Flashcards in UW - Med/ID Deck (48):
What is Chikungunya fever?
Polyarthralgias, w/ lymphopenia, thrombocytopenia, fever/malaise
Caused by Aedes mosquito, esp in Central/South America, tropical regions
How do you differentiate Rubella from Measles?
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
What clinical features are consistent w/ disseminated MAC in HIV pts? How could you prevent such a condition?
Sx: Fever, cough, night sweats, weight loss, diarrhea, splenomegaly, elevated Alk Phos, w/ CD4
What is the prophylaxis for Pneumocystis pneumonia?
2nd line Dapsone
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?
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
What is a major hematological complication of Mono?
Autoimmune hemolytic anemia and thrombocytopenia, due to cross reactivity of EBV induced Abs against RBCs and platelets (IgM cold agglutinin Abs, Coombs +)
What is most significantly associated w/ decreased UTIs in patients w/ neurogenic bladder?
Intermittent catheterizations, b/c indwelling catheters form biofilm and have increased risk of infection
What are the recommended vaccinations for patients w/ chronic kidney disease?
Tdap (Td booster every 10 years), Influenza (annually), PPSV23 once, revax w/ PCV13/PPSV23 at 65, Hep A/Hep B (if initial negative serologies)
What is the recommended pneumococcal vaccine for adults
PPSV23 alone immmediately
PCV13/PPSV23 at 65
What microbes can form hydatid cysts?
Echinococcus granulosus (tapeworm) - from intimate contact w/ dogs
What causes cysticercosis?
Taenia sollium --> cysts in the brain
What are key clinical features of toxic shock syndrome?
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
What is Sporotrichosis?
Fungal infection by dimoprhic Sporotrhix schenkii, looks like papule at site of inoculation, followed by ulceration and LAD; seen in gardeners
What is cutaneous larva migrans?
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)
What are the key clinical features of disseminated gonococcal infection?
-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)
What prophylaxis should be given in HIV+ pts w/ CD count
What is ehrlichiosis? Symptoms/findings?
Spotless rocky mountain fever - tick born illness, fever, malaise, HA, nausea, and vomit, leuko/thrombocytopenia on labs
How can you identify Nocardia spp. on staining?
partially acid-fast gram positive branching rods
What bugs can you use Aztreonam to treat?
gram negative bacterial infections, like pseudomonas aeruginosa
What life threatening conditions are associated w/ HIV therapy?
1. Didanosine - acute pancreatitis
2. Abacavir - hypersensitivity syndrome
3. Lactic acidosis - any NRTIs
4. SJS 2/2 any NNRTIs
5. Nevirapine - liver failure
What are the positive cutoffs for PPD skin test based on various patient risk factors?
>=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
What is the treatment of choice for primary syphilis? What if patient is allergic to 1st line? Pregnant patient?
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
What are contraindications to HCV therapy?
Major uncontrolled depression, ongoing alcohol or drug use
What are the signs of molluscum contagiosum and who are prone to get them?
Firm dome shaped flesh colored papules w/ central umbilication; passed by sex contact
-Cellular immunodeficient at risk (pox virus spreads dz)
What are the clinical features of trichinellosis?
Week 1: intestinal stage - Ab pain, N/V/D
Week 4: Muscle stage - Myositis, fever, subungual splinter hemorrhages, periorbital edema, eosinophilia
What is ascariasis?
parasite infection caused by parastic roundworm Ascaris lumbricoides
-SBO, intestinal sx + eosinophilia, nonproductive cough and asymptomatic intestinal phase
What is the presentation for Dengue fever?
Fever, Headache, Retro-orbital pain, rash, significant myalgias and arthralgias
What are the most important markers for hepatitis B infection?
HBsAg and anti-Hbcore b/c both are elevated during initial infection, and anti-HBc will remain high during window period
What are the signs and symptoms of Erysipelas? What is the most likely causative organism?
Inflammation of superficial dermis, prominent swelling, sharply demarcated, erythematous, edematous, tender skin lesion w/ raised borders
Group A strep - S. pyogenes
What should multiple hypodense non-enhancing lesions w/ no mass effect in cerebral white matter raise suspicion for (in immunocompromised patient)?
PML - JC Virus
What are the characteristics of CMV retinitis?
panless, fundoscopy shows fluffy granular lesions near retinal vessels & associated hemorrhages
What viruses can cause severe intraocular inflammation especially in immunocomprimised patients? What are the clinical features?
VZV & HSV --> eye pain, conjuctivitis, rapid progressive visual loss, Fundoscopy shows widespread pale, peripheral retinal lesions and central necrosis of retina
What should be considered in any bone marrow transplant recipient w/ pulm and GI symptoms? What would you find on CXR?
-Upper and lower GI ulcers
-CXR: Multifocal, diffuse patchy infiltrates
What are the toxicities associated with Isoniazid use?
Peripheral neuropathy and hepatotoxicity and sideroblastic anemia
What is the most common cause of pneumonia in patients following a viral infection (like influenza)?
Which patients are susceptible to pneumonia from Pseudomonas?
Nosocomial, pts w/ cystic fibrosis and bronchiectasis
What is the most common cause of osteomyelitis in adults w/ history of nail puncture wound?
What neurological effects are caused by CMV in HIV?
Retinitis (in patients w/ CD4
What key test is enough to confirm diagnosis of syphillis in someone w/ penile ulcer? What should be done next?
Dark field microscopy
HIV elisa next
What social history factors put patients at risk for TB infection?
-Incarceration, homelessness, foreign country (russia, india, china etc.)
What is the most common cause of traveler's diarrhea and how may patients present? When should parasitic cause be investigated?
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
What is the most important first test to screen for HIV? How do you confirm?
HIV antibody enzyme immunoassay (EIA)
Western blot assay to confirm
What patient populations are most likely to be affected by aspergillosis?
What are the clinical signs of vertebral osteo?
escalating dull aching back pain w/ tenderness to gentle percussion,
IV drug use can be a clue
What are the signs of secondary syphilis?
Rash starting on trunks and extending to periphery, reaches palms and soles of feet, generalized lymphadenopathy
Which areas have malaria resistant to chloroquine ppx? WHat should be used instead?
Sub-Saharan africa, SOuthern and southeast asia
-Use mefloquine, doxycycline, atovaquone-proguanil
What are the immunological phenomena of infective endocarditis?
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