IM-ID Flashcards by Beth A

What test is used in primary syphilis that has the higher sensitivity (>97%)

Treponemal tests (Fluorescent treponemal antibody absorption- FTA-antibodies)

How well did you know this?

Not at all

Perfectly

What is the bug and the treatment?

White plaques

Candidia

- Fluconazole

How well did you know this?

Not at all

Perfectly

What is the bug and the treatment?

Large linear ulcers

- Ganciclovir

How well did you know this?

Not at all

Perfectly

What is the bug and the treatment?

Vesicle and round/ovoid ulcers

- Acyclovir

How well did you know this?

Not at all

Perfectly

What is the bug and the treatment?

Aphthous ulcer

nonspecific canker sore

- for recurrent- use prednisone (if not responding to topical corticosteroids)

How well did you know this?

Not at all

Perfectly

Aspiration pneumonia can expose pt with what organisms and the tx

anaerobic

- clindamycin

How well did you know this?

Not at all

Perfectly

foul-smelling sputum

anaerobic organisms

How well did you know this?

Not at all

Perfectly

periodis febrile paroxysms, nonspecific malaise, headache, N/V, abd pain, myalgia, pallor, jaundice, petechiae, hepatosplenomegaly

Malaria

How well did you know this?

Not at all

Perfectly

how do you diagnose Malaria

-Thin & thick peripheral blood smears

How well did you know this?

Not at all

Perfectly

How does one gain protection from Malaria (not including medications) (2)

Hemoglobinopathies (Hgb S, Hgb C, thalassemia)

- Partial immunity from previous malaria illness

How well did you know this?

Not at all

Perfectly

The 5 antimalarial drugs are

Atovaquone-proguanil
Doxycycline
Mefloquine
chloroquine
Hydroxychloroquine

How well did you know this?

Not at all

Perfectly

What are the duration of the 3 stages for Lyme disease

early localization (days-1month)
early disseminated (weeks-months)
Late (Months-years)

How well did you know this?

Not at all

Perfectly

Clinical features for 1st stage (early localization) (5)

Erythema migrans
Fatigue
headache
myalgias
arthralgias

How well did you know this?

Not at all

Perfectly

Clinical features for 2nd stage (early disseminated) (5)

Multiple erythema migrans
unilateral/bilateral CN palsy ( CN VII)
Meningitis
Carditis (AV block)
Migratory arthralgias

How well did you know this?

Not at all

Perfectly

Clinica features for 3rd stage (late) (3)

Arthritis
Encephalitis
Peripheral neuropathy

How well did you know this?

Not at all

Perfectly

Tx for Lyme disease

Doxcycline

How well did you know this?

Not at all

Perfectly

4 bugs that can cause Urethritis in men

Neisseria gonorrhoeae (most common)
Chlamydia trachomatis
Mycoplasma genitalium
Trichomonas (rare)

How well did you know this?

Not at all

Perfectly

Diagnosis used for Chlamydia trachomatis is

Nucleic acid amplification testing

How well did you know this?

Not at all

Perfectly

Fever (>102.2), bradycardia related to fever, neurological symptoms, GI symptoms (diarrhea), unresponsive to beta-lactam and aminoglycoside, Cxray patchy infiltrates. Bug?
How do you treat (2)?

Legionella pneumophila

Macrolides or fluoroquinolones (levofloxacin)

How well did you know this?

Not at all

Perfectly

Lab clue for Legionella PNA (5)

Hyponatremia
hepatic dysfunction
Hematuria &
proteinuria
Sputum gram stain;- many neutrophils and few or no microorganisms

How well did you know this?

Not at all

Perfectly

Infective endocarditis due to Eikenella corrodens (gram -) anaerobe is common in what settings (3)

Poor dentition
Periodonal infection
dental procedures that manipulation of the gingiva or oral mucosa

How well did you know this?

Not at all

Perfectly

Prolonged fever, malaise, exudative pharyngitis, hepatosplenomegaly, generalized lymphadenopathy, hemolytic anemia and thrombocytopenia
Dx? Organism? Diagnostic?

Infectious mononucleosis
EBV
antiheterophile antibodies (monospot test), atypical lymphocytes on blood smear, & Coombs test

How well did you know this?

Not at all

Perfectly

How to treat toxoplasma encephalitis and ppx?

Sulfadiazine and pyrimethamine
- antiviral initiations
and ppx TMP-SMX (CD4<100)

How well did you know this?

Not at all

Perfectly

Slowly progressive confusion, paresis, ataxia, and seizure in HIV pt

Progressive multifocal leukoencephalopathy (PML)- JC virus reactivation with CD4 <200

How well did you know this?

Not at all

Perfectly

The 3 PEP drugs (post-exposure prophylaxis) are

- 2 NRTI ( Tenofovir + Emtricitabine) | - 1 from intergrase inhibitor (raltegravir) or protease inhibitor or NNRTI

Most likely microb to cause infective endocarditis in patients with Prosthetic valves, intravascular catheters, implanted devices, IV drug users

Staphylococcus aureus

Most likely microb to cause infective endocarditis in patients with Gingival manipulation Respiratory tract incision or biopsy

Viridans group streptococci (S. mutans, S. mitis, S. oralis, S. sanguinis)

Most likely microb to cause infective endocarditis in patients with prosthetic valves, IV catheters, Implanted devices

Staphylococcus epidermidis

Most likely microb to cause infective endocarditis in patients with nosocomial UTI

Enterococci

Most likely microb to cause infective endocarditis in patients with colon carcinoma, IBD

Streptococcus gallolyticus (S. Bovis)

Most likely microb to cause infective endocarditis in patients with an Immunocompromised host, IV catheters, prolonged antibiotic therapy

Fungi (Candida species)

Common causes of diarrhea in pt with AIDS (4)

- Cryptosporidium parvum - Microsporidium/Isosporidium - Mycobactrium Avium complex (MAC) - Cytomegalovirus (CMV)

The organism that causes Hydatid cyst? what is the definite host? what does the lesion look like on CT?

- Echinococcus granulosus - Dogs definitive host - eggshell calcification

Quick onset (1-6hrs), vomiting predominant. What bug? mechanism of foodborne illness

- Staph aureus & Bacillus cereus (reheated rice) | - Enterotoxin ingestion

Delayed onset (>1day), watery/bloody diarrhea, What bug? mechanism of foodborne illness

- Clostridium perfringens, ETEC/STEC, Vibrio cholera | - Enterotoxin made in intestine

Variable onset, watery/bloody diarrhea, fever, systemic illness, What bug? mechanism of foodborne illness

- Campylobacter Jejuni, nontyphoidal salmonella, Listeria monocytogenes (systemic illness) - Bacterial epithelial invasion

Symptoms of UTI, with UA pH of 8.5, with urinary calculi. What is the bug?

Proteus mirabilis- urease-producing bacterium | with Struvite stones (mg ammonium phosphate)

Bright red, firm, friable, exophytic nodules in a HIV pt, is? cause? Tx (2)?

- Bacillar angiomatosis - Bartonella (hensele/Quintana) (Gram neg bacillus) - Oral erythromycin or doxycycline

who are the patient at risk for bartonella exposure?

- cat exposure - homelessness (lice) - Severe immunocompromise (advanced HIV-CD4<100)

Hx of tick bite, febrile illness with symptomatic symptoms, leukopenia and or thrombocytopenia, elevated aminotransferases and rash with pt in endemic region. What is the bug?

Ehrlichia chaffeensis and E ewingii- Enhrlichiosis

Tx for uncomplicated acute pyelonephritis (2)

- Oral fluoroquinolone | - Trimethrprim-Sulfamethoxazole

Tx for complicated acute pyelonephritis (3)

- IV fluoroquinolone - Aminoglycoside - Extended spectrum beta-lactam/cephalosporin

indolent headache, malaise, fever, persistent dry cough, pharyngitis (nonexudative), macular/vesicular rash. Bug?

Mycoplasma pneumoniae

dx for Mycoplasma pneumonia (3)

- Normal leukocyte count - Subclinical hemolytic anemia (Cold agglutinins) - Interstitial infiltrate (Cxray)

Tx for Mycoplasma pneumonia (2)

- Macrolide or respiratory fluoroquinolone

Headache, malaise, fever, exudative pharyngitis/tonsillitis, lymphadenopathy and splenomegaly. Bug?

Epsten-Barr virus (Infectious mononucleosis)

-Ingestion of undercooked meat (pork), -from Mexico, china, Thailand, central Europe and Argentina - Gastric acid releasing larvae (1 wk of ingestion) that invade small intestine and develop into worms - Female worms release larvae that migrate and encyst in striated muscle Bug?

Trichinellosis

Clinical presentation for Trichinellosis (8)

- abd pain, - N/V, - diarrhea - Myositis - fever, - subungual splinter hemorrhages - Periorbital edema - Eosinophilia

An HIV patient should get HAV vaccine when? (3)

- Chronic liver disease (including HBV and HCV) - Men who have sex with men - IV drug users

An HIV patient should get HBV vaccine when?

All patient without documented immunity to HBV

An HIV patient should get HPV vaccine when?

All pt age 11-26

An HIV patient should get Influenza vaccine when?

Annually for all pt (inactivated formulation)

An HIV patient should get meningococcus (serogroups A, C, W, Y) vaccine when?

All patients

An HIV patient should get pneumococcus vaccine when? which one? (2)

- PCV13 once | - PPSV23 8 weeks later, 5 years later & at age 65

An HIV patient should get Tdap vaccine when? (2)

- Tdap once (repeat with each pregnancy in women) | - Td every 10 years

Which live vaccines are contraindicated if CD4 <200? (3)

- MMR - Zoster - Varicella

Who do you treat HIV pt with progressive disseminated histoplasmosis

Amphotericin B

Acute symmetric arthritis of the hands, knees and ankle joints, Bug? Dx?Tx?

- Parvovirus B 19 Anti-parvovirus B19 IgM -self-limiting

Transient Pure red cell aplasia in pt with Sickle cell anemia

Parvovirus B 19

Fever, Nausea and rash (slapped check)

``` Erythema infectiousm (fifth disease) Parvovirus B 19 ```

After your remove a tick with forceps/tweezers when do you prophylaxis for Lyme disease? It must meet all 5

- if >36hrs attached - Ppx with in 72hr of tick removal - No contraindication to doxycycline (pregnant or lactating) - Attached tick is an adult or nymphal/Ixodes scapularis (deer tick) - Local Borrelia burgodorferi infection rate >/= 20%

What are the work up needed for PCP (pneumocystic jiroveci PNA) (3)

- elevated LDH level - Diffuse reticular infiltrates on imaging - Induced sputum or BAL (stain)

Tx for PCP (pneumocystic jiroveci PNA) (2)

- TMP-SMX | - Prednisone if low oxygen level

Ppx for PCP (pneumocystic jiroveci PNA) in HIV pt

- TMP-SMX | - Antiretroviral

HIV pt with subacute cough and a cavitary, inflammatory upper lung lesion is likely to be

reactivataion TB

which bacterial likes to infect the lung apices due to high oxygen tensions and slower lymphatic elimination

Mycobacterium TB- causing reactivation TB at the site of latent infection (apical lobes)?

PPD testing is duration is __ for HIV pt

>/= 5mm at 48-72hrs

The most common behavioral risk factor for TB in USA is

Substance abuse

Diffused reticulonodular pattern on xray on HIV pt, with extrapulmonary disease in the lymph nodes, liver, bones and central nervous system

Miliary TB | Millet seed seen on cxray

frequent small volume diarrhea, hematochezia, abd pain, low-grade fever, weight loss in HIV pt. Bug?

cytomegalovirus, CMV

electric sensation that runs through the back and into the limbs. Name? Dx?

- Lhermitte's phenomenon/barber chair phenomenon | - Multiple sclerosis

HIV pt, fever, cough, abd pain, diarrhea, night sweats, wt loss, CD4 <50. Dx? Tx(2)?

Mycobacterium avian complex (MAC) | Azithromycin (can be used ppt) and clarithromycin

Two genital ulcers that are painful

- HSV | - Haemophilus ducreyi (Chancroid)

Two Genital ulcers that are painless

- Treponema Pallidum (Sypilis) | - Chlamydia trachoma's servers L1-L3 (lympogranuloma venereum)

Small, shallow genital ulcer-can progress to painful, fluctuant adenines (buboes)

Chlamydia trachoma's L1-L3

Single ulcer, regular borders and hard base

Syphilis (chancre)

Action and SE of Levodopa + Carbidopa

- Dopamine precursor - Somnolence, confusion, hallucinations, Dyskinesia, dizziness, headache, agitations After many years of therapy- Involuntary movements

Small pruritic vesicles or ulcers on erythematous base | Mild lymphadenopathy? Tx?

HSV | Acyclovir

slowly progressive, non painful, indurated mass around the submandibular, sinus tracts with sulfur granules, thick yellow discharge, fever/lyphadenopathy Dx? Tx?

Actinomyces | Penicillin 2-6 months , if sever surgery

Filamentous gram+ rods with rudimentary branching

Actinomyces

3 risk factors for Rhino-orbital-cerebral mucormycosis

- DM (ketoacidosis) - Hematologic malignancy - Solid organ or stem cell transplant

Treatment of r mucormycosis (Rhizopus) (2)

- Surgical debridement | - Liposomal amphotericin B

Sudden-onset server, stabbing pain along the V2 (maxillary) and V3 (mandibular) area. Dx? mechanism

``` Trigeminal neuralgia (usually unilateral and bilateral if it is with MS) - Demyelination of the nerve nuclei ```

Triad of tenosynovitis, dermatitis ( papule and pustules), asymmetric migratory polyarthralgias or - Purulent monoarthritis

Disseminated gonococcal infection | Neisseria gonorrheae

The most common secular transmitted disease causing septic arthritis

Disseminated gonococcal infection

Tx for viral (HSV) encephalitis

IV acyclovir

Culture media used for cryptococcal

Sabouraud agar

Tx for cryptococcal meningoencephalitis (2)

Amphoteric B with flucytosine (Initial) | Fluconazole (maintenance)

Common fungus in south/south-central states, Mississippi and Ohio river valleys, upper midwest states, great lakes step and Canadian provinces

Blastomycosis

low grade fever and violacoeous skin lesions with scrapings showing yeast, progressing to micro abscess

balstomyces dermatiditis

sore that, fever, muffled voice, drooling, stridor, and hoarseness

Infectious epiglottis (H Influenze type B)

Which microbiology gives those infective endocarditis associations? Prosthetic valves IV catheter Implanted devices IV drug users

Staphylococcus aureus

Which microbiology gives those infective endocarditis associations? Gingival manipulation Respiratory tract incision or biopsy

Viridans group streptococci

Which microbiology gives those infective endocarditis associations? Prostatic valves IV catheters Implanted devices

Staphylococcus epidermidis

Which microbiology gives those infective endocarditis associations? Nosocomial UTI

Enterococci

Which microbiology gives those infective endocarditis associations? Colon carcinoma Inflammatory bowel disease

Strptococcus gallolyticus (S. Bovis)

Which microbiology gives those infective endocarditis associations? Immunocompromised host IV catheters Prolonged antibiotic therapy

Fungi (Candida species)

Tropical/Subtropical parts of central/south America, Africa, and Asia A Aedes mosquito (that transmits dengue and Zika)

Chikungunya fever

Sever polyarthralgias, high fever, headache, myalgia, conjunctivitis, maculopapular rash, lymphopenia, thrombocytopenia, transaminitis

Chikungunya fever

Solid organ transplantations getting high-dose immunosuppressive medication are at risk for which two opportunistic infections?

- Pneumocystis pneumonia (PCP) | - Cytomegalovirus (CMV)

Systemic illness involving in patient with HIV/ Solid organ transplant with multiple organ systems symptoms like Pneumonitis, hepatitis, and GI-diarrhea should be tested for

CMV viremia

Abx used for lung abscesses, skin and soft-tissue infections, female URT infections- covers Gram+ and anaerobes

Clindamycin

Human bites have what kind of microbes? Tx?

- both aerobic and anaerobic | - Amoxicillin-Clavulanate (Augmentin)

fatigue, elevated transaminases, arthralgia, and kind findings with recurrent blisters on back of hand and forearm

Chronic hepatitis C infection with porphyria cutanea trarda (PCT)

HCV is strangely associated with

PCT (porphyria cutanea tarda)

Endemic mycosis of the desert southwest that causes community-acquried pneumonia, often accompanied by arthralgia, erythema nodosum, and erythema multiforme. Tx?

- Coccidioides | - Ketoconazole or fluconazole

Wt loss, fever, night sweats, Cxray- alveolar infiltrates and nodules with cavitation, immunocompromised host, finding on culture Gram+, partially acid-fast, filamentous, branching rods Dissemintated disease include lung, brain and skin. Dx? Tx?

Nocardia | - Trimethoprim-Sulfamethoxazole

When is one time PPSV23 alone recommended as a one time vaccine?

For adults <65, current smokers or | other conditions hearth or lung disease, DM, chronic liver disease

When is the PCV13 vaccine recommended

adults age > 65 followed by the PPSV23 at least 6-12 months later

Health care workers without previous HB vaccination or adequate antibody response, exposed to blood from HB patients should receive post-exposure prophylaxis with

-get complete HB vaccine series 1st dose within 12hrs next doses with standard schedule -Also they need to receive HB immune globulin as soon as possible (<24hrs)

Endomic to the nerowastern US, erythema migrant, carditis(AV block), and neurologic manifestations

Lyme disease | - Spirochete Borrelia burgdorferi

Skin infection of the upper dermis and superficial lymphatic system? Cause?

Erysipelas | group A Streptococcus

Individual with high-risk sexual intercourse should be screened for 2 viruses

HBV and HIV

Individual with use injection drugs, high-risk needle stick exposure or received blood transfusion before 1992 should be screened for what virus

HCV

electric sensation that runs through the back and into the limbs. Name? Dx?

Lhermitte's phenomenon/barber chair phenomenon | -Multiple sclerosis

When overheated and elevated boy temperature worsts neurological symptoms (blurry or reduced vision...)Name?Dx?

Uhthoff's phenomenon | -MS

The 4 disease pattern of MS are

- Relapsing-remitting - Primary progression - Secondary progressive - Progressive relapsing

Diagnostic for MS (2)

- T2 MRI lesions | - Oligoclonal IgG bands

What part of the brain is affected in MS that is seen in MRI?

- Periventricular - Juxtacortical - Infratentorial - Spinal cord

What type of gait disturbance does parkinsonism has

Shuffling gait | hyperkinetic gait

Action and SE of Levodopa + Carbidopa

- Dopamine precursor | - Somnolence, confusion, hallucinations, Dyskinesia

Action and SE of Trihexyphenidyl/benztropine

- Anticholinergic | - Dry mouth, blurred vision, constipation, Nausea and urinary retention

Action and SE of Amantadine

- Unclear mechanism | - Ankle edema and Lived reticulates

Action and SE of | Apomorphine, bromocriptine, pramiperxole, ropinorole

- Dopamine agonist | - Somnolence, hypotension and confusion, hallucinations

Action and SE of Entacapone or tolcapone

- COMPT inhibitor | - Dyskinesia, hallucinations, confusion, nausea, orthostatic hypotension

Action and SE of Selegiline

- MAO B inhibitor | - Insomnia and confusion

Sudden-onset server, stabbing pain along the V2 (maxillary) and V3 (mandibular) area

Trigeminal neuralgia (usually unilateral and bilateral if it is with MS)

Improperly canned foods (fruits and veg), aged seafood (cured fish), cause of the food borne disease

Clostridium botulism

-bilateral cranial neuropatheis, systemic descending muscle weakness, diaphragmatic weakness with respiratory failure

C. Botulisnum toxin

Tx of food-borne Botulism

Equine serum heptavalent botulism antitoxin

A brain dead person can have with central nervous system activities

Deep tendon reflexes

What are the two types of hearing loss

Sensorineural | Conductive

Disorder involving the inner ear, cochlea, or auditory nerve

Sensorineural hearing loss

any cause that limits sound from gaining access to the inner ear

Conductive hearing loss

The 5 sensorineural hearing loss disorders are

- Presbycusis - Meniere disease - Barotrauma - Acoustic neuroma - Cerebrovascular ischemia

The 5 causes of conductive hearing loss are

- Otitis external or media - Cholesteatoma - Trauma - Cerumen - Tympanic membrane perforation

Progressive bilaterally symmetric and predominantly high frequency sensorineural hearing loss that occurs over many years, tinnitus

Presbycusis (age related hearing loss)

What part tract in the UMN does pronator drift examine?

Pyramidal/corticospinal tract

The 5 abortive Migraine therapies are

- Triptans (sumatriptan) - NSAIDS (naproxen) - Acetaminophen - Antiemetics (metoclopramide, prochlorperazine) - ergotamine (dihydroergotamine)

The 4 preventives Migraine therapies

- Topiramate - Divalproex sodium - Tricyclic antidepressants - Beta-blockers (propranolol)

Pt with lacunar stroke presents after weeks with paroxysmal burning pain over the affected area when light touched. Dx?

Thalamic pain syndrome

Allodynia

burning pain with light touch

Weakly ring-enhanced periventricular mass on MRI of HIV patient with EBV DNA in the CSF

Primary CNS lymphoma

Hx of HTN, HLD, DM2, sever dizziness, systolic bruit at the base of the neck above the clavicle on the Left side, 4th heart sound heard. cause and Dx?

Subclavian artery occlusion | Subclavian steal syndrome

IM-ID Flashcards

(144 cards)