Infectious Diseases (12%) Flashcards
Management of influenza?
Mostly supportive
Antivirals (Oseltamivir) if w/in 48 hours of onset of sx
Side effects: N/V
What are the rashes that can affect the palm and soles? (x8)
Coxsackie (Hand Foot & Mouth)
RMSF (especially if wrist/ankles involved)
Syphilis (secondary)
Janeway lesions (cutaneous finding of endocarditis, along with osler nodes)
Kawasaki
Measles
Toxic Shock Syndrome
Reactive Arthritis (Keratoderma Blenorrhagica)
Meningococcemia
When will the prodrome of HSV first appear?
What are common sx of the prodrome?
Prodromal sx 24 hours prior
Burning, paresthesias, tingling
How does rubella typically present?
Compared to rubeola, rubella does/does not do what?
What may be present in young women with rubella, especially?
- Low-grade fever, cough, anorexia, lymphadenopathy (posterior cervical and posterior auricular)
Pink, light-red spotted maculopapular rash on face that spreads to the extremities (lasts 3 days).
Compared to rubeola, rubella spreads more rapidly & does NOT darken or coalesce.
- Transient photosensitivity & joint pains may be seen (especially in young women)
How is influenza spread?
What time of year is it most prevalent?
Airborne respiratory secretions
Fall/winter
Herpes zoster ophthalmicus: shingles involving the____ division of the _____ nerve
What is Hutchinson’s sign?
_______ lesions will be seen on slit lamp exam if _________ is present
1st
Trigeminal (CN V)
lesions on nose usually heralding ocular involvement
Dendritic
keratoconjunctivitis
How to diagnose pinworms?
Scotch tape test
performed early in the morning to look for eggs under a microscope
EBV infects ___ cells and is associated mostly with what lymphoma?
It may cause _______ lymphoma, too, and also ____ lymphoma in pts with AIDS.
B cells
Hodgkin Lymphoma
Burkitt’s lymphoma
CNS lymphoma
How do you dx a pt with HSV?
What is the most sensitive and specific test?
What will be seen on Tzacnk smear?
PCR = most sensitive and specific test for HSV
Clinical diagnosis
Tzanck smear: multinucleated giant cells and intranuclear inclusion bodies
POST HERPETIC NEURALGIA: pain ____ months, hyperesthesias or decreased sensation
>3 months
What is the mainstay of tx for pertussis?
Indication for abx?
Potential complications?
Supportive care
Abx for decreasing contagiousness, Macrolides are drug of choice (Erythromycin)
PNA, encephalopathy, otitis media, sinusitis, sz
Human Herpesvirus Family:
- _____
- _____
- _____
- _____
- _____
- _____
- _____
- _____
Human Herpesvirus Family:
- Oropharyngeal
- Genital
- Varicella Zoster
- Epstein Barr
- CMV
- Roseola
- Pityriasis Rosea
- Kaposi Sarcoma
The scientific name for pinworms is _____ ______
Enterobius vermicularis
What are the three kinds of oral lesions caused by HSV?
Acute herpetic gingivostomatitis
Acute herpetic pharyngotonsillitis
Herpes labialis
Pertussis is MC seen in what age group of pts?
<2 y/o
What can both types of coxsackie virus cause in a patient?
Aseptic meningitis, rashes, common cold sx, or no sx at all
HSV espohagitis presents as small deep ____ on EGD, and is seen primarily in ______ pts
small deep ulcers
immunocompromised
Secondary (Reactivation) TB infections:
Pts (are/are not) contagious
__-__% lifetime incidence of reactivation
Most commonly localized in the ___/___ lobes of the lungs with _____ lesions. Why there?
ARE CONTAGIOUS
5-10%
Apex/upper lobes (more O2 content)
cavitary
What is another name for measles?
Rubeola
Which influenza is associated with more severe, extensive outbreaks, A or B?
A
Mortality from TB is (low/high) when (treated/not treated)
High not treated
low when treated! (<5%)
Chronic/latent TB infections:
Pts (are/are not) contagious
____% of the population will control TB infeciton with _____ formation, which may become caseating. Caseating means: ____
ARE NOT
90%
granuloma
Caseating: central necrosis, acidic with low oxygen, making a hostile envr. for TB to grow
What is pleurodynia? How does it present?
Fever, severe pleuritic chest pain, and paroxysmal spasms of the chest/abdominal muscles including the diaphragm (may have swelling over the diaphragm), headache
Where are myalgias most commonly in a pt with influenza?
Legs and lumbosacral area
Influenza vaccines are given annually, usually in ___(months of the year)___
Contraindicated in pts with?
October-November
Egg, gelatin, or thimerosal allergies, or if severely ill
How do you dx rubella?
What assay is most commonly used?
Clinically
Rubella-specific IgM antibody via enzyme immunoassay
What is the incubation period of varicella zoster?
10-20 days
Usually, pts will become PPD + how many weeks after infection with TB?
2-4 weeks
In what ages is sixth’s disease most commonly diagnosed?
What is the incubation period?
<5 y/o
~10 day incubation period
What are the three phases of whooping cough?
Describe them (how long they last for, when is the pt most contagious, what are the presentations of each stage)
- Catarrhal phase: URI symptoms lasting 1-2 weeks. Most contagious during this phase.
- Paroxysmal phase: severe paroxysmal coughing fits with inspiratory whooping sound after cough fits. ± Post coughing emesis. Often lasts 2-4 weeks. ±Scattered rhonchi.
- Convalescent phase: resolution of the cough (coughing stage may last for up to 6 weeks)
Mononucleosis, otherwise known as the “kissing disease”, is caused by what herpes family virus?
How is it transmitted?
In what age group is it most commonly diagnosed in?
_____% of adults are seropositive
Epstein Barr virus (HHV 4)
Saliva
15-25 y/o
80%
Will a patient with mono have anterior or posterior cervical lymphadenopathy? Could it also be general?
What organs many be enlarged?
What kind of rash can present, especially if given ampicillin?
Posterior, yes
Spleen and possibly liver too
Petechial (~5%)
Describe the presentation of hand foot and mouth disease.
Mild fever, URI sx, decreased appetite starting 3-5 days after exposure
Oral enanthem: vesicular lesions with erythematous halos in the oral cavity (especially buccal mucosa & tongue)
Exanthem: 1-2 days afterwards: vesicular, macular or maculolapular lesions on the distal extremities (often includes the palms & soles)
Influenza has a (abrupt/gradual) onset.
Associated sx?
Abrupt
HA, fever, chills, malaise, URI sx
Enterobiasis is otherwise referred to as _______
Pinworms
How to treat active TB?
Common side effects of each?
After starting therapy, how long until patient is considered non-infectious?
“RIPE” or “RIPS”:
Rifampin – orange colored secretions
lsoniazid – hepatitis, peripheral neuropathy (which can be prevented by pyridoxine B6)
Pyrazinamide – photosensitive rash, hepatitis
Ethambutol – optic neuritis, peripheral neuropahty
(or Streptomycin) – ototoxicity (CN VIII), nephrotoxicity
2 weeks
When is a CXR indicated in pts with TB or possible TB?
- indicated to exclude active TB (ex. newly +PPD)
- used as yearly screening in pts w/ known + PPD to r/o active TB
The rubella virus belongs to what viral family?
Togavirus family
What is gold standard for dx of pertussis?
PCR of nasopharyngeal swab
Tuberculosis is caused by what infective agent?
Mycobacterium tuberculosis
What is the recommended management for 5th disease/ erythema infectiosum?
Supportive, anti-inflammatories
What is the recommended management of measles/rubeola?
What are possible complications of measles/rubeola?
Supportive, anti-inflammatories (no specific tx)
Vitamin A reduces mortality in all children with measles (decreased morbidity & mortality)
COMPLICATIONS: Diarrhea, otitis media, PNA, conjunctivitis, encephalitis
What is herpes whitlow?
Herpes infection of the finger or fingernail
How are pinworms transmitted?
Feco-oral
How does measles/rubeola typically present?
Prodrome?
What are the “3 C’s”?
- URI prodrome: high fever
“3 C’s”: Cough, Coryza (rhinitis), Conjunctivitis
Koplik Spots: small red spots in buccal mucosa with pale blue/white center) precedes rash by 24-48h, lasts 2-3 days
Morbiliform (maculopapular) brick-red rash on face beginning @ hairline then spreading down to extremities (palms & soles involvement usually seen last if it occurs) that darkens & coalesces.
- Rash usually lasts 7 days fading from top to bottom. Fever often concurrent with the rash
How does mumps usually present?
How do you dx mumps?
Low grade fever, myalgias, headache
Parotid gland pain & swelling
Dx clinically, or with serologies, look for elevated amylase
Acute herpetic gingivostomatitis: primary infection in (children/adults) with a sudden onset of fever, ______, ______, and ______ in the mouth,
Tongue and lips will have ____(color)____ lesions.
____% ofUS population is infected with HSV 1
children
anorexia
gingivitis
vesicles
grey-yellow
>90%
What does chronic TB cause in the lungs?
Granuloma formation
Describe sixth’s disease presentation, including prodrome, rash, how long it lasts for, and what the child feels like.
- Prodrome of HIGH FEVER 3-5 days (fever resolves before the onset of a rose, pink maculopapular, blanchable rash on the trunk/back that then spreads to the face.
Rash lasts hours (up to 1-2 days).
ONLY CHILDHOOD VIRAL EXANTHEM THAT STARTS ON TRUNK and then spreads to face
- Child appears “well” and alert during the febrile phase.
May be irritable during febrile phase.
What are possible complications of mumps?
What is mumps the most common cause of in children?
In what age group are complications of mumps most commonly seen in?
- Orchitis in males* (usually unilateral), oophoritis (inflammed ovary), encephalitis, aseptic meningitis
- Mumps MC cause of acute pancreatitis in children. Deafness, arthritis, infertility.
MC seen in older patients
HERPES ZOSTER OTICUS, otherwise known as _________, follows the ____ nerve. It can cause sx such as …
Ramsey Hunt Syndrome
facial nerve (CN VII)
otalgia, lesions on the ear, auditory canal & tympanic membrane, facial palsy, auditory sx: tinnitus; vertigo, deafness, ataxia.
What can be done to prevent mumps in patients?
MMR vaccine
Given at 12-15 months, with a second dose at 4-6 y/o
What does 5th disease/ erythema infectiosum present like?
What can it cause in older children and adults?
What can it cause in pregnant women?
- Coryza, fever –> “slapped cheek” rash on face with circumoral pallor 2-4 days –> lacy reticular rash on extremities (especially upper).
* Spares the palms & soles*
Resolves in 2-3 weeks
- Arthropathy/arthralgias: older children & adults
- Associated with fetal loss in pregnancy (fetal hydrops, CHF, spontaneous abortion)
Varicella (chicken pox) is the primary infection of HSV ____.
Sx include fever and malaise, and a rash that is described as … with all lesions at (the same stage/different stages), beginning on the ___ & ___ and spreading to the ____.
(Never/Sometimes/Usually) pruritic
More severe presentation may occur in (children/adults)
3
“dew drops on a rose petal” (clusters of vesicles on an erythematous base)
Different stages (macules, papules, vesivcles, pustules, and crusted lesions)
Face & trunk
extremities
Usually
adults
What would classic miliary TB look like on CXR?
Diffuse millet seed size infiltrates throughout the lung fields
How do you dx a pt with mono?
Within what timeframe will this test be positive?
What will be seen on a peripheral smear?
Heterophile (Mono) Ab Test {monospot}
Postive within 4 weeks
Peripheral smear: Atypical lymphocytes
What are Forcheimer spots? What other exanthem are they typically present in?
Forchheimer spots: small red macules or petechiae on soft palate –> also seen in Scarlet fever)
Pertussis, or whooping cough, is caused by what infectious agent?
Bordetella pertussis
Describe the potential complications that could occur if a pt is pregnant and contracts rubella.
Teratogenic esp 1st trimester
Congenital syndrome –> sensorineural deafness, cataracts, TTP (“blueberry muffin rash”), mental retardation, heart defects
(part of the TORCH syndrome)
(T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.
Bell palsy is associated with HSV (1/2)
1
Herpes labialis is a secondary infection caused most often by HSV (1/2). It results in a ____ ____, usually following a periord of _____ or illness
1
cold sore
stress
What is the clinical presentation of HSV?
Can HSV 1 and HSV 2 interchange?
Painful, grouped vesicles on an erythematous base
YES, oral (HHV 1) and genital (HHV 2) can be interchanged
What are the infectious dz that are associated with arthropathy?
Erythema Infectiosum (in older adults)
Rubella (especially in young women)
Coccidiomycosis (Valley fever also associated with erythema nodosum)
Herpes keratitis is usually (unilateral/bilaterl)
Upon examination with a slit lamp, one will see ____ _____
Management?
unilateral
dendritic ulcers
Antiviral eye drops (ex. Trijluridine, Vidarabine, Ganciclovir) and/or oral Acyclovir
Describe the presentation of herpangina.
Who is herpangina most commonly diagnosed in?
Sudden onset of high fevers, stomatitis: small vesicles on the soft palate, uvula & tonsillar pillars that ulcerate before healing, sore throat 3-5 days.
Most commonly seen in children 3-l0 y/o
What is the most common viral cause of pericarditis and myocarditis?
Coxsackie (B>A)
What would classic reactivation TB look like on CXR?
Infiltrates and cavitation in the upper lobe/apices
Acute herpetic pharyngotonsillitis is a primary infeciton in (children/adults) with vesicles that (do/do not) rupture, with ulcerative lesions with __(color)__ exudates in the (anterior/posterior) pharyngeal mucosa
adults
do rupture
grayish
posterior
What would classic primary TB look like on CXR?
Lower lobe consolidation, right sided hilar consolidation also seen here:
PVB19 may cause ______ in patients with sickle cell disease or with ____ deficiency
Aplastic crisis (a temporary cessation of RBC production; b/c of markedly shortened RBC survival time in patients with sickle cell dz, a precipitous drop in hgb occurs in the absence of adequate reticulocytosis)
G6PD
On CBC with Diff, what is the finding in a patient with pertussis?
Lymphocytosis (60-80%)
Elevated WBC count (50,000)
PPD testing for TB:
Is + vs - based off of erythema or induration?
In what kinds of pts would >=5mm be considered a + test?
In what kinds of pts would >=10mm be considered a + test?
In what kinds of pts would >=15mm be considered a + test?
INDURATION
5: Immunosuppressed/HIV
10: High risk/prevalence populations
15: Everyone else
HERPES ZOSTER (aka _______) is the VZV reactivation along one _______ of the dormant virus in the spinal root & _____ _____ ganglia
± Disseminated in pts with _____
Shingles
dermatome
cranial nerve
HIV
