Lbrdo IDS Flashcards
Major reservoir of bacteria in the body
GI tract
T/F infections are mostly normal flora
T
True about social history when considering infectious disease EXCEPT
a. ask for high risk behaviors like IV drug use, unsafe sexual behavior
b. potential gardening exposure to Sporotrix schenkii
c. risk of TB in funeral service worker
d. NOTA
D; all are true
Infections from raw or undercooked meat
a. E. coli
b. Toxoplasma Gondii
c. both
d. neither
C
Infection from unpasturized milk EXCEPT
a. Salmonella typhimurium
b. Legionella
c. L. Monocytogenes
d. M. Bovis
B
Infection from unpurified water EXCEPT
a. Leptospira
b. Vibrio
c. E. coli
d. NOTA
D; all are included
Infection from raw seafoods (3)
Norovirus
Helminths
Protozoa
What infections can be obtained from exposure to dog ticks?
Lyme disease
Rocky Mountain Spotted Fever
Erlichiosis
you can get Bartonella henselae from
Cats
reptiles:______
salmonella
rodents:______
leptospirosis
rabbits:______
tularemia
most likely infections from fresh water swimming
cryptosporidium
Giardia intestinalis
Amoebiasis
Definition of fever
T>38.3 deg celsius
For every 1degC increase in core temp, HR rises to
15-20bpm
Palpable epitrochlear lymph nodes
a. pathologic
b. physiologic
c. both
d. neither
A
T/F diagnostic testing should be limited to conditions that are likely lethal, important in terms of public health, providing differential diagnosis
F; not lethal, treatable dapat
elevations in neutrophils
a. bacteria
b. virus
c. parasite
A
Elevations in eosinophils
a. bacteria
b. virus
c. parasite
C
Elevations in lymphocytes
a. bacteria
b. virus
c. parasite
B
True about inflammatory markers
a. ESR and CRP are indirect but not direct markers
b. ESR and CRP are sensitive and spicific for inflammation
c. Elevated ESR of >90 has a 100% predictive value of a serious underlying pathology
d. NOTA
D
a. both direct and indirect
b. sensitive but not specific
c. Elevated ESR >100 has 90% predictive value
CSF gram stain _____ bacteria /ml –reliable positivity- specificity ~ 100%
> 10^5
Lymphocytic pleocytosis and low glucose- infection (3)
MTB
Listeria
Fungus
Non-infectious cause of CSF pleocytosis
malignancy
meningitis
sarcoidosis
True of obtaining cultures
a. culture of infected specimen or fluid mainstay of diagnosis
b. specimens should be collected before administration of antibiotics
c. culture of organism is important for identification, susceptibility, testing and for isolate typing during outbreaks
d. AOTA
D
mainstay of diagnosis in infectious diseases
culture
True of radiology EXCEPT
a. it is an adjunct to PE
b. it allows evaluation for LAD in mediastinum and intraabdominal sites
c. assessment for internal organs for evidence of infection
d. facilitates image guided percutaneous sampling of deep spaces
e. AOTA
B
The following should obtain an infectious disease consult
a. difficult to diagnose patient with presumed infections
b. patients not responding to treatment as expected
c. immunosuppresed
d. patients with exotic diseases
e. AOTA
E
True about treatment of infectious diseases EXCEPT
a. empirical antibiotic treatment should be given regardless of medical condition
b. for antibiotic treatment, general rule is to use a narrow spectrum as possible
c. empirical regimens are broad
d. AOTA
e. NOTA
A
In a febrile patient, this info on general appearance can give clue to critical illness
visible agitation or anxiety
These patients may not present with fever
a. elderly px
b. px with cirrhotic liver
c. px in glucocorticoid tx
d. px on NSAID
e. AOTA
f. NOTA
E
Importance of BP, HR, RR measurements
determines degree of hemodynamic and metabolic compromise
Skin finding seen meningococcemia or Rocky Mountain Spotted Fever, erythroderma
petechial rashes
Soft tissue examination- should be done to look for
areas of duskiness, edema, tenderness- necrotizing fasciitis
In acute endocarditis, how many sets of blood culture should be taken?
3 sets
Asplenic patients should have a buffy coat examined for
examined for bacteria - >10^6 organisms per ml of blood
A patient for lumbar tap but have papilledema, what should be done?
imaging first to evaluate risk of herniation
timing of antibiotics in patient with CNS infection
before imaging, after blood cultures have been drawn
Other infections require surgical intervention, give 2
necrotizing fasciitis
clostridial myonecrosis
adjunctive options for treatment:
bacterial mgt
dexamethasone
adjunctive options for treatment:
IV IgG given for
TSS
nectorizing fascitis by GA strep
In bacterial meningitis. which one is given first: steroids or antibiotics?
Steroid before antibiotics
glucocorticoids can be harmful with bad outcomes in
a. cerebral malaria
b. viral hepatitis
c. meningitis
All except C
True of sepsis without an obvious focus of infecion
a. patients with brief prodrome of non specific signs and symptoms which quickly progresses to hemodynamic instability
b. DIC is a poor prognostic sign
c. both
d. neither
C
True of septic shock EXCEPT
a. patients with bacteremia will progress to septic shock may have a focus of infection that is not evident initially
b. narrow spectrum antibiotics should be given within 2 hours of presentation
c. CRP/procalcitonin is not proven reliably in dx
d. CRP is helpful in de escalation of tx
B; broad spectrum, within the first hour
When should glucocorticoids be considered in severe sepsis?
Glucocorticoids should only be considered in severe sepsis who do not respond to fluid and vasopressor therapy
infections common in post/splenectomy
H influenza
Symptoms of babesiosis
SOB ecchymoses HA fever chills
Babesiosis symptoms will occur when?
1-4 weeks after tick bite
tick transmits borrelia Borgdorferi ( Lyme disease) and anaplasma
Ixodes scapularis
will present with febrile syndrome with hemolysis, jaundice, renal failure , hemoglobinuria. Mortality rate - >40 %
Babesia divergens
True about Babesiosis EXCEPT
a. sever babesiosis can happen in normal splenic function with underlying immunosuppression and malignancy with >55 y.o.
b. Babesia transmits borrelia borgdorferi
c. Ixodes scapularis will present with febrile syndrome with hemolysis, jaundice, renal failure, hemoglobinuria
d. NOTA
D
a. >60 y.o.
b. Ixodes scapularis - borrelia borgdorferi - lyme disease
c. Babesia divergens
True of meninggococcemia
a. presents with fever, headache, nausea, vomiting, myalgias, change in mental status, meningismus
b. rashi is pink, non-blancing, maculopapular
c. 20% of patients die
d. NOTA
A
b. blanching
c. 60% of patients die
in meninggococcemia:
Hypotension with petechiae for ______ associated with significant mortality
> 12 hours
T/F correction of protein S deficiency may improve outcome in meninggococcemia
F, protein C deficiency
T/F early initiation of treatment in meninggococcemia is life saving
T
infectious agent of rocky mountain spotted fever
Ricketsia ricketsii
True of rocky mountain spotted fever EXCEPT
a. History of travel or outdoor activity
b. half of patients with skin findings
c. nonblanching macules - wrist and ankles - trunk/extremities
d. lesions become petechial
e. AOTA
C
Treatment of rocky mountain spotted fever
Doxycycline
Cutaneous manifestation of DIC with large hemorrhagic bullae and ecchymotic areas
Associated primarily by N. Meningitides
Purpura fulminans
Purpura fulminans in spelenectomized patients etiologic agents
S. pneumo
H. influenza
S. aureus
Septic shock caused by pseudomonas/aeromonas hydrophila
Hemorrhagic vesicles surrounded by a rim of erythema with central necrosis and ulceration
Ecthyma gangrenosum
Ecthyma gangrenosum associated with (3)
burns
neutropenia
hypogammaglobulinemia
arthropod vector:
Lassa fever
arenaviridae
arthropod vector:
Rift valley fever
Bunyaviridae
arthropod vector:
hantavirus hemorrhagic fever
Bunyaviridae
arthropod vector:
ebola
filoviridae
arthropod vector:
yellow fever
flaviviridae
arthropod vector:
dengue
flaviviridae
arthropod vector:
margburg
filoviridae
often associated with trauma or surgery/can develop spontaneously
Incubation -12 to 24 hours and progress to massive necrotizing gangrene within hours
Clostridian myonecrosis
Gas gangrene etiologic agent
Clostridial myonecrosis
Clostridial myonecrosis:
skin over the affected area is
bronze-brown, mottled, and edematous
Clostridial myonecrosis:
Bullous lesions with serosanguineous drainage and a __________ odor can develop.
mousy or sweet
The following has poor outcome except:
a. coma
b. hypotension
c. meninggococcal etiology
d. respiratory distress
C; pneumococcal etiology
The following has poor outcome except:
a. CSF glucose level 0.3mmol/L
b. CSF protein level 3 g/L
c. peripheral WBC count 3000
d. serum sodium 136mmol/L
D Poor outcome: CSF glucose level of <0.6 mmol/L CSF protein level of >2.5 g/L peripheral white blood cell count of <5000/µL serum sodium level of <135 mmol/L
Most common symptom of brain abscess
headache 70%
Second most common symptoms of brain abscess
altered mental status 50%
Patient with brain abscess develop -sudden and severe deterioration in clinical status, what could have happened?
abscess rising hematogenously rupture into ventricular space
What are the stages of brain abscess?
encephalitis
localization
enlargement
rupture
Who are at risk of intracranial and spinal abscess?
Diabetes mellitus IV drug use chronic alcohol abuse; recent spinal trauma, surgery, or epidural anesthesia; and other comorbid conditions such as HIV infection
Intracranial Epidural Abcess (ICEAs) typically present as (3)
fever
mental status changes
neck pain
Spinal Epidural Abcess (SEAs) often present as (4)
fever
localized spinal tenderness
back pain
fever, mental status changes, and neck pain
a. Intracranial epidural Abscess
b. Spinal Epidural Abcess
A; B. fever localized spinal tenderness back pain
Outcomes -worse for
a. SEA due to MRSA
b. ICEA
A
Outcomes worse for SEA due to MRSA
a. higher vertebral body level
b. lower vertebral body level
A
Outcomes -worse for SEA due to MRSA
a. dorsal location
b. ventral location
A
Organisms involved in Acute bacterial endocarditis
S. aureus S. pneumoniae L. monocytogenes Haemophilus species streptococci of groups A, B, and G
Presentation of acute bacterial endocarditis
fever,
fatigue
malaise <2 weeks after onset of infection
PE findings in acute bacterial endocarditis
changing murmur and CHF Janeway lesions Petechiae Roth's spots Splinter hemorrhages
Swine flu
a. H5N1
b. H7N9
c. both
d. neither
D; H1N1
Avian flu
a. H5N1
b. H7N9
c. both
d. neither
C
high fever, an influenza-like illness, and lower respiratory tract symptoms; progress rapidly to bilateral pneumonia, acute respiratory distress syndrome, multiorgan failure, and death.
Avian flu/Swine flu
patients most at risk for swine/avian flu
children <5 years of age, elderly persons, patients with underlying chronic conditions, and pregnant women. Obesity also has been identified as a risk factor for severe illness.
Occurs in rural areas – WITH EXPOSURE TO RODENTS -present with a nonspecific viral prodrome of fever, malaise, myalgias, nausea, vomiting, and dizziness - to pulmonary edema and respiratory failure.
Hantavirus pulmonary syndrome
