Infectious - Internal Medicine Flashcards by Clyde Silverio

[Diagnose]

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

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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[Diagnose]

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

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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[Diagnose]

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

What will you see in Tzank Smear?

giant cells or intranuclear inclusions

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

IV acyclovir

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[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

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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[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

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

Doxycycline

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Compare chance vs chancroid in terms of etiology

Chancre = T. pallidum
Chancroid = H. ducreyi

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Compare chance vs chancroid in terms of presence of pain

Chancre = painless
Chancroid = painful

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[Diagnose]

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

yellow mucopurulent discharge from the cervical os.

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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What is the single best test for both chlamydia and gonorrhea

Nucelic acid amplification test

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what is the therapy for both gonorrhea + chlamydial infection?

(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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Ceftriaxine 250mg IM SD OR Cefixime 400mg PO SD

PLUS

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

In the regimen above, which covers for chlamydial infection?

Azithromycin or Doxycycline

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In chlamydial treatment, which is contraindicated in pregnancy?

Doxycycline

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[Diagnose]

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

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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[Diagnose]

20/F vulvar itching/irritation
white clumped discharge

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

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[Diagnose]

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

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

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[Diagnose]

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

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

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

Treat the asymptomatic partner

“Clue cells”

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[Diagnose]

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

(+) Nausea, vomiting, crampy bdominal pain

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

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

Fecal lactoferin

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[Diagnose]

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

Dx: non-inflammatory
Location: Proximal small bowel

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[Diagnose]

dysentery;

Stool findings - fecal PMN; substantial increase in fecal lactoferrin

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

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[Diagnose]

Enteric feve

Stool findings: fecal mononuclear leukocytes

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

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[Dx: bacterial etiology food poisoning]

6 hours PTC, nausea, vomiting diarrhea

Ham, poultry, potato, mayonnaise, egg salad intake

Etiology: S. aureus

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[Dx: bacterial etiology food poisoning] 6 hours PTC, nausea, vomiting diarrhea Fried rice intake

Etiology: B. cereus

[Dx: bacterial etiology food poisoning] 8 hours PTC, abdominal crapms, diarrhea, no vomiting beef, poultry, legumes, gravies intake

Etiology: C. perfringes

[Dx: bacterial etiology food poisoning] 8 hours PTC, abdominal crapms, diarrhea, no vomiting cereals, dried beans intake

Etiology: B. cereus

[Dx: bacterial etiology food poisoning] 20 hours PTC, watery diarrhea shellfish and water intake

Etiology: V. cholerae

[Dx: bacterial etiology food poisoning] 20 hours PTC, watery diarrhea salad, cheese, meat, water intake

ETEC

[Dx: bacterial etiology food poisoning] 20 hours PTC, bloody diarrhea ground beef, raw milk, salami, raw vegetables intake

EHEC

[Dx: bacterial etiology food poisoning] 20 hours PTC, inflammatory diarrhea poultry, egg, dairy intake

Salmonella spp

[Dx: bacterial etiology food poisoning] 20 hours PTC, inflammatory diarrhea poultry + raw milk intake

C. jejuni

[Dx: bacterial etiology food poisoning] 20 hours PTC, dysentery potato, egg salad, lettuce and raw vegetables intake

Shigella spp

[Dx: bacterial etiology food poisoning] 20 hours PTC, dysentery mollusk, crustacean intake

V. parahaemolyticus

[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

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

What are the component sof hemolytic uremic syndrome

Acute renal failure microangiopathy hemolytic anemia Thrombocytopenia

[E. coli pathotype: defining molecular trait] HUS, industrialized country, Lambda-like Stx1 or Stx2 encoding bacteriophage

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

[E. coli pathotype: defining molecular trait] Travelers to developing country; virulence plasmids

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

[E. coli pathotype: defining molecular trait] watery or persistent diarrhea; young children and neonates Presence of adherence factor plasmid

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

[E. coli pathotype: defining molecular trait] dysentery; developing country, virulence plasmid

Etiology: EIEC Trait: invasion of colonic epithelial cells

[E. coli pathotype: defining molecular trait] acute and persistent diarrhea, travelers diarrhea; both in developing and developed countries

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

[Diagnose] 40M fever, right sided abdominal pain/RUQ pain, no jaundice noted liver abscess on workup anchovy paste on needle aspiration

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

What is the definitive diagnosis of amebic colitis?

demonstration of hematophagous trophozoites of E. histolytica

How will you differentiate liver vs pyogenic abscess?

1. Age: Pyogenic are older people | 2. Gram staining and culture is the most important

What is the pathologic finding in intestinal amebiasis?

classic flask-shaped ulcer

What are the earliest colonic lesions of intestinal amebiasis?

microulcerations of the mucosa of the cecum, sigmoid, rectum

What will be your treatment regiment for asymptomatic carriers of amebiasis

1. Iodoquinol (luminal) OR paramomycin

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

1. Iodoquinol (luminal) | 2. paramomycin + Metronidazole 750mg PO x 5-10 dyas or Tinidazole

What will be your treatment regiment for amebic liver abscess?

1. Iodoquinol (luminal) | 2. paramomycin + Metronidazole 750mg PO x 5-10 dyas or Ornidazole

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

malaria

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

E. hystolitica

{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)

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

What is the most common manifestation of salmonella infection?

Enterocolitis

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

at the peak of high fever

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

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

In salmonella culture, which source has the greatest sensitivity?

bone marrow

Where will you obtain your culture? Abdominal pain, constipation, positive typhi dot 1st to 2nd week of illness

blood

Where will you obtain your culture? Abdominal pain, constipation, positive typhi dot, gradual increase of temp 3rd week of illness

stool

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

blood

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

stool

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

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

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

binding factor H a strong inhibitor of the complement system

[phase of leptospirosis] fever, 3-10 days negative antibody where will you get the culture?

Stage: Acute leptospiremic phase Culture source: blood Leptospires present in: blood

In acute leptospiremic phase, week 1, Leptospire location: Antibody titer:

Leptospire present in: Blood | Antibody titer: negative

In acute leptospiremic phase, week 2, Leptospire location: Antibody titer:

leptospire present in: CSF | Antibody titer: slightly increased

In leptospirosis convalescent stage, Leptospire location: Antibody titer:

Leptospire present in: urine | Antibody titer: high

What are the criteria for for leptospirosis?

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

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

Leptospiremic phase (1st 7 to 10 days)

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

PCR

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

4 fold rise

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

less than 7 days

What electrolyte is uniquely associated with leptospiral nephropathy?

magnesium

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

Doxycycline 100mg BOD PO

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

Penicillin G 1.5M units q68 IV for 7 days

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

bolus methylprednisolone within first 12 hours of onset

[leptospirosis prophylaxis] Low risk

Doxycycline 100mg 2 caps SD

[leptospirosis prophylaxis] moderate risk

Doxycycline 100mg 2 caps OD x 3-5 days

[leptospirosis prophylaxis] high risk and continuous exposure

Doxycycline 100mg 2 caps once weekly until end of exposure

[Diagnose] 32/M fever, chills, diaphoresis. History of palawan trip. enlarged liver and spleen

Dx: Malaria | Accurate test: Thick and thin blood smear

what is the infective stage during asexual cycle of malaria?

sporozoites

what are the dormant forms responsible for relapse?

hypnozoites

Plasmodium species capable of relapse

P. vivax | P. ovale

[Classify the species] Malignant tertian

P. falciparum

[Classify the species] benign tertian

P. vivax, P. ovale

[Classify the species] | benign quartan

P. malaria

What are the fatal complication of falciparum malaria?

1. cerebral malaria 2. malaria hyperpyrexia 3. blackwater fever

[malaria] The fever spikes after 48-72 hours coincides with

rupture of RBC

[malaria treatment according to WHO] Uncomplicated falciparum

ACT for 3 days

[malaria treatment according to WHO] severe falciparum malariaN

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

[malaria treatment according to WHO] Non-falciparum malaria

1. ACT or chlorquine | 2. Primaquine for 14 days for eradication of hypnozoites

[malaria treatment according to WHO] pregnancy (1st trimester)

1. Uncomplicated Falciparum: Quinine + Clindamycin (7 days) | 2. Non-falciparum: quinine

[malaria treatment according to WHO] prophylaxis

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

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

Dx: Dengue fever with warning sign (gum bleeding) Earliest CBC abnormality: decrease in total WBC

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

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

What is protective from severe dengue?

Malnutrition

What are the dengue warning signs?

LIC-PALM 1. Lethargy 2. Increase in Hct 3. Clinical fluid accumulation 4. Persistent vomiting 5. Abdominal pain or tenderness 5. Liver enlargement >2cm 3. Mucosal bleed

What are the criteria for severe dengue?

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

[Phase of dengue] non-specific signs and symptoms, tourniquet test, mucosal bleed, decreased WBC

Febrile phase (Day 2-7)

[Phase of dengue] Defervescence, progressive leukopenia, rapid decrease in PC and increase Hct Fluid accumulation shock, organ impairment, DICm hemorrhage

critical phase (Day 3-7)

What is a physical examination sign of dengue recovery?

"herman's rash" isles of white in the sea of red

NS 1 antigen can be positve as early as ____

1 day after symptom

Dengue IgM is detected in the first ___ days of illness

first 5 days

What are the signs of plasma leakage in Dengue?

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

[Diagnosis] 26/M from Samar Isles. Weight liss, abdominal enlargement and coffee ground vomiting. Hepatosplenomegaly. fecalysis: egg with small hook-like spine

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

What is the most important of the neglected tropical diseases?

Schistosomiasis

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

Swimmers itch Cercarial dermatitis

Katayama syndrome is also equivalent to ___

Acute schistosomiasis

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

Acute schistosomiasis

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

chronic schistosomiasis

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

Symmers clay pipestem fibrosis

[Schistosomiasis] Which lobe of the liver initially enlarges in hepatosplenic schistosomiasis?

left lobe

What is the most severe complication of hepatosplenic schistosomiasis?

Hematemesis

[Schistosomiasis] What is the standard diagnostic method to diagnose schistosomiasis?

Detect schistosome egg in stool

[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

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

What is the most common cause of death in tetanus?

Respiratory failure

What is the preferred antibiotic treatment for tetanus?

Metronidazole Alternative: penicillin

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

superficial abrasion

[HIV phase] fever, skin rash, pharyngitis, myalgia sudden onset of mononucleosis-like illness

Acute HIV syndrome

[HIV phase] active virus replication

Asymptomatic Stage

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

CD4 <200 dL

What is the hallmark of HIV?

profound immunodeficiency from progressive deficiency of helper T cells

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

plasma viral load

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

CD4 lymphocyte count

What is the most common neurologic syndrome in AIDS?

AIDS dementia complex

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

less than 6 months

What is the most common opportunistic infection affecting AIDS patient?

Pneumocystis pneumonia Tx: TMP-SMX

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

Giemsa or silver stain

When to start antiretroviral treatment?

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

What is the regiment in treating HIV?

2 NRTI | 1 NNRTI

What is the first line NRTI?

Zidovudine (AZT) + Lamivudine (3TC)

What is the first line NNRTI?

Nevirapine

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

Malignant lymphoma

What is the most common implicated infectious organism in FUO?

Infectious - Internal Medicine Flashcards

(133 cards)