ID- MKSAP Questions IV

Question 1

With a dog bite in an immunosuppressed patient (asplenia, cirrhosis, etc), what do you treat with?

Answer 1

3-5 day course of Augmentin

• if PCN allergy: Bactrim/FQ/doxycycline + flagyl/clinda

Question 2

What can you use to treat carbapenem-resistent Pseudomonas?

Answer 2

ceftolozane-tazobactam and colistin

Question 3

Most common bacteria causing CAP

Answer 3

• Strep pneumo
• H flu
• Chlamydia pneumo
• Mycoplasma
• Legionella

Question 4

Outpatient treatment of flu options

Answer 4

• within 48 hrs
• oseltamivir
• baloxavir
• zanamivir

Question 5

Name 3 neuraminidase inhibitors and route given

Answer 5

• oseltamivir (oral)
• zanamivir (intranasal)
• peramivir (IV for inpatients)

Question 6

What is baloxavir

Answer 6

Polymerase acidic endonuclease inhibitor (oral treatment for flu for outpatients)

Question 7

Empiric treatment in man with febrile UTI

Answer 7

• cefepime (empiric FQ no longer recommended 2/2 resistances)
• imaging of urinary tract esp if no improvement in 72 hours to look for prostatic abscess

Question 8

What agent to use in preventing opportunistic fungal infections after hematopoietic stem cell transplantation?

Answer 8

Posaconazole (has activity against candida, aspergillus, etc)

• there is an increase risk of invasive fungal infections even after neutropenia has improved (unlike other viral things you would want to prophylax for)

Question 9

How to treat TB meningitis?

Answer 9

• rifampine, isoniazid, pyrazinamide, ethambutol
  AND
• dexamethasone

Question 10

Most common causes of chronic meningitis are…

Answer 10

• Cryptococcus

- TB

Question 11

3 preferred treatment of latent TB + 1 alternate

Answer 11

1. 3 months of isoniazid plus rifapentine given once weekly
2. 4 months of rifampin given daily
3. 3 months of isoniazid + rifampin daily
4. 6-9 months of self-administered isoniazid

Question 12

Most common infections 1-month post-solid organ transplant.

Answer 12

Nosocomial infections similar to pts who have had other surgeries (i.e. C. diff)

Question 13

Cytoplasmic morulae (basophilic inclusion bodies composed of clusters of bacteria) in leukocytes (monocytes vs neutrophils)

Answer 13

• in monocytes: ehrlichiosis

- in neutrophils: anaplasmacytosis

Question 14

Intraerythrocytic banana-shaped gametocytes

Answer 14

Malaria (hemolytic anemia)

Question 15

Intraerythrocytic tetrad forms

Answer 15

Babesia (hemolytic anemia)

Question 16

Intraneutrophilic gram-positive diplococci

Answer 16

Pneumococcal infection

Question 17

Empiric candidemia coverage

Answer 17

Echniocandin (i.e. anidulafungin, capsofungin, micafungin)

NOT azoles cuz some candida have intrinsic resistance (C. glabrata, C. auris, and C. krusei)

Question 18

Haemophilus influenzae gram stain

Answer 18

pleomorphic gram-negative coccobacilli

Question 19

What common cause of meningitis is not covered by the quadrivalent meningococcal vaccine?

Answer 19

Serogroup B Neisseria meningitides

Question 20

Antibiotics for proctitis for people at risk for STIs.

Answer 20

CTX and doxycycline (to cover Chlamydia trachomatis and Neisseria gonorrhoeae)

Other causes of proctitis are HSV-1 and 2 and syphilis (if there is diarrhea- AKA protocolitis, Campylobacter, Shigella and Entamoeba histolytica should be considered)

Question 21

What do you treat CMV with?

Answer 21

Ganciclovir

Question 22

What does acyclovir ppx cover?

Answer 22

HSV and VZV (not CMV)

Question 23

When do you switch from vanc to dapto to treat MRSA endocarditis/OM/bacteremia?

Answer 23

When MIC of vanc is >2.