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ID Board Review > High Yield > Flashcards

High Yield Flashcards

1
Q

Treatment for Trichinella

A

Albendazole/Mebendazole

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2
Q

What are notable misses of Amphotericin?

A

candida lusitanae

candida auris

aspergillus terreus

scedosporium (vori)

Fusarium (+/-)

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3
Q

What does vori miss?

A

Mucor

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4
Q

When does CAP turn into HAP?

A

48 hours

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5
Q
A

vanco IgA bullous dermatosis

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6
Q

Traveller returns from Thailand with fever, myalgias and headache. He returned 3 weeks ago before onset of symptoms.

What is in play?

A

Malaria (up to 40 day incubation)

Typhoid (5-21 day incubation)

Shorter incubations:

Dengue up to 14

Zika up to 14

Chikungunya up to 14

Rickettsial/Salmonella/JEV/Yellow fever all shorter

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7
Q

Difference between FMF and TRAPS?

A

Rash in TRAPS - rare in FMF

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8
Q

When do you start ART?

A

In general, start immediately or next clinic visit. Reasonable to delay if concern for active comorbid condition/OI.

Even with most OI’s star w/in 2 weeks. Zolopa et al 2009. early ART arm resulted in lower AIDS progression and mortality with no increase in AE’s compared to alter arm.

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9
Q

Patient is Dx with AIDS AND ACTIVE PULMONARY TB. How do you approach?

A

Start anti TB therapy (RIPE)

  • if CD4 < 50, start ART w/in 2 weeks (severe IRIS is a risk, however benefits of AIDS progression/mortality with early ART outweigh that risk)
  • if CD4 > 50, start ART within 8 weeks
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10
Q

Patient is Dx with AIDS AND CNS TB. How to approach?

A

Delay ART x 4-8 weeks of TB therapy. IRIS can manifest as paradoxical worsening and cause increase cerebral edema. Also give steroids.

Torok et al 2011 https://www.nejm.org/doi/10.1056/NEJMoa040573

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11
Q

Patient is Dx with AIDS AND CRYPTO MENINGITIS. How to approach?

A
  • Ampho + Flucytosine (fluconazole)
  • Initiate ART 2-10 weeks after antifungal therapy is initiated (IDSA Guideline).
  • Benefits of immune recovery vs risk of IRIS. Trials show improved survival in delayed ART in crypto meningitis patients. Studies are in resource-limited countries – unclear if same applies to resource-rich. 20415574 24963568 23362285
  • NO STEROIDS (it’s like sugar for fungus)

https://www.nejm.org/doi/full/10.1056/nejmoa1312884

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12
Q

What do you do if an patient is Dx with AIDS and:

  • Cocci (not meningitis)
  • PCP
  • Toxo
  • CMV retinitis and neurologic disease
A
  • Cocci: initiate within 2 weeks (except in meningitis)
  • PCP: Initiate within 2 weeks of dx (preferably when stable on PCP regimen; Zolopa et al 2009 19440326)
  • Toxo: Initiate within 2 weeks of dx (preferably when stable on toxo regimen; Zolopa et al 2009, IDSA guideline)
  • CMV: Evidence Unclear – but recommended to start ART within 2 weeks after initiating therapy for CMV (IDSA guideline)
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13
Q

How to approach HIV and pregnancy?

A

Initiate ART ASAP (if not suppressed by 28 weeks, much higer rates of transmission)

Bictegravir and TAF not currently preferred in pregnancy (limited clinical data)

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14
Q

Preferred NRTI backbones in pregnancy?

A

TDF-FTC

abacavir-lamivudine

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15
Q

Preferred integrase and protease inhibitors in pregnancy?

A

dolutegravir (prev assoc w/NT defects, but subsequent data does not suggest) and raltegravir

Darunavir/Riton or Atazanavir/Riton

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16
Q

treatment for RMSF in pregnancy?

A

chloramphenicol

(aplastic anemia)

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17
Q

How do you approach TB in pregnancy:

Latent

Active

A
  • Latent: avoid until 3 months post partum (not worth it unless AIDS or exposure to known active pulmonary TB- Rif regimens preferred)
  • Active: treat with INH + rif + ethambutol x 2 months, then INH/Rif x 7 months (plus pyridoxine)
  • *pyrazinamide is recommended by WHO but not CDC due to lack of safety data
  • *avoid aminoglycosides, quinolones
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18
Q

A patient from TX presents with 6 plaques over his body on which he has no feeling. What is this and what is the treatment?

Does he need to be isolated?

A

Multibacillary or Lepromatous Leprosy

Dapson, rifampicin and clofazimine x 2 years

No - all guidelines suggest against isolation (although appears to be transmitted through respiratory droplets)

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19
Q

Patient starts treatment for lepromatous leprosy and develops multiple erosions and ulcers with serrated edges. What is this?

How would you treat?

A

Necrotic Vasculitis or “Lucio’s Phenomenon”

Hemorrhagic/Necrotic vasculitis resulting from treatment of lepromatous leprosy

treat with steroids and supportive care. Consider plasmapharesis and severe cases.

Also consider:

Type 1: Reversal Reaction (worsening of nodules/plaques treated with steroids)

Type 2: Erythema Nodosum Leprosum (similar except develop fevers/fatigue - treated with steroids and thalidomide)

*both can also develop neuritis

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20
Q

What is the post exposure ppx rabies shot series in a patient previously unvaccinated?

A

0 , 3, 7, and 14

https://www.cdc.gov/rabies/medical_care/vaccine.html

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21
Q

what is the infectious differential for eosinophilic meningitis (5)?

What are the associations and treatment?

A

Angiostrongylus - Asia, Hawaii, rats, snails/slugs - supportive care

Baylisascaris - US, racoons - albendazole

Gnathostoma - wide-spread, fish, pigs, snakes - no proven rx (albendazole)

Cryptococcus - HIV - Ampho+fluc

Coccidioides - West- fluc

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22
Q

which steroid is not metabolized by CYP?

A

beclometasone

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23
Q

When do you start ART in a patient diagnosed with MAC and AIDS?

A

ART should be started as soon as possible after the diagnosis of MAC disease

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24
Q

What are the indications for Valve Surgery in IE?

A

STRONG INDICATIONS

  • HF
  • Pulm HTN
  • Fungi/highly resistant orgs
  • INVASION (abscess, sinus, heartblock, etc)

Less Strong Indications

  • emboli
  • vege > 10mm
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25
Q

Patient with neisseria meningitis started on treatment - when to DC airborne precautions?

A

24 hours on treatment

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26
Q

Who gets Post Exposure Ppx for neisseria meningitis?

When should it be initiated?

What regimen?

A
  • “Close Contacts” in general 8 hours of exposure within 3 feet
  • Healthcare workers (unless direct exposure to respiratory secretions) usually do not need to be treated
  • Ideally within 1 hour - but up to 14 days (Beyond 14 days not recommended)
  • Rifampin, Cipro or ceftriaxone (2 days or single dose ceftriaxone)
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27
Q

Patient with ICD and + BCx for Staph aureus. When can device be re-implanted?

A

Negative blood cultures x 72 hours

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28
Q

When might you consider NOT removing an ICD with a positive blood culture?

A

GNR (e coli) with negative TEE and no suspicion of pocket infection

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29
Q

what bacteria have intrinsic resistance to polymyxins?

A

MAPPS

Morganella “and”

providencia

proteus

Serratia

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30
Q

Chroni

N155H, Y143C, T66I

A

Integrase mutations

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31
Q

Preferred treatment for NDM infection?

A

Avy-Caz + Aztreonam

or, cefiderocol

Aztreonam is resistant to NDM, but susceptible to other BL’s - therefore give Avy-Caz so the avibactam protects the aztreonam.

32
Q

commercially available beta lactamase inhibitor for NDM?

A

Doesn’t exist…

33
Q

what mutation causes dapto resistance in staph aureus?

A

mprF - changes charge of cell membrane disrupting dapto binding

34
Q

treatment for cat scratch fever?

A

azithromycin

(also doxy for severe disease)

35
Q

streptococcus iniae

A

fish-borne GPC causes cellulitis, bacteremia, endocarditis

Tilapia!

36
Q

Patient on TB therapy

A

Rifabutin!

can cause uveitis w/eye pain, vision changes and hypopyon. Ethambutol causes optic neuritis - which presents as difficulties with color discrimination and painless visual blurring

37
Q

50M with kidney transplant p/w swollen fingers/hands

A

voriconazole periostitis (patient was being treated for disseminated fungal infection)

elevated fluoride levels

alk phos

worsened by CNI’s (tacro)

must stop vori

38
Q

management of chronic active hep B in pregnant patient?

A

Tenofovir with start of 3rd trimester, then Hep immune prophaylxis (HBIG and Vaccination) at birth

39
Q

Dx and Rx of relapse Brucella?

A

Dx: rise in Ab titer 1:160 after rx of streptomycin/doxy x 6weeks

Rx: rifampin/doxy

40
Q

PAS-positive granules in foamy macrophages of the lamina propria

A

whipples disease

Rx: doxy+hydroxychloroquine x 1 year

41
Q

What cells serve as a reservoir for HHV8?

CMV?

A

HHV8 - B lymphocytes

CMV - lung, salivary glands and immune-privileged tissues

42
Q

Treatment for Primary VZV in adult?

Give VZIG?

A

Immunocompetent Valtrex

Immunosuppressed IV Acyclovir

*VZIG is given only for PPX (susceptible persons with immunocompromise: HIV, malignanc,y pregnancy, steroids) < 96 hours

43
Q

what cephalosporin does aztreonam cross react with?

A

ceftazadime

44
Q

Post Exposure Prophylaxis for Meningitis in Prego’s and Children

A

Ceftriaxone

45
Q

3 factors linked with decreased transmission of HIV from mother 2 baby

A
  1. Short interval between ROM and delivery
  2. VL < 1000
  3. cesarian section
46
Q

In NVE, when do you add gent to PCN for Strep Viridans?

A

PCN MIC > 0.12

47
Q

Difference between lesions from KS and Bacillary Angiomatosis?

A

Bacillary Angiomatosis lesions are painful and bleed easily

48
Q

what is the treatment for

Corynebacterium diphtheriae

A
  • Diphtheria antitoxin (obtain from CDC, +1 770-488-7100) + Erythromycin 40 mg/kg/d (maximum dose 500 mg four times a day) IV or po (as tolerated) in 3-4 divided doses x 14 days
  • Document with 2 neg cx
  • Close contacts should get vax booster and PCN G or erythromycin 7-10 days
49
Q

first line pangenotypic treatment for Hep c NO cirrhosis

w/compensated cirrhosis?

A

glecapravir/pibrentasvir x 8

or

sofosbovir/velpatasvir x 12

same except genotype 3

50
Q

bamboorat

A

Talaromyces marneffei

51
Q

beavers

A

giardia

52
Q

elephants

A

TB

53
Q

Ppx for RF?

A

RF with NO carditis/residual disease: 5 years or 21yo (whichever longer)

RF with carditis but NO residual disease: 10 years or 21yo (whichever longer)

RF with carditis AND residual disease: 40/lifelong

54
Q

abacavir NOT to be used when HIV RNA > 100 UNLESS?

A

combined with dolutegravir

55
Q

Hep B non responder exposed - PPx?

Hep B unknown Status exposed - PPx?

A

HBIG x 2 1 month apart

HBIG and initiate accelerated vaccine

56
Q

bullous lesions and sepsis in cirrhotic patient

Rx?

A

Vibrio Vulnificus!

ceftriaxion/ceftax + cipro/doxy

57
Q

What are the recommendations for PPX against rheumatic fever?

A

monthly benzathine PCN, or daily PO Pen VK

no Carditis

-5 years since most recent episode or 21 y/o, whichever is longer

Carditis but no valvular damage

-10 years since most recent episode or into adult which, whichever is longer

Carditis with residual heart disease

-until age 40 or 10 years after last ARF, whichever is longer

58
Q

Infliximab > adalimumab > etanercept increases risk of:

A

TB reactivation (TNF)

59
Q

abatacept increases risk of:

A

severe infections in general (CD28 binding, inhibiting T cell stimulation)

60
Q

alemtuzumab (campath) increases risk of:

A

PJP, herpes, CMV

61
Q

natalizumab increases risk of:

A

PML/JC virus (blocks VCAM1 inhibiting leukocyte migration)

62
Q

rituximab increases risk of:

A

hep B, PJP, JC virus

63
Q

fulminant hepatitis in pregnant woman with no foodborne exposures

A

HSV

(hep E if exposure/travel)

64
Q

how long is VZIG good for?

A

3 weeks - if a new exposure, check serology, administer VZIG if negative

*VZIG offers no additional benefit if Ab+

65
Q

what is first line antibiotic for tetatnus infection?

A

metronidazole

66
Q

first line therapy for mild cutaneous leish?

A

topical paramomycin (aminoglycoside)

67
Q

visceral leish species?

A

L. donovani, L infantum chgasi

68
Q

what are the sizes from small to big of AF intestinl parasites?

where does microsporidium fit in?

A

crypto (5), cyclo (10), cysto/iso (20-30)

microsporidium is ~1 but not acid fast

69
Q

what survives in swimming pools even with chlorine?

A

cryptosporidium

70
Q

What is a better test for recent strep infection? ASO or DNAse Abs?

A

DNAse Ab - while both are increased in pharyngitis, only dnase is elevated after SSTI

71
Q

Gent trough and peak?

A

<1

4-10

72
Q

What are the most and least hepatotoxic RIPE Drugs?

A

INH > PZA > RIF >>>EMB (which is not really hepatotoxic)

73
Q

Feared complication of typhoid?

A

terminal ileum perforation

74
Q
A

TB

75
Q

What is Sens/Spec PPV/NPV?

A

https://www.frontiersin.org/files/Articles/308890/fpubh-05-00307-HTML/image_m/fpubh-05-00307-g001.jpg

Sensitivity=[a/(a+c)]×100

Specificity=[d/(b+d)]×100

Positive predictive value(PPV)=[a/(a+b)]×100

Negative predictive value(NPV)=[d/(c+d)]×100.

76
Q

peripartum HIV management

A

mother VL > 1000 → c-section at 38 weeks

mother VL < 1000 ok for SVD

High Risk Birth: combination ART PPX (AZT,3TC,raltegravir) for baby

Low Risk Birth: Zidovudine PPX for baby

ID Board Review (11 decks)

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