infectious dz prep + review Flashcards
Dx of enterobiasis
pinworm - tape test
patient has signs and symptoms of herpes zoster ophthalmicus (HZO) with involvement of the first branch of the trigeminal nerve. what is recommended treatment?
start oral antiviral, analgesics and optho referral!
* vesicles on the nose (hutchinson’s sign) is a STRONG indicator of ocular involvement
first line treatment for cutaneous MRSA infection ?
TMP/SMX (vancomycin works but is ONLY available as IV )
Lymphogranuloma venereum (LGV) - what is its presentation and causative organism?
clinical manifestation of chlamydia (along w/ urethritis, PID and reiter’s syndrome)
- starts as painless ulcer/papule/nodule of genital/rectal area –> softening, suppuration and lymphadenopathy
Which of the following signs or symptoms would you expect to find at the bite site of a patient infected with rabies?
Paresthesias and fasciculations
what other s+s are consistent with diptheria other than the classic pseudomembrane?
“bull neck” - from swelling lymph nodes/mucosa. sore throat, dysphagia, fever, HA, skin- nonhealing grey lesions, runny nose, wheezing
level of induration for positive PPD for those confirmed exposure vs suspected exposure to TB
confirmed: >5mm
suspected: >10mm
AIDS w/ CD4 <50: how do s+s of CMV and MAC differ
CMV: retinitis (scrambled eggs/ketchup), esophagitis (large superficial ulcers)
MAC: often only pulmonary in immunocompetent - HIV = disseminated (fever, sweat, diarrhea, dyspnea, RUQ pain)
1 CNS pathogen in AIDS patients - likely cause of meningoencephalitis
cryptococcus neoformans
dx of cryptococcus vs toxoplasmosis in immunocomprimised pt
cryptococcus: CSF india ink stain
toxoplasmosis: PCR (antibody to toxoplasmosis not likely found in immunocompromised)
Cysticercosis
tapeworm infection. It affects the brain and muscles. It is also the major cause of adult onset seizures in low-income countries.
causative agent for rheumatic fever
strep PYOGENES
typical signs of Shigellosis. symptoms are severe and are not improving without intervention. what is the next step?
empiric FQs (while awaiting suscpetibility testing)
just returned from thailand, frequent bloody, loose, and mucous-filled bowel movements over the past five days. stool culture show gram negative rods
shigellosis
post-partum up to five months. cough, fatigue, nocturnal dyspnea = Dx?
dilated cardiomyopathy
long-standing history of smoking and who worked during his early career as a pipefitter, presents with progressive dyspnea over the past six months. He has also had a persistent dry cough. what is seen on CXR?
pleural plaques = asbestosis
Sporothrix schenckii - what is it? txt?
fungal spore “rose handler’s disease”
through a cut or puncture wound. Infection commonly occurs in otherwise healthy individual,s but is rarely life-threatening and can be treated with antifungals.
what cardiomyopathy does sarcoidosis cause?
restrictive
hallmark of restrictive cardiomyopathy on echo?
atrial dilation with normal ejection fraction and ventricular wall thickness and volume.
fluctuating cognitive impairment, visual hallucinations, and parkinsonism (which is seen in up to 50% of patients). Falls, syncope, and REM sleep disturbances are also manifestations. =Dx?
lewy body dementia
frontotemporal dementia causes what?
Personality and behavioral changes (not memory or motor)
Male offspring of carrier mothers have a 100% chance of getting the gene - what type of inheritance?
mitochondrial
X-linked trait, what rate do males get it if their mom is a carrier?
50% chance
cornerstone of treatment for symptomatic menopause or peri-menopause.
HRT:Women with an intact uterus should be prescribed estrogen and progesterone, while women who have undergone a hysterectomy only need estrogen.
pt in arizona, productive cough, SOB, fever, target lesion rash
coccidiomycosis (PNA + erythema infectiosum or nodosum)
cocciodiomycosis vs histoplasmosis
both fungus from bird droppings/soil w/ PNA-like symptoms +/- rash. coccidiomycosis - southwest, histoplasmosis - ohio/missisipi
Which of the following pathogens is most commonly associated with GI colitis, dysentery (bloody/mucus diarrhea) the risk of developing a hepatic abscess? txt?
Amebiasis (Entamoeba histolytica)
txt: flagyl
elevated white blood cell count, fever, fetal and maternal tachycardia, uterine tenderness, and purulent or foul-smelling amniotic fluid or vaginal discharge.
chorioamnionitis - risk PPROM and prolonged ROM
what gestational age defines premature for PROM ?
24-37 weeks’ gestation
for patients on steroid-replacement therapy for addison’s dz , what are guidelines for major surgery (i.e. knee replacement)
surgery = risk of addisonian crisis. = stress dose steroids on day of Sx
which is a bigger risk factor for PAD (smoking or DM)?
smoking
reccomended timeframe for amniocentesis (for assessment of chromosome abnormalities)
15-18 wks
what chromosome abnormality is turner syndrome associated with?
45 X
Which of the following is the principal factor leading to the development of diabetic peripheral neuropathy?
poor glycemic control > insulin resistance
3 year old with recurrent fever, lethargy, dysuria, high nitrates in urine. method of Dx and likely Dx?
voiding cystourethrography for eval of vesicoureteral reflux
suspected disc herniation (strain, + straight leg raise, sciatica symptoms) - what are guidelines for Dx?
observation (imaging not needed unless symptoms persist >6wks –> MRI)
what are the parameters of physiologic jaundice? (timing, peak bilirubin, rate of rise, time to resolution)
Visible jaundice usually occurs after 24 hours of age. The peak bilirubin level does not go above 15 mg/dL, and rises less than 5 mg/dL per day. Physiologic jaundice resolves by one week in full-term infants
initial test for complications of GERD ?
endoscopy (urea breath for H pylori after confirmation of gastritis)
Post-splenectomy (or SS pts w/ functional asplenia) patients are most susceptible to which of the following types of infections?
encapsulated bacteria (spleen lymphoid tissue removes encapsulated organsims - Hflu, Spneumo, Gonorrhea, GBS, Klebsiella)
overflor incontinence from BPH - what is both therapeutic and dx?
urethral cath of bladder
what class of meds is good for meniere’s txt?
diuretics
what are the risk factors for TTP ?
pregnancy, OCPs, CA, HIV
MC symptom of a concussion
HA
chloramphenicol for brain abscess txt, what is the most serious ADR?
aplastic anemia - so CBC checked bi-weekly while on treatment
txt for diverticulitis
metronidazole and cipro for 7-10 days to target E coli and anaerobes
The US Preventive Services Task Force (USPSTF) recommends biennual (every other year) screening mammography for women aged ___ to ____
50 to 74 years.
what age should men be screened for AAA?
65-75
who gets screened for osteoporsis?
WOMEN 65+ or younger w/ higher Fx risk
what is a good medication to treat both endometriosis and mastalgias from fibrocystic dz
Danazol (both a weak progestin and androgen which helps to inhibit ovarian function. )
what is raloxifene ?
preventative medication for breast cancer and osteoporosis in post-menopausal women.
Dx test of choice for bronchiectasis ? what is the finding?
High resolution chest CT showing dilated tortuous airways
for a varicocele found on clinical exam, what is the next step in care?
repeat exam at next visit (if no hypertrophy/pain no CT is needed)
finding on Xray of osteochondroma vs bone cyst vs ewing sarcoma vs osteosarcoma vs osteoid osteoma
osteochondroma - outgrowth/pedunculated
bone cyst- lucent area (dark)
ewing sarcoma - moth eaten in shaft of bone
osteosarcoma - sunburst/ onion @ metaphysis
osteiod osteoma - bright white in cortical (border) area
This is the most characteristic symptom of Schizotypal personality disorder vs schizoid
schizotypal: odd/eccentric behavior
schizoid: seeks isolation
differentiate different types of acute glomerulonephritis (etiology and presentation): IgA nephropathy (Berger’s) , post-strep, membranoproliferative, goodpastures, vasculitis
- IgA: MC cause adults worldwide, affects young males w/in days of URI or GI infxn.
- post-strep glom : following strep (impetigo or pharyngitis), young boys w/ coca-cola urine + facial edema 2-3 wks after infection
- membranoprolif: from SLE, HepC (chronic immune dz)- mixed nephritic/nephrotic picture
- goodpastures: anti-glom basement membrane antibodies in kidney + lung (kidney failure + hemoptysis)
- vasculitis: lack of immune deposits. + P-ANCA or C-ANCA (wegener’s)
almost all types of acute glomerulonephritis present with what ?
hematuria, edema (peripheral, periorbital), HTN (Na and H2O retention), fever / abd pain/ flank pain (from renal capsule expansion)
… less common w/ AKI (oliguria urine <200mL)
proteinuria, hypoalbuminemia, hyperlipidemia and anemia
nephrotic syndrome
3 etiologies of primary nephrotic syndrome
- minimal change dz
- focal segmental glomerulomephritis
- membranous nephropathy
minimal change dz
MC nephrotic syndrome in kids: edema (peripheral, periorbital, scrotal) usually worse in morning. anemia, DVT + hyperlipidemia (liver making more proteins - clotting factors and lipoprotieins- to increase oncotic pressure)
Abx for cholecystitis?
ceftriaxone + metronidazole (E coli, enterococcus, Klebsiella)
most common cause of dry eye due to increased evaporative loss?
Meibomian gland dysfunction (contact lens wearing is from abs of fluid by the lens, NOT evaporation)
What disease is associated with Charcot’s Triad: RUQ pain, fever and jaundice?
ascending cholangitis
MC ligament injured in ankle sprain
Anterior talofibular ligament
exposure to fava beans, infection, sulfa meds, antimalarial, ASA, or NSAIDs resulting in hemolytic anemia is from what?
G6PD deficiency
abdominal exam finding with sarcoidosis
hepatosplenomegaly (noncaseating granulomas)
6 Ps:pain (out of proportion to injury), pressure (unrelenting), pain with passive stretch (of muscles), paresis, paresthesia, and pulses present.
compartment syndrome
peripheral smear that shows basophilic stippling.
lead poisoning
sodium guidelines for CHF
sodium intake to 2-3 grams (5-6 grams salt)
The ostium secundum is the embryologic site of occurance of which of the following congenital heart diseases?
ASD
MC congenital infection, what does is the MC manifestation?
CMV, MC - hearing loss,
2nd degree AV block Type I
wenkybach
txt of chlamydia in pregnant women ?
azithromycin (doxycycline is a teratogen)
What abnormality would be found upon cerebral histology in an animal that had rabies?
negri bodies
extrapyramidal ADRs of antipysch meds is from what MOA?
inhibition of dopamine (D2) receptors
exudative effusion has what ratio of protein and LDH compared to serum?
both higher. protein >0.5 and LDH >0.6
causative organism of tinea capitis that does NOT show up on woods lamp
Trichophyton tonsurans
txt for symptomatic hyponatremia
hypertonic saline
txt for hemachromatosis
phlebotomy (only chelation if phleb is CI)
Which of the following diagnostic tests is most sensitive for detecting early diabetic nephropathy? what is the best txt
urine microabluminuria. lisinopril
txt for complete heart block (3rd degree)
transcutaneous pacing
MC type of bladder CA
Urothelial (transitional) cell carcinoma
what is the richter transformation?
transition of CLL to aggressive large B cell lymphoma
plt life span
7-10 days
struvite kidney stones are MC caused by what organism
proteus and pseudomonas
granuloma annulare
chronic skin condition that causes raised reddish or skin-colored bumps (lesions) in a ring pattern, usually on the hands and feet. MC over boney areas, sponatenously resolve. idiopathic or trauma induced
necrobiosis lipodica
necrotizing skin condition in DM or RA pts. brown plaques that become waxy
pyogenic granuloma
skin growths that are small, round, and usually bloody red in color. They tend to bleed because they contain a large number of blood vessels. They’re also known as lobular capillary hemangioma or granuloma telangiectaticum.
What is the first type of motion that is lost as a person develops progressively worsening osteoarthritis of the hip joint?
internal rotation
noted tumor lysis syndrome, what are the txt options
carefully monitored hydration of at least 3 L of saline/day, + allopurinol or rasburicase to decrease serum uric acid concentration and hyperuricosuria
stress fx on Xray can be seen how many days after symptom onset?
14-30 days
what is metritis and what are the risk factors for it?
inflamm of uterus. C-section, prolonged induction, fever
when can you d/c pap smears ? (if not high grade lesions or cerv CA hx )
over 65 yo
normal levels for HgB electrophoresis in an infant
maingly Hg A1 and HgF (little HgB A2)
beta thalessemia major vs minor on electrophoresis
major: only HgF
minor: HgF, HgA1 and elevated HgA2
what is diagnostic for alpha thalassemia
bart hemoglobin on electrophoresis (after neonatal period) aka first month of life.
Xray shows bones expanded and denser than normal. Dx and txt?
pagets Dz of bone, treat with bisphosphonates
pt w/ leiomyoma who wantes to preserve her fertility
GNRH analog (causing a hypogonadism = to shrink tumor) followed by myomectomy
txt for epidermoid CA of anus
Local resection, chemotherapy, and external beam radiation
post-inflamm hypopigmentation vs vitiligo
Post-inflammatory hypopigmentation are areas of lighter pigment, not complete depigmentation. BOTH can follow trauma
The organism responsible for most cases of peritonitis in patients on peritoneal dialysis is
staph aureus (abdominal peritoneum)
polyarteritis nodosa
systemic vasculitis of medium/small arteries –> necrotizing inflamm lesions. = renal (HTN, renal failure), constitutional (fever, myalgia, arthritis), CNS (neuropathy), derm (livedo reticularis (mottled reticular), ulcer/gangrene)
Dx of polyarteritis nodosa
tissue Bx of area induration
mainstay of Txt for TTP?
plasma exchange
which types of thrombocytopenia is it ok to give platelets?
ITP and DIC
general treatment options for thrombocytopenia (low plt)
steroids, IVIG/plasmapharesis , splenectomy
+/- FFP, plts (only in ITP and DIC)
urethritis, arthritis, and conjunctivitis?
reiter’s / reactive arthritis
increased heme production leads to what type of anemia
lead or sideroblastic = high serum Fe, high transferrin, MCV normal.
nevus sebaceous
type of birthmark that usually appears on the scalp. It is made of extra oil glands in the skin. flat pink or orange plaque (slightly raised area) w/out hair growth.
*remove before puberty for risk of becoming basal cell carcinoma
when do you test for gestational DM ? does it change if they are obese/have risk of DM?
24-28 wks gestation, same for all
txt for brown recluse bite
txt pain and f/u for serial wound eval
MC area for stress fracture in the foot?
2nd metatarsal
digital fibroma, what is it and what is the txt?
It is a smooth, firm, pink nodule that occurs on the fingers and toes up through early childhood. Surgical excision is recommended so that the function of the digit is not impaired.
screening for prostate CA
DREs are not recommended and PSA screening is recommended based upon patient risk, but only after discussing the benefits and risks with the patient and the patient expressing the desire to have the examination performed.
what screening needs to be done before starting TNF alpha inhibitor for RA?
latent TB (b/c med will increase risk of opportunistic infection)
what position should mom be in the relieve cord compression?
knee to chest
when is the LEEP procedure indicated?
recurrent histologic findings of cervical intraepithelial neoplasm grade 2 or 3
ASCUS and + HPV 16, what is the reccomended next step ?
repeat pap at 6mo and 12 mo or proceed to colposcopy
what sensory level is MC effected with thoracic outlet syndrome? which nerve is MC affected?
C8-T1, and MC ulnar nerve affected
A Bishop score greater than ___ is considered a positive predictor for safe delivery in a term pregnancy. (aka elective induction is safe). what does bishop score include?
6
“PEDS” position of cervix (posterior –> anterior) and consistency, effacement %, dilation, station
high on the differential for hypochromic, microcytic anemia?
blood loss, commonly occult and longstanding (maybe from CA? )
first line txt for mild exacerbation of eczema, moderate-severe?
topical steroid
mod-severe: tacrolimus cream
felty syndrome
“SANTA’s Red felt”
splenomegaly, anemia, neutropenia, thrombocytopenia, arthritis (deforming rheumatoid)
<2yo and >2yo “toeing in,” which of the following is the likely etiology?
< 2 is from tibial torsion
>2 femoral anteversion
txt for mastitis
dicloxacillin (clindamycin if PCN allergic)
txt for PMS
SSRI day 14 -3
x-linked icythosis
recessive condition affecting males. starts age 2-6wks
brown large scales, spares the palms and soles
test for primary adrenal insufficiecy (addison’s dz)
cosyntropin test (synthetic ACTH)
ADR of cyclosporine (immunosuppressant for RA) ?
HTN
why should an infant NOT be held at a level below the introitus after delivery?
excessive fluids can be passed to the infant, resulting in increased hematocrit and hemoglobin, which will hemolyze and cause hyperbilirubinemia.
pathophys of SJS
full-thickness necrosis of the epidermis associated with mild mononuclear cell infiltrate
txt for diarrhea from chronic pancreatitis?
pancreatic enzyme replacement (pancrealipase)
signs of infantile zinc deficiency
sharply demarcated scaling red rash on the face and in the diaper area. irritable, diarrhea, poor wound healing. MC breastfed infants
What is the radionuclide imaging pattern noted during a thyroid scan in patients with subacute thyroiditis?
diffusely low uptake
acute inflammation –> leakage of stored thyroid hormone
HRT for menopause increases or decreases risk of breast CA?
increases
mutation in the menin gene on the long arm of chromosome 11 (11q13) . AKA MEN1 syndrome includes what three abnormalities ?
hyperPTH, gastrinomas, pituitary adenoma
maintenance fluids for kids/infants
” 4-2-1”
4 mL/kg/hr for the first 10 kg
2 mL/kg/hr for the next 10 kg
1 mL/kg/hr for each kilogram thereafter.
risk factor for BPH (smoking or DM?)
DM
tx for acquired nephrogenic diabetes insipidus as a result of chronic lithium use.
low-sodium and low-protein diet +
thiazide (HCTX) +/- Ksparing diuretic like amiloride
txt for central diabetes insipidus?
desmopressin (synthetic ADH)
S+S of acute vs chronic intestinal ischemia
acute: N/V, bloody diarrhea
chronic: fear of eating
best Dx method for ovarian mass suspect for CA?
pelvic US
MC risk factors for stress gastritis
coagulopathy (low plt or high INR) and mechanical ventilation >48 hrs
define “preterm premature rupture of membranes”
occurs before labor onset (premature) and before 37wks (preterm)
metabolic acidosis anion gap (>14) vs non anion gap (<14)
anion gap = acid gain (i.e. lactic acidosis, ARF, drugs/toxins)
non-anion gap = bicarb loss (diarrhea) or impaired renal secretion
how to Dx RSV causing bronchiolitis
viral nasal washings
brown sequard syndrome
loss of motor/ vibration on side of lesion
loss of pain/temp on contralateral side
36 yo dyspnea, fatigue, fainting.Physical exam reveals increased jugular venous pressure, weak carotid pulses, clear lungs, and a loud S2.
pulm HTN (aortic stenosis in older pt with murmur)
MC Fx long bone in adults
tibia
what does oxytocin do for labor?
helps stimulate contractions
how do you differentiate acute uveitis from acute angle closure glaucoma?
uveitis: fixed small pupil
glaucoma: fixed dilated pupil
child w/ PNA, CXR shows pneumatoceles, pyopneumothorax or empyema = what organism caused ?
Staph > strep
txt for mild/asymp mitral valve prolapse
periodic echo
Txt for superior vena cava syndrome
steroids
Sx prophylaxis for for mitral valve replacement
cefazolin
MC location for hematogenous osteomyelitis in adults
lumbar vertebrae
what antipyschotic requires eye exams every 6mo for risk of cataracts ?
quietapine (seroquel) - Sero = zero sight ?
Med txt for WPW
flecainide (antiarrythmic)
dx for tinea capitis?
rarely work with woods lamp, need dermatophyte test media
