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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 long we tx chronic prostatis?
6-12 weeks
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
Blastomycosis

2. How to dx IM?
Ampicillin-sublactam; most bites contain eikenella
HIV viral load
Monospot test which screen heteropile ab that agglutinate horse rbc
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV

3. damae that is about to occur?
HIV viral load
Similar pathophysiology as ITP - tx zidovudine
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses

4. How to differentiate different types of necrotizing fascitis?
Immune mediated; circulating IgG and IgM to penicillin derivatives
Either TB or aspergillosis
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
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

5. after exposure of HIV when antibody testing is performed?
Pregnacy - urologic procedure - hip arthoplastu
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
ELISA; initial visit - 6 - 12 and 24 weeks;

6. How to dx lyme arthritis?
Monospot test which screen heteropile ab that agglutinate horse rbc
Ampicillin-sublactam; most bites contain eikenella
ELISA and western blot of synovial fluid.
Acyclovir

7. what if monospot test is neg in IM?
Pegylated interferon and lamivudine
Do EBV antibody test
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Bronchoalveolar washing and transbronchial biopsy

8. What is lag time to develop lyme arthritis after exposure to vector
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
Viral load and CD4 count
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

9. What is the mch of ampicillin induced rash in IM
Immune mediated; circulating IgG and IgM to penicillin derivatives
Cd4 count
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
Every 3-4 hours to determine appropritate time to start HAART

10. clinical manifestation of mucomycosis
Every 3-4 hours to determine appropritate time to start HAART
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
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin

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

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12. 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.
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
<500 copies/ml
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol

13. What is the prognosis of lyme arthritis?
Non pregnant premanopausal - elderly - dm - sci - chronic foley
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
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

14. How to dx bacterial meningitis from CSF study?

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15. what would be viral load after 4 weeks
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
<5000 copies/ml
Rifampin600mg q12. or cipro

16. When to give prophylaxis against MAC
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
Reddish orange discoloration of urine - feces - sweat - tears - sputum
ELISA and western blot of synovial fluid.
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma

17. where TB normally affects
Upper lobes; any fibrosis in this area suggestive of latent TB
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
Within 6 months viral load will be <50
Pegylated interferon and lamivudine

18. 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
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Mainly clinical - epidemiological and seasonal setting
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads

19. antibiotic with good prostate penetration?
Immune mediated; circulating IgG and IgM to penicillin derivatives
Viral load and CD4 count
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
Blastomycosis

20. aspergillosis
Vaccine titer >10mU/ml
Voriconazol. mycetoma-surgical removal
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Cd4 count

21. How often viral load is monitored after HAART?
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Immune mediated; circulating IgG and IgM to penicillin derivatives
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months

22. What are the subjective /objective measure of encephalopathy?
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
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

23. What is the pathophysiology of Meningococcal meningitis?
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges

24. What are indicators for progression of HIV
Viral load and CD4 count
Pregnacy - urologic procedure - hip arthoplastu
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
PML; focal neurological deficit like MM; no specific tx; regress with HAART

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

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26. How often HIV postiive patients CD4 count needs to be evaluated?
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.
Either TB or aspergillosis
Every 3-4 hours to determine appropritate time to start HAART
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -

27. How to differentiate gonococcal and nongonoccal urethritis?
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.
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
Aortic valve; endocardiits of AR p/w AV block and LBBB

28. When to tx influenza with antiviral therapy?
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
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
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
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

29. When to give abx to prevent recurrent uti
Immune mediated; circulating IgG and IgM to penicillin derivatives
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
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

30. how im is transmitted?
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
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
Oropharyngeal secretions; hence named as kissing disease

31. Do we need to give vaccine or immunoglobulin for rabies exposure in previously vaccinated person?
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Every 3-4 hours to determine appropritate time to start HAART
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.

32. How to confirm chlamydia infection?
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Upper lobes; any fibrosis in this area suggestive of latent TB
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

33. How to dx cryptococal meninggits
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
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
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

34. How to tx chronic hep B
Pegylated interferon and lamivudine
HBIG hep B immunoglobulin
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

35. How to dx IM?
Monospot test which screen heteropile ab that agglutinate horse rbc
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.
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
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

36. How to tx pseudomonas?
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)

37. What is the indication of corticosteroid in pcp infection?
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Upper lobes; any fibrosis in this area suggestive of latent TB
Aortic valve; endocardiits of AR p/w AV block and LBBB
AA gradient >35 or Po2 <70

38. when not to give INH therapy if ppd positive and patient asyptomatic
Pt who have been treated before for latent TB
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
HIV viral load

39. reddish colored papules with central umbilication in HIV or immunocompromised patient
Acyclovir
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Upper lobes; any fibrosis in this area suggestive of latent TB
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

40. How to dx progressive multifocal leukoencephalopathy
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

41. What is the Tx of STD uretheritis?
Oropharyngeal secretions; hence named as kissing disease
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
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
HBIG hep B immunoglobulin

42. patient is taking inhaled corticosteroid for asthma - now p/w oral candidiasis
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Pegylated interferon and lamivudine
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved

43. What is tetanus - diptheria - pertusis recommendation?
Voriconazol. mycetoma-surgical removal
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
Td every 10 years - tdap once before 65 and after 65
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

44. pathophysiology of toxic shock syndrom?
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
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
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
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.

45. What is characteristic for dx of rocky mountain spotted fever?
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
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
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles

46. dame that has already occurred
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Td every 10 years - tdap once before 65 and after 65
Cd4 count
Upper lobes; any fibrosis in this area suggestive of latent TB

47. What are the behavioral interventions decrease the risk of UTI
Postcoital voiding - increased intake of cranberry juice
If a sample is ELISA positive - it is tested fro western blot for confirmation
Either TB or aspergillosis
Need lumbar puncture to relieve pressure; they have high opening pressure >350

48. thrombocytopenia in HIV
Ampicillin-sublactam; most bites contain eikenella
Non pregnant premanopausal - elderly - dm - sci - chronic foley
Every 3-4 hours to determine appropritate time to start HAART
Similar pathophysiology as ITP - tx zidovudine

49. What is the classic signs of nec fasc?
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
Td every 10 years - tdap once before 65 and after 65
ELISA and western blot of synovial fluid.
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma

50. when western blot is done for HIV testing
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Within 6 months viral load will be <50
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
If a sample is ELISA positive - it is tested fro western blot for confirmation

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USMLE Step3 Infectious Disease

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