Infectious Disease Medical Review

Front 1

What organisms cause necrotizing fasciitis?

Back 1

- Group A strep
- Haemolytic strep (B, C, G)
- Staph aureus
- Clostridium perferingens
- Clostridium septicum
- Vibrio vulnificus

Front 2

What historical clues point to vibrio vulnificus?

Back 2

cur or puncture in hand after immersion in warm salt water. oysters, fish

Front 3

What causes necrotizing fasciitis in "black tar heroin" users?

Back 3

C. sordellii

Front 4

What is the initial treatment for vibrio vulnificus?

Back 4

tetracycline or third-generation cephalosporin

Front 5

How do you treat necrotizing fasciitis?

Back 5

Antibiotic therapy & aggressive surgical debridement.
- Vanco for MRSA, clinda for anaerobic

Front 6

Which antiretroviral should not be used in patients with asthma and suffering from Influenza?

Back 6

zanamivir - may induce bronchospasm

Front 7

What causes progressive multifocal leukencephalopathy (PML)? What is the treatment? What are the MRI findings?

Back 7

polyomavirus JK
No treatment. If not severe and caught early, may consider stopping immunosuppressive medication.
- lesions in the cortical areas of the left temporoparietal lobes and scattered throughout the deep white matter

Front 8

In patients status post transplant and mental status changes, which organism should be considered?

Back 8

polymovirus JK

Front 9

What does polymavirus BK cuase?

Back 9

nephropathy and deteriorating renal function

Front 10

How do you differentiate smallpox from chickenpox?

Back 10

Lesions are on soles and palms and same stage with smallpox. Also, fever tends to precede rash with smallpox

Front 11

Which virus causes vesicular lesions in hands, feet and mouth?

Back 11

coxsackievirus

Front 12

What sort of rash is associated with ebola?

Back 12

petechial rash

Front 13

How do you differentiate monkeypox from smallpox (variola) and varicella?

Back 13

monkeypox is a centrifugal rash, sometimes associated with a hemorrhagic component and associated with LAD (not present w/ the other two)

Front 14

How do you diagnose smallpox?

Back 14

sending tissue obtained by skin biopsy, fluid from an unroofed lesion, a swab from the tonsils, or a blood specimen to a reference laboratory for one of several tests, including DNA sequencing, electron microscopy, and immunohistochemical studies

Front 15

What vaccine can affect severity of monkeypox?

Back 15

vaccinia vaccine

Front 16

In whom is smallpox vaccine contraindicated? What should they be given?

Back 16

- pregnant women and immunosuppressed patients
- specific immune globulin

Front 17

Should contacts of patients with smallpox be vaccinated?

Back 17

yes, they should take their temperature twice daily for 17 days after exposure

Front 18

Should patients suspected to have smallpox be isolated?

Back 18

yes

Front 19

Does vaccination provide protection against smallpox if already exposed?

Back 19

yes, partially if given within 4 days

Front 20

What can cause encephalitis post-tranfusion?

Back 20

West Nile Virus, may remain in the circulation for 28 days

Front 21

What are the most common manifestations of West Nile encephalitis?

Back 21

Encephalitis, meningitis, flaccid paralysis, and fever

Front 22

What antibiotics are most appropriate for treating ESBL-producing gram-negative baccilli empirically?

Back 22

Carbapenems (imipenem, meropenem, ertapenem)

Front 23

If a patient is HIV+ with CD4 count < 200 & evidence of chronic Hep B w/active liver inflammation, what retrovirals shouls be used in HAART therapy?

Back 23

Lamivudine and Tenofovir - they have activity against chronic hepatitis B

Front 24

Which chronic Hep B patients are candidates for treatment?

Back 24

- active liver inflammation
- elevated serum alanine aminotransferase levels and
- evidence of ongoing infection (positive HBeAg or HBV DNA >105 copies/mL )

Front 25

What retrovirals can be used to treat chronic Hep B?

Back 25

Lamivudine, tenofovir or adefovir. Increased resistance to monotherapy with lamivudine.

Front 26

What infection is associated with hot tub exposure?

Back 26

Mycobacterium avium complex hypersensitivity pneumonitis

Front 27

What can be seen with Nocardia lung syndrome? Who is usually affected?

Back 27

- Nodular 'coin' lesions
- Patients with reduced cell-mediated immunity, immunosuppressed, chronic steroid tx
- usually caused by Nocardia asteroides

Front 28

In immunosuppressed or high risk individuals, what size induration is consdered positive for TB?

Back 28

> 5 mm

Front 29

Does a normal CXR rule out spinal TB?

Back 29

NO

Front 30

What is the most serious complication of spinal TB? How do you treat it?

Back 30

- spinal cord compression
- emergent MRI and surgical decompression

Front 31

What are the classic symptoms for Dengue fever?

Back 31

- fever
- myalgias
- arthralgias
- severe headache
- leukopenia
- thrombocytopenia

Front 32

What is the likely diagnosis for a patient that was recently in the caribbean and complaining of myalgias, fever, headache and thrombocytopenia?

Back 32

Dengue fever (also S. America & Central America)

Front 33

What is the treatment for dengue fever?

Back 33

supportive

Front 34

What would you see with Dengue hemorrhagic fever?

Back 34

signs or symptoms of hemorrhage or capillary fragility, such as a petechial rash, pleural effusion, or peripheral edema

Front 35

what clinical presentation strongly suggests underlying bronchiectasis?

Back 35

Development of chronic cough and sputum production following a severe episode of pneumonia several years ago and a chest radiographic with nospecific increased markings

Front 36

What organisms colonize bronchiectatic lungs?

Back 36

Strep pneumonia
Haemophilus influenzae
Staphylococcus aureus
Pseudomonas aeruginosa

Front 37

What prophylaxis do post-transplant patients receive against CMV?

Back 37

ganciclovir or valganciclovir

Front 38

What is the diagnosis of a post-transplant patient presenting with abdominal pain, anemia, melena and ulcers on EGD if off of ganciclovir?

Back 38

gastrointestinal CMV infection

Front 39

How to differentiate HSV from CMV in patients presenting with GI complaints?

Back 39

HSV causes ulcerated lesions in mouth & esophagus but rarely causes gastric or duodenal ulcers as does CMV.

Front 40

Who should receive prophylaxis for meningococcal infection?

Back 40

- Household contacts
- health care workers who have contact with respiratory secretions (intubation)

Front 41

Patient presents obtunded with signs of meningitis, history of middle ear infection and this gram stain. What is the diagnosis & treatment?

Back 41

Strep pneumoniae
Vanco + ceftriaxone + dexamethasone

Front 42

A patient returns from Africa with fever, myalgias, lymphadenopathy, and a erythematous and papulovesicular cutaneous with a single eschar. What is the diagnosis, organism & treatment?

Back 42

- African tick bite fever
- Rickettsia africae (carried by ticks)
- doxycycline or fluoroquinolone

Front 43

With Creutzfeldt-Jakob disease, what does CSF examination show?

Back 43

Normal except for an elevated protein level (14-3-3)

Front 44

How do you difinitively diagnose Creutzfeldt-Jakob disease?

Back 44

PrPsc in brain tissue obtained with biopsy or autopsy

Front 45

What is the typical EEG tracing in a patient with CJD?

Back 45

Sharp, or triphasic, waves occurring once every second (develops later in the disease)

Front 46

What are the most commonly used probable criteria for diagnosing CJD?

Back 46

presence of dementia (time course unspecified) with either “typical” electroencephalogram (EEG) findings or an elevated 14-3-3 protein level in the cerebrospinal fluid plus at least two of the following four symptoms:
1) visual/cerebellar signs
2) extrapyramidal/pyramidal signs
3) myoclonus, and
4) akinetic mutism

Front 47

Most common MRI finding for diagnosing sporadic CJD

Back 47

hyperintensity in the cortical gyri and basal ganglia on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) MRI sequences

Front 48

Diagnostic criteria for probable variant CJD

Back 48

Presence of a progressive neuropsychiatric illness for at least 6 months and four of the five following findings:
1) early psychiatric symptoms
2) persistent painful paresthesias
3) ataxia
4) dementia
5) myoclonus, chorea, or dystonia
(don't usually have typical EEG findings)

Front 49

What does MRI in patients with variant CJD show?

Back 49

Pulvinar sign, in which the pulvinar (posterior thalamus) is brighter than the anterior putamen on T2-weighted MRI.

Front 50

What is the prefered treatment for Listeria monocytogenes?

Back 50

ampicillin or penicillin G combined with an aminoglycoside

Front 51

What is the prefered treatment for Listeria monocytogenes in patients with PCN allergy?

Back 51

trimethoprim–sulfamethoxazole

Front 52

What is the recommended treatment for TB?

Back 52

1) isoniazid, rifampin, and pyrazinamide
2) isoniazid, rifampin, pyrazinamide, and ethambutol
3) isoniazid, rifampin, pyrazinamide, and streptomycin

Front 53

What is the recommended empiric therapy for a patient admitted to a general medical floor with community-acquired pneumonia?

Back 53

1) an intravenous β-lactam plus an intravenous or oral macrolide or doxycycline or
2) monotherapy with an intravenous fluoroquinolone

Front 54

What is the recommended empiric therapy for a patient admitted to the ICU with community-acquired pneumonia?

Back 54

intravenous β-lactam (ceftriaxone or cefotaxime) plus either an intravenous macrolide (azithromycin) or an intravenous fluoroquinolone. If the patient is at risk for P. aeruginosa infection, an anti-pseudomonal β-lactam should be used.

Front 55

Atypical organisms that typically cause community-acquired pneumonia?

Back 55

Mycoplasma pneumoniae, Chlamydophila pneumoniae (formerly Chlamydia pneumoniae), and Legionella pneumophila

Front 56

When does a chancre occur with primary syphillis?

Back 56

3 weeks after exposure

Front 57

When does seconday syphillis occur? How does it present?

Back 57

- 2-8 wks after primary chancre.
- fever, rash ('nickels and dimes' and lymphadenopathy

Front 58

What should you think of when a young person presents with alopecia?

Back 58

syphillis

Front 59

What can you see with tertiary syphillis?

Back 59

- aortitis (rupture is main cause of death)
- argyll-robertson pupil
- tabes dordalis (sensory ataxia, foot slap, wide gait, lightening pains, autonomic dysfunction)

Front 60

Treatment for the different stages of syphillis. Primary, Secondary, Latent, late Latent, neurosyphilis?

Back 60

*Primary, Secondary, early Latent: Benzathine PCN G 2.4 million IM x 1
*Late (> 1yr): PCN G 2.4 million IM weekly x 3
* Neuro: aqueous PCN G 4 million IV x 14 days

Front 61

What should you think of when a young person presents with alopecia?

Back 61

syphillis

Front 62

What type of infection are Immunosuppressed transplant recipients are at high risk for in their first month?

Back 62

Bacterial (staph wound infection (coag+ or Coag-), aspiration pneumonia, etc

Front 63

What should you think of when a young person presents with alopecia?

Back 63

syphillis

Front 64

What is superior to povidone-iodine for cleaning a catheter insertion site?

Back 64

Chlorhexidine

Front 65

What can you see with tertiary syphillis?

Back 65

- aortitis (rupture is main cause of death)
- argyll-robertson pupil
- tabes dordalis (sensory ataxia, foot slap, wide gait, lightening pains, autonomic dysfunction)

Front 66

What can you see with tertiary syphillis?

Back 66

- aortitis (rupture is main cause of death)
- argyll-robertson pupil
- tabes dordalis (sensory ataxia, foot slap, wide gait, lightening pains, autonomic dysfunction)

Front 67

Where is community-acquired MRSA endemic?

Back 67

prisons and low-income housing populations

Front 68

Treatment for the different stages of syphillis. Primary, Secondary, Latent, late Latent, neurosyphilis?

Back 68

*Primary, Secondary, early Latent: Benzathine PCN G 2.4 million IM x 1
*Late (> 1yr): PCN G 2.4 million IM weekly x 3
* Neuro: aqueous PCN G 4 million IV x 14 days

Front 69

Treatment for the different stages of syphillis. Primary, Secondary, Latent, late Latent, neurosyphilis?

Back 69

*Primary, Secondary, early Latent: Benzathine PCN G 2.4 million IM x 1
*Late (> 1yr): PCN G 2.4 million IM weekly x 3
* Neuro: aqueous PCN G 4 million IV x 14 days

Front 70

What type of infection are Immunosuppressed transplant recipients are at high risk for in their first month?

Back 70

Bacterial (staph wound infection (coag+ or Coag-), aspiration pneumonia, etc

Front 71

Prisoner presents with fever, hypotension, swollen arm, history of 'spider bite' & Gram+ org. What is the diagnosis & treatment?

Back 71

necrotizing fasciitis from community-acquired MRSA & Vanco

Front 72

What type of infection are Immunosuppressed transplant recipients are at high risk for in their first month?

Back 72

Bacterial (staph wound infection (coag+ or Coag-), aspiration pneumonia, etc

Front 73

What is superior to povidone-iodine for cleaning a catheter insertion site?

Back 73

Chlorhexidine

Front 74

What antibiotics, besides Vanco, are effective for treating MRSA?

Back 74

Ampicillin–sulbactam
cefazolin
oxacillin
Clindamycin (do sensitivity testing 1st)

Front 75

What is superior to povidone-iodine for cleaning a catheter insertion site?

Back 75

Chlorhexidine

Front 76

a asymptomatic HIV patient presents with increasing viral load and missing doses of antiretrovirals. What should be done next?

Back 76

Order HIV genotype resistance assay

Front 77

Where is community-acquired MRSA endemic?

Back 77

prisons and low-income housing populations

Front 78

Where is community-acquired MRSA endemic?

Back 78

prisons and low-income housing populations

Front 79

Prisoner presents with fever, hypotension, swollen arm, history of 'spider bite' & Gram+ org. What is the diagnosis & treatment?

Back 79

necrotizing fasciitis from community-acquired MRSA & Vanco

Front 80

Prisoner presents with fever, hypotension, swollen arm, history of 'spider bite' & Gram+ org. What is the diagnosis & treatment?

Back 80

necrotizing fasciitis from community-acquired MRSA & Vanco

Front 81

What is the recommended treatment for latent tuberculosis?

Back 81

isoniazid for 9 months

Front 82

What antibiotics, besides Vanco, are effective for treating MRSA?

Back 82

Ampicillin–sulbactam
cefazolin
oxacillin
Clindamycin (do sensitivity testing 1st)

Front 83

What antibiotics, besides Vanco, are effective for treating MRSA?

Back 83

Ampicillin–sulbactam
cefazolin
oxacillin
Clindamycin (do sensitivity testing 1st)

Front 84

a asymptomatic HIV patient presents with increasing viral load and missing doses of antiretrovirals. What should be done next?

Back 84

Order HIV genotype resistance assay

Front 85

a asymptomatic HIV patient presents with increasing viral load and missing doses of antiretrovirals. What should be done next?

Back 85

Order HIV genotype resistance assay

Front 86

What is the recommended treatment for latent tuberculosis?

Back 86

isoniazid for 9 months

Front 87

What is Mishap Probability?

Back 87

The probability that a hazard will result in a mishap or loss, based on an assessment of various factors.

Front 88

What are alternative treatments for latent TB (in stead of isoniazid)?

Back 88

-Rifampin and pyrazinamide for 2 months
OR
-Rfampin alone for 4 months

Front 89

Do patients who received BCG vaccine have positive tuberculin skin test?

Back 89

NO, occasional false +, but should treat for latent TB if positive

Front 90

What tuberculin skin tests are considered positive?

Back 90

* ≥15 mm of induration for persons at low or no risk of developing tuberculosis.
*10 to 14 mm of induration for recent immigrants from endemic areas, health care workers, injection drug users, and persons residing in long-term-care institutions.
* 5 to 9 mm of induration for immunosuppressed patients, recent contacts of patients with active tuberculosis, and persons with suspicious findings on chest radiographs.

Front 91

Patient steps on a rusty nail and later develops osteomyelitis? What are the causative organisms & what antibiotics should be used?

Back 91

- staphylococci, streptococci, anaerobes, and gram-negative bacilli
- Pseudomonas aeruginosa has been found between the layers of rubber soles of sneakers
- Tx: vanco + piperacillin-tazobactam

Front 92

What antiretroviral is approved for treating CMV infection?

Back 92

Cidofovir

Front 93

Which medication is helpful in preventing reactivation of varicella zoster virus in stem-cell transplant recipients?

Back 93

acyclovir

Front 94

How can contact dermatitis be differentiated from other skin infections?

Back 94

Usually pruritic, non-pustular vesicles without fever and leukocytosis

Front 95

What is the most appropriate empiric therapy for a patient with purulent meningitis following neurosurgery?

Back 95

Vancomycin plus cefepime

Front 96

What can be given to immunosuppressed patients requesting influenza A & B prophylaxis?

Back 96

oseltamivir (PLUS family members should be immunized)

Front 97

What can be done for aymptomatic patients who received a tick bite in areas endemic for Lyme?

Back 97

doxycycline - single dose

Front 98

What increases a person's risk of developing Lyme disease?

Back 98

If the tick is engorged with blood

Front 99

Which organism causes Lyme disease? How is infection confirmed?

Back 99

- Borrelia burgdorferi
- confirmation by Western blot analysis after detection of a positive enzyme-linked immunosorbent assay (ELISA), serology (not + in acute stage)

Front 100

What are early symptoms of Lyme disease?

Back 100

rash (erythema migrans), headache, fever, lymph nodes

Front 101

How can you treat Lyme disease?

Back 101

* Early/facial nerve palsy: doxycycline 100mg BID x 21 days or amoxicillin 500 mg Q8 x 21 days
* Late/Meningitis/carditis: ceftriaxone 2g IV x 21 dys, PCN G 3-4 million IV Q4 hrs x 14 dys
* Arthritis: doxy 100 mg BID x 21 dys, PCN G 3-4 million IV Q4 hrs x 14 dys

Front 102

What areas are endemic for Lyme disease?

Back 102

CT, Martha's Vineyards

Front 103

What is the treatment of choice for babesiosis?

Back 103

Mild:
- Atovaquone plus azithromycin
- quinine plus clindamycin
Severe:
-exchange transfusion, then antibiotics

Front 104

Where is babesiosis endemic?

Back 104

New England states (Mass, Nantucket, CT, RI)

Front 105

What organism causes babesiosis?

Back 105

Babesia microti (tick infection)

Front 106

What clinical findings, signs & symptoms of babesiosis?

Back 106

- fever, sweats, myalgias, chills, emotional lability
- hemoglobulinemia (predominant sign)
- FEBRILE HEMOLYTIC ANEMIA

Front 107

What do you see on peripheral blood smear?

Back 107

- intraerythrocytic parasites
- Maltese cross
(Malaria is circular)

Front 108

If a patient is low risk for HIV and has a positive ELISA and indeterminant Western, what should be offered?

Back 108

repeat testing in 3 months and 6 months

Front 109

What does an indeterminant HIV western blot indicate?

Back 109

HIV seroconversion or the presence of cross-reactive antibodies

Front 110

Should HIV RNA viral loads be tested in patients with indeterminant results?

Back 110

NO, low-level abnormal values may simply be a laboratory artifact

Front 111

What is a malodorous vaginal discharge with a high pH characteristic of?

Back 111

trichomoniasis or bacterial vaginosis

Front 112

What antibiotics can be used for candidemia?

Back 112

Echinocandin:
- caspofungin
- micafungin
- anidulafungin
- fluconazole once shown to be sensitive

Front 113

Which species of candida is fluconazole usually effective for?

Back 113

C. albicans or C. tropicalis

Front 114

In a patient with brain abscess, what empiric antibiotic should be used if had otitis media or mastoiditis?

Back 114

ceftriaxone/cefotaxime + metronidazole.
** Use cefepime if suspect pseudomonas**

Front 115

In a patient with brain abscess, what empiric antibiotic should be used if had sinusitis?

Back 115

Vanco + metronidazole + ceftriaxone/cefotaxime

Front 116

In a patient with brain abscess, what empiric antibiotic should be used if had dental sepsis?

Back 116

penicillin + metronidazole

Front 117

In a patient with brain abscess, what empiric antibiotic should be used if had lung abscess, ampyema or bronchiectasis?

Back 117

Vanco + ceftriaxone/cefotaxime \
** Use cefepime if suspect pseudomonas**

Front 118

In a patient with brain abscess, what empiric antibiotic should be used if had endocarditis?

Back 118

PCN + metronidazole + sulfonamide (Bactrim if Nocardia suspected)

Front 119

In a patient with brain abscess, what empiric antibiotic should be used if had

Back 119

Vanco + gent
OR
nafcillin + ampicillin + gent

Front 120

Which infections require respiratory precautions?

Back 120

TB, measles, Varicella (chickenpox)

Front 121

Which organisms cause brain abscesses from otitis media?

Back 121

Strep (anaerobic & aerobic), Bacteroides, Provetella, Enterobacteriacae

Front 122

What organisms cause toxic shock syndrome?

Back 122

* Staph aureus
* Group A Step (strep pyogenes)

Front 123

Which organism is most likely to cause TSS if patient had prior viral infection (chickenpox)?

Back 123

Strep

Front 124

What is used to treat TSS?

Back 124

Vanco + clindamycin

Front 125

What are the signs and symptoms of TSS?

Back 125

fever, hypotension, rash and must have 3 organ symptoms. Can have diarrhea & hypocalcemia.

Front 126

How should staph epi (coag neg staph) be treated if cause of TSS?

Back 126

Vanco +/- Rifampin +/- Gent

Front 127

Which pneumococcus is diplococci?

Back 127

H. influenzae

Front 128

What should be used to treat H. influenzae if blood cultures positive?

Back 128

IV nafcillin or Vanco.

Front 129

In patients with severe combined immunodeficiency, what type of blood products must they receive?

Back 129

- T cell depletion
- irradiated (to avoid CMV infection)
- cannot receive live viruses

Front 130

What infections are patients with X-linked gammaglobulinemia susceptible to? How do you treat?

Back 130

- encapsulated infections (pneumococcus, meningococcus)
- IVIG

Front 131

If a patient in their 20-30s presents with recurrent sinus and pulmonary infections, what should you suspect? How can you diagnose?

Back 131

- common variable immunodeficiency
- CT scan/biopsy - noncaseating granulomas in the spleen & liver

Front 132

What infection are patients with IgA deficiency susceptible to?

Back 132

giardia

Front 133

What other conditions do patients with IgA deficiency have?

Back 133

atopic dermatitis
asthma
rhinitis

Front 134

What type of deficiency should be suspected in patients with recurrent sinuopulmonary infections by encapsulated bacteria?

Back 134

Complement deficiency
- C2: most common
- C3: severe bacterial infections

Front 135

What types of infections are prominent in patients with terminal complement deficiency (C5-9)? How do you screen?

Back 135

- meningococcal, H. influenzae, pneumococci
- check CH 50 or CH 100

Front 136

What condition can patients with C1 deficiency have?

Back 136

- Hereditary angioedema
- suspect if another family member had it (even if on an ACEI - DON'T BE FOOLED)

Front 137

What causes infections 1-4 months following transplant?

Back 137

CMV
Hepatitis B
Nocardia

Front 138

What causes infections 2-6 months following transplant?

Back 138

viruses (varicella)

Front 139

How do you treat disseminated cryptococcus?

Back 139

flucytosine & lipid-form of amphotericin B

Front 140

Which organisms can reactivate in people with impaired immunity?

Back 140

-Nocardia
-TB
-Strongyloides (can stay 30-40 yrs)
- Histoplasmosis
- cryptococcus
- blastomycosis
- coccidiomycisis

Front 141

What organism should be suspected if patient has sepsis/endocarditis after TURP?

Back 141

Enterococcus

Front 142

What can be used to treat VRE?

Back 142

-daptomycin
-linezolid
- if sensitive, vanco, PCN + amp + gent

Front 143

What conditions does strep pyogenes cause?

Back 143

-pharyngitis
- TSS
- Rheumatic fever
- erysipelas or scarlet fever

Front 144

What signs and symptoms to do see with strep pyogenes pharyngitis?

Back 144

fever, leukocytosis, exudate tonsils (if hoarseness, think viral)

Front 145

If patient presents with pharyngitis and rapid strep negative, what other causes should you consider?

Back 145

- EBV (mono)
- acute retroviral syndrome

Front 146

What groups of patients get group B strep (agalactiae) wound infections?

Back 146

-DM
-ETOH
-very young or very old
- pregnant women (UTI)
- post-part endometritis/bacteremia

Front 147

How do you treat strep agalactiae?

Back 147

- amp + gent
- amp + ceftriaxone (3rd gen ceph)

Front 148

What does group D strep causes & what other condition is it associated with?

Back 148

-strep bovis
-bacteremia, endocarditis
- colon cancer (30% cases)

Front 149

Who gets Listeria monocytogenes (think goat cheese)?

Back 149

-pregnant women
- AIDS
-lymphoma
- Leukemia

Front 150

How do you treat listeria monocytogenes?

Back 150

amp or PCN +/- aminoglycoside

Front 151

Patient from Russia with URI, gray-white pharyngeal membrane, low fever. What is the likely diagnosis? How do you treat?

Back 151

- corynebacterium diptheria
- ampicillin or PCN +/- aminoglycoside

Front 152

Patient with painless papule, ulcer and black eschar. Gram stain shows Gram-postive rods. What is the diagnosis & treatment?

Back 152

- bacillus anthracis
- PCN G (if sensitive), tetracycline, erythromycin, quinolones. Can use Cipro until know sensitivities

Front 153

What do you see radiographically with b. anthracis pneumonia?

Back 153

widened mediastinum

Front 154

Do patients with b. anthracis need to be isolated?

Back 154

NO

Front 155

What are risks for infection with bacillus cereus?

Back 155

fried rice
contact lens wearers
IV catheters

Front 156

How do you treat bacillys cereus?

Back 156

supportive

Front 157

What is the early symptoms of infection with b. cereus? late symptoms?

Back 157

- early: emesis (preformed in food)
- late: profuse watery diarrhea, non-bloody with cramping

Front 158

Which strain of clostridium is associated with food poisoning? What is the treatment?

Back 158

-perferingens
- PCN

Front 159

Which strain of clostridium is associated with GI malignancy?

Back 159

c. septicum

Front 160

Which strain of clostridium is associated with tetanus? What is the treatment?

Back 160

- c. tetani
- PCN

Front 161

Which strains of clostridium is associated with gas gangrene?

Back 161

-c. septicum
-c. tetani
-c. perferingens
-c. noryi

Front 162

which organisms are associated with GI malignancy?

Back 162

-strep bovis
-clostridium septicum

Front 163

Who should receive prophylaxis for neisseria (gram neg cocci)?

Back 163

- people with intimate oral contact
- household contacts
- daycare
- significant others

Front 164

How do you treat Neisseria?

Back 164

Fluoroquinolones (Cipro)
Ceftriaxone (child or pregnancy)

Front 165

What organism causes a hot tub rash?

Back 165

pseudomonas

Front 166

What organism is associated with ecthyma gangrenosum? describe lesion?

Back 166

Pseudomonas
- round, black, indurated lesion with central ulceration

Front 167

Patient from Texas presents with large, localized lymphadenopathy and hemorrhagic pneumonia and fever. What is the likely diagnosis? Does this patient need to be isolated? How do you treat?

Back 167

- yersinia pestis (plague). Diagnose with LN biopsy
- YES
- stretomycin, chloramphenicol, doxycycline

Front 168

What is the differential diagnosis for hemorrhagic pneumonia?

Back 168

Yersinia pestis and Haunta virus
- Haunta virus has renal failure

Front 169

Which organisms should be suspected if patient gets lymphadenopathy after hunting? How do you differentiate?

Back 169

-Yersinia pestis & tulermia (francisella)
- Yersinia in SW states
- Tuleremia in Ok, arkansas & missouri

Front 170

How do you diagnose and treat tuleremia?

Back 170

Dx: serology for francisella
Tx: streptomycin, gent, tetracyclines

Front 171

How is tulermia transmitted?

Back 171

ticks or eating infected meat (rabbits, dear)

Front 172

Where is legionella (aerobic gram-neg baccilli) found?

Back 172

in water

Front 173

What symptoms can a patient have with legionella infection?

Back 173

pneumonia, CNS and diarrhea

Front 174

How do you treat legionella infection?

Back 174

erythromycin, clarithromycin, azithromycin

Front 175

If a hunter from Oklahoma, Missouri or arkansas presents with pneumonia and skin lesions, what is the likely diagnosis?

Back 175

blastomycosis

Front 176

If a hunter from Oklahoma, Missouri or arkansas presents with a cat scratch, no tick bite and lymphadenopathy, what is the likely diagnosis?

Back 176

- bartonella henselae (gram-neg)
- Tx: azithromycin

Front 177

Patient from Georgia presents with maculopapular rash on palms & soles, abdominal pain, exposure to ticks and hyponatremia. What is the diagnosis, how do you confirm & what is the treatment?

Back 177

- Rocky Mountain spotted fever
- serology
- doxycycline, chlorampenicol
(seen in midatlantic - delaware, NC, SC, GA)

Front 178

Patient presents after a tick bite with pancytopenia. What is the diagnosis, how do you confirm & what is the treatment?

Back 178

- Ehrlichia (spotless RMSF)
- serology, Monila smear
- Tx: doxycycline

Front 179

In what disease do you see PAS-foaming macrophages? What is the causative organism? How do you treat?

Back 179

- Whipples Disease
- tropheryma whippelli
- Ceftriaxone for 2 weeks, bactrim for 1 yr

Front 180

How do you treat actinomyces (sulfur granules)?

Back 180

anaerobic
Tx: PCN, ampicillin
2nd line: tetracycline

Front 181

what is seen clinically with leptospirosis? Are urine/blood cultures positive early or late in disease? How do you treat?

Back 181

- myalgias, fever, headache
- Weil's syndrome (hepatitis with renal symptoms, very elevated bilirubin)
- blood: early, urine: late
- Tx: PCN or doxy

Front 182

What organisms are the most common causes of nongonococcal septic arthritis in adults?

Back 182

staphylococci and streptococci
** higher in patients with RA**

Front 183

Which antiviral agent for influenza would require dosage adjustment for renal insufficiecy?

Back 183

Amantadine
**Although oseltamivir and zanamivir are excreted by the kidneys, dosage adjustment is not required in a patient with renal compromise**

Front 184

If traveling and at risk for Hepatitis A, when should vaccine be given?

Back 184

2 weeks prior to exposure. If less than 2 weeks, may give serum immune globulin.

Front 185

What is chronic granulomatous disease is characterized by? How is screening performed?

Back 185

- invasive skin infections due to deficient neutrophil function
- nitroblue tetrazolium dye test

Front 186

What screening is recommended for patients with defective cellular immunity?

Back 186

TB, mumps, candida antigens

Front 187

What suggests deficiency in cellular immunity?

Back 187

infections with viruses, intracellular pathogens, or fungi

Front 188

What is a 'halo' sign on CT indicative of?

Back 188

aspergillus

Front 189

What is one of the most common fungal infections in transplant recipients and one of the leading causes of death in allogeneic transplant recipients?

Back 189

Aspergillus, usually occurs within the first 3 months

Front 190

What can be used to treat aspergillus infection?

Back 190

- voriconazole (sign interaction with sirolimus)
- amphotericin B

Front 191

What are potential causative organisms for osteomyelitis in sickle cell patients?

Back 191

staphylococci, streptococci, and Salmonella

Front 192

what should a patient with sickle cell and osteomyelitis be treated with?

Back 192

Vanco and ceftriaxone

Front 193

What is the most appropriate therapy for a subdural empyema?

Back 193

Antimicrobial therapy and neurosurgical drainage

Front 194

Where is histroplasma capsulatum endemic? Who is at risk?

Back 194

- Midwestern US (mississippi & Ohio valleys), central America
- construction workers (bat/bird droppings)

Front 195

What are the signs & symptoms of histoplasmosis?

Back 195

- interstitial pneumonia, palate ulcers, splenomegaly
- 1/3 with anemia, neutropenia or pancytopenia

Front 196

What is used to treat histoplasmosis?

Back 196

itraconazole or voriconazole

Front 197

What is used to treat coccidioidomycosis?

Back 197

fluconazole, occasionally with amphotericin

Front 198

Where is coccidioidomycosis prevalent?

Back 198

SW US & Mexico

Front 199

Which fungal infection presents like sarcoid?

Back 199

coccidioidomycosis
- flu-like with athralgias, erythema multiforme +/- erythema nodosum

Front 200

What is used to treat blastomycosis?

Back 200

itraconazole

Front 201

What causes hepatitis and meningoencephalitis in immunosuppressed patients?

Back 201

Reactivation of human herpesviruses 6 and 7

Front 202

What can be used to treat HHV-6 infection?

Back 202

- ganciclovir & foscarnet

Front 203

What diseases does HHV-8 cause and is associated with?

Back 203

- Kaposi sarcoma
- Castleman's syndrime
- primary effusion lymphoma

Front 204

What is the gold standard for diagnosing primary TB?

Back 204

pistive sputum or tissue cultures and stains for acid-fast bacilli

Front 205

What is used to treat disseminated gonoccal infection?

Back 205

Ceftriaxone

Front 206

How is disseminated gonococcal infection manifested?

Back 206

dermatitis, tenosynovitis, and asymmetric arthritis

Front 207

How do you diagnose disseminated neisseria gonorrhoeae?

Back 207

swab the urethra, throat, and rectum for culture

Front 208

Which genotype is the most common for Hep C infections? Is it responsive to treatment?

Back 208

- Genotype 1
- NO

Front 209

What is the treatment of choice for hepatitis C?

Back 209

combination of pegylated interferon and ribavirin.

Front 210

How is penicillin resistance categorized?

Back 210

- Intermediate-level resistance (minimal inhibitory concentration [MIC] between 0.1 and 1 μg/mL)
- High-level resistance (MIC >1 μg/mL).

Front 211

What other antibiotics can be used if strep pneumonia resistant to penicillin?

Back 211

- fluoroquinolone
- Vanco
- linezolid
- Ceftriaxone (if MIC to PCN < 2 ug/ml)

Front 212

Which infection is associated with nephropathy and deteriorating renal function in renal transplant recipients?

Back 212

Polyomavirus BK

Front 213

What findings are highly indicative of polyomavirus BK?

Back 213

intranuclear inclusions in tubular epithelial cells or transitional cells

Front 214

What causes acute retinal necrosis in patients with HIV infection or AIDS?

Back 214

varicella-zoster virus or possibly by herpes simplex virus

Front 215

What is used to treat toxoplasmosis? How does it present?

Back 215

- Intravenous pyrimethamine + oral sulfadiazine + leukovorin (need folinic acid)
- CNS & eye disease

Front 216

What is the preferred treatment for acute retinal necrosis?

Back 216

acyclovir

Front 217

What is used to treat cytomegalovirus retinitis? What is a characteristic finding?

Back 217

- valganciclovir or Intravenous ganciclovir
- Cotton wool spots

Front 218

What is used to treat herpes zoster ophthalmicus?

Back 218

corticosteroids

Front 219

What symptoms does retinitis cause?

Back 219

floaters and photopsia (flashing lights) in addition to blurring and loss of vision

Front 220

Should a pregnant lady clean a cat litter? If not, what is she at risk for?

Back 220

NO, toxoplasmosis

Front 221

How does toxoplasmosis present in AIDS patients?

Back 221

headache, seizures and MRI with multiple lesions

Front 222

How do you diagnosis toxoplasmosis?

Back 222

acute IgM antibody

Front 223

How is toxoplasma gondii transmitted?

Back 223

inhalation

Front 224

What causes a city outbreak of watery, self-limited diarrhea in immunocompetent patients?

Back 224

crytosporidium

Front 225

How can cryptosporidium be treated in immunocompromised patients?

Back 225

nitazoxamide

Front 226

How do you treat bronchopulmonary aspergillosis?

Back 226

prednisone & oral itraconazole

Front 227

Which fungal infection increases risk for hematologic malignancy?

Back 227

aspergillosis

Front 228

What is used to treat aspergillus?

Back 228

voriconazole

Front 229

Patient presents with hemoptysis and serial CXR show varying locations of nodular mass. What is the likely diagnosis?

Back 229

aspergillus

Front 230

What are the types of aspergillosis?

Back 230

1. asymptomatic
2. fungus ball (with cavitaries in lung, old TB)
3. Invasive pulmonary (neutropenic pt) - die within 7-21 days, can embolize
4. allergic bronchopulmonary aspergillosis (asthma patients, diffuse nodular infiltrates, wheezing, coughing) - tx with steroids
5. tracheobronchitis (rare)

Front 231

How do you treat aspergilloma?

Back 231

surgical excision

Front 232

HIV/AIDS patient with low CD4 count and meningitis. What is the likely diagnosis?

Back 232

cryptococcus

Front 233

How do you diagnose cryptococcus?

Back 233

India ink or cryptococcal antigen

Front 234

How can cryptococcus manifest?

Back 234

pulmonary, cutaneous (pustular), meningitis

Front 235

A gardener is pricked by a thorn and later develops a nodular lesion that ulcerates 1-2 wks later. What is the likely cause/diagnosis?

Back 235

sporotrichum schenckii

Front 236

How is sporotrichosis diagnosed? Treated?

Back 236

culture
Itraconazole

Front 237

How does variant CJD vary from sporatic CJD in regards to patient population and presentation?

Back 237

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

Front 238

The development of focal lymphadenitis in a patient with HIV infection is most commonly caused by what organisms?

Back 238

Mycobacteria, Streptococcus species, or Staphylococcus species.

Front 239

At what CD4 count does M. avium complex or M. kansasii infection occur in AIDS patients?

Back 239

< 50/uL

Front 240

What is the most commonly recommended initial treatment for cryptococcal infection?

Back 240

Flucytosine and a lipid formulation of amphotericin B. (monotherapy with flucytosine is not recommended)

Front 241

In post transplant patients, the presents of fever, decreased mental function & fungemia is suggestive of what?

Back 241

cyrptococcal infection

Front 242

What empiric antibiotic should be used for infections caused by clenched fist injury?

Back 242

ampicillin-sulbactam

Front 243

What is is the most appropriate antiviral agent for a patient with genital herpes simplex virus infection without systemic complications?

Back 243

Oral valacyclovir

Front 244

What is the classic clinical presentation of botulism?

Back 244

prominent bulbar findings (including the four “D's” of diplopia, dysphonia, dysarthria, and dysphagia) with descending, symmetric flaccid paralysis that develops 12 to 72 hours after exposure

Front 245

How do you distinguish botulism from Guillain–Barré syndrome?

Back 245

In GB, ascending paralysis is a classic finding (vs decending flaccid paralysis)

Front 246

What are some other signs seen with botulism besides paralysis?

Back 246

No complaints of sensory deficits, NO fever, normal-slow HR

Front 247

How is botulism distinguished from myasthenia gravis?

Back 247

MG has bulbar symptoms but does not initially cause significant weakness at rest. It also progresses more slowly and does not involve genetically unrelated persons in a household.

Front 248

What type of disease is fatal familial insomnia?

Back 248

prion disease (very rare)

Front 249

What are the signs & symptoms of fatal familial insomnia?

Back 249

Insomnia is the predominant symptom, confusion, other signs of dementia, and signs of autonomic nervous system instability are also present

Front 250

what are the MRI findings of fatal familial insomnia?

Back 250

Diffusion-weighted imaging reveals slight hyperintensity of the cerebral cortex and basal ganglia

Front 251

How is the diagnosis of anaplasmosis confirmed?

Back 251

finding morulae in granulocytes

Front 252

What is the treatment of anaplasmosis?

Back 252

doxycycline

Front 253

How is anaplasmosis infection characterized? Where is it endemic?

Back 253

- Fever, flu-like symptoms, leukopenia, thrombocytopenia, and elevated liver chemistry test
- Virginia

Front 254

What should patients with anaplasmosis also be checked for?

Back 254

lyme and babesiosis

Front 255

If have a diabetic with a nosebleed & something black in the nose, what should you do?

Back 255

call the surgeon and start amphotericin B (mucor)

Front 256

Who is susceptible to giardia? How is it treated?

Back 256

- IgA deficiency, campers, travelers
- metronidazole

Front 257

What will aspiration from entamoeba histolytica show? how do you diagnose?

Back 257

NO amoeba or PMNs
Serology

Front 258

How do you treat entamoeba histolytica?

Back 258

Metrinidazole

Front 259

What organism is associated with 'anchovie paste' aspirate?

Back 259

entamoeba histolytica

Front 260

If pregnant patient is exposed to varicella and not previously vaccinated, what should be done?

Back 260

Patient should be given immune globulin within 4 days. DO NOT GIVE VACCINE BC LIVE VACCINE

Front 261

Which treatments decrease post-herpetic neuralgia for zoser?

Back 261

famciclovir & valacyclovir

Front 262

If patient presents with mono-like illness but negative monospot, what is the likely diagnosis?

Back 262

CMV

Front 263

How is CMV pneumonitis treated in post organ or bone marrow transplant patients?

Back 263

ganciclovir & IVIG

Front 264

What is the differential diagnosis for pharyngitis?

Back 264

-strep pneumonia
-CMV
-EBV
-acute HIV

Front 265

With which infection do patients develop a rash when treated with ampicillin?

Back 265

EBV (mono)

Front 266

What diseases, besides mono, is EBV associated with?

Back 266

-Burkitt's lymphoma
- b-cell lymphoma
-Hairy leukoplasia in HIV pts

Front 267

A patient with a small child presents with arthritis of hands and knees that resolves over several weeks. What is the likely diagnosis?

Back 267

Parvovirus 19 (diagnose with IgM)

Front 268

What causes aplastic crisis in sickle cell patients?

Back 268

parvovirus 19

Front 269

Patient presents with rash, retroauricular/suboccipital LN & fever. What is the likely diagnosis?

Back 269

rubella (German measles

Front 270

What condition is associated with orchitis, swollen salivary glands and occasionally meningeal signs?

Back 270

Mumps (no organisms on gram stain)

Front 271

Patient presents with rash that started at the hairline, coryza, conjunctivitis, cough and whitish spots in pharynx. What is the diagnosis?

Back 271

Measles (rubeola)

Front 272

Patient from Japan presents with paresis, gait disturbances, incontinence and weakness/stiffness. What is the likely diagnosis?

Back 272

HTLV-1 (spastic tropic paraparesis)
Also seen in Caribbean, S. America and Africa

Front 273

How do you treat HTLV-1 infection?

Back 273

corticosteroids, danazol, interferon B1a

Front 274

Patient from S. America or Mexico presents with achalasia, megaesophagus, megacolon, CNS symptoms and heartblock and CHF. What is the most likely diagnosis?

Back 274

Chagas disease (T. cruzi)

Front 275

Patient was serving in military in Iraq presents with abdominal pain, hepatomegaly, painless skin ulcers with heaped up margins that started after a small red papule. What is the diagnosis & treatment?

Back 275

Leishmaniasas (from sand fly)
Tx: sidum stibugluconate, meglumine, amphotericin B

Front 276

Veteran from WWII started chemo and now has abdominal complaints and eosinophilia. What is the likely diagnosis & treatment

Back 276

Strongyloides stercoralis
-can also have pulm or CNS symptoms
Tx: thiabendazole

Front 277

When do you start chemo treatment for Kaposi sarcoma?

Back 277

when develop extensive skin involvement or visceral involvement

Front 278

What are the most common pathogens of dog or cat bites? what is the treatment?

Back 278

- pastuerella multicoda, staphylococcus, strep pyogenes
- TMP-Clinda (if PCN allergy), otherwise amoxicillin-clavulate

Front 279

What helps prevent development of ventilator-associated pneumonia?

Back 279

Keeping mechanically ventilated patients semi-recumbent (at a 45-degree angle)

Front 280

what is a side effect of Linezolid?

Back 280

bone marrow suppression if continued fro more than 2 wks

Front 281

Which carbapenem is most convenient for outpatient treatment of ESBL infections and why?

Back 281

Ertapenem because once daily dosing

Front 282

What are patients with progressive massive fibrosis are at increased risk for developing?

Back 282

Tuberculosis

Front 283

What disease is surface mining associated with?

Back 283

Silicosis - characterized by small nodular opacities distributed mainly in the upper lungs. When these nodules coalesce to form masses, the condition is known as progressive massive fibrosis. In this final stage of the disease, cavitation of the masses and hilar lymphadenopathy are usually present

Front 284

What is the most common cause of diarrhea in travelers to developing countries?

Back 284

Enterotoxigenic Escherichia coli.

Front 285

What is the treatment for Enterotoxigenic Escherichia coli?

Back 285

Usually self-limiting and doesn't require treatment

Front 286

What is the most common bacterial cause of diarrhea in the United States?

Back 286

Camplobacter jejuni

Front 287

In whom is West Nile virus encephalitis is most likely to occur?

Back 287

in patients 65 years of age and older

Front 288

What are the findings in patients with West Nile virus encephalitis?

Back 288

Fever, severe headache, marked muscle weakness involving the lower motor neurons, mental status changes, and possibly seizures

Front 289

What is the most common cause of infectious esophagitis?

Back 289

Candida species, followed by herpes simplex virus and cytomegalovirus

Front 290

Patient presents with abdominal pain, diarrhea followed by renal failure and hemolytic anemia. what is the most likely diagnosis?

Back 290

E. coli O157:H7 (prodcues shiga toxin)

Front 291

What should be used to treat acyclovir-resistant herpes simplex virus infection?

Back 291

foscarnet

Front 292

What laboratory studies should be monitored with foscarnet treatment?

Back 292

electrolytes

Front 293

What is a side effect of cidofovir?

Back 293

nephrotoxicity

Front 294

A “halo sign” (a nodular lesion with a surrounding ground-glass appearance) on chest radiographs is characteristic of?

Back 294

Aspergillus pneumonia

Front 295

Patient presents with MRSA endocarditis and vanco treatment not successful. What should antibiotic be changed to?

Back 295

Daptomycin

Front 296

How should community-acquired pneumonia be treated?

Back 296

third-generation cephalosporin + macrolide

Front 297

What is the recommendation for HIV post-exposure prophylaxis?

Back 297

two or three antiretrovirals (within 2 hrs if a deep puncture)

Front 298

What can be used to treat CMV retinitis?

Back 298

Oral valganciclovir or intravenous ganciclovir

Front 299

How should patients with osteomyelitis and an epidural abscess who do not have focal neurologic deficits be treated?

Back 299

antimicrobial therapy alone, but must be monitored carefully

Front 300

How should patients with osteomyelitis and an epidural abscess who has focal neurologic deficits be treated?

Back 300

emergency surgical decompression

Front 301

Patient has 'watery' sputum that is blood-tinged. What is the diagnosis?

Back 301

yersinia pestis

Front 302

How does pneumonic plaque appear on chest xray?

Back 302

patchy bronchopneumonia

Front 303

What is is the most common cause of eosinophilic meningitis worldwide?

Back 303

Angiostrongylus cantonensis (the rat lungworm)

Front 304

Where is Angiostrongylus cantonensis endemic?

Back 304

tropical areas

Front 305

How do you treat Angiostrongylus cantonensis?

Back 305

The meningitis is self-limited

Front 306

What is the treatment of choice for patients with herpes zoster?

Back 306

Famciclovir and valacyclovir

Front 307

What infection is associated with fish tanks?

Back 307

Mycobacterium marinum

Front 308

How is the cutaneous form of mycobacterium marinum diagnosed?

Back 308

biopsy for histologic, culture & acid fast

Front 309

How does cutaneous Mycoplasma marinum?

Back 309

chronic nodule or ulcer of a digit, and is often referred to as a “fish tank” or “swimming pool” granuloma

Front 310

What is the preferred antimicrobial therapy for a patient with a brain abscess caused by Nocardia species?

Back 310

Trimethoprim–sulfamethoxazole

Front 311

What should Rocky Mountain spotted fever be treated with?

Back 311

doxycycline

Front 312

Besides genotype resistance assay, what is most important for determining a revised antiretroviral regimen?

Back 312

history of use of antiretroviral agents

Front 313

If unsure if infection is due to Aspergillus or Pseudallescheria, what can you treat with?

Back 313

Voriconazole

Front 314

Acute cellulitis in an immunosuppressed patient can be caused by?

Back 314

cryptococcus neoformans

Front 315

Which antiretroviral should not be used in pregnant HIV patients?

Back 315

Efavirenz

Front 316

Patient comes from Guatamala with copious diarrhea without fever, and a positive acid-fast smear of stool. What is the diagnosis & treatment/

Back 316

- Cyclospora infection
- trimethoprim–sulfamethoxazole

Front 317

What antibiotic can be used for aspiration pneumonia?

Back 317

Clindamycin

Front 318

How should prosthetic joint infections be treated?

Back 318

Remove prosthesis, treat with anitbiotic for 6 wks and then reimplant prosthesis

Front 319

Which beta-lactam can be used safely in patients with PCN allergy?

Back 319

aztreonam