IDS Flashcards
According to the current definition, which of the following criteria is NOT essential for a diagnosis of FUO?
a) Fever of ≥38.3°C (≥101°F) on at least two occasions
b) Illness duration of ≥3 weeks
c) No known immunocompromised state
d) Diagnosis uncertain after 1 week of inpatient evaluation
Correct Answer: d) Diagnosis uncertain after 1 week of inpatient evaluation
Rationale:
The text explicitly states that the requirement for 1 week of inpatient evaluation has been removed from the current definition of FUO.
patient with FUO who presents with urticaria, bone pain, and monoclonal gammopathy
Schnitzler syndrome,
Meaning of DRESS
More common causes of
drug reaction with eosinophilia and systemic symptoms; - is often accompanied by eosinophilia and also by
lymphadenopathy, which can be extensive.
Drugs that induce fever:
allopurinol
carbamazepine
lamotrigine,
phenytoin,
sulfasalazine,
furosemide,
antimicrobial drugs
(especially
sulfonamides, minocycline, vancomycin, β-lactam antibiotics, and
isoniazid),
some cardiovascular drugs
(e.g., quinidine),
and some
antiretroviral drugs (e.g., nevirapine).
Which species of malaria has the longest intrahepatic phase?
d) P. malariae
P. malariae has an intrahepatic phase of 15 days.
Which species of malaria is most likely to infect older red blood cells?
d) P. malariae
P. malariae preferentially infects older red blood cells.
Which species of malaria is known to cause relapses?
d) Both P. vivax and P. ovale
Both P. vivax and P. ovale are capable of causing relapses.
Which species of malaria has a 48-hour erythrocytic cycle?
d) Both P. falciparum and P. vivax
Both P. falciparum and P. vivax have an approximate duration of the erythrocytic cycle of 48 hours.
Which species of malaria is characterized by banana-shaped gametocytes?
a) P. falciparum
P. falciparum often has banana-shaped gametocytes.
Which of the following is NOT considered a major manifestation of severe falciparum malaria?
a) Cerebral malaria
b) Acidemia/acidosis
c) Jaundice
d) Severe normocytic, normochromic anemia
Answer: c) Jaundice
Rationale: While jaundice can occur in severe malaria, it is listed as an “Other” manifestation in the table, not a “Major” one.
What is the defining characteristic of cerebral malaria?
a) High fever
b) Unarousable coma
c) Seizures
d) Headache
Answer: b) Unarousable coma
Rationale: The table specifically states that cerebral malaria is characterized by “unarousable coma/failure to localize or respond appropriately to noxious stimuli; coma persisting for >30 min after generalized convulsion.”
Which of the following laboratory findings would support a diagnosis of severe anemia in the context of severe falciparum malaria?
a) Hematocrit of 18%
b) Hemoglobin level of 8 g/dL
c) Platelet count of 50,000/μL
d) White blood cell count of 12,000/μL
Answer: a) Hematocrit of 18%
Rationale: The table defines severe anemia as a hematocrit of <15% or hemoglobin level of <5 g/dL
What is the threshold for defining hypoglycemia in severe falciparum malaria?
a) Plasma glucose < 40 mg/dL
b) Plasma glucose < 70 mg/dL
c) Plasma glucose < 100 mg/dL
d) Plasma glucose < 150 mg/dL
Answer: a) Plasma glucose < 40 mg/dL
Which of the following is NOT a criterion for diagnosing acidemia/acidosis in severe falciparum malaria?
a) Arterial pH of <7.25
b) Base deficit >8 meq/L
c) Venous lactate level of >5 mmol/L
d) Respiratory rate >20 breaths/minute
Answer: d) Respiratory rate >20 breaths/minute
Rationale: While increased respiratory rate is a common finding in metabolic acidosis (as the body tries to compensate by expelling more CO2), it is not explicitly listed as a diagnostic criterion for acidemia/acidosis in this table.
What is the definition of hyperparasitemia in severe falciparum malaria?
a) Parasitemia level of >1%
b) Parasitemia level of >5% in non-immune patients
c) Parasitemia level of >10% in any patient
d) Parasitemia level of >20% in any patient
e) b and c
Answer: e) b and c (Parasitemia level of >5% in non-immune patients and >10% in any patient)
Rationale: The table states that hyperparasitemia is defined as a parasitemia level of >5% in non-immune patients and >10% in any patient.
Which of the following is a characteristic feature of hemoglobinuria in severe falciparum malaria?
a) Associated with G6PD deficiency
b) Typically associated with dark urine due to the presence of blood
c) Usually caused by medications
d) Not associated with effects of oxidant drugs or red blood cell enzyme defects
Answer: d) Not associated with effects of oxidant drugs or red blood cell enzyme defects
Rationale: The table specifically states that hemoglobinuria in severe falciparum malaria is “not associated with effects of oxidant drugs and red blood cell enzyme defects (such as G6PD deficiency).”
species of malaria associated with development of Burkitt type Lymphoma
P. Falciparum
What is the first-line treatment for uncomplicated malaria caused by chloroquine-sensitive strains of Plasmodium falciparum?
a) Chloroquine alone
b) Artesunate plus sulfadoxine-pyrimethamine
c) Artesunate plus amodiaquine
d) Artesunate plus mefloquine
Answer: b) Artesunate plus sulfadoxine-pyrimethamine
Rationale: The table lists “Artesunate (4 mg/kg qd for 3 days) plus sulfadoxine (25 mg/kg)/pyrimethamine (1.25 mg/kg) as a single dose” as one of the first-line treatment options for uncomplicated P. falciparum malaria.
Which medication is used for radical treatment of P. vivax or P. ovale infections to prevent relapses?
a) Chloroquine
b) Primaquine
c) Artesunate
d) Mefloquine
Answer: b) Primaquine
Rationale: The table specifically mentions primaquine as the medication used for radical treatment to prevent relapses in P. vivax and P. ovale infections.
What is the recommended treatment duration for severe falciparum malaria with artesunate?
a) 3 days
b) 5 days
c) 7 days
d) 10 days
Answer: c) 7 days
Rationale: The table states that the recommended treatment for severe falciparum malaria with artesunate is “Artesunate (2.4 mg/kg stat IV followed by 2.4 mg/kg at 12 and 24 h and then daily if necessary, for children weighing <20 kg, give 3 mg/kg per dose)”
1 for 7 days.
Which of the following medications can be used as part of the second-line treatment for imported malaria?
a) Chloroquine
b) Primaquine
c) Doxycycline
d) Sulfadoxine-pyrimethamine
Answer: c) Doxycycline
Rationale: The table lists doxycycline as one of the options for second-line treatment of imported malaria, typically used in combination with other medications like artesunate or quinine.
Which drug is known to have a significant risk of hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency?
a) Quinine
b) Chloroquine
c) Primaquine
d) Mefloquine
Answer: c) Primaquine
Which drug is most likely to cause neuropsychiatric reactions, including convulsions and encephalopathy?
a) Quinine
b) Chloroquine
c) Primaquine
d) Mefloquine
Answer: d) Mefloquine
Which drug is considered effective against multidrug-resistant P. falciparum malaria, but resistance has emerged in Southeast Asia?
a) Quinine
b) Chloroquine
c) Piperaquine
d) Amodiaquine
Answer: c) Piperaquine
Which drug primarily acts on the trophozoite stage of the parasite and has no action on the liver stages?
a) Quinine
b) Chloroquine
c) Primaquine
d) Mefloquine
Answer: a) Quinine
Which drug is considered a radical cure for Plasmodium vivax and Plasmodium ovale infections, eliminating both blood and liver stages of the parasite?
a) Quinine
b) Chloroquine
c) Primaquine
d) Mefloquine
Answer: c) Primaquine
Answer: c) Primaquine
What is the most effective time to avoid mosquito exposure?
a) Midday
b) Dusk
c) Dawn
d) Dusk to dawn
Answer: d) Dusk to dawn
Which of the following is NOT mentioned as a measure to reduce mosquito bites?
a) Using insect repellents with DEET
b) Wearing long-sleeved clothing
c) Using mosquito nets treated with pyrethroids
d) Avoiding areas with high humidity
Answer: d) Avoiding areas with high humidity
What is the recommended percentage of DEET in insect repellents?
a) 5-10%
b) 10-35%
c) 35-50%
d) 50-75%
Answer: b) 10-35%
Answer: b) 10-35%
Chemoprophylaxis for Resistant P.Falciparum:
atovaquone-proganil, doxycycline pr mefloquine
Chemoprophylaxis mainly for P. vivax
Primaquine
Anti-relapse therapy for P vivax and P ovale:
Primaquine
According to the table, a 21 year-old with an HIV infection would be classified as having Stage 3 if their CD4+ T lymphocyte count is below:
a) 200 cells/µL
b) 500 cells/µL
c) 1000 cells/µL
d) 1500 cells/µL
Answer: a) 200 cells/µL
HIV is an RNA virus whose hallmark is _________. The
replication cycle of HIV begins with the high-affinity binding via
surface-exposed residues within the _______ to its receptor on
the host cell surface, __________.
the reverse transcription of its
genomic RNA to DNA by the enzyme reverse transcriptase.
gp120 protein
the CD4 molecule
The two major co-receptors for HIV-1 :
CCR5 and CXCR4.
HIV-1 binds to
its target cell via the _______, leading to a conformational change in the
_________ that allows it to bind to the co-receptor _________. The virus then firmly attaches to the host cell membrane in a coiledspring fashion via the newly exposed_______ .
CD4 molecule
gp120 molecule
CCR5 (for R5-using
viruses).
gp41 molecule
Most common mode of HIV transmission:
Type of sexual practice with Highest risk of transmission:
Heterosexual
Receptive Anal intercourse
HIV:
long-term non-progressors if: they had been infected with HIV for a
long period (___ years), their CD4+ T-cell counts were in the normal
range, their plasma viremia remained relatively low (undetectable to
several thousand copies of HIV RNA/ml plasma), and they remained
clinically stable over years without receiving ART
others move on to require ART eventually and the remaining 1% that remains to have low viral load are called_________
≥10
Elite controllers
Accessory receptor that likely plays an important role in the transmission
of HIV at mucosal surfaces such as the genital tract and gut and
contributes somewhat to the pathogenesis of HIV disease.
Integrin α4β7
