ID exam 3

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ID exam 3
2014-03-19 15:29:49
ID exam

ID exam 3
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  1. what is the most common cause of all cestode infx worldwide
    hymenolepis nana
  2. what is the most common parasitic infestation of the CNS
  3. what is the most common presentation of diphyllobothriasis

    ** has numbness of extremities and pruritus ani for weird sxs
  4. what is the most common paragonimus that affects humans
    P westermani
  5. what is the most common helminth in the world
  6. what is the most common helminth in the US
    pinworm (enterobius vermicularis)
  7. what is the most common symptom of hookworm
    iron def anemia
  8. what is the most common method for making the dx of ascariasis
    microscopic identification of eggs in the stool
  9. what is the most common topically acquired dermatosis
    cutaneous larva migrans
  10. what is the most common parasite identified in stool specimens
    g. lamblia
  11. what is the most commonly used lab for leishmaniasis
    giemsa-stained slides
  12. where are the 2 most common places that Malaria is imported from
    • sub-Saharan africa
    • india (TB and malaria)
  13. what is the most common cause of chronic adenopathy in children
    cat scratch dz
  14. what is the most common symptom of cat scratch dz
    regional adenopathy (proximal to bite area)
  15. what is the most common manifestation of toxoplasmosis in an AIDS pt
    toxoplasmic encephalitis
  16. what is the most common presentation of congenital toxoplasmosis
  17. what is the most common zoonosis in the world
  18. what is the most common physical finding of encephalitis
    AMS and/or personality changes
  19. what is the most common cause of encephalitis in Western countriees
  20. what is the MC causes of meningitis in neonates
    • GBS
    • E coli
    • listeria
  21. what is the most common cause of bacterial meningitis in the US in most age groups
    strep pneumo
  22. which joint is most commonly affected for infections of the joint
  23. what is the MC cause of septic bursitis
  24. what areas are MC affected with septic bursitis
    • olecranon
    • prepatellar
  25. what is the MC etiology of osteomyelitis
  26. what is the triad for encephalitis
    • nuchal rigidity
    • HA
    • photophobia
  27. what is the triad for meningitis
    • fever
    • nuchal rigidity
    • MS changes
  28. an 8 y/o male presents to the clinic c/o restless sleep, anal pruritis, and nasal pruritis. His mom states that he was at a summer camp for the past 2 months. You draw his labs and notice eosinophilia. What is your suspected dx
  29. a 29 y/o female presents to the clinic c/o weight loss, malaise, and has noticed some subcutaneous nodules. She just returned from an 8 mo deployment from Africa where she ate local foods. what is your dx
  30. what is the most striking feature of T saginata
    passage of proglottids
  31. what are the labs to dx taeniasis
    • stool samples
    • cellophane tape swab
    • CBC (eosinophila)
    • Ab detection (useful in early invasive stages)
  32. a 21 y/o male presents to the ED c/o worsening chronic HA, double vision, and taste changes. He recently has returned from Korea. While waiting to be seen, he has a grand mal seizure. What is your possible dx
  33. what will you find on PE with cysticercosis
    • no fever
    • nonfocal neurologic findings
    • papilledema
    • meningismus
    • hyperreflexia
    • nystagmus or visual deficits
    • intraocular larvae
    • subcutaneous larvae
    • muscular pseudohypertrophy
  34. which diagnostic study should be ordered to help confirm the dx of cysticercosis
    CT (contrast and non-contrast)
  35. what can be used to tx ICP in a pt with cysticercosis
    • steroids
    • osmotic agents (dannitol)
    • diuretics
  36. a 45 y/o male presents to the clinic c/o fatigue, diarrhea, and numbness of his extremities. He is a recent immigrant from Russia and states he really liked to eat sushi. On PE you notice that he is pallor, has mild glossitis, hypesthesias, paresthesias, and disturbances of movement and coordination. His labs come back showing megaloblastic anemia. What is your suspected dx
    diphyllobothriasis (D. latum)
  37. how is diphyllobothriasis (D.latum) transmitted
    consumption of raw/undercooked freshwater fish
  38. when does eosinophilia occur with helminthic infx
    during the migrating phase
  39. a 37 y/o male reports to the clinic c/o abd pn and diarrhea x 2 moths. He states he recently has returned from a trip to South America where he spent most of his time either swimming or wading in local creeks and water and handled a lot of snails. He also states that he occasionally has bloody diarrhea. what is his suspected dx
    S. Mansoni
  40. which schistosomiasis is located just in Africa and Middle east
    S. haematobium
  41. which schistosomiasis is located in the far east
    S. japonicum
  42. which schistosomiasis is located in Africa, middle east and S. America/caribbean
    S. mansoni
  43. which schistosomiasis is excreted in the feces
    • S. japonicum
    • S. Mansoni
  44. which schistosomiasis is excreted in the urine
    S. haematobium
  45. how is schistosomiasis transmitted
  46. when trying to see if the pt has S haematobium, what times of days should the pt give a urine sample
    between noon and 3pm
  47. this is caused by consuming raw watercress from where sheep and cattle are raised
    fasciola hepatica (sheep liver fluke)
  48. what is the tx for fascioliasis
  49. a 56 y/o female reports to the clinic c/o mod-severe productive cough and constant malaise. She states that her sputum is blood tinged and remarkably foul. She also reports having all over urticarial. on PE you note RUL wheezing and her CXr show nodular, non-calcified infiltrates. What is your suspected dx
    Lung fluke (paragonimiasis)
  50. how is paragonimiasis transmitted
    inadequately cooked/pickled crab or crayfish
  51. how is paragonimiasis dx
    demonstration of eggs in stool or sputum
  52. how is strongyloidiasis transmitted
    larvae in soil penetrate bare feet
  53. how is strongyloidiasis dx
    microscopic identification of larvae (stool or duodenal fluid)
  54. what test is recommended in the dx as strongyloidiasis
  55. how is hookworm transmitted
    larbae in soil penetrates bare feet
  56. a pt comes in c/o a ground itch at what looks like a site of penetration from where he has been outside walking in his barefeet all summer. He is showing signs of pneumonitis, intestinal upset and pica. But he is really concerned bc he has just been sooooo tired lately. what is your suspected dx
  57. a pt comes to the clinic c/o hemoptysis and dyspnea. You think she also may have Loeffler's syndrome. What is your suspected dx
  58. this is found frequently in school- or preschool- children. Most children complain about pruritus ani esp at night. what is your suspected dx
    enterobius vermicularis (human pinworm)
  59. when should parent be told to do the scotch tape test when trying to collect enterobius vermicularis eggs
    she needs to put the tape on the perianal area first thing in the morning before the child defects or bathes
  60. a 14 y/o male c/o a rash on his left foot that has worsened over the past 3 weeks. He states he just got back from Alabama where he spent his summer vacation. When asked about shoe wear while on vaca he said "oh hell no I don't wear shoes!!" on PE you note serpiginous, slightly elevated, erythematous tunnels on the dorsal aspect of his foot.. What is your suspected dx
    cutaneous larva migrans
  61. this form of toxocariasis is often misdiagnosed as retinoblastomas
    ocular larva migrans
  62. people can get this by eating infected meat of carnivores
  63. A pt presents to the clinic c/o periorbital and facial edema that started out of conjunctivitis. On PE you notice he has splinter hemorrhages on his nails. You ask him about his diet and he states "I am a meat only kinda guy!" what is your suspected dx
    trichinellosis (during the larval migration)
  64. how can trichinellosis be dx
    • clinically
    • eosinophilia during migratory phase
    • EIA
    • muscle bx
  65. what are the s/s and considerations of amebiasis
    • amebic colitis
    • fulminant colitis
    • rectovaginal fistulas
    • fulminant or necrotizing colitis
    • amebic liver abscess
    • single abscess
    • possible hx of dysentery within the past year
  66. if you do a CT scan on a pt with abd pn and you see a rounded- low attenuation lesion with an enhancing rim. What is your suspected dx
  67. what has a high cure rate and shorter tx course for amebiasis
  68. a 7 y/o male is brought into the clinic with a mom c/o him having excessive flatulence and malodorous stools. She also states that his has had difficulty sleeping and is unusually irritable throughout the day, and has lost considerable weight over the past 2 months. His stool shows trophozoites or cysts that is consistent with which protozoal infx
  69. G.lamblia has high incidence with which groups of ppl
    • campers/backpackers in western states
    • southern states
    • children in daycare/institutional settings
  70. how is giardiasis transmitted
    fecal oral through contaminated water ingestion
  71. what is the TOC for giardiasis
    IFA or ELISA (stool antigen detection assays)
  72. what is the tx for giardiasis
    • tindamax
    • metronidazole
  73. a 26 y/o male reports to the clinic c/o of non-healing sore on his posterior calf. You ask about travel hx and he says he just got back from Iraq. on PE you notice a sore that has raised edges and a central crater that looks like its about to scab. What is your suspected dx
  74. what transmits leishmaniasis
  75. what factors determine the form of leishmaniasis
    • leishmanial species
    • geographic location
    • immune response of host
  76. which form of leishmaniasis has recurrent high fevers, weight loss, and is assoc with post kala-azar dermal leishmaniasis, and pancytopenia is common
  77. what is characteristic of visceral leishmaniasis
    darkening of the skin (lasts why they call it black water fever)
  78. how can leishmaniasis be tx
    • liposomal amphotericin B
    • fluconazole (cutaneous form)
    • thermomed radio frequency heat
  79. a 16 y/o females presents to your clinic with a c/o watery, non-bloody stools. You ask her what her job is and she says she is a lifeguard at the local lake resort. On PE she has a pos murphy's sign. What is your suspected dx
  80. this is found in contaminated water or recreational water parks
  81. this infection is limited to the jejunum in healthy individuals
  82. a 21 y/o female presents to the clinic c/o fever, chills, and marked malaise x 3 d. She states she just returned from hiking the Appalachian trail for 3 months. PE shows mild jaundice and splenomegaly and her labs show hyperbilirubinemia. what is your suspected dx
  83. how is babesiosis transmitted
    tick vector
  84. what is a big concern about pregnancy and babesiosis
    it may be transmitted in utero
  85. what will you see on a thin blood smear when testing for babesiosis
    maltese cross is classic
  86. what serology is diagnostic for babesiosis
    IgM IFA titer of 1:64
  87. what is the preferred regimen for severe babesiosis
    clindamycin + quinine
  88. what climate is best for malaria carrying mosquitos
    need warmth >77F
  89. which type of malaria is most widespread
    P vivax
  90. which type of malaria is primarily found in the tropics/subtropics
    P falciparum
  91. which type of malaria is primarily found in tropical west africa
    P ovale
  92. which forms of malaria have a hypnozoite form
    P vivax and P ovale
  93. a 23 y/o male reports to the clinic c/o feeling really tired, having a fever that comes and goes, and has mild-mod nausea. He recently has returned from the middle east and sub-Saharan Africa. What is your suspected dx
    malaria (plasmodium)
  94. which forms of malaria can relapse after longer periods of time
    P vivax and P ovale
  95. which type of malaria has a potential for a prolonged erythrocytic infx
    P malariae
  96. which forms of malaria have 48hr fevers
    • P falciparum
    • P vivax
    • P ovale
  97. which forms of malaria have 72hr fevers
    P malariae
  98. if a person has severe malaria, what is the most likely plasmodium species
    P falciparum
  99. why is P falciparum so bad
    • microvascular sequestration/dz
    • it targets all RBCs (the other forms target reticulocytes)
    • causes severe anemia
  100. which form of malaria can cause nephrotic syndrome
    chronic P malariae
  101. which malaria forms can cause splenic rupture
    vivax and ovale
  102. when should you do thick and thin smears for malaria
    soon after a fever spike has the highest yield
  103. which smear is used to see which malaria species is causing the infx
    thin smears
  104. which rapid test is FDA approved for malaria
  105. what are some of the reasons why people don't take their malaria prophylaxis
    • GI side effects
    • forgetfulness
    • low perception of risk (it wont happen to me)
  106. what is the terminal prophylaxis for malaria and what must you do prior to administering it to pts
    • primaquine phosphate
    • need to check G-6-PD status
  107. how is P falciparum treated
    • Quinidine gluconate IV plus one of the following:
    • Doxy
    • tetracycline
    • clindamycin
  108. how is treatment for malaria monitored
    thick and thin blood smears q 6-12hrs until parasitemia falls below 1%
  109. which form of malaria is associated with recrudescence
    P falciparum
  110. which form of malaria is most frequently associated with re-infection
    P falciparum
  111. what is one of the top precipitating factors of a sickle cell crisis
  112. what is the most common location for animal bites
  113. how are animal bites tx
    • copious irrigation of the wound
    • tetanus prophylaxis
    • consider rabies prophylaxis
  114. what is the DOC for dog/cat bites
    amoxicillin-clavulanate (augmentin)
  115. wounds from an animal bite can be closed by primary closure if on what part of the body
    facial wounds
  116. how are wounds on the hands or LE closed
    the are left open (more prone to infx)
  117. a mom brings her 6 y/o daughter into the clinic c/o a rash on her right arm. The daughter tells you that they have a new kitten and plays with it all the time. On PE you notice 3 small red papules on the anterior aspect of her R arm and she also has moderate axillary lymphadenopathy. What is your suspected dx
    cat scratch dz
  118. what is the vector that causes cat scratch dz
    bartonella henselae
  119. this syndrome is associated with cat scratch dz, its site of inoculation is the eyelid or conjunctiva. It is caused by the cat licking, scratching, or biting the person. The pt develops nonpurulent conjunctivitis, ocular granuloma, preauricular adenopathy
    parinaud oculoglandular syndrome
  120. what are some s/s of CNS (encephalitis) cat scratch dz
    • seizures
    • myelitis
    • peripheral neuropathy
    • retinitis
    • bells palsy
    • extremity weakness
  121. a 26 y/o female is c/o mild fatigue and fever that just wont go away. She is also c/o mild neck tenderness with pharyngitis. Pt also states she has 5 cats and has been recently been told she was pregnant. PE notes mild cervical lymphadenopathy and tonsillar erythema. What is your suspected dx
  122. how is toxoplasmosis transmitted
    from the feces of acutely infected cats
  123. what is the MC space occupying lesion in an AIDS pt
  124. how is chorioretinitis, fetal, and congenital toxo treated
    pyrimethamine + sulfadiazine + leucovorin
  125. how is toxo tx if its an acute dz in pregnancy
  126. how is cerebral toxo (acute) in AIDS pts tx
    pyrimethamine + sulfadiazine + leucovorin
  127. what is the primary prophylaxis for toxo in AIDS pts
    trimethoprim-sulfamethoxazole (Bactrum/Septra)
  128. a 56 y/o male reports to the clinic c/o a non-healing wound on his L hand. He said it started as a little bump but has gotten worse over the past 2 months. You asked about his hobbies and he states he is an avid aquarium hobbyist who works on tanks and collects fish off a local reef. On PE you note a heavily demarcated nodule with central ulceration on the posterior aspect of his L hand. What is your suspected dx
    fish tank granuloma
  129. what is the causative agent of fish tank granuloma
    mycobacterium marinum
  130. mycobacterium marinum grows best at what temp
    77-89.6F (25-32C)
  131. an 18 y/o reports to the clinic c/o fatigue, malaise, and leg pn that has gotten worse over the past 3 days. he said the onset was abrupt and that he just returned from a trip to Hawaii where he was hiking in the rainforest. He states he also swam in the rivers and streams. What is you suspected dx
  132. how is lepto transmitted
    direct contact with the body fluid of acutely infected animal. Can be from soil or fresh water
  133. what are the 2 recognizable clinical syndromes of lepto
    • anicteric lepto (self limited, mild flu like illness)
    • icteric lepto (severe illness, organ failure)- WEIL DZ
  134. what are the classic signs of icteric lepto
    calf and lumbar areas
  135. how is lepto confirmed
    isolation of the leptospires (gold standard)
  136. how is a severe infx of lepto tx
    PEN G
  137. what is the outpt tx for lepto
  138. if a pt has a prosthetic joint and it becomes infected, which organisms may be involved
    • MRSA
    • S. pyogenes
  139. which organism is associated with a cat bite
  140. what are the causes of osteomyelitis
    • trauma to periosteum
    • contiguous spread
    • hematogenous seeding of the bone
  141. when must a bx be done for osteomyelitis
    must be done 48hrs before starting or after stopping abx
  142. what are the 3 groups that fall under rickettsial dz
    • spotted fever grp
    • typhus grp
    • other rickettsial dz
  143. how are rickettsial dz's tx
    • doxy (not in children <8)
    • chloramphenicol
  144. how is Louse Borne Typhus transmitted
    by lice (pediculus humanus)
  145. a 28 y/o female reports to the c/o a rash that is located on her trunk and extremities but spares her face, palms, and soles. She also states that she has been running a fever and has a headache that wont go away (intractable HA). She said she recently has returned from a deployment in Nigeria where she stayed in an overcrowded village. On PE you observe some macules that are starting to turn into maculopapules and you also notice that there is some petechiae. What is your suspected dx
    louse borne typhus
  146. which rickettsial dz is assoc with fatal cardiac and renal failure
    louse borne typhus
  147. this dz is known due to the relapsing of louse-born typhus, it is associated with a fever, transient rash, and falling BP
    Brill-Zinsser dz
  148. in Brill-Zinsser dz, where is the organism located within the pts body
    spinal marrow
  149. this rickettsial dz is flea-borne and is transmitted rat to rat by a rat flea.
    murine typhus
  150. this rickettsial dz is transmitted by ticks (wood ticks and dog ticks). There is cardiac involvement, atelectasis, retinal dz, and may have enlargement of the liver and spleen
  151. what are the cardinal signs of RSMF
    • fever: (104-105.8-- persistent)
    • HA: (persistent, intense, intractable)
    • rash: (on wrists and ankles, palms and soles and spreads to extremities and trunk)
    • confusion: meningoencephalitis and coma
    • myalgia: manifests as thigh or calf tenderness
  152. this is caused by coxiella burnetii, you will see macrophages in the lungs and vegetations of the heart valves and there will NOT be a rash
    Q fever
  153. this dz is common in slaughter houses and livestock handling plants
    Q fever
  154. a 28 y/o male presents to your clinic c/o feeling totally out of it for the past 2 weeks. He also notes R knee pn not assoc with any trauma. His hobbies include hunting and camping in the Northeast. On questioning he said he did notice a strange rash on the posterior aspect of his R arm 2 mo prior to this visit but has since went away. What is your suspect dx
    lyme dz
  155. what are the 3 stages of lyme dz
    • localized
    • disseminated
    • persistent
  156. what is the name that is associated with lyme dz
    erythema migrans
  157. when does erythema migrans usually present itself
    usually 7-14 days after a tick bite
  158. what effects can lyme dz have on a heart and cranioneuropathy
    • carditis (usually manifests as heart block)
    • CN VII and Bell's palsy
  159. what is the hallmark of late lyme dz
  160. what is the most common joint that is affected by lyme dz
  161. how is lyme dz tx
    • doxy
    • if pregnant give amox
  162. what is the 2 step testing for lyme dz
    • EIA/IFA
    • confirmed with Western Blot
  163. most human rabies is caused by bites from what animal
    bat rabies
  164. what is the #1 domestic animal terrestrial rabies reported in the US
  165. what is the worldwide/international vector for rabies
  166. what is the genus of rabies
  167. what are the factors concerning rabies manifestation
    • quantity of virus in saliva
    • species of biting animal
    • site of bite
    • antirabies tx
  168. what is pathognomonic about the prodromal period in rabies
    paresthesia or pn, maybe a pinprickly or itchy feel at the inoculation site
  169. which type of rabies is associated with sxs of agitation, restlessness, biting, hallucinations, hyperactivity, thrashing or confusion
    furious rabies
  170. which type of rabies is associated with a relatively quiet pt, and paralysis occurs from the outset (not sure if it should say onset??)
    paralytic rabies
  171. what is pathognomonic during the neurologic period of rabies
    hydrophobia and aerophobia
  172. what is the most reliable test for rabies and when should it be done
    • nuchal skin biopsy
    • during the 1st week
  173. what is pathognomonic for rabies on a nuchal skin bx
    eosinophilic cytoplasmic inclusions (negri bodies)
  174. how is rabies tx
    • passive and active immunizations
    • IMMEDIATE VIGOROUS WOUND CLEANSING (solution of 1 part soap and 4 parts water)
  175. if you have ppl that may have a pre-exposure to rabies (civil affair workers, workers in 3rd world countries, vets), how are they tx
    • primary immunization: 1mL IM deltoid on days 0,7, and 21 or 28
    • booster immunization: 1mL IM deltoid
  176. what is the postexposure tx for rabies
    • NO prior vaccine with HDCV/PCEC: 1mL IM deltoid on days 0,3,7, and 14
    • if they have prior vaccines: 1mL IM deltoid on days 0 and 3
  177. how is the passive immunization for rabies given
    • most or all of the solution is infiltrated around the wound
    • the remaining solution should be administered IM in the gluteus away from the bite area
  178. what imaging should be done for encephalitis
    head CT (with and without contrast)
  179. which lab is essential for the dx of encephalitis
    CSF analysis
  180. how is HSE spread
    through the olfactory tracts
  181. what are the s/s of HSV-1/HSV-2 encephalitis
    • psych sxs
    • anterior opercular syndrome (loose control of facial movements, tongue and pharynx)
    • HSV-1- brainstem encephalitis
    • HSV-2- encephalitis may produce a myelitis
    • global aphasia
  182. how is HSE tx
  183. how is encephalitis transmitted
    • mosquito
    • tick (rare-- only in eastern Europe)
  184. what is the source of infection for mosquitos to pick up encephalitis
  185. what are the 2 most forms of arboviruses encephalitis
    • St Louis encephalitis (Mississippi river)
    • California virus (northern Midwest and east)
  186. this is a rare form of encephalitis  but has a high mortality and is found in New England and surrounding areas
    eastern equine encephalitis (EEE)
  187. what are the s/s of the St Louis encephalitis
    dysuria and pyuria
  188. what are the s/s of California encephalitis
    generalized or localized seizures
  189. what are the s/s of west nile virus
    • mild illness or asymptomatic
    • looks like typical encephalitis
    • extreme lethargy
    • flaccid paralysis
  190. what will labs show for leukocytes in west nile
  191. a 25 y/o female presents to the clinic c/o sudden onset of fever, HA, and neck stiffness. There are no obvious focal neurologic abnormalities. Pt states she has had a recent trip to china. On PE she has a positive Brudzinski sign and you may see possible papilledema. What is the suspected dx
  192. what 2 medical illness, if not treated, can lead to direct contiguous spread for meningitis
    • sinusitis
    • otitis media
  193. what is the most common cause of bacterial meningitis
    Strept pneumo
  194. which type of meningitis has CSF findings of an opening pressure of 200-300, 100-5000 WBC; >80% PMNs, glucose <40
    bacterial meningitis
  195. which type of meningitis has CSF findings of an opening pressure of 90-200, 10-300 WBC; lymphocytes, normal glucose, and normal protein
    viral meningitis
  196. what are the normal values for meningitis on CSF
    • opening pressure: 80-200
    • WBC: 0-5; lymphocytes
    • glucose: 50-75
    • protein: 15-40
  197. how is strep pneumo meningitis tx
    • ceftriaxone
    • b/c of emerging beta-lactam resistance, need to add vanco as part of empiric therapy
  198. what is the tx for listeria monocytogene meningitis
    amp and cefotaxime (claforan) for neonates
  199. what is the empiric therapy for all pts with new meningitis
    • ceftriaxone 2g IV q12h
    • vanc 15mg/kg q 12h
    • add amp 2g IV q4h for coverage of listeria if pt >50 y/o, immunosuppressed, pregnant or alcoholic
  200. what constitutes post-exposure prophylaxis for close contacts of N meningitidis
    • prolonged contact >8h
    • close proximity <3ft
    • directly exposed to pts oral secretions
    • within 1 week before onset of sxs
  201. what is the post-exposure prophylaxis for adults in N meningitis
    cipro 500mg PO once OR rifampin 600mg PO BID x 4 doses
  202. what is the MC cause of viral meningitis
    enterovirus (coxsackie)
  203. an 80 y/o male cannibal from New Guinea presents to your clinic with sporadic "twitching and jerking" in his arms and a c/o short and long term memory loss. Fhx is significant for post-mortem relative brain eating. On PE you note multifocal neurologic dysfxn, myoclonic jerking, and severe cognitive impairment. What is your suspected dx
    prion dz's
  204. what labs and imaging can be done for prion-related dz's
    • MRI- bilateral areas of increased intensity
    • CSF- increased protein