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OMS II - Becom Exam 4 > Stillwell's Lectures > Flashcards

Stillwell's Lectures Flashcards

1
Q

Reiter’s syndrome

A
  • urethritis
  • conjunctivitis
  • reactive inflammatory arthritis
  • HLA-B27+
  • often triggered by CHLAMYDIA
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2
Q

what do you do if sexually active person comes in with urethritis?

A
  • work up both UTI and STI

- STI most common -> asymptomatic in females; discharge from males

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3
Q

diagnosis of urethritis

A

-urine sample best done 1st void (1st 10 mL)

  • if Neisseria -> Thayer-martin, martin lewis, New York city agar in CO2
  • if trichomonas -> motile on wet mount
  • if non-gonococcal (chlamydia) -> WBCs w/o visible organisms
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4
Q

what can all STDs cause?

A

hematospermia

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5
Q

Chlamydia Trachomatis

A
  • obligate intracellular
  • most common bacterial STI
  • most common cause of NGU
  • NAAT/PCR tests
  • co infection common -> GC, mycoplasma genitalium, trichomonas
  • cervicitis in women >85% asymptomatic
  • Fitz-Hugh-Curtis syndrome
  • WBCs but NO bacteria on gram stain
  • proceed to Reiter syndrome
  • Trachoma & Trichiasis
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6
Q

Lymphogranuloma venereum

A
  • PAINLESS genital ulcers that progress to inguinal lymphadenopathy
  • seen w/ Chlamydia
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7
Q

what is associated w/ elementary & reticulate bodies?

A

Chlamydia

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8
Q

urethritis in men w/ chlamydia vs. men w/ Neisseriae gonorrhea

A
  • chlamydia -> watery or mucoid discharge

- Neisseria gonorrhea -> copious purulent discharge

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9
Q

treatment of Chlamydia

A
  • uncomplicated -> Azithromycin or Doxycycline

- coinfection w/ GC -> Ceftriazone w/ azithromycin or Doxycycline

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10
Q

Neisseria Gonorrheae

A
  • gram neg diplococci
  • thayer-martin, martin-lewis, New York city agars (chocolate)
  • Fitz-Hugh-Curtis syndrome
  • likes to disseminate -> triad: polyarthritis, tenosynovitis, dermatitis (skin lesions)
  • NAATs tests of choice
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11
Q

men/women who get pharyngitis w/ Nisseria Gonorrhea

A

-ASYMPTOMATIC

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12
Q

sugar fermentation w/ Neisseria Gonorrhea (GC)

A
  • Glucose = Gonorrhea

- Glucose/Maltose = Meningococcus

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13
Q

treatment of N. gonorrhea

A

uncomplicated -> Ceftriaxone IM + Azithromycin

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14
Q

Trichomonas Vaginalis

A
  • MOTILE on wet mount
  • STRAWBERRY CERVIX
  • yellow-green discharge; malodorous
  • high vaginal pH >4.5
  • most common non-viral STI in world
  • Hydrogenosome -> produce ATP
  • males carry short term; females long term
  • asymptomatic early on -> symptomatic 5-28 days
  • NAATs preferred
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15
Q

what is most common STI in world?

A

HPV

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16
Q

3 organisms that cause symptomatic vaginal discharge

A
  1. Candida (most common)
  2. BV
  3. Trichomonas
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17
Q

treatment of Trichomonas Vaginalis

A

Metronidazole or Tinidazole

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18
Q

Bacterial Vaginosis

A
  • Gardnerella vaginalis #1
  • Mobiluncus #2
  • white-grey discharge
  • fishy odor - +whiff test
  • high vaginal pH >4.5
  • CLUE CELLS
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19
Q

treatment of BV

A

Metronidazole or Clindamycin

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20
Q

Syphilis

A

-Treponema Pallidum (spirochete) -> MOBILE

  • Darkfield microscope
  • GUMMAS *(large, caseous)
  • contagious -> 1 exposure -> primary/secondary syphilis
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21
Q

primary syphilis

A
  • HARD chancre, PAINLESS

- non-tender regional lymph nodes

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22
Q

secondary syphilis

A
  • MUCOUS patches
  • condyloma latum
  • patchy alopecia
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23
Q

tertiary syphilis

A
  • GUMMAS (necrotizing, caseous)
  • vasculitis of vasa vasorum and thoracic aorta -> aneurysms
  • coronary artery stenosis
  • Tabes dorsalis
    • Rhomberg test
  • Argyll-Robertson pupils
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24
Q

congenital syphilis

A
  • saddle nose, SABER SHINS, Clutton’s joints, frontal bossing, Higoumenakis sign
  • HUTCHINSON’S teeth
  • notched incisors and Moon’s molars
  • perforated hard palate
  • snuffles and rhagades
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25
Q

diagnosis of syphilis

A

SEROLOGY main way
-need both + nontreponemal and treponemal tests

  • cardiolipin antigen
  • titer -> 1:32 (high) down to 1:8 (low) w/ treatment
  • Nontreponemal (initial screen)
  • RPR (blood)
  • VDRL (CSF)
  • Treponemal -> Abs against T. pallidum
  • confirms nontreponemal if +
  • POS for life (even if RPR is neg)
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26
Q

what is the prozone phenomenon?

A
  • high Ab titers can give you FALSE NEGATIVE syphilis test

- recheck RPR on DILUTED serum

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27
Q

False-Pos nontreponemal test

A
  • common
  • should have NEG treponemal test
  • due to SLE or autoimmune
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28
Q

False-Pos treponemal test

A

-rare

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29
Q

what do you do if you suspect neurosyphilis?

A

spinal tap

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30
Q

treatment of syphilis

A
  • PENICILLIN
  • 1,2,early latent -> Benzathine penicillin (IM 1 dose)
  • late latent -> Benzathine penicillin (IM weekly 3x doses)
  • Neurosyphilis -> Penicillin IV
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31
Q

Jarisch-Herxheimer Rxn

A

-spiked fevers with early syphilis after receiving therapy

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32
Q

Chancroid

A

-Haemophilus Ducreyi (gram neg rod)

  • “school of fish”, “railroad tracks”
  • PAINFUL, SOFT chancre
  • PAINFUL inguinal lymph nodes
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33
Q

Granuloma inguinale/Donovanosis

A
  • Klebsiella Granulomatis (encapsulated gram neg rod)
  • aka Calymmatobacterium granulomatis

-DONAVAN BODIES “safety pins”

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34
Q

PID

A
  • due to GC and Chlamydia

- POLYMICROBIAL

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35
Q

Mycoplasma/Ureaplasma

A
  • Mollicutes
  • diagnosis of exclusion
  • Myc. Genitalium -> #2 cause of NGU, prostatitis, cervicitis, PID
  • Ureaplasma -> urinary calculi, etc.; produces IgA protease
  • NAATs main
  • treat w/ Moxifloxacin > macrolide > tetracycline
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36
Q

highest risk groups for HIV

A

-blood exposure -> transfusions #1

  • unprotected sex in heterosexuals #1 worldwide -> passed easier from male to female
  • MSM #1 in US
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37
Q

risk of transmission in HIV

A
  • related to VIRAL LOAD
  • high load -> high risk
  • low load -> low risk

anal>vaginal>oral>receptive>insertive

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38
Q

acute phase of HIV

A
  • high viral load, low CD4
  • communicable
  • viral load decreases to set point
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39
Q

late phase of HIV

A
  • declining CD4
  • more symptoms
  • still communicable
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40
Q

chronic phase of HIV

A

-IMMUNE ACTIVATION (even if on therapy)

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41
Q

when do you develop AIDS defining illness?

A

-8-10 years after HIV infection w/o HAART

42
Q

HIV diagnosis testing

A
  1. 4th generation ELISA Ab/p24 antigen (initial)
  2. Immunoblot assay Ab (differentiate b/w HIV-1,2) to confirm
  3. viral load (quantitative RNA PCR)
43
Q

Acute HIV syndrome

A

-RASH w/ MONO like syndrome w/ SORE THROAT

  • rash on upper thorax, neck, face -> palms/soles
  • mucocutaneous ulcers
  • anorexia
  • retro-orbital headache
  • Leukopenia w/ atypical lymphocytes
  • heterophile Ab monospot test sometimes False Pos
44
Q

HIV-2

A
  • West Africa
  • long asymptomatic stage (slow CD4 decline)
  • RESISTANT to all NNRTIs, fusion inhibitors, PIs
45
Q

what test do you use to differentiate HIV-1 and HIV-2?

A

immunoblot assay

-confirms if ELISA screens are +

46
Q

Medical issues in HIV ptxs

A
  • crystalluria & kidney stones -> Atazanavir and Indinavir
  • cervical lesions/carcinoma from HPV
  • increased fractures, osteopenia, osteoporosis -> TDF
  • lipodystrophy w/ PIs and NRTIs -> abdomen, BUFFALO HUMP, breasts, nasolabial folds
  • jaundice w/ Atazanavir
47
Q

HAART

A

1 integrase inhibitor (dolutegravir, raltegravir) + 2 NRTIs***

  • Abacavir -> HLA-B5701 allele -> HYPERSENSITIVITY rxn
  • Maraviroc (CCR5 antagonist) -> TROPISM test
48
Q

HIV viral blips

A
  • temporary increase in viral load after HAART

- NOT virologic failure

49
Q

Virologic failure

A
  • larger increase in viral load

- assess for non-compliance

50
Q

HIV controllers

A
  • immune system prevents replication -> no need for ART
  • elite -> viral load <50 for 15-20 years
  • nonprogressors -> viral load <2,000-5,000 for 15-20 years
51
Q

IRIS syndrome

A
  • worsening of disease if given HAART w/o treating opportunistic infection 1st
  • get opportunistic under control 1st -> start ART 2-3 weeks after
  • DO NOT STOP ART IF ALREADY ON IT
52
Q

AIDS

A

-HIV+ plus CD4 <200 or lymphocyte <14% or AIDS defining illness

53
Q

mucocutaneous candida

A
  • Candida albicans most common in HIV+
  • Pseudohyphae on KOH
  • pseudomembranes SCRAPE OFF
  • oral and vulvovaginal NOT AIDS defining -> esophageal/tracheal/bronchial/pulmonary IS if CD4 <200
54
Q

what do you treat C. auris with?

A

Echinocandins bc it is amph. B and voriconazole resistant

55
Q

what do you treat esophageal candidiasis w/?

A

Fluconazole

56
Q

PCP/PJP

A
  • high mortality before HAART
  • normal Xray, bad presentation
  • hypoxic
  • HIGH LDH >500**
  • SPONTANEOUS pneumothorax
  • ping pong balls and tea cups on GMS stain
  • treat: TMP-SMX
57
Q

treatment for PCP

A
  • high dose TMP-SMX for 21 days
  • IV Pentamide 2nd choice -> hypoglycemia, pancreatitis, azotemia, hypotension
  • Dapsone + TMP -> methemoglobinemia

-if pO2 <70 or alveolar-arterial O2 gradient >/= 35 -> give CORTICOSTEROIDS -> prevents IRIS

58
Q

is it common to see deterioration in PCP?

A
  • YES
  • ptxs gets worse before gets better
  • do NOT think respiratory distress is treatment failure until 4-8 days*** - change therapy after that
59
Q

Cryptococcus Neoformans

A
  • LOVES TO GO TO BRAIN
  • meningitis or cryptocomma in brain
  • Pigeons in cities
  • HEADACHE
  • skin lesions
  • NARROW based budding
  • MUCICARMINE stain
  • HIGH OPENING PRESSURE (OP >25) -> confusion, blurred vision, papilledema -> REPEATED lumbar puncture
  • associated w/ IRIS syndrome
60
Q

induction treatment w/ crypto - 2 weeks

A

liposomal amphotericin B 1st (combo w/ 5-FC)

  • amph. B side effects -> nephrotoxic, low K+ and Mg2+, shake and bake
  • 5FC side effects -> BONE MARROW SUPPRESSION
61
Q

consolidation treatment w/ crypto - 8 weeks

A

Fluconazole

  • can cross blood brain barrier
  • side effects -> teratogen
62
Q

maintenance treatment w/ crypto - 1 year

A

Itraconazole

-no penetration of blood-brain

63
Q

Histoplasma Capsulatum

A
  • Ohio and MS river valley
  • problem in AIDS ptxs in AR -> AIDS defining illness
  • ULCERS in GI tract
  • skin lesions
  • diagnose w/ blood or urine antigens
  • histo in MACS, histo in WBCs
  • treat w/ liposomal amph. B (severe) -> Itraconazole if not severe
64
Q

Blastomyces Dermatitidis

A
  • NW Ar
  • NOT an AIDS defining
  • plaque like verrucous skin lesions
  • LIKES TO GO TO BONE -> lytic bone lesions
  • WIDE based budding
65
Q

Coccidioidomyces Immitis

A
  • SW US
  • SPHERULES
  • THIN WALLED CAVIITIES (upper lobe)
  • skin lesions, meningitis, pneumonia
  • Eosinophila
  • treat: liposomal amph. B -> itraconazole or fluconazole
66
Q

Mycobacteria

A
  • TB at any site is AIDS defining***

- atypical mycobacterium is NOT unless extra pulmonary or disseminated

67
Q

Mycobacterium Avium

A

WASTING SYNDROME if disseminated

-CD4 <100

68
Q

Toxoplasma Gondii

A
  • raw meat
  • brain lesions, necrotizing RETINITIS
  • Tachzoites
69
Q

how do you distinguish b/w Toxo and CNS lymphoma?

A

treat for toxo for 3 weeks

  • if improvement -> think toxo and keep treating
  • brain biopsy if no improvement

Toxo -> MULTIPLE ring enhancing lesions

CNS lymphoma -> FEWER ring enhancing lesions (periventricular, corpus callosum)

70
Q

CMV

A
  • necrotizing RETINITIS w/ yellow-white lesions
  • reactivation from latent
  • CNS POLYRADICULOPATHY -> paraplegia
  • OWLS EYE
  • diagnosis: quantitative DNA PCR***
  • treat: Ganciclovir or Foscarnet
71
Q

what is a common presentation of HIV-1,2?

A

-ulcerative esophagitis

72
Q

Recurrent Pneumonia

A

Strep Pneumonia and H. influenza***

-MULTI-LOBAR pneumonia

73
Q

Kaposi’s Sarcoma

A
  • HHV-8
  • primary effusion lymphoma (PEL)
  • multicentric Castleman’s disease (MCD)
  • purple skin lesions -> NOSE and ROOF OF MOUTH
74
Q

what lymphomas are HIV most associated with?

A

B cell lymphoma

  • NHL
  • Hodgkin’s lymphoma (NOT AIDS defining) -> EBV associated
75
Q

Cowdry type A nuclear inclusions

A

HSV-1, HSV-2

76
Q

SLE

A
  • Asians, Latinos, African Americans
  • high females
  • heart -> Libman-Sacks endocarditis and fibrinous or exudative pericarditis and myocarditis
  • lymph nodes -> hematoxylin/LE bodies
77
Q

if fever resolves w/ acetaminophen, NSAIDs, or steroids

A

think AUTOIMMUNE or malignancy

78
Q

if fever does NOT resolve w/ acetominophen, NSAIDs, or steroids

A

think infection or drug related

79
Q

what can SLE cause in the mucosal region?

A

NASAL PERFORATION

-mucosal and nasal septal ulcers

80
Q

what cutaneous lesions are associated w/ SLE

A
  • butterfly rash (spare nasolabial)
  • skin photosensitivity
  • discoid lupus
81
Q

what kind of lung disease is seen in SLE?

A

interstitial lung disease -> ground glass pattern

82
Q

2 most common hematologic diseases in SLE?

A
  • anemia of chronic disease

- leukopenia

83
Q

labs for SLE

A
  • ANA (95%) -> homogenous pattern of ANA
  • anti-dsDNA
  • anti-Smith
  • high ESR and CRP
  • hematoxylin/LE bodies
84
Q

does pos ANA alone mean you have SLE?

A

NO!!

85
Q

lupus like syndrome - drug induced lupus

A
  • rarely affects CNS or kidneys, unlike SLE

- male = female

86
Q

the high risk drugs for drug induced lupus

A
  • hydralazine (HTN)
  • Procainamide (restore rhythm)
  • Quinidine (restore rhythm)
87
Q

labs for drug induced lupus

A
  • ANA pos 95% -> homogenous pattern
  • anti-dsDNA neg
  • anti-histone Ab*** pos
88
Q

Sjogren’s Syndrome (SS)

A
  • xeropthlamia, xerostomia, xerosis, vaginal dryness -> SICCA SYNDROME
  • DRY MUCOUS MEMBRANES
  • high females
  • Schirmer’s test is decreased
89
Q

labs for Sjogren’s syndrome

A
  • ANA 1:320 -> speckled pattern

- anti-Ro/SSA and anti-La/SSB Abs***

90
Q

MCTD

A
  • high females
  • RAYNAUD’S PHENOMENON -> vasospasm of digital arteries
  • swollen hands or digits
  • deforming like RA
91
Q

MCTD labs

A
  • ANA pos -> speckled pattern

- anti-RNP Abs***

92
Q

CREST syndrome

A
  • C -> calcinosis cutis
  • R -> raynauds
  • E -> esophageal dysmotility
  • S -> sclerodactyly
  • T -> telangiectasia
93
Q

CREST labs

A
  • pos ant-centromere Ab**

- Anti-Scl-70 Neg** (for scleroderma)

94
Q

Antiphospholipid syndrome

A
  • autoimmune hyper coagulable state
  • Abs bind/inhibit protein C and S
  • high in females
  • mixing study for cardiolipin Abs or lupus anticoagulant
95
Q

what MHC is associated w/ ankylosing spondylitis & other spondyloarthropathies?

A

HLA-B27

  • MHC class I
  • > /=90% in AS
  • lower in others
96
Q

Ankylosing Spondylitis (AS)

A
  • > /= 90% w/ HLA-B27
  • male: female is 3:1**
  • low back pain -> improves w/ exercise, NOT rest
  • spine and sacroiliac joints
  • bamboo spine -> marginal syndesmophytes**
  • uveitis or aoritis
  • NO response to DMARDs
97
Q

Psoriatic Arthritis (PA)

A
  • males = females
  • psoriasis precedes PA by 7-10 years*** -> plaque psoriasis most common
  • NAIL PITTING, onycholysis, ridging/cracking, hyperkeratosis, leukonychia
  • oligoarthritis (DIP > PIP, MCP)
  • HLA-B27 +
  • can treat w/ DMARDs
98
Q

Classic Reactive Arthritis

A
  • microbes can’t be recovered
  • Reiter’s syndrome -> post-infectious arthritis, urethritis, conjunctivitis
  • oligoarthritis (spine and sacroiliac joints)
  • KERATODERMA BLENNORRHAGICUM
  • CIRCINATE BALANITIS
  • HLA-B27+
  • can use DMARDs
99
Q

the most common infectious cause of reactive arthritis?

A

-Chlamydia trachomatis

100
Q

Post-strep reactive arthritis

A
  • immune rxn after GAS > GCS, GGS
  • 1-10 days after pharyngitis
  • NON-MIGRATORY
  • minimal response to NSAIDs
  • HLA-B27+
  • only treat for >/= 1 year -> monitor closely
  • doesn’t tend to relapse
101
Q

Enteropathic Reactive Arthritis

A
  • ulcerative colitis and Chron’s disease most common
  • type 1 -> oligoarticular -> LARGE joints -> HAS IBD flares
  • type 2 -> polyarticular -> MCPs -> NOT associated w/ IBD flares
  • HLA-B27+
  • responds to DMARDs
102
Q

Celiac disease arthritis

A
  • rxn to gluten in small intestine
  • women > men
  • DERMATITIS HERPETIFORMIS
  • improves and Abs resolve w/ gluten free diet
  • if IgA deficiency -> rely on IgG tests

OMS II - Becom Exam 4 (8 decks)

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