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ID
notes from qbank
121
Medical
Graduate
05/19/2012

Additional Medical Flashcards

 


 

Cards

Term
MCC of acute infective endocarditis:
Definition
S. aureus
Term
MCCes of subacute IE:
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
Complications from IE:
Definition
Cardiac failure
myocardial abscess
solid organ damage 2/2 showered emboli
glomerulonephritis
Term
How can you diagnose IE?
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
How do you treat IE?
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
S. aureus
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
What is ehrlichiosis?
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
What is neutropenia?
Definition
When the ANC is less than 1500
Term
When does susceptibility to infection increase in neutropenia?
Definition
When the ANC < 1000
Term
When is the ability to control endogenous flora lost?
Definition
at an ANC < 500
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
pancreatitis
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
NRTIs
Term
Which HIV drug class may cause SJS?
Definition
NNRTIs
Term
What HIV drug is a/w liver failure?
Definition
nevirapine
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
Preseptal cellulitis
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
Orbital cellulitis:
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
piperacillin
Term
Malignant otitis externa
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
Cutaneous larva migrans
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
Mucormycosis
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
pneumococcus
Term
A nail puncture wound in an adult that results in osteomyelitis. What is the most likely pathogen?
Definition
pseudomonas
Term
Nodular infiltrate and cavitation on xray in an IV drug abuser:
Definition
S. aureus emboli from tricuspid infective endocarditis.
Term
Tell me about nocardia:
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
S. aureus
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
Echinococcus
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
Proteus UTI:
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
Fluorescein stain
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
Pyridoxine
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
- CD4 < 350
Term
What is the most common postinfectious complication seen in patients with impetigo?
Definition
- Glomerulonephritis
Term
What does gentamicin cover?
Definition
- excellent gram negative coverage
Term
What does clindamycin cover?
Definition
- gram positives and anaerobes
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