MKSAP11 Flashcards
A positive tourniquet test is seen in what disease?
Dengue (petechiae after taking BP); recall first infxn = breakbone fever; second can be more serious
What is the big difference between CMV ocular dz and Toxo ocular dz in AIDS pts
Both can cause retinitis but only toxo will also cause vitreous inflammation as well (vitritis)
What is Subacute Sclerosing Panencephalitis?
A syndrome of worsening encephalitis that usually occurs in ppl who were infected with the measles virus at a young age; with an intervening portion of asymptomatic years
What is the most appropriate mgmt of erysipelas?
Penicillin based regimen bc often infxn due to group A strep
As an internal medicine doctor what is the most important thing to keep in mind about prosthetic joints?
They can get infected, from now on when taking a history always consider them as possible sources of infection
MC cause of cat bite? Cat scratch? Rat bite? Dog Bite? Human bite?
Pasteurella multocida; Bartonella henselae, Strepobacillus moniliformis, Capnocytophaga canimorsus, Eikenella corrodens
What organism is likely to cause fever, headaches, elevated serum transaminases and leukopenia and thrombocytopenia?
Ehrlichiosis
When removing a catheter and doing a voiding trial, studies have shown that a person should be able to void at least __________ cc of urine and have a post void residual of less than __________
Pee out 150 and have a PVR of less than 100
What often causes beefy red, painless ulcers of the genitals?
Donovanosis; Klebsiella granulomatus (Granulomatosis inguinale)
In whom is adenovirus pneumonia the most common?
Among military recruits
How would typhoid fever, acute HIV, and erhlichiosis differ?
Typhoid fever would have fever, constipation, and a few rose spots probs on abdomen; ehrlichia would have HA, cytopenias, and elevated transaminases; HIV would have maculopapular rash, sore throat, maybe aseptic meningitis
What joints are most commonly affected in disemminated gonococcal infxn?
Usually the knees and ankles; Can get Dx from a blood or synovial fluid Cx but not commonly + in synovial fluid; check cervical and pharyngeal swabs
What is the most likely infectious etiology of a patient with gastroenteritis type sx who has a polymicrobial bacteremia? Tx?
Strongyloides hyperinfection syndrome where the nematodes start going through the intestinal wall leading to polymicrobial bacteremia; Tx is Ivermectin + tx of the bacteremia
Bilateral facial swelling and bilateral testicular pain is likely due to what
Mumps w/ Orchitis; tx is supportive
What tick borne illness is the most likely to cause DIC and ARDS
Babesia microti (Tx is Atovaquone + Azithromcyin OR if severe then quinine and clindamycin)
If TMP-SMX is unable to be tolerated, what meds should an HIV pt be on for ppx against PCP and Toxo?
Dapsone monotherapy is ok for PCP (CD4 <200); if CD4 <200 would need pyrimethamine + leucovorin; Atovaquone covers both but not preferred agent
Which carbapenem is least like zosyn?
In general the carbapenems have similar coverage to pip tazo but also cover ESBL organsims; however, Ertapenem does not cover pseud
Best MGMT for an asymptomatic pt with chronic indwelling urinary catheter with Ucx + for E. coli?
No therapy; asymptomatic bacteriuria is present in virtually all suprapubic catheter or indwelling foleys
Most appropriate mgmt of lyme arthritis
Either doxycycline or amoxicillin for 28 days
What issue may arise in patients on steroids and protease inhibitors for HIV?
Can get Cushing as protease inhibitors decrease breakdown of steroids
What is the most appropriate tx of Enterococcus endocarditis?
Ampicillin + Gentamicin (there is synergy here; recall aminoglycosides usually only good for aerobes; Enterococcus is a facultative anaerobe)
Name two organsims that cause a relative bradycardia
Legionella pneumophila and Salmonella Typhi (Typhoid fever and Legionairres)
What are the 2 tx options for Giardia?
Metronidazole and Nitazoxanide (I think also paramomycin if pregnant)
Most common cause of a cavitary lung lesion and fever in a patient from the desert southwest with no exposure to TB? Dx?
Coccidiodes (Dx = Coccidiodes ab); if from central, South America can be paracoccidiodes (Captains wheel)
What drug should be used for C. albicans endocarditis?
Amphotericin B; usually candidal bacteremia should be with an echinocandin
An acute infection w/ fevers after swimming in Sub-Saharan Africa may be due to _______
Katayama fever (Schistosomiasis) - but obviously need to consider malaria as well
At what point in the course of a dx of HIV do you start anti-retroviral drugs?
Immediately, you should always start them regardless of the CD4 count
What may clofazimine be used in the treatment of?
Leprosy; usually the tx is Rifampicin and Dapsone with the possibility of adding clofazimine
What is the most likely etiology of a purulent skin lesion in a patient with a household contact with a similar lesion?
MRSA (purulent skin lesions usually staph)
What are your general options for someone with an animal bite inpatient and outpatient?
Ampicillin sulbactam or amoxicillin clavulanate (P. multocida, C. canimorsus etc)
What is an important diagnostic consideration in a young patient with acute onset of fever, shotty LAD, maculopapular rash, and sore throat?
Acute HIV (need the antigen, p24; antibody may not be made; combined antigen antibody tests are best)
What medication class is recommended for oupatient empiric mgmt of acute uncomplicated pyelonephritis
Fluoroquinolones (Cipro or levofloxacin); if not getting better in 48-72 h then scan for renal abscess, emphysematous pyelo, or perinephric abscess
What is the most appropriate adjunctive medicine to Acute Bacterial meningitis in younger (under 50) ppl on vancomycin and ceftriaxone?
Dexamethasone 10 mg q6h x4 days; esp. if S. pneumo confirmed
MC cause of foamy vaginitis with a punctate appearing cervix
Trichomonas spirallis; tx is 2 g metro and tx the partner
What is the dx for a stool Cx showing trophozoites engulfing red cells?
Entamoeba histolytica
What needs to be considered in patients from developing countries presenting with hypoesthetic pigmented nodules? Dx? Tx?
Leprosy (Hansens dz); Skin biopsy; multiple drugs usually Rifampicin and Dapsone +/- Clofazimine
What is the recommended first line tx of Entamoeba histolytica?
Metronidazole; paramomycin also can be used (it is a luminal agent that can eradicate cysts)
How long should patients with Candidal bacteremia be treated for?
All should get 14 days of tx with an echinocandin; however, if endocarditis the tx is AmB and probs surgery as well
Most likely organism to cause a subacute presentation of submandibular cervicofacial mass lesion with woody induration
Actinomyces israelli; often confused for neoplasm tx with pcn
What prophylactic meds should a patient going to the Dominican Republic get?
Malaria ppx; Plasmodium falciparum is endemic there
When do you start bactrim for AIDS and what is the dose?
Start 1 TMP-SMX DS tab DAILY (BID is tx dose for PCP; unless PaO2 <70 then add steroids); start when CD4 count <200
What is the tx of disseminated MAC? Most important component?
Clarithromycin and Ethambutol; Clarithro is the most important part of that
What is a test that is rarely used that can potentially look for occult infections?
Tagged WBC scan
How may acute HIV present?
Acute onset of fever, maculopapular rash, sore throat, and LAD, possibly with aseptic meningitis; possibly genital ulcers
Fevers with muscle and bone pain and a positive tourniquet test in a returning traveler is suggestive of _________
Dengue virus w/ tx being supportive care; Aedes mosquito transmits
A pt is on Vanc + CTX + Ampicillin for empiric mgmt of meningitis and Cx comes back for Listeria what do you do?
DC the vanc and CTX and add gentamicin to the ampicillin
If a person has C. neoformans meningitis with nodules on imaging what are those called? What causes most of the complications in C. neoformans meningitis?
Cryptococcomas; it causes very elevated ICP may need lots of LPs etc.
The presence of oxidase positive GNRs in a hospitalized pt is most likely ________
P. aeruginosa; other oxidase positive organisms include C. jejuni but rarely does that cause a nosocomial infxn (they don?t ferment lactose and have + oxidase enzyme)
What is the treatment of CMV colitis?
Ganciclovir IV 5 mg/kg BID
Most appropriate mgmt of asymptomatic catheter associated candiduria?
Removal of the catheter if possible without antifungal tx; recall should urinate at least 150 and PVR of less than 100
What is the most appropriate mgmt of a patient with suspected meningitis who just had a seizure?
Aside from ativan and ABCs would want to give dexamethasone, check CT scan and then LP followed by empiric abx (vanc, CTX if young; vanc CTX and amp if old)
What is the most likely cause of developing an endocarditis or septic arthritis during/after a preceding pneumonia?
S. pneumo can lead to gram + bacteremia with seeding of heart valves and joints
Most appropriate mgmt of Campylobacter dysentery that is not responding to fluoroquinolone
Azithromycin or other macrolide
What is a typical presentation of Ehrlichiosis?
Often will have fever and headache, leukopenia and thromobocytopenia, and elevated transaminases
What is the tx of MSSA endocarditis of a prosthetic valve?
Nafcillin + Rifampin + Gentamicin for 6 weeks (Naf + Rifapin 6 weeks w/ 2 weeks of Gent usually)
What is the most likely organism to cause mild-moderate gastroenteritis in a man who ate raw oysters?
Vibrio parahaemolyticus; vibrio vulnificus also a possibility
What is the tx for SEVERE pulmonary histoplasmosis?
Amphotericin B; usually it would be either no treatment, or if necessary, itraconazole/vori
What is an intracellular protozoan that causes watery diarrhea and if persistent should make you think HIV? Tx?
Cryptosporidium parvum; Nitazoxanide
What is the most appropriate mgmt of invasive listeriosis? Does it matter if they are pregnant? What class has no activity?
IV ampicillin; no it is the same; cephalosporins do not have activity
What occurs with the first infxn with Dengue? Second?
Breakbone fever w/ muscle and bone pain and fevers with positive tourniquet test; second time can get a hemorrhagic illness with circulatory collapse
How long should malarial ppx be continued when returning from the endemic country? Why? Exception?
Another 4 weeks because there may still be some in the liver; Exception is atovaquone-proguanil can be stopped in 1 week as it kills liver schizont too (Schizont = divides by schizogony meaning asexual fission)
What is the preferred diagnostic test for Hansens dz?
Skin biopsy; Leprosy, Mycobacterium leprae
The findings of chronic GU complaints with sterile pyuria in someone from an endemic country should lead to work up of what?
GU TB w/ urine cultures for acid fast Cx; otherwise sterile pyuria makes you think interstitial nephritis
MC cause of watery diarrhea in ppl returning from developing countries. Tx?
Enterotoxigenic E. coli; Fluoroquinolone or Azithromcyin
DOC for candidemia?
Echinocandin (Mica/Caspo/Anidula); if only candiduria then fluconazole
What are the recommended first line tx of post neurosurgical meningitis?
Vanc and Cefepime (or ceftazidime) and NOT pip-tazo bc poor CNS penetration
What is the best diagnostic management for any pt who has travelled to malaria endemic places who comes back with a fever?
Repeat thick and thin smears until 3 are negative
Preferred diagnostic test to evaluate for jugular vein suppurative thrombophlebitis? MC bug?
CT with IV contrast; Fusobacterium necrophorum; look out for septic pulmonary emboli (looks like R sided endocarditis in that sense)
What is a common cause of subacute and chronic meningoencephalitis associated with raised ICP in immunocompromised patients?
Cryptococcus neoformans; most of the complications here are due to increased ICP
What are the most common causes of pyogenic liver abscess? Amebic liver abscess?
Pyogenic usually E. coli and K. pneumoniae; Amebic usually E. histolytica–so tx should target both pyogenic and amebic etiologies (i.e. CTX and metro); of note echinoccocosis would show a liver CYST not an abscess
Best Tx of conjunctivitis in a contact lens wearer
Fluoroquinolone eye drop
What should you consider in a patient with pneumonia and conjunctivitis?
Adenovirus- very common amoung military recruits; another consideration would be leptospirosis as that can cause conjunctival suffusion
What is the HIV medication that is associated with an asymptomatic rise in bilirubin?
Atazanavir; a protease inhibitor
What organism causes painful genital ulcers and suppurative inguinal nodes?
Haemophilus ducreyi
Most likely dx in a young wrestler with clumps of skin lesions? Tx?
Herpes gladiatorum; can Tx with acyclovir, famciclovir, or valacyclovir to hasten healing
What is the most appropriate empric mgmt for pt with possible toxic shock syndrome?
Broad spectrum vancomycin and zosyn but also clindamycin to cover for toxin-producing strains of Group A strep and S. aureus
What is the first line Tx of HBV? When to Tx?
Tenofovir or Entacavir; tx if viral load >200
A person who was scratched by a cat with lymphadenitis likely has what?
Bartonella henselae (Bubo)
When someone says there are pseudohyphae you should think of __________
Candida
How well does piperacillin-tazobactam penetrate the CNS?
Not very well
What is Strongyloides hyperinfection syndrome? Tx?
When someone has Strongy (often will have peripheral eosinophilia) and the nematodes traverse the bowel wall leading to a polymicrobial bacteremia; Ivermectin and tx of the bactermia
What is the preferred duration of tx for a pt with MRSA bacteremia who has a knee arthroplasty? Normally?
4-6 weeks; normally, assuming not endocarditis it is 2 weeks
