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USMLE HY notes > Internal + USMLE Micro > Flashcards

Internal + USMLE Micro Flashcards

1
Q

What are the 3 Genomes of HIV and what each one encode?

A

Env Gene - GP160&raquo_space; GP120 + GP41
Pol Gene- RT, Integrase, Protease (RIP)
Gag- P17, P24 (core proteins)

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2
Q

What is the role of G120 and GP41

A

GP120 = Docking protein&raquo_space; connect to CD4 + CCR5 or CXCR4

GP41 (Transmambrane)&raquo_space; Fusion and entry to the cell

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3
Q

Which co-receptor in infeciton with aids is associated with macrophage and which with T-cells and which type of infeciton (late or early)

A

Macrophages- CCR5 (also have on T cells) = Early infection
T helper cells - CXCR4 (exclusivly on T helpers )= Late infection

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4
Q

What will be the consequence of homozygous vs hetrozygous mutation on the E32. and which structure it will effect?

A

E32 mutation- effect CCR5
Homo- Immunity to HIV
Hetro- Slower course

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5
Q

What is the screeing test for HIV?
and if positive how we procced

A

4th generation HIV1/2 Ab and P24 antigen combined immunoessey.

if 1 of them positive&raquo_space; procced to HIV-1/2 Ab diffenetation immunoassay

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5
Q

What if HIV-1/2/ in Ab differantional immunoassay is negetive ( after 4th generation test is positive)

A

Probably window periot.
will procced to NAT test for HIV-1 (Check for Viral RNA = with negetive Ab test)
if positive = acute infection
negetive = negetive for HIV-1

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6
Q

Which testing is used to check suspect baby with HIV? (by matenral transfer)

A

NAAT- Check HIV viral load.
Ab can be transfer by the mom therefore this is not a recommeded test.

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7
Q

When HIV&raquo_space; AIDS

A
  1. CD4 < 200
  2. HIV + AIDS defining condition (eg. PCP, but cancer and ect.)
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8
Q

HIV pt + purple patches on skin?

Dx?

A

Kaposki sarcoma (HHV-8)

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9
Q

What will seen on histology of Kaposki Sarcoma?

A

Slit-like vascular spaces serrounded by prolifration of spindle cells (vascular tumors in histology)

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10
Q

What is the Pathophysiology of Kaposki sarcoma

A

VEGF disregulation&raquo_space; vascular proliferation and tumor formation

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11
Q

What is a DDx for Kaposki sarcoma?

A

Bacillary angiomatosis ( Bartonella henseale- cat scracth).
differentiate by biopsy- Kaposki- lymphocyte, Bacillary- PMN

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12
Q

Which type of hematologic cancer can HHV-8 can cause

A

B-cell primary effusion lymphoma

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13
Q

Itching umbilicated papules + Histolgy shows eosinophilic cytoplasmic inclusions
Dx?

A

Poxvirus = Molluscim contagiosum

if multiple lesions appears&raquo_space; take HIV test

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14
Q

What is acute retroviral syndrome?

A

Flu / mono like symptoms:
Fever, Pharyngitis, lymph, weight loss (2-6 wks after infection)

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15
Q

What are AIDS Def. ilness

A

Candida
Toxo
Carcival Cancer- Pap smear at diagnosis + every 1 year
KAposki

CaT- CaKA

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16
Q

HIV + MRI of brain showing Demyalination everywhere.
Dx?

A

PML (progressive multifocal enephalopathy)- JC virus

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17
Q

Wich drug that is used for MS can cuase reactivation of JC virus?

A

Natalizumab- monoclonal Ab against alpha-4 integrins

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18
Q

Which infections can be seen in HIV + CD4 < 500

A
  1. Candida albicans- whith trush, scapable
  2. EBV- oral hairy leukoplakia, unscarpable
  3. HHV-8- kaposki, localized cutaneous disease
  4. HPV- SSC at site of sexual contact
  5. TB
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19
Q

Which infections can be seen in HIV + CD4 < 200

A
  1. Histoplasma capsulutum- oval yeast cells within macropahges.
  2. HIV- neuropathy, dementia (cerebral atrophy)
  3. JC virus- PML, non-enhancing areas of dymilination
  4. HHV-8- dissaminated disease
  5. Pneumocystic jirovecii- “ground glass” opacities
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20
Q

Which infections can be seen in HIV + CD4 < 100

A
  1. Bacillary angiomatosis- Bartonella (similar to kaposki, neutrophil filtration)
  2. Candida esophagitis
  3. CMV- CREEP
  4. Cryptococcus neoformans- meningitis , india stain
  5. Cryptosporadium sp- watery diarrhea, acid fast oocyte in stool
  6. EBV- b-cell lymphoma
  7. mycobacterium avium/ complex
  8. toxoplasma- rimg enhencing lesions on MRI
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21
Q

What is the possible presentaiton of CMV in CD < 100

A

CREEP:
Colitis
Retinitis
Esophagitis
Enchepalitis
Pneumonitis

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22
Q

What is the treatment of PCP?

A

TMP-SMX

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23
Q

Which HLA should be checked in correlation to Abacavir hypersensetivity

A

HLAB57

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24
Q
A
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25
Q

what type HIV virus is?

A

Retrovirus (2 ssRNA copeis)

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26
Q

structure of HIV virion? Envelope + capsid + enzymes

A

Envelop&raquo_space; GP41 + GP120 glycoproteins&raquo_space; bind CD4 receptors CXCR4 & CCR5

Capsid&raquo_space; P24 proteins&raquo_space; help virus to fuse with the cell

Reverse transcriptse&raquo_space; turn dsRNA to DNA
Integrase&raquo_space; integrate the virus DNA into the host genome

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27
Q

Which mutation can lead to resistance to HIV

A

Homozygous mutation in E32&raquo_space; effect CCR5

*Hetrozygous&raquo_space; slower course of disease

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28
Q

Whats the diagnosis:
HIV + violaceous purple patches on the skin?
who is the pathogen?

A

Kaposki sarcome

pathogen: HHV8

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29
Q

Whats the diagnosis:
HIV + itching umbilicated papules + eosiniphilic cytoplasmic inclusions

who is the pathogen?

A

Pox virus&raquo_space; molluscon cintagiosum

if pt have multiple lesions&raquo_space; HIV test should be taken

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30
Q

what are the initial symptoms of HIV

A

Acute retrovial syndrome
Flu like symptoms 2-6 wks after infection: Fever, phyringitis, lymphadenopathy, loss of weight

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31
Q

when HIV is turned to AIDS

AIDS defining ilness and defining diseases

A

AIDS defining ilness = CD4 < 100
**AIDS defining diseases:
**
1. Candida esophagitis
2. Toxoplasmosis
3. Cervical cancer –> pap smear at diagnosis & every 1 yr.
4. Kaposki sarcoma

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32
Q

What is the clinical presentation of JC virus?

A

Progressive multifocal enephalopaty:
paretial, occiputal, cerebalum
non enhancing lesions (multiple)

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33
Q

which medication can ceasue activation of J.C virus

A

Rituximab, Natalizumab&raquo_space; supress immunity&raquo_space; JC virus&raquo_space; PML

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34
Q

in HIV, which pathgens / diseases in each CD4 count

CD4 < 500

1

A

candida esophagitis

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35
Q

PCP infection:
what we will see on CXR?
Which stain will be positive?
Whats the treatment?

A
  1. CXR- ground glass
  2. Silver stain
  3. TMP-SMX
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36
Q

in HIV, which pathgens / diseases in each CD4 count

CD4 < 200

4

A

PCP, Crypto,Coccido, Histoplasmosis

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37
Q

in HIV, which pathgens / diseases in each CD4 count

CD4 < 100

2

A

J.C virus (PML), Toxoplasma

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38
Q

in HIV, which pathgens / diseases in each CD4 count

CD4 < 50

3

A

CMV retinitis, Bacillary angiomatosis, Primary CNS lymphoma

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39
Q

What we need to check after confirming diagnosis of HIV

5 things

A
  1. Viral load
  2. lipid profile &glucose leves
  3. E32 mutations (CCR5)
  4. HLAB57 (abacavir hypersensetivity type IV)
  5. perform PDD (mentou) check for TB
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40
Q

Which vaccination shouldbe giver and in which interbal in HIV patients

3

A
  1. PPSV23 - every 5 years (2+3)
  2. HBV if not vaccinated yet
  3. Influenza - every year
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41
Q

What are the 2 prognostic factors in HIV

A
  1. CD4 count
  2. Viral load
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42
Q

what we check in the fetus of mother with AIDS?

A

HIV RNA
Ab - can be positive due to placental transfer

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43
Q

Diarrhea & HIV

Bloody Diarrhea
what is the diagnosis?

A

CMV

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44
Q

What is the most common reason for chronic waterydiarrhea in AIDS pt?

A

Cryptosporidoium

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45
Q

Diarrhea & HIV

HIV + Bloody Diarrhea
what is the diagnosis?

A

CMV

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46
Q

Diarrhea & HIV

HIV watery Diarrhea without fever
what is the diagnosis?

A

microsporidia

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47
Q

Diarrhea & HIV

HIV watery Diarrhea + fever
what is the diagnosis?

A

Cryptosporidium

most common cause of chronic watery diahhrea in AIDS pt.

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48
Q

Cryptosporidoium:
yes or no?
acid-fast?
colour of stain?

- protozoa

A

acid fast oocyte, stain of intraluminal red pink oocyte in stool

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49
Q

HIV + subacute memory loss + psycomotor deficit + Hyperintense lesions on subcortical white matter + biopsy with multinucleated gaint cells + microglial nodules

whats the diagnosis

A

HIV encepahlopathy

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50
Q

which type of nueron supporting cells HIV love and what it ceaused

A

Microglial cells&raquo_space; go inside&raquo_space; giant cell formation

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51
Q

most common cause of pneumonia in HIV pt?

A

Strep. pneumo (lobar pattern)

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52
Q

what is prophylaxias for HIV transmittion?

A

Tenofovir + Emtricitabine

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53
Q

what is the most common pathogen for viral gastroeneritis?

A

Norovirus-
מונו מונו אני “לבד” וטוב לי- הפוכה, בתי ספר, קרוזים , בתי אבות.
חשיפה – אחרי יומיים הקאות ושלשולים – עובר אחרי 72 שעות

EXplosive diarrhea- daycares + cruzes + placed with lots of ppl

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54
Q

מה הפתוגנזה של רוטה וירוס

A

Duedonum + proximal jeujonum&raquo_space; villi blunting, prolifration of crypts cells and loss of brush border enzymes

no fecal luekocytes

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55
Q

what Administration of moderate to severe dehydration in childrens?

which fluid and how

A

Bolus IV istotonic fluids

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56
Q

whats the pathogen?

Raw /prepared food (potato salad)&raquo_space; 3 hrs later&raquo_space; VOMITING + wattery stool

vomiting > diarrhea

A

S.aureus (by injestion of toxins)

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57
Q

what is the DDx for vomiting dominant gastroenteritis?

2

A

S. aureus
Bacillus Cereus

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58
Q

whats the pathogen?

Vomiting dominant Gastroenteritis after reheating rice

A

Bacillus cereus
סיראוס- סיר אוז
Enterotoxin

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59
Q

Whats the pathogens?
return from india w/acute onset od diarrhea and abdominal pain

A

Traveler’s diarrhea = ETEC E.coli (Exterotoxigenic)

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60
Q

what are the 2 types of ETEC toxin

A

Heat-labile = activation of adenylate cyclase = increase cAMP

Heat stable = activation oc Gunelate cyclase = increase cGMP

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61
Q

Whats the most common causeses (3) of acute onset bloody diarrhea?

A
  • E.coli O157:H7
  • Compylobacter
  • Shigella
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62
Q

whats the diagnosis?

31 yr old&raquo_space; 7 days of lower abdominal pain + bloody diarrhea (wakes at night). Hb 8. MCV 67, PLT 55K, WBC 11K, Cr 2.4, coombs negetive, schistocyts on blood smear

what cause it

A

Hemolytic Uremic Syndrome = HUS
Thrombocytopenia - around 40-60K

Diagnosis- E.coli O157:17 (STEC- shiga toxin) or Shigella dysenteriae

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63
Q

who have the greater risk for HUS

A

children < 10

E.coli (STEC O157:H7) or Shigella dysentheria

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64
Q

What the patogenesis of O157:H7 EHEC + Shigella dysenteriae

A

inhibition of 60S&raquo_space; block protein synthesis&raquo_space; cell death&raquo_space; watery diarrhea that may become bloody

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65
Q

True / False

pt with EHEC will always present with fever

A

False
will not have fever

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66
Q

how to EHEC transmitted

A

Contaminated / undercook foood

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67
Q

How to destinguisah Inflammatory diarrhea with non inflammatory?

A

preseance of fecal blood and leukocytes

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68
Q

which medicaiton can cause diarrhea

A
  1. Metformin
  2. allopurinol- prevent gout, lower uric acid levels
  3. orlistat- for loosing weight
  4. SSRI
  5. cholinesterase inhibitor
  6. PPI
  7. NSAIDS

MOCA PAN

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69
Q

How can we resolve osmotic diarrhea comapre to secretory diarrhea

A

osmotic diarrhea- can be resolved by fasting

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70
Q

what do Shigella cuease to the intestital epithelium

A

Invade and enter enterocytes&raquo_space; cell death of epithelium&raquo_space; ulcerationd and bloody / mucoid diarrhea

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71
Q

whare are the 2 classic symptoms of shigella infection?

A
  1. High fever
  2. Left side abdominal pain (rectosigmoid)
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72
Q

Which complecation can shigella cause in pediatrics?

A

Siezures

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73
Q

why shigella species rq low infection dose to cause disease?

A

survive in acidic enviroment of the GI tract

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74
Q

What are the characterstic of shigella on labratory:
1. lactose fermantation
2. which agar

A
  1. Non lactose fermentation
  2. Non hydrogen sulfide on triple sugar iron agar
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75
Q

What cause Campylobacter gastroeneritis?

2

A

Poultry (fram chickens) and domasticated animals (dogs..)

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76
Q

whats the diagnosis?

Diarrhea mucoid / bloody + fever + pseudoappendecitis (oliocetis) in a pt that have a dog

A

Yarsenia enterolitica

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77
Q

which pathogs are the 2 most common cuase of
psuadoappendicitis
in USMLE

A
  • Yersinisa enterolitica
  • Campulobacter jejuni
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78
Q

whats the diagnosis

trip to india&raquo_space; eat local food&raquo_space; 2 weeks later&raquo_space; fever 1 week&raquo_space; severe abdominal pain + distenaion + salomon colur (rose spots) circular lesions

also, who is the pathogen and how transmitted

A
  • Thypoid fever
  • Slamonella Thypi
  • Feco-oral transmittion
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79
Q

Which pathogen associated with contaminated food and water can cause Hemorrhagic enteritis (Bowl perforation)

A

Salmonella Thypi

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80
Q

How Slamonella thypi invade the immune sys?

A

Via capsular antigen&raquo_space; inhibit nuetophils&raquo_space;replication in macrophages

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81
Q

Which Hematological disease can present with Non-typhoidal salmonella osteomoylietis

A

Sickle cell

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82
Q

What the presentation of Non typpoidal salmonella?

A

bloody diarrhea after eating a lot of eggs / contact with turtules/pets

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83
Q

which pathogen cause a foul smelling amniotic fluid + gram positive bacilli

A

Listeria monocytogenes

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84
Q

Which pathogen is presented with “ Thumnling motility in room Tm”

A

Listeria monocytogenes

facultative anaerobe

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85
Q

Listeria monocytogenes:
in adult
in pregnent women

what the presentation?

A

Story of expose to deli meet / cheeses
adults- Self limiting Gastroenteritis
Pregnant- Intrauntrine fetal demise = death (Hepatic abcess)

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86
Q

When we will give Abx for acute diarrhea?

A
  1. Severe with systemic symptoms > 7 days
  2. immunocompromised
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87
Q

How to diagnosed C.difficle

A

**stool PCR analysis or enzyme Immunoassay **
for C.diff toxins
or
Glutamtate dheydrogenase antigen

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88
Q

Whats the diagnosis?

inpatint stay / use of antiontics in pat 12 wks , on day 3 on hospital present with fever, Watery diarrhea with trace of mucus and blood

A

C.difficile

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89
Q

All the following are major risk factor for ___________

Abx use, PPI, cytotoxic Chemotherapy, age >65, recent hospitalization

A

C. difficile

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90
Q

Whats C.difficle typical finding on colonoscopy

A

psuedomembranes

Fibrin & inflammatory cells

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91
Q

how so psuadomembranous form?

A

Ingestion of pores&raquo_space; Toxin A &Toxin B&raquo_space; inflammatory reaction&raquo_space; actin cytoskeletal structre disrapture

C. difficile (gram positivie)

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92
Q

Tx for C.difficile?

A

Vanco or Fidaxomicin (macrolide)

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93
Q

What is the mechanism of aciton of macrolide?

A

inhibit RNA polymerase&raquo_space; Bactericial

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94
Q

Tx for toxic mega colon after C.difficle

A

Bowl rest + NG tube + PO and rectal fidaxomicin / vanco and consider Metronidazole + Stop antinotility agents

if severe = consider colectomy

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95
Q

Which of the following wont prevent/ kill bacterial spoers of C.difficile?
1. handwashing
2. Alcohol
3. Nonsterile gloves + Gown

A

Alcohol woldn’t kill bacterial spores

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96
Q

Watery diarrhea after return from trip

A

ETEC

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97
Q

Watery diarrhea with “rice water stool”

A

Vibrio cholera

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98
Q

Watery diarrhea on cruise ship

A

Norovirous/ Norwalk virus

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99
Q

Watery diarrhea in HIV

A

Cryptospardium parvum

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100
Q

Bloddy diarrhea + consuming meat

A

Shigella
(or maybe EHEC, Compylobacter)

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101
Q

Bloddy diarrhea + lactose ferment

A

EHEC

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102
Q

Most common cause of bloddy diarrhea in usa

A

c. jujuni

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103
Q

Diarrhea that feels like Appendicitis

A

Yersiniea enterolitica

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104
Q

Protozoal cause bloody diarrhea

A

Entamoeba hystolitica

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105
Q

Blodody diarrhea + HUS

A

EHEC or Shigella

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106
Q

Diarrhea after consuming oysters / seafood

A

Vibrio parahemolyticus

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107
Q

Diarrhea after consuming oyster / seafood + elevated liver enzymes

A

Vibrio vulnificus

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108
Q

Diarrhea after sweimming in fresh water- (also aquarium association)

A

Aeromonas

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109
Q

Diarrhea after reheat rice

A

Bacillus cereus

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110
Q

Diarrhea 6-15 hrs after meat/ poultry left out long

A

Clostirdium Perfingens

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111
Q

Rash + slapped cheeks apprerance

A

parvo B7

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112
Q

Which solution recommended to treating children with waterry diarrhea?

A

Oral rehydration dolution

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113
Q

What innervate the parietal pleura?

A

Phrenic nerve (pleuritic chest pain)

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114
Q

what innervate the peicardium

A

Phrenic nerve = pleuritic chest pain

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115
Q

what are the 3 classical finding of pleural effusion?

A

Decrease breath sounds
Decrease tactile fremitus
Dull to percussion

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116
Q

Dx of pleural effusion on CXR?

A

Blunting of costophrenic angles

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117
Q

Gold standart for pleural effusion Dx

A

CT&raquo_space; Decubitus&raquo_space; create fluid layer (in CXR problem in fluid < 300 ml)

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118
Q

What is the most common cause of transudate effusion?

A

CHF (bi-lateral)

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119
Q

What can be adverse affect of loop diuretics?

A

Calcium oxalate kidney stones (loop ceause Ca excretion)

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120
Q

Which medication can ceuase Drug induce Pancreatitis?

A

Thiazide
(will not give in DM- will cuase hyperglykemia by opening K chaneels in beta pancreatic cells)

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121
Q

Defintion of pleural effusion

A

> 1 out of 3:

pleural Protein/ Serum protein > 0.5
pleural LDH/ serum LDH > 0.6 (from serum)
pleural LDH > 2/3 from upper limit of normal serum LDH

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122
Q

Common cause of exudative pleural effusion?

A
  1. infection&raquo_space; pneumonia&raquo_space; parapneumonic effusion
  2. malignancy
  3. Rheumatological diseases
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123
Q

What are the 2 mechanism of pleural transudate?

A
  1. Change in hydrostatic pressure (HF)
  2. change in oncotic pressure (nephrotic syndrome, liver chirrosis)
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124
Q

Foul smelling pleural effusion?

A

anaerobic = do fermantation

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125
Q

Surgical procedure&raquo_space; pleural effusion&raquo_space; yellow fluid (milky)?

A

Chylothorax (conatin chylomicrons)

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126
Q

Which syndrome is characterize with cystic hygroma and ammanorea

A

Turner syndrome.

Cystic hyfroma» lymph obstruction&raquo_space; Pleural effusion

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127
Q

Raddish pleural effusion + High RBC

A

Hemothorax

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128
Q

Raddish pleural effusion + High RBC

WITHOUT TRAUMA

A

Reapet&raquo_space; if still high RBC count&raquo_space; Cancer

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129
Q

Most common cancer in pleura?

A

Asbestosis

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130
Q

Pleural effusion + malignant cells.

what most common cause?

A

Metastasis (mainly from breast)

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131
Q

Lung cancer + consitpaiton?

A

Paraneoplastic syndrome&raquo_space; Squemous cells&raquo_space; PTHrP

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132
Q

Pleural effusion with High WBC (lympocyte predominant), High Adenosine deaminase content (ADA)

A

if acid fast&raquo_space; TB

if negetive acid fast ? not rule TB yet.

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133
Q

Pleural effusion + adnexal mass + Asicets

A

Meigs syndrome (benign ovarian tumor) - Thecoma fibroma

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134
Q

Which IL preserve granuloma?

A

TNF-alpha, IL-2

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135
Q

Cough + coryza + Conjuctuvitis (3C’s) + koplot spots

A

measles (Rubeola)

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136
Q

Gastroenteritis + paralysis

A

Poliovirus

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137
Q

Parotitis, orchitis, male sterility

A

Mumps virus

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138
Q

PDA/ Cataracts/ blindness in newborn

TORCH

A

Rubella

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139
Q

painful skin lesion in dermatotomal pettern

A

Varicella zoster virus (HHV3)

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140
Q

Virus dormant in Dorsal root ganglions

A

Varicella zoster virus (HHV3)

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141
Q

Retinitis in HIV

A

CMV

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142
Q

Painful vasicles on genitals

A

HSV2
somtimes HSV1

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143
Q

Hepatitis in pregnent with high mortality

A

HEV

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144
Q

Which gastroenteritis virus involve reassortment

A

Rota virus

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145
Q

Prophylaxis for RSV

A

Palivizumab

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146
Q

Segmented genome + Epidemic shift pneumonia

A

Influenza virus

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147
Q

Encephalitis in neonates

A

HSV (mainly temporal lobe)

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148
Q

Bloody diarrhea from undercooked chicken

A

C. jejuni

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149
Q

Hylorinic Acid capsule + M protein

A

Strep. pyogenes (GAS)

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150
Q

Encephalitis weeks after consuming uncooked pork

A

Taenia solium (neurocysticercosis)

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151
Q

Bloody diarrhea with Hepatomegaly

A

Enteoambea hystolitica

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152
Q

AFB stainning of stool smale in AIDS pt

A

Cryptosporadium parvum

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153
Q

Sexually active male with arthritis and skin petechia

A

N. gonorrhoeae

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154
Q

inf. of testicals / parotid gland

A

mumps

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155
Q

Sickle cell pt with low Hb / pancytopenia

A

Parvo-B19

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156
Q

Nuchal rigidity in 2wks old child

A

GBS

157
Q

most common cause of STD in US

A

Chlamydia trachomatis (D-K serovars)

158
Q

Most common UTI in US

A

E.coli

159
Q

Genetic property associated with worldwide influenza epidemic / pandemic

A

A segmented genome

160
Q

Viral conjuctuvitis

A

Adenovirus

161
Q

Black escher wound in DM

A

Psuedomonas aeruginosa (Echthyma Gangrenosum)

162
Q

Viral myocarditis

A

Cosackie B virus

163
Q

Flu like symptoms after visit hawaii

A

Leptospirosis

164
Q

Cellulitis in burned pt

A

pseudomonas a

165
Q

Bull’s eye rash

A

Lyme disease

166
Q

Straubbery tounge

A

GAS (S. pyogenes)

167
Q

Straberry cervix

A

Trichomonas vaginalis

168
Q

Diarrhea after Mexico and drinking water

A

ETEC

169
Q

Maculopapular rash after few weeks after spring break

A

Secondary syphilis

170
Q

Meningitis in college student

A

N. meningitis

171
Q

Meningitis in pt > 60 yrs

A

S.pneumonia

172
Q

Drug of choice (DOC) in N.meningitis

A

Ceftriaxone

173
Q

HIV + small vesicles and ulcers in endoscopy, in Biopsy Multinucleated giant cells and eosinophilic inclusions

A

HSV esophagitis

DDx: CMV esophagitis&raquo_space; large ulcers

174
Q

Unprotected sex + multiple painful ulcers

A

HSV

175
Q

lifecycle of HSV

A

Latent infection (sensory ganglion)&raquo_space; periodic flare ups

176
Q

HSV diagnosis

A

PCR or Tzanck smear

Multinucleated Gaint cells with round glass inclusions

177
Q

Mechanism of Acyclovir

A

Nucleoside analog&raquo_space; convert Thymidine kinase to monophosphate&raquo_space; Cellular enzyme form Tri-phosphate&raquo_space; incoparte into DNA&raquo_space; Inhibit DNA polymeras

178
Q

Which adverse affect can Acyclovir cause in IV

A

AKI with crystal neuropathy

need to be given with a lot of fluid to prevent

179
Q

Foul smelling diarrhea + drank water from river

A

Giardia

180
Q

Diagnosis of Giardia

A

Stool ova and parasites

181
Q

Which population is more prone to Giardia lambila

A

IgA deficeincy
CVID

182
Q

Green vaginal discharge with PH > 4.5

and treatment

A

Tricohomonas vaginalis

Tx: Metro to pt and partner

183
Q

low PLT, Anemia + fever 48hours + recent trip to develop country

A

P. Vivax or P. ovale

184
Q

low PLT, Anemia + fever 72hours + recent trip to develop country

A

P. malariea

185
Q

Plasmodium Spp. Associated with Hypnozoites (latent stage in liver)

A

P. vivax and P.ovale

186
Q

Child with itchy butt and Dx test

A

Enterobius vermicularis

Dx: Scotch tape test

187
Q

Microcytic anemia + worms attech to intestines in colonoscopy

A

Necator americanus or Ancylostoma duodenale

188
Q

Recent trip to egypts / swimming expedition

and association with cancer of—-

A

Schistosoma Haematobium

SCC of the Bladder

189
Q

Liver abcess + eat snails

A

Schistosoma mansoni or Japanicum

190
Q

Immunocomremised with diffuse marking on CXR

also diagnostic and treatment

A

PCP
Dx: Silver stain from sputum
TMP-SMX

191
Q

When we will add to PCP treatment steroids?

A

PaO2 < 70 or A-a gradient >35 or SpO2 < 92%

add to TM-SMX

192
Q

Meningitis in immunocompromised

and why ICP

A

Cryptococcus neoformans

ICP- due to cryptoccocal proteins accumulation, with Low LP openning pressue (proteins block )

193
Q

Microbes that cause Tinea infections (פטרייה עורית)

A

Tricophyton, Microsporum, Epidermophyton

194
Q

Skin finding with Cocciodomyosis?

A

Erythema nodosum

195
Q

Immunocompremised + 10% esoinophils + RUL nodule or cavitary lesion

A

Aspergillus

196
Q

Common Etiologies of esonophilia

A

Drugs, Eddison disease, Lymphoma, Vascular collagen disease (scleroderma), parasites

197
Q

Pulmonary signs + Skin finsgins + Lytic bone lesions + Upper lobe in CXR

Clue: Winsconsin

what Tx

A

Sys. Blastomycosis

Tx: Amphoteracin B

198
Q

Gardener with lesions on one exterimity associated with

A

Spirotrichosis

199
Q

DKA with Eschars on face

Histo?

A

Rhizopus or mucormycosis

on Histo- Asepatate hyhae branching 90 dagree

200
Q

Microbe branching 45 dagrees?

A

Aspergillus = Acute angels

Upper lobe nodules / cavitary lesions

201
Q

Bulls eye rash pathogen. transmittion?

A

Borrelia Burgdorferi (lyme disease)
Vector: Ixodes tick

202
Q

The only vaginal infection with PH < 4.5

A

Candida

203
Q

Which stage of shypilis present with macolupapillary rash?

A

Secondary syphilis (with condyloma lata)

204
Q

Meningitis with Gram negetive diploccoci

A

N. meningitis

Tx: Ceftriaxone

205
Q

Which pathogens is associated with water house fredrich syndrome?

A

N. meningitis

206
Q

What the diagnosis- Sepsis with Hypotension + low Na, high K, Metabolic acidosis

A

Water house fredrich syndrome with N.meningitis

207
Q

Tx in meningitis in intubeted pt

A

Rifampin or Ciprofloxacin or Cerftriaxone

208
Q

Most common ceause of meningitis in umimmunized pt (< 3 month)

A

pneumococcous

209
Q

Neonate (first 28 day of life) with meningitis?

A

GBS

210
Q

Microbe with hyloronic capsule

A

GAS (Strep. pyogenes)

211
Q

Whooping cough prophylaxis?

A

Azitromycin

212
Q

Sexually active female + ataxia + loss of vibration sense

A

Tabes dorsalis = Tertiary syphilis

213
Q

Enchipalitis after eating pork

A

Taenia solium

214
Q

Toxoplasma treatment

A

pyrimethamine and sulfadiazine

prophylaxis CD4 < 100 + positive IgG TMP-SMX

215
Q

sexually active male + arthritis + skin petechia

A

N. gonorrhoeae

216
Q

Large testicles + large parotid gland

A

MUMPS
also can present : Pancreatitis/ orchitis

217
Q

Sickle cell pt + low Hb

pathogen? situation?

A

Aplastic crisis &raquo_space; parvo B19

218
Q

Second most cause of UTI in US

A

Staph. Saprophyticus

first: E.coli

219
Q

Sore throat + conjuctuvitis?

clue: also associated with Hemorrahgic cystitis and gastroenteritis

A

Adenovirus

220
Q

Tx for measles

A

Isolation + Supportive with Vitamin A

221
Q

HPV associated with cervixal cancer

A

16,18,31,33

222
Q

Most common cause of cervical cancer death

A

Renal failure&raquo_space;Cancer cells spread up the urinary system and invade kydnys

223
Q

Congenital inf. the cause cataract to the newborn

A

Rubella

224
Q

Measles cause blindness by——-

A

Keratoconjuctuvitis

225
Q

Heart defect associated with Rubella

A

Patent ductus arterosus = wide Pulse pressure

226
Q

name of Genital HPV that cuase warts

A

Condyloma accuminta

227
Q

Treatment for CMV

A

Ganacycovir

228
Q

2 C/I for Rota virus

A

Meackels divertivulum
Intussusception

229
Q

2 most common of the “the common cold”

A

Rhinovirus
Coronavirus

230
Q

Child < 2 yrs + pneumonia with expiratory wheezes and treatment

A

RSV
Supportive

231
Q

Fever, myalgia, malasia in december

A

Influenza virus

232
Q

Neomate enchpalitis, LP RBC 400-500 (always < 1000), 1 lympocyte ,normal glucose

A

HSV

233
Q

Which microbe associate with Erythema chronicum migranatum

A

Lyme disease

234
Q

Which microbe is associates with erythema marginatum

A

GAS

235
Q

What microbe is a/w erythema infectiosum

A

Parvo virus B19

“Slapped cheeks”

236
Q

What micrbo is a/w erythema gangrenosum

A

psuedomonas

237
Q

Painless genital ulcer + indurated borders

A

typomona palidum (syphilis)

238
Q

Painless genital ulcer + beefy red rush no Lymphaadenopathy

A

Klebsiella granulomatis

239
Q

Hitology finding in Klebsiella granulomatis lesion

A

Donoven bodies

240
Q

STI associated with epithelial cells with inclusion bodies on histo

A

HSV-2

241
Q

STD with gram negetivie diplococci

A

N.gonorhea

242
Q

Painlees ulcer + progression to painful lymphadenopathy

A

Lymphogranuloma venerum (Clymedia trachomatisi L1-L3)

243
Q

Which are the nontreponemal test and the treponemal test

A

Non treponemal- RPR, VDRL
if positive
Treponemal test:
FTA-ABS, TPPA

244
Q

Painful genital ulcers + inguinal Lymphadenopathy

A

Haemophilus Ducreyi

(you cry with ducreiy)

245
Q

Septic arthritis + urethral discharge

A

N. gonorrhoeae

246
Q

Tx for N.gonorrhoeae

A

Ceftriaxone

247
Q

Tx for Chlymydia throchomatis

A

Azitromycin or Doxycycline

248
Q

Which Clamydia strain are the most coomon cause of blindness in developing world

A

type A-C

249
Q

Which Chlymdia types responsible for
STI

and which for Lymphogranuloma venerum (paunless ulcer )

A

STI- D-K types
Venerum- L1-L3

250
Q

Rash on palms + soles and trunks + recent painless chancre

A

Syphilis

251
Q

Rash on face and decesnt caudaly

A

Measles

252
Q

inhbit EF-2 by ribosylation, can cause myocarditis with parngytis

A

Cornybacterium dyphteria

253
Q

Mechanical truama to the teeth / mouth with slow enlraging nonpainful chronic madibular mass with multiple abcesses with drainage of yellow orange sulfur granules

A

Actinomyces (gram positive bacilli)

254
Q

Which pathogen express Panton-Valentine Leukocidin

A

S. Aureus&raquo_space; this virulant factor cause tissue necrosis and necrotizing pneumonia

255
Q

Rash on palms & soles + Mouth lesions

A

Coxsackie virus “ hand-foot-mouth disease”

256
Q

Rash for 3 days&raquo_space; then postaricular lymphadenopathy?

A

Rubella virus

257
Q

Most common pneumonia 2-4 yrs old

A

RSV

258
Q

HIV + consolidation on CXR

A

Pneumococcous

259
Q

HIV + Interstital inflitrates on CXR

A

PCP pneumonia

260
Q

Pnuemonia in alcaholics?

A

Klabsiella

261
Q

Interstitial inflitrates on CXR+ Pet store owner or bird handler

A

chylamydia psittaci

262
Q

Fever + weight loss & cough/ dyspnea + ulcer in mouth + Lymphadenopathy + Hepatosplenomegaly + high AST ALT

Dx?

A

Histoplasmosis capsulatum

Dx test: Urine / serum antigen test

263
Q

Fever + weight loss & cough/ dyspnea + ulcer in mouth + Lymphadenopathy + Hepatosplenomegaly + pancytopenia+ AST/ALT

A

Disseminated toxoplasmosis

264
Q

Pneumonia + recent trip to new mexico

A

Coccidiomycosis

265
Q

Microbre a/w rose coloured sputum?

A

pneumoccocus

266
Q

Microbre a/w red current jelly sputum?

A

klabsiella

267
Q

Microbre a/w pnuemonia + hyponathremia + diarrhea

A

Lagionella

268
Q

Pneumonia + handle cows

A

coxiella Burnetii = Q fever

269
Q

Most common pneumonia in CF < 20 yrs old

A

S.aureus

270
Q

Most common pneumonia in CF > 20 yrs old

A

Pseudomonas or Bokoderius cepacia

271
Q

3 most common cuases of atypical pneumonia

and what is the Tx?

A
  1. mycoplasma
  2. chlamydia
  3. legionella

Tx: Erytromycin (macrolide). check for long QT syndrome

272
Q

MOA of macrolide?

A

inhibit 50S subunit

273
Q

Pnuemonia in neonate + Gram positive cocci?

A

GBS

274
Q

Pnuemonia in neonate + Gram negetive rods?

A

E.coli

275
Q

Expiratory wheeze in neonates + pneumonia?

A

RSV

276
Q

inspiratory stridor in children + pneumonia?

A

epiglottitis (Hib)
Croup (pertussis)

277
Q

widen CXR in FBI agent or postamail?

A

Baccilus anthracis&raquo_space; polyglutamate protein

278
Q

pneumonia then develop lung abcess / cavitation

A

S. aueurus

279
Q

Pneumonia + spetic emboli IVDU

A

S. aurerus

280
Q

Water rice stool

A

Vibrio cholera

281
Q

HIV + large volume watery diarrhea?
Tx?

A

Cryptosporidium
Tx- Nitazoxanide

282
Q

Bloddy diarrhea after eating beef

A
  1. compylobacter jujeni
  2. EHEC
  3. Shigella
283
Q

Bloody diarrhea after eating eggs/ poultry

A

Salmonella

284
Q

Bloody diarrhea in lactose ferment?

A

e.coli (EHEC)

285
Q

Dx of C.diffcle?

A

Stool toxin assay

286
Q

Diarrhea + pain in LLQ?

A

Yersinia enterocilitica

287
Q

Protozoal cause bloody diarrhea + liver abcess?

A

Entemoeba histolytica

288
Q

Watery diarrhea + ate oyster or sea food?

A

vibrio parahaemolyticus

289
Q

Watery diarrhea + ate oyster or sea food + AST/ALT (specially with pt with liver disease)

A

vibrio vulnifucus

  • anypt with liver disease is at high risk (spacially hemochromatosis)
290
Q

diarrhea + extreme electrolyte abnormality?

A

Vibrio cholera

291
Q

Watery diarrhea + swam at aquarium or fresh water?

A

Aeromonas spp.

292
Q

Diarrhea + vomoting + patato salad 2 hours ago

A

S. aurues

293
Q

Fever + recent dental procedure

A

Strep. viridans

294
Q

Fever + heart murmur + Hx of sore trhoet

A

Pnuemococcus

295
Q

Sterile vagiation on Heart valve?

A

Libman sack endocarditis (secondary to SLE)

296
Q

most common cause of walking pneumonia?

A

Mycoplasma pneumonia

297
Q

pneumonia in alcoholics + fuel smelling?

A

anerobes pneumonia

298
Q

pneumonia in the setting of bats dropping, cave travel

A

Histoplasma capsulatum

299
Q

Pneumonia transmitted via air conditionig

A

lagionella pneumophilia

300
Q

Hemoraggic mediastinitis + pneumonia in postal worker?

A

Baccilus anthracis

301
Q

most common cause of pneumonia in young adults?

most common cause of pneumonia overall

A

in young adults- mycoplasma pneumonia (walking pneumonia)

overall- S. pneumonia

302
Q

pneumonia with lung abcess + anerobes?

A

Klabsiella pneumonia

303
Q

4 common usmle anerobes?

A

Peptostroptoccocus
prevotella
fusobacterium
bacteriodes

304
Q

Which pathogens indicate for negetive pressure romm + N95 respiratory?

A
  1. TB
  2. Varicella
  3. SARS
  4. Measles (rubeola)
305
Q

Which pathogens are inicate for contant percussion (gloves & gown)

A
  1. MRSA
  2. VRE
  3. C.diff
  4. E.coli 0157:H7
  5. Scabias
  6. RSV
306
Q

Which pathogen indicate for Droplet preccusion? mask within 1-2 meters from pt

A

Meningococcus
Hib
Mycoplasma pneumonia
Influenza
Adenovirus

307
Q

25YO, night swaet, lymphadenopathy, jiont pain, diarrhea, oral ulceration, generalized rash red oval macules

Dx?
Tx?

A

Acute HIV

Tx: Anti retroviral treatment no matter what + propylaxis (by CD4 count) + Testing for latent TB (regardless CD4 count)

308
Q

In what CD4 count Live attenuated VZV vaccine can be given to HIV pt?

A

CD4 > 200

309
Q

mother with HIV:
1.Tx during pregnancy?
2. cesarean delivary or vaginal?

A
  1. ART during all time (also post-partum)
  2. viral load >1000 = Cesarean + intrapartum zidovudine
    viral load < 1000 - vaginal delivery
310
Q

AIDS pt + CD40 < 50, Fever, weight loss abdominal pain diarrhea hepatomegaly, LAD, elevated ALP?\

Dx?
Tx?

A

Dx: MAC (avium/ intracellulare)

Tx: macrolide + ethambutol

311
Q

Whats the main different between SCID to Infantile HIV?

A

HIV- generlazied lympadenpathy
Scid- no

312
Q

infant with HIV + perihilar reticulonodular inflitrate + severt hypoxemia

Dx?
Diagnosis test
Tx?

A

Pneumocystic jirovecii

Diagnosis- Bronchoalverolar lavage

Tx- TMP-SMX (if PaO2 < 70 - corticosteroids)

313
Q

If HIV pediartic have pneumocystic jirovecci how we manage?

A

TMP- SMX until CD4 > 1500 and then&raquo_space; ART

in adults - start ART ASAP

314
Q

HIV + odynophagia + dysphagia + trush

A

HSV esophagitis

315
Q

HIV with linear ulcers in distlal esophagus with intracytoplasmic inclusion

A

CMV/ HSV esophagitis

316
Q

HIV. vasicular / ulcertive lesions and Histology with multineculeated giant cells?

A

HSV esophagitis

317
Q

AIDS + odynophagia (without dysphagia and Trush)

Dx?

A

CMV or HSV

318
Q

Chronicwatery diahrrhea + CD < 100
+
1. tempature 37.9
2. empature 36.5-
3.Tm 39.8 + CD4 < 50

A
  1. tempature 37.9 - Cryptosporadium
  2. tempature 36.5- Microsporidia/ isosporidium
    3.Tm 39.8- Mycobacterium avium complex
319
Q

What is the next step after colonoscopy for CMV colitis?

A

Rule out CMv retinitis

320
Q

Hematochezia , CMV <100, frequent small bloody stool

A

CMV colitis. will to colonoscopy with biopsy

321
Q

Low extrimity lymphadema + HIV + brown-purple nodules on different part of the body

Dx?

A

Kaposki Sarcoma (HHV-8)

322
Q

AIDS +MRI shows solitary, irregular, non homogeneous ring-enhancing mass.

Dx? and pathogen

A

Primry CNS lymphoma- EBV

(also for Non-hodjkin lymphoma)

323
Q

EBV present on CNS is higly suggestive of———-

A

Primary CNS lymphoma

324
Q

HIV propylaxis:
CD4 < 250
CD4 < 200
CD4 < 150
CD4 <100

what Tx and for what

A

CD4 < 250 - Fluconazole for coccicoidiomycosis (in desert places)
CD4 < 200- TMP-SMX for PCP
CD4 < 150- itaconazole for histopalsmosis capsulatum in OH / MS river and expose to bat pooping
CD4 <100- SMP-SMX for toxo if IgG test is positive

325
Q

AIDS patients + Close contact with a person with chickenpox or shingles + NO history of prior disease + Negative VZV antibodies → Best next step?

A

VariZIg or IVIG (4 days after exposure)

326
Q

when we will give post exposure prophylaxis for HIV and what we will give?

A

PEP:
ASAP (2-4 hours after exposure) → 2 NRTI + Another 1 (Integrase inhibitor; Protease inhibitor; NNRTI)

327
Q

Which patohgen Egypteian Aedes mosquitoes transfer?

A
  1. yellow fiver
  2. dunge
  3. zika
  4. Chikungubya fever
328
Q

32Y Female → Returned from Kibinimat → Sudden onset symptoms + Fever (39) + SEVERE joint pains (shoulder, elbows, knees) + No G.I symptoms + No skin rash + No murmurs + No crackles/wheezing + Soft abdomen + Swelling of elbow and knee + Labs: Hb 13, PLT 170,000, Leukocytes 2500, BUN 14, Cr 0.9 + Normal LFT’s → Most likely diagnosis?

A

Chikungunya Fever

329
Q

High fever + polyartralgia distal > proximal. with maculopapular rash after mosquito bite?

A

Chikungunya Fever

330
Q

Which test is a diagnostic for Dengue fever?

A

Tourniquet test ( petecha after sphygmomanometer cuff inflation for 5 min)

331
Q

What is the common pathogen that is often isolated from cat/dog bite wounds?

and Tx?

A

Patrulla

Tx- Amoxicillin- clavulanate

332
Q

Tx for Aspiration pneumonia?

A

Amoxicillin-Clavulanate

333
Q

Aspiration pneumonia + abcess or emphyema?

tx?

A

Ampicillin-Sulbactam

334
Q

When we treat asymptomatic bacteruria?

A
  1. Pregnent womens
  2. pt before orologic procedure
335
Q

Tx for pregnent women with asymptomatic bacteruria?

A

Fosfomycin > Cefpodoxime > Amoxicillin-Clavulanate > Nitrofurantoin (nitro- only 1st/3rd trimestir)

336
Q

Who gets prophylaxis for meningococcal?

A

Household members; Child Care center workers; Roommates or intimate contacts; Person seated next to affected person for ≥8 hr; Persons directly exposed to respiratory or oral secretions (INTUBATE)

337
Q

If you see tender, erythematous streaks extending proximally from the site of wound with tender, enlarged lymph nodes → What is the most likely diagnosis?

most commen pathogen
Tx?

A

Lymphangitis → Most common pathogen? → S.pyogenes & MSSA → Cephalexin

338
Q

When we will add Dexamethasome for meningtitis?

A

Strep. pneumonia

339
Q

treatment for bacterial meningitis? → Age < 50
age > 50, immunocompremised

A

age < 50 = Vanco + 3G cephalosporins

Age > 50 = Vanco + 3G cephalosporins + Ampicillin

imunmocompremised- Vanco + Cefepime + Ampicillin

340
Q

Neurosurgery/skull trauma (penetrating) (Tx)

A

Vanco + cefepime

341
Q

0Y old + Fever + Cervical lymphadenopathy + Tonsillar exudate + NO COUGH
What is the best next step in management?

A

Centor Criteria &raquo_space; Fever = 1p ; Lymphadenopathy = 1p; Tonsillar exudate = 1p; No cough =1p

0-1- go gome
2-3- Rapid antigen deteciton test (phyringitis)&raquo_space;if positive &raquo_space; Amoxicillin
4- Amoxicillin

full 10 days to prevent RF

342
Q

What vaccines are indicated for patients with liver cirrhosis?

A

At Dx- Pneumococcus
every 1 yr- Influenza
every 10 years- Tetanus

if not immune to Hep A or B give

343
Q

What vaccines are recommended for asplenic patients?

A

Extra:
Pneumococcal vaccine
Hib (1 dose)
Meningococci (every 5Y)

344
Q

Patient with “excessive dandruff and scaly facial rash despite using the same shampoo and cosmetic products as before”

Dx?

A

NEW ONSET RAPIDLY DEVELOPING SEBORRHEIC DERMATITIS

345
Q

all of the following can be a clue of which infectious disease?
1. parkinson
2. SEBORRHEIC DERMATITIS
3.RAPIDLY DEVELOPING PSORIASIS
4. RECURRENT VZV (IN WEIRD PLACES)

A

HIV

346
Q

What antibiotics are first-line for burn-related infections?

A

Piperacillin-tazobactam or carbapenem with vancomycin.

347
Q

What are the causes of post-surgical fever around 6 hrs after procedure

A
  1. Transfusion reaction- if blood gave
  2. Malignant hyperthemia (anedthetics induce)
348
Q

Thin malodorous discharge + Friable cervix + Motile motile ovoid organism on microscopy → Most likely diagnosis?

A

Trichomonas vaginalis
Treatment: ORAL metronidazole (PATIENT + PARTNER)

349
Q

Grayish-white discharge + Wet mount with clue cells → Most likely diagnosis?

how to diagnose?

A

Bacterial vaginosis (Gardnerlla vaginalis)

Dx: AMSEL criteria
Tx: metronidazole / clindamycin

TREAT only symptomathic patients

350
Q

Tx for Gonoccocal infection (PID + Pharyngitis/tonsillitis + Arthritis + Cervicitis)

A

IV G3 Cephalosporins

351
Q

Trade sex women, Few painful papules/pustules 9 days ago now with LARGE deep ulcers with gray/yellow exudate (well demarcated borders with soft friable base) + Enlarged and tender lymph nodes

Dx, Tx?

A

Haemophilus ducreyi (Gram - rod)

Azithromycin + Ceftriaxone

352
Q

Painful mucocutaneous shallow sharply demarcated ulcers on white base + Generalized lymphadenopathy + Rash → Diagnosis?

A

Acute HIV

353
Q

Painful and fluctuant adenitis (buboes)

Dx?

A

Chlamydia trachomatis serovars L1-L3

354
Q

Single painless papule → Painless nonexudative ulcer with indurated border + Bilateral painless lymphadenopathy → Diagnosis?

A

Primary shypilis (Chancre)

355
Q

Severe immunocompromised + Tap water/soil + Refractory fever + Skin lesions + Pulmonary findings
Dx?
Tx?

A

Dx- Fusariosis - mold
Tx- Amp B +- voriconazole

356
Q

Which pathogens cuase acute bacterial meningitis

A

Neisseria meningitidis;
Streptococcus pneumoniae;
Staphylococcus aureus

357
Q

Temporal lobe enchncment + opening pressure > 250

Dx?

A

HSV

358
Q

Opening pressure > 250 without temporal enhancment?

A

Cryptococcus neoformans
Pseudotumor cerebri

359
Q

The most appropriate treatment for pneumonia associated with erythema multiforme and mild hemolytic anemia is ——-

A

azithromycin to cover Mycoplasma pneumonua

360
Q

Fever + Eosinophilia + Returned from Kibinimat + Eating snails
Dx?
Tx?

A

Katayama fever (Katayama fever = Acute schistosomiasis = Snail fever)
Treatment → Corticosteroids & Praziquantel

361
Q

what is Lemierre’s syndrome

A

complication of bacterial pharyngitis/tonsillitis and involves an extension of the infection into the lateral pharyngeal spaces of the neck with subsequent septic thrombophlebitis of the internal jugular vein

362
Q

Recent pharyngitis → Neck pain & swelling + Persistent fever (despite antibiotics) + Cavitary lung lesions → → Septic thrombophlebitis (Lemierre’s syndrome)
common patogen?

A

Fusobacterium necrophorum (anaerobic)

363
Q

A 34-year-old man comes to the physician due to high fever, malaise, and intermittent headaches for the last 4-5 days. He recently returned from hiking for several days in wooded areas in Missouri. The patient’s temperature is 38.9 C. Physical examination shows a faint, non-pruritic, maculopapular rash confined to the trunk without central clearing. Laboratory results are as follows: Hb 14, MCV 84, PLT 90000, Leukocytes 2900 → Diagnosis?

A

Ehrlichiosis

Ehrlichia chaffeensis or Anaplasma Phagocytophilum

Tx: doxycycline (even to pregnant)

364
Q

Post transplantation infections:
> 6 month
1-6 month
< 1 month

A

> 6 month - as general population
1-6 month - CMV, PCP
< 1 month- MRSA, psuedomonas, C.diff

365
Q

Drooling & Peds

3 main things

A

Epiglottitis
Retropharyngeal abscess
teething (no FEVER)

366
Q

Porphyria cutanea tarda

which enzyme is deficent?

A

Uroporphyrinogen decarboxylase (UROD) deficiency

367
Q

Blastomycosis
which sites it effect?

A

bone with sinus tract; Papules; Genitalia

Blasto blasts bones, balls (epididymo-orchitis), and skin.

368
Q

Why is it important to treat with vitamin A in Measles?

A

prevent blindess

369
Q

Infectious complications of atopic dermatitis

A

Impetigo

370
Q

fungal thar cause Pruritic scaly patch between fingers?
Tx?

A

Tinea corporis

Tx- Topical antifungal EXCEPT → Clotrimazole

371
Q

Which Tinea type we will give oral antifugal

A

Tinea capitis; Tinea nail → Oral griseofulvin

372
Q

H.Pylori infection → → 4 weeks later ↓ PLT, Petechiae + EVERYTHING ELSE IS NORMAL + Normal PT & PTT .
Dx?

A

ITP

373
Q

treatment for neutropenic fever?

A

low risk- Oral antibiotics (amoxicillin-clavulanate + ciprofloxacin)
High risk- Blood cultures followed by antipseudomonal beta-lactams (Piperacillin-tazobactam)

Alternative: Cefepime/Ceftazidime/Meropenem

(If septic shock → add vancomycin)

374
Q

What are the low risk features in Neutropenic fever?

A
  1. no hematoligical diasese
  2. good oral intake & stable
  3. no-comorbisitied
  4. no significant GI symptoms
375
Q

Neutropenic fever + Skin manifestation?

A

Erythema gangrenosum

376
Q

Slowly growing non-tender jaw mass with sulfur granules

Dx, Tx

A

Cervicofacial actinomycosis

Tx- penicillin for 6-12 months

377
Q

Dilated cardiomyopathy, mega esophagus

A

Chagas disease

378
Q

2 Infectious causes of seizures:

A

Neurocysticercosis + Shigella (Peds)

379
Q

Vision loss in neonates:

pathogens

A
  1. Untreated congenital toxoplasmosis (chorioretinitis)
  2. CMV → Chorioretinitis
380
Q

CN involve in post herpatic neuralgia?

A

CN V

381
Q

What are the 3 timline presentation of lyme disease:

early
early disseminated
late

A

Lyme → Early → viral like symptoms & erythema migrans
Lyme → Early disseminated → arthralgia, carditis (AV block), facial nerve palsy, meningitis
Lyme → Late → intermittent/persistent arthritis > large joint (typical involved joint → knee joint)

382
Q

Lung & CNS disease together in immucosuppressed pt.

what to think?
how to diagnose?
Tx?

A

NOCARDIOSIS - acid-fast aerobic filamentous branching Gram positive rod. in CXR- nodular infiltration ± abscess

Tx- TMP-SMX

383
Q

Diagnosis of acute bacterial sinusitis → Criteria?

A

At least 1 of the following 3:

  1. Persistent symptoms ≥10 days without improvement
  2. Severe symptoms, high fever purulent nasal discharge, or facial pain ≥3 days
  3. Worsening symptoms ≥5 days after an initially improving viral upper respiratory infection
384
Q

Tx for acute bacterial infection

A

Amoxicillin-clavulanat

Alternative: Doxycycline or fluoroquinolones

385
Q

Cutaneous plaques/ulcerations + Bone lesions with sinus tracts + G.U signs/symptoms t.s Diagnosis?

A

Blastomycosis

Blasto Blasts Bone, Balls (epididymo-orchitis), Basal layer of skin

386
Q

Skin lesions + Lymphadenopathy + Meningitis + Osteoarticular infections

dx?

A

Coccidiomycosis

387
Q

USMLE & Tattooing Local infections

A

S.aureus > M.chelonae > Pseudomonas

if systemic complication- Hep C/ B or skin reaction

388
Q

Intervention & Bacteremia

Who to suspect? best next step?

A

S.bovis/septicum/gallolyticus

next step- Colonoscopy

389
Q

Nontyphoidal salmonella → Best next step?

A

HIV testing

390
Q

Abdominal pain + Recent history of pneumonia + Eosinophilia → Dx?

A

Strongyloidiasis

391
Q

How to diagnose Strongyloidiasis

A

Stool samples → Negative? → Obtain another stool sample → Stool sample negative? (i.e 2 stool samples are negative) → Serology for parasites → If 2 stool samples + negative serology → Duodenal biopsy + Empiric treatment with ivermectin (alternative → albendazole)

USMLE HY notes (27 decks)

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