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Clin Med II > ID Diagnosis > Flashcards

ID Diagnosis Flashcards

(65 cards)

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1
Q

What are the tests to diagnose HIV?

A

4th gen ELISA

confirm w/ western blot

PCR

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2
Q

What does HIV primary infection look like?

A

Fever, malaise, N/V/D, maculopapular rash, neuro sx

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3
Q

What labs do you want to monitor for HIV?

A

every 3-6 mo monitor:

CD4 cell count and HIV RNA

CBC

Chemistries

Liver, kidney, lipids, fasting glucose, HbA1c

Annual STIs, Hep B, C, HSV and cancer

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4
Q

Classic triad of RMSF

A

Classic triad: fever, headache & rash

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5
Q

Incubation of RMSF

A

2-14 d

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6
Q

Rash beings on ankles/wrists, palms/soles, spreads centrally, maculopapular, bit by tick

A

RMSF

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7
Q

What would labs for RMSF show?

A

eukopenia, thrombocytopenia

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8
Q

small painful ulcers on an erythematous base

A

HSV-1 & 2

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9
Q

large, shallow ulcers

A

CMV

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10
Q

ulcerations with exudate at

the base

A

Aphthous stomatitis

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11
Q

Kaposi’s sarcoma

A

associated w/ herpes virus

ca of enfothelium

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12
Q

Bacillary angiomatosis causative organism

A

Bartonella henselae

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13
Q

How is malaria transmitted?

A

Transmitted by female mosquito (Anopheles) → humans (intermediate host)

Can be transmitted via blood or to fetus but more rare

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14
Q

Epidemiology of malaria

A

MC Africa
South America

Malaria-endemic areas develop resistance to clinical dz slowly w/ age (quicker w/ higher intensity

*Resistance is to clinical manifestation NOT infection

Pregnant women more susceptible and lose resistance to infection

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15
Q

What to look for in labs if concerned about malaria

A

Anemia (Hgb <13)

Thrombocytomepia (<100K)

Leukopenia

↑ AST and ALT

↑ Creatinine

Microscopy- blood thin (species) & thick smears

Rapid Diagnostic Test

PCR

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16
Q

What type of malaria is the main cause of severe clinical malaria and death?

A

Plasmodium falciparum

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17
Q

How often is fever present for P vivax and P ovale?

A

every 2 days

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18
Q

How often is fever present for P malariae

A

every 3 days

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19
Q

What patient population is protected from P. vivax and why?

A

Duffy Ag absent in West African populations

Pts must have duffy antigen on their RBC in order for P. vivax to bind and invade

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20
Q

Where is Babesiosis MC seen?

A

New England, Wisconsin & Minnesota

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21
Q

What is the parasite that causes Babesiosis?

A

B. microti

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22
Q

How is Babesiosis transmitted?

A

Tick Ixodes scapularis (same as lyme)

*requires >24 hr of attachment

Can also be transmitted via blood transfusion

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23
Q

Microscopic exam of blood → “Maltese cross” pattern

Flu-like illness- fever, chills, fatigue, HA (lasting wks to mo)

A

Babesiosis

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24
Q

May be asymptomatic in children

Loose, foul-smelling stools

Steatorrhea (fat malabsorption)

Cramping, bloating, nausea

Anorexia, malaise, weight loss

No blood in stool

Chronic: steatorrhea, growth impairment

A

Giardia Intestinalis

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25
How is Giardia Intestinalis transmitted?
drink contaminated fresh water (beaver fever) 1-4 wk incubation
26
Gradual onset Liver abscess → sx >4 wk, fever, abd pain, hepatomegaly, jaundice, cough due to diaphragm irritation Amebic dysentery and colitis - fever w/ bloody diarrhea, cramping, abd pain, weight loss
Amoebiasis
27
Amoebiasis etiology
Entamoeba histolytica
28
Amoebiasis transmission
Fecal oral transmission Invades mucosa of large intestine and thickness of intestinal wall → perforation or peritonitis and can get into blood stream→ If gets into portal circulation goes to liver
29
Watery diarrhea Dehydration, weight loss, abd pain, N/V
Cryptosporidiosis
30
Cryptosporidiosis peak seasons
late summer and early fall
31
Cryptosporidiosis transmission
Outbreaks in day care centers Zoonotic transmission: farmers and animal handlers Waterborne infection: swimming pools, public drinking water
32
Winterbottom’s sign: posterior cervical adenopathy Intermittent fever: due to antigenic variation CNS involvement: Diurnal somnolence, nocturnal insomnia, constant HA, behavior changes→ DEATH Gambial HAT → mo to years Rhodesian HAT→ wks to mo
Human African Trypanosomiasis (HAT) “Sleeping Sickness”
33
Human African Trypanosomiasis (HAT) epi and eti
sub-Saharan Africa Trypanosoma brucei gambiense (West African) Trypanosoma brucei rhodesiense (East African)
34
How is Human African Trypanosomiasis (HAT) tranmitted?
Transmitted to human by Tsetse flies
35
Chagoma: indurated lesion at site of parasite entry Romaña’s sign when conjunctiva is port of entry Fever, facial edema Severe myocarditis w/ ECG changes Chronic: dilated, megacolon, cardiomyopathy
Chagas Disease
36
How is Leishmaniasis transmitted?
Sandfly Vector
37
Fever, weight Loss Hepatosplenomegaly Pancytopenia Hypergammaglobulinemia Hyperpigmentation (“Black Fever”)
Kala-azar Visceral Leishmaniasis (VL)
38
Kala-azar Visceral Leishmaniasis (VL) etiology
L. donovani (Asia-Africa L. infantum (southern Europe) L. chagasi (Brazil)
39
Mucocutaneous Leishmaniasis (ML) etiology
L. braziliensis (Central/South America)
40
What type of endocarditis is most likely to have peripheral manifestations?
Subacute Bacterial Endocarditis
41
What are peripheral manifestations of infectious endocarditis?
conjunctival petecchiae splinter hemorrhages Osler's nodes (pain, fingers and toes) Janeway lesions (macules on palms and soles) Roth's spots (retinal hemorrhages)
42
What pt pop is most likely to get SBE and what is the etiology of it?
Pts who recently had dental procedure or who have underlying valve abnormality MC = Viridans Streptococci (part of oral flora)
43
What pt pop is most likely to get ABE and what is the etiology?
MC w/ IVDU S. aureus**
44
What type of bacteria is most likely to be the cause of Cx neg endocarditis and why?
Coxiella burnetti or Chlamydia psittaci bc it doesnt grow well for cx
45
What bacteria is most likely the cause of prosthetic valve endocarditis if presentation is <60 days from surg?
S. aureus or S. epidermidis
46
What bacteria is most likely the cause of prosthetic valve endocarditis if presentation is >60 days from surg?
viridans streptococci
47
What valves are MC involved in infective endocarditis?
Mitral MC then aortic Tricuspid MC in IVDU
48
What bacteria is associated w/ high morbidity w/ CHF and emboli?
Coag neg staph → S. lugdunensis
49
Pathogenesis of NBTE
Endothelial cell damage, hypergoagulability (less common in US) RF: valvular dz, malig, CT d/o, intracardiac catheter, prolonged febrile illness, persistent fetal circulation
50
Pathogenesis of Transient bacteremia
MC in US Turbulent flow → high pressure flow, structural abnormality (regurg or narrow) and bacteremia (valvular adherence)
51
What baseline labs should you get for pt presenting w/ fever and neutropenia?
CBC Liver and renal function tests Urinalysis, blood and urine culture CXR
52
What pt pop is at risk for Neutropenia and Defects in Phagocytic Defenses?
Post chemotherapy or other myelosuppressive therapy, bone marrow transplant recipients, acute leukemics Risk of infection is significant at ANC <500
53
What pt pop is at risk for infections due to defects in Cellular Immunity?
Pts w/ AIDs, Hodgkin's lymphoma, monoclonal Ab therapy and LT corticosteroid use Infection due to opportunistic pathogens
54
What pt pop is at risk for infections due to Defects in Humoral Immunity?
Pts w/ gammaglobulinemia, Multiple Myeloma, CLL with hypogammaglobulinemia, splenectomized patients, sickle cell disease
55
what organisms are pts w/ Pts w/ gammaglobulinemia, Multiple Myeloma, CLL with hypogammaglobulinemia, splenectomized patients, sickle cell disease at risk for?
Offending organisms are encapsulated, pyogenic bacteria: S. pneumoniae, H. influenzae
56
What infections is HIV pt w/ CD4 <100 at risk for?
``` Cryptococcal Infections MAI CMV Toxoplasma Cryptosporidium ```
57
What infections is HIV pt w/ CD4 <200 at risk for?
PJP
58
What is qSOFA criteria?
RR>22, AMS, SBP <100 mmHg qSOFA ≥ 2 IDs pts w/ suspected infection who are likely to have a prolonged ICU stay or to die in the hospital
59
What type of bacteria is most likely to cause sepsis and why?
Endotoxin bacteria more likely to cause sepsis (due to cell wall component on gram negs)
60
Pathophys of sepsis
Life-threatening organ dysfn caused by a dysreg host response to infection Bacteria invade tissue → macrophages are triggered and released causing pro and antiinflam mediators to respond Sepsis occurs when proinflam mediators > anti and they exceed the boundaries of the local enviro
61
MC cause of septic shock
"Any source of infection→ MC is pneumo, intra-abd infection, UTI bacteremia MC G neg: E.Coli, Klebsiella, pseudomonas, enterobacter MC G pos: Staph aureus, Strep pneumo MC Fungi: candida"
62
Define septic shock
Sepsis w/ circulatory and cellular/metabolic abnormalities profound enough to substantially ↑ mortality (type of distributive shock bc of hypotension)
63
Criteria for septic shock
At least 1 of the following: Persistent hypotension after fluid resuscitation and requiring vasopressors to maintain MAP >65 mmHg Serum lactate level >2 mmol/L
64
W/u for septic shock
ID infection source: PE, blood cx, urine cx, resp cx, CXR, CT CBC, CMP, LFT, coags, lactate, ABG Assess preload (CVP, US)
65
What do you expect to see on w/u for DIC?
PT/INR ↑ (extrinsic coagulation factors) aPTT ↑ (intrinsic coagulation factors) Fibrinogen ↓ (can be high during early sepsis) D-Dimer ↑ Platelets ↓ (Thrombocytopenia)

Clin Med II (19 decks)

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