1
Q
The following is the general “criteria” for what?
- Fever >38.3degC (100.9F)
- At least 3wks duration
- No dx after 3 outpt visits or 3 days of hospitalization
A
Fever of unknown origin
2
Q
What are the 3 MC etiologies of Fever of Unknown Origin (FUO)?
A
- Infection
- Malignancy
- Connective Tissue Disease
3
Q
What is the #1 MC malignancy to cause FUO (fever of unknown origin)?
A
Lymphoma, especially non-hodgkins
4
Q
What is the main site of colonization of staphylococcal infections?
A
Nose
5
Q
Is staph aureus coagulase negative or positive
A
positive
(Staph epidermidis and staph saprophyticus are both coag neg)
6
Q
- Which staphylococcal strain is a frequent skin contaminant of blood cultures?
- What do you do to confirm whether a contaminant or a true cause of bacteremia?
A
- Staph epidermidis
- May have to draw from 2 sites
7
Q
Which bacteria causes infections of:
- Urine catheters
- IV lines
- Prosthetic joints/heart valves
- Dialysis catheters
A
Staph epidermidis
8
Q
Which staphylococcal strain is coagulase negative and is a leading cause of UTIs?
A
Staphylococcus saprophyticus
9
Q
What is the etiology of TSS?
A
Staph aureus
10
Q
Clinical presentation of what?
- Abrupt onset high fever
- Vomiting & watery diarrhea
- Sore throat, myalgias, h/a
- Hypotension with kidney and heart failure
- Diffuse macular erythematous rash and nonpurulent conjunctivitis
- Desquamation, esp. of palms & soles (late finding)
A
TSS
11
Q
Lab findings in TSS are consistent with what?
A
shock and organ failure
12
Q
What is empiric antibiotic tx for TSS?
A
Clindamycin + Vanco
(Also needs rapid rehydration–> 3L)
13
Q
What condition is caused by Staph aureus and is primarily in neonates 3-15 days old?
A
Staph Scalded Skin Syndrome (SSSS)
14
Q
Clinical presentation of which condition?
- Prodrome: fever, irritability
- Erythematous patches with large superficial fragile blisters
- When blisters rupture, skin appears red and scalded
- Nikolsky sign (only the first layer)
A
Staph Scalded Skin Syndrome (SSSS)
15
Q
Diagnosis of what?
- Clinical with cultures
- Skin biopsy shows intraepidermal cleavage without necrosis**
A
Staph Scalded Skin Syndrome (SSSS)
16
Q
What type of abx should be used to tx SSSS? If there is no response, what 2 meds should you consider?
A
- Penicillinase-resistant beta-lactam agents (Nafcillin)
- If no response, consider MRSA & tx with vancomycin
17
Q
Etiology of Anthrax?
A
Bacillus anthracis
18
Q
T/F: there has been bioterrorism w/ anthrax spores
A
True
19
Q
Hallmark of what condition?
- Painless eschar with extensive surrounding edema
(will be on exam)
A
Cutaneous clinical syndrome of Anthrax
20
Q
What causes:
- hemorrhagic mediastinitis
- occasionally necrotizing pneumonia
- Bacteremia
A
Inhalation clinical syndrome of Anthrax (the most dangerous form)
21
Q
Which clinical syndrome has a prodrome including sxs like hemoptysis and dyspnea and can resultmin death within days
A
INHALATION clinical syndrome of Anthrax
22
Q
What is seen on CXR of the inhaled form of Anthrax?
(will be on exam)
A
Widened mediastinum
23
Q
What is the GI form of Anthrax from?
A
consumptom of undercooked, infected meat from animals infected with anthrax
24
Q
Which infectious disease causes:
- Necrotic ulcers surrounded by extensive edema of infected intestinal segment and adjacent mesentery
- Can cause GI hemmorrhage
A
GI tract clinical syndrome of Anthrax
25
How do you tx anthrax if it is **systemic w/ meningitis**?
* Report/consult public health department
* **_Cipro + meropenem + Linezolid_**
* Antitoxin
* etc.
26
How do you tx Anthrax that is systemic WITHOUT meningitis?
* Report/consult public health department
* **_Cipro + Clinda_**
* Antitoxin
* etc.
27
How do you treat cutaneous Anthrax?
* Report/consult public health department
* _**Ciprofloxacin\*\***_
* Antitoxin
* etc.
\*\*\*definitely know abx- will be on exam\*\*\*
28
Which type of anthrax has the highest mortality rate? (cutaneou, injection, GI, inhalation or anthrax meningitis)
* **Anthrax meningitis-** even with treatment, mortality is 100%
* Inhalation is also very deadly with mortality rate of 45%
29
What is post-exposure prophylaxis for patients exposed to **aerosolized** B. anthracis (anthrax)?
Start **Cipro** w/in 48hrs- treat for 60 days
+
3 dose series of **Anthrax vaccine**
30
What is usually transmitted by the infected saliva of a **bat, raccoon or skunk**?
**_Rabies_** (caused by rhabdovirus)
31
Which infectious disease?
## Footnote
* Virus travels in **nerves to the brain**, multiplies in brain, then travels along efferent nerves to **salivary glands**
* Forms **_cytoplasmic inclusion bodie_**s – site of viral transcription & replication
Rabies
32
What infectious disease causes **percussion myoedema** (mounding of the muscle at the percussion site)?
Rabies
33
What are the two types of CNS presentations of Rabies? What do both forms progress to?
**•“furious” – encephalitic**
**•“dumb” – paralytic**
\*both forms progress to coma, ANS dysfunction, death
34
"Furious" (encephalitic) or "dumb" (paralytic) form of rabies?
* **MC**
* **paranoia,** terror
* **Hydrophobia**
* unquenchable thirst
* **oversalivating**
* Death by **cardiac arrest**
Furious (Encephalitic) rabies
35
"Furious" (encephalitic) or "dumb" (paralytic) form of rabies?
* **gradual coma**
* **_NO hydrophobia_**
* **paralysis**
* muscle weakness and loss of sensation
* death
**_Paralytic rabies_**
(this is less dramatic and usually longer course than furious rabies)
36
How do you diagnose rabies? (4)
* test animal if possible
* PCR of saliva
* viral culture of saliva
* Full thickness skin biopsy from posterior region of neck at hairline
37
How do you prevent rabies? (this is the main tx)
Immunize household pets and ppl w/ signifcant animal exposure
38
What is PEP and PrEP for rabies?
PEP= Human rabies immune globulin, Rabies vaccine
PrEP= Human diploid cell vaccine
39
Which infectious disease?
* ***Aedes*** mosquito
* Sexual, vertical or blood transmission
* Sxs: Acute onset **fever**, **maculopapular pruritic rash,** **nonpurulent conjunctivitis,** arthralgias
* most are asymptomatic
Zika
40
How do you dx Zika virus?
* Viral RNA or IgM
* real-time **RT-PCR of blood or urine** for Zika virus RNA
41
When is it important to test someone for Zika virus even if they are asymptomatic?
**Test asymptomatic pregnant women** for IgM **2-12 weeks** after:
* travel to endemic area OR
* sex w/ person with confirmed Zika
42
If you have a pregnant woman with Zika virus, what is the management?
Ultrasounds every 3-4wks looking for:
* **_Congenital microcephaly_**
* Also may see **arthrogryposis** (club foot) and spontaneous abortions
43
What are 3 complications of Zika virus?
* Guillain-Barré syndrome
* Myelitis
* Meningoencephalitis
44
What is tx for Zika virus?
rest
symptomatic tx
45
How do you prevent zika virus? (4)
* Mosquito control
* A**voidance of travel to affected areas when pregnant**
* Abstinence from sexual intercourse or barrier protection
* No blood donations
46
Which infectious disease is due to **Water reservoir contamination** and transmission is **never person-to-person**
Legionella
47
What are 5 risk factors for Legionella?
(you can be exposed without getting sick)
* **smoking**
* chronic lung disease
* older age
* **transplant recipient**
* biologic therapy
48
Which infectious disease has a **cough** that is initially mild and slightly productive and then develops **blood-streaked sputum** (rarely gross hemoptysis)
Legionella
49
What is seen on CXR for legionella?
•**Patchy unilobar infiltrat**e that progresses to consolidation
**_•Pleural effusions_** common
50
The following lab findings are seen in which infectious disease?
* Renal/hepatic dysfunction
* Thrombocytopenia
* **Leukocytosis**
* Hypophosphatemia
* **_Hyponatremia_**
* **Hematuria/proteinuria**
* Elevated serum ferritin
Legionella
51
what form of legionella is more mild and has the following:
## Footnote
•Fever, malaise, chills, fatigue, h/a
**_•No respiratory complaints_**
•Self-limited
Pontiac fever
52
How do you diagnose Legionella?
sputum culture
**_Urinary antigen tests_**
53
How do you tx legionella?
**Azithromycin** or clarithromycin or levofloxacin **x10-14days**
No isolation needed
54
How do you tx pontiac fever?
symptomatic tx
55
Which infectious disease **blocks release of _acetylcholine_ at the neuromuscular junction**
Botulism
56
How do alduts typically get botulism? infants?
Adults= **canned**, smoked or vacuum-packed food
**_Infants= honey_**
57
Clinical presentation of which infectious disease?
* **Descending weakness**
* NO fever
* Visual- **blurred vision, _diplopia_**, **_nystagmus_**, ptosis
* urinary retention & constipation
* _**\*\*\*Paralysis may progress to respiratory failure\*\*\***_
Botulism
58
How do you dx botulism?
**_Clinical dx_**
**Toxin in serum**, stool, etc
59
How do you tx Botulism?
* Equine serum **heptavalen**t botulism **antitoxin** w/in **24 hrs**
* intubation
* IV fluids
60
Which infectious disease has a gray membrane covering tonsils & pharynx?
Diphtheria
61
The exotoxin from Coryneybacterium diphtheriae causes what 2 things?
Myocarditis
neuropathy
62
What are the 2 complications of Diphtheria?
**•Myocarditis complication** – arrhythmias, heart block, heart failure
**•Neuropathy complication** – diplopia, slurred speech, dysphagia
63
How do you dx diphtheria?
Clinical dx
confirmed w/ culture and + toxin assay
64
How do you treat diphtheria? (4)
* Diphtheria equine **antitoxin**
* **_Penicillin or erythromycin x14 days_**
* Remove membrane by laryngoscopy
* **ISOLATION** until neg culture x3
65
What is PEP for diphtheria?
Booster + penicillin or erythromycin
66
Pathology of which infectious disease?
* Retrograde axonal transport within motor neuron
* **Blocks neurotransmission,** inactivating inhibitory neurotransmission causing:
* **_increased muscle tone_**
* **_painful spasms_**
* widespread autonomic instability
Tetanus
67
Which infectious disease?
* **_Trismus_** ("lock jaw")
* **_tonic/spastic muscle contraction in 1 EXTREMITY OR BODY REGION_**
* intermittent intense spasms
Tetanus
68
The following is a later finding of which infectious disease?
* **profuse sweating**
* **cardiac arrhythmias**
* labile HTN or hypotension
* fever
* **profuse sweating**
* **cardiac arrhythmias**
* labile HTN or hypotension
* fever
69
How do you dx tetanus?
**_clinical dx_** in setting of tetanus prone injury and hasn't had tetanus booster in last 5 yrs
70
How do you tx tetanus? (7 most important)
* ICU
* **Metronidazole**
* **Tetanus immune globin**
* Tetanus immunization x3
* Benzos
* airway management
* neuromuscular blocking agents
71
What causes lyme dz?
***Borrelia Burgdorferi***
transmitted by **deer tick** and **blacklegged tick**
72
Which disease has a bimodal distribution (**5-10 and 35-55**)
Lyme disease
73
For someone to get lyme disease: ticks need to feed for ___ to ___ hours to transmit infection
24-36 hours
74
Presentation of which disease?
* **_Erythema migrans_** (target lesion) 1 week after bite
* Viral like illness (myalgias, headache, fatigue,etc)
Lyme Disease
75
How do you dx early lyme?
clinical diagnosis
76
How do you dx late lyme? (intermittent or persistent arthritis, subtle encephalopathy, polyneuropathy)
Clinical dx + lab evidence
77
How do you tx Lyme Disease? Alternative tx for pregnant women?
**Doxycycline x10-14 days**
Amoxicillin for pregnant/lactating women
78
What are the complications of Lyme Disease in pregnancy?
•spontaneous abortion, still birth, preterm birth
79
What are 3 things that people with chronic lyme complain of?
1. fatigue
2. Arthralgias
3. Memory impairment
80
T/F: the following is some of the diagnostic for chronic lyme disease:
* H/o lyme treatment
* onset of nonspecific sxs (fatigue, arhtralgias, memory disturbances, etc) w/in 6 months
True
81
Criteria that must be met for you to give prophylactic antibioticcs for lyme disease:
## Footnote
* Tick attached for at least ____ hours
* Prophylaxis within ____ hours of the time the tick was removed
* More than 20% of ticks in the area are known to be infected with B burgdorferi
* No contraindication to the use of doxycycline
* Tick attached for at least **_36_** hours
* Prophylaxis within **_72_** hours of the time the tick was removed
82
What causes rocky mountain spotted fever?
Rickettsia rickettsia
| (tick borne illness)
83
Which infectious disease:
* MC men, \<10y/o and 40-64y/o
* Fever, **severe h/a**, malaiase, myalgias, arthralgias
* **_Rash on day 3-5_**: blanching erythematous rash w/ macules--\> **_petechiae_**
* rash starts on **ankles/wrists--\> trunk--\> palms/soles**
Rocky mountain spotted fever
84
Which infectious disease?
## Footnote
**_•Normal WBC count with immature bands_**
* Thrombocytopenia
* Hyponatremia
* Elevated LFTs
Rocky Mountain Spotted Fever
85
How do you dx Rocky mountain spotted fever?
•Serologic testing with IFA **(indirect fluorescent antibody**) for R. rickettsia antigen
86
How do you tx Rocky Mountain Spotted fever?
Doxycycline w/in 5 days of onset
87
Complications of which infectious disease?
* Renal failure
* **Sepsis**
* **Encephalitis**
* Noncardiogenic pulmonary edema
* ARDS
* **Cardiac arrhythmias**
* Coagulopathy/DIC
* GI bleeding
* **Skin necrosis**
Rocky Mountain Spotted Fever
88
Which infectious disease?
* 90-95% serum positive
* Transmitted throug**h intimate contact w/ saliva**
* Persists a**symptomatically for life**, reactivation uncommon
* Associated w/ **B cell lymphomas**, etc
Epstein Barr Virus (EBV)
89
The following is classic sxs of which disease?
* **tonsillitis/pharyngitis, cervical LAD, fever**
* Nausea, vomiting, anorexia (mild hepatitis in 90%)
* **_Splenomegaly_** (50-60%)
* Resolves in 1-2wks; fatigue persists x months
Infectious mononucleosis caused by EBV
90
Treatment of infective mononucleosis caused by EBV with ______ results in a morbiliform rash
Ampicillin
91
What is a good marker of acute infection of infectious mononucleosis (caused by EBV)
IgM and IgG antibodies against viral capsid antigen (VCA)
92
Infectious mono caused by EBV:
Early presence of what excludes acute infeciton?
IgG antibodies to **EBV nuclear antige**n (EBNA)
\*this indicates latent infection
93
What are the top 3 complications of infectious mononucleosis caused by Epstein Barr Virus?
1. Pneumonia
2. Hepatitis
3. Myocarditis
94
What are the 2 main treatments of infectious mononucleosis caused by EBV?
* Supportive care- NO ABX (Amox)
* Sports restrictions- no contact b/c of splenomegaly
95
What is the MC presentation of Cytomegalovirus?
CMV mono
96
The following is caused by what virus?
* Transmission: sex, close contact (daycare), blood, **perinatal**
* usually asymptomatic but **sxs in transplant pt**
Cytomegalovirus
97
T/F: CMV can be vertically transmitted and is associated w/ syndrome of congenital CMV in newborns
True
98
How do you dx CMV?
Quantitative DNA PCR
99
How do you tx cytomegalovirus
strong antivirals (ex: ganciclovir)
100
Which disease?
* Caused by **_cat feces_** or eating poorly cooked contaminated meat
Toxoplasmosis
101
Which disease is usually asymptomatic in immunocompetent patients but can have:
* **_b/l symmetrical nontender cervical or occipital adenopathy_**
* **Chorioretinitis** – visual loss or floaters
Toxoplasmosis
102
Which 4 things can be vertically transmitted? (TORCH)
T- Toxoplasmosis
O- Other (Syphilis)
R- Rubella
C- CMV
H- Herpes
103
Which disease can cause **_encephalitis with multiple necrotizing brain lesions_** in immunocompromised pts
Toxoplasmosis
(this is the most concerning presentation)
104
Toxoplasmosis in pregnancy can cause what 3 things
* Spontaneous abortion
* still-birth
* neonatal disease (neurologic & ophthalmic disorders)
105
How do you dx Toxoplasmosis
Serology- **ELISA**
106
Although most pts with Toxoplasmosis don't need treatment, If someone has **severe/prolonged infection**, or are **immunocompromized/pregnant**?
* P**yrimethamine + sulfadiazine OR pyrimethamine + clindamycin + leucovorin**
* Tx minimum of 2-4 weeks
* Ophthalmology
107
What is prophylactic treatment of Toxoplasmosis?
Trimethoprim- sulfamethoxazole
108
Which disease?
* **Pigeon dung**
* transmitted by inhalation
* usually asymptomatic
* Immunocomp- progressive lung disease and dissemination
Cryptococcosis
109
Presentation of what?
* Nodules, widespread infiltrates leading to **respiratory failure**
* Dissemination:
* CNS - **Meningitis**, AMS, CN abnormality
* **Skin – papules, plaques, abscesses, sinus tracts**
* MSK – osteolytic lesions
Cryptococcosis - presentation above is seen in immunodeficient patients
110
What 4 things are used to dx Cryptococcosis?
**_•Respiratory secretion or pleural fluid culture_**
* LP with CSF analysis
* MRI
* Antigen testing
111
How do you treat Cryptococcosis?
* Amphotericin B x 14 days
* Follow with fluconazole x 8 weeks
112
Which disease?
* **_Unilateral vesicular eruption in a dermatomal distribution_**
* old people (\>50)
VZV- Herpes Zoster
113
How do you dx VZV
clinical diagnosis
114
When would you treat VZV and what would you tx with?
**Acyclovir** w/in 72 hrs of onset
\>72 hrs if still getting new lesions
if immunocompromised
115
How would you tx a pt w/ VZV with mild pain
NSAIDs and acetaminophen
116
How would you tx a pt w/ VZV with mod-severe pain
Stronger opioid (Oxycodone, morphine)
117
The following are complications of what?
## Footnote
**_•Postherpetic neuralgia_** (90d of pain)
* Ocular complications – uveitis, keratitis
* Aseptic meningitis
* Encephalitis
**•Herpes zoster oticus (Ramsay Hunt syndrome)**- facial palsy w/ vesicles in ear
•Myelitis
VZV
118
When do you give the Herpes Zoster Vaccine?
**_50+_**
