ID 3

Question 1

Dx?

Infectious bloody diarrhea ass’d w/ poultry

Answer 1

Salmonella

Tx = Cipro for S. typhi, others don’t require ABX

Question 2

Dx?

Infectious bloody diarrhea (most common cause)

Answer 2

Campylobacter
(ass’d w/ GBS)

Tx = Erythromycin

Question 3

Dx?

Infectious bloody diarrhea ass’d w/ Hemolytic Uremic Syndrome (HUS)

Answer 3

• E. coli O157:H7
• Shigella (2nd most common w/ HUS)

Shigella Tx = TMP/SMX

Question 4

Dx?

Infectious bloody diarrhea ass’d w/ Shellfish

Answer 4

Vibrio

• Cruiseships –parahaemolyticus
• Hx of liver disease, skin lesions – vulnificus

Question 5

Dx?

Infectious bloody diarrhea ass’d w/ High affinity for iron, hemochromatosis, blood transfusions

Answer 5

Yersinia

Question 6

Dx?

Infectious bloody diarrhea ass’d w/ WBCs & RBCs in stool

Answer 6

C. dificile

Question 7

Infectious diarrhea – best initial test?

Answer 7

Blood &/or fecal leukocytes

stool lactoferrin has greater sensitivity & specificity than stool leukocytes

Question 8

Dx?

Nonbloody infectious diarrhea ass’d w/ vomiting

Answer 8

Bacillus cereus & Staphylococcus

Question 9

Infectious diarrhea – Tx of mild & severe disease?

Answer 9

Mild = Oral fluid replacement

Severe (high fever, bloody stools, or severe diarrhea)= Cipro (quinolones) & oral fluid replacement

Question 10

“Severe” infectious diarrhea means what?

Answer 10

Hypotension, Tachycardia, Fever, Abdominal pain, Bloody diarrhea, Metabolic acidosis

Question 11

Cryptosporidiosis – Tx?

Answer 11

Treat underlying AIDS – Nitazoxanide

Question 12

Acute Hepatitis – most common causes?

Answer 12

Hepatitis A or B

Hep C rarely presents as acute hepatitis, usually “silent” infection that presents later w/ cirrhosis

Question 13

Acute Hepatitis – symptoms on presentation?

Answer 13

• Jaundice
• Fever, weight loss, fatigue
• Dark urine
• Hepatosplenomegaly
• Nausea, vomiting, abdominal pain

Question 14

Acute Hepatitis Dx tests?

Answer 14

Increased:

• Direct Bilirubin
• ALT:AST ratio
• Alkaline Phosphatase

Question 15

Acute Hepatitis marker that correlates best w/ inc’d likelihood of mortality?

Answer 15

Prothrombin time

Question 16

Best initial Dx test to differentiate type of Hepatitis?

Answer 16

Hep A, B, D, & E: IgM antibody for acute infection, IgG for resolution of infection

Hep C: PCR to assess RNA level

Question 17

Serology marker of Hep B vaccination?

Answer 17

Positive Surface Antibody

surface- & e-antigen negative, core-Ab negative

Question 18

Serology marker of resolved/past Hep B infection?

Answer 18

Positive IgG Core antibody & Surface antibody

Question 19

Serology marker of acute or chronic Hep B infection?

Answer 19

Positive surface antigen, e-antigen, core antibody (IgG or IgM)

(negative surface antibody)

Question 20

Serology marker of “window period” of Hep B infection?

Answer 20

Positive IgM, then IgG Core antibody

antigens & surface antibody all negative

Question 21

What does positive e-antigen mean in Hep B?

Answer 21

High level of DNA polymerase activity — viral replication occurring

e-antigen is the best indication of the need for Tx in chronic disease

Question 22

Acute Hep C – Tx?

Answer 22

Interferon (injection), Ribavirin, & Boceprevir or Telaprevir

(dec likelihood of developing chronic infection w/ Hep C)

Question 23

Definition of “chronic” hepatitis B?

Answer 23

Presence of Surface antigen > 6 months

Question 24

Interferon – AEs?

Answer 24

• Arthralgia/myalgia
• Leukopenia & Thrombocytopenia
• Depression & flu-like symptoms

Question 25

Chronic Hepatitis w/ elevated E-antigen -- Tx?

Answer 25

Entecavir, Adefovir, Lamivudine, Telbivudine, Interferon, or Tenofovir (interferon is injection & has most side effects -- not best 1st choice)

Question 26

Goal of chronic Hepatitis therapy?

Answer 26

- Reduce DNA polymerase to undetectable levels | - Convert those patients w/ e-antigen to having anti-hepatitis e-antibody

Question 27

Acute Hep B -- Tx?

Answer 27

None. Hep B becomes chronic in 10% of patients & no Tx has been shown to alter this.

Question 28

Role of liver biopsy in chronic hepatitis management?

Answer 28

Fibrosis on biopsy = start Tx for Hep B or C right away - if there's active viral replication, fibrosis will progress to cirrhosis, which is irreversible

Question 29

Are ALT levels a good indication of activity of chronic hepatitis?

Answer 29

No, you can have significant infection w/ normal transaminase levels

Question 30

Ribavirin -- AEs?

Answer 30

- Hemolytic Anemia | - Severe Teratogen

Question 31

Goal of Hep C Tx?

Answer 31

Achieve an undetectable viral load

Question 32

Urethritis vs. Cystitis presentation?

Answer 32

Both: Dysuria w/ urinary frequency & burning | Urethritis = Urethral discharge cystitis does not give this