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1
Q

Brodie’s abscess presentation and X-ray findings

A

Chronic osteomyelitis, insidious onset. Localised abscess often near the site of the metaphysis
Xray: Lytic lesion with sclerotic margins

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2
Q

“Honeycomb” appearance on limb xray

A

Osteomyelitis - thickened bone with irregular and patchy sclerosis

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3
Q

When are topical aminoglycosides c/i in otitis externa

A

If the TM is perforated

Note acetic acid can be used as 1st line treatment if there is no hearing impairment or discharge

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4
Q

Side effect of chloramphenicol ear drops

A

Contact dermatitis (10% of people)

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5
Q

Mechanisms of action of the 3 drugs in typical PEP for HIV?

A

2 nucleoside reverse transcriptase inhibitors plus either non nucleoside RT inhibitor, protease inhibitor or integrase inhibitor

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6
Q

1st line antibiotics for pyelonephritis in patient > 3months

A

Oral: cefalexin or co-amoxiclav

If IV required co-amoxiclav

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7
Q

Onset of staph aureus food poisoning usually starts about 24hrs after ingestion of contaminated food T/F

A

F - onset is usually from 30 minutes to 8 hours post ingestion.

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8
Q

Diarrhoea with s aureus gastroenteritis is usually profuse and watery T/F

A

T - symptoms start with emesis and then diarrhoea a few hrs later, usually only symptomatic for one day

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9
Q

Vibrio vulnificus is classically associated with what food?

A

Oysters

Note: other seafood too. Symptoms vomiting, diarrhoea and fever about 24-48 hrs after ingestion

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10
Q

How long after ingestion of contaminated food does presentation with clostridium perfringens (welchii) or botulinum typically occur?

A

6-12 hours

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11
Q

What finding on a CBC is highly indicative of a helminth infection?

A

Eosinophilia

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12
Q

Antibiotics are routinely prescribed as part of the management of dental abscess T/F

A

F - only prescribed if the patient is systemically unwell

Mgmt is analgesia and dental referral

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13
Q

What is a kerion?

A

A large swelling that is a complication of tinea capitis, it is a hypersensitivity reaction

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14
Q

What is the treatment of a kerion?

A

Systemic antifungal +/- a short course of steroids

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15
Q

Herpes is a DS DNA virus T/F

A

True

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16
Q

Haemophilus ducreyi causes what STI?

A

Chancroid

Note: painful necrotising genital ulcer; it is a gram neg cocci

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17
Q

E coli is able to multiply in typical fridge temperatures of about 4degrees T/F

A

False - E coli can survive but not multiply.

Listeria monocytogenes can grow/multiple at temperatures of 0-4degrees C

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18
Q 
Prophylactic antibiotic(s) of choice for meningitis exposure
What should be used for a pregnant patient
A

Ciprofloxacin or CTX both only one dose
or
Rifampicin BID for 2 days

Pregnancy: ceftriaxone

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19
Q

Hepatosplenomegaly is common in which Reye’s syndrome, malaria, dengue or leptospirosis?

A

Malaria

Hepatomegaly is common in other diseases but splenomegaly is rare in the other disease

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20
Q

What is the incubation period of Dengue?

A

5-10 days

Note: incubation period for leptospirosis is 7-12 days

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21
Q

Patient’s with malaria may be hyper or hypoglycaemic at presentation T/F

A

F - hyper is usually earlier in disease and hypoglycaemia is in more severe disease or cerebral malaria

Other common findings in malaria - symptomatic haemolytic anaemia (systolic murmur) with hepatosplenomegaly and jaundice

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22
Q

Neisseria meningitidis morphology

A

Gram -ve coccus

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23
Q

Is psuedomonas aeruginosa gram + or -

A

Gram -ve

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24
Q

Is haemophilus influenzae gram + or -

A

Gram -ve

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25
Q

Morphology of e coli and klebsiella

A

Gram -ve bacillus

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26
Q

Morphology of listeria

A

Gram + bacillus

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27
Q

Morphology of strep

A

Gram + coccus in chains

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28
Q

What is the most common invasive fungal infection in children admitted to the ICU?

A

Invasive candida

Note: often associated with indwelling venous caterer

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29
Q

What is the tx of CNS aspergillosis?

A

IV voriconazole

Note: Allergic bronchopulmonary aspergillosis tx is Corticosteroids

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30
Q

What is the treatment of invasive mucormycosis?

A

Posaconazole or amphotericin B

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31
Q

When a patient is on voriconazole the dose of cyclosporin needs to be increased T/F

A

F - azole antifungals limit the metabolism of cyclosporin and hence increase it’s serum levels and so dose of cyclosporin needs to be reduced

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32
Q

C/I to lumbar puncture in suspected meningitis?

A 
An evolving and rapidly progressive rash
Coag abnormalities
Shock
Resp insufficiency
Local superficial infection at LP site
Signs of increased ICP (reduced or fluctuating level of consciousness, relative bradycardia, HTN, focal neuro signs or abnormal posturing)
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33
Q

Incubation period for N meningitidis?

A

2-7 days

Note: droplet spread, gram -ve diplococci

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34
Q

Morph of staph

A

Gram + cocci in clusters

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35
Q

Most common cause in community acquired pneumonia in those < 5 yrs?

A

Strep pneumo

Note: > 5 mycoplasma pneumonia

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36
Q

Children with parvovirus infection are no longer contagious once the rash has appeared T/F

A

T

Note: incubation period is 4-20 days

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37
Q

Classic exam findings in congenital TB?

A

Hepatomegaly, splenomegaly and abdo distension

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38
Q

Clinical manifestations of congenital TB?

A

Poor feeding, irritability, failure to thrive and fever

Cough +/- resp distress

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39
Q

Incubation period of scarlet fever? How long is a person infectious?

A

Incubation 1-7 days

Infectious for 3 weeks

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40
Q

What is Lemiere’s disease?

A

Retropharygneal abscess followed by thrombophlebitis of the internal jugular vein and another abscess (commonly in the lungs)

Note: most common cause is the anaerobe Fusobacterium necrophorum. Tx is surgical drainage and beta lactase stable antimicrobials for 3-6 weeks.

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41
Q

Use of azithromycin is C/I in those with a renal tx T/F

A

F - it is not CI but if the pt is on tacrolimus these two drugs interact and hence will need careful monitoring of tacro levels

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42
Q

What age patient and where does tuberculosus arthritis often effect?

A

2- 5 yrs old
Hip

Note: early signs on ray - decrease in density of bone (rarefication), followed by fuzziness and narrowing of joint space

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43
Q

How many serotypes does the botulinum toxin have?

A

7

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44
Q

What antibiotic needs to be avoided in those on theophylline?

A

Ciprofloxacin

Note: it is an enzyme inhibitor and increases serum levels of theophylline

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45
Q

Tx of non TB mycobacterium lymphadenopathy?

A

Surgical excision only! Antibiotics not needed

Can use azithromycin if excision is CI

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46
Q

Lab test for Wilson’s disease?

A

Serum ceruloplasmin - it is low

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47
Q

What is Menke’s disease?

A

Disease of Cu absorption leading to Cu deficiency

Features - kinky hair, FFT, neuro symptoms such as hypotonia

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48
Q

Features of leprospirosis?

A

Asymptomatic or flu like illness

Can progression to jaundice and renal impairment; conjunctival suffusion is characteristic but not always present

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49
Q

In the setting of Hep B was is AntiHBs indicative of?

A

Vaccination or prior infection (hep B surface antibody)

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50
Q

Lab finding indicative of a person with Hep B being highly infectious?

A

Hep B envelop antigen

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51
Q

In the setting of Hep B what is IgM antiHBc indicative

A

Acute infection

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52
Q

HBsAg and Anti HBc what type of hep B infection?

A

Unable to tell, could be acute or chronic

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53
Q

Tx of neonatal chlam conjunctivitis

A

oral erythromycin

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54
Q

Tx of neonatal gon conjunctivitis

A

IV ceftriaxone or cefotaxime
Also saline irrigation

Note: would last give one dose CTX for prophylaxis of an asymptomatic infant born to a mother with untreated gon

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55
Q

Which would be expected to present earlier, neontal conjunctivitis due to chlam or gon?

A

Gon - incubation is 2-5 days

Note: gon - serosanguious discharge which later becomes pustular.
Chlam incubation 5-14 days, inflammation of eyelids and purulent discharge

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56
Q

What percentage of infants with RSV require hospitalisation? When is the peak incidence?

A

1-3%

2-7 months

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57
Q

Leishman-Donovan bodies may be see in what disease?

A

Leishmaniasis

Can also be diagnosised using Giemsa stain

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58
Q

Main clue for diagnosis of visceral leishmaniasis

A

Dark skin, blackening of the skin (common name in India is black fever)

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59
Q

Tx of a <28 day old infant with chickenpox

A

IV acyclovir - cannot use PO in neonates as pharmacokinetics is unpredictable

Note: for prophylaxis use varicella zooster immunoglobulin

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60
Q

Hepatitis A incubation period is 1-7 days T/F

A

F

Incubation period is 14-28 days

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61
Q

Hepatitis A incubation period is 14-28 days T/F

A

T

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62
Q

A patient is vaccinated against varicella and then develops a rash. What is the likely aetiology?

A

A vesicular rash can occur due to vaccination - timing 15-42 days post vaccination
If the rash occurs less than 14 days or > 42 days it is likely due to wild type varicella

NB: samples should be taken from the lesions for diagnosis, to know if it is vaccine or wild type

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63
Q

How does salmonella typhi usually present?

A

Mild/mod diarrhoea + high fevers

Note: Yersinia enterocolitica can also present this was but tends to have more abdo pain

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64
Q

Prophylactic AEDs are indicated in the tx of HSV encephalitis T/F

A

F - there is insufficient evidence to rec this

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65
Q

What is the most common cause of community acquired pneumonia in those < 2 yrs?

A

Viral

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66
Q

Regarding the treatment of scabies when should all clothes and linens be washed?

A

At the end of treatment

Note: the permethrin cream also needs to be reapplied each time hands are washed as the cream needs to be on the skin for 8 - 10 hours

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67
Q

In children what is chronic bilateral parotid infection caused by?

A

It is pathognomonic of HIV

Presents with dry mouth, dry eyes and swelling of salivary glands and lymphadenopathy - similar to Sjogren’s but no autoantibodies

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68
Q

What type of virus is hepatitis B?

A

DNA virus

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69
Q

When are antibiotics required for the treatment of an AOM?

A

Symptoms for four days of more
Systemic upset (not only fever)
<2 yrs with bilateral infection
TM perforation or drainage in the ear canal

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70
Q

Acute hydrocephalus is a common feature of what type of meningitis?

A

TB meningitis

Note: clues to this un vaccinated child, lymphocyte predominance in CSF. Listeria would also cause a lymphocyte predominance but would not cause acute hydrocephalus

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71
Q

Features of chronic suppurative otitis media?

A

Recurrent discharge (> 2 weeks) which escapes through a perforated TM
Absence of an acute infection (no fever or pain)
Hx of previous AOM supports diagnosis

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72
Q

Mgmt of chronic suppurative otitis media?

A

ENT referral

Do not swab or treat w/antibiotics
Complications: mastoiditis, facial nerve palsy and intracranial infection. Hearing loss from perforation is usually temporary

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73
Q

In rheumatic fever who long are prophylactic antibiotics needed in those with carditis?

A

10 yrs or until the pt turns 21 (whichever is longer)

Note: need tx antibiotics for 10 days first

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74
Q

High fevers for 3 days without an obvious source and when the fever subsides a red maculo-papular rash develops on centrally. Rash resolves within 48-72 hours. What virus?

A

HHV 6 (aka roseola)

Also children will commonly have a febrile seizure

Note: Contrast this to rubella when the rash and fever are present at the same time

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75
Q

What life cycle stage is common is P vivax and ovale but not P falciparum?
What is the clinical significance of this?

A

Hypnozoites - a dormant liver stage

They can cause late relapses after treatment, hence to eradicate them (and prevent relapse) a course of primaquine must be given following a course of chloroquine for vivax/ovale

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76
Q

What is the treatment of schistosomiasis?

A

Praziquantel

Note: transmitted by freshwater snails

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77
Q

Who long should a child with diarrhoea or emesis stay out of school until?

A

48 hours after last emesis or diraahoea

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78
Q

Management of suspected Lyme disease?

A

1: Empiric treatment > 12 yr doxycycline, < 12 yrs amoxicillin
2: Acute and convalescent titres

Note: typical course is 21 days; if facial palsy 2 months. If arthritis is present need to use doxy, amoxicillin is only suitable for early localised disease.

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79
Q

Periventicular calcification are seen in what congenital infection?

A

CMV

Note: toxoplasma gondii will also have calcifications but they are diffuse

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80
Q

Erythema chronic migrans is assoc with what infectious disease?

A

Lyme disease

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81
Q

Patients with B19 are infectious for 5-7 days after the rash appears T/F

A

F - no longer infectious once rash appears

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82
Q

An infant is born to a mother with active TB but has no signs of TB themselves. What is the mgmt?

A

Isoniazid for 3 months (or until develops signs of TB) then do a Mantoux

  • if positive infant should be reassessed for TB
  • if negative 9 months total isoniazid

Note: mother may breastfeed after at least 2 weeks of (her own) treatment

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83
Q

What type of cells seen on LP in bacterial meningitis?

A

Lots of polymorphs
Few lymphocytes

Note: also up to 5g/L protein and glucose less than 2/3 of blood level

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84
Q

CSF findings in TB meningitis?

A

High protein
Low glucose
Lymphocytosis

Also CSF may have a cobweb appearance on standing

Note: also have lymphocytes in viral meningitis but low protein

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85
Q

In a child and neonate how many cell is normal in CSF

A

Child: 5 lymphocytes
Neonate: up to 15 cells of which 1-2 can be PMNs

Note: any PMNs in child is abnormal

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86
Q

Bilateral parotitis is a red flag for what in children?

A

HIV infection

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87
Q

Effective therapy can reduce maternal foetal transmission of HIV from 25% to 5% T/F

A

F - from 25% to 1%

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88
Q

For how many days prior to onset of vesicular rash is a person with chicken pox infectious? How long is the incubation period?

A

2 days prior (continues to be infectious until lesions are all crusted over).

Incubation period is 21 days

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89
Q

What age group does roseola usually affect?

A

6 months to 2 yrs

Note: Caused by human herpes virus. Typical presentation, several days of fever and then as the fever breaks a rash. A bulging fontanelle may be noted in 25%

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90
Q

What is the average total length of illness with acute otitis?

A

4 days

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91
Q

What is the average total length of illness with acute pharyngitis/tonsillitis?

A

1 week

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92
Q

What is the average total length of illness with the common cold?

A

1.5 weeks

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93
Q

What is the average total length of illness with acute rhinosinusitis?

A

2.5 weeks

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94
Q

What is the average total length of illness with acute cough?

A

3 weeks

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95
Q

CSF investigation of choice in a partially treated meningitis?

A

CSF latex agglutination - with identify polysaccharide cell walls from killed bacteria

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96
Q

Torula stain is for what pathogen?

A

Cryptococcus

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97
Q

HIV and Hep B can be transmitted through breast milk T/F

A

F - only HIV

Other diseases that can be transmitted - GBS, gc, CMV

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98
Q

A well appearing febrile infant of 2 months presents with urine dip concerning for a UTI what is the next step in mgmt?

A

Bloods - FBC, CRP, and blood culture; IV abx while awaiting results

Note: If < 1 month or ill appearing needs LP too

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99
Q

There is an increased risk of nec fasciitis when a patient with chickenpox infection is given what medication?

A

NSAIDs

Consider nec fac if they have rapidly progressing pain and erythema (likely GAS)

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100
Q

CBC findings in salmonella typhi?

A

Thrombocytopenia and neutropenia

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101
Q

Presentation of salmonella typhi in an infant?

A

Prolonged fever without significant exam findings
Relative bradycardia
Thrombocytopenia and neutropenia

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102
Q

What month is the peak of rotavirus?

A

March

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103
Q

What is the presentation of tick born viral encephalitis?

A

Typically a biphasic course
Features: headache, ataxia and meningism are commonest. Can also have myelitis or meningoradiculoneuritis (can cause flaccid paralysis of a single limb)

Note: arboviruses are among the commonest causes of meningoencephalitis worldwide ; endemic to eastern europe

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104
Q

Prior to starting a pt on primaquine what lab test need to be obtained?

A

G6PD

If pt is G6PD def primaquine will cause severe haemolytic anaemia

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105
Q

What is the incubation period of glandular fever / EBV?

A

1-2 months

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106
Q

What oral antibiotics for impetigo?

A

cephalosporin (e.g. cephalexin) or clindamycin

Want to cover both GAS and staph

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107
Q

What is the classic triad for congenital toxo?

A

Hydrocephalus (NB for differentiating from other TORCH infections)
Retinochoroiditis
Intracerebral calcification (diffuse)

Note: this is uncommon presentation, 90% are asymptomatic in neonatal period.

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108
Q

What is the most common mode of Hep C transmission worldwide?

A

Vertical

Note: vertical transmission rate is about 9%

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109
Q

What is the most likely infectious pathogen in mastitis?

A

S aureus

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110
Q

Leishmania infantum and donovani are endemic to much of the Mediterranean basin T/F

A

F - infantum is endemic to Mediterranean

Donovan is seen in east Africa and Asia

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111
Q

What is the initial treatment for uncomplicated H pylori eradication?

What is the exception?

A

One week of amoxicillin, clarithromycin and omeprazole

Exception: if haematemesis still do abx for 1 week but PPI is for 4 weeks

Note: can sub clarithromycin for metronidazole

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112
Q

What % of children with Kawaskai disease develop coronary artery aneurysm?

A

25% untreated

5% treated

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113
Q

Neuro manifestation occur in less than 10% of patients with Lyme disease T/F

A

F - neuro manifestations in approx 15%

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114
Q

Borrelia burgdorferi gram + or neg?

A

Neither - stains weakly

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115
Q

When should a mother be treated for syphilis to reduce the risk of vertical transmission?

A

At least one month prior to delivery

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116
Q

What titre in syphilis correlate with disease activity and hence increased risk of transmission?

A

High VDRL titres

Note: this is only if the case has already been confirmed by TPPA screening tests, as there is a high rate of false positive with VDRL
Positive IgM titres also indicates a recent infection

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117
Q

What are the 3 Kocher criteria and to what disease are they related?

A

Septic arthritis
NWB; WBC > 12 and ESR > 40

If all 3 present a 93% chance of septic arthritis

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118
Q

What are the typical bacteria that cause CRMO?

A

None! Bacterial cultures are usually negative and inflammatory markers normal

They do however have fever

119
Q

What bones does CRMO typically affect

A

Long bones

120
Q

What are the physical exam findings in brucellosis?

A

Papular rash
Hepatosplenomegaly
Marked lymphadenopathy

Note: incubation is 1-5 weeks; from unpasteurised dairy or working with goats, sheep, pigs or cattle
Has an acute and chronic phase. Chronic phase included relapsing fevers, sweats, arthralgia, constipation, emotional disturbance.

121
Q

What class of antibiotics (and examples) should be used to treat whooping cough?

A

Macrolides - azithromycin, clarithromycin and erythromycin

122
Q

Bordetella pertussis gram + or -ve?

A

Negative

123
Q

What is the treatment of choice for malaria falciparum?

A

Malarone (proguanil and atovaquone)

NB WHO recommends that all malaria tx should be combo due to high rates of resistance. Only exception is quinine mono therapy can be given initially to patients presenting with severe malaria as it can be given IV

124
Q

What malaria medication can be given IV? when would this be needed?

A

Quinine - severe malaria; this is the only time mono therapy should be used

125
Q

What is the medication of choice for malaria prophylaxis?

A

If > 11kg Malarone (proguanil and atovaquone) - not actually licensed for use in children but rec by CDC and Public Health England for those over 11kg travelling to endemic areas.

If > 5 but less than 11kg mefloquine

Note: can also give doxycycline

126
Q

Foul smelling perspiration is a classic sign of what infection?

A

Brucellosis

127
Q

How to interpret a mantoux in a patients

A

Positive if > 5mm and close contact with known or likely TB, clinical or radiograph evidence of TB or immunosuppressed
Positive if > 10mm if < 4 yrs or other RFs such as frequent exposure to homeless, incarcerated or nursing home, born or travel to endemic regions
Positive if > 15mm if > 4 yrs and no risk factors

128
Q

In a patient who is asymptomatic for TB but has a strongly positive mantoux what is the likely diagnosis latent or recovered from previous TB infection?

A

Latent TB

Note: in pt with a hx of TB but recovered would expect a negative or very weakly positive mantoux

129
Q

A patient with measles is infectious for how long?

A

4 days before and 4 days after rash onset.

Hence should be excluded from school for that long.

130
Q

When is a patient with parvovirus most infectious?

A

Most infectious prior to onset of rash

131
Q

Cough, coryza and conjunctivitis followed by a confluent rash that typically begins behind the ears?

A

Measles

132
Q

Treatment of choice in MRSA bacteraemia?

A

Need to use combo antibiotics and this combo should NOT include any beta lactams due to resistance possibility

Hence can use vancomycin + rifampicin or another duo (other options linezolid, tigecycline)

133
Q

3 classic features of pertussis infection

What is treatment?

A

Paroxysms of coughing
Subconjunctival haemorrhages from repeated coughing
Marked lymphocytosis

Treatment: supportive but azithromycin is given to limit infectivity of to other children

134
Q

Anorexia, abdo pain, megaloblastic anaemia and eosinophilia what infection?

A

Tapeworm (the anaemia is due to vitB12 def)

135
Q

What is the first line treatment of tapeworm infection

A

Praziquantel

136
Q

Meningococcal PCR is now a standard investigation in cases of suspected meningococcal septicaemia T/F

A

T - it gives a definitive diagnosis so should be prioritised

137
Q

What is the clinical significant of a rapidly spreading purpuric rash in a pt with suspected meningococcal infection?

A
  1. More likely to be septicaemia than meningitis (although the 2 can coexist)
  2. It is a C/I to LP due to concern for severe coag defects
138
Q

What is the standard treatment of Cryptosporidum related gastro?

A

Supportive care with oral rehydration

139
Q

When is treatment indicated in Cyrptosporidum related gastro?

A

Immunocompromised
Unusually severe features
Persistent (> 2 weeks)

Note: not great data for treatment but can try antiprotazoal agents such as albendazole, nitazoxanide or paromomycin

140
Q

What broad class of medication is mebendazole

A

Anthelminthic

141
Q

A feature about the presentation of eczema herpeticum that can help distinguish it from an eczema flare or superimposed bacterial infection?

A

Presentation of lesions at different stages - condition starts with a group of fluid filled lesions with further new lesions forming over 7 -10 days

142
Q

Indications for IV acyclovir in eczema herpeticum?

A

Severe infection
Rapid spread
Eye involvement

Note: otherwise can be treated outpatient with oral

143
Q

An eye infection with which pathogen would respond best to chloramphenicol eye drops? Chlamydia trachomatis, p aeruginosa, s aureus

A

S aureus would respond best

Chlamydia can be treated with chloramphenicol but responds better to a macrolide such as azithromycin

P aeruginosa is resistant

144
Q

In a patient with CF what is the commonest organism causing infection in the first year of life?

A

Staph aureus

Note: flucloxacillin prophylaxis can be used

145
Q

What is the typical presentation of dengue

A

Fever arthralgia and rash

Note: retro orbital pain and photophobia may also be prominent

146
Q

Treatment of group A strep pharyngitis?

A

Penicillin V for 10 days or amoxicillin

Note: greater treatment failure has been shown with a 7 day course.

147
Q

Phases of yellow fever?

A

Acute febrile flu like phase, recovery phase and then ill again

148
Q

What is the main feature on presentation to differentiate bacterial tracheitis from croup?

A

Both will have a preceding coryzal illness, stridor, fever and barking cough but the patient with bacterial tracheitis will be more more ill appearing.

149
Q

Peripheral neuropathy is a side effect of what medication used to treat TB?

A

Isoniazid

150
Q

Which blood group antigen helps to protect those of West African descent from P vivax malaria?

A

Duffy

Note: high rates in that pop and extremely rare in other populations

151
Q

In a pt with bacterial meningitis when are steroids indicated?

A
  1. Must be > 3 months old PLUS
  2. i CSF frankly purulent or
    ii CSF WBC > 1000 or
    iii CSF WBC elevated with protein conc 1 g
    iv or > or bacteria on gram stain

NB different in TB meningitis mgmt

152
Q

Steroids may be indicated in the mgmt of meningococcal septicaemia T/F

A

F - NEVER

Sometimes indicated in bacterial meningitis

153
Q

When should vancomycin be added in the treatment empiric tx of bacterial meningitis?

A

If hx of recent foreign travel or prolonged use of antibiotics

154
Q

Empirical tx of bacterial meningitis

A
  1. < 3 months CTX/cefotaxime (gram -ve esp E coli) PLUS ampicillin (GBS and listeria coverage)
  2. > 3 months CTX

+/- vanc if hx of recent abx use or foreign travel

+/- steroids (> 3months only)

155
Q

Which TB medication can cause elevation of AST and ALT?

A

Isoniazid

Note: the drug undergoes acetylation in the liver

156
Q

Infant with chlam trachomatis eye infection what treatment?

A

Oral macrolide such as erythromycin

No role for any topical treatment

157
Q

What is the approx carriage rates of c diff in neonates? More common in breast or formula feed?

A

50% in neonates

More common in formula feed

158
Q

Morphology of C diff

A

Anaerobic gram + rod

159
Q

Classic side effect of quinine?

A

Tinnitus

160
Q

Exposure prophylaxis for VZV in an asymptomatic immunosuppressed child?

Treatment if child develops symptoms?

A

Asymptomatic: IM varicella zoster Ig
Symptomatic: IV normal immunoglobulin

Note: if it is an onc patient on chemo should only hold the chemo if child becomes systemically unwell/haemodynamically unstable.

161
Q

Post exposure measles prophylaxis for immunosuppressed pt?

A

IM normal immunoglobulin, should be given within 6 days regardless of vaccination status

Note: The idea that normal immunoglobulin has contains antibodies against a range of infections including measles.
Immunoglobulin is not indicated in immunocompetent individuals who have been previously vaccinated

162
Q

What is the most common cause of viral encephalitis in infants?

A

Enteroviruses

163
Q

The mortality rate of untreated HSV encephalitis is 50% T/F

A

F - 75%

164
Q

The mortality rate of untreated HSV encephalitis is 75% T/F

A

T

165
Q

In a mother with HIV IV zidovudine during labour has been shown to decrease the risk of HIV transmission to the neonate T/F

A

F - no evidence to support this.

Oral zidovudine from 28 weeks gestation onwards and for the infant until 6 weeks old are both shown to reduce risk

166
Q

Which eye infections caries an increased risk of corneal perforation chlam or gonorrhoea?

A

Gonorrhoea

167
Q

Trichomonias and BV both cause a fishy bacterial odor, what clinical way to differenciate?

A

BV: no vaginal pain or itching, not associated with sexual activity
Trich: associated with pain and itching, sexually transmitted

168
Q

The parotid swelling in mumps is bilateral > 90% of time T/F

A

F - up to 25% of the time the swelling is unilateral

169
Q

All children with HIV infection require PCP prophylaxis regardless of CD4 count T/F

A

T

Note: in a new diagnosis HIV start prophylaxis immediately and plan to start anti retrovirals when the results of drug susceptibility and Hep B status are available

170
Q

How long is the course of treatment for TB meningitis?

A

1 year

Note: steroids are used at the start of the treatment course.

171
Q

Empiric abx for suspected meningitis for 3 month to 18 yr old patient?

A

IV CTX or cefotaxime

172
Q

H pylori is a common cause of gastritis T/F

A

F - not a common cause

173
Q

H pylori infection is often asymptomatic T/F

A

T

Note: it is a gram neg bacillus

174
Q

H pylori can be associated with nosocomial transmission T/F

A

T - endoscopes not correctly clean are one mode of nosocomial transmission

175
Q

Listeria meningitis can be associated with a minimal rise in CRP T/F

A

T

176
Q

Necator Americans is also known as?

A

Hookworm

Note: Ancylostoma duodenale is another type of hookworm
Common cause of chronic GI bloodless worldwide

177
Q

Enterobius vermicularis is AKA?

A

Pinworm

Anal itch, esp at night is the most common symptom. Can also cause vulvovaginitis and abdominal pain. Stool is often negative for ova but adults worms are frequently seen at the anus

178
Q

What physical exam finding is presenting in almost all patients with roseola infantum?

A

Lymphadenopathy, esp post auricular, occipital and cervical chain

Other features: bulging fontanelle (25%), Nagayama spots (red papules on soft palate), oedematous eyelids associated with palpebral conjunctivitis injected TMs, rash appears as fever abates

179
Q

Strawberry tongue classical found in what disease?

A

Scarlet fever (Group A strep pharyngitis)

Note: disease is characterised by exudate pharyngitis, fever and scarlatinform (sandpaper) rash

180
Q

What are pastia lines?

What disease are they pathognomonic of?

A 
Rash more prominent in antecubital fossa and axillae
Scarlet fever (GAS infection)
181
Q

Describe Koplik spots? What disease?

A

Grey white papules on buccal mucosa
Measles

Note: Koplik spots usually present before the typical rash

182
Q

Neurominidase inhibitors should not be started in influenza > 48 hours after symptom onset. T/F

A

F - although they are most effective when started within 24-48 hours of symptom onset, if started later they may still reduce the transmission to others. They should be given to all hospitalised patients and may reduce risk of complications for those with underlying Respiratory disease (eg asthma)

183
Q

When do most cases of discitis occur?

A

< 5 yrs old

184
Q

Presentation of discitis ?

A

Irritability, back pain and gait abnormality (including refusal to walk). Fever in up to 1/3; neuro signs include decreased muscle strength and diminished reflexes, decreased ROM at hip and loss of lumbar lordosis

185
Q

Finding on imaging in discitis?

A

Narrowing on intervertebral disc space; this will be seen on earlier on MRI that on X-ray

186
Q

Newborn with microcephaly, cataract and a PDA. What congenital infection?

A

Rubella

Other features: blueberry muffin rash, SN hearing loss

187
Q

HEENT findings in EBV?

A

Up to 50% may have peri orbital and eyelid edema (often before exudate pharyngitis and cervical lymphadenopathy)

Erythematous tonsils with membrane formation
Petechial lesions at the junction of hard and soft palate

Derm: morbilliform rash

188
Q

I and D is the mainstay of treatment of herpetic witlow T/F

A

F - this may lead to spreading of the herpes virus

Note: it is sometimes associated with oral herpes simplex infection

189
Q

Infants born with congenital Varicella should be treated with antivirals T/F

A

F - viral replication does not continue past the initial infection in utero.

Note: but if mother has signs of varicella 5 days before or 48 hours after birth the infant should receive Varicella zoster immune globulin

190
Q

Congenital cataracts are associated with what 2 infections?

A

Varicella

Rubella

191
Q

Treatment for non typhoidal Salmonella ?

A

Not indicated (if uncomplicated), does not shorten duration of disease and may prolong excretion of the organism

3 exceptions: infants < 3 months, immunocompromised and those with a haemoglobinopathy

192
Q

2 common causes of bacterial pneumonia post influenza infection?

A

Strep pneumoniae

Staph aureus

193
Q

What is the most common clinical presentation of tularaemia?

A

Ulceroglandular syndrome
maculopapular lesion at site of tick bite (ulcerates and heals slowly, can form eschar) and painful lymphadenopathy which often drain spontaneously

Other types: glandular only; oculoglandular; oropharyngeal or pneumonic

194
Q

Treatment options for tularaemia?

A

Gentamycin, amikacin or streptomycin 10 day course

Milder illness can use doxycycline or ciprofloxacin

Note: pathogen is Francisella tularensis; diagnosis is by serology - ELISA or PCR

195
Q

I and D + antimicrobial therapy is the treatment of choice for non TB mycobacterial lymphadenitis T/F

A

F - I and D is C/I due to the high risk of developing a chronically draining sinus tract.

Note: tx should be surgical excision +/- antimicrobials. ESR, CBC and CRP are typically normal.

196
Q

Violaceous discolouration is typically seen in nonTB mycobacterium lymphadenitis T/F

A

T - most commonly Mycobacterial avium-intracellulare

Other features: lymphadenopathy is typically prolonged (> 3wks), non or minimally tender and unilateral

197
Q

4 most common states for tularemia

A

Arkansas
Missouri
South Dakota
Oklahoma

198
Q

Most common cause of viral meningitis in the USA?

A

Enterovirus

Note: herpes simplex is the most common cause of meningoencephalitis when a cause is identified

199
Q

Treatment of Toxic Shock Syndrome

A

Clindamycin plus nafcillin (or vanc when MRSA suspected)

200
Q

Common causes of Toxic Shock Syndrome

A

Tampon use
Wound or surgical; wound packing
Progressive skin infection by Strep pyrogens

201
Q

Treatment if hypoCa from TSS is part of the mainstay of therapy T/F

A

F - do not treat the hypoCa unless ECG changes or symptomatic

202
Q

Ingestion of undercooked hamburger meat is the most common cause of HUS T/F

A

T

203
Q

Leucopaenia is a common finding in Pertussis infection T/F

A

F - lymphocytosis and thrombocytosis

204
Q

What is the most appropriate imaging modality in someone presenting with suspected osteomyelitis?

A

MRI

205
Q

Epididymo-orchitis is the most common complication of mumps in adolescent males and often leads to sterility T/F

A

F - it is the most common complication but rarely causes sterility

206
Q

The D test (double disc diffusion test) is helpful in deciding the treatment of what?

A

Infection due to MRSA, used to guide antimicrobial therapy.

207
Q

Unilateral non purulent conjunctivitis (+/- ocular granuloma) and ipsilateral preauricular lymphadenopathy, what pathogen?

A

Bartonella henselae

Note: this is an atypical presentation of cat scratch disease known a Parinaud occuloglandular syndrome

208
Q

3 common infectious causes of bloody vaginal discharge

A

Shigella flexneri or sonnei

Group A strep

209
Q

An infant is born to a mother with latent TB but has no signs of TB themselves. What is the mgmt?

A

No treatment indicated for the infant

Mother should be treated for 9 months with isoniazid and can breastfeed

210
Q

Granuloma gluteal infantum is characterised by numerous reddish-purple nodules in the diaper area that spare the inguinal folds T/F

A

F - the nodules do not spare the gluteal folds

Associated with Candida albicans infection

211
Q

Hyperinflation with minimal interstitial and alveolar infiltrates is seen on X-ray in infants with Chlam pneumonia T/F

A

T

NB - tx is with 2 weeks of erythromycin

212
Q

Clues to suggest neonatal Listeria meningitis

A

Increased peripheral monocytes
A history of maternal flu like illness in 2-3rd trimester

Note: enterovirus meningitis can also be due to maternal flu like illness but it would typically be in the last 1-3 weeks of pregnancy

213
Q

Treatment of neonatal listeria meningitis?

A

Ampicillin and gentamycin

214
Q

Mycobacterium marinum is associated with that exposure?

A

Exposure to fish.

Note: Usually presents as lymphadenopathy along the area of water exposure (eg along arm if it was put in a fish tank)

215
Q

Treatment of tetanus?

A

Human tetanus immune globulin immediately and

Penicillin G or metronidazole

216
Q

Contagious period for rubella?

A

Up until 7 days after onset of rash and hence should be excluded from school for that long

217
Q

6 week old child with osteochondritis and periostitis of arm with associated pain and decreased movement. What congenital infection?

A

Syphilis

Skeletal changes are painful and often associated with refusal to move arm, known as pseudo paralysis of Parrot

218
Q

Difference in presentation of blistering distal dactylitis vs herpetic whitlow?

A

Blistering distal dactylitis usually presents with one large bulla only, herpetic whitlow tends to form a cluster of discrete vesicles

219
Q

Where does blistering bullae dactylitis usually occur?

What pathogen?

A

Volar fat pads of fingers
Most commonly group A beta haemolytic strep; less commonly staph aureus

Note: less commonly on other areas of hands or feet. Tx is augmentin +/- incision and drainage

220
Q

What is Ramsay Hunt syndrome?

A

Acute peripheral facial neuropathy caused by varicella zoster infection

Note: tx is steroids and antiviral agents + analgesia

221
Q

What does brain imaging in Ramsay Hunt syndrome show?

A

Imaging is normal as it is a neuropathy affecting the facial nerve, hence it is not indicated

222
Q

Complete recovery of facial nerve function occurs in about 75% of those with Ramsay Hunt syndrome T/F

A

F - only in 50%

223
Q

For neonatal HSV with CNS disease what is the treatment duration?

A

21 days of IV acyclovir and a PCR at 21 days. If PCR is positive; weekly treatment extension until a negative result. Then oral suppressive treatment for 6 months

224
Q

All neonates treated for HSV should receive oral suppressive therapy for at least 6 months T/F

A

T - it has been shown to reduce future HSV outbreaks and improve neurodevelopment outcomes

225
Q

HEENT findings in herpangina

Pathogen

A

Discrete vesicles and ulcers covering ant tonsillar pillars, soft palate and uvula
Coxsackie virus

NB: HSV also presents with vesicles but they tend to be anterior (gingival) and perioral. Herpangina tends to spare the gingiva

226
Q

Typical presentation of early onset and late onset listeria in neonate

A 
Early onset (< 1 week): sepsis and pneumonia
Late onset (> 1 week): meningitis
227
Q

Common causes of retropharyngeal abscess?

A

Strep pyrogens (group A beta haemolytic strep)
Staph aureus
Resp anearobe

Note: X-ray shows prominent prevertebral tissue swelling, causing forward displacement of the trachea

228
Q

Enterococcal species typically have good susceptibility to cephalosporins T/F

A

F - they are uniformly resistant to all generations of cephalosporin (eg cephalexin or ceftazidime)

Note: typically susceptible to penicillin such as ampicillin or gentamicin or vac.

229
Q

Pathogen causing tinea versicolor

A

Malassezia furfur

Note: Small hypopigmented or hyperpigmented round or oval macules located on the trunk, proximal extremities, and/or neck. May seem in change appearance after sun exposure. Spaghetti and meatballs on KOH prep

230
Q

Most common causes of epiglottis? Empiric tx?

A

Staph aureus
Group A strep
Pneumococci

Tx: vanc and CTX

Note: HiB less common

231
Q

What may be found on CBC in Ehrlichia?

A

Pancytopaenia

232
Q

1st diagnosis of C diff initially treated with metronidazole recurs, what should it be treated with?

A

Metronidazole again or oral vancomycin

233
Q

What GI infection typically associated with uncooked hot dogs and goat cheese?

A

Listeria

234
Q

Treatment of staph scalded skin?

A

Fluid rehydration + abx ( if no concern for MSRA cefazolin + clindamycin or vancomycin + clindamycin if concern for MRSA)

235
Q

Rapidly progressive, symmetric, erythematous swelling of the hands and feet. Erythema is sharply demarcated at the wrists and ankles and often associated with painful papule, petechiae and purpura. What syndrome and what cause?

A

PPGSS - papular purpuric gloves and socks syndrome, parvovirus B19

Note: unlike erythema infectious/5th disease patients with PPGSS may still be infectious when the rash is present

236
Q

Patients with varicella infection will typically be febrile for about 6 or 7 days and no further work up is necessary. T/F

A

F - Any pt who continues to be febrile 5 days into the illness needed to be re-evaluated for with CBC and blood culture. Most common complication is bacterial infection of the lesions +/- bacteraemia/sepsis

237
Q

Lab findings in discitis?

A

Normal CBC
Elevated CRP and ESR
Blood cultures are usually negative and an organism is only identified following disc biopsy in 50 - 60%. Typically S aureus and then Kingella kingae

238
Q

Adenovirus infection is associated with nonpurulent conjunctivitis, exudative pharyngitis and pre-auricular lymphadenopathy T/F

A

T

239
Q

Are younger patients with EBV more or less likely to have a positive monospot test?

A

Less

240
Q

Post exposure prophylaxis for measles in a child > 1 who has not received their MMR or has only received one dose?

A

MMR vaccine should be given within 72 hours of exposure

241
Q

What is the recommended varicella prophylaxis?

A

In unimmunised children it depends on age and immune status

  1. > 12 months + no hx of natural varicella infection: varicella vaccine, ideally within 3 days post exposure
  2. < 12 months + no hx of natural varicella: nothing
  3. Immunocompromised + > 12 months + no hx of natural infection: VZIG, ideally within 4 days but up to 10 days
242
Q

Prominent post auricular and sub occipital lymphadenopathy, measles or rubella?

A

Rubella

Note: rubella rash is fine irregular discrete coalescing pinkish-red macule on face and trunk typically. Associated with reddish pink spots on soft palate (Forchheimer spots)
Measles rash is blotchy, erythematous, coalescing macule and papules on the face, trunk, palms and soles

243
Q

What is the most common cause of otitis external in a diabetic?

A

Pseudomonas a

Note: can treat with ciprofloxacin - can do drops if mild and PO if severe

244
Q

Classic features of disseminated gonococcal infection?

A

Triad of: migratory arthritis, tenosynovitis and dermatitis .

Presents within 2-3 weeks of primary GU infection often during menstruation

245
Q

What culture media is used for gonorrhoea?

A

Thayer Martin

Note: can do NAAT testing but it does not allow for sensitivity or resistance testing so culture needed too

246
Q

Treatment of sexual partners is indicated in BV infection T/F

A

F - it is not sexually transmitted

247
Q

Thin whitish vaginal discharge that typically smoothly coats the vaginal wall
Vaginal pH > 4.5
> 20 of cells are vaginal epithelial cells that appear stippled with adherent bacteria
What pathology?

A

BV

Note: other criteria is fishy odor. Need 3/4

248
Q

Pap smear recommendations for immunocompromised females?

A
  1. HIV - screen twice within first year after initial diagnosis and then annually
  2. All other immunocompromised: one year after the onset of sexual activity or at 21 yrs (whichever comes 1st)
249
Q

Gram stain of chancroid lesion morphology?

A

School of fish/train tracks/fingerprints

gram -ve coccobacilli

250
Q

What is a bubo?

A

Painful, unilateral inguinal lymphadenitis associated with chancroid

Note: tx of bubo is aspiration and drainage and antibiotics for the chancroid (single dose of oral azithromycin or single dose of IM CTX)

251
Q

Penile lesion described as painful inflamed, shallow ulcer with a greyish, fibrinous membrane and ragged, undermined borders

A

Chancroid

252
Q

Punctate petechial lesions of the vaginal wall and cervix are associated with which infection?

A

Trichomonas

“strawberry” cervix

253
Q

What is the treatment of trichomonas?

A

single 2g oral dose of metronidazole or tinidazole

254
Q

What are Donovan bodies and what pathology?

A

Rod shaped oval organisms within the cytoplasm of mononuclear phagocytes

Associated with granuloma inguinale caused by Klebsiella granulomatous

255
Q

What is the treatment of lymphogranuloma venereum?

A

Doxycycline 100mg PO BD for 21 days

Note: caused by chlam

256
Q

What is the treatment of uncomplicated gonorrhoea?

A

Single dose CTX 250mg IM and azithromycin 1g PO

257
Q

What is the treatment of uncomplicated chlamaydia?

A

Azithromycin 1g PO and retest for chlam in 3 months

258
Q

Tx of epididymitis?

A

1 dose CTX plus doxycycline (7 days) or 1 dose azithromycin

Most often caused by chlam or gonorrhoea

259
Q

Where is a Bartholin gland abscess located?

What is the treatment?

A

4 or 8 o’clock with respect to the vaginal introitus
Tx: I and D, abx not usually needed

Note: exceptions when abx are indicated recurrent infection, pregnancy, systemic signs of infection and/or localised cellulitis, immunosuppression, risk of MRSA, and gonorrhoea and/or chlam infection

260
Q

What is the recommended outpatient tx for PID?

A

CTX 250mg IM x1 plus doxycycline 100mg PO BD x 14 days

Note: add metronidazole for anaerobic cover if gynaecologist instrumentation in past 2 -3 weeks, abscess or trich or BV infection. Inpatient tx options

  1. Cefotetan or Cefoxitin PLUS doxycycline
  2. Clindamycin PLUS gentamycin
261
Q

What are the only antibiotics proven to reduce the effectiveness of the OCP?

A

Rifampin and rifabutin

262
Q

Postexposure prophylaxis for unimmunised individuals against hep A?

A

Single dose of Hep A vaccine as soon as possible within 2 weeks of exposure

Note: can also give immunoglobulin but vaccine is preferred

263
Q

Antibiotics for a dog/cat bite?

A
  1. Amoxicillin/clav

2. If allergic - TMX plus clindamycin

264
Q

Penetrating eye injury with ring abscess formation in cornea. Possible pathogens?

A

Bacillus cereus
Proteus
Pseudomonas

These are the 3 pathogens that cause ring abscess formation

265
Q

What is the most common cardiac abnormality in congenital rubella?

A

PDA

266
Q

Strawberry tongue and conjunctival hyperaemia can be part of the presentation of TSS T/F

A

T

Other features acute onset hypotension; hypoCa; diarrhoea; emesis; erythematous rash

267
Q

In TSS what is the most likely cause if cultures are negative and positive?

A

Negative: s aureus
Positive: strep pyogenes

268
Q

Difference between histoplasmosis vs blastomycosis?

A

Blastomycosis: broad based budding yeast; XR - “mass like” infiltrate or consolidation; central, south east or mid Atlantic states
Histoplasmosis: narrow based budding yeast; XR - hilarious adenopathy and focal alveolar infiltrates; south and midwest US (esp Mississippi and Ohio valleys)

269
Q

How long must a tick have been attached for Lyme disease prophylaxis to be indicated?

A

> 36 hours
Other factors also need to be satisfied:
-No C/I to doxycycline
-Prophylaxis can be started within 72 hours of removal
-Lyme disease is common in the area
-Tick can be identified as l scapularis tick

270
Q

What antibiotics are recommended for the treatment of suspected infantile botulism?

A

antibiotics are NOT indicated, esp aminoglycosides. They lyse the bacterial cells in the gut and can lead to further release of toxin –> clinical deterioration

271
Q

A child with fever and pharyngeal erythema, petechiae and exudates with conjunctivitis and runny nose most likely has strep pharyngitis . T/F

A

F - due to runny nose and conjunctivitis more likely to be viral pharyngitis. Other features to suggest viral is cough, hoarseness, oral ulcers, rash and diarrhoea.

272
Q

With Kawasaki disease coronary artery aneurysms are typically seen within the first week of illness T/F

A

F - typically seen after 10 days of illness

273
Q

In Kawasaki disease what are risk factors for coronary artery aneurysms?

A
  • Those with late diagnosis and delayed treatment with IVIG
  • Boys < 1 yrs or > 9 yrs
  • Fever > 14 days and/or failure to respond to initial dose IVIG
  • Abnormal labs, including high WBCs, low hematocrit, low albumin and low Na
274
Q

What may be found on abdominal USS in a patient with Kawasaki disease?

A

Acute distension of the GB ( AKA gallbladder hydrops)

Typically occurs in the first two weeks of the illness and is usually self limited

275
Q

How long should aspirin be used in tx of Kawasaki?

A

Until a follow up echo at 6-8 weeks shows no aneurysm

Note: first 10-14 days is 80-100mg/kg/day and then reduce to 3-5 mg/kg/day

276
Q

Which rash typically starts peripherally rather than centrally - measles or rubella?

A

Neither

Rubella typically starts on the face
Measles typically starts at the hairline

277
Q

Does the rash of RMSF start peripherally or centrally?

A

Typically starts peripherally (wrists and ankles often involves the palms and soles too)

278
Q

Common lab findings in RMSF?

A

Anaemia
Thrombocytopenia
Elevated transaminases
HypoNa

279
Q

Tx of RMSF and duration?

A

Doxycycline

Should be continues for 3 or more days after pt is afebrile

280
Q

RMSF can progress to neuro symptoms T/F

A

T - including ataxia, altered sensorium, seizures and CSF pleocytosis

281
Q

In a child care setting one case of either N meningitides or HiB warrants prophylaxis T/F

A

F - one case for N meningitides; need 2 cases for HiB prophylaxis to be recommended

282
Q

What is Alice in Wonderland syndrome and what infections is it associated with?

A

Perceptual distortions (sizes, shapes, colours and/or spatial relationships)

EBV
Viral encephalitis

Note: also associated with head trauma, epilepsy, migrainous ischaemia and cortisol irritability

283
Q

Treatment of a bat bite/scratch?

A
  1. Thorough cleansing of wound
  2. Human rabies immune globulin
  3. 4 dose series of human diploid cell vaccine or purified check embryo cell vaccine

Note: this is only indicated if bat unavailable for testing; no intervention needed if bat can be tested and found not to be rabid. Also immunocompromised individuals get 5 doses of vaccine

284
Q

The itch associated with scabies can persist for weeks, even after correct treatment T/F

A

T - this is because the symptoms of scabies are due to waste products of the mites as it tunnels through the hosts skin, hence can still cause irritation until that layer of skin naturally sloughs off

285
Q

After EBV what is the next most common cause of infectious mononucleosis?

A

CMV

286
Q

Itchy rash, numerous papules on one leg and raised, nonlinear bullous reddish brown tracks that extend several inches along the adjacent skin. What pathology and treatment?

A

Cutaneous larva migrans (caused by hookworm larva)

Tx: oral albendazole or ivermectin. If less than 2 yrs old or less than 15 kg, topical therapy instead

Note: due to direct contact with soil contaminated by dog/cat feces contains the worms –> usually located on feet or lower extremities

287
Q

Distinctive lab finding in pneumonia due to chlamydia trachomatis?

A

Eosinophilia

Note: characterised by tachypnea, staccato-like cough, nasal stuffiness, and rales in the absence of wheezing in a afebrile infant 4-12 weeks old

288
Q

Carditis is a late complication of untreated Lyme disease T/F

A

F

289
Q

Arthritis is a late complication of untreated Lyme disease T/F

A

T

290
Q

Asymptomatic international adoptees should be routinely screened for what infectious diseases?

A 
Hep B and C
HIV 
Syphilis 
TB
Giardia

Note: also have a CBC with Dif and red blood cell indices

291
Q

When should antibiotics for sinusitis be considered?

A

If persistent pain/congestions for > 7 - 10 days

292
Q

Management for purulent soft tissue infection

A

Note: most likely MRSA. Treatment guided by severity

  1. Mild - I and D only. No systemic features
  2. Moderate: oral clindamycin, doxycycline or TMX/sulfa. Systemic features such as fever
  3. Severe: IV antibiotics, vancomycin. Vital sign abnormalities
293
Q

What is the most specific test to diagnose acute EBV

A

IgM viral capsid antigen

294
Q

What pathogens typically cause chronic rhino sinusitis?

A

S aureus
Fungi
Aerobic gram neg bacilli
Anaerobes

Note: Features must be present > 12 weeks. These are not the same pathogens that cause acute sinusitis

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