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USMLE Step 2 CK Flash Cards > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

Microorganisms responsible for most cases of prolonged, profuse, watery diarrhea

A
  • Cryptosporidium parvum
  • Cyclospora
  • Giardia
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2
Q

Clinical hallmark of necrotizing fasciitis

A

Rapidly progressive erythema with pain and tenderness significantly out of proportion of physical findings

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3
Q

Most important and definitive treatment of necrotizing fasciitis

A

Surgical debridement

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4
Q

Risk factors to develop shingles

A
  • Advancing age
  • Immunosuppression
  • Trauma to the skin
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5
Q

How do you confirm gonococcal proctitis?

A

Nucleic acid amplification testing of rectal swab

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6
Q

What is Ludwig angina? Clinical presentation.

A
  • Rapidly progressive cellulitis of the submandibular space→most cases arise from dental infections
  • Rapidly systemic symptoms→fever, chills, malaise
  • Local compressive→mouth pain, drooling, dysphagia, muffled voice, airway compromise
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7
Q

Findings in the physical examination of Ludwig angina

A

Mass effect from edema; tender, indurated submandibular area; elevated floor of the mouth; tongue displaced; crepitus

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8
Q

Major risks factors for Clostridium difficile infection

A
  • Recent antibiotic use (fluoroquinolones, clindamycin, cephalosporins, penicillins)
  • Advanced age (>65 years)
  • Gastric acid suppression (Ex, PPI)
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9
Q

Gold standard for diagnosis Herpes encephalitis

A

PCR of HSV DNA in CSF

*Highly sensitive and specific. Replacing brain biopsy.

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10
Q

Most appropriate next step when suspect clinically amebic liver abscess

A

EIA test - antibodies for Entamoeba histolytica

*The role of microscopic stool examination is limited. Less than 30-40% of patients with amebic liver abscess have concomitant intestinal amebiasis, and 10% of the population is infected with the nonpathogenic strain of E. dispar

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11
Q

Most likely causal organism of a macular rash involving abdomen, chest, back, extremities and soles without fever and pruritus

A

Treponema pallidum

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12
Q

Most important clues to recognize a Valley Fever. Which is the etiology?

A
  • Valley Fever
    1. Desert Southwest (Ex, Arizona or California)
    2. Symptoms onset 7-14 days after inoculation, subclinical, >50% Community acquired pneumonia (fever, chest pain, dry or productive cough, lobar infiltrate)
    3. Often accompanied: arthralgias, erythema nodosum or erythema multiforme
  • Coccidioides immitis
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13
Q

Causal agent and treatment of Bacillary angiomatosis

A
  • Bartonella

- Oral Erythromycin

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14
Q

Most common cause of endocarditis in a patient with associated nosocomial urinary tract infection

A

Enterocci species, Ex Enterococcus faecalis

*Recent instrumentation can yield the bacteremia

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15
Q

Which germs that cause endocarditis or bacteremia are associated with colon pathology? What test you should perform?

A
  • Clostridium septicum>Streptococcus bovis
  • Perform colonoscopy➡rule out colon cancer

*Tumor cells undergo anaerobic glycolysis➡adequate environment for C. septicum spores germination; damage colonic mucosa➡bacteria transcolation into bloodstream

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16
Q

How do you treat endocarditis secondary to staphylococcus aureus on a protestic valve?

A

Oxacilin, Nafcilin or Cefazolin + Rifampin for 6 weeks

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17
Q

Strongest indication of surgery in acute endocarditis

A

Acute valve rupture and congestive heart failure

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18
Q

Most common bacteria causing endocarditis when culture is negative

A
  • Coxiella

- Bartonella

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19
Q

Pathognomonic sign of syphilis

A

Epitrochlear lymphadenopathy→2-handed “sailor’s handshake”

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20
Q

When do you consider an adequate or successful treatment of syphilis?

A

4-fold decrease in serologic titers at 6-12 months

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21
Q

What is the endemic typhus? Clinical presentation.

A

Louse-borne rickettsial infection→abrupt onset of fever, severe headache, malaise and centrifugally-spreading macular or maculopapular rash (sparing palms and soles)

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22
Q

How is the rash of the Rocky mountain spotted fever?

A

Maculopapular rash that spreads centripetally toward the trunk. Includes palms and soles. Petechial over time.

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23
Q

Treatment of tertiary syphilis

A

Intravenous Penicillin for 10-14 days

*Desensitize if penicillin allergy

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24
Q

What must you do with a pregnant woman with syphilis or a patient with neurosyphilis to treat them?

A

Penicillin desensitization

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25
Q

Diagnosis of Hepatitis C Virus chronic infection

A
  • Hepatitis C virus antibody→Positive serology

- HCV PCR→confirmatory molecular test (Do this because HCV may clear in up to half of patients)

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26
Q

Systemic manifestations of Blastomycosis

A
  • Skin compromise➡multiple, well-circumscribed, verrucous, crusted, ulcerated lesions
  • Lytic bone lesions

*In addition of chronic pulmonary symptoms: productive cough, low grade fever, night sweats, weight loss

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27
Q

Treatment of choice for pulmonary and disseminated nocardiosis

A

Trimethoprim-sulfamethoxazole (generally by 6-12 mo)

*Carbapenems may be added when brain is involved (brain abscess)

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28
Q

How do you distinguish Nocardia from Mycobacterium tuberculosis?

A

Nocardia➡Gram-positive, partially acid-fast rods

*Mycobacterium tuberculosis➡acid-fast rods, do not Gram stain

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29
Q

Treatment for necrotizing (malignant) otitis externa

A
  • Intravenous antipseudomonal antibiotic (Ciprofloxacin)

- ±Surgical debridement

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30
Q

Most common organism causing deep infections following puncture wound (through the sole of a shoe)

A

Staphylococcus aureus and Pseudomonas aeruginosa

*Risk of osteomyelitis

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31
Q

Treatment for HIV cachexia

A

Synthetic cannabinoids (dronabinol)

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32
Q

Antibiotic indicated for patients undergoing splenectomy and develop fever

A

Amoxicillin-clavulanate

*Levofloxacin (for penicillin allergy)

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33
Q

Triad frequently found in Trichinellosis

A
  • Eosinophilia
  • Myositis
  • Periorbital edema
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34
Q

Clinical presentation of HSV retinitis in an HIV positive patient

A
  • Acute retinal necrosis syndrome➡starts keratitis and conjunctivitis with eye pain; followed by rapidly progressive visual loss
  • Fundoscopy➡widespread, pale, peripheral lesions and central necrosis of the retina.

*Might be caused by VZV as well.

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35
Q

Clinical presentation of CMV retinitis in HIV positive patient

A
  • Painless

- Fundoscopy➡fluffy or granular retinal lesions near retinal vessels and associated hemorrhages

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36
Q

Cephalosporin that can cover MRSA

A

Ceftalorine (fifth generation)

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37
Q

Which cephalosporins can cover anaerobes? Side effects of them

A
  • Cefotixin and Cefotetan (Second generation)

- ⬇Prothrombin➡⬆Risk of bleeding; disulfiram-like effect with alcohol

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38
Q

What is the difference between ertapenem and the other carbapenems?

A

Ertapenem does not cover Pseudomonas

*All carbapenems cover gram-negative bacilli

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39
Q

How do you use the fluoroquinolones to treat diverticulitis and GI infections?

A
  • Ciprofloxacin, gemifloxacin, levofloxacin must be combined + metronidazole; they do not cover anaerobes
  • Moxifloxacin (exception) can be used alone; cover anaerobes
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40
Q

Classic side effects of quinolones

A
  • Bone growth abnormalities in children and pregnant women

- Tendonitis and Achilles tendon rupture

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41
Q

When do you order bacterial antigen detection (Latex Agglutination Tests) in suspected bacterial meningitis?

A

Patient has received antibiotics prior to lumbar puncture➡culture may be falsely negative

*Delay in LP may happen when head CT is indicated before (Ex, confused patients)

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42
Q

Important feature of the CSF in a tuberculous meningitis

A

Highest protein level

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43
Q

When do you suspect Listeria as the etiology of meningitis? How do you treat it?

A
  • Risk factors for Listeria:
  • Elderly
  • Neonates
  • Steroid use
  • AIDS or HIV
  • Immunocompromised, include alcoholism
  • Pregnant
  • Add Ampicillin to the Tx➡Listeria is resistant to all cephalosporins
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44
Q

Most common neurological deficit from untreated bacterial meningitis

A

Eighth cranial nerve deficit or deafness

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45
Q

Most accurate test for herpes encephalitis

A

PCR on CSF

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46
Q

Antibiotics that cover anaerobes in oral and GI infections

A
  • Oral: Penicillin (G, VK, ampicillin, amoxicillin), Clindamycin
  • Abdominal/GI: Metronidazole, beta-lactam/lactamase inhibitor, carbapenems, 2nd gen cephalosporins
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47
Q

Treatment for ESBL-producing organisms resistant to carbapenems

A
  • Ceftolozane/tazobactam
  • Ceftazidime/avibactam
  • Polymyxin (Risk for acute renal injury)
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48
Q

Treatment for encephalitis by aciclovir resistant herpes

A

Foscarnet

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49
Q

During acute hepatitis which test correlates the best with higher mortality?

A

⬆Prothrombin time➡⬆risk of fulminant hepatic failure and death

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50
Q

What is directly correlated with the amount or quantity of active hepatitis B virus replication?

A

Hepatitis B e-antigen➡present only when there is ⬆DNA polymerase activity

*e-antigen↔PCR DNA (viral load, is more precise)

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51
Q

Which indicates that active infection of hepatitis B has resolved?

A

No AgHBs found

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52
Q

Which is the best indication of treatment for chronic hepatitis B?

A
  • e-antigen or DNA polymerase (PCR DNA hepatitis B)➡strongest indicator of acute viral replication➡Degree of infectivity
  • e-antigen (qualitative)↔PCR DNA (quantitative, viral load, is more precise)
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53
Q

Best test to determine response to therapy or failure in therapy for chronic hepatitis B or hepatitis C

A

PCR DNA hepatitis B and PCR RNA hepatitis C

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54
Q

Most common method of transmission of hepatitis B

A

Perinatal transmission

  • e-antigen ➕➡90% children infected at birth
  • e-antigen ➖➡10% children infected
55
Q

Best treatment for Hepatitis C genotype 1, and for any genotype

A
  • Ledipasvir + Sofosbuvir for genotype 1

- Velpatasvir for all genotypes

56
Q

Goals of chronic hepatitis treatment

A
  • ⬇DNA polymerase to undetectable levels

- Convert patients from e-antigen to antibody e-antigen

57
Q

Indications to treat hepatitis C

A
  • ⬆PCR-RNA viral load

- Fibrosis on biopsy (even for hepatitis B)

58
Q

Sensitive and specific tests for syphilis study on CSF

A
  • FTA-ABS nearly 100% sensitive in CSF

- VDRL and PCR specific

59
Q

Which test may be useful to diagnose both chlamydia and Neisseria gonorrhoeae?

A

Nucleic acid amplification test (NAAT)

*Gram stain only detects gonorrhea, with chlamydia infection only see PMNs

60
Q

What is late secondary syphilis or latent infection?

A
  • Asymptomatic stage with ➕ serology
  • After chancre and rash of primary and secondary syphilis have resolved

*End or beyond the first year of infection

61
Q

Treatment of latent or late secondary syphilis

A

Benzathine Penicillin IM weekly for 3 weeks

62
Q

Treatment of primary and secondary syphilis

A
  • One dose IM Benzathine Penicillin

- Oral Doxycycline or Tetracycline for 14 days, for penicillin allergy

63
Q

Treatment of HACEK group of organisms causing endocarditis

A

Ceftriaxone

64
Q

Indications for prophylaxis for endocarditis

A
  • Significant cardiac defect:
  • Prosthetic valve
  • Previous endocarditis
  • Cardiac transplant recipient with valvulopathy
  • Unrepaired cyanotic heart disease
  • Risk of bacteremia:
  • Dental work with blood
  • Respiratory tract surgery that produces bacteremia
65
Q

Best initial empiric therapy for endocarditis

A

Vancomycin + Gentamicin

66
Q

Risk factors for endocarditis

A
  • Prosthetic valve ⬆⬆Risk
  • Regurgitant and stenotic lesions
  • Dental procedures
  • Surgery of mouth and respiratory tract + severe valvular disorder (prosthetic valve, cyanotic heart disease)
67
Q

Most common joint, neurological and cardiac manifestations of untreated Lyme disease

A
  • Joint➡Knee arthritis
  • Neurological➡7th cranial nerve or Bell palsy (classically bilateral)
  • Cardiac➡Transient AV block
68
Q

Treatment for Lyme disease when rash, joint compromised or 7th cranial nerve palsy

A
  • Doxycycline

- Amoxicillin or Cefuroxime

69
Q

Treatment for Lyme disease when cardiac or neurologic manifestations other than 7th CN palsy

A

Intravenous Ceftriaxone

70
Q

Prophylaxis indications for Lyme disease when tick bite and no symptoms

A

Single-dose of doxycycline within 72 hours of tick bite:

  • Ixodes scapularis clearly identified
  • Tick attachment >24 hours
  • Engorged nymph-stage tick
  • Endemic area

*Tick bite + no symptoms generally do not need prophylaxis; treat if rash shows up

71
Q

What must you test before start abacavir in an HIV patient? and why?

A

HLA B5701 mutation➡⬆risk of life-threatening skin reactions (Steven-Johnson syndrome)

72
Q

Most important adverse effects of Tenofovir

A
  • Renal Tubular Acidosis (RTA)
  • Bone demineralization

*Disoproxil version ⬆risk, alafenamide version is absorbed by CD4➡⬇plasma levels➡⬇adverse effects

73
Q

Treatment for baby from an HIV positive mother

A

Zidovudine intrapartum (to the pregnant woman) and for 6 wks (to the baby)➡prevent transmission

74
Q

Antiretroviral to be avoided during pregnancy

A

Efavirenz

75
Q

Indication for Pre-exposure prophylaxis (PrEP) for HIV and what drugs do you give?

A
  • High risk sexual and needle-stick practices with potentially HIV-infected contacts
  • Emtricitabine-Tenofovir before exposure and one month after the last exposure
76
Q

Best initial and definitive treatment for Mucormycosis

A
  • Best initial: Amphotericin B
  • Surgical emergency➡resect necrotic areas

*Follow up Tx➡Posaconazole or Isavuconazole

77
Q

Treatment for invasive Aspergillosis

A

Voriconazole, Isavuconazole, Caspofungin

  • DO NOT use Amphotericin B (is inferior)
78
Q

Tests for invasive Aspergillosis

A
  • Serum Galactomannan assay
  • B-D-glucan level
  • PCR

*2 of those ➕➡>95% specificity

79
Q

Treatment for Plasmodium falciparum

A

Mefloquine or Atovaquone/proguanil

80
Q

Treatment for Plasmodium non-falciparum

A
  • Chloroquine

- Primaquine (vivax and ovale only)➡eradicate the hypnozoites in the liver

81
Q

What you should rule out first before start Primaquine?

A

G6PD deficiency

82
Q

Treatment for severe malaria

A
  • Artemisinins (Artemether, Artesunate)

- IV Quinine➡⬇Efficacy, ⬆QT prolongation toxicity

83
Q

Prophylaxis for malaria when traveling to endemic regions with chloroquine resistance

A
  • Atovaquone-proguanil or mefloquine at least 2 weeks before travel and for 4 weeks after returning
  • Doxycycline

*Avoid Mefloquine in seizure, psychiatric, and
cardiac conduction disorders

84
Q

Treatment for Babesiosis

A

Azithromycin + Atovaquone

85
Q

Which infectious diseases may show morulae in WBCs? What is the morulae in WBCs?

A
  • Ehrlichiosis (Monocytic) and Anaplasmosis (Granulocytic)

- Obligate intracellular parasites➡form microcolonies in the cytoplasm of WBCs

86
Q

Best clinical clues that may suggest Legionnaires’ diseases?

A
  • Atypical community-acquired pneumonia
  • CSN features➡confusion
  • Gastrointestinal features➡abdominal pain, diarrhea, mild hepatitis
  • Hotel and cruise ships
  • Relative bradycardia (despite ⬆fever)
  • Hyponatremia
87
Q

Best initial test for Legionnaires’ disease?

A

Urine antigen testing

*Best overall➡Culture

88
Q

Treatment for cryptococcal meningitis

A

IV Amphotericin B + Flucytosine for 2 wks, then fluconazole for 8 wks

89
Q

Which vaccines are contraindicated in HIV patients?

A

Live vaccines (MMR, VZ) are contraindicated If CD4<200

*If CD4>200 there are no contraindications

90
Q

Main side effects of Isoniazid, what you should do to avoid one of them?

A
  • Drug-induced hepatitis

- Peripheral neuropathy➡Vitamin B6 (Pyridoxine) to prevent

91
Q

Diagnosis of Allergic Bronchopulmonary Aspergillosis

A
  • Previous history most commonly of Asthma or Cystic Fibrosis
  • Pulmonary infiltrates on CXR, eosinophilia, ➕skin aspergillus antigen test, antibodies to aspergillus on blood, ⬆IgE levels
92
Q

Life-threatening complication of untreated retropharyngeal abscess and treatment

A
  • Acute necrotizing mediastinitis

- Urgent surgical drainage to prevent spread to the posterior mediastinum➡lethal pleural and pericardial effusions

93
Q

Frequent history clues in orbital cellulitis that you should look for

A
  • Ocular trauma or surgery

- Sinusitis

94
Q

Best initial therapy for HIV

A

Two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) + one integrase inhibitor

95
Q

Treatment for Histoplasmosis chronic cavitary lesions

A

Itraconazole for >1 year

96
Q

Treatment for Histoplasmosis severe acute pulmonary disease or disseminated disease

A

Liposomal amphotericin B or amphotericin B for 14 days followed by itraconazole for 1 year or longer

97
Q

How is the geographic distribution of the most common systemic fungal infections in the United States?

A
  • Histoplasmosis➡ Ohio and Mississippi river valleys
  • Coccidioidomycosis➡ southwestern
  • Blastomycosis➡central and southeastern, particularly the Mississippi and Ohio river valleys
98
Q

Clues on history and laboratory findings in disseminated infection of Mycobacterium Avium Complex

A
  • AIDS patients with a CD4+ < 50/mm3
  • Fever, weakness, and weight loss, night sweats, diarrhea
  • Anemia, hypoalbuminemia, ↑alkaline phosphatase, ↑LDH
99
Q

Treatment and prophylaxis for MAC disseminated infection

A
  • Tx: Clarithromycin + ethambutol, and consider HAART if drug-naïve; Rifabutin is second line. Continue for > 12 months and until CD4+ is > 100/mm3 for > 6 months
  • Prophy: Azithromycin for those with a CD4+ < 50/mm3 or AIDS-defining opportunistic infection
100
Q

Which complications of infectious mononucleosis are indicated to treat with corticosteroids?

A
  • Airway compromise caused by tonsillar enlargement
  • Severe thrombocytopenia
  • Severe autoimmune hemolytic anemia
101
Q

Complications of Infective endocarditis

A
  • Embolic strokes
  • Metastatic infection (most common cause of splenic abscess)
  • Heart failure (valvular insufficiency)
  • Glomerulonephritis
102
Q

Infective endocarditis most common microorganism based on valve status

A
  • Prosthetic valve➡Streptococcus viridans➡mitral valve (mitral regurgitation)>aortic valve (non-IV drug users, dental procedures)
  • Normal valve➡Staphylococcus aureus➡tricuspid valve>mitral valve>aortic valve (IV drug users)
103
Q

Potential complications of infectious mononucleosis

A
  • Splenic rupture
  • Acute airway obstruction
  • Autoimmune hemolytic anemia and thrombocytopenia
104
Q

Treatment for foodborne botulism

A

Equine serum heptavalent botulinum antitoxin (horse derived antitoxin)

105
Q

Management of recurrent cystitis clearly linked to intercourse

A

Postcoital antibiotics➡Nitrofurantoin, TMP-SMX

106
Q

Common etiologies of aseptic meningitis

A
  • Enterovirus➡maculopapular rash
  • Herpes simplex virus
  • HIV➡maculopapular rash, transient unexplained fever, generalized lymphadenopathy
107
Q

Second most common cause of primary adrenal insufficiency worldwide

A

Tuberculous adrenalitis

108
Q

Which evaluations should be done on patients with any sexually transmitted infections or who ask for screening for STI?

A
  • Neisseria gonorrhoeae (NAAT)
  • Chlamydia trachomatis (NAAT)
  • HIV (antigen/antibody testing)
  • Syphilis (RPR)
  • Trichomonas vaginalis (wet mount or NAAT) in 👩
109
Q

Most common etiology of bacterial conjunctivitis

A

Staphylococcus aureus

110
Q

Best treatment for invasive or systemic burn wound infection

A
  • Piperacilin/tazobactam or carbapenem➡Pseudomonas aeruginosa
  • Vancomycin➡MRSA

*Systemic or invasive burn infection▶systemic manifestations (confusion, tachycardia)/microbial invasion into unburned tissue on biopsy

111
Q

Enterobius vermicularis infection clinical presentation

A
  • Pinworm=Oxiuros
  • Perianal pruritus at night
  • Mature pinworms spread to vagina➡vulvovaginitis
112
Q

Treatment for pinworm (Enterobius vermicularis) infection

A

Pyrantel pamoate or Albendazole for patient and all household contacts

113
Q

Cryptococcal meningitis treatment

A
  • Induction: Liposomal amphotericin B + flucytosine for ≥2 weeks until acute symptoms resolve or CSF becomes sterile
  • Consolidation: high-dose oral fluconazole for 8 weeks
  • Maintenance: low-dose oral fluconazole indefinitely or until CD4>100/mm3 for >3 months on ART
114
Q

Strongest indication for meningococcal vaccination

A

Asplenia➡highest risk of disseminated meningococcal infection

115
Q

Signs and symptoms of tissue-invasive CMV disease

A
  • Pulmonary➡dyspnea, dry cough, interstitial infiltrates on chest x-ray
  • GI➡abdominal pain, diarrhea, hematochezia
  • Mild hepatitis➡⬆AST, ALT, AP, Bilirubin
  • Pancytopenia

*Pneumonitis+gastroenteritis+hepatitis

116
Q

Treatment for tissue-invasive CVM disease

A
  • Minimal signs and symptoms➡Oral Valganciclovir

- Severe disease➡IV Ganciclovir

117
Q

Echocardiography finding of viral myocarditis

A

Dilated ventricular chambers and diffuse hypokinesis

118
Q

Empiric treatment for health-associated pneumonia

A
  • Antipseudomonal cephalosporin: Cefepime or ceftazidime
  • Antipseudomonal penicillin: Piperacillin/tazobactam
  • Carbapenems: Imipenem, meropenem, doripenem

*Macrolides are not acceptable as empiric therapy; Must cover gram-negative bacilli (E. coli or Pseudomonas)

119
Q

What is severe pneumocystis pneumonia? What you should add to the treatment to decrease mortality?

A
  • PCP with pO2<70 mmHg, A-a gradient>35

- Steroids

120
Q

Treatment for pneumocystis pneumonia when there is TMP/SMX toxicity

A
  • Clindamycin and primaquine (contraindicated on G6PD)
    or
  • Pentamidine
121
Q

Most common adverse effect of TMP/SMX

A
  1. Rash

2. Bone marrow suppression

122
Q

Prophylaxis indication and medications for PCP

A
  • AIDS whose CD4<200/μL
  • TMP/SMX
  • If TMP/SMX toxicity➡Atovaquone or Dapsone (contraindicated in G6PD)
123
Q

When may you stop the PCP prophylaxis after initiated?

A

CD4 is maintained above 200/μL for several months (? 6 at least)

124
Q

Treatment for a positive PPD or IGRA

A

Latent tuberculosis (Do first chest x-ray to rule out active TB):

  • 9 months of Isoniazid (use pyridoxine (B6)
  • combination of Isoniazid and Rifapentine for 12 weeks (given once a week)
125
Q

Disease caused by Burkholderia pseudomallei

A

Melioidosis

  • Facultative intracellular gram-negative bacilli
  • Thailand, Malaysia, Singapur, North Australia
  • Contaminated soil or water inoculated in subcutaneous tissue
126
Q

Clinical presentation of Melioidosis

A
  • Pneumonia: could be associated with shock. x-ray: bilateral opacities
  • Skin ulcers/abscesses: 25% of cases, purple colored lesions
  • Organ abscesses: kidney, prostate, spleen, liver
127
Q

How do you suspect disseminated gonococcal infection?

A

*Triad:
- Polyarticular involvement (asymmetric, migratory arthralgias)
- Tenosynovitis
- Petechial rash (vesiculopustular)
OR
*Septic arthritis (purulent monoarthritis)

128
Q

Associated adverse effects of fluoroquinolones, and in which patients you should avoid them?

A
  • Upregulate cell-matrix metalloproteases➡⬆collagen degradation▶Achilles tendon rupture, retinal detachment, aortic aneurysm rupture
  • Avoid in patients with aortic aneurysm or high risk for aortic aneurysm▶Marfan Sx, Ehlers-Danlos Sx, atherosclerotic disease, uncontrolled hypertension
129
Q

Most likely diagnosis in an adult patient with hyperkalemia, hyponatremia, eosinophilia, hypotension, lightheadedness (adrenal insufficiency), fever, weight loss, from southeast Asia and pulmonary airspace disease with lymphadenopathy.

A
  • Tuberculous adrenalitis due to miliary tuberculosis
  • Paraneoplastic syndrome is wrong because they are associated with ectopic ACTH production➡hypercortisolism

*Antituberculous therapy rarely improves function, irreversible destruction

130
Q

Most common etiology in a patient with a progressive lesion in the scalp (scaly patches with alopecia with lymphadenopathy) for 6 weeks, with no improvement after 7 days of antibiotics.

A 
*Suspect Tinea capitis
Dermatophytes:
- Trichophyton tonsurans
- Epidermophyton floccosum
- Microsporum canis
- Microsporum gypseum
131
Q

General empiric antibiotic therapy for immunocompromised patients with bacterial meningitis

A

Cefepime (Ceftazidime or Meropenem) + Vancomycin + Ampicillin

  • Cefepime: Streptococcus, Neisseria, GBS, H. influenzae, Pseudmona
  • Vancomycin: cephalosporin-resistant pneumococci
  • Ampicillin: Listeria monocytogenes
132
Q

Prophylaxis for chronic granulomatous disease

A

TMP-SMX, itraconazole, interferon gamma

133
Q

Most common microorganisms to cause brain abscess in a immunocompetent patient

A
  • Streptococcus viridans
  • Staphylococcus aureus
  • Direct spread (eg, otitis media, mastoiditis, sinusitis)
  • Hematogenous spread (eg, endocarditis)

USMLE Step 2 CK Flash Cards (17 decks)

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