worse, more dangerous, lasts for wks, darker rash, cough, coryza, conjunctivitis)
Rubella: low grade fever, sore throat, smaller and lighter rash that disappears in 3 days, post LAD.
88
viral exanthem w/ Forchheimer spots on soft palate (petechiae)
Rubella (German Measles)
89
rubella is
german measles
90
rubeola is
measles
91
cause of roseola
human herpesvirus 6 and 7
92
which can involve palms and soles: measles, german measles, or roseola
german measles / rubella
93
Where does rubella start?
Face
94
is dicloxacillin active against gram - ?
no
95
is amoxicillin active against gram - ?
yes
96
3 bac groups that augmentin covers
gram +, gram -, anaerobes
97
MC SE of penicillins
diarrhea
98
potential SE of penicillins at high doses
neurotoxicity: hyperreflexia, myoclonus, seizures
99
are cephalosporins effective against beta lactamase producing bacteria
yes
100
keflex covers what 3 bac groups? Gram + what? Gram - what?
gram + cocci, gram - rods, anaerobes
101
go-to cephalosporin for strep and staph infx
keflex
102
3 types of infx covered by 2nd generation cephalosporins
skin, ENT/resp, UTI
103
cephalosporin gen to use for bacterial meningitis and why
3rd,, good CNS penetration
104
3rd generation cephalosprin that covers pseudomonas
ceftazidime
105
3rd gen cephalosprin preferred in neonates
cefotaxime
106
MC SE of cephalosprins
GI upset: n/v, abd pain, lack of appetite
107
which abx class has broadest spectrum of coverage?
carbapenems
108
serious SE of imipenem to consider. what makes the SE worse?
CNS toxicity. renal insufficiency
109
coverage of monobactam aztreonam
gram - aerobes only
110
does aztreonam cover pseudomonas?
yes
111
polymyxin spectrum of activity (1)
gram -
112
does polymyxin cover psuedomonas?
yes
113
does ceftaroline cover pseudomonas?
no
114
vanc spectrum of coverage
gram + only
115
vanc has synergistic coverage with what class?
aminoglycosides
116
2 methods to prevent vanc flushing syndrom
slow infusion over 1-2 hrs, prophylactic antihistamines
117
vanc is toxic to.... (2)
ears, kidneys
118
tetracyclines: broad or narrow coverage?
broad
119
abx of choice for mycoplasma PNA
doxy
120
abx for vibrio
doxy
121
tetracyclines have impaired absorption if taken w/ ______ (5)
dairy, Al, Ca, Mg, Fe
122
which tetracycline is NOT CI in renal impairment?
doxy
123
macrolides: broad or narrow?
broad
124
best macrolide for atypical coverage
azith
125
macrolide ok in preg
erythromycin
126
macrolides CI in pts taking what 2 medications
niacin, statins
127
3 macrolide SE
GI upset from increased peristalsis, ototoxicity, prolonged QT
128
bacitracin spectrum of coverage
gram + only
129
is clindamycin broad or narrow coverage?
narrow
130
2 bac classes that clindamycin covers
gram + and anaerobes above the diaphragm
131
2 MC SE of clindamycin
diarrhea, allergic rxn
132
chloramphenicol: broad or narrow
broad
133
gentamicin class
aminoglycosides
134
aminoglycoside coverage
gram - aerobic bacilli (rods) only
135
do aminoglycosides cover pseudomonas?
yes
136
2 synergistic options w/ aminoglycosides
beta lactams, vanc
137
which 2 abx class causes increased muscular weakness in myasthenia gravis
macrolides, FQ
138
linezolid mainly used for what type of infx
resistant gram +
139
which abx causes a transient darkening of urine
metronidazole
140
main SE of metronidazole (4) besides disulfiram
HA, n/v/d, metallitc taste, peripheral neuropathy
141
daptomycin coverage
gram + only (alt to vanc)
142
2 most important SE of daptomycin
muscle toxicity/rhabdomyolysis, eosinophilic PNA
143
2nd best PO abx coverage of MRSA
bactrim (linezolid is 1st, but not commonly used)
144
4 main SE of bactrim
rash, GI sx, photosensitivity, folate deficiency
145
5 CI for bactrim
sulfa allergy, preg (1st trim, last month), nursing, neonate < 6 wks, G6PD
146
is nitrofurantoin effective against pseudomonas?
no
147
what to tell pt about taking macrobid
take w/ meals to increase absorption
148
indication for macrobid
uncomplicated cystitis in F only
149
is macrobid safe in preg?
yes except 38+ weeks
150
2 MC SE of macrobid
HA, GI upset
151
which FQ has the best gram - coverage?
cipro
152
moxifloxacin has the best ____ (3) coverage of all FQ
gram +, anaerobic, atypical
153
MC SE of FQ
GI upset
154
4 serious effects of FQ
tendinitis/tendon rupture, disordered glucose regulation,, prolonged QT, CNS (seizures, peripheral neuropathy)
155
2 CI for FQ
preg, kids <18
156
quinupristin/ dalfopristin can only be given ______
via central line
157
neurosyphillis requires what tx? what length of time?
penicillin G 4 million units IV Q4 hrs X 14 days. (no alternative)
158
lactate > ____ = septic shock
18
159
septic shock pt receives fluid resus but is still hypotensive. next tx?
NE
160
septic shock pt receives fluid resus and 1st line tx but is still hypotensive. next tx?
vasopressin, then epinephrine
161
MC PE finding in congenital syphilis
hepatomegaly
162
how do most newborns with congenital CMV present?
asx
163
tx for congenital CMV
IV ganciclovir
164
MC manifestation of congenital rubella
SNHL
165
does a woman with +HPV need to have a C section?
only if warts obscure birth canal
166
when should a women with +HSV have a C section?
if active lesions
167
HIV pt with chonric watery diarrhea. dx?
Cryptosporidium (parasite)
168
HIV pt w/ retinitis: fluffy white retinal necrosis w/ overlying hemorrhages. pathogen?
CMV
168
HIV pt w/ meningitis. CD4<100. consider what pathogen?
cryptococcus
169
HIV tx (classes)
INSTI + 2 NRTI
170
pt bit by rat. do they need rabies vax?
no
171
A 23 year-old female complains of fever and genital pain. Examination reveals the presence of lymphadenopathy in the groin and the presence of vulvar vesicles surrounded by erythematous skin. The diagnosis may be confirmed by
A culture of a vesicle using blood agar medium.
The presence of similar lesions on the fingers and hands.
A Gram stain of a scraping from the base of the lesion.
The presence of giant multinucleated cells on Tzanck smear
The presence of giant multinucleated cells on Tzanck smear
