IM: Test 3

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BrookeNH10
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227890
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IM: Test 3
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2013-07-23 00:53:23
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  1. Most common vector borne illness in US?
    Transmitted by?
    Ixodes ticks (ticks must be in place around 24 hours to transmit spirochetes)
  2. Lyme Disease Diagnosis
    ELISA, confirmed by Western Blot

    -Serology may be negative in early disease
  3. Lyme Disease Tx:
    EM, isolated CN palsies, 1st and 2nd degree AV block
    Doxycyclin PO
  4. Lyme Disease Tx:
    Meningitis, High degree AV block
    IV ceftriaxone 2g x 2-3 wks
  5. Lyme Disease Tx:
    Chronic arthirtis
    • PO therapy 1-2 wks
    • IV regiments 2-4 wks
    • Must use IV if neurologic disease w/ arthritis
  6. Lyme Disease Tx:
    Pregnant
    Amoxil
  7. Lyme Disease Tx: 
    Pregnant and PCN allergic
    Cefuroxime or erythromycin
  8. Tick Bite Prophylaxis:  Engorged tick resembling Ixodes sp, exposure to endemic areas, tick in place >48 hrs
    Give doxycycline 200 mg x 1 dose
  9. Best method for preventing lyme disease
    Avoid vector exposure
  10. Post- Lyme Disease Syndrome
    • Sx's like Fibromyalgia and Chronic fatigue syndrome
    • Nonspecific complaints (headache, fatigue, arthralgias)

    What do you do?  Do no retreat pt tha thas been correctly treated
  11. HME (Human Monocytic Ehrlichosis)

    Transmitted by?
    Lonestar Tick
  12. Anaplasmosis (formerly HGE) transmitted by
    Ixodes tick
  13. Lab findings in ehrlichiosis and anaplasmosis
    Leukopenia, thrombocytopenia, elevated transaminases
  14. Diagnostic test for Ehrlichiosis and Anaplasmosis
    Serum Ab titers, blood smear (morulae)
  15. Ehrlichiosis/Anaplasmosis Tx:
    Doxycycine 100 BID x 7-10 days
  16. Babesiosis:
    Transmitted by?
    Ixodes tick
  17. Babesiosis:
    Symptoms
    Fever, chills, NS, myalgias of gradual onset

    Can be severe in splenectomized pt
  18. Diagnostic test for babesiosis?
    Periopheral blood smear
  19. Babesios Tx?
    Quinine
  20. Babesiosis Tx:
    • Clindamycin/quinine x 7 days
    • Atovaquone/azythromcin x 7 days
    • Exchange tarnsfusions for severely ill pt
  21. Ixodes ticks transmit:
    Lyme Disease
    Anaplasmosis
    Babesiosis
    • Doxy, IV Ceftriaxone
    • Doxy
    • Quinine/ Clindamycin
  22. Ring form in RBC
    Babesiosis
  23. Morula in WBC
    Ehrlichiosis/Anaplasmosis
  24. Leptospirosis tx:
    Doxy or PCN
  25. Severe form of Leptospirosis
    Weil Syndrome- renal and hepatic failure, pulmonary infiltrates, hypotension

    Tx- PCN
  26. Tularemia (Ulceroglandular, associated w/ draining lymph nodes)
    Tx:  Streptomycin
  27. Anthrax Tx?
    Cipro or doxy
  28. Bioterrorism:  CXR= lobar pneumonia
    Tularemia
  29. Bioterrorism:  CXR= hilar/mediastinal
    Anthrax
  30. Bioterrorism:  Gram neg coccobacillia, alveolar pneumonia
    Yersinia pestis
  31. Similar to chicken pox, but all lesions same stage (papular)
    Small pox/vaccinia
  32. Positive PPD (TST):  >5 mm positive for
    • HIV+
    • Immunosuppressed
    • Recent contact of active case
    • CXR w/ old TB
  33. Positive PPD:  >10 mm
    HCW, substance abusers
  34. Positive PPD: >15 mm
    No risk factors
  35. Tx:  Latent TB infxn
    9 months INH
  36. Tx:  Active TB
    RIPE
  37. Endocarditis Tx
    Blood culture first then antibiotics

    (TEE better than TTE)
  38. Endocarditis:  Indications for surgery (6)
    • CHF
    • Valvular abscess
    • Exxtension of infxn (3o Heart Block)
    • Embolic events
    • Fungal endocarditis
    • Not responding or rx to tx
  39. Painless genital ulcer
    Syphilis
  40. Painful, multiple
    HSV2
  41. Single large painful
    • Chancroid
    • H. ducreyi (gram neg. coccobacilli- school of fish on CX)
  42. H ducreyi ulcer: Tx
    • Ceftriaxone
    • Azithromycin
  43. Painless, Donovan bodies on Bx
    Tx 3 wks of bactrim or doxy or azithro

    Klebsiella granuloma
  44. Urethritis or cervicitis: Tx
    Ceftriaxone plus doxy
  45. Bacterial vaginosis: KOH + fishy odor

    Tx?
    Flagyl x7 days
  46. Trichomonas: Tx
    Flagyl x1, tx partner
  47. PCP: Tx
    • TMP/SMX
    • Steroids when PaO2 <70 or A-a gradient >35
    • Bronchoscopy for definitive diagnosis
  48. Cryptococcal meningitis
    Amp B + Flucytosine

    Followed by diflucan
  49. Toxoplasmosis
    Treat empirically for 2 wks w/ pyrimethamine _ sulfadiazene _ folinic acid, if it doesn't resolve, biopsy it...likely CNS lymphoma
  50. HIV:  mass effect
    CNS lymphoma
  51. HIV: White matter changes
    PML
  52. HCW with HIV + needle sick
    PPX w/ 3 active HAART
  53. When to start HAART
    • Any detectable viral load
    • HIV+ pregant female (no efavirez)
    • HIVAN (HIV associated nephropathy)
    • Coinfection w/ Hep B
  54. HIV pt w/ central line loses vision in one eye
    Candidal endophthalmitis
  55. Sea water exposure, comma shape rods on gram stain
    Vibrio vulnificus

    tx. doxycycline
  56. Sore throat + ampicillin= rash
    Mononucleosis
  57. Influenza ppx
    Oselatmivir
  58. Bacterial meningitis tx
    Vanc, rocephin +/-amp
  59. Aseptic encephalitis w/ temporal lobe abnormalities on imaging - Check CNS for HSV PCR
    Start acyclovir empirically
  60. Fishtank granuloma
    Mycobacterium marinum

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