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EOR - Internal Med > Internal Med - Infectious DZ > Flashcards

Internal Med - Infectious DZ Flashcards

1
Q

Botulism is caused by

A

Gram (+) Bacteria associated with canned foods

Honey → do not give to babies until they are at least 12 months

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2
Q

Sx of Botulism

A

Muscle weakness + resp paralysis “floppy babies”

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3
Q

Tx of botulismn

A

Botulinum Antitoxin

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4
Q

Sx of vaginal candidiasis

A

Vulvar itching, erythema, white curdy discharge

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5
Q

Dx and tx of vaginal candiddiasis

A

Dx → KOH = Hyphae

Tx → Miconazole cream x 1-7 days or fluconazole 150mg PO single dose

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6
Q

Eosphageal candidiasis is MC in AIDS pts, what are the sx?

A

Substernal dysphagia, GE, refulx, or nausea w/ or w/o pain

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7
Q

Dx of Esophageal candidiasis

A

EGD w/ biopsy → Shows linear erosions

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8
Q

Tx of esophageal candidiasis

A

Fluconazole

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9
Q

Oral thrush sx and tx

A

Friable white plaques that bleed if scraped

Tx → Nystatin

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10
Q

Intertrigo sx and tx

A

Moist macerated areas, pruritic rash BEEFY RED ERYTHEMA w/ distinct scalloped borders and satellite lesion

Tx → Clotrimazole, Ketoconazole, miconazole topicals ;Keep area dry

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11
Q

MC STI

A

Chlamydia

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12
Q

Sx of chlamydia

A

Gram (-) Rods; Asymptomatic or dysuria

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13
Q

Dx and tx of chlamydia

A

Dx → NAAT

Tx → Azithromycin 1g PO x 1 or Doxy 100mg BID x 7 days

+

Ceftriaxone 500mg IM x 1 to cover for gonorrhea

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14
Q

In pregnant pts with chlamydia what is the tx

A

Azithromycin 1g PO single dose or Amoxicillin 500mg TID x 7 days

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15
Q

Cholera etiology

A

Acute infectious disease of the small bowel caused by vibrio cholerae gram negative bacteria which secretes a toxin that causes life-threatening RICE WATER DIARRHEA

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16
Q

Sx of chlorea

A

Rice water diarrhea

Extreme fluid and electrolyte depletion

Vomiting, muscle cramps, prostration, potential death without replacement of fluids and electrolytes

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17
Q

Dx & Tx of cholera

A

Dx → Stool culture confirms

Tx → Oral rehydration + abx (macrolides, fluroqu, tetracyclines)

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18
Q

Cryptococcus transmission

A

Through inhalation; Budding yeast found in soil contaminated with pigeon bird droppings

AIDS Defining illness

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19
Q

Dx and tx of Cryptococcus

A

Dx → CSF and serum serology

Tx → Amp B + Flucytosine for 2 weeks followed by Fluconazole for 10 weeks

*prophy in HIV → Fluconazole if CD4 is less than 100

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20
Q

enveloped double-stranded linear DNA virus in the herpesvirus family. It is also called human herpesvirus 5; It can cause infections that have a wide range of severity

A

CMV

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21
Q

How does CMV vary from mononucleosis

A

CMB can cause a syndrome similar to infectious mono but lacks severe pharyngitis

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22
Q

Sx of CMV

A

One of the TORCHES infections; Can cause hearing loss, seizures,petechial rash in newborns

Pneumonia and inflammation of retina and esophagus in immunocompromised; Associated with CD4 <50

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23
Q

Dx and tx of CMV

A

Dx → Visualization of owls eye inclusions in a cell

Tx → Ganciclovir, foscarnet, cidofovir

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24
Q

URI with thick gray pseudomembrane in the throat that bleeds if scrapped in someone who wasn’t vaccinated

A

Diptheria

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25
Q

Sx of Diptheria

A

Neck swelling d/t enlarged cervical lymphadenopathy (bull neck)

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26
Q

Why is Diptheria rare?

A
  • Rare in the US due to routine vaccination at 2, 4, 6 and 15-18 months with a booster at 4-6 years of age
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27
Q

Tx of Diptheria

A

Antitoxin and abx (PCN or macrolide)

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28
Q

Epstein Barr Mononucleosis sx

A

classic triad of fever + lymphadenopathy + pharyngitis

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29
Q

Dx and tx of Mononucleosis

A

Dx → Heterophile antibody screen (monospot) which may not appear in early illness (positive within 4 weeks)

Tx →Supportive

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30
Q

What should athletes with mono be cautious of?

A
  • Left upper quadrant pain secondary to splenomegaly and are at risk for splenic rupture - athletes should avoid vigorous sports for at least the first three to four weeks of the illness
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31
Q

Gonococcal infection sx in women and men

A

Women → Often asymptomatic; prolong infection can lead to PID when bacterium levels travel to pelvis

Men → yellow, creamy, profuse and purulent discharge

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32
Q

Tx of gonococcal infections

A

Ceftriaxone 500mg IM x 1

+

Tx for chlamydia (azithromycin 1g PO single or Doxycycline 100mg BID x 7 days)

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33
Q

Complictions of gonococcal infections

A

Gonococcal pharyngitis → Usually asymptomatic but may cause sore throat

Neonatal conjunctivitis and pharyngitis

*Disseminated infectious can occur resulting in → Septic arthritis, tenosynovitis, pustules on hands and feet

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34
Q

AIDS-defining illness, associated with soil containing birds and bat droppings in the Mississippi and Ohio River Valleys

A

Histoplasmosis

35
Q

Sx of Histoplasmosis

A

Highest risk in HIV with CD4 <100 → Fever multiorgan failure; fulminant dz, septic shock, death

36
Q

Dx and tx of Histoplasmosis

A

Increased Alk phosph + LDH

(+) blood cultures if disseminated

Tx→ Itraconazole for weeks to months or Amp B if failed itraconazole

37
Q

What dz are seen in HIV pts with CD4 200-500

A

TB, Kaposi Sarcoma, Thrush, Lymphoma, Zoster

38
Q

What dz are seen in HIV pts with CD4 <200

A

PJP and Histoplasmosis

Tx → TMP/SMX (bactrim) or Itraconazole

39
Q

What dz are seen in HIV pts with CD4 <100

A

Toxoplasmosis, cryptococcus

Tx with → TMP/SMX (Bactrim) or Fluconazole

40
Q

Tx of the influenza A & B

A

Dr. OZ → Zanamivir and Oseltamivir tx both

41
Q

Lyme dz is caused by

A

Borrelia burgdorferi (gram-negative spirochete) that is spread by Ixodes (deer) tick

42
Q

What rash is associated with Lyme Dz

A

Non-painful, gradually expanding erythema migrans (EM) “bull’s-eye” rash appearing at the site of tick bite; feels warm to palpation; may itch

43
Q

Helminths are worm-like parasites that infect several species. Those that infect humans

What are the 3 main types

A

Nematodes → Roundworm (ascaris), Hookworm, Pinworms; Roundworm most common intestinal which may cause vague abd sx

Cestodes → Tapeworms, cause GI symptoms + weight loss

Trematodes → Flukes associated with swimmers itch

44
Q

Tx of parasitic infections (worms)

A

Roundworms → Mebendazole

Tapeworms and flukes → Praziquantel

45
Q

Malaria is caused by

A

Caused by Plasmodium vivax, p. malaria, p. ovale, p. falciparum (most virulent)

Transmitted via Anopheles mosquito

46
Q

Dx & tx of Malaria

A

Giemsa stain peripheral smear (thin and thick) - parasites in RBCs, thrombocytopenia, increased LDH

Tx → chloroquine or mefloquine for chloroquine-resistant p. falciparum

47
Q

Pinworm infection, also known as enterobiasis vermicularis, is a human parasitic disease caused by the pinworm (a type of roundworm) Sx

A

The most common symptom is itching in the anal area. This can make sleeping difficult.

  • Perianal itching especially at night (eggs are laid at night)
  • Eggs cling to the fingers while itching and are transmitted to other people either directly or through food or surfaces
48
Q

Dx and tx of pinworms

A

Dx → Scotch tape test done in early morning

Tx → Albendazole or mebendazole

49
Q

What is the triad seen with toxoplasmosis

A

Toxoplasma gondii is a parasitic protozoan that causes the disease toxoplasmosis

Triad of encephalitis + chorioretinitis + intracranial calcifications in AIDS patients with a CD4 < 100

50
Q

What is the concern about toxoplasmosis and pregnant patients

A

Pregnant female with exposure to cat feces: Toxoplasmosis is the reason we tell pregnant mothers not to change cat litter

Infection to brain!

51
Q

Dx and tx of toxoplasmosis

A

CT of the brain shows ring-enhancing lesions. Toxo IgG and IgM

Congenital toxoplasmosis is part of ToRCH syndrome

Treatment: Prophylaxis for all HIV patients with CD4 count < 100 with Bactrim

52
Q

Highly contagious respiratory tract infection marked by a severe hacking cough followed by a high-pitched intake of breath

A

Whooping cough aka Pertussis

53
Q

What are the 3 stages of whooping cough aka pertussis?

A
  • Catarrhal stage: cold-like symptoms, poor feeding, and sleeping
  • Paroxysmal stage: high-pitched “inspiratory whoop”
  • Convalescent stage: residual cough (100 days)
54
Q

Dx and tx of pertusssi

A

Dx →Nasopharyngeal swab

Tx →Macrolide (clarithromycin/azithromycin) supportive care w/ steroids/beta 2 agonist for cough

  • Vaccination: 5 doses – 2, 4, 6, 15-18 mo, 4-6yrs (DTap)
  • 11-18 yo = 1 dose Tdap
  • Expectant mothers should get Tdap during each pregnancy, usually at 27-36 weeks
55
Q

Ubiquitous yeast-like fungus (doesn’t respond to antifungals) transmitted by aerosol route and causes NO disease in immunocompetent patients.

A

Pneumocystis or P. jiroveci

56
Q

MC opportunistic infection in pts with HIV, especially if CD4 <200

A

Pneumocystitis or p.jiroveci

57
Q

Dx and tx of pneumocystisitis or P. jiroveci

A

Dx → CXR → Diffuse bilateral perihilar infiltrates

Tx → Bactrim

  • Patients with pneumocystis pneumonia who have an arterial oxygen partial pressure (PaO2) less than 70 mmHg or alveolar-arterial gradient greater than 35 mmHg on room air should receive corticosteroids
  • Prophylaxis with daily Bactrim for high-risk patients with a CD4 < 200 or with a history of PJP infection
  • Pentamidine or atovaquone are second-line therapy if resistant or allergic to TMP-SMX
58
Q

Sx of Rabies

A

Hydrophobia (inability to swallow water) is a classic symptom. Pharyngeal spasms, aerophobia (fear of drafts of fresh air) and hyperactivity

59
Q

Dx and tx of Rabies

A

Dx →Fluorescent antibody tests → Negri bodies (eosinophilic inclusion bodies in the cytoplasm of hippocampal nerve cells) are considered pathognomonic and are found in the brain of dead animals

Tx →Post-exposure treatment: Rabies immunoglobulin + inactivated vaccine (4 doses over 14 days)

Fatal when there are neurological symptoms

60
Q

Rickettsia rickettsii a species of bacterium that is spread to humans by the American dog tick (Dermacentor variabilis)

A

Rocky Mountain Spotted Fever

61
Q

Sx of Rocky mountain spotted fever

A

2-14 days after tick bite will develop flu-like symptoms: fevers and chills, myalgias, and headache

Red maculopapular rash first onwrists and ankles (palms and soles) then spreading centrally over 2-3 days. The face is usually spared

62
Q

Dx and tx of rocky mountain spotted fever

A
  • Indirect fluorescent antibody (IFA) test remains the standard method of diagnosis of RMSF

Treat with doxycycline or chloramphenicol second lineDONE

62
Q

Dx and tx of rocky mountain spotted fever

A
  • Indirect fluorescent antibody (IFA) test remains the standard method of diagnosis of RMSF

Treat with doxycycline or chloramphenicol second lineDONE

62
Q

Dx and tx of rocky mountain spotted fever

A
  • Indirect fluorescent antibody (IFA) test remains the standard method of diagnosis of RMSF

Treat with doxycycline or chloramphenicol second line

63
Q

What are the 2 types of salmonella

A

Enteric fever (salmonella typhi): a flu-like bacterial infection characterized by fever, GI symptoms, and headache. Transmitted via the consumption of fecally contaminated food or water

Gastroenteritis (Salmonella Typhimurium, Enteritidis, and Newport): results from improperly handled food that has been contaminated by animal or human fecal material

64
Q

Sx of Enteric fever salmonella

A
  • GI symptoms may be marked constipation or “pea soup diarrhea”
  • Rose spots may be present (2-3 mm papule on trunk usually)
    • More common in the developing world (usually immigration cases)
65
Q

Tx of Salmonella

A

Ceftriaxone

66
Q

Gram-negative bacteria that results in watery diarrhea or dysentery (the frequent and often painful passage of small amounts of stool that contains blood, pus, and mucus)

A

Shigella

67
Q

Shigella sx

A
  • The illness starts abruptly with diarrhea, lower abdominal cramps, and tenesmus accompanied by fever, chills, anorexia, headache, and malaise
  • Stools are loose and mixed with blood and mucus. The abdomen is tender; dehydration is common
68
Q

Tx of Shigella

A

Bactrim or Cipro

69
Q

Syphillis is caused by

A

the spirochete Treponema pallidum and has increased in incidence over the last 10 years; it is associated with risk-taking behavior such as drug use. The disease has 3 phases, with an incubation period of about 3 weeks:

70
Q

3 types of Syphilis

A
  1. Primary syphilis: presents as a painless chancre in the genital or groin region persisting 3 to 6 weeks.
  2. Secondary syphilis: presents as an erythematous rash involving the palms and soles or a condyloma lata which is similar to the lesions of primary syphilis in its infectivity but differs in appearance.
  3. Tertiary syphilis (latent): Affects about 30% and is a representation of widespread systemic involvement and can present with major vessel changes, such as in the aorta, permanent CNS changes (neurosyphilis), or even benign mucosal growths called gummas.
71
Q

Dx and tx of Syphillis

A

Diagnosis is by RPR/VDRL and confirmed by treponemal antibody-absorption test (FTA-ABS). Lyme disease can cause a false positive.

Treatment is with

  • IM benzathine penicillin for primary and secondary disease
  • IV penicillin G (for Gummas) for congenital and late disease
72
Q

Where are clostridium tetani (tetanus) toxins found?

A

Clostridium tetani spores are ubiquitous in soil. The spores germinate in wounds where the bacteria produce a neurotoxin (tetanospasmin)

73
Q

Sx of tetanus

A

The first symptom is pain and tingling at the site of inoculation. Later muscle spasms, respiratory muscle tetany, and lockjaw

Uncontrolled spasm and exaggerated reflexes

*Puncture wounds are most susceptible. The elderly, migrant workers, newborns, and injection drug users are at particular risk

74
Q

What type of organism is tetanus?

A

Gram-positive organism

  • Neurotoxin
    • Transmission: Rusty nail
75
Q

Tx of tetanus

A
  • Treatment includes wound debridement, airway protection, benzodiazepines for muscle spasm, tetanus immune globulin immediately, and three doses of tetanus toxoid given by the standard schedule
  • Metronidazole or penicillin is also administered to destroy the organism and prevent toxin production

Prognosis: High mortality

76
Q

Cough, night sweats, weight loss, post-tussive rales, endemic area, immunocompromised

A

Mycobacterium tuberculosis

77
Q

Dx of Tuberculosis

A
78
Q

Mantoux Skin Test is positive if:

A

>5; pts at high risk like who have had TB in past, immunesupressed d/t HIV, or drugs, close contacts with infectious TB

>10 → some risk factors; injection drug users, prisons or homeless shelters , certain medical conditions

>15 in someone w/ no risks

79
Q

What are common s/e seen in RIPE drugs used to tx TB

A
  • Rifampin - Orange body fluids, hepatitis
  • Ethambutol - Optic neuritis, red-green blindness
  • Pyrazinamide - Hyperuricemia
  • Prophylaxis for household members: Isoniazid for 1 year
80
Q

Active TB treatment

A

RIPE for 8 weeks

81
Q

How is herpes zoster dx

A

Tzanck smear → Visualization of multinucleated giant cells

82
Q

Ramsey-hunt syndrome

A
  • Zoster Oticus (Ramsay-Hunt Syndrome): facial nerve (CN VII) otalgia, lesions on the ear, auditory canal and TM, facial palsy auditory symptoms

EOR - Internal Med (9 decks)

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