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1
Q

Most common cause of acute sinusitis?

A

viruses - also S. pneumo, H. flu, Moraxella

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2
Q

What 3 causes should you consider in someone with chronic sinusitis?

A

obstruction, ongoing low grade anaerobic infection, Mucor

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3
Q

What are the Centor Criteria for Strep pharyngitis?

A

Fever, tonsillar exudates, absence of cough, tender anterior cervical LAD - 3/4 = inc sensitivity of strep antigen test

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4
Q

What 3 features are suggestive of acute bacterial sinusitis (vs. viral)?

A

high fever, leukocytosis, purulent nasal discharge

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5
Q

Treatment for acute bacterial sinusitis?

A

amox/clav 500 mg PO TID x 10 d

OR clarith, azithro, TMP-SMX, fluoroquinolone or 2nd gen cephalo x 10 d (3-6 w for chronic)

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6
Q

Treatment for outpt CAP

A

macrolide or doxycycline (cover Mycoplasma)

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7
Q

Treatment for CAP w/ comorbidities/ > 65 yo?

A

fluoroquinolones or B-lactam + macrolide (add aerobic GNRs, S. aureus, Legionella, Chlamydia

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8
Q

Treatment for CAP requiring hospitalization?

A

fluoroquinolone or antipneumococcal B-lactam + macrolide (add anaerobes)

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9
Q

Treatment for CAP requiring ICU care?

A

antipneumococcal B-lactam + either azithromycin or fluoroquinolone (add pseudomonas)

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10
Q

Treatment for HAP?

A

extended spectrum cephalosporin OR antipseudomonal carbapenem; add aminoglycoside or fluoro to cover resistant orgs (pseudomonas) until sensitivities are known (cover GNR inc acinetobacter, S. aureus, Legionella, mixed flora)

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11
Q

Treatment of critically ill/worsening pneumonia cases?

A

add vanc or linezolid (MRSA); broader gram NEG coverage

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12
Q

What 4 epidemiological groups are at inc risk for disseminated cocci?

A

Pregnant, HIV +, Filipinos, AA’s

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13
Q

What is a common CBC finding in influenza?

A

leukopenia

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14
Q

Brudzinksi vs. Kernig signs?

A

Brud - hips/knees flex when neck is flexed

Kernig - inability to straighten knee with hip at 90 degrees (hamstring stiffness)

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15
Q

Two most common causes of encephalitis?

A

HSV and arboviruses

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16
Q

Common presentation of meningitis?

A

fever, HA, neck stiffness, photophobia, NV

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17
Q

Common presentation of encephalitis?

A

alt consciousness, HA, fever, seizures

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18
Q

What CSF finding is highly suggestive of HSV encephalitis in the absence of trauma?

A

RBC’s in CSF

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19
Q

Barrage of tests/stains to order on CSF in suspected encephalitis cases?

A

STAINS: gram, acid-fast, India ink for crypto, wet prep for free-living amebae, Giemsa (trypanosomes)

PCR: HSV, CMV, EBV, VZV, enterovirus

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20
Q

Tx for bacterial meningitis in pt’s 1-3 mos and 3 mos to adulthood?

A

IV vanc + ceftriaxon/cefotaxime

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21
Q

What antibiotic should be added to vanc and ceftriaxone/cefotaxime in meningitis pt’s 60 y?

A

ampicillin for listeria

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22
Q

Management of HIV+ mom and baby when not on anti-RV’s?

A

zioduvudine intra-partum; infants should receive zido (AZT) for 6 weeks after birth

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23
Q

What is the only live vaccine that should be given to HIV pt’s?

A

MMR

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24
Q

Clinical features of disseminated histo?

A

fever, malaise, weight loss, pancytopenia, HSM, palatal ulcers

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25
Dx disseminated histo?
urine/serum polysach antigen test - most sensitive
26
Presentation of P. jirovecii pneumonia?
DOE, nonproductive cough, impaired ox, present for weeks
27
Dx of P. jirovecii pneumonia?
silver stain and immunofluorescence + ABG for PaO2 + ground glass
28
Tx of P. jirovecii pneumonia?
high dose TMP-SMX for 21 d
29
Tx of MAC in AIDS pts?
clarithromycin (ethambutol and rifabutin are second line) (azithro for prophy)
30
Tx of toxoplasmosis in AIDS pt's?
high dose PO pyrimethamine + sulfadiazine and leucovorin (folic acid analog) for 4-8 w
31
GI complication of lymphogranuloma venereum?
proctocolitis (LGV serovar of chlamydia)
32
Tx options fo chlamydia?
doxy x 7 d; or azithro once
33
Tx of gonorrhea?
ceftrixone/cefixime
34
How many cases of 'late latent' secondary syphilis progress to tertiary?
1/3 (period of asymptomatic infxn beyond first year; tert appears 1-20 y after initial infection)
35
Two classic neuro findings of tertiary syphilis?
Tabes dorsalis (post column degen), Argyll Robertson pupil (constricts with accommodation but NOT reactive to light)
36
'VDRL' false positives?
Viruses (EBV, HSV, HIV, hep) Drugs/IV use Rheum fever/arth Leprosy/SLE
37
Treatment of primary/secondary syphilis?
benzathine penicillin IM x 1 (tetra or doxy x 14 d if allergic; preggers pt's must be desen)
38
Treatment of latent syphilis? Tertiary?
- B-penicillin: 1x for early latent; weekly dose x 3 for late latent/unknown - Penicillin IV x 14 d is the ONLY TREATMENT (must desen everyone)
39
What is the acute flulike illness that can occur with tx of syphilis?
Jarisch-Herxheimer reaction
40
Agent of chancroid? Presentation? Tx?
H. ducreyi; PAINFUL deep, necrotic genital lesions (1-3) + inguinal LAD = clinical dx; azithro or ceftriaxone
41
Common UTI agents? (SEEKS PP)
Serratia, E. coli, enterobacter, Klebsiella pneumoniae, Staph sapro, pseudomonas, proteus mirabilis (alk urine)
42
Treatment of complicated vs. uncomplicated UTI's?
UN - TMP-SMX x 3 d, fluoroquinolone x 3 d, nitrofurantoin x 5 d (complicated = 7-14 d)
43
Examples of complicated UTI patients?
men (congenital abnormality), urinary obs, renal translant, cath, instrumentation
44
What pt population should be treated for asymptomatic bacteriuria?
preggers - 20-30% will develop pyelo
45
Treatment of pyelonephritis?
FLUOROQUINOLONES + PO fluids | Inpt - IV fluoro, 3rd/4th cephalo, B lactam/B lactamase inh, carbapenem depending on severity
46
Common side effects of PIER tx of TB?
INH - hepatitis, peripheral neuropathy (give B6 to prevent neuro); Rifampin - orange body fluids; Ethambutol - optic neuritis
47
Gram + vs Gram - shock?
+ 2/2 fluid loss by exotoxins | - 2/2 vasodilation by endotoxin (LPS)
48
SIRS criteria? (you have to learn it...)
1) TEMP: 38.5 2) TACHYPNEA: > 20, PaCO2 90 4) LEUKOCYTOSIS/PENIA: 12k
49
Presentation of malaria?
periodic attacks of sequential chills, HIGH fever (> 105.8), diaphoresis occurring over 4-6 h + splenomegaly
50
Microscopic diagnosis of malaria?
Giemsa or Wright-stained thick and thin blood films
51
Anemia of malaria?
normochromic, normocytic, reticulocytosis
52
Treatment of P vivax and ovale?
You MUST add PRIMAQUINE to eradicate hypnozoites in liver
53
Treatment of falciparum?
Chloroquinolones (quinidine IV for severe cases) - BUT resistance is HIGH = mefloquine
54
Triad of infectious mono?
fever, pharyngitis, LAD (post cervical) (may also get bilateral upper EYELID EDEMA)
55
What happens when you treat mono as strep pharyngitis with ampicillin?
prolonged, pruritic maculopapular rash
56
CBC in EBV mono?
mild thrombocytopenia, lymphocytosis (B cell prolif), > 10% atypical T cells
57
Treatment of EBV?
supportive; corticosteroids for tonsillar enlargement, severe t-penia, severe AI hemolytic anemia
58
Most common COD in males with EBV mono?
fulminant hepatic necrosis
59
Definition of FUO?
> 100.9 of 3 weeks that is undx after 3 outpt visits OR 3 d hospitalization
60
Manifestations of secondary Lyme disease?
early disseminated - migratory polyarthropathies, Bell's, meningitis, myocarditis, conduction abnml (3rd degree block)
61
Manifestations of tertiary Lyme disease?
arthritis and subacute encephalitis (memory loss and mood change)
62
Pathophysiology of RMSF?
involves endo cells and causes small vessel vasculitis
63
Rash of RMSF?
initially macular beginning at wrists and ankles and SPREADS centrally becoming petechial/purpuric
64
FEVER & RASH? Think... (tiny GERMS = TGERMS)
``` Typhoid fever Gonococcemia Endocarditis RMSF Meningococcemia Sepsis ```
65
Common etiology of orbital cellulitis?
Paranasal sinusitis (strep, staph, H. flu in kids)
66
What is an EMERGENT conjunctivitis caused by?
N. gonorrhoeae conjunctivitis - corneal involvement can lead to perf and blindness; IM ceftriaxone, PO cipro or ofloxacin
67
What is the leading cause of preventable blindness worldwide? Tx?
C trachomatis A-C: recurrent epi keratitis in childhood; trichiasis, corneal scarring, entropion; azithro/tetra/erythro x 3-4 w
68
Most common cause of viral conjunctivitis?
adenovirus
69
Most common agents of otitis externa?
Pseudomonas, enterobacteriaceae
70
Causes of culture negative endocarditis?
HACEK (haemophilus parainf, actinobacillus, cardiobacterium, eikenella, kingella); coxiella burnetii, brucella, bartonella
71
Ophtho manifestation of endocarditis?
Roth's spots - retinal hemorrhages
72
Three manifestations of Bacillus anthracis?
cutaneous (eschar w/in 7-10 d), inhalational (hemorrhagic mediastinitis = WIDENED mediastinum), GI (poorly cooked contaminated meat)
73
What is Marjolin's ulcer?
long-standing chronic osteomyelitis w/ a draining sinus tract leading to SCC

Internal Medicine (4 decks)

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