fungal + protozoa + helminths

Question 1

endocarditis in IVDU

Answer 1

candida albicans

s. aureus

Question 2

treatment of superficial c. albicans infection

Answer 2

topical:
nystatin
-azole: clotrimazole
oral:
-azole: fluconazole

Question 3

treatment of disseminated c. albicans infection

Answer 3

if immunocompetent: fluconazole

if immuncompromised: amphotericin B or echinocandin

Question 4

AIDS patient with meningitis

Answer 4

cryptococcus neoformans meningitis

Question 5

soap bubble image in brain

Answer 5

crytptococcal meningitis

Question 6

treatment of cryptococcal meningitis

Answer 6

initially: IV amphotericin B + flucytosine

followed by: fluconazole

Question 7

causes of diffuse interstitial pneumonia

Answer 7

mycoplasma (bacteria)

pneumocystis jirovecii pneumonia (PCP)

Question 8

treatment of PCP

Answer 8

TMP-SMX: begin IV, then oral
if sulfa allergy: 
pentamidine or
clindamycin + primaquine
TMP-SMX prophylaxis: CD4

Question 9

treatment for aspergillus

Answer 9

voriconazole or

lipid formulation of amphotericin B

Question 10

treatment of rhinocerebral mucormycosis

Answer 10

amphotericin B

Question 11

treatment of dermatophyte infection

Answer 11

1) simple skin infection:
topical terbinafine or -azole
2) extensive skin infection or scalp/hair:
oral terbinafine or -azole
3) onychomycosis (tinea unguium, nail infection):
oral terbinafine or itraconazole or fluconazole
4) tinea versicolor:
topical azole or topical selenium sulfide or
oral azole

Question 12

spaghetti and meatball on KOH

Answer 12

Malassezi furfur causing tinea versicolor

Question 13

opportunistic fungal infections (infect those who are immunocompromised)

Answer 13

c. albicans
aspergillus
cryptococcus neoformans
pneumocysitis jirovecii
mucor + rhizopus species

Question 14

treatment of giardia lamblia

Answer 14

metronidazole or

tinidazole

Question 15

treatment of entamoeba histolytica

Answer 15

kill trophozoites: metronidazole or tinidazole

kill cysts in intestine: iodoquinol or paromomycin

Question 16

common causes of dystentery (blood diarrhea)

Answer 16

bacteria:
shigella
protozoa:
entamoeba histolytica

Question 17

metronidazole uses

Answer 17

GET GAP on the Metro
Giardia
Eentamoeba
Trichomonas
Gardnerella vaginalis
Anaerobic bacteria
Pylori (H. pylori)

Question 18

treatment for trichomonas vaginalis

Answer 18

metronidazole (flagyl)

Question 19

most common protozoal infection in US

Answer 19

trichomonas vaginalis

Question 20

treatment of toxoplasma gondii

Answer 20

sulfadiazine + pyrimethamine + folinic acid

Question 21

treatment of naegleria fowleri

Answer 21

amphotericin B

Question 22

treatment for chagas disease

Answer 22

benznidazole or

nifurtimox

Question 23

treatment of visceral leishmaniasis

Answer 23

liposomal amphotericin B

Question 24

treatment of cutaneous leishmaniasis

Answer 24

sodium stibogluconate

Question 25

treatment of p. vivax or p. ovale dormant malarial infection in liver

Answer 25

chloroquine + primaquine

Question 26

treatment of malaria

Answer 26

if p. vivax or p. ovale: chloroquine + primaquine (eradicate latent liver stage)
if chloroquine-resistant: 
quinine + doxycycline
atovaquone-proguanil
artemether-lumefantrine
mefloquine

Question 27

treatment of babesiosis

Answer 27

quinine + clindamycin

Question 28

most common helminth in US

Answer 28

enterobius vermicularis

Question 29

intestinal nematodes (roundworm)

Answer 29

ingest organism: EAT
Enterobius vermicularis (eggs: fecal-oral)
Ascaris lumbricoides (eggs: fecal-oral: swallow → intestine)
Trichinella spiralis (larvae: undercooked meat)
enter through skin (feet → swallow → intestines): SAND
Strongyloides stercoralis
Ancylostoma and Necator (hookworms)
D

Question 30

treatment of hookworm, pinworm, roundworm

Answer 30

1) benzimidazoles:
albendazole (worms are bendy = BEND)
mebendazole
2) OR pyrantel pamoate

Question 31

treatment of strongyloides stercoralis

Answer 31

ivermectin or

albendazole

Question 32

cestodes (tapeworms)

Answer 32

taenia solium
diphyllobothrium latum
echinococcus granulosus

Question 33

treatment of taenia solium

Answer 33

albendazole or
praziquantel
ADD: dexamethasone (prevent worsening CNS symptoms from dying larvae in brain)

Question 34

trematodes (flukes)

Answer 34

schistosoma
paragonimus westermani
clonorchis sinesis

Question 35

chronic infection with schistosoma haematobium associated with

Answer 35

squamous cell carcinoma of bladder!!

Question 36

egyptian immigrant with hematuria

Answer 36

squamous cell carcinoma of bladder from schistosoma haematobium

Question 37

treatment of schistosomiasis, paragonimus westermani, clonorchis

Answer 37

praziquantel

Question 38

ectoparasites: live on surface of hosts body

Answer 38

lice
scabies
bedbugs

Question 39

attach ova on hair shaft close to scalp (can see ova, not adult lice)

Answer 39

head lice

Question 40

scalp pruritis (ears, nape of neck)

Answer 40

head lice

Question 41

treatment of head lice (pediculosis capitus) or pubic lice (pediculosis pubis)

Answer 41

topical:
permethrin
pyrethrin
not lindane (neurotoxic + resistance)

Question 42

spread by sexual contact
(STD)
screen for OTHER STDS!
pruritic

Answer 42

pubic lice

Question 43

scabies mite
burrows under human skin - reproduces here
transmitted by sexual contact with infected person
WEBBING b/t fingers, WRISTS, ANKLES, PERIUMBILICAL, PENIS
severe pruritis
papules + linear burrows
dx: mites, egss, feces on skin scraping

Answer 43

scabies

Question 44

treatment of scabies

Answer 44

topical:
permethrin 5% cream
ivermectin

Question 45

on mattresses: can go months without eating
travel 100 feet in night
pruritis → superinfection

Answer 45

bedbugs

Question 46

treatment for giardia, entamoeba, trichomonas

Answer 46

metronidazole or tinidazole