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MOHD Keystone > Infectious Dz > Flashcards

Infectious Dz Flashcards

1
Q

Basis of skin’s resistance to infx (2):

A

physicochemical barriers

innate immunity

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2
Q

Risk factors/ initiating events for SSTIs (2) (→ ↓ ID50 by ≥ 100x)

A

breaks in the skin

foreign bodies lodged in the skin

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3
Q

Cytokine profile for acute inflammation:

A

TNFα
IL-1
IL-6
IL-8

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4
Q

Cytokine profile for chronic inflammation:

A

INFƔ
IL-2
IL-4
IL-5

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5
Q

Hallmark of acute inflammation:

A

pus (= PMNs)

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6
Q

Hallmark of chronic inflammation:

A

granulomas (nodular collections of epithelioid m∅s and giant cells)

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7
Q

Which type of microbes cause acute inflammation?

A

extracellular bacteria

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8
Q

Which type of microbes cause chronic inflammation?

A

intracellular bacteria

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9
Q

Most SSTIs (esp. community acquired) are caused by which 2 microbes?

A 
Staph Aureus
Strep pyogenes (GAS)
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10
Q

Special circumstances when the spectrum of causative microbes responsible for SSTIs is broader (3):

A

puncture wounds
penetrating
trauma
bites

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11
Q

Special pt. pops. when the spectrum of causative microbes responsible for SSTIs is broader (6):

A 
young people
old people
underlying skin dz
Diabetics
Pts. in HC facilities
Immunocomprimised
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12
Q

Principles of Rx for SSTIs (3):

A 
local hygienic care
Incision & Drainage (I&D)
Abx coverage for organisms only if:
 systemic ssx are present on PE 
 in special circumstances (e.g. puncture)
 in special pt. pops.
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13
Q

Most SSTIs present acutely/chronically

A

acutely → rubor, calor, tumor, dolor

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14
Q

Key components of innate immunity (5):

A 
AMPS
cytokines
dentritic cells
PMNs
complement
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15
Q

Signaling molecules that are an important component of the skin in preventing S. aureus and C. albicans infx (4):

A

IL-17
IL17R
STAT1
STAT3

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16
Q

Name that microbe:
clinical pres:
rapidly spreading rash, cellulitis lymphangiitis, or adenopathy

A

S. pyogenes

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17
Q

Name that microbe:
clinical pres.:
abscess formation
organ involvement may include: skin, blood, heart and bone

A

S. aureus

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18
Q 
Name that microbe:
gram(+) coccus in chains
catalase(-)
β-hemolytic
Bacitracin sensitive
A

S. pyogenes

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19
Q

Name that microbe:
gram(+) coccus in clusters
coagulase (+)
catalase(+)

A

S. aureus

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20
Q

Abx of choice for S. pyogenes

A

penicillin

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21
Q

Post-streptococcal complications

A

acute rheumatic fever

post-strep. glomerulonephritis

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22
Q

Exotoxin superAg that contribute to TSS and rash of scarlet fever (S. pyogenes) (2)

A

Pyrogenic exotoxin A

Pyrogenic exotoxin C

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23
Q

Exotoxin involved in staphylococcal scalded skin syndrome (SSS)

A

Exfoliative toxin

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24
Q

Bacteriophage encoded exotoxin found in methicillin resistant S. aureus strains

A

Panton-Valentine Leukocidin (PVL)

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25
Q

SuperAg exotoxin involved in staph mediated TSS

A

TSST-1

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26
Q

You suspect this microbe in a pt. presenting w/ lymphedema or disrupted lymphatics

A

S. pyogenes

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27
Q

Normal flora can potentially cause an SSTI in which setting?

A

indwelling percutaneous catheters

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28
Q

Anatomic determination of the upper urinary tract:

A

above the uretero-pelvic junction

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29
Q

Anatomic determination of the lower urinary tract:

A

the bladder and below

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30
Q

A women w/ (+) hx of dysuria and frequency w/o vaginal irritation or discharge has > ___% probability of a UTI.

A

> 90%

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31
Q

If a women w/ (+) hx of dysuria and frequency w/o vaginal irritation or discharge presents to your clinic, is further diagnostic testing indicated?

A

NO!!

Even if tests are negative the probability of a UTI is still sufficiently high to indicate tx

32
Q

MC microbe that causes a UTI

A

Uropathogenic E. Coli (UPEC)

33
Q

Rx of choice in uncomplicated UTI

A

TMP sulfa or Nitrofurantoin

34
Q

Characteristics of uncomplicated UTI (5):

A 
comprise majority of UTIs
occur in women
microbe = UPEC
ascending route of infx
readily treatable
35
Q

Characteristics of complicated UTI (5)

A 
systemic findings (VS)
occur in males or Diabetics
may be caused by atypical organisms
obstruction, instrumentation, and in-patient setting are common causes/RFs
imaging is indicated
36
Q

3 lab studies that may be used to help dx a UTI

A

Urinalysis
Culture and Abx sensitivity testing
Imaging studies

37
Q

2 dipstick urinalysis tests used to dx a UTI

A

esterase: (+) → presence of PMNs
nitrite: (+) → presence of bacteria

38
Q

ssx that ↑ likelihood of UTI dx (4):

A

dysuria
frequency
CVA tenderness
hematuria

39
Q

ssx (or lack thereof) that ↓ likelihood of UTI dx (4):

A

absence of dysuria
absence of back pain
presence of vaginal irritation
presence of vaginal discharge

40
Q

Scenarios when culture and Abx sensitivity testing is indicated for a UTI (3):

A

recurrent infx
lack of response to Rx
complicated UTI

41
Q

Scenarios when imaging studies are indicated for a UTI (3):

A

in males
certain complicated UTIs
when complications occur

42
Q

DDX for dysuria ± frequency (4)

A

UTI
STI (esp. in young adults)
kidney stones
chemical irritants

43
Q

RFs for UTIs in males (3):

A

insertive anal intercourse
female partner w/ active UTI
non-circumcised

44
Q

Abx w/ good prostate penetration (can use for male UTI tx) (2):

A

TMP-SMX

quinolones

45
Q

mechanism of UTI in pt. w/ prostate dz

A

urinary retention/ stasis → bacteria able to multiply in residual urine and adhere to bladder to cause infx

46
Q

U/A culture (+) for S. aureus in eval for UTI always means:

A

blood stream infx (e.g. endocarditis) → seeding of kidney and spill over into urine
NEED TO FIND SOURCE OF SEEDING!!

47
Q

Urease (+) microbe that can cause UTIs

A

proteus mirabilis

48
Q

alkaline urine (↑ pH) should make you think about which organism in an eval for a UTI?

A

proteus! → urease (+)

49
Q

DDx of dysuria in men (4):

A

urethritis
prostatitis
epididymitis
UTI

50
Q

GC and C. trachomatis are the MC pathogens for which STD syndromes in men and/or women(4)?

A

urethritis
cervicitis
epididymitis
PID

51
Q

3 characteristics of dysuria in urethritis seen in males:

A

may be most marked first thing in the AM (d/t ↑ acidity or solute content)
May ↑ w/ EtOH consumption
B/w micturitions may be perceived as pain, itching, frequency, urgency

52
Q

MC ssx seen in male urethritis (2):

A

purulent/ mucopurulent urethral discharge (clear or cloudy)

often accompanied by dysuria

53
Q

Specific ssx in hx during eval for a male w/ dysuria that suggest a different dx than urethritis (3):

A

discomfort only during ejaculation
deep pelvic pain
radiation of pain to back

54
Q

Before you can perform a PE on a male suspected of urethritis, what must you instruct him to do?

A

Do NOT urinate for ≥ 2 hrs before exam

55
Q

Incubation period of GC urethritis seen in males:

A

3-10 days

56
Q

Discharge present at the urethral meatus w/o stripping stongly suggests what?

A

GC urethritis

57
Q

If a man has sex w/ a chick that has GC, will he definitely become infected as well?

A

NO!

risk of infx w/ GC following a single episode of intercourse w/ an infected partner = 17%

58
Q

(+) “sock sign” (so much discharge from penis, man has to put a sock on it to prevent staining)

A

GC Urethritis

59
Q

Incubation period seen in non-GC urethritis

A

2-35 days (50% develop ssx w/in 4 days)

60
Q

MC local complication of gonorrhea in males:

What is it usually assoc. with?

A

Epididymitis→ usually assoc. w/ overt or subclinical urethritis

61
Q

MC offending microbe causing urethritis in older men w/o high-risk sexual activity? What 1º ssx can be misleading if present?

A

Gram (-) bacteria that cause UTIs;

Sometimes urethral ssx are absent and epididymal pain is the primary ssx

62
Q

Epididymitis ssx (2):

A

unilateral testicular pain

unilateral testicular swelling

63
Q

Findings on gram stain if urethral discharge consistent w/ urethritis

A

> 2 WBCs/ hpf

64
Q

Typical urinalysis w/ microscopy of first-void urine seen in urethritis in a male

A

(+) leukocyte esterase

> 10 WBC/ hpf

65
Q

lab test done for ID of C. trachomatis and N. gonorrhoeae

A

PCR

66
Q

When evaluating a pt. w/ a suspected STI, which pathogens should you screen for?

A 
GC
Chlamydia
Syphilis
HIV
(NOT HSV typically→ only if they have a painful ulcer)
67
Q

If a dx of GC urethritis is made, what other pathogen should you tx empirically for?

A

Chlamydia;

co-infx not uncommon

68
Q

Tx for N. gonorrhoeae

A

IV 3rd gen. cephalosporin

69
Q

Tx for Chlamydia (2):

A

Doxycycline (tetracycline) or

azithromycin (macrolide)

70
Q

An ulcer present on a sexually active man’s urethral meatus points to which pathogen?

A

HSV

71
Q

Possible pathogens responsible for urethritis in males (5):

A 
GC (lots of purulent discharge)
Chlamydia (clear discharge present only after stripping urethra)
HSV (+ulcer)
Trichomonas vaginalis (non-purulent)
Mycoplasma genitalium (doxycycline has poor efficacy)
72
Q

Possible pathogens that can cause cervicitis (3):

A

GC
Chlamydia
HSV

73
Q

Which 3 pt. populations should be screened for chlamydia and gonorrhea?

A

sexually active women

74
Q

Consequence of missing ongoing GC or Chlamydia infx in women

A

PID → severe infx and/or infertility

75
Q

“Gold Standard” for HSV encephalitis dx

A

HSV PCR on CSF

MOHD Keystone (6 decks)

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