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3rd Year (Step 2) > ID 3b > Flashcards

ID 3b Flashcards

1
Q

Infectious Diarrhea: Bloody – Dx?

Poultry

A

Salmonella

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2
Q

Infectious Diarrhea: Bloody – Dx?

Most common cause

A

Campylobacter

ass’d w/ GBS

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3
Q

Infectious Diarrhea: Bloody – Dx?

Hemolytic Uremic Syndrome (HUS)

A
  1. E. coli O157:H7

2. Shigella (2nd most common w/ HUS)

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4
Q

Infectious Diarrhea: Bloody – Dx?

Shellfish & cruiseships

A

Vibrio parahaemolyticus

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5
Q

Infectious Diarrhea: Bloody – Dx?

Shellfish, Hx of liver disease, skin lesions

A

Vibrio Vulnificus

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6
Q

Infectious Diarrhea: Bloody – Dx?

High affinity for iron, hemochromatosis, blood transfusions

A

Yersinia

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7
Q

Infectious Diarrhea: Bloody – Dx?

White & red cells in stool

A

Clostridium dificile

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8
Q

Best initial test in infectious diarrhea?

A

Blood &/or fecal leukocytes

Stool lactoferrin has greater sensitivity & specificity than stool leukocytes

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9
Q

Nonbloody infectious diarrhea ass’d w/ vomiting – organism(s)?

A

Bacillus cereus & Staphylococcus

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10
Q

Infectious diarrhea – Tx of mild & sever disease?

A

Mild = Oral fluid replacement

Severe = Fluid replacement & oral ABX like Ciprofloxacin

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11
Q

“Severe” infectious diarrhea means what?

A

Hypotension, Tachycardia, Fever, Abdominal pain, Bloody diarrhea, Metabolic acidosis

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12
Q

Cryptosporidiosis – Tx?

A

Treat underlying AIDS

- Nitazoxanide

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13
Q

Most common causes of acute hepatitis?

A

Hepatitis A or B

Hep C rarely presents as acute hepatitis, usually “silent” infection that presents later w/ cirrhosis

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14
Q

Acute Hepatitis presentation Sx?

A
  • Jaundice
  • Fever, weight loss, fatigue
  • Dark urine
  • Hepatosplenomegaly
  • Nausea, vomiting, abdominal pain
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15
Q

Acute Hepatitis Dx tests?

A

Increased:

  • Direct Bilirubin
  • ALT:AST ratio
  • Alkaline Phosphatase
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16
Q

Acute Hepatitis marker that correlates best w/ inc’d likelihood of mortality?

A

Prothrombin time

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17
Q

Best initial Dx test to differentiate type of hepatitis?

A

Hep A, B, D, & E: IgM antibody for acute infection, IgG for resolution of infection

Hep C: PCR to assess RNA level

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18
Q

Serology marker of Hepatitis B vaccination?

A

Positive Surface Antibody

surface- & e-antigen negative, core-Ab negative

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19
Q

Serology marker of resolved/past Hepatitis B infection

A

Positive IgG Core antibody & Surface antibody

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20
Q

Serology marker of acute or chronic Hepatitis B infection?

A

Positive surface antigen, e-antigen, core antibody (IgG or IgM)

(negative surface antibody)

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21
Q

Serology marker of “window period” of Hepatitis B infection?

A

Positive IgM, then IgG Core antibody

antigens & surface antibody all negative

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22
Q

What does positive e-antigen mean in hepatitis B?

A

High level of DNA polymerase activity — viral replication occurring

e-antigen is the best indication of the need for Tx in chronic disease

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23
Q

Acute Hepatitis C – Tx?

A

Interferon (injection), Ribavirin, & Boceprevir or Telaprevir

(dec likelihood of developing chronic infection w/ Hep C)

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24
Q

Definition: “Chronic” Hepatitis B

A

Presence of Surface antigen > 6 months

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25
Q

Interferon – AEs?

A
  • Arthralgia/myalgia
  • Leukopenia & Thrombocytopenia
  • Depression & flu-like symptoms
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26
Q

Chronic Hepatitis w/ elevated e-antigen – Tx?

A

Entecavir, Adefovir, Lamivudine, Telbivudine, Interferon, or Tenofovir
(interferon is injection & has most side effects – not best 1st choice)

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27
Q

Goal of Chronic Hepatitis therapy?

A
  • Reduce DNA polymerase to undetectable levels

- Convert those patients w/ e-antigen to having anti-hepatitis e-antibody

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28
Q

Acute Hepatitis B – Tx?

A

None. Hep B becomes chronic in 10% of patients & no Tx has been shown to alter this.

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29
Q

Role of Liver Biopsy in chronic Hepatitis management?

A

Fibrosis on biopsy = start Tx for Hep B or C right away

  • if there’s active viral replication, fibrosis will progress to cirrhosis, which is irreversible
30
Q

Are ALT levels a good indication of activity of chronic hepatitis?

A

No, you can have significant infection w/ normal transaminase levels

31
Q

Ribavirin – AEs?

A
  • Hemolytic Anemia

- Severe Teratogen

32
Q

Goal of Hep C therapy?

A

Achieve an undetectable viral load

33
Q

Urethritis vs. Cystitis presentation?

A

Both: Dysuria w/ urinary frequency & burning

Urethritis = Urethral discharge
cystitis does not give this

34
Q

Urethritis – Tx?

A

Cefexime or Ceftriaxone (gonorrhea)
+
Azithromycin or Doxycycline (chlamydia)

35
Q

Urethritis – best initial test?

A

Urethral swab for Gram stain

36
Q

Causes of Urethritis other than Gonorrhea/Chlamydia?

A

Mycoplasma genitalium & Ureaplasma

37
Q

Cervicitis – presentation?

A

Cervical discharge & inflamed “strawberry” cervix on PE

38
Q

Cervicitis – Tx?

A 
- Testing & Tx are identical to Urethritis
Tx =
Cefexime or Ceftriaxone  (gonorrhea)
\+
Azithromycin or Doxycycline  (chlamydia)
39
Q

Pelvic Inflammatory Disease (PID) – presentation?

A
  • Lower abdominal tenderness
  • Lower abdominal pain
  • Fever
  • Cervical motion tenderness
  • Leukocytosis
40
Q

PID – best 1st step?

A

Exclude pregnancy!

41
Q

Dx?

Painless genital ulcer

A

Syphilis

42
Q

Dx?

Painful genital ulcer

A

Chancroid (Haemophilus ducreyi)

43
Q

Dx?

Lymph nodes tender & suppurating + genital ulcer

A

Lymphogranuloma venereum

44
Q

Dx?

Painful vesicles, leading to ulcer

A

Herpes simplex

45
Q

Syphilis – Dx tests?

A

Dark-field microscopy

  • CDRL or RPR (75% sensitive in primary syphilis)
  • FTA or MHA-TP (confirmatory)
46
Q

Chancroid (H. ducreyi) – Dx tests?

A

Stain & culture on specialized media

47
Q

Lympogranuloma venereum – Dx tests?

A
  • Complement fixation titers in blood

- Nucleic acid amplification testing on swab (PCR)

48
Q

Herpes simplex – Dx tests?

A
  • Tzanck prep = best initial test

- Viral culture = most accurate test

49
Q

Syphilis – Tx?

A

Single dose of intramuscular benzathine penicillin
- Doxycycline in penicillin allergy

(ulcers resolve on their own, Tx is to prevent further stages)

50
Q

Chancroid (H. ducreyi) – Tx?

A

Azithromycin (single dose)

51
Q

Lymphogranuloma venereum – Tx?

A

Doxycycline

52
Q

Primary syphilis – presentation?

A
  • Painless genital ulcer w/ heaped-up INDURATED EDGES (becomes painful if secondarily infected w/ bacteria)
  • Painless adenopathy
53
Q

Secondary syphilis – presentation?

A
  • Rash (palms & soles)
  • Alopecia areata
  • Mucous patches
  • Condylomata lata
54
Q

Tertiary syphilis – presentation?

A

Neurosyphilis:

  • Meningovascular (stroke from vasculitis)
  • Tabes dorsalis (loss of P & V sense, incontinence, cranial nerve)
  • General paresis (memory & personality changes)
  • Argyll Robertson pupil (reacts to accommodation but not light)
  • Aortitis (aortic regurge & aneurysm)
  • Gummas (skin & bone lesions)
55
Q

Syphilis Tx: If PCN-allergic, when do you desensitize to PCN instead of switching to Doxycycline

A

If neurosyphilis exists or if the patient is pregnant

56
Q

Condyloma Acuminata – what is it?

A

Genital warts (papillomavirus)

57
Q

Condyloma Acuminata – Dx test(s)?

A

Visual appearance alone

58
Q

Condyloma Acuminata – Tx?

A

Remove w/ Cryotherapy w/ liquid nitrogen, surgery, laser, or “melting” w/ podophyllin or tricloroacetic acid

  • Imiquimod is a locally applied immunostimulant that leads to the sloughing off of the lesion
59
Q

Pediculosis

A

Crabs

  • found on hair bearing areas (axial, pubis)
  • Visible on surface
  • Causes itching
60
Q

Pediculosis – Tx?

A

Permethrin

Pediculosis = Crabs

61
Q

Scabies – Dx test(s)?

A

Must scrape them out of the skin & magnify to Dx

b/c they burrow beneath the skin but leave a visible trail

62
Q

Scabies – Tx?

A

Permethrin

63
Q

Scabies – where is it found?

A

Web spaces between fingers & toes or @ elbows or genitalia

64
Q

Pyelonephritis – Tx?

A
  • Ceftriaxone (1st), Ertapenem
  • Ampicillin & Gentamicin (if cultures are known)
  • Ciprofloxacin (oral for outpatient)

** any drug for gram-negative rods would be effective **

65
Q

Prostatitis – Tx?

A
  • Ceftriaxone (1st), Ertapenem
  • Ampicillin & Gentamicin (if cultures are known)
  • Ciprofloxacin (oral for outpatient)

** any drug for gram-negative rods would be effective **

66
Q

Chronic Prostatitis – Tx?

A

TMP/SMX x 6-8 wks

67
Q

Isoniazid – AEs?

A
  • Neurotoxicity (prevented by pyridoxine, B6)
  • Hepatotoxicity
  • Lupus-like syndrome
68
Q

Rifampin – AEs?

A
  • Minor hepatotoxicity & drug interactions (inc’s P450)

- Orange body fluids (nonhazardous)

69
Q

Pyrazinamide – AEs?

A
  • Hyperuricemia

- Hepatotoxicity

70
Q

Ethambutol – AEs?

A

Optic neuropathy (red-green color blindness)

71
Q

What type of drugs end in “navir”?

A

Protease inhibitors

72
Q

What type of drugs end in “vudine”?

A

NRTIs

though not all of these end in “vudine”

3rd Year (Step 2) (44 decks)

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