ID- MKSAP Questions III

Question 1

How long do you need to wait in between PCV13 and PPSV23 vaccines?

Answer 1

at least 8 weeks

Question 2

Treponemal testing

Answer 2

1st: EIA (enzyme immunoassay) = treponemal test
2nd: RPR/VDRL (nontreponemal test)
3rd: If EIA positive and RPR/VDRL negative, then confirm positive with 2nd treponemal test (i.e. FTA-ABS)

Question 3

What will treponemal testing look like in a patient who has successfully been treated for syphilis?

Answer 3

Positive treponemal tests (EIA and FTA-ABS) for life.

Non treponemal tests (RPR/VDRL) should remain negative unless re-infected.

Question 4

What is leading cause of swimming pool-related outbreaks of diarrheal illness?

Answer 4

Cryptosporidium

Question 5

How do you treat cyclospora infection?

Answer 5

Oral bactrim (1 DS tablet BID for 7-10 days)

Question 6

Where is cyclospora endemic?

Answer 6

Peru, Guatemala, Haiti, Nepal

Question 7

Do you change HIV regimen in pregnancy?

Answer 7

Not anymore

Question 8

Time frame of HAV vaccine prior to travel to endemic area?

Answer 8

Ideally 2-4 weeks prior to travel but x1 dose any time before usually good enough (though depending on the vax type, a second dose may be administered between 6-18 months)

Question 9

Preferred antibiotics for ESBL organisms

Answer 9

Carbapenem (even if it shows that it is susceptible to cefepime, zosyn)

Question 10

Kaposi sarcoma is associated with which virus?

Answer 10

Herpes virus 8

Question 11

A personal history of recurrent Neisseria infection of history of infection in multiple family members suggests a deficiency in…

Answer 11

one of the terminal complement components that make up the membrane attack complex (MAC) which comprises C5-C9

Question 12

Chronic granulomatous disease is a defect in ______ and is associated with _____ infections.

Answer 12

• neutrophil oxidation
• Aspergillus, Staph a, Burkholderia cepacia complex, Serratia marcescens, Norcardia

(Usually diagnosed in childhood)

Question 13

Myeloperoxidase plays a role in the destruction of ________.

Answer 13

Fungal organisms

Most people with this deficiency are asymptomatic.

Question 14

Infections associated with common variable immunodeficiency (CVID)

Answer 14

• recurrent respiratory tract and GI tract infections with encapsulated organisms
• low levels of IgG and IgA
• Strep pneumo, H flu, Mycoplasma
• Enterovirus, Norovirus, Giardia

Question 15

How do Mycobacterium marinum infections present?

Answer 15

Papules on extremities after trauma from fish (indolent skin or soft tissue infection)

Question 16

How does cutaneous anthrax present?

Answer 16

Cutaneous lesions that is initial pruritic and painless at site of old wound that progress to vesicular lesions surrounded by nonpitting edema.

Lesions then become hemorrhagic or necrotic and satellite lesions may form.

Then a central black eschar can develop and usually resolves over 6 weeks.

Question 17

Rhinocerebral aspergillosis vs mucormycosis

Answer 17

Aspergillosis usually occurs in patients with neutropenia typically secondary to hematologic malignancy vs mucormycosis is usually in DM (esp ketoacidosis) and can be distinguished by presence of eschar.

Biopsy is necessary to establish correct diagnosis because clinical presentation can be similar.

Question 18

What is Lemierre syndrome?

Answer 18

Jugular vein suppurative thrombophlebitis typically involving Fusobacterium necrophorum causing acute pharyngitis

Question 19

Treatment for patients with invasive candidiasis

Answer 19

oral azole or ampho B for duration 10-14 days

Note urine culture colonies may not correlate with active infection, so 10k colonies can still mean infection