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H&D > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

Define blepharitis:

A

Inflammation of the eyelid (hordeolum “stye” involves oil gland)

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2
Q

Define dacryocystitis:

A

Inflammation of the lacrimal sac (usually partial or complete obstruction)

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3
Q

Define conjunctivitis:

A

Inflammation of the conjunctiva (may extend to other parts of eye)

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4
Q

Define keratoconjunctivitis:

A

Extensive disease involving conjunctiva and cornea (may lead to ulceration, scarring, and blindness)

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5
Q

Define ophthalmia neonatorum:

A

Acute, sometimes severe conjunctivitis or keratoconjunctivitis of newborns

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6
Q

Define endophthalmitis:

A

Infection of aqeuous or vitreous humor

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7
Q

Define uveitis:

A

Inflammation of the uveal tract (iris, ciliary body, and choroid)

*most are not infectious origin

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8
Q

Define chorioretinitis:

A

Most common infective involvement of uveal tract (may lead to destruction of choroid and optic nerve inflammation)

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8
Q

Define chorioretinitis:

A

Most common infective involvement of uveal tract (may lead to destruction of choroid and optic nerve inflammation)

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9
Q

What are common infectious causes of blepharitis?

A

Staphylococcus aureus

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10
Q

What are common infectious causes of dacryocystitis?

A

Streptococcus pneumoniae
Staphylococcus aureus

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11
Q

What are common infectious causes of opthalmia neonatorum?

A

Neisseria gonorroeae
Chlamydia trachomatis

HSV

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12
Q

What are common infectious causes of endophthalmitis?

A

Staphylococcus aureus
Pseudomonas aeruginosa
*other gram-negative organisms

Candida spp.
Aspergillus spp.

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13
Q

What are common infectious causes of iridocyclitis?

A

Treponema pallidum

HSV
VZV

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14
Q

Where is the cutoff betweeon the upper and lower respiratory tract?

A

the glottis

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15
Q

Define lobar pneumonia. What organism is most likely (others also possible)?

A

Intra-alveolar exdate evolved into a consolidation

Streptococcus pneumoniae

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16
Q

Define bronchopneumonia:

A

Patchy distribution from bronchioles into adjacent alveoli of acute inflammatory infiltrates

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17
Q

Define atypical or walking pneumonia. What are likely pathogens?

A

Diffuse patchy infiltrates seen on interstitial areas of alveolar walls

Mycoplasma
Chlamydophila
Legionella
Viruses

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18
Q

Define aspiration:

A

The inhalation of either oropharyngeal or gastric contents into the lower airways

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19
Q

What is the main difference between aspiration pneumonia and aspiration pneumonitis?

A

Aspiration pneumonitis does not have an infectious etiology

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20
Q

Untreated aspiration pneumonia may progress to what specific disease condition?

A

Lung abscess- necrosis of pulmonary parenchyma with a collection of purulence

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21
Q

What are notable symptoms of a lung abscess? What are notable treatments?

A

Sx:
-Fever
-Productive cough
-Weight loss
-Diaphoresis

Tx:
-antibiotics w/ anaerobic coverage (should NOT use daptomycin)
-drainage/surgery

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22
Q

What is the difference between antigenic drift and antigenic shift as it pertains to the influenza virus? Which is responsible for influenza pandemics?

A

AD: Changes in H and N proteins due to genetic mutations in viral genome

AS: Two different strains infect same host and swap H or N proteins to create new strain

AS is responsible for pandemics

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23
Q

This CXR is a classic presentation of what kind of pneumonia? What major sx would be expected?

A

Bacterial pneumonia (CXR infiltrate)

Fever, productive cough, and dyspnea

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24
Q

What are the two distinct types of respiratory epithelium? Where is each type principally found?

A

-Stratified squamous epithelium (oropharynx and nasopharynx)

-Respiratory epithelium (paranasal sinuses, middle ear, respiratory tract below epiglottis)

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25
Q

Which type of respiratory epithelium is colonized with bacteria? Which type is sterile (more or less)?

A

Stratified squamous epithelium is colonized with bacteria

Respiratory epithelium is relatively sterile

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26
Q

What pathogen is most likely to cause rhinitis or rhinosinusitis? (Although many pathogens are possible candidates) Approximately what proportion of rhinitis is this pathogen responsible for?

A

Rhinovirus

50-60%

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27
Q

Patients diagnosed with sinusitis are not usually treated with abx with what three notable exceptions?

A

-Persistant sx w/ no improvement for 10 days

-Fever >102 F + facial pain/purulent nasal discharge for 3 days

-Second sickening- Abrupt worsening of sx after initial improvement

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28
Q

What treatments are recommended for sinusitis? If antibiotics are indicated which are preferred?

A

Acetaminophen, ibuprofen, decongestants, nasal steroids or nasal irrigation

Amoxicillin or amox-clav can be used but are not often indicated

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29
Q

Which fungi are most likely to cause allergic fungal rhinosinusitis? Which fungi are most likely to cause invasive fungal sinusitis?

A

Aspergillus spp.

Aspergillus spp. and mucormycetes

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30
Q

What is the treatment used for invasive fungal sinusitis?

A

Emergent/aggressive surgery, as well as azoles or amphotericin B

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31
Q

Is sinusitis more likely to be viral or bacterial in nature?

A

Viral (95%)

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32
Q

Which pathogens are most likely to cause otitis media?

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

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33
Q

Which pathogens are most likely to cause otitis externa?

A

Staphylococcus aureus
Pseudomonas aeruginosa

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34
Q

How is otitis media diagnosed? What are the pertinant signs? How is it commonly treated?

A

Clinical exam

Bulging and red tympanic membranes (in adults tympanic membrane may be retracted or bulging)

Tx:
-Mostly self-limiting (children >2yo may benefit from abx)
-If abx, usually amox or amox-clav for 5-10 days

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35
Q

What treatment is usually given for otitis externa? What patient population is at highest risk for malignant otitis externa (MOE)? What treatment is administered for MOE?

A

Tx w/ antibiotic drops

Elderly diabetics at highest risk for MOE
Tx:
Prolonged courses of IV abx

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36
Q

Approximately what percent of pharyngitis is viral? Which viruses are most likely?

A

30-60%

Rhinovirus > coronavirus > adenovirus

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37
Q

What are major symptoms of pharyngitis? How is it typically diagnosed?

A

Sx:
tonsillar exudate, fever, no cough, tender anterior cervical adenopathy

Dx:
-Rapid strep test (ELISA on Lancefield Group A carbohydrates)

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38
Q

What other notable bacteria besides GAS is a common cause of pharyngitis? What antibiotics may or may not be indicated in the best coverage of both bacteria?

A

Fusobacterium necrophorum

Azithromycin will NOT cover F. necrophorum, and should not be used for Tx of sore throat

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39
Q

What are two potential complications of sore throat?

A

Peritonsillar abscesses, which require immediate drainage and abx

Lemierre’s disease, which is an infected clot of the jugular vein

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40
Q

What other infectious pathology may appear similar to strep throat?

A

Mononucleosis (EBV infection), which can often present with abnormal liver tests and splenohepatomegaly

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41
Q

What are the Centor critiera? How are symptoms scored?

A

Fever
Tonsillar exudate
Tender anterior cervical adenopathy
No cough

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42
Q

Do all streptococci have a group? What is an example of a streptococci that cannot be grouped?

A

No

Streptococcus pneumoniae

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43
Q

What sign is visible on this x-ray? What is it suggestive of?

A

Thumb sign

epiglottitis

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44
Q

What are symptoms of epiglottitis? Though it is rare, what pathogen most commonly causes epiglottitis?

A

Severe sore throat with rapid progression to dysphagia and drooling

H. influenzae

*epiglottitis requires emergent evaluation

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45
Q

What sign is visible on this x-ray? What is it suggestive of?

A

Steeple sign

Croup (laryngotracheitis)

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46
Q

What is croup (laryngotracheitis)? In what age group is it most common?

A

Inflammation of the upper airway resulting in obstruction

6months to 6 years

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47
Q

What are major symptoms of croup?

A

Inspiratory stridor
Barking cough
Hoarse voice
Increased breathing work

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48
Q

Which viruses are the most common causes of croup?

A

Parainfluenza and rhinovirus

Also RSV, influenza, enterovirus

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49
Q

What are the available treatments for croup?

A

Steroids (all cases)
Inhaled epinephrine (if moderate to severe)

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50
Q

What are the two most common causes of bronchiolitis? During what seasons and which age demographics are most at risk?

A

RSV as well as rhinovirus

Fall or winter outbreaks are most common

Children under 2yo are most at risk

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51
Q

What are the common Sx of bronchiolitis? What Tx are used?

A

Sx:
Fever, cough, respiratory distress, wheezing crackles

Tx:
Supportive care

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52
Q

Of Influenza A, B, or C, which can be contracted by humans, birds and pigs?

A

Influenza A

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53
Q

What are the most direct results of damage to and sloughing of the respiratory epithelial cells caused by influenza?

A

Cough and pneumonia

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54
Q

What are common sx of an influenza infection? What are common diagnostic methods? What treatments are commonly used?

A

Sx:
Fever, aches and pains, fatigue, cough (due to immune response)

Dx:
-Rapid flu test (low sensitvity)
-RT-PCR (more sensitive, takes several hours)

Tx:
Oseltamivir/zamamivir

*resistance to oseltamivir is rare, but zamamivir usually works well in situations with resistance

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55
Q

What pathogens are associated with TORCH syndrome?

A

T- Toxoplasma gondii
O- Other (Treponema pallidum,VZV, LCM virus, Zika virus, Trypanosoma cruzi)
R- Rubella
C- CMV
H- HSV

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56
Q

Which TORCH infection is characterized by skin scarring, along with formation of a cicatrix?

A

Varicella zoster virus

57
Q

Which TORCH infections are most strongly associated with hydrocephalus and chorioretinitis?

A

Toxoplasma gondii
Lymphocytic choriomeningitis virus

58
Q

How is LCM virus transmitted?

A

Via rodent droppings

59
Q

How is Zika virus transmitted?

A

Via mosquitos

60
Q

Which TORCH infection is most characterized by microcephaly?

A

Zika virus

61
Q

Which TORCH infection is most characterized by cataracts and congenital heart defects?

A

Rubella

62
Q

Which TORCH infection is most characterized by sensorineural hearing loss and microcephaly?

A

Cytomegalovirus

63
Q

Which two TORCH infections are the most common?

A

CMV
Syphilis

64
Q

Which TORCH infections can be detected by PCR?

A

Zika virus
Rubella
CMV
HSV

65
Q

Which TORCH infections can be detected by IgM assay?

A

Toxoplasmosis
Zika virus
Rubella

66
Q

What diagnostic method can be used to detect Treponema pallidum?

A

RPR or VDRL (VDRL of CSF)

67
Q

Why is testing for IgG antibodies in infants not done?

A

Infants do not yet produce IgG, so serum IgG is provided by the mother through the placenta or through breast milk

68
Q

What are common hematologic disturbances in symptomatic TORCH infections?

A

Thrombocytopenia
Leukopenia
Anemia

69
Q

Roughly what percentage of patients with cCMV are symptomatic?

A

10-15%

70
Q

What is the #1 non-genetic cause of sensorineural hearing loss (SNHL) in children?

A

cCMV

71
Q

What is the median age of onset of cCMV?

A

33 months

72
Q

How can cCMV be diagnosed?

A

PCR on urine or saliva (saliva can give false positive if breastfeeding)

73
Q

Which infants with cCMV should receive treatment?

A

All of them

74
Q

What treatments should all cCMV receive?

A

-Regular auditory evaluation (most important)
-Careful monitoring of neurodevelopment
-Ophthalmologic evaluations

75
Q

Which cCMV patients should be treated with ganciclovir/valganciclovir?

A

Patients with moderate-severe symptoms

76
Q

What are good prevention practices for contraction of CMV?

A

-Hand hygiene
-Standard precautions
-Care around secretions from children (Saliva, urine, blood, etc)

77
Q

What pathology is shown on this CXR? Which viral pneumonia-causing pathogen would be most likely to present with this finding?

A

Ground glass opacity

SARS-CoV-2

78
Q

Which viral pneumonia-causing pathogen is especially notable for potential to cause multisystem inflammatory syndrome (MIS) in children?

A

SARS-CoV-2

79
Q

What are appropriate early and late treatments for a SARS-CoV-2 infection?

A

Tx- early
-Remdesivir
-Nirmatrelvir
-Molnupiravir

Tx- late
-Steroids
-Tocilizumab

80
Q

What three pathogens are most likely to cause typical community-aquired bacterial pneumonia?

A

S. pneumoniae (most common)
H. influenzae
M. catarrhalis

81
Q

What is the function of the enzyme pneumolysin, which is produced by S. pneumoniae?

A

To destroy epithelial cells, increasing the inflammatory resposne

82
Q

What is the appropriate treatment for typical community-acquired bacterial pneumonia?

A

Beta-lactam abx

83
Q

What is the appropriate treatment for atypical community-acquired bacterial pneumonia?

A

Macrolides or quinolones

84
Q

What are the three pathogens most likely to cause atypical community-acquired bacterial pneumonia?

A

Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumophila

85
Q

What is significant about the lack of a cell wall in Mycoplasma pneumoniae? What additional substance gives stability to the cell membrane?

A

It is beta-lactam resistant

Sterols

86
Q

What age group is at highest risk for a M. pneumoniae infection?

A

Children ages 5-15

87
Q

How can a M. pneumoniae infection be diagnosed?

A

PCR (microscopy doesn’t work, neither do stains due to lack of a cell wall)

88
Q

Which bacterial infection causing atypical pneumoniae usually presents with the most severe symptoms?

A

Legionella pneumophila

89
Q

How many serotypes are tested for in the Legionella pneumophila urine antigen test?

A

1 serotype

90
Q

Which two bacteria are most heavily associated with nosocomial infections, infections of ventilated pts, CF pts, and elderly pts?

A

P. aeruginosa
S. aureus

91
Q

What type of pathology is visible on this CXR? What is the most common etiology? What are other things that belong on the ddx?

A

Focal opacity in LLL

Pneumonia (PNA)

Cancer and pulmonary embolism (PE)

92
Q

What type of pathology is visible on this CXR? What things belong on the ddx?

A

Cavitary lesions

Septic emboli, cancer, TB (especially if in UL)

93
Q

What type of pathology is visible on this CXR? What things belong on the ddx?

A

Diffuse ground-glass opacities

PE, ARDS, COVID-19, PJP, vaping

94
Q

Mycobacteria possess a waxy coat which allows them to survive the phagolysosome effects in what principle cell type?

A

Inactivated (normal) macrophages

95
Q

What the the two most notable virulence factors of M. tuberculosis?

A

Chording factor
Sulatides

96
Q

What effect is achieved by the chording factor in M. tuberculosis?

A

Macrophages are activated -> granuloma formation -> release of TNF-a

97
Q

What effect is achieved by the sulatides in M. tuberculosis?

A

Phagolysosome fusion is inhibited

98
Q

Is TB airborne or droplet precautions?

A

Airborne (particles can last for several hours in the air)

99
Q

What four drugs compose the first line treatment for TB infection? What is the main toxicity associated with these drugs?

A

R- Rifampin
I- Isoniazid
P- Pyrazinamide
E- Ethambutol

Hepatotoxicity

100
Q

What is the MoA of Rifampin (RIF)? What unique side-effects does it present with?

A

RIF blocks DNA-dependent RNA polymerase

SE: Body fluid discoloration

101
Q

Due to the many drug interactions of Rifampin, what drug can be used in its place?

A

Rifabutin

102
Q

What is the MoA of Isoniazid? Why is pyridoxine given with treatment?

A

INH inhibits mycolic acid synthesis

To prevent deficiency leading to peripheral neuropathy

103
Q

What is the MoA of Pyrazinamide?

A

PZA is converted to pyrazinoic acid and lowers intracellular pH

104
Q

What is the MoA of Ethambutol? What unique side-effects does it present with?

A

EMB inhibits arabinosyl transferase

SE: Optic neuritis

105
Q

Into what Runyon group does Mycobacterium marinum fall?

A

Runyon I- Photochromogens

106
Q

How can a Mycobacterium leprae infection be diagnosed?

A

Skin biopsy or nasal mucosa scraping

107
Q

What are the two types of leprosy associated with M. leprae?

A

Lepromatous leprosy
Tuberculoid leprosy

108
Q

What are 3 facts that distinguish lepromatous from tuberculoid leprosy?

A

Lepromatous leprosy
-Poorly demarcated lesions
-Paresthesias
-Multibacillary

Tuberculoid leprosy
-Well demarcated lesions (also central hypopigmentation)
-Hypoesthesia
-Paucibacillary

109
Q

During a TST test or an IGRA, how are macrophages involved in the immune response?

A

Macrophages bind the TB antigen and act as an APC, presenting it to CD4+ Th1 cells

110
Q

What principle cytokine is released by Th1 cells after being activated by macrophages with the TB antigen?

A

IFN-gamma

111
Q

What substance is used for NAAT of a Mycobacterium tuberculosis infection?

A

sputum

112
Q

What is the name of the pathology shown here? What might they me indicative of?

A

Janeway lesions

Infective endocarditis

113
Q

What is the name of the pathology shown here? What might they me indicative of?

A

Osler nodes
*they are painful

Infective endocarditis

114
Q

What is the name of the pathology shown here? What might they me indicative of?

A

Splinter hemorrhage

Infective endocarditis

115
Q

What are major risk factors for infective endocarditis?

A

Age (> 50yo)
Male
Structural HD or Rheumatic HD
IV drug use
Poor dentition/dental procedures

116
Q

What is the mortality of untreated infective endocarditis? With treatment?

A

100%

25%

117
Q

What are the three most common symptoms of infective endocarditis? (above 25% of pts)

A

Fever (96%)
New heart murmur (48%)
Hematuria (26%)

118
Q

What are the two main tools used to diagnose infective endocarditis?

A

Echocardiography
Duke criteria

119
Q

What are the two types of echocardiography used for diagnosis of infective endocarditis (IE)?

A

Transthoracic (TTE)
Transesophageal (TEE)

120
Q

What are the pros and cons of using TTE or TEE to diagnose infective endocarditis?

A

TTE:
-Non-invasive
-Sensitivity for IE less than 60%

TEE:
-Sensitivity is greater than 90% for IE

121
Q

What are the treatments for infective endocarditis?

A

IV antibiotics

*Repeated blood cultures every 24-48 hours are taken, as well as subspeciality consult team meetings

122
Q

What are the risk factors for acute pericarditis?

A

Male
Age (20-50 yo)

123
Q

What are major symptoms of acute pericarditis?

A

Pain that worsens when lying down (pericardial stretching)
Friction rub
Hypotension
Kussmaul sign (JVD)
Distant heart sounds

124
Q

What EKG and CXR manifestations are consistant with acute pericarditis?

A

EKG: diffuse ST elevation

CXR: enlarged heart

125
Q

What are common treatments for acute pericarditis?

A

-Symptomatic pain management (usually NSAIDs, but gluccocorticoids can be used if NSAIDs are CI)

-Abx/antifungals etc.

-Surgical drainage if contrictive

126
Q

What are the two types of antigen reactions that are described as Type II hypersensitvity reactions?

A
127
Q

What kind of skin infection is shown here? Is it purulent or non-purulent? What layers of skin are affected?

A

Impetigo

Non-purulent

Epidermis

128
Q

Is this an example of flaccid or tense bullae?

A

Flaccid bullae

129
Q

What is the skin infection pictured here? Is it purulent or non-purulent? Which layers of skin does it affect?

A

Ecthyma

Non-purulent

Epidermis and upper dermis

130
Q

What is the skin infection pictured here? Is it purulent or non-purulent? What layers of skin does it affect?

A

Erysipelas

Non-purulent

Upper dermis

131
Q

What is the skin infection pictured here? Is it purulent or non-purulent? What layers of skin does it affect?

A

Cellulitis

Non-purulent

Subcutaneous

132
Q

What is the skin infection pictured here? Is it purulent or non-purulent? What layers of skin does it affect?

A

Folliculitis

Purulent

*Infection of hair follicle

133
Q

What is the skin infection pictured here? Is it purulent or non-purulent? What layers of skin does it affect?

A

Cutaneous abscess

Purulent

Subcutaneous tissue

134
Q

What is the skin infection pictured here? Is it purulent or non-purulent? What layers of skin does it affect?

A

Carbuncle

Purulent

*hair follicles, coalescence of several furuncles

135
Q

What is the skin infection pictured here? Is it purulent or non-purulent? What layers of skin does it affect?

A

Hidradenitis suppurativa

Purulent

chronic recurrent, relapsing suppurative infection of apocrine and sebaceous glands

136
Q

What two treatments can be used for most purulent skin infections?

A

Incision and drainage
Systemic antibiotics

137
Q

What organisms is most likely to have caused the necrotizing fasciitis with the presentation pictured here?

A

Vibrio vulnificus

138
Q

What is the name of the indicated cells on this histology slide? What infection are they characteristic of?

A

Henderson-Paterson inclusion bodies or molluscum bodies

Molluscum contagiosum

139
Q

What four disease conditions have a strong association with HLA-B27?

A

Psoriasis
Ankylosing spondylitis
IBD
Reactive arthritis

H&D (10 decks)

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