ID- MKSAP Question V

Question 1

Recommended treatment duration for VAP (PNA 48 hours after intubation)

Answer 1

7 days (longer does NOT improve outcomes)

Question 2

How does Anti-NMDAR encephalitis present?

Answer 2

• choreoathetosis, psychiatric symptoms, seizures, autonomic instability
• young woman
• associated with ovarian teratomas >50% cases
• detection of anti-NMDAR Ab in serum is confirmatory

Question 3

How does Lyme meningitis present?

Answer 3

• summer and fall, peripheral facial palsy

- may be indistinguishable from viral meningitis (fever, HA, meningismus)

Question 4

How does West Nile neuroinvasive disease present?

Answer 4

• June-Oct
• Limb weakness, symmetric or single extremity
• nonspecific viral exanthema
• MRI may have focal lesions in thalami, BG, and spinal cord
• can present with meningitis, encephalitis, or myelitis

Question 5

Do you start TB treatment before or after AFB staining of sputum?

Answer 5

AFTER you obtain sputum and run AFB stain/culture (along with NAAT to differentiated TB from other mycobacteria)

Question 6

Typical course of abx for active TB

Answer 6

isoniazid, rifampin, pyrazinamide, ethambutol for 8 weeks, then isoniazid and rifampin for 18 weeks

Question 7

What infection can you get from reptiles/amphibians and how does it present?

Answer 7

• nontyphoidal Salmonella

- crampy abdominal pain, fever, nonbloody (at least visibly) diarrhea, vomiting

Question 8

What kind of infection is Erysipelothrix rhusiopathiae?

Answer 8

• infects fish, swine, poultry and can infect humans who are butchers, fish handlers and vets
• present as local cutaneous violaceous lesions of fingers and hands (but can even cause bacteremia and endocarditis)

Question 9

What environment is Aeromonas hydrophilia associated with and how should it be treated?

Answer 9

• associated with fresh/brackish waters
• obtained by obtaining laceration/puncture wounds leading to nec fasc
• treatment is with doxy + cipro/CTX