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Infectious for step 2 > Infectious 1 > Flashcards

Infectious 1 Flashcards

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1
Q

What to do next if the patient tests positive for HIV?

A 
Start ART irrespective of CD4 count
Determine CD4 count
Determine viral load
Determine drug resistance
Prophylaxis based on CD4
Vaccination
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2
Q

Prophylaxis based on CD4 and other indications?

A

Primary prophylaxis
Cd4<200, Oropharengisl candidiasis, history of PCP-Dailey Cotri for PCP
<100(and positive serology for Toxo)–Daily Cotri for Toxo
<150 and live in an endemic area:Itraconazole for HC
Vancyclovir/acyclovir–For recurrent herpes
VarIG or IVIG administer within 4 days of exposure: For patients with close contact with shingle/Cp and no previous infection history and negative serology
Azithromycin for MAC and fluconazole for fungal infection not recommended more

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3
Q

Vaccine?

A

Varicella zoster-for patients with negative serology and have no shingles/chickenpox
Pneumococcal
Influenza
HAV and HBV

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4
Q

Alternative for COTRI?

A

For PCP:Dapsone,atovaquone and Pentamidine

For Toxo:Dapsone + Pyramitamine +lukoverine or Atovaqone +- pyramitamine + lukoverine

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5
Q

Lyme disease?

A

Transmitted by Ixodus thick bite
&-14 dy incubation
Caused by borrelia bergdoferi
Symptoms based on the stage
Common in the northeastern United States.
Stage 1—early localized: erythema migrans
(typical “bulls-eye” configuration B is
pathognomonic but not always present),
flu-like symptoms.
Stage 2—early disseminated: secondary lesions,
carditis, AV block, facial nerve (Bell) palsy,
migratory myalgias/transient arthritis.
Stage 3—late disseminated: encephalopathy,
chronic arthritis, peripheral neuropathy.
CSF:Lymphocytic predominancy

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6
Q

Managment?

A

Localized(EM)–Doxycyclin, amoxicillin for pregnants and azithromycin if patient allergic for both
Disseminated(Stage 2 &3)–IV ceftriaxone

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7
Q

Rhino cerebral mucormycosis CM?

A

caused by rhizopus specious(Irregular, broad, non septate hyphae branching at wide angles)
acute/progressive
Purulent nasal discharge, Fever, sinus pain,headache, and nasal congestion
Necrotic innovation of palate, orbit, and brain
Rhinocerebral, frontal lobe abscess; cavernous sinus thrombosis and cranial nerve involvement

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8
Q

Diagnosis and treatment?

A

Sinus endoscopy with biopsy and culture
Liposomal amphoteracine B
Surgical debridement
Treat underlying cause(hyperglycemia)

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9
Q

Risk for RCM?

A

DM(ketoacidosis)
Hematologic malignancy
Solid-organ or stem cell transplant

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10
Q

Prevention for meningiococcus?

A

Droplet precaution

Chemophrophlaxix(rifampin, ciprofloxacin, ceftriaxone, minocycline, and spiramycin)

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11
Q

Risk for PCP?

A

AIDS(<200 CD4) and Chronic Immunosuppressive therapy

This patient should receive COTRI prophylaxis

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12
Q

Clinical manifestation?

A

Indolent(AIDS) and respiratory failure(IST)
Fever, Dry cough, Hypoxia, and dyspnea
Increase LDH
Diffiuse bilateral reticulonodular infilitrate on CXR

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13
Q

Diagnosis?

A

Induced sputum or bronchoalveolar lavage

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14
Q

Managment?

A

Cotri(Po for mild and moderate and IV for sever) +/- Corticosteroid
AIDS: ART initiation within 2 weeks (after hypoxia improve)

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15
Q

Steroid and PCP?

A 
Cotri lyse bacteria and worsen inflammation--worsen pulmonary function
Indication
saturation < 92%
Spo2 < 70 mmg
PA-Pa gradient more than 35
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16
Q

What test to do inpatient with IE with S.Bovis?

A

Colonoscopy(especialy type I S.B)

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17
Q

Diagnosis of early Disseminated and late disseminated LD?

A

Serology

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18
Q

Bacillary angiomatosis RF?

A 
Bartonella hanselae/quintana
Cat scratch, Body/hair lice bitee, or homelessness
Sever IC(<100 CD4)
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19
Q

CM?

A 
Vascular cutanous lesion (papular ,pruritic, prple, pedanculated)
Systemic symptoms(fever, fatigue, and night sweet)
Organ involvement(liver, bone and CNS)
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20
Q

Diagnosis and managment?

A

Biopsy:Microscopy/histopathology
Doxycycline/azithromycin
ART for HIV

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21
Q

Clinical manifestation of influenza?

A

abrupt onset of symptom
Peak Jan-Feb
mild UR symptoms
High fever (possibly predominate), headache, and myalgia
Variable but often unremarkable PE finding(mild pharyngeal erythema w/o exudate)

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22
Q

Managment?

A

For the healthy patient: treat symptomatically and not require diagnostic modality
For patients present within 48 hours of symptoms and have the risk for influenza complication: Give antiviral (e.g oseltamivir)

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23
Q

Who are at risk of developing complication?

A 
Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis) Endocrine disorders (such as diabetes mellitus) 
Heart disease (such as congenital heart disease, congestive heart failure, and coronary artery disease) Kidney diseases.
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24
Q

Streptococcal pharyngitis?

A

Variable onset of symptom
Predominant pharyngeal symptom
variable possible fever/myalgia
Pharyngeal erythema, tonsilar hypertrophy, and exudate, tender cervical LN

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25
Viral URTI?
slow, stepwise, migratory or evolving Rhinorrhea, coryza, sneezing, and mild pharengitis Nasal edema, mild pharyngeal erythema or normal Mild systemic system
26
Managment of neutropenic fever?
Blood and urine culture empiric broad-spectrum antibiotic with antipseudomonal coverage(e.g cefepime, meropenem, and piperacillin -Tezobactem) Empiric antifungal with patient > 4 days of fever after antibiotic initiation
27
Neutropenia?
ANC<1500 Sever:ANC <500 ANC<1000:high risk for infection
28
Kaposi sarcoma?
Vivacious papular lesions predominantly affect the face, oral mucosa, perineum, and lower extremity Lymphedema can present(due to cytokine and Vessel obstruction) Can involve GI and other organs Caused by HHV8 The presence of other OI increase the risk of devt and exacerbation Is due to vascular proliferation
29
Diagnosis?
If atypical lesion or presence of systemic symptoms biopsy: To rule out BA
30
Managment?
HART | Surgery and chemotherapy in sever case
31
Clinical presentation of Chronic HCV infection
Asymptomatic Nonspesific symptome(joint pain,fatigu,nusea,anorexia,myalgia and wight loss) Increase transaminase(normal in 33%) Progression to cirrhosis in 33%:HCC
32
Extrahepatic symptom?
Mixed cryoglobulinemia(palpable purpura, arthralgia, Glomerulonephritis, and Low Complement Membroprolifrative disease Porphyria cutaneous tarda(present with Bulle/vesicle on trauma/sun exposed are and all patients with PCT need to be screened for HCV) Lichen planus(pruritic papular/vesicular lesion in dorsal forarm,butock and knee)
33
Trichinillosis epidimology and life cycle?
Caused by round worm trichinella Ingestion of undercooked meat(MC: pork) South America, Asia, and central Europe Gastric acid releases larvae within 1 week of ingestion-Invade SI and develop to worm--worm release larvae and invade striated muscle and encyst
34
Clinical presentation?
Intestinal stage(1 week) Abdominal pain, vomiting, diarrhea, and nausea Muscle stage(4 weeks) Fever and splinter hemorrhage Myositis(increase CK);pain,tenderness & swelling Periorbital edema, conjunctival/retinal hemorrhage Eosinophilia The disease can involve heart, lung & CNS
35
Sporotricosis caracter and risk?
Sporotrix shrunki (dimorphic fungi) Decaying plant matter/soil Gardners and landscapers
36
Clinical menifestasion?
subacute/chronic skin papule: papule can ulcerated, non-prulent and odorless discharge Proximal extension using lymphatic drainage LDP, deeper spread, and systemic symptoms are rare (Absence of this helps to differentiate from cat scratch disease and filariasis)
37
Diagnosis and managment?
Culture aspirate | 3-6 month of oral intraconazol
38
Epidemiology of disseminated histoplasmosis?
Midweast and the central US Soil contaminated by bird and bat dropping Increase dose exposure or IC
39
symptoms?
``` Fever, chills, weight loss and cachexia Cough and dyspnea Papules and nodules Hepatosplenomegaly Lymphadenopathy ```
40
Diagnosis?
``` Pancytopnia Transaminase elevation High LDH CXR(intersticial or reticulonudular infiltratin with hilar LDP) Urine/Serum Ag(sensetive/rapid) serology culture(2-4 week) ```
41
Managment?
Mild/maintainace(intraconazol) Moderate and severe (amphotericin B)-1-2 weeks then maintenance > 1-year itraconazole ART within 2 week
42
Cause of esophagitis in HIV patients?
Candidiasis(oral trush present concomitanteley) HSV(Orolabial lesion present concomitanteley) CMG(if no above lesion present) Odynophagia sever/predominate in viral case Dysphagia predominate in candidiasis
43
Endoscopy?
Candidiasis(white plaqu) HSV(Ulcerative round lesion) CMV(distal ulcerative lesion
44
Bright red, friable exophytic mass in HIV patient with the systemic symptom?
Bacilary angiomatosis | Oral erythromycin is a treatment choice
45
Clinical manifestation of cryptococcal meningoencephalitis?
Subacute presentation Symptom(Headache,Fever,Neck stiffness &AMS) LP:(elevated P,Low glucose,Low Wbc elevation(<50/ul),and elevated protein
46
Managment?
``` 2-week Amphoteracine B + Flucytosine Fluconazole maintenance (8 weeks) and consolidation for >1 year. Intrathecal AmpB for refractory case ```
47
Differentiation of cause of conjunctivitis?
different Clinical sign
48
Eye involvement?
V: U/B B: U/B A: B
49
Eye" stuck shut"?
In all 3 case
50
Discharge?
V: Watery, scanty, and string B: Prulent, thick A: Watery, scanty, and string
51
Discharge reaper with wiping?
V: No B: Yes A: No
52
sensation?
V: Burning, gritty B: Continous discharge sensation A: Itchy
53
Conjectural appearance?
V: diffuse injection, follicular: bumpy B: diffuse injection,non follicular C: diffuse injection, follicular: bumpy, conjunctival edema(bumpy)
54
Prenormal symptoms?
V: may have URTI symptom B: No A: No
55
MCC cause of bacterial conjunctivitis in adults?
S.Aures
56
HZ(shingle) pathogenesis?
VZ virus reactivation in sensory ganglia
57
Clinical manifestation?
predorm:pain,iching and tingling rash: vesicular rash in dermatomal distributuion Postherpetic neuralgia:Pain > 4 month from start of rash
58
Managment?
Acyclovir, valacyclovir and famciclovir
59
When to give PEP( Vaccine and immunoglobulin) for rabies exposure?
Must breach the skin Bite by a high-risk wild animal(raccoon, bat..) and animal unavailable for the exam(euthanasia and brain biopsy) If bitten by a domestic animal and become symptomatic within 10 day of followup Domestic animal unavailable for follow=up
60
what about low-risk animals?
mouth, rabites,chumpek, and squirrel | No PEEP
61
Blastomycosis?
Fever, productive cough, weight loss, and NS Skin ulceration and lytic bone lesion in a ribs(specific) Common in Mississippi and Ohio(Wisconsin)
62
INH liver toxicity managment?
If AT >10x .Immidiateley discontinu | If AT <100.Contniu tx and follow up
63
Managment of patient exposed to HBV infected and transmitting individual?
If vaccinate and known AB response: may only need a booster vaccine If not vaccinated: Vaccine + immunoglobulin Vaccine within 12 hr Immunoglobulins within 24 hr
64
Nocardia microbiology?
Partially acid-fast Filamentous G+ rode Aerobic
65
epidemiology?
Endemic in soil Contracted by inhalation and skin injury IC and elderly affected
66
Clinical fetcher?
Pnumonia:similar to TB CNS: Brain abscess Skin: abscesses on your hands, chest, or rear end.
67
Managment?
Antibiotic susceptibility assessment for all case TMP-SMX(6-12)month--to prevent a recurrence Add Ab like amikacine in sever case
68
Approch odynophagia and dysphagia in HIV patient?
If oral thrush:Fluconazole --if not respond endoscopy | No thrush?Endoscopy
69
CMV?
Gancyclovir
70
Aphthous ulcer?
Symptomatic therapy
71
Common 3 skin infection type?
Erysipelas Cellulitis(prulent) Cellulitis(non prulent)
72
Erysipelas?
``` Streptococcus pyogenic(GAS) Superficial dermis and lymphatics(E.ear involvement suggestive (lake deep dermis) Raised sharply demarcated edge Rapid spread and onset Fever in early course ```
73
Cellulitis(prulent)?
``` Streptococcus pyogenic and MRSSA Deep dermis and sucutanous fat Flat edge with poor demarcation Indolent(develop or days) Fever occurs latterly ```
74
Cellulitis(non prulent)?
``` MSSA and MRSA Purulent drainage Folliculitis;Hair follicle infection Furuncle:Folliculitis + dermis involvment--abcess Carbuncle: Multiple furuncle ```
75
Erysipilase managment?
No SS: oral amoxicillin If SS: Ceftriaxone, cephazolin extensive rash, Systemic toxicity, and comorbidity: culture Treat if there skin breach
76
Biopsy finding in HSV and CMV?
HSV: Multinucleated giant cell CMV: Intranuclear/cytoplasmic eosinophilic inclusion and balloning degeneration
77
Cause of urethritis in men?
N.G C.T M.G Tricomonas(Rare)
78
Diagnosis?
NAAT: Diagnose all N.G: Gram stain(G-ve rod) C.T: Culture negative and gram stain negative
79
Managment?
C:T: Azithromycin or doxycycline/add ceftriaxone if gonococcus not ruled out or suspected
80
Meningitis empiric managment?
Age 2-50---Vancomycine + ceftriaxon/cefotaxin(3rd GC) Age >50-Vancomycine + ceftriaxon/cefotaxin +Ampicilin IC:Vancomycine + Cefepime(4th GC) + ampicilin Nurosurgery/trauma(PS):Vancomycine + Cefepime Dexametazone:D/C if S.P ruled out Alternative for cefempime--Ceftazidime or meropinem Alternative for Ampiciline-- TMP-SMX
81
jarisch-herxheimer reaction?
Occur 6-48 hr after initiation of Ab to spirochete (syphilis, leptospirosis, and Lyme disease) infection Acute onset fever, chills, and myalgia Rash progression in case of 2ndary syphilis
82
Managment?
suportive(fluid and NSAID) | resolve within 48 HR
83
A complication of influenza?
inpatient with risk to develop complications Pneumonia(bilateral diffuse reticular opacity)-may be a secondary bacterial infection Muscle: Myositis and rhabdomyolysis Cardiac: Myocarditis and pericarditis CNS: encephalitis and TM Oseltamivir is indicated
84
Infective endocarditis symptoms?
Systemic: Fever, Wt loss, myalgia, Arthralgia & malaise Cardiac: Valvular insuficiency and HF Vascular phenomena immunologic phenomena
85
Vascular phenomena?
systemic emboli mycotic aneurysm Janeway lesion: macular, erythematous, and non-painful on palm and sole
86
immunologic phenomena?
Osler nodule: painful, violaceous nodule in fingertip/toes Roth spot: Edematous and hemorrhagic lesion in retina Glomerulonephritis Positive RF
87
HCV diagnosis?
First, do AB Confirm with PCR Asses genotype and liver fibrosis

Infectious for step 2 (3 decks)

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