Infectious disease Flashcards Preview

My Step 2 CK > Infectious disease > Flashcards

Flashcards in Infectious disease Deck (239)
1

What is the most common organism that causes of osteomyelitis?

S. aureus

2

What is the most common organism that causes of pyelonepritis?

E. Coli

3

When does S. epidermis causes infection?

1. catheter placement
2. prosthetic valves
3. dialysis

4

What is the initial treatment for MRSA infections?

Vancomycin (can used linezolid as second line)

5

What type of disease is associated with Strep viridans infection?

Endocarditis

6

What is the initial treatment for MSSA and Strep?

penicillinase-resistant penicillins (oxacillin, cloxacillin, dicloxacillin, naficillin)

7

What are the 1st generation cephalosporin?

1. cefazolin
2. cefadroxil
3. cephalexin

8

If pt develops rash with penicillin, what is the next treatment option for Staph and Strep infection?

1st or 2nd generation cephalosporin

9

What are the 2nd generation cephalosprin?

1. cefoxitin
2. cefotetan
3. cefuroxime
4. cefprozil
5. loracarbef

10

If pt develops anaphylaxis, what is the next treatment option for Staph and Strep infections?

1. macrolide, clindamycin or fluoroquinolones (if mild)
2. vancomycin, linezolid or daptomycin (if severe)
(Avoid B-lactams: pencillin, cephalosporin, monobactam, carbepenems)

11

What are effective antibiotics for gram negative rods?

1. 3rd and 4th generation cephalosporin
2. quinolones (ciprofloxcin for pseudomonas)
3. aminoglycosides (gentamicin)
4. aztreonam
5. carbapenems

12

What are the 3rd generation cephalosporins?

1.ceftazidime
2. cefotaxime
3. ceftriaxone
4. cefoxtamine

13

What is the 4th generation cephalosporin?

cefepime

14

What is the initial best treatment for anaerobic gram negative bacteria below the diaphragm?

Metronidazole

15

What is the initial best treatment for anaerobic gram negative bacteria above the diaphragm (pneumonia)?

Clindamycin

16

When should doxycycline be used as treatment?

1. chlamydia
2. rickettsia
3. early lyme disease (rash)

17

When should Bactrim be used as treatment?

1. PCP
2. uncomplicated cystitis

18

What is the most common cause of meningitis in pts older than neonatal age?

Strep pneumoniae

19

What is the most common cause of meningitis in adolescents?

Neisseria meningitidis

20

What organism is associated with meningitis in HIV pt?

Cryptococcus neoformans

21

What organism is likely to cause meningitis in a pt with hx of neurosurgery?

S. aureus

22

What is the most common cause of meningitis in neonates?

Group B Strep (Strep agalactiae)

23

What is the most common long term neuro complication of bacterial meningitis?

8th cranial nerve deficit

24

A pt presents with fever, photophobia, headache, photophobia and nuchal rigidity most likely suffers from ...

meningitis

25

A pt presenting with pulmonary symptoms and meningitis most likely suffers from ...

TB associated meningitis

26

A pt presenting with petechial rash and meningitis most likely suffers from ...

Neisseria meningitidis
(gram negative diplococci)

27

A pt presenting with meningitis and rash on wrists and ankle with centripetal spread toward the body after a pt was in carolinas/kentucky/tennesse most likely suffers from ...

Rocky mountain spotted fever

28

What medications can be used for influenza?

1. oseltamivir
2. zanamivir
(given w/in 48 hour of onset of symptoms to decrease duration)

29

Medications ending with "avir" are used to treat ..

AIDS (HIV)

30

Medications ending with "ovir" are used to treat ..

Herpes
("O" shit i have herpes)

31

A pt presenting with meningitis, facial nerve palsy, target lesions with hx of being in massachusetts/ connecticut most likely suffers from ...

Lyme disease meningitis

32

When should a head CT be done before a lumbar puncture?

1.papilledema
2. focal motor deficits
3. new onset seizures
4. altered mental status

33

A pt presents with fever, headache and confusion (altered mental status) most likely suffers from ...

Encephalitis

34

A pt presents with fever, headache and focal neuro deficits most likely suffers from ...

Brain abscess

35

What is the best initial test for meningitis if head CT does not need to be done?

lumbar puncture

36

What is the best initial test for Cryptococcus neoformans?

India ink stain of CSF

37

What is the most accurate test for Cryptococcus neoformans?

serum and CSF cryptococcal antigen titer

38

What is the empiric therapy for bacterial meningitis?

vancomycin and ceftriaxone
(add ampicillin if suspect Listeria- neonate or elderly)

39

What is the best treatment for Cryptococcus neoformans meningitis?

amphotericin intially; then fluconazole with HAART

40

What is the best treatment for Lyme meningitis?

Ceftriaxone

41

What is the best treatment for neurosyphilis?

high dose IV penicillin

42

What is an important adjunct therapy used with antibiotics for bacterial meningitis to decreased morbidity?

Steroids (dexamethasone 15-20 minutes prior to abx administration and with administration)

43

What is the most common cause of encephalitis?

HSV-1 (herpes) encephalitis

44

What is the best initial treatment for herpes encephalitis?

IV acyclovir

45

What area is predominantly affected by herpes encephalitis?

temporal lobes

46

What is the best initial test for a pt presenting with suspected brain abscess?

CT scan with contrast (ring enhancing lesion)

47

What are the two causes of brain abscesses in HIV pt?

1. Toxoplasmosis (respond to tx)
2. Lymphoma

48

What is the best initial treatment for brain abscess in HIV pt?

pyrimethamine and sulfadiazine (if respond after 10-14 days, then toxoplasmosis as cause)

49

What is the treatment for rocky mountain spotted fever?

doxycycline

50

A pt presents with ear pain, fever, decreased hearing and red, bulging tympanic membrane with limited mobility most likely suffers from ... and should be treated with ...

otitis media; amoxicillin
(amoxicillin-clavulanate if recurrent; azithromycin if penicillin allergic)

51

When should you treat with antibiotics in a pt presenting with facial pain, headache worse when leaning forward, post-nasal discharge, nasal discharge and sinus tenderness?

viral rhinosinusitis resolves in 7-10 days; abx if last longer or get worse

52

What are the two complications associated with strep throat?

1. rheumatic fever
2. glomerulonephitis

53

A pt presents with sore throat, cervical lymphadenopathy and inflammed pharynx with exudative covering most likely suffers from ....

Group A Strep (S. pyogenes); strep throat

54

What is the best initial test for suspected strep throat?

rapid streptococcal antigen (culture if rapid negative)

55

What antibiotics are given to close contacts of pt with neiserria meningitis?

ciprofloxacin or isonazid
(isolate pt)

56

What is the initial treatment for strep throat?

penicillin

57

If patient has recurrent infection with neisseria menigitidis, what is the likely underlying cause?

complement deficiency

58

Who should not receive influenza vaccine?

pts anaphylatically allergic to eggs

59

What is the most accurate diagnostic test for herpes encephalitis?

PCR for HSV DNA

60

A pt presents with fever, myalgias, headache, fever and upper respiratory symptoms most likely suffers from....

Influenza

61

A pt presenting with cough, sputum production, low grade fever, clear lungs and normal CXR most likely suffers from ..
(have smoking hx)

bronchitis (inflammation of trachebronchial tube)

62

What are the most common causes of sinusitis and otitis media?

1. Strep pneumoniae (40%)
2. H. influenzae (30%)
3. Moraxella catarrhalis (20%)

63

What is the best initial therapy for a lung abscess?

Clindamycin

64

A pt presents with fever, cough, foul smelling sputum production, chest pain, and weight loss in setting of aspiration risk most likely suffers from ...

Lung Abscess (usually anaerobic)

65

What is CXR finding for a lung abscess?

thick walled cavitary lesion

66

What is the cause of pneumonia in a smoker with COPD?

H. influenzae

67

What is the cause of pneumonia in a young healthy pt, associated bullous myringitis (vesicles on tympanic membrane), and hemolytic anemia due to cold agglutinin?

Mycoplasma pneumoniae

68

What is the cause of pneumonia in an older smoker who is located near infected water sources (i.e air conditioning systems)?

Legionella (associated GI distress and altered mental status)

69

What is the most common cause of pneumonia in an HIV pt with CD4 count < 200?

PCP

70

What is the most common cause of pneumonia in pt with exposure to animals (especially animals giving birth; vet and farmer)?

Coxiella burnetti (Q-fever)

71

What is the most common cause of pneumonia in alcoholics with associated currant jelly sputum?

Klebsiella pneumoniae

72

What is the most common cause of bacterial pneumonia after a viral infection?

S. aureus

73

What is the most common cause of pneumonia in pt who travelled/ live in deserts of southwest (Arizona)?

Coccidiodomycosis
(dry locations, effects joint and erythema nodosum)

74

What is the most common cause of pneumonia in pt in contact with birds?

Chlamydia psittaci

75

What is the most common cause of pneumonia in pt with exposure to bat/bird droppings (spelunking, cave exploration)?

Histoplasma capsulatum (wet river valleys)

76

What is the most common cause of pneumonia in pt with whooping cough and post-tussive emesis?

Bordetella pertussis

77

What is the most common cause of pneumonia in hunters (with exposure to rabbits)?

Francisella tularensis

78

What is the most common cause of pneumonia in a pt who travelled to southeast asia?

SARS (avian influenza)

79

What exam finding correlates best with pneumonia severity?

respiratory rate (hypoxia leads to hyperventilation)

80

What causes of pneumonia result in interstitial infiltrates?

1. PCP
2. Mycoplasma
3. Chlamydia
4. Coxiella
(5. Legionella)

81

What is CURB-65 and what is it used for?

C-confusion
U-uremia (elevated BUN)
R- respiratory distress (PO2 < 60, O2 sat 30)
B-low blood pressure (SBP< 90, DBP < 60)
65- 65 y/o or older
used to determine hospitalization for community acquire pneumonia

82

What is outpatient treatment for community acquired pneumonia?

azithrmyocin/ clarithromyocin
(can use levofloxacin/ moxifloxacin)

83

What is inpatient treatment for community acquired pneumonia?

1. levofloxacin/ moxifloxacin
2. ceftriaxone with azithromycin or doxycyline
3. zosyn

84

What is the treatment for PCP?

Bactrim (IV pentamidine if allergic to Bactrim)

85

When should steroids be added to PCP treatment with Bactrim?

if severe:
1. arterial PO2 < 70
2. A-a gradient > 35

86

What is the treatment for Coxiella brunetti (Q-fever)?

Doxycycline

87

What is the treatment for Coccidioidomycosis?

Treat disseminated disease with fluconazole or itraconazole

88

What is treatment for hospital acquired pneumonia?

1. ceftazidime with vancomycin/linezolid
2. carbapenems with vancomycin/linezolid
3. Zosyn with vancomycin/linezolid

89

A pt develops pneumonia after 5-7 days in hospital most likely is due to ...

1. drug resistant gram negative bacilli (E.coli, Pseudomonas)
2. MRSA

90

Why do you get hyponatremia with pneumonia?

SIADH

91

Who should recieve pneumococcal vaccine?

1. older than 65
2. COPD
3. Cirrhosis
4. Asplenic
5. diabetic
6. heart disease
7. HIV
8. Steroid use
9. kidney disease

92

A pt presents with fever, cough, sputum production, weight loss and night sweats most likely suffers from ... and the best initial test is ...

TB; CXR

93

What is the finding on pleural biopsy in suspected TB pneumonia?

caseating necrosis
(associated with Ghon complex-calcified nodule)

94

What is the treatment for active TB?

RIPE for 2 months (rifampin, INH, pyrazinamide, ethambutol) followed by just rifampin w/ INH for 4 more months

95

What should be added to INH treatment to prevent peripheral neuropathy?

vitamin B6 (pyridoxine)

96

When should TB be treated for more than 6 months?

1. TB meningitis (12 months)
2. Pregnancy (9 months)
3. Osteomyelitis
5. Miliary

97

When should steroids be added to TB treatment?

1. TB meninigitis
2. TB pericarditis

98

What is the common side effect of pyrazinamide?

benign hyperuricemia

99

What is the common side effect of ethambutol?

optic neuritis (color blindness)

100

What is considered positive PPD for late TB infection?

1. > 5 mm if close contact of active TB, HIV, abnormal CXR w/ old/healed TB, steroid/ transplant
2. > 10 mm if high risk group (healthcare workers, prisoners, nursing home)
3. > 15 mm if low risk

101

If symptomatic pt with CXR suggestive of TB, what is next best step in management?

sputum AFB stain and culture (tx if positive) (3 negatives rules out active disease)

102

If pt asymptomatic with positive PPD, what is the next best step in management?

CXR to look for active disease

103

What is the treatment for latent TB (positive TB with negative CXR)?

INH with vitamin B6 (pyridoxine) for 9 months

104

What is the cause of toxic shock syndrome?
(hypotension, fever, desquamative rash on hands and feet)

S. aureus infection due to use of tampon, sponges and surgical wound infections

105

What is the treatment for rocky mountain spotted fever?

doxycycline

106

What type of infections can be due to Toxoplasmosis?

1. chorioretinitis
2. CNS abscess
3. encephalitis

107

What is the treatment for Toxoplasmosis?

Pyrimethamine and sulfadiazine

108

If a pt who has never had a PPD and the first PPD is negative, what is the next best step in management?

repeat PPD within 2 weeks

109

A pt presents with voluntary muscle spasms, lockjaw, respiratory distress and dysphagia after a severe wound infection most likely suffers from ...

Tetanus (Clostridium tetani)

110

What is the prophylactic treatment of a severe dirty wound in pt not vaccinated?

1. tetanus vaccine
2. surgical debridement
3. antitoxin tetanus Ig
4. penicillin for 10-14 days

111

What is the prophylactic treatment of a severe dirty wound in pt who is fully vaccinated?

1. tetanus booster (if more than 5 years)
2. surgical debridement
3. penicillin for 10-14 days

112

What is the treatment for blastomycosis?

1. amphotericin (severe)
2. itraconazole/ ketoconazole (mild)

113

A pt presents with fever cough, chest pain, weight loss, neuro effects and skin lesions after spending time in southeast/ central united states most likely suffers from ...

Blastomycosis (broad budding yeast)
(brain, lungs, skin)

114

A pt w/ neutropenia/ steroid used/ cytotoxic drug use presents with cough, fever, wheezing, eosinophilia and a halo sign (low attenuation around a nodular lesion) on CT scan most likely suffers from ...

Allergic bronchopulmonary Aspergillosis

115

What is the treatment for allergic bronchopulmonary aspergillosis?

steroid taper and asthma meds

116

What is mycetoma and what is the treatment for it?

fungal ball due to aspergillosis; surgical removal

117

What is the treatment for invasive aspergillosis?

1. Voriconazole and caspofungin
2. amphotercin

118

What is the side effect of amphotercin B treatment?

1. type 1 renal acidosis (metabolic acidosis and hypokalemia)
2. renal dysfunction

119

An HIV pt with bilateral interstitial infiltrates in setting of pneumonia most likely suffers from .... and the best diagnostic test is ....

PCP; bronchoscopy with bronchoalveolar lavage (BAL)

120

What are the side effects of pentamidine?

1. pancreatitis
2. hyperglycemia
3. hypoglycemia

121

What can PCP prophylaxis be discontinued?

CD4 count > 200 for 6 months

122

An HIV pt presents with visual changes with low CD4 count most likely suffers from ...

CMV retinitis

123

What can be used for PCP propyhlaxis in Bactrim allergic pt?

1. Dapsone (avoid in G6PD)
2. Atorvoquone

124

An HIV pt presents with odynophagia, fever and retrosternal pain with CD4 count < 50 most likely suffers from ...

CMV esophagitis

125

What is the prophylaxis for mycobacterium avium complex in a patient with HIV?

Azithromycin if CD4< 50

126

What is the treatment used for CMV retinitis?

1. ganciclovir
2. foscarnet

127

What anti-retroviral medication can cause anemia?

Zidovudine

128

What anti-retroviral medication can cause peripheral neuropathy?

1. Ziduovudine
2. Didanosine

129

What anti-retroviral medication can cause kidney stones?

Indinavir

130

What anti-retroviral medications can cause hyperlipidemia, hyperglycemia, lipoatrophy and elevated LFTs?

Protease inhibitors ("avir")

131

When should a pt with HIV be started on HAART therapy?

1. CD4 < 500
2. viral load > 55,000

132

What is the only anti-retroviral medication that is contraindicated in pregnancy?

efavirenz

133

If HIV positive woman on HAART medication becomes pregnant, what is the next best step in management?

continue her current HAART regimen (except efavirenz)

134

When should a C-section be performed in an HIV pregnant women?

if CD4 count and viral load are not controlled with medications
(viral load > 1000)

135

If an HIV positive woman becomes pregnant but has a high CD4 count and low viral load, what is the next best step in management?

start Zidovudine (AZT) with 2 other retroviral medications for 2nd and 3rd trimester

136

What is post-exposure prophylaxis for a pt with serious exposure to blood containing body fluids of HIV positive pt?

AZT (Zidovudine), lamivudine, nelfinavir
(HAART for 4 weeks)

137

When can mycobacterium prophylaxis be discontinued for an HIV pt?

once CD4 count > 100 for months

138

What is treatment for active mycobacterium avium complex? (occurs in HIV pt w/ CD4< 50)

Clarithromycin and ethambutol (w/ or w/out rifabutin)

139

What is the treatment for Toxoplasmosis (ring enhancing lesions in HIV pt with CD4 < 100)?

Pyrimethamine and sulfadiazine

140

What is the treatment for cryptococcus neoformans in HIV pt with CD4 count < 100?

Amphotericin for 2 weeks followed by fluconazole

141

What are the vaccines that should be given to an HIV positive pt?

1. pneumococcus
2. flu
3. hep B
4. varicella (if CD4> 200)

142

What opportunistic infections occur in an HIV pt with CD4 count of 200-500?

1. Oral thrush (fluconazole)
2. Kaposi sarcoma (Tx w/ raising T cell count)
3. TB (RIPE)
4. Zoster/ Shingles

143

What opportunistic infections occur in an HIV pt with CD4 count of 100-200?

1. PCP (bactrim)
2. disseminated Histoplasmosis
3. disseminated coccidiomycosis

144

What opportunistic infections occur in a HIV pt with CD4 count <100?

1. Toxoplasmosis
2. Cryptococcus
3. Cryptosporidiosis (diarrhea)
4. disseminated herpes simplex

145

What opportunistic infections occur in a HIV pt with CD4 count < 50?

1. CMV (retinitis, esophagitis)
2. Mycobacterium avium complex
3. progressive multifocal leukoencephalopathy (PML)
4. CNS lymphoma

146

What is the side effect of foscarnet?

renal toxicity

147

What are the side effects of ganciclovir?

1. neutropenia
2. renal toxicity

148

What is the best indicator of response to anti-retroviral therapy in HIV pt?

HIV-RNA viral load

149

What is the tick and organism responsible for Lyme disease?

Ixodes scapularis; Borrelia burgdorferi

150

What is the initial symptom of Lyme disease?

Erythema migrans (erythematous rash with central clearing; bull's eye)

151

What are late manifestations of lyme disease?

1. migratory arthritis (joint)
2. cardiac (AV heart block, endocarditis)
3. Neuro (bilateral facial nerve palsy; meningitis, etc)

152

What is the most common neurologic manifestation of Lyme disease?

bilateral facial nerve palsy (7th nerve palsy)

153

What is the most common cardiac manifestation of Lyme disease?

AV heart block

154

What is treatment for pt with Lyme rash (erythema migrans), joint or facial palsy?

Amoxicillin or doxycyline

155

What is treatment for cardiac manifestations and neuro manifestations (other than facial palsy) in Lyme disease?

IV ceftriaxone

156

What is the next best step in management in a pt with a tick bite and asymptomatic?

do nothing

157

What is the treatment for Giardia associated diarrhea?

Metronidazole

158

What is the treatment for Campylobacter associated diarrhea?

Erythromycin

159

What is the only protozoan that is associated with bloody stool?

Entamoeba histolytica

160

What viral hepatic infection is associated with most severe presentation in pregnant women?

Hep E

161

What is the diagnostic test for Cryptosporidosis?

modified acid fast stain (AFB)

162

What is the next best step in management for a non-vaccinated person who suffers from a needlstick from a Hep B surface antigen positive pt?

Hep B Immunoglobulin with Hep B vaccine
(if pt has protective leves of surface antibody, nothing to do)

163

What cause of infectious diarrhea is associated with Guillain Barre syndrome?

Campylobacter

164

What finding in LFTs is suggestive of viral hepatitis?

elevated ALT greater than AST

165

A man presents with urinary frequency, urgency and burning along with purulent urethral discharge most likely suffers from ...

Urethritis (gonococcal and chlamydia)

166

What is the treatment for urethritis?

ceftriaxone and azithromycin

167

What is the diagnostic test for viral hepatitis (A,C,D,E)?

IgM -acute
IgG-chronic

168

What is the most common cause for liver transplant?

Hep C infection

169

What are the serology findings for acute hep B infection?

1. positive surface antigen
2. positive e-antigen (viral replication)
(possibly positive core antibody)

170

What are the serology findings for chronic hep B infection?

positive surface antigen for longer than 6 months
(w/ positive e-antigen and core antibody)

171

What are the serology findings for old, past, healed hep B infection?

1. positive core antibody
2. positive surface antibody

172

What are the serology findings for hep B vaccinated pt?

positive surface antibody only

173

A female presents with abdominal pain, fever, leukocytosis, cervical discharge with cervical motion tenderness most likely suffers from ...

PID (pelvic inflammatory disease)

174

What is the treatment for pelvic inflammatory disease?

inpatient: doxycycline/ azithromycin & cefoxitin
outpatient: doxycycline/ azithromycin & ceftriaxone

175

What is the most common side effect of interferon?

flu like symptoms

176

What is the most common side effect of ribavirin?

anemia

177

A pt presents with painful genital ulcer with ragged edges with painful lymphadenopathy most likely suffers from ...

Chancroid (Haemophilus ducreyi)

178

What is treatment for Chancroid (haemophilus ducreyi)?

azithromycin

179

What is the most accurate diagnostic test for pelvic inflammatory disease?

laparoscopy

180

A pt presents with signs and symptoms of pelvic inflammatory disease, what is the best initial step in management?

beta HCG (pregnancy test to rule out ectopic)

181

A pt presents with transient genital ulcer and prominent unilateral tender inguinal lymphadenopathy with associated draining sinus buboes most likely suffers from ...

Lymphogranuloma venereum (chlamydia trachomatis)

182

A pt presenting with polyarticular arthritis, tenosynovitis, petechial rash most likely suffer from ...

Disseminated gonorrhae (culture urethra, anus and mouth)

183

A pt presents with firm, painless genital ulcer and painless lymphadenopathy most likely suffers from ...

Syphilis (treponema pallidum)

184

What is treatment for lymphogranuloma venerem?

doxycycline

185

A pt presents with painless red nodule that develops into elevated granulomatous mass most likely suffers from ...

Granuloma inguinale (Calymmatobacterium granulomatis)

186

What is the diagnostic test of choice for primary syphilis (chancre)?

dark field exam

187

What is the diagnostic test of choice for tertiary syphilis (tabes dorsalis, argyll robertson pupil, aorta, gummas)?

FTA on CSF

188

What is the treatment for syphillis in penicillin allergic pt?

primary & secondary: doxycycline
tertiary, neurosyphilis, pregnant: desenitize to penicillin

189

What is diagnostic test and treatment for granuloma inguinale?

biopsy; bactrim/ ceftriaxone

190

A pt presents with multiple genital vesicles most likely suffers from ... and should be treated with ...

genital herpes (HSV1/2); acyclovir
(foscarnet for acyclovir resistant herpes)

191

What diagnostic test can be used for genital herpes?

Tzanck prep (best initial test) then viral culture
(done if vesicles unroofed resembling ulcer)

192

A pt presents with hearld patch, maculopapular rash that is not on hands and soles of feet, VRDL negative and rash on back looks like christmas tree most likely suffers from ...

Pityriasis rosea

193

What disease are donovan bodies on touch prep associated with?

granuloma inguinale

194

A pt presents with dysuria, urinary frequency, urgency and suprapubic tenderness most likely suffers from ... and what is best initial treatment?

Cystitis; Bactrim (if uncomplicated, no stones/ strictures/ tumor/ obstruction)

195

What is the organism associated with cystitis in young women after sexual intercourse?

Staph saprophyticus (honeymoon cystitis)

196

What is the best initial test for cystitis?

urinalysis (WBC; nitrites suggest gram negative)
(bacteria in pregnancy)

197

A pt presents with dysuria, urinary frequency, urgency, fever, flank pain and CVA tenderness most likely suffers from ...

Pyelonephritis

198

A pt presents with pyelonephritis symptoms that presist despite appropriate treatment most likely suffers from ...

Perinephric abscess (treatment must include drainage)

199

What is the most accurate test for perinephric abscess?

biopsy (can image with ultrasound/ MRI/ CT)

200

What is the treatment for cystitis in pregnant women?

nitrofurantoin

201

... is a skin infection involving epidermis and dermis presenting with a bright red, warm and tender lesion

Erysipelas

202

... is a skin infection involving epidermis, dermis and subcutaneous layers presenting with erythema, swelling, warmth and tender.

Cellulitis

203

... is a superficial skin infection involving epidermis only that presents with oozing, crusting and draining lesions

Impetigo

204

What is the best initial therapy for impetigo?

bacitracin and mupirocin (topical therapy)

205

What is the best empiric treatment for skin infections?

oxacillin, nafcillin, cefazolin, cephalexin

206

A pt presents with extensive pruritis, with burrowing tracts in skin, usually located in web spaces most likely suffers from ...

scabies

207

What is the diagnostic test for scabies?

skin scraping

208

What is treatment for scabies?

permethrin

209

A pt presenting with lice located near hair follicles and itching most likely suffers from ...

Pediculosis (Lice)

210

What is treatment for lice (pediculosis)?

permethrin

211

What is the treatment for fungal infection involving hair and/or nails?

Terbinafine or itraconazole

212

What is the best initial test for tinea?

KOH prep

213

What is the best initial step for a pt presenting with skin rash, crepitus, pain, and high fever?

Surgical debridement (for necrotizing fasciitis)

214

What is the side effect of terbinafine?

liver toxicity

215

Spaghetti and meatballs appearance on KOH prep most likely suggest...

Malassezia furfur (tinea versicolor)

216

What is the treatment for tinea versicolor?

topical selenium sulfide

217

How do you distinguish oral leukoplakia from oral thrush (candidiasis)?

leukoplakia: doesn't scrape off
thrush: scrapes

218

What fungal infection fluoresces under UV light of wood lamp?

Malassezia furfur

219

A pt presents with multiple skin-colored papules that have central umbilication most likely suffers from ...

Molluscum contagiosum (tx w/ removal)

220

A pt presenting with band of vesicles in a dermatomal distribution most likely suffers from ...

Shingles (Herpes zoster)

221

What is the best initial treatment for the pain associated with herpes zoster infection?

gabapentin

222

What is a significant risk factor for vertebral osteomyelitis?

IV drug use

223

What is the best initial test to exclude osteomyelitis?

X-ray (no periosteal elevation/ bone formation)

224

When should you obtain an MRI for suspected osteomyelitis?

if Xray is negative and clinical picture suggest osteomyelitis

225

What is the next best step in management if an Xray suggest osteomyelitis?

Bone biopsy (and culture to determine organism and sensitivity)

226

How do you follow response to therapy for osteomyelitis?

ESR

227

What is the best initial test for septic arthritis?

joint aspiration (WBCs >50,000)

228

A pt presents with polyarticular involvement, petechial rash, and tenosynovitis most likely suffers from ... and diagnosis via .. should be done

disseminated gonococcal disease; culture pharynx, rectum, urethra, cervix

229

A pt presents with severe pain, swelling and edema after wound from car accident that eventually develop crepitation and shock most likely suffers from ...

Gas Gangrene (Clostridium perfringens)

230

How do you definitively diagnosis and treat Gas Gangrene?

surgery; surgical debridement with antibiotics

231

A pt presents with a fever and a new murmur or change in previous murmur most likely suffers from ...

Endocarditis

232

What are extra-cardiac manifestations of endocarditis?

1. Janeway lesion (flat and painless)
2. Osler lesion (raised and painful)
3. Splinter hemorrhages
4. Roth's spots (oval pale retinal lesions surrounded by hemorrhage)

233

What is the most common cause of endocarditis in a pt with hx of IV drug abuse?

S. aureus

234

What is the best initial test for a pt with suspected endocarditis?

blood cultures

235

What is the empiric therapy for endocarditis?

vancomycin and gentamicin

236

What is the next best step in a pt diagnosed with Strep bovis associated endocarditis?

Colonoscopy (increased risk of colon cancer)

237

What cardiac conditions require prophylactic therapy for endocarditis in the setting of dental/ surgical procedures?

1. prosthetic valves
2. previous bacterial endocarditis
3. congential cardiac malformation
4. previous heart transplant

238

A pt presents with sharp, pleuritic chest pain that improves by sitting up and leaning forward and has associated friction rub most likely suffers from ...

acute pericarditis

239

What are the findings on EKG that are associated with pericarditis?

diffuse ST elevation
PR depression
(may get electrical alternans)