ID

Question 1

Occurs in South and Southeast Asia. Flu-like febrile illness, myalgias, joint pains, HA and Retro-Orbital Pain, Rash, petechial, thrombocytonepia, elevated LFTS. Dx? Rx?

Answer 1

Dengue Fever. Supportive Care.

Question 2

Fever, anemia, splenomegaly, cerebral endema can occur. Dx? Rx?

Answer 2

Plasmodium Falciparum Malaria.

Question 3

Intestinal perforation is a complication of this condition, fever, chills, bradycardiac, Abdominal Pain, Rose Spots. Dx? Rx?

Answer 3

Typhoid Fever.

Question 4

Associated with outpatient exposure, Fresh water swimming, household pets. GI symptoms, Conjunctival suffusion, Juanidce, renal failure.

Answer 4

Leptospirosis. Jaundice and renal failure is Weils syndrome.

Question 5

Infection arises in soil and organic matter, associated with outdoor activities or occupations. Starts as a papular lesion then ulcerates over time, non purulent dishcarge. Dx? Rx?

Answer 5

Sporotrichosis (fungal infection). Itracanazole.

Question 6

Candidal infeciton that can cause pneumonia or manifest on skin and bones. Dx?

Answer 6

Blastomycosis.

Question 7

Associated with cervicofacial disease (gingivitis, dental caries, extraction). Humans are the only reservoir. Dx?

Answer 7

Actinomycosis.

Question 8

Airbone fungus that causes cough, hemoptysis and erythema nodosum.

Answer 8

Coccidioidmycosis.

Question 9

Rx for Mild C. diff? Rx Severe? Rx if patient has illeus? Rx? for Toxic megacolon?

Answer 9

Oral flagyl. PO Vanc (and IV flagyl). IV flagyl and Rectal Vanc. Surgery.

Question 10

Fever, hypotension, swelling and erythema of leg. Pain out of proportion to findings. Dx? Rx?

Answer 10

Necrotizing Fascitis. Urgent Surgical debreidement and abx (Zosyn or Carbepenem +Vanc +Clindamycin)

Question 11

Fever, pharyngitis, posterior or diffuse cervical lymphadenapathy, hepatosplenomegaly. Dx? What is a possible complication after treatment?

Answer 11

Infectious Mononucelosis. Viral exanthema after improper administration of abx, immune mediated due to antibodies to penicillin.

Question 12

Associated with foreign body insertion, pt become febrile, lethargic, tachy, hypotensive Dx? Rx?

Answer 12

TSS. Clindamycin (prevents release of staph exotoxin) +/- Vanc

Question 13

What is the appropriate antimicrobial ppx to give pts who have been in close contact with a pt with neisseria meningitidis?

Answer 13

Rifampin, cipro, ceftriaxone

Question 14

Fever, cervical and occipital lymph nodes, maculopapular rash that begings on face and spreads caudally.

Answer 14

German measles Rubella. Supportive rx.

Question 15

Fever, malaise, HA, petechial rash that begins on the distal extremities palms and soles and then spreads to trunk.

Answer 15

Rocky Mountain Spotted Fever.

Question 16

High fever that rapidly resolves. Then eruption of rosy non pruritic rash that begins on trunk and spreads to extremities.

Answer 16

Roseola.

Question 17

Severe illness associated with cough, conjunctivitis and coryza, blue-white koplik spots found on buccal mucosa. Rash that begins on face and spreads down.

Answer 17

Measles.

Question 18

Occurs in HIV pt with CD4 count < 100 charastetic lesion is umblicaiton with central necrosis resembling molluscum contagiousum. Dx?

Answer 18

Disseminated Cryptococcus. Cutaneous Cryptococcus

Question 19

Pt underwent appendectomy now presents 2 weeks later with swinging fever, cough and shoulder pain. Dx? Next step in management?

Answer 19

Possible intra abdominal abscess or subphrenic abscess. Get US.

Question 20

What is the next step in mangement when health care workers have been exposed to a TB pt whose results come back positive on aFb?

Answer 20

PPD if first result negative then repeat PPD in 3 months.

Question 21

CSF analysis for bacterial meningitis ?

Answer 21

WBC > 1,000 Glucose <40 Protein > 250 (low glucose, high protein)

Question 22

CSF analysis for viral meningitis ?

Answer 22

WBC 100-1,000 Glucose > 40 Protein <100 (normal glucose, low protein)

Question 23

CSF analysis for TB meningitis ?

Answer 23

5-1,000 Glucose <10 Protein>250 (very low glucose, high protein)

Question 24

Immunocompromised pt, HIV develops focal neurological deficits MRI shows non-enhancing demyleinating lesions. Dx?

Answer 24

PML. CNS lymphoma and Toxo have ring enhancing lesions.

Question 25

Pt has watery discharge and no organism seen on gram stain. Dx? Rx?

Answer 25

Urethritis. Chlamidya. Azithromycin po 1g x1 or doxy for 7 days. Co infection is common so treat with ceftriaxone im x 1 for gonnorrhea.

Question 26

Appropriate abx for pregnant UTI pts ? For pregnant pylonephritis pts?

Answer 26

1. Amoxicillin, Nitrofurantoin, Keflex. 2. IV ceftriaxone, ampcillin, gentamicin.

Question 27

Occurs in children during the summer, characterized by painful red vesicles in the posterior oropharynx. Dx?

Answer 27

Herpagina from Cocksackie A virus.

Question 28

How do you treat an infant born to Hepatitis B mother?

Answer 28

Give immunoglbulin and Vaccine after the birth. 2nd vaccine at 2 months and 3rd at 6 months then check titers at 9 months.

Question 29

Bone marrow transplant p/w pulmonary symptoms and nasal bleeding/congestion. Dx?

Answer 29

Invasive aspergillous

Question 30

Treatment for latent TB?

Answer 30

Isoniazid and Rifapantine weekly for 3 months (not recommended in HIV pts) Isoniazid for 6-9 months, isoniazid and rifampin for 4 months

Question 31

Rx for CF pt with pneumonia?

Answer 31

Cefepime, Amicakin (2 drugs against pseudomonas) + Vanc if pt has hx of MRSA.

Question 32

Pt who was previously vaccinated against rabies gets a cat bite. Whats the management?

Answer 32

Give vaccine only. If no prior immunization, then vaccine and immunoglobulin are needed.

Question 33

Rx for cat scratch disease?

Answer 33

1. Azithromycin to kill Bartonella Henselea

Question 34

Difference between Rubella (German Measles) and Rubeola (Measles)

Answer 34

Rubeola has higher fevers and darker rash.

Question 35

Rx for strept pharyngitis? Dx?

Answer 35

Amoxcillin. Fever, Exudate, Cervical lymphadenopahthy, No cough. Centor criteria. Rapid strept, if negative then throat culture.

Question 36

Rx for uncomplicated pediatric pneumonia?

Answer 36

Amoxcillin.

Question 37

Rx for PID?

Answer 37

IV ceftriaxone/cefoxitin and IV doxy

Question 38

Common viruses that cause menigitdits and encephalitis in children?

Answer 38

Arbo or Enterovirus.

Question 40

Rx for endocarditis?

Answer 40

Vanc + gent

Question 41

Man developes fever, fatigue, myalgia, sore throat, lymphadenopathy, painful mucocutaenous ulcre and generalized rash (including palms and soles), leukopenia, thrombocytopenia 2 weeks after sexual encounter. Dx?

Answer 41

Acute HIV viral infection

Question 42

pt w/ multiple sex partners p/w fever, malaise, N/V, increase AST/ALT, enlarge liver. Dx?

Answer 42

Acute Hep B infection

Question 43

1. Rx for 1st recurrence CDI? 2. 2nd recurrence? 3. Subsequent recurrences?

Answer 43

1. Flagyl 2. Po Vancomycin 3. Fidoxamicin, fecal transplant

Question 44

Management of pregnant pt with Heb B infection.

Answer 44

Antiviral therapy and vaccination to mom. Vaccination and IVIF w/in 12 hrs for neonate.

Question 45

1. Rx for Primary, Secondary and early latent syphilis 2. Rx for late latent syphilis? 3. Rx for neurosyphilis? Complication of rx?

Answer 45

1. Pen G IM single dose 2. Pen G IM weekly for 3 weeks 3. Aqueous Pen G 4. Jarisch-Herxheimer reaction (supportive care)

Question 46

Fever, mayagias, athralgias, splenomegaly, glomerulonephritis (hematuria, proteinuria) + RF, splinter hemorrhages, janeway lesions. Dx?

Answer 46

Infective Endocarditis

Question 47

Dysuria, frequency, hematuria, eosinophilia in emigrant from US. Dx? Test? Rx?

Answer 47

Schistosomiasis. Urine sediment microscopy. Praziquental

Question 48

Rx for latent TB in adults? In kids ?

Answer 48

Isoniazid for 9 months in children and adults. Rifampin for 6 months in kids and 4 months in adults.

Question 49

Rx for post-exposure prophylaxis for HIV ?

Answer 49

2 nucleoside (tenovir, emtricitabine, lamuvidine, zidovudine) + 1 non-nucleoside (ripilivirine), integrase inhibitor raltegravir, protease inhibitor( atazanavir, ritonavir) w/ 72 hrs give it, continue for a month

Question 50

Flu like illness, myalgias, joint pain, retro-orbital pain, rash, thrombocytoenpia, petechia. Dx? Management?

Answer 50

Dengue Hemorrhagic fever. Supportive care.

Question 51

Associated with occupational eposure, fresh water swiming, conjunctival suffusion, GI symptoms, Jaundice, hepatosplenomegaly. Dx?

Answer 51

Leptospirosis

Question 52

fever, chills, abdominal pain, rose spots (faint-salmon-colored macules on trunk and abdomen) Dx?

Answer 52

Typhoid fever.

Question 53

Chorioretinitis, intracranial calcifications, hydrocephalus, hearing impairment. Dx?

Answer 53

Congenital Toxo. (mother eating undercooked meat.) Check maternal serology or amniocentesis.

Question 54

Involves lungs and proceeds verrucous skin lesions.

Answer 54

Blastomycosis

Question 55

Chemo/neutropenic pt developing glistening off white lesions of eyes? Chemo/neutropenic patient develops ulcerative rash.

Answer 55

1. Candida endopthalmitis. 2. Ecthyma gangrenosum caused by pseudomonas.

Question 56

Garderners, landscapers ulcerated nonpurulent odorless skin papule. Dx? rx?

Answer 56

Sporotrichosis. 3-6 months po itracanazole.

Question 57

Name the diferent stages of lyme disease. Dx? Rx?

Answer 57

Lyme disease caused by spirochete borrelia burgdorferi transmitted via ixodes (deer tick) Early symptoms ( erthema migrans) Early disseminated: Bells payls, cardiits Late: Athritis, neuropathy. Dx. Serology (ELISA and Western blot.) Doxycycline for 28 days. Amoxcillin for pregnant pts.