USMLE ID Flashcards
Diagnose severe community-acquired pneumonia
What needs to be tested?
- Blood cultures
- Legionella and Streptococcus pneumoniae urine antigen assays
- Endotracheal aspirate for Gram stain and culture
Blastomycosis
Coccidioidomycosis
Cryptococcosis
Histoplasmosis
Blastomycosis - Soil exposure / dimorphic fungus
Coccidioidomycosis: endemic in the southwestern US
Cryptococcosis: localized pulmonary lesions
Histoplasmosis: hilar LAD, interstitial / bats
What to do when MIC to van is > 2 in staph infections?
Daptomycin is recommended for treatment of bloodstream infections caused by methicillin-resistant Staphylococcus aureus when the minimal inhibitory concentration to vancomycin is more than 2 micrograms/mL.
Mucopurulent cervicitis, which is most commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis infection.
Treatment?
What if it was trich?
or BV?
Parenteral ceftriaxone and oral azithromycin
Trich /bv - Metronidazole for both
Antimicrobial prophylactic regimen for a patient with a clenched-fist injury ?
Tx of choice: amoxicillin-clavulanate
The combination of clindamycin and moxifloxacin isfor patinient that are allergic to penicillin.
In immunocompromised or pregnant persons within 96 hours of exposure to the varicella virus to prevent infection?
Varicella-zoster immune globulin (VZIG) or investigational VZIG (VariZIG™) or intravenous immune globulin (if a VZIG product is unavailable) should be used
Manage HIV infection in pregnancy.
In pregnant women with HIV infection, antiretroviral therapy with zidovudine, lamivudine, and lopinavir-ritonavir can reduce the risk of HIV transmission to the newborn to less than 2% and should be given regardless of CD4 cell count, viral load, or presence or absence of HIV symptoms.
Diagnose the acute retroviral syndrome.
HIV nucleic acid amplification test
Most persons in whom HIV infection develops experience an acute symptomatic illness within 2 to 4 weeks of infection, with symptoms ranging from a simple febrile illness to a mononucleosis-like syndrome.
Tick Born Diseases
- Lymes
- Babesiosis
- Ehrlichiosis and anaplasmosis
- Rocky mountain spotted fever
Lyme Disease
- The initial clinical manifestation of Lyme disease is erythema migrans, which is an erythematous skin lesion at the site of tick attachment.
- Although serologic studies are not recommended for diagnosing early localized Lyme disease, two-stage laboratory testing (enzyme-linked immunosorbent assay followed by confirmatory Western blot when the initial screening test is positive or equivocal) is required for the diagnosis of all later stages of infection.
- Serologic testing for Lyme disease should be restricted to patients with clinically suggestive signs or symptoms who either reside in or have traveled to an endemic area.
- The finding of B. burgdorferi antibodies in patients who have nonspecific symptoms of fatigue or myalgia or who are unlikely to have been exposed to a vector tick likely represents a false-positive test result for Lyme disease.
Babesiosis
- Babesiosis may be asymptomatic and when clinically apparent ranges from a self-limited febrile illness to fulminant multiorgan system failure and death.
- The preferred method for diagnosing babesiosis is polymerase chain reaction on whole blood specimens, which is more sensitive than direct microscopy.
- Treatment regimens for patients with mild babesiosis include the combination of atovaquone and azithromycin or quinine and clindamycin.
Ehrlichiosis and Anaplasmosis
- Both human monocytic ehrlichiosis and human granulocytic anaplasmosis are characterized by a nonfocal febrile illness with frequent headache, myalgia, and fatigue.
- Results of serologic testing may be negative in patients with acute human monocytic ehrlichiosis and human granulocytic anaplasmosis infection but may be positive 2 to 4 weeks after development of clinical illness if the diagnosis requires confirmation.
- Treatment of human monocytic ehrlichiosis and human granulocytic anaplasmosis should be initiated when infection is suspected because treatment delays are associated with poorer outcomes.
- Doxycycline is the treatment of choice for both human monocytic ehrlichiosis and human granulocytic anaplasmosis.
Rocky Mountain Spotted Fever
- The characteristic finding of Rocky Mountain spotted fever is a petechial rash, which may not present until several days after the onset of fever.
- Doxycycline should be started empirically whenever Rocky Mountain spotted fever is suspected and should not be withheld or discontinued based on serologic test results.
BV
Trichomoniasis
- (1) homogeneous thin discharge that coats the vaginal walls; (2) clue cells on saline microscopy; (3) pH of vaginal fluid >4.5; and (4) fishy odor of vaginal discharge (positive “whiff” test). Metronidazole, 7-day oral regimen
- Oral metronidazole is also used for the treatment of trichomoniasis, but it is typically given as a single 2-g dose
Diagnose dengue fever.
Classic manifestations of dengue infection in symptomatic persons include fever with chills, severe frontal headache, retro-orbital pain, and musculoskeletal pain that is characteristically severe in the lumbar spine, as well as a nonspecific macular or maculopapular rash sparing the palms and soles.
Diagnose Yersinia pestis infection
The bipolar staining Gram-negative bacillus giving the appearance of a closed “safety pin” is virtually pathognomonic for Y. pestis.
Diagnose anthrax infection
The rapid development of a septic state following a nonspecific prodromal flu-like syndrome and widening of the mediastinum is characteristic of inhalational anthrax.
Diagnose Pneumocystis pneumonia in a patient with AIDS.
Because this patient’s arterial PO2 level is less than 70 mm Hg (9.3 kPa), treatment would include corticosteroids plus trimethoprim-sulfamethoxazole.
Diagnose Pneumocystis pneumonia in a patient with AIDS.
Prevent ventilator-associated pneumonia.
A VAP prevention bundle of interventions includes: (1) maintaining the head of the patient’s bed above a 30° angle, (2) daily assessments of the patient’s readiness to wean from the ventilator, and (3) chlorhexidine mouth washes.
Manage hyperlipidemia in a patient with HIV infection.
- Atorvastatin is effective for treating hyperlipidemia in patients with HIV infection and should be started at a lower dose in patients taking protease inhibitors to avoid drug interactions.
- Simvastatin is contraindicated in patients taking HIV protease inhibitors because of cytochrome P-450 drug metabolism interactions
Treat a patient with tuberculous meningitis.
- The recommended duration of antituberculous treatment in patients with tuberculous meningitis is 9 to 12 months.
Manage a patient with esophageal candidiasis.
- Oral candidiasis with esophageal involvement is characterized by whitish plaques on the oral mucosa and difficulty swallowing; treatment with a systemic agent such as fluconazole is required.
Treat extensively drug-resistant Pseudomonas aeruginosa.
Colistin is one of the only available options for treatment of extensively drug-resistant Pseudomonas aeruginosa infection.
Treat pelvic inflammatory disease in an outpatient.
Women with abdominal or pelvic pain and cervical motion tenderness, adnexal tenderness, or uterine tenderness who can tolerate outpatient therapy should be treated for pelvic inflammatory disease, with single-dose intramuscular ceftriaxone and oral doxycycline for 14 days.
If really sick Inpatient Intravenous clindamycin and gentamicin for 7 days
Aspergillosis and Aspergilloma
Mucormycosis
Cryptococcosis
Blastomycosis
Histoplasmosis
Coccidioidomycosis
Sporotrichosis
Systemic Candidiasis
Gold Dx positive culture from the blood
Fluconazole or an echinocandin
Removal of intravenous catheters is strongly recommended for non-neutropenic patients with candidemia.
Aspergillosis and Aspergilloma
Pulmonary aspergillosis are allergic bronchopulmonary aspergillosis, aspergilloma (fungus ball), and invasive aspergillosis.
TX allergic bronchopulmonary aspergillosis oral corticosteroids acute phase/exacerbation with itraconazole added to achieve a corticosteroid-sparing effect.
Voriconazole is superior to conventional amphotericin B for primary treatment of invasive aspergillosis.
Mucormycosis
Finding black necrotic tissue on examination of the nose or palate is pathognomonic.
TX high-dose conventional or lipid-based amphotericin B and immediate, aggressive surgical debridement.
Cryptococcosis
The diagnosis of cryptococcosis histopathologic / cryptococci in culture.
Tx amphotericin B plus flucytosine induction therapy followed by fluconazole consolidation therapy.
Blastomycosis Ohio valley
A presumptive diagnosis of pulmonary blastomycosis is based on the finding of characteristic yeast forms on histopathologic samples, and the definitive diagnosis is established by isolation of Blastomyces dermatitidis on culture.
Tx itraconazole, and those with moderately severe to severe disease should receive a conventional or lipid formulation of amphotericin B followed by oral itraconazole.
Histoplasmosis
Dx histopathologic studies, antigen determination, and isolation of Histoplasma capsulatum on culture.
Itraconazole is the antifungal agent of choice for treating mild to moderate histoplasmosis, and a conventional or lipid formulation of amphotericin B is used to treat moderately severe to severe infection.
Coccidioidomycosis- South west
community-acquired pneumonia occurring 1 to 3 weeks following exposure.
Serologic tests are useful for diagnosing primary coccidioidal infection and monitoring the course of therapy; repeated testing may be needed to improve sensitivity.
Treatment of uncomplicated primary coccidioidal infection is ketoconazole, fluconazole, or itraconazole for 3 to 6 months.
Sporotrichosis
Cutaneous and osteoarticular Sporothrix schenckii infections are treated with itraconazole.
CURB-65
- confusion
- blood urea nitrogen level >19.6 mg/dL [7.0 mmol/L]
- respiration rate ≥30/min
- systolic blood pressure
- age ≥65 years),
- 0 or 1 indicating consideration for outpatient management, and a score of 2 or more indicating the need for hospitalization.
Prevent malaria in a pregnant patient.
Chloroquine
Mefloquine - second third trimaster as this is used in africa or resistant areas
Treat cat-scratch disease.
Cat Bite
Azithromycin is an effective antibiotic agent for treatment of cat-scratch disease.
Bite: Amoxicilline clavulanate or Doxy + metro
Treat invasive pulmonary aspergillosis in a patient with leukemia.
Voriconazole is the drug of choice for immunocompromised patients with invasive pulmonary aspergillosis.
Actinomycosis tx
- around mandibular region, non tender mass with sulfur granules, forms ascess, fistulas, sinus tract
- Tx:PCN for 6-12 months
Acute bacterial rhinosinusitis
Dx:
Tx:
Any of the following:
Persistent symptoms > 10 days
Sever symptoms High fever, purulent nasal discharbe > 3 days
Worsening symptoms after 5 days after initial improvement.
First line Amoxicillin clavulanate
Alteranate Doxy cycline or flouroquinolone
Acute bactyerial meningitis
bacteria
Tx:
Strep Pneumoniae and H. Influenzae most common
Tx: give Steriod Dexa prior to abx improves mortality
then give Vanc and Ceftriaxone / can give Acyclovir as well.
Animal Bites
Tx
- First line
- Augmentin
- Alternative
- Doxy / moxi / Bactrim
- Plus for anaerobic acitvity Metro / Clinda
Aortic dissection
Morphine
BBlk to bring SBP to 100-120
Transfer to ICU
Additional vasodilators ie Nitroprusside if still hypertensive
Surbery consult / TEE echo
B19
Symptoms
Dx
Tx
- 75% asymptomatic
- Erythema infectiosum
- Acute symmetrical arthralgias/arthritis of hands, wrists knees and feet
- Transient aplastic anemia - with hx of hematologic dz
Dx B19 IgM Ab / Nucleic acid amplification NAAT
Tx: supportive
Bacteremia that needs further workup
- Streptococcus bovis
- Colostridium septicum
- Nontypical salmonella
- Candidemia
- Streptococcus bovis
- Colonoscopy
- Colostridium septicum
- Colonoscopy
- Nontypical salmonella
- HIV
- Candidemia
- Ophthalmologic examination
Beta Lactamase producing organism tx
Imipenem, Meropenem
Candiduria
- Asymptomatic
- Asymptomatic antipated urological procedure
- Asymptomatic(neutropenic)
- Symptomatic
- Pyelonephritis
Asymptomatic
- Elimiinate predisposing factors / remove/exchange urine cath
Asymptomatic antipated urological procedure
- Consider systemic antifungal prior to following procedure
Asymptomatic(neutropenic)
- treat as disseminated candidiasis
Symptomatic
- Systemic antifungal therapy 7-10 days
Pyelonephritis
- Systemic antifungal > 2 weeks
Creepy skin stuff
- Cutaneous leishmaniasis
- Eumycetoma
- Swimmer’s itch
- Larva migrans
- Cutaneous leishmaniasis
Protozoan parasite transmitted to humans via sand fly / ulcer with granulomatous tissue
Fluconazole 200 mg dialy
- Eumycetoma
Chronic granulomatous fungal dz / chronic / can form fistulas and drain pus
- Swimmer’s itch
Schistosom cercarial - pruritic maculopapular rash -
Anti histamin
- Larva migrans
Serpiginous reddis brown lesion - can have pulmonary involvemneet rarely occurs
Tx Ivermectin
