Medicine-Infectious Disease Flashcards
(156 cards)
1
Q
What is the single question screening for EtOH abuse
A
How often do you have 5 (4 in Women) drinks in one occasion?
2
Q
What’s the most common type of transfusion rxn and what’s the etx? tx?
A
Febrile Non-Hemolytic transfusion rxn; blood being transfused contains accumulated cytokines; tx = APAP
3
Q
Describe [FUO-Fever of Unknown Origin];
It has 4 types - describe Classic -3
A
FUO = Prolonged Fever w/out established etx
- > 3 weeks
- Dx still uncertain after 3 days
- at least 3 hospitilization or outpatient visits
4
Q
Which vaccines should be given to HIV pts with CD4 LESS THAN 200?-4
A
- Pneumococcal
- Flu (inactivated)
- Hep A
- Hep B
5
Q
Objective findings for Mycobacterium Avium Complex-4
A
Widespread Reticuloendothelial system involvement…
- [Hepatomegaly –> ⬆︎AT(Aminotransferases) & ALP]
- Splenomegaly
- LAD
- ⬆︎Lactate DeHydrogenase
* MAC pts have Fever/Diarrhea/Wt loss*
6
Q
tx for Mycobacterium Avium Complex-3
A
REC the MAC
Rifabutin
Ethambutol
Clarithromycin
7
Q
In HIV pts, when is px against MAC indicated? Name the px
A
CD4 < 50; Azithromycin
8
Q
In HIV pts, when is px against Toxoplasmosis Gondii indicated? Name the px
A
CD4 < 100; Bactrim
9
Q
In HIV pts, when is px against PCP indicated? Name the px
A
CD4 < 200; Bactrim
10
Q
CD4 Count Normal range
A
500 - 1500 cells/µL
11
Q
Best immediate tx for Septic pt is _____
A
[10-20 cc/kg Fluid Resuscitation (NS vs LR) over 30 min]
12
Q
Which organisms usually cause UTI-associated Sepsis?-4
A
KEEP away, UTI!
Klebsiella
E.Coli
Enterococcus
Proteus
13
Q
How does Fever affect volume status?
A
Fever –> ⬆︎Metabolism –> DEHYDRATION & Inflammation
14
Q
Initial mngmt of Bacterial Meningitis-4
A
FBLA
1st: Fluid Resuscitation
2nd: Blood Cx
3rd: Lumbar puncture BEFORE ABX (unless pt requires Head CT 1st or is critically ill and can’t receive lumbar puncture)
**4th**: Abx: VACS Empirically (Vanc,AmpicillinGent,CefTriaxone,Steroids)
15
Q
Which bacteria cause Meningitis in pts 0-6 mo.
A
16
Q
Which bacteria cause Meningitis in pts 6 mo. - 6 yo
A
17
Q
Which bacteria cause Meningitis in pts 6 yo - 60 yo
A
18
Q
Which bacteria cause Meningitis in pts > 60 yo
A
19
Q
Fever, Weight loss and Night sweats should always make you think about _____
A
lymphoma! (These are B symptoms)
FML “fuck my life”: Fever/Mnight sweats/Loss wt
20
Q
Common causes of FUO in general pop -8
A
21
Q
When should PEP (Post Exposure Px) for incidental HIV exposure began? ; What regimen should be given? ; for how long?
A
WITHIN 72 HOURS
Triple drug regimen
28 days long!
22
Q
MIC for moderate resistant? MIC for VERY resistant?
A
MIC moderate resistant = (0.1-1)
MIC VERY RESISTANT = ( > 1)
23
Q
Tx options for Cellulitis -5
A
- Clindamycin ***
- Bactrim
- Vancomycin
- Cephalexin
- Zosyn
24
Q
Empiric tx for Meningitis-4 (before cx returns)
A
Good MDs VACS out the meninges!
Vanc + Amp + CefTriaxone + [Steroids for Strep]
25
Pyuria indicates UTI. What is the WBC for Pyuria?
\>10 WBC on hpf
26
Empiric Abx for Sepsis -4
# Choose one...
1. CefTriaxone
2. Zosyn
3. Aztreonam
4. Carbapenem
27
Brudzinski's sign is used to diagnose \_\_\_\_. Describe it
Meningitis; Involuntary hip flexion when neck is passively flexed
28
Kernig sign is used to diagnose \_\_\_\_. Describe it
Meningitis; With hip flexed 90º, Knee extension --\> ⬆︎neck pain & resistance
29
Why are pts *_Suspected_* of bacterial meningitis placed on ___ precauation?
**Droplet** precaution UNTIL NEISSERIA MENINGITIDIS IS RULED OUT!
30
Organisms requiring Droplet precaution -6
1. Flu
2. Rhinovirus
3. Neisseria Meningiditis
4. GASP
5. Bordatella
6. Adenovirus
31
Organisms requiring AIRBOURNE (and not just droplet) precaution -6
1. TB
2. Varicella
3. Smallpox
4. Measles Rubeola
5. MERS
6. SARS
## Footnote
*Airbourne = N95 Facemask + Negative Pressure Room*
32
Most common pathogens for Hospital Acquired Infection-8
1. Staphylococcus aureus
2. Enterococcus
3. E. coli
4. Coag neg staph epidermidis
5. Candida
6. Klebsiella and oxytoca
7. Pseudomonas
8. Enterobacter
33
Describe Serology for Hepatitis B -7
S - **S**E**C** - SCEb - Core - CEbSAb - CSAB - SAb
## Footnote
* unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
* CSAB = RESOLVED HEP B INFECTION*
34
Physiology of Chills-2
Infection--\>Cytokines--\>influences hypothalamus to ⬆︎ body temp set point--\>
1. Muscles repetively contract (shivering)
2. Peripheral vasoconstriction--\> "cold" sensation
35
Complications of PNA -3
1. **SEPSIS**
2. Parapneumonic effusion--\> Empyema
3. Pulm vessel infiltration --\>Seeding (*Heart, Meninges*)
## Footnote
*Consider these when pt treated for PNA isn't getting better*
36
Which vaccines are given to a s/p PNA pt?-2 ;What are their Risk/Benefit
1. **Flu**: Risk= less effective in elderly / Benefit= ⬇︎mortality & occurrence
2. **Pneumococcal**: Risk=does NOT ⬇︎ occurrence / Benefit= does ⬇︎ invasive dz from S.Pneumo
37
Tx for Bacterial endocarditis - 3
1. Staph coag + / MRSA= **Vanc**
2. Staph coag - = **Vanc**
3. Strep Virdans = **CefTriaxone or PCN G aqueous IV**
4. Enterococcus = **[amp/PCN + gent]**
38
Major culprits of Bacterial endocarditis - 4
1. Staph coag + / MRSA= **Vanc**
2. Staph coag - = **Vanc**
3. Strep Virdans = **CefTriaxone or PCN G aqueous IV**
4. Enterococcus = **[amp/PCN + gent]**
39
Name the mainstay Drugs for Staph Aureus (8)
i **L**ove **C**razy **C**razy **D**eranged **B**oys **N**' **TV**
1. **L**inezolid
2. **C**lindamycin
3. [**C**efTaroline 5° generation]
4. **D**aptomycin
5. [**B**actrim - *Skin Infection*]
6. [**N**afcillin - MSSA only]
7. **T**igecylcine
8. **V**ancomycin
40
Classic Sx Triad of Brain Abscess
1. Fever
2. HA
3. Focal Neuro changes (seizure)
41
A Single ring-enhancing Brain Abscess in **non-immunocompromised** pt results from what organisms?-2 ; How would you diganose this?
Staph Aureus vs Strep Viridans ; CT-guided aspiration for cx
## Footnote
*Toxo and Nocardia would occur in immunocomp pts*
42
Tx for **Neuro**syphillis
IV PCN x 10-14 days
43
In an immunocompromised pt, **EBV DNA in the CSF** raises suspicion for what condition?
Primary CNS lymphoma
## Footnote
*MRI: Solitary **Weakly** ring-enhancing mass in periventricular region*
44
Describe the MRI findings for Primary CNS lymphoma
Solitary **Weakly** ring-enhancing mass in periventricular region
45
*You find this MRI in an immunocompromised pt*
Identify Disease
PML (Progressive Multifocal Leukoencephalopathy) 2/2 [John Cunningham Polyoma Virus]
46
What are the 2 environments Clostridium Botulinum likes to germinate spores?
1. Improperly Canned Foods
2. Cured Fish
## Footnote
*Tx = Equine Heptavalent Antitoxin*
47
MOD for [Carcinoid Syndrome Heart Disease]
[R sided **endocardial** fibrosis] ---\> [Pulmonic and Tricuspid Valve Stenosis] or [Restrictive Cardiomyopathy]
## Footnote
***C**arcinoi**D** **S**yndrome: (**C**utaneous Flushing)/**D**iarrhea/(**S**OB wheezing)*
49
Describe [**Libman Sacks Endocarditis**]
[**Non-bacterial** wart-like vegations] accumulate on either side of a heart valve --\> Fibrotic Valve Thickening--\> MI
## Footnote
*Associated with SLE Lupus*
50
What 2 diseases is ***Streptococcus Gallolyticus Bovis*** associated with?
1. [**SBE-S**ubAcute **B**acterial **E**ndocarditis in pts WITH COLON INVOLVEMENT] (*Aortic Regurgitation*) (***SBE** also caused by Strep Viridans or Mutans)*
2. [GI Lesions --\> Colon CA]
AKA S. Bovis
51
Name the manifestations of Infective Endocarditis (7)
"Bacteria **FROM JANE**"
**F**ever
[**R**etinal Roth Spots - *Immunologic phenomena*]
[**O**sler "Ouch" Nodes- *Immunologic phenomena*]
[**M**VP with regurgitation]
[**J**aneway lesions on palms/sole]
**A**nemia
[**N**ailbed Subungal _Splinter_ Hemorrhages] - shown in image
[**E**mboli from valvular vegetations] - may appear as abscesses or nodular cavities on imaging!
*These will be accompanied by ⬆︎⬆︎⬆︎ESR*
52
Which Dz's cause **EITHER OR** Mitral vs. Tricuspid Regurgitation (2)
Rheumatic Fever and [Infective Endocarditis]
53
What are the 2 major concerns for Kidneys in IV drug users?
1. renal ischemia 2/2 septic emboli
2. Immune-mediated Glomerulonephritis
54
Hydatid Cyst with eggshell calcification are caused by \_\_\_\_\_\_\_. ; What is the definite host for this?
Echinococcus granulosus ; **DOGS**
## Footnote
cyst reside in sheep(intermediate host), which are fed to dogs. Dog poop contaminates water/food, and that water/food is consumed by Humans. Eggs hatch in small intestine, penetrate wall and travel to Liver where Hydatid cyst form
55
Pyogenic liver abscess follows after what 3 events?
Surgery, GI infxn, appendicitis
56
What is the triad for Congenital Rubella Syndrome? ; How do you prevent this?
1. BL Cataracts
2. PDA
3. Sensorineural hearing loss
Live Rubella vaccine **prior to conception**
Dx = Rubella IgM vs PCR (Transmission occurs 1st trimester)
57
Describe the cutaneous manifestation of blastomycosis
well circumscribed raised violaceous (wart like) nodules which --\> into microabscess
## Footnote
*Blastomycosis causes Skin, Bone and Pulmonary findings*
58
Describe cutaneous Sporotrichosis
pustular and ulcerated lesion localized to site of inoculation
59
Clinical presentation for Vertebral Osteomyelitis-4 ; Dx?-3
1. **FOCAL SPINAL TENDERNESS**
2. Back pain
3. Fever +/-
4. ⬆︎ESR\>100 and/or ⬆︎Platelets but with normal spinalXR (WBC may be normal!)
Dx = [spinalXR, Bcx, ESR/CRP] --\> MRI --\> [CT guided bx]
60
Most common causes of Travelers' Diarrhea - 4
1. Giardia
2. CryptoSPoridium (parasite) - can still occur in immunocompetent pts!
3. Cyclospora
4. ETEC
## Footnote
*Profuse watery diarrhea after traveling*
61
Describe the oral involvement for Hand Foot Mouth disease (Coxsackie A)
grayish vesicles on the tonsillar pillars and **posterior** oropharynx that --\> fibrin-coated ulcerations
## Footnote
*doesn't have to have hand or foot involvement*
62
Dx for EBV infectious mono - 2
1. Monospot Heterophile Ab test (only accurate after 1st week of sx)
2. Anti-EBV ab test
## Footnote
*No sports for ≥3weeks because of splenomegaly!*
63
What is the management for a pt who comes in with a tick on their arm? - 2
**REMOVE TICK with forceps**
+
Abx px/tx within 3 days only if..
1. pt is symptomatic
2. if tick is attached ≥36hrs OR
3. Tick is engorged OR
Abx = Doxy OR [Amoxicillin if pt \<8 yo]
64
Triad for Disseminated Gonococcal infection
**STD**
1. **S**everal migratory arthralgias
2. **T**enosynovitis pain along tendon sheaths
3. **D**ermatitis pustular rash
*pts may NOT have urinary or pelvic sx with Disseminated Gonococcal infection!*
65
What are the most common causes of viral aseptic meningitis in kids - 2
1. Echovirus
2. Coxsackie
66
What are the 4 examples of Strep Viridans
the Viridan **MOMS**
1. **M**utans
2. **O**ralis
3. **M**itis
4. **S**anguinis
67
clinical presentation for Walking Atypical PNA - 3
1. **INCESSANT DRY COUGH** in teen/young adult/military
2. nonexudative pharyngitis
3. Fever malaise
## Footnote
*CXR = ⬆︎interstitial infiltrates +/- pleural effusion*
68
Identify
Erysipelas from GASP
## Footnote
*Erythematous, warm, tender, rash with **raised demarcated borders** +/- external ear involvement*
69
What are the 4 px recommendations for HIV pts with CD4 \< 200
**P**oor **H**IV, **T**reat **M**e
70
When can pts with pyelonephritis be transitioned to PO abx?
If sx are improved at the **48 hour mark** pts can be transitioned to PO (i.e. Bactrim or Levofloxacin) abx
71
Pt presents with splenic abscess
What are the risk factors for splenic abscess? - 5
1. **INFECTIVE ENDOCARDITIS**
2. IVDA
3. Immunosuppression
4. Trauma
5. Hemoglobinopathy
72
Pt presents with 2 month productive cough
dx?
**Reactivation** TB
## Footnote
(cavitary UPPER lung lesion)
*This is different from Aspiration PNA since Aspiration PNA occurs in LOWER lobes*
73
A family member is diagnosed with Bordatella Pertussis
Which abx is given? ; Should the other family members receive anything?
Macrolides ; ALL CLOSE CONTACTS should receive Macrolide px
74
Organisms associated with Bloody Diarrhea - 6
Inflammatory Bloody diarrhea is not **SEECSY**!
1. **S**higella
2. **E**Coli EHEC - shiga toxin
3. **E**ntamoeba histolytica
4. **C**ampylobacter
5. **S**almonella
6. **Y**ersinia Enterocolitica
75
Diagnosis?
*Swiss Cheese Head CT*
Neurocysticercosis from Taenia cestaode helminths
76
How does transmission of Hydatid cyst to Humans occur?
Echinococcus granulosus
cyst reside in sheep(intermediate host), which are fed to dogs. Dog poop contaminates water/food, and that water/food is consumed by Humans. Eggs hatch in small intestine, penetrate wall and travel to Liver where Hydatid cyst form
Dx = US / Tx = [Cyst\<5cm=Albendazole]
77
Most esophagitis in HIV pts is caused by \_\_\_\_\_. When is this NOT the case?
Candida; pts with **sole odynophagia** who have no thrush nor difficulty swallowing = viral (HSV, CMV) esophagitis
78
When is the TDaP vaccine substituted for the booster in adults?-2
1. Pt never got TDaP **as an adult**
2. Pt's vaccine hx is unknown
## Footnote
*People should receive TDaP vaccine once at 11 yo and once as an adult. THEN, they switch to booster q10 years*
79
When is the 13 valent pneumococcal vaccine recommended?-2 ; What about the 23 valent pneumococcal vaccine?
13 = [Adults ≥65 yo x 1 --\> PCV23 6 mo later] OR [Adults \<65 yo with RF x 1 (SickleCell/CochlearImplant/RenalFailure/HIV)]
23 alone = [Adults \<65 yo with RF x 1] (*Heart/Lung/Liver/DM/Smoker*)
80
Diagnosis?
Miliary TB
## Footnote
*CP: **SLOW** progression of fever, wt loss, night sweats, COUGH*
81
Where are the most common sites for Kaposi Sarcoma?- 4
1. Face
2. Mouth
3. Genitals
4. Legs
## Footnote
*papules --\> violaceous plaques or nodules*
82
What are the most common organisms to cause Sinus infection (Rhinosinusitis)? - 3 ; Tx?
Strep Pneumo \> HFlu nontypeable \> moraxella
## Footnote
Tx = Augmentin
83
clinical presentation for Disseminated MAC - 3
## Footnote
*Mycobacterium Avium Complex*
1. Splenomegaly
2. ALP⬆︎
3. Systemic sx (fever, diarrhea, cough)
84
clinical presentation for Disseminated Histoplasmosis - 4
1. Mucocutaneous papules/nodules
2. Reticuloendothelial system involvement (LAD, Hepatosplenomegaly)
3. Pulmonary (SOB, cough, CXR reticulonodular infiltrates)
4. Pancytopenia from marrow infiltration
## Footnote
*Dx = serum or urine Histoplasma antigen immunoassay*
85
Most common side effects of INH isoniazid
**I**njuries to **N**erves and **H**epatocytes
**N**europathy (Pyridoxine B6 = tx/px)
**H**epatitis - THIS IS SELF LIMITED AND RESOLVE WITHOUT INTERVENTION
86
name the organisms sickle cell disease pts are at most risk of acquiring?-3 ; Which is most common and why?
**SH**i**N** = encapsulated organisms
1. **S**trep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes!
2. **H**Flu B
3. **N**eisseria Meningitidis
*these happen to asplenic pts because they have ⬇︎antibody mediated phagocytosis and complement activation*
87
What are the potential complications of orbital cellulitis - 3
Biggest RF: Bacterial Sinusitis
1. Orbital abscess
2. intracranial infection
3. cavernous sinus thrombosis
88
Pt presents with signs of Sarcoidosis but rapidly deteriorates after being given steroids
Dx?
Histoplasmosis
## Footnote
*Mississippi and Ohio River basins*
89
Pts who've undergone solid organ transplantation are at risk of acquiring what 2 infections?
1. CMV (ganciclovir/valganciclovir px)
2. PCP (Bacterim px)
90
PCN IM is the first line tx for Syphilis.
The alternative tx to Syphilis is \_\_\_\_. When is it indicated to desensitize and still give PCN?-3
1. Pregnancy (No DOXY for POXY)
2. 3° CNS syphilis
3. refractory to initial tx
91
How do you know when a pt if fully cured from Syphilis?
**4**-fold ⬇︎in FTA Ab titer by 12 month mark AT THE LATEST
92
An unvaccinated pt to Hepatits B has just been acutely exposed and positive S and E antigen (SEC)
What do you give them? - 2
1. Hep B Immunoglobulin
2. Hep B **VACCINE** still
## Footnote
*unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
93
What's the most ideal abx for aspiration PNA - 3
## Footnote
*foul sputum, fever, cough*
1. **CLINDAMYCIN**
2. Augmentin
3. Amoxicillin with Metronidazole
94
Empiric tx for Viridans Strep - 2
1. PCN G aqueous IV x4wks OR
2. Ceftriaxone IV x 4wks
95
Which viral illness is associated with pancytopenia?
EBV
## Footnote
**P**latelet thrombocytopenia
**A**nemia from autoimmune hemolytic anemia
**N**eutrophil/WBC ⬇︎ with atypical lymphocyte on blood smear due to viral suppression
96
What is the triad for Trichinellosis
1. Periorbital edema
2. Myositis (⬆︎CK)
3. Eosinophilia
## Footnote
*This is preceded by GI compaints and can be a/w subungual spliter hemorrhages as well!*
97
At what CD4 are HIV pts at risk for Candida Esophagitis? ; tx?-2
CD4\<100 ;
1. Fluconazole PO
2. Esophagoscopy with bx/cx if refractory to rx
98
What is the management for a patient bitten by a Cat?
Augmentin px s/p irrigation
## Footnote
Cat bites are **DEEP PUNCTURE WOUNDS** AT RISK for Pasteurella and oral anaerobes
99
From a lab perspective, how do you differentiate CMV from EBV?
CMV will have a negative heterophile Ab monospot test
100
Dx? - 2
1. EBV
2. CMV
101
Which organism should you suspect if a pt with PNA also c/o Diarrhea?
Legionella
102
What are the risk factors for TB - 4
1. Homelessness
2. Alcoholism
3. Immunosuppression
4. Healthcare worker
*Disseminated TB affects peritoneum, cervical lymph nodes, eyes, bones and skin*
103
When is the Rabies Vaccine and Immunoglobulin indicated?-2 ; What do you do if this is NOT the case?
1. Animal is unavailable
2. Animal is symptomatic
Pet Observation x 10 days or Test Wild Animals to determine need for Rabies px
104
Ventilator associated PNA occurs how long after intubation? ; What's the first 2 steps in mngmt for these pts
≥48 hrs ;
## Footnote
1st: lower respiratory tract Gram stain and culture
2nd: Empiric abx
105
The most common predisposing factor for Acute Bacterial Sinusitis is what?
preceding viral URI
106
The Hepatitis A vaccine is recommended for which groups - 3
1. Travelers going to countries where HepA is present
2. Gay Men
3. Chronic Liver Disease
Hepatitis A can cause **SIGNIFICANT but benign TRANSAMINITIS** so do not be alarmed by this
self limited to 1 month
107
What are the generalized signs of ANY congenital TORCH infection - 3
1. Hepatosplenomegaly
2. Blueberry muffin spot rash
3. Jaundice
108
Name the specific signs of congenital syphilis - 3
1. Rhinorrhea
2. Maculopapular rash ofo the palms and soles that dequamates or becomes bullous
3. Abnormal long bone xrays (i.e. metaphyseal lucency)
109
Leprosy is a chronic mycobacterial granulomatous disease
How does it present?-2 ; Dx?
1. Macular **Anesthetic** hypopigmented skin lesions with raised borders (looks more irregular than Erythema Multiforme)
2. Nodular **Painful** nearby nerves with ⬇︎sensory & motor function
Dx = Full thickness Skin bx of lesion
Tx = Rifampin WITH Dapsone
110
Leprosy is a chronic mycobacterial granulomatous disease
Tx? - 2
1. Rifampin **WITH**
2. Dapsone
111
Coccidioides cp - 4
1. CA-acquired PNA (fever, cp, cough, lobar infiltrate)
2. Arthralgias
3. Ertyehma Nodosum
4. Erythema Multiforme
## Footnote
*Health pts do NOT require antifugal therapy*
112
How is Neurocysticercosis transmitted?
ingestion of undercooked **PORK** that contains Taeia solium tapeworm **EGGS**
## Footnote
*Imaging: swiss cheese CT (image below) or cystic lesion with surrounding edema*
113
Tx for HIGHLY CONTAGIOUS Pinworm Enterobius Vermicularis - 2
1. Albendazole
2. Pyrantel Pamoate
114
Which bacteria is described as Rocky Mountain Spotted Fever without the spots? ; What other major lab findings are associated with this bacteria? -3
Ehrlichiosis (has malaise and AMS with no rash)
1. Leukopenia
2. Thrombocytopenia
3. Transaminitis
115
Which bacteria causes Pnuemonia in Adult cystic fibrosis pts?
Pseudomonas
116
Which bacteria causes Pnuemonia in Pediatric cystic fibrosis pts?
Staph Aureus
117
What's the most common valvular abnormality in patients with Infective Endocarditis?
"Bacteria **FROM JANE**"
[**M**itral Valve Prolapse with regurgitation that's new]
*These will be accompanied by ⬆︎⬆︎⬆︎ESR*
118
What are Lyme Borrelia px - 3
1. Tick repellant
2. protective gear
3. tick checks
THERE IS NO VACCINE!
119
Which organism should you suspect in a pt with severe rapidly developing cellulitis after sustaining a cut in a marine envrionment?
Vibrio Vulnificus
## Footnote
also causes food borne illness
120
Dx? ; Mode of Transmission?
Cutaneous larva migrans secondary to **Ancylostoma hookworm larvae** ; walking barefoot in contaminated sand or soil
Tx = Ivermectin
121
Sporothrix Schenckii is a ____ fungus found in \_\_\_\_
How does it clinically present?
dimorphic ; decaying plant and soil
papule at inoculation site ulcerates and drains odorless nonpurulent fluid. This then spread proximally along lines of lymphatic drainage
Tx = PO itraconazole
122
Describe the type of rash you'll see with secondary syphilis
Diffuse Maculopapular rash **starting at trunk and spreading to extremities TO INCLUDE PALMS AND SOLES**
123
cp of Chikungunya Fever - 4
1. Polyarthralgias severe
2. High Fever
3. Leukopenia
4. Thrombocytopenia
## Footnote
*Transmitted by Aedes mosquito (same as Dengue) in the tropics / Tx = supportive*
124
Beta D glucan is useful diagnostics for what organisms?
FUNGUS (it's apart of their cell wall) - and this is nonspecific
125
Progressive Multifocal Leukoencephalpathy etx
JC virus reactivation in HIV pts --\> ASYMMETRIC focal **nonenhancing white matter brain lesions WITH NO EDEMA**
## Footnote
*HIV neurocognitive disorder will have DIFFUSE enhancement*
126
In pts with mucopurulent urethritis, absence of growth on gram stain usually suggest which organism?
Chlamydia
## Footnote
*Gonorrhea will in fact result in gram stain*
127
What organism is the most common cause of Infective Endocarditis in IV Drug Users?
Staph Aureus
128
What organism is the most common cause of Infective Endocarditis in pts with colon disease?
Strep gallolyticus Bovis
129
What organism is the most common cause of Infective Endocarditis in pts with dental disease and/or procedures?
the Strep Viridan **MOMS**
## Footnote
**M**utans/**O**ralis/**M**itis/**S**anguinis
tx = CefTriaxone or PCN G aqueous IV
130
What is the mechanism for why asplenic pts are at ⬆︎risk of infection from _____ organisms
**SH**i**N** = encapsulated organisms
1. **S**trep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes!
2. **H**Flu B
3. **N**eisseria Meningitidis
they have ⬇︎antibody mediated phagocytosis and complement activation
131
What organism causes Acute Epididymitis? - 3
1. EColi if \>35yo (secondary to bladder outlet obstruction)
2. [Chlamydia or Gonorrhea if under 35 yo (secondary to STI)]
132
Ludwig angina is a rapidly progressive cellulitis of the _____ and _____ space
What is the source of infection?
sublingual and submandibular ; infected mandibular **MOLAR**
133
Why is RPR not reliable when on a person first develops syphilis?
There is a possible false negative result early in infection - follow with FTA
134
For Malaraia px, in areas with high resistance to Chloroquine, what are the alternatives?-3 ; How are Malaria px prescripted?
1. Malarone
2. Doxycycline
3. Mefloquine
and of course DEET
tx ≥2wks prior to travel, during stay and stopped 4 weeks after returning
135
How long does it take Jarisch Herxheimer reaction to resolve?
2 days
136
Diagnostic criteria for postive Purified Protein Derivative (PPD) test? - 2
1. ≥15 mm OR
2. ≥5 mm in HIV
Reads are done 2 days after injection
137
Prophyrlactic Erythromycin Ophthalmic ointment at birth is used to prevent what organism?
**Gonorrhea** only
138
What are the major organisms that cause contact lens keratitits?-2 ; cp?
1. Pseudomonas
2. Serratia
painful red eye and opacification with corneal ulceration
139
etx for hordeolum ; tx?
an external hordeolum = a stye = inflammation of eyelash follicle or tear gland --\> tender nodule at lid margin
tx = warm compresses
140
etx for Miliary TB ; describe the radiograph
Hematogenous spread of TB (possibly from primary infection or reactivation) that --\> subacute sx +/- extrapulmonary involvement (liver, lung, CNS) ; Millet seed diffuse reticulonodular pattern
141
cp for Toxic Shock Syndrome-3 ; What are the causes of Toxic Shock Syndrome?-3
1. Diffuse erythematous macular rash
2. hypOtension
3. fever
tampons, nasal packing, post surgery
142
tx for Malignant Necrotizing Otitis Externa (MOE)
Ciprofloxacin IV (anti-pseudomonas)
143
Management of Peritonsilar Abscess - 2
IV Abx --\> **urgent** Needle Peritonsilar Aspiration
144
What 2 laboratory values are the best diagnostic test for Hepatitis B?
S - **S**E**C** - SCEb - Core - CEbSAb - CSAB - SAb
[**S**Ag and **C**oreIgM]
145
What are the guidelines for ANNUAL GC/Chlamydia Screening (Women vs Men)
Women
1. ALL sexually active women \< 25
2. Sexually active women \> 25 **IF HIGH RISK**
Men: Insufficient evidence :-(
*ANNUAL GC/Chlamydia screening done via NAAT - vaginal or cervical swab*
146
Which pt demographics should receive Syphilis Screening (RPR, VDRL)? - 5
1. Pregnant Women at **1st** prenatal visit
2. Pts with other STDs
3. Gay Men
4. Sex Workers
5. Jailed people
147
What are the guidelines for HIV Screening ; What is the screening test?-2
EVERYONE between the ages 15-65 regardless of risk factors
[HIV p24 antigen and HIV antibody testing] together
148
Tx for
Active TB?
Latent TB?
1. RIPE x 6 months for **ACTIVE** TB
2. IP x 9 months for **latent** TB
latent TB = positive PPD with normal CXR
149
Which hepatitis virus is associated with Porphyria Cutanea Tarda?
hep**C**
150
What type of acid base disturbance does TB cause? Why?
TB is a common cause of Addison's primary adrenal insufficiency which --\> ⬇︎Aldosterone --\> **Normal Anion Gap Metabolic Acidosis**
151
T or F
Lactose intolerance is associated with weight loss
FALSE
152
What are the most common causes of diarrhea- 5
1. Irritable Bowel Syndrome
2. IBD
3. Chronic infxn
4. Malabsorption- CELIAC
5. Malabsorption- LACTOSE INTOLERANCE
## Footnote
*Dx= stool fat analysis and serum studies*
153
Dx for Lactose Intolerance- 4
1. Diarrhea after consuming lactose
2. [INC Stool osmotic gap]
3. [DEC Stool pH]
4. + Lactose Hydrogen Breath test
154
Dx Celiac Disease- 3
1. [INC Stool osmotic gap (like lactose intolerance)]
2. **Microcytic Anemia** 2/2 iron deficiency
3. Villous Atrophy
* Foul, Flatulence, Fat stool (large volume), Frail wt (wt loss), Frail blood (microcytic anemia)*
155
Dx Small Intestinal Bacterial Overgrowth- 2
1. B12 Deficiency --\> Macrocytic Anemia
2. + LactuLOSE breath test
156
histologic findings of Celiac Disease- 3
1. intraepithelial lymphocytic infiltrates
2. loss of villous architecture -\> villous atrophy
3. Crypt hyperplasia
* bx from distal duodenum*
157
Any RPR Titer greater than ___ is high syphilis titer (positive result)
1:16
## Footnote
*anything where they had to dilute it MORE than 16 times is HIGH RPR Syphilis titer*
