1/102
Looks like no tags are added yet.
Name | Mastery | Learn | Test | Matching | Spaced |
---|
No study sessions yet.
what is the most common cause of the common cold?
rhinovirus (30-50%)
What are the typical presenting symptoms for the common cold?
sniffles and stuffiness
-sore throat
-face pressure/sneezing
Is a fever commonly seen with the common cold?
only in children
How is a diagnosis for the common cold made?
clinically (can usually tell just by looking at them)
-can do viral respiratory panel in children
What is not effective in treating common cold?
codeine, newer gen antihistamines, intranasal glucocorticoids
What is the treatment for the common cold?
symptomatic management (tylenol,decongestant/antihistamine combo)
What are the four types of influenza, which are most commonly seen?
A,B,C,D
- A & B are most commonly seen
(A mutates more than B)
Which lineages are flu A and B from? Which are only circulated in humans?
A - avian & swine (bird, pig, and human spread)
B- yamatage & victora (only circulates in humans)
What are the main presenting symptoms of someone with the flu (3)?
- abrupt onset of fever (100 to 104)
- nonproductive cough
- body aches/myalgia
What is a common presenting symptoms of children with the flu?
N/V, diarrhea (pukes + poops)
What are common presenting symptoms of older adults with the flu?
may present w/o typical symptoms
- altered mental status
- anorexia
- weakness
- dizziness
In most cases, how long to fever & respiratory symptoms last with the flu? How long does a complete recovery take?
fever + respirtatory sx: last 3 days
complete recovery: by day 14
When would you perform a diagnostic test for the flu?
- immunocompromised pts at risk and super sick pts w acute respiratory symptoms, hospitalized pts w complications or at risk for complications
**testing should only be performed if it will change your medical decision making
What are testing options for the flu? Which is the most accurate?
- rapid antigen detection test (RIDT)
- rapid molecular assays (NAAT) is most accurate
- viral culture, RT-PCR, IFA
What is the treatment for the flu?
-NSAIDs for fever, HA, myalgias
-Tamiflu 75 mg BID x5 days only for sick pts (old/young/hospitalized) either ASAP or within 48 hours
When should oseltamivir (Tamiflu) 75 mg be started in high-risk pts with suspected or confirmed flu diagnosis?
ASAP
(hospitalized pts, severe/complicated illness, 65+, kids <2, pregnancy, HIV, etc)
When should Tamiflu be started for non-high risk pts?
within 48 hours of onset
- helps reduce illness 1-2 days, may help prevent flu complications
What are common side effects of Tamiflu?
N/V, HA, fatigue (flu like symptoms)
Who is the flu vaccine recommended for? Who is it not recommended for?
everyone > 6 months, except for ppl w anaphylaxis rxns to eggs or other flu vaccine + anyone with Guillen Barre
Who received treatment for SARS-CoV-2?
age > 75, immunocompromised, and ppl w multiple med comorbidities (HTN, DM, etc)
What is the treatment for SARS-CoV-2?
-symptoms < 5 days, normal hepatic function: paxlovid
- symptoms > 5 days, otherwise healthy: symptomatic treatment only
What percentage of adults have been infected with EBV? What percent are clinically silent?
90-95% have been infected
- about half are clinically silent
(infection w EBV resides in B lymphocytes for life)
What are some hallmark symptoms of mononucleosis?
- oropharyngeal exudates
- tonsillar enlargement
- palatal petichiae
What is a rare but potentially life threatening complication of mononucleosis?
splenic rupture (avoid physical contact x 3 weeks)
How is a diagnosis of mononucleosis made?
+ heterophile antibodies (monospot test)
CBC can show > 50% mononuclear cells; 10% atypical lymphocytes
What is the treatment for mononucleosis?
symptomatic tx w NSAIDs/acetaminophen
*avoid strenuous activity for 3x weeks (avoid splenic rupture)
-corticosteroids if airway obstructed (tonsillar enlargement)
If the monospot test is negative for heterophile antibodies, then mononucleosis is most likely caused by _______, not EBV
cytomegalovirus (CMV)
Which cause of infectious mononucleosis usually has milder symtpoms?
CMV
Is splenomegaly seen with CMV mono?
typically no
What are some differences between CMV and EBV infectious mono?
EBV:
-splenomegaly, exudative tonsilitis, cervical + diffuse LAD, teens & young adults, + heterophile antibodies
CMV:
-milder symptoms, children cervical LAD, older adults, rash, negative heterophile antibodies
What are the different cutaneous manifestations of Herpes simplex?
herpetic whitlow and herpetic gladiatorum
What type of herpes manifests as inoculation of finger through break in the skin, and heals similar to oral herpes?
herpetic whitlow
What type of cutaneous herpes manifests on the face, neck, and arms of wrestlers and is often misdiagnosed as bacterial folliculitis or impetigo?
herpetic gladiatorum
What is the lesion in herpetic keratitis seen with a slit lamp and florescein staining?
dendritic lesion
What can herpetic keratitis lead to?
retinal necrosis and blepharitis
What are severe manifestations of herpes simplex?
- encephalitis
- bells palsy
- aseptic meningitis
- hepatitis
What may occur 24 hours before herpetic lesions appear?
prodrome of pain, burning, tingling, itching
What type of rash is seen with herpes simplex?
vesicular cluster of lesions
- fluid-filled, red or yellow with reddish base
-painful, will break open and eventually crust over
What is the treatment for herpes simplex?
valacyclovir 1000mg BID
acyclovir 400mg TID
start tx within 72 hours, continue for 7-10 days
What is the treatment for a pregnant women w HSV?
acyclovir 400 mg TID
How is HSV transmitted to neonateS?
-utero
-perinatal (most common)
- post natal
HSV -> neonate during labor and delivery from infected site
What are the 3 categories of neonatal herpes simplex perinatal and postnatal infection?
-skin, eye, mouth disease (35-45%)
-CNS disease (33%)
-disseminated disease (25-30%)
What is the treatment for all 3 categories of neonate HSV?
IV acyclovir started ASAP
What is in utero (congenital) herpes and how is it transmitted?
In utero herpes occurs when HSV crosses the placenta during pregnancy, infecting the baby before birth. It is very rare.
What is the most common time for a baby to acquire herpes, and how does it happen?
During labor and delivery (perinatal), by exposure to HSV in the birth canal.
How can a baby get postnatal herpes?
After birth, through close contact with someone who has an active HSV infection, like a cold sore.
Which type of neonatal herpes is the rarest but can cause severe birth defects?
In utero (congenital) herpes
How is CNS disease diagnosed in neonates?
through PCR & CNS studies
What virus is characteristic for a "dew drop on rose petal" appearance?
varicella (chicken pox)
What type of rash appears with varicella?
pruritic vesicles that appear on face and trunk and spread
How long is varicella contagious?
one day before rash appears until lesions have crusted over
What type of virus typically has a dermatomal vesicular rash pattern, prodromal syndrome 103 days before lesions with pain, fever, HA, itching/burning?
varicella zoster (Herpes Zoster)
Does the Herpes Zoster rash cross the midline?
NO
The varicella virus remains dormant in nerve cells, when does the virus get reactivated to cause shingles?
immunosuppression, aging, or illness reactivates virus
What is the treatment for chicken pox?
mostly supportive care (antihistamines, tylenol, topical, trim fingernails)
Who is given antiviral tx with chicken pox?
unvaccinated, > 12, pregnant, or immunocompromised
-acyclovir in pregnancy
-valacyclovir
How is herpes zoster/shingles treated?
-valacyclovir 1000mg po TID for 7 days
- acyclovir 800mg 5x days for 7-10 days
*NSAIDs for adult pain
-may need opiates
If a healthy, vaccinated child has chicken pox, what is the treatment?
no treatment
*avoid aspirin in children (reyes syndrome)
What is the time frame of congenital infections with varicella to occur?
when mother is infected between 8-20 weeks
What occurs with congenital varicella infections ?
-cicatricial skin lesions (dermatomal pattern scars)
-ocular defects (optic nerve atrophy cataract)
- abnormal limbs
-low birth wright
-CNS (seizures, cognitive impairment)
How is congenital varicella treated in a pre-term infant, or birthing parent that had significant infection at time of delivery?
post-exposure prophylaxis with Varizig
IV acyclovir if active infection in newborn (only if they came out w infection)
What tests are used for prenatal diagnosis of congenital varicella syndrome?
PCR testing of fetal blood or amniotic fluid, and ultrasound to detect fetal abnormalities.
What should parents be counseled about if prenatal testing for VZV is positive?
The likely fatal outcome of the disease
What are key components of postnatal diagnosis of congenital varicella syndrome?
Maternal history of VZV infection during 1st or 2nd trimester, fetal abnormalities consistent with the syndrome, and evidence of intrauterine infection.
How is maternal VZV infection managed during pregnancy?
Acyclovir 5 times daily for 7 days and varicella-zoster immune globulin if the mother lacks immunity.
What vaccine is recommended prior to pregnancy for women with no VZV immunity?
Varivax (varicella vaccine).
What is the most common STI globally?
human papilloma virus (HPV)
There are over 200 types of of HPV, which are the high risk types?
16 & 18
Type 16 & 18 of HPV are considered the high risk types and are associated with what percentage of cervical and anal cancers?
- 70% of cervical cancers
- 90% of anal cancers
How does HPV present in men?
penile infection or anal infection (MSM)
- usually genital warts
How does HPV present in women?
anal infection
What are the risks of HPV in women?
- cervical cancer (virtually all cases due to HPV)
- vulvar and vaginal cancer
When does the CDC recommend initial vaccine for HPV?
11-12 years old (can give as early as 9 years)
Which population has a greater prevalence of HPV?
those with HIV
What is the target of attack in HIV?
the immune system, CD4 cells (T cells)
What are the different stages of HIV infection?
-acute HIV w seroconversion
-chronic HIV without AIDS
-chronic HIV w AIDS
What is AIDS defined by?
a CD4 cell count <200 cells/microL
- or the presence of any AIDs defining conditions
What are some examples of AIDS defining conditions?
opportunistic infections
-pneumocystis pneumonia, esophageal candidasis, toxoplasmosis (fungal infections)
-certain malignancies
-wasting or encephalopathy
How often should healthy people (adults and adolescents 13-75) get screened for HIV?
once
Who should always get tested for HIV?
pregnant women
-high risk behaviors
-exposed people/needle stick
What are the testing options for HIV? Which is recommended?
- at home antigen test
and combo antigen/antibody test which is recommended
If initial antigen/antibody test for HIV is negative, what is the assumed result?
negative, person does not have HIV
If initial antigen/antibody test is positive for HIV, what is necessary to confirm the diagnosis?
a confirmatory HIV-1/HIV-2 antibody differentiation immunoassay is performed to confirm the diagnosis
What is the treatment for HIV/AIDS?
Antiretroviral therapy (ART)
What does antiretroviral therapy (ART) do?
supresses serum viral RNA levels and increases CD4 cell counts in the vast majority of pts with acute and early HIV infection
*ART can also reduce the risk to transmission to others
What is important with starting ART therapy for HIV?
start ASAP
- initiate one multidrug regiment
*DO NOT delay treatment while awaiting results of resistance testing
-modify tx as needed once resistance testing results return
What is PEP? Who usually gets treatment and when?
post-exposure prophylaxis
-typically w needle sticks, but can be exposure during sex, sexually assaulted, or exposed at work
**start within 72 hours of exposure -> can prevent HIV development
What happens if PEP is initiated after 72 hours from exposure?
may not prevent HIV if started > 72 hours
What labs are necessary for those getting PEP?
baseline labs (CBC, CMP)
-test at baseline and 2 weeks
then HIV antibody testing: baseline, week 6, week 12 and at 6 months
What is the treatment regimen for post-exposure prophylaxis and what is the time frame?
3 drug regimen, TDF-FTC + dolutegravir
*one pill daily for 28 days
What is PrEP?
pre-exposure prophylaxis for those who are sexually active/or engage in high risk behaviors
*oral therapy with TDF-FTC
How is polio transmitted?
fecal-oral route
(virus may persist in the stool for up to 6 weeks)
What are the different types of polio?
mild illness
severe illness (nonparalytic + paralytic)
What are characteristics of mild polio?
3-6 days incubation
- fever, HA, sore throat, fatigue
symptoms resolve with 1-2 days without sequelae
What are characteristics of nonparalytic polio?
fever, HA, vomiting, meningsmus (meningitis like symptoms)
-CSF pleocytosis
-resolves in 1-2 weeks
- may progress to paralytic
What are characteristic of paralytic polio?
- acute flaccid weakness & pain; asymmetrical
-severe illness
-weakness in one muscle group, but could be quadriplegia and respiratory failure
*legs > arms
*proximal > distal muscles (core weakness)
How is a diagnosis of polio made?
2 stool samples & 2 oropharyngeal swabs 24 hours apart, during first 14 days after limb weakness onset
-CSF analysis
-MRI w contrast of the brain and spine to assess extent of SC inflammation
-NCS/EMG
What is the treatment for polio?
mostly supportive management (pain, PT), mechanical ventilation, cardiac monitoring if bulbar involvement
What is the incubation period for rabies?
1 to 3 months, can be longer
What is the prodrome associate with rabies?
flu like symptoms, often missed