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Test your basic knowledge |
USMLE Step3 Infectious Disease
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Subjects
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health-sciences
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usmle-step-3
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. What is the mch of ampicillin induced rash in IM
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
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
Immune mediated; circulating IgG and IgM to penicillin derivatives
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
2. How to dx IM?
Monospot test which screen heteropile ab that agglutinate horse rbc
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Voriconazol. mycetoma-surgical removal
Oropharyngeal secretions; hence named as kissing disease
3. What are indicators for progression of HIV
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
ELISA and western blot of synovial fluid.
Viral load and CD4 count
4. wisconsin - missisipi - ohio
Viral load and CD4 count
Aortic valve; endocardiits of AR p/w AV block and LBBB
Blastomycosis
Acyclovir
5. which heart valve is closer to ventricular conduction system/
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Aortic valve; endocardiits of AR p/w AV block and LBBB
Vaccine titer >10mU/ml
Clostridium perfringens after penetrative injuries/wounds
6. reddish colored papules with central umbilication in HIV or immunocompromised patient
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Aortic valve; endocardiits of AR p/w AV block and LBBB
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
PML; focal neurological deficit like MM; no specific tx; regress with HAART
7. INH
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
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
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
8. after exposure of HIV when antibody testing is performed?
ELISA; initial visit - 6 - 12 and 24 weeks;
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
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
Every 3-4 hours to determine appropritate time to start HAART
9. What is the Tx of STD uretheritis?
Bronchoalveolar washing and transbronchial biopsy
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
Immune mediated; circulating IgG and IgM to penicillin derivatives
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
10. How to tx pcp?
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
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)
11. How to tx IM?
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
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Either TB or aspergillosis
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
12. can HIV transmitted through human bite?
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
13. What is fatal consequence of RMSF?
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
14. what if monospot test is neg in IM?
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin
Do EBV antibody test
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
15. What is characteristic for dx of rocky mountain spotted fever?
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
AA gradient >35 or Po2 <70
Cd4 count
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles
16. What is the indication of corticosteroid in pcp infection?
Pt who have been treated before for latent TB
AA gradient >35 or Po2 <70
Postcoital voiding - increased intake of cranberry juice
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
17. What is tetanus - diptheria - pertusis recommendation?
Td every 10 years - tdap once before 65 and after 65
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Immune mediated; circulating IgG and IgM to penicillin derivatives
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
18. thrombocytopenia in HIV
Vaccine titer >10mU/ml
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Similar pathophysiology as ITP - tx zidovudine
19. How to dx progressive multifocal leukoencephalopathy
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
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
20. HIV patient having fat deposition on back of neck and abdomen - like cushing
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Ampicillin-sublactam; most bites contain eikenella
Others lesions are ring enhancing and have mass effect while PML don't
ELISA and western blot of synovial fluid.
21. systolic HTN in elderly
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
Oropharyngeal secretions; hence named as kissing disease
22. patient with diagnosed case of cryptococcal meningitis p/w severe headache and vomiting
Pt who have been treated before for latent TB
Need lumbar puncture to relieve pressure; they have high opening pressure >350
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
23. chshould we tx IM with abx (ampicilin) if throat cx is positive?
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
24. INH
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
<5000 copies/ml
Aortic valve; endocardiits of AR p/w AV block and LBBB
25. How to tx pseudomonas?
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
Rifampin600mg q12. or cipro
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
26. antibiotic with good prostate penetration?
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
27. How to differentiat PML from toxoxplasmosis - cns lymphoma adn brain abscess
28. infiltrate in upper lobe of lung?
HIV syndrome or anti-retroviral syndrome; 2-3w after virus exposure. similar to IM.
Do EBV antibody test
Either TB or aspergillosis
Upper lobes; any fibrosis in this area suggestive of latent TB
29. How often viral load is monitored after HAART?
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
ELISA and western blot of synovial fluid.
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
Aortic valve; endocardiits of AR p/w AV block and LBBB
30. When to give prophylaxis against MAC
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Need lumbar puncture to relieve pressure; they have high opening pressure >350
31. What is the pathophysiology of Meningococcal meningitis?
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Monospot test which screen heteropile ab that agglutinate horse rbc
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
Antipseudomonal penicillin (pipercillin) or cephalosporin (ceftazdidime/cefepime) and aminoglycoside (tobramycin/amikacin)
32. How to differentiate gonococcal and nongonoccal urethritis?
Staph - GBS - proteus - pseudomona - e coli - candida - bacteroids; organisms isolated only from deep curettage of ulcer
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
Td every 10 years - tdap once before 65 and after 65
When cd4 count falls below 200. 2p in pcp =200
33. Tx of choice for human bites
Ampicillin-sublactam; most bites contain eikenella
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
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Reddish orange discoloration of urine - feces - sweat - tears - sputum
34. rifampin
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
Others lesions are ring enhancing and have mass effect while PML don't
Reddish orange discoloration of urine - feces - sweat - tears - sputum
35. oligodendrocyte with intranuclear inclusion and demyelination in HIV patient
Monospot test which screen heteropile ab that agglutinate horse rbc
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
36. How to dx cryptococal meninggits
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
Do EBV antibody test
37. when not to give INH therapy if ppd positive and patient asyptomatic
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.
For mac - we give azithromycin - mac has a for azithromycin; cd4 <50; remember CML designates for <50 c-cmv; m- mac - L-cns lymphoma
Pt who have been treated before for latent TB
HIV viral load
38. When to tx asymptomatic bacteriurea >100 -000?
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
Pregnacy - urologic procedure - hip arthoplastu
Viral load and CD4 count
39. How to confirm chlamydia infection?
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
PML; focal neurological deficit like MM; no specific tx; regress with HAART
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
40. What are the behavioral interventions decrease the risk of UTI
Pt who have been treated before for latent TB
Clostridium perfringens after penetrative injuries/wounds
If a sample is ELISA positive - it is tested fro western blot for confirmation
Postcoital voiding - increased intake of cranberry juice
41. What is the criteria for Spontaneous bact peritonitis
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
<5000 copies/ml
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. worsening of TB after starting HAART in HIV
Monospot test which screen heteropile ab that agglutinate horse rbc
AA gradient >35 or Po2 <70
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
43. causative organisms of uti
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
HBIG hep B immunoglobulin
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
44. what would be viral load after 4 weeks
<5000 copies/ml
Aortic valve; endocardiits of AR p/w AV block and LBBB
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
45. patient is taking inhaled corticosteroid for asthma - now p/w oral candidiasis
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Others lesions are ring enhancing and have mass effect while PML don't
46. What is used for prophylaxis against meningo..meningitis?
Rifampin600mg q12. or cipro
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Clostridium perfringens after penetrative injuries/wounds
47. hypertriglyceridemia in HIV
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
48. what parameters increases risk of neurosyphilis in HIV patient
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.
Non pregnant premanopausal - elderly - dm - sci - chronic foley
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
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
49. pathophysiology of toxic shock syndrom?
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.
S. pneumonie. differentitate this from atypical pneumonia and pcp which are gradual onset - non productive cough -
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
50. How often HIV postiive patients CD4 count needs to be evaluated?
Others lesions are ring enhancing and have mass effect while PML don't
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Every 3-4 hours to determine appropritate time to start HAART