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Compiled PPS board reviewer > IDS > Flashcards

IDS Flashcards

1
Q

Fever without a focus definition

A

Rectal temperature of 38C or higher as the sole presenting feature

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2
Q

Common pathogens in late-onset neonatal bacterial disease

A

Group B streptococci
E. coli
Listeria monocytogenes

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3
Q

Most common serious bacterial infection in 1-3 age group and most common pathogen

A

Pyelonephritis

E. coli

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4
Q

Low risk criteria for child 1-3 mo old with fever

A 
CBC <15,000-20,000
Band:total ratio <0.2, absolute band ≤1,500
Urine <9-10 WBC
CSF <5-10 WBC
Stool <5 WBC
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5
Q

Pathogens that account for most cases of occult bacteremia in 3-36 mo age group

A

S. pneumoniae
N. meningitidis
Salmonella

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6
Q

Classic FUO

A

> 38C
3 weeks as outpatient, >2 visits
1 week in the hospital

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7
Q

Virulence factors:
slime layer, coagulase, Protein A, catalase, penicillinase, B-lactamase, Panton-Valentine leukocidin, exfoliatin A and B, TSST-1, altered PBP-2A

A

Staphylococcus aureus

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8
Q

Produces a yellow or orange pigment and B-hemolysis on blood agar

A

Staphylococcus aureus

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9
Q

Most common cause of osteomyelitis and suppurative arthritis in children

A

Staphylococcus aureus

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10
Q

Virulence factor responsible for methicillin resistance of MRSA isolates

A

altered PBP-2A

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11
Q

Common pathogens in cavitary pneumonia

A

S. aureus, M tuberculosis, K. pneumoniae

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12
Q

Treatment of TSS

A 
B-lactamase resistant antistaphylococcal antibiotic (nafcillin, oxacillin, first gen cephalosporin) 
PLUS clindamycin (to reduce toxin production
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13
Q

Most common cause of nosocomial bacteremia

A

S. epidermidis

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14
Q

Most common pathogen associated with CSF shunt meningitis

A

coagulase-negative staphylococci

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15
Q

Gram-positive, lancet-shaped, diplococci

A

Streptococcus pneumoniae

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16
Q

On solid media, forms unpigmented, umbilicated colonies surrounded by a zone of incomplete a hemolysis.
Bile soluble and Optochin-sensitive

A

Streptococcus pneumoniae

Average time to isolation is 14-15 hr

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17
Q

Gram-positive coccoid-shaped bacteria that tend to grow in chains
Zone of complete hemolysis that surrounds colonies grown in blood agar
Sensitive to bacitracin

A

Group A b-hemolytic streptococcus (S. pyogenes)

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18
Q

Rash appears 24-48 hours after onset of symptoms and begins to fade after 3-4 days
Starts around the neck and spreads over the trunk and extremities
Goose-pimple appearance
Strawberry tongue

A

Scarlet fever

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19
Q

Pathogen in bullous impetigo

A

S. aureus

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20
Q

Pathogen in nonbullous impetigo

A

GAS

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21
Q

Most common cause of acute pharyngitis in children

A

viruses

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22
Q

Most common cause of bacterial pharyngitis

A

GAS

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23
Q

Treatment of perianal streptococcal disease

A

oral cefuroxime

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24
Q

Latent period between GAS pharyngitis and poststreptococcal reactive arthritis

A

<10 days
Involves large joints, and small peripheral joints as well as the axial skeleton
Not migratory

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25
Q

Rheumatogenic GAS serotypes

A

M types 1, 3, 5, 6, 18, 29

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26
Q

Age of greatest risk for GAS pharyngitis

A

5-15 yr

Also highest incidence of both initial attacks and recurrences of acute rheumatic fever

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27
Q

Antiinflammatory therapy for arthritis with carditis without cardiomegaly or CHF

A

aspirin 50-70 mkday in QID x 3-5 days
then 50 mkday QID x 3 weeks
then half that dose for 2-4 weeks

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28
Q

Antiinflammatory therapy for arthritis with carditis, cardiomegaly, CHF

A 
prednisone 2 mkday QID x 2-3 weeks
then half the dose for 2-3 weeks 
then taper by 5 mg/24 hr every 2-3 days
When tapering prednisone, 
start asprin at 50 mkday QID x 6 weeks
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29
Q

Treatment for Sydenham chorea

A

phenobarbital 16-32 mg q6-8
If ineffective,
haloperidol 0.01-0.03 mkday BID pr
chlorpromazine 0.05 mkdose q4-6

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30
Q

Secondary prophylaxis for recurrences of ARF

A

Benzathine penicillin G 600,000 IU IM for ≤60 lb, 1,200,000 IU IM for >60 lb q21-28 days
or
Pen V 250 mg BI
or
Sulfadiazine or sulfisoxazole 0.5 g OD ≤60 lb or 1 g for >60 lb

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31
Q

Duration of secondary prophylaxis for ARF

  1. Rheumatic fever without carditis
  2. RF with carditis but without residual heart disease
  3. RF with carditis and residual heart disease
A
  1. RF w/o carditis: 5 years or until 21 yr
  2. RF with carditis, no residual heart disease: 10 yr or until 21 yr
  3. RF w/ carditis, with residual heart disease: 10 yr or until 40 yr, SOMETIMES FOR LIFE
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32
Q

Facultative anaerobic gram-positive cocci that form chains or diplococci in broth
Forms small gray-white colonies on solid medium
B-hemolytic, resistant to bacitracin and TMP-SMX
CAMP factor

A

Group B streptococcus

S. agalactiae

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33
Q

Vaginorectal GBS screening should be performed for all pregnant women ___ gestation

A

35-37 wk

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34
Q

Gram-positive, catalase-negative, facultative anaerobes that grown in pairs or short chains
Nonhemolytic on sheep blood agar
Able to grow in bile and hyrolyze esculin
Can grow in 6.5% NaCl and hydrolyze L-pyrrolidonyl-B-naphthylamide

A

Enterococcus

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35
Q

Aerobic, nonencapsulated, non-spore-forming, nonmotile, pleomorphic, GRAM POSITIVE BACILLI
Isolated in cystine-tellurite blood agar or Tinsdale agar - gray-black colonies
Urease negative
Elek test

A

Corynebacterium diphtheriae

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36
Q

62-kDa polypetide exotoxin

A

Diphtheria virulence factor

Inhibits protein synthesis and causes local tissue necrosis

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37
Q

Incubation period of diphtheria

A

2-4 days

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38
Q

The first evidence of cardiac toxicity occurs during the __ week of illness in diphtheria

A

2nd and 3rd

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39
Q

ECG findings in diphtheria toxic cardiomyopathy

A

prolonged PR interval
ST-T wave changes
dysrhythmias

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40
Q

In diphtheria, cranial neuropathies occur in the __ week, leading to oculomotor and ciliary paralysis

A

5th

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41
Q

Onset of symmetric polyneuropathy in diphtheria

A

10 days to 3 months after oropharyngeal infection

Distal weakness with proximal progression

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42
Q

Antimicrobial therapy for diphtheria

A

erythromycin 40-50 mkday IV/PO q6, max 2g/d
OR Pen G 100-150T ukd IV q6
OR daily procaine penicillin
<10 kg 300T u/d IM; >10 kg 600T u/d x 14 d

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43
Q

Antimicrobial prophylaxis for case contacts of diphtheria

A

Benzathine penicillin G
<6 yr: 600T u IM, >6 yr 1.2M u IM
OR erythromycin 40-50 mkday WID x 10d

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44
Q

Facultative anaerobic, non-spore-forming, motile, gram-positive bacilli
Catalase positive
tumbling motility, umbrella-type formation
grows at cold temp 4-10C

A

Listeria

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45
Q

Iron overload syndromes have high risk for __ because of sideraphores that scavenge iron

A

Listeriosis

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46
Q

Differentiate two clinical presentations for neonatal listeriosis

A

Early onset <5 days, septicemic form

Late-onset >5 days, mean 14 days, meningitic form

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47
Q

CBC findings in listeriosis

A

monocytosis or lymphocytosis

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48
Q

Treatment for listeriosis

A

ampicillin 100-200, up to 400 for meningitis mkday q6 alone or in combination with aminoglycoside 5-7.5 mkday q8
duration: 2-3 weeks

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49
Q

Actinomycosis in children suggests an underlying immunodeficiency, especially?

A

chronic granulomatous disease

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50
Q

Anaerobic, nonsporulating, gram-positive bacteria with a filamentous branching structure
Cultures in 24-48 hr
Forms loose masses of delicate branching filaments, with a characteristic spider-like growth
Does not stain with acid-fast stain

A

Actinomyces israelii

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51
Q

Sulfur granules - adherent mass of PMN attached to the radially arranged eosinophlic clubs of the granule on H&E staining - are characteristic of?

A

Actinomycosis

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52
Q

Chronic, granulomatous, suppurative disease characterized by direct extension to contiguous tissue across natural anatomic barriers with the formation of numerous draining fistulas and sinus tracts

A

actinomycosis

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53
Q

Lumpy jaw

A

actinomycosis

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54
Q

Chronic lower lobe pulmonary consolidation
Empyema
Wavy periostitis of the ribs

A

radiographic triad of thoracic actinomycosis

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55
Q

Treatment for actinomycosis

A

Penicillin G 250T ukday q4-6, max 18-24M u/day x 2-6 wk, followed by oral antibiotics for 3-12 mo
Penicillin V 100 mkday q6

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56
Q

Delicately branched, gram-positive, coccoid to bacillary bacteria that tend to fragment
Filamentous, obligate aerobe
Forms waxy, folded, or heaped colonies at the edges after 1-2 wk
Fragmented bacilli with stain concentrated in a beaded pattern along portions of the branching filaments with Kinyoun acid-fast staining

A

Nocardia

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57
Q

Treatment for nocardiosis

A

Trimethoprim-sulfamethoxazole
ampicillin and co-amox for N. brasiliensis
Superficial cutaneous 6-12 wk
6-12 mo for mycetoma, pulmonary, systemic

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58
Q

Gram-positive, fastidious, encapsulated, oxidase-positive, aerobic diplococus.

A

Neisseria meningitidis

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59
Q

Adrenal insufficiency caused by adrenal necrosis/hemorrhage in meningococcus

A

Waterhouse-Friedrichsen syndrome

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60
Q

Antibiotic treatment of meningococcemia

A

Penicillin G 300T umkday q4-6, max 12-14M
or ampicillin 200-400 mkday q6
or cefotaxime 200-300 mkday q6-8 (neonate)
or ceftriaxone 100 mkday q12-24

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61
Q

Most common complication of acute severe meningococcal septicemia

A

focal skin infarction

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62
Q

Antibiotic prophylaxis to prevent N. meningitidis infection

A 
Rifampin
Infants <1 mo: 5 mkdose q12 x 2 days
Children >1 mo: 10 mkdose q12 x 2 days
Ceftriaxone
<15 yr: 125 mg IM x 1 dose
>15 yr: 250 mg IM x 1 dose
Ciprofloxacin 
>1 mo: 20 mkdose x 1 dose
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63
Q

Nonmotile, aerobic, non-spore-forming, gram-negative, intracellular diplococcus with flattened adjacent surfaces
Thayer-Martin growth medium
Produces cytochrome oxidase

A

Neisseria gonorrhoeae

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64
Q

Most common sexually transmitted infection found in sexually abused children

A

Gonorrhea

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65
Q

Perihepatitis resulting from dissemination of gonococci from the fallopian tubes through the peritoneum to the liver capsule

A

Fitz-Hugh-Curtis syndrome

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66
Q

Two clinical syndromes of disseminated gonococcal infection

A
  1. Tenosynovitis-dermatitis syndrome

2. Suppurative arthritis syndrome

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67
Q

Painful, discrete, 1-20 mm pink or red macules that progress to maculopapular, vesicular, bullous, pustular or petechial lesions are dermatologic lesions associated with what pathogen?

A

Neisseria gonorrhoeae

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68
Q

Necrotic pustule on an erythematous base, including the palmar and plantar surfaces, sparing the face and scalp, numbering between 5 and 40

A

Neisseria gonorrhoeae

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69
Q

Antibacterial treatment for uncomplicated gonorrhea

A

Ceftriaxone 250 mg IM
Infant and children: 50 mkdose, max 125 mg

plus azithromycin 1 g PO x 1 dose
or doxycycline 100 mg PO BID x 7 days

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70
Q

Treatment for disseminated gonococcal infection

A

ceftriaxone 1 g/day x 7-14 days
Infant and children: 50 mkday max 1g

plus azithromycin 1 g PO x 1 dose
or doxycycline 100 mg PO BID x 7 days

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71
Q

Fastidious gram-negative, pleomorphic coccobacillus

A

H. influenzae

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72
Q

Most important known element of host defense against H. influenzae

A

Anti-PRP antibody

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73
Q

Treatment for H. influenzae meningitis

A

Ampicilli, cefotaxime or ceftriaxone
for 7-14 days
Dexamethasone 0.6 mkday q6 x 2 days

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74
Q

Duration of treatment for H. influenzae

  1. cellulitis
  2. preseptal cellulitis
  3. orbital cellulitis
  4. Supraglottitis/acute epiglottitis
  5. pneumonia
  6. suppurative arthritis
A
  1. cellulitis: 7-10 days, shift to oral once afebrile
  2. preseptal cellulitis: 5 days IV, 10 days total
  3. orbital cellulitis: 14 days IV
  4. supraglottis/epiglottitis: 7 days, shift to oral once able to take fluids by mouth
  5. pneumonia: 7-10 days
  6. suppurative arthritis: 5-7 days IV, 3 wk total or until normal CRP
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75
Q

H. influenzae prophylaxis

A

rifampin 0-1 mo 10 mkdose OD x 4 days

>1 mo 20 mkdose max 600 mg OD x 4 days

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76
Q

Small, fastidious, gram-negative coccobacilli

Colonize only ciliated epithelium

A

Bordetella

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77
Q

Virulence factors: filamentous hemagglutinin, agglutinogens, pertactin, tracheal cytotoxin, dermonecrotic factor

A

B. pertussis

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78
Q

Incubation period of B. pertussis

A

3-12 days

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79
Q

Stages of pertussis

A
  1. catarrhal stage (1-2 wk)
  2. paroxysmal stage (2-6 wk)
  3. convalescent stage (≥2 wk)
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80
Q

Cough of 14 days or longer

At least 1 associated symptom of paroxysms, whoop or posttussive vomiting. Consideration?

A

Pertussis

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81
Q

Infant younger than 3 mo, with gagging, gasping, apnea, cyanosis, apparent life-threatening event. Consideration?

A

Pertussis

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82
Q 
Features of a non-life-threatening paroxysm
1. duration
2. color change
3. HR, O2 sat
4. 
5.
6.
A
  1. Duration <45 sec
  2. Red but not blue color change
  3. tachycardia, bradycardia (not <60 in infants), or desaturation resolve spontaneously at the end of the paroxysm
  4. Brisk self-rescue
  5. Self-expectorated mucus plug
  6. Posttusive exhaustion but not unresponsiveness
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83
Q

Antimicrobial treatment for pertussis, <1 mo

A

azithromycin 10 mkday OD x 5 days

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84
Q

Antimicrobial treatment for pertussis, 1-5 mo

A

azithromycin 10 mkday OD x 5 days
or erythromycin 40-50 mkday QID x 14d
or clarithromycin 15 mkday BID x 7d
or TMP-SMZ

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85
Q

Antimicrobial treatment for pertussis, ≥6 mo

A

azithromycin 10 mkday OD max 500 on D1
then 5 mkday max 250 on D2-5
or erythromycin 40-50 mkday QID x 14d
or clarithromycin or TMP-SMZ

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86
Q

Optimal time to give Tdap to pregnant women

A

26-37 w AOG, every pregnancy

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87
Q

Motile, nonsporulating, nonencapsulated, gram negative rods

Resistant to many physical agents but can be killed by heating to 54.4C for 1 hr or 60C for 15 min

A

Salmonellae

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88
Q

Number of NTSbacteria to cause symptomatic disease in a healthy adult
Incubation period

A

10^6-10^8

Incubation period 6-72 hr (mean 24 hr)

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89
Q

Children with what hematologic disorder are at increased risk for Salmonella septicemia and osteomyelitis

A

sickle cell disease

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90
Q

Treatment of Salmonella gastroenteritis

A 
For <3 mo or immunocompromised 
cefotaxime 100-200 mkday q6-8 x 5-14 days
or 
ceftriaxone 75 mkday OD x 7 days
or
ampicillin 100 mkday q6-8 x 7 days
or 
cefixime 15 mkday x 7-10 days
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91
Q

Nontyphoidal Salmonella is excreted in feces for a median of __

A

5 weeks

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92
Q

Virulence factor of S. Typhi that has a protective effect against the bactericidal action of the serum of infected patients

A

polysaccharide capsule Vi

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93
Q

Infecting dose of S. Typhi

Incubation period

A

10^5-10^9

Incubation period 4-14 days

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94
Q

Macular or maculopapular rash visible around the 7th-10th day of illness, appearing in crops of 10-15 on the lower chest an abdomen and last 2-3 days. Lesion? Diagnosis?

A

Rose spots

Typhoid fever

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95
Q

Test that measures antibodies against O and H antigens of S. Typhi

A

Widal test

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96
Q

Treatment of uncomplicated typhoid fever

  1. Fully sensitive
  2. MDR
  3. Quinolone-resistant
A
  1. Fully sensitive: chloramphenicol 50-75 mkday x 14-21 days
    or amoxicillin 75-100 mkday x14 days
  2. MDR: fluoroquinolone 15 mkday x 5-7 days
    or cefixime 15-20 mkday x 7-14 days
  3. Quinolone-resistant: azithromycin 8-10 mkday x 7 days
    or ceftriaxone 75 mkday x 10-14 days
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97
Q

Treatment of sever typhoid fever

  1. Fully sensitive
  2. MDR
  3. Quinolone-resistant
A
  1. Fully sensitive: fluoroquinolone 15 mkday x 10-14 days
  2. MDR: fluoroquinolone 15 mkday x 10-14 d
  3. Quinolone-resistant: cefriaxone 60 mkday x 10-14 days
    or cefotaxime 80 mkday x 10-14 days
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98
Q

“Chronic carriers” are individuals who excrete S. Typhi for __

A

3 months or longer

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99
Q

Bacillary dysentery is caused by __ while amoebic dysentery is caused by __

A

Shigella; Entamoeba histolytica

100
Q

Ability to invade colonic epithelial cells by turning on a series of temperature-regulated proteins is the shared virulence trait of __

A

Shigella

101
Q

Syndrome of severe toxicity, convulsions, extreme hyperpyrexia and headache followed by brain edema following Shigellosis

A

Ekiri syndrome or lethal toxic encephalopathy

102
Q

Treatment of Shigellosis

A 
vitamin A 200,000 IU single dose
zinc 20 mg elemental x 14 days
ciprofloxacin 20-30 mkday BID
or ceftriaxone 50 mkday
or cefixime 8 mkday q 12-24
or nalidixic acid 55 mkday QID
or azithromycin 12 mkday D1, 6 mkday x 4 d
*5 day antibiotic course
103
Q

Facultative, anaerobic, gram-negative bacilli
member of Enterobacteriaceae family
Usually ferments lactose

A

E. coli

104
Q

Six major groups of diarrheagenic E. coli

A
  1. Enterotoxigenic
  2. Enteroinvasive
  3. Enteropathogenic
  4. Shiga toxin-producing/Enterohemorrhagic
  5. Verotoxin producing/Enteroaggregative
  6. Diffusely adherent
105
Q

Most common cause of traveler’s diarrhea

A

ETEC

Self-limited, resolves in 3-5 days

106
Q

E. coli that presents like bacillary dysentery

A

EIEC

107
Q

E. coli that cause acute, prolonged and persistent diarrhea in children younger than 2
Histopath: attaching and effacing lesion
Causes bluting of villi, inflammatory changes and sloughing of superficial mucosal cells

A

EPEC

108
Q

E. coli associated with HUS

A

STEC
E. coli O157:H7
Differs from shigellosis in that fever is uncommon

109
Q

E. coli that causes acute and persistent diarrhea in HIV-infected individuals
Forms a biofilm on the intestinal mucosa
Stacked-brick-like pattern

A

EAEC

110
Q

Antibiotics should not be given for this group of E. coli

A

STEC - can increase risk of HUS

111
Q

Gram-negative, comma-shaped bacillus

A

Vibrio cholerae

112
Q

Blood group at increased risk for cholera

A

O

113
Q

Incubation period of cholera

A

1-3 days

114
Q

Rice-water stools with a fishy smell is the hallmark of?

A

Cholera

115
Q

Most severe form of cholera

A

Cholera gravis

Purging of 500-1000 mL/hr

116
Q

Dark field microscopy showing darting motility in wet mounts of stools

A

Cholera

117
Q

Recommended antimicrobials for cholera

A

tetracycline 12.5 mkdose QID max 500 mg per dose x 3 days

or erythromycin, ciprofloxacin, doxycycline

118
Q

Dose of zinc

A

Started as soon as vomiting stops
<6 mo 10 mg oral zinc x 2 weeks
>6 mo 20 mg

119
Q

Gram-negative, curved, thin, non-spore-forming rods with tapered ends
Variable morphology:
- short comma-shaped or S-shaped
- long, multispiraled, filamentous, seagull
Motile, with a flagellum at 1 or both poles
Microaerophilic, oxidase positive
Transform into coccoid forms under adverse conditions, especially oxidation

A

Campylobacter

120
Q

Classic source of Campylobacter

A

chicken

raw milk

121
Q

Campylobacter species most likely to produce bacteremia

A

C. fetus

122
Q

Most common late-onset complications of Campylobacter

A

reactive arthritis
Guillain-Barre syndrome
Also IgA nephropathy, hemolytic anemia

123
Q

Onset of reactive arthritis after diarrhea

A

1-2 wk

124
Q

Onset of GBS after diarrhea

A

1-12 wk

125
Q

GBS variant more commonly affecting cranial nerves, characterized by ataxia, aeflexia, ophthalmoplegia

A

Miller-Fisher variant

126
Q

Drug of choice for Campylobacter gastroenteritis

A

erythromycin or azithromycin

127
Q

Drug of choice for Campylobacter sepsis

A

aminoglycosides, meropenem or imipenem

128
Q

Conditions with iron overload are at an increased risk for?

A

Listeria

Yersinia

129
Q

Most common form of Yersinia transmission to humans

A

Consumption of contaminated food, especially pork

130
Q

Manifestations of systemic Yersinia infection

A

splenic and hepatic abscess, osteomyelitis, septic arthritis, meningitis, endocarditis, mycotic aneurysms

131
Q

Empirical treatment for Yersinia enterocolitis

A

TMP-SMX x5 days

132
Q

Large, gram-negative coccobacillus
No bipolarity when stained with methylene blue and carbol fuschin
Ferments glucose and sucrose but not lactose
Oxidase negative
Reduces nitrate to nitrite
Facultative anaerobe, motile
Can grow at refrigerator temperature

A

Yersinia enterocolitica

133
Q

Most common presentation of Yersinia pseudotuberculosis

A

pseudoappendicitis

134
Q

Can present as Kawasaki disease-like illness

A

Yersinia pseudotuberculosis

135
Q

Most common mode of transmission of Y. pestis to humans

A

flea bites (Xenopsylla cheopis)

136
Q

3 clinical presentations of plague

A
  1. Bubonic - most common (80-90%)
  2. Septicemic
  3. Pneumonic
137
Q

Treatment for bubonic plague

A

Streptomycin 30 mkday max 2g/d, q12 IM x 10 days
Gentamicin 7.5 mkday q8
Doxycycline, ciprofloxacin or chloramphenicol
7-10 days

138
Q

Postexposure prophylaxis for pneumonic plague

A

tetracycline, doxycycline or TMP-SMX x 7 days

139
Q

Y. pestis incubation period

A

2-8 days

140
Q

Gram-negative rod, strict aerobe
Does not ferment lactose, oxidase positive
B-hemolysis on blood agar
Produce pyocyanin, pyoverdin, pyorubrin

A

Pseudomonas aeruginosa

141
Q

Quantitative culture value that differentiates Pseudomonas invasion from colonization

A

100,000 colony forming units/mL or g

142
Q

Antimicrobial treatment for Pseudomonas

A

ceftazidime 150-250 mkday q6-8 or
piperacillin tazobactam 300-450 mkday q6-8
or meropenem, ciprofloxacin

143
Q

Characteristic skin lesion of Pseudomonas

A

ecthyma gangrenosum

144
Q

Antimicrobial treatment for Burkholderia

A

TMP-SMX
or doxycycline
or meropenem

145
Q

Motile, gram-positive, spore-forming obligate anaerobe

Drumstick or tennis racket appearance

A

Clostridium tetani

146
Q

Most common form of tetanus

A

neonatal or umbilical tetanus

147
Q

Treatment for tetanus

A
  1. TIG 500 u IM x 1 dose
    or tetanus antitoxin 50T-100T u, 1/2 IM, 1/2 IV
  2. Pen G 100T ukday q4-6 IV x10-14 d
    or metronidazole 500 mg IV q8
  3. diazepam 0.1-0.2 mkdose q3-6. Sustain for 2-6 weeks before tapering
  4. vecuronium or pancuronium
  5. a- and/or b-blocking agents
148
Q

Poor prognosis in tetanus

  1. onset of trismus
  2. onset of tetanic spasms
A
  1. onset of trisumus <7 days after injury

2. onset of generalized spasms <3 days after onset of trismus

149
Q

Schedule of tetanus vaccination

A

DTaP 2, 4, 6, and 15-18 mo
DTaP booster at 4-6 yr and Tdap at 11-12 yr
then Td at 10 year intervals
For pregnant women, 1 dose Tdap at 27-36 wk AOG of each pregnancy

150
Q

Virulence factors: toxin A and toxin B

A

Clostridium difficile

151
Q

Gram-positive, anaerobic, spore-forming, bacillus resistant to alcohol

A

Clostridium difficile

152
Q

Antimicrobial treatment for C. difficile

A

oral metronidazole 20-40 mkday q6-8 x 7-10 days

or oral vancomycin 40 mkday q6 x 7-10 d

153
Q

Most common form of extrapulmonary tuberculosis in children

A

scrofula

154
Q

Complication of HAART in children with HIV and TB

A

immune reconstitution inflammatory syndrome (IRIS)

155
Q

Delicate, tightly spiraled, motile, spirochete with finely tapered ends

A

Treponema pallidum

156
Q

Characterized by a painless but highly contagious ulcer with raised borders and regional lymphadenitis

A

Primary syphilis

Appears 2-6 wk after inoculation

157
Q

Gray-white to erythematous wart-like plaques

A

condyloma lata

158
Q 
Generalized nonprupritic maculopapular rash involving the palsm and soles
Condyloma lata
Mucous patches
Flu-like illness
meningitis in 30% of patients
A

secondary syphilis

occurs 2-10 wk after chancre heals

159
Q

Early latent period syphillis

A

1st year of latency

160
Q

Marked by neurologic, cardiovascular, and gummatous lesions of the skin, bone, and liver resulting rom the host cytotoxic T-cell response

A

Tertiary syphilis

161
Q

Metaphyseal demineralization of the medial aspect of the proximal tibia
Diagnosis?

A

Wimberger lines

congenital syphilis

162
Q

Painful osteochondritis resulting in irritability and refusal to move involved extremity

A

pseudoparalysis of Parrot

congenital syphilis

163
Q

Bony prominence of the forehead caused by persistent or recurrent periostitis

A

Olympian brow

congenital syphilis

164
Q

Unilateral or bilateral thickening of the sternoclavicular third of the clavicle

A

Clavicular or Higoumenakia sign

congenital syphilis

165
Q

Anterior bowing of the midportion of the tibia

A

Saber shins

congenital syphilis

166
Q

Convexity along the medial border of the scapula

A

Scaphoid scapula

congenital syphilis

167
Q

Peg-shaped upper central incisors; they erupt during the 6th yr of life with abnormal enamel, resulting in a notch along the biting surface

A

Hutchinson teeth

congenital syphilis

168
Q

Abnormal 1st lower (6 yr) molars characterized by small biting surface and excessive number of cusps

A

Mulberry molars

congenital syphilis

169
Q

Depression of the nasal root, a result of syphilitic rhinitis destroying adjacent bone and cartilage

A

saddle nose

congenital syphilis

170
Q

Linear scars that extend in a spoke-like pattern from previous mucocutaneous fissures of the mouth, anus and genitalia

A

Rhagades

congenital syphilis

171
Q

Latent meningovascular infection; it is a rare and typically occurs during adolescence with behavioral changes, focal seizures, or loss of intellectual function

A

Juvenila paresis

congenital syphilis

172
Q

Rare spinal cord involvement and cardiovascular involvement with aortitis

A

Juvenile tabes

congenital syphilis

173
Q

Hutchinson teeth, interstitial keratitis and 8th nerve deafness

A

Hutchinson triad

congenital syphilis

174
Q

Unilateral or bilateral painless joint swelling (usually involving knees) from synovitis with sterile synovial fluid; spontaneous remission usually occurs after several weeks

A

Clutton joint

congenital syphilis

175
Q

Manifests with intense photophobia and lacrimation, followed within weeks or months by corneal opacification and complete blindness

A

Interstitial keratitis

176
Q

May be unilateral or bilateral, appears at any age, manifests initially as vertigo and high-tone hearing loss, and progresses to permanent deafness

A

8th nerve deafness

177
Q

Antimicrobial therapy for congenital syphilis

A

aqueous crystalline penicillin G 100T-150T ukday; 50T ukdose q12 x 7 days, then q18 for total of 10 days
or Pen G procaine 50T ukday IM x 1 dose x 10 days

178
Q

Antimicrobial therapy for syphilis in >1 mo

A
  1. Congenital syphilis 200-300T ukday as 50T ukdose q4-q6 x 10 days
  2. Primary, secondary and early latent
    Pen G benzathine 50T ukdose IM max 2.4M x 1 dose
  3. Late latent or unknown duration
    Pen G benzathine 50T ukdose IM x 3 weekly doses
  4. Neurosyphilis - aqueous crystalline pen G 200T-300T ukday q4-6 x 10-14 d
179
Q

Persons exposed for __ preceding diagnosis of syphilis in a sex partner should be treated presumptiveley even if seronegative

A

90 days or less

180
Q

Aerobic spiral bacterial with terminal hook at 1 or both ends

A

Leptspira

181
Q

Gold standard diagnostic method for leptospirosis

A

microscopic agglutination test

182
Q

Detected by Warthin-Starry silver stain

A

spirochetes

183
Q

Leptospires can be recovered from the blood or CSF during __ and from the urine __

A

the first 10 days of illness;

2nd week

184
Q

Treatment of leptospirosis

A

Penicillin, and tetracyclines

185
Q

Prophylaxis for leptospirosis

A

doxycycline 200 g PO once a week

186
Q

Obligate intracellular gram-negative organisms without detectable peptidoglycan

A

Chlamydia

187
Q

Two morphologically distinct forms of Chlamydia

A
  1. elementary body - infectious form

2. reticulate body - reproductive form

188
Q

Antimicrobial treatment for chlamydia

A

erythromycin 40 mkday BID x 10 days
or clarithromycin 15 mkday BID x 10 days
or azithromycin 10 mkday x 1 day, then 5 mkday x 4 days

189
Q

Diagnostic criteria for trachoma

A

2 of 4:

  1. lymphoid follicles on upper tarsal conjunctivae
  2. typical conjunctival scarring
  3. vascular pannus
  4. limbal follicles
190
Q

Treatment of trachoma

A

azithromycin 20 mkdose max 1 g x 1 dose

191
Q

First line treatment regimen for C. trachomatis genital infection

A 
azithromycin 1 g PO x 1 dose
and doxycycline 100 mg PO BID x 7 days
For pregnant:
azithromycin 1 g PO x 1 dose 
and amoxicillin 500 mg TID x 7 days
192
Q

Treatment for lymphogranuloma venereum

A

doxycycline 100 mg PO BID x 21 days

193
Q

3 morphologic forms of Candida

A
  1. blastospores/yeast cells
  2. chlamydospores
  3. pseudomycelium - tissue phase
194
Q

Germ tube test is used in the diagnosis of?

A

Candida albicans

195
Q

Fluconazole is inactive against all strains of?

A

C. krusei

and 5-25% of C. glabrata

196
Q

Duration of systemic antifungal therapy

A

21 days from last positive Candida culture

197
Q

Measles patients are infections from __ to __ after the onset of rash

A

3 days before to 4-6 days after the onset of rash

198
Q

Warthin-Finkeldey giant cells are pathognomonic for?

A

Measles

199
Q

Koplik spots are pathognomonic for?

A

Measles. Appear 1-4 days prior to the onset of rash

200
Q

Most common complication of measles

A

otitis media

201
Q

Characteristic EEG findings of SSPE

A

suppression-burst episodes

202
Q

Dose of vitamin A

A

<6 mo: 50,000 IU
6-11 mo: 100,000 IU
≥12 mo: 200,000 IU
OD x 2 days

203
Q

Period of highest communicability of rubella

A

5 days before to 6 days after the rash

204
Q

Tiny, rose-colored lesions on the oropharynx of a patient with rubella

A

Forchheimer spots

205
Q

Most common finding is nerve deafness
salt-and-pepper retinopathy
cataracts

A

Congenital Rubella Syndrome

206
Q

Period of infectiousness of mumps

A

1-2 days before to 5 days after onset of parotid swelling

207
Q

Salt-and-pepper retinopathy is the most common ocular abnormality in?

A

congenital rubella syndrome

208
Q

Most frequent cause of hand-foot-and-mouth disease

A

coxsackievirus A16

209
Q

Most common cause of viral meningitis in mumps-immunized population

A

Enteroviruses

210
Q

Virus that can cause aplastic crisis in patients with hemolytic anemias
Can also cause fetal anemia and hydrops
Cell receptor is erythrocyte P antigen

A

Parvovirus B19
Erythema infectiosum
fifth disease

211
Q

Slapped cheek appearance
Erythematous symmetric, maculopapular, truncal rash appears 1-4 days after, develops central clearing, becomes lacy, reticulated
Does not desquamate

A

Parvovirus B19
Erythema infectiosum
fifth disease

212
Q

Recurrent asceptic meningitis

A

Mollaret meningitis

213
Q

Treatment of acute mucocutaneous Herpes infection

A

acyclovir 15 mkdose 5x/day PO x 7 days

214
Q

Treatment of CNS herpes infection

A

acyclovir 10 mkdose q8 IV x 14-21 days

215
Q

Treatment of perinatal herpes infection

A

acyclovir 60 mkday q8 IV
SEM 14 days
CNS and disseminated 21 days

216
Q

Incubation period of varicella

A

10-21 days

Infective 1-2 days before the appearance of the rash

217
Q

Infants whose mothers demonstrate varicella in the period from __ to __ are at high risk for severe varicella

A

5 days prior to delivery to 2 days after delivery

Give 1 vial of VariZIG ASAP

218
Q

Cicatricial skin scarring, limb hypoplasia, neurologic (microcephaly, cortical atrophy, seizures, mental retardation), eye (chorioretinitis, microphthalmia, cataracts), renal (hydroureter and hydronephrosis) and ANS (neurogenic bladder, swallowing dysfunction, aspiration pneumonia) abnormalities in newborn. Diagnosis?

A

Congenital varicella syndrome

219
Q

Classic triad of primary EBV infection

A

fatigue, pharyngitis, generalized lymphadenopathy

220
Q

Primary immunodeficiency associated with severe EBV infection

A

X-linked lymphoproliferative syndrome (Duncan syndrome)

221
Q

“ampicillin rash”, associated with?

A

EBV

222
Q

Classic physical exam findings of EBV infection

A

generalized lymphadenopathy
splenomegaly
hepatomegaly

223
Q

Symmetric rash on the cheeks with multiple erythematous papules, which may coalesce into plaques and persist for 15-50 days

A

Gianotti-Crosti syndrome

EBV

224
Q

Alice in Wonderland syndrome is associated with which pathogen

A

EBV

225
Q

Transient heterophile IgM antibodies seen in infectious mononucleosis

A

Paul-Bunnel antibodies

226
Q

SGA, microcephaly, thrombocytopenia, hepatosplenomegaly, hepatitis, intracranial calcifications, chorioretinitis, hearing abnormalities, blueberry muffin appearance
Diagnosis?

A

Congenital CMV infection

227
Q

Nagayama spots (ulcers at the uvulopalatoglossal junction), fait pink or rose-colored, nonpuriritic, 2-3 mm morbilliform rash on the trunk, high fever 39.7C. Diagnosis?

A

Roseola infantum (exanthema subitum, sixth disease, HHV 6 & 7)

228
Q

History of 3 days of high fever in an otherwise nontoxic 10 mo old with a blanching maculopapular rash on the trunk. Possible diagnosis?

A

Roseola

229
Q

Passive immunoprophylaxis for RSV

A

palivizumab 15 mkdose IM once a month

230
Q

Antiviral agent for RSV

A

ribavirin inhaled x 3-5 days

231
Q

Principal vector of dengue virus

A

Aedes aegypti

Stegomyia family

232
Q

Incubation period of dengue

A

1-7 days

233
Q

Dengue IgM disappears after?

A

6-12 weeks

234
Q

Pathologic hallmark of rabies

A

Negri body

235
Q

Incubation period for rabies

A

1-3 mo

236
Q

Prophylaxis against cerebrovascular spasm in rabies

A

nimodipine

237
Q

Incubation interval for development of AIDS-defining condition after vertical transmission is __ while after horizontal transmission is __

A

vertical transmission 5 mo

horizontal transmission 7-10 yr

238
Q

Diagnostic viral testing for HIV in neonates should be performed by __, __ and __

A

by 48 hours of age
at 1-2 mo
and at 3-6 mo
HIV infection is confirmed if positive on 2 separate occasions

239
Q

Preferred virologic method for diagnosing HIV infection during infancy

A

HIV DNA PCR

240
Q

Prophylaxis for vertical transmission of HIV

A

zidovudine to the mother started by 4 weeks AOG continued during delivery and to the newborn for the first 6 weeks of life

241
Q

Benefit of CS delivery is negligible of HIV viral load of the mother is?

A

<500 copies/mL

242
Q

Treatment of toxoplasmosis

A

Pyrimethamine

Sulfadiazine

243
Q

Detectable form of malaria

A

Trophozoite

Ring form

244
Q

Treatment of malaria

A

Chloroquine
Mefloquine for P. falciparum
Doxycycline for mefloquine resistant P. falciparum

245
Q

Treatment for gastrointestinal ascariasis

A

Albendazole 400 mg PO x 1 dose
Or mebemdazole 100 mg BID x 3 days or 500 mg x 1 dose
Or ivermectin 150-200 mcg/kg PO x 1 dose

246
Q

Treatment of choice for intestinal or biliary obstruction from ascariasis

A

Piperazine citrate 75 mkday x 2 days max 3.5 g/d

Compiled PPS board reviewer (60 decks)

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