CMS 3: Infectious Disease

Koplik spots

Rubeola (whiteish grey)

Forscheimer spots

Rubella (red spots)

What should you supplement in a patient with rebellious

Vitamin A (to prevent blindness)

White granular spots and intraretinal hemorrhage on fundoscopic exam

CMV retinitis

Etiology of mono

EBV

NO CONTACT SPORTS x 6 WKS

What virus causes U/L epidydmo-orchitis

Mumps (paramyxovirus)

Also see parotitis

How does polio MC present

Asymptomatic!

Confirm DX with stool CX

Dew drop on a rose petal

varicella

Hutchinson sign is indicative of

Zoster opathalmicus

B/L painful arthritis is caused by what virus transmitted by a mosquito?

Chikungunkya Virus

Via Aedis aegypti mosquitos

Pregnant patient presents to your clinic with conjunctivitis and flu like symptoms and tests positive for Zika, what cognitive abnormality is her baby at risk for

Microcephaly

First line treatment for uncomplicated cystitis

-macrobid

-bactrim

-fosfomycin

What is indicative of an upper GU infection

WBC casts

Treatment of outpatient pyelonephritis

FQs / Bactrim

When should you treat a pregnant patient with a UTI?

ALWAYS (with macrobid)

etiology of Lyme disease

Borrelia burgdorferi

What is seen in early disseminated Lyme disease

Bell's palsy

What presents with a blanching rash on the palms and soles

RMSF (rickettsia rickettsia)

When should you give abx for furuncle or abscess

Multiple or >2 cm

(Give bactrim or doxy)

Pt presents with bright red, shiny, Malar rash. What's the etiology?

Erysipelas>>>

GABHS (strep pyogenes)

Treatment of TSS

Vanco + Clinda PLUS

-zosyn / cefepime / meropenem (one of them)

What rash presents with linear burrows that are worse at night

Scabies

Treatment of animal bites

Augmentin

Treatment for cat scratch disease

Azithromycin

>> caused by Bartonella henselae

How does congenital toxoplasmosis present?

-chorioretinitis

-intracranial calcifications

-hydrocephalus

What days should you give the rabies vaccine

Day 0, 3, 7, 14

What secondary infections can occur from the flu

PNA: strep or staph

What is the definition of of hospital acquired PNA?

>48 hrs after admission and was not present at time of admission

2nd MCC of walking PNA

Mycoplasma PNA

What etiology of PNA presents with AOM and sore throat

Mycoplasma PNA

What etiology of PNA is associated with birds

Chlamydia psittaci

What etiology of PNA is associated with aqueous habitats / ACs

Legionella

1st line TX for whooping cough

Azithromycin

Etiology: pertussis

Clustered vesicles on an erythematous base

HSV

what strains of HPV are associated with cervical cancer?

16 and 18

Disseminated gonnococcal triad

-tenosynovitis

-dermatitis

-poly arthritis

MCC of non-Gonococcal urethritis

Chlamydia

>> most presents ASX

+ clue cells

BV

Treat with metro

How does secondary syphilis present?

-money spots on palms and soles

-condyloma Lata

-moth eaten alopecia

tx of syphilis

PEN G

Painful genital ulcer

Chancroid >> H. Ducreyi

MCC of viral gastroenteritis

norovirus

Pt got a McChicken 3 days ago and presents today with RLQ pain, fevers, and watery diarrhea. What’s the etiology

C. Jejuni

Tx with azithro

What DDX C Jejuni from salmonella / shigella

Abdominal pain is seen with C. Jejuni !!

Pt presents with mucus and bloody stool

Shigella

What variant of E. coli causes travelers diarrhea

ETEC (it has a T for Travelers)

What variant of E. coli causes HUS

STEC / EHEC

Triad of EHEC (O157:H7)

-hemolytic anemia

-thrombocytopenia

-AKI

Sources of listeria and who should avoid eating them

-deli meat / hot dogs

-soft cheeses

PREGGY PTs

Treatment of listeria

Ampicillin / PEN G

4 mo old presents with flaccid paralysis and descending weakness after eating homemade baby food

Botulism

Rapid testing for C diff

EIA is rapid

Stool assay is GS

TX of C diff

Vanco / metro

what is the current variant of Covid

Omicron

Criteria for paxlovid

-unvaccinated people

-RF for severe disease

-> 18 y/o or 40 kg

-Sx x 5 days

Who is paxlovid CI in?

Renal dz or hepatic impairment

GS DX for TB

Sputum Culture

What should you do after intensive phase of TB treatment

Sputum - acid fast bacilli smear & Cx

Review PPD skin test results :)

>5 : HIV / immunocomp

>15: healthy

Millet seed on CXR

Disseminated (military) TB

1st line treatment for mycobacterium avium complex (MAC)

Azithromycin

Treatment for coccidiomycosis

fluconazole or itraconazole

Where is coccidioidomycosis found?

- SW US

- Farming / archeological digs / dust storm

Ohio Valley Fever

Histoplasmosis

>> seen in Ohio / Miss River valleys

Bird / bat droppings and high nitrogen soil

Histoplasmosis

Pigeon droppings

Cryptococcosis

Fish eyes on smear

Histoplasmosis

Treatment of cryptococcosis

Amphotericin B + Flucytosine

Trophozoites on smear

Malaria

Which etiology of malaria is the most virulent and lethal and see in Africa

P. Falciparum

What etiology of malaria is MC not seen in Africa

Vivax

Fever paroxysms every 2nd / 3rd day

Malaria

What worms lays larvae in the soil that penetrates bare feet

Strongyloidiasis

>> see eosinophilia with heavy worm load

What worm infestation commonly presents with iron deficiency anemia and ground itch?

Hook worm

What worm infestation releases eggs in feces and travels to lungs / intestines

Ascariasis

MC helminth worldwide

Ascariasis

Itchy butt

pinworm (Enterobiasis)

>> MC in US

tx for enterobiasis (pinworm)

Albendazole / Mebendazole

What helminth can be acquired by walking barefoot on the beach and presents as erythematous tracts on the feet

Cutaneous larva migrans

( i think there was a pic on the exam )

GS DX of schistosomiasis

Microscopic ID of eggs in urine / feces

Stool/GI: mansoni & japonicum

Urine/GU: haematobium

Who should be annually tested for HIV

-IVDU & sex parterners

-sex workers

-heterosexuals with + parter

-MSM

There was an HIV testing question and the answer was 4 wks

Idk if that's helpful but she used the same test Qs for Geri so idk

What CD4 count is considered AIDS?

less than 200

What diseases should you treat prophylactically when CD 4 < 50?

-MAC (azithro)

-fungal (Fluconazole)

-CMV (ganciclovir)

When should you treat PJP prophylactically?

CD4 <200

Tx w/ Bactrim

What is considered septic shock

Sepsis with persistent hypotension

SIRS criteria

Temp > 38

HR > 90

RR > 20

WBC >12K or <4K

2 of those^^

MCC of sporadic fatal encephalitis

HSV

MCC arboviral encephalitis

West Nile

PE findings of encephalitis

-AMS

-Seizures

-Ataxia

-Paralysis

Tx of meningitis in pts 1 months - 50 yrs

Vanco + 3rd gen ceph

MCC of bacterial meningitis

S. pneumoniae

MCC of meningitis in kids 11-17

N. Meningitidis

MCC meningitis in neonates?

GBS

Cornerstone of meningitis DX

LP / CSF

Dec glucose, Inc proteins

GS Dx of endocarditis

TEE

MCC of epidural abscess

Staph aureus

What is necrotizing fasciitis of the scrotum?

Fournier gangrene