Infectious Disease

Question 1

Patients undergoing cardiothoracic or orthopedic surgery should be screened for

Answer 1

nasal carriage of Staphylococcus aureus and, if positive, should have preoperative decolonization

Question 2

Immune reconstitution inflammatory syndrome is the return of a robust immune response resulting from treatment of HIV that may “unmask” a pre-existing infection; when this occurs,

Answer 2

the underlying infection should be treated while antiretroviral therapy is continued.

Question 3

In endemic areas such as California, as many as one third of cases of community-acquired pneumonia are caused by

Answer 3

Coccidioides species

Question 4

Guideline-based recommendations for empiric therapy of community-acquired pneumonia requiring ICU admission include

Answer 4

a β-lactam (ampicillin-sulbactam, cefotaxime, ceftriaxone, or ceftaroline) to treat Streptococcus pneumoniae, gram-negative bacilli, or Haemophilus influenzae plus an agent active against Legionella, such as a macrolide or quinolone.

Question 5

Initial studies for fever of unknown origin in most patients typically include a complete blood count with differential, complete metabolic profile with kidney and liver studies, at least three blood culture sets and cultures of other bodily fluids (such as urine or from other sources based on clinical suspicion), an erythrocyte sedimentation rate, tuberculosis testing, and serology for HIV; it is reasonable to perform

Answer 5

chest imaging (radiography or CT) &CT ABDOMEN & PELVIS as initial diagnostic imaging.

Question 6

Risk factors for invasive or disseminated aspergillosis include profound and prolonged neutropenia and stem cell and solid organ transplantation; patients have fever, cough, chest pain, and hemoptysis at presentation, and pulmonary infiltrates, nodules, or wedge-shaped densities may be seen on chest radiographs. The most efficient way to establish a definitive diagnosis (and then initiate antifungal therapy) is with?

Answer 6

Serum galactomannan testing in patients with suspected invasive pulmonary aspergillosis. Bronchoalveolar lavage and biopsy, if necessary, are recommended if the serum galactomannan result is negative but strong risk factors are present. (Added March 2020)

Question 7

Usually develops weeks after exposure, during the second phase of illness, and can present with uveitis, rash, conjunctival suffusion, sepsis, lymphadenopathy, kidney injury, and hepatosplenomegaly.

Answer 7

Leptospiral meningitis

Question 8

Fulminant Clostridium difficile infections require

Answer 8

oral vancomycin plus intravenous metronidazole; vancomycin enemas may also be added if ileus is present.

Question 9

A poorly understood sequela of Lyme disease thought to be due to a disordered immunologic response to the preceding infection; most patients slowly improve over a 6-month course, and treatment is directed toward symptom amelioration.

Answer 9

Post–Lyme disease syndrome

Question 10

Rapidly growing, non-tuberculous mycobacteria, such as _______________, can produce chronic, non-healing wounds that do not respond to conventional antimicrobial therapy.

Answer 10

Mycobacterium fortuitum

Question 11

In patients with a high likelihood of pelvic inflammatory disease without indications for hospitalization, empiric therapy with?

Answer 11

A single dose of IM Ceftriaxone, 500 mg, should be given (for persons ≥150 kg, the dose should be 1 g) along with oral doxycycline and metronidazole for 14 days without waiting for microbiologic testing results. (Updated by CDC in 07/2021)

Question 12

Screening for and possibly treating asymptomatic bacteriuria is supported by only two indications:

Answer 12

pregnancy and medical clearance before an invasive urologic procedure

Question 13

Preferred HIV postexposure prophylaxis regimens include

Answer 13

tenofovir disoproxil fumarate, emtricitabine, and either dolutegravir or raltegravir and are appropriate whether the exposure was occupational or nonoccupational

Question 14

Acute, uncomplicated pyelonephritis can usually be managed with oral outpatient antimicrobial therapy, with

Answer 14

fluoroquinolones ciprofloxacin and levofloxacin being the preferred, first-line agents. 5-7 day course

Question 15

Patients with selective IgA deficiency are susceptible to ________________ infection, manifesting as abdominal cramping, bloating, and chronic diarrhea.

Answer 15

Giardia lamblia

Question 16

In patients with potential Zika virus exposure more than 2 weeks previously, testing for

Answer 16

Zika virus IgM antibodies is necessary.

Question 17

is a cause of Ramsay Hunt syndrome, which usually presents with ear pain, a vesicular rash in the external ear (although the rash may be absent), and ipsilateral peripheral facial palsy.

Answer 17

Varicella-zoster virus

Question 18

Many zoonotic organisms have the potential to cause pulmonary infection (i.e Q fever pneumonia), but they can be differentiated based on the severity of illness and animal reservoir; relatively mild infection coupled with exposure to livestock indicates likely

Answer 18

Coxiella burnetii infection

Question 19

Coagulase-negative Staphylococcus is less virulent than S. aureus and is less likely to cause metastatic infection or endocarditis in patients without prosthetic devices or endovascular hardware in place (such as prosthetic heart valves) and may be treated with

Answer 19

simple removal of the intravenous catheter

Question 20

____________________________ should be considered when possible, and patients should be monitored for their ability to void spontaneously after catheter removal.

Answer 20

Early removal of urinary catheters

Question 21

Cat bite–associated wound infections comprise a mix of anaerobic and aerobic organisms, including Pasteurella species, which require treatment with

Answer 21

antibiotic agents such as piperacillin-tazobactam, ampicillin-sulbactam, imipenem, and meropenem; coverage for methicillin-resistant Staphylococcus aureus must be included in select patients who have risk factors for this infection.

Question 22

characterized by a nonfocal febrile illness associated with leukopenia, thrombocytopenia, elevated hepatic enzyme levels, and a rapid response to tetracycline.

Answer 22

Human monocytic ehrlichiosis infection

Question 23

In patients with health care–associated ventriculitis or meningitis

Answer 23

device removal, if present, should accompany empiric antimicrobial therapy.

Question 24

First-line treatment for primary pneumonic plague is

Answer 24

streptomycin or gentamicin

Question 25

Treatment of choice for disseminated histoplasmosis

Answer 25

Liposomal amphotericin B

Question 26

In patients with pneumonia unresponsive to appropriate antibiotic therapy,

Answer 26

a noninfectious cause mimicking pneumonia, antibiotic-resistant bacterial infection, infection with a nonbacterial organism, or loculated infection such as an empyema may be the cause.

Question 27

___________________________ should be suspected if the patient traveled to Africa, symptoms begin soon after return from an endemic area, and the peripheral blood smear shows a high level of parasitemia.

Answer 27

Plasmodium falciparum malaria

Question 28

Patients with spinal epidural abscess who also have neurologic compromise should immediately

Answer 28

begin broad-spectrum antimicrobial therapy and undergo surgical drainage.

Question 29

Fever is the major manifestation & is often associated with a relative bradycardia; additional symptoms may include a brief period of diarrhea followed by constipation, abdominal discomfort, nonproductive cough, mild confusion, and transient small blanching skin lesions (rose spots)

Answer 29

Typhoid (enteric) fever

Question 30

Is recommended immediately after a diagnosis of HIV infection to guide the selection of active agents for the antiretroviral regimen or after virologic failure of a regimen to guide adjustment of antiretroviral therapy?

Answer 30

Genotypic viral resistance testing

Question 31

Can cause acute aseptic meningitis year round and is the most common cause of recurrent viral meningitis?

Answer 31

Herpes simplex virus type 2

Question 32

Indications for influenza, tetanus-diphtheria-pertussis, hepatitis A virus, and human papillomavirus vaccines are the same for patients with HIV infection as for the general population.

Answer 32

HPV vaccine can be given up to age 26 & beyond age 26 as indicated

Question 33

In a patient with Lyme disease and possible central nervous system involvement, positive findings on ______________ can support the diagnosis of Neuroborreliosis, which necessitates parenteral therapy with ceftriaxone, cefotaxime, or penicillin.

Answer 33

Lumbar puncture

Note: New guidelines published in 2020 on the prevention, diagnosis, and treatment of Lyme disease allow for the choice of either intravenous (ceftriaxone, cefotaxime, penicillin G) or oral (doxycycline) antibiotics in patients with peripheral and/or central nervous system involvement without brain parenchymal involvement. Lumbar puncture is no longer necessary in these patients.

Question 34

Patients with no known direct exposure to anthrax

Answer 34

Do not require treatment or separation from those who may be infected.

Question 35

Preventing HIV acquisition?

Answer 35

The combination of tenofovir disoproxil fumarate (or tenofovir alafenamide, except in women engaging in receptive vaginal intercourse) plus emtricitabine taken once daily is more than 90% effective, if taken consistently

Question 36

Osteomyelitis in a patient with a diabetic foot infection and no evidence of skin or soft tissue infection or sepsis requires

Answer 36

A bone biopsy before antibiotics are administered

Question 37

In patients with previously treated syphilis,

Answer 37

treponemal serology results will remain positive, but nontreponemal tests will be negative; these patients require no further testing or treatment.

Question 38

A screening HIV test result that is positive on the initial antigen/antibody combination immunoassay but negative on the antibody differentiation immunoassay and nucleic acid amplification testing for HIV RNA represents

Answer 38

a false-positive result

Question 39

Is the most common cause of swimming pool–related outbreaks of diarrhea; diagnosis is made by microscopic examination of the stool or by stool antigen testing?

Answer 39

The protozoan Cryptosporidium

Question 40

Persons with chronic inflammatory bowel disease or who are immunocompromised are most susceptible to severe travelers’ diarrhea or complications, should be given:

Answer 40

Guidelines were updated regarding the prevention and treatment of travelers’ diarrhea. Ciprofloxacin is no longer recommended for prophylaxis.

Question 41

Central venous catheters should be

Answer 41

assessed daily for continued necessity and removed promptly when they are no longer needed.

Question 42

Cyclospora protozoan infections are typically acquired after consumption of fecal-contaminated food or water, particularly in countries where the parasite is endemic, such as Peru, Guatemala, Haiti, and Nepal. How do you treat?

Answer 42

Bactrim (trimethoprim-sulfamethoxazole)

Question 43

Antiretroviral therapy during pregnancy is crucial and significantly decreases the risk of perinatal transmission of HIV to the baby.

Answer 43

Tenofovir disoproxil fumarate (TDF), & emtricitabine, and efavirenz

OR

Zidovudine, lamivudine & ritonavir-boosted lopinavir is a valid alternative, it was previously a preferred regimen in pregnancy

Question 44

Hepatitis A vaccination should ideally occur 2 to 4 weeks before travel to an endemic region; however,

Answer 44

a single dose of the vaccine given any time before travel provides adequate protection to otherwise healthy persons.

Question 45

is the preferred class of agents for treating infections with extended-spectrum β-lactamase–producing organisms

Answer 45

The carbapenem class of antibiotics (imipenem, meropenem, doripenem, ertapenem)

Question 46

Patients receiving Daptomycin therapy should undergo:

Answer 46

baseline measurement of kidney function and creatine kinase level followed by weekly monitoring

Question 47

Kaposi sarcoma can develop in patients with AIDS infected with

Answer 47

human herpes virus type 8, presenting with painless violaceous skin nodules with oral involvement

Question 48

When managing methicillin-sensitive Staphylococcus aureus osteomyelitis in the setting of orthopedic hardware if the hardware cannot be removed?

Answer 48

Rifampin should be used in combination with another anti-staphylococcal agent e.g Cefazolin

Question 49

What is the recommended treatment for patients with animal bites who are immunosuppressed (including patients with cirrhosis and asplenia); have wounds with associated edema, lymphatic or venous insufficiency, or crush injury; have wounds involving a joint or bone; have deep puncture wounds; or have moderate to severe injuries, especially when involving the face, genitalia, or hand

Answer 49

Amoxicillin-clavulanate

Question 50

Can be used in the treatment of multidrug-resistant intra-abdominal infection?

Answer 50

Ceftolozane-tazobactam is a newer antipseudomonal cephalosporin combined with a β-lactamase inhibitor e.g. Colistin

Question 51

The microbiology of community-acquired pneumonia in pregnancy is similar to that seen in the general population; among patients requiring hospitalization, the most common pathogens are:

Answer 51

Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms, including Legionella species, Chlamydia pneumoniae, and Mycoplasma pneumoniae.

Question 52

Are indicated for the treatment of influenza A and B and can be administered through various routes (oral, intranasal, intravenous)?

Answer 52

Neuraminidase inhibitors (oseltamivir, zanamivir, peramivir) and the endonuclease inhibitor baloxavir

Question 53

Men with febrile urinary tract infections require prompt

Answer 53

Antimicrobial therapy and anatomic assessment of the upper and lower urinary tract with ultrasound.

Question 54

When sepsis is suspected among patients with osteomyelitis,

Answer 54

empiric antibiotic therapy should begin, even when the microbial cause of the infection has not yet been determined

Question 55

On testing for HIV infection, a positive result on HIV-1/2 antigen/antibody combination immunoassay is followed by testing with the HIV-1/HIV-2 antibody differentiation immunoassay; a negative antibody differentiation immunoassay but a positive follow-up HIV-1 nucleic acid amplification test is diagnostic of

Answer 55

acute HIV infection

Question 56

In a patient with clinical signs and symptoms of urethritis, treatment with

Answer 56

A single dose of IM ceftriaxone, 500 mg, should be given (for persons ≥150 kg, the dose should be 1 g). If concomitant chlamydial infection is not ruled out, oral doxycycline, 100 mg 2 times/day for 7 days, should be included.

Note: The CDC updated guidelines for the treatment of sexually transmitted infections in July 2021. For urethritis, combination therapy with azithromycin is no longer recommended.

Question 57

In patients who have undergone hematopoietic stem cell transplantation, the risk of invasive fungal infection remains elevated for the first few months, even after recovery of neutrophil counts, so

Answer 57

antifungal prophylaxis (such as Posaconazole) should be continued during this time

Question 58

Tuberculosis and cryptococcus are the most common causes of chronic meningitis (i.e. 4-weeks of symptoms); empiric treatment for tuberculous meningitis includes

Answer 58

four-drug antituberculous therapy (rifampin, isoniazid, pyrazinamide, and ethambutol) plus dexamethasone

Question 59

Treatment option for persons with latent tuberculosis infection, determined by a newly positive tuberculosis screening test but no signs or symptoms of active disease?

Answer 59

9 months of daily isoniazid can be self-administered OR once-weekly isoniazid and rifapentine for 12 weeks

Question 60

The first month after solid organ transplantation is when the most likely infections are nosocomial and similar to those in patients who have had other surgeries; patients who have recently completed antimicrobial treatment are particularly at increased risk for?

Answer 60

Clostridium difficile colitis, not cytomegalovirus even if the the transplant donor was seropositive for cytomegalovirus

Question 61

The Pap smear is normal. Nucleic acid amplification testing is positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. What’s the treatment?

Answer 61

Ceftriaxone plus azithromycin is no longer recommended for uncomplicated gonococcal infections of the cervix, urethra, or rectum. The CDC recommends ceftriaxone monotherapy.

Question 62

Can be diagnosed by visualization of intraerythrocytic parasites in a ring or tetrad form on a blood smear. Look for H/o outdoors, endemic areas (such Maine) & hemolytic anemia on presentation.

Answer 62

Babesiosis

Note: Morulae, basophilic inclusion bodies composed of clusters of bacteria, can be seen in the cytoplasm of monocytes and neutrophils of patients with ehrlichiosis & anaplasmacytosis, respectively. These tick-borne infections cause fever, leukopenia, & thrombocytopenia, but are not hemolytic anemia.
Schistocytes are a manifestation of microangiopathic hemolytic anemia caused by a thrombotic microangiopathy (TMA), such as hemolytic uremic syndrome or thrombotic thrombocytopenic purpura. Although both these syndromes can cause fever, hemolysis, and thrombocytopenia, the absence of acute kidney injury in this patient excludes a TMA.

Question 63

In patients who have an intact and functioning gastrointestinal tract, whose clinical status is improving, and who are not being treated for an infection for which parenteral therapy is preferred.

Answer 63

Intravenous-to-oral antibiotic switching should be considered

Question 64

A positive blood culture for Candida species should not be treated as a

Answer 64

contaminant, and empiric therapy with an echinocandin (anidulafungin, caspofungin, or micafungin) should be instituted immediately

Question 65

The recommended duration of antibacterial therapy for acute vertebral osteomyelitis is

Answer 65

6 weeks

Question 66

The treatment of an initial episode of severe Clostridium difficile infection

Answer 66

Oral vancomycin (or fidaxomicin) therapy is recommended

Question 67

The quadrivalent meningococcal vaccine does not include coverage for

Answer 67

serogroup B Neisseria meningitides, which now accounts for 40% of all meningitis infections in the United States.

Question 68

should be given empirically to patients with clinical evidence of proctitis who are at risk for sexually transmitted infections.

Answer 68

Ceftriaxone and doxycycline

Question 69

Cytomegalovirus disease after transplantation may manifest as a nonspecific febrile illness; may cause leukopenia and thrombocytopenia; or may cause organ-specific disease, most often pneumonitis, colitis, esophagitis, or hepatitis;

Answer 69

ganciclovir therapy should be initiated empirically in patients who present with signs and symptoms of cytomegalovirus infection.

Question 70

When treating methicillin-resistant Staphylococcus aureus bacteremia

Answer 70

Vancomycin should be used only if the minimum inhibitory concentration is 2 µg/mL or less.

Question 71

is the mainstay of infection prevention in patients with terminal complement deficiency.

Answer 71

Immunization with the quadrivalent meningococcal conjugate vaccine

Question 72

Nonpurulent cellulitis without systemic signs of infection is usually caused by streptococci, which can be treated with an oral agent such as

Answer 72

clindamycin, penicillin, cephalexin, or dicloxacillin.

Question 73

In patients with community-acquired pneumonia and risk factors for Pseudomonas aeruginosa infection,

Answer 73

the use of dual therapy with antipseudomonal, antipneumococcal β-lactam (e.g Cefepime), or an antipseudomonal carbapenem, and antipseudomonal quinolone agents (Moxifloxacin or Levofloxacin, not Cipro) is recommended for initial empiric therapy.

Question 74

Patients with ________________________ are at increased risk of recurrent respiratory tract infections with encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae), and they may develop chronic diarrhea because of enteroviruses, norovirus, or Giardia.

Answer 74

Common variable immunodeficiency

Question 75

Found worldwide in freshwater and saltwater aquatic environments, typically causing indolent skin or soft tissue infection and usually appearing as papules on extremities after contact and trauma from fish tanks, fish, or shellfish

Answer 75

Mycobacterium marinum

Question 76

Patients with HIV who are taking antiretroviral therapy and achieve CD4 cell counts greater than 200/µL for more than 3 months may safely discontinue

Answer 76

Prophylaxis for Pneumocystis jirovecii infection

Question 77

Ventilator-associated pneumonia should be treated for how long?

Answer 77

with a 7-day course of antibiotics; longer courses contribute to the emergence of antibiotic resistance, increase the risk for antibiotic-related adverse effects, and do not improve outcomes.

Question 78

When other causes of encephalitis have been ruled out in a patient presenting with associated changes in mood and behavior (i.e delusions & paranoid behavior). Occasionally, choreoathetoid movements of the bilateral upper extremities can be observed.

Answer 78

anti-N-methyl-D-aspartate receptor encephalitis should be suspected.

Question 79

The microbiologic diagnosis of tuberculosis should be verified by

Answer 79

acid-fast bacilli staining of sputum samples and nucleic acid amplification testing before initiating antituberculous therapy.

Question 80

Is commonly carried asymptomatically by reptiles and amphibians and transferred from the animals’ feces to people; human symptoms include crampy abdominal pain, fever, nonbloody diarrhea, and vomiting

Answer 80

Nontyphoidal Salmonella

Question 81

Staphylococcus aureus bacteremia persisting more than 72 hours after the start of appropriate antimicrobial therapy suggests a

Answer 81

complicated infection requiring additional evaluation; endocarditis, osteomyelitis, and intra-abdominal infections are important sites of metastatic infection.

Question 82

Lacerations and puncture wounds sustained in fresh and brackish water environments can result in necrotizing infection with Aeromonas hydrophila; this infection should be treated with

Answer 82

surgery, supportive care, and antibiotics with gram-negative coverage, such as doxycycline plus ciprofloxacin.

Question 83

In patients at high risk, doxycycline prophylaxis has been shown to decrease the risk of Lyme disease if

Answer 83

started within 72 hours of tick removal, assuming that the tick has been attached for at least 36 hours.

Question 84

In the event of possible exposure to smallpox (variola).

Answer 84

Vaccinia immunization is appropriate

Question 85

Infection with varicella-zoster virus in a young patient should prompt testing for?

Answer 85

HIV infection

Question 86

Is the most common form of prion disease, involving several neurologic systems and rapid progression of apparent dementia.

Answer 86

Sporadic Creutzfeldt-Jakob disease

Question 87

In patients with uncomplicated community-acquired pneumonia not requiring ICU admission, a short course of antibiotic therapy

Answer 87

5-7 days is sufficient.

Question 88

Is the most cost-effective diagnostic test that can confirm a suspected case of osteomyelitis, but it is not sufficiently sensitive to exclude the diagnosis.

Answer 88

Plain radiography

Question 89

In community-dwelling patients with aspiration pneumonia, the most common organisms are anaerobic bacteria, such as microaerophilic streptococci, Fusobacterium, Peptostreptococcus, and Prevotella species as well as Enterobacteriaceae. Therefore, treatment should include:

Answer 89

Anaerobic coverage such as Piperacillin-tazobactam

Question 90

Primary enterohemorrhagic Escherichia coli infections should receive

Answer 90

Supportive care; administration of antibiotics or antimotility medications is associated with increased risk for hemolytic uremic syndrome

Question 91

Is present in 60% to 90% of adults, and patients who are immunosuppressed may experience disease reactivation with retinitis, pneumonitis, hepatitis, bone marrow suppression, colitis with bloody diarrhea, esophagitis, or adrenalitis

Answer 91

Latent cytomegalovirus infection

Question 92

A superficial incisional infection involves the underlying soft tissue and presents with inflammatory changes at the incision site (erythema, tenderness), with or without purulent drainage, and few if any systemic signs of infection such as fever; therapy is guided by

Answer 92

Gram stain and culture of the wound

Question 93

Treatment of choice for cryptococcal meningitis?

Answer 93

Combination therapy with liposomal amphotericin B and flucytosine

Question 94

Is required for definitive diagnosis of late disseminated Lyme disease

Answer 94

An alternative approach, referred to as a modified two-tier test, has been developed for validating positive enzyme immunoassay (EIA) testing for Lyme disease; this approach uses a different second step test (typically a second EIA) rather than a Western blot. Therefore, the answer option of “C6 enzyme immunoassay antibody test” could also be correct. (Added March 2020

Question 95

Fluoroquinolone antibiotics such as ciprofloxacin are associated with the development of

Answer 95

tendinitis and tendon rupture, so patients should be counseled to report tendon or joint pain and swelling

Question 96

The preferred treatment for oropharyngeal candidiasis, including esophageal disease, is

Answer 96

oral fluconazole, although esophageal involvement warrants a more prolonged treatment course.

Question 97

In patients with invasive candidiasis, therapy with

Answer 97

an oral azole (if the Candida species is susceptible) or amphotericin B should be initiated immediately; the total duration of therapy should be 10 to 14 days.

Question 98

Is the most appropriate diagnostic choice for confirming genital ulcer disease caused by herpes simplex virus

Answer 98

Nucleic acid amplification testing (NAAT)

Question 99

In patients with necrotizing fasciitis caused by group A Streptococcus, the combination of

Answer 99

penicillin and clindamycin is indicated for antimicrobial therapy after surgical debridement.

Question 100

Asymptomatic bacteriuria in otherwise healthy, non-pregnant patients?

Answer 100

No treatment is indicated

Question 101

Characteristically presents, after being contracted during international travel, with fever, myalgia, and headache followed shortly by the appearance of a maculopapular and oftentimes petechial rash; a distinct black eschar is also classically present at the site of inoculation

Answer 101

Mediterranean spotted fever

Question 102

For patients presenting with aseptic meningitis and cerebrospinal fluid findings typical for viral infection, the “rule of 7s” can classify a patient at low risk for having

Answer 102

Lyme disease (headache duration <7 days, <70% mononuclear cells, and absence of a seventh facial nerve palsy).

Question 103

Can present several years after transplantation with fever, pancytopenia, generalized lymphadenopathy, and hepatosplenomegaly

Answer 103

Posttransplant lymphoproliferative disorder caused by Epstein-Barr virus

Note: Cytomegalovirus does not cause generalized lymphadenopathy or hepatosplenomegaly

Question 104

Purulent skin infections with systemic signs of infection should be managed with incision and drainage followed by empiric oral therapy with

Answer 104

Trimethoprim-sulfamethoxazole or doxycycline

Note: Mild (no evidence of systemic signs of infection), nonpurulent skin infections are typically caused by streptococci, and empiric outpatient treatment with an oral agent such as clindamycin, penicillin, cephalexin, or dicloxacillin would be appropriate.

Question 105

The criteria for a positive tuberculin skin test reaction have been established by the Centers for Disease Control and Prevention based on the patient’s risks for tuberculosis; in patients with no risk factors for tuberculosis,

Answer 105

15 mm or greater should be considered a positive result.

Question 106

A 5-mm induration on tuberculin skin testing is considered positive

Answer 106

in persons who are immunocompromised, including those with HIV; if no other signs of tuberculosis infection are present, treatment for latent tuberculosis infection should be initiated with isoniazid.

Question 107

the preferred antimicrobial agents for the treatment of recurrent cystis when trimethoprim-sulfamethoxazole local resistance rates are high or the patient has been treated with an antibiotic for a urinary tract infection within the previous 3 months.

Answer 107

Ciprofloxacin or levofloxacin & an urine culture

Question 108

Is a rapidly fatal infection that spreads from the sinuses retro-orbitally to the central nervous system in immunocompromised patients, especially those with uncontrolled diabetes or ketoacidosis; a pathognomonic finding on physical examination of the nose or palate is the presence of a black eschar.

Answer 108

Rhinocerebral mucormycosis