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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
Describe Serology for Hepatitis B -7
S - **S**E**C** - 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*
26
Physiology of Chills-2
Infection--\>Cytokines--\>influences hypothalamus to ⬆︎ body temp set point--\> 1. Muscles repetively contract (shivering) 2. Peripheral vasoconstriction--\> "cold" sensation
27
Complications of PNA -3
1. **SEPSIS** 2. Parapneumonic effusion--\> Empyema 3. Pulm vessel infiltration --\>Seeding (*Heart, Meninges*) ## Footnote *Consider these when pt treated for PNA isn't getting better*
28
Which vaccines are given to a s/p PNA pt?-2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What are their Risk/Benefit?
1. **Flu**: Risk= less effective in elderly / Benefit= ⬇︎mortality & occurrence 2. **Pneumococcal**: Risk=does NOT ⬇︎ occurrence / Benefit= does ⬇︎ invasive dz from S.Pneumo
29
Tx for Bacterial endocarditis - 4
1. Staph Aureus= **Vanc** 2. Staph Epidermidis= **Vanc** 3. [Strep Virdans = [**CefTriaxone or aPG]**] 4. Enterococcus = **[amp/gent]** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(aPG = aqueous Pencillin G IV)*
30
Major culprits of Bacterial endocarditis - 4
1. Staph Aureus = **Vanc** 2. Staph epidermidis = **Vanc** 3. Strep Virdans = [**CefTriaxone or aPG]** 4. Enterococcus = **[amp/gent]** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *aPG = aqueous PCN G*
31
Name the mainstay Drugs for Staph Aureus (8)
i **L**ove **C**ute **C**razy **D**eranged **B**oys **N**' **TV** 1. **L**inezolid 2. **C**lindamycin 3. [**C**efTaroline 5° generation] 4. **D**aptomycin 5. [**B**actrim - *Skin Infection*] 6. [**N**afcillin - MSSA only] 7. **T**igecylcine 8. **V**ancomycin
32
Classic Sx Triad of Brain Abscess
1. Fever 2. HA 3. Focal Neuro changes (seizure)
33
A Single ring-enhancing Brain Abscess in **immunoCOMPETENT** pt results from what organisms?-2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How would you diganose this?
[Staph Aureus] vs [Strep Viridans] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ CT-guided aspiration for cx *Toxo and Nocardia would occur in immunocomp pts*
34
Tx for **Congenital** syphillis
[aPG 50,000 u/kg/dose] [q10h] [x 10 days] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(aPG = aqueous PCN G -IV) /* *(**MU = million units)*
35
Tx for Syphilis : [Early latent \<12 mo]⼀[Primary Chancre]⼀[Secondary Systemic Sx]
[BPG 2.4MU] x 1 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(BPG = BENZATHINE PCN G -IM) /* *(**MU = million units)*
36
What other stages of Syphilis share the SAME TREATMENT as [Early latent \<12 mo] -2
[Primary Chancre] [Secondary Systemic sx]
37
What other stages of Syphilis share the SAME TREATMENT as [Late latent ≥12 mo] -3
[unknown duration], [+Gummas] or [+CV sx]
38
Tx for Syphilis : [Late latent ≥12 mo], [unknown duration], [+Gummas] or [+CV sx]
[BPG 2.4MU] [q week] [x 3 weeks] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(BPG = BENZATHINE PCN G -IM) /* *(**MU = million units)*
39
Tx for **Neuro**syphillis
[aPG 3-4MU] [q4h] [x 10-14 days] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(aPG = aqueous PCN G - IV) /* *(**MU = million units)*
40
In an immunocompromised pt, **EBV DNA in the CSF** raises suspicion for what condition?
Primary CNS lymphoma ## Footnote *MRI: Solitary **Weakly** ring-enhancing mass in periventricular region*
41
Describe the MRI findings for Primary CNS lymphoma
Solitary **Weakly** ring-enhancing mass in periventricular region
42
*You find this MRI in an immunocompromised pt* Identify Disease
PML (Progressive Multifocal Leukoencephalopathy) 2/2 [John Cunningham Polyoma Virus]
43
What are the 2 environments Clostridium Botulinum likes to germinate spores?
1. Improperly Canned Foods 2. Cured Fish ## Footnote *Tx = Equine Heptavalent Antitoxin*
44
MOD for [Carcinoid Syndrome Heart Disease]
[R sided **endocardial** fibrosis] ---\> [Pulmonic and Tricuspid Valve Stenosis] or [Restrictive Cardiomyopathy] ## Footnote ***C**arcinoi**D** **S**yndrome: (**C**utaneous Flushing)/**D**iarrhea/(**S**OB wheezing)*
45
Describe [**Libman Sacks Endocarditis**]
[**Non-bacterial** wart-like vegations] accumulate on either side of a heart valve --\> Fibrotic Valve Thickening--\> MI ## Footnote *Associated with SLE Lupus*
46
What 2 diseases is ***Streptococcus Gallolyticus Bovis*** associated with?
1. [**SBE-S**ubAcute **B**acterial **E**ndocarditis in pts WITH COLON INVOLVEMENT] (*Aortic Regurgitation*) (***SBE** also caused by Strep Viridans or Mutans)​* 2. [GI Lesions --\> Colon CA] AKA S. Bovis
47
Name the manifestations of Infective Endocarditis (7)
"Bacteria **FROM JANE**" **F**ever [**R**etinal Roth Spots - *Immunologic phenomena*] [**O**sler "Ouch" Nodes- *Immunologic phenomena*] [**M**VP with regurgitation] [**J**aneway lesions on palms/sole] **A**nemia [**N**ailbed Subungal _Splinter_ Hemorrhages] - shown in image [**E**mboli from valvular vegetations] - may appear as abscesses or nodular cavities on imaging! *These will be accompanied by ⬆︎⬆︎⬆︎ESR*
48
Which Dz's cause **EITHER OR** Mitral vs. Tricuspid Regurgitation (2)
Rheumatic Fever and [Infective Endocarditis]
49
What are the 2 major concerns for Kidneys in IV drug users?
1. renal ischemia 2/2 septic emboli 2. Immune-mediated Glomerulonephritis
50
Hydatid Cyst with eggshell calcification are caused by \_\_\_\_\_\_\_. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What is the definite host for this?
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
51
Pyogenic liver abscess follows after what 2 events?
[Appendicitis (GI infection)] Surgery
52
What is the triad for Congenital Rubella Syndrome? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How do you prevent this?
1. [Sensorineural Hearing loss] 2. [BL Cataracts] 3. PDA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Live Rubella vaccine **prior to conception** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** Dx = Rubella IgM vs PCR (Transmission occurs 1st trimester)
53
Describe the cutaneous manifestation of blastomycosis
[well circumscribed raised violaceous (wart like) nodules --\> microabscess] ## Footnote *Blastomycosis causes Skin, Pulmonary and Bone findings*
54
Describe cutaneous Sporotrichosis
pustular and ulcerated lesion localized to site of inoculation
55
Clinical presentation for Vertebral Osteomyelitis-4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Dx?-3
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]
56
Most common causes of Travelers' Diarrhea - 4
1. Giardia 2. CryptoSPoridium (parasite) - can still occur in immunocompetent pts! 3. Cyclospora 4. ETEC ## Footnote *Profuse watery diarrhea after traveling*
57
Describe the oral involvement for Hand Foot Mouth disease (Coxsackie A)
grayish vesicles on the tonsillar pillars and **posterior** oropharynx that --\> fibrin-coated ulcerations ## Footnote *doesn't have to have hand or foot involvement*
58
Dx for EBV infectious mono - 2
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!*
59
What is the management for a pt who comes in with a tick on their arm? - 2
**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]
60
Triad for Disseminated Gonococcal infection
**STD** 1. **S**everal migratory arthralgias 2. **T**enosynovitis pain along tendon sheaths 3. **D**ermatitis pustular rash *pts may NOT have urinary or pelvic sx with Disseminated Gonococcal infection!*
61
What are the most common causes of viral aseptic meningitis in kids - 2
1. Echovirus 2. Coxsackie
62
What are the 4 examples of Strep Viridans
the Viridan **MOMS** 1. **M**utans 2. **O**ralis 3. **M**itis 4. **S**anguinis
63
clinical presentation for Walking Atypical PNA - 3
1. **INCESSANT DRY COUGH** in teen/young adult/military 2. nonexudative pharyngitis 3. Fever malaise ## Footnote *CXR = ⬆︎interstitial infiltrates +/- pleural effusion*
64
Identify
Erysipelas from GASP ## Footnote *Erythematous, warm, tender, rash with **raised demarcated borders** +/- external ear involvement*
65
What are the px recommendations for HIV pts with CD4 \< 200
**P**oor Bactrim
66
When can pts with pyelonephritis be transitioned to PO abx?
If sx are improved at the **48 hour mark** pts can be transitioned to PO (i.e. Bactrim or Levofloxacin) abx
67
Pt presents with splenic abscess What are the risk factors for splenic abscess? - 5
1. **INFECTIVE ENDOCARDITIS** 2. IVDA 3. Immunosuppression 4. Trauma 5. Hemoglobinopathy
68
Pt presents with 2 month productive cough dx?
**Reactivation** TB ## Footnote (cavitary UPPER lung lesion) *This is different from Aspiration PNA since Aspiration PNA occurs in LOWER lobes*
69
*A family member is diagnosed with Bordatella Pertussis* Which class of abx are given? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Should the other family members receive anything?
Macrolides \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ YES. ALL CLOSE CONTACTS should receive Macrolide px
70
Organisms associated with Bloody Diarrhea - 6
Inflammatory Bloody diarrhea is not **SEECSY**! 1. **S**higella 2. **E**Coli EHEC - shiga toxin 3. **E**ntamoeba histolytica 4. **C**ampylobacter 5. **S**almonella 6. **Y**ersinia Enterocolitica
71
Diagnosis?
*Swiss Cheese Head CT* Neurocysticercosis from Taenia cestaode helminths
72
How does transmission of Hydatid cyst to Humans occur?
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
Most esophagitis in HIV pts is caused by \_\_\_\_\_. When is this NOT the case?
Candida; pts with **sole odynophagia** who have no thrush nor difficulty swallowing = viral (HSV, CMV) esophagitis
74
When is the 13 valent pneumococcal vaccine recommended?-2 ; What about the 23 valent pneumococcal vaccine?
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
Diagnosis?
Miliary TB ## Footnote *CP: **SLOW** progression of fever, wt loss, night sweats, COUGH*
76
Where are the most common sites for Kaposi Sarcoma?- 4
1. Face 2. Mouth 3. Genitals 4. Legs ## Footnote *papules --\> violaceous plaques or nodules*
77
What are the most common organisms to cause Sinus infection (Rhinosinusitis)? - 3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx?
Strep Pneumo \> HFlu nontypeable \> moraxella ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx = Amoxicillin/clavulanate
78
clinical presentation for Disseminated MAC - 3 ## Footnote *Mycobacterium Avium Complex*
1. Splenomegaly 2. ALP⬆︎ 3. Systemic sx (fever, diarrhea, cough)
79
clinical presentation for Disseminated Histoplasmosis - 4
"Histoplasma spreads to **PBS L**" 1. **P**ulmonary 2. [**B**lood (pancytopenia 2/2 marrow infiltration)] 3 [**S**kin (Mucocutaneous papules/nodules)] 4. [**L**ymphatic RES involvement] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * RES = ReticuloEndothelial System (Lymph node/Spleen/Liver)* * Dx = serum or urine Histoplasma antigen immunoassay*
80
Most common side effects of INH isoniazid
**I**njuries to **N**erves and **H**epatocytes **N**europathy (Pyridoxine B6 = tx/px) **H**epatitis - THIS IS SELF LIMITED AND RESOLVE WITHOUT INTERVENTION
81
name the organisms sickle cell disease pts are at most risk of acquiring?-3 ; Which is most common and why?
**SH**i**N** = encapsulated organisms 1. **S**trep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes! 2. **H**Flu B 3. **N**eisseria Meningitidis *these happen to asplenic pts because they have ⬇︎antibody mediated phagocytosis and complement activation*
82
What are the potential complications of orbital cellulitis - 3 Biggest RF: Bacterial Sinusitis
1. Orbital abscess 2. intracranial infection 3. cavernous sinus thrombosis
83
Pt presents with signs of Sarcoidosis but rapidly deteriorates after being given steroids Dx?
Histoplasmosis ## Footnote *Mississippi and Ohio River basins*
84
Pts who've undergone solid organ transplantation are at risk of acquiring what 2 infections?
1. CMV (ganciclovir/valganciclovir px) 2. PCP (Bacterim px)
85
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
1. Pregnancy (No DOXY for POXY) 2. 3° CNS syphilis 3. refractory to initial tx
86
How do you know when a pt if fully cured from Syphilis?
**4**-fold ⬇︎in FTA Ab titer by 12 month mark AT THE LATEST
87
An unvaccinated pt to Hepatits B has just been acutely exposed and positive S and E antigen (SEC) What do you give them? - 2
1. Hep B Immunoglobulin 2. Hep B **VACCINE** still ## Footnote *unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
88
Empiric tx for Viridans Strep - 2
1. PCN G aqueous IV x4wks OR 2. Ceftriaxone IV x 4wks
89
Which viral illness is associated with pancytopenia?
EBV ## Footnote **P**latelet thrombocytopenia **A**nemia from autoimmune hemolytic anemia **N**eutrophil/WBC ⬇︎ with atypical lymphocyte on blood smear due to viral suppression
90
What is the triad for Trichinellosis
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
At what CD4 are HIV pts at risk for Candida Esophagitis? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx?-2
CD4\<100 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Fluconazole PO 2. Esophagoscopy with bx/cx if refractory to rx
92
What is the management for a patient bitten by a Cat? -2
(irritation ➜ [amox/clav] ) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Cat bites are **DEEP PUNCTURE WOUNDS** AT RISK for Pasteurella and oral anaerobes
93
From a lab perspective, how do you differentiate CMV from EBV?
CMV will have a [**negative** *HAMS*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *HAMS = [Heterophile Antibody MonoSpot]*
94
Dx? - 2
1. EBV 2. CMV
95
Which organism should you suspect if a pt with PNA also c/o Diarrhea?
Legionella
96
What are the risk factors for TB - 4
1. Homelessness 2. Alcoholism 3. Immunosuppression 4. Healthcare worker *Disseminated TB affects peritoneum, cervical lymph nodes, eyes, bones and skin*
97
When is the Rabies Vaccine and Immunoglobulin indicated?-2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What do you do if this is NOT the case?
1. Animal is unavailable 2. Animal is symptomatic \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Pet Observation x 10 days or Test Wild Animals to determine need for Rabies px
98
Ventilator associated PNA occurs how long after intubation? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What's the first 2 steps in mngmt for these pts
≥48 hrs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1st: lower respiratory tract Gram stain and culture 2nd: Empiric abx
99
The most common predisposing factor for Acute Bacterial Sinusitis is what?
preceding viral URI
100
The Hepatitis A vaccine is recommended for which groups - 3
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
What are the generalized signs of ANY congenital TORCH infection - 3
1. Hepatosplenomegaly 2. Blueberry muffin spot rash 3. Jaundice
102
Name the specific signs of congenital syphilis - 3
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
Leprosy is a [chronic mycobacterial granulomatous disease] How does it present?-2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Dx?
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
Leprosy is a chronic mycobacterial granulomatous disease Tx? - 2
1. Rifampin **WITH** 2. Dapsone
105
Coccidioides cp - 4
1. CA-acquired PNA (fever, cp, cough, lobar infiltrate) 2. Arthralgias 3. Ertyehma Nodosum 4. Erythema Multiforme ## Footnote *Health pts do NOT require antifugal therapy*
106
How is Neurocysticercosis transmitted?
ingestion of undercooked **PORK** that contains Taeia solium tapeworm **EGGS** ## Footnote *Imaging: swiss cheese CT (image below) or cystic lesion with surrounding edema*
107
Tx for HIGHLY CONTAGIOUS [Pinworm Enterobius Vermicularis] - 2
1. Albendazole 2. Pyrantel Pamoate
108
Which bacteria is described as Rocky Mountain Spotted Fever without the spots? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What other major lab findings are associated with this bacteria? -3
Ehrlichiosis (has malaise and AMS with no rash) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Leukopenia 2. Thrombocytopenia 3. Transaminitis
109
Which bacteria causes Pnuemonia in Adult cystic fibrosis pts?
Pseudomonas
110
Which bacteria causes Pnuemonia in Pediatric cystic fibrosis pts?
Staph Aureus
111
What's the most common valvular abnormality in patients with Infective Endocarditis?
"Bacteria **FROM JANE**" [**M**itral Valve Prolapse with regurgitation that's new] *These will be accompanied by ⬆︎⬆︎⬆︎ESR*
112
What are Lyme Borrelia px - 3
1. Tick repellant 2. protective gear 3. tick checks THERE IS NO VACCINE!
113
Which organism should you suspect in a pt with severe rapidly developing cellulitis after sustaining a cut in a marine envrionment?
Vibrio Vulnificus ## Footnote also causes food borne illness
114
Dx? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Mode of Transmission?
[Cutaneous larva migrans secondary] to **Ancylostoma hookworm larvae** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ walking barefoot in contaminated sand or soil Tx = Ivermectin
115
Sporothrix Schenckii is a ____ fungus found in \_\_\_\_ How does it clinically present?
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
Describe the type of rash you'll see with secondary syphilis
Diffuse Maculopapular rash **starting at trunk and spreading to extremities TO INCLUDE PALMS AND SOLES**
117
cp of Chikungunya Fever - 4
1. Polyarthralgias severe 2. High Fever 3. Leukopenia 4. Thrombocytopenia ## Footnote *Transmitted by Aedes mosquito (same as Dengue) in the tropics / Tx = supportive*
118
Beta D glucan is useful diagnostics for what organisms?
FUNGUS (it's apart of their cell wall) - and this is nonspecific
119
Progressive Multifocal Leukoencephalpathy etx
[JC polyoma virus] reactivation in HIV pts --\> ASYMMETRIC focal **nonenhancing white matter brain lesions WITH NO EDEMA** ## Footnote *HIV neurocognitive disorder will have DIFFUSE enhancement*
120
In pts with mucopurulent urethritis, absence of growth on gram stain usually suggest which organism?
Chlamydia ## Footnote *Gonorrhea will in fact result in gram stain*
121
What organism is the most common cause of Infective Endocarditis in IV Drug Users?
Staph Aureus
122
What organism is the most common cause of Infective Endocarditis in pts with colon disease?
Strep gallolyticus Bovis
123
What organism is the most common cause of Infective Endocarditis in pts with dental disease and/or procedures?
the Strep Viridan **MOMS** ## Footnote **M**utans/**O**ralis/**M**itis/**S**anguinis tx = CefTriaxone or PCN G aqueous IV
124
What is the mechanism for why asplenic pts are at ⬆︎risk of infection from _____ organisms
**SH**i**N** = encapsulated organisms 1. **S**trep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes! 2. **H**Flu B 3. **N**eisseria Meningitidis they have ⬇︎antibody mediated phagocytosis and complement activation
125
What organism causes Acute Epididymitis? - 3
EColi if \>35yo (secondary to bladder outlet obstruction) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Chlamydia or Gonorrhea if under 35 yo (secondary to STI)]
126
Ludwig angina is a rapidly progressive cellulitis of the ⬜ and ⬜ space \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What is the source of infection?
sublingual and submandibular \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ infected mandibular **MOLAR**
127
Why is RPR not reliable when on a person first develops syphilis?
There is a possible false negative result early in infection - follow with FTA
128
For Malaraia px, in areas with high resistance to Chloroquine, what are the alternatives?-3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ How is Malaria px prescripted?
1. Mefloquine 2. Doxycycline 3. Malarone and of course DEET \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx [≥2wks prior to travel], [during stay] and [stopped 4 weeks after returning]
129
How long does it take Jarisch Herxheimer reaction to resolve?
2 days
130
Diagnostic criteria for postive Purified Protein Derivative (PPD) test? - 2
1. ≥15 mm OR 2. ≥5 mm in HIV Reads are done 2 days after injection
131
Prophyrlactic Erythromycin Ophthalmic ointment at birth is used to prevent what organism?
**Gonorrhea** only
132
What are the major organisms that cause contact lens keratitits?-2 ; cp?
1. Pseudomonas 2. Serratia painful red eye and opacification with corneal ulceration
133
etx for hordeolum \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx?
an external hordeolum = a stye = inflammation of eyelash follicle or tear gland --\> tender nodule at lid margin \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx = warm compresses
134
etx for Miliary TB ; describe the radiograph
Hematogenous spread of TB (possibly from primary infection or reactivation) that --\> subacute sx +/- extrapulmonary involvement (liver, lung, CNS) ; Millet seed diffuse reticulonodular pattern
135
cp for Toxic Shock Syndrome-3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What are the causes of Toxic Shock Syndrome?-3
1. Diffuse erythematous macular rash 2. hypOtension 3. fever \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tampons, nasal packing, post surgery
136
tx for Malignant Necrotizing Otitis Externa (MOE)
Ciprofloxacin IV (anti-pseudomonas)
137
Management of Peritonsilar Abscess - 2
IV Abx --\> **urgent** Needle Peritonsilar Aspiration
138
What 2 laboratory values are the best diagnostic test for Hepatitis B?
S - **S**E**C** - SCEb - Core - CEbSAb - CSAB - SAb [**S**Ag and **C**oreIgM]
139
What are the guidelines for ANNUAL GC/Chlamydia Screening (Women vs Men)
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
Which pt demographics should receive Syphilis Screening (RPR, VDRL)? - 5
1. Pregnant Women at **1st** prenatal visit 2. Pts with other STDs 3. Gay Men 4. Sex Workers 5. Jailed people
141
What are the guidelines for HIV Screening ; What is the screening test?-2
EVERYONE between the ages 15-65 regardless of risk factors [HIV p24 antigen and HIV antibody testing] together
142
Tx for Active TB? Latent TB?
1. RIPE x 6 months for **ACTIVE** TB 2. IP x 9 months for **latent** TB latent TB = positive PPD with normal CXR
143
Which hepatitis virus is associated with Porphyria Cutanea Tarda?
hep**C**
144
What type of acid base disturbance does TB cause? Why?
TB is a common cause of Addison's primary adrenal insufficiency which --\> ⬇︎Aldosterone --\> **Normal Anion Gap Metabolic Acidosis**
145
T or F Lactose intolerance is associated with weight loss
FALSE
146
What are the most common causes of diarrhea- 5
1. Irritable Bowel Syndrome 2. IBD 3. Chronic infxn 4. Malabsorption- CELIAC 5. Malabsorption- LACTOSE INTOLERANCE ## Footnote *Dx= stool fat analysis and serum studies*
147
Dx for Lactose Intolerance- 4
1. Diarrhea after consuming lactose 2. [INC Stool osmotic gap] 3. [DEC Stool pH] 4. + Lactose Hydrogen Breath test
148
Dx Celiac Disease- 3
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
Dx Small Intestinal Bacterial Overgrowth- 2
1. B12 Deficiency --\> Macrocytic Anemia 2. + LactuLOSE breath test
150
histologic findings of Celiac Disease- 3
1. intraepithelial lymphocytic infiltrates 2. loss of villous architecture -\> villous atrophy 3. Crypt hyperplasia * bx from distal duodenum*
151
Any RPR Titer greater than ___ is high syphilis titer (positive result)
1:16 ## Footnote *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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