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PANCE Practice > PANCE Prep- Infectious Disease > Flashcards

PANCE Prep- Infectious Disease Flashcards

1
Q

Anti-pseudomonal PCNs

A
  1. Piperacillin/Tazobactam (Zosyn)

2. Ticarcillin/Clavulante (Timentin)

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2
Q

Describe examples and reasons for different cephalosporins

A

1st gen: skin, soft tissue: Cephalexin
2nd gen: skin, resp./ENT, UTI, anaerobes: Cefuroximen, cefoxitin
3rd gen: PNA, CNS, gram neg: Ceftriazone, Ceftazidimine
4th gen: Cefepime (broad coverage including pseudomonas)
5th gen: ceftaroline (broadest)

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3
Q

Common SE of penicillins and ampicillin

A
  • hypersensitivity rxn
  • interstital nephritis

-amp: maculopapular rash in patients w/ infectious mononucleosis

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4
Q

Common SE of cephalosporins

A

10% cross reactivity in pts allergic to PCN

- Disulfiram raction

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5
Q

Common SE of vancomycin

A

Red man syndrome (Histamine release)

-Ototoxic (reversible)

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6
Q

Common SE of macrolides

A
  • GI upset
  • prolonged QT
  • muscle toxicity fo those on niacin or statins
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7
Q

Common SE of fluroquinolones

A
  • tendon rupture
  • exacerbate myasthenia gravis
  • prolonged QT
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8
Q

Common SE of Clindamycin

A
  • c. difficiles colitis
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9
Q

Common SE of tetracycline

A
  • deposition in teeth, teeth discoloration

- photosensitivity

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10
Q

Common SE of sulfonamides

A
  • kernicterus
  • sulfa allergy
  • hemolysis if G6PD def.
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11
Q

Common SE of Metronidazole

A
  • Avoid ETOH during and 48 hr after
  • Disulfiram-like rxn
  • Neurotoxicity
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12
Q

What PCN has the highest occurrence of diarrhea

A

augmentin

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13
Q

TX of:

  1. Esophagitis
  2. Vaginal Candidiasis
  3. Fungemia, Endocarditis
A
  1. Esophagitis: Fluconazole PO
  2. Vaginal Candidiasis: Miconazole, Clotriamazole
  3. Fungemia, Endocarditis: IV AmphotericinB
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14
Q

MC cause of fungal meningitits

A

Cryptococcosis neoformans (encapsulated

*Transmission: inhalation of pigeon/bird droppings

  • DX: India Ink stain shows encapsulated yeast
  • Cryptooccal antigen in CSF

TX: Amphotericin B + Flucytosin

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15
Q

AIDS-defining illness associated w/ soil containing bird/bat droppings in the Mississippi and Ohio River Valleys

A

Histoplasmosis

DX: Increased ALP, LDH, pancytopenia

TX: mild-mod: Itraconazole
Severe: Amphotericin B

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16
Q

MC opportunisitc infection in HIV
-O2 desaturation w/ ambulation
CXR: bilateral diffuse interstital infiltrates

A

Pneumocystis (PCP Pneumonia)

TX: Trimethoprim-sulfamethoxazole**
+/- Prednisone if hypoxic

PCP Prophylaxis: trimethoprime-sulfamethoxazole if CD4 200 or less

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17
Q

This fungus is commonly found in garden and houseplant soil and compost. It MC affects lungs, sinuses, and CNS. it produces Aflatoxin which is associated with an increased risk of hepatocellular carcinoma

A

Aspergillosis

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18
Q

MC overall bacterial cause of STDs in US

A

Chlamydia

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19
Q
  • Urethritis
  • PID, abdominal pain, + cervical motion tenderness
  • (urethritis, uveitis, arthritis)
A

Chlamydia

DX: Nucleic acid amplification (test of choice for C and G)

TX: azithro. 1g x1 dose or doxy 100mg BID x 10 days
*retest in 3 weeks

*Tx w/ ceftriazone 250mg IM x 1 dose for G infection too

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20
Q

gram-neg diplocci

  • MC cause of urethritis in men
  • urethritis and cervicitis: anal, vaginal, penile or phargyngeal discharge
A

Gonorrhea

DX:DX: Nucleic acid amplification (test of choice for C and G)

TX: ceftriazone 250mg IM x 1 dose
*tx w/ azithro. 1g x1 dose or doxy 100mg BID x 10 days for additional C. coverage

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21
Q

Cause and Tx of Cat Scratch Disease

A

Bartonella henselae

TX:
mild- symptomatic tx** (resolves in 7-21 days)
mod: azithro or doxy

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22
Q

Empiric tx, tx of choice, and prophylaxic for Meningococcal meningitis

A

*Neisseria meningitidis
Empiric:
adults- Ceftriaxone + Vanco
infants- Cefotaxime + ampicillin

if susceptible: Penicillin G

Prophylaxis/exposure: Cipro 500mg x 1 dose or Rifampin

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23
Q

Describe Kernigs sign and Brudzinskis sign

A

Kernigs: inability to straighten leg when hip is flexed 90

Brudzinski: neck flexion causes involuntary hip/knee flexion

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24
Q

Chancroid causes painful genital ulcers–> bubo formation (enlarged lymph nodes)
what organism is it caused by and how do you tx

A

Haemophilus ducreyi

TX: azithro 1g x 1 dose

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25
Q

Haemophilus influenza MC causes what diseases

A

MC cause of epiglottitis

2nd MC cause of CAP
*often associated w/ sinusitis and AOM

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26
Q

how do you t H. influenza infection

A

amoxicillin

IV ceftriaxone for epilottitits, PNA or meningitis

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27
Q

Cause and tx of hot tub foliculitis

A

Cause: pseudomonas aeruginosa

TX: resolves spontaneously in 7-14 days w/o tx
-Ciprofloxacin orally if persists

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28
Q

how do you dx and treat Q fever

A

*Coxiella burnetii- exposure to sheep, goats, cattle, and their products (wool)
DX: immunofluorescence IFA

TX: doxycycline

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29
Q

Cause of the plague, Dx, and TX

A

Cause: Yersinia pestis (gram neg rod)

DX: gram stain from tissue- “saftey pin appearance of organisms”

TX: streptomycin or gentamicin
*respiratory isolation for at least 48 hours

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30
Q

MC cause of necrotizing fasciitis (flesh eating bacteria) and tx

A

GABHS (often polymicrobial)

TX: surgical debridement + broad spectrum Abx (ampicillin/sulbactam- unasyn)

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31
Q

Tonsillopharyngitis or laryngtitis

  • pseudomembranes: friable gray/white membrane on pharyns taht bleeds if scaped
  • Bull neck*- neck swelling due to enlarged cervical LAD
  • myocarditis
A

Diptheria

(Corynecbacterium diphtheriae) gram positive rod

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32
Q

How do you dx and tx diptheria

A

DX: clinical- PCR- culture to confirm

TX: Diphtheria antitoxin (horse serum) most important + Erythromycin or PCN x 2 weeks

Prophylaxis: erythromycin x7-10 days
DTaP

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33
Q

severe muscle spasm

  • neck/jaw stiffness, trismus= lockjaw
  • Opisthotonus (arched back)
  • increased deep tendon reflexes
A

Tetanus

TX:

  1. Tetanus immune globulin immediately
  2. Tetanus toxoid given by standard schedule
  3. Penicllin
  4. benzo to reduce spasms

Prophylaxis: Tdapq 10 yrs

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34
Q

Systemic toxicity
-brown to blood tinged watery exudates w/ skin discoloration of the surrounding area
- Creptius/gas in the tissue palpated on PE
XRAY: air in soft tissues

A

Gas Grangrene (myonecrosis)

TX: IV pencillin + IV clindamycin (debridement)

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35
Q

Ingestion of toxin in canned/smoked/vacuum packaged foods
or infant ingests honey
-weakness, flaccid paralysis, resp. arrest
or get “Floppy baby syndrome”

A

Botulism
*Clostridium botulinum

TX: Antitoxins in all gases

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36
Q

What are the 8 D’s of botulism?

A
  1. Diplopia
  2. Dilated, fixed pupils
  3. Dry mouth
  4. Dysphagia
  5. Dysarthria
  6. Dysphonia
  7. Descending 8. Decreased muscle strength
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37
Q

endotoxin-producing, gram positive bacilli

MC found in contaminated foods (cold deli meats, unpasteurized dairy products (soft cheese, milk)

A

Listeriosis
*Listeria monocytogenes

TX: IV ampicillin

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38
Q
  • Gram-positive , spore-forming rod
  • Naturally found in livestock: cattle, horses, goats, sheeps
  • PAINLESS BLACK ESCHAR
  • hypoxia, flu like sx
  • GI bleeding, abdominal pain
  • Gram stain: boxcar-shaped encapsulated rods in chains
A

Anthrax

TX: ciprofloxacin (use for exposure too)

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39
Q

What organism cause syphilis

A

Treponema pallidum (“the great imitator”)

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40
Q

Describe primary, secondary, and tertiary syphilis

A

Primary: chancre: PAINLESS ulcer at/near inoculation site

Secondary (1-2 months after primary):

  • maculopapular rash (involves palms and soles)***
  • Condyloma lata: wart like
  • HA, fever, malaise generalized LAD

Tertiary: gumma- noncancerous granulomas on skin and tissue

  • neurosyphilis w/ Tabes dorsalis
  • Argyll-Robertson pups
  • CV: aortitis
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41
Q

s/s of congenital syphilis

A

Hutchinson teeth: notches on teeth, sensorineural hearing loss
-Saddle nose deformity
TORCH syndrome

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42
Q

How do you dx and tx syphilis

A

DX:

  1. darkfield microscopy (use w/ chancre or condyloma lata)
  2. RPR screening-
  3. FTA-ABS confirmation test***
  4. VDRL

TX: penicillin G (used in all stages)

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43
Q

-Erythema migrans
-expanding, warm, annualr, erythematous rash w/ central clearing or bulls eye appearance
-Rheumatologic arthritis
CN VII/facial nerve palsy

A

Lyme disease (Borrelia burgdorferi)

DX: Clinical
-Serologic testing: ELISA follwed by western blot if positive

TX: Doxy BID 10-21 days or amox. if <8y/o or preg.

44
Q
  • blanching, erythematous macular rash first on wrists/ankles==> palms/soles characteristic and spreading centrally over 2-3 days
  • petechiae
  • spread by ticks
  • potentially fatal if left untreated- CNS or resp. failure
A

Rocky Mountain Spotted Fever
*Rickettsia ricketsii

DX: clinical dx–> serologies

TX: *start treatment empirically before serologies come back (takes days) doxycycline**

45
Q

Tx of amebiasis

A

colitis: metronidazole

46
Q
  • RBC disease caused by Plasmodium*
  • Cyclical fever, leukopenia, hemolytic anemia, thromboyctopenia, N/V,
  • Recent travel to Africa
A

Malaria

DX: Giemsa stain peripheral smear (thin and thick)

TX:

  • uncomplicated cases when resistance is unknown: atovaquone-proguanil
  • those who are sensitive:Chloroquine
47
Q

blueberry muffin rash, hepatosplenomegaly, hearing loss, mental deveopment delay

  • common in immunocompromised pts CD4<100
  • MRI: ring-enhancing lesions
A

Toxoplasmosis

TX: sulfadiazene (or clindamycin) + Pyrimethamine (w/ folinic acid/leucovorin)

Prophylaxis for CD4=100, trimethoprime-sulfamethoxazole

48
Q
  • leading cause of CHF in Latin America
  • unilateral periorbital edema (Romana’s sign)
  • CHF, cardiomyopathy, Megacolon
A 
Chagas disease (American Trypanosomiasis)
*protozoa Trypanosoma cruzi
49
Q

Transmitted by raw or undercooked meat (esp. PORK, wild boar or bear)
-GI upset
-Muslce phase: myositis, palpebral/circumorbital edema
DX: **Eosinophilia hallmark: increased creatine kinase and LDH

A

Trichinosis (Trichenellosis)

TX: mild- self limited
severe- Alendazole

50
Q

Periorbital edema, myositits, and eosinophilia

A

Trichinosis (Trichenellosis)

51
Q

prodromal sx 24 hr prior (burning, paresthesias, tingling)–> painful grouped vesicles on an erythematous base

A

herpes simplex virus 1 and 2

DX: PCR most sensitive and specific
2. Tzanck smear

TX: acyclovir (IV for encephalitis)

52
Q

genital herpes is most commonly caused by ___

herpes labialis is most commonly caused by ___

A

HSV2

2ndary infection most often

53
Q
  • Present in most people in the US–> clinical disease only in immunocompromised patients
  • Primary disease: asymptomatic or Mono-like illness
  • Congenital: **sensorineural hearing loss, TTP blueberry rash, petechaie
A

CMV

DX: serologies, PCR

TX: Ganciclovir

54
Q
  • vesicles on an erythematous base “dew drops on a rose petal” in different stages*
  • itchy
A

varicella (chicken pox)

TX: symptomatic tx

55
Q

-vesicles along dermatome

A

herpes zoster (shingles)

TX: acyclovir if given w/in 72 hours to prevent PHN

56
Q

lesion on nose usually heralding ocular involvement, dendritic lesion seen on slit lamp

A

Herpes Zoster ophthalmicus

TX: PO antivirals

57
Q

otalgia, lesions on the ear, auditory canal and tympanic membrnae, facial palsy, auditory sx

A

herpes zoster oticus (Ramsay-Hunt Syndrome)

TX: oral acyclovir + corticosteroids

58
Q

Fever
Sore throat
Posterior cervical lymphadenopahty
splenomegaly

A

EBV (mono- HHV4)

DX: heterophile (monospot) Ab test
-peripheral smear w/ >10% atypical lymphocytes

TX: supportive- avoid trauma/sports

59
Q

You may develop a petechial rash if you have mono and are given ____

A

ampicillin

60
Q

what animals do you typically get rabies from

A

raccoons, bats, skunks, foxes, wolves

*not rodents

61
Q

How do you dx and tx rabies

A

DX: Negri bodies in brain of dead animal

TX: *once sx occurs pts rarely survive

Post exposure prophylaxis:

  • HDCV (rabies vaccine x 4) days 0, 3, 7, 14 + rabies immune globulin
  • if immunocompromised include day 28 into vx schedule
62
Q
  • flu like prodrome: abrupt onset of high fever and severe head/back pain*
  • skin eruptions in the same stage simultaneously*
  • palmar and plantar lesions common
A

smallpox (variola)

63
Q

What causes West nile fever and how do you tx

A

Flavivirus

TX: intense supportive

64
Q

What causes SARS and how do you dx
(non-specific flu-like sx
-atypical pneumonia*)

A

coronavirus

DX: PCR, stool is the 1st to be positive w/in 14 days

tx: supportive

65
Q

rapidly progressive dementia

A

creutzfeldt-jaob disease (prion mediated)

66
Q

what type of virus is HIV

A

retrovirus (changes viral RNA into DNA via reverse transcriptase)

67
Q

AIDS is defined as

A

CD4 count <200 or the development of an AIDS defining illness
(TB, kaposi sarcoma, Thrush, lymphoma, zoster, PCP, Histoplasmosis, Toxoplasmosis, cryptococcus, MAC, CMV retinitis)

68
Q

how do you DX HIV

A
  1. ELISA (screening)- if reactive confirmed by western blot
  2. western blot
  3. HIV RNA viral load
69
Q 
What opporunistic infections are susceptible with different CD4 counts
700-1500
>500
500-200
200 or less
150 or less
100 or less
50 or less
A 
700-1500: normal
>500: LAD
500-200: TB, kaposi sarcoma, thrush, lymphoma, zoster
200 or less: PCP, 
150 or less: histoplasmosis
100 or less: toxoplasmosis, cryptococcus
50 or less: MAC, CMV retinitis
70
Q

HAART regimens for treatment naive patients w/ HIV

A
  1. NNRTI (non-nucleoside reverse transcriptase inhibitor) + 2 NRTIs (nucleostide reverse transcriptase inhibitor)
    OR
  2. Protease inhibitor + 2 NRTIs
    OR
  3. Integrase strand transfer inhibitor + 2 NRTIs
71
Q

3Cs of rubeola

A

(measles)

Cough, coryza, conjunctivitis

72
Q
  • Koplik spots on buccal mucosa
  • maculopapular BRICK RED rash beginning at hair line/face–> extremities. (last 7 days)
  • cough, rhinitis, conjunctivitis
A

Rubeola (measles)

73
Q
  • maculopapular pink-light red spotted rash on face–> extremities (lasts 3 days)
  • post cervicla and postauricular LAD
  • photosensitivity and arthralgias
A

Rubella (German measles)

74
Q
  • Pink maculopapular blanchable rash
  • only childhood viral exanthema that starts n trunk/extremitites then goes to face
  • high fevers but appears well
A

Roseola (6th disease)

75
Q
  • red flushed face slapped cheeks w/ circumoral pallor–> lacy reticular rash on body
  • aplastic crisis in sickle cell disease
A 
erythema infectiosum (6th disease)
*parvovirus B19
76
Q
  • Flushed face, hearing loss (CN8), conjunctivitis

- maculopapular rash trunk and axilla

A

endemic typhus

77
Q
  • fluid filled blisters w/ positive Nikolsky sign: sloughing of skin with gentle pressure
  • painful diffuse red rash begins centrally
  • seen in kids <6
A

Scalded skin syndrome

78
Q
  • White and clumpy itchy vaginal discharge s/p antibiotic treatment for something else
  • No hx of STD nor does partner have one

-What is the Dx and how do you tx?

A

DX: vulvovaginal candidiasis
-confirmed by 10% KOH wet mount

TX: topical or oral antifungal (Fluconazole 150mg 1 tablet once)

79
Q

How do you treat:

  1. Bacterial vaginosis
  2. Trichomoniasis
  3. vulvovaginal candidiasis
  4. chlamydia
  5. gonoccal infection
A
  1. BV: metronidazole
  2. Trichomoniasis: metronidazole
  3. vulvovaginal candidiasis: antifungal (topical or oral fluconazole/difulcan)
  4. chlamydia: azithromycin
  5. gonoccal infection: Ceftriaxone
80
Q

HIV patient w/ SOB, cough and feeling of “catch” on inspiration

  • PPD negative
  • CXR: lobar infiltrates
  • CD4 count is 500

What is the most likely etiology?

A

Streptococcus pneumoniae

81
Q

What is the prophylaxic treatment for the following opportunistic infections and when do you initiate them?

  1. PCP:
  2. Toxoplasma:
  3. Mycobacterium avium:
  4. CMV:
  5. Mycobacterium tuberculosis:
A
  1. PCP: trimethoprim/sulfamethoxazole (when CD4 below 200 or recurrent thrush)
  2. Toxoplasma: trimethoprim/sulfamethoxazole when CD4 <100
  3. Mycobacterium avium: azithro or clarithro
  4. CMV: below 50-75
  5. Mycobacterium tuberculosis: Rifampin
82
Q
  • Immunocompromised patient with fever, general malaise lymphadenopathy, productive cough, chest pain, weight loss
  • CXR: Solitary or multiple nodules on
A

Cryptococcosis

Dx confirmed w/ India ink prep or histologic tissue stain

TX: oral or parenteral antifungals

83
Q

presents w/ productive (yellow) cough and SOB and low grade fever but otherwise healthy

  • Works in bat caves
  • CXR: cavitary lung lesions

What is the most likely diagnossi

A

Histoplasmosis

*Caught/found in soil, decaying wood, bird droppings, bats

84
Q
  • Fever, abdominal cramps, diarrhea (sometimes with blood)

- consumed raw eggs

A

salmonella enteritidis

TX: supportive- self limiting

85
Q
  • Fever, abdominal cramps, bloody diarrhea,

- High fever causing a seizure

A

Shigella

TX: supportive care

(Shigella and salmonella poisonings include same sx but salmonella does not cause seizures)*

86
Q

How can you differentiate shigella from salmonella poisoning?

*both poisonings have Fever, abdominal cramps, bloody diarrhea

A

Shigella and salmonella poisonings include same sx but salmonella does not cause seizures

87
Q

How is Vibrio cholerae transmitted? what are the sx? how is it tx?

A
  • through wounds
  • eating undercooked shellfish
  • drinking contaminated water

sx: profuse, watery (non-bloody) diarrhea that can lead to dehydration, low grade fever, abdominal cramps

TX: Azitho or doxycycline

88
Q
  • Gray pseudomembranes on tonsils**
  • congestion, sore throat, low grade fever, (TMs clear, lungs clear)
  • H/o Lack of medical care (missed childhood vaccines)
A

Corynebacterium diphtheriae

TX: parenteral PCN or erythromycin

89
Q

Causes of bloody diarrhea

A
  1. Salmonella
  2. Shigella (can cause febrile seizures)
  3. Entamoeba histolytica (sexually transmitted)
90
Q

This organism enters the skin and travels to the lungs. It then migrates into the mouth, are swallowed, and reproduce in the gut. They cause bleeding and subsequent anemia. Can also cause absorption problems

What is this organism? How do you dx and tx?

A

Hookworms

DX: microscopic analysis of stool

TX: albendazole

91
Q
  • Fever, coryza, conunctival involvment
  • prodrome dissipates as the characteristic rash develops first on HEAD and face and then on trunk
  • white spots on buccal mucosa
A

measles

*white spots= Koplik spots

92
Q

another name for roseola and what is it caused by

A

erythema subitum

HHV-6

93
Q

Tx of an abscess in a diabetic

A

I&D + Abx (clindamycin, bactrim, doxycycline, or linezolid)

94
Q

How do you Dx and TX H. pylori and how would you test for successful treatment

A

DX: urease breath, fecal Ag, serology

TX: CAP

  1. clindamycin
  2. Amoxicillin
  3. PPI

Test of cure: stop PPI 1-2 weeks prior to fecal Ag or breath tests
*PPIs are less likely to interfere with serology test

95
Q

What is the drug of choice for TB prophylaxis

A

Isonizide daily for 9 months

*risk of hepatitis so check LFTs during coarse

96
Q

mycoplasma pneumoniae can only be diagnosed by

A

PCR

97
Q

treatment of Legionnaire’s disease (Legionella PNA)

A

Gram neg.

In immunocompetent host: azitho 500mg daily or clarithromycin 500mg BID or levofloxacin 750mg daily for 10-14days

98
Q
  • SOB and cough
  • fever 4-5 days, malaise, muscle aches, HA
  • h/o working or being around RODENTS
  • CXR: Pulmonary edema
  • Labs: increased WBC, elevated hematocrit,, LDH, ALT and AST
A

Hantavirus
*rodent vector and usually manifest in hemorrhagice fever or Hantavirus pulmomary syndrome (rapidly progresses to resp. distress syndrome)

99
Q

What are Dengue and yellow fever caused by

A

Flaviviridae (Carried by mosquitos)

100
Q

Filoviruses causes ___

A

Ebola fever and Marburg fever

101
Q

What is typhoid fever caused by

A

salmonella typhus (contracted by contaminated food or water)

102
Q

Abdominal distention, constipation followed by diarrhea, splenomegaly, blanchable pink papular rash over the trunk and fever
+ blood cultures

A

typhoid fever

103
Q

Begins w/ fever and constitutional sx and in its more advanced form includes bradycardia, hypotension and jaundice

A

yellow fever (Flaviviridae)

104
Q

Presents w/ episodic bouts of high fever, chills, and sweats, separated by relatively asymptomatic periods
-infection progressed, other body systems may be involved including possible seizures

A

Malaria

105
Q

Brucellosis can be caused by exposure to ____

A

hogs, cattle or goats

106
Q
  • Exposure to parakeets*****

- fever, chills, HA, deep dry cough, atypical pneumonia sx

A

psittacosis

TX: tetracycline

PANCE Practice (26 decks)

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