Internal + USMLE Micro Flashcards
(392 cards)
1
Q
What are the 3 Genomes of HIV and what each one encode?
A
Env Gene - GP160»_space; GP120 + GP41
Pol Gene- RT, Integrase, Protease (RIP)
Gag- P17, P24 (core proteins)
2
Q
What is the role of G120 and GP41
A
GP120 = Docking protein»_space; connect to CD4 + CCR5 or CXCR4
GP41 (Transmambrane)»_space; Fusion and entry to the cell
3
Q
Which co-receptor in infeciton with aids is associated with macrophage and which with T-cells and which type of infeciton (late or early)
A
Macrophages- CCR5 (also have on T cells) = Early infection
T helper cells - CXCR4 (exclusivly on T helpers )= Late infection
4
Q
What will be the consequence of homozygous vs hetrozygous mutation on the E32. and which structure it will effect?
A
E32 mutation- effect CCR5
Homo- Immunity to HIV
Hetro- Slower course
5
Q
What is the screeing test for HIV?
and if positive how we procced
A
4th generation HIV1/2 Ab and P24 antigen combined immunoessey.
if 1 of them positive»_space; procced to HIV-1/2 Ab diffenetation immunoassay
5
Q
What if HIV-1/2/ in Ab differantional immunoassay is negetive ( after 4th generation test is positive)
A
Probably window periot.
will procced to NAT test for HIV-1 (Check for Viral RNA = with negetive Ab test)
if positive = acute infection
negetive = negetive for HIV-1
6
Q
Which testing is used to check suspect baby with HIV? (by matenral transfer)
A
NAAT- Check HIV viral load.
Ab can be transfer by the mom therefore this is not a recommeded test.
7
Q
When HIV»_space; AIDS
A
- CD4 < 200
- HIV + AIDS defining condition (eg. PCP, but cancer and ect.)
8
Q
HIV pt + purple patches on skin?
Dx?
A
Kaposki sarcoma (HHV-8)
9
Q
What will seen on histology of Kaposki Sarcoma?
A
Slit-like vascular spaces serrounded by prolifration of spindle cells (vascular tumors in histology)
10
Q
What is the Pathophysiology of Kaposki sarcoma
A
VEGF disregulation»_space; vascular proliferation and tumor formation
11
Q
What is a DDx for Kaposki sarcoma?
A
Bacillary angiomatosis ( Bartonella henseale- cat scracth).
differentiate by biopsy- Kaposki- lymphocyte, Bacillary- PMN
12
Q
Which type of hematologic cancer can HHV-8 can cause
A
B-cell primary effusion lymphoma
13
Q
Itching umbilicated papules + Histolgy shows eosinophilic cytoplasmic inclusions
Dx?
A
Poxvirus = Molluscim contagiosum
if multiple lesions appears»_space; take HIV test
14
Q
What is acute retroviral syndrome?
A
Flu / mono like symptoms:
Fever, Pharyngitis, lymph, weight loss (2-6 wks after infection)
15
Q
What are AIDS Def. ilness
A
Candida
Toxo
Carcival Cancer- Pap smear at diagnosis + every 1 year
KAposki
CaT- CaKA
16
Q
HIV + MRI of brain showing Demyalination everywhere.
Dx?
A
PML (progressive multifocal enephalopathy)- JC virus
17
Q
Wich drug that is used for MS can cuase reactivation of JC virus?
A
Natalizumab- monoclonal Ab against alpha-4 integrins
18
Q
Which infections can be seen in HIV + CD4 < 500
A
- Candida albicans- whith trush, scapable
- EBV- oral hairy leukoplakia, unscarpable
- HHV-8- kaposki, localized cutaneous disease
- HPV- SSC at site of sexual contact
- TB
19
Q
Which infections can be seen in HIV + CD4 < 200
A
- Histoplasma capsulutum- oval yeast cells within macropahges.
- HIV- neuropathy, dementia (cerebral atrophy)
- JC virus- PML, non-enhancing areas of dymilination
- HHV-8- dissaminated disease
- Pneumocystic jirovecii- “ground glass” opacities
20
Q
Which infections can be seen in HIV + CD4 < 100
A
- Bacillary angiomatosis- Bartonella (similar to kaposki, neutrophil filtration)
- Candida esophagitis
- CMV- CREEP
- Cryptococcus neoformans- meningitis , india stain
- Cryptosporadium sp- watery diarrhea, acid fast oocyte in stool
- EBV- b-cell lymphoma
- mycobacterium avium/ complex
- toxoplasma- rimg enhencing lesions on MRI
21
Q
What is the possible presentaiton of CMV in CD < 100
A
CREEP:
Colitis
Retinitis
Esophagitis
Enchepalitis
Pneumonitis
22
Q
What is the treatment of PCP?
A
TMP-SMX
23
Q
Which HLA should be checked in correlation to Abacavir hypersensetivity
A
HLAB57
24
25
what type HIV virus is?
Retrovirus (2 ssRNA copeis)
26
structure of HIV virion? Envelope + capsid + enzymes
Envelop >> GP41 + GP120 glycoproteins >> bind CD4 receptors CXCR4 & CCR5
Capsid >> P24 proteins >> help virus to fuse with the cell
Reverse transcriptse >> turn dsRNA to DNA
Integrase >> integrate the virus DNA into the host genome
27
Which mutation can lead to resistance to HIV
Homozygous mutation in E32 >> effect CCR5
*Hetrozygous >> slower course of disease
28
Whats the diagnosis:
HIV + violaceous purple patches on the skin?
who is the pathogen?
Kaposki sarcome
pathogen: HHV8
29
Whats the diagnosis:
HIV + itching umbilicated papules + eosiniphilic cytoplasmic inclusions
who is the pathogen?
Pox virus >> molluscon cintagiosum
**if pt have multiple lesions >> HIV test should be taken**
30
what are the initial symptoms of HIV
**Acute retrovial syndrome**
Flu like symptoms **2-6 wks after infection**: Fever, phyringitis, lymphadenopathy, loss of weight
31
when HIV is turned to AIDS
AIDS defining ilness and defining diseases
AIDS defining ilness = CD4 < 100
**AIDS defining diseases:
**
1. Candida esophagitis
2. Toxoplasmosis
3. Cervical cancer --> pap smear at diagnosis & every 1 yr.
4. Kaposki sarcoma
32
What is the clinical presentation of JC virus?
**Progressive multifocal enephalopaty:**
paretial, occiputal, cerebalum
non enhancing lesions (multiple)
33
which medication can ceasue activation of J.C virus
Rituximab, Natalizumab >> supress immunity >> JC virus >> PML
34
# in HIV, which pathgens / diseases in each CD4 count
CD4 < 500
| 1
candida esophagitis
35
PCP infection:
what we will see on CXR?
Which stain will be positive?
Whats the treatment?
1. CXR- ground glass
2. Silver stain
3. TMP-SMX
36
# in HIV, which pathgens / diseases in each CD4 count
CD4 < 200
| 4
PCP, Crypto,Coccido, Histoplasmosis
37
# in HIV, which pathgens / diseases in each CD4 count
CD4 < 100
| 2
J.C virus (PML), Toxoplasma
38
# in HIV, which pathgens / diseases in each CD4 count
CD4 < 50
| 3
CMV retinitis, Bacillary angiomatosis, Primary CNS lymphoma
39
What we need to check after confirming diagnosis of HIV
| 5 things
1. Viral load
2. lipid profile &glucose leves
3. E32 mutations (CCR5)
4. HLAB57 (abacavir hypersensetivity type IV)
5. perform PDD (mentou) check for TB
40
Which vaccination shouldbe giver and in which interbal in HIV patients
| 3
1. PPSV23 - every 5 years (2+3)
2. HBV if not vaccinated yet
3. Influenza - every year
41
What are the 2 prognostic factors in HIV
1. CD4 count
2. Viral load
42
what we check in the fetus of mother with AIDS?
HIV RNA
Ab - can be positive due to placental transfer
43
# Diarrhea & HIV
Bloody Diarrhea
what is the diagnosis?
CMV
44
What is the most common reason for chronic waterydiarrhea in AIDS pt?
Cryptosporidoium
45
# Diarrhea & HIV
HIV + Bloody Diarrhea
what is the diagnosis?
CMV
46
# Diarrhea & HIV
HIV watery Diarrhea without fever
what is the diagnosis?
microsporidia
47
# Diarrhea & HIV
HIV watery Diarrhea + fever
what is the diagnosis?
Cryptosporidium
most common cause of chronic watery diahhrea in AIDS pt.
48
Cryptosporidoium:
yes or no?
acid-fast?
colour of stain?
| - protozoa
acid fast oocyte, stain of intraluminal red pink oocyte in stool
49
HIV + subacute memory loss + psycomotor deficit + Hyperintense lesions on subcortical white matter + biopsy with multinucleated gaint cells + microglial nodules
| whats the diagnosis
HIV encepahlopathy
50
which type of nueron supporting cells HIV love and what it ceaused
Microglial cells >> go inside >> giant cell formation
51
most common cause of pneumonia in HIV pt?
Strep. pneumo (lobar pattern)
52
what is prophylaxias for HIV transmittion?
Tenofovir + Emtricitabine
53
what is the most common pathogen for viral gastroeneritis?
Norovirus-
מונו מונו אני "לבד" וטוב לי- הפוכה, בתי ספר, קרוזים , בתי אבות.
חשיפה -- אחרי יומיים הקאות ושלשולים -- עובר אחרי 72 שעות
EXplosive diarrhea- daycares + cruzes + placed with lots of ppl
54
מה הפתוגנזה של רוטה וירוס
Duedonum + proximal jeujonum >> villi blunting, prolifration of crypts cells and loss of brush border enzymes
| no fecal luekocytes
55
what Administration of moderate to severe dehydration in childrens?
| which fluid and how
Bolus IV istotonic fluids
56
# whats the pathogen?
Raw /prepared food (potato salad) >> 3 hrs later >> VOMITING + wattery stool
| vomiting > diarrhea
S.aureus (by injestion of toxins)
57
what is the DDx for vomiting dominant gastroenteritis?
| 2
S. aureus
Bacillus Cereus
58
whats the pathogen?
Vomiting dominant Gastroenteritis after reheating rice
Bacillus cereus
סיראוס- סיר אוז
Enterotoxin
59
Whats the pathogens?
return from india w/acute onset od diarrhea and abdominal pain
Traveler's diarrhea = ETEC E.coli (Exterotoxigenic)
60
what are the 2 types of ETEC toxin
Heat-labile = activation of adenylate cyclase = increase cAMP
Heat stable = activation oc Gunelate cyclase = increase cGMP
61
Whats the most common causeses (3) of acute onset bloody diarrhea?
* E.coli O157:H7
* Compylobacter
* Shigella
62
# whats the diagnosis?
31 yr old >> 7 days of lower abdominal pain + bloody diarrhea (wakes at night). Hb 8. MCV 67, PLT 55K, WBC 11K, Cr 2.4, coombs negetive, schistocyts on blood smear
| what cause it
Hemolytic Uremic Syndrome = HUS
Thrombocytopenia - around 40-60K
Diagnosis- E.coli O157:17 (STEC- shiga toxin) or Shigella dysenteriae
63
who have the greater risk for HUS
children < 10
E.coli (STEC O157:H7) or Shigella dysentheria
64
What the patogenesis of O157:H7 EHEC + Shigella dysenteriae
inhibition of 60S >> block protein synthesis >> cell death >> watery diarrhea that may become bloody
65
True / False
pt with EHEC will always present with fever
**False**
will not have fever
66
how to EHEC transmitted
Contaminated / undercook foood
67
How to destinguisah Inflammatory diarrhea with non inflammatory?
preseance of fecal blood and leukocytes
68
which medicaiton can cause diarrhea
1. Metformin
2. allopurinol- prevent gout, lower uric acid levels
3. orlistat- for loosing weight
4. SSRI
5. cholinesterase inhibitor
6. PPI
7. NSAIDS
| MOCA PAN
69
How can we resolve osmotic diarrhea comapre to secretory diarrhea
osmotic diarrhea- can be resolved by fasting
70
what do Shigella cuease to the intestital epithelium
Invade and enter enterocytes >> cell death of epithelium >> ulcerationd and bloody / mucoid diarrhea
71
whare are the 2 classic symptoms of shigella infection?
1. High fever
2. Left side abdominal pain (rectosigmoid)
72
Which complecation can shigella cause in pediatrics?
Siezures
73
why shigella species rq low infection dose to cause disease?
survive in acidic enviroment of the GI tract
74
What are the characterstic of shigella on labratory:
1. lactose fermantation
2. which agar
1. Non lactose fermentation
2. Non hydrogen sulfide on triple sugar iron agar
75
What cause Campylobacter gastroeneritis?
| 2
Poultry (fram chickens) and domasticated animals (dogs..)
76
whats the diagnosis?
Diarrhea mucoid / bloody + fever + pseudoappendecitis (oliocetis) in a pt that have a dog
Yarsenia enterolitica
77
which pathogs are the 2 most common cuase of
**psuadoappendicitis**
in USMLE
* Yersinisa enterolitica
* Campulobacter jejuni
78
# whats the diagnosis
trip to india >> eat local food >> 2 weeks later >> fever 1 week >> severe abdominal pain + distenaion + salomon colur (rose spots) circular lesions
| also, who is the pathogen and how transmitted
* Thypoid fever
* Slamonella Thypi
* Feco-oral transmittion
79
Which pathogen associated with contaminated food and water can cause **Hemorrhagic enteritis (Bowl perforation)**
Salmonella Thypi
80
How Slamonella thypi invade the immune sys?
Via capsular antigen >> inhibit nuetophils >>replication in macrophages
81
Which Hematological disease can present with Non-typhoidal salmonella osteomoylietis
Sickle cell
82
What the presentation of Non typpoidal salmonella?
bloody diarrhea after eating a lot of eggs / contact with turtules/pets
83
which pathogen cause a foul smelling amniotic fluid + gram positive bacilli
Listeria monocytogenes
84
Which pathogen is presented with " Thumnling motility in room Tm"
Listeria monocytogenes
| facultative anaerobe
85
Listeria monocytogenes:
in adult
in pregnent women
what the presentation?
Story of expose to deli meet / cheeses
adults- Self limiting Gastroenteritis
Pregnant- Intrauntrine fetal demise = death (Hepatic abcess)
86
When we will give Abx for acute diarrhea?
1. Severe with systemic symptoms > 7 days
2. immunocompromised
87
How to diagnosed C.difficle
**stool PCR analysis or enzyme Immunoassay **
for C.diff toxins
or
Glutamtate dheydrogenase antigen
88
Whats the diagnosis?
inpatint stay / use of antiontics in pat 12 wks , on day 3 on hospital present with fever, Watery diarrhea with trace of mucus and blood
C.difficile
89
All the following are major risk factor for ___________
Abx use, PPI, cytotoxic Chemotherapy, age >65, recent hospitalization
C. difficile
90
Whats C.difficle typical finding on colonoscopy
psuedomembranes
| Fibrin & inflammatory cells
91
how so psuadomembranous form?
Ingestion of pores >> Toxin A &Toxin B >> inflammatory reaction >> actin cytoskeletal structre disrapture
| C. difficile (gram positivie)
92
Tx for C.difficile?
Vanco or Fidaxomicin (macrolide)
93
What is the mechanism of aciton of macrolide?
inhibit RNA polymerase >> Bactericial
94
Tx for toxic mega colon after C.difficle
Bowl rest + NG tube + PO and rectal fidaxomicin / vanco and consider Metronidazole + Stop antinotility agents
| if severe = consider colectomy
95
Which of the following wont prevent/ kill bacterial spoers of C.difficile?
1. handwashing
2. Alcohol
3. Nonsterile gloves + Gown
Alcohol woldn't kill bacterial spores
96
Watery diarrhea after return from trip
ETEC
97
Watery diarrhea with "rice water stool"
Vibrio cholera
98
Watery diarrhea on cruise ship
Norovirous/ Norwalk virus
99
Watery diarrhea in HIV
Cryptospardium parvum
100
Bloddy diarrhea + consuming meat
Shigella
(or maybe EHEC, Compylobacter)
101
Bloddy diarrhea + lactose ferment
EHEC
102
Most common cause of bloddy diarrhea in usa
c. jujuni
103
Diarrhea that feels like Appendicitis
Yersiniea enterolitica
104
Protozoal cause bloody diarrhea
Entamoeba hystolitica
105
Blodody diarrhea + HUS
EHEC or Shigella
106
Diarrhea after consuming oysters / seafood
Vibrio parahemolyticus
107
Diarrhea after consuming oyster / seafood + elevated liver enzymes
Vibrio vulnificus
108
Diarrhea after sweimming in fresh water- (also aquarium association)
Aeromonas
109
Diarrhea after reheat rice
Bacillus cereus
110
Diarrhea 6-15 hrs after meat/ poultry left out long
Clostirdium Perfingens
111
Rash + slapped cheeks apprerance
parvo B7
112
Which solution recommended to treating children with waterry diarrhea?
Oral rehydration dolution
113
What innervate the parietal pleura?
Phrenic nerve (pleuritic chest pain)
114
what innervate the peicardium
Phrenic nerve = pleuritic chest pain
115
what are the 3 classical finding of pleural effusion?
Decrease breath sounds
Decrease tactile fremitus
Dull to percussion
116
Dx of pleural effusion on CXR?
Blunting of costophrenic angles
117
Gold standart for pleural effusion Dx
CT >> Decubitus >> create fluid layer (in CXR problem in fluid < 300 ml)
118
What is the most common cause of transudate effusion?
CHF (bi-lateral)
119
What can be adverse affect of loop diuretics?
Calcium oxalate kidney stones (loop ceause Ca excretion)
120
Which medication can ceuase Drug induce Pancreatitis?
Thiazide
(will not give in DM- will cuase hyperglykemia by opening K chaneels in beta pancreatic cells)
121
Defintion of pleural effusion
> 1 out of 3:
pleural Protein/ Serum protein > 0.5
pleural LDH/ serum LDH > 0.6 (from serum)
pleural LDH > 2/3 from upper limit of normal serum LDH
122
Common cause of exudative pleural effusion?
1. infection >> pneumonia >> parapneumonic effusion
2. malignancy
3. Rheumatological diseases
123
What are the 2 mechanism of pleural transudate?
1. Change in hydrostatic pressure (HF)
2. change in oncotic pressure (nephrotic syndrome, liver chirrosis)
124
Foul smelling pleural effusion?
anaerobic = do fermantation
125
Surgical procedure >> pleural effusion >> yellow fluid (milky)?
Chylothorax (conatin chylomicrons)
126
Which syndrome is characterize with cystic hygroma and ammanorea
Turner syndrome.
Cystic hyfroma>> lymph obstruction >> Pleural effusion
127
Raddish pleural effusion + High RBC
Hemothorax
128
Raddish pleural effusion + High RBC
WITHOUT TRAUMA
Reapet >> if still high RBC count >> Cancer
129
Most common cancer in pleura?
Asbestosis
130
Pleural effusion + malignant cells.
what most common cause?
Metastasis (mainly from breast)
131
Lung cancer + consitpaiton?
Paraneoplastic syndrome >> Squemous cells >> PTHrP
132
Pleural effusion with High WBC (lympocyte predominant), High Adenosine deaminase content (ADA)
if acid fast >> TB
if negetive acid fast ? not rule TB yet.
133
Pleural effusion + adnexal mass + Asicets
Meigs syndrome (benign ovarian tumor) - Thecoma fibroma
134
Which IL preserve granuloma?
TNF-alpha, IL-2
135
Cough + coryza + Conjuctuvitis (3C's) + koplot spots
measles (Rubeola)
136
Gastroenteritis + paralysis
Poliovirus
137
Parotitis, orchitis, male sterility
Mumps virus
138
PDA/ Cataracts/ blindness in newborn
| TORCH
Rubella
139
painful skin lesion in dermatotomal pettern
Varicella zoster virus (HHV3)
140
Virus dormant in Dorsal root ganglions
Varicella zoster virus (HHV3)
141
Retinitis in HIV
CMV
142
Painful vasicles on genitals
HSV2
somtimes HSV1
143
Hepatitis in pregnent with high mortality
HEV
144
Which gastroenteritis virus involve reassortment
Rota virus
145
Prophylaxis for RSV
Palivizumab
146
Segmented genome + Epidemic shift pneumonia
Influenza virus
147
Encephalitis in neonates
HSV (mainly temporal lobe)
148
Bloody diarrhea from undercooked chicken
C. jejuni
149
Hylorinic Acid capsule + M protein
Strep. pyogenes (GAS)
150
Encephalitis weeks after consuming uncooked pork
Taenia solium (neurocysticercosis)
151
Bloody diarrhea with Hepatomegaly
Enteoambea hystolitica
152
AFB stainning of stool smale in AIDS pt
Cryptosporadium parvum
153
Sexually active male with arthritis and skin petechia
N. gonorrhoeae
154
inf. of testicals / parotid gland
mumps
155
Sickle cell pt with low Hb / pancytopenia
Parvo-B19
156
Nuchal rigidity in 2wks old child
GBS
157
most common cause of STD in US
Chlamydia trachomatis (D-K serovars)
158
Most common UTI in US
E.coli
159
Genetic property associated with worldwide influenza epidemic / pandemic
A segmented genome
160
Viral conjuctuvitis
Adenovirus
161
Black escher wound in DM
Psuedomonas aeruginosa (Echthyma Gangrenosum)
162
Viral myocarditis
Cosackie B virus
163
Flu like symptoms after visit hawaii
Leptospirosis
164
Cellulitis in burned pt
pseudomonas a
165
Bull's eye rash
Lyme disease
166
Straubbery tounge
GAS (S. pyogenes)
167
Straberry cervix
Trichomonas vaginalis
168
Diarrhea after Mexico and drinking water
ETEC
169
Maculopapular rash after few weeks after spring break
Secondary syphilis
170
Meningitis in college student
N. meningitis
171
Meningitis in pt > 60 yrs
S.pneumonia
172
Drug of choice (DOC) in N.meningitis
Ceftriaxone
173
HIV + small vesicles and ulcers in endoscopy, in Biopsy Multinucleated giant cells and eosinophilic inclusions
HSV esophagitis
DDx: CMV esophagitis >> large ulcers
174
Unprotected sex + multiple painful ulcers
HSV
175
lifecycle of HSV
Latent infection (sensory ganglion) >> periodic flare ups
176
HSV diagnosis
PCR or Tzanck smear
Multinucleated Gaint cells with round glass inclusions
177
Mechanism of Acyclovir
Nucleoside analog >> convert Thymidine kinase to monophosphate >> Cellular enzyme form Tri-phosphate >> incoparte into DNA >> Inhibit DNA polymeras
178
Which adverse affect can Acyclovir cause in IV
AKI with crystal neuropathy
need to be given with a lot of fluid to prevent
179
Foul smelling diarrhea + drank water from river
Giardia
180
Diagnosis of Giardia
Stool ova and parasites
181
Which population is more prone to Giardia lambila
IgA deficeincy
CVID
182
Green vaginal discharge with PH > 4.5
| and treatment
Tricohomonas vaginalis
Tx: Metro to pt and partner
183
low PLT, Anemia + fever 48hours + recent trip to develop country
P. Vivax or P. ovale
184
low PLT, Anemia + fever 72hours + recent trip to develop country
P. malariea
185
Plasmodium Spp. Associated with Hypnozoites (latent stage in liver)
P. vivax and P.ovale
186
Child with itchy butt and Dx test
Enterobius vermicularis
Dx: Scotch tape test
187
Microcytic anemia + worms attech to intestines in colonoscopy
Necator americanus or Ancylostoma duodenale
188
Recent trip to egypts / swimming expedition
| and association with cancer of----
Schistosoma Haematobium
SCC of the Bladder
189
Liver abcess + eat snails
Schistosoma mansoni or Japanicum
190
Immunocomremised with diffuse marking on CXR
| also diagnostic and treatment
PCP
Dx: Silver stain from sputum
TMP-SMX
191
When we will add to PCP treatment steroids?
PaO2 < 70 or A-a gradient >35 or SpO2 < 92%
| add to TM-SMX
192
Meningitis in immunocompromised
| and why ICP
Cryptococcus neoformans
ICP- due to cryptoccocal proteins accumulation, with Low LP openning pressue (proteins block )
193
Microbes that cause Tinea infections (פטרייה עורית)
**Tricophyton**, Microsporum, Epidermophyton
194
Skin finding with Cocciodomyosis?
Erythema nodosum
195
Immunocompremised + 10% esoinophils + RUL nodule or cavitary lesion
Aspergillus
196
Common Etiologies of esonophilia
Drugs, Eddison disease, Lymphoma, Vascular collagen disease (scleroderma), parasites
197
Pulmonary signs + Skin finsgins + Lytic bone lesions + Upper lobe in CXR
**Clue: Winsconsin**
what Tx
Sys. Blastomycosis
Tx: Amphoteracin B
198
Gardener with lesions on one exterimity associated with
Spirotrichosis
199
DKA with Eschars on face
| Histo?
Rhizopus or mucormycosis
on Histo- Asepatate hyhae branching 90 dagree
200
Microbe branching 45 dagrees?
Aspergillus = Acute angels
Upper lobe nodules / cavitary lesions
201
Bulls eye rash pathogen. transmittion?
Borrelia Burgdorferi (lyme disease)
Vector: Ixodes tick
202
The only vaginal infection with PH < 4.5
Candida
203
Which stage of shypilis present with macolupapillary rash?
Secondary syphilis (with condyloma lata)
204
Meningitis with Gram negetive diploccoci
N. meningitis
Tx: Ceftriaxone
205
Which pathogens is associated with water house fredrich syndrome?
N. meningitis
206
What the diagnosis- Sepsis with Hypotension + low Na, high K, Metabolic acidosis
Water house fredrich syndrome with N.meningitis
207
Tx in meningitis in intubeted pt
Rifampin or Ciprofloxacin or Cerftriaxone
208
Most common ceause of meningitis in umimmunized pt (< 3 month)
pneumococcous
209
Neonate (first 28 day of life) with meningitis?
GBS
210
Microbe with hyloronic capsule
GAS (Strep. pyogenes)
211
Whooping cough prophylaxis?
Azitromycin
212
Sexually active female + ataxia + loss of vibration sense
Tabes dorsalis = Tertiary syphilis
213
Enchipalitis after eating pork
Taenia solium
214
Toxoplasma treatment
pyrimethamine and sulfadiazine
prophylaxis CD4 < 100 + positive IgG TMP-SMX
215
sexually active male + arthritis + skin petechia
N. gonorrhoeae
216
Large testicles + large parotid gland
MUMPS
also can present : Pancreatitis/ orchitis
217
Sickle cell pt + low Hb
pathogen? situation?
Aplastic crisis >> parvo B19
218
Second most cause of UTI in US
Staph. Saprophyticus
first: E.coli
219
Sore throat + conjuctuvitis?
clue: also associated with Hemorrahgic cystitis and gastroenteritis
Adenovirus
220
Tx for measles
Isolation + Supportive with Vitamin A
221
HPV associated with cervixal cancer
16,18,31,33
222
Most common cause of cervical cancer death
Renal failure >>Cancer cells spread up the urinary system and invade kydnys
223
Congenital inf. the cause cataract to the newborn
Rubella
224
Measles cause blindness by-------
Keratoconjuctuvitis
225
Heart defect associated with Rubella
Patent ductus arterosus = wide Pulse pressure
226
name of Genital HPV that cuase warts
Condyloma accuminta
227
Treatment for CMV
Ganacycovir
228
2 C/I for Rota virus
Meackels divertivulum
Intussusception
229
2 most common of the "the common cold"
Rhinovirus
Coronavirus
230
Child < 2 yrs + pneumonia with expiratory wheezes and treatment
RSV
Supportive
231
Fever, myalgia, malasia in december
Influenza virus
232
Neomate enchpalitis, LP RBC 400-500 (always < 1000), 1 lympocyte ,normal glucose
HSV
233
Which microbe associate with Erythema chronicum migranatum
Lyme disease
234
Which microbe is associates with erythema marginatum
GAS
235
What microbe is a/w erythema infectiosum
Parvo virus B19
"Slapped cheeks"
236
What micrbo is a/w erythema gangrenosum
psuedomonas
237
Painless genital ulcer + indurated borders
typomona palidum (syphilis)
238
Painless genital ulcer + beefy red rush no Lymphaadenopathy
Klebsiella granulomatis
239
Hitology finding in Klebsiella granulomatis lesion
Donoven bodies
240
STI associated with epithelial cells with inclusion bodies on histo
HSV-2
241
STD with gram negetivie diplococci
N.gonorhea
242
Painlees ulcer + progression to painful lymphadenopathy
Lymphogranuloma venerum (Clymedia trachomatisi L1-L3)
243
Which are the nontreponemal test and the treponemal test
Non treponemal- RPR, VDRL
**if positive**
Treponemal test:
FTA-ABS, TPPA
244
Painful genital ulcers + inguinal Lymphadenopathy
Haemophilus Ducreyi
(you cry with ducreiy)
245
Septic arthritis + urethral discharge
N. gonorrhoeae
246
Tx for N.gonorrhoeae
Ceftriaxone
247
Tx for Chlymydia throchomatis
Azitromycin or Doxycycline
248
Which Clamydia strain are the most coomon cause of blindness in developing world
type A-C
249
Which Chlymdia types responsible for
STI
and which for Lymphogranuloma venerum (paunless ulcer )
STI- D-K types
Venerum- L1-L3
250
Rash on palms + soles and trunks + recent painless chancre
Syphilis
251
Rash on face and decesnt caudaly
Measles
252
inhbit EF-2 by ribosylation, can cause myocarditis with parngytis
Cornybacterium dyphteria
253
Mechanical truama to the teeth / mouth with slow enlraging nonpainful chronic madibular mass with multiple abcesses with drainage of yellow orange sulfur granules
Actinomyces (gram positive bacilli)
254
Which pathogen express Panton-Valentine Leukocidin
S. Aureus >> this virulant factor cause tissue necrosis and necrotizing pneumonia
255
Rash on palms & soles + Mouth lesions
Coxsackie virus " hand-foot-mouth disease"
256
Rash for 3 days >> then postaricular lymphadenopathy?
Rubella virus
257
Most common pneumonia 2-4 yrs old
RSV
258
HIV + consolidation on CXR
Pneumococcous
259
HIV + Interstital inflitrates on CXR
PCP pneumonia
260
Pnuemonia in alcaholics?
Klabsiella
261
Interstitial inflitrates on CXR+ Pet store owner or bird handler
chylamydia psittaci
262
Fever + weight loss & cough/ dyspnea + ulcer in mouth + Lymphadenopathy + Hepatosplenomegaly + high AST ALT
Dx?
Histoplasmosis capsulatum
Dx test: Urine / serum antigen test
263
Fever + weight loss & cough/ dyspnea + ulcer in mouth + Lymphadenopathy + Hepatosplenomegaly + pancytopenia+ AST/ALT
Disseminated toxoplasmosis
264
Pneumonia + recent trip to new mexico
Coccidiomycosis
265
Microbre a/w rose coloured sputum?
pneumoccocus
266
Microbre a/w red current jelly sputum?
klabsiella
267
Microbre a/w pnuemonia + hyponathremia + diarrhea
Lagionella
268
Pneumonia + handle cows
coxiella Burnetii = Q fever
269
Most common pneumonia in CF < 20 yrs old
S.aureus
270
Most common pneumonia in CF > 20 yrs old
Pseudomonas or Bokoderius cepacia
271
3 most common cuases of atypical pneumonia
and what is the Tx?
1. mycoplasma
2. chlamydia
3. legionella
Tx: Erytromycin (macrolide). check for long QT syndrome
272
MOA of macrolide?
inhibit 50S subunit
273
Pnuemonia in neonate + Gram positive cocci?
GBS
274
Pnuemonia in neonate + Gram negetive rods?
E.coli
275
Expiratory wheeze in neonates + pneumonia?
RSV
276
inspiratory stridor in children + pneumonia?
epiglottitis (Hib)
Croup (pertussis)
277
widen CXR in FBI agent or postamail?
Baccilus anthracis >> polyglutamate protein
278
pneumonia then develop lung abcess / cavitation
S. aueurus
279
Pneumonia + spetic emboli IVDU
S. aurerus
280
Water rice stool
Vibrio cholera
281
HIV + large volume watery diarrhea?
Tx?
Cryptosporidium
Tx- Nitazoxanide
282
Bloddy diarrhea after eating beef
1. compylobacter jujeni
2. EHEC
3. Shigella
283
Bloody diarrhea after eating eggs/ poultry
Salmonella
284
Bloody diarrhea in lactose ferment?
e.coli (EHEC)
285
Dx of C.diffcle?
Stool toxin assay
286
Diarrhea + pain in RLQ +FEVER
Yersinia enterocilitica- somtines can be misdiagnosed as appendicitis
287
Protozoal cause bloody diarrhea + liver abcess?
Entemoeba histolytica
288
Watery diarrhea + ate oyster or sea food?
vibrio parahaemolyticus
289
Watery diarrhea + ate oyster or sea food + AST/ALT (specially with pt with liver disease)
vibrio vulnifucus
* anypt with liver disease is at high risk (spacially hemochromatosis)
290
diarrhea + extreme electrolyte abnormality?
Vibrio cholera
291
Watery diarrhea + swam at aquarium or fresh water?
Aeromonas spp.
292
Diarrhea + vomoting + patato salad 2 hours ago
S. aurues
293
Fever + recent dental procedure
Strep. viridans
294
Fever + heart murmur + Hx of sore trhoet
Pnuemococcus
295
Sterile vagiation on Heart valve?
Libman sack endocarditis (secondary to SLE)
296
most common cause of walking pneumonia?
Mycoplasma pneumonia
297
pneumonia in alcoholics + fuel smelling?
anerobes pneumonia
298
pneumonia in the setting of bats dropping, cave travel
Histoplasma capsulatum
299
Pneumonia transmitted via air conditionig
lagionella pneumophilia
300
Hemoraggic mediastinitis + pneumonia in postal worker?
Baccilus anthracis
301
most common cause of pneumonia in young adults?
most common cause of pneumonia overall
in young adults- mycoplasma pneumonia (walking pneumonia)
overall- S. pneumonia
302
pneumonia with lung abcess + anerobes?
Klabsiella pneumonia
303
4 common usmle anerobes?
Peptostroptoccocus
prevotella
fusobacterium
bacteriodes
304
Which pathogens indicate for negetive pressure romm + N95 respiratory?
1. TB
2. Varicella
3. SARS
4. Measles (rubeola)
305
Which pathogens are inicate for contant percussion (gloves & gown)
1. MRSA
2. VRE
3. C.diff
4. E.coli 0157:H7
5. Scabias
6. RSV
306
Which pathogen indicate for Droplet preccusion? mask within 1-2 meters from pt
Meningococcus
Hib
Mycoplasma pneumonia
Influenza
Adenovirus
307
25YO, night swaet, lymphadenopathy, jiont pain, diarrhea, oral ulceration, generalized rash **red oval macules**
Dx?
Tx?
Acute HIV
Tx: Anti retroviral treatment no matter what + propylaxis (by CD4 count) + Testing for latent TB (regardless CD4 count)
308
In what CD4 count Live attenuated VZV vaccine can be given to HIV pt?
CD4 > 200
309
mother with HIV:
1.Tx during pregnancy?
2. cesarean delivary or vaginal?
1. ART during all time (also post-partum)
2. viral load >1000 = Cesarean + intrapartum zidovudine
viral load < 1000 - vaginal delivery
310
AIDS pt + CD40 < 50, Fever, weight loss abdominal pain diarrhea hepatomegaly, LAD, elevated ALP?\
Dx?
Tx?
Dx: MAC (avium/ intracellulare)
Tx: macrolide + ethambutol
311
Whats the main different between SCID to Infantile HIV?
HIV- generlazied lympadenpathy
Scid- no
312
infant with HIV + perihilar reticulonodular inflitrate + severt hypoxemia
Dx?
Diagnosis test
Tx?
Pneumocystic jirovecii
Diagnosis- Bronchoalverolar lavage
Tx- TMP-SMX (if PaO2 < 70 - corticosteroids)
313
If HIV pediartic have pneumocystic jirovecci how we manage?
TMP- SMX until CD4 > 1500 and then >> ART
in adults - start ART ASAP
314
HIV + odynophagia + dysphagia + trush
HSV esophagitis
315
HIV with linear ulcers in distlal esophagus with intracytoplasmic inclusion
CMV/ HSV esophagitis
316
HIV. vasicular / ulcertive lesions and Histology with multineculeated giant cells?
HSV esophagitis
317
AIDS + odynophagia (without dysphagia and Trush)
Dx?
CMV or HSV
318
Chronicwatery diahrrhea + CD < 100
+
1. tempature 37.9
2. empature 36.5-
3.Tm 39.8 + CD4 < 50
1. tempature 37.9 - Cryptosporadium
2. tempature 36.5- Microsporidia/ isosporidium
3.Tm 39.8- Mycobacterium avium complex
319
What is the next step after colonoscopy for CMV colitis?
Rule out CMv retinitis
320
Hematochezia , CMV <100, frequent small bloody stool
CMV colitis. will to colonoscopy with biopsy
321
Low extrimity lymphadema + HIV + brown-purple nodules on different part of the body
Dx?
Kaposki Sarcoma (HHV-8)
322
AIDS +MRI shows solitary, irregular, non homogeneous ring-enhancing mass.
Dx? and pathogen
Primry CNS lymphoma- EBV
(also for Non-hodjkin lymphoma)
323
EBV present on CNS is higly suggestive of----------
Primary CNS lymphoma
324
HIV propylaxis:
CD4 < 250
CD4 < 200
CD4 < 150
CD4 <100
what Tx and for what
CD4 < 250 - Fluconazole for coccicoidiomycosis (in desert places)
CD4 < 200- TMP-SMX for PCP
CD4 < 150- itaconazole for histopalsmosis capsulatum in OH / MS river and expose to bat pooping
CD4 <100- SMP-SMX for toxo if IgG test is positive
325
AIDS patients + Close contact with a person with chickenpox or shingles + NO history of prior disease + Negative VZV antibodies → Best next step?
VariZIg or IVIG (4 days after exposure)
326
when we will give post exposure prophylaxis for HIV and what we will give?
PEP:
ASAP (2-4 hours after exposure) → 2 NRTI + Another 1 (Integrase inhibitor; Protease inhibitor; NNRTI)
327
Which patohgen Egypteian Aedes mosquitoes transfer?
1. yellow fiver
2. dunge
3. zika
4. Chikungubya fever
328
32Y Female → Returned from Kibinimat → Sudden onset symptoms + Fever (39) + SEVERE joint pains (shoulder, elbows, knees) + No G.I symptoms + No skin rash + No murmurs + No crackles/wheezing + Soft abdomen + Swelling of elbow and knee + Labs: Hb 13, PLT 170,000, Leukocytes 2500, BUN 14, Cr 0.9 + Normal LFT’s → Most likely diagnosis?
Chikungunya Fever
329
High fever + polyartralgia distal > proximal. with maculopapular rash after mosquito bite?
Chikungunya Fever
330
Which test is a diagnostic for Dengue fever?
Tourniquet test ( petecha after sphygmomanometer cuff inflation for 5 min)
331
What is the common pathogen that is often isolated from cat/dog bite wounds?
and Tx?
Patrulla
Tx- Amoxicillin- clavulanate
332
Tx for Aspiration pneumonia?
Amoxicillin-Clavulanate
333
Aspiration pneumonia + abcess or emphyema?
tx?
Ampicillin-Sulbactam
334
When we treat asymptomatic bacteruria?
1. Pregnent womens
2. pt before orologic procedure
335
Tx for pregnent women with asymptomatic bacteruria?
Fosfomycin > Cefpodoxime > Amoxicillin-Clavulanate > Nitrofurantoin (nitro- only 1st/3rd trimestir)
336
Who gets prophylaxis for meningococcal?
Household members; Child Care center workers; Roommates or intimate contacts; Person seated next to affected person for ≥8 hr; Persons directly exposed to respiratory or oral secretions (INTUBATE)
337
If you see tender, erythematous streaks extending proximally from the site of wound with tender, enlarged lymph nodes → What is the most likely diagnosis?
most commen pathogen
Tx?
Lymphangitis → Most common pathogen? → S.pyogenes & MSSA → Cephalexin
338
When we will add Dexamethasome for meningtitis?
Strep. pneumonia
339
treatment for bacterial meningitis? → Age < 50
age > 50, immunocompremised
age < 50 = Vanco + 3G cephalosporins
Age > 50 = Vanco + 3G cephalosporins + Ampicillin
imunmocompremised- Vanco + Cefepime + Ampicillin
340
Neurosurgery/skull trauma (penetrating) (Tx)
Vanco + cefepime
341
0Y old + Fever + Cervical lymphadenopathy + Tonsillar exudate + NO COUGH
What is the best next step in management?
Centor Criteria >> Fever = 1p ; Lymphadenopathy = 1p; Tonsillar exudate = 1p; No cough =1p
0-1- go gome
2-3- Rapid antigen deteciton test (phyringitis) >>if positive >> Amoxicillin
4- Amoxicillin
full 10 days to prevent RF
342
What vaccines are indicated for patients with liver cirrhosis?
At Dx- Pneumococcus
every 1 yr- Influenza
every 10 years- Tetanus
if not immune to Hep A or B give
343
What vaccines are recommended for asplenic patients?
Extra:
Pneumococcal vaccine
Hib (1 dose)
Meningococci (every 5Y)
344
Patient with “excessive dandruff and scaly facial rash despite using the same shampoo and cosmetic products as before”
Dx?
NEW ONSET RAPIDLY DEVELOPING SEBORRHEIC DERMATITIS
345
all of the following can be a clue of which infectious disease?
1. parkinson
2. SEBORRHEIC DERMATITIS
3.RAPIDLY DEVELOPING PSORIASIS
4. RECURRENT VZV (IN WEIRD PLACES)
HIV
346
What antibiotics are first-line for burn-related infections?
Piperacillin-tazobactam or carbapenem with vancomycin.
347
What are the causes of post-surgical fever around 6 hrs after procedure
1. Transfusion reaction- if blood gave
2. Malignant hyperthemia (anedthetics induce)
348
Thin malodorous discharge + Friable cervix + Motile motile ovoid organism on microscopy → Most likely diagnosis?
Trichomonas vaginalis
Treatment: ORAL metronidazole (PATIENT + PARTNER)
349
Grayish-white discharge + Wet mount with clue cells → Most likely diagnosis?
how to diagnose?
Bacterial vaginosis (Gardnerlla vaginalis)
Dx: AMSEL criteria
Tx: metronidazole / clindamycin
TREAT only symptomathic patients
350
Tx for Gonoccocal infection (PID + Pharyngitis/tonsillitis + Arthritis + Cervicitis)
IV G3 Cephalosporins
351
Trade sex women, Few painful papules/pustules 9 days ago now with LARGE deep ulcers with gray/yellow exudate (well demarcated borders with soft friable base) + Enlarged and tender lymph nodes
Dx, Tx?
Haemophilus ducreyi (Gram - rod)
Azithromycin + Ceftriaxone
352
Painful mucocutaneous shallow sharply demarcated ulcers on white base + Generalized lymphadenopathy + Rash → Diagnosis?
Acute HIV
353
Painful and fluctuant adenitis (buboes)
Dx?
Chlamydia trachomatis serovars L1-L3
354
Single painless papule → Painless nonexudative ulcer with indurated border + Bilateral painless lymphadenopathy → Diagnosis?
Primary shypilis (Chancre)
355
Severe immunocompromised + Tap water/soil + Refractory fever + Skin lesions + Pulmonary findings
Dx?
Tx?
Dx- Fusariosis - mold
Tx- Amp B +- voriconazole
356
Which pathogens cuase acute bacterial meningitis
Neisseria meningitidis;
Streptococcus pneumoniae;
Staphylococcus aureus
357
Temporal lobe enchncment + opening pressure > 250
Dx?
HSV
358
Opening pressure > 250 without temporal enhancment?
Cryptococcus neoformans
Pseudotumor cerebri
359
The most appropriate treatment for pneumonia associated with erythema multiforme and mild hemolytic anemia is -------
azithromycin to cover Mycoplasma pneumonua
360
Fever + Eosinophilia + Returned from Kibinimat + Eating snails
Dx?
Tx?
Katayama fever (Katayama fever = Acute schistosomiasis = Snail fever)
Treatment → Corticosteroids & Praziquantel
361
what is Lemierre's syndrome
complication of bacterial pharyngitis/tonsillitis and involves an extension of the infection into the lateral pharyngeal spaces of the neck with subsequent septic thrombophlebitis of the internal jugular vein
362
Recent pharyngitis → Neck pain & swelling + Persistent fever (despite antibiotics) + Cavitary lung lesions → → Septic thrombophlebitis (Lemierre's syndrome)
common patogen?
Fusobacterium necrophorum (anaerobic)
363
A 34-year-old man comes to the physician due to high fever, malaise, and intermittent headaches for the last 4-5 days. He recently returned from hiking for several days in wooded areas in Missouri. The patient's temperature is 38.9 C. Physical examination shows a faint, non-pruritic, maculopapular rash confined to the trunk without central clearing. Laboratory results are as follows: Hb 14, MCV 84, PLT 90000, Leukocytes 2900 → Diagnosis?
Ehrlichiosis
Ehrlichia chaffeensis or Anaplasma Phagocytophilum
Tx: doxycycline (even to pregnant)
364
Post transplantation infections:
> 6 month
1-6 month
< 1 month
> 6 month - as general population
1-6 month - CMV, PCP
< 1 month- MRSA, psuedomonas, C.diff
365
Drooling & Peds
3 main things
Epiglottitis
Retropharyngeal abscess
teething (no FEVER)
366
Porphyria cutanea tarda
which enzyme is deficent?
Uroporphyrinogen decarboxylase (UROD) deficiency
367
Blastomycosis
which sites it effect?
bone with sinus tract; Papules; Genitalia
Blasto blasts bones, balls (epididymo-orchitis), and skin.
368
Why is it important to treat with vitamin A in Measles?
prevent blindess
369
Infectious complications of atopic dermatitis
Impetigo
370
fungal thar cause Pruritic scaly patch between fingers?
Tx?
Tinea corporis
Tx- Topical antifungal EXCEPT → Clotrimazole
371
Which Tinea type we will give oral antifugal
Tinea capitis; Tinea nail → Oral griseofulvin
372
H.Pylori infection → → 4 weeks later ↓ PLT, Petechiae + EVERYTHING ELSE IS NORMAL + Normal PT & PTT .
Dx?
ITP
373
treatment for neutropenic fever?
low risk- Oral antibiotics (amoxicillin-clavulanate + ciprofloxacin)
High risk- Blood cultures followed by antipseudomonal beta-lactams (Piperacillin-tazobactam)
Alternative: Cefepime/Ceftazidime/Meropenem
(If septic shock → add vancomycin)
374
What are the low risk features in Neutropenic fever?
1. no hematoligical diasese
2. good oral intake & stable
3. no-comorbisitied
4. no significant GI symptoms
375
Neutropenic fever + Skin manifestation?
Erythema gangrenosum
376
Slowly growing non-tender jaw mass with sulfur granules
Dx, Tx
Cervicofacial actinomycosis
Tx- penicillin for 6-12 months
377
Dilated cardiomyopathy, mega esophagus
Chagas disease
378
2 Infectious causes of seizures:
Neurocysticercosis + Shigella (Peds)
379
Vision loss in neonates:
pathogens
1. Untreated congenital toxoplasmosis (chorioretinitis)
2. CMV → Chorioretinitis
380
CN involve in post herpatic neuralgia?
CN V
381
What are the 3 timline presentation of lyme disease:
early
early disseminated
late
Lyme → Early → viral like symptoms & erythema migrans
Lyme → Early disseminated → arthralgia, carditis (AV block), facial nerve palsy, meningitis
Lyme → Late → intermittent/persistent arthritis > large joint (typical involved joint → knee joint)
382
Lung & CNS disease together in immucosuppressed pt.
what to think?
how to diagnose?
Tx?
NOCARDIOSIS - acid-fast aerobic filamentous branching Gram positive rod. in CXR- nodular infiltration ± abscess
Tx- TMP-SMX
383
Diagnosis of acute bacterial sinusitis → Criteria?
At least 1 of the following 3:
1. Persistent symptoms ≥10 days without improvement
2. Severe symptoms, high fever purulent nasal discharge, or facial pain ≥3 days
3. Worsening symptoms ≥5 days after an initially improving viral upper respiratory infection
384
Tx for acute bacterial infection
Amoxicillin-clavulanat
Alternative: Doxycycline or fluoroquinolones
385
Cutaneous plaques/ulcerations + Bone lesions with sinus tracts + G.U signs/symptoms t.s Diagnosis?
Blastomycosis
Blasto Blasts Bone, Balls (epididymo-orchitis), Basal layer of skin
386
Skin lesions + Lymphadenopathy + Meningitis + Osteoarticular infections
dx?
Coccidiomycosis
387
USMLE & Tattooing Local infections
S.aureus > M.chelonae > Pseudomonas
if systemic complication- Hep C/ B or skin reaction
388
Intervention & Bacteremia
Who to suspect? best next step?
S.bovis/septicum/gallolyticus
next step- Colonoscopy
389
Nontyphoidal salmonella → Best next step?
HIV testing
390
Abdominal pain + Recent history of pneumonia + Eosinophilia → Dx?
Strongyloidiasis
391
How to diagnose Strongyloidiasis
Stool samples → Negative? → Obtain another stool sample → Stool sample negative? (i.e 2 stool samples are negative) → Serology for parasites → If 2 stool samples + negative serology → Duodenal biopsy + Empiric treatment with ivermectin (alternative → albendazole)
