ID

Question 1

MRSA w intermediate vanc sensitivity

Answer 1

MIC >2

-> use daptomycin

Question 2

ethambutol toxicity

Answer 2

retrobulbar neuritis -> decreased visual acuity and green-red color distinction
*perform visual acuity and color vision testing prior to starting

Question 3

disseminated MAC

Answer 3

fever, chills, sweats, fatigue, weight loss
lymphadenopathy, hepatosplenomegaly, anemia, leukopenia, and elevated alkaline phosphatase
can cause IRIS, especially if initial CD4

Question 4

Tx coccidioidal meningitis

Answer 4

fluconazole

Question 5

syphilis treatment

Answer 5

neurosyphilis: IV PCN

late latent syphilis: IM benzathine PCN G

Question 6

duration of pulmonary TB treatment

Answer 6

9mo for:
patients who do not receive pyrazinamide during the initial phase
patients whose sputum cultures are still positive at the end of the initial treatment phase

Question 7

HIV pre and post exposure prophylaxis

Answer 7

pre: tenofovir-emtricitabine
post: three-drug regimen of combination tenofovir-emtricitabine and raltegravir

Question 8

standard eval for encephalitis

Answer 8

LP
MRI
EEG

Question 9

treatment uncomplicated cutaneous anthrax

Answer 9

cipro, levofloxacin, moxi, doxy

Question 10

nitrofurantoin in pregnancy

Answer 10

avoid in last 30d if possible (can cause hyperbili) if alternative agent is available

Question 11

what age to add listeria coverage for meningitis

Answer 11

> 50yo

Question 12

West Nile Sx

Answer 12

Fever, headache, and focal limb weakness

Question 13

Management of varicella in immunocompromised

Answer 13

Same as disseminated (eg also contact and airborne isolation)

Question 14

Treatment of candidemia

Answer 14

caspofungin, anidulafungin, and micafungin
Transition to fluconazole can occur after 5 to 7 days of therapy with an echinocandin if the patient is clinically stable, the isolate is susceptible to fluconazole, and repeat blood cultures are negative.

Question 15

empiric treatment prostatitis

Answer 15

cipro 2-4wks

Question 16

Tx ESBL

Answer 16

carbapenem

Question 17

severe C diff

Answer 17

WBC >15,000
Cr >1.5
-> enteral vanc

Question 18

complicated C diff

Answer 18

severe disease with the additional findings of hypotension, ileus, or megacolon
Tx: enteral (or rectal) vanc plus IV metronidazole

Question 19

Creutzfeldt-Jakob

Answer 19

present in the seventh decade of life and have disordered cognition, ataxia or spasticity, myoclonus, and elevated 14-3-3 protein

Question 20

smallpox

Answer 20

small red dots on the pharyngeal and buccal mucosa with centripetal spreading to the hands and face, followed by the arms, legs, and feet; the rash progresses in synchronous fashion, from macules to papules to vesicles and pustules before crusting over

Question 21

whirlpool footbath furunculosis

Answer 21

Mycobacterium fortuitum

Question 22

monitoring long term nafcillin and other drugs

Answer 22

nafcillin: CBC, LFT, Cr
other beta lactams: CBC, Cr
anti pseudomonal PCNs: also check K

Question 23

anaplasmosis

Answer 23

fever, leukopenia, thrombocytopenia, and mild elevation in liver enzymes

Question 24

babesiosis

Answer 24

fever and signs of hemolysis, including jaundice, scleral icterus, and splenomegaly

Question 25

Lyme IgG and IgM interpretation

Answer 25

if Sx present for >1mo and negative IgG -> its not Lyme

Question 26

Babesiosis Tx

Answer 26

ASx: no treatment

mild: atovaquone and azithro
severe: clinda and quinine, exchange transfusion for severe anemia w >10% parasitemia

Question 27

inpt treatment PID

Answer 27

cefoxitin or cefotetan (second-generation cephalosporins) plus intravenous doxycycline

Question 28

eval/treat pulmonary cryptococcus

Answer 28

LP even if no CNS Sx to eval for possible CNS dz

fluconazole

Question 29

cutoff for treatment of CAUTI

Answer 29

> 1000 CFUs

Question 30

pseudomonas pneumonia

Answer 30

think of in bronchiectasis or other structural lung disease, frequent Abx, recent steroids
*need anti-pseudomonal double coverage
anti-pseudomonal beta lactam, aminoglycoside, and respiratory fluoroquinolone

Question 31

recurrent UTI

Answer 31

three UTIs in the previous 12 months or two UTIs in the previous 6 months -> provide prophylaxis

Question 32

acute progressive disseminated histoplasmosis

Answer 32

fever, wt loss
LAD, HSM
anemia, thrombocytopenia and leukopenia, and elevated serum aminotransferases and alkaline phosphatase
CXR: normal or show scattered nodular densities or a diffuse reticular pattern
Tx: liposomal amphotericin B