Flashcards in hammer22 Deck (50):
What is the treatment for Giardia?
What is the test and treatment for Cryptosporidosis?
Modified acid fast stain. Nitazoxanide
What is the treatmtent for severe infectious diarrhea
Fluid replacement and ciprofloxacin
Which hepatitis types are transmitted via sex, blood and from mother? From food and water?
How do you monitor Hepatitis C disease activity? Which test tells you who is going to respond?
PCR RNA level, it is also the first thing to change. Genotype test
Which antigen is raised in acute or chronic hepatitis B infection? Which antibody is not present in vaccinated patients? Which antibodies do not coexist? When is e antigen elevated?
Surface antigen and e antigen. Core antibody which only tells if IgM or IgG and doesnt distinguish between acute or resolved infection. Surface antigen and surface antibody. When surface antibody is elevated
When is core antibody present? Which is the direct correlate of the amount of active viral replication and the need to treat in chronic disease and best indicator pregnant woman transmits to her child?
In the window period. E-antigen.
What is the definition of chronic hepatitis B ?When is it treated? WIth which drug?
Surface antigen > 6 months. When both surface and e-antigen is elevated. Use only one of the following (Entecavir, Adefovir, Tenofovir, Lamivudine, Telbivudine, Interferon)
What are the adverse effects of interferon?
Arthralgia/myalgia, leukopenia and thrombocytopenia, depression and flu-like symptoms
What is the tretment for genotype 1 of chronic Hep C?
Ledipasvir and sofosbuvir orally for 12 weeks. Others genotypes get sofosbuvir and ribavurin
What is the best initial test for urethritis? What is the most accurate test?
Urethral swab for grain stain and WBC. Nucleic acid amplification test for both gonorrhea and chlamidya or DNA probe
What drugs can you use for chlamidya and gonnorrhea?
Chlamydia - Azithromycin and doxycycline
Gonorrhea - Cefixime and Ceftriaxone
What is the most accurate test for PID? When is it used?
Laparoscopy. When unclear diagnosis, symptoms persist ,recurrent episodes for unclear reasons
What is the INpatient treatment for PID? OUTpatient? What if there is anaphylaxis to penicillin?
Cefoxitin or cefotetan (anerobe coverage) plus doxycycline. Ceftriaxone and doxycycline. CLindamicin adn gentamicin for inpatient. Levofloxacin and metronidazole for outpatient,
What is the most accurate test for primary syphilis? Chancroid? Lymphogranuloma venerreum? Herpes simplex?
Dark field microscopy and if positive no further testing necessary). Stain and culture for chancroid. Complement fixation titers for LGV, NAAT. Viral cultures
What is the treatment for chancroid? Lymphogranuloma venereum? SYphilis if penicillin allergic??
Azithromycin. Doxycycline. Doxycycline.
What is the presentation of secondary syphilis?
Rash (palms and soles), alopecia areata, mucous patches, condyloma Lata
What is the presentation of tertiary syphilis?
Neurosyphilis (vasculitic stroke, tabes dorsalis , general paresis (memory and personality changes, argyll robertson pupil), aortitis ,gummas (skin and bone lesion)
WHen is VDRL or RPR most sensitive in Syphilis?. WHen are VDRL or RPR titers reliable?
For secondary or tertiary syphilis. When > 1.8
What is the treatment for Jarisch-Herxheimer reaction? When do you use penicillin desensitization?
Aspirin and antipyretics. Neurosyphilis and pregnant women
What is the treatment for pediculosis (crabs) and scabies? widespread (crusted) scabies? What is the diagnosis and treatment for warts?
Permethrin or lindane. Oral Ivermectin. Visual diagnosis, physically remove or podophylin or imoquid
What leads to and is the best initial therapy for UTI? Can betalactams be used in pregnancy?
Anatomic defects (stones, strictures, tumor, diabetes) extend ABX to 7 days. Quinolones. TMP/SMX is low resistance for 3 days. Yes.
What is the presentation of pyelonephritis? Treatment?
Dysuria with (Flank pain, high fever, occasional abdominal pain, UA with high WBC, imaging studies). Ampicillin and gentamicin (both excreted through urine), ciprofloxacin or any gram negative bacilli.
What is the treatment for chronic prostatitis?
TMP/SMZ or ciprofloxacin for 6 to 8 weeks
What is the best initial test for endocarditis?
Blood culture and not echo. IF positive do TTE, if not revealing do TEE.
What is the presentation and complications of endocarditis? What is the most common cause of death from endocarditis?
Fever + murmur. Janeway lesions and splinter hemorrhages (most common embolic phenomena). Kidney failure (hematuria and glomerulonephritis)
What is the management of endocarditis? Which ABX should you treat with initially?
Take blood culture and while waiting for results treat with vancomycin and gentamicin
What is the treatment for Viridians streptococci (mutans, miuri, sanguini)endocarditis? staph aureus sensitive? Staph epidermidis or resistant staph? Enterococci?
Ceftraixone for 4 weeks. Oxacillin, nafcillin or cefazolin.
Ampicillin and gentamicin (add aminoglycoside if treatment resistant)
When is surgery for endocarditis?
CHF, ruptured valve, fungal endocarditis, abscess, AV block, recurrent emboli while on antibiotics.
What drug should be added to prosthethic valve endocarditis? Most common culture negative endocarditis?
Rifampin. Coxiella (have to use complement fixation or PCR)
When is prophylaxis indicated for endocarditis?
If there is risk of both bacteremia (dental work with blood and surgery of respiratory tract) and significant cardiac defect (prosthetic valve, previous endocarditis, cardiac transplant, unrepaired cyanotic heart disease).
Which med for endocarditis prophylaxis?
Amoxicillin (or if penicillin allergic use clindamycin, azithromycin or clarithromycin)
What is the Lyme disease manifestation is not treated? What is the most common cardiac manifestation of Lyme disease?
Joint pain in 60% .Knee most commonly affected joint. Transient AV block
When is serologic test for Lyme disease?
With Joint, neurologic and cardiac manifestation,
For lyme disease what do you treat for rash and joint, , 7th CN palsy? What do you treat for cardiac and neurologic manifestations?
Doxycylcine and amoxicillin. IV ceftriaxone
At what CD4 count does PCP occur? What is the most common infection with CD4 > 200? Best initial test for HIV in adults? in infants?
<200. Bacterial PNA. ELISA test confirmed with western blot. PCR or viral culture?
What is the best initial drug regimen for HIV?
3 drugs from 2 different classes. Emtricitabine, Tenofovir, Efavirenz (teratogenic so switch to protease inhibitor if pregnant)
When do you perform C section in HIV positive mothers?
If viral load is >1000. But everyone gets intrapartum zidovudine.
What are the most commonly affected sites in hypertensive bleeding in the brain? IN cerebral amyloid angiopathy?
Basal ganglia, cerebellum and pons. Lobar hemorrhage with superficial and cortical involvement
What is treatment for Wernicke encephalopathy?
IV thiamine and Mg followed by glucose infusion
What is the next step after PAP smear shows LGSIL or HGSIL? When it shows ASCUS?
Colposcopy with endocervical curettage. HPV DNA testing
What should you suspect when patient presents with pain and swelling over tibial tubercule?
Osteochondritis (Osgood Schlatter) associated with active sports.
What should you suspect in a child that has fever, malaise, sore throat, headache and on imaging bronchial thickening and infiltration in the lower lobes? How do you treat?
Mycoplasma PNA. Macrolide.
What is the biopsy findings for primary biliary cirrhosis and unique findings of PBC? What lab values are elevated? What are the biopisy findings in PSC?
Periductal mononuclear inflammatory infiltrate with bile duct destruction. Xanthelasma and osteoporosis. Elevated alk phos with normal bili. In PSC both are elevated. Onion skinning (beading, narrowing or strictures) in biliary system
What are the features of lung masses that require resection?
Suspicious for malignancy (spiculated, > 1 cm, smoking, weight loss, older patient)
When is gestational diabetes tested? How is it tested?
24 - 28 weeks. Glucose load test with 50 grams and measure 1 hour later. If > 140 do a fasting test of 100 mg and measure after 1,2,3 hours after ingestion.
What is the test and findings of pericarditis?
Electrocardiogram showing diffuse ST elevation, PR depression and occasional flipped T waves
What is the presentation of chronic subdural hematoma in the elderly?
Confusion and senility
What is the mainstay treatment of osteoarthritis?
Exercise training and weight loss