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Internal Medicine > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Mono typically causes what LAD?

A

Posterior cervical LAD

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2
Q

What is used to treat rosacea?

A

Metronidazole

Localized facial erythema with/without pustules and papules

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3
Q

Histoplasmosis presentations (mild to severe)

A

Mild: Pulmonary + mediastinal LAD
Severe: Hepatosplenomegaly with diffuse LAD

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4
Q

Vomiting after foodborne preformed toxin occurs when?

A

Within 6 hours (not 36 hrs)

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5
Q

Tinea versicolor treatment

A

Topical ketoconazole, terbinafine, selenium sulfide

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6
Q

Complications of malaria

A

Children - cerebral malaria: Seizure, coma, hypoglycemia, metabolic acidosis
Adults: Jaundice, acute renal failure, acute pulmonary edema

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7
Q

What are additional complications of RMSF? What labs?

A

Encephalitis, pulmonary edema, bleeding, shock
Severe abdominal pain

Low platelets, hyponatremia, higher AST/ALT

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8
Q

Hidradenitis suppurativa - treatment

A

Mild: Topical clindamycin
Moderate: Oral tetracyclines
Severe: TNF-a inhibitors, oral retinoids, surgical excision

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9
Q

Asplenic adult patients should receive what vaccines? When should they receive them?

A

Pneumococcal (PCV20 or PCV15 + PPSV23); Hib (1 dose); Meningococcal (quad and sero B, q5years)

> =14d before or after the splenectomy

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10
Q

Candidemia - treatment

A
  1. Empiric antifungal (typically echinocandins first-line)
  2. Source control
  3. Evaluation for metastatic infection: ophthalmic, echocardiography
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11
Q

Utility of galactomannan, beta-D-glucan

A

Galactomannan: Aspergillus cell wall
Beta-D-glucan: sensitive (but not specific) for yeast infections

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12
Q

Organ transplant CMV affects which organ system most? Dx? Treatment?

A

GI - colitis/enteritis with multiple large shallow ulcers- fever, malaise, vomiting, bloody diarrhea, abdominal pain

Dx gold standard is biopsy of affected organ
Atypical lymphocytes on blood smear

Treat with ganciclovir and reduction of immunosuppression

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13
Q

Organ transplant herpes simplex-1 reactivation organ systems

A

Tracheobronchitis, esophagitis, pneumonia, and/or hepatitis

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14
Q

What is the most common cause of purulent pericaditis?

A

S. aureus from hematogenous spread; increased risk from chronic hemodialysis

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15
Q

Acute lymphangitis

A

Injection drug use inoculates skin flora into subcutaneous tissue

Sx: Tender red streaks up lymphatic channels with painful, swollen, erythematous regional lymphadnitis

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16
Q

Beta-D-glucan antigen

A

Rapid indicator of possible fungal infection (e.g. Candida)

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17
Q

Most common causes of catheter-related bloodstream infection (CRBSI)

A
  1. Coagulase-negative staph (e.g. S. epidermidis)
  2. S. aureus
  3. Enterococcus
  4. Candida

Draw 2 sets of blood cultures (1 from catheter, 1 from peripheral site) - differentiates contamination from true infection

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18
Q

Typical acute bacterial prostatitis antibiotics

A

E coli, Proteus:
1. Fluoroquinolone
2. Bactrim

Do this for 6 weeks

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19
Q

Echinococcus granulosus appears how on CT?

A

Thin-walled, septated lesions, occasionally with calcifications

Contracted from infected sheep or canines

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20
Q

Pulmonary histoplasmosis - chest x-ray

A

Healed granulomas (calcified)
Hilar lymphadenopathy

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21
Q

What virus can lead to toxic megacolon in immunocompromised patients?

A

CMV (cytomegalovirus colitis)

Treat with ganciclovir

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22
Q

Hydatid cyst appearance on CT; treatment

A

Large cyst with “eggshell” calcification, along with daughter cysts (internal septations)

Small cysts (<5 cm): Albendazole
Large cysts: Percutaneous therapy or surgery (watch for anaphylactic shock)

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23
Q

Cysticercosis - bug, location

A

Taenia solium

Cysts in brain or muscle

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24
Q

Uncomplicated parapneumonic effusion vs complicated vs empyema

A

Uncomplicated: Sterile exudate

Complicated: Bacterial invasion, moderate-large fluid, flowing or loculated, pH <7.2, glucose <60, WBC >50,000, LDH >1,000

Empyema: Frank pus in pleural space; bacteria positive on Gram stain

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25
Q
A
26
Q

Which bacteria for most deep puncture wounds?

A
  1. S. aureus
  2. Pseudomonas
27
Q

Antibiotics for anaerobic lung abscess

A

Zosyn
Carbapenem
Clindamycin (if beta-lactam allergy due to C diff risk)

28
Q

Sydenham chorea - signs, tests

A

Chorea, hypotonia, behavioral changes
Motor and psychiatric symptoms tend to wax/wane
Disappear during sleep

Group A strep testing + antistreptolysin O and anti-DNAse B titers

29
Q

What evaluation should all patients with bacterial meningitis receive before discharge?

A

Audiologic testing for hearing deficits - can result from inflammatory damage to cochlea

Cochlear ossification from fibrosis makes implantation surgery more difficult and outcomes poorer

30
Q

Invasive pulmonary aspergillosis treatment

A

Voriconazole iv 1-2 weeks + caspofungin (an echinocandin), then prolonged oral voriconazole

31
Q

Chikungunya - notable symptoms

A

Severe polyarthralgia (beginning in feet and hands) - Up to 70% develop chronic arthralgia/arthritis that lasts months/years - may require methotrexate

High fever, maculopapular rash, conjunctivitis

Lymphopenia, thrombocytopenia, transaminitis

32
Q

Molluscum contagiosum treatments

A
  1. Cryotherapy
  2. Curettage
  3. Topical (eg cantharidin)
33
Q

Type of infection based on time since transplant

A

<1 month: bacterial infection from surgery
1-6 months: opportunistic infections
>6 months: typical community acquired pathogens

34
Q

Disseminated histoplasmosis treatment

A

IV amphotericin B (fungicidal) 1-2 weeks, then itraconazole (fungistatic) 1 year

35
Q

JC virus on CT brain

A

Nonenhancing, asymmetric, white matter lessons without edema

36
Q

Granuloma with narrow-based budding yeast

A

Histoplasmosis

(Coccidioidomycosis would be spherules with endospores, unilateral lung)

37
Q

Candidal onychomycosis is least frequent in which part?

A

Toenails - most likely Trichophyton rubrum

38
Q

High-dose iv acyclovir concerns

A

Poor urine solubility, crystal formation in renal tubules and AKI
Give iv fluids and loop diuretic to flush

39
Q

When is clindamycin used in context of pulmonary ID?

A

Anaerobes or penicillin allergy with lung abscess or aspiration pneumonia

40
Q

AIDS esophageal infection - organisms and management

A
  1. Candida - mild pain and concurrent oral thrush - oral fluconazole
  2. HSV - well-circumscribed lesions with round/ovoid, “volcano-like” appearance, and ballooning degeneration and eosinophilic intranuclear inclusions - acyclovir
  3. CMV - large, linear ulcerations in distal esophagus with intranuclear/intracytoplasmic inclusions - ganciclovir
41
Q
A
42
Q

Is HIV adenopathy painful or not?

A

Not painful, unlike mono

43
Q

Rat-bite fever

A

Flu-like illness with diffuse maculopapular rash and arthralgia

44
Q

Q fever

A

Tick-borne Coxiella burnetii, pleomorphic rod

Prolonged flu-like illness
Maculopapular rash

45
Q

What else is transmitted by scratch besides Bartonella?

A

Pasteurella multocida - both are gram-negative coccobacilli

Bartonella causes papule and tender lymphadenopathy

Pasteurella causes cellulitis and lymphangitis

46
Q

Tularemia vs others

A

Tularemia has ULCERATING papule with central eschar and tender regional lymphadenitis

Sporothrix may ulcerate but is not painful

47
Q

Does Q fever produce lymphadenopathy?

A

No

48
Q

Does rat bite fever cause lymphadenopathy?

A

No

49
Q

Hep C - extrahepatic manifestations

A

Derm: Porphyria cutanea tarda, lichen planus
Renal: Membranoproliferative glomerulonephritis
Hematologic: Mixed cryoglobulinemia, ITP, AIHA

50
Q

Isoniazid heme concern

A

Pyridoxine antagonist -> acquired sideroblastic anemia presenting as microcytic hypochromic anemia (dimorphic RBCs)

Unlike IDA, iron and TIBC may be normal or other direction

Give pyridoxine

51
Q

Causes of false positive nontreponemal test

A

Pregnancy, HIV, IV drug use, liver disease, autoimmune

52
Q

What infection can lead to toxic epidermal necrolysis

A

Mycoplasma pneumoniae

53
Q

Bed bugs vs scabies

A

Bed bugs: linear tracks in exposed areas; palms not involved since skin too thick

Scabies: extensive excoriations and linear burrows, involves palm and web spaces, flexor wrists and extensor elbows, can develop pustules and wheals

54
Q

Scabies treatment

A

5% permethrin or oral ivermectin

55
Q

Hyphae and yeast in spaghetti and meatballs pattern

A

KOH prep of tinea versicolor

56
Q

Tinea versicolor treatment

A

Topical ketoconazole, terbinafine, or selenium sulfide

Caused by Malassezia
Often hypopigmented if after sun exposure (which pathologizes this commensal bacteria) due to darkening of surrounding skin

57
Q

Sporothrix treatment

A

Prolonged itraconazole

58
Q

Cigar-shaped yeast with narrow-based budding at 37 C

A

Sporothrix, a dimorphic fungus from decaying plants/soil

59
Q

Whipple disease - manifestation

A

Chronic malabsorptive diarrhea (steatorrhea, flatulence, distention)
Protein-losing enteropathy
Weight loss
Migratory non-deforming arthritis
LAD
Low-grade fever

60
Q

Whipple disease - diagnosis

A

Small intestinal biopsy and PCR
PAS stain positive macrophages in lamina propria with non-acid-fast Gram+ bacilli

61
Q

Aspergillus appearance on X-ray

A

Cavitary mass with air crescents at periphery

Internal Medicine (23 decks)

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