Approach to the Patient with an Infectious Disease

Question 1

Normal, healthy humans are colonized with ~50 trillion bacteria as well as countless viruses, fungi, and archaea; taken together, these microorganisms outnumber human cells by ~10 times in the human body. Where major reservoir are these microbes found?

Answer 1

gastrointestinal tract, but substantial numbers of microbes live in the female genital tract, the oral cavity, and the nasopharynx.

Question 2

What disease is the most likely cause when the patient is an avid gardener?

a. Enterococcus species
b. Sporothrix schenckii
c. M. tuberculosis
d. Listeria monocytogenes

Answer 2

b. Sporothrix schenckii

Question 3

What disease is the most likely cause when the patient works as a funeral service worker?

a. Enterococcus species
b. Sporothrix schenckii
c. M. tuberculosis
d. Listeria monocytogenes

Answer 3

c. M. tuberculosis

Question 4

What disease is the most likely cause when the patient is exposed to cats?

a. Bartonella henselae
b. Rickettsia spp.
c. Francisella tularensis
d. Listeria monocytogenes

Answer 4

a. Bartonella henselae

Question 5

For every 1°C (1.8°F) increase in core temperature, the heart rate typically rises by ____ beats/ min.

a. 5-10
b. 10-15
c. 15-20
d. 20-25

Answer 5

c. 15-20

Question 6

Faget’s sign aka _______?

Answer 6

relative bradycardia

where patients have a lower heart rate
than might be expected for a given body temperature

Question 7

A CSF Gram’s stain typically requires ___ bacteria/mL for reliable positivity; its specificity approaches 100%.

a. >10^3
b. >10^4
c. >10^5
d. >10^6

Answer 7

c. >10^5

Question 8

Most common cause of ESR >100mm/h
a. Infectious Diseases
b. Inflammatory Diseases
C. Malignancies
D. NOTA

Answer 8

Most common cause of ESR >100mm/h
a. Infectious Diseases 35-40%
b. Inflammatory Diseases 15-20 %
C. Malignancies 15-20 %

Question 9

Which of the ff type of meningitis/ encephalitis DOES NOT present with CSF Findings of predominantly lymphocytes?

a. Viral Meningitis
b. TB Meningitis
c. Encephalitis
d. Parasitic Meningitis

Answer 9

d. Parasitic Meningitis
↑↑ Eosinophils
(≥50%)

Question 10

CSF Findings with WBC count 150–2000 and 50–200 CHON

a. Bacterial Meningitis
b. TB Meningitis
c. Fungal Meningitis
d. Parasitic Meningitis

Answer 10

d. Parasitic Meningitis

Bacterial Meningitis
>1000 WBC
>100 CHON

Question 11

CSF Findings with OCCASIONALLY positive Gram stain

a. Bacterial Meningitis
b. TB Meningitis
c. Fungal Meningitis
d. Parasitic Meningitis

Answer 11

b. TB Meningitis

a. Bacterial Meningitis Positive (in >60% of cases)
b. TB Meningitis
c. Fungal Meningitis - Rarely positive
d. Parasitic Meningitis- Negative

Question 12

Gnathostoma spinigerum causes what type of meningitis/encephalitis?

Answer 12

Parasitic Meningitis
Angiostrongylus cantonensis,
Gnathostoma spinigerum,
Baylisascaris procyonis

Question 13

Influenza Virus causes what?

a. Viral Meningitis
b. Encephalitis
c. Both A and B
d. NOTA

Answer 13

b. Encephalitis

VIRAL MENINGITIS- Enteroviruses
ENCEPHALITIS- Herpesviruses, enteroviruses, influenza virus, rabies virus

Question 14

Empirical Treatment for Septic Shock

Answer 14

Vancomycin, 15 mg/kg q12hb
plus
A broad-spectrum antipseudomonal β-lactam
(piperacillin-tazobactam, 4.5 g q6h; imipenem,
1 g q8h; meropenem, 1 g q8h; or cefepime, 1–2 g
q8–12h)

Question 15

Empirical Treatment for Meningitis

Answer 15

Vancomycin, 15 mg/kg q12h
plus
Ceftriaxone, 2 g q12h

Question 16

Empirical Treatment for CNS abscess

Answer 16

Vancomycin, 15 mg/kg q12hb
plus
Ceftriaxone, 2 g q12h
plus
Metronidazole, 500 mg q8h

Question 17

Empirical Treatment for Acute endocarditis

native valve

Answer 17

Vancomycin, 15 mg/kg q12hb
plus
Cefepime, 2 g q8h

Question 18

For patients with suspected or proven
pneumococcal meningitis what drug should be added to the empiric treatment?
a. Vancomycin
b. Mannitol
c. Hypertonic Lactate
d. Dexamethasone

Answer 18

Dexamethasone (0.15 mg/
kg IV q6h for 2–4 d) should
be added for patients
with suspected or proven
pneumococcal meningitis, with
the first dose administered
10–20 min before the first
dose of antibiotics.

Question 19

For Skin and soft Tissue infections in additional to the empiric treatment with a consideration of MRSA, what drug is added?

a. Metronidazole
b. Clindamycin
c. Cirpofloxacin
d. Daptomycin

Answer 19

If MRSA is a consideration,
clindamycin, vancomycin (15
mg/kg q12hb), linezolid (600
mg IV/PO q12h), or TMP-SMX
(1–2 double-strength tablets
PO bidg) can be used.

Question 20

Empirical Treatment for outpatient CAP

Answer 20

Azithromycin, 500 mg PO × 1, then 250 mg PO qd ×

4 days