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USMLE2 Medicine 13
Infectious Disease 02
| Question | Answer |
|---|---|
| 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
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