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Infectious Disease-Notes Flashcards

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1
Q

What are some clinical features of irritable bowel syndrome?

A

pain relieved by BM
onset of pain related to change in frequency of stool and/or character of stool
noticeable abdominal bloating
sensation of incomplete evacuation or diarrhea with mucus in it.

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2
Q

What is a workup for suspected infectious diarrhea, bloody diarrhea?

A

ELISA tests for Rotavirus, C diff, Salmonella
Look for ova/parasites in the stool. helpful for giardia, entamoeba histolytica, ancylostoma duodenale. must do 3 samples.
sometimes…a colonoscopy. Ex: Cdiff would show pseudomembranous colitis.

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3
Q

What is the usual treatment for infectious diarrhea?

A

regular diet

oral rehydration

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4
Q

Infant pt is febrile. You find that stool is positive for salmonella. Do you do LP, blood cultures?

A

Yes.

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5
Q

What are some causes of infectious diarrhea to look out for in HIV patients?

A

cryptosporidium parvum
CMV
MAC

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6
Q

What are some important features of cryptosporidium parvum diarrhea in HIV patients?

A

protozoa
chronic watery diarrhea
acid fast cysts
happens when CD4

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7
Q

What are some important features of CMV colitis in HIV patients?

A

chronic bloody diarrhea

giant cells with owl’s eye inclusion bodies

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8
Q

What are some important features of MAC colitis in HIV patients?

A

chronic watery diarrhea

CD4

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9
Q 
Which antibiotics do you use to treat the following:
C diff
salmonella
EPEC
Entamoeba histolytica
A

C diff: metro/vanco
salmonella: cipro
EPEC: cipro
entamoeba histolytica: metro

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10
Q 
Which antibiotics do you use to treat the following:
shigella
EIEC
Vibrio Cholera
Giardiasis
Cryptosporidium
A 
shigella: cipro
EIEC: cipro
cholera: tetracycline, azithromycin
giardiasis: metro
cryptosporidium: nitazoxanide
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11
Q

Fever and bloody diarrhea could be caused by what?

A 
shigella
Salmonella
campylobacter
EHEC
E. histolytica
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12
Q

What are some important features of fever & bloody diarrhea caused by E. histolytica?

A

can mimic IBD, but will worsen with steroids
can cause a liver abscess
peripheral eosinophilia
charcot-leyden crystals in stool (from eosinophils)
treat with metronidazole

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13
Q

What are some causes of diarrhea that consist of no fever, no blood?

A 
norovirus
rotavirus
ETEC (will ONLY see diarrhea as a symptom)
EPEC (in infants)
Cholera
vibrio parahemolyticus (oysters)
giardia
cryptosporidium parvum
clostridium perfringens
bacillus cereus
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14
Q

What are some important things to know about giardia diarrhea?

A

fatty, smelly diarrhea
onset is 1-2 weeks later
use proper sewage
treat with metronidazole

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15
Q

If you have diarrhea + N/V…what do you have?

A

viral gastroenteritis

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16
Q

What’s the deal with tropic sprue?

A

chronic fatty diarrhea
blunting of villi with infiltration of lymphocytes, plasma cells, eosinophils
malabsorption, VB12/folate deficiency
can present years after a person was in the tropics

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17
Q

What’s the deal with trichinella?

A

present in undercooked pork
get watery diarrhea
treat with albendazole

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18
Q

Ascaris lumbricoides can present how? What is the treatment?

A

post-prandial abdominal pain or vomiting
can even cause pancreatic duct or bile duct obstruction if there is a heavy enough burden
tx: albendazole, pyrantel pamoate

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19
Q

Ancylostoma Duodenale?

A

cough, anemia, malabsorption, weight loss, eosinophilia

tx: mebendazole, pyrantel pamoate

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20
Q

Treatment for enterobius vermicularis?

A

mebendazole or pyrantel pamoate

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21
Q

What are some non-inflammatory food poisonings?

A

S. aureus (intense vomiting 24 hours)
B. cereus (vomiting and diarrhea), from bad rice
C. perfringens, profuse diarrhea, rewarmed meat.

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22
Q

Inflammatory food poisoning?

A

C. jejuni. undercooked chicken. superficial ulcers in colon
EHEC: undercooked hamburgers. look at mackonkey agar. worry about HUS.
Y. enterocolitica. RLQ pain, mimics appendicitis

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23
Q

What causes ascending paralysis? Descending paralysis?

A

Ascending paralysis: Guillan Barre

Descending paralysis: Botulism

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24
Q

Features of HUS?

A 
diarrhea illness
GI bleeding
purpura and HTN
microangiopathic hemolytic anemia
schistocytes
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25
What are some important things to know about salmonella typhi?
gallbladder is the reservoir, can cause necrotizing cholecystitis red spots on belly high fevers. treat with cipro, ceftriaxone
26
What are some things to know about shigella dysenteriae?
severe bloody diarrhea, seen in children in developing countries
27
What's the deal with necrotizing enterocolitis?
``` premature infants w/ reduced intestinal perfusion translocation of bacteria and gas into the bowel wall feeding intolerance (bilious emesis) abdominal distention decreased BS sepsis (low platelet count) hematochezia metabolic acidosis ``` w/u: serial abdominal radiographs. see pneumatosis intestinalis NG tube to suction
28
What is the treatment for necrotizing enterocolitis? Possible complications?
Tx: bowel rest vanco, gent, metro IVF NG tube suction surgery if: abdominal wall erythmea, air in portal vein, intestinal pneumatosis, pneumoperitoneum complications: septic shock, strictures, short bowel syndrome, death
29
What is pneumatosis coli?
NEC isolated to the colon can happen after midgut volvulus, or malrotation possible intestinal perforation
30
What is the organism seen in cat bites? treatment?
pasteurella multiocida | amoxicillin-clavulonate X5d (also covers anaerobes)
31
Causes sepsis in preterm infants?
enterococcus
32
Sepsis in infants under 2 mo?
Group B strep E Coli Listeria tx: amp and gent OR amp and cefotaxime amp needed for listeria
33
Sepsis in infants over 2 mo?
strep pneumo N. meningitidis ceftriaxone and vancomycin
34
CSF findings? Tuberculosis meningitis Viral meningitis Guillain Barre
Tuberculosis: glucose 250 Viral: High WBCs,
35
What is brudzinski and kernig?
brudzinski: flex the neck-->flex the legs kernig: flex the thigh-->can't extend the leg
36
``` Organisms that cause bacterial meningitis in these age groups? Neonates Infants Adults Elderly? ```
Neonates: GEL Infants and adults: S. pneumo, neisseria meningitidis, h. influenza elderly: s. pneumo, n. meningitidis, listeria
37
When do you need a CT in a bacterial meningitis workup in kiddos?
usu don't need b/c open anterior fontanel can accomodate increased ICP unstable neuro signs antibiotics, CT, LP focal neuro: CT stable neuro: LP then antibiotics
38
Once you have diagnosed meningococcemia...what do you treat it with?
Penicillin G
39
How do you treat N. meningitis?
ceftriaxone or rifampin | close contact: ceftriaxone, cipro, rifampin
40
Aseptic meningitis?
enteroviruses: coxsackie, echo HSV-1 mumps
41
What is the presentation of encephalitis?
``` AMS seizures paralysis HA photophobia nuchal rigidity increased ICP ``` HSV--focal neuro deficits, odd behavior (hypersexuality, hypomania, amnesia) abnormal EEG
42
What are the causes for encephalitis?
HSV2 (neonates) HSV1 (children) arboviruses St. louis, eastern equine, western equine, west nile enteroviruses (coxsackie, echo) toxoplasmosis and a bunch of other things.
43
What is the workup and treatment for encephalitis?
CSF, PCR HSV, CMV, EBV, VZV EEG tx: acyclovir for encephalitis anticonvulsants if seizures are present
44
What are the important features of gonococcal conjunctivitis?
occurs at 3-5 days of life bilateral purulent conjunctivitis can cause corneal ulceration Tx: topic erythromycin
45
What are the important features of chlamydia conjunctivitis?
1-2 weeks of life red conjunctiva, mucoid discharge, lid swelling tx: oral erythromycin can get chlamydial pneumonia from this.
46
What is important to know about otitis media?
``` S. pneumo H. influenza M. Catarrhalis other: s. pyogenes, p. aeruginosa, mycobacterium treat with amoxicillin ```
47
Chronic suppurative otitis media?
S. aureus, pseudomonas, E coli
48
What is keratinized squamous epithelium on the TM from chronic middle ear disease?
choleastoma
49
otitis externa?
pseudomonas E. Coli S. aureus Tx: Burrow's solution, 2% Acetic Acid, cipro ear drops
50
Mastoiditis?
s. pneumo or HIB post auricular pain and AOM pinna pushed lateral and down
51
Sinusitis?
most common: ethmoid sinus >18 mo: could be maxillary >6yo: could be frontal or sphenoidal see 10-14d nasal discharge S. pneumo, non-typeable HI, moraxella. CT, transillumination high dose amoxicillin
52
What is a juvenile angiofibroma?
nasal obstruction (1 side of nose always congested) epistaxis erosion thru the septum Tx: surgery
53
What's the deal with herpangina?
fever, sore throat, pain with swallowing, fever, HA 1-2mm vesicles and ulcers with red ring in back pharynx, gray lesions caused by coxsackievirus, echovirus. seasonal presentation.
54
If pt is resistant to nystatin mouthwash for candida...what is a good alternative?
clomitrazole
55
Cervical adenitis?
causes: viral URI, bilateral enlarged nodes bacterial: unilateral, staph & strep, bartonella (with maculopapular rash), atypical myco ``` tx: bartonella, cat scratch, use TMP-SMX clindamycin periodontal dx: amoxicillin excision/biopsy for w/u if >3cm fluctuant node. ```
56
Reye syndrome?
ASA in kiddos with influenza or varicella infections microvesicular fatty infiltration & hepatic mitochondrial dysfunction acute liver failure, encephalopathy high Transaminases, PR, INR, PTT, Ammonia
57
Common cold v. flu?
Common cold: itchy, watery eyes, productive cough, gradual onset of symptoms. Flu: dry cough, fever, fatigue, HA, myalgias, sudden onset
58
Fancy name for measles? | Rubella affects what?
measles=rubeola | rubella targets retroauricular, posterior cervical and occipital lymph nodes
59
Roseola?
Fever first, then rash | like Rose is super optimistic, when God takes away a fever, he gives you a rash.
60
Fifth disease?
parvovirus B19, creates erythema infectiosum | slapped cheek
61
What type of vaccine protects you from mumps? Possible complications?
parotitis is seen LAV protects you. can get meningitis within 10 days of onset can get orchitis in rare cases with males.
62
Rocky mountain spotted fever?
maculopapular rash that begins in the flexor surfaces, usu involves the palms and soles hyponatremia and thrombocytopenia may be seen give doxycycline
63
ITP?
thrombocytopenia, triggered by virus, otherwise healthy
64
T/F Cryptosporidium is only seen in HIV + patients? Treatment?
False. oddly enough also seen in daycare centers. | Give nitazoxanide
65
What are some clues that you have a viral cause of pharyngitis? Bacterial?
Viral: hoarseness, abdominal pain, diarrhea bacterial: localized, high grade fever
66
What are some bacterial causes of pharyngitis?
1. strep pyogenes 2. C. diphtheria 3. candida, mycoplasma, n. gonorrhea
67
Presentation of strep throat?
pharyngeal erythema, swelling, tonsillar exudates, edematous uvula, palatine petechiae, anterior cervical LAD, strawberry tongue
68
Complications of strep throat?
1. Acute Rheumatic Fever: after strep pharyngitis Jones criteria + ASO need penicillin for at least 5 years after that. 2. Post-strep glomerulonephritis: Type 3 hypersensitivity, immune complex deposition decreased C3/C4 hypercellular glomeruli, granular deposits, humps
69
Corynebacterium diphtheriae pharyngitis?
gram positive, club shaped grey film (made by ADP-ribosylation of mucosal cells), bleeding if you try to pull it off bull neck: massive LAD Treatment: Antiserum to toxin, vaccine, erythromycin, clindamycin
70
Bordatella Pertussis?
macrolides to pt and family. | respiratory isolation within the first 5 days.
71
Retropharyngeal abscess?
muffled voice, stridor, refusing to turn head to one side | I&D, ceftriaxone, ampicillin.
72
Peritonsilar abscess?
post strep, uvula deviation | I&D, ampicillin

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