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Systemic Infectious Diseases Flashcards

1
Q

Dx and Tx: Fish tank granuloma

A

Mycobacterium marinum, Rx: Clarithromycin + Ethambutol OR Rifampin

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2
Q

Dx: Rose thorn injury and rash

A

Sporothrix schenckii. Rx: Itraconazole (amphotericin B if systemic)

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3
Q

Dx and Tx: Dog and cat bite with
rapid infection

A

Pasteurella multocida. Rx: Amoxicillin-Clavulanate (augmentin —> “dogmentin”)

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4
Q

Dx: Reptile bites and infection

A

Salmonella

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5
Q

Dx: Sickle cell disease and joint
pain

A

Salmonella osteomyelitis

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6
Q

Dx: Cat scratch fever

A

Bartonella henselae. Tx: doxy; azithromycin in pregnancy

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7
Q

Dx and Tx: Human bite and
infection

A

Eikenella corrodens. Rx: amoxicillin-clavulanate

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8
Q

Dx: Gastroenteris on a cruise
ship

A

Norwalk virus

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9
Q

Dx: Gastroenteritis at a daycare

A

Rotavirus, (remember, there is a vaccine now).

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10
Q

Compare general Dx and Tx of
toxin-mediated vs. invasive
bacterial diarrheal illness

A

Toxin: abrupt onset, watery, non-bloody; Rx IVF, ± loperamide, ± Cipro (prolonged/severe ssx).

Invasive: gradual onset, bloody, systemic sx;
Rx: IVF, ± Cipro UNLESS kids or elderly patients with possible E. coli O157:H7 (can increase risk of HUS)

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11
Q

Dx: Watery diarrhea +
eggs/mayo

A

Staph. aureus (toxin)

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12
Q

Dx: Watery diarrhea + fried rice

A

Bacillus cereus (toxin)

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13
Q

Diarrhea + flatulence + recent
hiking and drinking from a fresh
water stream

A

Giardia lamblia. Parasitic infection. Test for it w/ a stool antigen (not ova and parasite). Rx: Metronidazole / tinidazole. People who are risk: hikers, children at daycare, and oral-anal sexual conduct.

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14
Q

Dx: Watery diarrhea + travel

A

Enterotoxgenic E. coli (toxin); if no blood in diarrhea, give 1 dose of Cipro 750mg. If pt traveled to southeast asia this is likely campylobacter and give 1,000mg of azithromycin,

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15
Q

Dx: Watery diarrhea +
meat/poultry

A

Clostridium perfringens (toxin)

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16
Q

Dx: Watery diarrhea + dark meat
fish + rash/itching

A

Scombroid (histamine fish toxicity). Dark fleshed, peppery tasting fish: tuna, mahi-mahi, mackerel. Excess histidine on fish broken down by bacteria to histamine. SSx: Histamine ingestion leads to anxiety, flushing, headache, palpitations, vomiting. Rx: antihistamines

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17
Q

Dx: Watery diarrhea +
carnivorous fish + neuro ssx

A

Ciguatera (toxin causes neuro ssx) - “hot cold reversal”

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18
Q

Dx: Bloody diarrhea +
undercooked eggs/chicken +
relative bradycardia

A

Salmonella typhi (invasive), cafeteria outbreaks, classically with high fever and relative bradycardia; can cause osteomyelitis in sickle cell patients.

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19
Q

Dx: Bloody diarrhea (severe) +
high fever + institutionalized

A

Shigella (invasive); can cause seizures in kids

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20
Q

Dx and Tx: Bloody diarrhea +
followed by weakness

A

Campylobacter (invasive). Associated: appendicitis mimic & Guillain- Barré; Rx: Azithro/Erythro (resistance to cipro)

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21
Q

Dx: Bloody diarrhea + farm
animals + appendicitis ssx

A

Yersinia (invasive); pseudoappendicitis (appy mimic) can cause terminal ileitis

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22
Q

Dx: Bloody diarrhea +
undercooked seafood +
alcoholic who gets very sick

A

Vibrio parahaemolyticus (invasive)

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23
Q

Dx: Bloody diarrhea + poorly
cooked ground beef/raw milk

A

E. coli O157:H7, associated with TTP (adults) and HUS (kids); NO
ANTIBIOTICS

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24
Q

Dx: Rice-water stools +
contaminated water

A

Vibrio cholerae (toxin). Oral rehydration tablets.

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25
Q

Dx and Tx: Profuse diarrhea
after recent antibiotics

A

Clostridium difficile (invasive). Rx: metronidazole or PO Vanco

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26
Q

Dx: Diarrhea + AKI ± low
platelets

A

E. coli O157:H7 causing TTP/HUS

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27
Q

Dx: Food-borne illness
associated with premature
delivery in pregnant patients

A

Listeria monocytogenes

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28
Q

What is the most common cause
of bacterial diarrhea in the US?

A

Salmonella; 2nd Campylobacter

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29
Q

What factors on hx prompt you
to get stools studies for patients
w/ diarrhea?

A
  1. Fever > 38.5C
  2. Symptoms for greater than 1 week
  3. Concerns for C.diff
  4. Immunocompromised or advanced age
  5. Underlaying IBD.
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30
Q

Dx and Tx: Botulism

A

Paralytic illness. Cause: Clostridium botulinum neurotoxins → blocks
ACh release at neuromuscular junction → flaccid paralysis. Forms: food borne (canned foods, honey), wound, infantile (most common).

SSx: floppy baby, constipation, weak cry (infants); CN/bulbar sx, dilated
pupils (differentiates from myasthenia), symmetric, descending flaccid
parlaysis / weakness (MC finding), parasympathetic blockade (dry
mouth/sore throat, urinary retention).

Tx: supportive care, resp.
monitoring (resp. failure = MCC death), antitoxin (Rx infants: BabyBIG,
Rx age>1: antoxin, abx (for wounds)

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31
Q

Leading cause of infertility?

A

Chlamydia trachomatis

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32
Q

Dx and Tx: Painless vesicular
lesions or ulcers to groin +
buboes (huge LNs)

A

Lymphogranuloma venereum (LGV). Chlamydia trachomatis. Rx: Doxy or Azithro (and treat partners), drain abscesses

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33
Q

Dx and Tx: Painful ulcer with
irregular borders to groin +
buboes (huge LNs)

A

Chancroid. Haemophilus ducreyi. SSx: looks like syphillis but the lesion is painful. Rx: CTX, Azithro or cipro (ANY one), drain abscesses

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34
Q

Dx: Neonate with copious
purulent discharge from eyes

A

Neisseria gonorrhoeae conjunctivitis. Tx: systemic cefotaxmine. Topical tx not enough.

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35
Q

Review the timing of the various
causes for neonatal conjunctivitis

A

Chemical: first 24 hours. Gonococcal: first 2-5 days. Chlamydial: 5 days to 2 weeks.

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36
Q

Tx for neonatal chlamydial
conjunctivas?

A

Systemic tx with azithromycin or erythromycin. Pt’s must be admitted to look for pneumonia as well.

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37
Q

Dx: “Gunmetal grey” pustules to
hands/skin, septic arthritis ±
tenosynovitis

A

Disseminated gonococcus. Arthritis-dermatitis syndrome. Gram-negative intracellular diplococci. Rx: IV ceftriaxone

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38
Q

Dx: Contact with armadillos

A

Leprosy. Mycobacterium leprae. Rx: dapsone + rifampin (+clofazimine for lepromatous disease)

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39
Q

Dx and Tx: Contact with prairie
dogs

A

Bubonic plague. Yersinia pestis. Rx: streptomycin, tetracycline,
doxycycline (alt. fluoroquinolones)

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40
Q

Most common cause of viral
pneumonia in adults?

A

Influenza

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41
Q

Dx and Tx: HIV + Lung Disease
+ Pancytopenia

A

Mycobacterium avium intracellulare (MAI). CD4 < 50. Rx: Rifampin + Ethambutol + Azithro/Erythro

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42
Q

Dx and Tx: Primary tuberculosis

A

Mycobacterium tuberculosis. Transmission via inhalation of droplets.
SSx: often asymptomatic. Can progress to latent or reactivation TB. Rx:
Isoniazid (INH) + Pridoxine (Vit B6) x9mo.

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43
Q

Most common CXR finding in
primary TB?

A

Most common overall: a single lobar infiltrate associated w/ hilar
adenopathy / children: pronounced hilar adenopathy / elderly: isolated
pleural effusion. Ghon complex: calcified lung lesion, ± calcified LNs
[a.k.a. Ranke complex] representing HEALED infection.
Immunocompromised pts often cannot form a Ghon complex.

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44
Q

Dx and Tx: Reactivation TB

A

SSx: often occurs if immunocompromised, other stressor; cough, fever,
night sweats, weight loss, hemoptysis. Dx: XR with upper lobe apical
lesions ± cavitation. Dx: MTB culture/PCR of sputum (takes weeks), AFB
smear (suggestive but not diagnostic, need culture to confirm). Tx: RIPE
(Rifampin, Isoniazid, Pyrazinamide, Ethambutol), respiratory isolation
(airborne precautions), test/treat contacts

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45
Q

Immunocompetent person
undergoes a high risk exposure
to TB, what should you do?

A
  1. Test them now w/ PPD or interferon gamma and test them again in 3 months for conversion.
  2. if either of these tests are positive obtain a CXR and call an ID specialist.
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46
Q

What are the common side
effects of TB treatment with
RIPE?

A

Rifampin: orange body fluids, hepatotoxicity.
Isoniazid: neuropathy, hepatotixicity, seizures (in overdose, Rx: Vit B6).
Pyrazinamide:hepatotoxicity, teratogenic (pregnancy). Ethambutol: optic neuritis (redgreen color blindness)

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47
Q

Dx and Tx: Rapidly progressive
skin infection, unusually high HR,
and indifferent patient

A

Gas gangrene/myonecrosis. Clostridial myonecrosis (usually C.
perfringens). SSx: similar presentation to necrotizing fasciitis, tachy out
of proportion to fever, la belle indifference. Dx: subQ/intramuscular gas,
incision with foul-smelling “dishwater” fluid and dead muscle. Rx: abx
(amp + gent + clinda) + wide surgical debridement (dont delay abx)

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48
Q

Review the definitions of SIRS,
sepsis, severe sepsis, septic
shock

A

SIRS: Temp <36 (96.8) or >38 (100.4), Tachy >90, RR>20, WBC <4k or >12k or >10% bands.
Sepsis: SIRS + infection. Severe Sepsis: sepsis + end organ damage.
Septic Shock: sepsis + refractory hypotension.
Note: ITE/boards still test these concepts.

49
Q

Review the key components of
Early Goal-Directed Therapy for
sepsis

A

Early IVF (30 cc/kg), early empiric antibiotics, MAP >65 (IVF or pressors),
SvO2>70%, CVP 8-12, transfuse pRBCs if Hct <30%. Note: strict
adherence to this regimen has been debunked by several recent trials,
but the necessity of adequate fluid resuscitation (30cc/kg) and early
antibiotics remains well-supported.

50
Q

Empiric abx for sepsis

A

CAP: CTX + Azithro. HAP: Vanc+Zosyn. Urinary: Amp+Gent. Intraabdominal:
Amp+Gent+Metronidazole. Biliary: pip+tazo. Device related:
Vanc+Gent. Skin/Soft tissue: Vanco

51
Q

Dx and Tx: Young woman with
high fever + rash + shock and
organ failure

A

Toxic Shock Syndrome. Cause: tampon, surgical or nasal packing or
other foreign body; bacterial superantigen. Staph (TSS): more common;
erythematous rash w/ desquamation, hypotension, fever, assoc. w/ fb;
Strep (STSS): fever, but less rash often with existing wound. Rx: remove
foreign bodies FIRST, supportive care, and antibiotics (clinda first to
reduce protein production, then empiric broad-spectrum for sepsis
coverage), IVIG for refractory cases

52
Q

Dx and Tx: Primary syphilis

A

Treponema pallidum (spirochete). SSx: painless genital ulcer (chancre), regional LAD. Dx: VDRL/RPR are nonspecific and often negative at this stage. Tx: PCN G benzathine 2.4 million U IM x1

53
Q

Dx and Tx: Secondary syphilis

A

Onset 5-8wks after primary. SSx: rash (papulosquamous) trunk →
palms/soles, condyloma lata. Dx: VDRL or RPR, confirm with FTA-ABS.
Tx: PCN G benzathine 2.4 million U IM x1 (if late disease three weekly
doses)

54
Q

Dx and Tx: Tertiary syphilis

A

Onset: years after primary. SSx: gummatous lesions throughout body,
neurosyphilis (meningitis, dementia, Argyll-Robertson pupils
[accommodate but don’t react to bright light], tabes dorsalis [dorsal
column demyelination causing impaired proprioception and vibratory
sense [ataxia]). Dx: CSF-VDRL, confirm with FTA-ABS. Tx: admit for IV
PCN q4h x2wks

55
Q

Dx: Worsened rash and toxicity
shortly after treatment of syphilis

A

Jarisch-Herxheimer reaction (2/2 endotoxin release from dying
spirochetes). Tx: Supportive.

56
Q

Care plan if syphilis pt is allergic
to penicillin?

A

Admit for desensitization, they need PCN

57
Q

Pathophysiology, Dx, and Tx:
Tetanus

A

Clostridium tetani spores which enter into wounds. Sources: dust, soil,
feces. Tetanospasmin = neurotoxin (blocks inhibitory [GABA] firing,
leads to unopposed excitatory firing). SSx: muscle spasticity (lockjaw,
painful tonic convulsions), but NORMAL mental status. Tx: supportive
(benzos, opioids, ± paralytics), wound care, abx (metronidazole > PCN),
Tdap vaccine (prevention) + tetanus IG (unimmunized + high risk
wounds

58
Q

Review indications for tetanus
prophylaxis

A

≥3 vaccine doses + low risk wound: dT >10 yrs since last dose. ≥3
vaccine doses + high risk wound: dT >5 yrs since last dose. Uncertain or
< 3 vaccine doses + low risk wound: dT. Uncertain or <3 vaccine doses
+ high risk wound: dT & TIG. High risk wound: >6hrs old, contaminated
(dirt, saliva, feces), puncture/crush/avulsion wounds, fb, frostbite

59
Q

Dx and Tx: Red rash to diaper
area with satellite lesions

A

Candida ; Rx: topical antifungals (also occurs in moist areas/skin folds esp. on diabetics)

60
Q

Dx and Tx: Immunocompromised
+ odynophasia/dysphasia

A

Candida esophagitis; Rx: oral fluconazole, low threshold for IV for those who can’t tolerate PO.

61
Q

Dx and Tx: Indwelling catheter +
yeast on blood cultures

A

Candida fungemia; Rx: Amphotericin B

62
Q

Dx and Tx: AIDS + Diarrhea

A

Cryptosporidium, Isospora , CMV, M. avium; often unclear cause. Rx:
symptomatic care

63
Q

Dx and Tx: Immunocompromised
+ Painless brown/black skin
lesions

A

Kaposi sarcoma (classically on face, chest, oral cavity), caused by HHV-8;
Rx: cryo or radiation. AIDS defining illness.

64
Q

Dx and Tx: AIDS + white plaque
on oropharynx

A

Candida/Thrush: plaques scrape off (Rx: clotrimazole) vs. Oral Hairy
Leukoplakia: lateral tongue, can’t scrape off, caused by EBV, very
specific for HIV, NOT precancerous (DON’T confuse with oral leukoplakia
which is PRECANCEROUS, tobacco)

65
Q

Dx and Tx: Meningitis and focal
neuro findings in AIDS pt

A

Cryptococcus neoformans (encapsulated yeast in soil with pigeon
poop), SSx: HA, neck pain, fever, AMS or CN abnormalities. Dx: CSF
cryptococcal antigen, LP with high opening pressure, + india ink stain
(send the CSF for cyptococcal antigen for confirmatory testing). Rx:
amphotericin B + flucytosine. MCC meningitis in AIDS.

66
Q

Dx and Tx: Histoplasmosis

A

Dimorphic fungus. Found in spelunkers, caves, bird/bat droppings; can
cause epidemics if soil upturned. Endemic to Ohio and Mississippi River
valleys. SSx: flu-like sx, disseminated disease or chronic progressive
pulmonary disease (diffuse infiltrates and calcified nodes). Rx:
itraconazole, amphotericin B.

67
Q

Dx and Tx: Immunocompromised
+ encephalitis + ring-enhancing
lesions on CT

A

Toxoplasmosis gondii (protozoan). Associated with cat poop, bad for fetus if infection occurs during pregnancy (TORCH). Tx: Pyrimethamine, sulfadiazine, folinic acid.

68
Q

Dx: Travel + cyclical fever

A

Malaria. Plasmodium protozoan transmitted by female Anopheles
mosquito. Infects RBCs & hepatocytes. SSx: cyclical fevers (febrile
during periods of RBC rupture and merozoite spread), splenomegaly,
thrombocytopenia. Complicated dz: profound hypoglycemia, hemolytic
anemia, sz, coma. Dx: thick+thin blood smears (ring forms) ± Giemsa or
Wright stain.

69
Q

Malaria Tx

A

Uncomplicated+chloroquine-sensitive (central america, Caribbean):
chloroquine. Uncomplicated+chloroquine resistant (South America,
South Asia, Africa): Quinine (hypoglycemia) + Doxy. Complicated or P.
Falciparum: Quinidine IV (QT prolongation)

70
Q

What is the most
dangerous/severe strain that
causes malaria?

A

P. falciparum: cerebral malaria, “Blackwater” fever, death; Rx: IV
quinidine

71
Q

Dx and Tx: traveler + myalgias
and fever

A

Dengue fever. Dengue virus + transmitted Aedes aegypti mosquito.
Common in Caribbean (Puerto Rico). SSx: high fever, dramatic myalgias
(“break-bone fever”), morbilliform rash. Dx: serology or ELISA,
leukopenia + thrombocytopenia. Rx: supportive

72
Q

What is the cause, vector, and
treatment of Lyme disease?

A

Ixodes tick (deer tick) carrying Borrelia burgdorferi, primarily in northeast
US & Wisconsin; tick bite history is often absent. Rx: doxycycline,
CNS/cardiac involvement: IV CTX. Pregnant, children <8 Rx: Amoxicillin

73
Q

What are the typical stages of
Lyme disease?

A

Stage 1: erythema migrans (“bull’s eye”) rash (1 wk). Stage 2: neuro
changes (meningoencephalitis = MC neuro finding with CN palsies -
bilateral Bell’s palsy), cardiac changes (variable AV block = MC cards
finding); (days to weeks). Stage 3: arthritis, neuro sx (months to years).
Tx: Doxy for everything other than severe carditis or neurological
manifestations, use IV ceftriaxone

74
Q

Describe prophylactic tx of Lyme
disease

A

Criteria: tick attached for ≥ 36hrs, ppx started within 72 hours of tick removal. Other factors: tx if tick engorged. Rx: single dose Doxy

75
Q

Dx, vector, and Tx: Recent hiking
or camping, rash spreading
inwards (“centripetal”,
palms/soles)

A

Rocky Mountain Spotted Fever. Rickettsia rickettsii. Transmission: wood
tick (Dermacentor andersoni), eastern US (Carolinas, Oklahoma). SSx:
fever (MC sx), centripetal (towards trunk) rash (palms+soles), calf
tenderness. Labs: low platelets, hypoNa. Rx: ALWAYS doxycycline
(even children)

76
Q

Dx and Tx of Ehrlichiosis

A

Ehrlichia spp. with tick vector. South central & south Atlantic US. SSx:
abrupt onset fevers/chills/myalgias/rigors (differentiates from other tick
borne illnesses) ± rash. Labs: leukopenia, thrombocytopenia, and
elevated LFTs. Rx: Doxy, alt. Rifampin

77
Q

Dx and Tx: Fever, exudative
pharyngitis, posterior
lymphadenopathy

A

Infectious mononucleosis. Epstein-Barr virus (EBV); Exam: ±
splenomegaly (risk rupture, limit contact/activity). Rx: supportive.

78
Q

Dx: Mono + amoxicillin for
presumed strep

A

90% develop maculopapuluar rash (NOT an allergy)

79
Q

What are associated lab
abnormalities found in patients
with mono?

A

Atypical lymphocytes, +heterophile antibodies (monospot test),
hemolytic anemia, thrombocytopenia, elevated LFTs, false positive RPR
or VDRL

80
Q

What is the difference between
genetic drift and genetic shift?

A

Antigenic drift: minor mutation. Antigenic shift: major mutation; often used in context of influenza (orthomyxovirus) and HA/NA surface antigens

81
Q

What defines a pandemic flu?

A

When antigenic shift takes place and a new strain of the influenza virus emerges.

82
Q

Who is at high risk for death with
influenza and what is the usual
cause of death?

A

Extremes of age and pregnant women are highest risk; most common cause of death is secondary pneumonia.

83
Q

What is the appropropriate tx
regimen and complications of tx
for influenza?

A

Oseltamivir/Tamiflu (GI sx) or Zanamivir/Relenta (bronchospasm,
wheezing) = Neuraminidase inhibitors if within 48hr of sx onset or hospitalized; No Amantadine/Rimantadine (both CNS sx) 2/2 resistance.

84
Q

Dx and Tx: Rat poop and ARDS

A

Hantavirus. Transmitted via aerosolized rodent excretions. SSx:
Hantavirus pulmonary syndrome - ARDS, thrombocytopenia. Starts with
a flulike syndrome and is then rapidly progressive (and therefore many
patients are discharged and return critically ill). Rx: supportive

85
Q

What is the location of dormant
herpes simplex?

A

Dorsal root ganglion, reactivated with stress/immunocompromise

86
Q

What are the classic
locations/presentations for HSV
1 and 2 and how are they
diagnosed?

A

HSV-1: mouth, stomatitis, keratitis (possible corneal ulcer), vesicles on
digits (Whitlow); HSV-2: anus, genital, & neonatal (C-section if pregnant
and in labor). Dx: Tzanck smear (multi-nucleated giant cells), viral
culture. Rx: acyclovir

87
Q

Compare the presentation and
treatment of chickenpox vs.
shingles (Varicella Zoster Virus)

A

Primary varicella (chickenpox): highly contagious, incubation ~2wks.
SSx: crops of vesicles in various stages of healing. Rash: “dew drop
rash on a rose petal”, starts on hairline → chest, palms/soles (+mucous
membranes). Rx: healthy/age <12: supportive, monitor for bacterial
superinfection; immuncompromised, age >12 = acyclovir. Shingles:
reactivation of dormant VZV. SSx: prodrome (itching, burning), rashpainful
vesicular eruption (usually unilaterally in a single dermatome), Rx:
acyclovir, steroids (controversial), pain control. Complication: postherpetic
neuralgia

88
Q

Dx: Bell’s palsy and vesicle on
ear

A

Ramsay-Hunt syndrome/Zoster Oticus (VZV of CN VIII)

89
Q

Dx: Vesicle on tip of nose

A

Hutchinson’s sign, V1 zoster, predicts corneal involvement/ulceration
(Zoster Ophthalmicus)

90
Q

Treatment of herpes zoster
ophthalmicus?

A

Systemic oral anti-virals and topical steroids. This happens when the nasociliary branch of CN V is infected with VZV. Emergent
ophthalmology follow up is needed.

91
Q

Tx of pregnant or
immunocompromised pt after
exposure to VZV?

A

Send titers to check for immunity, and if negative give varicella zoster
IG.

92
Q

Pregnant woman presents with
SOB and wide spread itchy
vesicular rash in various stages
of development.

A

Varicella pneumonia. Tx: Admit and tx with IV acyclovir. VZIG IS NOT ENOUGH treatment.

93
Q

what is the definition of
disseminated zoster?

A

Involvement of 3 or more dermatomes.

94
Q

What animals are high risk for
rabies transmission?

A

Domestic animals: cats > dogs (dogs in developing coutries are HIGH
risk). Wild animals (account for ~90% cases in US): bats (MCC in US) >
raccoons > skunks > foxes > coyotes, mongooses. NOT rabbits or
rodents.

95
Q

What are symptoms of rabies
infection?

A

Incubation 3-7wks, pain/paresthesia at bite site, hydrophobia (drinking water causes painful spasm), seizure, encephalitis, death

96
Q

What is the treatment for rabies?

A

There is no treatment for active disease. PEP: HRIG (at wound site), HDCV (rabies vaccine): 5 injections over a month. PEP (vaccine + RIG) for close proximity with a bat and exposure cannot be ruled out (e.g. awakening to find bat in room, unattended children)

97
Q

What defines AIDS?

A

HIV with CD4 < 200 OR AIDS defining illness (esophageal candidiasis,
cryptococcus, CMV, Kaposi, PCP, toxoplasmosis, TB (in an nonendemic
area)

98
Q

What is the usual presentation of
acute HIV infection?

A

Acute HIV (Seroconvesion) Syndrome. Often missed, 2-4wk postexposure.
SSx: non-specific viral syndrome (fever, rash, LAD, myalgias).
Most infectious stage of HIV (high viral load + shedding), but antibody
testing will be negative as seroconversion takes 3-12 wk post-exposure.

99
Q

How is HIV diagnosed

A

ELISA: to screen (sensitive), oral swab, delayed (+) weeks to months.
HIV-1/2 immunoassay & Western blot: to confirm; (sensitive + specific),
blood test.

100
Q

What opportunistic infections are
more likely below the following
CD4 counts: <500, <200, <100,
<50

A

<500: TB, HSV, VZV, Kaposi’s sarcoma. <200: PCP, HIV
encephalopathy, candidiasis, PML. <100: toxoplasmosis,
histoplasmosis, cryptococcus. <50: CMV (GI, pulm, retina), MAC avium,
CNS lymphoma. NOTE: HIV pts get all usual infections as well, but
have increased risk of opportunistic as CD4 drops.

101
Q

What common lab test can be
used as a surrogate to
determine CD4 count?

A

Absolute lymphocyte count (ALC). ALC < 1000→ suggests CD4 < 200

102
Q

What is the time range for
starting post-exposure
prophylaxis after HIV exposure?

A

Should start within 72hr

103
Q

Dx and Tx:
Immunocompromised +
pneumonia with severe
dyspnea/hypoxia + high LDH

A

PJP pneumonia. Pneumocystis jirovecii (formerly PCP). Most common
opportunistic infection in AIDS. SSx: fever, cough, desat on exertion.
Dx: CXR shows interstitial perihilar infilatrates (“bat wing” pattern). Rx:
TMP-SMX, steroids (indications: children, PO2< 70 mm Hg [~SaO2
~93%], A-a gradient > 35)

104
Q

What are possible side effects
with pentamidine (Tx for PCP
pna)

A

Hypoglycemia, hypotension, pneumothorax

105
Q

What are the appropriate
outpatient tx for PCP
pneumonia?

A

TMP-SMX; For sulfa allergic people: Primaquine + clindamycin, or TIMdapsone.
Pentamidine can be given but it’s only available in IV and
inhalation forms making outpatient therapy complicated. It also has many side effects. v

106
Q

What are typical CT (noncontrast
and contrast) findings
with Toxoplasmosma
encephalitis?

A

Non-contrast CT: multiple subcortical lesions in basal ganglia. Contrast
CT: ring-enhancing lesions with surrounding edema. Rx: Pyrimethamine,
sulfadiazine and leucovorin

107
Q

Dx: Ring-enhancing intracranial
lesions with 1) focal neuro deficit
or 2) generalized AMS

A

Focal deficits: Toxoplasma. Generalized AMS: CNS lymphoma
(hyperdense focal lesions, CD4 < 50)

108
Q

Dx: HIV + CD4 <200, focal
neurologic deficits with
nonenhancing white matter
lesions

A

PML (JC virus)

109
Q

Dx and Tx: Progressive
blindness in AIDS patient

A

CMV retinitis. Exam shows “fluffy white perivascular lesions (cotton wool
spots) with areas of hemorrhage.” Rx: IV Gancyclovir

110
Q

What factors increase the risk of
transmission after occupational
exposure to HIV?

A

Deep injury, visible blood, hollow bore needle from vein or artery, late
stage HIV/AIDS or high viral load; transmission risk is 0.3% with
needlestick, 0.1% with mucous membrane exposure

111
Q

What are the guidelines for postexposure
prophylaxis for HIV?

A

HIV+ and <72hr: HAART for 28d; if low risk and >72hr no treatment is
necessary. All others per clinical judgement.

112
Q

What are potential oral antibiotic
options for community acquired
MRSA?

A

Clindamycin, TMP-SMX, doxycycline (requires IV vanco if hospital acquired)

113
Q

Dx: Skin lesion, Gram positive
rod

A

Anthrax

114
Q

Dx and Tx: Cutaneous vs.
pulmonary anthrax

A

B. anthrasis (Gram positive rod). Cutaneous: pruritic, black eschar + painful LAD over 1-2wks. Pulmonary: due to inhaled spores (not
contagious), flu-like sx. CXR shows wide mediastinum; rapid
progression to sepsis + death. Rx: cipro

115
Q

Dx and Tx: Pneumonic and
bubonic plague

A

Yersinia pestis. Pulmonic: inhaled aerosolized rat droppings, very
contagious, severe pna, bio-terrorism agent. Bubonic: transmitted via flea bite, causes buboes + acral necrosis (black/dead distal extremities), may travel to lungs (contagious at this stage). Rx: streptomycin, gentamicin, doxycycline.

116
Q

What risk factor is most strongly
associated with cellulitis?

A

Lymphedema

117
Q

What is the appropriate
management of a patient with a
tick bite, target rash, and Bell’s
palsy?

A

CT and LP followed by ceftriaxone with concern for disseminated
Lyme/CNS Lyme

118
Q

What is the most infectious bloodborne
pathogen?

A

Hep B, followed by Hep C and HIV

119
Q

Dx and Tx: military recruit or
college student with fever, HA,
petechial rash

A

Meningococcemia. Neisseria meningitidis (aerobic, gram-negative
diplococcus). Rx: CTX + Vanco. Most common complication: Myocarditis
with CHF or conduction abnormalities. Comments: Waterhouse-
Friderichsen syndrome: bilateral adrenal hemorrhage +
meningococcemia

ITE (18 decks)

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