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ABIM: Pingumel > ID > Flashcards

ID Flashcards

1
Q

Less common g(+) organisms in neutropenia

A 
Corynebacterium
P. acnes
Bacillus
Leuconostoc 
*some not treated with Vancomycin
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2
Q

Are anaerobic infections common in neutropenia?

A

NO

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3
Q

What is the danger level for neutropenia?

A

500 cells/mm (granulocytes)

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4
Q

Most important exam points in febrile neutropenia

A

upper airway mucosa, teeth, eyes and rectum

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5
Q

Initial lab work in febrile neutropenia…also consider?

A

CBC, CMP, hepatic fxn, urine/blood cx

Also consider: Chest imaging if respiratory Sx (CXR if low risk, CT if high risk), LP (if confused), fugal markers bronch or open lung bx, skin bx

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6
Q

Choice of empiric therapy for febrile neutropenia in high risk patients (4)? (High risk: pt expected to have ANC 7 days and/or has major CMx or liver/kidney dysfxn)

A
  1. Mero
  2. Imipenem
  3. Cefepime
  4. Pip-tazo
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7
Q

When should you add Vanc or Zyvox to empiric coverage in febrile neutropenia? (6)

A
  1. Hemodynamic instability or other signs of severe sepsis
  2. Pneumonia
  3. Positive blood cultures for gram-positive bacteria while awaiting speciation and susceptibility results
  4. Suspected central venous catheter (CVC)-related infection
  5. Skin or soft tissue infection
  6. Severe mucositis in patients who were receiving prophylaxis with a fluoroquinolone lacking activity against streptococci and in whom ceftazidime is being used as empiric therapy.
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8
Q

Which 3 gram positives are NOT covered by Vanc?

A
  1. Leuconostoc
  2. Lactobacillus
  3. Pediococcus
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9
Q

Indications for echinocandins (3)?

A
  1. Invasive candidiasis
  2. Salvage therapy for disseminated aspergillosis
  3. Empiric anti-fungal therapy in febrile neutropenia (some cases)
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10
Q

Can fluconazole be used as empiric antifungal?

A

NO!

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11
Q

Most common inherited immune deficiency

A

selective IgA deficiency

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12
Q 
recurrent infections for encapsulated organisms
recurrent giardiasis
food/respiratory allergies
associated autoimmune disorders 
(Hashimoto's, SLE, RA)
A

IgA deficiency

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13
Q

3 things to be aware of with selective IgA deficiency

A
  1. women can have false positive urine pregnancy tests
  2. higher than normal blood transfusion anaphylaxis rates
  3. IVIG contraindicated
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14
Q

What types of infections are those with acquired humoral deficiencies susceptible to?

A

Recurrent, often severe, upper and lower respiratory tract infections with encapsulated bacteria (eg, Streptococcus pneumoniae, Haemophilus influenzae)
Chronic diarrhea

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15
Q

What diseases do you get with complement deficiency?

A

C1, C2, C4

  • recurrent bacterial infections (think bacteremia, sinopulm infections, and meningitis), esp w/ encapsulated bugs.
  • genetic deficiencies have strong assoc w/ later development of SLE

C3
-severe, recurrent infections with encapsulated bacteria, MC Pneumococcus > H. flu

C5-C9
Recurrent Neisseria infections (meningo and gonococcus)

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16
Q

Screening test of choice for complement deficiency

A

CH50

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17
Q

Most common complement deficiency

A

C2

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18
Q

What diseases are T cell deficient people likely to get?

A

Progressive infections with ordinarily “benign” viruses, opportunistic intracellular pathogens, or fungi. Major examples- CMV, EBV, other herpes viruses, mycobacteria, candida, aspergillus, crypto.

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19
Q

What are the infections & risk time-periods in post solid organ transplant patient?

A

1 month- donor infections or nosocomial infections
2-6 months - opportunistic infections from immune suppression
>6 months- community acquired infections

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20
Q

Which antibiotic binds to RNA polymerase and blocks transcription of DNA to RNA?

A

Rifampin

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21
Q

Which antibiotic targets DNA gyrase?

A

Quinolone

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22
Q

Which antibiotic affects cell membrane function and acts like a quinolone?

A

Metronidazole

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23
Q

Which antibiotics block folic acid?

A

Sulfa and trimethoprim

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24
Q

Which antibiotics affect cell wall synthesis?

A

Beta lactams

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25
Q

Which antibiotic binds reversably to the 30S subunit

A

Tetracyclines

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26
Q

Which antibiotics bind to to 50S subunit

A

Macrolides

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27
Q

Which antibiotic binds IRREVERSIBLY to the 30S subunit?

A

Aminoglycosides

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28
Q

What is the “rule of thumb” regarding MIC and MBC?

A

MBC is roughly 8-10x the MIC

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29
Q

Which antibiotics exhibit concentration-dependent killing?

A

Aminoglycosides and quinolones

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30
Q

Which antibiotics exhibit concentration-independent killing (time dependent killing)? What is the significance of this?

A

Beta-lactams

If you miss a dose, you have higher chance of treatment failure

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31
Q

In time-dependent killing, how long should a patient’s drug concentration be higher than the organism’s MIC?

A

50% of the dosing inteval

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32
Q

PCN is still the drug of choice for: (6)

A
  1. Strep agalactiae (GBS) ppx
  2. Viridans strep
  3. PCN sensitive S. pneumo
  4. Syphilis
  5. Actinomyces
  6. N. meningitidis (if PCN-sensitive)
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33
Q

Potential complication of nafcillin and dicloxacillin?

A

Tubulointerstitial nephritis: fever, eosinophilia and rash

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34
Q

Ampicillin is the drug of choice for: (4)

A

Listeria meningitis
Salmonellosis (if sensitive)
UTI (if susceptible)
Enterococcal infections

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35
Q

Uses for 1st Gen Cephalosporins

A

Skin/Soft tissue infxns
Surgical ppx
Oral treatment of mild UTI

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36
Q

Uses for 2nd Gen Cephs (Cefoxitin/Cefotetan)

A

PID

Post operative abd infections

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37
Q

Facts about 3rd generation cephs

A

pneumococcal coverage (1st line)
NO staph coverage (better to use 1st gen)
NO anaerobic coverage (better to use 2nd gen)

Ceftazadime is only 3rd generation that covers pseudomonas

3 indicated for Enterobactericacae meningitis: ceftriaxone, cefotetan and ceftazidime

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38
Q

What is one clue to ESBL production

A

selective susceptibility to Cefipime,

but resistance to all other beta-lactams

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39
Q

Best use for aztreonam

A

Gram neg coverage and pseudomonal coverage in patient with BETA LACTAM ALLERGY

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40
Q

Potential complication of imipenem use?

A

Lower seizure threshold

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41
Q

When should you consider using a drug other than Vanc for a staph infection?

A

If MIC is >1mcg/mL

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42
Q

How do you treat Red Man syndrome?

A

Slow Vanc infusion time or with antihistamines

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43
Q

Complications of Linezolid?

A

Reversible thrombocytopenia, anemia, leukopenia
Sensory neuropathy
Serotonin Syndrome

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44
Q

What organ system is Daptomycin ineffective in?

A

Lungs - interacts with pulmonary surfactant, resulting in

inhibition of antibacterial activity

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45
Q

What are the gaps in coverage for Tigecycline?

A

Pseudomonas
Proteus
Providencia

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46
Q

What two antibiotics exhibit post-antibiotic effect?

A

Aminoglycosides and Quinolones

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47
Q

4 facts about quinolones

A
  1. Vitamins and laxatives reduce absorption
  2. Can increase theophylline levels
  3. Not for kids or pregnant/lactating patients
  4. Not for MRSA, even if susceptible
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48
Q

Best quinolone to treat pseudomonas?

A

Cipro…who knew?

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49
Q

Oseltamivir and zanamivir treat which type of Influenza?

A

Type A and B

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50
Q

Major side effects of Ketoconazole

A

Hepatitis
***Gynecomastia
Decreased libido

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51
Q

Candida species that are resistant to Fluconzaole

A

C. krusei

C. glabrata

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52
Q

For Boards, what is the drug of choice for MRSA infection?

A

Vancomycin

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53
Q

For Boards, should you use Tygacil for MRSA bacteremia coverage?

A

No (limited data at this time)

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54
Q

Fever, diarrhea, hypotension
hypocalcemia
Diffuse sunburn-like rash or erythema
Multisystem organ failure (kidney, liver, GI, ARDS, coags)

A

TSS

Menstruating female, post surgical (nasal packing, gauze packed wounds).

Tx: Carbapenem or Pcn with beta lactamase inhibitor + clinda;
narrow to clinda+naf if possible.
IVIG might be helpful.

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55
Q

One major difference between Staph and Strep pyogenes toxic shock?

A

Blood cx usually negative with staph,

but positive with Strep pyogenes

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56
Q

Most common cause of catheter related bacteremia?

A

Staph epi

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57
Q

Which states can you see increased infections with encapsulated organsims?

A 
(lack of spleen and/or lack of antibodies):
sickle cell
extremities of age
CLL
MM
agammaglobulinemia
also, alcoholics
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58
Q

3 sx usually found in Strep pharyngitis

A

Fever
Tender cervical lymphadenopathy
exudative tonsils

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59
Q

What organism should you suspect if patient gets endocarditis or sepsis after GU manipulation?

A

Enterococcus

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60
Q

Treatment of choice for “simple” enterococcal infections

A

PCN G, amp, vanc (if susc)

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61
Q

Treatment of choice for suspected enterococcal sepsis or endocarditis

A

PCN G, amp or vanc+gent (if susc)

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62
Q

Treatment of choice for Listeria

A

PCN or AMP (add gent if severe or meningitis)

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63
Q

Sx and treatment of choice for Diphtheria?

A

LOW fever, hoarseness, sore throat, gray-white membrane.

Erythromycin (2nd choice PCN)

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64
Q

Fever, dyspnea, CP
mediastinal widening.

Enlarging, painless ulcer with black eschar surrounded by edema.

Travel to Middle East, AFrica, S America, Asia. Exposure to wool, hides, or animal hair from there.

A

Inhalational anthrax.
Cutaneous.

To prevent: vaccinate, cipro x 60d.
Tx: IV cipro + 2 additional if severe.
Oral for cutaneous.

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65
Q

Severe nausea and vomiting after fried rice? Treatment

A

B. cereus

Symptomatic treatment

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66
Q

Contaminated meat or gravy?

A

Clostridium perfringens

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67
Q

People with complete complement deficiency are prone to which organism?

A

Meningococcus

can’t kill intracellular organisms

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68
Q

Empiric treatment for suspected meningococcus? What if PCN allergy?

A

3rd gen cephalosporin + vancomycin (if meningitis)

If PCN allergy, use chloromphenacol

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69
Q

Who should prophylaxis for meningococcus be given to OTHER than the patient?

A
  1. People who live in same household
  2. Contacts at daycare
  3. People exposed to oral secretions
    (i. e. intubation..NOT normal clinical encounters)
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70
Q

What drugs are best to eradicate carrier state for meningococcus in certain populations?

A

Rifampin (children and non-pregnant adults)
Quinolones (non-pregnant adults)
Ceftriaxone (pregnant adults, children

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71
Q

Which organism should you suspect with nail puncture wounds through tennis shoe?

A

Pseudomonas

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72
Q

Which organism should you suspect with osteo or endocarditis in IV drug users

A

Pseudomonas

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73
Q

Which organsim should you suspect in otitis externa in severe diabetics?

A

Pseudomonas

74
Q

“Hot tub rash” =

A

Pseudomonas

75
Q

“Iguanas and lizards” =

A

Salmonella

76
Q

“Recent travel, fever,
“rose spots” on trunk one week after fever,
leukopenia

A

Typhoid fever
Salmonella typhi
Quinolone, 3rd gen ceph, amp, TMP/SMX

77
Q

Adenopathy after hunting?

A

Plague - Yersinia (southwest) or

Tularemia (AK, OK, MO)

78
Q

Plague dx and treatment?

A

Aspirate lymph nodes.
Streptomycin (1st line),
Tetracycline or Quinolones (2nd line)

79
Q

What requires charcoal yeast extract to culture?

A

Legionella

80
Q

Diarrhea, delirium, HA, pneumonia

A

Legionella.
Tx: Azithro, quinolones.
If severe, add rifampin.

81
Q 
Unpasteurized milk
culture negative endocarditis
orchitis
thyroiditis
adrenal insufficiency?

Treatment?

A

Brucellosis
Doxycycline + Aminoglycoside x4 weeks -or- Doxy+Rifampin x 4weeks

Cultures may take 6 weeks to grow!
Can also check acute/convalescent titers.

82
Q

Treatment for tularemia?

A

Streptomycin or gent…Tetracycline if not very ill.

83
Q

Cat scratch fever? Treatment?

A

Bartonella henslae.
Bacillary angiomatosis in immunocompromised.
Rifampin + (gent or azithro, depending on severity)

84
Q 
Rash (distal extremities first, becomes petechial)
Fever
headache
arthralgia
tick exposure. 
May also present with diarrhea & abd pain. 
Hyponatremia, 
Increased LFTs
Thrombocytopenia. 
Increased D-dimer.
A

RMSF.
SE and S Central US.

Dx clinical, confirm with serology.
Definite dx: do IF staining on biopsy.
Doxy/Tetracycline or Chloramphenicol (if pregnant)

85
Q

Fever in person who works in slaughterhouse or person who births animals?

A

Q fever
Inhaling aerosols of infected animals
Tx: Doxy if severe, but usu remits spontaneously.

86
Q 
Pancytopenia
fever (can persist for months)
HA.
tick bite in MO and AR or northeast/upper midwest. 
No rash (except 40% of HME).
Morulae in cytoplasm.
A

Ehrlichiosis. “Rocky Mtn. Spotless Fever”.
Convalescent seriologic test.
Doxy/tetracycline.

87
Q

Non healing skin ulceration
(strings of lesions along lymphatic channels)
in people working around fish tanks or
diabetic/immunodeficient.

A

Mycobacterium marninum

Tx with ethambutol +rifampin

88
Q

Pleural effusion analysis- lymph 1,000-6,000,
low glc,
high protein,
elevated LDH.

A

M. tuberculosis

89
Q

Cervicofacial “sulfur” granules…“lumpy jaw”

A

Actinomyces

90
Q

PID in the setting of IUD placement

A

Actinomyces

91
Q

Myalgias, rigors, high fever.
Exposure to poultry
pneumonia
splenomegaly.

A

Chlamydia psittaci.

Ddx: Histoplasma also causes pna & splenomegaly,
assoc with bird & bat droppings.

92
Q

Pneumonia after pharyngitis.

Severe bronchospasm.

A

Chlamydia pneumonia

93
Q

Painless chancre, regional lymphadenopathy

A

Primary syphilis

94
Q

Lung cavitary lesion–>chronic neutrophilic meningitis.
Nodular skin lesions.
Aspirate is culture negative.

A

Nocardia
Note: most chronic meningitis are LYMPHOCYTIC
Tx: high dose TMP/SMX
Amikacin/imipenim if severely ill

95
Q

Nickel and dime lesions on palms and soles,
generalized lymphadenopathy
cutaneous lesions that look like a number of other things.

A

Secondary syphilis

Skin lesions “the great imitator”

96
Q 
Personality changes
Affect reduced 
Reflexes abnl
Eyes Argyll-Robertson pupil (miotic, irregular, constricts to accommodation but not light)
Sensation decreased 
Intelligence impaired
Slurred Speech.
A

Tertiary syphillis

“PARESIS”

97
Q

Pt. has +RPR, -MHA-TP for syphilis…Dx?

A

Early infection or false positive RPR in low risk population, can repeat test in 6 weeks.

98
Q

Pt. has +RPR, +MHA-TP. Dx?

A

Infection with syphilis

99
Q

Pt. has -RPR, +MHA-TP. Dx?

A

Long standing untreated tertiary disease, or

cross reaction with antibodies from Lyme infection

100
Q

If VDLR or RPR is negative in tertiary syphilis, does this mean disease is cured?

A

NO, non-treponemal tests can be negative in tertiary syph…

MHA-TP or FTA-ABS would be positive, however.

101
Q

What is treatment for syphillis in pregnant woman with PCN allergy?

A

Densitization and then treatment with PCN.

102
Q 
Fever, myalgia, HA
Eventually leading to severe hepatitis
renal failure
hemorrhagic complications.
Also resp failure, myocarditis, rhabdo.
*Conjunctival suffusion.*
 Contact with dog or rat urine.
A

Leptospirosis. Tropics (Hawaii).
Dx: serology.
Tx: most self-limited, but doxy and pcn to shorten duration or for severe.

103
Q

How do you diagnose leptospirosis

A

blood and or CSF clutures within 10d of illness

After 10d: urine cx and serum anti-leptospira IgM

104
Q

Two disease spready by Ixodes tick in NE

A

Babesiosis and Lyme disease

105
Q

Tick bite, followed by irregular erythematous rash with clearing center, arthralgia, myalgia, fever, HA

A

Stage I Lyme disease

Rash is erythema migrans

106
Q

Weeks after rash and camping, patient develops neuritis (Bell’s Palsy) and/or lymphocytic meningitis. Also 2nd degree heart block.

A

Stage II Lyme

Can be 1st, 2nd or 3rd degree block (usually alternates)

107
Q

Describe stage III Lyme disease

A

Months to years after stage II
Chronic arthritis
Possibly chronic Neuro sx

108
Q

Patient shows up with erythema migrans, do you check Lyme serology?

A

NO, just treat

109
Q

Fatigue, arthralgia, muscle ache.

Check serologies or treat for Lyme disease?

A

NO on both counts.
Findings non-specific.
If has Erythema Multiforme, then treat as EM IS specific.

110
Q

Treatment for Lyme

A

Early disease or Bell’s Palsy- doxy/amox 10-21 days
Lyme arthritis- doxy/amox 28 days
Cardiac/Neurologic dz:
Ceftriaxone 2gm or PCN G 20 MU x 21 days

111
Q

Risks for candidal infections

A

Immunosuppressed
Indwelling caths
Uncontrolled DM

112
Q

Can candida in a blood culture represent a contaminant?

A

NO. Always represents disease, even if pt. is asymptomatic.

113
Q

What exam should a patient with candidemia have?

A

Dilated eye exam

114
Q

Should you use lipid ampho B or regular ampho B in urinary candidemal infections?

A

Regular…lipid ampho B does not penetrate kidneys

115
Q

immunosuppressed patient
headache, fever
pulmonary lesions.
Increased opening pressure on LP.

A

Cryptococcal meningitis.
Most common form of meningitis in AIDS.

Dx: antigen in CSF or culture.
OS can be >200 cm H2O - tx with serial LP.

Tx: Ampho B and flucytosine…then fluconazole

116
Q 
Southwest US
erythema nodosum or multiforme 
arthralgias, flu-like sx. 
1-3wks after exposure.
Consider in pts with pulmonary sx + prolonged constitutional sx.
Misdiagnosed as sarcoidosis.
A

Coccidioidomycosis.

117
Q 
Flu like illness
pulmonary infiltrates
splenomegaly
palate ulcers
Midwest residence.
Consider in complex pulm dz (nodular, cavitary, LAD)
A

Histoplasmosis (immunocompetent)

Sepsis syndrome in immunocompromised patients.
Serum/urine test not helpful

Itraconazole if severe localized disease in immunocompetent.

Ampho B followed by itra in immunocompromised

118
Q 
Warty lesions with central ulceration 
bacterial pneumonia-like syndrome 
Arkansas and Wisconsin hunters/loggers
4-6wks after exposure.
(MS, MO, OH river valleys)
A

Blastomycosis

119
Q

Lymphangitis in a gardener.

A

Sporotrichosis

Tx: potassium iodide or itraconazole.

120
Q

Black necrotic spot on nose or sinuses in a poorly controlled diabetic

A

Rhizopus - Zygomycosis

121
Q

Differences between protozoa and helminths

A

Protozoa replicate in body & do NOT have eos

Helminths do NOT replicate in body & HAVE eos

122
Q

Whole township breaks out into watery diarrhea…what is cause?

A

Crysptosporidium

123
Q

Raspberries from Guatemala.

A

Cyclospora- treat with bactrim

124
Q

“banana shaped gametocytes”

A

Falciparum malaria
**high rate of chloroquine resistance
1 infected RBC per slide (higher than others)
No schizonts (as opposed to others)

125
Q

What should you screen for prior to starting malaria treatment

A

G-6-PD - if deficient, primaquine can induce hemolytic anemia

126
Q

Months of fever, sweats, myalgias and shaking chills.
Hemoglobinuria.
Severe hemolytic anemia
Jaundice
Renal failure.
Cross-like pattern seen in RBC on peripheral smears. NE US in summer or early fall.

A 
Babesia
**aplenic patients have worse disease
"Maltese cross" pattern on RBC
Hemoglobinuria is predominant sign
Tx: quinine and clinda, or atovaquone + azithro.
127
Q

Treament for amebiasis

A

Metronidazole, followed by paromomycin or iodoquinol even if stool doesn’t have organisms.

Examine stool or get serology.
Aspirate of liver abscess often shoes no ameba or PMNs.

128
Q

watery, smelly diarrhea and flatulence

Child in daycare, camper, or immunocompromised person

A

Giardia
Tx: metronidazole or tinidazole or nitazoxanide.
Albendazole for kids
paromomycin in pregnancy.

129
Q

3rd degree heart block
achalasia or megacolon
South America and Mexico

A

Chagas disease (Trypanosoma cruzi).
Most common cause of CHF in Brazil.
Tx: antimonials & arsenicals from CDC.

130
Q

Multinucleated giant cells on Tzank smear

A

Herpes virus or Varicella

131
Q 
Temporal lobe seizures 
(smells burning rubber) 
focal neuro signs
altered MS
high CSF protein and RBC
erythema multiforme
A

Herpes encephalitis

132
Q

When should you not treat neurocystercercosis with antiparisitic drug?

A

When lots of cerebral inflammation.

Treat with steroids only.

133
Q

LBPx 10 hours,
zoster infection is suspected but no vescicles present.
What is immediate course of treatement.

A

Nothing…acyclovir has no effect until vesicles are present.

134
Q

What age should people get zoster vaccination

A

60

135
Q

How is CMV diagnosed

A

Antibody titers if immunocompetent

Antigenemia if immunosuppressed

136
Q

Lymphocytosis with >10% atypical lymphocytes. Which antibiotic do you NOT give.

A

EBV

Ampicillin-causes rash

137
Q

Cough, corza, conjunctivitis, rash
Koplik spots on buccal mucosa
(white spots with Erythematous base)

A

Measles

138
Q

Caver presents with acute delirium, hydrophobia and choking

A

Rabies
**serology is not helpful
Preventative vaccine indicated for animal worker, caver, vet, anyone who works with bats (NOT hunters)

139
Q

AIDS patient or sickle cell patient
red rash on cheeks
acute pancytopenia
Bone marrow bx shows giant pronormoblasts

A

Parvovirus
“Slapped cheek” appearance
Likely in aplastic crisis

140
Q

Young patient with hemorrhagic pna
thrombocytopenia
increased hematocrit

A

Hantavirus

Likely develops ARDS

141
Q

Most common cause of prosthetic valve endocarditis 1 year after surgery

A

Staph epi

142
Q

Labs that support infective endocarditis

A 
Blood cx (3/4 positive at least prior to abx)
ESR/CRP
Thrombocytopenia
Proteinuria/RBC casts
low complement/cryoglobinemia
RPR+
RF (minor)
143
Q

Indications for TEE in suspected endocarditis

A

Prosthetic valve
Suspicion for perivalvular abscess
***negative TEE with native valve has neg predictive valvue of almost 100%

144
Q

Duke criteria diagnosis of endocarditis

A

2 major
1 major + 3 minor
5 minor

Major
+ blood cx
(typical IE organism, 2cx 12 hrs apart, any cx for Coxiella burnetti, majority of cx + for atypical organism)
Abnormal Echo

Minor

  • Predisposing condition (valve dz, IV drug use)
  • Fever
  • Vascular phenomena
  • Immunologic phenomena (osler nodes, roth spots, +RF, acute glomerulonephritis)
  • Positive blood cx that does NOT meet major criterion
145
Q

Empiric treatment for meningitis

A

3rd Gen Ceph + Vanc

Add ampicillin if neonate or >60 to cover Listeria

146
Q

Additional tests required for aseptic meningitis

A

VDRL, acid fast,,

cryptococcal antigen, fungal serology

147
Q

Meningitis sx after raccoon exposure in California. CSF shows eosiniphilia.

A

Baylisacaris (nematode)

**no effective tx

148
Q

6th nerve palsy
basilar enhancement on CT scan
CSF negative for bacteria.

A

TB meningitis

149
Q

Pt. with Bell’s palsy, foot drop

Camping in past several weeks

A 
Lyme meningitis
Tx: Ceftriaxone or high dose PCN G
no doxy (due to penetration)
150
Q

Empiric tx for brain abscess

A

PCN (3rd gen ceph if allergic) + metronidazole

Add vanc to cover staph if penetrating trauma or sugery

151
Q

HAART combos to avoid

A

d4T+ ZDV (“4 z extra point”)
ddC+ddI (CI for contraindication)
INdinavir + SAquinavir (INSAne to use together)
3TC + d4T (“3, 4, out the door!”)

152
Q

Sudden F/C, myalgias, arthralgias
followed by an irregular ulcer that may persist for months.
Regional lymphadenopathy that might necrose/suppurate
AR, MO, OK.

A

Franciscella tularensis - “rabbit fever”.
Transmitted by ticks/flies, but can be ingested/inhaled.
Dx: serologic testing.
Tx: Streptomycin or gent. Tetracycline if not severe.

153
Q

Malaria prophylaxis

A

Chloroquine: 1-2wks before + 4-6wks after.

If resistant area: Mefloquine or atovaquone/proguanil.
Resistant areas: 
S. America
SE Asia
emerging: E Africa
154
Q

GI sx, hepatomegaly
huge splenomegaly
cutaneous dz in traveler

A

Leishmaniasis - sand flies.

Tx: Sodium stibogluconate (pentavalent antimony), pentamidine, or ampho B.

155
Q 
Only helminth that replicates in body. 
Tropical regions, southern US. 
GI and pulmonary sx
eosinophilia. 
Immunosuppressed: abd pain/distention, neuro & pulm sx, shock.
A

Strongyloides - infxn can persist for decades.
Dx: serial stool samples
Tx: Ivermectin or albendazole

156
Q

Fleeting, migratory pulmonary infiltrates, eosinophilia

A

Visceral larva migrans - Toxocara canis.

Tx: albendazole or mebendazole.

157
Q

Eosinophilic meningitis in travelers from S. Pacific

A

Angiostrongylus cantonensis - rat lungworm. Ingestion of snails, vegetables contaminated by snail slime, crabs, shrimp.

158
Q

Eosinophilic meningitis in kid playing in sandbox

A

Baylisascaris procyonis - roundworm in raccoon droppings

159
Q

Mexican immigrant with new onset seizures

A

Cysticercosis - pork tapeworm.
Tx: Niclosamide, albendazole, or praziquantel;
steroids first if lots of edema/inflammation.
No tx needed for calcified lesions and no h/o clinical dz.

160
Q

Eating raw fish, biliary obstruction

A

Clonorchis - Chinese liver fluke.

Praziquantel x 1 day

161
Q 
Travelers diarrhea - 
2 months later, fever, 
lymphadenopathy, 
marked eosinophilia. 
Cirrhosis with varicose 
(not spiders, gyneco, or ascites)
A

Schistosomiasis “Katayama fever”)
Dx: eggs in stool or urine
Tx: Praziquantel x 1 day

162
Q

Tetanus booster need?

A

None if last booster 5 yrs

163
Q

Arthralgias, Abd pain, Weight loss, Diarrhea.

May have severe malabsorption
neuro sx (lymphatic obstruction)
Skin hyperpig in sun-exposed areas.

Foamy macrophages on PAS stain small bowel biopsy, or PCR CSF.

A

Tropheryma whippelii
gram + actinomycete.

Ceftriaxone or IV PCN x 14d, then 1 year bactrim.

Ddx: lymphoma

164
Q

Ertapenem use?

A

once daily. One of few beta-lactams with good staph coverage and extended spectrum GNR.
No pseudomonas.
Outpt parenteral tx - diabetic feet, infections of abdomen, pelvis, skin/soft tissue.

165
Q

Drugs that can cause fever

A

Phenytoin, carbamazepine
Beta lactams, sulfonamides, nitrofurantoin
Allopurinol

166
Q

How is smallpox different from chickenpox?

A

Smallpox: rash begins 2-3d after fever
(V: same time)

rash begins on face/arms/legs -> chest/distal
(V: trunk -> face/extremities)

rash in same stage
(V: different stages at any time)

167
Q

Fatigue, HA, ST
fever with posterior cervical LAD
splenomegaly
atypical lymphocytosis.

Aseptic meningitis/enceph,
hepatitis,
hemolyic anemia, thrombocytopenia.

A

EBV - infectious mono.

Monospot test. If neg, repeat in 2 wks or EBV serology.

168
Q

Criteria for +Tb test

A

> 15mm no risk factors

> 10mm: IVDU, recent arrival, high-risk congregate living, lab workers, high risk for active dz, kids 5mm: HIV, recent contact, old Tb on CXR, transplant, >15mg/d prednisone for >4wks.

169
Q

Gradual dyspnea + nonproductive cough, HIV
F/C/NS, weight loss
Tachypnea, crackles
Most common cause of pneumothorax in AIDS

A 
Pneumocystis jirovecii Pna - PJP
Dx: Silver stain exam of induced sputum or bronch - cysts
Tx - bactrim for mild-moderate
IV bactrim for mod-severe
Steroids if A-a>35 or PO2
170
Q 
Diplopia
Dysphonia
Dysarthria
Dysphagia
Descending paralysis (starting with face), 12-72hrs after exposure.
A

Botulism.
Wound botulism: debride wound.
Trivalent antitoxin from CDC - only stops, can’t reverse progression.

171
Q

Where do you find chloroquine-resistant malaria?

A 
Thailand
Myanmar
Cambodia
Vietnam.
For prophylaxis: atovaquone-proguanil, mefloquine, or doxy.
172
Q

Osteomyelitis: characteristic organisms in…
-Foot puncture wound through shoe

  • sickle cell
A
  • Pseudomonas

- Salmonella and S. aureus

173
Q 
Genital ulcers: multiple 1-2mm tender vesicles or erosions
Tender LAD.
If immunocompromised - 
\+ hepatitis
esophagitis
colitis
chorioretinitis
acute retinal necrosis
tracheobronchitis
pna
A

HSV

174
Q

Genital ulcers: Single 0.5-1cm painless indurated ulcer

Nontender bilateral inguinal LAD

A

syphilis

175
Q

Genital ulcers: ragged, purulent, painful ulcers.

Painful LAD - rapidly get fluctuant and rupture.

A

Chancroid (H. ducreyi).
Tx: 1 dose IM ceftriaxone or 1g azithro.
Or: 3d cipro or 7d erythro.

176
Q

Single 0.2-1cm genital ulcer
sometimes painful, disappears in 1-3wks.

2-6 wks later: tender unilateral LAD which my suppurate and fistulae

A

C. trachomatis - Lymphogranuloma venereum (LGV).

Tx: Doxy or erythro x 21d.

177
Q

HIV: OI prophylaxis

A
178
Q 
Encephalitis
chorioretinitis
pneumonitis
focal neurologic syndrome
mono-like sx
AIDS
A

Toxoplasmosis.
IgM and IgG serologic testing.
Sulfadiazine, pyrimethamine, and folic acid.

179
Q 
Transplant, first month:
-GI perforations and bleeding
= pna and resp failure
- Reactivation of EBV, polyomaviruses, hep B,C
- increased risk of renal graft failure
A

CMV infection

Prophylaxis: gan, valgan, or high dose acyclovir

180
Q

What lab must be checked weekly for patients treated with Daptomycin?

A

CK - risk of severe myopathy, hepatotox

181
Q

Definition of febrile neutropenia?

A

Pt w/ ANC 38.3°C (101.0°F) or a temperature of >38.0°C (100.4°F) sustained for >1 hour

182
Q

Define high vs low risk for febrile neutropenia

A

Low risk is expected to be neutropenic (

ABIM: Pingumel (1 decks)

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