KTK III Flashcards
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?
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
What is the pre vs post exposure prophylaxis for Rabies
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
What is the Tx drug for Rabies
Not prophylaxis
Immune Globin HRIG
Most or All solution in the wound, rest in the glute
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
Infection with H. Nana
Tx: praziquantel and supportive care
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
T. Saginata (more) or T. Solium (less)
Tx: Praziquantel
Or surgery with more severe S/s
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?
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
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?
Cysticercosis, test for T. Solium
Tx: Albendazole and.or praziquantel+ dexamethasone
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 ?
Diphyllobothriasis
Numbness comes from anemia
And B12/folate deficiency which causes low HH and a High MCV
TxOC: Vitmain supplementation
+ Praziquantel
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
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
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
Fascioliasis
(Assoc with biliary and bladder d/o)
Find the eggs in the stool
Or can use a Fast-Elisa
Tx:L triclabendazole
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
P. Westermani
(paragonimiasis)!!
Can order a EIA and CXR
Tx: praziquantel
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
Strongyloidiasis
(Strong assoc with barefootedness)
Test for larvae in the stool or EIA
TX: ivermectin and Albendazole
A pt presents with “ground itch” after walking around barefoot. Also has IRON DEFICIENCY ANEMIA +pica
What is the infection and Tx
Hook worm infection
Tx: Albendazole or Mebendazole
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
Fecal oral contamination of ascariasis
Albendazole and/or mebendazole
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
Order a scotch tape test For Enterobiasis (pinworm)
Tx: Mebendazole and food pt education or removing clothes and bed sheets
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?
Cutaneous larva migrans
(Ancyclostoma caninum!!!)
(Most common topically acquired dermatosis)
Tx: Albendazole and or Ivermectin and WEAR SHOES!
What is the infection of Toxocara canis (dog round worm)
Toxocariasis
Causes Viscearl and Ocular migrans from fecal oral contamination
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
Visceral or Ocular Larva migrans
From toxocariasis
Tx: albendazole and or mebendazole
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
Trichinellosis
Can do muscle biopsy or EIA
Tx; Steroids and Albendazole and or mebendazole
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
Test is Enteric Parasite Panel for Amebiasis
Tx Metromadiazole/ Tinidazole or
Iodoquinol or Paromomycin
With SRGRY for Fulminant Amebic Colitis
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
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
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
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)
Where are the common places for visceral leishmaniasis and its s/s
India, Bangaladesh, Napal, Brazil, Sudan
Signif liver/spleen megaly where the spleen can be bigger than the liver with recurrent fevers
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
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
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
Babesiosis (tick bite)
Pts without spleen do particularly bad
Tx: Clindamycin +quinine
(Perferred)
+supportive care or hospitalization
What is the mosquito that transmits Malaria
Anopheles mosquito
A 23 yr male presents with N/V and fatigue, recently returned from Africa,
What is the condition and Tx approach
Think malaria until proven otherwise
A pt presents with a cycle of Fever everything 24 hours from a mosquito bite
Think
Knowlesi
A pt presents with a cycle of fever q 48 hours from mosquito bite
Think
Vivax or Ovale
A pt presents with cycle of Fever q 72 hours from mosquito bite think
Malariae
A pt presents with cyclic fever and headache
R/u? Tx?
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
Why is P. Falcirumpium so bad?
It effects all red blood cells and causes severe anemia
Should steroids be used to treated cerebral malaria
NO, it.will make it worse
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
Pasturella multicida
And treat with Dogmentin
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
Bartonella henselae
(Cat scratch fever)
Tx: Azithromycin
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 ?
Toxoplasmosis (Gondii)
(Increased risk to fetus)
Tx: Pyrimethamine+ sulfa+ leucovorin!!
What is the most common presentation of Toxoplasmosis
Encephalitis (order a HIV screen)
In newborns: chorioretenitis
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:
M. Marinum infection
Tx: Clarithromycin and ethambutol
Or ethambutol+ rifampin
A pt presents with nodules, plaques, and large ulcers after contact with Dogs from africa,
What is the condition and tX ?
Infection with M. Ulcerans
Tx: Rifampicic and Clarithryomycin for 8 weeks
With skin grafts and debridment
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?
M. Leprae
Dx: Skin scarpings AFB
Tx: rifampin, dapsone, and clofazimine for 12 months
Not treating leads to disfigurement and scaring (finger loss)
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)
M. Chelonae
Tx: Tobramycin or clarithromycin
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 ?>
Leptospirosis
(Most common zoonosis in the world)
Tx: IV pen G (severe)
Output: Doxy
A pt presents with extreme lethargy, and flaccid paralysis, with leukopenia
What is the condition and tx
Encephalitis
Tx: supportive care
What is the number one cause of Meningitis is children and adults
And what is the empiric tx
N. Meningitidis
Most common in neonates is group B strep
Tx: Cefotaxime or Ceftriaxone
+vancomycin
+Dexamethasone
Listeria monocytogenes is an increased RSK to what pts
Pregnancy pts!! Causes meningitis
Also pts over 50, Alcohilics, Immunosuppresed pts
Tx: ampicillin and gentamicin
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
CANNIBAL!
kuru, Jokab, Bovine spongiform
(Prion)
No treatment, always fatal
Always screen for transplants
What is the ABX for gonorrhea
Ceftriaxone
What are the 4 pressure injury stages for Skin ulcers
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
Pts with sickle cell dz who develop osteomyelitis are commonly infected with what agent
Salmonella
If you suspect MRSA, what is the ABX OC
Vancomycin
FOr Non resistant staph what is the ABX OC
Nafacillin or Oxacillin
A pt presents after stepping on a nail through the tennis shoe, what is the ABX OC
Ciprofloxacin
What is the Tx for all rickettsial Dz
Doxy
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
Louse borne typhyus
Tx: Doxy
What rickettsial Dz is assoc with homelessness
Murine Typhus/ Louse Bourne
A pt presents after being bitten by a Wood tick/ Dog tick
Rickettsia rickettsii (RMSF)
What is the day to day progression of RMSF
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
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
Q fever
Doxy
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
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
What is the Hallmark of Late stage Dz of Lyme Dz
Arthritis
