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
2
Q
Sx of Botulism
A
Muscle weakness + resp paralysis “floppy babies”
3
Q
Tx of botulismn
A
Botulinum Antitoxin
4
Q
Sx of vaginal candidiasis
A
Vulvar itching, erythema, white curdy discharge
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
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
7
Q
Dx of Esophageal candidiasis
A
EGD w/ biopsy → Shows linear erosions
8
Q
Tx of esophageal candidiasis
A
Fluconazole
9
Q
Oral thrush sx and tx
A
Friable white plaques that bleed if scraped
Tx → Nystatin
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
11
Q
MC STI
A
Chlamydia
12
Q
Sx of chlamydia
A
Gram (-) Rods; Asymptomatic or dysuria
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
14
Q
In pregnant pts with chlamydia what is the tx
A
Azithromycin 1g PO single dose or Amoxicillin 500mg TID x 7 days
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
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
17
Q
Dx & Tx of cholera
A
Dx → Stool culture confirms
Tx → Oral rehydration + abx (macrolides, fluroqu, tetracyclines)
18
Q
Cryptococcus transmission
A
Through inhalation; Budding yeast found in soil contaminated with pigeon bird droppings
AIDS Defining illness
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
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
21
Q
How does CMV vary from mononucleosis
A
CMB can cause a syndrome similar to infectious mono but lacks severe pharyngitis
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
23
Q
Dx and tx of CMV
A
Dx → Visualization of owls eye inclusions in a cell
Tx → Ganciclovir, foscarnet, cidofovir
24
Q
URI with thick gray pseudomembrane in the throat that bleeds if scrapped in someone who wasn’t vaccinated
A
Diptheria
25
Sx of Diptheria
Neck swelling d/t enlarged cervical lymphadenopathy (bull neck)
26
Why is Diptheria rare?
* 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
27
Tx of Diptheria
Antitoxin and abx (PCN or macrolide)
28
Epstein Barr Mononucleosis sx
classic triad of **fever + lymphadenopathy + pharyngitis**
* [**Maculopapular rash**](https://smartypance.com/wp-content/uploads/2018/01/Mononucleosis-Rash.jpg) develops in 80% of patients **treated with ampicillin**
29
Dx and tx of Mononucleosis
Dx → Heterophile antibody screen (monospot) which may not appear in early illness (positive within 4 weeks)
Tx →Supportive
30
What should athletes with mono be cautious of?
* 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**
31
Gonococcal infection sx in women and men
Women → Often asymptomatic; prolong infection can lead to PID when bacterium levels travel to pelvis
Men → yellow, creamy, profuse and purulent discharge
32
Tx of gonococcal infections
Ceftriaxone 500mg IM x 1
+
Tx for chlamydia (azithromycin 1g PO single or Doxycycline 100mg BID x 7 days)
33
Complictions of gonococcal infections
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**
34
**AIDS-defining illness**, associated with **soil containing birds and bat droppings** in the **Mississippi and Ohio River Valleys**
Histoplasmosis
35
Sx of Histoplasmosis
Highest risk in HIV with CD4 \<100 → **Fever multiorgan failure; fulminant dz, septic shock, death**
36
Dx and tx of Histoplasmosis
Increased Alk phosph + LDH
(+) blood cultures if disseminated
Tx→ Itraconazole for weeks to months or Amp B if failed itraconazole
37
What dz are seen in HIV pts with CD4 200-500
TB, Kaposi Sarcoma, Thrush, Lymphoma, Zoster
38
What dz are seen in HIV pts with CD4 \<200
PJP and Histoplasmosis
Tx → TMP/SMX (bactrim) or Itraconazole
39
What dz are seen in HIV pts with CD4 \<100
Toxoplasmosis, cryptococcus
Tx with → TMP/SMX (Bactrim) or Fluconazole
40
Tx of the influenza A & B
**Dr. OZ →** Zanamivir and Oseltamivir tx both
41
Lyme dz is caused by
**Borrelia burgdorferi** (gram-negative spirochete) that is spread by **Ixodes (deer) tick**
42
What rash is associated with Lyme Dz
Non-painful, gradually expanding [**erythema migrans (EM)**](https://smartypance.com/wp-content/uploads/2018/01/Erythema-Migrans.jpg) **"bull's-eye” rash** appearing at the site of tick bite; feels warm to palpation; may itch
43
**Helminths** are **worm-like parasites** that infect several species. Those that **infect humans**
**What are the 3 main types**
**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
Tx of parasitic infections (worms)
**Roundworms →** Mebendazole
**Tapeworms and flukes →** Praziquantel
45
Malaria is caused by
Caused by Plasmodium vivax, p. malaria, p. ovale, p. falciparum (most virulent)
Transmitted via Anopheles mosquito
46
Dx & tx of Malaria
**Giemsa stain peripheral smear** (thin and thick) - parasites in RBCs, thrombocytopenia, increased LDH
Tx → **chloroquine** or **mefloquine** for chloroquine-resistant p. falciparum
47
**Pinworm infection**, also known as **enterobiasis vermicularis**, is a human parasitic disease caused by the pinworm (a type of roundworm) **Sx**
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
Dx and tx of pinworms
Dx → Scotch tape test done in early morning
Tx → Albendazole or mebendazole
49
What is the triad seen with toxoplasmosis
**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
What is the concern about toxoplasmosis and pregnant patients
**Pregnant female** with exposure **to cat feces:** Toxoplasmosis is the reason we tell pregnant mothers not to change cat litter
Infection to brain!
51
Dx and tx of toxoplasmosis
CT of the brain shows [**ring-enhancing lesions**](https://smartypance.com/wp-content/uploads/2017/12/Ring-Enhancing-Lesions-of-Toxoplasmosis.jpg)**.** Toxo IgG and IgM
Congenital toxoplasmosis is **part of ToRCH syndrome**
Treatment: Prophylaxis for all HIV patients with **CD4 count \< 100 with Bactrim**
52
Highly contagious respiratory tract infection marked by a s**evere hacking cough** followed by a h**igh-pitched intake of breath**
Whooping cough aka Pertussis
53
What are the 3 stages of whooping cough aka pertussis?
* Catarrhal stage: cold-like symptoms, poor feeding, and sleeping
* Paroxysmal stage: high-pitched **"inspiratory whoop"**
* Convalescent stage: residual cough (100 days)
54
Dx and tx of pertusssi
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
Ubiquitous yeast-like fungus (doesn't respond to antifungals) transmitted by aerosol route and **causes NO disease in immunocompetent patients.**
Pneumocystis or P. jiroveci
56
MC opportunistic infection in pts with HIV, especially if CD4 \<200
Pneumocystitis or p.jiroveci
57
Dx and tx of pneumocystisitis or P. jiroveci
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
Sx of Rabies
**Hydrophobia** (inability to swallow water) is a classic symptom. Pharyngeal spasms, aerophobia (fear of drafts of fresh air) and hyperactivity
59
Dx and tx of Rabies
Dx →Fluorescent antibody tests → [**Negri bodies**](https://smartypance.com/wp-content/uploads/2018/01/Negri-Bodies.jpg) (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
***Rickettsia*** ***rickettsii*** a species of bacterium that is spread to humans by the American **dog tick** (*Dermacentor variabilis*)
Rocky Mountain Spotted Fever
61
Sx of Rocky mountain spotted fever
2-14 days after tick bite will develop flu-like symptoms: **fevers** and **chills**, **myalgias**, and **headache**
Red maculopapular rash first on[**wrists and ankles**](https://smartypance.com/wp-content/uploads/2015/12/rocky-mountain-spotted-fever-s7-photos-of-rmsf-on-childs-angkles-and-wrists.jpg) **(palms** and **soles)** then spreading centrally over 2-3 days. The face is usually spared
62
Dx and tx of rocky mountain spotted fever
* **Indirect fluorescent antibody (IFA)** test remains the standard method of diagnosis of RMSF
Treat with **doxycycline** or chloramphenicol second line[DONE](https://smartypance.com/wp-admin/admin-post.php?action=mark_uncompleted&button=625980-rocky-mountain-spotted-fever)
62
Dx and tx of rocky mountain spotted fever
* **Indirect fluorescent antibody (IFA)** test remains the standard method of diagnosis of RMSF
Treat with **doxycycline** or chloramphenicol second line[DONE](https://smartypance.com/wp-admin/admin-post.php?action=mark_uncompleted&button=625980-rocky-mountain-spotted-fever)
62
Dx and tx of rocky mountain spotted fever
* **Indirect fluorescent antibody (IFA)** test remains the standard method of diagnosis of RMSF
Treat with **doxycycline** or chloramphenicol second line
63
What are the 2 types of salmonella
**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
Sx of Enteric fever salmonella
* GI symptoms may be marked constipation or **"pea soup diarrhea"**
* [**Rose spots**](https://smartypance.com/wp-content/uploads/2018/01/rose-colored-spots.jpg) may be present (2-3 mm papule on trunk usually)
* More common in the developing world (usually immigration cases)
65
Tx of Salmonella
Ceftriaxone
66
**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**)
**Shigella**
67
Shigella sx
* 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
Tx of Shigella
Bactrim or Cipro
69
Syphillis is caused by
**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
**3 types of Syphilis**
1. **Primary syphilis:** presents as a [**painless chancre**](https://smartypance.com/wp-content/uploads/2018/01/chancre.jpg) in the genital or groin region **persisting 3 to 6 weeks.**
2. **Secondary syphilis:** presents as **an erythematous rash** involving the [**palms and soles**](https://smartypance.com/wp-content/uploads/2018/01/Syphilis-Rash.jpg) 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**](https://smartypance.com/wp-content/uploads/2018/01/Syphilitic-Gumma.jpg).
71
Dx and tx of Syphillis
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
Where are clostridium tetani (tetanus) toxins found?
Clostridium tetani spores are ubiquitous in soil. The spores germinate in wounds where the bacteria **produce a neurotoxin** (tetanospasmin)
73
Sx of tetanus
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
What type of organism is tetanus?
**Gram-positive** organism
* Neurotoxin
* Transmission: Rusty nail
75
Tx of tetanus
* 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
Cough, **night sweats,** weight loss, post-tussive rales, endemic area, immunocompromised
Mycobacterium tuberculosis
77
Dx of Tuberculosis
* * Xray: [**cavitary lesions**](https://smartypance.com/wp-content/uploads/2018/12/tuberculosis.jpg)**,** infiltrates, [**ghon complexes in the apex of lungs**](https://smartypance.com/wp-content/uploads/2018/12/tuberculosis-x-ray-1.jpg)
* **Acid-fast bacilli stain**
* Biopsy: Caseating granulomas
78
**Mantoux Skin Test is positive if:**
**\>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
What are common s/e seen in RIPE drugs used to tx TB
* **Rifampin -** Orange body fluids, hepatitis
* **Ethambutol** - Optic neuritis, red-green blindness
* **Pyrazinamide** - Hyperuricemia
* Prophylaxis for household members: Isoniazid for 1 year
80
Active TB treatment
RIPE for 8 weeks
81
How is herpes zoster dx
Tzanck smear → Visualization of multinucleated giant cells
82
Ramsey-hunt syndrome
* **Zoster Oticus (Ramsay-Hunt Syndrome):** facial nerve (CN VII) otalgia, lesions on the ear, auditory canal and TM, facial palsy auditory symptoms
