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USMLE Step3 Infectious Disease

Subjects : health-sciences, usmle-step-3

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1. How to dx cryptococal meninggits
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
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
Mainly clinical - epidemiological and seasonal setting
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine

2. how HAART therapy affects HIV viral loads?
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Clostridium perfringens after penetrative injuries/wounds
Within 6 months viral load will be <50
ELISA and western blot of synovial fluid.

3. where TB normally affects
Monospot test which screen heteropile ab that agglutinate horse rbc
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Upper lobes; any fibrosis in this area suggestive of latent TB
When cd4 count falls below 200. 2p in pcp =200

4. When not to tx asymptomatic bacteriura?
Similar pathophysiology as ITP - tx zidovudine
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Ampicillin-sublactam; most bites contain eikenella
Non pregnant premanopausal - elderly - dm - sci - chronic foley

5. pathophysiology of toxic shock syndrom?
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Viral load and CD4 count
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol

6. How to dx progressive multifocal leukoencephalopathy
Ampicillin-sublactam; most bites contain eikenella
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region

7. can HIV transmitted through human bite?
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
HBIG hep B immunoglobulin
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.

8. what would be viral load after 2-4m of HAART?
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
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
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
<500 copies/ml

9. What is difference between uti relapse versus recurrence?
Pregnacy - urologic procedure - hip arthoplastu
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
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
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash

10. gas gangrene
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
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
Clostridium perfringens after penetrative injuries/wounds

11. hypertriglyceridemia in HIV
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.
Td every 10 years - tdap once before 65 and after 65
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate

12. when HIV patient develop pcp?
Need lumbar puncture to relieve pressure; they have high opening pressure >350
If a sample is ELISA positive - it is tested fro western blot for confirmation
Td every 10 years - tdap once before 65 and after 65
When cd4 count falls below 200. 2p in pcp =200

13. which heart valve is closer to ventricular conduction system/
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
Monospot test which screen heteropile ab that agglutinate horse rbc
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Aortic valve; endocardiits of AR p/w AV block and LBBB

14. infiltrate in upper lobe of lung?
Vaccine titer >10mU/ml
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
<5000 copies/ml
Either TB or aspergillosis

15. when not to give INH therapy if ppd positive and patient asyptomatic
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
Postcoital voiding - increased intake of cranberry juice
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -

16. What is the Tx of cryptococcal meninngitis
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Oropharyngeal secretions; hence named as kissing disease
Upper lobes; any fibrosis in this area suggestive of latent TB

17. How often HIV postiive patients CD4 count needs to be evaluated?
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
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
Acyclovir

18. How often viral load is monitored after HAART?
Postcoital voiding - increased intake of cranberry juice
Pregnacy - urologic procedure - hip arthoplastu
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)

19. patient with diagnosed case of cryptococcal meningitis p/w severe headache and vomiting
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Need lumbar puncture to relieve pressure; they have high opening pressure >350
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
Every 3-4 hours to determine appropritate time to start HAART

20. after recent exposure - negative ELISA - How to confirm?
Clostridium perfringens after penetrative injuries/wounds
PML; focal neurological deficit like MM; no specific tx; regress with HAART
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
Bronchoalveolar washing and transbronchial biopsy

21. How to differentiate different types of necrotizing fascitis?
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
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
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)

22. antibiotic with good prostate penetration?
Either TB or aspergillosis
Rifampin600mg q12. or cipro
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ

23. how im is transmitted?
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Oropharyngeal secretions; hence named as kissing disease

24. How to give postexposure prophylaxis for HIV
Voriconazol. mycetoma-surgical removal
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
Viral load and CD4 count

25. What are the subjective /objective measure of encephalopathy?
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Td every 10 years - tdap once before 65 and after 65
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Blastomycosis

26. patient is taking inhaled corticosteroid for asthma - now p/w oral candidiasis
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine

27. What are indicators for progression of HIV
Pt who have been treated before for latent TB
Viral load and CD4 count
Reddish orange discoloration of urine - feces - sweat - tears - sputum
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

28. How to tx pcp?
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
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Vaccine titer >10mU/ml

29. thrombocytopenia in HIV
Similar pathophysiology as ITP - tx zidovudine
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
Bronchoalveolar washing and transbronchial biopsy

30. How to dx IM?
Others lesions are ring enhancing and have mass effect while PML don't
Postcoital voiding - increased intake of cranberry juice
Monospot test which screen heteropile ab that agglutinate horse rbc
<500 copies/ml

31. clinical manifestation of mucomycosis
Clostridium perfringens after penetrative injuries/wounds
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads

32. wisconsin - missisipi - ohio
HIV viral load
When cd4 count falls below 200. 2p in pcp =200
Blastomycosis
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid

33. causative organisms of uti
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Within 6 months viral load will be <50
High risk 19-64; 1-2 dose - above 65; one dose
6-12 weeks

34. Tx of choice for human bites
Acyclovir
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
Ampicillin-sublactam; most bites contain eikenella
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol

35. What is the criteria for Spontaneous bact peritonitis
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Similar pathophysiology as ITP - tx zidovudine

36. How to tx IM?
Pegylated interferon and lamivudine
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
ELISA; initial visit - 6 - 12 and 24 weeks;
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma

37. INH
Others lesions are ring enhancing and have mass effect while PML don't
Postcoital voiding - increased intake of cranberry juice
High risk 19-64; 1-2 dose - above 65; one dose
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50

38. acute febrile reaction develops after starting penicilin tx to syphilis patient
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
Others lesions are ring enhancing and have mass effect while PML don't
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
Oropharyngeal secretions; hence named as kissing disease

39. What is used for prophylaxis against meningo..meningitis?
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
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
Similar pathophysiology as ITP - tx zidovudine
Rifampin600mg q12. or cipro

40. what parameters increases risk of neurosyphilis in HIV patient
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
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
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.

41. How to tx TSS?
If a sample is ELISA positive - it is tested fro western blot for confirmation
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Doesn't exceed more than 15 mm and size significantly decreases after 15 years

42. What are the behavioral interventions decrease the risk of UTI
Postcoital voiding - increased intake of cranberry juice
Rifampin600mg q12. or cipro
<5000 copies/ml
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma

43. rifampin
Within 6 months viral load will be <50
Td every 10 years - tdap once before 65 and after 65
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole

44. low grade fever - maculopapular rash - lymphadenopathy
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Td every 10 years - tdap once before 65 and after 65
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes

45. foot infections in DM
Pegylated interferon and lamivudine
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV

46. oligodendrocyte with intranuclear inclusion and demyelination in HIV patient
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
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

47. aspergillosis
AA gradient >35 or Po2 <70
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
Voriconazol. mycetoma-surgical removal
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. When to give prophylaxis against MAC
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
Ampicillin-sublactam; most bites contain eikenella
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Do EBV antibody test

49. When to tx influenza with antiviral therapy?
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
Td every 10 years - tdap once before 65 and after 65
Within 6 months viral load will be <50
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

50. dame that has already occurred
Cd4 count
HBIG hep B immunoglobulin
Upper lobes; any fibrosis in this area suggestive of latent TB
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.

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USMLE Step3 Infectious Disease

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