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250 Cards in this Set

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MC form of candidiasis
Candida Albicans
to predisposing factors for candidiasis
- poor immune system
-antibiotic use
what is the most common opportunistic fungal infection?
Candidiasis
what is the most common form of Candida infection? (Tissue type)
Mucocutaneous infection a.k.a. thrush
what are predisposing factors To muco cutaneous candidiasis?
antibiotics, corticosteroids, xerostomia, radiation
a healthy adult patient presents with chelitis, esophogitis, and local patches of white that do not rub off what is in your differential for predisposing factor
HIV
a patient presents with odynophagia localized to the substernal area. what condition is his classic for?
Candidial Esophagitis
what is the most common location for mucocutaneous Candida
vula/vagina
what are five risk factors for vulvovaginitis from candida?
increased estrogen
diabetes
corticosteroids
antibiotics
HIV
a woman presents with curd-like discharge, swollen labia, and vaginal walls with white plaques
Volvovaginitis
what is the most common location of cutaneous candidiasis?
intertriginous areas under the breasts
how do you treat thrush in normal patients? how does this differ with HIV?
clotrimazole troches or nystatin x 7 -14 days

HIV: oral fuconazole x 14 days
how do you treat vaginal candidiasis?
diflucan 150 x 1 or miconazole cream (lots more)
how do you treat esophageal candidiasis?
100 mg fluconazole x 14 days
how do you treat cutaneouscandidiasis?
nystatin cream
what are the most common sites (5) for disseminated candidiasis
eyes, kidneys, liver, spleen, brain
what is the name of disseminated candidiasis?
candidemia
what is a common CV complication for candidiasis
endocarditis
a gay Pidgeon keeper presents to your clinic with meningitis, nuchal rigidity, lethargy, personality changes, increasingly severe headache over several weeks, chest pain, and cough. what does he have?
cyrptococcosis
a patient with cryptococcosis can be diagnosed with what laboratory test?
Lumbar puncture showing in India ink smeared Gram stain of CSF with blooding encapsulated fungal cells

Or

Cryptococcal antigen in CSF or serum
What type of fungus is cryptococcosis?
Yeast
how do you handle increased headache with vocal in their logic signs and papilledema
CT or MRI of head
How do you treat crptococossis with CNS sequellea
Amphotericin B IV 1 mg/kg qd and oral flucytosine 100mg/kg qid x 6 weeks
How do you prevent croptococcosis in AIDS people?
fluconazole 200 mg qd
How do you fight cryptococcosis in the lungs?
Fluconazole 400 mg qd x 6-12 mo
What agent causes histoplasmosis?
Histoplasma capsulatum
What is the MC endemic mycosis in the US and where is it active?
Histoplasmosis in Ohio and Miss. river valley
How do you get histoplasmosis
inhalation of bat and bird droppings
A guano farmer from Cincinnati presents with four days of influenza like symptoms and shows Hiler adenopathy and pneumonitis on chest x-ray , he has red patches on his skin consistent with erythema nodosum. What does he have?
histoplasmosis
a bird dropping inspector from Memphis has no symptoms, what is she diagnosed with?
histoplasmosis ( most histoplasmosis is asymptomatic)
the patients is diagnosed with acute histoplasmosis, what is his prognosis?
He'll be sick for one to six months and probably not die ( he got it in an epidemic)
a patient is diagnosed with progressive disseminated histoplasmosis, what is his prognosis?
he will die in six weeks or less. He will have a large spleen and bleed from the ulcers in his mouth
who get chronic progressive pulmonary histoplasmosis (demographic) and how do you know(clinica tests)?
older patients with COPD diagnosed with chest x-rays with apical cavities
who gets disseminated histoplasmosis?
AIDS patients with CD4 counts less than 100 often from a reactivation
in disseminated histoplasmosis what you see on chest x-ray?
Miliary pattern
what you see in the blood tests for histoplasmosis
anemia of chronic disease, Pancytopenia, elevated alkp, ferritin, and ldh
had defined histoplasmosis in the urine?
histoplasmosis antigen
what are four ways to test for histoplasmosis directly and which is least effective?
Bronchoalveolar lavage
blood and bone marrow cultures (takes weeks)
urine
sputum (least effective unless chronic)
How do you treat histoplasmosis?
symptomatic unless over four weeks
otherwise
itraconazole 200 mg x 6-12wks
or amphotericin B if itro doesn't work or pt. has contraindication
what you do with AIDS patients with histoplasmosis?
lifelong itraconazole
what blood test and threshold indicate an increased risk for pneumocystis
CD4 < 200
a patient presents with hacking nonproductive cough, retrosternal chest tightness, fever, respiratory distress, tachypnea, tachycardia, sinuses, and respiratory alkylosis. The patient has a diffuse interstitial infiltration on chest x-ray and low CD4 counts. what is the diagnosis?
pneumocystis
can pneumocystis be cultured?
no
how can you detect pneumocystis?
Bronchoalveolar lavage, trans bronchial biopsy, or sputum culture with giemsa stain or methenamine silve rstain to detect cysts
how do you treat pneumocystis? How do you treat severe pneumocystis?
Severe: corticosteroids

Regular and prophylactic:
Bactrim or Pentamidine
can use stain tuberculosis?
no
the patient is diagnosed with primary tuberculosis, what is the most common symptom?
patients with primary tuberculosis or asymptomatic unless they are immunocompromised
a patient has latent tuberculosis, are you at risk as a healthcare provider of contracting the disease?
no
approximately how many cases of primary tuberculosis continued to progress of tuberculosis?
5%
a patient has cough, fever, night sweats, malaise, fatigue, weight loss, non-flirted chest pain, and dyspnea. The patient describes their coffers dry at first but it becomes productive of purulent sputum. The patient appears malnourished. What is the primary diagnosis?
Active tuberculosis
laboratory results come back positive for acid fast bacili on microscopic evaluation. what are two potential causes?
leprosy and tuberculosis
what are some ways to diagnose tuberculosis?
Fiber-optic bronchoscopy wit trans bronchial washing
needle biopsy
biopsy
culture
the patient has small homogeneous infiltrates with Tyler and parrot tracheal lymph node enlargement, and segmental atelectasis with cavitation. What is their diagnosis?
Tuberculosis
what diseases miliary pattern classically associated with?
tuberculosis
what disease are ghon compleses and ranke complexes associated with?
tuberculosis, ghon = calcified primary focus, ranke = calcified primary focus and calcified Hilar lymph node
what are late findings of tuberculosis and HIV infected people?
military infiltrates, pleural effusion, I learned mediastinal lymph node enlargement, and lower lungs zone involvement
can a TB skin test indicated someone has been infected with tuberculosis?
Yes
can a TB skin test indicate someone has a latent tuberculosis infection?
Yes
Can a TB skin test to determine whether someone has active versus latent infection?
No
what is a Mantoux test
the TB skin test
an aids guy comes in with a TB skin test, what is the critical threshold for diagnosing disease? (? mm)
5 mm
a healthy guy comes in and assist TB skin test was a critical threshold for diagnosing disease? (? mm)
15 mm
a guy who works in a TB lab comes in with the TB skin test who likes to shoot up on the weekends, what is this critical threshold for diagnosing the disease (? mm)
10 mm
How do you treat TB in Non HIV people?
isoiazin, rifampin, prazinamide, ethambutol for 2 mo

THEN

isoniazin and rifampin (if isolate sensitive) for 4 MO
if PPD comes back positive, what do you do?
Get a chest x-ray or sputum culture
what do you do with the wife of an active TB patient especially if she has AIDS??
treat her
retest for TB in 10 - 12 weeks
how do you treat latent TB?
INH - 9 months
OR
rifampin and pyraninamide for 2 MO
OR
and rifampin for 4 mo
who should receive the TB screen?
contacts of active TB patients

HIV people

drug users

the chronically ill

people living in high TB countries

healthcare workers


poor people

Young people connected to high-risk people
what is MAC?
an atypical mycobacterial disease
the patients diagnosed with atypical mycobacterial disease, do you test their close contacts?
no
the patient presents with chronic cough, sputum production, fatigue, malaise, dyspnea, fever, hemoptysis, fever, rails, and Ronca. chest x-ray shows thin-walled parenchymal infiltrate. What is the diagnosis?
A typical mycobacterial disease
how do you treat M Kansasii?
Rifampin, isoiazid, ethambutol for 18 mo
how you treat MAC in the lungs?
clarithromycin, rifampin or ethambutol
+/- streptomycin for first two months
what shape of bacteria causes Lyme disease?
Spirochete
what is the most common vector-borne infection in the US?
Lyme disease
on which side of the country would you expect to get Lyme disease in the summer?
The eastern United States and Midwestern United States
a patient comes in with flu-like symptoms, bull's-eye lesion that result in four weeks. What disease and staged do they have?
lime disease stage one
what starts the progression of stage two lyme disease?
the blood down infection is to the length within days or weeks after inoculation
a patient comes in with Bell's palsy, encephalitis, headache, joint pain, and heart blocks. What stage of Lyme disease are they in?
Second stage
a person comes in a joint pain, memory loss, mood changes, sleep disturbances and was bit by a tick 10 years ago. What do they have?
Lyme disease, stage three
a patient gets bitten by a tick in Lyme, Connecticut and develops a skin rash. What further testing is required to confirm diagnosis?
None, documented EM is enough
how do you detect lyme disease?
Serum antibodies
what is associated with B. burgdorferi?
Lyme disease
how do you treat Lyme disease?
Doxycycline, amoxicillin, or cefuroxime
how do you treat Lyme disease is CNS symptoms?
IV ceftriaxone, cefotaxime, or penicillin G. for two weeks
what does Rickettsia Rickettsii cause?
Rocky Mountain spotted fever
in what demographic is the highest incidence of Rocky Mountains by the fear
children between five and nine years old
would type of tick spreads Rekhi Mountain spotted fever?
dog tick
in the southern states, what is the season for Rocky Mountain spotted fever?
April to September
how long does Rocky Mount spotted fever incubate?
2 - 14 days
85 to nine year old child comes in with anorexia, your debility, and malaise of abrupt onset with a fever, myalgia, rigors, photophobia, Nadia vomiting, and a rash. What does the child have?
Rocky Mountain spotted fever
what is the usual cause of death and Rocky Mountain spotted fever?
Pneumonitis was respiratory or cardiac failure
labs as Rocky Mountain spotted fever show high or low sodium?
Low
what to liver labs are elevated in Rocky Mountain spotted fever?
Aminotransferase &hyperbilirubinemia
how can you diagnose Rocky Mount spotted fever in the acute phase?
Skin biopsy
what is the treatment for Rocky Mountain spotted fever? What is the treatment and pregnant women?
Doxycycline or chloramphenicol in pregnant women
what organism causes syphilis?
Treponema pallidum
what type of organism is Treponema pallidum?
Spirochete
a person walks in with a Chancher. What do they have?
Syphilis
what are three ways that you can get syphilis?
Sexual contact
congenital
blood products
during which stage is syphilis contagious (early or late)
early
in which stage does syphilis involve skin, bones, and viscera
late stage syphilis
a syphilis patient has re-occurring lesions in their mucous membranes, what stage of syphilis do they have?
Early-stage syphilis
can you culture syphilis?
negative
what does the RPR test for?
Syphilis
what does the VDRL test for?
Syphilis
what is FTA -- ABS?
A test for syphilis
what are to non-serologic test things for syphilis?
Biopsy showing tissue damage
microscopic detection of the organism in the lesions
how you treat syphilis?
Penicillin,
OR
tetracycline, doxycycline,
OR
ceftriaxone and azithromycin
would organism causes botulism?
Clostridium botulinum
what type of organism (characteristics of organism) causes botulism?
A spore forming, gram-positive, obligate anaerobe
what system does botulism target?
the nervous system creating paralysis
where can you find C. botulinum
soil, marine environments, and agricultural products
what is the most potent poison of humans?
Botulinum toxin
what are for clinical forms a botulism? (source)
Foodborne
wound
infant
inhalation
what is the most common form of botulism (source )
food
what is the incubation period in botulism?
18 to 36 hours
a patient presents with the double vision, dysphonia, dysphagia and they ate canned spinach. What do they have?
Botulism
a patient has peripheral nerve involvement botulism. What is the most common complication?
Respiratory failure
an infant presents with weakness, constipation, hypothermia and cannot orally feed. What do they have?
Infant botulism
how can you tell someone has botulism?
Stool sample, gastric contents, or food for toxin to C. botulinum
how do you treat botulism in adults?
Treat the symptoms, give immunization with an antitoxin, and remove the toxin with gastric lavage
how do you treat infants with infant botulism?
Treat symptoms they will get better
someone comes in with wound botulism, when you give them?
Penicillin and flagyl. debreed. give antitoxin
what causes chlamydia?
Chlamydia trachomatis
what type of bacteria is Chlamydia trachomatis?
An intracellular bacteria
how does Chlamydia get transmitted?
purulent exudate on inoculated skin or mucous membrane gain entry through tiny lacerations or abrasions
what are three main sites of chlamydia infection?
Genital tract, eye, respiratory tract
what percentage of men have symptoms of chlamydia?
50%
a woman comes to you with dysuria, increased frequency, and pyuria. She has a mucopurulent cervicitis. vaginal bleeding, lower abdominal pain and uterine tenderness. What do you suspect?
Chlamydia
what is the primary disease in your differential diagnosis for chlamydia?
Gonorrhea
what is the treatment for chlamydia?
1 g single-dose azithromycin
a patient has acute onset of watery diarrhea. What do you suspect?
Cholera
what organism causes cholera?
Vibrio cholerea
what is the prognosis of an untreated cholera patient?
Death within hours
where would you expect to see cholera?
Everywhere but the United States, Australia, Canada and Europe
how is cholera spread?
The water
how do you detect cholera?
Stool culture
how you treat cholera?
Replacement of fluids
other than replacing fluids can you do anything else for cholera?
You can use adjunctive antibiotics
what organism causes diphtheria?
Corynebacterium diphtheriae
what type of organism, or classification of organism, causes diphtheria?
Gram-positive bacillus
what are the two primary infection spots of diphtheria?
Tonsils and skin
the diphtheria toxin can cause what type of -itises (2 of them)
myocarditis and neuritis
How do you get the diphtheria? (what is the mode of transmission)
droplets or direct contact with secretions or skin lesions
how long can diphtheria survive in dust?
Weeks to months
Can an immunized person carry diphtheria?
Yes
an old man walks into your clinic with sore throat, malaise, fever, pharyngeal erythema followed 24 to 48 hours by grayish membrane that bleeds if attempted to remove. What is your diagnosis?
Diphtheria
what is a classic cutaneous manifestation of diphtheria?
Deep, punched out ulcers with grayish membranes
can you culture diphtheria?
Yes
should you notify the health department if you see a diphtheria case?
Yes
how do you prevent diphtheria?
With immunization
what should you do with all contacts of the diphtheria patient?
Give them the booster
what causes the clap?
Neisseria gonorrheae
what are three places that can be affected by gonorrhea (locations)
poop hole, piss hole, mouth
what is the incubation period of gonorrhea?
Three to five days
would you expect unilateral or bilateral swelling of the inferior lateral portion of the introitis in gonorrhea?
unilateral
a man walks into your clinic was milky discharge one to three days later with bloody discharge. The man is otherwise asymptomatic. What's wrong with him?
He has gonorrhea
say you had gonorrhea and it were to travel to somewhere else in your body. Where would that somewhere else be?
You will get gonorrhea in your eyes somehow as it is most commonly an auto inoculated.
A baby gets gonorrhea from where?
They get it in their eyes from an infected birth canal
a little girl has gonorrhea, what do you do?
treat and call CPS
a patient comes in with maculopapular, hemorrhagic, peripheral skin lesions and tenosynovitis in the knees, their risk for meningitis and have an intermittent fever. What do they have?
Disseminated gonorrhea
what happens if you don't treat gonorrhea in women?
salpingitis
what is fitz-hugh-curtis syndrome?
right upper quadrant pain, fever, nausea secondary to perihepatitis from ascending salpingitis
what are for specific ways of preventing gonorrhea?
Screen high-risk populations
treat sexual partners
abstain from sex or seven days after therapy is initiated
re-examine three weeks after treatment
how do you treat uncomplicated gonorrhea?
Ceftriaxone 250 mg IM plus doxycycline or azithromycin

Cefixime with dox or azyth

Levaquin or Cipro plus a azyth and doxy
how do you treat pharyngeal gonorrhea?
Ceftriaxone and Bactrim
what type of organism causes salmonella?
a gram-negative bacillus
what is the most common clinical manifestation of salmonella?
Enterra colitis
how do you get salmonella
eating food or water that someone else is gone #2 in
what is being to incubation period for salmonella
eight to 48 hours
a patient comes to you with onset of crampy abdominal pain and diarrhea with gross blood in the stools and nausea and vomiting. What is it?
Salmonella
how do you diagnose Salmonella?
Stool culture
how do you treat Salmonella?
Replace fluids and electrolytes
if you really wanted to use an antibiotic for a Salmonella would you use?
Cipro
what is the leading cause shigella in the United States? (organism)
Shigella Sonnei
a patient comes to you with diarrhea, lower of Domino cramps, Tenesmus, anorexia a malaise headache fever chills and stool mixed with blood and mucus. What does the patient have?
Shigella
how do you treat Shigella?
Bactrim or Cipro and fluid replacement
what causes tetanus
Clostridium tetani
what type of organism is tetanus?
Gram-positive bacillus
where do you find tetanus?
Cultivated soil
a patient comes in with tingling pain at sight of inoculation which leads to spasticity of nearby muscles. What does the patient have?
Tetanus
a patient has spasm of the glotis and respiratory muscles after stepping on a nail. What does the patient have?
Tetanus
a patient walks into your clinic naked with an arched back, clenched fists, and curled toes. What does the patient have?
Tetanus
how do you prevent tetanus?
vaccinate
how do you treat tetanus?
Give the immunoglobulin, then vaccinate the person

Give the person respiratory support

Give the patient benzos

Treat the patient with penicillin
what are the two species of amebiasis
entamoeba histolytica
and
entamoeba dispar
how does the amebiasis get into you
you the cysts from water that people pooped into then it breaks through the intestinal wall
where do you see the highest incidence of amebiasis?
Tropical in developing countries
what are some modes of transmission of amebiasis?
eating the cysts

flies and other arthropods

fertilizing your fields instead of using the bathroom and then feeding your neighbors the food without washing it
if you are a carrier of amebiasis, what are your most likely symptoms?
You probably don't have any or you would get it fixed
a person comes into your office having just drinking toilet water a couple days ago and has diarrhea and abdominal pain. They also have colitis and dysentery. What is their most likely diagnosis?
Amebiasis
a man that has unorthodox methods of fertilizing his fields comes to your clinic after a three-week walk (in which he was not treated) and on physical exam has intestinal perforation and hemorrhage. What is his diagnosis and stage?
Amebiasis fulminant disease
a patient experiences diarrhea and weight loss for eight weeks and has amoebic appendicitis. What is his diagnosis and stage?
Amebiasis -- chronic
where is the most common extra intestinal site for amebiasis?
Liver
if someone has liver amebiasis would they experience colitis?
Possibly
how would you know that someone has amoebic liver disease
look for leukocytosis and elevated LFT's
where would you expect to see in the amoebic liver disease in the liver (like which lobe)?
right lobe
how do you diagnose amebiasis
get three stool specimens and look for organisms in a stool
would you prefer to get serial object testing for amebiasis from someone who has had the disease for two weeks or one day?
The sensitivity is lower in early disease
how you treat amebiasis?
Metrondiazole or trindiazole AND
linal amebicides like diloxinide, iodiquinol, or paromomycin
what organism causes Hookworms?
ancylostoma duodenale and necatar americanus
How do you get Hookworms?
skin penetration leads to migration of the hookworm to pulmonary capillary where they get into the bowle and becomes swallowed and then go into the bowel where eggs come out the butt and into someone else's skin
What type of hookwarm can be injested?
Ancylostoma
How do hookworms eat?
They attach to the intestinal mucus and suck blood.
What symptoms do most hookworm sufferers have?
Most are asymptomatic
A patient who lives in subtropical area and walks in moist soil gets a itchy maculopapular rash. What disease and stage to you expect?
hookworm initial presentation with scratching d/t 2o infection
A patient with a penchant for walking barefoot gets a dry cough with blood-tinged (blond-tinged in the notes) sputum. What does he have and what stage?
Hookworm, pumonary stage.
A pt has anorexia, diarrhea, iron deficiency anemia and protien malnutrition what does the patient have?
Hookworms, intestinal severe dz
How do diagnose hookworm?
look for eggs in the TP
what blood tests and chemistries would you expect with hookworm
hemoccult would be positive
hypochromic, microcytic anemia
hypoalbuminemia
esponophilia
how do you treat hookworms?
albendazole or mebendazole
and
Fe-sulfate
what is the most important parasitic disease in humans?
Malaria
what causes malaria?
Things that start with Plasmodium
how is malaria transmitted?
In a mosquito
a patient comes in this headache, fatigue, fever. He did not sleep with his net last night. What disease do you suspect and an onstage?
Pandrome of malaria
where the classic signs of malaria?
Chills, high fever, sweats
a patient comes in with myalgia, cough, chest pain, abdominal pain, anorexia, N/V/D and was hanging out in Nigeria for the last two months. What do you suspect?
Malaria
would you expec hepatomegaly in malaria?
mild
would you expect anemia in malaria?
mild
would you expect iron deficient anemia and malaria?
no that would be hookworms
what is the worst type of malaria (agent)
p. falciparum
what type of blood tests do you want if you suspect malaria?
thick and thin smear with giemsa stain
what aging causes toxoplasmosis?
Toxoplasma Gandhi
what is the definitive host of toxoplasmosis?
cats
how can you transmit toxoplasmosis?
ingestion of cysts in raw meat
ingestion of contaminated meat
cat litter
transplacental
direct innoculation
what is incubation period For toxoplasmosis?
one to two weeks
what is the most common symptom of toxoplasmosis
cervical lymphadenopathy
a patient comes in with headache, malaise, fatigue, fever, atypical lymphocytes, mono like symptoms and the symptoms resolve within a few months. The patient eats under cooked cats. What you suspect?
Toxoplasmosis
what is the worst trimester to get toxoplasmosis in?
if you get it in the first trimester you kill your child, if you get it in this third trimester you transmit it to your child.
word associate retinochoroiditis to a dz
toxoplasmosis in early pregnancy
a baby is born with eye disease, and hepatosplenomegaly, lymphadenopathy and retinochroiditis. What happened to the child.
toxoplasmosis
I have blurred vision, scotoma, photophobia and eye pain. What do I have?
retinochoroiditis
you just got AIDS and then you get cancer and go on chemo then you get ocular pain, fever, cough, dyspnea. What has secondarily infected you?
Toxoplasmosis
how do you treat toxoplasmosis in healthy athelete-like people
you don't
how do you treat toxoplasmosis in pregnant men?
spiramcyin since pregnant men are really pregnant women who think they are men.
what is a good antibiotic for toxoplasmosis?
pyrimethamine plus sulfadiazine with folinic acid to prevent bone marrow suppression
if you do not want to use sulfadiazine for toxoplasmosis, what else could you use?
clindamycin or bactrim
how can you prevent toxoplasmosis if you have kitty cats?
feed your cats dry food and change their litter boxes
would it be mean to make your pregnant housecleaner change your litter box?
yes, it puts them at risk for toxoplasmosis
what is another name for enterobiasis
pinworms
what causes pinworms? (organism)
Enterobius vermicularis
how do you get pinworms?
You eat them as eggs (sunny-side up)
how long does it take pinworm females to mature and stay viable
1 mo and 1 mo
where do pinworm larvae spend their teen-age years
the cecum
if you were a pinworm, where would you lay your eggs
on the lips of someone's a-hole
what is the MC symptom of enterobiasis?
perianal itching
How do you catch a pinworm?
put scotch tape on your child's butt hole first thing in the AM
How do you treat pinworms?
albendazole, mebendazole or pyantel pamaate? repeat in two weeks.
Do you need to treat pinworm contacts
yes