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Flashcards in learning objectives we didn't learn Deck (55):
1

opportunisitic pathogen part of the normal GI and GU flora?

candida albicans

2

manifestations of candidiasis?

1) oral thrush: nystatin
2) esophagitis: think HIV
3) vaginal candidiasis: curd-like discharge
4) intertrigo: beefy red with satellite lesions
5) fungemia: BAD; usually with indwelling catheters
6) endocarditis: in patients with HIV; treat with amphotericin B

3

how to diagnose candidiasis?

KOH! budding yeast and branching hyphae

4

SO, what are the manifestations of candidiasis mostly seen in patients with HIV?

esophagitis and endocarditis!

5

when you hear pigeon/bird droppings, think...

cryptococcosis (YEAST)

6

what is the most common cause of fungal meningitis?

cryptococcosis

7

when may cryptococcosis show up in a patient with HIV/AIDS?

CD4

8

diagnosis and treatmente of cryptococcosis?

india ink stain of CSF

tx: amphotericin B

9

how do we treat cryptococcosis prophylactically in AIDS?

fluconazole

10

when you hear soil contaminated by bird/bat droppings, think...

histoplasmosis!

11

when does histoplasmosis typically present in AIDS patient?

CD4

12

how does histoplasmosis present in immunocompetent vs. immunosuppressed?

immunocompetent: asymptomatic or flu-like symptoms

immunocompromised: disseminated! OROPHARYNGEAL ULCERS, adrenal insufficiency, bloody diarrhea

13

histoplasmosis can also cause an atypical case of....

pneumonia!

14

how do we treat histoplasmosis in immunocompromised?

same as candidiasis and cryptococcosis because they are all yeasts!

amphotericin B if severe

15

what is THE most common opportunistic infection in patients with HIV?

pneumocystis pneumonia! caused by pneumocystis jiroveci (fungus)

16

what is interesting about the treatment of pneumocystic pneumonia?

it is caused by a fungus but does NOT respond to anti-fungals!

17

how do we treat and prophylax against pneumocystic pneumonia?

treat with bactrim!

prophylax with bactrim if CD4

18

what is key to diagnosing pneumocystic pneumonia/.

get chest xray!

bilateral diffuse interstitial infiltrates

19

how does one acquire acute rheumatic fever?

2-3 weeks post untreated strep pharyngitis (caused by group A strep AKA strep pyogenes)

20

complication of acute rheumatic fever?

rheumatic valve disease!

most common is mitral valve then aortic

21

what is the jones criteria associated with?

acute rheumatic fever

22

drug of choice for treating strep?

penicillin

23

patient presents with diplopia, dry mouth, dysphagia, dysarthria, dysphonia, decreased muscle strength, dilated fixed pupils.......

botulism!

clostridium botulinum (gram positive spore forming rods)

24

pathogenesis of botulism?

neurotoxin inhibits acetylcholine release at neuromuscular junction causing weakness and flaccid paralysis

potential for respiratory arrest

25

common causes of botulism in:
1) adult
2) baby
3) active person

1) ingestion of canned/smoked/vaccuum packed foods
2) ingestion of honey
3) traumatic injury

26

treatment of botulism?

antitoxin and respiratory support if respiratory failure!

antibiotics ONLY in wound botulism

27

when you hear "rice water" diarrhea, think...

cholera

it is grey, turbid, without odor, blood, or pus

28

pathophysiology of cholera?

vibrio cholera; ingestion of fecally contaminated food or water.

toxin is produced that causes hypersecretion of water and chloride ion and massive diarrhea

29

complications of cholera?

dehydration, hypotension, electrolyte imbalance, death

30

diagnosis & treatment of cholera?

stool culture

oral or IV rehydration!

antibiotics reserved for severe cases: tetracycline, bactrim, fluoroquinolones

31

will alcohol disinfect water?

no!

32

patient presents with friable grey/white membrane on pharynx that bleeds when scraped...diagnosis?

diptheria

these are pseudomembranes

33

how does one acquire diptheria?

inhalation of respiratory secretions; the exotoxin induces inflammatory response

34

treatment of diptheria?

diptheria antitoxin (horse serum) and erythromycin x 2 weeks

35

should you treat close contacts of an individual with diptheria?

yes! and keep them in isolation until they have 3 negative cultures

36

other manifestations of diptheria

bull neck, fevers, nasopharyngeal symptoms, myocarditis & neuropathy

37

how to prevent diptheria?

vaccine given at:
2 months
4 months
6 months
15 months

booster at age 4-6

38

what are the three manifestations of salmonellosis?

1) enteric (typhoid) fever
2) gastroenteritis: most common
3) bacteremia

39

enteric (typhoid) fever is characterized by what presentation?

"pea soup" diarrhea

malaise, HA, fever, splenomegaly, bradycardia, abdominal distention

40

how to diagnose typhoid fever due to salmonella?

stool is unreliable! blood culture during 1st week only

41

treatment of typhoid fever?

ampicillin, chloramphenicol, and bactrim x 2 weeks

42

what will the diarrhea of salmonellosis gastroenteritis look like?

bloody!

fever, nausea, vomiting, cramping as well

43

how do we treat gastroenteritis due to salmonella?

self-limiting

ABX only for severe cases

44

what is bacteremia secondary to salmonella?

prolonged, recurrent fevers and local infection of bone, joints, pleura, pericardium, or lungs

COMMON IN IMMUNOSUPPRESSED

45

how do we treat bacteremia due to salmonella?

same as enteric (typhoid!) ampicillin, chloramphenicol, and bactrim x 2 weeks

46

what will the diarrhea be like with shigellosis?

mixed blood AND mucous

diarrhea, cramps, TENESMUS, fever, chills, anorexia

47

shigellosis is linked with what type of systemic manifestation?

reactive arthritis!

48

what is the difference in onset between salmonellosis vs. shigellosis?

salmonellosis is insiduous, shigellosis is ABRUPT

49

how to diagnose shigellosis?

stool culture for leukocytes, RBC, and culture

sigmoidoscopy: punctate lesions and ULCERS

50

treatment of shigellosis?

replace fluid volume!

bactrim

51

where is clostridium tetani found? how does it infect us?

it is ubiquitous in the soil; germinates through puncture and crush wounds

52

what is the pathogenesis of clostridium tetani?

blocks release of acetylcholinesterase, leading to Ach-mediated sustained contractions at neuromuscular junction

53

early symptoms & late symptoms of tetanus?

early: local muscle spasms, neck/jaw stiffness, dysphagia, hyperirritability

late: trismus (lockjaw), drooling, muscle rigidity in DESCENDING fashion

54

treatment of tetanus?

metronidazole or penicillin + tetanus immune globulin

55

prophylaxis of tetanus?

Tdap vaccine given every 10 years

or if major cut occurs >5 years since last booster)