all the stuff Flashcards
1
Q
what is the standard for fever of unknown origin?
A
fever >38.3 (100.9),
3 days,
three outpatient visits,
3 week illness
2
Q
what are the categories for FUO?
A
nosocomial,
neutropenic,
HIV,
Organ transplant
3
Q
how do you define a nosocomial FUO?
A
> 38.3 (100.9)
3 days,
not at admission
initial culture neg
4
Q
how do you define neutropenic FUO?
A
fever
neutrophil less than 400/microliter
unknown diagnoses after 3 days
inpatient/outpatient
5
Q
how do you define HIV FUO?
A
fever 4 weeks duration outpatient, 3 days as an inpatient w/ 2 days of culture
6
Q
what is an iatrogenic disease?
A
we did it, caused by medical treatment
7
Q
what does equivocal diagnosis mean?
A
vague or ambiguous “best guess”, or working diagnosis
8
Q
what is active immunity?
A
gained through exposure to an antigen
9
Q
what is passive immunity
A
immunization using pre-formed antibody from another individual
10
Q
what is partial immunity?
A
just a decreased immunity overtime
11
Q
wht is non-sterile immunity
A
trace disease is left over, but not active
12
Q
concomitant infection
A
2 infections at the same time, thnk staphy pneumonia and influenza, chlamydia and gonorrhea
13
Q
what is sensitivity?
A
the portion of true positive it detects of all positives
14
Q
what is specificity?
A
proportion of true negatives it detects of all the negatives. Measure of how accurately it identifies negatives
15
Q
what does left shift mean?
A
increased number of immature neutrophils (band forms). suggests acture inflammation
16
Q
what does an O & P not test for?
A
cryptosporidium, done w/ 3 stools each >24 hrs apart
17
Q
obligate intracellular parasites?
A
virus
18
Q
may be free living, obligate intracellular parasites, or obligate pathogens living outside of cells. They are prokaryotic w/ DNA. May or may not have a barbohydrate capsule, fimbriae, pili, or flagella. Reporduce using binary fission so 2 parent cells and 4 offspring.
A
bacteria
19
Q
eukaryotic organism w/ lipid bilayer plasma membrane, DNA that makes RNA that makes proteins. They are unicellular, multicellular, or both. Usually are opportunistic, and can live freely in the environment (most of the time), but the ones that are on humans are extracellular. Reproduce sexually, or asexually.
A
fungi (yeast, filamentous, dimorphic)
20
Q
unicellular eukaryotic organisms, sever life cycle stages, sexual or asexual reproduction, can live freely or be obligate.
A
protozoan parasites
21
Q
macroscopic, multicellular w/ organs and sexual reproduction, live in humans and can live in intestines
A
helminth (worm) parasites
22
Q
what would you see on CXR for anthrax?
A
widened mediastinum
23
Q
what is the PEP for anthrax length and DOC?
A
60 days ciprofloxacin 500 mg PO BID, w/ vaccination AVA biothrax
24
Q
what is the treatment for anthrax from an uncomplicated cutaneous disease, where the source is naturally occuring?
A
7-10 day course
25
what is the alternative medication for anthrax?
obiltoxaximab
26
what do you get from the hides of animals (cattle, sheep, goats, camels), ingestion of contaminated meat, or the inhalation of spores?
anthrax
27
where is one of the most common places on earth for plague?
madagascar
28
where is plague in the US and what animals is it associated w/?
south west, NM, AZ, CO. Cats and rats w/ fleas
29
what plague are fleas associated w/?
bubonic
30
what does the bubonic plague appear w/?
high fever, malaise, tender lymphnodes (buboes)
31
what do the labs for plague show?
DIC, inc. LFT, inc. WBC w/ L shift
32
what does microscope show for labs for plague?
gram negative coccobacillus, safety pin bipolar staining
33
what is the treatment for plague?
gentamicin or streptomicin
34
what is the PEP for plague?
doxycycline or septa
35
describe the small pox rash
starts on face, oropharynx, then moves trunk, arms, legs. Begins as a maculopapular rash, then 1-2 days later becomes ulceration or vesicles, then becomes pustules or pocks, then becomes a scab.
36
describe hemorrhagic small pox
dusty erythema, then petechiae, then hemorrhage
37
who is at risk of developing cowpox?
people w/ imported rodents as pets, horses, feral cats and dairy cows
38
how do you send in a suspected case of small pox?
send in a sealed vacutainer, then put vacutainer in second waterproof container, then send samples to high containment lab (BL-4) to be analyzed under electron microscopy
39
what is the treatment for small pox?
cidofovir, symptomatic care.
40
how long is the small pox vaccine good for?
10-15 years
41
explain small pox post exposure prophylaxis
w/ in 3 days ideal w/in 24 hrs, and give vaccinia immune globulin .6 ml/kg IM
42
what is described as vesicular on erythematous base?
varicella
43
– Clustered vesicles on an erythematous base
– Develops crust (5-7 days)
– Constitutional symptoms
herpes
44
what is the treatment for herpes?
something that ends in vir, specifically valacyclovir
45
what are the medical treatments for HPV?
imiquimod
podofilox
trichloroacetic acid
46
how are the HPV vaccines dosed?
IM, 1st stat, 2nd 2 mos., 3rd 6 mos
47
gram negative intracellular, diplococcus
gonorrhea
48
what can a woman develop if her gonorrhea or chlamydia is not treated.
PID same symptoms but cervical motion tenderness and adnexal tenderness
49
joint pain following gonnorhea
disseminated gonoccal infection, other weird arthritis stuff too
50
what is the diagnostic standard for detection of gonorrhea?
isolation through culture
51
who is most likely to have gonoccal strains w/ antimicrobial resistance?
MSM
52
what is the treatment for gonorrhea?
ceftriaxone (rocephin) 250 mg IM and azithromycin 1 gm PO for chlamydia
53
what is the alternate therapy for gonorrhea?
azithromycin 2 g PO
54
what is the treatment for treatment failure for gonorrhea?
ceftriaxone 500mg and azithromycin 2 gm, plus test of cure in one week
55
what is the most frequently reported infectious disease in the US?
chlamydia
56
what STD may be asymptomatic?
chlamydia
57
what is the treatment for chlamydia?
azithromycin 1 gm
58
what is the alternate treatment for chlamydia?
doxycycline 100 mg po q12 hrs x 7 days
59
where is lymphogranuloma venereum located?
india, africa, central america, southeast asia
60
what causes lymphogranuloma venereum?
c. trachomatis
61
what is a non painful herpetiform lesion associated w/?
lymphogranuloma venereum
62
what is the first stage of lymphogranuloma venereum associated w/?
a painless herpetiform ulcer that clears by itself
63
what is the second stage of lymphogranuloma venereum associated w/?
2-6 weeks after lesion, painful lymph buboes w/ groove sign
64
what is the third stage of lymphogranuloma venereum associated w/?
proctocolitis, weight loss, fever rectal pain, weight loss, perirectal fistulas, abcesses, strictures
65
what is the treatment for lymphogranuloma venereum?
needle aspirate and doxy for 2 weeks
66
what is the MC nongonoccal urethritis?
chlamydia
67
what does urethritis present w/?
urethral discharge, dyuria, orchalgia, foreign body sensation
68
what is the treatment for non-gonoccal urethritis?
azithromycin or doxy
69
what is the treatment for gonoccal urethriitis?
ceftriaxone and azithromycin
70
what are the signs and symptoms of primary syphilis?
painless sore and NONtender lymphadenopathy
71
what are the signs and symptoms of secondary syphilis?
2-10 weeks after primary lesion rash on palms and sole, could get warts too. remember great imitator, myalgias as well, and maybe constitutional signs
72
what is MC affected by cardiovascular syphilis?
ascending aorta
73
what is cutaneous gummas?
rubbery granulomas found on liver, skeleton and testes they are associated w/ tertiary
74
what are non treponemal tests and when are they most effective?
rapid plasma reagin, RPR, veneral disease research lab RPR secondary syphilis
75
how do you track efficacy of care for syphilis?
VDRL titers
76
what is the DOC for treating syphilis?
benzathine penicillin G
77
what can happen after treatment of syphilis?
jarisch-herxheimer reaction, just fever and chills from rapid death of spirochetes
78
what does bacterial vaginosis present with?
strong fish like odor, especially after intercourse,
white or gray thin discharge,
pH greater than 4.5,
clue cells
79
what are the is the treatment for bacterial vaginosis?
metronidazole, tinidazole, clindamycin
80
what causes chancroid?
haemophilus ducreyi
81
how does chancroid present?
small red papules that suppurate into ulcers w/ deep undermined edges and irregular borders. VERY PAINFUL, can have bubo
82
what will a gram stain show and what is the definitive test to diagnose for haemophilus ducreyi?
school of fish, culture is definitive diagnosis
83
what is the treatment for haemophilus influenza?
ceftriaxone, azithromycin
84
how will granuloma inguinale present?
PAINLESS small beefy red pump that is elevated and velvety nodule. It will spread can eat the tissue through inguinal folds. it bleeds easily and will cause depigmentation
85
what will you see on a punch biopsy for granuloma inguinale?
donovan bodies (donovanosis)
86
what is the DOC and length for treatment of granuloma inguinale?
azithromycin for 3 weeks
87
what do you give if the granuloma inguinale (donovanosis) is not clearing?
aminoglycoside
88
how can you tell how long a pediculosis capitis infection has been going on?
the distance away from the scalp
89
what is a test of pediculosis?
fluoresce under wood's lamp
90
what is the treatment for lice?
permethrin wash off after 10 min,
malathion 8-12 hrs then wash off,
ivermectin lotion 10 min for >6 mos for resistance
repeat 7-10 days later
91
what is a key symptom in scabies?
nocturnal pruritis
92
what is pathognomnic for scabies?
short elevated serpiginous (s shaped) tack
93
what is the treatment for scabies?
permethrin cream wash after 8-14 hrs,
| ivermectin PO
94
what disease can bed bugs spread?
hepatitis B
95
what do you have to be worried about with bed bugs?
anaphlactic reaction
96
what are some signs of bed bugs?
pungent odor, papules/wheals/bullae, and hemorrhagic puncta
97
what is an aversion to smoking associated w/?
viral hepatitis
98
in advanced viral hepatitis what might you see?
dark urine- coca cola
jaundice
tender hepatomegaly
99
what strands of hepatits become chronic?
B and C
100
what are some physical signs of hepatitis?
icterus, jauindice, tender liver, signs of dehydration (tachycardia, dry mucous membranes, loss of skin turgor)
101
what types of hepatitis are spread fecal to oral?
A and E
102
what hepatitis is assoicated w/ day care centers and residential institutions?
hepatitis A
103
what type of hepatitis is associated w/ raw shellfish and infected food handlers?
hep A and E
104
how do you you diagnose acute hep a?
igM anti HAV from 5-10 days before to 6 months after
105
what are the two Hepatitis A vaccines?
havrix and vaqta
twinRIX
106
how are hep a vaccines dosed?
0, 6-12 mos >12 mos
twin rx 3 dose (0,1,6 mo) >18
107
what would you give for immediate protection against hepatitis A?
immune serum globulin
108
what group of people need to be worried about Hepatitis E?
pregnant females
109
what is the treatment for E?
just avoidance, IG does not protect
110
what age group normally develops chronic hep b infectin?
younger
111
what is the first serum marker for heptatis b?
HBsAg
112
what is an indicator of immunity/immunization/ that shows up 4-6 months after infection in hep B?
anti-HBs
113
what are indicateors of chronic hep B?
continued HBsAg and/ or anti-HBc
114
what is the treatment for chronic hepatitis B?
something that ends in VIR
115
what is prevention for hep B?
Hep B IG w/in 7 days of exposure and immunization
116
what is hep C usually coinfected w/?
HIV
117
what transmission is Hep C associated w/?
intravenous drug use
118
what populations have hep c?
veterans, prisoners
119
hep C leads to cirrohsis, what will speed that up?
increased alcohol intake, age >40, HiV coinfection, male, chronic HBV coinfec
120
what is the leading cause for liver transplants in the US?
chronic hep C
121
how do you test for hep C?
EIA for anti-hcv, confirmed w/ RT-pcr for RNA, repeat if negative
122
how do you stage a hep c patient?
assessment of liver, LFTs, and biopsy
123
what is the treatment for chronic hep C?
pegylated interferon + ribavirin
or -vir
124
what is something to consider when treating hep C?
the harsh side effects of interferon
125
what is important to note about hep D?
it is a coinfection w/ hep B
126
how quickly can you detect antibodies in the blood in HIV?
3-6 weeks post exposure and 3 months post exposure
127
what is the screeing test for HIV?
elisa
128
what is the confirmatory test for HiV?
western blot
129
cd4 count is an indicator of what?
disease progression
130
viral load indicates what?
amount of actively replicating virus
131
susceptibility to opportunistic infections begins when?
<200
132
who is category A?
never a CD4 below 500
133
who is category B?
t cells 500-200/ category defining disease (candidiasis, hairy leukoplakia, herpes, PID) and NEVER a category C disease
134
who is category C?
less than 200 or aids defining illness
candidiasis-esophageal
135
what are the aids defining illnesses?
candidiasis, esophagus, trachea, bronchi, lungs
cryptococcus, extrapulmonary
cryptosporidosis diarrhea >1 month
cytomegalovirus
HSV ulcers >1 month
kaposis <60
lymphoma brain
mycobacterium avium or kansasii
pneumocystis jiroveci
toxoplasmosis
136
what is associated w/ 50 or fewer CD4?
cryptosporidosis, toxoplasmosis
137
what is associated w/ cd4 100 or fewer?
aspergillosis, AIDS dementia, cytomegalovirus
138
what is associated w/ cd4 200 or fewer?
candidiasis, kaposi's sarcoma, p. joroveci penumonia
139
what is the initial workup for HIV
CD4/viral loadPPD, CMV/toxo, std, ophthalmologic, hep panel
140
what is not considered infectious for HIV unless visibly bloody?
feces, nasal secretions, saliva, sputum, sweat, tears, urine, vomitus
141
what are the civilian PEP meds for HIV and how long?
tenofovir + emtricitabine (truvada) & raltegravir for 28 days w/in 72 hrs
142
what are the military meds for PEP for HIV?
combivir, truvada, zarit + kaletra, evotraz for 28 days w/in 72 hrs.
143
what time periods is somebody tested w/ EIA for seroconversion after exposure?
baseline, 6 weeks, 12 weeks, 6 months then to 12 months if develops Hep C
144
what is the PrEP for HIV?
truvada (emtricabine + tenofovir)
145
how long does it take for HIV PrEP to become effective?
3 weeks
146
what do you have to do before giving PrEP HIV prophylaxis?
Neg HIV test, comprehensive STD screening, CrCl levels prior to initiation
147
what influenza is most associated w/ school and military camps?
influenza B
148
what flu is most associated w/ antigenic drift?
inflenza A
149
what populatino has the highest attack rate for influenza?
children
150
what population has the highest risk of complication for influenza?
elderly
151
ifluenza presents w/ what?
```
viral prodrome
high fever >104 4-5 days
chills
myalgia first 3 days
severe HA first 2 days
```
152
what can you consider if a person has influenza less than 48 hrs?
antiviral -mivir A-H1N1
neuraminidase inhibitors influenza A or b
153
what age groups can get flumist?
2-49
154
who should get the flu vaccine
.65, nursing home resident, chronic disease, long term aspirin <18 y/o, health care workers,
155
who shoulnt get the flu vaccine?
anaphylaxis to eggs, reaction to thimerosal contact solution, acute febrile illness, guillain barre
156
what complications are associated w/ flu?
pneumonia
157
what is the MC transplant pneumonia?
HSV
158
what does HSV look like on x-ray?
small nodule on periphery
159
what does cmV look like on X-ray
lower lobes
160
what does RSV look like on x-ray
bilateral interstitial or patchy infiltrates
161
what does varicella look like on x-ray
diffuse, fluffy, reticular, or nodular infiltrates
162
what can you get from exposure to rodent/rodent feces specifically from a deer mice?
hanta virus
163
what does not hantavirus look like on x-rays?
basilar or perihilar pattern
164
what does hantavirus present w/?
from NM/CO, myslagia particularly in back and legs, tachypnea, fever tachycardia, abdominal tenderness, increased HCT, acidosis, myalgia
165
what is the treatment for hantavirus?
ribavirin
166
what is the MC common cause of community acquired pneumonia?
strep pneumoniae
167
who is more susceptible to stroptococcus/pneumococcal pneumonia?
asplenic patients
168
how may strep pneumo present?
after viral upper respiratory, acute, productive cough (rather than dry like viral), high fever, pleuritic chest pain
169
what does strep pneumo look like on x-ray
alveolar pattern and the radiograph stays worse longer than the patient
170
what labs will be changed for strep pneumo?
left shift and elevated ESR and CRP
171
what is the treatment for strep pneumo?
- cillin or
- floxacin
until afebrile or a min of 5 days
172
who should get the pneumococcal vaccine?
>= 65, high risk, before splenectomy, immunocrompromised
173
what is the MC cause of CAP in health people 5-35
mycoplasma pneumoniae
174
how will mycoplasma penumoniae present on x-ray?
fluffy infiltrates
175
what is associated w/ mycoplasma pneumoniae?
bullous myringitis (fluid fill blisters on the ear drum)
176
what can you consider treating mycoplasma pneumonia w/?
doxy or azithromycin
177
who will get chlamydophila psittaci (psitacosis)?
people that work with psittacine birds like poultry workers and pet stores. Its from inhalation of dried bird droppings
178
what will chlamydiophila psittaci present w/?
horder's spots, splenomegaly, hemturia, exertional dypsnea, cough, and fever
179
what do you use to treat chlamydophila psittaci?
doxy, erythromycin
180
where are some places that you will find legionella?
cruise ship, showers, cooling systems
181
what sign does legionella have that's different?
a higher incidence of confusion
182
what test can you do for legionella?
legionella urine antigen testing
183
what is the treatment for legionionella?
azithromycin or levofloxacin
184
what is likely the cause of a newborn with fever, tachypnea, ciculatory collapse, cough, and respiratory distress that had a preceding viral illness?
staphylococcus aureus
185
if an adult gets influenze what are you worry about them potentially developing?
s. aureus
186
what is the treatment for staph A?
vanc, nafcillin, drain effusion, chest tube
187
what is treatment for kelbsiella?
imipenem
188
what is associated w/ klebsiella?
upper lobe caviation, alcoholics, and currant jelly sputum
189
what causes bronchitis in a healthy person?
influenza A/B, adenovirus, RSV, rhinovirus
190
why are smokers more likely to have bronchitis?
their ciliary action is paralyzed
191
what do you treat bronchitis w/ in smokers
amoxicillin
192
what is asociated w/ pertussis besides the whoop?
post-tussive gagging and/or vomiting. and apneic spells in infants, cough greater than 14 days in adults, FRENIC ULCER
193
what might be coinfecting w/ pertussis?
pneumonia
194
what do you treat bordettla w/?
azithromycin
195
what causes severe acute respiratory syndrome?
coronavirus
