Core 2 Spp

Front 1

Which two bacteria are the most frequent cause of cellulitis?

How would you treat cellulitis?

Back 1

1. Staph aureus
2. Strep pyogenes

Treat with a penicillin derivative or vancomycin.

Front 2

What pathogen is associated with infection of puncture wounds?

Back 2

Clostridium perfringens

Front 3

Describe allergic rhinitis.

Back 3

Allergic rhinitis is a seasonal or intermittent nasal mucosal inflammation caused by an allergen. It is characterized by nasal discharge, congestion, itching, and sneezing.

Front 4

Describe allergic conjunctivitis.

What can alleviate associated symptoms?

Back 4

Allergic conjunctivitis is characterized by itching, redness, and irritation of the conjunctiva due to exposure to an allergen.

The itching can be relieved by second generation antihistamines or topical antihistamines.

Front 5

Describe atopic/allergic dermatitis.

What can alleviate associated symptoms?

Back 5

Atopic dermatitis is inflammation of the skin due to allergic sensitization.

Topical corticosteroids help treat the inflammation, and antihistamines can be used to reduce itching.

Front 6

What is urticaria?

What helps alleviate symptoms?

Back 6

Urticaria is a vascular reaction in the skin, sometimes allergic. (AKA hives)

Antihistamines decrease itching, particularly first generation antihistamines at night.

Front 7

Describe anaphylaxis.

How can it be treated?

Back 7

Anaphylaxis is a systemic hypersensitivity reaction that includes respiratory distress, vascular collapse, shock, and possibly death.

Antihistamines help with skin symptoms. Epinephrine is injected to help with respiratory and circulatory problems.

Front 8

Name the six viruses thought to cause the common cold.

Back 8

1. Rhinoviruses
2. Parainfluenzaviruses
3. Respiratory syncytial viruses
4. Coronaviruses
5. Adenoviruses
6. Enteroviruses

Front 9

What are the six major symptoms of the common cold?

Back 9

1. Nasal congestion
2. Nasal discharge
3. Postnasal drip
4. Throat clearing
5. Sneezing
6. Cough

Front 10

What are the four major symptoms of influenza?

Back 10

1. Fever
2. Headache
3. Myalgia
4. Weakness

Front 11

What are the eleven viruses responsible for acute pharyngitis?

What is the major bacterial cause?

Back 11

1-6. Same as common cold
7. Metapneumovirus
8. HSV
9. EBV
10. HIV
11. Influenzavirus

Group A strep is the most common bacterial cause, accounting for 10% of adult cases.

Front 12

What are the major symptoms of acute bronchitis?

Back 12

1. Cough
2. Purulent sputum
3. Fever
4. Constitutional complaints

Front 13

What is one of the most common causes of antibiotic abuse? Why?

Back 13

Acute bronchitis is one of the most common causes of antibiotic abuse because it is usually caused by a virus but physicians may prescribe antibiotics.

Front 14

What are the six viruses thought to cause acute bronchitis?

Back 14

1. Influenza A and B (higher morbidity, potential for targeted treatment)
2. Parainfluenzavirus
3. Coronavirus
4. Rhinovirus
5. Respiratory syncytial virus
6. Human metapneumovirus

Front 15

Describe the symptoms of pertussis.

Back 15

Initially, pertussis has symptoms similar to minor respiratory tract infections. A paroxysmal cough develops and is often worse at night. Coughing paroxysms often end with an inspiratory whooping sound. Sometimes vomiting occurs after a coughing fit.

Front 16

What are first generation antihistamines used for?

Back 16

First generation antihistamines are OTC drugs usually used as common cold treatments, in conjunction with decongestants.

They are not usually used for allergic rhinitis.

Front 17

Which first generation antihistamine has been implicated in the death of children under 2 years of age?

Back 17

promethazine/Phenergan

Front 18

What are some adverse effects of first generation antihistamines?

Back 18

Somnolence, interference with cognition, learning and memory impairment, decreased work productivity, impaired psychomotor performance, increased risk of on-the-job injuries

Front 19

Name four common first generation antihistamines.

Back 19

1. Diphenhydramine (Benadryl)
2. Chlorpheniramine (Chlor-Trimeton)
3. Brompheniramine
4. Promethazine (Phenergan)

Front 20

Which first generation antihistamines are used to alleviate motion sickness?

Back 20

Diphenhydramine (Benadryl) and Promethazine (Phenergan)

Front 21

What are the three most common second generation antihistamines?

Back 21

1. Cetirizine (Zyrtec)
2. Loratidine (Claritin)
3. Fexofenadine (Allegra)

Front 22

Which second generation antihistamine has no sedative effect even at high doses?

...has the best established long term safety?

...was first available OTC?

Back 22

Fexofenadine (Allegra)

Cetirizine (Zyrtec)

Loratidine (Claritin)

Front 23

A 22-year-old medical student was well until she developed sneezing, nasal congestion, rhinorrhea, and a mild sore throat four days ago. On the second day she developed a mild dry cough and malaise. She has no fever or chills. On the fourth day she went to student health because she was no better. On physical exam, her temperature was 98.6F and she was in no acute distress. She had mild inflammation of her pharynx with no exudates, and no palpable enlarged cervical nodes. Her TMs were clear and her lung were clear to auscultation.

What is her most likely diagnosis?

Wat treatment or medication would you recommend?

Back 23

Common cold.

Rest. She could take first generation antihistamines and nasal decongestants if she wanted to.

Front 24

A 23-year-old medical student went to student health with nasal congestion, rhinorrhea, sneezing, and postnasal drip. He gets similar symptoms ever September-October. He has mild headaches, but no cough, fever, or chills. He is eating well. ON physical exam, he has no fever and is in no acute distress. H efrequently sniffs and his eyes appear mildly inflamed. His nasal mucosa is mildly inflamed with clear mucus. His throat is not inflamed. He has no palpable cervical nodes and his lungs are clear to auscultation.

What is his most likely diagnosis?

What treatment or medication would you recommend?

Back 24

Allergic rhinitis and conjunctivitis.

A second generation antihistamine, like Loratidine, Fexofenadine, or Cetirizine.

Front 25

An 18-year-old college student was well until she developed nasal congestion, rhinorrhea, a cough, and body aches yesterday. Overnight she developed fever, chills, mild nausea, and headache. On physical exam, her oral temperature was 102.0F and she appeared to be in mild distress, holding her head and coughing frequently. She had moderate inflammation of her pharynx with no exudates, and small palpable anterior cervical nodes. Her TMs were clear and her lungs revealed rare crackles on auscultation bilaterally.

What is her most likely diagnosis?

Back 25

Influenza

Front 26

What is the classical location of pain associated with appendicitis?

Back 26

It starts in the periumbilical region and radiates to the lower right quadrant.

Front 27

A 26-year-old woman awakes with vague periumbilical pain, nausea, and a couple episodes of vomiting. Twelve hours later, the pain becomes focused to the right lower quadrant and she is diagnosed with appendicitis in the Emergency Room. Is the periumbilical pain more likely visceral or parietal?

Back 27

Visceral, because visceral pain is generally more vague.

Front 28

In a female of childbearing age, what illness might present similarly to appendicitis?

Back 28

Ectopic pregnancy

Front 29

Name a physical sign, besides rebound tenderness at McBurney's point, that would indicate appendicitis.

Back 29

The psoas sign: Abdominal pain with either passive extension of the thigh of a patient lying on their side (with knee extended) or active flexure of the thigh at the hip.

Front 30

Where would you most likely find rebound tenderness on a patient with appendicitis?

Back 30

McBurney's point: One third of the way from the ASIS to the umbilicus

Front 31

Is parietal pain with appendicitis usually diffuse or localized?

Back 31

Localized

Front 32

Does pain with percussion indicate appendicitis?

Back 32

Yes.

Front 33

Before a vaccine against this illness was developed, it was the most common cause of viral meningitis. What virus is it?

Back 33

Mumps

Front 34

A 4-month-old infant is brought in by his parents for a rash. He has had no recent illnesses or symptoms except for one day of fever yesterday. he is up to date on his childhood immunizations. Today he is afebrile with a nonpruritic maculopapular rash on his trunk. What is the most likely diagnosis?

Back 34

Roseola.

The rash occurs after the fever.

Front 35

A 3-year-old healthy girl presents to the ER with a rash and fever. She did have a cold/flu one week prior, which is now resolved. On exam, she has a red flushed appearance on her cheeks and a lacy red rash on her trunk and arms. What is the most likely diagnosis? When is she contagious?

Back 35

Fifth disease/parvovirus.

She was contagious until the rash appeared.

Front 36

A 3-year-old male is brought to the ER for rash and fever. His parents report a 5-day history of cough, nasal congestion, and red eyes. These findings are confirmed on physical examination along with the finding of white spots in his mouth. The parents also report that the child had accompanied a sibling to the ER 7-10 days prior to the onset of symptoms. His Temperature is 104.5F, heart rate 145, RR 33, BP 99/60. What is the most likely diagnosis? Which symptom is the giveaway?

Back 36

Measles/rubeola.

The white spots (Koplik spots) are pathognomonic.

Front 37

Infection with which virus requires complete quarantine?

Back 37

Variola

Front 38

A 27-year-old international male visiting graduate student is observed to have a maculopapular rash. Upon questioning he reports a 1-week history of a "flu" characterized by cough, nasal congestion, red eyes & fever. Over the next few days his fever continues, but his rash and cough worsen, eventually requiring hospitalization. Which virus is the most likely cause of this case?

Back 38

Rubeola/measles

Front 39

A 4-year-old girl with no underlying medical problems presents with a rash. The parents report that she had a non-specific "flu" that resolved one week prior to the rash. On exam, the rash appears as a red flushed appearance on cheeks & lacy red rash on trunk and arms. When is the child no longer contagious?

Back 39

When the rash appears

Front 40

Acyclovir causes few side effects and is suitable for treating herpes and varicella-zoster viral infections in pregnant women and children. Why is acyclovir safe for the host?

Back 40

Its activation requires a virus-specific kinase.

Front 41

A 7-month-old infant is brought in by his parents for a rash. He is up-to-date on his childhood immunizations. The parents report that he had no preceding upper respiratory illness, but a fever of 103F yesterday. The fever resolved today but in its place appeared the rash. You find a maculopapular rash on his trunk, with no blisters or apparent itching. Which virus is the most likely cause of this case?

Back 41

Roseola

Front 42

For which major viral exanthem groups do we not have a vaccine?

Back 42

Parvovirus B19 and roseola

Front 43

First-trimester maternal infection with which virus results in a high (~50%) risk of congenital malformations?

Back 43

Rubella

Front 44

A 15-year-old boy is brought in by his parents for a rash. The boy and his family recently immigrated to the US, and the parents report that he has had no childhood immunizations, and is otherwise usually healthy. The boy has been complaining of sore bumps behind his ears for the past 7-10 days and has had a mild fever that started 2-3 days ago. You observe a diffuse red blanching maculopapular rash with post-auricular lymphadenopathy. Which virus is the most likely cause of this case?

Back 44

Rubella

Front 45

What is the best treatment for most viral exanthems?

Back 45

Symptom relief

Front 46

A young immigrant male complains of a new onset blister-like rash. He is uncertain about his history of childhood illnesses or vaccines. He as a fever and his blisters are at various stages. Which virus is the most likely cause?

Until when is he contagious?

How can you treat this?

Back 46

Varicella.

Contagious until rash is crusted.

Treat with acyclovir if desired.

Front 47

A young girl is being evaluated for a blister-like rash. The rash was preceded by several days of flu with fever and body aches. The rash started on her face, then spread to her body. The rash started as red spots that becae raised bumps that then filled with fluid. Which virus is the most likely cause?

Back 47

Variola.

Quarantine her and call the CDC (after you check with Dr. Holtom, of course)!

Front 48

What is the latin name for the rash associated with roseola? Describe the general disease progression.

Back 48

Exanthem subitus.

The virus has a 5-15 day incubation period, with a fever followed by appearance of a nonpruritic maculopapular rash. Some patients may experience febrile seizures, and in rare cases the CNS or bone marrow may become infected.

Front 49

What are the three C's of measles?

Back 49

Cough, coryza, conjunctivitis

Front 50

What is the latin name for the rash associated with parvovirus B19 infection?

What is the prodromal period with this virus similar to?

Back 50

Erythema infectiosum.

Similar to flu.

Front 51

When is rubella contagious?

Back 51

One week before and up to two weeks after the appearance of the rash.

Front 52

At what point is variola no longer contagious?

How long is the incubation period? Are infected people contagious during this time?

Back 52

After the last blister crust falls off.

12-14 day non-contagious incubation.