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ABIM > ID 5 > Flashcards

ID 5 Flashcards

1
Q

Rx for Latent TB? (3)

A
  1. Isoniazid + Rifapentine weekly for 3 months
  2. Isoniazid for 6-9 months (Give Pyridoxine for Neuropathy)
  3. Rifampin 4 months
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2
Q

Pt presents with Poor Denal Hygiene, New Murmur and Enlarged Spleen? Next step in management?

A

Blood cultures + TTE for IE

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3
Q

60 Y Man presents with Difficulty walking, Decreased Sensation and Weakness in lower extremities.
Pt also has Early Diastolic Murmur over Aortic area.
Dx? Test? Rx?

A

Dx: Tertiary Syphilis. Pt has Tabes Dorsalis with Cardiac Syphilis involvement.

Test: RPR (Chronic) will be negative but T. Pallidum is 100% Positive.

Rx: Neurosyphilis —> IV PCN for 10-14 days.

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4
Q

Abx Commonly associated with C. Diff?

A
  1. Fluoroquinolone
  2. Clindamycin
  3. Penicillin.

FCP Flush Clean Poop

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5
Q

Pt from Laos presents with Abdominal Pain, Hx of PNA and Asthma. Eosinophilia 15%. Stool Studies Negative. Dx? Test? Rx?

A

Dx: Strongyloidiasis.

Rx: Check Serology, (ELISA IgG Antibody) or Duodenal Biopsy/Aspirate.

Stool cultures often negative.

Rx: Ivermectin, Albendazole.

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6
Q

44 Yo M hx of HIV presents with fevers, progressive generalized fatigue, poor appetitie and marked weightloss over 2 months. Last CD4 count 6 months ago 90. Temp 101. BP 91/53 pulse 105. He has pale conjunctiva dry mucous membranes. CT Chest & Abdomen shows lucencies in skeleton and bulk mediastinal and abdominal lymphadenopathy.

What will bone marrow biopsy show?

A

Non-Hodgkin Lymphoma. (4% of HIV Patients ( with high viral load and low CD4 coun) have lymphoma at the time of diagnosis.)

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7
Q

Pt who was swimming in Fresh Water presents with Fever and Eosinophilia, Urticiaria, Angioedema returning from Sub-Saharan Africa. Dx? Rx?

A

Schistosomiasis. (Katayama Fever) Steroids and Praziquantel - want to prevent longterm sequelae of hydronephrosis and bladder cancer.

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8
Q

Can get it in the water and presents with nonspecific Gastrointestinal symptoms (Flatulence, Diarrhea, Lactose Intolerance, Malabsorption.)

A

Amebiasis

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9
Q

Pt with a hx of breast cancer presents with 3 days fever, cough, bloody sputum, night sweats, R sided Pleuritic Chest Pain, Tachycardia and Generalized malaise. She is started on Vanc and Zoysn and fail to improve.

CT Scan shows 1-2 cm Nodular Lesions scatted throughout the lung with Surrounding Ground-Glass Attenuation.
Blood and Sputum Negative
Bronchoscopy and Broncholoalveolar Lavage are peformed for culture and cytology.

Next Step in management?

A

Voriconazole.

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10
Q
  1. Seen in asthma/CF patients, fever, wheezing, bronchial hyper-reactivity, productive cough with Brownish Mucous plugs and Hemoptysis. Dx? Rx?
  2. Fungus Ball in Pre-Existing Lung Cavity, No Systemic Symptoms, Cavity remains Stable for Months. Dx? Rx?
  3. > 1 Lung cavities in immunocompetent patients, Symptoms > 3 months. Diagnosed with IgA Aspergillus Antibodies. Dx? Rx?
  4. Similar to Chronic PA with Shorter duration in Immunocompromised Patients. Dx? Rx?
  5. Severly Immunocompromised Patients. CT can Shows Small nodules with/without cavitation Surrounded by Ground-gGass Infiltrate. Dx? Rx?
A
  1. ABPA. Steroids + Itraconazole
  2. Simple Aspergilloma. Asymptomatic No Rx. Others Surgical Resection
  3. Chronic Cavitary PA. Itraconazole/ Voriconazole
  4. Chronic Nectroziting PA. Voriconazole
  5. Invasive Aspergillosis. Voriconazole
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11
Q

Since most Patients Improve Clinically. What is the treatment for Hep B and when is it indicated?

A

Tenofovir, Entecovir.
1. > 4 weeks of symptoms, jaundice, bilirubin
4. INR
5. Acute Liver failure

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12
Q

South Asia Travel, Fever, bacteremia, Relative Bradycardia, Abdominal pain with macular rash. Dx? Most Sensitive Test?

A

Typhoid Fever. Bone Marrow Culture.

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13
Q

South Asia Travel, Fever, abdominal pain, malaise, HA, CONJUNCTIVAL Suffusion. Dx?

A

Leptospirosis

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14
Q

What is the management of Unvaccinated Household contacts exposed to a Patient with Hep A.

A

HAV Vaccine to 12month to 40 yo. HAV vaccine and immunolgobuline to the babies, elders and immunocompromised.

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15
Q
  1. Common nosocomial infections that occur in the 1st month of transplant surgery?
  2. Common infection that occurs between 1-6 months?
  3. Common infection that occurs > 6 months.
A
  1. VRE, Pseudomonas, MRSA
  2. CMV
  3. Nocardia.

Merge the CMV to the land of Nocardia

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16
Q
  1. 36 yo M wakes up with dyspnea, Non productive cough, fever, malaise. They are vacationing in Florida and staying in a old dusty rental. Last night they HAD SEX in the Hot Tub. CXR shows Interstitiial Infiltrate. Dx? Rx?
  2. What other bacteria can infected people in the hot tub and what does it cause?
A
  1. Nontuberculous mycobacteria Pneumonia (Hypersensitivity Pneumonitis (Mycobacterium Avium complex)
    Rx: Self limited and resolves with supportive care.
  2. Pseudomonas: Hot tub folliculitis
17
Q

Which organism causes bacteremia and spontaneous gas gangrene in the Lower extremity without Hx of Trauma? What Pathology is it associated with?

A

Clostridium Septicum. GI tract Pathology - Spreads from GI to Blood. (Colon Cancer, IBD, Diverticulitis).

All Patients should undergo Colonoscopy.

18
Q

What infectious disease are IV Drug users at risk for developing? What is the common organism?

A

Infective Endocarditis caused by S. Aureus which is common on skin.

Strept is common in mouth/Oral.

19
Q

HIV Patient presents with Fever, cough, Chest pain, Weight loss, Headache, Night Sweats, Chills, Fatigue. LDH > and Hypoxemia seen on ABG. CXR shows Interstitial Infiltrated. Dx? Common Complication of this Dx?

A

PCP. Spontaneous Pneumothorax (Rupture of Cystic Lesions)

20
Q

Elderly nursing home resident presents with Confusion (Neurologic), HIGH Fever and bradycardia. He has Low Sodium, Low Platelets and Elevated AST and ALT on on labs.
He is started on Vanc and Zoysn but fails to respond.

Dx?
What confirms this diagnosis?
Rx?

A
  1. Legionella Pneumonia
  2. Urine Antigen and Respiratory Cultures
  3. Respiratory Fluoroquinolones (Levofloxaxin) or Azithromycin
21
Q

What is the management of a Cat bite
1.Medication?
2. What if there is a PCN Allergy?
3. Vaccine?
4. Wound Closure?

A
  1. Augmentin (Amoxicillin Clavulanic Acid). First Dose IV then ORAL for 3-5 days
  2. Doxy or Bactrim if there is PCN Allergy
  3. Vaccine only if due < 5 years Tetanus
  4. Leave open and alllow to close with Secondary intent.
22
Q

Management of PCP:

  1. Mild/Moderate?
  2. Severe?
A

PCP. Mild (P02 > 70 mmhg) or ( moderate 60-70mmhg)

Bactrim BID x 21 d if allergic then Atovaquone

Severe < 50mmhg:

Bactrim IV q8 or Pentamidine (if allergic to Bactrim) + Steroids.

23
Q

What treatment is added to Secondary Bacterial Pneumonia?

A

Ceftriaxone and Azithromycin + Vancomycin (MRSA Coverage)

24
Q

Determine the cause of the Rash:

  1. Young Patient with boy friend Develops rash after being given Amoxicillin.
  2. Associated with Polyarteritis Nodosa and Palpable Purpura.
  3. Pt travels to North Carolina develops Systemic Symptoms then Macular Petechial rash Several Days later.
A
  1. Infectious mononucleosis
  2. Chronic Hep B
  3. Rocky Mountain Spotted Fever
25
Q

What is the difference in heart disease manifestations in Lyme disease and Chagas disease?

A

Lyme Carditis - AV Block
Chagas Dz- Dilated Cardiomyopathy

26
Q

Young women presents fever, swollen joints in knee and wrist. She has pustular lesions on skin.
1. Dx?
2. Test?
3. Rx?
4. Concomitant Abx?
5. Who else do you want to treat?

A
  1. Disseminated Gonococcal Infection.
  2. Synovial fluid analysis (10,000-50,000) , blood cultures ( Maybe negative)
    Best test is Culture of Pharynx and Cervix, rectal, urethral)
  3. IV Ceftriaxone, Can switch to oral Cefepime if there is improvement.
  4. Azithromycin or Doxycycline for Chlamydia
  5. All partners.
27
Q

Rx for Hospital Acquired Bacterial Meningitits?

A

Cefepime (Needed for Pseudomonal Coverage) and Vancomycin.

Community Acquired ( S. Pnumonia) - Ceftriaxone.

28
Q

50 yo M presents with non healing skin lesion on R side that is draining purulent material, occaisional productive cough and foot pain. He travels to Mississipi once or twice per year. CT scan shows lytic lesions in mid foot. CXR shows patchy alveolar opacities in the R upper lung lobe. Dx?

A

Disseminated Blastomycosis.

Blasto blast bones, balls (epididymo-orchitis) and kin

29
Q

What can happen in each stage of Lyme dz.
1. Early localized Dz?
2. Early disseminated Dz?
3. Late Lyme Dz?

A
  1. Viral like Symptoms and Erythema Migrans
  2. Acute Arthralgias, Lyme Carditis, Facial nerve Palsy
  3. Arthritis in large joints.
30
Q

Young women traveling from the Carribean develops Persistent fever and unbearable pain in Shoulder, Left Elbow and Left Knee. She has swelling of the left elbow and left knee. Dx?

A

Chickungunya

31
Q

Associated with Rodents, Can cause cardiopulmonary syndrome and hemorrhaggic fever with renal syndrome. Dx?

A

Hantavirus. (Transittmed through Rodents)

32
Q

Associated with systemic disorders (IBD, Malignancy, Athropathies). Pt develops rapidly painful purulent ulcer with violaceous and underminded border. Dx?

A

Pyoderma gangrenosum.

33
Q

Occurs in non-chlorinated water. Associated with fishermen, oyster handlers, swimmers and aquarium workers. DX?

A

Mycobacterium Marinum.

34
Q

Associated with outbreaks at restaurants, health care settings and travel. Vomiting predominant gastroenteritis.

A

Norovirus.

ABIM (45 decks)

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