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USMLE Step 3 Master the board > Infectious Disease COPY > Flashcards

Infectious Disease COPY Flashcards

1
Q

What are the empiric antibiotics choices for aspiration pneumonia?

A

Ceftriaxone IV + azithromycin IV + clindamycin IV

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2
Q

Rx of pneumonia in patient with cystic fibrosis

A

Tobramycin and ticarcillin-clavulanate

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3
Q

What are the major classes of antiretroviral drugs?

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

Name 7 examples of NRTIs

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

Stavudine

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5
Q

Name 5 examples of NNRTIs

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

Use mneumonic “N DEER”

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6
Q

Name 5 examples of PIs

A

Atazanavir

Indinavir

Nelfinavir

Ritonavir

Saquinavir

Use the mnemonic RAINS to remember the PIs

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7
Q

Major side effects of didanosine

A

Pancreatitis

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8
Q

When to begin Rx with HAART?

A

In symptomatic patients (any CD4 or viral load)

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

In pregnant women

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

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9
Q

Common side effect of tenofovir

A

Renal toxicity

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10
Q

Common side effect of zidovudine (AZT)

A

Myopathy

Bone marrow suppression (Anemia)

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11
Q

Common side effect of abacavir

A

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

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12
Q

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

A

Diarrhea

Nausea

Headache

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13
Q

Common side effect of protease inhibitors

A

Increase lipids, redistribute fat and cause DM

  • Hyperglycemia
  • Hyperlipidemia
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14
Q

Common side effect of indinavir

A

Renal stones

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15
Q

What is the indication and Rx of PCP in HIV

A

CD4 count < 200

or previous hx of PCP

or oral thrush

Rx: TMP SMX, dapsone or atovoquon

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16
Q

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

A

CD4 < 50

Rx: azithromycin wkly

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17
Q

What is the indication and Rx of toxoplasma gondii in HIV

A

CD4 < 100 and toxoplasma IgG +

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18
Q

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

A

IV Oxacillin/ nafcillin, or

IV cefazolin (first-generation cephalosporin)

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

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19
Q

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

A

Dicloxacillin or

Cephalexin (first-generation cephalosporin)

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

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20
Q

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

A

Vancomycin

Linezolid

Daptomycin

Ceftaroline

Tigecycline

Telavancin

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

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21
Q

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

A

Trimethoprim/ sulfamethoxazole (TMP/ SMX)

Clindamycin

Doxycycline

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

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22
Q

Listh the side effects of the following medications:

Daptomycin

Linezolid

Imipenem

A

Daptomycin: myopathy

Linezolid: low platelets

Imipenem: seizures

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

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23
Q

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

A

Cephalosporins

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24
Q

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

A

Macrolides (azithromycin, clarithromycin)

Clindamycin

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

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25
What is the altenative Rx for severe infection in the presence of penicillin allergy?
Vancomycin Linezolid Daptomycin Telavancin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 310). . Kindle Edition.
26
What is the altenative Rx for minor infection in the presence of penicillin allergy?
Macrolides (azithromycin, clarithromycin) Clindamycin TMP/ SMX Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 312). . Kindle Edition.
27
List 3 antibiotics specific for Rx of Streptococcus
Penicillin Ampicillin Amoxicillin
28
List 6 Gram-negative bacilli (rods)
Escherichia coli Enterobacter Citrobacter Morganella Pseudomonas Serratia Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 317). . Kindle Edition.
29
List 6 classes of medications and their examples for the Rx of Gram-negative bacilli
Cephalosporins (Ex: Cefepime Ceftazidime) Penicillins (Ex: Piperacillin Ticarcillin ) Monobactam (Ex: Aztreonam ) Quinolones (Ex: Ciprofloxacin Levofloxacin Moxifloxacin Gemifloxacin ) Aminoglycosides (Ex: Gentamicin Tobramycin Amikacin ) Carbapenems (Ex: Imipenem Meropenem Ertapenem Doripenem) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 322-344). . Kindle Edition.
30
Name the only Carbapenem that does not cover Pseudomonas
Ertapenem
31
List the two penicillins for Rx of GN bacilli that also cover Streptococci and anaerobes
Piperacillin Ticarcillin
32
List 3 quinolones used for the Rx of GN bacilli that are excellent pneumococcal drugs
Levofloxacin Gemifloxacin Moxifloxacin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 349-350). . Kindle Edition.
33
-------------- are excellent antianaerobic medications. They cover streptococci and all sensitive staphylococcus (MSSA). ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 351-352). . Kindle Edition.
Carbapenems
34
--------------- work synergistically with other agents to treat staph and strep. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 350-351). . Kindle Edition.
Aminoglycosides
35
-------------------- covers MRSA and is broadly active against gram-negative bacilli. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 353). . Kindle Edition.
Tigecycline
36
Gemifloxacin is a ---------- for pneumonia. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 354-355). . Kindle Edition.
Quinolone
37
Another name for gastrointestinial anaerobes
Bacteroides
38
-------------- is the best medication for abdominal anaerobes. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 359). . Kindle Edition.
Metronidazole
39
---------------, ----------------, and ---------------- are equal in efficacy for abdominal anaerobes compared to metronidazole. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 361-362). . Kindle Edition.
Carbapenems Piperacillin Ticarcillin
40
-------------------- is the best drug for anaerobic strep (respiratory anaerobes). ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 367-368). . Kindle Edition.
Clindamycin
41
List some medications with no anaerobic coverage ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 369). . Kindle Edition.
Aminoglycosides Aztreonam Fluoroquinolones Oxacillin/ nafcillin All the cephalosporins except **cefoxitin and cefotetan** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 370-372). . Kindle Edition.
42
Rx for herpes simplex and varicella zoster
Acyclovir Valacyclovir Famciclovir (n/b: they are all of equal efficacy) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 382). . Kindle Edition.
43
Rx for cytomegalovirus (CMV)
Valganciclovir Ganciclovir Foscarnet (these agents are also effective against simplex and varicella) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 383-384). . Kindle Edition.
44
Name the best long-term Rx for CMV retinitis
Valganciclovir ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 385). . Kindle Edition.
45
Adverse effects of Valganciclovir and ganciclovir
Neutropenia Bone marrow suppression Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 387-388). . Kindle Edition.
46
Adverse effect of foscarnet
Renal toxicity
47
Rx for influenza A and B
Oseltamivir Zanamivir Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 390). . Kindle Edition.
48
What class of drugs are oseltamivir and zanamivir
Neuraminidase inhibitors ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 390). . Kindle Edition.
49
Use of Ribavirin
Hepatitis C (in combination with interferon) Respiratory syncytial virus (RSV) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 391-392). . Kindle Edition.
50
Rx of chronic hepatitis B
Lamivudine Interferon Adefovir Tenofovir Entecavir Telbivudine: Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 392-393). . Kindle Edition.
51
Drug of 1st choice for Candida (not Candida krusei or Candida glabrata), Cryptococcus, oral and vaginal candidiasis as an alternative to topical mediations ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 395-396). . Kindle Edition.
**Fluconazole** **Itraconazole** (equal to fluconazole but less easy to use; rarely the best initial therapy for anything) **Voriconazole** (Covers all Candida; best agent against Aspergillus. Adverse effect: – Some visual disturbance) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 397-400). . Kindle Edition.
52
Best agent against aspergillus
Voriconazole
53
Name the family of antifungal agent most excellent for neutropenic fever patients
Echinocandins
54
List three examples of Echinocandins
Caspofungin Micafungin Anidulafungin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 400-401). . Kindle Edition.
55
-------------- is effective against all Candida, Cryptococcus, and Aspergillus: ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 409-410). . Kindle Edition.
Amphotericin B
56
Aspergillus: ---------- superior to amphotericin B ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.
Voriconazole
57
Neutropenic fever: --------------- is superior to amphotericin B ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.
Caspofungin
58
Candida: -------------- is equal to amphotericin for efficacy but has much fewer adverse effects Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.
Fluconazole
59
List the Adverse effects of amphotericin B
Renal toxicity (increased creatinine) Hypokalemia Metabolic acidosis Fever, shakes, chills Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 418-422). . Kindle Edition.
60
List the diagnostic testings for osteomyelitis
Best initial test: Plain x-ray Best second-line test (if there is high clinical suspicion and x-ray is negative): MRI Most accurate test: bone biopsy and culture Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 431-433). . Kindle Edition.
61
What is the earliest finding of osteomyelitis on an x-ray Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 445). . Kindle Edition.
Periosteal elevation
62
Which test has greater sensitivity, the MRI or the bone scan? ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 470-471). . Kindle Edition.
Both have equal sensitivity
63
Which test has greater specificity, the MRI or the bone scan? Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 470-471). . Kindle Edition.
MRI
64
Best means of monitoring improvement in Rx of osteomyelitis
Monitoring ESR
65
Most common cause of osteomyelitis
Staphylococcus
66
Why is swimming commonly associated with otitis externa
Because swimming washes out the acidic environment normally found in the external auditory canal. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 503). . Kindle Edition.
67
Rx for otitis externa
Topical antibiotics, such as ofloxacin or polymyxin/ neomycin. Add topical hydrocortisone to decrease swelling and itching. Adding acetic acid and water solution to reacidify the ear can help eliminate the infection. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 509-511). . Kindle Edition.
68
Diagnostic tests for malignant otitis externa
Best initial test: Skull x-ray or MRI Most accurate test: Biopsy Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 517-519). . Kindle Edition.
69
Rx of malignant otitis externa
Surgical debridement and antibiotics active against Pseudomonas such as ciprofloxacin, piperacillin, cefepime, carbapenem, or aztreonam. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 521-523). . Kindle Edition.
70
Rx of otitis media
Best initial therapy: Amoxicillin. Usual course is 7– 10 days; longer for younger patients and shorter for older patients. Next step: Perform the most accurate test, tympanocentesis and aspirate of the tympanic membrane for culture. This is rarely necessary and is only done for recurrent or persistent cases that fail therapy. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 533-536). . Kindle Edition.
71
List the common bacterial causes of sinusitis or otitis media
Streptococcus pnuemoniae Haemophilus influenzae Moraxella catarrhalis
72
---------- or ---------- is the Rx for influenza if the patient presents within the first 48 hours after the onset of symptoms. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 577-578). . Kindle Edition.
Oseltamivir or zanamivir
73
Strongest indications for vaccination against influenza
COPD CHF Dialysis patients Steroid use Health care workers Everyone \> 50 Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 583-584). . Kindle Edition.
74
Causes of impetigo
Streptococcus pyogenes Staphylococcus aureus
75
Rx of impetigo
Topical mupirocin or retapamulin (mupirocin has greater activity against MRSA, bacitracin has less efficacy as a single agent) Severe disease: Oral dicloxacillin or cephalexin Community-acquired MRSA (CA-MRSA): TMP/ SMZ; clindamycin is sometimes useful Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 593-595). . Kindle Edition.
76
What is Erysipelas?
This is a group A (pyogenes) streptococcal infection of the skin. The skin is very bright red and hot because of dilation of the capillaries of the dermis due to locally released inflammatory mediators Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 602-605). Kindle Edition.
77
What is the most common site of Erysipelas?
The face
78
Best initial Rx for Erysipelas
**Oral dicloxacillin or cephalexin**. Topical antibiotics are useless. If the organism is confirmed as group A beta hemolytic streptococci, you may treat with **penicillin VK**. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 615-617). . Kindle Edition.
79
What is the basis for lower extremity doppler ultrasonography in cellulitis of the leg?
Beacuse both a blod clot and cellulitis may cause fever
80
Rx for cellulitis
Minor disease: Dicloxacillin or cephalexin orally Severe disease: Oxacillin, nafcillin, or cefazolin IV Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 626-628). . Kindle Edition.
81
What skin infection does Staphylococcus epidermidis cause? Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 633-634). . Kindle Edition.
None. S. epidermidis is a normal commensal inhabitant of the skin. It lives there and does not cause skin infection. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 634-635). . Kindle Edition.
82
What is the difference among folliculitis, furuncles, carbuncles, and boils
The only fifference is size. Folliculitis \< Furuncles \< Carbuncles \< Boils Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 636-637). . Kindle Edition.
83
Causative agent for folliculitis, furuncles, carbuncles, and boils.
Staphylococcus aureus
84
Rx for folliculitis, furuncles, carbuncles and boils.
Minor disease: Dicloxacillin or cephalexin orally Severe disease: Oxacillin, nafcillin, or cefazolin IV If large, as in boils, do I & D.
85
Best initial diagnostic test for fungal infection of the skin or nail
* KOH preparation 1. Scrape the skin or nail. 2. Place the scraping on a slide with KOH and acid and heat it. 3. The epithelial cells will dissolve and leave the fungal forms behind, visible on the slide Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 650-654). . Kindle Edition.
86
Rx for fungal infection of the skin and nail
Topical antifungal medication (if no hair or nail involvement): Clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin, or ciclopirox Oral antifungal medication for scalp (tinea capitis) or nail (onychomycosis) – Terbinafine: Causes increased liver function tests – Itraconazole – Griseofulvin (for tinea capitis): Has less efficacy than either terbinafine or itraconazole Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 656-665). . Kindle Edition.
87
Best initial test for urethritis
Urethral swab for Gram stain, WBC count, culture, and DNA probe Nucleic acid amplification tests (NAATs) are highly effective as well Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 672-673). . Kindle Edition.
88
Basic principle for Rx of urethritis
Two medications: one for gonorrhea and another for Chlamydia
89
List some gonorrhea medications
Ceftriaxone IM Cefixime oral Cefpodoxime oral Ciprofloxacin oral (2nd line)
90
List the medications for Chlamydia urethritis
Azithromycin (single dose) Doxycycline (for one week)
91
Rx for urethritis in pregnancy
Ceftriaxone IM and Azithromycin
92
What predisposes a patient to recurrent infections with Neisseria?
Terminal complement deficiency
93
Single best test for gonorrhea and Chlamydia?
Nucleic acid amplification test (NAAT)
94
What blood finding is a measure of severity in PID?
Leukocytosis
95
Best initial test for PID
Pregnancy test, then cervical culture and DNA probe for Chlamydia and gonorrhea Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 722-724). . Kindle Edition.
96
Most accurate test for PID
Laparoscopy
97
How to collect samples for nucleic acid amplification test
NAAT can be done on voided urine for men or blind vaginal swab in women. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 726-727). . Kindle Edition.
98
Outpatient Rx for PID
Ceftriaxone (IM) and doxycycline (oral) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 740). . Kindle Edition.
99
Inpatient Rx of PID
Cefoxitin (IV) and doxycycline and maybe metronidazole. Cefotetan can be used instead of cefoxitin. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 741-742). . Kindle Edition.
100
List four family of antibiotics safe in pregancy
Penicillins Cephalosporins Aztreonam Macrolides (Azithromycin and Erythromycin)
101
Presentation of epidydimo-orchitis
An extremely painful and tender testicle with a normal position in the scrotum. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 750-752). . Kindle Edition.
102
Rx of epidydimo-orchitis
\< 35 years of age: Ceftriaxone and doxycycline \> 35 years of age: Fluoroquinolone Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 754-755). . Kindle Edition.
103
Causative agent: painful genital ulcer
Haemophilus ducreyi Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 760-761). . Kindle Edition.
104
Best initial test for chancroid
Swab for Gram stain (gram-negative coccobacilli) and culture **(will require specialized medium: Nairobi medium or Mueller-Hinton agar)**. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 763-764). . Kindle Edition.
105
Rx for chancroid
Single IM shot of ceftriaxone or single oral dose of azithromycin. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 765-766). . Kindle Edition.
106
Causative agent: Lymphogranuloma venereum (LGV)
Chlamydia trachomatis
107
Rx of Lymphogranuloma venereum (LGV)
Aspirate the bubo. Treat with: * Ddoxycycline * Azithromycin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 773-774). . Kindle Edition.
108
Causative agent: Genital herpes
Herpes simplex virus type 2 (HSV2)
109
When is it necessary to do the Tzanck prep test in HSV2
If the roofs come off the vesicles and the lesion becomes an ulcer of unclear etiology, Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 785-786). . Kindle Edition.
110
Rx for HSV2
Acyclovir Valacyclovir Famciclovir Rx is for 7– 10 days Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 784-785). . Kindle Edition.
111
Rx for acyclovir resistant herpes
Foscarnet
112
Rx for HSV2 in pregnancy
Acyclovir
113
Rx for cytomegalovirus (CMV)
Ganciclovir
114
What is the most accurate test in primary syphilis?
**Darkfield microscopy**. Darkfield microscopy is far more sensitive than a VDRL or RPR in primary syphilis. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 804-805). . Kindle Edition.
115
Rx for primary syphylis
Single shot of IM penicillin
116
Rx of primary syphilis in those with penicillin allergy
Doxycycline
117
Diagnosis: development of fever, headache, and myalgia within 24 hours after treatment for early stage syphilis. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 810-811). . Kindle Edition.
Jarisch-Herxheimer reaction. It is a benign, self-limited reaction caused by the release of pyrogens from dying treponemal. Treat with aspirin and continue the treatment. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 810). . Kindle Edition.
118
Initial diagnostic test for secondary syphilis
RPR (Rapid Plasma Reagin) FTA (Flourescent Treponemal Antibody)
119
Rx for secondary syphilis
Single IM shot of penicillin Use doxycycline for the penicillin-allergy Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 815-816). . Kindle Edition.
120
Features of tertiary syphilis
Neurosyphilis: **Tabes doralis, general paresis, Argyll-Robertson pupil** **Gummas** **Aortitis** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 851-854). . Kindle Edition.
121
Initial diagnostic test for tertiary syphilis
RPR and FTA Lumbar puncture for neurosyphilis (test CSF with VDRL and FTA). CSF VDRL is only 50 percent sensitive. Neurosyphilis is excluded with a negative CSF FTA. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 820-821). . Kindle Edition.
122
Rx for tertiary syphilis
IV penicillin If allergic, desensitize
123
Rx of syphilis in pregnancy
Desensitization
124
Diagnosis: rare, beefy red genital lesion that ulcerates. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 876-877). . Kindle Edition.
Granuloma inguinale
125
What is the diagnostic testing and causative organism for Granulama inguinale
Biopsy or “touch prep,” Klebsiella granulomatis Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 879-880). . Kindle Edition.
126
Rx for Granuloma inguinale
Doxycycline TMP/SMX Azithromycin
127
Compare and contrast pediculosis and scabies
Pediculosis Scabies * Larger • Small * In hair-bearing areas, such as the pubic area or axilla • Burrows in web spaces * Visible on the surface • Scrape and magnify * Treat with permethrin, pyrethrins, or lindane. • Treat with permethrin, lindane, or ivermectin. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 887-898). . Kindle Edition.
128
Rx of Warts
Perform surgical removal if large. Imiquimod is an immunostimulant that leads to sloughing off of the wart. Cryotherapy, laser removal, and melting with podophyllin are other options. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 902-904). . Kindle Edition.
129
Rx of cystitis
Uncomplicated cystitis is treated with TMP/ SMX orally for 3 days, if E. coli resistance in that area is low. If resistance is \> 20 percent, then use ciprofloxacin or levofloxacin. “Complicated” cystitis is treated with 7 days of TMP/ SMX or ciprofloxacin. Complicated means an anatomic abnormality is present, such as a stone, stricture, tumor, or obstruction. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 911-915). . Kindle Edition.
130
When is it right to treat asymptomatic bacteriuria
In pregnancy
131
What are the outpatient and inpatient Rx of pyelonephritis
Outpatient: Ciprofloxacin Inpatient: IV Ampicillin + Gentimicin
132
Diagnoses: 1. Dysuria + white cells in urine + suprapubic tenderness 2. Dysuria + white cells in urine + flank pain + fever Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 948-950). . Kindle Edition.
1. Cystitis 2. Pyelonephritis
133
How is clinical diagnosis of endocarditis made
Based on the Duke Critera. By the presence of 2 major criteria, or 1 major and 3 minor criteria, or 5 minor criteria. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 979-980). . Kindle Edition.
134
List the major Duke's criteria
1. Two positive cultures with: * Staphylococcus aureus * Viridans streptococci, **Streptococcus bovis/ epidermis**, enterococci, gram-negative rods, **Candida** **HACEK organisms are generally culture-negative** * Haemophilus aphrophilus/ parainfluenzae * Actinobacillus actinomycetemcomitans * Cardiobacterium hominis * Eikenella corrodens * Kingella kingae 2. Abnormal echocardiogram * Intracardiac mass or valvular vegetation OR * Abscess OR * New partial dehiscence of prosthetic valve Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 987-1006). . Kindle Edition.
135
List the minor Duke's criteria
**Fever (\> 38.0 ° C)** **Presence of risk factors:** * IV drug use (IDU) * Presence of structural heart disease * Prosthetic heart valve * Dental procedures involving bleeding * History of endocarditis **Vascular findings:** * Janeway lesions * Septic pulmonary infarcts * Arterial emboli * Mycotic aneurysm * Conjunctival hemorrhage **Immunological findings:** * Roth spots * Osler’s node * Glomerulonephritis **Microbiologic findings:** * One positive blood culture but does not meet major criteria Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1007-1017). . Kindle Edition.
136
Best empiric therapy for infective endocarditis
Vancomycin + Gentimicin
137
Indications for surgery in infective endocarditis
Valve rupture Abscess Prosthetic valves Fungal endocarditis Embolic events once already started on antibiotics Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1070-1077). . Kindle Edition.
138
List the cardiac defects requiring prophylaxis against infective endocarditis
Prosthetic valves Unrepaired cyanotic heart disease Previous endocarditis Transplant recipients who develop valve disease Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1080-1081). . Kindle Edition.
139
List the procedures requiring prophylaxis against infective endocarditis
**Dental procedures that cause bleeding**: The prophylactic antibiotic to use for dental procedures is amoxicillin. For penicillin-allergic patients, clindamycin is the drug of choice. **Respiratory tract surgery** **Surgery of infected skin** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1083-1085). . Kindle Edition.
140
Procedures not requring prophylaxis against infective endocarditis
Dental fillings All flexible scopes All OB/ GYN procedures All urinary procedures, including cystoscopy Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1087-1088). . Kindle Edition.
141
Cardiac defects not requiring prophylaxis against infective endocarditis
Aortic stenosis or regurgitation Mitral stenosis or regurgitation Atrial or ventricular septal defects Pacemakers and implantable defibrillators Mitral valve prolapse, even if there is a murmur HOCM (IHSS) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1090-1092). . Kindle Edition.
142
Name an example of fusion inhibitor
Enfuvirtide (T20)
143
Common side effects of enfuvirtide (T20)
Injection site reactions
144
Diagnosis: HIV patient with shortness of breath, dry cough, hypoxia, and increased LDH. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1162-1163). . Kindle Edition.
PCP
145
PCP investigation: 1. Best initial diagnosis 2. Most accurate diagnosis
1. A chest x-ray will show increased interstitial markings bilaterally 2. Bronchoalveolar lavage Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1164-1166). . Kindle Edition.
146
Rx of PCP opportunistic infection in HIV patient
**IV TMP/ SMX** If there is a rash, use **IV pentamidine** **Atovaquone** can be used for mild pneumocystis **Dapsone** is not intravenous and is **used for prophylaxis, not treatment** If PCP is severe (**pO2 \< 70 or A-a gradient \> 35**), then give **steroids** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1167-1171). . Kindle Edition.
147
Diagnosis: HIV positive patient with headache, nausea, vomiting, and focal neurologic findings. What is the best initial test for above patient? Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1173). . Kindle Edition.
Diagnosis: Toxoplamosis Best initial test: **head CT with contrast** showing “ring” or contrast-enhancing lesions. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1174). . Kindle Edition.
148
Rx for toxoplasmosis
**Pyrimethamine and sulfadiazine for 2 weeks and repeat the CT scan**. If the lesions are smaller, then this is confirmative of toxoplasmosis. If the lesions are unchanged in size, then perform a brain biopsy, since this is most likely lymphoma. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1175-1177). . Kindle Edition.
149
Daignosis: HIV with \< 50 CD4 cells and blurry vision. Rx for above patient Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1179-1180). . Kindle Edition.
Cytomegalovirus (CMV) Rx: **Ganciclovir** or **foscarnet** (if resistant to ganciclovir) Maintenance therapy is with oral valganciclovir lifelong, unless the CD4 goes up with HAART. If the CD4 rises, you can stop the CMV medications. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1183-1185). . Kindle Edition.
150
Diagnosis: HIV and \< 50 CD4 cells with fever and headache. Best initial test for above patient Most accurate test for aove patient Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1187-1188). . Kindle Edition.
Cryptococcus The best initial test is an India ink stain, which has about a 60 percent sensitivity. The most accurate test is a cryptococcal antigen test, which is over 95 percent sensitive and specific. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1189-1191). . Kindle Edition.
151
Rx of cryptococcus
Treat initially with amphotericin, followed by fluconazole. The fluconazole is continued lifelong unless the CD4 count rises. If the CD4 count rises, all opportunistic infection treatment and prophylaxis can be stopped. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1194-1196). . Kindle Edition.
152
Diagnosis: HIV and \< 50 CD4 cells with focal neurologic abnormalities. What is the best initial test for above patient? Rx for above patient Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1199-1200). . Kindle Edition.
Progressive Multifocal Leukoencephalopathy (PML) CT head or MRI brain: No ring enhancement is seen No specific Rx. Rx with HAART. PML resolves with improvement with HAART Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1198). . Kindle Edition.
153
Diagnosis: HIV and \< 50 CD4 cells. There is wasting with weight loss, fever, and fatigue. Anemia is frequent from invasion of the bone marrow. Increased alkaline phosphatase and GGTP with a normal bilirubin is characteristic of hepatic involvement. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1205-1208). . Kindle Edition.
Mycobacterium Avium-Intracellulare (MAI) ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1204-1205). . Kindle Edition.
154
Diagnostic tests for MAI in descending order of sensitivity
Liver biopsy is the most sensitive. Bone marrow is more sensitive. Blood culture is the least sensitive. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1209-1211). . Kindle Edition.
155
Rx for MAI
Clarithromycin and ethambutal
156
Diagnosis: Animal exposure + Jaundice + Renal Test and Rx of above patient
Leptospirosis Diagnosed with serology Rx with ceftriaxone or penicillin
157
Diagnosis: Hunter who touch a rabbit + ulcer at the site of contact + enlarged lymph nodes + conjuctivitis Test and Rx of above patient
Tularemia Diagnosed with serology Rx with: * Doxycycline (oral) * Ciprofloxacine (oral) * Aminoglycoside (Streptomycin (IM), gentimicin (IM or IV))
158
Diagnosis: Ate pork meat + CT scan of head showing thin-walled cysts that may be calcified Rx of above patient
Cysticercosis Rx with **albendazole**
159
Diagnosis: Camping/hiking + Target-shaped rash Name given to Target-shaped rash Causative organism Vector for causative organism Teast and Rx of above patient
Lyme disease Erythema migrans Borrelia burgdorferi Ixodes genus (deer) tick Serology for IgM Oral doxycycline or amoxicillin
160
List the long-term manifestations/complications of Lyme disease
Joint involvement (most common late manifestation) Cardiac: the most common being AV conduction block/defect Neurologic: the most common being 7th cranial nerve palsy (Bell's palsy)
161
Diagnosis of long term complications of Lyme disease
Serology: * IgM * IgG * ELISA * Western blot * PCR
162
Lyme disease: 1. Rx of rash, joint or Bell's palsy 2. Rx of CNS or cardiac involvement
1. Oral doxycycline or amoxicillin 2. IV ceftriaxone
163
1. Apart from lyme disaese name two other tick-borne diseases tranmitted by Ixodes (deer) tick 2. What are the actual causative organisms for the diseases in 1 3. Method of diagnosis and findings 4. Rx modalities
1. a). Babesiosis; b). Ehrlichia 2. a). Babesia microti; b). Ehrlichia is GNB in the family of Anaplasmataceae 3. Peripheral blood smear or PCR: a). tetrads of intraerythrocytic ring forms; b). "morulae", i.e. inclusion bodies in WBCs 4. a). Clindamycin and quinine; b). Doxycycline
164
Features of babesiosis
* Common in Northeast * Hemolytic anemia * Hemolytic anemia is severe in asplenic individuals
165
Features of Ehrlichia
* No rash * Elevated LFT (ALT and AST) * Thrombocytopenia * Leukopenia
166
Rx of acute malaria
Quinine and doxycycline
167
Prophylaxis for malaria
* Mefloquine (weekly) or * Atovoquone/proguanil (Malarone, daily) * Daily doxycycline (NOT the best answer)
168
Side effects of mefloquine
* Neuropsychiatric side effects * Sinus bradycardia * QT elongation
169
---------- gives branching, gram-positive filaments that are weakly acid fast. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1308-1309). . Kindle Edition.
Norcadia
170
Norcadia: * Best initial test * Most accurate test * Rx
* Chest X-ray * Culture * TMP/SMX
171
Norcadia: 1. Those at risk * Most common areas of dissemination of pulmonary disease
1. **Immunocompromised:** 1. Leukemia 2. Lymphoma 3. Prolong steroid use 4. HIV 2. **Skin and brain**
172
Rx of actinomyces What prediposes an individual to actinomyces
Penicillin Trauma (facial or dental) **Actinomyces is part of the normal mouth flora**
173
Clues to histoplasmosis
1. Wet areas: Ohio and Mississippi River valeys 2. Lung disease with viral syndrome 3. Associated with bat droppings from caves 4. Palate and oral ulcers on PE 5. Slenomegaly on PE **Anything TB can do histoplasmosis can do**
174
* Best initial test * Most accurate test * Rx of histoplasmosis
* Best initial test: Histoplasmosis urine antigen * Most accurate test: Biopsy with culture is most accurate for both histoplasmosis and tuberculosis * Acute pulmonary disease is transient and requires no therapy * The disseminated disease is treated with amphotericin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1330-1331). . Kindle Edition.
175
---------- is an acute respiratory illness that occurs in **very dry areas like Arizona**. It causes **joint pain** and **erythema nodosum**. Rx for above condition Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1335-1337). . Kindle Edition.
Coccidioidomycosis Itraconazole
176
Diagnosis: Broad budding yeast Rx of above condition Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1344). . Kindle Edition.
Blastomycosis **Amphotericin** or **Itraconazole**
177
What is the IV Rx for methicillin sensitive Staphylococcus Aureus (MSSA)?
IV Oxacillin/ nafcillin, or IV cefazolin (first-generation cephalosporin) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 291-292). . Kindle Edition.
178
What is the oral Rx for methicillin sensitive Staphylococcus Aureus (MSSA)?
Dicloxacillin or Cephalexin (first-generation cephalosporin) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 293). Kindle Edition.
179
What are the drugs of choice for Rx severe resistant Staphylococcus?
Vancomycin Linezolid Daptomycin Ceftaroline Tigecycline Telavancin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 295-296). Kindle Edition.
180
What are the drugs of choice for Rx minor resistant Staphylococcus?
Trimethoprim/ sulfamethoxazole (TMP/ SMX) Clindamycin Doxycycline Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 298). . Kindle Edition.
181
Listh the side effects of the following medications: Daptomycin Linezolid Imipenem
Daptomycin: myopathy Linezolid: low platelets Imipenem: seizures Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 304). . Kindle Edition.
182
What is the altenative in the presence of penicillin allergic as rash?
Cephalosporins
183
What is the altenative Rx in the presence of penicillin anaphylaxis?
Macrolides (azithromycin, clarithromycin) Clindamycin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 308). . Kindle Edition.
184
What is the altenative Rx for severe infection in the presence of penicillin allergy?
Vancomycin Linezolid Daptomycin Telavancin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 310). . Kindle Edition.
185
What is the altenative Rx for minor infection in the presence of penicillin allergy?
Macrolides (azithromycin, clarithromycin) Clindamycin TMP/ SMX Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 312). . Kindle Edition.
186
List 3 antibiotics specific for Rx of Streptococcus
Penicillin Ampicillin Amoxicillin
187
List 6 Gram-negative bacilli (rods)
Escherichia coli Enterobacter Citrobacter Morganella Pseudomonas Serratia Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 317). . Kindle Edition.
188
List 6 classes of medications and their examples for the Rx of Gram-negative bacilli
Cephalosporins (Ex: Cefepime Ceftazidime) Penicillins (Ex: Piperacillin Ticarcillin ) Monobactam (Ex: Aztreonam ) Quinolones (Ex: Ciprofloxacin Levofloxacin Moxifloxacin Gemifloxacin ) Aminoglycosides (Ex: Gentamicin Tobramycin Amikacin ) Carbapenems (Ex: Imipenem Meropenem Ertapenem Doripenem) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 322-344). . Kindle Edition.
189
Name the only Carbapenem that does not cover Pseudomonas
Ertapenem
190
List the two penicillins for Rx of GN bacilli that also cover Streptococci and anaerobes
Piperacillin Ticarcillin
191
List 3 quinolones used for the Rx of GN bacilli that are excellent pneumococcal drugs
Levofloxacin Gemifloxacin Moxifloxacin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 349-350). . Kindle Edition.
192
-------------- are excellent antianaerobic medications. They cover streptococci and all sensitive staphylococcus (MSSA). ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 351-352). . Kindle Edition.
Carbapenems
193
--------------- work synergistically with other agents to treat staph and strep. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 350-351). . Kindle Edition.
Aminoglycosides
194
-------------------- covers MRSA and is broadly active against gram-negative bacilli. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 353). . Kindle Edition.
Tigecycline
195
Gemifloxacin is a ---------- for pneumonia. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 354-355). . Kindle Edition.
Quinolone
196
Another name for gastrointestinial anaerobes
Bacteroides
197
-------------- is the best medication for abdominal anaerobes. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 359). . Kindle Edition.
Metronidazole
198
---------------, ----------------, and ---------------- are equal in efficacy for abdominal anaerobes compared to metronidazole. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 361-362). . Kindle Edition.
Carbapenems Piperacillin Ticarcillin
199
-------------------- is the best drug for anaerobic strep (respiratory anaerobes). ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 367-368). . Kindle Edition.
Clindamycin
200
List some medications with no anaerobic coverage ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 369). . Kindle Edition.
Aminoglycosides Aztreonam Fluoroquinolones Oxacillin/ nafcillin All the cephalosporins except **cefoxitin and cefotetan** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 370-372). . Kindle Edition.
201
Rx for herpes simplex and varicella zoster
Acyclovir Valacyclovir Famciclovir (n/b: they are all of equal efficacy) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 382). . Kindle Edition.
202
Rx for cytomegalovirus (CMV)
Valganciclovir Ganciclovir Foscarnet (these agents are also effective against simplex and varicella) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 383-384). . Kindle Edition.
203
Name the best long-term Rx for CMV retinitis
Valganciclovir ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 385). . Kindle Edition.
204
Adverse effects of Valganciclovir and ganciclovir
Neutropenia Bone marrow suppression Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 387-388). . Kindle Edition.
205
Adverse effect of foscarnet
Renal toxicity
206
Rx for influenza A and B
Oseltamivir Zanamivir Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 390). . Kindle Edition.
207
What class of drugs are oseltamivir and zanamivir
Neuraminidase inhibitors ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 390). . Kindle Edition.
208
Use of Ribavirin
Hepatitis C (in combination with interferon) Respiratory syncytial virus (RSV) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 391-392). . Kindle Edition.
209
Rx of chronic hepatitis B
Lamivudine Interferon Adefovir Tenofovir Entecavir Telbivudine: Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 392-393). . Kindle Edition.
210
Drug of 1st choice for Candida (not Candida krusei or Candida glabrata), Cryptococcus, oral and vaginal candidiasis as an alternative to topical mediations ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 395-396). . Kindle Edition.
**Fluconazole** **Itraconazole** (equal to fluconazole but less easy to use; rarely the best initial therapy for anything) **Voriconazole** (Covers all Candida; best agent against Aspergillus. Adverse effect: – Some visual disturbance) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 397-400). . Kindle Edition.
211
Best agent against aspergillus
Voriconazole
212
Name the family of antifungal agent most excellent for neutropenic fever patients
Echinocandins
213
List three examples of Echinocandins
Caspofungin Micafungin Anidulafungin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 400-401). . Kindle Edition.
214
-------------- is effective against all Candida, Cryptococcus, and Aspergillus: ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 409-410). . Kindle Edition.
Amphotericin B
215
Aspergillus: ---------- superior to amphotericin B ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.
Voriconazole
216
Neutropenic fever: --------------- is superior to amphotericin B ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.
Caspofungin
217
Candida: -------------- is equal to amphotericin for efficacy but has much fewer adverse effects Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 411-416). . Kindle Edition.
Fluconazole
218
List the Adverse effects of amphotericin B
Renal toxicity (increased creatinine) Hypokalemia Metabolic acidosis Fever, shakes, chills Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 418-422). . Kindle Edition.
219
List the diagnostic testings for osteomyelitis
Best initial test: Plain x-ray Best second-line test (if there is high clinical suspicion and x-ray is negative): MRI Most accurate test: bone biopsy and culture Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 431-433). . Kindle Edition.
220
What is the earliest finding of osteomyelitis on an x-ray Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 445). . Kindle Edition.
Periosteal elevation
221
Which test has greater sensitivity, the MRI or the bone scan? ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 470-471). . Kindle Edition.
Both have equal sensitivity
222
Which test has greater specificity, the MRI or the bone scan? Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 470-471). . Kindle Edition.
MRI
223
Best means of monitoring improvement in Rx of osteomyelitis
Monitoring ESR
224
Most common cause of osteomyelitis
Staphylococcus
225
Why is swimming commonly associated with otitis externa
Because swimming washes out the acidic environment normally found in the external auditory canal. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 503). . Kindle Edition.
226
Rx for otitis externa
Topical antibiotics, such as ofloxacin or polymyxin/ neomycin. Add topical hydrocortisone to decrease swelling and itching. Adding acetic acid and water solution to reacidify the ear can help eliminate the infection. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 509-511). . Kindle Edition.
227
Diagnostic tests for malignant otitis externa
Best initial test: Skull x-ray or MRI Most accurate test: Biopsy Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 517-519). . Kindle Edition.
228
Rx of malignant otitis externa
Surgical debridement and antibiotics active against Pseudomonas such as ciprofloxacin, piperacillin, cefepime, carbapenem, or aztreonam. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 521-523). . Kindle Edition.
229
Rx of otitis media
Best initial therapy: Amoxicillin. Usual course is 7– 10 days; longer for younger patients and shorter for older patients. Next step: Perform the most accurate test, tympanocentesis and aspirate of the tympanic membrane for culture. This is rarely necessary and is only done for recurrent or persistent cases that fail therapy. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 533-536). . Kindle Edition.
230
List the common bacterial causes of sinusitis or otitis media
Streptococcus pnuemoniae Haemophilus influenzae Moraxella catarrhalis
231
---------- or ---------- is the Rx for influenza if the patient presents within the first 48 hours after the onset of symptoms. ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 577-578). . Kindle Edition.
Oseltamivir or zanamivir
232
Strongest indications for vaccination against influenza
COPD CHF Dialysis patients Steroid use Health care workers Everyone \> 50 Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 583-584). . Kindle Edition.
233
Causes of impetigo
Streptococcus pyogenes Staphylococcus aureus
234
Rx of impetigo
Topical mupirocin or retapamulin (mupirocin has greater activity against MRSA, bacitracin has less efficacy as a single agent) Severe disease: Oral dicloxacillin or cephalexin Community-acquired MRSA (CA-MRSA): TMP/ SMZ; clindamycin is sometimes useful Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 593-595). . Kindle Edition.
235
What is Erysipelas?
This is a group A (pyogenes) streptococcal infection of the skin. The skin is very bright red and hot because of dilation of the capillaries of the dermis due to locally released inflammatory mediators Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 602-605). Kindle Edition.
236
What is the most common site of Erysipelas?
The face
237
Best initial Rx for Erysipelas
**Oral dicloxacillin or cephalexin**. Topical antibiotics are useless. If the organism is confirmed as group A beta hemolytic streptococci, you may treat with **penicillin VK**. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 615-617). . Kindle Edition.
238
What is the basis for lower extremity doppler ultrasonography in cellulitis of the leg?
Beacuse both a blod clot and cellulitis may cause fever
239
Rx for cellulitis
Minor disease: Dicloxacillin or cephalexin orally Severe disease: Oxacillin, nafcillin, or cefazolin IV Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 626-628). . Kindle Edition.
240
What skin infection does Staphylococcus epidermidis cause? Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 633-634). . Kindle Edition.
None. S. epidermidis is a normal commensal inhabitant of the skin. It lives there and does not cause skin infection. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 634-635). . Kindle Edition.
241
What is the difference among folliculitis, furuncles, carbuncles, and boils
The only fifference is size. Folliculitis \< Furuncles \< Carbuncles \< Boils Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 636-637). . Kindle Edition.
242
Causative agent for folliculitis, furuncles, carbuncles, and boils.
Staphylococcus aureus
243
Rx for folliculitis, furuncles, carbuncles and boils.
Minor disease: Dicloxacillin or cephalexin orally Severe disease: Oxacillin, nafcillin, or cefazolin IV If large, as in boils, do I & D.
244
Best initial diagnostic test for fungal infection of the skin or nail
* KOH preparation 1. Scrape the skin or nail. 2. Place the scraping on a slide with KOH and acid and heat it. 3. The epithelial cells will dissolve and leave the fungal forms behind, visible on the slide Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 650-654). . Kindle Edition.
245
Rx for fungal infection of the skin and nail
Topical antifungal medication (if no hair or nail involvement): Clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin, or ciclopirox Oral antifungal medication for scalp (tinea capitis) or nail (onychomycosis) – Terbinafine: Causes increased liver function tests – Itraconazole – Griseofulvin (for tinea capitis): Has less efficacy than either terbinafine or itraconazole Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 656-665). . Kindle Edition.
246
Best initial test for urethritis
Urethral swab for Gram stain, WBC count, culture, and DNA probe Nucleic acid amplification tests (NAATs) are highly effective as well Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 672-673). . Kindle Edition.
247
Basic principle for Rx of urethritis
Two medications: one for gonorrhea and another for Chlamydia
248
List some gonorrhea medications
Ceftriaxone IM Cefixime oral Cefpodoxime oral Ciprofloxacin oral (2nd line)
249
List the medications for Chlamydia urethritis
Azithromycin (single dose) Doxycycline (for one week)
250
Rx for urethritis in pregnancy
Ceftriaxone IM and Azithromycin
251
What predisposes a patient to recurrent infections with Neisseria?
Terminal complement deficiency
252
Single best test for gonorrhea and Chlamydia?
Nucleic acid amplification test (NAAT)
253
What blood finding is a measure of severity in PID?
Leukocytosis
254
Best initial test for PID
Pregnancy test, then cervical culture and DNA probe for Chlamydia and gonorrhea Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 722-724). . Kindle Edition.
255
Most accurate test for PID
Laparoscopy
256
How to collect samples for nucleic acid amplification test
NAAT can be done on voided urine for men or blind vaginal swab in women. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 726-727). . Kindle Edition.
257
Outpatient Rx for PID
Ceftriaxone (IM) and doxycycline (oral) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 740). . Kindle Edition.
258
Inpatient Rx of PID
Cefoxitin (IV) and doxycycline and maybe metronidazole. Cefotetan can be used instead of cefoxitin. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 741-742). . Kindle Edition.
259
List four family of antibiotics safe in pregancy
Penicillins Cephalosporins Aztreonam Macrolides (Azithromycin and Erythromycin)
260
Presentation of epidydimo-orchitis
An extremely painful and tender testicle with a normal position in the scrotum. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 750-752). . Kindle Edition.
261
Rx of epidydimo-orchitis
\< 35 years of age: Ceftriaxone and doxycycline \> 35 years of age: Fluoroquinolone Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 754-755). . Kindle Edition.
262
Causative agent: painful genital ulcer
Haemophilus ducreyi Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 760-761). . Kindle Edition.
263
Best initial test for chancroid
Swab for Gram stain (gram-negative coccobacilli) and culture **(will require specialized medium: Nairobi medium or Mueller-Hinton agar)**. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 763-764). . Kindle Edition.
264
Rx for chancroid
Single IM shot of ceftriaxone or single oral dose of azithromycin. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 765-766). . Kindle Edition.
265
Causative agent: Lymphogranuloma venereum (LGV)
Chlamydia trachomatis
266
Rx of Lymphogranuloma venereum (LGV)
Aspirate the bubo. Treat with: * Ddoxycycline * Azithromycin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 773-774). . Kindle Edition.
267
Causative agent: Genital herpes
Herpes simplex virus type 2 (HSV2)
268
When is it necessary to do the Tzanck prep test in HSV2
If the roofs come off the vesicles and the lesion becomes an ulcer of unclear etiology, Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 785-786). . Kindle Edition.
269
Rx for HSV2
Acyclovir Valacyclovir Famciclovir Rx is for 7– 10 days Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 784-785). . Kindle Edition.
270
Rx for acyclovir resistant herpes
Foscarnet
271
Rx for HSV2 in pregnancy
Acyclovir
272
Rx for cytomegalovirus (CMV)
Ganciclovir
273
What is the most accurate test in primary syphilis?
**Darkfield microscopy**. Darkfield microscopy is far more sensitive than a VDRL or RPR in primary syphilis. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 804-805). . Kindle Edition.
274
Rx for primary syphylis
Single shot of IM penicillin
275
Rx of primary syphilis in those with penicillin allergy
Doxycycline
276
Diagnosis: development of fever, headache, and myalgia within 24 hours after treatment for early stage syphilis. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 810-811). . Kindle Edition.
Jarisch-Herxheimer reaction. It is a benign, self-limited reaction caused by the release of pyrogens from dying treponemal. Treat with aspirin and continue the treatment. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 810). . Kindle Edition.
277
Initial diagnostic test for secondary syphilis
RPR (Rapid Plasma Reagin) FTA (Flourescent Treponemal Antibody)
278
Rx for secondary syphilis
Single IM shot of penicillin Use doxycycline for the penicillin-allergy Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 815-816). . Kindle Edition.
279
Features of tertiary syphilis
Neurosyphilis: **Tabes doralis, general paresis, Argyll-Robertson pupil** **Gummas** **Aortitis** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 851-854). . Kindle Edition.
280
Initial diagnostic test for tertiary syphilis
RPR and FTA Lumbar puncture for neurosyphilis (test CSF with VDRL and FTA). CSF VDRL is only 50 percent sensitive. Neurosyphilis is excluded with a negative CSF FTA. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 820-821). . Kindle Edition.
281
Rx for tertiary syphilis
IV penicillin If allergic, desensitize
282
Rx of syphilis in pregnancy
Desensitization
283
Diagnosis: rare, beefy red genital lesion that ulcerates. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 876-877). . Kindle Edition.
Granuloma inguinale
284
What is the diagnostic testing and causative organism for Granulama inguinale
Biopsy or “touch prep,” Klebsiella granulomatis Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 879-880). . Kindle Edition.
285
Rx for Granuloma inguinale
Doxycycline TMP/SMX Azithromycin
286
Compare and contrast pediculosis and scabies
Pediculosis Scabies * Larger • Small * In hair-bearing areas, such as the pubic area or axilla • Burrows in web spaces * Visible on the surface • Scrape and magnify * Treat with permethrin, pyrethrins, or lindane. • Treat with permethrin, lindane, or ivermectin. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 887-898). . Kindle Edition.
287
Rx of Warts
Perform surgical removal if large. Imiquimod is an immunostimulant that leads to sloughing off of the wart. Cryotherapy, laser removal, and melting with podophyllin are other options. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 902-904). . Kindle Edition.
288
Rx of cystitis
Uncomplicated cystitis is treated with TMP/ SMX orally for 3 days, if E. coli resistance in that area is low. If resistance is \> 20 percent, then use ciprofloxacin or levofloxacin. “Complicated” cystitis is treated with 7 days of TMP/ SMX or ciprofloxacin. Complicated means an anatomic abnormality is present, such as a stone, stricture, tumor, or obstruction. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 911-915). . Kindle Edition.
289
When is it right to treat asymptomatic bacteriuria
In pregnancy
290
What are the outpatient and inpatient Rx of pyelonephritis
Outpatient: Ciprofloxacin Inpatient: IV Ampicillin + Gentimicin
291
Diagnoses: 1. Dysuria + white cells in urine + suprapubic tenderness 2. Dysuria + white cells in urine + flank pain + fever Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 948-950). . Kindle Edition.
1. Cystitis 2. Pyelonephritis
292
How is clinical diagnosis of endocarditis made
Based on the Duke Critera. By the presence of 2 major criteria, or 1 major and 3 minor criteria, or 5 minor criteria. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 979-980). . Kindle Edition.
293
List the major Duke's criteria
1. Two positive cultures with: * Staphylococcus aureus * Viridans streptococci, **Streptococcus bovis/ epidermis**, enterococci, gram-negative rods, **Candida** **HACEK organisms are generally culture-negative** * Haemophilus aphrophilus/ parainfluenzae * Actinobacillus actinomycetemcomitans * Cardiobacterium hominis * Eikenella corrodens * Kingella kingae 2. Abnormal echocardiogram * Intracardiac mass or valvular vegetation OR * Abscess OR * New partial dehiscence of prosthetic valve Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 987-1006). . Kindle Edition.
294
List the minor Duke's criteria
**Fever (\> 38.0 ° C)** **Presence of risk factors:** * IV drug use (IDU) * Presence of structural heart disease * Prosthetic heart valve * Dental procedures involving bleeding * History of endocarditis **Vascular findings:** * Janeway lesions * Septic pulmonary infarcts * Arterial emboli * Mycotic aneurysm * Conjunctival hemorrhage **Immunological findings:** * Roth spots * Osler’s node * Glomerulonephritis **Microbiologic findings:** * One positive blood culture but does not meet major criteria Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1007-1017). . Kindle Edition.
295
Best empiric therapy for infective endocarditis
Vancomycin + Gentimicin
296
Indications for surgery in infective endocarditis
Valve rupture Abscess Prosthetic valves Fungal endocarditis Embolic events once already started on antibiotics Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1070-1077). . Kindle Edition.
297
List the cardiac defects requiring prophylaxis against infective endocarditis
Prosthetic valves Unrepaired cyanotic heart disease Previous endocarditis Transplant recipients who develop valve disease Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1080-1081). . Kindle Edition.
298
List the procedures requiring prophylaxis against infective endocarditis
**Dental procedures that cause bleeding**: The prophylactic antibiotic to use for dental procedures is amoxicillin. For penicillin-allergic patients, clindamycin is the drug of choice. **Respiratory tract surgery** **Surgery of infected skin** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1083-1085). . Kindle Edition.
299
Procedures not requring prophylaxis against infective endocarditis
Dental fillings All flexible scopes All OB/ GYN procedures All urinary procedures, including cystoscopy Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1087-1088). . Kindle Edition.
300
Cardiac defects not requiring prophylaxis against infective endocarditis
Aortic stenosis or regurgitation Mitral stenosis or regurgitation Atrial or ventricular septal defects Pacemakers and implantable defibrillators Mitral valve prolapse, even if there is a murmur HOCM (IHSS) Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1090-1092). . Kindle Edition.
301
Name an example of fusion inhibitor
Enfuvirtide (T20)
302
Common side effects of enfuvirtide (T20)
Injection site reactions
303
Diagnosis: HIV patient with shortness of breath, dry cough, hypoxia, and increased LDH. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1162-1163). . Kindle Edition.
PCP
304
PCP investigation: 1. Best initial diagnosis 2. Most accurate diagnosis
1. A chest x-ray will show increased interstitial markings bilaterally 2. Bronchoalveolar lavage Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1164-1166). . Kindle Edition.
305
Rx of PCP opportunistic infection in HIV patient
**IV TMP/ SMX** If there is a rash, use **IV pentamidine** **Atovaquone** can be used for mild pneumocystis **Dapsone** is not intravenous and is **used for prophylaxis, not treatment** If PCP is severe (**pO2 \< 70 or A-a gradient \> 35**), then give **steroids** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1167-1171). . Kindle Edition.
306
Diagnosis: HIV positive patient with headache, nausea, vomiting, and focal neurologic findings. What is the best initial test for above patient? Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1173). . Kindle Edition.
Diagnosis: Toxoplamosis Best initial test: **head CT with contrast** showing “ring” or contrast-enhancing lesions. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1174). . Kindle Edition.
307
Rx for toxoplasmosis
**Pyrimethamine and sulfadiazine for 2 weeks and repeat the CT scan**. If the lesions are smaller, then this is confirmative of toxoplasmosis. If the lesions are unchanged in size, then perform a brain biopsy, since this is most likely lymphoma. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1175-1177). . Kindle Edition.
308
Daignosis: HIV with \< 50 CD4 cells and blurry vision. Rx for above patient Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1179-1180). . Kindle Edition.
Cytomegalovirus (CMV) Rx: **Ganciclovir** or **foscarnet** (if resistant to ganciclovir) Maintenance therapy is with oral valganciclovir lifelong, unless the CD4 goes up with HAART. If the CD4 rises, you can stop the CMV medications. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1183-1185). . Kindle Edition.
309
Diagnosis: HIV and \< 50 CD4 cells with fever and headache. Best initial test for above patient Most accurate test for aove patient Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1187-1188). . Kindle Edition.
Cryptococcus The best initial test is an India ink stain, which has about a 60 percent sensitivity. The most accurate test is a cryptococcal antigen test, which is over 95 percent sensitive and specific. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1189-1191). . Kindle Edition.
310
Rx of cryptococcus
Treat initially with amphotericin, followed by fluconazole. The fluconazole is continued lifelong unless the CD4 count rises. If the CD4 count rises, all opportunistic infection treatment and prophylaxis can be stopped. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1194-1196). . Kindle Edition.
311
Diagnosis: HIV and \< 50 CD4 cells with focal neurologic abnormalities. What is the best initial test for above patient? Rx for above patient Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1199-1200). . Kindle Edition.
Progressive Multifocal Leukoencephalopathy (PML) CT head or MRI brain: No ring enhancement is seen No specific Rx. Rx with HAART. PML resolves with improvement with HAART Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1198). . Kindle Edition.
312
Diagnosis: HIV and \< 50 CD4 cells. There is wasting with weight loss, fever, and fatigue. Anemia is frequent from invasion of the bone marrow. Increased alkaline phosphatase and GGTP with a normal bilirubin is characteristic of hepatic involvement. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1205-1208). . Kindle Edition.
Mycobacterium Avium-Intracellulare (MAI) ## Footnote Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1204-1205). . Kindle Edition.
313
Diagnostic tests for MAI in descending order of sensitivity
Liver biopsy is the most sensitive. Bone marrow is more sensitive. Blood culture is the least sensitive. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1209-1211). . Kindle Edition.
314
Rx for MAI
Clarithromycin and ethambutal
315
Diagnosis: Animal exposure + Jaundice + Renal Test and Rx of above patient
Leptospirosis Diagnosed with serology Rx with ceftriaxone or penicillin
316
Diagnosis: Hunter who touch a rabbit + ulcer at the site of contact + enlarged lymph nodes + conjuctivitis Test and Rx of above patient
Tularemia Diagnosed with serology Rx with: * Doxycycline (oral) * Ciprofloxacine (oral) * Aminoglycoside (Streptomycin (IM), gentimicin (IM or IV))
317
Diagnosis: Ate pork meat + CT scan of head showing thin-walled cysts that may be calcified Rx of above patient
Cysticercosis Rx with **albendazole**
318
Diagnosis: Camping/hiking + Target-shaped rash Name given to Target-shaped rash Causative organism Vector for causative organism Test and Rx of above patient
Lyme disease Erythema migrans Borrelia burgdorferi Ixodes genus (deer) tick Serology for IgM Oral doxycycline or amoxicillin
319
List the long-term manifestations/complications of Lyme disease
Joint involvement (most common late manifestation) Cardiac: the most common being AV conduction block/defect Neurologic: the most common being 7th cranial nerve palsy (Bell's palsy)
320
Diagnosis of long term complications of Lyme disease
Serology: * IgM * IgG * ELISA * Western blot * PCR
321
Lyme disease: 1. Rx of rash, joint or Bell's palsy 2. Rx of CNS or cardiac involvement
1. Oral doxycycline or amoxicillin 2. IV ceftriaxone
322
1. Apart from lyme disaese name two other tick-borne diseases tranmitted by Ixodes (deer) tick 2. What are the actual causative organisms for the diseases in 1 3. Method of diagnosis and findings 4. Rx modalities
1. a). Babesiosis; b). Ehrlichia 2. a). Babesia microti; b). Ehrlichia is GNB in the family of Anaplasmataceae 3. Peripheral blood smear or PCR: a). tetrads of intraerythrocytic ring forms; b). "morulae", i.e. inclusion bodies in WBCs 4. a). Clindamycin and quinine; b). Doxycycline
323
Features of babesiosis
* Common in Northeast * Hemolytic anemia * Hemolytic anemia is severe in asplenic individuals
324
Features of Ehrlichia
* No rash * Elevated LFT (ALT and AST) * Thrombocytopenia * Leukopenia
325
Rx of acute malaria
Quinine and doxycycline
326
Prophylaxis for malaria
* Mefloquine (weekly) or * Atovoquone/proguanil (Malarone, daily) * Daily doxycycline (NOT the best answer)
327
Side effects of mefloquine
* Neuropsychiatric side effects * Sinus bradycardia * QT elongation
328
---------- gives branching, gram-positive filaments that are weakly acid fast. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1308-1309). . Kindle Edition.
Norcadia
329
Norcadia: * Best initial test * Most accurate test * Rx
* Chest X-ray * Culture * TMP/SMX
330
Norcadia: 1. Those at risk * Most common areas of dissemination of pulmonary disease
1. **Immunocompromised:** 1. Leukemia 2. Lymphoma 3. Prolong steroid use 4. HIV 2. **Skin and brain**
331
Rx of actinomyces What prediposes an individual to actinomyces
Penicillin Trauma (facial or dental) **Actinomyces is part of the normal mouth flora**
332
Clues to histoplasmosis
1. Wet areas: Ohio and Mississippi River valeys 2. Lung disease with viral syndrome 3. Associated with bat droppings from caves 4. Palate and oral ulcers on PE 5. Slenomegaly on PE **Anything TB can do histoplasmosis can do**
333
* Best initial test * Most accurate test * Rx of histoplasmosis
* Best initial test: Histoplasmosis urine antigen * Most accurate test: Biopsy with culture is most accurate for both histoplasmosis and tuberculosis * Acute pulmonary disease is transient and requires no therapy * The disseminated disease is treated with amphotericin Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1330-1331). . Kindle Edition.
334
---------- is an acute respiratory illness that occurs in **very dry areas like Arizona**. It causes **joint pain** and **erythema nodosum**. Rx for above condition Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1335-1337). . Kindle Edition.
Coccidioidomycosis Itraconazole
335
Diagnosis: Broad budding yeast Rx of above condition Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1344). . Kindle Edition.
Blastomycosis **Amphotericin** or **Itraconazole**
336
What is the most accurate test in diagnosing osteomyelitis in the vertebra and in diabetic foot?
MRI

USMLE Step 3 Master the board (33 decks)

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