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Dx of Tb
- M. tuberculosis culture on DNA/RNA (sputum and bronchoscophy washings)
- Findings on xray
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TB findings on exray
- hilar lymphadenopathy
- segmental atelectasis
- cavitations
- Gohn complex
- Reactivation-fibrocavitary apical disease
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PPD criteria
> 5: HIV positive, exposure to TB, CXR changes consistent with TB, immunosuppressed
>10: recent immigrants, HIV (-) drug user, lab personnel, Residents of facility, children < 4
>15 mm: 0 risk factors
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Tx of TB
- Report to public health
- Directly observed therapy
- No coninfection with HIV: 6 months of tx (2 months of isoniazid, rifampin, pyrazinamide, and ethambutol, then isoniazid and rifampin x 4 months) (RIPE)
- HIV+: Same tx, add pyridoxine
- Latent: Isoniazid x 9 months with rifampin and pyrazinimide x 2 months
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Side effects of isoniazid
Peripheral neuropathy, hepatitis, rash
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Side effects of rifampin
Hepatitis, flu like sx, kidney failure
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Side effects of pyrazinimide
Hepatotoxic, GI upset, rash, joint pain
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Side effects of ethambutol
Optic neuritis (should assess visual acuity)
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Side effects of streptomycin
Increasing resistance, nephrotoxic
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Dx of Lyme
- EM or one late manifestation of the disease
- IFA or ELISA preferred, if those are unclear, do Western blot
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Sx unique to RMSF and not lyme
Restlessness and insomnia; rash on palms and soles
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Dx of RMSF
IFA 7-10 days after onset, Abs after 2 weeks
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Tx of RMSF
- Doxy 100
- kids: Doxy
- pregnant women: chloramphenicol
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Multinucleated cells on Tzanck smear
HSV
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Tx of Hsv
- Immunocompetent: no tx necessary
- Genital: initials= acyclovir 5x/day x 7-10 days; Recurrent: acyclovir 800 mg TID x 2 days
- Oral: topical or oral antivirals
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Dx of chix pox
- Clinical
- PCR with evidence of multinucleated cells
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Ramsay-Hunt syndrome
External ear, vertigo, tinnitus, taste change
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Tx of EBV
- supportive
- avoid contact sports
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EBV associated with what dz other than mono
- African Burkitt's lymphoma
- Nasopharyngeal carcinomas
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Pizza pie lesions on retina
CMV
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Dx of CMV
- PCR of dried blood in neonates (congenital CMV m/c)
- Immunocompetent: heterphil AB and +IgM, or 4x increase in IgG
- Immunocompromised: PCR analysis
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Tx of CMV retininitis
Ganciclovir (IV or via implant)
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HIV dx
HIV Ab ELISA, if (+), then do Western Blot
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How long does it take for HIV Ab to seroconvert?
<6 weeks
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When do you tx HIV?
- All sxmatic
- Asx with CD4 < 350
- Asx with rapidly declining CD4 and increasing viral load
- Asx with viral hep co infection
- asx with rsisk for cardiac or non-HIV related Ca
- Asx pts with HIV neuropath
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Tx of toxoplasmosis in HIV
- Bactrim DS QD or TIW
- Only tx if CD4 < 100
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TX of PCP in HIV
- only tx when CD4 < 200
- Bactrim DS TIW; stop when CD4 is > 250 for 3-6 months
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Tx of M tuberculosis in HIV
Isoniazid 300 mg PO QD with pyridoxine 50 mg QD x 9-12 months
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Tx of MAC in HIV
- When CD4 lymphocytes <75-100
- Azithromycin 1200 mg QIW
- d/c if CD4 > 100
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Tx of CMV in HIV
Don't prophylax b/c ganciclovir causes neutropenia
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Cause and spread of Mumps
- paramyxovirus
- respiratory droplets
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M/C cause of pancreatitis in kids
mumps
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Cause of rubella
Togavirus
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Most important sequelae of rubella
- Teratogenic, the younger the fetus, the more adverse the effects
- If a baby is born with rubella, it may end up with cataracts, micropthalmia, hearing defects, heart defects, and organomegaly
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Fine maculopapular rash that appears on face, trunk, and extremities and lasts no longer than a day in each arae
Rubella
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Tender suboccipital adenitis
Rubella
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cause and spread of measles
paramyxovirus, spread by respiratory droplets
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What are koplik spots?
- patho for measles
- tiny crystal salts seen on buccal mucosa
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tiny pinhead sized papules that coalesce to form brick red, irregular maculopapular rash; beginning first on the face, going to the trunk and extremities
Measles
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Measles tx
- give MMR
- isolate at onset of rash, bedrest until fever resolves
- Tx sxmatic
- Vit A for GI side effects
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Cause of roseola
herpesvirus 6
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m/c cause of febrile seizures in babies
roseola
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High fever folloewd by maculopapular/macular rose or pink blanching rash
roseola
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What is protective against malaria?
SCA, G6PD, Hemoglobin C
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hallmark of malaria
cyclical, recurring fevers and sx (occurs QOD or q3d)
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Dx of malaria
Giemsa thick and thin smears of peripheral blood
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Tx of malaria
- uncomplicated p/ vivax/ovale chloroquine and primaquine
- uncomplicated p falciparum: quinine sulfate and doxy
- complicated p falciparum: quinidine gluconate IV and doxy
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Bullet shaped RNA virus
rabies
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rabies tx: no previous immunization
rabies immune globulin 0, 3, 7, 14, 28
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Massive PMN infiltration into large and small bowel
salmonellosis
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diarrhea in salmonellosis
bloody, lasts 3-5 days
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Tx of salmonellosis
supportive if uncomplicated
- with comorbiditis:
- bactrim 1 tab BID x 5 days
- cipro 750 mg BID x 5 days
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extensive ulceration of epithelial surface of colonic mucosa with an exudate
Shigellosis
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Tx of Shigellosis
- no tx required
- Bactrim in severe cases can shorten illness and carrier state
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Hallmark of toxoplasmosis infection
cell death and focal necrosis with an acute inflamatory response
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toxoplasmosis affect on fetus
- multi organ failure and intrauterine death
- can be nl at birth, but may develop brain/eye sequalae later
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Tx of toxoplasmosis
- immunocompetent: nothing
- Immunocompromised: bactrim
- congenital: pyrimethamine and sulfadiaine for 1 year, may add prednisone and spiramycin
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Tx of ascariasis
- albendazole or mebendazole
- pregnancy: pyrantel pamoate
- recheck stool q2w until clear
- if obstructed, NG tube placement, IV fluids, possible surgery
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Intestinal hookworm tx
- albendazole (off label0
- mebendazole
- pyrantel pamoate
- high protein diet x 3 months
- check stools for two weeks post tx
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nighttime perinanal pruritus
enterobiasis (pinworms)
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pinworms tx
- clear tape to perinala region in morning prior to bathroom and look for worms or eggs under microscope
- melbendazole
- albendazole
- pyrantel pamoate
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Hallmark of acute rheumatic fever
valvular damage (almost always mitral valve, possible atrial or tricuspid)
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Heart involvement in rheumatic fever
- mitral regurge leading to stenosis
- pericarditis
- myocardial inflammation
- chorea
- polyarthritis
- erythema marginatum
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Jones Criteria
Major: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
Minor: fever, polyarthralgia, increased ESR or leukocytes
Need 2 major, or 1 major and 2 minor, plus (+) ASO to make DX
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Tx of acute rheumatic fever
- ABX
- salicylates and NSAIDs
- CHF
- chorea
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bacterial cause of acute rheumatic fever
GABHS
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yeast like fungus
cryptococcus
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Tx of cryptococcus
- Pulm sx: fluconazole
- Extrapulmonary: fluconazole, +/- ampho B
- CNS: amB plus flucytosine
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Histoplasmosis CXR findings
pneumonitis or mediastinal adenopathy
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Tx of histoplasmosis
- immunocompetent: none
- Acute pulm: lipid amphotericin B with glucocorticoids for 1-2 weeks then itraconazole for 12 weeks
- Chronic pulm: itraconazole
- Progressive disseminated: lipid amph B plus itraconazole
- CNS: liposomal amph B then intraconazole
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Pathophys of tetanus
- toxin release binds to the peripheral motor neuron terminals, enters the axon
- transported to nerve cell body in the brainstem and spinal cord
- toxin migrates across synapse to block release of neurotransmitters
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Clinical presentation of tetanus
- First: pain/tingling at wound site
- Next: stiffness: jaw and neck, sore throat, dysphagia, irritability
- next: hyperreflexive, trismus, rigidity and spams/spine, neck and abdomen (spasms generalized or localized and triggered by noise or touch)
- Final: laryngeal spasm, respiratory failure/reduced chest wall compliance and then death
- Sensory exam WNL
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Tetanus tx
- ICU
- Flagyl
- Antitoxin
- Supportive
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clinical presentation of botulism in infants
constipation, weak cry, can't suck or swallow, hypotonia
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Botulism tx
- admit to hospital and monitor for resp failure
- equine antitoxin ASAP if foodborne
- infants: supportive care, administer human immune globulin, parental nutrition
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Diptheria tx
- Diptheria antitoxin
- erythromycin or PCN to prevent transmission
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Pathogenesis of cholera
- toxin causes cAMP to inhibit the Na transport system and activates secretory chloride to transport system
- NaCl accumulates in the intestines, causing water to move into the gut
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Tx of cholera
- fluid/electrolyte replacement
- Abx to shorten duration: single dose of tetracycline or doxy
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erythematous papule at site of inoculation that becomes vesicular with a purple to black center, which in turn ulcerates, becomes necrotic, and sloughs
Anthrax
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Anthrax tx
cipro or another fluoro is Tx of choice, doxy is alternative
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Tx of pertussis
- erythromycin
- alternatives: azithromycin, clarithromycin, bactrim
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HPV virus causing genital warts
6,11
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HPV causing cervical ca
16, 18, 35
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cause of influenza
orthomyxovirus
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most pathogenic influenza
A
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Tx of flu
- supportive
- Ralenza or Tamiflu if given < 48 hours into sx
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soil contaminated with pigeon dung
cryptococcus
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blanchable, pink, papular rash over the trunk and fever that increases in stepwise fashion
typhoid fever
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Cause of dysentary
entamoeba histolytica
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Tx of Legionnaire's pneumonia
erythromycin
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m/c transmission of cholera
eating undercooked shellfish
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Tx of kaposi sarcoma
intralesional vinblastine or by observing over time
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Dental prophylaxis in endocarditis if PCN allergy
clindamycin
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parakeet transmitted disease
psittacosis
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Tx of cat scratch dz
supportive
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bacteria in cat scratch dz
bortonella henselae
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fever followed by a diffuse maculopapular rash that spares the face and resolves in about 2 days
erythema subitum
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which antiretroviral will cause kidney stones?
idinavir
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m/c sign of secondary syphilis
generalized maculopapular rash
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hallmark of tertiary syphilis
gummas
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Worms that enter through soles of feet, travels to the lungs, to mouth, and then is swallowed
Hookworms
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Tx of parvovirus
selif-limited
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Tx of babesiosis
atovaquone plus azithromycin
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CXR in PCP PNA
diffuse or perihilar infiltrates
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Basic presentation of measles
abrupt onset of high fever in previously health with maculopapular rash on trunk and extremities that blanches
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rodent borne illness and cause of hemorrhagic fever and pulmonary syndrome
hantavirus
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