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IPAP JUNIOR SEM. > KTK III > Flashcards

KTK III Flashcards

1
Q

A pt presents with a bite mark on their ear after having slept outside 5 days ago,

Today they are having
HA, malaise, chills, anorexia, fever, and pharyngitis, With a TINGLING FEELING around the bite mark

Starts to feel hydrophobia and aerophobia (laryngospasm)

What is the most reliable test for this condition?

What is the Tx?

A

This is rabies

Most reliable test is Nuchal Skin Biopsy

(Can also use a RFFIT test)

Saliva contains the virus

And you can see Niagara bodies on labs.

Tx: copious aggressive wound cleaning with 1 parts soap and 4 parts water

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2
Q

What is the pre vs post exposure prophylaxis for Rabies

A

Pre: IMM 1ml deltoid of days 0,7,21,28 (list of 7s)
With a booster in the deletion

Post:
No prior Vax: Days 0,3,7,14
(No vax, shorter days)
Prior Vax: Day 0 and day 3

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3
Q

What is the Tx drug for Rabies

Not prophylaxis

A

Immune Globin HRIG

Most or All solution in the wound, rest in the glute

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4
Q

A pt presents with irritability, diarrhea, abdominal pain, anal pruritus, and nasal pruritus, w/ blood diarrhea, increased appetite

You find eggs in the stool sample but no adult larvas

What is this condition and what is the Tx

A

Infection with H. Nana

Tx: praziquantel and supportive care

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5
Q

A pt presents with active and passive passage of proglottids in the stool with S/s of appendicitis and cholangitis, states they were eating raw beef and pork.

What is the condition and what is the appropriate Tx

A

T. Saginata (more) or T. Solium (less)

Tx: Praziquantel
Or surgery with more severe S/s

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6
Q

A pt presents with SZR after a trip from Korea (or Southern California) where they were eating raw/ undercooked pork

What is the condition and what is the Tx?

A

NeuroCysticercosis
(dissemination of T. Solium)
(PORK)
(MOST COMMON Parasitic INFX of the CNS)

Tx: supportive care for SZR

Surgical removal of Cysts if possible

Albendazole and or praziquantel+ dexamethasone

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7
Q

A pt presents with Asysmpotomatic subcutaneous nodules and calcified intramuscular nodules after eating raw/undercooked pork

What is the condition and what is the Tx for it?

A

Cysticercosis, test for T. Solium

Tx: Albendazole and.or praziquantel+ dexamethasone

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8
Q

A pt recently immigrated from Russian, with CC of fatigue, diarrhea, and extremity numbness, Tachycardia, and decreased DTRs with megaloblastic anemia, with proglottids in the stool ,

+sensations of hunger
+pruritus ani

Pt was eating raw fish from a fresh water local lake/ river

What is the condition and what is the TxOC ?

A

Diphyllobothriasis

Numbness comes from anemia
And B12/folate deficiency which causes low HH and a High MCV

TxOC: Vitmain supplementation
+ Praziquantel

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9
Q

A pt presents with abd pain and bloody diarrhea, and jump high fever, recently travelled to South America, where they were swimming in local creeks and rivers with ova present in the stool
+heptaosplenomegaly

What is the condition and what is the Tx of Choice

A

Schistosomiasis !!
Haematobium: Middle East/ Africa (BLADDER CANCER)

Japonicum; Far East

Mansoni : S. America, Africa, Middle East

Order Stool/urine labs between noon and 3 pm

Tx : Praziquantel

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10
Q

A pt presents with Fever, abd pain, hepatomegaly, Diarrhea, with intermediate biliary obstruction
After eating raw/ uncooked fish (raw watercrest)

What is the condition and what is the Tx of Choice

A

Fascioliasis

(Assoc with biliary and bladder d/o)

Find the eggs in the stool
Or can use a Fast-Elisa

Tx:L triclabendazole

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11
Q

A pt presents with wheezing and abd tenderness, after eating undercooked crawfish/ pickled crab,
S/s: diarrhea, fever, cough, urticaria, hepatosplenomegaly and pulmonary d/o

+hemoptysis/ Discolored sputum, CXR
(can look like tb)

What is the condition and the Tx of Choice

A

P. Westermani
(paragonimiasis)!!

Can order a EIA and CXR

Tx: praziquantel

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12
Q

A newborn presents with worm in the diaper, after a 6 week vacation in Central America/ southern United States,
(Or children running around bearfoot in the southern US)

S/s Abdominal pain and Diarrhea, with Loefflers syndrome, +urticarial rashes

Pts with DM, HIV, Cancer, or immunocomp are at increased risk

MOST SEVERE: meningitis and sepsis in immuno comp

What is the condition and the Tx of choice

A

Strongyloidiasis
(Strong assoc with barefootedness)

Test for larvae in the stool or EIA

TX: ivermectin and Albendazole

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13
Q

A pt presents with “ground itch” after walking around barefoot. Also has IRON DEFICIENCY ANEMIA +pica

What is the infection and Tx

A

Hook worm infection

Tx: Albendazole or Mebendazole

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14
Q

A pt is infected with the most common and largest helmith world wide, S/s Abdominal pain, and intestinal obstruction, ORAL EXPULSION OF WORMS and obstruction of biliray tract

What is the condition and Tx of Choice

A

Fecal oral contamination of ascariasis

Albendazole and/or mebendazole

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15
Q

A pt presents (age preschool age) with the most common helmith infection in the US,
S/s anal itching at night, and or recto vaginal fistulas

+ appendicitis features

What is the condition and Tx of Choice

A 
Order a scotch tape test 
For Enterobiasis (pinworm)

Tx: Mebendazole and food pt education or removing clothes and bed sheets

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16
Q

A 14 yr old pt presents with rash on his foot, and was walking around barefoot in the southern US, there is a snake like tunnel on his foot with intense pruritus and pain

What is the Condition and Tx of Choice?

A

Cutaneous larva migrans
(Ancyclostoma caninum!!!)

(Most common topically acquired dermatosis)

Tx: Albendazole and or Ivermectin and WEAR SHOES!

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17
Q

What is the infection of Toxocara canis (dog round worm)

A

Toxocariasis

Causes Viscearl and Ocular migrans from fecal oral contamination

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18
Q

A pt presents with fever, anorexia, wt loss, cough and wheezing, rashes, hepatosplenomegaly and hyper eosinophilia

With ophthalmic lesions and cataract appearance in the eye (kids)

What is the condition and Tx approach

A

Visceral or Ocular Larva migrans

From toxocariasis

Tx: albendazole and or mebendazole

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19
Q

A pt presents form eating undercooked bear or wild boar up in Alaska,
S/s N/V/D, with perioribital and facial edema, and very high fever, with myalgias, and weakness, with signifigant PAIN
And splinter hemorrhages
+conjuntavitis (FIRST SIGN)

What is the condition and what is the Tx of Choice

A

Trichinellosis

Can do muscle biopsy or EIA

Tx; Steroids and Albendazole and or mebendazole

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20
Q

A 28 year old male presents with abd pain and bloody diarrhea, after a trip to South America, has amebic liver abscess, +fever, fulminant colitis that can lead to necrotizing colitis, +/- rectovaginal fistulas

What is the condition, test of choice and Tx of choice

A

Test is Enteric Parasite Panel for Amebiasis

Tx Metromadiazole/ Tinidazole or
Iodoquinol or Paromomycin

With SRGRY for Fulminant Amebic Colitis

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21
Q

A 7 yo pt presents with decent onset of flatulence and malodorous stools (!!)

+difficulty sleeping with irritability
+wt loss
+signifigant abd pain

+troph in the stool (most common parasite in the stool)

What is the condition and the Tx

A

GIARDIASIS!! From fecal oral through water ingestion

Common in Southern states, Camping states, or daycares

(EPP) PCR Is test of choice

Tx:
Tinidazole/ metronidazole

No SRGY intervention/ may resolve spontaneous

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22
Q

A 26 year old male has a non healing ulcer on his calf after deployment to Syria/turkey/iraq

Lesion is 3 cm with rolled edges with a central crater with crusting/scabbing and moderate lymphadenopathy’

What is the condition and Tx

A

Leishmaniasis caused by the sand fly

S/s presents month after initial bite

Only Treat with more than 5 cm lesion!

Tx: is just good to know, get somone else to look at it
(infx Dz)

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23
Q

Where are the common places for visceral leishmaniasis and its s/s

A

India, Bangaladesh, Napal, Brazil, Sudan

Signif liver/spleen megaly where the spleen can be bigger than the liver with recurrent fevers

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24
Q

A 16 yr old female (CHILD) presents with nonbloody diarrhea (water) after working at a local pool/ water park
+Murphys sign
Infection in the jejunum

What is the condition and Tx of choice

A

Cryptosporididosis from contaminated recreational water,

Danger to pts with DC4 less than 200 (50)

Tx: If immuno comprimised tx with HAART

Im immunocompetent: May use nitazoxanide

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25
Q

21 yo female returns form hiking on the Appalachian (upper state)
S/S: Fatigue, fever, and a progresión of chills to fever to diaphoresis to prostration (KTK)
Without malaria exposure

+/- jaundice
+anemia
+thrombocytopenia

What is the condition and Tx

A

Babesiosis (tick bite)

Pts without spleen do particularly bad

Tx: Clindamycin +quinine
(Perferred)
+supportive care or hospitalization

26
Q

What is the mosquito that transmits Malaria

A

Anopheles mosquito

27
Q

A 23 yr male presents with N/V and fatigue, recently returned from Africa,

What is the condition and Tx approach

A

Think malaria until proven otherwise

28
Q

A pt presents with a cycle of Fever everything 24 hours from a mosquito bite

Think

A

Knowlesi

29
Q

A pt presents with a cycle of fever q 48 hours from mosquito bite

Think

A

Vivax or Ovale

30
Q

A pt presents with cycle of Fever q 72 hours from mosquito bite think

A

Malariae

31
Q

A pt presents with cyclic fever and headache

R/u? Tx?

A

Malaria

Found on Thick and thin smears, 12-24 hours apart

Tx: Start prophylaxis 1-2 weeks before trip and continue 2-4 weeks after return

32
Q

Why is P. Falcirumpium so bad?

A

It effects all red blood cells and causes severe anemia

33
Q

Should steroids be used to treated cerebral malaria

A

NO, it.will make it worse

34
Q

A 6 yr old female presents with multiple dog bites on her hand from a chihuahua

What is the most common pathogen assoc and what is the Tx

A

Pasturella multicida

And treat with Dogmentin

35
Q

A 6 yr old female presents with rash on her right arm, after playing with her cat,

Rash is small rep papules on the anterior aspect of the arm with +lymphadenopathy
+fever
+granulosas of the eyes/ conjunctiva

there are severe cat scratches on the arm

What is the condition and what is the tx

A

Bartonella henselae
(Cat scratch fever)

Tx: Azithromycin

36
Q

A 26 yr old female presents with fatigue and mild fever, she is pregnant and has cats at home.

You see scratches on her arm

What is a condition she is at risk for and what is the Tx ?

A

Toxoplasmosis (Gondii)
(Increased risk to fetus)

Tx: Pyrimethamine+ sulfa+ leucovorin!!

37
Q

What is the most common presentation of Toxoplasmosis

A

Encephalitis (order a HIV screen)

In newborns: chorioretenitis

38
Q

A pt presents with an abrasion from working in a Fish tank

Has a papule/ nodule at the site of the abrasion,

What is the condition and Tx:

A

M. Marinum infection

Tx: Clarithromycin and ethambutol

Or ethambutol+ rifampin

39
Q

A pt presents with nodules, plaques, and large ulcers after contact with Dogs from africa,

What is the condition and tX ?

A

Infection with M. Ulcerans

Tx: Rifampicic and Clarithryomycin for 8 weeks
With skin grafts and debridment

40
Q

A pt presents with macular lesions about 10 cm in diamonds and red nodules after contact with Armadillos

The skin lesions are accompanied by peripheral neuropathy
(Bilateral ulnar nerve neuropathy)

What is the condition and Tx?

A

M. Leprae
Dx: Skin scarpings AFB

Tx: rifampin, dapsone, and clofazimine for 12 months

Not treating leads to disfigurement and scaring (finger loss)

41
Q

A pt presents with skin and soft tissue infections after playing with frogs and turtles
(Can also be caused by tattoo shops in foreign areas)

A

M. Chelonae

Tx: Tobramycin or clarithromycin

42
Q

An 18 yo presents with fatigue, malaise, and leg pain x 3days

He recently returned from Hawaii (tropics) , and was hiking in rainforests.

+low grade fever
+icterus (severe)

What is the condition and tx ?>

A

Leptospirosis
(Most common zoonosis in the world)

Tx: IV pen G (severe)

Output: Doxy

43
Q

A pt presents with extreme lethargy, and flaccid paralysis, with leukopenia

What is the condition and tx

A

Encephalitis

Tx: supportive care

44
Q

What is the number one cause of Meningitis is children and adults
And what is the empiric tx

A

N. Meningitidis

Most common in neonates is group B strep

Tx: Cefotaxime or Ceftriaxone
+vancomycin
+Dexamethasone

45
Q

Listeria monocytogenes is an increased RSK to what pts

A

Pregnancy pts!! Causes meningitis

Also pts over 50, Alcohilics, Immunosuppresed pts

Tx: ampicillin and gentamicin

46
Q

An 80 yo male from New Guinea presents with twitching and jerking in his arms with short term memory loss

What is the condition and tx

A

CANNIBAL!

kuru, Jokab, Bovine spongiform
(Prion)

No treatment, always fatal

Always screen for transplants

47
Q

What is the ABX for gonorrhea

A

Ceftriaxone

48
Q

What are the 4 pressure injury stages for Skin ulcers

A

Stage.1: intact skin, with non blanchable redness

Stage 2: Partial thickness loss of dermis presenting as a shallow open ulcer without slough, may also be and intact or open blister. Presents as a shiny or dry shallow ulcer.

Stage 3: Full thickness tissue loss, subcutaneous fat, slow, necrotic tissue may be visible

Stage 4: Full thicknesss with exposed bone

49
Q

Pts with sickle cell dz who develop osteomyelitis are commonly infected with what agent

A

Salmonella

50
Q

If you suspect MRSA, what is the ABX OC

A

Vancomycin

51
Q

FOr Non resistant staph what is the ABX OC

A

Nafacillin or Oxacillin

52
Q

A pt presents after stepping on a nail through the tennis shoe, what is the ABX OC

A

Ciprofloxacin

53
Q

What is the Tx for all rickettsial Dz

A

Doxy

54
Q

A pt presents 1-2 weeks after having been bit by body louse

With Fever, HA, Rash starting in the trunk that spreads to the extremities

Following a macules to maculopapules to petechia pattern

Think

A

Louse borne typhyus

Tx: Doxy

55
Q

What rickettsial Dz is assoc with homelessness

A

Murine Typhus/ Louse Bourne

56
Q

A pt presents after being bitten by a Wood tick/ Dog tick

A

Rickettsia rickettsii (RMSF)

57
Q

What is the day to day progression of RMSF

A

Day 1-2 abrupt onset of high fever and HA

DAy 2-3 faint rash starts on wrists ankles then spreads centrally
+abd pain, + vomiting, +cough
+dyspnea +calf tenderness, + peri orbital edema

Day 5-7 
Progression of fever above 104F 
\++dyspnea 
\++abd pain 
Rash spreads to Soles and palms. 
Day 7-9 Rash turns into purpura, and begins necrosing of the digits leading to gangrene 
\+septic shock 
\+ renal failure 
\+ARDS 
\+death
58
Q

A pt presents with a fever and HA, chest pain, and cough
There is NO RASH
+/-pneumonia/ pleural effusion
After working in a slaughterhouse/ animal fluids

What is the condition and tx of choice

A

Q fever

Doxy

59
Q

A 28 yo male presents complaining of feeling out of it the last two week, +R Knee pain, +fever, Chills, Myalgias, and tender Adenopathy
He is an avid hiker,
PHx of a strange rash on his fish arm that resolved spont
(Erthyema Migrans 7-14 days after bite)
(Target lesion)

What is the condition and tx OC

A

Lyme Dz

Will later present with fever, conjunctivitis, and meningitis, and cranial nerve 7 (Bell’s palsy)
(Add 10 day taper of steroids)

Late late with effect the heart (carditis leading to AV heart blocks)

Tx: Doxy except when pregnant
Amoxicillin in pregnancy

60
Q

What is the Hallmark of Late stage Dz of Lyme Dz

A

Arthritis

IPAP JUNIOR SEM. (43 decks)

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