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USMLE step3 > infection > Flashcards

infection Flashcards

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USMLE® Step 1 flashcards
1
Q

catheter removal indication in catheter-related blood stream infection

A

severe sepsis
hemodynamic instability
evidance of metastatic infection
pus at the exit site f the catheter
continued symptoms after 72 hours of empiric therapy
long term more than 14 days ; if the blood culture is s aureus , Pseudomonas or fungai

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2
Q

Lyme disease

A

erythema migrans < fatigue headache and myalgia and arthralgia,

erly disseminated; erythema migrans, unilateral or bilateral cranial nerve palsy( like & (looks like bells palsy)
meningitis, carditis migratory arthralgia,
late; arthritis encephalitis and peripheral neuropathy

arthritis ( 20,000 neut ( vs bacterial def more than 50,ooo)

28 days of doxycycline and you are disease free

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3
Q

cryptococal meningitis treatment

A

induction : amphotericin B and flucytosin for two weeks antiviral after this phase)
consolidation ; high dose oral fluconazole for 8 weeks;
maintenance ; low dose fluconazole for more than a year

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4
Q

therapy for necroziting fasciatis

A

Ab start surgery
piperacilin azobactam or imipenem + vanco+clinda (for toxins)

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5
Q

ART treatment and viral load

A

4 weeks less than 5000
8-12 weeks less than 500
16-24 less than 50

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6
Q

low and high clostrdiodes difficile infection AB

A

high; fluoroquinolones , clinda, 3-4 cephal, carbapenem, monobactam

low : cotri, macrolides tetra amino

we can change the AB and extend it till the end of other AB therapy

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7
Q

lyme and pregnancy

A

no congenital is reported , amoxicilin is the drug of choice and for 14-21 days

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8
Q

cat scratch disease treatment

A

azthro

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9
Q

corticosteroid use in pneumonia (PCP ) patients

A

A-a gradiant lmore than 35 or Pa O2 less than 70

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10
Q

breast feeding and doxy

A

no

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11
Q

aspergilosis biomarkers

A

galactomannan, beta d glucan
noduled in imaging ( IMP) with ground glass opacities ( halo sign)
voriconazole for treatment

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12
Q

Hi management in pregnancy

A

viral load montly til undetectable then 3 months
CD4 every 3 mnthes
avoidance of aminocentesis if detectable viral load
avoidance of artificial ROM, scalp electrode, operative vaginal delivery
under 50 art+ vaginal
till 1000 art +zido + vaginal
more than 1000. art + zido+ cesarean

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13
Q

breast feeding contra

A

active untreated TB
HIV
herpetic breast lesions
active VZV
chemo or radiotherapy
active substance use

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14
Q

meningococcal meningitis AB prophylaxis

A

who live in the same house or more than 8 hours within 3 feet, secretions( intubation),
child care workers

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15
Q

ecythema gangrenosum

A

pseudomona , painless red macules rapifly progressive to bullae and then gangrenous ulcers

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16
Q

no treatment for heb b unless

A

INR more than 1.5 or multiple comorbities(hepc and HIV) prolonged ( more than 4 weeks)

17
Q

latent tb treatment

A

isoniazid 609 months
rifampine 4 months or
riphampine +izoniazide 3 months

18
Q

cystic fibrosis

A

CFTR gene
AR
recurrent sinopulmonary inf
intestinal obstructions
pancreatic insufficiency and diabetes
male infertility
elevated sweat chloride
abnormal nasal potential difference
nutritional support
airway clearance
AB(staph and pseudo)

19
Q

VZV IG and Vaccine

A

if vaccine 2 dose then ok
if not if immunosuppressive we give variIVIG but if not only vaccines

20
Q

left apical ventricular aneurysm

A

chagas

21
Q

drug resistance fosfomycine vancomycin and penicilin and cephalosphorins

A

fosfomycin; nam nag that inhibits mura : efflux pump or alterations to mura that prevent binding
vanco; d alanin : d lactate
pen and cephal; production of penicilinase ( beta lactam binding )
tetra : eflux or altrations to the ribosome ( binding site)

22
Q

vaccines for HIV infections

A

HAV,HBV,HPV,influanza<(inactivated),meningococcal( all 11-18 and people living in military collages and asplenia)
pneumococ:PCV20, PCV15 follow by PPSV23
Tdap

contra( MMR, LIVE, under 200)

23
Q

serum sickness like reaction

A

immune complex formation
AB( beta lactamn sulfa)
acute hepatitisB IMP

1-2 week after exposure
fever skin rash polyarthralgia
supportive
and steroids and plasmapheresis if very severe

24
Q

syphilis treatment

A

primary or secondary or early latent ; 2.4 im pen
latent more than 12 2.4 benz pen weekly *3

neuro ; 3-4 aqueous pen every 4 hours for two weeks

congenital; aqueous pen 50.000/kg every 8 hr for 10 days

25
Q

when to give AB to patients with diarrhea and ..

A

high risk features: bloody or high dose fever, sever disease hospitalized, elderly, immunocompromised, diarrhea more than 7 days

then we do stool stud ; if there was a inflammatory inf that is not shigatoxin producing then we can give AB

26
Q

complications of diftheria

A

toxic mediated myocarditis , neuritis, kidney disease

27
Q

lyme what to do

A

treat with clinical diagnosis, it can cause bilateral cranial nerve palsy ( like 7) it can be like bells pals

28
Q

pneumonia treatment

A

inpatient ; levo or cef + azithro
ICU : cef + azithro or cef+ levo
outpatient; amoxi or doxy +or- macrolide

29
Q

giardias treatmnet

A

tinidazole or nitazoxanide , metronidazole for children

30
Q

adult vaccines

A

Tdap every 10 after 19
influenza after 19
herpes zoster after 50 2 dose at least 2 month apart
more than 65 pneumo either one 20 or 15+23(after 1 year)

under 65 either 20 or 15 +23(after 8 weeks)

31
Q

HIV and one chronic inflamatory disease

A

after a while IRIS(immune reconstition inflammatory sundrome) fever and worsend symptomes(like in TB) nothing to be done

32
Q

skin papules with central umbilicatio+HIV+hepatosplenomegalyand reticuloendotheliail systme maybe respiratory symptomes

A

cryptocucus neoformans

33
Q

neurosyphlis

A

early: meningitis , ocular; posterio uveitis (most common), decreased visual acuity, ogen with meningitis,
meningocular

late; general paresis . Progressive dementia, tabes dorsalis ; posterio column, pipillary defect, may have normal CSF

34
Q

antiviral therapy for influanza

A

under 48 hours
more than 65 years
pregnant to postpartum
chronic disease(cardiovascular, chronic pulmonary, renal ,hepatic,
immunosuppressed
morbidly obese
residents of nursing home or long term facilities

35
Q

tb drugs adverse effect

A

rifampin(dna dependent rna polymerase); gastro, rash , red and orange body fluids, cytopenia,

isoniazide*mycolic acid synthesis); neurotoxicity (B6 pyridoxine) hepatotoxicity ,
pyrazinamide(unclear); hepatotoxicity and hyperuricemia

ethambutol (inhibition of arabinosyl transferase; optic neuropathy

36
Q

Complications of mouth hanf foot disease

A

myopericarditis , aseptic meningitis, nail dystrophy

37
Q

dengue fever

A

flu-like symptoms, pre orbital pain, diffuse maculopapular rash, leukopenia, positive tourniquet test (petechia after sphygmomanometer cuff inflation for 5 min),

warning signs, abdominal pain persistent vomiting, fluid accumulation, mucusal bleeding, lethargy or restlessness, hepatomegaly more than 2 CM, increased hematocrit with rapidly decreasing platlate count

progression: shock , respiratory distress, sever bleeding, sever organ involvement ( last alt , impaired consciousness, organ failure)

38
Q

chemoprophylaxis

A

Atovaquone- proguanil

Expensive,Gl disturbance (eg, abdominal pain), 1 liver function tests

Doxycycline Inexpensive Gl disturbance, sun sensitivity, teratogenic

Mefloquine,Neuropsychiatric effects Agent of choice in pregnancy

Weekly dosing

Areas with chloroquine- ine- susceptible P falciparum (in addition to options above)

Chloroquine, hydroxychloroquine, Need to be started 1-2 weeks in advance, Potential exacerbation of some skin conditions

Areas without P falciparum (parts of South America, Mexico, Korean peninsula)

Primaquine, Potential teratogenicity, Hemolysis in patients with G6-PD deficiency

39
Q
A

USMLE step3 (17 decks)

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