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Internal Medicine - MCCQE 1 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What is malignant otitis externa?

A

It is osteomyelitis of the skull from pseudomonas in a diabetic patient.
Sxs - brain abscess and destruction of skull
Dx - CT or MRI (initially); Biopsy (most accurate)
Tx - surgical debridement and abx against pseudomonas

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2
Q

What are some of the antibiotics active against pseudomonas?

A

ciprofloxacin, piperacillin, cefepime, carbapenem, aztreonam

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3
Q

Treatment of gonorrhea?

A

Ceftriaxone IM

*Safe to use in Pregnant patients

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4
Q

Treatment for Chlamydia?

A

Azithromycin (single dose);
Doxycycline (for a week);
*Use azithromycin in pregnant patient
“Dogs chase cats”

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5
Q

Diagnostic management for PID?

A

Best initial test: Pregnancy test, cervical culture and DNA probe(NAAT) for G and C
Most accurate test: Laproscopy

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6
Q

What is the treatment for PID?

A

Outpatient: IM ceftriaxone and PO doxycycline
Inpatient: IV cefoxitin and doxycycline; may be metronidazole. Cefotetan = cefoxitin
PCN allergy: Clindamycin and gentamycin

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7
Q

Antibiotics that are safe in pregnancy?

A

Penicillins; Cephalosporins; Aztreonam; Erythromycin; Azithromycin

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8
Q

What is the treatment for HSV?

A

acyclovir, valacyclovir, famciclovir x 7-10 days

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9
Q

Best initial diagnostic test for Primary syphilis?

A

Darkfield microscopy

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10
Q

What is Jarisch-Herxheimer rxn?

A

fever, headache and myalgia developing 24 hours after tx for early stage syphilis. Tx with aspirin

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11
Q

When to desensitize pt with syphilis?

A

Neurosyphilis and Pregnancy

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12
Q

Alternative Tx for syphilitic patient with PCN allergy?

A

Doxycycline

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13
Q

Treatment for periodontitis?

A

Clindamycin or Amox-clav for anaerobic bacteria

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14
Q

What are some distinguishing features of legionella?

A

contaminated water sources; high grade fever, GI sxs(diarrhea), neurologic sxs (ataxia, confusion)
Dx: hyponatremia, lobar infiltrates on CXR, lots on PMNs no bacteria, urine legionella antigen
Tx with Azithromycin or levofloxacin

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15
Q

dirty wound Tetanus ppx?

A

If no vaccine in last 10 years or status unknown –> Vaccine and Ig

if vaccine in last 10 years but no booster within last 5 years –> Vaccine only

If vaccine in last 10 years and booster in last 5 years –> no vaccine needed today

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16
Q

clean minor wound tetanus ppx?

A

If no vaccine in last 10 years or status unknown –> Vaccine only

If vaccine in last 10 years –> no vaccine needed today

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17
Q

clues to histoplasmosis?

A

erythema nodosum, Pulmonary manifestations, hx of being in a heavily wooded area (ohio and mississippi river valley)

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18
Q

What is the most common regiment for H pylori eradication?

A

(PPI, Amoxicillin, metronidazole, clarithromycin) or

PPI, bismuth, Metronidazole, tetracycline

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19
Q

how to confirm eradication of h pylori?

A

carbon 13 urea breath test

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20
Q

diagnosis of h pylori?

A

EGD; H pylori fecal antigen test; h pylori serology test

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21
Q

what is the treatment for syphilis?

A

benzathine penicillin G

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22
Q

which test is very sensitive for acid fast bacilli on microscopic examination of sputum smears?

A

auramine-rhodamine fluorescent stain

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23
Q

what is the first choice patient-applied therapy option for the treatment of anogenital warts?

A

podophyllotoxin 0.5% solution x 3 days bid topical application; rest period x 4 days; repeated up to 4 times.

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24
Q

When should a PCP patient be give prednisone?

A

when on ABG shows Po2 <70 mmhg or A-a gradient is 35 or more

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25
Q

how to treat cat bite and what organism is most likely involved?

A

Pasteurella multocida (gram neg rod); 1st choice is Amoxicillin-clav; if allergic then use doxycylcine

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26
Q

what should be suspected in patient experiencing memory loss, altered personality and behavioural changes, with increased irritability and aggression?

A

encephalitis

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27
Q

covers anaerobics and aerobics (gram positives) and is drug of choice for lung abscess?

A

clindamycin

*metronidazole does not cover aerobics

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28
Q

med regimen to treat bacterial meningitis in adult age group?

A

ceftriaxone+vancomycin+ampicillin

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29
Q

what is the treatment for HSV type 1 encephalitis?

A

IV acyclovir

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30
Q

Features of RMSV?

A

triad of fever, headache, myalgia; rash on the palm and soles that becomes hemorrhagic

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31
Q

What ART regimen in the setting of rifampin-based TB treatment is preferred?

A

Efavirenz plus two NRTIs (emtricitabine + tenofovir)

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32
Q

What is the first line treatment for sever onychomycosis?

A

oral terbinafine

*oral itraconazole is second line and is contraindicated in pts on statins

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33
Q

MOA and adverse effects of RIPE regimen?

A

Rifampin (inhibits DNA dependent RNA synthesis; side effect is nausea);
INH (inhibits bacterial cell wall synthesis; side effect is hepatotoxocity and neuropathy); pyrazinamide (inhibits mycolic acid synthesis; side effect is urate underexcretion); ethmabutol (inhibit arabinosyl transferase; side effect is visual problems)

34
Q

which is the most common complication of EBV infectious mononucleosis?

A

hepatic complications (elevated liver enzymes)

35
Q

CSF analysis of viral meningitis?

A

clear appearance; normal opening pressure; low cell count in contrast to bacterial meningitis; protein is slightly high; glucose is normal; glucose CSF:serum ratio is elevated; Chloride is normal

36
Q

what is CSF chloride level in TB meningitis?

A

Low

37
Q

microorganism in cat bite?

A

pasteurella multocida

38
Q

microorganism in cat scratch?

A

bartonella henselae

39
Q

antimalaria agent mefloquine would be contraindicated in which patients?

A

epileptic patients since it has potential neuropsychiatric side effects

40
Q

how to prevent frequent recurrence of tinea versicolor?

A

once-monthly topical selenium sulphide or ketoconazole shampoo

41
Q

What are chemo-prophylactic options for N meningitidis?

A

Rifampin
Ciprofloxacin
Ceftriaxone

42
Q

Which vasopressors are indicated when fluid resuscitation does not restore organ perfusion and blood pressure?

A

Norepinephrine and dopamine;

Norepi is preferred!

43
Q

What is the treatment for scabies?

A

topical permethrin and lindane

44
Q

how to diagnose cryptosporidiosis?

A

acid fast stain of the stool;
cryptosporidium parvum is the most common cause of chronic diarrhea in HIV-positive patients with CD4 count less than 200 cells/mm3

45
Q

What distinguishes Legionella from other types of pneumonia?

A

Hyponatremia

46
Q

what species can cause mucormycosis?

A

rhizopus, Mucor, absidia

47
Q

PCP treatment

A

oral/IV TMP-SXS; clindamycin and Primaquine; pentamidine

Antifungals are not effective such Amphotericin B and flucytosine

48
Q

What is Brill-Zinsser disease?

A

it is a recurrent form of epidemic typhus, caused by infection with Rickettsia prowazekii. it presents abruptly with chills, fever, headache, malaise, and rash on the fourth day.

49
Q

what is the treatment for HIV-associated lipodystrophy?

A

Tesamorelin is a growth hormone-releasing factor. it is given daily subcutaneously

50
Q

What is carditis or neuropathy due to lyme disease treated with?

A

IV ceftriaxone

51
Q

what is the treatment of entamoeba histolytica?

A

metronidazole or tinidazole plus intraluminal antiobiotic (eg paromomycin)

52
Q

diseases with rashes on palms and soles?

A

syphilis, RMSF

53
Q

ehrlichiosis?

A

tick bite; febrile illness, leukopenia, thrombocytopenia, elevated LFTs; rash is common; “RMSV without spots”; Tx with doxycycline

54
Q

What is the vaccination protocol in HIV?

A

no live attenuated vaccines such as varicella, zoster, MMR if CD4 count <200.
all other inactivated vaccine are good to go.
Pneumococcal and HBV are esp recommended in HIV patients

55
Q

what is time regime for HIV post exposure PPX?

A

immediately (within 24 hrs) with 2 NRTI (tenofovir and emtricitabine) plus 1 integrase strand transfer inhibitor (eg, raltegrovir) or protease inhibitor or NNRTI x 28 days

56
Q

what are the malaria chemoprophylaxis options?

A

chloroquine; in chloroquine resistance areas like India options are Mefloquine, doxycycline, atovaquone-proguanil

57
Q

How to diagnose Legionella and its Tx?

A

Urine antigen test and sputum culture on charcoal yeast agar; Tx is fluoroquinolones and macrolides

58
Q

How to diagnose PCP?

A

Examination of induced sputum; if this fails then perform bronchoalveolar lavage

59
Q

What is one of the common adverse effects of vancomycin?

A

vancomycin flushing syndrome; it is drug induced pseudo-allergic skin reaction; non IgE mediated mast cell degranulation; sxs flushing, erythema, pruritus mainly on face, upper trunk and neck

60
Q

What is the best medicine for URTI caused by Strep pneumoniae?

A

Erythromycin; MOA is by binding with 50S ribosomal subunit and thereby inhibiting bacterial protein synthesis

61
Q

What is the next best step in lyme disease induced bell’s palsy?

A

Lyme disease serology with ELISA; once confirmed then IV ceftriaxone

62
Q

What is most effective pharmacological treatment for traveller’s diarrhea?

A

Azithromycin or a fluroquinolone

63
Q

CSF analysis of bacterial meningitis is?

A

High Opening pressure (>180 mm H2O);

WBC (0.01X10^9 - 10X10^9, predominantly PMNs); low Glucose <2.5 mmol/l; high protein >20g/l

64
Q

What is treatment for uncomplicated pyelonephritis?

A

outpatient treatment with fluoroquinolones such as ciprofloxacin

65
Q

What is the treatment for human bites?

A

amoxicillin/clavulanate;

Ticarcillin/clavulanate; ampicillin/sulbactum

66
Q

What are the high risk wild animals for rabies?

A

bats, raccoons, skunks, foxes, coyote

67
Q

what is coccidioidomycosis?

A

endemic mold of the dessert Southwest USA (Arizona, california); Sxs include CAP, arthralgia, erythema nodosum or multiforme lasting for weeks or months. Dx with serology and treatment with IV amphotercin B in those with disseminated disease. Otherwise it self resolves in healthy people

68
Q

What is histoplasmosis?

A

similar region as blastomycosis i.e midwest USA; mold in soil from bird droppings; sarcoidosis or TB like sxs so be careful not to initiate immunosuppressive therapy; dx with histoplasma urine antigen test. treatment is either self resolve or with antifungal for severe sxs

69
Q

What is blastomycosis?

A

similar region as Histoplasmosis i.e midwest USA and great lakes; mold in soil from bird droppings or WOODS; sarcoidosis or TB like sxs so be careful not to initiate immunosuppressive therapy; dx with sputum analysis showing Broad based buddying yeast. treatment is either self resolve or with antifungal for severe sxs

70
Q

Which Vector transmits chikungunya, dengue, yellow fever, and zika virus?

A

Aedes mosquitos

71
Q

Most common causes of encephalitis?

A

HSV, EBV, Varicella;
Dx with PCR;
Tx with IV acyclovir

72
Q

Most common causes of infectious esophagitis in HIV patients?

A

Candidiasis (oral thrush, tx with oral fluconazole)
HSV (endoscopy shows oval/round, volcano-like esophagial lesions; multinucleated giant cells on biopsy; tx with acyclovir/valacyclovir)
CMV (endoscopy shows linear ulcers; intracytoplasmic inclusions on biopsy; tx with IV ganciclovir)

73
Q

Diagnosis and treatment of pertussis?

A

Pertussis PCR and treatment with Macrolides

74
Q

Renal calculi with struvite stones (Magnesium ammonium phosphate); UTI sxs; pH >8;

A

Proteus mirabilis; urease producing bacteria; urease generates ammonium resulting in urine alkalinization which decreases the solubility of phosphate and increases the risk of renal calculi

75
Q

filamentous, aerobic, gram positive, partially acid fast bacteria?

A

Nocardia causes pulmonary or disseminated disease in immunocompromised hosts; treat it with TMP-SMX

76
Q

Clinically suspected diagnosis meningococcal meningitis?

A

If clinical suspicion is high, empiric vancomycin and ceftriaxone should be administered as soon as possible; lumbar puncture should not delay the treatment. However, obtain blood cultures before giving antibiotics.
Head CT to r/o intracranial lesions and IV ceftriaxone while waiting for LP, blood cultures

77
Q

Partially acid fast gram positive aerobic bacteria?

A

norcardia; contracted via inhalation or skin; causes pneumonia similar to TB (infiltrates and cavitary lesions); abscesses; Diagnose with induced sputum sample or BAL for culture and sensitivity; Gram stain; Tx with TMP-SMX

78
Q

Tx for cervicofacial actinomyces?

A

Penicillin

79
Q

What is the treatment for chlamydia?

A

Azithromycin 1g PO or Doxycycline 200mg PO BID x 7 days

80
Q

What is the next best step in female with cervical warts?

A

refer to specialist clinic for colposcopic exam; biopsy required before treatment

81
Q

What are anogenital warts also known as?

A

Condylomata acuminata caused by HPV

Internal Medicine - MCCQE 1 (13 decks)

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