My notes: a small gift for you.......... - triplehelix

[ArchivalUser]

Thanks a lot and bump........

[ArchivalUser]

hi guys, i have a query..what does 14-3-3 mean in points 12 and 83..i am not very sure..thanks

[ArchivalUser]

see this docnar:

http://www.neurology.org/cgi/content/abstract/63/3/436

http://en.wikipedia.org/wiki/14-3-3_protein

[ArchivalUser]

thanks triplehelix, it will nice if you could post the MKSAP 14 question bank or post a link to download it.

[ArchivalUser]

thanks a lot triple...and i saw ur notes first in bdj's thread not in step 3 forum..elba put a link i guess..thx again

[ArchivalUser]

thanks a lot triplehelix..

[ArchivalUser]

this is not small gift. its big . thanks

[ArchivalUser]

it is specific protein that is searched in case of Cjakob suspicion

[ArchivalUser]

OK, here is the Infectious Diseases notes

635. Vibrio vulnificus infections are associated with exposure to seawater and fish.
636. Wound infections caused by Vibrio vulnificus may result in necrotizing fasciitis.
637. Oseltamivir and zanamivir are both active against influenza A and B.
638. Because zanamivir may induce bronchospasm, it is contraindicated in patients with asthma.
639. Progressive multifocal leukoencephalopathy is a demyelinating disease with a high mortality rate that occurs primarily in immunosuppressed patients.
640. No treatment is available for patients with progressive multifocal leukoencephalopathy.
641. The rash of smallpox is most prominent on the face and extremities, and lesions are all at the same stage of development.
642. The rash of chickenpox is most prominent on the trunk, with sparing of the palms and soles, and lesions are at different stages of development.
643. West Nile virus can be transmitted in blood products.
644. Most patients with West Nile virus infection have a subclinical infection.
645. he carbapenems (imipenem, meropenem, ertapenem) are the most appropriate empiric agents for treating infections due to gram-negative bacilli that produce extended-spectrum β-lactamases (ESBLs).
646. Antiretroviral therapy should be initiated for a treatment-naïve patient with HIV infection and a CD4 cell count less than 200/µL (0.2 × 109/L), even if the patient is asymptomatic.
647. A regimen containing lamivudine, efavirenz, and tenofovir is appropriate for a treatment-naïve patient with HIV infection who also has chronic hepatitis B.
648. Mycobacterium avium complex hypersensitivity pneumonitis is associated with use of hot tubs.
649. Mycobacterium avium complex is present in the water supply in most areas of the United States.
650. In a patient with marked paralytic ileus, oral medications are unlikely to be transported to the colon in sufficient quantity to be therapeutic
651. Differentiating bacterial from mycobacterial infections of the spine generally requires CT-guided needle biopsy of a lesion for histopathologic examination and cultures.
652. Almost all immunocompetent patients with spinal tuberculosis have a positive intermediate-strength tuberculin skin test, whereas false-negative test results are more common in immunosuppressed patients.
653. In immunosuppressed transplant recipients and other persons at high risk for developing active tuberculosis, a tuberculin skin test result of >5 mm of induration is considered a positive test.
654. Dengue fever is characterized by the abrupt onset of severe headache, high fever, myalgias, arthralgias, leukopenia, and thrombocytopenia.
655. Dengue hemorrhagic fever is associated with hemorrhage and capillary fragility.
656. Bronchiectasis is a risk factor for the development of Pseudomonas aeruginosa community-acquired pneumonia.
657. Administration of ganciclovir or valganciclovir has greatly reduced, but not eliminated, the occurrence of cytomegalovirus infections in transplant recipients.
658. Person-to-person transmission of meningococcal organisms occurs by the respiratory route.
659. Prophylaxis of health care workers exposed to a patient with a meningococcal infection is needed only after contact with the patient's respiratory secretions.
660. MRI and CT scans are the imaging procedures of choice in the diagnosis of patients with suspected osteomyelitis.
661. The most appropriate empiric therapy for Streptococcus pneumoniae meningitis is vancomycin plus ceftriaxone and dexamethasone.
662. African tick bite fever is the most common rickettsial infection in humans.
663. Symptoms of African tick bite fever are relatively mild and are characterized by a vesicular rash with an inoculation eschar.
664. Symptoms of Creutzfeldt“Jakob disease typically include cognitive changes (dementia), behavioral and personality changes, difficulty with movement and coordination, and visual and constitutional symptoms.
665. The course of Creutzfeldt“Jakob disease is rapid and progressive; 90% of patients die within 1 year of diagnosis.
666. The most appropriate therapy for a patient with Listeria meningitis and a severe allergy to penicillin is trimethoprim“sulfamethoxazole.
667. When initiating antituberculous therapy, a four-drug regimen must be used if the probability of resistance to isoniazid is greater than 4%.
668. The recommended empiric therapy for a patient with community-acquired pneumonia who is hospitalized on a general medical floor is either monotherapy with an intravenous fluoroquinolone or combination therapy with an intravenous β-lactam plus either an intravenous or oral macrolide or doxycycline.
669. The recommended empiric therapy for a patient with community-acquired pneumonia who is hospitalized in an intensive care unit is an intravenous β-lactam plus either an intravenous macrolide or an intravenous fluoroquinolone.
670. Penicillin is the treatment of choice for all forms of syphilis.
671. Treatment of a pregnant patient with newly diagnosed syphilis is essential in order to prevent congenital syphilis in the fetus.
672. A pregnant patient with newly diagnosed syphilis who may be allergic to penicillin should undergo skin testing for a penicillin allergy.
673. Immunosuppressed transplant recipients are at high risk for development of bacterial infections during the first month after surgery.
674. In patients with a contiguous foot ulcer and possible osteomyelitis, bone biopsy with cultures and histopathologic examination should be performed before initiating antimicrobial therapy.
675. Intravascular catheter“associated bloodstream infections are preventable if proper insertion procedures are used.
676. Chlorhexidine is superior to povidone-iodine for cleaning a catheter insertion site.
677. Vancomycin is the antimicrobial agent of choice for treatment of methicillin-resistant Staphylococcus aureus infections.
678. All β-lactam agents are inactive against methicillin-resistant Staphylococcus aureus infections.
679. HIV genotype resistance testing is indicated for patients with HIV infection who may have developed resistance to one or more antiretroviral agents.
680. No currently available test can differentiate true-positive from false-positive tuberculin skin test reactions in a person who previously received bacille Calmette“Guérin vaccine.
681. The recommended treatment for latent tuberculosis is isoniazid for 9 months.
682. Infection due to Pseudomonas aeruginosa, which is often found between layers of rubber soles in sneakers, may occur following puncture wounds of the foot.
683. Contacts of patients with possible smallpox should receive smallpox vaccine.
684. Contacts of patients with possible smallpox should take their temperature twice daily for 17 days; a contact who develops a temperature over 38 °C (100.4 °F) during this time should be isolated.
685. Acyclovir is effective in preventing reactivation of varicella zoster virus in stem-cell transplant recipients.
686. Noninfectious skin lesions can be differentiated from infectious disorders because the former are not associated with fever and other systemic signs and symptoms or abnormal laboratory studies and culture results.
687. The most appropriate empiric therapy for a patient with purulent meningitis following neurosurgery is vancomycin plus cefepime.
688. The finding of 14-3-3 protein in cerebrospinal fluid has a specificity and sensitivity of greater than 90% for diagnosing sporadic Creutzfeldt“Jakob disease.
689. Live attenuated influenza vaccine is contraindicated in an immunosuppressed patient.
690. All family members of an immunosuppressed patient should be immunized against influenza to decrease the patient's risk of exposure to this virus.
691. Doxycycline in a single dose is highly effective for preventing erythema migrans in patients from areas endemic for Lyme disease who present with an embedded, engorged tick.
692. Contact isolation is most effective for reducing spread of Clostridium difficile in hospitals.
693. The treatment of choice for patients with symptomatic babesiosis is atovaquone plus azithromycin.
694. A positive Western blot analysis confirms the diagnosis of HIV infection; a negative test rules out this diagnosis.
695. An indeterminate Western blot analysis may indicate either HIV seroconversion or the presence of cross-reactive antibodies.
696. Stained specimens of vaginal discharge from patients with candidal vaginitis show pseudohyphae and budding yeast.
697. Stained specimens of vaginal discharge from patients with bacterial vaginosis show gram-negative bacilli attached to squamous epithelial cells (clue cells).
698. In patients with catheter-associated bloodstream infections, the catheter should be removed whenever possible.
699. Echinocandins such as caspofungin, micafungin, and anidulafungin are effective in treating patients with candidemia.
700. Patients with Mycobacterium tuberculosis infection may be considered noninfectious after they are placed on effective antituberculous therapy, demonstrate clinical improvement, and have three different sputum smears that are negative for acid-fast bacilli.
701. Brain abscesses that result from contiguous spread of head and neck infections may contain multiple organisms.
702. Ceftriaxone plus metronidazole is the most appropriate empiric antimicrobial therapy for a brain abscess resulting from contiguous spread of an otitic focus of infection.
703. Vancomycin plus clindamycin is the most appropriate empiric antibiotic regimen for a patient with suspected streptococcal or staphylococcal toxic shock syndrome.
704. Gram-positive bacteria (staphylococci and streptococci) are the most common causes of nongonococcal septic arthritis in adults.
705. Because amantadine is excreted by the kidneys, dosage adjustment is required in patients with renal compromise.
706. Although oseltamivir and zanamivir are excreted by the kidneys, dosage adjustment is not required in a patient with renal compromise.
707. A highly effective vaccine is available for hepatitis A, which must be administered at least 2 weeks before a potential exposure.
708. Patients taking anti“tumor necrosis factor-α inhibitors are at increased risk for developing latent tuberculosis.
709. Patients about to begin therapy with anti“tumor necrosis factor-α inhibitors should undergo tuberculin skin test screening.
710. Transplant recipients are at risk for development of opportunistic infections such as fungal pneumonia.
711. Almost all patients with amebic abscesses will have high levels of antibodies directed against Entamoeba histolytica.
712. In a patient with sickle cell disease and osteomyelitis, potential causative organisms are staphylococci, streptococci, and Salmonella species.
713. Penicillin is the only antimicrobial agent approved for treatment of neurosyphilis.
714. Patients who are allergic to penicillin but for whom alternative antimicrobial agents cannot be prescribed require desensitization to penicillin.
715. Genital herpes simplex virus in a male patient is generally characterized by a limited number of genital vesiculoulcerative lesions without systemic symptoms.
716. Subdural empyema is a medical and surgical emergency.
717. Antimicrobial therapy and neurosurgical drainage are the most appropriate initial management for a patient with a subdural empyema.
718. Surgical site infections are a common complication of operations, especially coronary artery bypass graft surgery.
719. The appropriate dose, timing, and duration of prophylactic perioperative antibiotics help decrease the risk of surgical site infections.
720. Deep fungal infections such as histoplasmosis are a risk to travelers to endemic areas.
721. Reactivation of human herpesviruses 6 and 7 is being increasingly recognized in immunosuppressed patients.
722. Reactivation of human herpesviruses 6 and 7 may cause hepatitis and meningoencephalitis.
723. Treatment of latent tuberculosis is indicated for any person with a known tuberculin skin test conversion, regardless of the person's age.
724. Most cases of toxic shock syndrome are caused by Staphylococcus aureus or Streptococcus pyogenes.
725. Ceftriaxone provides effective empiric therapy for patients with possible disseminated gonococcal infection.
726. Health care workers in contact with a patient with possible smallpox require gown, gloves, and a personal respirator for protection.
727. A qualitative assay for hepatitis C virus RNA viral load is the most sensitive test for diagnosing hepatitis C infection.
728. Penicillin resistance is categorized as either intermediate-level resistance (minimal inhibitory concentration [MIC] between 0.1 and 1 μg/mL) or high-level resistance (MIC >1 μg/mL).
729. ¢ Organisms that are resistant to penicillin generally remain sensitive to fluoroquinolones and are uniformly sensitive to vancomycin and linezolid
730. Polyomavirus BK is associated with nephropathy and deteriorating renal function in renal transplant recipients.
731. The presence of intranuclear inclusions in tubular epithelial cells or transitional cells is highly indicative of polyomavirus BK.
732. Acute retinal necrosis occurs most often in patients with HIV infection or AIDS.
733. Intravenous acyclovir is the preferred treatment for acute retinal necrosis.
734. In contrast to patients with sporadic, genetic, or iatrogenic Creutzfeldt“Jakob disease, patients with the variant form of the disorder tend to be younger and have psychiatric symptoms rather than dementia early in the disease, more prominent sensory findings, and MRI abnormalities in pulvinar area of the thalamus rather than in the basal ganglia and putamen.
735. Ninety percent of urinary tract infections are associated with indwelling catheters.
736. Administering prophylactic antibiotics, acidifying the urine, or using disinfecting washes have not been shown to prevent urinary tract infections.
737. Vancomycin plus cefepime is the most appropriate empiric antimicrobial therapy for a patient with an epidural abscess and a history of injection drug use.
738. The development of focal lymphadenitis in a patient with HIV infection is most commonly caused by mycobacteria, Streptococcus species, or Staphylococcus species.
739. Cryptococcal infection in transplant recipients is associated with high morbidity and mortality.
740. Flucytosine plus a lipid formulation of amphotericin B is usually effective for treating cryptococcal infections in transplant recipients.
741. Empiric antibiotic therapy while awaiting culture results is required for patients with an infected clenched-fist injury.
742. Oral valacyclovir is the most appropriate antiviral agent for a patient with genital herpes simplex virus infection without systemic complications.
743. The four œD's that characterize botulism are diplopia, dysphonia, dysarthria, and dysphagia.
744. Fatal familial insomnia is the rarest of the prion diseases.
745. ¢ Fatal familial insomnia is characterized by severe insomnia, confusion, other signs of dementia, and autonomic nervous system instability
746. Anaplasmosis (formerly human granulocytic ehrlichiosis) is characterized by fever, flu-like symptoms, leukopenia, thrombocytopenia, liver chemistry abnormalities, and a peripheral blood smear showing morulae.
747. Doxycycline is the treatment of choice for anaplasmosis.
748. A patient with suspected herpes simplex virus encephalitis requires polymerase chain reaction of the cerebrospinal fluid and MRI of the brain to confirm the diagnosis.
749. Acyclovir is the preferred initial therapy for a patient with herpes simplex virus encephalitis.
750. Keeping mechanically ventilated patients semi-recumbent (at a 45-degree angle) helps prevent development of ventilator-associated pneumonia.
751. Thrombocytopenia may occur in patients who take linezolid for 2 or more weeks.
752. The decision about whether admission to an intensive care unit is needed for patients with community-acquired pneumonia is based on the presence of specific major and minor criteria.
753. Because Legionella pneumonia is of particular concern in a patient with severe community-acquired pneumonia, testing for urinary Legionella antigen is indicated.
754. Whenever possible, outpatient parenteral therapy should use drugs that can be given once daily for convenience and patient comfort.
755. In patients with HIV infection and Kaposi's sarcoma, the sarcoma frequently regresses and sometimes resolves completely after successful treatment with highly active antiretroviral therapy.
756. Oral levofloxacin rather than intravenous levofloxacin is indicated for empiric treatment of a highly compliant patient with acute pyelonephritis who can eat and drink.
757. The most appropriate treatment for a cat bite in a patient with a penicillin allergy is trimethoprim“sulfamethoxazole plus clindamycin.
758. Patients with progressive massive fibrosis are at increased risk for developing tuberculosis.
759. The most appropriate diagnostic studies for suspected tuberculosis are tuberculin skin testing and sputum for acid-fast stain and culture.
760. Staphylococcus aureus and Pseudomonas aeruginosa are the most likely causes of septic arthritis in an injection drug user.
761. Enterotoxigenic Escherichia coli is the most common cause of diarrhea in travelers to developing countries.
762. Diarrhea due to enterotoxigenic E. coli is usually a mild and self-limited illness.
763. West Nile virus encephalitis is most likely to occur in patients 65 years of age and older.
764. Findings in patients with West Nile virus encephalitis include fever, severe headache, marked muscle weakness involving the lower motor neurons, mental status changes, and possibly seizures.
765. The need for isolation precautions is based on the route of transmission of the suspected pathogen or the clinical symptoms of the patient.
766. Because Francisella tularensis is not transmitted from person to person, only standard precautions, rather than isolation procedures, are required for patients with tularemia.
767. Esophagitis in an immunosuppressed patient is most often caused by Candida.
768. Echinocandins and triazoles are both effective for treating Candida esophagitis.
769. Shiga toxin“producing Escherichia coli is associated with development of the hemolytic uremic syndrome.
770. Administration of foscarnet is indicated for a patient with acyclovir-resistant herpes simplex virus infection.
771. Administration of foscarnet may be associated with significant electrolyte abnormalities.
772. Prophylaxis is not required for household contacts of patients with an invasive streptococcal infection.
773. If two or more cases of invasive streptococcal disease occur in postpartum or postsurgical patients hospitalized within 6 months in the same institution, an epidemiologic investigation is required to determine if a hospital worker is a carrier.
774. Immunosuppressed patients are at increased risk for developing nosocomial pneumonia even when mechanical ventilation is not required.
775. A œhalo sign (a nodular lesion with a surrounding ground-glass appearance) on chest radiographs is characteristic of Aspergillus pneumonia.
776. Bactericidal agents such as daptomycin are mandatory for treatment of endocarditis.
777. Emergence of resistance to daptomycin is rare, and daptomycin is not correlated with cross-resistance to any other drug class.
778. Current recommendations do not support use of tuberculin skin testing as a screening test in otherwise healthy persons with no personal or occupational exposure to persons with tuberculosis.
779. Pneumococcal strains are becoming increasingly resistant to penicillins and macrolides.
780. Most experts and guidelines support the use of a third-generation cephalosporin plus a macrolide for treatment of community-acquired pneumonia.
781. West Nile virus can be transmitted by blood transfusions.
782. West Nile virus can be transmitted to transplant recipients from organ donors.
783. he primary pathogens associated with bloodborne exposures in health care workers are HIV, hepatitis B, and hepatitis C.
784. ¢ Two or three antiretroviral agents are recommended when a health care worker sustains a deep, penetrating injury from a source patient who is HIV seropositive.
785. Oral valganciclovir is as effective as intravenous ganciclovir for treating patients with cytomegalovirus retinitis.
786. A maculopapular rash, especially on the palms and soles, is characteristic of disseminated (secondary) syphilis.
787. A patient with possible neurosyphilis should receive intravenous aqueous crystal penicillin G for 14 days.
788. Patients with osteomyelitis and an epidural abscess who do not have focal neurologic deficits can usually be treated with antimicrobial therapy alone, but must be monitored carefully.
789. Aspiration and culture of joint fluid is the most appropriate test for determining whether a prosthetic joint is infected.
790. Patients with pneumonic plague typically present with high fever, headache, myalgias, dyspnea, hemoptysis, and watery sputum.
791. Patients with pneumonic plague have a mortality rate approaching 100% if not treated with streptomycin within 24 hours of development of symptoms.
792. Angiostrongylus cantonensis (the rat lungworm) is the most common cause of eosinophilic meningitis worldwide.
793. Prevention of nosocomial mycobacterial infections requires airborne isolation of the patient and personal respirators for health care workers.
794. The most common distribution of herpes zoster (shingles) is a unilateral rash in the thoracic region.
795. Famciclovir and valacyclovir have replaced acyclovir as the treatment of choice for patients with herpes zoster.
796. Cutaneous Mycobacterium marinum infection is most often associated with exposure to fish tanks.
797. The most appropriate diagnostic study is biopsy of a nodule for histopathologic examination, acid-fast stain, and culture.
798. Trimethoprim“sulfamethoxazole is the preferred antimicrobial therapy for a patient with a brain abscess caused by Nocardia species.
799. Patients with a presumptive diagnosis of Rocky Mountain spotted fever should receive treatment with doxycycline even before the diagnosis is confirmed.
800. Campylobacter jejuni is the most common cause of bacterial diarrheal disease in the United States.
801. C. jejuni often causes disease by cross-contamination of cooking utensils or surfaces such as countertops.
802. A complete history of antiretroviral drug use is essential for a patient with HIV infection who has been on many drugs and is not benefiting from the current treatment regimen.
803. Aspergillosis is the most common pulmonary mold infection in immunosuppressed patients in the United States.
804. Aspergillus infection cannot be distinguished from infection caused by Pseudallescheria before culture results are available
805. Nosocomial outbreaks of Clostridium difficile and norovirus have been well documented in recent years.
806. Nosocomial outbreaks of C. difficile and norovirus require contact isolation and increased cleaning of all patients' rooms.
807. Options for treatment of community-acquired pneumonia in an outpatient without additional risk factors include an advanced-generation macrolide or a ketolide or doxycycline.
808. Treatment of an outpatient with community-acquired pneumonia should be started without waiting for results of Gram stain and culture.
809. Patients with central nervous system Lyme disease who are allergic to β-lactam antibiotics should be given doxycycline.
810. Corticosteroids have been shown to significantly alleviate acute pain in patients with herpes zoster (shingles).
811. Corticosteroids are contraindicated in patients with poorly controlled plasma glucose levels, osteoporosis, or hypertension.
812. Hospitalized patients with community-acquired pneumonia can usually be changed from an intravenous to an oral antibiotic regimen when fever, cough, and dyspnea have resolved; oral intake is satisfactory; and the leukocyte count is returning towards normal.
813. Asymmetric migratory joint pain and pustular lesions are characteristic of disseminated gonococcal infection.
814. Cultures of the pharynx, cervix, and anus should be obtained for a woman with suspected disseminated gonococcal infection.
815. Approximately 50% of patients with AIDS and progressive multifocal leukoencephalopathy will survive the latter disease if highly active antiretroviral therapy is administered.
816. Polymerase chain reaction of cerebrospinal fluid is the preferred test for diagnosing herpes simplex virus encephalitis.
817. Acute cellulitis in an immunosuppressed patient may be due to unusual pathogens, such as Cryptococcus neoformans.
818. Administration of zidovudine to a pregnant patient with HIV infection is believed to reduce the risk of maternal-to-child transmission of HIV.
819. Efavirenz is contraindicated in a pregnant patient with HIV infection.
820. Cyclosporiasis is associated with positive acid-fast“stained stool specimens and copious diarrhea without fever.
821. The treatment of choice for cyclosporiasis is trimethoprim“ sulfamethoxazole.
822. The incidence of fluoroquinolone-resistant N. gonorrhoeae has been increasing, especially on the West Coast of the United States and in Hawaii.
823. The most appropriate treatment for concurrent gonorrhea and a chlamydial infection is a single dose of intramuscular ceftriaxone plus oral azithromycin.
824. Patient-administered antibiotic therapy is usually appropriate for women with recurrent episodes of uncomplicated urinary tract infections.
825. Risk factors for aspiration pneumonia include difficulty swallowing, episodes of depressed consciousness, and mechanical factors such as esophageal obstruction.
826. Clindamycin provides effective treatment for anaerobic aspiration pneumonia.
827. Necrotizing fasciitis in an injection drug user may be due to many different organisms.
828. The most effective initial empiric antibiotic regimen for necrotizing fasciitis in an injection drug user is vancomycin plus piperacillin“tazobactam plus clindamycin.
829. The most successful therapy for treating infected prosthetic joints involves removal of the prosthesis and a 6-week course of antimicrobial therapy followed by reimplantation of a new prosthesis.
830. Aztreonam can be used safely in patients who are allergic to penicillin.
831. The U.S. Centers for Disease Control and Prevention include aerosolized viruses that cause Ebola, Marburg, and Lassa fevers; Argentine hemorrhagic fever; and Bolivian hemorrhagic fever as most likely to be used as biochemical weapons.
832. Influenza virus resistance develops rapidly following exposure to rimantadine.
833. If one family member develops resistance after taking rimantadine for treatment of influenza, the resistant virus can be transmitted to other family members.
834. Hyponozoites of Plasmodium vivax malaria may remain in the liver for long periods and become reactivated at a later date.

[ArchivalUser]

thanks Th