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285 Cards in this Set
- Front
- Back
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
|
Itraconazole (mild/mod)
Amphotericin B (severe) |
|
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
|
Pyrimethamine
Sulfadiazine |
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Where does VZV lie dormant?
|
Dorsal root ganglia of nerve
|
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Malaria Dx
|
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
|
Toxoplasmosis
|
|
Progressive HA, AMS changes, new-onset seizure
|
Toxoplasmosis
|
|
Ring-enhancing mass lesions on head CT
|
Toxoplasmosis
|
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Toxoplasmosis Dx
|
Serology
Biopsy Imaging |
|
Toxoplasmosis Tx
|
Pyrimethamine
Sulfadiazine |
|
Where does VZV lie dormant?
|
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
|
Acyclovir
|
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Hutchinson's sign
|
VZV on nose (trigeminal nerve)
Optho consult |
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Waldeyer's Ring exudate
|
Ebstein-Barr Virus
|
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Posterior cervical lymphadenopathy (3)
|
EBV
Toxoplasmosis Rubella |
|
Aminopenicillin given to EBV patient
|
maculopapular rash
|
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EBV Dx
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Exam findings
Atypical lymphocytosis Heterophile agglutination test (Monospot) |
|
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
|
Cytomegalovirus
|
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Common in AIDS patients with < 50 CD4 cells
|
Cytomegalovirus
|
|
3 severe reactions seen in Cytomegalovirus
|
CMV retinitis (brush fire appearance)
GI CMV (ulcers esophagus, anus) Pulmonary CMV ("Pneumonia") |
|
Cytomegalovirus Dx
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Serology
PCR +/- biopsy |
|
Cytomegalovirus Tx
|
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
|
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 |
|
Rabies Tx
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4 injections in deltoid
|
|
Acute HIV Syndrome Dx
|
HIV RNA level
Viral load usually done by PCR bc usually too early for ELISA |
|
HIV screening test
|
ELISA
|
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HIV confirmatory test
|
WB
|
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Used to test for neonatal HIV
|
HIV viral load
|
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Only used to screen for Acute HIV Syndrome
|
HIV Viral load
|
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CD4 >500
|
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)
|
CMV retinitis
Toxoplasmosis Cryptococcus |
|
<50 CD4
|
M. avium complex (MAC)
|
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HIV Tx
|
Look for answer with 3-4 drugs
2 drugs should have 3 letter abbreviation in parenthesis One drug ending in -vir |
|
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
|
Rash
|
|
Efavirenz SEs
|
CNS disengagement (vivid dreams)
|
|
Protease inhibitor SEs
|
Facial/peripheral fat and large stomach (lipodystrophy/metabolic side effects)
|
|
Indinavir SEs
|
Nephrolithiasis
|
|
HIV Pneumocyctosis prophylaxis
|
Bactrim
|
|
HIV Toxoplasmosis prophylaxis
|
Bactrim
|
|
HIV MAC prophylaxis
|
Azithromycin or clarithromycin
|
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When should HIV pts be given prophylaxis for Pneumocyctosis?
|
CD4 <200
|
|
When should HIV pts be given prophylaxis for Toxoplasmosis?
|
CD4 <100
|
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When should HIV pts be given prophylaxis for MAC?
|
CD4 <50
|
|
Rickettsia rickettsii
|
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
|
Rocky Mt Spotted Fever
|
|
Rocky Mt Spotted Fever Tx
|
Doxycycline
|
|
Presents like Rocky Mt. Spotted Fever rash involves trunk, spares hands/feet
|
Ehrlichiosis/anaplasmosis
|
|
Ehrlichiosis/anaplasmosis Dx
|
Leukopenia
Thrombocytopenia Elevated ALT/AST |
|
Morulae occasionally seen on WBC smear
|
Ehrlichiosis/anaplasmosis
|
|
Ehrlichiosis/anaplasmosis Tx
|
Doxycycline
|
|
Tetanus Prevention
|
Vaccination +/- tetanus immune globulin (TIG)
|
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Tetanus infection Tx
|
Tetanus vaccine + TIG + penicillin G
|
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Sudden onset of diplopia, dry mouth, dysphagia, dysphonia, and muscle weakness followed by respiratory paralysis
|
Botulism
|
|
Botulism Tx
|
Botulism immune globulin (infants)
Trivalent equine antitoxin (adults) |
|
Borrelia burgdorferi
|
Lyme disease
|
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Common in northeast and upper midwest
Transmitted by tick bite |
Lyme disease
|
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Erythema migrans
|
Lyme disease
|
|
Lyme disease Dx (if in question)
|
Screening ELISA with confirmatory WB
|
|
Lyme disease Tx
|
Doxycycline (>8 yo)
Amoxicillin (<8 yo) Ceftriaxone in more severe disease |
|
Anthrax
|
Bacillus anthracis
|
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Inhaled spores cause mediastinitis/hemorrhagic lymphadenitis
Widened mediastinum on CXR |
Inhaled anthrax
|
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Anthrax Tx
|
Prophylaxis: FQ x60 days
Disease: FQ + clinda +/- rifampin |
|
Smallpox
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Variola major
|
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Smallpox Tx
|
Cidofovir and vaccinate
|
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Presents with vaginal pruritis and a malodorous frothy, yellow-green discharge
|
Trich
|
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Strawberry cervix
|
Trich
|
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Trichomonads seen on wet prep
|
Trich
|
|
Trich Tx
|
Metronidazole 2g PO
Treat partners |
|
Most common STI
|
Chlamydia
|
|
Both sexes may present with reactive arthritis/tenosynovitis or Reiter's syndrome
|
Chlamydia
|
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Reiter's syndrome
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Urethritis
Conjunctivitis Arthritis Mucocutaneous lesions |
|
Chlamydia Dx
|
Nucleic acid amplification testing of discharge or urine
|
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Chlamydia Tx
|
Azithromycin or doxycycline
|
|
Starts with painless mucosal lesion, followed by lymphatic spread, inguinal bubo, draining sinus tracts
|
Lymphogranuloma venereum
|
|
Lymphogranuloma venereum Tx
|
Doxy
|
|
Lymphogranuloma venereum
|
Chlamydia trachomatis
|
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Chlamydia Tx in pregnancy
|
Azithromycin or erythromycin
|
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Presents with yellow, creamy profuse discharge
Women may be asymptomatic |
Gonorrhea
|
|
Fitz-Hugh Curtis syndrome
|
Perihepatic gonorrhea
|
|
Presents with fever and RUQ pain
Extension of infection from fallopian tubes to peritoneum and liver capsule |
Fitz-Hugh-Curtis syndrome
|
|
Gonhorrhea Dx
|
Gram stain/culture of discharge
NAAT of discharge or urine |
|
Gonhorrhea Tx
|
Ceftriaxone plus azithromycin
(Always treat chlamydia too) |
|
Most common cause of external genital warts
|
HPV 6 and 11
|
|
Most common for cervical dysplasia
|
HPV 16, 18, 31, 33, 25
|
|
Condylomata acuminata
|
Anorectal warts (more malignant)
|
|
HPV Dx
|
Biopsy
|
|
HPV Tx
|
Ablation
Imiquimod (Aldara) Podofilox |
|
Associated with Bell's Palsy
|
HSV1
|
|
HSV Dx
|
Tzanck smear
DFA Serology PCR |
|
Chancroid
|
Haemophilus ducreyi
|
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Chancroid Tx
|
Ceftriaxone or azithromycin
|
|
Granuloma inguinale
|
Klebsiella granulomatis
|
|
Chroni relapsing granulomatous anogenital infection
Painful infiltrated nodules (ulcer with red friable base of granualtion tissue) |
Granuloma inguinale
|
|
Donovan's bodies seen on Wright or Giemsa stains
|
Granuloma inguinale
|
|
Granuloma inguinale Tx
|
Doxycycline or Bactrim
|
|
Syphilis
|
Treponema pallidum
|
|
Painless ulcer at site of exposure
Chancre |
Primary syphillis
|
|
Generalized maculopapular rash (even palms/soles)
|
Secondary syphilis
|
|
Condylomata lata
|
Secondary syphilis
|
|
Infiltrative tumors (gummas), aortitis, neurosyphilis
|
Tertiary syphilis
|
|
Hutchinson's tooth in kids
|
Syphilis
|
|
Syphilis screening
|
VDRL or RPR
|
|
Syphilis confirmation
|
FTA-ABS or MHA-TP
|
|
Syphilis Tx
|
PCN G
|
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Inflammation of the bone/bone marrow
|
Osteomyelitis
|
|
Most common overall cause of Osteomyeltitis
|
S. aureus
|
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Most common cause of osteomyelitis in sickle cell patients
|
Salmonella
|
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Osteomyelitits Dx
|
Labs, imaging, bone biopsy with histopathology and cultures
|
|
Osteomyelitis Tx
|
ABX and surgery
|
|
Inflammation of a joint from a pyogenic organism, usually from a transient bacteremia
|
Infectious arthritis
|
|
Most common cause of infectious arthritis
|
S. aureus
|
|
Presents with single, hot, swollen joint
|
S. aureus infectious arthritis
|
|
S. aureus infectious arthritis Dx
|
Joint aspiration
|
|
S. aureus infectious arthritis Tx
|
anti-staph ABX
|
|
Most common cause of infectious arthritis in young men
|
N. gonorrhoea
|
|
Presents with fever, migratory polyarthralgias, tenosynovitis, and dermatitis
|
N. gonorrhoea infectious arthritis
|
|
N. gonorrhoea infectious arthritis
|
Ceftriaxone
|
|
Microbial infection of the lining of the heart
Characteristic lesion is a vegetation found on valvular structures |
Infective endocarditis
|
|
Native valve endocarditis (3)
|
Viridans streptococci
S. aureus Enterococci |
|
Prothetic valve endocarditis early infections (<2 months after valve placed) (2)
|
Coagulase (-) staphylococci
S. aureus |
|
Prothetic valve endocarditis late infections (3)
|
Viridans streptococci
S. aureus Enterococci |
|
HACEK Organisms
|
Endocarditis infections:
Haemophilus parainfluenzae/aphrophilus Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eikenella corredens Kingella kingae |
|
Most common cause of right-sided IE (IVDU)
|
S. aureus
|
|
Splinter hemorrhates
|
Subungal
Endocarditis |
|
Painful, violaceous raised lesions of fingers/toes
|
Osler nodes
Endocarditits |
|
Painless erythematous lesions of palms/toes
|
Janeway lesions
Endocarditits |
|
Retinal exudative lesions
|
Roth's spots
Endocarditis |
|
Petchiae of palate, conjunctiva, beneath fingernails
|
Endocarditis
|
|
Gold standard endocarditits Dx
|
Echo (TEE more sensitive than TTE)
|
|
Endocarditits Tx
|
Nafcillin + ampicillin + gentimicin
Vancomycin + gentimicin |
|
Most common meningitis
Acute, life-threatening CNS infection that develops over hours to days Classified as Bacterial or Aseptic |
Acute Meningitis
|
|
Meningitis symptoms lasting longer than a week
Usually caused by mycobacterium, various fungi, or B. burgdorferi |
Subacute Meningitis
|
|
Meningitis with symptoms present for months or years
Examples inclue TB and neurosyphilis |
Chronic Meningitis
|
|
Infections involving both the leptomeninges and brain parenchyma
Often HSV or Arboviruses |
Meningoencephalitis
|
|
Space-occupying lesions that mimic symptoms of acute meningitis
Includes subdural empyema, epidural abscess, brain abscess |
Parameningeal infections
|
|
Preterm Bacterial Meningitis (3)
|
S. agalactiae (Group B strep)
E. coli Listeria |
|
Most common bacterial meningitis in children and adults (2)
|
S. pneumonia (most common)
N. meningitides |
|
Most common bacterial meningitis in elderly/patients with comorbidities (2)
|
S. pneumonia
Listeria |
|
Most common aseptic meningitis causes (2)
|
Coxsackieviruses
Echovirus |
|
Meningitis Dx
|
CSF
|
|
Bacterial Meningitis CSF
|
Increased PSI
Increased cell count PMNs usually Decreased glucose Increased protein GS and Cx often positive |
|
Aseptic Meningitis CSF
|
Normal or minimal PSI and cell count
Lymphs usually Glucose nrmal Protein normal or minimally elevated GS and Cx negative |
|
Community-acquired acute meningitis
|
Vancomycin + ceftriaxone +/- ampicillin
Dexmethasone also added |
|
Most common cause of sporadic fatal encephalitis in the US
|
HSV Meningoencephalitis
|
|
Febrile illness accompanied by impaired sensorium
More likely to have seizures and neurologic findings |
Meningoencephalitis
|
|
Muscle weakness
Flaccid paralysis "unique" to this meningoencephalitis |
West Nile Virus
|
|
Meningoencephalitis Dx
|
CSF evaluation
MRI |
|
Meningoencephalitis Tx
|
Supportive care
Empiric acyclovir |
|
Infection of the epidermis/dermis
Cuased by S. pyogenes Red, glistening, demarcated |
Erysipelas
|
|
Erysipelas Tx
|
Keflex (anti-staph ABX)
|
|
Infection of the epidermis/dermis/CT
Presents with fever/chills, erythema, and induation Lymphangitis and systemic toxicity (indicated by streaking) common |
Cellulitis
|
|
Erysipelas
|
S. pyogenes
|
|
Cellulitis
|
S. pyogenes
S. aureus |
|
Cellulitis Tx
|
Anti-staph ABX
|
|
Infection of the hair follicle and apocrine glands
Presents as small, tender, erythematous papules often topped by a cental pustule |
Folliculitis
|
|
Folliculitis
|
S. aureus
|
|
Folliculitis Tx
|
Warm compresses
Topical mupiricin |
|
Acquired from contaminated pools/hot tubs
Pruritic, sometimes tender papule/pustule |
Hot Tub Folliculitis
|
|
Hot Tub Folliculitis
|
P. aeruginosa
|
|
Hot Tub Folliculitis Tx
|
Warm compresses
Anti-pruritis meds ABX not indicated |
|
Secondary spread of folliculitis to subcutaneous tissue
Presents as firm, tender, erythematous nodules that become fluctuant |
Furuncles (boils)
|
|
Furuncles (Boils)
|
S. aureus
|
|
Furuncles Tx
|
I & D
Anti-staph ABX |
|
Multiple abscesses separated by CT exteding into subcutaneous fat in areas of thick, inelastic skin (neck, back, thighs)--Tracks
|
Carbuncles
|
|
Carbuncles
|
S. aureus
|
|
Carbuncle Tx
|
I & D
Anti-staph ABX |
|
Infection that progressively destroys the subcutaneous fascia/fat with muscle sparing
|
Necrotizing fasciitis
|
|
Necrotizing fasciitis
|
S. pyogenes
|
|
Present like cellulitis, but exam findings (systemic toxicity, pain) are out of proportion
|
Necrotizing fasciitis
|
|
Necrotizing fasciitis Tx
|
Extensive debridement
Broad spectrum ABX |
|
Polymicrobial necrotizing fasciitis of the scrotum +/- perineum, penis, or abdominal wall
Often in diabetics |
Fournier's Gangrene
|
|
Fournier's Gangrene Tx
|
Extensive debridement
Broad spectrum ABX |
|
Infection that progressively destroys the subcutaneous fascia, fat, and muscle
High CPK |
Clostridial Myonecrosis (Gas Gangrene)
|
|
Gas Gangrene
|
C. perfringens
|
|
Derm condition often from traumatic wounds or enteric surgery
Severe pain, systemic toxicity, +/- crepitus |
Gas Gangrene
|
|
Gas Gangrene Tx
|
Extensive debridement
Broad-spectrum ABX |
|
Human Bites
|
Eikenella corrodens
|
|
Bite Tx
|
Amoxicillin/clavulanate (PO) or ampicillin/sulbactam (IV)
Cefuroxime or doxycycline or Bactrim or floroquinoline PLUS clinda or metronidazole |
|
Large volume watery stool
No blood/PMNs Nausea/flue-like symptoms common |
Noninflammatory Diarrhea
|
|
Anti-peristaltic agents ok in Noninflammatory Diarrhea?
|
Yes
|
|
Anti-peristaltic agents ok in Inflammatory Diarrhea?
|
No
|
|
Small volume frequently bloody/mucosy stools
Many PMNs Fever/chills and crampy abdominal pain common |
Inflammatory Diarrhea
|
|
"Winter Vomitting Disease"
Cruise ships |
Norovirus
|
|
Norovirus Tx
|
Supportively with oral rehydration therapy
|
|
Most common parasitic etiology of infectious diarrhea in US
|
Giardiasis
|
|
Associated with camping/hiking
Affects small intestine |
Giardiasis
|
|
Giardiasis Dx
|
Stool EIA
|
|
Giardiasis Tx
|
Metronidazole
|
|
"Cholera-like" diarrhea affecting colon
Self-limiting in most patients |
Cryptosporidiosis
|
|
Cryptosporidiosis Dx
|
Stool EIA
|
|
Cryptosporidiosis Tx
|
Symptomatic
Refer immunosuppressed patient |
|
"Food poisoning"
Exotoxin is released into a food product that is then eaten |
Staphylococcus aureus
|
|
"Food poisoning"
Exotoxin is released into a food product (rice) that is then eaten |
Bacillus cereus
|
|
Rice water stool
|
Cholera
|
|
Cholera Dx
|
Stool culture
|
|
Cholera Tx
|
ORT
Azithromycin |
|
Amebiasis
|
Entamoeba histolytica
|
|
Causes most diseases in colon/liver
|
Amebiasis
|
|
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
|
|
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
|
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Constipation or "pea soup" diarrhea
Rose spots on trunk |
Salmonellosis
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Salmonellosis Tx
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Flouroquinolones
Ceftriaxone |
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Clinical syndrome characterized by constitutional symptoms, GI symptoms, and HA
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S. typhi
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Enteric Fever Salmonella
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S. typhi
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Gastroenteritis salmonella
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S. typhimuium
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Most common viral etiology of diarrhea
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Norovirus
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Most common bacterial etiology of diarrhea
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Salmonella
Campylobacter |
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Most common parasitic etiology of diarrhea
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Giardia
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Norovirus transmission route
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Contaminated food/H2O
Person-to-person contact |
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Giardiasis transmission route
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Fecal-oral
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Cryptosporidiosis transmission route
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Fecal-oral
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Cholera transmission route
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contaminated food/water
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Amebiasis transmission route
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Fecal-oral
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Salmonellosis transmission route
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Ingestion of organism, usually from contaminated food or drink
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