Infectious Disease

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Infectious Disease
2012-08-15 21:26:54

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  1. Acid fast bacilli
  2. Post apical rales
  3. Dx of Tb
    • M. tuberculosis culture on DNA/RNA (sputum and bronchoscophy washings)
    • Findings on xray
  4. TB findings on exray
    • hilar lymphadenopathy
    • segmental atelectasis
    • cavitations
    • Gohn complex
    • Reactivation-fibrocavitary apical disease
  5. 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
  6. 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
  7. Side effects of isoniazid
    Peripheral neuropathy, hepatitis, rash
  8. Side effects of rifampin
    Hepatitis, flu like sx, kidney failure
  9. Side effects of pyrazinimide
    Hepatotoxic, GI upset, rash, joint pain
  10. Side effects of ethambutol
    Optic neuritis (should assess visual acuity)
  11. Side effects of streptomycin
    Increasing resistance, nephrotoxic
  12. Dx of Lyme
    • EM or one late manifestation of the disease
    • IFA or ELISA preferred, if those are unclear, do Western blot
  13. Sx unique to RMSF and not lyme
    Restlessness and insomnia; rash on palms and soles
  14. Dx of RMSF
    IFA 7-10 days after onset, Abs after 2 weeks
  15. Tx of RMSF
    • Doxy 100
    • kids: Doxy
    • pregnant women: chloramphenicol
  16. Multinucleated cells on Tzanck smear
  17. 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
  18. HHV-3
    Chicken pox
  19. Dx of chix pox
    • Clinical
    • PCR with evidence of multinucleated cells
  20. Ramsay-Hunt syndrome
    External ear, vertigo, tinnitus, taste change
  21. HHV-4
  22. Tx of EBV
    • supportive
    • avoid contact sports
  23. EBV associated with what dz other than mono
    • African Burkitt's lymphoma
    • Nasopharyngeal carcinomas
  24. Pizza pie lesions on retina
  25. 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
  26. Tx of CMV retininitis
    Ganciclovir (IV or via implant)
  27. Tx of CMV
    • Ganciclovir
    • HAART
  28. HIV dx
    HIV Ab ELISA, if (+), then do Western Blot
  29. How long does it take for HIV Ab to seroconvert?
    <6 weeks
  30. 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
  31. Tx of toxoplasmosis in HIV
    • Bactrim DS QD or TIW
    • Only tx if CD4 < 100
  32. TX of PCP in HIV
    • only tx when CD4 < 200
    • Bactrim DS TIW; stop when CD4 is > 250 for 3-6 months
  33. Tx of M tuberculosis in HIV
    Isoniazid 300 mg PO QD with pyridoxine 50 mg QD x 9-12 months
  34. Tx of MAC in HIV
    • When CD4 lymphocytes <75-100
    • Azithromycin 1200 mg QIW
    • d/c if CD4 > 100
  35. Tx of CMV in HIV
    Don't prophylax b/c ganciclovir causes neutropenia
  36. Cause and spread of Mumps
    • paramyxovirus
    • respiratory droplets
  37. M/C cause of pancreatitis in kids
  38. Tx of mumps
  39. Cause of rubella
  40. 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
  41. Fine maculopapular rash that appears on face, trunk, and extremities and lasts no longer than a day in each arae
  42. Tender suboccipital adenitis
  43. Rubeola
  44. cause and spread of measles
    paramyxovirus, spread by respiratory droplets
  45. What are koplik spots?
    • patho for measles
    • tiny crystal salts seen on buccal mucosa
  46. tiny pinhead sized papules that coalesce to form brick red, irregular maculopapular rash; beginning first on the face, going to the trunk and extremities
  47. Measles tx
    • give MMR
    • isolate at onset of rash, bedrest until fever resolves
    • Tx sxmatic
    • Vit A for GI side effects
  48. Sixth's Disease
  49. Cause of roseola
    herpesvirus 6
  50. m/c cause of febrile seizures in babies
  51. High fever folloewd by maculopapular/macular rose or pink blanching rash
  52. Tx of roseola
  53. What is protective against malaria?
    SCA, G6PD, Hemoglobin C
  54. hallmark of malaria                         
    cyclical, recurring fevers and sx (occurs QOD or q3d)
  55. Dx of malaria
    Giemsa thick and thin smears of peripheral blood
  56. 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
  57. Bullet shaped RNA virus
  58. rabies tx: no previous immunization
    rabies immune globulin 0, 3, 7, 14, 28
  59. Massive PMN infiltration into large and small bowel
  60. diarrhea in salmonellosis
    bloody, lasts 3-5 days
  61. Tx of salmonellosis
    supportive if uncomplicated

    • with comorbiditis:
    • bactrim 1 tab BID x 5 days
    • cipro 750 mg BID x 5 days
  62. extensive ulceration of epithelial surface of colonic mucosa with an exudate
  63. Tx of Shigellosis
    • no tx required
    • Bactrim in severe cases can shorten illness and carrier state
  64. Hallmark of toxoplasmosis infection
    cell death and focal necrosis with an acute inflamatory response
  65. toxoplasmosis affect on fetus
    • multi organ failure and intrauterine death
    • can be nl at birth, but may develop brain/eye sequalae later
  66. Tx of toxoplasmosis
    • immunocompetent: nothing
    • Immunocompromised: bactrim
    • congenital: pyrimethamine and sulfadiaine for 1 year, may add prednisone and spiramycin
  67. Tx of ascariasis
    • albendazole or mebendazole
    • pregnancy: pyrantel pamoate
    • recheck stool q2w until clear
    • if obstructed, NG tube placement, IV fluids, possible surgery
  68. Intestinal hookworm tx
    • albendazole (off label0
    • mebendazole
    • pyrantel pamoate
    • high protein diet x 3 months
    • check stools for two weeks post tx
  69. enterobiasis
  70. nighttime perinanal pruritus
    enterobiasis (pinworms)
  71. pinworms tx
    • clear tape to perinala region in morning prior to bathroom and look for worms or eggs under microscope
    • melbendazole
    • albendazole
    • pyrantel pamoate
  72. Hallmark of acute rheumatic fever
    valvular damage (almost always mitral valve, possible atrial or tricuspid)
  73. Heart involvement in rheumatic fever
    • mitral regurge leading to stenosis
    • pericarditis
    • myocardial inflammation
    • chorea
    • polyarthritis
    • erythema marginatum
  74. 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
  75. Tx of acute rheumatic fever
    • ABX
    • salicylates and NSAIDs
    • CHF
    • chorea
  76. bacterial cause of acute rheumatic fever
  77. yeast like fungus
  78. Tx of cryptococcus
    • Pulm sx: fluconazole
    • Extrapulmonary: fluconazole, +/- ampho B
    • CNS: amB plus flucytosine
  79. Histoplasmosis CXR findings
    pneumonitis or mediastinal adenopathy
  80. 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
  81. 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
  82. 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
  83. Tetanus tx
    • ICU
    • Flagyl
    • Antitoxin
    • Supportive
  84. clinical presentation of botulism in infants
    constipation, weak cry, can't suck or swallow, hypotonia
  85. Botulism tx
    • admit to hospital and monitor for resp failure
    • equine antitoxin ASAP if foodborne
    • infants: supportive care, administer human immune globulin, parental nutrition
  86. Diptheria tx
    • Diptheria antitoxin
    • erythromycin or PCN to prevent transmission
  87. 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
  88. Tx of cholera
    • fluid/electrolyte replacement
    • Abx to shorten duration: single dose of tetracycline or doxy
  89. erythematous papule at site of inoculation that becomes vesicular with a purple to black center, which in turn ulcerates, becomes necrotic, and sloughs
  90. Anthrax tx
    cipro or another fluoro is Tx of choice, doxy is alternative
  91. Tx of pertussis
    • erythromycin
    • alternatives: azithromycin, clarithromycin, bactrim
  92. HPV virus causing genital warts
  93. HPV causing cervical ca
    16, 18, 35
  94. cause of influenza
  95. H5N1
    avian flu
  96. most pathogenic influenza
  97. Tx of flu
    • supportive
    • Ralenza or Tamiflu if given < 48 hours into sx
  98. soil contaminated with pigeon dung
  99. blanchable, pink, papular rash over the trunk and fever that increases in stepwise fashion
    typhoid fever
  100. Cause of dysentary
    entamoeba histolytica
  101. Tx of Legionnaire's pneumonia
  102. m/c transmission of cholera
    eating undercooked shellfish
  103. Tx of kaposi sarcoma
    intralesional vinblastine or by observing over time
  104. Dental prophylaxis in endocarditis if PCN allergy
  105. parakeet transmitted disease
  106. Tx of cat scratch dz
  107. bacteria in cat scratch dz
    bortonella henselae
  108. fever followed by a diffuse maculopapular rash that spares the face and resolves in about 2 days
    erythema subitum
  109. which antiretroviral will cause kidney stones?
  110. m/c sign of secondary syphilis
    generalized maculopapular rash
  111. hallmark of tertiary syphilis
  112. Worms that enter through soles of feet, travels to the lungs, to mouth, and then is swallowed
  113. Tx of parvovirus
  114. Tx of babesiosis
    atovaquone plus azithromycin
  115. CXR in PCP PNA
    diffuse or perihilar infiltrates
  116. Basic presentation of measles
    abrupt onset of high fever in previously health with maculopapular rash on trunk and extremities that blanches
  117. rodent borne illness and cause of hemorrhagic fever and pulmonary syndrome