Term
| MCC of acute infective endocarditis: |
|
Definition
|
|
Term
|
Definition
S. viridans
enterococci
coagulase negative staph |
|
|
Term
| Where does acute IE occur? |
|
Definition
| on normal heart valves. Dealth occurs in less than 6 weeks if left untreated. |
|
|
Term
| Where does subacute IE occur? |
|
Definition
| Subacute IE occurs on damaged valves. It takes much longer than 6 weeks to be fatal. |
|
|
Term
|
Definition
Cardiac failure
myocardial abscess
solid organ damage 2/2 showered emboli
glomerulonephritis |
|
|
Term
|
Definition
three ways, using Duke's criteria:
2 major criteria
1 major + 3 minor
5 minor |
|
|
Term
| What are the major criteria? |
|
Definition
1. Sustained bacteremia with an organism known to cause IE
2. Endocardial involvement, documented by an echo, or a NEW murmur. |
|
|
Term
| What are the minor criteria? |
|
Definition
1. A predisposing condition
2. Fever
3. Vascular phenomena, such as septic emboli, mycotic aneurysms, ICH, or Janeway lesions.
4. Immune phenomena, such as GN, Osler's nodes, Roth spots, rheumatoid factor.
5. A positive echo that does not meet major criteria. |
|
|
Term
|
Definition
| Penicillin or vancomycin + an aminoglycoside. |
|
|
Term
| How long do you treat IE? |
|
Definition
| 4-6 weeks of IV antibiotics that cover the culture-proven organism. |
|
|
Term
| A post-operative, elderly patient presents with painfull swelling of the cheek aggrevated by chewing. He has a high fever, tenderness, and erythema. Diagnosis? |
|
Definition
| Acute bacterial parotiditis. |
|
|
Term
| How do you prevent acute bacterial parotiditis as a post op complication? |
|
Definition
| Adequate hydration and oral hygeine |
|
|
Term
| What is the mcc of acute bacterial parotiditis? |
|
Definition
|
|
Term
What is the first line treatment for Lyme disease?
What do you use in a pregnant or nursing mother? |
|
Definition
1st line: doxycycline. This has the advantage of treating a possible coinfection with human ehrlichiosis which has the same vector.
For nursing or pregnant women, the treatment of choice is amoxicillin. |
|
|
Term
|
Definition
| A tick borne illness cause by 3 species of gram negative bacteria, each with a different tick vector. |
|
|
Term
| Where is ehrlichiosis endemic? |
|
Definition
| SE, S-central, mid atlantic, upper midwest, and California. |
|
|
Term
| What does ehrlichiosis look like? |
|
Definition
| Infected individuals present 1-3 weeks after a tick bite with fever, malaise, myalgia, headache, and N/V. there is usually no rash, leading to the name "spotless rocky mountain spotted fever." Laboratory studies may reveal leukopenia and/or thrombocytopenia with elevated transaminases. The treatment of choice is doxycycline. |
|
|
Term
| TOC for E. coli UTI in pregnancy: |
|
Definition
amoxicillin
f/u pt in case of resistance. Other choices include nitrofurantoin and cephalexin. |
|
|
Term
| most common pathogens for meningitis in neonates: |
|
Definition
1. Group B strep
2. E. coli
3. Listeria |
|
|
Term
| What is the empiric treatment for meningitis in an infant less than 3 months? |
|
Definition
| Cefotaxime + ampicillin + vancomycin (or an aminoglycoside if less than 4 weeks) |
|
|
Term
| What are the most common pathogens for meningitis in children aged 3 months to 18 years? |
|
Definition
1. Neiseria meningiditis
2. S. pneumo
3. H. flu |
|
|
Term
| What are the most common pathogens for meningitis in adults 18-50? (community aquired meningitis) |
|
Definition
1. S. pneumo
2. N. meningitidis
3. H. flu |
|
|
Term
| What is the empiric treatment for meningitis in a patient aged 3 months to 50 years? |
|
Definition
| ceftriaxone or cefotaxime + vancomycin |
|
|
Term
| What are the most common pathogens for meningitis in adults over the age of 50? |
|
Definition
1) S. pneumo
2) N. meningitidis
3) Listeria |
|
|
Term
| What is the empiric treatment for meningitis in a patient aged greater than 50 years? |
|
Definition
| ceftriaxone or cefotaxime + vancomycin + ampicillin |
|
|
Term
| What are the most common pathogens for meningitis in the immunocompromised? |
|
Definition
1) Listeria
2) Gram negative bacilli (think pseudomonas)
3) S. pneumo |
|
|
Term
| What is the empiric treatment for meningitis in the immunocompromised? |
|
Definition
| Ceftazidime + ampicillin + vancomycin |
|
|
Term
| acute, unilateral lymphadenopathy in a child: |
|
Definition
| most likely bacterial infection with s. aureus or group A strep. Pts are usually less than 5 years and non-toxic appearing. |
|
|
Term
| bilateral, subacute/chronic lymphadenopahty: |
|
Definition
| most likely EBV virus. EBV will be associated with fever, pharyngitis, and hepatosplenomegaly. |
|
|
Term
| What is bacillary angiomatosis? |
|
Definition
An infection that generally infects immunocompromised patients, caused by bartonella henslae and bartonella quintana together.
Patients develop non-specific constitutional symptoms and characterisitc lesions of the skin and vicera: large, pedunculated, exophytic papules with collarette of scale.
Dx: biopsy and visualization of microbes. |
|
|
Term
| What is an acute febrile non-hemolytic transfusion reaction? |
|
Definition
| ACNHTR is an immune mediated phenomenon where host antibodies bind to donor cells leading to complement activation and inflammatory cytokine release. |
|
|
Term
| How do you recognize AFNHTR? |
|
Definition
AFNHTR usually presents during or a few hours after the transfusion with a 1 degree C increase in body temp and rigors.
Treatment: discontinue the transfusion and give anti-pyretics. |
|
|
Term
| when do you give the pneumococcal vaccine in HIV infected patients? |
|
Definition
| All children and adults with HIV and a CD4 count above 200 should receive the vaccine. |
|
|
Term
| When do you give the Hepatitis A vaccine to HIV infected patients? |
|
Definition
| HIV pts who already have hepatitis B, C, or both should receive the hepatitis A vaccine; IV drug users, MSM, and pts with liver disease should receive it as well. |
|
|
Term
| When do HIV + pts receive the meningococcus vaccine? |
|
Definition
| The meningococcus vaccine is not recommended to HIV + individuals since the response is suboptimal in HIV infected pts. |
|
|
Term
| When should you suspect actinomycosis? |
|
Definition
In a patient with a draining infection in the cervicofacial, throacic, or abdominal region. The area usually begins to drain fluid containing sulfur granules. Treat with high dose penicillin for 6-12 weeks.
Actinomycoses israeli is a gram positive branching bacteria. |
|
|
Term
| Esophagitis in advanced HIV: |
|
Definition
-may occur when CD4 < 50
-sx include odynophagia and substernal burning
-MCC: candida. In a suspicious case, start empiric fluconazole. If there is no clinical response in 3 days, further investigation is warranted. (Ie, esophagoscopy, cytology, biopsy, and culture.) other organisms: HSV and CMV |
|
|
Term
| What does the rash of rubella look like? |
|
Definition
| A maculopapular erythematous rash that begins on the face and progresses to the trunk and extremities. |
|
|
Term
| What is the prodrome of rubella? |
|
Definition
| fever, lymphadenopathy, malaise, occipital and posterior cervical lymphadenopathy are suggestive of rubella. Some patients develop mild coryza and conjunctivitis. Adult women usually have associated arthritis. |
|
|
Term
| What is the presentation of congenital toxoplasmosis infection at birth? |
|
Definition
-hepatosplenomegaly
-hydrocephalus
-chorioretinitis
-intracranial calcifications |
|
|
Term
| What is the presentation of congenital rubella at birth? |
|
Definition
-sensorineural hearing loss
-cataracts
-heart defects
-hepatosplenomegaly
-microcephaly
-thrombocytopenic purpura (blueberry muffin rash) |
|
|
Term
| What is the presentation of congenital CMV at birth? |
|
Definition
-IUGR
-hepatosplenomegaly
-petichiae or purpura
-microcephaly
-chorioretinitis
-sensorineural hearing loss
-periventricular calcifications |
|
|
Term
| What is the presentation of congenital HIV at birth? |
|
Definition
| Congenital HIV is usually asymptomatic at birth. |
|
|
Term
| What is the presentation of congenital syphilis at birth? |
|
Definition
Syphilis may be asymptomatic at birth, however, if the baby has symptoms they will be:
-cutaneous lesions on the palms and soles
-hepatosplenomegaly
-jaundice
-anemia
-rhinorrhea.
Xray will show metaphyseal dystrophy and periostitis. |
|
|
Term
| Can the late findings of congenital syphilis be prevented? |
|
Definition
| Yes, with early treatment. Treatment is penicillin G. |
|
|
Term
| Presentation of influenza: |
|
Definition
acute onset of fever, chills, malaise, myalgias, cough, and coryza.
Leukopenia is common; proteinuria may or may not be present. |
|
|
Term
|
Definition
| When the ANC is less than 1500 |
|
|
Term
| When does susceptibility to infection increase in neutropenia? |
|
Definition
|
|
Term
| When is the ability to control endogenous flora lost? |
|
Definition
|
|
Term
| What when is fever in neutropenia? |
|
Definition
a single reading over 100.9 (38.3)
or a sustained temp over 100.4 (38) over 1 hr |
|
|
Term
| What is the MCC of neutropenic fever |
|
Definition
| bacterial infections caused by endogenous skin or colon flora |
|
|
Term
| How do you treat neutropenic fever? |
|
Definition
| Febrile neutropenia is a medical emergency. Broad-spectrum antibiotics covering pseudomonas should be started. When neutropenic fever persists despite tx, amphotericin B should be added. |
|
|
Term
| What HIV medication is associated with crystal induced nephropathy? |
|
Definition
indinavir (a protease inhibitor)
It is caused by precipitation of the drug in the urine and obstructing urine flow. |
|
|
Term
| What is a life threatening reaction caused by didanosine? |
|
Definition
|
|
Term
| What is a life threatening reaction caused by abacavir? |
|
Definition
| abacavir related hypersensitivity syndrome |
|
|
Term
| Which HIV drug class may cause lactic acidosis? |
|
Definition
|
|
Term
| Which HIV drug class may cause SJS? |
|
Definition
|
|
Term
| What HIV drug is a/w liver failure? |
|
Definition
|
|
Term
| How do you treat influenza? |
|
Definition
neuraminidase inhibitors: oseltamivir and zanamivir
Only affective against inf a: rimantadin and amantadine. |
|
|
Term
| What bacteria make preformed toxins that cause food poisoning? |
|
Definition
S. aureus (meats and eggs)
B. cereus (rice and starches) |
|
|
Term
| What is the classic scenario of food poisoning? |
|
Definition
| Several people who all partook of the same meal present < 6 hours after ingestion with nausea and vomiting but no diarrhea. |
|
|
Term
|
Definition
| an infection of the soft tissues anterior to the orbital septum that is most commonly caused by contiguous spread of infection from facial or eyelid trauma. |
|
|
Term
|
Definition
an infection posterior to the orbital septum. It may manifest as decreased eye movements, decreased visual acuity, double vision, or proptosis.
Requires hospitalization. |
|
|
Term
| name an anti-pseudomonal penicillin |
|
Definition
|
|
Term
|
Definition
-presents c ear discharge and severe ear pain often radiating to the tmj
-exam shows granulation tissue at the external auditory meatus
-DM and immunosuppression are risk factors
-most common organism: pseudomonas |
|
|
Term
| How do you treat a cat bite? |
|
Definition
-tetanus shot
-rabies eval
-clean wound
-FIVE DAY COURSE OF AUGMENTIN in case of pasteurella infection in a deep puncture wound leading to cellulitis. |
|
|
Term
| What does the heterophile ab test test for? |
|
Definition
| EBV. Both sensitive and specific: abs typically arise within 1 wk of sxs and persist for up to 1 yr. |
|
|
Term
|
Definition
-common in travelers to tropical regions
-characterized by puritic, elevated serpiginous lesions on the skin
-infection is often aquired through contact c sand or soil contaminated with cat or dog feces. |
|
|
Term
| 5 y/o c pharyngitis, fever, dysphagia, neck stiffness, a muffled voice, and posterior pharyngeal bulge. |
|
Definition
-retropharyngeal abscess
-children 6 mo to 6 yrs
-potentially life threatening |
|
|
Term
|
Definition
| Caused by rhizopus fungus, requires aggressive surgical debridement and early systemic therapy c amp B |
|
|
Term
| A child has been bitten by a dog. The dog has been captured, but has no proof of rabies vaccine. Do you give prophylaxis? |
|
Definition
| -The dog is kept for observation for 10 days. If the dog develops rabid features, prophylaxis is indicated immediately and dx is confirmed by FA examination of the brain. |
|
|
Term
| The dog is not captured. Does the child receive prophylaxis? |
|
Definition
| Yes. The dog is then assumed rabid. |
|
|
Term
| A dog bites a child on the neck. Do you give prophylaxis? |
|
Definition
| Yes. any rabies exposure involving the head and neck is indication for prophylaxis. |
|
|
Term
| How do you give rabies prophylaxis? |
|
Definition
| Both acitve and passive immunity. |
|
|
Term
| An inflamed, tender, fluctulent lymph node in a child: |
|
Definition
| staph and strep infection. Treat with a penicillin with good coverage of both. |
|
|
Term
| MCC of pneumonia in HIV pts? |
|
Definition
|
|
Term
| A nail puncture wound in an adult that results in osteomyelitis. What is the most likely pathogen? |
|
Definition
|
|
Term
| Nodular infiltrate and cavitation on xray in an IV drug abuser: |
|
Definition
| S. aureus emboli from tricuspid infective endocarditis. |
|
|
Term
|
Definition
| An aerobic, gram +, partially acid-fast branching rod in chains. It is present in the soil worldwide. |
|
|
Term
| How can nocardiasis present? |
|
Definition
| With pulmonary, cns, or cutaneous manifestations. Patients deficient in cell-mediated immunity (lymphoma, AIDS, transplant recipients) are at risk for pulmonary or disseminated disease. |
|
|
Term
| What does pulmonary nocardiasis look like? |
|
Definition
| usually manifests as subacute pneumonia that develops over days to weeks. 1/3 develop empyema, and 1/2 have extra-pulmonary dissemination--most commonly to the brain. |
|
|
Term
| What is the treatment of choice for nocardiasis? |
|
Definition
1. Bactrim
2. minocicline
The risk of disease may be decreased in the immunocompromised with bactrim prophylaxis. |
|
|
Term
| MCC of osteomyelitis in infants and children: |
|
Definition
|
|
Term
| What parasite is the disease cysticercosis caused by? |
|
Definition
| Taenia solium, the pork tapeworm. It is contracted when a person consumes t. solium eggs excreted by another person. Humans are the definitive host, and the adult tapeworm lives in the upper jejunum and excretes its eggs into the person's feces. |
|
|
Term
| Contraction of cysticercosis: |
|
Definition
| A human eats human-feces conaminated food that has the eggs of t. solium in it. The embryoes are released in the intestine, and invade the intestinal wall. They disseminate hematogenously to encyst in the human brain, muscle, sub q, or eye. |
|
|
Term
| What is the most common manifestation of cysticercosis? |
|
Definition
neurocysticercosis. This is characterized by multiple, small fluid filled cysts in the brain parenchyma.
These cysticerci have a membranous wall and often demonstrate a characteristic invaginated scolex on imaging. |
|
|
Term
| What is the treatment for a human bite? |
|
Definition
| -augmentin to cover for gram +, gram -, and anaerobes. |
|
|
Term
| DDx of acute bloody diarrhea: |
|
Definition
EHEC (shiga toxin 0157:H7)
Shigella
Salmonella
Campylobcter |
|
|
Term
| HIV pt c odynophagia who failed a 3 day trial of fluconazole and has biopsy showing large, shallow, superficial ulcerations and intranuclear, intracytoplasmic inclusion bodies. |
|
Definition
| CMV esophagitis. Treat with ganciclovir. |
|
|
Term
| Same pt c multiple, well circumscribed ulcers taht have a volcano like (small and deep) appearance. |
|
Definition
| HSV esophagitis. Tx c acyclovir. |
|
|
Term
| A pulmonary nodule with the "halo sign" in a CT from an immunocompromised pt c/o fever and cough. |
|
Definition
| Aspergilosis. CXR may show a cavitary lesion. |
|
|
Term
| causes of viral meningitis? |
|
Definition
| 90% are caused by non-polio enteroviruses such as echovirus and coxackievirus. |
|
|
Term
| Meds affective against pseudomonas: |
|
Definition
cefepime
piperacillin-tazobactam
aztreonam
ciprofloxacin
imipenem/cilastatin
tobramycin
gentamicin
amikacin |
|
|
Term
| Does a negative heterophile antibody test in the first few weeks of mononucleosis rule it out? |
|
Definition
| No. The antibodies may not appear until late in the course of illness. |
|
|
Term
| What prophylaxis do HIV+ pts require when their CD4 count falls below 50? |
|
Definition
| azithromycin or clarithromycin prophylaxis for MAC. |
|
|
Term
| A young woman presents with vesicular skin rash on hands, and regional lymphadenopathy. She has a cat at home. |
|
Definition
| Cat scratch, caused by bartonella henslae. |
|
|
Term
| Tell me about cat scratch |
|
Definition
-May be transmitted by cat scratch, cate bite, or flea bite.
-Young, immcompetent hosts
-localized cutaneous and lymph node d/o near innoculum site with rare liver, spleen, eye, or CNS involvement.
-A local skin lesion evolves through vesicular, erythemetous, and papular phases.
-Localized regional lymphadenopathy which is tender and my be suppurative.
-clinical diagnosis, or + b. henslae ab test or tissue c + Warthin-Starry stain.
-Tx: 5 days of azithromycin. |
|
|
Term
|
Definition
| Big cyst in the liver with dauthter cysts. A/w close living to sheep and dogs. = Hydatid cysts. |
|
|
Term
| Pts with S. bovis endocarditis or septicemia are at increased risk of: |
|
Definition
occult colorectal or upper GI cancer.
Tx with antibiotics and endoscopic or radiographic evaluation for GI malignancy. |
|
|
Term
|
Definition
| ALKALINE urine bc proteus makes urease. Suspect this in pts who live in long-term care facilities. |
|
|
Term
| Hematologic complication of I.M.: |
|
Definition
| -autoimmune hemolytic anemia and thrombocytopenia which is due to cross reactivity of the EBV-induced antibodies agianst RBCs and platelets. IgM cold agglutinin antibodies knon as anit-i antibodies which lead to complement mediated destruction of RBCs. Usually Coombs test +. (The onset of hemolytic anemia may be 2-3 weeks after onset of symptoms. |
|
|
Term
| What is the immune response from a vaccine against an encapsulated organism? |
|
Definition
A B-cell only, T-cell indepenedent response. Capsules are made of polysaccharides, therefore capsular vaccines are made of polysaccharides.
While peptides are presented to T-cells by macrophages after digestion, polysaccharides cannot be presented to T-cells. |
|
|
Term
| Do you give MMR to an HIV+ pt who has never had it? |
|
Definition
| Yes, as long as their CD4 > 200 and they have never had an AIDS defining illness. |
|
|
Term
|
Definition
| An eye test that uses an orange dye (fluorescein) and blue light to detect foreign bodies in the eye. This test can also detect damage to the cornea. |
|
|
Term
| A healthcare worker with an HIV+ needlestick. What do you do? |
|
Definition
-obtain baseline serum studies
- 2-3 drug treatment for prophylaxis
- Repeat blood draws in 6 weeks, 3 months, and 6 months. |
|
|
Term
| What is the backup treatment for syphilis in penicillin-allergic patients: |
|
Definition
- Doxycycline or tetracycline
- Azithromycin |
|
|
Term
| What prophylaxis is indicated in post-transplant patients? |
|
Definition
| TMP-SMX to prevent pcp pneumonia. |
|
|
Term
| What vaccines are indicated in post-transplant patients? |
|
Definition
| influenza, pneumococcus, hepatitis B |
|
|
Term
| Bone marrow transplant patient with both lung and interstitial involvement: |
|
Definition
CMV pneumonitis. Risks include certain types of immunosuppressive therapy, older age, and seropositivity before transplant.
-median time after BMT: 45d
-CXR: multifocal diffuse patchy infiltrates
-HRCT: parenchymal opacification or multiple small nodules.
-BAL: diagnostic in most cases
-Other than pneumonitis, CMV infection post-BMT also manifests as upper and lower GI ulcers, bone marrow suppression, arthralgials, myalgias, and esophagitis. |
|
|
Term
| An HIV+ man presents with SOB (or cough or other lung problem) and heaped up verrucous lesions. Wet prep of the lesions shows yeast. |
|
Definition
Blastomycosis. Endemic in SC and NC US; usually affects lungs, skin, bones, joints, and prostate. Uncommon in immunocompoetent hosts. The cutaneous diesease is either verrucous or ulcerative. Verrucous lesions are papulopustular, and then become crusted, heaped up, warty, with a violaceous hue. They have sharp boarders and may be surrounded by microabscesses.
-broad based budding yeast. |
|
|
Term
| Pt with copper hue to skin, lung disease, and cirrhosis. |
|
Definition
| Listeria in a patient with hemochromatosis. Pts c hemochromotosis and cirrhosis are at increased risk of infection with listeria, yersinia enterocolitis, and septicemia from vibrio vulnificans. |
|
|
Term
| Pt who recently ate BBQ pork just over a week ago presents with splinterhemorrhages, conjunctivitis, and periorbital edema. Last week pt reports abd pain, N/V, and diarrhea. |
|
Definition
Trichinellosis/Trichinosis
-parasitic infection caused by the roundwork trichinella. It is aquired by eating undercooked pork that contains encysted trichinella larvae.
- 1st phase: first week of infection when the larvae invade the intestinal wall; manifests as abd pain, N/V/D.
-2nd phase, second week: local and systemic hypersensitivity, reaction caused by larval migration and features such as splinter hemorrhages, orbital edema, conjunctivits, retinal hemorrhages, and chemosis.
- 3rd phase: larvae enter skeletal muscle causing muscle pain, tenderness, swelling,a nd weakness.
-characterized by eosinophilia. |
|
|
Term
| What is the induction treatment for CNS cryptococcal infection in AIDS? |
|
Definition
Amphotericin B and flucytosine.
Maintenance: flucytosine |
|
|
Term
| What is the treatment for INH toxicity? |
|
Definition
|
|
Term
| Child presents with a sharply demarkated erythematous, edemous skin lesion with raised borders. |
|
Definition
Erysipelas: specific type of cellulitis characterized by inflammation of the superficial dermis producing swelling.
- classic findings as described
- Onset is abrupt and there are usually systemic signs including fever and chills.
- The legs are the most frequently involved site
- Most likely organism: S. pyogenes |
|
|
Term
| Man from Arizona presents with fatigue, fever, dry cough, and pleuritic chest pain. He also has joint pain. |
|
Definition
Coccidiomycosis
-endemic in SW US as well as central and South America.
- Primary pulmonary infection has nonspecific features such as fatigue, fever, dry coug, weight loss, and pleuritic chest pain.
- Cutaneous findings such as erythema multiforme and erythema nodosum and arthralgias are common. |
|
|
Term
| Drugs for toxoplasmosis in an HIV+ pt? |
|
Definition
prophylaxis: bactrim
treatment: sulfadiazine and pyrimethamine |
|
|
Term
| When does qbank say to start HAART? |
|
Definition
|
|
Term
| What is the most common postinfectious complication seen in patients with impetigo? |
|
Definition
|
|
Term
| What does gentamicin cover? |
|
Definition
| - excellent gram negative coverage |
|
|
Term
| What does clindamycin cover? |
|
Definition
| - gram positives and anaerobes |
|
|
