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USMLE Step3 Infectious Disease

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 tx for herpes zoster
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
If a sample is ELISA positive - it is tested fro western blot for confirmation
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)
Acyclovir

2. how CMV presents in immunocompromised patients
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
Rifampin600mg q12. or cipro
Similar pathophysiology as ITP - tx zidovudine
Mainly clinical - epidemiological and seasonal setting

3. How to tx TSS?
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
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
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV

4. dame that has already occurred
ELISA; initial visit - 6 - 12 and 24 weeks;
Cd4 count
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine

5. How to confirm dx if pcp?
Bronchoalveolar washing and transbronchial biopsy
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
Voriconazol. mycetoma-surgical removal
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -

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

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7. How to dx IM?
Classic triad: fever - pharyngitis - postauricular lymaphdenopahty - caused by EBV
Markedly elevated csf pressure >200 - inc protein - low glucose ; tx amphotericin and flucytosine
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
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

8. what would be viral load after 2-4m of HAART?
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Every 3-4 hours to determine appropritate time to start HAART
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
<500 copies/ml

9. causative organisms of uti
HBIG hep B immunoglobulin
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Bronchoalveolar washing and transbronchial biopsy
Oropharyngeal secretions; hence named as kissing disease

10. INH
Others lesions are ring enhancing and have mass effect while PML don't
Blastomycosis
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate

11. which heart valve is closer to ventricular conduction system/
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
Pregnacy - urologic procedure - hip arthoplastu
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.
Aortic valve; endocardiits of AR p/w AV block and LBBB

12. Tx of choice for human bites
Similar pathophysiology as ITP - tx zidovudine
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Ampicillin-sublactam; most bites contain eikenella

13. When to tx asymptomatic bacteriurea >100 -000?
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
Pregnacy - urologic procedure - hip arthoplastu
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate
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. Do we need to give vaccine or immunoglobulin for rabies exposure in previously vaccinated person?
Monospot test which screen heteropile ab that agglutinate horse rbc
Aortic valve; endocardiits of AR p/w AV block and LBBB
Bronchoalveolar washing and transbronchial biopsy
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.

15. wisconsin - missisipi - ohio
Blastomycosis
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
HIV lipodystrophy; no correlation with viral load; p/w insulin resistance and dyslipidemia (inc cholesterol - dec HDL)

16. What is the prognosis of lyme arthritis?
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
ELISA; initial visit - 6 - 12 and 24 weeks;
Only vaccine. immunoglobuin not required. previously unvaccinated person will receive both.
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6

17. antibiotic with good prostate penetration?
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Quinoloes (cipro/levo) cure rate 70% - TMP-SMZ
Acyclovir
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved

18. How to tx chronic hep B
Pegylated interferon and lamivudine
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
Postcoital voiding - increased intake of cranberry juice
<500 copies/ml

19. How long abx is given in pseudomonas infection?
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
Leukocytosis >100 cells - dec glucose - inc protien - inc opening pressure; in viral there will be lymphocytosis - normal glucose (virus doesn't eat) -
2 weeks in neutropenic patients and 7-10 days after catheter removed/patient improved
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

20. hypertriglyceridemia in HIV
Pt who have been treated before for latent TB
Postcoital voiding - increased intake of cranberry juice
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Exacerbate by HAART; give statin - if triglyceride >500 - give a fibrate

21. How to dx?
Mainly clinical - epidemiological and seasonal setting
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
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

22. damae that is about to occur?
When cd4 count falls below 200. 2p in pcp =200
HIV viral load
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes

23. worsening of TB after starting HAART in HIV
Others lesions are ring enhancing and have mass effect while PML don't
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)
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

24. hypertension in children
Tx with amoxicillin or ceftriaxone. 90% are disease free after one year after tx
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Reddish orange discoloration of urine - feces - sweat - tears - sputum
AA gradient >35 or Po2 <70

25. drugs work well on hypertriglyceridia?
Aortic valve; endocardiits of AR p/w AV block and LBBB
Others lesions are ring enhancing and have mass effect while PML don't
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

26. 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
Fever of unknown orign - esophagiti - retinitis - diarrhoea - encephalits
AMS - focal neurological signs - seizures - multiorgan dysfunction - death; tx; doxycycline; for pregnant give chloramphenicle
Massive (even 20L/day) fluid resuscitaiton which may clear toxin

27. 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
Pegylated interferon and lamivudine
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose

28. How long we tx chronic prostatis?
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
6-12 weeks
PML; focal neurological deficit like MM; no specific tx; regress with HAART
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx

29. How to dx progressive multifocal leukoencephalopathy
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
Throat cx of positive of GAS means bacteria are colonized bur not infected in IM. tx with ampi can trigger maculopaular rash
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region

30. What is difference between uti relapse versus recurrence?
Blastomycosis
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Every 3-4 hours to determine appropritate time to start HAART
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

31. What is the indication of corticosteroid in pcp infection?
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
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
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
AA gradient >35 or Po2 <70

32. How to give postexposure prophylaxis for HIV
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Within 72hrs of unprotected sex with HIV pos person - give two nucleosidase inhibitors (eg. zidovudin - lamivudein - tenofovir -) X4w
Every 3-4 hours to determine appropritate time to start HAART
Aspergillosis. common in bone marrow transplants. typically involves lungs and sinuses

33. what would be viral load after 4 weeks
High risk 19-64; 1-2 dose - above 65; one dose
<5000 copies/ml
Aortic valve; endocardiits of AR p/w AV block and LBBB
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

34. infiltrate in upper lobe of lung?
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Either TB or aspergillosis
Postcoital voiding - increased intake of cranberry juice
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.

35. oligodendrocyte with intranuclear inclusion and demyelination in HIV patient
Trimethoprime-sulphamethoxazole if intolerant give pentamidine (cause pancreatitis p for p)
PML; focal neurological deficit like MM; no specific tx; regress with HAART
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
Mainly clinical - epidemiological and seasonal setting

36. what parameters increases risk of neurosyphilis in HIV patient
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Hepatotoxitcity incidence 2.6% - commonly seen in alcoholic - liver disease - >50
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.
Every 3-4 hours to determine appropritate time to start HAART

37. What is characteristic for dx of rocky mountain spotted fever?
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Every 3-4 hours to determine appropritate time to start HAART
4 months; characterized by knee joint effusion-large amount - joint stiffness - pain
Petechial rash developed 3-5th days of illness begins ankle or wrist and spread to palm/soles

38. patient is taking inhaled corticosteroid for asthma - now p/w oral candidiasis
Massive (even 20L/day) fluid resuscitaiton which may clear toxin
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
Give nystatin suspension or clotrimazol with an oral antifungal eg. fluconazol
Fever - facial swelling - nasal discha - maxilary pain and tenderness - headache - present in DKA - caused by zygomycetes tx surgical debridement and intranasal amphotericin

39. How often viral load is monitored after HAART?
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil
Tampoon in nostril/vagina. think t for t - staph release exotoxin --activation of t cells directly--release of massive cytokines.

40. How to dx bacterial meningitis from CSF study?

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41. can HIV transmitted through human bite?
Mainly clinical - epidemiological and seasonal setting
Most common E coli; less common; klebsiella - enterobacter - proteus - staph - groupd d strep
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
HIV present in very minimal quantities in human saliva. exposure/contact of saliva will never trasmit HIV

42. How often HIV postiive patients CD4 count needs to be evaluated?
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
250 neutrophil/mm3 in peritoneal fluid - tx empiric abx; if tremor or other neuro sign give lactulose
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

43. aspergillosis
HBIG hep B immunoglobulin
Voriconazol. mycetoma-surgical removal
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole

44. What are the subjective /objective measure of encephalopathy?
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Harrt ---rapid improvement of immune function---increased inflammatory reaction--worsening of clinical symptoms; self limiting....needs no tx
Bed rest - NSAID - avoid contact sports; if patient develop SOB due to pharyngeal edema - give corticosteroid
Doesn't exceed more than 15 mm and size significantly decreases after 15 years

45. What is the classic signs of nec fasc?
Non pregnant premanopausal - elderly - dm - sci - chronic foley
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
Doesn't exceed more than 15 mm and size significantly decreases after 15 years
Every 3-4 hours to determine appropritate time to start HAART

46. acute febrile reaction develops after starting penicilin tx to syphilis patient
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol
Jarish-Herxheimer reaction; immunologica reaction due to rupture of sprochetes
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
Gemfibrozil and other fibrate drugs; statin and niacin also work not as good as fibrate drugs like gemfibrozil

47. INH
Vitamin B6 antagonist - can cause peripheral neuropathy if not give with b6
Rifampin600mg q12. or cipro
Due to decrease elasticity of arterial wall; only systolic - diastolic normal - wide pulse pressure
Mainly clinical - epidemiological and seasonal setting

48. What is the pathophysiology of Meningococcal meningitis?
HBIG hep B immunoglobulin
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
N meningitidis colonize in nasopharynx; cause mucosal invasion - systemic bacterimia and seeding in the meninges
Most common; fibromuscular dysplasia - Rt renal artery more common - angiography string of beads

49. when western blot is done for HIV testing
At first 4 weeks - then 8-12weks; remeasusing every 2m until viral load is undetectatable. then every 3 months
Immunocompromised patient ? dec vision - weakness/tingling of extremities or other neurological symptoms - MRI nonenhancing lesion in parietooccipital region
Chlamydia pcr - 88% sensitivity and 99% specificity; if negative think about MUT organims; mycoplasma - ureaplasma and trichomonas; tx MUT with metronidazole
If a sample is ELISA positive - it is tested fro western blot for confirmation

50. What is the Tx of cryptococcal meninngitis
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
CTP subjective; MELD objective; meld uses serum billirubin - inr and serum creatinin. meld used to determine 90 day mortality of liver diease
Reddish orange discoloration of urine - feces - sweat - tears - sputum
Start with amphotericin B and flucytosin for 2 weeks - if there is clinical improvement discontinue them and start with fluconazol