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Glossary of IM Infectious Dz USMLE 2

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MCC of UTI

MC w/ GU instruments?
MCC: E. coli

MC w/ GU instruments: Pseudomonas
UTI w/ Alkaline urine is suggestive of which bug?
Proteus
(2) MC bugs for Urethritis
Chlamydia


Gonorrhea
What meds (2) can be given to a pregnant woman with bacteriuria?
Nitrofurantoin


Ampicillin
DOC for non-pregnant uncomplicated Cystitis and UTI

Tx for how many days?

What bug does it not work on?
TMP-SMX (Bactrim)

3 - 5 days

Does not work on:
Pseudomonas
DOC for Pseudomonas pyelonephritis, cystitis and UTI

Tx for how many days for pyelonephritis?
FQ (Cipro)


Pyelonephritis:
7 - 14 days
Difference b/t discharge of Chlamydia and Gonorrhea
Chlamydia:
Non-purulent discharge

Gonorrhea:
Purulent dischange
DOC for

1. Chlamydia

2. Gonorrhea
Chlamydia:
1g Azithromycin PO (one dose)

Gonorrhea:
125mg Ceftriaxone IM (one dose)
What protects the vagina by providing it with an acidic environment (also used to make yogurt)?
A Yoplait a day keeps the Vaginitis away:

Lactobacilli
What is the "whiff" test?

What (2) bugs does it work with?
Whiff test:
applying KOH to wetmount, causing enhancement of odor for:

Gardnerella;

Trichomonas
DOC for Pregnant patient w/ vaginitis
Clotrimazole
What should patient on Metronidazole be warned about ingesting while on the drug?
Alcohol:

can cause Disulfuram-like effects
Dx:
possible vaginal itch and burning, abnormal fishy odor

What is seen on wet mount?

Tx?
Gardnerella
("Bacterial Vaginosis")

wet mount:
Clue cells (epithelial cells w/ bacteria)

Tx:
Metronidazole
Dx:
vaginal itch and burning; rancid fish odor; green, frothy discharge; Strawberry cervix

What is seen on wet mount?

Tx?
Trichomonas

Wet mount:
Motile Trichomonads

Tx:
Metronidazole
Dx:
vaginal itch and burning; cheese-like discharge; no odor

What is seen on wet mount?

Tx?
Candida Albicans
("Yeast infection")

Wet mount:
Pseudohyphae

Tx:
Fluconazole (Nystatin)
On exam, how can you tell a syphillitic pupil?
Like a Prostatute:

It accomodates, but doesn't react
Describe the (4) stages of Syphillis
Primary:
Painless chancre; Bubo LN

Secondary:
Rash on palms and soles; Condylomata Lata

Latent stage (asymptomatic)

Tertiary:
Gummas in CNS, heart, aorta; Tabes dorsalis; Argyll Robertson pupil
Bug name of Syphillis

What common test does it not show-up on?

What test is used?
Treponema Pallidum

Does not grow on Blood culture

Darfield Microscopy - will see Spirochetes
DOC for Syphillis
Penicillin G
Definition:
inflammation of the glans penis

(2) causes and Tx for each
Balanitis

Causes:

1. Candida - Tx w/ Nystatin

2. Reiter's syndrome - Tx w/ NSAIDs
What should patients w/ balanitis be screened for?
Diabetes
Dx:
painful vesicular lesions on erythematous base; local lymphadenopathy

Dx test?

Tx?
Herpes

Test:
Tzanck smear and culture
(also herpes serologies)

Tx:
Acyclovir
(2) adverse effects of Acyclovir
Renal crystals;

Allergic Interstitial Nephritis
What Dx can a mother w/ HPV cause in a child during delivery?
Laryngeal Papillomatosis
What UTI bug is a predisposing factor for PID?
Chlamydia
Dx:
Diabetic patient w/ a black necrotic parasinus lesion
Mucormycosis
Dx:
man w/ perineal and suprapubic pain, dysuria and urinary frequency, fever, tender w/ rectal exam

(2) main causes

Tx? (2)
Bacterial Prostatitis

Causes:
E. coli
Pseudomonas

Tx (for 21 days):
TMP-SMX
Ciprofloxacin
Pneumonia bug w/ "salmon pink" sputum and cavitary lesions

Tx?
S. Aureus

Tx:
Beta-lactam Abx
Pneumonia bug w/ "buldging fissure" and "currant jelly"

Tx?
Klebsiella

Tx:
Cephalosporin
(+/- aminoglycosides)
Dx:
21-yo female complains of dry cough, malaise, and low-grade fevers for "2 weeks", has a CXR w/ hazy infiltrates
Mycoplasma Pneumonia
Dx:
patient w/ confusion and diarrhea is found to have a large infiltrate on CXR w/ pleural effusions
Legionella
WHat is the most common pneumonia w/ cystic fibrosis?
Pseudomonas
Dx:
Respiratory infection w/ low fever, sore throat, N/V and causes a gray exudative pseudomembrane
Corynebacterium Diptheria
Dx:
fever, rash, nausea, skin desquamatization, kidney and liver failure in women using tampons

Bug?
Toxic Shock Syndrome

(S. Aureus)
Dx:
pharyngitis, strawberry tongue, rash that begins on trunk and spreads to extremities

Bug?
Scarlet fever

(S. pyogens)
Dx:
HIV patient w/ dry cough for 1 week. No fever or chills. White count is normal.
Mycoplasma Pneumonia
Cause of brain lesion in AIDS patient:

Ring-enhancing lesion w/ mass effect
Toxoplasmosis
Cause of brain lesion in AIDS patient:

Periventricular ring
CMV
Cause of brain problem in AIDS patient:

CNS lymphoma
EBV
Cause of meningitis in AIDS patient:

Sensation of smell and behavior changes
Herpes

(Temporal lobe)
Cause of meningitis in AIDS patient:

India ink stain w/ round organisms
Cryptococcus
Dx:
29-yo w/ HIV and CD-4 count of 100 has unexplained fever and elevated Alk-Phos.
Mycobacterium Avium Complex
Dx:
HIV patient w/ painful, poorly healing perirectal lesion
Herpes
Dx:
patient has fever, N/V and maculopapular rash on distal extremities that progresses to trunk
What can it cause?

Tx?
Rocky Mt Spotted Fever

(Rickettsia)

Causes: Myocarditis and heart block

Tx:
Doxycycline
Dx:
42-yo man who recently camped in the woods of Vermont presents to ER w/ one-sided facial droop and a skin rash w/ central clearing

Tx?
Lyme Dz

(B. Burgdorferi)

Tx:
Penicillin
Dx:
fever, chills, myalgias, "hemolytic anemia" in patient who lives in Northeast or Midwest

Tx? (2)
Babesiosis

Tx:
Quinine and Clindamycin
Dx:
Tick or flea bite causing an ulcer at the bite site

Tx?
Tularemia

Tx:
Gentamicin
(or Tetracycline)
Dx:
40-yo patient recently returned from Kenya presents w/ body aches, malaise and fever. Labs show normal WBC, anemia and elevated LFT

Tx?
Malaria

Tx:
Cloroquine
When does antiretroviral therapy start for HIV?
CD4 count < 500
what is the prophylaxis med and CD4-count start time in AIDS for:

PCP
med: TMP-SMX

(or Dantrolene if pt is intolerant to TMP-SMX)

CD4: < 200
what is the prophylaxis med and CD4-count start time in AIDS for:

Mycobacterium Avium complex
med: Azithromycin (or Clarithromycin)

CD4: < 100
what is the prophylaxis med and CD4-count start time in AIDS for:

Cryptococcal and Candida infections
med: Fluconazole

CD4: < 100
what is the only live vaccine able to be given to an HIV patient?
MMR
What vaccines can you give to HIV patients?
(4)
1. Hepatitis B

2. Inactivated Polio vaccine
(never oral polio vaccine)

3. Pneumococcal

4. Influenza
patient has HIV w/ severe hypoxia, normal CXR (or diffuse bilateral interstitial infiltrates) w/ dry and non-productive cough.

Dx?
Test?
med Tx?
Dx: PCP

test: Silver stain
(Wright-Giemsa, methenamine silver)

Tx: TMP-SMX

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