Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
USMLE2 Medicine 14
Infectious Disease 03
| Question | Answer |
|---|---|
| Tx of uncomplicated cystitis | 3d TMP/SMX |
| Tx of uncomplicated cystitis in DM | 7d TMP/SMX |
| If cystitis in pregnancy, what drug do you not use? | flouroquinolones |
| pts with pyelo who are immunosuppressed or have indwelling catheters -- what org caused the pyelo? | Candida |
| Tx of pyelo | 2 weeks of cipro |
| how to tx pregnant pt who has pyelo | admit them |
| pt with presentation of pyelo but doesn't get better with tx | consider perinephric abscess |
| how to tx perinephric abscess | Abx (CTX) and drainage |
| If suspect pernephric abscess, how to dx? | Initial test is U/S, then CT or MRI. Then need aspiration to get bacterial sensitivity. |
| Layers of skin | layers CLoGS B skin: stratum Corneum, stratum Lucidum, stratum Granulosum, stratum Spinosum, stratum Basale. |
| child with pustular skin infection on arms, legs, face with oozing, crusting (golden yellow), and draining lesions - what is the disease and what is it caused by? | impetigo by GAS or Staph aureus (called bullous impetigo if S aureus) |
| How to tx impetigo - mild and serious cases, PCN allergic? | mild - topical bacitracin. Severe - oral keflex or oxacillin (cover GAS and S aureus). PCN allergic use azithromycin |
| pt with BL shiny red, indurated edematous tender lesions on face, arms, legs, sharply demarcated from surrounding skin. | erysipelas (superficial cellulitis), caused by GAS. |
| How to tx erysipelas? | If sure it's strep, use PCN. If not sure if erysipelas or cellulitis, use oxacillin to cover Staph. |
| Tx of tinea corporis/unguium (nails)/capitis | oral itraconazole or terbinafine |
| Tx of tinea pedis/cruris | topical clotrimazole or ketoconazole |
| How to tx systemic Candidal infection? | amphotericin, fluconazole if less serious |
| How to tx Candida paronychia? | (swelling around the nails) amphotericin |
| Spaghetti and meatballs under microscope | hyphae and spores of malassezia furfur (pityrosporum orbiculare) |
| tan brown white scaling macular lesions that coalesce and don't tan (chest/abd/face) | tinea versicolor - malassezia furfur (pityrosporum orbiculare) |
| How to tx tinea versicolor? | Topical Selenium sulfide, clotrimazole, or ketoconazole. If lots of surface area affected, can use oral tx. |
| pruritis on flexor surfaces of wrists and finger webs | Scabies (sarcoptes scabiei) |
| Scabies is associated with what type of pts? | Down Syndrome |
| How to dx scabies? | show parasite in skin scrapings! Ewww! |
| Tx for scabies | permethrin |
| Tx for lice | permethrin |
| Tx for Norwegian scabies | a version of scabies that affects immunocompromised pts with crusting and malodorous discharge. Use permethrin and ivermectin |
| skin colored waxy umbilicated papules | molluscum contagiosum, poxvirus |
| how to tx molluscum contagiosum | freezing/curettage |
| osteomyelitis in children - where and what org? | long bones - femur and tibia, S. aureus |
| osteomyelitis in adults - where and what org? | vertebral bodies (lumbar) --> epidural abscess, S. aureus |
| risk factor for vertebral osteomyelitis | IVDU |
| osteomyelitis in someone with prosthetic joint - what org? | S. aureus |
| osteomyelitis in DM - where and what org? | small bones of the lower extremity (repeated trauma), S. aureus |
| Best test for osteomyelitis | MRI or technetium bone scan early on, but then definitive is the bone bx |
| how to tx acute hematogenous osteo in children? In adults? | in children, abx (oxacillin OR [vanc if MRSA + CTX]) only; in adults, abx with drainage and debridement |
| how to tx chronic osteomyelitis? | oxacillin or [vanc if MRSA + CTX], depending on sensitivities, for 12 weeks |
| Septic arthritis - what organisms? | Gonorrhea --> S. aureus --> Strep |
| Difference between gonoccocal and non-gonoccocal septic arthritis | Gonococcal is polyarticular mostly with petechiae or purpura and nongonococcal is monoarticular |
| How to dx Gonococcal vs. Non-gonococcal septic arthritis? | Gonococcal culture cervix/pharynx/rectum/urethra. Nongonococcal culture the synovial fluid. |
| How to tx septic arthritis? | joint aspiration and abx with CTX if gonococcal or oxacillin + CTX if non-gonococcal |
| soldier in Iraq with shrapnel injury and wound with brownish sweet-smelling discharge | gas gangrene, C. perfringens |
| How to tx gas gangrene? | high dose PCN or clindamycin PLUS debridement or amputation |
| most common org causing infective endocarditis | S. aureus |
| manifestations of infective endocarditis | Jane Osler Roth has a splinter in her pet. Janeway lesions painless, Osler nodes painful, Roth spots on retina, and petechiae |
| How to dx infective endocarditis? | 2 MAJOR criteria: blood cx, echo (TEE) or 1 major and 3 minor. MINOR: fever, cardiac lesion, vascular phenomena, immuno phenoma, micro evidence. |
| Empiric of infective endocarditis | vancomycin and gentamicin for native valve and IVDU; vanc, gent, and rifampin for prosthetic valves |
| In what circumstance would you prophylax for bacterial endocarditis? | only with dental procedures - amoxicillin or clinda for PCN allergic |
| pulsus paradoxus | cardiac tamponade |
| tx of viral pericarditis | anti-inflammatory - indomethacin --> prednisone if no response |
| Tx for TB pericarditis | TB meds and steroids |
| myocarditis - most common org | coxsackie |
| EKG for myocarditis | nonspecific STT changes |
| facial palsy | Lyme |
| dx of PCP PNA | CXR, LDH, BAL |
| Tx for PCP PNA | TMP/SMX. If severe (PO2<70 or A-a grad >35) then add steroids. |
| Prophylaxis for PCP PNA. When to start and stop prophylaxis? | TMP/SMX. Start when CD4<200, stop when CD4>200 >6mo |
| Retinitis or esophagitis in HIV pt with shallow ulcers in distal esophagus. What is the CD4 count? | CMV CD4<50 |
| Tx of CMV in HIV+ pt | Valganciclovir - retinitis and GI. Ganciclovir --> foscarnet for CNS infection. |
| Prophylaxis for CMV in HIV+ pt | Valganciclovir |
| Tx of Mycobacteria avium in HIV+ pt | Clarithromycin and ethambutol +/- rifabutin |
| Prophylaxis for Mycobacteria avium in HIV+ pt. When to stop prophylaxis? | Azithromycin qweek. Stop when CD4>100 for a few months |
| ring enhancing lesion on contrast head CT | toxoplasmosis CD4<100 |
| Tx for toxoplasmosis in HIV+ pt | pyrimethamine and sulfadiazine (sulfa allergic then clinda). Also add leucovorin to prevent bone marrow suppression |
| Prophylaxis for toxoplasmosis in HIV+ pt | TMP/SMX |
| Vaccinations for HIV+ pt | PIB Pneumococcus, influenza, hepatitis B |
| AIDS illness for CD4 <50 | CMV, MAI, PML, CNS lymphoma |
| AIDS illness for CD4 <100 | Toxoplasmosis, Herpes - disseminated, Cryptosporidiosis, Cryptococcus |
| AIDS illness for CD4 <100-200 | PCP, Histo, Cocci, Dementia |
| AIDS illness for CD4 <200-500 | thrush, Kaposi, TB, Zoster |
| How to know if HIV+ pt has adequate response to antiretrovial tx? | goal is complete suppression of viremia with <50 to 70 copies of HIV-RNA; adequate response when drop of at least 50% of viral load in first month |
| When to start AIDS therapy | when CD4 <350 or viral load >55K |
| What drugs to start in AIDS tx | 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine OR AZT/Lamivudine) and one or two protease inhibitors (Ritonavir plus another -navir) |
| "boosted protease inhibitors" | give protease inhibitor in combination with ritonavir --> synergystic, decreases the metab of the other PI and enables higher drug levels and increases chances of success |
| What to know about Efavirenz | a non-nucleoside reverse transcriptase inhibitor, part of the single HAART pill, only antiretroviral that is contraindicated in pregnancy |
| When should HIV+ pregnant woman plan for a C-section? | when viral load >1K |
| If HIV+ pregnant pt is not on treatment for her own disease, when should she start antiretroviral treatment for the pregnancy? | 14 weeks of pregnancy |
| Post exposure prophy for needlestick from HIV+ | AZT + lamivudine + nelfinavir (PI) for 4 weeks |
| undercooked meat (pork/lamb) | Toxoplasmosis |
| Tx Q fever | doxy |
| Tx for RMSF | doxy |
| halo sign around nodular lesion on CXR or chest CT | Aspergillus |
| Tx for aspergillus | Voriconazole |
Created by:
christinapham