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Flashcards in UW - Med/ID Deck (48):
1

What is Chikungunya fever?

Polyarthralgias, w/ lymphopenia, thrombocytopenia, fever/malaise

Caused by Aedes mosquito, esp in Central/South America, tropical regions

2

How do you differentiate Rubella from Measles?

w/ measles fever is higher (>40), cranial caudal spread of rash is slower (over days)

Rubella can cause polyarthralgias and/or arthritis in adults and rash spreads over hours

3

What clinical features are consistent w/ disseminated MAC in HIV pts? How could you prevent such a condition?

Sx: Fever, cough, night sweats, weight loss, diarrhea, splenomegaly, elevated Alk Phos, w/ CD4

4

What is the prophylaxis for Pneumocystis pneumonia?

1. Trimethoprim-sulfamethoxazole
2nd line Dapsone

5

What is the proper Tx regimen for patients presenting w/ acute bacterial meningitis who are 2-50 yo, >50, Neurosurg/shunt, immune compromised, Penetrating trauma to skull? What else should be given?

1. 2-50 yo: Vanc + Ceftriaxone (N. menin, Strep pneumo_
2. >50 yo: Vanc + Amp + Ceftriaxone (" " + listeria)
3. NS/Shunt: Vanc + Cefepime (GNR, S. Aur, coag - staph)
4. IC: Vanc + Amp + Cefepime (Pneumo, N. Menin, Listeria, GNR)
5. Penetrating: Vanc + Cefepime (S. Aureus, caog - stpah, GNRs)

+ Dexamethasone to all

6

What is a major hematological complication of Mono?

Autoimmune hemolytic anemia and thrombocytopenia, due to cross reactivity of EBV induced Abs against RBCs and platelets (IgM cold agglutinin Abs, Coombs +)

7

What is most significantly associated w/ decreased UTIs in patients w/ neurogenic bladder?

Intermittent catheterizations, b/c indwelling catheters form biofilm and have increased risk of infection

8

What are the recommended vaccinations for patients w/ chronic kidney disease?

Tdap (Td booster every 10 years), Influenza (annually), PPSV23 once, revax w/ PCV13/PPSV23 at 65, Hep A/Hep B (if initial negative serologies)

9

What is the recommended pneumococcal vaccine for adults

PPSV23 alone immmediately

PCV13/PPSV23 at 65

10

What microbes can form hydatid cysts?

Echinococcus granulosus (tapeworm) - from intimate contact w/ dogs

11

What causes cysticercosis?

Taenia sollium --> cysts in the brain

12

What are key clinical features of toxic shock syndrome?

Fever, diffuse myalgias, vomiting, profuse diarrha, HoTN, diffuse macular erythroderma (sunburn), possible leukocytosis (especially BLASTS), and thrombocytopenia
-Hx of tampon use, surgical wound infections, sinusitis, septorhinoplasty/nasal packing

13

What is Sporotrichosis?

Fungal infection by dimoprhic Sporotrhix schenkii, looks like papule at site of inoculation, followed by ulceration and LAD; seen in gardeners

14

What is cutaneous larva migrans?

Helminthic disease caused by larvae Anclyostoma braziliense (dog/cat hookworm) -> occurs after skin contact w/ soil contaminated by dog/cat feces (tropical/subtropical regions of Southeast USA, beaches/sandboxes)

15

What are the key clinical features of disseminated gonococcal infection?

-Prurulent arthritis w/o skin lesions OR triad of Tenosynovitis (wrist, ankles, fingers, knees), Dermatitis (pustules, macules, papules, bullae), Migratory asymmetric polyarthralgia
-high yield link: sexually active, young individual (immediately think gonorrhea in young sex active w/ arthritis)

16

What prophylaxis should be given in HIV+ pts w/ CD count

Trimethoprim-Sulfamethoxazole (CD

17

What is ehrlichiosis? Symptoms/findings?

Spotless rocky mountain fever - tick born illness, fever, malaise, HA, nausea, and vomit, leuko/thrombocytopenia on labs

18

How can you identify Nocardia spp. on staining?

partially acid-fast gram positive branching rods

19

What bugs can you use Aztreonam to treat?

gram negative bacterial infections, like pseudomonas aeruginosa

20

What life threatening conditions are associated w/ HIV therapy?

1. Didanosine - acute pancreatitis
2. Abacavir - hypersensitivity syndrome
3. Lactic acidosis - any NRTIs
4. SJS 2/2 any NNRTIs
5. Nevirapine - liver failure

21

What are the positive cutoffs for PPD skin test based on various patient risk factors?

>=15 mm; LOW RISK: asymptomatic pt, no Hx of exposure or risks

>= 10 mm; HIGH RISK: recent endemic immigrants, IV drug user, High risk environment (prison, homeless), High risk for TB reactivation (diabetes, ESRD, leukemia), Peds =5 mm; IMMUNE SUPPRESSED: HIV+, recent known TB contacts, nodular/fibrotic on CXR, Organ Tx recpipients or other immunosuppressed

22

What is the treatment of choice for primary syphilis? What if patient is allergic to 1st line? Pregnant patient?

1. Intramuscular benzathine penicillin
2. Doxycycline (if penicillin allergy)
3. Aizthromycin - but resistance is increasing

If pregnant can only use penicillin (NOT DOXY), pt should undergo desensitization if allergic

23

What are contraindications to HCV therapy?

Major uncontrolled depression, ongoing alcohol or drug use

24

What are the signs of molluscum contagiosum and who are prone to get them?

Firm dome shaped flesh colored papules w/ central umbilication; passed by sex contact

-Cellular immunodeficient at risk (pox virus spreads dz)

25

What are the clinical features of trichinellosis?

Week 1: intestinal stage - Ab pain, N/V/D

Week 4: Muscle stage - Myositis, fever, subungual splinter hemorrhages, periorbital edema, eosinophilia

26

What is ascariasis?

parasite infection caused by parastic roundworm Ascaris lumbricoides

-SBO, intestinal sx + eosinophilia, nonproductive cough and asymptomatic intestinal phase

27

What is the presentation for Dengue fever?

Fever, Headache, Retro-orbital pain, rash, significant myalgias and arthralgias

28

What are the most important markers for hepatitis B infection?

HBsAg and anti-Hbcore b/c both are elevated during initial infection, and anti-HBc will remain high during window period

29

What are the signs and symptoms of Erysipelas? What is the most likely causative organism?

Inflammation of superficial dermis, prominent swelling, sharply demarcated, erythematous, edematous, tender skin lesion w/ raised borders

Group A strep - S. pyogenes

30

What should multiple hypodense non-enhancing lesions w/ no mass effect in cerebral white matter raise suspicion for (in immunocompromised patient)?

PML - JC Virus

31

What are the characteristics of CMV retinitis?

panless, fundoscopy shows fluffy granular lesions near retinal vessels & associated hemorrhages

32

What viruses can cause severe intraocular inflammation especially in immunocomprimised patients? What are the clinical features?

VZV & HSV --> eye pain, conjuctivitis, rapid progressive visual loss, Fundoscopy shows widespread pale, peripheral retinal lesions and central necrosis of retina

33

What should be considered in any bone marrow transplant recipient w/ pulm and GI symptoms? What would you find on CXR?

-CMV pneumonitis
-Upper and lower GI ulcers
-CXR: Multifocal, diffuse patchy infiltrates

34

What are the toxicities associated with Isoniazid use?

Peripheral neuropathy and hepatotoxicity and sideroblastic anemia

35

What is the most common cause of pneumonia in patients following a viral infection (like influenza)?

Staph Aureus

36

Which patients are susceptible to pneumonia from Pseudomonas?

Nosocomial, pts w/ cystic fibrosis and bronchiectasis

37

What is the most common cause of osteomyelitis in adults w/ history of nail puncture wound?

Pseudomonas aeruginosa

38

What neurological effects are caused by CMV in HIV?

Retinitis (in patients w/ CD4

39

What key test is enough to confirm diagnosis of syphillis in someone w/ penile ulcer? What should be done next?

Dark field microscopy

HIV elisa next

40

What social history factors put patients at risk for TB infection?

-Incarceration, homelessness, foreign country (russia, india, china etc.)

41

What is the most common cause of traveler's diarrhea and how may patients present? When should parasitic cause be investigated?

Enterotoxigenic Escherichia coli (ETEC) - which typically causes a self-limited, relatively mild diarrheal illness that can be treated symptomatically
-Longer bouts of diarrhea require stool ova/parasite analysis

42

What is the most important first test to screen for HIV? How do you confirm?

HIV antibody enzyme immunoassay (EIA)

Western blot assay to confirm

43

What patient populations are most likely to be affected by aspergillosis?

Immunocompromised/neutropenic

44

What are the clinical signs of vertebral osteo?

escalating dull aching back pain w/ tenderness to gentle percussion,
IV drug use can be a clue

45

What are the signs of secondary syphilis?

Rash starting on trunks and extending to periphery, reaches palms and soles of feet, generalized lymphadenopathy

46

Which areas have malaria resistant to chloroquine ppx? WHat should be used instead?

Sub-Saharan africa, SOuthern and southeast asia
-Use mefloquine, doxycycline, atovaquone-proguanil

47

What are the immunological phenomena of infective endocarditis?

1. Osler's nodes - painful violaceous nodules on fingertips and toes
2. Roth spots - edematous and hemorrhagic lesions on retina
3. Glomerulonephritis - dark cloudy urine
4. Arthritis or positive Rheumatoid factor

48

What is the treatment of choice for early localized lyme disease in pregnant/lactating women and children

Oral amoxacillin (doxy causes teeth discoloration and retards skeletal development)