Infectious Disease 2 Flashcards
1
Q
2 ABX that should be avoided in neonates?
A
Ceftriaxone, Sulfonamides
2
Q
Why should Ceftriaxone, Sulfonamides be avoided in neonates?
A
Hyperbilirubinemia
3
Q
43 yo male presents with fever, HA, joint pain, myalagias; Just returned from trip to India; After BP cuff is applied to arm, petechia develop in that area; PE shows cervical LAD, hepatosplenomegaly; Labs show PL 48, WBC 2.8, ALT 168, AST 232 – diagnosis?
A
Dengue
4
Q
Complication of Dengue?
A
Cardiovascular collapse
5
Q
5 aspects of clinical presentation for Dengue?
A
High fever, retroorbital pain, arthralgia, myalgias, petechia
6
Q
15 mo female presents for 4 days of fever, rhinorrhea, cough, sore throat, bilateral conjunctivitis, facial rash (spares palms/soles); PE shows anterior cervical LAD - diagnosis?
A
Rubeola
7
Q
Alternate name for Rubeola?
A
Measles
8
Q
Clinical aspects of presentation for measles?
A
Cough, conjunctivitis, coryza + rash with craniocaudal spread
9
Q
24 yo male presents for R-sided facial weakness; 2 months ago, went hiking in Appalachian Mountains; At that time, experienced illness with HA, fatigue, annular rash; PE shows R eyebrow that is unable to raise fully, along with inability to fully close R eye - what is next step in management?
A
Lyme serology
10
Q
24 yo male presents for R-sided facial weakness; 2 months ago, went hiking in Appalachian Mountains; At that time, experienced illness with HA, fatigue, annular rash; PE shows R eyebrow that is unable to raise fully, along with inability to fully close R eye - diagnosis?
A
2nd stage Lyme disease
11
Q
What is best management of 2nd stage Lyme disease (2 ABX)?
A
Doxycycline, Ceftriaxone
12
Q
Alternate name for 2nd stage Lyme disease?
A
Early disseminated Lyme disease
13
Q
34 yo female presents for 24 hours of HA, myalgias, low-grade fever; HX of pyelonephritis; LP is performed, CSF analysis shows large RBCs, no xanthochromia, 100 WBCs, 50 protein, 90 glucose - diagnosis?
A
Traumatic LP
14
Q
What is the most indicative finding of Traumatic LP on CSF analysis?
A
High RBCs, without xanthochromia
15
Q
19 yo male presents for dysuria, watery urethral discharge; Sexually active; Gram stain of urethral swab is negative for bacterial, positive for many PMNs - diagnosis?
A
Non-gonoccocal urethritis
16
Q
Urethral discharge seein in gonoccocal urethritis?
A
Thick, purulent
17
Q
19 yo male presents for dysuria, watery urethral discharge; Sexually active; Gram stain of urethral swab is negative for bacterial, positive for many PMNs - best management?
A
Azithromycin … OR … Doxycycline
18
Q
19 yo male presents for dysuria, watery urethral discharge; Sexually active; Gram stain of urethral swab is negative for bacterial, positive for many PMNs; Treated with Azithromycin, but returns to office 2 weeks later for persistent dysuria; NAAT negative for gonorrhea, chlamydia - best next step?
A
Repeat urethral swab and Gram stain
19
Q
Classic lab finding associated with hookworms?
A
Eosinophilia
20
Q
Complication of hookworm infection?
A
Iron deficiency anemia
21
Q
Best initial diagnostic test of hookworm infection?
A
Stool ova and parasite
22
Q
26 yo male is undergoing CTX for metastatic seminoma; Presents to ED for fever, chills; PE shows T102; Labs show WBC 690 (20% PMNs), pancytopenia - diagnosis?
A
Febrile neutropenia
23
Q
Definition of Febrile neutropenia?
A
Absolute PMN count < 1500
24
Q
26 yo male is undergoing CTX for metastatic seminoma; Presents to ED for fever, chills; PE shows T102; Labs show WBC 690 (20% PMNs), pancytopenia - what is initial therapy?
A
Piperacillin-Tazobactam
25
Most common pathogen responsible for Febrile neutropenia?
Pseudomonas
26
3 ABX of choice for Febrile neutropenia?
Piperacillin-Tazobactam, Cefepime, Meropenem
27
Patients with oral thrush and no history of recent ABX, inhaled corticosteroid, or CTX should be evaluated for …
HIV
28
Best screening test for HIV?
HIV Ag, HIV 1-2 Ig
29
Pathogen responsible for HFM disease?
Coxsackie
30
19 yo female presents for N, abdominal pain, D; Recently returned home from trip to Guatemala; PE shows abdominal distention; Fecal occult is (+); Labs show Hgb 10.4, Eosinophils 13% - diagnosis?
Intestinal helminths
31
Best management of Intestinal helminths?
Albendazole
32
Complication of C.Diff infection?
Intestinal perforation
33
3 hallmark symptoms of C. Diff infection?
Profuse watery diarrhea, fever, leukocytosis
34
What is best management of colonic distension (toxic megacolon) that results from C. Diff infection?
Surgical consultation
35
4 hallmark features of toxic megacolon that results from C. Diff infection?
Systemic toxicity (hypotension, tachycardia), abdominal distension, leukocytosis, radiographic evidence of large-bowel dilation
36
32 yo female presents with cough, SOB; 3 episodes of PNA during past 1 year, along with 1 episode bloody diarrhea; CXR shows RLL infiltrate, LUL fibrosis - what is most likely diagnosis?
Humoral immunity defect
37
What is best initial step of workup for patients with suspected Humoral immunity defect?
Quantitative measurement of serum Ig
38
5 yo male presents for WCC; Hospitalized 1 month ago for asthma exacerbation; Scheduled for have MMR vaccine today, but mother reports fever to 103 during first MMR - should child get MMR today?
Yes
39
Age at which children should get MMR vaccine?
1 and 4 yo
40
CI to MMR vaccine?
Anaphylaxis to MMR, gelatin, neomycin; Immunodeficiency (HIV with CD4 < 200), Pregnancy
41
40 yo male presents with AMS, decreased strength in LUE; HIV (+) with CD4 count 40; CT scan shows well-demarcated small focal lesion in R hemisphere, consistent with primary CNS lymphoma - what is best prognostic indicator for primary CNS lymphoma?
Increase in CD4 count after HAART initiation
42
Primary CNS lymphoma is strongly related to which pathogen?
EBV
43
20 yo male presents with fever, dysphagia, poor coordination, drooling; Symptoms started 1 week ago with fever, sore throat, fatigue; Went on school trip to caves 2 months ago; PE shows drool pooling in mouth - diagnosis?
Rabies
44
Hallmark presentation of Rabies?
Hydrophobia, pharyngeal spasms
45
2 most common animal reservoirs for rabies?
Racoons, bats
46
Prognosis for human Rabies infection once symptomatic?
Poor, usually results in death (treatment typically palliative); Post-exposure PPX is effective only in preventing disease prior to manifestation of symptoms
47
42 yo male presents for fever, chills, HA, myalgias, abdominal pain, NV; Recently returned from African safari ~2.5 weeks ago; Vitals show T 103, HR 114; PE shows mild pharyngeal erythema, splenomegaly; Labs shows pancytopenia - diagnosis?
Malaria
48
Pathogen responsible for Malaria?
Plasmodium falciparum
49
DOC for chlamydia infection in non-pregnant patients?
Doxycycline
50
DOC for chlamydia infection in pregnant patients?
Azithromycin
51
2 complications of untreated chlamydia infection in pregnant patients?
PPROM, Postpartum endometritis
52
Best screening test for Hepatitis C infection?
HCV antibody testing
53
If a patient has a (+) result for HCV antibody testing, how can you determine who has ongoing, active disease?
Further testing with HCV RNA
54
What is the value of NAAT testing for chlamydia and gonorrhea?
High sensitivity and specificity
55
64 yo male presents to ED after developing fever while completing HD via tunneled catheter – diagnosis?
Catheter-related bloodstream infection
56
Best empiric ABX for Catheter-related bloodstream infection?
Vancomycin + Cefepime
57
Additional aspect of workup for Catheter-related bloodstream infection?
2 sets of blood cultures
58
When should you NOT leave a catheter in placed in setting of Catheter-related bloodstream infection?
Patient develops sepsis, Patient is HD-unstable, Evidence of metastatic infection, Pus at site of catheter, Continued symptoms after 72 hours of empiric ABX
59
Diagnostic test of choice for suspected osteomyelitis?
MRI spine
60
Confirmation of osteomyelitis requires …
CT-guided biopsy
61
13 yo male develops poison ivy after camping trip – what is the best recommendation for reducing spread of active lesions?
Immediate removal of contaminated apparel and cleansing of exposed areas
62
6 yo male presents to ED 1 day after dog bite; Dog and patient are UTD on vaccinations; Patient reports worsening pain, worse with making a fist; PE shows minimal serous drainage from laceration; Wound is copiously irrigated with saline – what is best management of wound?
Wound should be left open to heal by secondary intention
63
4 features of wounds that have high risk of infection?
Cat or human bite; Bite occurred 24+ hours ago on body; Bite occurred 12+ hours ago on face; Bites on extremity
64
How should bite wounds on face be managed?
Should be closed
65
Which HPV serotypes cause genital words?
6, 11
66
Which HPV serotypes cause cancer?
16, 18
67
HPV vaccine series should be offered to all patients ages …
11-26
68
Best management of active TB infection in pregnant females?
INH + Rifamin + Ethambutol + Vitamin B6 (2 months) … + … INH + Rifamin (7 months)
69
How should croup be diagnosed?
Clinical diagnosis … no XR needed for diagnosis
70
3 aspects of presentation for croup?
Barking cough, inspiratory stridor, hoarseness
71
Best treatment for mild croup?
Humidified air + Single-dose steroids (reduce stridor)
72
Best treatment for moderate/severe croup?
Corticosteroids + Nebulized epinephrine (relieves upper airway obstruction)
73
Sydenham chorea most commonly occurs ___ after streptococcal infection
1-8 months
74
5 aspects of clinical presentation for Acute Rheumatic Fever?
JONES – Joint pain, Carditis, Nodules, Erythema marginatum, Sydenham chorea
75
Best management of Sydenham chorea?
IM penicillin until adulthood … treat the underlying Acute Rheumatic Fever, and prevent recurrent ARF
76
17 yo female presents with rash; Reports fatigue, myalgias, fever, sore throat for past 10 days; Tried treating symptoms with amoxicillin, but denies relief; Reports that she is sexually active; PE shows T100.4, fatigue, enlarged tonsils with white exudate, tender cervical LAD; Labs show HGB 12, WBC 15 – diagnosis?
Infectious mononucleosis
77
Pathogen responsible for Infectious mononucleosis?
EBV
78
Best management of Infectious mononucleosis?
Supportive care
79
Prognosis for Infectious mononucleosis?
Most symptoms resolve spontaneously, but fatigue will persist for many months
80
10 yo male presents with mother, after tick bite, which mother believes occurred yesterday; Patient’s mother was able to remove the tick with tweezers; PE shows 0.5cm erythematous macule in the L popliteal area – what is best counseling for family?
Erythema is most likely due to local irritation, which only needs supportive care
81
Pathogen responsible for Lyme disease?
Borrelia
82
Borrelia is transmitted by …
Ixodes tick
83
Timeframe in which Ixodes tick transmits Borrelia?
36-48 hours
84
Prognosis for Tick that is removed at < 36 hours?
Unlikely to transmit Lyme disease
85
Physical feature of tick that can suggest whether or not Borrelia transmission has occurred?
Engorgement = most likely transmission
86
Timeframe in which erythema migrans develops in the setting of Lyme disease?
>3 days … (but more commonly, 7-14 days)
87
26 yo male presents to clinic after a sexual partner tested (+) for HIV; Patient reports intermittent HA, N, blurry vision, fatigue; PE shows generalized LAD; Screening for HIV immunoassay is (+), HIV viral load is 2 million, CD4 count is 250, RPR is positive; Fluorescent treponemal Ig is (+) … what is best step in management of patient’s syphilis infection?
Perform LP and CSF analysis for neurosyphilis … patient’s who present with neurologic symptoms require LP to evaluate for neurosyphilis
88
26 yo male presents to clinic after a sexual partner tested (+) for HIV; Patient reports intermittent HA, N, blurry vision, fatigue; PE shows generalized LAD; Screening for HIV immunoassay is (+), HIV viral load is 2 million, CD4 count is 250, RPR is positive; Fluorescent treponemal Ig is (+) … what is best treatment?
3 weeks of Penicillin G (IM)
89
Best management of primary syphilis?
Penicillin G (IM), single dose
90
Best management of secondary syphilis?
Penicillin G (IM), single dose
91
Best management of tertiary syphilis?
Aqueous Penicillin G (IV) for 10-14 days, q4H
92
Best management of congenital syphilis?
Aqueous Penicillin G (IV) for 10 days, q8H
93
Best management of latent syphilis, duration <12 months?
Penicillin G (IM), single dose
94
Best management of latent syphilis, duration >12 months?
Penicillin G (IM), 3-week dose
95
Best management of latent syphilis, duration unknown?
Penicillin G (IM), 3-week dose
96
___ refers to acute febrile syndrome that occurs within 24 hours of initial spirochete infection
Jarisch-Herxheimer reaction
97
Prognosis for Jarisch-Herxheimer reaction?
Self-resolution within 24 hours
98
Best prevention for Jarisch-Herxheimer reaction?
None available
99
18 yo female presents with dysuria and urinary frequency; UA is (+) for leukocyte esterase, nitrites; She reports 2 episodes of UTI in past 6 months – what is next best step of management?
ABX prophylaxis
100
At what point is ABX prophylaxis necessary for UTI?
>2 UTI in 6 months; >3 UTI in 12 months
101
3 most common ABX for UTI prophylaxis in sexually-active females?
Nitrofurantoin, TMP-SMX, Fluoroquinolones
102
Which groups of patients should receive prophylaxis for meningococcal meningitis?
>8 hours in close proximity; Direct exposure to respiratory secretions within 7 days of symptom onset
103
3 options for prophylaxis for meningococcal meningitis?
Ceftriaxone (250mg, single dose), Rifampin (600mg BID for 2 days), Ciprofloxacin (500mg, single dose)
104
26 yo daycare worker reports close contact with child who has meningococcal meningitis; she takes OCPs – what is best advice?
Ciprofloxacin or ceftriaxone
105
26 yo male presents for dysuria, increased urinary frequency; Reports blood at end of urinary; Originally from Ghana; Finished 7 day course of ABX, but no improvement in UTI symptoms; Labs show HGB 10.4, MCV 76, Eosinophils 8% – diagnosis?
Urinary schistosomiasis
106
Epidemiology of Urinary schistosomiasis?
Sub-Saharan Africa
107
Diagnostic tool for Urinary schistosomiasis?
Urine sediment microscopy … to ID parasite eggs
108
Best management of Urinary schistosomiasis?
Praziquantel
109
26 yo male presents after bat scratch; He sustained a similar scratch 1 year ago, completed his anti-rabies vaccination at that time – what is best management?
Rabies booster vaccine only
110
Best management for previously rabies-vaccinated patients who are potentially re-exposed to rabies?
Rabies booster vaccine only … (2 doses)
111
Best management for NOT previously rabies-vaccinated patients who are potentially re-exposed to rabies?
Ig + full vaccination series … (4 doses)
112
70 yo male presents for 2 days of fever, chills, SOB, cough productive of yellow-green sputum; Reports smoking 1PPD; Vitals show T 103, HR 118, RR 28, O2 sat 86% on room air; Labs show WBC 17 with 80% PMNs; CXR shows consolidation in RML and RLL – best management?
Hospitalization, ceftriaxone + azithromycin
113
What does CURB-65 stand for?
Confusion, Uremia > 20, RR > 30, BP < 90/60, Age 65
114
CURB-65 score that suggests outpatient treatment?
Score 0-1
115
CURB-65 score that suggests hospitalization?
Score 2
116
CURB-65 score that suggests ICU admission?
Score > 3
117
2 treatment options for community-acquired PNA in outpatient setting?
b lactam + Macrolide … OR … Fluoroquinolone; Amoxicillin OR doxycycline
118
2 treatment options for community-acquired PNA in inpatient setting?
b lactam + Macrolide … OR … Fluoroquinolone
119
2 treatment options for community-acquired PNA in ICU setting?
b lactam + Macrolide … OR … b lactam + Fluoroquinolone
120
4 yo male presents after refusing to walk at home; HX of atopic dermatitis, and viral pharyngitis 1 week ago; PE shows T 101.5; Labs show WBC 14, CRP 4.0 – diagnosis?
Septic arthritis
121
2 most common joints affected by septic arthritis in children?
Hip, knee
122
What is best initial step of workup for septic arthritis?
Immediate joint aspiration
123
4 criteria that can differentiate septic arthritis from transient synovitis in children?
Septic arthritis will was 3+ of following … non-weight bearing, fever, ESR or CRP elevation, leukocytosis
124
Best management of septic arthritis?
Empiric IV ABX
125
3 most common pathogens responsible for septic arthritis in children < 3 mo?
Staph aureus, GBS, GNB
126
2 most common pathogens responsible for septic arthritis in children > 3 mo?
Staph aureus, group A strep
127
Diagnosis of septic arthritis can be made by which finding on joint aspiration?
Synovial WBC > 50,000
128
Best empiric ABX coverage for Staph aureus, strep?
Vancomycin
129
Best empiric ABX coverage for GBS, GNB?
Vancomycin + cefotaxime
130
66 yo male presents to ED with progressive lower back pain, urinary incontinence, decreased appetite; Patient was recently diagnosed with L4-L5 disc herniation, received epidural injection 2 weeks ago; Vitals show temperature 100.9; PE shows TTP of lumbar spine, absent deep tendon reflexes; Rectal exam shows decreased rectal sphincter tone; Labs show WBC 25, ESR 104 - diagnosis?
Spinal epidural abscess
131
Most common pathogen responsible for spinal epidural abscess?
Staph aureus
132
Classic triad of symptoms seen in spinal epidural abscess?
Fever, back pain, neurologic findings
133
Classic lab value associated with spinal epidural abscess?
Elevated ESR
134
Diagnostic test for spinal epidural abscess?
MRI
135
Best management of spinal epidural abscess?
Broad-spectrum ABX, urgent surgical decompression
136
3 mo female presents for increased fussiness, decreased appetite; PE shows L leg flexed and ER, decreased ROM of L hip; Labs show WBC 16, CRP 8.5 - diagnosis?
Septic arthritis
137
Most common age for transient synovitis?
Children age 3-8 yo
138
Definition of UTI?
Pyuria (LE on UA) + Bacteriuria
139
Best management of all children < 2 yo with febrile UTI?
Undergo renal + bladder US
140
28 yo female RN presents after accidental needlestick while drawing bread from HIV+ patient, who is on HAART therapy, has an undetectable viral load; Labs show that RN is negative for HIV antibody and antigen - what is most appropriate next step in management?
Treat with combination HAART for 4 weeks
141
82 yo female presents with AMS, fatigue; Recently underwent PCI for NSTEMI; Vitals show T 96.3, BP 90/40, O2 sat 94%; Labs show HGB 10.4, WBC 15, Cr 2.2; UA is negative - what is next best step of workup?
NS bolus + broad-spectrum ABX
142
How can you calculate sepsis risk with qSOFA?
RR > 22, AMS, SBP < 100 … 2+ points means high sepsis risk
143
Pathogen responsible for erysipelas?
Strep pyogenese
144
Best management of erysipelas?
Penicillin
145
Pathogen responsible for cellulitis?
Strep pyogenese, MSSA
146
Pathogen responsible for abscess?
MRSA, MSSA
147
4 yo female presents with fever, fatigue, AMS; Grandpa visiting from South Asia; Family has pet cat; Vitals show T 100.4; PE shows (+) knee flexion with neck flexion, medial deviation of R eye; Fundoscopic exam shows several raised yellow-white nodules near optic discs bilaterally; CSF analysis shows Glucose 8, Protein 300, Lymphocyte predominance - diagnosis?
TB meningitis
148
Fundoscopic findings associated with TB meningitis?
Choroidal tubercles … yellow-white nodules near the optic disc
149
CSF findings associated with TB meningitis?
Elevated protein, low glucose, Lymphocyte predominance
150
Diagnostic tool needed for TB meningitis?
Serial LPs with CSF examination for acid-fast bacilli
151
Best treatment of TB meningitis?
4-drug therapy (RIPE) for 2 months, then 2-drug therapy (RI) for 9-12 weeks + steroids
152
Role of steroids in treatment of TB meningitis?
Significantly reduces morbidity + mortality
153
5 yo male presents with sore throat, fatigue, HA, pain with swallowing; Vitals show T 100.4; PE shows pharyngeal erythma with vesicles on the posterior soft palate, no cervical LAD - diagnosis?
Herpangina
154
Clinical presentation of aphthous ulcers?
Ulcers on anterior oral mucosa + no systemic symptoms
155
Clinical presentation of herpangina?
Ulcers + vesicles on posterior palate + systemic symptoms
156
Pathogen responisble for herpangina?
Coxsackie A
157
Best management of herpangina?
Supportive care
158
Best strategy for preventing spread of herpangina?
Hand washing
159
Clinical presentation of herpes gingivostomatitis?
Ulcers + vesicles on anterior oral mucosa + systemic symptoms
160
Clinical presentation of Group A strep pharyngitis?
Tonsillar exudate + systemic symptoms
161
Clinical presentation of infectious mononucleosis?
Tonsillar exudate + systemic symptoms + Hepatosplenomegaly
162
26 yo female calls after-hours for 2 days of dysuria, frequency with urination; Last UTI was 1 year ago, treted with ABX; Currently has IUD for contraception - best next step?
Prescribe TMP-SMX
163
Which patients with suspected UTI require physical exam?
Possibility of pregnancy, symptoms of pyelonephritis
164
2 first-line ABX choices for uncomplicated UTI?
TMP-SMX for 3 days; Nitrofurantoin for 5 days
165
24-year-old male presents with fatigue, fever, sweats, headache, fatigue, sore throat, myalgia. Sexually active but rarely uses condoms. PE shows erythematous maculopapular rash on face, trunk, palms, soles. Oropharyngeal examination shows shallow, tender ulcer with white exudate on posterior oropharynx. Several enlarged mobile lymph nodes are present in the cervical, axillary, occipital regions. Labs show WBC 1.6, PMN predominant, PL 120 - what is most likely diagnosis?
Acute HIV infection
166
When does acute HIV infection typically occur?
2-4 weeks after exposure
167
Typical clinical presentation for acute HIV infection?
Mononucleosis-like syndrome
168
2 common lab findings seen in cases of acute HIV infection?
Leukopenia, thrombocytopenia
169
Best management of rhino orbital mucomycosis?
Amphotericin B
170
__ is required for both diagnosis and treatment of Mucormycosis
Sinus endoscopy
171
Pathogen responsible for mucormycosis?
Rhizopus
172
5 aspects of clinical presentation for infectious mononucleosis?
Fever, fatigue, exudative pharyngitis, lymphadenopathy, hepatosplenomegaly
173
Along should patients with infectious mononucleosis avoid contact sports?
Minimum of 4 weeks
