Infectious Disease 2

Question 1

Most common manifestation in primary (spontaneous) bacterial peritonitis

Answer 1

Fever

Question 2

Diagnostic criterion for peritoneal fluid in PBP

Answer 2

> 250 PMNu/L

Question 3

Common etiologic agents in PBP

Answer 3

Typically single organism
(E. coli, and occasional other gram positive bacteria - streptococci, enterococci, somestimes pneumococci)

vs secondary peritonitis- mixed flora and anarobes is the rule

Question 4

Continuous ambulatory peritoneal dialysis (CAPD) peritonitis etiologic agent

Answer 4

Usually single organism
Most common - Staphylococcus sp

Question 5

Most common cause of liver abscess

Answer 5

Associated disease of the biliary tractin

Question 6

Single most reliable lab finding in liver abscess

Answer 6

Elevated alk phos

Question 7

Treatment of candidal liver abscess

Answer 7

Initial administration of amphotericin B (3-5mg/kg IV daily) or an echinocandin with subsequent fluconazole therapy

Question 8

Most common associated infection in splenic abscess

Answer 8

Bacterial endocarditis

Question 9

Most common bacterial isolates in splenic abscess

Answer 9

Streptococcal species then S. aureus

vs liver: enteric gram negative bacilli and enterococci (anaerobes generally not involved unless w previous surgery or pelvic source)

Question 10

Antibiotic therapy for epididymitis caused by N. gonorrhoeae or C. trachomatis

Answer 10

Ceftriaxone 500mg singel dose IM followed by doxycycline 100mg by mouth twice daily for 10 days

Question 11

Diagnosis of MPC

Answer 11

Detection of cardinal signs at the cervix:
yellow mucopurulent discharge from the cervical os
Endocervical bleeding upon gentle swabbing
Edematous cervical ectopy

Question 12

Increases risk of IRIS

Answer 12

Earlier ART is started
Lower baseline CD4 count

*ART should not be initiated during the first 8 weeks of TB treatment in patients with TB meningitis

Question 13

Lung lobes commonly affected in primary pulmonary TB

Answer 13

Middle and lower lung zones

Question 14

Lung lobes commonly affected in postprimary TB

Answer 14

apical and posterior segments of the upper lobes
superior segments of the lower lobe

Question 15

Rasmussen’s aneurysm

Answer 15

inflammatory pseudo-aneurysmal dilatation of a branch of a pulmonary artery (PA) adjacent to a tubercular cavity

Rupture may cause hemoptysis

Question 16

Most common lymph node affected in lymph node TB

Answer 16

posterior cervical and supraclavicular sites

Question 17

Establishment of diagnosis in lymph nodes is via

Answer 17

FNAB or surgical excision biopsy

Question 18

Characteristic of urine suggestive of GU TB

Answer 18

culture-negative pyuria in acidic urine

*culture of 3 morning specimens yields a definitive diagnosis

Question 19

Most common spine level affected in adults with skeletal TB

Answer 19

Lower thoracic and upper lumbar

vs children: upper thoracic

Question 20

CSF profile if tuberculous meningitis

Answer 20

high leukocyte count (up to 1000/μL)

usually with a predominance of lymphocytes but sometimes with a predominance of neutrophils in the early stage

protein content of 1–8 g/L (100–800 mg/dL)

and a low glucose concentration

Question 21

Used in severe paradoxical reactions (IRIS)

Answer 21

Glucocorticoids

Question 22

Chemoprophylaxis for meningococcal meningitis

Answer 22

Rifampicin 600mg every 12 hours for 2 days (not recommended in pregnant women)
Azithromycin 500mg single dose
Ceftrriaxone 250mg IM single dose

Question 23

Drug of choice for pneumococcal meningitis if MIC > 1ug/mL

Answer 23

Vancomycin
*Rifampicin added for synergistic effect
Duration: 2 weeks
(vs uncomplicated meningococcal 7 days)

Question 24

Indications for EMERGENT (same day) surgery in IE (4)

Answer 24

1. Valve dysfunction with pulmonary edema or cardiogenic shock
2. Acute aortic regurgitation plus preclosure of mitral valve
3. Sinus of Valsalva abscess ruptured into right heart
4. Rupture into pericardial sac

Question 25

Type 1 Leprosy reaction

Answer 25

“reversal reaction”
Delayed hypersensitivity reaction associated with sudden alteration of CMI status
Usually observed in borderline portion of the spectrum
(+) Acute swelling and redness of skin leasions
(+) neuritis –> nerves may be painful and tender –> nerve damage and disfigurement

Question 26

Type 2 Leprosy reaction

Answer 26

aka Erythema nodosum Leprosum (type 3 hypersensitivity rxn)
(+) Evanescent, pink-to-red maculopapular, papular, nodular, or plaque lesions suddenly appear and are usually accompanied by constitutional symptoms like malaise and fever

Question 27

Clinical dx of leprosy (3)

Answer 27

2 ouf of 3 required:

Hypopigmented or erythematous skin lesion(s) with definite loss or impairment of sensation

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

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 28

Earliest abnormality seen in CBC in Dengue

Answer 28

Decrease in total WBC

Question 29

Dengue serotypes associated with severe disease accompanying secondary dengue infections

Answer 29

DEN 2 and DEN 3

Question 30

Individuals suffering from Dengue are protected from clinical illness with a different serotype within _____ months of the primary infection but with no long-term cross-protective immunity

Answer 30

2-3 months

*Primary infection is thought to induce lifelong protective immunity to the infecting serotype

Question 31

Higher case fatality rate in which Dengue serotype

Answer 31

When DEN 2 is followed by DEN 1

Question 32

Homecare advise for Dengue on fluid intake

Answer 32

Adequate fluid intake (>5 glasses for average-sized adult or accordingly in children)
- Milk, fruit juice (caution with diabetes patient) and isotonic electrolyte solution (ORS) and barley/rice water
- Plain water alone may cause electrolyte imbal-ance
-Reduce osmolarity of ORS containing sodium 45 to 60 mmol/liter.
🚫- Sports drinks should NOT be given due to its high osmolarity which may cause more danger to the patient.

Question 33

Fluids in Dengue fever with SHOCK

Answer 33

Give 10mL/kg plain isotonic crystalloid
> over 1 hour in compensated shock
> over 15m in hypotensive shock
(Get baseline CBC first)

If no improvement in Hct, give 2nd bolus fluid 10ml/kg (compensated) and 10-20ml/kg (hypotensive)

-Should not exceed 3L/day to avoid fluid overload
-Monitor Hct every 6 h if feasible (or as necessary
-If with overt/occult bleeding - fresh whole blood 20m/kg or pRBC 10ml/kg

Question 34

Discharge criteria for Dengue

Answer 34

ALL must be present

1. No fever for 48 hours
2. Improvement in clinical status (general well-being,
   appetite, hemodynamic status, urine output, no res-
   piratory distress)
3. Increasing trend of platelet count
4. Stable hematocrit without intravenous fluids

Question 35

Infectious diarrhea MILD signs of dehydration:

Answer 35

Dry mouth, decreased axillary sweat, decreased urine output, and slight weight loss

VS MODERATE: orthostatic fall in blood pressure, skin tenting, and sunken eye

Severe: lethargy, obtundation, feeble pulse, hypotension, and frank shockn

Question 36

Diagnostic criteria for C diff

Answer 36

1. diarrhea (≥3 unformed stools per 24 h for ≥2 days) with no other recognized cause plus
2. detection of toxin A or B in the stool, detection of toxin-producing C. difficile in the stool by nucleic acid amplification testing (NAAT; e.g., polymerase chain reaction [PCR]) or by culture, or visualization of pseudomembranes in the colon

Question 37

Primary treatment (DOC) for GAS necrotizing fasciitis

Answer 37

Clindamycin (600–900 mg IV q6–8h) plus penicillin G (4 million units IV q4h)

*T/N: Same if gas gangrene

Alternative: Clindamycin (600–900 mg IV q6–8h) plus a cephalosporin (first- or second-generation)

Question 38

Primary treatment (DOC) for mixed arobes and anaerobes necrotizing fasciitis

Answer 38

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

Question 39

Appropriate empiric antibiotic tx for mixed aerobic-anaerobic infections

Answer 39

(1) clindamycin (600–900 mg IV every 8 h) or metronidazole (500 mg every 6 h)

plus

(2) ampicillin or ampicillin-sulbactam (1.5–3 g IV every 6 h)

plus

(3) gentamicin (1–1.5 mg/kg every 8 h)