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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 to give postexposure prophylaxis to patient who received vaccine but titer inadequate
HBIG hep B immunoglobulin
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
Td every 10 years - tdap once before 65 and after 65
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

2. hypertriglyceridemia in HIV
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
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)

3. What is difference between uti relapse versus recurrence?
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
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
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Doesn't exceed more than 15 mm and size significantly decreases after 15 years

4. wisconsin - missisipi - ohio
Pregnacy - urologic procedure - hip arthoplastu
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses
Monospot test which screen heteropile ab that agglutinate horse rbc
Blastomycosis

5. HIV patient having fat deposition on back of neck and abdomen - like cushing
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Either TB or aspergillosis
Monospot test which screen heteropile ab that agglutinate horse rbc

6. reddish colored papules with central umbilication in HIV or immunocompromised patient
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Do EBV antibody test
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
Ampicillin-sublactam; most bites contain eikenella

7. What is the pathophysiology of Meningococcal meningitis?
Either TB or aspergillosis
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges

8. when HIV patient develop pcp?
Postcoital voiding - increased intake of cranberry juice
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
When cd4 count falls below 200. 2p in pcp =200

9. What are the behavioral interventions decrease the risk of UTI
Every 3-4 hours to determine appropritate time to start HAART
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
Postcoital voiding - increased intake of cranberry juice
Voriconazol. mycetoma-surgical removal

10. How to dx?
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
Postcoital voiding - increased intake of cranberry juice
Mainly clinical - epidemiological and seasonal setting

11. antibiotic with good prostate penetration?
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
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -

12. how CMV presents in immunocompromised patients
Similar pathophysiology as ITP - tx zidovudine
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Either TB or aspergillosis

13. pathophysiology of toxic shock syndrom?
Every 3-4 hours to determine appropritate time to start HAART
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
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
AA gradient >35 or Po2 <70

14. How to tx chronic hep B
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Postcoital voiding - increased intake of cranberry juice
Pegylated interferon and lamivudine

15. What is the Tx of STD uretheritis?
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
Clostridium perfringens after penetrative injuries/wounds
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
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

16. can HIV transmitted through human bite?
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep

17. after exposure of HIV when antibody testing is performed?
Pegylated interferon and lamivudine
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
<500 copies/ml
ELISA; initial visit - 6 - 12 and 24 weeks;

18. worsening of TB after starting HAART in HIV
ELISA and western blot of synovial fluid.
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
Pt who have been treated before for latent TB
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx

19. where TB normally affects
Do EBV antibody test
ELISA; initial visit - 6 - 12 and 24 weeks;
Aortic valve; endocardiits of AR p/w AV block and LBBB
Upper lobes; any fibrosis in this area suggestive of latent TB

20. How to dx cryptococal meninggits
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid

21. patient with diagnosed case of cryptococcal meningitis p/w severe headache and vomiting
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
Need lumbar puncture to relieve pressure; they have high opening pressure >350
Postcoital voiding - increased intake of cranberry juice
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)

22. chshould we tx IM with abx (ampicilin) if throat cx is positive?
ELISA; initial visit - 6 - 12 and 24 weeks;
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Immune mediated; circulating IgG and IgM to penicillin derivatives
<500 copies/ml

23. what if monospot test is neg in IM?
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Ampicillin-sublactam; most bites contain eikenella
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
Do EBV antibody test

24. when we see echym gangrenosum?
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
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
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

25. aspergillosis
HIV viral load
Voriconazol. mycetoma-surgical removal
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
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

26. after recent exposure - negative ELISA - How to confirm?
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
If a sample is ELISA positive - it is tested fro western blot for confirmation
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease

27. when not to give INH therapy if ppd positive and patient asyptomatic
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
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Pt who have been treated before for latent TB

28. How often HIV postiive patients CD4 count needs to be evaluated?
ELISA and western blot of synovial fluid.
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Every 3-4 hours to determine appropritate time to start HAART
Doesn't exceed more than 15 mm and size significantly decreases after 15 years

29. what would be viral load after 4 weeks
Td every 10 years - tdap once before 65 and after 65
Aortic valve; endocardiits of AR p/w AV block and LBBB
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
<5000 copies/ml

30. How to dx bacterial meningitis from CSF study?

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31. How to dx IM?
Monospot test which screen heteropile ab that agglutinate horse rbc
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
<500 copies/ml
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w

32. How to dx progressive multifocal leukoencephalopathy
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
Td every 10 years - tdap once before 65 and after 65
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose

33. What is used for prophylaxis against meningo..meningitis?
Rifampin600mg q12. or cipro
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
Immune mediated; circulating IgG and IgM to penicillin derivatives
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

34. when western blot is done for HIV testing
High risk 19-64; 1-2 dose - above 65; one dose
<5000 copies/ml
Pregnacy - urologic procedure - hip arthoplastu
If a sample is ELISA positive - it is tested fro western blot for confirmation

35. How to differentiate gonococcal and nongonoccal urethritis?
Postcoital voiding - increased intake of cranberry juice
Pegylated interferon and lamivudine
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 count

36. How to differentiate different types of necrotizing fascitis?
Immune mediated; circulating IgG and IgM to penicillin derivatives
Need lumbar puncture to relieve pressure; they have high opening pressure >350
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
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

37. hypertension in children
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Clostridium perfringens after penetrative injuries/wounds

38. How long abx is given in pseudomonas infection?
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
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
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx

39. What is the criteria for Spontaneous bact peritonitis
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Within 6 months viral load will be <50
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes

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

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41. How to tx pseudomonas?
ELISA; initial visit - 6 - 12 and 24 weeks;
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle

42. INH
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Voriconazol. mycetoma-surgical removal
Either TB or aspergillosis

43. How to give postexposure prophylaxis for HIV
ELISA; initial visit - 6 - 12 and 24 weeks;
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
If a sample is ELISA positive - it is tested fro western blot for confirmation

44. gas gangrene
Clostridium perfringens after penetrative injuries/wounds
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Blastomycosis
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months

45. pneumococcal vaccine indication?
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
High risk 19-64; 1-2 dose - above 65; one dose

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

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47. What is the classic signs of nec fasc?
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
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
Non pregnant premanopausal - elderly - dm - sci - chronic foley
Postcoital voiding - increased intake of cranberry juice

48. how im is transmitted?
Oropharyngeal secretions; hence named as kissing disease
Do EBV antibody test
Aortic valve; endocardiits of AR p/w AV block and LBBB
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.

49. How to tx TSS?
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
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
Either TB or aspergillosis
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

50. how HAART therapy affects HIV viral loads?
Ampicillin-sublactam; most bites contain eikenella
Within 6 months viral load will be <50
Cd4 count
Every 3-4 hours to determine appropritate time to start HAART

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USMLE Step3 Infectious Disease

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