ID

Question 1

CURB -65: Inpatient vs outpatient for PNA

Answer 1

Confusion
Uremia (BUN > 19)
Resp > 30
BP

Question 2

ABx for meningitis infants

Answer 2

Cefotaxime + amp + vanc (+aminoglycoside if

Question 3

ABx for meningitis 3 mo to 50 yrs

Answer 3

Ceftriaxone + vanc

Question 4

ABx for 50 yrs + or impaired cellular immunity

Answer 4

Ceftriaxone + amp + vanc

Question 5

Hepatitis B is associated with which vasculitis?

Answer 5

PAN

Question 6

Uncomplicated UTI tx in non-pregnant person

Answer 6

Bactrim x 3 days or nitrofurantoin x 5 days or fosfomycin single dose

Complicated extend tx to 7 days

Question 7

UTI in pregnant woman tx

Answer 7

Ampicillin, amox, or a cephalosporin for 7-10 days

Question 8

Pyelonephritis uncomplicated tx

Answer 8

Bactrim or fluoroquinolone for 10-14 days; adjust after Ucx is back

Question 9

Pyelonephritis complicated tx (pregnant, elderly, ill, cannot tolerate PO, concern for urosepsis)

Answer 9

IV amp + gent for 14-21 days (neg blood ctx) or 3 weeks (pos blood ctx)

Question 10

HAART regimen must include

Answer 10

2 NRTs + either NNRT OR protease inhibitor

Question 11

PPx in HIV

Answer 11

Bactrim for PCP

Question 12

Chancroid

Answer 12

Haemophilus ducreyi; ragged edged ulcers, painful; tx with azithro or ceftriaxone

Question 13

Lymphogranuloma venerum

Answer 13

C. trachomatis, painless ulcer with tender inguinal LAD; tx with doxy

Question 14

RMSF

Answer 14

rash starts peripherally and then spreads centrally; may have elevated LFTs and thrombocytopenia; treat with doxycycline

Question 15

Malaria treatment

Answer 15

If chloroquine resistance, give mefloquiine

Question 16

Leptospirosis (spirochete)

Answer 16

Reservoir is rodents/farm animals, spread via water. Anicteric: rash, LAD, elev LFTs. Icteric: renal/liver failure, vasculitis, vascular collapse. Tx: doxy or tetracycline; IV penicillin if severe

Question 17

Ehrlichiosis (intracellular, gram neg bacteria)

Answer 17

Spread via tick bite; fevere, chills, malaise, can progress to renal failure/GI bleed. Tx: doxycycline

Question 18

Tularemia (Francisella tularensis, small gram-neg bacteria)

Answer 18

Spread by ticks, animal bites. Reservoir is rabbits. Fever, HA, nausea, ulcer at side of bite, painful LAN. Tx: Im streptomycin or gentamicin

Question 19

Q fever causative organism

Answer 19

Coxiella burnetti

Question 20

Q fever features

Answer 20

Reservoir is farm animals. Spread via blood, milk, inhalation. Acute: B sx, N/V. Chronic: endocarditis. Tx: acute- doxy or fluorquinolone. Chronic: rifampin

Question 21

Cat scratch disease

Answer 21

Bartonella. Causes LAD. Tx: self-limited but give doxy to sx

Question 22

Cryptococcus (yeast)

Answer 22

Assoc with pigeon droppings. Can cause pulm infection and/or CNS disease. Meningitis: elevated opening pressure. Tissue bx shows lack of inflammatory response. India ink shows halos. Tx: amphotericin + flucytosine x 2 weeks, followed by oral fluconazole.

Question 23

Blastomycosis (dimorphic fungus)

Answer 23

Causes pulmonary and/or disseminated disease. Can cause verrucous skin findings. Tx: itraconazole (ampho if meningitis)

Question 24

Histoplasmosis (dimorphic fungus w/ septate hyphae)

Answer 24

Bird/bat droppings in Ohio/Mississippi River valley. Flu-like sx, HSM, erythema nodosum. Tx: itraconazole (ampho if severe or immunocompromised)

Question 25

Coccidiomycosis (dimorphic fungus)

Answer 25

Asx or nonspecific resp sx. Disseminated causes focal CNS findings. Tx fluconazole or itraconazole (ampho if severe or immunocompromised)

Question 26

Sporotrichosis

Answer 26

Tx: itraconazole or K iodide for lymphocutaneous

ampho if disseminated

Question 27

Cryptosporidium (protozoa)

Answer 27

Fecal oral spread. Causes watery diarrhea. Supportive care only

Question 28

Amebiasis (E. histolytica, protozoa)

Answer 28

Bloody diarrhea, abd pain, +/- liver abscess. Metronidazole for abscess.

Question 29

Ascariasis (roundworm)

Answer 29

May be asx, can have abd pain, vomiting. If heavy worm burden can have bowel or bile duct obstruction. Tx: albendazole, mebendazole, or pyrantel pamoate.

Question 30

Hookworm

Answer 30

Larve enter skin –> lung –> cough and swallow –> GI tract. Cough, anemia, malabsorption, anemia, eosinophilia. Tx: mebendazole or pyrantel pamoate

Question 31

Enterobiasis (enterobius vermicularis or pinworm)

Answer 31

Perianal pruritis at night. Tx: mebendazole or pyrantel pamoate

Question 32

Tapeworm (cestodes e.g. Taenia solium)

Answer 32

Cysticercosis. From pork etc. Most common cause of epilepsy worldwide. Tx: praziquantel, vitamin b12 if deficient (fish tapeworm).

Question 33

Schistosomiasis (trematode)

Answer 33

Penetration of skin in contaminated fresh water –> lungs –> portal vein –> venules of mesentery, bladder, uterus. Can cause fever/diarrhea, and later cause liver fibrosis, pHTN. Tx: praziquantel

Question 34

Giardiasis (protozoa)

Answer 34

Lauren’s diarrhea lol

Tx: metronidazole

Question 35

Trichinellosis (roundworm)

Answer 35

Infection from undercooked meat. Triad: periorbital edema, myositis, eosinophilia. Also see subungual splinter hemorrhages, retinal hemorrhages.

Question 36

Chikungunya (virus)

Answer 36

Spread by mosquitos. Sudden onset high fever, rash, JOIN PAIN. Can cause chronic joint pain.

Question 37

Dengue fever

Answer 37

Spread by mosquitoes. Fever, myalgias, rash that looks like measles. In small number of cases, can cause hemorrhagic fever.

Question 38

What types of diarrhea are treated with abx?

Answer 38

Salmonella only if immunocompromised, tx with cipro.
Shigella tx with Bactrim.
Campylobacter tx with erythromycin.
Giardiasis tx with metronidazole.