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USMLE Step 3 > Infectious Disease > Flashcards

Infectious Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the empiric antibiotics choices for aspiration pneumonia?

A

Ceftriaxone IV + azithromycin IV + clindamycin IV

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2
Q

Rx of pneumonia in patient with cystic fibrosis

A

Tobramycin and ticarcillin-clavulanate

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3
Q

What are the major classes of antiretroviral drugs?

A
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Protease inhibitors (PIs)
  • Fusion inhibitors (FIs)
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4
Q

Name 7 examples of NRTIs

A
  • Zidovudine (AZT)
  • Didanosine (ddI)
  • Abacavir
  • Emtricitabine (FTC) and lamivudine (3TC)
  • Tenofovir (TNV)

Stavudine

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5
Q

Name 5 examples of NNRTIs

A
  • Efavirenz (EFV)
  • Nevirapine (NVP)
  • Delaverdine (DLV)
  • Etravirine
  • Rilpivirine

Use mneumonic “N DEER”

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6
Q

Name 5 examples of PIs

A

Atazanavir

Indinavir

Nelfinavir

Ritonavir

Saquinavir

Use the mnemonic RAINS to remember the PIs

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7
Q

Major side effects of didanosine

A

Pancreatitis

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8
Q

When to begin Rx with HAART?

A

In symptomatic patients (any CD4 or viral load)

In asymptomatic patients with a CD4 of 350 and any viral load

In pregnant women

In the setting of a needle stick involving blood from an HIV- patient.

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9
Q

Common side effect of tenofovir

A

Renal toxicity

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10
Q

Common side effect of zidovudine (AZT)

A

Myopathy

Bone marrow suppression (Anemia)

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11
Q

Common side effect of abacavir

A

hypersensitivity reaction (e.g., fever, chills and dyspnea)

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12
Q

Common side effect of emtricitabine (FTC) and lamivudine (3TC)

A

Diarrhea

Nausea

Headache

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13
Q

Common side effect of protease inhibitors

A

Increase lipids, redistribute fat and cause DM

  • Hyperglycemia
  • Hyperlipidemia
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14
Q

Common side effect of indinavir

A

Renal stones

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15
Q

What is the indication and Rx of PCP in HIV

A

CD4 count < 200

or previous hx of PCP

or oral thrush

Rx: TMP SMX, dapsone or atovoquon

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16
Q

What are the indication and Rx of mycobacterium avium intercellulare (MAI) in HIV

A

CD4 < 50

Rx: azithromycin wkly

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17
Q

What is the indication and Rx of toxoplasma gondii in HIV

A

CD4 < 100 and toxoplasma IgG +

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18
Q

What is the IV Rx for methicillin sensitive Staphylococcus Aureus (MSSA)?

A

IV Oxacillin/ nafcillin, or

IV cefazolin (first-generation cephalosporin)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 291-292). . Kindle Edition.

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19
Q

What is the oral Rx for methicillin sensitive Staphylococcus Aureus (MSSA)?

A

Dicloxacillin or

Cephalexin (first-generation cephalosporin)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 293). Kindle Edition.

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20
Q

What are the drugs of choice for Rx severe resistant Staphylococcus?

A

Vancomycin

Linezolid

Daptomycin

Ceftaroline

Tigecycline

Telavancin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 295-296). Kindle Edition.

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21
Q

What are the drugs of choice for Rx minor resistant Staphylococcus?

A

Trimethoprim/ sulfamethoxazole (TMP/ SMX)

Clindamycin

Doxycycline

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 298). . Kindle Edition.

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22
Q

Listh the side effects of the following medications:

Daptomycin

Linezolid

Imipenem

A

Daptomycin: myopathy

Linezolid: low platelets

Imipenem: seizures

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 304). . Kindle Edition.

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23
Q

What is the altenative in the presence of penicillin allergic as rash?

A

Cephalosporins

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24
Q

What is the altenative Rx in the presence of penicillin anaphylaxis?

A

Macrolides (azithromycin, clarithromycin)

Clindamycin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 308). . Kindle Edition.

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25
Q

What is the altenative Rx for severe infection in the presence of penicillin allergy?

A

Vancomycin

Linezolid

Daptomycin

Telavancin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 310). . Kindle Edition.

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26
Q

What is the altenative Rx for minor infection in the presence of penicillin allergy?

A

Macrolides (azithromycin, clarithromycin)

Clindamycin

TMP/ SMX

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 312). . Kindle Edition.

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27
Q

List 3 antibiotics specific for Rx of Streptococcus

A

Penicillin

Ampicillin

Amoxicillin

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28
Q

List 6 Gram-negative bacilli (rods)

A

Escherichia coli

Enterobacter

Citrobacter

Morganella

Pseudomonas

Serratia

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 317). . Kindle Edition.

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29
Q

List 6 classes of medications and their examples for the Rx of Gram-negative bacilli

A

Cephalosporins (Ex: Cefepime Ceftazidime)

Penicillins (Ex: Piperacillin Ticarcillin )

Monobactam (Ex: Aztreonam )

Quinolones (Ex: Ciprofloxacin Levofloxacin Moxifloxacin Gemifloxacin )

Aminoglycosides (Ex: Gentamicin Tobramycin Amikacin )

Carbapenems (Ex: Imipenem Meropenem Ertapenem Doripenem)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 322-344). . Kindle Edition.

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30
Q

Name the only Carbapenem that does not cover Pseudomonas

A

Ertapenem

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31
Q

List the two penicillins for Rx of GN bacilli that also cover Streptococci and anaerobes

A

Piperacillin

Ticarcillin

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32
Q

List 3 quinolones used for the Rx of GN bacilli that are excellent pneumococcal drugs

A

Levofloxacin

Gemifloxacin

Moxifloxacin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 349-350). . Kindle Edition.

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33
Q

————– are excellent antianaerobic medications. They cover streptococci and all sensitive staphylococcus (MSSA).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 351-352). . Kindle Edition.

A

Carbapenems

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34
Q

————— work synergistically with other agents to treat staph and strep.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 350-351). . Kindle Edition.

A

Aminoglycosides

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35
Q

——————– covers MRSA and is broadly active against gram-negative bacilli.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 353). . Kindle Edition.

A

Tigecycline

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36
Q

Gemifloxacin is a ———- for pneumonia.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 354-355). . Kindle Edition.

A

Quinolone

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37
Q

Another name for gastrointestinial anaerobes

A

Bacteroides

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38
Q

————– is the best medication for abdominal anaerobes.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 359). . Kindle Edition.

A

Metronidazole

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39
Q

—————, —————-, and —————- are equal in efficacy for abdominal anaerobes compared to metronidazole.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 361-362). . Kindle Edition.

A

Carbapenems

Piperacillin

Ticarcillin

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40
Q

——————– is the best drug for anaerobic strep (respiratory anaerobes).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 367-368). . Kindle Edition.

A

Clindamycin

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41
Q

List some medications with no anaerobic coverage

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 369). . Kindle Edition.

A

Aminoglycosides

Aztreonam

Fluoroquinolones

Oxacillin/ nafcillin

All the cephalosporins except cefoxitin and cefotetan

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 370-372). . Kindle Edition.

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42
Q

Rx for herpes simplex and varicella zoster

A

Acyclovir

Valacyclovir

Famciclovir

(n/b: they are all of equal efficacy)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 382). . Kindle Edition.

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43
Q

Rx for cytomegalovirus (CMV)

A

Valganciclovir

Ganciclovir

Foscarnet

(these agents are also effective against simplex and varicella)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 383-384). . Kindle Edition.

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44
Q

Name the best long-term Rx for CMV retinitis

A

Valganciclovir

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 385). . Kindle Edition.

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45
Q

Adverse effects of Valganciclovir and ganciclovir

A

Neutropenia

Bone marrow suppression

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 387-388). . Kindle Edition.

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46
Q

Adverse effect of foscarnet

A

Renal toxicity

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47
Q

Rx for influenza A and B

A

Oseltamivir

Zanamivir

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 390). . Kindle Edition.

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48
Q

What class of drugs are oseltamivir and zanamivir

A

Neuraminidase inhibitors

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 390). . Kindle Edition.

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49
Q

Use of Ribavirin

A

Hepatitis C (in combination with interferon)

Respiratory syncytial virus (RSV)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 391-392). . Kindle Edition.

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50
Q

Rx of chronic hepatitis B

A

Lamivudine

Interferon

Adefovir

Tenofovir

Entecavir

Telbivudine:

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 392-393). . Kindle Edition.

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51
Q

Drug of 1st choice for Candida (not Candida krusei or Candida glabrata), Cryptococcus, oral and vaginal candidiasis as an alternative to topical mediations

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 395-396). . Kindle Edition.

A

Fluconazole

Itraconazole (equal to fluconazole but less easy to use; rarely the best initial therapy for anything)

Voriconazole (Covers all Candida; best agent against Aspergillus. Adverse effect: – Some visual disturbance)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 397-400). . Kindle Edition.

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52
Q

Best agent against aspergillus

A

Voriconazole

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53
Q

Name the family of antifungal agent most excellent for neutropenic fever patients

A

Echinocandins

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54
Q

List three examples of Echinocandins

A

Caspofungin

Micafungin

Anidulafungin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 400-401). . Kindle Edition.

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55
Q

————– is effective against all Candida, Cryptococcus, and Aspergillus:

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 409-410). . Kindle Edition.

A

Amphotericin B

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56
Q

Aspergillus: ———- superior to amphotericin B

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.

A

Voriconazole

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57
Q

Neutropenic fever: ————— is superior to amphotericin B

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.

A

Caspofungin

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58
Q

Candida: ————– is equal to amphotericin for efficacy but has much fewer adverse effects

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.

A

Fluconazole

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59
Q

List the Adverse effects of amphotericin B

A

Renal toxicity (increased creatinine)

Hypokalemia

Metabolic acidosis

Fever, shakes, chills

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 418-422). . Kindle Edition.

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60
Q

List the diagnostic testings for osteomyelitis

A

Best initial test: Plain x-ray

Best second-line test (if there is high clinical suspicion and x-ray is negative): MRI

Most accurate test: bone biopsy and culture

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 431-433). . Kindle Edition.

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61
Q

What is the earliest finding of osteomyelitis on an x-ray

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 445). . Kindle Edition.

A

Periosteal elevation

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62
Q

Which test has greater sensitivity, the MRI or the bone scan?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 470-471). . Kindle Edition.

A

Both have equal sensitivity

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63
Q

Which test has greater specificity, the MRI or the bone scan?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 470-471). . Kindle Edition.

A

MRI

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64
Q

Best means of monitoring improvement in Rx of osteomyelitis

A

Monitoring ESR

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65
Q

Most common cause of osteomyelitis

A

Staphylococcus

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66
Q

Why is swimming commonly associated with otitis externa

A

Because swimming washes out the acidic environment normally found in the external auditory canal.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 503). . Kindle Edition.

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67
Q

Rx for otitis externa

A

Topical antibiotics, such as ofloxacin or polymyxin/ neomycin.

Add topical hydrocortisone to decrease swelling and itching.

Adding acetic acid and water solution to reacidify the ear can help eliminate the infection.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 509-511). . Kindle Edition.

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68
Q

Diagnostic tests for malignant otitis externa

A

Best initial test: Skull x-ray or MRI

Most accurate test: Biopsy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 517-519). . Kindle Edition.

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69
Q

Rx of malignant otitis externa

A

Surgical debridement and antibiotics active against Pseudomonas such as ciprofloxacin, piperacillin, cefepime, carbapenem, or aztreonam.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 521-523). . Kindle Edition.

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70
Q

Rx of otitis media

A

Best initial therapy: Amoxicillin. Usual course is 7– 10 days; longer for younger patients and shorter for older patients.

Next step: Perform the most accurate test, tympanocentesis and aspirate of the tympanic membrane for culture. This is rarely necessary and is only done for recurrent or persistent cases that fail therapy.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 533-536). . Kindle Edition.

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71
Q

List the common bacterial causes of sinusitis or otitis media

A

Streptococcus pnuemoniae

Haemophilus influenzae

Moraxella catarrhalis

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72
Q

———- or ———- is the Rx for influenza if the patient presents within the first 48 hours after the onset of symptoms.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 577-578). . Kindle Edition.

A

Oseltamivir or zanamivir

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73
Q

Strongest indications for vaccination against influenza

A

COPD

CHF

Dialysis patients

Steroid use

Health care workers

Everyone > 50

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 583-584). . Kindle Edition.

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74
Q

Causes of impetigo

A

Streptococcus pyogenes

Staphylococcus aureus

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75
Q

Rx of impetigo

A

Topical mupirocin or retapamulin (mupirocin has greater activity against MRSA, bacitracin has less efficacy as a single agent)

Severe disease: Oral dicloxacillin or cephalexin

Community-acquired MRSA (CA-MRSA): TMP/ SMZ; clindamycin is sometimes useful

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 593-595). . Kindle Edition.

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76
Q

What is Erysipelas?

A

This is a group A (pyogenes) streptococcal infection of the skin. The skin is very bright red and hot because of dilation of the capillaries of the dermis due to locally released inflammatory mediators

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 602-605). Kindle Edition.

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77
Q

What is the most common site of Erysipelas?

A

The face

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78
Q

Best initial Rx for Erysipelas

A

Oral dicloxacillin or cephalexin. Topical antibiotics are useless.

If the organism is confirmed as group A beta hemolytic streptococci, you may treat with penicillin VK.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 615-617). . Kindle Edition.

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79
Q

What is the basis for lower extremity doppler ultrasonography in cellulitis of the leg?

A

Beacuse both a blod clot and cellulitis may cause fever

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80
Q

Rx for cellulitis

A

Minor disease: Dicloxacillin or cephalexin orally

Severe disease: Oxacillin, nafcillin, or cefazolin IV

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 626-628). . Kindle Edition.

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81
Q

What skin infection does Staphylococcus epidermidis cause?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 633-634). . Kindle Edition.

A

None. S. epidermidis is a normal commensal inhabitant of the skin. It lives there and does not cause skin infection.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 634-635). . Kindle Edition.

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82
Q

What is the difference among folliculitis, furuncles, carbuncles, and boils

A

The only fifference is size. Folliculitis < Furuncles < Carbuncles < Boils

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 636-637). . Kindle Edition.

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83
Q

Causative agent for folliculitis, furuncles, carbuncles, and boils.

A

Staphylococcus aureus

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84
Q

Rx for folliculitis, furuncles, carbuncles and boils.

A

Minor disease: Dicloxacillin or cephalexin orally

Severe disease: Oxacillin, nafcillin, or cefazolin IV

If large, as in boils, do I & D.

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85
Q

Best initial diagnostic test for fungal infection of the skin or nail

A
  • KOH preparation
    1. Scrape the skin or nail.
    2. Place the scraping on a slide with KOH and acid and heat it.
    3. The epithelial cells will dissolve and leave the fungal forms behind, visible on the slide

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 650-654). . Kindle Edition.

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86
Q

Rx for fungal infection of the skin and nail

A

Topical antifungal medication (if no hair or nail involvement): Clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin, or ciclopirox

Oral antifungal medication for scalp (tinea capitis) or nail (onychomycosis)

– Terbinafine: Causes increased liver function tests

– Itraconazole

– Griseofulvin (for tinea capitis): Has less efficacy than either terbinafine or itraconazole

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 656-665). . Kindle Edition.

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87
Q

Best initial test for urethritis

A

Urethral swab for Gram stain, WBC count, culture, and DNA probe

Nucleic acid amplification tests (NAATs) are highly effective as well

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 672-673). . Kindle Edition.

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88
Q

Basic principle for Rx of urethritis

A

Two medications: one for gonorrhea and another for Chlamydia

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89
Q

List some gonorrhea medications

A

Ceftriaxone IM

Cefixime oral

Cefpodoxime oral

Ciprofloxacin oral (2nd line)

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90
Q

List the medications for Chlamydia urethritis

A

Azithromycin (single dose)

Doxycycline (for one week)

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91
Q

Rx for urethritis in pregnancy

A

Ceftriaxone IM and

Azithromycin

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92
Q

What predisposes a patient to recurrent infections with Neisseria?

A

Terminal complement deficiency

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93
Q

Single best test for gonorrhea and Chlamydia?

A

Nucleic acid amplification test (NAAT)

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94
Q

What blood finding is a measure of severity in PID?

A

Leukocytosis

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95
Q

Best initial test for PID

A

Pregnancy test, then cervical culture and DNA probe for Chlamydia and gonorrhea

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 722-724). . Kindle Edition.

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96
Q

Most accurate test for PID

A

Laparoscopy

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97
Q

How to collect samples for nucleic acid amplification test

A

NAAT can be done on voided urine for men or blind vaginal swab in women.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 726-727). . Kindle Edition.

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98
Q

Outpatient Rx for PID

A

Ceftriaxone (IM) and doxycycline (oral)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 740). . Kindle Edition.

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99
Q

Inpatient Rx of PID

A

Cefoxitin (IV) and doxycycline and maybe metronidazole.

Cefotetan can be used instead of cefoxitin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 741-742). . Kindle Edition.

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100
Q

List four family of antibiotics safe in pregancy

A

Penicillins

Cephalosporins

Aztreonam

Macrolides (Azithromycin and Erythromycin)

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101
Q

Presentation of epidydimo-orchitis

A

An extremely painful and tender testicle with a normal position in the scrotum.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 750-752). . Kindle Edition.

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102
Q

Rx of epidydimo-orchitis

A

< 35 years of age: Ceftriaxone and doxycycline

> 35 years of age: Fluoroquinolone

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 754-755). . Kindle Edition.

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103
Q

Causative agent: painful genital ulcer

A

Haemophilus ducreyi

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 760-761). . Kindle Edition.

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104
Q

Best initial test for chancroid

A

Swab for Gram stain (gram-negative coccobacilli) and culture (will require specialized medium: Nairobi medium or Mueller-Hinton agar).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 763-764). . Kindle Edition.

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105
Q

Rx for chancroid

A

Single IM shot of ceftriaxone or single oral dose of azithromycin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 765-766). . Kindle Edition.

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106
Q

Causative agent: Lymphogranuloma venereum (LGV)

A

Chlamydia trachomatis

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107
Q

Rx of Lymphogranuloma venereum (LGV)

A

Aspirate the bubo.

Treat with:

  • Ddoxycycline
  • Azithromycin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 773-774). . Kindle Edition.

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108
Q

Causative agent: Genital herpes

A

Herpes simplex virus type 2 (HSV2)

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109
Q

When is it necessary to do the Tzanck prep test in HSV2

A

If the roofs come off the vesicles and the lesion becomes an ulcer of unclear etiology,

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 785-786). . Kindle Edition.

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110
Q

Rx for HSV2

A

Acyclovir

Valacyclovir

Famciclovir

Rx is for 7– 10 days

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 784-785). . Kindle Edition.

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111
Q

Rx for acyclovir resistant herpes

A

Foscarnet

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112
Q

Rx for HSV2 in pregnancy

A

Acyclovir

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113
Q

Rx for cytomegalovirus (CMV)

A

Ganciclovir

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114
Q

What is the most accurate test in primary syphilis?

A

Darkfield microscopy. Darkfield microscopy is far more sensitive than a VDRL or RPR in primary syphilis.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 804-805). . Kindle Edition.

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115
Q

Rx for primary syphylis

A

Single shot of IM penicillin

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116
Q

Rx of primary syphilis in those with penicillin allergy

A

Doxycycline

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117
Q

Diagnosis: development of fever, headache, and myalgia within 24 hours after treatment for early stage syphilis.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 810-811). . Kindle Edition.

A

Jarisch-Herxheimer reaction. It is a benign, self-limited reaction caused by the release of pyrogens from dying treponemal. Treat with aspirin and continue the treatment.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 810). . Kindle Edition.

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118
Q

Initial diagnostic test for secondary syphilis

A

RPR (Rapid Plasma Reagin)

FTA (Flourescent Treponemal Antibody)

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119
Q

Rx for secondary syphilis

A

Single IM shot of penicillin

Use doxycycline for the penicillin-allergy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 815-816). . Kindle Edition.

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120
Q

Features of tertiary syphilis

A

Neurosyphilis: Tabes doralis, general paresis, Argyll-Robertson pupil

Gummas

** Aortitis**

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 851-854). . Kindle Edition.

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121
Q

Initial diagnostic test for tertiary syphilis

A

RPR and FTA

Lumbar puncture for neurosyphilis (test CSF with VDRL and FTA).

CSF VDRL is only 50 percent sensitive.

Neurosyphilis is excluded with a negative CSF FTA.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 820-821). . Kindle Edition.

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122
Q

Rx for tertiary syphilis

A

IV penicillin

If allergic, desensitize

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123
Q

Rx of syphilis in pregnancy

A

Desensitization

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124
Q

Diagnosis: rare, beefy red genital lesion that ulcerates.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 876-877). . Kindle Edition.

A

Granuloma inguinale

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125
Q

What is the diagnostic testing and causative organism for Granulama inguinale

A

Biopsy or “touch prep,”

Klebsiella granulomatis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 879-880). . Kindle Edition.

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126
Q

Rx for Granuloma inguinale

A

Doxycycline

TMP/SMX

Azithromycin

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127
Q

Compare and contrast pediculosis and scabies

A

Pediculosis Scabies

  • Larger • Small
  • In hair-bearing areas, such as the pubic area or axilla • Burrows in web spaces
  • Visible on the surface • Scrape and magnify
    • Treat with permethrin, pyrethrins, or lindane. • Treat with permethrin, lindane, or ivermectin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 887-898). . Kindle Edition.

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128
Q

Rx of Warts

A

Perform surgical removal if large.

Imiquimod is an immunostimulant that leads to sloughing off of the wart.

Cryotherapy, laser removal, and melting with podophyllin are other options.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 902-904). . Kindle Edition.

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129
Q

Rx of cystitis

A

Uncomplicated cystitis is treated with TMP/ SMX orally for 3 days, if E. coli resistance in that area is low. If resistance is > 20 percent, then use ciprofloxacin or levofloxacin.

“Complicated” cystitis is treated with 7 days of TMP/ SMX or ciprofloxacin. Complicated means an anatomic abnormality is present, such as a stone, stricture, tumor, or obstruction.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 911-915). . Kindle Edition.

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130
Q

When is it right to treat asymptomatic bacteriuria

A

In pregnancy

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131
Q

What are the outpatient and inpatient Rx of pyelonephritis

A

Outpatient: Ciprofloxacin

Inpatient: IV Ampicillin + Gentimicin

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132
Q

Diagnoses:

  1. Dysuria + white cells in urine + suprapubic tenderness
  2. Dysuria + white cells in urine + flank pain + fever

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 948-950). . Kindle Edition.

A
  1. Cystitis
  2. Pyelonephritis
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133
Q

How is clinical diagnosis of endocarditis made

A

Based on the Duke Critera. By the presence of 2 major criteria, or 1 major and 3 minor criteria, or 5 minor criteria.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 979-980). . Kindle Edition.

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134
Q

List the major Duke’s criteria

A
  1. Two positive cultures with:
  • Staphylococcus aureus
  • Viridans streptococci, Streptococcus bovis/ epidermis, enterococci, gram-negative rods, Candida

HACEK organisms are generally culture-negative

  • Haemophilus aphrophilus/ parainfluenzae
  • Actinobacillus actinomycetemcomitans
  • Cardiobacterium hominis
  • Eikenella corrodens
  • Kingella kingae
  1. Abnormal echocardiogram
  • Intracardiac mass or valvular vegetation OR
  • Abscess OR
  • New partial dehiscence of prosthetic valve

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 987-1006). . Kindle Edition.

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135
Q

List the minor Duke’s criteria

A

Fever (> 38.0 ° C)

Presence of risk factors:

  • IV drug use (IDU)
  • Presence of structural heart disease
  • Prosthetic heart valve
  • Dental procedures involving bleeding
  • History of endocarditis

Vascular findings:

  • Janeway lesions
  • Septic pulmonary infarcts
  • Arterial emboli
  • Mycotic aneurysm
  • Conjunctival hemorrhage

Immunological findings:

  • Roth spots
  • Osler’s node
  • Glomerulonephritis

Microbiologic findings:

  • One positive blood culture but does not meet major criteria

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1007-1017). . Kindle Edition.

136
Q

Best empiric therapy for infective endocarditis

A

Vancomycin + Gentimicin

137
Q

Indications for surgery in infective endocarditis

A

Valve rupture

Abscess

Prosthetic valves

Fungal endocarditis

Embolic events once already started on antibiotics

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1070-1077). . Kindle Edition.

138
Q

List the cardiac defects requiring prophylaxis against infective endocarditis

A

Prosthetic valves

Unrepaired cyanotic heart disease

Previous endocarditis

Transplant recipients who develop valve disease

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1080-1081). . Kindle Edition.

139
Q

List the procedures requiring prophylaxis against infective endocarditis

A

Dental procedures that cause bleeding: The prophylactic antibiotic to use for dental procedures is amoxicillin. For penicillin-allergic patients, clindamycin is the drug of choice.

Respiratory tract surgery

Surgery of infected skin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1083-1085). . Kindle Edition.

140
Q

Procedures not requring prophylaxis against infective endocarditis

A

Dental fillings

All flexible scopes

All OB/ GYN procedures

All urinary procedures, including cystoscopy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1087-1088). . Kindle Edition.

141
Q

Cardiac defects not requiring prophylaxis against infective endocarditis

A

Aortic stenosis or regurgitation

Mitral stenosis or regurgitation

Atrial or ventricular septal defects

Pacemakers and implantable defibrillators

Mitral valve prolapse, even if there is a murmur

HOCM (IHSS)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1090-1092). . Kindle Edition.

142
Q

Name an example of fusion inhibitor

A

Enfuvirtide (T20)

143
Q

Common side effects of enfuvirtide (T20)

A

Injection site reactions

144
Q

Diagnosis: HIV patient with shortness of breath, dry cough, hypoxia, and increased LDH.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1162-1163). . Kindle Edition.

A

PCP

145
Q

PCP investigation:

  1. Best initial diagnosis
  2. Most accurate diagnosis
A
  1. A chest x-ray will show increased interstitial markings bilaterally
  2. Bronchoalveolar lavage

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1164-1166). . Kindle Edition.

146
Q

Rx of PCP opportunistic infection in HIV patient

A

IV TMP/ SMX

If there is a rash, use IV pentamidine

Atovaquone can be used for mild pneumocystis

Dapsone is not intravenous and is used for prophylaxis, not treatment

If PCP is severe (pO2 < 70 or A-a gradient > 35), then give steroids

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1167-1171). . Kindle Edition.

147
Q

Diagnosis: HIV positive patient with headache, nausea, vomiting, and focal neurologic findings.

What is the best initial test for above patient?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1173). . Kindle Edition.

A

Diagnosis: Toxoplamosis

Best initial test: head CT with contrast showing “ring” or contrast-enhancing lesions.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1174). . Kindle Edition.

148
Q

Rx for toxoplasmosis

A

Pyrimethamine and sulfadiazine for 2 weeks and repeat the CT scan.

If the lesions are smaller, then this is confirmative of toxoplasmosis. If the lesions are unchanged in size, then perform a brain biopsy, since this is most likely lymphoma.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1175-1177). . Kindle Edition.

149
Q

Daignosis: HIV with < 50 CD4 cells and blurry vision.

Rx for above patient

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1179-1180). . Kindle Edition.

A

Cytomegalovirus (CMV)

Rx: Ganciclovir or foscarnet (if resistant to ganciclovir)

Maintenance therapy is with oral valganciclovir lifelong, unless the CD4 goes up with HAART. If the CD4 rises, you can stop the CMV medications.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1183-1185). . Kindle Edition.

150
Q

Diagnosis: HIV and < 50 CD4 cells with fever and headache.

Best initial test for above patient

Most accurate test for aove patient

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1187-1188). . Kindle Edition.

A

Cryptococcus

The best initial test is an India ink stain, which has about a 60 percent sensitivity.

The most accurate test is a cryptococcal antigen test, which is over 95 percent sensitive and specific.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1189-1191). . Kindle Edition.

151
Q

Rx of cryptococcus

A

Treat initially with amphotericin, followed by fluconazole.

The fluconazole is continued lifelong unless the CD4 count rises.

If the CD4 count rises, all opportunistic infection treatment and prophylaxis can be stopped.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1194-1196). . Kindle Edition.

152
Q

Diagnosis: HIV and < 50 CD4 cells with focal neurologic abnormalities.

What is the best initial test for above patient?

Rx for above patient

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1199-1200). . Kindle Edition.

A

Progressive Multifocal Leukoencephalopathy (PML)

CT head or MRI brain: No ring enhancement is seen

No specific Rx. Rx with HAART. PML resolves with improvement with HAART

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1198). . Kindle Edition.

153
Q

Diagnosis: HIV and < 50 CD4 cells. There is wasting with weight loss, fever, and fatigue. Anemia is frequent from invasion of the bone marrow. Increased alkaline phosphatase and GGTP with a normal bilirubin is characteristic of hepatic involvement.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1205-1208). . Kindle Edition.

A

Mycobacterium Avium-Intracellulare (MAI)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1204-1205). . Kindle Edition.

154
Q

Diagnostic tests for MAI in descending order of sensitivity

A

Liver biopsy is the most sensitive.

Bone marrow is more sensitive.

Blood culture is the least sensitive.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1209-1211). . Kindle Edition.

155
Q

Rx for MAI

A

Clarithromycin and ethambutal

156
Q

Diagnosis: Animal exposure + Jaundice + Renal

Test and Rx of above patient

A

Leptospirosis

Diagnosed with serology

Rx with ceftriaxone or penicillin

157
Q

Diagnosis: Hunter who touch a rabbit + ulcer at the site of contact + enlarged lymph nodes + conjuctivitis

Test and Rx of above patient

A

Tularemia

Diagnosed with serology

Rx with:

  • Doxycycline (oral)
  • Ciprofloxacine (oral)
  • Aminoglycoside (Streptomycin (IM), gentimicin (IM or IV))
158
Q

Diagnosis: Ate pork meat + CT scan of head showing thin-walled cysts that may be calcified

Rx of above patient

A

Cysticercosis

Rx with albendazole

159
Q

Diagnosis: Camping/hiking + Target-shaped rash

Name given to Target-shaped rash

Causative organism

Vector for causative organism

Teast and Rx of above patient

A

Lyme disease

Erythema migrans

Borrelia burgdorferi

Ixodes genus (deer) tick

Serology for IgM

Oral doxycycline or amoxicillin

160
Q

List the long-term manifestations/complications of Lyme disease

A

Joint involvement (most common late manifestation)

Cardiac: the most common being AV conduction block/defect

Neurologic: the most common being 7th cranial nerve palsy (Bell’s palsy)

161
Q

Diagnosis of long term complications of Lyme disease

A

Serology:

  • IgM
  • IgG
  • ELISA
  • Western blot
  • PCR
162
Q

Lyme disease:

  1. Rx of rash, joint or Bell’s palsy
  2. Rx of CNS or cardiac involvement
A
  1. Oral doxycycline or amoxicillin
  2. IV ceftriaxone
163
Q
  1. Apart from lyme disaese name two other tick-borne diseases tranmitted by Ixodes (deer) tick
  2. What are the actual causative organisms for the diseases in 1
  3. Method of diagnosis and findings
  4. Rx modalities
A
  1. a). Babesiosis; b). Ehrlichia
  2. a). Babesia microti; b). Ehrlichia is GNB in the family of Anaplasmataceae
  3. Peripheral blood smear or PCR: a). tetrads of intraerythrocytic ring forms; b). “morulae”, i.e. inclusion bodies in WBCs
  4. a). Clindamycin and quinine; b). Doxycycline
164
Q

Features of babesiosis

A
  • Common in Northeast
  • Hemolytic anemia
  • Hemolytic anemia is severe in asplenic individuals
165
Q

Features of Ehrlichia

A
  • No rash
  • Elevated LFT (ALT and AST)
  • Thrombocytopenia
  • Leukopenia
166
Q

Rx of acute malaria

A

Quinine and doxycycline

167
Q

Prophylaxis for malaria

A
  • Mefloquine (weekly) or
  • Atovoquone/proguanil (Malarone, daily)
  • Daily doxycycline (NOT the best answer)
168
Q

Side effects of mefloquine

A
  • Neuropsychiatric side effects
  • Sinus bradycardia
  • QT elongation
169
Q

———- gives branching, gram-positive filaments that are weakly acid fast.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1308-1309). . Kindle Edition.

A

Norcadia

170
Q

Norcadia:

  • Best initial test
  • Most accurate test
  • Rx
A
  • Chest X-ray
  • Culture
  • TMP/SMX
171
Q

Norcadia:

  1. Those at risk
    * Most common areas of dissemination of pulmonary disease
A
  1. **Immunocompromised: **
    1. Leukemia
    2. Lymphoma
    3. Prolong steroid use
    4. HIV
  2. Skin and brain
172
Q

Rx of actinomyces

What prediposes an individual to actinomyces

A

Penicillin

Trauma (facial or dental)

Actinomyces is part of the normal mouth flora

173
Q

Clues to histoplasmosis

A
  1. Wet areas: Ohio and Mississippi River valeys
  2. Lung disease with viral syndrome
  3. Associated with bat droppings from caves
  4. Palate and oral ulcers on PE
  5. Slenomegaly on PE

Anything TB can do histoplasmosis can do

174
Q
  • Best initial test
  • Most accurate test
  • Rx of histoplasmosis
A
  • Best initial test: Histoplasmosis urine antigen
  • Most accurate test: Biopsy with culture is most accurate for both histoplasmosis and tuberculosis
  • Acute pulmonary disease is transient and requires no therapy
  • The disseminated disease is treated with amphotericin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1330-1331). . Kindle Edition.

175
Q

———- is an acute respiratory illness that occurs in very dry areas like Arizona. It causes joint pain and erythema nodosum.

Rx for above condition

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1335-1337). . Kindle Edition.

A

Coccidioidomycosis

Itraconazole

176
Q

Diagnosis: Broad budding yeast

Rx of above condition

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1344). . Kindle Edition.

A

Blastomycosis

Amphotericin or Itraconazole

177
Q

What is the IV Rx for methicillin sensitive Staphylococcus Aureus (MSSA)?

A

IV Oxacillin/ nafcillin, or

IV cefazolin (first-generation cephalosporin)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 291-292). . Kindle Edition.

178
Q

What is the oral Rx for methicillin sensitive Staphylococcus Aureus (MSSA)?

A

Dicloxacillin or

Cephalexin (first-generation cephalosporin)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 293). Kindle Edition.

179
Q

What are the drugs of choice for Rx severe resistant Staphylococcus?

A

Vancomycin

Linezolid

Daptomycin

Ceftaroline

Tigecycline

Telavancin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 295-296). Kindle Edition.

180
Q

What are the drugs of choice for Rx minor resistant Staphylococcus?

A

Trimethoprim/ sulfamethoxazole (TMP/ SMX)

Clindamycin

Doxycycline

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 298). . Kindle Edition.

181
Q

Listh the side effects of the following medications:

Daptomycin

Linezolid

Imipenem

A

Daptomycin: myopathy

Linezolid: low platelets

Imipenem: seizures

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 304). . Kindle Edition.

182
Q

What is the altenative in the presence of penicillin allergic as rash?

A

Cephalosporins

183
Q

What is the altenative Rx in the presence of penicillin anaphylaxis?

A

Macrolides (azithromycin, clarithromycin)

Clindamycin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 308). . Kindle Edition.

184
Q

What is the altenative Rx for severe infection in the presence of penicillin allergy?

A

Vancomycin

Linezolid

Daptomycin

Telavancin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 310). . Kindle Edition.

185
Q

What is the altenative Rx for minor infection in the presence of penicillin allergy?

A

Macrolides (azithromycin, clarithromycin)

Clindamycin

TMP/ SMX

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 312). . Kindle Edition.

186
Q

List 3 antibiotics specific for Rx of Streptococcus

A

Penicillin

Ampicillin

Amoxicillin

187
Q

List 6 Gram-negative bacilli (rods)

A

Escherichia coli

Enterobacter

Citrobacter

Morganella

Pseudomonas

Serratia

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 317). . Kindle Edition.

188
Q

List 6 classes of medications and their examples for the Rx of Gram-negative bacilli

A

Cephalosporins (Ex: Cefepime Ceftazidime)

Penicillins (Ex: Piperacillin Ticarcillin )

Monobactam (Ex: Aztreonam )

Quinolones (Ex: Ciprofloxacin Levofloxacin Moxifloxacin Gemifloxacin )

Aminoglycosides (Ex: Gentamicin Tobramycin Amikacin )

Carbapenems (Ex: Imipenem Meropenem Ertapenem Doripenem)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 322-344). . Kindle Edition.

189
Q

Name the only Carbapenem that does not cover Pseudomonas

A

Ertapenem

190
Q

List the two penicillins for Rx of GN bacilli that also cover Streptococci and anaerobes

A

Piperacillin

Ticarcillin

191
Q

List 3 quinolones used for the Rx of GN bacilli that are excellent pneumococcal drugs

A

Levofloxacin

Gemifloxacin

Moxifloxacin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 349-350). . Kindle Edition.

192
Q

————– are excellent antianaerobic medications. They cover streptococci and all sensitive staphylococcus (MSSA).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 351-352). . Kindle Edition.

A

Carbapenems

193
Q

————— work synergistically with other agents to treat staph and strep.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 350-351). . Kindle Edition.

A

Aminoglycosides

194
Q

——————– covers MRSA and is broadly active against gram-negative bacilli.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 353). . Kindle Edition.

A

Tigecycline

195
Q

Gemifloxacin is a ———- for pneumonia.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 354-355). . Kindle Edition.

A

Quinolone

196
Q

Another name for gastrointestinial anaerobes

A

Bacteroides

197
Q

————– is the best medication for abdominal anaerobes.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 359). . Kindle Edition.

A

Metronidazole

198
Q

—————, —————-, and —————- are equal in efficacy for abdominal anaerobes compared to metronidazole.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 361-362). . Kindle Edition.

A

Carbapenems

Piperacillin

Ticarcillin

199
Q

——————– is the best drug for anaerobic strep (respiratory anaerobes).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 367-368). . Kindle Edition.

A

Clindamycin

200
Q

List some medications with no anaerobic coverage

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 369). . Kindle Edition.

A

Aminoglycosides

Aztreonam

Fluoroquinolones

Oxacillin/ nafcillin

All the cephalosporins except cefoxitin and cefotetan

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 370-372). . Kindle Edition.

201
Q

Rx for herpes simplex and varicella zoster

A

Acyclovir

Valacyclovir

Famciclovir

(n/b: they are all of equal efficacy)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 382). . Kindle Edition.

202
Q

Rx for cytomegalovirus (CMV)

A

Valganciclovir

Ganciclovir

Foscarnet

(these agents are also effective against simplex and varicella)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 383-384). . Kindle Edition.

203
Q

Name the best long-term Rx for CMV retinitis

A

Valganciclovir

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 385). . Kindle Edition.

204
Q

Adverse effects of Valganciclovir and ganciclovir

A

Neutropenia

Bone marrow suppression

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 387-388). . Kindle Edition.

205
Q

Adverse effect of foscarnet

A

Renal toxicity

206
Q

Rx for influenza A and B

A

Oseltamivir

Zanamivir

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 390). . Kindle Edition.

207
Q

What class of drugs are oseltamivir and zanamivir

A

Neuraminidase inhibitors

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 390). . Kindle Edition.

208
Q

Use of Ribavirin

A

Hepatitis C (in combination with interferon)

Respiratory syncytial virus (RSV)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 391-392). . Kindle Edition.

209
Q

Rx of chronic hepatitis B

A

Lamivudine

Interferon

Adefovir

Tenofovir

Entecavir

Telbivudine:

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 392-393). . Kindle Edition.

210
Q

Drug of 1st choice for Candida (not Candida krusei or Candida glabrata), Cryptococcus, oral and vaginal candidiasis as an alternative to topical mediations

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 395-396). . Kindle Edition.

A

Fluconazole

Itraconazole (equal to fluconazole but less easy to use; rarely the best initial therapy for anything)

Voriconazole (Covers all Candida; best agent against Aspergillus. Adverse effect: – Some visual disturbance)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 397-400). . Kindle Edition.

211
Q

Best agent against aspergillus

A

Voriconazole

212
Q

Name the family of antifungal agent most excellent for neutropenic fever patients

A

Echinocandins

213
Q

List three examples of Echinocandins

A

Caspofungin

Micafungin

Anidulafungin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 400-401). . Kindle Edition.

214
Q

————– is effective against all Candida, Cryptococcus, and Aspergillus:

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 409-410). . Kindle Edition.

A

Amphotericin B

215
Q

Aspergillus: ———- superior to amphotericin B

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.

A

Voriconazole

216
Q

Neutropenic fever: ————— is superior to amphotericin B

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.

A

Caspofungin

217
Q

Candida: ————– is equal to amphotericin for efficacy but has much fewer adverse effects

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.

A

Fluconazole

218
Q

List the Adverse effects of amphotericin B

A

Renal toxicity (increased creatinine)

Hypokalemia

Metabolic acidosis

Fever, shakes, chills

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 418-422). . Kindle Edition.

219
Q

List the diagnostic testings for osteomyelitis

A

Best initial test: Plain x-ray

Best second-line test (if there is high clinical suspicion and x-ray is negative): MRI

Most accurate test: bone biopsy and culture

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 431-433). . Kindle Edition.

220
Q

What is the earliest finding of osteomyelitis on an x-ray

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 445). . Kindle Edition.

A

Periosteal elevation

221
Q

Which test has greater sensitivity, the MRI or the bone scan?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 470-471). . Kindle Edition.

A

Both have equal sensitivity

222
Q

Which test has greater specificity, the MRI or the bone scan?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 470-471). . Kindle Edition.

A

MRI

223
Q

Best means of monitoring improvement in Rx of osteomyelitis

A

Monitoring ESR

224
Q

Most common cause of osteomyelitis

A

Staphylococcus

225
Q

Why is swimming commonly associated with otitis externa

A

Because swimming washes out the acidic environment normally found in the external auditory canal.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 503). . Kindle Edition.

226
Q

Rx for otitis externa

A

Topical antibiotics, such as ofloxacin or polymyxin/ neomycin.

Add topical hydrocortisone to decrease swelling and itching.

Adding acetic acid and water solution to reacidify the ear can help eliminate the infection.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 509-511). . Kindle Edition.

227
Q

Diagnostic tests for malignant otitis externa

A

Best initial test: Skull x-ray or MRI

Most accurate test: Biopsy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 517-519). . Kindle Edition.

228
Q

Rx of malignant otitis externa

A

Surgical debridement and antibiotics active against Pseudomonas such as ciprofloxacin, piperacillin, cefepime, carbapenem, or aztreonam.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 521-523). . Kindle Edition.

229
Q

Rx of otitis media

A

Best initial therapy: Amoxicillin. Usual course is 7– 10 days; longer for younger patients and shorter for older patients.

Next step: Perform the most accurate test, tympanocentesis and aspirate of the tympanic membrane for culture. This is rarely necessary and is only done for recurrent or persistent cases that fail therapy.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 533-536). . Kindle Edition.

230
Q

List the common bacterial causes of sinusitis or otitis media

A

Streptococcus pnuemoniae

Haemophilus influenzae

Moraxella catarrhalis

231
Q

———- or ———- is the Rx for influenza if the patient presents within the first 48 hours after the onset of symptoms.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 577-578). . Kindle Edition.

A

Oseltamivir or zanamivir

232
Q

Strongest indications for vaccination against influenza

A

COPD

CHF

Dialysis patients

Steroid use

Health care workers

Everyone > 50

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 583-584). . Kindle Edition.

233
Q

Causes of impetigo

A

Streptococcus pyogenes

Staphylococcus aureus

234
Q

Rx of impetigo

A

Topical mupirocin or retapamulin (mupirocin has greater activity against MRSA, bacitracin has less efficacy as a single agent)

Severe disease: Oral dicloxacillin or cephalexin

Community-acquired MRSA (CA-MRSA): TMP/ SMZ; clindamycin is sometimes useful

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 593-595). . Kindle Edition.

235
Q

What is Erysipelas?

A

This is a group A (pyogenes) streptococcal infection of the skin. The skin is very bright red and hot because of dilation of the capillaries of the dermis due to locally released inflammatory mediators

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 602-605). Kindle Edition.

236
Q

What is the most common site of Erysipelas?

A

The face

237
Q

Best initial Rx for Erysipelas

A

Oral dicloxacillin or cephalexin. Topical antibiotics are useless.

If the organism is confirmed as group A beta hemolytic streptococci, you may treat with penicillin VK.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 615-617). . Kindle Edition.

238
Q

What is the basis for lower extremity doppler ultrasonography in cellulitis of the leg?

A

Beacuse both a blod clot and cellulitis may cause fever

239
Q

Rx for cellulitis

A

Minor disease: Dicloxacillin or cephalexin orally

Severe disease: Oxacillin, nafcillin, or cefazolin IV

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 626-628). . Kindle Edition.

240
Q

What skin infection does Staphylococcus epidermidis cause?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 633-634). . Kindle Edition.

A

None. S. epidermidis is a normal commensal inhabitant of the skin. It lives there and does not cause skin infection.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 634-635). . Kindle Edition.

241
Q

What is the difference among folliculitis, furuncles, carbuncles, and boils

A

The only fifference is size. Folliculitis < Furuncles < Carbuncles < Boils

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 636-637). . Kindle Edition.

242
Q

Causative agent for folliculitis, furuncles, carbuncles, and boils.

A

Staphylococcus aureus

243
Q

Rx for folliculitis, furuncles, carbuncles and boils.

A

Minor disease: Dicloxacillin or cephalexin orally

Severe disease: Oxacillin, nafcillin, or cefazolin IV

If large, as in boils, do I & D.

244
Q

Best initial diagnostic test for fungal infection of the skin or nail

A
  • KOH preparation
    1. Scrape the skin or nail.
    2. Place the scraping on a slide with KOH and acid and heat it.
    3. The epithelial cells will dissolve and leave the fungal forms behind, visible on the slide

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 650-654). . Kindle Edition.

245
Q

Rx for fungal infection of the skin and nail

A

Topical antifungal medication (if no hair or nail involvement): Clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin, or ciclopirox

Oral antifungal medication for scalp (tinea capitis) or nail (onychomycosis)

– Terbinafine: Causes increased liver function tests

– Itraconazole

– Griseofulvin (for tinea capitis): Has less efficacy than either terbinafine or itraconazole

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 656-665). . Kindle Edition.

246
Q

Best initial test for urethritis

A

Urethral swab for Gram stain, WBC count, culture, and DNA probe

Nucleic acid amplification tests (NAATs) are highly effective as well

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 672-673). . Kindle Edition.

247
Q

Basic principle for Rx of urethritis

A

Two medications: one for gonorrhea and another for Chlamydia

248
Q

List some gonorrhea medications

A

Ceftriaxone IM

Cefixime oral

Cefpodoxime oral

Ciprofloxacin oral (2nd line)

249
Q

List the medications for Chlamydia urethritis

A

Azithromycin (single dose)

Doxycycline (for one week)

250
Q

Rx for urethritis in pregnancy

A

Ceftriaxone IM and

Azithromycin

251
Q

What predisposes a patient to recurrent infections with Neisseria?

A

Terminal complement deficiency

252
Q

Single best test for gonorrhea and Chlamydia?

A

Nucleic acid amplification test (NAAT)

253
Q

What blood finding is a measure of severity in PID?

A

Leukocytosis

254
Q

Best initial test for PID

A

Pregnancy test, then cervical culture and DNA probe for Chlamydia and gonorrhea

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 722-724). . Kindle Edition.

255
Q

Most accurate test for PID

A

Laparoscopy

256
Q

How to collect samples for nucleic acid amplification test

A

NAAT can be done on voided urine for men or blind vaginal swab in women.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 726-727). . Kindle Edition.

257
Q

Outpatient Rx for PID

A

Ceftriaxone (IM) and doxycycline (oral)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 740). . Kindle Edition.

258
Q

Inpatient Rx of PID

A

Cefoxitin (IV) and doxycycline and maybe metronidazole.

Cefotetan can be used instead of cefoxitin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 741-742). . Kindle Edition.

259
Q

List four family of antibiotics safe in pregancy

A

Penicillins

Cephalosporins

Aztreonam

Macrolides (Azithromycin and Erythromycin)

260
Q

Presentation of epidydimo-orchitis

A

An extremely painful and tender testicle with a normal position in the scrotum.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 750-752). . Kindle Edition.

261
Q

Rx of epidydimo-orchitis

A

< 35 years of age: Ceftriaxone and doxycycline

> 35 years of age: Fluoroquinolone

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 754-755). . Kindle Edition.

262
Q

Causative agent: painful genital ulcer

A

Haemophilus ducreyi

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 760-761). . Kindle Edition.

263
Q

Best initial test for chancroid

A

Swab for Gram stain (gram-negative coccobacilli) and culture (will require specialized medium: Nairobi medium or Mueller-Hinton agar).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 763-764). . Kindle Edition.

264
Q

Rx for chancroid

A

Single IM shot of ceftriaxone or single oral dose of azithromycin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 765-766). . Kindle Edition.

265
Q

Causative agent: Lymphogranuloma venereum (LGV)

A

Chlamydia trachomatis

266
Q

Rx of Lymphogranuloma venereum (LGV)

A

Aspirate the bubo.

Treat with:

  • Ddoxycycline
  • Azithromycin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 773-774). . Kindle Edition.

267
Q

Causative agent: Genital herpes

A

Herpes simplex virus type 2 (HSV2)

268
Q

When is it necessary to do the Tzanck prep test in HSV2

A

If the roofs come off the vesicles and the lesion becomes an ulcer of unclear etiology,

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 785-786). . Kindle Edition.

269
Q

Rx for HSV2

A

Acyclovir

Valacyclovir

Famciclovir

Rx is for 7– 10 days

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 784-785). . Kindle Edition.

270
Q

Rx for acyclovir resistant herpes

A

Foscarnet

271
Q

Rx for HSV2 in pregnancy

A

Acyclovir

272
Q

Rx for cytomegalovirus (CMV)

A

Ganciclovir

273
Q

What is the most accurate test in primary syphilis?

A

Darkfield microscopy. Darkfield microscopy is far more sensitive than a VDRL or RPR in primary syphilis.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 804-805). . Kindle Edition.

274
Q

Rx for primary syphylis

A

Single shot of IM penicillin

275
Q

Rx of primary syphilis in those with penicillin allergy

A

Doxycycline

276
Q

Diagnosis: development of fever, headache, and myalgia within 24 hours after treatment for early stage syphilis.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 810-811). . Kindle Edition.

A

Jarisch-Herxheimer reaction. It is a benign, self-limited reaction caused by the release of pyrogens from dying treponemal. Treat with aspirin and continue the treatment.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 810). . Kindle Edition.

277
Q

Initial diagnostic test for secondary syphilis

A

RPR (Rapid Plasma Reagin)

FTA (Flourescent Treponemal Antibody)

278
Q

Rx for secondary syphilis

A

Single IM shot of penicillin

Use doxycycline for the penicillin-allergy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 815-816). . Kindle Edition.

279
Q

Features of tertiary syphilis

A

Neurosyphilis: Tabes doralis, general paresis, Argyll-Robertson pupil

Gummas

** Aortitis**

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 851-854). . Kindle Edition.

280
Q

Initial diagnostic test for tertiary syphilis

A

RPR and FTA

Lumbar puncture for neurosyphilis (test CSF with VDRL and FTA).

CSF VDRL is only 50 percent sensitive.

Neurosyphilis is excluded with a negative CSF FTA.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 820-821). . Kindle Edition.

281
Q

Rx for tertiary syphilis

A

IV penicillin

If allergic, desensitize

282
Q

Rx of syphilis in pregnancy

A

Desensitization

283
Q

Diagnosis: rare, beefy red genital lesion that ulcerates.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 876-877). . Kindle Edition.

A

Granuloma inguinale

284
Q

What is the diagnostic testing and causative organism for Granulama inguinale

A

Biopsy or “touch prep,”

Klebsiella granulomatis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 879-880). . Kindle Edition.

285
Q

Rx for Granuloma inguinale

A

Doxycycline

TMP/SMX

Azithromycin

286
Q

Compare and contrast pediculosis and scabies

A

Pediculosis Scabies

  • Larger • Small
  • In hair-bearing areas, such as the pubic area or axilla • Burrows in web spaces
  • Visible on the surface • Scrape and magnify
    • Treat with permethrin, pyrethrins, or lindane. • Treat with permethrin, lindane, or ivermectin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 887-898). . Kindle Edition.

287
Q

Rx of Warts

A

Perform surgical removal if large.

Imiquimod is an immunostimulant that leads to sloughing off of the wart.

Cryotherapy, laser removal, and melting with podophyllin are other options.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 902-904). . Kindle Edition.

288
Q

Rx of cystitis

A

Uncomplicated cystitis is treated with TMP/ SMX orally for 3 days, if E. coli resistance in that area is low. If resistance is > 20 percent, then use ciprofloxacin or levofloxacin.

“Complicated” cystitis is treated with 7 days of TMP/ SMX or ciprofloxacin. Complicated means an anatomic abnormality is present, such as a stone, stricture, tumor, or obstruction.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 911-915). . Kindle Edition.

289
Q

When is it right to treat asymptomatic bacteriuria

A

In pregnancy

290
Q

What are the outpatient and inpatient Rx of pyelonephritis

A

Outpatient: Ciprofloxacin

Inpatient: IV Ampicillin + Gentimicin

291
Q

Diagnoses:

  1. Dysuria + white cells in urine + suprapubic tenderness
  2. Dysuria + white cells in urine + flank pain + fever

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 948-950). . Kindle Edition.

A
  1. Cystitis
  2. Pyelonephritis
292
Q

How is clinical diagnosis of endocarditis made

A

Based on the Duke Critera. By the presence of 2 major criteria, or 1 major and 3 minor criteria, or 5 minor criteria.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 979-980). . Kindle Edition.

293
Q

List the major Duke’s criteria

A
  1. Two positive cultures with:
  • Staphylococcus aureus
  • Viridans streptococci, Streptococcus bovis/ epidermis, enterococci, gram-negative rods, Candida

HACEK organisms are generally culture-negative

  • Haemophilus aphrophilus/ parainfluenzae
  • Actinobacillus actinomycetemcomitans
  • Cardiobacterium hominis
  • Eikenella corrodens
  • Kingella kingae
  1. Abnormal echocardiogram
  • Intracardiac mass or valvular vegetation OR
  • Abscess OR
  • New partial dehiscence of prosthetic valve

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 987-1006). . Kindle Edition.

294
Q

List the minor Duke’s criteria

A

Fever (> 38.0 ° C)

Presence of risk factors:

  • IV drug use (IDU)
  • Presence of structural heart disease
  • Prosthetic heart valve
  • Dental procedures involving bleeding
  • History of endocarditis

Vascular findings:

  • Janeway lesions
  • Septic pulmonary infarcts
  • Arterial emboli
  • Mycotic aneurysm
  • Conjunctival hemorrhage

Immunological findings:

  • Roth spots
  • Osler’s node
  • Glomerulonephritis

Microbiologic findings:

  • One positive blood culture but does not meet major criteria

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1007-1017). . Kindle Edition.

295
Q

Best empiric therapy for infective endocarditis

A

Vancomycin + Gentimicin

296
Q

Indications for surgery in infective endocarditis

A

Valve rupture

Abscess

Prosthetic valves

Fungal endocarditis

Embolic events once already started on antibiotics

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1070-1077). . Kindle Edition.

297
Q

List the cardiac defects requiring prophylaxis against infective endocarditis

A

Prosthetic valves

Unrepaired cyanotic heart disease

Previous endocarditis

Transplant recipients who develop valve disease

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1080-1081). . Kindle Edition.

298
Q

List the procedures requiring prophylaxis against infective endocarditis

A

Dental procedures that cause bleeding: The prophylactic antibiotic to use for dental procedures is amoxicillin. For penicillin-allergic patients, clindamycin is the drug of choice.

Respiratory tract surgery

Surgery of infected skin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1083-1085). . Kindle Edition.

299
Q

Procedures not requring prophylaxis against infective endocarditis

A

Dental fillings

All flexible scopes

All OB/ GYN procedures

All urinary procedures, including cystoscopy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1087-1088). . Kindle Edition.

300
Q

Cardiac defects not requiring prophylaxis against infective endocarditis

A

Aortic stenosis or regurgitation

Mitral stenosis or regurgitation

Atrial or ventricular septal defects

Pacemakers and implantable defibrillators

Mitral valve prolapse, even if there is a murmur

HOCM (IHSS)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1090-1092). . Kindle Edition.

301
Q

Name an example of fusion inhibitor

A

Enfuvirtide (T20)

302
Q

Common side effects of enfuvirtide (T20)

A

Injection site reactions

303
Q

Diagnosis: HIV patient with shortness of breath, dry cough, hypoxia, and increased LDH.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1162-1163). . Kindle Edition.

A

PCP

304
Q

PCP investigation:

  1. Best initial diagnosis
  2. Most accurate diagnosis
A
  1. A chest x-ray will show increased interstitial markings bilaterally
  2. Bronchoalveolar lavage

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1164-1166). . Kindle Edition.

305
Q

Rx of PCP opportunistic infection in HIV patient

A

IV TMP/ SMX

If there is a rash, use IV pentamidine

Atovaquone can be used for mild pneumocystis

Dapsone is not intravenous and is used for prophylaxis, not treatment

If PCP is severe (pO2 < 70 or A-a gradient > 35), then give steroids

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1167-1171). . Kindle Edition.

306
Q

Diagnosis: HIV positive patient with headache, nausea, vomiting, and focal neurologic findings.

What is the best initial test for above patient?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1173). . Kindle Edition.

A

Diagnosis: Toxoplamosis

Best initial test: head CT with contrast showing “ring” or contrast-enhancing lesions.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1174). . Kindle Edition.

307
Q

Rx for toxoplasmosis

A

Pyrimethamine and sulfadiazine for 2 weeks and repeat the CT scan.

If the lesions are smaller, then this is confirmative of toxoplasmosis. If the lesions are unchanged in size, then perform a brain biopsy, since this is most likely lymphoma.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1175-1177). . Kindle Edition.

308
Q

Daignosis: HIV with < 50 CD4 cells and blurry vision.

Rx for above patient

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1179-1180). . Kindle Edition.

A

Cytomegalovirus (CMV)

Rx: Ganciclovir or foscarnet (if resistant to ganciclovir)

Maintenance therapy is with oral valganciclovir lifelong, unless the CD4 goes up with HAART. If the CD4 rises, you can stop the CMV medications.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1183-1185). . Kindle Edition.

309
Q

Diagnosis: HIV and < 50 CD4 cells with fever and headache.

Best initial test for above patient

Most accurate test for aove patient

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1187-1188). . Kindle Edition.

A

Cryptococcus

The best initial test is an India ink stain, which has about a 60 percent sensitivity.

The most accurate test is a cryptococcal antigen test, which is over 95 percent sensitive and specific.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1189-1191). . Kindle Edition.

310
Q

Rx of cryptococcus

A

Treat initially with amphotericin, followed by fluconazole.

The fluconazole is continued lifelong unless the CD4 count rises.

If the CD4 count rises, all opportunistic infection treatment and prophylaxis can be stopped.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1194-1196). . Kindle Edition.

311
Q

Diagnosis: HIV and < 50 CD4 cells with focal neurologic abnormalities.

What is the best initial test for above patient?

Rx for above patient

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1199-1200). . Kindle Edition.

A

Progressive Multifocal Leukoencephalopathy (PML)

CT head or MRI brain: No ring enhancement is seen

No specific Rx. Rx with HAART. PML resolves with improvement with HAART

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1198). . Kindle Edition.

312
Q

Diagnosis: HIV and < 50 CD4 cells. There is wasting with weight loss, fever, and fatigue. Anemia is frequent from invasion of the bone marrow. Increased alkaline phosphatase and GGTP with a normal bilirubin is characteristic of hepatic involvement.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1205-1208). . Kindle Edition.

A

Mycobacterium Avium-Intracellulare (MAI)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1204-1205). . Kindle Edition.

313
Q

Diagnostic tests for MAI in descending order of sensitivity

A

Liver biopsy is the most sensitive.

Bone marrow is more sensitive.

Blood culture is the least sensitive.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1209-1211). . Kindle Edition.

314
Q

Rx for MAI

A

Clarithromycin and ethambutal

315
Q

Diagnosis: Animal exposure + Jaundice + Renal

Test and Rx of above patient

A

Leptospirosis

Diagnosed with serology

Rx with ceftriaxone or penicillin

316
Q

Diagnosis: Hunter who touch a rabbit + ulcer at the site of contact + enlarged lymph nodes + conjuctivitis

Test and Rx of above patient

A

Tularemia

Diagnosed with serology

Rx with:

  • Doxycycline (oral)
  • Ciprofloxacine (oral)
  • Aminoglycoside (Streptomycin (IM), gentimicin (IM or IV))
317
Q

Diagnosis: Ate pork meat + CT scan of head showing thin-walled cysts that may be calcified

Rx of above patient

A

Cysticercosis

Rx with albendazole

318
Q

Diagnosis: Camping/hiking + Target-shaped rash

Name given to Target-shaped rash

Causative organism

Vector for causative organism

Test and Rx of above patient

A

Lyme disease

Erythema migrans

Borrelia burgdorferi

Ixodes genus (deer) tick

Serology for IgM

Oral doxycycline or amoxicillin

319
Q

List the long-term manifestations/complications of Lyme disease

A

Joint involvement (most common late manifestation)

Cardiac: the most common being AV conduction block/defect

Neurologic: the most common being 7th cranial nerve palsy (Bell’s palsy)

320
Q

Diagnosis of long term complications of Lyme disease

A

Serology:

  • IgM
  • IgG
  • ELISA
  • Western blot
  • PCR
321
Q

Lyme disease:

  1. Rx of rash, joint or Bell’s palsy
  2. Rx of CNS or cardiac involvement
A
  1. Oral doxycycline or amoxicillin
  2. IV ceftriaxone
322
Q
  1. Apart from lyme disaese name two other tick-borne diseases tranmitted by Ixodes (deer) tick
  2. What are the actual causative organisms for the diseases in 1
  3. Method of diagnosis and findings
  4. Rx modalities
A
  1. a). Babesiosis; b). Ehrlichia
  2. a). Babesia microti; b). Ehrlichia is GNB in the family of Anaplasmataceae
  3. Peripheral blood smear or PCR: a). tetrads of intraerythrocytic ring forms; b). “morulae”, i.e. inclusion bodies in WBCs
  4. a). Clindamycin and quinine; b). Doxycycline
323
Q

Features of babesiosis

A
  • Common in Northeast
  • Hemolytic anemia
  • Hemolytic anemia is severe in asplenic individuals
324
Q

Features of Ehrlichia

A
  • No rash
  • Elevated LFT (ALT and AST)
  • Thrombocytopenia
  • Leukopenia
325
Q

Rx of acute malaria

A

Quinine and doxycycline

326
Q

Prophylaxis for malaria

A
  • Mefloquine (weekly) or
  • Atovoquone/proguanil (Malarone, daily)
  • Daily doxycycline (NOT the best answer)
327
Q

Side effects of mefloquine

A
  • Neuropsychiatric side effects
  • Sinus bradycardia
  • QT elongation
328
Q

———- gives branching, gram-positive filaments that are weakly acid fast.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1308-1309). . Kindle Edition.

A

Norcadia

329
Q

Norcadia:

  • Best initial test
  • Most accurate test
  • Rx
A
  • Chest X-ray
  • Culture
  • TMP/SMX
330
Q

Norcadia:

  1. Those at risk
    * Most common areas of dissemination of pulmonary disease
A
  1. **Immunocompromised: **
    1. Leukemia
    2. Lymphoma
    3. Prolong steroid use
    4. HIV
  2. Skin and brain
331
Q

Rx of actinomyces

What prediposes an individual to actinomyces

A

Penicillin

Trauma (facial or dental)

Actinomyces is part of the normal mouth flora

332
Q

Clues to histoplasmosis

A
  1. Wet areas: Ohio and Mississippi River valeys
  2. Lung disease with viral syndrome
  3. Associated with bat droppings from caves
  4. Palate and oral ulcers on PE
  5. Slenomegaly on PE

Anything TB can do histoplasmosis can do

333
Q
  • Best initial test
  • Most accurate test
  • Rx of histoplasmosis
A
  • Best initial test: Histoplasmosis urine antigen
  • Most accurate test: Biopsy with culture is most accurate for both histoplasmosis and tuberculosis
  • Acute pulmonary disease is transient and requires no therapy
  • The disseminated disease is treated with amphotericin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1330-1331). . Kindle Edition.

334
Q

———- is an acute respiratory illness that occurs in very dry areas like Arizona. It causes joint pain and erythema nodosum.

Rx for above condition

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1335-1337). . Kindle Edition.

A

Coccidioidomycosis

Itraconazole

335
Q

Diagnosis: Broad budding yeast

Rx of above condition

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1344). . Kindle Edition.

A

Blastomycosis

Amphotericin or Itraconazole

336
Q

What is the most accurate test in diagnosing osteomyelitis in the vertebra and in diabetic foot?

A

MRI

USMLE Step 3 (15 decks)

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