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USMLE Step3 Infectious Disease

Subjects : health-sciences, usmle-step-3

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1. How often HIV postiive patients CD4 count needs to be evaluated?
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
Every 3-4 hours to determine appropritate time to start HAART
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

2. HIV patient having fat deposition on back of neck and abdomen - like cushing
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
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 lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash

3. wisconsin - missisipi - ohio
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
When cd4 count falls below 200. 2p in pcp =200
Blastomycosis
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges

4. when HIV patient develop pcp?
HIV viral load
When cd4 count falls below 200. 2p in pcp =200
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)

5. When to tx influenza with antiviral therapy?
Postcoital voiding - increased intake of cranberry juice
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
<5000 copies/ml
Oropharyngeal secretions; hence named as kissing disease

6. Tx of choice for human bites
Ampicillin-sublactam; most bites contain eikenella
Pegylated interferon and lamivudine
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Voriconazol. mycetoma-surgical removal

7. when we see echym gangrenosum?
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
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
Oropharyngeal secretions; hence named as kissing disease

8. What is the prognosis of lyme arthritis?
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Vaccine titer >10mU/ml

9. How to dx bacterial meningitis from CSF study?

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10. INH
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
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

11. hypertension in children
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Do EBV antibody test
Either TB or aspergillosis

12. hypertriglyceridemia in HIV
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
ELISA and western blot of synovial fluid.

13. acute febrile reaction develops after starting penicilin tx to syphilis patient
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
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
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes

14. oligodendrocyte with intranuclear inclusion and demyelination in HIV patient
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Pegylated interferon and lamivudine

15. chshould we tx IM with abx (ampicilin) if throat cx is positive?
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
Oropharyngeal secretions; hence named as kissing disease
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

16. gas gangrene
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Viral load and CD4 count
Clostridium perfringens after penetrative injuries/wounds

17. dame that has already occurred
Cd4 count
Rifampin600mg q12. or cipro
Monospot test which screen heteropile ab that agglutinate horse rbc
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

18. pneumococcal vaccine indication?
Every 3-4 hours to determine appropritate time to start HAART
Postcoital voiding - increased intake of cranberry juice
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
High risk 19-64; 1-2 dose - above 65; one dose

19. patient is taking inhaled corticosteroid for asthma - now p/w oral candidiasis
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

20. What is the pathophysiology of Meningococcal meningitis?
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.

21. What is characteristic for dx of rocky mountain spotted fever?
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Ampicillin-sublactam; most bites contain eikenella
Every 3-4 hours to determine appropritate time to start HAART
<500 copies/ml

22. after recent exposure - negative ELISA - How to confirm?
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
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

23. When to tx asymptomatic bacteriurea >100 -000?
Oropharyngeal secretions; hence named as kissing disease
<5000 copies/ml
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Pregnacy - urologic procedure - hip arthoplastu

24. acute onset +rusty sputum
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
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 -
HIV viral load

25. 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
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
<5000 copies/ml

26. What is lag time to develop lyme arthritis after exposure to vector
Acyclovir
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Similar pathophysiology as ITP - tx zidovudine
Postcoital voiding - increased intake of cranberry juice

27. What are the behavioral interventions decrease the risk of UTI
Upper lobes; any fibrosis in this area suggestive of latent TB
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
Postcoital voiding - increased intake of cranberry juice
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

28. systolic HTN in elderly
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
6-12 weeks
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure

29. How to dx IM?
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
<5000 copies/ml
ELISA and western blot of synovial fluid.
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV

30. When to give prophylaxis against MAC
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
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
HBIG hep B immunoglobulin

31. What is tetanus - diptheria - pertusis recommendation?
Postcoital voiding - increased intake of cranberry juice
Td every 10 years - tdap once before 65 and after 65
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

32. reddish colored papules with central umbilication in HIV or immunocompromised patient
Bronchoalveolar washing and transbronchial biopsy
ELISA and western blot of synovial fluid.
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
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w

33. can HIV transmitted through human bite?
Others lesions are ring enhancing and have mass effect while PML don't
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
<500 copies/ml
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

34. What are the subjective /objective measure of encephalopathy?
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
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Voriconazol. mycetoma-surgical removal
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

35. How long we tx chronic prostatis?
6-12 weeks
Postcoital voiding - increased intake of cranberry juice
Pt who have been treated before for latent TB
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole

36. What is tx for herpes zoster
6-12 weeks
<500 copies/ml
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Acyclovir

37. causative organisms of uti
Aortic valve; endocardiits of AR p/w AV block and LBBB
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
If a sample is ELISA positive - it is tested fro western blot for confirmation
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -

38. How to confirm dx if pcp?
Oropharyngeal secretions; hence named as kissing disease
Bronchoalveolar washing and transbronchial biopsy
Acyclovir
High risk 19-64; 1-2 dose - above 65; one dose

39. rifampin
Reddish orange discoloration of urine - feces - sweat - tears - sputum
PML; focal neurological deficit like MM; no specific tx; regress with HAART
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

40. What is the Tx of cryptococcal meninngitis
ELISA; initial visit - 6 - 12 and 24 weeks;
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
Voriconazol. mycetoma-surgical removal

41. What is fatal consequence of RMSF?
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
Mainly clinical - epidemiological and seasonal setting
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.

42. aspergillosis
Voriconazol. mycetoma-surgical removal
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
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
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin

43. after bone marrow transplant - patient develop headache - fever - cought and chest pain. What is dx?
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
HIV viral load

44. How to give postexposure prophylaxis to patient who received vaccine but titer inadequate
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
HBIG hep B immunoglobulin
Pegylated interferon and lamivudine

45. How often viral load is monitored after HAART?
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
High risk 19-64; 1-2 dose - above 65; one dose
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

46. How to tx chronic hep B
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Pegylated interferon and lamivudine
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
HBIG hep B immunoglobulin

47. How to dx cryptococal meninggits
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Td every 10 years - tdap once before 65 and after 65
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine

48. How to dx IM?
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
High risk 19-64; 1-2 dose - above 65; one dose
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
Monospot test which screen heteropile ab that agglutinate horse rbc

49. How to tx TSS?
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
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
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Others lesions are ring enhancing and have mass effect while PML don't

50. When not to tx asymptomatic bacteriura?
HBIG hep B immunoglobulin
Non pregnant premanopausal - elderly - dm - sci - chronic foley
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
Monospot test which screen heteropile ab that agglutinate horse rbc

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USMLE Step3 Infectious Disease

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