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Patient Presentations Flashcards

1
Q

Abnormal protein causing neurodegenerative disorders. “Spongiform” degeneration. Polymorphic changes on chromosome 20, at residue 129. 100% fatality.

A

Prion diseases

PrPsc

Normal has more alpha, is soluble, present on cell surfact. PrPsc is more beta, insoluble, present in vacuoles.

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2
Q

Most common prion disease

A

CJD

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3
Q

Prion disease with **early onset and longer course. **

A

familial fCJD

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4
Q

A 60 y/o patient comes in with behavioral changes, disordered sleep, and vision/motor changes. Patient’s family complains of **rapid cognitive decline. **

A

sCJD

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5
Q

A patient from Papua New Guinea comes to you “shivering”, saying he ate a family member 40 years ago. Your examination reveals tremors, ataxia, and _amyloid plaques in the brain. _

A

Kuru

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6
Q

True/false: Scrapie, a disease where sheep scrape their coats and do excessive lip-smacking, have hopping gait and seizures . . . is NOT transmissible to humans.

A

True

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7
Q

When “mad cow disease” gets transmitted to humans, it is called . . .

A

nvCJD

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8
Q

You do a lymphoid biopsy of your patient’s tonsils and discover PrPsc. What disease most likely caused this?

A

Your patient probably ate a cow and got infected with nvCJD

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9
Q

Your 28 y/o patient presents with bizarre psychiatric and behavior symptoms. You order an EEG and MRI and see a pulvinar sign as well as **florid plaques. **The diagnosis is confirmbed by biopsy of lymph tissue.

A

nvCJD

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10
Q

What disease is NOT destroyed by UV light, EtOH, disinfectants, ammonia . . . and can be transmitted by transplants or contaminated neurosurgical instruments.

A

iatrogenic CJD

MUST: USE DISPOSABLE instruments or steam autoclave, bleach, etc

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11
Q

You see a large brick-shaped DNA virus. It is most likely a

A

poxvirus

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12
Q

List 4 major poxviruses

A

smallpox, monkeypox, moluscum contagiosum, orf

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13
Q

A patient comes in with a history of malaise, high fever, vomiting, and severe HA. She says that 2-3 days later, a vesicular rash appeared on her face, palms and soles. When you examine her, you find lesions on her trunk with umbilicated centers. All of the lesions are in the same stage of development.

A

smallpox

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14
Q

Airborne and contact precautions

  • disease is communicable from onset until 7-10 days.
  • isolate until scabs separate
A

smallpox management

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15
Q

A child comes in from a rural tribe in Africa. He presents with a rash that looks like small-pox, but you notice he has puffy cheeks (**lymphadenopathy). **Upon further questioning, he says that he and his pet monkey were playing with a rat.

A

monkeypox

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16
Q

Your patient presenting with a vesicular rash works at a zoo where they train prairie dogs and gambian giant rats. What disease is your top differential?

A

monkey pox

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17
Q

You are examining an HIV patient, and discover multiple umbilicated skin papules that measure >1cm. When you open a lesion, is contains *white, waxy curd-like core. *

A

molluscum contagiosum

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18
Q

A patient comes into your office with reddish nodules on their hands. They work at a slaughter house _(sheep and goats). _

A

Orf, will self-heal in 3-6 weeks.

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19
Q

An 18 y/o male presents with purulent discharge, dysuria, and urethritis. He reports unprotected sexual activity a week ago. You suspect gonorrhea. How do you treat?

A

Single dose cephalosporin.

**Widespread penicillin resistance. **

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20
Q

“arthritis-dermatitis syndrome”, characterized by *asymmetrical polyarthritis and tenosynovitis. *Also may have hemorrhagic papules and pustules.

A

disseminated gonorrhea

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21
Q

You suspect your patient has gonorrhea. What specific kind of media should you ask the lab to use?

A

Thayer martin

but nucleic acid probes are most commonly used for diagnosis.

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22
Q

What is the most common cause of NGU urethritis?

A

chlamydia

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23
Q

What causes a

  • *proctitis:** rectal strictures, fistulae, abscess
  • *reactive arthritis:** immune mediated ASEPTIC arthritis
A

chlamydia

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24
Q

In this disease, there is an asymptomatic papule/ulcer that occurs 3-30 days post infection. Days to weeks later, there is adenopathy with progress to an **inflammatory mass. **

A

Lymphogranuloma Venerum

Chlamydia

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25
Q

What is the best test for diagnosing Chlamydia?

A

rapid swab, Nucleic acid amplification test

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26
Q

What would you give the following for?

**azithro **1g single dose

**doxy **100 mg bid, 7-14 days

A
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27
Q

Your pregnant patient presents with thick yellow vaginal discharge, and vulvovaginal irritation. You are most worried about what complications?

A

Likely trichomonas

  • premature rupture of membranes
  • low birth weight
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28
Q

Diagnosis of trichomonas

A

wet prep

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29
Q

What STI would treat with
metronidazole 2g single dose or 500 mg BID for a week?

A

trichomonas

and

bacterial vaginosis (week)

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30
Q

Your patient complains of a tender papule on the genitals. They said it became pustular and **formed a painful ulcer. ** Upon exam, you find *tender inguinal lymph nodes. *When you do a culture, you discover gram - rods in a “school fish pattern”

A

Chancroid

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31
Q

Your sexually active 20 y/o female patient presents with increased vaginal discharge that has a “fishy odor”. The gram stain shows “clue cells” and you also do a vaginal swab.

A

bacterial vaginosis

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32
Q

Your 25 y/o patient comes in saying that a month ago he noticed a painless papule on his mouth. It eventually eroded and went away 4 weeks later. Yesterday, he noticed a maculopapular rash on his palms and soles. They are starting to coalesce and form **condylomata lata. **

A

primary syphilis (inital inoculation)

becoming

secondary syphilis

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33
Q

What stage of syphilis is characterized by neurologic disease (endarderitis obliterants >> multiple infacts, progressive neurlogical deficits, seizures).

A

tertiary

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34
Q

What does PARESIS stand for in tertiary syphilis?

A

parenchymatous disease

Personality

Affect

Reflexes

Eyes (argyll robinson)

Sensorium

Intellect

Speech

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35
Q

what is tabes dorsalis?

A

demyelination of dorsal root ganglia

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36
Q

UNILATERAL

deafness, CN VII and VIII palsies, aortitis/aneurysm formation, gummas

ARE ALL SEEN WITH

A

tertiary syphilis

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37
Q

When is RPR testing for syphilis most reliable?

A

secondary phase

confirmatory tests are FTA-ABS and MHA-TP

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38
Q

A positive VDRL is proof of . . .

A

CNS involvement in syphlis

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39
Q

How do you treat syphilis?

A

PENICILLIN

IM injections (extremely painful)

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40
Q

Most likely cause of epiglottitis?

Characteristic drooling, dysphonia

A

H. influenzae type b

Treat with ampicillin and ceph

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41
Q

True/false: you should use prophylaxis in household contacts who are <4 y/o if their sibling has epiglottis

A

TRUE

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42
Q

Why do adults usually not get croup?

characteristic inspiratory stridor

A

B/c airway is bigger.

Most likely caused by parainfluenza (also RSV)

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43
Q

Characteristic “steeple sign” and spasmodic cough is seen with?

A

croup

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44
Q

Acute localized otitis, is usually caused by

A

staph aureus

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45
Q

otitis externa “swimmer’s ear” is usually caused by? also “Malignant” otitis externa affecting elderly and diabetics?

A

pseudomonas

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46
Q

What is the most common cause of otitis media?

A

strep pneumo

ALSO

H. flu, moraxella, mycoplasma, viruses

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47
Q

Etiology of sinusitis? 50% of cases caused by

A

**strep pneumo and H flu. **

nosocomial more likely staph and gram neg.

immunocompromised is gram neg and fungi.

48
Q

A productive cough on most days during at least _3 consecutive month_s for more than **2 consecutive years. **

A

chronic bronchitis definition

49
Q

At what ANC is the risk of infection significant?

A

<500

50
Q

What are opportunistic pathogens in defective cellular immunity?

A

Bacteria: listeria, myobacterium, nocardia, legionella, salmonella

Fungi: cryptococcus, histoplasma, coccidioidis, pnerumocystis

Virus: VZV, HSV, CMV

Helminths: strongyloides

51
Q

When do you see defects in humoral immunity?

A

agammaglobulinemia, multiple myeloma, CLL, hypogammaglobulinemia, splenectomized patients, sickle cell

offending organisms are ENCAPSULATED

strep pneumo, H flu, niesseria

52
Q

Should you treat a neutropenic patient empirically if fever is the only symptom?

A

yes

53
Q

What should you consider when selecting antimicrobial treatment for neutropenic patients?

A

gram neg coverage is mandatory

54
Q

An HIV patient is at risk for what when their CD4 <200?

A

PCP

55
Q

An HIV patient is at risk for what when their CD4 count is <100?

A

Cryptococcal, MAI, CMV, toxoplasma, Cryptosporidium

56
Q

How is a genital HSV lesion different in an HIV patient?

A

the lesions may coalesce

57
Q

List two cutaneous infections that can occur in an HIV patient

A
  1. bacillary angiomatosis

cutaneous and visceral (liver) disease buy bartonella henselae

  1. molluscum contagiosum

warts (poxvirus), umbilicated lesions

58
Q

Your HIV patient describes **progressive visual loss, blurring and “floaters.” **What is the most likely diagnosis?

A

CMV retinitis

59
Q

What disease can cause acalculous cholecystitis in an HIV patient?

A

CMV

and

cryptosporidium

*CMV can also affect the entire GI system

60
Q

What causes ascending weakness and loss of reflexes, flaccid paralysis in an HIV patient? polyradiculopathy

A

CMV

61
Q

When should you being prophylaxis for PJP?

A

CD4 <200

BACTRIM *note also protects against toxoplasma

62
Q

When should you begin prophylaxis for MAI in an HIV patient?

A

CD4 <100

azithro

63
Q

When should you give prophylactic isoniazid to HIV patients?

A

all with a positive PPD or close contacts of a patient with TB

64
Q

adminisitration of pre-formed antibodies to treat or prevent infection =

A

passive immunization

65
Q

stimulation of an immune response by administration of antigens =

A

active immunization

“vaccination”

66
Q

IgG and IgM

Route of admin: SQ, ID, IM

A

Systemic immunity

67
Q

IgA

Route of admin: oral, intranasal

A

mucosal immunity

68
Q

What is a component that increases the immune response to an antigen called?

A

adjuvant

69
Q

Which age category does not respond well to polysaccharide vaccines?

A

infants

*b/c need T-cell help. Wait until 2 yrs

70
Q

The minimal interval between priming and boosting with vaccines

A

4 months

71
Q

Response:

  • recruit T-cell help
  • high antibody response
  • induce immunlogic memory
A

T cell dependent response

vs

no immune memory, only B cell response

72
Q

Conjugating polysaccharides to larger carrier proteins . . .

A

recruites helper T cells

73
Q

True/false: _live viral vaccines should NOT be given during pregnancy or to immunocompromised hosts. _

A

true

74
Q

All persons >6 months, annually should get . . .

A

the flu shot

Children <9 yrs should receive 2 doses the first time, separated by 4 weeks.

75
Q

the LAIV

A
  • quadrivalent
  • intranasal
  • use in 2-49 yrs

note: history of asthma/wheezing is contraindication

76
Q

Which vaccine should be given to the following:

- age >65

**- asplenia **

-2 wks before splenectomy

- CSF leaks

- chronic illness (diabetes)

- long-term care residents

- immunocompromised: HIV, chronic steroids, malignancy

A

pneumococall vaccine

NOT approved for children <2

77
Q

which penumococcal vaccine should be given to infants?

A

pneumococall CONJUGATE vaccine

78
Q

What is the difference between Gardasil and cervarix?

A

Gardasil is quadrivalent

Cervarix just 16 and 18

males: gardasil only

79
Q

List examples of beta-lactams

cell-wall synthesis inhibitors

A

penicillins, cephalosporins

inhibit enzymes that cross-link peptidoglycan side chains

80
Q

List an example of a glycopeptide

cell wall synthesis inhibitors

A

vancomycin

inhibit extension of peptidoglycan chain

81
Q

List classes of inhibitors of protein sythesis:

A

macrolides

tretracycline

aminoglycosides

oxazolidinones (linezolid)

82
Q

List inhibitors of nucleic acid synthesis

A

fluoroquinolones

rifampin

83
Q

List inhibitors of metabolism

A

sulfonamides

trimethoprim

84
Q

Which antibiotics

  • require good host immune response
  • slower response
  • for less serious infections
A

bacteriostatic

85
Q

What kind of antibiotic should be used in immunocompromised?

A

bacteriocidal

86
Q

What should you do after isolating bacteria in culture?

A

do susceptibility testing

MIC, E-test, disc

87
Q

True/false: the concentration of antibiotic should be greater than MIC.

A

true

88
Q

What is an example of an antibiotic that cannot cross the BBB?

A

aminoglycoside

89
Q

Which antibiotics have the highest CSF conc?

A

3rd gen cephalosporins

90
Q

Which antibiotics should be avoided in pregnancy?

A

Tetracycline: discolored teeth

Tigecycline: teratogenic

Amioglycoside: hearing abnormalities

Fluoroquinolones: cartilage defects

91
Q

What antibiotics are safe in PG?

A
  1. penicillins (except ticarcillin)
  2. cephs
  3. erythomycin/azithro
  4. dapto/clindamycin
  5. amphotericin B
92
Q

Rapid acetylators are more common in

A

asians

93
Q

Which drugs inhibit P450 metabolism?

A

macrolides

azoles

protease inhibitors

cipro

94
Q

What category are the following potential bioterrosism agents:

anthrax

plague

tularemia

smallpox

viral hemorrhagic fever

botulinum toxin

A

category A

95
Q

What category are the following potential bioterrosism agents:

brucellosis, psittacosis

Q fever

Typhus

Burkholderia

Viral encephalitis

Food/water safety

staph enterotoxin B

Ricin

C. perfringens

A

category B

96
Q

What category are the following potential bioterrosism agents:

nipa virus

hantavirus

A

Category C

97
Q

why would you suspect a bioterrorism incident?

A
  • epidemic curve that rises and falls during a short period of time
  • clusters of patients arriving from a single locale
98
Q

What kind of isolation precuations should you use with smallpox?

A

contact and airborne

99
Q

A patient comes in with a small papule that has progressed to a necrotic ulcer with eschar. The patient says that the lesion is **painless. **What are you suspecting?

A

anthrax

100
Q

Illness characterized by fever, fatigue, chest pain, and non-productive cough. After 1-3 days, abrupt onset of respiratory distress and hemorrhagic mediastinitis.

A

inhalation anthrax

101
Q

What is empiric treatment of anthrax?

A

cipro or doxycycline

*if pregnant, give penicillin/amox

102
Q

Post-exposure prophylaxis for anthrax includes . . .

A

antibiotics by gavage, for 30 days

vaccine on days 1, 15

103
Q

A 28 m/o male with a prior history of eczema presented with generalized papulovesicular rash on the face, neck, and upper extremities. Progressed to umbilicated lesions. Had contact with father (military) who had received smallpox vaccine 21 days earlier.

A

Eczema vaccinatum

104
Q

What are the three most common **bacterial causes of **meningitis?

A

strep pneumo, H flu, n. meningitidis

105
Q

Which hepatitis viruses cause acute hepatitis?

A

A through E

106
Q

Which hepatitis viruses cause chronic hepatitis?

A

B,C, and D

107
Q

Which hepatitis viruses are transmitted through the fecal/oral route?

A

A and E

108
Q

Which hepatitis can cause fulminant hepatitis in pregnancy? 3rd trimester

A

Hepatitis E

109
Q

Which hepatitis requires HBV to replicate?

A

Hepatitis D

110
Q

What is the most common cause of neonatal sepsis?

A

Group B strep.

onset first week of life, pneumonia

111
Q

How do you prevent GBS and neonatal sepsis?

A

screen women late in PG

give antibiotics to GBS + during labor

112
Q

What is the most common cause of late onset neonatal sepsis?

A

coagulase negative staph.

  • onset AFTER frist week of life*
  • meningitis most common presentation*
113
Q

What neonatal infection presents with **hearing loss, **microcephaly, periventricular calcifications?

A

CMV

114
Q

What neonatal infection presents with cataracts, blueberry muffin baby, heart defects, etc?

A

Rubella

115
Q

Hydrops fetalis d/t fetal anema and CHF can be caused by which infection during PG.

A

parvovirus B19

116
Q

What should you suspect if your pregnant patient says that she ate raw meat and changed the cat litter box?

A

toxopasmosis

TRIAD:

chorioretinitis

intracranial calcification

hydrocephalus

117
Q
A

Micro (1 decks)

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