Nbme Infectious Disease

Front 1

Evaluation of pulsatile tinnitus

Back 1

Patients with pulsatile tinnitus should be evaluated for the possible presence of an intracranial vascular anomaly, such as stenosis, arteriovenous malformation, or glomus tumor as a cause of their symptoms

Front 2

most effective treatments for edema due to chronic venous stasis

Back 2

sodium restriction, leg elevation, weight reduction, and compression stockings; diuretics should be avoided

Front 3

severe Clostridium difficile infection

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leukocyte count greater than 15,000/microliter (15 × 109/L), and a significant decrease in kidney function (increase in the serum creatinine level greater than 1.5 times the baseline level)

Front 4

histoplasmosis

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Histoplasma capsulatum is a dimorphic fungal organism endemic to the southeastern United States; is found in soil contaminated with bird or bat droppings; and is characterized by a flu-like syndrome and dyspnea, cough, and chest discomfort

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treatment of shigellosis

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In a patient with shigellosis confirmed by microbiologic diagnosis,ciprofloxacin is indicated to hasten clearance of fecal shedding of bacteria and reduce the risk of secondary spread to other persons even if the illness has resolved

Front 6

treatment of bloodstream infections caused by methicillin-resistantStaphylococcus aureus when the minimal inhibitory concentration to vancomycin is more than 2 micrograms/mL

Back 6

daptomycin

linezolid has activity against S. aureus but is not indicated for the treatment of bloodstream infection

Front 7

mucopurulent cervicitis: causative organisms and treatment

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most commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis infection

Rx: ceftriaxone, 250 mg intramuscularly in a single dose, plus azithromycin, 1 g orally in a single dose

Front 8

first line therapy for clenched-fist injury

Back 8

amoxicillin-clavulanate

if PCN allergy,combination of clindamycin and moxifloxacin

Front 9

prophylactic treatment of immunocompromised or pregnant persons within 96 hours of exposure to the varicella virus?

Back 9

Varicella-zoster immune globulin (VZIG) or investigational VZIG (VariZIG™) or IVIG if these are not available

Front 10

liver disease + Vibrio vulnificus infection =

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necrotizing fasciitis

Front 11

effect on serum levels of cyclosporine, tacrolimus, or sirolimus with co-administration of macrolide abx or azole antifungals?

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increased levels of one or both drugs

metabolism by hepatic cytochrome P-450 enzymes is significantly inhibited by macrolide antibiotics; the interaction between these two agents leads to several-fold increases in tacrolimus levels, resulting in toxicity

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most common cause of benign recurrent lymphocytic meningitis

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Herpes simplex virus type 2

diagnosis is established by cerebrospinal fluid polymerase chain reaction

Front 13

preferred treatment for cryptococcal meningitis in a patient with AIDS

Back 13

conventional amphotericin B plus flucytosine, 2-week induction course; followed by oral fluconazole for a minimum of 8 weeks

Lipid formulations of amphotericin B are reserved for those with or predisposed to kidney dysfunction

Front 14

who should be treated for PID?

what is the treatment?

Back 14

Women with abdominal or pelvic pain and cervical motion tenderness, adnexal tenderness, or uterine tenderness who can tolerate outpatient therapy

single-dose intramuscular ceftriaxone and oral doxycycline for 14 days

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Lymphogranuloma venereum (LGV)

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a genital ulcer disease caused by the L1, L2, and L3 serovars of Chlamydia trachomatis. Classic LGV presents as a painless papule or ulcer at the site of inoculation that resolves without treatment and is followed by painful unilateral inguinal lymphadenopathy accompanied by fever and malaise

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presentation of reactive arthritis

Back 16

an asymmetric oligoarthritis

Front 17

treatment of mild pulmonary histoplasmosis in a healthy host

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none

if Rx of acute pulmonary histoplasmosis is indicated (e.g. immunocompromised), the treatment of choice is itraconazole

more severe forms may be treated with amphotericin B or one of the newer triazole antifungal agents

Front 18

Initiating combination antiretroviral therapy is appropriate in patients with:

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history of an AIDS-defining opportunistic infection or malignancy, the presence of symptoms, a CD4 cell count less than 500/microliter, HIV-associated nephropathy, active co-infection with hepatitis B virus infection, and pregnancy

Front 19

risk factors for drug-resistant Streptococcus pneumoniae infection

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age greater than 65 years, recent (within the past 3 months) β-lactam therapy, medical comorbidities, immunocompromising conditions and immunosuppressive therapy, alcoholism, and exposure to a child in day care

Front 20

presentation of coccidioidomycosis

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frequently asymptomatic!

may present with a subclinical pulmonary infection, systemic symptoms, joint pain, and erythema nodosum

Front 21

duration of TB therapy when initial-phase treatment is interrupted

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When the lapse is less than 2 weeks, recommendations are that the initial regimen should be continued until the planned total number of doses is taken, provided that all doses are taken within 3 months.

An interruption of 2 or more weeks during the initial 2-month phase of therapy requires restarting the same regimen from the beginning

Front 22

treatment of mild to moderate disseminated extrapulmonary blastomycosis

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oral itraconazole

Front 23

side effects of pyrazinamide

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hyperuricemia and gout, by inhibiting renal tubular excretion of uric acid

Other potential side effects include hepatitis, rash, and gastrointestinal upset.

Front 24

one of the few agents with reliable activity against resistant gram-negative bacilli, such as extensively drug-resistant Pseudomonas aeruginosa

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colistin

Front 25

characteristics of inhalational anthrax

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rapid development of a septic state following a nonspecific prodromal flu-like syndrome and widening of the mediastinum on CXR

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diagnosis of sporadic Creutzfeldt-Jakob disease

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definitive diagnosis requires finding spongiform changes on pathologic examination of brain tissue.

Clinical features include rapidly progressive dementia and myoclonus, bland cerebrospinal fluid findings, and nondiagnostic neuroimaging studies

14-3-3 protein in CSF is nonspecific

Front 27

presentation of botulism

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a classic triad of symmetric, descending flaccid paralysis with prominent bulbar palsies (diplopia, dysarthria, dysphonia, and dysphagia); normal body temperature; and a clear sensorium

Front 28

antiretroviral therapy for pregnant women with HIV infection

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zidovudine, lamivudine, and lopinavir-ritonavir

Front 29

manifestations of dengue infection in symptomatic persons

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after an incubation period of 4 to 7 days, patients experience abrupt fever with chills, severe frontal headache, retro-orbital pain, and musculoskeletal pain, characteristically severe in the lumbar spine, earning dengue the name “break-bone fever”

Front 30

CMV syndrome

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typically occurs in the first few months after transplantation

presents with fever, cytopenias, and hepatitis; may include pneumonitis or colitis

Front 31

recommended empiric therapy for bacterial meningitis

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combination of vancomycin, ampicillin, and a third-generation cephalosporin (cefotaxime or ceftriaxone), with adjunctive dexamethasone for suspected or proven pneumococcal meningitis concomitant with or just prior to the first dose of antimicrobial therapy

Front 32

Successful management of mucormycosis

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prompt administration of appropriate antifungal therapy coupled with aggressive surgical debridement

Front 33

Infection control management of patients with suspected or known invasive disease caused by group A β-hemolytic streptococci, including toxic shock syndrome and necrotizing fasciitis

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contact precautions until completion of 24 hours of antibiotic therapy

Front 34

treatment of cat-scratch disease due to Bartonella henselae

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azithromycin

Front 35

presentation and treatment of sporotrichosis

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Following cutaneous inoculation, typically of the hand or forearm, a papule or nodule with overlying erythema develops and may ulcerate. Similar lesions develop along lymphatic channels proximal to the draining lymph nodes. Itraconazole is the preferred treatment.

Front 36

simvastatin in HIV?

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contraindicated in patients taking HIV protease inhibitors because of cytochrome P-450 drug metabolism interactions, which would raise simvastatin concentrations to dangerous levels

Front 37

recommended empiric therapy for pneumococcal meningitis

Back 37

vancomycin plus a third-generation cephalosporin (either ceftriaxone or cefotaxime)

Front 38

presentation of infection with Yersinia pestis, the causative agent of plague

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Plague typically consists of three clinical syndromes: (1) pneumonic plague, occurring with inhalation of bacteria (most likely bioterrorism scenario); (2) bubonic plague, characterized by purulent lymphadenitis near the inoculation site; and (3) septicemic plague, a septic presentation arising from either of the other syndromes

Front 39

presentation of typhoid fever

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should be considered in patients returning from endemic areas who present with a rash, rising fever, abdominal pain, and constipation possibly followed by diarrhea

Front 40

Patients with visceral leishmaniasis present with:

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weight loss, fever, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia

Front 41

recommended therapy for patients with Lyme myocarditis associated with second- or third-degree heart block

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IV ceftriaxone

Front 42

indications for infective endocarditis antimicrobial prophylaxis for patients who will undergo a dental procedure involving manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa

Back 42

(1) the presence of a prosthetic cardiac valve

(2) a history of infective endocarditis

(3) unrepaired cyanotic congenital heart disease

(4) congenital heart disease repair with prosthetic material or device for the first 6 months after intervention

(5) presence of palliative shunts and conduits

(6) cardiac valvulopathy in cardiac transplant recipients