Kp Id: Step 2 Ck

Front 1

Q001. Infective Endocarditis - What is it; Risk Factors

Back 1

A001. Infection of endocardium secondary to infectious causes; MC affects heart valves - especially mitral valve; Risk Factors - dental procedures that cause bleeding, oral & upper respiratory surgery, certain GI procedures, GU surgery, prosthetic heart valves, valvular heart disease, alimentation caths in right heart pressure monitoring caths, IVDU

Front 2

Q002. Infective Endocarditis - Causes

Back 2

A002. acute - S. aureus; subacute - S. viridans; IVDU - S. aureus; prosthetic valve - coag-negative Staph,; coexisting GI malignancy - Strep. bovis; fungal – Candida, Aspergillus; predisposing factors - long-term indwelling, IV catheter, immunosup from malignancy, AIDS, organ transplant, IVDU

Front 3

Q003. Infective Endocarditis - Hx

Back 3

A003. Fever; chills; weakness; dyspnea; sweats; anorexia; skin lesions; IVDU; in patients with h/o valve disease or IVDU - fever alone should be red flag

Front 4

Q004. Infective Endocarditis - PE

Back 4

A004. Fever; heart murmur; Osler's nodes; Janeway lesions; splinter hemorrhages; Roth's spots

Front 5

Q005. Infective Endocarditis - Dx

Back 5

A005. Fulfill Duke's criteria:; major criteria - • positive Blood culture - 2+ sets • abnormal echo – vegetations, paravalvular abscess, new regurgitation, new partial dehiscence of prosthetic valve • TTE - very specific • TEE - very sensitive; or 1 major and 3 minor criteria - PE findings, emboli, glomerulonephritis, positive Rh factor; Other findings – leukocytosis, left shift, increased ESR, increased C-reactive protein, mild anemia, microscopic hematuria, EKG

Front 6

Q006. Infective Endocarditis - Tx

Back 6

A006. Tx based on organisms & sensitivity; if very ill – empiric empiric - antistaph, antistrep & gentamicin, change as soon as know organism; surgery if - severe CHF from valve incompetence, paravalvular leak around prosthetic valve, fungal endocarditis, persistent bacteremia despite Antibiotics, extravalvular infection; Antibiotics prophylaxis before: • dental work – amoxicillin, if PCN allergy - clindamycin or azithromycin, clarithromycin or cephalexin • urinary or GI procedures - ampicillin and gentamicin, if PCN allergy - vancomycin and gentamicin

Front 7

Q007. Candidal Thrush - What is it & risk factors

Back 7

A007. Infection of C. albicans, risk factors; xerostomia; corticosteroid inhaler use; immune def. immunosuppressive Tx; leukemia; lymphoma; cancer; diabetes; obesity; pregnancy; can cause skin infections in noncompromised (diaper rash)

Front 8

Q008. Candidal Thrush - Hx/PE

Back 8

A008. White, cream-colored or yellow plaques can be scraped off, leaves bleeding surface, frequent complaint of mucosal burning; oral candidiasis; intertriginous; candidal paronychia; vulvovaginitis - pregnancy, DM

Front 9

Q009. Candidal Thrush - Dx

Back 9

A009. Clinical Dx; KOH; Cx - definitive

Front 10

Q010. Candidal Thrush - Tx

Back 10

A010. Hair & nails involved - can't use topical, must use systemic; not involved – topical nystatin; clotrimazole; fluconazole, miconazole; amphotericin; oral nystatin - 4x/day, "swish and swallow" use for 5-7 days after lesions disappear

Front 11

Q011. Pneumocystis Carinii Pneumonia; What is it

Back 11

A011. Organism of low virulence; found in lung of humans; predisposing factor in development of PCP - impaired cell- mediated immunity

Front 12

Q012. Pneumocystis Carinii Pneumonia; Hx/PE

Back 12

A012. Pneumonia; DOE; dry cough; fever; chest pain; impaired oxygenation; SOB; tachypnea; tachycardia

Front 13

Q013. Pneumocystis Carinii Pneumonia; Dx

Back 13

A013. Principle diagnostic test - bronchoscopy with bronchoalveolar lavage; CXR - b/l diffuse perihilar infiltrates; silver stain and immunofluorescence of sputum samples

Front 14

Q014. Pneumocystis Carinii Pneumonia; Tx

Back 14

A014. TMP-SMX; pentamidine; steroids - adjunct if severe - PaO2 <70, A-a gradient >35 Prophylaxis:; TMP-SMX - oral, #1; dapsone - #2; atovaquone - #3; aerolized pentamidine; prophylaxis can be stopped - if antiretrovirals raise CD4 > 200 for >6 months

Front 15

Q015. Chlamydia - What is it

Back 15

A015. MC bacterial STD in US; Chlamydia trachomatis; can infect genital tract, urethra, anus and eye; in newborns - conjunctivitis, pneumonia; coexists or mimics gonorrhea; test for both

Front 16

Q016. Chlamydia - Hx/PE

Back 16

A016. Hx - often asymp; urethritis – dysuria, urgency; mucopurulent cervicitis, vaginal discharge, bleeding, dyspareunia; salpingitis; PID - abdom pain, fever; nongonocc urethritis - men; PE - mucopurulent discharge, cervical or adnexal tenderness, penile discharge, testicular tenderness

Front 17

Q017. Chlamydia - Dx

Back 17

A017. Ligase chain reaction test - of voided urine; serology- fluorescent Ab; (swab of male urethra); (gram stain of discharge - may show PMNs, but no bact.)

Front 18

Q018. Chlamydia - Tx

Back 18

A018. Doxycycline; or azithromycin; pregnant - erythromycin

Front 19

Q019. Chlamydia - Complications

Back 19

A019. Chronic infection; pelvic pain; Reiter's syndrome; Fitz-Hugh-Curtis syndrome; PID => infertility; epididymitis

Front 20

Q020. Gonorrhea - What is it

Back 20

A020. Gram-negative diplococcus; can infect almost any site in female reproductive tract; men - usually limited to urethra

Front 21

Q021. Gonorrhea - Hx/PE

Back 21

A021. Greenish-yellow discharge; pelvic or adnexal pain; swollen Bartholin's glands; purulent urethral discharge; dysuria; erythema of urethral meatus

Front 22

Q022. Gonorrhea - Dx

Back 22

A022. Swab & culture on Thayer-Martin medum; gram stain cervical discharge; Culture - most specific test

Front 23

Q023. Gonorrhea - Tx

Back 23

A023. single-dose ceftriaxone 250 IM and doxycycline for 7 days; or single-dose ceftriaxone 250 IM and single-dose azithromycin; or single-dose oral cipro or cefixime; (also treating for chlamydia - doxycycline or macrolide); condoms for prophylaxis

Front 24

Q024. Gonorrhea - Complications

Back 24

A024. Urethritis; epididymitis; cervicitis; PID; tubo-ovarian abscess & rupture; Fitz-Hugh-Curtis; DGI (Disseminated Gonoc Infec); persistent infection with pain

Front 25

Q025. Syphilis - What causes it

Back 25

A025. Treponema pallidum; spirochete

Front 26

Q026. Syphilis - Hx/PE

Back 26

A026. Primary - 10-60 days after infection, chancre (painless ulcer) near area of contact, spontaneously heals in 3-9 weeks; Secondary - 1-2 months after see chancre, maculopapular rash on soles, palms, low-grade fever, headache, malaise, lymphadenopathy, can see alopecia, meningitis, hepatitis & nephritis may also be seen, very infective 2o eruptions, coalesce => condylomata lata, spontaneously heals in 2-6 weeks; Early latent - no symptoms, positive serology, first yr of infection; Late latent - no symptoms, positive or negative serology, > 1 yr of infection, 1/3 will progress to tertiary; Tertiary - 3-20 yrs after init infection, not contagious, gummas, Tabes dorsalis, Argyll Robertson pupil, CV – aortitis, aortic root aneurysms, aortic regurgitation

Front 27

Q027. Syphilis - Dx

Back 27

A027. Best diagnostic in primary - dark-field microscopy; secondary - RPR/VDRL

Front 28

Q028. Syphilis - Tx

Back 28

A028. primary & secondary - IM PCN 2.4 million units/wk, primary - 1 wk, secondary - 3 weeks; tertiary - IV PCN, 10-20 million units/day x 10D; PCN allergic - primary & secondary – doxy, tertiary or pregnant - desensitize; Jarisch-Herxheimer - > 50% of patients, fever, headache, sweating rigors, temp exacerbations of lesions, 6-12 hrs post Tx

Front 29

Q029. Histoplasmosis - What is it

Back 29

A029. Dimorphic fungus; environment - mold (mycelial), yeast in body; endemic - MS River, OH; self-limited flu-like Symptoms; mediastinal fibrosis, residual scar tissue; chronic cavitary disease - if obstructive lung disease; disseminated histoplasmosis - especially in immune compromised, infants, fatal if untreated; risk factors – AIDS, spelunking, bird and bat feces

Front 30

Q030. Histoplasmosis - Hx/PE

Back 30

A030. Acute infection - arthralgia, erythema nodosum, erythema multiforme; chronic infection - low-grade fever, anorexia, weight loss, night sweats, productive cough

Front 31

Q031. Histoplasmosis - Dx

Back 31

A031. polysaccharide Ag detection, fast test for Dx and monitoring relapse; complement fixation Ab of 1:8 of 1:16; silver stain on Biopsy, bone marrow, l. node, liver; bronchoalveolar lavage; CXR; chest CT

Front 32

Q032. Histoplasmosis - Tx

Back 32

A032. amphotericin B; ketoconazole

Front 33

Q033. Coccidioidomycosis - What is it

Back 33

A033. Dimorphic fungi; environment - breaks up into arthroconidia; spherules in tissue; endemic - SW, S. CA; can present as flu-like or acute pneumonia; if disseminates, can involve - bone, meninges, skin; the "great imitator"; incubation period is 1-4 weeks after exposure

Front 34

Q034. Coccidioidomycosis - Hx/PE

Back 34

A034. Fever; headache; anorexia; chest pain; cough; dyspnea; night sweats; arthralgias

Front 35

Q035. Coccidioidomycosis - Dx

Back 35

A035. Precipitin Ab - rise within 2 weeks, disappear after 2 months; complement fixation Ab - rise at 1-3 months; culture – sputum, wound exudate, joint aspirate; CXR; consider – bronchoscopy, fine-needle Biopsy, open lung Biopsy, pleural Biopsy

Front 36

Q036. Coccidioidomycosis - Tx

Back 36

A036. Ketoconazole or fluconazole, amphotericin B

Front 37

Q037. Cryptococcosis - What is it

Back 37

A037. C. neoformans; encapsulated yeast in soil with pigeon droppings; can cause asymp pulmon infect; affects meninges; defining opportunistic infection for AIDS

Front 38

Q038. Cryptococcosis - Hx/PE

Back 38

A038. Meningitis - frontal or temporal headache; fever; impaired mentation; no meningismus; pneumonia - nonproductive cough, SOB, fever

Front 39

Q039. Cryptococcosis - Dx

Back 39

A039. LP with init eval by india ink; then cryptococcal Ag testing; worse prognosis - high opening pressure, high Ag titer, low CSF cell count; fungal culture; latex agglutination test; CT - if neuro deficits; fungal meningitis - CSF glucose decreased, protein increased, leukocyte count high, lymphocytes predominate

Front 40

Q040. Cryptococcosis - Tx

Back 40

A040. IV Amphotericin - 2 weeks, then oral fluconazole for life; prophylaxis - fluconazole not recommended, effective, but incidence of meningitis too low

Front 41

Q041. Anthrax - What is it

Back 41

A041. B. anthracis; forms spores; gram positive rods; occupational hazard for veterinarians & farmers; animal wool/hair, hides, bone meal products, biological weapon; MC - cutaneous; inhalational - most deadly; intestinal

Front 42

Q042. Anthrax - Hx/PE

Back 42

A042. Cutaneous - 1-7 days after skin exposure and penetration of spores; MC - exposed upper extremities; pruritic papule in 24-48 hrs forms ulcer with edematous halo; in 7-10 days => black eschar; regional lymphadenopathy

Front 43

Q043. Anthrax - Dx

Back 43

A043. Aerobic culture; gram stain of ulcer exudate

Front 44

Q044. Anthrax - Tx

Back 44

A044. Meningeal anthrax - PCN - meningeal dose; doxycycline, chloramphenicol, quinolone 1-2 weeks (PCN allerg); ciprofloxacin prophylaxis - postexposure prophylaxis, 60 days to prevent inhalational anthrax

Front 45

Q045. Lyme Disease - What is it

Back 45

A045. Borrelia spirochete; Ixodes tick; usually seen in summer months; endemic - NE, Pacific, North midwest; MC vector-borne disease in NA

Front 46

Q046. Lyme Disease - Hx/PE

Back 46

A046. Rash, fever, malaise, headache, myalgias, joint pain; often recent history of camping, hiking in endemic areas; tick needs 24 hours of attachment to transfer Borrelia; primary - Erythema migrans, eryth macule or papule at tick- feeding site, slowly expands, central clearing, "bull's eye"; secondary - migratory polyarthropathy, neuro - Bell's palsy – MC, meningitis, myocarditis: MC - AV heart block; tertiary – arthritis, subacute encephalitis, severe arthritis - HLA-DR2

Front 47

Q047. Lyme Disease - Dx

Back 47

A047. rash; 1 late manifestation; lab confirms organism: ELISA - positive = exposure, not active disease; Western Blot - to confirm

Front 48

Q048. Lyme Disease - Tx

Back 48

A048. Doxycycline - minor Symptoms; IV ceftriaxone - major Symptoms

Front 49

Q049. Rocky Mt Spotted Fever - What is it

Back 49

A049. Rickettsia rickettsii; dermacentor tick; invades endothel lining of cap => small-vessel vasculitis; rapidly fatal if untreated

Front 50

Q050. Rocky Mt Spotted Fever - Hx/PE

Back 50

A050. Headache; fever; rash - before 6th day, macular pink rash, starts at wrists, ankles, maculopapular and darker petechial/purpuric as spreads, spreads centripetally (in) => palms & soles; in severe cases - altered mental status, DIC

Front 51

Q051. Rocky Mt Spotted Fever - Dx

Back 51

A051. Clinical; confirm - complement fixation test, Weil-Felix test

Front 52

Q052. Rocky Mt Spotted Fever - Tx

Back 52

A052. Doxycycline

Front 53

Q053. UTIs - What is it; Causes

Back 53

A053. Cystitis, pyelonephritis, perinephric abscess; cystitis - very common, affects women > men; E. coli - 80%; due to - urinary stasis, foreign body, tumor, stones, stricture, BPH, neurogenic bladder, honeymoon cystitis; major cause – catheters, risk related to length (time) of catheterization

Front 54

Q054. UTIs - UTI bugs

Back 54

A054. SEEKS PP; S. saprophyticus; E. coli; Enterobacter; Klebsiella; Serratia; Proteus; Pseudomonas

Front 55

Q055. UTIs - Cystitis; Hx/PE

Back 55

A055. Dysuria; urgency; frequency; hematuria; low-grade fever; suprapubic pain; PE - suprapubic tenderness; kids - bedwetting; infants - poor feeding; recurrent febrile episodes; foul-smelling urine

Front 56

Q056. UTIs - Dx

Back 56

A056. Best initial test - UA; look for: WBC = #1, RBC, protein, bacteria; if nitrites - gram negative; increased urine pH - Proteus; WBC < 5 is normal; UC > 100,000 colonies confirmatory, not always necessary if; have Symptoms and positive UA

Front 57

Q057. UTIs - Tx

Back 57

A057. Uncomplicated cystitis - TMP-SMX or any quinolone for 3 days, DM - 7 days, pregnant - no quinolones; elderly, comorbid disease or acute toxicity - admit; IV ciprofloxacin or ampicillin & gentamicin; recurrent UTIs - prophylaxis Antibiotics

Front 58

Q058. Pyelonephritis - What is it

Back 58

A058. Ascending UTI that has reached renal parenchyma; More common in – women, pregnancy, childhood, after catheterization or instrumentation; if immunosuppressed - prone to Candida; due to obstruction from – strictures, tumor, stones, bph, neurogenic bladder, vesicoureteral reflux

Front 59

Q059. Pyelonephritis - Hx/PE

Back 59

A059. Costovertebral angle tenderness; flank pain; fever/chills; n/v; dysuria; frequency; urgency

Front 60

Q060. Pyelonephritis - Dx

Back 60

A060. Clean-catch urine for - UA, UC, sensitivity, >100,000 colonies suggestive; US - to rule out obstruction; WBC casts; leukocytosis; UC; radiology if – pregnancy, history of urolithiasis, prior GU surgery, recurrent pyelonephritis, prepubescent age, fever > 5-7 days without appropriate med eval, elderly; IVP - #1 choice (if not pregn); US - safe in pregnancy; CT - if nondiagnostic IVP & US, if don't respond to therapy after 3 days of Tx

Front 61

Q061. Pyelonephritis - Tx

Back 61

A061. Any Antibiotics or gram negative rods; 10-14 days; (fluoroquinolone, TMP-SMX, ampicillin, gentamicin, 3rd gen cephalosporin)

Front 62

Q062. Sepsis - What is it

Back 62

A062. Systemic infection plus; a reaction called Systemic Inflammatory Response Syndrome (SIRS)

Front 63

Q063. Sepsis - What causes SIRS

Back 63

A063. A release of many mediators into the blood that activate inflammatory and coag pathways

Front 64

Q064. Sepsis - What is severe sepsis

Back 64

A064. Sepsis and signs of failure of at least 1 organ

Front 65

Q065. Sepsis - What is septic shock

Back 65

A065. Sepsis-induced severe sepsis; organ hypoperfusion; hypotension (systolic BP < 90); poor response to initial fluid resuscitation; most cases - hosp.-acquired gram negative bacilli or gram positive cocci; gram-positive shock - secondary to fluid loss caused by exotoxins; gram-negative shock - caused by vasodilation due to endotoxin (LPS)

Front 66

Q066. Sepsis - What causes septic shock in; neonates

Back 66

A066. Group B strep; E. coli; Klebsiella

Front 67

Q067. Sepsis - What causes septic shock in; kids

Back 67

A067. H. influenzae; pneumococcus; meningococcus

Front 68

Q068. Sepsis - What causes septic shock in; adults

Back 68

A068. Gram-positive cocci; aerobic bacilli; anaerobes

Front 69

Q069. Sepsis - What causes septic shock in; IV drug users

Back 69

A069. S. aureus

Front 70

Q070. Sepsis - What causes septic shock in; asplenic patients

Back 70

A070. Pneumococcus; H. influenzae; meningococcus; (in other words, encapsulated organisms)

Front 71

Q071. Sepsis - Hx/PE

Back 71

A071. Hx - abrupt onset of fever & chills, often hyperventilation, altered mental status; PE – fever, tachy, tachypnea, in septic shock - may start as warm shock, warm skin and extremities => cold shock, cool skin and extremities; petechiae or ecchymoses - DIC; elderly patient with altered mental status - consider urosepsis

Front 72

Q072. Sepsis - Dx

Back 72

A072. WBCs initially decreased, WBCs increased in 1-4 hrs. with increased PMNs - especially bands, thrombocytopenia; BC; UC; sputum; CXR; coag studies, DIC panel

Front 73

Q073. Sepsis - Tx

Back 73

A073. May need ICU admission; treat aggressively; maintain BP; IV fluids; pressors; Antibiotics; treat underlying cause

Front 74

Q074. Pneumonia - What is it

Back 74

A074. Infection of lung parenchyma/alveoli has inflammatory exudate; only cause of death in top 10 from infectious disease; not necessary to have predisposing condition; but predisposed if – cigarettes, DM, alcoholism, malnutrition, immunosuppression, bronchial obstruction (tumor); neutropenia, steroids => aspergillosis

Front 75

Q075. Pneumonia - Categories of "typical" and "atypical"

Back 75

A075. Typical - bacteria from nasopharynx; Atypical - from organism inhaled from envi, hard to see on gram stain, not susceptible to Antibiotics that act on cell wall (B-lactams); RSV; adenovirus; mycoplasma; legionella; chlamydia

Front 76

Q076. Pneumonia - What is aspiration pneumonia

Back 76

A076. Secondary to inhaling a large amount of oropharyngeal secretions into larynx and lower respiratory tract; aspiration of small amount in pts with impaired pulmonary defenses; MCC of death in patients with dysphagia due to neurologic disorder

Front 77

Q077. Pneumonia - What is chemical pneumonitis

Back 77

A077. Secondary to inhaling gastric contents; causes chemical injury to lung

Front 78

Q078. Pneumonia - Hx; Mycoplasma Hx; Legionella Hx; PCP Hx

Back 78

A078. Productive cough - green or yellow sputum; rust-colored = pneumococcus; currant jelly = klebsiella; hemoptysis, dyspnea, fever/chills, night sweats, pleuritic chest pain; atypical organisms present - more gradual onset, dry cough, headaches, myalgias, sore throat, pharyngitis; Mycoplasma - dry cough, sore chest, bullous myringitis, anemia (from hemolysis from cold agglutinins), rare to be inpatient/need to admit; Legionella – confusion, headache, lethargy, diarrhea, abdom pain; PCP - marked dyspnea, DOE, chest soreness, cough, HIV+

Front 79

Q079. Pneumonia - PE

Back 79

A079. Decreased or bronchial breath sounds; crackles (rales); wheezing; dullness to percussion; egophony; tactile fremitus; elderly, COPD or DM - may have minimal signs on PE

Front 80

Q080. Pneumonia - Dx

Back 80

A080. CXR - initial test; sputum Culture - most specific diagnosis for lobar (atypicals don't show up on gram stain or regular Culture); invasive tests sometimes to confirm, open lung Biopsy - most specific; Mycoplasma - Ab titers, cold agglutinins - limited; Legionella - special Culture media: charcoal yeast extract, urine Ag tests, direct fluorescent Ab, Ab titers; PCP - bronchoalveolar lavage, increased LDH; Chlamydias, Coxiella, Coccidio - Ab titers; CBC – leukocytosis, left shift; sputum gram stain & culture- ID organism, ID Antibiotics susceptibility, good sputum sample - many PMNs (> 25 cells/hpf), few epith cells (< 25/hpf); BC; ABG for recurrent pneumonias - consider underlying disease

Front 81

Q081. Pneumonia - Outpt community-acq < 65 y/o, otherwise healthy; What are pathogens

Back 81

A081. S. pneumoniae; M. pneumoniae; Chlamydia; H. flu; viral

Front 82

Q082. Pneumonia - Outpt community-acq < 65 y/o; otherwise healthy; What is init coverage

Back 82

A082. In uncomplicated cases, Tx on outpatient basis; erythromycin; tetracycline; smokers with H. flu – clarithromycin, azithromycin

Front 83

Q083. Pneumonia - Outpt community-acq > 65 y/o or with comorbidity; What are pathogens

Back 83

A083. S. pneumoniae; H. flu; E. coli; Enterobacter; Klebsiella; S. aureus; Legionella; viruses

Front 84

Q084. Pneumonia - Outpt community-acq > 65 y/o or with comorbidity; What is init coverage

Back 84

A084. Require admission; cefuroxime (2nd gen cephalo); TMP-SMX; amoxicillin; if atypicals suspected - add erythromycin; if patient has obstructive disease - add pseudomonal coverage

Front 85

Q085. Pneumonia - Community-acq req. admission; What are pathogens

Back 85

A085. S. pneumoniae; H. flu; anaerobes; aerobic GNRs; Legionella; Chlamydia

Front 86

Q086. Pneumonia - Community-acq req. admission; What is init coverage

Back 86

A086. Cefotaxime or ceftriaxone (2nd or 3rd gen); or B-lactam with B-lactam inhib; if atypicals suspected - add erythomycin

Front 87

Q087. Pneumonia - Severe community-acquired, require ICU; What are pathogens

Back 87

A087. S. pneumoniae; H. flu; anaerobes; aerobic GNRs; Mycoplasma; Legionella; Pseudomonas

Front 88

Q088. Pneumonia - Severe community-acq req. ICU; What is init coverage

Back 88

A088. Erythromycin – macrolide; and antipseudomonal agent; and aminoglycoside

Front 89

Q089. Nosocomial pneumonia - (hospitalized > 48 hrs or in long- term care fac. > 14 days); What are pathogens

Back 89

A089. E. coli; Enterobacter; Klebsiella; Pseudomonas; S. aureus; Legionella; mixed flora

Front 90

Q090. Nosocomial pneumonia - (hospitalized > 48 hrs or in long- term care fac. > 14 days); What is init coverage

Back 90

A090. 3rd gen cephalosporin with anti-pseudomonal activity and gentamicin

Front 91

Q091. Pneumonia - Who gets pneumococcal vaccine

Back 91

A091. > 65 y/o; any serious lung, cardiac, liver, renal disease; immunocompromised; splenectomized; sickle cell; DM; leukemia; lymphoma; 60-70% effective, redose in 5 years if - severe immunocompromised, original vaccine at < 65 y/o

Front 92

Q092. Tuberculosis - What is it

Back 92

A092. Mycobacterium tuberculosis; most cases of symptomatic TB - reactivation of old infection, remain confined to lung; common cause of FUO; MC site of Extrapulmonary infection - lymph nodes (adenitis); most significant defect associated with reactivation - impaired T cell- mediated cellular immunity; risk factors – immunosuppression, alcoholism, preexisting lung disease, immigrants from developing nations, DM, advancing age, homelessness, malnourishment, crowded living conditions, prisoners, nursing home residents, health care workers, sick contacts

Front 93

Q093. Tuberculosis - Hx/PE

Back 93

A093. Cough; hemoptysis; weight loss; night sweats; dyspnea; fever; cachexia; hypoxia; tachy; lymphadenopathy; abnormal lung sounds; (positive Babinski - when affects spine)

Front 94

Q094. Tuberculosis - Dx

Back 94

A094. CXR - best init test; AFB stain - allows for specific Dx, need 3 negative for >90% sensitivity; Culture - the most specific, need for sensitivity testing; pleural Biopsy - most sensitive test; if AFB stain unrevealing – thoracentesis, gastric aspirate (kids); Biopsy (extrapulmonary organ), needle aspiration (extrapulmonary); LP (if meningitis)

Front 95

Q095. Tuberculosis - PPD test

Back 95

A095. Length of induration measured at 48-72 hrs. BCG vaccine- PPD positive for 1 yr; 2-stage testing - no recent PPD test, have reactivity < 10mm, 2nd test within 2 weeks; Positive results indicated by - 5 mm – HIV, close TB contacts, steroid use, organ transplant recipient, abnorm CXR - old, healed TB; 10 mm – homeless, recent immigrant, IVDU, chronic illness, residents of health & correctional institutions, healthcare workers, immunocompromised other than in "5mm" group; 15 mm - everybody else; if positive PPD - get CXR, abnormal CXR - get 3 AFB; if positive AFB - Tx; if negative AFB - latent TB, INH and B6 for 9 months ("prophylaxis"); if positive PPD - get CXR, normal CXR - latent TB, INH and B6 for 9 months ("prophylaxis")

Front 96

Q096. Tuberculosis - Tx

Back 96

A096. All cases reported to local & state health depatients; respiratory isolation; Directly Observed Therapy - rifampin (RIF), ethambutol (ETB), pyrazinamide (PZA), INH & B6 for 2 months (until know sensitivity); ETB & PZA discontinued, cont. RIF & INH for 4 more months; if sensitivity not known - give ETB; TB meningitis - Tx 12 months, TB meds and steroids; TB pericarditis - TB meds and steroids; TB in pregnancy - Tx 9 months; TB in osteomyelitis & HIV - Tx 6-9 months; pregnant - no pyrazinamide, no streptomycin; all but streptomycin => liver toxicity; RIF - stains contacts and underwear; ETB - optic neuritis => color blind; PZA - benign hyperuricemia, don't Tx unless gout Symptoms

Front 97

Q097. Fever of Unknown Origin (FUO)- What is it; MCC; Risk factors

Back 97

A097. Temp > 38.3 for 3 weeks, undx after 3 outpt visits or 3 days of hospitalization; MCC - infections & cancer, autoimmune disease (15%); Risk factors - recent travel, immune deficiency, drug abuse

Front 98

Q098. Fever of Unknown Origin (FUO)- Hx/PE

Back 98

A098. Fever; headache; myalgia; malaise

Front 99

Q099. Fever of Unknown Origin (FUO)- Dx

Back 99

A099. CBC with diff; BC; ESR; CXR; PPD; CT & MRI - if malig or abscess suspected; specific tests if infectious or autoimmune suspected

Front 100

Q100. Fever of Unknown Origin (FUO)- Tx

Back 100

A100. If severely ill - empiric broad-spectrum Antibiotics; stop if no response

Front 101

Q101. Neutropenic Fever - What is it

Back 101

A101. One oral temp of 38.3 or 38.0 > 1 hour in neutropenic patient; 38.3 C = 101 F; 38.0 C = 100.4 F

Front 102

Q102. Neutropenic Fever - Hx/PE

Back 102

A102. Common in patients undergoing chemo; ANC nadir 7-10 days post chemo; if severely neutropenic - inflammation may be min. or 0; pain at MC infected sites – skin, eye, peridontium, pharynx, lungs, lower esoph, abdomen, perineum, anus

Front 103

Q103. Neutropenic Fever - Dx

Back 103

A103. Thorough PE; NEVER do rectal exam; CBC with diff; BC; BUN/Cr; transaminases; CXR - if resp signs; CT - to check for abscess

Front 104

Q104. Neutropenic Fever - Tx

Back 104

A104. Empiric Antibiotics; Tx algorithm

Front 105

Q105. Congenital Infections - Common sequelae

Back 105

A105. Can occur at any time during, pregnancy, labor, delivery; common sequelae - premature delivery, CNS abnorm, jaundice, anemia, hepatosplenomegaly, growth retardation

Front 106

Q106. Congenital Infections - What are they; (mnemonic)

Back 106

A106. TORCHeS; Toxoplasmosis; Other; Rubella; CMV; Herpes; Syphilis

Front 107

Q107. Congenital Infections - Toxoplasmosis; How transmitted; Specific findings

Back 107

A107. Transplacental - rare; primary infection - consumption of raw meat - undercooked pork & lamb, contact with cat feces; Specific findings - intracranial calcifications, chorioretinitis, hydrocephalus, ring-enhancing lesions on Head CT; immunocompetent - usually asymp; best diagnostic test - visualize parasite in tissue or fluid; MC - serology

Front 108

Q108. Congenital Infections - Other (TORCHeS); What are they

Back 108

A108. HIV; parvovirus; Varicella; Listeria; TB; malaria; fungi

Front 109

Q109. Congenital Infections - Rubella; How transmitted; specific findings

Back 109

A109. Transplacental transmission in 1st trimester; Specific findings - rubella; purpuric blueberry muffin Rash; PDA; Cataracts; Deafness; Mental retardation; Microcephaly

Front 110

Q110. Congenital Infections - CMV; How transmitted; specific findings

Back 110

A110. CMv is MC congenital infection; transplacental transmission; Specific findings - petechial rash, periventricular calcifications

Front 111

Q111. Congenital Infections - Herpes; How transmitted; specific findings

Back 111

A111. Intrapartum transmission if mom has active lesions; Specific findings - skin, eye and mouth infections, life- threatening CNS/systemic infection

Front 112

Q112. Congenital Infections - Syphilis; How transmitted; specific findings

Back 112

A112. Intrapartum transmission; Specific findings - maculopapular skin rash, lymphadenopathy, hepatomegaly, "snuffles" - mucopur rhinitis, osteitis; In childhood, late congen - saber shins, saddle nose, CNS involvement; Hutchinson's triad - peg-shape upr central incisors, deafness, interstitial keratitis (photophobia, lacrimation)

Front 113

Q113. Congenital Infections - Dx

Back 113

A113. Serologic testing – rubella, toxoplasmosis, HSV; UC - CMV; syphilis - dark field exam - skin lesions, material serum, test cord blood for increased IgM; viral isolation; amniocentesis - PCR for CMV, antigen detection; all ill newborns – BC, LP, empiric Antibiotics

Front 114

Q114. Congenital Infections - Toxoplasmosis; Tx

Back 114

A114. Pyrimethamine; sulfadiazine; spiramycin (if 3rd trimester)

Front 115

Q115. Congenital Infections - Syphilis; Tx

Back 115

A115. PCN

Front 116

Q116. Congenital Infections - HSV; Tx

Back 116

A116. Acyclovir

Front 117

Q117. Congenital Infections - CMV; Tx

Back 117

A117. Ganciclovir

Front 118

Q118. Congenital Infections - Toxoplasmosis; Prevention

Back 118

A118. Avoid exposure to cats & cat feces during pregnancy; women with primary infection - pyrimethamine and sulfadiazine in third trimester - spiramycin

Front 119

Q119. Congenital Infections - Rubella; Prevention

Back 119

A119. Immunize before pregnancy; consider abortion if infected or exposed; vaccinate mom after delivery if titers remain negative

Front 120

Q120. Congenital Infections - Syphilis; Prevention

Back 120

A120. PCN in pregnant women who test positive

Front 121

Q121. Congenital Infections - CMV; Prevention

Back 121

A121. Avoid exposure

Front 122

Q122. Congenital Infections - HSV; Prevention

Back 122

A122. C-section if lesions present at delivery

Front 123

Q123. Congenital Infections - HIV; Prevention

Back 123

A123. AZT - pregnant with HIV; C-section; AZT prophylaxis - infant; no breast-feeding

Front 124

Q124. Osteomyelitis - What is it

Back 124

A124. Three types:; acute hematogenous – kids, long bones of lower extremities, MC - staph; secondary to contig infection - recent trauma, placement of prosthesis, MC – polymicrobial, MC single organism - staph; vascular insufficiency - >50 y/o, DM or PVD, repeated minor trauma, not noticed cuz of neuropathy, small bones of lower extremity, MC – polymicrobial, MC single organism - staph

Front 125

Q125. Osteomyelitis - Common Pathogens

Back 125

A125. Most people - staph; IVDU - staph or pseudomonas; SCD - salmonella; hip replaced - s. epidermidis; foot puncture wound - pseudomonas; chronic - staph, pseudomonas, enterobacter

Front 126

Q126. Osteomyelitis - Hx/PE

Back 126

A126. Fever; localized bone pain; localized warmth, tenderness, swelling, erythema; limited ROM

Front 127

Q127. Osteomyelitis - Dx

Back 127

A127. XR - initial test, periosteal elevation - 1st abnorm; technetium bone scan; MRI - better differentiation; ESR – nonspecific, can follow during Tx; Biopsy and Cx - best diagnostic, most invasive

Front 128

Q128. Osteomyelitis - Tx

Back 128

A128. Depends on isolate; oxacillin/nafcillin and aminoglycoside or 3rd gen ceph until specific Dx; chronic - 12 weeks of IV therapy, then 8-12 weeks orally

Front 129

Q129. Osteomyelitis - Complications

Back 129

A129. Chronic osteomyelitis; soft tissue infection; sepsis; septic arthritis; chronic osteomyelitis with draining sinus tract => squamous cell ca (Marjolin's ulcer)

Front 130

Q130. HIV - What is it; Risk factors

Back 130

A130. Retrovirus; targets and destroys CD4+; CD4+ count = marker for extent of disease progression; viral load = indicates rate; Risk factors - MC risk – IV drug user, 2nd MC risk – homosexuality, unprotected sex, maternal HIV infection, needle sticks, mucocutaneous exposure, receipt of blood products

Front 131

Q131. HIV - Hx/PE

Back 131

A131. Primary infection often asymp; may present with flu-like Symptoms; Later - night sweats, weight loss, thrush, cachexia; complications correlate with CD4+ count

Front 132

Q132. HIV - Dx

Back 132

A132. ELISA - high sensitivity, moderate specificity, detects anti- HIV ab, can take up to 6 months to appear after exposure; Western blot – confirmatory, low sensitivity, high specificity; viral load; PPD with anergy panel; VDRL; CMV serology; toxoplasmosis serology

Front 133

Q133. HIV - Tx; Tx During Pregnancy; Tx for Needlesticks

Back 133

A133. Start when - CD4+ <350 or viral load >55,000 (PCR-RNA); 1) 2 reverse transcriptase inhibitors + protease inhibibtor; 2) 2 reverse transcriptase + 2 protease inhibitor; 3) 2 reverse transcriptase + efavirenz. adequate Tx - viral load decreased 50% in 1st month PREGNANCY:; if low CD4+ or high load - 3x's antiretrovirals as nonpregnant patient; C-section - only if CD4+ & viral load not controlled; all get AZT, start AZT by 14th week; AZT => transient anemia; no efavirenz - teratogen; Postexposure Prophylaxis (Needlestick) - AZT + lamivudine + nelfinavir for 4 weeks

Front 134

Q134. HIV - PCP; CD4+ Level at Presentation; Tx

Back 134

A134. CD4+ <200; TMP-SMX; pentamidine; steroids - if severe; prophylaxis - TMP-SMX - orally, #1; dapsone - #2; atovaquone -#3; pyrimethamine - aerolized, #4; prophylaxis may be discontinued if antivirals raise CD4 >200 for more than 6 months

Front 135

Q135. HIV - Mycobacterium Avium Complex; CD4+ Level at Presentation; Tx

Back 135

A135. CD4+ <50; clarithromycin and ethambutol; prophylaxis - azithromycin - orally once a week; or clarithromycin BID; rifabutin - alternative; prophylaxis can be stopped if antiretrovirals raise CD4 >100 for several months

Front 136

Q136. HIV - Toxoplasma; CD4+ Level at Presentation; Tx

Back 136

A136. CD4+ <100; pyrimethamine and sulfadiazine (clindamycin is substitute for sulfadiazine if sulfa-allergy); prophylaxis - TMP-SMX, dapsone/pyrimethamine

Front 137

Q137. HIV - TB; Indication for prophylaxis; Medication

Back 137

A137. PPD > 5mm; INH x 9 months or rifampin + pyrazinamide or rifabutin + pyrazinamide

Front 138

Q138. HIV - Candida; Indication for prophylaxis; Medication

Back 138

A138. Multiple recurrences; Fluconazole or itraconazole

Front 139

Q139. HIV - HSV; Indication for prophylaxis; Medication

Back 139

A139. Multiple recurrences; Acyclovir or; famciclovir or; valacyclovir

Front 140

Q140. HIV - Pneumococcus; Indication for prophylaxis; Medication

Back 140

A140. All patients; Pneumovax

Front 141

Q141. HIV - Influenza; Indication for prophylaxis; Medication

Back 141

A141. All patients; Influenza vaccine

Front 142

Q142. Otitis Externa - What is it; Common etiologic agents

Back 142

A142. "Swimmer's ear"; inflammation of skin lining ear canal and surrounding soft tissue from moisture => maceration of skin; breeding ground for bacteria; from trauma - usually from objects for cleaning; Pseudomonas; Enterobacteriaceae

Front 143

Q143. Otitis Externa - Hx/PE

Back 143

A143. Pain; pruritus; possible purulent discharge; pain with movement of tragus/pinna; edematous, eryth ear canal

Front 144

Q144. Otitis Externa - Dx

Back 144

A144. Clinical; gram stain & culture if suspect fungal; CT if patient looks toxic

Front 145

Q145. Otitis Externa - Tx

Back 145

A145. Eardrops - polymyxin B, neomycin, hydrocortisone; acute - dicloxacillin; DM - at risk for malignant OE, at risk for osteomyelitis of skull bone, admit, IV Antibiotics

Front 146

Q146. Encephalitis - What is it

Back 146

A146. Inflammation of the brain; meninges and parenchyma; MCC - viral infection; MC virus - HSV

Front 147

Q147. Encephalitis - Hx

Back 147

A147. Can have any level of neuro deficit; any level of focal deficit; 1st clue - altered mental status, fever, headache, nuchal rigidity, mild lethargy, confusion, stupor, coma

Front 148

Q148. Encephalitis - PE

Back 148

A148. Focal neuro signs - hemiparesis; focal seizures; autonomic dysfunction; increased ICP; SIADH

Front 149

Q149. Encephalitis - Dx

Back 149

A149. CT or MRI; HSV affects temporal lobe; LP - key to Dx; PCR - eliminates need for Biopsy

Front 150

Q150. Encephalitis - Tx

Back 150

A150. HSV - immediate IV acyclovir; CMV - ganciclovir or foscarnet; HIV - if suspect resistant HSV, foscarnet

Front 151

Q151. Meningitis - Hx/PE

Back 151

A151. Fever; malaise; headache; neck stiffness; photophobia; altered mental status; seizures; MC focal neuro deficits - visual fields; MC long-term damage - CN8; signs of meningeal irritation- Kernig and Brudzinski, often absent in < 2 y/o

Front 152

Q152. Meningitis - Dx

Back 152

A152. LP - to establish Dx; CSF Culture - most accurate test, cell count & differential - most useful; CT best initial test if – papilledema, focal motor deficits, severe abnorm in mental status; give ceftriaxone prior if 20-30 min. delay in LP; best init step - ceftriaxone or cefotaxime, add ampicillin if suspect Listeria

Front 153

Q153. Meningitis - Tx

Back 153

A153. Empiric - ceftriaxone or cefotaxime; Listeria - add ampicillin; Staph after surgery - vanco; PCN resistant - vanco; Lyme - ceftriaxone; Syphllis - PCN; TB - steroids (adults); viral - no proven useful Tx; cryptococcus - amphotericin, then lifelong fluconazole if also HIV positive contacts of patients with meningococcal meningitis - rifampin prophylaxis

Front 154

Q154. Meningitis - Complications; Tx

Back 154

A154. Hyponatremia - admin fluids, monitor sodium concentration; Seizures – benzos, phenytoin; Subdural effusions - may be seen on CT; 50% of infants with H. influenzae meningitis, no Tx necessary; Cerebral edema - presents with loss of oculocephalic reflex, IV mannitol; Subdural empyema - presents as intractable Seizures, surgical evacuation; Brain abscess - surgical drainage; Ventriculitis - presents as: worsening clinical pic, yet improved CSF findings, need ventriculostomy, possibly intraventricular Antibioticss

Front 155

Q155. Sinusitis - What is it; Risk factors

Back 155

A155. Infection of sinuses due to undrained collection of pus; MC infected - maxillary; Risk factors – barotraumas, allergic rhinitis, viral infection, asthma, smoking, nasal decongestant overuse

Front 156

Q156. Sinusitis - Acute sinusitis; Definition; MC associations

Back 156

A156. Symptoms last < 1 month; MC associated with - S. pneumonia, H. influenza, Moraxella catarrhalis, viral infection

Front 157

Q157. Sinusitis - Chronic sinusitis; Definition

Back 157

A157. Symptoms persist > 3 months; often ongoing low-grade anaerobic infections; DM - mucormycosis can start in nose and maxillary sinuses

Front 158

Q158. Sinusitis - Hx/PE

Back 158

A158. Fever; facial pain can radiate to upper teeth; nasal congestion; headache, headache worse when lean forward; tenderness, erythema, swelling over affected area; purulent discharge; in chronic - pain may be absent; febrile ICU patients - may have occult sinusitis, especially if intubated or have NGT

Front 159

Q159. Sinusitis - Dx

Back 159

A159. Obvious cases - no XR before Tx; maxillary sinus XR - best init test, air-fluid levels, opacification; coronal CT - greater detail; sinus puncture - if don't respond to Tx, frequent recurrences, confirms bacteria

Front 160

Q160. Sinusitis - Tx

Back 160

A160. Mild or acute uncomplicated – decongestant (oral pseudoephedrine or ozymetazoline spray); severe pain & discolored discharge - amoxicillin - best initial; amoxicillin-clavulanate - if recent amoxicillin use or don't respond, or 2nd or 3rd ceph OK to use

Front 161

Q161. Sinusitis - Complications

Back 161

A161. Osteomyelitis of frontal bone; meningitis; orbital cellulitis; cavernous sinus thrombosis; abscess of epidural or subdural spaces

Front 162

Q162. Acute Pharyngitis - What is it; Etiologies

Back 162

A162. Usually self-limited; must differentiate strep from other causes; MC - viral causes; Grp A B-hemolytic strep; Grp C B-hemolytic strep; N. gonorrhoeae, C. diphtheria,M. pneumonia, rhinovirus, coronavirus, adenovirus, HSV, EBV, CMV, influenza, coxsackie

Front 163

Q163. Acute Pharyngitis - Hx/PE

Back 163

A163. Typical of strep - sudden-onset sore throat; pharyngeal erythema; fever; ant. cervical lymphadenopathy; soft palate petechiae; headache; vomiting; scarlatiniform rash; tonsillar exudate - EBV can give exudate, mild S. pyogenes may not

Front 164

Q164. Acute Pharyngitis - Dx

Back 164

A164. Clinical; rapid group A strep Ag detect; throat culture; positive rapid group A strep Ag - equivalent to positive Cx; negative test - confirm with Cx

Front 165

Q165. Acute Pharyngitis - Tx

Back 165

A165. Reduce symptoms - fluids; rest; antipyretics; salt-water gargles; PCN V po x 10 days or PCN G benzathine M x 1 dose; if allergic to PCN – macrolides, oral 2nd gen cephalosporins

Front 166

Q166. Acute Pharyngitis - Complications

Back 166

A166. Nonsuppurative - acute rheumatic fever, poststrep glomerulonephritis; suppurative - cervical lymphadenitis, mastoiditis, sinusitis, otitis media, retropharyngeal or peritonsillar abscess; peritonsillar abscess – odynophagia, trismus (lockjaw), muffled voice, unilateral tonsil enlargement, erythema, uvula & soft palate deviate away; intraoral US or CT; Culture abscess fluid; Drain; PCN or erythromycin; elective tonsillectomy later

Front 167

Q167. Lymphogranuloma Venereum - What is it

Back 167

A167. Contagious STD; Chlamydia trachomatis

Front 168

Q168. Lymphogranuloma Venereum - Hx/PE

Back 168

A168. Lesion ulcerates & heals; unilateral inguinal lymph nodes enlarge => draining buboes; scar formation; fever; joint pains; headache

Front 169

Q169. Lymphogranuloma Venereum - Dx

Back 169

A169. Clinical exam and Hx; high or increased Ab titer; isolate Chlamydia from bubo pus

Front 170

Q170. Lymphogranuloma Venereum - Tx

Back 170

A170. Doxycycline; erythromycin - alternative

Front 171

Q171. Chancroid - What is it

Back 171

A171. Haemophilus ducreyi; gram negative rod

Front 172

Q172. Chancroid - Hx/PE

Back 172

A172. Small, soft, painful papules; become shallow ulcers; have ragged edges; vary in size & coalesce; inguinal lymph nodes enlarge

Front 173

Q173. Chancroid - Dx

Back 173

A173. Clinical; gram stain with Cx to confirm; PCR

Front 174

Q174. Chancroid - Tx

Back 174

A174. Azithromycin single dose; or ceftriaxone 250 IM one dose; erythromycin x7D (alternative); cipro x3D (alternative)

Front 175

Q175. Genital Herpes - What is it

Back 175

A175. HSV-2 (85%); HSV-1 can be seen

Front 176

Q176. Genital Herpes - Hx/PE

Back 176

A176. Vesicles erode; painful, circular; with red areola; can have inguinal lymphadenopathy; relapses

Front 177

Q177. Genital Herpes - Dx

Back 177

A177. Tzanck smear and Cx

Front 178

Q178. Genital Herpes - Tx

Back 178

A178. Acyclovir; famciclovir or; valacyclovir

Front 179

Q179. Granuloma Inguinale - What is it

Back 179

A179. Chronic granulomas; spread by sexual contact; Donovania granulomatis; Calymmatobacterium granulomatis

Front 180

Q180. Granuloma Inguinale - Hx/PE

Back 180

A180. Painless, red nodule; develops into elevated granuloma; heals slow; scars form

Front 181

Q181. Granuloma Inguinale - Dx

Back 181

A181. Giemsa or Wright stain; Donovan bodies - confirm; punch Biopsy

Front 182

Q182. Granuloma Inguinale - Tx

Back 182

A182. Doxycycline or TMP/SMZ; erythromycin (alternative)

Front 183

Q183. Genital Warts - What are they

Back 183

A183. HPV 6 & 11

Front 184

Q184. Genital Warts - Hx/PE

Back 184

A184. Soft, moist, pink or red; grow fast; cauliflower appearance; condylomata acuminata

Front 185

Q185. Genital Warts - Dx

Back 185

A185. Clinical; must differentiate between - warts and c. lata of syphilis

Front 186

Q186. Genital Warts - Tx

Back 186

A186. Remove - curettage; sclerotherapy; trichloroacetic acid; cryotherapy; podophyllin; laser; imiquimod (immune stimulant)

Front 187

Q187. Perinephric Abscess - What is it; Causes

Back 187

A187. Not common; pyelonephritis => abscess, rupture into perinephric space; caused by - any factor predisposing to pyelonephritis, stones - #1, structural abnorm, trauma, recent surgery, DM; "SEEKS PP" pathogens; MC - E. coli, then Klebsiella, Proteus, S. aureus - hematogenous

Front 188

Q188. Perinephric Abscess - Hx/PE

Back 188

A188. Insidious; 2-3 weeks of Symptoms before 1st visit; fever; flank pain; abdom pain; palpable abdom mass; persistence of pyelonephritic Symptoms even the Tx for pyelonephritis

Front 189

Q189. Perinephric Abscess - Dx

Back 189

A189. UA/UC - initial tests; fever, pyuria & negative UC or polymicrobial UC - suggestive; US - best initial scan; CT or MRI - better imaging; Biopsy - necessary for definitive bacterial Dx

Front 190

Q190. Perinephric Abscess - Tx

Back 190

A190. Antibiotics for gram negative rods - ex. - 3rd gen ceph; drainage (usually percutaneous); antipseudomonal PCN: ticarcillin/clavulanate, often with aminoglycoside

Front 191

Q191. Brain Abscess - What is it

Back 191

A191. Bacteria spread from contiguous infections - dental infections, otitis media, mastoiditis, sinusitis; spread hematogenously – endocarditis, pneumonia; Toxoplasmosis can reactivate if CD4 <100; MC have Strep, then Bacteroides, Enterobacteriae, Staph, polymicrobial

Front 192

Q192. Brain Abscess - Hx/PE

Back 192

A192. MC Sx - headache; fever; focal neuro; seizures

Front 193

Q193. Brain Abscess - Dx

Back 193

A193. CT with contrast - init test; MRI - more accurate; bacteria - Biopsy for gram stain and Cx

Front 194

Q194. Brain Abscess - Tx

Back 194

A194. HIV - 90% Toxo or lymphoma; empiric Tx to establish Dx; if respond to sulfadiazine and pyrimethamine, continue Tx; Other Tx - based on etiology

Front 195

Q195. Bronchitis - What is it

Back 195

A195. Infection limited to bronchial tree; Caused by - S. pneumonia, H. influenza, Moraxella, viruses; MC causative factor - cigarettes; acute and chronic form; chronic can => COPD

Front 196

Q196. Bronchitis - Hx/PE

Back 196

A196. Cough; sputum; discolored sputum = bacteria; may have low-grade fever; most are afebrile

Front 197

Q197. Bronchitis - Dx

Back 197

A197. Clinical; CXR - 1st test; normal CXR confirms!

Front 198

Q198. Bronchitis - Tx

Back 198

A198. Mild - no Tx needed, usually from virus, resolves spontaneously; severe - amoxicillin, doxycycline or TMP-SMZ; repeated infection or not responding - amoxicillin/clavulanate, clarithromycin, azithromycin, oral 2nd or 3rd gen cephalo or new fluoroquinolones

Front 199

Q199. Lung Abscess - What is it

Back 199

A199. Necrosis of pulmonary parenchyma; caused by bacterial infection; 90% - anaerobes involved; Staph, E. coli, Klebsiella; periodontal disease, predisposition to aspiration; noninfectious causes - pulmonary infarction, cancer, vasculitis (Wegener's)

Front 200

Q200. Lung Abscess - Hx/PE

Back 200

A200. Fever; cough; chest pain; foul-smelling sputum; chronic course

Front 201

Q201. Lung Abscess - Dx

Back 201

A201. CXR; CT; Biopsy - for specific bacterial Dx; sputum for gram stain & Cx - will NOT show causative organism; common sites of aspiration - lower lobes - if upright; posterior segment of right upper lobe - if supine

Front 202

Q202. Lung Abscess - Tx

Back 202

A202. Clindamycin - empiric; PCN - alternate empiric

Front 203

Q203. Impetigo - What is it

Back 203

A203. Skin infection; mainly kids; S. pyogenes, S. aureus (bullous); untreated => lymphangitis, a. glomerulonephritis, cellulitis, furunculosis

Front 204

Q204. Impetigo - Hx/PE

Back 204

A204. Superficial, pustular oozing, crusting, draining of lesions; common on - arms, legs, face; may follow trauma to skin; maculopapular => vesicles

Front 205

Q205. Impetigo - Tx

Back 205

A205. Oral 1st gen ceph or ox-, clox-, or dicloxacillin; mild - topical mupirocin or bacitracin; PCN-allergy - macrolide

Front 206

Q206. Erysipelas - What is it

Back 206

A206. Superficial cellulitis; S. pyogenes

Front 207

Q207. Erysipelas - Hx/PE

Back 207

A207. Bilateral shiny, red, edematous; face, arms, legs

Front 208

Q208. Erysipelas - Tx

Back 208

A208. If can't tell from cellulitis- 1st gen cephalosporin, oxa-, cloxa, dicloxacillin; if sure, Strep - PCN

Front 209

Q209. Tinea Versicolor - What is it

Back 209

A209. Skin infection; Malassezia furfur (Pityrosporum orbiculare)

Front 210

Q210. Tinea Versicolor - Hx/PE

Back 210

A210. Tan, brown, white lesions; may coalesce; on chest, neck, abdomen, face; lesions do not tan

Front 211

Q211. Tinea Versicolor - Tx

Back 211

A211. Topical selenium sulfide,; ketoconazole,; oral itraconazole

Front 212

Q212. Scabies - What is it

Back 212

A212. Parasitic skin infection; Sarcoptes scabiei (itch mite); transmitted skin-to-skin contact

Front 213

Q213. Scabies - Hx/PE

Back 213

A213. Digs into skin at skin folds; burrows; pruritis; flexor surfaces of - wrists; finger webs; axillary folds; areola (women); genitals (men)

Front 214

Q214. Scabies - Dx

Back 214

A214. See in scrapings (mineral oil)

Front 215

Q215. Scabies - Tx

Back 215

A215. Permethrin; lindane (Kwell)

Front 216

Q216. Pediculosis - What is it

Back 216

A216. Skin infestation by lice; Head - pediculus humanus capitis; Body - pediculus humanus corporis

Front 217

Q217. Pediculosis - Hx/PE

Back 217

A217. Itching; excoriation; secondary bacterial infections

Front 218

Q218. Pediculosis - Dx

Back 218

A218. Direct exam of hair-bearing surfaces

Front 219

Q219. Pediculosis - Tx

Back 219

A219. Permethrin; lindane (Kwell)

Front 220

Q220. Molluscum Contagiosum - What is it

Back 220

A220. Skin-colored, waxy, umbilicated papule; poxvirus

Front 221

Q221. Molluscum Contagiosum - Hx/PE

Back 221

A221. Small papules; central umbilication; anywhere on skin; asymptomatic; adults - usually by venereal contact, genitals, pubic area

Front 222

Q222. Molluscum Contagiosum - Dx

Back 222

A222. Appearance; giemsa stain - large cells with inclusion bodies

Front 223

Q223. Molluscum Contagiosum - Tx

Back 223

A223. Freezing; curettage; electrocautery; cantharidin

Front 224

Q224. Gas Gangrene; (Clostridial Myonecrosis) - What is it

Back 224

A224. Wounds contaminated by Clostridium perfringens; not common, increased in wartime; trauma (50%): shrapnel, MVA, postop; nontraumatic: uterine gangrene - was complication of improper abortion

Front 225

Q225. Gas Gangrene; (Clostridial Myonecrosis) - Hx/PE

Back 225

A225. <1-4 days of incubation - pain, edema => hypotension; tachycardia; fever; crepitation; renal failure

Front 226

Q226. Gas Gangrene; (Clostridial Myonecrosis) - Dx

Back 226

A226. Gram stain - positive rods, no WBC; Culture - not diagnostic; gas bubbles on XR - not diagnostic. diagnostic - direct visualization; pale, dead muscle; brown, sweet-smelling discharge

Front 227

Q227. Gas Gangrene; (Clostridial Myonecrosis) - Tx

Back 227

A227. High-dose PCN; PCN-allergy - clindamycin; surgical debridement or amputation; hyperbaric O2 - controversial

Front 228

Q228. Septic Arthritis - What is it

Back 228

A228. Infection due to any agent; MC – bacterial, rickettsia, virus, spirochete; may also cause gonococcal and nongonococcal; nongonococcal - any previous damage to joint, OA, RA, previous surgery, prosthesis placement, IVDU, gout, sickle cell; gram positive - S. aureus (60%), Strep (15%); gram negative (15%); polymicrobial

Front 229

Q229. Septic Arthritis - Hx/PE

Back 229

A229. Gonococcal - polyarticular 50%, tenosynovitis, migratory polyarthralgia, petechiae & purpura; nongonococcal – monoarticular, swollen, tender, erythematous, decreased ROM, usually knee

Front 230

Q230. Septic Arthritis - Dx

Back 230

A230. gonococcal - hard to Culture, Culture sites other than knee - greater yield; nongonococcal - synovial fluid aspiration: Cx, gram stain, cell count – high, mainly PMN, low glucose

Front 231

Q231. Septic Arthritis - Tx

Back 231

A231. gonococcal - ceftriaxone; nongonoccocal - good empiric - staph/strep & gram- negative drug, nafcillin or oxacillin & aminoglycoside or 3rd gen ceph

Front 232

Q232. Myocarditis - What is it

Back 232

A232. Associated with every group of infectious agent; MC - Coxsackie B; also noninfectious – radiation, drugs, collagen vascular disease, hyperthyroidism

Front 233

Q233. Myocarditis - Hx/PE

Back 233

A233. Any presentation possible; MC - dyspnea & fatigue; can be asymp, subclinical, or rapid progression to death; PE - normal or S3 and murmurs

Front 234

Q234. Myocarditis - Dx

Back 234

A234. Any EKG abnormality; MC - ST-T changes; any type of heart block possible; cardiac enzymes may be increased; Ab titers may be increased; viruses may be isolated – stool, saliva; NPA; endomyocardial Biopsy - best diagnostic test

Front 235

Q235. Myocarditis - Tx

Back 235

A235. Viral - supportive; most spontan resolve; no steroids (damaging); other Tx depends on agent

Front 236

Q236. MCC of UTI; MC with GU instruments?

Back 236

A236. MCC: E. coli; MC with GU instruments: Pseudomonas

Front 237

Q237. UTI with Alkaline urine is suggestive of which bug?

Back 237

A237. Proteus

Front 238

Q238. (2) MC bugs for Urethritis

Back 238

A238. Chlamydia; Gonorrhea

Front 239

Q239. What meds (2) can be given to a pregnant woman with bacteriuria?

Back 239

A239. Nitrofurantoin; Ampicillin

Front 240

Q240. DOC for non-pregnant uncomplicated Cystitis and UTI; Tx for how many days?; What bug does it not work on?

Back 240

A240. TMP-SMX (Bactrim), 3 - 5 days; Does not work on: Pseudomonas

Front 241

Q241. DOC for Pseudomonas pyelonephritis, cystitis and UTI; Tx for how many days for pyelonephritis?

Back 241

A241. FQ (Cipro); Pyelonephritis: 7 - 14 days

Front 242

Q242. Difference b/t discharge of Chlamydia and Gonorrhea

Back 242

A242. Chlamydia: Non-purulent discharge; Gonorrhea: Purulent dischange

Front 243

Q243. DOC for; 1. Chlamydia; 2. Gonorrhea

Back 243

A243. Chlamydia: 1g Azithromycin PO (one dose); Gonorrhea: 125mg Ceftriaxone IM (one dose)

Front 244

Q244. What protects the vagina by providing it with an acidic environment (also used to make yogurt)?

Back 244

A244. A Yoplait a day keeps the Vaginitis away: Lactobacilli

Front 245

Q245. What is the "whiff" test?; What (2) bugs does it work with?

Back 245

A245. Whiff test: applying KOH to wetmount, causing enhancement of odor for: Gardnerella; Trichomonas

Front 246

Q246. DOC for Pregnant patient with vaginitis

Back 246

A246. Clotrimazole

Front 247

Q247. What should patient on Metronidazole be warned about ingesting while on the drug?

Back 247

A247. Alcohol: can cause Disulfuram-like effects

Front 248

Q248. Dx:; possible vaginal itch and burning, abnormal fishy odor; What is seen on wet mount?; Tx?

Back 248

A248. Gardnerella ("Bacterial Vaginosis"); wet mount: Clue cells (epithelial cells with bacteria); Tx: Metronidazole

Front 249

Q249. Dx:; vaginal itch and burning; rancid fish odor; green, frothy discharge; Strawberry cervix; What is seen on wet mount?; Tx?

Back 249

A249. Trichomonas; Wet mount: Motile Trichomonads; Tx: Metronidazole

Front 250

Q250. Dx:; vaginal itch and burning; cheese-like discharge; no odor; What is seen on wet mount?; Tx?

Back 250

A250. Candida Albicans ("Yeast infection"); Wet mount: Pseudohyphae; Tx: Fluconazole (Nystatin)

Front 251

Q251. On exam, how can you tell a syphillitic pupil?

Back 251

A251. Like a Prostatute:; It accomodates, but doesn't react

Front 252

Q252. Describe the (4) stages of Syphillis

Back 252

A252. Primary: Painless chancre; Bubo LN; Secondary: Rash on palms and soles; Condylomata Lata; Latent stage (asymptomatic); Tertiary: Gummas in CNS, heart, aorta; Tabes dorsalis; Argyll Robertson pupil

Front 253

Q253. Bug name of Syphillis; What common test does it not show-up on?; What test is used?

Back 253

A253. Treponema Pallidum; Does not grow on Blood culture; Darfield Microscopy - will see Spirochetes

Front 254

Q254. DOC for Syphillis

Back 254

A254. Penicillin G

Front 255

Q255. Definition:; inflammation of the glans penis; (2) causes and Tx for each

Back 255

A255. Balanitis Causes:; 1. Candida - Tx with Nystatin; 2. Reiter's syndrome - Tx with NSAIDs

Front 256

Q256. What should patients with balanitis be screened for?

Back 256

A256. Diabetes

Front 257

Q257. Dx:; painful vesicular lesions on erythematous base; local lymphadenopathy; Dx test?; Tx?

Back 257

A257. Herpes; Test: Tzanck smear and culture (also herpes serologies); Tx: Acyclovir

Front 258

Q258. (2) adverse effects of Acyclovir

Back 258

A258. Renal crystals;; Allergic Interstitial Nephritis

Front 259

Q259. What Dx can a mother with HPV cause in a child during delivery?

Back 259

A259. Laryngeal Papillomatosis

Front 260

Q260. What UTI bug is a predisposing factor for PID?

Back 260

A260. Chlamydia

Front 261

Q261. Dx:; Diabetic patient with a black necrotic parasinus lesion

Back 261

A261. Mucormycosis

Front 262

Q262. Dx:; man with perineal and suprapubic pain, dysuria and urinary frequency, fever, tender with rectal exam; (2) main causes; Tx? (2)

Back 262

A262. Bacterial Prostatitis; Causes: E. coli, Pseudomonas; Tx (for 21 days): TMP-SMX, Ciprofloxacin

Front 263

Q263. Pneumonia bug with "salmon pink" sputum and cavitary lesions; Tx?

Back 263

A263. S. Aureus; Tx: Beta-lactam Antibiotics

Front 264

Q264. Pneumonia bug with "buldging fissure" and "currant jelly"; Tx?

Back 264

A264. Klebsiella; Tx: Cephalosporin (+/- aminoglycosides)

Front 265

Q265. Dx:; 21-yo female complains of dry cough, malaise, and low- grade fevers for "2 weeks", has a CXR with hazy infiltrates

Back 265

A265. Mycoplasma Pneumonia

Front 266

Q266. Dx:; patient with confusion and diarrhea is found to have a large infiltrate on CXR with pleural effusions

Back 266

A266. Legionella

Front 267

Q267. WHat is the most common pneumonia with cystic fibrosis?

Back 267

A267. Pseudomonas

Front 268

Q268. Dx:; Respiratory infection with low fever, sore throat, N/V and causes a gray exudative pseudomembrane

Back 268

A268. Corynebacterium Diptheria

Front 269

Q269. Dx:; fever, rash, nausea, skin desquamatization, kidney and liver failure in women using tampons; Bug?

Back 269

A269. Toxic Shock Syndrome; (S. Aureus)

Front 270

Q270. Dx:; pharyngitis, strawberry tongue, rash that begins on trunk and spreads to extremities; Bug?

Back 270

A270. Scarlet fever; (S. pyogens)

Front 271

Q271. Dx:; HIV patient with dry cough for 1 week. No fever or chills. White count is normal.

Back 271

A271. Mycoplasma Pneumonia

Front 272

Q272. Cause of brain lesion in AIDS patient:; Ring-enhancing lesion with mass effect

Back 272

A272. Toxoplasmosis

Front 273

Q273. Cause of brain lesion in AIDS patient:; Periventricular ring

Back 273

A273. CMV

Front 274

Q274. Cause of brain problem in AIDS patient:; CNS lymphoma

Back 274

A274. EBV

Front 275

Q275. Cause of meningitis in AIDS patient:; Sensation of smell and behavior changes

Back 275

A275. Herpes; (Temporal lobe)

Front 276

Q276. Cause of meningitis in AIDS patient:; India ink stain with round organisms

Back 276

A276. Cryptococcus

Front 277

Q277. Dx:; 29-yo with HIV and CD-4 count of 100 has unexplained fever and elevated Alk-Phos.

Back 277

A277. Mycobacterium Avium Complex

Front 278

Q278. Dx:; HIV patient with painful, poorly healing perirectal lesion

Back 278

A278. Herpes

Front 279

Q279. Dx:; patient has fever, N/V and maculopapular rash on distal extremities that progresses to trunk; What can it cause?; Tx?

Back 279

A279. Rocky Mt Spotted Fever (Rickettsia); Causes: Myocarditis and heart block; Tx: Doxycycline

Front 280

Q280. Dx:; 42-yo man who recently camped in the woods of Vermont presents to ER with one-sided facial droop and a skin rash with central clearing; Tx?

Back 280

A280. Lyme Dz (B. Burgdorferi); Tx: Penicillin

Front 281

Q281. Dx:; fever, chills, myalgias, "hemolytic anemia" in patient who lives in Northeast or Midwest; Tx? (2)

Back 281

A281. Babesiosis; Tx: Quinine and Clindamycin

Front 282

Q282. Dx:; Tick or flea bite causing an ulcer at the bite site; Tx?

Back 282

A282. Tularemia; Tx: Gentamicin (or Tetracycline)

Front 283

Q283. Dx:; 40-yo patient recently returned from Kenya presents with body aches, malaise and fever. Labs show normal WBC, anemia and elevated LFT; Tx?

Back 283

A283. Malaria; Tx: Cloroquine

Front 284

Q284. When does antiretroviral therapy start for HIV?

Back 284

A284. CD4 count < 500

Front 285

Q285. what is the prophylaxis med and CD4-count start time in AIDS for:; PCP

Back 285

A285. med: TMP-SMX (or Dantrolene if pt is intolerant to TMP- SMX); CD4: < 200

Front 286

Q286. what is the prophylaxis med and CD4-count start time in AIDS for:; Mycobacterium Avium complex

Back 286

A286. med: Azithromycin (or Clarithromycin); CD4: < 100

Front 287

Q287. what is the prophylaxis med and CD4-count start time in AIDS for:; Cryptococcal and Candida infections

Back 287

A287. med: Fluconazole; CD4: < 100

Front 288

Q288. what is the only live vaccine able to be given to an HIV patient?

Back 288

A288. MMR

Front 289

Q289. What vaccines can you give to HIV patients?; (4)

Back 289

A289. 1. Hepatitis B; 2. Inactivated Polio vaccine (never oral polio vaccine); 3. Pneumococcal; 4. Influenza

Front 290

Q290. patient has HIV with severe hypoxia, normal CXR (or diffuse bilateral interstitial infiltrates) with dry and non-productive cough. Dx?; Test?; med Tx?

Back 290

A290. Dx: PCP; test: Silver stain (Wright-Giemsa, methenamine silver); Tx: TMP-SMX

Front 291

Q291. Malassezia furfur

Back 291

A291. Patient with blotchy hypopigmentation of skin; KOH scraping shows spaghetti and meatballs

Front 292

Q292. Dermatophytes

Back 292

A292. (Trichophyton - skin, hair, nails; Microsporum - hair and skin; Epidermophyton - nails and skin); Patient with scaly, ringlike lesions of ski that may involved hair shafts or nails; KOH scraping shows arthroconidia and hyphae

Front 293

Q293. Sporothrix schenckii

Back 293

A293. Patient with subcutaneous/lymphocutaneous mycetoma; Fardener, florist, basket weaver; Cigar-shaped yeasts in pus

Front 294

Q294. Histoplasma capsulatum

Back 294

A294. Normal patient with acute pulmonary; immunocompromised patient with chronic pulmonary or disseminated infection; States following drainages of Great Lakes to Gulf of Mexico; Exposure to bird or bat excrement; Sputum or blood cultures with mononuclear cells packed with yeast cells

Front 295

Q295. Coccidioides immitis

Back 295

A295. Normal patient with erythema nodosum or self resolving pneumonia; Immunocompromised patient with calcifying chronic pulmonary or disseminated infections; Pregnant female in third trimester, disseminated infection; Desert southwest; Sputum has spherule with endospores

Front 296

Q296. Blastomyces dermatitidis

Back 296

A296. Normal patient with acute pulmonary symptoms; Immunocompromised patient with chronic pulmonary or disseminated infection; North and South Carolina Sputum has broad-based, budding yeasts with double, refractile cell walls; Sputum has broad-based budding yeasts with double refractile cell walls

Front 297

Q297. Aspergillus fumigatus

Back 297

A297. Patient with asthma allergies-growing mucous plugs in lung; Patient with cavitary lung lesions-fungus ball; Patient with burns-cellulitis invasion; Immunocompromised patient-penumonia, meningitis; Septate hyphae branch at acute angles (45-degrees)

Front 298

Q298. Candida albicans

Back 298

A298. Immunocrompromised patient, overuse of antibiotics- thrust,spread down GI tract, septicemia; IV drug abusers-endocarditis; Germ tube test demonstrates pseudohyphae and hyphae

Front 299

Q299. Cryptococcus neoformans

Back 299

A299. Pigeon breeder with acute pulmonary symptoms; Hodgkins/AIDS patient with meningitis; India ink mount of CSF with encapsulated yeasts

Front 300

Q300. Mucor, Rhizopus, Absidia

Back 300

A300. Ketoacidotic diabetic or leukemic patient with rhinocerebral infection; Biopsy with nonseptate, irregular-width hyphae branching at 90-degree angles

Front 301

Q301. Pneumocystis jiroveci

Back 301

A301. Premature infant or AIDS patient with atypical pneumonia; Biopsy with honeycomb exudate and silver staining cysts; X-ray: ground glass

Front 302

Q302. Staphylococcus epidermidis

Back 302

A302. Coagulase (-); gram (+) cocci; Novobiocin sensitive; Infections of catheters and shunts

Front 303

Q303. Staphylococcus saprophyticus

Back 303

A303. Coagulase (-); gram (+) cocci; Novobiocin resistant; "Honeymoon cystitis"

Front 304

Q304. Staphylococcus aureas

Back 304

A304. Coagulase (+), gram (+) cocci in clusters; Gastroenteritis: 2-6 hours onset, salty foods, custards; Endocarditis: acute; Toxic shock syndrome: desquamating rash, fever, hypotension; Impetigo: bullous; Pneumonia: nosocomial, typical, acute; Osteomyelitis: #1 cause unless HbS mentioned

Front 305

Q305. Streptococcus pyogenes (Group A)

Back 305

A305. Catalase (-), Beta hemolytic, gram (+) cocci, bacitracin sensitive; Pharyngitis: abrupt onset, tonsillar abscesses; Scarlet fever: blanching, sandpaper rash, strawnerry tongue; Impetigo: honey-crusted lesions; Rheumatic fever; Increased ASO titer; Acute glomerulonephritis after skin or throat infection, hypertension, edema, smoky urine; Bacitracin sensitive, gram (+) cocci

Front 306

Q306. Streptococcus agalactiae (Group B)

Back 306

A306. Bacitracin resistant, gram (+) cocci; Hydrolyze hippurate; CAMP test (+); Catalase (-), Beta hemolytic, gram (+) cocci, bacitracin resistant; MCC of Neonatal meningitis and septicemia: especially in prolonged labors

Front 307

Q307. Streptococcus pneumoniae

Back 307

A307. Gram (+), catalase (-), alpha hemolytic, optochin sensitive, bile soluble; Lancet shaped diplococci; MCC of typical pneumonia, rusty sputum; MCC pf adult meningitis - many PMNs, decreased glucose, increased protein in CSF; MCC of otitis media and sinusitis

Front 308

Q308. Viridans Streptococc (S. sanguis, S. mutans)

Back 308

A308. Gram (+), catalase (-), alpha hemolytic, optochin resistant, bile insoluble; Plaque and dental caries; Subacute bacterial endocarditis - preexisting damage to the heart valves; follows dental work

Front 309

Q309. Enterococcus faecalis/faecium

Back 309

A309. Gram (+), catalase (-), variable hemolysis, hydrolyzes esculin; Urinary and biliary tract infections - elderly males after prostate treatment; Subacute bacterial endocarditis - elderly males, follows GI/GU surgery, preexisting heart valve damage

Front 310

Q310. Bacillus antracis

Back 310

A310. Gram (+), spore forming aerobic rods; Contact with animal hides or postal worker; eschar or life- threatening pneumonia; Rapid-onset gastroenteritis; Fried rice, Chinese restaurants

Front 311

Q311. Clostridium tetani

Back 311

A311. Dirty puncture wound; Rigid paralysis

Front 312

Q312. Clostridium botulinum

Back 312

A312. Home-canned alkaline vegtables; Floppy baby syndrome (infant with flaccid paralysis); Reversible flaccid paralysis

Front 313

Q313. Clostridium perfringens

Back 313

A313. Contamined wound; Pain, edema, gas, fever, tachycardia; Food poisoning: reheated meats, noninflammatory diarrhea

Front 314

Q314. Clostridium difficile

Back 314

A314. Hospitalized patient on antibiotics; Develops colitis, diarrhea

Front 315

Q315. Listeria monocytogenes

Back 315

A315. Gram (+), beta hemolytic bacilli, facultative intracellular; Foodborne (deli foods); Transplacental - granulomatosis infantiseptica; Neonatal septicemia and meningitis (third most common cause); MCC of meningitis in renal transplant or cancer patients

Front 316

Q316. Corynebacterium diphtheriae

Back 316

A316. Gram (+), aerobic, non-spore forming rods; Bull neck, myocarditis, nerve palsies; Gray pseudomembrane → airway obstruction; Toxin produced by lysogeny and ribosylates EF-2; heart, nerve damage

Front 317

Q317. Actinomyces israelii

Back 317

A317. Mycetoma on jaw line or spread from IUD; Sulfur granules in pus grow anaerobic, gram (+), non-acid fast branching rods

Front 318

Q318. Nocardia asteroides and brasiliensis

Back 318

A318. Gram (+) filamentous bacilli, aerobic, partially acid fast; Cavitary bronchopulmonary disease, mycetomas

Front 319

Q319. Mycobacterium tuberculosis

Back 319

A319. High-risk patient (low SES, HIV+, IV drug user); Chronic cough, weight loss; Ghon complex; Auramine-rhodamine staining, acid fast bacilli in sputum, faculative intracellular; Produce niacin, heat-sensitive catalase; Positive DTH test (PPD)

Front 320

Q320. Mycobacterium leprae

Back 320

A320. Acid fast bacilli in punch biopsy; Immigrant patient with sensory loss in extremities; Armadillos in Texas and Louisana; Hansen's disease

Front 321

Q321. Mycobacterium avium intracellulare, Mycobacterium kansasii

Back 321

A321. AIDS patients, cancer, chronic lung disease with pulmonary, GI, disseminated symptoms, atypical mycobacteria

Front 322

Q322. Mycobacterium marinum

Back 322

A322. Fish tank granuloma - cutaneous granulomas

Front 323

Q323. Mycobacterium scrofulaceum

Back 323

A323. Solitary cervical lymph node in kids, lymphadenitis, atypical mycobacteria

Front 324

Q324. Meningococcal meningitis

Back 324

A324. Gran (-) diplococcus in CSF; Young adults with meningitis, abrupt onset with signs of endotoxin toxicity

Front 325

Q325. Neisseria gonorrhoeae

Back 325

A325. Sexually active patient; Urethral/vaginal discharge (leukorrhea); Arthiritis possible; Neonatal opthalmia; Gram (-) diplococcus in neutrophils

Front 326

Q326. Moraxella catarrhalis

Back 326

A326. Gram (-) diplococcus causes otitis media, sinusitis, bronchitis, bronchopneumonia in elderly patients with COPD

Front 327

Q327. Pseudomonas aeruginosa

Back 327

A327. Gram (-), oxidase (+), aerobic bacillus; Blue-green pigments, fruity odor; Burn infections - blue-green pus, fruity odor; Typical pneumonia - Chonic granulomatous disease or Cystic fibrosis; UTI - catheterized patients

Front 328

Q328. Legionella pneumophilia

Back 328

A328. Elderly smoker, heavy drinker or immunosuppressed; Exposure to aerosols of water; Atypical pneumonia; Pontiac fever

Front 329

Q329. Francisella tularensis

Back 329

A329. Patient with ulceroglandular disease, atypical pneumonia, or gastrointestinal disease; Arkansas/Missouri; Exposure to rabbits/ticks; Tularemia

Front 330

Q330. Bordetella pertussis

Back 330

A330. Unvaccinated child (immigrant family or religious objections); Cough with inspiratory "whoop"; Whooping cough

Front 331

Q331. Brucella species

Back 331

A331. Patient with acute septicemia; Exposure to animals or unpasteurized dairy; California/Texas or travel to Mexico

Front 332

Q332. Campylobacter jejuni

Back 332

A332. Patient with inflammatory diarrhea; Gram (-), curved rod, microaerophilic, exidase (+), grows at 42 degrees C

Front 333

Q333. Helicobacter pylori

Back 333

A333. Patient with gastritis, ulcers, stomach cancer; Gram (-), helical bacilli, oxidase (+), microaerophilic, urease (+)

Front 334

Q334. Escherichia coli

Back 334

A334. MCC of UTI; Neonatal septicemia (2nd MCC)

Front 335

Q335. Escherichia coli (ETEC)

Back 335

A335. Gastroenteritis, Traveler's diarrhea; Infantile diarrhea (2nd MCC); Hemorrhagic colitis, HUS; Lactose fermenter, gram-negative rod; Inflammatory diarrhea, similar to shigellosis

Front 336

Q336. Shigella sonnei (MC in US), dysenteriae (most severe)

Back 336

A336. Patient with acute bloody diarrhea and fever; Gram (-) bacilli, which are nonmotile, nonlactose fermenters, do not produce H2S

Front 337

Q337. Klebsiella pneumoniae

Back 337

A337. Elderly patient with typical pneumonia currant-jelly sputum; UTI - catheterized patients; Septicemia: immunocompromised or nosocomial; Gram (-) bacilli, oxidase (-), encapsulated, lactose fermenters

Front 338

Q338. Klebsiella granulomatis

Back 338

A338. Patient from Caribbean or New Guinea with subcutaneous genital nodules; Encapsulated gram (-) rods inside mononuclear cells

Front 339

Q339. Salmonella enterica typhi

Back 339

A339. Patient with fever, abdominal pain with travel to endemic area

Front 340

Q340. Salmonella enterica typhi / non-typhi

Back 340

A340. Gram (-), encapsulated, nonlactose fermenter, produces H2S gas; Widal test

Front 341

Q341. Salmonella enterica non-typhi

Back 341

A341. Enterocolitis - inflammatory, follows ingestion of poultry products or handling pet reptiles; Septicemia - very young or elderly; Osteomyelitis - sickle cell disease

Front 342

Q342. Yersinia pestis

Back 342

A342. Patient with high fever, buboes, conjunctivitis, pneumonia; Exposure to small rodents, desert southwest

Front 343

Q343. Yersinia enterocolitica

Back 343

A343. Patient with inflammatory diarrhea or pseudoappendicitis; Cold climates; Unpateurized milk, pork; Gram (-) bacilli, non-lactose fermenters, non-H2S producers

Front 344

Q344. Proteus mirabilis / vulgaris

Back 344

A344. Patient with UTI or septicemia; Swarming motility; Staghorn renal calculi (struvite stones); Gram (-), non-lactose fermenting, urease (+)

Front 345

Q345. Gardnerella vaginalis

Back 345

A345. Female patient with thin vaginal discharge, post antibiotic or menses; Clue cells; Whiff test

Front 346

Q346. Vibrio cholerae

Back 346

A346. Patient with noninflammatory diarrhea; Rice-water stool; Dehydration; Gram (-) curved rods, polar flagellae, oxidase (+), travel to endemic area

Front 347

Q347. Pasteurella multocida

Back 347

A347. Patient with cat (animal) bite; Cellulitis / lymphadenitis

Front 348

Q348. Haemophilus influenzae

Back 348

A348. 3 mo-2 year old unvaccinated child - meningitis, pneumonia, epiglottitis; Smokers with COPD - bronchitis, pneumonia; Gram (-) rod, requires factors X and V

Front 349

Q349. HACEK group infections

Back 349

A349. MCC of gram-negative endocarditis in non-IV drug users

Front 350

Q350. Haemophilus ducreyi

Back 350

A350. Painful chancre

Front 351

Q351. Bacteroides fragilis

Back 351

A351. Patient with abdominal trauma, emergency abdominal surgery; Septicemia, peritonitis, abscess; Gram (-) bacilli, anaerobic

Front 352

Q352. Treponema pallidum

Back 352

A352. Sexually active patient or neonate of IV drug-using female; Primary disease - nontender indurated genital chancre; Secondary disease - maculopapular, copper-colored rash, condylomata lata; Tertiary disease - gumma in CNS and cardiovascular system; Spirilar, gram (-) bacteria visualized by dark-field or fluorescent antibody; FTA-ABS, VDRL

Front 353

Q353. Borrelia burgdorferi

Back 353

A353. Patient with influenza-like symptoms and erythema migrans; Spring/summer seasons, noreast, midwest, west coast; Later-neurologic, cardiac, arthiritis/arthralgias; Lyme disease

Front 354

Q354. Leptospira interrogans

Back 354

A354. Patients with influenza-like symptoms +/- GI symptoms; Occupational or recreational exposure to water aerosols; Hawaii; Spirochetes with terminal hook

Front 355

Q355. Rickettsia rickettsii

Back 355

A355. Patient with influenza-like symptoms and petechial rash that begins on ankles and wrists and moves to trunk; East coast mountainous areas; Sring/summer seasons, outdoor exposure, Weil-Felix (+); Rocky Mountain spotted fever

Front 356

Q356. Coxiella burnetii

Back 356

A356. Patient with fever, pneumonia, granulomatous hepatitis; Exposure to domestic animal breeding operation, gram (-) bacilli, diagnose serologically

Front 357

Q357. Chlamydia trachomatis

Back 357

A357. Sexually active patient or neonate; Adult: urethritis, cervicitis, PID, inclusion conjunctivitis; Neonate: inclusion conjunctivitis / pneumonia; Immigrant from Africa/Asia, swollen genital lymphadenopathy; Cytoplasmic inclusion bodies in scrapings

Front 358

Q358. Chlamydia pneumoniae

Back 358

A358. Atypical pneumonia, sputum with intracytoplasmic inclusion

Front 359

Q359. Chlamydia psittaci

Back 359

A359. Atypical pneumonia, exposure to parrots

Front 360

Q360. Mycoplasma pneumonia

Back 360

A360. Young adult with atypical pneumonia (MCC); Mulberry-shaped colonies on media containing sterols; Positive cold agglutinin test

Front 361

Q361. Ureaplasma urealyticum

Back 361

A361. Adult patient with urethritis, prostitis, renal calculi; Alkaline urine; Non-Gram-staining, urease (+)

Front 362

Q362. Entamoeba histolytica

Back 362

A362. Amebiasis: dysentery; Liver abscesses (protozoa etiology); Inverted flask shaped lesions

Front 363

Q363. Giardia lamblia

Back 363

A363. Fatty, foul-smelling diarrhea leading to malabsorption; Fecal (human, beaver, muskrat), water , food, day care; Trophozoites with "falling leaf" motility

Front 364

Q364. Cryptosporidium species

Back 364

A364. Transient diarrhea in healthy, severe in immunocompromisted hosts, acid fast round oocysts in stool; Undercooked meat, water - no killed by chlorination, cysts

Front 365

Q365. Trichomonas vaginalis

Back 365

A365. Frothy vaginal discharge,; motile trophozoites with corkscrew motility,; sexual transmission

Front 366

Q366. Plasmodium vivax

Back 366

A366. Chills,; fever spike,; and malarial rigors,; relapses

Front 367

Q367. Plasmodium falciparum

Back 367

A367. Irregular fever spikes,; causes cerebral malaria,; multiple ring forms and crescent-shaped gametes

Front 368

Q368. Trypanosoma cruzi

Back 368

A368. Chagas diseases,; Romana sign (swelling around eye),; cardiac muscle, liver, brain often involved,; reduviid bug

Front 369

Q369. Trypanosoma brucei, gambiense, rhodesiense

Back 369

A369. African sleeping sickness,; tsetse fly,; antigenic variation

Front 370

Q370. Leishmania donovani

Back 370

A370. Viseral Leishmaniasis,; sandfly,; amastigotes in macrophages in bone marrow, liver, spleen

Front 371

Q371. Leismania species

Back 371

A371. Cutaneous Leishmaniasis,; sandfly,; amastigotes in cutaneous lesions

Front 372

Q372. Babesia

Back 372

A372. Malaria-like Babesiosis,; NE, N Central, California, and NW U.S.,; Ixodes tick,; co-infection with Borrelia

Front 373

Q373. Toxoplasma gondii

Back 373

A373. Cat is definitive host,; raw meat in US #1 = pork, contact with cat feces,; deadly in pregnant patients

Front 374

Q374. Schistosoma mansoni, japonicum

Back 374

A374. Intestinal schistosomiasis; Skin penetration,; mature in veins of mesentery,; eggs cause granulomas in liver

Front 375

Q375. Schistosoma haematobium

Back 375

A375. Vesicular schistosomiasis; Skin penetration,; bladder carcinoma in Egypt and Africa

Front 376

Q376. Clonorchis sinesis

Back 376

A376. Chinese liver fluke; Raw fish ingestion, serum-like sickness

Front 377

Q377. Paragonimus westermani

Back 377

A377. Lung fluke; Raw crabs, crayfish,; mimics pulmonary TB

Front 378

Q378. Taenia solium

Back 378

A378. Pork tapeworm; Cysticercosis, calcified larva in brain, eye, heart, lung, IH: pigs; Raw pork containing cysticerci ingested by humans, DH: humans - intestinal tapeworm, proglottids in feces

Front 379

Q379. Diphyllobothrium latum

Back 379

A379. Raw pickled fism containing a sparganum, intestinal tapeworm, megaloblastic anemia (B12 deficiency); Fish tapeworm

Front 380

Q380. Enchinococcus granulosus

Back 380

A380. Hydatid cyst disease

Front 381

Q381. Enterobius vermicularis

Back 381

A381. Pinworms, large intestine, perinal itching; Scotch tape test; Most frequent helminth parasite in U.S.

Front 382

Q382. Ascaris lumbricoides

Back 382

A382. Ascariasis; MC helminth worldwide; Largest roundworm, may obstruct intestine or bile duct

Front 383

Q383. Toxocara canis or cati

Back 383

A383. Visceral Larva Migrans - larvae wader aimlessly until they die,; cause inflmmation,; from hangling puppies or eating dirt (pica)

Front 384

Q384. Necator americanus

Back 384

A384. Hookworm,; larva penetrates intact skin of bare feet,; penumonitis,; anemia,; occult blood fecal may be +

Front 385

Q385. Strongyloides stercoralis

Back 385

A385. Threadworm,; early: pneumonitis, diarrhea, abdominal pain; later: malabsorption, ulcers, bloody stools, larva penerates intact skin

Front 386

Q386. Trichinella spiralis

Back 386

A386. Trichinosis,; variable encysted larvae in meat, wild game meat, in muscle,; fever, myalgia, splinter hemorrhages, eosinophilia

Front 387

Q387. Wucheria bancrofti

Back 387

A387. Elephantiasis, mosquito

Front 388

Q388. Loa loa

Back 388

A388. Pruritus,; calabar swelling,; chrysops mango fly, African eye worm

Front 389

Q389. Onchocerca volvulus

Back 389

A389. River blindness, itchy leopard rash

Front 390

Q390. Dracunculus medinesis

Back 390

A390. Creeping eruptions,; ulcerations,; rash,; remove with stick, fiery serpant

Front 391

Q391. B19 - Parvoviridae

Back 391

A391. School-aged child with fever and indurated facial rash, slapped cheek fever; Pregnant woman with flu-like symptoms, hydrops fetalis or spontaneous abortion

Front 392

Q392. HPV - Papovaviridae

Back 392

A392. Warts; Cervical intraepithelial neoplasia (CIN); Biopsy or pap smear reveals koilocytic cells

Front 393

Q393. HSV-1 and HSV-2 - Herpesviridae

Back 393

A393. Cold sores / gential vesicles; Keratoconjunctivitis; Meningoencephalitis / encephalitis; Neonatal disseminated / encephalitis; Tzanck smear, Cowdry type A inclusion bodies

Front 394

Q394. HSV-1 - Herpesviridae

Back 394

A394. Latency in trigeminal ganglion; Latency in sacral ganglion

Front 395

Q395. VZV - Herpesviridae - Chickenpox

Back 395

A395. unvaccinated child with asynchronous rash

Front 396

Q396. VZV - Herpesviridae - Shingles

Back 396

A396. Elderly with unilateral vesicular rash that follows dermatome

Front 397

Q397. VZV - Herpesviridae

Back 397

A397. Tzanck smear, Cowdry type A inclusion bodies, and synctia intranuclear inclusions; Latency in DRG

Front 398

Q398. EBV - Herpesviridae

Back 398

A398. Young adult with fever, lymphadenopathy, splenomegaly; Downey type II atypical T lymphocytes reach 70% in blood; Heterophile (monospot) positive mononucleosis; Latency in B cells; Kissing disease

Front 399

Q399. CMV - Herpesviridae

Back 399

A399. Heterophile-negative mononucleosis in children and adults; Neonate with jaundice, hepatosplenomegaly, thrombocytic purpura; Owl-eye inclusion bodies in biopsy

Front 400

Q400. HHV-6 - Herpesviridae

Back 400

A400. Infant with fever leading to lacy body rash

Front 401

Q401. HHV-8 - Herpesviridae

Back 401

A401. AIDS patient with sarcoma; Kaposi sarcoma

Front 402

Q402. EBV, CMV - Herpesviridae

Back 402

A402. Latency in mononuclear cells

Front 403

Q403. Adenovirus - Adenoviridae

Back 403

A403. Young adults with ARDS, spring and winter peak; Swimmers and shipyard workers: nonpurulent conjunctivitis; Daycare: viral gastroenteritis

Front 404

Q404. Molluscum Contagiosum - Poxviridae

Back 404

A404. Young adult (wrestling, swim team), umbilicated warts, Eosinophilic cytoplasmic inclusion bodies

Front 405

Q405. Variola - Poxviridae

Back 405

A405. Virus extinct; Syncronous rash begins in mouth goes to face and body; Guarnieri bodies (intracytoplasmic inclusions); Smallpox

Front 406

Q406. HBV - Hepadnaviridae

Back 406

A406. Dane particle, infectious

Front 407

Q407. HAV - Picornavirus

Back 407

A407. Fecal oral, infectious

Front 408

Q408. HCV - Flavivirus

Back 408

A408. Parenteral, sexual, post-transfusion,; 80% chronic carriers,; primary HCC,; cirrhosis

Front 409

Q409. HDV - Defective

Back 409

A409. Parenteral, sexual, superinfection,; cirrhosis,; fulminant hepatitis

Front 410

Q410. HEV - Calcivirus

Back 410

A410. Fecal oral, enteric,; pregnant patients severly affected

Front 411

Q411. Subacute Bacterial Endocarditis (SBE)

Back 411

A411. Streptococcus Viridans: Mutans, Intermedius,; Streptococcus Bovis; Enterococcus Faecalis

Front 412

Q412. Local: UTI, Billiary tract infection; Systemic: SBE

Back 412

A412. Enterococcus Faecalis

Front 413

Q413. Local: Dental carries, Brain or abdominal abscesses. Systemic: SBE

Back 413

A413. Carries: S. Mutans; Brain or Abdominal abscesses:Intermedius

Front 414

Q414. Neonatal: meningitis, pneumonia, sepsis

Back 414

A414. Streptococcus Agalactiae

Front 415

Q415. Glomerulonephritis with hematuria, periorbital edema, HTN; Rheumatic Fever with carditis,chorea, polyarthritis, erythema marginatum, subcue nodules

Back 415

A415. Streptococcus Pyogenes (immune-mediated)

Front 416

Q416. Scarlet Fever with sandpaper rash, strawberry tongue. TSS; Necrotizing Fasciitis

Back 416

A416. Streptococcus Pyogenes (toxin-mediated)

Front 417

Q417. Pharyngitis; Impetigo; Erysipelas; Cellulitis

Back 417

A417. Streptococcus Pyogenes (infection)

Front 418

Q418. UTI, Cystitis

Back 418

A418. Staphlococcus Saprophyticus

Front 419

Q419. Local: impetigo, cellulitis,flolliculitis, carbuncles, pneumonia with cavitations; Systemic: acute endocarditis, meningitis,osteomyelitis, septic arthritis

Back 419

A419. Staphylococcus Aureus (infections)

Front 420

Q420. TSS; SSS (ritters disease in newborn); Food Poisoning (custards, heat stable toxins, enterotoxin EA A)

Back 420

A420. Staphylococcus Aureus (toxin-mediated)

Front 421

Q421. Infection of indwelling medical device (catheter, iv line, prosthetic valve.

Back 421

A421. Staphylococcus EpidermidisA

Front 422

Q422. Abscesses in mouth, lungs, GI tract, GU tract. Draining sinus tracts

Back 422

A422. Actinomyces Israelii

Front 423

Q423. Local: pseudomembrane. airway obstruction; Systemic: myocarditis, polyneuritis

Back 423

A423. Corynebacterium Diphtheriae

Front 424

Q424. Listerosis: meningitis and sepsis in neonates and immumoncompromised

Back 424

A424. Listeria Monocytogenes

Front 425

Q425. cellulitis; gas gangrene (myonecrosis with crepitus); food poisonoing (meat, poultry)

Back 425

A425. Clostridium Perfringens

Front 426

Q426. Pseudomenbranous colitis (PMC); Diarrhea

Back 426

A426. Clostridium Difficile

Front 427

Q427. Adult botulism (food poisoning, canned foods, hours); Infant botulism (contiminated honey, floppy baby, days); no fever (bacteria doesn't invade)

Back 427

A427. Clostridium Botulinum

Front 428

Q428. spastic paralysis; lockjaw, risus sardonicus

Back 428

A428. Clostridium Tetani

Front 429

Q429. Local: cutaneous tissue hemorrhage and necrosis-- >malignant pustules; Dysentery (secondary to lesions in GI tract); Systemic:fever, dyspnea, nonproductive cough (woolsorters disease)

Back 429

A429. Bacillus Anthracis

Front 430

Q430. food poisoning from contiminated rice

Back 430

A430. Bacillus Cereus

Front 431

Q431. Local: Lobar pneumonia, otitis media; Systemic: Meningitis

Back 431

A431. Streptococcus pneumoniae

Front 432

Q432. Pneumonia; Abscesses in kidney, brain; immune compromised

Back 432

A432. Norcardia

Front 433

Q433. Streptococcus Bovis DOC?

Back 433

A433. PCN

Front 434

Q434. Enterococcus Faecalis DOC?

Back 434

A434. Ampicillin or Vancomycin; and; Aminoglycosides (synergistic)

Front 435

Q435. Streptococcus Agalactiae DOC?

Back 435

A435. PCN G; Prophylaixs: Ampicillin for preg women

Front 436

Q436. Streptococcus Pyogenes DOC?; for Glomerulonephirits or Rheumatic Fever (immune- mediated)

Back 436

A436. Symptomatic Tx. Prophylaxis: PCN to pts with Hx of; Rheumatic Fever to prevent further valve damage.

Front 437

Q437. Streptococcus Pyogenes DOC?; for Scarlet Fever, TSS, Necrotizing Fasciitis (toxin-mediated)

Back 437

A437. PCN G; Clindamycin added in TSS (prevents Scarlet fever toxin); Surgery and Debridement for Necrotizing Fasciitis

Front 438

Q438. Streptococcus Pyogenes DOC?; Pharyngitis, Impetigo, Ersipelas, Cellulitis (Infections)

Back 438

A438. PCN G

Front 439

Q439. Staphylococcus Saprophyticus DOC?

Back 439

A439. TMP-SMX

Front 440

Q440. Staphylococcus Epidemidis DOC?; Infections of Indwelling Medical Devices

Back 440

A440. Vancomycin ( most strains resistant to PCN and Cephalosporins); Remove foreign body

Front 441

Q441. Staphylococcus Aureus DOC?; Infections: Impetigo, cellulits, folliculitis, furnuncles, carbuncles, pseumonia with cavitations, Acute Endocarditis, Meningitis, Osteomylitis, Septic Arthritis.

Back 441

A441. MSSA: Penicillinase-resistant PCN; MRS: Vancomycin

Front 442

Q442. Staphylococcus Aureus DOC?; Toxin Mediated: TSS, SSS (Ritter's disease in Newborn), Food Poisoning

Back 442

A442. Remove foreign body, drainage of purpulent fluid, fluid replacement,; Penicillanase-resistant PCN

Front 443

Q443. Actinomyces Israelii DOC?; Abcesses in mouth, lungs, GI Tract, GU tract.

Back 443

A443. PCN G; Surgical Drainage of abscesses

Front 444

Q444. Corynebacterium Diphtheriae DOC?

Back 444

A444. antitoxin; PCN or Erythormycin for local infection; DTaP booster

Front 445

Q445. Listeria Monocytogenes DOC?

Back 445

A445. Ampicillin + or - Gentamicin; TMP-SMX

Front 446

Q446. Clostridium Perfringens DOC?

Back 446

A446. Surgical removable of infected areas; Hyperbaric oxygen to keill anaerobic organisms; PCN, Clindamycin (effective in local, weak infections)

Front 447

Q447. Clostridium Botulinum DOC?

Back 447

A447. antitoxin; respiratory support

Front 448

Q448. Clostridium Tetani DOC?

Back 448

A448. Prophylaxis DTaP vaccine, tetanus toxoid, boosters required; clean wound, antitoxin; DTaP booster; PCN, Metronidazole; Diazepam (a GABA-agonist)

Front 449

Q449. Bacillus Anthracis DOC?

Back 449

A449. parenteral PCN G; anti-PA vaccine

Front 450

Q450. Bacillus Cereus DOC?

Back 450

A450. rehydration; good food handling

Front 451

Q451. Viridans Streptococci : Mutans, Intermedius DOC?

Back 451

A451. PCN G

Front 452

Q452. Streptococcus Pneumoniae DOC?

Back 452

A452. PCN or Cepholosporin; Except Vancomycin for Meningitis

Front 453

Q453. Norcardia: Asteroides, Brasiliensis DOC?

Back 453

A453. TMP-SMX; Surgical drainage of abcess

Front 454

Q454. c diff associated with

Back 454

A454. pseudomembrane colitis, secondary to clinda or amp use

Front 455

Q455. tx of pseudomembrane colitis

Back 455

A455. metro, oral vanco

Front 456

Q456. diphtheria

Back 456

A456. exotoxin inhibits protein synthesis by ADP ribosylation of EF-2; grey-white membrane in pharynx with LAD; tx: diphtheria antitoxin, DPT vaccine, penecillin

Front 457

Q457. anthrax

Back 457

A457. contact: malignant pustule; inhalation: flulike symptoms that rapidly progress to fever, pulmonary hemorrhage, shock

Front 458

Q458. actinomyces

Back 458

A458. normal oral flora, bad if immunocompromised

Front 459

Q459. neisseria gonococci cause

Back 459

A459. urethritis, cervicitis, PID, epididymitis; most common cause of septic arthritis; ophthalmia neonatorum- sticky eye discharge, tx- EES eye drops

Front 460

Q460. H influ

Back 460

A460. epiglottitis, meningitis, otitis, pneumonia; can vaccinate

Front 461

Q461. enterbacter

Back 461

A461. aerobic GN rods; e coli, salmonella, shigella, klebsiella, enterobacter, serratia, proteus

Front 462

Q462. kleb

Back 462

A462. pneumonia, sepsis, UTI; red currant jelly sputum

Front 463

Q463. salmonella

Back 463

A463. motile, most common food associated diarrhea; do not tx- you will prolong the carrier state; see in chicken and eggs

Front 464

Q464. shigella

Back 464

A464. bacterial dysentery- water diarrhea then mucousy diarrhea

Front 465

Q465. S typhi

Back 465

A465. typhoid fever; fever,; RUQ pain,; resides in GB

Front 466

Q466. S flexeneri

Back 466

A466. Reiter's syndrome

Front 467

Q467. Yersinia entercolitica

Back 467

A467. pet feces (puppy)

Front 468

Q468. seafood bugs

Back 468

A468. vibrio parahaemolyticus,; v vulnificus

Front 469

Q469. EHEC and EHIC

Back 469

A469. have sHIga like toxin - inhibits 60s ribosome

Front 470

Q470. E coli general

Back 470

A470. diarrhea,; UTI,; neonatal meningitis/pneumonia/sepsis

Front 471

Q471. ETEC

Back 471

A471. most common cause of traveler's diarrhea; tx: TMP-SMX, fluoroquinolones; similar to cholera, rice water diarrhea; no intestinal wall invasion

Front 472

Q472. EHEC

Back 472

A472. O157:H7--> HUS- hemolysis, renal failure, TCP

Front 473

Q473. enteropathogenic

Back 473

A473. similar to shigella

Front 474

Q474. EIEC

Back 474

A474. intestinal wall invasion- blood diarrhea and fever

Front 475

Q475. bloody diarrhea

Back 475

A475. campylobacet,; salmonella,; shigella,; EHEC,; EIEC,; yersinia enterocolitica,; C diff,; entamoeba

Front 476

Q476. watery diarrhea

Back 476

A476. ETEC,; vibrio,; c perfringens,; protozoa- giardia, cryptosporidium,; viruses- rota, adeno, norwalk

Front 477

Q477. campylobacter and cholera

Back 477

A477. comma shaped organisms

Front 478

Q478. cAMP inducers

Back 478

A478. cholera,; pertussus,; e coli,; bacillus

Front 479

Q479. proteus mirabilis

Back 479

A479. very motile, flagella- no distinct colonies can be grown; common cause of UTI; carries urease (also h pylori and c neoformans)

Front 480

Q480. cat scratch

Back 480

A480. bartonella

Front 481

Q481. dog/cat bite

Back 481

A481. pasteurella multocida

Front 482

Q482. cat feces

Back 482

A482. toxoplasmosis

Front 483

Q483. animal urine

Back 483

A483. leptospira

Front 484

Q484. rat bites

Back 484

A484. spirillum minus

Front 485

Q485. francisella tularemia

Back 485

A485. rabbits

Front 486

Q486. brucella

Back 486

A486. undulant fever, dairy products, contact with animals

Front 487

Q487. legionella

Back 487

A487. poorly staining GN rod- use silver stain; aerosol transmission from environmental water source habitat; tx: ees; detect with urinary antigen test

Front 488

Q488. pseudomonas causes

Back 488

A488. pneumonia (CF, immunocompromised),; burn wound infections,; UTI,; external otitis,; hot tub folliculitis,; osteomyelitis (DM, IVDA),; sepsis,; endocarditis (IVDA),; corneal infections in contact lens wearers

Front 489

Q489. pseudomonas things

Back 489

A489. water source, produces endotoxin, blue green pigment; tx: AG + extended spectrum penicillin

Front 490

Q490. H pylori

Back 490

A490. duodenal ulcers and gastric ulcers; tx with triple therapy; urease positive

Front 491

Q491. DDX granulomatous disease

Back 491

A491. fungal infections,; silica/be exposure,; TB,; foreign bodies,; sarcoid-hilar LAD,; bartonella

Front 492

Q492. primary TB

Back 492

A492. ghon complex,; hilar nodes

Front 493

Q493. secondary TB

Back 493

A493. fibrocaseous cavitary lesion- classic TB

Front 494

Q494. how do we kill TB

Back 494

A494. kill by T memory lymphokines--> activate macrophages-- >kill

Front 495

Q495. Ghon complex

Back 495

A495. TB granulomas (Ghon focus) with lobar and perihilar lymph node involvement;; reflects primary infection or exposure

Front 496

Q496. TB symptoms

Back 496

A496. fever,; night sweats,; weight loss,; hemoptysis

Front 497

Q497. M kansasii

Back 497

A497. pulmonary TB like symptoms

Front 498

Q498. M scrofulaceum

Back 498

A498. cervical LAD in kids

Front 499

Q499. MAIC

Back 499

A499. disseminated disease in AIDs

Front 500

Q500. M marinum

Back 500

A500. marine activity, skin infection

Front 501

Q501. M leprae

Back 501

A501. likes cool temperatures- infects skin and superficial nerves; Tx: l/t dapsone, rifampin

Front 502

Q502. lepromatous leprosy

Back 502

A502. worse, failed cell mediated immunity

Front 503

Q503. tuberculoid leprosy

Back 503

A503. self limited

Front 504

Q504. lyme disease

Back 504

A504. caused by borrelia burgdorferi- transmitted by ixodes tick; erythema chronicum migrans rash with central clearing; tx: TCN, doxy

Front 505

Q505. stage 1 lyme

Back 505

A505. erythema chronicum migrans,; flulike symptoms

Front 506

Q506. stage 2 lyme

Back 506

A506. neurologic and cardiac manifestations

Front 507

Q507. stage 3 lyme

Back 507

A507. AI migratory polyarthritis

Front 508

Q508. primary syph

Back 508

A508. painless chancre

Front 509

Q509. secondary syph

Back 509

A509. disseminated disease with constitutional symptoms,; maculopapular rash,; condyloma lata,; alopecia areata

Front 510

Q510. tertiary syph

Back 510

A510. gumma,; aortitis,; neurosyph (tabes dorsalis- no proprioception),; argyll robertson pupil

Front 511

Q511. congenital syph

Back 511

A511. saber shins,; saddle nodes,; deafness,; notched incisors,; interstitial keratitis

Front 512

Q512. argyll robertson pupil

Back 512

A512. accomodates to convergence but does not react to light

Front 513

Q513. VRDL false positives

Back 513

A513. viruses (mono, hep),; drugs,; rheumatic fever/RA,; lupus,; leprosy

Front 514

Q514. spirochetes

Back 514

A514. borrelia,; leptospira,; treponema

Front 515

Q515. C pneumo and C psittaci

Back 515

A515. atypical pneumo- no fever or SOB, interstitial pneumo only; psittaci- avian resevoir

Front 516

Q516. CT A-C

Back 516

A516. chronic infection,; cause blindness in africa

Front 517

Q517. CT D-K

Back 517

A517. urethritis,; PID,; ectopic pregnancy,; neonatal pneumonia,; neonatal conjunctivitis (tx with EES)

Front 518

Q518. CT L1-L3

Back 518

A518. lymphogranuloma venereum

Front 519

Q519. Rickettsia triad

Back 519

A519. HA,; fever,; rash,; arthropod vector

Front 520

Q520. tx for rickettsia

Back 520

A520. TCN

Front 521

Q521. why is coxiella atypical

Back 521

A521. no rash, no vector, negative weil-felix reaction, aerosol; Q fever- interstitial pneumonia like woolsorters disease

Front 522

Q522. RMSF

Back 522

A522. rickettsia rickettsii- rash on palms and soles (migrates inward), HA, fever; endemic to east coast

Front 523

Q523. acrodynia

Back 523

A523. peeling of palms and soles because of Hg poisoning

Front 524

Q524. Endemic typhus (fleas)

Back 524

A524. R typhi

Front 525

Q525. Epidemic typhus (human body louse)

Back 525

A525. R prowsezekii

Front 526

Q526. Weil-Felix reaction

Back 526

A526. antirickettsia AB cross react with proteus antigen

Front 527

Q527. Myco pneumo

Back 527

A527. atypical walking pneumonia (insidious onset, HA, nonproductive cough, diffuse interstitial infiltrate), high titer of cold agglutinins (IgM); Tx: TCN, EES; bacterial cell membrane contains cholesterol; younger patients in clusters

Front 528

Q528. gives rigid support, protects against osmotic pressure

Back 528

A528. peptidoglycan

Front 529

Q529. major surface antigen - has teichoic acid - induces acute phase reactants TNF and IL1

Back 529

A529. cell wall/cell membrane

Front 530

Q530. site of endotoxin (LPS), major surface antigen

Back 530

A530. outer membrane (GN)

Front 531

Q531. LPS components

Back 531

A531. lipid A (induces TNF and IL1),; core polysaccharide,; outer O side chain

Front 532

Q532. site of oxidative and transport enzymes

Back 532

A532. plasma membrane

Front 533

Q533. space between cytoplasmic membrane and outer membrane in GN bacteria

Back 533

A533. periplasm

Front 534

Q534. protects against phagocytosis

Back 534

A534. capsule

Front 535

Q535. mediates adherence of bacteria to cell surface, sex pilus forms attachment between 2 bacteria during conjugation

Back 535

A535. pilus/fimbria

Front 536

Q536. motility

Back 536

A536. flagellum

Front 537

Q537. provides resistance to dehydration, heat and chemicals

Back 537

A537. spore

Front 538

Q538. contains a variety of genes for antibiotic resistance, enzymes and toxins

Back 538

A538. plasmid

Front 539

Q539. organisms with IgA proteases

Back 539

A539. S pneumo,; N mening,; N gonorrhea,; H influ

Front 540

Q540. bugs that do not gram stain well

Back 540

A540. treponema,; rickettsia,; mycobacteria,; mycoplasma,; legionella,; chlamydia

Front 541

Q541. exotoxin

Back 541

A541. secreted from cell,; made of polypeptide,; induces high titer antibodies- antitoxins

Front 542

Q542. endotoxin

Back 542

A542. part of the cell,; made of LPS,; poorly antigenic

Front 543

Q543. superantigens

Back 543

A543. bind directly to MHC II and TCR,; activating large numbers of T cell to stimulate release of IFN-gamma and IL2

Front 544

Q544. S aureus toxins

Back 544

A544. TSST-1- TSS; enterotoxin (preformed)- food poisoning; a-toxin- hemolysis; b-toxin- sphingomyelinase; leukocidin and hemolysin; epidermolytic/exfoliative- epithelial cell lysis, SSSS

Front 545

Q545. S pyogenes toxins

Back 545

A545. streptolysin O- hemolysis; streptolysin S- hemoylsis; erythrogenic/pyrogenic toxins- skin rash and fever of scarlet fever

Front 546

Q546. diphtheria toxin

Back 546

A546. inactivates EF2,; causes pharyngitis and pseudomembrane colitis

Front 547

Q547. vibrio toxin

Back 547

A547. stimualates adenylyl cyclase;; increases pumping of Cl and water into gut- voluminous rice water diarrhea

Front 548

Q548. e coli toxin

Back 548

A548. heat labile toxin stimulates adenylyl cyclase causing watery diarrhea; heat stabile toxin stimulates guanylyl cyclase

Front 549

Q549. bordatella toxin

Back 549

A549. stimulates adenylyl cyclase,; causes whopping cough;; inhibits chemokine receptor, causing lymphocytosis

Front 550

Q550. perfringens toxin

Back 550

A550. gas gangrene

Front 551

Q551. tetanus toxin

Back 551

A551. blocks release of inhibitor transmitter glycine- causes lockjaw

Front 552

Q552. botulinum toxin

Back 552

A552. blocks release of Ach,; causes anticholinergic symptoms,; CNS paralysis especially cranial nerves

Front 553

Q553. anthracis toxin

Back 553

A553. edema factor,; lethal factor,; protective antigen

Front 554

Q554. shiga toxin

Back 554

A554. like E coli O157:H7 cleaves host cell rRNA;; enhances cytokine release causing HUS

Front 555

Q555. bacteria that secrete enterotoxins

Back 555

A555. vibrio,; e coli,; staph,; salmonella,; shigella

Front 556

Q556. what does C3a do

Back 556

A556. hypotension, edema; mast cell and basophil degranulation--> histamien

Front 557

Q557. what does C5a do

Back 557

A557. neutrophil chemotaxis

Front 558

Q558. H influ media

Back 558

A558. chocolate agar with factors V and X

Front 559

Q559. M TB media

Back 559

A559. Lowenstein Jensen agar,; 2-4 weeks,; slow growing

Front 560

Q560. Lactose fermenting enterics media

Back 560

A560. MacConkey's agar

Front 561

Q561. Features of MacConkeys

Back 561

A561. bile salts and crystal violet- inhibit GP; lactose- only carbohydrate; neutral red stain (those that ferment lactose will pick it up)

Front 562

Q562. congo red stains for

Back 562

A562. amyloid; (green apply birefringence because of beta pleated sheets)

Front 563

Q563. giema stains for

Back 563

A563. borrelia,; plasmodium,; trypanosomes,; chlamydia

Front 564

Q564. Ziehl-Neelson stains for

Back 564

A564. acid fact bacteria

Front 565

Q565. india ink stains for

Back 565

A565. C neoformans

Front 566

Q566. silver stains for

Back 566

A566. fungi,; PCP,; legionella

Front 567

Q567. methods for exchanging DNA cell to cell

Back 567

A567. conjugation,; transduction,; transformation

Front 568

Q568. method for plasmid transfer

Back 568

A568. conjugation by f-pillus

Front 569

Q569. obligate aerobes

Back 569

A569. nocardia,; pseudomonas,; myco TB,; bacillus; "nagging pests must breathe"

Front 570

Q570. m TB likes...

Back 570

A570. apices of the lung which have the highest PO2

Front 571

Q571. obligate anaerobes

Back 571

A571. clostridium,; bacteriodes,; actinomyces; cannot use aminoglycosides against them; lack catalase/superoxide dismutase

Front 572

Q572. obligate IC bugs

Back 572

A572. rickettsia, chlamydia; cannot make their own ATP

Front 573

Q573. encapsulated bacteria

Back 573

A573. strep pneumo,; H influ,; neisseria mening,; kleb pneumo

Front 574

Q574. spore formers

Back 574

A574. bacillus anthracis,; clostridium perfringens,; c tetani,; coxiella

Front 575

Q575. Conidia

Back 575

A575. Asexual fungal spores (most spores)

Front 576

Q576. Candida albicans Infxn

Back 576

A576. Systemic or superficial fungal infection; Thrush esophagitis in ICH; Endocarditis in IV drug user; Post-Antibiotics vaginitis; Diaper rash

Front 577

Q577. Candida albicans transmission?

Back 577

A577. Inhalation of spores. No person-to-person spread.

Front 578

Q578. Candida albicans treatment?

Back 578

A578. Superficial infxn: nystatin; Systemic infxn: amphotericin B

Front 579

Q579. Systemic (inhaled) mycoses - diseases (4)

Back 579

A579. Histoplasmosis; Blastomycosis; Coccidiodomycosis; Paracoccidiomycosis

Front 580

Q580. Histoplasmosis; Endemic location and pathologic features

Back 580

A580. MS and OH river valley; Causes pneumonia; Bird/bat droppings; Intracellular (see Macs filled with yeast)

Front 581

Q581. Blastomycosis; Endemic location and pathologic features

Back 581

A581. MS river states + Central America; Inflammatory lung disease; Can disseminate to skin and bone; Granulomatous nodules; Culture on Sabouraud's agar; Broad Base Budding; "Cold=Mold"; "Heat=Yeast"

Front 582

Q582. Coccidiodomycosis; Endemic location and pathologic features

Back 582

A582. SW US, CA; "Valley fever"; Pneumonia and meningitis; Can disseminate to bone and skin; Spherules filled with endospores

Front 583

Q583. Paracoccidiomycosis; Endemic location and pathologic features

Back 583

A583. Rural Latin America; Budding yeast with "Captain's wheel" appearance

Front 584

Q584. Diseases caused by dimorphic fungi (4)

Back 584

A584. Histoplasmosis; Blastomycosis; Coccidiomycosis; Paracoccidiomycosis

Front 585

Q585. Dimorphic fungi properties

Back 585

A585. COLD=MOLD (soil); HEAT=YEAST (body temp) (except coccidiomycosis: spherule in tissue); All can cause pneumonia and disseminate; Systemic infxns can mimic TB (granuloma formation)

Front 586

Q586. Treatment of Dimorphic fungi

Back 586

A586. local: fluconazole or ketoconazole; systemic: amphotericin B

Front 587

Q587. Cutaneous mycosis

Back 587

A587. Tinea versicolor; Tinea pedis; Tinea cruris; Tinea capitis; Tinea corporis

Front 588

Q588. Tinea versicolor

Back 588

A588. Caused by Maelassezia furfur; hot, humid weather; "Spaghetti and meatball appearance"; Treat: miconazole, selenium sulfide

Front 589

Q589. Tinea pedis, cruris, corporis, capitis

Back 589

A589. Pruritic lesion with central clearing resembling a ring; Caused by dermatophytes; Mold hyphae in KOH prep are not dimorphic; Pets are reservoirs; Treat: azoles

Front 590

Q590. Opportunistic fungal infxns (7)

Back 590

A590. Candida albicans; Aspergillus fumigatus; Cryptococcus neoformans; Mucor; Rhizopus; Pneumocystis jiroveci; Sporothrix schenckii

Front 591

Q591. Mucor and Rhizopus spp.

Back 591

A591. Mucormycosis; Found in ketoacidotic diabetics and leukemic Pts; Proliferate in walls of BVs; Cause infarction and necrosis; Rhinocerebral, frontal lobe abcesses

Front 592

Q592. Pneumocystis jiroveci (PCP)

Back 592

A592. Diffuse interstitial pneumonia (PCP); Inhaled yeast. Most infxns--asymptomatic; Dx: lung biopsy or lavage, silver stain; Treat: TMP-SMX, pentamidine, dapsone; AIDS: prophylaxis at CD4 < 200

Front 593

Q593. The molds

Back 593

A593. aspergillus,; mucor/rhizopus,; cutaneous mycoses

Front 594

Q594. The yeasts

Back 594

A594. candida albicans,; crypto neoformans,; pneumocystis carinii

Front 595

Q595. The dimorphic

Back 595

A595. sporothrix,; coccidio,; histoplasmosis,; paracoccidio,; blastomycosis

Front 596

Q596. Candida infections

Back 596

A596. thrush in immunocompromised,; vulvovaginitis,; disseminated candidiasis,; chronic mucocutaneous candidiasis,; ballanitis,; esophagitis,; endocarditis,; diaper rash

Front 597

Q597. What is seen in diaper rash

Back 597

A597. irregular border with satellite lesions

Front 598

Q598. Treatment for candida

Back 598

A598. nystatin or azoles for superficial,; Amp B for systemic

Front 599

Q599. Features of thrush

Back 599

A599. will scrape,; will not swab

Front 600

Q600. Aspergillus infections

Back 600

A600. allergic bronchopulmonary aspergillosis,; lung cavity aspergilloma ("fungus ball"),; invasive aspergillosis

Front 601

Q601. Aspergillus features

Back 601

A601. mold with septate hyphae that branch at acute angles

Front 602

Q602. C neoformans infections

Back 602

A602. cryptococcal meningitis (HIV/AIDS),

Front 603

Q603. C neoformans features

Back 603

A603. encapsulated yeast,; found in soil, pigeon droppings; stains with India ink, urease positive; SNOWMAN

Front 604

Q604. Mucor and rhizopus

Back 604

A604. branches at wide angles,; disease mostly in ketoacidosis diabetes and leukemic patients;; can cause infarction, rhinocerebral or frontal lobe abscesses; wide angle branching!

Front 605

Q605. PCP

Back 605

A605. causes diffuse interstital pneumonia, inhaled, mostly asymptomatic;; immunosupressed; dx by lung biospy or lavage; silver stain; tx: tmp-smx, pentamidine, dapsone; prophylaxis when CD4 < 200

Front 606

Q606. coccidio

Back 606

A606. SW US, CA;; mold "winebarrels" -arthroconidia;; sandstorms; San Joaquin Valley or desert fever

Front 607

Q607. Histoplasmosis

Back 607

A607. MS and OH river valleys,; bird or bat droppings,; intracellular tiny yeast inside macrophages

Front 608

Q608. Paracoccidio

Back 608

A608. Rural Latin America,; multiple budding yeast form

Front 609

Q609. Blastomycosis

Back 609

A609. States E of MS river, Central America; big broad-based budding yeast

Front 610

Q610. Tinea infections caused by...

Back 610

A610. microsporum,; trichophyton,; epidermophyton,; spidermophyton

Front 611

Q611. infections associated with birds

Back 611

A611. C neoformans,; H capsulatum,; C psittaci,; West Nile,; Avian influenza (H5, N1)

Front 612

Q612. Amp MOA, use, toxicities

Back 612

A612. Amp B (also nystatin) binds to ergosterol, pokes holes in the membrane; systemic infections, intrathecally; fever/chills, hypotension, nephro(affinity for cells in the GBM)/hepatotox, arrythmias, anemia, IV phlebitis

Front 613

Q613. nystatin use

Back 613

A613. too toxic for systemic,; use orally or topical

Front 614

Q614. Azole MOA; uses; toxicity

Back 614

A614. inhibit fungal steroid (ergosterol) synthesis; systemic mycoses (fluconazole for cryptococcal meningitis in AIDS pts), also hypercortisolism; hormone synthesis inhibition (gynecomastia), liver dysfunction (inhibits cyt P 450), fever chills

Front 615

Q615. flucytosine mechanism, uses

Back 615

A615. inhibits DNA synthesis by conversion to fluorouracil; systemic fungal infections

Front 616

Q616. capsofungin uses

Back 616

A616. invasive aspergillosis; (inhibits cell wall synthesis)

Front 617

Q617. terbinafine mechanism

Back 617

A617. inhibits fungal enzyme squalene epoxidase,; used topically or orally

Front 618

Q618. griseofulvin mechanism, use, Toxicity

Back 618

A618. interferes with microtubule function, disrupts mitosis, deposits in keratin containing tissues; oral treatment of superficial infections, inhibits growth of dermatophytes; teratogenic, carcinogenic, confusion, headaches, increase P450 met and warfarin metabolism

Front 619

Q619. Giardiasis

Back 619

A619. Giardia lamblia; Transmitted by Cysts in water; often seen in campers/hikers; Bloating, flatulence, foul-smelling diarrhea; Diagnosis: trophozoites or cysts in stool; Tx: Metronidazole

Front 620

Q620. Chagas disease

Back 620

A620. Trypanosoma cruzi; The reduviid bug ("kissing bug") is responsible for the transmission of this organism; South America; dilated cardiomyopathy, megacolon, megaesophagus;; Dx: Blood smear; tx: Nifurtimox

Front 621

Q621. African sleeping sickness

Back 621

A621. Etiology: Trypanosoma gambiense, Trypanosoma rhodesiense; The tsetse fly is responsible for transmission; Enlarged lymph nodes, recurring fever (due to antigenic variation), somnolence, coma; dx: Blood smear; tx: Suramin, The treatment for African sleeping sickness that has penetrated the CNS is Melarsoprol

Front 622

Q622. Visceral leishmaniasis (kala-azar)

Back 622

A622. Leishmania donovani; The sandfly transmits; spiking fevers, hepatosplenomegaly, pancytopenia; dx: Macrophages containing amastigotes; tx: Sodium stibogluconate

Front 623

Q623. Name the four types of malaria

Back 623

A623. Plasmodium vivax,; Plasmodium ovale,; Plasmodium malariae,; Plasmodium falciparum

Front 624

Q624. What are the common sx of malaria

Back 624

A624. Cyclic fever,; headache,; anemia,; splenomegaly

Front 625

Q625. What types of Plasmodium have dormant forms in liver (hypnozoites) and causes relapsing malaria?

Back 625

A625. P. vivax and P. ovale

Front 626

Q626. What Plasmodium cases severe malaria that can affect CNS

Back 626

A626. P. falciparum

Front 627

Q627. What is the treatment for malaria?

Back 627

A627. Chloroquine (primaquine to prevent relapse caused by P. vivax, P. ovale),; sulfadoxine + pyrimethamine,; mefloquine,; quinine

Front 628

Q628. Babesiosis

Back 628

A628. Transmitted by Ixodes tick; fever and hemolytic anemia; Maltese cross: A classic sign of Babesiosis: a RBC has no RBC pigment and a cross shape can be seen; Tx: Quinine, clindamycin

Front 629

Q629. Cryptosporidium

Back 629

A629. -

Front 630

Q630. How is Cryptosporidium? diagnosed?

Back 630

A630. transmitted through cysts in water; Mild disease (watery diarrhea) in non-immunocompromised. Severe diarrhea in AIDS. Dx: cysts on acid-fast stain; There is no treatment for Cryptosporidium

Front 631

Q631. Toxoplasma gondii

Back 631

A631. Transmitted by cysts in meat or cat feces; crosses placenta (pregnant women should avoid cats); causes brain abscess in HIV and birth defects; pregnant women should avoid cats; dx: Serology, biopsy; tx: Sulfadiazine and pyrimethamine

Front 632

Q632. Amebiasis

Back 632

A632. Entamoeba histolytica; Transmitted by cysts in water; cause bloody diarrhea, liver abscess, and RUQ pain; dx: Serology and/or trophozoites or cysts in stool; RBCs in cytoplasm of entmoeba; tx: Metronidazole and iodoquinol

Front 633

Q633. Rapidly fatal meningoencephalitis

Back 633

A633. Naegleria fowleri is responsible; Transmission: Swimming in freshwater lakes (enter via cribriform plates); dx: Amoebas in spinal fluid

Front 634

Q634. echinococcus

Back 634

A634. eggs in dog feces--> cysts in liver,; causes anaphylaxis if echinococcal antigens are released from cysts

Front 635

Q635. schistosoma

Back 635

A635. snail are host (freshwater),; cercariae penetrate skin of humans,; causes granulomas, fibrosis, and inflammation of spleen and liver

Front 636

Q636. clonorchis

Back 636

A636. undercooked fish,; causes inflammation of biliary tract

Front 637

Q637. tx for schistosoma, clonorchis, and paragonimus

Back 637

A637. Praziquantel

Front 638

Q638. tx for taenia solium

Back 638

A638. praziquantel,; albendazole

Front 639

Q639. echinococcus tx

Back 639

A639. albendazole

Front 640

Q640. ancylostoma

Back 640

A640. larvae penetrate skin of feet;; intestinal infection can cause anemia;; Fe deficiency

Front 641

Q641. ascaris

Back 641

A641. eggs visible in feces, intestinal infection;; in 1/3 of the world

Front 642

Q642. enterobius

Back 642

A642. food contaminated with eggs,; intestinal infection,; causes anal pruritis (most common worm in US),; scotch tape test

Front 643

Q643. strongyloides

Back 643

A643. larvae in soil penetrate the skin, intestinal infection;; life cycle similar to ascaris

Front 644

Q644. tx for ancylostoma, ascaris, enterobius

Back 644

A644. mebendazole/pyrantel pamoate

Front 645

Q645. tx for enterobius

Back 645

A645. mebendazole,; PP

Front 646

Q646. tx for strongyloides

Back 646

A646. ivermectin/thiabendazole

Front 647

Q647. wuchereria bancrofti

Back 647

A647. female mosquito;; causes blockage of lymphatics (elephantiasis);; tx with diethylcarbamazine

Front 648

Q648. bladder cancer in 3rd world countries

Back 648

A648. schistosoma hematobium

Front 649

Q649. hookworm

Back 649

A649. ancylostoma

Front 650

Q650. roundworm

Back 650

A650. ascaris

Front 651

Q651. trichinella

Back 651

A651. from undercooked meat,; causes muscle inflammation and periorbital edema

Front 652

Q652. tx of entamoeba, giardia, trichomonas

Back 652

A652. metronidazole

Front 653

Q653. giardia

Back 653

A653. causes bloating,; flatulence,; foul-smelling diarrhea (campers, hikers),; from cysts in water

Front 654

Q654. most common malariae

Back 654

A654. Plasmodium vivax and falciparum

Front 655

Q655. Malaria disease

Back 655

A655. cyclic fever,; headache,; anemia,; splenomegaly

Front 656

Q656. treatment of malaria

Back 656

A656. chloroquine and primaquine (esp with PV and PO relapse),; sulfadoxine and pyrimethamine, mefloquin, quinine and doxycycline

Front 657

Q657. malaria form that causes fevers and chills

Back 657

A657. merozoite

Front 658

Q658. replicating malaria

Back 658

A658. shizont

Front 659

Q659. PF gametes

Back 659

A659. banana shaped

Front 660

Q660. trichomonas

Back 660

A660. foul smelling,; greenish discharge,; itching and burning,; sexual tramsition;; motile trophozoites on wet mount with flagella

Front 661

Q661. T. cruzi

Back 661

A661. Chagas- dilated cardiomyopathy, megacolon, megaesophagus; Frum reduviid bug

Front 662

Q662. Leischmania donovanii

Back 662

A662. visceral leishmaniasis,; infects liver and spleen;; from the sandfly but dogs are resevoir;; tx with sodium stibugluconate

Front 663

Q663. most common protozoal infectoin

Back 663

A663. giardia/trichomonas

Front 664

Q664. erythrocyte ingested trophozoite

Back 664

A664. entamoeba histolytica

Front 665

Q665. malaria stage that looks like a diamond ring

Back 665

A665. trophozoite

Front 666

Q666. malaria stage that ruptures the host cell

Back 666

A666. merozoite

Front 667

Q667. malaria stage that replicated intracellularly

Back 667

A667. shizont

Front 668

Q668. malaria stage injected from anopheles mosquito

Back 668

A668. sporozoite

Front 669

Q669. Segmented Viruses

Back 669

A669. BOAR; bunya; orthomyxo; arena; reo; can undergo reassortment causing antigenic shifts which result in pandemics!

Front 670

Q670. Tzanck Test

Back 670

A670. smear of open skin vesicle to detect multinucleated giant cells; picks up hsv and vzv

Front 671

Q671. HA vs NA

Back 671

A671. HA attaches to host sialic acid receptors on upper rest tract; NA cleaves neuramic acid and disrupts mucin barrier exposing sialic acid binding site below

Front 672

Q672. Reye's Syndrome

Back 672

A672. severe brain/liver disease resulting from children being given asa when they have influenza or varicella

Front 673

Q673. Parainfluenza Virus

Back 673

A673. upper resp tract symptoms; can cause croup (infection of larynx) in kids

Front 674

Q674. RSV

Back 674

A674. number 1 cause of pneumonia in young kids; contains F proteins that form multinucleated giant cells (syncytial cells)

Front 675

Q675. Treatment of RSV

Back 675

A675. palivizumab

Front 676

Q676. Measles

Back 676

A676. Cough, Coryza, Conjunctivitis (3Cs); Koplick spots; Paint drip rash; can cause SSPE later one

Front 677

Q677. Enteroviruses

Back 677

A677. all the picorna viruses except Rhino and HAV; spread by fecal oral route

Front 678

Q678. What does polio damage?

Back 678

A678. gray matter, mainly anterior horn of spinal cord and motor nuclei of pons/medulla

Front 679

Q679. HFM disease

Back 679

A679. coxA

Front 680

Q680. CoxB symptoms

Back 680

A680. pleurodynia; myocarditis; pericarditis

Front 681

Q681. Yellow Fever Symptoms

Back 681

A681. Black vomit; high fever, jaudice; transmitted by aedes mosquito

Front 682

Q682. CSF findings of viral, bacterial, and fungal/TB meningitis

Back 682

A682. Bacteria: low glucose, high pressure, high protein, mostly PMNs; Viral: normal/high pressure, normal glucuse, normal protein, mostly lymphs; Fungal/TB: same as bacteria except mostly lymphs!

Front 683

Q683. Rubella symptoms

Back 683

A683. 3day measleas, mild; if congential, BAD, deafness, PDA, cataracts, pulmonary artery stenosis, hydrocephalus