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UWORLD-STEP2 (BA) > IM-ID > Flashcards

IM-ID Flashcards

1
Q

What test is used in primary syphilis that has the higher sensitivity (>97%)

A

Treponemal tests (Fluorescent treponemal antibody absorption- FTA-antibodies)

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2
Q

What is the bug and the treatment?

White plaques

A
  • Candidia

- Fluconazole

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3
Q

What is the bug and the treatment?

Large linear ulcers

A
  • CMV

- Ganciclovir

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4
Q

What is the bug and the treatment?

Vesicle and round/ovoid ulcers

A
  • HSV

- Acyclovir

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5
Q

What is the bug and the treatment?

Aphthous ulcer

A

nonspecific canker sore

- for recurrent- use prednisone (if not responding to topical corticosteroids)

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6
Q

Aspiration pneumonia can expose pt with what organisms and the tx

A
  • anaerobic

- clindamycin

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7
Q

foul-smelling sputum

A

anaerobic organisms

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8
Q

periodis febrile paroxysms, nonspecific malaise, headache, N/V, abd pain, myalgia, pallor, jaundice, petechiae, hepatosplenomegaly

A

Malaria

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9
Q

how do you diagnose Malaria

A

-Thin & thick peripheral blood smears

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10
Q

How does one gain protection from Malaria (not including medications) (2)

A
  • Hemoglobinopathies (Hgb S, Hgb C, thalassemia)

- Partial immunity from previous malaria illness

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11
Q

The 5 antimalarial drugs are

A
  • Atovaquone-proguanil
  • Doxycycline
  • Mefloquine
  • chloroquine
  • Hydroxychloroquine
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12
Q

What are the duration of the 3 stages for Lyme disease

A
  • early localization (days-1month)
  • early disseminated (weeks-months)
  • Late (Months-years)
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13
Q

Clinical features for 1st stage (early localization) (5)

A 
Erythema migrans
Fatigue
headache
myalgias
arthralgias
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14
Q

Clinical features for 2nd stage (early disseminated) (5)

A 
Multiple erythema migrans
unilateral/bilateral CN palsy ( CN VII)
Meningitis
Carditis (AV block)
Migratory arthralgias
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15
Q

Clinica features for 3rd stage (late) (3)

A

Arthritis
Encephalitis
Peripheral neuropathy

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16
Q

Tx for Lyme disease

A

Doxcycline

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17
Q

4 bugs that can cause Urethritis in men

A

Neisseria gonorrhoeae (most common)
Chlamydia trachomatis
Mycoplasma genitalium
Trichomonas (rare)

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18
Q

Diagnosis used for Chlamydia trachomatis is

A

Nucleic acid amplification testing

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19
Q

Fever (>102.2), bradycardia related to fever, neurological symptoms, GI symptoms (diarrhea), unresponsive to beta-lactam and aminoglycoside, Cxray patchy infiltrates. Bug?
How do you treat (2)?

A

Legionella pneumophila

Macrolides or fluoroquinolones (levofloxacin)

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20
Q

Lab clue for Legionella PNA (5)

A
  • Hyponatremia
  • hepatic dysfunction
  • Hematuria &
  • proteinuria
  • Sputum gram stain;- many neutrophils and few or no microorganisms
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21
Q

Infective endocarditis due to Eikenella corrodens (gram -) anaerobe is common in what settings (3)

A
  • Poor dentition
  • Periodonal infection
  • dental procedures that manipulation of the gingiva or oral mucosa
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22
Q

Prolonged fever, malaise, exudative pharyngitis, hepatosplenomegaly, generalized lymphadenopathy, hemolytic anemia and thrombocytopenia
Dx? Organism? Diagnostic?

A
  • Infectious mononucleosis
  • EBV
  • antiheterophile antibodies (monospot test), atypical lymphocytes on blood smear, & Coombs test
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23
Q

How to treat toxoplasma encephalitis and ppx?

A

Sulfadiazine and pyrimethamine
- antiviral initiations
and ppx TMP-SMX (CD4<100)

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24
Q

Slowly progressive confusion, paresis, ataxia, and seizure in HIV pt

A

Progressive multifocal leukoencephalopathy (PML)- JC virus reactivation with CD4 <200

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25
Q

The 3 PEP drugs (post-exposure prophylaxis) are

A
  • 2 NRTI ( Tenofovir + Emtricitabine)

- 1 from intergrase inhibitor (raltegravir) or protease inhibitor or NNRTI

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26
Q

Most likely microb to cause infective endocarditis in patients with
Prosthetic valves, intravascular catheters, implanted devices, IV drug users

A

Staphylococcus aureus

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27
Q

Most likely microb to cause infective endocarditis in patients with
Gingival manipulation
Respiratory tract incision or biopsy

A

Viridans group streptococci (S. mutans, S. mitis, S. oralis, S. sanguinis)

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28
Q

Most likely microb to cause infective endocarditis in patients with
prosthetic valves, IV catheters, Implanted devices

A

Staphylococcus epidermidis

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29
Q

Most likely microb to cause infective endocarditis in patients with nosocomial UTI

A

Enterococci

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30
Q

Most likely microb to cause infective endocarditis in patients with colon carcinoma, IBD

A

Streptococcus gallolyticus (S. Bovis)

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31
Q

Most likely microb to cause infective endocarditis in patients with an Immunocompromised host, IV catheters, prolonged antibiotic therapy

A

Fungi (Candida species)

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32
Q

Common causes of diarrhea in pt with AIDS (4)

A
  • Cryptosporidium parvum
  • Microsporidium/Isosporidium
  • Mycobactrium Avium complex (MAC)
  • Cytomegalovirus (CMV)
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33
Q

The organism that causes Hydatid cyst? what is the definite host? what does the lesion look like on CT?

A
  • Echinococcus granulosus
  • Dogs definitive host
  • eggshell calcification
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34
Q

Quick onset (1-6hrs), vomiting predominant. What bug? mechanism of foodborne illness

A
  • Staph aureus & Bacillus cereus (reheated rice)

- Enterotoxin ingestion

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35
Q

Delayed onset (>1day), watery/bloody diarrhea, What bug? mechanism of foodborne illness

A
  • Clostridium perfringens, ETEC/STEC, Vibrio cholera

- Enterotoxin made in intestine

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36
Q

Variable onset, watery/bloody diarrhea, fever, systemic illness, What bug? mechanism of foodborne illness

A
  • Campylobacter Jejuni, nontyphoidal salmonella, Listeria monocytogenes (systemic illness)
  • Bacterial epithelial invasion
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37
Q

Symptoms of UTI, with UA pH of 8.5, with urinary calculi. What is the bug?

A

Proteus mirabilis- urease-producing bacterium

with Struvite stones (mg ammonium phosphate)

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38
Q

Bright red, firm, friable, exophytic nodules in a HIV pt, is? cause? Tx (2)?

A
  • Bacillar angiomatosis
  • Bartonella (hensele/Quintana) (Gram neg bacillus)
  • Oral erythromycin or doxycycline
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39
Q

who are the patient at risk for bartonella exposure?

A
  • cat exposure
  • homelessness (lice)
  • Severe immunocompromise (advanced HIV-CD4<100)
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40
Q

Hx of tick bite, febrile illness with symptomatic symptoms, leukopenia and or thrombocytopenia, elevated aminotransferases and rash with pt in endemic region. What is the bug?

A

Ehrlichia chaffeensis and E ewingii- Enhrlichiosis

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41
Q

Tx for uncomplicated acute pyelonephritis (2)

A
  • Oral fluoroquinolone

- Trimethrprim-Sulfamethoxazole

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42
Q

Tx for complicated acute pyelonephritis (3)

A
  • IV fluoroquinolone
  • Aminoglycoside
  • Extended spectrum beta-lactam/cephalosporin
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43
Q

indolent headache, malaise, fever, persistent dry cough, pharyngitis (nonexudative), macular/vesicular rash. Bug?

A

Mycoplasma pneumoniae

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44
Q

dx for Mycoplasma pneumonia (3)

A
  • Normal leukocyte count
  • Subclinical hemolytic anemia (Cold agglutinins)
  • Interstitial infiltrate (Cxray)
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45
Q

Tx for Mycoplasma pneumonia (2)

A
  • Macrolide or respiratory fluoroquinolone
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46
Q

Headache, malaise, fever, exudative pharyngitis/tonsillitis, lymphadenopathy and splenomegaly. Bug?

A

Epsten-Barr virus (Infectious mononucleosis)

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47
Q

-Ingestion of undercooked meat (pork),
-from Mexico, china, Thailand, central Europe and Argentina
- Gastric acid releasing larvae (1 wk of ingestion) that invade small intestine and develop into worms
- Female worms release larvae that migrate and encyst in striated muscle
Bug?

A

Trichinellosis

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48
Q

Clinical presentation for Trichinellosis (8)

A
  • abd pain,
  • N/V,
  • diarrhea
  • Myositis
  • fever,
  • subungual splinter hemorrhages
  • Periorbital edema
  • Eosinophilia
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49
Q

An HIV patient should get HAV vaccine when? (3)

A
  • Chronic liver disease (including HBV and HCV)
  • Men who have sex with men
  • IV drug users
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50
Q

An HIV patient should get HBV vaccine when?

A

All patient without documented immunity to HBV

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51
Q

An HIV patient should get HPV vaccine when?

A

All pt age 11-26

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52
Q

An HIV patient should get Influenza vaccine when?

A

Annually for all pt (inactivated formulation)

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53
Q

An HIV patient should get meningococcus (serogroups A, C, W, Y) vaccine when?

A

All patients

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54
Q

An HIV patient should get pneumococcus vaccine when? which one? (2)

A
  • PCV13 once

- PPSV23 8 weeks later, 5 years later & at age 65

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55
Q

An HIV patient should get Tdap vaccine when? (2)

A
  • Tdap once (repeat with each pregnancy in women)

- Td every 10 years

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56
Q

Which live vaccines are contraindicated if CD4 <200? (3)

A
  • MMR
  • Zoster
  • Varicella
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57
Q

Who do you treat HIV pt with progressive disseminated histoplasmosis

A

Amphotericin B

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58
Q

Acute symmetric arthritis of the hands, knees and ankle joints, Bug? Dx?Tx?

A
  • Parvovirus B 19
    Anti-parvovirus B19 IgM
    -self-limiting
59
Q

Transient Pure red cell aplasia in pt with Sickle cell anemia

A

Parvovirus B 19

60
Q

Fever, Nausea and rash (slapped check)

A 
Erythema infectiousm (fifth disease)
Parvovirus B 19
61
Q

After your remove a tick with forceps/tweezers when do you prophylaxis for Lyme disease? It must meet all 5

A
  • if >36hrs attached
  • Ppx with in 72hr of tick removal
  • No contraindication to doxycycline (pregnant or lactating)
  • Attached tick is an adult or nymphal/Ixodes scapularis (deer tick)
  • Local Borrelia burgodorferi infection rate >/= 20%
62
Q

What are the work up needed for PCP (pneumocystic jiroveci PNA) (3)

A
  • elevated LDH level
  • Diffuse reticular infiltrates on imaging
  • Induced sputum or BAL (stain)
63
Q

Tx for PCP (pneumocystic jiroveci PNA) (2)

A
  • TMP-SMX

- Prednisone if low oxygen level

64
Q

Ppx for PCP (pneumocystic jiroveci PNA) in HIV pt

A
  • TMP-SMX

- Antiretroviral

65
Q

HIV pt with subacute cough and a cavitary, inflammatory upper lung lesion is likely to be

A

reactivataion TB

66
Q

which bacterial likes to infect the lung apices due to high oxygen tensions and slower lymphatic elimination

A

Mycobacterium TB- causing reactivation TB at the site of latent infection (apical lobes)?

67
Q

PPD testing is duration is __ for HIV pt

A

> /= 5mm at 48-72hrs

68
Q

The most common behavioral risk factor for TB in USA is

A

Substance abuse

69
Q

Diffused reticulonodular pattern on xray on HIV pt, with extrapulmonary disease in the lymph nodes, liver, bones and central nervous system

A

Miliary TB

Millet seed seen on cxray

70
Q

frequent small volume diarrhea, hematochezia, abd pain, low-grade fever, weight loss in HIV pt. Bug?

A

cytomegalovirus, CMV

71
Q

electric sensation that runs through the back and into the limbs. Name? Dx?

A
  • Lhermitte’s phenomenon/barber chair phenomenon

- Multiple sclerosis

72
Q

HIV pt, fever, cough, abd pain, diarrhea, night sweats, wt loss, CD4 <50. Dx? Tx(2)?

A

Mycobacterium avian complex (MAC)

Azithromycin (can be used ppt) and clarithromycin

73
Q

Two genital ulcers that are painful

A
  • HSV

- Haemophilus ducreyi (Chancroid)

74
Q

Two Genital ulcers that are painless

A
  • Treponema Pallidum (Sypilis)

- Chlamydia trachoma’s servers L1-L3 (lympogranuloma venereum)

75
Q

Small, shallow genital ulcer-can progress to painful, fluctuant adenines (buboes)

A

Chlamydia trachoma’s L1-L3

76
Q

Single ulcer, regular borders and hard base

A

Syphilis (chancre)

77
Q

Action and SE of Levodopa + Carbidopa

A
  • Dopamine precursor
  • Somnolence, confusion, hallucinations, Dyskinesia, dizziness, headache, agitations
    After many years of therapy- Involuntary movements
78
Q

Small pruritic vesicles or ulcers on erythematous base

Mild lymphadenopathy? Tx?

A

HSV

Acyclovir

79
Q

slowly progressive, non painful, indurated mass around the submandibular, sinus tracts with sulfur granules, thick yellow discharge, fever/lyphadenopathy
Dx? Tx?

A

Actinomyces

Penicillin 2-6 months , if sever surgery

80
Q

Filamentous gram+ rods with rudimentary branching

A

Actinomyces

81
Q

3 risk factors for Rhino-orbital-cerebral mucormycosis

A
  • DM (ketoacidosis)
  • Hematologic malignancy
  • Solid organ or stem cell transplant
82
Q

Treatment of r mucormycosis (Rhizopus) (2)

A
  • Surgical debridement

- Liposomal amphotericin B

83
Q

Sudden-onset server, stabbing pain along the V2 (maxillary) and V3 (mandibular) area. Dx? mechanism

A 
Trigeminal neuralgia (usually unilateral and bilateral if it is with MS)
- Demyelination of the nerve nuclei
84
Q

Triad of tenosynovitis, dermatitis ( papule and pustules), asymmetric migratory polyarthralgias
or
- Purulent monoarthritis

A

Disseminated gonococcal infection

Neisseria gonorrheae

85
Q

The most common secular transmitted disease causing septic arthritis

A

Disseminated gonococcal infection

86
Q

Tx for viral (HSV) encephalitis

A

IV acyclovir

87
Q

Culture media used for cryptococcal

A

Sabouraud agar

88
Q

Tx for cryptococcal meningoencephalitis (2)

A

Amphoteric B with flucytosine (Initial)

Fluconazole (maintenance)

89
Q

Common fungus in south/south-central states, Mississippi and Ohio river valleys, upper midwest states, great lakes step and Canadian provinces

A

Blastomycosis

90
Q

low grade fever and violacoeous skin lesions with scrapings showing yeast, progressing to micro abscess

A

balstomyces dermatiditis

91
Q

sore that, fever, muffled voice, drooling, stridor, and hoarseness

A

Infectious epiglottis (H Influenze type B)

92
Q

Which microbiology gives those infective endocarditis associations?

Prosthetic valves
IV catheter
Implanted devices
IV drug users

A

Staphylococcus aureus

93
Q

Which microbiology gives those infective endocarditis associations?
Gingival manipulation
Respiratory tract incision or biopsy

A

Viridans group streptococci

94
Q

Which microbiology gives those infective endocarditis associations?
Prostatic valves
IV catheters
Implanted devices

A

Staphylococcus epidermidis

95
Q

Which microbiology gives those infective endocarditis associations?
Nosocomial UTI

A

Enterococci

96
Q

Which microbiology gives those infective endocarditis associations?
Colon carcinoma
Inflammatory bowel disease

A

Strptococcus gallolyticus (S. Bovis)

97
Q

Which microbiology gives those infective endocarditis associations?
Immunocompromised host
IV catheters
Prolonged antibiotic therapy

A

Fungi (Candida species)

98
Q

Tropical/Subtropical parts of central/south America, Africa, and Asia
A Aedes mosquito (that transmits dengue and Zika)

A

Chikungunya fever

99
Q

Sever polyarthralgias, high fever, headache, myalgia, conjunctivitis, maculopapular rash, lymphopenia, thrombocytopenia, transaminitis

A

Chikungunya fever

100
Q

Solid organ transplantations getting high-dose immunosuppressive medication are at risk for which two opportunistic infections?

A
  • Pneumocystis pneumonia (PCP)

- Cytomegalovirus (CMV)

101
Q

Systemic illness involving in patient with HIV/ Solid organ transplant with multiple organ systems symptoms like Pneumonitis, hepatitis, and GI-diarrhea should be tested for

A

CMV viremia

102
Q

Abx used for lung abscesses, skin and soft-tissue infections, female URT infections- covers Gram+ and anaerobes

A

Clindamycin

103
Q

Human bites have what kind of microbes? Tx?

A
  • both aerobic and anaerobic

- Amoxicillin-Clavulanate (Augmentin)

104
Q

fatigue, elevated transaminases, arthralgia, and kind findings with recurrent blisters on back of hand and forearm

A

Chronic hepatitis C infection with porphyria cutanea trarda (PCT)

105
Q

HCV is strangely associated with

A

PCT (porphyria cutanea tarda)

106
Q

Endemic mycosis of the desert southwest that causes community-acquried pneumonia,
often accompanied by arthralgia, erythema nodosum, and erythema multiforme.
Tx?

A
  • Coccidioides

- Ketoconazole or fluconazole

107
Q

Wt loss, fever, night sweats, Cxray- alveolar infiltrates and nodules with cavitation, immunocompromised host, finding on culture Gram+, partially acid-fast, filamentous, branching rods
Dissemintated disease include lung, brain and skin. Dx?
Tx?

A

Nocardia

- Trimethoprim-Sulfamethoxazole

108
Q

When is one time PPSV23 alone recommended as a one time vaccine?

A

For adults <65, current smokers or

other conditions hearth or lung disease, DM, chronic liver disease

109
Q

When is the PCV13 vaccine recommended

A

adults age > 65 followed by the PPSV23 at least 6-12 months later

110
Q

Health care workers without previous HB vaccination or adequate antibody response, exposed to blood from HB patients should receive post-exposure prophylaxis with

A

-get complete HB vaccine series
1st dose within 12hrs
next doses with standard schedule
-Also they need to receive HB immune globulin as soon as possible (<24hrs)

111
Q

Endomic to the nerowastern US, erythema migrant, carditis(AV block), and neurologic manifestations

A

Lyme disease

- Spirochete Borrelia burgdorferi

112
Q

Skin infection of the upper dermis and superficial lymphatic system? Cause?

A

Erysipelas

group A Streptococcus

113
Q

Individual with high-risk sexual intercourse should be screened for 2 viruses

A

HBV and HIV

114
Q

Individual with use injection drugs, high-risk needle stick exposure or received blood transfusion before 1992 should be screened for what virus

A

HCV

115
Q

electric sensation that runs through the back and into the limbs. Name? Dx?

A

Lhermitte’s phenomenon/barber chair phenomenon

-Multiple sclerosis

116
Q

When overheated and elevated boy temperature worsts neurological symptoms (blurry or reduced vision…)Name?Dx?

A

Uhthoff’s phenomenon

-MS

117
Q

The 4 disease pattern of MS are

A
  • Relapsing-remitting
  • Primary progression
  • Secondary progressive
  • Progressive relapsing
118
Q

Diagnostic for MS (2)

A
  • T2 MRI lesions

- Oligoclonal IgG bands

119
Q

What part of the brain is affected in MS that is seen in MRI?

A
  • Periventricular
  • Juxtacortical
  • Infratentorial
  • Spinal cord
120
Q

What type of gait disturbance does parkinsonism has

A

Shuffling gait

hyperkinetic gait

121
Q

Action and SE of Levodopa + Carbidopa

A
  • Dopamine precursor

- Somnolence, confusion, hallucinations, Dyskinesia

122
Q

Action and SE of Trihexyphenidyl/benztropine

A
  • Anticholinergic

- Dry mouth, blurred vision, constipation, Nausea and urinary retention

123
Q

Action and SE of Amantadine

A
  • Unclear mechanism

- Ankle edema and Lived reticulates

124
Q

Action and SE of

Apomorphine, bromocriptine, pramiperxole, ropinorole

A
  • Dopamine agonist

- Somnolence, hypotension and confusion, hallucinations

125
Q

Action and SE of Entacapone or tolcapone

A
  • COMPT inhibitor

- Dyskinesia, hallucinations, confusion, nausea, orthostatic hypotension

126
Q

Action and SE of Selegiline

A
  • MAO B inhibitor

- Insomnia and confusion

127
Q

Sudden-onset server, stabbing pain along the V2 (maxillary) and V3 (mandibular) area

A

Trigeminal neuralgia (usually unilateral and bilateral if it is with MS)

128
Q

Improperly canned foods (fruits and veg), aged seafood (cured fish), cause of the food borne disease

A

Clostridium botulism

129
Q

-bilateral cranial neuropatheis, systemic descending muscle weakness, diaphragmatic weakness with respiratory failure

A

C. Botulisnum toxin

130
Q

Tx of food-borne Botulism

A

Equine serum heptavalent botulism antitoxin

131
Q

A brain dead person can have with central nervous system activities

A

Deep tendon reflexes

132
Q

What are the two types of hearing loss

A

Sensorineural

Conductive

133
Q

Disorder involving the inner ear, cochlea, or auditory nerve

A

Sensorineural hearing loss

134
Q

any cause that limits sound from gaining access to the inner ear

A

Conductive hearing loss

135
Q

The 5 sensorineural hearing loss disorders are

A
  • Presbycusis
  • Meniere disease
  • Barotrauma
  • Acoustic neuroma
  • Cerebrovascular ischemia
136
Q

The 5 causes of conductive hearing loss are

A
  • Otitis external or media
  • Cholesteatoma
  • Trauma
  • Cerumen
  • Tympanic membrane perforation
137
Q

Progressive bilaterally symmetric and predominantly high frequency sensorineural hearing loss that occurs over many years, tinnitus

A

Presbycusis (age related hearing loss)

138
Q

What part tract in the UMN does pronator drift examine?

A

Pyramidal/corticospinal tract

139
Q

The 5 abortive Migraine therapies are

A
  • Triptans (sumatriptan)
  • NSAIDS (naproxen)
  • Acetaminophen
  • Antiemetics (metoclopramide, prochlorperazine)
  • ergotamine (dihydroergotamine)
140
Q

The 4 preventives Migraine therapies

A
  • Topiramate
  • Divalproex sodium
  • Tricyclic antidepressants
  • Beta-blockers (propranolol)
141
Q

Pt with lacunar stroke presents after weeks with paroxysmal burning pain over the affected area when light touched. Dx?

A

Thalamic pain syndrome

142
Q

Allodynia

A

burning pain with light touch

143
Q

Weakly ring-enhanced periventricular mass on MRI of HIV patient with EBV DNA in the CSF

A

Primary CNS lymphoma

144
Q

Hx of HTN, HLD, DM2, sever dizziness, systolic bruit at the base of the neck above the clavicle on the Left side, 4th heart sound heard. cause and Dx?

A

Subclavian artery occlusion

Subclavian steal syndrome

UWORLD-STEP2 (BA) (19 decks)

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