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Internal Medicine > ID > Flashcards

ID Flashcards

1
Q

Alcoholic with blood tinged sputum and it’s foul smelling. Dx? Test? Rx?

A

Lung abscess from aspiration pneumonia. CXR. Can’t differentiate btw abscess and emphysema then do CT. Sputum grain stain and culture with empiric abx then when culture comes back give specific therapy (Organisms are Peptostreptococcus and Fusobacterium, Bacteroides, Provetella.) Rx. with Clindamycin.

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2
Q

Intracytoplasmic inclusions + periventricular calcifications indicate what viral infection?

A

CMV which can cause GI upset in HIV patients

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3
Q

Abrupt onset (like a train hit the pt) of sever fever and myalgias with mild eye and nose congestion. Mild sore throat. Dx? When should rx begin? What happens if patient comes to doc late?

A

This is influenza virus caused by Type A or Type B. C cause minor illness. Need to treat with Oseltsmivir w/in 48 hrs otherwise it’s symptomatic treatment. Amantidine (Also uses in parkinsons side effect-livdeo reticularis) can be used for type A.

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4
Q

Treatment of choice for Cryptococcal Meningitis ?

A

IV Amphotericin and IV flucytosine

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5
Q

Pt with fever, malaise, pharyngeal erythema, swollen tonsils, and tender cervical lymph node. NO COUGH. Dx? Test? Most accurate? Rx?

A

Acute strept pharyngitis give penicillin VK x 10 days. Clinical diagnosis based on the centor criteria. Can do rapid strept test. Throat culture is most accuarate but rarely done, only if clinical findings and rapid strept equivocal.

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6
Q

Name describe the 3 stages of Lyme disease. Test? Rx? Rx for pregnant pts?

A

Stage 1: Erythema migrans. Stage 2: Early disseminated- constitutional symptoms (HA and musculoskeletal pain) Late disseminated - Meningitis, Encephalitis, (cranial neuritis), Bell’s palsy, AV block and Pericarditis. Stage 3: Lyme Arthritis. Test: ELISA and Confirm with Western blot (like HIV.) Rx: PO Doxy x 21 days if preggo then Amoxicillin.

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7
Q
  1. Regular meningitis Rx ages 2-50yrs old? 2. Those immunocompromised and > 50? 3. < age 2?
A
  1. Regular and age 2-50: ceftriaxone + vancomycin
  2. immunocompromised and > 50 : ceftriaxone + vancomycin + ampicillin (Need listeria coverage)
  3. Neonates: Ampicillin and gentamicin DO NOT GIVE Ceftriaxone.
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8
Q

Treatment for Pyelonephritis: Empiric? Outpatient? Inpatient? What you treat for sappryticus.

A

Empiric is Ampicillin and Gentamicin. Outpatient: Cipro PO. Inpatient IV Ceftriaxone or IV Cipro.

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9
Q

Diseases when 1. HIV CD4 count 200-500? 2. CD4 count 100-200 3. CD4 count < 100 ? 4. CD4 count < 50 and give treatments.

A
  1. CD4 200-500: Candida/thrush (Itracanozaole, Flucanazole), Kaposi, Herpes- Acyclovir, TB (RIPE) 2. CD4 100-200: PCP- Bactrim, Histo and Coccidomycosis( Itracanozole, Flucanozole, Amphotericin) 3. CD4 <50 CMV- Gangcilovir, Foscarnet MAV- Azothromycin, PML
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10
Q

Name 2 (1) first, (2) second, (3) third generation-use? cephalosporins. Name 4th generation cephalosporin. Name 5th generation, use?.

A
  1. PO Cephaxelin (keflex), Cefazolin (skin). 2. PO Cefuroxime, PO Cefaclor, IV Cefotetan and IV Cefoxitin -cover some PELVIC Anaerobes (pelvic inflammatory dz)) 3. IM and IV Ceftriaxone (does not cover pseudomonas penetrates CNS), Ceftazidime, Ceftaxime (covers pseudomonas) 4. Cefipime (HCAP) 5. Ceftoraline (MRSA)
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11
Q

What is the antibiotic of choice for a human bite?

A

This infection is poly microbial so amoxicillin - clauvanate (Augmentin) .

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12
Q

Use of oaxcillin, naficillin, dicloxcillin?

A

Cellulitis, Erysipelas, Impetigo, Osteomyelitis, Septic Arthritis (MSSA).

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12
Q

Use of penicillin VK, penicllin G (IV). What diseases?

A

Strept Pneumoniae, Strept Pyogens, Strept Viridans (at the Dentitis), Treponema. Syphilis (Pen G) and Pharyngitis (Pen VK)

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13
Q

Use of penicillin VK, penicllin G (IV). What diseases?

A

Strept Pneumoniae, Strept Pyogens (Group A Strept), Strept Viridans (at the Dentitis), Treponema. Syphilis (Pen G) and Pharyngitis (Pen VK)

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15
Q

Use of Clarithromycin, Azithromycin

A
  1. Add on therapies for HCAP 2. Sinusitis, Bronchitis, Otitis, H pylori. 3. Atypical organisms (legionalla, mycoplasma, chlamydia, Coxiella) LmCC
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15
Q

Use of Tetracyclines: Doxycyline, Minocycline. Side effect?

A

Chlamydia (2nd line Azithromycin is first), Rickettsia, Lyme, Syphiliis (Penis and Skin.) Side effect: Stained TEETH and PHOTOSENSITIVITY

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16
Q

Uses of (Aminopenicillins) Ampicillin and Amoxcillin? Diseases?

A
  1. Otitis, Sinusitis, Dental infections, UTI in pregnant female. Listeria.
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17
Q

Use of Glycopeptide: Vancomycin, Teicoplanin, Telavancin

A

MRSA, C. diff (Recent abx and Hospilizations and OLD age can cause this)

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18
Q

Use of Clindamycin. Side effect?

A

Gram positive (MRSA, strep) AND ANEROBES with Aspiration pneumonia.

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19
Q

Pt presents with fever, nonproductive cough, SOB, abdominal pain, loose stoles, hyponatremia. Dx? Test? Rx?

A

Legionella pneuomonia. Urinary antigen test. Levo or Azithromycin.

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20
Q

Use of Metronidazole, Side effect?

A

Bacterial Vagionosis, Trichnomonas Vaginalis, C. Diff, Disulfram effect - dont drink with this.

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21
Q

Use of Polymyxin B and Colistin ?

A

Very toxic abx for very severe ICU infections.

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22
Q

Which HAART therapy can cause Crystal Nephropathy?

A

Indinavir ( protease inhbitor) even when you hydrate the patient they can still develop this. They also cause hyperglycemia, lipidistrophy.

23
Q

Pt develops bloody diarrhea without fever?

A

EHEC. 0157:H7 HUS-TTP Shiga toxin

24
Q

Difference in rash presentation between Rickettsia and Syphillis and Rubella?

A
  1. Rickesttia: Rash starts on wrist and ankles and spreads to trunk (centrally) 2. Syphillis: Rash begins on trunk then spreads to palms and soles (peripherially) 3. Rubella : rash begins on head then spreads down.
26
Q

Name 3 organisms that cause Viral Encephalitis in an immunocompetent patient?

A

Herpes, EBV, Varicella.

26
Q

From South Central (Mississippi) and North Central US (Detroit, Ohio) and Immunocompent has skin lesions, lung symptoms.

A

Blastomycosis

28
Q

Pt from Mid-Atlantic (South Crolina) Central US (Alabama,) with lung symptoms and no skin findings? Dx? Test? Rx?

A

Histoplasmossis.Urine antigen test for acute. Chronic you can do fungal blood cultures - take up to 6 months to detect in the blood. Itraconazole.

28
Q

Best initial test for Cervicitis (Strawberry Cervix)? Most accurate test?

A
  1. Vaginal Swab for gram stain. 1. Culture DNA probe/NAAT/PCR
29
Q

Best initial test for Urethritis? Most accurate test? Rx?

A
  1. Urethral swab Gram stain for Men. Women do vaginal swab for gram stain. 2. Urethral Culture DNA Probe/NAAT/PCR
30
Q

For each give Dx, Best initial and most accurate Test and Rx: 1. Painless Ulcer 2. Painful Ulcer 3. Lymph nodes tender and suppurating 4. Vesicles prior to ulcer and painful

A
  1. Syphilis, VDRL initial test FTA ABS (confirmatory), Darkfield Microscopy most accurate, Single dose IM Pen G 2. Chancroid (Haemophilus Ducreyi) Specialized Media, Azithromycin 3. Lymphogranuloma Venereum, Complement fixation titers in blood Does not gram stain like Chlamydia, Doxy 4. Herpes, Tzanck prep initial, Viral culture most accurate, Acyclovir.
31
Q

What is the best initial and confirmatory test to diagnose a baby with HIV? Why?

A
  1. PCR 2. Viral load/Culture. The infant will have his mothers antibodies up until 6 months after delivery so the ELISA test will not be accurate (False Positive)
32
Q

Pt presents with lower abdominal tenderness, lower abdominal pain, fever, cervical motion tenderness. Dx? Best initial test? Most accurate test? Rx?

A

PID (Pelvic Inflammatory Disease) Cervical Swab (PAP) for gram stain and cultures DNA probe/NAAT/PCR. Laproscopy most accurate (rarely done unless refractory to Rx and unclear of diagnosis) Inpatient: IV Cefoxitin or IV Cefotetan and IV Doxy Outpatient: IM Ceftriaxone and Doxy

33
Q
  1. When to start treatment once someone has contracted HIV? 2. What is the best initial therapy?
A
  1. Any CD4 count and any Viral load. The virus causes immunologic destruction as soon as it is contracted. 2. Emitracitabine/Tenofovir (Nucleoside Reverse Transcriptase Inhibitors/Efavirenez(Non-Nucleoside RTI) (2) Nucleosides RTIs and (1) Non-nuceoside or Protease Inhibitor.
34
Q
  1. Best initial test for HIV in Adult? 2. Most accurate test? 3. What is the best initial and confirmatory test to diagnose a baby with HIV? Why?
A
  1. ELISA 2. Confirm with Western Blot 1. PCR 3. Viral load/Culture. The infant will have his mothers antibodies up until 6 months after delivery so the ELISA test will not be accurate (False Positive)
36
Q

Name the side effects of each: 1. Zidovudine 2. Stavudine and Didanosine 3. Abacavir 4. Protease Inhibitors (Class effect), Indinavir 6. Tenovir

A
  1. Macrocystic Anemia 2. Peripheral neuropathy and pancreatitis 3. Hypersensitivity/Stevens Johnsons 4. Hyperglycemia and Hyperlipidemia 5. In addition to class effect also causes Crystal nephropathy. 6. Renal Insufficiency.
36
Q

Meds for MRSA or purulent cellulitis. (5)

A

Bactrim, Doxy, Clinda, Lizenolid, Vanco.

37
Q

What is the Rx? ANC < 500

A

ANC = WBC x (neurtophils + Bands)/100. The precentage of mature neutrophils. Normal 1500-1800. <500 needs hospitalization with IV abx (Zosyn) or Cefepime For bother moderate and severe you can add Vanco if there is a skin or line infection. Add fungal if pt is still febrile 4-7 after.

38
Q

AIDs pts: 1. Multiple ring enhancing lesions of the basal ganglia? 2. One solitary weakly enhancing lesion that is periventricular? 3. Multiple non enhancing lesions? 4. Subcortical and Cortical atrophy with ventricular enlargement

A
  1. Toxo 2. CNS lymphoma EBV DNA found in CSF 3.PML 4. AIDS Dementia.
39
Q

Flu-like illness (high fever, HA, myalgias, chills), confusion. Rash is uncommon. LEUKOPENIA and THROMBOCYTOPENIA. Intracytoplasmic morulae. Dx? Most accurate test? Rx?

A

Ehrlichia Chaffeenis. PCR. Doxy.

41
Q

Difference btw Rubella and Measles?

A

The fever in Measles (Rubeola) is more severe > 104.

41
Q

Child was recent sick 2 weeks ago and now presents with pain and stiffness first in her knees and now in wrist. She has a erythematous centrifugal rash present on trunk. Dx?

A

Rheumatic fever ( s/p group A strept infection) Major criteria: carditis, syndenam chorea, subcu nodules, erythema marginatum.

43
Q

Child was recent sick 2 weeks ago and now presents with pain and stiffness first in her knees and now in wrist. She has a erythematous centrifugal rash present on trunk. Dx?

A

Rheumatic fever ( s/p group A strept infection) Major Criteria: carditis, syndenam chorea, subcu nodules, erythema marginatum.

43
Q

Drug of choice for actinomyces? Drug of Choice for Nocardia?

A
  1. Penicillin 2. Bactrim
44
Q

Pt has been complaining of an intractable HA that is not relieved by rest or pain meds. States she was bitten in the cheek by a bug 2 weeks ago. R sided Eyelid is and cheek are edematous, erythematous and tender. EOMI are restricted. Forehead and cheeks are extremely tender to palpation. Dx? Test? Rx?

A

Cavernous Sinus Thrombosis ( 2/2 infection of the facial skin the ophthalmic and facial nerves are valvesss which predisposes people to infection) Magnetic venograpy. IV abx

46
Q

Use of Quinolones: Ciprofloxacin, Levofloxacin, Moxifloxacin, Oflaoxacin. Diseases? What is special about Moxi. What does Cipro not cover?

A

Diseases: CAP, HCAP, Cysitis, Diverticulitis - Moxi can be used as monotherapy for this. Cipro - doesnt cover gram positive so not used in pneumonia.

47
Q

HIV patients who has had all his childhood vaccinations. What vaccinations should he receive as an adult.

A

Tdap once in adulthood, Hep B once, Td booster every 10 years, Pneumovax every 5 years, Influenza Yearly

48
Q

Name 3 organisms with diagnostic urinary antigen test

A

CMV, Histoplsmosis, Legionella

51
Q

Periorbital edema, Myositis and Eosinophilia >20%. Dx?

A

Trichenellosis caused by Trichenella.

52
Q

Management of mild infectious diarrhea? Management of severe (Tachycardia, Hypotension, abdominal pain)?

A
  1. Oral fluids and electrolyte replacement. 2. IVF and Cipro
53
Q

Pt presents with sore throat, bilateral cervical lymph adenopathy, palatal petechiea and splenomegaly. Dx? Test? Rx?

A

Mono. CBC with diff (Atypical lymphocytosis > 50% on diff) Heterotrophile antibodies. May be falsely negative in the beginning. Do a repeat test if still negative do EBV antibdoy test. Supportive care avoid contact sports for 3 weeks.

54
Q

Fever, HA, Retro-orbital pain, Sevre Lumbar Spine Pain, Rash, Athralgia, Myalgias.

A

Dengue Fever.

55
Q

Best initial and most diagnostic test and Rx for Necrotizing infection caused by C. Prifrigens?

A
  1. Gram stain, culture, xray shows gas bubbles 2.Direct visualization most accurate. Rx surgical debriedment and High dose IV penicillin.
56
Q

School teacher and mom of 3 presents with symmetric athritis is wrist, hands, knees and ankles. Dx? Test? Rx?

A

Parovirus B19. She got it from her kids. Anti-IgM antibodies. Resolves on its own.

57
Q

Fever in first week, salmon colored rash in 2nd week, hepatosplenomegaly and intestinal complications such as intestinal bleeding and perforation during the 3rd week.

A

Typhoid Fever.

58
Q

Child presents with fever, drooling, in ability to extend neck or open mouth. CXR is significant for a widened prevertebral space. Dx?

A

Peritonsilar Abscess.

59
Q

HIV, Immunocompromised, transplant pt presents with large pedunculated exophytic purple skin masses on lower abdomen with a collarette scale. Dx?

A

Bartonella Henslea.

Internal Medicine (13 decks)

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