Infectious Disease

Question 1

_______are the most common cause of viral meningitis, usually presenting with symptoms of headache, fever, nuchal rigidity, photophobia, nausea, vomiting, myalgias, pharyngitis, maculopapular rash, and cough between May and November

Answer 1

Enteroviruses

Herpesviruses can cause meningitis year round; herpes simplex virus 2 is the most common cause and can recur.

Question 2

______ 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 2

Leptospiral meningitis

Question 3

Add listeria coverage as ampicillin after age _____

Answer 3

50

Question 4

Other random causes of meningitis/encephalitis

Answer 4

Naegleria fowleri, brucella, aspetic meningitis (NSAID, IgG, SLE), chemical following procedures

Question 5

Odd feature of TB meninitis_____

Answer 5

SIADH (Hyponatremia)

Question 6

Most common causes of encephalitis: The most common known causes are viral (herpes simplex virus types 1 and 6, varicella-zoster virus, and West Nile virus) and autoimmune diseases.

Question 7

Encephalitis in transplant patients __________________

Answer 7

CMV, HHV6

Question 8

Varicella-zoster virus (VZV) is a treatable form of encephalitis and may present without vesicular rash, so polymerase chain reaction of the cerebrospinal fluid (CSF) or a serum-to-CSF anti-VZV IgG should be ordered in all patients with encephalitis.

Answer 8

WNV can cause meningitis, encephalitis, acute flaccid paralysis (similar to poliomyelitis), neuropathy, and retinopathy.

Question 9

_______ is most common auto-immune encephalitis; it was initially described as a paraneoplastic syndrome affecting young women with ovarian teratomas, but it can be associated with other tumors (sex cord stromal tumors, small cell lung cancer) or occur without a tumor.

Answer 9

Anti-N-methyl-D-aspartate receptor encephalitis

Treatment includes intravenous glucocorticoids, intravenous immune globulin, tumor removal (if present), and, in some cases, plasmapheresis and rituximab

Question 10

Treatment of toxic shock syndrome also involves use of ____ apart from standard staph/strepp coverage

Answer 10

Clindamycin 2/2 toxin

Question 11

Pneumococcal antigen testing is not recommended in adults with community-acquired pneumonia (CAP), except in those with severe CAP;

Question 12

Lyme disease (Morelia) spread by _______, treated with ____ only with 36hr attachment, high endemic rate of infection

Answer 12

Deer tick

Doxycycline, can also use ceftrioxone/penicillin for CNS penetration

Early Disseminated disease; he most common manifestation is a flu-like illness characterized by fevers, arthralgia, myalgia, and lymphadenopathy

Testing involves Serum ELISA, with confirmatory western blot for late infection signs, but can be clinical diagnosis without testing

Question 13

____ and ___ and ____are spread by deer tick

Answer 13

Lyme, Babesiosis, Anaplasmosis

The hallmark of babesiosis is hemolysis, with anemia almost invariably present. With severe disease, thrombocytopenia, elevated liver enzyme levels, and acute kidney injury are possible.

Smear = Maltese cross tetrads

Question 14

Treatment of Babesiosis

Answer 14

Atovaquone plus azithromycin are most appropriate for mild disease, whereas clindamycin plus quinine remains the regimen of choice for severe disease

Question 15

Another tick born disease causing erythema migrans, but occurring in the southern states like Texas

Answer 15

STARI, treated with Doxy

spread by Lone star tick, so is Erlichiosis

Question 16

Do you typically get a rash in Anaplasmosis _____

Answer 16

No

Question 17

Petechia palms/soles, rash, as vector born disease_____

Answer 17

Rocky mountains spotted fever

Also called ricketsia rickets

Can be tested with skin serologies

Fever first then rash

Question 18

Hallmark feature of Erlichiosis _______

Answer 18

Monocyte morula

Question 19

Both ____ and anaplasmosis need PCR tests, will be negative serologies

Answer 19

erlichiosis,

Anaplasma/erlichiosis treated with doxycycline

Question 20

Treatment of asymptomatic bacteriuria is indicated in pregnant women and __________

Answer 20

in patients scheduled to undergo an invasive procedure involving the urinary tract.

Question 21

2nd line treatment for UTI_______

Answer 21

Floroquinolone

Question 22

Recurrent UTI in women____

Answer 22

Prophylactic daily antimicrobial therapy is an option in women who have had three or more urinary tract infections in the previous 12 months or two or more in the previous 6 months; other options include postcoital antimicrobial prophylaxis and self-diagnosis with self-treatment

Question 23

Treatment of acute bacterial prostatitis_____

Answer 23

Fluoroquinolone antibiotics are the preferred oral agents for treating acute bacterial prostatitis but should not be used if recent genitourinary instrumentation was performed because most E. coli strains are now resistant to fluoroquinolones.

Question 24

Quantiferon gold not effected by BCG vaccine_______

Answer 24

True

Question 25

If signs of extrapulmonary tuberculosis infection are present, samples from those areas should be obtained and sent for acid-fast bacilli staining, mycobacterial culture, and histopathology.

Question 26

Latent TB treatments 1)Isoniazid/Rifapentine x3 months 2) Rifampin x 4 months 3) Isoniazid Rifapmin x 3 months 4) Isoniazid 6-9 months + pyridoxine (Pregnant)

Answer 26

Rifampin monotherapy has not been proven in HIV+ patients Rifampin also used as post exposure prophylaxis for H/Influenza and meningitis

Question 27

Active TB treatment______

Answer 27

6 to 9 months of treatment in patients with drug-susceptible active tuberculosis; a four-drug regimen is given daily for 2 months, followed by a continuation phase of isoniazid plus rifampin daily, usually for 4 months. 2 months = RIPE 4 months = Rifampin/Isoniazid (discontinue ethambutol, and pyrazinamide)

Question 28

Treatment of drug resistant TB______

Answer 28

In patients with multidrug-resistant tuberculosis, at least a five-drug regimen should be provided for 5 to 7 months, followed by a four-drug regimen for a total treatment duration of 15 to 21 months.

Question 29

You may delay ART initiation for HIV TB to prevent immune reconstitution (True/False)

Answer 29

True, 2 -12 weeks

Question 30

Disseminated candida should not be treated with fluconazole, instead initiate____

Answer 30

micafungin (echinocandin), but does not work for candida neoformans

Question 31

First-line treatment of invasive or chronic pulmonary Aspergillus infection is with _______

Answer 31

a triazole, such as voriconazole, posaconazole, or isavuconazole; Azoles work for aspergillus, echinocandins work for candida

Question 32

Treatment of Cryptococcus

Answer 32

In HIV patients, meningitis ambisome + flucytosine

Question 33

Treatment for disseminated Histo_______________

Answer 33

Ambisome

Question 34

Treatment of coccidiomycosis______ Treatment of blastomycosis_______

Answer 34

Fluconazole Itraconazole

Question 35

Test of cure is not recommended in patients with Chlamydia trachomatis infection except in pregnancy;

Question 36

painful ulcer with tender and suppurative regional lymphadenopath_____ Painless genital papule or ulcer with unilateral tender inguinal lymphadenopathy______

Answer 36

Chancroid, tx: Azithro/Ceftriox/Cipro Lymphogranuloma Venereum, basically a complicated Chlymidia infection (Tx: Doxycycline)

Question 37

Treatment of symptomatic genital wards______

Answer 37

Patient-applied therapies include imiquimod, podofilox, and sinecatechins; provider-administered therapies include trichloroacetic acid or bichloroacetic acid, cryotherapy with liquid nitrogen or cryoprobe, or surgical removal. Asymptomatic, dont treat

Question 38

Anti staph Abx and ______ is indicated for ortho hardware osteomyelitis

Answer 38

Rifampin + Cefazolin/Vanc

Question 39

Vaccination with complement deficiency______

Question 40

Repeated sinopulmonary infection, GI infection

Answer 40

IgA deficiency

Question 41

Live vaccines should be avoided in people with common variable immunodeficiency (T/F)

Answer 41

True

Question 42

Early component complement deficiency is associated with an increased rate of_______and risk of infection with encapsulated organisms; terminal complement defects can result in recurrent Neisseria infections. Any defect in the classical complement pathway will result in low total hemolytic complement (CH50) level.

Answer 42

SLE

Question 43

Asymptomatic persons exposed to aerosolized Yersinia pestis and close contacts of infected patients within the previous 7 days warrant postexposure prophylaxis with levofloxacin or doxycycline.

Question 44

Clue to IgA deficiency __________

Answer 44

Anaphylaxis to blood products may occur because of the presence of anti-IgA antibodie

Question 45

Patients with common variable immunodeficiency can experience recurrent infections and are at increased risk of noninfectious complications, including autoimmune disease, inflammatory bowel disease, granulomatous disease, bronchiectasis, and malignancy.

Question 46

personal or family history of recurrent Neisseria infections is an indication to test the ____________because any defect in the classical complement pathway will result in a low total level.

Answer 46

total hemolytic complement (CH50) level

Question 47

Asymptomatic persons exposed to aerosolized Y. pestis and close contacts of infected patients within the previous 7 days warrant postexposure prophylaxis

Question 48

Botulism characterized by : Patients present with symmetric, _______ flaccid paralysis with prominent bulbar signs (the “4 Ds”: diplopia, dysarthria, dysphonia, and dysphagia), which may progress to respiratory failure.

Answer 48

descending, guillan barre is ascending Botulism treatment includes supportive care and early administration of antitoxin, although this will not reverse existent paralysis.

Question 49

___________________ fever with headache, arthralgia, myalgia, pharyngitis, and anorexia follows a 1- to 2-week incubation period. Abdominal pain and tenderness can be accompanied by early-onset diarrhea, which may spontaneously resolve or become severe late in disease. One fifth of patients have constipation at diagnosis During the second week of illness, discrete, blanching, 1- to 4-mm salmon-colored macules, known as rose spots (Figure 19) develop in crops on the chest and abdomen in about 20% of patients. Moderate hepatosplenomegaly, leukopenia, anemia, thrombocytopenia, and elevated aminotransferase levels are common

Answer 49

Salmonella typhi and Salmonella paratyphi (A, B, and C) Ceftriaxone, fluoroquinolones, and azithromycin are preferred treatments for typhoid fever; dexamethasone decreases mortality in severe disease, such as patients with shock and encephalopathy.

Question 50

_____ characterized by acute febrile illness associated with frontal headache, retro-orbital pain, myalgia, and arthralgia, with or without minor spontaneous bleeding. Gastrointestinal or respiratory symptoms may predominate. Severe lumbosacral pain is characteristic. As the fever abates, a macular or scarlatiniform rash, which spares the palms and soles, may develop and evolve into areas of petechiae on extensor surfaces [tourniquets sign]

Answer 50

Dengue

Question 51

Symptoms of ___________ resemble dengue fever, including abrupt onset of fever (≥39.0 °C [102.2 °F]) and severe bilateral and symmetrical polyarthralgia, often involving the hands and feet; a maculopapular rash on the limbs and trunk is common

Answer 51

chikungunya

Question 52

When is Hep A immunoglobin indicated: _______

Answer 52

Serum immune globulin is indicated for persons aged 12 months or younger and for those who decline vaccination or are allergic to its components. It has also been recommended for immunocompromised persons (who are less responsive to hepatitis A vaccine) and patients with chronic liver disease.

Question 53

____________ characterized by fever, headache, malaise, conjunctivitis, and pharyngitis often accompanied by a maculopapular, vesicular, or petechial rash

Answer 53

Rickettsia typhus

Question 54

treatment of choice for uncomplicated brucellosis is a combination of doxycycline, rifampin, and streptomycin (or gentamicin), often given for several weeks; neurobrucellosis requires several months of combined ceftriaxone, doxycycline, and rifampin.

Answer 54

Brucella risk from abroad, unpasteurized products

Question 55

___________ osteomyelitis also can occur and is classically associated with sickle cell disease.

Answer 55

Salmonella

Question 56

EHEC: Enterohemorrhagic Escherichia coli strains produce a Shiga-like toxin that can cause hemorrhagic colitis; treatment is primarily supportive because antibiotics and antimotility agents may increase the risk of developing hemolytic uremic syndrome and do not appear to shorten the duration of infection.

Answer 56

For EHEC, you actually do not use antibiotics

Question 57

Severe C.Diff requires addition of IV Flagyl

Question 58

The protozoan ____________ is the most common cause of swimming pool–related outbreaks of diarrhea

Answer 58

Cryptosporidium

Question 59

Treatment of cyclospora___________

Answer 59

Bactrim Symptoms can last for several weeks and may be more pronounced in HIV-infected patients.

Question 60

common viral early post transplant infection___________

Answer 60

HSV

Question 61

_____________ is the most significant viral infection after transplantation, with risk for infection depending on donor and recipient serology.

Answer 61

Cytomegalovirus

Question 62

______________ is a protozoan that can reactivate with immunosuppression after transplantation, usually causing encephalitis with fever, headache, and focal neurologic deficits and with multiple ring-enhancing brain lesions on imaging.

Answer 62

Toxoplasma gondii

Question 63

____________ is the most common fungal infection without prophylaxis; it is typically a more aggressive pneumonia in patients after transplantation than in those with AIDS

Answer 63

Pneumocystis pneumonia

Question 64

PREP regiment___________

Answer 64

tenofovir disoproxil fumarate (or tenofovir alafenamide, except in women engaging in receptive vaginal intercourse) plus emtricitabine; 90% effective

Question 65

post exposure prophylaxis_______________

Answer 65

A three-drug regimen is given for 4 weeks; the preferred regimen is tenofovir disoproxil fumarate and emtricitabine plus either raltegravir or dolutegravir HIV usually takes 18-45 days to be detected on the assay

Question 66

__________, a very commonly used nucleoside analogue in HIV therapy, is associated with increased risks of tubular nephrotoxicity and worsening of bone mineral density

Answer 66

Tenofovir disoproxil fumarate (TDF) tenofovir alafenamide should be used preferentially over TDF in patients with or at risk for bone or kidney disease.

Question 67

IRIS usually occurs within a few months of initiating effective antiretroviral therapy in patients with low pretreatment CD4 cell counts (<100/µL). Management of IRIS includes continuing antiretroviral therapy while treating the opportunistic infection

Question 68

HIV drugs to avoid in pregnancy_____________

Answer 68

1) bictegravir and tenofovir

Question 69

_______ encephalitis associated with teratomas

Answer 69

auto-immune (anti NMDA receptor) : steroids, rituximab

Question 70

In lyme disease, late presenting complicated presentation much be confirmed with ELISA/Western blot before treatment

Answer 70

Localized, acute disease maybe serologically negative, but you clinically treat with doxycycline Late disease treated with IV ceftrioxone for 28 days arthritis/facial nerve palsy = doxycycline *pregancy cannot have doxy *post lyme can be chronic lyme that is untreated, therefore have to serologically confirm first

Question 71

Treatment of rocky mountain spotted fever in pregnant patients___________

Answer 71

chloramphenicol, non pregnant = Doxycycline Rash starting in lower extremities, affecting palms and soles

Question 72

Complicated UTI treated with____________

Answer 72

Cipro/Levo Pregnant patient: augmentin, nitrofurantoin

Question 73

Latent TB Treatment 1)Normal: Rifampin 4 months or Isoniazid 6 months 2)HIV+ : Isoniazid 9 months

Question 74

Treatment of invasive aspergillosis______ Treatment of ABPA_______________

Answer 74

Voriconazole Steroids ---> Itraconazole

Question 75

Treatment of cryptococcus________________

Answer 75

Induction: Amphotericin + flucytosine

Question 76

PID not responding to antibiotics______

Answer 76

tubo-ovarian abscess

Question 77

neurosyphillis: have to be admitted for 14 days of IV penicillin Pregnant patients will need de-sensitization, since Doxy cannot be used Doxy/Tetracycline option for therapy for non-pregnant penicillin allergy

Question 78

Anthrax post exposure_________________

Answer 78

Cipro 60 days, vaccine, Raxibacumab

Question 79

Treatment of cryptosporidium_____________

Answer 79

Nitazoxanide for symptomatic patients

Question 80

Tenofovir cannot be used in pregnancy

Question 81

emtricitabine (FTC), lamivudine (3TC), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) have activity against both HIV and HBV,

Answer 81

But you cannot use tenofovir during pregnancy

Question 82

When can live vaccines be given for HIV+______

Answer 82

After CD4>200

Question 83

Treatment of Toxoplasma Gondiii_______

Answer 83

Sulfadiazine/Pyrimethamine, folic acid

Question 84

Varicella post exposure:__________

Answer 84

vaccine + Ig for immunocompromised