USMLE Forum Archives - USMLE Step 3 - ID (HY info)
ID (HY info)
meduploader - 05-03-09 12:07
20 YOM with mucopurulent discharge per urethra. O/E there is no other positive findings. most likelu Dx? Gonnorrhea.
NAAT (PCR) recommended by CDC.
if female patient with gonorreha and wats the next best step --> do pregnancy test
RX: Ceftriaxone + Azithro
pregnants: spctinomycin
20YO sexually active F with C/O dysuria 3 - 4 days. denies fever. pt started on TMP?SMX for 3 days. come back with same Sx. Urinalysis shows Inc WBCs, no bacteruria and urine culture is negative. most likelyu Dx? Chlamydia
next step _-> Urine PCR for chlamydia
Rx: Doxycycline, if pregnant: erythro/ azithromycin
20YOF with fever pain on movement of wrist joint, has single pustular lesion over dorsal surface of hand, swollen right knee joint. joint aspirte: Inc cell count, gram -- ive cocci. most likely Dx:disseminated gonococcal infection.
joint fluid culture could be negative --> culture all the orifices
Rx: Ceftriaxone + Doxycycline
Spactinomycin if alleric to penicclin
patient having reccurent gonococcal inf. next step --> CH50 level
if CH 50 level low --> check terminal compliment defficiency.
ptient diagnosed with goneorrhea which of the following next test would u offer --> test for syphillis nd HIV (CCS only MHA; FTA not in the software)
20 YOM presents with C/O generelized reddish brown maculopapular rash icluding palsm and sole, low grade fever, generalized lymphoadenopathy, heterophil anitbody test is negative. next step --> VDRL
Mlae patient with lesion like cond accuminata in the perineal area, which of the follwoing is most importnat thing to adress?
A: sexual practice.
Which of the following u will like to offer?
A: Syp and HIV
M patient with condyloma accuminata lesion on genital area. which of the following is approprite thing?
A: screen sexual partner for cervical Ca
Patient dignosed with syphillis, recieved benzithine penicillin after 2 hrs developed fever, chills rash. most likely dx: JH reaction
Rx: bed rest aspirin
in case of neurosyphilis it develops after 12 hrs
50 YOM came for routine check up found to have VDRL + ive, pt is asymptomatic, doesnt recall any history of genital ulcer or rash. most likely diagnosis? Latent syphilis
Rx: benzithine penicillin IM weekly for 3 doses. If allergic to penicillin - doxy for one month
55 YOM with paresthesias, abnormal gait,ARP (accomodation reflex present, light reflex absent) VDRL + ive, CSF - Inc WBCs, mainly lymphocytes, Inc protien, normal glucose. most likely diagnosis Tertiary syphillis
Penicclin G IV
ptient worked up for dementia. VDRL is positive --> send CSF for VDRL
PROZONE Reaction: patient with syphillis. VDRL is --ive. most likely cause prozone reaction ( dilute the serum)
Syphillis follwoup: primary 4 folds in 6 months and 8 folds in 12 months
4 forlds in 12 months for neurosyphilis
chancroid: gram negative rod
genital herpes not responding to acyclovir, switc to foscarnat
meduploader - 05-03-09 12:07
20 YOM with mucopurulent discharge per urethra. O/E there is no other positive findings. most likelu Dx? Gonnorrhea.
NAAT (PCR) recommended by CDC.
if female patient with gonorreha and wats the next best step --> do pregnancy test
RX: Ceftriaxone + Azithro
pregnants: spctinomycin
20YO sexually active F with C/O dysuria 3 - 4 days. denies fever. pt started on TMP?SMX for 3 days. come back with same Sx. Urinalysis shows Inc WBCs, no bacteruria and urine culture is negative. most likelyu Dx? Chlamydia
next step _-> Urine PCR for chlamydia
Rx: Doxycycline, if pregnant: erythro/ azithromycin
20YOF with fever pain on movement of wrist joint, has single pustular lesion over dorsal surface of hand, swollen right knee joint. joint aspirte: Inc cell count, gram -- ive cocci. most likely Dx:disseminated gonococcal infection.
joint fluid culture could be negative --> culture all the orifices
Rx: Ceftriaxone + Doxycycline
Spactinomycin if alleric to penicclin
patient having reccurent gonococcal inf. next step --> CH50 level
if CH 50 level low --> check terminal compliment defficiency.
ptient diagnosed with goneorrhea which of the following next test would u offer --> test for syphillis nd HIV (CCS only MHA; FTA not in the software)
20 YOM presents with C/O generelized reddish brown maculopapular rash icluding palsm and sole, low grade fever, generalized lymphoadenopathy, heterophil anitbody test is negative. next step --> VDRL
Mlae patient with lesion like cond accuminata in the perineal area, which of the follwoing is most importnat thing to adress?
A: sexual practice.
Which of the following u will like to offer?
A: Syp and HIV
M patient with condyloma accuminata lesion on genital area. which of the following is approprite thing?
A: screen sexual partner for cervical Ca
Patient dignosed with syphillis, recieved benzithine penicillin after 2 hrs developed fever, chills rash. most likely dx: JH reaction
Rx: bed rest aspirin
in case of neurosyphilis it develops after 12 hrs
50 YOM came for routine check up found to have VDRL + ive, pt is asymptomatic, doesnt recall any history of genital ulcer or rash. most likely diagnosis? Latent syphilis
Rx: benzithine penicillin IM weekly for 3 doses. If allergic to penicillin - doxy for one month
55 YOM with paresthesias, abnormal gait,ARP (accomodation reflex present, light reflex absent) VDRL + ive, CSF - Inc WBCs, mainly lymphocytes, Inc protien, normal glucose. most likely diagnosis Tertiary syphillis
Penicclin G IV
ptient worked up for dementia. VDRL is positive --> send CSF for VDRL
PROZONE Reaction: patient with syphillis. VDRL is --ive. most likely cause prozone reaction ( dilute the serum)
Syphillis follwoup: primary 4 folds in 6 months and 8 folds in 12 months
4 forlds in 12 months for neurosyphilis
chancroid: gram negative rod
genital herpes not responding to acyclovir, switc to foscarnat
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#3
Re: ID (HY info) InSitu - 05-03-09 13:24 Doc Harry...Please use the MCQ feature for your CMQ threads :)...thanks bro
#4
Re: ID (HY info)
meduploader - 05-03-09 13:51 HIV
Newborn from HIV mother --> DNA PCR
Pt had unprotected sex two weeks ago, came to know partenr was HIV +. he wants to be testing for HIV --> HIV RNA PCR
HIV patient with thrombocytopenia --> HAART
HIV patient with anemia --> anemia of ch disease (normocytic nromochromic anemia). how will u treat? give erythropoetin
Note: Pt on AZT has macrocytic anemia
HIV patient with neuropenia --> GCSF (Filgastrim)
HIV patient exposed to chicken pox, with -- ive Hx of chickenpox in past, -- ive antiboies --> VZIG
HIV patient with CD4 count 30 on HAART and on TMP/SMX --> MAI proph
Fusion inhibitors: in multidrug resistance HIv
Asymp children delievered to HIV + mother ---> TMP-SMX at 4 wk
HIV patient on protease inhibitor with inc LDL --> DOC is pravostatin (1st line), atorvastatin (2nd line, choose when parvo is not in the answer)
HIV patient with CD4 < 200 on TMP/SMX, it goes < 100 --> add claritrho/azithro
but if patient was on dapsone for PCP than clarithro/azithro + pyramethine
Pregnant ptient present in labor with no prenatal care --> rapid HIV test
Pt on aerozolised pentamidine can develop apical PCP --> switch on TMP/SMX or dapsone
IVDA with C/O fever, maculopapular rash, cervical lymphadenopathy, lymphopenia, HIV --ive, heterophil AB test --ive most likely DX: Ac retroviral synd (it occurs 10 - 20 days to before seroconversion, ELISA becomes + after 6 - 12 weeks)
next best step is HIV RNA PCR, P24 Ag
Pt had unprotected sex 2 weeks ago, came to know partner was HIV + ive. next best step --> HIV RNA PCR
HIV pt with CMV Ig G -- ive needs blood trnasfusion --> ask blood bank to give CMV --ive blood
HIV patient comes with fever, cough, SOB, O/E right lower lobe crackels. CXR: lower lobe infiltrate. CD 4 350 --> CAP (In HIV its also MCC of pbneumonia)
HIV pat comes with fever, cough, SOB. O/E bilateral diffuse crackle and rhoonchi present. CXR: bilateral diffuse infilrate. CD 4 150 --> PCP ( it may be given with severe hypoxia and Inc LDH)
next best step --> sputum for methenamine 9Wright Giemsa stain)
if no sputum --> BAL
SE of TMP SMX: rash, fever, BMS, Inc K, Inc serum Cr
HIV patient admitted with PCP being treted with IV TMP/SMX, develops left sided chest pain, SOB. O/E Dec breathing sound on left upper chest, cardiac enzyme and troponin levels are pending. CXR shown --> Pneumothorax (pt with PCP can easily develop Pneumthorax)
Youn HIv patient comes with change in mental status, headache and weakness of exteremities. CT head: two ring enhancing lesions. CD 4< 100Most likely Dx --> Toxoplasmosis
once you suspect toxoplasmosis start empiric treatment (sulfadiazine + pyrimatehamine + folinic acid)
If allergic to sulfa --> clindamycin + pyri + folinic acid
reevaluate the lesion in two weeks, if decrease in size --> continue the treatment for 4 - 8 weeks. Lifelong prophylaxis for toxo no matter of CD4.
If not improved, next best step --> brain biopsy for lymphoma
nonenhancing lesion --> PML ( JC virus): no specific Rx
Hiv patient came with blurry vision. on opthalmoscopy perivascular hemmorhage and fluffy exudates --> CMV retinitis
Rx: genicyclovir. Causes neutropenia (avoiid with AZT). life long proph
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