Ppal99 Dissecting The Usmle 1,2,3 Fungi/parasites/protozoa

Front 1

Fungi:
ideal environment and tx
membrane
stains

Back 1

• Like warm, moist, sugar = >
Tx: cool and dry
• ergosterol membrane
• Methenamine silver stains

Front 2

"little black balls on hail shaft" Dx and tx

Back 2

Piedra"- fungus eats keratin off hair shaft (Tx: cut hair off)

Front 3

Candidiasis presentation and tx

Back 3

-white cheesy itchy discharge, oral thrush, + KOH pseudohyphae
• T x: 15Omg Fluconazole

Front 4

Cutaneous Fungi
give 2 treatments

Back 4

• topical Clotrimazole- for most
• Griseofulvin+Selenium- for capitis and versicolor (in stratum corneum)

Front 5

leoffers syndrome: Sx
what bugs causes these (5)

Back 5

Sx: pulm eosinophilia
Necator americanus
Ancylostoma duodenale
Ascaris lumbncoides
Schistosomiasis
strongyloides

Front 6

Tinea capitis
presentation
pathogen
tx

Back 6

flaky crusty lesion of scalp, hair loss
Caused by trichophyon
Tx: terbinafine

Front 7

Kerion

Back 7

= tinea capitis + infection "boggy"

Front 8

Tinea barbae

Back 8

razor bump infection on skin

Front 9

Tinea corporis

Back 9

ringworm on body/face (from cats)

Front 10

Tinea intertrigo

Back 10

skin touches skin (armpits, under breasts) => skin peels off

Front 11

Tinea versicolor: location, presentation and tx
what makes it worse

Back 11

on back; "spaghetti·meatball'' distribution, worse in heat
(Tx: Ketoconazole)

Front 12

Tinea unguium

Back 12

under nail => discolored nails

Front 13

Tinea nigra

Back 13

flaking palms=> dark lines

Front 14

Tinea manis

Back 14

pealing between finger webs "maceration"

Front 15

Tinea pedis: presentation and tx

Back 15

pealing between toes "athlete's foot"
(Tx: Tolnaftate cream)

Front 16

Tinea cruris

Back 16

on groin "jock itch"

Front 17

PIE Syndrome:

Back 17

• Aspergillus
• Loeffler's
• Churg-Strauss

Front 18

Systemic fungi: name all 7, describe and tx

Back 18

Inhale spores (Tx:Itraconazole)
Histoplasma
Blastomyces
Paracoccidioides
Rhizopus & Mucor
Sporothrix schenckii
Cryptococcus neoformans
Aspergillus

Front 19

a) Histoplasma
b) Coccidioides
c) Paracoccidioides

Back 19

a) bat poop (Mississippi river), lives in MP, oral ulcers "history in Mississippi"
b) soil (Arizona), desert.bump fever, budding yeast
c) looks like-a ship's wheel (S. America)

Front 20

Blastomyces

Back 20

pigeon poop (NY), broad-based hyphen
rotting wood in beaver dams
NY blast!'

Front 21

Rhizopus & Mucor- mucormycosis
location
Dx
Tx

Back 21

(eats eyes, nose, sinus)
Dx: orbital--CT
Tx: Surgery+ Amphotericin B

Front 22

Sporothrix schenckii

Back 22

rosebush prick
(Tx: topical KI)

Front 23

Cryptococcus neoformans
patients
enzyme, stain, type

Back 23

AIDS pt
Urease positive, stains w / India ink, encapsulated yeast

Front 24

Cryptococcus neoformans Lung Tx:

Back 24

Fluconazole

Front 25

Cryptococcus neoformans Meningitis Tx

Back 25

Tx: amphotericin B/Flucytosine ⇨ lifelong Fluconazole
Induction phase: amphotericin B/Flucytosine (10-14 days)
Maintenance therapy: Fluconazole 400 mg/day for the first 2-3 months followed by 200 mg/day. Give it until CD4 count is >100 cell/mm3 continiously for 1 year

should be followed closely and therapy should be instituted if CD4 count decreases to less than 100 cell/mm3

Front 26

Aspergillus
location
invation
allergic reaction/presentation
tx

Back 26

moldy hay/basement
invades blood vv.
fungal ball, mimics asthma, hemotysis
Allergic rxn => pulmonary Infiltrate w/ Eosinophilia "PIE syndrome"
• Tx: Steroids (or Voriconazole if necrotizing)

Front 27

Polyenes:
MOA
systemic and topical form
SE

Back 27

bind ergosterol => pores in fungal wall
Topical: Nystatin
Systemic: Amphotericin B attacks fungi ergosterol and human cholesterol
• SE: hyperkalemia (systemic toxicity) and hypoKalemia (renal failure), SIADH

Front 28

Azoles
MOA
systemic and topical drugs

Back 28

inhibit ergosterol synthesis
Topical:
• Miconazole
• Clotrimazole
• Econazole
Systemic:
• Ketoconazole
• Itraconazole
• fluconazole

Front 29

Ketoconazole
SE

Back 29

inhibits p450, inhibits 5α reductase => gynecomastia, excess menstruation

Front 30

fluconazole
unique feature

Back 30

crosses BBB ''flew to the brain"

Front 31

Griseofulvin
MOA
type of compound

Back 31

Microtubule inhibitor:
fat soluble

Front 32

Anti-metabolites:

Back 32

• Terbinafine
• Flucytosine

Front 33

Terbinafine is tx for what diesease

Back 33

tx cutaneous fungi

Front 34

Flucytosine
MOA
what should be given with?

Back 34

stops DNA replication (give with Amphotericin B)

Front 35

Parasites:
Sx:
Lab:

Back 35

Sx: Gastroenteritis (duodenum) = >microcytic anemia
Lab: Eosinophils, T cells, MP low volume state

Front 36

Liver Flukes:
labs and tx

Back 36

Liver Flukes: ⇧ALT / AST
(Tx: Praziquntel)

Front 37

Liver Flukes: (5)

Back 37

Schistosoma
Toxocara Cati
Toxocara Cani
Echinococcus
Clonorchis Sinensis

Front 38

Clonorchis Sinensis:
family
presentation and location
complication

Back 38

0pisthorchis: likes biliary tract (⇧alk phos) => cholangiosarcoma

Front 39

Echinococcus:
how is it acquired
presentation
test

Back 39

raw lamb/dog poop
Hydatid cyst w / eggshell calcifications
• Liver abscess
( +) Casoni test

Front 40

Toxocara Cani:

Back 40

dog poop

Front 41

Toxocara Cati:

Back 41

cat poop

Front 42

Schistosoma:
how is it acquired? carrier?
what are its two types?

Back 42

walking barefoot in a swamps, snail is carrier
s. Haematobium
s. Mansoni

Front 43

s. Mansoni
disease
presentation (2)

Back 43

=> liver cancer
have lateral spine, pipe-stem fibrosis

Front 44

s. Haematobium
most common in what country?

Back 44

=>bladder cancer (SCC), Egypt

Front 45

hookworms:
invation and presentation
name them

Back 45

hook into intestine wall=> diarrhea
"can't keep a NEAT ASS"
Necator Americanus
Enterobius Vermicularis
Ancylostoma Duodenale
Trichuris Trichiura
Ascaris lumbricoides
Strongyloides stercoralis

Front 46

general tx for hook worms
management

Back 46

Tx: now, then repeat 1 wk later to kill hatched worms
Mebendazole- most of them (paralyzes microtubules) "hookworms bend"

Front 47

Pinworm
tx second line

Back 47

2 ⁰ Pyrantel Pamoate

Front 48

tx Strongyloides

Back 48

Thiabendazole -

Front 49

Necator Americanus
describe
infective stage

Back 49

most common worm in US, infective stage = metacercariae

Front 50

Enterobius Vermicularis
presentation

Back 50

pinworm=> pruritis ani (ass itching)

Front 51

test for Enterobius Vermicularis

Back 51

Scotch tape test: only female can make it from cecum to anus to lay eggs

Front 52

Ancylostoma Duodenale

Back 52

=> duodenal obstruction

Front 53

Trichuris Trichiura

Back 53

whipworm =>rectal prolapse, tenesmus

Front 54

Ascaris lumbricoides
type of worm
presentation
how is it acquired

Back 54

roundworm
swallow and cough
ingest egg-from human feces

Front 55

Strongyloides stercoralis
symptoms
type of worm

Back 55

threadworm => dermatitis, pulmonary eosinophlia

Front 56

Tapeworms:
Tx
name (4)

Back 56

Tapeworms:
Tx: Niclosamide
Taenia Solium
Diphyllobothrium Latum
tenia saginata
Trichinella Spiralis

Front 57

Niclosamide MOA

Back 57

inhibits oxidative phosphorylation

Front 58

Diphyllobothrium Latum
how is it acquired?
what does it eat?

Back 58

raw fish, eats Vit. B-12

Front 59

tenia saginata

Back 59

raw beef , "saged"

Front 60

Taenia Solium
how is it aquired?
what is cystercercosis?

Back 60

raw pork
(cysticercosis = larva swims in aqueous humor)

Front 61

Trichinella Spiralis
how is it aquired?
presentation

Back 61

raw pork, muscle pain, periorbital edema
"spiral under muscles"

Front 62

Oncohocerca
vector
presentation

Back 62

Roundworms:
blackfly, river blindness; moving knuckle nodules

Front 63

Protozoans:Skin:

Back 63

Leishmania-Donovani
Leishmania Rhodiensis

Front 64

Leishmania-Donovani
presentation
how is it aquired?
syndrome

Back 64

sandfly attacks skin and nostrils
rash
"Gulf War syndrome"

Front 65

Leishmania Rhodiensis
vector
diesease

Back 65

sandflies, attacks organs "kala-azar"

Front 66

Protozoans of the brain: name all 3

Back 66

Toxoplasmosis
Naegleria Fowleri
Trypanosoma crucei

Front 67

Toxoplasmosis
how is it acquired
what is seen
tx and MOA

Back 67

cat urine => multiple ring-enhancing brain lesions
• Tx = Pyrimethamine (inhibits DHF reductase) + Sulfadiazine (mimics PABA)

Front 68

Naegleria Fowleri
how is it acquired?
diesease
prognosis

Back 68

>>swamp trauma
>>Fulminant-meningoencephalitis- eats through cribriform plate into brain=> die in 48 hr

Front 69

Trypanosoma crucei
vector
disease
why they die?

Back 69

tsetse fly=> African sleeping sickness (⇧GABA)

Front 70

Malaria protection
for AA? mediterraneans?

Back 70

Sickle cell: AAs
G-6PD: Mediterraneans

Front 71

Protozoans Eye: (2)

Back 71

Acanthamoeba
Ehrlichia

Front 72

Ehrlichia:
how is it aquired?
vector
presentation
tx

Back 72

dog lick=> ixodes tick=> puncture wound near eye
(Tx: doxycyline)

Front 73

Acanthamoeba
how is it aquired?
how does it infect
what disease does it cause?

Back 73

in contact lenses
eats through cornea
HIVencephalitis

Front 74

The Multiple Liver abscesses

Back 74

Entamoeba histolytica

Front 75

Multiple Cerebral abscesses:

Back 75

Citrobacter

Front 76

Multiple Lung aneurysms:

Back 76

Osler-Weber-Randu

Front 77

protozoa of the Heart:
vector
how does it infect
complication

Back 77

Trypanosoma Cruzi (reduviid bug) => Chaga's: eats ganglia => heart block, achalasia, Hirschsprung's

Front 78

protozoans of the Lung:
who is at risk
stains
tx

Back 78

Pneumocystis Jirovecii- AIDS pts, silver stains lung
• Tx: Bactrim, Pentamidine

Front 79

Fever:
4-5/ day
Every 2 days
Every 3 days
Every wk

Back 79

Fever:
4-5/ day= Brucella
Every 2 days= Plasmodium sp.
Every 3 days= Plasmodium malaria
Every wk = Borrelia recurrentis

Front 80

GI protozoans (4)

Back 80

Giardia Iamblia
Entamoeba histolytica
Microsporidia
Cryptosporidia

Front 81

Giardia Iamblia clues (3)
location

Back 81

hiker's, mountain streams, Army-boot
camp = > duodenum

Front 82

Giardia Iamblia
describe the test
how does it infect and appearance
presentation
tx (in general and pregnancy)
confirmation

Back 82

String test- swallow into duodenum, pull it up and see bugs
• Adheres via a "ventral sucking disc", crescent-shaped protozoa, watery diarrhea
• Tx: IV Metronidazole (or Paromomycin if pregnant) confirm. stool Ag before tx

Front 83

Entamoeba histolytica
how does it infect?
presentation
motility, abscess, lesions
tx

Back 83

- eats RBC => multiple liver abscesses, "Erlenmeyer flask lesions"
dysenteric diarrhea
• "falling leaf' motility on wet mount
• "anchovy paste" liver abscesses,
• Tx: Metronidazole (8wks),

Front 84

Microsporidia
at risk

Back 84

most common diarrhea in AIDS pts

Front 85

Cryptosporidia
presentation
stain

Back 85

watery diarrhea in AIDS pts-, partially acid fast

Front 86

Malaria Tx: and MOA

Back 86

oxidize RBC membrane
• Quinine
• Mefloquine
• Primaquine
• Chloraquine

Front 87

malaria Prophylaxis: management

Back 87

1 pill/wk (-2 to +4 weeks) = > need 11 tablets for a 5-wk trip

Front 88

Quinine
treatment for what disease
SE

Back 88

Malaria Tx:
tinnitus, resp depression

Front 89

Mefloquine
treatment for what disease
advantages

Back 89

Malaria Tx:
good liver penetration

Front 90

Primaquine
treatment for what?
advantage

Back 90

Malaria Tx:
prevents relapse

Front 91

Chloraquine
treatment for what?
SE

Back 91

malaria tx
kills RBCs

Front 92

GU protozoan:
presentation
tx

Back 92

triichomonas vaginalis: green frothy discharge
Tx: 2g Metronidazole

Front 93

Blood protozoans

Back 93

Babesiosis
Plasmodium Malaria
Plasmodium Falciparum
Plasmodium Vivax/ Ovale

Front 94

Babesiosis:
vector
co-infection
peripheral smear
tx

Back 94

ixodes tick, similar to malaria (East coast),
co-infection with Lyme dz
• live in RBCs, tetrads on smear
• Tx: Quinine + Clindamycin

Front 95

Plasmodium Malaria
pathogenesis
presentation

Back 95

invade old RBC, fever every
3days "quartian"

Front 96

Plasmodium Falciparum
disease
prognosis
vector
pathogenesis and presentation

Back 96

fatal, black water fever,
anopheles mosquito
• attacks RBCs =>massive hemolysis=> urine black w/ bilirubin

Front 97

Plasmodium Vivax/ Ovale
type of malaria
what does it attack?

Back 97

chronic malaria in liver
• attacks reticulocyes (virgin RBCs)

Front 98

Lymphatics protozoa
tx

Back 98

Wucheria Bancrofti -elephantiasis (no tx) or diethylcarbamazepine