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[2b] A- step 2 CK > Medicine-Infectious Disease > Flashcards

Medicine-Infectious Disease Flashcards

1
Q

What is the single question screening for EtOH abuse

A

How often do you have 5 (4 in Women) drinks in one occasion?

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2
Q

What’s the most common type of transfusion rxn and what’s the etx? tx?

A

Febrile Non-Hemolytic transfusion rxn; blood being transfused contains accumulated cytokines; tx = APAP

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3
Q

Describe [FUO-Fever of Unknown Origin];

It has 4 types - describe Classic -3

A

FUO = Prolonged Fever w/out established etx

  1. > 3 weeks
  2. Dx still uncertain after 3 days
  3. at least 3 hospitilization or outpatient visits
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4
Q

Which vaccines should be given to HIV pts with CD4 LESS THAN 200?-4

A
  1. Pneumococcal
  2. Flu (inactivated)
  3. Hep A
  4. Hep B
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5
Q

Objective findings for Mycobacterium Avium Complex-4

A

Widespread Reticuloendothelial system involvement…

  1. [Hepatomegaly –> ⬆︎AT(Aminotransferases) & ALP]
  2. Splenomegaly
  3. LAD
  4. ⬆︎Lactate DeHydrogenase
    * MAC pts have Fever/Diarrhea/Wt loss*
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6
Q

tx for Mycobacterium Avium Complex-3

A

REC the MAC

Rifabutin

Ethambutol

Clarithromycin

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7
Q

In HIV pts, when is px against MAC indicated? Name the px

A

CD4 < 50; Azithromycin

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8
Q

In HIV pts, when is px against Toxoplasmosis Gondii indicated? Name the px

A

CD4 < 100; Bactrim

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9
Q

In HIV pts, when is px against PCP indicated? Name the px

A

CD4 < 200; Bactrim

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10
Q

CD4 Count Normal range

A

500 - 1500 cells/µL

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11
Q

Best immediate tx for Septic pt is _____

A

[10-20 cc/kg Fluid Resuscitation (NS vs LR) over 30 min]

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12
Q

Which organisms usually cause UTI-associated Sepsis?-4

A

KEEP away, UTI!

Klebsiella

E.Coli

Enterococcus

Proteus

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13
Q

How does Fever affect volume status?

A

Fever –> ⬆︎Metabolism –> DEHYDRATION & Inflammation

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14
Q

Initial mngmt of Bacterial Meningitis-4

A

FBLA

1st: Fluid Resuscitation
2nd: Blood Cx
3rd: Lumbar puncture BEFORE ABX (unless pt requires Head CT 1st or is critically ill and can’t receive lumbar puncture)

**4th**: Abx: VACS Empirically (Vanc,AmpicillinGent,CefTriaxone,Steroids)

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15
Q

Which bacteria cause Meningitis in pts 0-6 mo.

A
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16
Q

Which bacteria cause Meningitis in pts 6 mo. - 6 yo

A
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17
Q

Which bacteria cause Meningitis in pts 6 yo - 60 yo

A
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18
Q

Which bacteria cause Meningitis in pts > 60 yo

A
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19
Q

Fever, Weight loss and Night sweats should always make you think about _____

A

lymphoma! (These are B symptoms)

FML “fuck my life”: Fever/Mnight sweats/Loss wt

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20
Q

Common causes of FUO in general pop -8

A
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21
Q

When should PEP (Post Exposure Px) for incidental HIV exposure began? ; What regimen should be given? ; for how long?

A

WITHIN 72 HOURS

Triple drug regimen

28 days long!

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22
Q

MIC for moderate resistant? MIC for VERY resistant?

A

MIC moderate resistant = (0.1-1)

MIC VERY RESISTANT = ( > 1)

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23
Q

Tx options for Cellulitis -5

A
  1. Clindamycin ***
  2. Bactrim
  3. Vancomycin
  4. Cephalexin
  5. Zosyn
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24
Q

Empiric tx for Meningitis-4 (before cx returns)

A

Good MDs VACS out the meninges!

Vanc + Amp + CefTriaxone + [Steroids for Strep]

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25
Q

Pyuria indicates UTI. What is the WBC for Pyuria?

A

>10 WBC on hpf

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26
Q

Empiric Abx for Sepsis -4

A

Choose one…

  1. CefTriaxone
  2. Zosyn
  3. Aztreonam
  4. Carbapenem
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27
Q

Brudzinski’s sign is used to diagnose ____. Describe it

A

Meningitis; Involuntary hip flexion when neck is passively flexed

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28
Q

Kernig sign is used to diagnose ____. Describe it

A

Meningitis; With hip flexed 90º, Knee extension –> ⬆︎neck pain & resistance

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29
Q

Why are pts Suspected of bacterial meningitis placed on ___ precauation?

A

Droplet precaution UNTIL NEISSERIA MENINGITIDIS IS RULED OUT!

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30
Q

Organisms requiring Droplet precaution -6

A
  1. Flu
  2. Rhinovirus
  3. Neisseria Meningiditis
  4. GASP
  5. Bordatella
  6. Adenovirus
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31
Q

Organisms requiring AIRBOURNE (and not just droplet) precaution -6

A
  1. TB
  2. Varicella
  3. Smallpox
  4. Measles Rubeola
  5. MERS
  6. SARS

Airbourne = N95 Facemask + Negative Pressure Room

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32
Q

Most common pathogens for Hospital Acquired Infection-8

A
  1. Staphylococcus aureus
  2. Enterococcus
  3. E. coli
  4. Coag neg staph epidermidis
  5. Candida
  6. Klebsiella and oxytoca
  7. Pseudomonas
  8. Enterobacter
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33
Q

Describe Serology for Hepatitis B -7

A

S - SEC - SCEb - Core - CEbSAb - CSAB - SAb

  • unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
  • CSAB = RESOLVED HEP B INFECTION*
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34
Q

Physiology of Chills-2

A

Infection–>Cytokines–>influences hypothalamus to ⬆︎ body temp set point–>

  1. Muscles repetively contract (shivering)
  2. Peripheral vasoconstriction–> “cold” sensation
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35
Q

Complications of PNA -3

A
  1. SEPSIS
  2. Parapneumonic effusion–> Empyema
  3. Pulm vessel infiltration –>Seeding (Heart, Meninges)

Consider these when pt treated for PNA isn’t getting better

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36
Q

Which vaccines are given to a s/p PNA pt?-2 ;What are their Risk/Benefit

A
  1. Flu: Risk= less effective in elderly / Benefit= ⬇︎mortality & occurrence
  2. Pneumococcal: Risk=does NOT ⬇︎ occurrence / Benefit= does ⬇︎ invasive dz from S.Pneumo
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37
Q

Tx for Bacterial endocarditis - 3

A
  1. Staph coag + / MRSA= Vanc
  2. Staph coag - = Vanc
  3. Strep Virdans = CefTriaxone or PCN G aqueous IV
  4. Enterococcus = [amp/PCN + gent]
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38
Q

Major culprits of Bacterial endocarditis - 4

A
  1. Staph coag + / MRSA= Vanc
  2. Staph coag - = Vanc
  3. Strep Virdans = CefTriaxone or PCN G aqueous IV
  4. Enterococcus = [amp/PCN + gent]
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39
Q

Name the mainstay Drugs for Staph Aureus (8)

A

i Love Crazy Crazy Deranged Boys N’ TV

  1. Linezolid
  2. Clindamycin
  3. [CefTaroline 5° generation]
  4. Daptomycin
  5. [Bactrim - Skin Infection]
  6. [Nafcillin - MSSA only]
  7. Tigecylcine
  8. Vancomycin
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40
Q

Classic Sx Triad of Brain Abscess

A
  1. Fever
  2. HA
  3. Focal Neuro changes (seizure)
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41
Q

A Single ring-enhancing Brain Abscess in non-immunocompromised pt results from what organisms?-2 ; How would you diganose this?

A

Staph Aureus vs Strep Viridans ; CT-guided aspiration for cx

Toxo and Nocardia would occur in immunocomp pts

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42
Q

Tx for Neurosyphillis

A

IV PCN x 10-14 days

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43
Q

In an immunocompromised pt, EBV DNA in the CSF raises suspicion for what condition?

A

Primary CNS lymphoma

MRI: Solitary Weakly ring-enhancing mass in periventricular region

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44
Q

Describe the MRI findings for Primary CNS lymphoma

A

Solitary Weakly ring-enhancing mass in periventricular region

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45
Q

You find this MRI in an immunocompromised pt

Identify Disease

A

PML (Progressive Multifocal Leukoencephalopathy) 2/2 [John Cunningham Polyoma Virus]

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46
Q

What are the 2 environments Clostridium Botulinum likes to germinate spores?

A
  1. Improperly Canned Foods
  2. Cured Fish

Tx = Equine Heptavalent Antitoxin

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47
Q

MOD for [Carcinoid Syndrome Heart Disease]

A

[R sided endocardial fibrosis] —> [Pulmonic and Tricuspid Valve Stenosis] or [Restrictive Cardiomyopathy]

CarcinoiD Syndrome: (Cutaneous Flushing)/Diarrhea/(SOB wheezing)

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49
Q

Describe [Libman Sacks Endocarditis]

A

[Non-bacterial wart-like vegations] accumulate on either side of a heart valve –> Fibrotic Valve Thickening–> MI

Associated with SLE Lupus

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50
Q

What 2 diseases is Streptococcus Gallolyticus Bovis associated with?

A
  1. [SBE-SubAcute Bacterial Endocarditis in pts WITH COLON INVOLVEMENT] (Aortic Regurgitation) (SBE also caused by Strep Viridans or Mutans)​
  2. [GI Lesions –> Colon CA]

AKA S. Bovis

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51
Q

Name the manifestations of Infective Endocarditis (7)

A

“Bacteria FROM JANE”

Fever

[Retinal Roth Spots - Immunologic phenomena]

[Osler “Ouch” Nodes- Immunologic phenomena]

[MVP with regurgitation]

[Janeway lesions on palms/sole]

Anemia

[Nailbed Subungal Splinter Hemorrhages] - shown in image

[Emboli from valvular vegetations] - may appear as abscesses or nodular cavities on imaging!

These will be accompanied by ⬆︎⬆︎⬆︎ESR

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52
Q

Which Dz’s cause EITHER OR Mitral vs. Tricuspid Regurgitation (2)

A

Rheumatic Fever and [Infective Endocarditis]

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53
Q

What are the 2 major concerns for Kidneys in IV drug users?

A
  1. renal ischemia 2/2 septic emboli
  2. Immune-mediated Glomerulonephritis
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54
Q

Hydatid Cyst with eggshell calcification are caused by _______. ; What is the definite host for this?

A

Echinococcus granulosus ; DOGS

cyst reside in sheep(intermediate host), which are fed to dogs. Dog poop contaminates water/food, and that water/food is consumed by Humans. Eggs hatch in small intestine, penetrate wall and travel to Liver where Hydatid cyst form

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55
Q

Pyogenic liver abscess follows after what 3 events?

A

Surgery, GI infxn, appendicitis

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56
Q

What is the triad for Congenital Rubella Syndrome? ; How do you prevent this?

A
  1. BL Cataracts
  2. PDA
  3. Sensorineural hearing loss

Live Rubella vaccine prior to conception

Dx = Rubella IgM vs PCR (Transmission occurs 1st trimester)

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57
Q

Describe the cutaneous manifestation of blastomycosis

A

well circumscribed raised violaceous (wart like) nodules which –> into microabscess

Blastomycosis causes Skin, Bone and Pulmonary findings

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58
Q

Describe cutaneous Sporotrichosis

A

pustular and ulcerated lesion localized to site of inoculation

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59
Q

Clinical presentation for Vertebral Osteomyelitis-4 ; Dx?-3

A
  1. FOCAL SPINAL TENDERNESS
  2. Back pain
  3. Fever +/-
  4. ⬆︎ESR>100 and/or ⬆︎Platelets but with normal spinalXR (WBC may be normal!)

Dx = [spinalXR, Bcx, ESR/CRP] –> MRI –> [CT guided bx]

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60
Q

Most common causes of Travelers’ Diarrhea - 4

A
  1. Giardia
  2. CryptoSPoridium (parasite) - can still occur in immunocompetent pts!
  3. Cyclospora
  4. ETEC

Profuse watery diarrhea after traveling

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61
Q

Describe the oral involvement for Hand Foot Mouth disease (Coxsackie A)

A

grayish vesicles on the tonsillar pillars and posterior oropharynx that –> fibrin-coated ulcerations

doesn’t have to have hand or foot involvement

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62
Q

Dx for EBV infectious mono - 2

A
  1. Monospot Heterophile Ab test (only accurate after 1st week of sx)
  2. Anti-EBV ab test

No sports for ≥3weeks because of splenomegaly!

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63
Q

What is the management for a pt who comes in with a tick on their arm? - 2

A

REMOVE TICK with forceps

+

Abx px/tx within 3 days only if..

  1. pt is symptomatic
  2. if tick is attached ≥36hrs OR
  3. Tick is engorged OR

Abx = Doxy OR [Amoxicillin if pt <8 yo]

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64
Q

Triad for Disseminated Gonococcal infection

A

STD

  1. Several migratory arthralgias
  2. Tenosynovitis pain along tendon sheaths
  3. Dermatitis pustular rash

pts may NOT have urinary or pelvic sx with Disseminated Gonococcal infection!

65
Q

What are the most common causes of viral aseptic meningitis in kids - 2

A
  1. Echovirus
  2. Coxsackie
66
Q

What are the 4 examples of Strep Viridans

A

the Viridan MOMS

  1. Mutans
  2. Oralis
  3. Mitis
  4. Sanguinis
67
Q

clinical presentation for Walking Atypical PNA - 3

A
  1. INCESSANT DRY COUGH in teen/young adult/military
  2. nonexudative pharyngitis
  3. Fever malaise

CXR = ⬆︎interstitial infiltrates +/- pleural effusion

68
Q

Identify

A

Erysipelas from GASP

Erythematous, warm, tender, rash with raised demarcated borders +/- external ear involvement

69
Q

What are the 4 px recommendations for HIV pts with CD4 < 200

A

Poor HIV, Treat Me

70
Q

When can pts with pyelonephritis be transitioned to PO abx?

A

If sx are improved at the 48 hour mark pts can be transitioned to PO (i.e. Bactrim or Levofloxacin) abx

71
Q

Pt presents with splenic abscess

What are the risk factors for splenic abscess? - 5

A
  1. INFECTIVE ENDOCARDITIS
  2. IVDA
  3. Immunosuppression
  4. Trauma
  5. Hemoglobinopathy
72
Q

Pt presents with 2 month productive cough

dx?

A

Reactivation TB

(cavitary UPPER lung lesion)

This is different from Aspiration PNA since Aspiration PNA occurs in LOWER lobes

73
Q

A family member is diagnosed with Bordatella Pertussis

Which abx is given? ; Should the other family members receive anything?

A

Macrolides ; ALL CLOSE CONTACTS should receive Macrolide px

74
Q

Organisms associated with Bloody Diarrhea - 6

A

Inflammatory Bloody diarrhea is not SEECSY!

  1. Shigella
  2. EColi EHEC - shiga toxin
  3. Entamoeba histolytica
  4. Campylobacter
  5. Salmonella
  6. Yersinia Enterocolitica
75
Q

Diagnosis?

A

Swiss Cheese Head CT

Neurocysticercosis from Taenia cestaode helminths

76
Q

How does transmission of Hydatid cyst to Humans occur?

A

Echinococcus granulosus

cyst reside in sheep(intermediate host), which are fed to dogs. Dog poop contaminates water/food, and that water/food is consumed by Humans. Eggs hatch in small intestine, penetrate wall and travel to Liver where Hydatid cyst form

Dx = US / Tx = [Cyst<5cm=Albendazole]

77
Q

Most esophagitis in HIV pts is caused by _____. When is this NOT the case?

A

Candida; pts with sole odynophagia who have no thrush nor difficulty swallowing = viral (HSV, CMV) esophagitis

78
Q

When is the TDaP vaccine substituted for the booster in adults?-2

A
  1. Pt never got TDaP as an adult
  2. Pt’s vaccine hx is unknown

People should receive TDaP vaccine once at 11 yo and once as an adult. THEN, they switch to booster q10 years

79
Q

When is the 13 valent pneumococcal vaccine recommended?-2 ; What about the 23 valent pneumococcal vaccine?

A

13 = [Adults ≥65 yo x 1 –> PCV23 6 mo later] OR [Adults <65 yo with RF x 1 (SickleCell/CochlearImplant/RenalFailure/HIV)]

23 alone = [Adults <65 yo with RF x 1] (Heart/Lung/Liver/DM/Smoker)

80
Q

Diagnosis?

A

Miliary TB

CP: SLOW progression of fever, wt loss, night sweats, COUGH

81
Q

Where are the most common sites for Kaposi Sarcoma?- 4

A
  1. Face
  2. Mouth
  3. Genitals
  4. Legs

papules –> violaceous plaques or nodules

82
Q

What are the most common organisms to cause Sinus infection (Rhinosinusitis)? - 3 ; Tx?

A

Strep Pneumo > HFlu nontypeable > moraxella

Tx = Augmentin

83
Q

clinical presentation for Disseminated MAC - 3

Mycobacterium Avium Complex

A
  1. Splenomegaly
  2. ALP⬆︎
  3. Systemic sx (fever, diarrhea, cough)
84
Q

clinical presentation for Disseminated Histoplasmosis - 4

A
  1. Mucocutaneous papules/nodules
  2. Reticuloendothelial system involvement (LAD, Hepatosplenomegaly)
  3. Pulmonary (SOB, cough, CXR reticulonodular infiltrates)
  4. Pancytopenia from marrow infiltration

Dx = serum or urine Histoplasma antigen immunoassay

85
Q

Most common side effects of INH isoniazid

A

Injuries to Nerves and Hepatocytes

Neuropathy (Pyridoxine B6 = tx/px)

Hepatitis - THIS IS SELF LIMITED AND RESOLVE WITHOUT INTERVENTION

86
Q

name the organisms sickle cell disease pts are at most risk of acquiring?-3 ; Which is most common and why?

A

SHiN = encapsulated organisms

  1. Strep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes!
  2. HFlu B
  3. Neisseria Meningitidis

these happen to asplenic pts because they have ⬇︎antibody mediated phagocytosis and complement activation

87
Q

What are the potential complications of orbital cellulitis - 3

Biggest RF: Bacterial Sinusitis

A
  1. Orbital abscess
  2. intracranial infection
  3. cavernous sinus thrombosis
88
Q

Pt presents with signs of Sarcoidosis but rapidly deteriorates after being given steroids

Dx?

A

Histoplasmosis

Mississippi and Ohio River basins

89
Q

Pts who’ve undergone solid organ transplantation are at risk of acquiring what 2 infections?

A
  1. CMV (ganciclovir/valganciclovir px)
  2. PCP (Bacterim px)
90
Q

PCN IM is the first line tx for Syphilis.

The alternative tx to Syphilis is ____. When is it indicated to desensitize and still give PCN?-3

A
  1. Pregnancy (No DOXY for POXY)
  2. 3° CNS syphilis
  3. refractory to initial tx
91
Q

How do you know when a pt if fully cured from Syphilis?

A

4-fold ⬇︎in FTA Ab titer by 12 month mark AT THE LATEST

92
Q

An unvaccinated pt to Hepatits B has just been acutely exposed and positive S and E antigen (SEC)

What do you give them? - 2

A
  1. Hep B Immunoglobulin
  2. Hep B VACCINE still

unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin

93
Q

What’s the most ideal abx for aspiration PNA - 3

foul sputum, fever, cough

A
  1. CLINDAMYCIN
  2. Augmentin
  3. Amoxicillin with Metronidazole
94
Q

Empiric tx for Viridans Strep - 2

A
  1. PCN G aqueous IV x4wks OR
  2. Ceftriaxone IV x 4wks
95
Q

Which viral illness is associated with pancytopenia?

A

EBV

Platelet thrombocytopenia

Anemia from autoimmune hemolytic anemia

Neutrophil/WBC ⬇︎ with atypical lymphocyte on blood smear due to viral suppression

96
Q

What is the triad for Trichinellosis

A
  1. Periorbital edema
  2. Myositis (⬆︎CK)
  3. Eosinophilia

This is preceded by GI compaints and can be a/w subungual spliter hemorrhages as well!

97
Q

At what CD4 are HIV pts at risk for Candida Esophagitis? ; tx?-2

A

CD4<100 ;

  1. Fluconazole PO
  2. Esophagoscopy with bx/cx if refractory to rx
98
Q

What is the management for a patient bitten by a Cat?

A

Augmentin px s/p irrigation

Cat bites are DEEP PUNCTURE WOUNDS AT RISK for Pasteurella and oral anaerobes

99
Q

From a lab perspective, how do you differentiate CMV from EBV?

A

CMV will have a negative heterophile Ab monospot test

100
Q

Dx? - 2

A
  1. EBV
  2. CMV
101
Q

Which organism should you suspect if a pt with PNA also c/o Diarrhea?

A

Legionella

102
Q

What are the risk factors for TB - 4

A
  1. Homelessness
  2. Alcoholism
  3. Immunosuppression
  4. Healthcare worker

Disseminated TB affects peritoneum, cervical lymph nodes, eyes, bones and skin

103
Q

When is the Rabies Vaccine and Immunoglobulin indicated?-2 ; What do you do if this is NOT the case?

A
  1. Animal is unavailable
  2. Animal is symptomatic

Pet Observation x 10 days or Test Wild Animals to determine need for Rabies px

104
Q

Ventilator associated PNA occurs how long after intubation? ; What’s the first 2 steps in mngmt for these pts

A

≥48 hrs ;

1st: lower respiratory tract Gram stain and culture
2nd: Empiric abx

105
Q

The most common predisposing factor for Acute Bacterial Sinusitis is what?

A

preceding viral URI

106
Q

The Hepatitis A vaccine is recommended for which groups - 3

A
  1. Travelers going to countries where HepA is present
  2. Gay Men
  3. Chronic Liver Disease

Hepatitis A can cause SIGNIFICANT but benign TRANSAMINITIS so do not be alarmed by this

self limited to 1 month

107
Q

What are the generalized signs of ANY congenital TORCH infection - 3

A
  1. Hepatosplenomegaly
  2. Blueberry muffin spot rash
  3. Jaundice
108
Q

Name the specific signs of congenital syphilis - 3

A
  1. Rhinorrhea
  2. Maculopapular rash ofo the palms and soles that dequamates or becomes bullous
  3. Abnormal long bone xrays (i.e. metaphyseal lucency)
109
Q

Leprosy is a chronic mycobacterial granulomatous disease

How does it present?-2 ; Dx?

A
  1. Macular Anesthetic hypopigmented skin lesions with raised borders (looks more irregular than Erythema Multiforme)
  2. Nodular Painful nearby nerves with ⬇︎sensory & motor function

Dx = Full thickness Skin bx of lesion

Tx = Rifampin WITH Dapsone

110
Q

Leprosy is a chronic mycobacterial granulomatous disease

Tx? - 2

A
  1. Rifampin WITH
  2. Dapsone
111
Q

Coccidioides cp - 4

A
  1. CA-acquired PNA (fever, cp, cough, lobar infiltrate)
  2. Arthralgias
  3. Ertyehma Nodosum
  4. Erythema Multiforme

Health pts do NOT require antifugal therapy

112
Q

How is Neurocysticercosis transmitted?

A

ingestion of undercooked PORK that contains Taeia solium tapeworm EGGS

Imaging: swiss cheese CT (image below) or cystic lesion with surrounding edema

113
Q

Tx for HIGHLY CONTAGIOUS Pinworm Enterobius Vermicularis - 2

A
  1. Albendazole
  2. Pyrantel Pamoate
114
Q

Which bacteria is described as Rocky Mountain Spotted Fever without the spots? ; What other major lab findings are associated with this bacteria? -3

A

Ehrlichiosis (has malaise and AMS with no rash)

  1. Leukopenia
  2. Thrombocytopenia
  3. Transaminitis
115
Q

Which bacteria causes Pnuemonia in Adult cystic fibrosis pts?

A

Pseudomonas

116
Q

Which bacteria causes Pnuemonia in Pediatric cystic fibrosis pts?

A

Staph Aureus

117
Q

What’s the most common valvular abnormality in patients with Infective Endocarditis?

A

“Bacteria FROM JANE”

[Mitral Valve Prolapse with regurgitation that’s new]

These will be accompanied by ⬆︎⬆︎⬆︎ESR

118
Q

What are Lyme Borrelia px - 3

A
  1. Tick repellant
  2. protective gear
  3. tick checks

THERE IS NO VACCINE!

119
Q

Which organism should you suspect in a pt with severe rapidly developing cellulitis after sustaining a cut in a marine envrionment?

A

Vibrio Vulnificus

also causes food borne illness

120
Q

Dx? ; Mode of Transmission?

A

Cutaneous larva migrans secondary to Ancylostoma hookworm larvae ; walking barefoot in contaminated sand or soil

Tx = Ivermectin

121
Q

Sporothrix Schenckii is a ____ fungus found in ____

How does it clinically present?

A

dimorphic ; decaying plant and soil

papule at inoculation site ulcerates and drains odorless nonpurulent fluid. This then spread proximally along lines of lymphatic drainage

Tx = PO itraconazole

122
Q

Describe the type of rash you’ll see with secondary syphilis

A

Diffuse Maculopapular rash starting at trunk and spreading to extremities TO INCLUDE PALMS AND SOLES

123
Q

cp of Chikungunya Fever - 4

A
  1. Polyarthralgias severe
  2. High Fever
  3. Leukopenia
  4. Thrombocytopenia

Transmitted by Aedes mosquito (same as Dengue) in the tropics / Tx = supportive

124
Q

Beta D glucan is useful diagnostics for what organisms?

A

FUNGUS (it’s apart of their cell wall) - and this is nonspecific

125
Q

Progressive Multifocal Leukoencephalpathy etx

A

JC virus reactivation in HIV pts –> ASYMMETRIC focal nonenhancing white matter brain lesions WITH NO EDEMA

HIV neurocognitive disorder will have DIFFUSE enhancement

126
Q

In pts with mucopurulent urethritis, absence of growth on gram stain usually suggest which organism?

A

Chlamydia

Gonorrhea will in fact result in gram stain

127
Q

What organism is the most common cause of Infective Endocarditis in IV Drug Users?

A

Staph Aureus

128
Q

What organism is the most common cause of Infective Endocarditis in pts with colon disease?

A

Strep gallolyticus Bovis

129
Q

What organism is the most common cause of Infective Endocarditis in pts with dental disease and/or procedures?

A

the Strep Viridan MOMS

Mutans/Oralis/Mitis/Sanguinis

tx = CefTriaxone or PCN G aqueous IV

130
Q

What is the mechanism for why asplenic pts are at ⬆︎risk of infection from _____ organisms

A

SHiN = encapsulated organisms

  1. Strep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes!
  2. HFlu B
  3. Neisseria Meningitidis

they have ⬇︎antibody mediated phagocytosis and complement activation

131
Q

What organism causes Acute Epididymitis? - 3

A
  1. EColi if >35yo (secondary to bladder outlet obstruction)
  2. [Chlamydia or Gonorrhea if under 35 yo (secondary to STI)]
132
Q

Ludwig angina is a rapidly progressive cellulitis of the _____ and _____ space

What is the source of infection?

A

sublingual and submandibular ; infected mandibular MOLAR

133
Q

Why is RPR not reliable when on a person first develops syphilis?

A

There is a possible false negative result early in infection - follow with FTA

134
Q

For Malaraia px, in areas with high resistance to Chloroquine, what are the alternatives?-3 ; How are Malaria px prescripted?

A
  1. Malarone
  2. Doxycycline
  3. Mefloquine

and of course DEET

tx ≥2wks prior to travel, during stay and stopped 4 weeks after returning

135
Q

How long does it take Jarisch Herxheimer reaction to resolve?

A

2 days

136
Q

Diagnostic criteria for postive Purified Protein Derivative (PPD) test? - 2

A
  1. ≥15 mm OR
  2. ≥5 mm in HIV

Reads are done 2 days after injection

137
Q

Prophyrlactic Erythromycin Ophthalmic ointment at birth is used to prevent what organism?

A

Gonorrhea only

138
Q

What are the major organisms that cause contact lens keratitits?-2 ; cp?

A
  1. Pseudomonas
  2. Serratia

painful red eye and opacification with corneal ulceration

139
Q

etx for hordeolum ; tx?

A

an external hordeolum = a stye = inflammation of eyelash follicle or tear gland –> tender nodule at lid margin

tx = warm compresses

140
Q

etx for Miliary TB ; describe the radiograph

A

Hematogenous spread of TB (possibly from primary infection or reactivation) that –> subacute sx +/- extrapulmonary involvement (liver, lung, CNS) ; Millet seed diffuse reticulonodular pattern

141
Q

cp for Toxic Shock Syndrome-3 ; What are the causes of Toxic Shock Syndrome?-3

A
  1. Diffuse erythematous macular rash
  2. hypOtension
  3. fever

tampons, nasal packing, post surgery

142
Q

tx for Malignant Necrotizing Otitis Externa (MOE)

A

Ciprofloxacin IV (anti-pseudomonas)

143
Q

Management of Peritonsilar Abscess - 2

A

IV Abx –> urgent Needle Peritonsilar Aspiration

144
Q

What 2 laboratory values are the best diagnostic test for Hepatitis B?

A

S - SEC - SCEb - Core - CEbSAb - CSAB - SAb

[SAg and CoreIgM]

145
Q

What are the guidelines for ANNUAL GC/Chlamydia Screening (Women vs Men)

A

Women

  1. ALL sexually active women < 25
  2. Sexually active women > 25 IF HIGH RISK

Men: Insufficient evidence :-(

ANNUAL GC/Chlamydia screening done via NAAT - vaginal or cervical swab

146
Q

Which pt demographics should receive Syphilis Screening (RPR, VDRL)? - 5

A
  1. Pregnant Women at 1st prenatal visit
  2. Pts with other STDs
  3. Gay Men
  4. Sex Workers
  5. Jailed people
147
Q

What are the guidelines for HIV Screening ; What is the screening test?-2

A

EVERYONE between the ages 15-65 regardless of risk factors

[HIV p24 antigen and HIV antibody testing] together

148
Q

Tx for

Active TB?

Latent TB?

A
  1. RIPE x 6 months for ACTIVE TB
  2. IP x 9 months for latent TB

latent TB = positive PPD with normal CXR

149
Q

Which hepatitis virus is associated with Porphyria Cutanea Tarda?

A

hepC

150
Q

What type of acid base disturbance does TB cause? Why?

A

TB is a common cause of Addison’s primary adrenal insufficiency which –> ⬇︎Aldosterone –> Normal Anion Gap Metabolic Acidosis

151
Q

T or F

Lactose intolerance is associated with weight loss

A

FALSE

152
Q

What are the most common causes of diarrhea- 5

A
  1. Irritable Bowel Syndrome
  2. IBD
  3. Chronic infxn
  4. Malabsorption- CELIAC
  5. Malabsorption- LACTOSE INTOLERANCE

Dx= stool fat analysis and serum studies

153
Q

Dx for Lactose Intolerance- 4

A
  1. Diarrhea after consuming lactose
  2. [INC Stool osmotic gap]
  3. [DEC Stool pH]
    • Lactose Hydrogen Breath test
154
Q

Dx Celiac Disease- 3

A
  1. [INC Stool osmotic gap (like lactose intolerance)]
  2. Microcytic Anemia 2/2 iron deficiency
  3. Villous Atrophy
    * Foul, Flatulence, Fat stool (large volume), Frail wt (wt loss), Frail blood (microcytic anemia)*
155
Q

Dx Small Intestinal Bacterial Overgrowth- 2

A
  1. B12 Deficiency –> Macrocytic Anemia
    • LactuLOSE breath test
156
Q

histologic findings of Celiac Disease- 3

A
  1. intraepithelial lymphocytic infiltrates
  2. loss of villous architecture -> villous atrophy
  3. Crypt hyperplasia
    * bx from distal duodenum*
157
Q

Any RPR Titer greater than ___ is high syphilis titer (positive result)

A

1:16

anything where they had to dilute it MORE than 16 times is HIGH RPR Syphilis titer

[2b] A- step 2 CK (16 decks)

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