Exam 2 Flashcards
(397 cards)
1
Q
Name the most common bacterial STI in the US
A
Chlamydia
2
Q
Name two common antibiotics used to treat atypical bacteria like chlamydia and mycoplasma
A
- Azithromycin
- Doxycycline
3
Q
Which bacteria causes nongonococcal urethritis?
A
Chlamydia trachomatis
4
Q
Name the most common chlamydial infection in men
A
Nongonococcal urethritis
5
Q
Most common symptoms of nongonococcal urethritis
A
- Dysuria
- Subtle urethral discharge (maybe only with milking)
6
Q
Diagnostic test for nongonococcal urethritis
A
NAAT
- urine is test of choice for men
- vaginal swab for females (not urine, since STI)
Patient are recommended to be tested for gonorrhea and HIV too
7
Q
Treatment for nongonococcal urethritis
A
Doxycycline or azithromycin
- treat partners too
- add ceftriaxone for gonorrhea if present
8
Q
Which organism is the most common cause of epidiymitis?
A
Chlamydia trachomatis
9
Q
Symptoms of epididymitis
A
- Fever
- Unilateral scrotal pain
- Palpable swelling of epididymis
10
Q
The Prehn sign is performed on physical exam to confirm this condition
A
Epididymitis
11
Q
Diagnostic test for epididymitis
A
NAAT (urine)
12
Q
Treatment for epididymitis
A
Ceftriaxone and doxycycline
13
Q
Women with this condition are most often (85%) asymptomatic, but may have yellow/green cervical discharge or intermenstrual/postcoital bleeding.
Physical exam is often normal (80-90%), but you may see a friable endocervix.
A
Mucopurulent cervicitis
14
Q
Diagnostic test for mucopurulent cervicitis
A
Vaginal/cervical swab
15
Q
Treatment for mucopurulent cervicitis
A
Doxycycline or azithromycin
16
Q
Where is the most common location for chlamydia infection in women?
A
Cervix
17
Q
Which organism causes mucopurulent cervicits?
A
Chlamydia trachomatis
18
Q
Which organism causes acute proctitis?
A
Chlamydia trachomatis
19
Q
This condition is associated with anal intercourse in men
A
Acute proctitis
20
Q
Acute proctitis symptoms
A
- Rectal pain
- Rectal discharge
- Rectal bleeding
- Tenesmus
(usually asymptomatic in women)
21
Q
Diagnostic testing for acute proctitis
A
Anoscopy and NAAT
22
Q
Treatment for acute proctitis
A
Doxycycline and ceftriaxone
23
Q
Which organism causes lymphogranuloma venereum?
A
Chlamydia trachomatis serovar
24
Q
Where in the world is lymphogranuloma venereum most common?
A
Tropical regions
25
Diagnostic testing for lymphogranuloma venereum
NAAT (urine or urethral swab)
25
Symptoms of lymphogranuloma venereum
- *Painless* genital ulcer that heals in a *few days*
- Followed by suppurative regional lymphadenopathy 6 weeks later
- Rectal pain/bloody-purulent discharge
- Fever and malaise
26
Treatment for lymphogranuloma venereum
Doxycycline
27
Perinatal infections of a child born to a mother with chlamydia usually present as ...
Either *conjunctivitis* or *pneumonia*
28
In a child born to a mother with chlamydia who develops a perinatal infection, would you expect to see them develop conjunctivitis or pneumonia first?
- Conjunctivitis first
- Pneumonia later (4-8 weeks)
29
Diagnostic testing for perinatal infections caused by chalmydia
- NAAT or culture
- Screen (and treat) all pregnant women <25)
30
Treatment for perinatal infections due to chlamydia
- Oral azithromycin
- *not* doxycycline since age <9
(topicals medication often ineffective)
31
What is trachoma?
Chronic conjunctivitis caused by recurrent infection with certain chlamydia trachomatis *serovars*
32
What is the leading infectious cause of blindness worldwide?
Trachoma
33
How is trachoma transmitted?
Via ocular/nasal secretions (hands, fomites)
34
This conditions caused by chlamydia trachomatis *serovars* is known as a cicatricial disease
Trachoma
(cicatricial = scarring)
35
Average age of patients with active trachoma infections
Under 10 years old
36
Diagnostic testing for trachoma
NAAT (if available)
37
Treatment for trachoma
Topical tetracycline
(ok in kids since topical)
38
This infection caused by Neisseria is associated with spread in college dorms
Neisseria meningitidis
39
What are the number one *and* two causes of bacterial meningitis in the general population
1. Strep pneumoniae
2. Neisseria meningitidis
(Neisseria is most common cause in children and young adults)
40
How is Neisseria meningitidis transmitted?
- Prolonged intimate contact
- Respiratory/oral secretions
41
What condition is associated with the classic triad of:
1. Fever
2. Stiff neck
3. Altered mentation
Meningitis
- 58% if caused by Strep pneumoniae
- 27% if caused by Neisseria meningitidis
42
Symptoms for Neisseria meningitidis
- Fever
- Headache
- Nausea/vomiting
- Decreased concentration
- Myalgias
Seen in a *previously healthy patient*
43
A college student comes to the dormitory nurses station complaining of flu-like symptoms with body aches and stated "this is the sickest I've ever felt".
What is a must not miss diagnosis?
Neisseria meningitidis
44
What condition is associated with physical exam findings of petechiae near belts/elastic straps?
Neisseria meningitidis
(1/2 of patients will have petechiae somewhere)
45
Diagnostic testing for Neisseria meningitidis
Culture blood and CSF (lumbar puncture)
46
Treatment for Neisseria meningitidis
Ceftriaxone
(treat on suspicion, don't wait for confirmation)
47
This gram negative diplococci most often causes urethral discharge in men and endocervical infection in women and can cause arthritis-dermatitis syndrome when disseminated (spread through the body)
Neisseria gonorrhoeae
48
Complications of Neisseria gonorrhoeae
- Cervicitis
- Urethritis
- PID
- Proctitis
- Arthritis-dermatitis syndrome
49
Most common symptoms of Neisseria gonorrhoeae
Men
- Discharge most common
- Dysuria second
Women
- Endocervical infection primarily
- Discharge, vaginal pruritis, menorrhagia, dyspareunia
50
Diagnostic testing for Neisseria gonorrhoeae
NAAT
- urine or swab in men
- swab in women
51
Treatment for Neisseria gonorrhoeae
Ceftriaxone
(give doxycycline too if chlamydia hasn't been ruled out by NAAT)
52
Which atypical bacteria can cause pneumonia?
Mycoplasma
53
What is the most common cause of walking pneumonia?
Mycoplasma pneumoniae
54
Symptoms of mycoplasma pneumoniae
- 50% have: fever, nonproductive cough, dyspnea, sore throat, and headache
- 25% have: vomiting, erythema multiforme
55
Treatment for mycoplasma pneumoniae
Azithromycin or doxycycline
56
Diagnostic testing for mycoplasma pneumoniae
*Only treat if encephalitis/life-threatening illness!*
(CXR, sputum testing, cold agglutinins)
57
Risk factors for sinusitis
Anatomic
- block sinus drainage
- deviated septum etc
Environmental
- impair ciliary action
- smoking, cocaine, topical decongestants
58
75% of sinusitis cases are caused by these two pathogens
S. pneumoniae and H. influenzae
59
Is frontal and maxillary sinusitis more common in children or adults?
Adults
(frontal sinus doesn't develop until age 7)
60
Is ethmoid and maxillary sinusitis more common in children or adults?
Children
61
Symptoms of bacterial sinusitis typically begin this many days after initial mucosal inflammation
7-10 days after initial mucosal inflammation
(facial, tooth, eye pain, purulent discharge)
62
Physical exam signs of sinusitis
- Facial tenderness
- Opacity with transillumination (low sens and spec.)
63
Sinusitis is typically a clinical diagnosis.
However, chronic sinusitis mucosal thickening, sinus opacification, and air-fluid levels can be evaluated with these imaging methods
X-ray and/or CT
64
Treatments for sinusitis
- Sinus rinse followed by intranasal steroids
- Humidifier
- Intranasal saline
Antibiotics if moderate/severe infection or failed above treatments
- Amoxicillin/Augmentin
- Doxycycline or Bactrim if allergy
65
Otitis media is most commonly caused by these three pathogens
- H. influenzae
- M. catarrhalis
- S. pneumoniae
66
Otitis media is most common in this age group
Young children
67
Symptoms of otitis media
- Ear pain/rubbing, hearing loss
- Low-grade fever
In young children:
- nonspecific fussiness
- disturbed sleep
- poor feeding
- GI symptoms
68
Physical exam signs of otitis media
- Purulence
- Visibly dilated vessels on and around TM
- Impaired mobility with pneumatic otoscopy
69
On physical exam, how will otitis media with effusion look different from acute otitis media?
Acute otitis media
- bulging, red, inflamed
Otitis media with effusion
- bubbly, fluid level
- less red/inflamed/vascular
70
Treatment for acute otitis media
- Ibuprofen/acetaminophen
Don't *have* to give antibiotics, 81% recover without
Give antibiotics if very young/old/ill/immunocompromised
- Amoxicillin (Augmentin if b-lactam in last 30 days or history of recurrent AOM unresponsive to amoxicillin)
71
Otitis externa infections are often precipitated by ...
Moisture/trauma in external auditory canal
72
Risk factors for otitis externa
- Swimming
- Trauma (cotton buds)
- Occlusive devices
73
Symptoms of otitis externa
- Pruritus and pain in ear
- May have discharge
74
Physical exam signs of otitis externa
- Pain with movement of external ear/tragus
- Inflamed ear canal
- Drainage
75
Treatment for otitis externa
- Clean ear canal with hydrogen peroxide
Mild symptoms:
- acetic acid and hydrocortisone
Mod/severe symptoms:
- polymyxin B + neomycin
OR
- ciprofloxacin + hydrocortisone (ofloxacin = safest if can't see TM)
76
Which, bacterial or viral, is the more common kind of pharyngitis?
Viral much more common
77
Treatment for viral pharyngitis
- Analgesics (NSAIDs preferred)
- Warm tea with honey (only age 1+)
- Salt water gargles
78
Which condition is associated with the Centor criteria? And what are the four components of the Centor criteria?
Streptococcal pharyngitis
- Fever
- Absence of cough
- Cervical lymphadenopathy
- Tonsillar exudates
(FACT)
79
Diagnosis for streptococcal pharyngitis
- Rapid Ag test in office
- Follow up with throat culture for children (need to be sure, risk of complications)
80
Treatment for streptococcal pharyngitis
- Penicillin or amoxicillin
- Erythromycin or azithromycin if allergy
(change toothbrush!)
81
Describe Quinsy
Peritonsillar abscess
- Collection of pus between capsule of tonsil and pharyngeal mm. (membrane?)
- Complication of group A strep tonsilitis in young patient
82
Symptoms of peritonsillar abscess (Quinsy)
- *Muffled "hot potato" voice*
- Sore throat
- Fever
- Dysphagia with drooling
83
Physical exam findings in peritonsillar abscess (Quinsy)
- Tonsil is displaced towards midline
- Uvula often deviated
84
Diagnostic tools for peritonsillar abscess (Quinsy)
- Ultrasound (need experienced technician)
- CT neck
85
Treatment for peritonsillar abscess (Quinsy)
Penicillin and drainage
(prompt surgery if airway compromised)
86
Retropharyngeal abscess symptoms
- *Tripod/sniffing position*
- Fever
- Toxicity
- Neck pain
- Dysphagia
- Muffled voice
- Drooling
- Stridor
- Anxiety
87
Physical exam findings in retropharyngeal abscess
- Erythema and bulging of posterior pharyngeal wall
- Pain with neck extension
88
Diagnostic tool for retropharyngeal abscess
CT
89
Treatment for retropharyngeal abscess
Hospitalization and ENT consultation
90
Acute epiglottitis is most common in this age group
Age 2-8
91
Acute epiglottitis is most commonly caused by these three pathogens
- H. influenzae
- Pneumococci
- Streptococci
*having problems swallowing*
92
Symptoms of acute epiglottitis
- Severe sore throat
- Fever
- Dysphagia
- Drooling
- Respiratory distress
Do not use tongue blade!
93
Diagnostic tool for acute epiglottitis
Lateral neck x-ray
- *Thumbprint sign*
94
Treatment for acute epiglottitis
Nasotracheal intubation + antibiotic therapy (e.g. cefuroxime)
95
The common cold is most often caused by this pathogen
Rhinovirus
96
Symptoms of the common cold
- Sneeze
- Cough
- Sore throat
- Nasal drainage
- Minimal lymphadenopathy, lungs clear to auscultation
97
Common colds typically self resolve in [time period], but is longer in [these types of patients]
- Usually resolves in 5-7 days
- Longer in smokers/underlying lung disease
98
Common cold treatments
- Acetaminophen/NSAIDs for symptoms
- Saline helps clearance, promotes vasoconstriction
- Hydration, thins secretions
- Avoid OTC cold meds in children <6/12
99
Symptoms of acute bronchitis
Severe/prolonged cough (productive or non-productive)
100
Acute bronchitis can be treated without antibiotics because it will typically self resolve in this time period
1-3 weeks
101
Physical exam signs of acute bronchitis
- Ronchi that *clears with coughing*
- Maybe wheezing
102
Treatment for acute bronchitis
Antibiotics are *not* indicated
- Lozenges, hot tea, honey
- Cough suppressants: benzonatate, DM
- Albuterol/steroids only if wheezing/underlying lung disease
Avoid codeine
103
Influenza symptoms
- *Rapid onset* of fever, nonproductive cough, myalgias, chills, headache, sore throat, congestion
- Nausea, vomiting, diarrhea suggest influenza *B*
Symptoms more subtle in elderly/immunocompromised:
- Weakness
- Dizziness
- Altered mental status
104
Diagnostic tools for influenza
- Real time PCR (high sens/spec. *best test if available*)
- Rapid molecular test
- Rapid antigen test
105
Treatments for influenza
- Rest
- Hydration
- Antipyretics
- Antitussives
Antivirals only given if risk factors
(very young/old/fat/sick/pregnant)
- Neuraminidase inhibitors (oseltamivir)
- Give within 48 hours of symptom onset
106
An influenza patient who improves initially from the virus, then has a relapse of fever with the addition of a productive cough most likely has pneumonia secondary to influenza that is most often caused by this pathogen
S. pneumoniae
107
Primary influenza pneumonia has this appearance on chest x-ray
Bilateral reticulo-nodal opacities
108
Inflammation of the subglottic airway is known as ...
Croup (viral layngotracheitis)
109
Croup (viral layngotracheitis) is most common in this age group
6 months to 3 years of age
110
Symptoms of croup (viral layngotracheitis)
- *Barking/seal-like cough*
- Inspiratory stridor
- Hoarseness
Symptoms often *worse at night*
111
Diagnostic tools for croup (viral layngotracheitis)
- Clinical
- Check vitals, mental status, hydration status
- X-rays not often done, but would show *steeple sign* if performed
112
Treatment for croup (viral layngotracheitis)
- Single dose oral dexamethasone or prednisolone
(epinephrine + IV steroids if severe)
113
Respiratory syncytial virus is the most common cause of this respiratory condition
Bronchiolitis - acute inflammation of the bronchioles
114
Bronchiolitis is usually seen in patients aged [blank] and is most dangerous between ages [blank]
- Usually seen in patient under 2 years old
- Most dangerous between ages 2 and 6 months
115
Symptoms of bronchiolitis
- Low fever (<101f) and rhinorrhea for 1-3 days
- Followed by wheezing, cough, and maybe respiratory distress (RR>70, retractions, rales, cyanosis)
116
Diagnosis for bronchiolitis
- Clinical
- Rapid antigen test only if results will alter management
117
Bronchiolitis treatment
Hospitalization if respiratory distress
118
Coronavirus symptoms
- Nonproductive cough
- Congestion and rhinorrhea
- Myalgia/malaise
- Sore throat
- Headache
- Diarrhea
119
If you administer a rapid COVID test in office too early, are you more likely to get a false positive or false negative result?
False negative: virus hasn't replicated enough yet
120
Viral pneumonia from COVID most commonly appears 10-12 days after symptom onset and has this appearance on chest x-ray
Ground-glass opacities
121
Differentiate between these stages of COVID severity:
- Mild
- Moderate
- Severe
- Critical
- Cytokine storm
- Mild: minimal symptoms
- Moderate: fever with signs of pneumonia
- Severe: Respiratory distress
- Critical: Respiratory failure, shock, organ failure
- Cytokine storm: Hyperinflammation leading to multiple organ failure
122
COVID treatment
Only treat if high risk:
- 65+, immunocompromised, severe disease, 65+ and unvaccinated
- Paxlovid
- Remdesivir
123
Tuberculosis is caused by this pathogen
Mycobacterium tuberculosis
124
Risk factors for tuberculosis
- Men
- Poor
- Immigrants
- Immunosuppressed
125
Symptoms of acute tuberculosis infection
- *Fever*
- Chest pain
- Nonproductive cough
- Night sweats
- Weight loss (consumption)
126
Chest x-ray findings in acute symptomatic tuberculosis infection
Hilar lymphadenopathy
127
After catching tuberculosis and passing through the acute asymptomatic infection phase, a patient will enter the [blank] phase
Latent phase
128
A patient with asymptomatic latent TB will have these results:
- Chest x-ray: [normal/abnormal]
- TB skin test: [positive/negative]
- Chest x-ray: Normal
- TB skin test: Positive
129
True or false.
Latent tuberculosis is transmissable
False
- Can only catch active TB (fever, symptoms)
130
When is reactivation of latent tuberculosis most likely to occur?
Anything that suppresses immune system, TB gets out from sequestration
- HIV
- Organ transplant
- Silicosis
- TNF-a blockers
- Dialysis
131
Does reactivation of latent tuberculosis have an abrupt or insidious onset?
Slow and insidious
132
Symptoms of latent tuberculosis reactivation
- Weight loss
- Night sweats
- Fever (diurnal)
- Hemoptysis
- Chest pain
133
Are cavitations on chest x-ray more likely to be seen in a primary tuberculosis infection or a reactivation of latent disease?
Reactivation of latent disease
- Cavitation rare in primary TB infection
- Hasn't had enough time for immune system to build walls around
134
What is "miliary" tuberculosis?
- Hematogenous dissemination
- TB spreading around the body through the blood
135
Most common presentation of extrapulmonary tuberculosis
Lymphadenitis (scrofula)
- A big lymph node full of TB
136
What methods of tuberculosis screening are available for latent disease in cases of known exposure, health care workers, etc
- Interferon-gamma release assay (IGRA) is preferred if available (WBC test)
- Tuberculin (Mantoux) test (skin test)
137
How would you interpret the following measurements of induration 2-3 days after administration of a tuberculin skin test:
- 5mm
- 10mm
- 15mm
5mm
- Positive if HIV or known close contact
10mm
- Positive if immigrant, prisoner, homeless, IV drug user, nursing home resident, chronic illness
15mm
- Anyone with this much induration is considered positive
138
If an asymptomatic patient has a positive screening (TST or IGRA) for tuberculosis, what is the next test to confirm?
Chest x-ray
- Looking for mediastinal lymphadenopathy, consolidation, effusion, cavitation
139
Patient who have signs of active tuberculosis OR who have a positive screening + chest x-ray findings should have this testing done next ...
Collect sputum and perform any of the following
- Acid-fast bacilli smear (AFB) - fastest and cheapest
- Nucleic acid amplification testing (NAAT) = better sens. than AFB
- Culture
140
Treatment for latent tuberculosis disease
Isoniazid for 6-9 months
141
Side effects of isoniazid
- Can develop peripheral neuropathy (preventable with pyridoxine = vitamin B6)
- Liver toxicity
142
Side effects of rifampin
- Orange discoloration of urine/sweat/tears/saliva
- Liver toxicity
143
Pyrazinamide side effects
- Liver toxicity
144
Ethambutol side effects
- Ocular toxicity
145
Name two diseases (not tuberculosis) caused by mycobacteria
- Mycobacterium avium complex (MAC)
- Mycobacterium leprae (leprosy)
146
What is the #1 opportunistic bacterial infection in AIDS patients?
Mycobacterium avium
147
Mycobacterium avium is thought to be acquired from ...
Municipal water
148
Symptoms of mycobacterium avium
- Fever
- Chills
- Night sweats
- Profound weight loss
- Diarrhea
- Malabsorption
(can also cause pulmonary disease)
149
Diagnostic tools for mycobacterium avium
Cultures and smears
150
Treatments for mycobacterium avium
- Antiretroviral therapy (keep helper T cells up in HIV patients)
- Azithromycin or clarithromycin
151
Mycobacterium leprae primarily affects these parts of the anatomy
Skin and peripheral nerves
152
Symptoms of mycobacterium leprae
- Hypopigmented/reddish patches on skin
- Paresthesia on hands/feet
- Painless wounds/burns on hands/feet
- Tender, enlarged peripheral nerves
Late findings:
- Weakness and deformities
153
How is a diagnosis of mycobacterium leprae confirmed?
Biopsy
154
How is herpes simplex virus transmitted?
Direct contact of secretions with mucosal surfaces/breaks in skin
(not respiratory droplets or fomites)
155
Which of the following is more common with HSV 1 or 2?
- Orofacial disease
- Genital disease
- Orofacial disease = HSV-1
- Genital disease = HSV-2
156
Herpes simplex virus is neurovirulent. Which nerves do HSV-1 and HSV-2 live in?
- HSV-1: Trigeminal ganglia
- HSV-2: S2-S5 ganglia
157
Common causes of dormant herpes infection reactivation
- Fever
- Trauma
- Emotional stress
- Sunlight
- Menstruation
158
Which, HSV-1 or HSV-2, is more common in newborns due to maternal spread?
HSV-2 from vaginal delivery (or across placenta - rare)
159
How does the presentation of primary oral-labial herpes differ from reactivation?
- Primary: gingivostomatitis or pharyngotonsillitis
- Reactivation: cold sores
Generally, more likely to see abrupt onset, intra-oral ulcers, and systemic symptoms with first infection
160
Oral-labial herpes typically first occurs between these ages
6 months to 5 years
161
What are the prodromal symptoms of herpes labialis?
Pain, burning, tingling
162
Ocular herpes is usually due to [HSV-1/HSV-2]
HSV-1
163
Symptoms of ocular herpes
- *Unilateral* conjunctivitis, blepharitis, or corneal opacities
- Pain, photophobia
- Blurry vision
- Tearing, redness
164
The most common *corneal* cause of blindness in the US is ...
HSV keratitis
165
Symptoms of genital herpes
- *Painful* vesicular genital lesions
- Fever, malaise, inguinal lymphadenopathy
Recurrent episodes are milder and shorter
166
Perianal and anal herpes is most commonly seen in ...
Gay men
167
Symptoms of perianal and anal herpes
- Pain
- Itching
- Tenesmus
- Rectal discharge
- Fever, chills
- Sacral paresthesia
- Headache
- Dysuria
168
Differentiate between localized and disseminated neonatal herpes infections
Localized:
- Skin, eye, mucous membrane disease (SEM disease) presents at 10-12 days old
- Good outcome with prompt antiviral therapy
Disseminated:
- Severe disease with hepatic/pulm/neuro failure
- High mortality if not promptly treated
Possibility of sepsis or CNS infection (encephalitis) at 2-3 weeks of age (lethargy, irritability, seizures)
169
Is there a higher risk of neonatal transmission of herpes in a primary or recurrent infection of the mother?
Primary (50% vs 5% for recurrence)
170
Herpes infections are often diagnosed clinically. However, this lab test is the best
PCR assay
171
How to prevent neonatal herpes transmission if a pregnant mother has active lesions
C-section
172
Treatment for (neonatal, ocular, genital) herpes
Acyclovir
173
How is varicella-zoster virus transmitted?
- Aerosolized respiratory droplets
- Direct contact with vesicular fluid
- Contagious from 48 hours before rash, until lesions are crusted
174
Symptoms of varicella zoster (chicken pox)
- Prodrome of fever, malaise, pharyngitis
- Subsequent generalized vesicular rash
175
Herpes zoster (shingles) typically occurs in these kinds of patients
- Older
- Immunocompromised
176
Postherpetic neuralgia, Ramsay Hunt syndrome, and segmental myelitis are potential complications of this condition
Herpes zoster (shingles)
- Need to treat shingles asap!
177
Diagnosis of herpes zoster (shingles) is often clinical. But this lab test is best if confirmation is needed
PCR testing
(culture too slow, don't have time)
178
Symptoms of herpes zoster (shingles)
Pain in a dermatome followed by vesicular eruption in a dermatome
179
Treatment for varicella-zoster (shingles)
Acyclovir - within 3 days of onset
(if immunocompromised, give IV acyclovir)
180
Symptoms of postherpetic neuralgia
- Pain persisting >3 months after shingles rash started
- Burning, itching, or sharp pain localized to a dermatome
- Usually thoracic, cervical, or trigeminal
181
Risk factors for postherpetic neuralgia
- Age >60
- Severe pain/rash with previous acute herpes zoster (shingles) episode
182
How is cytomegalovirus transmitted?
- Blood, respiratory secretions, saliva, urine, semen, cervical mucus, tears, breast milk
(anything wet)
183
Cytomegalovirus is most commonly seen in these patients
- Transplant patients (immunosuppressed)
184
Symptoms of cytomegalovirus
- Usually asymptomatic or mild mono-like symptoms (sore throat, fatigue, fever)
Immunocompromised = multiple organs affected
- GI manifestations (colitis)
- Neurologic, ocular, CV complications
185
What would be seen in the peripheral blood smear of a patient with cytomegalovirus?
Lymphocytosis with atypical T lymphocytes
186
What is the best lab test for cytomegalovirus?
PCR
(only test immunocompromised/transplant patients though)
187
Treatment for cytomegalovirus
Ganciclovir or valganciclovir
188
This virus has a long incubation time (1-2 months), is asymptomatic in young children, but can cause fever, pharyngitis, lymphadenopathy, fatigue, and splenomegaly
Epstein-Barr virus (mono)
189
Symptoms of infectious mononucleosis
- Fever
- Pharyngitis (exudative or non-exudative)
- Lymphadenopathy
- Fatigue
- Splenomegaly
(body attacks infected b-cells)
190
Diagnostic tools for Epstein-Barr virus
- Monospot: detect heterophile antibodies
- CMP: elevated LFTs
- Peripheral blood smear: lymphocytosis with atypical lymphocytes
191
Treatment for Epstein-Barr virus
- Supportive
- Steroids for airway obstruction/severe thrombocytopenia/hemolytic anemia
192
How long after an episode of infectious mononucleosis can a patient return to sports?
Four weeks at the earliest
193
How is measles (rubeola) spread?
Respiratory aerosol droplets (very contagious)
194
Symptoms of measles (rubeola)
- *Koplik spots* on buccal mucosa and conjunctiva
- Fever, malaise
- Eye problems (conjunctivitis, photophobia, periorbital edema)
- Cough
- Coryza (congestion)
- Rash starting at hairline, spreading downwards
195
Which, measles (rubeola) or rubella (German measles) has a rash that lasts longer (6-7 days)?
Measles (rubeola)
196
These lesions that appear in the buccal mucosa and conjunctiva are described as "small grains of sand on a red background"
Koplik spots - seen in rubeola (measles)
197
Symptoms of mumps
- *Parotid tenderness/swelling* within 48 hours
- Fever, headache, malaise
198
Diagnostic tools for mumps
- PCR (buccal swab)
- Serum IgM
199
This condition has potential complications of epididymo-orchitis in postpubertal males, pancreatitis, oophoritis, and hearing loss
Mumps
200
Symptoms of rubella (German measles)
- Prodrome of fever, headache, malaise, mild conjunctivitis
- Rach beginning on face/forehead, spreads to trunk and extremities
(NO Koplik spots, NO cough, NO coryza)
201
Symptoms of erythema infectiosum (parovirus B19/fifth disease)
- Fiery-red rash on both cheeks (slapped cheek disease)
- Pallor around mouth
- Extremity rash later, spreads to trunk
- Arthritis/arthralgia
202
Symptoms of molluscum contagiosum
- Multiple painless, pearly white 2-5mm nodules with central umbilication
- Appear everywhere *except* soles and palms
- NO symptoms other than rash
203
Both gonorrhea and chlamydia are often asymptomatic. But which one, if symptomatic, is generally more purulent and aggressive?
Gonorrhea
204
Symptoms of urethritis/cervicitis
- Urethral discharge
- Dysuria
- Itching at distal urethra
205
What kind of organism is Neisseria Gonorrhea?
Gram negative diplococci bacteria
206
Best test for gonorrhea diagnosis
Nucleic acid amplification test (NAAT)
207
Which patients are recommended to get three site testing when screening for gonorrhea?
Men who have sex with men and other high risk populations
208
Treatment for gonorrhea
- Ceftriaxone 500-1000mg (weight based) IM
(if chlamydia not excluded add doxycycline/azithromycin)
209
Between chlamydia and gonorrhea, which one is more likely to cause a *clear* discharge?
Chlamydia
210
What is the number one reported bacterial infectious disease in the US?
Chlamydia
211
Prevalence of chlamydia is highest in this age group
<25
212
Symptoms of chlamydia
- Most often asymptomatic
- Dysuria
- Discharge
- Dyspareunia
- Abdominal/testicular pain
- Breakthrough bleeding
213
All women diagnosed with chlamydia during pregnancy should be tested for reinfection in [time period]
Three months
214
Both chlamydia and gonorrhea have the potential to cause conjunctivitis. But which one is more likely to be beefier and more red?
Gonorrhea (gonococcal conjunctivitis)
215
Treatment for chlamydia
- Doxycycline 100mg PO BID x7
OR
- Azithrmoycin 1g PO single dose
216
Treatment for chlamydia in pregnancy
- Azithromycin 1g PO single dose
- Safe in all trimesters
(Can't give doxycycline)
217
What is the most common cause of vaginal discharge in women of reproductive age?
Bacterial vaginosis
218
Bacterial vaginosis is a polymicrobial condition but is mostly associated with this bacteria
- Gardnerella vaginalis
(also anaerobes, prevotella, mobiluncus, and mycoplasma)
219
What condition is associate with the Amsel diagnostic criteria and what is the criteria?
Bacterial vaginosis
- Homogenous, white, uniformly adherent discharge
- Vaginal pH >4.5
- Clue cells on wet mount
- Fishy odor with Whiff test
- Absence of WBCs
220
Treatment for bacterial vaginosis
*Must perform pelvic exam and lab testing to confirm before treating!*
- Metronidazole 500mg PO BID x7
221
Topical, intravaginal treatments, such as clindamycin cream, for bacterial vaginosis are effective (if no upper GU involvement) with fewer side effects for pregnant women.
However, these types of creams should be used with caution as they can weaken condoms and diaphragms.
Oil-based creams
222
This condition is associated with a sexually transmitted protozoan (parasite)
Trichomoniasis
223
Risk factors for trichomoniasis
- Black
- Smoking
- Incarceration
- Poor
224
Symptoms of trichomoniasis
70% are asymptomatic!
Men
- Itching/irritation inside penis
- Burning with urination/ejaculation
- Penile discharge
Women
- Copious frothy discharge
- Itching, burning, redness, sore genitals
- Discomfort with urination
225
Diagnostic criteria of trichomonas vaginalis
- Profuse, frothy green/yellow vaginal discharge
- Vulvar itching
- Motile trichomonads on microscopy
226
Treatment for trichomoniasis
- Metronidazole or tinidazole
- Partners should be treated
227
Which condition is associated with pseudohyphae seen on microscopy?
Vulvovaginal candidiasis
228
Symptoms of vulvovaginal cadidiasis
- Odorless cottage cheese discharge
- Dysuria
- Genital burning/pain
- Erythema, fissures, edema
229
Vulvovaginal candidiasis is usually caused by this pathogen
Candida albicans
230
This pathogen, that can cause vulvovaginal candidiasis, is known to have a "snowman" appearance
Candida glabrata
231
Treatment for vulvovaginal candidiasis
Fluconazole 150mg PO single dose
232
In a patient with recurrent yeast infections, what underlying virus might you test for?
- Look for undiagnosed HSV
- Serologic testing for HSV-1 and HSV-2 IgM and IgG
233
Symptoms of cytolytic vaginosis
- Symptoms are *CYCLIC, during luteal phase*
- Pruritus, dysuria, dyspareunia, white cheesy discharge
234
In a patient with vaginal pruritus, dysuria, dyspareunia, white cheesy discharge you see lactobacilli, crenated epithelial cells, isolated nuclei on wet prep. You do not see WBCs, clue cells, flagellate protozoans, or pseudohyphae.
What is the likely diagnosis?
Cytolytic vaginosis
- differentiate from lactobacillosis with presence of crenated epithelial cells or intracellular debris
235
Treatment for cytolytic vaginosis
- Baking soda sitz baths
- Can be done prior to onset of symptoms (luteal phase)
236
Describe the appearance of the lactobacilli seen on microscopy of a patient with lactobacilliosis
Long rods
237
Syphilis is caused by this pathogen
Treponema pallidum
238
It is recommended to offer syphilis testing to all sexually active people between the ages of ....
15 to 44
239
Symptoms of *primary* syphilis
- Firm, round *PAINLESS* chancre
- Raised border, red smooth base
- Lasts 3-6 weeks
240
Symptoms of *secondary* syphilis
- 3-6 weeks after development of primary chancre
- Rash with sores in mouth and other mucus membranes
- Systemic symptoms: fever, headache, lymphadenopathy, fatigue, myalgias,
- Maculopapular rash on palms and soles of feet
- Condylomata lata = contagious weepy warts
241
Symptoms of *latent* syphilis
- No symptoms
- Positive serologic testing though
242
Symptoms of *tertiary* syphilis
- Damage to the brain and nervous system, heart, and blood vessels
- Gummatous (necrotic) lesions
- May present as psychiatric illness (neurosyphilis)
243
Which patients are most at risk of developing *neurosyphilis* in the tertiary phase?
Untreated HIV patients with low CD4 count
244
Which patients are most at risk of developing *ocular* syphilis?
Men who have sex with men
245
Physical exam signs and symptoms of ocular syphilis
- Symptoms:
- Eye pain, redness, bluriness, vision loss, flashing lights
- PE signs
- Small, irregular pupils
- Do *NOT* constrict to light
- *DO* constrict when focusing (accomodation)
246
Which sexually transmitted disease can present as ADHD in children?
Syphilis
(can present as any psychiatric condition)
247
Which sensory loss can present as the first sign of syphilis?
Hearing loss
- Otosyphilis: irreversible hearing loss, tinnitus, vertigo
248
What screening tests are performed when looking for syphilis?
- VDRL, RPR, non-treponemal
- If positive: treponemal-specific tests to confirm
249
Treatment for syphilis
- Penicillin benzathine IM single dose
- Clinical and serologic follow-up at (3 in CM3) 6, 12 months
250
Screening to prevent congenital syphilis
- Screen all women in early pregnancy
- Screen again *twice* in 3rd trimester if high risk community/population
251
Symptoms of genital herpes
- *PAINFUL* ulcers/vesicles
- Undermined border
- Lymphadenopathy
252
Diagnostic test for genital herpes
- Culture, Tzanck prep
253
Herpes simplex virus treatment
Acyclovir 400mg TID x7-10
254
A painful genital ulcer with ragged borders and buboes (suppurative lymphadenopathy), but no prodromal symptoms is most suggestive of this condition
Chancroid (h. ducreyi)
255
Diagnostic tests for chancroid (h. ducreyi)
- No available testing, clinical diagnosis
- Suspicion based on *painful* lesion +/- regional lymphadenopathy
- Negative for HSV, syphilis
256
Treatment for chancroid (h. ducreyi)
- Azithromycin 1g PO
OR
- Ceftriaxone 250mg IM
- Lymph node aspiration for comfort
- Confirm resolution 3-7 days later
257
Symptoms of lymphogranuloma venereum
- Unilateral tender inguinal or femoral lymphadenopathy
- Painless, shallow ulcer
- Proctocolitis if rectal exposure (may resemble IBS)
258
Which condition is an invasive form of chlamydia that is associated with the "Groove sign" (matted inguinal lymph nodes)
Lymphogranuloma venereum
- Groove due to unilateral lymph enlargement
259
Which sexually transmitted disease can cause the complication of genital elephantiasis?
Lymphogranuloma venereum
260
Treatment for lymphogranuloma venereum
- Doxycycline 100mg PO BID x21
OR
- Azithrmoycin 1g *weekly* x 21
OR
- Erythromycin 500mg QID x21
(all 21 days)
261
Symptoms of granuloma inguinale (Donovanosis)
- *Painless* ulcerations that are highly vascularized and *beefy red*
- Lesions bleed easily on contact
- Lesions heal inwards from ulcer margins
- *NO* regional lymphadenopathy
262
Treatment for granuloma inguinale (Donovanosis)
Azithromycin 1g PO weekly x21
263
Out of the following, which have *PAINFUL* lesions?
- Chancroid (h. ducreyi)
-Granuloma inguinale (Donovanosis)
Lymphogranuloma venereum
- Herpes simplex virus
- Non-sexually acquired genital ulcers (NSAGU
- Chancroid (h. ducreyi)
- Herpes simplex virus
- NSAGU
264
Symptoms of non-sexually acquired genital ulcers (NSAGU)
- *Painful* genital ulcers
- Yellow or black center due to necrosis
- Often around menses
265
Treatment for non-sexually acquired genital ulcers (NSAGU)
- Analgesics
- Corticosteroids
(both oral or topical)
266
Symptoms/physical exam findings of pelvic inflammatory disease (PID)
Uterine/adnexal/cervical motion tenderness
267
Treatment for pelvic inflammatory disease (PID)
- Cetriaxone + doxycycline + metronidazole
268
Define a UTI
An inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria
269
Risk factors for getting a UTI
- Female
- Age
- Hospitalization
- Sexually active women
- Diabetes
- Anatomic and function abnormalities (VUR, stones, catheter, stent)
270
Most UTIs are caused by this *category* of bacteria
Facultative anaerobes
271
This bacteria is the most common cause of UTIs
E. coli
272
This gram negative bacteria causes UTIs and alkalizes the urine, so is associated with stones
Proteus
273
Risk factors for ascending UTIs
- Post menopausal women (less estrogen = less lactobacilli = more room for e.coli)
- Spermicide/diaphragm
- Soilage of the perineum
274
Symptoms of cystitis
- Dysuria
- Urinary frequency and urgency
- Suprapubic pain
275
Symptoms of pyelonephritis
- Fever
- Chills
- Flank pain
276
Cloudy and malodorous urine can most commonly be a sign of ...
UTI
277
Diagnostic tools for UTIs
- Urinalysis
- Microscopy (pyuria, hematuria, bacteriuria
278
The presence of nitrite in the urine is suggestive of a UTI caused by this type of bacteria
- Gram negative (typically e. coli)
(gram negatives convert nitrates to nitrites)
279
The presence of squamous epithelial cells in a urinalysis are suggestive of ...
- Contamination (unclean catch)
280
Urine culture with growth of 10^2 colony forming units (CFU) defines bacteriuria in [dysuric/asymptomatic] patients, whereas growth of 10^5 CFU is diagnostic in [dysuric/asymptomatic] patients
- 10^2 CFU is diagnostic in *DYSURIC* patients (lower threshold if symptoms)
- 10^5 CFU is diagnostic in *ASYMPTOMATIC*
281
Physical exam sign for pyelonephritis
- Costovertebral pain with percussion (CVAT) = kidney punch test
282
White blood cell casts, pyuria, and bacteriuria are associated with this type of UTI
Pyelonephritis
283
Renal and perirenal abscesses are mostly secondary to ...
- Ascending UTI with e. coli
(also often associated with renal stones/obstruction)
284
Symptoms of renal and perirenal abscesses
- Insidious onset
- Chronic fever
- Weight loss
- Night sweats
- Anorexia
- Flank/back pain
285
Diagnostic tools for renal and perirenal abscesses
Ultrasound or CT
286
Symptoms of acute and chronic prostatitis
- Acute: chills, dysuria, urinary frequency, urgency, perineal pain
- Chronic: recurrent bacteriuria, low grade fever, back/pelvic pain
287
Diagnostic tools for prostatitis
- History and physical
- Urinalysis
- Urine culture
- Residual urine determination (post void residual)
288
Four common medications used to treat UTIs
- Bactrim (most widely used)
- Nitrofurantoin
- Cephalosporins (Keflex) (good in pregnancy)
- Fluoroquinolones (Cipro/Levo)
289
Treatment for acute uncomplicated pyelonephritis
- Bactrim or fluoroquinolones
- *Not* nitrofurantoin (no tissue penetration)
290
Which UTI medications should be avoided during pregnancy?
- Bactrim (kernicterus + fetal toxicity)
- Fluoroquinolones (tendons)
(also tetracyclines)
291
True or false.
You should *not* treat a UTI in a patient with a foley catheter *unless* they are having symptoms
True
- Only treat catheterized patients if they are having symptoms such as fever, pain, dysuria, urgency/incontinence, foul odor)
292
What is the most common nosocomial infection?
Catheter associated UTI
293
Asymptomatic bacteriuria should only be treated in patients who are ...
Pregnant
294
All febrile children with no obvious cause of infection in this age group should be evaluated for a UTI
2 to 24 months
295
When assessing a child for a UTI use this type of urine sample
Catheter specimen
296
This category of bacteria is found deep in layers of colon, between teeth and gums, or in tissue with damaged blood vessels/restricted blood flow
Anaerobes
(seen in abscesses, GI tract, penetration of foreign matter, and devitalized tissue)
297
Clostridium, Bacteroides, and Actinomyces all fall into this category of bacteria
Anaerobes
*CBA = can't breathe air*
298
Histotoxic clostridia is associated with lowered host resistance. Give me two examples of this
- Trauma: c. perfringes
- Colon cancer: c. septicum
(skin is part of host resistance)
299
Symptoms and physical exam findings of gas gangrene (myonecrosis)
- Sudden, severe pain
- Pale/purple/red skin
- Induration
- Destruction
- Toxemia and shock
300
Which bacteria most commonly causes gas gangrene (myonecrosis)?
Histotoxic clostridia
301
Treatment for histotoxic clostridia
- Irrigation, debridement
- Zosyn (+) and Clindamycin (-)
302
This bacteria is the second most common cause of foodborne infection after salmonella
Clostridium perfringes
303
Risk factors for clostridium difficile
- Recent use of clindamycin, fluoroquinolone, or beta-lactam
- Age 65+
- Recent hospitalization/nursing home
- PPI use
304
Most common symptoms of clostridium difficile
- Diarrhea (3 or more episodes in 24 hrs)
- Abdominal cramps
305
Diagnostic tool for clostridium difficile
Liquid stool sample
306
Treatments for clostridium difficile
- Fidamoxicin, vancomycin, or bezlotoxumab
- Fecal transplant ("live biotherapeutic products")
307
Which neurotoxic clostridia releases a toxin that blocks nervous system *excitation*?
- C. botulinum
- Targets cholinergic synapses
308
Which neurotoxic clostridia releases a toxin that blocks nervous system *inhibition*?
- C. tetani
- Blocks inhibitory neurons
309
Symptoms of tetanus (c. tetani)
- Restlessness
- Painful spasm/stiffness
- Trismus (lockjaw)
- Opisthotonos (arching of body due to extreme contraction)
310
Treatment for tetanus (c. tetani)
- Minimize stimuli (dark, quiet room)
- Wound debridement
- Metronidazole
- Antitoxin
- Muscle relaxants/sedatives
311
What is the most common anaerobe isolated from intra-abdominal infections and bacteremia?
Bacteroides fragilis
312
Treatment for bacteroides fragilis
- Metronidazole or beta-lactam/beta-lactamase inhibitor/carbapenem
313
Actinomyces is associated with infections on this area of the body
- Cervicofacial (neck and jaw)
314
Risk factors for actinomyces infections
- Dental infections
- Oromaxillofacial trauma
315
Treatment for actinomyces
- Penicillin G
316
Traveler's diarrhea is most commonly caused by this pathogen
E. coli (enterotoxigenic)
317
Symptoms of traveler's diarrhea
- Watery diarrhea
- Usually self-limited to 3-5 days
318
Symptoms of infection with shiga toxin-producing E. coli
- Painful, watery diarrhea
- Progresses to bloody diarrhea
- Hemolytic uremic syndrome
319
Diagnostic tools for shiga toxin-producing E. coli
- Stool sample
- Rectal swab
(must send off quickly)
320
Treatments to give and *avoid* in shiga toxin-producing E. coli
- Treat dehydration
- Do *NOT* give antibiotics - releases more toxin
- Do *NOT* give NSAIDs - already dehydrated, will reduce kidney blood flow
- Do *NOT* give opioids - don't want to slow down excretion
- Do *NOT* give IV ondansetron - increases risk of hemolytic anemia
321
Risk factor for proteus mirabilis infection
- Long term catheters
322
Treatment for proteus mirabilis infection
- Bactrim or fluoroquinolone
323
Risk factors for klebsiella pneumoniae infections
- Hospitalized/immunocompromised (weak)
- Alcoholism
- Diabetes
324
Symptom associated with klebsiella pneumoniae infection
- Currant jelly sputum
325
Diagnostic tools for klebsiella pneumoniae infection
- Culture sputum, blood, urine
326
Name three types of gram-positive aerobic bacilli
- Listeria
- Bacillus
- Corynebacterium
327
Symptoms and physical exam findings of corynebacterium diphtheriae
- Pharyngitis
- Malaise
- Low fevers
- White/gray membrane in posterior pharynx that bleeds with scraping
328
Diagnostic tools for corynebacterium diphtheriae
- Culture the membrane, deep to the membrane, and nasal passage
- Test for presence of toxin
329
Treatment for corynebacterium diphtheriae
- *Monitor airway!* - membrane can block
- Hospitalization
- Erythromycin or PCN G/V
- Antitoxin
330
Listeriosis is primarily a foodborne pathogen that most often causes self-limited gastroenteritis in healthy people.
However, listeria has the potential to spread to these two areas of concern
- Brain: meningitis
- Placenta: fetal infections
331
Risk factors for severe disease from a listeria infection
- Age 70+
- Pregnant
- Immunocompromised
332
How to prevent listeriosis
- Avoid unsterilized/undercooked foods
- Hot dogs should be steaming hot!
333
Treatment for listeriosis
- Ampicillin +/- penicillin
334
Risk factors for Nocardiosis
- Immunosuppression:
- *Glucocorticoids*
- Diabetes, HIV, transplant, cancer
335
Most common symptoms of Nocardiosis
- Pulmonary nocardiosis most common:
- Productive cough
- Pleuritic chest pain
- Dyspnea
- Fever
- Anorexia
- Weight loss
(can spread to any organ though, brain abscesses, skin infections)
336
Nocardiosis diagnosis tools
- Sputum culture or skin biopsy
337
Treatment for Nocardiosis
- Bactrim, imipenem, ceftriaxone
338
Apart from bioterrorism, how else might someone contract anthrax?
- Industrial processing of animal hides
339
Symptoms of anthrax
- Papule > vesicle > eschar (black stuff in the middle)
- Respiratory infection resembling influenza
340
Treatment for anthrax
- Ciprofloxacin or doxycycline
341
Mean age of patients with endocarditis
58
342
Definition of endocarditis
Infection of a cardiac valve or the endocardium caused by bacteria, fungi, rickettsia, or chlamydiae
343
Risk factors for endocarditis
- *Prosthetic valves/devices* (highest risk)
- Congenital heart disease
- Heart valve disease
- Previous endocarditis
- Skin abscess (biggest way bacteria gets in)
344
Right sided endocarditis will embolize to the lungs and is most likely caused by ...
IV drug use
345
Emboli from left-sided endocarditis can spread to ...
Anywhere!
346
Most common bacteria causing endocarditis
- Staph aureus
- Streptococci
(pseudomonas most common gram negative cause)
347
Which, acute infective or subacute, endocarditis is more likely to respond to antibiotics?
- Subacute endocarditis
348
Which, acute infective or subacute, endocarditis is more likely to occur in a patient with previously *healthy* valves?
- Acute infective endocarditis
349
Compare and contrast symptoms of subacute and acute bacterial endocarditis
Subacute:
- "Sick and weirdly sick"
- Fever, sweats, weakness, myalgias, arthralgias, malaise, anorexia, fatigue
Acute:
- Abrupt onset
- Rigors
- Temp 103-105f
- Petechiae
350
Which condition is associated with Osler's nodes (tender) and Janeway lesions (non-painful)?
- Subacute bacterial endocarditis
351
Physical exam findings in subacute bacterial endocarditis
- Osler's nodes (tender)
- Janeway lesions (non-painful)
- Murmurs
- Petechiae in conjunctivae, oropharynx, skin, legs
- Linear subungual hemorrhages
352
Which condition is associated with the Duke's criteria?
Endocarditis
353
Describe the diagnostic criteria for endocarditis
Duke's criteria
Pathologic criteria:
- Proof of vegetation
Clinical criteria:
- 2 major OR
- 1 major + 2 minor OR
- 5 minor criteria
Major criteria:
- Positive blood culture x2
- Evidence of endocardial involvement (echo showing oscillating intracardiac mass or cardiac CT)
354
Diagnostic *imaging tools* for endocarditis
- Echocardiogram (TTE is first choice, unless prosthetic valves, then TEE)
- Cardiac CT
(also scintigraphy and FDG-PET)
355
Diagnostic *lab tests* for endocarditis
- CBC with differential (neutrophilia)
- ESR
- CRP
- Blood culture!
356
Treatment for endocarditis
- Parenteral antibiotics for at least six weeks
- Empiric therapy should cover staphylococci, streptococci, and enterococci
- High risk (prosthetic valve) patients get prophylactic antibiotics for dental procedures (ampicillin, cefazolin, azithromycin, doxycycline)
357
HIV primarily affects these immune cells
CD4 (T cells)
358
At what point can it be said that a HIV patient has advanced to full blown AIDS?
- CD4 cell count below 200
OR
- CD4 less than 14%
OR
- Any CD4 count + opportunistic infection
359
Risk factors for HIV
- Men who have sex with men
- Sex workers
- Multiple partners
- STDs
- IV drug use
- Vertical transmission (mother to fetus)
360
What is the most common mode of HIV transmission
Receiving gay anal sex (being sodomized)
361
Between what ages does the CDC recommend patients be screened for HIV?
13 to 64
(USPSTF 15 to 65)
362
Which generation of HIV test can detect both antigens (Ag) and antibodies (Ab)?
4th generation
363
At what CD4 count should antiretroviral therapy be started for a HIV patient?
Begin right away regardless of CD4 count
364
For post exposure prophylaxis for HIV, within what time frame should antiretroviral therapy be started?
Within 72 hours of exposure
365
What is the most common cause of sepsis?
Pneumonia
366
Which *group* of bacteria is most commonly found in patients with sepsis?
Gram positive (and opportunistic fungi)
367
Definition of sepsis
Life-threatening organ dysfunction caused by a dysregulated response to infection
368
Describe the severity stages of sepsis
- Infection
- Bacteremia
- Sepsis
- Septic shock
- Multiple organ dysfunction syndrome (MODS)
- Death
369
Definition of septic shock
Sepsis plus failure to respond to fluid resuscitation/require vasopressors to maintain a MAP >65 mmHg
370
What does the SIRS criteria measure?
- Abnormal vital signs to estimate a systemic inflammatory response syndrome
371
In what part of the body does sepsis most commonly originate?
- Lungs (pneumonia)
372
Risk factors for sepsis
- Any patient with infection or bacteremia
- Age >65
- ICU admission/previous hospitalization
- Immunosuppression
- Diabetes
- Obesity
- Cancer
- Community acquired pneumonia
373
Early symptoms and physical exam signs of sepsis
Early:
- Subtle symptoms, confusion, decreased sensorium
- Unexplained decrease in urine output
- Sudden cholestatic jaundice
- Metabolic alkalosis
- Excess bleeding at venipuncture sites
- Early shock: high CO, low systemic vascular resistance (high HR, low BP)
374
Symptoms and physical exam signs of established sepsis
- Hypotension
- Tachycardia
- Fever
- Leukocytosis
- Organ dysfunction
- Warm flushed skin, becomes cool/clammy
- Decreased capillary refill/cyanosis/mottling
375
Two most commonly used scores/criteria to diagnose/risk assess sepsis
- qSOFA (quick sequential organ failure assessment)
- NEWS (national early warning score)
376
What are the three criteria of the qSOFA score for sepsis?
- Respiratory rate >22
- Altered mentation
- Systolic blood pressure <100
(2 of 3 = worse prognosis)
377
There is no single lab test that is sufficient to diagnose sepsis. However, these lab values are helpful and should be done on all patients with sepsis
- CRP and/or procalcitonin suggest bacterial cause
- Lactate - sign of organ hypoperfusion
- CBC - low platelets
- CMP - high creatinine
- Blood cultures - get before giving abx, from two different sites
- EKG
378
Which condition is associated with MODS (multiple organ dysfunction syndrome)?
Sepsis
- MODS = failure of 2 or more organ systems
379
This syndrome is a common type of organ failure ins sepsis, contributing to MODS
- ARDS (acute respiratory distress syndrome)
380
Chest x-ray findings in ARDS (acute respiratory distress syndrome)
Bilateral, symmetrical alveolar opacities
381
Treatment for sepsis
Fluid resuscitation:
- Urgent IV access, within first 3 hours
- 30 mL/kg of crystalloid fluid IV
Vasopressor:
- Start with Levophed to maintain MAP >65
- Can add epinephrine, phenylephrine, dopamine, vasopressin, dobutamine
Antibiotics:
- Start broad (Vancomycin/Zosyn)
- Nutritional support
- DVT prophylaxis
- Ulcer prophylaxis (PPIs)
- Management of blood glucose (<180)
- Blood transfusion (Hgb >7)
- Hydrocortisone IV if refractory shock
382
Which, Hodgkin's or non-Hodgkin's lymphoma, is more common?
Non-Hodgkin's lymphoma (85%)
383
Non-Hodgkin's lymphoma most commonly effects these types of cells in the body
B cells
384
Risk factors for non-Hodgkin's lymphoma
- Males
- Age
- Immunosuppressive therapy
- Autoimmune diseases
- Family history
- Agricultural pesticides
- Agent orange
385
Treatment for non-Hodgkin's lymphoma
- Watch and wait (if indolent)
- Chemotherapy
- Radiation
- Immunotherapy
- Targeted drugs
- Hematopoietic stem cell transplant
386
Which condition is associated with Reed-Sternberg cells?
Hodgkin's lymphoma
387
Treatment for Hodgkin's lymphoma
Chemotherapy
388
Most common physical exam sign of lymphoma
- Lymphadenopathy
(palpable, rubber like, but painless)
389
Pain in a patient's lymph nodes immediately after drinking alcohol is a worrying symptom that could indicate this disease
Hodgkin's lymphoma
390
Symptoms of lymphoma
- Palpable lump in lymph node most common
- Cough, airway obstruction, cardiac tamponade, superior vena cava syndrome, spinal cord compression if aggressive
- B-symptoms: drenching night sweats, fever >38c/100.4f, weight loss = likely more aggressive
391
Which, Hodgkin's or non-Hodgkin's lymphoma, is more associated with:
- skip pattern/non-contiguous spread
- multiple lymph node involvement
- extra-nodal/organ involvement
- less predictable spread
Non-Hodgkin's lymphoma
392
Which, Hodgkin's or non-Hodgkin's lymphoma, is more associated with:
- contiguous spread pattern
- limited to one group of lymph nodes
- rarely has extra-nodal involvement
- Spreads predictably
Hodgkin lymphoma
393
Which areas of the body should be assessed when doing a physical exam for lymphoma?
- Lymphoid survey
- Waldeyer's ring (tonsils, base of tongue, nasopharynx)
- Liver and spleen (hepatosplenomegaly)
394
Which condition is classified in severity by the Ann Arbor scale?
Hodgkin's or non-Hodgkin's lymphoma
395
Name the four stages on the Ann Arbor scale
- 1. Single lymph node (LN) region
- 2. Two or more LN regions on the *same* side of the diaphragm
- 3. Involves LN regions on *both* sides of the diaphragm
- 4. Disseminated extra-lymphatic disease involving one or more organs OR with distant, non-regional lymph node involvement
396
Best diagnostic tool for the confirmation of lymphoma
Excisional biopsy
