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MCCQE1 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Antibiotics for in-patient tx of Community-acquired pneumonia.

A

Ceftriaxone + Azithromycin

*B-lactam allergy: moxifloxacin

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2
Q

Antibiotics for out-patient tx of Community-acquired pneumonia.

A

Azithromycin, doxycycline

*B-lactam allergy: moxifloxacin

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3
Q

Antibiotics for healthcare-associated pneumonia.

A

Vancomycin + Piptazo
or
Linezolid + Meropenem

Key: MRSA or Pseudomona

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4
Q

Antibiotics for Meningitis

A

Vancomycin + Ceftriaxone 2gr BID + Steroids

*If immunocompromised: Ampicillin

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5
Q

Antibiotics for outpatient UTI

A 
Amoxicillin
Or
Ampicillin
Or 
Tmp-smx

*If b-lactam allergy: nitrofurantoin

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6
Q

Antibiotic for Pyelonephritis

A

ceftriaxone

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7
Q

Antibiotic for out-patient strep cellulitis

A

Amoxicillin

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8
Q

Antibiotic for in-patient strep cellulitis

A

ceftriaxone

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9
Q

Antibiotic for out-patient staph cellulitis

A

Clindamycin, cefazolin

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10
Q

Antibiotic for out-patient staph cellulitis

A

vancomycin

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11
Q

Patient with Flu-like sx, myalgias, arthralgias, lymphadenopathy, fever.
• Flu (-), mononucleosis (-)
• HIV ELISA (-)

Dx, next step, tx?

A

Antiretroviral syndrome

Next step: PCR (viral load)

Tx: HAART (2+1)

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12
Q

Patient with opportunistic infection, HIV ELISA (+)

Next steps, tx?

A

Confirmation HIV with western blot
Other tests:
o Viral load (decreases quickly with tx)
o CD4 count (slowly increases only 300 of start point)
o Genotype (“culture”)
o Screen for gonorrhea, chlamydia, syphilis, HBV, HCV, toxoplasma.

Tx: HAART 2+1 depending on genotype

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13
Q

What is HAART 2+1?

A

2 nucleoside reverse transcriptase inhibitors (NRT-i) plus 1 of the following:
• Non- nucleoside reverse transcriptase inhibitors (NNRT-i)
• Protease inhibitor (P-i)
• Entry inhibitor
• Fusion inhibitor

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14
Q

Meds for PrEP?

A

Tenofovir + Emtricitabine

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15
Q

Meds for post-exposure prophylaxis (PEP)?

A

Tenofovir + Emtricitabine +/- Raltegravir

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16
Q

Vertical transmission prophylaxis of HIV?

A
  • Mom on HAART 2+1

* If unknown before: AZT

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17
Q

Prophylaxis of PCP pneumonia in HIV?

A
  1. Tmp-smx
  2. Dapsone
  3. Atovaquone
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18
Q

Prophylaxis of toxoplasmosis pneumonia in HIV?

A
  1. Tmp-smx

2. Pyrimethamine + leucovorin

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19
Q

Prophylaxis of Mycobacterium avium complex (MAC) pneumonia in HIV?

A

Azithromycin

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20
Q

Tx of Thrush in HIV?

A

Nystatin

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21
Q

Tx of Pneumocystis (PCP) pneumonia in HIV?

A

Tmp-Smx, dapsone

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22
Q

Tx of Crypto meningitis in HIV?

A

Amphotericin + fluticasone

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23
Q

Tx of Esophageal candidiasis in HIV?

A

Fluconazole

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24
Q

Tx of HSV Esophagitis in HIV?

A

Acyclovir

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25
Q

Tx of CMV Esophagitis in HIV?

A

ganciclovir

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26
Q

Tx of Toxoplasmosis in HIV?

A

Pyrimethamine sulfadoxine

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27
Q

Tx of Disseminated Mycobacterium avium complex (MAC) in HIV?

A

Clarithromycin + ethambutol

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28
Q

Tx of CMV retinitis in HIV?

A

Valaciclovir, foscarnet

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29
Q

Patient with close contacts, HIV/AIDS, Transplants, Chemo. How much is a positive PPD?

A

> 5mm

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30
Q

Prisoners, Homeless, Healthcare worker, Traveled to endemic area. How much is a positive PPD?

A

> 10 mm

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31
Q

Western patient with no risk factor. How much is a positive PPD?

A

> 15 mm

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32
Q

TB screening.
+ PPD
- CRx

Dx and next step?

A

Latent TB

INH + B6 x 9 months

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33
Q

TB screening.
+ PPD
+ CRx

Next step?

A

AFB smear

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34
Q

TB screening.
+ PPD
+ CRx
- AFB smear

Dx and next step?

A

Latent TB

INH + B6 x 9 months

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35
Q

TB screening.
+ PPD
+ CRx
+ AFB smear

Dx and next step?

A

Active TB

RIPE

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36
Q

Young patient with hemoptysis, night sweets, weight loss.
CRx with apical lesions
(+) AFB smear

Dx and next step?

A

Active TB

RIPE

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37
Q

Young patient with hemoptysis, night sweets, weight loss.
CRx with apical lesions
(-) AFB smear

Dx and tx?

A

Latent TB

INH + B6 x 9 months

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38
Q

Young patient with hemoptysis, night sweets, weight loss.
Normal CRx
(-) AFB smear

Next step?

A

Nucleic acid amplification test (NAAT) to rule out TB

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39
Q

Patient with suspicion of TB. culture is initially (-) but then comes back (+) after 6 weeks.
Dx?

A

Mycobacterium avium complex (MAC)

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40
Q

Side effects of Rifampicin

A

Red urine and hepatotoxicity

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41
Q

Side effects of INH

A

Neuropathy (B6 for prophylaxis) and hepatotoxicity

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42
Q

Side effects of Pyrazinamide

A

Hyperuricemia, gout and hepatotoxicity

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43
Q

Side effects of Ethambutol

A

Optic neuritis (Eye) and hepatotoxicity

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44
Q

Definition of sepsis

A

Severe organ dysfunction from dysregulated response to infection

Organ dysfunction is screen with qSOFA > 2 points

  • RR > 22
  • BP < 100 mmHg
  • Altered mental status (GCS < 15)
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45
Q

Criteria of qSOFA?

A

Organ dysfunction in sepsis is screen with qSOFA > 2 points

  • RR > 22
  • BP < 100 mmHg
  • Altered mental status (GCS < 15)
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46
Q

Definition of septic shock

A

Sepsis which is NOT responsive to IVFs presenting with:

  • Persistent hypotension requiring vasopressors
  • Serum lactate > 2 mmol/L
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47
Q

Definition of MODS (multiorgan dysfunction syndrome)

A

Septic shock + multiple organs failing

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48
Q

Goals of Early goal-directed therapy (management of sepsis)

A 
Early -> Intervene within 6 hours
Goals
- Central venous pressure 10-12 mmHg
- Urinary output > 0.5 cc/kg/hr
- MAP > 65 mmHg
- Central venous saturation (ScvO2) > 70%
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49
Q

Management of sepsis

A
  • IVFs (bolus of 30cc/kg)
  • Empiric antibiotics (e.g., vanco + pip/tazo)
    • Get cultures before
  • Remove potential sources like drainage or plastics (e.g., central lines, endotracheal tubes, foley)
  • Oxygen
  • RBCs if Hb < 7
  • Vasopressors if not responsive to IVFs
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50
Q

Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.

Probable dx and Next step?

A

Meningitis

Next step: lumbar punction

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51
Q

Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.

Lumbar punction shows 1000 PMN.

Dx and tx? What would be the tx if immunosuppressed?

A

Bacterial meningitis

Treat empirically with Ceftriaxone + vancomycin + steroids while the results of Cx come out.

If the patient were immunosuppressed, add ampicillin

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52
Q

Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has rash that moves from arms to trunk. The patient was camping recently.

No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.

Lumbar punction shows no significant changes.

Dx and tx?

A

Rocky mountains spotty fever

Tx: Ceftriaxone

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53
Q

Patient with Fever, Headache, Photophobia, Phonophobia, arthralgias, Nausea and vomiting. On physical exam has a targetoid rash. The patient had a recent trip to Connecticut

No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.

Lumbar punction shows no significant changes.

Dx and tx?

A

Lyme disease

Tx: Ceftriaxone

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54
Q

Patient AIDS with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting.

Dx, next step and tx?

A

Cryptococcal

Next step: cryptococcal antigen

Tx; Amphoericin

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55
Q

Patient (homeless/prisoner) with Fever, Headache, Photophobia, Phonophobia, night sweats, weight loss, hemoptisis Nausea and vomiting. On physical exam has stiff neck.

No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.

Lumbar punction shows no significant changes.

Dx and tx?

A

Meningitis for TB

Tx: 
Rifampicin
INH
Pyrazinamide
Ethambutol
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56
Q

Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
Altered mental status, suspition of Immunosuppression, history of Seizures. Vitals: HTN, RR: 28, HR: 45.

Probable dx and Next step?

A

Meningitis

Next step:

  • Empiric Abx (Ceftriaxone + vancomycin + steroids. If immunosuppressed, add ampicillin)
  • Then, CT scan
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57
Q

Patient HIV (+) with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting.

Probable dx and Next step?

A

Toxoplasmosis

Next step:
Toxo Ab

Treat toxo and repeat scan in 6 weeks

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58
Q

Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
Altered mental status, history of Seizures. Vitals: HTN, RR: 28, HR: 45.

Toxo Ab: Negative

Next step?

A

Biopsy to distinguis between cancer and abscess.

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59
Q

Patient with Fever, Headache, Photophobia, Phonophobia, Nausea and vomiting. On physical exam has stiff neck.
No Altered mental status, no Immunosuppressed, no history of Seizure. Normal vitals.

Lumbar punction shows ↑ lymphocites.

Dx, next step and tx?

A

Encephalitis

HSV PCR

Tx:

  • If HSV PCR (+): IV acyclovir
  • If HSV PCR (-): Supportive care
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60
Q

Patient with Red, hot, tender skin, Demarcated area with Site of entry. No abscess. Normal vitals.

Dx, microorganism and tx?

A

Cellulitis

Microorganism: Strep A (no abscess)

Tx: Cefalexin
Mark the edge of the infection and follow its evolution

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61
Q

Patient with Red, hot, tender skin, Demarcated area with Site of entry, abscess. Normal vitals.

Dx, microorganism and tx?

A

Cellulitis

Microorganism: Staph

Tx: Tmp-smx (PO)
Mark the edge of the infection and follow its evolution

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62
Q

Patient with Red, hot, tender skin, Demarcated area with Site of entry, abscess. The patient looks septic.

Dx, microorganism and tx?

A

Cellulitis

Microorganism: Staph

Tx: Vancomycin or Linezolid (IV) or Clindamycin
Mark the edge of the infection and follow its evolution

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63
Q

Patient with refractory celullitis. Dx?

A

Rule out Osteomyelitis

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64
Q

Patient Penetrating Wound with exposed bone. Dx and microorganism?

A

Osteomyelitis

S. Aureous, pseudomona

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65
Q

Patient with sickle cell with osteomyelitis. Microorganism?

A

S. Aureous, salmonella

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66
Q

Patient who was gardening and has Osteomyelitis. Microorganism?

A

S. Aureous, sporothrix

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67
Q

Patient with DM who has Osteomyelitis. Microorganism?

A

S. Aureous, pseudomona

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68
Q

Patient with cirrhosis who eats Oysters and has hematogenous Osteomyelitis. Microorganism?

A

S. Aureous, V. vulnificus

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69
Q

Patient with refractory celullitis. Next steps, tx and F/U?

A

Nest steps:

  • 1st X-Ray
  • 2nd MRI
  • Best: Bx and Cx

Tx:

  • Debridement
  • 4-6 weeks of antibiotics
  • Empirical: Vanco + pip/tazo

F/U: ESR, CRP. If they decrease, transition to PO

70
Q

Patient penetrating wound contaminated with feces. On physical has Crepitus on skin. Dx, next step and tx?

A

Gas gangrene

Next step:
- X-Ray shows subcutaneous gas

Tx:

  • Debridement
  • Penicillin + Clinda
71
Q

Patient with Refractory rapidly evolving cellulitis, Septic, Pain out of proportion, Crepitus, Blue/gray discoloration. Dx, next step and tx?

A

Necrotizing fasciitis

Next step:
- X-Ray showing gas

Tx:

  • Surgical debridement
  • 3rd gen cephalosporin + clinda + ampicillin
72
Q

Who’s called the Necrotizing fasciitis on the groin?

A

Fournier’s gangrene

73
Q

Most common microorganism in Community-acquired pneumonia (CAP)?

A

S. Pneumo

74
Q

Most common microorganism in CAP in COPD patient?

A

H. Influenza

75
Q

Patient with pneumonia for aspiration. Mos common microorganism?

A

Klebsiella and anaerobes

76
Q

Patient who had the flu and then has again cough, fever and consolidation. Microorganism?

A

S. Aureus

77
Q

Most common microorganism in CAP in immunosupressed patient?

A

Legionella

78
Q

Patient with fever, productive cough. CxR normal. Dx and tx?

A

Bronchitis

Tx:
Azithromycin or doxycycline or moxifloxacin

79
Q

Patient with fever, productive cough. CxR with cavitatory lession. Next step?

A

CT scan to differentiate between Fungus, Cancer, TB and abscess.

If abscess –> ceftriaxone + clinda

80
Q

Patient with fever, productive cough. CxR with consolidation. > 90 days from exposure to a “healthcare facility”
< 48 hrs from admission to a hospital
Dx and Tx?

A

Comminuty adquired PNA (CAP)

Tx:
3rd gen cephalosporin 
\+
Macrolide (Azithromycin)
OR
Moxifloxacin
81
Q

Patient with fever, productive cough. CxR with consolidation. < 90 days from exposure to a “building”
> 48 hrs from admission to a hospital
Dx and Tx?

A

Healthcare associated PNA (HCAP)

Tx:
Pip/tazo or Cephepime
+
Vancomycin

82
Q

Patient HIV/AIDS with slowly developing SOB and productive cough.
Dx, next step, and Tx?

A

Pneumocystis (PCP) PNA

Next step:
Silver stain of sputum

Tx:
TMP-SMX
+/-
Steroids (if hypoxemic)

83
Q

How to define who needs to be admitted in PNA?

A

CURB-65 (if one is met, they are admitted)

  • Confusion of new onset
  • Urea > 7 / BUN > 19
  • Respiratory rate > 30
  • Blood pressure < 90/60
  • > 65 years old
84
Q

Tx of influenza?

A

Oseltamivir (Tamiflu)

85
Q

Men with urethral dischrage. Dx, next step and tx?

A

Urethritis

Next step: Urinary GC/Chlamydia

Tx:
Ceftriaxone 250 mg IM, single dose
+
Azithromycin PO x 1 or doxycyclin PO x 7 days

F/U: HIV screening

86
Q 
Pregnant patient with. 
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf

Dx and tx?

A

ASx bacteruria

Tx: amoxicillin; nitrofurantoin if PNC allergic

F/U: Repeat the screen

87
Q 
Asx patient, no risk factors. 
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf

Next step?

A

Nothing

88
Q 
Patient with Urgency, frequency, dysuria.  No risk factors.
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf

Dx, next step and tx?

A

Uncomplicated cystitis

Next step: nothing, no need for culture

Tx: 
TMP-SMX x 3 days
or
Nitrofurantoin x 3 days
or
Fosfomicin x 3 days
89
Q

Criteria for complicated cistitis

A
  • Penis (men)
  • Plastic (e.g., foley)
  • Procedure
  • Pyelonephritis
90
Q 
Men with Urgency, frequency, dysuria, and a foley catheter. 
Uroanalysis:
- Leukocyte Esterase
- Nitrites
- > 10 wbc/hpf

Dx and tx?

A

Complicated cystitis

Tx: 
TMP-SMX x 7 days
or
Nitrofurantoin x 7 days
or
Fosfomicin x 7 days
91
Q

When to do a culture in UTI?

A
  • Pregnant
  • Procedure
  • Pyelonephritis
  • Multi-drug resistance
  • Abx failure

Positive if > 105 colonies

92
Q

Patient with Urgency, frequency, dysuria, Fever, chills. On physical exam has costo-vertebral angle (CVA) tenderness.

Uroanalysis:

  • Leukocyte Esterase
  • Nitrites
  • > 10 wbc/hpf

Dx, next step and tx?

A

Pyelonephritis

Next step: Culture

Tx:

  • IV Ceftriaxone or ampi-sulb if hospitalized x 10 days
  • PO ciprofloxacin if ambulatory x 10 days
93
Q

Patient with pyelonephritis who doesn’t improve after 72 hrs

Dx, next step and tx?

A

Perinephric abscess

Next step:

  • CT scan if non-pregnant
  • U/S if pregnant

Tx:

  • Drainage
  • Continue Abx for 14 days
94
Q

Patient with singular, painless genital ulcer with nontender lymphadenopathy.
Dx, next step and tx?

A

Primary Syphilis

Next step: dark field microscopy

Tx: Penicillin x 1 IM

F/U
- HIV screening

95
Q

Patient with fever targetoid rash involving palms and soles.

Dx, next step and tx?

A

Secondary Syphilis

Next step: RPR, if positive confirm with FTA-Abs

Tx: Penicillin x 1 IM

F/U

  • Repeat RPR–> dilusions have to decrease after treatment
  • HIV screening
96
Q

Patient ASx, (+) RPR, Contraction < 1 year.

Dx and tx?

A

Early Latent Syphilis

Tx: Penicillin x 1 IM

F/U

  • Repeat RPR–> delusions have to decrease after treatment
  • HIV screening
97
Q

Patient ASx, (+) RPR, Contraction > 1 year.

Dx and tx?

A

Late latent Syphilis

Tx: Penicillin q week x 3 weeks

F/U

  • Repeat RPR–> delusions have to decrease after treatment
  • HIV screening
98
Q

Patient with Tabes dorsalis and Argyll-Roberston pupils (bilateral irregular small pupils that accommodate but don’t react to light)
Dx, next step and tx?

A

Tertiary Syphilis

Next step: Lumbar punction CSF-RPR, if positive confirm with CSF-FTA-Abs

Tx: Penicillin q4h IV x 10-14 days

F/U

  • Repeat RPR–> delusions have to decrease after treatment
  • HIV screening
99
Q

Patient with Singular, painless gential ulcer with tender lymphadenopathy.
Dx, next step, tx?

A

Lymphogranuloma venereum

Next step: NAAT

Tx: Doxycycline

100
Q

Patient with Singular, painful genital ulcer with tender lymphadenopathy.
Dx, next step, tx?

A

Chancroid

Next step: Gram stain + culture

Tx: Azithromycin or cipro

101
Q

Patient with painful vesicles in genitals with erythematous base that tend to coalesce.
Dx, next step, tx?

A

Herpes

Next step: PCR

Tx: Acyclovir or valacyclovir

102
Q

Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear.
Dx and next step?

A

Otitis media

Pneumatic insufflation

103
Q

Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear.
On physical Pneumatic insufflation, the membrane doesn’t move.
Dx and tx?

A

Otitis media

Tx:

  • 1st: Amoxicillin
  • 2nd: Amoxicillin-clavulanate
  • Penicillin allergy: Cefdinir, azithromycin
104
Q

Indications of tympanostomy

A

3 or more otitis in 6 months or 4 in a year

105
Q

Patient with Unilateral ear pain, Worse by pulling the pinna.
Dx and tx?

A

Otitis externa

Tx:

  • Spontaneous resolution
  • Cipro drops
  • Steroid drops
106
Q

Patient with Unilateral ear pain, Relieved by pulling the pinna, Loss of light reflex, Bulging, erythematous tympanic membrane, Fluid behind the ear, Swelling behind the ear, Anteriorly rotated ear.
Dx and tx?

A

Mastoiditis

Tx: Surgical decompression

107
Q

Patient with more than 10 days of Congestion, Bilateral purulent discharge, Painful facial tap

A

Bacterial sinusitis

Amoxicillin-clavulanate

108
Q

Patient with Sore throat, Odynophagia and fever. Cough (+), no exudates, no nodes.
Dx, and tx?

A

Pharingitis centor 1 (viral)

Centor criteria
•	no Cough +1
•	Exudate +1
•	Nodes +1
•	****Temp +1****
•	OR < 14 +1; > 44 -1

Tx: Centor >= 1–> viral, supportive tx

109
Q

Patient with Sore throat, Odynophagia and fever. No cough, no exudates, no nodes.
Dx and next step?

A

Pharingitis centor 2

Centor criteria
•	****no Cough +1****
•	Exudate +1
•	Nodes +1
•	****Temp +1****
•	OR < 14 +1; > 44 -1

Next step: Centor 2-3: Rapid strep (if positive get culture)

110
Q

Patient with Sore throat, Odynophagia and fever. No cough, exudates, anterior nodes in neck.
Dx and next step?

A

Bacterial Pharingitis centor 4

Centor criteria
•	****no Cough +1****
•	***Exudate +1****
•	****Nodes +1****
•	****Temp +1****
•	Age < 14 +1; > 44 -1

Next step: Centor > 4: Amoxicillin-clavulanate

111
Q

Patietn with pharyngitis + enlarged spleen. Dx?

A

Mononucleosis

112
Q

Baby that snores and has cyanosis when eating, pink when crying. Dx and tx?

A

Choanal atresia

Tx: Surgery

113
Q

Duke criteria

A

Major

  • Bacteremia (strep, staph, HACEK)
  • New regurgitation murmur
  • Vegetation on Echo

Minor

  • Risk factors: PWID, history of endocarditis, prosthetic valves
  • Fever
  • Vascular complications (acute limb ischemia; Splinter hemorrhage; Janeway lesions)
  • Rheumatologic complications: Roth spots; osler nodes, glmerulonephritis)
114
Q

Splinter hemorrhage

A

hemorrhages underneath nails

115
Q

Janeway lesions

A

non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles.

116
Q

Roth spots

A

retinal hemorrhages

117
Q

osler nodes

A

painful red, raised lesions found on the hands and feet

118
Q

Patient PWID with CHF, Bacteremia and Toxic. Dx and next step?

A

Acute endocarditis

Next step:

  • Blood cultures
  • TEE

Tx: Treat until culture negative

119
Q

Patient with Recurrent fever, with retinal hemorrhages and painful red, raised lesions found on the hands and feet.
Dx, next step and tx?

A

Subcute endocarditis

Next step:

  • Blood cultures
  • TEE

Tx:
Genta + ceftriaxone x 4-6 weeks. Start when cultures become positive

120
Q

Antibiotics for infective endocarditis in native valve?

A

Vancomycin

121
Q

Antibiotics for infective endocarditis in new prostetic valve of < 60 days?

A

Vancomycin + gentamycin + cefepime

122
Q

Antibiotics for infective endocarditis in prostetic valve of 60-365 days?

A

Vancomycin + gentamycin

123
Q

Antibiotics for infective endocarditis in old prostetic valve > 365 days?

A

Vancomycin + gentamycin + ceftriaxone

124
Q

Patient with infective endocarditis who’s allergic to vancomycin. How to replace vanco?

A

Daptomicin

125
Q

Indications for surgery in infective endocarditis

A
  • Vegetation > 15 mm
  • Vegatation > 10 mm + embolization
  • Abscess
  • CHF
  • Fungus
126
Q

When to give prophylaxis for infective endocarditis?

A

[Congenital heart disease OR prostetic valve OR history of endocarditis]
AND
[Dental procedure OR bronchoscopy]

127
Q

Antibiotic for prophylaxis for infective endocarditis?

A

Amoxicillin

128
Q

Patient with infective endocarditis whose blood culture is positive for strep bovi. Next step?

A

Do colonoscopy. Patient highly suspicious of colon cancer

129
Q

The three most common causes of fever of unknown origin (FUO).

A

Infection, cancer, and autoimmune disease.

130
Q

Four signs and symptoms of streptococcal pharyngitis.

A

Fever, pharyngeal erythema, tonsillar exudate, lack of cough.

131
Q

A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.

A

Postinfectious glomerulonephritis.

132
Q

Asplenic patients are particularly susceptible to these organisms.

A

Encapsulated organisms—pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella.

133
Q

The number of bacteria on a clean-catch specimen to

diagnose a UTI.

A

105 bacteria/mL.

134
Q

Which healthy population is susceptible to UTIs?

A

Pregnant women. Treat this group aggressively because of potential complications.

135
Q

A patient from California or Arizona presents with fever, malaise, cough, and night sweats.

Diagnosis? Treatment?

A

Coccidioidomycosis. Amphotericin B.

136
Q

Nonpainful chancre.

A

1° syphilis.

137
Q

A “blueberry muffin” rash is characteristic of what congenital infection?

A

Rubella.

138
Q

Meningitis in neonates. Causes? Treatment?

A

Group B strep, E. coli, Listeria. Treat with gentamicin and

ampicillin.

139
Q

Meningitis in infants. Causes? Treatment?

A

Pneumococcus, meningococcus, H. infl uenzae. Treat with cefotaxime and vancomycin.

140
Q

What should always be done prior to LP?

A

Check for ↑ ICP; look for papilledema.

141
Q

CSF findings:

■ Low glucose, PMN predominance

A

Bacterial meningitis

142
Q

CSF findings:

■ Normal glucose, lymphocytic predominance

A

Aseptic (viral) meningitis

143
Q

CSF findings:

■ Numerous RBCs in serial CSF samples

A

Subarachnoid hemorrhage (SAH)

144
Q

CSF findings:

■ ↑ gamma globulins

A

Multiple Sclerosis

145
Q

Initially presents with a pruritic papule with regional
lymphadenopathy; evolves into a black eschar after 7–10
days. Treatment?

A

Cutaneous anthrax. Treat with penicillin G or ciprofloxacin.

146
Q

Findings in 3° syphilis.

A

Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms.

147
Q

Characteristics of 2° Lyme disease.

A

Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis.

148
Q

Cold agglutinins (a form of autoimmune hemolytic anemia in which cold agglutinins –agglutinating autoantibodies with an optimum temperature of 3 to 4°C–can cause clinical symptoms related to agglutination of red blood cells in cooler parts of the body and hemolytic anemia).

Associated with?

A

Mycoplasma.

149
Q

A 24-year-old man presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?

A

Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension or fluconazol.

150
Q

Begin Pneumocystis jiroveci (formerly P. carinii) pneumonia prophylaxis in an HIV-positive patient at what CD4 count?

Mycobacterium avium–intracellulare (MAI) prophylaxis?

A

≤ 200 for P. jiroveci (with TMP-SMX)

≤ 50–100 for MAI (with clarithromycin/azithromycin).

151
Q

Risk factors for pyelonephritis.

A

Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones.

152
Q

Neutropenic nadir postchemotherapy.

A

7–10 days.

153
Q

Erythema migrans.

Dx?

A

Lesion of 1° Lyme disease.

154
Q

Classic physical findings for endocarditis.

A

Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots.

155
Q

Aplastic crisis in sickle cell disease.

Microorganism?

A

Parvovirus B19.

156
Q

Ring-enhancing brain lesion on CT with seizures.

A

Taenia solium (cysticercosis).

157
Q

Name the organism:

■ Branching rods in oral infection

A

Actinomyces israelii

158
Q

Name the organism:

■ Painful chancroid

A

Haemophilus ducreyi

159
Q

Name the organism:

■ Dog or cat bite

A

Pasteurella multocida

160
Q

Name the organism:

■ Gardener

A

Sporothrix schenckii

161
Q

Name the organism:

■ Pregnant women with pets

A

Toxoplasma gondii

162
Q

Name the organism:

■ Meningitis in adults

A

Neisseria meningitidis

163
Q

Name the organism:

■ Meningitis in elderly

A

Streptococcus pneumoniae

164
Q

Name the organism:

■ Alcoholic with pneumonia

A

Klebsiella

165
Q

Name the organism:

■ “Currant jelly” sputum

A

Klebsiella

166
Q

Name the organism:

■ Infection in burn victims

A

Pseudomonas

167
Q

Name the organism:

■ Osteomyelitis from foot wound puncture

A

Pseudomonas

168
Q

Name the organism:

■ Osteomyelitis in a sickle cell patient

A

Salmonella

169
Q

A 55-year-old man who is a smoker and a heavy drinker
presents with a new cough and fl ulike symptoms. Gram
stain shows no organisms; silver stain of sputum shows
gram-negative rods. What is the diagnosis?

A

Legionella pneumonia.

170
Q

A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy.

What is the likely diagnosis, and how did he get it? Treatment?

A

Lyme disease, Ixodes tick, doxycycline.

171
Q

A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?

A

S. aureus or S. epidermidis.

MCCQE1 (19 decks)

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