diseases and DDX Flashcards
(86 cards)
1
Q
Common vaginal infections - types and bugs
A
- Bacterial vaginosis (Gardnerella vaginalis)
- Thrichomoniasis (trichomonas vaginalis)
- Candida vulvovaginitis (Candida)
2
Q
Common vaginal infections - treatment
A
- Bacterial vaginosis –> metronidazole/clinddamycin
- Thrichomoniasis –> metronidazole (also treat sexual partner)
- Candida vulvovaginitis –> -azoles
3
Q
Common vaginal infections - labs
A
- Bacterial vaginosis –> clue cells, ph>4.5, amine whiff test (mixing discharge with 10% KOH enhance, fishy odor
- Thrichomoniasis –> motile trichomonas, ph>4.5
- Candida vulvovaginitis –> pseudohyphae, ph normal (4-4.5)
4
Q
Common vaginal infections - signs and symptoms
A
- Bacterial vaginosis –> no inflammation, thin white discharge with fishy odor
- Thrichomoniasis –> inflammation (strawberry cervix), frothy, grey geen, foul smeeling discharge
- Candida vulvovaginitis –> inflammation, thick white cottage cheese discharge
5
Q
Rashes in childhood - bugs and disease
A
- Coxsackievirus type A –> Hand-foot-mounth disease
- HHV-6 (Less commonly HHV-7)–> Roseola (exannthem subitum or 6th disease)
- Measles virus –> Measles (rubeola)
- B19 –> Erythema infectiosum (Slapped cheek, 5th disease)
- Rubella virus –> Rubella (German measles)
- S. pyogenes –> Scarlet fever
- VZV –> chickenpox
6
Q
Congenital infections - bugs
A
ToRCHeS infections: (+ other)
- Toxoplasma gondi
- Rubella
- CMV
- HIV
- HSV-2
- Syphilis
- S. agalactiae 8. E.coli 9. Listeria, 10. B19
7
Q
Toxoplasma gondi - neonatal manifestation
A
classic triad: 1. chorioretinitis 2. hydrocephalus 3. intracranial calcifications
+/- blueberry muffin rash
8
Q
Rubella - neonatal manifestation
A
classic triad: 1. PDA (or pulmonary artery stenosis, or septal defects)
2. Hearing loss 3. Deafness
+/- blueberry muffin rash
9
Q
CMV - neonatal manifestation
A
- hearing loss
- seizures
- petechial rash
- blueberry muffin rash
- periventricular calcifications
10
Q
HSV -2 neonatal manifestation
A
- encephalitis
2. herpetic (vesicular) lesions
11
Q
Congenital infections - definition / transmission
A
microbes that may pass from mother to fetus:
1. transplacental (MC) 2. delivery
12
Q
Non-specific signs of congenital infection
A
- hepatosplenomegaly
- jaundice
- thrombocytopenia
- growth retardation
13
Q
Scarlet fever is caused by? clinical presentation
A
Streptococcus pyogenes
Erythematus sandpaper-like rash with fever and sore throat
14
Q
Serratia marcescens - special features (2)
A
- red pigment (some stains)
2. often nosocomial and drug resistance
15
Q
Pseudomonas aeruginosa - - special features (2)
A
- Bleu-green pigment and fruity odor
2. often nosocomial and drug resistance
16
Q
Chlamydia trachomatis serotypes D-K causes
A
- Urethritis/PID
- ectopic pregnancy
- neonatal pneumonia (staccato cough) with eosinophilia
- neonatal conjunctivitis
17
Q
common skin infections - types
A
- erysipelas
- cellulitis (nonpurulent)
cellulitis (purulent)
18
Q
erysipelas - organisms and manifestation
A
- S. pyogenes
- superficial dermis + lymphatics
- raised, sharply demarcated edges
- rapid spread + onset
- fever early in course
19
Q
nonpurulent cellulitis - organisms and manifestation
A
S. pyogenes + MSSA - deep dermis + subcutaneous fat - flat edges with poor demarcation - indolent (over days) localized (fever later in course)
20
Q
purulent cellulitis - organism and manifestation
A
- MMSA + MRSA
- Purulent drainage
- folliculitis: infected hair follicle
- Furuncles: Folliculitis –> dermis –> abcess
- Carbuncle: muutluple furuncles
21
Q
infectious genital ulcers - DDX
A
painful: HSV. Haemophilus ducrei (chancroid)
painless: Clamydia trachomatis (L1-L3) (lymphogranuloma venereum), syphilis
22
Q
infectious genital ulcer - HSV
A
- painful
- small vesicles or ulcers on erythematus base
- mild lymphadenopathy
23
Q
infectious genital ulcer - Haemophilus ducreyi (chancroid)
A
- painful
- large, deep ulcer with gray, yellow exudate
- WELL-demarcated borders + soft, friable base
- sever lymphadenopathy that my suppurate
24
Q
infectious genital ulcer - lymphogranuloma venereum
A
- painless
- small shallow ulcers (often missed)
- can progress to painful, fluctant adenitis (buboes)
25
MC opportunistic infections in patients received solid organ transplant
CMV and PCP
| For sure TMP-SXM in the beginning for 1/2-1 year, maybe ganciclovir as well
26
most reliable sign for spinal osteomyelitis
tenderness to gentle percussion over the spinous process of the involved vertebra
- FEVER AND LEYKOCYTOSIS ARE UNRELIABLE
27
osteomyelitis - fever
less than 50%
- ESR slightly elevated
- normal leukocytes
28
solid organ transplant with systemic illness (pneumonitis, hepatitis, GI) - test for
CMV viremia
29
C. difficile - diagnosis and treatment
diagnosis: stool PCR or enzyme immunoassay --> if (-) --> consider colonoscopy and biopsy)
treatment: oral metronidazole or vancomycin
30
C. difficile - diagnosis and treatment
diagnosis: stool PCR or enzyme immunoassay --> if (-) --> consider colonoscopy + biopsy
treatment: oral metronidazole or vancomycin
31
meningococcal vaccination - when
- primary vaccination preferebly at age 11-12
- booster at age 16-21
- if high risk (complement def, asplenia, collage, military, travel to endemic, outbreaks): vaccinate even after 18
32
anti-TNF - vaccination
avoid live-attenuated
33
contraindications for yellow fever vaccination
1. allergy to vaccine components (eg. eggs)
2. AIDS (CD less than 200), certain immunodef,
3. immunosuppressive therapy (anti-TNF, high dose cortisol)
34
another symptom of meningococcal meningitis
severe myalgias
35
meningogcoccal mening - treatment
3rd gener + vancomycin
- steroids not helpful
chrmoprophylaxis: rifampin, cipro, ceftriaxone to all resp contacts
36
N. gonor - screening
men are alwasy symptomatic
women can be asymptomatic: indications: sexually active before 25, no condoms, history of multiple partners or other STD, pregnancy
37
Evaluation of suspected ventilator-associated pneumonia
abnormal X-ray --> Lower resp tract endotracheal tube samle (culture, microscopy) --> Empiric antibiotics:
- (-) cultures: stop antibiotics and evaluate other causes
- (+) with clinical improvement: narrow antibiotics according to culture
- (+) cultures without clinical improvement --> consider changing antibiotcs, assess for VAP complications (abcess, empyema), consider other causes --> CT
38
ventilator-associated pneumonia - what to cover empirically
- Gram (+)
- pseudomonal and gram (-)
- MRSA
39
ventilator-associated pneumonia - onset
48 or more hours after incubation
40
Recommenced vaccines for adults - influenza
annually
41
Recommended vaccines in adults - Tdap?
Tdap once as substitute for Td booster (as adult), then Td every 10 years
42
PCV - recommended vaccines for adults
- if 65 or older: 1 dose of PCV13 followed by PPSV23 at 6-12 months later
- 19-64: PPSV23 alone in heart or liver disease, DM, smoker, alcoholic
OR both (LIKE OLDER THAN 65) in very high risk: CSF leak, cochlear implants, SCD, aspenia, immne, kidney disease, HIV
43
chronic liver disease - vaccination
1. Tdap/Td
2. infl: annually
3. HAV: 2 doses with 6 months apart with initial (-) serologies)
4. HBV: 3 doses at 0 months. 1 month + 4 months
5. PPSV23 alone, followed by sequential PCV13 + PPSV 23 at age 65
44
Liver disease - pneumococcal vaccination
PPSV23 alone, followed by sequential PCV13 + PPSV 23 at age 65
45
Hospital acquired pneumonia treatment
vancomycin + tazosin
46
urethritis in men - etiology
1. N. gonor (MC)
2. Chlamydia trachomatis
3. Mycoplasma genitalum
4. Trichomonas (rare)
47
urethritis in men - diagnosis
- urinalysis
- gram stain + culture
- PCR
48
urethritis in men - treatment
- azythromycin or doxycycline
| - PLUS ceftriaxone if gonococcus suspected or not ruled out
49
indication for CT scan in acute pyelonephritis
1. not improvement despite 49-72 hours of therapy
2. history of nephrolythiasis
3. complicated
4. unusual urinary findings (eg. gross hematuria, suspicion for urinary obstruction)
50
clinical features of toxic shock syndrome
1. fever higher than 38.9
2. hyptotension
3. Diffuse macular erythroderma
4. skin desquamation (including palms and soles (1-2 weeks after illness onset)
5. multisystem involvement (3 or more)
51
Ludwig angina?
rapidly progressive cellulitis (polymicrobial) of the submandibular + sublingual spaces --> the source of infection is most commonly an infected mandibular molar
- early intervention with IV antibiotics prevents airway compromise
- local compressive + systemic symptoms + crepitus
- CT to confirm and rule out abscess
52
medications that can cause pill esophagitis
1. potassium chloride
2. tetracyclines
3. biphosphonates
4. NSAID
53
MRSA pneumonia - people?
superinfection in young people with inf infection
- rapidly progressive necrotizing pneumonia, often fatal
- malitlobular cavitary infiltrates
- often causes leukopenia
54
clindamycin - covers
```
anaerobic and gram (+)
NOT GRAM (-)
```
55
anaerobic coverage in lungs
- metronidazole + amoxicillin
- clindamycin
- augmentin
- carbapenem
56
TMP - SXM - oral or IV
both
57
TMP-SXM SE
rash neutropenia, hyperkalemia, elevated transaminases
58
initial management for neutropenic fever
monotherapy with antipseudomonal: cefepime, tazosin, meropenem
59
another symptom of mycoplasma infection
macular/vesicular rash / nonexudative pharyngitis
60
test to diagnose dengue fever
turniquet test
61
Tetanus prophylaxis - clean or minor wound
1. if received 3 or more tetanus toxoid doses: tetanuus toxoid-containing vaccine only if last dose more than 10 years ago, NO TIG
2. unimmunized or less than 3 doses: tetanus toxoid vaccine only, NO TIG
62
Tetanus prophylaxis in dirty or sever wound
1. if received 3 or more tetanus toxoid doses: vaccine only if last dose 5 or more years before, NO TIG
2. unimmunized or less than 3 doses: vaccine PLUS TIG
63
Evaluation of vertebral osteomyelitis
fever, back pain, focal spinal tenderness --> blood cultures, ESR, CRP, plain spinal x-rays --> if high ESR/CRP but normal x-ray --> MRI --> CT guided needle aspiration/biopsy
64
infection in diabetic foot - mechanism and type of microorganism
polymicrobial with gram (-), gram (+), and anaerobic
osteomyelitis due to continuous extension
(superficial can be monomicrobial, but deeper infections are always polymicrobial
65
foot infectons in diabetics foot start with localized skin erythema, warmth, tenderness and edema - suspect deeper infection when
1. long standing wounds (more than 1-2 weeks)
2. systemic symptoms
3. large ulcers (more than 2 cm)
4. elevated ESR
5. presence of bone in the ulcer base
66
patients with puncture wound and osteomyelitis - organism
pseudomonas
67
splenic abscess - manifestation / RF / treatment / causes
triad: 1. fever 2. LUQ pain 3. leukocytosis
- Left pleural effusion, possible splenomegaly
- RF: invective endocarditis, hemoglobinopathies, immunosuppression, IV drugs, trauma
- CT scan
- treatment: antibiotics + splenectomy (if not candidate: percuteneous: drainage)
causes: STREP, STAPH, SALMONELLA
68
upper resp illnesses - types
1. viral upper resp syndrome
2. influenza
3. Strep pharyng
69
upper resp illnesses - onset of symptoms
1. viral upper resp syndrome: slow stepwise, migrator or evolving
2. influenza: abrupt
3. Strep pharyng: variable
70
upper resp illnesses - upper resp symptoms
1. viral upper resp syndrome: rhinorrhea, coryza, sneezing, mild pharyngitis
2. influenza: usually mild
3. Strep pharyng: predominantly pharyngeal symptoms
71
upper resp illnesses - systemic symptoms
1. viral upper resp syndrome: usually mild
2. influenza: prominent with possible high fever, myalgias, headache
3. Strep pharyng: variable with possible fever and myalgias
72
upper resp illnesses - examination signs
1. viral upper resp syndrome: nasal edema with normal or slightly erythematous pharynx
2. influenza: variable but often unremarkable
3. Strep pharyng: pharyngeal erythema, tonsillar hypertrophym exudates, tender cervica; lymphnodes
73
human bite - treatment
polymicrobial (aerobic and anaerobic) --> augmentin
+ Tetanus vaccination
- maybe surgical debridement and left open
74
major pathologic mechanism of foodborne illness (and organisms)
1. enterotoxin ingested: S/ aureus, Bacillus cereus) --> Usually vomiting
2. Entertoxin made in intestine: Clost perringens, ETEC, STEC, V. cholera --> watery/bloody diarrhea
3. Bacterial epithelial invasion: C.jujuni, Nontyphoidal salmonella, Listeria --> watery/bloody diarrhea
75
an effective measure to reduce the risk for catheter associated UTI
clean intermittent cathetirzation (periodic insertio and removal every 4-6 hours)
76
superinfection to inf - orgnanisms and empiric treatment
S. aureus (rapid onset, necrotizing pneumornia)
S. pneum
- multibroad empiric antibiotics (vanco, Tazosin, levofloxacin)
77
MCC of bloody diarrhea in the absent of fever
E. coli
78
MCCs of bloody diarrhea
1. E. coli
2. campylobacter
3. shigella
79
bacterial mengitis empiric therapy in older than 50 ... (common organisms)
S. pneum, N. menig, Listeria
| vancom + 3rd gener ceph + Ampicillin
80
bacterial mengitis empiric therapy in immonocompromised ... (common organisms)
S. pneum, N. menig, Listeria, gram (-) robs
vancom + Ampicillin + cefepime
alternative to cefepime: meropenem or ceftazidime
81
bacterial mengitis empiric therapy in neurosurgery/penetrating skull trauma ... (common organisms)
Gram (-) robs, MRSA, coagulase (-) staph
| Vancom + cefepime
82
alternative to ampicillin in bacterial meningitis
TMP-SXM
83
3rd generation cephalosporins for bacterial meningitis
ceftriaxone or cefotaxime
84
routine blood and pustule cultures in disseminated gonoccocal infection
could be negative (65%) --> do PCR
85
(+) test for N. gonor - next steps beside treatment
screen for other STD (including chlamydia, HIV, syphilis, HBV)
86
disseminated gonococcal infection - treatment
IV ceftriaxone, switch to oral (cefixime) when clinically improved)
- empiric azithromyzn or doxyxycline for concomitant chlamydial infection
- joint drainage for purulent arthritis
