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Pearls Flashcards

1
Q

What drug do you use for malaria, considering there is a lot of antibiotic resistance?
Diagnose with?
If not resistant, what is the original drug?
Also see malaria in spreadsheet

A

Artemether-lumefantrine

anti meter light infanty

chloroquine if sensitive

dx: blood smear

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2
Q

Mycobacterium marinum
Where do you find it?
Where do you NOT find it?
What develops on the body? and where usually

A

I.C hosts

Atypical mycobacterium.

Present in hot or cold fresh/salt water including aquariums

Handling fish, cutting a cut. Getting cut on coral

not present in chlorinated water like swimming pools

Lesion develops, usually on upper body

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3
Q

What bacteria is not present in chlorinated water ?

A

Mycobacterium marinum

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4
Q

Common symptoms of trichinosis/trichinellosis?
Which pathogen?
Cause?
TX

A

Trichinella spiralis
–raw/undercooked meat esp pork
—larvae encyst in striated muscle cell called “nurse cells” causing inflammation of muscle: think that they SPIRAL into the muscle cells

1.Fever
2.Muscle pain (myositis)
3.Periorbital edema

Tx:
Mild: self-limited
CNS/CV/Pulm involvement: albendazole/mebendazole
Thiabendazole +/- steroids

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5
Q

How do you treat UTI? 3

A

Nitrofurantoin
TMP/SMX
Fosfomycin

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6
Q

Treatment for GAS/pharyngitis? 2

A

Penicillin V
Amoxicillin

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7
Q

How do you treat gonococcal urethritis or cervicitis?
What about if co-infected with chlamydia?
Who should be screened?

A

Ceftriaxone IM

If chlamydia infection has NOT been excluded, treat for chlamydia as well with doxy or azithromycin

If pregnant: azithromycin instead of doxycycline

All sexually active women under 25

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8
Q

How do you treat anogenital warts, patient applied? Or provider administered?

A

Patient applied: imiquimod or podofilox 0.5% solution or sinecatechins ointment

Provider administered: cryotherapy with liquid nitrogen or cryoprobe, or surgical removal by tangential scissor excision, tangential shave excision, curettage, laser, electrosurgery or trichloroacetic TCA or bichloroacetic acid (BCA)

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9
Q

How do you treat trichomonas vaginitis?
Symptoms
Diagnosis/test

A

Metronidazole (“tricho/metro” or “vaginal canal is like a metro tube”)

Green/yellow dischage
Strawberry cervix

Wet mount, trophozoites (protozoa)

pH: >4.5

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10
Q

What is first line for tuberculosis? 4

A

Rifampin, isoniazid, pyrazinamide, ethambutol
(RIPE)

Check LFTs sine the first three are hepatotoxic.

Isoniazid also causes neuropathy in distal extremities

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11
Q

Treatment for cryptococcal meningoencephalitis - 2

Etiology

A

Caused by cryptococcus neoformans

FAB-ulously inflamed brain
F=flucytosine
A=amphotericin
B= B!

Liposomal Amphotericin B
AND
Flucytosine

Etiology
Cryptococcus neoformans
Transmission: inhalation of pigeon and bird droppings, also found in the soil.
most common in HIV patients with CD4 count <100

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12
Q

What is on a NAAT test? 2

How would you treat these two things?

A

Gonorrhoea and chlamydia

Chlamydia (most common!!)

If G only: ceftiaxone IM only

If G and C: + chlamydia w/doxycycline or azithromycin

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13
Q

What is first line for pneumocystis pneumonia? (caused by the fungus Pneumocystis jirovecii)
Provide three names for the drug

A

TMP/SMX also known as cotrimazole or bactrim

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14
Q

First line for HIV/AIDS

A

AIDS is defined as CD4 count<200

on exam, you’ll see three drugs that don’t look like anything you recognise!

Generally consists of two nucleoside reverse transcriptase inhibitors (NRTIs) administered in combination with a third active ARV drug from one of three drug classes: an integrate strand transfer inhibitor (INSTITUT), a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor (PI) with a pharmacokinetic (PK) enhancer (also known as a booster)

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15
Q

Treatment for botulism and tetanus?
Characteristics of paralysis for each?

A

In both diseases, the specific toxin immunoglobulin are part of the care

Droopy paralysis from canned food and honey (botulism)

Wound infection, toxin, spastic paralysis (tetanus)

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16
Q

Cerebral toxoplasmosis treatment - 3
Also see toxoplasma Gondii in spreadsheet

What is used to prevent toxoplasma encephalitis in HIV infected patients with low CD4 counts?

A

Pyri-metha-mine
Leucovorin (foilic acid)
Sulfa-diazine

poisonous feline (folic) shit

This is an infection due to Toxoplasma gondii which is a protozoa

Most common in AIDS patients not taking their meds. If low CD4 counts, treat with TMP/SMX (which is also used in Pneumocystis pneumonia prophylaxis)

transmission usually from soil or cat litter, contamination with cat feces

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17
Q

Chloroquine resistant malaria, what is the treatment?

A

Artemether-lumefantrine

DX of malaria generally made by blood smear after suggestive clinical history

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18
Q

Who do you screen for chlamydia and gonorrhea ?

A

Sexually active women under 25

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19
Q

How do you diagnose Lyme neuroborreliosis clinically? 7
Which lab?

A

Cranial neuropathy
Facial nerve palsy
Waxing and waning headache, rather than persistent
Neck stiffness
Photophobia
Negative Kernig/Brudzinksi

CSF pleocytosis
CSF to serum anti Borrelia burgdorferi index >1.0

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20
Q

Herpes simplex and varicella zoster, how does it manifest in the body?

A

Travels up the roots
Dorsal root ganglion,
Transmitted through neural tissue

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21
Q

Distinguish between erythema infectiosum and roseola infantum

A

Infectiosum: Parvovirus B19 / fifth disease
five finger hand to slap someone
Fever, coryza, headache, nausea and diarrhea THEN followed by an erythematous malar rash/butterfly rash across cheeks with circumoral pallor
slapped cheek

Roseola
Three to five days of a high fever that resolves abruptly and then a rash develops : blanching, starting on the neck and then moving to trunk

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22
Q

Infant with congenital CMV infection, how do you diagnose? With which specific specimen?

A

Quantitative PCR for CMV DNA in the URINE of the infant.

This is for pregnant women with mono-like syndrome but a negative Monospot test for CMV antibodies

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23
Q

Pregnant women with mononucleosis-like syndrome and negative monospot, what should you test for?

A

Test for CMV antibodies

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24
Q

Skin scarring diagnosis? What do you test for?

A

PCR testing for varicella-zoster virus DNA

Think: you can get scarring from chickenpox

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25
What diseases are you at risk for with a needlestick infection?
Hep B Hep C HIV
26
E.Coli UTI — describe the 5 steps
1. Colonise the vaginal and periurethral areas with uropathogens such as **uropathogenic E.coli (UPEC)** that usually reside in the gut 2. They migrate up to the bladder 3. UPEC type 1 pili adhere to **uroplakins on umbrella cells** >> bacteria are internalised 4. UPEC multiply to form intracellular bacterial communities (IBCs) 5. Efflux of IBCs = reinvasion of neighbouring cells
27
Alternative treatments for UTIs —5
A lot of resistance Alternatives: Cranberries Probiotics D-mannose Methenamine hippurate, Estrogens Intravesical glycosaminoglycans and immunostimulants
28
What is the MOA of cranberry components in tx of UTI—2
Fructose **inhibits the binding of type 1 fimbriae** to uroplakin receptors Proanthocyanidins **prevent binding of P fimbriae** to glycolipid receptors **_basically, prevents fimbriae binding_**
29
How does lactobacilli prevent UTI ? 6
—competitive **inhibition** of uropathogen **binding** to epi.cells —**congregate** around uropathogens —production of **bacteriocins, hydrogen peroxide, and lactic acid** —**acid environment **caused by lactic acid —**inhibition** of bacterial **biofilm** formation —**down reg**. of **pro inflamm cytokines**
30
Pulmonary TB refers to which bacteria?
Mycobacterium tuberculosis
31
IV drug use, what could you contract? 2
Staph. Aureus Right sided endocarditis
32
Hepatitis Panel Anti-HAV IgM (+ means ??) HBsAg (+ ??) Anti-HBs (+?? Anti-HBc (+ ??) Anti-HBc IgM (+ ??) Anti-HBc IgG (+ ??) Anti-HCV (+ ??) HCV RNA (??)
Hepatitis Panel Anti-HAV IgM (+ means acute HepA infection) HBsAg (+ means Hep B infection, does not distinguish between acute/chronic) Anti-HBs (+ means protected (s=surface/shield)against Hep B either from vaccine or prior infection) Anti-HBc (+ indicated past or current Hep B infection. Does not provide protection like HBs) Anti-HBc IgM (+ usually indicates an acute new Hep B infection <6mo) Anti-HBc IgG (+ usually indicates a chronic Hep B infection) Anti-HCV (+ indicates infected with Hep C at some point in time and have antibodies, does not tell if you’re currently infected) HCV RNA (follow up test to Anti-HCV, + determines that you are chronically infected with Hep C)
33
Pregnant women in her first trimester could infect her newborn with which virus? If she traveled to South America? What classic presentation would the baby have?
Congenital Zika syndrome Microcephaly Microphthalmia Seizures Spasticity Contractures Sensorineural hearing loss
34
Characteristics of rubeola (measles) Which virus What are the symptoms (one you keep forgetting) Defining symptom?
Genus: Morbillivirus — fever, malaise, cough, coryza, **conjunctivitis** — THEN followed by **rash** — **koplik spots on back of throat**
35
Scarlet fever Which pathogen Characteristic symptoms Scarlet fever + what can lead to ?
Strep pyogenes (releases an erythrogenic toxin = scarlet!) Erythematous eruption + pharyngitis Blanches Papular elevations **sandpaper skin** Scarlet fever + pharyngitis could lead to **rheumatic fever**
36
Rubella, aka? Symptoms?
German measles Rubella virus Rash **begins on face and spreads caudally — NOT palms and soles** Fever & LAD : 2-3 days "think efficient Germans get through the virus quickly!"
37
Scalded Skin Syndrome Which pathogen? Symptoms?
Staph aureus Toxin A or B is exfoliative Rapidly progresses extensively, flaccid bullae, erosions, **sheet-like desquamation**
38
Erythema infectiosum Which virus Defining symptoms
Parvovirus B19 / **fifth disease** Fever, coryza, headache, nausea and diarrhea THEN followed by an erythematous malar rash with circumoral pallor **slapped cheek**
39
Roseola infantum (Exanthum subitum) Which viruses?
**high fever and then later a rash!** Mild URTICARIA HHV 6B HHV 7 Three to five days of a high fever that *resolves* abruptly and then a rash develops : blanching, starting on the neck and then moving to trunk Can involve **seizures**
40
Which two childhood exanthems are most common because there aren’t vaccines? Which viruses are they attributable to?
Erythema infectiosum (parvovirus B19) Roseola infantum (HHV6/7)
41
Learn these
42
Recognise this disease What is it caused by
**COXSACKIE VIRUS**
43
Rose coloured spots on abdomen, think
salmonella typhi
44
Aplastic anemia associated with
Parvovirus B19, fifth disease, erythema infectiosum
45
Warm, swollen, red, joints, think? 2
Late stage lyme (treat with ceftiaxone) Gonococcal arthritis Also septic arthritis
46
Untreated strep throat (pharyngitis) can cause How would you confirm?
rheumatic fever Elevated ASO titer to confirm
47
TX for pyelonephritis 2
Pyridium - phenazopyridine (for pain) **CIPRO or LEVO!**
48
Bacteria resistance/susceptibility
Just know that the larger the zone of inhibition the more susceptible that bacteria is to that antimicrobial. If there is not a zone of inhibition, the bacteria is resistance to that antimicrobial
49
Look at diseases with AIDS references Crytptosporidium hominis Toxoplasma gondii TB Cryptococcus neofomans (also meningitis) Pneumocystis jiroveci HH8 page 277
**Crytptosporidium hominis** Not usually treated except in AIDs pts Can use _nitazoxamide_ **Toxoplasma gondii** Encephalitis in AIDs pts: cat litter: Poisonous Feline Shit **TB** 4th med in RIPE is added for severe cases and AIDs pts **Cryptococcus neofomans (also meningitis)** AIDs pts can be given oral fluconazole Meningitis: "FAB" **Pneumocystis jiroveci** TMP/SMX **HH8** Kaposi's sarcoma in AIDs pts
50
Trichomonas vaginalis Protozoa shape?
pear shaped **treat both partners** **METRONIDAZOLE**
51
Toxoplasma gondii — which medications (3) for congenital or disseminated disease? — which medication do you give HIV patients prophylactically to prevent encephalitis? Dx with?
*Poisonous Feline Shit* —**Pyrimethamine, folinic acid (leucovorin) sulfadiazone** —**TMP/SMX** is used to prevent toxoplasma encephalitis in **HIV** infected, AIDS patients with a low CD4 count, also used for **pneumoncystis pneumonia** —Sabin Feldman dye test —serologic tests for IgM and IgG —trophozoites or cysts visible in tissue
52
Biomedical reaction of e.Coli (there is already a card for this)
53
What is used prophylactically or Pneumocystis pneumonia?
TMP/SMX
54
Know Malaria How do you diagnose? What is old/resistant med? What is used now?
—diagnose on blood smear —chloroquine resistant now —TX: artemether-lumefantrine (double regimen)
55
What is chloroquine resistant?
Malaria
56
Enterobius vermicularis What is it? Who? Characteristic symptoms? Treatment
—think "enterobius WORMicularis" —pinworm infection —usually children —**itching present at night and wakes them** —perinatal pruritus —eggs visible by **scotch tape** technique —Tx: **mebendazole or pyrantel pamoate**
57
What is this? —usually children —**itching present at night and wakes them** —perinatal pruritus **Treatment**
Enterobius vermicularis (pinworm: WORMicularis) **Mebendazole** or pyrantel pamoate
58
Which pathogen is associated with pseudo-appendicitis ? From consumption of what? What other sx?
**campylobacter jejuni** diarrhea —exposure to poultry or unpasteurised milk —periumbilical abdominal pain that may radiate to the RLQ —**blood diarrhea and malaise** —may have fever
59
What can mimic appendicitis? How would you treat it? Which pathogens can cause traveller's diarrhea? 4 Tx
**Yersinia enterocolitica** TX: hydration & **cipro/levo (fluoroquinolones)** Abdominal pain **Fecal/oral, contaminated _pork_** *Also: campylobacter jejuni diarrhea patients may present with pseudo-appendicitis* Traveller's diarrhea: E.Coli Salmonella Shigella Campylobacter **azithromycin or cipro (fluoroquinelones)**
60
HIV positive, headache, low grade fever, budding **yeast in CSF** in **india pink preparation** What is it? Caused by which pathogen? Which test to dx? Tx? If acid fast rods are seen, what's the diagnosis?
**Meningitis** caused by **cryptococcus neoformans** Very specific for AIDS patients Most accurate **latex agglutination test** which detects the capsular polysaccharide antigen of Cryptococcus **TX: flucytosine & amphotericin B** If **acid fast rods** are seen in spinal fluid, think: **Mycobacterium tuberculosis**
61
If **acid fast rods** are seen in spinal fluid, think:
Mycobacterium tuberculosis
62
What is the most common HIV-associated opportunistic infection of the nervous system? prevent with?
Cryptococcal meningitis From *cryptococcal neoformans* Prevent with: **oral fluconazole** (TMP/SMX is given prophylactically to AIDs patients for toxoplasmi gondii (cat shit) and pneumocystis pneumonia!) Treat with: **Amphotericin B + flucytosine**
63
12 year old, painful arm, pain gotten worse, temperature 100F Aspirate reveals gram-positive cocci in clusters
Staph aureus Most common cause of osteomyelitis in children
64
Most common cause of osteomyelitis in children
Staph aureus
65
50 year old, chemotherapy, has a catheter _sudden onset blindness_ **budding yeast that formed germ tubes** What yeast? Source of infection Condition?
Candida albicans Catheter infection > embolus > bloodstream > reached the eye Endophthalmitis
66
60 year old Non productive cough Kidney transplant 6 weeks ago **owl eye inclusion bodies with nucleus** — think? Treatment?
CMV HH5 pneumonia Not a big deal unless for a newborn Owl eye inclusion bodies (tissue biopsy), think virus Dx: also with serology: CMV specific IgM antibodies Treatment: "megalo" need the whole "gang" = **Ganciclovir**
67
Brain biopsy: gram positive in long filaments. Weakly acid-fast
Nocardia Asteroides *think about the "long filament" trail an asteroid leaves across the sky*
68
20 year old, severe headache, vomiting, confused, stiff neck. NO bacteria on gram stain
Viral meningitis Often caused by **Coxsackie virus** Which is also responsible for HFM syndrome and Herpangina (Coxsackie A)
69
Viral meningitis often caused by?
Coxsackie virus Could also be: —HSV —mumps —west Nile
70
Had TB, cured, cavity left over, culture of sputum grew **septate hyphae w/ straight parallel walls**
Aspergillosis fumigatus “fungus ball” **aspergilloma** Not very pathogenic, taking advantage of the cavity but needs to be surgically removed
71
3 month old, watery, non-bloody diarrhea — normal flora
Rotavirus **most common cause of diarrhea infants**
72
Swollen, red, hot and tender ankle, with fever. No history of trauma. **gram negative diplococci are seen in joint fluid aspirate**
Neisseria gonorrhoeae
73
Most common cause of infectious arthritis in sexually active adults
Neisseria gonorrhoeae Septic arthritis
74
When will gonorrhea likely travel up and cause PID? Why?
During or after menses pH interrupted during menses
75
What does the botulism toxin do? DX:
it is a protease that cleaves the proteins involved in the release of acetylcholine at the NMJ = flaccid paralysis DX: toxin assay
76
Painful, hot, spreading rash, temperature Gram + cocci in chains aspirated Clear beta hemolysis Inhibited by bacitracin What is it? Complication?
Strep pyogenes Cellulitis Acute glomerulonephritis (AGN)
77
4 year old, wakes up, anal itching, worms on scotch tape
Pin worm Enterobius vermicularis
78
Cellulitis caused by normal flora in cat’s mouth
Pasteurella multocida "think that you find flora (flowers) out in the pasteur (pasteurella)"
79
Bloody diarrhea, think 4 things
Campylobacter jejuni (indole negative) OR Enterohemorrhagic strains of E.Coli (indole positive) OR E.histolytica If 0157:H7, unable to ferment sorbitol
80
Pneumonia Cold agglutinin test is positive, think Seen in which population? 3 symptoms CXR findings Tx
Atypical pneumonia caused by **Mycoplasma pneumoniae** "walking pneumonia" because it is seen in **young healthy people** -pharyngitis -URI prodrome -cough **diffuse, patchy interstitial infiltrates on CXR** **_Macrolides or Doxy_**
81
Patients with a fracture of the cribiform plate who leak spinal fluid into the nose, think
Meningitis caused by **strep pneumoniae**
82
Atypical pneumonia is defined as what on CXR
Diffuse interstitial infiltrates bilaterally — viral **"Lobar" is typical pneumonia** Treat with **macrolides**
83
Pneumonia in young kids is caused by (+ CXR has interstitial infiltrates bilaterally. ELISA detected viral antigen in nasal washings) What type of cells?
RSV — most common cause of pneumonia and bronchiole it is in infants (this is still an atypical pneumonia because of the interstitial infiltrates bilaterally) RSV causes giant cells (syncytia)
84
Acute endocarditis is caused by? Subacute?
S.aureus Subacute can also be caused by viridans group: streptococcus sanguinis
85
**Neonatal** sepsis is caused by what if gram + cocci in chains seen? What about gram neg rods? Or gram + rods?
**Strep agalactiae** - think newborns drink milk (galactose) Think E.Coli if gram neg rods are seen Or Listeria monocytogenes if gram positive rods are seen
86
Smear of material from the base of the vesicle reveals **multinucleated giant cells with intra _nuclear inclusions_**
**Herpes Zoster (Shingles)** caused by the activated **varicella zoster virus** Can also diagnose with **fluorescent antibody assay** Could also be **HSV2**, think about a neonate with several vesicles on scalp and around the eyes
87
Oval rash, inflammed border, central clearing, **hyphae are seen on KOH prep** What is it? What does this pathogen use as a nutrient source?
Tinea corporis (ringworm) **keratin**
88
Toxic Shock is caused by which pathogen?
Staph aureus *stimulates the release of large amounts of cytokines from many help T cells*
89
Papular rash, trunk, arms, palms, does not itch. Lesions on labia **dark-field microscope revealed spirochetes** Which disease Which pathogen Which test to confirm Lesion with each stage?
Secondary syphilis *T.pallidum* VDRL Primary: chancre Secondary: rash + condyloma lata (lesions in the genital area) Tertiary: gumma lesions (invades blood vessels, scalp!) aortitis
90
Otitis media caused by? 2 Treatment
S.pneumoniae H.influenzae (gram neg rods) TX: First line amoxicillin, second-line augmentin, macrolides if penicillin-allergic
91
High fever, several purple skin lesions, scattered everywhere, HR 140, BP 60/10 Culture grew: gram neg diplococci
**meningococcemia** caused by Neisseria meningiditis Purpuric lesions manifestation of DIC
92
Burn or crush injuries can cause
Septic shock like symptoms **Norepinephrine** is the first-line vasopressor agent for patients with septic shock if initial fluid resuscitation fails to restore mean arterial pressure to 65 mm Hg or greater
93
Morphology
94
Blood smear reveals **ring shaped trophozoites within red blood cells**
Malaria caused by *plasmodium* species
95
**banana-shaped gametocytes** on blood smear, think
Plasmodium falciparum - the worse malaria~ Can cause life threatening complications such as cerebral malaria
96
Negri bodies / eosinophilic inclusion bodies in the cytoplasm of neurons, think
Rabies
97
Night sweats, chills, fatigue, ate unpasteurised cheese, culture grew **small gram negative rods** Think of the cow that produced the milk..
Brucellosis **unpasteurised diary products** Could also have typhoid fever called by *Salmonella typhi* but that does not have a animal reservoir
98
Erythematous rash located over malar eminences — 6 year old girl What is a complication of this disease?
Slapped cheek Parvo B19 **aplastic anemia because it preferentially infects and kills erythroblasts** Can also cause hydrous fetalis Arthritis
99
Necrotising fasciitis is usually caused by
Strep pyogenes
100
Sub-sahara, massive watery stool without blood Gram negative curved rods
Vibrio cholerae
101
C.jejuni usually causes what type of diarrhea
Bloody
102
What does helicobacter pylori cause? What does it not cause?
Gastritis Peptic ulcer **not diarrhea**
103
MRI reveals mass in the parietal lobe, removal of the mass reveals **larva within a cystlike sac** Treatment
**Cysticercosis caused by the larva of Taenia solium** Albendazole
104
1 week old, yellowish exudate in corners of eyes. Giemsa stained smear of the exudate reveals **a large cytoplasmic inclusion**
Conjunctivitis from **Chlamydia trachomatis** Confirm with direct fluorescent antibody test Transmission through birth canal **intracellular replicating forms called reticulate bodies**

Z Infectious Disease (17 decks)

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