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My Step 2 CK > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What is the most common organism that causes of osteomyelitis?

A

S. aureus

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2
Q

What is the most common organism that causes of pyelonepritis?

A

E. Coli

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3
Q

When does S. epidermis causes infection?

A
  1. catheter placement
  2. prosthetic valves
  3. dialysis
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4
Q

What is the initial treatment for MRSA infections?

A

Vancomycin (can used linezolid as second line)

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5
Q

What type of disease is associated with Strep viridans infection?

A

Endocarditis

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6
Q

What is the initial treatment for MSSA and Strep?

A

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

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7
Q

What are the 1st generation cephalosporin?

A
  1. cefazolin
  2. cefadroxil
  3. cephalexin
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8
Q

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

A

1st or 2nd generation cephalosporin

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9
Q

What are the 2nd generation cephalosprin?

A
  1. cefoxitin
  2. cefotetan
  3. cefuroxime
  4. cefprozil
  5. loracarbef
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10
Q

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

A
  1. macrolide, clindamycin or fluoroquinolones (if mild)
  2. vancomycin, linezolid or daptomycin (if severe)
    (Avoid B-lactams: pencillin, cephalosporin, monobactam, carbepenems)
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11
Q

What are effective antibiotics for gram negative rods?

A
  1. 3rd and 4th generation cephalosporin
  2. quinolones (ciprofloxcin for pseudomonas)
  3. aminoglycosides (gentamicin)
  4. aztreonam
  5. carbapenems
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12
Q

What are the 3rd generation cephalosporins?

A
  1. ceftazidime
  2. cefotaxime
  3. ceftriaxone
  4. cefoxtamine
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13
Q

What is the 4th generation cephalosporin?

A

cefepime

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14
Q

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

A

Metronidazole

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15
Q

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

A

Clindamycin

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16
Q

When should doxycycline be used as treatment?

A
  1. chlamydia
  2. rickettsia
  3. early lyme disease (rash)
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17
Q

When should Bactrim be used as treatment?

A
  1. PCP

2. uncomplicated cystitis

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18
Q

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

A

Strep pneumoniae

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19
Q

What is the most common cause of meningitis in adolescents?

A

Neisseria meningitidis

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20
Q

What organism is associated with meningitis in HIV pt?

A

Cryptococcus neoformans

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21
Q

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

A

S. aureus

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22
Q

What is the most common cause of meningitis in neonates?

A

Group B Strep (Strep agalactiae)

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23
Q

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

A

8th cranial nerve deficit

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24
Q

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

A

meningitis

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25
Q

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

A

TB associated meningitis

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26
Q

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

A

Neisseria meningitidis

gram negative diplococci

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27
Q

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 …

A

Rocky mountain spotted fever

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28
Q

What medications can be used for influenza?

A
  1. oseltamivir
  2. zanamivir
    (given w/in 48 hour of onset of symptoms to decrease duration)
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29
Q

Medications ending with “avir” are used to treat ..

A

AIDS (HIV)

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30
Q

Medications ending with “ovir” are used to treat ..

A

Herpes

“O” shit i have herpes

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31
Q

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

A

Lyme disease meningitis

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32
Q

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

A
  1. papilledema
  2. focal motor deficits
  3. new onset seizures
  4. altered mental status
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33
Q

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

A

Encephalitis

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34
Q

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

A

Brain abscess

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35
Q

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

A

lumbar puncture

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36
Q

What is the best initial test for Cryptococcus neoformans?

A

India ink stain of CSF

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37
Q

What is the most accurate test for Cryptococcus neoformans?

A

serum and CSF cryptococcal antigen titer

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38
Q

What is the empiric therapy for bacterial meningitis?

A

vancomycin and ceftriaxone

add ampicillin if suspect Listeria- neonate or elderly

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39
Q

What is the best treatment for Cryptococcus neoformans meningitis?

A

amphotericin intially; then fluconazole with HAART

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40
Q

What is the best treatment for Lyme meningitis?

A

Ceftriaxone

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41
Q

What is the best treatment for neurosyphilis?

A

high dose IV penicillin

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42
Q

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

A

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

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43
Q

What is the most common cause of encephalitis?

A

HSV-1 (herpes) encephalitis

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44
Q

What is the best initial treatment for herpes encephalitis?

A

IV acyclovir

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45
Q

What area is predominantly affected by herpes encephalitis?

A

temporal lobes

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46
Q

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

A

CT scan with contrast (ring enhancing lesion)

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47
Q

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

A
  1. Toxoplasmosis (respond to tx)

2. Lymphoma

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48
Q

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

A

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

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49
Q

What is the treatment for rocky mountain spotted fever?

A

doxycycline

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50
Q

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 …

A

otitis media; amoxicillin

amoxicillin-clavulanate if recurrent; azithromycin if penicillin allergic

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51
Q

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?

A

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

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52
Q

What are the two complications associated with strep throat?

A
  1. rheumatic fever

2. glomerulonephitis

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53
Q

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

A

Group A Strep (S. pyogenes); strep throat

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54
Q

What is the best initial test for suspected strep throat?

A

rapid streptococcal antigen (culture if rapid negative)

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55
Q

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

A

ciprofloxacin or isonazid

isolate pt

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56
Q

What is the initial treatment for strep throat?

A

penicillin

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57
Q

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

A

complement deficiency

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58
Q

Who should not receive influenza vaccine?

A

pts anaphylatically allergic to eggs

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59
Q

What is the most accurate diagnostic test for herpes encephalitis?

A

PCR for HSV DNA

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60
Q

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

A

Influenza

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61
Q

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

A

bronchitis (inflammation of trachebronchial tube)

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62
Q

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

A
  1. Strep pneumoniae (40%)
  2. H. influenzae (30%)
  3. Moraxella catarrhalis (20%)
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63
Q

What is the best initial therapy for a lung abscess?

A

Clindamycin

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64
Q

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

A

Lung Abscess (usually anaerobic)

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65
Q

What is CXR finding for a lung abscess?

A

thick walled cavitary lesion

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66
Q

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

A

H. influenzae

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67
Q

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?

A

Mycoplasma pneumoniae

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68
Q

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

A

Legionella (associated GI distress and altered mental status)

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69
Q

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

A

PCP

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70
Q

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

A

Coxiella burnetti (Q-fever)

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71
Q

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

A

Klebsiella pneumoniae

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72
Q

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

A

S. aureus

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73
Q

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

A

Coccidiodomycosis

dry locations, effects joint and erythema nodosum

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74
Q

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

A

Chlamydia psittaci

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75
Q

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

A

Histoplasma capsulatum (wet river valleys)

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76
Q

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

A

Bordetella pertussis

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77
Q

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

A

Francisella tularensis

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78
Q

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

A

SARS (avian influenza)

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79
Q

What exam finding correlates best with pneumonia severity?

A

respiratory rate (hypoxia leads to hyperventilation)

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80
Q

What causes of pneumonia result in interstitial infiltrates?

A
  1. PCP
  2. Mycoplasma
  3. Chlamydia
  4. Coxiella
    (5. Legionella)
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81
Q

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

A

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

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82
Q

What is outpatient treatment for community acquired pneumonia?

A

azithrmyocin/ clarithromyocin

can use levofloxacin/ moxifloxacin

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83
Q

What is inpatient treatment for community acquired pneumonia?

A
  1. levofloxacin/ moxifloxacin
  2. ceftriaxone with azithromycin or doxycyline
  3. zosyn
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84
Q

What is the treatment for PCP?

A

Bactrim (IV pentamidine if allergic to Bactrim)

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85
Q

When should steroids be added to PCP treatment with Bactrim?

A

if severe:

  1. arterial PO2 < 70
  2. A-a gradient > 35
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86
Q

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

A

Doxycycline

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87
Q

What is the treatment for Coccidioidomycosis?

A

Treat disseminated disease with fluconazole or itraconazole

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88
Q

What is treatment for hospital acquired pneumonia?

A
  1. ceftazidime with vancomycin/linezolid
  2. carbapenems with vancomycin/linezolid
  3. Zosyn with vancomycin/linezolid
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89
Q

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

A
  1. drug resistant gram negative bacilli (E.coli, Pseudomonas)
  2. MRSA
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90
Q

Why do you get hyponatremia with pneumonia?

A

SIADH

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91
Q

Who should recieve pneumococcal vaccine?

A
  1. older than 65
  2. COPD
  3. Cirrhosis
  4. Asplenic
  5. diabetic
  6. heart disease
  7. HIV
  8. Steroid use
  9. kidney disease
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92
Q

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

A

TB; CXR

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93
Q

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

A 
caseating necrosis
(associated with Ghon complex-calcified nodule)
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94
Q

What is the treatment for active TB?

A

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

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95
Q

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

A

vitamin B6 (pyridoxine)

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96
Q

When should TB be treated for more than 6 months?

A
  1. TB meningitis (12 months)
  2. Pregnancy (9 months)
  3. Osteomyelitis
  4. Miliary
97
Q

When should steroids be added to TB treatment?

A
  1. TB meninigitis

2. TB pericarditis

98
Q

What is the common side effect of pyrazinamide?

A

benign hyperuricemia

99
Q

What is the common side effect of ethambutol?

A

optic neuritis (color blindness)

100
Q

What is considered positive PPD for late TB infection?

A
  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
Q

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

A

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

102
Q

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

A

CXR to look for active disease

103
Q

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

A

INH with vitamin B6 (pyridoxine) for 9 months

104
Q

What is the cause of toxic shock syndrome?

hypotension, fever, desquamative rash on hands and feet

A

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

105
Q

What is the treatment for rocky mountain spotted fever?

A

doxycycline

106
Q

What type of infections can be due to Toxoplasmosis?

A
  1. chorioretinitis
  2. CNS abscess
  3. encephalitis
107
Q

What is the treatment for Toxoplasmosis?

A

Pyrimethamine and sulfadiazine

108
Q

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

A

repeat PPD within 2 weeks

109
Q

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

A

Tetanus (Clostridium tetani)

110
Q

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

A
  1. tetanus vaccine
  2. surgical debridement
  3. antitoxin tetanus Ig
  4. penicillin for 10-14 days
111
Q

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

A
  1. tetanus booster (if more than 5 years)
  2. surgical debridement
  3. penicillin for 10-14 days
112
Q

What is the treatment for blastomycosis?

A
  1. amphotericin (severe)

2. itraconazole/ ketoconazole (mild)

113
Q

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 …

A

Blastomycosis (broad budding yeast)

brain, lungs, skin

114
Q

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 …

A

Allergic bronchopulmonary Aspergillosis

115
Q

What is the treatment for allergic bronchopulmonary aspergillosis?

A

steroid taper and asthma meds

116
Q

What is mycetoma and what is the treatment for it?

A

fungal ball due to aspergillosis; surgical removal

117
Q

What is the treatment for invasive aspergillosis?

A
  1. Voriconazole and caspofungin

2. amphotercin

118
Q

What is the side effect of amphotercin B treatment?

A
  1. type 1 renal acidosis (metabolic acidosis and hypokalemia)
  2. renal dysfunction
119
Q

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

A

PCP; bronchoscopy with bronchoalveolar lavage (BAL)

120
Q

What are the side effects of pentamidine?

A
  1. pancreatitis
  2. hyperglycemia
  3. hypoglycemia
121
Q

What can PCP prophylaxis be discontinued?

A

CD4 count > 200 for 6 months

122
Q

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

A

CMV retinitis

123
Q

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

A
  1. Dapsone (avoid in G6PD)

2. Atorvoquone

124
Q

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

A

CMV esophagitis

125
Q

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

A

Azithromycin if CD4< 50

126
Q

What is the treatment used for CMV retinitis?

A
  1. ganciclovir

2. foscarnet

127
Q

What anti-retroviral medication can cause anemia?

A

Zidovudine

128
Q

What anti-retroviral medication can cause peripheral neuropathy?

A
  1. Ziduovudine

2. Didanosine

129
Q

What anti-retroviral medication can cause kidney stones?

A

Indinavir

130
Q

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

A

Protease inhibitors (“avir”)

131
Q

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

A
  1. CD4 < 500

2. viral load > 55,000

132
Q

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

A

efavirenz

133
Q

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

A

continue her current HAART regimen (except efavirenz)

134
Q

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

A

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

135
Q

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?

A

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

136
Q

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

A

AZT (Zidovudine), lamivudine, nelfinavir

HAART for 4 weeks

137
Q

When can mycobacterium prophylaxis be discontinued for an HIV pt?

A

once CD4 count > 100 for months

138
Q

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

A

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

139
Q

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

A

Pyrimethamine and sulfadiazine

140
Q

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

A

Amphotericin for 2 weeks followed by fluconazole

141
Q

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

A
  1. pneumococcus
  2. flu
  3. hep B
  4. varicella (if CD4> 200)
142
Q

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

A
  1. Oral thrush (fluconazole)
  2. Kaposi sarcoma (Tx w/ raising T cell count)
  3. TB (RIPE)
  4. Zoster/ Shingles
143
Q

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

A
  1. PCP (bactrim)
  2. disseminated Histoplasmosis
  3. disseminated coccidiomycosis
144
Q

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

A
  1. Toxoplasmosis
  2. Cryptococcus
  3. Cryptosporidiosis (diarrhea)
  4. disseminated herpes simplex
145
Q

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

A
  1. CMV (retinitis, esophagitis)
  2. Mycobacterium avium complex
  3. progressive multifocal leukoencephalopathy (PML)
  4. CNS lymphoma
146
Q

What is the side effect of foscarnet?

A

renal toxicity

147
Q

What are the side effects of ganciclovir?

A
  1. neutropenia

2. renal toxicity

148
Q

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

A

HIV-RNA viral load

149
Q

What is the tick and organism responsible for Lyme disease?

A

Ixodes scapularis; Borrelia burgdorferi

150
Q

What is the initial symptom of Lyme disease?

A

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

151
Q

What are late manifestations of lyme disease?

A
  1. migratory arthritis (joint)
  2. cardiac (AV heart block, endocarditis)
  3. Neuro (bilateral facial nerve palsy; meningitis, etc)
152
Q

What is the most common neurologic manifestation of Lyme disease?

A

bilateral facial nerve palsy (7th nerve palsy)

153
Q

What is the most common cardiac manifestation of Lyme disease?

A

AV heart block

154
Q

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

A

Amoxicillin or doxycyline

155
Q

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

A

IV ceftriaxone

156
Q

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

A

do nothing

157
Q

What is the treatment for Giardia associated diarrhea?

A

Metronidazole

158
Q

What is the treatment for Campylobacter associated diarrhea?

A

Erythromycin

159
Q

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

A

Entamoeba histolytica

160
Q

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

A

Hep E

161
Q

What is the diagnostic test for Cryptosporidosis?

A

modified acid fast stain (AFB)

162
Q

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?

A

Hep B Immunoglobulin with Hep B vaccine

if pt has protective leves of surface antibody, nothing to do

163
Q

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

A

Campylobacter

164
Q

What finding in LFTs is suggestive of viral hepatitis?

A

elevated ALT greater than AST

165
Q

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

A

Urethritis (gonococcal and chlamydia)

166
Q

What is the treatment for urethritis?

A

ceftriaxone and azithromycin

167
Q

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

A

IgM -acute

IgG-chronic

168
Q

What is the most common cause for liver transplant?

A

Hep C infection

169
Q

What are the serology findings for acute hep B infection?

A
  1. positive surface antigen
  2. positive e-antigen (viral replication)
    (possibly positive core antibody)
170
Q

What are the serology findings for chronic hep B infection?

A

positive surface antigen for longer than 6 months

w/ positive e-antigen and core antibody

171
Q

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

A
  1. positive core antibody

2. positive surface antibody

172
Q

What are the serology findings for hep B vaccinated pt?

A

positive surface antibody only

173
Q

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

A

PID (pelvic inflammatory disease)

174
Q

What is the treatment for pelvic inflammatory disease?

A

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

175
Q

What is the most common side effect of interferon?

A

flu like symptoms

176
Q

What is the most common side effect of ribavirin?

A

anemia

177
Q

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

A

Chancroid (Haemophilus ducreyi)

178
Q

What is treatment for Chancroid (haemophilus ducreyi)?

A

azithromycin

179
Q

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

A

laparoscopy

180
Q

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

A

beta HCG (pregnancy test to rule out ectopic)

181
Q

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

A

Lymphogranuloma venereum (chlamydia trachomatis)

182
Q

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

A

Disseminated gonorrhae (culture urethra, anus and mouth)

183
Q

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

A

Syphilis (treponema pallidum)

184
Q

What is treatment for lymphogranuloma venerem?

A

doxycycline

185
Q

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

A

Granuloma inguinale (Calymmatobacterium granulomatis)

186
Q

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

A

dark field exam

187
Q

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

A

FTA on CSF

188
Q

What is the treatment for syphillis in penicillin allergic pt?

A

primary & secondary: doxycycline

tertiary, neurosyphilis, pregnant: desenitize to penicillin

189
Q

What is diagnostic test and treatment for granuloma inguinale?

A

biopsy; bactrim/ ceftriaxone

190
Q

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

A 
genital herpes (HSV1/2); acyclovir
(foscarnet for acyclovir resistant herpes)
191
Q

What diagnostic test can be used for genital herpes?

A 
Tzanck prep (best initial test) then viral culture
(done if vesicles unroofed resembling ulcer)
192
Q

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 …

A

Pityriasis rosea

193
Q

What disease are donovan bodies on touch prep associated with?

A

granuloma inguinale

194
Q

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

A

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

195
Q

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

A

Staph saprophyticus (honeymoon cystitis)

196
Q

What is the best initial test for cystitis?

A

urinalysis (WBC; nitrites suggest gram negative)

bacteria in pregnancy

197
Q

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

A

Pyelonephritis

198
Q

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

A

Perinephric abscess (treatment must include drainage)

199
Q

What is the most accurate test for perinephric abscess?

A

biopsy (can image with ultrasound/ MRI/ CT)

200
Q

What is the treatment for cystitis in pregnant women?

A

nitrofurantoin

201
Q

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

A

Erysipelas

202
Q

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

A

Cellulitis

203
Q

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

A

Impetigo

204
Q

What is the best initial therapy for impetigo?

A

bacitracin and mupirocin (topical therapy)

205
Q

What is the best empiric treatment for skin infections?

A

oxacillin, nafcillin, cefazolin, cephalexin

206
Q

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

A

scabies

207
Q

What is the diagnostic test for scabies?

A

skin scraping

208
Q

What is treatment for scabies?

A

permethrin

209
Q

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

A

Pediculosis (Lice)

210
Q

What is treatment for lice (pediculosis)?

A

permethrin

211
Q

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

A

Terbinafine or itraconazole

212
Q

What is the best initial test for tinea?

A

KOH prep

213
Q

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

A

Surgical debridement (for necrotizing fasciitis)

214
Q

What is the side effect of terbinafine?

A

liver toxicity

215
Q

Spaghetti and meatballs appearance on KOH prep most likely suggest…

A

Malassezia furfur (tinea versicolor)

216
Q

What is the treatment for tinea versicolor?

A

topical selenium sulfide

217
Q

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

A

leukoplakia: doesn’t scrape off
thrush: scrapes

218
Q

What fungal infection fluoresces under UV light of wood lamp?

A

Malassezia furfur

219
Q

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

A

Molluscum contagiosum (tx w/ removal)

220
Q

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

A

Shingles (Herpes zoster)

221
Q

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

A

gabapentin

222
Q

What is a significant risk factor for vertebral osteomyelitis?

A

IV drug use

223
Q

What is the best initial test to exclude osteomyelitis?

A

X-ray (no periosteal elevation/ bone formation)

224
Q

When should you obtain an MRI for suspected osteomyelitis?

A

if Xray is negative and clinical picture suggest osteomyelitis

225
Q

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

A

Bone biopsy (and culture to determine organism and sensitivity)

226
Q

How do you follow response to therapy for osteomyelitis?

A

ESR

227
Q

What is the best initial test for septic arthritis?

A

joint aspiration (WBCs >50,000)

228
Q

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

A

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

229
Q

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

A

Gas Gangrene (Clostridium perfringens)

230
Q

How do you definitively diagnosis and treat Gas Gangrene?

A

surgery; surgical debridement with antibiotics

231
Q

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

A

Endocarditis

232
Q

What are extra-cardiac manifestations of endocarditis?

A
  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
Q

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

A

S. aureus

234
Q

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

A

blood cultures

235
Q

What is the empiric therapy for endocarditis?

A

vancomycin and gentamicin

236
Q

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

A

Colonoscopy (increased risk of colon cancer)

237
Q

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

A
  1. prosthetic valves
  2. previous bacterial endocarditis
  3. congential cardiac malformation
  4. previous heart transplant
238
Q

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 …

A

acute pericarditis

239
Q

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

A

diffuse ST elevation
PR depression
(may get electrical alternans)

My Step 2 CK (21 decks)

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