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1.01) INFECTIOUS DISEASES > UWorld > Flashcards

UWorld Flashcards

1
Q

What is the Most Common bacterial Etiology of Cellulitis?

A

Streptococcus pyogenes (Group A Strep)

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2
Q

What is the Most Common bacterial Etiology of an Abscess?

A

Staphylococcus aureus

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3
Q

What are (3) Clinical Features of Cellulitis?

A
  1. Poorly demarcated Inflammation
  2. Induration involving Deep Dermis & Subcutaneous Fat
  3. +/- Fever
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4
Q

What are (4) Clinical Features of an Abscess?

A
  1. Fluctuant, Tender, Erythematous Nodule
  2. Collection of Pus within the Dermis or Subcutaneous Tissue
  3. +/- Surrounding Cellulitis
  4. +/- Fever
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5
Q

What is the Treatment & Duration for well-appearing, afebrile patients with Cellulitis?

A

Systemic Antibiotics that cover Strep. pyogenes (eg, Cephalexin)

Duration:≥ 5 days

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6
Q

Under which (3) Conditions should MRSA coverage be utilized in the Treatment of Cellulitis?

A
  1. Cellulitis + Febrile
  2. Cellulitis + Previous MRSA infection
  3. Cellulitis + Recent Hospitalization
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7
Q

What are the (2) management steps in the Treatment of an Abscess?

A
  1. Incision & Drainage
  2. Systemic Antibiotics with MRSA coverage (if > 2cm or Surrounding Cellulitis present).
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8
Q

What is the Most Common Side Effect of Isoniazid medication?

A

Hepatotoxicity

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9
Q

What are the (5) Risk Factors for Isoniazid-induced Hepatotoxicity?

A
  1. Daily Alcohol Intake
  2. HIV
  3. Underlying Liver Disease (eg, Chronic Viral Hepatitis)
  4. Age > 50
  5. Active IVDU
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10
Q

For patients taking Isoniazid medication, what lab should be taken at baseline and every month thereafter while on therapy?

A

Aminotransferases (ALT, AST)

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11
Q

What are (2) Maternal Risk Factors associated with Perinatal Hepatitis B Infection?

A
  1. Maternal Viral Load
  2. Maternal HBeAg Positive
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12
Q

What are (2) Lab Findings in Infants with Perinatal Hepatitis B Infection?

A
  1. High Viral Load
  2. HBeAg Positive
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13
Q

What are infants with Perinatal Hepatitis B Infection at risk for?

A

High Risk for Chronic Hepatitis B Infection?

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14
Q

What are (4) methods for Preventing Perinatal Hepatitis B Infection?

A
  1. Maternal Antiviral therapy (in some cases).
  2. Newborn Hepatitis B Vaccination & Immunoglobulin within 12 hours (Decreases risk to < 5%).
  3. Routine Immunization.
  4. Serology approx. 3 months after 3rd dose of vaccine.
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15
Q

What is the primary Maternal Risk Factor for Perinatal Hepatitis B Infection that is Directly Related with the R_isk of Vertical_ Transmission?

A

Maternal Viral Load

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16
Q

In a patient with Advanced HIV (CD4 < 100) what is a Sign of Disseminated Cryptococcus Disease?

A

Cutaneous Cryptococcus

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17
Q

In a patient with advanced HIV, (CD4 < 100) what are the Most Common Clinical Manifestations of Cutaneous Cryptococcus?

A

Rapid Onset of multiple Papular lesions with Central Umbilication and Central Hemorrhage/Necrosis.

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18
Q

What is the Most Common Clinical Manifestation in an HIV+ patient with Cryptococcal neoformans infection?

A

Meningoencephalitis

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19
Q

Cryptococcal neoformans has what structure, and is what kind of Fungus?

A

Encapsulated Yeast

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20
Q

How is the Diagnosis of Cutaneous Cryptococcus infection typically Confirmed?

A

Lesion Biopsy with Histopathological examination

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21
Q

What are (3) Risk Factor for Congenital Toxoplasmosis?

A
  1. Raw or Undercooked Meat
  2. Unwashed Fruits/Vegetables
  3. Cat Feces
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22
Q

What are (4) Clinical Features of Congenital Toxoplasmosis?

A
  1. Macrocephaly/Hydrocephaly (neurologic)
  2. Diffuse Intracranial Calcifications (neurologic)
  3. Chorioretinitis (eye abnormality)
  4. Hearing Impairment
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23
Q

What are (2) Methods for Diagnosing Congenital Toxoplasmosis PRENATALLY?

A
  1. Maternal Serology
  2. Amniocentesis
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24
Q

What is the method for Diagnosing Congenital Toxoplasmosis in the Newborn?

A

Neonatal Serology

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25
Q

What are the (3) Medications given to Treat Congenital Toxoplasmosis and What is the duration of treatment?

A

Treat for One Year with the following (3) Medications:

  1. Pyrimethamine (antiparisitic)
  2. Sulfadiazine (antiparisitic)
  3. Folate (supplemental)
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26
Q

Which Type of Parisites cause Toxoplasmosis?

A

Tachyzoites (Toxoplasma gondii)

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27
Q

What are (2) common Pelvic Examination findings in a patient with Bacterial Vaginosis?

A
  1. Thin, Off-white Discharge with Fishy odor.
  2. NO vaginal inflammation.
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28
Q

What is the Genus of Anaerobic Bacterium that causes Bacterial Vaginosis?

A

Gardnerella vaginalis

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29
Q

What is the Name of Protozoan Parasite that causes Trichomoniasis?

A

Trichomonas vaginalis

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30
Q

What are (3) common Pelvic Examination findings in a patient with Trichomoniasis?

A
  1. Thin, Yellow-Green, Malodorous, Frothy Discharge.
  2. Vaginal Inflammation (vulvogaginal pruritis & erythema).
  3. Punctate Hemorrhages (in vagina or on cervix)
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31
Q

What are (2) common Pelvic Examination findings in a patient with Candida Vaginitis?

A
  1. Thick “Cottage Cheese” Discharge.
  2. Vaginal Inflammation.
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32
Q

What is the Name of the Opportunistic Pathogenic Yeast that causes Candida Vaginitis?

A

Candida albicans

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33
Q

What are (3) Lab Findings in a patient with suspected Bacterial Vaginosis?

A
  1. pH > 4.5
  2. “Clue” Cells
  3. + Whiff Test (Amine Odor with KOH prep)
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34
Q

What are (2) Lab Findings in a patient with suspected Trichomoniasis?

A
  1. pH > 4.5
  2. Motile Trichomonads
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35
Q

What are (2) Lab Findings in a patient with suspected Candida Vaginitis?

A
  1. Normal pH (3.8 - 4.5)
  2. PseudoHyphae
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36
Q

What are (2) Medications given to Treat Bacterial Vaginosis?

A
  1. Metronidazole, or
  2. Clindamycin
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37
Q

What Medication is given to Treat Trichomoniasis?

A

Metronidazole (PO) single dose.

(Tx: both Patient & Sexual Partner)

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38
Q

For which type of Vaginitis Infection should you treat Both the Patient & their Sexual Partner?

A

Trichomoniasis (Tx both Patient & Partner with Metronidazole)

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39
Q

What Medication is given to Treat Candida Vaginitis?

A

Fluconazole

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40
Q

Where are Intestinal Helminths Endemic?

A

Developing Countries where Water & Sewage Sanitation are poor.

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41
Q

What do the Primary Symptoms of Intestinal Helminth infection Reflect?

A

The Lifecycle of the Worm

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42
Q

Which (2) Systems are most commonly affected by Intestinal Helminth infection?

A
  1. Transient Pulmonary symptoms, followed by
  2. Long-Term Gastrointestinal symptoms
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43
Q

What are (2) common Lab Findings in a patient with an Intestinal Helminth infection?

A
  1. Peripheral Eosinophilia
  2. + Fecal Occult Blood
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44
Q

How is the Diagnosis of Intestinal Helminth infection made?

A

Stool Ova & Parasite testing

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45
Q

What Medication is given to Treat Intestinal Helminth infections?

A

Albendazole (typically curative)

46
Q

What Lab Finding should raise Suspicion for Factitious Disorder in a patient with NO Malignancy or Immunosuppressive condition?

A

Repeated Polymicrobial Bacteremia

47
Q

What are the (2) Most Common Demographics in patients with Factitious Disorder?

A
  1. Women
  2. Healthcare Workers
48
Q

Which Virus causes Infectious Mononucleosis?

A

Ebstein-Barr Virus (EBV)

49
Q

What are the (2) Treatments for Infectious Mononucleosis?

A
  1. Supportive Care: Rest, Hydration, Nutrition, Avoid Contact Sports/Strenuous activities.
  2. NSAIDs

**Infection is typically self-limiting**

50
Q

What are (4) potential SEVERE Complications of Infectious Mononucleosis infection?

A
  1. Airway Obstruction
  2. Overwhelming Infection
  3. Aplastic Anemia
  4. Thrombocytopenia
51
Q

What Medication should you add for patients who develop SEVERE Complications associated with Infectious Mononucleosis infection?

A

Corticosteroids - if the patient has Airway Obstruction, Overwhelming Infection, Aplastic Anemia, Thrombocytopenia)

52
Q

What is the Pathogenesis of Lactational Mastitis?

A

Skin Flora (eg, Staph aureus) enters Ducts through Nipple & Multiplies in Stagnant Milk

53
Q

What are (2) Risk Factors associated with Lactational Mastitis?

A
  1. History of Mastitis.
  2. Engorgement & Inadequate Milk Drainage.
54
Q

What are (6) potential Causes for Engorgement & Inadequate Milk Drainage of the Breast that can lead to Mastitis?

A
  1. Sudden Increase in Sleep Duration.
  2. Replacing Nursing with Formula or Pumped Breast Milk.
  3. Weaning.
  4. Pressure on the Duct (eg, tight bra/clothing, prone sleeping).
  5. Cracked or Clogged Nipple pore.
  6. Poor Latch.
55
Q

What are (3) Signs/Symptoms associated with Lactational Mastitis infection?

A
  1. Fever
  2. Firm, Red, Tender, Swollen QUADRANT of Unilateral Breast
  3. +/- Myalgia, Chills, Malaise
56
Q

What are (3) general Treatments for Lactational Mastitis?

A
  1. Analgesia
  2. Frequent Breast Feeding or Pumping
  3. Antibiotics
57
Q

What is the Most Common Cause of Pain During Breastfeeding?

A

Poor Positioning or Latching, which can be evaluated by a Lactation Consultant

58
Q

What are (4) Systems Most Commonly affected by Infective Endocarditis?

A
  1. Cardiac
  2. Neurologic
  3. Renal
  4. Musculoskeletal
59
Q

What are (4) CARDIAC Complications associated with Infective Endocarditis?

A
  1. Valvular Insufficiency (common cause of Death).
  2. Perivalvular Abscess.
  3. Conduction Abnormalities.
  4. Mycotic Aneurysm
60
Q

What are (4) NEUROLOGIC Complications associated with Infective Endocarditis?

A
  1. Embolic Stroke
  2. Cerebral Hemorrhage
  3. Brain Abscess
  4. Acute Encephalopathy or Meningoencephalitis
61
Q

What are (3) RENAL Complications associated with Infective Endocarditis?

A
  1. Renal Infarction
  2. Glomerulonephritis
  3. Drug-Induced Acute Interstitial Nephritis from Therapy
62
Q

What are (3) MUSCULOSKELETAL Complications associated with Infective Endocarditis?

A
  1. Vertebral Osteomyelitis
  2. Septic Arthritis
  3. Musculoskeletal Abscess
63
Q

What are the (2) Causes of both Cerebral & Systemic Mycotic Aneurysms that arise from Infective Endocarditis?

A
  1. Septic Embolization
  2. Localized Vessel Wall Destruction
64
Q

What are (2) ways in which Intracranial Mycotic Aneurysms can Present?

A
  1. Expanding Mass with Focal Neurologic findings
  2. Aneurysm Rupture & Subarachnoid Hemorrhage (SAH)
65
Q

What are (4) Risk Factors for Pyelonephritis in Pregnancy?

A
  1. Asymptomatic Bacteriuria
  2. Diabetes Mellitus
  3. Age < 20
  4. Tobacco use
66
Q

What are (4) common Pathogens that cause Pyelonephritis in Pregnancy?

A
  1. E. coli (most common)
  2. Klebsiella
  3. Enterobacter
  4. Group B Strep
67
Q

What are (3) Complications associated with Pyelonephritis in Pregnancy?

A
  1. Preterm Labor
  2. Low Birthweight (LBW)
  3. Acute Respiratory Distress Syndrome (ARDS)
68
Q

What are the (2) Treatment Methods for a patient with Pyelonephritis in Pregnancy?

A
  1. IV Antibiotics (Broad-spectrum ß -Lactams. eg, Ceftriaxone or Cefipime)
  2. Supportive Care
69
Q

What are (2) common Physical Examination findings in a patient with Pyelonephritis in Pregnancy?

A
  1. Fever
  2. Costovertebral Tenderness
70
Q

Which Demographic is at Greatest Risk for Urethritis?

A

Young Males

71
Q

What are (3) common Signs/Symptoms of Urethritis?

A
  1. Dysuria
  2. Itching at Urethral Meatus
  3. Urethral Discharge
72
Q

Which Diagnostic Method is used to help Categorize patients as having Gonococcal (intracellular diplococci) vs. Nongonococcal (aseptic) Urethritis?

A

Gram Stain of Urethral Fluid

73
Q

What is the Most Common Cause of Nongonococcal Urethritis?

A

Chlamydia trachomatis

74
Q

What is the Empiric Treatment for Urethritis caused by Chlamydia trachomatis?

A

Azithromycin

75
Q

What Diagnostic Test should all patients with suspected Urethritis receive to Confirm the Pathologic Organism?

A

Nucleic Acid Amplification Test (NAAT) of the Urine.

76
Q

What are (2) Causes for Continued Symptoms of Nongonococcal Urethritis after initial treatment with Azithromycin therapy?

A
  1. Reinfection
  2. Infection with an organism Not Susceptible to Azithromycin (eg, Mycoplasma genitalium)
77
Q

What is the Mainstay of Treatment for Toxic Shock Syndrome?

A

Supportive Therapy

78
Q

What are (4) Clinical Manifestations of Pneumocystis jiroveci Pneumonia?

A
  1. Indolent HIV (slowly progressing) or Acute Respiratory Failure (immunocompromised)
  2. Fever
  3. A dry Cough
  4. Decreased Oxygen levels
79
Q

What are (3) Diagnostic Workup findings in a patient with Pneumocystis jiroveci Pneumonia?

A
  1. Increased LDH level
  2. Diffuse Reticular Infiltrates on Imaging
  3. Induced Sputum on BAL (stain)
80
Q

What is the Treatment for Pneumocystis jiroveci Pneumonia?

A

TMP-SMX (Bactrim)

81
Q

What should you Add to the treatment for Pneumocystis jiroveci Pneumonia if the patient has Decreased Oxygen levels?

A

Prednisone

82
Q

Which (2) Medications are given as Prophylaxis to Pneumocystis jiroveci Pneumonia?

A
  1. TMP-SMX (Bactrim)
  2. Antiretrovirals (only if HIV)
83
Q

What are (3) indolent Clinical Manifestations of Elevated Intracranial Pressure (ICP)?

A
  1. Headache
  2. Blurred Vision
  3. Papilledema
84
Q

What is the Most Likely Diagnosis given the (2) Clinical Features of Extremely Elevated Opening CSF Pressure and Molluscum Contagiosum-like Skin Lesions?

A

Cryptococcal Meningoencephalitis

85
Q

What YEAST commonly Causes Opportunistic CNS Infections in patients with AIDS (CD4 < 100)?

A

Cryptococcus neoformans

86
Q

What are (4) Manifestations of a Cryptococcus neoformans CNS Infection that typically develop over 1 -2 weeks?

A
  1. Fever
  2. Headache
  3. Lethargy
  4. Molluscum Contagiosum-like Skin Lesions (papular lesions with central umbilication)
87
Q

What are (5) CSF Findings in a patient with Cryptococcal Meningoencephalitis?

A
  1. Extremely Elevated Opening Pressure (>250 - 300)
  2. WBC: < 50 cells/uL
  3. Glucose: < 40 mg/dL
  4. Protein: > 40 mg/dL
  5. + India Ink or + Cryptococcal Antigen Test
88
Q

What (2) Medications are used as First-Line Treatment in an HIV patient with Cryptococcal Meningitis?

A
  1. Amphotericin B (2+ weeks)
  2. Flucytosine (2+ weeks)
89
Q

What is the Management for a patient with Cryptococcal Meningitis who develop Recurrent Symptoms of Elevated ICP (eg, Headache, N/V, Visual Changes, Papilledema, CN Palsies)?

A

Serial Lumbar Punctures (to relieve pressure)

90
Q

What is the Pathophysiology for the Extremely Elevated ICP in patients with Cryptococcal Meningitis?

A

Patients often have Dramatic CSF Fungal burdens (> 1,000,000). The Yeast and Capsular Polysaccharides clog the Arachnoid Villa, preventing CSF Flow ⇒ Elevated ICP.

91
Q

What is the (2) Steps in Transition Therapy for Cryptococcal Meningitis in a patient with HIV AFTER the 2+ week Initial Treatment, and AFTER the Abatement of Symptoms and CSF Sterilization?

A
  1. High-Dose Fluconazole (8 weeks, Consolidative therapy)
  2. Low-Dose Fluconazole (1+ Years, Maintenance therapy)
92
Q

In an Untreated patient with HIV who has contracted Cryptococcal Meningitis, when should Antiretroviral Therapy for HIV begin?

A

2 - 10 weeks AFTER starting treatment for meningitis.

93
Q

In a patient who has had Close Contact with an individual recently diagnosed with Active Tuberculosis, what is considered a Positive PPD?

A

PPD ≥ 5mm

94
Q

What Medication is indicated for Latent Tuberculosis?

A

Isoniazid

95
Q

What is the main Side Effect of Isoniazid?

A

Hepatotoxicity (within the first 2 months of therapy)

96
Q

What are (5) Risk Factors for Isoniazid-induced Hepatotoxicity?

A
  1. Alcohol intake
  2. HIV
  3. Underlying Liver Disease (e.g., chronic viral hepatitis)
  4. Age > 50
  5. Active IVDU
97
Q

What are the (2) Lab Criteria that, if either is met, would signal to immediately discontinue Isoniazid therapy for TB?

A
  1. Asymptomatic with Aminotransferases ≥ 5 times the upper limit of normal (if baseline value is normal)
  2. Symptomatic (eg, jaundice, mental status changes) with Aminotransferases ≥ 3 times ULN (if baseline value is normal).
  3. 2-3 fold increased Aminotransferases from baseline (if baseline value is NOT normal).
  • *Aminotransferases (AST, ALT):*
  • Normal:8 - 40 U/L** (so ULN = 40)*
  • 5x40 = 200 U/L and Asymptomatic*
  • 3x40 = 120 U/L and Symptomatic*
98
Q

What Disorder is considered a Type III (Immune-Complex-mediated) Hypersensitivity reaction that occurs when Circulating Antibodies combine with Antigen (classically Heterologous Proteins such as Equine Protein) in Blood & Tissue and Overload normal Clearance Mechanisms –> Activation of Complement –> Disease?

A

Serum Sickness (SS)

99
Q

What are (3) Etiologies of Serum Sickness (SS)?

A
  1. Immune Complex formation
  2. Antibiotics (eg, Beta-Lactam, Sulfa)
  3. Acute Hepatitis B (eg, contracted from IVDU)
100
Q

What are (3) Clinical Features of Serum Sickness (SS)?

A

Symptoms occur 1 -2 weeks AFTER exposure:

  1. Fever
  2. Skin Rash/Dermatitis
  3. Polyarthralgia/Polyarthritis
101
Q

What are (3) Treatments for Serum Sickness (SS)?

A
  1. Remove/Avoid offending Agent
  2. Supportive Care
  3. Steroids or Plasmapheresis if severe
102
Q

A Serum Sickness-like syndrome Can occur in a patient during the Prodromal Phase of what VIRAL Infection?

A

Hepatitis B Virus (HBV) infection

  • attributed to circulating immune complexes,
  • Including Extrahepatic Manifestations: PolyArteritis Nodosa (PAN) & Glomerulonephritis
103
Q

What are the CSF Leukocyte count, Glucose level, and Protein level for the following patients?

  1. Normal
  2. Bacterial Meningitis
  3. Tuberculosis Meningitis
  4. Viral Meningitis
  5. Guillain-Barre
A

SEE PICTURE

104
Q

TETANUS PROPHYLAXIS

Describe the Tetanus Prophylaxis for the (4) Immunization & Wound Type scenarios.

A

SEE PICTURE

105
Q

CYSTITiS

What are most cases of Acute, Uncomplicated Cystitis due to?

A

Fecal-Flora, especially from E. coli (75% - 90%)

Risk greatest in those with Recent Sexual Activity or History of UTI.

106
Q

CYSTITIS

What are (4) Manifestations of Acute, Uncomplicated Cystitis?

A
  1. Dysuria
  2. Increased Frequency/Urgency
  3. Hematuria
  4. Suprapubic Pain
107
Q

CYSTITIS

Most cases of Acute, Uncomplicated Cystitis are diagnosed clinically based on symptoms and treated without further tests. However, which (3) Conditions require a Physical Exam & Urine Culture prior to treatment

A
  1. Patients likely to be Pregnant (eg, no contraception, no recent menstrual period)
  2. Likely have Pyelonephritis (eg, fever, chills, flank pain)
  3. Vaginal Infection (eg, pruritis, discharge)
108
Q

CYSTITIS

What are (2) Empiric Treatments often used for Acute, Uncomplicated Cystitis?

A
  1. TMP-SMX
  2. Nitrofurantoin
109
Q

MAMMALIAN BITE WOUNDS

  1. What is the PO Drug of Choice for significant wound infections due to Mammalian Bites (including humans)?
  2. What is the IV Drug of Choice for significant wound infections due to Mammalian Bites (including humans)?
A
  1. PO = Amoxicillin/Clavulanate
  2. IV = Ampicillin/Sulbactam
110
Q

MAMMALIAN BITE WOUNDS

What are the (4) Most Likely Bacterial causes of infection following a Mammalian (including humans) Bite Wounds?

A
  1. Eikenella corrodens
  2. α -hemolytic Streptococci (Strep viridans)
  3. Staphylococcus aureus
  4. Other Anaerobes (eg, Fusobacterium, Prevotella)
111
Q

MAMMALIAN BITE WOUNDS

What are (4) Management Steps when dealing with Human Bite Wounds?

A
  1. Local Wound Care & Irrigation
  2. Antibiotics
  3. Consider Tetanus Booster
  4. NO Primary closure (except Face)
112
Q

TUBERCULOSIS

What is the Treatment for Active Tuberculosis in a Pregnant Woman?

A

3 Drug Therapy with:

  1. Isoniazid (INH)
  2. Rifampin
  3. Ethambutol

**2 months with all 3, then 7 more months with INH only**

1.01) INFECTIOUS DISEASES (10 decks)

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