Infectious Disease

Question 1

Who does the CDC recommend should not get the flu vaccine?

Answer 1

Children who are 6 months or younger, children who are febrile, known hypersensitivity to eggs/vaccine components (get recombinant)

Question 2

What interventions are most appropriate for all unvaccinated/frail patients during known flu outbreak?

Answer 2

Flu vaccine plus antiviral ppx with oseltamivir (because immunity to antibodies can take up to 2 weeks to develop)

Question 3

Who is eligible for antiviral therapy during an influenza outbreak?

Answer 3

Normal healthy individuals within 48 hours of onset, hospitalized patients at any time, pregnancy, age > 65, underlying medical illness, nursing home residents, children < 2 years

Question 4

What are the current pneumococcal vaccine guidelines?

Answer 4

Indications for pneumococcal vaccination include patients with chronic illness at high risk for invasive disease (DM, COPD, CVD), institutionalization, age > 65, immunocompromised, and tobacco use (19-64). All adults 65 or older should receive PCV13 before 23.

Question 5

Who is PCV-13 recommended for in addition to those > 65?

Answer 5

ESRD, asplenia, HIV, etc (NOT smoking/COPD)

Question 6

Who is PCV-23 recommended for in addition to those > 65?

Answer 6

Smokers, COPD at any age

Question 7

What is the first-line treatment for C. diff?

Answer 7

Metronidazole 250mg QID or 500mg TID x 10 days

Question 8

What are the criteria for severe C. diff and what is the preferred treatment?

Answer 8

WBC > 15000, creatinine > 1.5x baseline

Vancomycin

Question 9

What are reasonable treatment options for recurrent C. Diff infection?

Answer 9

Repeat a course of metronidazole

Treat with a course of oral vancomycin

Question 10

Who should have head CT prior to performing LP for meningitis diagnosis?

Answer 10

HIV/AIDS, immunosuppressive drugs, transplant recipients, history or CNS disease such as brain tumor/stroke, new-onset seizures, papilledema on exam, abnormal/focal neurologic deficit or abnormal level of consciousness

Question 11

What adjunctive therapy is indicated for patients with pneumococcal meningitis?

Answer 11

Dexamethasone (give empirically until proven not pneumococcal)

Question 12

What should highly resistant S. pneumoniae infections of the CNS be treated with?

Answer 12

Vancomycin and a third-generation cephalosporin

Question 13

What encapsulated organisms should patients undergoing splenectomy be vaccinated against?

Answer 13

S. pneumoniae, meningococcus, and HiB

Question 14

What should the next step be if a high-risk patient has a non-responsive TST?

Answer 14

Repeat the TST in 2 weeks (positivity doubles between first and second tests in initial non-responders)

Question 15

At what induration are TB tests positive for various populations?

Answer 15

5-10mm: CXR with past or current infection, HIV, recent close contact with person with TB
10-15mm: IVDU, institutionalization, immunocompromise, children < 4, healthcare workers
> 15mm: No risk factors

Question 16

What cardiac conditions are considered high risk for infective endocarditis and what antibiotics can be used for dental ppx?

Answer 16

Prosthetic valves (all types), congenital heart disease, and previous history of infective endocarditis
Amoxicillin 2g, Azithromycin 500mg, Clindamycin 600mg

Question 17

When is dental ppx recommended?

Answer 17

Prior to cleaning of teeth and removal plaque, tooth extractions, periodontal procedures (but not tooth fillings)

Question 18

How should scabies be treated?

Answer 18

Single-dose oral ivermectin 200mcg/kg repeated in 2 weeks for adults with nodular disease, with scabies crustosa, or in epidemic settings (avoid in kids < 15kg)
Permethrin cream x 8-14 hours with subsequent bath for all other cases. Treat all family members regardless of symptoms.

Question 19

What is the best diagnostic test for pinworms?

Answer 19

Scotch tape test - wrap cellophane tape around a tongue depressor, sample the perianal area first thing in the morning, store in fridge, and then exam microscopically

Question 20

What is the treatment for pinworms?

Answer 20

Treat the patient and the entire family with mebendazole 100mg orally daily for 14 days, wash all the bed linens

Question 21

What is the difference in presentation between RMSF and monocytic ehrlichiosis?

Answer 21

RMSF is a tick-borne illness caused by Rickettsia with fever and headache followed by maculopapular eruption beginning at the wrists and ankles and spreading centrally, eventually becoming petechial. It is endemic to the southeastern US, Atlantic states, and northern Rockies.
Ehrlichiosis is a tick-borne illness that presents with fever and flu-like symptoms but no rash. It is endemic to midwestern, south central, and southeastern states

Question 22

What is the treatment for RMSF?

Answer 22

Doxycycline 100mg BID

Question 23

What is the treatment for head lice?

Answer 23

Application of 1% permethrin cream to all family members for 10 minutes followed by rinsing, combing out all nits with a special louse comb, and decontaminating affected garments and bed linens. Repeat in 7 days.

Question 24

What are the two organisms responsible for toxic shock syndrome and what is the appropriate treatment?

Answer 24

Staph and Strep - IV Clindamycin and vancomycin to treat the toxin

Question 25

What oral antibiotics treat MRSA?

Answer 25

Bactrim, Doxycycline, Linezolid

Question 26

What are characteristic signs of Malaria and Dengue Fever?

Answer 26

Malaria: cyclical fevers with positive thin and thick blood smears
Dengue Fever: retro-orbital eye pain and severe arthralgias/myalgias