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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. infiltrate in upper lobe of lung?
Either TB or aspergillosis
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
Type 1: patient with dm and pvd; caused by staph/GAS/ e coli/bacteroids; type2 - no associated medical illness - caused by laceration - trauma - surgery - IV drug abuse - caused mainly by GAS
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

2. How to confirm chlamydia infection?
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Cd4 count
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole

3. How to tx pseudomonas?
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
Within 6 months viral load will be <50
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)

4. dame that has already occurred
Monospot test which screen heteropile ab that agglutinate horse rbc
Voriconazol. mycetoma-surgical removal
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Cd4 count

5. How to dx adequate response to HBV vaccine
Vaccine titer >10mU/ml
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
Rifampin600mg q12. or cipro
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.

6. What is the prognosis of lyme arthritis?
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Upper lobes; any fibrosis in this area suggestive of latent TB
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure

7. when not to give INH therapy if ppd positive and patient asyptomatic
Pt who have been treated before for latent TB
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
High risk 19-64; 1-2 dose - above 65; one dose
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.

8. When to tx asymptomatic bacteriurea >100 -000?
Clostridium perfringens after penetrative injuries/wounds
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
Pregnacy - urologic procedure - hip arthoplastu
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.

9. oligodendrocyte with intranuclear inclusion and demyelination in HIV patient
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Similar pathophysiology as ITP - tx zidovudine
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved

10. What are the behavioral interventions decrease the risk of UTI
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Postcoital voiding - increased intake of cranberry juice
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.

11. when western blot is done for HIV testing
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
Mainly clinical - epidemiological and seasonal setting
If a sample is ELISA positive - it is tested fro western blot for confirmation
Oropharyngeal secretions; hence named as kissing disease

12. pathophysiology of toxic shock syndrom?
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Every 3-4 hours to determine appropritate time to start HAART
Voriconazol. mycetoma-surgical removal
Mainly clinical - epidemiological and seasonal setting

13. HIV patient having fat deposition on back of neck and abdomen - like cushing
Postcoital voiding - increased intake of cranberry juice
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Do EBV antibody test

14. hypertriglyceridemia in HIV
Pregnacy - urologic procedure - hip arthoplastu
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
Monospot test which screen heteropile ab that agglutinate horse rbc
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6

15. How long we tx chronic prostatis?
6-12 weeks
Pt who have been treated before for latent TB
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ

16. What are the subjective /objective measure of encephalopathy?
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
<500 copies/ml
Immune mediated; circulating IgG and IgM to penicillin derivatives

17. What is the criteria for Spontaneous bact peritonitis
High risk 19-64; 1-2 dose - above 65; one dose
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
Oropharyngeal secretions; hence named as kissing disease
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose

18. pneumococcal vaccine indication?
Rifampin600mg q12. or cipro
High risk 19-64; 1-2 dose - above 65; one dose
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
ELISA; initial visit - 6 - 12 and 24 weeks;

19. how CMV presents in immunocompromised patients
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
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
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Within 6 months viral load will be <50

20. How to dx bacterial meningitis from CSF study?

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21. chshould we tx IM with abx (ampicilin) if throat cx is positive?
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash

22. when HIV patient develop pcp?
When cd4 count falls below 200. 2p in pcp =200
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -

23. INH
AA gradient >35 or Po2 <70
Either TB or aspergillosis
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6

24. What is the pathophysiology of Meningococcal meningitis?
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Every 3-4 hours to determine appropritate time to start HAART
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
High risk 19-64; 1-2 dose - above 65; one dose

25. after exposure of HIV when antibody testing is performed?
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.
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Either TB or aspergillosis
ELISA; initial visit - 6 - 12 and 24 weeks;

26. acute febrile reaction develops after starting penicilin tx to syphilis patient
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Postcoital voiding - increased intake of cranberry juice
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin

27. thrombocytopenia in HIV
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.
Similar pathophysiology as ITP - tx zidovudine
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.

28. after bone marrow transplant - patient develop headache - fever - cought and chest pain. What is dx?
If a sample is ELISA positive - it is tested fro western blot for confirmation
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses

29. drugs work well on hypertriglyceridia?
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
Ampicillin-sublactam; most bites contain eikenella

30. How to give postexposure prophylaxis to patient who received vaccine but titer inadequate
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Blastomycosis
HBIG hep B immunoglobulin
Reddish orange discoloration of urine - feces - sweat - tears - sputum

31. What is characteristic for dx of rocky mountain spotted fever?
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Pt who have been treated before for latent TB

32. What is difference between uti relapse versus recurrence?
Pregnacy - urologic procedure - hip arthoplastu
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
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
Within 6 months viral load will be <50

33. How to tx pcp?
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
No skin changes but pain out of proportion; infection spreads along fascial plane rapidly with blister - erythema - and bullae formation; marked tenderness on palpation - and CREPITUS
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

34. When to tx influenza with antiviral therapy?
Pt who have been treated before for latent TB
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
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

35. Tx of choice for human bites
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Ampicillin-sublactam; most bites contain eikenella
Clostridium perfringens after penetrative injuries/wounds

36. What is the mch of ampicillin induced rash in IM
Oropharyngeal secretions; hence named as kissing disease
Immune mediated; circulating IgG and IgM to penicillin derivatives
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer

37. What is the indication of corticosteroid in pcp infection?
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
AA gradient >35 or Po2 <70
Others lesions are ring enhancing and have mass effect while PML don't
HIV viral load

38. causative organisms of uti
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Pegylated interferon and lamivudine
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

39. How to give postexposure prophylaxis for HIV
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Voriconazol. mycetoma-surgical removal
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

40. low grade fever - maculopapular rash - lymphadenopathy
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Every 3-4 hours to determine appropritate time to start HAART
Clostridium perfringens after penetrative injuries/wounds
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles

41. How to dx cryptococal meninggits
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Bronchoalveolar washing and transbronchial biopsy
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
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine

42. aspergillosis
High risk 19-64; 1-2 dose - above 65; one dose
Voriconazol. mycetoma-surgical removal
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
ELISA; initial visit - 6 - 12 and 24 weeks;

43. foot infections in DM
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Every 3-4 hours to determine appropritate time to start HAART
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Either TB or aspergillosis

44. what if monospot test is neg in IM?
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Voriconazol. mycetoma-surgical removal
Do EBV antibody test

45. which heart valve is closer to ventricular conduction system/
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Aortic valve; endocardiits of AR p/w AV block and LBBB
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -

46. What is tetanus - diptheria - pertusis recommendation?
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
Td every 10 years - tdap once before 65 and after 65
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Cd4 count

47. How to differentiate gonococcal and nongonoccal urethritis?
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
High risk 19-64; 1-2 dose - above 65; one dose
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
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

48. rifampin
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Reddish orange discoloration of urine - feces - sweat - tears - sputum
<5000 copies/ml
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads

49. How to dx IM?
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Monospot test which screen heteropile ab that agglutinate horse rbc
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
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses

50. What is the classic signs of nec fasc?
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
6-12 weeks
No skin changes but pain out of proportion; infection spreads along fascial plane rapidly with blister - erythema - and bullae formation; marked tenderness on palpation - and CREPITUS
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles

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USMLE Step3 Infectious Disease

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