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USMLE STEP 3 Questions > ID > Flashcards

ID Flashcards

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USMLE® Step 1 flashcards
1
Q

Who should get HAV vaccine?

A

MSM
HBV, HCV pts
IVDU

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2
Q

What vaccines should HIV pt get?

A

PCV 13 then PPSV23 8 wks later and every 5y
Live vaccines only if cd4>200 and no AIDS defining illness
Hep a

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3
Q

Corynebacterium diphtheriae causes what

A

It releases diphtheria toxin which is life threatening and causes URI symp
If high suspicion then give diphtheria antitoxin (horse serum) to avoid myocarditis, neuritis, and nephreitis but risk of anaphylaxis in 10%

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4
Q

Severe pain, erythema fever, hypotension after wood splinter may be due to which organism/disease?

A

Gp a strep/nec fasciitis

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5
Q

Most common organism in bloodstream inf is

A

Staph epidermidis

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6
Q

Nec fasciitis treatment involves

A

Broad abx - zosyn, vanc, clinda and urgent surgical debridement before imaging

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7
Q

Tx of giardia or amoeba infection

A

Flagyl

Also the inf is not assoc w eosinophilia

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8
Q

Tx of parasitic inf like roundworm, hookworm etc. NOT amoeba

A

Albendazole or mebendazole

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9
Q

Rubella vs rubeola vs roseola

A

Rubella - 3 day german measles - maculopap rash that begins in face and spreads caudually and disapears in 5 days, may have cough, co
May be assoc w arthritis. quick progression.

Roseola - high fever that resolves and followed by rosy nonpruritic rash on trunk spreading to extremities

Rubeola - is measles - 3 c’s cough coryza conjunctivitis, koplik spots and sick appearing

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10
Q

When do u start steroids for PCP? What a-a gradient and what pao2?

A

A-a gradient 35

Pao2 70

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11
Q

Which types of abx incr risk for seiZures?

A

Pcns, cephalosporins, IMIPENEM, fluoroquinolonrs

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12
Q

hydroPhobia, f/drool, dysphagia, ataxia!! Started one week ago with throat pain and hx of caves exploring

A

Rabies!!!! Vs epiglottitis is more acute and have stridor

Hydrophobia bc water triggers pharyngeal spasms

Once pt develops symptoms death is common… Only tx is palliative

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13
Q

Do u give zoster vaccine to those who have had zoster?

A

Yes if >60. 5% chance reactivation

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14
Q

Iris - immune reconstitution syndrome treatment

A

Worsening of hiv symp after starting haart due to rapid immune response. Since it is self limited there is no treatment and just continue haart. Unless there is severe organ dysfunction

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15
Q

What is considered severe c diff?

A

Wbc>15, cr >1.5x baseline, high fever and can consider oral vanco as first tx

If severe an high wbc>20 and lactic acidosis and ileus than may need colectomy

frequent relapses- consider fidaxomicin and fecal transplant

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16
Q

Progressive neuro deficits in someone w aids whohas brain bx of oligodendrocytes with intranuclear inclusions, demyelination, astrogliosis is due to? Tx?

A

pmL - progressive multifocal leukoencephalopthy due to jc virus 4% aids. Tx is HAART.

Wo tx majority of ppl will die in 3-6mo

17
Q 
Who is supposed to get abx ppx for meningococcal meningitis exposure? 
Intubator?
Ambulance driver?
Coworker?
Child care center worker?
Family in home?

What is tx?

A

Anyone with close contact with secretions- intubator, family, child care

Not coworker, not ambulance driver, not coworker

Rifampin q12h for 4 doses. Could also use one time dose of cipro and ceft

18
Q

Ppd cutoffs for 5, 10, 15 mm?

Tx for latent tb?

A

5 - hiv or immunocomp or recent contact w active tb

10 - healthcare, recent immigrant, ivdu

15 no risk factors

Tx with 9 mo inh or 4 mo rifampin

19
Q

What is gold standard to diagnose active tb?

A

Sputum studies - 3 specimens 8-24 hrs apart with at least a morning specimen. For those who cant give sample then sputum induction with aerosolized hypertonic saline

If they have three neg sputums but still have high suspicion then get BAL

20
Q

3 negative afbs even with symptoms of tb mean

A

Noninfectious but should still tx them bc afb sputum has low sensitivity

21
Q

Immunocomp pt wih cough, cp, fever, and headache with nasal bleeding!!!

A

Invasive aspergillosos!! Will also see pulm lobe infitrate!!

22
Q

Tropical travel and come back wih fever, myagia, headache, LAD, pharyngeal edema, hemorrhagic tendoncies like petechiae after tournequet and elevated liver enz

A

Dengue fever

Bc of incr capillary permeability, incr risk of circulatory collapse, pleural eff, ascites

23
Q

If you are exposed to someone w tb and get ppd and its neg, what is next step?

A

Get ppd in 3 mo

24
Q

What type of contact precautions needed for herpes zoster?

A

Airbone and contact until lesions are crusted over

25
Q

What is best screening test for hiv?

A

Hiv p24 ag and ab screen

not hiv rna

26
Q

Hiv pt w dysphagia/n/v/epigastric pain and also eye involvement and pain w white lesions in eye into vitreous

Tx?

A

Candidiasis disseminated causing candida endopthalmitis

Tx w vitrectomy and amphotericin b

Note that ketoconazole isnt strong enough

27
Q

What is best indicator of pts current immune status? Of their prognosis?

A

Cd4. Prognosis by viral load

28
Q

Pt w recent abx for uti now w neck pain and stiffness and csf w high protein, low glc, leukocytes in CSF w high neutrophils but neg gram stain and cx has

A

Bacterial meningitis!! Gram stain has lower yield if recent abx

Not aseptic viral meningitis

29
Q

Hiv pt cd4 600 and low viral load is prego. On haart. Anychanges to haart if they are prego?

A

No change bc current regimen working

And pt can get vaginal delivery unless vira load >1000 and they should get csection

30
Q

Rabies exposure but got rabies vaccine a year ago. Next step

A

Give rabies vaccineX 2 days

If no vaccine before give both rabies ivig and vaccine (x 4)

31
Q

Hiv pt w painful swallowing a egd shows biopsy w giant ulcer and NO viruses
Next tx is

A

Steroids!!!

Aphthous ulcer

If cmv or hsv would see virus!!

32
Q

Hiv pt w syphillis and neuro complaints has csf neg for neurosyphillis, how much duration tx should he get?

A

Penicillin g qweek for 3 wks bc he has latent syphillis - likely >12 months infected

If less than 12 mo, then just one time dose

33
Q

Syphillis pt receives pcn and within 24 hrs has fever, mailase, headache, what is this and hoe to prevent?

A

Jarish hercheimer rxn and due to rapid spirochete lysis and cannot prevent

34
Q

Teenage boy w hx of multiple ona and sbo comes in a pna/green sputum. What does he have an what tx?

A

Cf and pna likely pseudomonas and staph

Need to cover two pseudomonal ie cefepime and amikacin it zosyn or penem

35
Q

Guy w urethritis gram stain shows many neutrophils (diagnostic) but no organisms!! Means which organism?

A

Chlam!!!! If gonorrhea would see dipplococci

Tx w doxy it azithro

If pt had gonorrhea need to tx ceft and cover for chlam too

In those who dont get better tx w flagyl bc trichomonas can also cause

36
Q

Healthcare worker exposed to someone w tb. When to check ppd?

A

Now for baseline and then in 3 mo

37
Q

Pt w mono w rash after abx. Txv

A

Just supportive

No steroid!

38
Q

If seborrheic dermatitis throughout face, body, chest next test is

A

Hiv test !!!! See in severe sevorhejc dermatitis

Dont do fungal cx of skin scraping

USMLE STEP 3 Questions (20 decks)

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