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Riboflavin deficiency - Riboflavin=B2 -angular stomatitis (changes at the angles of the mouth) -cheilosis (cracked lips) -glossitis -ocular problems (corneal neovascularization) -skin changes Babesiosis - -causes hemolytic anemia -severe in asplenic individuals -carried by Ixodes (deer) tic...

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  • August 17, 2024
  • 40
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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USMLE Step 3

Riboflavin deficiency - Riboflavin=B2

-angular stomatitis (changes at the angles of the mouth)

-cheilosis (cracked lips)

-glossitis

-ocular problems (corneal neovascularization)

-skin changes



Babesiosis - -causes hemolytic anemia

-severe in asplenic individuals

-carried by Ixodes (deer) tick (like Lyme)

-dx with blood smear that shows tetrads of intraerythrocytic ring forms OR with PCR

-tx with clinda or quinine



Aeromonas hydrophila - This gram-negative bacterium is found in freshwater environments,
although it may also be present in brackish water. Infections are more likely to occur during warmer
weather. Soft tissue involvement and bacteremia/sepsis can develop in patients with underlying
immunocompromising diseases, including cirrhosis and cancer. The clinical presentations of infection
with Vibrio vulnificus and Aeromonas species can be quite similar. This organism is often susceptible to
fluoroquinolones, trimethoprim-sulfamethoxazole, tetracyclines, imipenem, aminoglycosides, and third-
or fourth-generation cephalosporins



5 causes of microcytic anemia - iron deficiency, lead poisoning, anemia of chronic disease (but
usually normocytic), thalassemia, sideroblastic anemia (can also have high MCV)



Abx safe in pregnancy - -PCNs

-cephalosporins

-aztreonam

-erythromycin

,-azithromycin



Abx with NO anaerobic coverage - aminoglycs, aztreonam, fluoroquinolones, oxacillin/nafcillin, all
cephalosporins EXCEPT cefoxitin and cefotetan



Acanthocytes on blood smear (looks like spur cell but with more rounded spurs) - liver disease,
hypothyroidism, alcoholism



Achalasia - -high tone LES

-bird's beak on barium swallow

-histology shows hypertrophied inner circular muscle with absence of ganglia of Auerbach's plexus

-tx with balloon dilation or surgery



Actinomyces - -normal immune system w/ facial or dental trauma

-dx with gram stain and confirm with anaerobic cx

-branching, filamentous bacteria (LIKE nocardia!)

-tx with PCN



Adequacy of sputum sample - <10 squamous cells and >25 leuks per LPF



Adjustment of levothyroxine in pregnancy - -INCREASE dose as soon as pregnancy is confirmed

-most pt.s require increase of 25-50%

-check TSH once a trimester

-checking T3 and T4 not effective b/c these levels are increased during pregnancy due to increased
thyroid-binding globulin



Adverse effects of NNRTIs - ??



efavirenz

,nevirapine



Adverse effects of NRTIs - lactic acidosis



zidovudine: anemia

didanosine: pancreatitis and peripheral neuropathy

stavudine: pancreatitis and neuropathy

lamivudine: none

abacavir: rash

emtricitabine: none



Adverse effects of protease inhibitors - hyperglycemia

hyperlipidemia



indinavir: kidney stones

ritonavir

lopinavir

nelfinavir

saquinavir

darunavir

tipranavir

amprenavir

atazanavir




Alcoholic ketoacidosis - -AG acidosis

-increased osmolal gap

-ketonemia or ketonuria

-variable blood glucose level, but if higher than 250 think DKA

, -tx with IVF (D5NS) and thiamine



Alcoholic with PNA - strep pneumo, oral anaerobes, Klebsiella pneumo, Acinetobacter, M.
tuberculosis



Anaerobes - -metronidazole is BEST for abdominal anaerobes (carbapenems, piperacillin, and
ticarcillin have equal efficacy)

-cefoxitin and cefotetan are the ONLY cephalosporins

-respiratory anaerobes: clindamycin



Antibiotics for GNRs - Cephalosporins: cefepime, ceftazidime

PCNs: piperacillin, ticaricillin

Monobactam: Aztreonam

Quinolones: cipro, levo, gati, moxi

Aminoglycs: gentamicin, tobramycin, amikacin

Carbapenems: imipenem, mero, erta



Antibiotics for MRSA - IV: vanc, linezolid, daptomycin, tigecycline;

if minor infection, can use oral: TMP/SMX, doxy, minocycline, or maybe clindamycin (there is inducible
resistance to clinda though)



Antibiotics for MSSA - Oxacillin/nafcillin, dicloxacillin (IV and oral), cefazolin (IV), cephalexin (oral)



Antibiotics for strep - PCN, ampicillin, amoxicillin



Antibiotics to use for Staph with PCN allergy - cephalosporins if rash only; macrolides,
clindamycin, vancomycin, linezolid, daptomycin, TMP/SMX



Antibody test for celiac disease - anti-endomysial, tissue transglutaminase (small bowel bx is best
though)

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