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Flashcards in Systemic Infectious Disorders Deck (86)
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1

FROM JANE mnemonic for endocarditis

Fever
Roth spots
Osler nodes
Murmur
Janeway lesions - embolic showering to skin
Anemia
Nail bed hemorrhage
Emboli (peripheral cavitating pulmonary nodules)

2

Types of presentations of tularemia

1. Ulceroglandular disease (most common): ulcerated skin, regional lymphadenopathy, fever

2. Glandular tularemia (2nd most common): regional lymphadenopathy without skin lesion

3. Oculoglandualr: Conjunctivitis with preauricular adenopathy

4. Oropharyngeal: Severe pharyngitis with cervical lymphadenitis

5. Typhoidal: Fever, chills, GI sx, no skin lesions

6. Pulmonary: Fever, chills, nonproductive cough, SOB

3

Tx for tularemia

Streptomycin

4

Mononucleosis infects which cells leading to widespread proliferation of disease?

B cells
T cells fight the infection

5

Lesser known clinical presentation of RMSF

Known:
- Fever, muscle aches, malaise, rash typically maculopapular and blanching at first and becomes petechial

Late:
- Meningitis, renal failure, respiratory failure, myocarditis

6

Lab findings of RMSF

- Isolated thrombocytopenia
- Mild transaminitis
- Hyponatremia
Dx by immunofluorescent or antibody testing

7

What is Rumpel-Leede phenomenon

In RMSF, petechiae formation after blood pressure cuff inflation

8

Which STIs have high rate of cotransmission with HIV?

Disorders characterized by genital ulcers (syphilis, herpes, chancroid, lymphogranuloma venereum, granuloma inguinale)

9

Presentation and causative agent for lymphogranuloma venereum

Painless small, shallow painless ulcer or vesicle
Tender inguinal/femoral lymphadenopathy

Chlamydia trachomatis
#965851

10

Presentation and causative agent for granuloma inguinale

Painless, beefy red ulcer with painless papule

Klebsiella granulomatis
#965851

11

Presentation and causative agent for Syphilis

Painless penile chancre, indurated ulcer

Treponema pallidum
#965851

12

Presentation and causative agent for Chancroid

Multiple painful papules that ulcerate and inguinal bubo

Haemophilus ducreyi
#965851

13

Presentation and causative agent for genital herpes

Shallow, tender, painful lesions

HSV
#965851

14

Best way to remove a tick

Grab close to tick’s head with forceps and pull upward

15

Classic infections that cause pulse-temperature dissociation (expected tachycardic HR based on temp is not seen) - Faget sign

- Typhoid
- Legionella
- Mycoplasma
- Yellow fever (flavivirus)
- Tularemia
- Brucellosis
- Colorado tick fever (Coltivirus)

16

Tx of choice for typhoid?

Rehydration and fluoroquinolone

17

Location of ulcers between hand, foot, mouth and herpangina

Hand, foot, mouth: anterior such as tongue, buccal mucosa, palate, and gingiva

Herpangina: posterior oral cavity

18

T/F: Onychomadesis (shredding of the proximal nail) is a benign complication of hand, foot, and mouth disease occurring 7-10 days after presentation of other symptoms

True

19

MOA of rifampin

Inhibits bacterial RNA synthesis by binding to beta subunit of DNA-dependent RNA polymerase, blocking RNA transcription

20

Uses for rifampin

- Meningococcal prophylaxis
- TB, active and latent
- Anaplasmosis
- Brain abscess
- Brucellosis
- Cholestatic pruritus
- Endocarditis (prosthetic valve)
- Leprosy
- Osteomyelitis

21

Adverse effects of rifampin

- Hepatotoxicity
- Skin rash
- Abdominal cramps
- Diarrhea
- Red/orange discoloration to tears and urine

22

Two alternatives to rifampin for post-exposure prophylaxis from meningococcemia?

Ceftriaxone and ciprofloxacin

23

Clinical presentation of hantavirus

Initial prodrome flu-like sx with myalgias, fever, n/v, malaise, dizziness 1-2 weeks post exposure
Tachypnea and tachycardia and cxr with bilateral pulmonary edema
Can progress to respiratory distress and to respiratory failure and postural hypotension can progress to cardiogenic shock
CBC may show thrombocytopenia

24

Where are most reported cases of Hanta virus in the United States?

Western USA

25

Kaposi sarcoma is most commonly caused by what virus?

HHV-8 and in patients with CD4 <200

26

Treatment for Entamoeba histolytica

Metronidazole (or tinidazole, nitazoxanide) and paromomycin (luminal agent that follows metronidazole)

27

Determining type of meningitis by LP results

Q141663

28

Symptoms of symptomatic hyperleukocytosis

Pulm:
- Shortness of breath
- Hypoxia
Neuro:
- Headache
- Dizziness
- Gait instability
- Confusion
- Coma

Less common:
- ECG signs of ischemia
- Renal insufficiency
- Priapism
- Acute limb ischemia
- Bowel infarction

29

Tx of symptomatic hyperleukocytosis

- Contact oncology for emergency induction chemotherapy
- Abx for possible concomitant serious infection
- Fluid bolus
- hydroxyurea, allopurinol, leukapheresis
- ICU dispo

30

Lab abnormalities in leukostasis (symptomatic hyperleukocytosis)

- Arterial pO2 can be falsely decreased bc of enhanced metabolic activity of malignant cells
- Plt count may be overestimated
- Tumor lysis syndrome
- DIC

31

Metabolic complications associated with tumor lysis syndrome?

- Hyperuricemia
- Hyperkalemia
- Hyperphosphatemia
- Hypocalcemia

32

What is the leading cause of non-solid organ cancer-related death?

Non-Hodgkin Lymphoma

33

Leading cause of cancer-related death overall?

Adenocarcinoma of the lung

34

Only third-generation cephalosporin with anti-pseudomonal coverage

Ceftazidime

35

What disease can toxic shock syndrome be mistaken for?

Kawasaki (both with conjunctival hyperemia and a strawberry tongue), but TSS has much more acute onset

36

Tx of toxic shock syndrome

Nafcillin, oxacillin or cefazolin plus clinda

37

Oral lesions in hand foot mouth disease occur where?

Anterior oral cavity (most commonly on tongue and buccal mucosa; also hard palate, gingivae, lips)

38

Herpangina vs. hand, foot, mouth

Herpangina - ulcers of posterior oral cavity
Hand, foot, mouth - ulcers of anterior oral cavity

39

Three rare complications of hand, foot, mouth

1. Myocarditis
2. Pneumonia
3. Meningoencephalitis

40

Oral abx with MRSA coverage

- Doxycycline
- Bactrim
- Clindamycin
- Linezolid

41

Most common pathogens implicated in erysipelas?

Beta-hemolytic streptococci

42

Clues necrotizing fasciitis is due to Clostridial infection

- Trauma (C. perfringens)
- Dirty wound and lack of appropriate medical resources
- Spores found in soil and marine environments
- Crepitus on exam or air in tissues on plain films
- Spontaneous (C. septicum)

43

Presentation of sporotrichosis

Characteristic rash begins with an ulcer or papule (innocuous puncture wound from rose bush thorn) and then spreads proximally along lymphatic channels with skip lesions of suppurating subcutaneous nodules

44

Tx for sporotrichosis

3-6 months of itraconazole
(Amphotericin B for severe, disseminated)

Require admission if disseminated or involves joints, bones, or tendons

45

What mosquito transmits malaria?

Anopheles

46

Malaria presentation

Nonspecific fever, malaise, myalgias
Hepatosplenomegaly, generalized abdominal tenderness
Can progress to seizures, coma, acute respiratory failure, renal failure, hypoglycemia, death

If lymphadenopathy or rash think alternative or additional diagnosis

47

What is the most severe species for malaria?

P. Falciparum

48

What disease is transmitted by Aedes aegypti mosquito?

Yellow fever

(Also chikungunya, dengue, Zika)

49

What can mimic tetanus?

Strychnine poisoning

50

Presentation of tetanus?

Trismus (lockjaw), rigidity and spasms of muscles

51

Tx for tetanus

Benzos, metronidazole, TIG, immunization

52

What test is most sensitive for TB?

TB skin test or Mantoux test or PPD test
(Type IV hypersensitivity reaction)

53

Positive TB skin tests based on population

>5mm: HIV+, recent contact with an active TB patient, nodular or fibrotic changes on CXR, organ transplant

>10mm: Recent arrivals (<5 yrs) from high-prevalence countries, IVDU, resident/employee of high-risk congregate settings, comorbid conditions, children <4 y/o, infants, children and adolescents exposed to high-risk categories

>15mm: Persons with no known risk factors for TB

54

What is the clinical relevance of CD4 count 200-500 in HIV

- Thrush
- Pneumonia
- Zoster
- Hairy leukoplakia
- B-cell lymphoma
- Hodgkin disease
- Kaposi sarcoma
- Tuberculosis

55

What is the clinical relevance of CD4 <200 in HIV

- Esophageal candidiasis
- CMV retinitis
- PCP
- HIV encephalopathy
- Disseminated histoplasmosis
- Salmonella septicemia

56

What is the clinical relevance of CD4 Count <50 in HIV?

- Disseminated CMV
- Mycoplasma avium

57

Toxoplasma gondii vs. primary CNS lymphoma vs. PML in HIV

Toxoplasma gondii : ring-enhancing intracranial lesions + focal neurologic deficits

Primary CNS lymphoma: ring-enhancing intracranial lesions + AMS

PML: focal neurologic deficits, non-enhancing white matter lesions

58

What sites in the CNS does rabies show predilection for?

Pons and medulla

59

Symptoms of rabies

Viral prodrome with headache, fever, rhinorrhea, sore throat, myalgias and vomiting

Encephalitis with agitation, hallucinations, ataxia, weakness, seizures

Aerophobia (fear of air in motion) and severe hydrophobia (violent diaphragmatic contraction while drinking water and a strong protective gag reflex)

60

Rabies postexposure prophylaxis

Not previously vaccinated: rabies immune globulin 20 U/kg infiltrate around wound(s) and vaccine 1mL IM days 0,3,7,14 (add day 28 if immunocompromised)

Previously vaccinated: RIG not indicated; vaccine 1mL IM days 0,3 (add all other days if immunocompromised)

61

Which gram-negative organisms which are difficult to culture can cause endocarditis?

HACEK
- haemophilus
- actinobacillus
- cardiobacterium
- eikenella
- kingella

62

Possible CXR findings in histoplasmosis

In over 1/2 of cases CXR will be normal
Other potential findings include perihilar adenopathy or mild diffuse infiltrates

63

How is definitive diagnosis made of histoplasmosis

Antigen testing

64

Tx of histoplasmosis

Oral itraconazole or amphotericin B

65

What are the indications for steroids in addition to antibiotics in PJP?

PaO2 <70 mm Hg or A-a gradient >35

66

Viruses and bacteria requiring droplet precautions

- Influenza
- Parainfluenza
- Adenovirus
- RSV
- Human metapneumovirus
- Bordetella pertussis
- N. Meningitides (first 24 hours of therapy)
- Group A strep (first 24 hours of therapy)

67

Viruses and bacteria requiring airborne precautions

- TB
- Measles
- Varicella-zoster
- COVID 19

68

Common viral cause of parotitis

Paramyxovirus

69

Who should oseltamivir be given to?

Greatest benefit given within 48 hrs, but can still be beneficial up to 5 days after symptom onset
Those at high risk for developing complications of influenza
- Kids <2 y/o and people >65
- Pregnancy (risk increases by trimester) and postpartum (2 weeks)
- Pulmonary disease (increases with use of corticosteroids)
- CV disease (NOT isolated HTN)
- Chronic renal insufficiency
- Morbid obesity (BMI >40)
- Cancer
- DM
- Hemoglobinopathies
- People <19 on long-term ASA
- Immunosuppression
- Residents of nursing homes and other chronic care facilities

70

Clostridium tetani pathophysiology

Symptoms are caused by bacterial release of exotoxin tetanospasmin which prevents the presynaptic release of the inhibitory neurotransmitters GABA and glycine

Descending tetanic spasms

71

Important distinction between tularemia and anthrax?

Absence of a widened mediastinum -> tularemia

72

Which bacterium causes bubonic plague?

Yersinia pestis

73

What is the recommended abx regimen for a brain abscess from an oral or sinus source?

IV metronidazole and ceftriaxone (or cefotaxime) +/- vancomycin

74

Upper limit of normal of retropharyngeal space at C2 and C6 (adults and peds)

C2: <5-7 mm
C6: <14 mm (peds) <22 mm (adults)

75

How is diagnosis of botulism confirmed?

Specialized laboratory testing for botulinum toxin in the stool

Tx should occur prior to definitive dx with botulism immune globulin as early as possible

76

Clinical presentation of infant botulism

- Constipation
- Weak suck, feeble cry, poor gag reflex, pooled secretions
- Generalized weakness, hypotonia, loss of head control
Descending, symmetric, flaccid paralysis

77

What type of infection due to Clostridium botulinum should be treated with antibiotics?

Wound - treated with penicillin G

78

Which appears first in neonate, conjunctivitis caused by N. Gonorrhoeae or C. Trachomatis?

N. Gonorrhoeae within first 5-7 days of birth
C. Trachomatis 5-14 days of birth

79

When would you prefer IV abx vs. PO abx in cellulitis

Vital sign abnormalities, rapid progression and involvement of large area of skin

80

Risk factors for cryptococcal meningoencephalitis

- HIV
- Chronic steroid use
- Solid organ transplantation
- Cancer (especially hematologic malignancies)

81

At what CD4 count are patients with HIV at increased risk of cryptococcal meningitis?

<100

82

Clinical presentation of leptospirosis

- Contaminated freshwater
- Abrupt onset of fever, rigors, myalgia, headache
- ***Conjunctival suffusion (redness without exudates)
- Jaundice
- Nonproductive cough

Complication = Weil Syndrome caused by circulating antibodies = progression to aseptic meningitis, renal failure, hepatitis, uveitis, rash, circulatory collapse

83

Tx of leptospirosis

Mild = amoxicillin or doxy
Severe = IV penicillin or ceftriaxone

84

Clinical presentation of Leishmaniasis

Most commonly cutaneous disease
Can involve visceral organs and lead to weight loss, fever, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia

85

Clinical presentation of MAC

Fever, diarrhea, weight loss, anemia

86

Tx for MAC

Clarithromycin and ethambutol for at least 12 months (+/- rifampin)