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DSE > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Acute rheumatic fever

A

Autoimmune inflammatory process that develops as a sequela of streptococcal infection

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2
Q

Dx of acute rheumatic fever

A

There is no specific diagnostic test for dx

Focus is on prevention with tx of strep and avoid repeated untreated infections

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3
Q

Rheumatic heart dz

A

The most significant complication of acute rheumatic fever which occurs after repeated bouts of acute illness

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4
Q

Abx and rheumatic heart dz

A

Antibiotic therapy does not alter the course, frequency, or severity of cardiac involvement once a pt develops rheumatic heart dz

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5
Q

Clinical manifestations of acute reheumatic fever

A 
Polyarthritis
Carditis
Erythema marginatum
Chorea
Subcutaneous nodules
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6
Q

PE of acute rheumatic fever

A

80% of pts present early on with painful migratory arthritis in large joint such as knees, ankles, elbows, or shoulders
Chorea is a rare late-onset sign
Carditis (with progressive CHF, a new murmur, or pericarditis) may be the presenting sign and most lethal

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7
Q

Work up of acute rheumatic fever

A

ASO titers should be combined with a careful clinical evaluation and other antibodies such as antistreptokinase and anti-DNAse.
Throat culture may only be positive in 25-40% at time of rheumatic fever

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8
Q

Tx of acute rheumatic fever

A

PCN: either an injection of benzathine benzylpenicillin, or pcn
OR
Oral cephalosporin if allergic to pcn and pt is ok with risk of 20% cross-reactivity and risk of allergic reaction with cephalosporin

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9
Q

Organisms of chlamydia

A

C. pneumoniae- mild pna or bronchitis in adolescents and young adults
-Older adults can have more severe infection
C. psittaci- Psittacosis after exposure to infected birds
-Transmission of both C. pneumoniae and C. psittaci is through repsiratory secretions
-Chlamydia causes 10-20% of cases of CAP
C. trachomatis- sexually transmitted

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10
Q

Hx/PE of chlamydia

A

Incubation period is 3-4 wks, with gradual onset of mild sx (low grade fever, rhinitis, laryngitis, pharyngitis, sinusitis) to more cough with scant sputum, then malaise, hoarseness and HA in 58%
Rhonchi and rales present even in mild dz
C. psittaci pneumonia when exposed to birds (sick birds) with high fever 103-105 degrees
Best test is isolation in sputum culture (for pts not responding to outpatient therapy)

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11
Q

Tx of chlamydia- non STI

A

Tetracyclines and macrolides are the drugs of choice

  • Doxycycline if >9 yo and not pregnant- 100 mg BID x 10-14 days
  • Clarithromycin 500 mg BID x 10 days (or azithromycin 500 mg daily for 7-10 days)
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12
Q

When to suspect STI chlamydia in women

A

If pt has deep internal pain with intercourse

With bimanual exam she will experience intense pain with manipulation of cervix

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13
Q

S/sx of chlamydia in women

A

May be asymptomatic and the onset often indolent. It can cause cervicitis, endometritis, PID, urethritis, epididymitis, neonatal conjunctivitis, and pediatric PNA

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14
Q

Tx for STI chlamydia

A

Azithromycin 1 g PO in a single dose (OK in pregnancy) OR
Doxycycline 100 mg PO BID x 7 days (NOT OK in pregnancy)
Alternatives:
Erythromycin base 500 mg PO QID x 7 days
OR
Erythromycin ethylsuccinate 800 mg PO QID x 7 days
OR
Ofloxacin 300 mg PO BID x 7 days
OR
Levofloxacin 500 mg PO once daily x 7 days

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15
Q

Gonorrhea

A

A purulent infection of ANY mucus membrane surfaced caused by N. gonorrhea, but usually affects the genital mucous membranes

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16
Q

What should occur in pts positive for any STI?

A

Should have a full eval for risk of other diseases such as Chlamydia, syphilis, Hep B and C, and HIV. If high risk- the pt should be tested.
But insurance may not always reimburse every time- pts need to be made aware of risk, cost, and importance of prophylaxis

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17
Q

Hx/PE of gonorrhea in females

A 
Vaginal discharge: MC presenting symptom
-Thin, purulent, and mildly odorous
Dysuria
Intermenstrual bleeding
Dyspareunia
Mild lower abdominal pain
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18
Q

Hx/PE of gonorrhea in females if it progresses to PID

A

Lower abdominal pain, the MC symptom of PID
Increased vaginal discharge or mucopurulent
Dysuria: usually without urgency or frequency
Cervical motion tenderness
Adnexal tenderness (usually bilat) or adnexal mass
Intermenstrual bleeding
Fever, chills, nausea, and vomiting (less common)

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19
Q

Hx/PE of gonorrhea in males

A

Urethritis: the major manifestation of gonococcal infection in men; initial characteristics include burning upon urination and a serous discharge; a few days later, the discharge usually becomes more profuse, purulent, and at times, tinged with blood
Acute epididymitis: Usually unilateral and often occurs in conjunction with a urethral exudate
Urethral strictures: Have become uncommon in the antibiotic era, but they can present with a decreased and abnormal urine stream, as well as with the secondary complications of prostatitis and cystitis

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20
Q

Tx of gonorrhea

A

Ceftriaxone 250 mg intramuscular single dose PLUS
Azithromycin 1 g PO single dose OR
Doxycycline 100 mg PO BID x 7 days

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21
Q

Diphtheria

A

Either an upper respiratory tract or cutaneous infection caused by aerobic Gram pos bacteria Corynebacterium diphtheria.
Occurs in spring or winter mos and continues for 2-6 wks without antibiotic tx

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22
Q

Who is susceptible to diphtheria?

A

Those not immunized or those with a weak antibody level exposed to diphtheria

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23
Q

Hx/PE of diphtheria

A

Sx start as nonspecific upper respiratory sx, then sore throat
Development of a localized pseudomembrane- dense, gray debris in the posterior pharynx
Removal of the membrane reveals a bleeding, edematous mucosa
Cervical adenopathy and swollen mucosa gives a bull’s neck appearance

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24
Q

Tx of diphtheria

A

Admit for tx

Horse serum antitoxin is given in early stages, then a macrolide

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25
Q

What causes infectious mononucleosis?

A

Epstein-Barr virus

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26
Q

Lab work for infectious mononucleosis

A

Test with the mono spot test which is usually done in primary care offices with a drop of blood.
Or a serologic test for EBV

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27
Q

More serious dz caused by Epstein-Barr virus

A

The virus persists in the body for life and can reactivate quietly without sx and lead to chronic illness
Particularly in pts with compromised immune systems, that can lead to some forms of lymphoma

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28
Q

What has been linked to EBV but no studies have proven a causal link?

A

Chronic fatigue syndrome

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29
Q

Central sx of infectious mononucleosis

A

Fatigue
Malaise
Loss of appetite
HA

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30
Q

Throat sx of infectious mononucleosis

A

Soreness

Reddening

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31
Q

Respiratory sx of infectious mononucleosis

A

Cough

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32
Q

Systemic sx of infectious mononucleosis

A

Chills
Fever
Aches

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33
Q

Visual sx of infectious mononucleosis

A

Photophobia

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34
Q

Tonsil sx of infectious mononucleosis

A

Reddening
Swelling
White patches

35
Q

Lymph node sx of infectious mononucleosis

A

Swelling

36
Q

Spleen sx of infectious mononucleosis

A

Enlargement

Abdominal pain

37
Q

Gastric sx of infectious mononucleosis

A

Nausea

38
Q

What is the causative organism of erythema infectiosum (fifth disease)?

A

Human parvovirus B19

39
Q

Sx of fifth dz

A 
Mild prodromal sx begin 1 wk after exposure and last 2-3 days
HA
Low-grade fever
Sore throat
Pruritis
Rhinitis
Arthralgias
Then the reddened cheeks over 2-4 days
Then the erythematous maculopapular rash that fades into a classic lacelike reticular pattern
The rash can occur off and on for wks
40
Q

Workup of fifth’s dz

A

No testing needed. Dx on clinical presentation only

41
Q

Tx of fifth’s dz

A

Supportive care with NSAIDs and antihistamines if needed for pruritis.

42
Q

Herpes zoster

A

Reactivation of the varicella-zoster virus that has remained dormant in the dorsal root ganglia after the pt’s initial illness from chickenpox
Usually this is a self-limited vesicular dermatomal rash lasting approx one week with mild to moderate pain
Sometimes it can be more serious and lead to chronic postherpetic neuralgia

43
Q

What can herpes zoster be accompanied by?

A

Malaise
Myalgia
HA
Uncommonly fever

44
Q

PE of herpes zoster

A

Grouped herpetiform vesicles on an erythematous base appearing unilaterally and stopping midline at the limit of the sensory coverage of the involved dermatome

45
Q

Dx of herpes zoster

A

Usually based clinically

PCR testing is available if dx is unclear

46
Q

Tx of herpes zoster

A

Antiviral meds if caught within first 72 hrs
-Valacyclovir- 1 gm TID x 7 days
Consider steroid taper if severe
-Prednisone pack 10 mg strength over 7 days
Neuralgia- Lyrica 75 mg BID x 7-14 days if severe pain or gabapentin 300 mg BID-TID
Warn pt of possible side effects of Lyrica and Gabapentin causing dizziness

47
Q

Manifestations of HPV

A

Condylomata- discrete, papillary, cauliflower-like lesions on multiple sites on moist surfaces
Keratotic warts- often seen on dry surfaces such as the labia
Discrete papules 1-3 mm can present on the shaft of the penis

48
Q

Testing of HPV

A

Dx can be made clinically or with application of acetic acid and bx
Careful exam and colposcopy is essential for cervical lesions
Detection of HPV DNA is now approved by the FDA and is valuable as a screening tool in women older than 30 yrs and is taken from the Pap test sample

49
Q

Tx of HPV

A

No single curative tx for condylomata acuminata
Primary goal is reduction of sx and reserved for pts with visible warts
Surgical incision
Chemical ablation (aldara- apply 3 times a wk)
Cryotherapy

50
Q

HIV

A

A blood-borne virus spread by blood exposure, sexual intercourse, shared needles, or to a fetus from an infected mother

51
Q

What is a new guideline for antiretroviral drug therapy (HIV/AIDS)?

A

For asymptomatic pts with HIV and a CD4 count over 500/mm

52
Q

Physical findings of symptomatic phase of HIV

A

No physical findings are specific to the asymptomatic phase
Acute seroconversion manifests as a flulike illness, with malaise and a rash
Generalized LAD is common

53
Q

Screening for HIV- USPSTF

A

Strongly recommends that clinicians screen for HIV in all adolescents and adults at increased risk for HIV infection and all pregnant women

54
Q

CDC screening recs for HIV

A

Recommends opt-out screening for pts in all healthcare settings
Persons at high risk for HIV infection should be screened at least annually

55
Q

American College of Physicians recs for HIV screening

A

Clinicians adopt routine screening for HIV and encourage all pts to be tested

56
Q

What should be used for HIV screening?

A

ELISA for screening
Positive result should be followed with confirmatory testing (e.g., Western blot assays)
HIV-2 should be tested for in pts from an endemic area or those with indeterminate results on HIV-1 Western blot testing
Early detection using combination screens may be more effective than simply using serology

57
Q

CD4 T-cell counts and HIV/AIDS

A

Reliably reflects the current risk of acquiring opportunistic infections, as follows:
-Reference range, 500-2000 cells/microL
Because CD4 counts vary, serial counts are generally a better measure of significant changes
For surveillance, a CD4 count below 200/microL is considered AIDS-defining in the US

58
Q

Viral load and progression to AIDS

A

Pts with viral loads >30,000/microL are 18.5 times more likely to die of AIDS than those with undetectable viral loads

59
Q

Viral loads and therapy with HIV/AIDS

A

With therapy, viral loads can often be suppressed to an undetectable level (<20-75 copies/mL; optimal viral suppression)

60
Q

Systemic sx of acute HIV infection

A

Fever

Weight loss

61
Q

Mouth sx of acute HIV infection

A

Sores

Thrush

62
Q

Esophagus sx of acute HIV infection

A

Sores

63
Q

Muscle sx of acute HIV infection

A

Myalgia

64
Q

Liver and spleen sx of acute HIV infection

A

Enlargement

65
Q

Central sx of acute HIV infection

A

Malaise
HA
Neuropathy

66
Q

Lymph node sx of acute HIV infection

A

LAD in neck and axilla

67
Q

Skin sx of acute HIV infection

A

Rash

68
Q

Gastric sx of acute HIV infection

A

Nausea

Vomiting

69
Q

What other infections should be screened for in a person iwth an HIV infection?

A 
PPD for TB
CMV
Syphilis
Rapid amplification testing for gonococcal and chlamydial infection
Hep A, B, and C serology
Anti-Toxoplasma antibody
Ophthalmologic exam
70
Q

Types of antiretroviral therapy- HIV/AIDS

A

Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors (PIs)
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
Fusion inhibitors
CCR5 co-receptor antagonists (entry inhibitors)
HIV integrase strand transfer inhibitors

71
Q

Central sx of AIDS

A

Encephalitis

Meningitis

72
Q

Eye sx of AIDS

A

Retinitis

73
Q

Lung sx of AIDS

A

Pneumocystis PNA
TB (multiple organs)
Tumors

74
Q

Skin sx of AIDS

A

Tumors

75
Q

GI sx of AIDS

A

Esophagitis
Chronic diarrhea
Tumors

76
Q

Prophylaxis for pneumocystic jiroveci- AIDS

A

Septra DS- one daily or 3x/wk

77
Q

Prophylaxis for Toxoplasma- AIDS

A

Sulfadiazine 4x daily plus pyrimethamine plus leucovirin

78
Q

Prophylaxis for Mycobacterium avium complex- AIDS

A

Clarithromycin 500 BID plus ethambutol if CD4 <50/microL

79
Q

Prophylaxis for fungal and viral infections: AIDS

A

Although prophylaxis for these infections is not routinely necessary, some recommend fluconazole inp ts with CD4 T-cell counts >50/microL to prevent candidial or cryptococcoal infections and to protect against endemic fungal infections
Oral ganciclovir is indicated for CMV prophylaxis in pts with advanced AIDS
Acyclovir daily to prevent herpes simplex

80
Q

MRSA prevention- AIDS

A

Mupirocin 2% nasal ointment to each nostril twice daily

81
Q

What is the goal of HIV tx?

A

To prevent the immune system from deteriorating to the point that opportunistic infections become more likely

82
Q

Prognosis of untreated HIV/AIDS

A

Prognosis in pts with untreated HIV infection is poor, with an overall mortality rate of >90%. Average time from infection to death is 8-10 yrs
Once infection has progressed to AIDS, the survival period is usually <2 yrs in untreated pts

83
Q

Pt education- HIV/AIDS

A

Be counseled about the risks of infecting their sexual partners with HIV
Safer sex practices and tx of concurrent STIs, both in the pt and in sexual partners, considerably reduces the risk of transmission

DSE (14 decks)

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