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103 Cards in this Set
- Front
- Back
Endocarditis
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- bacterial colonies embedded in fibrin on heart valves
- SBE prophylaxis prior to dental procedures: amoxicillin 500mg, 4 po 1hr before |
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Endocarditis
- Risk Factors |
- immunosuppressed pt.
- invasive or surgical procedure - intravascular devices - widespread use of broad spectrum antibiotics that suppress NL flora |
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Bacteria that commonly cause Endocarditis
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1. Viridans streptococci
2. enterococcus 3. Strep. bovis (Group D, non-enterococcus) 4. Cardiobacterium 5. Eikenella 6. Coagulase (-) staph. |
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Endocarditis: In IV drug abusers, the most common isolate is ______.
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Staph aureus
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Blood culture specimen collection
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- 3 sets of aer/ana bottles
- 1/2 hr prior to expected onset of fever spike - separate sites - prior to admin. of antibiotics - 5-10mls per bottle - continuous monitoring |
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CSF Infections
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1. Meningitis
2. Encephalitis 3. Meningoencephalitis |
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Meningitis
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- infx. w/in subarachnoid space
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Encephalitis
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- inflammation of brain parenchyma (usually viral etiology)
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Meningoencephalitis
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- inflammation of meninges
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CSF analysis
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- lumbar puncture: tube #2 goes to micro, spun specimen and sediment plated
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CSF analysis
a) bacterial etiology b) viral etiology c) mycobacterial or fungal etiology |
a) PMNs, low glucose, high protein
b) lymphocytes, NL glucose, NL to mod. elevated protein c) eosinophilia, low glucose, high protein |
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Additional CSF testing
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- latex agglutination testing for antigen
- gram stain - VDRL for Abs |
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CSF testing: VDRL for Abs against what organisms?
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- Treponema pallidum (syphilis)
- Cryptococcal antigen |
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Prozone effect
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- false negative due to a lot of organisms preset
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NL flora of genital tract of females
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- varies w/age depending on pH and estrogen concentration
- Staph., Cornyebacterium, Lactobacillus, Streptococci, Enterobacteriaceae, anaerobes |
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NL flora of genital tract of males
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- Staph, Cornyebacterium, Mycobacterium smegmatis in uncircumcised males
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Pathogens of GU tract
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- vaginal Candiasis
- protozoan, Trichomonas vaginalis - N.gonorrheae - C.trachomatis - M. hominis - Peptococcus species - Ureaplasma urealyticum - Bacteroids - H.influenzae - Gardnerella vaginalis - Strep. species - viruses: HSV1 & 2 - Haemophilus ducreyi |
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Vaginal Candiasis is assoc. with:
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- antibiotic therapy
- DM - pregnancy - immunosuppressed pt. - corticosteroid use |
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Vaginal Candiasis presents:
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- cottage cheese discharge, adheres to vaginal mucosa
- vulvar pruritis (may be exacerbated w/onset of menses and somewhat relieved at onset of menstrual flow) |
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Most common sx. of vaginal candiasis:
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- vulvar pruritis
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Vaginal candiasis: STD?
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- usually NOT sexually transmitted
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Vaginal candiasis: swab
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- swab lateral and posterior fornices while avoiding cervical mucus with a pH of 7
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Vaginal candiasis: lab
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- wet mount or saline prep
- 10% KOH prep - if inconclusive consider vaginal culture -(+) culture does not mean Candida is responsible for vaginal sxs. |
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Vaginal candiasis: TX
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- oral or topical azole prep (Diflucan 150mg, single dosing, Gyne-Lotrimin, Monistat, Terazole)
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Caution about vaginal preps
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- oil based and may weaken latex condoms/diaphragms
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Most common cause of inc'd malodorous (fishy) discharge
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- Bacterial vaginitis
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Bacterial vaginitis
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- fishy smelling discharge
- pH >4.5 - vaginal irritation and pain are UNCOMMON |
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Bacterial vaginitis: pathogen
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- no single pathogen is responsible
- usually due to overgrowth of anaerobes replacing NL lactobacillus - Garderella vaginalis, Mycoplasma hominis, Bacteriodes |
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Bacterial vaginitis: labs
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- positive whiff test with 10% KOH
- clues cells on wet mount - culture not useful as Gardnerella vaginalis can be isoloted from 1/2 of NL women |
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Bacterial vaginitis: Tx
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- metroniazole (Flagyl) 500mg PO BID x 7 days
- contraindicated in pregnancy - avoid alcohol during tx and for 24 hours after tx due to disulfiram-like antabuse effect - alternate tx: metroniazole gel (Metrogel vaginal) 0.75% one applicator (5g) intravaginially BID x 5 days - Clindimycin |
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Clues cells
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- epithelial cells with inclusive bacteria
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Disulfiram-like antabuse effect
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- nausea, flushing, metallic taste
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Trichomonas vaginitis
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- STD
- protozoan Trichomonas vaginalis |
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Trichomonas vaginitis: sxs
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- some are asymptomatic
- copious amts. of malodorous FROTHY YELLOW-GREEN DISCHARGE - VULVAR IRRITATION - PRURITIS - dyspareunia - worsening following menses - STRAWBERRY CERVIX due to petechiae - majority of men are asymptomatic |
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Trichomonas vaginitis: dx
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- observing motile trichomonads and PMNs on wet mount
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Trichomonas vaginitis: Tx
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- metroniazole (Flagyl) 2gm single dosing or 500mg BID x 7 days
- contraindicated in first trimester of pregnancy but may be considered after w/2gm single dose |
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PID
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- Polymicrobial: N.gonorrheae, C.trachomatis, M.hominis, Peptococcus species, U.urealyticum, Bacteroids,H.influenzae, Gardnerella vaginalis, Strep species, viruses
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PID: risk factors
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- age <25
- multiple sex partners - IUDs - recent invasive gyn procedure - smoking - vaginal douches - parturition |
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PID: clinical dx
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- BL lower abd. pain
- change in discharges - irreg. bleeding - dysuria, fever - adnexal tenderness/swelling - cervical motion tenderness aka "CHANDELIER SIGN" |
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PID: Labs
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- gram stain
- urine pregnancy (ectopic) - CBC (appendicitis) - syphilis serology - HIV testing |
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PID: gold standard for confirming dx
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- laparoscopy (invasive)
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Most prevalent STD in U.S.
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- gonorrhea
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Neisseria gonorrheae
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- gram (-) diplococci
- incubation: 2-5 days |
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Gonorrhea is characterized by:
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- MUCOPURULENT DISCHARGE
- acute urethritis in men - cervicitis in women - Skene’s & Bartholin glands commonly infected |
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Gonorrhea: sequellae
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- salpingitis
- scarring of fallopian tubes - (PID) - can lead to sterility |
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Gonorrhea: Dx
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- gram stain PMNs & intracellular gram (-) diplococci
- presumptive dx in men, not women-have NL Neisseria in vaginal area |
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Gonorrhea: culture required growth on _____
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- Thayer-Martin Plate
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Gonorrhea: Tx
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- all sexual partners w/in past 30 days
- no intercourse until cured - treat newborns w/anbx drops to prevent gonococcal ophthalmia - Rochephin 125 mg IM single dose or Cipro 500 mg orally |
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Syphilis: pathogen
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- Treponema pallidum
("great masquerader") |
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Syphilis:
a) hosts b) higher incidence |
a) humans are the only host
b) southern U.S., blacks, hispanics |
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Syphilis: modes of transmission
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- skin
- mucus membranes - body fluids & secretions - transplacentally |
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Stages of Syphilis
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- primary
- secondary - latent - tertiary |
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Syphilis: primary stage
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- painless chancre
- appears 2-6 wks after exposure - at site of exposure, genital area, lip, tongue, buccal mucosa |
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Syphilis: secondary stage
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- 2-6 months later
- skin lesions - palms and soles - highly contagious as lesion borders are loaded w/ spirochetes - sore throat,fever,chills, H/A,anorexia,weight loss, generalized alopecia, lymphadenopathy |
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Syphilis: latent stage
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- pt. is asymptomatic but diagnostic testing is (+)
- early latent: up to 1 year - late latent: after 1 year w/o sxs |
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Syphilis: tertiary stage
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- chronic inflammatory dz, can affect any organ
- gummas (thought to result from delayed hypersensitivity rxx) |
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Granuloma Inguinale
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- aka Donovanosis
- Calyminatobacterium granulomatis (gnr) - “Donovan Body” in cytoplasm of mononuclear cells. |
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Granuloma Inguinale: sns/sxs
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- painless granulomatous ulcer at inoculation site
- lymphadenopathy is uncommon |
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Granuloma Inguinale: labs
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- punch bx
- Wright/Giemsa stain |
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Granuloma Inguinale: Tx
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- doxycycline 100mg BID
- or Bactrim |
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Lymphogranuloma Venereum
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- Chlamydia trachomatis
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Chlamydia trachomatis
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- uncommon in US
- prevalent in tropical areas - 2 stages |
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2 stages of C.trachomatis
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1. painless papule that ulcerates
2. tender, U/L inguinal adenopathy, BUBO formation |
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BUBO formation
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- accumulation of tender lypmh nodes
- may rupture - fistula may form |
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C.trachomatis: labs
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- Ab/complement fixation test: >1:32 indicative of active dz
- culture of BUBO aspirate |
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C.trachomatis: Tx
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- doxycycline for 21 days
- treat any sexual partners w/in past 30 days |
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Chancroid (Haemophilus ducreyi)
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- painful genital ulcer
- 1-14 days of incubation - tropics, subtropics |
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Chancroid (H.ducreyi): labs
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- gram stain
- culture ulcer edge or inguinal node aspirates |
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Chancroid (H.ducreyi): Tx
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- azithromycin
- erythromycin - ceftriaxone |
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HSV 1 and HSV 2
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- ds DNA virus
- direct contact w/mucus membrane - 2-20 day incubation |
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HSV: what happens to virus after acute episode?
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- virus migrates to sensory or autonomic ganglia
- becomes dormant - may reactivate |
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HSV: sxs
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- painful eruption of localized grouped vesicles on an erythematous base
- fever, malaise, H/A |
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HSV: initial eruption
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- more severe and lasts longer than subsequent recurrences
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Herpes Genitalis
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- can occur anywhere on genitals
- on labia in females |
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HSV: definitive test
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- viral culture
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HSV: labs
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- viral culture
- special transport media - cross reactivity - STD testing - Tzanck smear |
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HSV: why are serological tests of limited value?
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- >85% adults have Ab to HSV1
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Tzanck smear
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- scrape base of lesion with blade
- place on slide - stain with Wright/Giemsa/toluidine blue |
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HSV: what is seen on Tzanck smear?
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- multinucleated giant cells
- negative test does not disprove dx. - specific only to herpes virus - WILL NOT DISTINGUISH SIMPLEX FROM ZOSTER |
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HSV: Tx
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- Acyclovir (Zovirax)
- Valtrex - Famvir |
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HSV: cold sores
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- treated for 3 days
- Abreva OTC: prevents virus from infecting new cells |
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HSV: suppressive therapy
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- Zovirax for up to a year reduces frequency and severity of infxs.
- does not reduce viral shedding. |
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HSV: prevention
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- HSV2 vaccines under clinical trial
- condom use |
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Chlamydia trachomatis invades only ____.
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- columnar epithelium
|
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GI: S.aureus
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- S.aureus
- PREFORMED ENTEROTOXIN - rapid onset - 2-8hrs of N/V/D, H/A, cramps - |
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GI: Clostridium botulinum
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- anaerobic, spore-forming
- gram (+) bacillus - one of most powerful toxins known |
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GI: C.botulinum
a) incubation b) symptoms |
- incubation: 12-36 hours
- sxs: N/V/D, dizzy, difficulty swallowing, double vision, nerve paralysis |
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GI: C.botulinum
a) dx b) tx |
a) toxin ID in serum or food source
b) antitoxin and airway maintenance |
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rice water stools
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- cholera
|
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Vibrio parahaemolyticus
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- gram (-) bacillus
- contaminated shellfish, sushi, improperly cooked seafood - incubation: 2-24 hours - N/V/D, abd. pain - tx: self-limiting |
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GI: Preformed Toxin
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- S. aureus
- C. botulinum |
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GI: Enterotoxin
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- Vibrio cholerae
- Vibrio parahaemolyticus - Bacillus cereus - Clostridium difficile |
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GI: spores may not be killed during cooking, rice/grain dishes
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- Bacillus cereus
|
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GI: B.cereus
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- watery diarrhea, abd. pain, rectal spasm, nausea
- lasts about 24-48 hours - tx: supportive |
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pseudomembranous colitis
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- Clostridum difficile
|
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causative agent of antibiotic-associated diarrhea
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- Clostridium difficile
|
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GI: C.difficile
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- anaerobic, gpb
- spore forming - part of NL flora |
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Antibiotics involved in C.difficile infx.
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- any antibiotic can cause it
- ampicillin, clindamycin, cephalosporins are the most common causes |
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C.diff: sxs
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- may be mild or...
- bloody diarrhea, abd. cramping, fever - Latex agglutination |
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C.diff: tx
|
- discontinue antibiotics
- treat with Flagyl or vancomycin |
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Salmonella
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- >2000 serotypes
- gnb (Enterobacteriaceae) |
|
Most common species of Salmonella in the U.S.
|
- S. enteridis
- incubation 6-48 hours but may be delayed for 7-12 days |
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Salmonella reservoirs
|
- livestock, turtles, iguanas, snakes
- food sources: raw eggs, undercooked beef or poultry, cutting boards or contaminated utensils, food handler |