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1
Q

What’s herpetic whitlow

A

Herpes of the hand, often due to hand jobs or dental work. Have focal area of grouped vesicles on an erythematous base.

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2
Q

In pts with widespread molluscum contagiosum, consider testing for

A

Hiv

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3
Q

Side effect of ethambutol

A

Optic neuritis

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4
Q

Side effect of isoniazid

A

Peripheral neuropathy And hepatitis

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5
Q

If pt in septic shock doesn’t respond to abx and fluid resus, whAt should you do

A

Administer vasopressors and admit to icu

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6
Q

Ppx meds of choice for close contacts of pts with meningococcal meningitis

A

Rifampin and cipro

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7
Q

Rbcs jn csf without hx of trauma is highly suggestive of

A

Hsv encephalitis

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8
Q

Two most common causes of encephalitis

A

Hsv and adenovirus

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9
Q

Tx of cmv encephalitis

A

Iv ganciclovir and possiby foscarnet

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10
Q

Most common postviral pneumonia bug in elderly

A

S aureus

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11
Q

Tx of brain abscess

A

Broad spec iv abx and surgical drainage

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12
Q

Triad of headache, fever, and focal neuro deficit, think

A

Brain abscess

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13
Q

Hiv destroys what cells

A

Cd4+ t lymphocytes

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14
Q

Dx of hiv

A

Elisa and then western blot to confirm
If Elisa is neg and pt had acute exposure do hiv rna pcr

Rapid hiv test also available

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15
Q

Babes of hiv positive moms should receive ___ six weeks postpartum

A

Zidovudine

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16
Q

Which are the only live vaccines that should be given to hiv pts

A

Mmr and Varicella

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17
Q

Should you give oral polio vaccine to aids pts

A

No

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18
Q

Mac in aids pts occurs when cd4 count is under

A

50

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19
Q

In Mac, serum alk phos and ldh Are

A

High

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20
Q

Biopsy of bone marrow, intestine or liver in Mac reveals

A

Foamy macrophages with acid fast bacilli

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21
Q

Ppx against Mac in aids pts

A

Azithromycin

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22
Q

Tx of gonorrhea

A

Ceftriaxone Im and azithro P.O. (for chlamydia tx)

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23
Q

Primary Syphillis occurs ___ after infection and presents with a ___

A

10-90 days

Painless ulcer

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24
Q

Secondary Syphillis occurs ___ after chancre and presents with a ___

A

4-8 wks

Low grade fever, headache, lymphadenopathy, maculopapular rash on soles and palms and condyloma lata

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25
Q

Tertiary Syphillis appears ___ after initial infection

A

1-20 years

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26
Q

What is tabes dorsalis

A

Posterior column degeneration seen in tertiary Syphillis

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27
Q

treatment of Syphillis can result in acute flulike illness (headache, fever, chills, myalgias) known as ___, which results from ___

A

Jarisch-herxheimer reaction, release of endotoxins by the killed organisms

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28
Q

Criteria of sirs

A
  • temp below 36 or over 38
  • tachypnea >20 breaths per minute
  • tachycardia
  • leukocytosis or leukopenia
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29
Q

Uncomplicated malaria can be treated with

A

Chloroquine

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30
Q

In cases of p vivax, p ovale or unknown species, how do you treat malaria

A

Chloroquine plus primaquine

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31
Q

Ppx against chloroquine resistant malaria

A

Atovaquone-proguanil

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32
Q

Tx of neutropenic fever

A

Empiric antibiotic therapy with anti-pseudomonal agent (cefepime, pip-tazo)

Admit if high risk

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33
Q

Most common causes of otitis externa (swimmers ear)

A

Pseudomonas and enterobacter

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34
Q

Pain with movement of the tragus/pinna, think

A

Otitis externa

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35
Q

Infective endocarditis in an iv drug user is due to

A

S aureus

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36
Q

Infective endocarditis in pts just having undergone dental procedure is due to what bug

A

Strep viridans

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37
Q

S bovis endocarditis is associated with

A

Gi malignancy

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38
Q

Presentation of endocarditis

A 
From Jane
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail hemorrhage
Emboli
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39
Q

Noseptate dangerous fungi

A

Mucormycosis

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40
Q

Most common organism for osteomyelitis? How about in scd pts?

A

Normally s aureus

For scd salmonella

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41
Q

Long standing chronic osteomyelitis with a draining sinus may lead eventually to

A

Squamous cell carcinoma (marjolin ulcer)

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42
Q

Labs in acute rheumatic fever

A

High esr and Crp

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43
Q

Clinical features of acute rheumatic fever

A 
Jones
Joints
Carditis
Nodules (subcutaneous)
Erythema marginatum
Sydenham chorea
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44
Q

Demographic in acute rheumatic fever

A

Age 5-15, girls>boys

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45
Q

Condylomata acuminata are caused by

A

Hpv

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46
Q

Verrucous papilliform lesions that are pink or skin colored

A

Condylomata acuminata

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47
Q

Preseptal cellulitis is usually due what

A

Break in periorbital skin eg abrasion or insect bite

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48
Q

Orbital cellulitis is an infection of what space

A

Space posterior to orbital septum

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49
Q

How can preseptal cellulitis be differentiated from orbital cellulitis

A

Preseptal cellulitis does not have:

  • painful or impaired eom
  • proptosis (no orbital fat involvement)
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50
Q

Inability to extend neck and widened prevertebral space in a kiddo suggests a diagnosis of

A

Retropharyngeal abscess

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51
Q

Name three viruses that can cause thrombocytopenia

A

Ebv
Hep c
Hiv

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52
Q

all pts with presumed itp should be tested for what viruses

A

Hiv and hep c

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53
Q

If preggo has hep c what should you do

A

Give hep a and b vaccines ; ribavirin is teratogenic

54
Q

Most common viruses causing myocarditis (2)

A

Coxsackie b and adenovirus

55
Q

Viral prodrome preceding worsening resp distress from acute left heart failure and pulm edema, possibly with a holosystolic murmur and hepatomegaly. Think

A

Viral myocarditis

56
Q

Treatment of viral myocarditis

A

Supportive measures eg diuretics and inotropes

57
Q

What is asymptomatic bacteruria

A

Growth of > 10,000 colony units from a clean catch without uti sx

58
Q

First line treatments for asymptomatic bacteriuria

A

Cephalexin, augmentin, nitrofurantoin

59
Q

Bactrim is ___ in first tri and ___ in second tri

A

Contraindicated

Safe

60
Q

Fluoroquinolones are __ in preg

A

Contraindicated

61
Q

What age do you get mmr

A

1 and 4

62
Q

Measles is spread by

A

Respiratory particles

63
Q

Tx of Lyme dz in preggos and kids under 8

A

Amoxicillin

64
Q

Do you get fever and leukocytosis with osteomyelitis

A

Sometimes not always

65
Q

Are most cases of vertebral osteo chronic and insidious

A

Yes

66
Q

Old man with mild leukocytosis, and bilateral diffuse reticular infiltrates on cxr likely has pneumonia due to

A

Influenza

67
Q

Old man with sig leukocytosis, high fever and lobar infiltrates on cxr likely has pneumonia due to

A

S pneumo, s aureus or pseudomonas

68
Q

Parvo presents with __ arthralgias in adults

A

Symmetric polyarticular

69
Q

Positive anti-hbs and negative all other hep b markers means

A

Person has been immunized against hep b

70
Q

Tic that causes flu-like sx, anemia, thrombocytopenia, dark urine, increased bili/ldh/lfts

A

Babesiosis

71
Q

Causes of meningitis in babes under three months (4)

A

GBs
E Coli
Listeria
Hsv

72
Q

Causes of meningitis in kids 3 months to 10 years

A

S pneumo

N meningitidis

73
Q

Causes of meningitis in Children over eleven

A

N meningitis

74
Q

Fever headache focal neuro deficits and seizure, plus rfs of congenital heart disease and or recurrent sinusitis. Think

A

Brain abscess

75
Q

Sporotrichosis is due to ___ infection

A

Fungal

76
Q

How do you treat Syphillis in a pt with a penicillin allergy

A

Doxy

77
Q

Is cmv retinitis painful?

A

No

78
Q

Fundoscopy in cmv retinitis shows

A

Fluffy/glandular retinal lesions near retinal vessels and associated hemorrhage

79
Q

Describe presentation of mumps

A

Viral infection that presents with fever and parotitis after nonspecific prodrome in school aged children.

80
Q

Two complications of mumps

A

Aseptic meningitis and orchitis

81
Q

How do you rule out septic arthritis

A

Synovial fluid analysis

82
Q

Bartonella is gram __ and is seen with ___ stain

A

Negative

Warthrin starry stain

83
Q

Presentation of cat scratch disease

A

Fever
Regional lymphadenopathy esp in axilla or groin
Localized papules or nodular skin lesion

84
Q

Tx of cat scratch disease

A

Usually self limiting but can be treated with azithromycin

85
Q

Most common causes of pneumonia in copd (2)?

A

H flu and klebsiella

86
Q

Are s pneumo, s aureus and h flu encapsulated

A

Yes

87
Q

Can you give neonates ceftriaxone? Justify

A

No

Risk of biliary sludging and kernicterus

88
Q

Tx of confirmed chlamydia

A

Azithromycin

89
Q

Tx of confirmed gonorrhea

A

Azithro + cef

90
Q

Cysts, msm, liver abscess and ruq pain think

A

Entamoeba histolytica

91
Q

Anchovy paste consistency of liver abscess. What am I?

A

Entamoeba histolytica

92
Q

Dx of entamoeba histolytica

A

Trophozoite with endocytosed rbcs on stool o&p

93
Q

Tx of entamoeba histolytica

A

Metronidazole

94
Q

Pertussis is associated with ___cytosis

A

Lymphocytosis

95
Q

Catarrhal phase of pertussis sx

A

Injected conjunctiva and lacrimation

96
Q

What causes whooping cough

A

Pertussis

97
Q

Tx of pertussis

A

Azithromycin

98
Q

Pertussis vaccine is what kind of vaccine

A

Acellular

99
Q

Pneumocystis pjiroveci is associated with cd count under

A

200

100
Q

What kind of pneumonia does Pneumocystis pjiroveci cause

A

Diffuse interstitial causing dyspnea and fever but not productive cough

101
Q

What do you see on cxr in Pneumocystis pjiroveci

A

Sometimes nothing otherwise ground glass infiltrate with crushed ping pong balls

102
Q

Dx of Pneumocystis pjiroveci

A

Bronchoalveolar lavage then methamine silver stain

103
Q

Ppx against and tx of Pneumocystis pjiroveci

A

Bactrim or pentamidine

104
Q

How many doses of vzv vaccine do you need

A

Two

Age 1 and 4

105
Q

If you suspect endocarditis what do you do

A

Serial blood cultures BEFORE starting antibiotics

106
Q

HbsAg indicates

A

Antibody to hbsag; immunity (eg immunized)

107
Q

What does IgM HBcAb indicate

A

Antibody to hbcag; igM positive in window period between when antigen disappears and antibody arrives

108
Q

What does IgG HBcAb indicate

A

Indicates prior or current hep B infection

109
Q

HBsAb and HBcAb positive means

A

Person has hep b and is now immune

110
Q

Positive HBsAb and neg HBcAb means

A

Immunized against hep b

111
Q

Pp with solid organ transplants on immunosuppression are at risk for what two opportunistic infections

A

Pcp and cmv

112
Q

Triad of congenital rubella

A

Pda, hearing loss, cataracts

113
Q

What do you see on ct of nec fas?

A

Air in the deep tissue

114
Q

Tx of aspiration pneumonia

A

Anaerobic coverage including metronidazole with amoxicillin, augmentin and clinda

115
Q

Abx for human bite wounds

A

Augmentin

116
Q

Most common bacterial colonization in cf patients under twenty? Over twenty?

A

Under: staph aureus
Over: pseudomonas

117
Q

Who gets legionella pneumonia?

A

Those in the hospital or have traveled (eg cruise)

118
Q

Hyponatremia, diarrhea and pneumonia, think

A

Legionella

119
Q

Dx of legionella

A

Urine legionella antigen

120
Q

Tx of legionella

A

Fluoroquinolone or macrolide

121
Q

Ldh level in pc pneumonia?

A

Very high

122
Q

Pcp is seen in hiv pts with cd4 counts under

A

200

123
Q

Can autoimmune hemolytic anemia and thrombocytopenia be seen in mono pts

A

Yes

124
Q

Can you get a maculopapular rash with ebv

A

Yes, If mistakenly given amoxicillin or ampicillin

125
Q

What is bacillary angiomatosis

A

Friable papules and plaques in immunocompromised pts as a result of Bartonella species, often associated with fever and other systemic sx

126
Q

Types of strep viridans

A

Momms

Mitis
Oralis
Mutans
Sanguinis
Milleri
127
Q

Viral esophagitis is more common than candida esophagitis in pts who have what sx

A

Severe odynophagia (pain with swallowing) but no dysphagia

128
Q

Infant botulism is caused by

A

Botulism spores

129
Q

Food borne botulism is caused by

A

Ingestion of preformed botulinum toxin

130
Q

Can rpr be negative in early Syphillis infection

A

Yes

131
Q

Confirm dx of genital herpes with what test?

A

Pcr

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