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Adult Primary Care > T2 - ID + STI > Flashcards

T2 - ID + STI Flashcards

1
Q

What is Hutchinson’s sign?

A

A herpetic lesion on the nose that could indicate zoster involvement of ophthalmic branch of trigeminal nerve - refer!! Red flag!!

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2
Q

If your patient complains of prodromal burning eye pain, what should you do?

A

Be concerned about zoster and refer to ophtho.!!

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3
Q

T/F: you can have herpes zoster without eruptions.

A

True.

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4
Q

Pain management for acute zoster?

A

Tramadol, codeine.
NO Gabapentin, TCA or steroids.

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5
Q

when is antiviral benefit the best for herpes zoster?

A

Age >50 and <72hrs of symptom onset.

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6
Q

Herpes zoster tx

A

Valacyclovir 1000mg TID x7 days.

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7
Q

What is post herpetic neuralgia?

A

Pain that persists after the zoster lesions have disappeared. >90days .

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8
Q

How do you treat PHN?

A

Post herpetic neuralgia
Gabapentin, pregabalin, TCA (add for mod-severe pain)

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9
Q

When is herpes zoster infectious and what should you teach patients?

A

Infectious until lesions crust over. Stay away from pregnant people, babies and immunocompromised and keep your rash covered.

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10
Q

What vaccines are available for herpes zoster? Which is most effective? When can you get it?

A

Zostavax age >50, 51% effective for shingles and 67% for PHN
Shingrex is preferred (x2 dose for >50) 97% effective.

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11
Q

You can get shingrex if you’ve had the zostavax - just wait ______

A

8 weeks

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12
Q

Herpes zoster lesions usually crust in _________ and 2-3% develop a _________

A

7-10 days
Secondary bacterial infection.

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13
Q

What pathogens are most common cause of mono?

A

EBV and CMV.

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14
Q

What is the mono triad presentation?

A

Fever, pharyngitis and lymphadenopathy.

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15
Q

Your patient has fever, pharyngitis and lymphadenopathy. They have a fever of 104 that has lasted for over 2 weeks. You feel hepatomegaly on exam and the patient is very fatigued. What do you suspect?

A

Mono.

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16
Q

What labs can you draw to test for mono?

A

Heterophil antibodies serology 85% of cases are POs.
VCA, IgG, IgM POs in 1-2 weeks.
LFTs elevated in 80-90% of cases.

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17
Q

3-30% of patients with mono also have ________

A

GABH strep.

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18
Q

What happens if you treat a patient for strep but they actually have mono (either and)

A

They break out in a rash from taking the amoxicillin or ampicillin.

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19
Q

Management of mono

A

NSAIDS - no ASA, throat lozenges or lidocaine, bed rest, refrain from strenuous exercise or contact sports for 3-4 weeks to avoid splenic rupture.

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20
Q

How long does a tick need to be attached to transmit disease?

A

24-48hours

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21
Q

What are the stages of Lyme disease?

A

Stage 1 = early, localized, x1 EM where the tick bit 3-30 days post bite. Regional lymphadenopathy nd minor constitutional symptoms.
Stage 2 = Early disseminated infx, 3-5 weeks aft the tick bite. Multiple secondary EM, constitutional symptoms. Bell’s palsy, , meningitis etc can evolve if not treated.
Stage 3 = Late persistent = months after usually in winter, mono articular arthritis of large joints. Fatigue, keratitis, mental disorders, ataxic gait.

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22
Q

Tx for Lyme

A

Doxy 100mg BID x14 days.
ALT Amoxicillin (good for Kids and pregnant women). 500mg TID x14days.
If there are other system involvement - then 21-28 day therapy.

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23
Q

If there are neurological abnormalities or other serious complications from Lyme, then what is the treatment?

A

IV Ceftriaxone.

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24
Q

T/F: if there is a tick bite suspicious for Lyme, then you can give prophylactic treatment.

A

True. Single dose of doxy 200mg.

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25
Q

Babesiosis is a _____
Anaplasmosis is a _______
Ehrlichiosis is a _______
And RMSF is a ______

A

Protozoa
Bacteria
Bacteria
Bacteria

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26
Q

RMSF must begin treatment _______ or else may rapidly progress to fatal.

A

5 days.

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27
Q

Tx for babesiosis

A

Atovaquone and Azithromycin 7-10 days.
OR
clindamycin and quinine.

28
Q

Tx for RMSF, anaplasmosis and ehrlichiosis,

A

Doxy 100mg BID x14days.
2nd line is amoxicillin (pregnant women and children)
3rd Cefuroxime.

29
Q

S/s more specific to ehlichiosis

A

GI and AMS

30
Q

S/s more specific to RMSF

A

High fever, edema around eyes and back of hands, GI symptoms

31
Q

West Nile Virus, JEV, Dengue, Zika - all types of ______ virus transmitted by ______ and ______ are the reservoirs.

A

Flaviviridae
Mosquitos
Birds

32
Q

“Bone break fever” refers to _______

A

Dengue

33
Q

Triad of symptoms in Dengue

A

HA, eye pain and rash.

34
Q

Do not give ______ for dengue. Why?

A

NSAIDS. Increased risk for bleeding.

35
Q

While dengue and chikununya virus are similar and transmitted through the same mosquito, the S/s of chick usually primarily ________

A

Joint symptoms- bilateral, symmetric and debilitating.
Also have rash, HA, fever an eye pain

36
Q

Zika and _____ are linked.

A

GBS

37
Q

Acute diarrheal syndrome is ______ weeks. Tx is _____

A

<2 weeks
Supportive

38
Q

What is tenesmus?

A

Anal retching - having to poop but nothing coming out.

39
Q

Viruses, ETEC, C perfringens, Staph A, giardia cause a non-inflammatory ____________ bowel “acute watery diarrhea”

A

Proximal small bowel

40
Q

Salmonella typhi causes _______ _____ ______ bowel diarrhea.

A

Penetrating distal small bowel

41
Q

Campylobacter jejunum, shigella, EHEC, salmonella non-tynpi and C-diff are inflammatory ______ and are _______

A

Colon grossly bloody.

42
Q

If there is any blood in diarrhea, or suspect EHEC, then ________ antibiotics.

A

Withhold - it could be EHEC which release shiga toxin when killed with abx and can cause HUS.

43
Q

Salmonella - onset ________, lasts ________, TX: _________

A

12-36hours
5days -2weeks
Azithromycin, Ceftriaxone.

44
Q

Tx for campylobacter jejuni

A

Macrolides. self-limited in healthy patients and resolves in 1 week.

45
Q

Tx for giardia

A

Metronidazole
Watery, greasy stools with many GI cramping, belching, etc.

46
Q

Traveler’s diarrhea is cause in large portion by _______.

A

ETEC.

47
Q

Tx for traveler’s diarrhea.

A

Azithromycin
Loperamide.

48
Q

When should you NOT use loperamide for diarrhea?

A

Not if febrile or grossly bloody stools
Use in caution with combination antibiotics.

49
Q

Syphilis is contagious __________

A

During primary and secondary stage.

50
Q

Syphilis prevention/tx in pregnancy

A

Screen at first prenatal visit, and beginning of 3rd trimester. Screen again at delivery if high risk.

51
Q

Screening MSM for syphilis

A

Annually, or more frequently if high risk

52
Q

For someone who has had syphilis, they’re _______ test will always be positive. For repeat infections, you look at ______

A

FTA-AB
RPR titre - would increase by at least 8-fold

53
Q

You want to see a _________ decrease in RPR to show that syphilis is adequately treated

A

8-fold.

54
Q

Treatment for syphilis:
Primary + secondary
Latent early/late
Tertiary

A

PCN Benzathine 2.4 for primary and secondary and early latent
PCN Benzathine 2.4mu (1weekly x3 weeks) for late latent and tertiary.

55
Q

If someone has ocular syphilis or otosyphilis , what should you do?

A

Admit and give PCN G Benzathine IV.

56
Q

What is a Jarisch-Herxheimer reaction

A

Fever, malaise, n/v, chills, exacerbation of secondary syphilis rash occurring a few hours to 24 hours after PCN administration.

57
Q

T/F: a Jarisch-Herxheimer reaction is a type of allergic reaction

A

False. It is NOT an allergic reaction. treat with fluid and antipyretics. Resolves in 24 hours.

58
Q

Patients who are treated for syphilis in primary and secondary should get follow up at ____ and _____ post treatment

A

6mo and 12mo

59
Q

Patients who are treated for Latent syphilis should have follow up testing at ___________

A

6, 12 and 24mo.

60
Q

When can someone who has syphilis resume sexual activity?

A

At least 7 days after COMPLETING syphilis tx AND all mucosal and skin lesions have resolved, AND sex partners have been treated for syphilis.

61
Q

If you’re testing for syphilis, you should always test for _____ too.

A

HIV (and other STIs)

62
Q

For patients positive with syphilis, you should notify all sexual partners in the past ________

A

90 days

63
Q

When should you offer PrEP?

A

MSM who are positive for syphilis.

64
Q

Tx for chlamydia?

A

100mg doxy BID x7 days (non pregnangt)
Pregnant Azithromycin 1gm x1 oral.

65
Q

Tx for gonorrhea

A

Ceftriaxone 500mg IM x1. Co treat with doxy since G/C usually come together

66
Q

Treatment for trichomoniasis.

A

Women: Metronidazole 500mg BID x7 days
Men: 2G orally single dose.

67
Q

Tx for herpes

A

1st episode Acyclovir 400mg TIDx 7-10 days
Recurrent episodes: Acyclovir 800mg BID-TID x 2-5 days

Adult Primary Care (18 decks)

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