infectious dz exam 2

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crazysupermedic
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infectious dz exam 2
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2014-02-21 11:50:25
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infectious dz exam 2
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  1. this mycotic dz borders the Mississippi and ohio rivers and outbreaks are caused by moist soil enriched with decaying vegetation
    blastomycosis
  2. when doing a cx for blastomycosis, at what temperatures will mold/yeast grow
    • mold at 77F
    • yeast 98.6F
  3. what is the treatment for blastomycosis
    • amphotericin B (life-threating infx &CNS infx)
    • itraconazole (sporanox)- mild- mod disseminated blastomycosis
    • fluconazole (diflucan )
  4. this mycotic dz is seen in Az, central cali, southern N. Mexico, and west texas, and in what 2 groups of ppl is this dz worse for
    coccidioidomycosis

    • Filipinos
    • pregnancy
  5. what are the tests and diagnostic Px for coccidioidomycosis
    • direct- smear, tissue
    • culture- biohazard and arthroconidia (77F-- hyphae, barrel shaped
  6. what is the tx for coccidiodomycosis
    • acute pulmonary- symptomatic only
    • other pulmonary and disseminated dx- severe-- amphotericin B, other-- fluconazole or itraconazole
    • Meningitis- life long fluconazole, IV amphotericin B
  7. this mycotic dz is known as the darling dz, it is associated with Starlings, bats, chickens and other birds
    histoplasmosis
  8. what are the tests and dx studies for histoplasmosis
    • direct- smears
    • culture- temp dependent dipmorphism
    • serology
  9. how is histoplasmosis tx
    • acute pulmonary- tx only if hypoxic or if lasts for > 1mo
    • other- (severe, life threatening)- amphotericin B- severe, itraconazole- mild to moderate
    • AIDS- life long suppression with itraconazole
  10. this mycotic dz is associated with pigeon dropping, and is usually uncommon in immunocompetent individuals
    cryptococcosis
  11. what is the most common manifestation of cryptococcosis
    meningitis
  12. what are the tests and diagnostic Px for cryptococcosis
    • direct/microscopic exam- smear, tissue
    • culture- urease producing yeast (bird seed agar)
    • serology- antigen testing (very useful in meningitis)
    • radiology- CT prior to LP
  13. what is the tx for cryptococcosis
    immunocompetent: pulmonary- fluconazole, CNS- amphotericin B

    Immunocompromised: same meds for conditions but life long therapy
  14. this mycotic dz can be found in DM females that don't take their meds correctly and that don't control their sugars. They tend to present to the clinic c/o white-curdish d/c from the vaginal area along with extreme pruritis. What is the dz
    candidiasis
  15. what is the most common form of candidiasis
    candida albicans
  16. if you have a young pt presenting to the clinical with a new onset of oral thrush, what must you always be thinking for a dx
    HIV
  17. how is candidiasis prescribed
    single dose fluconazole 150 mg po
  18. this is when candidiasis can be found in the moist skin folds such as, diaper rash, and how is it treated
    intertrigo

    Tx- nystatin and other powders are effective
  19. what are some superficial forms of candidiasis
    • tinea cruris- jock it
    • tinea pedis- athletes foot
    • tinea unguium (onychomycosis)
  20. what are the tests and diagnostic px for candidiasis
    • direct- observe lesions, smears- gram stain, KOH, tissue- gram stain, GMS, PAS
    • culture- yeast, germ-tube formation
  21. what do you treat a pt with systemic candidiasis with
    amphotericin B
  22. which diarrheal illnesses are bloody
    • campylobacter jejuni "pseudoappendicitis"
    • shigellosis- blood from get go
    • E. Coli 0157:H7- starts watery then turns grossly bloody
  23. which diarrheal illnesses are associated with a fever
    • campylobacter
    • typhoid
    • shigella
    • salmonella
  24. 1-5 days of watery diarrhea with prominent nausea and vomiting is known as what
    acute gastroenteritis
  25. when would you suspect that your pt has a viral AGE
    • vomiting is prominent
    • 14+ hr incubation
    • over in less than 3 days
    • no bacterial warning signs
    • no epidemiologic clues
  26. this virus causes diarrhea to be a more prolonged course than the rotavirus, and causes multiple viral illnesses (the cold)
    adenovirus
  27. this virus is the common cause of pediatric diarrhea, and has a possible association with intussusception
    calicivirus
  28. this virus is associated with cruise ship and raw oysters
    norovirus
  29. this is a common cause of AGE in children and infants and it may cause URIs
    rotavirus
  30. this virus causes diarrhea in the immunocompromised pts, possibly cause dysentery, and can benefit from antivirals (gancyclovir)
    cytomegalovirus
  31. this bacteria causes diarrhea with severe cramping, is misdiagnosed as appendicitis, and is associated with polyarticular arthritis
    Yersinia entercolitica
  32. this bacterial diarrhea is caused by a toxin in food and is known as the "I want to die" gastroenteritis
    staph aureus
  33. this bacterial diarrhea is caused from contaminated fried rice and has a systemic movement through the GI tract
    bacillus cereus
  34. this diarrhea causing bacteria is known for causing gas gangrene
    clostridium perfringens
  35. this organism is fecal-oral route and undercooked chicken accounts for most infx
    campylobacter (can also be found in unpasteurized milk)
  36. you have an ill appearing pt in the clinic that has RLQ tenderness, a fever of 104F, HA and myalgias. He is complaining that he has had 10+ watery bloody BM per day.. what organism are you thinking
    campylobacter
  37. what is the tx for campylobacter
    azithromycin
  38. you have a pt in the clinic c/o non-bloody loose stool with occasional watery diarrhea. states he was handling some reptiles at the local zoo and about 12-36 hrs later his diarrhea started. what is the organism
    salmonellosis
  39. how is salmonellosis dx and tx
    • culture- MacConkey agar
    • tx- cipro
  40. what type of fever has hallmark signs of invasion/multiplication in the liver, lymph nodes, spleen, or peyer patches of the ileum
    typhoid fever
  41. what are the features typhoid fever in the first week of inoculation
    • HA
    • malaise
    • rising remittent fever (103-104F)
  42. when do the rose spots of typhoid fever appear
    day 7-12
  43. this type of pulse is associated with typhoid fever
    dicrotic pulse (pulse marked by a double beat)
  44. what are the features of typhoid fever in the second week of inoculation
    • toxic appearing pt
    • apathetic manner
    • sustained pyrexia
    • slightly distended abd
    • splenomegaly
  45. what are the features of typhoid fever in the 3rd week of inoculation
    • increased toxicity
    • considerable weight loss
    • pyrexia
    • delirious state (typhoid state)
    • liquid, foul, green-yellow diarrhea (pea soup diarrhea)
    • Death may occur at this stage
  46. what are the features of typhoid fever in the 4th week of inoculation
    • the following sxs slowly resolve: fever, mental status change, abd distention
    • relapses occur at this stage (possible carrier state)
  47. what is the definitive dx for typhoid fever
    isolation of the organism (found in blood or marrow)
  48. what is the tx for typhoid fever
    • cipro
    • azithromycin if acquired in Asia
  49. what are the 2 mechanisms that cause bacillary dysentry
    • invasion of the colonic epithelium
    • production of enterotoxin
  50. a pt comes in c/o acute bloody diarrhea, fever, tenesmus and passage of mucous in his stools. You do a stool culture and he has positive findings and fecal leukocytes and erythrocytes. What is the offending organism
    shigellosis
  51. how is shigellosis tx and what type of medication should be avoided
    • self-limited
    • ciprofloxacin
    • avoid narcotic-related antidiarrheals
  52. a pt presents with abd cramping and frequent explosive bowel movements, and N/V. He states he just came back from a trip in Latin America. What is his dx
    travelers diarrhea
  53. how is travelers diarrhea (ETEC) treated
    loperamide with cipro
  54. a pt c/o that he has been having bloody diarrhea since he has eaten at a BBQ yesterday. He stated that at first it was just frequent watery stools but not he is noticing it is more bloody. What is his dx
    E. Coli O157:H7 (EHEC)
  55. how is EHEC dx
    stool culture
  56. what is the treatment of EHEC
    • NO ANBX
    • NO Anti-diarrheals
    • tx with dialysis PRN
  57. this type of diarrhea can cause death within hours of infx, pt c/o that their stool kind of has a fishy smell to it and it looks like rice water.
    cholera
  58. what it the tx of cholera
    • supportive (Fluid replacement)
    • anbx (doxy or azithromycin)
  59. this organism can cause diarrhea by ingesting dairy and raw fruit and vegetables (also cheese and hotdogs)
    listeria monocytogenes
  60. what are the diagnostic tests for listeria
    • blood cultures (+60-75% of pts with CNS infx)
    • CSF culture (+ in nearly 100% of pts)
    • wet mounts (listeria organisms are motile)
  61. what is the tx for listeria
    • ampicillin
    • trimethoprim-sulfamethoxazole (septra)
  62. there are 4 serotypes for Dengue fever: DEN-1, DEN-2, DEN-3, DEN-4, what is the most virulent
    DEN-2
  63. how is Dengue transmitted
    mosquito-- day time biting mosquito
  64. a pt comes in after their vacation from the florida keys, they are c/o a very high fever of 105.8, HA, retro-orbital pn and has a truncal scarlatinaform rash. What do you think is his dx
    dengue fever
  65. what is the dengue fever triad
    • HA
    • fever
    • rash
  66. this fever is associated with saddleback fever (fever abates for a day but then comes back)
    dengue fever
  67. what is the most common physical finding in a pt with dengue hemorrhagic fever
    petechiae and bleeding at venipuncture site
  68. what lab/diagnostic procedure can you do to see if a pt is positive for dengue fever
    tourniquet test: inflate a BP cuff on the upper arm, midway between diastolic and systolic, hold for 5 minutes.. will be positive is there are 20 petechiae per square inch
  69. what is the most common metabolic change seen in dengue fever
    hyponatremia
  70. which WHO classification of DHF has a fever accompanied by nonspecific constitutional sxs, with a positive tourniquet test or scattered petechiae as the only hemorrhagic manifestations
    Grade 1
  71. which WHO classification of DHF has a fever accompanied by nonspecific constitutional sxs, with a positive tourniquet test or scattered petechiae with spontaneous hemorrhagic manifestations
    grade II
  72. which WHO classification of DHF has circulatory failure manifested by rapid, weak pulse, narrowing of pulse pressure (20mmHg or less), or HoTN
    grade III
  73. which WHO classification for DHF is associated with profound shock with undetectable pulse and BP
    grade IV
  74. a drop in Hct of ____ is significant hemorrhage in dengue fever
    10%
  75. a pts is brought to the ER by EMS, they state the pt is in a state of delirium and that on their way to the ER she vomited bilious black substance twice. Family members tell you that she recently returned from Brazil and had been complaining of severe flu-like illness that resolved. On PE you notice she is jaundice, has diffuse petechiae, mild epistaxis, and the beginning stages of anasarca. what do you think she has
    yellow fever
  76. what labs/diagnostic px do you want to do for yellow fever
    • CBC (leukopenia/thrombocytopenia)
    • coag studies
    • chemistries
    • LFTs
    • ECG and cardiac monitoring
  77. what is the tx for yellow fever
    • supportive therapy is critical
    • if active bleed give fresh frozen plasma
    • isolate pts
  78. a pt is brought to your clinic in the democratic republic of congo, he is c/o severe HA with a fever, all over muscle aches, distal numbness, and anorexia. He develops mild dysphagia and hiccups while waiting to be seen. You draw his labs and notice thrombocytopenia, leukopenia, and pronounced lymphopenia. What is your suspected dx
    Ebola
  79. which hemorrhagic fever is associated with expressionless Hippocratic "ghost-like" facies
    ebola/marbug
  80. what is the tx for ebola
    • no specific therapy
    • supportive
    • ribavarin
    • human convalescent plasma
    • interferon alpha 2-b
  81. a pt presents to the clinic while in Nigeria, she is pregnant and in her 3rd trimester and is c/o retro-sternal pn. she states she is living in an area that is surrounded rodents. Upon exam you are unable to detect a fetal heart tone. what is your suspected dx
    Lassa
  82. what is the most common sequela of lassa
    deafness
  83. this hemorrhagic fever is associated with swollen baby syndrome
    Lassa
  84. what is the tx for lassa
    ribavirin (best if started within the first 6 days of illness)
  85. you are stationed in Korea and a AD SM comes in c/o HA, chills, abd cramping and fatigue. You ask about his recreational activities and he said he has started collecting local wildlife, esp rodents, to feed his cat. On PE you see that he has some subconjunctival hemorrhage and petechiae on the soft palate. you did notice his pulse was low at 46 so you have him to some flutter kicks to raise his HR, after which you notice there was no change to the HR. His labs reveal proteinuria, elevated Hct and thrombocytopenia. What is your proposed dx
    Hemorrhagic fever with renal failure syndrome (Korean hemorrhagic fever AKA hanta virus)
  86. what is the triad for Korean Hemorrhagic fever
    • fever
    • hemorrhage
    • renal insufficiency
  87. which stage of Korean Hemorrhagic is where most pts die
    oliguric stage
  88. what is the tx for Korean Hemorrhagic fever
    • fluid and electrolyte replacement
    • supportive care
    • ribavarin
  89. you are in central Africa and a pt is brought in to you to be examined. You note he has significant extremity ecchymosis, flushing of the head and chest, and looks toxic. You had blood drawn for samples and you notice that he continues to ooze blood from the phlebotomy site 45 minutes after the stick. What is your proposed dx
    Crimean congo hemorrhagic fever
  90. what transmits Crimean congo
    hard ticks
  91. what is the tx for Crimean congo hemorrhagic fever
    ribavarin
  92. a pt is brought to the clinic c/o spitting out bloody, rust-colored mucus. He also states he has been having night sweats and unpredictable febrile periods. On hx you find out that he is an immigrant from India. what is your proposed dx
    TB
  93. what will a CXR show if a pt has miliary TB
    snow storm appearance or millet seed appearance
  94. what is the tx for active TB
    4 drugs: INH, pyrazinamide, rifampin, ethambutol/streptomycin

    * can stop ethambutol/streptomycin if fully susceptible
  95. which mask is worn if you are the one to give an active TB pt meds
    N-95 particulate respirator
  96. how long after the PPD injection is given should it be read
    48-72 hrs
  97. what is considered a positive PPD for pts that live in close contact with newly dx TB, HIV positive, organ transplant pts, long term steroid use, or have fibrotic lesions on CXR
    larger than or equal to 5mm
  98. what is considered a positive PPD for people in the military, IV drug users (known to be HIV neg), recent converters, children less than 4 years with adult TX exposure, and residents and employees of high risk facilities
    larger than or equal to 10mm
  99. how is LTB tx
    INH 300mg po x 9 mo
  100. which TB medication is associated with hepatocellular dz, peripheral neuropathy, and interacts with phenytoin
    INH
  101. which TB med is associated with thrombocytopenia, accelerated clearance of drugs, and decreased effectiveness of OCPs
    rifampin
  102. which TB med is associated with visual acuity change
    ethambutol
  103. this dz is a rapidly spreading infx of the deep tissue, looks like severe cellulitis, and the skin opens with gentle pressure or light cut
    necrotizing fasciitis
  104. what is the treatment for necrotizing fasciitis
    • PEN G
    • doripenem
    • vanc
    • extensive debridement

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