Critical Care (7%) and ID (5%)

Question 1

EBV is ass’d with rash after what drugs?

Answer 1

Ampicillin, amoxicillin

Question 2

Viral symptoms in patient with recent transplant

Answer 2

Cytomegalovirus – looks like GvH, but that’s not on the blueprint so consider this first

Question 3

Buzzword: gray-white covering of posterior pharynx

Answer 3

(“Pseudomembrane”) –> diptheria

Question 4

What are some complications of EBV?

Answer 4

• Lymphomas (Hodgkin, Burkitt, CNS)
• Nasopharyngeal carcinoma
• Gastric carcinoma

Question 5

Erythema migrans + recurrent arthritis

Answer 5

Consider lyme

Question 6

How is Lyme diagnosed?

Answer 6

Western blot

Question 7

How is Lyme treated?

Answer 7

Early = doxycycline; if CIx, use IV PCN G

Late = IV Doxy or ceftriaxone if considering a bacterial pathogen, if there are late neuro signs, or if there is minimal response to early treatment

Question 8

Pulmonary s/sx + Ohio river valley, caves, bats, or birds

Answer 8

Histoplasmosis

Question 9

Pulmonary s/sx + San Jaquin valley, AZ, UT, or NV

Answer 9

Coccidiomycosis

Question 10

What is the MC HIV-related PNA?

Answer 10

Pneumocystis (jirovecii)

Question 11

Tick bite +

• Fever
• Rash from feet up, blanching macules
• April - September

Answer 11

RMSF, treat with doxy

Question 12

Tick bite, Gram (-), targets endothelial cells

Answer 12

RMSF

Question 13

Severe salmonellosis can be treated with

Answer 13

FQ or bactrim

Question 14

Diarrheal illness ass’d with prisons, daycares, hospitals

Answer 14

Shigellosis

Question 15

Treatment for suspected tetanus exposure

Answer 15

For puncture wound:

• Airway
• Benzos for spasms
• Tetanus immune globin
• Tetanus toxoid x 3
• Metronidazole or PCN (stop toxin production, kill bact)

Question 16

MRI showing ring-enhancing lesions in an immunocompromised patient exhibiting confusion

Answer 16

Toxoplasmosis

Question 17

Tx for a patient with confusion, persistent HA, and MRI showing ring-enhancing lesions

Answer 17

Pyrimethamine + sulfadiazine (tx for toxoplasmosis)

Question 18

Treatment for latent TB

Answer 18

Iso + Rifampin weekly x 3 months (12 doses)

Question 19

Treatment for TB Disease

Answer 19

Isoniazid + ethambutol + rifampin + pyrazinamide

Question 20

AEs associated with ethambutol

Answer 20

E = Eyes

Optic neuritis, red-green colorblindness

Question 21

AEs associated with rifampin

Answer 21

R = Renal impairment
Orange secretions
Flu-like symptoms
*Has the most drug interactions of the TB drugs

Question 22

AEs associated with isoniazid

Answer 22

I = Eyes, optic neuritis
Peripheral neuropathy
Hepatotoxicity

Question 23

AEs associated with pyrazinamide

Answer 23

Hepatotoxicity
Gout
GI effects

Question 24

Who gets treated for chickenpox, and with what?

Answer 24

13+ YO

• Acyclovir if w/in 72 hours of onset
• If resistant, use foscarnet

Question 25

What is Hutchinson's sign?

Answer 25

Involvement of tip of nose in shingles infection; involves likely involvement of cornea, urgent ophthal referral

Question 26

Tx for uncomplicated candidiasis

Answer 26

1 dose fluconazole 150 mg PO Can repeat dose after 72 hours if necessary

Question 27

Tx for Chlamydia

Answer 27

Doxy 100mg PO x 7 days (use 1 dose AZ in pregnancy; doxy preferable in other patients) + 500mg IM ceftriaxone to cover for possible gonorrhea co-infection

Question 28

Tx for gonorrhea

Answer 28

500 mg IM ceftriaxone + Doxy 100mg PO x 7 days to cover for possible chlamydia co-infection; alt 1 dose AZ in pregnant patients (higher resistance tho)

Question 29

Buzzword: giant multinucleated cells on Tzank smear

Answer 29

HSV

Question 30

How is HSV diagnosed?

Answer 30

Viral culture from unroofing an unruptured vesicle

Question 31

Difference between chancre and chancroid, and disease associations?

Answer 31

Chancre is painless and associated with syphilis Chancroid is painful and associated with granuloma inguinale (H ducreyi)

Question 32

How is syphilis diagnosed?

Answer 32

RPR (nontreponemal test, just indicates presence of IgM/G antibodies) MC to screen --> Reflex to treponemal test - FTA-Abs - MHA-TP - TPPA - TP-EIA - CIA

Question 33

Differentiate morphology of chlamydia vs gonorrhea

Answer 33

Both are Gram (-) Chlamydia is coccoid Gonorrhea is diplococcoid

Question 34

Describe early manifestations of Lyme disease

Answer 34

- Erythema migrans | - Nonspecific, viral-like symptoms (fatigue, anorexia, HA, neck stiffness, myalgia/arthralgia, fever, etc)

Question 35

Describe manifestations of early disseminated Lyme

Answer 35

- May see multiple erythema migrans lesions - Neurologic symptoms: - - Peripheral neuropathy - - Radiculopathy - - Uni/bilateral cranial nerve palsies (esp facial) - - Mononeuropathy multiplex - - Lymphocytic meningitis - Cardiac symptoms: - - AV heart block (mild) - Ocular manifestations

Question 36

Describe late manifestations of Lyme disease

Answer 36

Intermittent arthritis, large joints, esp knee Neuro: mononeuropathy multiplex Encephalomyelitis Subtle encephalopathy

Question 37

What is the most likely source of bleeding in a patient with melena, jaundice, and ascites?

Answer 37

Esophageal varices 2/2 portal HTN

Question 38

The anatomical location of bleeding in a patient who presents with melena is MC where?

Answer 38

Proximal to the ligament of Treitz

Question 39

The anatomical location of bleeding in a patient who presents with hematemesis is MC where?

Answer 39

Proximal to the ligament of Treitz

Question 40

The anatomical location of bleeding in a patient who presents with hematochezia is MC where?

Answer 40

Distal to the ligament of Treitz (unless it is massive upper GI bleeding)

Question 41

What is the MC cause of upper GI bleeding?

Answer 41

Peptic ulcer disease Esophageal varices are close second

Question 42

What is the MC cause of lower GI bleeding?

Answer 42

Diverticulitis (sigmoid colon is MC location)

Question 43

What is the critical care treatment for a patient with significant GI bleed?

Answer 43

- ABCs - Type and cross - 2 large bore IVs; IVF (but replace blood with blood: transfuse as needed) - NPO Pharmacotherapy: - PPI - Octreotide (somatostatin analogue, used for variceal bleeding/cirrhosis) - IV ceftriaxone or an FQ - Immediate GI surg consult

Question 44

Why are IVF important in the critical care treatment of cardiac tamponade?

Answer 44

Must maintain sufficient preload to prevent RV collapse

Question 45

What is the critical care treatment of symptomatic CAD?

Answer 45

``` MONA-BASH-C: - Morphine - O2 - Nitro - ASA (325 acute, then 81mg) - B-blocker (EXCEPT with R-sided infarct, but these patients should be in cath lab anyway!) - ACE-i - reduce afterload - Statin - Heparin: stabilize potential thrombus +/- Clopidogrel: add clopidogrel if there is high sus this pain is CAD ```

Question 46

What is the management for a patient with NSTEMI and elevated troponins?

Answer 46

Urgent cath lab

Question 47

What is the management for a patient with NSTEMI and no elevation in troponins?

Answer 47

Serial troponins, observe overnight - If positive --> urgent cath lab - If negative, arrange elective stress test for the morning - --- If positive: elective cath - --- If negative: only way to truly r/o CAD is with cath, they can opt to do this or not

Question 48

What is the tx for angina that is worst in the morning/on waking, not associated with exertion

Answer 48

Prinzmetal angina: use CCB (no BB) and long-acting nitrates like amlodipine

Question 49

EKG changes including transient ST elevations, inverted U waves and angina in the early hours of the morning

Answer 49

Prinzmetal angina