KTK III Flashcards by Demetré Harris

A pt presents with a bite mark on their ear after having slept outside 5 days ago,

Today they are having
HA, malaise, chills, anorexia, fever, and pharyngitis, With a TINGLING FEELING around the bite mark

Starts to feel hydrophobia and aerophobia (laryngospasm)

What is the most reliable test for this condition?

What is the Tx?

This is rabies

Most reliable test is Nuchal Skin Biopsy

(Can also use a RFFIT test)

Saliva contains the virus

And you can see Niagara bodies on labs.

Tx: copious aggressive wound cleaning with 1 parts soap and 4 parts water

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What is the pre vs post exposure prophylaxis for Rabies

Pre: IMM 1ml deltoid of days 0,7,21,28 (list of 7s)
With a booster in the deletion

Post:
No prior Vax: Days 0,3,7,14
(No vax, shorter days)
Prior Vax: Day 0 and day 3

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What is the Tx drug for Rabies

Not prophylaxis

Immune Globin HRIG

Most or All solution in the wound, rest in the glute

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A pt presents with irritability, diarrhea, abdominal pain, anal pruritus, and nasal pruritus, w/ blood diarrhea, increased appetite

You find eggs in the stool sample but no adult larvas

What is this condition and what is the Tx

Infection with H. Nana

Tx: praziquantel and supportive care

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A pt presents with active and passive passage of proglottids in the stool with S/s of appendicitis and cholangitis, states they were eating raw beef and pork.

What is the condition and what is the appropriate Tx

T. Saginata (more) or T. Solium (less)

Tx: Praziquantel
Or surgery with more severe S/s

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A pt presents with SZR after a trip from Korea (or Southern California) where they were eating raw/ undercooked pork

What is the condition and what is the Tx?

NeuroCysticercosis
(dissemination of T. Solium)
(PORK)
(MOST COMMON Parasitic INFX of the CNS)

Tx: supportive care for SZR

Surgical removal of Cysts if possible

Albendazole and or praziquantel+ dexamethasone

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A pt presents with Asysmpotomatic subcutaneous nodules and calcified intramuscular nodules after eating raw/undercooked pork

What is the condition and what is the Tx for it?

Cysticercosis, test for T. Solium

Tx: Albendazole and.or praziquantel+ dexamethasone

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A pt recently immigrated from Russian, with CC of fatigue, diarrhea, and extremity numbness, Tachycardia, and decreased DTRs with megaloblastic anemia, with proglottids in the stool ,

+sensations of hunger
+pruritus ani

Pt was eating raw fish from a fresh water local lake/ river

What is the condition and what is the TxOC ?

Diphyllobothriasis

Numbness comes from anemia
And B12/folate deficiency which causes low HH and a High MCV

TxOC: Vitmain supplementation
+ Praziquantel

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A pt presents with abd pain and bloody diarrhea, and jump high fever, recently travelled to South America, where they were swimming in local creeks and rivers with ova present in the stool
+heptaosplenomegaly

What is the condition and what is the Tx of Choice

Schistosomiasis !!
Haematobium: Middle East/ Africa (BLADDER CANCER)

Japonicum; Far East

Mansoni : S. America, Africa, Middle East

Order Stool/urine labs between noon and 3 pm

Tx : Praziquantel

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A pt presents with Fever, abd pain, hepatomegaly, Diarrhea, with intermediate biliary obstruction
After eating raw/ uncooked fish (raw watercrest)

What is the condition and what is the Tx of Choice

Fascioliasis

(Assoc with biliary and bladder d/o)

Find the eggs in the stool
Or can use a Fast-Elisa

Tx:L triclabendazole

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A pt presents with wheezing and abd tenderness, after eating undercooked crawfish/ pickled crab,
S/s: diarrhea, fever, cough, urticaria, hepatosplenomegaly and pulmonary d/o

+hemoptysis/ Discolored sputum, CXR
(can look like tb)

What is the condition and the Tx of Choice

P. Westermani
(paragonimiasis)!!

Can order a EIA and CXR

Tx: praziquantel

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A newborn presents with worm in the diaper, after a 6 week vacation in Central America/ southern United States,
(Or children running around bearfoot in the southern US)

S/s Abdominal pain and Diarrhea, with Loefflers syndrome, +urticarial rashes

Pts with DM, HIV, Cancer, or immunocomp are at increased risk

MOST SEVERE: meningitis and sepsis in immuno comp

What is the condition and the Tx of choice

Strongyloidiasis
(Strong assoc with barefootedness)

Test for larvae in the stool or EIA

TX: ivermectin and Albendazole

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A pt presents with “ground itch” after walking around barefoot. Also has IRON DEFICIENCY ANEMIA +pica

What is the infection and Tx

Hook worm infection

Tx: Albendazole or Mebendazole

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A pt is infected with the most common and largest helmith world wide, S/s Abdominal pain, and intestinal obstruction, ORAL EXPULSION OF WORMS and obstruction of biliray tract

What is the condition and Tx of Choice

Fecal oral contamination of ascariasis

Albendazole and/or mebendazole

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A pt presents (age preschool age) with the most common helmith infection in the US,
S/s anal itching at night, and or recto vaginal fistulas

+ appendicitis features

What is the condition and Tx of Choice

Order a scotch tape test 
For Enterobiasis (pinworm)

Tx: Mebendazole and food pt education or removing clothes and bed sheets

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A 14 yr old pt presents with rash on his foot, and was walking around barefoot in the southern US, there is a snake like tunnel on his foot with intense pruritus and pain

What is the Condition and Tx of Choice?

Cutaneous larva migrans
(Ancyclostoma caninum!!!)

(Most common topically acquired dermatosis)

Tx: Albendazole and or Ivermectin and WEAR SHOES!

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What is the infection of Toxocara canis (dog round worm)

Toxocariasis

Causes Viscearl and Ocular migrans from fecal oral contamination

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A pt presents with fever, anorexia, wt loss, cough and wheezing, rashes, hepatosplenomegaly and hyper eosinophilia

With ophthalmic lesions and cataract appearance in the eye (kids)

What is the condition and Tx approach

Visceral or Ocular Larva migrans

From toxocariasis

Tx: albendazole and or mebendazole

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A pt presents form eating undercooked bear or wild boar up in Alaska,
S/s N/V/D, with perioribital and facial edema, and very high fever, with myalgias, and weakness, with signifigant PAIN
And splinter hemorrhages
+conjuntavitis (FIRST SIGN)

What is the condition and what is the Tx of Choice

Trichinellosis

Can do muscle biopsy or EIA

Tx; Steroids and Albendazole and or mebendazole

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A 28 year old male presents with abd pain and bloody diarrhea, after a trip to South America, has amebic liver abscess, +fever, fulminant colitis that can lead to necrotizing colitis, +/- rectovaginal fistulas

What is the condition, test of choice and Tx of choice

Test is Enteric Parasite Panel for Amebiasis

Tx Metromadiazole/ Tinidazole or
Iodoquinol or Paromomycin

With SRGRY for Fulminant Amebic Colitis

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A 7 yo pt presents with decent onset of flatulence and malodorous stools (!!)

+difficulty sleeping with irritability
+wt loss
+signifigant abd pain

+troph in the stool (most common parasite in the stool)

What is the condition and the Tx

GIARDIASIS!! From fecal oral through water ingestion

Common in Southern states, Camping states, or daycares

(EPP) PCR Is test of choice

Tx:
Tinidazole/ metronidazole

No SRGY intervention/ may resolve spontaneous

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A 26 year old male has a non healing ulcer on his calf after deployment to Syria/turkey/iraq

Lesion is 3 cm with rolled edges with a central crater with crusting/scabbing and moderate lymphadenopathy’

What is the condition and Tx

Leishmaniasis caused by the sand fly

S/s presents month after initial bite

Only Treat with more than 5 cm lesion!

Tx: is just good to know, get somone else to look at it
(infx Dz)

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Where are the common places for visceral leishmaniasis and its s/s

India, Bangaladesh, Napal, Brazil, Sudan

Signif liver/spleen megaly where the spleen can be bigger than the liver with recurrent fevers

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A 16 yr old female (CHILD) presents with nonbloody diarrhea (water) after working at a local pool/ water park
+Murphys sign
Infection in the jejunum

What is the condition and Tx of choice

Cryptosporididosis from contaminated recreational water,

Danger to pts with DC4 less than 200 (50)

Tx: If immuno comprimised tx with HAART

Im immunocompetent: May use nitazoxanide

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21 yo female returns form hiking on the Appalachian (upper state) S/S: Fatigue, fever, and a progresión of chills to fever to diaphoresis to prostration (KTK) Without malaria exposure +/- jaundice +anemia +thrombocytopenia What is the condition and Tx

Babesiosis (tick bite) Pts without spleen do particularly bad Tx: Clindamycin +quinine (Perferred) +supportive care or hospitalization

What is the mosquito that transmits Malaria

Anopheles mosquito

A 23 yr male presents with N/V and fatigue, recently returned from Africa, What is the condition and Tx approach

Think malaria until proven otherwise

A pt presents with a cycle of Fever everything 24 hours from a mosquito bite Think

Knowlesi

A pt presents with a cycle of fever q 48 hours from mosquito bite Think

Vivax or Ovale

A pt presents with cycle of Fever q 72 hours from mosquito bite think

Malariae

A pt presents with cyclic fever and headache R/u? Tx?

Malaria Found on Thick and thin smears, 12-24 hours apart Tx: Start prophylaxis 1-2 weeks before trip and continue 2-4 weeks after return

Why is P. Falcirumpium so bad?

It effects all red blood cells and causes severe anemia

Should steroids be used to treated cerebral malaria

NO, it.will make it worse

A 6 yr old female presents with multiple dog bites on her hand from a chihuahua What is the most common pathogen assoc and what is the Tx

Pasturella multicida | And treat with Dogmentin

A 6 yr old female presents with rash on her right arm, after playing with her cat, Rash is small rep papules on the anterior aspect of the arm with +lymphadenopathy +fever +granulosas of the eyes/ conjunctiva there are severe cat scratches on the arm What is the condition and what is the tx

Bartonella henselae (Cat scratch fever) Tx: Azithromycin

A 26 yr old female presents with fatigue and mild fever, she is pregnant and has cats at home. You see scratches on her arm What is a condition she is at risk for and what is the Tx ?

Toxoplasmosis (Gondii) (Increased risk to fetus) Tx: Pyrimethamine+ sulfa+ leucovorin!!

What is the most common presentation of Toxoplasmosis

Encephalitis (order a HIV screen) In newborns: chorioretenitis

A pt presents with an abrasion from working in a Fish tank Has a papule/ nodule at the site of the abrasion, What is the condition and Tx:

M. Marinum infection Tx: Clarithromycin and ethambutol Or ethambutol+ rifampin

A pt presents with nodules, plaques, and large ulcers after contact with Dogs from africa, What is the condition and tX ?

Infection with M. Ulcerans Tx: Rifampicic and Clarithryomycin for 8 weeks With skin grafts and debridment

A pt presents with macular lesions about 10 cm in diamonds and red nodules after contact with Armadillos The skin lesions are accompanied by peripheral neuropathy (Bilateral ulnar nerve neuropathy) What is the condition and Tx?

M. Leprae Dx: Skin scarpings AFB Tx: rifampin, dapsone, and clofazimine for 12 months Not treating leads to disfigurement and scaring (finger loss)

A pt presents with skin and soft tissue infections after playing with frogs and turtles (Can also be caused by tattoo shops in foreign areas)

M. Chelonae Tx: Tobramycin or clarithromycin

An 18 yo presents with fatigue, malaise, and leg pain x 3days He recently returned from Hawaii (tropics) , and was hiking in rainforests. +low grade fever +icterus (severe) What is the condition and tx ?>

Leptospirosis (Most common zoonosis in the world) Tx: IV pen G (severe) Output: Doxy

A pt presents with extreme lethargy, and flaccid paralysis, with leukopenia What is the condition and tx

Encephalitis Tx: supportive care

What is the number one cause of Meningitis is children and adults And what is the empiric tx

N. Meningitidis Most common in neonates is group B strep Tx: Cefotaxime or Ceftriaxone +vancomycin +Dexamethasone

Listeria monocytogenes is an increased RSK to what pts

Pregnancy pts!! Causes meningitis Also pts over 50, Alcohilics, Immunosuppresed pts Tx: ampicillin and gentamicin

An 80 yo male from New Guinea presents with twitching and jerking in his arms with short term memory loss What is the condition and tx

CANNIBAL! kuru, Jokab, Bovine spongiform (Prion) No treatment, always fatal Always screen for transplants

What is the ABX for gonorrhea

Ceftriaxone

What are the 4 pressure injury stages for Skin ulcers

Stage.1: intact skin, with non blanchable redness Stage 2: Partial thickness loss of dermis presenting as a shallow open ulcer without slough, may also be and intact or open blister. Presents as a shiny or dry shallow ulcer. Stage 3: Full thickness tissue loss, subcutaneous fat, slow, necrotic tissue may be visible Stage 4: Full thicknesss with exposed bone

Pts with sickle cell dz who develop osteomyelitis are commonly infected with what agent

Salmonella

If you suspect MRSA, what is the ABX OC

Vancomycin

FOr Non resistant staph what is the ABX OC

Nafacillin or Oxacillin

A pt presents after stepping on a nail through the tennis shoe, what is the ABX OC

Ciprofloxacin

What is the Tx for all rickettsial Dz

Doxy

A pt presents 1-2 weeks after having been bit by body louse With Fever, HA, Rash starting in the trunk that spreads to the extremities Following a macules to maculopapules to petechia pattern Think

Louse borne typhyus Tx: Doxy

What rickettsial Dz is assoc with homelessness

Murine Typhus/ Louse Bourne

A pt presents after being bitten by a Wood tick/ Dog tick

Rickettsia rickettsii (RMSF)

What is the day to day progression of RMSF

Day 1-2 abrupt onset of high fever and HA DAy 2-3 faint rash starts on wrists ankles then spreads centrally +abd pain, + vomiting, +cough +dyspnea +calf tenderness, + peri orbital edema ``` Day 5-7 Progression of fever above 104F ++dyspnea ++abd pain Rash spreads to Soles and palms. ``` ``` Day 7-9 Rash turns into purpura, and begins necrosing of the digits leading to gangrene +septic shock + renal failure +ARDS +death ```

A pt presents with a fever and HA, chest pain, and cough There is NO RASH +/-pneumonia/ pleural effusion After working in a slaughterhouse/ animal fluids What is the condition and tx of choice

Q fever Doxy

A 28 yo male presents complaining of feeling out of it the last two week, +R Knee pain, +fever, Chills, Myalgias, and tender Adenopathy He is an avid hiker, PHx of a strange rash on his fish arm that resolved spont (Erthyema Migrans 7-14 days after bite) (Target lesion) What is the condition and tx OC

Lyme Dz Will later present with fever, conjunctivitis, and meningitis, and cranial nerve 7 (Bell’s palsy) (Add 10 day taper of steroids) Late late with effect the heart (carditis leading to AV heart blocks) Tx: Doxy except when pregnant Amoxicillin in pregnancy

What is the Hallmark of Late stage Dz of Lyme Dz

Arthritis

KTK III Flashcards

(60 cards)