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319 Cards in this Set
- Front
- Back
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What is the ANC for neutropenia?
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500
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What serum tests can be used for Aspergillus?
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galactomannan antigen and beta-D-glucan
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Which gram positive organisms are not covered by vancomycin?
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Leuconostoc
Lactobacillus Pediococcus |
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What should be added (specifically) if neutropenic fever is going on for 1 week despite empiric abx?
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Add antifungal - an echinocandin (caspofungin); ambpho B or voriconazone
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What is not covered by caspofungin?
What is not covered by fluconazole? |
Crypto, C. parapsilosis, Fusarium, Mucor, Aspergillus, endemic fungi (histo/blasto/cocci)
Diflucan ineffective against aspergillus and C. glabrata, C. krusei |
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What Apache score is needed for activated protein C?
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25 or higher
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What is the effect of abx prophylaxis on neutropenia? Neupogen?
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Abx- decrease the number of serious gram negative infections, but do not affect survival.
Neupogen- reduce hospital stay and resolve neutropenia |
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What is the most common inherited immunologic defect?
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Selective IgA deficiency
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What can happen with pregnancy testing in selective IgA deficiency? With blood transfusion, IVIG?
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Women can have false-positive tests.
Blood transfusion (and IVIG) is associated with higher risk of anaphylaxis. |
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What should you suspect in a patient with 3 episodes of recurrent giardiasis?
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Suspect the patient having an acquired humoral deficiency
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What infectious diseases are worse in a patient who has a splenectomy?
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S pneumoniae infection, malaria and babesiosis (both are intra-RBC parasites)
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What does recurrent Neisseria infections (gonococcus and meningococcus) suggest?
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Terminal complement deficiency (C5-C9)
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When should you screen for a classical complement deficiency? How should you do it?
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Recurrent bacterial infections with normal CBC and immunoglobulins or repeat neisserial infections.
Screen with CH50 (total hemolytic complement or THC). |
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What systemic diseases result in hypocomplementemia?
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SLE
Mixed cryoglobulimenmia 2/2 HBV or HCV PAN glomerulonephritides (some) |
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After solid organ transplantation what infectious are patients at risk for?
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Month 1- nosocomial, donor infections
Months 2-6- OI's > 6 months- community-acquired infections |
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What does rifampim block? Quinolones? Aminoglycosides? Tetracyclines? Macrolides?
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Rifampin- blocks DNA polymerase
Quinolones- blocks DNA gyrase Aminoglycosides- irreversible to 30S subunit (translation) Tetracyclines- reveversible to 30s Macrolides- reversible to 50s |
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Which abx block folic acid production?
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Bactrim and sulfa drugs
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What does disk diffusion testing tell you?
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Is the organism susceptible or resistant to particular drug
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What is the difference between concentration-dependent killing and time-dependent killing? Examples of each?
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Concentration dependent killing is dose-dependent (examples are aminoglycosides and quinolones). You get post-antibiotic effect (persistent killing even after concentration has fallen below MIC) -- can dose once daily.
Concentration-independent killing (time-dependent)- (beta-lactams), so missing a dose can cause serious risk of Rx failure. |
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What is the drug of choice for MSSA/MSSE?
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Nafcillin (or dicloxacillin, oxacillin, methicillin)
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In time-dependent killing with abx, how long should a patient's serum concentration of a drug be higher than the MIC?
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Drug concentration should be be higher for at least 50% of dosing interval.
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What coverage does ampicillin add over pcn/nafcillin/diclox? How about extended-spectrum pcn's? how about with beta-lactam inhibitors?
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Ampicillin covers some GNR.
Extended-spectrum pcn's (piperacillin)- pseudomonal coverage |
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What gene in Staph causes MRSA and MRSE?
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mecA gene - reduces affinity of all beta-lactams
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What antibiotic is indicated for meningococcal infections? What about for carrier states?
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Meningococcal infectious should be treated with penicillin.
Carrier states should be treated with rifampin or quinolones (better penetration for upper respiratory tracts). |
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What is pcn the drug of choice for (8 total)?
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-Erysipelas 2/2 Strep pyogenes
-Group B strep -Strep viridans -Pcn-sensitive strep pneumoniae -Syphilis -Leptospirosis -Actinomycosis -Neisseria meningitidis bacteremia and meningitis |
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What is an important potential complication of nafcillin and dicloxacillin?
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tubulointerstitial nephritis
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How does tubulointerstitial nephritis manifest?
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fever, eosinophilia, and rash
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What is ampicillin the drug of choice for (4 total)?
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Listeria meningitis
Salmonellosis UTI's if susceptible Enterococcal infections |
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What organisms are penicillins able to treat that cephalosporins are not?
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Enterococci and listeria (need ampicillin for both)
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What generation cephalosporin is cefazolin? keflex?
cefoxitin and cefotetan? cefuroxime? |
both cefazolin and keflex are first generation
Cefoxitin, cefotetan and cefuroxime are 2nd generation |
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What are 2nd generation cephalosporins used to treat? In what way are they better than 3rd generation abx?
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2nd generation cephalosporins are used to treat PID and postop abdominal infections.
They are better than 3rd generation's for anaerobic infections 2/2 gut flora. |
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What do 3rd generation cephalosporins (eg ceftriaxone) not treat? What does ceftaz cover that the rest of the 3rd generations not cover?
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Staph, anaerobes
Ceftazidine is the only 3rd gen that covers pseudomonas |
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In a patient that gets empiric treatment with a beta-lactam and then gets worse again, what should you suspect? What else can clue you in? How do you treat it?
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ESBL -- also suspect when there is selective susceptibility to cefepime
Treat with carbapenem |
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Does aztreonam cover pseudomonas?
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Yes it does
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What is a significant side effect of imipenem? what drug is imi given with?
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lowers seizure threshold.
it is always given with cilastatin -- impairs the metabolism of imi in the renal tubule |
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How is ertapenem different from imi and meropenem? Why is this important?
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It is once daily IV dosing with no Pseudomonal coverage.
Once daily dosing is important bc beta-lactams are normally time-dependent killing and have more frequent dosing schedules. |
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Which cephalosporins have anaerobic activity?
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2nd generation (and limited from 4th generation)
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What cephalosporins cover Enterobacteriaceae meningitis?
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3rd generation
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At what MIC should vanc not be used to treat staph?
How to prevent red man syndrome? |
MIC = 1
slowing vanc infusion or pretreat with benadryl |
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Besides pancytopenia what are other side effects of linezolid?
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Sensory neuropathy and serotonin syndrome
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Synercid (quinupristin/dalfopristin) requires what? What are side effects? Treats what?
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-Requires central venous catheter
-Side effects are myalgias, infusion rxns, thrombophlebitis -Treats VRE.faecium (not faecalis), but linezolid supplanted it |
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What does tigecycline treat? side effects?
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Everything except pseudomonas, proteus, and providencia
Side effects are nausea/vomiting |
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What type of killing is seen with aminoglycosides?
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Concentration dependent
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What should you avoid giving the same time as a quinolone?
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Cations (chelate them)
Theophylline |
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What should you avoid using a quinolone for even if isolate is sensitive to it?
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MRSA – rapid resistance
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What is given for Neisseria meningitidis prophylaxis (non-pregnant, close contacts)?
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Ciprofloxacin
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What the preferred drug for legionella?
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Levofloxacin
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What does levofloxacin lose compared to cipro?
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Antipseudomonal coverage
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How do you treat Q fever (Coxiella burnetti)?
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Tetracycline
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What does erythromycin do to warfarin level? Cyclosporine? Theophylline?
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Increases all these levels
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What is the preferred drug to treat CMV infections? Does this change if there is known acyclovir resistance?
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Ganciclovir; however acyclovir resistance predicts ganciclovir resistance, may use foscarnet instead
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What is foscarnet toxicity?
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Renal failure, electrolytes and calcium derangements
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What is used to treat RSV? What else does it treat?
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Ribavirin. Also used as part of combo Rx for hepatitis C.
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What are the 4 major classes of antifungals?
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Polyenes, imidazoles, triazoles, and echinocandins
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What is an example of a polyene?
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Amphotericin B; also topical nystatin and ampho for candida
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What are side effects of amphotericin B deoxycholate?
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Renal failure, low K+ and Mg2+, fever, phlebitis, acidosis
Hypotension with the 1st dose |
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How often to dose ampho B?
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EOD is the same as every day
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What are the advantages and disadvantage of lipid-associated ampho B of ampho B deoxycholate?
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Less nephrotoxic; better in treating cryptococcal meningitis, disseminated histo, pulmonary aspergillus, and mucor/rhizopus
However it is more expensive |
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What is in the class imidazoles? What are drug interactions and side effects?
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1) Ketoconazole – do not give in pts with H2 blockers/PPI’s bc decreased pH decreases absorption of ketoconazole
Can cause hepatitis, decreased androgen production (gynecomastia) 2) Also clotrimazole for vaginal and for tinea versicolor, ringworm Rx |
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What is in the class triazoles?
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Itraconazole, Fluconazole, Vori, Posaconzole
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What are indications for itraconazole? Side effect profile?
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Indications are for endemic fungi, oral and esophageal candidiasis (esp if fluconazole resistant), and sporotrichosis
Safer (few side effects) vs ketoconazole |
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What are indications for fluconazole?
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candidemia, candidiasis, crypto, and vulvovaginal candidiasis
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Does diflucan have good CSF penetration?
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yes it does
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Should diflucan be used empirically to treat febrile neutropenia?
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never
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Which candidal species are resistant and to what degree to diflucan?
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C. krusei is entirely resistant; C. glabrata is somewhat
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What is the coverage of vori? Side effects
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Voriconazole treats C. glabrata and C. krusei, Fusarium
Side effect is transient, reversible hallucination |
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What is the benefit of posaconazole?
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Same coverage as vori plus zygomycetes
Also FDA approved for aspergillus and candida prophylaxis |
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What are the echinocandins?
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Caspofungin and micafungin
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What is caspofungin good for?
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Drug of choice for febrile neutropenia. Invasive aspergillosis if intolerant of ampho, all candidal infections
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What needs to be given with flucytosine (in its own class) and why? Indications? Side effects?
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Flucytosine gets metabolized to 5-FU, if used alone resistance develops quickly.
Give it with ampho B to treat crypto and serious candida. Side effects are GI, hepatic, renal and pancytopenia |
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What drug treats all schistosoma? What else is this good drug for?
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praziquantel. also good for flukes and tapeworms including T.solium (neurocysticercosis)
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What are side effects or pentamidine?
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Azotemia, leukopenia, pancreatitis
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At what MIC for vanco is MRSA bactermia associated with treatment failure?
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MIC > 0.5 (so use linezolid or dapto if MIC > 1)
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What electrolyte abnormality is seen in toxic shock syndrome? How to manage it?
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Hypocalcemia -only treat if sxs or ECG signs
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What are types of coag neg Staph?
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S epidermidis and S saprophyticus
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What is the major protein on cell surface of Strep pyogenes?
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M protein
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What is erysipelas?
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Strep pyogenes cellulitis can lead to TSS
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Blood cx's in toxic shock syndrome tend to show what?
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Strep TSS - they are usually positive
Staph TSS- usually negative cx's |
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Enterococcus is treated with what? What should you not use to treat it?
What are the types of enterococcus? Which is more common? |
If simple, use penicillin G, amp, vanco. If severe - add low-dose gentamicin. Do not use cephalosporins.
Types- E. faecalis (most) and E. faecium |
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What is listeria resistant to? What can you add to ampicillin for serious infections?
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All cephalosporins.
Can add gentamicin |
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Does diphtheria present with fever? How do you treat it?
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A low fever - not a high fever
Treat diphtheria with erythromycin plus diphtheria antitoxin. |
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Who gets Corynebacterium jeikeium and how do you treat it?
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Immunosuppressed patients get it, need to treat with vancomycin
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Who gets arcanobacterium haemolyticum and what does it cause? How do you treat it?
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Adolescents causing pharyngitis, similar to S pyogenes.
Treat with pcn, erythromycin |
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What are clinical manifestations of bacillus anthracis?
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Cutaneous, pulmonic (woolsorter's disease), and pharyngeal/GI
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What does cutaneous anthrax present as?
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Painless papule --> painless ulcer --> painless black eschar --> painless induration
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What does inhalation anthrax present as? Any signs on CXR?
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Influenza type symtpoms with woresning hypoxia and hypotension and death
See mediastinal widening on CXR |
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How do you get GI anthrax and what are the sxs?
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By eating undercooked contaminated meat.
Sxs are pharyngeal eschars +/- GI distress |
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How do you treat anthrax?
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Pcn, tetracycline, erythromycin, and quinololnes
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Does bacillus cereus present acutely w toxin like S aureus?
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Yes it does
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How do you treat B cereus GI infection?
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Nothing, sxs resolve in 1 day.
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How do you treat C. tetani?
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Flagyl with tetanus toxoid and immune globulin
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Who is prone to getting Neiserria meningococcemia? Presentation?
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Patients with complement deficiency.
Presents w/ sepsis, DIC, diffuse purpura. |
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How do you treat Neiserria meningococcemia?
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Treat wit ceftriaxone + vancomycin.
Also need to give a prophylactic drug bc pcn does not penetrate the anterior nares where it can colonize. |
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How do you prophylax close contacts of patient with N. meningitis infection?
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Treat with rifampin, fluoroquinolones, ceftriaxone (if pregnant), and aizthro.
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What does N. gonorrheae look like on Gram stain?
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Gram negative diplococci
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What is ecthyma gangrenosum?
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Round, indurated black lesion with central ulceration seen with Pseudomonas bacteremia
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What is the management of hot tub rash?
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Self-limited (results from improper cholrination)
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What is included in Enterobacteriaceae?
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SPACE organisms, salmonella, yersinia, shigella, Enterobacter
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How does Salmonella typhi present? How do you get it?
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Typhoid fever from contaminated food, milk, or water.
Presents with leukopenia and rose spots (2-3mm angiomas) 1 wks after fever. |
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What travel destinations warrant typohhoid vaccine?
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Latin America, Asia and Africa
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What is the ddx for coming home from hunting with LAD?
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Yersinia pestis and tularemia
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What is the clinical manifestation of the plague? How do you diagnose it? How does it differ from tularemia?
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Buboes (localized LAD that is suppurative), also can have pneumonic form (very contagious).
Diagnose by aspirating LN's. Plague is usually in the desert southwest. |
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How do you treat plague?
How do you treat tularemia? |
Streptomycin
Streptomycin |
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How is francisella tularensis transmitted?
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By ticks or also inhaled and ingested.
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What to suspect if you see an irregular ulcer at the site of a tick bite for months?
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Tularemia
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What does bartonella henselae cause in immunocompromised patients?
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Bacillary angiomatosis
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What is bartonellosis and what is it caused by? How is it transmitted?
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Bartonellosis is caused by bartonella bacilliformis -- Oroya fever and chronic verruga peruaa.
Transmitted by sand flies in the Andes Mountains in Peru. |
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What is oroya fever?
Verruga peruana? How do you treat Bartonella bacilliformis? |
Rapid, febrile hemolytic anemia w/50% mortality.
Verruga peruana is chronic cutaneous lesions. Treat bartenollosis with chloramphenicol (bc Salmonella commonly co-infects) or tetracycline. |
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How does bacillary angiomatosis present? How do you terat Bartonella henselae?
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Verruga peruana
Treat with rifampin |
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What to labs show in RMSF? How do you treat?
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Pancytopenia, hyponatremia, increased LFT's
Treat with tetra/doxy or chloramphenicol |
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What is Q fever caused by and how is it transmitted? Who gets it? How do you treat it?
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Q fever is caused by Coxiella burnetti. It is transmitted by inhalation via animals.
Seen in slaughterhouse workers and with people birthing animals. Treat with doxy if needed (usually self-limited). |
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What is ehrlichia similar to and how? How does it differ from this?
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Ehrlichia is similar to RMSF- spread by ticks, pancytopenia, treated w/doxycycline.
Different from RMSH-- "spotless RMSF" bc no rash. |
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What organism is seen in bacterial vaginonsis and what is managment of it?
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Gardnerella vaginalis. Treat with flagyl.
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What does acid-fast bacteria mean?
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Red on a green background
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How does Mycobacteria marinum present? How do you treat it?
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Non-healing skin ulcers usually along lymphatics.
Treat with ethambutol+rifampin. |
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How does Nocardia stain? What is its morphology?
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Weakly acid-fast, so it is easily missed.
Beaded, branching, filamentous. |
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Where in the body does Nocardia asteroides like to invade?
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It usually starts as a lung infection (thin-walled cavitary lesion) but can cause a chronic, neutrophilic meningitis; brain abscess; nodular skin lesions.
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How do you treat Nocardia?
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High dose bactrim, can add aminoglycosides and imipenem.
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What is nocardia brasiliensis and how do you get it? How do you treat it and what not to give?
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Like M. marinum it causes skin lesions along the lymphatics.
It is in the soil. Rx with sulfa/bactrim again but it is resistant to imipenem (unlike N. asteroides). |
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What is the usual presentation of actinomycosis?
What else can actinomyces affect? |
Cervicofacial involvement (lumpy jaw) - yellow 'sulfur' granules.
Can cause PID when there is an IUD in place. |
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How do you treat actinomyces?
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Treat with pcn or ampicillin.
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What is a physical exam finding associated with C. psittaci PNA?
What is on the ddx? |
Splenomegaly.
Histoplasmosis (assoc with bird and bat droppings) also causes PNA and splenomegaly. |
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What is trachoma and where is it usually found?
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Trachoma is a chronic external eye infection causing cataracts
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What does 'nickel and dime' lesions on the palms and soles describe?
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Secondary syphilis
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Strokes are seen in which stage of syphilis? How far after the secondary syphilis stage does tertiary occur?
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Secondary syphilis.
Tertiary syphilis occurs in about 1/3 of patients within the next decade. |
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What does tertia syphilis cause?
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Gummas (soft granulomas), aortitis and neurosyhpilis (tabes dorsalis), Argyll-Robertson pupils.
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What is MHA-TP ab the same as?
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FTA-abs.
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What does a negative RPR but positive MHA-TP/FTA-abs represent?
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Long standing untreated tertiary disease, or false positive 2/2 cross-reacting ab's from Lyme infection
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What does a positive RPR and negative MHA-TP represent?
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Early infection or false positive in a low-risk population (repeat in 6 weeks)
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What do Lyme disease ab's cause false positives in?
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FTA-ABS and MHA-TB but not in VDRL/RPR
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In what cases does VDRL or RPR become negative?
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After successful treatment but also in untreated people with tertiary syphilis.
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What is the screening procedure for pregnant women and syphilis?
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They should all get a non-treponemal test (RDR/VDRL) at 1st trimester; if high-risk, repeat at 3rd trimester and delivery.
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What is duration of treatment for primary and early secondary syphilis? What about late secondary and tertiary?
What do you treat with and what if pcn-allergic? What about neurosyphiis? |
Duration of treatment is 2 weeks or 3 weeks (4 weeks if doxy).
Treat with pcn, if pcn allergic doxy. If pregnant then de-sensitive the pcn allergy. If neurosyphilis then PCN or ceftriaxone - not doxy. |
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What kind of organism is leptospirosis from? How is it transmitted?
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Spirochete (Borrelia, Lepto, Treponema)
Transmitted via animals or contaminated water. |
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How does leptospirosis manifest?
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Sxs vary but can include fevers/aches/meningitis/Weil syndrome (severe hepatitis w/renal failure and bleeding)
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What is a clue for leptospirosis? How is it diagnosed and treated?
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Hx of contact with dog or rat urine
Diagnosed with blood or CSF cx's on special media w/in the 10 days. After that, cx urine and send blood for ab's. Treat w PCN or doxy. |
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What organism is carried by the Ixodes tick?
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Borrelia burgodrferi (Ixodes pacificus) and Babesia (Ixodes scapularis)
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How long does a tick need to be feeding on someone to transmit Lyme disease? What is management if it is definitely less than this time?
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It takes 2 days -- if tick was only there for 1-2 hours then you can reassure that no Rx is necessary.
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What are the stages of Lyme disease?
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Stage 1- erythema migrans and constituinal sxs
Stage 2- weeks/mths later-- neuroloic problems like Bell palsy, myocarditis causing rapidly alternating degrees of heart block Stage 3- months to years later- oligo or migratory arthritis |
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How do you diagnose stage I Lyme disease?
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Serology is mostly negative this early on so based on history/exam.
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If a patient presents with erythema migrans do you ever check for Lyme serology?
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No -- just treat
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If there is a positive serology (ELISA) for Lyme disease, what next?
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Confirm with Western Blot because there is a high rate of false positives.
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How do you treat Lyme disease?
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Depends on manifestation:
Early disease and Bell palsy- doxy or amoxicillin x 3 weeks Arthritis- doxy/amoxi x 4 wks, and another 4 weeks if incomplete resolution. If refractory can try synovectomy and/or plaquenil Cardiac and neuro- ceftriaxone x 3 weeks |
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What does thrush do if you try to scrape it off?
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It will come off and leave an erythematous base and maybe bleed
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What is the treatment of candidemia?
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If non-neutropenic - diflucan
If neutropenic- caspofungin or ampho/ vori |
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What should you suspect if a fungemic neutropenic patient develops fever and pain in RUQ, transaminitis? How can you diagnose this?
How do you treat it? |
Hepatosplenic candidiasis - CT abd will show small abscesses in liver and spleen.
Treat with lipid ampho followed by diflucan |
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In whom should candida in urine be worrisome and how to further evaluate regardless?
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In diabetics, recent GU manipulation, and systemically ill.
Further evaluate with u/s or CT scan |
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What should you not use to treat candida in urine?
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lipid ampho (does not penetrate the kidneys)
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What disease can coccidiomycosis mimic? What does pulmonary lesion look like?
How do you treat it? |
Sarcoidosis (erythema multiforme, erythema nodosum, arthralgias).
"coin-like" lesion Most patients- no treatment, it is self-limited. Can use itraconazole or diflucan. If severe use ampho B. |
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What pulmonary disease does Histo sometimes mimic?
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TB -- it can cause a cavitary PNA
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Who gets blastomycosis? Manifestations?
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Arkansas and Wisconsin hunters and loggers.
flu-like, similar to bacterial PNA, has skin involvement (verrucous lesions w/ulcerations), bone lesions |
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Histo manifestations? Diagnosis?
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interstitial PNA, ulcers, splenomegaly
if immunocompetent may need path for dx. if immunocompromised cx's and the Ag may be enough. |
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How do you treat tinea corporis (ringworm)? Tinea capitis (hair follicles)?
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Ringworm with topical clotrimazole; if needed, itraconazole or terbinafine.
Tinea capitis with oral griseofulvin. |
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How do you treat sporotrichosis? What is the differential for its presentation?
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Oral potassium iodide or itraconazole.
Mycobacterium marinum also causes lesions over the lymphatic channels. |
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What are RF's for rhizopus?
|
Diabetes, hemochromatosis (iron overload patients on deferoxamine chelation), and immunocompromised
|
|
|
What are fungi that can cause a necrotizing, cavitating PNA?
|
Aspergillus and zygomycetes (Mucor, Rhizopus)
|
|
|
What are the 2 types of parasites? Which one(s) cause eosinophilia?
|
protozoa and helminthic organisms
Only the worms cause eos |
|
|
What are examples of the protozoa?
|
toxo, crypto, babesia, plasmodium (malaria), ameba, giardia, trichomonas, leishmania, trypanosoma
|
|
|
What are the 3 types of protozoa?
|
Sporozoa, Ameba, Flagellates
|
|
|
What are examples of sporozoa?
|
Toxo, cryptosporidium, isospora, plamodium, PCP, babesia
|
|
|
Examples of Ameba and flagellates?
|
Ameba- Entameba histolytica
Flagellates- GI- giardia; GU- trichomonoas- blood- Leishmania, Trypanosomes |
|
|
What is the definitive host of Toxoplasma gondii?
|
Cats
|
|
|
When is toxoplasmosis a serious infection in immunocompetent people, and how is it diagnosed?
|
Serious only if acquired during pregnancy (risk of congenital toxo).
However the women are usually asymptomatic - dx with ab titers that are rising. |
|
|
How does toxo manifest in immunocompromised patients and how is it diagnosed?
|
It manifests with multiple mass lesions.
Because it represents reactivation, serum titers do not help. Clinical dx. |
|
|
How does ocular toxo present?
|
Causes retinal lesions that look like yelllow-white cotton patches (ddx for cotton wool patches is candidiasis).
|
|
|
How do you treat toxoplasmosis?
|
Pyrimethamine and a sulfa x 3 weeks. If AIDS, Rx until CD4 goes up.
|
|
|
How is cryptosporidium transmitted? How is it diagnosed? What is on ddx as another OI if pt w/AIDS and how is it differentiated?
|
In any animal feces including human (unlike toxo which is just cats' feces)
It is diagnosed with acid-fast stains- small and round. Isospora belli - also acid-fast but it is large and oval |
|
|
What is a 3rd acid-fast protozoa causing diarrhea and what is RF for it?
|
Cyclospora. Clue is raspberries from Guatemala.
|
|
|
What is the vector for plasmodium?
|
Anopheles mosquito.
|
|
|
What are the types of malaria? Which is the worst? What is seen on blood smear with this type?
What do schizonts on a blood smear indicate? |
P. vivax, P. ovale, P. malariae, and P. falciparum.
P. falciparum. See 'banana-shaped gametocytes' -- diagnostic Schizonts are seen only with one of the other 3 types. |
|
|
What is the RBC antigen that P vivax takes advantage of?
What is the renal involvement in Plasmodium? |
The Duffy RBC antigen.
Any of the malaria subtypes can cause nephritis from immune complex deposition. P. malariae is associated with nephrotic syndrome. |
|
|
What is treatment for non-falciparum plasmodium?
|
Treat P. vivax, ovale, and malariae with chloroquine. For P. vivax and ovale also use primaquine for getting rid of liver involvement.
|
|
|
What needs to be done before treating someone with primaquine?
|
Primaquine induces hemolytic anemia in G6PD deficiency.
Screen for G6PD deficiency before prescribing primaquine. |
|
|
What needs to be considered in treating P falciparum? How do you treat?
|
Chloroquine resistance.
If resistant, use atovaquone/mefloquine |
|
|
What should be used for malaria prophylaxis?
|
Chloroquine if no resistant falciparum is present -- start 1-2 wks before and 4-6 after leaving.
If resistant areas, use mefloquine/atovaquone. can use primaquine in addiiton if known P. vivax or P. ovale in area. |
|
|
How does babesia present? What is the vector?
Where is it most prevalent? |
Febrile hemolytic anemia, can last for months. Hemoglobinuria is a predominant sign, and patients are often emotionally labile.
Vector is Ixodes tick (like Lyme disease). It is most prevalent in the Northeast U.S. |
|
|
What is the association between asplenia and babesia? malaria?
|
More severe disease with asplenia
|
|
|
How do you distinguish babesia from plasmodium?
|
intra-RBC pear shapes which can form a tetrad causing a Maltese cross
|
|
|
What does babesia often coexist with?
|
Ehrlichia and borrelia
|
|
|
What are RF's for getting Entamoeba histolytica?
|
Imprisoned, immigrants, and MSM
|
|
|
How do you diagnose amebiasis?
|
Dx extraintestinal manifestation (liver abscess) with serology. The abscess is usually nonsuppurative and no ameba seen on aspiration.
Dx intestinal disease with stool inspection. |
|
|
How do you treat amebiasis?
|
Flagyl for the abscess! (no benefit to draining it)
Also treat intestinal disease regardless of sxs - use paramomycin or iodoquinol. |
|
|
Who gets giardia? What in the body does it infect?
What is the most common manifestiation? |
Campers, travelers, children in daycare, HIV+, MSM, IgA deficiency.
It infects the duodenum 3/4 people who are infected are asymptomatic. |
|
|
How do you diagnose giardia?
|
Microscopy on fresh stool samples x 3, or Giardia ag on stool x1
|
|
|
What are the types of trypanosoma infections?
|
Trypanosoma brucei is sleeping sickness caused by the tsetse fly
Trypanosoma cruzi is Chagas disease |
|
|
What is the most common cause of CHF in Brazil?
|
Chagas disease
|
|
|
What does infection with Leishmania donovani cause? Vector?
|
L. donovani causes visceral leishmaniasis (kala-azar) - GI sxs, hepatosplenomegaly.
Transmitted by sand flies. |
|
|
Sand flies can transmit what diseases?
|
Bartonella brucellosis (oroya fever and Peruvian warts) and Leishmaniasis (kala-azar)
|
|
|
What type of worm will cause rectal itching?
|
Pinworm (Enterobius)
|
|
|
What worm will cause cutaneous larva migrans?
|
Hookworm (eg Necator americanus)
|
|
|
What worms are found in pork?
|
Tapeworm (Taneia solium) and Trichinella
|
|
|
What infection causes elephantiasis and how? What is the mode of transmission?
|
Wuchereria bancrofti - blocks lymphatics.
Transmitted by mosquito (but requires a lot of bites to get this). |
|
|
Why does it require a lot of mosquito bites to get elephantiasis from Wuchereria bancrofti?
|
Unlike protozoa, worms (helminths) do not multiple in the body except for Strongyloides
|
|
|
What is unique about Strongyloides?
|
It is the only helminthic organism that replicates in the body Can last for decades.
|
|
|
What worms cause pulmonary issues?
|
Strongyloides (in addition to GI), and Toxocara canis (causes visceral larva migrans which presents with fleeting migratory pulmonary infiltrates that self-resolve.
|
|
|
What is the host for toxocara canis?
|
Dog
|
|
|
What worm is a problem for travelers returning from the South Pacific? How is it transmitted?
|
Rat lungworm (Angiostrongylus) - causes eosinophilic meningitis.
Transmitted thru snails, crabs, shrimp |
|
|
What other worm causes eosinophilic meningitis besides angiostrongylus? How do you get it?
|
Baylisascaris. Via ingested raccoon droppings.
|
|
|
What are the presentations of Taenia solium?
|
If cysticerci are ingested - tapeworm grows in the intestines (taeniasis).
If egg-contaminated food are ingested -- cystercosis. |
|
|
How does cystercosis manifest and at what point after ingestion?
|
It will go to the CNS and eyes. The cysts do nothing until the organism dies -- then causes inflammation.
Seizures are the first sx. Suspect if pt is or is close to a Mexican immigrant. |
|
|
If incidental findings of calcified lesions on brain imaging with no hx of clinical disease, what is the management?
|
No treatment necessary.
|
|
|
What parasitic infection is associated with eating raw fish? How does it manifest?
|
Clonorchis (Chinese liver fluike) - endemic in the Far East. Can present w/ biliary obstruction.
|
|
|
What is Katayama fever and when does it happen in the course of infection?
What is the most serious complication of schistosomiasis? |
Acute schistosomiasis, 2 months after inoculation.
Presents with fever, LAD, diarrhea. Most serious complication is cirrhosis w/ esophageal varices (in addition the cystitis..) |
|
|
How do you treat flukes (including Schistosomiasis and clonorchis)?
|
Treat with praziquantel x 1 day only
|
|
|
What is the most common infectious cause of blindness in the developed world?
|
Recurrent HSV-1 eye infection causing keratitis
|
|
|
What does the Tzanck smear show when it is positive? What is it positive in?
|
It is positive in HSV and VZV.
Tzanck smear shows multinuclearted giant cells |
|
|
What are temporal lobe seizure symptoms?
|
Abnormal behavior, smelling burning rubber
|
|
|
What should you use to treat HSV if the strain is acyclovifr-resistant strain?
|
Forscarnet (as in CMV). Ganciclovir has similar resistane pattern
|
|
|
How do you avoid transmission of HSV to babies? What is a RF for transmitting to babies?
|
C-section if signs or sxs of genital herpes or prodrome at delivery
RF is if it is first occurrence. (less risk if mom has recurrence) |
|
|
What would MRI brain show in pt with HSV encephalitis?
|
It may show abnormalities in the temporal lobes.
|
|
|
When do you not treat neurocysticercosis with antiparasitic? How about no treatment?
|
Do not need to treat with antiparasitic (only steroid initially) if cerebral edema/inflamation.
No treatment if only calcified dz, no hx of clinical disase |
|
|
What is the management of pregnant women exposed to chickenpox? What should not be given?
|
Zoster immune globulin w/in 4 days. If after 4 days, it is not indicated anymore.
Do NOT give varicella virus vaccine bc it is a live virs. If present w/in 24 hours of developing rash, treat with acyclovir x 5 days as well. |
|
|
What is the role of prednisone in treating shingles? does it differ by pt population?
|
In immunosuppressed patients it will prolong the course.
In immunocompetent, there is no benefit at all. |
|
|
How do you treat zoster and what is the benefit?
|
High dose acyclovir alone treats zoster (<72 h of vesicle formation)-- shortens the course of acute illness, but does not impact posterherpetic neuralgia.
Only famciclovir and valacyclovir will decrease postherpetic neuralgia. |
|
|
At what point in clinical presentation do you treat zoster (if they present with a prodrome is it indicated?)?
|
Only when vesicles form
|
|
|
Who gets vaccinated for shingles?
|
All people 60 and older; not if immunosuppressed
|
|
|
How does CMV infection manifest in an immunosuppressed patient?
|
Post-transplant: brain/liver/GI/adrenals/eye. encephalitis, hepatitis, colitis, adrenalitis (causing AI), and retinitis.
HIV/AIDS (CD4 < 100): eyes/lungs/GI tract. chorioretininits (distinctive), pneumonitis, esophagitis, colitis |
|
|
How do you treat CMV chorioretinitis?
|
Ganciclovir +/- foscarnet
|
|
|
What is a manifestation of EBV infection in HIV patients?
|
Hairy leukoplakia - mucocutaneous lesion, white, adherent; usually on border of tongue
|
|
|
What is seen on CBC diff in EBV-infected patients? What is on the differential for a patient who is heterophil-negative w/mono sxs?
|
> 10% atypical lymphocytes.
HIV and CMV. |
|
|
What is German measles known as? How is it diagnosed? What if it is negative in a newly exposed pregnant patient? What if it is positive?
|
German measles = rubella. Diagnosed with hemagglutination inhibition test. If negative, repeat it in 3 weeks.
If positive -- offer patient option of therapeutic abortion. Immune globulin may give fetal protection. |
|
|
What does rubella present with?
|
Postauricular adenopathy, mild illness, "3 day measles." "morbilliform" aka measles like rash beginning on face and extremities.
|
|
|
What is rubeola? Symptoms?
|
Measles. Cough, coryza, conjunctivitis w/photophobia.
Koplik spots (whitish spots on erythematous base) on buccal mucosa before the rash. Skin rash starts at hairline and spreads downwards, lasts 5 days. |
|
|
What does HTLV-1 cause?
|
T-cell leukemia and spastic tropical paraparesis (Japan and Caribbean)
|
|
|
What is the window for treating influenza?
|
48 hours. but the earlier the better for reducing duration.
|
|
|
What is SARS and who should you suspect it in?
|
SARS is Severe Acute Respiratory Sydrome. Suspect in someone who traveled to Asia recently and has early flu-like sxs w/quick progression.
|
|
|
How does polio present?
|
Mostly self-limited- aseptic meningitis and asymmetric and areflexic; flacid paralaysis
|
|
|
What animals usually carry rabies?
How soon after exposure does it present and what is presentation? |
Bats, raccoons (not squirrels), skunks and foxes.
Presents w/in 1-3 months, w/viral prodrome and then encephalitis and hydrophobia/choking; may mimic Guillain-Barre. Diagnosed w/saliva, skin, brain bx, CSF. Not serology. |
|
|
Who should get vaccinated?
How to treat? What if person has been previously vaccinated? |
Vaccinate cave explorers, vets, bat handlers.
Treat w/immune globulin in tissues around the wound. If previously vaccinated only needs a booster though. |
|
|
When does mumps most commonly occur? What is presentation? Complication of it?
How do you differentiate bacterial parotitis from mumps? What else is on ddx for enlarged parotid glands? |
Winter/early spring.
Parotitis, aseptic meningitis/encephalitis, epididymo-orchitis (usually unilateral). Complication- rarely can have post-infection sterility. Differentiate by checking Gram stain of parotid secretions - will be sterile. Also on ddx is frequent vomiting. |
|
|
What is erythema infectiosum? In another manifestation of the virus causing this, what is seen on BM biopsy?
|
5th Disease caused by Parvovirus B19. Slapped cheek rash + arthritis.
In aplastic anemia, will see giant pronormoblasts in BM |
|
|
What is the most common type of arbovirus? What is the presentation?
|
West Nile virus. most are asymptomatic but can present with fever, headache, encephalitis
|
|
|
What infection is transmitted with deer mouse or cotton rat as reservoir? How does it present?
|
Hantavirus. Presents with myalgias, fever, cough --> ARDS and death. See severe hemorrhagic PNA w/ thrombocytopenia.
|
|
|
What causes Dengue fever and what is the vector? Where is it seen more commonly? How does it present? What is a more serious complication?
|
Flavivirus, vector is Aedes mosquito. Seen in South America and Mexico.
Dengue fever presents w/high fever, myalgias and arthralgias ("Breakbone fever", severe h/a and a red rash covering most of the body. "Saddleback fever" -- temp goes up, then down, then resurgence. Dengue hemorrhagic fever. shock, spontaneous bleeding |
|
|
What CD4 count is associated with JC virus reactivation in HIV? Presentation and diagnosis?
|
CD4 < 200 -- to get PML. Presents w/altered MS with varied motor/sensory deficits.
Dx w/MRI-- demyelinating lesions and brain bx. or CSF PCR. |
|
|
What is a rare complication of measles? Presentation?
|
SSPE (subacute sclerosing panencephalitis) - seen in pts who had measles < 2yo, then new dementia and seizures. Represents defective measles virus.
|
|
|
What are examples of prion diseases and how do you get them?
|
Creutzfeldt-Jacob is sporadic, but 5% from infected corneal transplants
Mad cow disease (variant CJ) Kuru in New Guinea by ingesting raw human brain tissue |
|
|
How do you diagnose prion disease besides brain bx? Presentation of mad cow disease?
|
EEG is diagnostic
Mad cow disease- young person from England w/ progressive psych sxs and ataxia |
|
|
How does HIV bind to CD4 T cell?
|
It has gp120 antigen that will bind to both CD4 and CCR5 molecule
|
|
|
Infections in AIDS patients- is there an increase in infections only that are cell-mediated?
|
No - also with infections seen with humoral deficiency (larger B cell population 2/2 deregulation from CD4, but decreased function)
|
|
|
What is the pathogenesis of HIV dementia? HIV enteropathy?
|
Direct infection of HIV in glial cells or in GI epithelium
|
|
|
How do you diagnose HIV?
|
Elisa -- then confirm with Western blot. HIV PCR DNA is the earliest way to detect HIV -- yes or no re infection. (vs viral load which is HIV RNA)
|
|
|
How does viral load influence decision to treat HIV? Why?
|
VL > 1 million should be treated regardless of CD4 count. The viral set point - which is VL after the body's immune sys has tried to control infection- determines ultimate course of the disease (develop AIDS earlier if high).
|
|
|
What are the classes of ART therapy?
|
NRTI, NNRTI, PI, fusion inhibitor, integrase inhibitor
|
|
|
What are common examples of Nucleoside RTI's? Side effects?
|
-Zidovudine or AZT
-ddI (didanosie)/d4t (stavudine) -3TC (lamivudine), emtricitabine -abacavir ZDV causes BM suppression, myopathy. AZT causes lipoatrophy after 5 years. ddI, d4t cause panceatitis and peripheral neuropathy, mitochondiral toxicity. abacavir- hypersensitivity rxn w/in 4 weeks |
|
|
What to do with abacavir hypersensitivity? Any way to prevent this?
|
Can check HLA B-5701 gene.
If pt had the reaction, never give it again bc can cause death next time |
|
|
What are examples of Nucleotide RTI's? Side effects?
|
Tenofovir - asthenia, h/a, GI. azotemia/AKI
|
|
|
NNRTI example + side effects?
|
Nevirapine -- rash is main toxicity
Efavirenz - teratogenic |
|
|
Protease inhibitor examples and side effects? What med should be avoided with PI?
|
Indinavir. All PI's except nelfinavir are given w/ritonavir to boost PI level.
Fat redistribution, lipid abnormalities (hyperTG and LDL), DM 2, Osteoperosis are side effects. Do not use sinvastatin or lovastatin with any PI's in treating lipid abnormalities. |
|
|
What PI is associated with long QT?
|
Saquinavir
|
|
|
What are side effects of ritonavir? Indinavir? Nelfinavir? Atazanavir?
|
Nausea, flushing, taste changes.
Indinavir causes asymptomatic hyperbili and kidney stones. Nelfinavir causes diarrhea and rash. Atazanavir is a PI and causes indirect hyperbilirubinemia |
|
|
What is efavirenz and what are side effects?
|
Efarivirenz is an NNRTI - teratogenic but also causes bad dreams
|
|
|
Which PI is not associated with hyperlipidemia?
|
atazanavir
|
|
|
When should viral load be tested in pt with HIV who 1) just started therapy? 2) on therapy? 3) not on therapy?
|
1) just started - check in 1-2 months
2) on therapy - every 3-4 months 3) off therapy - every 3-4 months |
|
|
Who gets tested for viral resistance?
|
Everyone before starting Rx, or when switching Rx's due to failure of Rx
|
|
|
If asymptomatic at what CD4 level do you start ART? What are other indications besides AIDS defining illness?
|
CD4 < 350.
Also if CD4 declining > 100/year, if VL > 100,000, pregnancy, HIV-associated nephropathy, or if getting Hepatitis B treatment |
|
|
What is the best predictor of long-term outcome in HIV?
|
Viral load
|
|
|
Do you give post-exposure prophylais for HIV intact skin exposures? Urine-source exposures?
|
No for both
|
|
|
What is the treatment for post-exposure prophylaxis in HIV exposure?
|
HAART for 4 weeks
|
|
|
If a woman is already on ART and becomes pregnant then what? What is the goal? What if she is not on ART and becomes pregnant? What drug should she not use?
|
If on ART already then continue it, goal is to reduce VL to 0.
If not on ART then start ART and add Zidovudine (shown to reduce maternal-fetal transmission). She should not use efavirenz (teratogenic) and nevirapine (if CD4 > 250 -- hepatotoxicity) and d4T/ddI (lactic acidosis) |
|
|
How do you manage the actual delivery? What is the management of infants?
|
Zidovudine should be infused continuusly during labor in addition to the HAART. C-section if VL > 1,000.
Infants should get zidovudine for 1.5 months. |
|
|
What if you suspect primary HIV infection and the Elisa is neg, Viral load is < 10,000 (but present)?
|
Repeat viral load to look for false-positive
|
|
|
What can hairy leukoplakia be associated with?
|
HIV
|
|
|
What is the most common opportunistic infection in AIDS? What kind of onset? When do you start prophylaxis?
|
PJP -- it has an insidious (not acute) onset
Give prophylaxis at CD4 < 200 or if the patient has oropharyngeal candidiasis. |
|
|
What is Rx of PJP?
|
If mild- bactrim or atovaquone
If moderate/severe- PaO2 < 70 or A-a > 35 -- Bactrim x 3 weeks and steroids |
|
|
What are side effects of pentamidine?
|
Fever, n/v, diarrhea, renal failure.
Recurrent pentamidine destroyes islet cells of pancreas causing hypoglycemia; also hyperglycemia. Check a glucometer if a patient on pentamidine seizes. |
|
|
What does bactrim protect against besides PJP?
|
Toxoplasmosis
|
|
|
What does CXR look like in TB in AIDS patients?
|
Hardly ever cavitation and sometimes no infiltrates.
|
|
|
How do you treat MAI infection? How do you prevent it?
|
Clarithromycin and ethambutol +/- rifampin
Prophylaxis if CD4< 50. |
|
|
How do you treat cryptococcal meningitis in HIV? Prophylaxis?
|
Ampho B + flucytosine x 2 weeks and then oral diflucan for consolidation.
No primary; give diflucan as secondary |
|
|
How do you treat severe histoplasmosis? Prophylaxis?
|
Liposomal (not deoxycholate) amphotericin B x 2 weeks and then itraconazole for consolidation.
Primary prophylaxis with itraconazole if CD4 < 150 in endemic area. Secondary prophylaxis w/ daily itraconazole. |
|
|
What fungal disease can resemble sarcoidosis and how? How do you treat it? Prophylaxis?
|
Coccidioides - hilar adenopathy, arthralgieas, erythema multiforme, and erythema nodosom.
Treat with ampho B or diflucan if meningitis. Primary prophylaxis if CD4 < 250 in endemic area. Secondary with daily diflucan. |
|
|
What infection is associated with marijuana use in HIV? What presentation does it have in common with zygomycetes (rhizopus, mucor)?
|
Aspergillus.
Both can cause a necrotizing cavitating pneumonia |
|
|
How do you treat esophageal candidiases? Long-term management?
|
IV fluconazole or itraconazole suspension
HAART is the best long-term management. |
|
|
How do you treat Cryptosporidia? Cyclospora? Isospora?
|
HAART.
Cyclospora and Isospora with bactrim |
|
|
How do you treat toxo?
|
Pyrimethamine + sufadiazine x 6 weeks.
Or can use clinda + leucovorin. |
|
|
When do you stop giving prophylaxis for PJP? for MAC?
|
PJP - when CD4 > 200 x 3 months
MAC - when CD4 > 100 for 3 months (note CD4<50 is the indication) |
|
|
What is the most common cause of endocarditis? 2nd most common? What is the most virulent?
|
S. aureus is both the most common and most virulent.
S. viridans is the 2nd most common. |
|
|
What is the management of prosthetic valve endocarditis? Does it matter what time of prosthetic valve?
|
If < 2 months out of surgery, needs emergent surgery.
If > 2 months out and in the 1st year, usually it is S. epidermidis. and usually needs surgery (invades annulus). If it is S. viridans though abx may be enough. Bioprosthetic valve usually has better outcome than metal valves. |
|
|
How many sets of blood cultures should be drawn in a patient suspected of having endocarditis?
|
3 sets
|
|
|
How many blood cultures need to be positive to meet Duke Criteria?
|
2 positive for a typical organism, and 3 positive for an atypical organism (unless pt is immunosuppressed or has a prosthetic device). If Coxiella burnetti -- any 1 blood dx is positive!
|
|
|
What are HACEK organisms and how do you treat them?
|
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella.
Susceptible to beta-lactams (ceftriaxone x 4 weeks) |
|
|
What is TEE's negative predictive value for native valves? prosthetic valves?
|
nearly 100%; significantly lower
|
|
|
What are the modified Duke criteria? What is required for definite IE?
|
Either: pathologic evidence of disease, 2 major, 1 major + 3 minor, or 5 minor.
Major (2) positive blood cx's (see above) and abnormal echo Minor (5): predisposing condition, fever, vascular phenomenoa, immunologic phenomena, +blood cx's not meeting major criterion |
|
|
What in general changes treatment duration for endocarditis?
|
If S viridans or MSSA you add gent in a native valve can reduce it to 2 weeks. (MRSA or CONS is 4-6 wks)
If a prosthetic valve, will be 6 weeks (with vanc/nafcillin, gent and rifampin) |
|
|
What is the role of aminoglycosides in meningitis?
Who gets ampicillin? |
Poor CSF penetration but still used for synergy in treating listerial meningitits.
Give amp for empiric treatment to those above 60 yo. |
|
|
When should you consider amebic meningitis?
|
Patient swimming in brackish water (cow ponds)
|
|
|
Where geographically is there a higher incidence of raccoon bite-induced meningitis? What is it due to?
What is characteristic of it? Ddx? |
In California - nematode parasite Baylisascaris on raccoons
Eosinophilic meningitis (ddx - Coccidioides) |
|
|
What meningitis will sometimes have CN palsies with it? What is also seen on imaging?
|
TB meningitis, especially abducens. Lyme meningitis - CN 7.
Look for basilar enhancement on CT scan. |
|
|
How useful is CSF VDRL in neurosyphillis diagnosis? CSF FTA-ABS?
|
CSF VDRL is 100% specific, 50% sensitive.
CSF FTA-ABS is very sensitive but not specific enough. |
|
|
When should you give abx empirically for infectious diarrhea? What should you use and why?
When is it appropriate to not give abx and why not? |
Treat empirically if there are fecal WBC's, can give cipro to treat shigella/campylobacter.
If salmonella - abx may prolong infection. If Ecoli O157:H57 - abx may increase risk of HUS. |
|
|
What kind of testing is needed for Cryptosporidium diarrhea?
|
acidfast stains of stool
|
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What is a risk factor for severe vibrio vulnificus disease? How does this manifest?
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Immunocompromised and chronic liver disease
Manifests with sepsis and skin infections |
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What is a chancroid and what causes it? How do you treat it?
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Chancroid is tender genital papules, very painful LAD also. Caused by H. ducreyi.
Treat with ceftriaxone x1 or azithro x1 |
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What is LGV and how does it present? What causes it? Treatment?
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LGV starts w/painless papule --> ulcerates and then disappears. Inguinal LAD then appears. Caused by Chlamydia trachomatis.
Treat with doxy x 3 wks. |
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What about donovanosis? What causes it, how does it presenta nd how to treat?
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Donovanosis (granuloma inguinale) is caused by Klebsiella granulomatis and presents w/terrible looking genital ulcers that are painless. Also doxy x 3 weeks.
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DDx for genital ulcers?
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5 things:
Syphilis, HSV, Haemophilus ducreyi (chancroid), Chlamydia trachomatis (LGV), granuloma inguinale |
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What is treatment of PID?
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PO: ceftriaxone IM x 1, doxy x 2 weeks +/- flagyl
IV: cefotetan and doxy; clinda and gent; unasyn and doxy if TOA |
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When does PID treatment become inpatient?
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If there is a tubo-ovarian abscess
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What does gonococcus look like on gram stain?
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Gram negative intracellular dpilococci
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How do you treat urethritis? What should not be used?
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non-GC is treated with with azithro x 1 or doxy x 7 days
GC urethritis should also cover chlamydia-- treat with cefixime or ceftriaxone x 1, plus azithro x1/doxy x7days Do not use quinolones |
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How does disseminated gonorrhea present? How is it related to menses? How do you diagnose and how do you treat it?
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Presents with fever, asymmetric arthralgias, tenosynovitis, very rad papules.
More common during menstruation. Diagnose with swabbing all orifices. Treat with gc + chlam Rx |
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What organisms cause epididymitis?
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E. coli in men > 35
STD (Chlamydia) in men < 35 |
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What are clue cells seen in and what are they? What else goes along with this infection and anything else on ddx with that?
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Clue cells are in bacterial vaginosis (bacteria attached to epithelial cells).
Fishy odor when mixed with KOH (+whiff test) and pH > 5.0 -- Trichomonoas vaginalis also has whiff test and pH > 5.0 |
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What is strawberry cervix seen with? What is the vaignal pH in this (and what is normal)?
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Strawberry cervix is seen in trichomonas vaginalis.
Vaginal pH is normally < 4.5. It is > 5.0 in Trich and in BV. |
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How do you treat trichomonoas?
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Flagyl
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What are some populations have higher incidence for UTI?
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MSM, DM, Sickle cell, hyperparathyroidism and gout (last 2 are 2/2 stone formation and obstruction)
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What is a nasal smear useful for? What is on the differential?
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Useful for differentiating allergic from bacterial sinusitis.
High eos is seen in allergic and nonallergic rhinitis w/eos syndrome (NARES) |
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How does mycobacterium marinum present?
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Non-healing skin ulceration - may present as a single granuloma but often invades lymphatics (like sporotrichosis).
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What are the 3 most common nosocomial infections?
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UTI > post-op wound > pna
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What needs to be done diagnostically in pt with prosthetic joint suspected of having osteomyelitis?
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Joint aspiration
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What vaccines are live?
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MMR, varicella, zoster, typhoid (one type), BCG, intranasal influenza, smallpox and yellow fever
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Who gets pneumovax and how often?
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65yo and older -- if 5 years have elapsed since last dose if last dose was < 65yo
< 65 if chronic illness -- can do it in 5 years |
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What is the age range for HPV vaccine? Who gets zoster vaccine?
What is the titer level for adequate HBV vaccination? |
HPV up to age 26.
Zoster vaccine can be given for > 60yo > 10 for HBV |
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How do you manage potential tetanus exposure?
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If Tdap/Td or last tetanus booster < 5 years ago - NTD
If > 5 yrs ago - give Tdap If uncertain - give Tdap + tetanus IG |
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If an adult patient doesn't know if they had chicken pox do you give the vaccine? Who should not get it and why?
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Check immune status first and then give vaccine.
Also do not give to immunocompromised bc it is a live vaccine. |
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Who gets meningococcal vaccine?
How many doses of MMR is required? |
College students and at risk adults w/q5 booster (includes asplenia, sub-Saharan Africa travel)
2 doses of MMR are needed (> 1 month apart) |
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What is meningococcemia prophylaxis? Do healthcare workers get it?
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Rifampin, cipro or ceftriaxone. healthcare workers get it only if they had intimate oral contact w patient.
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What is prophylaxis for travelers' diarrhea? Treatment and duration?
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Usually none unless hx of IBD or ill.
Use cipro, azithro, rifaximin to treat. Not bactrim or amoxicillin (resistance) -- 1-3 days. |
