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285 Cards in this Set
- Front
- Back
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Linked to bird droppings or bat guano exposure along Ohio River Valley
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Histoplasmosis
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Histo Dx
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Biopsy
Urinary Test |
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Histo Tx
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Itraconazole (mild/mod)
Amphotericin B (severe) |
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Linked to soil exposure along the Ohio River Valley
Dust exposure (construction or evacuation) |
Blastomycosis
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Blastomycosis Dx
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Biopsy
Culture |
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Blastomycosis Tx
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Itraconazole (mild/mod)
Amphotericin B (severe) |
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San Joaquin Valley Fever
Erythema nodosum common |
Coccidioidomycosis
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Coccidiodomycosis Dx
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Serology
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Coccidiodomycosis Tx
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None
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Common in AIDS pts with <200 CD4 cells
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Pneumocystis jiroveci
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Physical exam not usually consistent with degree of hypoxemia
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Pneumocystis jiroveci
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Most common opportunistic infection in AIDS patients
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Pneumocystis jiroveci
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Pneumocystis jiroveci Dx
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CXR (interstitial infiltrates)
Sputum/bronchoscopy DFA |
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Pneumocystis jiroveci Tx
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Bactrim
Use prednisone if PaO2 <70 |
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Most common cause of fungal meningitis
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Cryptococcus
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Cryptococcus Dx
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CSF
Serum cryptococal antigen India Ink may be positive |
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Cryptococcus Tx
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Amphotericin B or fluconazole
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Brown sputum
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Allergic bronchopulmonary aspergillosis
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Allergic bronchopulmonary aspergillosis Tx
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Prednisone +/- itraconazole
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Fungal ball commonly misdiagnosed as lung cancer
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Aspergilloma
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Aspergilloma Dx
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Resection
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Most common in patients with prolonged neutropenia for greater than 10-14 days (leukemia pt)
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Invasive aspergillosis
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Presents with vulvar itching, erythema, and white, curdy discharge
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Vaginal candidiasis
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KOH shows hyphae
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Vaginal candidiasis
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Vaginal candidiasis Tx
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-conazole cream x1-7 days or fluconazole 100-200 mg PO
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May present with substernal odynophagia, GE reflux, or nausea with or without substernal pain
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Esophageal candidiasis
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Esophageal candidiasis Dx
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EGD with biopsy
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Esophageal candidiasis Tx
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Fluconazole
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North American Malaria
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Babesiosis
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Most virulent malaria
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P. falciparum
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Malaria Dx
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Thick/thin blood smears
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Presents with periodic chills, fever, sweats
HA, malagia, splenomegally, anemia, and leukopenia common after travel in tropical regions |
Malaria
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Malaria prophylaxis
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Chloroquine (if no P. falciparum)
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Transmitted by eating contaminated food or handling cat litter
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Toxoplasmosis
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Common infection in AIDS patients with < 100 CD4 cells
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Toxoplasmosis
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Progressive HA, AMS changes, new-onset seizure
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Toxoplasmosis
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Ring-enhancing mass lesions on head CT
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Toxoplasmosis
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Toxoplasmosis Dx
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Serology
Biopsy Imaging |
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Toxoplasmosis Tx
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Pyrimethamine
Sulfadiazine |
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Where does VZV lie dormant?
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Dorsal root ganglia of nerve
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Malaria Dx
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Thick/thin blood smears
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Presents with periodic chills, fever, sweats
HA, malagia, splenomegally, anemia, and leukopenia common after travel in tropical regions |
Malaria
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Malaria prophylaxis
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Chloroquine (if no P. falciparum)
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Transmitted by eating contaminated food or handling cat litter
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Toxoplasmosis
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Common infection in AIDS patients with < 100 CD4 cells
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Toxoplasmosis
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Progressive HA, AMS changes, new-onset seizure
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Toxoplasmosis
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Ring-enhancing mass lesions on head CT
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Toxoplasmosis
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Toxoplasmosis Dx
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Serology
Biopsy Imaging |
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Toxoplasmosis Tx
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Pyrimethamine
Sulfadiazine |
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Where does VZV lie dormant?
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Dorsal root ganglia of nerve
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Most common long-term complication of Shingles
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Post-herpetic neuralgia
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Shingles Dx
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Tzanck smear
Immunofluorescent antibody staining |
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Shingle's Tx
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Acyclovir
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Hutchinson's sign
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VZV on nose (trigeminal nerve)
Optho consult |
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Waldeyer's Ring exudate
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Ebstein-Barr Virus
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Posterior cervical lymphadenopathy (3)
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EBV
Toxoplasmosis Rubella |
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Aminopenicillin given to EBV patient
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maculopapular rash
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EBV Dx
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Exam findings
Atypical lymphocytosis Heterophile agglutination test (Monospot) |
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EBV + trauma
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Splenic rupture
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EBV Tx
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Fluids and analgesics
Steriods if tonsilar involvement |
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Primary infection presents similar to mono in immunocompetent hosts
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Cytomegalovirus
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Common in AIDS patients with < 50 CD4 cells
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Cytomegalovirus
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3 severe reactions seen in Cytomegalovirus
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CMV retinitis (brush fire appearance)
GI CMV (ulcers esophagus, anus) Pulmonary CMV ("Pneumonia") |
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Cytomegalovirus Dx
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Serology
PCR +/- biopsy |
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Cytomegalovirus Tx
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Gangiclovir
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HHV-8
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Kaposi's sarcoma
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Red-purple macules, papules, nodules, or patches throughout the body
AIDS patients |
Kaposi's sarcoma
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Kaposi's sarcoma Tx
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Reconstitiute immune system
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Caused by rhabdovirus
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Rabies
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Rabies Preventative Tx
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Passive immunization with rabies immune globulin
At least 50% infused at wound site Rest given IM at another site |
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Rabies Tx
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4 injections in deltoid
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Acute HIV Syndrome Dx
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HIV RNA level
Viral load usually done by PCR bc usually too early for ELISA |
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HIV screening test
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ELISA
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HIV confirmatory test
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WB
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Used to test for neonatal HIV
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HIV viral load
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Only used to screen for Acute HIV Syndrome
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HIV Viral load
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CD4 >500
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Lymphadenopathy
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200-500 CD4 (5)
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Pulmonary TB
Bacterial pneumonia Herpes zoster NH-lymphoma Kaposi's sarcoma |
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100-200 CD4
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PCP
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50-100 CD4 (3)
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CMV retinitis
Toxoplasmosis Cryptococcus |
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<50 CD4
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M. avium complex (MAC)
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HIV Tx
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Look for answer with 3-4 drugs
2 drugs should have 3 letter abbreviation in parenthesis One drug ending in -vir |
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AZT SE
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Bone marrow suppression
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ddI, ddC, d4T SEs
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Peripheral neuropathy/pancreatitis
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ABC SEs
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Hypersensitivity reaction
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NNRTI SEs
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Rash
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Efavirenz SEs
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CNS disengagement (vivid dreams)
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Protease inhibitor SEs
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Facial/peripheral fat and large stomach (lipodystrophy/metabolic side effects)
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Indinavir SEs
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Nephrolithiasis
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HIV Pneumocyctosis prophylaxis
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Bactrim
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HIV Toxoplasmosis prophylaxis
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Bactrim
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HIV MAC prophylaxis
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Azithromycin or clarithromycin
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When should HIV pts be given prophylaxis for Pneumocyctosis?
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CD4 <200
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When should HIV pts be given prophylaxis for Toxoplasmosis?
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CD4 <100
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When should HIV pts be given prophylaxis for MAC?
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CD4 <50
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Rickettsia rickettsii
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Rocky Mt Spotted Fever
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Red macular rash appears bn 2-6 day of fever, starting on the wrists and ankles and spreading centrally
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Rocky Mt Spotted Fever
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Rocky Mt Spotted Fever Tx
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Doxycycline
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Presents like Rocky Mt. Spotted Fever rash involves trunk, spares hands/feet
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Ehrlichiosis/anaplasmosis
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Ehrlichiosis/anaplasmosis Dx
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Leukopenia
Thrombocytopenia Elevated ALT/AST |
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Morulae occasionally seen on WBC smear
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Ehrlichiosis/anaplasmosis
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Ehrlichiosis/anaplasmosis Tx
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Doxycycline
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Tetanus Prevention
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Vaccination +/- tetanus immune globulin (TIG)
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Tetanus infection Tx
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Tetanus vaccine + TIG + penicillin G
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Sudden onset of diplopia, dry mouth, dysphagia, dysphonia, and muscle weakness followed by respiratory paralysis
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Botulism
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Botulism Tx
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Botulism immune globulin (infants)
Trivalent equine antitoxin (adults) |
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Borrelia burgdorferi
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Lyme disease
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Common in northeast and upper midwest
Transmitted by tick bite |
Lyme disease
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Erythema migrans
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Lyme disease
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Lyme disease Dx (if in question)
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Screening ELISA with confirmatory WB
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Lyme disease Tx
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Doxycycline (>8 yo)
Amoxicillin (<8 yo) Ceftriaxone in more severe disease |
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Anthrax
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Bacillus anthracis
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Inhaled spores cause mediastinitis/hemorrhagic lymphadenitis
Widened mediastinum on CXR |
Inhaled anthrax
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Anthrax Tx
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Prophylaxis: FQ x60 days
Disease: FQ + clinda +/- rifampin |
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Smallpox
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Variola major
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Smallpox Tx
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Cidofovir and vaccinate
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Presents with vaginal pruritis and a malodorous frothy, yellow-green discharge
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Trich
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Strawberry cervix
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Trich
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Trichomonads seen on wet prep
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Trich
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Trich Tx
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Metronidazole 2g PO
Treat partners |
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Most common STI
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Chlamydia
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Both sexes may present with reactive arthritis/tenosynovitis or Reiter's syndrome
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Chlamydia
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Reiter's syndrome
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Urethritis
Conjunctivitis Arthritis Mucocutaneous lesions |
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Chlamydia Dx
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Nucleic acid amplification testing of discharge or urine
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Chlamydia Tx
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Azithromycin or doxycycline
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Starts with painless mucosal lesion, followed by lymphatic spread, inguinal bubo, draining sinus tracts
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Lymphogranuloma venereum
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Lymphogranuloma venereum Tx
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Doxy
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Lymphogranuloma venereum
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Chlamydia trachomatis
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Chlamydia Tx in pregnancy
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Azithromycin or erythromycin
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Presents with yellow, creamy profuse discharge
Women may be asymptomatic |
Gonorrhea
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Fitz-Hugh Curtis syndrome
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Perihepatic gonorrhea
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Presents with fever and RUQ pain
Extension of infection from fallopian tubes to peritoneum and liver capsule |
Fitz-Hugh-Curtis syndrome
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Gonhorrhea Dx
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Gram stain/culture of discharge
NAAT of discharge or urine |
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Gonhorrhea Tx
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Ceftriaxone plus azithromycin
(Always treat chlamydia too) |
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Most common cause of external genital warts
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HPV 6 and 11
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Most common for cervical dysplasia
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HPV 16, 18, 31, 33, 25
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Condylomata acuminata
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Anorectal warts (more malignant)
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HPV Dx
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Biopsy
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HPV Tx
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Ablation
Imiquimod (Aldara) Podofilox |
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Associated with Bell's Palsy
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HSV1
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HSV Dx
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Tzanck smear
DFA Serology PCR |
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Chancroid
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Haemophilus ducreyi
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Chancroid Tx
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Ceftriaxone or azithromycin
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Granuloma inguinale
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Klebsiella granulomatis
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Chroni relapsing granulomatous anogenital infection
Painful infiltrated nodules (ulcer with red friable base of granualtion tissue) |
Granuloma inguinale
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Donovan's bodies seen on Wright or Giemsa stains
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Granuloma inguinale
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Granuloma inguinale Tx
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Doxycycline or Bactrim
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Syphilis
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Treponema pallidum
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Painless ulcer at site of exposure
Chancre |
Primary syphillis
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Generalized maculopapular rash (even palms/soles)
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Secondary syphilis
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Condylomata lata
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Secondary syphilis
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Infiltrative tumors (gummas), aortitis, neurosyphilis
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Tertiary syphilis
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Hutchinson's tooth in kids
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Syphilis
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Syphilis screening
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VDRL or RPR
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Syphilis confirmation
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FTA-ABS or MHA-TP
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Syphilis Tx
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PCN G
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Inflammation of the bone/bone marrow
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Osteomyelitis
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Most common overall cause of Osteomyeltitis
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S. aureus
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Most common cause of osteomyelitis in sickle cell patients
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Salmonella
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Osteomyelitits Dx
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Labs, imaging, bone biopsy with histopathology and cultures
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Osteomyelitis Tx
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ABX and surgery
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Inflammation of a joint from a pyogenic organism, usually from a transient bacteremia
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Infectious arthritis
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Most common cause of infectious arthritis
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S. aureus
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Presents with single, hot, swollen joint
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S. aureus infectious arthritis
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S. aureus infectious arthritis Dx
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Joint aspiration
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S. aureus infectious arthritis Tx
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anti-staph ABX
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Most common cause of infectious arthritis in young men
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N. gonorrhoea
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Presents with fever, migratory polyarthralgias, tenosynovitis, and dermatitis
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N. gonorrhoea infectious arthritis
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N. gonorrhoea infectious arthritis
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Ceftriaxone
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Microbial infection of the lining of the heart
Characteristic lesion is a vegetation found on valvular structures |
Infective endocarditis
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Native valve endocarditis (3)
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Viridans streptococci
S. aureus Enterococci |
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Prothetic valve endocarditis early infections (<2 months after valve placed) (2)
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Coagulase (-) staphylococci
S. aureus |
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Prothetic valve endocarditis late infections (3)
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Viridans streptococci
S. aureus Enterococci |
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HACEK Organisms
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Endocarditis infections:
Haemophilus parainfluenzae/aphrophilus Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eikenella corredens Kingella kingae |
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Most common cause of right-sided IE (IVDU)
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S. aureus
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Splinter hemorrhates
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Subungal
Endocarditis |
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Painful, violaceous raised lesions of fingers/toes
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Osler nodes
Endocarditits |
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Painless erythematous lesions of palms/toes
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Janeway lesions
Endocarditits |
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Retinal exudative lesions
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Roth's spots
Endocarditis |
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Petchiae of palate, conjunctiva, beneath fingernails
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Endocarditis
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Gold standard endocarditits Dx
|
Echo (TEE more sensitive than TTE)
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Endocarditits Tx
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Nafcillin + ampicillin + gentimicin
Vancomycin + gentimicin |
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Most common meningitis
Acute, life-threatening CNS infection that develops over hours to days Classified as Bacterial or Aseptic |
Acute Meningitis
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Meningitis symptoms lasting longer than a week
Usually caused by mycobacterium, various fungi, or B. burgdorferi |
Subacute Meningitis
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Meningitis with symptoms present for months or years
Examples inclue TB and neurosyphilis |
Chronic Meningitis
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Infections involving both the leptomeninges and brain parenchyma
Often HSV or Arboviruses |
Meningoencephalitis
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Space-occupying lesions that mimic symptoms of acute meningitis
Includes subdural empyema, epidural abscess, brain abscess |
Parameningeal infections
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Preterm Bacterial Meningitis (3)
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S. agalactiae (Group B strep)
E. coli Listeria |
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Most common bacterial meningitis in children and adults (2)
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S. pneumonia (most common)
N. meningitides |
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Most common bacterial meningitis in elderly/patients with comorbidities (2)
|
S. pneumonia
Listeria |
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Most common aseptic meningitis causes (2)
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Coxsackieviruses
Echovirus |
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Meningitis Dx
|
CSF
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Bacterial Meningitis CSF
|
Increased PSI
Increased cell count PMNs usually Decreased glucose Increased protein GS and Cx often positive |
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Aseptic Meningitis CSF
|
Normal or minimal PSI and cell count
Lymphs usually Glucose nrmal Protein normal or minimally elevated GS and Cx negative |
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Community-acquired acute meningitis
|
Vancomycin + ceftriaxone +/- ampicillin
Dexmethasone also added |
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Most common cause of sporadic fatal encephalitis in the US
|
HSV Meningoencephalitis
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Febrile illness accompanied by impaired sensorium
More likely to have seizures and neurologic findings |
Meningoencephalitis
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Muscle weakness
Flaccid paralysis "unique" to this meningoencephalitis |
West Nile Virus
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Meningoencephalitis Dx
|
CSF evaluation
MRI |
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Meningoencephalitis Tx
|
Supportive care
Empiric acyclovir |
|
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Infection of the epidermis/dermis
Cuased by S. pyogenes Red, glistening, demarcated |
Erysipelas
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Erysipelas Tx
|
Keflex (anti-staph ABX)
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Infection of the epidermis/dermis/CT
Presents with fever/chills, erythema, and induation Lymphangitis and systemic toxicity (indicated by streaking) common |
Cellulitis
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Erysipelas
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S. pyogenes
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Cellulitis
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S. pyogenes
S. aureus |
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Cellulitis Tx
|
Anti-staph ABX
|
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Infection of the hair follicle and apocrine glands
Presents as small, tender, erythematous papules often topped by a cental pustule |
Folliculitis
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Folliculitis
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S. aureus
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Folliculitis Tx
|
Warm compresses
Topical mupiricin |
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Acquired from contaminated pools/hot tubs
Pruritic, sometimes tender papule/pustule |
Hot Tub Folliculitis
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Hot Tub Folliculitis
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P. aeruginosa
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Hot Tub Folliculitis Tx
|
Warm compresses
Anti-pruritis meds ABX not indicated |
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Secondary spread of folliculitis to subcutaneous tissue
Presents as firm, tender, erythematous nodules that become fluctuant |
Furuncles (boils)
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Furuncles (Boils)
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S. aureus
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Furuncles Tx
|
I & D
Anti-staph ABX |
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Multiple abscesses separated by CT exteding into subcutaneous fat in areas of thick, inelastic skin (neck, back, thighs)--Tracks
|
Carbuncles
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Carbuncles
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S. aureus
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Carbuncle Tx
|
I & D
Anti-staph ABX |
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Infection that progressively destroys the subcutaneous fascia/fat with muscle sparing
|
Necrotizing fasciitis
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Necrotizing fasciitis
|
S. pyogenes
|
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Present like cellulitis, but exam findings (systemic toxicity, pain) are out of proportion
|
Necrotizing fasciitis
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Necrotizing fasciitis Tx
|
Extensive debridement
Broad spectrum ABX |
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Polymicrobial necrotizing fasciitis of the scrotum +/- perineum, penis, or abdominal wall
Often in diabetics |
Fournier's Gangrene
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Fournier's Gangrene Tx
|
Extensive debridement
Broad spectrum ABX |
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Infection that progressively destroys the subcutaneous fascia, fat, and muscle
High CPK |
Clostridial Myonecrosis (Gas Gangrene)
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Gas Gangrene
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C. perfringens
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Derm condition often from traumatic wounds or enteric surgery
Severe pain, systemic toxicity, +/- crepitus |
Gas Gangrene
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Gas Gangrene Tx
|
Extensive debridement
Broad-spectrum ABX |
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Human Bites
|
Eikenella corrodens
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Bite Tx
|
Amoxicillin/clavulanate (PO) or ampicillin/sulbactam (IV)
Cefuroxime or doxycycline or Bactrim or floroquinoline PLUS clinda or metronidazole |
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Large volume watery stool
No blood/PMNs Nausea/flue-like symptoms common |
Noninflammatory Diarrhea
|
|
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Anti-peristaltic agents ok in Noninflammatory Diarrhea?
|
Yes
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Anti-peristaltic agents ok in Inflammatory Diarrhea?
|
No
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Small volume frequently bloody/mucosy stools
Many PMNs Fever/chills and crampy abdominal pain common |
Inflammatory Diarrhea
|
|
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"Winter Vomitting Disease"
Cruise ships |
Norovirus
|
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Norovirus Tx
|
Supportively with oral rehydration therapy
|
|
|
Most common parasitic etiology of infectious diarrhea in US
|
Giardiasis
|
|
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Associated with camping/hiking
Affects small intestine |
Giardiasis
|
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Giardiasis Dx
|
Stool EIA
|
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Giardiasis Tx
|
Metronidazole
|
|
|
"Cholera-like" diarrhea affecting colon
Self-limiting in most patients |
Cryptosporidiosis
|
|
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Cryptosporidiosis Dx
|
Stool EIA
|
|
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Cryptosporidiosis Tx
|
Symptomatic
Refer immunosuppressed patient |
|
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"Food poisoning"
Exotoxin is released into a food product that is then eaten |
Staphylococcus aureus
|
|
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"Food poisoning"
Exotoxin is released into a food product (rice) that is then eaten |
Bacillus cereus
|
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Rice water stool
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Cholera
|
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Cholera Dx
|
Stool culture
|
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Cholera Tx
|
ORT
Azithromycin |
|
|
Amebiasis
|
Entamoeba histolytica
|
|
|
Causes most diseases in colon/liver
|
Amebiasis
|
|
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Amebiasis Dx
|
Stool sample
Serology Abdominal CT |
|
|
Amebiasis Tx
|
Metronidazole or tinidazole for colonic disease
Followed by paromomycin (for cysts) |
|
|
Associated with undercooked hamburger, unpasteurized milk/juice, and raw fruit/vegetables
|
E. coli
|
|
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Afebrile + bloody diarrhea
|
E. coli
|
|
|
Hemolytic Uremic Syndrome (3)
|
ARF
Thrombocytopenia Hemolytic anemia |
|
|
HUS associated with
|
E. coli
|
|
|
E. coli tx
|
Supportive
|
|
|
Antibiotic associated diarrhea
|
Clostridium difficile
|
|
|
Fecal incontinance
Horse stable odor |
Clostridium difficile
|
|
|
Clostridium difficile Dx
|
Stool toxin assay/PCR
Leukocytosis common |
|
|
Clostridiusystemic toxicitym difficile Tx
|
Metronidazole
Try to d/c other ABX Place in contact isolation |
|
|
Day-care diarrhea outbreaks
|
Shigellosis
|
|
|
Presents abruptly with bloody diarrhea, abdomnial pain, tenesmus, and systemic toxicity
|
Shigellosis
|
|
|
Shigellosis Tx
|
Fluoroquinolones in adults
Bactrim or azith in kids |
|
|
Gram (-) S-shaped rod diarrhea
|
Campylobacteriosis
|
|
|
Most common bacterial cause of infectious diarrhea in the US
|
Campylobacteriosis
|
|
|
Raw/poorly cooked chicken
|
Campylobacteriosis
|
|
|
Associated with Guillain Barre and reactive arthritis
|
Campylobacteriosis
|
|
|
Campylobacteriosis Tx
|
Azith
|
|
|
Associated with raw egs and reptiles
|
Salmonellosis
|
|
|
Diarrhea presenting with enteric fever or gastroenteritis
|
Salmonellosis
|
|
|
Constipation or "pea soup" diarrhea
Rose spots on trunk |
Salmonellosis
|
|
|
Salmonellosis Tx
|
Flouroquinolones
Ceftriaxone |
|
|
Clinical syndrome characterized by constitutional symptoms, GI symptoms, and HA
|
S. typhi
|
|
|
Enteric Fever Salmonella
|
S. typhi
|
|
|
Gastroenteritis salmonella
|
S. typhimuium
|
|
|
Most common viral etiology of diarrhea
|
Norovirus
|
|
|
Most common bacterial etiology of diarrhea
|
Salmonella
Campylobacter |
|
|
Most common parasitic etiology of diarrhea
|
Giardia
|
|
|
Norovirus transmission route
|
Contaminated food/H2O
Person-to-person contact |
|
|
Giardiasis transmission route
|
Fecal-oral
|
|
|
Cryptosporidiosis transmission route
|
Fecal-oral
|
|
|
Cholera transmission route
|
contaminated food/water
|
|
|
Amebiasis transmission route
|
Fecal-oral
|
|
|
Salmonellosis transmission route
|
Ingestion of organism, usually from contaminated food or drink
|
