Infectious Disease

Question 1

How is adenovirus treated?

Answer 1

Cidofovir with pre/post hydration and probenecid
Can have renal toxicity and Fanconi-type syndrome (proteinuria, glucosuria, bicarbonate wasting)

Question 2

Recall the table of antivirals

Answer 2

Question 3

Which tick borne disease does not get treated with doxy?

Answer 3

Babesiosis- atovaquone + azith, consider exchange transfusion

Question 4

What are features that help differentiate Staph and Strep TSS?

Answer 4

Staph- primarily young women, tampons/nasal packing, rare pain, erythroderma and tissue necrosis are rare, 2-6% mortality

Strep- 20-50yo, equal gender, trauma/NSAIDs/postpartum, severe pain and erythroderma and bacteremia are common, mortality 33-81%

Question 5

Recall some bioterrorism buzzwords

Answer 5

Question 6

What are the pulmonary findings in Nocardiosis?

Answer 6

nodules, infiltrates, GGOs, pleural effusions
Tx with bactrim
Remember weakly acid fast branching

Question 7

Recall some parasitic buzzwords

Answer 7

First three treated with albendazole, last is praziquantel

Question 8

What adjunct is used for prosthetic valve MSSA/MRSA endocarditis?

Answer 8

Gentamicin for 2 weeks in addition to standard targeted therapy

Question 9

What are the features of DRESS/DIHS?

Answer 9

2-6 weeks post drug exposure
Fever and LAD, rash, facial edema
Eosinophilia and 1 other organ involvement

Tx with stopping drug, steroids, IVIG is controversial

Question 10

When is vanco indicated for empiric neutropenic fever treatment?

Answer 10

Sepsis/shock
Indwelling line/port
STI
PNA

Question 11

How long do you treat bacteremia associated with acute cholagnitis?

Answer 11

7-10 days, can narrow the antibiotic coverage based on culture data including anaerobic coverage

Question 12

Which immunosuppressants can cause PRES?

Answer 12

tacrolimus, cyclosporine, sirolimus, cisplatin, interferon

Question 13

What are the indications for getting a head CT prior to an LP?

Answer 13

Immunocompromised, history CNS disease, new onset seizures within 1 week, papilledema, focal deficit, abnormal level of consciousness

Question 14

How do WNV and Guillain Barre syndromes differ?

Answer 14

WNV- asymmetric weakness, proximal>distal, no sensory symptoms, encephalopathy, pleiocytosis in CSF

Question 15

What are the features of a submandibular infection (Ludwig’s)?

Answer 15

drooling, dysphagia, trismus is absent, muffled voice, woody induration, no adenopathy
Cover GNRs and beta lactamase oral anaerobes

Question 16

What are the features of para-pharyngeal infections (Lemierre’s)?

Answer 16

Septic thrombophlebitis of JV, bacteremia, metastatic infection, often Fusobacterium
Cover GNR and beta lactamase anaerobes for 4-6 weeks, no anticoagulation

Question 17

What is the abdominal perfusion pressure?

Answer 17

MAP-IAP
Maintaining an APP >60 correlated with survival in IAH and Abdominal compartment syndrome

Question 18

What is the utility in S pneumoniae urinary antigen?

Answer 18

POC, easy to obtain. Doesn’t identify subtype
Sensitivity better in bacteremia patients, but specificity is high to allow for early narrowing of abx

Question 19

Which bacteremia can be treated for only one week?

Answer 19

Gram negative bacteremia is noninferior to 2 weeks

Question 19

What skin manifestations accompany Pseudomonas bacteremia?

Answer 19

Ecythma gangrenosum (hemorrhagic pustules)

Question 20

What are the features of brucellosis?

Answer 20

Contaminated meat or dairy, endemic to Middle East, central Asia, sub-Saharan Africa, and central/south America

Undulating fevers, productive cough, myalgias, arthralgias, leukopenia, transaminitis, abnormal chest imaging. Need tissue biopsy

Tx doxy and aminoglycoside

Question 21

What is time dependent killing vs concentration dependent killing?

Answer 21

Time-dependent: cumulative percentage of time over 24hr that free antibiotic exceeds the MIC (beta lactams)

Concentration-dependent: peak concentration in a dosing interval divided by MIC (aminoglycosides, dapto)

Concentration dependent with time dependent: area under the curve over 24hr period divided by the MIC (vanc, fluoroquinolones, tigecycline, linezolid)

Question 22

What are the surgical indications for IE?

Answer 22

Valve dysfunction, heart block, annular/aortic abscess, persistent and uncontrolled infection, highly resistant or fungal organisms, recurrent emboli or enlarging vegetations, large (>10mm) vegetations

Question 23

What defines severe pneumonia?

Answer 23

MV with PEEP 5 or higher
HFNC with p/f <300 with FiO2 50% or more
p/f <300 with NRB

Question 24

Which meds have good synergy for NDM-1 producing K pneumoniae?

Answer 24

ceftazidime-avibactam plus aztreonam

Question 25

What are the risk factors for multi-drug resistant VAP?

Answer 25

RRT prior to VAP onset, prior abx within 90days, septic shock at the time of VAP, ARDS preceding VAP, 5+ days hospitalization prior to VAP

Question 26

What can reduce VAP in patients with acute brain injuries who are comatose and have undergone intubation?

Answer 26

1 dose ceftriaxone within 12h of admission

Question 27

What are the features of leptospirosis?

Answer 27

Acute bacteremic phase followed by immune-mediated recrudescence

Tropical exposure

conjunctival suffusion, edema, erythema without purulence. Meningeal symptoms, jaundice, DAH, myocarditis, arrhythmias, AKI

Question 28

What are some unique features of strongyloides?

Answer 28

Migrating rash, polymicrobial bacteremia