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128 Cards in this Set

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Genital Herpes -
What is it
HSV-2 (85%)
HSV-1 can be seen
Genital Herpes -
Hx/PE
Vesicles erode
painful, circular
with red areola
can have inguinal lymphadenopathy
relapses
Genital Herpes -
Dx
Tzanck smear and Cx
Genital Herpes -
Tx
Acyclovir
famciclovir or
valacyclovir
Granuloma Inguinale -
What is it
Chronic granulomas
spread by sexual contact
Donovania granulomatis
Calymmatobacterium granulomatis
Donovania granulomatis
Donovania granulomatis
Granuloma Inguinale -
Hx/PE
Painless, red nodule
develops into elevated granuloma
heals slow
scars form
Granuloma Inguinale -
pain??
Painless
Granuloma Inguinale -
Dx
Giemsa or Wright stain
Donovan bodies
Granuloma Inguinale -
Dx
- confirm
punch Bx
Granuloma Inguinale -
Tx
Doxycycline or TMP/SMZ
erythromycin (alternative)
Genital Warts -
What are they
HPV 6 & 11
Genital Warts -
Hx/PE
Soft, moist, pink or red
grow fast
cauliflower appearance
condylomata acuminata
Genital Warts -
Dx
Clinical
must differentiate between -
warts and c. lata of syphilis
Genital Warts -
Tx
Remove -
curettage
sclerotherapy
trichloroacetic acid
cryotherapy
podophyllin
laser
imiquimod (immune stimulant)
Perinephric Abscess -
Causes
• pyelonephritis => abscess
rupture into perinephric space
• caused by -
any factor predisposing to pyelonephritis
stones - #1
structural abnorm
trauma
recent surgery
DM
• "SEEKS PP" pathogens
MC - E. coli
then Klebsiella,
Proteus
S. aureus - hematogenous
MC - E. coli
then Klebsiella,
Proteus
S. aureus - hematogenous
Perinephric Abscess -
Hx/PE
Insidious
2-3 wks of Sxs before 1st visit
fever
flank pain
abdom pain
palpable abdom mass
persistence of pyelonephritic Sxs even tho Tx for pyelonephritis
Perinephric Abscess -
Dx
UA/UC - init. tests
fever, pyuria & neg. UC or
polymicrobial UC - suggestive
US - best init. scan
CT or MRI - better imaging
Bx - nec. for definitive bacterial Dx
Perinephric Abscess -
Tx
Abx for gram neg rods
drainage (usu percutaneous)

ex. -
3rd gen ceph
antipseudomonal PCN
ticarcillin/clavulanate
often with aminoglycoside
Brain Abscess -
• Bacteria spread from
contiguous infections -
dental infections
otitis media
mastoiditis
sinusitis
Brain Abscess -
• spread hematogenously -
endocarditis
pneumonia
Brain Abscess - Toxoplasmosis can reactivate
if
• Toxoplasmosis can reactivate
if CD4 <100
MC have
Strep
then Bacteroides,
Enterobacteriae,
Staph,
polymicrobial
Brain Abscess -
Hx/PE
MC Sx - headache
fever
focal neuro
seizures
Brain Abscess -
Dx - init test
CT with contrast
Brain Abscess -
Dx
MRI - more accurate
bacteria -
Bx for gram stain and Cx
Brain Abscess -
Tx
HIV -
90% Toxo or lymphoma
empiric Tx to establish Dx
if respond to sulfadiazine and pyrimethamine,
continue Tx
Brain Abscess -
Tx
Other Tx - based on etiology
Bronchitis -
What is it
Infection limited to bronchial tree
Caused by -
S. pneumonia
H. influenza
Moraxella
viruses
MC causative factor -
cigarettes
acute and chronic form
chronic can
=> COPD
Bronchitis -
Hx/PE
Cough
sputum
discolored sputum = bacteria
may have low-grade fever
most are afebrile
Bronchitis -
Dx
Clinical
CXR - 1st test
normal CXR confirms!
Bronchitis -
Tx Mild -
no Tx needed
usually from virus
resolves spontaneously
Bronchitis -
Tx severe -
amoxicillin,
doxycycline
or TMP-SMZ
repeated infection
or not responding -
amoxicillin/clavulanate,
clarithromycin,
azithromycin,
oral 2nd or 3rd gen cephalo
or new fluoroquinolones
Lung Abscess -
What is it
Necrosis of pulmonary parenchyma
caused by bacterial infection
Lung Abscess -
What is it
90% - anaerobes involved
Staph
E. coli
Klebsiella
periodontal disease
predisposition to aspiration
noninfectious causes -
pulmonary infarction
cancer
vasculitis (Wegener's)
Lung Abscess -
Hx/PE
Fever
cough
chest pain
foul-smelling sputum
chronic course
Lung Abscess -
Dx
CXR
CT
Bx - for specific bact. Dx
sputum for gram stain & Cx -
will NOT show causative org.
common sites of aspiration -
if upright
lower lobes -
post. segment of rt. upr lobe -
if supine
Lung Abscess -
Tx
Clindamycin - empiric
PCN - alternate empiric
Impetigo -
What is it
Skin infection
mainly kids
Impetigo - causes
S. pyogenes
S. aureus (bullous)
if untreated =>
lymphangitis
a. glomerulonephritis
cellulitis
furunculosis
Impetigo -
Hx/PE
Superficial
pustular
oozing, crusting, draining of lesions
Impetigo -
Hx/PE
• common on -
arms, legs, face
• may follow trauma to skin
• maculopapular => vesicles
Impetigo -
Tx
Oral 1st gen ceph or
ox-, clox-, or dicloxacillin
Impetigo -
Tx mild -
topical mupirocin or bacitracin
PCN-allergy - macrolide
Erysipelas -
What is it
Superficial cellulitis
S. pyogenes
IErysipelas -
Hx/PE
B/L
shiny, red, edematous
face, arms, legs
Tinea Versicolor -
Erysipelas -
Tx If can't tell from cellulitis-
1st gen cephalosporin
oxa-, cloxa, dicloxacillin
Erysipelas - if sure Strep -
PCN
Tinea Versicolor -
What is it
Skin infection
Malassezia furfur
(Pityrosporum orbiculare)
Tinea Versicolor -
Hx/PE
Tan, brown, white lesions
coalesce
chest, neck, abdomen, face
lesions do not tan
Tinea Versicolor -
Tx
Topical selenium sulfide,
ketoconazole,
oral itraconazole
Scabies -
What is it
Parasitic skin infection
Sarcoptes scabiei
(itch mite)
transmitted skin-to-skin contact
Scabies -
Hx/PE
Digs into skin at skin folds
burrows
pruritis
flexor surfaces of -
wrists
finger webs
axillary folds
areola (women)
genitals (men)
Scabies -
Dx
See in scrapings (mineral oil)
Scabies -
Tx
Permethrin
lindane (Kwell)
Pediculosis -
What is it
Skin infestation by lice
• Head -
pediculus humanus capitis
• Body -
pediculus humanus corporis
Pediculosis -
Hx/PE
Itching
excoriation
secondary bacterial infections
Pediculosis -
Dx
Direct exam of hair-bearing surfaces
Pediculosis -
Tx
Permethrin
lindane (Kwell)
Molluscum Contagiosum -
What is it
Skin-colored, waxy,
umbilicated papule
poxvirus
Molluscum Contagiosum -
Hx/PE
Small papules
central umbilication
anywhere on skin
asymptomatic
Molluscum Contagiosum -
Hx/PE
adults -
usually by venereal contact
genitals, pubic area
Molluscum Contagiosum -
Dx
Appearance
giemsa stain -
large cells with
inclusion bodies
Molluscum Contagiosum -
Tx
Freezing
curettage
electrocautery
cantharidin
Gas Gangrene
(Clostridial Myonecrosis) -
What is it
Wounds contaminated by
Clostridium perfringens
not common
inc. in wartime
trauma (50%)
shrapnel
MVA
postop
nontraumatic
uterine gangrene -
was complication of
improper abortion
uterine gangrene -
was complication of
improper abortion
Gas Gangrene
(Clostridial Myonecrosis) -
Hx/PE
<1-4 days of incubation -
pain, edema
=> hypotension
tachycardia
fever
crepitation
renal failure
Gas Gangrene
(Clostridial Myonecrosis) -
Dx Gram stain -
pos. rods, no WBC
Gas Gangrene
(Clostridial Myonecrosis) -
Dx Cx -
not diagnostic
gas bubbles on XR
- not diag.
Gas Gangrene
(Clostridial Myonecrosis) -
Dx diagnostic -
direct visualization
pale, dead muscle
brown, sweet-smelling discharge
Gas Gangrene
(Clostridial Myonecrosis) -
Tx
High-dose PCN
PCN-allergy - clindamycin
surgical debridement
or amputation
hyperbaric O2 - controversial
Septic Arthritis -
What is it
Infection due to any agent
Septic Arthritis - MC -
bacterial
Septic Arthritis -
rickettsia, virus, spirochete
may also cause
gonococcal and nongonococcal
• nongonococcal -
any previous damage to joint
OA, RA
previous surgery
prosthesis placement
IVDU
gout
sickle cell
gram pos -
S. aureus (60%)
Strep (15%)
gram neg (15%)
polymicrobial
Septic Arthritis -
Hx/PE • Gonococcal -
polyarticular 50%
tenosynovitis
migratory polyarthralgia
petechiae & purpura
Septic Arthritis -
Hx/PE• nongonococcal -
monoarticular
swollen, tender
erythematous
dec. ROM
usually knee
Septic Arthritis -
Dx • gonococcal -
hard to Cx
Cx sites other than knee -
greater yield
Septic Arthritis -
Dx• nongonococcal -
synovial fluid aspiration:
Cx
gram stain
cell count -
high
mainly PMN
low glucose
Septic Arthritis -
Tx • gonococcal -
ceftriaxone
Septic Arthritis -
Tx • nongonoccocal -
good empiric -
staph/strep & gram-neg. drug
nafcillin or oxacillin &
aminoglycoside or 3rd gen ceph
Myocarditis -
What is it
Associated with every group of
infectious agent
Myocarditis - MC -
Coxsackie B
Myocarditis
also noninfectious -
radiation
drugs
collagen vascular dis.
hyperthyroidism
Myocarditis -
Hx/PE
Any presentation possible
MC - dyspnea & fatigue
can be asymp,
subclinical,
or rapid progression to death
PE -
normal or
S3 and murmurs
Myocarditis -
Dx
cardiac enzymes may be inc.
Ab titers may be inc.
viruses may be isolated -
stool
saliva
NPA
Myocarditis -
Tx
Viral -
supportive
most spontan resolve


other Tx depends on agent
steroids???
no steroids (damaging)
Myocarditis -
Dx any type of heart block possible
Any EKG abnormality
MC - ST-T changes
any type of heart block possible
Myocarditis - best diag. test
endomyocardial Bx -
herpes1
acyclovir
herpes2
acyclovir
famcyclovir
Donovan bodies
Donovan bodies
- S. aureus
Aspergillus
Candida
erythrocyte
gentamycin
ampicillin
erythromycin
clarithromycin
azythromycin
leukemia
nystatin