Fungus, Animals, Outdoors

Question 1

the most common fungal infection in immunocompromised patients that is a common normal flora that takes advantage of a change in normal flora

Answer 1

candida albicans

Question 2

a patient presents with cottony feeling in mouth, loss of taste, pain with eating/swallowing, and has white plaques. Dx?

Answer 2

oropharyngeal candidiasis

Question 3

how to diagnose candidiasis?

Answer 3

KOH prep

Question 4

the presence of candidiasis where, is an AIDS defining illness?

Answer 4

esophagus

Question 5

what are 2 treatment options for mucosal candidiasis?

Answer 5

fluconazole
itraconazole

Question 6

primarily an opportunistic infection in immunocompromised hosts; the most common cause of fungal meningitis, causes pulmonary disease, is found in dried pigeon dung, and is acquired via inhalation.

Answer 6

cryptococcosis

Question 7

an immunocompromised patient presents with fever, chest pain, dyspnea, cough, hemoptysis. Dx?

Answer 7

cryptococcal pneumonia

Question 8

an immunocompetent patient presents with headache, fever, lethargy, personality changes, memory loss, nuchal rigidity/meningeal signs, and N/V. Dx?

Answer 8

cryptococcal meningoencephalitis

Question 9

how does an immunocompromised patient with cryptococcal meningoencephalitis present differently from a immunocompetent patient?

Answer 9

immunocompromised pt may not have meningeal signs

Question 10

what are 2 diagnostics for cryptococcosis?

Answer 10

CT lungs
lumbar puncture - encapsulated yeast in CSF

Question 11

what is the treatment for cryptococcosis? (3)

Answer 11

amphotericin B + flucytosine
then fluconazole

Question 12

linked to bird droppings and bat exposure; causing respiratory illness

Answer 12

histoplasmosis

Question 13

a patient presents with chills, headache, myalgia, anorexia, cough, and chest pain; after being around birds. Dx?

Answer 13

acute pulmonary histoplasmosis

Question 14

a patient presents with fever, enlarged liver and spleen, adrenal insufficiency, oropharynx ulcers, fever, dyspnea, cough, weight loss, and chest radiograph shows miliary pattern. Dx?

Answer 14

progressive disseminated histoplasmosis

Question 15

a patient presents with productive cough, dyspnea, chest pain, fatigue, fever, sweats, and fibrotic apical infiltrates with cavitation on chest radiographs. Dx?

Answer 15

chronic pulmonary histoplasmosis

Question 16

what diagnostics can be used for histoplasmosis? (4)

Answer 16

CT/Chest xray
biopsy
fungal cultures
urinary antigen

Question 17

what is the treatment for stable histoplasmosis for under 4 weeks?

Answer 17

no treatment

Question 18

what is the treatment for mild-moderately severe disseminated histoplasmosis?

Answer 18

itraconazole

Question 19

what is the treatment for severe histoplasmosis that is causing meningitis and ARDS?

Answer 19

IV amphotericin B

Question 20

what is the lifelong treatment for AIDS-related histoplasmosis?

Answer 20

Itraconazole

Question 21

the deadliest parasitic disease in which transmission requires the female anopheles mosquito

Answer 21

malaria

Question 22

which 2 malaria-causing species have a liver phase?

Answer 22

P. vivax
P. ovale

Question 23

which malaria-causing species is the worst/most dangerous?

Answer 23

P. falciparum

Question 24

how is malaria contracted? (5)

Answer 24

bite of infected female Anopheles mosquito
sporozoites go to liver
hepatic schizont ruptures
goes to merozoites
infects RBCs

Question 25

a patient presents with cold sensation and shivering, then has fever, headaches, vomiting, and then has sweats and tiredness. On physical exam, they have elevated temp, diaphoresis, splenomegaly, mild jaundice, hepatomegaly, and tachypnea. Dx?

Answer 25

uncomplicated malaria

Question 26

a patient presents with AMS, deep breathing/resp distress, metabolic acidosis, pulmonary edema/ARDs, severe anemia, hypoglycemia, clinical jaundice, and disseminated intravascular coagulation. Dx?

Answer 26

severe malaria (P. falciparum)

Question 27

why is P. falciparum the most virulent?

Answer 27

targets ANY RBC and leads to end organ damage

Question 28

what is the gold standard to diagnose malaria?

Answer 28

giemsa-stained blood smear

Question 29

what other diagnostic can be done for malaria?

Answer 29

dipstick test

Question 30

what is the treatment for malaria?

Answer 30

chloroquine

Question 31

what other medication can be used for malaria in chloroquine-resistant areas?

Answer 31

mefloquine

Question 32

which medication can treat malaria in the liver phase (p. vivax and p. ovale)?

Answer 32

primaquine

Question 33

what are 2 preventatives for malaria?

Answer 33

DEET-based mosquito repellant prophylactic atovaquone-proguanil + doxycycline

Question 34

what is the most common tick-borne disease in the US and europe?

Answer 34

lyme disease

Question 35

what tick stage is the primary vector in lyme disease?

Answer 35

nymphal stage

Question 36

a patient presents with an erythema migrans rash that looks like a "bulls-eye" lesion, myalgias, arthralgias, headache, and fatigue. Dx?

Answer 36

early localized Lyme disease

Question 37

a patient presents with secondary skin lesions similar to erythema migrans, malaise, fever, fatigue, headache, neck pain, achiness, facial palsy. Dx?

Answer 37

early disseminated Lyme disease

Question 38

a patient presents with swollen joints on the knees, memory loss, mood change, and sleep disturbance. on physical exam, you notive acrodermatitis chronica atrophican (bluish-red discoloration of the skin with sclerotic plaques and atrophy). Dx?

Answer 38

late persistent Lyme disease

Question 39

what can be used to diagnose a patient with lyme disease if they are not an in endemic are or the diagnosis is unclear?

Answer 39

antibody testing with enzyme immunoassays

Question 40

what is the prophylactic treatment for lyme disease if the tick is ixodes species, the exposure took place in an area with endemic lyme, or if the tick was attached for 36 hours or more?

Answer 40

one dose doxycycline

Question 41

what antibiotics can be used to treat lyme disease in an adult/non pregnant patient? (1) child/pregnant patient? (2)

Answer 41

doxycycline amoxicillin OR cefuroxime

Question 42

illness in which the principle vector in the U.S is dermacentor viriabilis (the american dog tick)

Answer 42

rocky mountain spotted fever (RMSF)

Question 43

a patient presents with faint macules that progress to maculopapules and then petechiae on the palms and soles, high fever, fatigue, myalgias, headaches, and GI symptoms. Dx?

Answer 43

Rocky Mountain Spotted Fever

Question 44

what is the best diagnostic for RMSF?

Answer 44

indirect immunofluorescent antibody assay (IFA)

Question 45

what is the treatment for RMSF?

Answer 45

doxycycline

Question 46

how is toxoplasmosis contracted? (2)

Answer 46

oocyte ingestion by contamination of cats transplacental transmission of trophozoites

Question 47

how does a primary infection of toxoplasmosis occur in immunocompetent patients?

Answer 47

travels through lymphatics

Question 48

a patient presents with nontender cervical or diffuse lymphadenopathy, fever, malaise, myalgias, headache, sore throat, and rash. Dx?

Answer 48

primary toxoplasmosis

Question 49

how does congental infection of toxoplasmosis occur?

Answer 49

pregnant woman exposes fetus

Question 50

what can occur d/t early fetal toxoplasmosis infections? (4)

Answer 50

spontaneous abortion stillbirth seizures retardation

Question 51

what can occur d/t late fetal toxoplasmosis infections? (2)

Answer 51

appear normal at birth present symptoms later in life

Question 52

a patient presents with pain, photophobia, visual changes associated with toxoplasmosis. what syndrome is this?

Answer 52

retinochoroiditis

Question 53

what is the most common late presentation of congenital toxoplasmosis?

Answer 53

retinochoroiditis

Question 54

how does toxoplasmosis present in immunocompromised patients?

Answer 54

reactivated toxoplasmosis

Question 55

what is the most common manifestation of toxoplasmosis in immunocompromised patients?

Answer 55

advanced AIDS

Question 56

what are 2 diagnostics for toxoplasmosis?

Answer 56

serological test PCR

Question 57

what lab finding indicates acute toxoplasmosis?

Answer 57

tachyzoites

Question 58

what lab finding indicates acute or chronic toxoplasmosis?

Answer 58

cysts

Question 59

what is the treatment for toxoplasmosis in an immunocompetent patient?

Answer 59

none

Question 60

what is the treatment for toxoplasmosis in a pregnant patient <18 week gestation?

Answer 60

spiramycin until delivery

Question 61

what is the treatment for toxoplasmosis in a pregnant patient >18 week gestation, if fetal infection is present by positive amniotic fluid PCR?

Answer 61

pyrimethamine + sulfadiazine

Question 62

a viral encephalitis transmitted by infected saliva by an animal bite or an open wound

Answer 62

rabies

Question 63

a patient presents with an animal bite, fever, malaise, headache, N/V, and aerophobia. Dx?

Answer 63

rabies

Question 64

which form is considered the classic rabies in which delirium alternates with periods of calm, and includes hydrophobia and hypersalivation?

Answer 64

encephalitic form

Question 65

which form of rabies is characterized by acute ascending paralysis that resembles Guillain-Barre?

Answer 65

paralytic form

Question 66

what will be found in the skin of humans to diagnose Rabies?

Answer 66

negri bodies

Question 67

when does death from rabies occur after symptoms present?

Answer 67

after 7 days

Question 68

what is the prophylactic treatment for rabies that must be started before S&S develop? (2)

Answer 68

human rabies immune globulin (HRIG) + human diploid cell vaccine OR purified chick embryo cell vaccine

Question 69

how is tetanus contracted? (3)

Answer 69

spores in soil introduced to wound toxin binds to neurons leads to uncontrolled spasms of muscle

Question 70

the most common and severe form of tetanus in which the patient has trismus (lockjaw), tonic contraction of their skeletal muscles, intense muscular spasms, stiff neck, opisthotonus (arching body), and risus sardonicus (sardonic smile).

Answer 70

generalized tetanus

Question 71

the form of tetanus that includes tonic and spastic muscle contractions in one extremity or body region

Answer 71

local tetanus

Question 72

the form of tetanus that is secondary to head/neck injuries, involves the cranial nerves (often fascial); causes dysphagia, trismus, and focal cranial neuropathies

Answer 72

cephalic tetanus

Question 73

the form of tetanus that causes a new born to refuse eating, difficulty opening mouth d/t trismus, clenched hands, dorsiflexed feet, and increased muscle tone

Answer 73

neonatal tetanus

Question 74

what is a differential diagnosis of tetanus?

Answer 74

strychnine poisoning (rat poisoning)

Question 75

what is the treatment for tetanus? (5)

Answer 75

debride wound penicillin OR metronidazole human tetanus immunoglobulin (HTIG) Mg sulfate (for autonomic instability) labetalol (hypertension/tachycardia)