Infectious Disease

Question 1

Leptospires have this type of flagella

Answer 1

2 periplasmic flagella

Question 2

Most impt reservoir of leptospires

Answer 2

rodents

Question 3

T/F

The vast majority of infections with Leptospira cause no or only mild disease in humans.

Answer 3

True

Question 4

T/F

During the immune phase, the appearance of antibodies coincides with the disappearance of leptospires from the blood.

Answer 4

True
However, the bacteria persist in various organs, including liver, lung, kidney, heart, and brain

During the immune phase, resolution of symptoms may coincide with the appearance of antibodies, and leptospires can be cultured from the urine

Question 5

Usual incubation period of leptospirosis

Answer 5

2-30

The incubation period is usually 1–2 weeks but ranges from 2 to 30 days.

Question 6

2 phases of leptospirosis

Answer 6

The acute leptospiremic phase is characterized by fever of 3–10 days’ duration, during which time the organism can be cultured from blood and detected by (PCR).

During the immune phase, resolution of symptoms may coincide with the appearance of antibodies, and leptospires can be cultured from the urine.

Question 7

Weil’s syndrome triad

Answer 7

Weil’s syndrome, encompasses the triad of hemorrhage, jaundice, and acute kidney injury.

Question 8

Typical electrolyte abnormality in leptospirosis

Answer 8

Typical electrolyte abnormalities include hypokalemia and hyponatremia

Question 9

Common ECG finding in leptospirosis

Answer 9

Cardiac involvement is commonly reflected on the electrocardiogram as nonspecific ST- and T-wave changes. Repolarization abnormalities and arrhythmias are considered poor prognostic factors

Question 10

Most common radiologic finding in severe leptospirosis

Answer 10

The most common radiographic finding is a patchy bilateral alveolar pattern that corresponds to scattered alveolar hemorrhage.

Question 11

Based on Harrisons , how is leptospirosis confirmed

Answer 11

A definitive diagnosis of leptospirosis is based on isolation of the organism from the patient, on a positive result in the PCR, or on seroconversion or a rise in antibody titer.

In cases with strong clinical evidence of infection, a single antibody titer of 1:200–1:800 (depending on whether the case occurs in a low- or high-endemic area) in the microscopic agglutination test (MAT) is required.

** In CPG At least 1:1600 is enough for diagnosis

Preferably, a fourfold or greater rise in titer is detected between acute- and convalescent-phase serum specimens.

Question 12

In rare instances, a ______ reaction
develops within hours after the initiation of antimicrobial therapy for leptospirosis

Answer 12

Jarisch-Herxheimer

Question 13

Treatment for leptospirosis

Answer 13

Question 14

Based on CPG when do you suspect leptospirosis?

Answer 14

Question 15

Based on CPG what are the lab results that may indicate severe leptospirosis?

Answer 15

Question 16

Based on CPG what are the recommended tests for AKI in leptospirosis?

Answer 16

Question 17

Based on CPG what is the IVF of choice for px with leptospirosis presenting with shock?

Answer 17

Plain NSS with K incorporation

Question 18

Based on CPG, what are the indications for HD

Answer 18

Almost same values as severe lepto but K should be > 5

HD should be done DAILY in critically ill px

Question 19

Based on CPG how do you manage oliguria in leptospirosis

Answer 19

Question 20

Based on CPG, what is the 1st sign of pulmonary involvement in leptospirosis?

Answer 20

tachypnea >30

Question 21

Based on CPG, what are the 2 most common pulmonary complications of leptospirosis?

Answer 21

Pulmonary hemorrhage and ARDS

Question 22

Based on CPG, how do you treat the pulmonary complications of leptospirosis?

Answer 22

Methylprednisolone should be given as 1gm IV for 3 days then should be continued as oral prednisolone 1mg/kg/day for 7 more days

Question 23

Based on CPG, recommended PRE exposure prophy for leptospirosis

Answer 23

Question 24

Based on CPG, duration of POST exposure prophylaxis for leptospirosis

Answer 24

Question 25

Which of the Plasmodium species can cause relapse

Answer 25

Question 26

What stage of the Plasmodium species invade the RBCs?

Answer 26

Merozoites invade RBCs to become trophozoites

Question 27

Phenotype resistant to P. vivax

Answer 27

Most West Africans and people with origins in that region are the Duffy-negative FyFy phenotype and are generally resistant to P. vivax malaria

Question 28

The most effective mosquito vectors of malaria are those

Answer 28

Anopheles gambiae species complex in Africa, that are long-lived, occur in high densities in tropical climates, breed readily, and bite humans in preference to other animals.

Question 29

P. ___ and P. ___ show a marked predilection for young RBCs and P. ____for old cells;

Answer 29

vivax and ovale - young
malariae- old

Question 30

Genetic abnormalities/ conditions with reduced risk of dying from severe P. falciparum malaria

Answer 30

The geographic distributions of the thalassemias, sickle cell disease, hemoglobins C and E, hereditary ovalocytosis, and (G6PD) deficiency closely resemble that of falciparum malaria before the introduction of control measures. This similarity suggests that these genetic disorders confer protection against death from falciparum malaria

Hemoglobin S–containing RBCs impair parasite growth at low oxygen tensions, and P. falciparum– infected RBCs containing hemoglobin S or C exhibit reduced cytoadherence because of reduced surface presentation of the adhesin PfEMP1

Question 31

T/F
In malaria, the corneal reflexes are
preserved even when patients are in deep coma

Answer 31

False

preserved except in deep coma

Question 32

Pathophysiology of hypoglycemia in severe malaria

Answer 32

Hypoglycemia, an important and common complication of severe malaria, is associated with a poor prognosis and is particularly problematic in children and pregnant women. Hypoglycemia in malaria results from both a failure of hepatic gluconeogenesis and an increase in the consumption of glucose by the host and, to a much lesser extent, the malaria parasites.

Question 33

Manifestations of severe malaria

Answer 33

Question 34

Features indicating poor prognosis in severe malaria

Answer 34

Question 35

T/F

Transfusion associated malaria may still have relapses from P. vivax and ovale

Answer 35

False

there is no preerythrocytic stage of development, and thus there are no relapses of P. vivax and P. ovale infections

Question 36

Plasmodium species associated with Quartan malaria

Answer 36

P. malariae

Question 37

Identify the stages of P. falciparum

Answer 37

A. Young trophozoite. B. Old trophozoite. C. Trophozoites in erythrocytes and pigment in polymorphonuclear cells. D. Mature schizont. E. Female gametocyte. F. Male gametocyte

Question 38

Answer 38

A. Young trophozoite. B. Old trophozoite. C. Mature schizont. D. Female gametocyte. E. Male gametocyte

Question 39

disadvantage of RDTs for diagnosis of P. falciparum

Answer 39

A disadvantage of RDTs is that they do not quantify parasitemia

Question 40

In severe malaria, a poor prognosis is indicated by a predominance of more mature P. falciparum parasites (i.e., >___% of parasites with visible pigment) in the peripheral-blood film or by the presence of phagocytosed malarial pigment in >__% of neutrophils (an indicator of recent schizogony)

Answer 40

20%

5%

Question 41

What are the diagnostic tests used for malaria

Answer 41

Question 42

First line tx for uncomplicated P. falciparum malaria

Answer 42

The World Health Organization (WHO) recommends artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated P. falciparum malaria in malaria-endemic areas

Question 43

Tx for severe falciparum malaria

Answer 43

Artesunate therefore is now the drug of choice for all patients with severe malaria everywhere

Severe falciparum malaria constitutes a medical emergency requiring intensive nursing care and careful management. Adjunctive treatments such as high-dose glucocorticoids, urea, heparin, dextran, desferrioxamine, antibody to tumor necrosis factor α, high-dose phenobarbital (20 mg/kg), mannitol, or large-volume fluid or albumin boluses have proved either ineffective or harmful in clinical trials and should not be used. In acute renal failure or severe metabolic acidosis, hemofiltration or hemodialysis should be started as early as possible

Question 44

Tx to prevent relapse for P. vivax and P. ovale

Answer 44

Need to add primaquine in addition to chloroquine or amodiaquine

Primaquine eradicates hepatic forms of P. vivax and P. ovale;

Note: primaquine should NOT be given in severe G6PD deficiency

Question 45

When a patient with severe malaria is unconscious, what lab test/s should you request for?

Answer 45

When the patient is unconscious, the blood glucose level should be measured every 4–6 h. All patients should receive a continuous infusion of dextrose, and blood concentrations ideally should be maintained above 4 mmol/L. Hypoglycemia (<2.2 mmol/L or 40 mg/dL) should be treated immediately with bolus glucose.

The parasite count and hematocrit should be measured every 6–12 h. It has been recommended that if the hematocrit falls to <20%, whole blood (preferably fresh) or packed cells should be transfused slowly, with careful attention to circulatory status.

Question 46

What antimalarial drug is associated with hypoglycemia

Answer 46

Quinine

Question 47

What antimalarial drug is associated with Hypotension

Answer 47

Chloroquine

Question 48

What anti malarial drug is associated with Agranulocytosis and should not be used with efavirenz

Answer 48

Amodiaquine

Question 49

What antimalarial drug is associated with Megaloblastic anemia

Answer 49

Pyrimethamine

Question 50

Artemisinin and derivatives (artemether, artesunate) do not have action on these stages of Plasmodium

Answer 50

kills all but fully mature gametocytes of P. falciparum. No action on liver stages

Question 51

Treatment for acute pulmonary edema in malaria

Answer 51

This syndrome is caused by increased pulmonary capillary permeability. Patients should be positioned with the head of the bed at a 45° elevation and should be given oxygen and IV diuretics. Positive-pressure ventilation should be started early if the immediate measures fail

Question 52

Treatment for hypoglycemia in malaria

Answer 52

An initial slow injection of 20% dextrose (2 mL/kg over 10 min) should be followed by an infusion of 10% dextrose (0.10 g/kg per hour). The blood glucose level should be checked regularly thereafter as recurrent hypoglycemia is common, particularly among patients receiving quinine

Question 53

Treatment for spontaneous bleeding in malaria

Answer 53

Patients who develop spontaneous bleeding should be given fresh blood and IV vitamin K.

Question 54

Treatment for convulsions in malaria

Answer 54

Convulsions should be treated with IV or rectal benzodiazepines and, if necessary, respiratory support.

Question 55

the only drug advised for pregnant women traveling to areas with drug-resistant malaria;

Answer 55

Mefloquine

this drug is generally considered safe in the second and third trimesters of pregnancy;

Question 56

When should pre exposure prophylaxis be taken when visiting a malaria endemic region

Answer 56

Travelers to a malaria endemic region should start taking antimalarial drugs 2 days to 2 weeks before departure so that any untoward reactions can be detected before travel and so that therapeutic antimalarial blood concentrations will be present if and when any infections develop

Antimalarial prophylaxis should continue for 4 weeks after the traveler has left the endemic area, except if atovaquone-proguanil or primaquine has been taken; these drugs have significant activities against the liver stage of the infection (causal prophylaxis) and can be discontinued 1 week after departure from the endemic area

Question 57

Atovaquone-proguanil is contraindicated in persons with _______

Answer 57

severe renal impairment (creatinine clearance rate, <30 mL/min).

Question 58

T/F
Serotypes of Salmonella that are only restricted to human hosts

Answer 58

The growth of serotypes Salmonella Typhi and Salmonella Paratyphi is restricted to human hosts, in whom these organisms cause enteric (typhoid) fever.

Question 59

T/F

All Salmonella infections begin with ingesting organisms, most commonly in contaminated food or water.

Answer 59

True

The infectious dose ranges from 200 colony-forming units (CFU) to 106 CFU, and the ingested dose is an important determinant of incubation period and disease severity

Question 60

Mean incubation period for S. typhi

Answer 60

The mean incubation period for S. Typhi is 10–14 days but ranges from 5 to 21 days, depending on the inoculum size and the host’s health and vaccination status.

The most prominent symptom is prolonged fever (38.8°–40.5°C [101.8°–104.9°F]), which can continue for up to 4 weeks if untreated

Question 61

When do yo usually see rose spots in typhoid fever

Answer 61

Rose spots make up a faint, salmon-colored, blanching, maculopapular rash located primarily on the trunk and chest. The rash is evident in ~30% of patients at the end of the first week and resolves without a trace after 2–5 days.

Question 62

When do you expect to see GI complications of typhoid fever?

Answer 62

Gastrointestinal bleeding (6%) and intestinal perforation (1%) most commonly occur in the third and fourth weeks of illness and result from hyperplasia, ulceration, and necrosis of the ileocecal Peyer’s patches at the initial site of Salmonella infiltration

Question 63

What are the neurologic manifestations associated with Typhoid fever

Answer 63

meningitis, Guillain-Barré syndrome, neuritis, and neuropsychiatric symptoms (described as “muttering delirium” or “coma vigil”), with picking at bedclothes or imaginary objects

Question 64

Chronic carriage of Salmonella is common among which subsets of patients

Answer 64

Chronic carriage is more common among women, infants, and persons who have biliary abnormalities or concurrent bladder infection with Schistosoma haematobium

Question 65

Definitive diagnostic test for typhoid fever

Answer 65

The definitive diagnosis of enteric fever requires the isolation of S. Typhi or S. Paratyphi from blood, bone marrow, other sterile sites, rose spots, stool, or intestinal secretions.

The diagnostic sensitivity of blood culture is only ~60% and is lower with low blood sample volume and among patients with prior antimicrobial use or in the first week of illness, reflecting the small number of S. Typhi organisms (i.e., <15/mL) typically present in the blood

Bone marrow culture is >80% sensitive, and, unlike that of blood culture, its yield is NOT reduced by up to 5 days of prior antibiotic therapy

Stool cultures, although negative in 60–70% of cases during the first week, can become positive during the third week of infection in untreated patients.

Question 66

If blood, bone marrow, and intestinal secretions are all cultured, the yield is >___ for Salmonella

Answer 66

90%

Question 67

Antimicrobial tx for Typhoid fever

Answer 67

If drug susceptible, use FQ

Question 68

How do you prevent typhoid fever?

Answer 68

Two typhoid vaccines are commercially available in the United States:

(1) Ty21a, an oral live attenuated S. Typhi vaccine (given on days 1, 3, 5, and 7, with revaccination with a full four-dose series every 5 years); and

(2) Vi CPS, a parenteral vaccine consisting of purified Vi polysaccharide from the bacterial capsule (given in a single dose, with a booster every 2 years)

Question 69

S. Enteritidis infection associated with what food?

Answer 69

chicken eggs

Question 70

Treatment of choice for non typhoidal salmonellosis (NTS)

Answer 70

Because of increased resistance to conventional antibiotics such as ampicillin and TMP-SMX, extended-spectrum cephalosporins and fluoroquinolones have emerged as the agents of choice for the treatment of MDR NTS infections

Question 71

Bacteremia and metastatic infection are most common with which non typhoidal salmonellosis (NTS) species?

Answer 71

Salmonella Choleraesuis and Salmonella Dublin

Question 72

Endovascular infection should be suspected if there is high-grade bacteremia (>___% of three or more blood cultures positive) of non typhoidal salmonellosis (NTS) species

Answer 72

50%

Echocardiography, CT, and indium-labeled white cell scanning are used to identify localized infection

Question 73

Antimicrobial tx for NTS

Answer 73

Preemptive antibiotic treatment should be considered for patients at increased risk for invasive NTS infection, including 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

Question 74

Duration of tx for NTS with endocarditis, arteritis

Answer 74

If the patient has endocarditis or arteritis, treatment for 6 weeks with an IV β-lactam antibiotic (such as ceftriaxone or ampicillin) is indicated

Question 75

Vectors of dengue viruses

Answer 75

Mosquitoes (predominantly Aedes aegypti, A. albopictus)

Dengue virus is under flaviviruses

Question 76

Pathogenesis of encephalitis in arthropod borne viruses

Answer 76

Viremia leads to multifocal entry into the CNS, presumably through infection of olfactory neuroepithelium, with passage through the cribriform plate, “Trojan horse” entry with infected macrophages, or infection of brain capillaries

Question 77

the most nonspecific of the disease syndromes caused by arthropod-borne and rodent-borne viruses

Answer 77

Fever and myalgia syndrome

Treatment is supportive, but acetylsalicylic acid is avoided because of the potential for exacerbated bleeding or Reye’s syndrome

Question 78

The most clinically significant flaviviruses that cause the fever and myalgia syndrome are

Answer 78

dengue viruses 1–4

Question 79

Duration of incubation of dengue

Answer 79

After dengue virus infection and an incubation period averaging 4–7 days, three evolving phases are described: a febrile phase, a critical phase, and a recovery phase.

Question 80

What is a positive tourniquet test in dengue

Answer 80

A positive tourniquet test—i.e., the detection of 10 or more new petechiae in one square inch of the upper arm after a 5-min blood pressure cuff inflation to midway between systolic and diastolic pressure—may demonstrate microvascular fragility associated with dengue but is more likely to be associated with severe disease.

Question 81

When do rashes appear in dengue?

Answer 81

Near the time of defervescence on days 3–5, a maculopapular rash begins on the trunk and spreads to the extremities and the face.

Question 82

The most significant flaviviruses that cause VHF are the mosquito-borne _____ and ____

Answer 82

dengue viruses 1–4 and yellow fever virus

Question 83

Subset of people that may be given Dengvaxia

Answer 83

A tetravalent live attenuated dengue vaccine based on the attenuated yellow fever virus 17D platform (CYD-TDV, or Dengvaxia) was licensed in 2015 and registered in 20 countries for individuals 9–45 years of age. However, retrospective analysis of phase 3 trials in Latin America and Asia suggested protection from severe dengue only in previously seropositive individuals; indeed, the risk of severe dengue was actually increased in seronegative vaccine recipients over that in nonvaccinated seronegative individuals, a result suggesting that a “first serologic hit” from the vaccine predisposes naïve recipients to more severe natural dengue infection.

Question 84

The clinical manifestations of tetanus occur only after tetanus toxin has reached _________

Answer 84

presynaptic inhibitory nerves

Question 85

. Serum anti-tetanus immunoglobulin G also may be measured in a sample taken before the administration of antitoxin or immunoglobulin; levels >_____ (measured by standard enzyme-linked immunosorbent assay) are deemed protective and do not support the diagnosis of tetanus

Answer 85

0.1 IU/mL

Question 86

Antimicrobial therapy for tetanus

Answer 86

Metronidazole (400 mg rectally or 500 mg IV every 6 h for 7 days) is preferred for antibiotic therapy. An alternative is penicillin (100,000–200,000 IU/ kg per day), although this drug theoretically may exacerbate spasms and in one study was associated with increased mortality

Question 87

Two types of antitoxin preparations available for tetanus

Answer 87

Antitoxin should be given early in an attempt to deactivate any circulating tetanus toxin and prevent its uptake into the nervous system.

Two preparations are available: human tetanus immune globulin (TIG) and equine antitoxin.

TIG is the preparation of choice, as it is less likely to be associated with anaphylactoid reactions. A single IM dose (500–5000 IU) is given, with a portion injected around the wound.

Equine-derived antitoxin is available widely and is used in low-income countries; after hypersensitivity testing, 10,000–20,000 U is administered IM as a single dose or as divided doses.

Question 88

Factors associated with poor prognosis in tetanus

Answer 88

Question 89

Schedule for tetanus vaccination

Answer 89

0,1,6 months

followed by one dose in subsequent pregnancies (or intervals of at least 1 year), to a total of five doses to provide long-term immunity.

Question 90

Individuals sustaining tetanus-prone wounds should be immunized if their vaccination status is incomplete or unknown or if their last booster was given >__ years earlier

Answer 90

10

Question 91

T/F

Giardia remains a pathogen of the proximal large bowel and does not disseminate hematogenously

Answer 91

proximal SMALL bowel

Question 92

How is giardiasis diagnosed?

Answer 92

Giardiasis is diagnosed by detection of parasite antigens in the feces, by identification of cysts in the feces or of trophozoites in the feces or small intestines, or by nucleic acid amplification tests (NAATs).

Cysts are oval, measure 8–12 μm × 7–10 μm, and characteristically contain four nuclei. Trophozoites are pear-shaped, dorsally convex, flattened parasites with two nuclei and four pairs of flagella

Question 93

Treatment for giardiasis

Answer 93

Cure rates with metronidazole (250 mg thrice daily for 5 days) are usually >90%.

Tinidazole (2 g once by mouth) may be more effective than metronidazole.

Nitazoxanide (500 mg twice daily for 3 days) is an alternative agent for treatment of giardiasis.

Paromomycin, an oral aminoglycoside that is not well absorbed, can be given to symptomatic PREGNANT patients, although information is limited on how effectively this agent eradicates infection.

Question 94

T/F

T. vaginalis can also infect men

Answer 94

Many men infected with T. vaginalis are asymptomatic, although some develop urethritis and a few have epididymitis or prostatitis.

Question 95

How is trichomoniasis diagnosed?

Answer 95

Detection of motile trichomonads by microscopic examination of wet mounts of vaginal or prostatic secretions has been the conventional means of diagnosis. Although this approach provides an immediate diagnosis, its sensitivity for the detection of T. vaginalis is only ~50–60% in routine evaluations of vaginal secretions.
Direct immunofluorescent antibody staining is more sensitive (70–90%) than wet-mount examinations. T. vaginalis can be recovered from the urethra of both males and females and is detectable in males after prostatic massage.

NAATs are FDA approved and are highly sensitive and specific for urine and for endocervical and vaginal swabs from women

Question 96

Treatment for trichomoniasis

Answer 96

Metronidazole (either a single 2-g dose or 500-mg doses twice daily for 7 days) or tinidazole (a single 2-g dose) is effective.

Reinfection often accounts for apparent treatment failures, but strains of T. vaginalis exhibiting high-level resistance to metronidazole have been encountered. Treatment of these resistant infections with higher oral doses, parenteral doses, or concurrent oral and vaginal doses of metronidazole or with tinidazole has been successful.

Question 97

T/F

There is only one antigenic type of rubella virus, and humans are its only known reservoir.

Answer 97

True

Question 98

Duration of shedding period of rubella

Answer 98

Individuals with acquired rubella may shed virus from 7 days before rash onset to ~5–7 days thereafter.

Question 99

Lymphadenopathy, particularly occipital and postauricular, may be noted during the ___week after exposure to Rubella

Answer 99

second

Question 100

What are the transient and permanent manifestation of congenital rubella syndrome?

Answer 100

Question 101

Diagnostic test for rubella

Answer 101

Laboratory assessment of rubella virus infection is conducted by serologic and virologic methods. For acquired rubella, serologic diagnosis is most common and depends on the demonstration of IgM antibodies in an acute-phase serum specimen or a fourfold rise in IgG antibody titer between acute- and convalescent-phase specimens. To detect a rise in IgG antibody titer indicative of acute disease, the acute phase serum specimen should be collected within 7–10 days after onset of illness and the convalescent-phase specimen ~14–21 days after the first specimen. The enzyme-linked immunosorbent assay IgM capture technique is considered most accurate for serologic diagnosis, but the indirect IgM assays also are acceptable. After rubella virus infection, IgM antibody may be detectable for up to 6 weeks. In case of a negative result for IgM in specimens taken earlier than day 5 after rash onset, serologic testing should be repeated.

Question 102

Classic triad of congenital rubella syndrome

Answer 102

The classic triad of CRS—clinical manifestations of cataracts, hearing impairment, and heart defects—is seen in ~10% of infants with CRS

Hearing impairment is the most common single defect of CRS.

Question 103

Among women infected with rubella virus during the first 10 weeks of gestation, the risk of delivering an infant with Congenital Rubella syndrome is __%.

Answer 103

90%

Question 104

When should administration of Ig for Rubella be considered?

Answer 104

Administration of immunoglobulin should be considered only if a pregnant woman who has been exposed to a person with rubella will not consider termination of the pregnancy under any circumstances. In such cases, IM administration of 20 mL of immunoglobulin within 72 h of rubella exposure may reduce—but does not eliminate—the risk of rubella

Question 105

The most effective method of preventing acquired rubella and CRS is through ____

Answer 105

vaccination with an RCV (Rubella containing Vaccine)

One dose induces seroconversion in ≥95% of persons ≥1 year of age. Immunity is considered long-term and is probably lifelong. The most commonly used vaccine globally is the RA27/3 virus strain.

Question 106

Contraindications for rubella containing vaccines

Answer 106

Because of the theoretical risk of transmission of live attenuated rubella vaccine virus to the developing fetus, women known to be pregnant should not receive RCV.

In addition, pregnancy should be avoided for 28 days after receipt of RCV. In follow-up studies of ~3000 unknowingly pregnant women who received rubella vaccine, no infant was born with CRS. Receipt of RCV during pregnancy is not ordinarily a reason to consider termination of the pregnancy

Question 107

Incubation period of syphilis

Answer 107

2-6 weeks

Question 108

The only known natural host for T. pallidum subsp. pallidum

Answer 108

human

Question 109

The generalized parenchymal, constitutional, mucosal, and cutaneous manifestations of secondary syphilis usually appear ~___ weeks after infection, although primary and secondary manifestations may occasionally overlap.

Answer 109

6-12

Question 110

Most commonly involves vessel in cardiovascular syphillis

Answer 110

usually involving the vasa vasorum of
the ascending aorta and resulting in aneurysm);

Question 111

Description of typical primary chancre

Answer 111

single painless papule that rapidly erodes and becomes indurated, with a characteristic cartilaginous consistency on palpation of the edge and base of the ulcer.

Question 112

Location of primary chancre in syphillis

Answer 112

usually located on the penis, where it is readily seen , but in MSM, it may also be found in the anal canal, rectum, or mouth.

In women, common primary sites are the cervix, vaginal wall, and labia, as well as anal canal and mouth.

Consequently, primary syphilis goes unrecognized in women and MSM more often than in heterosexual men.

Question 113

The classical manifestations of the secondary stage of syphillis include ___________

Answer 113

mucocutaneous or cutaneous lesions and generalized nontender lymphadenopathy

Rarely, severe necrotic lesions (lues maligna) may appear and are more commonly reported in HIV-infected individuals.

Question 114

Definition of latent syphilis

Answer 114

Positive serologic tests for syphilis, together with a normal CSF examination and the absence of clinical manifestations of syphilis, indicate a diagnosis of latent syphilis in an untreated person.

Question 115

Definition of early latent syphillis

Answer 115

Early latent syphilis is limited to the first year after infection, whereas late latent syphilis is defined as that of ≥1 year’s (or unknown) duration.

The classical definition of early latent syphilis would include a person whose secondary rash has resolved, as well as a person whose chancre has healed but who has not yet developed secondary manifestations.

Question 116

In several large studies, neurosyphilis was associated with an RPR titer of ≥____, regardless of clinical stage or HIV infection status.

Answer 116

1:32

While most experts agree that neurosyphilis is more common among persons with untreated HIV infection, the immune reconstitution seen with effective ART may have a protective effect against development of clinical neurosyphilis in HIV-infected persons with syphilis

Question 117

Most common presentation of meningovascular syphilis

Answer 117

The most common presentation is a strokes yndrome involving the middle cerebral artery of a relatively young adult.

Question 118

late manifestation of syphilis that presents as symptoms and signs of demyelination of the posterior columns, dorsal roots, and dorsal root ganglia, including ataxia, foot drop, paresthesia, bladder disturbances, impotence, areflexia, and loss of positional, deep-pain, and temperature sensations.

Answer 118

Tabes dorsalis

Question 119

the test of choice for rapid serologic diagnosis in a clinical setting for syphilis

Answer 119

The RPR test is easier to perform and uses unheated serum or plasma; it is the test of choice for rapid serologic diagnosis in a clinical setting.

Question 120

Standard test of choice for examining CSF for neurosyphilis

Answer 120

The VDRL test remains the standard for examining CSF and is superior to the RPR for this purpose.

The CSF VDRL test is highly specific and, when reactive, is considered diagnostic of neurosyphilis; however, this test is insensitive and may be nonreactive even in cases of symptomatic neurosyphilis.

VDRL -Very good for the Vrain

Question 121

Expected result of CSF exam of a patient with neurosyphilis

Answer 121

Involvement of the CNS is detected by examination of CSF for mononuclear
pleocytosis (>5 white blood cells/μL), increased protein concentration (>45 mg/dL), or CSF VDRL reactivity

Question 122

Treatment of choice for all stages of syphilis

Answer 122

Penicillin G

Question 123

Alternative drug for primary, early and latent syphilis is allergic to penicillin

Answer 123

For penicillin-allergic patients with syphilis, a 2-week (early syphilis) or 4-week (late or late latent syphilis) course of therapy with doxycycline or tetracycline is recommended

Doxycycline (100 mg PO bid) or tetracycline HCl (500 mg PO qid) for 2 weeks

Question 124

Alternative drug for neurosyphilis is allergic to penicillin

Answer 124

NONE

Desensitize and treat with penicillin

Question 125

Form of Pen G used for neurosyphilis to ensure treponemicidal concentrations of penicillin G in CSF

Answer 125

Administration of either IV aqueous crystalline penicillin G or of IM aqueous procaine penicillin G plus oral probenecid in recommended doses is thought to ensure treponemicidal concentrations of penicillin G in CSF

Question 126

Alternative drug for syphilis in pregnant patients if patient is allergic to penicillin

Answer 126

Penicillin is the only recommended agent for the treatment of syphilis in pregnancy. If the patient has a documented penicillin allergy, desensitization and penicillin therapy should be undertaken

Question 127

A dramatic although self-limited reaction consisting of fever, chills, myalgia, headache, tachycardia, increased respiratory rate, increased circulating neutrophil count, and vasodilation with mild hypotension may follow the initiation of treatment for syphilis.

Answer 127

JARISCH-HERXHEIMER REACTION

The Jarisch-Herxheimer reaction occurs in ~50% of patients with primary syphilis, 90% of those with secondary syphilis, and a lower proportion of persons with later-stage disease.

Question 128

When should patients treated for syphilis be monitored for response to treatment

Answer 128

Patients with primary or secondary syphilis should be examined 6 and 12 months after treatment, and persons with latent or late syphilis at 6, 12, and 24 months.

More frequent clinical and serologic examination (3, 6, 9, 12, and 24 months) is recommended for patients concurrently infected with HIV, regardless of the stage of syphilis

Question 129

What test should be used for monitoring response to treatment of patients with syphilis

Answer 129

Efficacy of treatment should be assessed by clinical evaluation and monitoring of the quantitative VDRL or RPR titer for a fourfold decline (e.g., from 1:32 to 1:8).

Because treponemal tests may remain reactive despite treatment for seropositive syphilis, these tests are not useful in following the response to therapy.

Question 130

N. gonorrhea is oxidase positive or negative

Answer 130

positive

Question 131

T/F

Gonorrhea is transmitted from males to females more efficiently than in the opposite direction.

Answer 131

True

Question 132

most abundant gonococcal surface protein

Answer 132

Porin

Question 133

most common clinical manifestation of gonorrhea in male patients

Answer 133

Acute urethritis is the most common clinical manifestation of gonorrhea in male patients. The usual incubation period after exposure is 2–7 days, although the interval can be longer and most men remain asymptomatic.

Question 134

Pyuria in the absence of bacteriuria visible on Gram’s stain of unspun urine, accompanied by urine cultures that fail to yield >102 colonies of bacteria usually associated with urinary tract infection, signifies the possibility of urethritis usually due to __________

Answer 134

C. trachomatis

Urethral infection with N. gonorrhoeae also may occur in this context, but in this instance, urethral cultures are usually positive

Question 135

Description of skin lesions seen in disseminated gonococcal infection

Answer 135

Skin lesions are seen in ~75% of patients and include papules and pustules, often with a hemorrhagic component

Question 136

Most commonly involved joint in gonococcal arthritis

Answer 136

Suppurative arthritis involves one or two joints, most often the knees, wrists, ankles, and elbows (in decreasing order of frequency); other joints occasionally are involved.

Question 137

T/F gonococcal urethritis in men and gonococcal cervicitis in women may be diagnosed via gram stain

Answer 137

No. Only in men

The detection of gram-negative intracellular monococci and diplococci is usually highly specific and sensitive in diagnosing gonococcal urethritis in symptomatic males but is only ~50% sensitive in diagnosing gonococcal cervicitis.

Question 138

Blood should be cultured in suspected cases of Disseminated Gonococcal Infection. The probability of positive blood cultures decreases after ____ of illness.

Answer 138

48h

Question 139

Treatment of choice for gonorrhea

Answer 139

The third-generation cephalosporin ceftriaxone is now recommended as the first-line regimen for use at twice the previous dose (now, 500 mg IM, single dose) based on doubling of mean inhibitory concentrations (MICs) of current strains compared with MICs 20 years ago

Azithromycin, which had been recommended to provide additional treatment of gonorrhea (also to include treatment of chlamydial infection) is NO longer recommended as part of a first line regimen

Question 140

If chlamydial infection with gonorrhea cannot be excluded, what must be added to the first line treatment for gonorrhea

Answer 140

If chlamydial infection cannot be excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended

Question 141

Test of cure for uncomplicated genital gonorrheal infection

Answer 141

None
Persons with uncomplicated genital or rectal infections who receive ceftriaxone or an alternative regimen do not need a test of cure; however, cultures for N. gonorrhoeae should be performed if symptoms persist after therapy with an established regimen, and any gonococci isolated should be tested for antimicrobial susceptibility.

Question 142

Treatment for gonococcal meningitis and endocarditis

Answer 142

Gonococcal meningitis and endocarditis should be treated in the hospital with high-dose IV ceftriaxone (1–2 g IV every 12–24 h); therapy should continue for 10–14 days for meningitis and for at least 4 weeks for endocarditis

Question 143

All persons who experience more than one episode of disseminated gonococcal infection should be evaluated for _____

Answer 143

complement deficiency.

Question 143

All sex partners of persons with gonorrhea should be evaluated and treated for N. gonorrhoeae and C. trachomatis infections if their last contact with the patient took place within ______ before the onset of symptoms or the diagnosis of infection in the patient

Answer 143

60 days

If the patient’s last potential sexual exposure to infection was >60 days before onset of symptoms or diagnosis, the patient’s most recent sex partner should be treated

Question 144

T/F
An absence of typical gram-negative diplococci on Gram’s-stained smear of urethral exudate containing inflammatory cells warrants a preliminary diagnosis of non gonococcal urethritis

Answer 144

True as this test is 98% sensitive for the diagnosis of gonococcal urethral infection.

Question 144

In sexually active men under age 35, acute epididymitis is caused most frequently by _______

Answer 144

C. trachomatis and less commonly by N. gonorrhoeae and is usually associated with overt or subclinical urethritis.

Question 145

In developing countries, where clinics or pharmacies often dispense treatment based on symptoms alone without examination or testing, oral treatment with _________ —particularly with a 7-day regimen—provides reasonable coverage against both trichomoniasis and BV, the usual causes of symptoms of vaginal discharge.

Answer 145

metronidazole

Question 146

T/F
Culture is the most sensitive test for T. vaginalis

Answer 146

NAAT for T. vaginalis is more sensitive than culture.

Question 147

STD that may present with vaginal fluid of pH>=5

Answer 147

Trichomoniasis

Question 148

STD that may present with vaginal discharge with fishy odor

Answer 148

bacterial vaginosis

assoc with Gardnerella vaginalis

Question 149

Treatment for vulvovaginal candidiasis

Answer 149

Azole cream, tablet, or suppository—e.g., miconazole (100-mg vaginal suppository) or clotrimazole (100-mg vaginal tablet) once daily for 7 days OR

Fluconazole, 150 mg orally (single dose)

Question 150

Treatment for partners of patients with Trichomonas

Answer 150

Examination for sexually transmitted infection; treatment with metronidazole, 2 g PO (single dose)

Question 151

Clue cells are seen in what STD

Answer 151

Bacterial vaginosis

Question 152

Amsel criteria for diagnosing bacterial vaginosis

Answer 152

BV is conventionally diagnosed clinically with the Amsel criteria, which include any three of the following four clinical abnormalities:
(1) objective signs of increased white homogeneous vaginal discharge;
(2) a vaginal discharge pH of >4.5;
(3) liberation of a distinct fishy odor (attributable to volatile amines such as trimethylamine) immediately after vaginal secretions are mixed with a 10% solution of KOH; and
(4) microscopic demonstration of “clue cells”

Question 153

Treatment for bacterial vaginosis

Answer 153

> Metronidazole, 500 mg PO bid for 7 days >Metronidazole gel, 0.75%, one applicator (5 g) intravaginally once daily for 5 days
Clindamycin, 2% cream, one full applicator vaginally each night for 7 days

Question 154

The presence of ≥__ PMNs per 1000× microscopic field within strands of cervical mucus not contaminated by vaginal squamous epithelial cells or vaginal bacteria indicates endocervicitis

Answer 154

20

Question 155

Treatment and alternative tx for M. genitalium

Answer 155

Although the antimicrobial susceptibility of M. genitalium is not yet well defined, the organism frequently persists after doxycycline therapy, and it currently seems reasonable to use azithromycin to treat possible M. genitalium infection in such cases.

With resistance of M. genitalium to azithromycin now recognized, moxifloxacin may be a reasonable alternative.

Question 156

Etiology of PID that causes greatest degree of tissue inflammation and damage

Answer 156

C. trachomatis

Question 157

What will you consider if a patient with PID presents with RUQ pain

Answer 157

Perihepatitis/ Fitz-Hugh–Curtis syndrome

Pleuritic upper abdominal pain and tenderness, usually localized to the right upper quadrant (RUQ), develop in 3–10% of women with acute PID

Question 158

Treatment for PID

Answer 158

Question 159

When do you expect clinical improvement in PID

Answer 159

Hospitalized patients should show substantial clinical improvement within 3–5 days. Women treated as outpatients should be clinically reevaluated within 72 h.

Question 160

Surgical indication for PID

Answer 160

Surgery is necessary for the treatment of salpingitis only in the face of life-threatening infection (such as rupture or threatened rupture of a tuboovarian abscess) or for drainage of an abscess. Conservative surgical procedures are usually sufficient. Pelvic abscesses can often be drained by posterior colpotomy, and peritoneal lavage can be used for generalized peritonitis.

Question 161

Most common cause of genital ulcers

Answer 161

PCR testing of genital ulcers now clearly implicates genital herpes as by far the most common cause of genital ulceration in most developing countries.

Question 162

T/F

All cases of genital ulcers should be tested for syphilis using rapid serologic test

Answer 162

True

Clinicians should order a rapid serologic test for syphilis in all cases of genital ulcer and treat presumptively while awaiting serology in a patient at high risk (especially MSM)

Question 163

Typical vesicles or pustules or a cluster of painful ulcers preceded by vesiculopustular lesions suggest genital _____

Answer 163

herpes

These typical clinical manifestations make detection of the virus optional; however, many patients want confirmation of the diagnosis, and differentiation of HSV-1 from HSV-2 has prognostic implications, because the latter causes more frequent genital recurrences and is more infectious to vulnerable sex partners.

Question 164

Painless, nontender, indurated genital ulcers with firm, nontender inguinal adenopathy suggest

Answer 164

primary syphilis.

Question 165

Demonstration of H. ducreyi by culture (or by PCR, where available) is most useful when ________

Answer 165

ulcers are painful and purulent, especially if inguinal lymphadenopathy with fluctuance or overlying erythema is noted;

Question 166

What should you consider when genital ulcers persist beyond the natural history of initial episodes of herpes (2–3 weeks) or of chancroid or syphilis (up to 6 weeks) and do not resolve with syndrome-based antimicrobial therapy

Answer 166

in addition to the usual tests for herpes, syphilis, and chancroid—biopsy is indicated to exclude donovanosis as well as carcinoma and other nonvenereal dermatoses.

Question 167

Causative agent of genital ulcers that are frequently tender

Answer 167

Herpes and Chancroid

Question 168

Causative agent of genital ulcers that is associated with pseudobuboes

Answer 168

Donovanosis

Question 169

Causative agent of genital ulcers that presents with elevated ulcer

Answer 169

Donovanosis

Question 170

Causative agent of genital ulcers that bleeds easily

Answer 170

Chancroid and Donovanosis

B-C-D
Bleed-chancroid-donovanosis

Question 171

Treatment for confirmed/suspected chancroid

Answer 171

Question 172

causes of the most cases of infectious proctitis in women and MSM

Answer 172

Acquisition of HSV, N. gonorrhoeae, or C. trachomatis (including LGV strains of C. trachomatis) during receptive anorectal intercourse causes most cases of infectious proctitis in women and MSM.

Question 173

Gonococcal or chlamydial proctitis typically involves the __________ and is clinically mild, without systemic manifestations.

Answer 173

most distal rectal mucosa and the anal crypts

Question 174

Causative agents of proctitis that usually produce severe anorectal pain and often cause fever

Answer 174

In contrast, primary proctitis due to HSV and proctocolitis due to the strains of C. trachomatis that cause LGV usually produce severe anorectal pain and often cause fever

Question 175

In MSM without HIV infection, enteritis is often attributable to __________

Answer 175

In MSM without HIV infection, enteritis is often attributable to Giardia lamblia.

Question 176

Sexually acquired proctocolitis is most often due to ________

Answer 176

Sexually acquired proctocolitis is most often due to Campylobacter or Shigella species.

Question 177

Treatment for proctitis

Answer 177

Pending test results, patients with proctitis should receive empirical syndromic treatment—e.g., with ceftriaxone (a single IM dose of 500 mg for gonorrhea) plus doxycycline (100 mg by mouth twice daily for 7 days for possible chlamydial infection) plus treatment for herpes or syphilis if indicated.

If LGV proctitis is proven or suspected, the recommended treatment is doxycycline (100 mg by mouth twice daily for 21 days); alternatively, 1 g of azithromycin once a week for 3 weeks is likely to be effective but is little studied.

Question 178

consistent condom use is associated with significant protection of both males and females against all STIs. The only exceptions are probably sexually transmitted are _________

Answer 178

Pthirus pubis and Sarcoptes scabiei infestations

Question 179

Screening sexually active female patients ≤___ years of age for C. trachomatis whenever they present for health care (at least once a year)

Answer 179

25

In women 25–29 years of age, chlamydial infection is uncommon but still may reach a prevalence of 3–5% in some settings;

Question 180

Optimal age for recommended vaccination for HPV

Answer 180

The optimal age for recommended vaccination is 11–12 years because of the very high risk of HPV infection after sexual debut.

Question 181

Serovars associated with
Trachoma
Oculogenital Chlamydia
LGV

Answer 181

Trachoma serovars A, B, Ba, and C
the oculogenital serovars D–K
and the LGV serovars L1–L3.

Question 182

two highly specialized morphologic forms of Chlamydia

Answer 182

Elementary body, which is the infectious form and is specifically adapted for Extracellular survival, and the metabolically active and

Replicating Reticulate body, which is not infectious, is adapted for an intracellular environment, and does not survive well outside the host cell.

E-E-nfectious
R- Replicating

Question 183

Because the duration of the chlamydial growth cycle is ~48–72 h, the incubation period of sexually transmitted chlamydial infections is relatively long—generally ___ weeks.

Answer 183

1-3

Question 184

an invasive STD characterized by acute lymphadenitis with bubo formation and/or acute hemorrhagic proctitis

Answer 184

LGV

Question 185

Definition of post gonococcal urethritis (PGU)

Answer 185

The designation PGU refers to NGU developing in men 2–3 weeks after treatment of gonococcal urethritis with single doses of agents such as penicillin or cephalosporins, which lack antimicrobial activity against chlamydiae.

Question 186

What constitutes reactive arthritis

Answer 186

Reactive arthritis consists of conjunctivitis, urethritis (or, in female patients, cervicitis), arthritis, and characteristic mucocutaneous lesions.

Question 187

NGU is the initial manifestation of reactive arthritis in 80% of patients, typically occurring within __ days after sexual exposure.

Answer 187

14

Arthritis usually begins ~4 weeks after the onset of urethritis but may develop sooner or, in a small percentage of cases, may actually precede urethritis

Question 188

Clinical experience and collaborative studies indicate that a cutoff of >__ polymorphonuclear leukocytes (PMNs)/1000× field in a Gram-stained smear of cervical mucus correlates best with chlamydial or gonococcal cervicitis.

Answer 188

30

Question 189

In the absence of infection with uropathogens such as coliforms or Staphylococcus saprophyticus, _______ is the pathogen most commonly isolated from college women with dysuria, frequency, and pyuria

Answer 189

C. trachomatis

Question 190

Diagnostic assay of choice for Chlamydia

Answer 190

The first nonculture assays, such as direct fluorescent antibody staining of clinical material and enzyme immunoassay (EIA), have been replaced by NAATs, which are currently recommended by the CDC as the diagnostic assays of choice.

Question 191

Recommended screening test sample for Chlamydia in asymptomatic women

Answer 191

For screening of asymptomatic women, the CDC now recommends that self-collected or clinician-collected vaginal swabs, which are slightly more sensitive than urine, be used.

Question 192

Recommended screening test sample for Chlamydia in symptomatic women and male patients

Answer 192

For symptomatic women undergoing a pelvic examination, cervical swab samples are desirable because they have slightly higher chlamydial counts.

For male patients, a urine specimen is the sample of choice, but self-collected penile-meatal swabs have been shown to be very effective.

Question 193

Presumptive diagnosis for NGU/PGU and epididymitis, reactive arthritis

Answer 193

Question 194

LGV titer for confirming diagnosis of LGV

Answer 194

LGV CF titer, ≥1:64; MIF titer, ≥1:512

Question 195

Until when should you not use NAAT as a test for cure for Chlamydia

Answer 195

Residual nucleic acid from cells rendered noninfective by antibiotics may continue to yield a positive result in NAATs for as long as 3 weeks after therapy when viable organisms have actually been eradicated. Therefore, clinicians should not use NAATs for test of cure until after 3 weeks.

Question 196

When should you do test of cure after treatment for infection with C. trachomatis?

Answer 196

The CDC currently does not recommend a test of cure after treatment for infection with C. trachomatis. However, because incidence studies have demonstrated that previous chlamydial infection increases the probability of becoming reinfected, the CDC does recommend that previously infected individuals be rescreened 3 months after treatment.

Question 197

Serologic test of choice for LGV

Answer 197

The serologic test of choice is the microimmunofluorescence (MIF) test

Question 198

Treatment for Chlamydia

Answer 198

A 7-day course of oral doxycycline (100 mg twice daily) or a single 1-g oral dose of azithromycin are the primary recommended regimens of treatment for uncomplicated chlamydial infections.

Alternative 7-day oral regimens include erythromycin (500 mg four times daily), or a fluoroquinolone (ofloxacin, 300 mg twice daily; or levofloxacin, 500 mg/d) can be used.

The single 1-g oral dose of azithromycin is as effective as a 7-day course of doxycycline for the treatment of uncomplicated genital C. trachomatis infections in adults

Question 199

How can trachoma be diagnosed clinically?

Answer 199

The clinical diagnosis of classic trachoma can be made if two of the following signs are present: (1) lymphoid follicles on the upper tarsal conjunctiva; (2) typical conjunctival scarring; (3) vascular pannus; or (4) limbal follicles or their sequelae, Herbert pits.

Question 200

What are lepra cells?

Answer 200

On slit-skin smear examination at the lepromatous end of the disease spectrum, M. leprae is predominantly found in clumps or globi within macrophages (lepra cells).

Question 201

Temperature required for survival and proliferation of M. leprae

Answer 201

The temperature required for survival and proliferation—between 27°C and 30°C—explains the greater impact of the disease on surface areas such as the skin, peripheral nerves, testicles, and upper airways, with less inner visceral involvement.

Question 202

Main reservoir of infection for M. leprae.

Answer 202

It is assumed that humans are the main reservoir of infection for M. leprae. The armadillo is also a reservoir for human infection.

Question 203

The incubation period of leprosy is estimated to range from _____ to ______

Answer 203

2 to ≥10 years.

Question 204

Risk factos for leprosy

Answer 204

Poverty-associated factors such as low level of education, poor hygiene, and food shortages have been identified as risk factors for leprosy, but the most important risk factors are associated with intimacy and duration of contact with a leprosy patient, in particular with an index case with multibacillary leprosy, and the intensity of contact with and physical distance from the index patient.

Question 205

often, but not always, the first clinical
sign of leprosy; manifests as one or a few hypopigmented or faintly erythematous, ill-defined to well-defined macular lesions measuring 1–5 cm in diameter. There is no thickening of the corresponding cutaneous and peripheral nerves.

Answer 205

Indeterminate Leprosy (IL)

Question 206

Type of leprosy that presents either as a well-defined, hypopigmented macule or as a raised, erythematous/ brown/copper-colored plaque with a well-defined edge. The lesions may be found on any part of the skin and are characterized by complete loss of fine touch and temperature sensations over their surface.

Answer 206

TT leprosy

On slit-skin smear examination, no acid-fast
bacilli (AFB) are normally found. The lepromin skin test is strongly positive, signifying good host CMI status.

Question 207

One of the most striking features of this type of leprosy is susceptibility to a type 1 leprosy reaction that exacerbates skin lesions and/or peripheral nerves. If not diagnosed and treated early, disease in these patients tends to downgrade across the spectrum

Answer 207

Borderline Tuberculoid (BT) Leprosy

Question 208

This form of leprosy is unstable. Many cases downgrade toward BL and LLs disease, especially if not treated. There are multiple plaque lesions and, not infrequently, macular lesions; the lesions are of various shapes and sizes, are bilateral, and usually occur in a more or less symmetrical distribution. In annular lesions, the inner edge is well demarcated and “punched out,” and the outer edge is ill defined and merges with normal-looking skin.

Answer 208

Mid-Borderline (BB) Leprosy

Question 209

In this type of leprosy, there are numerous bilateral, round or oval, macular, diffusely infiltrated, erythematous or hypopigmented lesions with moderately defined borders. The lesions are usually 2–3 cm in diameter, may have a coppery hue, and tend to become symmetrical. Some loss of sensation may be detected, particularly over older lesions; however, no loss of sensation is observed over fresh lesions.

Answer 209

Borderline Lepromatous Leprosy

Question 210

This type of leprosy presents with innumerable bilateral, symmetrically distributed, diffusely indurated, erythematous, copper-colored or skin-colored patches or plaques. There is no loss of sensation over these lesions, which have a smooth, shiny surface. The lesions spread over the face, earlobes, ears, extensor aspects of the upper and lower extremities, back, and buttocks.
Coarse induration on the face sometimes results in gross skin folds that lead to an appearance referred to as “lion face”

Answer 210

Lepromatous leprosy

clue: symmetric lesions, lion face

Question 211

portal of entry for M. leprae and is the earliest site of involvement in LL leprosy.

Answer 211

The nose is the portal of entry for M. leprae and is the earliest site of involvement in LL leprosy.

Question 212

rare form of LL leprosy in which waxy, shiny, firm, symmetrical or asymmetrical nodules and plaques are observed over normal-looking skin

Answer 212

Histoid leprosy

Question 213

rare form of non-nodular LL leprosy occurring in Mexico and Central America is characterized by diffuse shiny infiltration of the skin and widespread sensory loss. The skin looks waxy and has a shiny appearance (“lepra bonita,” or beautiful leprosy), with obvious diffuse induration of the earlobes and forehead as well as loss of eyebrows, sometimes eyelashes, and not infrequently all body hair. This form of leprosy can be complicated by an unusual reaction known as Lucio’s phenomenon

Answer 213

Diffuse leprosy of Lucio and Latapi

Question 214

Type of lepra reaction that is considered as a delayed hypersensitivity reaction associated with sudden alteration of CMI status and leading to a shift in the patient’s position on the leprosy spectrum. Skin lesions are characterized by acute swelling and redness

Answer 214

Type 1

Question 215

Type of lepra reaction also known as ENL (erythema nodosum leprosum) that is an immune complex–mediated syndrome that causes inflammation of the skin, nerves, and other organs as well as general malaise.

Answer 215

Type 2

Question 216

Type of lepra reaction that is observed in diffuse leprosy of Lucio and Latapí and may be a variant of erythema nodosum necroticans. It is characterized by marked vasculitis and thrombosis of the superficial and deep vessels result in hemorrhage and infarction of the skin.

Answer 216

Lucio phenomenon

Question 217

Three cardinal signs indicate a diagnosis of leprosy.

Answer 217

Three cardinal signs indicate a diagnosis of leprosy. The diagnosis can be established when two of these three signs are present:
1. Hypopigmented or erythematous skin lesion(s) with definite loss or impairment of sensation
2. Involvement of the peripheral nerves, as demonstrated by definite thickening with sensory impairment
peripheral nerves commonly palpated in a leprosy patient are the greater auricular, ulnar, radial, radial cutaneous, median, lateral popliteal, posterior tibial, sural, and superficial peroneal nerves.
3. A positive result for AFB in slit-skin smears, establishment of the presence of AFB in a skin smear or biopsy sample, or a positive result in a biopsy PCR.

Question 218

Normally a slit-skin smear is taken from four sites which include

Answer 218

the right earlobe, the forehead above the eyebrows, the chin, and the left buttock in men or the left upper thigh in women.

Question 219

a specific lipid on the M. leprae cell wall that has been used for serologic diagnosis of leprosy, yielding positive results in 90–95% of multibacillary cases and 25–60% of paucibacillary cases

Answer 219

PGL-1 ELISA

Question 220

A negative lepromin test is generally seen in patients with which types of leprosy

Answer 220

LL or BL leprosy, indicating the lack of a protective cellular response.

Question 221

Nerves that are usually tested for touch sensation in leprosy

Answer 221

The ulnar and median nerves and the posterior tibial nerve are usually tested for touch sensation.

The most reliable test is the Semmes-Weinstein monofilament (SWM) test.

Question 222

Treatment for leprosy

Answer 222

Question 223

Syndrome associated with dapsone severe adverse event that is not uncommon in some countries.

Answer 223

“DDS syndrome” (also called the dapsone hypersensitivity syndrome) is a severe adverse event that is not uncommon in some countries.

It usually develops 6 weeks after the commencement of dapsone administration and manifests as fever, skin rash, eosinophilia, lymphadenopathy, hepatitis, and encephalopathy.

Question 224

The most noticeable adverse event of Clofazimine

Answer 224

The most noticeable adverse event is skin discoloration ranging from red to purple or black, with the degree of discoloration depending on the dosage

The abnormal pigmentation usually fades within 6–12 months of clofazimine discontinuation, although traces of discoloration may remain for up to 4 years.

Question 225

The cure rate for leprosy with multidrug therapy is ___%, but relapse is possible.

Answer 225

99%

Question 226

Treatment for rifampicin resistant leprosy

Answer 226

For rifampin-resistant leprosy, the WHO guidelines recommend daily treatment with at least two second-line drugs—clarithromycin, minocycline, or a quinolone (ofloxacin, levofloxacin, or moxifloxacin)—plus clofazimine for 6 months, followed by clofazimine plus one of the second-line drugs daily for an additional 18 months.

Leprosy patients infected with M. leprae resistant to both rifampin and ofloxacin may be treated daily with the following regimen: clarithromycin, minocycline, and clofazimine for 6 months, followed by clarithromycin or minocycline plus clofazimine for an additional 18 months.

Question 227

Post exposure prophylxis for leprosy

Answer 227

A large randomized controlled trial has shown that single-dose rifampin, given once to household contacts, neighbors, and social contacts, reduces the recipients’ risk of leprosy by ~60%.

Question 228

Treatment of choice for T1 Leprosy reaction

Answer 228

Oral, short-acting glucocorticoids are the treatment of choice for T1R.

Prednisolone is used most often in an initial dose of 1 mg/kg of body weight once a day, usually with a maximum of 60–80 mg

The dose is tapered slowly, usually by 5 mg every 2 weeks over a period of 20 weeks—a schedule that results in better outcomes and lower reaction relapse rates than the previously recommended 12-week glucocorticoid regimen.

Patients should be examined every 2 weeks, and the examination should include a quick nerve function assessment.

Question 229

Treatment for Type 2 Leprosy reaction

Answer 229

Mild first-time T2R (or ENL) reactions with localized skin nodules may be treated with aspirin and pentoxifylline.

If a rapid effect is needed, the most effective drug to date is thalidomide, which rapidly suppresses clinical signs, including nerve impairment and iritis. A dose of 100–200 mg is given either once or twice daily. In patients with severe recurrent ENL, a daily thalidomide maintenance dose of 50 mg may be effective in suppressing new episodes.

High-dose clofazimine also is effective in preventing recurrent ENL, but attainment of a maximal effect takes several weeks.

Question 230

Treatment of neuropathic pain for Leprosy

Answer 230

Generally, for the treatment of neuropathic pain, three classes of medication are available: tricyclic antidepressants, phenothiazines, and anticonvulsants (carbamazepine, oxcarbazepine, gabapentin, and pregabalin).

Question 231

Up to what age may you give HPV vaccine (quadrivalent) in males

Answer 231

26

Question 232

Most common cause of community acquired abscess

Answer 232

K. pneumoniae

Question 233

Most common cause of community acquired endocarditis

Answer 233

Viridans streptococci
if hospital acquired: S. aureus

Question 234

Duration of tx for febrile neutropenia with bacteremia

Answer 234

Until neutropenia resolves

Question 235

First line tx for streptococcal pharyngitis

Answer 235

Benzathine Pen G 1.2 mU or Pen V 250 mg TID or 500 mg BID x 10 days

Question 236

Main species of Schistosoma in PH

Answer 236

S. japonicum

Question 237

Treatment of choice for filariasis

Answer 237

Diethylcarbamazine

Question 238

Drug of choice for asymptomatic carriage of Entamoeba

Answer 238

Iodoquinol or Paromomycin

Question 239

Most common form of botulism

Answer 239

foodborne botulism

Question 240

Most common source of sepsis

Answer 240

pulmonary infection

Question 241

5 moments of hand hygiene

Answer 241

Before touching a patient
Before clean or aseptic procedures
After exposure to bodily fluids or risk of exposure
After touching a patient
After touching a patient’s surrounding

Question 242

Precaution for aspergillosis

Answer 242

Standard

Question 243

Precaution for Avian Influenza

Answer 243

Airborne

but if Influenza A and B –> droplet

Question 244

Precaution for Coxsackie

Answer 244

Droplet

Question 245

2nd line TB drug that can cause hypothyroidism

Answer 245

Ethionamide

Question 246

Vibrio vulnificus is highly susceptible to what drug

Answer 246

tetracycline

Question 247

Impetigo contagiosa is caused by ______, and bullous impetigo is due to ______

Answer 247

Impetigo contagiosa is caused by S. pyogenes, and bullous impetigo is due to S. aureus.

Question 248

T/F Rheumatic fever is not a complication of skin infection caused by S. pyogenes.

Answer 248

True
PSGN is a complication but not rheumatic fever (molecular mimicry)

Question 249

most common cause of localized folliculitis

Answer 249

S. aureus

Question 250

Hot-tub folliculitis is caused by _______ in waters that are insufficiently chlorinated and maintained at temperatures of 37–40°C.

Answer 250

Pseudomonas aeruginosa

Question 251

Verruga peruana is caused by _________ , which is transmitted to humans by the sandfly Phlebotomus.

Answer 251

Bartonella bacilliformis

Question 252

Erysipelas is due to ________ and is characterized by an abrupt onset of fiery-red swelling of the face or extremities.

Answer 252

S. pyogenes

Flaccid bullae may develop during the second or third day of illness, but extension to deeper soft tissues is rare.

Question 253

The gram-positive aerobic rod _______ is most often associated with fish and domestic swine and causes cellulitis primarily in bone renderers and fishmongers.

Answer 253

Erysipelothrix rhusiopathiae

remains susceptible to most β-lactam antibiotics (including penicillin), erythromycin, clindamycin, tetracycline, and cephalosporins but is resistant to sulfonamides, chloramphenicol, and vancomycin.

Its resistance to vancomycin, which is unusual among gram-positive bacteria, is of potential clinical significance since this agent is sometimes used in empirical therapy for skin infection.

Question 254

Strains of MRSA that produce the ____ toxin have been reported to cause necrotizing fasciitis.

Answer 254

Panton-Valentine leukocidin (PVL) toxin

Question 255

Treatment of choice for animal bites
>prophylaxis
>established infection

Answer 255

Question 256

Treatment of choice for gas gangrene and necrotizing fasciitis (caused by GAS)

Answer 256

Same Pen G + Clinda

but if necrotizing fascitis is caused by mixed aerobes and anaeroebs = Ampisul+ clinda + cipro

Question 257

Treatment of choice for bacillary angiomatosis

Answer 257

Question 258

Which of the 3 types of polio has not been eradicated?

Answer 258

Type 1

Question 259

T/F
breast-feeding is not a contraindication for live-virus or other vaccines.

Answer 259

True

Question 260

Vaccine/s contraindicated when px has immediate hypersensitivity rxn to yeast

Answer 260

HPV

Question 261

Vaccine contraindicted when px has immediate hypersensitivity rxn to latex

Answer 261

Td, Tdap, Serogroup B meningococcal

Question 262

Vaccine contraindicted when px has immediate hypersensitivity rxn to gelatin or neomycin

Answer 262

MMR

Question 263

If with History of Arthus-type hypersensitivity reactions after a previous dose of TD- or DT-containing vaccines (including MenACWY). Defer
vaccination until at least ___ years have elapsed since the last dose.

Answer 263

10

Question 264

In general, inactivated vaccines (e.g., inactivated influenza, pneumococcal polysaccharide, and meningococcal conjugate vaccines) are stored at _____temperature, while vials of lyophilized-powder live-virus vaccines (e.g., varicella, live zoster, and MMR vaccines) are stored at _____ temperature

Answer 264

refrigerator

freezer

Question 265

With the exception of ______ vaccination, an interruption in the schedule does not require restarting of the entire series or the addition of extra doses

Answer 265

oral typhoid

Question 266

The majority of reported syncope episodes after vaccination occur within _____

Answer 266

15 minThe ACIP recommends that vaccine providers strongly consider observing patients, particularly adolescents, with patients seated or lying down for 15 min after vaccination. If syncope develops, patients should be observed until the symptoms resolve

Question 267

prototypic lesion of infective endocarditis (IE)

Answer 267

vegetation

Question 268

most common bacterial species causing IE

Answer 268

S. aureus

Question 269

Causative agents of IE that results in an acute course

Answer 269

β-Hemolytic streptococci, S. aureus, and pneumococci typically result in an acute course, although S. aureus occasionally causes subacute disease. IE caused by Staphylococcus lugdunensis (a coagulase-negative species) or by enterococci may present acutely.

In patients with subacute presentations, fever is typically low-grade rarely exceeding 39.4°C (103°F); in contrast, temperatures of 39.4°– 40°C (103°–104°F) are often noted in acute IE.

Question 270

Causative agents of IE that results in a subacute course

Answer 270

Subacute IE is typically caused by viridans streptococci, enterococci, CoNS, and the HACEK group.

In patients with subacute presentations, fever is typically low-grade rarely exceeding 39.4°C (103°F); in contrast, temperatures of 39.4°– 40°C (103°–104°F) are often noted in acute IE.

Question 271

Causative agents of IE that results in a indolent course

Answer 271

IE caused by Bartonella species, T. whipplei, C. burnetii, or M. chimaera is exceptionally indolent.

Question 272

Most common symptom of IE

Answer 272

fever

Question 273

Risk factors associated with an increased risk of embolization

Answer 273

S. aureus IE, mobile vegetations >10 mm in diameter, and infection involving the mitral valve anterior leaflet are independently associated with an increased risk of embolization.

Arterial emboli, one-half of which precede the diagnosis of IE, are clinically apparent in up to 50% of patients.

Question 274

Diagnosis of infective endocarditis

Answer 274

A clinical diagnosis of definite IE requires documentation of two major criteria, of one major and three minor criteria, or of five minor criteria.

Question 275

T/F
Electrocardiographic-gated multislice cardiac CT angiogram (CTA), which is comparable to TEE in detection of vegetations and possibly superior in defining paravalvular infection, may be definitive.

Answer 275

True

Question 276

Features Guiding the Need for Echocardiographic Assessment in Patients with Selected Monomicrobial Bacteremia

Answer 276

Question 277

Next step when patient is high risk for developing IE and has undergone 2 negative TEE and still highly suspected to have IE

Answer 277

Consider CTA or FDG-PET/CT^

Question 278

33/M is being managed for hypotensive shock
from dengue. Initial resuscitation done with 20
mL/Kg of normal saline IV. Patient remained
hypotensive and serial H7H showed decreasing
hematocrit. What is the next best step in
management?

Answer 278

Transfuse pRBC since with decreasing hct. Look for signs of bleeding. May also consider whole blood for unstable px

Question 279

Most bacterial pneumonias can be treated for ___ days

Answer 279

5-7

Question 280

Treatment duration for MRSA pneumonia with bacteremia

Answer 280

up to 28 days
if MSSA up to 21 days

Question 281

Treatment duration for pneumonia caused by Mycoplasma and Chlamydophila

Answer 281

10-14 days

Question 282

Treatment duration for pneumonia caused by Legionella

Answer 282

14-21 days

Question 283

T/F
NGT increases risk for HAP

Answer 283

True by aspiration of oropharyngeal contents in the lower respiratory tract

Question 284

most common site of Pseudomonas aeruginosa infections?

Answer 284

lungs

Question 285

Level of lactate that portends a poor prognosis in severe falciparum malaria

Answer 285

> 5 mmol/L

Question 286

Which is more resistant? E. faecium or E. faecalis?

Answer 286

E. faecium

Question 287

Treatment for IE caused by streptococci and enterococci

Answer 287

Question 287

T/F
Daptomycin is only FDA approved for right sided IE and not left sided IE

Answer 287

Although it is FDA approved only for right-sided IE at a dose of 6 mg/kg daily, most recommend doses of 8–10 mg/kg daily for treatment of left-sided IE.

Question 288

Treatment for IE caused by CONS and HACEK

Answer 288

Question 289

Treatment for IE caused by Bartonella and Coxiella

Answer 289

Question 290

Tx for culture negative IE

Answer 290

Pending the availability of diagnostic data, blood culture–negative subacute NVE is treated with vancomycin plus ampicillin-sulbactam (12 g every 24 h) or ceftriaxone; doxycycline (100 mg twice daily) is added for enhanced Bartonella coverage.
If cultures are negative because of prior antibiotic administration, pathogens likely to be inhibited by the specific prior therapy should be considered.

Question 291

Generator pocket infection without bacteremia is treated with a ____-day course, some of which can be given orally

Answer 291

10- to 14

Question 292

Defervescence can be expected __ hours after percutaneous drainage of intraabdominal abscesses.

Answer 292

48

Question 293

recommended duration of antibiotic therapy for foot osteomyelitis in which the removal of dead bone cannot be achieved

Answer 293

12wks

Question 294

Amount > ____ mL of retained urine for it to qualify for complicated UTI

Answer 294

100

Question 295

T/F
Blood cultures are NOT routinely recommended in px with acute uncomplicated pyelonephritis except in patients with sepsis

Answer 295

True

Question 296

When should you repeat Blood CS for px with IE

Answer 296

Control of peripheral sites of infection—source control—should be addressed promptly. Blood cultures should be repeated daily until sterile in patients with IE due to S. aureus or difficult-to-treat organisms, rechecked if there is recrudescent fever, and performed again 4–6 weeks after therapy to document cure.

Question 297

Expected duration before blood CS become sterile in IE tx with appropriate abx

Answer 297

Blood cultures become sterile after 2 days of appropriate therapy when infection is caused by viridans streptococci, E. faecalis, or HACEK organisms.

In MSSA IE, β-lactam therapy results in sterile cultures in 3–5 days, whereas in MRSA IE, the duration of bacteremia is often longer with vancomycin or daptomycin treatment.

Question 298

When fever persists for ___ days despite appropriate antibiotic therapy for IE, patients should be evaluated further for paravalvular abscess, extracardiac abscesses (spleen, kidney), or complications (embolic events).

Answer 298

7

Question 299

Indications for surgery in IE

Answer 299

Question 300

Indications for emergent surgical indication in patients with IE

Answer 300

Question 301

Indications for urgent surgical indication in patients with IE

Answer 301

Question 302

Indications for elective surgical indication in patients with IE

Answer 302

Question 303

test of choice to detect paravalvular abscesses

Answer 303

TEE with color Doppler is the test of choice to detect paravalvular abscesses (sensitivity, ≥85%).

Question 304

Nonurgent cardiac surgery should be delayed for _____ after a large nonhemorrhagic embolic infarction and for _______ after a significant cerebral hemorrhage.

Answer 304

2–3 weeks

4 weeks

Question 305

Cerebral aneurysms should be monitored by ________

Answer 305

angiography

Question 306

Antibiotic prophylaxis of IE in px with High risk cardiac lesions

Answer 306

Question 306

High risk cardiac lesions that would require dental prophylaxis

Answer 306

Question 307

Definition of recurrent UTI

Answer 307

> =2 episodes in 6 mos; >=3 in 12 mos

Question 308

Definition of presumptive TB

Answer 308

SSx + chext xray suggestive of PTB

Question 309

How do you screen HCW for PTB

Answer 309

Symptom screening + CXR

Question 310

How many sputum samples do you need for Gene Xpert and sputum microscopy

Answer 310

1 for Gene Xpert:on the spot
2 for sputum microscopy: on the spot + 1 hr after or early AM the following day

Question 311

Usual location of post primary TB

Answer 311

apical and posterior segment of the upper lobe, superior segment of the lower lobe

APU
SS

Question 312

Most common site of involvement of spinal TB

Answer 312

Adult: lower thoracic and upper lumbar
Childern: Upper thoracic

Question 313

A TB patient whose tx was interrupted for __ consecutive months is classified as lost to follow up

Answer 313

2

Question 314

Role of glucocorticoids in typhoid fever

Answer 314

In px with shock/ Obtundation

Question 315

Severe dengue is commonly associated with what type of serovar

Answer 315

2

Females are more commonly affected than males

Question 316

Difference between rabies and GBS in relation to parlysis

Answer 316

Rabies- quadriplegia
GBS- lower extremity paralysis

Question 317

Blood transfusion is necessary for what level of hematocrit in severe malaria

Answer 317

< 20

Question 318

Reservoir sites for leptospirosis

Answer 318

Proximal tubules, eyes, brain

Question 319

T/F Leptospires can enter intact mucous memberane

Answer 319

True

Question 320

T/F Severe hepatocellular necrosis is not uncommon in leptospiross

Answer 320

False

Severe hepatocellular necrosis is not a feature of leptospirosis

Question 321

In Weil’s disease, renal failure develops in __ week of illness

Answer 321

2nd

most common cause of death: pulmo complications

Question 322

A- a gradient of ___ or Pao2 of <= ___ mmHg in PCP pneumonia warrant steroids

Answer 322

> 35 and 70

Question 323

T/F Acyclovir is also used for routine prophylaxis for HIV

Answer 323

False

Question 324

Rabies immunoglobulin can be given until Day __ from D0 of vaccine

Answer 324

7

Question 325

What samples can you test for RTPCR for rabies

Answer 325

Brain, CSF, Saliva, Skin

Question 326

Complication of severe malaria that is common in children but relatively infrequent in non pregnant adults

Answer 326

hypoglycemia

Question 327

T/F Malnutrition and female sex are risk factors for severe dengue

Answer 327

False
malnutrition - protective
female sex- risk factor

Question 328

Recommended protocol for anti malaria prophylaxis with chloroquine in adults

Answer 328

1-2 weeks before travelling, once a week on the same day of the week and for for weeks upon return

Question 329

T/F Immune active E. coli fractions can be used to prevent recurrent UTI

Answer 329

True

Question 330

When do you expect reduncion in sputum production in CAP

Answer 330

4 weeks

Question 331

Phase of pneumonia that corresponds to successful containment of infection and improvement of gas exchange

Answer 331

Gray hepatization

Question 332

Rationale for repeating CXR 4-6 weeks after CAP

Answer 332

Exclude possibility of malignancy after CAP

Question 333

Recommended treatment for Salmonella that are MDRO and quinolone resistant

Answer 333

CRO 2g IV OD

Question 334

Duration of tx for chronic carriers of Salmonella typhi

Answer 334

28 days of Cipro

Question 335

Earliest CBC abnormality in dengue

Answer 335

Leukopenia

Question 336

T/F Visible AFB on microscopy correlates directly with likelihood of transmission

Answer 336

True

Question 337

Most potent risk factor for development of TB

Answer 337

HIV

Question 338

T/F
False negative reactions are common among those with overwhelming TB

Answer 338

True

Question 339

Which of HRZE needs renal dose adjustment?

Answer 339

Ethambutol

E for adjustment based on EGFR

Question 340

Electrolyte urinary loss associated with leptospiral nephropathy

Answer 340

Magnesium

Question 341

How many mL of specimen is needed for MTB gene xpert

Answer 341

1-4 mL for all specimen except CSF 0.5-4 mL

Question 342

Primary mode of transmission of PTB

Answer 342

Droplet

Question 343

T/F Clinical criteria alone should be used to diagnose HAP/VAP

Answer 343

True as per IDSA guidelines

Question 344

In px suspected to have VAP, abx should cover which organisms

Answer 344

S. aureus
P. aeruginosa
G- bacilli

VAP–> SPG

Question 345

Recommended duration of tx for HAP

Answer 345

7 days

Question 346

Additional diagnostic test to clinical criteria to guide discontinuation of abx for px with HAP/VAP

Answer 346

Procalcitonin

CPIS not suggested

Question 347

What could be given as an alternative tx for septic shock px who are allergic to beta lactams

Answer 347

Aztreonam + FQ

Question 348

Schedule of tetanus vaccine if no primary course of vaccination in childhood

Answer 348

three doses 1 month apart then 2 boosters 6 months apart

if with primary course, 2 doses only 1 month apart

Question 349

After recovering from tetanus how many doses of vaccines should be given?

Answer 349

3 doses of full primary course of immunization since natural infection is poorly immunogenic

Question 350

T/F
Both remdesivir and glucocorticoids were shown to be effective in improving mortality rate in px with severe COVID-19 infection

Answer 350

False. Only glucocorticoids

Remdeivir- no improvement in 30-day survival rate

Question 351

Recommended specimen type for lab confirmatory diagnosis of Monkey Pox

Answer 351

Skin lesion fluid or crusts

Question 352

Difference between enteritis necroticans and necrotizing enterocolitis

Answer 352

In contrast to enteritis necroticans, which most commonly involves the jejunum, necrotizing enterocolitis affects the ileum and frequently the ileocecal valve.

Question 353

treatment for Clostridial infections

Answer 353

Question 354

T/F Falsely neg TST are common among both immunosuppressed px and those with overwhelming TB infection

Answer 354

True

Question 355

When do you send DSSM samples for clinically diagnosed TB for monitoring?

Answer 355

2nd month only

bacteriologically confirmed yung 2,5,6

Question 356

Most common cause of purpura fulminans

Answer 356

N. meningitides

Question 357

Most commonly involved encapsulated organism in asplenic patients

Answer 357

S. pneumoniae

Question 358

Common cause of ecthyma gangrenosum in neutropenic px

Answer 358

P. aeruginosa

Question 359

Type of meningitis with normal opening pressure

Answer 359

Parasitic

Question 360

Most common pattern of pneumonia in nosocomial infections

Answer 360

bronchopneumonia

Question 361

Major risk factor for primary lung abscess

Answer 361

Aspiration

most common etiology: polymicrobial

Question 362

Symptoms of gas gangrene

Answer 362

The first symptom of spontaneous gas gangrene may be confusion followed by the abrupt onset of excruciating pain in the absence of trauma. These findings, along with fever, should heighten suspicion of spontaneous gas gangrene. However, because of the lack of an obvious portal of entry, the correct diagnosis is frequently delayed or missed.

Question 363

trauma must be sufficient to interrupt the blood supply and thereby to establish an optimal anaerobic environment for growth of these species.

Answer 363

It is important to recognize that, for C. perfringens and C. novyi, trauma must be sufficient to interrupt the blood supply and thereby to establish an optimal anaerobic environment for growth of these species. These conditions are not strictly required for the more aerotolerant species such as C. septicum and C. tertium, which can seed normal tissues from gastrointestinal lesions.

Question 364

Major virulence factor of C. perfringens

Answer 364

Alpha toxin

Question 365

T/F
When spontaneous gas gangrene is suspected by Clostridia species, blood should be cultured since bacteremia usually precedes cutaneous manifestations by several hours

Answer 365

True

Mortality rates are relatively high among patients with spontaneous gas gangrene, especially that due to C. septicum

Question 366

Treatment for spontaneous or taumatic gas gangrene

Answer 366

Except for infection caused by C. tertium (see below), antibiotic treatment of traumatic or spontaneous gas gangrene consists of the administration of penicillin and clindamycin for 10–14 days.

C. tertium is resistant to penicillin, cephalosporins, and clindamycin. Appropriate antibiotic therapy for C. tertium infection is vancomycin (1 g every 12 h IV) or metronidazole (500 mg every 8 h IV).

Question 367

The incubation period of rabies is usually ____days

Answer 367

20-90

Question 368

Rabies virus spreads centripetally vs centrifugally? 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.

Answer 368

centripetally toward CNS

Centrifugal spread along nerves to salivary glands, skin, cornea, and other organs

Question 369

T/F
There is no well-documented evidence for hematogenous spread of rabies virus.

Answer 369

True

Question 370

Pathologic studies show mild inflammatory changes in the CNS in rabies, with mononuclear inflammatory infiltration in the leptomeninges, perivascular regions, and parenchyma, including microglial nodules called ____ nodules.

Answer 370

Babes

Question 371

earliest specific neurologic symptoms of rabies

Answer 371

The earliest specific neurologic symptoms of rabies include paresthesias, pain, or pruritus near the site of the exposure, one or more of which occur in 50–80% of patients and strongly suggest rabies.

Question 372

Difference between encephalitic vs paralytic stage or rabies

Answer 372

Question 373

Diagnostically useful specimens for rabies

Answer 373

Diagnostically useful specimens include serum, CSF, fresh saliva, skin biopsy samples from the neck, and brain tissue (rarely obtained before death).

Corneal impression smears are of low diagnostic yield and are generally not performed

Question 374

Treatment for rabies

Answer 374

There is no established treatment for rabies. Aggressive management with supportive care in critical care units has resulted in the survival of at least 30 patients with rabies. Many of these survivors have recently been reported from India.

There have been many recent treatment failures (more than 55) with the combination of antiviral drugs, ketamine, and therapeutic (induced) coma—measures that were used in a healthy survivor in whom neutralizing antibodies to rabies virus were detected at presentation. Expert opinion is recommended before a course of experimental therapy is embarked upon. A palliative approach may be appropriate for many patients who are not considered candidates for aggressive management

Question 375

T/F
PEP is not necessary if the animal remains healthy.

Answer 375

True

Question 376

T/F
For rabies Wound care should not be delayed, even if the initiation of immunization is postponed pending the results of the 10-day observation period

Answer 376

True

Question 377

If patient has category III dog bite and the animal was not captured, what is/are the recommended medications for post exposure trophy?

Answer 377

RIG and vaccine

If RIG is not immediately available, it should be administered no later than 7 days after the first vaccine dose.

After day 7, endogenous antibodies are being produced, and passive immunization may actually be counterproductive.

Question 378

Where do you inject rabies vaccine?

Answer 378

Four 1-mL doses of rabies vaccine should be given IM in the deltoid area. (The anterolateral aspect of the thigh also is acceptable in children.) Gluteal injections, which may not always reach muscle, should not be given and have been associated with rare vaccine failures

Question 379

Schedule for rabies vaccination

Answer 379

0,3,7,14
Ideally, the first dose should be given as soon as possible after exposure; failing that, it should be given without further delay. The three additional doses should be given on days 3, 7, and 14; a fifth dose on day 28 is no longer recommended

Question 380

What could be given if human RIG is unavailable

Answer 380

If human RIG is unavailable, purified equine RIG can be used in the same manner at a dose of 40 IU/kg

Question 381

Dose of human RIG (rabies Ig)

Answer 381

If anatomically feasible, the entire dose of RIG (20 IU/kg) should be infiltrated at the site of the bite, and any RIG remaining after infiltration of the bite site should be administered IM at a distant site.

Only given for previously UNvaccinated

Question 382

Schedule for preexposure prophylaxis

Answer 382

Preexposure rabies prophylaxis should be considered for people with an occupational or recreational risk of rabies exposures and also for certain travelers to rabies-endemic areas. The primary schedule consists of three doses of rabies vaccine given on days 0, 7, and 21 or 28. Serum neutralizing antibody tests help determine the need for subsequent booster doses. When a previously immunized individual is exposed to rabies, two booster doses of vaccine should be administered on days 0 and 3. Wound care remains essential. As stated above, RIG should not be administered to previously vaccinated persons.

Question 382

most common manifestation of UTI

Answer 382

Acute cystitis

Question 383

Cystitis is temporally related to recent sexual intercourse in a dose–response manner

Answer 383

True

increased relative risk ranging from 1.4 with one episode of intercourse in the preceding week to 4.8 with five episodes.

Question 384

Early recurrence (within __weeks) is usually regarded as relapse rather than reinfection and may indicate the need to evaluate the patient for a sequestered focus.

Answer 384

2

Question 385

The only consistently documented
behavioral risk factors for recurrent UTI

Answer 385

frequent sexual intercourse and spermicide use.

Question 386

Most common organism causing UTI

Answer 386

E. coli

E. coli accounts for 75–90% of isolates; Staphylococcus saprophyticus for 5–15% (with particularly frequent isolation from younger women); and Klebsiella, Proteus, Enterococcus, and Citrobacter species, along with other organisms, for 5–10%

Question 387

T/F

Bacteria can gain access to the urinary tract through the bloodstream.

Answer 387

True
However, hematogenous spread accounts for <2% of documented UTIs and usually results from bacteremia caused by relatively virulent organisms, such as Salmonella and S. aureus

The pathogenesis of candiduria is distinct in that the hematogenous route is common. The presence of Candida in the urine of a non-instrumented immunocompetent patient implies either genital contamination or potentially widespread visceral dissemination.

Question 388

critical initial step in the pathogenesis of UTI

Answer 388

Colonization of the vaginal introitus and periurethral area with organisms from the intestinal flora (usually E. coli) is the critical initial step in the pathogenesis of UTI

Question 389

main feature distinguishing cystitis from pyelonephritis

Answer 389

Fever is the main feature distinguishing cystitis from pyelonephritis. The fever of pyelonephritis typically exhibits a high spiking “picket-fence” pattern and resolves over 72 h of therapy.

Question 390

Emphysematous pyelonephritis is a particularly severe form of the disease that is associated with the production of gas in renal and perinephric tissues and occurs almost exclusively in ____ patients

Answer 390

diabetic

Question 391

A combination of dysuria and urinary frequency in the absence of vaginal discharge increases the probability of UTI to ___

Answer 391

96%

Question 392

Based from Harrisons Studies of women with symptoms of cystitis have found that a colony count threshold of ≥ ___ bacteria/mL is more sensitive (95%) and specific (85%) than a threshold of 105/mL for the diagnosis of acute cystitis in women. In men, the minimal level indicating infection appears to be ___/mL.

Answer 392

10^2

10^3

Question 393

The diagnosis of ASB involves both microbiologic and clinical criteria. The microbiologic criterion (including in urinary catheter–associated asymptomatic bacteriuria) is ≥___ bacterial CFU/mL of urine. The clinical criterion is an absence of signs or symptoms referable to UTI.

Answer 393

10^5

Question 394

Most fluoroquinolones are highly effective as short-course therapy for cystitis when the causative organism is susceptible to them; the exception is _______ , which may not reach adequate urinary levels.

Answer 394

moxifloxacin

Question 395

Treatment for acute uncomplicated cystitis from Harrisons

Answer 395

Question 396

First line tx for acute uncomplicated pyelonephritis

Answer 396

High rates of TMP-SMX-resistant E. coli in patients with pyelonephritis have made fluoroquinolones the first-line therapy for acute uncomplicated pyelonephritis.

Question 397

Antibiotics for UTI that are safe in pregnancy

Answer 397

Nitrofurantoin, ampicillin, and the cephalosporins are considered
relatively safe in early pregnancy

Ampicillin and the cephalosporins have been used extensively in pregnancy and are the drugs of choice for the treatment of asymptomatic or symptomatic UTI in this group of patients.

ASB are treated for 4–7 days in the absence of evidence to support single-dose therapy.

Question 398

Treatment duration for acute bacterial prostatitis vs chronic bacterial prostatitis

Answer 398

If acute bacterial prostatitis is suspected, antimicrobial therapy should be initiated after urine and blood are obtained for cultures. Therapy can be tailored to urine culture results and should be continued for 2–4 weeks. For documented chronic bacterial prostatitis, a 4- to 6-week course of antibiotics is often necessary.

Question 399

Treatment for xanthogranulomatous pyelonephritis

Answer 399

Xanthogranulomatous pyelonephritis is treated with nephrectomy. .

Question 400

Treatment for emphysematous pyelonephritis

Answer 400

Percutaneous drainage can be used as the initial therapy in emphysematous pyelonephritis and can be followed by elective nephrectomy as needed.

Question 401

The accepted threshold for bacteriuria to meet the definition of CAUTI is ≥___ CFU/mL of urine, while the threshold for bacteriuria to meet the definition of ASB is ≥___ CFU/mL.

Answer 401

The accepted threshold for bacteriuria to meet the definition of CAUTI is ≥10^3 CFU/mL of urine, while the threshold for bacteriuria to meet the definition of ASB is ≥10^5 CFU/mL.

Question 401

Antibiotic of choice for prophylaxis for UTI

Answer 401

Continuous prophylaxis and postcoital prophylaxis usually entail low doses of TMP-SMX or nitrofurantoin. These regimens are all highly effective during the period of active

Question 401

Based on Harrisons, Treatment of ASB does not decrease the frequency of symptomatic infections or complications except in pregnant women, persons undergoing urologic surgery, and perhaps ______ and _______

Answer 401

neutropenic patients and renal transplant recipients.

Question 402

Infective stage of Schistosoma

Answer 402

cercaria

Question 402

the only stage of the shcistosoma life cycle that can be detected in humans, either in excreta or in tissue biopsies

Answer 402

schistosome egg

Question 403

In px infected with Schistosoma, egg-induced granulomatous responses lead to severe periportal fibrosis ( AKA as ______ ), with deposition of collagen around the portal vein, occlusion of the smaller portal branches, and severe, often irreversible, pathology

Answer 403

Symmers clay pipestem fibrosis

Question 404

What causes Katayama fever?

Answer 404

Antigen excess from eggs results in the formation of soluble immune complexes, which may be deposited in several tissues and initiate a serum sickness–like illness.

. The onset occurs between 2 weeks and 3 months after exposure to the parasite

Question 404

Cercarial invasion may be associated with dermatitis arising from dermal and subdermal inflammatory reactions in response to _______

Answer 404

dying cercariae that trigger innate immune responses

A particularly severe form of cercarial dermatitis is commonly seen after exposure to cercariae from avian schistosomes. These cercariae cannot complete their development in humans and die in the skin, causing an inflammatory allergic reaction. This form of cercarial dermatitis can occur in people who have been in contact with water from lakes (e.g., in Europe or the United States) where various species of water birds, such as ducks, geese, and swans, are found

Question 405

In which veins to adult schistosome worms reside in intestinal schistosomiasis

Answer 405

mesenteric veins

Question 406

Characteristic sign in the active stage of urogenital schistosomiasis

Answer 406

A characteristic sign in the active stage is painless, terminal hematuria.

Dysuria and suprapubic discomfort or pain are associated with active urogenital schistosomiasis and may persist throughout the course of active infection. Eggs deposited in the bladder mucosa may give rise to an intense inflammatory response of the bladder wall, which may cause ureteric obstruction and lead to hydroureter and hydronephrosis. These early inflammatory lesions, including obstructive uropathy, can be visualized by ultrasonography

Question 407

Cystoscopy findings in urogenital schistosomiasis

Answer 407

As the infection progresses, the inflammatory component decreases and fibrosis becomes more prominent. The symptoms at this stage are nocturia, urine retention, dribbling, and incontinence. Cystoscopy reveals “sandy patches” composed of large numbers of calcified eggs surrounded by fibrous tissue and an atrophic mucosal surface. The ureters are less commonly involved, but ureteral fibrosis can cause irreversible obstructive uropathy that can progress to uremia

Question 408

Chronic S. haematobium infection is associated with what cancer

Answer 408

squamous cell carcinoma of the urinary bladder

Question 409

Samples where Schistosoma eggs can be detected

Answer 409

stool, rectal biopsy, pap smear (S. mansoni and S. hematobium) and semen samples (S. hematobium)

Schistosoma DNA can be detected in cerebrospinal fluid samples for diagnosis of neuroschistosomiasis

Question 410

Treatment for schistosomiasis

Answer 410

see pic