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1 USMLE Step 3 Main one > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

INTRAVENOUS treatment for MSSA

bone, heart, skin, joint

A
  • oxacillin
  • nafcillin
  • cefazolin (1st gen cephalosporin)
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2
Q

ORAL treatment for MSSA

bone, heart, skin, joint

A
  • dicloxacillin

- cephalexin (1st gen cephalosporin)

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3
Q

treatment for MINOR MRSA infection

bone, heart, skin, joint

A
  • trimethoprim/sulfamethoxazole (TMP/SMX)
  • clindamycin
  • doxycycline
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4
Q

treatment for MAJOR MRSA infection

bone, heart, skin, joint

A
  • vancomycin
  • linezolid
  • daptomycin
  • ceftaroline
  • tigecycline
  • telavancin
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5
Q

adverse effect of linezolid

A

thrombocytopenia

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6
Q

adverse effect of daptomycin

A

myopathy (elevated CPK)

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7
Q

treatment of Staph aureus if penicillin allergy: RASH

bone, heart, skin, joint

A

cephalosporins

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8
Q

treatment of Staph aureus if penicillin allergy: ANAPHYLAXIS

bone, heart, skin, joint

A
  • macrolides (azithromycin, clarithromycin)

- clindamycin

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9
Q

treatment of Staph aureus if penicillin allergy: MINOR INFECTION

(bone, heart, skin, joint)

A
  • macrolides (azithromycin, clarithromycin)
  • clindamycin
  • trimethoprim/sulfamethoxazole (TMP/SMX)
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10
Q

treatment of Staph aureus if penicillin allergy: MAJOR INFECTION

(bone, heart, skin, joint)

A
  • vancomycin
  • linezolid
  • daptomycin
  • telavancin
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11
Q

can you use the same antibiotics for Staph as Streptococcus?

A

YES

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12
Q

antibiotics SPECIFIC for Streptococcus

A
  • penicillin
  • ampicillin
  • amoxicillin
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13
Q

Gram-negative bacilli (rods)

A
  • Escherichia coli
  • Enterobacter
  • Citrobacter
  • Morganella
  • Pseudomonas
  • Serratia
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14
Q

antibiotic classes that are EQUAL in efficacy for treatment of Gram-NEGATIVE bacilli (rods)

A
  1. cephalosporins
  2. penicillins
  3. monobactam
  4. quinolones
  5. aminoglycosides
  6. carbapenems
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15
Q

ONLY carbapenem that does NOT cover Pseudomonas

A

ERTAPENEM

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16
Q

cover GNR and ALSO cover Streptococci and anaerobes

A
  1. PIPERACILLIN

2. TICARCILLIN

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17
Q

EXCELLENT pneumococcal (Streptococcus pneumoniae) drugs

A
  1. LEVOFLOXACIN
  2. GEMIFLOXACIN
  3. MOXIFLOXACIN
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18
Q

work SYNERGISTICALLY against Staph and Strep

A

AMINOGLYCOSIDES

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19
Q

EXCELLENT anaerobic coverage, and cover Strep and MSSA

A

CARBAPENEMS

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20
Q

covers MRSA and GNR

A

TIGECYCLINE

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21
Q

adverse effect of imipenem

A

SEIZURES

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22
Q

BEST medication for gastrointestinal anaerobes (Bacteroides)

A

metronidazole

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23
Q

can also be used for gastrointestinal anaerobes (Bacteroides)

A
  • carbapenems
  • piperacillin
  • ticarcillin
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24
Q

ONLY cephalosporins that cover anaerobes

A
  • CEFOXITIN

- CEFOTETAN

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25
Q

BEST medication for respiratory anaerobes (anaerobic Strep)

A

clindamycin

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26
Q

antibiotics with NO anaerobic coverage

A
  • aminoglycosides
  • aztreonam
  • fluoroquinolones
  • oxacillin
  • nafcillin
  • all cephalosporins EXCEPT cefoxitin and cefotetan
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27
Q

red, flushed skin (particularly on neck) from histamine release is d/t?

A

vancomycin

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28
Q

red man syndrome treatment

A

slow rate of vancomycin infusion

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29
Q

treatment for herpes simplex, and varicella zoster (all 3 are equal in efficacy)

A
  1. acyclovir
  2. valacyclovir
  3. famciclovir
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30
Q

treatment for cytomegalovirus (CMV)

A
  1. ganciclovir
  2. valganciclovir
  3. foscarnet
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31
Q

BEST long-term treatment for CMV RETINITIS

A

VALGANCICLOVIR

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32
Q

adverse effects of ganciclovir and valganciclovir

A
  • neutropenia

- bone marrow suppression

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33
Q

adverse effect of foscarnet

A

renal toxicity

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34
Q

treatment for influenza A and B

A
  • oseltamivir
  • zanamivir

(neuraminidase inhibitors)

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35
Q

treatment for hepatitis C (in combination w/ interferon), and respiratory syncytial virus (RSV)

A

ribavirin

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36
Q

treatment for hepatitis B

A
  • lamivudine
  • interferon
  • adefovir
  • tenofovir
  • entecavir
  • telbivudine
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37
Q

treatment for oral and vaginal candidiasis (alternative to topical medications)

A

fluconazole

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38
Q

best treatment against Aspergillus

A

voriconazole

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39
Q

adverse effect of voriconazole

A

visual disturbance

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40
Q

EXCELLENT for neutropenic fever patients

A
  • caspofungin
  • micafungin
  • anidulafungin

(echinocandins)

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41
Q

which antifungals do NOT cover Cryptococcus?

A

echinocandins

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42
Q

adverse effects of echinocandins?

A

NONE

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43
Q

effective against ALL Candida, Cryptococcus, and Aspergillus

A

amphotericin

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44
Q

superior to amphotericin in treatment of Aspergillus

A

voriconazole

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45
Q

superior to amphotericin in treatment of neutropenic fever

A

caspofungin

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46
Q

superior to amphotericin in treatment of Candida

A

fluconazole (same efficacy, but LESS adverse effects)

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47
Q

adverse effects of amphotericin

A
  1. renal toxicity (increased creatinine)
  2. hypOkalemia
  3. metabolic acidosis
  4. fever, shakes, chills
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48
Q

occurs in DIABETES, PVD, or both with an ULCER, or SOFT TISSUE infection

A

OSTEOMYELITIS

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49
Q

best INITIAL test for osteomyelitis

A

plain X-ray

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50
Q

best SECOND-line test for osteomyelitis

A

MRI

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51
Q

most ACCURATE test for osteomyelitis

A

bone BIOPSY and culture

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52
Q

EARLIEST finding of osteomyelitis on X-ray

A

periosteal elevation

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53
Q

what percentage of calcium of bone must be lost in osteomyelitis before the X-ray becomes abnormal?

A

50%

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54
Q

how much time will it take before X-ray becomes abnormal in osteomyelitis?

A

up to 2 weeks

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55
Q

is osteomyelitis associated with fracture?

A

NO

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56
Q

best method for following response to therapy of osteomyelitis

A

ESR (erythrocyte sedimentation rate)

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57
Q

osteomyelitis is MOST COMMONLY caused by

A

direct contiguous spread from overlying tissue

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58
Q

what do you do in osteomyelitis if ESR is still markedly elevated after 4-6 weeks of treatment?

A

continue treatment

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59
Q

MCC of osteomyelitis

A

Staphylococcus

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60
Q

treatment for osteomyelitis if Staphylococcus is sensitive

A

OXACILLIN, or NAFCILLIN for 4-6 WEEKS

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61
Q

treatment for osteomyelitis if Staphylococcus is resistant (MRSA)

A

VANCOMYCIN, LINEZOLID, or DAPTOMYCIN for 4-6 WEEKS

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62
Q

can you treat Staphylococcal osteomyelitis with PO antibiotics?

A

NO

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63
Q

Gram-negative bacilli that can cause osteomyelitis

A
  • Salmonella

- Pseudomonas

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64
Q

ONLY form osteomyelitis that can be treated with PO antibiotics

A

Salmonella, and Pseudomonas osteomyelitis

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65
Q
  • ITCHING and DRAINAGE from external auditory canal

- form of cellulitis of external auditory canal

A

otitis externa

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66
Q

otitis externa is associated with?

A
  • SWIMMING

- FOREIGN OBJECTS

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67
Q

treatment for otitis externa

A
  1. topical antibiotics
  2. topical hydrocortisone (decreases swelling/itching)
  3. acetic acid and water (reacidify ear)
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68
Q

OSTEOMYELITIS OF SKULL from Pseudomonas in patient with diabetes

A

malignant otitis externa

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69
Q

malignant otitis externa can cause

A
  • brain abscess

- skull destruction

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70
Q

best INITIAL test of malignant otitis externa

A

SKULL X-RAY, or MRI

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71
Q

MOST ACCURATE TEST for malignant otitis externa

A

BIOPSY

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72
Q

treatment for malignant otitis externa

A
  1. SURGICAL DEBRIDEMENT

2. ANTIPSEUDOMONAL ANTIBIOTICS

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73
Q

antipseudomonal antibiotics that can be used in malignant otitis externa

A
  • ciprofloxacin
  • piperacillin
  • cefepime
  • carbapenem
  • aztreonam
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74
Q

key features of otitis media

A
  • redness
  • bulging
  • decreased hearing
  • loss of light reflex
  • TM immobility
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75
Q

MOST SENSITIVE finding in otitis media

A

TM IMMOBILITY

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76
Q

diagnostic testing for otitis media

A

NONE, based on PE

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77
Q

best INITIAL treatment of otitis media

A

AMOXICILLIN for 7-10 days

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78
Q

MOST ACCURATE TEST for otitis media

A

tympanocentesis and aspirate of TM for culture

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79
Q

if otitis media does not begin improving after 3 days, what do you do?

A

switch antibiotics!

  • amoxicillin/clavulanate
  • cefdinir
  • ceftibuten
  • cefuroxime
  • cefprozil
  • cefpodoxime
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80
Q

nasal discharge, headache, facial tenderness, tooth pain, bad taste in mouth, decreased transillumination of sinuses

A

sinusitis

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81
Q

MCC of sinusitis

A

VIRAL

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82
Q

MCC of sinusitis that are NOT viral

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catarrhalis
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83
Q

best INITIAL test for sinusitis

A

X-ray

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84
Q

MOST ACCURATE TEST for sinusitis

A

sinus aspirate for culture

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85
Q

treatment for sinusitis

A

amoxicillin and INHALED STEROIDS

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86
Q
  • pain/sore throat
  • exudate
  • adenopathy
  • NO cough/hoarseness
A

pharyngitis

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87
Q

best INITIAL test for pharyngitis

A

RAPID STREP TEST

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88
Q

MOST ACCURATE TEST for pharyngitis

A

CULTURE

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89
Q

treatment for pharyngitis

A

PENICILLIN, or AMOXICILLIN

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90
Q

treatment for pharyngitis if penicillin allergy

A

azithromycin, or clarithromycin

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91
Q
  • arthralgia
  • myalgia
  • cough
  • headache
  • fever
  • sore throat
  • feeling of tiredness
A

influenza

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92
Q

next best step to diagnose influenza

A

viral antigen detection

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93
Q

when should you treat influenza?

A

if patient presents within first 48 hours after onset of symptoms

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94
Q

what drug class works against BOTH influenza A and B?

A

neuraminidase inhibitors

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95
Q

treatment for influenza

A
  • oseltamivir

- zanamivir

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96
Q

WRONG answers to treat influenza

A
  • amantadine

- rimantadine

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97
Q

who should get vaccinated against influenza?

A

everyone

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98
Q
  • most SUPERFICIAL bacterial skin infections
  • weeping, crusting, oozing of skin
  • Strep PYOGENES or Staph aureus
A

impetigo

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99
Q

treatment for impetigo

A
  1. topical mupirocin

2. topical retapamulin

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100
Q

treatment for SEVERE impetigo

A
  1. dicloxacillin

2. cephalexin

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101
Q

treatment for community-acquired MRSA impetigo

A

TMP/SMZ (trimethoprim/sulfamethoxazole)

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102
Q

treatment for impetigo if penicillin allergy: RASH

A

cephalosporins

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103
Q

treatment for impetigo if penicillin allergy: ANAPHYLAXIS

A
  1. clindamycin
  2. doxycycline
  3. linezolid
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104
Q

treatment for impetigo if penicillin allergy: SEVERE INFECTION WITH ANAPHYLAXIS

A
  1. vancomycin
  2. telavancin
  3. linezolid
  4. daptomycin
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105
Q
  • group A (PYOGENES) streptococcal infection of skin
  • very bright red, hot
  • often affects FACE
A

erysipelas

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106
Q

can erysipelas cause rheumatic fever?

A

NO, but it can cause glomerulonephritis

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107
Q

what can cause rheumatic fever and glomerulonephritis?

A

PHARYNGITIS

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108
Q

best INITIAL treatment for erysipelas

A
  1. dicloxacillin

2. cephalexin

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109
Q

treatment for erysipelas if organism is CONFIRMED as group A beta hemolytic streptococci (Strep pyogenes)

A

PENICILLIN VK

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110
Q
  • warm, red, swollen, tender skin

- usually presents in arm or leg

A

cellulitis

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111
Q

what should you order in a case of cellulitis of the leg?

A

LOWER EXTREMITY DOPPLER to exclude blood clot

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112
Q

treatment for cellulitis: MINOR disease

A
  1. dicloxacillin PO

2. cephalexin PO

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113
Q

treatment for cellulitis: SEVERE disease

A
  1. oxacillin IV
  2. nafcillin IV
  3. cefazolin IV
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114
Q

treatment for cellulitis if penicillin allergy: RASH

A

cephalosporins (cefazolin)

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115
Q

treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and MINOR disease

A
  • macrolides

- clindamycin

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116
Q

treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and SEVERE disease

A
  1. vancomycin
  2. linezolid
  3. daptomycin
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117
Q

what skin infection does Staphylococcus epidermidis cause?

A

NONE

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118
Q

all skin infections can lead to?

A

post-streptococcal GLOMERULONEPHRITIS

but NOT rheumatic fever

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119
Q

Staph aureus-related skin infections beginning at the hair follicle

A

folliculitis

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120
Q

what is FOLLICulitis?

A

infected hair FOLLICle

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121
Q

what is a furuncle?

A

deep folliculitis

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122
Q

what is a Carbuncle?

A

a Cluster of furuncles

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123
Q

what is an abscess?

A

a collection of pus

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124
Q

diagnosis of folliculitis, furuncles, carbuncle, abscess

A

based on appearance

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125
Q

treatment for folliculitis/furuncles/carbuncles/abscesses: MINOR disease

A
  1. dicloxacillin PO

2. cephalexin PO

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126
Q

treatment for folliculitis/furuncles/carbuncles/abscesses: SEVERE disease

A
  1. oxacillin IV
  2. nafcillin IV
  3. cefazolin IV
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127
Q

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: RASH

A

cephalosporins (cefazolin)

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128
Q

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and MINOR disease

A
  • macrolides

- clindamycin

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129
Q

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and SEVERE disease

A
  1. vancomycin
  2. linezolid
  3. daptomycin
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130
Q

abscesses respond well to?

A

drainage

131
Q

severe itching of scalp, dandruff, bald patches

A

fungal SKIN infection

132
Q

thickened nails, yellow, cloudy, appear fragile and broken

A

onychomycosis

133
Q

best INITIAL test for fungal skin/nail infections

A

KOH preparation

134
Q

antifungal treatment if NO hair or nail involvement

hint: 5 -azole’s, and 2 others

A

topical:

  • clotrimAZOLE
  • miconAZOLE
  • ketoconAZOLE
  • econAZOLE
  • terconAZOLE
  • nystatin
  • ciclopirox
135
Q

PO antifungal tx for scalp (tinea capitis), or nail (onychomycosis)

A
  1. terbinafine
  2. itraconazole
  3. griseofulvin (for tinea capitis)
136
Q

adverse effect of terbinafine

A

increased transaminases

137
Q

less efficacious than terbinafine and itraconazole

A

griseofulvin

138
Q
  • URETHRAL DISCHARGE

+/- dysuria

A

urethritis

139
Q

diagnostic testing for urethritis

A
  • urethral swab (gram stain, WBC count, culture, DNA probe)

- nucleic acid amplification test (NAAT)

140
Q

treatment for urethritis

A

2 medications: one for gonorrhea, one for chlamydia

141
Q
  1. polyarticular disease
  2. petechial rash
  3. tenosynovitis
A

disseminated gonorrhea

142
Q

medications for gonorrhea in urethritis

A
  • ceftriaxone IM
  • cefpodoxime PO
  • ciprofloxacin PO
143
Q

treatment for gonorrhea if patient has urethritis and is PREGNANT

A

ceftriaxone IM

144
Q

medications for chlamydia in urethritis

A
  • azithromycin (SINGLE dose)

- doxycycline (for 1 week)

145
Q

treatment for chlamydia if patient has urethritis and is PREGNANT

A

azithromycin

146
Q

cervical discharge

A

cervicitis

147
Q

diagnostic testing for cervicitis

A
  • swab (gram stain, WBC count, culture, DNA probe)

- nucleic acid amplification test (NAAT)

148
Q

is just as accurate as a speculum examination for cervicitis

A

nucleic acid amplification testing (NAAT)

149
Q

treatment for cervicitis

A

2 medications: one for gonorrhea, one for chlamydia

150
Q

medications for gonorrhea in cervicitis

A
  • ceftriaxone IM
  • cefpodoxime PO
  • ciprofloxacin PO
151
Q

treatment for gonorrhea if patient has cervicitis and is PREGNANT

A

ceftriaxone IM

152
Q

medications for chlamydia in cervicitis

A
  • azithromycin (SINGLE dose)

- doxycycline (for 1 week)

153
Q

treatment for chlamydia if patient has cervicitis and is PREGNANT

A

azithromycin

154
Q
  • lower abdominal pain
  • tenderness
  • fever
  • cervical motion tenderness
    +/- dysuria
    +/- vaginal discharge
A

pelvic inflammatory disease (PID)

155
Q

measure of severity in pelvic inflammatory disease (PID)

A

leukocytosis

156
Q

best INITIAL test for pelvic inflammatory disease (PID)

A
  1. pregnancy test
  2. cervical culture
  3. NAAT (nucleic acid amplification testing)
157
Q

MOST ACCURATE test for pelvic inflammatory disease (PID)

A

laparoscopy (rarely needed)

158
Q

OUTPATIENT treatment for PID

A

ceftriaxone IM AND doxycycline PO

159
Q

INPATIENT treatment for PID

A

cefoxitin IV AND doxycycline IV (and maybe metronidazole)

160
Q

antibiotics safe in pregnancy

A
  1. penicillins
  2. cephalosporins
  3. aztreonam
  4. erythromycin
  5. azithromycin
161
Q
  • extremely painful and tender testicle

- NORMAL position of testicle in scrotum

A

epididymo-orchitis

162
Q
  • extremely painful and tender testicle

- ELEVATED testicle in an ABNORMAL TRANSVERSE position

A

testicular torsion

163
Q

treatment for epididymo-orchitis: if LESS THAN 35 years of age

A

ceftriaxone AND doxycycline

164
Q

treatment for epididymo-orchitis: if MORE THAN 35 years of age

A

fluoroquinolone

165
Q

PAINFUL ulcer caused by Haemophilus ducreyi

A

chancroid

166
Q

best INITIAL test for chancroid

A

swab for gram stain and culture

167
Q

treatment for chancroid

A
  • ceftriaxone (single IM shot), OR

- azithromycin (single PO dose)

168
Q
  • LARGE TENDER NODES
  • ulcer
  • may develop suppurating, draining sinus tract
A

lymphogranuloma venereum (LGV)

169
Q

diagnose lymphogranuloma venereum (LGV)

A

serology for Chlamydia trachomatis

170
Q

treatment for lymphogranuloma venereum (LGV)

A
  1. aspirate the bubo

2. doxycycline, OR azithromycin

171
Q

clear vesicular lesions

A

HSV2 (herpes simplex virus 2; genital herpes)

172
Q

treatment for HSV2

A
  • acyclovir
  • valacyclovir
  • famciclovir
    for 7-10 days
173
Q

best INITIAL test if roofs come off of vesicles making etiology unclear

A

Tzanck prep

174
Q

MOST ACCURATE test for HSV2

A

viral culture

175
Q

cause of syphilis

A

Treponema pallidum

176
Q
  • PAINLESS, firm genital lesion

- painless inguinal adenopathy

A

syphilis

177
Q

MOST ACCURATE test for PRIMARY syphilis

A

darkfield microscopy

178
Q

symptoms of PRIMARY syphilis

A
  • CHANCRE

- ADENOPATHY

179
Q

treatment for PRIMARY syphilis

A

SINGLE IM shot of PENICILLIN

180
Q

treatment for PRIMARY syphilis if penicillin allergy

A

doxycycline

181
Q
  • fever, headache, myalgia

- develops 24 hours after treatment of primary syphilis

A

Jarisch-Herxheimer reaction

182
Q

symptoms of SECONDARY syphilis

A
  • RASH
  • MUCOUS PATCH
  • ALOPECIA AREATA (bald patches)
  • CONDYLOMATA LATA (warts on genitals)
183
Q

INITIAL diagnostic test for SECONDARY syphilis

A

RPR and FTA

184
Q

treatment for SECONDARY syphilis

A

SINGLE IM shot of PENICILLIN

185
Q

treatment for SECONDARY syphilis if penicillin allergy

A

doxycycline

186
Q

manifestations of TERTIARY syphilis

A
  • TABES DORSALIS
  • ARGYLL-ROBERTSON PUPIL
  • GENERAL PARESIS (paralysis)
  • gumma
  • aortitis
187
Q

INITIAL diagnostic test for TERTIARY syphilis

A

RPR and FTA

FTA is more sensitive for neurosyphilis

188
Q

best INITIAL diagnostic test for NEUROsyphilis

A

LUMBAR PUNCTURE

189
Q

treatment for TERTIARY syphilis

A

IV PENICILLIN

190
Q

treatment for TERTIARY syphilis if penicillin allergy

A

desensitization to penicillin

191
Q

beefy red genital lesion that ULCERATES

A

granuloma inguinale

192
Q

diagnostic test for granuloma inguinale

A

biopsy

193
Q

causative organism for granuloma inguinale

A

Klebsiella granulomatis

194
Q

treatment for granuloma inguinale

A
  • doxycycline
  • TMP/SMX
  • azithromycin
195
Q
  • urinary frequency
  • urgency
  • burning
  • dysuria
A

cystitis

196
Q

best INITIAL test for cystitis

A

urinalysis

197
Q

MOST ACCURATE test for cystitis

A

urine culture

198
Q

treatment for UNCOMPLICATED cystitis

A

fosfomycin, or nitrofurantoin PO for 3 days

199
Q

treatment for UNCOMPLICATED cystitis if high resistance to TMP/SMX

A
  • ciprofloxacin

- levofloxacin

200
Q

treatment for COMPLICATED cystitis

A
  • TMP/SMX
  • ciprofloxacin

for 7 days

201
Q

what qualifies as “complicated” cystitis?

A
  • stone
  • stricture
  • tumor
  • obstruction
202
Q

should you treat asymptomatic bacteriuria?

A

NO

203
Q

who should get treated for asymptomatic bacteriuria?

A

only PREGNANT women

204
Q
  • urinary frequency
  • urgency
  • burning
  • dysuria
  • FLANK PAIN and TENDERNESS
A

pyelonephritis

205
Q

best INITIAL test for pyelonephritis

A

urinalysis

206
Q

MOST ACCURATE test for pyelonephritis

A

urine culture

207
Q

OUTpatient treatment for pyelonephritis

A

ciprofloxacin

208
Q

INpatient treatment for pyelonephritis

A
  • ceftriaxone
  • ertapenem
  • quinolones
  • ampicillin
  • gentamicin
209
Q

why are sonography or CT scanning done in a patient with a UTI?

A
  • to determine etiology

- if pyelonephritis; stone? stricture? tumor? obstruction?

210
Q

think of this in a patient who does not respond to treatment AFTER 5-7 days

A

perinephric abscess

211
Q

necessary diagnostic test for perinephric abscess

A

biopsy to determine microbe

212
Q

treatment for perinephric abscess

A

quinolone AND staphylococcal coverage

because treatment for GN bacteria selects out staphylococci

213
Q

positive NITRITES indicate

A

gram negative bacteria in urine

214
Q
  • frequency
  • urgency
  • dysuria
  • PERINEAL or SACRAL PAIN
  • prostate tenderness
A

prostatitis

215
Q

best INITIAL test for prostatitis

A

urinalysis

216
Q

MOST ACCURATE test for prostatitis

A

urine WBC’s AFTER PROSTATE MASSAGE

217
Q

treatment for ACUTE prostatitis

A
  • ciprofloxacin
  • TMP/SMX

FOR 2 WEEKS

218
Q

treatment for CHRONIC prostatitis

A
  • ciprofloxacin
  • TMP/SMX

FOR 6 WEEKS

219
Q

endocarditis is clinically diagnosed using

A

Duke’s criteria

2 MAJOR, or 5 minor criteria

220
Q

what are the 2 MAJOR criteria for Duke’s criteria?

A
  1. 2 positive blood cultures

2. abnormal echocardiogram

221
Q

what are the minor criteria for Duke’s criteria?

A
  1. fever
  2. presence of risk factors
  3. vascular findings
  4. immunologic findings
  5. microbiologic findings
222
Q

fever + murmur =

A

POSSIBLE endocarditis

do blood cultures

223
Q

2 positive blood cultures + positive echo =

A

ENDOCARDITIS

224
Q

next best step in patient with fever, and new murmur or change in murmur

A

blood cultures

225
Q

next best step in patient with fever, a murmur (new or changed), and positive blood cultures

A

echocardiogram

226
Q

most common causes of culture NEGATIVE endocarditis

A

Coxiella and Bartonella

227
Q

is associated even more with colonic pathology than Streptococcus bovis

A

Clostridium septicum

228
Q

most common organisms for bacterial endocarditis

A
  1. Staph aureus
  2. MRSA
  3. Strep viridans group
229
Q

best empiric therapy for endocarditis

A

vancomycin AND gentamicin in COMBINATION

(covers MC organisms)

for 4-6 weeks

230
Q

if cause of endocarditis is Streptococcus bovis or Clostridium septicum, need to do what?

A

COLONOSCOPY

231
Q

what are the indications for surgery (valve replacement) in endocarditis?

A

ANATOMIC DEFECTS

  1. valve rupture
  2. abscess
  3. prosthetic valves
  4. fungal endocarditis
  5. embolic events even after abx
232
Q

when do you start HAART?

A
  1. CD4 count
233
Q

adverse effect of NRTI (nucleoside reverse transcriptase inhibitors)

A

lactic acidosis

234
Q

adverse effects of PI (protease inhibitors)

A
  1. hypERglycemia

2. hypERlipidemia

235
Q

adverse effect of NNRTI (nonnucleoside reverse transcriptase inhibitors): efavirenz

A

drowsiness

236
Q

adverse effect of zidovudine

A

anemia

237
Q

adverse effects of didanosine

A
  1. pancreatitis

2. peripheral nEUropathy

238
Q

adverse effects of stavudine

A
  1. pancreatitis

2. peripheral nEUropathy

239
Q

adverse effect of abacavir

A

rash

240
Q

adverse effects of lamivudine

A

NONE

241
Q

adverse effect of tenofovir

A

renal toxicity

242
Q

adverse effect of indinavir

A

kidney stones

243
Q

postexposure prophylaxis:

  • needle-stick injury
  • unprotected sex
A

HAART for ONE MONTH

tenofovir, emtricitabine, AND integrase inhibitor, or protease inhibitor

244
Q

blocks CCR5 receptor of CD4 cell

A

maraviroc

245
Q

which protease inhibitor inhibits the hepatic p450 system increasing blood levels of other PI’s?

A

ritonavir

246
Q

when do you start HIV meds in HIV+ pregnant women?

A

right away in first trimester

regardless of CD4 count/viral load

247
Q

HIV+ with CD4 count

A

Pneumocystis jiroveci pneumonia (PCP)

248
Q

best ppx for Pneumocystis jiroveci pneumonia (PCP)

A

TMP/SMX

249
Q

ppx for Pneumocystis jiroveci pneumonia (PCP) if TMP/SMX causes RASH

A
  • atovaquone

- dapsone

250
Q

CANNOT be used for PCP ppx if G6PD deficiency

A

dapsone

251
Q

HIV+ with CD4 count

A

Mycobacterium avium-intracellulare (MAI)

252
Q

ppx for Mycobacterium avium-intracellulare (MAI)

A

azithromycin Qweekly

253
Q

PCP presentation

A
  1. SOB
  2. dry cough
  3. hypoxia
  4. elevated LDH
254
Q

best INITIAL test for PCP

A

CXR

increased interstitial markings B/L

255
Q

MOST ACCURATE test for PCP

A

BAL

256
Q

treatment for PCP

A

TMP/SMX IV

257
Q

treatment for PCP if TMP/SMX causes RASH

A

pentamidine IV

258
Q

when do you give steroids in PCP?

A

pO2 35

259
Q

headache, N/V, FND in immunocompromised patient

A

toxoplasmosis

260
Q

best INITIAL test for toxoplasmosis

A

CT head WITH contrast

“ring” enhancing lesions

261
Q

treatment for toxoplasmosis

A

pyrimethamine and sulfadiazine for 2 WEEKS

262
Q

HIV with

A

cytomegalovirus (CMV) retinitis

263
Q

treatment for CMV retinitis

A
  • ganciclovir

- foscarnet

264
Q

adverse effect of ganciclovir

A

low WBC’s

265
Q

adverse effect of foscarnet

A

high creatinine

266
Q

maintenance therapy for CMV retinitis

A

valganciclovir PO LIFELONG, unless CD4 count increases

267
Q

best INITIAL test for cryptococcal meningitis

A

INDIA INK STAIN on CSF

268
Q

MOST ACCURATE test for cryptococcal meningitis

A

cryptococcal antigen test

269
Q

treatment for cryptococcal meningitis

A
  • amphotericin and 5-FC (flucytosine)

- then LIFELONG fluconazole, unless CD4 count increases

270
Q
  • HIV and
A

progressive multifocal leukoencephalopathy (PML)

271
Q

best INITIAL test for PML

A

head CT or MRI

272
Q

MOST ACCURATE test for PML

A

PCR of CSF for JC virus

273
Q

treatment for PML

A
  • no specific treatment
  • HAART

(will resolve when CD4 counts increases)

274
Q

does NOT cover crytpococcus

A

caspofungin

275
Q
  • HIV with
A

Mycobacterium avium intracellulare (MAI)

276
Q

diagnostic tests in order from least to most sensitive

A

LEAST sensitive= blood cultures
more sensitive= bone marrow biopsy
MOST sensitive= LIVER BIOPSY

277
Q

treatment for Mycobacterium avium intracellulare (MAI)

A

clarithromycin AND ethambutol +/- rifabutin

278
Q

animal exposure + jaundice + renal =

fever, abdominal pain, muscle aches

A

leptospirosis

279
Q

treatment for leptospirosis

A
  • ceftriaxone

- penicillin

280
Q
  • rabbits
  • ulcer at site of contact
  • enlarged lymph nodes
  • conjunctivitis
A

tularemia

281
Q

diagnose tularemia with

A

serology

282
Q

treatment for tularemia

A
  • gentamicin

- streptomycin

283
Q
  • thin-walled cysts, often calcified on CTH

- infected pork that’s ingested

A

cysticercosis

284
Q

treatment for cysticercosis

A

albendazole

285
Q

camping/hiking + target-shaped rash =

  • transmitted by Ixodes tick
A

Lyme disease

286
Q

long-term manifestations/complications of Lyme disease

A
  1. joints = LATE manifestation
  2. cardiac = AV conduction block/defect
  3. neurologic = 7th CN palsy (Bell’s palsy)
287
Q

diagnosis of Lyme disease

A

serology

288
Q

treatment for Lyme disease: rash, joint, Bell’s palsy

A
  • doxycycline PO
  • amoxicillin PO
  • cefuroxime PO
289
Q

treatment for Lyme disease: CNS, cardiac involvement

A

ceftriaxone IV

290
Q
  • also transmitted by Ixodes tick
  • common in northeast
  • HEMOLYTIC ANEMIA
A

babesiosis

291
Q

diagnosis of babesiosis

A
  • PBS

- PCR

292
Q

treatment for babesiosis

A
  • azithromycin

- atovaquone

293
Q
  • also transmitted by Ixodes tick
  • NO RASH
  • elevated LFT’s
  • THROMBOCYTOPENIA
  • LEUKOPENIA
A

ehrlichia/anaplasma

294
Q

diagnosis of ehrlichia/anaplasma

A
  • PBS

- PCR

295
Q

treatment for ehrlichia/anaplasma

A

doxycycline

296
Q
  • traveler returning from endemic area
  • HEMOLYSIS
  • GI COMPLAINTS
A

malaria

297
Q

diagnosis of malaria

A

blood smear

298
Q

treatment for malaria: ACUTE disease

A
  • mefloquine
  • atovaquone/proguanil
  • quinine/doxycycline (severe cases)
299
Q

prophylaxis for malaria:

A
  • mefloquine (weekly)

- atovaquone/proguanil (daily)

300
Q
  • immunocompromised patients
  • respiratory disease, can spread anywhere, usually skin or brain
  • branching, gram positive filaments, weakly acid-fast
A

Nocardia

301
Q

best INITIAL test for Nocardia

A

CXR

302
Q

MOST ACCURATE test for Nocardia

A

culture

303
Q

treatment for Nocardia

A

TMP/SMX

304
Q
  • normal immune system
  • h/o facial/dental trauma
  • branching, gram positive filaments
A

Actinomyces

305
Q

diagnosis and confirmation of Actinomyces

A
  1. gram stain

2. ANaerobic culture

306
Q

treatment for Actinomyces

A

penicillin

307
Q
  • WET areas (river valleys)
  • a/w bat droppings from caves
  • palate and oral ulcers
  • splenomegaly
  • pancytopenia if there’s bone dissemination
A

Histoplasmosis

308
Q

best INITIAL test for Histoplasma

A

Histoplasma urine antigen

309
Q

MOST ACCURATE test for Histoplasma

A

BIOPSY with culture

310
Q

treatment for acute pulmonary disease d/t Histoplasma

A

none needed

311
Q

treatment for disseminated Histoplasmosis

A

amphotericin

312
Q
  • VERY DRY areas (Arizona)
  • joint pain
  • erythema nodosum
A

Coccidioidomycosis

313
Q

treatment for Coccidioidomycosis

A

itraconazole

314
Q
  • acute respiratory disease
  • rural southeast
  • BROAD BUDDING YEAST
  • bone lesions are common
A

Blastomycosis

315
Q

treatment for Blastomycosis

A
  • amphotericin

- itraconazole

316
Q

MOA of echinocandins

A

1,3-glucan inhibition in fungi ONLY

317
Q

treatment for chronic hepatitis C

A
  • boceprevir
  • simeprevir
  • sofosbuvir
  • ledipasvir

(none used as a single agent)

318
Q

which antiviral agents for chronic hepatitis C not to be combined with interferon?

A
  • sofosbuvir

- ledipasvir

319
Q

How long does it take for lyme disease to develop after being bit by a tick?

A

Lyme diease is transfered by ixodes tick after 36-38 hours. And wheele formation after engorged tick is a sign of infection. However, small bite with out engorged tick is not likely to result in lyme disease. So no intervention is needed

319
Q

Should pregnant woman recieve a live vaccine?

A

No, but household members can

320
Q

Do you have to notify a school of a childs HIV status?

A

No

321
Q 
Tuberculosis skin 
Interferon gamma releases
Smear microscopy
Sputum culture
Nucleic acid amplificatin
A 
Tuberculosis skin 
Interferon gamma released
Smear microscopy
Sputum culture
Nucleic acid amplificación
322
Q

Sputum AFB is?

A

Cheap afb testing is specific so cannot rule out disease due ro low sensitivity and poor differentiation so can’t tell the difference between active and latent tb. If skin test is posiitve then do gold standard mycobacterium culture and naa testing( which is also very sensitive)

323
Q

What does macular papular rash look like?

A

Check website and upload online

1 USMLE Step 3 Main one (37 decks)

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