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General ID 2019 > Masquerades, ICU, pharyngitis, immuno > Flashcards

Masquerades, ICU, pharyngitis, immuno Flashcards

1
Q

Chitlins…you say?

A

Yersinia

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2
Q

Bulls eye - rash?

A

lyme disease (erythema migrans or STARI)

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3
Q

Behcet’s disease? treatment?

A

triad of aphthous oral ulcers, genital lesions, and recurrent eye inflammation. Can also have pustule at site of venipuncture. Tx with colchicine

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4
Q

Sweet syndrome?

A

sudden onset of fever and painful rash on the arms, legs, trunk, face, or neck. It’s also known as acute febrile neutrophilic dermatosis. Associated with acute luekmia

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5
Q

Pyoderma gangrenosum syndrome, dx and associations?

A
  • Painful, pathergy, purulent base, purple
  • Inflammation, irregular border
  • Erosions
  • Dx of exclusion
  • Exam
  • Rule out Labs (RF, APLS, Cryoglobulin, ANCA)
  • Microscopic evaluation (neutrophilic dermatosis)
  • GI disorders (IBD)
  • Arthritis (RA, PAPA)
  • Neoplasms (solid organ, MPN)
  • Genetic predisposiiton
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6
Q

Monospot test tests?

A

rapid test for EBV infection

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7
Q

what are the two types of HLH?

A

HLH is hemophagocytic lymphohistiocytosis. Primary (familal) or secondary - triggered by infections (EBV, HIV histoplasmosis) or malignancy (lymphoma/leukemia)

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8
Q

HLH clues?

A
  1. EBV or other infection with progressively symptoms
  2. elevated ferritin
  3. cytopenia with negative infectious evaluation
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9
Q

what are the Yamaguchi criteria?

A

This is for adult still’s disease:

Major:

  1. Fever for more than 1 week
  2. arthritis/arthralgia more than 2 weeks
  3. nonpruritic mac-pap rash during febrile episodes
  4. >10K Leukocytes with 80% granulocytes

Minor:

  1. Sore throat
  2. lymphadenopathy
  3. hepatosplenomegaly
  4. Abnormal LFts or LDH
  5. Negative ANA & RF
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10
Q

Clues to Adult Still’s disease?

A
  • Evanescent salmon colored rash
  • elevated ferritin
  • pharyngitis
  • Koebner phenomenon - rash elicited by stroking sin or areas of pressure
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11
Q

what are the infectious causes of Erythema nodosum?

A

SMORES SHINTS (Streptococci, Mycoplasma, OCP, Rickettsia, Eponymous (Behçet),Salmonella, Sulfonamides, Hansen’s Disease (Leprosy), IBD, NHL, TB, Sarcoidosis. Also, granulomatous infections, yersinia, and campylobacter

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12
Q

what is lofgren syndrome?

A

triad of hilar lymphadenopathy, acute arthritis, erythema nodosum

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13
Q

what are the buzz words for sarcoidosis?

A

hilar lymphadenopathy, erythema nodosum, uveitis, aspetic meningitis with basilar enhancement, non-caseating granulomas

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14
Q

what is kikuchi?

A

acute necrotizing histiocytic lymphadenitis

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15
Q

buzz words for kikuchi?

A

Young woman with acute onset of fever, cervical lymphadenopathy with atypical lymphocytes (mono-like syndrome) with lymph node biopsy showing necrotizing adenitis with histiocytosis

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16
Q

what is clinical characteristics of DRESS syndrome?

A

2-6 weeks after drug initiation with morbiliform rash, lymphadenopathy, facial edema with visceral invovlement (hepatitis, interstitial nephritis, interstitial pneumonitis). HIgh mortality, slow resolution with 6-9 weeks of relapse

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17
Q

what triggers do you need to look for in DRESS?

A

Allopurinol, anti-seizure drugs, vancomycin, raltegravir, dapsone, and sulfas

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18
Q

what is erythema multiforme?

A

immune mediated distinctive target lesions associated with oral, ocular, genital mucosal lesions that is self-limiting 10-14 days associated with infections, drugs.

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19
Q

what is the difference between SJS and TEN?

A

SJS<10% while ten>30%

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20
Q

characteristics of SJS/TEN?

A

fever with erosive mucositis of oral, urogenital, ocular sites between 4-28 days with partial/full thickness, painful necrolysis with fever 8-12 days. Leucopenia and no eosinphils. positive nikolsky sign

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21
Q

what is a positive nikolsky sign?

A

slight rubbing of the skin resulting in exfoliation of the outermost layer.

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22
Q

what are notorious non-infectious drugs associated with hyperthermia?

A

allopurinol, anticonvulsants, recreational drugs

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23
Q

what are the common antibiotics associated with hyperthermia?

A

sulfonamides, nitrofurantoin, beta lactams, minocycline

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24
Q

what are the things you need to think about with hyperpyrexia (T>41.5)?

A

NMS, malignant hyperthermia, serotonin syndrome

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25
Q

what is malignant hyperthermia?

A

Usually less than 1 hour, with muscle conraction, elevated CK, autosomal dominant associated with halothane, succinylcholine

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26
Q

what is neuroleptic malignant syndrome?

A

1-3 days within first 2 weeks with lead pipe rigidity, fever, associated with antiemetics like metoclopramide, antipsychotics. Tx with dantrolene adn dopamine agonists (bromocriptine)

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27
Q

what is serotonin syndrome?

A

6-24 hours of starting a drug/increasing dose with shivering , myoclonus, GI symptoms

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28
Q

what drugs are associated with serotonin syndrome?

A

Linezolid, SSRI inhibitors (buproprion), antiemetics (granisetron), TCA (amitriptyline)

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29
Q

what causative drugs associated with hypothermia?

A

beta blockers, alpha blockers, opioids, ethanol, antidepressants, antipsychotics, oral hypoglyemics

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30
Q

what signifies that a blood culture is likely due to line infection?

A

If blood culture drawn through IV line is 3 hours prior to blood culture drawn peripherally.

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31
Q

quick SOFA score calculation?

A
  1. AMS?
  2. RR>22?
  3. SBP<100

1 = low risk, 2 = intermediate risk, 3 = high risk

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32
Q

which antibacterials can be given through rapid infusion?

A

Meropenem (3-5 min), Ceftaroline (5-60 min), and daptomycin (10 min after mixing)

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33
Q

what are teh common pathogens associated with VAP?

A

Staph aureus, pseduomonas, klebsiella, enterobacter, E.Coli

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34
Q

Pneumonia with eosinphophils ddx?

A
  • Tobacco
  • Collagen diseases (wegners, eosinophilic granulomatosis with polyangitis)
  • Helminths (ascaris, strongyloides)
  • Fungi (cocici, bronchopulmonary aspergilosis)
  • Drugs (dapto, sulfa etc)
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35
Q

what is cryptogenic organizing pneumonia?

A

inflammation of the bronchioles with pneumonia like picture, nonresponsive to antibiotics. “organizing” means unresolved pneumonia in which alveolar exudate persists undergoing fibrosis in which fibrous tissue forms in teh alveoli, typically following bacterial infection. Treatment is steroids.

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36
Q

How would you characterize pharyngitis of group A strep?

A
  • Sudden onset
  • Fever
  • winter and spring
  • lymphadenopathy
  • exposure to close contact
  • Complications of peritonsilar and retrophyarngeal abscess
  • immunologic complications of rheumatic fever, glomerulonephritis
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37
Q

clinical characteristics of viral pharyngitis?

A
  • Cough, coryza, conjunctivitis
  • hoarseness and diarrhea
  • ulcerative stomatitis
  • red tonsils but not enlarged and purulent
38
Q

what is the modified centor score?

A

useful for negative predictive valvue to exclude streptococcal pharyngitis

  • Can’t Cough
  • Exudate
  • Neck adenopathy
  • Temperature elevation
  • OR: Age<15 + 1 and Age>44 - 1
39
Q

Strawberry tongue ddx?

A
  • group A strep
  • Staph Toxic shock
  • kawasaki disease
40
Q

what is the tx for GAS pharyngitis?

A

First line:

  • Benzathine PCN 1.2 M x 1
  • oral penicillin or amoxicillin x 10 days

Second line:

  • cephalosporin
  • macrolides
  • clindamycin
41
Q

what does arcanobacterium hemolyticum illness script?

A
  • young adult with fever, sore throat
  • scarlet fever like rash
  • negative strep test
42
Q

what type of abx and characteristics of arcanobacterium haemolyticum?

A
  • gram positive rod
  • scarletniform rash, most prominent on extremities
  • tx with azithromycin, clinda, penicillin
43
Q

what types of pharyngitis would you expect after receptive oral intercourse?

A
  • Neisseria gonorrhea (mimics strep pharyngitis, dx with NAAT)
  • HSV-1/2 with acute infection, nonspecific presentation with tonsilar erythema and exudates, lymphadenopathy with oral and genital ulcers
44
Q

what illness script is suggestive of adenovirus phyarngitis?

A

college kid with sore throat, fever, conjunctivitis with closed quarters.

45
Q

Hand, foot and mouth. Symptoms and organism?

A

Caused by an enterovirus (most common is coxsackie). If oral lesions only, herpangina.

sore throat, low grade fever, lesions on palms and soles with sick contacts

46
Q

Symptoms of oropharyngeal tularemia?

A

exudative tonsilitis, ulcers, swollen LAN, through the inadequately cooked game, rodent contamination, contaminated tap water (turkey).

47
Q

Dx and tx of oropharyngeal tularemia?

A

dx through culture and serology. Tx is streptomycin or doxycycline

48
Q

pharyngitis + chest pain

A

Lemierre syndrome caused by fusobacterium necrophorum.

49
Q

Describe Lemierre syndrome?

A
  • sore throat, chills, GI upset with new-onset cough and pleuritic chest pain
  • Septic phlebitis of the internal jugular vein
  • Often follows strep pharyngitis or mono
  • Causes septic pulmonary emboli
  • The classic cause is fusobacterium necrophorum, anaerobic GNR
50
Q

Describe epiglotttitis?

A
  • Fever, sore throat
  • Hoarse, drooling
  • thumb sign on lateral neck x-ray
  • H.Influenza B, pneumooccus
51
Q

Describe vincent angina?

A
  • Trench mouth/acute necrotizing ulcerative gingivitis
  • oropharyngeal pain, bad breath, sloughing of gingiva
  • mixed anaerobes
52
Q

Describe ludwig angina?

A
  • bilateral cellulitis of floor mouth often starts with infected molar
  • Fever, chills, drooling, dysphagia
  • mixed oral organisms (viridians, anaerobes)
53
Q

Bull neck, gray pseudomembrane association

A

Diptheria

54
Q

what does grey pseudomembrane mean?

A

diptheria; extends onto palate or uvula, bleeds when scraped

55
Q

what does TNF do?

A

fever acute phase response

56
Q

What conditions do you use TNF alpha blockers?

A

RA, Crohns, GVH, psoriasis

57
Q

GIve examples of TNF blocking agents?

A

I - CAGE

Infliximab - Remicade

Certolizumab - Cimiza

Adalimumab - Humira

Golimumab - Simponi

Etanercept - Enbrel

58
Q

what are viral infections associated with TNF blockade?

A

CMV, vzv, HBV, HCV

59
Q

what do TNF blockers basically do in respect for infections?

A

break down granulomas

60
Q

what do you need to screen for prior to initiating TNF blocking agents?

A

Screen for HBV, HCV, TB, probably HIV, h/o of exposure to endemic fungi.

Vaccinate at least 4 weeks prior to Rx for Influenza, pneumococcus, HBV, Zoster age>50, no live virus vaccines

61
Q

what bacterial infections associated with TNF blockade?

A

listeria monocytogenes, nocardia, salmonella, legionella, septic arthritis

62
Q

what things outside bacteria and fungi that are associated with TNF blockade?

A

Mycobacteria (NTM, TB) and Fungi (molds, PCP, candida, aspergillus)

63
Q

what happens if HCV is positive prior to TNF inhibitor initiation? What about HBs Ag positive?

A

Treat HCV if possible prior to TNF inhibitor. IF HBSAg positive, start entecavir or tenofovir

64
Q

what happens if HBsAb negative but HBcAb positive prior to initiation to TNF inhibitor?

A

Monitor LFTs and HBV q3 months and treat if positive

65
Q

what are IL-1 blockers used for?

A

RA and autoinflammatory syndromes

66
Q

Give examples of 3 agents that are IL-1 blockers?

A

Anakinra, rilonacept, canakinumab

67
Q

what are adverse events associated with IL-1 blockade?

A
  • Injection site reactions are common
  • URI
  • Dose-dependent reactions
68
Q

what do cytokine receptors use?

A

janus kinases

69
Q

what adverse events associated with Jakinibs?

A

dose dependent

Cytopenias

Intracellular infections (TB, Fungi, VZV)

70
Q

what is CAMPATH?

A
  • ALemtuzumab
  • CD52 target
  • Used for lymphoma, leukemia, BMT, (MS)
71
Q

what infections do you need to be wary of in patients that deplete lymphocyte T-cells?

A

Viral (CMV), bacterial, fungal especially PCP (Campath)

72
Q

what is muromonab used for and target?

A

Solid organ transplant

OKT3, CD3

73
Q

Drug regimen for prophylaxis for alemtuzumab?

A

CAMPATH. Start bactrim at the initiation of therapy. Stop 2 months post-therapy or CD4>200

74
Q

when do you use rituximab?

A

CLL, lymphoma, SLE, RA, MG

75
Q

Give examples of B-lymphocyte depleting immunosuppressants?

A

Rituximab, ibritumomab, ibrutinib

76
Q

what infections do you need to worry about with B-cell lymphocyte depleting drugs?

A

PML, occasional hypogammaglobulinemia

77
Q

when do you use Ibrutinib?

A

CLL, mantle cell, waldenstrom

78
Q

what infections do you need to worry about Rituximab?

A

HBV reactivation with case reports showing PML, CMV, cryptococcus, and PCP

79
Q

Give examples of adhesion blocking agents (2) and their use? Infection to be worried about?

A
  • Natalizumab (Tysabri) - MS, Crohns
  • Vedolizumab (Entyvio) - Crohns, UC
  • PML
80
Q

Give 2 examples of checkpoint inhibitors and their complications?

A

Pembrolizumab (Keytruda) and Nivolimab (opdivo)

Complications: Infection, autoimmunity, IBD, derepression of autoimmune tolerance

81
Q

which immunosuppresant associated with checkpoint augmentation and infection associated?

A

Abatacept (orencia, CTLA4 mimic), used for RA. Not much infection

82
Q

what is the MOA, and indication for Eculuzimab? Infection risk?

A
  • blocks terminal complement activation
  • Used for atypical HUS, PNH
  • Encapsulated organisms
  • Meningitis vaccine 2 weeks prior to administration
83
Q

Give two examples of anti-cancer drugs and their use?

A

Gemtuzumab (CD33, myelotarg) - AML

Bevacizumab (avastin, anti-VEGF), solid tumors, ocular for retinopathy

84
Q

what are the infections associated with anticancer drugs?

A
  • post-op bowel rupture
  • wound dehiscence
  • poor wound healing
85
Q

what complicated associated with anticytokine autoantibody of FIN?

A

disseminated OI

86
Q

what complicated associated with anticytokine autoantibody of EPO?

A

pure red cell aplasia

87
Q

what complicated associated with anticytokine autoantibody of IL-6?

A

staphylococcal infections

88
Q

what complicated associated with anticytokine autoantibody of G-CSF?

A

Felty syndrome (SANTA)

  • S: Splenomegaly
  • A: anemia
  • N: neutropenia
  • T: thrombocytopenia
  • A: Arthritis (Rheumatoid)
89
Q

what complicated associated with anticytokine autoantibody of GM-SCF?

A

pulmonary alveolar proteinosis (no surfectant)

90
Q

what complicated associated with anticytokine autoantibody of IL-17?

A

severe mucocutaneous candidiasis

General ID 2019 (19 decks)

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