Pearls Flashcards
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
Artemether-lumefantrine
anti meter light infanty
chloroquine if sensitive
dx: blood smear
Mycobacterium marinum
Where do you find it?
Where do you NOT find it?
What develops on the body? and where usually
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
What bacteria is not present in chlorinated water ?
Mycobacterium marinum
Common symptoms of trichinosis/trichinellosis?
Which pathogen?
Cause?
TX
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
How do you treat UTI? 3
Nitrofurantoin
TMP/SMX
Fosfomycin
Treatment for GAS/pharyngitis? 2
Penicillin V
Amoxicillin
How do you treat gonococcal urethritis or cervicitis?
What about if co-infected with chlamydia?
Who should be screened?
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
How do you treat anogenital warts, patient applied? Or provider administered?
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)
How do you treat trichomonas vaginitis?
Symptoms
Diagnosis/test
Metronidazole (“tricho/metro” or “vaginal canal is like a metro tube”)
Green/yellow dischage
Strawberry cervix
Wet mount, trophozoites (protozoa)
pH: >4.5
What is first line for tuberculosis? 4
Rifampin, isoniazid, pyrazinamide, ethambutol
(RIPE)
Check LFTs sine the first three are hepatotoxic.
Isoniazid also causes neuropathy in distal extremities
Treatment for cryptococcal meningoencephalitis - 2
Etiology
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
What is on a NAAT test? 2
How would you treat these two things?
Gonorrhoea and chlamydia
Chlamydia (most common!!)
If G only: ceftiaxone IM only
If G and C: + chlamydia w/doxycycline or azithromycin
What is first line for pneumocystis pneumonia? (caused by the fungus Pneumocystis jirovecii)
Provide three names for the drug
TMP/SMX also known as cotrimazole or bactrim
First line for HIV/AIDS
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)
Treatment for botulism and tetanus?
Characteristics of paralysis for each?
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)
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?
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
Chloroquine resistant malaria, what is the treatment?
Artemether-lumefantrine
DX of malaria generally made by blood smear after suggestive clinical history
Who do you screen for chlamydia and gonorrhea ?
Sexually active women under 25
How do you diagnose Lyme neuroborreliosis clinically? 7
Which lab?
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
Herpes simplex and varicella zoster, how does it manifest in the body?
Travels up the roots
Dorsal root ganglion,
Transmitted through neural tissue
Distinguish between erythema infectiosum and roseola infantum
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
Infant with congenital CMV infection, how do you diagnose? With which specific specimen?
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
Pregnant women with mononucleosis-like syndrome and negative monospot, what should you test for?
Test for CMV antibodies
Skin scarring diagnosis? What do you test for?
PCR testing for varicella-zoster virus DNA
Think: you can get scarring from chickenpox
What diseases are you at risk for with a needlestick infection?
Hep B
Hep C
HIV
E.Coli UTI — describe the 5 steps
- Colonise the vaginal and periurethral areas with uropathogens such as uropathogenic E.coli (UPEC) that usually reside in the gut
- They migrate up to the bladder
- UPEC type 1 pili adhere to uroplakins on umbrella cells»_space; bacteria are internalised
- UPEC multiply to form intracellular bacterial communities (IBCs)
- Efflux of IBCs = reinvasion of neighbouring cells
Alternative treatments for UTIs —5
A lot of resistance
Alternatives:
Cranberries
Probiotics
D-mannose
Methenamine hippurate, Estrogens
Intravesical glycosaminoglycans and immunostimulants
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
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
Pulmonary TB refers to which bacteria?
Mycobacterium tuberculosis
IV drug use, what could you contract? 2
Staph. Aureus
Right sided endocarditis
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)
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
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
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
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!”
Scalded Skin Syndrome
Which pathogen?
Symptoms?
Staph aureus
Toxin A or B is exfoliative
Rapidly progresses extensively, flaccid bullae, erosions, sheet-like desquamation
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
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
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)
Learn these
Recognise this disease
What is it caused by
COXSACKIE VIRUS
Rose coloured spots on abdomen, think
salmonella typhi
Aplastic anemia associated with
Parvovirus B19, fifth disease, erythema infectiosum
Warm, swollen, red, joints, think? 2
Late stage lyme (treat with ceftiaxone)
Gonococcal arthritis
Also septic arthritis
Untreated strep throat (pharyngitis) can cause
How would you confirm?
rheumatic fever
Elevated ASO titer to confirm
TX for pyelonephritis 2
Pyridium - phenazopyridine (for pain)
CIPRO or LEVO!
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
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
Trichomonas vaginalis
Protozoa shape?
pear shaped
treat both partners
METRONIDAZOLE
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
Biomedical reaction of e.Coli (there is already a card for this)
What is used prophylactically or Pneumocystis pneumonia?
TMP/SMX
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)
What is chloroquine resistant?
Malaria
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
What is this?
—usually children
—itching present at night and wakes them
—perinatal pruritus
Treatment
Enterobius vermicularis (pinworm: WORMicularis)
Mebendazole or pyrantel pamoate
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
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)
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
If acid fast rods are seen in spinal fluid, think:
Mycobacterium tuberculosis
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
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
Most common cause of osteomyelitis in children
Staph aureus
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
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
Brain biopsy: gram positive in long filaments. Weakly acid-fast
Nocardia Asteroides
think about the “long filament” trail an asteroid leaves across the sky
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)
Viral meningitis often caused by?
Coxsackie virus
Could also be:
—HSV
—mumps
—west Nile
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
3 month old, watery, non-bloody diarrhea — normal flora
Rotavirus most common cause of diarrhea infants
Swollen, red, hot and tender ankle, with fever.
No history of trauma.
gram negative diplococci are seen in joint fluid aspirate
Neisseria gonorrhoeae
Most common cause of infectious arthritis in sexually active adults
Neisseria gonorrhoeae
Septic arthritis
When will gonorrhea likely travel up and cause PID? Why?
During or after menses
pH interrupted during menses
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
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)
4 year old, wakes up, anal itching, worms on scotch tape
Pin worm
Enterobius vermicularis
Cellulitis caused by normal flora in cat’s mouth
Pasteurella multocida
“think that you find flora (flowers) out in the pasteur (pasteurella)”
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
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
Patients with a fracture of the cribiform plate who leak spinal fluid into the nose, think
Meningitis caused by strep pneumoniae
Atypical pneumonia is defined as what on CXR
Diffuse interstitial infiltrates bilaterally — viral
“Lobar” is typical pneumonia
Treat with macrolides
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)
Acute endocarditis is caused by?
Subacute?
S.aureus
Subacute can also be caused by viridans group: streptococcus sanguinis
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
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
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
Toxic Shock is caused by which pathogen?
Staph aureus
stimulates the release of large amounts of cytokines from many help T cells
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
Otitis media caused by? 2
Treatment
S.pneumoniae
H.influenzae (gram neg rods)
TX: First line amoxicillin, second-line augmentin, macrolides if penicillin-allergic
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
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
Morphology
Blood smear reveals ring shaped trophozoites within red blood cells
Malaria caused by plasmodium species
banana-shaped gametocytes on blood smear, think
Plasmodium falciparum - the worse malaria~
Can cause life threatening complications such as cerebral malaria
Negri bodies / eosinophilic inclusion bodies in the cytoplasm of neurons, think
Rabies
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
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
Necrotising fasciitis is usually caused by
Strep pyogenes
Sub-sahara, massive watery stool without blood
Gram negative curved rods
Vibrio cholerae
C.jejuni usually causes what type of diarrhea
Bloody
What does helicobacter pylori cause?
What does it not cause?
Gastritis
Peptic ulcer
not diarrhea
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
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
