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Term 5 > Pathophys: ID > Flashcards

Pathophys: ID Flashcards

1
Q

3 most common causes of bacterial meningitis

A

S. pna
H. flu
N. meningitis

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2
Q

Meningitis: terminal complement pathway deficiency

A

NM

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3
Q

Meningitis: cochlear implants/CSF leak

A

S. pna

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4
Q

Meningitis: inability to opsonize

A

S. pna

H. flu

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5
Q

Meningitis: CS use

A

Listeria & Crypto

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6
Q

Meningitis: HIV

A

S. pna, Listeria, Crpyto

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7
Q

Meningitis: exposure to others with meningitis

A

H. flu, NM

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8
Q

Meningitis: otitis media

A

S. pna, H. flu

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9
Q

Meningitis belt of N. sub-Saharan Africa

A

NM

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10
Q

Pathogenesis of N. meningitis meningitis

A

Oropharynx colonization

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11
Q

Pathogenesis of S. pna meningitis

A

Nasopharynx, skull fracture, PNA, otitis media

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12
Q

Pathogenesis of H. flu meningitis

A

Nasopharynx

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13
Q

Pathogenesis of L. monocytogenes meningitis

A

Food; placenta

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14
Q

Pathogenesis of Coag-negative staph meningitis

A

Foreign body; CSF shunt

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15
Q

Pathogenesis of S. aureus meningitis

A

Foreign body, spread from bacteremic source, epidural abscess

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16
Q

Gram-positive diplococci, bile soluble, alpha hemolysis, catalase positive

A

S. pna

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17
Q

Gram-negative diplococci; LOS

A

NM

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18
Q

Gram-negative pleomorphic; ox+, chocolate agar/hemin, NAD

A

H. flu

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19
Q

Gram-positive rod, motile; beta-hemolytic

A

LM

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20
Q

Which pathogen has the worst prognosis in bacterial meningitis?

A

S. pna

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21
Q

DDX for bacterial meningitis

A

Viral, fungal, TB, encephalitis (W. Nile), SA bleed

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22
Q

Major risk factors for meningitis

A
  1. Functional or anatomic asplenia
  2. Chronic immunodeficiency: HIV/nephrotic/C1-4 deficiency
  3. Heart/Lung disease
  4. CSF leak
  5. Cochlear implant
  6. DM
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23
Q

Pili & adhesion factors help with colonization. Which meningitis organisms have these?

A

NM, H. flu - Pili

S. pna - Adhesion

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24
Q

The main pharmacotherapy principle in treating bacterial meningitis is:

A

ABX to penetrate BBB at high levels

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25
Q

Vaccines are available for which causes of meningitis?

A

H. flu B, S. pna

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26
Q

Major post-infection manifestations of Group A Strep infection

A
  1. PSGN
  2. Scarlet fever
  3. Acute rheumatic fever
  4. PANDAS
  5. Local suppurative extension: abscess, OM, necrotizing fascitis
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27
Q

Skin infection: cat bite

A

Pasturella

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28
Q

Skin infection: dog bite

A

Capnocytophaga

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29
Q

Skin infection: salt water

A

Vibrio vulnificus

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30
Q

Skin infection: fresh water

A

Aeromonas

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31
Q

Skin infection: hot tub folliculitis/neutropenia/wet wounds

A

Pseudomonas

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32
Q

Skin infection: domestic animal (vets)

A

Erysipelothrix rhusopathaie

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33
Q

Skin infection: IC host

A

Cryptococcus

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34
Q

DDX skin infection

A
  1. Abscess
  2. Necrotizing fasciitis
  3. Bursitis over joints
  4. DVT
  5. Contact dermatitis
  6. Gout
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35
Q

Etiology of most cellulitis

A

Beta-hemolytic strep, Staph

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36
Q

What is the difference between furuncle and carbuncle?

A

Furuncle: hair follicle
Carbuncle: multiple hair follicles

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37
Q

Spider bite papule, erythema, induration, fever and hypotension; bone/joint/CNS/lung/heart valve involvement

A

Staph aureus

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38
Q

3 Staph aureus toxins and 1 Leukocidin

A

Heat-stable food toxin
TSST-1: TSS
Exfoliatoxin: scalded skin/neonates
PVL: leukocyte destruction and tissue necrosis

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39
Q

What is the technical definition of nosocomial MRSA?

A

Occurs after 48 hours admission; or in the community up to 12 months following hospitalization

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40
Q

3 major microbes of skin/soft tissue

A

S. aureus, GAS, GBS

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41
Q

2 y.o. female febrile and irritable with eye-discharge in the AM. Bug?

A

H. flu

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42
Q

3 major bugs associated with otitis media. Comment on viral causes.

A

S. pna
H. flu (non-typable)
Moraxella catarrhalis
2/3: combined viral & bacterial

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43
Q

Major risk factors for otitis media

A
  1. 6-18 months
  2. Family history
  3. Day care, smoking, lack of breast feeding
  4. First nations people of N. America, Australia
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44
Q

T/F Approximately 2/3 cases of otitis media are combined viral/bacterial in origin

A

True

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45
Q

Complications of otitis media

A

Hearing loss, balance and motor problems
Tympanic membrane rupture
Extension to adjacent structures (mastoiditis)
CNS infection

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46
Q

Comment on the 4 categories of rhinosinusitis: acute, subacute, chronic, recurrent

A

Acute: < 4 weeks
SA: 4-12 weeks
Chronic: >12 weeks
Recurrent: >4 with resolution

47
Q

On an X-ray, pus shows up as:

A

Air-fluid level

48
Q

Most commonly, acute sinusitis is viral/bacterial in origin

A

Viral (rhino, influenza, parainfluenza) with possible bacterial secondary infection (S. pna, H. flu, M. catarrhalis)

49
Q

Risk factors for sinusitis

A

Allergic rhinitis, obstruction, odontogenic infection, intranasal cocaine, impaired mucociliary clearance, swimming, IC host, children in day care

50
Q

Sinusitis complicated by bacterial infection…

A

Persistent symptoms (purulent D/C, facial pain) after 10 days, but less than 30
Severe symptoms with fever, purulent D/C: 3-4 days
Worsening symptoms after initial improvement

51
Q

Complications of sinusitis.

Urgent referral is required for…

A

Periorbital cellulitis, OM, CNS infection, deep neck infection; urgent referral for: diplopia, decreased LOC, meningismus, proptosis

52
Q

CAP: exposure to parrots (bug)

A

Chlamydophilia psittaci

53
Q

CAP: exposure to pregnant (parturient animals) (bug)

A

Coxiella burnetti

54
Q

CAP: exposure to water vapor & soil (bug)

A

Legionella

55
Q

CAP: classic presentation

Elderly? Young

A

Fever, cough, chest pain, SOB
Elderly: confusion, low temp
Young: fever, irritability

56
Q

CAP: mucopurulent sputum associated with rust-colored sputum

A

S. pna

57
Q

CAP: risk factors

A

Decreased LOC, smoking, ETOH, >65 yo, Postviral, CHF, esophageal dysmotility; mechanical obstruction, clearance problems, IC

58
Q

CAP: 3 most common bugs post-viral

A

S. pna
H. flu (non-typable)
S. aureus (including CA-MRSA)

59
Q

CAP: common in elderly (bug)

A

C. pna

60
Q

CAP: common with crowding, children, young adults (bug)

A

M. pna

61
Q

CAP: common in ETOH-ics (bug)

A

Klebsiella

62
Q

CAP: common in IS, chronic structural lung disease (bug)

A

Pseudomonas

63
Q

CAP: to grow Legionella, what medium must be used? It it an IC or EC organism?

A

IC organism: buffered charcoal yeast

64
Q

Legionella can cause 2 sydromes

A
  1. Pontiac fever

2. PNA

65
Q

Classic symptoms of Legionella PNA.
Findings on sputum GS
Failure to respond to: which ABX?
Diagnosis based on:

A

GI complaints, fever > 40, hyponatremia, hematuria
GS: 3+ WBC, but no organisms
Failure to respond to beta-lactams
Urinary Legionella Ag

66
Q

CAP: IC pathogen with elementary and reticulate body

A

Chlamydophilia

67
Q

CAP: Psittacosis diagnosis is based on…

A

Serology; highly infectious organism in cell culture

68
Q

HAP: Pathogenesis of Pseudomonas PNA

A

Micro-abscesses with hemorrhage and necrosis of alveolar septae

69
Q

Several different infections associated with Pseudomonas

A
  1. Hot tub folliculitis
  2. Puncture osteomyelitis
  3. Burn infections
  4. Bacteremia
  5. Malignant otitis externa [diabetic patients]
  6. Post-op CNS infection
  7. Endocarditis (IVDU/prosthetic valves)
70
Q

Malignant otitis externa is caused by… in what patients?

A

Pseudomonas (DM)

71
Q

What drug turns urine orange?

A

Rifampin

72
Q

First and second most common ID deaths in the world

A
  1. HIV

2. TB

73
Q

The 4 possible outcomes of TB infection

A
  1. Eradication
  2. Latent infection
  3. Primary disease
  4. Reactivation
74
Q

What percentage of people infected with TB will develop active disease?

A

10%

75
Q

Primary TB infection occurs when a tubercle forms. What is a Ghon complex?

A

Granuloma: macrophages, monocytes, neutrophils with involvement of lymph nodes

76
Q

The key factor for re-activation of TB is…

A

Host immunity: AIDS/HIV; Transplant, etc.

77
Q

Who is more likely to reactivate TB: young or old?

A

Young

78
Q

DDX TB

A

Other mycobacteria, sarcoidosis, endemic fungal infection, Q fever, Lymphoma, foreign body vasculitis from IVDU, HIV/AIDS

79
Q

Describe some examples of miliary TB

A

Meningitis, scrofula, hepatitis, bowel involvement, Pott’s disease, mycotic aneurysm, adrenal involvement with AI

80
Q

Other mycobacterial infection…

A

Leprosy: lepromatous, multibacillary

81
Q

Mycobacterium: LAD in children

A

M. scrofulaceum

82
Q

Mycobacterium: skin lesions by direct inoculation

A

M. marinum

83
Q

Mycobacterium: infection in lung in elderly/AIDS CD4 <50

A

MAC

84
Q

Modified Duke’s criteria for endocarditis: Major

A
  1. Persistent + BC with typical EC organism
    • TEE; new valvular regurgitation
  3. Serologic evidence Coxiella burnetti infection
85
Q

Modified Duke’s criteria for endocarditis: Minor

A
  1. Predisposition: prosthetic valve, IVDU
  2. Fever
  3. Vascular: emboli, aneurysm, Janeway
  4. Immunologic phenomena: GN, Osler’s, Roth Spots, RF
  5. Intermittent bacteremia/fungemia
86
Q

Is RF elevated in bacterial endocarditis? Are RBC casts present?

A

Yes & yes

87
Q

3 major organisms of bacterial endocarditis (and others)

A
  1. S. aureus
  2. S. viridans
  3. Enterococci
    Culture negative, Coag negative, S. bovis, HACEK, fungi
88
Q

Endocarditis: most common reason of death

A

Heart failure, also valve ring abscess; emboli; metastatic abscesses

89
Q

Major causes of infectious hepatitis

A

A, B, C, CMV, EBV, Leptospira (Weil’s disease)

90
Q

Non-infectious causes of hepatitis

A

AI, ETOH, Tylenol, Mushroom

91
Q

Does HAV have a carrier state?

A

No

92
Q

HAV belongs to which virus family?

A

Picorna-virus

93
Q

Most important risk factor for HAV in US?

A

International travel

94
Q

HBV has the highest risk of becoming chronic for young or old people?

A

Young (90% perinatal); 5% adults

95
Q

HBV, HCV, HIV: which is most easily transmitted by blood?

A

HBV

96
Q

HBV belongs to which virus family?

A

Hepadna

97
Q

The full HBV viral particle is called…

A

Dane particle

98
Q

Does HBV utilize reverse transcription? Which drugs does that mean we can use to treat HBV?

A

Yes; Tenofovir (HIV RT inhibitor)

99
Q

Extra-hepatic manifestations of HBV

A

Polyarteritis nodosa, Membranous nephropathy, Aplastic anemia

100
Q

LTM effects of HBV on liver? Factors associated with poorer prognosis

A

Cirrhosis, HCC

* prolonged HBeAg+ stage, ETOH, HDV

101
Q

HBSAg

A

Surface Ag (Vaccine or Infection = Ab)

102
Q

HBCAg

A

Core antigen: infection (Ab = past infection)

103
Q

HBeAg

A

Full virus particle in blood (high levels)

104
Q

HBVDNA

A

HBV activity: marker of treatment effectiveness

105
Q

Most common indication for LT in US

A

HCV

106
Q

Risk factors HCV

A

IVDU, blood, jail, poor SES

107
Q

HCV virus family (and other viruses)

A

Flavi: Dengue, WNV, Yellow fever, Japanese encephalitis)

108
Q

Does HCV have an intermediate DNA genome?

A

No: no RT

109
Q

Host factors associated with HCV chronic infection

A

IL-28B: CC – better response to therapy
40-55: more rapid progression
HIV, Fatty liver, ETOH: greater risk of progression

110
Q

Best predictor of progression of HCV…

A

Liver bx [or fibroscan]: +/- fibrosis

111
Q

Extra-hepatic manifestations HCV

A

Mixed cryoglobulinma, lymphoma, MPGN, porphyria, DM

112
Q

3 major manifestations of AIDS

A

PCP, esophageal candida, HIV wasting

113
Q

Stage B HIV Symptoms

A

Term 5 (9 decks)

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