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92 Cards in this Set

  • Front
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216. Pt has urinary urgency, frequency, dysuria; lab: pyuria (+) or nitrite (+). TOW?
Cystitis due to E. coli
217. Significant UTI is confirmed by semiquantitative MSU culture based on the threshold of
> 1,000 cfu/mL
218. Mode of acquisition of uropathogen is
Endogenous
219. Microbial (structure) factor favoring bacterial persistence /colonization and UTI is
bacterial binding via fimbriae
220. Factor favoring bacterial persistence/colonization and UTI despite high osmolarity and urea concentrations and low pH is
high bacterial growth rates
221. Host factor favoring bacterial persistence/colonization and UTI is
Urinary stasis
222. Host factor favoring bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is
Absence of bactericidal effects of secreted proteins
223. Pyogenic inflammation in complicated UTI due to Gram- negative bacteria is due to
Lipopolysaccharide
224. Empiric DOC to treat community-acquired UTI in adults is
ciprofloxacin
225. These drugs inhibit DNA topoisomerases (DNA gyrase and topoisomerase IV) by binding to DNA-enzyme complexes, thereby interfering with bacterial DNA replication.
Fluoroquinolones
226. Avoid fluoroquinolones for the empiric Tx of UTI in pregnant women; alternative is
Nitrofurantoin
227. Gram-positive bacteria that cause uncomplicated UTI in sexually active, young women are
Staphylococcus saprophyticus
228. Differentiation of Staphylococcus saprophyticus from S. epidermidis (both coagulase negative) is based on
novobiocin resistance [i.e., S. saprophyticus is resistant, S. epidermidis is not]
229. In elderly or pt with risks of urinary stasis, fever, chills, flank pain, and CVA tenderness; Lab: pyuria, casts, nitrite+. TOW?
Pyelonephritis due to E. coli
230a. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GNR; fermenter; encapsulated; intrinsic ampicillin resistance)
Klebsiella pneumoniae
230b. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GNR; slow fermenter; red pigment; intrinsic drug resistance)
Serratia marcescens
230c. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GNR; swarming growth [very motile]; slow fermenter; intrinsic drug resistance)
Proteus mirabilis
230d. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GNR; non fermenter; oxidase+, blue pigment; intrinsic drug resistance)
Pseudomonas aeruginosa
230e. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GPC in chains; catalase-neg; grows in high salt; penicillin resistance)
Enterococcus faecalis
231. If a patient with complicated UTI is severely ill or not improving with therapy, do what rapid test next?
renal ultrasound (to rule out urinary tract obstruction)
232. For a patient with complicated UTI, once culture and sensitivity available, switch to what?
Narrow-spectrum abx
233. Genital chancre begins as a papule, ulcerates to form a single, painless, clean-based ulcer. TOW?
Primary (1°) syphilis
234. Cause of genital chancre, begining as a papule, ulcerating to form a single, painless, clean-based ulcer.
Treponema pallidum
235. Hx of pen-allergy in a non-pregnant woman, who has fever, "copper penny" macular lesions on the palms and/or soles; RPR(+). DOC?
Doxycycline
236. Hx of pen-allergy in a pregnant woman, who is RPR(+) and has tabes dorsalis (10-20yrs), or iritis, uveitis, iridocyclitis, Argyll- Robertson pupils. Manage how?
Desensitization
237. Hx of painful clustered vesicles with an erythematous base; urinary retention in a promiscuous woman. TOW?
HSV-2 >> 1
238. Giemsa stain of fluid from a herpetic lesion should reveal
Multinucleated giant cells
239. Patient with genital herpes does not respond to acyclovir because pt is infected with
thymidine kinase deficient HSV
240. A pregnant woman with 1° symptomatic HSV-2 infection is at risk of her baby developing
neonatal (congenital) herpes
241. Cause of painful genital ulcers (no induration); purulent, dirty grey base; painful inguinal adenitis (bubos), in a man with multiple sexual partners
Haemophilus ducreyi
242. Fastidious organism found within the granulocytic infiltrate of the penile ulcer and co-localized with neutrophils and fibrin, in a pt w/ chancroid is
Haemophilus ducreyi
243. All sex partners of pt with chancroid, regardless of symptoms, should be examined and treated with
Azithromycin > ceftriaxone
244. Most common cause of mucopurulent endocervical exudate (Gram stain non revealing) in a sexually promiscuous woman
Chlamydia trachomatis D-K
245. Dx of mucopurulent urethral discharge, dysuria, penile pruritis is based on
NAAT of urethral specimen or urine (+)
246. DOC of most frequent cause of non-gonococcal urethritis
Azithromycin > doxycycline
247. Cause of rare genital ulcers, inguinal lymphadenopathy in men with cytology(-) for multi-nucleated giant cells, RPR (-) is:
Chlamydia trachomatis L1-L3
248. Hx of systemic Sx/Sn w/ cervical motion tenderness in a woman with turbo-ovarian abscess. TOW?
PID
249. Cause of mucopurulent urethritis, dysuria, penile pruritis [Smear (+):Gram-negative diplococci co-populated w/ PMNs] is
Neisseria gonorrhoeae
250. Hx of frequent gonorrhea and disseminated gonococcal infection in a woman is due to deficiency in serum factors?
Terminal complements
251. Immune evasion of Neisseria gonorrhoeae in frequent mucosal infection is due to
Antigenic variation of pili
252. Auxotrophic strains of N. gonorrhoeae (needing arginine for growth) and also with serum (complements) resistance are likely to cause
Septic arthritis (aka: DGI - disseminated gonococcal infection)
253. Most frequent complication of gonococcal (GC) infection in men
Epididymitis
254. Cause of "bull headed clap", urethral stricture, prostatitis is
Neisseria gonorrhoeae
255. Urethritis is treated with ceftriaxone + azithromycin because
Concurrent GC + Chlamydia
256. An older woman with PID and tubo-ovarian abscess receives ceftriaxone, azithromycin, and metronidazole because
Polymicrobic (endogenous) infection
257. Cause of anogenital warts w/ histology (+): koilocytes is
HPV 6 and 11
258. Cause of atypical squamous cells of undetermined significance (ASCUS) on pap smear w/ no clinical signs of infection is
HPV 16 and 18
259. Cause of koilocytotic cells and possible progression to squamous cell carcinoma
HPV 16 and 18
260. Next step to identify viral cause of ASCUS on pap smear w/ and further management in a woman of age > 29 years is
Colposcopy > HPV DNA in bpsy
261. Wet prep of vaginal discharge from a sexually promiscuous woman w/ vaginal pruritis; ectocervical erythema ("strawberry cervix") should reveal
motile tissue flagellate
262. Gram stain of vaginal discharge w/ fishy odor from a sexually promiscuous woman w/ vaginal pruritis but no erythema and normal cervix should reveal
SECs stippled with Gram- variable organisms.
263. DOC of bacterial vaginosis (BV) is
metronidazole
264. Disruption of normal vaginal flora and depletion of lactobacilli in pt with BV cause overgrowth of anaerobic Mobiluncus species and
Gardnerella vaginalis
265. Wet prep of curdy discharge (no odor), adhering to vaginal walls, from a pregnant woman w/ recent UTI, who now has severe vaginal pruritis; vulvovaginal area - erythematous should reveal
budding yeasts with pseudohyphae
266. Normal commensal of skin, GI & GU tracts; endogenous overgrowth of budding yeast, capable of >10 diseases. TOW?
Candida albicans
267. Mechanism of action of a PO DOC of vulvovaginal candidiasis is
blocks C14α-lanosterol demethylase
[The DOC for vulvovaginal candidiasis is an Azole medication]
268. Hx of flu-like illness, lymphadenopathy, maculopapular rash in a bisexual man. Lab: lymphopenia and transaminase elevations; monospot/all serology (-). TOW?
Acute retroviral syndrome
269. Time from infection (acquisition) to acute seroconversion detected by HIV serology (ELISA/ WBlot) is
6-12 weeks.
270. Hx of mononucleosis-like illness and lymphadenopathy in a man with MSM. Serology (-). What is HIV viral load?
>10,000 copies/ml
271. Host-cell receptor for HIV-1 infection
CD4
272. Homozygous for deletions in what gene renders resistance to infection and some protection against progression.
CCR5
273. Host cells that trap HIV and mediate the efficient transinfection of CD4+ T cells are
Dendritic cells
274. A man, who practices "sex with another man" has antibodies to HIV (ELISA and WB) but asymptomatic. TOW?
Clinical latency
275. What happens to HIV-1 virus when acute retroviral syndrome progresses to clinical latency?
Virus continues to replicate low level.
276. CD4 count of a man/woman who is HIV-1 (+) and has 2 of: Candidiasis, Invasive cervical CA, Coccidiodomycosis, Cryptococcosis, Cryptosporidiosis, CMV retinitis, HIV encephalopathy, HSV ulcers, histoplasmosis, isosporiasis, Kaposi sarcoma, Burkitt lymphoma, primary brain lymphoma, MAC or Myco. kansasii infection, Myco. tuberculosis, pneumocystis, progressive multifocal leukoencephalopathy, Toxoplasmosis of brain, HIV-wasting syndrome
CD4+ < 200/μL
277. A man with HIV infection has lymphadenopathy, chronic diarrhea, oral thrush + herpes lesions. Expected CD4+ count is
50 cells/μL.
278. Most common cause of HIV- associated peripheral skin or mucosal ulcers
HSV-1 (>> Histo > CMV > VZV > Syphilis)
279. Most common cause of HIV- associated nodules (neoplasia)?
HHV-8 (aka KSHV)
280. Hx of fatigue, nausea, abdominal pain, diarrhea, fever, chills, night sweats, dry persistent cough w/ SOB and weight loss in a man with AIDS. Lab: PPD (-); blood culture (+) for AFB [Acid-Fast Bacilli]. TOW?
Mycobacterium avium- intracellulare complex
281. Common cause of retinitis, viral pneumonitis or esophagitis in AIDS
CMV
282. Hx: progressive CNS dz in a pt w/ AIDS: hemiparesis, visual, ataxia, aphasia, cranial nerves, sensory. MRI: ring- enhancing lesions. Toxo antibody (-). TOW?
JC virus
283. Definitive indication for initial HAART (CD4+ count) is
CD4+ 350/mm3.
284. Objective of ARV Tx is to reduce viremia to what level of genomic RNA/mL
< 50 copies RNA/mL.
285. Initial regimen of anti-retroviral therapy is
Emtricitabine + Tenofovir + Efavirenz
286. Abacavir, emtricitabine, lamivudine, zidovudine, tenofovir belong to what class of antiretrovirals?
NRTIs
287. Efavirenz, nevirapine belong to what class of antiretrovirals?
NNRTIs
288. Atazanavir, Lopinavir, Saquinavir belong to what class of antiretrovirals?
Protease inhibitors
289. This drug binds to gp41 and prevents conformational change required for viral fusion and entry into cells.
enfuvirtide
290. This drug inhibits integrase, responsible for insertion of HIV proviral DNA into the host genome.
raltegravir
291. A man has AIDS and CD4 <200cells/μL or thrush. Antibacterial prophylaxis needed besides HAART is
TMP-SMX (for PCP)
292. A man has AIDS and CD4 <100 + pos toxo IgG. Chemoprophylaxis needed besides HAART is
TMP-SMX (for Toxoplasma encephalitis)
293. A man has AIDS and CD4 <100 + PPD >5mm induration. Antibacterial prophylaxis needed besides HAART is
INH + pyridoxine
294. A man has AIDS and CD4 <50. Antibacterial prophylaxis needed besides HAART is
azithromycin (for MAC)
295. Hx of fever, a pustule at a cat scratch site, adenopathy, hepatosplenomegaly in a pt w/ AIDS. Warthin-Starry stain tissue (+). TOW (clue: bacillary angiomatosis)?
Bartonella henselae
296. Mnemonic of the leading causes of congenital infections
ToRCH3eS-List -- To = Toxoplasma gondii, R = Rubella, C = CMV, H = HSV-2, H = HIV, H = HBV, S = Syphilis, List = Listeria monocytogenes
297. Cause of chorioretinitis, intracranial calcifications, and hydrocephalus in a neonate (mom at pregnancy had mono-like illness after eating raw meat) is
Toxoplasma gondii
298. Hx of deafness, cataracts, heart defects, microcephaly, or mental retardation in a child (of a seronegative mom, exposed to "Blueberry muffin baby" in a very poor neighborhood). TOW?
congenital rubella syndrome
299. Microcephaly, seizures, sensorineural hearing loss, feeding difficulties, petechial rash, hepatosplenomegaly, or jaundice in a neonate. PCR of urine should yield
CMV
300. Hepatosplenomegaly, neurologic abnormalities, frequent infections in a neonate w/ low CD4+ counts. Woman before birthing should have received
Nevirapine
301. Cause of vesicular skin lesions + conjunctivitis in a child (asymptomatic at birth)
HSV-2
302. Hx of cutaneous lesions, hepatosplenomegaly, jaundice, saddle nose, saber shins. Hutchinson teeth, + CN VIII deafness in a neonate (mom is a prostitute). TOW?
3° syphilis
303. Neonatal septicemia or meningitis (mom had flu-like Sx and ate imported cheese during pregnancy). TOW?
Listeria monocytogenes