MTB 3

Question 1

Painless genital ulcer w heaped-up indurated edges and Painless adenopathy

Answer 1

Primary Syphilis

Question 2

Rash in palms and soles, alopecia areata, mucous patches, condylomata lata

Answer 2

Secondary Syphilis

Question 3

What is condylomata lata

Answer 3

Wart like lesions on genitals

Question 4

When do we see false positive VDRL/RPR

Answer 4

Infxn
Older age
IVDA
AIDS
Malaria
Antiphospholipid syndrome
Endocarditits

Question 5

When do we desensitize pts to PCN

Answer 5

Tertiary Syphilis

Pregnancy

Question 6

What is jarisch-Herxheimer RXn

Answer 6

Fever and worse sx’s after TX

Give ASA and antipyretic

Question 7

What is condylomata Acuminata?

DX?

Answer 7

Genital warts caused by papillomavirus

DX based on visual appearance

Question 8

TX for condylomata Acuminata?

Answer 8

Cryotherapy w liquid Nitrogen
Surgery
Podophyllin
Imiquimod

Question 9

TX for pediculosis

Answer 9

Permethrin

- found on hair bearing areas, itching

Question 10

TX for Scabies

Answer 10

Permethrin

Question 11

Presentation of Interstitial Cystitis

Answer 11

Urinary urgency, frequency, chronic pelvic pain
Worse w sex, bladder filling, exercise, spicy food
Relieved by voiding

Question 12

Management of Interstitial Cystitis

Answer 12

Cytoscopy - submucosal petechia,

ulcerations

Question 13

Pt presents w dysuria and WBCs elevated, next step?

Answer 13

TX TMP SMX for 3 days - uncomplicated, 7 days for complicated
Don’t need to culture

Question 14

Best initial test in cystitis

Answer 14

UA w more than 10 WBCs

Question 15

Most accurate test cystitis

Answer 15

Urine culture

Question 16

TX options for cystitis

Answer 16

TMP/SMX
Cipro
Cephalexin
Nitrofuantoin - pregnant women

Question 17

TX for pyelonephritis

Answer 17

Amp and Gent
Cipro
Aztreonam
Ceftriaxone

Question 18

Pt that is unresponsive for 72 hours to Abx - next step?

Answer 18

Renal US

Question 19

Presentation of acute prostatitis

Answer 19

Dysuria
Perineal Pain
Tender prostate

Question 20

Presentation of perinephric abscess

Answer 20

Pyelonephritis that does not respond to tx

Question 21

What bugs cause perinephric abscess

Answer 21

E.Coli
Klebsiella
Proteus

Question 22

Management of perinephric abscess

Answer 22

Drainage of fluid

Culture to guide tx

Question 23

What is a perinephric abscess

Answer 23

collection of infected material around kidney

Question 24

Presentation of Infective endocarditis

Answer 24

Fever + Murmur
Splinter hemorrhages
Janeaway lesions = flat and painless
Osler nodes = raised and painful

Question 25

Best initial test for IE

Answer 25

Blood culture + TTE

Question 26

Best initial tX for IE

Answer 26

Vanco + Gent

Question 27

TX for viridans strep IE

Answer 27

Ceftriaxone 4 weeks

Question 28

TX for staph auereus IE

Answer 28

Oxacillin Nafcillin Cefazolin

Question 29

TX for fungal IE

Answer 29

Amphotericin | Valve replacement

Question 30

TX for staph epidermidis or resistant staph

Answer 30

Vanco + Gent

Question 31

Tx for enterococci IE

Answer 31

Amp + Gent

Question 32

What is MCC of IE w nosocomial infxn

Answer 32

Enterococci

Question 33

What is MCC IE w IV catheters

Answer 33

Staph Epidermidis

Question 34

When is Surgery answer for IE

Answer 34

CHF Ruptured valve Chordae tendineae Prosthetic valves

Question 35

What TX do we add for prosthetics

Answer 35

Rifampin for staph

Question 36

What are the culture negative organisms for IE

Answer 36

``` HACEK Haemophilis athrophilis/parainfluenza Actinobacilis Cardiobacteriium Eikenella KIngella ```

Question 37

TX for HACEK IE

Answer 37

Ceftriaxone

Question 38

What are the MCC of culture negative endocarditis

Answer 38

Coxiella | Bartonella

Question 39

WHen is PPX needed for IE

Answer 39

Significant cardiac defect + Risk of bacteremia | Cardiac defect - VSD, MS, AR, MR

Question 40

Risk of bacteremia?

Answer 40

Dental work w blood | Resp tract surgery

Question 41

Best initial management for PPX for IE

Answer 41

Amoxicillin 1 hour before surgery | If allergic - Clindaycin, Azithromycin, Clarithromycin

Question 42

Lyme Dz Rash Presentation

Answer 42

5 - 14 days after | Erythema migrans = round red lesion with pale center

Question 43

Joint pain in Lyme Dz

Answer 43

Oligoarthritis = few joints | Knee - MC affected

Question 44

Most common cardiac manifestation in Lyme

Answer 44

Transient AV block

Question 45

When do we do serological testing for Lyme

Answer 45

Joint Neuro Cardiac NOT for rash

Question 46

TX for Lyme Rash

Answer 46

Doxycycline | Amoxicillin = pregnant and children

Question 47

TX for Lyme Joint or CN (7) palsy

Answer 47

Doxycycline | Amoxicillin = pregnant and children

Question 48

TX for Cardiac and neuro - Lyme Dz

Answer 48

IV Ceftriaxone | Can use transcutaneous pacemaker

Question 49

When do we send tick for routine analysis

Answer 49

Never.

Question 50

PPX Doxycycline in aysmptomatic tick bite

Answer 50

Ixodes scapularis Id'd | Tick attached for > 24 hours