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[2a] A ⼀ Step 2 OD USLME > ✅Infectious Disease > Flashcards

✅Infectious Disease Flashcards

1
Q

What is the single question screening for EtOH abuse

A

do you ever have > 5 (>4 in Women) drinks in one occasion?

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2
Q

What’s the most common type of transfusion rxn

________________

what’s the etx?

________________

tx?

A

[Febrile Non-Hemolytic transfusion rxn]

________________

[(1-6h) after blood transfusion, pre-contained cytokines ➜ [Febrile non-hemolytic transfusion rxn]

________________

tx = APAP

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3
Q

[FUO-Fever of Unknown Origin];

diagnositc criteria -3

A

FUO = Prolonged Fever w/out established etx

  1. [> 3 weeks]
  2. [Dx still uncertain after 3 days]
  3. [≥ 3 hospitilization or outpatient visits]
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4
Q

Which vaccines should be given to HIV pts with CD4 LESS THAN 200?-4

A
  1. Pneumococcal
  2. Flu (inactivated)
  3. Hep A
  4. Hep B
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5
Q

Objective findings for Mycobacterium Avium Complex-4

A

Widespread Reticuloendothelial system involvement…

  1. [Hepatomegaly –> ⬆︎AT(Aminotransferases) & ALP]
  2. Splenomegaly
  3. LAD
  4. ⬆︎Lactate DeHydrogenase
    * MAC pts have Fever/Diarrhea/Wt loss*
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6
Q

In HIV pts, when is px against MAC indicated? Name the px

A

CD4 < 50; Azithromycin

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7
Q

In HIV pts, when is px against Toxoplasmosis Gondii indicated? Name the px

A

CD4 < 100; Bactrim

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8
Q

In HIV pts, when is px against PCP indicated? Name the px

A

CD4 < 200; Bactrim

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9
Q

CD4 Count Normal range

A

500 - 1500 cells/µL

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10
Q

Best immediate tx for Septic pt is _____

A

[10-20 cc/kg Fluid Resuscitation (NS vs LR) over 30 min]

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11
Q

How does Fever affect volume status?

A

Fever –> ⬆︎Metabolism –> DEHYDRATION & Inflammation

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12
Q

Initial mngmt of Bacterial Meningitis-4

A

FBLA

1st: Fluid Resuscitation
2nd: Blood Cx
3rd: Lumbar puncture BEFORE ABX (unless pt requires Head CT 1st or is critically ill and can’t receive lumbar puncture)

**4th**: Abx: VACS Empirically (Vanc,AmpicillinGent,CefTriaxone,Steroids)

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13
Q

Fever, Weight loss and Night sweats should always make you think about ⬜ or ⬜

A

[lymphoma B symptoms]

or

[TB]

FML “fuck my life”: Fever/Mnight sweats/Loss wt

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14
Q

Common causes of FUO in general pop -8

A
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15
Q

When should PEP (Post Exposure Px) for incidental HIV exposure began?

________________

What regimen should be given?

________________

for how long?

A

WITHIN 72 HOURS

________________

Triple drug regimen

________________

28 days long!

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16
Q

MIC for moderate resistant?

A

0.1 - 1

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17
Q

MIC for VERY resistant?

A

> 1

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18
Q

Empiric tx for Meningitis-4 (before cx returns)

A

Good MDs VACS out the meninges!

Vanc + Amp + CefTriaxone + [Steroids for Strep]

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19
Q

Pyuria indicates UTI. What is the WBC for Pyuria?

A

>10 WBC on hpf

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20
Q

Brudzinski’s sign is used to diagnose ⬜

________________

Describe it

A

Meningitis

________________

Involuntary hip flexion when neck is passively flexed

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21
Q

Kernig sign is used to diagnose ⬜

________________

Describe it

A

Meningitis

________________

With [hip flexed 90º] and [knee flexed 90º] extension of knee –> ⬆︎neck pain & resistance

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22
Q

Organisms requiring Droplet precaution -6

A
  1. Flu
  2. Rhinovirus
  3. Neisseria Meningiditis
  4. GASP
  5. Bordatella
  6. Adenovirus
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23
Q

Organisms requiring AIRBOURNE (and not just droplet) precaution -5

A
  1. TB
  2. Varicella
  3. Smallpox
  4. [Measles RubeOla]
  5. Coronavirus (SARS/MERS)

Airbourne = N95 Facemask + Negative Pressure Room

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24
Q

Most common pathogens for HOSPITAL Acquired Infection-9

A
  1. Pseudomonas
  2. Staph A
  3. Staph epidermidis
  4. E. Coli
  5. Enterococcus
  6. Enterobaacter
  7. Candida
  8. Klebsiella
  9. Oxytoca
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25
Q

Describe Serology for Hepatitis B -7

A

S - SEC - SCEb - Core - CEbSAb - CSAB - SAb

  • • unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
  • • CSAB = RESOLVED HEP B INFECTION*
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26
Q

Physiology of Chills-2

A

Infection–>Cytokines–>influences hypothalamus to ⬆︎ body temp set point–>

  1. Muscles repetively contract (shivering)
  2. Peripheral vasoconstriction–> “cold” sensation
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27
Q

Complications of PNA -3

A
  1. SEPSIS
  2. Parapneumonic effusion–> Empyema
  3. Pulm vessel infiltration –>Seeding (Heart, Meninges)

Consider these when pt treated for PNA isn’t getting better

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28
Q

Which vaccines are given to a s/p PNA pt?-2

________________

What are their Risk/Benefit?

A
  1. Flu: Risk= less effective in elderly / Benefit= ⬇︎mortality & occurrence
  2. Pneumococcal: Risk=does NOT ⬇︎ occurrence / Benefit= does ⬇︎ invasive dz from S.Pneumo
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29
Q

Tx for Bacterial endocarditis - 4

A
  1. Staph Aureus= Vanc
  2. Staph Epidermidis= Vanc
  3. [Strep Virdans = [CefTriaxone or aPG]]
  4. Enterococcus = [amp/gent]

________________

(aPG = aqueous Pencillin G IV)

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30
Q

Major culprits of Bacterial endocarditis - 4

A
  1. Staph Aureus = Vanc
  2. Staph epidermidis = Vanc
  3. Strep Virdans = [CefTriaxone or aPG]
  4. Enterococcus = [amp/gent]

________________

aPG = aqueous PCN G

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31
Q

Name the mainstay Drugs for Staph Aureus (8)

A

i Love Cute Crazy Deranged Boys N’ TV

  1. Linezolid
  2. Clindamycin
  3. [CefTaroline 5° generation]
  4. Daptomycin
  5. [Bactrim - Skin Infection]
  6. [Nafcillin - MSSA only]
  7. Tigecylcine
  8. Vancomycin
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32
Q

Classic Sx Triad of Brain Abscess

A
  1. Fever
  2. HA
  3. Focal Neuro changes (seizure)
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33
Q

A Single ring-enhancing Brain Abscess in immunoCOMPETENT pt results from what organisms?-2

________________

How would you diganose this?

A

[Staph Aureus] vs [Strep Viridans]

________________

CT-guided aspiration for cx

Toxo and Nocardia would occur in immunocomp pts

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34
Q

Tx for Congenital syphillis

A

[aPG 50,000 u/kg/dose]

[q10h]

[x 10 days]

________________

(aPG = aqueous PCN G -IV) / (**MU = million units)

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35
Q

Tx for Syphilis :

[Early latent <12 mo]⼀[Primary Chancre]⼀[Secondary Systemic Sx]

A

[BPG 2.4MU]

x 1

________________

(BPG = BENZATHINE PCN G -IM) / (**MU = million units)

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36
Q

What other stages of Syphilis share the SAME TREATMENT as

[Early latent <12 mo] -2

A

[Primary Chancre]

[Secondary Systemic sx]

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37
Q

What other stages of Syphilis share the SAME TREATMENT as

[Late latent ≥12 mo] -3

A

[unknown duration], [+Gummas] or [+CV sx]

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38
Q

Tx for Syphilis :

[Late latent ≥12 mo], [unknown duration], [+Gummas] or [+CV sx]

A

[BPG 2.4MU]

[q week]

[x 3 weeks]

________________

(BPG = BENZATHINE PCN G -IM) / (**MU = million units)

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39
Q

Tx for Neurosyphillis

A

[aPG 3-4MU]

[q4h]

[x 10-14 days]

________________

(aPG = aqueous PCN G - IV) / (**MU = million units)

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40
Q

In an immunocompromised pt, EBV DNA in the CSF raises suspicion for what condition?

A

Primary CNS lymphoma

MRI: Solitary Weakly ring-enhancing mass in periventricular region

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41
Q

Describe the MRI findings for Primary CNS lymphoma

A

Solitary Weakly ring-enhancing mass in periventricular region

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42
Q

You find this MRI in an immunocompromised pt

Identify Disease

A

PML (Progressive Multifocal Leukoencephalopathy) 2/2 [John Cunningham Polyoma Virus]

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43
Q

What are the 2 environments Clostridium Botulinum likes to germinate spores?

A
  1. Improperly Canned Foods
  2. Cured Fish

Tx = Equine Heptavalent Antitoxin

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44
Q

MOD for [Carcinoid Syndrome Heart Disease]

A

[R sided endocardial fibrosis] —> [Pulmonic and Tricuspid Valve Stenosis] or [Restrictive Cardiomyopathy]

CarcinoiD Syndrome: (Cutaneous Flushing)/Diarrhea/(SOB wheezing)

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45
Q

Describe [Libman Sacks Endocarditis]

A

[Non-bacterial wart-like vegations] accumulate on either side of a heart valve –> Fibrotic Valve Thickening–> MI

Associated with SLE Lupus

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46
Q

What 2 diseases is Streptococcus Gallolyticus Bovis associated with?

A
  1. [SBE-SubAcute Bacterial Endocarditis in pts WITH COLON INVOLVEMENT] (Aortic Regurgitation) (SBE also caused by Strep Viridans or Mutans)​
  2. [GI Lesions –> Colon CA]

AKA S. Bovis

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47
Q

Name the manifestations of Infective Endocarditis (7)

A

“Bacteria FROM JANE”

Fever

[Retinal Roth Spots - Immunologic phenomena]

[Osler “Ouch” Nodes- Immunologic phenomena]

[MVP with regurgitation]

[Janeway lesions on palms/sole]

Anemia

[Nailbed Subungal Splinter Hemorrhages] - shown in image

[Emboli from valvular vegetations] - may appear as abscesses or nodular cavities on imaging!

These will be accompanied by ⬆︎⬆︎⬆︎ESR

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48
Q

Which Dz’s cause EITHER OR Mitral vs. Tricuspid Regurgitation (2)

A

Rheumatic Fever and [Infective Endocarditis]

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49
Q

What are the 2 major concerns for Kidneys in IV drug users?

A
  1. renal ischemia 2/2 septic emboli
  2. Immune-mediated Glomerulonephritis
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50
Q

Hydatid Cyst with eggshell calcification are caused by _______.

________________

What is the definite host for this?

A

Echinococcus granulosus

________________

DOGS

cyst reside in sheep(intermediate host), which are fed to dogs(definite host). Dog poop contaminates water/food, and that water/food is consumed by Humans. Eggs hatch in small intestine, penetrate wall and travel to Liver where Hydatid cyst form

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51
Q

Pyogenic liver abscess follows after what 2 events?

A

[Appendicitis (GI infection)]

Surgery

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52
Q

What is the triad for Congenital Rubella Syndrome?

________________

How do you prevent this?

A
  1. [Sensorineural Hearing loss]
  2. [BL Cataracts]
  3. PDA

________________

Live Rubella vaccine prior to conception

________________

Dx = Rubella IgM vs PCR (Transmission occurs 1st trimester)

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53
Q

Describe the cutaneous manifestation of blastomycosis

A

[well circumscribed raised violaceous (wart like) nodules –> microabscess]

Blastomycosis causes Skin, Pulmonary and Bone findings

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54
Q

Describe cutaneous Sporotrichosis

A

pustular and ulcerated lesion localized to site of inoculation

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55
Q

Clinical presentation for Vertebral Osteomyelitis-4

________________

Dx?-3

A
  1. FOCAL SPINAL TENDERNESS
  2. Fever +/-
  3. [ESR>100 and/or ⬆︎Platelets but normal spinalXR] (WBC may be normal!)

________________

Dx = [spinalXR, Bcx, ESR/CRP] –> MRI –> [CT guided bx]

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56
Q

Most common causes of Travelers’ Diarrhea - 4

A
  1. Giardia
  2. CryptoSPoridium (parasite) - can still occur in immunocompetent pts!
  3. Cyclospora
  4. ETEC

Profuse watery diarrhea after traveling

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57
Q

Describe the oral involvement for Hand Foot Mouth disease (Coxsackie A)

A

grayish vesicles on the tonsillar pillars and posterior oropharynx that –> fibrin-coated ulcerations

doesn’t have to have hand or foot involvement

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58
Q

Dx for EBV infectious mono - 2

A
  1. [positive HAMS] (only accurate for 1 week after sx start)
  2. Anti-EBV test

________________

  • HAMS = [Heterophile Antibody MonoSpot]*
  • No sports for ≥3weeks because of splenomegaly!*
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59
Q

What is the management for a pt who comes in with a tick on their arm? - 2

A

REMOVE TICK with forceps

+

Abx px/tx within 3 days only if..

  1. pt is symptomatic
  2. if tick is attached ≥36hrs OR
  3. Tick is engorged OR

Abx = Doxy OR [Amoxicillin if pt <8 yo]

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60
Q

Triad for Disseminated Gonococcal infection

A

STD

  1. Several migratory arthralgias
  2. Tenosynovitis pain along tendon sheaths
  3. Dermatitis pustular rash

pts may NOT have urinary or pelvic sx with Disseminated Gonococcal infection!

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61
Q

What are the most common causes of viral aseptic meningitis in kids - 2

A
  1. Echovirus
  2. Coxsackie
62
Q

What are the 4 examples of Strep Viridans

A

the Viridan MOMS

  1. Mutans
  2. Oralis
  3. Mitis
  4. Sanguinis
63
Q

clinical presentation for Walking Atypical PNA - 3

A
  1. INCESSANT DRY COUGH in teen/young adult/military
  2. nonexudative pharyngitis
  3. Fever malaise

CXR = ⬆︎interstitial infiltrates +/- pleural effusion

64
Q

Identify

A

Erysipelas from GASP

Erythematous, warm, tender, rash with raised demarcated borders +/- external ear involvement

65
Q

What are the px recommendations for HIV pts with CD4 < 200

A

Poor

Bactrim

66
Q

When can pts with pyelonephritis be transitioned to PO abx?

A

If sx are improved at the 48 hour mark pts can be transitioned to PO (i.e. Bactrim or Levofloxacin) abx

67
Q

Pt presents with splenic abscess

What are the risk factors for splenic abscess? - 5

A
  1. INFECTIVE ENDOCARDITIS
  2. IVDA
  3. Immunosuppression
  4. Trauma
  5. Hemoglobinopathy
68
Q

Pt presents with 2 month productive cough

dx?

A

Reactivation TB

(cavitary UPPER lung lesion)

This is different from Aspiration PNA since Aspiration PNA occurs in LOWER lobes

69
Q

A family member is diagnosed with Bordatella Pertussis

Which class of abx are given?

________________

Should the other family members receive anything?

A

Macrolides

________________

YES. ALL CLOSE CONTACTS should receive Macrolide px

70
Q

Organisms associated with Bloody Diarrhea - 6

A

Inflammatory Bloody diarrhea is not SEECSY!

  1. Shigella
  2. EColi EHEC - shiga toxin
  3. Entamoeba histolytica
  4. Campylobacter
  5. Salmonella
  6. Yersinia Enterocolitica
71
Q

Diagnosis?

A

Swiss Cheese Head CT

Neurocysticercosis from Taenia cestaode helminths

72
Q

How does transmission of Hydatid cyst to Humans occur?

A

Echinococcus granulosus

[EG Cyst] reside in sheep(intermediate host)

Dogs eat Sheep ➜ Dog poop contaminates [Human water/food] with [EG eggs]

Humans consume contaminated water/food ➜ [EG eggs] hatch in small intestine,

[EG eggs] penetrate [small intestinal wall] and travel to Liver where Hydatid cyst form

________________

Dx = US / Tx = [Cyst<5cm=Albendazole]

73
Q

Most esophagitis in HIV pts is caused by _____. When is this NOT the case?

A

Candida; pts with sole odynophagia who have no thrush nor difficulty swallowing = viral (HSV, CMV) esophagitis

74
Q

When is the 13 valent pneumococcal vaccine recommended?-2 ; What about the 23 valent pneumococcal vaccine?

A

13 = [Adults ≥65 yo x 1 –> PCV23 6 mo later] OR [Adults <65 yo with RF x 1 (SickleCell/CochlearImplant/RenalFailure/HIV)]

23 alone = [Adults <65 yo with RF x 1] (Heart/Lung/Liver/DM/Smoker)

75
Q

Diagnosis?

A

Miliary TB

CP: SLOW progression of fever, wt loss, night sweats, COUGH

76
Q

Where are the most common sites for Kaposi Sarcoma?- 4

A
  1. Face
  2. Mouth
  3. Genitals
  4. Legs

papules –> violaceous plaques or nodules

77
Q

What are the most common organisms to cause Sinus infection (Rhinosinusitis)? - 3

________________

Tx?

A

Strep Pneumo > HFlu nontypeable > moraxella

________________

Tx = Amoxicillin/clavulanate

78
Q

clinical presentation for Disseminated MAC - 3

Mycobacterium Avium Complex

A
  1. Splenomegaly
  2. ALP⬆︎
  3. Systemic sx (fever, diarrhea, cough)
79
Q

clinical presentation for Disseminated Histoplasmosis - 4

A

“Histoplasma spreads to PBS L”

  1. Pulmonary
  2. [Blood (pancytopenia 2/2 marrow infiltration)]

3 [Skin (Mucocutaneous papules/nodules)]

  1. [Lymphatic RES involvement]

________________

  • RES = ReticuloEndothelial System (Lymph node/Spleen/Liver)*
  • Dx = serum or urine Histoplasma antigen immunoassay*
80
Q

Most common side effects of INH isoniazid

A

Injuries to Nerves and Hepatocytes

Neuropathy (Pyridoxine B6 = tx/px)

Hepatitis - THIS IS SELF LIMITED AND RESOLVE WITHOUT INTERVENTION

81
Q

name the organisms sickle cell disease pts are at most risk of acquiring?-3 ; Which is most common and why?

A

SHiN = encapsulated organisms

  1. Strep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes!
  2. HFlu B
  3. Neisseria Meningitidis

these happen to asplenic pts because they have ⬇︎antibody mediated phagocytosis and complement activation

82
Q

What are the potential complications of orbital cellulitis - 3

Biggest RF: Bacterial Sinusitis

A
  1. Orbital abscess
  2. intracranial infection
  3. cavernous sinus thrombosis
83
Q

Pt presents with signs of Sarcoidosis but rapidly deteriorates after being given steroids

Dx?

A

Histoplasmosis

Mississippi and Ohio River basins

84
Q

Pts who’ve undergone solid organ transplantation are at risk of acquiring what 2 infections?

A
  1. CMV (ganciclovir/valganciclovir px)
  2. PCP (Bacterim px)
85
Q

PCN IM is the first line tx for Syphilis.

The alternative tx to Syphilis is ____. When is it indicated to desensitize and still give PCN?-3

A
  1. Pregnancy (No DOXY for POXY)
  2. 3° CNS syphilis
  3. refractory to initial tx
86
Q

How do you know when a pt if fully cured from Syphilis?

A

4-fold ⬇︎in FTA Ab titer by 12 month mark AT THE LATEST

87
Q

An unvaccinated pt to Hepatits B has just been acutely exposed and positive S and E antigen (SEC)

What do you give them? - 2

A
  1. Hep B Immunoglobulin
  2. Hep B VACCINE still

unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin

88
Q

Empiric tx for Viridans Strep - 2

A
  1. PCN G aqueous IV x4wks OR
  2. Ceftriaxone IV x 4wks
89
Q

Which viral illness is associated with pancytopenia?

A

EBV

Platelet thrombocytopenia

Anemia from autoimmune hemolytic anemia

Neutrophil/WBC ⬇︎ with atypical lymphocyte on blood smear due to viral suppression

90
Q

What is the triad for Trichinellosis

A
  1. PeriOrbital edema
  2. Myositis (⬆︎CK)
  3. Eosinophilia

________________

This is preceded by GI compaints and can be a/w [nailbed subungual splinter hemorrhages] as well!

91
Q

At what CD4 are HIV pts at risk for Candida Esophagitis?

________________

tx?-2

A

CD4<100

________________

  1. Fluconazole PO
  2. Esophagoscopy with bx/cx if refractory to rx
92
Q

What is the management for a patient bitten by a Cat? -2

A

(irritation ➜ [amox/clav] )

________________

Cat bites are DEEP PUNCTURE WOUNDS AT RISK for Pasteurella and oral anaerobes

93
Q

From a lab perspective, how do you differentiate CMV from EBV?

A

CMV will have a [negative HAMS]

________________

HAMS = [Heterophile Antibody MonoSpot]

94
Q

Dx? - 2

A
  1. EBV
  2. CMV
95
Q

Which organism should you suspect if a pt with PNA also c/o Diarrhea?

A

Legionella

96
Q

What are the risk factors for TB - 4

A
  1. Homelessness
  2. Alcoholism
  3. Immunosuppression
  4. Healthcare worker

Disseminated TB affects peritoneum, cervical lymph nodes, eyes, bones and skin

97
Q

When is the Rabies Vaccine and Immunoglobulin indicated?-2

________________

What do you do if this is NOT the case?

A
  1. Animal is unavailable
  2. Animal is symptomatic

________________

Pet Observation x 10 days or Test Wild Animals to determine need for Rabies px

98
Q

Ventilator associated PNA occurs how long after intubation?

________________

What’s the first 2 steps in mngmt for these pts

A

≥48 hrs

________________

1st: lower respiratory tract Gram stain and culture
2nd: Empiric abx

99
Q

The most common predisposing factor for Acute Bacterial Sinusitis is what?

A

preceding viral URI

100
Q

The Hepatitis A vaccine is recommended for which groups - 3

A
  1. Travelers going to countries where HepA is present
  2. Gay Men
  3. Chronic Liver Disease

Hepatitis A can cause SIGNIFICANT but benign TRANSAMINITIS so do not be alarmed by this

self limited to 1 month

101
Q

What are the generalized signs of ANY congenital TORCH infection - 3

A
  1. Hepatosplenomegaly
  2. Blueberry muffin spot rash
  3. Jaundice
102
Q

Name the specific signs of congenital syphilis - 3

A
  1. Rhinorrhea
  2. Maculopapular rash ofo the palms and soles that dequamates or becomes bullous
  3. Abnormal long bone xrays (i.e. metaphyseal lucency)
103
Q

Leprosy is a [chronic mycobacterial granulomatous disease]

How does it present?-2

________________

Dx?

A
  1. Macular Anesthetic hypopigmented skin lesions with raised borders (looks more irregular than Erythema Multiforme)
  2. Nodular Painful nearby nerves with ⬇︎sensory & motor function

________________

[Dx = FULL THICKNESS Skin bx of lesion]

________________

Tx = Rifampin WITH Dapsone

104
Q

Leprosy is a chronic mycobacterial granulomatous disease

Tx? - 2

A
  1. Rifampin WITH
  2. Dapsone
105
Q

Coccidioides cp - 4

A
  1. CA-acquired PNA (fever, cp, cough, lobar infiltrate)
  2. Arthralgias
  3. Ertyehma Nodosum
  4. Erythema Multiforme

Health pts do NOT require antifugal therapy

106
Q

How is Neurocysticercosis transmitted?

A

ingestion of undercooked PORK that contains Taeia solium tapeworm EGGS

Imaging: swiss cheese CT (image below) or cystic lesion with surrounding edema

107
Q

Tx for HIGHLY CONTAGIOUS [Pinworm Enterobius Vermicularis] - 2

A
  1. Albendazole
  2. Pyrantel Pamoate
108
Q

Which bacteria is described as Rocky Mountain Spotted Fever without the spots?

________________

What other major lab findings are associated with this bacteria? -3

A

Ehrlichiosis (has malaise and AMS with no rash)

________________

  1. Leukopenia
  2. Thrombocytopenia
  3. Transaminitis
109
Q

Which bacteria causes Pnuemonia in Adult cystic fibrosis pts?

A

Pseudomonas

110
Q

Which bacteria causes Pnuemonia in Pediatric cystic fibrosis pts?

A

Staph Aureus

111
Q

What’s the most common valvular abnormality in patients with Infective Endocarditis?

A

“Bacteria FROM JANE”

[Mitral Valve Prolapse with regurgitation that’s new]

These will be accompanied by ⬆︎⬆︎⬆︎ESR

112
Q

What are Lyme Borrelia px - 3

A
  1. Tick repellant
  2. protective gear
  3. tick checks

THERE IS NO VACCINE!

113
Q

Which organism should you suspect in a pt with severe rapidly developing cellulitis after sustaining a cut in a marine envrionment?

A

Vibrio Vulnificus

also causes food borne illness

114
Q

Dx?

________________

Mode of Transmission?

A

[Cutaneous larva migrans secondary] to Ancylostoma hookworm larvae

________________

walking barefoot in contaminated sand or soil

Tx = Ivermectin

115
Q

Sporothrix Schenckii is a ____ fungus found in ____

How does it clinically present?

A

dimorphic ; decaying plant and soil

papule at inoculation site ulcerates and drains odorless nonpurulent fluid. This then spread proximally along lines of lymphatic drainage

Tx = PO itraconazole

116
Q

Describe the type of rash you’ll see with secondary syphilis

A

Diffuse Maculopapular rash starting at trunk and spreading to extremities TO INCLUDE PALMS AND SOLES

117
Q

cp of Chikungunya Fever - 4

A
  1. Polyarthralgias severe
  2. High Fever
  3. Leukopenia
  4. Thrombocytopenia

Transmitted by Aedes mosquito (same as Dengue) in the tropics / Tx = supportive

118
Q

Beta D glucan is useful diagnostics for what organisms?

A

FUNGUS (it’s apart of their cell wall) - and this is nonspecific

119
Q

Progressive Multifocal Leukoencephalpathy etx

A

[JC polyoma virus] reactivation in HIV pts –> ASYMMETRIC focal nonenhancing white matter brain lesions WITH NO EDEMA

HIV neurocognitive disorder will have DIFFUSE enhancement

120
Q

In pts with mucopurulent urethritis, absence of growth on gram stain usually suggest which organism?

A

Chlamydia

Gonorrhea will in fact result in gram stain

121
Q

What organism is the most common cause of Infective Endocarditis in IV Drug Users?

A

Staph Aureus

122
Q

What organism is the most common cause of Infective Endocarditis in pts with colon disease?

A

Strep gallolyticus Bovis

123
Q

What organism is the most common cause of Infective Endocarditis in pts with dental disease and/or procedures?

A

the Strep Viridan MOMS

Mutans/Oralis/Mitis/Sanguinis

tx = CefTriaxone or PCN G aqueous IV

124
Q

What is the mechanism for why asplenic pts are at ⬆︎risk of infection from _____ organisms

A

SHiN = encapsulated organisms

  1. Strep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes!
  2. HFlu B
  3. Neisseria Meningitidis

they have ⬇︎antibody mediated phagocytosis and complement activation

125
Q

What organism causes Acute Epididymitis? - 3

A

EColi if >35yo (secondary to bladder outlet obstruction)

________________

[Chlamydia or Gonorrhea if under 35 yo (secondary to STI)]

126
Q

Ludwig angina is a rapidly progressive cellulitis of the ⬜ and ⬜ space

________________

What is the source of infection?

A

sublingual and submandibular

________________

infected mandibular MOLAR

127
Q

Why is RPR not reliable when on a person first develops syphilis?

A

There is a possible false negative result early in infection - follow with FTA

128
Q

For Malaraia px, in areas with high resistance to Chloroquine, what are the alternatives?-3

________________

How is Malaria px prescripted?

A
  1. Mefloquine
  2. Doxycycline
  3. Malarone

and of course DEET

________________

tx [≥2wks prior to travel], [during stay] and [stopped 4 weeks after returning]

129
Q

How long does it take Jarisch Herxheimer reaction to resolve?

A

2 days

130
Q

Diagnostic criteria for postive Purified Protein Derivative (PPD) test? - 2

A
  1. ≥15 mm OR
  2. ≥5 mm in HIV

Reads are done 2 days after injection

131
Q

Prophyrlactic Erythromycin Ophthalmic ointment at birth is used to prevent what organism?

A

Gonorrhea only

132
Q

What are the major organisms that cause contact lens keratitits?-2 ; cp?

A
  1. Pseudomonas
  2. Serratia

painful red eye and opacification with corneal ulceration

133
Q

etx for hordeolum

________________

tx?

A

an external hordeolum = a stye = inflammation of eyelash follicle or tear gland –> tender nodule at lid margin

________________

tx = warm compresses

134
Q

etx for Miliary TB ; describe the radiograph

A

Hematogenous spread of TB (possibly from primary infection or reactivation) that –> subacute sx +/- extrapulmonary involvement (liver, lung, CNS) ; Millet seed diffuse reticulonodular pattern

135
Q

cp for Toxic Shock Syndrome-3

________________

What are the causes of Toxic Shock Syndrome?-3

A
  1. Diffuse erythematous macular rash
  2. hypOtension
  3. fever

__________________

tampons, nasal packing, post surgery

136
Q

tx for Malignant Necrotizing Otitis Externa (MOE)

A

Ciprofloxacin IV (anti-pseudomonas)

137
Q

Management of Peritonsilar Abscess - 2

A

IV Abx –> urgent Needle Peritonsilar Aspiration

138
Q

What 2 laboratory values are the best diagnostic test for Hepatitis B?

A

S - SEC - SCEb - Core - CEbSAb - CSAB - SAb

[SAg and CoreIgM]

139
Q

What are the guidelines for ANNUAL GC/Chlamydia Screening (Women vs Men)

A

Women

  1. ALL sexually active women < 25
  2. Sexually active women > 25 IF HIGH RISK

Men: Insufficient evidence :-(

ANNUAL GC/Chlamydia screening done via NAAT - vaginal or cervical swab

140
Q

Which pt demographics should receive Syphilis Screening (RPR, VDRL)? - 5

A
  1. Pregnant Women at 1st prenatal visit
  2. Pts with other STDs
  3. Gay Men
  4. Sex Workers
  5. Jailed people
141
Q

What are the guidelines for HIV Screening ; What is the screening test?-2

A

EVERYONE between the ages 15-65 regardless of risk factors

[HIV p24 antigen and HIV antibody testing] together

142
Q

Tx for

Active TB?

Latent TB?

A
  1. RIPE x 6 months for ACTIVE TB
  2. IP x 9 months for latent TB

latent TB = positive PPD with normal CXR

143
Q

Which hepatitis virus is associated with Porphyria Cutanea Tarda?

A

hepC

144
Q

What type of acid base disturbance does TB cause? Why?

A

TB is a common cause of Addison’s primary adrenal insufficiency which –> ⬇︎Aldosterone –> Normal Anion Gap Metabolic Acidosis

145
Q

T or F

Lactose intolerance is associated with weight loss

A

FALSE

146
Q

What are the most common causes of diarrhea- 5

A
  1. Irritable Bowel Syndrome
  2. IBD
  3. Chronic infxn
  4. Malabsorption- CELIAC
  5. Malabsorption- LACTOSE INTOLERANCE

Dx= stool fat analysis and serum studies

147
Q

Dx for Lactose Intolerance- 4

A
  1. Diarrhea after consuming lactose
  2. [INC Stool osmotic gap]
  3. [DEC Stool pH]
    • Lactose Hydrogen Breath test
148
Q

Dx Celiac Disease- 3

A
  1. [INC Stool osmotic gap (like lactose intolerance)]
  2. Microcytic Anemia 2/2 iron deficiency
  3. Villous Atrophy
    * Foul, Flatulence, Fat stool (large volume), Frail wt (wt loss), Frail blood (microcytic anemia)*
149
Q

Dx Small Intestinal Bacterial Overgrowth- 2

A
  1. B12 Deficiency –> Macrocytic Anemia
    • LactuLOSE breath test
150
Q

histologic findings of Celiac Disease- 3

A
  1. intraepithelial lymphocytic infiltrates
  2. loss of villous architecture -> villous atrophy
  3. Crypt hyperplasia
    * bx from distal duodenum*
151
Q

Any RPR Titer greater than ___ is high syphilis titer (positive result)

A

1:16

anything where they had to dilute it MORE than 16 times is HIGH RPR Syphilis titer

[2a] A ⼀ Step 2 OD USLME (21 decks)

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