Internal Medicine Board Reveiw Infectious Disease Flashcards
(321 cards)
0
Q
guillian barre assoc with what GI infection?
A
campylobacter jejuni
1
Q
Genital HSV prevent transmission
A
suppress w/ valtrex
2
Q
guillian barre assoc w/ what other infections
A
EBV, CMV, HIV, mycoplasma, Lyme, other upper respiratory infections
3
Q
guillian barre symptoms
A
ascending paralysis
no reflexes
4
Q
Guillian barre cause
A
segmental demyelination of peripheral nerves
5
Q
guillian barre ? need CSF for diagnosis?
A
no but would show elevated Pro, minimal incr WBC
6
Q
Botulism
A
descending paralysis
first dysphonia, dysphagia, diplopia, blurred vision
then muscle weakness and resp insuff
7
Q
polio
A
meningeal symptoms, fever,
asymmetric paralysis
8
Q
tick paralysis
A
ascending flaccid paralysis and ataxia
while tick is attached
neurotoxin
9
Q
rabies
A
encephalitis
fever, hydrophobia, agitation
coma and death
no periph nerve findings
10
Q
parvo B19
A
red cell aplasia in HIV, chronic severe anemia
decr Retic and high erythropoeitin levels
11
Q
parvo B19 treatment
A
IVIG
12
Q
zidovudine (retrovir) side effects
A
anemia which stops 0nce med is d/c’d
13
Q
HTLV-1 blood effects
A
T-cell lymphoma, leukemia
14
Q
inhaled pentamidine side effects
A
rarely systemic se’s since poorly absorbed
15
Q
blastomycosis
A
lung mass, draining cutaneous lesion
16
Q
blastomycosis
A
budding yeast
broad based budding
(“4 B’s”)-blasto, broad, based, bud
17
Q
blastomycosis
A
arkansas
18
Q
coccidiomycosis
A
southwest, spherule, not budding yeast
“cocci california”
19
Q
blastomycosis
A
itraconazole x 6-12 months
if severely ill, amphotericin B
20
Q
itraconazole needs what kind of environment for absorption?
A
acidic
so H2 blockers and PPI’s affect absorption
21
Q
parvo B19 in adults
A
3 get into trouble:
1) pregnant women -increased miscarriage and hydrops fetalis
2) HIV + - red cell aplasia (rx w/ IVIG)
3) Chronic hemolysis (sickle cell) acute red cell aplasia rx transfuse (will resolve)
22
Q
roseola caused by what organism
A
HHV 6
Pneumonia and meningitis in immunocompromised adults
23
Q
Lyme disease
A
erythema migrans early
late arthritis - asymmetric mono- or oligo
24
chlamydophila pneumoniae
nonprod cough
low grade fever
sore throat
hoarseness
25
c. psittaci (birds)
sudden onset F
prounced headache
dry cough
26
pneumonia with Splenomegaly
```
C. psittaci or
Coxiella Burnetii (cows and contact with placentas)
```
27
chills rusty sputum
strep pneumoniae
28
listeria
gm + diphtheroid-like
pregnancy 3rd trimester , eats goat imported cheese esp from mexico
or immigrant living in California
rx w/ amp or pcn (add Gent for synergy) or bactrim if pcn allergic
29
diphtheroid organism on blood culture
think skin contamination or
| if semi= immune compromised (pregnancy) or immunocompromised think sepsis
30
c dificile treatment
metronidazole ($20/10 days)
if severe -vanco ($1000/10 days)
25% relapse-treat again with metronidazole
findaxomicin approved 2011-- 50% decrease in relapses ($3000 / 10 days)
31
pneumococcal meningitis treatment
Vanco and ceftriaxone until sensitivities avail
32
CD4 count <50 prophylax against
MAC - zithromax weekly
33
Whipple disease
long time , nonspecific complaints
(weight loss, Diarrhea, arthropathies)
organism trophermyma whipplei
34
whipple disease diarrhea description
episodic and watery
| steattorhea, w/ abd pain , 20% heme + stool
35
skin hyperpigmentation in sun exposed areas
whipples disease
36
whipple's disease diagnosis
lymph node or mass biopsy,
endoscopy biopsy --whitish yellowish plaques
PAS stain
PCR
37
PAS stain + foamy macrophages
Whipple disease
| melanosis coli
38
whipple disease (trophermyma whipplei) treatment
bactrim
or cefriaxone if severely ill x 2 weeks or more
(use chloramphenicol if CNS disease b/c it penetrates well)
39
histoplasma
memphis TEN ("his ten")
40
PCP
rare outside the lung
41
CD4 count of 300
more concerned about TB than histo
42
histoplasmosis disseminated
check serum or urine histo Ag
43
HSV meningoencephalitis
bizarre behavior and
temporal lobe
seizures
44
HSV meningoencephalitis diagnosis
PCR for HSV DNA on CSF
| culture rarely +
45
neurosyphilis -how long to develop symptoms
decades
46
cat scratch disease
Bartonella HEnselae
| seizures
47
cipro
antacids and sucrulfate interfere w/ absorption
| if contains Al, Mg or Ca
48
otitis externa in diabetic most likely organism
pseudomonas
49
alcoholic with liver disease exposure to sea water or raw fish--sepsis confusion and bullous skin lesions
vibrio
50
hearing loss in young person
look for neurosyphilis
51
alopecia in young person
look for syphilis
52
neurosyphilis
rx w/ 3 million units q 4hrs
53
csf vdrl --always + in neurosyphilis?
no only 1/2 the time
is very specific (+ is really + )
but not very sensitive (negative csf vdrl doesn't r/o syphilis)
54
candida krusei -sensitive to fluconazole?
no and often decr sens to ampho B
55
candida krusei treatment
caspofungin
micafungin
anidulafungin
tolerated better than ampho b
56
+ candida blood culture
never consider contaminant!
57
post transplant infections-early
hospital acquired: Pseudomonas, Staph,
58
post transplant infections-1-4 months after
CMV, PCP
59
post transplant infections >4months after
Cryptococcus
60
anti-TB meds
PZA, with INH and rifampin may cause increased LFT's
61
INH side effects
peripheral neuropathy
62
PZA and ethambutol side effects
rash
63
ethambutol side effects
optic neuritis
64
pyrazinamide side effect
hyperuricemia
65
optic neuritis (esp color vision)
side effect of ethambutol
66
bartonella henselae
cat scratch disease
67
necrotizing granulomas
TB
| Cat scratch disease
68
cat scratch disease symptoms
conjunctivitis
pre-auricular node
or axillary node and hand scratches
69
CMV retinitis
CD4<50
floaters, then lose vision
must be treated quickly
large wite infiltrate with retinal hemorrhages
70
cmv retinitis treatment
po valganciclovir
| intravitreal gancicylovir if sight is threatened
71
early prosthetic valve endocarditis <2 months
<2 months -Staph aureus and coag-neg staph
72
endocarditis s/p valve replacement >2 months
viridans strep
73
tularemia
fransciella tularensis
acute and convalescent titers
DON'T BIOPSY or ASPIRATE lymph node since might blow it in the air and aspirate in lab workers!!!
74
which treatment for tularemia is assoc w/ higher risk of relapse?
`po doxycycline
75
tularemia treatment
streptomycin
IV Gent
po doxy
76
erlichiosis
```
fever, nonspecific symptoms
splenomegaly
pancytopenia
elevated LFT's
missouri endemic
```
77
which state is erlichiosis found in?
Missouri
78
which diseases present with pneumonia and skin lesions?
Histo and Blasto mycosis
79
disseminated Neisseria gonorrheae
.
80
yersinia diarrhea
after eating "chitlins" chitterlings
| lasts much longer
81
clostridium perefrigens gastroenteritis
```
6 hours after eating
watery diarrhea
crampy abdominal pain
brown gravy and meat
rx: supportive
```
82
group A strep skin and soft tissue infection
gm + cocci in chains
| necrotizing fasciitis
83
gm + diplococci
pneumococcus
meningitis
rx vanco and cefriaxone
84
crepitus and bullae after trauma
think necrotizing fasciitis and toxic shock syndrome
85
TSS rx GAS infection
PCN G and Clindamycin
86
fried rice assoc w/ what illness w/ N/V, no D
bacillus cereus
quick onset due to toxin
dx stool cx + toxin
rx supportive
87
PCP
GSM stain + or + DFA stain
88
post organ transplant infection
opportunistic infections (PCP, viruses -RSV, influenza, adeno)
89
PCP treatment
bactrim and prednisone
90
lancet shaped diploccocci
pneumococcus
91
staph toxic shock syndrome
shock fever and rash + 3 or more organ systems
| healthy to deathly sick in a couple of days
92
healthy to very sick in a couple of days
TSS, RMSF, meningococcemia
93
TSS rash
erythroderma
94
RMSF rash
petechiae
95
rx TSS
vanco and clinda
96
arcanobacterium
strep presentation and erythematous rash like scarlet fever but without desquamation and pestia lines
97
heterophile ab
monospot test (+ in 60--80% EBV pts)
98
scarlet fever
pestia lines (petechiae in skin creases) & desquamation.
99
enteroviral pharyngitis
vesiculopustular rash
100
culture not recommended in adults even when strep test is neg
.
101
fever and rash, mucosal ulcerations
think primary HIV infection (PCR .10, 000 copies)
102
secondary syphilis
causes painless mouth ulcers, no rashes
| palm and soles rash "Nickle and dime lesions"
103
group B strep
G+ cocci in chains
| rx iv PCN G
104
clusters (staph) vs. chains (strep)
.
105
GBS - cause of severe pneumonia in elderly
chains
| caused confusion, predisposed in hospitalized with CHF or DM, high rate of coexisting sepsis
106
condyloma lata
seen in 2ndary syphilis
107
condyloma lata
mouth or genital region
108
"conjuctival suffusion"
leptospirosis
| hawaii highest incidencd
109
leptospirosis meningitis
think when triathlete competes in open water
110
leptospirosis treatment
doxycycline, ceftriaxone or cefotaxime
111
Lyme
erythema migrans-painless
| rx doxy, amox, cefuroxime
112
Lyme arthritis
false + RPR often
if + confirmation using western blot
PCR testing on joint fluid
113
B. burgdorferi
.
114
ivda using diluents like lemon juice
candida fungemia
115
eye fungemia complication
ophthalmitis-vitrectomy + antifungals
116
cryptococcal meningitis
chronic steroid use,
very high opening pressure CSF
consider TB also
117
diagnosis crypto meningitis
serum crypto Ag, fungal cx
118
treatment crytpo meningitis
Ampho B + flucytosine as induction, then fluconazole + keep ICP <20with repeated LP's or VP shunt
119
Cocci infection ("valley fever")
Arizona, E.Nodosum
120
cocci dx
fungal stains & cx,
| IgG & IgM serum
121
cocci treatment
supportive if not severe
| -if severe, immunosuppr or pregnant- itraconazole or fluconazole
122
histoplasmosis lung
farm buildings, bird-roosting locations, bat guano, spelunking (cave exploration) in SE or S central US
123
Dx histo severe dz+
Ag
fungal stains of sputum
histo Ag urine , blood or BAL
serum C fixation test
124
histo treatment
Ampho B if severe
| itraconazole (sporonox) if not severe
125
Blastomycosis
4 B's
126
blastomycosis
chronic
| hunting in midwest
127
blasto diagnosis
no blood tests, ID yeast
128
blastomycosis treatment
rx : itraconazole mild
| ampho B if severe
129
tetanus
ivda with trismus (contaminated drug)
| muscle contractions stimulated by loud noises and light
130
tetanus treatment
icu, nm blockade, benzos, wound debridement, flagyl, tetanus Immune globulin
Td or Tdap
131
primary syphilis
painless ulcer
132
painful genital lesions
HSV (cluster vesicles then they rupture) or
| chancroid (large and single)
133
syphilis diagnosis
do LP if titer is >1:32
134
syphilis treatment
single im PCN G
| doxy, macrolides, ceftriaxone
135
sporotrichosis
gardener
| if alcoholic, DM, HIV/AIDS -disseminated sporo -- hypotension and pneumonia
136
sporotrichosis diagnosis
aspirates , biopsy fungal stains and cx
papules along lymph channels
"fungal lymphangitis!!!"
137
zygomycosis (used to be called mucormycosis)
uncontrolled DM black area near nose,
| chronic purulent d/c from nose
138
zygomycosis treatment
supportive , surgical debridement, lipid ampho B
139
toxoplasmosis
CNS disease is usually reactivation
| multiple ring enhanced lesions
140
HSV encephalitis and brain abscesses
single lesion usually
141
toxoplasmosis diagnosis
brain biopsy
142
diarrhea : pink cysts in stool of people swimming in local pool
cryptosporidium
143
crypto treatment
not needed if nrl immune
if immunocompromised: nitrazolxanide
(no public swimming pools x 2 weeks after treat)
144
banana gametocytes from Africa
falciparum malaria
145
malaria
fever, splenomegaly
146
malaria diagnosis
thick and thin smears with Giemsa to ID parasites
147
malaria treatment depends on region
```
chloroquine if sensitive
artemisinin combo (amodiaquine, atorquone-proguanil-(mefloquine), lumefantrine, clinda doxy, and others)
```
148
Midwest hunter F, h/a, splenomegaly, hepatitis
babesiosis
149
maltese cross +++++
babesiosis
150
babesiosis treatment
atovaquone + zithromax or quinine + clinda
151
giardiasis "smelly disease"
smelly watery stool that floats
pass gas
sulfur burping
152
hiker drinks moutain water
giardiasis only 50% of O&P are +
153
gay male with diarrhea , sulfur belch, chronic floating stool
giardiasis
154
anchovy paste aspirate from liver cyst -no organisms
amebic liver abscess
155
E. histolytica diagnosis
ameba in liver
| E. histolytica Ab tests, h&e stain of aspirate and culture
156
E. histolytica treatment
metronidazole + paromomycin, diiodohydroxyquin, or diloxanide
157
pinworms
enterobius vermicularis
158
pinworm treatment
albendazole
159
uncooked pork or bear meat symptoms 1 week after
trichinellosis
160
symptoms trichinellosis
```
eye pain , periorbital edema, conj and subconj hemorrhages
myalgias,
muscle swelling-incr CPK
LE edema
incr WBC
```
161
trichinellosis treatment
albendazole only if symptoms
162
trichinellosis diagnosis
3 weeks after do Ab test + muscle biopsy
163
neurocysticercosis
MRI + anticystercercosis Ab, Ag
| visualize parasites directly on fundoscopic exam!!!
164
eye exam== you can SEE parasites !!!
cystercercosis
165
neurocystercercosis symptoms
seizure, nrl cbc, chem, Contrast CT- mostly enhancing , edema lesions , some calcified
rx: seizure meds, albendazole + prednisone for no edema, no rx if only calcified lesions
surgery if edema and hydrocephalus
166
HSV encephalitis
bloody CSF, temporal lobe enhancement
check CSF DNA by PCR
viral cx , brain bx if unusual
Rx: IV acyclovir 14-21 days
167
varicella pneumonia
dx: PCR on clinical specimens + viral cx
| if severe, IV acyclovir
168
varicella zoster in first div of trigeminal nerve
tip of nose involved-can get VZV ophthalimcus
169
exudative pharyngitis + incr LFT
```
Mono and Q fever (animal exposure)
CMV
no incr LFT's in GAS
heterophile Ab +
no contact sports x 3 weeks
```
170
koplick's spots (bluish white spots on buccal mucosa)
measles
171
measles diagnosis
4 fold rise in titer acute and convalescent
172
measles treatment
vaccine
173
influenza
often have eye pain w/ movement
174
rabies
```
anxiety irritability
fever
refuses to drink water
excessive salivation
pharyngeal spasms in response to seeing water or feeling cold air
```
175
rabies diagnosis
immunofluprescence stain of biopsy
viral cx (csf, saliva, biopsy)
brain biopsy postmortem
176
rabies treatment
vaccine + rabies IG
177
mumps diagnosis
4 fold incr in acute and conval serum (IgG & IgM)
| viral culture
178
```
arborvirus encephalitis (west nile), st. louis encephalitis,
eastern equine encephalitis
```
altered mental status with tremors and clonus
mosquito borne
midwest or (Missouri, texas)
179
arborvirus diagnosis
PCR for arbovirus
| serum and csf for arborvirus Ab
180
hantavirus
rapidly progressive
| severe pneumonia southwest
181
hantavirus diagnosis
4 fold incr titers
182
hantavirus
poss ribavirin (controversial)
183
jacob creutzfeldt
progr multifocal leukoencephalopathy
PML
immunosuppressants :
rx antiretroviral rx
184
systemic MAC
diarrhea
acid fast in blood
(dissesminiated MAC more likely to cause Diarrhea than disseminated TB
185
MAC
clarithromycin or zithromax + ethambutol _ rifabutin
186
brain abscess from dental abscess where located?
frontal lobe
187
brain abscess dental source treatment
metronidazole +PcnG, ceftriaxone or cefotaxime
188
brain abscess sepsis caused
vanco + metronidazole + PCN G, ceftriaxone or cefotaxime
189
post op neurosurgery brain abscess
vanco + ceftazidime, cefepime or meropenem
190
brain abscess s/p penetrating trauma
Vanco + ceftriaxone, cefotaxime
191
campylobacter diarrhea
chicken
cross contamination of food utensils and surfaces (is killed easily by cooking)
guillian barre assoc
rx : supportive , if severe- cipro or zithromax
192
enterohermorrhagic E. coli (e. coli 0157:H7)
raw beef
bloody diarrhea
poss no fever
193
C. dificile
fulminant colitis w/ toxic megacolon or
| following antibiotic use
194
cholera
raw oysters
profuse diarrhea
mucousy flecks in diarrhea ("rice water diarrhea")
dehydrate within hours
195
cholera treatment
sheets of gm neg rods
| ivf + doxy or cipro
196
vibrio parahemolyticus
shrimp and crab
197
vibrio vulnificus septicemia
```
iron overload (hemochromatosis), raw oysters, bullous skin lesions, sepsis
chesapeake bay, gulf coast
```
198
vibrio rx
doxy + cefriaxone
199
gonorrhea
treat with both rocephin and zithromax or doxy (not just to cover chamydia-)
200
disseminated gonorrhea
recent menstruation
tenosynovitis fingers
skin lesions -pustular nodular lesions
201
trichomonas
```
yellow d/c
dysuria
pain w/ intercourse
punctate hemorrhages on cervix
WM motile organisms
```
202
prostatitis
bactrim or cipro
if GP chains - amox or Iv amp
GP clusters keflex , diclox or Iv ancef
203
osteo in diabetic
need bone biopsy often due to wound contamination by many organisms
204
osteo in DM
vanco - amp-sulbactam (unasyn), ertapenem (invanz), pip-tazo (zosyn), imipenem (primaxem)
205
disseminated fusariosis
painful nodular lesions , immune suppression
| acute branching septate hyphae
206
fusariosis
branching septate hyphae can also be aspergillus (but no painfl skin lesions w/ this)
207
fusariosis treatment
ampho B and voriconazole
208
central line infection if fails ceftazidime (fortaz)
covers MSSA
| rx w/ vanco
209
gram + diplococci (lancet shaped ) with splenectomy
pneumococcus
210
staph saprophyticus UTI (not comtaminated)
keflex or augmentin
211
asymptomatic bacteriuria
assoc w/ miscariage, ptl , increased preterm mortality
do 2 urine cx to confirm
always treat in pregnant women
inpatient IV antibiotics 10-14 days
rx amp, keflex, bactrim (unless late --causes kernicterus)
bacteria in urine without symptoms or signs attributable to UTI
212
psittacosis
splenomeg in 10% but often included in history
| parrot fever
213
bird exposure pneumonia
```
psittascosis (acute) and
hypersensitivity pneumonitis (recurrent after cleaning out cage)
```
214
psittacosis treatment
doxy
215
gm + cocci in chains pneumonia
group B strep (S. agalactiae)
216
strep bovis endocarditis what other study should this pt have?
colonoscopy - 20-30% chance of colon ca
217
s/p cystcopy F , chills arthralgias wt loss diastolic murmur rusb
enterococcal endocarditis
218
gm + cocci in chains
group B strep and enterococcus
219
enterococcal endocarditis treatment
Gent + Pen G or Gent + vanco x 4-6 weeks
220
strep viridans endocarditis -assoc w/ what kind of recent procedures?
recent mouth teeth work
221
gm + rods meningitis in elderly
listeria
222
listeria treatment
amp or pen G (gent often added)
223
gm + rods -corynebacterium jeikeium treatment
vanco
assoc w/ catheter sepsis esp w/ hematological malignancies
rarely contaminant
224
diphtheria major cause of mortality
toxin induced myocarditis
225
diphtheria -symptoms
gray membrane in throat
| can cause stridor and resp compromise
226
scarlet fever type rash with neg strep
arcanobacterium pharyngitis
227
aracnobacterium pharyngitis - strep type rash and throat w/ neg strep test treatment --
erthromycin
228
textile factory worker develops- itchy painless papule, vesicle, black center w/ surrounding edema
cutaneous anthrax
229
lesions w/ necrotic centers
cutanous anthrax
ecthyma gangrenosum (pseudomonas)-
systemic fungal infections (also lung involvement w/ these)
230
AIDS pt w/ necrotic center lesion
pseudomonas
| ecthyma gangrenosum
231
anthrax treatment
cipro or doxy
| change to pcn v or amox if suseptible
232
widened mediastinum (enlarged mediastinal lymph nodes) fever headache
inhalation anthrax
233
inhalation anthrax - what seen on grm stain
gm + rods look like "boxcars"
234
inhalation anthrax treatment
IV cipro + imepenem
235
AML s/p BMT prolonged neutropenia on broad spectrum antibx (vanco, pip-tazo) and antifungal -capsofungin- which organism likely
conidia
236
conidia under microscope
septate hyphae
237
fusariosis (quite rare for mold to grow in blood)
red nodular skin lesions
238
red nodular skin lesions in immunosuppressed pt
conidia or candida (not aspergillus)
239
acute branching septate hyphae
aspergillus and conidia
240
does aspergillus grow in blood ?
no
241
disseminated fusarium -what % have fungemia
50%
242
conidia appears as what form in blood
mold-like features (as apposed to candida which is yeast forms)
243
fusarium fungemia treatment
liposomal ampho B + voriconazole + get rid of neutropenia
244
splenectomy patient w/ dohle bodies and toxic granulations and sepsis , petechiae
pneumococcal sepsis
245
gm + diplococci on buffy coat
pneumcoccus
246
splenectomy patient w sepsis and DIC
pneumococcus
247
pneumococcal sepsis in splenectomized pt -treatment
vanco + cetriaxone or cefotaxime until sensitivies
248
gram negative cocci
meningococcus
249
petechial rash, incr lfts , dic
meningococcemia,
rmsf
pneumococcemia
250
meninococcal meningitis treatment
ceftriaxone -change to pcn g if suseptible
| close contact prophylaxis w/ rifampin, cipro or ceftriaxone
251
shoe + pw
pseudomonas
252
pw cellulitis (pseudomonas) treatment
cipro
iv ceftazidime, cefepime, imipenem, gent, tobra, cipro, aztreonam, pip-tazo, ticar-clavulanic i
if super sick- b lactams + AG or quinolone
253
b lactam antibiotics
pcn's, cephalosporins, aztreonam, daptomycin
254
antipseudomonal cephalosporin
ceftazidime (fortaz-IV ) , cefepime (maxipime)
255
necrotic ulceration in immunosuppressed
| gm neg rod (esp if catheter)
pseudomonas
| ecthyema gangrenosum
256
exposure to snakes and diarrhea bloody
salmonella
257
flagellate organism and bloody diarrhea
salmonella
258
typhoid fever
salmon colored rash on trunk ("salmonella typhi"
| rose spots
259
typhoid fever
flagella
| long incubation
260
typhoid fever
```
rose spots (salmon colored rash)
culture these to get organism (and blood, stool and BM)
```
261
typhoid fever treatment
Quinolones, cephalosporins, zithromax
262
complication of typhoid fever
ileal perforation (intestinal hemorrhage can be fatal)
263
gram negative bacilli from lymph node in homeless
bubonic plaque
inguinal "bubo"
Yersinia pestis
264
bubonic plague
safety pin organisms + bacilli and cocco-bacilli
265
bubonic plague treatment
streptomycin or gentamicin
| get vaccine for vets or exterminators
266
pneumonic plague
homeless person w/ pneumonia
| highly contagious
267
pneumonic plague treatment
quarantine!!!!!
| streptomycin or gent
268
rancher w/ bicupsid aortic valve
has fever, HSM, adenop, new diastolic murmur (aortic vegetation), crp incr,
gm neg blood cultures
neg coxiella serology
brucella endocarditis
| check acute and conv titers
269
culture neg endocarditis
brucella and coxiella
270
coxiella-- chronic Q fever
IgG titer >1:800
271
hunter kill and skins rabbit-papule on hand, fever, h/a, armpit adenop
tularemia
272
new kitten, papular lesions forearm and painful adenop axillary
cat scratch fever
bartonella
no treatment usually for lymphadenitis alone
if needed zithromax (rarely disseminates to eye, liver or cns)
273
hiker from AZ diffuse rash, hepatitis, fever
RMSF (SE and SCentral)
pancytopenia (DIC picture w/ nrl PT/PTT!!)
low na
274
purpura fulminans
menincoccemia
| DIC
275
RMSF treatment
doxy immediately (testing takes a bit and need to treat quickly
276
animal placental exposure (helping birth calves, goats)
Q Fever -coxiella burnetii
incr LFT's
pneumonia
277
Rocky Mountain SPOTLESS fever
ehrlichiosis
only 1/3 have rash
wooded area with deer
278
ehrlichiosis
what vector born illness has a hallmark of *leukopenia* (ex: 2,100)?
cytoplasmic inclusions
279
ehrlichiosis
incubation 8-20 days
Tick bite, no rash, myalgia, fever, headache, low platelets and WBCs, increased ALT
280
treatment scrofula
4 drug TB meds (INH, rifampin, ethambutol, pyrazinamide)x 2 months, then 2 drugs x 4 months
281
scrofula
draining sinus from TB lymph node
| +ppd (whereas other atypical TB won't have fully +ppd)
282
scrofula (tb lymphnode infection )
caseating granulomas and +CXR
283
SLE on prednisone, interstitial infiltrates, filamentous branching grm + rods (partially acid fast) single mass lesion brain on CTScan
disseminated nocardiosis
284
pulmonary and brain findings =
nocardia
285
filamentous branching gm + rods
nocardia
286
nocardia treatment
bactrim , cefriaxone, cefotaxime imipenem, amikacin
287
dm poor dental hygiene sinus draining from angle of jaw "gritty material"
cervicofacial actinomycosis "Lumpy Jaw"
288
cerivofacial actinomycosis
not acid fast
rx high dose pcn x 2-6 months
anaerobe
289
nocardia
partially acid fast and aerobe
290
differential diagnosis of enterocolitis (mneumonic)
Mnemonic for Enterocolitis: "Vomit Big GREY Smelly Chunks"
Vomit - Vibrio cholerae
Big - B.cereus (reheated rice - "be cerious")
```
Giardia - G AS/
Rotavirus
Entamoeba
E. coli
Yersinia enterocolitidis
```
"Smelly"
Staph. aureus
Shigella
"chunks"
Campylobacter
Cryptosporidium
Clostridium - perfr., difficile, botulinum
291
hemochromatosis
avoid alcohol
avoid vitamin C (increases Fe absorption).
avoid uncooked seafood
292
marfan
increased risk of aortic dissection (increased diam of aortic root)
"thumb sign" (thumb pokes out of inside a closed hand)
wrist sign thumb overlaps 5th finger when wrapped around wrist
293
ectopic lentis assoc w/
marfan's
294
marfan's assoc with what gene mutation
FBN1 Gene
295
marfan's
yearly ultrasound to follow aortic root and b blockers to slow progression
no high intensity exercise
296
C1-2 subluxation seen in
RA
symptoms : decreased sensation to LT in both hands and grip in both hands
typically seen in older pts
297
long term prednisone /osteoporosis use assoc with
compression fractures back
298
whipple disease
vertical gaze palsy
Weight loss, diarrhea, arthritis, fever, adenopathy, hyperpigmentation
diff dx: hyperthyroidism, CTD, HIV, IBD,
PCR of saliva and stool
difficult to culture
Tropheryma whippelii organisms; partially destroyed organisms are present in macrophage lysosomes (positive for PAS)
rx: ceftriaxone x 2 weeks then 1 year of bactrim
299
psoriatic arthritis
```
sev diff kinds
DIP (like OA)
symmetrical polyarthritis (like RA)
oligo (1 knee or ankle)
axial spondylitis (Like AS)
arthritis mutilans ("mutilated telescoping destruction of joints)
rx : nsaids, nonbiologic DMARD (MTX or sulfasalazine) for periph disease
TNF inhib if axial dz
```
300
"Milwaukee shoulder"
- elderly with destructive arthritis
- hemorrhagic fluid (non -inflammatory) from shoulder joint "with polarizing crystals" only on special stain
hydroxyapatite arthropathy
301
CPPD
positively birefringent crystals
302
hydroxyapatite arthropathy
can't see crystals unless special stain
| rx: joint steroid injection , shoulder replacement if refractory
303
positive RF in diseases other than RA
Lyme arthritis (late in Lyme disease)
chronic infections
vasculitis
chronic lung disease
304
Ankylosing spondylitis
```
young man w/ ant uveitis
pain and stiff back
asymm periph synovitis
sausage digit asymmetrical (dactylitis)
restricted , painful achilles tendon (achilles enesthopathy)
bilat sacroilitis on xray
HLA B27 +
```
305
reactive arthritis
```
within 2 months of GI or GU infection -chlamydia
urethritis
conjunctivitis
arthritis mouth ulcer
achilles tendon pain
"seronegative sponyloarthropathy"
```
306
lupus arthritis
```
fever
wt loss
arthralgias
PAINLESS mouth ulcers
rash on malar area
synovitis of MCP/ PIP
no erosions on xray
+coombs, RPR, ANA, anti-Sm, anti-dsDNA
```
307
SLE
```
mneumonic SOAP BRAIN MD
S-serositis (pleurisy, pericarditis)
O- PAINLESS oral ulcers, esp palate
A-arthritis
P-photosensitivity
```
B-blood d/o's -leukopenia, lymphopenia, thrombocytopenia, hemolytic anemia
R-renal -proteinuria, cellular casts
A-ANA+ >1:160 in absence of other meds that cause Lupus like reaction
I-dsDNA; anti-Sm Ab's , antiphospholipid Ab's (anticardiolipin immunoglobulin G [IgG] or immunoglobulin M [IgM] or lupus anticoagulant); biologic false-positive VDRL, lupus erythematosus (LE) cells (omitted in 1997 revised criteria)
N-neurological-seizures or psychosis
M-malar rash
D-discoid rash
308
sjogrens
increased dental caries
dry eyes
if severe: pulmonary infiltrates , Type 1 RTA (stones and nephrogenic DI), arthritis, nervous system
later - lymphoma , enlarged parotid gland
+ANA
+ Ro/La antibodies
nonbiologic DMARD's for arthritis
309
lupus like med reactions
hydralazine
+ histone and + ANA
-anti ds DNA
310
mixed CTD
+ ANA , RF, Anti-U1-RNP, anti-CCP
neg all other tests
arthralgias, myalgias prox m's nrl CPK
PAINLESS mouth ulcers
311
adult onset Still's disease
ferritin >1000, F, Arthritis, salmon rash on chest , incr ESR, incr LFT's , neg Ab's
yamaguchi criteria (4 of 5)
(macrophage activation syndr sometimes w/ treatment sometimes)
312
primary raynauds
ulcerations fingertips all by themselves
313
symmetric proximal weakness, incr CPK, incr LFT's seen in what condition
polymyositis
(not Inclusion body myositis b/c distal and prox muscles involved and atrophy of muscles in hands, ant tib, and quads)
not dermatomyositis -lacking skin findings
314
myasthenia gravis
nrl CPK
| + acetylcholine R Ab's
315
polymyositis
anti Jo assoc w/ ILD
| skin and heart involvement--
316
dermatomyositis
40-50 yold
myalgias--incr CPL
symmetrical prox weakness x months
scaly erythem macules over DIP, PIP (gottron papules)
violacous circles around eyes
erythem rash over ant chest ("shawl rash")
incr LFT's
317
gottron papules
dermatomyositis
318
anti-Mi-2 Ab good or bad prognosis in DMyositis?
good
319
antisynthetase syndrome
```
dermato-polymyositis
arthritis
"mechanics hands" rough dry
ILD
Raynaud's
anti synthetase Ab
```
320
meds for cholesterol in polymyositis
statins
| drug induced myopathy
