Infectious disease Flashcards
1
Q
What is the most common organism that causes of osteomyelitis?
A
S. aureus
2
Q
What is the most common organism that causes of pyelonepritis?
A
E. Coli
3
Q
When does S. epidermis causes infection?
A
- catheter placement
- prosthetic valves
- dialysis
4
Q
What is the initial treatment for MRSA infections?
A
Vancomycin (can used linezolid as second line)
5
Q
What type of disease is associated with Strep viridans infection?
A
Endocarditis
6
Q
What is the initial treatment for MSSA and Strep?
A
penicillinase-resistant penicillins (oxacillin, cloxacillin, dicloxacillin, naficillin)
7
Q
What are the 1st generation cephalosporin?
A
- cefazolin
- cefadroxil
- cephalexin
8
Q
If pt develops rash with penicillin, what is the next treatment option for Staph and Strep infection?
A
1st or 2nd generation cephalosporin
9
Q
What are the 2nd generation cephalosprin?
A
- cefoxitin
- cefotetan
- cefuroxime
- cefprozil
- loracarbef
10
Q
If pt develops anaphylaxis, what is the next treatment option for Staph and Strep infections?
A
- macrolide, clindamycin or fluoroquinolones (if mild)
- vancomycin, linezolid or daptomycin (if severe)
(Avoid B-lactams: pencillin, cephalosporin, monobactam, carbepenems)
11
Q
What are effective antibiotics for gram negative rods?
A
- 3rd and 4th generation cephalosporin
- quinolones (ciprofloxcin for pseudomonas)
- aminoglycosides (gentamicin)
- aztreonam
- carbapenems
12
Q
What are the 3rd generation cephalosporins?
A
- ceftazidime
- cefotaxime
- ceftriaxone
- cefoxtamine
13
Q
What is the 4th generation cephalosporin?
A
cefepime
14
Q
What is the initial best treatment for anaerobic gram negative bacteria below the diaphragm?
A
Metronidazole
15
Q
What is the initial best treatment for anaerobic gram negative bacteria above the diaphragm (pneumonia)?
A
Clindamycin
16
Q
When should doxycycline be used as treatment?
A
- chlamydia
- rickettsia
- early lyme disease (rash)
17
Q
When should Bactrim be used as treatment?
A
- PCP
2. uncomplicated cystitis
18
Q
What is the most common cause of meningitis in pts older than neonatal age?
A
Strep pneumoniae
19
Q
What is the most common cause of meningitis in adolescents?
A
Neisseria meningitidis
20
Q
What organism is associated with meningitis in HIV pt?
A
Cryptococcus neoformans
21
Q
What organism is likely to cause meningitis in a pt with hx of neurosurgery?
A
S. aureus
22
Q
What is the most common cause of meningitis in neonates?
A
Group B Strep (Strep agalactiae)
23
Q
What is the most common long term neuro complication of bacterial meningitis?
A
8th cranial nerve deficit
24
Q
A pt presents with fever, photophobia, headache, photophobia and nuchal rigidity most likely suffers from …
A
meningitis
25
A pt presenting with pulmonary symptoms and meningitis most likely suffers from ...
TB associated meningitis
26
A pt presenting with petechial rash and meningitis most likely suffers from ...
Neisseria meningitidis
| gram negative diplococci
27
A pt presenting with meningitis and rash on wrists and ankle with centripetal spread toward the body after a pt was in carolinas/kentucky/tennesse most likely suffers from ...
Rocky mountain spotted fever
28
What medications can be used for influenza?
1. oseltamivir
2. zanamivir
(given w/in 48 hour of onset of symptoms to decrease duration)
29
Medications ending with "avir" are used to treat ..
AIDS (HIV)
30
Medications ending with "ovir" are used to treat ..
Herpes
| "O" shit i have herpes
31
A pt presenting with meningitis, facial nerve palsy, target lesions with hx of being in massachusetts/ connecticut most likely suffers from ...
Lyme disease meningitis
32
When should a head CT be done before a lumbar puncture?
1. papilledema
2. focal motor deficits
3. new onset seizures
4. altered mental status
33
A pt presents with fever, headache and confusion (altered mental status) most likely suffers from ...
Encephalitis
34
A pt presents with fever, headache and focal neuro deficits most likely suffers from ...
Brain abscess
35
What is the best initial test for meningitis if head CT does not need to be done?
lumbar puncture
36
What is the best initial test for Cryptococcus neoformans?
India ink stain of CSF
37
What is the most accurate test for Cryptococcus neoformans?
serum and CSF cryptococcal antigen titer
38
What is the empiric therapy for bacterial meningitis?
vancomycin and ceftriaxone
| add ampicillin if suspect Listeria- neonate or elderly
39
What is the best treatment for Cryptococcus neoformans meningitis?
amphotericin intially; then fluconazole with HAART
40
What is the best treatment for Lyme meningitis?
Ceftriaxone
41
What is the best treatment for neurosyphilis?
high dose IV penicillin
42
What is an important adjunct therapy used with antibiotics for bacterial meningitis to decreased morbidity?
Steroids (dexamethasone 15-20 minutes prior to abx administration and with administration)
43
What is the most common cause of encephalitis?
HSV-1 (herpes) encephalitis
44
What is the best initial treatment for herpes encephalitis?
IV acyclovir
45
What area is predominantly affected by herpes encephalitis?
temporal lobes
46
What is the best initial test for a pt presenting with suspected brain abscess?
CT scan with contrast (ring enhancing lesion)
47
What are the two causes of brain abscesses in HIV pt?
1. Toxoplasmosis (respond to tx)
| 2. Lymphoma
48
What is the best initial treatment for brain abscess in HIV pt?
pyrimethamine and sulfadiazine (if respond after 10-14 days, then toxoplasmosis as cause)
49
What is the treatment for rocky mountain spotted fever?
doxycycline
50
A pt presents with ear pain, fever, decreased hearing and red, bulging tympanic membrane with limited mobility most likely suffers from ... and should be treated with ...
otitis media; amoxicillin
| amoxicillin-clavulanate if recurrent; azithromycin if penicillin allergic
51
When should you treat with antibiotics in a pt presenting with facial pain, headache worse when leaning forward, post-nasal discharge, nasal discharge and sinus tenderness?
viral rhinosinusitis resolves in 7-10 days; abx if last longer or get worse
52
What are the two complications associated with strep throat?
1. rheumatic fever
| 2. glomerulonephitis
53
A pt presents with sore throat, cervical lymphadenopathy and inflammed pharynx with exudative covering most likely suffers from ....
Group A Strep (S. pyogenes); strep throat
54
What is the best initial test for suspected strep throat?
rapid streptococcal antigen (culture if rapid negative)
55
What antibiotics are given to close contacts of pt with neiserria meningitis?
ciprofloxacin or isonazid
| isolate pt
56
What is the initial treatment for strep throat?
penicillin
57
If patient has recurrent infection with neisseria menigitidis, what is the likely underlying cause?
complement deficiency
58
Who should not receive influenza vaccine?
pts anaphylatically allergic to eggs
59
What is the most accurate diagnostic test for herpes encephalitis?
PCR for HSV DNA
60
A pt presents with fever, myalgias, headache, fever and upper respiratory symptoms most likely suffers from....
Influenza
61
A pt presenting with cough, sputum production, low grade fever, clear lungs and normal CXR most likely suffers from ..
(have smoking hx)
bronchitis (inflammation of trachebronchial tube)
62
What are the most common causes of sinusitis and otitis media?
1. Strep pneumoniae (40%)
2. H. influenzae (30%)
3. Moraxella catarrhalis (20%)
63
What is the best initial therapy for a lung abscess?
Clindamycin
64
A pt presents with fever, cough, foul smelling sputum production, chest pain, and weight loss in setting of aspiration risk most likely suffers from ...
Lung Abscess (usually anaerobic)
65
What is CXR finding for a lung abscess?
thick walled cavitary lesion
66
What is the cause of pneumonia in a smoker with COPD?
H. influenzae
67
What is the cause of pneumonia in a young healthy pt, associated bullous myringitis (vesicles on tympanic membrane), and hemolytic anemia due to cold agglutinin?
Mycoplasma pneumoniae
68
What is the cause of pneumonia in an older smoker who is located near infected water sources (i.e air conditioning systems)?
Legionella (associated GI distress and altered mental status)
69
What is the most common cause of pneumonia in an HIV pt with CD4 count < 200?
PCP
70
What is the most common cause of pneumonia in pt with exposure to animals (especially animals giving birth; vet and farmer)?
Coxiella burnetti (Q-fever)
71
What is the most common cause of pneumonia in alcoholics with associated currant jelly sputum?
Klebsiella pneumoniae
72
What is the most common cause of bacterial pneumonia after a viral infection?
S. aureus
73
What is the most common cause of pneumonia in pt who travelled/ live in deserts of southwest (Arizona)?
Coccidiodomycosis
| dry locations, effects joint and erythema nodosum
74
What is the most common cause of pneumonia in pt in contact with birds?
Chlamydia psittaci
75
What is the most common cause of pneumonia in pt with exposure to bat/bird droppings (spelunking, cave exploration)?
Histoplasma capsulatum (wet river valleys)
76
What is the most common cause of pneumonia in pt with whooping cough and post-tussive emesis?
Bordetella pertussis
77
What is the most common cause of pneumonia in hunters (with exposure to rabbits)?
Francisella tularensis
78
What is the most common cause of pneumonia in a pt who travelled to southeast asia?
SARS (avian influenza)
79
What exam finding correlates best with pneumonia severity?
respiratory rate (hypoxia leads to hyperventilation)
80
What causes of pneumonia result in interstitial infiltrates?
1. PCP
2. Mycoplasma
3. Chlamydia
4. Coxiella
(5. Legionella)
81
What is CURB-65 and what is it used for?
C-confusion
U-uremia (elevated BUN)
R- respiratory distress (PO2 < 60, O2 sat 30)
B-low blood pressure (SBP< 90, DBP < 60)
65- 65 y/o or older
used to determine hospitalization for community acquire pneumonia
82
What is outpatient treatment for community acquired pneumonia?
azithrmyocin/ clarithromyocin
| can use levofloxacin/ moxifloxacin
83
What is inpatient treatment for community acquired pneumonia?
1. levofloxacin/ moxifloxacin
2. ceftriaxone with azithromycin or doxycyline
3. zosyn
84
What is the treatment for PCP?
Bactrim (IV pentamidine if allergic to Bactrim)
85
When should steroids be added to PCP treatment with Bactrim?
if severe:
1. arterial PO2 < 70
2. A-a gradient > 35
86
What is the treatment for Coxiella brunetti (Q-fever)?
Doxycycline
87
What is the treatment for Coccidioidomycosis?
Treat disseminated disease with fluconazole or itraconazole
88
What is treatment for hospital acquired pneumonia?
1. ceftazidime with vancomycin/linezolid
2. carbapenems with vancomycin/linezolid
3. Zosyn with vancomycin/linezolid
89
A pt develops pneumonia after 5-7 days in hospital most likely is due to ...
1. drug resistant gram negative bacilli (E.coli, Pseudomonas)
2. MRSA
90
Why do you get hyponatremia with pneumonia?
SIADH
91
Who should recieve pneumococcal vaccine?
1. older than 65
2. COPD
3. Cirrhosis
4. Asplenic
5. diabetic
6. heart disease
7. HIV
8. Steroid use
9. kidney disease
92
A pt presents with fever, cough, sputum production, weight loss and night sweats most likely suffers from ... and the best initial test is ...
TB; CXR
93
What is the finding on pleural biopsy in suspected TB pneumonia?
```
caseating necrosis
(associated with Ghon complex-calcified nodule)
```
94
What is the treatment for active TB?
RIPE for 2 months (rifampin, INH, pyrazinamide, ethambutol) followed by just rifampin w/ INH for 4 more months
95
What should be added to INH treatment to prevent peripheral neuropathy?
vitamin B6 (pyridoxine)
96
When should TB be treated for more than 6 months?
1. TB meningitis (12 months)
2. Pregnancy (9 months)
3. Osteomyelitis
5. Miliary
97
When should steroids be added to TB treatment?
1. TB meninigitis
| 2. TB pericarditis
98
What is the common side effect of pyrazinamide?
benign hyperuricemia
99
What is the common side effect of ethambutol?
optic neuritis (color blindness)
100
What is considered positive PPD for late TB infection?
1. > 5 mm if close contact of active TB, HIV, abnormal CXR w/ old/healed TB, steroid/ transplant
2. > 10 mm if high risk group (healthcare workers, prisoners, nursing home)
3. > 15 mm if low risk
101
If symptomatic pt with CXR suggestive of TB, what is next best step in management?
sputum AFB stain and culture (tx if positive) (3 negatives rules out active disease)
102
If pt asymptomatic with positive PPD, what is the next best step in management?
CXR to look for active disease
103
What is the treatment for latent TB (positive TB with negative CXR)?
INH with vitamin B6 (pyridoxine) for 9 months
104
What is the cause of toxic shock syndrome?
| hypotension, fever, desquamative rash on hands and feet
S. aureus infection due to use of tampon, sponges and surgical wound infections
105
What is the treatment for rocky mountain spotted fever?
doxycycline
106
What type of infections can be due to Toxoplasmosis?
1. chorioretinitis
2. CNS abscess
3. encephalitis
107
What is the treatment for Toxoplasmosis?
Pyrimethamine and sulfadiazine
108
If a pt who has never had a PPD and the first PPD is negative, what is the next best step in management?
repeat PPD within 2 weeks
109
A pt presents with voluntary muscle spasms, lockjaw, respiratory distress and dysphagia after a severe wound infection most likely suffers from ...
Tetanus (Clostridium tetani)
110
What is the prophylactic treatment of a severe dirty wound in pt not vaccinated?
1. tetanus vaccine
2. surgical debridement
3. antitoxin tetanus Ig
4. penicillin for 10-14 days
111
What is the prophylactic treatment of a severe dirty wound in pt who is fully vaccinated?
1. tetanus booster (if more than 5 years)
2. surgical debridement
3. penicillin for 10-14 days
112
What is the treatment for blastomycosis?
1. amphotericin (severe)
| 2. itraconazole/ ketoconazole (mild)
113
A pt presents with fever cough, chest pain, weight loss, neuro effects and skin lesions after spending time in southeast/ central united states most likely suffers from ...
Blastomycosis (broad budding yeast)
| brain, lungs, skin
114
A pt w/ neutropenia/ steroid used/ cytotoxic drug use presents with cough, fever, wheezing, eosinophilia and a halo sign (low attenuation around a nodular lesion) on CT scan most likely suffers from ...
Allergic bronchopulmonary Aspergillosis
115
What is the treatment for allergic bronchopulmonary aspergillosis?
steroid taper and asthma meds
116
What is mycetoma and what is the treatment for it?
fungal ball due to aspergillosis; surgical removal
117
What is the treatment for invasive aspergillosis?
1. Voriconazole and caspofungin
| 2. amphotercin
118
What is the side effect of amphotercin B treatment?
1. type 1 renal acidosis (metabolic acidosis and hypokalemia)
2. renal dysfunction
119
An HIV pt with bilateral interstitial infiltrates in setting of pneumonia most likely suffers from .... and the best diagnostic test is ....
PCP; bronchoscopy with bronchoalveolar lavage (BAL)
120
What are the side effects of pentamidine?
1. pancreatitis
2. hyperglycemia
3. hypoglycemia
121
What can PCP prophylaxis be discontinued?
CD4 count > 200 for 6 months
122
An HIV pt presents with visual changes with low CD4 count most likely suffers from ...
CMV retinitis
123
What can be used for PCP propyhlaxis in Bactrim allergic pt?
1. Dapsone (avoid in G6PD)
| 2. Atorvoquone
124
An HIV pt presents with odynophagia, fever and retrosternal pain with CD4 count < 50 most likely suffers from ...
CMV esophagitis
125
What is the prophylaxis for mycobacterium avium complex in a patient with HIV?
Azithromycin if CD4< 50
126
What is the treatment used for CMV retinitis?
1. ganciclovir
| 2. foscarnet
127
What anti-retroviral medication can cause anemia?
Zidovudine
128
What anti-retroviral medication can cause peripheral neuropathy?
1. Ziduovudine
| 2. Didanosine
129
What anti-retroviral medication can cause kidney stones?
Indinavir
130
What anti-retroviral medications can cause hyperlipidemia, hyperglycemia, lipoatrophy and elevated LFTs?
Protease inhibitors ("avir")
131
When should a pt with HIV be started on HAART therapy?
1. CD4 < 500
| 2. viral load > 55,000
132
What is the only anti-retroviral medication that is contraindicated in pregnancy?
efavirenz
133
If HIV positive woman on HAART medication becomes pregnant, what is the next best step in management?
continue her current HAART regimen (except efavirenz)
134
When should a C-section be performed in an HIV pregnant women?
if CD4 count and viral load are not controlled with medications
(viral load > 1000)
135
If an HIV positive woman becomes pregnant but has a high CD4 count and low viral load, what is the next best step in management?
start Zidovudine (AZT) with 2 other retroviral medications for 2nd and 3rd trimester
136
What is post-exposure prophylaxis for a pt with serious exposure to blood containing body fluids of HIV positive pt?
AZT (Zidovudine), lamivudine, nelfinavir
| HAART for 4 weeks
137
When can mycobacterium prophylaxis be discontinued for an HIV pt?
once CD4 count > 100 for months
138
What is treatment for active mycobacterium avium complex? (occurs in HIV pt w/ CD4< 50)
Clarithromycin and ethambutol (w/ or w/out rifabutin)
139
What is the treatment for Toxoplasmosis (ring enhancing lesions in HIV pt with CD4 < 100)?
Pyrimethamine and sulfadiazine
140
What is the treatment for cryptococcus neoformans in HIV pt with CD4 count < 100?
Amphotericin for 2 weeks followed by fluconazole
141
What are the vaccines that should be given to an HIV positive pt?
1. pneumococcus
2. flu
3. hep B
4. varicella (if CD4> 200)
142
What opportunistic infections occur in an HIV pt with CD4 count of 200-500?
1. Oral thrush (fluconazole)
2. Kaposi sarcoma (Tx w/ raising T cell count)
3. TB (RIPE)
4. Zoster/ Shingles
143
What opportunistic infections occur in an HIV pt with CD4 count of 100-200?
1. PCP (bactrim)
2. disseminated Histoplasmosis
3. disseminated coccidiomycosis
144
What opportunistic infections occur in a HIV pt with CD4 count <100?
1. Toxoplasmosis
2. Cryptococcus
3. Cryptosporidiosis (diarrhea)
4. disseminated herpes simplex
145
What opportunistic infections occur in a HIV pt with CD4 count < 50?
1. CMV (retinitis, esophagitis)
2. Mycobacterium avium complex
3. progressive multifocal leukoencephalopathy (PML)
4. CNS lymphoma
146
What is the side effect of foscarnet?
renal toxicity
147
What are the side effects of ganciclovir?
1. neutropenia
| 2. renal toxicity
148
What is the best indicator of response to anti-retroviral therapy in HIV pt?
HIV-RNA viral load
149
What is the tick and organism responsible for Lyme disease?
Ixodes scapularis; Borrelia burgdorferi
150
What is the initial symptom of Lyme disease?
Erythema migrans (erythematous rash with central clearing; bull's eye)
151
What are late manifestations of lyme disease?
1. migratory arthritis (joint)
2. cardiac (AV heart block, endocarditis)
3. Neuro (bilateral facial nerve palsy; meningitis, etc)
152
What is the most common neurologic manifestation of Lyme disease?
bilateral facial nerve palsy (7th nerve palsy)
153
What is the most common cardiac manifestation of Lyme disease?
AV heart block
154
What is treatment for pt with Lyme rash (erythema migrans), joint or facial palsy?
Amoxicillin or doxycyline
155
What is treatment for cardiac manifestations and neuro manifestations (other than facial palsy) in Lyme disease?
IV ceftriaxone
156
What is the next best step in management in a pt with a tick bite and asymptomatic?
do nothing
157
What is the treatment for Giardia associated diarrhea?
Metronidazole
158
What is the treatment for Campylobacter associated diarrhea?
Erythromycin
159
What is the only protozoan that is associated with bloody stool?
Entamoeba histolytica
160
What viral hepatic infection is associated with most severe presentation in pregnant women?
Hep E
161
What is the diagnostic test for Cryptosporidosis?
modified acid fast stain (AFB)
162
What is the next best step in management for a non-vaccinated person who suffers from a needlstick from a Hep B surface antigen positive pt?
Hep B Immunoglobulin with Hep B vaccine
| if pt has protective leves of surface antibody, nothing to do
163
What cause of infectious diarrhea is associated with Guillain Barre syndrome?
Campylobacter
164
What finding in LFTs is suggestive of viral hepatitis?
elevated ALT greater than AST
165
A man presents with urinary frequency, urgency and burning along with purulent urethral discharge most likely suffers from ...
Urethritis (gonococcal and chlamydia)
166
What is the treatment for urethritis?
ceftriaxone and azithromycin
167
What is the diagnostic test for viral hepatitis (A,C,D,E)?
IgM -acute
| IgG-chronic
168
What is the most common cause for liver transplant?
Hep C infection
169
What are the serology findings for acute hep B infection?
1. positive surface antigen
2. positive e-antigen (viral replication)
(possibly positive core antibody)
170
What are the serology findings for chronic hep B infection?
positive surface antigen for longer than 6 months
| w/ positive e-antigen and core antibody
171
What are the serology findings for old, past, healed hep B infection?
1. positive core antibody
| 2. positive surface antibody
172
What are the serology findings for hep B vaccinated pt?
positive surface antibody only
173
A female presents with abdominal pain, fever, leukocytosis, cervical discharge with cervical motion tenderness most likely suffers from ...
PID (pelvic inflammatory disease)
174
What is the treatment for pelvic inflammatory disease?
inpatient: doxycycline/ azithromycin & cefoxitin
outpatient: doxycycline/ azithromycin & ceftriaxone
175
What is the most common side effect of interferon?
flu like symptoms
176
What is the most common side effect of ribavirin?
anemia
177
A pt presents with painful genital ulcer with ragged edges with painful lymphadenopathy most likely suffers from ...
Chancroid (Haemophilus ducreyi)
178
What is treatment for Chancroid (haemophilus ducreyi)?
azithromycin
179
What is the most accurate diagnostic test for pelvic inflammatory disease?
laparoscopy
180
A pt presents with signs and symptoms of pelvic inflammatory disease, what is the best initial step in management?
beta HCG (pregnancy test to rule out ectopic)
181
A pt presents with transient genital ulcer and prominent unilateral tender inguinal lymphadenopathy with associated draining sinus buboes most likely suffers from ...
Lymphogranuloma venereum (chlamydia trachomatis)
182
A pt presenting with polyarticular arthritis, tenosynovitis, petechial rash most likely suffer from ...
Disseminated gonorrhae (culture urethra, anus and mouth)
183
A pt presents with firm, painless genital ulcer and painless lymphadenopathy most likely suffers from ...
Syphilis (treponema pallidum)
184
What is treatment for lymphogranuloma venerem?
doxycycline
185
A pt presents with painless red nodule that develops into elevated granulomatous mass most likely suffers from ...
Granuloma inguinale (Calymmatobacterium granulomatis)
186
What is the diagnostic test of choice for primary syphilis (chancre)?
dark field exam
187
What is the diagnostic test of choice for tertiary syphilis (tabes dorsalis, argyll robertson pupil, aorta, gummas)?
FTA on CSF
188
What is the treatment for syphillis in penicillin allergic pt?
primary & secondary: doxycycline
| tertiary, neurosyphilis, pregnant: desenitize to penicillin
189
What is diagnostic test and treatment for granuloma inguinale?
biopsy; bactrim/ ceftriaxone
190
A pt presents with multiple genital vesicles most likely suffers from ... and should be treated with ...
```
genital herpes (HSV1/2); acyclovir
(foscarnet for acyclovir resistant herpes)
```
191
What diagnostic test can be used for genital herpes?
```
Tzanck prep (best initial test) then viral culture
(done if vesicles unroofed resembling ulcer)
```
192
A pt presents with hearld patch, maculopapular rash that is not on hands and soles of feet, VRDL negative and rash on back looks like christmas tree most likely suffers from ...
Pityriasis rosea
193
What disease are donovan bodies on touch prep associated with?
granuloma inguinale
194
A pt presents with dysuria, urinary frequency, urgency and suprapubic tenderness most likely suffers from ... and what is best initial treatment?
Cystitis; Bactrim (if uncomplicated, no stones/ strictures/ tumor/ obstruction)
195
What is the organism associated with cystitis in young women after sexual intercourse?
Staph saprophyticus (honeymoon cystitis)
196
What is the best initial test for cystitis?
urinalysis (WBC; nitrites suggest gram negative)
| bacteria in pregnancy
197
A pt presents with dysuria, urinary frequency, urgency, fever, flank pain and CVA tenderness most likely suffers from ...
Pyelonephritis
198
A pt presents with pyelonephritis symptoms that presist despite appropriate treatment most likely suffers from ...
Perinephric abscess (treatment must include drainage)
199
What is the most accurate test for perinephric abscess?
biopsy (can image with ultrasound/ MRI/ CT)
200
What is the treatment for cystitis in pregnant women?
nitrofurantoin
201
... is a skin infection involving epidermis and dermis presenting with a bright red, warm and tender lesion
Erysipelas
202
... is a skin infection involving epidermis, dermis and subcutaneous layers presenting with erythema, swelling, warmth and tender.
Cellulitis
203
... is a superficial skin infection involving epidermis only that presents with oozing, crusting and draining lesions
Impetigo
204
What is the best initial therapy for impetigo?
bacitracin and mupirocin (topical therapy)
205
What is the best empiric treatment for skin infections?
oxacillin, nafcillin, cefazolin, cephalexin
206
A pt presents with extensive pruritis, with burrowing tracts in skin, usually located in web spaces most likely suffers from ...
scabies
207
What is the diagnostic test for scabies?
skin scraping
208
What is treatment for scabies?
permethrin
209
A pt presenting with lice located near hair follicles and itching most likely suffers from ...
Pediculosis (Lice)
210
What is treatment for lice (pediculosis)?
permethrin
211
What is the treatment for fungal infection involving hair and/or nails?
Terbinafine or itraconazole
212
What is the best initial test for tinea?
KOH prep
213
What is the best initial step for a pt presenting with skin rash, crepitus, pain, and high fever?
Surgical debridement (for necrotizing fasciitis)
214
What is the side effect of terbinafine?
liver toxicity
215
Spaghetti and meatballs appearance on KOH prep most likely suggest...
Malassezia furfur (tinea versicolor)
216
What is the treatment for tinea versicolor?
topical selenium sulfide
217
How do you distinguish oral leukoplakia from oral thrush (candidiasis)?
leukoplakia: doesn't scrape off
thrush: scrapes
218
What fungal infection fluoresces under UV light of wood lamp?
Malassezia furfur
219
A pt presents with multiple skin-colored papules that have central umbilication most likely suffers from ...
Molluscum contagiosum (tx w/ removal)
220
A pt presenting with band of vesicles in a dermatomal distribution most likely suffers from ...
Shingles (Herpes zoster)
221
What is the best initial treatment for the pain associated with herpes zoster infection?
gabapentin
222
What is a significant risk factor for vertebral osteomyelitis?
IV drug use
223
What is the best initial test to exclude osteomyelitis?
X-ray (no periosteal elevation/ bone formation)
224
When should you obtain an MRI for suspected osteomyelitis?
if Xray is negative and clinical picture suggest osteomyelitis
225
What is the next best step in management if an Xray suggest osteomyelitis?
Bone biopsy (and culture to determine organism and sensitivity)
226
How do you follow response to therapy for osteomyelitis?
ESR
227
What is the best initial test for septic arthritis?
joint aspiration (WBCs >50,000)
228
A pt presents with polyarticular involvement, petechial rash, and tenosynovitis most likely suffers from ... and diagnosis via .. should be done
disseminated gonococcal disease; culture pharynx, rectum, urethra, cervix
229
A pt presents with severe pain, swelling and edema after wound from car accident that eventually develop crepitation and shock most likely suffers from ...
Gas Gangrene (Clostridium perfringens)
230
How do you definitively diagnosis and treat Gas Gangrene?
surgery; surgical debridement with antibiotics
231
A pt presents with a fever and a new murmur or change in previous murmur most likely suffers from ...
Endocarditis
232
What are extra-cardiac manifestations of endocarditis?
1. Janeway lesion (flat and painless)
2. Osler lesion (raised and painful)
3. Splinter hemorrhages
4. Roth's spots (oval pale retinal lesions surrounded by hemorrhage)
233
What is the most common cause of endocarditis in a pt with hx of IV drug abuse?
S. aureus
234
What is the best initial test for a pt with suspected endocarditis?
blood cultures
235
What is the empiric therapy for endocarditis?
vancomycin and gentamicin
236
What is the next best step in a pt diagnosed with Strep bovis associated endocarditis?
Colonoscopy (increased risk of colon cancer)
237
What cardiac conditions require prophylactic therapy for endocarditis in the setting of dental/ surgical procedures?
1. prosthetic valves
2. previous bacterial endocarditis
3. congential cardiac malformation
4. previous heart transplant
238
A pt presents with sharp, pleuritic chest pain that improves by sitting up and leaning forward and has associated friction rub most likely suffers from ...
acute pericarditis
239
What are the findings on EKG that are associated with pericarditis?
diffuse ST elevation
PR depression
(may get electrical alternans)
