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Flashcards in UW - Med/ID Deck (48)
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1
Q

What is Chikungunya fever?

A

Polyarthralgias, w/ lymphopenia, thrombocytopenia, fever/malaise

Caused by Aedes mosquito, esp in Central/South America, tropical regions

2
Q

How do you differentiate Rubella from Measles?

A

w/ measles fever is higher (>40), cranial caudal spread of rash is slower (over days)

Rubella can cause polyarthralgias and/or arthritis in adults and rash spreads over hours

3
Q

What clinical features are consistent w/ disseminated MAC in HIV pts? How could you prevent such a condition?

A

Sx: Fever, cough, night sweats, weight loss, diarrhea, splenomegaly, elevated Alk Phos, w/ CD4

4
Q

What is the prophylaxis for Pneumocystis pneumonia?

A
  1. Trimethoprim-sulfamethoxazole

2nd line Dapsone

5
Q

What is the proper Tx regimen for patients presenting w/ acute bacterial meningitis who are 2-50 yo, >50, Neurosurg/shunt, immune compromised, Penetrating trauma to skull? What else should be given?

A
  1. 2-50 yo: Vanc + Ceftriaxone (N. menin, Strep pneumo_
  2. > 50 yo: Vanc + Amp + Ceftriaxone (“ “ + listeria)
  3. NS/Shunt: Vanc + Cefepime (GNR, S. Aur, coag - staph)
  4. IC: Vanc + Amp + Cefepime (Pneumo, N. Menin, Listeria, GNR)
  5. Penetrating: Vanc + Cefepime (S. Aureus, caog - stpah, GNRs)

+ Dexamethasone to all

6
Q

What is a major hematological complication of Mono?

A

Autoimmune hemolytic anemia and thrombocytopenia, due to cross reactivity of EBV induced Abs against RBCs and platelets (IgM cold agglutinin Abs, Coombs +)

7
Q

What is most significantly associated w/ decreased UTIs in patients w/ neurogenic bladder?

A

Intermittent catheterizations, b/c indwelling catheters form biofilm and have increased risk of infection

8
Q

What are the recommended vaccinations for patients w/ chronic kidney disease?

A

Tdap (Td booster every 10 years), Influenza (annually), PPSV23 once, revax w/ PCV13/PPSV23 at 65, Hep A/Hep B (if initial negative serologies)

9
Q

What is the recommended pneumococcal vaccine for adults

A

PPSV23 alone immmediately

PCV13/PPSV23 at 65

10
Q

What microbes can form hydatid cysts?

A

Echinococcus granulosus (tapeworm) - from intimate contact w/ dogs

11
Q

What causes cysticercosis?

A

Taenia sollium –> cysts in the brain

12
Q

What are key clinical features of toxic shock syndrome?

A

Fever, diffuse myalgias, vomiting, profuse diarrha, HoTN, diffuse macular erythroderma (sunburn), possible leukocytosis (especially BLASTS), and thrombocytopenia
-Hx of tampon use, surgical wound infections, sinusitis, septorhinoplasty/nasal packing

13
Q

What is Sporotrichosis?

A

Fungal infection by dimoprhic Sporotrhix schenkii, looks like papule at site of inoculation, followed by ulceration and LAD; seen in gardeners

14
Q

What is cutaneous larva migrans?

A

Helminthic disease caused by larvae Anclyostoma braziliense (dog/cat hookworm) -> occurs after skin contact w/ soil contaminated by dog/cat feces (tropical/subtropical regions of Southeast USA, beaches/sandboxes)

15
Q

What are the key clinical features of disseminated gonococcal infection?

A
  • Prurulent arthritis w/o skin lesions OR triad of Tenosynovitis (wrist, ankles, fingers, knees), Dermatitis (pustules, macules, papules, bullae), Migratory asymmetric polyarthralgia
  • high yield link: sexually active, young individual (immediately think gonorrhea in young sex active w/ arthritis)
16
Q

What prophylaxis should be given in HIV+ pts w/ CD count

A

Trimethoprim-Sulfamethoxazole (CD

17
Q

What is ehrlichiosis? Symptoms/findings?

A

Spotless rocky mountain fever - tick born illness, fever, malaise, HA, nausea, and vomit, leuko/thrombocytopenia on labs

18
Q

How can you identify Nocardia spp. on staining?

A

partially acid-fast gram positive branching rods

19
Q

What bugs can you use Aztreonam to treat?

A

gram negative bacterial infections, like pseudomonas aeruginosa

20
Q

What life threatening conditions are associated w/ HIV therapy?

A
  1. Didanosine - acute pancreatitis
  2. Abacavir - hypersensitivity syndrome
  3. Lactic acidosis - any NRTIs
  4. SJS 2/2 any NNRTIs
  5. Nevirapine - liver failure
21
Q

What are the positive cutoffs for PPD skin test based on various patient risk factors?

A

> =15 mm; LOW RISK: asymptomatic pt, no Hx of exposure or risks

> = 10 mm; HIGH RISK: recent endemic immigrants, IV drug user, High risk environment (prison, homeless), High risk for TB reactivation (diabetes, ESRD, leukemia), Peds =5 mm; IMMUNE SUPPRESSED: HIV+, recent known TB contacts, nodular/fibrotic on CXR, Organ Tx recpipients or other immunosuppressed

22
Q

What is the treatment of choice for primary syphilis? What if patient is allergic to 1st line? Pregnant patient?

A
  1. Intramuscular benzathine penicillin
  2. Doxycycline (if penicillin allergy)
  3. Aizthromycin - but resistance is increasing

If pregnant can only use penicillin (NOT DOXY), pt should undergo desensitization if allergic

23
Q

What are contraindications to HCV therapy?

A

Major uncontrolled depression, ongoing alcohol or drug use

24
Q

What are the signs of molluscum contagiosum and who are prone to get them?

A

Firm dome shaped flesh colored papules w/ central umbilication; passed by sex contact

-Cellular immunodeficient at risk (pox virus spreads dz)

25
Q

What are the clinical features of trichinellosis?

A

Week 1: intestinal stage - Ab pain, N/V/D

Week 4: Muscle stage - Myositis, fever, subungual splinter hemorrhages, periorbital edema, eosinophilia

26
Q

What is ascariasis?

A

parasite infection caused by parastic roundworm Ascaris lumbricoides

-SBO, intestinal sx + eosinophilia, nonproductive cough and asymptomatic intestinal phase

27
Q

What is the presentation for Dengue fever?

A

Fever, Headache, Retro-orbital pain, rash, significant myalgias and arthralgias

28
Q

What are the most important markers for hepatitis B infection?

A

HBsAg and anti-Hbcore b/c both are elevated during initial infection, and anti-HBc will remain high during window period

29
Q

What are the signs and symptoms of Erysipelas? What is the most likely causative organism?

A

Inflammation of superficial dermis, prominent swelling, sharply demarcated, erythematous, edematous, tender skin lesion w/ raised borders

Group A strep - S. pyogenes

30
Q

What should multiple hypodense non-enhancing lesions w/ no mass effect in cerebral white matter raise suspicion for (in immunocompromised patient)?

A

PML - JC Virus

31
Q

What are the characteristics of CMV retinitis?

A

panless, fundoscopy shows fluffy granular lesions near retinal vessels & associated hemorrhages

32
Q

What viruses can cause severe intraocular inflammation especially in immunocomprimised patients? What are the clinical features?

A

VZV & HSV –> eye pain, conjuctivitis, rapid progressive visual loss, Fundoscopy shows widespread pale, peripheral retinal lesions and central necrosis of retina

33
Q

What should be considered in any bone marrow transplant recipient w/ pulm and GI symptoms? What would you find on CXR?

A
  • CMV pneumonitis
  • Upper and lower GI ulcers
  • CXR: Multifocal, diffuse patchy infiltrates
34
Q

What are the toxicities associated with Isoniazid use?

A

Peripheral neuropathy and hepatotoxicity and sideroblastic anemia

35
Q

What is the most common cause of pneumonia in patients following a viral infection (like influenza)?

A

Staph Aureus

36
Q

Which patients are susceptible to pneumonia from Pseudomonas?

A

Nosocomial, pts w/ cystic fibrosis and bronchiectasis

37
Q

What is the most common cause of osteomyelitis in adults w/ history of nail puncture wound?

A

Pseudomonas aeruginosa

38
Q

What neurological effects are caused by CMV in HIV?

A

Retinitis (in patients w/ CD4

39
Q

What key test is enough to confirm diagnosis of syphillis in someone w/ penile ulcer? What should be done next?

A

Dark field microscopy

HIV elisa next

40
Q

What social history factors put patients at risk for TB infection?

A

-Incarceration, homelessness, foreign country (russia, india, china etc.)

41
Q

What is the most common cause of traveler’s diarrhea and how may patients present? When should parasitic cause be investigated?

A

Enterotoxigenic Escherichia coli (ETEC) - which typically causes a self-limited, relatively mild diarrheal illness that can be treated symptomatically
-Longer bouts of diarrhea require stool ova/parasite analysis

42
Q

What is the most important first test to screen for HIV? How do you confirm?

A

HIV antibody enzyme immunoassay (EIA)

Western blot assay to confirm

43
Q

What patient populations are most likely to be affected by aspergillosis?

A

Immunocompromised/neutropenic

44
Q

What are the clinical signs of vertebral osteo?

A

escalating dull aching back pain w/ tenderness to gentle percussion,
IV drug use can be a clue

45
Q

What are the signs of secondary syphilis?

A

Rash starting on trunks and extending to periphery, reaches palms and soles of feet, generalized lymphadenopathy

46
Q

Which areas have malaria resistant to chloroquine ppx? WHat should be used instead?

A

Sub-Saharan africa, SOuthern and southeast asia

-Use mefloquine, doxycycline, atovaquone-proguanil

47
Q

What are the immunological phenomena of infective endocarditis?

A
  1. Osler’s nodes - painful violaceous nodules on fingertips and toes
  2. Roth spots - edematous and hemorrhagic lesions on retina
  3. Glomerulonephritis - dark cloudy urine
  4. Arthritis or positive Rheumatoid factor
48
Q

What is the treatment of choice for early localized lyme disease in pregnant/lactating women and children

A

Oral amoxacillin (doxy causes teeth discoloration and retards skeletal development)