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94 Cards in this Set
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first test for lyme disease |
Enzyme immunoassay or immunofluorescence assay |
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2nd line test for lyme with s&s for less than 30 days? |
IgM, IgG and western blot. |
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2nd line test for lyme with s&s for more than 30 days? |
IgG and western blot only. |
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Lyme test interpretation IgM antibodies positive. IgG antibodies positive. Western blot positive. interpretation? |
likely lyme disease if consistent with S&S |
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Lyme test interpretation IgM antibodies positive. IgG antibodies negative. Western blot negative. interpretation? |
early infection or false pos |
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Lyme test interpretation IgM antibodies negative. IgG antibodies negative Western blot not done because of 2 negatives interpretation ? |
no infection present. Consider something else. or antibodies too low to read. |
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Lyme test interpretation IgM antibodies negative. IgG antibodies positive. Western blot positive. interpretation ? |
late or previous infection |
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Lyme test interpretation IgM antibodies negative. IgG antibodies positive. Western blot negative. interpretation ? |
patient has recovered from previous infection or false pos. |
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IgG and IgM can be found in blood and what else? |
CSF |
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gram negative coccobacilli (one tenth the size of regular bacteria) |
rickettsial disease |
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how is rickettsial disease transmitted |
arthropod vector like lice, ticks or mites. |
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gram positive bacteria are ? Corny Actors Knock Back Listerine in the Closet |
Corny Actors Knock Back Listerine in the Closet - the gram positive bacteria are Corynebacteria, Actinomyces, Nocardia, Bacillus , Listeria, and Clostridium. (plus Staph, and Strep - the t looks like a + sign) |
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Remeber... All bacilli are gram negative except "L DATTA"L - |
ListeriaD - Diphtheria Actinomycetes Tetani Clostridium TB Mycobacterium Anthrax bacillus |
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who gets rickettsia ricksttsii |
children 5 to 9 especially in NY. |
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incubation period for rocky mountain spotted fever |
7 days or 2 to 14 days |
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what are some interfereing factors with lyme disease diagnosis |
false pos from other spirochete infectino and rheumatoid factors. Individuals in endemic areas may already have antibodies. |
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tx for rockymountain spotted fever |
doxycycline |
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white/brown coating on tongue |
RMSF |
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rash begins at wrists and ankles and moves proximally |
RMSF |
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–Acute and convalescent serum specimensare acquired. A 4-fold rise in serumantibody titer is preferable, but a single titer of 1:64 is highly suggestive. |
freebee. I don't know what to do with iths |
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what tests would you use to dx RMSF |
latex agglutination and immunofluorescent |
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Immunofluorescent test - Biopsy specimensof skin can be tested 3 to 4 days after symptoms appear. Require trained personnel and fluorescencemicroscope. This method can be used for what disease? |
RMSF |
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most common fungal pathogen in immunocomprimised patients |
candida |
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how do I get vaginal candidiasis |
ABX or change in pH |
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how do I get oral thrush |
diabetes. corticosteroids. HIV. Dentures |
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how do I get skin infection with candida |
get it in the intertriginous areas |
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how do I get candida in my heart (endocarditis) |
IVDA |
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how to tx candida |
nystatin, clotrimazole, fluconazole or ketoconazole |
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If my patient has difficult swallowing and a candida infection what am I thinking? |
really bad infection and it is not just candida. |
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how to dx candida |
gram stain or wet mount and see hyphae. |
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where is Cryptococcosis from? |
pigeon poo |
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who gets Cryptococcosis? |
AIDS, leukemia and lymphoma patients. |
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dx of Cryptococcosis? |
CXR, culture, INDIA ink of CSF and latex agglutination. India ink and latex agglutination are the important ones. |
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tx of Cryptococcosis? |
fluconazole and itraconazole. |
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How do antifungal meds effect the body? |
they are hepatotoxic so they need to be taken for a long time at low doses. |
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India Ink stain |
Cryptococcosis |
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Histoplasmosis from where |
soil contaminated with bats, chickens and starlings. |
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dx of Histoplasmosis |
skin tests, test for antibodies, biopsy and culture. |
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tx for Histoplasmosis? |
: Liposomal Amphotericin B (terribledrug) or Itraconazole |
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how do I get Histoplasmosis |
mid west in the histo belt. Also from parenteral feeding with upper GI perfs. |
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what should you think if the patient has low calcitonin and they are not improving on ABX? |
maybe fungal or the ABX are not addressing the antigen. |
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the most common seriours opportunistic infection with CD4 below 200? |
pneumcystic jeroveci |
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dx of Pneumocystis jeroveci? |
Toluidine blue O stain of cyst wall and Giemsa stain of intracystic bodies .
Get the specimen from bronchoalveolar lavage, lungbiopsy, special stains, PCR. HIV patient – examine first morning sputumspecimen. |
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special handling instruction with viral cultures |
specimens must be kept cool and moist in a holding medum. requires inoculation on cell cultures. specimen must be collected in the first few days of illness. |
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how long to get viral cultures |
28 days |
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does negative viral culture rule out the ds |
no. |
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tx for PJC??? |
TMP-SMX and pentalamine, which may cause hypoglycemia. |
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CMV in pregnancy does what |
stillbirth, birth defects or brain damage. |
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dx CMV |
culture confirms. antibody titers. CMV antigen aids in early detection. TORCH test. (perinatal test) |
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CMV risk factors? |
transplant, AIDS, immunosuppressed. |
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I put 5% acetic acid on some bumps in the privates and they are what? |
condyloma acuminata |
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condyloma lata vs condyloma acuminata |
lata is second stage syphilis. acuminata is genital warts and they turn white when acetic acid is put on them. |
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what should you do with genitcal warts to rule out a bad differential? |
biopsy to rule out squamous cell carcinoma. Put acetic acid on them. Should turn white |
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HSV 1 where? HSV 2 where? |
1 - above waist 2 below waist. Would be legit except anal oral vaginal and all kinds of sex. |
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larger and fewer vesicles than HSV1? |
pharyngitis with ulcers. |
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phryngitis with ulcers tx? |
acyclovir, |
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vesicular lesions on skin of eyelids with dendritic corneal lesions with regional adenopathy. Whats the tx? |
DO NOT give steroids. The can go BLIND! refer to ophthalmologist. they will tx with antivirals ending in ine or ir like : trifluridine, acyclovir, vidaribine,idoxuridine, no steroids |
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tx for herppes simplex |
trifluridine, acyclovir, vidaribine, idoxuridine |
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tzanck smear (non-secific) with multinucleated giant cells |
genital herpes |
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peak incidence of gentital herpes |
15 to 29 |
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rapid method for dx of gential herpes |
fluorescent antigen and moncloncal antibody |
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pharyngitis, edudates in half of patients, fever, painful nodes, fatigue, palatal petechiae in 25%. Enlarged speen and liver |
EBV virus in infectious mononucleosis |
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atyplical lymphocytes on bood smear, then monospot test for what? |
EBV with infectious mono |
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tx of EBV |
Ampicillin is contraindicated. avoid vigerous exercise. |
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HIV dx |
ELISA, Western blot |
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how to tell what the viral load is in HIV |
IFA and PCR |
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dx of influenza |
Rapid culture for A & B using monoclonal antibodies and immunofluorescence. Serology seldom practical, used for epidemiology, presence of IgM antibodyindicates acute infection. |
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herpes zoster aka shingles dx |
culture. serology. fluorescent antibody detection. fluorescent antigen detection are more sensitive. PCR has greater sensitivity. |
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erythema infectosum dx? aka fith disease. |
serology of IgG antibodies not as valuable as IgM. PCR also used. |
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slapped face apearance |
fifth disease |
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fifth disease virus? |
parovirus B19 |
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dx for mumps and what virus? |
paramyxovirus. serologic test for antibodies. Acute and convalescent antibodies increase 4 fold. Also can use fluorescent antibodies. |
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rubella aka german measles dx |
cell culture of throat, blood urine, CSF serology which is an antibody titer. |
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measles aka rubeola dx |
culture from blood and other secretion, serum antibodies 3 days after rash and peaks 2 to 4 weeks later |
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koplicks spots with high fever, cough, rhinorhea, puffy red eyes, photophobia, conjunctivitis, malaise. |
measles or rubeola |
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rash that starts over the face, neck, eyelids, then moves to armsm back chest abdomen, feet and things. |
measles |
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roseola infantum is in what virus family |
herpes. herpes 6 virus |
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rash profuse on neck, arms and trunk with mild rash on face and legs. |
roseola infantum |
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roseola dx is ? |
serology |
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rabies dx |
•Virus isolation from patient’ssaliva or throat. Fluorescent antibodyof blood, skin biopsy, Negri bodies(viral inclusions inneurons) are found in 90% of rabid animals. |
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tx of rabies is? |
wound care. antirabies serum with 5 IM infections over a month. |
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Entamoeba histolytica, giardia lamblia, Cryptosporidium parvum, Toxoplasma gondii and malaria are all examples of what? |
protozoans |
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malaria dx |
hx. ID parasite in RBC's. decreased HgB, protein, and WBC's in urine. thrombocytopenia, increased PT and PTT. Decreased fibrinogen. |
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malaria tx |
oral chloroquine, atovaquone-proguanil. |
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toxoplasma gondii dx |
tissue biosy and blody fluids. CT and MRI. |
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when should antimicrobial susceptibility be performed? |
Isolateis not predictable based on the genus and species. Organismis not part of the normal flora of the specimen site. Organismis isolated from a transplant or immunocompromised patient. |
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most popular method to determine microbila suceptibility ? |
microdilution method Standardconcentration of bacteria is incubated in dilutions of common antibioticscommercially prepared on a 96-well plate.Lowest concentration of antibiotic thatinhibits visible growth of bacteria is theminimum inhibitory concentration(MIC). That is the number at which an antibiotic will be bactericidal. |
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with the microdilution methad what does it mean if there is a high reading? |
It takes more antibiotic to kill the bacteria |
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what is the simplest and most reliable mothod for determining susceptibility? |
disc diffusion |
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the antimicrobial gradient method or E-test is what? |
used for testing fastidious organisms that require special growing conditions. MICs are determined by the intersectionof the elliptically–shaped zone of growth inhibition and the E-strip |
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MIC is what |
minimum inhibitory concentration |
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when would you see increased procalcitonin levels in an ICU? |
sepsis particularly in bacterial sepsis. |
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what should happen to warfarin doses when on ABX? |
warfarin dose should decrease when on ABX |
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most common cause of C dif? |
ampicillin |