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USMLE Step 3 > Infectious Disease > Flashcards

Infectious Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

INTRAVENOUS treatment for MSSA (bone, heart, skin, joint)

A
  • oxacillin - nafcillin - cefazolin (1st gen cephalosporin)
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2
Q

ORAL treatment for MSSA (bone, heart, skin, joint)

A
  • dicloxacillin - cephalexin (1st gen cephalosporin)
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3
Q

treatment for MINOR MRSA infection (bone, heart, skin, joint)

A
  • trimethoprim/sulfamethoxazole (TMP/SMX) - clindamycin - doxycycline
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4
Q

treatment for MAJOR MRSA infection (bone, heart, skin, joint)

A
  • vancomycin - linezolid - daptomycin - ceftaroline - tigecycline - telavancin
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5
Q

adverse effect of linezolid

A

thrombocytopenia

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6
Q

adverse effect of daptomycin

A

myopathy (elevated CPK)

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7
Q

treatment of Staph aureus if penicillin allergy: RASH (bone, heart, skin, joint)

A

cephalosporins

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8
Q

treatment of Staph aureus if penicillin allergy: ANAPHYLAXIS (bone, heart, skin, joint)

A
  • macrolides (azithromycin, clarithromycin) - clindamycin
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9
Q

treatment of Staph aureus if penicillin allergy: MINOR INFECTION (bone, heart, skin, joint)

A
  • macrolides (azithromycin, clarithromycin) - clindamycin - trimethoprim/sulfamethoxazole (TMP/SMX)
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10
Q

treatment of Staph aureus if penicillin allergy: MAJOR INFECTION (bone, heart, skin, joint)

A
  • vancomycin - linezolid - daptomycin - telavancin
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11
Q

can you use the same antibiotics for Staph as Streptococcus?

A

YES

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12
Q

antibiotics SPECIFIC for Streptococcus

A
  • penicillin - ampicillin - amoxicillin
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13
Q

Gram-negative bacilli (rods)

A
  • Escherichia coli - Enterobacter - Citrobacter - Morganella - Pseudomonas - Serratia
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14
Q

antibiotic classes that are EQUAL in efficacy for treatment of Gram-NEGATIVE bacilli (rods)

A
  1. cephalosporins 2. penicillins 3. monobactam 4. quinolones 5. aminoglycosides 6. carbapenems
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15
Q

ONLY carbapenem that does NOT cover Pseudomonas

A

ERTAPENEM

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16
Q

cover GNR and ALSO cover Streptococci and anaerobes

A
  1. PIPERACILLIN 2. TICARCILLIN
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17
Q

EXCELLENT pneumococcal (Streptococcus pneumoniae) drugs

A
  1. LEVOFLOXACIN 2. GEMIFLOXACIN 3. MOXIFLOXACIN
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18
Q

work SYNERGISTICALLY against Staph and Strep

A

AMINOGLYCOSIDES

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19
Q

EXCELLENT anaerobic coverage, and cover Strep and MSSA

A

CARBAPENEMS

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20
Q

covers MRSA and GNR

A

TIGECYCLINE

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21
Q

adverse effect of imipenem

A

SEIZURES

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22
Q

BEST medication for gastrointestinal anaerobes (Bacteroides)

A

metronidazole

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23
Q

can also be used for gastrointestinal anaerobes (Bacteroides)

A
  • carbapenems - piperacillin - ticarcillin
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24
Q

ONLY cephalosporins that cover anaerobes

A
  • CEFOXITIN - CEFOTETAN
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25
Q

BEST medication for respiratory anaerobes (anaerobic Strep)

A

clindamycin

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26
Q

antibiotics with NO anaerobic coverage

A
  • aminoglycosides - aztreonam - fluoroquinolones - oxacillin - nafcillin - all cephalosporins EXCEPT cefoxitin and cefotetan
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27
Q

red, flushed skin (particularly on neck) from histamine release is d/t?

A

vancomycin

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28
Q

red man syndrome treatment

A

slow rate of vancomycin infusion

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29
Q

treatment for herpes simplex, and varicella zoster (all 3 are equal in efficacy)

A
  1. acyclovir 2. valacyclovir 3. famciclovir
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30
Q

treatment for cytomegalovirus (CMV)

A
  1. ganciclovir 2. valganciclovir 3. foscarnet
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31
Q

BEST long-term treatment for CMV RETINITIS

A

VALGANCICLOVIR

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32
Q

adverse effects of ganciclovir and valganciclovir

A
  • neutropenia - bone marrow suppression
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33
Q

adverse effect of foscarnet

A

renal toxicity

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34
Q

treatment for influenza A and B

A
  • oseltamivir - zanamivir (neuraminidase inhibitors)
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35
Q

treatment for hepatitis C (in combination w/ interferon), and respiratory syncytial virus (RSV)

A

ribavirin

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36
Q

treatment for hepatitis B

A
  • lamivudine - interferon - adefovir - tenofovir - entecavir - telbivudine
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37
Q

treatment for oral and vaginal candidiasis (alternative to topical medications)

A

fluconazole

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38
Q

best treatment against Aspergillus

A

voriconazole

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39
Q

adverse effect of voriconazole

A

visual disturbance

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40
Q

EXCELLENT for neutropenic fever patients

A
  • caspofungin - micafungin - anidulafungin (echinocandins)
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41
Q

which antifungals do NOT cover Cryptococcus?

A

echinocandins

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42
Q

adverse effects of echinocandins?

A

NONE

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43
Q

effective against ALL Candida, Cryptococcus, and Aspergillus

A

amphotericin

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44
Q

superior to amphotericin in treatment of Aspergillus

A

voriconazole

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45
Q

superior to amphotericin in treatment of neutropenic fever

A

caspofungin

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46
Q

superior to amphotericin in treatment of Candida

A

fluconazole (same efficacy, but LESS adverse effects)

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47
Q

adverse effects of amphotericin

A
  1. renal toxicity (increased creatinine) 2. hypOkalemia 3. metabolic acidosis 4. fever, shakes, chills
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48
Q

occurs in DIABETES, PVD, or both with an ULCER, or SOFT TISSUE infection

A

OSTEOMYELITIS

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49
Q

best INITIAL test for osteomyelitis

A

plain X-ray

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50
Q

best SECOND-line test for osteomyelitis

A

MRI

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51
Q

most ACCURATE test for osteomyelitis

A

bone BIOPSY and culture

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52
Q

EARLIEST finding of osteomyelitis on X-ray

A

periosteal elevation

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53
Q

what percentage of calcium of bone must be lost in osteomyelitis before the X-ray becomes abnormal?

A

50%

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54
Q

how much time will it take before X-ray becomes abnormal in osteomyelitis?

A

up to 2 weeks

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55
Q

is osteomyelitis associated with fracture?

A

NO

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56
Q

best method for following response to therapy of osteomyelitis

A

ESR (erythrocyte sedimentation rate)

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57
Q

osteomyelitis is MOST COMMONLY caused by

A

direct contiguous spread from overlying tissue

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58
Q

what do you do in osteomyelitis if ESR is still markedly elevated after 4-6 weeks of treatment?

A

continue treatment

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59
Q

MCC of osteomyelitis

A

Staphylococcus

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60
Q

treatment for osteomyelitis if Staphylococcus is sensitive

A

OXACILLIN, or NAFCILLIN for 4-6 WEEKS

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61
Q

treatment for osteomyelitis if Staphylococcus is resistant (MRSA)

A

VANCOMYCIN, LINEZOLID, or DAPTOMYCIN for 4-6 WEEKS

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62
Q

can you treat Staphylococcal osteomyelitis with PO antibiotics?

A

NO

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63
Q

Gram-negative bacilli that can cause osteomyelitis

A
  • Salmonella - Pseudomonas
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64
Q

ONLY form osteomyelitis that can be treated with PO antibiotics

A

Salmonella, and Pseudomonas osteomyelitis

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65
Q
  • ITCHING and DRAINAGE from external auditory canal - form of cellulitis of external auditory canal
A

otitis externa

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66
Q

otitis externa is associated with?

A
  • SWIMMING - FOREIGN OBJECTS
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67
Q

treatment for otitis externa

A
  1. topical antibiotics 2. topical hydrocortisone (decreases swelling/itching) 3. acetic acid and water (reacidify ear)
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68
Q

OSTEOMYELITIS OF SKULL from Pseudomonas in patient with diabetes

A

malignant otitis externa

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69
Q

malignant otitis externa can cause

A
  • brain abscess - skull destruction
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70
Q

best INITIAL test of malignant otitis externa

A

SKULL X-RAY, or MRI

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71
Q

MOST ACCURATE TEST for malignant otitis externa

A

BIOPSY

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72
Q

treatment for malignant otitis externa

A
  1. SURGICAL DEBRIDEMENT 2. ANTIPSEUDOMONAL ANTIBIOTICS
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73
Q

antipseudomonal antibiotics that can be used in malignant otitis externa

A
  • ciprofloxacin - piperacillin - cefepime - carbapenem - aztreonam
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74
Q

key features of otitis media

A
  • redness - bulging - decreased hearing - loss of light reflex - TM immobility
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75
Q

MOST SENSITIVE finding in otitis media

A

TM IMMOBILITY

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76
Q

diagnostic testing for otitis media

A

NONE, based on PE

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77
Q

best INITIAL treatment of otitis media

A

AMOXICILLIN for 7-10 days

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78
Q

MOST ACCURATE TEST for otitis media

A

tympanocentesis and aspirate of TM for culture

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79
Q

if otitis media does not begin improving after 3 days, what do you do?

A

switch antibiotics! - amoxicillin/clavulanate - cefdinir - ceftibuten - cefuroxime - cefprozil - cefpodoxime

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80
Q

nasal discharge, headache, facial tenderness, tooth pain, bad taste in mouth, decreased transillumination of sinuses

A

sinusitis

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81
Q

MCC of sinusitis

A

VIRAL

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82
Q

MCC of sinusitis that are NOT viral

A
  1. Streptococcus pneumoniae 2. Haemophilus influenzae 3. Moraxella catarrhalis
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83
Q

best INITIAL test for sinusitis

A

X-ray

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84
Q

MOST ACCURATE TEST for sinusitis

A

sinus aspirate for culture

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85
Q

treatment for sinusitis

A

amoxicillin and INHALED STEROIDS

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86
Q
  • pain/sore throat - exudate - adenopathy - NO cough/hoarseness
A

pharyngitis

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87
Q

best INITIAL test for pharyngitis

A

RAPID STREP TEST

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88
Q

MOST ACCURATE TEST for pharyngitis

A

CULTURE

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89
Q

treatment for pharyngitis

A

PENICILLIN, or AMOXICILLIN

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90
Q

treatment for pharyngitis if penicillin allergy

A

azithromycin, or clarithromycin

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91
Q
  • arthralgia - myalgia - cough - headache - fever - sore throat - feeling of tiredness
A

influenza

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92
Q

next best step to diagnose influenza

A

viral antigen detection

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93
Q

when should you treat influenza?

A

if patient presents within first 48 hours after onset of symptoms

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94
Q

what drug class works against BOTH influenza A and B?

A

neuraminidase inhibitors

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95
Q

treatment for influenza

A
  • oseltamivir - zanamivir
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96
Q

WRONG answers to treat influenza

A
  • amantadine - rimantadine
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97
Q

who should get vaccinated against influenza?

A

everyone

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98
Q
  • most SUPERFICIAL bacterial skin infections - weeping, crusting, oozing of skin - Strep PYOGENES or Staph aureus
A

impetigo

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99
Q

treatment for impetigo

A
  1. topical mupirocin 2. topical retapamulin
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100
Q

treatment for SEVERE impetigo

A
  1. dicloxacillin 2. cephalexin
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101
Q

treatment for community-acquired MRSA impetigo

A

TMP/SMZ (trimethoprim/sulfamethoxazole)

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102
Q

treatment for impetigo if penicillin allergy: RASH

A

cephalosporins

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103
Q

treatment for impetigo if penicillin allergy: ANAPHYLAXIS

A
  1. clindamycin 2. doxycycline 3. linezolid
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104
Q

treatment for impetigo if penicillin allergy: SEVERE INFECTION WITH ANAPHYLAXIS

A
  1. vancomycin 2. telavancin 3. linezolid 4. daptomycin
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105
Q
  • group A (PYOGENES) streptococcal infection of skin - very bright red, hot - often affects FACE
A

erysipelas

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106
Q

can erysipelas cause rheumatic fever?

A

NO, but it can cause glomerulonephritis

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107
Q

what can cause rheumatic fever and glomerulonephritis?

A

PHARYNGITIS

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108
Q

best INITIAL treatment for erysipelas

A
  1. dicloxacillin 2. cephalexin
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109
Q

treatment for erysipelas if organism is CONFIRMED as group A beta hemolytic streptococci (Strep pyogenes)

A

PENICILLIN VK

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110
Q
  • warm, red, swollen, tender skin - usually presents in arm or leg
A

cellulitis

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111
Q

what should you order in a case of cellulitis of the leg?

A

LOWER EXTREMITY DOPPLER to exclude blood clot

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112
Q

treatment for cellulitis: MINOR disease

A
  1. dicloxacillin PO 2. cephalexin PO
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113
Q

treatment for cellulitis: SEVERE disease

A
  1. oxacillin IV 2. nafcillin IV 3. cefazolin IV
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114
Q

treatment for cellulitis if penicillin allergy: RASH

A

cephalosporins (cefazolin)

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115
Q

treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and MINOR disease

A
  • macrolides - clindamycin
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116
Q

treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and SEVERE disease

A
  1. vancomycin 2. linezolid 3. daptomycin
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117
Q

what skin infection does Staphylococcus epidermidis cause?

A

NONE

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118
Q

all skin infections can lead to?

A

post-streptococcal GLOMERULONEPHRITIS (but NOT rheumatic fever)

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119
Q

Staph aureus-related skin infections beginning at the hair follicle

A

folliculitis

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120
Q

what is FOLLICulitis?

A

infected hair FOLLICle

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121
Q

what is a furuncle?

A

deep folliculitis

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122
Q

what is a Carbuncle?

A

a Cluster of furuncles

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123
Q

what is an abscess?

A

a collection of pus

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124
Q

diagnosis of folliculitis, furuncles, carbuncle, abscess

A

based on appearance

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125
Q

treatment for folliculitis/furuncles/carbuncles/abscesses: MINOR disease

A
  1. dicloxacillin PO 2. cephalexin PO
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126
Q

treatment for folliculitis/furuncles/carbuncles/abscesses: SEVERE disease

A
  1. oxacillin IV 2. nafcillin IV 3. cefazolin IV
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127
Q

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: RASH

A

cephalosporins (cefazolin)

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128
Q

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and MINOR disease

A
  • macrolides - clindamycin
129
Q

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and SEVERE disease

A
  1. vancomycin 2. linezolid 3. daptomycin
130
Q

abscesses respond well to?

A

drainage

131
Q

severe itching of scalp, dandruff, bald patches

A

fungal SKIN infection

132
Q

thickened nails, yellow, cloudy, appear fragile and broken

A

onychomycosis

133
Q

best INITIAL test for fungal skin/nail infections

A

KOH preparation

134
Q

antifungal treatment if NO hair or nail involvement (hint: 5 -azole’s, and 2 others)

A

topical: - clotrimAZOLE - miconAZOLE - ketoconAZOLE - econAZOLE - terconAZOLE - nystatin - ciclopirox

135
Q

PO antifungal tx for scalp (tinea capitis), or nail (onychomycosis)

A
  1. terbinafine 2. itraconazole 3. griseofulvin (for tinea capitis)
136
Q

adverse effect of terbinafine

A

increased transaminases

137
Q

less efficacious than terbinafine and itraconazole

A

griseofulvin

138
Q
  • URETHRAL DISCHARGE +/- dysuria
A

urethritis

139
Q

diagnostic testing for urethritis

A
  • urethral swab (gram stain, WBC count, culture, DNA probe) - nucleic acid amplification test (NAAT)
140
Q

treatment for urethritis

A

2 medications: one for gonorrhea, one for chlamydia

141
Q
  1. polyarticular disease 2. petechial rash 3. tenosynovitis
A

disseminated gonorrhea

142
Q

medications for gonorrhea in urethritis

A
  • ceftriaxone IM - cefpodoxime PO - ciprofloxacin PO
143
Q

treatment for gonorrhea if patient has urethritis and is PREGNANT

A

ceftriaxone IM

144
Q

medications for chlamydia in urethritis

A
  • azithromycin (SINGLE dose) - doxycycline (for 1 week)
145
Q

treatment for chlamydia if patient has urethritis and is PREGNANT

A

azithromycin

146
Q

cervical discharge

A

cervicitis

147
Q

diagnostic testing for cervicitis

A
  • swab (gram stain, WBC count, culture, DNA probe) - nucleic acid amplification test (NAAT)
148
Q

is just as accurate as a speculum examination for cervicitis

A

nucleic acid amplification testing (NAAT)

149
Q

treatment for cervicitis

A

2 medications: one for gonorrhea, one for chlamydia

150
Q

medications for gonorrhea in cervicitis

A
  • ceftriaxone IM - cefpodoxime PO - ciprofloxacin PO
151
Q

treatment for gonorrhea if patient has cervicitis and is PREGNANT

A

ceftriaxone IM

152
Q

medications for chlamydia in cervicitis

A
  • azithromycin (SINGLE dose) - doxycycline (for 1 week)
153
Q

treatment for chlamydia if patient has cervicitis and is PREGNANT

A

azithromycin

154
Q
  • lower abdominal pain - tenderness - fever - cervical motion tenderness +/- dysuria +/- vaginal discharge
A

pelvic inflammatory disease (PID)

155
Q

measure of severity in pelvic inflammatory disease (PID)

A

leukocytosis

156
Q

best INITIAL test for pelvic inflammatory disease (PID)

A
  1. pregnancy test 2. cervical culture 3. NAAT (nucleic acid amplification testing)
157
Q

MOST ACCURATE test for pelvic inflammatory disease (PID)

A

laparoscopy (rarely needed)

158
Q

OUTPATIENT treatment for PID

A

ceftriaxone IM AND doxycycline PO

159
Q

INPATIENT treatment for PID

A

cefoxitin IV AND doxycycline IV (and maybe metronidazole)

160
Q

antibiotics safe in pregnancy

A
  1. penicillins 2. cephalosporins 3. aztreonam 4. erythromycin 5. azithromycin
161
Q
  • extremely painful and tender testicle - NORMAL position of testicle in scrotum
A

epididymo-orchitis

162
Q
  • extremely painful and tender testicle - ELEVATED testicle in an ABNORMAL TRANSVERSE position
A

testicular torsion

163
Q

treatment for epididymo-orchitis: if LESS THAN 35 years of age

A

ceftriaxone AND doxycycline

164
Q

treatment for epididymo-orchitis: if MORE THAN 35 years of age

A

fluoroquinolone

165
Q

PAINFUL ulcer caused by Haemophilus ducreyi

A

chancroid

166
Q

best INITIAL test for chancroid

A

swab for gram stain and culture

167
Q

treatment for chancroid

A
  • ceftriaxone (single IM shot), OR - azithromycin (single PO dose)
168
Q
  • LARGE TENDER NODES - ulcer - may develop suppurating, draining sinus tract
A

lymphogranuloma venereum (LGV)

169
Q

diagnose lymphogranuloma venereum (LGV)

A

serology for Chlamydia trachomatis

170
Q

treatment for lymphogranuloma venereum (LGV)

A
  1. aspirate the bubo 2. doxycycline, OR azithromycin
171
Q

clear vesicular lesions

A

HSV2 (herpes simplex virus 2; genital herpes)

172
Q

treatment for HSV2

A
  • acyclovir - valacyclovir - famciclovir for 7-10 days
173
Q

best INITIAL test if roofs come off of vesicles making etiology unclear

A

Tzanck prep

174
Q

MOST ACCURATE test for HSV2

A

viral culture

175
Q

cause of syphilis

A

Treponema pallidum

176
Q
  • PAINLESS, firm genital lesion - painless inguinal adenopathy
A

syphilis

177
Q

MOST ACCURATE test for PRIMARY syphilis

A

darkfield microscopy

178
Q

symptoms of PRIMARY syphilis

A
  • CHANCRE - ADENOPATHY
179
Q

treatment for PRIMARY syphilis

A

SINGLE IM shot of PENICILLIN

180
Q

treatment for PRIMARY syphilis if penicillin allergy

A

doxycycline

181
Q
  • fever, headache, myalgia - develops 24 hours after treatment of primary syphilis
A

Jarisch-Herxheimer reaction

182
Q

symptoms of SECONDARY syphilis

A
  • RASH - MUCOUS PATCH - ALOPECIA AREATA (bald patches) - CONDYLOMATA LATA (warts on genitals)
183
Q

INITIAL diagnostic test for SECONDARY syphilis

A

RPR and FTA

184
Q

treatment for SECONDARY syphilis

A

SINGLE IM shot of PENICILLIN

185
Q

treatment for SECONDARY syphilis if penicillin allergy

A

doxycycline

186
Q

manifestations of TERTIARY syphilis

A
  • TABES DORSALIS - ARGYLL-ROBERTSON PUPIL - GENERAL PARESIS (paralysis) - gumma - aortitis
187
Q

INITIAL diagnostic test for TERTIARY syphilis

A

RPR and FTA (FTA is more sensitive for neurosyphilis)

188
Q

best INITIAL diagnostic test for NEUROsyphilis

A

LUMBAR PUNCTURE

189
Q

treatment for TERTIARY syphilis

A

IV PENICILLIN

190
Q

treatment for TERTIARY syphilis if penicillin allergy

A

desensitization to penicillin

191
Q

beefy red genital lesion that ULCERATES

A

granuloma inguinale

192
Q

diagnostic test for granuloma inguinale

A

biopsy

193
Q

causative organism for granuloma inguinale

A

Klebsiella granulomatis

194
Q

treatment for granuloma inguinale

A
  • doxycycline - TMP/SMX - azithromycin
195
Q
  • urinary frequency - urgency - burning - dysuria
A

cystitis

196
Q

best INITIAL test for cystitis

A

urinalysis

197
Q

MOST ACCURATE test for cystitis

A

urine culture

198
Q

treatment for UNCOMPLICATED cystitis

A

fosfomycin, or nitrofurantoin PO for 3 days

199
Q

treatment for UNCOMPLICATED cystitis if high resistance to TMP/SMX

A
  • ciprofloxacin - levofloxacin
200
Q

treatment for COMPLICATED cystitis

A
  • TMP/SMX - ciprofloxacin for 7 days
201
Q

what qualifies as “complicated” cystitis?

A
  • stone - stricture - tumor - obstruction
202
Q

should you treat asymptomatic bacteriuria?

A

NO

203
Q

who should get treated for asymptomatic bacteriuria?

A

only PREGNANT women

204
Q
  • urinary frequency - urgency - burning - dysuria - FLANK PAIN and TENDERNESS
A

pyelonephritis

205
Q

best INITIAL test for pyelonephritis

A

urinalysis

206
Q

MOST ACCURATE test for pyelonephritis

A

urine culture

207
Q

OUTpatient treatment for pyelonephritis

A

ciprofloxacin

208
Q

INpatient treatment for pyelonephritis

A
  • ceftriaxone - ertapenem - quinolones - ampicillin - gentamicin
209
Q

why are sonography or CT scanning done in a patient with a UTI?

A
  • to determine etiology - if pyelonephritis; stone? stricture? tumor? obstruction?
210
Q

think of this in a patient who does not respond to treatment AFTER 5-7 days

A

perinephric abscess

211
Q

necessary diagnostic test for perinephric abscess

A

biopsy to determine microbe

212
Q

treatment for perinephric abscess

A

quinolone AND staphylococcal coverage (because treatment for GN bacteria selects out staphylococci)

213
Q

positive NITRITES indicate

A

gram negative bacteria in urine

214
Q
  • frequency - urgency - dysuria - PERINEAL or SACRAL PAIN - prostate tenderness
A

prostatitis

215
Q

best INITIAL test for prostatitis

A

urinalysis

216
Q

MOST ACCURATE test for prostatitis

A

urine WBC’s AFTER PROSTATE MASSAGE

217
Q

treatment for ACUTE prostatitis

A
  • ciprofloxacin - TMP/SMX FOR 2 WEEKS
218
Q

treatment for CHRONIC prostatitis

A
  • ciprofloxacin - TMP/SMX FOR 6 WEEKS
219
Q

endocarditis is clinically diagnosed using

A

Duke’s criteria (2 MAJOR, or 5 minor criteria)

220
Q

what are the 2 MAJOR criteria for Duke’s criteria?

A
  1. 2 positive blood cultures 2. abnormal echocardiogram
221
Q

what are the minor criteria for Duke’s criteria?

A
  1. fever 2. presence of risk factors 3. vascular findings 4. immunologic findings 5. microbiologic findings
222
Q

fever + murmur =

A

POSSIBLE endocarditis (do blood cultures)

223
Q

2 positive blood cultures + positive echo =

A

ENDOCARDITIS

224
Q

next best step in patient with fever, and new murmur or change in murmur

A

blood cultures

225
Q

next best step in patient with fever, a murmur (new or changed), and positive blood cultures

A

echocardiogram

226
Q

most common causes of culture NEGATIVE endocarditis

A

Coxiella and Bartonella

227
Q

is associated even more with colonic pathology than Streptococcus bovis

A

Clostridium septicum

228
Q

most common organisms for bacterial endocarditis

A
  1. Staph aureus 2. MRSA 3. Strep viridans group
229
Q

best empiric therapy for endocarditis

A

vancomycin AND gentamicin in COMBINATION (covers MC organisms) for 4-6 weeks

230
Q

if cause of endocarditis is Streptococcus bovis or Clostridium septicum, need to do what?

A

COLONOSCOPY

231
Q

what are the indications for surgery (valve replacement) in endocarditis?

A

ANATOMIC DEFECTS 1. valve rupture 2. abscess 3. prosthetic valves 4. fungal endocarditis 5. embolic events even after abx

232
Q

when do you start HAART?

A
  1. CD4 count
233
Q

adverse effect of NRTI (nucleoside reverse transcriptase inhibitors)

A

lactic acidosis

234
Q

adverse effects of PI (protease inhibitors)

A
  1. hypERglycemia 2. hypERlipidemia
235
Q

adverse effect of NNRTI (nonnucleoside reverse transcriptase inhibitors): efavirenz

A

drowsiness

236
Q

adverse effect of zidovudine

A

anemia

237
Q

adverse effects of didanosine

A
  1. pancreatitis 2. peripheral nEUropathy
238
Q

adverse effects of stavudine

A
  1. pancreatitis 2. peripheral nEUropathy
239
Q

adverse effect of abacavir

A

rash

240
Q

adverse effects of lamivudine

A

NONE

241
Q

adverse effect of tenofovir

A

renal toxicity

242
Q

adverse effect of indinavir

A

kidney stones

243
Q

postexposure prophylaxis: - needle-stick injury - unprotected sex

A

HAART for ONE MONTH (tenofovir, emtricitabine, AND integrase inhibitor, or protease inhibitor)

244
Q

blocks CCR5 receptor of CD4 cell

A

maraviroc

245
Q

which protease inhibitor inhibits the hepatic p450 system increasing blood levels of other PI’s?

A

ritonavir

246
Q

when do you start HIV meds in HIV+ pregnant women?

A

right away in first trimester (regardless of CD4 count/viral load)

247
Q

HIV+ with CD4 count

A

Pneumocystis jiroveci pneumonia (PCP)

248
Q

best ppx for Pneumocystis jiroveci pneumonia (PCP)

A

TMP/SMX

249
Q

ppx for Pneumocystis jiroveci pneumonia (PCP) if TMP/SMX causes RASH

A
  • atovaquone - dapsone
250
Q

CANNOT be used for PCP ppx if G6PD deficiency

A

dapsone

251
Q

HIV+ with CD4 count

A

Mycobacterium avium-intracellulare (MAI)

252
Q

ppx for Mycobacterium avium-intracellulare (MAI)

A

azithromycin Qweekly

253
Q

PCP presentation

A
  1. SOB 2. dry cough 3. hypoxia 4. elevated LDH
254
Q

best INITIAL test for PCP

A

CXR (increased interstitial markings B/L)

255
Q

MOST ACCURATE test for PCP

A

BAL

256
Q

treatment for PCP

A

TMP/SMX IV

257
Q

treatment for PCP if TMP/SMX causes RASH

A

pentamidine IV

258
Q

when do you give steroids in PCP?

A

pO2 35

259
Q

headache, N/V, FND in immunocompromised patient

A

toxoplasmosis

260
Q

best INITIAL test for toxoplasmosis

A

CT head WITH contrast (“ring” enhancing lesions)

261
Q

treatment for toxoplasmosis

A

pyrimethamine and sulfadiazine for 2 WEEKS

262
Q

HIV with

A

cytomegalovirus (CMV) retinitis

263
Q

treatment for CMV retinitis

A
  • ganciclovir - foscarnet
264
Q

adverse effect of ganciclovir

A

low WBC’s

265
Q

adverse effect of foscarnet

A

high creatinine

266
Q

maintenance therapy for CMV retinitis

A

valganciclovir PO LIFELONG, unless CD4 count increases

267
Q

-

A

cryptococcal meningitis

268
Q

best INITIAL test for cryptococcal meningitis

A

INDIA INK STAIN on CSF

269
Q

MOST ACCURATE test for cryptococcal meningitis

A

cryptococcal antigen test

270
Q

treatment for cryptococcal meningitis

A
  • amphotericin and 5-FC (flucytosine) - then LIFELONG fluconazole, unless CD4 count increases
271
Q
  • HIV and
A

progressive multifocal leukoencephalopathy (PML)

272
Q

best INITIAL test for PML

A

head CT or MRI

273
Q

MOST ACCURATE test for PML

A

PCR of CSF for JC virus

274
Q

treatment for PML

A
  • no specific treatment - HAART (will resolve when CD4 counts increases)
275
Q

does NOT cover crytpococcus

A

caspofungin

276
Q
  • HIV with
A

Mycobacterium avium intracellulare (MAI)

277
Q

diagnostic tests in order from least to most sensitive

A

LEAST sensitive= blood cultures more sensitive= bone marrow biopsy MOST sensitive= LIVER BIOPSY

278
Q

treatment for Mycobacterium avium intracellulare (MAI)

A

clarithromycin AND ethambutol +/- rifabutin

279
Q

animal exposure + jaundice + renal = (fever, abdominal pain, muscle aches)

A

leptospirosis

280
Q

treatment for leptospirosis

A
  • ceftriaxone - penicillin
281
Q
  • rabbits - ulcer at site of contact - enlarged lymph nodes - conjunctivitis
A

tularemia

282
Q

diagnose tularemia with

A

serology

283
Q

treatment for tularemia

A
  • gentamicin - streptomycin
284
Q
  • thin-walled cysts, often calcified on CTH - infected pork that’s ingested
A

cysticercosis

285
Q

treatment for cysticercosis

A

albendazole

286
Q

camping/hiking + target-shaped rash = - transmitted by Ixodes tick

A

Lyme disease

287
Q

long-term manifestations/complications of Lyme disease

A
  1. joints = LATE manifestation 2. cardiac = AV conduction block/defect 3. neurologic = 7th CN palsy (Bell’s palsy)
288
Q

diagnosis of Lyme disease

A

serology

289
Q

treatment for Lyme disease: rash, joint, Bell’s palsy

A
  • doxycycline PO - amoxicillin PO - cefuroxime PO
290
Q

treatment for Lyme disease: CNS, cardiac involvement

A

ceftriaxone IV

291
Q
  • also transmitted by Ixodes tick - common in northeast - HEMOLYTIC ANEMIA
A

babesiosis

292
Q

diagnosis of babesiosis

A
  • PBS - PCR
293
Q

treatment for babesiosis

A
  • azithromycin - atovaquone
294
Q
  • also transmitted by Ixodes tick - NO RASH - elevated LFT’s - THROMBOCYTOPENIA - LEUKOPENIA
A

ehrlichia/anaplasma

295
Q

diagnosis of ehrlichia/anaplasma

A
  • PBS - PCR
296
Q

treatment for ehrlichia/anaplasma

A

doxycycline

297
Q
  • traveler returning from endemic area - HEMOLYSIS - GI COMPLAINTS
A

malaria

298
Q

diagnosis of malaria

A

blood smear

299
Q

treatment for malaria: ACUTE disease

A
  • mefloquine - atovaquone/proguanil - quinine/doxycycline (severe cases)
300
Q

prophylaxis for malaria:

A
  • mefloquine (weekly) - atovaquone/proguanil (daily)
301
Q
  • immunocompromised patients - respiratory disease, can spread anywhere, usually skin or brain - branching, gram positive filaments, weakly acid-fast
A

Nocardia

302
Q

best INITIAL test for Nocardia

A

CXR

303
Q

MOST ACCURATE test for Nocardia

A

culture

304
Q

treatment for Nocardia

A

TMP/SMX

305
Q
  • normal immune system - h/o facial/dental trauma - branching, gram positive filaments
A

Actinomyces

306
Q

diagnosis and confirmation of Actinomyces

A
  1. gram stain 2. ANaerobic culture
307
Q

treatment for Actinomyces

A

penicillin

308
Q
  • WET areas (river valleys) - a/w bat droppings from caves - palate and oral ulcers - splenomegaly - pancytopenia if there’s bone dissemination
A

Histoplasmosis

309
Q

best INITIAL test for Histoplasma

A

Histoplasma urine antigen

310
Q

MOST ACCURATE test for Histoplasma

A

BIOPSY with culture

311
Q

treatment for acute pulmonary disease d/t Histoplasma

A

none needed

312
Q

treatment for disseminated Histoplasmosis

A

amphotericin

313
Q
  • VERY DRY areas (Arizona) - joint pain - erythema nodosum
A

Coccidioidomycosis

314
Q

treatment for Coccidioidomycosis

A

itraconazole

315
Q
  • acute respiratory disease - rural southeast - BROAD BUDDING YEAST - bone lesions are common
A

Blastomycosis

316
Q

treatment for Blastomycosis

A
  • amphotericin - itraconazole
317
Q

MOA of echinocandins

A

1,3-glucan inhibition in fungi ONLY

318
Q

treatment for chronic hepatitis C

A
  • boceprevir - simeprevir - sofosbuvir - ledipasvir (none used as a single agent)
319
Q

which antiviral agents for chronic hepatitis C not to be combined with interferon?

A
  • sofosbuvir - ledipasvir

USMLE Step 3 (20 decks)

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