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STEP 3 > Infectious disease > Flashcards

Infectious disease Flashcards

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1
Q

Small papules with central umbilication and central necrosis in an HIV + patient

A

Cutaneous cryptococcosis
Dx w/ biopsy
Treat with ampho B + flucytosine for 2 or more weeks, then oral fluconazole for a year

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2
Q

Pt with meningoencephalitis with mosquito bites on arms

A

West Nile virus
Dx: West Nile IgM in CSF
Tx: supportive

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3
Q

Perinatal hep B infection

A

Tx: immunoglobulin and vaccine within 12 hours of birth
Routine vaccine series: 0, 2 and 6 months
Serology ~3 months after 3rd vaccine dose

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4
Q

Active tuberculosis

A

Dx with sputum acid-fast bacilli smear and culture
Smear has low sensitivity
Wait for culture or nucleic acid amplification (NAA) testing for definitive results

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5
Q

Infectious mononucleosis

A

Caused by EBV
Fever, fatigue, exudative pharyngitis/tonsillitis (“white exudate”, posterior cervical lymphadenopathy
Atypical reactive lymphocytes on smear

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6
Q

Streptococcal pharyngitis

A

Caused by S. pyogenes
Sudden fever, sore throat. No URI symptoms.
Tx: amoxicillin for 10 days
Alternatives: IM penicillin if unable to tolerate oral, cephalosporin if mild penicillin allergy, azithromycin x5d if severely allergic

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7
Q

What does a positive antibody test to HCV mean?

A

Active ongoing infection
Past infection that has resolved
False positive
F/u test with HCV RNA

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8
Q

Chlamydia in pregnancy

A

Screen at first visit and 3rd trimester if risk factors present
Tx w/ azithromycin
Complications if left untreated include PPROM, preterm labor and postpartum endometritis

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9
Q

HIV-associated lipodystrophy

A

Lipoatrophy: loss of subQ fat in arms, legs, buttocks; seen with NRTIs (zidovudine)
Fat accumulation: buffalo hump, visceral abdominal fat
Also insulin resistance, dyslipidemia and incr. CV risk
Tx w/ statin

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10
Q

Screening test for HIV

A 
HIV antigen (p24) and HIV-1/HIV-2 antibodies
Cautious use during window period (first 4 weeks), can repeat test
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11
Q

What conditions should you screen for prior to initiating antiretroviral therapy?

A

Hep B (some antiretroviral meds have dual activities)
Hep C
TB
STDs

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12
Q

Syphilis testing

A

Screen with RPR

Confirm with FTA-ABS or VDRL

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13
Q

Tx of syphilis

A

Primary, Secondary or early latent <12mo: benzathine penicillin IM x1
Late latent >12mo or unknown duration, gummatous/CV syphilis: benzathine penicillin IM weekly x3
Neurosyphilis: aqueous penicillin G IV q4h for 2 weeks
Congenital syphilis: similar to neurosyphilis
No prevention for Jarisch-Herxheimer reaction

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14
Q

Dx and Tx of latent TB

A

Dx: positive IFB-g assay w/o symptoms or CXR findings
Tx: isoniazid for 9mo, alternative is rifampin for 4-6 months

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15
Q

Tx of chlamydia

A

Azithromycin

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16
Q

Tx of gonorrhea

A

Ceftriaxone (+azithromycin to cover chlamydia)

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17
Q

Persistent urethritis despite tx for chlamydia/gonorrhea

A

Repeat urethral swab and gram stain

Often due to infections caused by Mycoplasma genitalium or Trichomonas vaginalis

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18
Q

Which patients should you give oseltamivir regardless of symptom duration?

A

Age 65 or more
Women who are pregnant and up to 2 weeks postpartum
Underlying chronic medical illness (cardiac, pulmonary, hepatic or renal)
Immunosuppressed
Morbidly obese
Native Americans
Nursing home or care facility residents

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19
Q

Tx of human bites

A

Augmentin

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20
Q

Lactational mastitis

A

Fever, breast pain and focal inflammation

Tx with dicloxacillin or cephalexin

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21
Q

Post-exposure management of Hep B

A

Healthcare worker immune: NTD
Healthcare worker not immune and source patient:
-Positive for Hep B -> hep B immunoglobulin and vaccinate
-Negative for Hep B -> vaccinate

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22
Q

Tuberculous meningitis

A

Choroidal tubercles (yellow-white nodules near the optic disc)
Basilar meningeal enhancement on imaging
CSF with low glucose, high protein, WBC count 100-500
Dx with CSF AFB staining and culture
Tx with 4-drug therapy for 2 mo and 9-12mo of continuation therapy

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23
Q

Tx of acute cystitis and asymptomatic bacteriuria

A

Cephalexin, amoxicillin-clavulanate, fosfomycin

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24
Q

Cervical and preauricular adenopathy with unilateral conjunctivitis

Study These Flashcards
A 
Oculoglandular syndrome (Parinaud syndrome) due to catscratch disease
Can treat with azithromycin and needle aspiration to prevent lymph node suppuration
25
Side effect of isoniazid
Hepatotoxicity | Ok to continue unless LFTs >5x ULN and asymptomatic or >3x ULN and symptomatic
26
Disseminated gonococcal infection triad
Dermatitis: 2-10 painless pustules on distal extremities Tenosynovitis: swelling and pain with passive extension Polyarthralgia: asymmetric small and large joints Dx: NAAT of urinary specimen
27
Hand-foot-mouth disease
Caused by coxsackievirus
28
Sporotrichosis
Painless papule which ulcerates and drains nonpurulent, odorless fluid Proximal lesions form along lymphatic chain Dx: culture Tx: 3-6mo of oral itraconazole
29
1st line agents for acute uncomplicated cystitis
TMP-SMX for 3 days or nitrofurantoin for 5 days
30
1st line for uncomplicated pyelonephritis
Ciprofloxacin
31
Organism responsible for concurrent otitis media and purulent conjunctivitis (otitis-conjunctivitis syndrome)
Nontypeable H. influenzae | Tx with augmentin if received amoxicillin alone in last month
32
Tx of infectious mono with imminent airway obstruction
IV corticosteroids
33
Man w/ 3 months of pelvic pain and dysuria, bacteriuria and urine leukocytes on UA
Chronic prostatitis | Tx: 6 weeks of ciprofloxacin or TMP-SMX (shorter courses result in tx failure)
34
Ecthyma gangrenosum
Immunosuppressed pt, central catheter Painless red macules that rapidly develop into bullae and then quickly evolve into gangrenous ulcers with raised violaceous margins Tx w/ anti-pseudomonal beta lactam (pip-tazo) and aminoglycoside (gentamicin)
35
Indications for corticosteroid use in the ICU
Alveolar-arterial oxygen gradient 35mmHg or more | Arterial oxygen tension (PaO2) <70
36
Dx and Tx of PJP
Dx: sputum culture or bronchoalveolar lavage Tx: TMP-SMX +/- corticosteroids
37
Dx and Tx of cryptococcal meningitis
Markedly elevated opening pressures >250, low WBC count <50 with lymphocytic predominance Positive india ink stain or cryptococcal antigen test Tx with ampho B and flucytosine (at least 2w), then high dose fluconazole for 8 weeks then low dose for ~1 year. Can be complicated by high ICPs requiring serial lumber punctures
38
Antibiotics for pediatric sepsis
<28 days: ampicillin + gentamicin or cefotaxime (caused by E. coli and GBS) >28 days: ceftriaxone or cefotaxime + vanco if meningeal involvement suspected (S. pneumo or N. meningitidis)
39
TB tx in pregnancy
``` 3-drug therapy for 2 months (no pyrazinamide), the ONH + RIF for 7 additional months Give pyridoxine (B6) supplementation ```
40
Tx sinusitis
1st line: augmentin | 2nd line: doxycycline or fluoroquinolones
41
Management of pediatric pneumonia
Preschool/focal findings: amoxicillin for strep pneumo | School/bilateral diffuse: azithromycin for Mycoplasma
42
Name the source of the following oral lesions in childrem: - Recurrent ulcers on anterior oral mucosa, no fever or systemic symptoms - Vesicles and ulcers on posterior oropharynx - Vesicles and ulcers on anterior oral mucosa and around mouth with fever - Tonsillar exudate with diffuse lymphadenopathy, fever +/1 hepatosplenomegaly - Tonsillar exudate with fever and anterioc cervical lymphadenopathy
``` Aphthous ulcers Herpangina (Coxsackie A virus) Herpes gingivostomatitis Infectious mononucleosis Group A strep ```
43
Pulmonary aspergillosis - Classic triad - Dx - Tx
Triad: cough, pleuritic chest pain, hemoptysis Dx: CT chest with nodule w/ ground-glass opacities and/or cavitations with air-fluid levels; galactomannan and beta-d-glucan serum levels, sputum for fungal culture Tx: voriconazole (surgery if needed)
44
What is immune reconstitution inflammatory syndrome?
When someone is started on antiretroviral therapy for HIV, rapid improvement in immune function can cause a paradoxical worsening of infectious symptoms Treat symptomatically w/ NSAIDs or with short course of steroids
45
Croup vs epiglottitis
Croup: barking cough, parainfluenza, steeple sign, use racemic epinephrine/IM corticosteroids Epiglottitis: respiratory distress, drooling, high fever, H. influenzae type b (vaccine preventable), thumb sign, intubate + IV abx
46
Tx vaginitis - Bacterial vaginosis - Trichomoniasis - Candida vaginitis
- Metronidazole or clindamycin - Metronidazole, treat partner - Fluconazole
47
Most specific and sensitive tests for osteomyelitis
Specific: probe-to-bone (91%) Sensitive: MRI (90%)
48
Most common complication from diptheria
Toxin-mediated myocarditis
49
Tx of salmonella
Supportive | Use ciprofloxacin, Bactrim, or ceftriaxone for at risk individuals
50
Presentation of subphrenic abscess
2-3 weeks after abdominal surgery, swinging fever and leukocytosis. Dx w/ ultrasound
51
Indications for dialysis catheter removal in setting of infection
Severe sepsis Hemodynamic instability Evidence of metastatic infection (endocarditis) Pus at the exit site of the catheter Continued symptoms 72h after initiation of antibiotics Long-term catheter (>14 days) with evidence of S. aureus, P. aeruginosa or fungi on blood cx
52
Headache, myalgia, arthralgia | Macular, erythematous rash and few petechiae on bilateral wrists and ankles
Rocky Mountain Spotted Fever Labs: low platelets and sodium, increased transaminases Dx: Rickettsia serology, skin biopsy Tx: doxycycline
53
Pt with fever after travelling, after BP cuff is applied, diffuse petechiae noted on skin underneath
Hemorrhagic dengue fever, at risk for circulatory collapse
54
Congenital infections
Toxoplasmosis: calcification, hydrocephalus, hearing impairment, chorioretinitis Rubella: heart defects, eye abnormalities and hearing impairment, symptomatic illness (fever, maculopapular rash) in mother
55
Tx of intestinal helminths
Albendazole
56
Tx of shingles (HSV)
Valacyclovir
57
Abx tx for necrotizing fasciitis
Vancomycin Pip/tazo or carbapenem Clindamycin Usu. caused by group A strep
58
Tx for vibrio vulnificus
IV ceftriaxone and doxycycline
59
How to diagnose Lyme disease
Serum enzyme-linked immunosorbent assay and Western Blot

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