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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
Bronchoalveolar washing and transbronchial biopsy
<5000 copies/ml
Rifampin600mg q12. or cipro

2. How long we tx chronic prostatis?
6-12 weeks
Vaccine titer >10mU/ml
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

3. When to give prophylaxis against MAC
Td every 10 years - tdap once before 65 and after 65
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Blastomycosis

4. acute febrile reaction develops after starting penicilin tx to syphilis patient
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges

5. low grade fever - maculopapular rash - lymphadenopathy
Need lumbar puncture to relieve pressure; they have high opening pressure >350
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region

6. which heart valve is closer to ventricular conduction system/
Aortic valve; endocardiits of AR p/w AV block and LBBB
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w

7. oligodendrocyte with intranuclear inclusion and demyelination in HIV patient
AA gradient >35 or Po2 <70
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses
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

8. What is used for prophylaxis against meningo..meningitis?
Every 3-4 hours to determine appropritate time to start HAART
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Rifampin600mg q12. or cipro
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.

9. 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.
AA gradient >35 or Po2 <70
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

10. where TB normally affects
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Upper lobes; any fibrosis in this area suggestive of latent TB
Every 3-4 hours to determine appropritate time to start HAART
HIV viral load

11. reddish colored papules with central umbilication in HIV or immunocompromised patient
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
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
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

12. What is difference between uti relapse versus recurrence?
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
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles

13. How to dx IM?
Aortic valve; endocardiits of AR p/w AV block and LBBB
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Monospot test which screen heteropile ab that agglutinate horse rbc
Postcoital voiding - increased intake of cranberry juice

14. what would be viral load after 2-4m of HAART?
Aortic valve; endocardiits of AR p/w AV block and LBBB
<500 copies/ml
Mainly clinical - epidemiological and seasonal setting
Oropharyngeal secretions; hence named as kissing disease

15. When not to tx asymptomatic bacteriura?
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
Non pregnant premanopausal - elderly - dm - sci - chronic foley
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol

16. how HAART therapy affects HIV viral loads?
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
Within 6 months viral load will be <50

17. How to confirm dx if pcp?
Similar pathophysiology as ITP - tx zidovudine
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Bronchoalveolar washing and transbronchial biopsy

18. worsening of TB after starting HAART in HIV
Every 3-4 hours to determine appropritate time to start HAART
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Upper lobes; any fibrosis in this area suggestive of latent TB

19. after bone marrow transplant - patient develop headache - fever - cought and chest pain. What is dx?
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
When cd4 count falls below 200. 2p in pcp =200
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses

20. What is the criteria for Spontaneous bact peritonitis
ELISA and western blot of synovial fluid.
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose

21. pneumococcal vaccine indication?
Need lumbar puncture to relieve pressure; they have high opening pressure >350
Reddish orange discoloration of urine - feces - sweat - tears - sputum
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
High risk 19-64; 1-2 dose - above 65; one dose

22. patient is taking inhaled corticosteroid for asthma - now p/w oral candidiasis
HIV RNA PCR assay; there may be small amount of virus that are not detectable in ELISA.
Do EBV antibody test
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved

23. infiltrate in upper lobe of lung?
Either TB or aspergillosis
Cd4 count
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Pregnacy - urologic procedure - hip arthoplastu

24. What is the classic signs of nec fasc?
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
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
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol

25. can HIV transmitted through human bite?
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Ampicillin-sublactam; most bites contain eikenella
Every 3-4 hours to determine appropritate time to start HAART
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV

26. what if monospot test is neg in IM?
Do EBV antibody test
AA gradient >35 or Po2 <70
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -

27. systolic HTN in elderly
Voriconazol. mycetoma-surgical removal
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
Acyclovir

28. What are the behavioral interventions decrease the risk of UTI
Postcoital voiding - increased intake of cranberry juice
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Pegylated interferon and lamivudine
Oropharyngeal secretions; hence named as kissing disease

29. How to dx lyme arthritis?
ELISA and western blot of synovial fluid.
Aortic valve; endocardiits of AR p/w AV block and LBBB
Viral load and CD4 count
Reddish orange discoloration of urine - feces - sweat - tears - sputum

30. 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
HIV viral load
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
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

31. thrombocytopenia in HIV
Similar pathophysiology as ITP - tx zidovudine
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Td every 10 years - tdap once before 65 and after 65

32. What is lag time to develop lyme arthritis after exposure to vector
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
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
Similar pathophysiology as ITP - tx zidovudine
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain

33. How to tx pcp?
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Within 6 months viral load will be <50

34. What is the indication of corticosteroid in pcp infection?
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
Oropharyngeal secretions; hence named as kissing disease
Either TB or aspergillosis
AA gradient >35 or Po2 <70

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

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36. How often HIV postiive patients CD4 count needs to be evaluated?
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
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
Monospot test which screen heteropile ab that agglutinate horse rbc

37. How long abx is given in pseudomonas infection?
Td every 10 years - tdap once before 65 and after 65
Pregnacy - urologic procedure - hip arthoplastu
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease

38. How to tx pseudomonas?
ELISA; initial visit - 6 - 12 and 24 weeks;
Pt who have been treated before for latent TB
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Pegylated interferon and lamivudine

39. when western blot is done for HIV testing
Td every 10 years - tdap once before 65 and after 65
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
If a sample is ELISA positive - it is tested fro western blot for confirmation

40. antibiotic with good prostate penetration?
AA gradient >35 or Po2 <70
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
Immune mediated; circulating IgG and IgM to penicillin derivatives
Either TB or aspergillosis

41. How to dx bacterial meningitis from CSF study?

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42. drugs work well on hypertriglyceridia?
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
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
Viral load and CD4 count

43. What is the mch of ampicillin induced rash in IM
Immune mediated; circulating IgG and IgM to penicillin derivatives
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
Similar pathophysiology as ITP - tx zidovudine
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

44. How to dx?
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
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
Mainly clinical - epidemiological and seasonal setting

45. Tx of choice for human bites
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Ampicillin-sublactam; most bites contain eikenella
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
<5000 copies/ml

46. HIV patient having fat deposition on back of neck and abdomen - like cushing
Need lumbar puncture to relieve pressure; they have high opening pressure >350
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Acyclovir

47. What is the prognosis of lyme arthritis?
Cd4 count
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
When cd4 count falls below 200. 2p in pcp =200
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

48. foot infections in DM
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
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
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
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

49. What is the Tx of cryptococcal meninngitis
HBIG hep B immunoglobulin
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
PML; focal neurological deficit like MM; no specific tx; regress with HAART

50. How to tx IM?
<5000 copies/ml
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
6-12 weeks
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash

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USMLE Step3 Infectious Disease

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