Term
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Definition
| systemic infection c/b encapsulated fungus, Cryptococcus neoformans. in immunocompromised ppl |
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Term
| what is the most common manifestation of disseminated cryptococcosis? |
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Definition
| CNS infection - meningitis or encephalitis |
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Term
| what is the second most common manifestation of disseminated cryptococcosis? |
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Definition
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Term
| characteristic skin lesions of cryptococcosis? |
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Definition
| red colored papules of varying size with slight central umbilication -- usually like Molluscum contagiosum |
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Term
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Definition
| superficial bacterial skin infection - mtuliple vesiculopulstular lesions, face/extremities |
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Term
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Definition
| generalized term, refers to any inflammatory pustular skin lesions with eventual necrosis and ulceration |
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Term
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Definition
| most common form of cutaneous tuberculosis. solitary skin lesions of neck and face. apple-jelly nodules, central atrophy |
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Term
| how to confirm dx of cutaneous cryptococcosis? |
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Definition
| must do a bpx for histopathologic exam. = shows granulomatous inflamm rxn w/ multinucleated giant cells, histiocytes, lymphocytes, neutropiles, and plasma cells w/ numerous yeast like organisms |
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Term
| what are some special stains for crytococcoosis after bpx? |
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Definition
| Periodic Acid Schiff and Gomori's methenamine silver nitrate |
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Term
| what is antigen testing or India ink preparation useful for? |
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Definition
| in identifying the organism in CSF specimens |
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Term
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Definition
| RUQ pain, high bili, markedly elevated AST/ALT (10-20X the upper limit of norm) |
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Term
| when to anti-HCV ab's develop? |
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Definition
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Term
| for HepC infection - sx include? |
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Definition
| nausea, jaundice, RUQ abd pain lasting 2012 weeks. sx start 2-26w after viral exposure |
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Term
| dx: acute infection of hep C? |
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Definition
| elevated aminotransferases and positive hep C virus RNA THEN positive anti-HCV Ab's within 12w |
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Term
| dx: resolved hepc infection? |
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Definition
| normal aminotranferases, neg HCV RNA, positive anti-HCV Ab's |
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Term
| hepC infection - how long it takes for Ab's to form? |
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Definition
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Term
| how long after exposure can HCV RNA be detected? |
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Definition
| within days to 8 weeks following viral exposure |
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Term
| for hepB - a window period of negative HBsAg and neg HBsAg Ab's typically occurs when? |
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Definition
| after sx resolution and elevated LFT's |
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Term
| TB skin test - diagnoses latent or active TB or both? |
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Definition
| dx latent TB but not active TB |
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Term
| interferon gamma release assay for TB dx - latent or active or both TB dx? |
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Definition
| results cannot differentiate b/w latent and active TB |
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Term
| smear microscopy for TB dx is what? |
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Definition
| estimates quantitative # of bacilli. can determine active infxn, monitor tx progress. cannot distinguish from non-TB mycobacteria |
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Term
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Definition
| gold standard. quantitative results, takes 3-8w. allows for drug sensitivity testing |
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Term
| nucleic acid amplification for TB dx has what role? |
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Definition
| high specificity, higher sensitivity than smear microscopy. dx in 1-2d. can diff from nonTB mycobacteria. can be pos in pts after TB tx |
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Term
| when is bronchoscopy w/ bronchoalveolar lavage used to confirm dx in TB pt's? |
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Definition
| when they cannot adequately produce enough sputum samples, who have neg sputum studies but high TB suspicion, or poss alternative dx |
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Term
| can gastric aspirates be cultured for mycobacterium TB? |
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Definition
| yes but mainly just used in kids who can't produce sputum |
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Term
| patients with 3 neg smears are considered what? |
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Definition
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Term
| subphrenic abscess typically develops from what? |
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Definition
| 14-21d after abd surgery. cough ad shoulder tip pain occur |
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Term
| how to dx subphrenic abcess? |
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Definition
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Term
| abd abscesses - how best to dx? |
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Definition
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Term
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Definition
| erythema migrans, early localized, days-1MO after tick bite |
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Term
| what causes Lyme disease? |
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Definition
| spirochete, Borrelia burgdorferi, transmitted by deer tick (Ixodes scapularis) |
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Term
| where is lyme disease most prevalent? |
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Definition
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Term
| Lyme arthritis usually presents how |
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Definition
| usually well-appearing, can bear weight on the joint, less likely to have fever and other constitutional sx |
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Term
| Lyme serology after a knee aspirate usually shows what? |
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Definition
| non-bloody inflammatory profile, ave leuks ct 25,000 cells/uL. |
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Term
| primary diagnostic test for Lyme arthritis is? |
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Definition
| enzyme-linked immunosorbent assay then western blot testing |
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Term
| what seroligies would be positive in Lyme arthritis? |
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Definition
| IgG serologies to B burgdorferi |
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Term
| how is Lyme arthritis tx? |
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Definition
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Term
| anti-citrullinated peptide Ab's and RF ordered for what? |
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Definition
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Term
| what is the most important step in the evaluation of monoarticular joint effusion? |
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Definition
| synovial fluid aspiration to r/o destructive forms of bacterial arthritis |
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Term
| what is the prognosis of Lyme arthritis? |
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Definition
| 28d course of oral doxycycline or amox usually curative (amox for kids <8 YO and preg women). dis free in 6-12 MO |
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Term
| neuroborreliosis (e.e meningitis, encephalitis) - what tx? |
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Definition
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Term
| intrapartum - if HIV+ mom is not on HAART, what to do with baby? |
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Definition
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Term
| intrapartum - if HIV+ mom w/ viral load >1,000 copies/mL, what to do for baby? |
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Definition
| C-section, and start Zidovudine |
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Term
| postnatal care for HIV+ mom and baby? |
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Definition
| mom should cont HAART. infant should get Zidovudine for >/= 6w PLUS serial HIV PCR testing |
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Term
| what should HIV+ mom be on during preg? |
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Definition
| 3 drug HAART (dual NRTI + NNRTI or protease inhibitor) |
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Term
| HIV+ preg mom- when should she get ppx? |
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Definition
| ppx for infxn if CD4 cell ct <200/uL |
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Term
| HIV+ preg mmom- what prenatal testing should she undergo? |
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Definition
| HIV-1 viral load monthly until undetectable then q3 MO. CD4 cell ct q3 MO |
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Term
| what is first line dual NRTI therapy during preg for mom? |
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Definition
| Zidovudine/lamivudine. Another prefered is Tenofovir/emtricitabine |
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Term
| what is the preferred NNRTI after 8th wk of preg? |
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Definition
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Term
| what are maternal contraindications to breast feeding? |
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Definition
| active TB (moms can start breastfeeding 2w after anti-tuberculin therapy), maternal HIV infx, herpetic breast lesions, varicella <5d before or 2d after delivery, chemo or radiation, active abuse of etoh/drugs |
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Term
| what is infant contraindic's to breast feedign? |
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Definition
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Term
| in which cases is it ok for HIV+mom to breast feed baby? |
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Definition
| in resource poor countries where no formula there, antiretroviral drugs pass through BM in sig quantities and decrease risk of postnatal HIV transmission that way |
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Term
| preg women w/ non drug resistant TB tx? |
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Definition
| standard tx: isoniazide (INH), rifampin, ethambutol for 9 MO |
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Term
| preg women w/ drug resistant TB tx? |
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Definition
| INH, rifampin, ethambutol, pyrazinamide which we do not knw if safe in preg... |
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Term
| can streptomycin be used in preg women? |
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Definition
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Term
| what are some sx of acute bacterial rhinosinusitis? |
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Definition
| fever, nasal congestion/obstruction, purulent nasal d/c, maxillary tooth pain, facial pain/pressure when bending forward |
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Term
| dix criteria for acute bacterial sinusitis- |
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Definition
| 1. persistent sx >/= 10d w/o improvement 2. severe sx, high fever temp >102, purulent nasal d/c, facial pain >3, worsening sx >/= 5d after an initially improving viral URI |
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Term
| whats first line therapy for bacterial sinusitis? |
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Definition
| augmentin. alternate agent: doxy or fluoroquinolones |
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Term
| supportive care for bacterial sinusitis? |
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Definition
| analgesics, decongestants, saline irrig, topical glucocorticoids |
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Term
| what are most common bugs for sinusitis? |
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Definition
| strep pneu, Haemophilus influ, Moraxella cat |
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Term
| toxic shock syndrome - caused by? |
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Definition
| staph aur, staph exotoxin TSS toxin-1 |
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Term
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Definition
|
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Term
| what is the pathophys of TSS? |
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Definition
| widespread activation of T cells by exotoxins acting as superAg's i.e. can activate T cells dreictly w/o needing to be processed by Ag recog cells --> massive cytokine release |
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Term
| think ____ in pt's with septic shock sx with some kind of packing (e.g. nasal packing) |
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Definition
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|
Term
| bacterial overgrowth and dissemination is characteristic of _____ |
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Definition
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|
Term
| the main mechanism of septic shock is? |
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Definition
| massive bacterial lysis and circulating endotoxin |
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|
Term
| patients with TSS may require ___ fluid/day |
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Definition
|
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Term
|
Definition
| clindamycin = theoretically prvents toxin synthesis. maybe also anti-staph: vanc, oxacillin, or nafcillin). corticosteroids not recommended |
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|
Term
| ____ vasopressor is usually reserved for cardiogenic shock |
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Definition
|
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Term
| list some possible causes of acute viral hepatitis |
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Definition
| hep A/B, alcoholic hepatitis, drug-induced or toxic liver injury (tylenol poisining), autoimmune hep, ischemic liver injury, herpesvirus fam (herpes simpelx, varicella-zoster, Ebstien-Barr, cytomegalovirus) |
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|
Term
| what clinical picture would favor acute viral hepatitis? |
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Definition
| acute onset of sx w/o fulminant hepatic injury |
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|
Term
| hospitalization should be considered for what situation of acute hepatitis? |
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Definition
| HD instab or fulminant liver failure )encephalopathy, sig elev bili). also consider for: older, sig comorbidities, poor PO intake, no social support |
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Term
| what situation would pt w/ hepatitis need IV abx? |
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Definition
| acute hepatocellular injury w/ signs of acute cholangitis (e.g. fever, leukocytosis, biliary obstruction) |
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Term
| what is Budd-Chiari syndrome? |
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Definition
| hepatic vein thrombosis. tx thrombolytic therapy. pt would have ascites. |
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Term
| acute hepatitis B infection serologies = ? |
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Definition
| +HBsAg, HBeAg (means high infectivity), and IgM anti-HBc, high AST/ALT's, detectable hep B DNA |
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Term
| serology for chronic hep B infection? |
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Definition
| HBsAg with anti-HBe, and IgG anti-HBc |
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Term
| most patients with hepB can be managed how? |
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Definition
| w/ supportive care and appropriate f/u. they dont need tx and |
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Term
| antiviral therapy for hep B infection is recommended for what group of patietns? |
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Definition
| immunosuppression, concrurent hepatitis C, severe hepatitis, or fulminant hepatic failure |
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