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Infectious Disease (OSI type) > Infectious - Internal Medicine > Flashcards

Infectious - Internal Medicine Flashcards

1
Q

[Diagnose]

20/M painful penile rash on his penis. Multiple vesicular lesions on an erythematous base present.

A

Dx: Genital Herpes
Etiology: HSV Type 2
Initial Test: Tzank smear
Accurate Test: Detect virus, viral antigen, viral DNA in scraping from lesions

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2
Q

[Diagnose]

20/M non-painful rash on his penis. PE: non-tender ulcerated nodule

A 
Dx: Primary syphilis
Etiology: T. pallidum
Most infectious state: secondary syphilis 
Accurate Test: Dark Field microscopy
Tx: single dose penicillin IM
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3
Q

[Diagnose]

20/M painful penile rash on his penis. Multiple vesicular lesions on an erythematous base present.

What will you see in Tzank Smear?

A

giant cells or intranuclear inclusions

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4
Q

What is the drug of choice for HSV encephalitis and neonatal herpes?

A

IV acyclovir

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5
Q

[Diagnose]

20/M with a previous history of non-painful ulcerated penile nodule 2 weeks ago. Now has widely distributed macular rash on palms and soles; presence of condyloma lata

A 
Dx: Secondary syphilis
Etiology: T. pallidum
Most infectious state: secondary syphilis 
Accurate Test: RPR/VDRL or FTA ABS
Tx: single dose penicillin IM
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6
Q

[Diagnose]

20/M with a previous history of non-painful ulcerated penile nodule, macular rash on palms and soles and presence of condyloma lata.

Years later, patient has tabes dorsalis, gummas, Argyll-Robertson pupil

A

Dx: Tertiary syphilis
Etiology: T. pallidum
Most infectious state: secondary syphilis
Accurate Test: RPR/VDRL or FTA ABS or Lumbar punction
Tx: single dose penicillin IM

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7
Q

If patient with syphilis is allergic with penicillin, what is the alternative drug?

A

Doxycycline

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8
Q

Compare chance vs chancroid in terms of etiology

A 
Chancre = T. pallidum
Chancroid = H. ducreyi
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9
Q

Compare chance vs chancroid in terms of presence of pain

A 
Chancre = painless
Chancroid = painful
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10
Q

[Diagnose]

26/F yellowish vaginal discharge and dysuria. history of unprotected sex.

yellow mucopurulent discharge from the cervical os.

A

Dx: Mucupurulent cervicitis
Etiology: N. gonorrhea or chlamydia trachomatis
Initial test: Gram staining
Accurate test: NAAT or culture
Tx: single dose regimen for gonorrhea + treat chlamydia

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11
Q

What is the single best test for both chlamydia and gonorrhea

A

Nucelic acid amplification test

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12
Q

what is the therapy for both gonorrhea + chlamydial infection?

A

(Neisseria)
1. Ceftriaxine 250mg IM SD OR Cefixime 400mg PO SD

PLUS

(Chlamydia)
2. Doxycycline 100mg PO BID x 7days OR Azithromycin 1g PO SD

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13
Q
  1. Ceftriaxine 250mg IM SD OR Cefixime 400mg PO SD

PLUS

  1. Doxycycline 100mg PO BID x 7days OR Azithromycin 1g PO SD

In the regimen above, which covers for chlamydial infection?

A

Azithromycin or Doxycycline

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14
Q

In chlamydial treatment, which is contraindicated in pregnancy?

A

Doxycycline

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15
Q

[Diagnose]

20/F, lower abdominal pain, tenderness, fever. (+) leukocytosis and cervical motion tenderness

A 
Dx: PID
Next step: Pregnancy test
Initial test: cervical culture or NAAT
Accurate test: laparoscopy
Tx: Ceftriaxone IM + 14days Doxycycline + 14 days metronidazole
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16
Q

[Diagnose]

20/F vulvar itching/irritation
white clumped discharge

A

Dx: Vulvovaginal Candidiasis
Etiology: C. albicans
Tx: Fluconazole 150mg PO SD

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17
Q

[Diagnose]

20/F vulvar itching, produse white/yellow homogenous discharge.

A

Dx: Trichomonal vaginitis
Etiology: T. vaginalis
Tx: Metronidazole 2g PO SD OR Metronizadole 500mg BID PO x 7 days

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18
Q

[Diagnose]

20/F fishy odor with 10% KOH, slightly increased vaginal discharge

presence of vaginal epithelial cells with cocobacillary organisms giving a granular apperance

A

Dx: Bacterial vaginosis
Etiology: Gardnerella vaginalis
Tx: Metronidazole 500mg BID PO x 7 days

Treat the asymptomatic partner

“Clue cells”

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19
Q

[Diagnose]

18/M with loose bowel stools 6 hours after eating potato and egg salad.

(+) Nausea, vomiting, crampy bdominal pain

A

Dx: Bacterial food poisoning
Etiology: S. aureus
Next step: hydrate

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20
Q

what is the marker of fecal leukocytes that is more sensitive and is available in latex agglutination and ELISA formats?

A

Fecal lactoferin

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21
Q

[Diagnose]

Watery diarrhea;
Stool findings - no fecal leukocytes, no increase in fecal lactoferrin

A

Dx: non-inflammatory
Location: Proximal small bowel

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22
Q

[Diagnose]

dysentery;

Stool findings - fecal PMN; substantial increase in fecal lactoferrin

A

Dx: inflammatory (invasion or cytotoxin)
Location: Colon or distal small bowel

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23
Q

[Diagnose]

Enteric feve

Stool findings: fecal mononuclear leukocytes

A

Dx: penetrating
Etiologies: S. typhi, Y. enterocolitica

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24
Q

[Dx: bacterial etiology food poisoning]

6 hours PTC, nausea, vomiting diarrhea

Ham, poultry, potato, mayonnaise, egg salad intake

A

Etiology: S. aureus

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25
Q

[Dx: bacterial etiology food poisoning]

6 hours PTC, nausea, vomiting diarrhea

Fried rice intake

A

Etiology: B. cereus

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26
Q

[Dx: bacterial etiology food poisoning]

8 hours PTC, abdominal crapms, diarrhea, no vomiting

beef, poultry, legumes, gravies intake

A

Etiology: C. perfringes

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27
Q

[Dx: bacterial etiology food poisoning]

8 hours PTC, abdominal crapms, diarrhea, no vomiting

cereals, dried beans intake

A

Etiology: B. cereus

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28
Q

[Dx: bacterial etiology food poisoning]

20 hours PTC, watery diarrhea

shellfish and water intake

A

Etiology: V. cholerae

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29
Q

[Dx: bacterial etiology food poisoning]

20 hours PTC, watery diarrhea

salad, cheese, meat, water intake

A

ETEC

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30
Q

[Dx: bacterial etiology food poisoning]

20 hours PTC, bloody diarrhea

ground beef, raw milk, salami, raw vegetables intake

A

EHEC

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31
Q

[Dx: bacterial etiology food poisoning]

20 hours PTC, inflammatory diarrhea

poultry, egg, dairy intake

A

Salmonella spp

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32
Q

[Dx: bacterial etiology food poisoning]

20 hours PTC, inflammatory diarrhea

poultry + raw milk intake

A

C. jejuni

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33
Q

[Dx: bacterial etiology food poisoning]

20 hours PTC, dysentery

potato, egg salad, lettuce and raw vegetables intake

A

Shigella spp

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34
Q

[Dx: bacterial etiology food poisoning]

20 hours PTC, dysentery

mollusk, crustacean intake

A

V. parahaemolyticus

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35
Q

[Diagnose]

18M with 2 day history of loose bowel stools, initially non bloody now bloody, after eating burgers, fries, spaghetti.

PE: stable VS, dry mouth abdominal pain, low grade fever

Labs: anemia and thrombocytopenia

A

Dx: Hemorrhagic colitis t/c HUS
Etiology: E. coli 0157:H7
Toxin: shiga toxin

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36
Q

What are the component sof hemolytic uremic syndrome

A

Acute renal failure
microangiopathy hemolytic anemia
Thrombocytopenia

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37
Q

[E. coli pathotype: defining molecular trait]

HUS, industrialized country,
Lambda-like Stx1 or Stx2 encoding bacteriophage

A

Etiology: EHEC/STED/ST-EAEC
Trait: Shiga toxin

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38
Q

[E. coli pathotype: defining molecular trait]

Travelers to developing country; virulence plasmids

A

Etiology: ETEC
Trait: Heat stable and labile enterotoxins, colonization factor

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39
Q

[E. coli pathotype: defining molecular trait]

watery or persistent diarrhea; young children and neonates

Presence of adherence factor plasmid

A

Etiology: EPEC
Trait: attaching and effacing lesion of intestinal epithelium

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40
Q

[E. coli pathotype: defining molecular trait]

dysentery; developing country, virulence plasmid

A

Etiology: EIEC
Trait: invasion of colonic epithelial cells

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41
Q

[E. coli pathotype: defining molecular trait]

acute and persistent diarrhea, travelers diarrhea; both in developing and developed countries

A

Etiology: EAEC
Trait: aggregative/diffuse adherence; virulence factors regulated by AggR

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42
Q

[Diagnose]

40M fever, right sided abdominal pain/RUQ pain, no jaundice noted liver abscess on workup

anchovy paste on needle aspiration

A

Dx: Amebic liver abscess
Etiology: E. histolytica
Most common type of infection related to the pathogen: asymtomatic cyst passage

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43
Q

What is the definitive diagnosis of amebic colitis?

A

demonstration of hematophagous trophozoites of E. histolytica

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44
Q

How will you differentiate liver vs pyogenic abscess?

A
  1. Age: Pyogenic are older people

2. Gram staining and culture is the most important

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45
Q

What is the pathologic finding in intestinal amebiasis?

A

classic flask-shaped ulcer

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46
Q

What are the earliest colonic lesions of intestinal amebiasis?

A

microulcerations of the mucosa of the cecum, sigmoid, rectum

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47
Q

What will be your treatment regiment for asymptomatic carriers of amebiasis

A
  1. Iodoquinol (luminal) OR paramomycin
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48
Q

What will be your treatment regiment for acute colitis due to amebiasis?

A
  1. Iodoquinol (luminal)

2. paramomycin + Metronidazole 750mg PO x 5-10 dyas or Tinidazole

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49
Q

What will be your treatment regiment for amebic liver abscess?

A
  1. Iodoquinol (luminal)

2. paramomycin + Metronidazole 750mg PO x 5-10 dyas or Ornidazole

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50
Q

What is the most common cause of death due to parasitic infection worldwide?

A

malaria

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51
Q

What is the second most common cause of death due to parasitic infection worldwide?

A

E. hystolitica

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52
Q

{Diagnose]

30/M with 5-day history of fever and abdominal pain. Ha a history of travel to a developing country.

PE: Faint salmon-colored, maculopapular rash on the trunk (rose spots on trunk and chest)

A

Dx: Typhoid fever
Etiology: S. typhi or paratyphi
Accurate test: Blood culture
Tx: Ciprofloxacin

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53
Q

What is the most common manifestation of salmonella infection?

A

Enterocolitis

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54
Q

In S. typhi, when will you see the relative bradycardia?

A

at the peak of high fever

55
Q

GI bleeding and intestinal perforation in salmonella typhi infection is due to?

A

Hyperplasia, ulceration and necrosis of the ileocecal peyers patches at the initial site of salmonella infiltration

56
Q

In salmonella culture, which source has the greatest sensitivity?

A

bone marrow

57
Q

Where will you obtain your culture?

Abdominal pain, constipation, positive typhi dot

1st to 2nd week of illness

A

blood

58
Q

Where will you obtain your culture?

Abdominal pain, constipation, positive typhi dot, gradual increase of temp

3rd week of illness

A

stool

59
Q

In typhoid fever, the patient ‘s temp is rapidly rising/spiking, where will you get your culture?

A

blood

60
Q

A typhoid patient developed nausea, vomiting, diarrhea at onset with low grade fever

A

stool

61
Q

24/M waded on flood waters, developed fever, body aches, conjunctival suffusion and abdominal pain, jaundice with no UO

PE: 120/70, clear breath sounds, crea at 3mg/dL

A 
Dx: leptospirosis
Next step: hydrate with pNSS
gold standard: culture and isolation
First line abx mild : Doxycycline
First line abx severe: penicillin G
62
Q

Leptospira are able to survive in non immune host since they evade complement-mediated killing by means of ____

A

binding factor H

a strong inhibitor of the complement system

63
Q

[phase of leptospirosis]

fever, 3-10 days
negative antibody

where will you get the culture?

A

Stage: Acute leptospiremic phase

Culture source: blood
Leptospires present in: blood

64
Q

In acute leptospiremic phase, week 1,

Leptospire location:
Antibody titer:

A

Leptospire present in: Blood

Antibody titer: negative

65
Q

In acute leptospiremic phase, week 2,

Leptospire location:
Antibody titer:

A

leptospire present in: CSF

Antibody titer: slightly increased

66
Q

In leptospirosis convalescent stage,

Leptospire location:
Antibody titer:

A

Leptospire present in: urine

Antibody titer: high

67
Q

What are the criteria for for leptospirosis?

A
  1. Residing in flooded area or has high risk exposure
  2. Acute febrile illness of at least 2 days
  3. At least 2 of the following:
    C JOHAM

Calf tenderness, conjunctival suffusion, chills, Jaundice, Oliguria, Abdominal pain, Myalgia

68
Q

At what phase of lepstosprirosis where dark field microscopy or IF is important?

A

Leptospiremic phase (1st 7 to 10 days)

69
Q

__ is the test that has the highest yield during leptospiremic phase before the appearance of antibodies

A

PCR

70
Q

Indirect detection of leptospirosis via Microagglutination test is confirmatory of there is ___ rise in titer

A

4 fold rise

71
Q

Specific IgM rapid test for leptospirosis is sensitive and highly specific if take within ___ days

A

less than 7 days

72
Q

What electrolyte is uniquely associated with leptospiral nephropathy?

A

magnesium

73
Q

What is the first line treatment for mild cases of leptospirosis?

A

Doxycycline 100mg BOD PO

74
Q

What is the first line treatment for severe cases of leptospirosis?

A

Penicillin G 1.5M units q68 IV for 7 days

75
Q

What is the treatment of choice for pulmonary hemorrhage in leptospirosis?

A

bolus methylprednisolone within first 12 hours of onset

76
Q

[leptospirosis prophylaxis]

Low risk

A

Doxycycline 100mg 2 caps SD

77
Q

[leptospirosis prophylaxis]

moderate risk

A

Doxycycline 100mg 2 caps OD x 3-5 days

78
Q

[leptospirosis prophylaxis]

high risk and continuous exposure

A

Doxycycline 100mg 2 caps once weekly until end of exposure

79
Q

[Diagnose]

32/M fever, chills, diaphoresis. History of palawan trip.

enlarged liver and spleen

A

Dx: Malaria

Accurate test: Thick and thin blood smear

80
Q

what is the infective stage during asexual cycle of malaria?

A

sporozoites

81
Q

what are the dormant forms responsible for relapse?

A

hypnozoites

82
Q

Plasmodium species capable of relapse

A

P. vivax

P. ovale

83
Q

[Classify the species]

Malignant tertian

A

P. falciparum

84
Q

[Classify the species]

benign tertian

A

P. vivax, P. ovale

85
Q

[Classify the species]

benign quartan

A

P. malaria

86
Q

What are the fatal complication of falciparum malaria?

A
  1. cerebral malaria
  2. malaria hyperpyrexia
  3. blackwater fever
87
Q

[malaria]

The fever spikes after 48-72 hours coincides with

A

rupture of RBC

88
Q

[malaria treatment according to WHO]

Uncomplicated falciparum

A

ACT for 3 days

89
Q

[malaria treatment according to WHO]

severe falciparum malariaN

A
  1. Artesunanate IV/IM day 1
  2. ACT for 3 days
  3. Primaquine
90
Q

[malaria treatment according to WHO]

Non-falciparum malaria

A
  1. ACT or chlorquine

2. Primaquine for 14 days for eradication of hypnozoites

91
Q

[malaria treatment according to WHO]

pregnancy (1st trimester)

A
  1. Uncomplicated Falciparum: Quinine + Clindamycin (7 days)

2. Non-falciparum: quinine

92
Q

[malaria treatment according to WHO]

prophylaxis

A

take antimalarial drugs 2 days to 2 weeks before departure; continue for 4 weeks after

93
Q

[diagnose]

20/M. 3 days fever, body pains, abdominal pain and gum bleeding. Tourniquet test positive. Leukopenia and elevated Hct

A

Dx: Dengue fever with warning sign (gum bleeding)

Earliest CBC abnormality: decrease in total WBC

94
Q

What are the factors that increases the susceptibility to severe dengue?

A
  1. <12 years old
  2. Female sex
  3. Had previous dengue virus followed by dengue virus 2
95
Q

What is protective from severe dengue?

A

Malnutrition

96
Q

What are the dengue warning signs?

A

LIC-PALM

  1. Lethargy
  2. Increase in Hct
  3. Clinical fluid accumulation
  4. Persistent vomiting
  5. Abdominal pain or tenderness
  6. Liver enlargement >2cm
  7. Mucosal bleed
97
Q

What are the criteria for severe dengue?

A
  1. AST/ALT >/ 1000
  2. Impaired consciousness
  3. Shock
  4. Fluid accumulation with respiratory distress
98
Q

[Phase of dengue]

non-specific signs and symptoms, tourniquet test, mucosal bleed, decreased WBC

A

Febrile phase (Day 2-7)

99
Q

[Phase of dengue]

Defervescence, progressive leukopenia, rapid decrease in PC and increase Hct

Fluid accumulation

shock, organ impairment, DICm hemorrhage

A

critical phase (Day 3-7)

100
Q

What is a physical examination sign of dengue recovery?

A

“herman’s rash”

isles of white in the sea of red

101
Q

NS 1 antigen can be positve as early as ____

A

1 day after symptom

102
Q

Dengue IgM is detected in the first ___ days of illness

A

first 5 days

103
Q

What are the signs of plasma leakage in Dengue?

A
  1. Rising hematocrit
  2. Effusion or ascites
  3. Shock (decreased pulse pressure)
104
Q

[Diagnosis]

26/M from Samar Isles. Weight liss, abdominal enlargement and coffee ground vomiting. Hepatosplenomegaly.

fecalysis: egg with small hook-like spine

A

Dx: Schistosomiasis
Etiology: Schistosoma japonicum
Infective stage: cercarial skin penetration
Tx: Praziquantel

105
Q

What is the most important of the neglected tropical diseases?

A

Schistosomiasis

106
Q

Itchy maculopapular rash masnifesting 2 or 3 days after skin invasion of schistosoma

A

Swimmers itch

Cercarial dermatitis

107
Q

Katayama syndrome is also equivalent to ___

A

Acute schistosomiasis

108
Q

[Schistosomiasis]

Occurs 4-8 weeks after skin invasion, fever, hepatosplenomegaly, high degree of eosinophilia

A

Acute schistosomiasis

109
Q

[Schistosomiasis]

begin few months after infection, colicky abdominal pain, bloody diarrhea, anemia, hepatosplenomegaly, portal hypertension, esophageal varices

A

chronic schistosomiasis

110
Q

[Schistosomiasis]

egg induced granulomatous response lead to severe periportal fibrosis. It is also called

A

Symmers clay pipestem fibrosis

111
Q

[Schistosomiasis]

Which lobe of the liver initially enlarges in hepatosplenic schistosomiasis?

A

left lobe

112
Q

What is the most severe complication of hepatosplenic schistosomiasis?

A

Hematemesis

113
Q

[Schistosomiasis]

What is the standard diagnostic method to diagnose schistosomiasis?

A

Detect schistosome egg in stool

114
Q

[Diagnosis]

19/M sustained punctured wound after he step in a nail. Presents one week later with sore throat, difficulty talking and opening his mouth

A

Dx: Tetanus
Etiology: C. tetani
Toxin responsible: Tetanospasmin
Common site of infection: superficial abrasion to the limbs
What muscles are affected first: muscles of the face and jaw
What is the preferred treatment: metronidazole

115
Q

What is the most common cause of death in tetanus?

A

Respiratory failure

116
Q

What is the preferred antibiotic treatment for tetanus?

A

Metronidazole

Alternative: penicillin

117
Q

Where is the most common infection site of tetanus infection in adults?

A

superficial abrasion

118
Q

[HIV phase]

fever, skin rash, pharyngitis, myalgia

sudden onset of mononucleosis-like illness

A

Acute HIV syndrome

119
Q

[HIV phase]

active virus replication

A

Asymptomatic Stage

120
Q

[HIV]

Constitutional signs and symptoms start to appear in what CD4 level?

A

CD4 <200 dL

121
Q

What is the hallmark of HIV?

A

profound immunodeficiency from progressive deficiency of helper T cells

122
Q

What is the best predictor of long-term clinical outcome in HIV infection?

A

plasma viral load

123
Q

What is the best predictor of short-term risk of developing and opportunistic infection?

A

CD4 lymphocyte count

124
Q

What is the most common neurologic syndrome in AIDS?

A

AIDS dementia complex

125
Q

What is the mean survival time from onset of severe AIDS dementia complex?

A

less than 6 months

126
Q

What is the most common opportunistic infection affecting AIDS patient?

A

Pneumocystis pneumonia

Tx: TMP-SMX

127
Q

The definitive dianosis of PCP pneumonia is by the use of what stain?

A

Giemsa or silver stain

128
Q

When to start antiretroviral treatment?

A

CD4 <350 or presence of AIDS defining illness or symptomatic regardless of CD4

129
Q

What is the regiment in treating HIV?

A

2 NRTI

1 NNRTI

130
Q

What is the first line NRTI?

A

Zidovudine (AZT) + Lamivudine (3TC)

131
Q

What is the first line NNRTI?

A

Nevirapine

132
Q

What is the most common diagnosis of FUO among the neoplasms?

A

Malignant lymphoma

133
Q

What is the most common implicated infectious organism in FUO?

A

TB

Infectious Disease (OSI type) (24 decks)

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