Doctors Hospital Infectious Disease Inservice Exam Review

Front 1

Treatment for Lyme disease if 1st degree AV block?

Back 1

doxy

Note: only treat 2nd/3rd degree AV block with ceftriaxone

Front 2

non bullous impetigo treatment?

Back 2

mupirocin

Front 3

salmonella gastroenteritis treated how?

Back 3

usually self limiting only give antibiotics if severe or invasive (quinolone, macrolide, 3rd gen cef)

Front 4

most common cause of osteomyelitis in patient with a nail puncture?

Back 4

Pseudomonas Note Staph is most common overall cause of osteomyelitis but this is exception

Front 5

How is diptheria treated?

Back 5

anti diptheria antibodies, with metronidazole, or penicillin G or erythromycin

Front 6

How is pertussis treated? Are the contacts treated?

Back 6

erythromycin for 14 days and treat contacts same way

Front 7

Treatment for legionaire's disease?

Back 7

azythromycin or moxifloxacin

Front 8

What is first test in suspected legionaire's? Gold standard?

Back 8

Urine antigen first, sputum culture gold std

Front 9

Organism causing cellulitis in someone with DMII or burns? Treatment in burn patients?

Back 9

pseudomonas, treat with topical sulfadiazine or bacitracin

Front 10

How is tuleremia treated?

Back 10

tetracycline or doxycycline

Front 11

what is prophylactic treatment for any cat bite? What organism are you worried about?

Back 11

amoxicillin with clavulanate for Pasturella multicodia

Front 12

What are 2nd line prophylactic agents for any cate bite?

Back 12

can use bactrim or doxy or cefuroxime or quinolone with either clindamycin or metronidazole for aneorobic coverage

Front 13

treatment for bacterial conjunctivitis?

Back 13

topical macrolide or topical polymixin B

Front 14

treatment of acanthomeaba infection of eyes?

Back 14

propamidine and polymixin opthalmic solution

Front 15

Treatment of a chalazion or hordeolum?

Back 15

warm compresses and if no improvement referral to an opthomologist

Front 16

How is osteomyelitis treated?

Back 16

surgical debridement and IV antibiotics for 6 weeks Note: if vertebral osteo treat for 8 weeks

Front 17

How is inhaled anthrax treated? What are characteristics of organism?

Back 17

1) ciprofloxacin or doxycycline

2) gram + aerobic bacillis, nonmotile, boxcar shape

Front 18

treatment of sporotrix?

Back 18

itraconazole #1, may use lugols solution or sski which are iodine solutions

Front 19

Treatment of blastomycosis?

Back 19

itraconazole

Front 20

treatment of histoplasmosis?

Back 20

itraconazole

Front 21

treatment of coccidiomycosis?

Back 21

itraconazole, fluconazole or ketoconazole are equal

Front 22

Treatment for systemic histoplasmosis, blastomycosis, coccicoidomycosis?

Back 22

amphotericin

Front 23

Treatment of norcardia?

Back 23

TMP-SMX

Front 24

Treatment of actinomyces?

Back 24

penicillin G (SNAP = sulfas for nocardia and PCN for actinomyces)

Front 25

What type of bacteria is actinomyces?

Back 25

gram + filamentous anearobic

Front 26

What type of bacteria is norcardia?

Back 26

gram + weakly acid fast filamentous aerobic

Front 27

What 2 organisms predominately cause toxic shock syndrome? How is it treated empirically?

Back 27

1) Staph aureus and GAS

2) vanco or PCN and add clindamycin to either of these to prevent toxin formation

Front 28

suspect someone of having herpes because of vesicles and inguinal adenopathy next step?

Back 28

skip Tzanck smear or any testing and treat immediately with acyclovir or valcyclovir

Front 29

tx of bartonella hensale?

Back 29

z-pak #1 or doxy Note: typically is self-limiting, so do not need to treat unless severe infection

Front 30

peritonsillar abscess tx?

Back 30

I&D + PO clindamycin

Front 31

Treatment of neurocystocercosis?

Back 31

albendazole

Front 32

when to use steroids in tx pneumocystis?

Back 32

Aa grad >35 or PaO2 <70mmHg

Front 33

tx of legionella pneumonia?

Back 33

macrolides or quinolones

Front 34

tx of inpatient pneumonia (Not ICU pt)?

Back 34

macrolide + ceftriaxone or respiratory quinolone alone

Front 35

tx of outpatient pneumonia in healthy patient vs pt with comorbidity's (diabetes, malignancy, etc...)

Back 35

healthy = macrolide or doxy

unhealthy = respiratory quinolone or macrolide + beta-lactam

Remember: tx duration is 7 days

Front 36

tx of human bites?

Back 36

amoxicillin/clavulanate

Front 37

coccidiomycosis triad?

Back 37

lung skin and bone problems

Front 38

tx of candidia inf of nipple?

Back 38

topical azole

Front 39

most common cause of cavernous sinus thrombosis?

Back 39

S aureus

Front 40

drug to prophylax with for influenza?

Back 40

oseltamivir if given within 72 hours

Front 41

2nd line tx for Pneumocystis?

Back 41

dapsone and pyrimethamine 2nd line pentamidine is 3rd line Note: bactrim still #1 for treatment and prophylaxis

Front 42

tx of scabies?

Back 42

5% pimethrin cream from neck down on 2 separate occassions

Front 43

HIV drug causing weird dreams?

Back 43

efavirenz

Front 44

s aureus pneumonia most often occurs in who?

Back 44

IV drug users, cystic fibrosis (<10yo), post viral inf, chronically ill

Front 45

Late post surgical incision infection (4-10 days) most likely caused by?

Back 45

S aureus #1, Pseudomonas #2, E coli #3

Front 46

Early post surgical site incision infection (<72 hours) most likely caused by?

Back 46

GAS or clostridium (if clostridium the infected site will have few leukocytes and mild erythema, but extreme pain compared to exam findings)

Front 47

empiric tx for infective endocarditis?

Back 47

IV vancomycin

Front 48

Treatment of hepatitis C?

Back 48

Unlikely to ask given that new treatments are out, but in case new meds are sofosbuvir and simeprevir adn old meds are interferon with ribavirin

Front 49

pt with SCD and osteomyelitis tx empirically with? to cover for?

Back 49

Salmonella #1 and staph with vanco or nafcillin or cefazolin + aminoglycoside

Front 50

most common cause of osteomyelitis in SCD pt?

Back 50

salmonella

Front 51

aminoglycoside side effect?

Back 51

sensorineural hearing loss

Front 52

most common cause of meningitis <3 months?

Back 52

GBS

Front 53

most common cause of meningitis 3 months to 9yrs?

Back 53

S pneumoniae

Front 54

most common cause of meningitis 10-18?

Back 54

N meningitidis

Front 55

most common cause of meningitis >18?

Back 55

S pneumoniae

Front 56

tx of meningitis <3 months?

Back 56

IV vancomycin, ampicillin, ceftriaxone

Front 57

tx of meningitis 3 months to 50 yo?

Back 57

IV vancomycin and ceftriaxone

Front 58

tx of meningitis >50 yo?

Back 58

IV 3rd gen ceph + vanco +ampicillin

Front 59

tx of meningitis in immunocompromised?

Back 59

IV vanco, cefotazidime, ampicillin

Front 60

What is the role of steroids in meningitis?

Back 60

used to prevent negative neurologic sequale of S pneumoniae meningitis. Note: give to all pts where S pneumoniae may be suspected

Front 61

tx of gonorrheal conjunctivitis?

Back 61

IM ceftriaxone and topical erythromycin

Front 62

tx of otitis externa?

Back 62

clean canal, topical cipro or acidic antibiotic + hydrocortisone cream

Front 63

most common cause of prosthetic valve endo?

Back 63

s aureus

Front 64

tx of gonoccocal conjunctivitis in neonate?

Back 64

oral penicillin or IM cef with topical erythromcyin eyedrops

Front 65

hemochromatosis is suscpetable to?

Back 65

susceptable to iron loving bacteria: listeria, vibrio and yersina enterolytica

Front 66

tx for yersinia enterolytica?

Back 66

ciprofloxacin or doxycycline

Front 67

tx of SBP?

Back 67

3rd gen cef

Front 68

redman syndrome?

Back 68

pruritus, redness above waist, hypotension, dyspnea associated with vancomycin... stop giving drug then readminster later at a slower rate

Front 69

Is lymphogranuloma venerum painless or painful lesion?

Back 69

painless

Front 70

How is amebic liver dz tx?

Back 70

metronidazole

Front 71

A pt with asplenia is at risk for what infection if bitten by a dog?

Back 71

capnocytophaga

Front 72

A pt with asplenia has erythema chronica migrans and a severe hemolytic anemia and thrombocytopenia. What coinfection do they likely have?

Back 72

babesia, asplenia predisposes to severe babesia infection, therefore if question looks like lyme dz but is very severe and they say pt had spleenectomy then suspect babesia

Front 73

intraleukocytic morulae are concerning for? How does rash on pt appear?

Back 73

erlichosis and rash appears like lymes w/o central clearing

Front 74

what is the antibiotic of choice for prophylaxis against endocarditis?

Back 74

amoxicillin

Front 75

what is the antibiotic of choice for prophylaxis against endocarditis when pt is unable to take PO med?

Back 75

Either ampicillin or ceftriaxone or cefazolin

Front 76

What is the antibiotic of choice for prophylaxis against endocarditis when PCN allergic?

Back 76

clindamycin or azithromycin or if can take cephalosporin cephalexin

Front 77

What are agents are used to treat CNS toxoplasmosis?

Back 77

sulfadiazine and pyramethamine

Front 78

What agents are used to treat prophylax against toxoplasmosis?

Back 78

tmp-SMX

Front 79

What are 4 common agent that inhibit dihydrofolate reductase, such that leucorvin (folinic acid) or folic acid should also be prescribed?

Back 79

phenytoin, methotrexate, pyramethamine, trimethoprim

Front 80

How is MAC treated?

Back 80

3 drug regimen: ethambutol, azithromycin or clarithromycin +/- rifampin or ribabutin

Front 81

What candidial species are resistant to the azole antifungals and require an echinocandin (caspofungin/micafungin)?

Back 81

C. krusei and C. glabrata

Front 82

treatment of lymes dz causing bells palsy?

Back 82

oral doxy Note: only give ceftriaxone if meningitis or heart block

Front 83

it is generally best to avoid treating travelers diarrhea, unless moderate or severe; however, what medications can be used?

Back 83

quinolones (#1) or azithromycin Note: do not give antibx prophylaxis

Front 84

What antibiotics are recommended for treatment of vibrio cholarae/volnificus/parahemolyticus?

Back 84

doxy or quinolone

Front 85

How is babesiosis treated?

Back 85

Mild or moderate: azithromycin + atovaquone (preferred) or clindamycin + quinine and Severe: clindamycin + quinine

Front 86

treatment for N meningitidis meningitis?

Back 86

ceftriaxone or cefotaxime. Remember the vanco is added only for possible penicillin resistant pneumococcal pneumonia not the neisseria

Front 87

Treatment for Allergic bronchopulmonary aspergillosis?

Back 87

steroids + itraconazole

Front 88

Treatment of invasive aspergillosis?

Back 88

voriconzale #1, but amphotericin can be used also

Front 89

Blood stream infection with which 2 bacterial species warrants a colonoscopy to r/u GI malignancy?

Back 89

strep bovis, strep gallolyticus and clostridium septicum

Front 90

ribavirin is used in the treatment of which 2 viruses?

Back 90

RSV and HCV Note: it is pregnancy category X

Front 91

How is typhoid treated?

Back 91

floroquinolone or 3rd gen ceph

Front 92

best prophylactic med to chloroquine resistant areas when pt is pregnant?

Back 92

mefloquine

Front 93

At what CD4 count do you prophylax against pcp? What med?

Back 93

CD4 <200 with tmp-smx

Front 94

at what CD4 count do you prophylax against toxoplasmosis? What med?

Back 94

CD4 <100 with tmp-smx

Front 95

At what CD4 count do you prophylax against MAC? What med?

Back 95

CD4 <50 with azithromycin and continue until 3 months after CD4 count has been >100

Front 96

Which vaccines should be avoided in AIDS pts?

Back 96

MMR, intranasal influenza, varicella, zoster, yellow fever, bcg, typhoid, sabin polio, small pox. Note: all are live virus

Front 97

Penicillin is the TOC for all stages of syphillis. How should you treat your pt if they are PCN allergic (anaphyllactic) in primary, secondary and tertiary syphillis?

Back 97

doxycycline in primary and secondary. Ceftriaxone in tertiary. Note: If PCN desensitization is answer choice for tertiary syphillis, this will be answer, even if ceftriaxone is a choice

Front 98

How is post-herpetic neuralgia managed acutely? And after 30 days?

Back 98

opiates, tramadol, lidocaine patches acutely. Longterm consider TCA's or gabapentin

Front 99

Who is the zoster vaccine recommended in?

Back 99

age >60, immunocompromised states (DM, renal failure, liver failure, severe COPD, etc...), HIV if CD4 >200

Front 100

Treatment for zoster should be administered within how many hours?

Back 100

72 hrs with acyclovir, valcyclovir, etc...

Front 101

What fungus has narrow angle branching with septae? Which is wide angle and w/o septae?

Back 101

aspergillous = narrow angle, septae. mucor = wide angle, NO septae (spagetti and meat ball appearance on microscopy)

Front 102

TOC for mucormycosis?

Back 102

amphotericin, need to debride

Front 103

Besides surgical consultation what are the treatment regimens in necrotizing fascitis?

Back 103

Need to have MRSA coverage: vanco or dapto or linezolid. Also need gram neg and aneorobic coverage: cefepime + clindamycin or a carbapenem

Front 104

If cause of necrotizing fascitis is suspected to be from strep pyogenes or clostridial species what should treatment regimen be? Why?

Back 104

PCN + clindamycin. Note: clindamycin translation of bacterial toxin protein

Front 105

treatment for yersinia pestis (plague)? What are characteristics of the organism?

Back 105

1) a tetracycline or streptomycin or quinolone

2) gram negative, safety pin shape

Note: px people with a quinolone or doxy

Front 106

If you suspect meningitis do you give antibiotics first, get imaging first or LP first?

Back 106

always treat meningitis when suspected clinically before obtaining other tests

Front 107

If you suspect SBP do you give antibiotics first or obtain paracentesis first?

Back 107

paracentesis first

Front 108

Who should receive prophylaxis for N meningitidis when exposed to someone that has it?

Back 108

people in household, anyone handling respiratory secretions, i.e. intubating physician. Note: triage nurse, doctor who did spinal tap do NOT need it

Front 109

What drug is used for N meningitidis prophylaxis?

Back 109

rifampin

Front 110

epididymitis in men <35 is most commonly caused by? And in men >35?

Back 110

<35 is gonorrhea/chlamydia and >35 E. coli

Front 111

How is leptospirosis treated?

Back 111

Doxy or PCN or ceftriaxone

Front 112

How is stronglyoides treated?

Back 112

ivermectin #1, albendazole #2

Front 113

What are 3 painless ulcers caused by STD's?

Back 113

syphillis, lymphogranuloma venereum, klebsiella granulomatosis

Front 114

How should the initial episode of C. diff be treated if it is mild to moderate?

Back 114

PO metronidazole

Front 115

If the initial episode of C diff is severe w/o other organ failure how should it be treated?

Back 115

PO vancomycin

Front 116

If the initial episode of C diff is severe with multiple organ failure how should it be treated?

Back 116

PO vancomycin + IV metronidazole

Front 117

How should the first recurrence of C diff be treated?

Back 117

same as initial episode and based on severity, i.e. if not severe infection and pt was treated before with PO metronidazole he can have that again, or if it was severe and he had PO vanco he should have that again

Front 118

How is Giardia treated?

Back 118

metronidazole

Front 119

Treatment of cryptococcal meningitis?

Back 119

amphotericin with flucytosine. Note: the only time on boards you will use flucytosine is for crypto!

Front 120

Treatment of reactive arthritis following a GI infection with either shigella, salmonella, camplobacter, etc...?

Back 120

Give NSAIDS for diarrheal causes, can use antibiotics if a chlamydial GU infection is causing

Front 121

Treatment of Bacteroides infection in mouth?

Back 121

Need aneorobic coverage: amoxicillin, clindamycin, ampicillin

Front 122

What medications are used to treat male UTI?

Back 122

either bactrim or quinolone. Note: if male UTI you are treating prostatitis, course is minimum of 2-4 weeks

Front 123

Which antibx are safe to use for UTI in pregnancy?

Back 123

nitrofurantoin, ampicillin, cephalosporins

Front 124

ESBL UTI is best treated with?

Back 124

carabpenem

Front 125

the majority of pts with candiduria have catheters, which if removed tends to clear infection. If the infection does not clear with catheter removal or the pt is high risk (neutropenic) how should you treat them?

Back 125

fluconazole #1

Front 126

Which antibx class is preferred for pyelonephritis in pregnancy?

Back 126

cephalosporins w/ or w/o aminoglycoside

Front 127

What is test of choice for diagnosing osteomyelitis? Definitive diagnosis?

Back 127

"MRI test of choice, Bone biopsy with gram staining definitive

Front 128

Treatment for Whipples dz? What are characteristics of the organism?

Back 128

1) rocephin or IV PCN initially followed by 1 year of bactrim PO

2) Gram + rod that is PAS positive

Front 129

When should postcoital antibxs be given?

Back 129

Give when >/= to 2 infections in 6 months or >/= to 3 infections in 12 months

Use bactrim, cipro, nitrofurantoin, keflex

Front 130

Staph saprophyticus UTI is found most commonly in what population? What are characteristics of the organism that distinguish it from other staph species?

Back 130

1) young women

2) gram positive coagulase negative

Front 131

What type of penicillin is used for primary and secondary syphillis?

Back 131

IM 2.4M units of benzathine PCN

Front 132

What type of PCN is used for neurosyphillis?

Back 132

Aqueous crystalline penicillin G 18-24 million units divided into 3-4 million units IV q4h or continuous infusion for 10-14 days

Front 133

Treatment of chancroid? Organism that causes? What are characteristics of organism?

Back 133

1) macrolide or ceftriaxone

2) haemophylus ducreyi

3) fastidious gram-negative coccobacillus

Front 134

HPV strains more commonly causing warts? strains more commonly causing cancer?

Back 134

6 and 11 = warts

16 and 18 = cervical CA

Front 135

How does ebola present?

Back 135

1) Begins with flu like symptoms: fevers, malaise, arthragias

2) followed by diarrhea and abd pain, CP, SOB, confusion, hemotypsis

Note: ~7 days in pts develop maculopapular rash and/or petichae and subconjunctival bleeding

Front 136

Treatment of aeromonas hydrophilia? Characteristics of organism?

Back 136

1) bactrim or quinolone or 3rd gen ceph

2) GNR, oxidase positive, facultative aneorobe, beta-lactamase producer

Front 137

treatment of RMSF? Characteristics of organism?

Back 137

1) doxycycline

2) Gram neg coccobacillis

Front 138

what type of organism is babesia? How is treated?

Back 138

1) protozoan

2) first-line is quinine plus clindamycin but can use atovaquone plus azithromycin

Front 139

How is babesia diagnosed?

Back 139

1) maltese cross on PBS

2) PCR

Front 140

What are the indications to px someone for infective endocarditis?

Back 140

1) mechanical/prosthetic valve

2) congenital heart dz (repaired and unrepaired)

3) prior episode of endocarditis

4) heart transplant with valvulopathy

Front 141

Treatment of botulinum toxin?

Back 141

Immune globulin

Front 142

Leptospirosis is what type of organism? How is it treated?

Back 142

1) spirochete found mainly in tropic 2/2 dog urine contaminated water

2) PCN or doxy, if severe use ceftriaxone

Front 143

How is candidemia treated in non-neutropenic pt and in neutropenic pt?

Back 143

1) fluconazole, unless severe then echinocandin

2) if neutropenic use echinocandin or voriconazole

Front 144

How is candidial meningitis or endopthalmitis treated?

Back 144

voriconazole, remember that echinocandins can't penetrate cns

Front 145

honey moon cystitis caused by?

Back 145

staph saprophyticus, associated with condom use

Front 146

How does hanta virus present? what are some lab findings?

Back 146

1) fever, rash, myalgias and develop ARDS within 10 days

2) thrombocytopenia, elevated hct

Note: known as the 4 corners dz: AZ, CO, UT, NM

Front 147

diertle stain is used for?

Back 147

It is a silver stain used for organisms like syphillis, klebsiella, bartonella henslae

Front 148

vibrio volnificus and aeromonas hydrophilia both have a similar presentation How can you differentiate them?

Back 148

based on where they were acquired

1) vibrio = salt water

2) aeromonas = fresh water

Front 149

treatment of latent TB?

Back 149

INH x9 months or

INH + rifapentine for 3 months or

rifampin for 4 months or

INH and rifampin for 4 months

Front 150

treatment of active TB?

Back 150

4 drug combo x2 months (INH, rifampin, pyrazinamide, ethambutol) followed by 6 months of INH and rifampin

Front 151

Treatment for acute prostatitis?

Back 151

Quinolone or bactrim

Remember presents with flu like symptoms: fevers, chills, myalgias

Front 152

Treatment for chronic prostatitis?

Back 152

Treat with quinolone has better prostate penetration than bactrim

Remember presents with recurrent dysuria NOT like acute

Front 153

Which medications can cause renal stones?

Back 153

sulfamethoxazole, methotrexate, IV acyclovir, sulfadiazine, IV ativan, Indinavir

Front 154

What are renal side effects of trimethoprim in the kidney?

Back 154

1) inhibits secretion of Cr in PCT, so get small rise in Cr

2) causes RTA type 4

Front 155

Define neutropenia!

Back 155

ANC <1500 = mild

ANC <1000 = moderate

ANC <500 = severe

Front 156

First line treatment for neutropenic fever? What bug are you concerned for initially to always?

Back 156

carbapenem, cefepime, zosyn

Want pseudomonal coverage initially

Front 157

What are indications to broaden coverage in neutropenic fever?

Back 157

Add vanco with pseudomonal coverage initially if:

H/O MRSA

hypotension, shock

strong evidence of line infection

cellulitis

Front 158

Treatment for neutropenic fever at presentation? If still spiking fevers after 48 hours? If still spiking fevers after 5-7 days?

Back 158

Initially antipseudomonal: carbapenem, zosyn, cefepime

After 48 hours cover MRSA: vanco, daptomycin, linezolid

After 5-7 days cover fungal: caspofungin, amphotericin, voriconizole

Front 159

Treat asymptomatic bacturia in who?

Back 159

1) pts undergoing undergoing urologic procedure

2) neutropenic pts

3) pregnant pts

Front 160

Who is intranasal influenza vaccine indicated in?

Back 160

ages 2-49

It is live virus

Front 161

Who is intranasal influenza vaccine contraindicated in?

Back 161

CD4 <200

chronic cardiopulmonary disesases, CKD, DM

Prior guillan Barre

Pregnancy

Note: inactive vaccine can be given to people >6 months old

Front 162

Symptoms and diagnosis of enterobius vermicularis?

Back 162

anal pruritus at night

diagnosis with scotch tape test

TOC is albendazole

Note: this is a pinworm

Front 163

TOC in acute otitis media?

Back 163

amoxicillin

ampicillin if amoxicillin fails

Front 164

Treatment of crusted scabies?

Back 164

PO ivermectin with topical permethrin

Note: this disease is not alway pruritic, but is more extensive and has a psoriatic look occurring in elderly and AIDS pts

Front 165

Treatment of mild-moderate rosacea?

Back 165

topical metronidazole

Front 166

Treatment of severe papulopustular rosacea?

Back 166

a tetracycline (doxy or minocycline)

can use erythromycin also

Front 167

How does Malazzesia Furfur present and how would you treat it?

Back 167

hypo/hyperpigmented patches of skin

TOC is topical agents: -azole, terbenifine, selenium sulfide

Front 168

How does Malazzesia Furfur look on microscopy?

Back 168

spagetti and meat balls

Remember: also known as Tinea versicoler

Front 169

what are centors criteria

Back 169

fever

tender LAD

tonsillar exudates

absent cough

Note: if 2-3 present get rapid strep, if all 4 just treat w/o testing, <2 seek other cause

Front 170

What are the 4 gram + rods classes?

Back 170

Listeria

Cornybacterium

Bacillus (anthrax, cereus)

Clostrdium

Front 171

Skin manifestations of HCV?

Back 171

Porphyria cutanea tarda

Lichen planus

Leukocytoclastic 2/2 cryoglobulinemia

Front 172

Skin diseases causes by HIV?

Back 172

sudden severe psoriasis

severe seborrheic dermatitis

Front 173

treatment for dermatitis herpetaformis

Back 173

dapsone

Front 174

Erythematous pruritic rash in intertriginous areas that turns red with woods lamp?

Back 174

erythrasma from Cornybacterium minitissimum

Front 175

treatment of malignant otitis externa in a diabetic?

Back 175

cipro or rocephin, caused by pseudomonas, develop bony erosions and nerve palsies

Front 176

Thumb print sign on lateral X-ray? Steeples sign on X-ray?

Back 176

thumbprint = epiglottitis (haemophylus)

Steeples = croup (paramyxovirus)

Front 177

Treatment of epiglottis empirically?

Back 177

vanco and rocephin

Though haemophylus is main cause, staph (MRSA) and strep species can also cause

Front 178

sensitivity of rapid strep test? Is there a need to get throat culture in adults?

Back 178

85-90% and given that incidence is <10% in adults no need to get culture if rapid test negative, just assume not strep

Front 179

A patient has hives with eggs, can they get prophyllaxis with flu vaccine(s)?

Back 179

Yes but need observation period of 30 minutes after administering

Note: the live attenuated forms except one (RIV) have egg components and so does the nasal live form

Front 180

Can a pt with angioedema or anaphylaxis to eggs get influenza vaccine?

Back 180

Yes but use the Recombinant-hemagluttonin Influenza Vaccine (RIV)

Front 181

bacteria that are red or stain red?

Back 181

Mycobacterium (red snapper)

Nocardia (gram +, weakly acid fast)

serratia (red pigment)

Front 182

Routine vaccines in pregnancy?

Back 182

attenuated influenza and Tdap

Special circumstance vaccines: hepB or A, pneumoccal, hemophylus, meningococcus, rhogam

Front 183

Signs of bacterial vaginosis and treatment?

Back 183

2/2 gardnerella vaginalis

pH >4.5, clue cells (stippled epithelial cells), whiff test positive, thin gray dc, fishy smell

Note: absence of symptoms

treat with metronidazole or clindamyin (aneorobic)

Front 184

Signs of trichomonas and treatment?

Back 184

yellow-green malodorous dc, vaginal inflammation and pain

Treat pt and partner with metronidazole

Front 185

Signs of candidal vaginitis and treatment?

Back 185

thick cottage cheesy white nastiness with vaginal inflammation and pain pH normal (<4.5) with signifcant prurititus

Treat with topical or PO -azole

Front 186

Tetrad of whipples disease?

Back 186

abdominal pain, arthralgias, diarrhea, weight loss

Note: PAS foamy macrophages

Front 187

rust colored sputum is? currant jelly sputum is?

Back 187

rust = strep pneumoniae

currant jelly = klebsiella

Front 188

recurrent proteus UTI's are associated with?

Back 188

recurrent renal stones

Front 189

beef red painful urogenital lesion showing school of fish on microscopy? Treatment?

Back 189

Chancroid: hemophilous ducreyi

macrolide or rocephin

Front 190

Lab findings in RMSF?

Back 190

thrombocytopenia, increased LFT's, elevated PT/PTT

Front 191

buffy coat stain is for?

Back 191

anaplasma

Front 192

lab findings in erlichia/anaplasma?

Back 192

thrombocytopenia, leukopenia, increased LFT's

Note: RMSF and Lyme will not cause leukopenia so this a clue to what pt has

Front 193

maltese cross indicative of?

Back 193

babesia

Front 194

Duke criteria?

Back 194

Diagnosis with 2 major or 1 major + 3 minor or all 5 minor

Major Criteria: + blood cx, endocardial involvement or veg on imaging

Minor Criteria: predisposing condition (cardiac lesion/material or IVDA); fever; embolic phenom; Immunologic phenom (glomerulonephritis, skin lesions, etc...); + blood cx not meeting major criteria

Front 195

skin findings in infective endocarditis?

What is seen on retinal exam of pt with endocarditis?

Back 195

janeway lesions = nontender

osler nodes = tender

Roth spot in retina

Front 196

first line treatment for rhinosinusitis 2/2 bacterial cause? what can be used if PCN allergy?

Back 196

amoxicillin-clavulanate #1

cover with doxy or respiratory quinolone (moxifloxicin or levaquin)

Note: other meds like macrolides, bactrim have higher rates of resistance

Front 197

Indications for treatment of rhinosinusitis with antibiotic?

Back 197

symptoms >10 days

severe symptoms fever (>102) with facial pain >3days,

worsening symptoms >5 days after an initially improving viral infection

Front 198

How does bacterial keratitis present, who is at risk and how is it treated?

Back 198

seen typically in contact pts wearing contact lenses that develop conjunctivitis, mucopurulent dc, photosensitivity and corneal ulceration with florescin dye

TOC is topical quinolone

Front 199

what are 2 antibiotics that can cause vision changes?

Back 199

ethambutol - color vision changes

linezolid - foggy vision and optic disc edema

Front 200

buffy coat stain for?

Back 200

erlichia and anaplasma

Front 201

hanta virus presents with? transmitted via?

Back 201

hemoptysis and renal failure

rodent urine

Front 202

how can hanta virus be distinguished from pneumonic form of plaque based on labs?

Back 202

hanta virus has elevated hematocrit which is unique for this infection

Front 203

features of leptospirosis?

Back 203

subconjunctival hemorrhage/suffusion

jaundice (weils syndrome)

liver failure

Front 204

Diagnostic features to know for EBV?

Back 204

+heterophile antibody

atypical lymphocytes - contain foamy like cytoplasm

Front 205

Side effect of INH? Medication to give to prevent?

Back 205

peripheral neuropathy

Pyridoxine

Front 206

Most common cause of endocarditis <2 months after valve surgery? Most common >2 months?

Back 206

<2 months Staph aureus

>2 months Strep viridian's

Front 207

Most common cause of otitis exeterna in diabetic?

Back 207

pseudomonas

Note: should be hospitalized for IV antipseudomonal drug (zosyn, cefepime)

Front 208

2 infections that pts should not breast feed if they have?

Back 208

TB, HIV

Front 209

Indications for both Tdap and Tetanus Ig?

Back 209

<3 total immunizations

unkwown if they have had 3

serious wounds

Front 210

What should be done for a pt with a clean would in terms of tetanous vaccine and Ig if they had 3 vaccines, the last being 8 years ago?

Back 210

If <10 years nothing and wound is clean nothing

Note: If wound is dirty then need Tdap if >5 years since last vaccine, otherwise if <5 years needs nothing

Front 211

Age to use DTdap?

Age to use Tdap?

Back 211

DTap if <7

Tdap if >7

Front 212

skin infection in people that handle fish or have fish tanks think?

Back 212

mycobacterium marinum

Front 213

Do you prophylax people from others with pulmonary anthrax?

Back 213

no it is not spread person to person, only from powder source

Front 214

what is the difference between bubonic plague and respiratory plague in regards to isolation?

Back 214

bubonic = no isolation

pneumonic = isolation

Front 215

sickle cell pt with red cell aplasia likely caused by?

Back 215

parvovirus b19

Front 216

post transplant infections <1 month

Back 216

staph and pseudomonas or other common organisms like C diff, enterococcus

Front 217

post transplant infections 1-6 months

Back 217

cmv, pcp, hsv, tb, hsv, bk virus, listeria, nocardia, toxo

Front 218

post transplant infections >4 months

Back 218

crytpococcus

Front 219

pt with confusion and fevers. EEG shows temporal lobe abnormalities. Think?

Back 219

HSV

Front 220

young pt with fevers and confusion presents. LP shows hemorrhagic tap. think?

Back 220

HSV

Front 221

HSV1 more likely to cause what CNS disease? HSV2 more likely to cause what CNS disease?

Back 221

HSV1 = encephalitis (cold sore)

HSV2 = meningitis (std)

Front 222

features on exam that should make you concerned for syphillis in a young pt?

Back 222

alopecia

hearing loss

Front 223

Most specific test for syphillis in the CSF?

Back 223

VDRL, not very sensitive in CSF but highly speicific. Opposite that of blood.

Front 224

palatal ulcer in AIDS pt think?

palatal petichiae?

Ulcerative lesions on soft palate?

Back 224

histoplasmosis = palatal ulcer

EBV = palatal petechiae

Coxsackie = ulcerative lesion on soft palate

Front 225

Community outbreak of watery diarrhea with protozoa that is partially acid fast positive?

Back 225

Cryptosporidium parvum

Front 226

food outbreak of watery diarrhea with protozoa this acid fast positive?

Back 226

cyclospora

Note: cyclospora causes smaller food outbreaks, where cryptosporidium causes large community outbreaks

Front 227

Should you diagnose tularemia with biopsy of lymph node?

Back 227

no there is risk of aerosolizing

Front 228

Drugs that can be used to prophylaxis a pt with meningococcal meningitis? which med if pt is pregnant?

Back 228

rifampin

ceftriaxone = if pregnant

cipro

Front 229

How is paralysis in botulism present that distinguishes it from GBS?

Back 229

typically cranial nerve dysfxn first: dysphagia, dysphonia, diplopia

Front 230

conjunctivitis after swimming in a pool?

Back 230

adenovirus

Front 231

Rheumatic fever develops after what forms of strep infection?

Back 231

only pharyngeal form

Note: can develop glomerulonephritis with either skin or pharyngeal infection with GAS

Front 232

Liver forms of malaria?

Back 232

vivox and ovale

(vodka goes to liver)

Front 233

cell type seen on blood smear diagnostic for P falciparum?

Back 233

banana gametocyte

Front 234

Drugs that need to be continued for 4 weeks after returning home for malaria px?

Back 234

chloroquine, mefloquine, doxy

Note: only need to continue atorvaquine/proguanil 1 week and 2 weeks for primaquine

Front 235

Rubella and Rubeola are also known as?

Back 235

Rubella = german measles

Rubeola = regular measles

Front 236

How can measles be distinguished from german measles?

Back 236

german measles = rash that starts on face and spreads down with posterior cervical LAD

measles = koplik spots, diffuse erythematous rash, conjunctivitis

Front 237

when can a pt with shingles return to work?

Back 237

no need to be off, keep covered and avoid critical care pts or transplant units

Front 238

Most common cause of indwelling catheter or prosthetic material infections?

Back 238

staph epidermidis

Front 239

Oral agents for MRSA?

Back 239

clindamycin

tmp-smx (skin and soft tissue, not lung)

linezolid

doxycycline

Front 240

IV agents for MRSA?

Back 240

vanco

linezolid (can be used in lung, soft tissue infections)

daptomycin (can't treat lung because it is inactivated by surfactant, but is better for blood stream infections because it is large molecule)

ceftaroline (5th gen cef)

Tigecycline (skin and soft tissue infections only)

Front 241

Why is the D-zone test done?

Back 241

used to determine resistance to erythromycin/clindamycin in staph species, and therefore need to treat with TMP/SMX

Front 242

who should receive the strep pneumonia PPSV23 vaccine?

Back 242

age 19-64 if they have heart, lung, liver dz or dm or current smoker or alcoholic

Front 243

who should get sequential PPSV13 then PPSV23 pneumovax?

Back 243

age >65

age 19-64 if they have asplenia, are immunocompromised, or have ckd

Front 244

how often should a pt get a booster for tetanus? what type should they get?

Back 244

every 10 years need Td, but need to substitute Tdap one time for pertusis coverage

Front 245

How long after a pt has a TB exposure should a PPD be performed?

Back 245

perform at time of exposure, if negative need to repeat in 8-12 weeks

Front 246

syndrome when herpes zoster affects trigemminal V1 branch? Next step in management?

Back 246

Hutchinson syndrome

urgent optho consult

If optho not available use topical steroid drops

Front 247

what is india ink used to check for in the csf?

Back 247

crypto

Front 248

treatment of crypto meningitis when there is high opening pressure?

Back 248

in addition to amphotericin need to do serial LP's or VP shunt to reduce pressure

Front 249

an immigrant from central or south america that presents with new onset seizures, be concerned for?

Back 249

neurocysterocosis

caused by Taenia solium a tapeworm

Front 250

presentation of dengue fever?

Back 250

fever, retro-orbital pain, myalgias, arthralgias, epistaxis (thrombocytopenia)

AKA: break bone fever

Front 251

trypanosoma cruzi is transmitted by what? Causes what? Disease is known as?

Back 251

Reduvid bug (kissing bug)

dilated cardiomopathy

Chagas disease

Front 252

lemiere's syndrome is?

Back 252

Fusobacterium necrophorum forms abscess in neck that penetrates jugular vein

Front 253

ludwigs angina is?

Back 253

submandibular space infection, often caused by GAS

Front 254

what test is recommended in all MRSA bacteremia pts?

Back 254

at least TTE, consider TEE

Front 255

Treatment of meningitis in a recent neurosurgical procedure, penetrating skull wound or a VPshunt?

Back 255

cefepime and vancomycin

Front 256

treatment of meningitis in an immunocompromised pt?

Back 256

vanco, cefepime, ampicillin

Front 257

what is the best way to slow the number of new cases with outbreak of influenza in a nursing?

Back 257

ostelmavir for all residents and vaccinate those who have not yet received

Front 258

signs of secondary syphillis?

Back 258

flu like illness

moth eaten alopecia

macular papular diffuse rash involving palms and soles (nickel and dime lesions)

hepatitis

Front 259

skin rash following an HSV infection?

Back 259

erythema multiforme

Front 260

hbv vasculitis? HBV renal disease?

Back 260

PAN

membranous nephropathy

Front 261

older female with NO smoking hx and acid fast organism on BAL?

Back 261

MAC causing pneumonia

AKA: lady windem

Front 262

infections associated with hot tubs?

Back 262

pseudomonal folliculitis

legionella pneumonia

MAC

Front 263

diagnosis of acute retroviral syndrome?

Back 263

HIV RNA

Front 264

Organisms causing PNA and spleenomegaly?

Back 264

chlamydia psittaci

coxiella burnetti

Front 265

which infection causes a descending paralysis? Ascending paralysis?

Back 265

botulinum = descending

ascending = tick paralysis

Front 266

DOC in tx of malaria in pregnancy?

Back 266

mefloquine

Front 267

skin rash with flower petal shape?

Back 267

tinea corporis

Front 268

presentation of tuleremia?

Back 268

central papular-ulcerative lesion that forms central eschar and has tender LAD, will have fevers

Front 269

Jones Criteria for rheumatic fever?

Back 269

Major: carditis, migratory arthritis, subQ nodules, sydhams chorea

Minor: fevers, prolonged PR, elevated ESR/CRP, arthralgias

Front 270

2 forms of disseminated gonnococcus?

Back 270

purlent arthritis alone w/o skin lesions

triad of migratory assymetric polyarthritis, tensynovitis, painless pustular lesions

Front 271

HBV serum sickness presentation?

Back 271

urticaria, prurititus, symmetric arthritis, fever

Front 272

donovan bodies are seen in what disease?

Back 272

granuloma inguinale

Klebsiella granulomatosis

Front 273

Treatment regimens of necrotizing pancreatitis?

Back 273

carbapenem alone

quinolone + metronidazole

Front 274

triple therapy for h pylori

Back 274

PPI + clarithromycin + amoxicillin for 10-14 days

Note: substitute metronidazole for amox if PCN allergic

Front 275

quadruple therapy for h pylori?

Back 275

bismuth + PPI + metronidazole + tetracycline for 10-14 days

Note: only use if pt fails triple therapy or if metronidazole or macrolide resistant strain

Front 276

If testing for H pylori on EGD with biopsy is negative what is next step?

Back 276

get another test, want 2 negatives to rule out even with negative EGD

Urea breath test, stool antigen

Front 277

A pt is treated for H pylori, what are reasons to repeat testing to detect clearance?

Back 277

still symptomatic

H pylori ulcer

concern for MALT or adenocarcinoma

Do not routinely repeat for clearance in pt that was diagnosed with urea breath test or stool antigen

Front 278

Post Herpetic Neuralgia treatment? Treatment for trigeminal neuralgia?

Back 278

PNH = gabapentin or pregabalin

TN = carbamazapine

Front 279

Treatment of Pacemaker lead infection? Device pocket infection?

Back 279

In both instances need to remove leads and generator.

If only pocket infection, treat with antibiotics for 10-14 days, if cultures negative replace PM

If vegetation seen on PM lead or valve will need 4-6 weeks antibiotics with repeat cultures being negative before reinsertion

Front 280

If blood cultures are positive in a patient with suspected PM infection at pocket site or on wires what is next step?

Back 280

TEE to look for vegetations on leads and valves

Front 281

Metronidazole and clindamycin are typically used for aneorobic infections. Which is used for respiratory and oral infections and which is used more for lower GI pathology? Why?

Back 281

Clindamycin = upper/lower respiratory system and oral cavity

Metronidazole good for lower GI tract. It lacks ability to cover for any aerobic or microareophillic bacteria found in many abscesses. Need to combine with something like a PCN

Front 282

if a patient is intubated and grows candida on sputum cx, what are indications to treat it?

Back 282

if immunocompromised

if there is a distant source of infection with candida (i.e. septic joint, etc...)

Remember candida lung infections occur in immunocompetent people via hematogenous spread NOT through aspiration

Front 283

Organisms causing ventilator associated PNA?

Back 283

MRSA

MSSA

Pseudomonas

Acinetobacter

Stenotrophomonas

Front 284

Who should be treated for TB if the PPD shows >/= 5mm induration?

Back 284

exposure to known contact

HIV or transplant patient

Anyone on immunosuppressive therapy

CXR findings consistent with prior TB

Front 285

Who should be treated for TB if the PPD shows >/= 10mm induration?

Back 285

Hospital employees

IVDU

People at higher risk for reactivation: DM, ESRD, etc...

Immigrants from known areas with TB if <5 years since arrival

Front 286

Who should be treated for TB if the PPD shows >/= 15mm induration?

Back 286

Everyone not listed in the 5 and 10mm range, i.e. healthy and non-immigrants

Front 287

Main side effects of INH?

Back 287

hepatitis (stop indefinitely if transaminases increase >3x upper limits of normal)

neuropathy

Front 288

A patient is still having some symptoms after being treated for H pylori with triple therapy. Next step?

Back 288

get test to document current infection (stool antigen or Hydrogen breath test, not serology) then start Quadruple therapy

Front 289

What test should generally be avoided in diagnosing H pylori if patient is on a ppi?

Back 289

hydrogen breath test, ppi should be held 2 weeks prior to testing

Front 290

What patients are at risk for bacterial overgrowth? How is it treated?

Back 290

scleroderma, gastroparesis, surgical obstruction, meckels diverticulum

rifaxamin or ampicillin or metronidazole + cephalosporin

Front 291

how is bacterial overgrowth diagnosed?

Back 291

hydrogen breath test

gold standard is jejunal aspirate showing >10^5 bacteria per mL

Front 292

Diagnosis of peritoneal dialysis peritonitis?

Back 292

Suggest by peritoneal WBCs >100 or 50% neutrophilic predominance in fluid

Gram stain usually negative but culture positive ~90% of time

Front 293

How should peritoneal dialysis peritonitis be treated?

Back 293

with intraperitoneal vancomycin and a 3rd or 4th generation cephalosporin or gentamicin

Front 294

What is the most common organism to cause peritoneal dialysis catheter related peritonitis?

Back 294

Staph, but need to treat for gram negatives also

Front 295

what procedures are considered high risk and mandate patients with risk factors for endocarditis receive prophylaxis before the procedure?

Back 295

prophylaxis is needed if patient has an active infection in some other portion of the body, i.e. UTI, colitis, abscess, etc...

Dental procedure involving gingiva or periapical region of teeth

Respiratory tract procedure if biopsy is to be performed

Note: all other GI and GU procedures are consider low risk and you don't px

Front 296

A patient presents with variceal bleeding how should you manage from an ID standpoint?

Back 296

>20% of pts presenting with variceal bleed have sbp; therefore, start quinolone or ceftriaxone. Continue for 7 days

Front 297

How do the esophageal ulcers on EGD appear with CMV vs HSV?

Back 297

CMV = Deep, volcano-like, linear, raised borders. Treat with IV ganciclovir

HSV = shallow, circumscribed extreme pain. Treat with IV acyclovir

Front 298

When can empiric therapy with fluconazole be used in the treatment of odynophagia/dysphagia in a patient with AIDS?

Back 298

Only treat empirically if thrush is seen

If no thrush is present ~20% of time, need to get EGD to rule out CMV/HSV/malignancy

If no improvement with empiric fluconazole get EGD

Front 299

What areas are the following Schistomasiasis found: japonicium, mansoni, hematobium?

Back 299

japonicium = SE asia

Mansoni = africa and south america

Hematobium = south america

Front 300

Side effect of amphotericin in the kidney?

Back 300

RTA 1