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USMLE2 Medicine 13

Infectious Disease 02

QuestionAnswer
Who is at risk for reactivation TB? those with decreased T-cell-mediated immunity (steroids, transplant, CA, HIV)
What is the most sensitive test to dx TB? pleural bx
Tx for active TB First 2 months or until get sensitivities: RIPE Rifampin INH Pyrazinamide Ethambutol. Then INH and Rifampin for additional 4 months.
In tx of active TB, who should be treated for longer than 6 months? TB meningitis (12 mo), TB in preg (9 mo, should not get pyrazinamide), TB osteomyelitis.
When to use TB meds AND steroids? TB meningitis, TB pericarditis
Those with positive PPD >5mm close contacts of active TB, HIV+, Abnl CXR with old TB, Steroid/Transplant. CHCS
Those with positive PPD >10mm high-risk groups: health care, prisoners, nursing homes, <4yo, immigrants and other immunocomp
Those with positive PPD >15mm low risk populations
Tx of latent TB 9 mo of INH and B6
contaminated clams oysters mussels Vibrio parahemolyticus
raw shellfish Vibrio vulnificans
infection in those with liver disease + shellfish Vibrio vulnificans
infection in those with Fe overload + shellfish Vibrio vulnificans
GI infection with bullous skin lesions Vibrio vulnificans
GI infections in children (2) Norwalk or rotavirus
unrefrigerated meat - what org? C. perfringens
ciguatera toxin from which animals? barracuda, red snapper, grouper
how to tx ciguatera poisoning? no tx
eating fish at restaurant then getting paresthesias, N/V and abd cramps ciguatera toxin from barracuda, red snapper or grouper
vomiting 1-6 hours after eating, then diarrhea later S aureus or B cereus
Protozoa ass with bloody stool Entameoba histolytica
Empiric tx of GI bug causing diarrhea cipro
Tx of campylobacter diarrhea erythromycin
Tx of Giardia metronidazole
Tx of Cryptosporidia diarrhea control underlying HIV viral load
Tx of scromboid diphenhydramine
Most common disease leading to liver transplantation Hep C
Post exposure prophy for Hep A, B, C, D A and B: IVIg and vaccine. C and D - none
which viral hepatitis most associated with hepatocellular CA? Hep B
Pt with jaundice, dark urine, light stool, with fatigue, wt loss, tender liver consider acute viral hepatitis
What hepatitis associated with PAN? Hep B
What hepatitis associated with pregnant women? Hep E
ALT > AST is associated with what? AST>ALT? ALT>AST - viral hepatitis. AST>ALT with drug-induced/EtOH hepatitis
which hepatitis associated with joint pain, rash, and glomerulonephritis? Hep B > Hep C
HBsAg means what? first viral marker of acute hep B
What does presence of HBeAg mean? high viral replication, very infective
What marker shows definitive resolution of active Hep B infection no more HBsAg --> development of HBsAb
how to tx acute hepatitis? no tx
how to tx chronic Hep B? interferon or lamivudine
how to tx chronic Hep C? interferon AND ribavirin
If needle stick from pt with HBsAg, how to tx? IVIg and vaccine
Most common org causing urethritis Gonorrhea --> Chlamydia --> Ureaplasma urealyticum
What is the most specific test for gonorrhea? Cx
How to dx chlamydia urethritis? urethral swab --> DFA
Tx for urethritis CTX x1 (gonorrhea coverage) and azithromycin x1 (Chlamydia coverage)
Tx cervicitis single dose cipro
Thayer Martin cx gonorrhea
Difinitive dx of PID laparoscopy
pt with purulent urethral d/c, dysuria, urgency and frequency of urination urethritis
pt with cervical motion tenderness and adnexal tenderness PID
Inpt tx for PID. Outpt tx. Inpt (if high WBC or high fever): doxy and cefoxitin. Outpt CTX x1 and doxy x2wks.
Complications of PID Infertility and ectopic pregnancy
Hutchinson teeth congenital syphilis
Primary syphilis presents with…. (2) painless chancre (3 wks post infection lasting until 3 months), painless LAD
Secondary syphilis presents with…. (3) symmetrical rash on flexor surfaces and palms and soles; condyloma lata (very infectious!), alopecia
Are pts contagious in tertiary syphillis? Yes with primary and secondary, but not with tertiary.
Gumma is in which stage of syphilis? tertiary
Rash is which stage of syphilis? tertiary
Argyll Robertson pupils tertiary syphilis
what will give you false positive on VDRL? EBV, TB, bacterial endocarditis, and collagen vascular disease
How to tx syphilis? PCN
Jarisch Herxheimer fever HA sweats and worsening of syphilis lesions after start tx; it's only temporary
tx for syphilis 1 2 latent and 3. what if PCN allergic? benzathine PCN once for 1 and 2 syphilis; qwk for 3 weeks for latent syphilis. 3 tx with PCN IV for 10d. If PCN allergic, 1 and 2 can get doxy. If 3 or pregnant, must undergo PCN desensitization!
Tx of Chancroid Azithromycin x1 or CTX x1
Tx of Chlamydia Doxy or erythro
Donovan bodies Granuloma inguinale - granulomatous, chronic, sexual contact
How to dx granuloma inguinale? punch bx or smear from lesion
Tx of granuloma inguinale Doxy or CTX
How to tx herpes that is resistant to acyclovir? foscarnet
Cauliflower wart HPV
condyloma acuminata HPV
Created by: christinapham