Usmle Ck - Id

Front 1

HIV pt with CD4<50 with sx of esophagitis?

Back 1

- MC is candida so start on fluconazole
- if no response in 3-5d, do esophagoscopy, don't to esophagoscopy first
- ddx HSV, CMV

Front 2

pt with osteomyeltitis s/p nail puncture... organism?

Back 2

- nosocomial = pseudomonas
- tx fluoroquinolones
- if hx of DM = strep, staph

Front 3

fungal infx in facial sinuses?

Back 3

- mucormycosis 2/2 rhizopus
- tx: surgical debridement + IV amphotericin
- deadly!
- DM is RF

Front 4

immunocompromized pt with pulm nodule with halo sign?

Back 4

- invasive aspergillosis
- CT: halo signs around nodules or lesions with air crescent

Front 5

Histo
Blasto
Coccidioidomycosis

Back 5

- Histo: south east, mid atlantic, hilar adenopathy, pneumonitis
- blaso: central US, lungs, skin, bones, prostate
- SW US, C and S America - cutaneous findings, erythema multiforme/nodosum, arthralgias

Front 6

PCP

Back 6

- hypoxia out of proportion to radiographic findings, elevated LDH
- give bactrim
- steroid also reduces mortality: indications = PaO2 <70, A-a >35
- pentamidine if can't tolerate bactrim

Front 7

CSF of bacterial meningitis?

Back 7

- increased WBC, protein, decreased glucose
- if skin lesions = meningococcal
- if no skin lesions, consider pneumococcal

Front 8

DM pt with black nectroic ear lesion?

Back 8

- pseudomonas

Front 9

MC cause bacterial sinusitis w/ no necrosis?

Back 9

- H flu, moraxella

Front 10

meningitis in immunosuppressed pts?

Back 10

- cryptococcus

Front 11

pt with lung infx during long steroid, immunosuppressed tx?

Back 11

- acid fast, G+, branching rods = nocardiosis (in soil, see noducles with cavitations, chest wall invasion, can spread subQ or brain abscess => tx is bactrim
- acid fast rods, no gram stain = TB
- Actinomyces - presents similar to nocardia but aerobic and facultative anaerobic, cervicofacial dz and sinus tracts, sulfer granules

Front 12

sulfer granules

Back 12

actinomyces

Front 13

murmur that increases with inspiration?

Back 13

- right sided murmur b/c increased inspiration increases venous return

Front 14

endocarditis

Back 14

- IVDU = staph => VANC
- no IVDU = strep, enterococci => amp-sublactam

Front 15

karposi sarcoma

Back 15

- HHV-8

Front 16

pt with flu sx that gets better with med, but dvlps sx again a week alter?

Back 16

- influenza infx followed by staph PNA infx

Front 17

staph PNA?

Back 17

- uncommon cause of CAP, occurs in hospital, nursing home, IVDU, CF, s/p influenza infx
- G+ cocci in clusters

Front 18

Klebsiella PNA
Pseudo PNA
Mycoplasma PNA

Back 18

- kleb: drinkers, DM, currant jelly, empyema, cavitation, see G- encapsulated rods
- pseudo: G- rod, CF, bronchiectasis
- Myco: HA, non productive cough, neg cultures, + cold agglutinins

Front 19

pt with erythema migrans?

Back 19

- asympt, bulls-eye, other nonspecific complains = lyme -> just tx, clinical dx,give oral doxy
- if intermediate pretest prob => elisa followed by western blot
- if pregant give amox, if early dissmenated or late give ctx

Front 20

pt jaundice s/p tick bite?

Back 20

babesiosis => hemolytic anemia; can dvlp rash if thrombocytopenic
- lots of blood abnormalities, abnormal LFTs, low complement, high ESR
- very ill if no spleen
- do Giemsa stain
- tx: guinine- clindamycin or atovaquone-azithromycin

Front 21

ehrlichiosis

Back 21

spotless rock mountain spotted fever via tick
- leukopenia, thrombocytopenia

Front 22

Q fever

Back 22

- coxiella burnetti, sheep, cattle, goat
- flu like, hepattis PNA

Front 23

endocarditis in pt with valve?

Back 23

- staph epidermidis

Front 24

which HIV drug causes crystal induced nephropathy?

Back 24

- indinavir (protease inhibitor)
- hydration may help somewhat

Front 25

rx to HIV meds

Back 25

- didanosine- pancreatitis
- abacavir - hypersensitivity
- NRTIs- lactic acidosis
- NNRTIs - SJS
- nevirapine - Liver failure

Front 26

where is chloroquine resistant p.falciparum?
- tx of p vivax or ovale?

Back 26

- - resitance: sub saharan africa and indian subcontientn; give mefloquine instead
- vivax, ovale - give primaquine

Front 27

pinworm tx

Back 27

albendazole (enterobius vermicularis)

Front 28

HIV vaccination?

Back 28

- pneumococcal if CD >200
- if +HBV or HCV then HAV vaccination

Front 29

sx of malaria infx?

Back 29

- cyclical with RBC lyses by parasites
- vivax and ovale - 48hrs, P malariae - 72 hrs, no cycle with falciparum
- cold chills => hot, fever => sweating, no fever
- splenomegaly, anemia

Front 30

dx of infectious mono?

Back 30

- heterophile test, but if neg it doesn't r/o b/c Ab appear later in dz
- EBC specific Ab is useless b/c detects old infx = 90% population

Front 31

tx of human bite infx?

Back 31

- amox+ clavulanate
- clavulanate for anaerobes
- coveres polymicrobila, G+,G-, anaerobes
- also used to tx dog bites

Front 32

clinda, cipro, erythromycin

Back 32

- clinda: G+ anaerboes, lung abscess, female GU infx
- cipro: not good against anaerobes
- erythromycin: legionnaire, CAP, not good anaerobes

Front 33

tx for bacterial meningitis in:
- old man
- 3 month old
- hospitalized pts

Back 33

- old man: CTX, vanc, amp; ctx and vanc for strep pneumo, h fllu, n meningitides, am for L monocytogens
- 3 mon: cefotaxime-amp for L monocyto, don't use CTX b/c biliary sludge
- hospitalized - IV ceftazidime + vanc for psueo and staph

Front 34

meningitis in immunocompromised?

Back 34

L monocytogens

Front 35

man with abd pain, week later with splinter hemorrhage, lock jaw? high eos?

Back 35

- trichinellosis
- worm invades intestine => N/V, abd pain => 2nd wk local and systemic hypersensitivity => splinter hemm, conjunctivitis, retinal hemorrhage, periorbital edema, chemosis => 3rd wk invades muscle

Front 36

ascariasis

Back 36

- lung phase to intestinal phase 2/2 obstruction

Front 37

GBS

Back 37

- s/p mild resp and GI infx => tingling toes, fingers => ascending paralysis

Front 38

angioedema

Back 38

CI inhibitor def, ACE-I use

Front 39

pt with PID

Back 39

- test for HIV, RPR, hep B, pap smear, no need to test for HSV

Front 40

foreign man with area of hypopigmented plaque with no sensation?

Back 40

- leprosy => do skin biopsy for acid-fast bacili
- neg blood cultures

Front 41

pt s/p bone marrow tx now with sx of lung and GI?

Back 41

- always consider CMV penumonitis in ddx of bone marrow tx pt
- CT- many small nodules, patchy infiltrates, GI ulcers
- Dx with bronchoalveolar lavage

Front 42

pt s/p exploring cave? or clearing bird cage?

Back 42

histo, dimorphic fungi, targets histiocytes and reticuloendotehelial system
- palatal ulcers, hilar lymphadenopathy

Front 43

blasto lung vs histo lung

Back 43

- blasto: multiple nodules or consolidation, plaque lesions on mucous membrane, skin ulcers
- histo: hilar lymph with or without pneumonitis

Front 44

tx nocardia?

Back 44

- bactrim
- pt siwht transplant => lung dz => crooked branching, beaded G+ acid fast filaments

Front 45

immunosuppressed pt with exophitic purple skin like cherry angioma or granulom and constitutional sx with visceral lesions?

Back 45

- bacilliary angiomatosis by bartorella, tissue bsiopy
- note excision causes hemorrhage
- abx

Front 46

CMV peripheral smear?

Back 46

- leukocytosis, basophilic lymphocytes with vacuolated appearance
- neg pharyngitis, neg LAD

Front 47

abrupt onset N/V s/p food? if water diarrhea? traveler's diarrhea?

Back 47

- preformed toxins by s. aureus; if ate rice => bacillus cereus
- c. perfringens
- enterotoxigenic e coli

Front 48

hereditary hemochromatosis is increased risk of which infx?

Back 48

- L. moncytogens 2/2 decreased phag from iron overload
- y. enteroculitica or vibrio vulnificus = Fe loving

Front 49

cryptococcus meningitis? histoplasma meningitis?

Back 49

- crypt: encapsulated yeast => amphotericin plus flucytosine then oral fluconazole
- histo: amphotericin then itraconaozole

Front 50

dog bite?

Back 50

- if dog not capture tx for rabies
- if dog captured and has no sx of rabies, observe dog for 10d
- if bite in head or neck, tx for rabies

Front 51

pt with ulcerative esophagitis doesn't respond to flucaonazole?

Back 51

- If not candida then next MC is CMV: see intranuclear and intracytoplasmic inclusions, tx is IV gangcclovir
- apthous ulcers (nonspecific) => prednisone
- HSV: mulstiple small well circumscribed, volcano like cells with ballooning degeneration and eosinophil, intranuclear includsions; tx acycloir
- oral itraconazole for fluconazole resistant candida

Front 52

pt dx with syphilis by dark field microscopy, what next?

Back 52

- test for HIV
- don't do more tests for syphillis e.g. VDRL, FTA-ABD

Front 53

HIV needle prick

Back 53

- start on at least 2 drugs and check blood 6wks, 3mo, 6mo
- use 3 drugs if host was very infected e.g. low CD4, high viral count

Front 54

bloody diarrhea, no hx of travel? ddx?

Back 54

- no fever, + abd pain = enterohemmorhagic e oli 0157:h7 from raw meat; complications = HUS, TTP
- + fever or no abd pain = shigella, salmonella, campy
- ddx IBD by acute or chronic sx (acute =infx)
- pt living on gulf = vibrio
- hx of travel = giardia, crypto, entamoeba

Front 55

HIV pt w/ bloody diarrhea, CD4 <50?

Back 55

- MC is CMV, do colonoscopy w biopsy => eosinophilic intranuclear and basophilic intracytoplasmic inclusions; tx: gangcyclovir, else foscarnet
- if non bloody and gian cells => crypto
- if blood, visualize trophozoites on stool, flask shaped colonic ulcers = e. histolytica
- nonbloody, involves small bowel = diss MAC

Front 56

pt with infx on side of neck, serosanguinous drainage, G+ branching bacteria?

Back 56

- actinomyces causes infx in cervicofacial, thoaraci, abd
- drains yellow sulfur granule containing fluid, tx: high dose PCN 6-12 wks
- must ddx TB which can grow in same area with acid fast

Front 57

HSV meningitis?

Back 57

- no meningeal signs, affects temporal lobes => bizarre behavior, hallucinations
- non specific CSF = low glucose, pleocytosis, high lymphocytes (so know it's not bact)
- dx by PCR, don't culture
- IV acyclovir

Front 58

contact with soil contaminated by cat/dog poo in southeast sand?

Back 58

- cutaneous larvae migrans
- ancylostoma brazilianse - helminth
- erythematous papules at sight of contact -> elevated serpiginous lesions

Front 59

HIV, ring enhaning lesion in brain?

Back 59

- toxo, give bactrim, CD4 <100
- note: b/c of high prevalence of toxo in pts, screen for Ab in newly dx HIV => give bactrim prophylactically b/c most cerebral toxo is 2/2 reactivation

Front 60

prophylaxis for CD4 <50?

Back 60

- azithromycin for MAC

Front 61

pt with neutrapenia, now sick?

Back 61

- sick = single temp > 100.9 or sustained temp > 100.4 for 1 hr
- MC is skin flora bacteria infx with G+
- start empiric covering pseudo = monotherapy of ceftazidime, imipenem, cefepime or meropenem
- combo: aminoglycocide + antipseudo beta lactam

Front 62

cefazolin?

Back 62

- primary gen ceph, G+ > G-, no pseudo coverage

Front 63

eating undercooked pork? seafood? poulty?

Back 63

- pork: sporadic persiniosis
- seafood: vibrio parahaemolyticus
- poultry: campy

Front 64

CXR with multiple small tin wall cavities?

Back 64

- post viral USI staph aureus nectrotizing PNA
- most likely old man

Front 65

pulm infx in CF child?

Back 65

- MC is pseudo => aminoglycoside and antipseudo PCN e.g. piperacillin or anti pseudo ceph (ceftazidine, cefepime)
- adults: fluoroquinolone
- if mild, most likely staph infx

Front 66

PPD positive in HIV pt with neg CXR?

Back 66

- tx prophylactically with isoniazid + pryidoxine x 9 months
- pyridoxine prevents neuropathic complications of isoniazid but not hepatitis so check LFTs
- PPD >5

Front 67

tx syphilis?

Back 67

IM benzathine PCN G.
- if allergic, give doxy or tetra x 14 d
- if neurosyphlis, IV aqueous crystalline PCN or IM procaine PCN

Front 68

anogenital warts

Back 68

- condylomata xeuminati; skin colored, verrucous papilliform lesions around anus;
TX:
- chemical/physical agenets - trichloroacetic acid, 5-FU epi gel, podophyllin (teratogenic)
- immune therapy: imiquimod, interferon alpha
- surgery

Front 69

traveller's diarrhea?

Back 69

E. coli
- parasites are area except in hyperedemic regions
- nepal = giardia, cyclospore
- giardia = mountainous areas of N,W USA

Front 70

UTI with alkaline urine?

Back 70

- proteus

Front 71

HIV prophylaxis if live in SE?

Back 71

CD4 <100 = histo => itraconazole

Front 72

HIV pt with disseminated Histo?

Back 72

- IV amphotericin B + life long itraconazole to prevent relapse

Front 73

erysipelas

Back 73

- Group A strep = s. pyrogens

Front 74

Jarisch-Herxheimer rxn

Back 74

tx of primary or secondary syphilis => spirochetes die quickly => antigen-Ab copmlex released => immunological rxn like acute syph flare up

Front 75

proper removal of tick?

Back 75

- tweezers, no pet jelly

Front 76

women s/p rubella vaccine, risk to pregnancy?

Back 76

minimal risk for congenital rubella, rec is try not to get pregnant within 28 days, but if you do, oh well

Front 77

tx HSV

Back 77

- oral valacyclovir is drug of choice
- acyclovir is effective and less expensive
- oral steroids for sx
- topical lidocaine doesn't help
- TCA for post-herpetic pain

Front 78

tx Bartonella henselae?

Back 78

- azithro
- hallmark = regional LAD, clinical dx
- cat scratch dz

Front 79

clostridium perfringens?

Back 79

- watery diarrhea 8-14 hrs s/p meat, poultry, gravy

Front 80

MC valve involved in infective endo?

Back 80

- mitral
- IVDU = tricuspid

Front 81

osteo in kids? infant? SS? prostehtic? hx UTI or cath?

Back 81

- kids- staph aureus, pyrogens
- infant - e coli, GBS (s. agalactiae)
- SS: salmonella
- prosthetic: s. epi
- UTI/cath: psuedo

Front 82

meningitis

Back 82