ID Flashcards
What is a case series?
A descriptive study about a group of patients with the same disease or condition who all have the exposure of interest.
What is a main weakness of a case series?
It does not contain a control group.
What should antibiotic regimens for intrahepatic abscesses cover?
Both pyogenic and amoebic causes.
True or False: Early acute bacterial conjunctivitis may not need antibiotics.
True.
When is multidrug prophylaxis for HIV transmission prevention typically considered?
Within the first 72 hours after potential HIV exposure.
What are three common features of shigella infection?
- Bloody diarrhea
- Abdominal cramps
- Fever
When can symptoms of primary HIV infection begin after initial exposure?
Days after initial exposure and can last for several weeks.
When should steroids be given in meningitis?
Prior to the first dose or at the same time as the first dose of antibiotics.
How is an uncomplicated parapneumonic effusion typically treated?
(antibiotics)
What includes uncomplicated parapneumonic effusion?
- Exudative with normal pH
- Glucose
What diagnostics are recommended for suspected Bordetella pertussis in the first four weeks of symptoms?
PCR and culture.
What are the most common pathogens in a pyogenic liver abscess?
- Enteric bacteria (especially E. Coli)
- Klebsiella
- Streptococcus species (especially Anginosus)
True or False: If blood or synovial fluid culture for Neisseria gonorrhea are negative, disseminated gonococcal infection is likely ruled out.
False.
What percentage of patients typically have positive cultures for urogenital, rectal, or pharyngeal cultures for Neisseria gonorrhea?
Roughly 50 to 80%.
How long should long antimicrobial courses be for catheter-associated bacteremia?
4 to 6 weeks.
What should adults who have previously received only the 23 valent pneumococcal polysaccharide vaccine (PPSV23) receive?
Either PCV15 or PCV20 at least one year after their last PPSV23 dose.
What organisms typically cause cellulitis?
Streptococcal organisms, which are sensitive to penicillin.
What should empiric iv abx therapy for post-neurosurgical meningitis cover?
- MRSA
- Coagulase negative staph
- Gram-negative bacilli (including pseudomonas)
Are patients with cavitary TB typically smear positive or negative?
Positive.
What defines neutropenia?
Absolute neutrophil count that is <500 or expected to fall below that value in next 48 hours.
For chronic HBV patients that test negative for the E antigen, when is treatment recommended?
If the viral load is greater than 2000 IU/mL and the Ala is greater than twice the upper limit of normal.
What are the typical treatments for moderate to severe vibrio parahaemolyticus infection?
- Doxycycline
- Fluoroquinolones
- Macrolides
What common symptoms are associated with primary HIV infection?
- Fever
- Myalgias
- Rash
- Pharyngitis
- Oral or genital ulcers
What is the initial step in the evaluation of olecranon bursitis?
Joint aspiration.
What type of staining is Nocardia associated with?
Acid fast.
What should victims of sexual assault receive for prevention of trichomoniasis?
Metronidazole.
What indicates gas gangrene after a traumatic puncture of the skin?
Presence of tissue necrosis and crepitus.
What characterizes a complicated parapneumonic effusion?
An exudative effusion with a pH <7.2 or glucose less than 60.
When can administration of steroids be considered in bacterial meningitis?
In cases with purulent CSF and/or positive gram stain.
What type of bacteria is Nocardia?
Gram positive with branching filaments.
For severe shigella infection, when is the recommended 3-day course of fluoroquinolones extended?
For people with HIV coinfection or shigella dysenteriae type one infection.
What is the best test to confirm the clinical diagnosis of active pulmonary TB?
Sputum stain and culture.
Why are Tigecycline and Linezolid not appropriate therapies for MRSA bacteremia?
They have bacteriostatic as opposed to bactericidal activity against MRSA.
How long should prophylactic antibiotics be given to people with a history of rheumatic fever and carditis without valvular disease?
For 10 years after the last attack or until age 21, whichever is longer.
When is primary prophylaxis with TMP-SMX indicated?
When the CD4 count drops to less than 200.
What is the specificity and sensitivity of thin smears of peripheral blood for diagnosing malaria?
100% specific but not 100% sensitive.
What characterizes infection with Haemophilus ducreyi?
Painful, ragged appearing genital ulcers and tender suppurative inguinal lymphadenopathy.
What should be suspected if oropharyngeal candidiasis is associated with odynophagia or dysphagia?
Esophageal candidiasis.
What is the recommended treatment regimen for a patient with a port abscess and fungemia?
- Port removal
- Incision and drainage
- Antifungal therapy for at least 14 days after the first negative blood culture.
What antibiotics should a patient with a hepatic abscess receive?
Antibiotics that cover either a pyogenic or amoebic cause.
What causes a pale or dusky appearance of the skin in gas gangrene?
Small vessel thrombosis.
What should initial empiric coverage for toxic shock syndrome include?
- A carbapenem class of drug
- Clindamycin to cover for Group A strep and staph aureus
- Vancomycin
What are the typical classes of antibiotics for atypical bacteria?
- Macrolides
- Fluoroquinolones
- Tetracyclines
What antibiotics are typically used for anaerobes?
- Metronidazole
- Clindamycin
- Zosyn
- Carbapenems
- Amp-sulbactam
- Amoxicillin-clavulanate
What is the hierarchy of evidence for observational studies in order of ascending validity?
- Case series
- Case control study
- Cohort study
- Systematic review or meta-analysis of cohort studies.
When does cerebral toxoplasmosis generally occur?
When the CD4 count is below 200.
What is the ideal treatment for GAS pharyngitis?
Penicillin or azithromycin if allergic.
What are the symptoms of syphilis?
Low-grade constitutional symptoms with maculopapular rash on trunk, palms, and soles.
What did a retrospective study show about immediate lumbar puncture compared with CT scan before lumbar puncture?
It reduced mortality in meningitis.
What can the BK virus potentially cause in kidney transplant or immune-compromised patients?
Hemorrhagic cystitis.
What is required for parapneumonic effusions?
Diagnostic thoracentesis to determine further management.
What are typical symptoms of delayed onset prosthetic joint infections?
Often lack fever, leukocytosis, or local symptoms over the joint.
What typically characterizes early onset prosthetic joint infections?
Caused by Staphylococcus aureus and will typically show fever, leukocytosis, and symptoms over the joint.
What should empiric treatment for acute exacerbation of bronchiectasis cover?
- Haemophilus influenzae
- Moraxella catarrhalis
- Staph aureus
- Pseudomonas
What is the first-line therapy for severely symptomatic patients with shigella dysentery?
A 3-day course of a fluoroquinolone, such as ciprofloxacin.
What exceptions exist for treatment of asymptomatic pyuria?
- Pregnancy
- Before a urologic procedure
- 1-3 months after renal transplantation.
What are the three most common causes of immune thrombocytopenia in adults?
- HIV
- Hepatitis
What does sigmoidoscopy typically demonstrate in gastrointestinal CMV disease?
Severe colitis with multiple clean based ulcers
What is the indicated treatment for patients with catheter associated bacteremia?
Long antimicrobial courses of 4 to 6 weeks along with catheter removal if patient has persistent symptoms, bacteremia, fungemia, or evidence of endocarditis or suppurative thrombophlebitis
What are three common causes of immune thrombocytopenia in adults?
- HIV
- Hepatitis
- H. pylori
How is toxoplasmosis typically acquired?
From raw or undercooked meat or oocysts from cats
What is the strong association found between infections with streptococcus gallolyticus subsp gallolyticus?
Colon cancer
What is the next diagnostic step for suspected colon cancer?
Colonoscopy
When should a catheter be removed in cases of catheter associated bacteremia?
If the infection was caused by Staph aureus, Pseudomonas aeruginosa, or Candida species
What is the most common cause of septic arthritis?
Staphylococcus or streptococcus species affecting a single joint
What leukocyte count is consistent with prosthetic joint infection?
Greater than 1700 mm3
What is the highest risk for CMV infection in solid organ transplants?
When the transplant recipient is seronegative for CMV and the donor is seropositive
What prophylaxis is appropriate for an adult exposed to Neisseria meningitidis?
- Oral rifampin
- Oral ciprofloxacin
- Parenteral ceftriaxone
What do antibiotic lock solutions combine?
A highly concentrated antibiotic with an anticoagulant for local instillation into the catheter lumen
True or False: The genital urinary tract is a common site for extra pulmonary tuberculosis.
True
What is the next step for a patient with >3 tetanus vaccines and a clean wound less than 10 years since the last vaccine?
Supportive care, no vaccine is needed
What should be suspected if oropharyngeal Candidiasis is associated with odynophagia or dysphagia?
Esophageal Candidiasis
What are the treatment choices for invasive CMV disease?
- Intravenous ganciclovir
- Oral valganciclovir
What scoring system is used to estimate the risk for Group A strep infection in patients with pharyngitis?
4-point Centor scoring system
What does the presence of positive hepatitis B surface antigen and core antibodies with negative surface antibody and E antigen indicate?
Chronic hepatitis B infection
What CD4 count is typically associated with cerebral toxoplasmosis?
Below 200
What are the x-ray findings of a prosthetic joint infection?
Periprosthetic lucency and loosening of the tibial component
What does a holosystolic cardiac murmur at the apex in a young adult with a history of acute rheumatic fever indicate?
Mitral regurgitation
Which carbapenem does not cover Pseudomonas?
Ertapenem
What is the most common mode of transmission for Neisseria meningitidis?
Short ranged aerosolized secretions
What are common symptoms associated with primary HIV infection?
- Fever
- Myalgias
- Rash
- Pharyngitis
- Oral or genital ulcers
What is the presence of leukocytes greater than 1700 mm3 in the aspirate consistent with?
Prosthetic joint infection
What is recommended after four weeks of symptoms suspecting Bordetella pertussis?
Serologic testing
What should a patient with an unknown vaccine history and a dirty wound receive?
Tdap and immune globulin
What is the empiric treatment for pertussis if presented within three weeks of cough onset?
A 5 to 7 day course of a macrolide
What should broad spectrum treatment for a large abscess always include?
MRSA coverage
How does disseminated gonococcal infection typically present?
Transient systemic illness followed by gonococcal arthritis, which is typically monoarticular
What is the treatment for acute uncomplicated bronchitis?
Supportive care including albuterol if wheezing is present
What is the most common cause of pyogenic liver abscess?
Biliary disease, especially in diabetic patients
What effects do steroids have in adults with streptococcal pneumoniae meningitis?
Positive effects
When do early onset prosthetic joint infections typically occur?
Within 3 months of surgery
What is the incubation period for Shigella?
Typically from 1 to 7 days
What is the most appropriate regimen to initiate for suspected streptococcus pneumoniae meningitis?
Dexamethasone plus both vancomycin and ceftriaxone
What is the most effective therapy to reduce transmission of herpes simplex in recurrent outbreaks?
Daily suppressive therapy with oral Acyclovir, Famciclovir, or Valacyclovir
What does persistence or recurrence of UTI symptoms 1 to 2 weeks after treatment suggest?
Infection with antimicrobial resistant strain
What does Albendazole treat?
Echinococcus granulosus, a cestode that causes hydatid liver cysts
What is the initial treatment for the first episode of acute pericarditis?
Aspirin and colchicine
What is indicated for patients with a Centor score >2?
A rapid antigen test or throat culture for group A strep
What are the first steps for a patient with neutropenic fever?
- Obtain 2 sets of blood cultures
- Start empiric antibiotics
- Order imaging studies based on symptoms
How is streptococcus gallolyticus blood infection typically treated?
- Vancomycin
- Penicillin
- Ceftriaxone
What is the first line therapy for severely symptomatic patients with shigella dysentery?
A 3 day course of a fluoroquinolone
What does CMV retinitis usually cause?
Painless loss of vision with fluffy white retinal infiltrates but no significant vitreous inflammation
What is the recommended treatment regimen for a patient with a port abscess and fungemia?
- Port removal
- Incision and drainage
- Antifungal therapy for at least 14 days after the first negative blood culture
What should be repeated every 12 to 24 hours for a patient suspected of malaria?
Thick and thin smears until at least three smear sets have been evaluated
What is the appropriate empiric therapy for bacterial conjunctivitis in a contact lens wearer?
Fluoroquinolone eyedrops
What should be done if a heterophile antibody (Monospot) test for Epstein Barr is negative?
A repeat monospot test or EBV-specific serologic testing is warranted
What does the empiric IV antibiotic therapy for post neurosurgical meningitis cover?
- MRSA
- Coagulase negative staph
- Gram-negative bacilli including Pseudomonas
What is the treatment for a patient with a port abscess and fungemia?
- Port removal
- Incision and drainage
- Antifungal therapy for at least 14 days after the first negative blood culture
What is the significance of finding Gram negative intracellular diplococci in a college student?
It indicates infection with Neisseria meningitidis
What should adults who previously received only the 23 valent pneumococcal polysaccharide vaccine (PPSV23) receive?
Either PCV15 or PCV20 at least one year after their last PPSV23 dose
What injury is Unasyn known to cause?
Liver injury
What is the treatment regimen for patients with catheter related bloodstream infections if they have negative follow up cultures?
10 to 14 days of IV antibiotics or prompt resolution of symptoms following antibiotic administration
What should be done for patients with suspected endovascular focus of infection?
Obtain at least two sets of blood cultures before initiating antibiotic therapy
What type of bacteria typically infects patients with delayed onset prosthetic joint infection?
Low virulence bacteria such as coagulase negative Staphylococcus
What is polyarthralgia?
Polyarthralgia means there can be multiple joints affected
Although usually it is monoarticular in nature, the arthritis can also be migratory.
What should be done if a heterophile antibody (Monospot) test for Epstein Barr is negative in the first week?
A repeat Monospot test or EBV-specific serologic testing is warranted
No back content.
What is the broad-spectrum coverage for meningitis?
- Vancomycin: for resistant streptococcus
- Ceftriaxone: streptococcus species
- Ampicillin: for listeria
No back content.
What does sigmoidoscopy typically demonstrate in gastrointestinal CMV disease?
Severe colitis with multiple clean-based ulcers
No back content.
True or False: The tuberculin skin test can distinguish between latent and active TB infection.
False
Neither the tuberculin skin test nor the gamma interferon test can distinguish between latent and active TB infection.
What are common symptoms associated with primary HIV infection?
- Fever
- Myalgias
- Rash
- Pharyngitis
- Oral or genital ulcers
No back content.
What is indicated for patients with catheter-associated bacteremia?
Long antimicrobial courses of 4 to 6 weeks along with catheter removal if persistent symptoms, bacteremia, fungemia, or evidence of endocarditis or suppurative thrombophlebitis
No back content.
What is indicated for patients with catheter-related bacteremia who have a prosthetic heart valve?
Transesophageal echocardiogram (TEE)
No back content.
How are moderate to severe vibrio parahaemolyticus infections typically treated?
With doxycycline, fluoroquinolones, and macrolides
No back content.
What are the first-line antiviral therapies for chronic hepatitis B?
- Tenofovir
- Entecavir
No back content.
True or False: You should begin antiretroviral therapy regardless of CD4 count.
True
You should begin antiretroviral therapy regardless of CD4 count.
What should be done for people who have been sexually assaulted by someone with an unknown HIV status?
A 28-day course of multidrug antiretroviral therapy is indicated
No back content.
What usually causes acute bronchitis?
A respiratory virus, and in some cases, atypical bacteria
No back content.
True or False: The absence of redness over a skin lesion likely rules out cellulitis.
True
No back content.
What initial empiric coverage should be included for toxic shock syndrome?
A carbapenem class of drug, Clindamycin for Group A strep and Staph aureus, as well as Vancomycin
No back content.
What should empiric IV antibiotic therapy for post-neurosurgical meningitis cover?
- MRSA
- Coagulase-negative staph
- Gram-negative bacilli including pseudomonas
No back content.
What are common causes of bacterial conjunctivitis in adults in the US?
- Staph
- Strep
- Haemophilus
No back content.
What are the most common pathogens in a pyogenic liver abscess?
- Enteric bacteria, especially E. Coli
- Klebsiella
- Streptococcus species, especially Anginosus
No back content.
What should a patient with catheter-related blood stream infections receive if they have negative follow-up cultures?
10 to 14 days of IV antibiotics or prompt resolution of symptoms following antibiotic administration
No back content.
What is the empiric treatment for acute exacerbation of bronchiectasis?
An oral antibiotic such as a quinolone that covers Haemophilus influenzae, Moraxella catarrhalis, Staph aureus, or Pseudomonas
No back content.
What are examples of typical oral antibiotics used for MRSA treatment?
- Doxycycline
- Bactrim
- Linezolid
- Clindamycin
Doxycycline, Bactrim, Linezolid, and Clindamycin are examples of the typical oral antibiotics used for MRSA treatment.
What are the typical IV forms used for MRSA treatment?
- Vancomycin
- Daptomycin
No back content.
Common symptoms associated with primary HIV infection include?
Fever, myalgias, rash, pharyngitis, and oral or genital ulcers.
Is Bordetella pertussis a relatively common cause of persistent severe cough in adults?
True
Three common features of shigella infection are?
Bloody diarrhea, abdominal cramps, and fever.
What is the most likely organism to cause mild to moderate gastroenteritis following consumption of raw seafood?
Vibrio parahaemolyticus.
People with delayed onset prosthetic joint infection are typically infected with?
Low virulence bacteria such as coagulase negative Staphylococcus.
Results in patients typically being asymptomatic.
For a patient with catheter associated bacteremia, when should the catheter be removed?
If the infection was caused by Staph aureus, Pseudomonas aeruginosa, or Candida species.
How often should thick and thin smears be repeated for a patient suspected of malaria?
Every 12 to 24 hours until at least three smear sets have been evaluated.
People with a history of rheumatic heart disease and valvular sequelae should receive prophylactic antibiotics for how long?
10 years or until age 40, whichever is longer.
How is streptococcus gallolyticus blood infection typically treated?
With vancomycin, penicillin, or ceftriaxone.
What is the typical class of antibiotics used for a multi-drug resistant UTI?
Carbapenems.
Is infection with haemophilus ducreyi likely ruled out if there is more than one painful genital ulcer?
False
What clinical finding describes severe pain on the body with no obvious skin findings, fluctuance, or swelling?
Pain out of proportion to exam findings.
Septic arthritis of more than one joint in the context of pneumonia and endocarditis is most likely caused by?
Infection with Streptococcus pneumoniae.
What renal abnormality can TMP-SMX cause?
Decrease in creatinine clearance.
Is Vibrio parahaemolyticus a gram positive or negative organism?
Gram negative.
What is the most appropriate treatment for a pregnant woman with syphilis and serious penicillin allergy?
Penicillin using a desensitization protocol.
What pneumococcal vaccines should adults 65 and over receive?
PCV15 or PCV20.
What are the first steps for a patient with neutropenic fever?
Obtain 2 sets of blood cultures, start empiric antibiotics, and order imaging studies based on symptoms.
How should GAS pharyngitis ideally be treated?
With penicillin or azithromycin if allergic.
Can the Monospot test be negative in up to 25% of patients within the first week of infection?
Yes.
Warrants test to be repeated or serologic testing to be performed.
If a patient has >3 tetanus vaccines and a dirty wound and > 5 years since last vaccine, what is the next step?
Give tetanus vaccine only.
What is the only antibiotic proven to reduce the risk for relapse in patients with recurrent nonpurulent cellulitis?
Penicillin.
After a sexual assault, what should victims receive for prevention of trichomoniasis?
Metronidazole.
For a patient with RA presenting with septic arthritis, what is the first step?
Joint aspiration followed by broad spectrum antibiotics.
As the fever from disseminated gonococcal infection resolves, patients typically present with?
A triad of tenosynovitis, dermatitis, and polyarthralgia, or with frank arthritis.
Transmission for shigella typically happens in?
Overcrowded settings such as daycare centers.
What does a patient with fever, headache, and a stiff neck shortly after neurosurgery probably have?
Post neurosurgical meningitis.
What do case-control studies compare?
The characteristics of individuals who already have a particular disease with those who don’t.
What is the most effective therapy to reduce transmission of herpes simplex in a patient with recurrent outbreaks?
Daily suppressive therapy with oral Acyclovir, Famciclovir, or Valacyclovir.
What is the first line treatment for Tinea corporis?
Topical azoles or allylamines such as terbinafine.
What is the next diagnostic step for infections with streptococcus gallolyticus subsp gallolyticus?
Colonoscopy.
Diarrhea associated with Giardia is watery and typically does not contain?
Blood or leukocytes.
What should be done for diagnosing malaria?
Thin smears of peripheral blood should be repeated.
How can UTIs that recur more than 1 month after an extensive abx course be treated?
With another short course of another first-line antibiotic.
Ocular toxoplasmosis in children and adults usually results in?
Retinochoroidal scars and may be subclinical.
When acute HIV infection is suspected, what testing is recommended?
HIV RNA testing.
What does CMV retinitis usually cause?
Painless loss of vision with fluffy white retinal infiltrates but no significant vitreous inflammation.
People with a history of rheumatic fever and carditis without valvular disease should receive prophylactic antibiotics for how long?
10 years after the last attack or until age 21, whichever is longer.
What usually causes erysipelas?
Group A streptococci or other beta hemolytic streptococci.
Are case series studies retrospective or prospective?
Retrospective.
What is the empiric treatment for acute exacerbation of bronchiectasis?
An oral antibiotic such as a quinolone that covers Haemophilus influenzae, Moraxella catarrhalis, Staph aureus, or Pseudomonas.
What are the most common pathogens in a pyogenic liver abscess?
Enteric bacteria, especially E. Coli, and Klebsiella, and Streptococcus species, especially Anginosus.
What types of antibiotics are typically used for Pseudomonas coverage?
Cefepime, Zosyn, aminoglycosides, carbapenems, fluoroquinolones.
What can confirm the diagnosis of esophageal/oral candidiasis?
Potassium hydroxide staining and culture of oral scrapings.
What is the hierarchy of evidence for observational studies in order of ascending validity?
Case series, case control study, cohort study, and systematic review or meta-analysis of cohort studies.
What is the initial treatment for the first episode of acute pericarditis?
Aspirin and colchicine.
If a patient has >3 tetanus vaccines and a dirty wound and < 5 years since last vaccine, what is the next step?
Supportive care, no vaccine needed.
What is the treatment choice for invasive CMV disease?
Either intravenous ganciclovir or oral valganciclovir.
What is the first line treatment in a patient with ESRD with MRSA bacteremia?
IV Vancomycin.
In patients on HD, vanc should be given after HD.
What is the recommended treatment regimen for a patient with a port abscess and fungemia?
Port removal, incision and drainage, and antifungal therapy for at least 14 days after the first negative blood culture.
What describes a cohort type of study?
Participants are classified into two groups: exposed and unexposed, and the incidence of the outcome of interest is compared.
What should an adult with persistent cough with severe coughing fits and vomiting be evaluated for?
Bordetella pertussis.
What does metronidazole cover?
Both anaerobes as well as Entamoeba histolytica.
What is the most useful diagnostic test for a patient with suspected prosthetic joint infection?
Aspiration of the joint.
What is the diagnosis for a patient from Central America with esophageal dysfunction, conduction abnormalities, and dilated cardiomyopathy?
Chagas Disease.
What is the diagnosis for an itchy, annular, red plaque in one or multiple areas on a person’s body?
Tinea corporis.
If a patient receives the PCV15 vaccine, when should a dose of pneumococcal polysaccharide vaccine (PPSV23) be given?
Usually at least one year later.
What must a patient presenting with an infection from one or more sources after a recent hospitalization have?
Coverage for multidrug resistant pathogens.
What should raise suspicion for pertussis?
Severe and persistent paroxysmal coughing episodes after a phase of low grade fever and nasal congestion.
What is the empiric treatment for pertussis if they present within three weeks of cough onset?
A 5 to 7 day course of a macrolide.
For a patient with RA presenting with septic arthritis, what is the next appropriate step in management after joint aspiration?
Broad spectrum antibiotics.
What is recommended for diagnosing Bordetella pertussis in the first four weeks of symptoms?
PCR and culture are both recommended for diagnostics.
What can be considered for some cases of bacterial meningitis?
Administration of steroids.
What should be repeated for diagnosing malaria?
Thick and thin smears should be repeated every 12 to 24 hours until at least three smear sets have been evaluated.
When can administration of steroids be considered?
For some cases of bacterial meningitis including those with purulent CSF and/or positive gram stain.
What do case-control studies compare?
They compare the characteristics of individuals who already have a particular disease with those who don’t.
How do case-control studies differ from case-series?
Case-control studies contain a control group.
What is colchicine typically used for?
Treatment of an acute gout flare.
What should be done for a patient with catheter-associated bacteremia?
The catheter should be removed if the infection was caused by staph aureus, pseudomonas aeruginosa, or candida species.
Is shigella diagnosed without bloody diarrhea?
False. Without bloody diarrhea, shigella is not the diagnosis.
Is involvement of more than one joint in septic arthritis common?
It is less common but may occur in patients with high-grade bacteremia including endocarditis or with underlying connective tissue diseases.
What is the post-exposure prophylaxis for gonorrhea and chlamydia after sexual assault?
Typically accomplished by administering ceftriaxone and doxycycline.
What was the traditional prophylaxis for gonorrhea and chlamydia as of 2022?
Traditionally it was ceftriaxone and azithromycin.
Are antibiotics recommended for acute bronchitis?
True, antibiotics are not recommended for acute bronchitis.
What can linezolid precipitate if given with an antidepressant?
Serotonin syndrome, especially with an SSRI.
What is the most appropriate initial management of a complicated parapneumonic effusion?
Pleural fluid drainage via tube thoracostomy.
What are the most common pathogens in a pyogenic liver abscess?
Enteric bacteria, especially E. Coli, Klebsiella, and streptococcus species, especially Anginosus.
What triad do patients with disseminated gonococcal infection typically present with?
Tenosynovitis, dermatitis, and polyarthralgia.
What important infectious agent should be ruled out in a patient from Mexico with chronic prostatitis?
Tuberculosis.
What is the diagnostic method for tuberculosis in this context?
Urine acid-fast bacillus smear and culture.
What should be given after the PCV15 vaccine?
A dose of pneumococcal polysaccharide vaccine (PPSV23) should also be given, usually at least one year later.
When is TEE indicated in patients with catheter-related bacteremia?
In patients with a prosthetic heart valve, pacemaker, implantable ICD, or persistent bacteremia or fungemia.
What is the most effective therapy to reduce transmission of herpes simplex?
Daily suppressive therapy with oral Acyclovir, Famciclovir, or Valacyclovir.
What is the association between streptococcus gallolyticus and colon cancer?
There is a strong association; the next diagnostic step is colonoscopy.
When is treatment recommended for chronic HBV patients who test negative for the E antigen?
If the viral load is greater than 2000 IU/mL and the Ala is greater than twice the upper limit of normal.
What is the treatment for a pregnant woman with syphilis and serious penicillin allergy?
Penicillin using a desensitization protocol.
How long should prophylactic antibiotics be given to people with a history of rheumatic heart disease?
For 10 years or until age 40, whichever is longer.
What is antibiotic lock therapy commonly considered for?
Adjunctive treatment of bacteremia associated with central venous catheters.
What neurologic effect do carbapenems have?
They lower the seizure threshold.
What should initial empiric coverage for toxic shock syndrome include?
A carbapenem class of drug, Clindamycin for Group A strep, and staph aureus, and vancomycin.
What should a patient with an unknown vaccine history and a dirty wound receive?
Tdap and immune globulin.
What are common causes of bacterial conjunctivitis in adults in the US?
Staph, strep, and haemophilus.
What usually causes acute bronchitis?
A respiratory virus, and in some cases, atypical bacteria such as chlamydia pneumonia, mycoplasma, or Bordetella pertussis.
What is the recommended vaccination for adults 65 and over?
Pneumococcal conjugate vaccines PCV15 or PCV20, especially for those with underlying conditions.
What is the classic sign of ocular toxoplasmosis?
A nidus of fluffy white necrotizing retinitis that is adjacent to a pigmented chorioretinal scar.
What is indicated for patients with a Centor score >2?
A rapid antigen test or throat culture.
What is the treatment for gastrointestinal CMV disease?
Sigmoidoscopy typically demonstrates severe colitis with multiple clean-based ulcers.
What is the common site of extrapulmonary tuberculosis?
The genitourinary tract.
What is the appropriate prophylaxis for an adult exposed to Neisseria meningitidis?
Oral rifampin, oral ciprofloxacin, or parenteral ceftriaxone.
What is the treatment for acute uncomplicated bronchitis?
Supportive care, including albuterol if wheezing is present.
What should be suspected if oropharyngeal Candidiasis is associated with odynophagia or dysphagia?
Esophageal Candidiasis.
What is characteristic of infection with haemophilus ducreyi?
Painful, ragged appearing genital ulcers and tender suppurative inguinal lymphadenopathy.
What is the purpose of the 4-point Centor scoring system?
To estimate the risk for Group A strep infection and determine if additional testing or treatment is needed.
What common physical exam finding is associated with gas gangrene and mesenteric ischemia?
Pain out of proportion to exam findings.
What should be done for patients with catheter-associated bacteremia?
Long antimicrobial courses of 4 to 6 weeks along with catheter removal are indicated if the patient has persistent symptoms, bacteremia, fungemia, or evidence of endocarditis or suppurative thrombophlebitis.
What are the typical forms for MRSA coverage?
Vancomycin and daptomycin are the typical IV forms for MRSA coverage.
What is the first-line option for treatment of acute uncomplicated cystitis?
Nitrofurantoin.
What is the treatment for primary HIV infection?
Symptoms can begin days after initial exposure and can last for several weeks, followed by a long asymptomatic period.
What is indicated for catheter associated bacteremia with persistent symptoms?
Long antimicrobial courses of 4 to 6 weeks along with catheter removal are indicated if the patient has persistent symptoms.
When is a TEE indicated in patients with catheter related bacteremia?
A TEE would be indicated in patients with catheter related bacteremia who have a prosthetic heart valve, pacemaker, implantable ICD, or persistent bacteremia.
When should antibiotic therapy for Group A strep infection be prescribed?
Antibiotic therapy for Group A strep infection should only be prescribed after a positive rapid antigen test or throat culture.
What should be done if a patient has an unknown vaccine status or less than 3 tetanus vaccines and a dirty wound?
The next step is to give the tetanus vaccine plus immune globulin; immune globulin is needed due to the dirty wound.
In what time frame can the Monospot test be negative in patients?
The Monospot (heterophile antibody) test can be negative in up to 25% of patients within the first week of the infection.
What should be done if the Monospot test is negative?
The test warrants being repeated or serologic testing to be performed.
