ID Flashcards
(118 cards)
1
Q
What is seen on CXR of the inhaled form of Anthrax?
(will be on exam)
A
Widened mediastinum
2
Q
What is post-exposure prophylaxis for patients exposed to aerosolized B. anthracis (anthrax)?
A
Start Cipro w/in 48hrs- treat for 60 days
+
3 dose series of Anthrax vaccine
3
Q
Although most pts with Toxoplasmosis don’t need treatment, If someone has severe/prolonged infection, or are immunocompromized/pregnant?
A
- Pyrimethamine + sulfadiazine OR pyrimethamine + clindamycin + leucovorin
- Tx minimum of 2-4 weeks
- Ophthalmology
4
Q
How do you treat diphtheria? (4)
A
- Diphtheria equine antitoxin
- Penicillin or erythromycin x14 days
- Remove membrane by laryngoscopy
- ISOLATION until neg culture x3
5
Q
T/F: the following is some of the diagnostic for chronic lyme disease:
- H/o lyme treatment
- onset of nonspecific sxs (fatigue, arhtralgias, memory disturbances, etc) w/in 6 months
A
True
6
Q
The following is caused by what virus?
- Transmission: sex, close contact (daycare), blood, perinatal
- usually asymptomatic but sxs in transplant pt
A
Cytomegalovirus
7
Q
What is usually transmitted by the infected saliva of a bat, raccoon or skunk?
A
Rabies (caused by rhabdovirus)
8
Q
Which infectious disease?
- Aedes mosquito
- Sexual, vertical or blood transmission
- Sxs: Acute onset fever, maculopapular pruritic rash, nonpurulent conjunctivitis, arthralgias
- most are asymptomatic
A
Zika
9
Q
- Which staphylococcal strain is a frequent skin contaminant of blood cultures?
- What do you do to confirm whether a contaminant or a true cause of bacteremia?
A
- Staph epidermidis
- May have to draw from 2 sites
10
Q
The following is classic sxs of which disease?
- tonsillitis/pharyngitis, cervical LAD, fever
- Nausea, vomiting, anorexia (mild hepatitis in 90%)
- Splenomegaly (50-60%)
- Resolves in 1-2wks; fatigue persists x months
A
Infectious mononucleosis caused by EBV
11
Q
If you have a pregnant woman with Zika virus, what is the management?
A
Ultrasounds every 3-4wks looking for:
- Congenital microcephaly
- Also may see arthrogryposis (club foot) and spontaneous abortions
12
Q
Which infectious disease?
•Normal WBC count with immature bands
- Thrombocytopenia
- Hyponatremia
- Elevated LFTs
A
Rocky Mountain Spotted Fever
13
Q
what form of legionella is more mild and has the following:
•Fever, malaise, chills, fatigue, h/a
•No respiratory complaints
•Self-limited
A
Pontiac fever
14
Q
How do you prevent rabies? (this is the main tx)
A
Immunize household pets and ppl w/ signifcant animal exposure
15
Q
Which disease is usually asymptomatic in immunocompetent patients but can have:
- b/l symmetrical nontender cervical or occipital adenopathy
- Chorioretinitis – visual loss or floaters
A
Toxoplasmosis
16
Q
Which infectious disease has a gray membrane covering tonsils & pharynx?
A
Diphtheria
17
Q
Which staphylococcal strain is coagulase negative and is a leading cause of UTIs?
A
Staphylococcus saprophyticus
18
Q
How do you dx VZV
A
clinical diagnosis
19
Q
How do you tx tetanus? (7 most important)
A
- ICU
- Metronidazole
- Tetanus immune globin
- Tetanus immunization x3
- Benzos
- airway management
- neuromuscular blocking agents
20
Q
How do you tx Rocky Mountain Spotted fever?
A
Doxycycline w/in 5 days of onset
21
Q
When do you give the Herpes Zoster Vaccine?
A
50+
22
Q
What 4 things are used to dx Cryptococcosis?
A
•Respiratory secretion or pleural fluid culture
- LP with CSF analysis
- MRI
- Antigen testing
23
Q
How do you dx Zika virus?
A
- Viral RNA or IgM
- real-time RT-PCR of blood or urine for Zika virus RNA
24
Q
What is PEP for diphtheria?
A
Booster + penicillin or erythromycin
25
What causes:
* **_hemorrhagic mediastinitis_**
* occasionally **_necrotizing pneumonia_**
* Bacteremia
Inhalation clinical syndrome of Anthrax (the most dangerous form)
26
Toxoplasmosis in pregnancy can cause what 3 things
* Spontaneous abortion
* still-birth
* neonatal disease (neurologic & ophthalmic disorders)
27
Presentation of which disease?
* **_Erythema migrans_** (target lesion) 1 week after bite
* Viral like illness (myalgias, headache, fatigue,etc)
Lyme Disease
28
Which disease has a bimodal distribution (**5-10 and 35-55**)
Lyme disease
29
How do you tx anthrax if it is **systemic w/ meningitis**?
* Report/consult public health department
* **_Cipro + meropenem + Linezolid_**
* Antitoxin
* etc.
30
How do you tx pontiac fever?
symptomatic tx
31
How do you dx Toxoplasmosis
Serology- **ELISA**
32
Clinical presentation of which condition?
* Prodrome: fever, irritability
* Erythematous patches with large ***_superficial_*** **fragile blisters**
* When blisters rupture, skin appears red and scalded
* **Nikolsky sign** (only the first layer)
Staph Scalded Skin Syndrome (SSSS)
33
How do you dx Rocky mountain spotted fever?
•Serologic testing with IFA **(indirect fluorescent antibody**) for R. rickettsia antigen
34
How do you dx diphtheria?
Clinical dx
confirmed w/ culture and + toxin assay
35
What are the 3 MC etiologies of Fever of Unknown Origin (FUO)?
1. **_Infection_**
2. Malignancy
3. Connective Tissue Disease
36
Which infectious disease?
## Footnote
* Virus travels in **nerves to the brain**, multiplies in brain, then travels along efferent nerves to **salivary glands**
* Forms **_cytoplasmic inclusion bodie_**s – site of viral transcription & replication
Rabies
37
How do you dx tetanus?
**_clinical dx_** in setting of tetanus prone injury and hasn't had tetanus booster in last 5 yrs
38
How do you dx botulism?
**_Clinical dx_**
**Toxin in serum**, stool, etc
39
Presentation of what?
* Nodules, widespread infiltrates leading to **respiratory failure**
* Dissemination:
* CNS - **Meningitis**, AMS, CN abnormality
* **Skin – papules, plaques, abscesses, sinus tracts**
* MSK – osteolytic lesions
Cryptococcosis - presentation above is seen in immunodeficient patients
40
What type of abx should be used to tx SSSS? If there is no response, what 2 meds should you consider?
* **Penicillinase-resistant beta-lactam agents (Nafcillin)**
* If no response, consider MRSA & tx with vancomycin
41
What infectious disease causes **percussion myoedema** (mounding of the muscle at the percussion site)?
Rabies
42
Which disease?
* Caused by **_cat feces_** or eating poorly cooked contaminated meat
Toxoplasmosis
43
What is the main site of colonization of staphylococcal infections?
Nose
44
When would you treat VZV and what would you tx with?
**Acyclovir** w/in 72 hrs of onset
\>72 hrs if still getting new lesions
if immunocompromised
45
What are the two types of CNS presentations of Rabies? What do both forms progress to?
**•“furious” – encephalitic**
**•“dumb” – paralytic**
\*both forms progress to coma, ANS dysfunction, death
46
Etiology of Anthrax?
*Bacillus anthracis*
47
T/F: CMV can be vertically transmitted and is associated w/ syndrome of congenital CMV in newborns
True
48
How would you tx a pt w/ VZV with mod-severe pain
Stronger opioid (Oxycodone, morphine)
49
How do you tx Botulism?
* Equine serum **heptavalen**t botulism **antitoxin** w/in **24 hrs**
* intubation
* IV fluids
50
Which infectious disease is due to **Water reservoir contamination** and transmission is **never person-to-person**
Legionella
51
"Furious" (encephalitic) or "dumb" (paralytic) form of rabies?
* **gradual coma**
* **_NO hydrophobia_**
* **paralysis**
* muscle weakness and loss of sensation
* death
**_Paralytic rabies_**
(this is less dramatic and usually longer course than furious rabies)
52
How do you diagnose rabies? (4)
* test animal if possible
* PCR of saliva
* viral culture of saliva
* Full thickness skin biopsy from posterior region of neck at hairline
53
What are the top 3 complications of infectious mononucleosis caused by Epstein Barr Virus?
1. Pneumonia
2. Hepatitis
3. Myocarditis
54
What condition is caused by **Staph aureus** and is primarily in **_neonates 3-15 days old_**?
Staph Scalded Skin Syndrome (SSSS)
55
Hallmark of what condition?
* Painless **_eschar with extensive surrounding edema_**
**_(will be on exam)_**
Cutaneous clinical syndrome of Anthrax
56
Diagnosis of what?
* Clinical with cultures
* Skin biopsy shows **intraepidermal cleavage _without necrosis\*\*_**
Staph Scalded Skin Syndrome (SSSS)
57
How do you tx cytomegalovirus
strong antivirals (ex: ganciclovir)
58
What are 3 things that people with chronic lyme complain of?
1. fatigue
2. Arthralgias
3. Memory impairment
59
Which infectious disease:
* MC men, \<10y/o and 40-64y/o
* Fever, **severe h/a**, malaiase, myalgias, arthralgias
* **_Rash on day 3-5_**: blanching erythematous rash w/ macules--\> **_petechiae_**
* rash starts on **ankles/wrists--\> trunk--\> palms/soles**
Rocky mountain spotted fever
60
How do you tx legionella?
**Azithromycin** or clarithromycin or levofloxacin **x10-14days**
No isolation needed
61
What causes lyme dz?
***Borrelia Burgdorferi***
transmitted by **deer tick** and **blacklegged tick**
62
The following is a later finding of which infectious disease?
* **profuse sweating**
* **cardiac arrhythmias**
* labile HTN or hypotension
* fever
* **profuse sweating**
* **cardiac arrhythmias**
* labile HTN or hypotension
* fever
63
How do you treat Cryptococcosis?
* Amphotericin B x 14 days
* Follow with fluconazole x 8 weeks
64
Which disease?
* **_Unilateral vesicular eruption in a dermatomal distribution_**
* old people (\>50)
VZV- Herpes Zoster
65
What is tx for Zika virus?
rest
symptomatic tx
66
Which infectious disease?
* 90-95% serum positive
* Transmitted throug**h intimate contact w/ saliva**
* Persists a**symptomatically for life**, reactivation uncommon
* Associated w/ **B cell lymphomas**, etc
Epstein Barr Virus (EBV)
67
What are the complications of Lyme Disease in pregnancy?
•spontaneous abortion, still birth, preterm birth
68
Which 4 things can be vertically transmitted? (TORCH)
T- Toxoplasmosis
O- Other (Syphilis)
R- Rubella
C- CMV
H- Herpes
69
Clinical presentation of what?
* **Abrupt** onset **high fever**
* Vomiting & watery diarrhea
* Sore throat, myalgias, h/a
* Hypotension with kidney and heart failure
* **_Diffuse macular erythematous rash and nonpurulent conjunctivitis_**
* **_Desquamation, esp. of palms & soles_** (late finding)
TSS
70
Clinical presentation of which infectious disease?
* **Descending weakness**
* NO fever
* Visual- **blurred vision, _diplopia_**, **_nystagmus_**, ptosis
* urinary retention & constipation
* _**\*\*\*Paralysis may progress to respiratory failure\*\*\***_
Botulism
71
What is a good marker of acute infection of infectious mononucleosis (caused by EBV)
IgM and IgG antibodies against viral capsid antigen (VCA)
72
How do you prevent zika virus? (4)
* Mosquito control
* A**voidance of travel to affected areas when pregnant**
* Abstinence from sexual intercourse or barrier protection
* No blood donations
73
"Furious" (encephalitic) or "dumb" (paralytic) form of rabies?
* **MC**
* **paranoia,** terror
* **Hydrophobia**
* unquenchable thirst
* **oversalivating**
* Death by **cardiac arrest**
Furious (Encephalitic) rabies
74
Which bacteria causes infections of:
* Urine catheters
* IV lines
* Prosthetic joints/heart valves
* Dialysis catheters
Staph epidermidis
75
How do alduts typically get botulism? infants?
Adults= **canned**, smoked or vacuum-packed food
**_Infants= honey_**
76
Treatment of infective mononucleosis caused by EBV with ______ results in a morbiliform rash
Ampicillin
77
Which type of anthrax has the highest mortality rate? (cutaneou, injection, GI, inhalation or anthrax meningitis)
* **Anthrax meningitis-** even with treatment, mortality is 100%
* Inhalation is also very deadly with mortality rate of 45%
78
Is staph aureus coagulase negative or positive
**_positive_**
(Staph epidermidis and staph saprophyticus are both coag neg)
79
What causes rocky mountain spotted fever?
Rickettsia rickettsia
| (tick borne illness)
80
What are 5 risk factors for Legionella?
(you can be exposed without getting sick)
* **smoking**
* chronic lung disease
* older age
* **transplant recipient**
* biologic therapy
81
What is the etiology of TSS?
Staph aureus
82
How do you tx Anthrax that is systemic WITHOUT meningitis?
* Report/consult public health department
* **_Cipro + Clinda_**
* Antitoxin
* etc.
83
Which disease can cause **_encephalitis with multiple necrotizing brain lesions_** in immunocompromised pts
Toxoplasmosis
(this is the most concerning presentation)
84
The following is the general "criteria" for what?
* Fever **\>38.3**degC (100.9F)
* At least **3wks duration**
* **No dx** after 3 outpt visits or 3 days of hospitalization
Fever of unknown origin
85
How do you dx early lyme?
clinical diagnosis
86
The following lab findings are seen in which infectious disease?
* Renal/hepatic dysfunction
* Thrombocytopenia
* **Leukocytosis**
* Hypophosphatemia
* **_Hyponatremia_**
* **Hematuria/proteinuria**
* Elevated serum ferritin
Legionella
87
When is it important to test someone for Zika virus even if they are asymptomatic?
**Test asymptomatic pregnant women** for IgM **2-12 weeks** after:
* travel to endemic area OR
* sex w/ person with confirmed Zika
88
Which infectious disease?
* **_Trismus_** ("lock jaw")
* **_tonic/spastic muscle contraction in 1 EXTREMITY OR BODY REGION_**
* intermittent intense spasms
Tetanus
89
What is prophylactic treatment of Toxoplasmosis?
Trimethoprim- sulfamethoxazole
90
What is the GI form of Anthrax from?
consumptom of **_undercooked_**, infected meat from animals infected with anthrax
91
What is seen on CXR for legionella?
•**Patchy unilobar infiltrat**e that progresses to consolidation
**_•Pleural effusions_** common
92
How do you dx late lyme? (intermittent or persistent arthritis, subtle encephalopathy, polyneuropathy)
Clinical dx + lab evidence
93
T/F: there has been bioterrorism w/ anthrax spores
True
94
Pathology of which infectious disease?
* Retrograde axonal transport within motor neuron
* **Blocks neurotransmission,** inactivating inhibitory neurotransmission causing:
* **_increased muscle tone_**
* **_painful spasms_**
* widespread autonomic instability
Tetanus
95
How do you tx Lyme Disease? Alternative tx for pregnant women?
**Doxycycline x10-14 days**
Amoxicillin for pregnant/lactating women
96
How do you treat cutaneous Anthrax?
* Report/consult public health department
* _**Ciprofloxacin\*\***_
* Antitoxin
* etc.
\*\*\*definitely know abx- will be on exam\*\*\*
97
The exotoxin from Coryneybacterium diphtheriae causes what 2 things?
Myocarditis
neuropathy
98
Which infectious disease has a **cough** that is initially mild and slightly productive and then develops **blood-streaked sputum** (rarely gross hemoptysis)
Legionella
99
Which infectious disease causes:
* **Necrotic ulcers** surrounded by **extensive edema** of infected intestinal segment and adjacent mesentery
* Can cause **GI hemmorrhage**
**GI tract** clinical syndrome of **Anthrax**
100
What is the MC presentation of Cytomegalovirus?
CMV mono
101
Which infectious disease **blocks release of _acetylcholine_ at the neuromuscular junction**
Botulism
102
What is PEP and PrEP for rabies?
PEP= Human rabies immune globulin, Rabies vaccine
PrEP= Human diploid cell vaccine
103
What are 3 complications of Zika virus?
* Guillain-Barré syndrome
* Myelitis
* Meningoencephalitis
104
Lab findings in TSS are consistent with what?
shock and organ failure
105
What is empiric antibiotic tx for TSS?
**Clindamycin + Vanco**
| (Also needs rapid rehydration--\> 3L)
106
Which clinical syndrome has a prodrome including sxs like **hemoptysis and dyspnea** and can resultmin **_death within days_**
INHALATION clinical syndrome of Anthrax
107
How do you dx CMV?
Quantitative DNA PCR
108
How would you tx a pt w/ VZV with mild pain
NSAIDs and acetaminophen
109
How do you diagnose Legionella?
sputum culture
**_Urinary antigen tests_**
110
Criteria that must be met for you to give prophylactic antibioticcs for lyme disease:
## Footnote
* Tick attached for at least ____ hours
* Prophylaxis within ____ hours of the time the tick was removed
* More than 20% of ticks in the area are known to be infected with B burgdorferi
* No contraindication to the use of doxycycline
* Tick attached for at least **_36_** hours
* Prophylaxis within **_72_** hours of the time the tick was removed
111
The following are complications of what?
## Footnote
**_•Postherpetic neuralgia_** (90d of pain)
* Ocular complications – uveitis, keratitis
* Aseptic meningitis
* Encephalitis
**•Herpes zoster oticus (Ramsay Hunt syndrome)**- facial palsy w/ vesicles in ear
•Myelitis
VZV
112
What is the #1 MC malignancy to cause FUO (fever of unknown origin)?
Lymphoma, especially non-hodgkins
113
Complications of which infectious disease?
* Renal failure
* **Sepsis**
* **Encephalitis**
* Noncardiogenic pulmonary edema
* ARDS
* **Cardiac arrhythmias**
* Coagulopathy/DIC
* GI bleeding
* **Skin necrosis**
Rocky Mountain Spotted Fever
114
Infectious mono caused by EBV:
Early presence of what excludes acute infeciton?
IgG antibodies to **EBV nuclear antige**n (EBNA)
\*this indicates latent infection
115
What are the 2 complications of Diphtheria?
**•Myocarditis complication** – arrhythmias, heart block, heart failure
**•Neuropathy complication** – diplopia, slurred speech, dysphagia
116
For someone to get lyme disease: ticks need to feed for ___ to ___ hours to transmit infection
24-36 hours
117
Which disease?
* **Pigeon dung**
* transmitted by inhalation
* usually asymptomatic
* Immunocomp- progressive lung disease and dissemination
Cryptococcosis
118
What are the 2 main treatments of infectious mononucleosis caused by EBV?
* Supportive care- NO ABX (Amox)
* Sports restrictions- no contact b/c of splenomegaly
