Infectious disease

Question 1

RIPE therapy for TB the most common indication to discontinue therapy?

Answer 1

Rifampin, Isoniazid, Pyrazinamide, and Ethambutol.
The most common indication to alter or discontinue therapy is an elevation of liver enzymes 5 times greater than baseline.

Question 2

Patient with HIV and a CD4+ count less than 50 along with painless vision loss

Answer 2

Is most likely suffering from cytomegalovirus (CMV) retinitis. He should be treated with valgancyclovir.

Question 3

Positive tuberculin test

Answer 3

Low-risk patients: greater than or equal to 15mm in diameter read at 48-72 hours.
Persons with diabetes, malignancy, silicosis, immigrants from high prevalence countries who arrived within five years, and persons who use illicit drugs: > or equal to 10mm.
HIV, fibrotic changes from previous TB, and recent contact with persons with active TB: > or equal to 5mm.

Question 4

Necrotizing fasciitis is most commonly caused by?

Answer 4

Streptococcus pyogenes (Group A strep).

Question 5

Common causes of epiglottitis in vaccinated patients?

Answer 5

Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus.

Question 6

Bordatella pertussis choice of treatment?

Answer 6

Macrolides

Question 7

Rocky Mountain Spotted Fever

Answer 7

Is a tick-borne infection caused by Ricketsia rickettsii.
Southeastern and south-central United States (e.g Tennessee, North Carolina).
Fevers, headaches, myalgia, and malaise, starting less than one week after exposure. The associated, “spotted” rash starts as a maculopapular rash on the ankles and wrist, and eventually develops into a petechial rash that moves to the trunk.
It appears within 2-6 days of exposure due to a small vessel vasculitic process, although some patients with RMSF will not have the classical rash.
Doxycycline is the therapy of choice.

Question 8

Any patient with a contaminated penetrating injury and unclear tetanus vaccination history should be treated with?

Answer 8

A tetanus vaccine and tetanus immune globulin.

Question 9

Leprosy

Answer 9

Caused by a mycobacterial infection. Leprosy can occur in a diffuse or lepromatous form, which occurs when a weak immune response is mounted.

Tuberculoid form, which has limited involvement of skin. The tuberculoid form often presents with a raised skin lesion, loss of sensation over the affected area, and loss of any overlying hair.

Leprosy can be confirmed via biopsy.

Question 10

Antibiotic coverage for intraabdominal infections

Answer 10

Should target gram-negative and anaerobic pathogens.
Regimens that are commonly used: ceftriaxone/metronidazole, ciprofloxacin/metronidazole, piperacillin-tazobactam, or ampicillin-sulbactam.

Question 11

The most common cause of acute bacterial rhinosinusitis?

Answer 11

Moraxella catarrhalis