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Foundations of Clinical Practice II > Infectious Disease > Flashcards

Infectious Disease Flashcards

(91 cards)

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1
Q

Fever of Unknown Origin (FUO): criteria

A
  1. Fever >38.3 C (100.9 F)
  2. 3 + weeks
  3. No other diagnosis for 3 outpatient visits (or 3 days in the hospital)
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2
Q

FUO: common etiologies (3)

A
  1. Infection
  2. Malignancy
  3. Connective tissue disease
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3
Q

FUO: name 3 less common infectious reasons

A
  1. Intra-abdominal abscesses
  2. Osteomyelitis
  3. Tuberculosis
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4
Q

FUO: name 4 malignancies

A
  1. Hepatocellular carcinoma
  2. Leukemia
  3. Lymphoma (NHL)
  4. Renal cell carcinoma
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5
Q

FUO: systemic inflamatory causes

A
  • Giant cell arteritis

- Polyarteritis nodosa

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6
Q

FUO: management

A
  • Refer to infectious disease

- Consider admission

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7
Q

Staphylococcal infection

A
  • Nose (main site of colonization)
  • 3 major species (Staph aureus, Staph epidermitis, Staph saprophyticus)
  • Coagulase postive (staph aureus)
  • Beta-hemolytic
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8
Q

Staphylococcus epidermitis

A
  • coagulase negative
  • frequent skin contaminant on blood cultures
  • LOVES to grow on catheters, IV lines, prosthetic joints
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9
Q

Staphylococcus saprophyticus

A
  • coagulase negative
  • Leading UTI cause
  • lives in female genital tract
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10
Q

Toxic Shock syndrome

A
  • Staph aureus
  • “super antigens”
  • abrupt high fever, vomiting, watery diarrhea, rash, conjunctivitis, desquamation of the palms and soles*
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11
Q

Toxic Shock syndrome: Empiric Treatment

A

Clindamycin + Vancomycin

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12
Q

Staph Scalded Skin Syndrome (SSSS)

A
  • affects neonates 3-15 days old
  • loss of cell-to-cell adhesions leading to intra-epidermal splitting
  • erythematous patches with large superficial fragile blisters**
  • Nikolsky sign*
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13
Q

Staph Scalded Skin Syndrome: treatment

A

Penicillin-ase resistant beta-lactam

if no response –>Vancomycin

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14
Q

What causes anthrax?

A

Bacillus anthracis

  • gram-positive rod
  • spores
  • GI tract, skin, inhalation*, direct injection
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15
Q

Most common form of anthrax

A

cutaneous

  • small, painless, pruritic papules that turn into vesicles/bulla –>leave painless necrotic ulcer with black, depressed eschar**
  • Edema + lymphadenopathy
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16
Q

Anthrax inhalation clinical course

A
  • spores phagocytosed and transported to mediastinal lymph nodes
  • Spores germinate and release toxins
  • Toxins cause hemorrhagic necrosis of thoracic lymph nodes (hemoptysis)
  • Fulminant is fatal (usually)
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17
Q

Anthrax: CXR

A

Widened mediastinum (opacity around the hilar lymph nodes)**

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18
Q

How do you test for anthrax?

A

Report to public health/Send em to CDC!

culture, immunohistochemical staining, molecular testing ex. ELISA, lumbar puncture if concerned for meningitis

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19
Q

How many samples need to be taken from a cutaneous anthrax lesion?

A

2

  • Swab for gram stain
  • Swab for PCR
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20
Q

Anthrax: cutaneous treatment

A

Ciprofloxacin/Levofloxacin

or doxycycline

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21
Q

Treatment for people exposed to aerosolized Bacillus anthracis

A
  1. Ciprofloxacin
    - start within 48 hours
    - 60 days of treatment
  2. Anthrax vaccine (3 dose)
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22
Q

Rabies: cause

A

rhabdovirus (RNA virus)

  • travels along nerves to brain
  • multiplies in brain
  • travels along efferent nerves to salivary glands
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23
Q

Rabies: clinical presentation

A
  1. Pain/parethesias radiating proximally
  2. Percussion myoedema (mounding of the muscle at percussion site)
  3. CNS
    - “furious” - encephalitic (80%)
    - “dumb” - paralytic (20%), kinda like guillan-barre
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24
Q

Rabies: Treatment

A
  • Immuneglobulin

- Rabies vaccine

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25
Zika: cause
flavivirus (arthropod--borne virus)
26
Zika transmission
1. Aedes mosquito 2. Sexual transmission 3. Vertical transmission 4. Blood product transfusion/organ transplant
27
Zika diagnostics
Viral RNA or IgM | PCR blood or urine
28
When do you test asymptomatic pregnant women for zika
-Look for IgM 2-12 weeks after they travel to endemic area or sexual contact with person with confirmed zika infection
29
Zika virus: monitoring of pregnancy
US every 3-4 weeks (congenital microcephaly) complications: meningoencephalitis!
30
Legionella: etiology
Legionella pneumophila gram-negative bacilli ***Water reservoir contamination***
31
Legionella risk factors
- cigarette smoking - chronic lung disease - older age - biologic therapy
32
Legionella: clinical presentation
1. Cough (blood-streaked sputum) 2. GI symptoms (NVD) 3. Rales and signs of consolidation
33
Legionella: CXR
patchy unilobar infiltrate that progresses to consolidation | -pleural effusion
34
Pontiac fever
mild form of legionella infection - no respiratory - self-limited
35
Legionella: diagnostic
1. Sputum culture (if hospitalized) | 2. Urinary antigen test* (still postiive after antibiotics unlike sputum)
36
Legionella: treatment
Azithromycin (or clarithromycin) or Fluroquinolone x 10 -14 days! ***
37
Botulism: cause
Clostridium botulinum | gram-positive +
38
Botulism: pathophys
-blocks release of acetylcholine (esp. in excitatory synapses)
39
What should infants avoid eating?
honey (haven't developed gut immunity to botulism)
40
Botulism: clinical presentation
- Bilateral cranial neuropathies - DESCENDING WEAKNESS******* - blurred vision, diplopia, nystagmus, ptosis, dysphagia, dysarthria - Urinary retention and constipation
41
EMG: compare and contrast MG and botulism
Botulism: wave amplitude increases the more it is stimulated MG: wave amplitude decreases the more it is stimulated
42
Botulism: who do you call
1. Health Department | 2. CDC
43
Botulism: treatment
Equine serum heptavalent botulism antitoxin (within 24 hours)
44
Diphtheria: cause
Corynebacterium diphtheriae | gram positive bacillus
45
Diphtheria: clinical presentation
- Can happen anywhere in the URT | - Pharyngeal - gray membrane covering tonsils and pharynx ******
46
Name the 2 scary complications of Diphtheria
1. Myocarditis (arrhythmias, heart block, heart failure) | 2. Neuropathy (diplopia, slurred speech, dysphagia)
47
What are the non specific lab findings of diphtheria
1. Elevated WBC | 2. Proteinuria
48
Diphtheria: treatment
**AIRWAY MANAGEMENT!** 1. Diphtheria equine antitoxin 2. Penicillin (or erythromycin) x 14 days
49
What precautions need to be taken with Diphtheria
Respiratory droplet isolation until 3 negative oropharyngeal cultures
50
Tetanus: cause
Clostridium tetani - Found in soil - rod-shaped bacterium (transforms after inoculation)
51
Tetanus: patho
retrograde axonal transport within motor neuron -blocks neurotransmission of inhibitory neurons
52
Tetanus: clinical presentation
Generalized (MC and severe of the 4 clinical patterns!) - Trismus (lock jaw)** - increased muscle tone - painful spasms - widespread autonomic instability (ex. labile HTN, fever)
53
Tetanus: treatment
1. Metronidazole 2. Tetanus immune globulin (neutralize toxins) (also, benzos)
54
Tetanus prevention/post puncture wound
Immunization! If puncture wound.... give vaccine + immune globulin if never boosted or >5 years since last booster
55
Lyme disease: etiology
Borrelia burgdorferi * mc tick-borne illness - white footed mouse and deer - Ixodes scapularis (deer tick)*** - Spring and summer
56
How long do deer ticks need to feed to transmit lyme?
24 -36 hours
57
What is the name of the rash associated with Lyme?
erythemia migrans
58
Lyme early clinical manifestations
Early disseminated: 1. Cardiac (ex. arrhythmias) 2. Neurological (ex. aspetic meningitis, radiculopathy) 3. Eyes (ex.conjunctivitis, keratitis)
59
Lyme late manifestions
1. Musculoskeletal: arthritis esp in knee**
60
Lyme: diagnostic criteria
1. Exposure to tick habitiat within 30 days of developing erythema migrans
61
What are the two important labs to help confirm Lyme disease
1. ELISA antibody 2. Western immunoblot assay ~elevated SED, LFTs
62
Lyme disease: Treatment
Doxycycline (10-14 days)
63
Lyme disease: pregnant lady (or kid <8 yrs)
Amoxicillin!
64
Who gets prophylactic antibiotics?
1. Tick attached for 36+ hours 2. Treatment can be started within 72 hours or tick removal 3. >20% of the ticks in the area are infected 4. No contraindications to treatment
65
Rocky mountain spotted fever: cause
-Rickettsia rickettsii gram-negative (obligate intracellular bacterium) -Tick borne
66
Rocky mountain spotted fever: clinical presentation
Rash (blanching macules that transition to petechiae) - ankles and wrists, spread to trunk - Seen on palms and soles
67
Rocky mountain spotted fever: diagnostics
- Normal WBC count with immature bands - Thrombocytopenia (prolonged PTT/PT) - Hyponatremia - Elevated LFTs
68
Rocky mountain spotted fever: treatment
Doxycycline | Start within 5 days of symptoms!
69
Epstein Barr virus: virus type
herpes virus - transmitted by intimate contact with saliva - associated with B cell lymphomas, Hodgkin lymphoma, nasopharyngeal carcinoma, gastric tumors)
70
EBV: classic symptoms
- tonsillitis/pharyngitis - cervical lymphadenopathy** - fever
71
What happens if you treat EBV with ampicillin cause you thought it was strep throat?
morbilliform rash!!!
72
What is the key finding on CBC for EBV?
lymphocytosis (WBC 12-18,000)
73
What is the best way to diagnose EBV?
Heterophile antibody test (+ for 3 months after onset)
74
EBV: best marker of acute infection
IgM and IgG antibodies against viral capsid antigen (VCA)
75
EBV: best marker of latent virus (present for life)
Nuclear antigen | if you see this, not an acute infection
76
EBV: treatment
Corticosteroids -Restrict from playing sports for 4 weeks!
77
Cytomegalovirus: most common presentation in healthy individual vs. HIV
Healthy: CMV mono (looks similar to EBV) HIV/AIDS: retinitis
78
CMV: treatment
Antiviral (ex. ganciclovir, valganciclovir, foscarnet, cidofovir)
79
Toxoplasmosis: etiology
Toxoplasma gondii (intracellular protozoan)
80
Toxoplasmosis: transmission
definitive host = cat - contaminated food, water, meat from infected animal - vertical transmission**
81
Toxoplasmosis: clinical presentation
- Bilateral symmetrical nontender cervical or occiptal adenopathy * Chorioretinitis (visual loss or floaters)** "headlights in the fog"
82
What is the scarriest thing to be concerned for if your immunocompromised patient get toxoplasmosis?
encephalitis with multiple necrotizing brain lesions!
83
Toxoplasmosis: diagnosis
ELISA
84
Toxoplasmosis: prophylaxis
TMP-SMX | treatment: pyrimethamine + sulfadiazine x 2-4 wks
85
Cryptococcosis: etiology
Cryptococcus neoformans -encapsulated budding yeast found in soil, dried pigeon dung** inhaled**
86
Cryptococcus treatment
Amphotericin B x14 days then fluconazole x8 weeks
87
Where does varicellla zoster become latent?
sensory dorsal root ganglia
88
VZV rash
- MC thoracic or lumbar dermatomes - Opthalmic branch of trigeminal is SERIOUS!!! - rash preceded by acute neuritis prodromal pain
89
VZV: treatment
1. Antiviral therapy** - start within 72 hours 2. Analgesia (NSAIDs or Opioids)
90
What is the name for herpes zoster oticus?
Ramsay Hunt Syndrome
91
Who gets the VZV vaccine?
60+ recommended -Shingrix** (recombinant zoster vaccine)

Foundations of Clinical Practice II (25 decks)

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