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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. how CMV presents in immunocompromised patients
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Bronchoalveolar washing and transbronchial biopsy
Vaccine titer >10mU/ml
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)

2. patient with diagnosed case of cryptococcal meningitis p/w severe headache and vomiting
Need lumbar puncture to relieve pressure; they have high opening pressure >350
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
Td every 10 years - tdap once before 65 and after 65
Pregnacy - urologic procedure - hip arthoplastu

3. What is the Tx of STD uretheritis?
Others lesions are ring enhancing and have mass effect while PML don't
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Clostridium perfringens after penetrative injuries/wounds
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

4. How to dx cryptococal meninggits
Similar pathophysiology as ITP - tx zidovudine
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
Upper lobes; any fibrosis in this area suggestive of latent TB
<5000 copies/ml

5. INH
If a sample is ELISA positive - it is tested fro western blot for confirmation
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Ampicillin-sublactam; most bites contain eikenella
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6

6. What is fatal consequence of RMSF?
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.

7. What is the Tx of cryptococcal meninngitis
AA gradient >35 or Po2 <70
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
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
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

8. when HIV patient develop pcp?
When cd4 count falls below 200. 2p in pcp =200
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
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

9. What is used for prophylaxis against meningo..meningitis?
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
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
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Rifampin600mg q12. or cipro

10. when not to give INH therapy if ppd positive and patient asyptomatic
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
Pt who have been treated before for latent TB
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

11. aspergillosis
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
<5000 copies/ml
Voriconazol. mycetoma-surgical removal

12. What are indicators for progression of HIV
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Viral load and CD4 count

13. When to give prophylaxis against MAC
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
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
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Voriconazol. mycetoma-surgical removal

14. How to give postexposure prophylaxis for HIV
Pregnacy - urologic procedure - hip arthoplastu
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
ELISA and western blot of synovial fluid.
Need lumbar puncture to relieve pressure; they have high opening pressure >350

15. pneumococcal vaccine indication?
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
<5000 copies/ml
High risk 19-64; 1-2 dose - above 65; one dose
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

16. How to differentiat PML from toxoxplasmosis - cns lymphoma adn brain abscess

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17. What is the prognosis of lyme arthritis?
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Td every 10 years - tdap once before 65 and after 65
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Reddish orange discoloration of urine - feces - sweat - tears - sputum

18. What is the pathophysiology of Meningococcal meningitis?
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
High risk 19-64; 1-2 dose - above 65; one dose
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

19. how HAART therapy affects HIV viral loads?
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
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Within 6 months viral load will be <50
AA gradient >35 or Po2 <70

20. low grade fever - maculopapular rash - lymphadenopathy
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
Rifampin600mg q12. or cipro
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine

21. what would be viral load after 4 weeks
Pegylated interferon and lamivudine
<5000 copies/ml
ELISA and western blot of synovial fluid.
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle

22. infiltrate in upper lobe of lung?
Td every 10 years - tdap once before 65 and after 65
Aortic valve; endocardiits of AR p/w AV block and LBBB
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
Either TB or aspergillosis

23. clinical manifestation of mucomycosis
Do EBV antibody test
ELISA and western blot of synovial fluid.
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
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin

24. oligodendrocyte with intranuclear inclusion and demyelination in HIV patient
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w

25. How to tx IM?
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
Bronchoalveolar washing and transbronchial biopsy
Do EBV antibody test
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid

26. gas gangrene
Clostridium perfringens after penetrative injuries/wounds
HBIG hep B immunoglobulin
Vaccine titer >10mU/ml
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses

27. if a patient received BCG vaccine - how big is his PPD induration

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28. How to differentiate different types of necrotizing fascitis?
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
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

29. How often HIV postiive patients CD4 count needs to be evaluated?
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
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
Every 3-4 hours to determine appropritate time to start HAART
Viral load and CD4 count

30. acute onset +rusty sputum
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
High risk 19-64; 1-2 dose - above 65; one dose
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

31. How to give postexposure prophylaxis to patient who received vaccine but titer inadequate
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
HBIG hep B immunoglobulin
Viral load and CD4 count
<500 copies/ml

32. where TB normally affects
Upper lobes; any fibrosis in this area suggestive of latent TB
Similar pathophysiology as ITP - tx zidovudine
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Postcoital voiding - increased intake of cranberry juice

33. dame that has already occurred
Cd4 count
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)

34. when western blot is done for HIV testing
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
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

35. 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.
Rifampin600mg q12. or cipro
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

36. damae that is about to occur?
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
Rifampin600mg q12. or cipro
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
HIV viral load

37. thrombocytopenia in HIV
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.
Similar pathophysiology as ITP - tx zidovudine
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Mainly clinical - epidemiological and seasonal setting

38. What is the indication of corticosteroid in pcp infection?
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Similar pathophysiology as ITP - tx zidovudine
Acyclovir
AA gradient >35 or Po2 <70

39. What are the behavioral interventions decrease the risk of UTI
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
Postcoital voiding - increased intake of cranberry juice
If a sample is ELISA positive - it is tested fro western blot for confirmation
PML; focal neurological deficit like MM; no specific tx; regress with HAART

40. antibiotic with good prostate penetration?
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Do EBV antibody test
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
Pregnacy - urologic procedure - hip arthoplastu

41. When to tx influenza with antiviral therapy?
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Acyclovir
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

42. How to tx chronic hep B
Pegylated interferon and lamivudine
HBIG hep B immunoglobulin
6-12 weeks
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle

43. hypertriglyceridemia in HIV
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
ELISA; initial visit - 6 - 12 and 24 weeks;
Immune mediated; circulating IgG and IgM to penicillin derivatives
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate

44. When to tx asymptomatic bacteriurea >100 -000?
Pregnacy - urologic procedure - hip arthoplastu
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ

45. acute febrile reaction develops after starting penicilin tx to syphilis patient
Pregnacy - urologic procedure - hip arthoplastu
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.
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
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes

46. Tx of choice for human bites
Ampicillin-sublactam; most bites contain eikenella
Within 6 months viral load will be <50
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Oropharyngeal secretions; hence named as kissing disease

47. rifampin
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Similar pathophysiology as ITP - tx zidovudine

48. What is characteristic for dx of rocky mountain spotted fever?
Aortic valve; endocardiits of AR p/w AV block and LBBB
<500 copies/ml
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma

49. How to dx progressive multifocal leukoencephalopathy
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Blastomycosis

50. causative organisms of uti
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Postcoital voiding - increased intake of cranberry juice
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep

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USMLE Step3 Infectious Disease

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