Infectious Disease 3

Question 1

Best tetanus prophylaxis in clean wound, patient has received 3+ tetanus vaccines?

Answer 1

TDAP if last dose was 10+ years ago; No Tetanus Ig

Question 2

Best tetanus prophylaxis in clean wound, patient has received uncertain tetanus vaccination?

Answer 2

TDAP; No Tetanus Ig

Question 3

Best tetanus prophylaxis in dirty wound, patient has received 3+ tetanus vaccines?

Answer 3

TDAP if last dose was 5+ years ago; No Tetanus Ig

Question 4

Best tetanus prophylaxis in dirty wound, patient has received uncertain tetanus vaccination?

Answer 4

TDAP + Tetanus Ig

Question 5

Pathogen responsible for Chagas disease?

Answer 5

Dilated cardiomyopathy, GI disease

Question 6

2 most common complications of Chagas disease?

Answer 6

Trypanosoma cruzi

Question 7

ECHO finding that is pathognomonic for dilated cardiomyopathy due to Chagas disease?

Answer 7

L ventricular aneurysm

Question 8

In addition to L ventricular aneurysm what are 2 other cardiac complications of Chagas disease?

Answer 8

AV block, ventricular tachycardia

Question 9

4 people who should receive ABX prophylaxis for exposure to Neisseria meningitis?

Answer 9

Household members, Child care workers, People directly exposed to oral/respiratory secretion (intubation), People seated next to infected patient for >8 hours

Question 10

DOC for ABX prophylaxis for exposure to Neisseria meningitis?

Answer 10

Rifampin

Question 11

2 alternative DOCs for ABX prophylaxis for exposure to Neisseria meningitis?

Answer 11

Ciprofloxacin, Ceftriaxone

Question 12

Best management of spontaneous splenic rupture in setting of EBV infection?

Answer 12

Resuscitation + stabilization with IV fluids

Question 13

What accounts for splenomegaly in setting of EBV infection?

Answer 13

Lymphocytic infiltration into splenic capsule

Question 14

2 most common routes by which healthcare professionals contract HIV from patients?

Answer 14

Percutaneous injury (needlestick); Mucous membrane or non-intact skin exposure

Question 15

3 high-risk fluids involved in transmission of HIV from patient to healthcare professionals?

Answer 15

Blood, semen, vaginal secretions

Question 16

4 bodily fluids that are considered non-infectious for HIV?

Answer 16

Urine, feces, vomit, tears

Question 17

Epidemiology of Allergic Bronchopulmonary Aspergillosis (ABPA)?

Answer 17

Asthma, Cystic fibrosis

Question 18

3 aspects of diagnosis for Allergic Bronchopulmonary Aspergillosis (ABPA)?

Answer 18

(+) aspergillosis skin test, Eosinophilia, Elevated serum IgE

Question 19

2 aspects of management for Allergic Bronchopulmonary Aspergillosis (ABPA)?

Answer 19

Corticosteroids + Antifungals

Question 20

2 antifungals that can be used in treatment of Allergic Bronchopulmonary Aspergillosis (ABPA)?

Answer 20

Itraconazole, Voriconazole

Question 21

Additional medication that can be used in treatment of Allergic Bronchopulmonary Aspergillosis (ABPA)?

Answer 21

Omaluzimab … monoclonal antibody against IgE

Question 22

Pathogen responsible for shingles?

Answer 22

VZV

Question 23

Description of localized shingles?

Answer 23

Appearance of lesions within single or adjacent dermatomes

Question 24

Description of disseminated shingles?

Answer 24

Appearance of lesions outside primary or adjacent dermatomes

Question 25

Best management of shingles?

Answer 25

Oral valacyclovir

Question 26

Precautions for localized shingles?

Answer 26

Standard precautions + lesion covering

Question 27

Precautions for disseminated shingles?

Answer 27

Standard precautions + Contact + Airborne precautions

Question 28

Role of oral valacyclovir in treatment of shingles?

Answer 28

Reduce transmission risk, prevent new lesion formation, decrease risk of post-herpetic neuralgia

Question 29

How is shingles diagnosed?

Answer 29

Clinically

Question 30

54 yo male presents for 3 months of increased urinary freuquency/urgency, pelvic pain, pain with ejaculation; Symptoms improved after 1-week course of TMP-SMX, but then quickly recurred; PE shows mild enlargement of prostate; UA shows 20 WBCs, moderate bacteruria - diagnosis?

Answer 30

Chronic bacterial prostatitis

Question 31

Diagnostic findings for Chronic bacterial prostatitis?

Answer 31

Pelvic pain, urine leukocytosis, bacteruria for 3+ months

Question 32

Best management of Chronic bacterial prostatitis?

Answer 32

6 week course of ciprofloxacin, TMP-SMX

Question 33

Compared to the general population, patients with HIV are at increased risk of ___ pulmonary infections, most commonly with …

Answer 33

Bacterial; Strep pneumoniae

Question 34

29 yo female presents after unprotected sexual intercourse with man she just learned is HIV (+); Immediate HIV and pregnancy tests are negative - what is best next step in management?

Answer 34

Post-Exposure Prophylaxis with HAART for 4 weeks

Question 35

Optimal timing of initiation of HIV Post-Exposure Prophylaxis?

Answer 35

Within 72 hours of exposure

Question 36

64 yo female with HX of myasthenia gravis presents for 2 days of worsening fever, neck pain; Treated 12 days ago for UTI with ceftriaxone and IVIG; T101; PE reveals neck pain, stiffness; Labs show WBC 13; LP is performed, CSF analysis reveals pressure 300, glucose 30, protein 180, WBC 2,000 with PMN predominence; CSF Gram stain and culture are negative, cryptococcal Ag is negative - diagnosis?

Answer 36

Bacterial meningitis … negative Gram stain and culture due to recent ABX treatment

Question 37

17 yo male presents for 3 days of productive cough, chest pain with deep inspiration; HX of multiple hospitalizations for PNA; Also has HX of SBO as newborn; PE reveals crackles; Diagnosis?

Answer 37

Cystic fibrosis

Question 38

17 yo male presents for 3 days of productive cough, chest pain with deep inspiration; HX of multiple hospitalizations for PNA; Also has HX of SBO as newborn; PE reveals crackles; What is most appropriate ABX therapy?

Answer 38

Cefepime + Amikacin … total = vancomycin + 2 anti-pseudomonal drugs

Question 39

2 most common pathogens responsible for pulmonary exacerbations?

Answer 39

Pseudomonas, Staph aureus

Question 40

What is best strategy for TB screening in patients who have receieved BCG vaccine? |

Answer 40

IFN-gamma release assay … BCG vaccine can cause false (+) TB skin test

Question 41

Patient who has receieved BCG vaccine tests (+) for IFN-gamma release assay; CXR is negative - diagnosis?

Answer 41

Latent TB

Question 42

Patient who has receieved BCG vaccine tests (+) for IFN-gamma release assay; CXR is negative - what is best management?

Answer 42

Treatment with INH for 9 months

Question 43

DOC for bartonella infection?

Answer 43

Clindamycin, Azithromycin

Question 44

6 yo female presents with R sided, painful cervical LAD; Reports increased fatigue, now FB sensation in R eye with increased tearing; PE shows injection of R conjunctiva, TTP of cervical and preauricular LNs - diagnosis?

Answer 44

Bartonella infection

Question 45

Complicaiton of Bartonella infection?

Answer 45

LN suppuration

Question 46

Best treatment for Bartonella infection?

Answer 46

Azithromycin

Question 47

Bartonella infection leads to ___ syndrome

Answer 47

Oculoglandular

Question 48

57 yo male returns from cruise to Bahamas; Now has fever, cough, SOB, HA, abdominal pain, D; CXR shows BL interstitial infiltrates - diagnosis?

Answer 48

Leigonella

Question 49

ABX of choice for treatment of Leigonella?

Answer 49

Fluoroquinolones, Macrolide

Question 50

Clinical presentation of Leigonella infection?

Answer 50

PNA + diarrhea

Question 51

8 yo female presents after brother develops active TB infection; Patient’s IFN-gamma assay is positive, CXR is negative; Brother’s TB infection is resistent to isoniazid, but susceptible to other drugs - diagnosis?

Answer 51

Latent TB infection

Question 52

8 yo female presents after brother develops active TB infection; Patient’s IFN-gamma assay is positive, CXR is negative; Brother’s TB infection is resistent to isoniazid, but susceptible to other drugs - what is best management?

Answer 52

9 months INH … OR 4-6 months of rifampin (if INH resistent)

Question 53

4 aspects of clinical presentation for congenital rubella?

Answer 53

Sensorineural hearing loss, PDA, cataracts, blueberry muffin rash

Question 54

34 yo female presents after new diagnosis of HIV; CD4 550, Viral load 20,000; Positive for toxoplasma IgG - what is best step in management?

Answer 54

Initiate HAART

Question 55

Which HIV patients should be started on HAART?

Answer 55

All … regardless of CD4 count

Question 56

What is best recommendation for HC workers exposed to patient with active TB infection, if HC workers then had negative TB test?

Answer 56

Repeat TB test in 8-10 weeks

Question 57

6 yo male presents with new difficulty breathing after mild sore throat, fever; PE shows tripod position, inspiratory stridor - what is best next step of management? | Prepare for intubation Pathogen responsible for epiglottitis?

Answer 57

H. flu (type B)

Question 58

6 do male presents for poor feeding, difficulty waking, jaundice; Vitals show fever, tachycardia; Labs show WBC 18 with PMN 80%, T. bili 12.8, Alk phos 250; UA shows (+) leukocyte esterase, 15 WBCs - diagnosis?

Answer 58

Neonatal infection with … E. coli or GBS

Question 59

DOC for neonatal infection?

Answer 59

Ampicillin + Cefotaxime/Gentamycin