Micro Nath Utis/stis

Front 1

Pt has urinary urgency, frequency, dysuria; lab: pyuria (+)
or nitrite (+). TOW?

Back 1

Cystitis due to E. coli

Front 2

Significant UTI is confirmed by semiquantitative MSU culture based on the threshold of

Back 2

>/ 1,000 cfu/mL

Front 3

Mode of acquisition of uropathogen is

Back 3

Endogenous

Front 4

Microbial (structure) factor favoring bacterial persistence/colonization and UTI is

Back 4

bacterial binding via fimbriae

Front 5

Factor favoring bacterial persistence/colonization and UTI
despite high osmolarity and urea concentrations and low pH is

Back 5

high bacterial growth rates

Front 6

Host factor favoring bacterial persistence/colonization and UTI is

Back 6

Urinary stasis

Front 7

Host factor favoring bacterial persistence/colonization and
UTI despite frequent voiding and high urinary flow is

Back 7

Absence of bactericidal
effects of secreted proteins

Front 8

Pyogenic inflammation in complicated UTI due to Gram-negative bacteria is due to

Back 8

Lipopolysaccharide

Front 9

Empiric DOC to treat community-acquired UTI in adults is

Back 9

ciprofloxacin

Front 10

These drugs inhibit DNA topoisomerases (DNA gyrase and
topoisomerase IV) by binding to DNA-enzyme complexes, thereby
interfering with bacterial DNA replication. What?

Back 10

Fluoroquinolones

Front 11

Avoid fluoroquinolones for the empiric Tx of UTI in pregnant women; alternative is

Back 11

Nitrofurantoin

Front 12

Gram-positive bacteria that cause uncomplicated UTI in
sexually active, young women are

Back 12

Staphylococcus saprophyticus

Front 13

Differentiation of Staphylococcus saprophyticus from S. epidermidis (both coagulase negative) is based on

Back 13

novobiocin resistance

Front 14

In elderly or pt with risks of urinary stasis, fever, chills, flank pain, and CVA tenderness; Lab: pyuria, casts, nitrite+. TOW?

Back 14

Pyelonephritis due to E. coli

Front 15

Pt hospitalized > 72 h forcomorbidity 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)

Clue: GNR; slow fermenter; red pigment; intrinsic drug resistance)

Clue: GNR; swarming growth [very motile]; slow fermenter; intrinsic
drug resistance)

Clue: GNR; non fermenter; oxidase+, blue pigment; intrinsic drug resistance)

Clue: GPC in chains; catalase-neg; grows in high salt; penicillin
resistance)

Back 15

Klebsiella pneumoniae

Serretia marcescens

Proteus mirabilis

Pseudomonas aeruginosa

Enterococcus faecalis

Front 16

If a patient with complicated UTI is severely ill or not improving with therapy, do what rapid test next?

Back 16

renal ultrasound (to rule out urinary tract obstruction)

Front 17

For a patient with complicated UTI, once culture and sensitivity available, switch to what?

Back 17

Narrow-spectrum abx

Front 18

Genital chancre begins as a papule, ulcerates to form a single, painless, clean-based ulcer. TOW?

Back 18

1o syphilis

Front 19

Cause of genital chancre, begining as a papule, ulcerating to form a single, painless, clean-based ulcer.

Back 19

Treponema pallidum

Front 20

Hx of pen-allergy in a non-pregnant woman, who has fever,
"copper penny" macular lesions on the palms and/or soles; RPR(+).
DOC?

Back 20

Doxycycline

Front 21

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?

Back 21

Desensitization

Front 22

Hx of painful clustered vesicles with an erythematous base;
urinary retention in a promiscuous woman. TOW?

Back 22

HSV-2 >> 1

Front 23

Giemsa stain of fluid from a herpetic lesion should reveal

Back 23

Multinucleated giant cells

Front 24

Patient with genital herpes does not respond to acyclovir because pt is infected with

Back 24

thymidine kinase deficient
HSV

Front 25

A pregnant woman with 1o symptomatic HSV-2 infection is
at risk of her baby developing

Back 25

neonatal (congenital) herpes

Front 26

Cause of painful genital ulcers (no induration); purulent,
dirty grey base; painful inguinal adenitis (bubos), in a man with
multiple sexual partners

Back 26

Haemophilus ducreyi

Front 27

Fastidious organism found within the granulocytic infiltrate
of the penile ulcer and co-localized with neutrophils and fibrin, in a
pt w/ chancroid is

Back 27

Haemophilus ducreyi

Front 28

All sex partners of pt with chancroid, regardless of symptoms, should be examined and treated with

Back 28

Azythromycin > ceftriaxone

Front 29

Most common cause of mucopurulent endocervical exudate (Gram stain non revealing) in a sexually promiscuous woman

Back 29

Chlamydia trachomatis D-K

Front 30

Dx of mucopurulent urethral discharge, dysuria, penile pruritis is based on

Back 30

NAAT of urethral specimen
or urine (+)

Front 31

DOC of most frequent cause of nongonococcal urethritis

Back 31

Azythromycin > doxycycline

Front 32

Cause of rare genital ulcers, inguinal lymphadenopathy [cytology(-) for multi-nucleated giant cells; RPR (-)] in men is

Back 32

Chlamydia trachomatis L1-L3

Front 33

Hx of systemic Sx/Sn w/ cervical motion tenderness in a woman with turbo-ovarian abscess. TOW?

Back 33

PID

Front 34

Cause of mucopurulent urethritis, dysuria, penile pruritis
[Smear (+):Gram-negative diplococci co-populated w/ PMNs] is

Back 34

Neisseria gonorrhoeae

Front 35

Hx of frequent gonorrhea and disseminated gonococcal
infection in a woman is due to deficiency in serum factors?

Back 35

Terminal complements

Front 36

Immune evasion of Neisseria gonorrhoeae in frequent
mucosal infection is due to

Back 36

Antigenic variation of pili.

Front 37

Auxotrophic strains of N. gonorrhoeae (needing arginine
for growth) and also with serum (complements) resistance are
likely to cause

Back 37

Septic arthritis (aka: DGI)

Front 38

Most frequent complication of gonococcal (GC) infection in
men

Back 38

Epididymitis

Front 39

Cause of "bull headed clap", urethral stricture, prostatitis is

Back 39

Neisseria gonorrhoeae

Front 40

Urethritis is treated with ceftriaxone + azythromycin because

Back 40

Concurrent GC + Chlamydia

Front 41

An older woman with PID and tubo-ovarian abscess
receives ceftriaxone, azythromycin, and metronidazole because

Back 41

Polymicrobic (endogenous)
infection

Front 42

Cause of anogenital warts w/ histology (+): koilocytes is

Back 42

HPV 6 and 11

Front 43

Cause of atypical squamous cells of undetermined
significance (ASCUS) on pap smear w/ no clinical signs of infection is

Back 43

HPV 16 and 18

Front 44

Cause of koilocytotic cells and possible progression to squamous cell carcinoma

Back 44

HPV 16 and 18

Front 45

Next step to identify viral cause of ASCUS on pap smear w/
and further management in a woman of age > 29 years is

Back 45

Colposcopy > HPV DNA in
bpsy

Front 46

Wet prep of vaginal discharge from a sexually promiscuous woman w/ vaginal pruritis; ectocervical erythema ("strawberry
cervix") should reveal

Back 46

motile tissue flagellate

Front 47

Gram stain of vaginal discharge w/ fishy odor from a
sexually promiscuous woman w/ vaginal pruritis but no erythema
and normal cervix should reveal

Back 47

SECs stippled with Gram-variable organisms.

Front 48

DOC of bacterial vaginosis (BV) is

Back 48

metronidazole

Front 49

Disruption of normal vaginal flora and depletion of lactobacilli in pt with BV cause overgrowth of anaerobic
Mobiluncus species and

Back 49

Gardnerella vaginalis

Front 50

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

Back 50

budding yeasts with
pseudohyphae

Front 51

Normal commensal of skin, GI & GU tracts; endogenous overgrowth of budding yeast, capable of >10 diseases. TOW?

Back 51

Candida albicans

Front 52

Mechanism of action of a po DOC of vulvovaginal candidiasis is

Back 52

blocks C14alpha-lanosterol demethylase

Front 53

Hx of flu-like illness, lymphadenopathy, maculopapular
rash in a bisexual man. Lab: lymphopenia and transaminase
elevations; monospot/all serology (-). TOW?

Back 53

Acute retroviral syndrome

Front 54

Time from infection (acquisition) to acute seroconversion detected by HIV serology (ELISA/ WBlot) is

Back 54

6-12 weeks.

Front 55

Hx of mononucleosis-like illness and lymphadenopathy in a man with MSM. Serology (-). What is HIV viral load?

Back 55

>10,000 copies/ml

Front 56

Host-cell receptor for HIV-1 infection

Back 56

CD4

Front 57

Homozygous for deletions in what gene renders resistance to infection and some protection against progression.

Back 57

CCR5

Front 58

Host cells that trap HIV and mediate the efficient transinfection of CD4+ T cells are

Back 58

Dendritic cells

Front 59

A man, who practices “sex with another man”, has antibodies to HIV (ELISA and WB) but asymptomatic. TOW?

Back 59

Clinical latency

Front 60

What happens to HIV-1 virus when acute retroviral syndrome progresses to clinical latency?

Back 60

Virus continues to replicate
low level.

Front 61

A man who practices “sex with another man”, is now HIV-1
serology (+) and has dual symptomatic infections/cancer (any two
from below). Expected CD4+ count is
i. Candidiasis, esophageal, bronchi, trachea, or lungs
ii. Cervical cancer, invasive
iii. Coccidioidomycosis, extrapulmonary
iv. Cryptococcosis, extrapulmonary
v. Cryptosporidiosis, chronic intestinal
vi. Cytomegalovirus retinitis (with vision loss)
vii. Encephalopathy, HIV-related
viii. Herpes simplex - Chronic ulcers
ix. Histoplasmosis, disseminated or extrapulmonary
x. Isosporiasis, chronic intestinal (duration >1 mo)
xi. Kaposi sarcoma
xii. Lymphoma, Burkitt
xiii. Lymphoma, primary, of the brain
xiv. Mycobacterium avium complex or Mycobacterium
kansasii infection, extrapulmonary
xv. Mycobacterium tuberculosis infection, any site
(pulmonary or extrapulmonary)
xvi. Pneumocystis pneumonia
xvii. Progressive multifocal leukoencephalopathy
xviii. Toxoplasmosis of the brain
xix. Wasting syndrome due to HIV infection

Back 61

CD4+ < 200/&L

Front 62

A man with HIV infection has lymphadenopathy, chronic diarrhea, oral thrush + herpes lesions. Expected CD4+ count is

Back 62

50 cells/&L.

Front 63

Most common cause of HIV-associated peripheral skin or mucosal ulcers

Back 63

HSV-1 (>> Histo > CMV > VZV > Syphilis)

Front 64

Most common cause of HIV- associated nodules (neoplasia)?

Back 64

HHV-8 (aka KSHV)

Front 65

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. TOW?

Back 65

Mycobacterium avium-intracellulare complex

Front 66

Common cause of retinitis, viral pneumonitis or esophagitis in AIDS

Back 66

CMV

Front 67

Hx: progressive CNS dz in a pt w/ AIDS: hemiparesis,
visual, ataxia, aphasia, cranial nerves, sensory. MRI: ring-enhancing lesions. Toxo antibody (-). TOW?

Back 67

JC virus

Front 68

Definitive indication for initial HAART (CD4+ count?) is

Back 68

CD4+ 350/mm.

Front 69

Objective of ARV Tx is to reduce viremia to what level of genomic RNA/mL

Back 69

< 50 copies RNA/mL.

Front 70

Initial regimen of anti-retroviral therapy is

Back 70

Emtricitabine + Tenofovir +
Efavirenz

Front 71

Abacavir, emtricitabine, lamivudine, zidovudine, tenofovir belong to what class of antiretrovirals?

Back 71

NRTIs

Front 72

Efavirenz, nevirapine belong to what class of antiretrovirals?

Back 72

NNRTIs

Front 73

Atazanavir, Lopinavir, Saquinavir belong to what class of antiretrovirals?

Back 73

Protease inhibitors

Front 74

This drug binds to gp41 and prevents conformational change required for viral fusion and entry into cells.

Back 74

enfuvirtide

Front 75

This drug inhibits integrase, responsible for insertion of HIV proviral DNA into the host genome.

Back 75

raltegravir

Front 76

A man has AIDS and CD4 <200cells/L or thrush. Antibacterial prophylaxis needed besides HAART is

Back 76

TMP-SMX (for PCP)

Front 77

A man has AIDS and CD4 <100 + pos toxo IgG. Chemoprophylaxis needed besides HAART is

Back 77

TMP-SMX (for Toxoplasma
encephalitis)

Front 78

A man has AIDS and CD4 <100 + PPD >5mm induration. Antibacterial prophylaxis needed besides HAART is

Back 78

INH + pyridoxine

Front 79

A man has AIDS and CD4 <50. Antibacterial prophylaxis needed besides HAART is

Back 79

azithromycin (for MAC)

Front 80

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)?

Back 80

Bartonella henselae

Front 81

Mnemonic of the leading causes of congenital infections

Back 81

ToRCH3eS-List
To = Toxoplasma gondii
R = Rubella
C = CMV
H = HSV-2
H = HIV
H = HBV
S = Syphilis
List = Listeria monocytogenes

Front 82

Cause of chorioretinitis, intracraneal calcifications, and
hydrocephalus in a neonate (mom at pregnancy had mono-like illness after eating raw meat) is

Back 82

Toxoplasma gondii

Front 83

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?

Back 83

congenital rubella syndrome

Front 84

Microcephaly, seizures, sensorineural hearing loss, feeding
difficulties, petechial rash, hepatosplenomegaly, or jaundice in a neonate. PCR of urine should yield

Back 84

CMV

Front 85

Hepatosplenomegaly, neurologic abnormalities, frequent infections in a neonate w/ low CD4+ counts. Woman before birthing should have received

Back 85

Nevirapine

Front 86

Cause of vesicular skin lesions + conjunctivitis in a child
(asymptomatic at birth)

Back 86

HSV-2

Front 87

Hx of cutaneous lesions, hepatosplenomegaly, jaundice,
saddle nose, saber shins. Hutchinson teeth, + CN VIII deafness in a neonate (mom is a prostitute). TOW?

Back 87

3o syphilis

Front 88

Neonatal septicemia or meningitis (mom had flu-like Sx and ate imported cheese during pregnancy). TOW?

Back 88

Listeria monocytogenes