Communicable Diseases (recalls) Flashcards
In patients with sepsis, microbiological results were positive in 70% of individuals considered infected. Of these isolates recognized these organisms were noted to be most common:
Pseudomonas and Eschericia coli
This defines sepsis-induced hypotension:
SBP <90mmHg
Wound culture positive for p.aeruginosa what is antibiotic of choice
Beta lactamase and aminoglycoside
Drugs for Malaria
pg.1378
Pt had an accident oozing blood in arms and head, unrecalled vaccination. What is the tetanus status?
Severe blood loss and unrecalled
vaccine give both tetanus toxoid and ig
Malaria that causes nephrotic syndrome?
P. malariae
Traveler went to Palawan experience fever and chills. Attending physician found out that it is distinct with Tertian Fever.
Vivax
Test done to differentiate Plasmodium species ata
Thin - ht of fever
Bitten by a rabid dog. Test that should be done
direct flour. Ab test
Cont to #17 (Bitten by a rabid dog. ): The doctor decided to give rabies vaccination. 1st dose April 1 and was done, second dose on April 4 but the patient came back on April 6. What should be done to the vaccination schedule?
Give due dose and keep treatment schedule
Rabies vacs given to pts except
Hypersensitivity to quinine
This is an unusual course of death for rabies patient.
congestive heart failure
Relatively high risk active for tb infected by tb bacilli
tobacco smoking? gastrojejunal bypass? dm? tobacco siguro.
76yo, female, fever, blood tinged cough 3mos. CXR suggestive of ptb. AFB negative.
Presumptive tb
The nurse do the skin test with equine endotoxin but the result is positve?
A. 100,000-300,00 TIG
B. 30,000-60,000 TIG
C. 30-50 equine + IV steroid
D. 1-3 TIG
vector of malaria
Anopheles
Plamodium species that can cause cytoadherence.
P. Falciparum
Diabetic septic patient?
Hypoglycemia
Most common microorganism that causes severe sepsis
Gram –
Organ dysfunction during sever sepsis, principally biochemical not structural
True – Harrison page 1754
Associated with a poor prognosis in tetanus.
Incubation period less than 7 days.
What treatment should be started in the stated patient above (no. 47 - Associated with a poor prognosis in tetanus.)
a. 2 HRZE/ 4HR
b. 2 HRZES/ 4HRE
c. 1 HRZE/ 5 4HR d. 1 HRZES/ 5HRE
Drugs that can’t be use ng TB Category I
Levofloxacin
This should not be given to PTB Category 1 patients:
Levofloxacin
Gardener bitten by a bat that flew away.
Treat With soap and water + tetanus toxoid + rabies vaccine
- True regarding lesptospire, EXCEPT:
A. Are highly motile organism with hooked
ends of seperate Order Class as syphilis and
yaws
B. Leptospira interrogans is the only pathogenic leptospira
C. May be grown using special media after weeks of incubation
D. May be acquired after exposure to contaminated environment with or without abrasion
A. Are highly motile organism with hooked
ends of seperate Order Class as syphilis and
yaws
True of Weils Disease:
Starts off as an Anicteric form
11. Features of vulvovaginitis, except A. Chronic staining B. Discharge C. Vulvar discomfort D. Dyspareunia
A. Chronic staining
Fitz hugh curtis syndrome
PID
Levofloxacin is used in Epididymitis for?
To cover enterobacteriaceae
21. Characteristics of bacterial vaginosis, except? A. erythema of vaginal and vulvar B. presence of clue cells C. homogenous vaginal secretions D. malodorous vaginal secretions
A. erythema of vaginal and vulvar

Organism transmitted by oral fecal route
Campylobacter
Tenesmus and constipation are common features of
Proctitis
Hemorrhagic Uremic Syndrome maybe a severe complication of diarrhea of which of the following organism:
Shigella Dysenteriae
Most common cause of nosocomial diarrhea?
A. Norovirus
B. Staph
C. Clostridium
D. sorry nakalimutan ko po
- The following are the recommendations in prevention of nasocomial infection except:
A. Elevate head of the patient at 30-45 degres
B. Completely shave the hair of the patient before the surgery
C. Apply alcohol hand rub before and after seeing the patient
D. (Nakalimutan ko)
?
Droplets precaution is for: A. Tb B. Pneumonia C. Measle D. Varicella
C????
- Etiologic agent sa case (bipedal edema and gradual enlarging of the abdomen)
a) S. japonicum
b) S. haematobium
c) S. mongeki
d) S. mansoni
S. mansoni
- True statement regarding clinical course of typhoid fever
A. relapse on 2-3 months
B. s. typhi present on feces for 2-3 weeks
C. chronic asymptomatic carriage,
shedding s.typhi in either urine or stool for >

C. chronic asymptomatic carriage,
shedding s.typhi in either urine or stool for >

**Most common bacteria: surgical site infection. (24-48 hours)
Group A strep & Clostridium
Sexually transmitted via oro-fecal transmission:
Campylobacter
Cervical CA
HPV
Precaution to T.Fever: A. contact pre. b.airborne C. droplet pre. D AOTA
?
Antibiotics is neccesary for rhinosinusitis because 90-98% is bacterial in origin.
true or false?
Antibiotics not guaranteed to help acute rhinosinusitis even if the causative agent is bacteria.
true or false?
Other potent drug for chb A. Adenovir B entecavir C telbivudine D lamivudine
?
- Which of the following is correct in acute retroviral syndrome:
A. Occur in 5% HIV
B. 3 months after infection
C. May present as influenza like illness
D. Opportunistic infection may set in
?
- Most common transmission of acute hepatitis:
A. Parenteral
B. Eating of raw meat
?
Nephrotic syndrome
WHO stage 4
Case. Patient treated with TB but stopped 2 weeks due of feeling better. Category of the patient?
?
HIV Staging for (+) blood IGRA
?
Matching type Chickenpox
A. hhv1
B. hhv2
C. hhv3
D. hhv4
Associated with acute lower respiratory tract infections among military recruits in the US.
A. Rhinovirus
B. Coronarivus
C. Adenovirus
D. Influenza
Entamoeba histolytica
A. presence of fecal mononuclear lymphocyte and fecal ( nkalimutan ko )
B. (di ko na maalala)
C. …. that causes watery diarrhea
Post herpetic neuralgia
hhv 3
Sporadic viral encephalitis
A. Hhv1
B. Hhv2
C. Hhv3
D. Hhv4
Which drug is not given to patients with PTB category II?
A. Rifampicin B. Azithromycin C. Levofloxacin D. Sulfa based drugs E. Isoniazid
Avian flu virus responsible for most human illness worldwide, assoc with serious illnesses and highest mortality?
A. H7N9, H5N1
16. Lespostires specimen during first week of illness except A. CSF B. Blood C. Urine D. Dialysate
?
67-80% remain in this phase
Inactive CHB phase
Nasopharyngeal CA
A. HHV1
B. HHV2
C. HHV3
D. HHV4
A 47 yr old female grew up in surigao del sur came to manila 3 weeks ago, came in with complaint of bipedal edema and continous enlarging of abdomen. What is the causative agent?
A. S. Japonicum
B. S. Hematobium
C. S. Mansoni
Best desribe herpes zoster
A. Lesion infectious
B. Widespread lesion
C. Primary infx with varicella
D. Common in young adult and immunocompetent
Medical student was exposed to his classmate in their dorm up to 1 days before onset of acute heap which happened 4 days ago. Both have no history of heap and vaccine. What is your recommendation?
A. Observe exposed patient
B. Start on post exposure prophylaxis
C. Exposure not within period of communicability. No need for post exposure prophylaxis
D. HAV iG and HAV vaccine ASAP within 2 weeks of exposure
Elevated ALT with (+) HbeAg, elevated > or = 20,000 iu/ml
HbeAg(+) immune-active phase
Management of influenza. Which of the following is correct:
A. All patient with the same condition should take antiviral therapy
B. Greatest benefit when given within 48 hrs after onset of illness
C. Severe complicated or progressive giving anti viral beyond 48 hours is useless
D. Antiviral therapy is CI in pregnancy
Affects the respiratory tract (type 1 & 2 pneumocytes) via ACE II receptor.
SARS-COV
True about Immune Reconstitute Inflammatory Syndrome (IRIS)
Immunulogic reaction to HIV antigen
The most common mode of transmission of HIV
Sexual
CASE chest xray- butterfly pattern. Ct scan- ground glass appearance -
Pneumocystis pneumonia
Mgt of HIV
?
Anemia neutropenia thrombocytopenia
Stage 3 HIV
Generalized lymphadenopathy
stage 1
Abdominal diarrhea weight loss
stage 3
Mycobacterium avian complex
stage 3
Medical student was exposed to his classmate in their dorm up to 1day before onset of acute hepa which happened 4 days ago. Both have no history of hepa and vaccine.. what is your reccomendation
C. Exposure not within period of
communicability no need for for post
exposure prophylaxi
Specific anti-viral treatment for acute viral hepatitis includes the ff.except? A. HAV B. HBV C. HCV D. NONE OF THE ABOVE
A. HAV
The best that describe for the use of nucleotide/side
analogue for chB
A.
B.
C. Use in all phase of chB D. Monotherapy is needed
Aside from entecavir, what other NA is highly potent…, and as same use as anti- retrovirus
Tenofovir
67 to 80% remain in this condition
?
Elevated hbv-dna typically >1millioniu/ml (at replicable phase) and normal ALT.
Matching type B. (+) hbv replicable phase
BURKITT’S
HHV4
CNS LYMPHOMA IN AIDS
HHV4
NASOPHARYNGEAL CARCINOMA
HHV4
KAPOSI SACROMA
HHV8
TRIAD OF FEVER PHARYNGITIS, LYMPHADENOPATHY W/ DOWNEY IN THE PERIPHERAL SMEAR AND ALSO
CALLED KISSING DISEASE
(Epstein-Barr virus) HHV4
COMMON COMPLICATION OF CHICKEN POX WITH HIGHEST MORBIDITY AND
PNEUMONIA
CORRECT TRANSMISSION OF HSV
LOCATION- OROGENITAL
ASIDE FROM MULTIPLE VESICLES, WHAT ARE THE OTHER COMPLAINS OF PX WITH PRIMARY GENITAL HERPES?
First-episode primary genital herpes is characterized by fever, headache, malaise, and myalgias. Pain, itching, dysuria, vaginal and urethral discharge, and tender inguinal lymphadenopathy are the predominant local symptoms
CHICKEN POX CASE
AFTER 2 DAYS OF ONSET AND INCUBATION

Colored sputum is indicative of bacterial infection t/F?
FALSE
Inappropriate use of antibiotic is common in management of viral respiratory infection. t/f?
FALSE
True about bird flu virus transmission.
D. AOTA
best describe bird flu
A influenza b virus
B common affects people (?)
C no effective anti viral drug (?)
D human to human transmission is not sustained
Avian flu with asean lineage
A. H7N9 H5N1
Upper viral respi tract infxn which is associated with exacerbation of asthma and chronic bronchitis
Rhinovirus
Sneezing, burning sensation in nasopharynx,
1st gen. Anti histamine
Sudden onset of high fever, malaise, fatigue, myalgia
Influenza a
Management of influenza.
Greatest benefit if given within 48hrs after

Which of the ff: statement is correct about SARS-COV?
C. Systemic infections onset within 2-7days
(hoarseness, shortness of breath)
After an incubation period that generally lasts 2–7 days (range, 1–14 days), SARS usually begins as a systemic illness marked by the onset of fever, which is often accompanied by malaise, headache, and myalgias and is followed in 1–2 days by a nonproductive cough and dyspnea.
Affects the resp tract (type1 &type 2) via ACE II receptor
SARS-CoV
In patient with sepsis, microbial results were positive in 70% of individual consodered infected. of these isolates recognized these organism were noted to be most common.
pseudomona and e. coli
80 y.o. diagnosed of Pneumonia. Goal of mgt:
A. CVP of >5mmHg
B. Effective IV antimicrobials
C. Monitor blood sugar
D. Increase MAP more than equal 50mmHg E. Urine output of >0.5mL/kg/min
Cough >4 weeks left pleuritic chest pain
A. Rifampicin, INH, Pyrazinamide
B. INH, rifampicin
C. INH, Rifampicin, Pyrazinamide, ethambutol
D. Ethambutol streptomycin
67 y/o, male, renal transplant patient taking azathioprine and prednisone. With fever, night sweats, chills, AFB smear positive with cavitary lesions
A. Isoniazid, Rifampicin, Ethambutol
B. Isoniazid, Rifampicin, Pyrazinamide, Ethambutol
C. Isoniazid, Rifampicin
D. Streptomycin, Ethambutol
Bite by a bat, with oozing blood arms. Unrecalled vaccination
clean with soap and water, give anti tetanus and ig
Treatment for acute attack of Falciparum
A. Quinine
B. Primaquine
C. Chloroquine
D. Co Artem
Which is true for TB and HIV
A. Tb treatment is same with Hiv +/-
B. Tb is developed if CD count is <100
C. Plasma HIVDNA is decreased in active tb
D. Extrapulmonary disease is more common in Pulmo disease than HIV + patient
-Extrapulmonary TB is common among HIV- infected patients. In various series, extrapulmonary TB—alone or in association with pulmonary disease—has been documented in 40–60% of all cases in HIV-co-infected individuals.
Which type of malaria is true
Duffy is resistant to P. vivax
A 30 yo, vehicular accident, with oozing blood on his hands, uncertain of vaccination.
A.
B.
C.
D. If uncertain, you still administer tetanus toxoid and ig.
Positive for Duffy antigens
vivax
Malaria that can cause comatose
?
Quartan pattern of fever in malaria
P. malariae
Tertian Fever
P. vivax, P. ovale
The test that can be done on above patient (question#15) to identify plasmodium is:
C. thin smear at the height of fever
Before, Blood collection is at the peak of fever, now as long as it is febrile
*THICK – More sensitive, can’t speciate *THIN – Less sensitive, Facilitate speciation
Maid bitten by suspected rabid dog. Aside from biopsy of dead animal’s body what would be the initial diagnostic test?
A. Direct antibody fluoresence
B. ???
C. Wound culture with gram staining D. Indirect antigen fluorescence
Usual cause of death of rabies patient:
Valvular or myocarditis
FG is diagnosed with TB. She is the only one who has this in their household. She is classified as
index case
Highest relative risk for development of active tb among infected tb ptx?
A. Gastroduodenal
B. Jejunoileal
C. tobacco D. DM
A 56 y/o female presents with fever and productive blood tinged sputum for 4 wks duration. She consults with a physician who requests for chest x ray with findings supportive PTB. Her sputum AFB smear are all negative. The physician thinks that this is a case of TB. What classification?
A. Bacteriographiclly confirmed B. Clinically diagnosed
C. Presumptive TB
D. Tb exposure
) Case…….. primary CMI against TB infection:
Macrophages & T cells
Rabies aside from dog and cat:
bats and monkeys
40 yr old driver had a punctured left arm. The nurse do skin test for equine antitoxin but the result is positive. What dose will you give the patient?
A. 30,000-60,000 IU of TIG
B. 3,000-6,000 IU OF TIG
C. 300-200 Equine + IV steroid D. 30-60 IU of Equine
Aside from vaccine and TIG, most important antibiotic is?
A. Clindamycin
B. Ampicillin
C. Metronidazole
D. 3rd gen. Cephalosporin
Patient developed upward rolling of the eye and spasm. What medication is to be given to address the spasm
Benzodiazepines ( Harrison page 986)
Antiobiotic for tetanus
Metronidazole
Clinical manifestation of tetanus occur during this event
when the toxin reach the presynaptic
inhibitory
Most common symptom of esophageal ca
dysphagia
Plasmodium spp that causes relapse
A. Falciparum - No B. Ovale - Yes C. Vivax – Yes D. Malariae – No In P. vivax and P. ovale infections, a proportion of the intrahepatic forms do not divide immediately but remain inert for a period ranging from 3 weeks to ≥1 year before reproduction begins. These dormant forms, or hypnozoites, are the cause of the relapses that characterize infection with these two species.
symptoms of rabies:
B. Atypical encephalitis without loss of
consciousness
Site of rabies virus replication
acinar cells of salivary glands
Rabies virus replicates in acinar cells of the salivary glands and is secreted in the saliva of rabid animals that serve as vectors of the disease
This plasmodium species can cause cytoadherence
Falciparum
Serum tumor marker of hepatocellular ca:
A. CA 12-2
B. CA 19-9
C. AFP D. CEA
Microscopic pathology of rabies
Negri bodies in hippocampal pyramidal

These inclusions occur in a minority of infected neurons, are commonly observed in Purkinje cells of the cerebellum and in pyramidal neurons of the hippocampus, and are less frequently seen in cortical and brainstem neurons
37 y/o male consulted at clinic with xray of cavitary PTB and (+) DSSM. He was given anti-TB drug 3 years ago but stopped after 2 weeks because he felt better. What is the category of the patient?
A. I B. IIA C. IA D. IIB CATEGORY II - Pulmonary or EPTB cases who has been previously treated for TB. CATEGORY II A - Same patients as Category II, EPTB previously treated drug susceptible TB of the bones, joints, CNS
What tx plan should be started in the above px?
( 37 y/o male consulted at clinic with xray of cavitary PTB and (+) DSSM. He was given anti-TB drug 3 years ago but stopped after 2 weeks because he felt better. What is the category of the patient?)
C
A. 2HRZE/4HR - CATEGORY 1 B. 2HRZES/4HRE C. 1HRZE/5HR D. 1HRZES/5HRE CATEGORY I - 2HRZE/ 4HR CATEGORY IA - 2 HRZE/ 10 HR CATEGORY II - 2 HRZES/ 1 HRZE/ 5 HRE CATEGORY II A – 2 HRZES / 1 HRZE / 9 HRE
Treatment given to above patients
( 37 y/o male consulted at clinic with xray of cavitary PTB and (+) DSSM. He was given anti-TB drug 3 years ago but stopped after 2 weeks because he felt better. What is the category of the patient?)
A) 5 first line drugs
B) 4 first line drugs
C) second line drugs
D) 5 first line drugs + ciprofloxacin
Should not be given in category II tb patient.
A. Rifampicin
B. Azithro and other macrolide
C. Levofloxacin
D. Sulf drugs antibiotics E. Isoniazid
Travelers diarrhea
ETEC
Post-diarrheal complication of Campylobacter infection:
Guillain Barre Syndrome
Another complication is reactive arthritis
5 True regarding diarrhea caused by Entamoeba histolytica EXCEPT?
A. Infection occuring in distal small bowel
B. Isolated fecal polymorphous clear leukocytes with substantial increase fecal lactoferrin
C. Enterotoxin causes watery diarrhea
D. Mechanism of inflammation is invasion
Enterotoxin causes watery diarrhea
Inflammation due to invasion. (19th ed. p852, table 160-1)
Venereal sexual cause of std except: A. Scabies B. Aphthous ulcer C. clostridium D. Molluscum
Aphthous ulcer
C. difficile isn’t even an STD
True about role of toxin in infectious diarrhea (Choices non-verbatim but same thought)
A. Staph aureus and Bacillus cereus produce toxins involving CNS that cause n&v
Neurotoxins are usually produced by bacteria outside the host and therefore cause symptoms soon
after ingestion. Included are the staphylococcal and Bacillus cereus toxins, which act on the central nervous system to produce vomiting.
B. Cholera toxin increase Cl and Na absorption that cause diarrhea
The prototypical enterotoxin is cholera
toxin…which increases Cl– secretion and decreases Na+ absorption, leading to a loss of fluid and the production of diarrhea.
C. Heat labile ETEC is similar to cholera toxin in producing diarrhea
Enterotoxigenic strains of E. coli may produce a protein called heatlabile enterotoxin (LT) that is similar to cholera toxin and causes secretory diarrhea by the same mechanism.
D. Shiga toxin of E. coli is assoc with hemorrhagic colitis
Enteric pathogens that produce such cytotoxins include Shigella dysenteriae type 1, Vibrio parahaemolyticus, and Clostridium difficile. S. dysenteriae type 1 and Shiga toxin– producing strains of E. coli produce potentcytotoxins and have been associated with outbreaks of hemorrhagic colitis and hemolytic-uremic syndrome.
(19th ed., p853)
AOTA???
Tenesmus as a feauture of proctitis is caused by what organism?
Clostridium difficile
Best antibiotic prescribed in immunocompromised patient exposed in high risk area now experiencing inflammatory diarrhea
d. azithromycin
Most individuals who present with dysentery (bloody diarrhea and fever) should be treated empirically with an antimicrobial agent (e.g., a fluoroquinolone or a macrolide) pending microbiologic analysis of stool….Because of widespread resistance of Campylobacter to fluoroquinolones, especially in parts of Asia, a macrolide antibiotic such as erythromycin or azithromycin may be preferred for this infection. (19th ed., p857)
- True statement regarding LEPTOSPIROSIS except:
a. Outbreak can happen without flood as flood is to outbreak
b. almost all mammals species are affected
c. it is traveller’s disease
d. risk factor include only the exposure to
animals’ urine
d. risk factor include only the exposure to
animals’ urine
Transmission of leptospires may follow direct contact with urine, blood, or tissue from an infected animal or, more commonly, exposure to environmental contamination (19th ed., p1142)
Stage ng disease…circulating antibody…meningeal?
Leptospiruric
Best specimen for leptospirosis 2 wks –
Stool kato-katz is a fecalysis method
Best treatment of choice for moderate- severe leptospirosis
Cefotaxime 2gm q12
Liver lesion in leptospiruric phase –
Centrilobular necrosis
Not leptospirosis
Severe metabolic alkalosis
Severe Leptospirosis:
• WBC>12,000
• plt <100,000
• Crea=>3mg/dl or crea clearance <20ml/min
• AST/ALTratio>4x
• Bilirubin>190umol/l
• Prolonged PT <85%
• Serum K= >4 mmol/l
• ABG= severe metabolic acidosis & hypoxemia (pH <7.2,HCO3 <10) (PAO2 <60mmHg,SaO2<90%,Pfratio<250)
• Chest X-ray = extensive alveolar infiltrates • 12L ECG= signs of heart block, myocarditis, repolarization abnormalities
16) True of leptospirosis prophylaxis, EXCEPT
a. individuals with single history of wading in
flood or contaminated water and the
presence of the wounds is low risk of exposure
b. Doxycycline 200mg once weekly until the end of exposure for moderate to high risk
c. PEP is not routinely recommended
d. Post exposure prophylaxis depends on the duration, degree of exposure, and presence of wounds.
Low Risk Exposure - single history of wading in the flood or contaminated water w/o wounds or cuts.
Moderate-risk Exposure - individuals w/single history of wading in flood or contaminated water and the presence of wounds and cuts or accidental ingestion of contaminated
Most common site of nosocomial infection:
Genitourinary
Urinary tract infections (UTIs) account for ~30–40% of nosocomial infections; up to 3% of bacteriuric patients develop bacteremia.(19th ed. p913)
True of HAP/VAP
C. Poor prognosis if late onset
- True of nosocomial infections except
A. Cross contamination most common exogenous route.
B. 2/3 ifc patients develop gram positive bacteria
C. Retrograde movement up the urethra most common endogenous route.
D. NOTA
B. 2/3 ifc patients develop gram positive bacteria
Virtually all patients develop bacteriuria by 30 days of catheterization = associated with 2/3 cases of nosocomial gram negative bacteremias.
Most common and most important nosocomial
Patient
typhoid fever prevention-based- precaution
.Contact precaution\
Contact precautions: diarrhea, Typhoid, MDR organisms, lice, draining wounds Droplet precautions: influenza, diphtheria, pneumonia, meningococcemia, SARS
Most common etiologic agent in nosocomial infection
E.coli
Appropriate time to administer antibiotic prophylaxis for surgery
1 hr before skin incision
Administer prophylactic antibiotics within 1 h before surgery; discontinue within 24 h. (19th ed., p914)
Which of the following matches its intermediate host?
S.Japonicum - Oncomelania quadrasi
INFECTIVE STAGE OF SCHISTOSOMIASIS IN SNAILS?
Miracidium
Stage causes schistosoma dermatitis
Ceracia
True of chronic schistosomiasis
Species dependent
Intestinal schistosoma except:
S. Haematobium
True statement regarding management of Schistosomiasis.
Patients with hepatomegaly are responsive to tx
True about STD
d) the chance of person to acquire the
infection is inversely proportional to the
times he protects himsel
Causative agent of Chancroid
H. Ducreyi
Urethritis in men except?
A.cardinal sign- Dysuria, discomfort betwen micturation
B. First void urine sampling contain 2-5 leukocytes per high dry fields
C. Non gonoccocal urethritis- mucopurulent discharge
D. Trichomas vaginalis is one of the causative agent >10-15 leukocytes
B. First void urine sampling contain 2-5 leukocytes per high dry fields
- Not true of Fitz-Hugh-Curtis Syndrome
Elevated liver function test
- Which is true regarding rose spots?
Typically resolves after 2-5 days
Early physical findings of enteric fever include rash (“rose spots”; 30%), hepatosplenomegaly (3–6%), epistaxis,
and relative bradycardia at the peak of high fever (<50%). Rose spots (Fig. 190-2; see also Fig. 25e-9) make up a faint, salmon- colored, blanching, maculopapular rash located primarily on the trunk and chest. The rash is evident in ~30% of patients at the end of the first week and resolves without a trace after 2–5 days. Patients can have two or three crops of lesions, and Salmonella can be cultured from punch biopsies of these lesions. The faintness of the rash makes it difficult to detect in highly pigmented patients. (19th ed., p1051)
. Gastrointestinal bleeding or intestinal perforation may occur during
3rd week
Most commonly occur in the third and fourth weeks of illness and result from hyperplasia, ulceration, and necrosis of the ileocecal Peyer’s patches at the initial site of Salmonella infiltration.
clinical course typhoid
stool exam 2-3 weeks
Case. Bloody diarrhea… Mollusks and crustaceans.
Vibrio parahemolyticus
19th ed., p1066, Table193-5
Major endemic countries for S.Haematobium except?
a. Africa
b. Philippines
c. Middle East
d. NOTA
b. Philippines
True about Leptospirosis:
d. MAT is best collected >1week
- Culture and Isolation is still GOLD standard but limited by disadvantages
- can identify serovar but is insensitive
- Micro Agglutination Test (MAT) that has a 4-fold rise of the titer is confirmatory. In endemic areas like the
Philippines, a single titer of 1:1600 in symptomatic patients
*Infectious dose of S. typhi:
10 3-10 6
The infectious dose ranges from 200 colony- forming units (CFU) to 10 6 CFU (19th ed., p1049)
Characteristic of a normal vaginal secretion
b. lactobacilli - should be predominant
d. odorless
19th ed., p873, Table 163-5
Most common pathogen for Surgical Site Infection (24-48 hrs)
S. aureus
Signs of moderate dehydration, except:
a. Orthostatic hypotension
b. Decreased urine output (UO)
c. Sunken eyes
d. Skin tenting
b. Decreased urine output (UO)
PE, Signs of Dehydration:
a. Mild Dehydration- thirst, dry mouth, decreased axillary sweat, decreased urine output, and slight weight loss
b. Moderate Dehydration- orthostatic fall in blood pressure, skin tenting, and sunken eyes (or, in infants, a sunken fontanelle).
c. Severe dehydration- lethargy, obtundation, feeble pulse, hypotension, and frank shock.
Most common cause of nosocomial diarrhea:
Clostridium difficile
The most commonly diagnosed diarrheal illness acquired in the hospital, Clostridium Difficile Infection results from the ingestion of spores of C. difficile that vegetate, multiply, and secrete toxins, causing diarrhea and pseudomembranous colitis (PMC) in the most severe cases.
True about vaccine in Typhoid:
Single dose ViCPS with booster every 2
years
note:
a. Minimal age of ViCPS is 6 y/o
b. Ty21a booster every 2years Ty21a, an
oral live attenuated S. typhi vaccine (given on days 1, 3, 5, and 7, with a booster every 5 years)
d. NOTA
Vi CPS, a parenteral vaccine consisting of purified Vi polysaccharide from the bacterial capsule (given in a single dose, with a booster every 2 years)
Gold standard in diagnosing Typhoid
Blood culture
Other than a positive culture, no specific laboratory test is diagnostic for enteric fever. (19th ed., p1051)
Lab test result in Typhoid
a. increased liver enzymes
b. increased muscle enzymes
c. neutropenia
In 15–25% of cases, leukopenia and neutropenia are detectable…Other nonspecific laboratory findings include moderately elevated values in liver function tests and muscle enzyme levels.
True in IRISH(?) among patient w/ HIV
Immune reactivation
In HIV infection, an exaggerated inflammatory reaction to a disease-causing microorganism that sometimes occurs when the immune system begins to recover following treatment with antiretroviral (ARV) drugs. Immune reconstitution inflammatory syndrome (IRIS) occurs in two forms: “unmasking” IRIS refers to the flare-up of an underlying, previously undiagnosed infection soon after antiretroviral therapy (ART) is started; “paradoxical” IRIS refers to the worsening of a previously treated infection after ART is started. IRIS can be mild or life- threatening. Commonly seen in patient with low initial CD4 (Dr. Yapendon’s notes)
49y/o MSM xray butterfly pattern ct scan glassy appearance. Dx?
A.PCP
Chest radiograph typically demonstrates diffuse, bilateral, symmetrical interstitial infiltrates emanating from the hila in a butterfly pattern; however, a chest radiograph may be normal in patients with early disease.
Thin-section computed tomography (CT) demonstrating patchy ground-glass attenuation (Dr. Yapendon’s notes)
Anemia, neutropenia, thrombocytopenia
hiv stage 3
CNS toxoplasmosis
hiv stage 4
Best describes Hep. A
no chronicity
medical student was exposed to his classmate in their dorm up to 1day before onset of acute hepa which happened
4 days ago. Both have no history of hepa and vaccine.. what is your reccomendation
Exposure not within period of
communicability, no need for post exposure

Antiviral drug is not indicated in which of the ff:
HAV
Aside from entecavir, what other NA is highly potent…, and has same use as anti- retrovirus
Adenofovir
67-80% will remain in this phase
?
> 1Million iu/l
?
Elevated HBV DNA more than 20,000
HBe (+)
Burkitts lymphoma
HHV4
best describe as varicella
A. Recurrent HSV infection
B.
C. Young and immunocompetent D.
Chickenpox
B. 1-2 days before and 5 days after
Period of communicability 1-2 days before the rash appears and until all blisters have formed scabs, lasts for 4-5 days
True or false
Antibiotic is not helpful in acute rhinosinovitus……causative agent is bacterial (sorry nakalimutant ko yung exact sentence.)
f?
Therapy in the form of firstgeneration antihistamines and nonsteroidal anti- inflammatory drugs may be beneficial in patients with particularly pronounced symptoms, and an oral decongestant may be added if nasal obstruction is particularly troublesome. Reduction of activity is prudent in instances of significant discomfort or fatigability. Antibacterial agents should be used only if bacterial complications such as otitis media or sinusitis develop. (19th ed., p1203)
Rhinosinusitis is treated with amoxicillin or amoxicillin-clavunate and is the first line drug. t/f?
f
URTI drugs: Penicillins, cephalosporins, and macrolides
Anaerobic intraabdominal infection, metronidazole is preferred over clindamycin . t/f?
False
Clindamycin is active against almost all anaerobes except B. fragilis, a normal commensal in the GUT
In anaerobic head and neck infection and adpiration pneumonia, clindamycin is preffered over metronidazole. t/f?
true
Metronidazole: no coverage in aerobic bacteria except C. difficile
Antibiotic stewardship definition. ( sorry di ko maalala exactly )
Refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration. Seeks to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity, and other adverse effects, reduce costs of healthcare for infections, and limit antimicrobial resistant strains.
Empiric therapy must be indicated in patients with severe cases and diagnosis still pending.
true
“best guess,” broad spectrum, multiple drugs, evidence usually only controlled trials, more adverse reactions, expensive
. Best describes bird flu
human to human transmission is not sustained
upper respi tract assoc with exacerbation of chronic bronchitisand asthma
rhinovirus
Sneezing, burning sensation, nasal obstruction, mild sorethroat,
low grade of day 1
First gen. Anti histamine
Management for influenza
Antiviral should be given within 48 hrs after

A 5-day course of oseltamivir or zanamivir reduces the duration of signs and symptoms of uncomplicated influenza by 1–1.5 days if treatment is started within 2 days of the onset of illness and may be effective if started up to 5 days after onset of symptoms. (19th ed., p1213)
Clinical features of sars-cov
systemic.. within 2-7 days after infection of?
After an incubation period that generally lasts 2–7 days (range, 1–14 days), SARS usually begins as a systemic illness (19th ed., p1204)
Outbreaks of acute lower respi disease in military recruits
Adenovirus
Corona Virus that infects type 1 and type 2 alveolar pneumocytes, binds to ACE inhibitor
Either SARS or MERS COV
SARS-CoV infects cells of the respiratory tract via the angiotensin converting enzyme
2 receptor… and coronavirus particles have been detected in type II pneumocytes. Because MERS-CoV was so recently detected, little is known at present about its pathogenesis. However, it may well be similar to that of SARS-CoV. (19th ed., p1204)
33/male bitten by bat.. In the ER with oozing wound at the right arm… No history of tx nor pre exposure prophylaxis for rabies, unsure of tetanus vaccine, management?
Human rabies Ig M, +
True for tb and hiv
Tb treatment same for hiv
age??? productive cough for 3 wks, chest x ray (+) TB, AFB (-), clinician still suspecting TB?
Clinically diagnosed
30y.o mason had an accident and sustained several oozing wounds on the arms and neck. Uncertain of immunization. What describe this tetanus?
If patiend is uncertain of immunization, give tetanus toxoid and ig
Individuals sustaining tetanus-prone wounds should be immunized if their vaccination status is incomplete or unknown or if their last booster was given >10 years earlier. Patients sustaining wounds not classified as clean or minor should also undergo passive immunization with TIG. It is recommended that tetanus toxoid be given in conjunction with diphtheria toxoid (19th ed., p986)
Positive for duffy agents
P. Vivax
Which can lead to coma
P. falciparum due to cerebral malaria
The test that can be done on above patient to identify plasmodium is?
Thin smear at the height of fever
Before, blood collection is at the peak of fever, now, as log as febrile, do thick and thin smears
22 y/o maid was bitten by a dog suspected to be rabid. Aside from doing biopsy of the dead animals brain tissue, the standard diagnostic test of rabies is:
Direct fluorescent antibody test
Direct fluorescent antibody (DFA) testing with rabies virus antibodies conjugated to fluorescent dyes is highly sensitive and specific and can be performed quickly and applied to skin biopsies and brain tissue. (19th ed., p1302)
Vero vaccine scheduled for april 1 and 4 but patient came in on april 6.
give scheduled dose and original schedule
not a condition to mandatorily give HRIG
Asymptomatic HIV
Common cause of death in rabies
Myocarditis
Which of the following animals has rabies virus.
bats & monkeys
Source of human rabies
1) dogs- most common in the philippines 2) cats
3) infected bats
4) monkeys
5) raccoons
6) foxes
7) skunks
8) cattle
9) wolves
Treatment for spasm
benzodiazepines
Vector for malaria
anopheles
Symptoms of rabies
B. Atypical encephalitis without loss of
consciousness
MRSA is naturally resistant to carbapanem
t/f?
Male in er, lbm, ( mucoid bloodstreak) 3days eating in crustaceans, f vegetables and fried rice
Vibrio
Vibrio is the only one on the choices that causes inflammatory or bloody diarrhea(19th ed., p852, Table 160-1)
See also p1066, Table193-5
Treatment/management for case in #48 (Male in er, lbm, ( mucoid bloodstreak) 3days eating in crustaceans, f vegetables and fried rice)
Most cases of V. parahaemolyticus– associated gastrointestinal illness, regardless of the presentation, are self-limited. Fluid replacement should be stressed. The role of antimicrobials is uncertain, but they may be of benefit in moderate or severe disease. Doxycycline, fluoroquinolones, or macrolides are usually used. (19th ed., p1065)
