Exam Review 3 Flashcards

Question

How is babesiosis treated?

Answer 1

Not necessary in asymptomatic; If treated, prolonged courses; evaluate for Lyme; if mild microtii - atovaquone plus azithromycin; if severe, clindamycin plus quinine; b divergens requires immediate complete RBC exchange transfusion (plus cindamycin and quinine)

Answer 2

Highly contagious, bacterial infection of superficial epidermal layers; Mostly Staphylococcus aureus or Streptococcus pyogenes; 3 clinical presentations (Non-bullous, Bullous, Ecthymatous)

Answer 3

1. Bullous: flaccid bullae with clear yellow fluid that becomes purulent, & ruptured leaves a thick brown crust, caused by exfoliative toxin producing S. aureus (Exotoxin A & B); 2. Non-bullous: papules surrounded by erythema that progress to pustules, which enlarge & rupture into thick, adherent crusts with gold appearance; 3. Ecthymatous: “punched-out” ulcer with black eschar surrounded by raised margin

Answer 4

Local care, bacterial culture; if healthy w/ limited infection: topical antibiotic; if complicated or widespread: oral antibiotic (1st gen cephalosporin or beta lactam-beta lactamase combo)

Answer 5

superficial infection of hair follicles presenting as perifollicular pustules; Majority of bacterial folliculitis due to S. aureus; Exposure to hot tub/swimming pool  Pseudomonas; Acne patients treated with antibiotics  gram-negative bacteria

Answer 6

antibacterial washes, topical antibiotics if localized, Oral antibiotics if widespread, resistant or recurrent, extensive surrounding cellulitis, immunosuppression, risk for MRSA (Methicillin-resistant S. aureus), systemic signs of infection; bacterial culture should be sent

Answer 7

Bacterial infection of dermis often begins with portal of entry; can be associated with lymph node or lymphatic channels; Erysipelas is superficial cellulitis with marked dermal lymphatic involvement

Answer 8

Local trauma (bug bites, laceration, abrasion, puncture wound), Underlying skin lesion (furuncle, ulcer), Inflammation (local dermatitis, radiation therapy), Edema and impaired lymphatics in affected area, Preexisting skin infection (impetigo, tinea pedis); NOTE: Cellulitis from the following is rare: hematogenous spread of infection or direct spread of subjacent infections (fistula from osteomyelitis)

Answer 9

Outpatients with non-purulent cellulitis: empirically treat for β-hemolytic streptococci (Group A) and MSSA; Outpatients with purulent cellulitis: empirically treat for community-associated MRSA

Answer 10

presents with erythema, scale, pruritus, erosions, exudate, and crust; usually located in the lower third of the legs, superior to medial malleolus; can occur bilaterally or unilaterally; edema often present, as well as varicose veins and hemosiderin deposits (pinpoint yellow-brown macules)

Answer 11

I&D: 1. Analgesia and sedation; 2. Incision; 3. Manual expression of contents; 4. Lysis of intracavitary septae; 5. Saline irrigation; 6. Wound stenting

Answer 12

Superficial fungal infections caused by organisms that invade and proliferate in keratin-containing layers of hair, skin & nails; classified by site

Answer 13

Cellulitis, Tinea corporis

Answer 14

Microscopic evaluation of scale treated with potassium hydroxide (KOH) solution; Take skin scrapings for KOH exam from MARGIN;

Answer 15

Topical treatment is usually appropriate as first-line agent for tinea pedis and tinea corporis; Oral medications considered when involvement is extensive, tinea corporis transmitted by an animal, fungal infection of hair or nails

Answer 16

caused by Malassezia species; clinical manifestations when yeast transforms to mycelial form; Characterized by well-demarcated, tan, salmon, or hypo/hyper-pigmented patches, most commonly on trunk; scale often not visible, but seen when rubbed – diagnostic

Answer 17

topical or oral antifungals

Answer 18

Viral infection due to pox virus; Benign, usually asymptomatic (no systemic manifestations); Characterized by 2 to 20 discrete, 5-mm-diameter, skin-colored to translucent, dome-shaped papules, some with central umbilication; Spread via skin-to-skin contact, fomite exposure, & autoinoculation; Lesions commonly occur on trunk, face, & extremities but rarely generalized

Answer 19

Young children (especially those with atopy) (NOT a sign of immunocompromise); Sexually active adults (STD); Immunosuppressed individuals (Adults with chronic MC outside the genital area should be evaluated for immunosuppression)

Answer 20

Various treatment options available: cantharidin, curettage, cryotherapy, topical retinoids, imiquimod; Children: spontaneous remission frequently occurs (“no treatment” is an option)

Answer 21

HPV that infects skin and mucosal epithelia

Answer 22

Majority common warts spontaneously resolve in 1-2 years without scar; Most treatments are destructive or aim at stimulating the immune response to HPV (Cryotherapy, Salicylic acid, Topical tretinoin, Podophyllin, Imiquimod); No specific antiviral therapy for cure; high recurrence rates

Answer 23

Herpes zoster of nasal tip; must Refer to ophthalmology patients with V1 Zoster due to risk of ocular disease and permanent loss of sight

Answer 24

Dorsoventrally flattened; 1st intermediate host always a snail

Answer 25

Bisexual flukes (dioecious) – Dorsoventrally flattened male clasps a cylindrical female in a ventral groove; Live in Blood vessels; Penetrate skin of definitive host

Answer 26

Peaking in the age group of 15 to 20 years; Decline in intensity - not in prevalence - as patients get older

Answer 27

1. Eggs in fresh water; 2. Snail as intermediate host; 3. Cercariae released in fresh water; 4. penetrate the human skin; 5. larvae migrate to the lungs, then to the heart and the liver; 6. worms pair off; 7. worms migrate to the bowel or else cause chronic schisto; 8. eggs are excreted

Answer 28

Cercarial Dermatitis (Pruritic, papular rash found on skin at the site of the cercarial penetration), Occurs within 24 hours of exposure - Usually on lower legs (“Swimmer’s itch”); Symptoms 4 to 8 weeks after exposure of Katayama Fever (Fever, sweats, chills, cough, diarrhea and headaches) - most likely to occur in new travelers

Answer 29

Lymphadenopathy and hepatosplenomegaly, Skin lesions – urticaria, Respiratory symptoms 2/3 – interstitial pneumonitis, Eosinophilia, Hyperglobulinemia

Answer 30

Presumptive - Praziquantel works only against adult worms, so retreatment necessary

Answer 31

Eggs may or may not be present stool/urine, so dx with eosinophilia and positive serology

Answer 32

Eggs in the intestinal wall that induce inflammation and microabscess formation; Symptoms/signs: Diarrhea (more common in children), Pain in the left lower quadrant, Occult blood in stool or visible, Colonic polyposis; Eggs can also embolize liver, causing granulomatous inflammatory response and periportal collagen deposits, portal hypertension and bleeding; hepatosplenic disease

Answer 33

Gold standard – eggs in patient’s stool; Serologic tests – FAST ELISA - not useful in someone from an endemic area

Answer 34

Usually seen in children - Eggs deposit around the lower end of ureters and in the bladder wall; Symptoms are seen large percentage infected; causes fetal head sign; can cause squamous cell carcinoma; caused by S. haematobium

Answer 35

Hematuria – 10 -12 weeks after exposure; Dysuria and hematuria – early and late; Late manifestations: Calcifications in bladder, Obstruction of the ureter, Proteinuria – nephrotic range, Renal Failure

Answer 36

Eggs in urine (Viability test – hatching test), Eggs in bladder biopsy, FAST ELISA

Answer 37

Pyrazinoisoquinoline; Action Unknown

Answer 38

Humans are only known reservoir, Spread by fecal-oral transmission, Peaks during warm months in temperate climates

Answer 39

Complication after 30-40 years; Not an infectious process

Answer 40

May range from clinically inapparent illness (90% of infections) to paralytic polio; Abortive poliomyelitis (8% of cases): Fever, headache, sore throat, no neurological sequelae; Nonparalytic poliomyelitis (1-2%): Severe headache, neck stiffness (“aseptic meningitis”) w/ full recovery after 2-10 days; Spinal paralytic poliomyelitis (less than 1%): weakness and flaccid asymmetric lower limb paralysis, can involve respiratory muscles, recover from paralysis (often incomplete) can occur, 10% fatality rate; Bulbar paralytic poliomyelitis (less than 0.1%): Cranial nerve paralysis (mostly CN 9, 10), Vasomotor and respiratory centers involved, may be fatal due to respiratory muscle paralysis, 50% fatality rate

Answer 41

Inactivated poliovirus vaccine, IPV: injected, does not cause disease, does not produce intestinal immunity, currently used; Oral poliovirus vaccine, OPV: easier to administer, produces intestinal immunity, usually reverts during intestinal replication, no longer used in US

Answer 42

Usually no GI symptoms; Common childhood infections; Worldwide distribution, summer peaks in temperate climates; Diagnosed clinically or viral culture or PCR

Answer 43

Aseptic meningitis; Encephalitis (Echovirus and Coxsackievirus); Chronic meningoencephalitis; Enterovirus paralysis (Infrequently associated with echovirus and Coxsackievirus infections, Less severe than poliomyelitis, Not permanent)

Answer 44

Prodrome: fever, chills, malaise, URI; presents as headache, fever, stiff neck, photophobia; NOTE: 90% of viral aseptic meningitis in community due to group B Coxsackieviruses; Diagnosed by PCR of spinal fluid; Therapy is supportive

Answer 45

Morbilliform - fine, erythematous, maculopapular; seen on face, arms, trunk; Associated with echovirus 9

Answer 46

Distinct vesicular eruptions in mouth, on hands and feet; Associated with Coxsackievirus A16 or enterovirus 71; may cause neurologic disease; large outbreaks in Asia

Answer 47

Single most important cause of severe diarrheal illness in infants and young children worldwide - 30-50%; Seven different serogroups, infect many different animals. A, B, C infect humans; Segmented dsRNA genome = reassortment; High mortality in developing world due to dehydration

Answer 48

Transmitted by fecal-oral contamination; only requires 10-100 infectious particles; Repeated infections with our without illness can occur with same or different strains; Increasing levels of immunity with repeated exposures or vaccination; Young children 3 mo - 2 yo primarily affected; disrupts tight junctions and microvillar network; secretes enterotoxin

Answer 49

Self-limiting disease, vomiting, watery diarrhea, low grade fever; Asymptomatic infections play a role in spread; Incubation period 1-3 days; Vomiting followed by 4-8 days of diarrhea; Recovery usually complete unless fluid/electrolyte replacement is not done - particularly risky for children under 2

Answer 50

RotaTeq: human - bovine reassortant; Rotarix - infectious attenuated human isolate

Answer 51

Caliciviridae; (+) strand RNA virus; Causes 50% of all food-borne outbreaks of gastroenteritis (23 million/yr US)

Answer 52

Fecal-oral spread; Retain infectivity passing through stomach; Blunting of villi in proximal jejunum, but site of replication not known; Basis for vomiting, diarrhea not known

Answer 53

Affects all ages; Year round, peaks in cold weather; Outbreaks often occur in semi-closed environments (nursing homes, hospitals, cruise ships), the military, schools and at recreational activities (sports events, camping trips, travel) that favor person-to-person spread; Incubation period 10-51 hr; Viral shedding: Peaks 1-3 days after illness onset, but may persist for 56 days; Immunity: short term homologous only; reinfection may occur

Answer 54

Sudden onset of vomiting (more common in children) and diarrhea (more common in adults); 30% asymptomatic infections; Severity: Less than other diarrheal infections but can lead to dehydration; Duration of illness: 28-60 hr; sometimes longer, especially in immunocompromised or with underlying illness

Answer 55

Delayed replication (i.e. dormant); Merozoites produced months after initial infection; P. vivax and P. ovale only; Not sensitive to chloroquine, quinine, mefloquine or artemisinin

Answer 56

Prodromal body aches, fatigue 2 – 3d prior; 1. Cold stage: feeling of intense cold and shivering for 15-60min; 2. Hot stage: intense heat, dry burning skin, throbbing headaches; 3. Sweating stage: profuse, declining temperature, 2 – 4 hours, exhausted and weak (sleep); this is a cyclical pattern!

Answer 57

1. Merozoite; 2. Ring; 3. Trophozoite; 4. Schizont

Answer 58

48 hr in P vivax, P ovale, 72 hr in P malaria, 24 hr in P knowlesi; P falciform can have any pattern

Answer 59

Malaria found in mainly South-East Asia, Americas; Host Duffy receptor required (almost never encountered in (West) Africa); Very acute febrile illness; Almost no fatalities – beware exceptions!; Recurrent infections (hypnozoites)

Answer 60

Malaria w/ oval erythrocytes with fimbriated edges; found in Sub-Sahara Africa & Western Pacific islands; Recurrent infections (hypnozoites); Lower parasitemia; Difficult to distinguish from P. vivax

Answer 61

Mild disease; Chronic stage: very low parasitemia, no evidence of persistent liver stages; Quartan 72 hr life cycle; Rare Nephrotic syndrome

Answer 62

Severe disease - Malaysia in 2002 saw increase of “atypical malaria”; Only primate parasite with 24h erythrocytic cycle

Answer 63

Severe malaria; Extensive parasite sequestration & organ dysfunction: anemia, Coma / Cerebral malaria, Acute respiratory distress syndrome (ARDS), Lactic acidosis, Severe jaundice, Hypoglycemia (decreased gluconeogenesis), Hyperparasitemia

Answer 64

Interval to development of symptoms: less than 10 days: P. falciparum; 10 – 60 days: Any species; more than 60 days: very unusual for P. falciparum; more than 3 years: P. malariae

Answer 65

Giemsa stain; BinaxNow - rapid detection test;

Answer 66

PfEMP1 - protective immunity takes years, immunity lost within 1 year of leaving endemic area; Antibodies are limited to geographic regions; pregnancy causes new receptors (CSA) and wipes away immunity

Answer 67

coma more than 1 hour after seizure or treatment for hypoglycemia and P. falciparum parasitemia; fatal if not treated! if treated, fatal in 10-20%

Answer 68

may aid in diagnosis (particularly of cerebral malaria - but not all patients have this); White centered hemorrhages, Macular whitening, Orange discoloration of vessels

Answer 69

six-fold reduction in death, impaired parasite growth at lower oxygen tension

Answer 70

unique to P. falciparum, Protein insertion RBC

Exam Review 3 Flashcards

(94 cards)