Primer 13 Flashcards
4 most common side effects of B-blocker meds?
3 patients that should be monitored carefully on B-Blockers?
- Bronchocnstrxn.
- Bradycardia
- AV Block
- Mask hypoglycemia
- COPD/ asthma
- DM patients on meds
- Acute CHF patients (may exacerbate acute episode)
Match the disease to the following immunopathology:
- Antimicrobial Abs
- Antiplatelet Abs
- Newborn with chronic diarrhea, failure to thrive, chronic candidiasis
- Child with eczema, coarse facial features, cold accesses
- Child with partial albinsism, peripheral neuropathy, recurrent infections
- Primary biliary cirrhosis
- ITP (immune thrombocytopenia purpura)
- SCID
- Hyper IgE (Job Syndrome)
- Chediak Higashi Syndrome
Clinical uses for first, second, third, fourth generation cephalosporins:
1st: gram +, PEK
2nd: gram +, HEN PEK
3rd: gram - (pseudomonas, n. gonorrhea)
4th (cefipime): gram +, gram -
Recall HEN PEK organisms
H. flu
Enterobacter
Neisseria
Proteus
E Coli
Klebsiella
Gardinella Vaginalis (Bacterial Vaginosis): Discharge Vaginal pH Wet Mount Treatment
- Thin, gray-white, fishy smell
- pH»> 4.5
- CLUE CELLS (epi cells with dots = the bacteria)
- whiff test (mix with KOH and smell = STANKY)
- Metronidazole, Clindamycin
Candida Albicans/ Vaginal Candidiasis: Discharge Pelvic exam Vaginal pH Wet Mount Treatment
- Chunky, white, cottage cheese
- may see exhortations due to itch
- pH = 4-4.5
- yeast formations (hyphae, buds)
- -azole, nystatin
Trichomonas Vaginalis: Discharge Pelvic Exam Vaginal pH Wet Mount Treatment
- Frothy, green-yellow, fishy smell
- strawberry cervix
- pH»>4.5
- motile pear shaped flagellated organisms
- metronidazole
How do we treat pregnant females with syphilis that are allergic to penicillin?
BENZOTHENE PENICILLIN G upon desensitization
Early manifestations of congenital syphilis (4):
- HSM w/ ^ LFTs
- Rash–> desquamation of hands and feet
- snuffles (bloody nasal secretions)
- skeletal abnormalities on XR
Late Manifestations of congenital syphilis (6):
- Frontal bossing
- Saddle nose
- Saber shin
- Hutchinson teeth
- Interstitial keratitis
- perforation of hard palate
What is condyloma accuminata?
What pathogens cause this disease?
Histological findings?
Genital warts
HPV 6, 11
Koilocytes (perinuclear cytoplasmic clearing)
How does N. Gonnorrhea infection present in:
Women?
Men?
Women: asymptomatic until PID develops
Men: urethritis, dysuria, mucopurulent discharge, epididymitis, disseminated infection with septic arthritis
JOINT PAIN IN YOUNG SEXUALLY ACTIVE MALES
What is the #1 bacterial STI?
Chlamydia!
What is the #1 cause of Reiter’s Syndrome/ Reactive arthritis?
Chlamydia!
Which serotypes of chlamydia cause STI?
D-K
How does a Chlamydia infection typically present in:
Women?
Men?
Typically asymptomatic!
Women: cervicitis, urethritis w/ dysuria–> PID
Men: epididymitis, prostatitis
Both: Conjunctivitis, lymphogranuloma venereum
What is lymphogranuloma venereum?
Chlamydial infection
PAINLESS general ulcer–> Bubos (engorged, swollen inguinal nodes that can burst)
Which STIs cause painLESS genital ulcers?
- chlamydia (lymphogranuloma venereum)
2. treponema pallidum (syphillis) chancre
Which STIs cause painFUL genital ulcers?
- chancroid (H. ducreyi)
2. HSV2»>HSV1
Which organism has a “school of fish” look under the microscope?
H. ducreyi
Describe the clinical manifestations of primary, secondary and tertiary syphilis infection:
1:
chancre
2:
systemic sx (nonspecific/flu-ish)
erythematous macules on palms and soles of feet
condyloma late (flat, smooth, moist lesions)
3: neurosyphilis (tabes dorsalis, argyle robertson pupil) cardiovascular syphilis (aortitis) gummatous syphilis (granulomatous lesions on skin)
What is PID?
What are the two most common causative agents?
Treatment?
3 complications without treatment:
Ascending, polymicrobial, inflammatory infection of female upper reproductive tract
- Chlamydia, Gonorrhea (break through cervical mucus)
- Tx: Broad spectrum ABX
- Infertility, chronic pelvic pain, ectopic preggos
What is Fitzhugh Curtis Syndrome?
Characteristic finding?
Infection of the renal capsule caused by extension of PID
- violin string adhesions + inflammation
Clinical symptoms of PID (3):
- Pelvic/ lower abdominal pain
- cervical motion tenderness (chandelier sign)
- mucopurulent discharge
6 physiological manifestations of PID (what gets inflamed?):
- Endometritis
- Salpingitis
- Oophoritis
- Hydrosalpynx
- Tubo-ovarian access
- Fitzhugh Curtis
1 cause of UTI in general population + 3 others ?
#1: Fecal flora (gram - rods like e coli) #2: proteus, klebsiella, enterobacter
Most common cause of UTI in sexually active females?
staph saprophiticus (gram + !!)
Which bugs cause nosocomial UTI? What is the #1 route of infection?
#1: e coli, cath related Also consider pseudomonas, candida
Who typically gets UTI (7)?
- women
- infants with anatomical abnormalities (vesicouretal reflux)
- obstruction (BPH, tumor, stone)
- catheterized patients
- bladder dysfunction/ urinary stasis
- preggos
- immunocompromised
Symptoms of cystitis?
- dysuria
- ^ frequency + urgency
- suprapubic pain
- hematuria
Symptoms of Pyelonephritis?
Symptoms of cystitis + flank pain, costovertebral tenderness
What will you find in a urinalysis for a patient with cystitis (5)?
Pyelonephritis (1)?
- bateria +
- pyuria (10 wbc/ uL)
- leukocyte esterase +
- nitrite (enterobacteraia +)
- hematuria +/-
- WHITE BLOOD CELL CASTS IF PYELO!
What does urease do and which bacteria produce it (2)?
Catalyst: urea–> ammonia, alkalizing urine–> ^ risk struvite stones
- proteus
- klebsiella
Which bugs cause ventilator acquired pneumonia?
Aspiration pneumonia?
Vent:
- pseudomonas
- s. aureus
Aspiration:
- polymicribial, worry about anaerobes
Which bugs cause central venous cath infection?
- s. epi
Which bug is most likely too infect a surgical wound or decubitus ulcer?
- s. aureus
Which bug infects patients on parenteral nutrition?
candida
Which bug causes nocicomial diarrhea?
c. diff
Toxoplasma Gondii:
Transmission?
Clinical triad in infant?
cat feces, undercooked meat
- chorioretinitis
- hydrocephalus
- intracranial calcification
Parvo B19:
Clinical manifestation of infection in kiddos? Infants? adults?
Where does this virus replicate?
Kids: Erythema Infectionosum/ Fifth’s Disease (slapped cheek rash)
Infants: fetal anemia, hydrops fetalis (diffuse fluid effusion)
Adults: polyarthritis
*repilcates in RBC precursors
Rubella:
Clinical manifestations in kids, infants?
Kids: mild fever with rash
infants:
1. cataracts
2. PDA
3. sensorineural deafness
4. blueberry muffin rash
CMV:
Clinical manifestation in adults/kids, infants?
adult/kid: mononucleosis infection
infant:
1. jaundice + HSM
2. sensorineural deafness
HIV:
How to prevent fetal transmission during preggos?
- HAART while preggos
- Intrapartum zidovudine and admin. to infant postpartum
- C-section
- NO BREASTFEEDING
HSV:
clinical manifestation of infant infection (4)?
how do we prevent fetal transmission during delivery?
- vesicular rash
- conjunctivitis
- pneumonia
- CNS disease
Px: Acyclovir @ 36 weeks, C-section if active infection at time of delivery
