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PSBIM 2024 recall > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

IE: Factors associated with increased risk of embolization

A

S. aureus IE, mobile vegetations >10 mm in diameter, and infection involving the mitral valve anterior leaflet

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2
Q

Definite IE requires:

A

2 major criteria or
1 major 3 minor or
5 minor

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3
Q

Possible IE definition:

A

1 major + 1 minor or
3 minor

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4
Q

Definition of “evidence of endocardial involvement” in Duke criteria

A

Positive echocardiogram:
- Oscillating intracardiac mass on valve or supporting structures or in the path of regurgitant jets or in implanted material, in the absence of an alternative anatomic explanation, or
- Abscess, or
- New partial dehiscence of prosthetic valve,

or

New valvular regurgitation (increase or change in preexisting murmur not sufficient)

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5
Q

Negative TEE but IE still likely, next dx step:

A

Repeat TEE in 7-10 daysC

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6
Q

Imaging comparable to TEE in detection of vegetations and possibly superior in defining paravalvulaar infection

A

Cardiac CT angiogram (CTA)

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7
Q

Drug of choice for streptococci endocarditis

A

Penicillin + Gentamicin regimen (duration depends on sensitivity)

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8
Q

Preferred duration of treatment for PVE

A

6 weeks

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9
Q

Used in streptococci IE for patients with immediate (urticarial) severe penicillin allergy

A

Vancomycin

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10
Q

Dose of gentamicin for Streptococcal IE

A

Gentamicin 3mg/kg daily IV or IM as a single dose or divided into equal doses

Duration:
2 weeks if penicillin susceptible and relatively penicillin-resistant
6 weeks if moderately penicillin-resistant strep

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11
Q

Preferred cell wall-active agent for use in combination with gentamicin for Enterococci IE

A

Ampicillin or penicillin

Regimen:
Penicillin G (4–5 mU IV q4h) plus gentamicin (1 mg/ kg IV q8h), both for 4–6 weeks

Ampicillin (2 g IV q4h) plus gentamicind (1 mg/kg IV q8h), both for 4–6 weeks

If penicillin allergic or isolates are resistant to penicillin/ampicillin: may use Vancomycin

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12
Q

Alternative regimen for E. faecalis (not E. faecium) if strains possess high level gentamicin resistance

A

Ampicillin-Ceftriaxone

Ampicillin (2 g IV q4h) plus ceftriaxone (2 g IV q12h), both for 6 weeks

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13
Q

Multidrug regimen for MRSA PVE

A

VAN + Genta (2 weeks only) + Rif

Vancomycin (15 mg/kg IV q12h for 6–8 weeks)
plus
Gentamicin (1 mg/kg IM or IV q8h for 2 weeks)
plus
Rifampin (300 mg PO q8h for 6–8 weeks)

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14
Q

Multidrug regimen for MSSA PVE

A

Naf/oxa/flucloxa + Genta 2 weeks only) + Rif

Nafcillin, oxacillin, or flucloxacillin (2 g IV q4h for 6–8 weeks)
plus
Gentamicin (1 mg/kg IM or IV q8h for 2 weeks)
plus
Rifampin (300 mg PO q8h for 6–8 weeks)

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15
Q

Regimen for MRSA NVE

A

Vancomycin (15 mg/kg IV q8–12h) or daptomycin (8–10 mg/kg daily) for 6 weeks

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16
Q

Drug of choice for febrile patients in whom prolonged neutropenia (>7 days) is anticipated

A

(1) ceftazidime or cefepime
(2) piperacillin/tazobactam
(3) imipenem/cilastatin or meropenem

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17
Q

When to initiate and stop G-CSF / GM-CSF

A

Start 24-72h after chemotherapy
Continue until ANC is 10,000 /uL
Do not use concurrently with chemo or radiation therapy

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18
Q

Fever of unknown origin work up (required)

A

TB: tuberculin skin test (TST) or interferon γ release assay (IGRA)

Inflammation: ESR, CRP, LDH, Ferritin

Hema: CBC: platelet count; leukocyte count and differential; hemoglobin, protein electrophoresis

Immunologic: antinuclear antibodies, and rheumatoid factor

GI: Alkaline phosphatase, ALT, AST

Renal: Electrolytes, creatinine, total protein, urinalysis, creatine kinase

Cultures: Blood cultures (n = 3)
Urine culture

Imaging: chest x-ray, Abdominal ultrasonography

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19
Q

Most common among the neoplasms that present with FUO

A

Malignant lymphoma

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20
Q

Next work up in FUO after obligatory investigations, manipulation with thermometer and drug fever excluded, and still with misleading or absent PDCs

A

Cryogobulin and fundoscopy

> FDG-PET/CT or gallium scan/labeled leukocyte scintigraphy
If normal, repeat history and PE and PDC driven invasive testing
If still no diagnosis, late state work up is chest CT and abdominal CT, temporal artery biopsy >55y

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21
Q

Tx if still with no dx for FUO after chest and abdominal CT and temporal artery biopsy

A

Stable: follow up and consider NSAID tx
Deterioration: further tests and consider therapeutic trial with Anakinra

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22
Q

Condition that may increase the risk of an adverse event or that may compromise the ability of the vaccine to evoke immunity

A

Precaution

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23
Q

Condition that increases the risk of a serious adverse reaction to vaccination

A

Contraindication

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24
Q

Permanent contraindications to vaccination

A

Severe allergic reaction to a vaccine component or following a prior dose

Encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination

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25
Q

Gold standard for a diagnosis of HIV infection

A

positive EIA with a positive HIV RNA assay

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26
Q

In cases with strong clinical evidence of leptospirosis, a SINGLE antibody titer (MAT) __ is required for diagnosis

A

1:200-1:800

27
Q

Treatment for severe leptospirosis (4)

A

Penicillin (1.5 million units IV or IM q6h) or

Ceftriaxone (2 g/d IV) or
Cefotaxime (1 g IV q6h) or
Doxycycline (loading dose of 200 mg IV, then 100 mg IV q12h)

28
Q

Chemoprophylaxis for Leptospirosis

A

Doxycycline (200 mg PO once a week) or Azithromycin (250 mg PO once or twice a week)

  • Doxy contraindicated if pregnant
29
Q

Tx for mild leptospirosis (3)

A

Doxycycline (100 mg PO bid) or Amoxicillin (500 mg PO tid) or Ampicillin (500 mg PO tid)

30
Q

First line treatment for uncomplicated P. falciparum malaria in malaria endemic areas

A

Artemisin-based combination therapy (ACT)

31
Q

Prophylaxis in areas with chloroquine- or mefloquine- resistant P. falciparum

A

Atovaquone-proguanil (Malarone)
Doxycycline

32
Q

Only drug advised for pregnant women traveling to areas with drug-resistant malaria

A

Mefloquine

33
Q

Timing of antimalarial drugs

A

Start 2 days to 2 weeks before departure
Continue for 4 weeks after the traveler has left the endemic area
If atovaquone-proguanil was given- can d/c after 1 week

34
Q

Added to regimen tovprevent relapse incap. vivax or P. ovale infection

A

Primaquine

35
Q

Rabies spreads ____ along peripheral nerves toward the spinal cord or brainstem via retrograde fast axonal transport (rate, up to ~250 mm/d), with delays at intervals of ~12 h at each synapse

A

CENTRIPETALLY

36
Q

Eosinophilic cytoplasmic inclusions in brain neurons that are composed of rabies virus proteins and viral RNA

A

Negri bodies

37
Q

Rabies PRE exposure prophylaxis schedule

A

Day 0, 7, 21 OR 28

38
Q

Rabies Post exposure prophylaxis schedule

A

Day 0, 3, 7, 14, 28

39
Q

Rabies category of “minor or superficial scratches or abrasions without bleeding, including those induced to bleed”

A

Ctagory 2

But all cat 2 on head and neck are considered cat 3

40
Q

Management of Cat 2 rabies

A

Wash with soap and water
No RIG indicated
Complete vaccination until Day 28 if
-animal is laboratory proven to be rabid
-animal is killed without lab testing
-animal has signs and sx of rabies
-animal is not available to be observed for 14 days

40
Q

Site of administration of RIG

A

Entire dose of RIG (20IU/kg) should be infiltrated at the site of the bite

T/N: rabies vaccine and RIG should never be administered at the same site or with the same syringe

40
Q

Preferred antibiotic therapy for tetanus

A

Metronidazole 400mg rectally or 500mg IV q6h for 7 days

40
Q

Treatment of tetanus

A

Antitoxib should be given early (HUMAN tetanus Ig or equine antitoxin)

40
Q

Tetanus toxoid in pregnancy… how many doses

A

All pregnant women should received at least TWO doses tetanus toxoid containing vaccine with interval of at least 4 weeks between doses and second dose at least 2 weeks before birth

3rd dose should be given 6 months after the 2nd dose
4th and 5th doses should be given with interval of at least 1 year or in subsequent pregnancies (to complete 5 doses) to ensure lifelong protection

40
Q

Most common site of infectious arthritis in IV drug users

A

spine, sacroiliac joints, sternoclacivular joints

40
Q

Antibiotics added in case of IV drug users for coverage of PAE infectious arthritis

A

Cefepime 2g q8h-12h or
Ceftazidime 2g q8h

40
Q

Primary treatment for gas gangrene

A

Clindamycin + Pen G

Clindamycin (600–900 mg IV q6–8h) plus penicillin G (4 million units IV q4–6h)

alternative: Clinda+cefoxitin 2 grams IV q6h

41
Q

Primary treatment for necrotizing fasciitis (Group A strep)

A

Clindamycin + Pen G

Clindamycin (600–900 mg IV q6–8h) plus penicillin G (4 million units IV q4–6h)

alternative:Clinda+1st or 2nd gen ceph

42
Q

Primary treatment for necrotizing fasciitis (mixed aerobes and anaerobes)

A

Ampicillin + Clindamycin + Ciprofloxacin

Ampicillin (2 g IV q4h) plus clindamycin (600–900 mg IV q6–8h) plus ciprofloxacin (400 mg IV q6–8h)

alternative: VAN + Metro + Ciprofloxacin

43
Q

Usual cause of traumatic gangrene (from penetrating injuries)

A

Clostridium species

C. perfringens, C. septicum, C. histolyticum

44
Q

Lucio’s phenomenon

A

Leprosy reaction, observed in diffuse leprosy of Lucio and Latapi and may be a variant of erythema nodosum
Marked vasculitis and thrombosis of the superficial and deep vessels result in hemorrhage and infarction of the skin

45
Q

3 cardinal signs for diagnosis of leprosy (need 2 of 3 for dx)

A

Hypopigmented or erythematous skin lesions with definite loss or impairment of sensation

Involvement of the peripheral nerves as demonstrated by definite thickening with sensory impairment

Positive result for AFB in slit-skin smears / biopsy sample / positive result in a biopsy PCR v

46
Q

Treatment for T1R leprosy reaction

A

Glucocorticoids
Prednisolone 1mg/kg body weight once a day (max 60-80mg) tapered slowly

47
Q

Treatment for multibacillary leprosy (adult)

A

Dapsone 100mg daily
Rifampin 600mg monthly
Clofazimine 50mg daily, 300mg monthly

*supervised 4-weekly dose of rifampin and clofazimine

for 12 months
(6 months for paucibacillary)

48
Q

Syndrome of fever, myalgia, general malaise, fatigue, headache, nonproductive cough, abdominal symptoms in a patient who contracted schistosomiasis

A

Katayama fever / Katayama syndrome

49
Q

Preemptive treatment for px at risk for invasive NTS infection considered for:

A

neonates (probably up to 3 months of age); persons >50 years of age with known or suspected atherosclerosis; and patients with immunosuppression, cardiac valvular or endovascular abnormalities, or significant joint disease

49
Q

UTI: Definition of significant pyuria

A

> 10 WBC/HPF

49
Q

UTI: Definition of positive gram stain of unspun urine

A

> 2microorganism/oif

50
Q

Asymptomatic bacteriuria cut off

A

Women: 2 consecutive voided urine with same bacterial strain >100,000 cfu/mL

Men: clean-catch voided urine with same bacterial strain >100,000 cfu/mL

If catheterized: 100cfu/mL

51
Q

Definition of recurrent UTI

A

3 or more AUC in a year or
2 or more in 6 months
*documented by urine culture

Relapse if it occurs 1-2 weeks after stopping tx
Reinfection if >2 weeks

52
Q

Cut off value for significant bacteriuria in complicated UTI

A

100,000 cfu/mL

53
Q

Treatment duration in complicated UTI

A

at least 7-14 days
Repeat urine culture 1-2 weeks after completion of antibiotics

54
Q

Cut off value for bacteriuria in CA-UTI

A

10^3 aka 1,000 cfu/mL in a single catheter urine specimen or in a midstream voided urine specimen

PSBIM 2024 recall (9 decks)

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