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ABIM > MKSAP11 > Flashcards

MKSAP11 Flashcards

1
Q

A positive tourniquet test is seen in what disease?

A

Dengue (petechiae after taking BP); recall first infxn = breakbone fever; second can be more serious

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2
Q

What is the big difference between CMV ocular dz and Toxo ocular dz in AIDS pts

A

Both can cause retinitis but only toxo will also cause vitreous inflammation as well (vitritis)

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3
Q

What is Subacute Sclerosing Panencephalitis?

A

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

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4
Q

What is the most appropriate mgmt of erysipelas?

A

Penicillin based regimen bc often infxn due to group A strep

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5
Q

As an internal medicine doctor what is the most important thing to keep in mind about prosthetic joints?

A

They can get infected, from now on when taking a history always consider them as possible sources of infection

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6
Q

MC cause of cat bite? Cat scratch? Rat bite? Dog Bite? Human bite?

A

Pasteurella multocida; Bartonella henselae, Strepobacillus moniliformis, Capnocytophaga canimorsus, Eikenella corrodens

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7
Q

What organism is likely to cause fever, headaches, elevated serum transaminases and leukopenia and thrombocytopenia?

A

Ehrlichiosis

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8
Q

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 __________

A

Pee out 150 and have a PVR of less than 100

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9
Q

What often causes beefy red, painless ulcers of the genitals?

A

Donovanosis; Klebsiella granulomatus (Granulomatosis inguinale)

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10
Q

In whom is adenovirus pneumonia the most common?

A

Among military recruits

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11
Q

How would typhoid fever, acute HIV, and erhlichiosis differ?

A

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

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12
Q

What joints are most commonly affected in disemminated gonococcal infxn?

A

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

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13
Q

What is the most likely infectious etiology of a patient with gastroenteritis type sx who has a polymicrobial bacteremia? Tx?

A

Strongyloides hyperinfection syndrome where the nematodes start going through the intestinal wall leading to polymicrobial bacteremia; Tx is Ivermectin + tx of the bacteremia

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14
Q

Bilateral facial swelling and bilateral testicular pain is likely due to what

A

Mumps w/ Orchitis; tx is supportive

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15
Q

What tick borne illness is the most likely to cause DIC and ARDS

A

Babesia microti (Tx is Atovaquone + Azithromcyin OR if severe then quinine and clindamycin)

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16
Q

If TMP-SMX is unable to be tolerated, what meds should an HIV pt be on for ppx against PCP and Toxo?

A

Dapsone monotherapy is ok for PCP (CD4 <200); if CD4 <200 would need pyrimethamine + leucovorin; Atovaquone covers both but not preferred agent

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17
Q

Which carbapenem is least like zosyn?

A

In general the carbapenems have similar coverage to pip tazo but also cover ESBL organsims; however, Ertapenem does not cover pseud

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18
Q

Best MGMT for an asymptomatic pt with chronic indwelling urinary catheter with Ucx + for E. coli?

A

No therapy; asymptomatic bacteriuria is present in virtually all suprapubic catheter or indwelling foleys

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19
Q

Most appropriate mgmt of lyme arthritis

A

Either doxycycline or amoxicillin for 28 days

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20
Q

What issue may arise in patients on steroids and protease inhibitors for HIV?

A

Can get Cushing as protease inhibitors decrease breakdown of steroids

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21
Q

What is the most appropriate tx of Enterococcus endocarditis?

A

Ampicillin + Gentamicin (there is synergy here; recall aminoglycosides usually only good for aerobes; Enterococcus is a facultative anaerobe)

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22
Q

Name two organsims that cause a relative bradycardia

A

Legionella pneumophila and Salmonella Typhi (Typhoid fever and Legionairres)

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23
Q

What are the 2 tx options for Giardia?

A

Metronidazole and Nitazoxanide (I think also paramomycin if pregnant)

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24
Q

Most common cause of a cavitary lung lesion and fever in a patient from the desert southwest with no exposure to TB? Dx?

A

Coccidiodes (Dx = Coccidiodes ab); if from central, South America can be paracoccidiodes (Captains wheel)

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25
Q

What drug should be used for C. albicans endocarditis?

A

Amphotericin B; usually candidal bacteremia should be with an echinocandin

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26
Q

An acute infection w/ fevers after swimming in Sub-Saharan Africa may be due to _______

A

Katayama fever (Schistosomiasis) - but obviously need to consider malaria as well

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27
Q

At what point in the course of a dx of HIV do you start anti-retroviral drugs?

A

Immediately, you should always start them regardless of the CD4 count

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28
Q

What may clofazimine be used in the treatment of?

A

Leprosy; usually the tx is Rifampicin and Dapsone with the possibility of adding clofazimine

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29
Q

What is the most likely etiology of a purulent skin lesion in a patient with a household contact with a similar lesion?

A

MRSA (purulent skin lesions usually staph)

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30
Q

What are your general options for someone with an animal bite inpatient and outpatient?

A

Ampicillin sulbactam or amoxicillin clavulanate (P. multocida, C. canimorsus etc)

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31
Q

What is an important diagnostic consideration in a young patient with acute onset of fever, shotty LAD, maculopapular rash, and sore throat?

A

Acute HIV (need the antigen, p24; antibody may not be made; combined antigen antibody tests are best)

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32
Q

What medication class is recommended for oupatient empiric mgmt of acute uncomplicated pyelonephritis

A

Fluoroquinolones (Cipro or levofloxacin); if not getting better in 48-72 h then scan for renal abscess, emphysematous pyelo, or perinephric abscess

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33
Q

What is the most appropriate adjunctive medicine to Acute Bacterial meningitis in younger (under 50) ppl on vancomycin and ceftriaxone?

A

Dexamethasone 10 mg q6h x4 days; esp. if S. pneumo confirmed

34
Q

MC cause of foamy vaginitis with a punctate appearing cervix

A

Trichomonas spirallis; tx is 2 g metro and tx the partner

35
Q

What is the dx for a stool Cx showing trophozoites engulfing red cells?

A

Entamoeba histolytica

36
Q

What needs to be considered in patients from developing countries presenting with hypoesthetic pigmented nodules? Dx? Tx?

A

Leprosy (Hansens dz); Skin biopsy; multiple drugs usually Rifampicin and Dapsone +/- Clofazimine

37
Q

What is the recommended first line tx of Entamoeba histolytica?

A

Metronidazole; paramomycin also can be used (it is a luminal agent that can eradicate cysts)

38
Q

How long should patients with Candidal bacteremia be treated for?

A

All should get 14 days of tx with an echinocandin; however, if endocarditis the tx is AmB and probs surgery as well

39
Q

Most likely organism to cause a subacute presentation of submandibular cervicofacial mass lesion with woody induration

A

Actinomyces israelli; often confused for neoplasm tx with pcn

40
Q

What prophylactic meds should a patient going to the Dominican Republic get?

A

Malaria ppx; Plasmodium falciparum is endemic there

41
Q

When do you start bactrim for AIDS and what is the dose?

A

Start 1 TMP-SMX DS tab DAILY (BID is tx dose for PCP; unless PaO2 <70 then add steroids); start when CD4 count <200

42
Q

What is the tx of disseminated MAC? Most important component?

A

Clarithromycin and Ethambutol; Clarithro is the most important part of that

43
Q

What is a test that is rarely used that can potentially look for occult infections?

A

Tagged WBC scan

44
Q

How may acute HIV present?

A

Acute onset of fever, maculopapular rash, sore throat, and LAD, possibly with aseptic meningitis; possibly genital ulcers

45
Q

Fevers with muscle and bone pain and a positive tourniquet test in a returning traveler is suggestive of _________

A

Dengue virus w/ tx being supportive care; Aedes mosquito transmits

46
Q

A pt is on Vanc + CTX + Ampicillin for empiric mgmt of meningitis and Cx comes back for Listeria what do you do?

A

DC the vanc and CTX and add gentamicin to the ampicillin

47
Q

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?

A

Cryptococcomas; it causes very elevated ICP may need lots of LPs etc.

48
Q

The presence of oxidase positive GNRs in a hospitalized pt is most likely ________

A

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)

49
Q

What is the treatment of CMV colitis?

A

Ganciclovir IV 5 mg/kg BID

50
Q

Most appropriate mgmt of asymptomatic catheter associated candiduria?

A

Removal of the catheter if possible without antifungal tx; recall should urinate at least 150 and PVR of less than 100

51
Q

What is the most appropriate mgmt of a patient with suspected meningitis who just had a seizure?

A

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)

52
Q

What is the most likely cause of developing an endocarditis or septic arthritis during/after a preceding pneumonia?

A

S. pneumo can lead to gram + bacteremia with seeding of heart valves and joints

53
Q

Most appropriate mgmt of Campylobacter dysentery that is not responding to fluoroquinolone

A

Azithromycin or other macrolide

54
Q

What is a typical presentation of Ehrlichiosis?

A

Often will have fever and headache, leukopenia and thromobocytopenia, and elevated transaminases

55
Q

What is the tx of MSSA endocarditis of a prosthetic valve?

A

Nafcillin + Rifampin + Gentamicin for 6 weeks (Naf + Rifapin 6 weeks w/ 2 weeks of Gent usually)

56
Q

What is the most likely organism to cause mild-moderate gastroenteritis in a man who ate raw oysters?

A

Vibrio parahaemolyticus; vibrio vulnificus also a possibility

57
Q

What is the tx for SEVERE pulmonary histoplasmosis?

A

Amphotericin B; usually it would be either no treatment, or if necessary, itraconazole/vori

58
Q

What is an intracellular protozoan that causes watery diarrhea and if persistent should make you think HIV? Tx?

A

Cryptosporidium parvum; Nitazoxanide

59
Q

What is the most appropriate mgmt of invasive listeriosis? Does it matter if they are pregnant? What class has no activity?

A

IV ampicillin; no it is the same; cephalosporins do not have activity

60
Q

What occurs with the first infxn with Dengue? Second?

A

Breakbone fever w/ muscle and bone pain and fevers with positive tourniquet test; second time can get a hemorrhagic illness with circulatory collapse

61
Q

How long should malarial ppx be continued when returning from the endemic country? Why? Exception?

A

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)

62
Q

What is the preferred diagnostic test for Hansens dz?

A

Skin biopsy; Leprosy, Mycobacterium leprae

63
Q

The findings of chronic GU complaints with sterile pyuria in someone from an endemic country should lead to work up of what?

A

GU TB w/ urine cultures for acid fast Cx; otherwise sterile pyuria makes you think interstitial nephritis

64
Q

MC cause of watery diarrhea in ppl returning from developing countries. Tx?

A

Enterotoxigenic E. coli; Fluoroquinolone or Azithromcyin

65
Q

DOC for candidemia?

A

Echinocandin (Mica/Caspo/Anidula); if only candiduria then fluconazole

66
Q

What are the recommended first line tx of post neurosurgical meningitis?

A

Vanc and Cefepime (or ceftazidime) and NOT pip-tazo bc poor CNS penetration

67
Q

What is the best diagnostic management for any pt who has travelled to malaria endemic places who comes back with a fever?

A

Repeat thick and thin smears until 3 are negative

68
Q

Preferred diagnostic test to evaluate for jugular vein suppurative thrombophlebitis? MC bug?

A

CT with IV contrast; Fusobacterium necrophorum; look out for septic pulmonary emboli (looks like R sided endocarditis in that sense)

69
Q

What is a common cause of subacute and chronic meningoencephalitis associated with raised ICP in immunocompromised patients?

A

Cryptococcus neoformans; most of the complications here are due to increased ICP

70
Q

What are the most common causes of pyogenic liver abscess? Amebic liver abscess?

A

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

71
Q

Best Tx of conjunctivitis in a contact lens wearer

A

Fluoroquinolone eye drop

72
Q

What should you consider in a patient with pneumonia and conjunctivitis?

A

Adenovirus- very common amoung military recruits; another consideration would be leptospirosis as that can cause conjunctival suffusion

73
Q

What is the HIV medication that is associated with an asymptomatic rise in bilirubin?

A

Atazanavir; a protease inhibitor

74
Q

What organism causes painful genital ulcers and suppurative inguinal nodes?

A

Haemophilus ducreyi

75
Q

Most likely dx in a young wrestler with clumps of skin lesions? Tx?

A

Herpes gladiatorum; can Tx with acyclovir, famciclovir, or valacyclovir to hasten healing

76
Q

What is the most appropriate empric mgmt for pt with possible toxic shock syndrome?

A

Broad spectrum vancomycin and zosyn but also clindamycin to cover for toxin-producing strains of Group A strep and S. aureus

77
Q

What is the first line Tx of HBV? When to Tx?

A

Tenofovir or Entacavir; tx if viral load >200

78
Q

A person who was scratched by a cat with lymphadenitis likely has what?

A

Bartonella henselae (Bubo)

79
Q

When someone says there are pseudohyphae you should think of __________

A

Candida

80
Q

How well does piperacillin-tazobactam penetrate the CNS?

A

Not very well

81
Q

What is Strongyloides hyperinfection syndrome? Tx?

A

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

82
Q

What is the preferred duration of tx for a pt with MRSA bacteremia who has a knee arthroplasty? Normally?

A

4-6 weeks; normally, assuming not endocarditis it is 2 weeks

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