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Infectious for step 2 > Infectious 2 > Flashcards

Infectious 2 Flashcards

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1
Q

The patient started on empiric vancomycin and culture grow susceptible S.Mutans to penicillin what to do?

A

Change to penicillin V or ceftriaxone

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2
Q

Disseminated gonococcal infection?

A

Purulent Arthritis
Triads of tenosynovitis, dermatitis, and migratory polyarthralgia
NAAT: From genital area
Culture is less sensitive

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3
Q

Symptoms of CNS Toxo?

A

Headache
Confusion
Fever
Focal neurologic deficiet

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4
Q

Diagnosis?

A

AIDS with CD4<100
Positive Toxo IgG
Multiple ring-enhancing lesions on MRI

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5
Q

managment?

A

sulfadiazine & pyramitamine(lukovorine)
ART whithin 2 week
Prophaxis:TMP-SMX(CD4 < 100)

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6
Q

Progressive multifocal leukoencephalopathy?

A

JC virus reactivation(JC virus infect in childhood and remain dormant in kidney and lymphoid thishu, Reactivation in CD4 < 200 and cause oligodendrocyte damage in white matter)
In IC patient

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7
Q

Manifestation?

A 
Slowly progressive
Confusion
Paresis
Ataxia
Seizure
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8
Q

Diagnosis?

A

MRI: Asymmetric, hypodense, white matter lesion with no enhancement and edema.
LP: PCR JC virus
Biopsy: rarely needed

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9
Q

Treatment?

A

Often fatal
Antiretroviral
Most patients develop a neurologic complication

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10
Q

HIV-associated dementia imaging?

A

Cortical atrophy
Ventriculomegaly
Reduced attenuation of white matter

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11
Q

Fungal pneumonia and erythema nodusum?

A

Histoplasmosis

Especially people come from Mississippi and Ohio

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12
Q

Differential dignosis in same rigion(M & O)?

A

Blastomycosis But B: Skin ulcer, bone erosion, and prostatitis but In H: erythema nodusum and HL

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13
Q

When to consider meningitis?

A 
Presence of >=2 signs from 4 signs and symptoms
1-Headache
2-Fever >38
3-Nuchal rigidity
4-AMS
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14
Q

A common cause of bacterial meningitis in age >2?

A

S.pnumonia

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15
Q

hemophilus ducri(Chancroid) symptoms?

A

Large, deep ulcer with gray/yellow discharge
well-demarcated border with & soft friable mass
Severe, painful LDP that may be superlative
Diagnosis requires culture
azithromycin is curative

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16
Q

tissue invasive CMV infection?

A

Common inpatient with IC and not receiving Px(indicated in organ transplant patient)
manifestation
-Hepatitis
-gastroenteritis
–intersticilal pnumonia
-Meningoencephalitis
diagnose with blood/tissue biopsy(GS)– PCR
Manage with IV gancyclovir in severe cases and PO in mild

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17
Q

Gonnococal pharengitis?

A

In sexually active by orogenital contact
Bilateral non tender LD
Prharengial erythema and edema w/o exudate
Concomitant PID/STI

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18
Q

HIV prophylaxis recommended in?

A

High-risk exposure

  • mucosal, nonintact skin, and subcutaneous exposure
  • Blood, Semen, Vaginal fluid, and anybody secretion with blood content.
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19
Q

What and when to give?

A

Initiate urgently
Continue for a 28 day
>= 3 drug
2NRTI + 1 II/PI/NNRTI
even if the patient serostatus not known but at risk
De serostatus at a spot for a baseline then 6 weeks,3 months, and 6 month

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20
Q

Cryptosporidium?

A 
CD4 <180
animal contact, water, and person to person tm
Severe watery diarrhea
low-grade fever
wight loss
examine with modified acid-fast stain (3-6 um oocyst)
Treatment is supportive and ART
Infection persist until CD4 improve
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21
Q

Mirosporidium/isospora?

A

CD4 < 100
watery diarrhea
lower abdominal pain
wight loss
fever is rare
Microsporidia(spore in stool and treat with albenda)
Isospora Belli (oocyst and treat with TMP-SMX)

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22
Q

MAC?

A

CD4 < 50
Sever fever(>39)
watery diarrhea and fever

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23
Q

CMV?

A 
CD4 <50
frequent Bloody diarrhea
low-grade fever
Wt loss
Abdominal pain
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24
Q

Tetanus PEP?

A 
------Clean minor wound
Td/TDaP If
the last dose is given> 10 year
History of childhood Vx<3, uncertain or not Given
-----Dirty/sever wound
Td/TDaP If
the last dose is given> 5 year
With Tetanus immunoglobulin if History of childhood Vx<3, uncertain or not Given
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25
Childhood vaccination?
2,4 and 6 month 15-18 month Every 10 year Td
26
Why TD/TDaP?
Diphtheria and pertussis need booster
27
Babisiosis epidimology?
babesia microti NE USA Ixodus scapularis thick bite
28
Clinical menifestasion?
Flu-like symptom sign of IV hemolysis ARDS, CHF, DIC, and splenic rupture in severe case mild hepatosplenomegaly Anemia,thrombocytopenia,Elevated LDH/LFT/bilirubin
29
Diagnosis?
thin blood smear(intraerythrocytic ring(maltase cross)
30
treatment?
Atovaquone + azithromycin sever: Quinine + clindamycin 7-10 days and up to 3 months until resolve
31
watery diarrhea in HIV patient approach?
microscopy/Culture stool for ova and parasite Clostridium difficile AG AFS: for cryptosporidium
32
Infectious mononucleosis etiology?
EBV
33
Clinical manifestation?
``` Fever and fatigue Tonsilitis/pharengitis +-exudate Posterior cervical/diffiuse LDP +-Hepatosplenomegaly +-rash after amoxicillin ```
34
Diagnostic finding?
Hetrophile Ab(monospot test)--FN in first 1 week Lymphocytosis transient hepatitis
35
Managment?
Avoid sport for > 3 weeks and contact sport >4 week
36
Varicella vaccine for HIV?
If CD4 >200--Since it is LAV For Low anti varicella Ab on serology immediately at diagnosis of HIV
37
Pertussis clinical presentation?
cathera l(1-2 weeks): mild cough and rhinitis paroxysmal(2-6)week: cough with an inspiratory whoop,posttusive vomiting, apnea in an infant convalescent: weeks to month:resolve
38
diagnosis?
Pertussis culture/PCR | Lymphocytosis
39
treatment?
Macrolide
40
what about allergic aspergillosis?
occur in patients with CF/Asthma bronchial obstruction symptom eosinophilia/not lymphocytosis
41
Mycoplasma pneumonia symptom?
Respiratory droplet winter/fall close-quarter/young military and dorm
42
CM?
indolent headche,fever,mailase persistent dry cough nonexudative pharengitis vesicular/macular rash on extremity
43
Diagnosis?
``` Normal leukocyte count intersticial pnumonia/infilitrate on CXR subclinical hemolysis(Cold agglutinin) ```
44
Treatment?
usually emperic | Macrolid or respiratory floouroquinolol
45
Acute HIV infection CM?
Lasts 2-4 week Mononucleosis like symptoms Generalized macular rash(oral ulcer(painful), oval,pink macular lesion)--Transient and stay for a week GI symptom
46
Diagnosis?
High viral load(>100,000) Normal CD4 count Serology may be negative
47
Managment?
Start HAART | Partner screening and secondary prophylaxis based on serology
48
Prophylaxis should be given?
TMP-SMX--PCP Gancyclovir--CMV(based on donor serostatus) PCV and HBV vaccination prior to transplant--to make sure of immune response IM influenza vaccine yearly Antifungal prophylaxis for lung and liver transplant
49
ehrlichiosis?
Transmitted by tick bite(Lonestar thick) | SE & Central USA
50
clinical manifestation?
``` Flue like illness Nurologic symptom(AMS and Neck stiffness) rash uncommon(<30 % RMSF like lesion w/o spot) ```
51
Diagnosis?
Lukopnia and thrombocytopnia Intracytoplasmic morula(on monocyte) Elevated TA and LDH PCR
52
managment?
Doxycycline while waiting for the result
53
S.pnumonia is common in what CD4 count?
If CD4 <200
54
Indolent murmur can be seen in patients with fever?
Mid systolic, G2 murmur on left cost sternal --Due to high blood flow.
55
UTI with alkaline urine indicates?
Urase producing bacteria infection - -proteus(MC) - -Klebsiella
56
Neurocysticercosis epidemiology?
Tenia Solium(pork tapeworm) egg feco-oral transmission C & S America,Subsaharan Africa and asia
57
CM?
``` Prolonged incubation(month-years) Seizure ICH sign cysticercosis can involve liver and muscle Systemic sympoms are absent ```
58
Diagnosis?
MRI/CT | cyst(hypodense/edema or enhancement)
59
Treatment?
Seizure/ICH treatment Antiparasitic therapy(Albendazole) Corticosteroid
60
Treatment of latent TB IN HIV?
``` Positive PPD(Induration >=5 mm) or Positive INTY assay Rule out active disease(Symptom + CXR) ( month of INH + pyridoxine) ```
61
Microbiology of IE?
based on patient risk
62
S.Aures?
IV drug user Implanted devise catheter prosthetic valve
63
Viridian streptococci(SM and SS)?
Gingival manipulation | Respiratory incision or biopsy
64
streptococcus epidermidis?
Implanted devise Iv catheter prosthetic valve
65
Enterococcus?
Nosocomial UTI | GU procedure
66
Streptococcus gallolycoticus/bovis?
Colonic CA | IBD
67
Fungi(candidia)?
IV drug IC prolonged antibiotic
68
Parvovirus B-19 infection CM?
``` Flu-like symptom Slapped check rash in children and lacy in adult Erythema infectiousum(fifth disease) Acute, Symmetric arthritis Transient pure cell aplasia ```
69
diagnosis?
``` Acute IgM in Imunocompitent NAAT in immunocompromise Reactivation IgG and NAAT ```
70
Nocardia Tx when the brain is involved?
TMP-SMX + carbapenem | If possible drain abscess
71
Fluconzole proflaxise in HIV?
Given as secondary prophylaxis | Pateint previous history with still low CD4 count
72
Early HAART tx benefit?
early CD4 recovery decrease inflammation related cardiac and renal complication Decease oncogenic virus reactivation Decrease public transmission risk
73
IE treatment?
Acute; empiric vancomycin | Subacute; Based on culture result
74
Syphilis diagnosis?
Non-treponemal | Treponemal
75
Non-treponemal?
``` RPR and VDRL Ab to cardiolipin -cholesterol-lecitine Ag Quantitative(tITER) Possible -Ve in early disease Decrease titer confirms treatment ```
76
Treponemal?
``` FTA-AB and TP-EIA Ab to treponemal antigen Qualitative(R/NR) High sensitivity in early disease Positive after treatment ```
77
HAV vaccination indication?
Chronic hepatitis Gay IV drug user
78
Treatment of NG positive and CT negative urethritis by NAAT?
Ceftriaxone and azithromycin(dec resistance) | If azithromycin C/I substitute doxycycline
79
ecthyma gangrenosum?
Typical pseudomonal skin infection Occur in immunocompromised patients Vascular invasion of media and adventitia--vascular obstruction--skin necrosis(gangrenous skin ulceration fever
80
Managment for patients with severe penicillin allergy and have syphilis?
``` P-Doxyxycline 14 day S-Doxyxycline 14 day L-Doxyxycline 28 day T-Ceftriaxone 14 day Do NTAB titer after 6-12 month ```
81
Travelers diarrhea cause?
``` profuse watery diarrhea Transmitted by water Cryptosporidium Giardiasis Cyclospora ```
82
Managment of pyelonephritis?
Complicated oral FQ or TMP-SMX complicated IV cephalosporins,FQ, aminoglycoside or ESBL
83
Complicated?
``` DM URT obstruction Renal failure Instrumentation Immunosuppression Hospital aquired ```
84
Monospot test negative and strong suspicion for IM?
IgM and IgG for EBV | IgM for CMV
85
Leprosy CM?
A macular anesthetic lesion with a raised border | Nodular, painfully nearby nerve with loss of sensory and motor function
86
Diagnosis and managment?
``` Full skin biopsy Tubercloid Dopson + rifampicin Lepromatous Dapsone + Rifampcine + CFZ ```

Infectious for step 2 (3 decks)

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