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169 Cards in this Set
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20 yo sexually active female came with complaint of dysuria for 3-4 days. Denies fever. Pt is started on bactrim for 3 days. She came back with the same sxs. UA: no bacteria with increased wbcs and Urine culture is negative. Most likely diagnosis? Next test? Treatment?
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Chlamydia infection, NAAT: Nucleic acid amplification, tx: erythromycin or azithromycin or doxycycline
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20 yoF came with fever, pain with movement of wrist joint, single pustular lesion over dorsal surface of the hand with swollen right knee. Joint aspiration shows gram negative cocci, increased cell count and negative cultures. Diagnosis? what do you do next? Tx?
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Disseminated gonoccocal infection (50% are culture negative. next gather cultures from all orifices (oral, anal and vaginal). tx: ceftriaxone + doxycycline
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What is the preferred treatment from patients with gonorrhea/ chlamydia?
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Ceftriaxone IM + Azithromycin 1 gm PO. (also DOC for preggers)
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condyloma lata vs condyloma accuminata
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Lata: secondary syphilis: flat velvety, gray to white lesion in perineal area
Accuminata: HPV (ano-genital wart) skin colored, or pink verrucous, ppilliform, cauliflower like lesion in the perineal area (painless) |
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which treatment for condyloma accuminata is contraindicated in pregnancy?
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Podophyllin
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Male patient having lesions like condyloma accuminata perianally, which of the following is important to know in the history? What other tests would you order?
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sexual practice; HIV and syphilis
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Male patient having condyloma accuminata type lesions on genitalia, what should the partner be screened for?
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Cervical cancer
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12 hours after treatment of neurosyphilis a patient develops fever, chills, HA, why and what is the pathophysiology? Tx?
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Jarisch herxheimer 2/2 to release of lipo-polysaccharides from the dying spirochetes. Tx: bed rest and aspirin.
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50 yo female here for rountine check up found to have VDRL positive. Pt is asymptomatic and does not recall any history of genital ulcer. Dx? tx?
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latent syphilis; benzathine PCN IM every week for 3 weeks or doxycycline for 30 days.
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55 yo came with paresthesias, abnormal gait, argyll robertson pupil. VDRL is positive, CSF examination had increased WBCs, mainly lymphocytes and incr protein and normal glucose. Dx? tx?
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Neurosyphilis; CSF findings similar to aseptic meningitis. Tx: IV PCN G
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pt being worked up for dementia found to have VDRL positive, what do you want to do next?
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LP--> send CSF for VDRL (r/o neurosyphilis)
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What are the four most common causes of a false positive serologic test of syphilis?
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SLE, IVDA, Chronic liver dz, HIV
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What is the prozone reaction?
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Affects VDRL (non treponemal test) and is d/t high titer of antibody (mismatch between concentration of antigen and antibody)
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At what titer level is VDRL titer considered positive?
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1:8
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How fast should titer level fall in primary and secondary syphilis with tx? latent and neurosyphilis?
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a) decrease 4 fold in 6 months and 8 fold in 12 months
b) decrease by 4 fold in 12 months |
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Pt presents with a painful genital ulcer with a soft and necrotic base. Pt also complains of painful lymphadenopathy and significant inguinal swelling. Dx? Cause? Tx?
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Dx: Chancroid
Cause: Hemophilus ducreyi (gram negative rod with school of fish appearance) Tx: Azithromyci 1 gm PO x 1 dose of ceftriaxone 250 mg IV |
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pt presents with b/l large tender inguinal LN with draining sinuses. On exam you notice groove between the superficial and deep inguinal LN. Dx? Cause? Tx?
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Lympho-granuloma Venerum (LGV)
Cause: L1, L2, L3 chlamydia trachomatis Tx: Doxycycline |
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pt presents with painless large ulcerated lesion in the genital area with beefy red friable base of granulation tissue. Dx? Cause? tx?
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Granuloma inguinale
cause: Calymmatobacterium granulomatis (look for donovan bodies) Tx: Tetracycline or erythromcyin |
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which genital ulcers are painless? Painful?
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Painless: Syphilis, LGV and Granuloma inguinale
Painful: chancroid, genital herpes |
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young female came with fever, neck stiffness, HA and vaginal d/c. On exam a painful erythematous lesion on genitalia is noticed along with large tender inguinal lyphadenopathy. CSF examination shows incr WBCs mainly lymphocytes, mildly elevated proteins and normal glucose. Dx? Tx?
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genital herpes leading to aseptic meningitis
tx: acyclovir |
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74 yo female with complaint of watery yellowish vaginal d/c, dysparunia. Vagina is thin and pale. Wet mount shows numerous wbcs and no bacteria. KOH negative Dx? TX?
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Atrophic vaginitis
Tx: Topical estrogen |
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what is the needle stick transmission rates for HIV, Hep B and Hep C?
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HIV: 0.3%
Hep C: 3% Hep B: 30% |
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What do you start immediately after a needle stick from HIV pt?
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AZT+ 3TC + indinavir for 4 weeks.
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What screening test for HIV is recommended for newborns of HIV mother?
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HIV DNA PCR
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When can a Elisa or western blot be used to diagnose the child of an HIV mother?
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>18 months.
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IVDA came with fever, maculopapular rash, cervical lymphadenopathy, lymphopenia. HIV test is negative and heterophile test is negative. Dx? How to confirm?
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Dx: Acute retroviral syndrome (ARS) which occurs 10-21 days prior to seroconversion. Elisa becomes positive 6-12 weeks after exposure.
Confirm? p24 or HIV RNA PCR |
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pt had unprotected sex. Came to know that partner was HIV positive. All of this occurred two weeks ago. Pt wants to be tested and asks which tests will be helpful?
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HIV RNA PCR or p24
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Cd4 < 200: prophylaxis?
Cd4 < 100: prophylaxis? Cd4 < 50: prophylaxis? |
<200: PCP prophylaxis: Bactrim DOC or dapson or aerosilized pentamidine or atovaquone.
<100: Toxo prophylaxis (if pt is Toxo IgG +ve): bactrim or dapson + pyrimethamine + leucovorin <50: MAI prophylaxis: Azithromycin or clarithromycin. |
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Pt has a cd4 count of 160 and h/o PCP found to be allergic to bactrim presents to your ER with SOB and dyspnea. CXR shows a PTX. What is the cause of the pt's PTX?
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Prophylactic aerosolized pentamidine which has increased incidence of PTX in pts with h/o PCP.
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At what Cd4 count can MMR and Varicella vaccines be given?
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>200
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What are the live Vaccines?
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Oral Polio virus,
yellow fever, MMR and Varicella Intranasal flu |
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HIV pt with cd4 30. Pt is on 3 ART drugs and bactrim. What else does this pt need?
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Azithromycine for MAI prophylaxis-- given weekly
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HIV pt has anemia, what type of anemia does this pt have? How do you treat it?
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Anemia of chronic disease. tx: EPO
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HIv pt with neutropenia. Tx?
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GCSF (filgraftin) or neupogen
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HIV + thrombocytopenia. Tx?
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None. Just treat the HIV
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What are the NNRTIs? (10)
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Zidovudine (AZT), Didanosine (DDI), Zalcitabine (ddc), Stavudine (d4T), Lamivudine (3TC), abacavir, Tenofovir, Emtricitabine, Combivir (AZT +3TC), Truvada (Tenofovir + emtricitabine)
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NNRTIs?
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Nevirapine, Delaviridine, efavirenza
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Protease Inhibitors?
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-navir
Kaletra = lopinavir/ ritonavir |
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Fusion inhibitors name and how does it work?
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Enfuviritide: blocks entry of HIV into cells
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Integrase inhibitor: name and how does it work?
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Raltegravir: inhibits viral replication
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CCR5 inhibitor: name and how does it work?
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Maraviroc -- entry inhibitor
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Side effect of Nucleoside + protease inhibitors?
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Lipodystrophy (elevated cholesterol and TG level, insulin resistance, DM and changes in body fat composition)--- abdominal obesity and skeletal wasting.
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Which ART meds have activity against hep B?
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Lamivudine, tenofovir and emtricitabine
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What ART drug combination is contraindicated in preggers? why?
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Stavudine + didanosine because of increased risk of lactic acidosis
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pt on AZT, 3TC and indinavir found to have hb 7 with mcv of 110. cause of anemia?
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AZT which causes macrocytic anemia
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HIV pt came with fever, cough, SOB. On examination RLL crackles present. CXR shows RLL infiltrate. CD4 count is 350 Dx?
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CAP
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HIV pt with fever, cough, SOB on examination has b/l diffuse crackles. CXR shows b/l diffuse infiltrates. CD4 count is 150. Dx? Confirmation? TX? what if they are allergic? When do you add steroids?
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PCP
Confirm with sputum for PCP stained with methamine silver or wright giemsa stain. If that is not possible than do bronchoscopy and send BAL tx: Bactrim IV. If allergic to bactrim tx with pentamidine IV or IV clindamycin + PO prymaquine. Add steroids which PaO2 < 70 or A-a gradient > 35 |
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How do you differentiate between PCP and CAP?
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PCP: crackles and diffuse infiltrates. Pt will be very sick and will have more SOB. LDH is elevated in PCP.
CAP: usually focal infiltrate and focal crackles. |
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Side effects of Bactrim?
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Fever, BMS, hyperK, increased serum Cr
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HIV pt admitted with sxs of PCP being tx with IV bactrim suddenly develops left sided CP and SOB. ON examination decreased Breath sounds on LU chest. Tracheal deviation is present to the right. Cardiac enzymes are pending. Dx?
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PTX
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MC side effect of NRTIs?
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Peripheral neuropathy
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Most troublesome side effect of didanosine (DDI)?
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Pancreatitis
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SE of abacavir?
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HSN syndrome: flu like symptoms with rash and fever
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SEs of Tenofovir? (2)
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Acute renal failure, fanconi syndrome
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SEs Nevirapine?
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Liver toxicity, rashes including TEN and Stevens-Johnson syndrome
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Efavirenz SE? What population is this ART contraindicated in?
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Neurologic disturbance. CI for women of child bearing age
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Indinavir SE?
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Kidney stone
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Nelfinavir SE?
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Diarrhea
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Stavudine SE?
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Progressive ascending neuromuscular weakness (Like Guillain Barre)
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What is the treatment for Toxoplasmosis? What about allergic pts?
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Sulfadiazine + pyrimethamine + leucovorin
sulfa allergic: Clindamycin + pyrmethamine + leucovorin |
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HIV presents with cortical blindness and hemiparesis. CT was done and showed a nonenhancing demyelinating hypodense lesion in white matter. Dx? cause? Tx?
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Progressive multifocal leukoencephalopathy
Cause: JC virus TX: ART |
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HIV pt with fever + AMS with negative CT. CSF was + for encapsulated yeast with india ink staining. Dx? Cause? Tx?
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Dx: Cryptococcal meningitis
Cause: Cryptococcus meningitis TX: Ampho B + flucytosine |
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HIV pt with blurring vision. What will you see on ophthlamoscopy? Dx? Tx and SE of specific txs?
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Ophthalmoscopy: Perivascular hemorrhage and fluffy exudates
Dx: CMV retinitis TX: Ganciclovir (avoid with AZT 2/2 neutropenia SE), Valganciclovir (Inc PO bioavailability), Cidofovir (nephrotoxic), Foscarnet (nephrotoxic/ hypocalcemia) |
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HIV pt with centrally umbilicated papular lesion on the skin. What test must be done in order to diagnose this pt? Tx?
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Cryptococcal antigen test
tx: if antigen test negative: Curettage or cryotherapy If antigen test + : Fluconazole. |
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HIV pt with papular reddish vascular lesion with fever. Dx? Cause? Tx?
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Dx: Bacillary angiomatosis
Cause: bartonella hensalae, Bartonella Quintana Tx: doxy or erythromycin |
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HIV pt with papular reddish vascular lesion. Dx? Tx?
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Kaposi sarcoma (MC HIV related malignancy)
TX: Vincristine, Vinblastine, Alfa interferon |
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HIV pt with white lesion on the lateral aspect of the tongue that cannot be removed on scraping. Dx? Tx?
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hairy leukoplakia. Tx: acyclovir
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HIV pt with white lesion on the oral mucosa also and easily removed on scraping. Dx? TX?
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Oral candidiasis. Tx: Clotrimazole troches or Nystatin swish and swallow
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HIV with dysphagia with diffuse white lesions on endoscopy. Dx? Tx?
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Dx: esophageal candidiasis tx: fluconazole
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HIV with dysphagia with deep, small, multiple lesions found on endoscopy. Dx? Tx?
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Dx: Herpes Simplex Tx: Acyclovir
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HIV with dysphagia with superficial large lesions found on endoscopy. Dx? Tx?
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CMV
Tx: Ganciclovir |
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A) Tx for HIV pt with Diarrhea 2/2 cryptosporidia?
B) TX for HIV pt diarrhea 2/2 Cyclospora or Isospora? |
a) Nitazoxanide or paromomycin
b) Bactrim |
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HIV pt presents with diarrhea. AFB staining of stool for ova and parasite was negative. What to do next?
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Colonoscopy
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Colonoscopy for HIv pt with diarrhea found large cells containing basophilic intanuclear inclusion which is surrounded by a clear halo and associated with clusters of intracytoplasmic inclusions. Dx?
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CMV colitis
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HIV pt with fever, NS, wt loss, cough, cervical/ axillary LN, CXR RUL infiltrate Dx?
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TB
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HIv pt with fever, NS, severe wt loss, on examination no obvious source of fever. CXR negative and CD4 30. Dx? Investigation? TX?
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MAI. BCx. Tx: Clarithromycin + ethambutol +/- rifabutin (cousin of rifampin)
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HIV pt with fever, cough, hemoptysis, CXR b/l nodular densities. Dx? Confirm? Tx?
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Aspergillosis
Confirm with broncoscopic biopsy which will show regularly branched septate hyphae. Tx: Ampho B or Voriconazole |
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PT is on Ampho B for aspergillosis, but not improving. What to do now?
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Surgical consult for surgical resection.
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DOC for Sporotrichosis? What if the pt has HIV or systemic dz?
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Itraconazole
HIV? Ampho B |
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Pt presents to your ER in california with fever, cough, pleuritic chest pain, and arthalgias. What do you expect on CXR? Confirm? Dx? Tx?
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CXR: multiple nodular lesion with cavity
Confirm: Serology antibody or sputum for fungal stain and culture Dx: Coccidiodomycosis Tx: Itraconzole or Fluconazole (less severe cases); In severe cases: Ampho B |
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What populations are most likely to develop cryptococcosis?
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HIV, Hodgkin's dz, or on steroids (aka immunocompromised pt)
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What is the most common cause of fungal meningitis? TX?
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Cryptococcosis
Tx: Amphotericin B + flucytosine |
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Pt presents with cough, SOB, HSM and oral ulcers. After a thorough history you discover that pt went splunking in Ohio a few days prior to all of his symptoms starting. You suspect Histoplasmosis. How do you confirm your suspicion? and What is the tx? What is the pt was pregnant, what would be the treatment then?
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Confirm: Urine and serum for histoplasma antigen or histoplasma complement fixation test.
Tx: amphotericin B, Itraconazole Preggers tx: Amphotericin B |
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location based fungal infections:
Histoplasmosis: a) Blastomycosis: b) Coccidiomycosis: c) |
a) Ohio River and Mississippi Valley
b) Midwest, South central c) Southwest |
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Pt presents with raised verrucous lesion and central atrophic scar. Further history provided states that pt was recently in Kansas for a fast food convention. What would you expect on wet mount and how do you tx it?
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wet mount: Multinucleate yeast cell with thick refractile cell wall
Tx: itraconazole Dx: blastomycosis |
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What are the risk factors for invasive candidiasis?
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Central Venous catheter, TPN, Corticosteroid therapy, Neutropenia, Broad spectrum antibiotic therapy.
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What are the dangerous complication of invasive candidiasis?
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Candida endophthalmitis, loss of vision, endocarditis, multiorgan involvement
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DOC for invasive candidiasis?
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Fluconazole; alt Ampho B
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A febrile neutropenic pt presents to your ER. Culture is pending, which antifungal do you want to start the pt on empirically?
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Caspofungin or Ampho B
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Pt presents to your ER with fever, night sweats and weight loss. Blood culture showed Partially acid fast, filamentous, branching gram positive rods. Dx? Tx?
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Dx: Nocardiosis (nocardia asteroides)
Tx: TMPSMX (if sulfa-allergic give 3rd gen cephalosporin or amikacin or imipenem) |
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Pt presents to your urgent care with a mass on his jaw draining yellowish/ greenish d/c. Pt recently underwent a root canal. What would you expect to see on culture? Dx? Tx?
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Cx: Gram positive filamentous bacteria
Dx: Actinomycosis (actinomyces israeli) Tx: PCN (DOC) + surgical drainage allergic: tetracycline, erythromycin, clindamycin |
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DM pt comes with bloody nasal d/c. On exam has black necrotic lesion of nose. Dx? Tx?
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Mucormycosis
Tx: Surgical debridement + ampho B IV and tight control of DM |
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HIV pt with sxs of PNA has oral ulcer, HSM, coming from Ohio. Dx?
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Histoplasmosis
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HIV pt with sxs of PNA + severe joint pain, erythema nodosum with recent travel to NM dx?
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Cocci
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Pt in ICU on TPN via central catheter complains of ocular discomfort with visual loss in R eye. Dx?
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Candida endophthalmitis
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Pt admitted to hospital with BC + for candida. Pt is afebrile now. What to do?
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Tx pt: Fluconazole
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Pt in hospital with central line develops fever. Central line removed and pt becomes afebrile. After 48 hours BC grows staph A, what to do? What Tx do you choose?
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Tx the staph A and order TEE to r/o endocarditis; Tx: Vancomycin or Nafcillin.
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Pt went to connecticut for fishing and developed a rash on thigh which disappeared in a few days and dizziness. EKG shows heart block. Dx? What organism is to blame?
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Lyme Dz
caused by Borrelia Burgdorferi transmitted by ixodes scapularis |
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How do you differentiate between an aspergillious infection vs a Mucor infection?
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Mucor = irregularly branched with septation
Aspergillosis= reg branched with septation |
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What are the 4 diseases transmitted by Ticks?
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Lyme dz
Babesiosis Ehrlichiosis Rocky Mountain spotted fever |
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How do you tx each stage of lyme dz?
a) Erythema chronicum migrans b) First degree AV block c) 2nd/3rd degree AV block d) bell's palsy or foot drop e) Sxs of meningitis f) after months to year later comes with arthritis |
a) Doxycycline
b) Doxycycline c) Ceftriaxone d) Doxycycline e) Ceftriaxone f) Doxycycline |
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What alternative do you give to children < 8 yo with lyme dz?
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amoxicillin or macrolides (if allergic)
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How long must a tick being attached in order to transmit lyme dz? Which two other tick transmitted dzes do NOT have a time frame for transmission?
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at least 48 hours
Other: Ehrlichiosis and babesiosis |
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Pt om Mew Jersey came with complaint of rash on thigh. On examination: erythematous rash, slightly raised with central clearing. Pt says lesion is slowly growing. What to do? Dx? Tx?
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No further test required. Dx: lyme Dz. Tx: Doxycycline
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Young Female with fever and HA after returning from vacation in Long island, NY. On examination has right facial palsy. Dx?
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Lyme dz
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young male with complaint of weakness of R foot. He recently travelled to connecticut for hiking where he did develop rash in axilla which cleared by itself. He denies any history of tick bite. on examination has weakness of dosiflexion of foot Dx?
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Lyme dz
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What 3 diseases must you think when a pt presents with foot or wrist drop?
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Lyme dz, lead poisoning and PAN
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What disease presents like malaria but is not malaria? Tx?
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Babeisiosis. Tx: Atovaquone + azithromycin
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Pt from connecticut presents with fever + HA recently back from a camping trip. Found to have leukopenia and thrombocytopenia on CBC. Dx? Tx?
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Ehrlichiosis
Tx: Doxy |
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Pt from connecticut presents with fever + HA and a macular rash on distal extremities after returning from a camping trip. Dx? Tx?
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Rocky Mountain spotted fever
Tx; Doxy |
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3 yo presents to your office with a h/o of high fever for 4 days that recently broke and a maculopapular rash developed all over the body. Dx? Cause? Tx?
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Roseola infantum (aka exanthem subitum)
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2 yo child presents with erythematous rash on cheeks b/l, found to have a lace like rash on the body. Dx? Cause? Tx? Complications?
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Erythema infectiosum (fifth dz)
Cause: Parvovirus B19 Tx: none Complications: pregnant women exposed to Parvo are at risk for fetal loss or hydrops fetalis |
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5 yo male presents with Cough, runny nose, injected conjunctiva. Found to have Small red spots with a grey center on buccal mucosa. Dx?
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Measles (rubeola)
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6 yo male presents to your office with cough, runny nose, conjunctivitis, fever and a brick red maculopapular rash that began on the face and is now spreading downward. Dx? Complication?
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Measles
Complication: Subacute sclerosing panencephalitis (7 years later), PNA |
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2 yo female presents with mild fever, posterior cervical and posterior auricular lymphadenopathy dx with a URI and sent home. 5 days later pt presents back to your office with a maculopapular rash that began on the face and is now spreading downward. Dx?
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Rubella (german Measles)
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What is congenital rubella syndrome?
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Deafness, cataract, PDA, mental retardation and microcpehaly
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newborn with machinery heart murmur has absence of red reflex in eye, microcephalic, most likely dx?
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Congenital rubella syndrome
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5 yo presents to your office with a erythematous rash that blanches on pressure found on the truck initially that has now generalized avoiding hands and soles. On exam pt has circumoral pallor and a strawberry tongue. The skin feels like sand paper to palpation. Dx? cause? TX?
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Dx: Scarlet fever
cause: GAS TX: PCN |
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How long is varicella infectious?
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until all lesions are crusted (usually 8-21 days)
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What are the complications with varicella?
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PNA, encephalitis (ataxia and nystagmus) and Reye's syndrome with ASA.
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Pregnant pt got exposed to someone with chicken pox, if they are not immune what can you give them?
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Immune globulin
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If pregnant pt already contracted chicken pox, what do you do?
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Supportive care
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Child < 2 yo found to have wheezing, dyspnea, fever and cough. On exam pt has exploratory wheezes. Dx? Cause? Tx?
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Bronchiolitis
Caused by: RSV Tx: Supportive, Oxygen |
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Pt presents with fever, pain, and swelling in 1 or both parotid gland in a child. Dx? Complication?
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Mumps
Complication: epididymal orchitis which can lead to testicular atrophy and can also dev pancreatitis and meningoencephalitis |
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Child with fever + barking cough + inspiratory stridor. Dx? Cause? tx?
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acute laryngeotracheal bronchitis or croup
cause: parainfluenza, influenza virus Tx: supportive: humidified oxygen + inhaled steroids Severe: nebulized epi |
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pt presents to your office with facial palsy, vesicular lesions on the external ear, vertigo, tinnitus and deafness. Dx? tx?
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Dx: ramsay Hunt syndrome
Tx: Acyclovir, famciclovir, Valacyclovir |
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Pt presents with fever, sore throat and vesicular lesion on positerior pharyngeal wall and palate. Dx?
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Herpangina caused by coxsackie virus
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Pt presents with fever, vesicular lesion on the oral by buccal mucosa, small tender cutaneous vesicular lesions on hands, feet and buttocks. Dx?
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Hand, foot, and mouth syndrome caused by coxsackie virus
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What does the Tx of zoster with acyclovir decrease the incidence of?
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Post herpetic neuralgia
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Pt presents with severe pain at the site of shingles after healing dx? Tx?
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Dx: post herpetic neuralgia
Tx: amitriptyline, opioids, topical capsaicin, gabapentine |
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Pt presents with fever, sore throat, enlarged tonsils, tender cervical LN, erythematous pharynx, dysphagia and a muffled voice. On exam tonsil is displaced medially. Dx? Tx?
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Peritonsillar abscess
Tx: tonsillectomy or needle drainage + PCN |
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Pt presents with fever and respiratory distress. On entering the room, pt is seen sittin, leaning forward with open mouth and drooling. Dx? Tx?
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Dx: epiglottitis 2/2 HIB
Tx: intubation- Nasal tracheal intubation + antibiotic (3rd gen cephalosporin + vancomycin or clindamycin (to cover staph)). |
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lateral xray shows Steeple sign: Dx?
AP xray shows thumbprint: Dx? |
a) Croup
b) Epiglottitis |
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Pt presents with fever, sore throat and cervical lymphadenopathy. What do you do next? If positive tx?
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Rapid antigen test to r/o strep infection. If positive do not culture. Tx: PCN or erythromycin
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Pt presents with fever, sore throat, lymphadenopathy, splenomegaly. On peripheral smear atypical lymphocytes are noted. Next test? If positive Dx? If negative Dx?
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Test: heterophile antibody test
+ Dx: infectious momnucleosis - Dx: r/o CMV infection. Order CMV IgM |
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Pt with fever, sore throat, gray membrane over tonsil and pharynx. Dx? Tx? What do you tx household contacts with?
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Diphtheria. Tx: diphtheria anti-toxin and erythromycin
Place on droplet isolation household: erythromcyin x 7 days or benzathine PCN IM x 1 dose to eradicate carrier state |
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5 yo Pt presents with dizziness, lightheadedness, diplopia and slurred speech. Pt has recently immigrated from peru and is not UTD on their shots. DX?
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Diphtheria.
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22 yo female presents to your office complaining of dysuria, increased frequency and abdominal pain. UA was done which should +nitrites and Leuk esterase. Ph was > 8.0. Dx? Most likely organism? Tx?
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UTI
Proteus (>8 ph) Tx: bactrim or cipro x 3 days |
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24 week pregnant woman presents to your office complaining of fever x 3 days, dysurgia, polyuria, N and Vomiting. On physical exam pt has flank pain and abdominal discomfort. UA + for nitrites and Leuk esterase. Dx? Tx? Is prophylaxis necessary?
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Dx: pyelonephritis
Tx: Ampicillin + Gentamycin IV (if PCN allergic use aztreoname or Imipenem) Prophylaxis: yes: nitrofurantoin or cephalexin throughout the rest of the pregnancy. |
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chemotherapy pt presents to your ER with 3 days history of fevers with Tmax of 103. vital show a temp of 102.4, hypotension and tachycardia. physical exam shows irritated and red gumline. CBC is drawn which shows the absolute neutrophile count at 560. What tx should you start on this pt?
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Vancomycin + ceftazidime
( covers MRSA and Pseudomonas) |
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What should be added to a febrile neutropenic pt if they are still febrile after 5 days of appropriate antibiotic therapy?
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Antifungal (ampho B, vori or caspofungin)
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Pt presents to your Er with fever, HA and neck stiffness x 2 days. On exam a petechial rash is noted over the distal extremities. Dx? Tx?
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Dx: Meningococcemia
Tx: PCN G IV or 3rd gen ceph. If allergic: chloramphenicol |
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Pt with diagnosed meningococcemia suddenly develops hypotension and shock, dx? tx?
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waterhouse friderichsen syndrome -- adrenal hemorrhage.
Tx: IV CS + antibiotics for meningococcemia. |
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What drugs are used for prophylaxis of meningococcemia?
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Rifampin, ciprofloxacin, ceftriaxone
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5% of infants taking erythromycin can develop what worrisome complication?
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infantile hypertrophic pyloric stenosis
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4 yo female presents to your ER with FUO x 2 weeks. On exam you notice a scratch just under the left axilla as well as HSM. Dx? Tx?
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Cat scratch dz 2/2 bartonella henselae
tx: Rifampin + azithromycin (children) aduls: Azithromycin |
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What is the best single test to screen for complement deficiency?
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CH 50
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A fish tank cleaner who works in a pet shop comes with a nonhealing skin ulcer. Biopsy of the lesion is positive for AFB. Dx? TX?
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Dx: mycobacterium marinum
Tx: doxycycline or bactrim |
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What drugs are associated with causing a drug induced fever?
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Antimicrobials (sulfa, PCN, nitro, vanco, antimalarials)
H1/ H2 blocking agents Antiepileptics Iodides NSAIDs and salicylates AntihTN (hydralazine/ methyldopa) Antiarrhythmic drugs antithyroid drugs |
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Tx for Brucellosis?
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children: oral Bactrim + rifampin for 6 weeks
adults: Doxycycline + streptomycin or rifampin for six weeks |
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A Zoo worker presents to your office with a complaint of fever and a single lesion on their arm. on examination, the lesion is an erythematous papuloulcerative lesion with a central eschar and tender regional LN. Dx? Cause? Tx?
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Dx: tularemia
Cause: Francisella Tx: Streptomycin |
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Pt presents to ER after returning from Hawaii with yellowing of the skin, oliguria, rigor with red eyes and abdominal pain. Labs show an elevated AST/ ALT, BUN and cr ratio > 20:1 and an elevated indirect bilirubin. Dx? Tx?
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Weil's syndrome: severe form of leptospirosis.
Tx: IV PCN, ceftriazone or cefotaxime. if less severe: doxy for adults, amox for children |
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Young child presents with perianal itching that is worse at night. Dx? investigation? Tx?
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Dx: pinworm caused by enterobius vermicularis
investigation: scotch tae test Tx: Mebendazole or albendzole |
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Pig raiser comes with seizure. MRI suggest cystic lesion in the brain. Dx? Tx?
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Neurocystercercosis
Tx: a) albendazole + prenisolone or dexamethasone + phenytoin or carbamazepine for seizure b) praziquantel + prednisolone or dexamethasone + phenytoin or carbamazepine for seizure |
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Sheep raiser came with RUQ pain. US shows cystic lesion in the liver. Dx? Cause? Tx?
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Dx: echinococcosus
cause: echinococcus granulosus tx:surgery + albendazole (if pt can tolerate it) If pt is a nonsurgical candidate then do albendazole + PAIR procedure (cyst is aspirated and then filled with ethanol or hypertonic saline which will be aspirated after 15 minutes). |
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Pt presents to your clinic with complaint of snake like skin lesions on feet and buttocks + abdominal pain and hemoptysis. Pt recent went to florida for a family vacation and stayed on the beach. Dx? Cause? Tx?
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Dx: strongyloidosis
Cause: Strongyloides stercoralis Tx: thiobenazole or ivermectin |
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Pt presents to your clinic with complaint of snake like skin lesions on feet and buttocks. Pt recent went to florida for a family vacation and stayed on the beach. Dx? Cause? Tx?
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Cutaneous larva migrans
Cause: Ancylostoma Brazilience (hook worm) Tx: ivermectin or albenazole |
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Tx for chagas' disease?
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Nifurtimox and benznidazole
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Pt presents to your ER with fever x 2 weeks. BC grew Streptococcus bovis. What needs to be r/o?
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Carcinoma of the colon
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Name the Gram positive cocci:
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a) staphylococcus
b) streptococci - Beta hemolytic (hemolysis) GAS, GBS, GDS, non enterococci - Non beta hemolytic strep: S. pneumo, Viridans Strep |
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Name the Gram negative cocci
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Neisseria Gonorrhea and meningitidis
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name the Gram positive bacilli
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a) bacillus species: cereus and anthracis
b) clostrium species: Botulinum, tetani, perfringens, Difficile c) corynebacterium d) Listeria monocytogenes |
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Name the Gram negative rods
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a) enterobacteriaceae
- Escheria (ETEC, EHEC) - Shigella -Salmonella - Klebsiella - proteus - enterobactor - Serratia b) Pseudomonas c) acinetobactor calcoaceticus : nosocomial PNA D) moraxella e) vibrio f) Campylobactor Jejuni g) Yersinia H) francisella Tularensis I) Pastruella |
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What organism can cause hemorrhagic necrosis in neutropenic patients cause ecthyma gangrenosum?
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Pseudomonas aeruginosa
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Name the pleomorphic Gram negative rods
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Hemophilus IB
Hemophilus Ducreyi Bordetella pertussis Brucella |
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Name the anerobic bacteria
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Gram -: Bacillus fragilis
Gram +: Actinomyctes, nocardia, lactobacillus |
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Unusual small gram negative bacteria (2)
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Chlamydia and legionalla pneumophilia
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What type of MRSA is daptomycin ineffective at treating?
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MRSA PNA
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When is the earliest that Aminoglycosides can cause nephrotoxicity? Ototoxicity?
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Nephro: after 5 days of use
Oto: after 14 days of use |
