ID- MKSAP Questions

Question 1

Best way to prevent Staph a surgical site infection for ortho and CT surgery

Answer 1

• Nasal Staph screen and preop decolonization 2 weeks prior to surgery (mupirocin ointment for 5 days with or without chlorhexidine gluconate body wash)

Question 2

IRIS (immune reconstitution inflammatory syndrome) is the return of a robust immune response resulting from treatment of HIV. This may “unmask” a pre-existing infection. What do you do when this occurs?

Answer 2

• treat underlying infection while continuing ART

Question 3

When does IRIS usually present?

Answer 3

• median 48 days after initiation of ART

Question 4

When do you start prednisone in IRIS?

Answer 4

• life threatening OR

- involves pericardium or CNS

Question 5

CAP requiring ICU admission empiric abx:

Answer 5

B-lactam (unasyn, cefotaxime, CTX, or ceftaroline (but NOT ceftazidime because it has min activity against GPC aka Strep pneumo) for Strep and GNR (H flu) PLUS agent active against legionella (macrolide or quinolone)

Question 6

Initial studies for fever of unknown origin:

Answer 6

• CBC with diff
• CMP
• Blood culture x3
• Cultures of other bodily fluids of suspicion (UCx)
• ESR
• TB
• HIV
• CXR/chest CT

Question 7

(Sub)Conjunctival suffusion is associated with which infection?

Answer 7

Leptospirosis

characterized by redness of conjunctiva that resembles conjunctivitis but does not involve inflammatory exudates

Question 8

What is post-lyme disease syndrome (PLDS)

Answer 8

poorly understood sequela of Lyme disease thought to be 2/2 disordered immunologic response to preceding infection; most patients slowly improve over a 6-months course (treatment is symptomatic)

Question 9

Course for early localized Lyme disease

Answer 9

Doxy 10-21 days

Question 10

What is Powassan virus?

Answer 10

Tick-borne illness carried by Ixodes (like Anaplasma, Babesia, and Borrelia) that can cause meningoencephalitis

Question 11

Rapidly growing ______ _______ such as, _______ ________ can produce chronic, nonhealing wounds that do not respond to conventional antimicrobial therapy.

Answer 11

NonTB mycobacteria; Mycobacterium fortuitum

Question 12

Cut off for bacteriuria vs contamination in UCx sample for men

Answer 12

Voided urine: 10^5
I&O Cath: 10 ^2
of a single bacterial species

Question 13

PEP regimens

Answer 13

• TAF (NRTI) + emtricitabine (NRTI) + dolutegravir/raltegravir (integrase inhibitor) for 4 weeks
• testing for HIV immediately, 4-6 weeks then 3 months after exposure

Question 14

Outpatient uncomplicated pyelo regimens

Answer 14

• cipro 7 days
• levo 5 days
• initial dose of long-active IV med (CTX of aminoglycoside) if local FQ resistance (>10%)
• unless pregnant, no need for follow-up cultures
• get imaging if no response after 72 hours of appropriate treatment

Question 15

Patients with selective IgA deficiency are susceptible to _________ infection, manifesting as abdominal cramping, bloating, and chronic diarrhea.

Answer 15

Giardia lambdia

Question 16

What is the definition of recurrent UTI?

Answer 16

x3 episodes in 12 months or x2 in 6 months

Question 17

What is the definition of relapse UTI?

Answer 17

Infection caused by same strain and occurs within 2 weeks of completing therapy

Question 18

What is the definition of reinfection UTI?

Answer 18

UTI caused by different strain or if there is negative UCx in between

Question 19

When local bactrim resistance is high, what is the next line abx for recurrent cystitis?

Answer 19

Cipro or levofloxacin

Question 20

Pathognomonic finding for rhinocerebral mucormycosis

Answer 20

Black eschar on nose of palate