Usmle Step 2 Ck - Infectious Diseases

Front 1

Meningitis in 0-6 mos

Back 1

GBS
E.coli/Gram neg rods
Listeria

Front 2

Meningitis in 6 mo - 6 yo

Back 2

S. pneumonie
H. influenza B
Neisseria meningitis
Enterovirus

Front 3

Meningitis in 6 -60yo

Back 3

S. pneumonie
N. meningitis
Enterovirus
HSV

Front 4

Meningitis in elderly >60yo

Back 4

S. pneumonie
N. meningitis
Listeria
Gram neg rods

Front 5

Diagnostic test for legionella

Back 5

urine legionella antigen

Front 6

diagnostic test for mycoplasma

Back 6

serum cold agglutinins and serum mycoplasma antigen

Front 7

diagnostic test for strep pneumo

Back 7

urine pneumococcal antigen

Front 8

UTI
(Main organism and empirical Abx to tx)

Back 8

E. coli

TMP-SMZ, nitrofurantoin, amoxicillin, quinolones

Front 9

Bronchitis
(Main organism and empirical Abx to tx)

Back 9

Virus: no abx

Haemophilus influenza: Azithromycin/Erythromycin (macrolides "-mycin")

Moraxella: either watchful waiting, quinolone (ciprofoxacin, "-floxacin"), erythromycin

Front 10

Classic pneumonia
(Main organism and empirical Abx to tx)

Back 10

Strep pneumo, H.influenza

azithromycin, 3rd gen cephalosporin (ceftriaxone,etc)

Front 11

Atypical pneumonia
(Main organism and empirical Abx to tx)

Back 11

Mycoplasma, Chlamydia

Macrolide (azithromycin, "-mycin"), doxycycline

Front 12

Osteomyelitis
(Main organism and empirical Abx to tx)

Back 12

Staph aureus, Salmonella

Oxacillin, cefazlin, vancomycin

Front 13

Cellulitis
(Main organism and empirical Abx to tx)

Back 13

Stretococci, staphyloccoci

Cephalexin, dicloxacillin
If suspect MRSA: clindamycin or TMP-SMZ

Front 14

Meningitis in neonate
(Main organism and empirical Abx to tx)

Back 14

Group B Strep, E.coli, Listeria

Ampicillin + aminoglycoside (streptomycin/amikacin/gentamicin/tobramicin), cefotaxime

Front 15

Meningitis in child/adult
(Main organism and empirical Abx to tx)

Back 15

Strep pneumoniae, Neisseria meningitidis
*H. influenza if the child is NOT VACCINATED

Cefotaxine or ceftriaxone + vancomycin

Front 16

Endocarditis
(Main organism and empirical Abx to tx)

Back 16

Staphylcocci and streptococci

Dicloxacillin/methicillin (antistaph penicillin) or vancomycin + aminoglycoside (strepomycin/amikacin/gentamicin/tobramicin)

Front 17

Sepsis
(Main organism and empirical Abx to tx)

Back 17

Gram-negative organisms, streptococci, staphylococci

3rd gen cephalosporin (ceftriaxone) or 3rd gen penicillin (ticarcillin/carbicillen) + aminoglycoside (strepomycin/amikacin/gentamicin/tobramicin), or imipenam

Front 18

Septic arthritis (monogamous/nonsex vs sexually active young pt)
(Main organism and empirical Abx to tx)

Back 18

monogamous pt: staph aureus
sexually active pt: n. gonorrhea

Vancomycin
Ceftazidime/ceftriaxone: for gram neg
Gonococci: ceftrixone, ciprofloxacin, or spectinomycin

Front 19

Empiric abx for:
Strep A or B

Back 19

Penicillin, cefazolin

Alt: Erythromycin

Front 20

Empiric abx for:
S. pneumoniae

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3rd gen cephalosporin + vancomycin

Alt: Fluoroquinolone

Front 21

Empiric abx for:
Enterococcus

Back 21

Penicillin/ampicillin + aminoglycoside (amikacin/strepomycin/gentamicin/tobramicin)

Alt: Vancomycin + aminoglycoside

Front 22

Empiric abx for:
Staph Aureus

Back 22

Methicillin

Alt: Vancomycin if MRSA

Front 23

Empiric abx for:
Gonococcus

+Additional step?

Back 23

Ceftriaxone or cefixime

Alt: Spectinomycin

ADDITIONALLY, tx for chlamydia: doxycycline

Front 24

Empiric abx for:
Meningococcus

Back 24

Ceftriaxone or cefotaxime

Alt: Pencillin G (if susceptible to pencillin) or chloramphenicol

Front 25

Empiric abx for:
Haemophilus

Back 25

2nd gen cephalosporin (cefoxitin, ceflaclor) or 3rd gen (ceftriaxone/cefixime)

Alt: ampicillin

Front 26

Empiric abx for:
Pseudomonas

Back 26

Ticarcillin/pipercillin + clavulanate/tazobactam (beta lactamase inhibitor)

Alt: ceftazidime, cefepime (4th gen), imipenemm, cipro

Front 27

Empiric abx for:
Bacteroides

Back 27

Metronidazole

Alt: Clindamycin

Front 28

Empiric abx for:
Mycoplasma

Back 28

Erythromycin, azithromycin

Alt: doxycycline

Front 29

Empiric abx for:
Treponema pallidum

Back 29

Penicillin

Alt: Doxycycline

Front 30

Empiric abx for:
Chlamydia

Back 30

Doxycycline, azithromycin

Alt: erythromycin, ofloxacin

Front 31

Empiric abx for:
Lyme disease/Borrelia burgdorfei

Back 31

Doxycycline, amoxicillin, cefuroxime (2nd gen)

Front 32

Gram stain blue/purple = ?
Gram stain red = ?

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Blue/purple = gram positive
Red = gram neg

Front 33

Gram + cocci in chains

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Streptococci

Front 34

Gram + cocci in clusters

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Staphyloccoci

Front 35

Gram + cocci in pairs (diplococci)

Back 35

Strep pneumoniae

Front 36

Gram neg coccobacilli (small rods)

Back 36

Haemophilus

Front 37

Gram neg diplococci

Back 37

Neisseria (STD, septic arthritis, meningitis)

Moraxella (lungs, sinusitis)

Front 38

Gram neg rod with thick capsule (mucoid appearance)

Back 38

Klebsiella

Front 39

Gram + rods that form spores

Back 39

Clostridium

Bacillus

Front 40

Pseudohyphae

Back 40

Candida

Front 41

Acid fast organism

Back 41

Mycobacterium (usually M. tuberculosis)

Nocardia (weakly acid fast)

Front 42

Gram + with sulfur granules

Back 42

Actinomyces (PID in IUD users, rarely case neck mass or cervical adenitis)

Front 43

Silver staining

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Pneumocystis jirovecii

Cat scratch dz (bartonella henselae)

Front 44

Positive India ink (thick capsule)

Back 44

Cryptococcus neoformans

Front 45

Spirochete

Back 45

Treponema (syphilis)

Leptospira
[above 2 seen on dark field microscopy]

Borrelia (seen on regular light microscope)

Front 46

Stuck with thorn/gardening

Back 46

Sporothrix schenckii

Tx with ketoconazole or oral potassium (K) iodide

Front 47

Aplastic crisis in sickle cell dz

Back 47

Parvovirus B19

Front 48

Sepsis after splenectomy

Back 48

SHiN
S. pneumoniae
H. influenzae
N. meningitis

(encapsulated bugs)

Front 49

Pneumonia in southwest (CA, arizona)

Back 49

Coccidioides immits

Tx: itraconazole or fluconazole
Amphotericin B if severe

Front 50

Pneumonia in Ohio/mississippi river
Or after cave exploring/bird droppings

Back 50

Histoplasma capsulatum

Tx:
Mild pulm dz: itraconazole or supportive

Chronic pulm dz (cavitation on CXR): itraconazole x >1yr

Disseminated dz (HSM, palatal ulcers, pancytopenia): Liposomal amphotericin B x 2 yrs, then itraconazole x life

Front 51

Pneumonia after exposure to parrot/exotic bird

Back 51

Chlamydia psittaci

Front 52

Fungus ball/hemopytsis after TB or cavitary lung dz

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Aspergillus sp

Tx: voriconazole

Front 53

Pneumonia in miner/sandblaster (silicosis)

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TB

Front 54

Diarrhea after hiking/drinking from a stream

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Giarda lamblia

Dx: stool cysts
Tx: metronidazole

Front 55

Pregnant woman with cats

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Toxoplasma gondii

Dx: peripheral blood smear shows trophozoites
Tx: spiramycin

Front 56

B12 deficiency and abd sx

Back 56

Diphyllobothrium latum

Could tx with praziquantal

Front 57

Seizures with ring-enhancing brain lesions on CT

Back 57

Taenia solium (cysticercosis)

Tx: albendazole or praziquantel + steroids

Also toxoplasmosis; tx with pyrimethamine or clindamycin

Tx: anticonvulsants

Front 58

Squamous cell bladder cancer in Middle east or Africa

Back 58

Schistosoma haematobium

Front 59

Worm infxn in children

Back 59

Enterobius

Dx: positive tape test; pt complains of perianal itching

Tx: mebendazole or albendazole

Front 60

Fever + muscle pain + eosinophilia + periorbital edema after eating raw meat

Back 60

Trichinella spiralis (pork worm)

Dx: muscle bx
Tx: mebendazole or albendazole if serious, usually self-resolves

Front 61

Gastroenteritis in young kids

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Rotavirus
Norwalk virus

Front 62

Food poisoning after eating reheated rice

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Bacillus cereus

self-limited

Front 63

Food poisoning after eating seafood

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Vibrio parahaemolyticus

Front 64

Diarrhea after travel to Mexico

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E.coli

Tx: ciprofloxacin

(entertoxic e.coli is the usual cause of traveler's diarrhea)

Front 65

Tx for clostridium difficle

Back 65

Metronidazole or vancomycin

Front 66

Baby paralyzed after eating honey

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Clostridium botulinum

Tx: antitoxin

Front 67

Genital lesions on kid without sexual abuse/activity

Back 67

Molluscum contagiosum (spread from hand to peepee bc they touch it)

(By DNA poxvirus); warts, self-resolves

Front 68

Cellulitis after cat/dog bites

Back 68

Pasteurella multicoda

Ppx tx: amoxicillin-clavulanate

Front 69

Slaughterhouse worker with fever

Back 69

Brucellosis

Tx: streptomycin and doxycycline

Front 70

Pneumonia after being in hotel/cruise ship/air conditioner/water tower

Back 70

Legionella pneumophilia

Tx: azithromycin or levofloxacin

Front 71

Burn wound infxn with blue/green color

Back 71

Pseudomonas

(S. aureus also in burn but not blue/green)

Front 72

Tx for acute pharyngitis with 3/4 Centor criteria

Back 72

Center criteria for group A beta-hemolytic strep pyogenes:
1. fever
2. tonsillar exudate
3. tender anterior cervical LAD
4. lack of cough

Tx with penicillin x 10 days

Front 73

Lemierre's syndrome

Back 73

complication of group A strep pharyngitis

thrombophlebitis of the jugular vein

Front 74

Sinusitis dx and tx

Back 74

Dx: CT scan
Tx:
- usually self-limited if viral
- acute bacterial: amoxicillin/clavulanate or TMP-SMZ

Front 75

Postviral/influenza pneumonia organism

Back 75

Staph aureus

Front 76

Meningitis vs encephalitis sx

Back 76

meningitis: fever, HA, neck stiffness, photophobia
encephalitis: fever, HA, seizures, AMS

Front 77

ppx for close contacts of pt with meningococcal meningitis

Back 77

rifampin

Front 78

pt with encephalitis sx with RBCs in CSF with h/o trauma

what will be on MRI?

Back 78

HSV encephalitis

increased temporal lobe signaling

start IV acyclovir asap

Front 79

CMV encephalitis tx

Back 79

IV ganciclovir +/- foscarnet

Front 80

young male pt with paranasal sinusitis, then with brain abscess, what is the organism?

Back 80

strep miller

Front 81

empiric tx for bacterial meningitis in <1 mo

Back 81

ampicillin + cefotaxime/gentamicin

Front 82

empiric tx for bacterial meningitis in 1-3 mo

Back 82

IV vancomycin + ceftriaxone /cefotaxime

Front 83

empiric tx for bacterial meningitis in 3 mos - adulthood

Back 83

IV vancomycin + ceftriaxone/cefotaxime

Front 84

empiric tx for bacterial meningitis >60 yo/alcoholism/chronic illness

Back 84

Ampicillin + vancomycin + ceftriaxone/cefotaxime

Front 85

HIV ppx levels

Back 85

<200, against PCP; 1x TMP-SMZ

<100, against MAC; weekly azithromycin

<50, against toxoplasma; 2x TMP-SMZ

Front 86

AIDS pathogens

Back 86

The Major Pathogens Concerning Complete T-Cell Collapse
(Toxic MAC PCP Canada Crypt neo, TB CMV, crypt parvo)

Toxoplasma gondii
MAC
PCP
Cryptococcus neo
CMV
TB
Candidasis
Crypt parvum

Front 87

Tx for candida

Back 87

Esophagitis: fluconazole
Oral: nystatin swish and swallow

Front 88

S. pneumoniae ppx in AIDS pt

Back 88

Pneumovax q5yrs when CD4>200

Front 89

Pseudohyphae + budding yeast

Back 89

Candida

Front 90

45 angle branching septae hyphae + rare fruiting bodies

Back 90

Aspergillus

fruity ass at a cute (45) angle

Front 91

Yeasts with wide capular halo, narrow-based unequal budding

Back 91

Cryptococcus

Front 92

Irregular broad, nonseptate, hyphae, wide-angle branching

Back 92

Mucor

Front 93

AIDS + pigeon droppings; HA/fever without meningitis signs

Back 93

Dx: CSF cryptococcal antigen, or India stain
Tx: IV amphotericin B + flucytosine x2 wk, fluconazole for life

Front 94

HIV pt with nonproductive cough + dyspnea

also check what else?

Back 94

Pneumocystis carinii pneumonia (PCP)

check for PaO2 (it will be very low)

Tx: high dose TMP-SMZ x 3 wks + predisone taper if PaO2 <70

Front 95

Disseminated dz in HIV pts CD4<50; fever weight loss and HSM/LAD in pts not on HAART therapy

clinical lab findings

Back 95

MAC

Lady windermere syndrome: the pulmonary form in healthy nonsmokers

Lab: increased alk phos and LDH
foamy macrophages with acid-fast bacilli

Tx: clarithromycin if not in HAART

Front 96

Lyme dz vs Rocky Mt Spotted Fever

Back 96

Lyme: target ("bull's eye"; erythema migrans); can get Bell's palsy and arthritis and encephalitis
- mostly in Wisconsin and the northeast states near Maine

Rocky mt (by Rickettsia rickettsii): macular (spotty) rash at wrists and ankles and become itchy and spread centrally
- midsouth states like Alabama/OK

Tx both with doxycycline

Front 97

CXR finding for inhaling anthrax

Back 97

Widened mediastinum

tx: ciprofloxacin

Front 98

Pathogen in swimmer's ear (otitis externa)

Back 98

Pseudomonas

Ear drops of strepmycin/amikacin/tobramicin (aminoglycosides)

Front 99

Osteomyelitis in pt with no risk factors

Back 99

S. aureus

Front 100

Osteomyelitis in IV drug user

Back 100

Pseudomonas or S. aureus

Front 101

Osteomyelitis in sickle cell dz

Back 101

Salmonella

Front 102

Osteomyelitis in hip replacement

Back 102

Staph epidermis

Front 103

Osteomyelitis in foot puncture wound

Back 103

Pseudnomonas

Front 104

Chronic osteomyelitis

Back 104

S. aureus, pseudomonas, Enterbacteriaecae

Front 105

Diabetic with osteomyelitis

Back 105

Polymicrobial, pseudomonas, S. aureus, streptococci, anaerobes