ID

Question 1

Sudden onset fevers, chills, weakness, painful lymphadenopathy with swelling with rapid progression to sepsis with pneumonia, meningitis or shock after exposure to rats, travel to southwestern US

Answer 1

Yersinia pestis

Question 2

Fever, severe myalgias, asymmetrical arthralgias and a fine macular rash after exposure to a rat

Answer 2

Rat bite fever. Streptobacillus moniliformis

Question 3

Persistently positive nontreponemal testing after approrpriate treatment for syphilis causes:

Answer 3

Inadequate or inappropriate treatment (indicative when RPR does not fall 4 fold within 6-12 months of treatment), reinfection or serofast reaction (low titer indefinitely positive after initial 4 fold decline)

Question 4

Treatment for primary syphilis

Answer 4

Pen G IM x1 or doxycycline x14 days

Question 5

Treatment for secondary syphilis

Answer 5

Pen G IM x1 or doxycyline x14 days

Question 6

Treatment for latent syphilis

Answer 6

Pen G IM x3 weeks or doxycycline x28 days

Question 7

Treatment of tertiary syphilis

Answer 7

Pen G IM x3 weeks or doxycycline x 28 days

Question 8

Neurosyphilis treatment

Answer 8

Pen G IV x 10-14 days or Ceftriaxone IV x14days

Question 9

Diagnostic criteria for MAC

Answer 9

Clinical: Pulmonary symptoms, CXR showing nodular or cavitary opacities or high rest CT Scan with bronchiectasis AND approrpirate exclusion of other diagnoses
Microbio: 2 positive sputum cultures OR one BAL with positive culture OR lung biopsy with histopathological features or positive culture

Question 10

Acute sinusitis cause in immunocompromised host that often rapidly progresses as invades into eye structures and brain. Imaging may demonstrate edematous mucosa and destrcution of facial bone and periorbital tissues

Answer 10

Mucormycosis

Question 11

Indications for catheter removal in CVC associated infections

Answer 11

Severe sepsis, suppartive thrombophlebitis, persistent bloodstream infection >72 hours after appropriate antimicrobial therapy, hemodynamically usntalbe, S. aureus, P. aeruginosa, fungi, mycobateria`

Question 12

Next steps for a patient who’s partner was recently diagnosed with syphilis

Answer 12

Exposed wihtin 90 days of diagnosis of primary, secondary or early latent syphilis in a sex partner should receive presumptive treatment

Question 13

Lyme like symptoms, but with cytopenias and high fevers

Answer 13

Consider coinfection with anaplasma - carried by same tick as lyme disease

Question 14

Immunocompromised patient with break in skin exposed to tap water or soil presenting with fevers, skin lesions and lung disease. Diagnosed with positive blood cultures or skin biopsy demonstrating mold like organism

Answer 14

Fusariosis

Question 15

Asymmetric migratory joint pain and pustular skin lesions

Answer 15

Disseminated gonococcal infection

Question 16

Persistent high fevers and severe polyarthralgias +/- lymphopenia and thrombocytopenia after recent visit to Central/South America

Answer 16

Chikungunya fever

Question 17

Abrupt onset systemic and GI symptoms with muscle tenderness, hepatosplenomegaly and conjunctival suffusion with recent travel to a tropical area

Answer 17

Leptospirosis

Question 18

Intraerythrocytic ring inclusions with tetrads “maltese cross”

Answer 18

babesiosis

Question 19

Intracytoplasmic inclusions in granulocytes

Answer 19

Anaplasmosis

Question 20

What should be given with pyrimethamine when treating for toxoplasmosis?

Answer 20

Leucovorin. Pyrimethamine is a folic acid antagonist, so giving leucovorin with it prevents hematologic complications.

Question 21

Acute self limited flu-like illness with dypsnea, cough, malaise and fever in the setting of exposure to a hot tub

Answer 21

“hot tub lung” - a hypersensitivity pneumonitis from MAC

Question 22

Acute febrile illness following treatment for syphilis

Answer 22

Jarisch-Herxheimer reaction