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1
Q

What is the treatment for candidiasis?

A

Candidal esophagitis requires systemic therapy (as opposed to thrush which can be treated with topical swish and spit antifungal preparations).

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2
Q

What is the treatment for malignant otitis externa?

A

Malignant otitis externa as evidenced by the discharge, granulation tissue within the ear canal, fever, and pain on pulling the tragus.

Associated with an immunocompromised state, such as diabetes.

Otitis externa is often pseudomonal–> oral ciprofloxacin.

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3
Q

What is the treatment for herpes virus?

A

Acyclovir

If resistant to that then.. foscarnet

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4
Q

What is a positive PPD test for immunocompromised patient?

A

cutoff for patients with HIV/AIDS, transplant patients, chronic steroid use, and close contacts to patients with TB is >/= 5 mm. The next step after a positive PPD is the chest X-ray.

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5
Q

What should you do with pyelonephritis that does not improve with antibiotics?

A

If a patient with pyelonephritis does not show any signs of improvement at 48 hours (such as decrease in leukocytosis or resolution of fevers), imaging should be undertakne to evaluate for the presence of an abscess.

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6
Q

What is the treatment for mild community acquired pneumonia?

A

Mild community-acquired pneumonia can be treated with oral antibiotics - macrolide (clarithromycin, azithromycin), beta-lactam with inhibitor, or a fluroquinolone (levofloxaci)

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7
Q

What is the best test for diagnosing endocarditis?

A

Best test is transesophageal echocardiogram (TEE)

but do Transthoracic echocardiogram (TTE) if you have low pretest probability and want to rule out endocarditis.

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8
Q

How does (Haemophilus ducreyi) present?

A

A single painful ulcer with inguinal lymphadenopathy is chancroid

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9
Q

What is the treatment for pneumocystitis jiroveci pneumonia?

A

TMP/SMX. If there is profound hypoxia, steroids should also be given.

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10
Q

indications for endocarditis prophylaxis

A

surgery (mouth and throat) and a bad valve (prosthetic, congenital heart, or history of endocarditis).

Amoxicillin is the antibiotic you’d like to use

Allergic to penicillins, you can use cephalexin

If anaphylactic reaction (no penicillins or cephalosporins)
then use clindamycin and macrolides

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11
Q

How is osteomyelitis treated?

A

XRay–> MRI–> bone biopsy

Treating osteomyelitis without a biopsy is the right answer only when they are toxic.

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12
Q

What is the empiric therapy for bacterial meningitis?

A

Empiric therapy for bacterial meningitis includes ceftriaxone, vancomycin, and dexamethasone. Ampicillin should be added if immunocompromised.

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13
Q

Ring-enhancing brain lesions with a positive HIV should prompt suspicion for

A

toxoplasmosis- treat with Sulfadiazine, pyrimethamine, and folinic acid

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14
Q

Male UTIs treatment

A

Male UTIs are complicated UTIs by definition. They require 7 days of antimicrobial therapy.

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15
Q

Most commmon bug causing pneumonia in a COPD patient?

A

Pneumonia in a patient with COPD and smoking history should prompt suspicion for Haemophilus influenzae.

K.pneumoniae is associated with alcoholics and currant-jelly sputum.

S.aureus is associated with pneumonias following viral illnesses.

The most common organism is Streptococcus pneumoniae (regardless of risk factors).

M.catarrhalis is a common organism for sinusitis and pulmonary infections.

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16
Q

PCP prophylaxis?

A

CD4 Count <200 needs PCP prophylaxis TMP/SMX > dapsone > atovaquone.

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17
Q

What is the treatment for bronchitis?

A

Low fever, sputum production, and cough but no findings on chest xray–> bronchitis

Tx w/ tetracycline (doxy) or macrolide (azithromycin)

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18
Q

What is the outpatient management for pyelonephritis?

A

if not bad pyelo the no need to admit

treat w/ fluoroquinolone (ciprofloxacin)

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19
Q

How do you treat asymptomatic UTI in pregnant woman?

A

oral amoxicillin

Recheck culture in 2 weeks to confirm eradication

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20
Q

What is acute prostatitis?

A

Sounds like a UTI but w/ tender prostate/

Treat w/ TMP/SMX or fluoroquinolone

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21
Q

How to treat severe pyelonephritis?

A

Get cultures first AND THEN start pt on IV ceftriaxone

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22
Q

What antibiotics should be used for ascending cholangitis?

A

Intra abdominal infections require gram negative and anaerobic coverage.

Examples:
Ciprofloxacin for gram (-) coverage
Metronidazole for anaerobic coverage

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23
Q

What is the treatment for syphilis?

A

Treatment of choice is penicillin

if minor allergy or pregnant–> desensitize to pen and then give it

If anaphylaxis to pen–> Doxycycline (unless pregnant)

  • can’t give doxy to pregnant *
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24
Q

How do you know when antibiotic is not effective (ie bacteria is resistant to it)?

A

If mean inhibitor concentration MIC >2

ex: if MIC for vanco is 2.5 then switch it to daptomycin to tx endocarditis

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25
What is the treatment for endocarditis?
Acute endocarditis w/ staph--> empriric Vancomycin only Vancomycin+ gentamycin+ Cefepime for new valve <60 days old Vancomycin+gentamycin+ceftriaxone for old valve > 365 days old Subacute endocarditis- No empiric antibiotics until (+) culture and then start specific antibiotic
26
meningitis empiric antibiotics
Neonates < 1month of age: ampicillin and cefotaxime Children to Adults < 50 years of age: ceftriaxone and vancomycin Adults >50 years of age: ceftriaxone, vancomycin, and ampicillin
27
Drug of choice for endocarditis prophylaxis for dental procedures
Amoxicillin
28
Treatment for Hepatitis C
Direct-acting antivirals (DAAs) Patient should be tested for NS5A resistance-associated substitutions
29
Organophosphate toxicity treatment
Organophosphate toxicity leads to the inhibition of acetylcholinesterase and overstimulation of the parasympathetic nervous system. The treatment for organophosphate toxicity is the combination of atropine and pralidoxime.
30
AIDS patients CD4 and CD8 counts
Normally, there are more CD4 cells than CD8 cells In AIDS the CD4:CD8 ratio is typically less than 1 since CD4 T cells are targeted by the virus
31
Diagnosis of bacterial vaginosis?
Amsel Criteria for Diagnosis of BV (at least three criteria must be present) 1) Thin, grayish discharge smoothly coats vaginal walls 2) Vaginal pH >4.5 3) Positive whiff (amine) test 4) Clue cells on wet mount
32
Antidotes to Heavy Metal Toxicities: Copper
Penicillamine, trientine
33
Antidotes to Heavy Metal Toxicities: Iron
Deferoxamine, deferasirox, deferiprone
34
Antidotes to Heavy Metal Toxicities: Lead, Mercury, Arsenic
Dimercaprol, succimer
35
Treatment for amyotrophic lateral sclerosis (ALS)
Neurodegenerative disease characterized by lower and upper motor neuron signs (wrist drop, diff swallowing, muscle atrophy, clonus, hyperreflexia) Treated with riluzole (decreases presynaptic glutamate release)
36
Pheochromocytoma
``` Catecholamine secreting tumor that arises from the chromaffin cells of the adrenal medulla Classic triad: 1) Tachycardia 2) Headaches 3) Diaphoresis ``` Dx: serum or urine metanephrines.
37
Pheochromocytoma has classically been associated with:
Von Hippel-Lindau syndrome, multiple endocrine neoplasia types 2A and 2B, and neurofibromatosis type 1
38
Wernicke encephalopathy
Chronic alcohol abuse, nystagmus, and confusion. WE is caused by thiamine (vitamin B1) deficiency, Wet & Dry beriberi Wet beriberi- dilated high-output cardiomyopathy and heart failure Dry beriberi- distal peripheral polyneuropathy
39
milk-alkali syndrome
Hypercalcemia due to repeated ingestion of calcium and absorbable alkali such as calcium carbonate, or excess milk consumption "bones, stones, groans, and psychiatric overtones" QT-interval shortening and J-wave or Osborn wave on ECG
40
Patient with multiple aneurysms in the mesenteric and renal arteries
They have Polyarteritis nodosa (PAN) PAN can be acquired as a complication of hepatitis B (HBV)
41
Most autoimmune disorders are characterized by what type of hypersensitivity?
Type II hypersensitivity reactions occur when preformed antibodies bind to antigens in the body.
42
Type III hypersensitivity
Type III hypersensitivity involves aggregates of antibody-antigen complexes that initiate an inflammatory response. An example is systemic lupus erythematosus.
43
Type IV hypersensitivity
Type IV hypersensitivity is characterized by cell mediated immunity. It results in a delayed hypersensitivity reaction. An example is contact dermatitis or PPD test.
44
Serologic panel for HBV Susceptible
Negative hepatitis B surface antigen (HBsAg) anti-HBc anti-HBs
45
Serologic panel for HBV Immune (infected then recovered):
HBsAg (–) anti-Hbc (+) anti-HBs (+)
46
Serologic panel for HBV Immune (Vaccined):
HBsAg (–) anti-Hbc (–) anti-HBs (+)
47
Serologic panel for HBV Acute infection:
HBsAg (+) anti-HBc (+) IgM anti-HBc (+) anti-HBs (–)
48
Serologic panel for HBV Chronic infection:
HBsAg (+) anti-Hbc (+) IgM anti-HBc (–) anti-HBs (–)
49
Treatment for Pseudomonas aeruginosa infections
aerobic gram-negative rod that is non-lactose fermenting and oxidase positive Aminoglycoside plus extended spectrum penicillin
50
Aspiration pneumonia
Usually due to anaerobes Peptostreptococcus, Fusobacterium nucleatum, Prevotella spp., Bacteroides melaninogenicus, and other Bacteroides species.
51
Salmonella enterica typhimurium
Lactose-negative, hydrogen sulfide-producing gram-negative bacteria Transmitted through contaminated food Fever, diarrhea that can contain red blood cells and abdominal cramps 12-72 hours after infection
52
Pediculus humanus capitis.
Head lice
53
Pityrosporum ovale
Malassezia
54
Sarcoptes
Sarcoptes scabiei- scabies that dig into stratum corneum layer to lay eggs
55
Trichinella spiralis
nematode parasite transmitted through undercooked meat (especially pork) Causes trichinosis- fever, vomiting, nausea, periorbital edema, and muscle aches
56
Trichosporon asahii
"white piedra" nodules along hair shaft gritty nodules that are easily removed
57
Common laboratory findings in acute osteomyelitis
Leukocytosis, elevated C-reactive protein, and elevated erythrocyte sedimentation rate Blood cultures are only positive in approximately 50% of infections.
58
Name of infection caused by Corynebacterium minutissimum?
Erythrasma -which is minimally scaling hyperpigmented thin plaque in skin folds. Coral-red fluorescence under Wood's lamp Tx: Topical anti-bacterial agents
59
Treatment for Gas gangrene secondary to C perfringens
IV clindamycin
60
Prophylactic treatment for close contacts of pt diagnosed with Neisseria meningitidis
Rifampin (don't use in pregnancy) Ceftriaxone- Safe during pregnancy Ciprofloxacin
61
Pneumococcal 23 vaccination recommendations
≥ 65 years Younger with high risk (COPD, asthma, diabetes, active smoker)
62
Purified Protein Derivative (PPD) Testing < 5 mm
HIV infected patients with close contact with an individual with active, contagious disease
63
Purified Protein Derivative (PPD) Testing ≥ 5 mm
* HIV infection. * Abnormal chest x-ray with findings consistent with pervious TB infection. * Immunosuppressed patients (prolonged steroid use, chemotherapy, organ transplant, TNF-alpha blocker use) * Close contact with an individual with active, contagious disease
64
Purified Protein Derivative (PPD) Testing ≥ 10 mm
* Children < 4 years old * Foreign born in a country with TB incidence > 25/100,000 * Residents and employees of high risk environments including healthcare facilities, long term care facilities, jails, and prisons * Individuals with clinical conditions that increase risk including IV drug abuse, dialysis, diabetes, underweight, and certain malignancies
65
Purified Protein Derivative (PPD) Testing ≥ 15 mm
Healthy individuals, ≥ 4 years, without risk factors and low likelihood of active TB
66
If positive PPD but negative chest xray
Latent TB treat with isoniazid for 9 months
67
Antibiotic prophylaxis for travelers' diarrhea
only recommended for patients who are at high risk of health-related complications (use rifaximim) Otherwise use no antibiotic just bismuth subsalicylate is recommended
68
Method for detecting semen from vagina
Alkaline phosphatase assay detects the presence of semen in vaginal samples up to 72 hours following a sexual assault. Wood's ultraviolet light lamp is a sensitive but nonspecific method for detecting semen.
69
First line blood pressure medications for African Americans in the absence of proteinuria
Calcium channel blocker or thiazide diuretic
70
Retinopathy specific to Diabetics
Neovascularization
71
Retinopathy specific to HTN
Arteriovenous nicking
72
can occur in both diabetic and hypertensive retinopathy
Cotton wool spots, retinal hemorrhage, and microaneurysm
73
Post-exposure rabies vaccination
Exposure involving small rodents (squirrels, hamsters, guinea pigs, rats, mice, gerbils, chipmunks, and rabbits) does not require treatment

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