infectious disease 2 Flashcards
(91 cards)
1
Q
rocky mountain spotted fever vector
A
Dog ticks
2
Q
clinical features + lab features of rocky mountain spotted fever
A
- fever, headache, rash
- rash beginning in ankles and wrists
- thrombocytopenia, mild transaminitis, ***hyponatremia
3
Q
rocky mountain spotted fever treatment
A
doxycycline
4
Q
rocky mountain spotted fever geography
A
South central and southeast states
5
Q
most all tic borne diseases are treated with
A
doxycycline
6
Q
treatment of complete heart block from lyme disease
A
CTX
- NOT pacemaker
7
Q
only tic borne disease not treated with doxy
A
babesia (parasite, not TIC)
8
Q
treatment of babesiosis
A
azithromycin + atovaquone
9
Q
most common cause of transfusion related infection in US
A
Babesiosis
10
Q
anaplasmosis lab features
A
- thrombocytopenia + elevated liver enzymes + leukopenia
* morulae in granulocytes
11
Q
diseases with black legged tick as vector
A
- Babesiosis
- Anaplasmosis
- Lyme disease
12
Q
ehrlichiosis lab features
A
- Thrombocytopenia + elevated liver enzymes
- morulae in monocytes
13
Q
anasplasmosis vs. ehrlichiosis
A
murulae are in monocytes in ehrlichiosis, granulocytes in anaplasmosis
14
Q
Unique clinical features of dengue fever
A
- after inflating BP cuff, petechia are present
- headache localized behind the eyes
15
Q
Chikungunya clinical features
A
- severe polyarthralgia affecting small distal joints
16
Q
other clinical + lab features of dengue
A
- joint pain
- macular rash sparing palms and soles
- leukopenia
- elevated liver enzymes
17
Q
norovirus clinical features
A
- outbreaks in nursing home
* *Vomiting predominant, rather than diarrhea predominant
18
Q
most common cause of traveler’s diarrhea
A
ETEC
19
Q
deli meats, unfermented
A
listeria
20
Q
reheated rice syndrome pathogen
A
bacillus
21
Q
rapid onset vomiting after eating potato salad
A
staph aureus
22
Q
swimming in recreational facility with treated water with treated water
A
cryptosporidium (not killed by chlorine)
23
Q
unpasteurized milk pathogen
A
brucellosis
24
Q
direct exposure to TB or recent TB contact cutoff
A
greater than 5 mm
25
Caveat about treating TB for patients on warfarin
Can't use rifampin or rifapentine
26
TB drug least likely to cause LFT elevation
ethambutol
27
organisms requiring airborne precautions
TB
VZV
measles
SARS
28
hanta virus clinical features
see memory palace
29
francissela tularemia clinical features
- Francis has wings on + is sweating profusely + has a ulcer like below on his hand/variable presentation severe febrile pulmonary infection OR ulcerative disease at inoculation site).
30
cutaneous larva migrans clinical features
parasite living in intestines of dogs + larvae in sandy soil + red intensely pruritic eruption that looks like twirling lesions
31
Lyme disease treatment
doxycycline
32
Lyme disease treatment if neurologic or cardiac involvement
CTX
33
Management of patient testing PCR positive for anaplasmosis and treated with doxy but fails to improve
- likely has babesiosis, treat or babesiosis
34
babesiosis treatment
azithromycin + atovaquone
35
Cryptosporidium watery or bloody diarrhea
watery
36
salmonella watery or bloody diarrhea
bloody
37
campylobacter watery or bloody diarrhea
bloody
38
cyclospora watery or bloody diarrhea
watery
39
Shigella watery or bloody diarrhea
bloody
40
Enterobacter watery or bloody diarrhea
bloody
41
Chitlins (chitterlings) + association
- pork intestines
| - yersinia
42
Yersinia watery or bloody diarrhea
bloody
43
yersinia clinical features
Ben is there in a bathtub next to her dancing around/causes acute diarrhea or pseudoappendicitis (right lower abdominal pain due to mesenteric adenitis and/or terminal ileitis). + bloody diarrhea
44
Yersinia treatment
supportive care
45
Shigella clinical features
Shitting into bucket + Spenser’s sweating profusely + eyes super sunken in/causes bloody diarrhea + abdominal pain + high fever + severe dehydration.
46
Other clinical associations of anthrax
- exposure to animal hair, hides
| - mediastinal widening on CXR
47
Parapneumonic effusion vs. empyema or complicated parapneumonic effusion
Parapneumonic effusion = effusion in pleural space.
| *Complicated parapneumonic effusion and empyema occur when bacteria infect the pleural space
48
Empyema definition
Collection of pus within the pleural space
49
Complex effusion definition
effusion with internal locations
50
initial treatment of invasive aspergillosis
voriconazole
51
Other distinguishing features of conjunctivitis
```
Bacterial = purulent discharge
Viral = viral prodrome, other viral URI symptoms
Allergic = itching of eyes, nasal congestion, sneezing, wheezing
```
52
botulism presentation
Gram is stuffing sword down throat + he has big headphones on + he has eyes in is forehead/is four-eyed (diplopia code) + duck tape over his mouth + darts all over his body/classic presentation = 3 D’s: diplopia + dysphagia + dysphonia + skeletal muscle weakness + dysarthria (*key to differentiating presentation from anticholinergic effects). Also, dry mouth + mydriasis.
53
Treatment of botulism
Antitoxin
54
Timing of antiviral therapy for VZV
- Start therapy within 72 hours of onset
| - IF after 72 hours, only start antiviral therapy if new lesions are appearing (indicating ongoing viral replication)
55
Treatment of varicella
acyclovir, valacyclovir, famciclovir
56
HPV vaccination age
11-26 (can be administered starting at age 9)
| *after age 26 on individual basis, recommended if new sexual partners.
57
Chagas disease presentation
massive colon hanging across top of courtyard + huge Mr. Farrington with the top of his head cut off + Massive head with esophagus + huge ureters hanging from courtyard and dripping piss/presentation = dilated cardiomyopathy with apical atrophy + megacolon + megaesophagus + megaureter (all by below pathophys mechanism) + achalasia. His right eye is swollen like below/unilateral periorbital swelling (Romana sign) characteristic of acute stage.
58
Haemophilus ducreyi (Chancroid) presentation
Walls of room covered in grey and yellow exudate + shenk with a painful, draining abscess on his dick/multiple and deep ulcers + base may have gray to yellow exudate. Draining buboes.
59
Pasteurella multocida clinical features
- Location: kitchen at M&D's house
- Picture the nipper/kuma with eye glasses on/looking like louie Pasteur + he’s biting dad in the calf causing a large skin abscess + an eel in dad’s leg/part of normal flora in cats and dogs and bits cause skin abscesses + cellulitis + osteomyelitis.
60
Pasteurella multocida treatment
Terry is fucking kuma in the butt/treat with penicillin.
61
leprosy treatment
Nate at the top of a ramp + daphne doing a dab + chloe from Dartmouth as a centar/treatment = dapsone + rifampin AND add clofazimine.
62
Nocardia treatment
- Location: asteroid
| - Jan playing a DJ set/treat with sulfonamides (TMP-SMX).
63
Nocardia clinical features
- Big caves all around asteroid with Neil walking out of them + magic Johnson with wings flying next to helicopter/pulmonary nocardiosis occurs in immunocompromised + can present as cavitary pneumonia and is commonly confused with TB.
- Big holes/depressions in her head + circular rays of light coming out of her head/imaging reveals abscesses in brain (ring-enhancing focal lesion).
64
presentation of MAC + imaging
* similar to TB (cough, fever, *weight loss)
- typical occurs in patients with underlying lung disease but can also occur in absence of prior lung disease
- nodular or cavitary opacities
- HRCT: multifocal bronchiectasis + small nodules
65
Treatment of pulmonary MAC
combination therapy with clarithromycin + ethambutol + rifampin
66
pulmonary MAC diagnosis
2 positive sputum cultures
OR
1 bronchial lavage wash with positive culture
OR
bronch with lung biopsy with histopathological features of mycobacterial infection and positive culture
67
Differential + management of patient with positive RPR titer after treatment for syphilis
- reinfection vs. inadequate treatment vs serofast reaction
- IF titer significantly decreased --> prob serofast reaction, so repeat RPR in 6 months to make sure its stable and not rising + check HIV
- IF failure to fall 4 fold or persistent symptoms -- LP to rule out neurosyphilis
IF reinfection (new parters or new symptoms) -- treat again
68
epidemiology of blastomycosis and histoplasmosis
Both in Mississippi and Ohio River Valley
| - Blasto more in Midwestern US
69
Blastomycosis clinical features
- cutaneous plaques/ulcerations
- bone lesions with sinus tracts
- pulmonary involvement (cough, dyspnea)
- GU involvement (epididymo-orchitis)
70
Coccidioidomycosis clinical features
- skin lesions
- lymph node involvement
- meningitis
71
Treatment of blastomycosis
IF mild to moderate -- itraconazole
| If severe -- amphotericin B
72
Other clinical feature of histoplasmosis
Pulmonary involvement with hilar or mediastinal adenopathy
73
antibiotic regimen for patient who is flu positive with superimposed PNA
Azithro + CTX + vanc
(cover for strep and staph)
*just add vanc
74
Treatment of jarisch-herxheimer reaction
- supportive (tylenol, NSAIDS, IV fluids) (self-limiting)
75
Management of bell palsy
- prednisone ASAP
76
clinical features of meningococcal meningitis
- severe myalgia
- rapid deterioration within 22 hours of symptom onset
- nonspecific: fever/HA/vomiting
- specific: petechia, meningeal signs, AMS
77
treatment of meningococcal meningitis
CTX
| *chemoprophylaxis for close contacts
78
isolation precautions for meningococcal meningitis
droplet precautions
79
chemoprophylaxis for contacts of meningococcal meningitis infected patients
Rifampin + cipro + CTX
80
P jirovecii pneumonia presentation + imaging
- subacute: dyspnea, dry cough, fever
- similar to TB: weight loss, headache, night sweats
- immunocompromised patient
- high LDH
- imaging = interstitial infiltrates + can have cavitary lesions
- can have spontaneous PTX
81
parvovirus presentation
- asymptomatic or flulike
| - acute symmetric arthralgia (hands, wrists, knees and feet (resembling RA)
82
syndrome caused by parvovirus in SCD patients
- pure red cell aplasia
83
parvovirus diagnosis
*IgM (a lot of people have IgG from previous infection, which documents immunity)
84
acute rheumatic fever presentation
- fever + migratory arthritis involving large joints + chorea + erythema marginatum + pancarditis + subcutaneous nodules
85
mono presentation
fever + pharyngitis + LAD + atypical lymphocytosis
86
Toxo plasmodia treatment in HIV patients
pyrimethamine + sulfadiazine + *leucovorin (pyrimethamine is a folic acid antagonist)
87
Drugs that interfere with folic acid metabolism
- MTX
- phenytoin
- pyrimethamine
- trimethoprim
88
west-nile encephalomyelitis presentation
- patient in hot, humid weather in summer
- *Asymmetric flaccid paralysis
- Extrapyrimidal symptoms
- maculopapular rash (20-50%) in chest, arms, back
- can have parkinsonism symptoms (rigidity)
89
Post-polio syndrome clinical features
- history of paralytic polio, then develop worsening of previous weakness later in life
- weakness, fatigue, muscle, or joint pain (no infectious symptoms)
90
lung abscess clinical features + CXR findings
- fever, night sweats, weight loss, cough with foul-smelling sputum
- *weeks or months of above symptoms
* cavitary lesion with air-fluid level
91
first-line treatment of lung abscess
Ampicillin-sulbactam
OR
carbapenem
*clinda no longer recommended due to risk of treatment-associated Cdiff
*bronch not required (unlike other abscesses, lung abscesses don't require drainage and frequently respond to antibiotics)
*treat until repeat CXR is clear or shows small, stable residual lesion
