SAN LAZARO SAMPLEX QUESTION BANK             

                
Causes infection transmitted primarily by sexual contact, causes vaginitis in women and NGU in men: Chlamydia Trachomatis
Primary treatment for simple abscess/ boils: Incision and Drainage / Antibiotics
Fever, Myalgia, arthralgia, chills, and hypotension 6-8 hours after initial dose of anti-syphilitic treatment: Jarisch-Herxheimer
Reaction
Primary skin lesion of syphilis: Chancre
Most endemic malarial species in the PH: Plasmodium Falciparum
For screening and monitoring of treatment response of syphilis: VDRL / RPR
2 malarial species with dormancy state in the liver: Vivax / Ovale
Two important co-receptors in the cell surface of CD4+ T-lymphocytes that facilitates entry and fusion of HIV: CCR5 / CXCR4
Window period fo HIV/AIDS: 8 months
HIV related malignancies: Kaposi's Sarcoma, Non-Hodgkin's Lymphoma
Vaccine Preventable Malignancies: Cervical Malignancy, Hepatocellular Carcinoma
Envelope glycoprotein detected in HIV-1 positive Western Blot Confirmatory Test: gp120, gp41
Enzyme needed to trasncribe RNA to DNA in AIDS patients: Reverse Transcriptase Enzyme

Give the clinical problems encountered during the different phases of dengue

1. Febrile Phase
1. Hemorrhage
2. Dehydration
3. High fever causing neurological disturbances and febrile seizures in children
2. Clinical Phase
1. Prolonged shock from plasma leakage
2. Severe Hemorrhage
3. Organ impairment
4. Intracranial bleed
5. Heepatic failure
6. Coagulopathy
7. Metabolic abnormalities (Hypoglycemia, Hyponatremia, Hypocalcemia)
3. Recovery Phase
1. Hypervolemia / Intravascular fluid overload

Recommended anti-TB drugs, duration and dosage of therapy for CNS TB in a 30 year old male (Body wt = 40kg)

Intensive Phase: 2HRZE

Isoniazid - 5-7mg/kg/day
Rifampicin - 10mg/kg/day
Pyrazinamide - 25-35mg/kg/day
Ethambutol - 15 - 25 mg/kg/day
Streptomycin - 20 - 40mg/kg/day

Maintenance Phase: 10HR

Isoniazid - 5 -7mg/kg/day
Rifampicin - 10mg/kg/day

60y/o male sustained a puncture wound. Facial and UE musucle spasm. Rigid abdomen. What will you tell the patient's family? -
Should be admitted because he is having stage 2 tetanus complications
What is the clinical type of tetanus - Generalized
Stage 3 tetanus comprises the following: <7 days incubation, (+) Trismus, Paroxysmal spasms frequent and problonged
Doc for Tetanus - Metronidazole
Upon discharge, tetanus toxoid schedule? - 0, 1, 6 then yearly for 2 years
Fever for 3 days with reddening of conjunctiva. With nausea and vomiting, myalgia. CBC and UA requested, physician said
probably dengue. 2 days after, moderate grade fever, tachypneic, decreased urine output.
Diagnosis - Leptospirosis
Increased risk of mortality of patient with this diagnosis: Altered Mental Status
Gold standard for diagnosis: Culture and Isolation
Prophylaxis of low exposure with single history of wading in flood: Doxycycline 200mg OD once 24-72 hours after exposure
2 alternative treatment for moderate - severe leptospirosis: Ceftriaxone, IV Ampicillin

7 Year old, 37kgs. Bitten by stray cat. Avulsed wound over right forearm. Date of incident: March 23, 2015. Sought consult:
March 24, 2015.
Category of exposure: Category 3
Give dose of rabies immunoglobulin: ERIG 7.4mL HRIG 4.92mL
Give completed updated 2 site ID post-EP schedule (day of immunization, dose, site, of injection)
D0 - Right deltoid (0.1)
D3 - Left Deltoid (0.1)
D7 - Right Thigh (0.1)
D28 - Left Thigh (0.1)

Give the reformulated old and new oral rehydrating solutions

Glucose - 111 - 75
Sodium - 90 - 75
Potassium - 20 - 20
Chloride - 80 - 65
Citrate - 10 - 10

Common bacterial pathogens that causes bacterial meningitis with the ff predisposing factors:
<1 month: E.Coli , Group B Strep
>50 years old: S. pneumonia , N. meningitides , L. monocytogenes , H. influenzae

5 Serotypes that cause invasive meningococcal disease: A B C X W-135

Rabies has 100% fatality rate - TRUE

HIV is curable and preventable - TRUE
Snake bites from vipers manifest as rapid sweating, tissue necrosis, and abdominal bleeding while sea snake bites manifest as
myalgia - TRUE
Suspect case refers to individuals harboring the pathogen but without manifesting the signs and symptoms - FALSE - Carrier
State
in PH, malnutrition is the leading cause of mortality among children 0 - 15 years old - TRUE

SIRS:

<36 >38C
HR > 90
RR >20 or PaCO2 <32mmhG
WBC >12000mm3 <4000 or >10% bands

Sepsis - SIRS + Infection

Severe Sepsis - Sepsis + Organ dysfunction
Septic Shock - Severe sepsis + Hypotension
Toxoid - modified toxin from pathogen, non-toxic but still used as antigen
Passive immunity - Humoral immunity that is short-term and given via antibodies coming from another person or animal
Endotoxin - toxic heat stable lipopolysaccharide from membrane of gram negative bacteria that is released from the cell
upon lysis
Weil's syndrome - Severe form of Leptospirosis. Jaundice, abdominal pain, nausea, vomiting, diarrhea, oliguria/anuria,
meningeal irritation, septic shock, altered sensorium, DOB, Hemoptysis
Nosocomial infection - hospital or health facility acquired infection. Occurs within 48 hours of hospital admission, >3
days after discharge or 30 days after surgery

DRUGS OF CHOICE:
S. typhi - Chloramphenicol
MRSA - Vancomycin
MSSA - Oxacillin
Pseudominas aeruginosa - Ceftazidime, Ticarcillin, Piperacillin - Tazobactam
Schistosoma Japonicum - Praziquantel
Clostridium tetani - Metronidazole
Candida Albicans - Fluconazole
Plasmodium Falciparum - Artemether/Lumefantrine
Pneumocystis Carinii - Trimethoprim-Sulfamethoxazole
Treponema Pallidum - Pen G
Toxoplasma gondii - Pyrimethamine + Sulfadiazine
Corynebacterium diptheriae - Metronidazole, Erythromycin, Procaine Pen G
Cryptococcus Neoformans - Fluconazole
Neiserria Gonorrheae - Ceftriaxone IM + Azithromycin PO
Neiserria Meningitidis - Pen G
Herpes Simplex Virus - Acyclovir
Diphtheria - Aqueous Penicillin
Syphillis - Benzathene Penicillin

Breast feeding with good attachment:

Chin touching the breast

Mouth wide open
Lower lip turned outward
More aerola visible above than below the mouth

Uses TB drugs and Steroids - TB meningitis, Miliary TB

Regimens: 

New cases EXCEPT CNS/bones/joint: 2HRZE + 4HR

New cases CNS/bones/joint: 2HRZE + 10HR
Previous case EXCEPT CNS/bones/joint: 2HRZES + 1HRZE + 5HRE
Previous case CNS/bones/joint: 2HRZES + 1HRZE + 9HRE

Latent TB: After inhalation of droplet nuclei, reactive TST, absence of clinical and radiographic changes
Pott's disease: 2HRZE + 6/9/12/18HR

TETANUS ABBETT CLASSIFICATION

Management of Tetanus:

Metronidazole 500mg IV q6 x 7 days

Tetanus Toxoidd
Tetanus IMmunoglobulin 3000 - 6000 IU
Benzodiazepine

Diphtheria etiologic agent - Corynebacterium Diptheriae

significant affected site except respiratory obstruction - Tender lymph nodes at anterior triangle of neck (Bull's Neck) ,
Laryngeal Involvement (stridor and dyspnea)
Prevention: DTP. Prophylaxis : Erythrommycin 1g/day PO x 7 days

Cholera: Vibrio Cholerae

s/sx: Rice Water Stool, vomiting, abdominal cramps, dehydration
Diagnostic test: Direct stool examination, TCBS agar culture, slide agglutination tests

Dengue: Aedes aegypti, Aedes albopictus

Management: Supportive fluids and Paracetamol
Phases: 

Febrile - 4-7 days

Critical - 24-48hrs after
Recovery - next 4-7 days

Platelet reproduction - 48 hours

Dengue NS1 - First 4 days. False negatives: yellow fever, flavivirus infection
Usual Rash: Maculopapular Petechial Rash

Leptospirosis diagnostic test: Migroagluttination test (4 fold increase or seroconversion)

Prophylaxis: Doxycycline 100mg 2 caps once weekly until the end of exposure

Malaria fever pattern (P. falciparum) - Every 48 hours

72 hours - P. malariae

Viper snake - Tissue necrosis, Swelling, Hemorrhage

Sea Snake - Myalgia

Leading cause of death in children 0-5years: Malnutrition

No dehydration - May go home

Some dehydration - 75ml/kg given over 4 hours
Severe dehydration - 30ml/kg initial, 70ml/kg

5 strains of corona virus: 

HCOV 229E
HCOV OC43
HCOV NL63
HCOV KHU1
MERS COV

AIDS CD4 T cell count: <200/uL

Main tropism: CD4+ Tcell
First line treatment: ARV

Rubeola - Maculopapular, 1st disease, Centrifugal rash (rash before fever)

Rubella - Peak of fever = Rash, Forscheimer spot
Scarlet Fever - Sandpaper rash, Strawberry tongue
Varicella - Vesicular, Macular, Papular Rashes (Constellation Sign)

Xray how do you know which side of lungs - Gastric Bubbles

Dextrocardia - Shift of aorta knob
Pneumothorax - Visible pleural line
Effusion - Meniscus Sign
Scapula - PA: Winged Inward AP: Winged outward
Clavicle: PA: V shaped AP: Horizontal
Shifting of structures: Lung collapse
Atelectasis: Ipsilateral
Effusion : Contralateral
Tension Pneumothorax: Contralateral

Diarrhea + Blood Streaked and mucoid + Tenesmus - 

Etiologic agent: E. histiolytica

Pathologic agent: Trophozoite
Infective agent: Cyst
DOC: Metronidazole
Dfiferential Diagnosis: AGE, Typhoid Fever, Cholera

Initial IVF for 3yr old brought to ER with 3 days history of watery mucoid stools: D5LR
1 year old male brought to ER + 3 days high fever + bluish spot in the center of inner aspect of chest: Measles

Gold standard Leptospirosis diagnosis: Culture and Isolation

Prophylaxis Leptospirosis low risk exposure with single history of wading in contaminated water: Doxycycline 200mg OD once,
24-72 hours after exposure
Alternative treatments for moderate to severe leptospirosis: Ampicillin, Azithromycin, Cefotaxime, Ceftriaxone

Oppurtunistic infections if CD4 count <200 (AIDS):

Pneumocystic jiroveci pneumonia

Atypical Mycobacteria
 CMV retinitis
Candidiasis
Coccidiodomycosis
Cryptosporidosis
Histoplasmosis
Toxoplasmoasis

3 differentials for dyspnea and cough: Pneumonia, Tracheitis, Bronchitis, PTB

Moderate pneumocystis pneumonia, what is the drug of choice?: Co-Trimoxazole (TMP-SMX) (TMP 15-20mg) (SMX 75-
100mg) per kg per day IV Q6/8 x 21 days (moderate to severe)

Co-trimoxazole (TMP - SMX) (TMP 15-20mg) (SMX 75-100mg) per kg/day PO in 3 divided doses for 21 days
(mild to moderate)

Male had casual sex -> dysuria, urethral discharge and gram stain showed intracellular and extracellular gram negative
diplococci (GONORRHEA)
What antibacterials will be prescribed to these patients?

Ceftriaxone (250mg IM, single dose)

Azithromycin (1g PO, single dose)

Consideration: Uncomplicated urethral gonococcal infection, Co-infection with Chlamydia

Signs/Symptoms of Cholera: sudden onset explosive diarrhea with Rice water stools, Vomiting, Dehydration, Muscle
Cramps
Diagnostic test for Cholera: Dark field microscopy identification,  Culture (TCBS agar)
Diseases transmitted airborne: Chickenpox, Measles, Tuberculosis
Particle size that can reach the alveoli: <0.1um
Drug of choice for syphillis: Pen G Benzathine
Severe complication of tetanus: Respiratory Failure
Diphtheria: Corynebacterium diphtheriae
Leading cause of mortality in children 0-5 years old: Malnutrition
When are steroids indicated in TB: TB meningitis, Miliary TB
Mainstay of treatment in dengue: IV fluids and Oral fluid intake
Skin lesions of primary syphillis: Chancre
Envelope glycoprotein detected in HIV-1 positive Western Blot confirmatory test: GP 120/160

Tests to diagnose cryptococcal meningitis: 

India ink test - Encapsulated org on microscopy

Cryptococcal antigen test
Culture of CSF - cream colored mucoid colonies are seen on agar plates generally within 3 to 7 days

Kawasaki Disease: CBC, PC, ESR // IVIG, high dose aspirin

What vaccines should be given to a 4yr old: DPT, rabies
Schedule of antirabies vaccine: 0 3 7 14 28

Prophylaxis - use of antibiotics pre-emptively to prevent acquisition of the infection

Chemoprophylaxis - 
Strep pneumoniae - lancet shaped gram positive facultative anaerobic bacteria, causes bacterial pneumonia, otitis media,
sinusitis, meningitis, and bacteremia
Ophthalmia neonatorum - neonatal conjunctivitis, passage through a birth canal from a mother infected with N.
gonorrheae or C. trachomatis
Polyarthritis - arthritis involving 5 or more joints

Drug of choice for asymptomatic bacteriuria in pregnancy: Cephalexin 500mg BID for 7 days

PCP Prophylaxis:

TMP 15-20mg/kg/day
SMX 75-100 mg/kg/day

Dapsone/Trimethoprim

Dapsone 100mg OD
TMP 15mg/kg/day

Uncomplicated Cystitis Treatment:

Nitrofurantoin monohydrate - 100mg BID for 5 days

Cotrimoxazole
Fosfomycin - 3g single dose
Pivemcillinam - 400mg TID for 3 to 7 days

Measles with pus in the urine:

Measles IgM antibody and Measles RNA through PCR

Supportive treatment (Paracetamol), Vitamin A (Immunomodulation)
Lymphoma associated with HIV: NHL, DLBCL
Cancer preventable by vaccine: Hepatocellular Carcinoma, Cervical Cancer 
At risk for Malaria: Recent travel to endemic area, Blood transfusion, IV drug users
Interval of fever for P. Falciparum - 36-48 hours
Prevention of Diphtheria: Toxoid immunization (DPT), 1 dose toxoid + Erythromycin 1g/day orally for 7 days
Congenital rubella syndrome: ASD, PDA, Pulmonary Artery Stenosis NOT MYOCARDITIS
12 years old bitten by dog while feeding + spontaneous bleeding: Tetanus toxoid, ATS, Anti-rabies Vaccine, ERIG (Equine
Rabies Immunoglobulin)
Prophylaxis to meningococcemia: Rifampicin 450-600 BID // Ciprofloxacin 500mg/tab OD

With infection, no symptoms: Carrier

Droplets do not travel for more than: 3 feet
Pathogenesis of Rotavirus: Flattening of the villous
Usual site of neonatal tetanus: Umbilical Stump
Organs most affected by Schistosoma: Liver and GIT
Basis of IMCI: Not all but common diseases that affect children
Dengue virus circulating in the Philippines: 3 and 4
Gold standard for typhoid: Blood culture
Where can you isolate lepto in the first 10 days: CSF
Composition of ORS based on UNICEF/WHO: Glucose + Sodium + Chloride + Potassium Chloride + Citrate
Natural reservoir of meningococcemia: nasopharynx
Recrudescence: recurrence of s/sx of P. falciparum
Relapse: vivax, ovale, hypnozoites
Rash in dengue: petechiae
Plasma leakage: Dengue fever
Hydrophobia: Rabies
Washerwoman's hands
Rice water stools: Cholera
Calf pain: Leptospirosis
Cicatrix: Pulmonary TB
Chronic form of Malaria: Vivax and Ovale
Recrudescence of Malaria: P Falciparum

Presents with dog bite at ER, what to give now?

Human Rabies Immunoglobulin (HRIG)

Anti rabies vaccine, PVRV
Tetanus Toxoid
Tetanus Immunoglobulin

Malaria gold standard for diagnosis: Thick and Thin Smears

Management (first line non-severe): CQ + SP
Second line if unresponsive: Artemether Lumefantrine (Co-artem)
Severe: Q + T/D
P. Falciparum: Primaquine to prevent transmission and eradicate extrahepatic stages
P.Vivax: Chloroquine

Warning signs for Dengue:

Bleeding mucous membranes

Abdominal tenderness
Persistent Vomiting
Hepatomegaly >2cm
Lethargy/Restlessness
Increase in HCT with decrease in platelets

Signs of Envenomation:
 Myotoxicity
Neurotoxicity
Hemorrhage

Meningitis: Nuchal rigidity, Fever, Altered Mental Status

CSF Analysis bottles:

1: glucose and protein

2: total cell count and differential count
3: microbiological

Pleural fluid analysis bottles:

1: AFB gs/cs
2: culture and sensitivity
3: cell cytology
4: protein and sugar analysis

Creatinine clearance computation in males: Cockcroft Gault formula

Weil's syndrome: Kidney failure, Jaundice, Bleeding

Associated with onset of tuberculosis hypersensitivity in primary complex: Erythema nodosum
Always suggests primary TB regardless of the lung field involved: Pneumonia with hilar adenopathy

General rule: all travelers who have been to malaria endemic areas within how many days who present with fever are considered
to have malaria unless proven otherwise: 7 days 
Treatment for uncomplicated chloroquine resistant P. falciparum or P. vivax malaria: Artemeter
Transmitted by a bat except: H1N1 influenza
Malarial paroxysms lasting for hours with regular periodicity coincide with: Exit of merozoites into the bloodstream after
breaking down their host cell membrane
Person with Ebola virus can resume unrpotected sexual activity within this period: 3 months
HRIG: single dose 20 IU/kg in all age groups
Paralytic rabies: Hypophonia, Ascending paralysis, neck stiffness, normal sensorium
Biphasic fever: Dengue Hemorrhagic feever
Patients with malaria, schistosomasis or histoplasmosis are at increased risk of severe disease with this entity: Salmonella typhi
Renal complications are rare in this disease: Typhoid fever
Differential diagnosis of DHF: Japanese B encephalitis, Yellow fever
Adult antibiotic prophylaxis for household or intimate contacts of patients with meningococcal disease: Rifampicin 600mg q12
for 2 days in adults

Herpes Zoster: vesicular eruption painful affecting nerve root ganglia

Schistosomiasis: Aquired by wading in waters that are inhabited by larva cercaria
Liver abscess: RUQ pain and hepatomegaly with fever, without jaundice
Endocarditis
Meningococcemia: High grade fever with purpuric rash or ecchymoses and rapid deterioration of clinical condition
Cellulitis: Acute spreading infection of the skin extending deeper to involve the subcutaneous tissue due to Group A
streptococcus or taphylococcus aureus
AIDS: main targets T lymphocytes
Dengue fever: female aedes with incubatino of 2-7 days
Diphtheria: Disease of oropharynx characterized by grayish pseudomembrane

Pregnant with complicated typhoid: Ceftriaxone

Prengant with malaria: quinine
Clinical leptospirosis: penG
Severe pneumonia: Imipenem, Carbapenems
Tetanus: Metronidazole

Pertussis - Bardetella pertussis - Erythromycin

Acute parotitis - mumps - supportive
Washerwoman's hands - Vibrio cholerae - Ciprofloxacin
Amoebiasis - Entamoeba Histiolytica - Metronidazole

Cut off for fast breathing in 2months to 12 months - 50cpm

Types of liver abscess - Pyogenic, Amoebic abscess