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683 Cards in this Set

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Q001. Infective Endocarditis - What is it; Risk Factors
A001. Infection of endocardium secondary to infectious causes; MC affects heart valves - especially mitral valve; Risk Factors - dental procedures that cause bleeding, oral & upper respiratory surgery, certain GI procedures, GU surgery, prosthetic heart valves, valvular heart disease, alimentation caths in right heart pressure monitoring caths, IVDU
Q002. Infective Endocarditis - Causes
A002. acute - S. aureus; subacute - S. viridans; IVDU - S. aureus; prosthetic valve - coag-negative Staph,; coexisting GI malignancy - Strep. bovis; fungal – Candida, Aspergillus; predisposing factors - long-term indwelling, IV catheter, immunosup from malignancy, AIDS, organ transplant, IVDU
Q003. Infective Endocarditis - Hx
A003. Fever; chills; weakness; dyspnea; sweats; anorexia; skin lesions; IVDU; in patients with h/o valve disease or IVDU - fever alone should be red flag
Q004. Infective Endocarditis - PE
A004. Fever; heart murmur; Osler's nodes; Janeway lesions; splinter hemorrhages; Roth's spots
Q005. Infective Endocarditis - Dx
A005. Fulfill Duke's criteria:; major criteria - • positive Blood culture - 2+ sets • abnormal echo – vegetations, paravalvular abscess, new regurgitation, new partial dehiscence of prosthetic valve • TTE - very specific • TEE - very sensitive; or 1 major and 3 minor criteria - PE findings, emboli, glomerulonephritis, positive Rh factor; Other findings – leukocytosis, left shift, increased ESR, increased C-reactive protein, mild anemia, microscopic hematuria, EKG
Q006. Infective Endocarditis - Tx
A006. Tx based on organisms & sensitivity; if very ill – empiric empiric - antistaph, antistrep & gentamicin, change as soon as know organism; surgery if - severe CHF from valve incompetence, paravalvular leak around prosthetic valve, fungal endocarditis, persistent bacteremia despite Antibiotics, extravalvular infection; Antibiotics prophylaxis before: • dental work – amoxicillin, if PCN allergy - clindamycin or azithromycin, clarithromycin or cephalexin • urinary or GI procedures - ampicillin and gentamicin, if PCN allergy - vancomycin and gentamicin
Q007. Candidal Thrush - What is it & risk factors
A007. Infection of C. albicans, risk factors; xerostomia; corticosteroid inhaler use; immune def. immunosuppressive Tx; leukemia; lymphoma; cancer; diabetes; obesity; pregnancy; can cause skin infections in noncompromised (diaper rash)
Q008. Candidal Thrush - Hx/PE
A008. White, cream-colored or yellow plaques can be scraped off, leaves bleeding surface, frequent complaint of mucosal burning; oral candidiasis; intertriginous; candidal paronychia; vulvovaginitis - pregnancy, DM
Q009. Candidal Thrush - Dx
A009. Clinical Dx; KOH; Cx - definitive
Q010. Candidal Thrush - Tx
A010. Hair & nails involved - can't use topical, must use systemic; not involved – topical nystatin; clotrimazole; fluconazole, miconazole; amphotericin; oral nystatin - 4x/day, "swish and swallow" use for 5-7 days after lesions disappear
Q011. Pneumocystis Carinii Pneumonia; What is it
A011. Organism of low virulence; found in lung of humans; predisposing factor in development of PCP - impaired cell- mediated immunity
Q012. Pneumocystis Carinii Pneumonia; Hx/PE
A012. Pneumonia; DOE; dry cough; fever; chest pain; impaired oxygenation; SOB; tachypnea; tachycardia
Q013. Pneumocystis Carinii Pneumonia; Dx
A013. Principle diagnostic test - bronchoscopy with bronchoalveolar lavage; CXR - b/l diffuse perihilar infiltrates; silver stain and immunofluorescence of sputum samples
Q014. Pneumocystis Carinii Pneumonia; Tx
A014. TMP-SMX; pentamidine; steroids - adjunct if severe - PaO2 <70, A-a gradient >35 Prophylaxis:; TMP-SMX - oral, #1; dapsone - #2; atovaquone - #3; aerolized pentamidine; prophylaxis can be stopped - if antiretrovirals raise CD4 > 200 for >6 months
Q015. Chlamydia - What is it
A015. MC bacterial STD in US; Chlamydia trachomatis; can infect genital tract, urethra, anus and eye; in newborns - conjunctivitis, pneumonia; coexists or mimics gonorrhea; test for both
Q016. Chlamydia - Hx/PE
A016. Hx - often asymp; urethritis – dysuria, urgency; mucopurulent cervicitis, vaginal discharge, bleeding, dyspareunia; salpingitis; PID - abdom pain, fever; nongonocc urethritis - men; PE - mucopurulent discharge, cervical or adnexal tenderness, penile discharge, testicular tenderness
Q017. Chlamydia - Dx
A017. Ligase chain reaction test - of voided urine; serology- fluorescent Ab; (swab of male urethra); (gram stain of discharge - may show PMNs, but no bact.)
Q018. Chlamydia - Tx
A018. Doxycycline; or azithromycin; pregnant - erythromycin
Q019. Chlamydia - Complications
A019. Chronic infection; pelvic pain; Reiter's syndrome; Fitz-Hugh-Curtis syndrome; PID => infertility; epididymitis
Q020. Gonorrhea - What is it
A020. Gram-negative diplococcus; can infect almost any site in female reproductive tract; men - usually limited to urethra
Q021. Gonorrhea - Hx/PE
A021. Greenish-yellow discharge; pelvic or adnexal pain; swollen Bartholin's glands; purulent urethral discharge; dysuria; erythema of urethral meatus
Q022. Gonorrhea - Dx
A022. Swab & culture on Thayer-Martin medum; gram stain cervical discharge; Culture - most specific test
Q023. Gonorrhea - Tx
A023. single-dose ceftriaxone 250 IM and doxycycline for 7 days; or single-dose ceftriaxone 250 IM and single-dose azithromycin; or single-dose oral cipro or cefixime; (also treating for chlamydia - doxycycline or macrolide); condoms for prophylaxis
Q024. Gonorrhea - Complications
A024. Urethritis; epididymitis; cervicitis; PID; tubo-ovarian abscess & rupture; Fitz-Hugh-Curtis; DGI (Disseminated Gonoc Infec); persistent infection with pain
Q025. Syphilis - What causes it
A025. Treponema pallidum; spirochete
Q026. Syphilis - Hx/PE
A026. Primary - 10-60 days after infection, chancre (painless ulcer) near area of contact, spontaneously heals in 3-9 weeks; Secondary - 1-2 months after see chancre, maculopapular rash on soles, palms, low-grade fever, headache, malaise, lymphadenopathy, can see alopecia, meningitis, hepatitis & nephritis may also be seen, very infective 2o eruptions, coalesce => condylomata lata, spontaneously heals in 2-6 weeks; Early latent - no symptoms, positive serology, first yr of infection; Late latent - no symptoms, positive or negative serology, > 1 yr of infection, 1/3 will progress to tertiary; Tertiary - 3-20 yrs after init infection, not contagious, gummas, Tabes dorsalis, Argyll Robertson pupil, CV – aortitis, aortic root aneurysms, aortic regurgitation
Q027. Syphilis - Dx
A027. Best diagnostic in primary - dark-field microscopy; secondary - RPR/VDRL
Q028. Syphilis - Tx
A028. primary & secondary - IM PCN 2.4 million units/wk, primary - 1 wk, secondary - 3 weeks; tertiary - IV PCN, 10-20 million units/day x 10D; PCN allergic - primary & secondary – doxy, tertiary or pregnant - desensitize; Jarisch-Herxheimer - > 50% of patients, fever, headache, sweating rigors, temp exacerbations of lesions, 6-12 hrs post Tx
Q029. Histoplasmosis - What is it
A029. Dimorphic fungus; environment - mold (mycelial), yeast in body; endemic - MS River, OH; self-limited flu-like Symptoms; mediastinal fibrosis, residual scar tissue; chronic cavitary disease - if obstructive lung disease; disseminated histoplasmosis - especially in immune compromised, infants, fatal if untreated; risk factors – AIDS, spelunking, bird and bat feces
Q030. Histoplasmosis - Hx/PE
A030. Acute infection - arthralgia, erythema nodosum, erythema multiforme; chronic infection - low-grade fever, anorexia, weight loss, night sweats, productive cough
Q031. Histoplasmosis - Dx
A031. polysaccharide Ag detection, fast test for Dx and monitoring relapse; complement fixation Ab of 1:8 of 1:16; silver stain on Biopsy, bone marrow, l. node, liver; bronchoalveolar lavage; CXR; chest CT
Q032. Histoplasmosis - Tx
A032. amphotericin B; ketoconazole
Q033. Coccidioidomycosis - What is it
A033. Dimorphic fungi; environment - breaks up into arthroconidia; spherules in tissue; endemic - SW, S. CA; can present as flu-like or acute pneumonia; if disseminates, can involve - bone, meninges, skin; the "great imitator"; incubation period is 1-4 weeks after exposure
Q034. Coccidioidomycosis - Hx/PE
A034. Fever; headache; anorexia; chest pain; cough; dyspnea; night sweats; arthralgias
Q035. Coccidioidomycosis - Dx
A035. Precipitin Ab - rise within 2 weeks, disappear after 2 months; complement fixation Ab - rise at 1-3 months; culture – sputum, wound exudate, joint aspirate; CXR; consider – bronchoscopy, fine-needle Biopsy, open lung Biopsy, pleural Biopsy
Q036. Coccidioidomycosis - Tx
A036. Ketoconazole or fluconazole, amphotericin B
Q037. Cryptococcosis - What is it
A037. C. neoformans; encapsulated yeast in soil with pigeon droppings; can cause asymp pulmon infect; affects meninges; defining opportunistic infection for AIDS
Q038. Cryptococcosis - Hx/PE
A038. Meningitis - frontal or temporal headache; fever; impaired mentation; no meningismus; pneumonia - nonproductive cough, SOB, fever
Q039. Cryptococcosis - Dx
A039. LP with init eval by india ink; then cryptococcal Ag testing; worse prognosis - high opening pressure, high Ag titer, low CSF cell count; fungal culture; latex agglutination test; CT - if neuro deficits; fungal meningitis - CSF glucose decreased, protein increased, leukocyte count high, lymphocytes predominate
Q040. Cryptococcosis - Tx
A040. IV Amphotericin - 2 weeks, then oral fluconazole for life; prophylaxis - fluconazole not recommended, effective, but incidence of meningitis too low
Q041. Anthrax - What is it
A041. B. anthracis; forms spores; gram positive rods; occupational hazard for veterinarians & farmers; animal wool/hair, hides, bone meal products, biological weapon; MC - cutaneous; inhalational - most deadly; intestinal
Q042. Anthrax - Hx/PE
A042. Cutaneous - 1-7 days after skin exposure and penetration of spores; MC - exposed upper extremities; pruritic papule in 24-48 hrs forms ulcer with edematous halo; in 7-10 days => black eschar; regional lymphadenopathy
Q043. Anthrax - Dx
A043. Aerobic culture; gram stain of ulcer exudate
Q044. Anthrax - Tx
A044. Meningeal anthrax - PCN - meningeal dose; doxycycline, chloramphenicol, quinolone 1-2 weeks (PCN allerg); ciprofloxacin prophylaxis - postexposure prophylaxis, 60 days to prevent inhalational anthrax
Q045. Lyme Disease - What is it
A045. Borrelia spirochete; Ixodes tick; usually seen in summer months; endemic - NE, Pacific, North midwest; MC vector-borne disease in NA
Q046. Lyme Disease - Hx/PE
A046. Rash, fever, malaise, headache, myalgias, joint pain; often recent history of camping, hiking in endemic areas; tick needs 24 hours of attachment to transfer Borrelia; primary - Erythema migrans, eryth macule or papule at tick- feeding site, slowly expands, central clearing, "bull's eye"; secondary - migratory polyarthropathy, neuro - Bell's palsy – MC, meningitis, myocarditis: MC - AV heart block; tertiary – arthritis, subacute encephalitis, severe arthritis - HLA-DR2
Q047. Lyme Disease - Dx
A047. rash; 1 late manifestation; lab confirms organism: ELISA - positive = exposure, not active disease; Western Blot - to confirm
Q048. Lyme Disease - Tx
A048. Doxycycline - minor Symptoms; IV ceftriaxone - major Symptoms
Q049. Rocky Mt Spotted Fever - What is it
A049. Rickettsia rickettsii; dermacentor tick; invades endothel lining of cap => small-vessel vasculitis; rapidly fatal if untreated
Q050. Rocky Mt Spotted Fever - Hx/PE
A050. Headache; fever; rash - before 6th day, macular pink rash, starts at wrists, ankles, maculopapular and darker petechial/purpuric as spreads, spreads centripetally (in) => palms & soles; in severe cases - altered mental status, DIC
Q051. Rocky Mt Spotted Fever - Dx
A051. Clinical; confirm - complement fixation test, Weil-Felix test
Q052. Rocky Mt Spotted Fever - Tx
A052. Doxycycline
Q053. UTIs - What is it; Causes
A053. Cystitis, pyelonephritis, perinephric abscess; cystitis - very common, affects women > men; E. coli - 80%; due to - urinary stasis, foreign body, tumor, stones, stricture, BPH, neurogenic bladder, honeymoon cystitis; major cause – catheters, risk related to length (time) of catheterization
Q054. UTIs - UTI bugs
A054. SEEKS PP; S. saprophyticus; E. coli; Enterobacter; Klebsiella; Serratia; Proteus; Pseudomonas
Q055. UTIs - Cystitis; Hx/PE
A055. Dysuria; urgency; frequency; hematuria; low-grade fever; suprapubic pain; PE - suprapubic tenderness; kids - bedwetting; infants - poor feeding; recurrent febrile episodes; foul-smelling urine
Q056. UTIs - Dx
A056. Best initial test - UA; look for: WBC = #1, RBC, protein, bacteria; if nitrites - gram negative; increased urine pH - Proteus; WBC < 5 is normal; UC > 100,000 colonies confirmatory, not always necessary if; have Symptoms and positive UA
Q057. UTIs - Tx
A057. Uncomplicated cystitis - TMP-SMX or any quinolone for 3 days, DM - 7 days, pregnant - no quinolones; elderly, comorbid disease or acute toxicity - admit; IV ciprofloxacin or ampicillin & gentamicin; recurrent UTIs - prophylaxis Antibiotics
Q058. Pyelonephritis - What is it
A058. Ascending UTI that has reached renal parenchyma; More common in – women, pregnancy, childhood, after catheterization or instrumentation; if immunosuppressed - prone to Candida; due to obstruction from – strictures, tumor, stones, bph, neurogenic bladder, vesicoureteral reflux
Q059. Pyelonephritis - Hx/PE
A059. Costovertebral angle tenderness; flank pain; fever/chills; n/v; dysuria; frequency; urgency
Q060. Pyelonephritis - Dx
A060. Clean-catch urine for - UA, UC, sensitivity, >100,000 colonies suggestive; US - to rule out obstruction; WBC casts; leukocytosis; UC; radiology if – pregnancy, history of urolithiasis, prior GU surgery, recurrent pyelonephritis, prepubescent age, fever > 5-7 days without appropriate med eval, elderly; IVP - #1 choice (if not pregn); US - safe in pregnancy; CT - if nondiagnostic IVP & US, if don't respond to therapy after 3 days of Tx
Q061. Pyelonephritis - Tx
A061. Any Antibiotics or gram negative rods; 10-14 days; (fluoroquinolone, TMP-SMX, ampicillin, gentamicin, 3rd gen cephalosporin)
Q062. Sepsis - What is it
A062. Systemic infection plus; a reaction called Systemic Inflammatory Response Syndrome (SIRS)
Q063. Sepsis - What causes SIRS
A063. A release of many mediators into the blood that activate inflammatory and coag pathways
Q064. Sepsis - What is severe sepsis
A064. Sepsis and signs of failure of at least 1 organ
Q065. Sepsis - What is septic shock
A065. Sepsis-induced severe sepsis; organ hypoperfusion; hypotension (systolic BP < 90); poor response to initial fluid resuscitation; most cases - hosp.-acquired gram negative bacilli or gram positive cocci; gram-positive shock - secondary to fluid loss caused by exotoxins; gram-negative shock - caused by vasodilation due to endotoxin (LPS)
Q066. Sepsis - What causes septic shock in; neonates
A066. Group B strep; E. coli; Klebsiella
Q067. Sepsis - What causes septic shock in; kids
A067. H. influenzae; pneumococcus; meningococcus
Q068. Sepsis - What causes septic shock in; adults
A068. Gram-positive cocci; aerobic bacilli; anaerobes
Q069. Sepsis - What causes septic shock in; IV drug users
A069. S. aureus
Q070. Sepsis - What causes septic shock in; asplenic patients
A070. Pneumococcus; H. influenzae; meningococcus; (in other words, encapsulated organisms)
Q071. Sepsis - Hx/PE
A071. Hx - abrupt onset of fever & chills, often hyperventilation, altered mental status; PE – fever, tachy, tachypnea, in septic shock - may start as warm shock, warm skin and extremities => cold shock, cool skin and extremities; petechiae or ecchymoses - DIC; elderly patient with altered mental status - consider urosepsis
Q072. Sepsis - Dx
A072. WBCs initially decreased, WBCs increased in 1-4 hrs. with increased PMNs - especially bands, thrombocytopenia; BC; UC; sputum; CXR; coag studies, DIC panel
Q073. Sepsis - Tx
A073. May need ICU admission; treat aggressively; maintain BP; IV fluids; pressors; Antibiotics; treat underlying cause
Q074. Pneumonia - What is it
A074. Infection of lung parenchyma/alveoli has inflammatory exudate; only cause of death in top 10 from infectious disease; not necessary to have predisposing condition; but predisposed if – cigarettes, DM, alcoholism, malnutrition, immunosuppression, bronchial obstruction (tumor); neutropenia, steroids => aspergillosis
Q075. Pneumonia - Categories of "typical" and "atypical"
A075. Typical - bacteria from nasopharynx; Atypical - from organism inhaled from envi, hard to see on gram stain, not susceptible to Antibiotics that act on cell wall (B-lactams); RSV; adenovirus; mycoplasma; legionella; chlamydia
Q076. Pneumonia - What is aspiration pneumonia
A076. Secondary to inhaling a large amount of oropharyngeal secretions into larynx and lower respiratory tract; aspiration of small amount in pts with impaired pulmonary defenses; MCC of death in patients with dysphagia due to neurologic disorder
Q077. Pneumonia - What is chemical pneumonitis
A077. Secondary to inhaling gastric contents; causes chemical injury to lung
Q078. Pneumonia - Hx; Mycoplasma Hx; Legionella Hx; PCP Hx
A078. Productive cough - green or yellow sputum; rust-colored = pneumococcus; currant jelly = klebsiella; hemoptysis, dyspnea, fever/chills, night sweats, pleuritic chest pain; atypical organisms present - more gradual onset, dry cough, headaches, myalgias, sore throat, pharyngitis; Mycoplasma - dry cough, sore chest, bullous myringitis, anemia (from hemolysis from cold agglutinins), rare to be inpatient/need to admit; Legionella – confusion, headache, lethargy, diarrhea, abdom pain; PCP - marked dyspnea, DOE, chest soreness, cough, HIV+
Q079. Pneumonia - PE
A079. Decreased or bronchial breath sounds; crackles (rales); wheezing; dullness to percussion; egophony; tactile fremitus; elderly, COPD or DM - may have minimal signs on PE
Q080. Pneumonia - Dx
A080. CXR - initial test; sputum Culture - most specific diagnosis for lobar (atypicals don't show up on gram stain or regular Culture); invasive tests sometimes to confirm, open lung Biopsy - most specific; Mycoplasma - Ab titers, cold agglutinins - limited; Legionella - special Culture media: charcoal yeast extract, urine Ag tests, direct fluorescent Ab, Ab titers; PCP - bronchoalveolar lavage, increased LDH; Chlamydias, Coxiella, Coccidio - Ab titers; CBC – leukocytosis, left shift; sputum gram stain & culture- ID organism, ID Antibiotics susceptibility, good sputum sample - many PMNs (> 25 cells/hpf), few epith cells (< 25/hpf); BC; ABG for recurrent pneumonias - consider underlying disease
Q081. Pneumonia - Outpt community-acq < 65 y/o, otherwise healthy; What are pathogens
A081. S. pneumoniae; M. pneumoniae; Chlamydia; H. flu; viral
Q082. Pneumonia - Outpt community-acq < 65 y/o; otherwise healthy; What is init coverage
A082. In uncomplicated cases, Tx on outpatient basis; erythromycin; tetracycline; smokers with H. flu – clarithromycin, azithromycin
Q083. Pneumonia - Outpt community-acq > 65 y/o or with comorbidity; What are pathogens
A083. S. pneumoniae; H. flu; E. coli; Enterobacter; Klebsiella; S. aureus; Legionella; viruses
Q084. Pneumonia - Outpt community-acq > 65 y/o or with comorbidity; What is init coverage
A084. Require admission; cefuroxime (2nd gen cephalo); TMP-SMX; amoxicillin; if atypicals suspected - add erythromycin; if patient has obstructive disease - add pseudomonal coverage
Q085. Pneumonia - Community-acq req. admission; What are pathogens
A085. S. pneumoniae; H. flu; anaerobes; aerobic GNRs; Legionella; Chlamydia
Q086. Pneumonia - Community-acq req. admission; What is init coverage
A086. Cefotaxime or ceftriaxone (2nd or 3rd gen); or B-lactam with B-lactam inhib; if atypicals suspected - add erythomycin
Q087. Pneumonia - Severe community-acquired, require ICU; What are pathogens
A087. S. pneumoniae; H. flu; anaerobes; aerobic GNRs; Mycoplasma; Legionella; Pseudomonas
Q088. Pneumonia - Severe community-acq req. ICU; What is init coverage
A088. Erythromycin – macrolide; and antipseudomonal agent; and aminoglycoside
Q089. Nosocomial pneumonia - (hospitalized > 48 hrs or in long- term care fac. > 14 days); What are pathogens
A089. E. coli; Enterobacter; Klebsiella; Pseudomonas; S. aureus; Legionella; mixed flora
Q090. Nosocomial pneumonia - (hospitalized > 48 hrs or in long- term care fac. > 14 days); What is init coverage
A090. 3rd gen cephalosporin with anti-pseudomonal activity and gentamicin
Q091. Pneumonia - Who gets pneumococcal vaccine
A091. > 65 y/o; any serious lung, cardiac, liver, renal disease; immunocompromised; splenectomized; sickle cell; DM; leukemia; lymphoma; 60-70% effective, redose in 5 years if - severe immunocompromised, original vaccine at < 65 y/o
Q092. Tuberculosis - What is it
A092. Mycobacterium tuberculosis; most cases of symptomatic TB - reactivation of old infection, remain confined to lung; common cause of FUO; MC site of Extrapulmonary infection - lymph nodes (adenitis); most significant defect associated with reactivation - impaired T cell- mediated cellular immunity; risk factors – immunosuppression, alcoholism, preexisting lung disease, immigrants from developing nations, DM, advancing age, homelessness, malnourishment, crowded living conditions, prisoners, nursing home residents, health care workers, sick contacts
Q093. Tuberculosis - Hx/PE
A093. Cough; hemoptysis; weight loss; night sweats; dyspnea; fever; cachexia; hypoxia; tachy; lymphadenopathy; abnormal lung sounds; (positive Babinski - when affects spine)
Q094. Tuberculosis - Dx
A094. CXR - best init test; AFB stain - allows for specific Dx, need 3 negative for >90% sensitivity; Culture - the most specific, need for sensitivity testing; pleural Biopsy - most sensitive test; if AFB stain unrevealing – thoracentesis, gastric aspirate (kids); Biopsy (extrapulmonary organ), needle aspiration (extrapulmonary); LP (if meningitis)
Q095. Tuberculosis - PPD test
A095. Length of induration measured at 48-72 hrs. BCG vaccine- PPD positive for 1 yr; 2-stage testing - no recent PPD test, have reactivity < 10mm, 2nd test within 2 weeks; Positive results indicated by - 5 mm – HIV, close TB contacts, steroid use, organ transplant recipient, abnorm CXR - old, healed TB; 10 mm – homeless, recent immigrant, IVDU, chronic illness, residents of health & correctional institutions, healthcare workers, immunocompromised other than in "5mm" group; 15 mm - everybody else; if positive PPD - get CXR, abnormal CXR - get 3 AFB; if positive AFB - Tx; if negative AFB - latent TB, INH and B6 for 9 months ("prophylaxis"); if positive PPD - get CXR, normal CXR - latent TB, INH and B6 for 9 months ("prophylaxis")
Q096. Tuberculosis - Tx
A096. All cases reported to local & state health depatients; respiratory isolation; Directly Observed Therapy - rifampin (RIF), ethambutol (ETB), pyrazinamide (PZA), INH & B6 for 2 months (until know sensitivity); ETB & PZA discontinued, cont. RIF & INH for 4 more months; if sensitivity not known - give ETB; TB meningitis - Tx 12 months, TB meds and steroids; TB pericarditis - TB meds and steroids; TB in pregnancy - Tx 9 months; TB in osteomyelitis & HIV - Tx 6-9 months; pregnant - no pyrazinamide, no streptomycin; all but streptomycin => liver toxicity; RIF - stains contacts and underwear; ETB - optic neuritis => color blind; PZA - benign hyperuricemia, don't Tx unless gout Symptoms
Q097. Fever of Unknown Origin (FUO)- What is it; MCC; Risk factors
A097. Temp > 38.3 for 3 weeks, undx after 3 outpt visits or 3 days of hospitalization; MCC - infections & cancer, autoimmune disease (15%); Risk factors - recent travel, immune deficiency, drug abuse
Q098. Fever of Unknown Origin (FUO)- Hx/PE
A098. Fever; headache; myalgia; malaise
Q099. Fever of Unknown Origin (FUO)- Dx
A099. CBC with diff; BC; ESR; CXR; PPD; CT & MRI - if malig or abscess suspected; specific tests if infectious or autoimmune suspected
Q100. Fever of Unknown Origin (FUO)- Tx
A100. If severely ill - empiric broad-spectrum Antibiotics; stop if no response
Q101. Neutropenic Fever - What is it
A101. One oral temp of 38.3 or 38.0 > 1 hour in neutropenic patient; 38.3 C = 101 F; 38.0 C = 100.4 F
Q102. Neutropenic Fever - Hx/PE
A102. Common in patients undergoing chemo; ANC nadir 7-10 days post chemo; if severely neutropenic - inflammation may be min. or 0; pain at MC infected sites – skin, eye, peridontium, pharynx, lungs, lower esoph, abdomen, perineum, anus
Q103. Neutropenic Fever - Dx
A103. Thorough PE; NEVER do rectal exam; CBC with diff; BC; BUN/Cr; transaminases; CXR - if resp signs; CT - to check for abscess
Q104. Neutropenic Fever - Tx
A104. Empiric Antibiotics; Tx algorithm
Q105. Congenital Infections - Common sequelae
A105. Can occur at any time during, pregnancy, labor, delivery; common sequelae - premature delivery, CNS abnorm, jaundice, anemia, hepatosplenomegaly, growth retardation
Q106. Congenital Infections - What are they; (mnemonic)
A106. TORCHeS; Toxoplasmosis; Other; Rubella; CMV; Herpes; Syphilis
Q107. Congenital Infections - Toxoplasmosis; How transmitted; Specific findings
A107. Transplacental - rare; primary infection - consumption of raw meat - undercooked pork & lamb, contact with cat feces; Specific findings - intracranial calcifications, chorioretinitis, hydrocephalus, ring-enhancing lesions on Head CT; immunocompetent - usually asymp; best diagnostic test - visualize parasite in tissue or fluid; MC - serology
Q108. Congenital Infections - Other (TORCHeS); What are they
A108. HIV; parvovirus; Varicella; Listeria; TB; malaria; fungi
Q109. Congenital Infections - Rubella; How transmitted; specific findings
A109. Transplacental transmission in 1st trimester; Specific findings - rubella; purpuric blueberry muffin Rash; PDA; Cataracts; Deafness; Mental retardation; Microcephaly
Q110. Congenital Infections - CMV; How transmitted; specific findings
A110. CMv is MC congenital infection; transplacental transmission; Specific findings - petechial rash, periventricular calcifications
Q111. Congenital Infections - Herpes; How transmitted; specific findings
A111. Intrapartum transmission if mom has active lesions; Specific findings - skin, eye and mouth infections, life- threatening CNS/systemic infection
Q112. Congenital Infections - Syphilis; How transmitted; specific findings
A112. Intrapartum transmission; Specific findings - maculopapular skin rash, lymphadenopathy, hepatomegaly, "snuffles" - mucopur rhinitis, osteitis; In childhood, late congen - saber shins, saddle nose, CNS involvement; Hutchinson's triad - peg-shape upr central incisors, deafness, interstitial keratitis (photophobia, lacrimation)
Q113. Congenital Infections - Dx
A113. Serologic testing – rubella, toxoplasmosis, HSV; UC - CMV; syphilis - dark field exam - skin lesions, material serum, test cord blood for increased IgM; viral isolation; amniocentesis - PCR for CMV, antigen detection; all ill newborns – BC, LP, empiric Antibiotics
Q114. Congenital Infections - Toxoplasmosis; Tx
A114. Pyrimethamine; sulfadiazine; spiramycin (if 3rd trimester)
Q115. Congenital Infections - Syphilis; Tx
A115. PCN
Q116. Congenital Infections - HSV; Tx
A116. Acyclovir
Q117. Congenital Infections - CMV; Tx
A117. Ganciclovir
Q118. Congenital Infections - Toxoplasmosis; Prevention
A118. Avoid exposure to cats & cat feces during pregnancy; women with primary infection - pyrimethamine and sulfadiazine in third trimester - spiramycin
Q119. Congenital Infections - Rubella; Prevention
A119. Immunize before pregnancy; consider abortion if infected or exposed; vaccinate mom after delivery if titers remain negative
Q120. Congenital Infections - Syphilis; Prevention
A120. PCN in pregnant women who test positive
Q121. Congenital Infections - CMV; Prevention
A121. Avoid exposure
Q122. Congenital Infections - HSV; Prevention
A122. C-section if lesions present at delivery
Q123. Congenital Infections - HIV; Prevention
A123. AZT - pregnant with HIV; C-section; AZT prophylaxis - infant; no breast-feeding
Q124. Osteomyelitis - What is it
A124. Three types:; acute hematogenous – kids, long bones of lower extremities, MC - staph; secondary to contig infection - recent trauma, placement of prosthesis, MC – polymicrobial, MC single organism - staph; vascular insufficiency - >50 y/o, DM or PVD, repeated minor trauma, not noticed cuz of neuropathy, small bones of lower extremity, MC – polymicrobial, MC single organism - staph
Q125. Osteomyelitis - Common Pathogens
A125. Most people - staph; IVDU - staph or pseudomonas; SCD - salmonella; hip replaced - s. epidermidis; foot puncture wound - pseudomonas; chronic - staph, pseudomonas, enterobacter
Q126. Osteomyelitis - Hx/PE
A126. Fever; localized bone pain; localized warmth, tenderness, swelling, erythema; limited ROM
Q127. Osteomyelitis - Dx
A127. XR - initial test, periosteal elevation - 1st abnorm; technetium bone scan; MRI - better differentiation; ESR – nonspecific, can follow during Tx; Biopsy and Cx - best diagnostic, most invasive
Q128. Osteomyelitis - Tx
A128. Depends on isolate; oxacillin/nafcillin and aminoglycoside or 3rd gen ceph until specific Dx; chronic - 12 weeks of IV therapy, then 8-12 weeks orally
Q129. Osteomyelitis - Complications
A129. Chronic osteomyelitis; soft tissue infection; sepsis; septic arthritis; chronic osteomyelitis with draining sinus tract => squamous cell ca (Marjolin's ulcer)
Q130. HIV - What is it; Risk factors
A130. Retrovirus; targets and destroys CD4+; CD4+ count = marker for extent of disease progression; viral load = indicates rate; Risk factors - MC risk – IV drug user, 2nd MC risk – homosexuality, unprotected sex, maternal HIV infection, needle sticks, mucocutaneous exposure, receipt of blood products
Q131. HIV - Hx/PE
A131. Primary infection often asymp; may present with flu-like Symptoms; Later - night sweats, weight loss, thrush, cachexia; complications correlate with CD4+ count
Q132. HIV - Dx
A132. ELISA - high sensitivity, moderate specificity, detects anti- HIV ab, can take up to 6 months to appear after exposure; Western blot – confirmatory, low sensitivity, high specificity; viral load; PPD with anergy panel; VDRL; CMV serology; toxoplasmosis serology
Q133. HIV - Tx; Tx During Pregnancy; Tx for Needlesticks
A133. Start when - CD4+ <350 or viral load >55,000 (PCR-RNA); 1) 2 reverse transcriptase inhibitors + protease inhibibtor; 2) 2 reverse transcriptase + 2 protease inhibitor; 3) 2 reverse transcriptase + efavirenz. adequate Tx - viral load decreased 50% in 1st month PREGNANCY:; if low CD4+ or high load - 3x's antiretrovirals as nonpregnant patient; C-section - only if CD4+ & viral load not controlled; all get AZT, start AZT by 14th week; AZT => transient anemia; no efavirenz - teratogen; Postexposure Prophylaxis (Needlestick) - AZT + lamivudine + nelfinavir for 4 weeks
Q134. HIV - PCP; CD4+ Level at Presentation; Tx
A134. CD4+ <200; TMP-SMX; pentamidine; steroids - if severe; prophylaxis - TMP-SMX - orally, #1; dapsone - #2; atovaquone -#3; pyrimethamine - aerolized, #4; prophylaxis may be discontinued if antivirals raise CD4 >200 for more than 6 months
Q135. HIV - Mycobacterium Avium Complex; CD4+ Level at Presentation; Tx
A135. CD4+ <50; clarithromycin and ethambutol; prophylaxis - azithromycin - orally once a week; or clarithromycin BID; rifabutin - alternative; prophylaxis can be stopped if antiretrovirals raise CD4 >100 for several months
Q136. HIV - Toxoplasma; CD4+ Level at Presentation; Tx
A136. CD4+ <100; pyrimethamine and sulfadiazine (clindamycin is substitute for sulfadiazine if sulfa-allergy); prophylaxis - TMP-SMX, dapsone/pyrimethamine
Q137. HIV - TB; Indication for prophylaxis; Medication
A137. PPD > 5mm; INH x 9 months or rifampin + pyrazinamide or rifabutin + pyrazinamide
Q138. HIV - Candida; Indication for prophylaxis; Medication
A138. Multiple recurrences; Fluconazole or itraconazole
Q139. HIV - HSV; Indication for prophylaxis; Medication
A139. Multiple recurrences; Acyclovir or; famciclovir or; valacyclovir
Q140. HIV - Pneumococcus; Indication for prophylaxis; Medication
A140. All patients; Pneumovax
Q141. HIV - Influenza; Indication for prophylaxis; Medication
A141. All patients; Influenza vaccine
Q142. Otitis Externa - What is it; Common etiologic agents
A142. "Swimmer's ear"; inflammation of skin lining ear canal and surrounding soft tissue from moisture => maceration of skin; breeding ground for bacteria; from trauma - usually from objects for cleaning; Pseudomonas; Enterobacteriaceae
Q143. Otitis Externa - Hx/PE
A143. Pain; pruritus; possible purulent discharge; pain with movement of tragus/pinna; edematous, eryth ear canal
Q144. Otitis Externa - Dx
A144. Clinical; gram stain & culture if suspect fungal; CT if patient looks toxic
Q145. Otitis Externa - Tx
A145. Eardrops - polymyxin B, neomycin, hydrocortisone; acute - dicloxacillin; DM - at risk for malignant OE, at risk for osteomyelitis of skull bone, admit, IV Antibiotics
Q146. Encephalitis - What is it
A146. Inflammation of the brain; meninges and parenchyma; MCC - viral infection; MC virus - HSV
Q147. Encephalitis - Hx
A147. Can have any level of neuro deficit; any level of focal deficit; 1st clue - altered mental status, fever, headache, nuchal rigidity, mild lethargy, confusion, stupor, coma
Q148. Encephalitis - PE
A148. Focal neuro signs - hemiparesis; focal seizures; autonomic dysfunction; increased ICP; SIADH
Q149. Encephalitis - Dx
A149. CT or MRI; HSV affects temporal lobe; LP - key to Dx; PCR - eliminates need for Biopsy
Q150. Encephalitis - Tx
A150. HSV - immediate IV acyclovir; CMV - ganciclovir or foscarnet; HIV - if suspect resistant HSV, foscarnet
Q151. Meningitis - Hx/PE
A151. Fever; malaise; headache; neck stiffness; photophobia; altered mental status; seizures; MC focal neuro deficits - visual fields; MC long-term damage - CN8; signs of meningeal irritation- Kernig and Brudzinski, often absent in < 2 y/o
Q152. Meningitis - Dx
A152. LP - to establish Dx; CSF Culture - most accurate test, cell count & differential - most useful; CT best initial test if – papilledema, focal motor deficits, severe abnorm in mental status; give ceftriaxone prior if 20-30 min. delay in LP; best init step - ceftriaxone or cefotaxime, add ampicillin if suspect Listeria
Q153. Meningitis - Tx
A153. Empiric - ceftriaxone or cefotaxime; Listeria - add ampicillin; Staph after surgery - vanco; PCN resistant - vanco; Lyme - ceftriaxone; Syphllis - PCN; TB - steroids (adults); viral - no proven useful Tx; cryptococcus - amphotericin, then lifelong fluconazole if also HIV positive contacts of patients with meningococcal meningitis - rifampin prophylaxis
Q154. Meningitis - Complications; Tx
A154. Hyponatremia - admin fluids, monitor sodium concentration; Seizures – benzos, phenytoin; Subdural effusions - may be seen on CT; 50% of infants with H. influenzae meningitis, no Tx necessary; Cerebral edema - presents with loss of oculocephalic reflex, IV mannitol; Subdural empyema - presents as intractable Seizures, surgical evacuation; Brain abscess - surgical drainage; Ventriculitis - presents as: worsening clinical pic, yet improved CSF findings, need ventriculostomy, possibly intraventricular Antibioticss
Q155. Sinusitis - What is it; Risk factors
A155. Infection of sinuses due to undrained collection of pus; MC infected - maxillary; Risk factors – barotraumas, allergic rhinitis, viral infection, asthma, smoking, nasal decongestant overuse
Q156. Sinusitis - Acute sinusitis; Definition; MC associations
A156. Symptoms last < 1 month; MC associated with - S. pneumonia, H. influenza, Moraxella catarrhalis, viral infection
Q157. Sinusitis - Chronic sinusitis; Definition
A157. Symptoms persist > 3 months; often ongoing low-grade anaerobic infections; DM - mucormycosis can start in nose and maxillary sinuses
Q158. Sinusitis - Hx/PE
A158. Fever; facial pain can radiate to upper teeth; nasal congestion; headache, headache worse when lean forward; tenderness, erythema, swelling over affected area; purulent discharge; in chronic - pain may be absent; febrile ICU patients - may have occult sinusitis, especially if intubated or have NGT
Q159. Sinusitis - Dx
A159. Obvious cases - no XR before Tx; maxillary sinus XR - best init test, air-fluid levels, opacification; coronal CT - greater detail; sinus puncture - if don't respond to Tx, frequent recurrences, confirms bacteria
Q160. Sinusitis - Tx
A160. Mild or acute uncomplicated – decongestant (oral pseudoephedrine or ozymetazoline spray); severe pain & discolored discharge - amoxicillin - best initial; amoxicillin-clavulanate - if recent amoxicillin use or don't respond, or 2nd or 3rd ceph OK to use
Q161. Sinusitis - Complications
A161. Osteomyelitis of frontal bone; meningitis; orbital cellulitis; cavernous sinus thrombosis; abscess of epidural or subdural spaces
Q162. Acute Pharyngitis - What is it; Etiologies
A162. Usually self-limited; must differentiate strep from other causes; MC - viral causes; Grp A B-hemolytic strep; Grp C B-hemolytic strep; N. gonorrhoeae, C. diphtheria,M. pneumonia, rhinovirus, coronavirus, adenovirus, HSV, EBV, CMV, influenza, coxsackie
Q163. Acute Pharyngitis - Hx/PE
A163. Typical of strep - sudden-onset sore throat; pharyngeal erythema; fever; ant. cervical lymphadenopathy; soft palate petechiae; headache; vomiting; scarlatiniform rash; tonsillar exudate - EBV can give exudate, mild S. pyogenes may not
Q164. Acute Pharyngitis - Dx
A164. Clinical; rapid group A strep Ag detect; throat culture; positive rapid group A strep Ag - equivalent to positive Cx; negative test - confirm with Cx
Q165. Acute Pharyngitis - Tx
A165. Reduce symptoms - fluids; rest; antipyretics; salt-water gargles; PCN V po x 10 days or PCN G benzathine M x 1 dose; if allergic to PCN – macrolides, oral 2nd gen cephalosporins
Q166. Acute Pharyngitis - Complications
A166. Nonsuppurative - acute rheumatic fever, poststrep glomerulonephritis; suppurative - cervical lymphadenitis, mastoiditis, sinusitis, otitis media, retropharyngeal or peritonsillar abscess; peritonsillar abscess – odynophagia, trismus (lockjaw), muffled voice, unilateral tonsil enlargement, erythema, uvula & soft palate deviate away; intraoral US or CT; Culture abscess fluid; Drain; PCN or erythromycin; elective tonsillectomy later
Q167. Lymphogranuloma Venereum - What is it
A167. Contagious STD; Chlamydia trachomatis
Q168. Lymphogranuloma Venereum - Hx/PE
A168. Lesion ulcerates & heals; unilateral inguinal lymph nodes enlarge => draining buboes; scar formation; fever; joint pains; headache
Q169. Lymphogranuloma Venereum - Dx
A169. Clinical exam and Hx; high or increased Ab titer; isolate Chlamydia from bubo pus
Q170. Lymphogranuloma Venereum - Tx
A170. Doxycycline; erythromycin - alternative
Q171. Chancroid - What is it
A171. Haemophilus ducreyi; gram negative rod
Q172. Chancroid - Hx/PE
A172. Small, soft, painful papules; become shallow ulcers; have ragged edges; vary in size & coalesce; inguinal lymph nodes enlarge
Q173. Chancroid - Dx
A173. Clinical; gram stain with Cx to confirm; PCR
Q174. Chancroid - Tx
A174. Azithromycin single dose; or ceftriaxone 250 IM one dose; erythromycin x7D (alternative); cipro x3D (alternative)
Q175. Genital Herpes - What is it
A175. HSV-2 (85%); HSV-1 can be seen
Q176. Genital Herpes - Hx/PE
A176. Vesicles erode; painful, circular; with red areola; can have inguinal lymphadenopathy; relapses
Q177. Genital Herpes - Dx
A177. Tzanck smear and Cx
Q178. Genital Herpes - Tx
A178. Acyclovir; famciclovir or; valacyclovir
Q179. Granuloma Inguinale - What is it
A179. Chronic granulomas; spread by sexual contact; Donovania granulomatis; Calymmatobacterium granulomatis
Q180. Granuloma Inguinale - Hx/PE
A180. Painless, red nodule; develops into elevated granuloma; heals slow; scars form
Q181. Granuloma Inguinale - Dx
A181. Giemsa or Wright stain; Donovan bodies - confirm; punch Biopsy
Q182. Granuloma Inguinale - Tx
A182. Doxycycline or TMP/SMZ; erythromycin (alternative)
Q183. Genital Warts - What are they
A183. HPV 6 & 11
Q184. Genital Warts - Hx/PE
A184. Soft, moist, pink or red; grow fast; cauliflower appearance; condylomata acuminata
Q185. Genital Warts - Dx
A185. Clinical; must differentiate between - warts and c. lata of syphilis
Q186. Genital Warts - Tx
A186. Remove - curettage; sclerotherapy; trichloroacetic acid; cryotherapy; podophyllin; laser; imiquimod (immune stimulant)
Q187. Perinephric Abscess - What is it; Causes
A187. Not common; pyelonephritis => abscess, rupture into perinephric space; caused by - any factor predisposing to pyelonephritis, stones - #1, structural abnorm, trauma, recent surgery, DM; "SEEKS PP" pathogens; MC - E. coli, then Klebsiella, Proteus, S. aureus - hematogenous
Q188. Perinephric Abscess - Hx/PE
A188. Insidious; 2-3 weeks of Symptoms before 1st visit; fever; flank pain; abdom pain; palpable abdom mass; persistence of pyelonephritic Symptoms even the Tx for pyelonephritis
Q189. Perinephric Abscess - Dx
A189. UA/UC - initial tests; fever, pyuria & negative UC or polymicrobial UC - suggestive; US - best initial scan; CT or MRI - better imaging; Biopsy - necessary for definitive bacterial Dx
Q190. Perinephric Abscess - Tx
A190. Antibiotics for gram negative rods - ex. - 3rd gen ceph; drainage (usually percutaneous); antipseudomonal PCN: ticarcillin/clavulanate, often with aminoglycoside
Q191. Brain Abscess - What is it
A191. Bacteria spread from contiguous infections - dental infections, otitis media, mastoiditis, sinusitis; spread hematogenously – endocarditis, pneumonia; Toxoplasmosis can reactivate if CD4 <100; MC have Strep, then Bacteroides, Enterobacteriae, Staph, polymicrobial
Q192. Brain Abscess - Hx/PE
A192. MC Sx - headache; fever; focal neuro; seizures
Q193. Brain Abscess - Dx
A193. CT with contrast - init test; MRI - more accurate; bacteria - Biopsy for gram stain and Cx
Q194. Brain Abscess - Tx
A194. HIV - 90% Toxo or lymphoma; empiric Tx to establish Dx; if respond to sulfadiazine and pyrimethamine, continue Tx; Other Tx - based on etiology
Q195. Bronchitis - What is it
A195. Infection limited to bronchial tree; Caused by - S. pneumonia, H. influenza, Moraxella, viruses; MC causative factor - cigarettes; acute and chronic form; chronic can => COPD
Q196. Bronchitis - Hx/PE
A196. Cough; sputum; discolored sputum = bacteria; may have low-grade fever; most are afebrile
Q197. Bronchitis - Dx
A197. Clinical; CXR - 1st test; normal CXR confirms!
Q198. Bronchitis - Tx
A198. Mild - no Tx needed, usually from virus, resolves spontaneously; severe - amoxicillin, doxycycline or TMP-SMZ; repeated infection or not responding - amoxicillin/clavulanate, clarithromycin, azithromycin, oral 2nd or 3rd gen cephalo or new fluoroquinolones
Q199. Lung Abscess - What is it
A199. Necrosis of pulmonary parenchyma; caused by bacterial infection; 90% - anaerobes involved; Staph, E. coli, Klebsiella; periodontal disease, predisposition to aspiration; noninfectious causes - pulmonary infarction, cancer, vasculitis (Wegener's)
Q200. Lung Abscess - Hx/PE
A200. Fever; cough; chest pain; foul-smelling sputum; chronic course
Q201. Lung Abscess - Dx
A201. CXR; CT; Biopsy - for specific bacterial Dx; sputum for gram stain & Cx - will NOT show causative organism; common sites of aspiration - lower lobes - if upright; posterior segment of right upper lobe - if supine
Q202. Lung Abscess - Tx
A202. Clindamycin - empiric; PCN - alternate empiric
Q203. Impetigo - What is it
A203. Skin infection; mainly kids; S. pyogenes, S. aureus (bullous); untreated => lymphangitis, a. glomerulonephritis, cellulitis, furunculosis
Q204. Impetigo - Hx/PE
A204. Superficial, pustular oozing, crusting, draining of lesions; common on - arms, legs, face; may follow trauma to skin; maculopapular => vesicles
Q205. Impetigo - Tx
A205. Oral 1st gen ceph or ox-, clox-, or dicloxacillin; mild - topical mupirocin or bacitracin; PCN-allergy - macrolide
Q206. Erysipelas - What is it
A206. Superficial cellulitis; S. pyogenes
Q207. Erysipelas - Hx/PE
A207. Bilateral shiny, red, edematous; face, arms, legs
Q208. Erysipelas - Tx
A208. If can't tell from cellulitis- 1st gen cephalosporin, oxa-, cloxa, dicloxacillin; if sure, Strep - PCN
Q209. Tinea Versicolor - What is it
A209. Skin infection; Malassezia furfur (Pityrosporum orbiculare)
Q210. Tinea Versicolor - Hx/PE
A210. Tan, brown, white lesions; may coalesce; on chest, neck, abdomen, face; lesions do not tan
Q211. Tinea Versicolor - Tx
A211. Topical selenium sulfide,; ketoconazole,; oral itraconazole
Q212. Scabies - What is it
A212. Parasitic skin infection; Sarcoptes scabiei (itch mite); transmitted skin-to-skin contact
Q213. Scabies - Hx/PE
A213. Digs into skin at skin folds; burrows; pruritis; flexor surfaces of - wrists; finger webs; axillary folds; areola (women); genitals (men)
Q214. Scabies - Dx
A214. See in scrapings (mineral oil)
Q215. Scabies - Tx
A215. Permethrin; lindane (Kwell)
Q216. Pediculosis - What is it
A216. Skin infestation by lice; Head - pediculus humanus capitis; Body - pediculus humanus corporis
Q217. Pediculosis - Hx/PE
A217. Itching; excoriation; secondary bacterial infections
Q218. Pediculosis - Dx
A218. Direct exam of hair-bearing surfaces
Q219. Pediculosis - Tx
A219. Permethrin; lindane (Kwell)
Q220. Molluscum Contagiosum - What is it
A220. Skin-colored, waxy, umbilicated papule; poxvirus
Q221. Molluscum Contagiosum - Hx/PE
A221. Small papules; central umbilication; anywhere on skin; asymptomatic; adults - usually by venereal contact, genitals, pubic area
Q222. Molluscum Contagiosum - Dx
A222. Appearance; giemsa stain - large cells with inclusion bodies
Q223. Molluscum Contagiosum - Tx
A223. Freezing; curettage; electrocautery; cantharidin
Q224. Gas Gangrene; (Clostridial Myonecrosis) - What is it
A224. Wounds contaminated by Clostridium perfringens; not common, increased in wartime; trauma (50%): shrapnel, MVA, postop; nontraumatic: uterine gangrene - was complication of improper abortion
Q225. Gas Gangrene; (Clostridial Myonecrosis) - Hx/PE
A225. <1-4 days of incubation - pain, edema => hypotension; tachycardia; fever; crepitation; renal failure
Q226. Gas Gangrene; (Clostridial Myonecrosis) - Dx
A226. Gram stain - positive rods, no WBC; Culture - not diagnostic; gas bubbles on XR - not diagnostic. diagnostic - direct visualization; pale, dead muscle; brown, sweet-smelling discharge
Q227. Gas Gangrene; (Clostridial Myonecrosis) - Tx
A227. High-dose PCN; PCN-allergy - clindamycin; surgical debridement or amputation; hyperbaric O2 - controversial
Q228. Septic Arthritis - What is it
A228. Infection due to any agent; MC – bacterial, rickettsia, virus, spirochete; may also cause gonococcal and nongonococcal; nongonococcal - any previous damage to joint, OA, RA, previous surgery, prosthesis placement, IVDU, gout, sickle cell; gram positive - S. aureus (60%), Strep (15%); gram negative (15%); polymicrobial
Q229. Septic Arthritis - Hx/PE
A229. Gonococcal - polyarticular 50%, tenosynovitis, migratory polyarthralgia, petechiae & purpura; nongonococcal – monoarticular, swollen, tender, erythematous, decreased ROM, usually knee
Q230. Septic Arthritis - Dx
A230. gonococcal - hard to Culture, Culture sites other than knee - greater yield; nongonococcal - synovial fluid aspiration: Cx, gram stain, cell count – high, mainly PMN, low glucose
Q231. Septic Arthritis - Tx
A231. gonococcal - ceftriaxone; nongonoccocal - good empiric - staph/strep & gram- negative drug, nafcillin or oxacillin & aminoglycoside or 3rd gen ceph
Q232. Myocarditis - What is it
A232. Associated with every group of infectious agent; MC - Coxsackie B; also noninfectious – radiation, drugs, collagen vascular disease, hyperthyroidism
Q233. Myocarditis - Hx/PE
A233. Any presentation possible; MC - dyspnea & fatigue; can be asymp, subclinical, or rapid progression to death; PE - normal or S3 and murmurs
Q234. Myocarditis - Dx
A234. Any EKG abnormality; MC - ST-T changes; any type of heart block possible; cardiac enzymes may be increased; Ab titers may be increased; viruses may be isolated – stool, saliva; NPA; endomyocardial Biopsy - best diagnostic test
Q235. Myocarditis - Tx
A235. Viral - supportive; most spontan resolve; no steroids (damaging); other Tx depends on agent
Q236. MCC of UTI; MC with GU instruments?
A236. MCC: E. coli; MC with GU instruments: Pseudomonas
Q237. UTI with Alkaline urine is suggestive of which bug?
A237. Proteus
Q238. (2) MC bugs for Urethritis
A238. Chlamydia; Gonorrhea
Q239. What meds (2) can be given to a pregnant woman with bacteriuria?
A239. Nitrofurantoin; Ampicillin
Q240. DOC for non-pregnant uncomplicated Cystitis and UTI; Tx for how many days?; What bug does it not work on?
A240. TMP-SMX (Bactrim), 3 - 5 days; Does not work on: Pseudomonas
Q241. DOC for Pseudomonas pyelonephritis, cystitis and UTI; Tx for how many days for pyelonephritis?
A241. FQ (Cipro); Pyelonephritis: 7 - 14 days
Q242. Difference b/t discharge of Chlamydia and Gonorrhea
A242. Chlamydia: Non-purulent discharge; Gonorrhea: Purulent dischange
Q243. DOC for; 1. Chlamydia; 2. Gonorrhea
A243. Chlamydia: 1g Azithromycin PO (one dose); Gonorrhea: 125mg Ceftriaxone IM (one dose)
Q244. What protects the vagina by providing it with an acidic environment (also used to make yogurt)?
A244. A Yoplait a day keeps the Vaginitis away: Lactobacilli
Q245. What is the "whiff" test?; What (2) bugs does it work with?
A245. Whiff test: applying KOH to wetmount, causing enhancement of odor for: Gardnerella; Trichomonas
Q246. DOC for Pregnant patient with vaginitis
A246. Clotrimazole
Q247. What should patient on Metronidazole be warned about ingesting while on the drug?
A247. Alcohol: can cause Disulfuram-like effects
Q248. Dx:; possible vaginal itch and burning, abnormal fishy odor; What is seen on wet mount?; Tx?
A248. Gardnerella ("Bacterial Vaginosis"); wet mount: Clue cells (epithelial cells with bacteria); Tx: Metronidazole
Q249. Dx:; vaginal itch and burning; rancid fish odor; green, frothy discharge; Strawberry cervix; What is seen on wet mount?; Tx?
A249. Trichomonas; Wet mount: Motile Trichomonads; Tx: Metronidazole
Q250. Dx:; vaginal itch and burning; cheese-like discharge; no odor; What is seen on wet mount?; Tx?
A250. Candida Albicans ("Yeast infection"); Wet mount: Pseudohyphae; Tx: Fluconazole (Nystatin)
Q251. On exam, how can you tell a syphillitic pupil?
A251. Like a Prostatute:; It accomodates, but doesn't react
Q252. Describe the (4) stages of Syphillis
A252. Primary: Painless chancre; Bubo LN; Secondary: Rash on palms and soles; Condylomata Lata; Latent stage (asymptomatic); Tertiary: Gummas in CNS, heart, aorta; Tabes dorsalis; Argyll Robertson pupil
Q253. Bug name of Syphillis; What common test does it not show-up on?; What test is used?
A253. Treponema Pallidum; Does not grow on Blood culture; Darfield Microscopy - will see Spirochetes
Q254. DOC for Syphillis
A254. Penicillin G
Q255. Definition:; inflammation of the glans penis; (2) causes and Tx for each
A255. Balanitis Causes:; 1. Candida - Tx with Nystatin; 2. Reiter's syndrome - Tx with NSAIDs
Q256. What should patients with balanitis be screened for?
A256. Diabetes
Q257. Dx:; painful vesicular lesions on erythematous base; local lymphadenopathy; Dx test?; Tx?
A257. Herpes; Test: Tzanck smear and culture (also herpes serologies); Tx: Acyclovir
Q258. (2) adverse effects of Acyclovir
A258. Renal crystals;; Allergic Interstitial Nephritis
Q259. What Dx can a mother with HPV cause in a child during delivery?
A259. Laryngeal Papillomatosis
Q260. What UTI bug is a predisposing factor for PID?
A260. Chlamydia
Q261. Dx:; Diabetic patient with a black necrotic parasinus lesion
A261. Mucormycosis
Q262. Dx:; man with perineal and suprapubic pain, dysuria and urinary frequency, fever, tender with rectal exam; (2) main causes; Tx? (2)
A262. Bacterial Prostatitis; Causes: E. coli, Pseudomonas; Tx (for 21 days): TMP-SMX, Ciprofloxacin
Q263. Pneumonia bug with "salmon pink" sputum and cavitary lesions; Tx?
A263. S. Aureus; Tx: Beta-lactam Antibiotics
Q264. Pneumonia bug with "buldging fissure" and "currant jelly"; Tx?
A264. Klebsiella; Tx: Cephalosporin (+/- aminoglycosides)
Q265. Dx:; 21-yo female complains of dry cough, malaise, and low- grade fevers for "2 weeks", has a CXR with hazy infiltrates
A265. Mycoplasma Pneumonia
Q266. Dx:; patient with confusion and diarrhea is found to have a large infiltrate on CXR with pleural effusions
A266. Legionella
Q267. WHat is the most common pneumonia with cystic fibrosis?
A267. Pseudomonas
Q268. Dx:; Respiratory infection with low fever, sore throat, N/V and causes a gray exudative pseudomembrane
A268. Corynebacterium Diptheria
Q269. Dx:; fever, rash, nausea, skin desquamatization, kidney and liver failure in women using tampons; Bug?
A269. Toxic Shock Syndrome; (S. Aureus)
Q270. Dx:; pharyngitis, strawberry tongue, rash that begins on trunk and spreads to extremities; Bug?
A270. Scarlet fever; (S. pyogens)
Q271. Dx:; HIV patient with dry cough for 1 week. No fever or chills. White count is normal.
A271. Mycoplasma Pneumonia
Q272. Cause of brain lesion in AIDS patient:; Ring-enhancing lesion with mass effect
A272. Toxoplasmosis
Q273. Cause of brain lesion in AIDS patient:; Periventricular ring
A273. CMV
Q274. Cause of brain problem in AIDS patient:; CNS lymphoma
A274. EBV
Q275. Cause of meningitis in AIDS patient:; Sensation of smell and behavior changes
A275. Herpes; (Temporal lobe)
Q276. Cause of meningitis in AIDS patient:; India ink stain with round organisms
A276. Cryptococcus
Q277. Dx:; 29-yo with HIV and CD-4 count of 100 has unexplained fever and elevated Alk-Phos.
A277. Mycobacterium Avium Complex
Q278. Dx:; HIV patient with painful, poorly healing perirectal lesion
A278. Herpes
Q279. Dx:; patient has fever, N/V and maculopapular rash on distal extremities that progresses to trunk; What can it cause?; Tx?
A279. Rocky Mt Spotted Fever (Rickettsia); Causes: Myocarditis and heart block; Tx: Doxycycline
Q280. Dx:; 42-yo man who recently camped in the woods of Vermont presents to ER with one-sided facial droop and a skin rash with central clearing; Tx?
A280. Lyme Dz (B. Burgdorferi); Tx: Penicillin
Q281. Dx:; fever, chills, myalgias, "hemolytic anemia" in patient who lives in Northeast or Midwest; Tx? (2)
A281. Babesiosis; Tx: Quinine and Clindamycin
Q282. Dx:; Tick or flea bite causing an ulcer at the bite site; Tx?
A282. Tularemia; Tx: Gentamicin (or Tetracycline)
Q283. Dx:; 40-yo patient recently returned from Kenya presents with body aches, malaise and fever. Labs show normal WBC, anemia and elevated LFT; Tx?
A283. Malaria; Tx: Cloroquine
Q284. When does antiretroviral therapy start for HIV?
A284. CD4 count < 500
Q285. what is the prophylaxis med and CD4-count start time in AIDS for:; PCP
A285. med: TMP-SMX (or Dantrolene if pt is intolerant to TMP- SMX); CD4: < 200
Q286. what is the prophylaxis med and CD4-count start time in AIDS for:; Mycobacterium Avium complex
A286. med: Azithromycin (or Clarithromycin); CD4: < 100
Q287. what is the prophylaxis med and CD4-count start time in AIDS for:; Cryptococcal and Candida infections
A287. med: Fluconazole; CD4: < 100
Q288. what is the only live vaccine able to be given to an HIV patient?
A288. MMR
Q289. What vaccines can you give to HIV patients?; (4)
A289. 1. Hepatitis B; 2. Inactivated Polio vaccine (never oral polio vaccine); 3. Pneumococcal; 4. Influenza
Q290. patient has HIV with severe hypoxia, normal CXR (or diffuse bilateral interstitial infiltrates) with dry and non-productive cough. Dx?; Test?; med Tx?
A290. Dx: PCP; test: Silver stain (Wright-Giemsa, methenamine silver); Tx: TMP-SMX
Q291. Malassezia furfur
A291. Patient with blotchy hypopigmentation of skin; KOH scraping shows spaghetti and meatballs
Q292. Dermatophytes
A292. (Trichophyton - skin, hair, nails; Microsporum - hair and skin; Epidermophyton - nails and skin); Patient with scaly, ringlike lesions of ski that may involved hair shafts or nails; KOH scraping shows arthroconidia and hyphae
Q293. Sporothrix schenckii
A293. Patient with subcutaneous/lymphocutaneous mycetoma; Fardener, florist, basket weaver; Cigar-shaped yeasts in pus
Q294. Histoplasma capsulatum
A294. Normal patient with acute pulmonary; immunocompromised patient with chronic pulmonary or disseminated infection; States following drainages of Great Lakes to Gulf of Mexico; Exposure to bird or bat excrement; Sputum or blood cultures with mononuclear cells packed with yeast cells
Q295. Coccidioides immitis
A295. Normal patient with erythema nodosum or self resolving pneumonia; Immunocompromised patient with calcifying chronic pulmonary or disseminated infections; Pregnant female in third trimester, disseminated infection; Desert southwest; Sputum has spherule with endospores
Q296. Blastomyces dermatitidis
A296. Normal patient with acute pulmonary symptoms; Immunocompromised patient with chronic pulmonary or disseminated infection; North and South Carolina Sputum has broad-based, budding yeasts with double, refractile cell walls; Sputum has broad-based budding yeasts with double refractile cell walls
Q297. Aspergillus fumigatus
A297. Patient with asthma allergies-growing mucous plugs in lung; Patient with cavitary lung lesions-fungus ball; Patient with burns-cellulitis invasion; Immunocompromised patient-penumonia, meningitis; Septate hyphae branch at acute angles (45-degrees)
Q298. Candida albicans
A298. Immunocrompromised patient, overuse of antibiotics- thrust,spread down GI tract, septicemia; IV drug abusers-endocarditis; Germ tube test demonstrates pseudohyphae and hyphae
Q299. Cryptococcus neoformans
A299. Pigeon breeder with acute pulmonary symptoms; Hodgkins/AIDS patient with meningitis; India ink mount of CSF with encapsulated yeasts
Q300. Mucor, Rhizopus, Absidia
A300. Ketoacidotic diabetic or leukemic patient with rhinocerebral infection; Biopsy with nonseptate, irregular-width hyphae branching at 90-degree angles
Q301. Pneumocystis jiroveci
A301. Premature infant or AIDS patient with atypical pneumonia; Biopsy with honeycomb exudate and silver staining cysts; X-ray: ground glass
Q302. Staphylococcus epidermidis
A302. Coagulase (-); gram (+) cocci; Novobiocin sensitive; Infections of catheters and shunts
Q303. Staphylococcus saprophyticus
A303. Coagulase (-); gram (+) cocci; Novobiocin resistant; "Honeymoon cystitis"
Q304. Staphylococcus aureas
A304. Coagulase (+), gram (+) cocci in clusters; Gastroenteritis: 2-6 hours onset, salty foods, custards; Endocarditis: acute; Toxic shock syndrome: desquamating rash, fever, hypotension; Impetigo: bullous; Pneumonia: nosocomial, typical, acute; Osteomyelitis: #1 cause unless HbS mentioned
Q305. Streptococcus pyogenes (Group A)
A305. Catalase (-), Beta hemolytic, gram (+) cocci, bacitracin sensitive; Pharyngitis: abrupt onset, tonsillar abscesses; Scarlet fever: blanching, sandpaper rash, strawnerry tongue; Impetigo: honey-crusted lesions; Rheumatic fever; Increased ASO titer; Acute glomerulonephritis after skin or throat infection, hypertension, edema, smoky urine; Bacitracin sensitive, gram (+) cocci
Q306. Streptococcus agalactiae (Group B)
A306. Bacitracin resistant, gram (+) cocci; Hydrolyze hippurate; CAMP test (+); Catalase (-), Beta hemolytic, gram (+) cocci, bacitracin resistant; MCC of Neonatal meningitis and septicemia: especially in prolonged labors
Q307. Streptococcus pneumoniae
A307. Gram (+), catalase (-), alpha hemolytic, optochin sensitive, bile soluble; Lancet shaped diplococci; MCC of typical pneumonia, rusty sputum; MCC pf adult meningitis - many PMNs, decreased glucose, increased protein in CSF; MCC of otitis media and sinusitis
Q308. Viridans Streptococc (S. sanguis, S. mutans)
A308. Gram (+), catalase (-), alpha hemolytic, optochin resistant, bile insoluble; Plaque and dental caries; Subacute bacterial endocarditis - preexisting damage to the heart valves; follows dental work
Q309. Enterococcus faecalis/faecium
A309. Gram (+), catalase (-), variable hemolysis, hydrolyzes esculin; Urinary and biliary tract infections - elderly males after prostate treatment; Subacute bacterial endocarditis - elderly males, follows GI/GU surgery, preexisting heart valve damage
Q310. Bacillus antracis
A310. Gram (+), spore forming aerobic rods; Contact with animal hides or postal worker; eschar or life- threatening pneumonia; Rapid-onset gastroenteritis; Fried rice, Chinese restaurants
Q311. Clostridium tetani
A311. Dirty puncture wound; Rigid paralysis
Q312. Clostridium botulinum
A312. Home-canned alkaline vegtables; Floppy baby syndrome (infant with flaccid paralysis); Reversible flaccid paralysis
Q313. Clostridium perfringens
A313. Contamined wound; Pain, edema, gas, fever, tachycardia; Food poisoning: reheated meats, noninflammatory diarrhea
Q314. Clostridium difficile
A314. Hospitalized patient on antibiotics; Develops colitis, diarrhea
Q315. Listeria monocytogenes
A315. Gram (+), beta hemolytic bacilli, facultative intracellular; Foodborne (deli foods); Transplacental - granulomatosis infantiseptica; Neonatal septicemia and meningitis (third most common cause); MCC of meningitis in renal transplant or cancer patients
Q316. Corynebacterium diphtheriae
A316. Gram (+), aerobic, non-spore forming rods; Bull neck, myocarditis, nerve palsies; Gray pseudomembrane → airway obstruction; Toxin produced by lysogeny and ribosylates EF-2; heart, nerve damage
Q317. Actinomyces israelii
A317. Mycetoma on jaw line or spread from IUD; Sulfur granules in pus grow anaerobic, gram (+), non-acid fast branching rods
Q318. Nocardia asteroides and brasiliensis
A318. Gram (+) filamentous bacilli, aerobic, partially acid fast; Cavitary bronchopulmonary disease, mycetomas
Q319. Mycobacterium tuberculosis
A319. High-risk patient (low SES, HIV+, IV drug user); Chronic cough, weight loss; Ghon complex; Auramine-rhodamine staining, acid fast bacilli in sputum, faculative intracellular; Produce niacin, heat-sensitive catalase; Positive DTH test (PPD)
Q320. Mycobacterium leprae
A320. Acid fast bacilli in punch biopsy; Immigrant patient with sensory loss in extremities; Armadillos in Texas and Louisana; Hansen's disease
Q321. Mycobacterium avium intracellulare, Mycobacterium kansasii
A321. AIDS patients, cancer, chronic lung disease with pulmonary, GI, disseminated symptoms, atypical mycobacteria
Q322. Mycobacterium marinum
A322. Fish tank granuloma - cutaneous granulomas
Q323. Mycobacterium scrofulaceum
A323. Solitary cervical lymph node in kids, lymphadenitis, atypical mycobacteria
Q324. Meningococcal meningitis
A324. Gran (-) diplococcus in CSF; Young adults with meningitis, abrupt onset with signs of endotoxin toxicity
Q325. Neisseria gonorrhoeae
A325. Sexually active patient; Urethral/vaginal discharge (leukorrhea); Arthiritis possible; Neonatal opthalmia; Gram (-) diplococcus in neutrophils
Q326. Moraxella catarrhalis
A326. Gram (-) diplococcus causes otitis media, sinusitis, bronchitis, bronchopneumonia in elderly patients with COPD
Q327. Pseudomonas aeruginosa
A327. Gram (-), oxidase (+), aerobic bacillus; Blue-green pigments, fruity odor; Burn infections - blue-green pus, fruity odor; Typical pneumonia - Chonic granulomatous disease or Cystic fibrosis; UTI - catheterized patients
Q328. Legionella pneumophilia
A328. Elderly smoker, heavy drinker or immunosuppressed; Exposure to aerosols of water; Atypical pneumonia; Pontiac fever
Q329. Francisella tularensis
A329. Patient with ulceroglandular disease, atypical pneumonia, or gastrointestinal disease; Arkansas/Missouri; Exposure to rabbits/ticks; Tularemia
Q330. Bordetella pertussis
A330. Unvaccinated child (immigrant family or religious objections); Cough with inspiratory "whoop"; Whooping cough
Q331. Brucella species
A331. Patient with acute septicemia; Exposure to animals or unpasteurized dairy; California/Texas or travel to Mexico
Q332. Campylobacter jejuni
A332. Patient with inflammatory diarrhea; Gram (-), curved rod, microaerophilic, exidase (+), grows at 42 degrees C
Q333. Helicobacter pylori
A333. Patient with gastritis, ulcers, stomach cancer; Gram (-), helical bacilli, oxidase (+), microaerophilic, urease (+)
Q334. Escherichia coli
A334. MCC of UTI; Neonatal septicemia (2nd MCC)
Q335. Escherichia coli (ETEC)
A335. Gastroenteritis, Traveler's diarrhea; Infantile diarrhea (2nd MCC); Hemorrhagic colitis, HUS; Lactose fermenter, gram-negative rod; Inflammatory diarrhea, similar to shigellosis
Q336. Shigella sonnei (MC in US), dysenteriae (most severe)
A336. Patient with acute bloody diarrhea and fever; Gram (-) bacilli, which are nonmotile, nonlactose fermenters, do not produce H2S
Q337. Klebsiella pneumoniae
A337. Elderly patient with typical pneumonia currant-jelly sputum; UTI - catheterized patients; Septicemia: immunocompromised or nosocomial; Gram (-) bacilli, oxidase (-), encapsulated, lactose fermenters
Q338. Klebsiella granulomatis
A338. Patient from Caribbean or New Guinea with subcutaneous genital nodules; Encapsulated gram (-) rods inside mononuclear cells
Q339. Salmonella enterica typhi
A339. Patient with fever, abdominal pain with travel to endemic area
Q340. Salmonella enterica typhi / non-typhi
A340. Gram (-), encapsulated, nonlactose fermenter, produces H2S gas; Widal test
Q341. Salmonella enterica non-typhi
A341. Enterocolitis - inflammatory, follows ingestion of poultry products or handling pet reptiles; Septicemia - very young or elderly; Osteomyelitis - sickle cell disease
Q342. Yersinia pestis
A342. Patient with high fever, buboes, conjunctivitis, pneumonia; Exposure to small rodents, desert southwest
Q343. Yersinia enterocolitica
A343. Patient with inflammatory diarrhea or pseudoappendicitis; Cold climates; Unpateurized milk, pork; Gram (-) bacilli, non-lactose fermenters, non-H2S producers
Q344. Proteus mirabilis / vulgaris
A344. Patient with UTI or septicemia; Swarming motility; Staghorn renal calculi (struvite stones); Gram (-), non-lactose fermenting, urease (+)
Q345. Gardnerella vaginalis
A345. Female patient with thin vaginal discharge, post antibiotic or menses; Clue cells; Whiff test
Q346. Vibrio cholerae
A346. Patient with noninflammatory diarrhea; Rice-water stool; Dehydration; Gram (-) curved rods, polar flagellae, oxidase (+), travel to endemic area
Q347. Pasteurella multocida
A347. Patient with cat (animal) bite; Cellulitis / lymphadenitis
Q348. Haemophilus influenzae
A348. 3 mo-2 year old unvaccinated child - meningitis, pneumonia, epiglottitis; Smokers with COPD - bronchitis, pneumonia; Gram (-) rod, requires factors X and V
Q349. HACEK group infections
A349. MCC of gram-negative endocarditis in non-IV drug users
Q350. Haemophilus ducreyi
A350. Painful chancre
Q351. Bacteroides fragilis
A351. Patient with abdominal trauma, emergency abdominal surgery; Septicemia, peritonitis, abscess; Gram (-) bacilli, anaerobic
Q352. Treponema pallidum
A352. Sexually active patient or neonate of IV drug-using female; Primary disease - nontender indurated genital chancre; Secondary disease - maculopapular, copper-colored rash, condylomata lata; Tertiary disease - gumma in CNS and cardiovascular system; Spirilar, gram (-) bacteria visualized by dark-field or fluorescent antibody; FTA-ABS, VDRL
Q353. Borrelia burgdorferi
A353. Patient with influenza-like symptoms and erythema migrans; Spring/summer seasons, noreast, midwest, west coast; Later-neurologic, cardiac, arthiritis/arthralgias; Lyme disease
Q354. Leptospira interrogans
A354. Patients with influenza-like symptoms +/- GI symptoms; Occupational or recreational exposure to water aerosols; Hawaii; Spirochetes with terminal hook
Q355. Rickettsia rickettsii
A355. Patient with influenza-like symptoms and petechial rash that begins on ankles and wrists and moves to trunk; East coast mountainous areas; Sring/summer seasons, outdoor exposure, Weil-Felix (+); Rocky Mountain spotted fever
Q356. Coxiella burnetii
A356. Patient with fever, pneumonia, granulomatous hepatitis; Exposure to domestic animal breeding operation, gram (-) bacilli, diagnose serologically
Q357. Chlamydia trachomatis
A357. Sexually active patient or neonate; Adult: urethritis, cervicitis, PID, inclusion conjunctivitis; Neonate: inclusion conjunctivitis / pneumonia; Immigrant from Africa/Asia, swollen genital lymphadenopathy; Cytoplasmic inclusion bodies in scrapings
Q358. Chlamydia pneumoniae
A358. Atypical pneumonia, sputum with intracytoplasmic inclusion
Q359. Chlamydia psittaci
A359. Atypical pneumonia, exposure to parrots
Q360. Mycoplasma pneumonia
A360. Young adult with atypical pneumonia (MCC); Mulberry-shaped colonies on media containing sterols; Positive cold agglutinin test
Q361. Ureaplasma urealyticum
A361. Adult patient with urethritis, prostitis, renal calculi; Alkaline urine; Non-Gram-staining, urease (+)
Q362. Entamoeba histolytica
A362. Amebiasis: dysentery; Liver abscesses (protozoa etiology); Inverted flask shaped lesions
Q363. Giardia lamblia
A363. Fatty, foul-smelling diarrhea leading to malabsorption; Fecal (human, beaver, muskrat), water , food, day care; Trophozoites with "falling leaf" motility
Q364. Cryptosporidium species
A364. Transient diarrhea in healthy, severe in immunocompromisted hosts, acid fast round oocysts in stool; Undercooked meat, water - no killed by chlorination, cysts
Q365. Trichomonas vaginalis
A365. Frothy vaginal discharge,; motile trophozoites with corkscrew motility,; sexual transmission
Q366. Plasmodium vivax
A366. Chills,; fever spike,; and malarial rigors,; relapses
Q367. Plasmodium falciparum
A367. Irregular fever spikes,; causes cerebral malaria,; multiple ring forms and crescent-shaped gametes
Q368. Trypanosoma cruzi
A368. Chagas diseases,; Romana sign (swelling around eye),; cardiac muscle, liver, brain often involved,; reduviid bug
Q369. Trypanosoma brucei, gambiense, rhodesiense
A369. African sleeping sickness,; tsetse fly,; antigenic variation
Q370. Leishmania donovani
A370. Viseral Leishmaniasis,; sandfly,; amastigotes in macrophages in bone marrow, liver, spleen
Q371. Leismania species
A371. Cutaneous Leishmaniasis,; sandfly,; amastigotes in cutaneous lesions
Q372. Babesia
A372. Malaria-like Babesiosis,; NE, N Central, California, and NW U.S.,; Ixodes tick,; co-infection with Borrelia
Q373. Toxoplasma gondii
A373. Cat is definitive host,; raw meat in US #1 = pork, contact with cat feces,; deadly in pregnant patients
Q374. Schistosoma mansoni, japonicum
A374. Intestinal schistosomiasis; Skin penetration,; mature in veins of mesentery,; eggs cause granulomas in liver
Q375. Schistosoma haematobium
A375. Vesicular schistosomiasis; Skin penetration,; bladder carcinoma in Egypt and Africa
Q376. Clonorchis sinesis
A376. Chinese liver fluke; Raw fish ingestion, serum-like sickness
Q377. Paragonimus westermani
A377. Lung fluke; Raw crabs, crayfish,; mimics pulmonary TB
Q378. Taenia solium
A378. Pork tapeworm; Cysticercosis, calcified larva in brain, eye, heart, lung, IH: pigs; Raw pork containing cysticerci ingested by humans, DH: humans - intestinal tapeworm, proglottids in feces
Q379. Diphyllobothrium latum
A379. Raw pickled fism containing a sparganum, intestinal tapeworm, megaloblastic anemia (B12 deficiency); Fish tapeworm
Q380. Enchinococcus granulosus
A380. Hydatid cyst disease
Q381. Enterobius vermicularis
A381. Pinworms, large intestine, perinal itching; Scotch tape test; Most frequent helminth parasite in U.S.
Q382. Ascaris lumbricoides
A382. Ascariasis; MC helminth worldwide; Largest roundworm, may obstruct intestine or bile duct
Q383. Toxocara canis or cati
A383. Visceral Larva Migrans - larvae wader aimlessly until they die,; cause inflmmation,; from hangling puppies or eating dirt (pica)
Q384. Necator americanus
A384. Hookworm,; larva penetrates intact skin of bare feet,; penumonitis,; anemia,; occult blood fecal may be +
Q385. Strongyloides stercoralis
A385. Threadworm,; early: pneumonitis, diarrhea, abdominal pain; later: malabsorption, ulcers, bloody stools, larva penerates intact skin
Q386. Trichinella spiralis
A386. Trichinosis,; variable encysted larvae in meat, wild game meat, in muscle,; fever, myalgia, splinter hemorrhages, eosinophilia
Q387. Wucheria bancrofti
A387. Elephantiasis, mosquito
Q388. Loa loa
A388. Pruritus,; calabar swelling,; chrysops mango fly, African eye worm
Q389. Onchocerca volvulus
A389. River blindness, itchy leopard rash
Q390. Dracunculus medinesis
A390. Creeping eruptions,; ulcerations,; rash,; remove with stick, fiery serpant
Q391. B19 - Parvoviridae
A391. School-aged child with fever and indurated facial rash, slapped cheek fever; Pregnant woman with flu-like symptoms, hydrops fetalis or spontaneous abortion
Q392. HPV - Papovaviridae
A392. Warts; Cervical intraepithelial neoplasia (CIN); Biopsy or pap smear reveals koilocytic cells
Q393. HSV-1 and HSV-2 - Herpesviridae
A393. Cold sores / gential vesicles; Keratoconjunctivitis; Meningoencephalitis / encephalitis; Neonatal disseminated / encephalitis; Tzanck smear, Cowdry type A inclusion bodies
Q394. HSV-1 - Herpesviridae
A394. Latency in trigeminal ganglion; Latency in sacral ganglion
Q395. VZV - Herpesviridae - Chickenpox
A395. unvaccinated child with asynchronous rash
Q396. VZV - Herpesviridae - Shingles
A396. Elderly with unilateral vesicular rash that follows dermatome
Q397. VZV - Herpesviridae
A397. Tzanck smear, Cowdry type A inclusion bodies, and synctia intranuclear inclusions; Latency in DRG
Q398. EBV - Herpesviridae
A398. Young adult with fever, lymphadenopathy, splenomegaly; Downey type II atypical T lymphocytes reach 70% in blood; Heterophile (monospot) positive mononucleosis; Latency in B cells; Kissing disease
Q399. CMV - Herpesviridae
A399. Heterophile-negative mononucleosis in children and adults; Neonate with jaundice, hepatosplenomegaly, thrombocytic purpura; Owl-eye inclusion bodies in biopsy
Q400. HHV-6 - Herpesviridae
A400. Infant with fever leading to lacy body rash
Q401. HHV-8 - Herpesviridae
A401. AIDS patient with sarcoma; Kaposi sarcoma
Q402. EBV, CMV - Herpesviridae
A402. Latency in mononuclear cells
Q403. Adenovirus - Adenoviridae
A403. Young adults with ARDS, spring and winter peak; Swimmers and shipyard workers: nonpurulent conjunctivitis; Daycare: viral gastroenteritis
Q404. Molluscum Contagiosum - Poxviridae
A404. Young adult (wrestling, swim team), umbilicated warts, Eosinophilic cytoplasmic inclusion bodies
Q405. Variola - Poxviridae
A405. Virus extinct; Syncronous rash begins in mouth goes to face and body; Guarnieri bodies (intracytoplasmic inclusions); Smallpox
Q406. HBV - Hepadnaviridae
A406. Dane particle, infectious
Q407. HAV - Picornavirus
A407. Fecal oral, infectious
Q408. HCV - Flavivirus
A408. Parenteral, sexual, post-transfusion,; 80% chronic carriers,; primary HCC,; cirrhosis
Q409. HDV - Defective
A409. Parenteral, sexual, superinfection,; cirrhosis,; fulminant hepatitis
Q410. HEV - Calcivirus
A410. Fecal oral, enteric,; pregnant patients severly affected
Q411. Subacute Bacterial Endocarditis (SBE)
A411. Streptococcus Viridans: Mutans, Intermedius,; Streptococcus Bovis; Enterococcus Faecalis
Q412. Local: UTI, Billiary tract infection; Systemic: SBE
A412. Enterococcus Faecalis
Q413. Local: Dental carries, Brain or abdominal abscesses. Systemic: SBE
A413. Carries: S. Mutans; Brain or Abdominal abscesses:Intermedius
Q414. Neonatal: meningitis, pneumonia, sepsis
A414. Streptococcus Agalactiae
Q415. Glomerulonephritis with hematuria, periorbital edema, HTN; Rheumatic Fever with carditis,chorea, polyarthritis, erythema marginatum, subcue nodules
A415. Streptococcus Pyogenes (immune-mediated)
Q416. Scarlet Fever with sandpaper rash, strawberry tongue. TSS; Necrotizing Fasciitis
A416. Streptococcus Pyogenes (toxin-mediated)
Q417. Pharyngitis; Impetigo; Erysipelas; Cellulitis
A417. Streptococcus Pyogenes (infection)
Q418. UTI, Cystitis
A418. Staphlococcus Saprophyticus
Q419. Local: impetigo, cellulitis,flolliculitis, carbuncles, pneumonia with cavitations; Systemic: acute endocarditis, meningitis,osteomyelitis, septic arthritis
A419. Staphylococcus Aureus (infections)
Q420. TSS; SSS (ritters disease in newborn); Food Poisoning (custards, heat stable toxins, enterotoxin EA A)
A420. Staphylococcus Aureus (toxin-mediated)
Q421. Infection of indwelling medical device (catheter, iv line, prosthetic valve.
A421. Staphylococcus EpidermidisA
Q422. Abscesses in mouth, lungs, GI tract, GU tract. Draining sinus tracts
A422. Actinomyces Israelii
Q423. Local: pseudomembrane. airway obstruction; Systemic: myocarditis, polyneuritis
A423. Corynebacterium Diphtheriae
Q424. Listerosis: meningitis and sepsis in neonates and immumoncompromised
A424. Listeria Monocytogenes
Q425. cellulitis; gas gangrene (myonecrosis with crepitus); food poisonoing (meat, poultry)
A425. Clostridium Perfringens
Q426. Pseudomenbranous colitis (PMC); Diarrhea
A426. Clostridium Difficile
Q427. Adult botulism (food poisoning, canned foods, hours); Infant botulism (contiminated honey, floppy baby, days); no fever (bacteria doesn't invade)
A427. Clostridium Botulinum
Q428. spastic paralysis; lockjaw, risus sardonicus
A428. Clostridium Tetani
Q429. Local: cutaneous tissue hemorrhage and necrosis-- >malignant pustules; Dysentery (secondary to lesions in GI tract); Systemic:fever, dyspnea, nonproductive cough (woolsorters disease)
A429. Bacillus Anthracis
Q430. food poisoning from contiminated rice
A430. Bacillus Cereus
Q431. Local: Lobar pneumonia, otitis media; Systemic: Meningitis
A431. Streptococcus pneumoniae
Q432. Pneumonia; Abscesses in kidney, brain; immune compromised
A432. Norcardia
Q433. Streptococcus Bovis DOC?
A433. PCN
Q434. Enterococcus Faecalis DOC?
A434. Ampicillin or Vancomycin; and; Aminoglycosides (synergistic)
Q435. Streptococcus Agalactiae DOC?
A435. PCN G; Prophylaixs: Ampicillin for preg women
Q436. Streptococcus Pyogenes DOC?; for Glomerulonephirits or Rheumatic Fever (immune- mediated)
A436. Symptomatic Tx. Prophylaxis: PCN to pts with Hx of; Rheumatic Fever to prevent further valve damage.
Q437. Streptococcus Pyogenes DOC?; for Scarlet Fever, TSS, Necrotizing Fasciitis (toxin-mediated)
A437. PCN G; Clindamycin added in TSS (prevents Scarlet fever toxin); Surgery and Debridement for Necrotizing Fasciitis
Q438. Streptococcus Pyogenes DOC?; Pharyngitis, Impetigo, Ersipelas, Cellulitis (Infections)
A438. PCN G
Q439. Staphylococcus Saprophyticus DOC?
A439. TMP-SMX
Q440. Staphylococcus Epidemidis DOC?; Infections of Indwelling Medical Devices
A440. Vancomycin ( most strains resistant to PCN and Cephalosporins); Remove foreign body
Q441. Staphylococcus Aureus DOC?; Infections: Impetigo, cellulits, folliculitis, furnuncles, carbuncles, pseumonia with cavitations, Acute Endocarditis, Meningitis, Osteomylitis, Septic Arthritis.
A441. MSSA: Penicillinase-resistant PCN; MRS: Vancomycin
Q442. Staphylococcus Aureus DOC?; Toxin Mediated: TSS, SSS (Ritter's disease in Newborn), Food Poisoning
A442. Remove foreign body, drainage of purpulent fluid, fluid replacement,; Penicillanase-resistant PCN
Q443. Actinomyces Israelii DOC?; Abcesses in mouth, lungs, GI Tract, GU tract.
A443. PCN G; Surgical Drainage of abscesses
Q444. Corynebacterium Diphtheriae DOC?
A444. antitoxin; PCN or Erythormycin for local infection; DTaP booster
Q445. Listeria Monocytogenes DOC?
A445. Ampicillin + or - Gentamicin; TMP-SMX
Q446. Clostridium Perfringens DOC?
A446. Surgical removable of infected areas; Hyperbaric oxygen to keill anaerobic organisms; PCN, Clindamycin (effective in local, weak infections)
Q447. Clostridium Botulinum DOC?
A447. antitoxin; respiratory support
Q448. Clostridium Tetani DOC?
A448. Prophylaxis DTaP vaccine, tetanus toxoid, boosters required; clean wound, antitoxin; DTaP booster; PCN, Metronidazole; Diazepam (a GABA-agonist)
Q449. Bacillus Anthracis DOC?
A449. parenteral PCN G; anti-PA vaccine
Q450. Bacillus Cereus DOC?
A450. rehydration; good food handling
Q451. Viridans Streptococci : Mutans, Intermedius DOC?
A451. PCN G
Q452. Streptococcus Pneumoniae DOC?
A452. PCN or Cepholosporin; Except Vancomycin for Meningitis
Q453. Norcardia: Asteroides, Brasiliensis DOC?
A453. TMP-SMX; Surgical drainage of abcess
Q454. c diff associated with
A454. pseudomembrane colitis, secondary to clinda or amp use
Q455. tx of pseudomembrane colitis
A455. metro, oral vanco
Q456. diphtheria
A456. exotoxin inhibits protein synthesis by ADP ribosylation of EF-2; grey-white membrane in pharynx with LAD; tx: diphtheria antitoxin, DPT vaccine, penecillin
Q457. anthrax
A457. contact: malignant pustule; inhalation: flulike symptoms that rapidly progress to fever, pulmonary hemorrhage, shock
Q458. actinomyces
A458. normal oral flora, bad if immunocompromised
Q459. neisseria gonococci cause
A459. urethritis, cervicitis, PID, epididymitis; most common cause of septic arthritis; ophthalmia neonatorum- sticky eye discharge, tx- EES eye drops
Q460. H influ
A460. epiglottitis, meningitis, otitis, pneumonia; can vaccinate
Q461. enterbacter
A461. aerobic GN rods; e coli, salmonella, shigella, klebsiella, enterobacter, serratia, proteus
Q462. kleb
A462. pneumonia, sepsis, UTI; red currant jelly sputum
Q463. salmonella
A463. motile, most common food associated diarrhea; do not tx- you will prolong the carrier state; see in chicken and eggs
Q464. shigella
A464. bacterial dysentery- water diarrhea then mucousy diarrhea
Q465. S typhi
A465. typhoid fever; fever,; RUQ pain,; resides in GB
Q466. S flexeneri
A466. Reiter's syndrome
Q467. Yersinia entercolitica
A467. pet feces (puppy)
Q468. seafood bugs
A468. vibrio parahaemolyticus,; v vulnificus
Q469. EHEC and EHIC
A469. have sHIga like toxin - inhibits 60s ribosome
Q470. E coli general
A470. diarrhea,; UTI,; neonatal meningitis/pneumonia/sepsis
Q471. ETEC
A471. most common cause of traveler's diarrhea; tx: TMP-SMX, fluoroquinolones; similar to cholera, rice water diarrhea; no intestinal wall invasion
Q472. EHEC
A472. O157:H7--> HUS- hemolysis, renal failure, TCP
Q473. enteropathogenic
A473. similar to shigella
Q474. EIEC
A474. intestinal wall invasion- blood diarrhea and fever
Q475. bloody diarrhea
A475. campylobacet,; salmonella,; shigella,; EHEC,; EIEC,; yersinia enterocolitica,; C diff,; entamoeba
Q476. watery diarrhea
A476. ETEC,; vibrio,; c perfringens,; protozoa- giardia, cryptosporidium,; viruses- rota, adeno, norwalk
Q477. campylobacter and cholera
A477. comma shaped organisms
Q478. cAMP inducers
A478. cholera,; pertussus,; e coli,; bacillus
Q479. proteus mirabilis
A479. very motile, flagella- no distinct colonies can be grown; common cause of UTI; carries urease (also h pylori and c neoformans)
Q480. cat scratch
A480. bartonella
Q481. dog/cat bite
A481. pasteurella multocida
Q482. cat feces
A482. toxoplasmosis
Q483. animal urine
A483. leptospira
Q484. rat bites
A484. spirillum minus
Q485. francisella tularemia
A485. rabbits
Q486. brucella
A486. undulant fever, dairy products, contact with animals
Q487. legionella
A487. poorly staining GN rod- use silver stain; aerosol transmission from environmental water source habitat; tx: ees; detect with urinary antigen test
Q488. pseudomonas causes
A488. pneumonia (CF, immunocompromised),; burn wound infections,; UTI,; external otitis,; hot tub folliculitis,; osteomyelitis (DM, IVDA),; sepsis,; endocarditis (IVDA),; corneal infections in contact lens wearers
Q489. pseudomonas things
A489. water source, produces endotoxin, blue green pigment; tx: AG + extended spectrum penicillin
Q490. H pylori
A490. duodenal ulcers and gastric ulcers; tx with triple therapy; urease positive
Q491. DDX granulomatous disease
A491. fungal infections,; silica/be exposure,; TB,; foreign bodies,; sarcoid-hilar LAD,; bartonella
Q492. primary TB
A492. ghon complex,; hilar nodes
Q493. secondary TB
A493. fibrocaseous cavitary lesion- classic TB
Q494. how do we kill TB
A494. kill by T memory lymphokines--> activate macrophages-- >kill
Q495. Ghon complex
A495. TB granulomas (Ghon focus) with lobar and perihilar lymph node involvement;; reflects primary infection or exposure
Q496. TB symptoms
A496. fever,; night sweats,; weight loss,; hemoptysis
Q497. M kansasii
A497. pulmonary TB like symptoms
Q498. M scrofulaceum
A498. cervical LAD in kids
Q499. MAIC
A499. disseminated disease in AIDs
Q500. M marinum
A500. marine activity, skin infection
Q501. M leprae
A501. likes cool temperatures- infects skin and superficial nerves; Tx: l/t dapsone, rifampin
Q502. lepromatous leprosy
A502. worse, failed cell mediated immunity
Q503. tuberculoid leprosy
A503. self limited
Q504. lyme disease
A504. caused by borrelia burgdorferi- transmitted by ixodes tick; erythema chronicum migrans rash with central clearing; tx: TCN, doxy
Q505. stage 1 lyme
A505. erythema chronicum migrans,; flulike symptoms
Q506. stage 2 lyme
A506. neurologic and cardiac manifestations
Q507. stage 3 lyme
A507. AI migratory polyarthritis
Q508. primary syph
A508. painless chancre
Q509. secondary syph
A509. disseminated disease with constitutional symptoms,; maculopapular rash,; condyloma lata,; alopecia areata
Q510. tertiary syph
A510. gumma,; aortitis,; neurosyph (tabes dorsalis- no proprioception),; argyll robertson pupil
Q511. congenital syph
A511. saber shins,; saddle nodes,; deafness,; notched incisors,; interstitial keratitis
Q512. argyll robertson pupil
A512. accomodates to convergence but does not react to light
Q513. VRDL false positives
A513. viruses (mono, hep),; drugs,; rheumatic fever/RA,; lupus,; leprosy
Q514. spirochetes
A514. borrelia,; leptospira,; treponema
Q515. C pneumo and C psittaci
A515. atypical pneumo- no fever or SOB, interstitial pneumo only; psittaci- avian resevoir
Q516. CT A-C
A516. chronic infection,; cause blindness in africa
Q517. CT D-K
A517. urethritis,; PID,; ectopic pregnancy,; neonatal pneumonia,; neonatal conjunctivitis (tx with EES)
Q518. CT L1-L3
A518. lymphogranuloma venereum
Q519. Rickettsia triad
A519. HA,; fever,; rash,; arthropod vector
Q520. tx for rickettsia
A520. TCN
Q521. why is coxiella atypical
A521. no rash, no vector, negative weil-felix reaction, aerosol; Q fever- interstitial pneumonia like woolsorters disease
Q522. RMSF
A522. rickettsia rickettsii- rash on palms and soles (migrates inward), HA, fever; endemic to east coast
Q523. acrodynia
A523. peeling of palms and soles because of Hg poisoning
Q524. Endemic typhus (fleas)
A524. R typhi
Q525. Epidemic typhus (human body louse)
A525. R prowsezekii
Q526. Weil-Felix reaction
A526. antirickettsia AB cross react with proteus antigen
Q527. Myco pneumo
A527. atypical walking pneumonia (insidious onset, HA, nonproductive cough, diffuse interstitial infiltrate), high titer of cold agglutinins (IgM); Tx: TCN, EES; bacterial cell membrane contains cholesterol; younger patients in clusters
Q528. gives rigid support, protects against osmotic pressure
A528. peptidoglycan
Q529. major surface antigen - has teichoic acid - induces acute phase reactants TNF and IL1
A529. cell wall/cell membrane
Q530. site of endotoxin (LPS), major surface antigen
A530. outer membrane (GN)
Q531. LPS components
A531. lipid A (induces TNF and IL1),; core polysaccharide,; outer O side chain
Q532. site of oxidative and transport enzymes
A532. plasma membrane
Q533. space between cytoplasmic membrane and outer membrane in GN bacteria
A533. periplasm
Q534. protects against phagocytosis
A534. capsule
Q535. mediates adherence of bacteria to cell surface, sex pilus forms attachment between 2 bacteria during conjugation
A535. pilus/fimbria
Q536. motility
A536. flagellum
Q537. provides resistance to dehydration, heat and chemicals
A537. spore
Q538. contains a variety of genes for antibiotic resistance, enzymes and toxins
A538. plasmid
Q539. organisms with IgA proteases
A539. S pneumo,; N mening,; N gonorrhea,; H influ
Q540. bugs that do not gram stain well
A540. treponema,; rickettsia,; mycobacteria,; mycoplasma,; legionella,; chlamydia
Q541. exotoxin
A541. secreted from cell,; made of polypeptide,; induces high titer antibodies- antitoxins
Q542. endotoxin
A542. part of the cell,; made of LPS,; poorly antigenic
Q543. superantigens
A543. bind directly to MHC II and TCR,; activating large numbers of T cell to stimulate release of IFN-gamma and IL2
Q544. S aureus toxins
A544. TSST-1- TSS; enterotoxin (preformed)- food poisoning; a-toxin- hemolysis; b-toxin- sphingomyelinase; leukocidin and hemolysin; epidermolytic/exfoliative- epithelial cell lysis, SSSS
Q545. S pyogenes toxins
A545. streptolysin O- hemolysis; streptolysin S- hemoylsis; erythrogenic/pyrogenic toxins- skin rash and fever of scarlet fever
Q546. diphtheria toxin
A546. inactivates EF2,; causes pharyngitis and pseudomembrane colitis
Q547. vibrio toxin
A547. stimualates adenylyl cyclase;; increases pumping of Cl and water into gut- voluminous rice water diarrhea
Q548. e coli toxin
A548. heat labile toxin stimulates adenylyl cyclase causing watery diarrhea; heat stabile toxin stimulates guanylyl cyclase
Q549. bordatella toxin
A549. stimulates adenylyl cyclase,; causes whopping cough;; inhibits chemokine receptor, causing lymphocytosis
Q550. perfringens toxin
A550. gas gangrene
Q551. tetanus toxin
A551. blocks release of inhibitor transmitter glycine- causes lockjaw
Q552. botulinum toxin
A552. blocks release of Ach,; causes anticholinergic symptoms,; CNS paralysis especially cranial nerves
Q553. anthracis toxin
A553. edema factor,; lethal factor,; protective antigen
Q554. shiga toxin
A554. like E coli O157:H7 cleaves host cell rRNA;; enhances cytokine release causing HUS
Q555. bacteria that secrete enterotoxins
A555. vibrio,; e coli,; staph,; salmonella,; shigella
Q556. what does C3a do
A556. hypotension, edema; mast cell and basophil degranulation--> histamien
Q557. what does C5a do
A557. neutrophil chemotaxis
Q558. H influ media
A558. chocolate agar with factors V and X
Q559. M TB media
A559. Lowenstein Jensen agar,; 2-4 weeks,; slow growing
Q560. Lactose fermenting enterics media
A560. MacConkey's agar
Q561. Features of MacConkeys
A561. bile salts and crystal violet- inhibit GP; lactose- only carbohydrate; neutral red stain (those that ferment lactose will pick it up)
Q562. congo red stains for
A562. amyloid; (green apply birefringence because of beta pleated sheets)
Q563. giema stains for
A563. borrelia,; plasmodium,; trypanosomes,; chlamydia
Q564. Ziehl-Neelson stains for
A564. acid fact bacteria
Q565. india ink stains for
A565. C neoformans
Q566. silver stains for
A566. fungi,; PCP,; legionella
Q567. methods for exchanging DNA cell to cell
A567. conjugation,; transduction,; transformation
Q568. method for plasmid transfer
A568. conjugation by f-pillus
Q569. obligate aerobes
A569. nocardia,; pseudomonas,; myco TB,; bacillus; "nagging pests must breathe"
Q570. m TB likes...
A570. apices of the lung which have the highest PO2
Q571. obligate anaerobes
A571. clostridium,; bacteriodes,; actinomyces; cannot use aminoglycosides against them; lack catalase/superoxide dismutase
Q572. obligate IC bugs
A572. rickettsia, chlamydia; cannot make their own ATP
Q573. encapsulated bacteria
A573. strep pneumo,; H influ,; neisseria mening,; kleb pneumo
Q574. spore formers
A574. bacillus anthracis,; clostridium perfringens,; c tetani,; coxiella
Q575. Conidia
A575. Asexual fungal spores (most spores)
Q576. Candida albicans Infxn
A576. Systemic or superficial fungal infection; Thrush esophagitis in ICH; Endocarditis in IV drug user; Post-Antibiotics vaginitis; Diaper rash
Q577. Candida albicans transmission?
A577. Inhalation of spores. No person-to-person spread.
Q578. Candida albicans treatment?
A578. Superficial infxn: nystatin; Systemic infxn: amphotericin B
Q579. Systemic (inhaled) mycoses - diseases (4)
A579. Histoplasmosis; Blastomycosis; Coccidiodomycosis; Paracoccidiomycosis
Q580. Histoplasmosis; Endemic location and pathologic features
A580. MS and OH river valley; Causes pneumonia; Bird/bat droppings; Intracellular (see Macs filled with yeast)
Q581. Blastomycosis; Endemic location and pathologic features
A581. MS river states + Central America; Inflammatory lung disease; Can disseminate to skin and bone; Granulomatous nodules; Culture on Sabouraud's agar; Broad Base Budding; "Cold=Mold"; "Heat=Yeast"
Q582. Coccidiodomycosis; Endemic location and pathologic features
A582. SW US, CA; "Valley fever"; Pneumonia and meningitis; Can disseminate to bone and skin; Spherules filled with endospores
Q583. Paracoccidiomycosis; Endemic location and pathologic features
A583. Rural Latin America; Budding yeast with "Captain's wheel" appearance
Q584. Diseases caused by dimorphic fungi (4)
A584. Histoplasmosis; Blastomycosis; Coccidiomycosis; Paracoccidiomycosis
Q585. Dimorphic fungi properties
A585. COLD=MOLD (soil); HEAT=YEAST (body temp) (except coccidiomycosis: spherule in tissue); All can cause pneumonia and disseminate; Systemic infxns can mimic TB (granuloma formation)
Q586. Treatment of Dimorphic fungi
A586. local: fluconazole or ketoconazole; systemic: amphotericin B
Q587. Cutaneous mycosis
A587. Tinea versicolor; Tinea pedis; Tinea cruris; Tinea capitis; Tinea corporis
Q588. Tinea versicolor
A588. Caused by Maelassezia furfur; hot, humid weather; "Spaghetti and meatball appearance"; Treat: miconazole, selenium sulfide
Q589. Tinea pedis, cruris, corporis, capitis
A589. Pruritic lesion with central clearing resembling a ring; Caused by dermatophytes; Mold hyphae in KOH prep are not dimorphic; Pets are reservoirs; Treat: azoles
Q590. Opportunistic fungal infxns (7)
A590. Candida albicans; Aspergillus fumigatus; Cryptococcus neoformans; Mucor; Rhizopus; Pneumocystis jiroveci; Sporothrix schenckii
Q591. Mucor and Rhizopus spp.
A591. Mucormycosis; Found in ketoacidotic diabetics and leukemic Pts; Proliferate in walls of BVs; Cause infarction and necrosis; Rhinocerebral, frontal lobe abcesses
Q592. Pneumocystis jiroveci (PCP)
A592. Diffuse interstitial pneumonia (PCP); Inhaled yeast. Most infxns--asymptomatic; Dx: lung biopsy or lavage, silver stain; Treat: TMP-SMX, pentamidine, dapsone; AIDS: prophylaxis at CD4 < 200
Q593. The molds
A593. aspergillus,; mucor/rhizopus,; cutaneous mycoses
Q594. The yeasts
A594. candida albicans,; crypto neoformans,; pneumocystis carinii
Q595. The dimorphic
A595. sporothrix,; coccidio,; histoplasmosis,; paracoccidio,; blastomycosis
Q596. Candida infections
A596. thrush in immunocompromised,; vulvovaginitis,; disseminated candidiasis,; chronic mucocutaneous candidiasis,; ballanitis,; esophagitis,; endocarditis,; diaper rash
Q597. What is seen in diaper rash
A597. irregular border with satellite lesions
Q598. Treatment for candida
A598. nystatin or azoles for superficial,; Amp B for systemic
Q599. Features of thrush
A599. will scrape,; will not swab
Q600. Aspergillus infections
A600. allergic bronchopulmonary aspergillosis,; lung cavity aspergilloma ("fungus ball"),; invasive aspergillosis
Q601. Aspergillus features
A601. mold with septate hyphae that branch at acute angles
Q602. C neoformans infections
A602. cryptococcal meningitis (HIV/AIDS),
Q603. C neoformans features
A603. encapsulated yeast,; found in soil, pigeon droppings; stains with India ink, urease positive; SNOWMAN
Q604. Mucor and rhizopus
A604. branches at wide angles,; disease mostly in ketoacidosis diabetes and leukemic patients;; can cause infarction, rhinocerebral or frontal lobe abscesses; wide angle branching!
Q605. PCP
A605. causes diffuse interstital pneumonia, inhaled, mostly asymptomatic;; immunosupressed; dx by lung biospy or lavage; silver stain; tx: tmp-smx, pentamidine, dapsone; prophylaxis when CD4 < 200
Q606. coccidio
A606. SW US, CA;; mold "winebarrels" -arthroconidia;; sandstorms; San Joaquin Valley or desert fever
Q607. Histoplasmosis
A607. MS and OH river valleys,; bird or bat droppings,; intracellular tiny yeast inside macrophages
Q608. Paracoccidio
A608. Rural Latin America,; multiple budding yeast form
Q609. Blastomycosis
A609. States E of MS river, Central America; big broad-based budding yeast
Q610. Tinea infections caused by...
A610. microsporum,; trichophyton,; epidermophyton,; spidermophyton
Q611. infections associated with birds
A611. C neoformans,; H capsulatum,; C psittaci,; West Nile,; Avian influenza (H5, N1)
Q612. Amp MOA, use, toxicities
A612. Amp B (also nystatin) binds to ergosterol, pokes holes in the membrane; systemic infections, intrathecally; fever/chills, hypotension, nephro(affinity for cells in the GBM)/hepatotox, arrythmias, anemia, IV phlebitis
Q613. nystatin use
A613. too toxic for systemic,; use orally or topical
Q614. Azole MOA; uses; toxicity
A614. inhibit fungal steroid (ergosterol) synthesis; systemic mycoses (fluconazole for cryptococcal meningitis in AIDS pts), also hypercortisolism; hormone synthesis inhibition (gynecomastia), liver dysfunction (inhibits cyt P 450), fever chills
Q615. flucytosine mechanism, uses
A615. inhibits DNA synthesis by conversion to fluorouracil; systemic fungal infections
Q616. capsofungin uses
A616. invasive aspergillosis; (inhibits cell wall synthesis)
Q617. terbinafine mechanism
A617. inhibits fungal enzyme squalene epoxidase,; used topically or orally
Q618. griseofulvin mechanism, use, Toxicity
A618. interferes with microtubule function, disrupts mitosis, deposits in keratin containing tissues; oral treatment of superficial infections, inhibits growth of dermatophytes; teratogenic, carcinogenic, confusion, headaches, increase P450 met and warfarin metabolism
Q619. Giardiasis
A619. Giardia lamblia; Transmitted by Cysts in water; often seen in campers/hikers; Bloating, flatulence, foul-smelling diarrhea; Diagnosis: trophozoites or cysts in stool; Tx: Metronidazole
Q620. Chagas disease
A620. Trypanosoma cruzi; The reduviid bug ("kissing bug") is responsible for the transmission of this organism; South America; dilated cardiomyopathy, megacolon, megaesophagus;; Dx: Blood smear; tx: Nifurtimox
Q621. African sleeping sickness
A621. Etiology: Trypanosoma gambiense, Trypanosoma rhodesiense; The tsetse fly is responsible for transmission; Enlarged lymph nodes, recurring fever (due to antigenic variation), somnolence, coma; dx: Blood smear; tx: Suramin, The treatment for African sleeping sickness that has penetrated the CNS is Melarsoprol
Q622. Visceral leishmaniasis (kala-azar)
A622. Leishmania donovani; The sandfly transmits; spiking fevers, hepatosplenomegaly, pancytopenia; dx: Macrophages containing amastigotes; tx: Sodium stibogluconate
Q623. Name the four types of malaria
A623. Plasmodium vivax,; Plasmodium ovale,; Plasmodium malariae,; Plasmodium falciparum
Q624. What are the common sx of malaria
A624. Cyclic fever,; headache,; anemia,; splenomegaly
Q625. What types of Plasmodium have dormant forms in liver (hypnozoites) and causes relapsing malaria?
A625. P. vivax and P. ovale
Q626. What Plasmodium cases severe malaria that can affect CNS
A626. P. falciparum
Q627. What is the treatment for malaria?
A627. Chloroquine (primaquine to prevent relapse caused by P. vivax, P. ovale),; sulfadoxine + pyrimethamine,; mefloquine,; quinine
Q628. Babesiosis
A628. Transmitted by Ixodes tick; fever and hemolytic anemia; Maltese cross: A classic sign of Babesiosis: a RBC has no RBC pigment and a cross shape can be seen; Tx: Quinine, clindamycin
Q629. Cryptosporidium
A629. -
Q630. How is Cryptosporidium? diagnosed?
A630. transmitted through cysts in water; Mild disease (watery diarrhea) in non-immunocompromised. Severe diarrhea in AIDS. Dx: cysts on acid-fast stain; There is no treatment for Cryptosporidium
Q631. Toxoplasma gondii
A631. Transmitted by cysts in meat or cat feces; crosses placenta (pregnant women should avoid cats); causes brain abscess in HIV and birth defects; pregnant women should avoid cats; dx: Serology, biopsy; tx: Sulfadiazine and pyrimethamine
Q632. Amebiasis
A632. Entamoeba histolytica; Transmitted by cysts in water; cause bloody diarrhea, liver abscess, and RUQ pain; dx: Serology and/or trophozoites or cysts in stool; RBCs in cytoplasm of entmoeba; tx: Metronidazole and iodoquinol
Q633. Rapidly fatal meningoencephalitis
A633. Naegleria fowleri is responsible; Transmission: Swimming in freshwater lakes (enter via cribriform plates); dx: Amoebas in spinal fluid
Q634. echinococcus
A634. eggs in dog feces--> cysts in liver,; causes anaphylaxis if echinococcal antigens are released from cysts
Q635. schistosoma
A635. snail are host (freshwater),; cercariae penetrate skin of humans,; causes granulomas, fibrosis, and inflammation of spleen and liver
Q636. clonorchis
A636. undercooked fish,; causes inflammation of biliary tract
Q637. tx for schistosoma, clonorchis, and paragonimus
A637. Praziquantel
Q638. tx for taenia solium
A638. praziquantel,; albendazole
Q639. echinococcus tx
A639. albendazole
Q640. ancylostoma
A640. larvae penetrate skin of feet;; intestinal infection can cause anemia;; Fe deficiency
Q641. ascaris
A641. eggs visible in feces, intestinal infection;; in 1/3 of the world
Q642. enterobius
A642. food contaminated with eggs,; intestinal infection,; causes anal pruritis (most common worm in US),; scotch tape test
Q643. strongyloides
A643. larvae in soil penetrate the skin, intestinal infection;; life cycle similar to ascaris
Q644. tx for ancylostoma, ascaris, enterobius
A644. mebendazole/pyrantel pamoate
Q645. tx for enterobius
A645. mebendazole,; PP
Q646. tx for strongyloides
A646. ivermectin/thiabendazole
Q647. wuchereria bancrofti
A647. female mosquito;; causes blockage of lymphatics (elephantiasis);; tx with diethylcarbamazine
Q648. bladder cancer in 3rd world countries
A648. schistosoma hematobium
Q649. hookworm
A649. ancylostoma
Q650. roundworm
A650. ascaris
Q651. trichinella
A651. from undercooked meat,; causes muscle inflammation and periorbital edema
Q652. tx of entamoeba, giardia, trichomonas
A652. metronidazole
Q653. giardia
A653. causes bloating,; flatulence,; foul-smelling diarrhea (campers, hikers),; from cysts in water
Q654. most common malariae
A654. Plasmodium vivax and falciparum
Q655. Malaria disease
A655. cyclic fever,; headache,; anemia,; splenomegaly
Q656. treatment of malaria
A656. chloroquine and primaquine (esp with PV and PO relapse),; sulfadoxine and pyrimethamine, mefloquin, quinine and doxycycline
Q657. malaria form that causes fevers and chills
A657. merozoite
Q658. replicating malaria
A658. shizont
Q659. PF gametes
A659. banana shaped
Q660. trichomonas
A660. foul smelling,; greenish discharge,; itching and burning,; sexual tramsition;; motile trophozoites on wet mount with flagella
Q661. T. cruzi
A661. Chagas- dilated cardiomyopathy, megacolon, megaesophagus; Frum reduviid bug
Q662. Leischmania donovanii
A662. visceral leishmaniasis,; infects liver and spleen;; from the sandfly but dogs are resevoir;; tx with sodium stibugluconate
Q663. most common protozoal infectoin
A663. giardia/trichomonas
Q664. erythrocyte ingested trophozoite
A664. entamoeba histolytica
Q665. malaria stage that looks like a diamond ring
A665. trophozoite
Q666. malaria stage that ruptures the host cell
A666. merozoite
Q667. malaria stage that replicated intracellularly
A667. shizont
Q668. malaria stage injected from anopheles mosquito
A668. sporozoite
Q669. Segmented Viruses
A669. BOAR; bunya; orthomyxo; arena; reo; can undergo reassortment causing antigenic shifts which result in pandemics!
Q670. Tzanck Test
A670. smear of open skin vesicle to detect multinucleated giant cells; picks up hsv and vzv
Q671. HA vs NA
A671. HA attaches to host sialic acid receptors on upper rest tract; NA cleaves neuramic acid and disrupts mucin barrier exposing sialic acid binding site below
Q672. Reye's Syndrome
A672. severe brain/liver disease resulting from children being given asa when they have influenza or varicella
Q673. Parainfluenza Virus
A673. upper resp tract symptoms; can cause croup (infection of larynx) in kids
Q674. RSV
A674. number 1 cause of pneumonia in young kids; contains F proteins that form multinucleated giant cells (syncytial cells)
Q675. Treatment of RSV
A675. palivizumab
Q676. Measles
A676. Cough, Coryza, Conjunctivitis (3Cs); Koplick spots; Paint drip rash; can cause SSPE later one
Q677. Enteroviruses
A677. all the picorna viruses except Rhino and HAV; spread by fecal oral route
Q678. What does polio damage?
A678. gray matter, mainly anterior horn of spinal cord and motor nuclei of pons/medulla
Q679. HFM disease
A679. coxA
Q680. CoxB symptoms
A680. pleurodynia; myocarditis; pericarditis
Q681. Yellow Fever Symptoms
A681. Black vomit; high fever, jaudice; transmitted by aedes mosquito
Q682. CSF findings of viral, bacterial, and fungal/TB meningitis
A682. Bacteria: low glucose, high pressure, high protein, mostly PMNs; Viral: normal/high pressure, normal glucuse, normal protein, mostly lymphs; Fungal/TB: same as bacteria except mostly lymphs!
Q683. Rubella symptoms
A683. 3day measleas, mild; if congential, BAD, deafness, PDA, cataracts, pulmonary artery stenosis, hydrocephalus