Infectious Disease 1 Flashcards
1
Q
2 most common aspects of presentation for children with streptococcal pharyngitis?
A
Fever, Sore throat
2
Q
2 most common exam findings for streptococcal pharyngitis?
A
Tonsillar exudates, Tender anterior cervical LNs
3
Q
Most common time of year for streptococcal pharyngitis?
A
Late fall – Winter – Early spring
4
Q
What test is needed before initiation of ABX in cases of streptococcal pharyngitis?
A
Throat cultures OR Rapid strep antigen testing
5
Q
Next step after (+) rapid strep antigen testing in suspected streptococcal pharyngitis?
A
ABX treatment … No throat culture needed
6
Q
Next step after (-) rapid strep antigen testing in suspected streptococcal pharyngitis?
A
Throat culture
7
Q
2 ABX of choice in setting of streptococcal pharyngitis?
A
Penicillin OR Amoxicillin
8
Q
Purpose of ABX treatment in streptococcal pharyngitis?
A
Prevent acute rheumatic fever
9
Q
DOC for treatment of streptococcal pharyngitis in patients with penicillin allergy?
A
Cephalosporins
10
Q
2 most common bacteria associated with human bite wounds?
A
Eikenella, Staph aureus … but usually polymicrobial
11
Q
Structure of Eikenella?
A
Gram (-) anaerobe
12
Q
3 aspects of treatment for human bite wounds?
A
ABX, Tetanus prophylaxis, Left open to heal by secondary intention … (avoid primary closure)
13
Q
Bite wound in which location should be treated with primary closure?
A
Face … (cosmetic outcome is important, risk of infection is low)
14
Q
Oral ABX of choice for bite wound due to suspected Eikenella?
A
Amoxicillin-Clavulanate
15
Q
IV ABX of choice for bite wound due to suspected Eikenella?
A
Ampicillin-Sulbactam
16
Q
3 types of inactivated vaccines?
A
Polio, Hepatitis A, Influenza
17
Q
2 types of inactivated vaccines?
A
Diphtheria, Tetanus
18
Q
5 types of inactivated vaccines?
A
Rotavirus, Measles, Mumps, Rubella, Varicella
19
Q
Should children of pregnant females receive live-attenuated vaccines?
A
Yes – risk of child bringing home full-strength virus is greater risk to pregnant mother
20
Q
How often should CD4 count and viral load be evaluated in pregnant female with HIV?
A
Every 3 months
21
Q
Delivery modality of choice for pregnant females with HIV viral load < 1,000?
A
Low risk of perinatal transmission … Vaginal delivery recommended
22
Q
Delivery modality of choice for pregnant females with HIV viral load > 1,000?
A
High risk of perinatal transmission … C-section delivery recommended
23
Q
6 maternal contraindications to breastfeeding?
A
Active TB, HIV, Herpetic breast lesions, Active varicella infection, CTX/XRT treatment, Active substance abuse
24
Q
1 infant contraindication to breastfeeding?
A
Galactosemia
25
What is considered (+) TB test for healthcare professionals?
Induration > 10mm
26
Next step of workup for healthcare professional with (+) TB test (induration >10 mm)?
CXR
27
Definition of latent TB?
(+) TB test, NML CXR, No symptoms of active TB
28
Is latent TB considered infectious or non-infectious?
Non-infectious
29
Can patients with latent TB continue working?
Yes, they may continue working without mask restrictions … even if they decline or do not complete isoniazid treatment
30
Typical treatment offered to patients with latent TB?
6-9 months of isoniazid
31
When are patients with active TB considered to be non-infectious?
After 3 consecutive acid-fast bacilli sputum smears are (-)
32
Vector of West Nile virus?
Mosquito
33
6 aspects of clinical presentation of West Nile virus?
Fever, HA, nuchal rigidity, AMS, hyperreflexia, maculopapular rash
34
Diagnostic test for West Nile virus?
Detection of West Nile IgM antibody in CSF
35
Best treatment for West Nile virus?
Supportive
36
Epidemiology of CMV infection?
HIV patients (with AIDS); Post-transplant patients
37
5 aspects of clinical presentation for CMV infection?
Fever, cough, coryza, conjunctivitis, diffuse maculopapular rash (descending)
38
Necrotizing fasciitis refers to a …
Fulminant infection of subcutaneous tissue that spreads rapidly along fascial planes, leading to extensive tissue necrosis and shock
39
Which patients are most commonly affected by Type A necrotizing fasciitis?
Previously-healthy patients
40
Most common pathogen responsible for Type A necrotizing fasciitis?
Strep pyogenes … (Group A Strep)
41
Which patients are most commonly affected by Type B necrotizing fasciitis?
Patients with underlying poor circulation (DM)
42
Most common pathogen responsible for Type B necrotizing fasciitis?
Polymicrobial
43
Best treatment for patient with necrotizing fasciitis?
Urgent, aggressive surgical exploration + ABX + Hemodynamic support
44
3 empiric ABX recommended for necrotizing fasciitis?
Piperacillin/Tazobactam OR Carbapenem; Vancomycin; Clindamycin
45
Role of Piperacillin/Tazobactam OR Carbapenem; in empiric treatment for necrotizing fasciitis?
Covers Strep pyogenes + anaerobes
46
Role of Vancomycin in empiric treatment for necrotizing fasciitis?
Covers Staph aureus + MRSA
47
Role of Clindamycin in empiric treatment for necrotizing fasciitis?
Inhibits toxin formation by streptococci + staphylococci
48
Recommendation for HIV (+) children attending school?
Should attend without any restrictions; Disclosure of HIV (+) status by family is voluntary
49
Pathogen responsible for Infectious Mononucleosis?
EBV
50
5 aspects of clinical presentation for Infectious Mononucleosis?
Fatigue, fever, exudative pharyngitis, LAD, hepatosplenomegaly
51
Best treatment for Infectious Mononucleosis?
Supportive care …
52
Diagnostic test for Infectious Mononucleosis?
Heterophile Ig
53
Best treatment for Infectious Mononucleosis, in which airway obstruction appears imminent?
Corticosteroids
54
2 DOCs for treatment of oral candidiasis from inhaled corticosteroids in patient with asthma?
Nystatin suspension; Clotrimazole lozenges
55
Pathogen responsible for condyloma accuminata?
HPV
56
Alternate name for condyloma accuminata?
Anogenital warts
57
Diagnostic test for condyloma accuminata?
Application of acetic acid turns the lesions white
58
Transmission of condyloma accuminata?
Sexual transmission
59
2 medications that can treat condyloma accuminata?
Trichloroacetic acid, Podophyllin
60
Which medication is indicated for treatment of vaginal condyloma accuminata?
Trichloroacetic acid
61
MOA of Trichloroacetic acid in treatment of vaginal condyloma accuminata?
Protein coagulation
62
Why should Podophyllin not be used in treatment of vaginal condyloma accuminata?
Podophyllin should be used for external (not internal) lesions
63
Additional contraindication for Podophyllin?
Pregnancy
64
Clinical presentation for Disseminated Gonococcal Infection?
Purulent monoarthritis OR … triad of polyarthralgia, tenosynovitis, dermatitis
65
Best diagnostic test for Disseminated Gonococcal Infection?
NAAT of urogenital specimen
66
Additional testing that should be performed in setting of Disseminated Gonococcal Infection?
Testing for other sexually-transmitted diseases (HIV, chlamydia infection)
67
Best treatment for Disseminated Gonococcal Infection that is (+) for Neisseria gonorrhea, (-) for Chlamydia?
Single IM dose of Ceftriaxone
68
Best treatment for Disseminated Gonococcal Infection that is (+) for Neisseria gonorrhea, (+) for Chlamydia?
Single IM dose of Ceftriaxone + Oral doxycycline
69
Risk of CLABSI (Central Line Associated Bloodstream Infection) is greatest when central catheter has been in place for > ___ days
6
70
Does replacement of central catheter using a guidewire result in increased OR decreased risk of CLASBI?
Increased
71
Does placement of central catheter in subclavian vein (vs. internal jugular vein) increased OR decreased risk of CLASBI?
Decreased
72
2 measures that can decrease risk of CLASBI?
Sterile barriers (drapes), Chlorhexidine-based antiseptic
73
Recommended screening test for HIV?
HIV Ag + HIV1/HIV2 Ig
74
When are HIV Ag + HIV Ig too low to be detected with 100% accuracy?
Window period … 1-4 weeks after infection
75
When should HIV Ag + HIV1/HIV2 Ig screening tests be repeated?
4 weeks after infection
76
Before initiation of HAART in patient with (+) HIV screening test – which additional tests should be performed?
Hepatitis B, Hepatitis C, TB, Neisseria gonorrhea, syphilis
77
Best management for patient who presents with symptomatic acute Hepatitis B infection?
Outpatient supportive care, with close follow-up
78
Likelihood that adult with symptomatic acute Hepatitis B infection will progress to chronic infection?
5%
79
Likelihood that perinatal acute Hepatitis B infection will progress to chronic infection?
90%
80
Likelihood that child 1-5 yo with symptomatic acute Hepatitis B infection will progress to chronic infection?
20-50%
81
Most likely outcome of symptomatic acute Hepatitis B infection in adults?
Spontaneous resolution
82
At what point in course of acute Hepatitis B infection does it become chronic?
HBsAg does not clear after 6 months of infection
83
15 yo female presents with fever, sore throat; PE shows gray pharyngeal patches that coalesce into pseudomembrane – diagnosis?
Diphtheria
84
Complication of systemic absorption of diphtheria toxins?
Myocarditis
85
Classic triad of Rickettsia infection?
Fever, HA, rash around wrists + ankles
86
Best treatment for Rickettsia infection?
Doxycycline … (for ALL patients, including pregnant females + children)
87
3 lab values seen in setting of Rickettsia infection?
ALT/AST, ¯ platelets, ¯ Na+
88
HIV patients with CD4 count ___ are susceptible to Pneumocystic jiroveci PNA
< 200
89
Least invasive way to obtain a respiratory sample from patient with suspected PCP?
Induced sputum
90
Next step for patient with suspected PCP, but (-) induced sputum sample?
Further testing with bronchoalveolar lavage
91
Best treatment for PCP?
TMP-SMX, prednisone
92
Best treatment for community-acquired PNA?
Ceftriaxone, Azithromycin
93
Patient with suspected PCP experiences respiratory decompensation after 2-3 days of TMP-SMX treatment – etiology?
Organism lysis
94
Reason for treating patients with suspected PCP with corticosteroids?
Reduce risk of intubation
95
2 criteria needed for patients with suspected PCP to be treated with corticosteroids?
AA gap > 35; PaO2 < 70
96
Most common pathogen responsible for lobar PNA?
Strep pneumoniae
97
Treatment of choice for Strep pneumoniae lobar PNA?
High-dose amoxicillin PO
98
5 aspects of clinical presentation for toxoplasmosis in infants?
Hydrocephalus, intracranial calcifications, hepatomegaly, hearing impairment, chorioretinitis
99
Route of transmission for congenital toxoplasmosis (from mother to fetus)?
Trans-placental
100
Maternal exposures that increased risk of congenital toxoplasmosis?
Cat feces, undercooked meat, contaminated soil
101
Treatment for congenital toxoplasmosis?
1 yr treatment of pyrimethamine + sulfadiazine; Folate supplementation
102
Post-exposure prophylaxis for people exposed to hepatitis B … not previously vaccinated OR did not mount satisfactory Ig response to Hep B vaccine?
Hep B Ig + Hep B vaccine
103
Post-exposure prophylaxis for people exposed to hepatitis B, but previously mounted satisfactory Ig response to Hep B vaccine?
No post-exposure prophylaxis necessary
104
Location of abnormality in setting of botulinum toxicity?
Presynaptic NMJ
105
Role of botulinum toxin at the presynaptic NMJ?
Inhibits release of ACH into synaptic cleft
106
O2 consumption of clostridium botulinum?
Anaerobic
107
Clinical presentation of botulinum toxicity?
Descending weakness, Autonomic dysfunction, response, Preserved sensation
108
Clinical presentation of Guillain-Barre syndrome?
Ascending weakness
109
Pathogen responsible for Guillain-Barre syndrome?
Campylobacter jejuni
110
Cases of Guillain-Barre syndrome are frequently preceded by …
Respiratory, GI illness
111
2 aspects of clinical presentation for HAART-associated lipodystrophy?
Lipoatrophy, Fat accumulation
112
Description of lipoatrophy seen in setting of HAART-associated lipodystrophy?
Loss of subcutaneous fat from face, arms, legs
113
2 most common HAART drugs associated with lipodystrophy?
Statuvidine, Ziduvidine (NRTIs)
114
Description of fat accumulation seen in setting of HAART-associated lipodystrophy?
Buffalo hump, Visceral abdominal fat accumulation
115
Metabolic abnormality associated with HAART-associated lipodystrophy?
Insulin resistance
116
Complication of HAART-associated lipodystrophy?
Increased risk of cardiovascular disease
117
Best management of dyslipidemia in setting of HAART-associated lipodystrophy?
Statin treatment for patients with estimated 10-year cardiovascular risk > 7.5%
118
Most common pathogen responsible for plantar warts?
HPV
119
Best treatment for plantar warts?
Topical salicylic acid + soaking in warm water
120
When does salicylic acid typically begin working on plantar warts?
2-3 weeks
121
Early neurosyphilis most commonly occurs during the ___ stage of syphilis
2nd
122
2 hallmark clinical features of secondary syphilis?
Maculopapular rash, LAD
123
Clinical presentation of ocular syphilis?
Posterior uveitis
124
Triad of clinical presentation for disseminated gonococcemia?
Rash, tenosynovitis, polyarthralgia
125
Clinical presentation of Acute Retroviral Syndrome?
Similar to the flu … (fever, LAD, weight loss, myalgias) + diarrhea
126
When does Acute Retroviral Syndrome occur, in relation to infection with HIV?
2-4 weeks after infection
127
Dermatologic condition that may also present in patients with HIV?
Seborrheic dermatitis
128
Clinical presentation of Seborrheic dermatitis?
Dandruff, scaly face rash
129
Initial screening for diagnosis of osteomyelitis?
Probe-to-Bone testing
130
Diagnostic test for osteomyelitis?
Foot MRI
131
Gold standard test for identifying pathogens responsible for osteomyelitis?
Bone biopsy with culture
132
DOC for treatment of Lyme disease in pregnant females?
Amoxicillin … (not doxycycline)
133
Duration of Amoxicillin treatment of Lyme disease in pregnant females?
14-21 days
134
Long-term consequences of Lyme disease in pregnant females?
None, if mother is receives adequate treatment
135
Why should doxycycline NOT be used for treatment of Lyme disease in pregnant females?
Risk of fetal long-bone deformity + tooth discoloration in infants
136
Best STI screening for an asymptomatic male, 27 yo?
HIV screening … with p24 Ag + HIV Ig
137
Who should receive a 1-time asymptomatic screening for HIV?
Patients 13-65 yo
138
Route of transmission for Giardia?
Fecal-oral
139
Epidemiology of Giardia infection?
Hikers
140
Best management for Giardia infection in symptomatic patients?
Metronidazole
141
Important step in controlling the spread of Giardia infection?
Hand hygiene with soap + water … (hand sanitizer won’t kill the Giardia trophozoites)
142
Additional step in controlling spread of Giardia infection?
Limiting recreational water venue visits by infected patients
143
34 yo male presents with fever, HA, night sweats, fatigue; HA has worsened, now experiencing double vision; Reports HX of IVDU; PE shows leftward gaze restriction in L eye; Labs show elevated ICP, elevated WBC count in CSF with lymphocyte predominance, elevated protein – diagnosis?
Cryptococcal meningitis, due to underlying HIV infection
144
Diagnostic CSF test for Cryptococcal meningitis?
(+) India ink, (+) cryptococcal antigen testing
145
1st step of pharmacologic management for Cryptococcal meningitis?
Amphotericin B + Flucytosine for 2 weeks
146
2nd step of pharmacologic management for Cryptococcal meningitis?
High-dose oral fluconazole for 8 weeks
147
3rd step of pharmacologic management for Cryptococcal meningitis?
Low-dose fluconazole for 1 year
148
Patient with Cryptococcal meningitis presents with worsening symptoms of elevated ICP – what is best management of elevated ICP?
Serial LPs … (not mannitol)
149
Change to CSF in setting of meningitis caused by Strep Pneumoniae or Neisseria meningitis?
Elevated WBC with PMN predominance
150
Empiric therapy for meningitis caused by Strep Pneumoniae or Neisseria meningitis?
Ceftriaxone + Vancomycin
151
Empiric therapy for meningitis caused by Strep Pneumoniae or Neisseria meningitis … in a patient >50 yo?
Ampicillin
152
In cases of newly-diagnosed HIV, what public health role does the physician play?
Physician must report case to Department of Public Health … should encourage patient to notify sexual partners (but does not always need to notify partners directly
153
Patient has had close contact with an individual recently diagnosed with active TB; Which induration represents a (+) PPD test?
>5 mm
154
Treatment of choice for latent TB … (+) PPD test, (-) CXR?
Isoniazid
155
Most common AE of Isoniazid?
Hepatotoxicity
156
Clinical presentation of Isoniazid-associated Hepatotoxicity?
Asymptomatic, self-limited transaminitis
157
What degree of Hepatotoxicity warrants a patient discontinuing use of Isoniazid? (2)
Liver enzymes > 5x Upper Limits of NML; Symptomatic transaminitis
158
Which TB drug is associated with hyperuricemia?
Pyrazinamide
159
Which TB drug is associated with ocular toxicity?
Ethambutol
160
Which TB drug is associated with drug-induced SLE?
Isoniazid
161
2 other drugs associated with drug-induced SLE?
Procainamide, Hydralazine
162
Which additional drug should be administered with Isoniazid?
Vitamin B6 (pyridoxine)
163
Contraindication for initiation of HIV Pre-Exposure Prophylaxis for MSM?
Patients with abnormal renal function (CKD, ESRD)
164
27 yo HIV (+) male with HX of IVDU presents with SOB, dry cough, R-sided CP (worse with deep inspiration); PE shows T = 103, systolic murmur at L sternal border; CXR shows nodular opacities in both lung fields – diagnosis?
R-sided infective endocarditis
165
Which heart valve is most commonly affected by IVDU?
Tricuspid
166
Pathogen responsible for infective endocarditis involving the tricuspid valve?
Staph aureus
167
Diagnostic test for infective endocarditis?
Transthoracic ECHO
168
What accounts for R-sided CP (worse with deep inspiration) seen in setting of infective endocarditis?
Septic pulmonary emboli
169
Appearance of Septic pulmonary emboli on CXR in setting of infective endocarditis?
Multiple nodular opacities
170
How can you distinguish PCP PNA from infective endocarditis in an HIV (+) patient?
PCP PNA is subacute (low-grade fever for weeks) vs. Infective endocarditis high fever
171
Guillain-Barre syndrome typically occurs after …
GI or respiratory infection
172
What accounts for development of Guillain-Barre syndrome after GI or respiratory infection?
Molecular mimicry … Corss-reacting Ig to PNS components
173
Pathogen responsible for Guillain-Barre syndrome?
Campylobacter
174
Clinical presentation of Guillain-Barre syndrome?
Ascending symmetric muscle weakness, Dysautonomia
175
Complication of Guillain-Barre syndrome?
Respiratory failure
176
How should impending respiratory failure be monitored in Guillain-Barre syndrome?
Frequent measurement of vital capacity + negative inspiratory force
177
Best treatment for Guillain-Barre syndrome?
IVIG, plasma exchange
178
Which groups of patients should receive IVIG or plasma exchange for Guillain-Barre syndrome?
Non-ambulatory, Within 4 weeks of symptom onset
179
Prognosis for Guillain-Barre syndrome?
Slow, spontaneous resolution over period of months
180
What is the value of IVIG or plasma exchange in treatment of Guillain-Barre syndrome?
Shortens recovery time by ~50%
181
Role of oseltamivir for treatment of flu? (2)
Reduce symptom duration, Decrease risk of developing post-influenza PNA
182
Which patients with a (+) flu test should be given oseltamivir?
Patients who present within 48 hours of symptom onset; Patients who are admitted for severe illness (or age > 65, immunocompromise) … regardless of symptom duration
183
Best treatment for patient with (+) flu test, who presents > 48 hours after symptom onset?
Symptomatic care
184
2 aspects of clinical presentation for patient with early Lyme disease?
Erythema migrans, Viral-like symptoms
185
Best management of early Lyme disease?
Diagnose early (no need for ELISA), Treat empirically with oral doxycycline
186
Initial clinical presentation of Sporothrix schenckii?
Painless papule at site of inoculation; Soon ulcerates and drains clear, odorless fluid
187
Late clinical presentation of Sporothrix schenckii?
Appearance of more painless papules along the proximal lymphatic chain
188
Best management of Sporothrix schenckii infection?
Itraconazole
189
Clinical presentation of Blastomycosis?
PNA, verrucous (“heaped up”) skin lesions
190
Clinical presentation of Actinomyces?
Multiple abscesses, fistulas, sinus tracts that drain thick, yellow discharge with granules
191
Clinical presentation of Coccidiomycosis?
PNA, soft-tissue abscesses
192
Clinical presentation of Histoplasmosis?
PNA, fever, fatigue, weight loss (mimics TB)
193
3 classic CXR findings associated with active TB infection?
Upper lobe cavitation, Hilar LAD, Pleural effusion
194
Best initial test for diagnosis of active TB infection?
Sputum sampling
195
3 tests that should be performed on sputum from patient with high clinical suspicion for active TB?
Acid-fast staining, Mycobacterial culture, NAAT
196
Why are TB-skin testing or IFN-g testing not helpful for diagnosis of active TB infection?
TB-skin testing and IFN-g testing cannot distinguish between latent vs. active TB infection
197
Limitation of Acid-fast staining of sputum in patient with high clinical suspicion for active TB?
Acid-fast staining has low SN … (so lots of false negatives)
198
Diagnostic test for Lyme Disease?
ELISA, or Western Blot
199
Prognosis for Lyme Disease?
Most cases resolve … but patients are at increased risk for recurrent arthritis with joint damage
200
Best management of Lyme Disease?
Doxycycline + Amoxicillin
201
Duration of Doxycycline + Amoxicillin treatment for Lyme Disease?
28 days
202
Epidemiology of vibrio vulinficus infection?
Marine environments, wound infections; Pts with liver disease
203
Clinical presentation of vibrio vulinficus infection?
Septic shock, cellulitis
204
How do wounds in Vibrio vulinficus infection differ from wounds in Mycobacterium marinum?
Vibrio vulinficus = necrotizing, bullous; Mycobacterium marinum = popular, ulcerative
205
How does onset of symptoms in Vibrio vulinficus infection differ from onset of symptoms in Mycobacterium marinum?
Vibrio vulinficus = rapid onset over several hours; Mycobacterium marinum = develops over several days
206
Best treatment for vibrio vulinficus infection?
Doxycycline + Ceftriaxone
207
Pathogen responsible for bronchiolitis?
RSV
208
Best management of RSV?
Supportive care
209
Clinical presentation of bronchiolitis?
Nasal congestion, rhinorrhea, wheezing, nasal flaring, accessory muscle use
210
Patients diagnosed with bronchiolitis should be placed on ___ precautions
Contact + Respiratory
211
Diagnostic test for bronchiolitis?
Clinical diagnosis
212
Complication of bronchiolitis in patients < 2 mo?
Apnea, Respiratory failure
213
Complication of bronchiolitis in patients > 6 mo?
Recurrent wheezing
214
What is the primary risk factor for vertical transmission of Hepatitis B?
Maternal viral load at time of delivery
215
Best treatment for newborn who is at risk for vertical transmission of Hepatitis B?
Hep B vaccine, Hep B Ig
216
What is the Hep B vaccine schedule for infants at risk for vertical transmission of Hepatitis B?
) months, 2 months, 6 months
217
When should Hep B serology be obtained for infant at risk for vertical transmission of Hepatitis B?
9 months
218
How can you distinguish tick paralysis from Guillain-Barre syndrome?
Both show ascending paralysis; Guillain-Barre syndrome = GI + respiratory infection
219
Clinical presentation for tick paralysis?
Ataxia, weakness, ascending paralysis, absent DTRs
220
MOA of tick paralysis?
Neurotoxins in tick saliva are transmitted to host during 4-7 days of tick attachment
221
Best initial step of workup for tick paralysis?
Meticulous skin exam to ID a tick
222
Pathogen responsible for Tinea versicolor?
Malassezia
223
Time of year in which Tinea versicolor is most prominent?
Summer
224
Best management of Tinea versicolor?
Topical anti-fungal
225
2 topical anti-fungal options for Tinea versicolor?
Selenium sulfide, ketoconazole
226
Clinical presentation of scombroid poisoning?
Flushing, HA, palpitations, abdominal cramps, diarrhea, oral burning
227
Scombroid poisoning results from ingestion of …
Improperly stored seafood
228
Taste of scombroid poisoning?
Bitter taste
229
Prognosis for scombroid poisoning?
Self-limited
230
3 most common pathogens that can lead to infection after mammalian bites?
Pasteurella (from animal’s oral flora), Strep + Staph (from patient)
231
Best management of a mammalian bite?
Leave to heal via secondary intention; ABX prophylaxis
232
ABX of choice for prophylaxis in setting of mammalian bite?
Amoxicillin-clavulanate
233
Clinical presentation of Chikungunya Fever?
Fever, severe polyarthralgia
234
Epidemiology of Chikungunya Fever?
Tropical Caribbean, Africa, Asia
235
Vector in transmission of Chikungunya Fever?
Aedes mosquito
236
Best management of Chikungunya Fever?
Supportive care
237
Prognosis of Chikungunya Fever?
Development of chronic arthritis
238
Clinical presentation of Ehrlichiosis?
Polyarthralgia, Lab abnormalities (leukopenia, thrombocytopenia)
239
Lab abnormality seen in setting of malaria?
Hemolytic anemia
240
Pathogen responsible for typhoid fever?
Salmonella
241
Clinical presentation of typhoid fever?
Abdominal pain, cutaneous rose spots
242
Infant botulism results from ingestion of …
Clostridium botulinum spores
243
Mechanism of action of clostridium botulinum in causing botulism?
Neurotoxin inhibits presynaptic ACH release in neuromuscular junction
244
Clinical manifestation of infant botulism?
Constipation, ptosis, poor suck reflex, descending paralysis
245
Complication of infant botulism?
Respiratory failure
246
Best management of infant botulism?
Botulism IG
247
Clinical prognosis for invent botulism?
Full recovery with botulism IG
248
Treatment of choice for HIV-associated thrombocytopenia?
Anti-retroviral therapy
249
What is the expected viral load for a patient started on anti-retroviral therapy for HIV 6 months ago?
< 50 copies/mL
250
Definition of virologic failure in patients with HIV started on anti-retroviral therapy?
Failure to achieve viral load of < 200 copies/mL within 6 months of ART therapy
251
What are the 2 most common causes of virologic failure in HIV?
Drug resistance, Non-compliance
252
Pathogen responsible for traveler’s diarrhea?
Enterotoxic E. coli (ETEC)
253
Route of transmission for traveler’s diarrhea?
Fecal-oral
254
Clinical presentation for traveler’s diarrhea?
Watery diarrhea, crampy abdominal pain
255
Clinical prognosis for traveler’s diarrhea?
Self-limited resolution with supportive care … within 3-4 days
256
Clinical presentation for diarrhea caused by Giardia infection?
Foul-smelling, fatty stools
257
Typical onset of diarrhea caused by Giardia infection?
Symptoms arise more than 1 week after exposure
258
In addition to waning cellular immunity, what is another potential trigger for viral replication in herpes zoster?
Physical trauma
259
Best treatment for herpes zoster, diagnosed within 72 hours of rash appearance?
7 days of oral valacyclovir
260
Best treatment for herpes zoster, diagnosed more than 72 hours of rash appearance?
Pain control … zinc oxide cream + analgesia
261
Value of valacyclovir in patients with herpes zoster?
Reduce transmission risk, prevent new lesion formation, reduce risk of postherpetic neuralgia
262
Healthcare professionals are immune from VZV if …
Documented previous varicella history; Received 2-dose varicella immunization
263
Do immunized healthcare professionals require post-exposure prophylaxis after working with patients with herpes zoster?
No
264
Which varicella zoster lesions still have potential for transmission to other individuals?
Lesions that are not completely crusted over
265
Route of transmission from active varicella zoster lesions?
Direct contact, aerosolization
266
___ refers to continued pain and sensitivity in area of former herpes zoster rash, several months after lesion resolution
Postherpetic neuralgia
267
DOC for Postherpetic neuralgia?
TCA (amitriptyline)
268
Contraindication for use of TCAs in Postherpetic neuralgia?
Elderly
269
Alternative DOC for Postherpetic neuralgia in elderly?
Gabapentin
270
Pathogen responsible for Molluscum contagiosum?
Poxvirus
271
Route of transmission of Molluscum contagiosum?
Skin-to-skin contact
272
Additional testing that should be considered in patients who present with molluscum contagiosum?
HIV testing
273
Topical agent that can be used to treat molluscum contagiosum lesions?
Podophyllotoxin
274
Pathogen responsible for Toxic Shock Syndrome?
Staph aureus
275
How does Staph aureus cause Toxic Shock Syndrome?
Exotoxin production (TSS-1) leads to massive activation of T cells
276
Best management of Toxic Shock Syndrome?
Extensive fluid replacement + ABX
277
ABX of choice for Toxic Shock Syndrome?
Clindamycin
278
2 options for rifampin-based treatment of latent TB?
Rifampin for 4 months; Isoniazid + rifampin for 3 months
279
Clinical presentation of Parvovirus B19?
Flu-like illness, Reticular rash, Symmetric joint pain
280
Best test for diagnosis of Parvovirus B19?
Parvovirus B19 IgM
281
Rash associated with Acute Rheumatic Fever?
Erythema marginatum
282
Rash associated with Lyme disease?
Erythema migrans
283
Best management of Parvovirus B19 infection?
Supportive care
284
Long term sequela of Parvovirus B19 infection?
None
285
Patient with untreated HIV presents with widespread skin papules with central umbilication?
Cutaneous cryptococcosis
286
How can you distinguish Cutaneous cryptococcosis vs. Molluscum contagiosum?
Both have papule with central umbilication; Cutaneous cryptococcosis = central hemorrhage + necrosis
287
Most common manifestation of cryptococcosis?
Meningoencephalitis
288
CD4 count associated with cryptococcosis?
CD4 < 100
289
Best diagnostic test for Cutaneous cryptococcosis?
Biopsy of lesion with histopathologic examination
290
Patient with HIV is started on HAART therapy, along with 4-regimen treatment for active TB infection; After initial symptomatic improvement, patient develops worsening fever, cough, pulmonary infiltrates – diagnosis?
Immune reconstitution inflammatory syndrome (IRIS)
291
Best management of Immune reconstitution inflammatory syndrome (IRIS)?
No change in HAART or RIPE therapy … but symptomatic treatment of NSAIDs and steroids
292
Clinical prognosis for Immune reconstitution inflammatory syndrome (IRIS)?
Transient symptoms
293
Best tetanus prophylaxis in clean wound, patient has received 3+ tetanus vaccines?
TDAP if last dose was 10+ years ago; No Tetanus Ig
