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USMLE Step3 Infectious Disease

Subjects : health-sciences, usmle-step-3

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Answer 50 questions in 15 minutes.
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1. What is the pathophysiology of Meningococcal meningitis?
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Mainly clinical - epidemiological and seasonal setting
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
Similar pathophysiology as ITP - tx zidovudine

2. What is the Tx of cryptococcal meninngitis
Monospot test which screen heteropile ab that agglutinate horse rbc
Every 3-4 hours to determine appropritate time to start HAART
Pregnacy - urologic procedure - hip arthoplastu
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol

3. What are the subjective /objective measure of encephalopathy?
Pregnacy - urologic procedure - hip arthoplastu
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease

4. How to dx lyme arthritis?
When patient is older >65 - pregnant - cardiac of pulmonary disease; patient without above risks are treated when they come within 48 hours of symptom onset
Immune mediated; circulating IgG and IgM to penicillin derivatives
Gonococcal with purulent discharges and presence of multiple diplococi and neurotrophils in urethral swab; non gonoccal (chlamydia) are watery disch - swab abacterial - sometimes have intracellular organism
ELISA and western blot of synovial fluid.

5. wisconsin - missisipi - ohio
<500 copies/ml
Blastomycosis
Upper lobes; any fibrosis in this area suggestive of latent TB
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

6. How to confirm chlamydia infection?
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Immune mediated; circulating IgG and IgM to penicillin derivatives
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole

7. what would be viral load after 2-4m of HAART?
Blastomycosis
Either TB or aspergillosis
Oropharyngeal secretions; hence named as kissing disease
<500 copies/ml

8. How to dx adequate response to HBV vaccine
Vaccine titer >10mU/ml
Relapse: infecting organism is same as original infecting organism within 2 weeks of tx completion; recurrence: if the infecting organism is different from that of the original organism
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Bronchoalveolar washing and transbronchial biopsy

9. where TB normally affects
Upper lobes; any fibrosis in this area suggestive of latent TB
If a sample is ELISA positive - it is tested fro western blot for confirmation
Aortic valve; endocardiits of AR p/w AV block and LBBB
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w

10. What are the behavioral interventions decrease the risk of UTI
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Postcoital voiding - increased intake of cranberry juice
Similar pathophysiology as ITP - tx zidovudine

11. When not to tx asymptomatic bacteriura?
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Acyclovir
Non pregnant premanopausal - elderly - dm - sci - chronic foley
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin

12. How to tx pseudomonas?
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Blastomycosis
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
HBIG hep B immunoglobulin

13. When to tx influenza with antiviral therapy?
Ampicillin-sublactam; most bites contain eikenella
When patient is older >65 - pregnant - cardiac of pulmonary disease; patient without above risks are treated when they come within 48 hours of symptom onset
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole

14. How to dx IM?
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
Monospot test which screen heteropile ab that agglutinate horse rbc
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50

15. What are indicators for progression of HIV
Upper lobes; any fibrosis in this area suggestive of latent TB
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
Viral load and CD4 count
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50

16. acute febrile reaction develops after starting penicilin tx to syphilis patient
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
ELISA; initial visit - 6 - 12 and 24 weeks;

17. patient is taking inhaled corticosteroid for asthma - now p/w oral candidiasis
Aortic valve; endocardiits of AR p/w AV block and LBBB
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ

18. after recent exposure - negative ELISA - How to confirm?
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
If a sample is ELISA positive - it is tested fro western blot for confirmation
Gonococcal with purulent discharges and presence of multiple diplococi and neurotrophils in urethral swab; non gonoccal (chlamydia) are watery disch - swab abacterial - sometimes have intracellular organism
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.

19. how HAART therapy affects HIV viral loads?
Within 6 months viral load will be <50
If a sample is ELISA positive - it is tested fro western blot for confirmation
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Monospot test which screen heteropile ab that agglutinate horse rbc

20. How to dx IM?
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid

21. antibiotic with good prostate penetration?
Pregnacy - urologic procedure - hip arthoplastu
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Do EBV antibody test
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ

22. How to tx TSS?
Blastomycosis
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Ampicillin-sublactam; most bites contain eikenella
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

23. what if monospot test is neg in IM?
Postcoital voiding - increased intake of cranberry juice
Oropharyngeal secretions; hence named as kissing disease
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Do EBV antibody test

24. How to give postexposure prophylaxis to patient who received vaccine but titer inadequate
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Pts with pseudomonas bacerimia have this. they have perivascular bacterial invasion of the media and adventitia of arteries and veins. then ishcemic necrosis; skin and mucous membrane have nodular patches wtih hemorrhage and ulceration
Tx emptirically both gonococcus and chlamydia; 30% gono have coexsiting chlamydial infection; single dose ceftriaxone for gono and Azithromycin for chlamydia. if no improvement give metronidazol for trichomonas infection
HBIG hep B immunoglobulin

25. What is characteristic for dx of rocky mountain spotted fever?
Others lesions are ring enhancing and have mass effect while PML don't
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
HBIG hep B immunoglobulin
<5000 copies/ml

26. What is the indication of corticosteroid in pcp infection?
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
AA gradient >35 or Po2 <70
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Every 3-4 hours to determine appropritate time to start HAART

27. What is the mch of ampicillin induced rash in IM
HBIG hep B immunoglobulin
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Others lesions are ring enhancing and have mass effect while PML don't
Immune mediated; circulating IgG and IgM to penicillin derivatives

28. how CMV presents in immunocompromised patients
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Within 6 months viral load will be <50
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved

29. gas gangrene
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Either TB or aspergillosis
Clostridium perfringens after penetrative injuries/wounds
ELISA; initial visit - 6 - 12 and 24 weeks;

30. How to differentiate gonococcal and nongonoccal urethritis?
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Vaccine titer >10mU/ml
Gonococcal with purulent discharges and presence of multiple diplococi and neurotrophils in urethral swab; non gonoccal (chlamydia) are watery disch - swab abacterial - sometimes have intracellular organism
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.

31. thrombocytopenia in HIV
Similar pathophysiology as ITP - tx zidovudine
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
Cd4 count
High risk 19-64; 1-2 dose - above 65; one dose

32. causative organisms of uti
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Postcoital voiding - increased intake of cranberry juice
6-12 weeks
Need lumbar puncture to relieve pressure; they have high opening pressure >350

33. acute onset +rusty sputum
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV

34. how im is transmitted?
Oropharyngeal secretions; hence named as kissing disease
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV

35. when not to give INH therapy if ppd positive and patient asyptomatic
AA gradient >35 or Po2 <70
Pt who have been treated before for latent TB
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses
Either TB or aspergillosis

36. What is fatal consequence of RMSF?
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Need lumbar puncture to relieve pressure; they have high opening pressure >350
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle

37. How to dx progressive multifocal leukoencephalopathy
Oropharyngeal secretions; hence named as kissing disease
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits

38. What is the Tx of STD uretheritis?
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Similar pathophysiology as ITP - tx zidovudine
Tx emptirically both gonococcus and chlamydia; 30% gono have coexsiting chlamydial infection; single dose ceftriaxone for gono and Azithromycin for chlamydia. if no improvement give metronidazol for trichomonas infection

39. reddish colored papules with central umbilication in HIV or immunocompromised patient
Think about cutaneous cryptococous; lesions looks like molluscus contagiousm. present in face/trunk/anywherer; dx biopsy of lesion which shows granulomatous inflammation with multinucleated giant cell
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Upper lobes; any fibrosis in this area suggestive of latent TB
Acyclovir

40. How to give postexposure prophylaxis for HIV
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
CD4 less than 350 and RPR >1:32; HIV infected patient with syphilis >1 yr should have CSF exam before tx. if csf normal tx with benzathine penicillin weekly for 3 weeks.
Vaccine titer >10mU/ml

41. damae that is about to occur?
Tx emptirically both gonococcus and chlamydia; 30% gono have coexsiting chlamydial infection; single dose ceftriaxone for gono and Azithromycin for chlamydia. if no improvement give metronidazol for trichomonas infection
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Relapse: infecting organism is same as original infecting organism within 2 weeks of tx completion; recurrence: if the infecting organism is different from that of the original organism
HIV viral load

42. When to give abx to prevent recurrent uti
Tx emptirically both gonococcus and chlamydia; 30% gono have coexsiting chlamydial infection; single dose ceftriaxone for gono and Azithromycin for chlamydia. if no improvement give metronidazol for trichomonas infection
More than two UTI in six months or more than 3 uti in a year; cipro/bactrim/nitrofurantoin; abx may be given continuous or postcoital
Do EBV antibody test
Upper lobes; any fibrosis in this area suggestive of latent TB

43. What is tx for herpes zoster
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Acyclovir

44. How to dx cryptococal meninggits
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
<5000 copies/ml
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine

45. How to dx bacterial meningitis from CSF study?

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46. What is lag time to develop lyme arthritis after exposure to vector
Oropharyngeal secretions; hence named as kissing disease
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Rifampin600mg q12. or cipro

47. drugs work well on hypertriglyceridia?
Cd4 count
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes

48. foot infections in DM
Non pregnant premanopausal - elderly - dm - sci - chronic foley
Relapse: infecting organism is same as original infecting organism within 2 weeks of tx completion; recurrence: if the infecting organism is different from that of the original organism
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol

49. How to tx chronic hep B
Pegylated interferon and lamivudine
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Non pregnant premanopausal - elderly - dm - sci - chronic foley
Vaccine titer >10mU/ml

50. What is used for prophylaxis against meningo..meningitis?
Rifampin600mg q12. or cipro
High risk 19-64; 1-2 dose - above 65; one dose
Ampicillin-sublactam; most bites contain eikenella
Cd4 count

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USMLE Step3 Infectious Disease

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