-
what is the most common cause of all cestode infx worldwide
hymenolepis nana
-
what is the most common parasitic infestation of the CNS
cysticercosis
-
what is the most common presentation of diphyllobothriasis
asymptomatic
** has numbness of extremities and pruritus ani for weird sxs
-
what is the most common paragonimus that affects humans
P westermani
-
what is the most common helminth in the world
ascariasis
-
what is the most common helminth in the US
pinworm (enterobius vermicularis)
-
what is the most common symptom of hookworm
iron def anemia
-
what is the most common method for making the dx of ascariasis
microscopic identification of eggs in the stool
-
what is the most common topically acquired dermatosis
cutaneous larva migrans
-
what is the most common parasite identified in stool specimens
g. lamblia
-
what is the most commonly used lab for leishmaniasis
giemsa-stained slides
-
where are the 2 most common places that Malaria is imported from
- sub-Saharan africa
- india (TB and malaria)
-
what is the most common cause of chronic adenopathy in children
cat scratch dz
-
what is the most common symptom of cat scratch dz
regional adenopathy (proximal to bite area)
-
what is the most common manifestation of toxoplasmosis in an AIDS pt
toxoplasmic encephalitis
-
what is the most common presentation of congenital toxoplasmosis
chorioretinitis
-
what is the most common zoonosis in the world
leptospirosis
-
what is the most common physical finding of encephalitis
AMS and/or personality changes
-
what is the most common cause of encephalitis in Western countriees
HSE
-
what is the MC causes of meningitis in neonates
-
what is the most common cause of bacterial meningitis in the US in most age groups
strep pneumo
-
which joint is most commonly affected for infections of the joint
knee
-
what is the MC cause of septic bursitis
staph
-
what areas are MC affected with septic bursitis
-
what is the MC etiology of osteomyelitis
staph
-
what is the triad for encephalitis
- nuchal rigidity
- HA
- photophobia
-
what is the triad for meningitis
- fever
- nuchal rigidity
- MS changes
-
an 8 y/o male presents to the clinic c/o restless sleep, anal pruritis, and nasal pruritis. His mom states that he was at a summer camp for the past 2 months. You draw his labs and notice eosinophilia. What is your suspected dx
hymenolepiasis
-
a 29 y/o female presents to the clinic c/o weight loss, malaise, and has noticed some subcutaneous nodules. She just returned from an 8 mo deployment from Africa where she ate local foods. what is your dx
taeniasis
-
what is the most striking feature of T saginata
passage of proglottids
-
what are the labs to dx taeniasis
- stool samples
- cellophane tape swab
- CBC (eosinophila)
- Ab detection (useful in early invasive stages)
-
a 21 y/o male presents to the ED c/o worsening chronic HA, double vision, and taste changes. He recently has returned from Korea. While waiting to be seen, he has a grand mal seizure. What is your possible dx
neurocysticercosis
-
what will you find on PE with cysticercosis
- no fever
- nonfocal neurologic findings
- papilledema
- meningismus
- hyperreflexia
- nystagmus or visual deficits
intraocular larvae - subcutaneous larvae
- muscular pseudohypertrophy
-
which diagnostic study should be ordered to help confirm the dx of cysticercosis
CT (contrast and non-contrast)
-
what can be used to tx ICP in a pt with cysticercosis
- steroids
- osmotic agents (dannitol)
- diuretics
-
a 45 y/o male presents to the clinic c/o fatigue, diarrhea, and numbness of his extremities. He is a recent immigrant from Russia and states he really liked to eat sushi. On PE you notice that he is pallor, has mild glossitis, hypesthesias, paresthesias, and disturbances of movement and coordination. His labs come back showing megaloblastic anemia. What is your suspected dx
diphyllobothriasis (D. latum)
-
how is diphyllobothriasis (D.latum) transmitted
consumption of raw/undercooked freshwater fish
-
when does eosinophilia occur with helminthic infx
during the migrating phase
-
a 37 y/o male reports to the clinic c/o abd pn and diarrhea x 2 moths. He states he recently has returned from a trip to South America where he spent most of his time either swimming or wading in local creeks and water and handled a lot of snails. He also states that he occasionally has bloody diarrhea. what is his suspected dx
S. Mansoni
-
which schistosomiasis is located just in Africa and Middle east
S. haematobium
-
which schistosomiasis is located in the far east
S. japonicum
-
which schistosomiasis is located in Africa, middle east and S. America/caribbean
S. mansoni
-
which schistosomiasis is excreted in the feces
-
which schistosomiasis is excreted in the urine
S. haematobium
-
how is schistosomiasis transmitted
snail
-
when trying to see if the pt has S haematobium, what times of days should the pt give a urine sample
between noon and 3pm
-
this is caused by consuming raw watercress from where sheep and cattle are raised
fasciola hepatica (sheep liver fluke)
-
what is the tx for fascioliasis
triclabendazole
-
a 56 y/o female reports to the clinic c/o mod-severe productive cough and constant malaise. She states that her sputum is blood tinged and remarkably foul. She also reports having all over urticarial. on PE you note RUL wheezing and her CXr show nodular, non-calcified infiltrates. What is your suspected dx
Lung fluke (paragonimiasis)
-
how is paragonimiasis transmitted
inadequately cooked/pickled crab or crayfish
-
how is paragonimiasis dx
demonstration of eggs in stool or sputum
-
how is strongyloidiasis transmitted
larvae in soil penetrate bare feet
-
how is strongyloidiasis dx
microscopic identification of larvae (stool or duodenal fluid)
-
what test is recommended in the dx as strongyloidiasis
ELISA
-
how is hookworm transmitted
larbae in soil penetrates bare feet
-
a pt comes in c/o a ground itch at what looks like a site of penetration from where he has been outside walking in his barefeet all summer. He is showing signs of pneumonitis, intestinal upset and pica. But he is really concerned bc he has just been sooooo tired lately. what is your suspected dx
hookworm
-
a pt comes to the clinic c/o hemoptysis and dyspnea. You think she also may have Loeffler's syndrome. What is your suspected dx
ascariasis
-
this is found frequently in school- or preschool- children. Most children complain about pruritus ani esp at night. what is your suspected dx
enterobius vermicularis (human pinworm)
-
when should parent be told to do the scotch tape test when trying to collect enterobius vermicularis eggs
she needs to put the tape on the perianal area first thing in the morning before the child defects or bathes
-
a 14 y/o male c/o a rash on his left foot that has worsened over the past 3 weeks. He states he just got back from Alabama where he spent his summer vacation. When asked about shoe wear while on vaca he said "oh hell no I don't wear shoes!!" on PE you note serpiginous, slightly elevated, erythematous tunnels on the dorsal aspect of his foot.. What is your suspected dx
cutaneous larva migrans
-
this form of toxocariasis is often misdiagnosed as retinoblastomas
ocular larva migrans
-
people can get this by eating infected meat of carnivores
trichinellosis
-
A pt presents to the clinic c/o periorbital and facial edema that started out of conjunctivitis. On PE you notice he has splinter hemorrhages on his nails. You ask him about his diet and he states "I am a meat only kinda guy!" what is your suspected dx
trichinellosis (during the larval migration)
-
how can trichinellosis be dx
- clinically
- eosinophilia during migratory phase
- EIA
- muscle bx
-
what are the s/s and considerations of amebiasis
- amebic colitis
- fulminant colitis
- rectovaginal fistulas
- fulminant or necrotizing colitis
- amebic liver abscess
- single abscess
- possible hx of dysentery within the past year
-
if you do a CT scan on a pt with abd pn and you see a rounded- low attenuation lesion with an enhancing rim. What is your suspected dx
amebiasis
-
what has a high cure rate and shorter tx course for amebiasis
tindamax
-
a 7 y/o male is brought into the clinic with a mom c/o him having excessive flatulence and malodorous stools. She also states that his has had difficulty sleeping and is unusually irritable throughout the day, and has lost considerable weight over the past 2 months. His stool shows trophozoites or cysts that is consistent with which protozoal infx
giardiasis
-
G.lamblia has high incidence with which groups of ppl
- campers/backpackers in western states
- southern states
- children in daycare/institutional settings
-
how is giardiasis transmitted
fecal oral through contaminated water ingestion
-
what is the TOC for giardiasis
IFA or ELISA (stool antigen detection assays)
-
what is the tx for giardiasis
-
a 26 y/o male reports to the clinic c/o of non-healing sore on his posterior calf. You ask about travel hx and he says he just got back from Iraq. on PE you notice a sore that has raised edges and a central crater that looks like its about to scab. What is your suspected dx
leishmaniasis
-
what transmits leishmaniasis
sandflies
-
what factors determine the form of leishmaniasis
- leishmanial species
- geographic location
- immune response of host
-
which form of leishmaniasis has recurrent high fevers, weight loss, and is assoc with post kala-azar dermal leishmaniasis, and pancytopenia is common
visceral
-
what is characteristic of visceral leishmaniasis
darkening of the skin (lasts why they call it black water fever)
-
how can leishmaniasis be tx
- liposomal amphotericin B
- fluconazole (cutaneous form)
- thermomed radio frequency heat
-
a 16 y/o females presents to your clinic with a c/o watery, non-bloody stools. You ask her what her job is and she says she is a lifeguard at the local lake resort. On PE she has a pos murphy's sign. What is your suspected dx
crypto
-
this is found in contaminated water or recreational water parks
crytpo
-
this infection is limited to the jejunum in healthy individuals
crypto
-
a 21 y/o female presents to the clinic c/o fever, chills, and marked malaise x 3 d. She states she just returned from hiking the Appalachian trail for 3 months. PE shows mild jaundice and splenomegaly and her labs show hyperbilirubinemia. what is your suspected dx
babesiosis
-
how is babesiosis transmitted
tick vector
-
what is a big concern about pregnancy and babesiosis
it may be transmitted in utero
-
what will you see on a thin blood smear when testing for babesiosis
maltese cross is classic
-
what serology is diagnostic for babesiosis
IgM IFA titer of 1:64
-
what is the preferred regimen for severe babesiosis
clindamycin + quinine
-
what climate is best for malaria carrying mosquitos
need warmth >77F
-
which type of malaria is most widespread
P vivax
-
which type of malaria is primarily found in the tropics/subtropics
P falciparum
-
which type of malaria is primarily found in tropical west africa
P ovale
-
which forms of malaria have a hypnozoite form
P vivax and P ovale
-
a 23 y/o male reports to the clinic c/o feeling really tired, having a fever that comes and goes, and has mild-mod nausea. He recently has returned from the middle east and sub-Saharan Africa. What is your suspected dx
malaria (plasmodium)
-
which forms of malaria can relapse after longer periods of time
P vivax and P ovale
-
which type of malaria has a potential for a prolonged erythrocytic infx
P malariae
-
which forms of malaria have 48hr fevers
- P falciparum
- P vivax
- P ovale
-
which forms of malaria have 72hr fevers
P malariae
-
if a person has severe malaria, what is the most likely plasmodium species
P falciparum
-
why is P falciparum so bad
- microvascular sequestration/dz
- it targets all RBCs (the other forms target reticulocytes)
- causes severe anemia
-
which form of malaria can cause nephrotic syndrome
chronic P malariae
-
which malaria forms can cause splenic rupture
vivax and ovale
-
when should you do thick and thin smears for malaria
soon after a fever spike has the highest yield
-
which smear is used to see which malaria species is causing the infx
thin smears
-
which rapid test is FDA approved for malaria
BinaxNOW
-
what are some of the reasons why people don't take their malaria prophylaxis
- GI side effects
- forgetfulness
- low perception of risk (it wont happen to me)
-
what is the terminal prophylaxis for malaria and what must you do prior to administering it to pts
- primaquine phosphate
- need to check G-6-PD status
-
how is P falciparum treated
- Quinidine gluconate IV plus one of the following:
- Doxy
- tetracycline
- clindamycin
-
how is treatment for malaria monitored
thick and thin blood smears q 6-12hrs until parasitemia falls below 1%
-
which form of malaria is associated with recrudescence
P falciparum
-
which form of malaria is most frequently associated with re-infection
P falciparum
-
what is one of the top precipitating factors of a sickle cell crisis
malaria
-
what is the most common location for animal bites
hand
-
how are animal bites tx
- copious irrigation of the wound
- tetanus prophylaxis
- consider rabies prophylaxis
-
what is the DOC for dog/cat bites
amoxicillin-clavulanate (augmentin)
-
wounds from an animal bite can be closed by primary closure if on what part of the body
facial wounds
-
how are wounds on the hands or LE closed
the are left open (more prone to infx)
-
a mom brings her 6 y/o daughter into the clinic c/o a rash on her right arm. The daughter tells you that they have a new kitten and plays with it all the time. On PE you notice 3 small red papules on the anterior aspect of her R arm and she also has moderate axillary lymphadenopathy. What is your suspected dx
cat scratch dz
-
what is the vector that causes cat scratch dz
bartonella henselae
-
this syndrome is associated with cat scratch dz, its site of inoculation is the eyelid or conjunctiva. It is caused by the cat licking, scratching, or biting the person. The pt develops nonpurulent conjunctivitis, ocular granuloma, preauricular adenopathy
parinaud oculoglandular syndrome
-
what are some s/s of CNS (encephalitis) cat scratch dz
- seizures
- myelitis
- peripheral neuropathy
- retinitis
- bells palsy
- extremity weakness
-
a 26 y/o female is c/o mild fatigue and fever that just wont go away. She is also c/o mild neck tenderness with pharyngitis. Pt also states she has 5 cats and has been recently been told she was pregnant. PE notes mild cervical lymphadenopathy and tonsillar erythema. What is your suspected dx
toxoplasmosis
-
how is toxoplasmosis transmitted
from the feces of acutely infected cats
-
what is the MC space occupying lesion in an AIDS pt
toxoplasmosis
-
how is chorioretinitis, fetal, and congenital toxo treated
pyrimethamine + sulfadiazine + leucovorin
-
how is toxo tx if its an acute dz in pregnancy
spiramycin
-
how is cerebral toxo (acute) in AIDS pts tx
pyrimethamine + sulfadiazine + leucovorin
-
what is the primary prophylaxis for toxo in AIDS pts
trimethoprim-sulfamethoxazole (Bactrum/Septra)
-
a 56 y/o male reports to the clinic c/o a non-healing wound on his L hand. He said it started as a little bump but has gotten worse over the past 2 months. You asked about his hobbies and he states he is an avid aquarium hobbyist who works on tanks and collects fish off a local reef. On PE you note a heavily demarcated nodule with central ulceration on the posterior aspect of his L hand. What is your suspected dx
fish tank granuloma
-
what is the causative agent of fish tank granuloma
mycobacterium marinum
-
mycobacterium marinum grows best at what temp
77-89.6F (25-32C)
-
an 18 y/o reports to the clinic c/o fatigue, malaise, and leg pn that has gotten worse over the past 3 days. he said the onset was abrupt and that he just returned from a trip to Hawaii where he was hiking in the rainforest. He states he also swam in the rivers and streams. What is you suspected dx
leptospirosis
-
how is lepto transmitted
direct contact with the body fluid of acutely infected animal. Can be from soil or fresh water
-
what are the 2 recognizable clinical syndromes of lepto
- anicteric lepto (self limited, mild flu like illness)
- icteric lepto (severe illness, organ failure)- WEIL DZ
-
what are the classic signs of icteric lepto
calf and lumbar areas
-
how is lepto confirmed
isolation of the leptospires (gold standard)
-
how is a severe infx of lepto tx
PEN G
-
what is the outpt tx for lepto
doxy
-
if a pt has a prosthetic joint and it becomes infected, which organisms may be involved
-
which organism is associated with a cat bite
pasturella
-
what are the causes of osteomyelitis
- trauma to periosteum
- contiguous spread
- hematogenous seeding of the bone
-
when must a bx be done for osteomyelitis
must be done 48hrs before starting or after stopping abx
-
what are the 3 groups that fall under rickettsial dz
- spotted fever grp
- typhus grp
- other rickettsial dz
-
how are rickettsial dz's tx
- doxy (not in children <8)
- chloramphenicol
-
how is Louse Borne Typhus transmitted
by lice (pediculus humanus)
-
a 28 y/o female reports to the c/o a rash that is located on her trunk and extremities but spares her face, palms, and soles. She also states that she has been running a fever and has a headache that wont go away (intractable HA). She said she recently has returned from a deployment in Nigeria where she stayed in an overcrowded village. On PE you observe some macules that are starting to turn into maculopapules and you also notice that there is some petechiae. What is your suspected dx
louse borne typhus
-
which rickettsial dz is assoc with fatal cardiac and renal failure
louse borne typhus
-
this dz is known due to the relapsing of louse-born typhus, it is associated with a fever, transient rash, and falling BP
Brill-Zinsser dz
-
in Brill-Zinsser dz, where is the organism located within the pts body
spinal marrow
-
this rickettsial dz is flea-borne and is transmitted rat to rat by a rat flea.
murine typhus
-
this rickettsial dz is transmitted by ticks (wood ticks and dog ticks). There is cardiac involvement, atelectasis, retinal dz, and may have enlargement of the liver and spleen
RSMF
-
what are the cardinal signs of RSMF
- fever: (104-105.8-- persistent)
- HA: (persistent, intense, intractable)
- rash: (on wrists and ankles, palms and soles and spreads to extremities and trunk)
- confusion: meningoencephalitis and coma
- myalgia: manifests as thigh or calf tenderness
-
this is caused by coxiella burnetii, you will see macrophages in the lungs and vegetations of the heart valves and there will NOT be a rash
Q fever
-
this dz is common in slaughter houses and livestock handling plants
Q fever
-
a 28 y/o male presents to your clinic c/o feeling totally out of it for the past 2 weeks. He also notes R knee pn not assoc with any trauma. His hobbies include hunting and camping in the Northeast. On questioning he said he did notice a strange rash on the posterior aspect of his R arm 2 mo prior to this visit but has since went away. What is your suspect dx
lyme dz
-
what are the 3 stages of lyme dz
- localized
- disseminated
- persistent
-
what is the name that is associated with lyme dz
erythema migrans
-
when does erythema migrans usually present itself
usually 7-14 days after a tick bite
-
what effects can lyme dz have on a heart and cranioneuropathy
- carditis (usually manifests as heart block)
- CN VII and Bell's palsy
-
what is the hallmark of late lyme dz
arthritis
-
what is the most common joint that is affected by lyme dz
knee
-
how is lyme dz tx
- doxy
- if pregnant give amox
-
what is the 2 step testing for lyme dz
- EIA/IFA
- confirmed with Western Blot
-
most human rabies is caused by bites from what animal
bat rabies
-
what is the #1 domestic animal terrestrial rabies reported in the US
cats
-
what is the worldwide/international vector for rabies
dog
-
what is the genus of rabies
lyssavirus
-
what are the factors concerning rabies manifestation
- quantity of virus in saliva
- species of biting animal
- site of bite
- antirabies tx
-
what is pathognomonic about the prodromal period in rabies
paresthesia or pn, maybe a pinprickly or itchy feel at the inoculation site
-
which type of rabies is associated with sxs of agitation, restlessness, biting, hallucinations, hyperactivity, thrashing or confusion
furious rabies
-
which type of rabies is associated with a relatively quiet pt, and paralysis occurs from the outset (not sure if it should say onset??)
paralytic rabies
-
what is pathognomonic during the neurologic period of rabies
hydrophobia and aerophobia
-
what is the most reliable test for rabies and when should it be done
- nuchal skin biopsy
- during the 1st week
-
what is pathognomonic for rabies on a nuchal skin bx
eosinophilic cytoplasmic inclusions (negri bodies)
-
how is rabies tx
- passive and active immunizations
- IMMEDIATE VIGOROUS WOUND CLEANSING (solution of 1 part soap and 4 parts water)
-
if you have ppl that may have a pre-exposure to rabies (civil affair workers, workers in 3rd world countries, vets), how are they tx
- primary immunization: 1mL IM deltoid on days 0,7, and 21 or 28
- booster immunization: 1mL IM deltoid
-
what is the postexposure tx for rabies
- NO prior vaccine with HDCV/PCEC: 1mL IM deltoid on days 0,3,7, and 14
- if they have prior vaccines: 1mL IM deltoid on days 0 and 3
-
how is the passive immunization for rabies given
- most or all of the solution is infiltrated around the wound
- the remaining solution should be administered IM in the gluteus away from the bite area
-
what imaging should be done for encephalitis
head CT (with and without contrast)
-
which lab is essential for the dx of encephalitis
CSF analysis
-
how is HSE spread
through the olfactory tracts
-
what are the s/s of HSV-1/HSV-2 encephalitis
- psych sxs
- anterior opercular syndrome (loose control of facial movements, tongue and pharynx)
- HSV-1- brainstem encephalitis
- HSV-2- encephalitis may produce a myelitis
- global aphasia
-
-
how is encephalitis transmitted
- mosquito
- tick (rare-- only in eastern Europe)
-
what is the source of infection for mosquitos to pick up encephalitis
birds
-
what are the 2 most forms of arboviruses encephalitis
- St Louis encephalitis (Mississippi river)
- California virus (northern Midwest and east)
-
this is a rare form of encephalitis but has a high mortality and is found in New England and surrounding areas
eastern equine encephalitis (EEE)
-
what are the s/s of the St Louis encephalitis
dysuria and pyuria
-
what are the s/s of California encephalitis
generalized or localized seizures
-
what are the s/s of west nile virus
- mild illness or asymptomatic
- looks like typical encephalitis
- extreme lethargy
- flaccid paralysis
-
what will labs show for leukocytes in west nile
leukopenia
-
a 25 y/o female presents to the clinic c/o sudden onset of fever, HA, and neck stiffness. There are no obvious focal neurologic abnormalities. Pt states she has had a recent trip to china. On PE she has a positive Brudzinski sign and you may see possible papilledema. What is the suspected dx
meningitis
-
what 2 medical illness, if not treated, can lead to direct contiguous spread for meningitis
-
what is the most common cause of bacterial meningitis
Strept pneumo
-
which type of meningitis has CSF findings of an opening pressure of 200-300, 100-5000 WBC; >80% PMNs, glucose <40
bacterial meningitis
-
which type of meningitis has CSF findings of an opening pressure of 90-200, 10-300 WBC; lymphocytes, normal glucose, and normal protein
viral meningitis
-
what are the normal values for meningitis on CSF
- opening pressure: 80-200
- WBC: 0-5; lymphocytes
- glucose: 50-75
- protein: 15-40
-
how is strep pneumo meningitis tx
- ceftriaxone
- b/c of emerging beta-lactam resistance, need to add vanco as part of empiric therapy
-
what is the tx for listeria monocytogene meningitis
amp and cefotaxime (claforan) for neonates
-
what is the empiric therapy for all pts with new meningitis
- ceftriaxone 2g IV q12h
- vanc 15mg/kg q 12h
- add amp 2g IV q4h for coverage of listeria if pt >50 y/o, immunosuppressed, pregnant or alcoholic
-
what constitutes post-exposure prophylaxis for close contacts of N meningitidis
- prolonged contact >8h
- close proximity <3ft
- directly exposed to pts oral secretions
- within 1 week before onset of sxs
-
what is the post-exposure prophylaxis for adults in N meningitis
cipro 500mg PO once OR rifampin 600mg PO BID x 4 doses
-
what is the MC cause of viral meningitis
enterovirus (coxsackie)
-
an 80 y/o male cannibal from New Guinea presents to your clinic with sporadic "twitching and jerking" in his arms and a c/o short and long term memory loss. Fhx is significant for post-mortem relative brain eating. On PE you note multifocal neurologic dysfxn, myoclonic jerking, and severe cognitive impairment. What is your suspected dx
prion dz's
-
what labs and imaging can be done for prion-related dz's
- MRI- bilateral areas of increased intensity
- CSF- increased protein
|
|