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Z Infectious Disease > Pearls > Flashcards

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
Q

What diseases are you at risk for with a needlestick infection?

A

Hep B
Hep C
HIV

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26
Q

E.Coli UTI — describe the 5 steps

A
  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&raquo_space; bacteria are internalised
  4. UPEC multiply to form intracellular bacterial communities (IBCs)
  5. Efflux of IBCs = reinvasion of neighbouring cells
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27
Q

Alternative treatments for UTIs —5

A

A lot of resistance

Alternatives:
Cranberries
Probiotics
D-mannose
Methenamine hippurate, Estrogens
Intravesical glycosaminoglycans and immunostimulants

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28
Q

What is the MOA of cranberry components in tx of UTI—2

A

Fructose inhibits the binding of type 1 fimbriae to uroplakin receptors

Proanthocyanidins prevent binding of P fimbriae to glycolipid receptors

basically, prevents fimbriae binding

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29
Q

How does lactobacilli prevent UTI ? 6

A

—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

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30
Q

Pulmonary TB refers to which bacteria?

A

Mycobacterium tuberculosis

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31
Q

IV drug use, what could you contract? 2

A

Staph. Aureus
Right sided endocarditis

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32
Q

Hepatitis Panel
Anti-HAV IgM (+ means ??)

HBsAg (+ ??)
Anti-HBs (+??
Anti-HBc (+ ??)
Anti-HBc IgM (+ ??)
Anti-HBc IgG (+ ??)

Anti-HCV (+ ??)
HCV RNA (??)

A

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)

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33
Q

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?

A

Congenital Zika syndrome
Microcephaly
Microphthalmia
Seizures
Spasticity
Contractures
Sensorineural hearing loss

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34
Q

Characteristics of rubeola (measles)
Which virus
What are the symptoms (one you keep forgetting)
Defining symptom?

A

Genus: Morbillivirus

— fever, malaise, cough, coryza, conjunctivitis
— THEN followed by rash
— koplik spots on back of throat

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35
Q

Scarlet fever
Which pathogen

Characteristic symptoms

Scarlet fever + what can lead to ?

A

Strep pyogenes (releases an erythrogenic toxin = scarlet!)

Erythematous eruption + pharyngitis

Blanches

Papular elevations sandpaper skin

Scarlet fever + pharyngitis could lead to rheumatic fever

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36
Q

Rubella, aka?
Symptoms?

A

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!”

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37
Q

Scalded Skin Syndrome
Which pathogen?
Symptoms?

A

Staph aureus

Toxin A or B is exfoliative

Rapidly progresses extensively, flaccid bullae, erosions, sheet-like desquamation

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38
Q

Erythema infectiosum

Which virus

Defining symptoms

A

Parvovirus B19 / fifth disease

Fever, coryza, headache, nausea and diarrhea THEN followed by an erythematous malar rash with circumoral pallor

slapped cheek

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39
Q

Roseola infantum (Exanthum subitum)

Which viruses?

A

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

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40
Q

Which two childhood exanthems are most common because there aren’t vaccines?
Which viruses are they attributable to?

A

Erythema infectiosum (parvovirus B19)

Roseola infantum (HHV6/7)

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41
Q

Learn these

A
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42
Q

Recognise this disease
What is it caused by

A

COXSACKIE VIRUS

43
Q

Rose coloured spots on abdomen, think

A

salmonella typhi

44
Q

Aplastic anemia associated with

A

Parvovirus B19, fifth disease, erythema infectiosum

45
Q

Warm, swollen, red, joints, think? 2

A

Late stage lyme (treat with ceftiaxone)
Gonococcal arthritis
Also septic arthritis

46
Q

Untreated strep throat (pharyngitis) can cause

How would you confirm?

A

rheumatic fever

Elevated ASO titer to confirm

47
Q

TX for pyelonephritis 2

A

Pyridium - phenazopyridine (for pain)

CIPRO or LEVO!

48
Q

Bacteria resistance/susceptibility

A

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
Q

Look at diseases with AIDS references
Crytptosporidium hominis
Toxoplasma gondii
TB
Cryptococcus neofomans (also meningitis)
Pneumocystis jiroveci
HH8

page 277

A

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
Q

Trichomonas vaginalis
Protozoa shape?

A

pear shaped

treat both partners
METRONIDAZOLE

51
Q

Toxoplasma gondii
— which medications (3) for congenital or disseminated disease?
— which medication do you give HIV patients prophylactically to prevent encephalitis?
Dx with?

A

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
Q

Biomedical reaction of e.Coli (there is already a card for this)

A
53
Q

What is used prophylactically or Pneumocystis pneumonia?

A

TMP/SMX

54
Q

Know Malaria
How do you diagnose?
What is old/resistant med?
What is used now?

A

—diagnose on blood smear
—chloroquine resistant now
—TX: artemether-lumefantrine (double regimen)

55
Q

What is chloroquine resistant?

A

Malaria

56
Q

Enterobius vermicularis
What is it?
Who?
Characteristic symptoms?
Treatment

A

—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
Q

What is this?

—usually children
—itching present at night and wakes them
—perinatal pruritus

Treatment

A

Enterobius vermicularis (pinworm: WORMicularis)

Mebendazole or pyrantel pamoate

58
Q

Which pathogen is associated with pseudo-appendicitis ?

From consumption of what?
What other sx?

A

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
Q

What can mimic appendicitis?
How would you treat it?

Which pathogens can cause traveller’s diarrhea? 4
Tx

A

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
Q

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?

A

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
Q

If acid fast rods are seen in spinal fluid, think:

A

Mycobacterium tuberculosis

62
Q

What is the most common HIV-associated opportunistic infection of the nervous system?

prevent with?

A

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
Q

12 year old, painful arm, pain gotten worse, temperature 100F
Aspirate reveals gram-positive cocci in clusters

A

Staph aureus
Most common cause of osteomyelitis in children

64
Q

Most common cause of osteomyelitis in children

A

Staph aureus

65
Q

50 year old, chemotherapy, has a catheter
sudden onset blindness
budding yeast that formed germ tubes

What yeast?
Source of infection
Condition?

A

Candida albicans

Catheter infection > embolus > bloodstream > reached the eye

Endophthalmitis

66
Q

60 year old
Non productive cough
Kidney transplant 6 weeks ago
owl eye inclusion bodies with nucleus — think?
Treatment?

A

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
Q

Brain biopsy: gram positive in long filaments. Weakly acid-fast

A

Nocardia Asteroides
think about the “long filament” trail an asteroid leaves across the sky

68
Q

20 year old, severe headache, vomiting, confused, stiff neck.
NO bacteria on gram stain

A

Viral meningitis
Often caused by Coxsackie virus

Which is also responsible for HFM syndrome and Herpangina (Coxsackie A)

69
Q

Viral meningitis often caused by?

A

Coxsackie virus

Could also be:
—HSV
—mumps
—west Nile

70
Q

Had TB, cured, cavity left over, culture of sputum grew septate hyphae w/ straight parallel walls

A

Aspergillosis fumigatus “fungus ball” aspergilloma

Not very pathogenic, taking advantage of the cavity but needs to be surgically removed

71
Q

3 month old, watery, non-bloody diarrhea — normal flora

A

Rotavirus most common cause of diarrhea infants

72
Q

Swollen, red, hot and tender ankle, with fever.
No history of trauma.
gram negative diplococci are seen in joint fluid aspirate

A

Neisseria gonorrhoeae

73
Q

Most common cause of infectious arthritis in sexually active adults

A

Neisseria gonorrhoeae

Septic arthritis

74
Q

When will gonorrhea likely travel up and cause PID? Why?

A

During or after menses
pH interrupted during menses

75
Q

What does the botulism toxin do?

DX:

A

it is a protease that cleaves the proteins involved in the release of acetylcholine at the NMJ = flaccid paralysis

DX: toxin assay

76
Q

Painful, hot, spreading rash, temperature
Gram + cocci in chains aspirated
Clear beta hemolysis
Inhibited by bacitracin

What is it?
Complication?

A

Strep pyogenes
Cellulitis

Acute glomerulonephritis (AGN)

77
Q

4 year old, wakes up, anal itching, worms on scotch tape

A

Pin worm
Enterobius vermicularis

78
Q

Cellulitis caused by normal flora in cat’s mouth

A

Pasteurella multocida

“think that you find flora (flowers) out in the pasteur (pasteurella)”

79
Q

Bloody diarrhea, think 4 things

A

Campylobacter jejuni (indole negative)
OR
Enterohemorrhagic strains of E.Coli (indole positive)
OR
E.histolytica

If 0157:H7, unable to ferment sorbitol

80
Q

Pneumonia
Cold agglutinin test is positive, think

Seen in which population?

3 symptoms

CXR findings

Tx

A

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
Q

Patients with a fracture of the cribiform plate who leak spinal fluid into the nose, think

A

Meningitis caused by strep pneumoniae

82
Q

Atypical pneumonia is defined as what on CXR

A

Diffuse interstitial infiltrates bilaterally — viral

“Lobar” is typical pneumonia

Treat with macrolides

83
Q

Pneumonia in young kids is caused by (+ CXR has interstitial infiltrates bilaterally. ELISA detected viral antigen in nasal washings)
What type of cells?

A

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
Q

Acute endocarditis is caused by?
Subacute?

A

S.aureus

Subacute can also be caused by viridans group: streptococcus sanguinis

85
Q

Neonatal sepsis is caused by what if gram + cocci in chains seen?
What about gram neg rods?
Or gram + rods?

A

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
Q

Smear of material from the base of the vesicle reveals multinucleated giant cells with intra nuclear inclusions

A

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
Q

Oval rash, inflammed border, central clearing, hyphae are seen on KOH prep
What is it?
What does this pathogen use as a nutrient source?

A

Tinea corporis (ringworm)

keratin

88
Q

Toxic Shock is caused by which pathogen?

A

Staph aureus
stimulates the release of large amounts of cytokines from many help T cells

89
Q

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?

A

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
Q

Otitis media caused by? 2
Treatment

A

S.pneumoniae
H.influenzae (gram neg rods)

TX: First line amoxicillin, second-line augmentin, macrolides if penicillin-allergic

91
Q

High fever, several purple skin lesions, scattered everywhere, HR 140, BP 60/10
Culture grew: gram neg diplococci

A

meningococcemia caused by Neisseria meningiditis

Purpuric lesions manifestation of DIC

92
Q

Burn or crush injuries can cause

A

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
Q

Morphology

A
94
Q

Blood smear reveals ring shaped trophozoites within red blood cells

A

Malaria caused by plasmodium species

95
Q

banana-shaped gametocytes on blood smear, think

A

Plasmodium falciparum - the worse malaria~

Can cause life threatening complications such as cerebral malaria

96
Q

Negri bodies / eosinophilic inclusion bodies in the cytoplasm of neurons, think

A

Rabies

97
Q

Night sweats, chills, fatigue, ate unpasteurised cheese, culture grew small gram negative rods
Think of the cow that produced the milk..

A

Brucellosis
unpasteurised diary products

Could also have typhoid fever called by Salmonella typhi but that does not have a animal reservoir

98
Q

Erythematous rash located over malar eminences — 6 year old girl

What is a complication of this disease?

A

Slapped cheek
Parvo B19
aplastic anemia because it preferentially infects and kills erythroblasts

Can also cause hydrous fetalis

Arthritis

99
Q

Necrotising fasciitis is usually caused by

A

Strep pyogenes

100
Q

Sub-sahara, massive watery stool without blood
Gram negative curved rods

A

Vibrio cholerae

101
Q

C.jejuni usually causes what type of diarrhea

A

Bloody

102
Q

What does helicobacter pylori cause?
What does it not cause?

A

Gastritis
Peptic ulcer
not diarrhea

103
Q

MRI reveals mass in the parietal lobe, removal of the mass reveals larva within a cystlike sac

Treatment

A

Cysticercosis caused by the larva of Taenia solium

Albendazole

104
Q

1 week old, yellowish exudate in corners of eyes.

Giemsa stained smear of the exudate reveals a large cytoplasmic inclusion

A

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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