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UWorld > Infectious Disease 1 > Flashcards

Infectious Disease 1 Flashcards

1
Q

2 most common aspects of presentation for children with streptococcal pharyngitis?

A

Fever, Sore throat

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2
Q

2 most common exam findings for streptococcal pharyngitis?

A

Tonsillar exudates, Tender anterior cervical LNs

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3
Q

Most common time of year for streptococcal pharyngitis?

A

Late fall – Winter – Early spring

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4
Q

What test is needed before initiation of ABX in cases of streptococcal pharyngitis?

A

Throat cultures OR Rapid strep antigen testing

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5
Q

Next step after (+) rapid strep antigen testing in suspected streptococcal pharyngitis?

A

ABX treatment … No throat culture needed

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6
Q

Next step after (-) rapid strep antigen testing in suspected streptococcal pharyngitis?

A

Throat culture

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7
Q

2 ABX of choice in setting of streptococcal pharyngitis?

A

Penicillin OR Amoxicillin

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8
Q

Purpose of ABX treatment in streptococcal pharyngitis?

A

Prevent acute rheumatic fever

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9
Q

DOC for treatment of streptococcal pharyngitis in patients with penicillin allergy?

A

Cephalosporins

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10
Q

2 most common bacteria associated with human bite wounds?

A

Eikenella, Staph aureus … but usually polymicrobial

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11
Q

Structure of Eikenella?

A

Gram (-) anaerobe

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12
Q

3 aspects of treatment for human bite wounds?

A

ABX, Tetanus prophylaxis, Left open to heal by secondary intention … (avoid primary closure)

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13
Q

Bite wound in which location should be treated with primary closure?

A

Face … (cosmetic outcome is important, risk of infection is low)

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14
Q

Oral ABX of choice for bite wound due to suspected Eikenella?

A

Amoxicillin-Clavulanate

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15
Q

IV ABX of choice for bite wound due to suspected Eikenella?

A

Ampicillin-Sulbactam

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16
Q

3 types of inactivated vaccines?

A

Polio, Hepatitis A, Influenza

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17
Q

2 types of inactivated vaccines?

A

Diphtheria, Tetanus

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18
Q

5 types of inactivated vaccines?

A

Rotavirus, Measles, Mumps, Rubella, Varicella

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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

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20
Q

How often should CD4 count and viral load be evaluated in pregnant female with HIV?

A

Every 3 months

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21
Q

Delivery modality of choice for pregnant females with HIV viral load < 1,000?

A

Low risk of perinatal transmission … Vaginal delivery recommended

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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

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23
Q

6 maternal contraindications to breastfeeding?

A

Active TB, HIV, Herpetic breast lesions, Active varicella infection, CTX/XRT treatment, Active substance abuse

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24
Q

1 infant contraindication to breastfeeding?

A

Galactosemia

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25
Q

What is considered (+) TB test for healthcare professionals?

A

Induration > 10mm

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26
Q

Next step of workup for healthcare professional with (+) TB test (induration >10 mm)?

A

CXR

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27
Q

Definition of latent TB?

A

(+) TB test, NML CXR, No symptoms of active TB

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28
Q

Is latent TB considered infectious or non-infectious?

A

Non-infectious

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29
Q

Can patients with latent TB continue working?

A

Yes, they may continue working without mask restrictions … even if they decline or do not complete isoniazid treatment

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30
Q

Typical treatment offered to patients with latent TB?

A

6-9 months of isoniazid

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31
Q

When are patients with active TB considered to be non-infectious?

A

After 3 consecutive acid-fast bacilli sputum smears are (-)

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32
Q

Vector of West Nile virus?

A

Mosquito

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33
Q

6 aspects of clinical presentation of West Nile virus?

A

Fever, HA, nuchal rigidity, AMS, hyperreflexia, maculopapular rash

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34
Q

Diagnostic test for West Nile virus?

A

Detection of West Nile IgM antibody in CSF

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35
Q

Best treatment for West Nile virus?

A

Supportive

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36
Q

Epidemiology of CMV infection?

A

HIV patients (with AIDS); Post-transplant patients

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37
Q

5 aspects of clinical presentation for CMV infection?

A

Fever, cough, coryza, conjunctivitis, diffuse maculopapular rash (descending)

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38
Q

Necrotizing fasciitis refers to a …

A

Fulminant infection of subcutaneous tissue that spreads rapidly along fascial planes, leading to extensive tissue necrosis and shock

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39
Q

Which patients are most commonly affected by Type A necrotizing fasciitis?

A

Previously-healthy patients

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40
Q

Most common pathogen responsible for Type A necrotizing fasciitis?

A

Strep pyogenes … (Group A Strep)

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41
Q

Which patients are most commonly affected by Type B necrotizing fasciitis?

A

Patients with underlying poor circulation (DM)

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42
Q

Most common pathogen responsible for Type B necrotizing fasciitis?

A

Polymicrobial

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43
Q

Best treatment for patient with necrotizing fasciitis?

A

Urgent, aggressive surgical exploration + ABX + Hemodynamic support

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44
Q

3 empiric ABX recommended for necrotizing fasciitis?

A

Piperacillin/Tazobactam OR Carbapenem; Vancomycin; Clindamycin

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45
Q

Role of Piperacillin/Tazobactam OR Carbapenem; in empiric treatment for necrotizing fasciitis?

A

Covers Strep pyogenes + anaerobes

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46
Q

Role of Vancomycin in empiric treatment for necrotizing fasciitis?

A

Covers Staph aureus + MRSA

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47
Q

Role of Clindamycin in empiric treatment for necrotizing fasciitis?

A

Inhibits toxin formation by streptococci + staphylococci

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48
Q

Recommendation for HIV (+) children attending school?

A

Should attend without any restrictions; Disclosure of HIV (+) status by family is voluntary

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49
Q

Pathogen responsible for Infectious Mononucleosis?

A

EBV

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50
Q

5 aspects of clinical presentation for Infectious Mononucleosis?

A

Fatigue, fever, exudative pharyngitis, LAD, hepatosplenomegaly

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51
Q

Best treatment for Infectious Mononucleosis?

A

Supportive care …

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52
Q

Diagnostic test for Infectious Mononucleosis?

A

Heterophile Ig

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53
Q

Best treatment for Infectious Mononucleosis, in which airway obstruction appears imminent?

A

Corticosteroids

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54
Q

2 DOCs for treatment of oral candidiasis from inhaled corticosteroids in patient with asthma?

A

Nystatin suspension; Clotrimazole lozenges

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55
Q

Pathogen responsible for condyloma accuminata?

A

HPV

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56
Q

Alternate name for condyloma accuminata?

A

Anogenital warts

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57
Q

Diagnostic test for condyloma accuminata?

A

Application of acetic acid turns the lesions white

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58
Q

Transmission of condyloma accuminata?

A

Sexual transmission

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59
Q

2 medications that can treat condyloma accuminata?

A

Trichloroacetic acid, Podophyllin

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60
Q

Which medication is indicated for treatment of vaginal condyloma accuminata?

A

Trichloroacetic acid

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61
Q

MOA of Trichloroacetic acid in treatment of vaginal condyloma accuminata?

A

Protein coagulation

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62
Q

Why should Podophyllin not be used in treatment of vaginal condyloma accuminata?

A

Podophyllin should be used for external (not internal) lesions

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63
Q

Additional contraindication for Podophyllin?

A

Pregnancy

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64
Q

Clinical presentation for Disseminated Gonococcal Infection?

A

Purulent monoarthritis OR … triad of polyarthralgia, tenosynovitis, dermatitis

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65
Q

Best diagnostic test for Disseminated Gonococcal Infection?

A

NAAT of urogenital specimen

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66
Q

Additional testing that should be performed in setting of Disseminated Gonococcal Infection?

A

Testing for other sexually-transmitted diseases (HIV, chlamydia infection)

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67
Q

Best treatment for Disseminated Gonococcal Infection that is (+) for Neisseria gonorrhea, (-) for Chlamydia?

A

Single IM dose of Ceftriaxone

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68
Q

Best treatment for Disseminated Gonococcal Infection that is (+) for Neisseria gonorrhea, (+) for Chlamydia?

A

Single IM dose of Ceftriaxone + Oral doxycycline

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69
Q

Risk of CLABSI (Central Line Associated Bloodstream Infection) is greatest when central catheter has been in place for > ___ days

A

6

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70
Q

Does replacement of central catheter using a guidewire result in increased OR decreased risk of CLASBI?

A

Increased

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71
Q

Does placement of central catheter in subclavian vein (vs. internal jugular vein) increased OR decreased risk of CLASBI?

A

Decreased

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72
Q

2 measures that can decrease risk of CLASBI?

A

Sterile barriers (drapes), Chlorhexidine-based antiseptic

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73
Q

Recommended screening test for HIV?

A

HIV Ag + HIV1/HIV2 Ig

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74
Q

When are HIV Ag + HIV Ig too low to be detected with 100% accuracy?

A

Window period … 1-4 weeks after infection

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75
Q

When should HIV Ag + HIV1/HIV2 Ig screening tests be repeated?

A

4 weeks after infection

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76
Q

Before initiation of HAART in patient with (+) HIV screening test – which additional tests should be performed?

A

Hepatitis B, Hepatitis C, TB, Neisseria gonorrhea, syphilis

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77
Q

Best management for patient who presents with symptomatic acute Hepatitis B infection?

A

Outpatient supportive care, with close follow-up

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78
Q

Likelihood that adult with symptomatic acute Hepatitis B infection will progress to chronic infection?

A

5%

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79
Q

Likelihood that perinatal acute Hepatitis B infection will progress to chronic infection?

A

90%

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80
Q

Likelihood that child 1-5 yo with symptomatic acute Hepatitis B infection will progress to chronic infection?

A

20-50%

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81
Q

Most likely outcome of symptomatic acute Hepatitis B infection in adults?

A

Spontaneous resolution

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82
Q

At what point in course of acute Hepatitis B infection does it become chronic?

A

HBsAg does not clear after 6 months of infection

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83
Q

15 yo female presents with fever, sore throat; PE shows gray pharyngeal patches that coalesce into pseudomembrane – diagnosis?

A

Diphtheria

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84
Q

Complication of systemic absorption of diphtheria toxins?

A

Myocarditis

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85
Q

Classic triad of Rickettsia infection?

A

Fever, HA, rash around wrists + ankles

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86
Q

Best treatment for Rickettsia infection?

A

Doxycycline … (for ALL patients, including pregnant females + children)

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87
Q

3 lab values seen in setting of Rickettsia infection?

A

­ ALT/AST, ¯ platelets, ¯ Na+

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88
Q

HIV patients with CD4 count ___ are susceptible to Pneumocystic jiroveci PNA

A

< 200

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89
Q

Least invasive way to obtain a respiratory sample from patient with suspected PCP?

A

Induced sputum

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90
Q

Next step for patient with suspected PCP, but (-) induced sputum sample?

A

Further testing with bronchoalveolar lavage

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91
Q

Best treatment for PCP?

A

TMP-SMX, prednisone

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92
Q

Best treatment for community-acquired PNA?

A

Ceftriaxone, Azithromycin

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93
Q

Patient with suspected PCP experiences respiratory decompensation after 2-3 days of TMP-SMX treatment – etiology?

A

Organism lysis

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94
Q

Reason for treating patients with suspected PCP with corticosteroids?

A

Reduce risk of intubation

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95
Q

2 criteria needed for patients with suspected PCP to be treated with corticosteroids?

A

AA gap > 35; PaO2 < 70

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96
Q

Most common pathogen responsible for lobar PNA?

A

Strep pneumoniae

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97
Q

Treatment of choice for Strep pneumoniae lobar PNA?

A

High-dose amoxicillin PO

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98
Q

5 aspects of clinical presentation for toxoplasmosis in infants?

A

Hydrocephalus, intracranial calcifications, hepatomegaly, hearing impairment, chorioretinitis

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99
Q

Route of transmission for congenital toxoplasmosis (from mother to fetus)?

A

Trans-placental

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100
Q

Maternal exposures that increased risk of congenital toxoplasmosis?

A

Cat feces, undercooked meat, contaminated soil

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101
Q

Treatment for congenital toxoplasmosis?

A

1 yr treatment of pyrimethamine + sulfadiazine; Folate supplementation

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102
Q

Post-exposure prophylaxis for people exposed to hepatitis B … not previously vaccinated OR did not mount satisfactory Ig response to Hep B vaccine?

A

Hep B Ig + Hep B vaccine

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103
Q

Post-exposure prophylaxis for people exposed to hepatitis B, but previously mounted satisfactory Ig response to Hep B vaccine?

A

No post-exposure prophylaxis necessary

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104
Q

Location of abnormality in setting of botulinum toxicity?

A

Presynaptic NMJ

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105
Q

Role of botulinum toxin at the presynaptic NMJ?

A

Inhibits release of ACH into synaptic cleft

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106
Q

O2 consumption of clostridium botulinum?

A

Anaerobic

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107
Q

Clinical presentation of botulinum toxicity?

A

Descending weakness, Autonomic dysfunction, response, Preserved sensation

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108
Q

Clinical presentation of Guillain-Barre syndrome?

A

Ascending weakness

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109
Q

Pathogen responsible for Guillain-Barre syndrome?

A

Campylobacter jejuni

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110
Q

Cases of Guillain-Barre syndrome are frequently preceded by …

A

Respiratory, GI illness

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111
Q

2 aspects of clinical presentation for HAART-associated lipodystrophy?

A

Lipoatrophy, Fat accumulation

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112
Q

Description of lipoatrophy seen in setting of HAART-associated lipodystrophy?

A

Loss of subcutaneous fat from face, arms, legs

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113
Q

2 most common HAART drugs associated with lipodystrophy?

A

Statuvidine, Ziduvidine (NRTIs)

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114
Q

Description of fat accumulation seen in setting of HAART-associated lipodystrophy?

A

Buffalo hump, Visceral abdominal fat accumulation

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115
Q

Metabolic abnormality associated with HAART-associated lipodystrophy?

A

Insulin resistance

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116
Q

Complication of HAART-associated lipodystrophy?

A

Increased risk of cardiovascular disease

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117
Q

Best management of dyslipidemia in setting of HAART-associated lipodystrophy?

A

Statin treatment for patients with estimated 10-year cardiovascular risk > 7.5%

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118
Q

Most common pathogen responsible for plantar warts?

A

HPV

119
Q

Best treatment for plantar warts?

A

Topical salicylic acid + soaking in warm water

120
Q

When does salicylic acid typically begin working on plantar warts?

A

2-3 weeks

121
Q

Early neurosyphilis most commonly occurs during the ___ stage of syphilis

A

2nd

122
Q

2 hallmark clinical features of secondary syphilis?

A

Maculopapular rash, LAD

123
Q

Clinical presentation of ocular syphilis?

A

Posterior uveitis

124
Q

Triad of clinical presentation for disseminated gonococcemia?

A

Rash, tenosynovitis, polyarthralgia

125
Q

Clinical presentation of Acute Retroviral Syndrome?

A

Similar to the flu … (fever, LAD, weight loss, myalgias) + diarrhea

126
Q

When does Acute Retroviral Syndrome occur, in relation to infection with HIV?

A

2-4 weeks after infection

127
Q

Dermatologic condition that may also present in patients with HIV?

A

Seborrheic dermatitis

128
Q

Clinical presentation of Seborrheic dermatitis?

A

Dandruff, scaly face rash

129
Q

Initial screening for diagnosis of osteomyelitis?

A

Probe-to-Bone testing

130
Q

Diagnostic test for osteomyelitis?

A

Foot MRI

131
Q

Gold standard test for identifying pathogens responsible for osteomyelitis?

A

Bone biopsy with culture

132
Q

DOC for treatment of Lyme disease in pregnant females?

A

Amoxicillin … (not doxycycline)

133
Q

Duration of Amoxicillin treatment of Lyme disease in pregnant females?

A

14-21 days

134
Q

Long-term consequences of Lyme disease in pregnant females?

A

None, if mother is receives adequate treatment

135
Q

Why should doxycycline NOT be used for treatment of Lyme disease in pregnant females?

A

Risk of fetal long-bone deformity + tooth discoloration in infants

136
Q

Best STI screening for an asymptomatic male, 27 yo?

A

HIV screening … with p24 Ag + HIV Ig

137
Q

Who should receive a 1-time asymptomatic screening for HIV?

A

Patients 13-65 yo

138
Q

Route of transmission for Giardia?

A

Fecal-oral

139
Q

Epidemiology of Giardia infection?

A

Hikers

140
Q

Best management for Giardia infection in symptomatic patients?

A

Metronidazole

141
Q

Important step in controlling the spread of Giardia infection?

A

Hand hygiene with soap + water … (hand sanitizer won’t kill the Giardia trophozoites)

142
Q

Additional step in controlling spread of Giardia infection?

A

Limiting recreational water venue visits by infected patients

143
Q

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?

A

Cryptococcal meningitis, due to underlying HIV infection

144
Q

Diagnostic CSF test for Cryptococcal meningitis?

A

(+) India ink, (+) cryptococcal antigen testing

145
Q

1st step of pharmacologic management for Cryptococcal meningitis?

A

Amphotericin B + Flucytosine for 2 weeks

146
Q

2nd step of pharmacologic management for Cryptococcal meningitis?

A

High-dose oral fluconazole for 8 weeks

147
Q

3rd step of pharmacologic management for Cryptococcal meningitis?

A

Low-dose fluconazole for 1 year

148
Q

Patient with Cryptococcal meningitis presents with worsening symptoms of elevated ICP – what is best management of elevated ICP?

A

Serial LPs … (not mannitol)

149
Q

Change to CSF in setting of meningitis caused by Strep Pneumoniae or Neisseria meningitis?

A

Elevated WBC with PMN predominance

150
Q

Empiric therapy for meningitis caused by Strep Pneumoniae or Neisseria meningitis?

A

Ceftriaxone + Vancomycin

151
Q

Empiric therapy for meningitis caused by Strep Pneumoniae or Neisseria meningitis … in a patient >50 yo?

A

Ampicillin

152
Q

In cases of newly-diagnosed HIV, what public health role does the physician play?

A

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
Q

Patient has had close contact with an individual recently diagnosed with active TB; Which induration represents a (+) PPD test?

A

> 5 mm

154
Q

Treatment of choice for latent TB … (+) PPD test, (-) CXR?

A

Isoniazid

155
Q

Most common AE of Isoniazid?

A

Hepatotoxicity

156
Q

Clinical presentation of Isoniazid-associated Hepatotoxicity?

A

Asymptomatic, self-limited transaminitis

157
Q

What degree of Hepatotoxicity warrants a patient discontinuing use of Isoniazid? (2)

A

Liver enzymes > 5x Upper Limits of NML; Symptomatic transaminitis

158
Q

Which TB drug is associated with hyperuricemia?

A

Pyrazinamide

159
Q

Which TB drug is associated with ocular toxicity?

A

Ethambutol

160
Q

Which TB drug is associated with drug-induced SLE?

A

Isoniazid

161
Q

2 other drugs associated with drug-induced SLE?

A

Procainamide, Hydralazine

162
Q

Which additional drug should be administered with Isoniazid?

A

Vitamin B6 (pyridoxine)

163
Q

Contraindication for initiation of HIV Pre-Exposure Prophylaxis for MSM?

A

Patients with abnormal renal function (CKD, ESRD)

164
Q

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?

A

R-sided infective endocarditis

165
Q

Which heart valve is most commonly affected by IVDU?

A

Tricuspid

166
Q

Pathogen responsible for infective endocarditis involving the tricuspid valve?

A

Staph aureus

167
Q

Diagnostic test for infective endocarditis?

A

Transthoracic ECHO

168
Q

What accounts for R-sided CP (worse with deep inspiration) seen in setting of infective endocarditis?

A

Septic pulmonary emboli

169
Q

Appearance of Septic pulmonary emboli on CXR in setting of infective endocarditis?

A

Multiple nodular opacities

170
Q

How can you distinguish PCP PNA from infective endocarditis in an HIV (+) patient?

A

PCP PNA is subacute (low-grade fever for weeks) vs. Infective endocarditis high fever

171
Q

Guillain-Barre syndrome typically occurs after …

A

GI or respiratory infection

172
Q

What accounts for development of Guillain-Barre syndrome after GI or respiratory infection?

A

Molecular mimicry … Corss-reacting Ig to PNS components

173
Q

Pathogen responsible for Guillain-Barre syndrome?

A

Campylobacter

174
Q

Clinical presentation of Guillain-Barre syndrome?

A

Ascending symmetric muscle weakness, Dysautonomia

175
Q

Complication of Guillain-Barre syndrome?

A

Respiratory failure

176
Q

How should impending respiratory failure be monitored in Guillain-Barre syndrome?

A

Frequent measurement of vital capacity + negative inspiratory force

177
Q

Best treatment for Guillain-Barre syndrome?

A

IVIG, plasma exchange

178
Q

Which groups of patients should receive IVIG or plasma exchange for Guillain-Barre syndrome?

A

Non-ambulatory, Within 4 weeks of symptom onset

179
Q

Prognosis for Guillain-Barre syndrome?

A

Slow, spontaneous resolution over period of months

180
Q

What is the value of IVIG or plasma exchange in treatment of Guillain-Barre syndrome?

A

Shortens recovery time by ~50%

181
Q

Role of oseltamivir for treatment of flu? (2)

A

Reduce symptom duration, Decrease risk of developing post-influenza PNA

182
Q

Which patients with a (+) flu test should be given oseltamivir?

A

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
Q

Best treatment for patient with (+) flu test, who presents > 48 hours after symptom onset?

A

Symptomatic care

184
Q

2 aspects of clinical presentation for patient with early Lyme disease?

A

Erythema migrans, Viral-like symptoms

185
Q

Best management of early Lyme disease?

A

Diagnose early (no need for ELISA), Treat empirically with oral doxycycline

186
Q

Initial clinical presentation of Sporothrix schenckii?

A

Painless papule at site of inoculation; Soon ulcerates and drains clear, odorless fluid

187
Q

Late clinical presentation of Sporothrix schenckii?

A

Appearance of more painless papules along the proximal lymphatic chain

188
Q

Best management of Sporothrix schenckii infection?

A

Itraconazole

189
Q

Clinical presentation of Blastomycosis?

A

PNA, verrucous (“heaped up”) skin lesions

190
Q

Clinical presentation of Actinomyces?

A

Multiple abscesses, fistulas, sinus tracts that drain thick, yellow discharge with granules

191
Q

Clinical presentation of Coccidiomycosis?

A

PNA, soft-tissue abscesses

192
Q

Clinical presentation of Histoplasmosis?

A

PNA, fever, fatigue, weight loss (mimics TB)

193
Q

3 classic CXR findings associated with active TB infection?

A

Upper lobe cavitation, Hilar LAD, Pleural effusion

194
Q

Best initial test for diagnosis of active TB infection?

A

Sputum sampling

195
Q

3 tests that should be performed on sputum from patient with high clinical suspicion for active TB?

A

Acid-fast staining, Mycobacterial culture, NAAT

196
Q

Why are TB-skin testing or IFN-g testing not helpful for diagnosis of active TB infection?

A

TB-skin testing and IFN-g testing cannot distinguish between latent vs. active TB infection

197
Q

Limitation of Acid-fast staining of sputum in patient with high clinical suspicion for active TB?

A

Acid-fast staining has low SN … (so lots of false negatives)

198
Q

Diagnostic test for Lyme Disease?

A

ELISA, or Western Blot

199
Q

Prognosis for Lyme Disease?

A

Most cases resolve … but patients are at increased risk for recurrent arthritis with joint damage

200
Q

Best management of Lyme Disease?

A

Doxycycline + Amoxicillin

201
Q

Duration of Doxycycline + Amoxicillin treatment for Lyme Disease?

A

28 days

202
Q

Epidemiology of vibrio vulinficus infection?

A

Marine environments, wound infections; Pts with liver disease

203
Q

Clinical presentation of vibrio vulinficus infection?

A

Septic shock, cellulitis

204
Q

How do wounds in Vibrio vulinficus infection differ from wounds in Mycobacterium marinum?

A

Vibrio vulinficus = necrotizing, bullous; Mycobacterium marinum = popular, ulcerative

205
Q

How does onset of symptoms in Vibrio vulinficus infection differ from onset of symptoms in Mycobacterium marinum?

A

Vibrio vulinficus = rapid onset over several hours; Mycobacterium marinum = develops over several days

206
Q

Best treatment for vibrio vulinficus infection?

A

Doxycycline + Ceftriaxone

207
Q

Pathogen responsible for bronchiolitis?

A

RSV

208
Q

Best management of RSV?

A

Supportive care

209
Q

Clinical presentation of bronchiolitis?

A

Nasal congestion, rhinorrhea, wheezing, nasal flaring, accessory muscle use

210
Q

Patients diagnosed with bronchiolitis should be placed on ___ precautions

A

Contact + Respiratory

211
Q

Diagnostic test for bronchiolitis?

A

Clinical diagnosis

212
Q

Complication of bronchiolitis in patients < 2 mo?

A

Apnea, Respiratory failure

213
Q

Complication of bronchiolitis in patients > 6 mo?

A

Recurrent wheezing

214
Q

What is the primary risk factor for vertical transmission of Hepatitis B?

A

Maternal viral load at time of delivery

215
Q

Best treatment for newborn who is at risk for vertical transmission of Hepatitis B?

A

Hep B vaccine, Hep B Ig

216
Q

What is the Hep B vaccine schedule for infants at risk for vertical transmission of Hepatitis B?

A

) months, 2 months, 6 months

217
Q

When should Hep B serology be obtained for infant at risk for vertical transmission of Hepatitis B?

A

9 months

218
Q

How can you distinguish tick paralysis from Guillain-Barre syndrome?

A

Both show ascending paralysis; Guillain-Barre syndrome = GI + respiratory infection

219
Q

Clinical presentation for tick paralysis?

A

Ataxia, weakness, ascending paralysis, absent DTRs

220
Q

MOA of tick paralysis?

A

Neurotoxins in tick saliva are transmitted to host during 4-7 days of tick attachment

221
Q

Best initial step of workup for tick paralysis?

A

Meticulous skin exam to ID a tick

222
Q

Pathogen responsible for Tinea versicolor?

A

Malassezia

223
Q

Time of year in which Tinea versicolor is most prominent?

A

Summer

224
Q

Best management of Tinea versicolor?

A

Topical anti-fungal

225
Q

2 topical anti-fungal options for Tinea versicolor?

A

Selenium sulfide, ketoconazole

226
Q

Clinical presentation of scombroid poisoning?

A

Flushing, HA, palpitations, abdominal cramps, diarrhea, oral burning

227
Q

Scombroid poisoning results from ingestion of …

A

Improperly stored seafood

228
Q

Taste of scombroid poisoning?

A

Bitter taste

229
Q

Prognosis for scombroid poisoning?

A

Self-limited

230
Q

3 most common pathogens that can lead to infection after mammalian bites?

A

Pasteurella (from animal’s oral flora), Strep + Staph (from patient)

231
Q

Best management of a mammalian bite?

A

Leave to heal via secondary intention; ABX prophylaxis

232
Q

ABX of choice for prophylaxis in setting of mammalian bite?

A

Amoxicillin-clavulanate

233
Q

Clinical presentation of Chikungunya Fever?

A

Fever, severe polyarthralgia

234
Q

Epidemiology of Chikungunya Fever?

A

Tropical Caribbean, Africa, Asia

235
Q

Vector in transmission of Chikungunya Fever?

A

Aedes mosquito

236
Q

Best management of Chikungunya Fever?

A

Supportive care

237
Q

Prognosis of Chikungunya Fever?

A

Development of chronic arthritis

238
Q

Clinical presentation of Ehrlichiosis?

A

Polyarthralgia, Lab abnormalities (leukopenia, thrombocytopenia)

239
Q

Lab abnormality seen in setting of malaria?

A

Hemolytic anemia

240
Q

Pathogen responsible for typhoid fever?

A

Salmonella

241
Q

Clinical presentation of typhoid fever?

A

Abdominal pain, cutaneous rose spots

242
Q

Infant botulism results from ingestion of …

A

Clostridium botulinum spores

243
Q

Mechanism of action of clostridium botulinum in causing botulism?

A

Neurotoxin inhibits presynaptic ACH release in neuromuscular junction

244
Q

Clinical manifestation of infant botulism?

A

Constipation, ptosis, poor suck reflex, descending paralysis

245
Q

Complication of infant botulism?

A

Respiratory failure

246
Q

Best management of infant botulism?

A

Botulism IG

247
Q

Clinical prognosis for invent botulism?

A

Full recovery with botulism IG

248
Q

Treatment of choice for HIV-associated thrombocytopenia?

A

Anti-retroviral therapy

249
Q

What is the expected viral load for a patient started on anti-retroviral therapy for HIV 6 months ago?

A

< 50 copies/mL

250
Q

Definition of virologic failure in patients with HIV started on anti-retroviral therapy?

A

Failure to achieve viral load of < 200 copies/mL within 6 months of ART therapy

251
Q

What are the 2 most common causes of virologic failure in HIV?

A

Drug resistance, Non-compliance

252
Q

Pathogen responsible for traveler’s diarrhea?

A

Enterotoxic E. coli (ETEC)

253
Q

Route of transmission for traveler’s diarrhea?

A

Fecal-oral

254
Q

Clinical presentation for traveler’s diarrhea?

A

Watery diarrhea, crampy abdominal pain

255
Q

Clinical prognosis for traveler’s diarrhea?

A

Self-limited resolution with supportive care … within 3-4 days

256
Q

Clinical presentation for diarrhea caused by Giardia infection?

A

Foul-smelling, fatty stools

257
Q

Typical onset of diarrhea caused by Giardia infection?

A

Symptoms arise more than 1 week after exposure

258
Q

In addition to waning cellular immunity, what is another potential trigger for viral replication in herpes zoster?

A

Physical trauma

259
Q

Best treatment for herpes zoster, diagnosed within 72 hours of rash appearance?

A

7 days of oral valacyclovir

260
Q

Best treatment for herpes zoster, diagnosed more than 72 hours of rash appearance?

A

Pain control … zinc oxide cream + analgesia

261
Q

Value of valacyclovir in patients with herpes zoster?

A

Reduce transmission risk, prevent new lesion formation, reduce risk of postherpetic neuralgia

262
Q

Healthcare professionals are immune from VZV if …

A

Documented previous varicella history; Received 2-dose varicella immunization

263
Q

Do immunized healthcare professionals require post-exposure prophylaxis after working with patients with herpes zoster?

A

No

264
Q

Which varicella zoster lesions still have potential for transmission to other individuals?

A

Lesions that are not completely crusted over

265
Q

Route of transmission from active varicella zoster lesions?

A

Direct contact, aerosolization

266
Q

___ refers to continued pain and sensitivity in area of former herpes zoster rash, several months after lesion resolution

A

Postherpetic neuralgia

267
Q

DOC for Postherpetic neuralgia?

A

TCA (amitriptyline)

268
Q

Contraindication for use of TCAs in Postherpetic neuralgia?

A

Elderly

269
Q

Alternative DOC for Postherpetic neuralgia in elderly?

A

Gabapentin

270
Q

Pathogen responsible for Molluscum contagiosum?

A

Poxvirus

271
Q

Route of transmission of Molluscum contagiosum?

A

Skin-to-skin contact

272
Q

Additional testing that should be considered in patients who present with molluscum contagiosum?

A

HIV testing

273
Q

Topical agent that can be used to treat molluscum contagiosum lesions?

A

Podophyllotoxin

274
Q

Pathogen responsible for Toxic Shock Syndrome?

A

Staph aureus

275
Q

How does Staph aureus cause Toxic Shock Syndrome?

A

Exotoxin production (TSS-1) leads to massive activation of T cells

276
Q

Best management of Toxic Shock Syndrome?

A

Extensive fluid replacement + ABX

277
Q

ABX of choice for Toxic Shock Syndrome?

A

Clindamycin

278
Q

2 options for rifampin-based treatment of latent TB?

A

Rifampin for 4 months; Isoniazid + rifampin for 3 months

279
Q

Clinical presentation of Parvovirus B19?

A

Flu-like illness, Reticular rash, Symmetric joint pain

280
Q

Best test for diagnosis of Parvovirus B19?

A

Parvovirus B19 IgM

281
Q

Rash associated with Acute Rheumatic Fever?

A

Erythema marginatum

282
Q

Rash associated with Lyme disease?

A

Erythema migrans

283
Q

Best management of Parvovirus B19 infection?

A

Supportive care

284
Q

Long term sequela of Parvovirus B19 infection?

A

None

285
Q

Patient with untreated HIV presents with widespread skin papules with central umbilication?

A

Cutaneous cryptococcosis

286
Q

How can you distinguish Cutaneous cryptococcosis vs. Molluscum contagiosum?

A

Both have papule with central umbilication; Cutaneous cryptococcosis = central hemorrhage + necrosis

287
Q

Most common manifestation of cryptococcosis?

A

Meningoencephalitis

288
Q

CD4 count associated with cryptococcosis?

A

CD4 < 100

289
Q

Best diagnostic test for Cutaneous cryptococcosis?

A

Biopsy of lesion with histopathologic examination

290
Q

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?

A

Immune reconstitution inflammatory syndrome (IRIS)

291
Q

Best management of Immune reconstitution inflammatory syndrome (IRIS)?

A

No change in HAART or RIPE therapy … but symptomatic treatment of NSAIDs and steroids

292
Q

Clinical prognosis for Immune reconstitution inflammatory syndrome (IRIS)?

A

Transient symptoms

293
Q

Best tetanus prophylaxis in clean wound, patient has received 3+ tetanus vaccines?

A

TDAP if last dose was 10+ years ago; No Tetanus Ig

UWorld (21 decks)

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