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Infectious Disease Flashcards

0
Q

What is most common viral pathogen to cause aseptic meningitis in both children and adults?

A

Entero virus

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1
Q

Which cancer is associated with HTLV2 infection?

A

Hairy cell leukemia

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2
Q

What is best diagnostic test for west Nile meningitis?

A

IgM antibody in CSF

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3
Q

What is most common pathogen for causing benign recurrent lymphocytic meningitis?

A

HSV 2

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4
Q

What age do you need to add ampicillin to abx coverage for meningitis for listeria coverage?

A

50 years old

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5
Q

Bacterial pathogens most common in meningitis associated with basilar skull fracture?

A

H. Influenza
S. Pneumoniae
GAS

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6
Q

Bacterial pathogens associated with meningitis and post neurosurgery/head trauma

A

Staphylococcus aureus
CONS
P. Aeruginosa

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7
Q

Common bacterial pathogens that cause meningitis with associated VPS or intraventricular catheters

A

S. Aureus
CONS
GNR esp. P. Aeruginosa
Diphtheroids (p. Acnes)

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8
Q

What time frame should LP be repeated in bacterial meningitis if there is failure to respond to IV abx and dexamethasone treatment?

A

36-48 hours

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9
Q

What is most common empiric treatment for brain abscess?

A

3rd generation cephalosporin
Metronidazole
Vancomycin

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10
Q

What size of brain abscess requires stereotactical aspiration?

A

> 2.5 cm

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11
Q

What is standard length of treatment for bacterial brain abscess?

A

6-8 weeks IV abx, maybe 3-4 weeks of surgically removed

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12
Q

What is the most common condition to predispose someone to a cranial subdural empyema?

A

Para nasal sinusitis

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13
Q

What is the most common pathogen that causes sinus epidural abscess?

A

S. Aureus

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14
Q

What is empiric abx coverage for spinal epidural abscess

A

Vancomycin

Anti pseudomonas cephalosporin or carbapenum

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15
Q

What are 2 most common pathogens that cause encephalitis in USA?

A

HSV

West Nile Virus

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16
Q

What type of paralysis is seen with west Nile viral encephalitis?

A

Acute flaccid paralysis - similar to polio

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17
Q

What is diagnostic test of choice for diagnosing west Nile neuro invasive disease?

A

Detection of west Nile IgM antibody in CSF

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18
Q

What are the hallmarks of creutzfeldt Jacob disease?

A

Rapidly Progressive dementia

Myoclonus

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19
Q

Which neural protein is elevated in CSF with creutzfeldt Jacob disease?

A

14-3-3 protein

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20
Q

What pathogen is associated with cellulitis and freshwater contact/brackish water?

A

Aeromonas hydrophilic

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21
Q

What organism is associated with cellulitis with areas of bullae and hemorrhage and recent salt water/seafood?

A

Vibrio vulnificus

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22
Q

What pathogen causes cellulitis usually of the hands or arms after handling saltwater marine life?

A

Erysipelthrix rhusiopathiae

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23
Q

What pathogen is associated with a cellulitis and contact primarily with dogs?

A

Capnocytophaga canimorsus - common in asplenia

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24
Q

What organism is associated with a cellulitis with central eschars?

A

Bacillus anthracis

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25
Q

What organism is associated with a cellulitis with ulcerative lesions and central eschar and recent contact with infected animals (particularly cats)?

A

Francisella tularensis

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26
Q

What organism causes a cellulitis at a site of trauma and recent contact with fresh or salt water?

A

Mycobacterium marinum

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27
Q

What type of patient is at increase risk of vibrio vulnificans necrotizing fasciitis?

A

Immunocompromised pts with iron overload syndrome such as cirrhosis

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28
Q

What are the two bacteria that cause toxic shock syndrome?

A

Staphylococcus

Streptococcus (group A or b)

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29
Q

What are good prophylactic antibiotic regimens for animal bites?

A

Augmentin
Or
Doxycycline/fluoroquonolone plus clindamycin

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30
Q

What is antibiotic of choice for treatment of cat scratch disease?

A

Azithromycin

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31
Q

What organisms should be considered if there is a CAP with lung cavities?

A 
CA-MRSA
Oral anaerobes
Fungal pathogens
TB
Atypical mycobacterium
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32
Q

What organism can cause CAP with exposure to bat or bird droppings?

A

Histoplasmosis

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33
Q

What organism can cause CAP with recent exposure to farm animals or cats?

A

Coxiella burnetti

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34
Q

What organism can cause CAP with recent travel to southeast or east Asia?

A

Burkholderia pseudomallei

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35
Q

What 2 antigen tests should be preformed on all ICU pts with CAP?

A

Urine legionella and pneumonococcal antigens

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36
Q

What are good beta lactam antibiotics for outpatient treatment of CAP?

A

Augmentin
Cefpodoxime
Cefuroxime

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37
Q

What is preferred abx treatment for legionella?

A

Fluoroquinolone, Azithromycin or doxycycline

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38
Q

What patients need a follow up chest X-ray 6-8 weeks after a pneumonia to evaluate for underlying mass?

A

> 40 years old

Smoker

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39
Q

What geographic regions is Lyme disease most prevalent?

A

Northeast

North central

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40
Q

What geographic location is most common for ehrlichiosis?

A

Southeast
South central
Mid-Atlantic

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41
Q

What is best diagnostic test for Lyme disease if in early disseminated stage (3-6weeks)?

A

ELISA with confirmatory western blot

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42
Q

What forms of Lyme disease require IV antibiotic treatment?

A

Myocarditis with 2nd or 3rd degree heart block
Meningitis
Encephalitis

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43
Q

What joint is most commonly involved in Lyme arthritis?

A

Knee

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44
Q

What are antibiotic options for treating Lyme disease?

A

Doxycycline, amoxicillin or Cefuroxime of PO or IV Ceftriaxone

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45
Q

What is geographic location common for Babesiosis?

A

North east

North central

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46
Q

Which tick Bourne illness can present with hemolytic anemia, splenomegaly, hepatomegaly, DIC and multi organ failure?

A

Babesiosis

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47
Q

What is preferred diagnostic test for babesiosis?

A

PCR of serum

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48
Q

What is the treatment for Babesiosis?

A

Atorvaquone plus Azithromycin
Or
Quinine plus clindamycin

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49
Q

When do you do exchange transfusion for Babesiosis?

A

If > 10% parasitemia

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50
Q

What organism causes southern tick-associated rash illness (STARI)?

A

Amblyomma americanum

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51
Q

What geographic location is STARI common in?

A

South central
Southeast
Mid-Atlantic

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52
Q

What is treatment of STARI?

A

Empiric treatment of Eyrthema Migricans with doxycycline

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53
Q

What geographic location is anaplasmosis seen in?

A

Northeast

North central

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54
Q

What geographic location is ehrlichiosis seen in?

A

Southeast
South central
Mid-Atlantic

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55
Q

What is a characteristic pathology finding for ehrlichiosis or anaplasmosis?

A

Intraleukocytic clusters of bacteria (morulae) on buffy coat stain

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56
Q

What is treatment of ehrlichiosis or anaplasmosis?

A

Doxycycline for 7-14 days

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57
Q

What lab finding can help differentiate between anaplasmosis/ehrlichiosis and RMSF?

A

RMSF usually has normal white count and others have leukocytosis

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58
Q

When do you consider using post coital antibiotic prophylaxis for recurrent UTIs?

A

> 2 UTI in 6 months or

>3 in 12 months

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59
Q

Which fluoroquinolone should not be used to treat acute pyelonephritis?

A

Moxifloxacin

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60
Q

What is the treatment of choice for acute prostatitis?

A

Bactrium (alt fluoroquinolone) x 4-6 weeks

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61
Q

What is a Ghon complex?

A

Localized pulmonary and lymph node scarring secondary to tuberculosis

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62
Q

What patients is a PPD of 5 mm considered positive?

A

HIV
Recent contact with active TB
CXR with possible PPD
Organ transplant/immunocompromosed

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63
Q

What patients is a positive PPD > 10 mm?

A 
Recent travel to high prevalence countries
IVDU
Resident jail/nursing home et
Healthcare workers
Children < age 4
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64
Q

What is first choice antibiotic treatment for shigellosis?

A

Ciprofloxacin

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65
Q

What is first choice alternative for vancomycin for treatment of blood stream infections or endocarditis caused by MRSA?

A

Daptomycin

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66
Q

What is the preferred test for tuberculosis screening in children less than age 5?

A

PPD

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67
Q

What patients require post varicella exposure treatment?

A

Immunocompromised or pregnant patients
Treat with VZIG or IVIG
Treat within 96 hrs of exposure

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68
Q

What is the typical rash seen with smallpox?

A

Starts on buccal and pharyngeal mucosa, spreads to face and trunk and finally extremities (centrifugally)
Starts as macules to papules to vesicles to bullae and finally crust over after which they are no longer infectious

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69
Q

What anti-rejection medication levels increase with addition of macrolid antibiotics or azoles?

A

Tacrolimus/sirolimus

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70
Q

What are two alternative treatment regimens for latent TB?

A

Directly observed rifapentine and isoniazid for 3 months

Rifampin daily x 4 months

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71
Q

What is typical length of treatment for tuberculosis meningitis?

A

9-12 months

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72
Q

What TB drug can cause an optic neuritis?

A

Ethambutol

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73
Q

What drugs is Multi-drug resistant TB resistant to?

A

Isoniazid

Rifampin

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74
Q

What drugs are Extensively drug-resistant (XDR) tuberculosis resistant to?

A

At least 1 of 2nd line drugs: kanamycin, capreomycin, or amikacin
Fluoroquinolones

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75
Q

What type of TB disease is BCG vaccine most effective in preventing?

A

Disseminated TB and tuberculosis meningitis in children

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76
Q

What is Lady Windermere syndrome?

A

Mycobacterium about complex (MAC) pulmonary infection in middle aged or elderly women who smoke

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77
Q

What is “hot-tub lung”?

A

MAC hypersensitivity like pneumonitis due to inhaled aerosolsized water

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78
Q

At what CD4 count are MAC infections most likely to occur?

A

< 50

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79
Q

What is antibiotic treatment for MAC?

A

Macrolide (Azithromycin, clarithromycin), ethambutol and rifampin
Add amikacin or streptomycin if severe disease

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80
Q

What is treatment of MAC lymphadenitis?

A

Excisional surgery alone

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81
Q

Where is mycobacterium kansasii most commonly found?

A

Urban municipal water supplies

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82
Q

When do you initiate anti retroviral therapy in HIV patients?

A 
History of AIDS defining opportunistic infection or malignancy
CD4 count <500
HIV nephropathy
Presence of symptoms
Pregnancy 
Co infection with hepatitis C/B
Active cardiovascular disease
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83
Q

What extrapulmonary manifestations of TB should adjuvant prednisone be added to quadruple therapy?

A

Pericarditis

Meningitis

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84
Q

How long is treatment for mycobacterium kansasii?

A

18 months - sputum cultures must be negative for 12 months

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85
Q

What is primary risk factor for development of a rapidly growing mycobacterium (RGM) infections?

A

Often hospital acquired with exposure to colonized liquid or tap water

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86
Q

What is preferred treatment for candidiasis in a severely ill patient?

A

Echinocandin- capsofungin, micafungin, or anidulafungin

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87
Q

Which type of malaria has classic “banana shaped” gametocytes on blood smear?

A

Plasmodium flaciparum

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88
Q

Which TB medication can precipitate gout?

A

Pyrazinamide

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89
Q

What is length of treatment for candidemia?

A

14 days after clearance of cultures

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90
Q

What is treatment of choice for candidal pyelonephritis?

A

Flu comatose

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91
Q

What type of infection with candida should NOT be treated with echinocandins?

A

Meningitis

Endophthalmitis

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92
Q

What is the treatment for allergic bronchopulmonary asperguillosis?

A

Corticosteroids during exacerbation

Itraconazole

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93
Q

What is definitive therapy for pulmonary aspergilloma (fungal ball)?

A

Surgical resection

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94
Q

What is the galactomannan antigen immunoassay useful for detecting?

A

Detecting asperguillosis in the CSF, serum, or BAL

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95
Q

What is first line treatment for asperguillosis?

A

Voriconazole

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96
Q

What patient populations are at increased risk for development of mucormycosis?

A

Prolonged neutropenia
Severe burns or trauma
Poorly controlled diabetes mellitus
Immunosuppressed

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97
Q

What fungus has characteristic broad, ribbon-like, irregular, aseptate hyphae with right angle branching?

A

Mucormycosis

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98
Q

What is treatment of mucormycosis?

A

Surgical debridement

Amphotericin B

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99
Q

What is primary treatment for non invasive cutaneous cryptococcosis?

A

Fluconazole

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100
Q

What is the primary treatment for disseminated cryptococcous, immunocompromised patient, meningoencephalitis?

A

2 weeks induction with amphoB and flucytosine (4 weeks if Not immunocompromised) followed by consolidation therapy with flu console x 8 weeks
Maintenance therapy should be continued if HIV until CD >100 for at least 3 months and at least 1 year antifungal therapy

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101
Q

What fungus has single broad based yeast buds?

A

Blastomycosis

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102
Q

What is the treatment of mild acute pulmonary/extra pulmonary blastomycosis?

A

May not require treatment
If moderate infection oral itraconazole 6-12 months
Severe - amphotericin B 1-2 weeks followed by itraconazole 6-12 months

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103
Q

What is 2nd most common site of blastomycosis infection after pulmonary involvement?

A

Skin

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104
Q

What is the treatment of mild pulmonary histoplasmosis?

A

No treatment needed

105
Q

What is first line treatment of for histoplasmosis?

A

Moderate infection - itraconazole

Severe - amphotericin B

106
Q

What is length of treatment needed for coccidiomycosis infection?

A

3-6 months

107
Q

What is treatment of coccidiomycosis meningitis?

A

Oral fluconazole for life

108
Q

What is the presentation of Sporothrix schenckii infection?

A

Papule or infected lesion after gardening

109
Q

What is treatment for sporotrichosis?

A

Itraconazole

110
Q

What are common STD that cause proctitis?

A

Chlamydia
Gonorrhea
HSV
Syphilis

111
Q

Which partners should be screen if patient positive for chlamydia?

A

Any within the past 60 days or the last partner if >60 days

112
Q

When do you need to hospitalize for PID?

A
  1. Inability to exclude surgical emergency
  2. Pregnancy
  3. Failure to respond to outpt treatment
  4. Inability to tolerate PO therapy
  5. Signs of toxicity
  6. Suspected tubo-ovarian abscess
113
Q

What is the most common organism to cause epididymitis?

114
Q

What is IV abx choice for PID?

A

Cefotetan plus doxycycline
Or
Clindamycin plus gentamicin

115
Q

When do you classify a patient as having early latent secondary syphilis?

A

Disease known to be < 1 year

116
Q

When do you treat the partners of patient with syphilis?

A

All partners exposed within previous 3 months even if serologic results are negative

117
Q

What illicit drug is associated with a higher rates of chancroid?

A

Crack cocaine

118
Q

What is treatment of chancroid?

A

Azithromycin 1g PO x 1
Or
Ceftriaxone 250mg IM x 1

119
Q

What is treatment of lymphogranuloma venerum?

A

Doxycycline 100 mg PO BID x 21 days

120
Q

What is typical presentation of lymphogranuloma venerum?

A

Proctitis or proctocolitis in men who have sex with men with perianal ulcers

121
Q

What is the most common location of hematogenous osteomyelitis in adults?

A

Vertebral column

122
Q

What imaging modality is preferred to diagnose osteomyelitis if MRI not possible?

123
Q

How many weeks must a patient have fevers in order to be consider for FUO?

A 
3 weeks (outpatient)
3 days (inpatient)
124
Q

What are the two most common causes of FUO in HIV/AIDS patients?

A
  1. Infections in particular mycobacterial infections

2. Non Hodgkin’s lymphoma

125
Q

What organisms often cause FUO that turns out to be endocarditis?

A 
HACEK organisms
Hemophilus aphrophilus
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis 
Eikenella corrodens 
Kingella kingae
126
Q

Which FUO syndrome presents with sensorineural hearing loss, urticarial rash, fever, abdominal pain, and eventually amyloidosis?

A

Muckle Wells syndrome

127
Q

Which autoimmune diseases are frequently associated with CVID?

A

Pernicious anemia
IBD
Rheumatoid arthritis
Hemolytic anemias

128
Q

What is diagnostic tests for CVID?

A

1st quantitative immunoglobulins
Then
Antibody response to vaccines (don’t do if IgG < 200 because you already know they won’t respond)

129
Q

What type of infections do people get with complement deficiencies?

A

Encapsulated organisms

130
Q

Which complement deficiencies lead to increased infections with particularly Neisseria infections?

A

C5, C6, C7 and C8

Properdin deficiency

131
Q

What type of paralysis is caused by botulism?

A

Descending flaccid paralysis

132
Q

What is preferred treatment for tularemia?

A

Stretomycin or gentamicin

133
Q

What is preferred treatment for anthrax or yersinia pestis?

A

Doxycycline or Ciprofloxacin

134
Q

What organism has a distinct “box-car” shaped appearance, aerobic non motile bacillus?

135
Q

How do you diagnose anthrax?

A

PCR of any fluid

136
Q

What CXR or chest CT finding is concerning for pulmonary anthrax?

A

Mediastinal widening

137
Q

What is length of treatment for anthrax?

A

10-14 days IV abx, total treatment 60 days

138
Q

What is post exposure protocol for anthrax?

A

Treatment with Ciprofloxacin or doxycycline plus anthrax vaccine x 3 doses

139
Q

What is serious eye complication that can occur from smallpox?

A

Blindness from keratitis or corneal ulceration

140
Q

What characteristic differentiates smallpox rash from varicella?

A

Varicella has multiple stages of lesions while smallpox all lesions are at the same stage of maturation on any area of the body

141
Q

When should post exposure vaccination be done if exposed to smallpox?

A

Any close contacts, given within 3 days of exposure

142
Q

What are the common presentations o the plague?

A
  1. Primary cutaneous (bubonic) with lymphadenitis
  2. Septicemia plague
  3. Primary pneumonic plague
  4. Secondary pneumonic plague
143
Q

What is characteristic shape of yersinia pestis?

A

Gram negative bacilli with bipolar staining and “safety pin” shape

144
Q

What is length of treatment for the plague?

145
Q

What is post exposure prophylaxis for the plague?

A

Doxycycline or fluorquinolone for 7 days

146
Q

What is classic triad of botulism?

A
  1. Descending flaccid paralysis with prominent bulbar signs
  2. Normal body temperature
  3. Normal mental status
147
Q

What are the common presentations of tularemia?

A
  1. Pneumonic
  2. Typhoidal
  3. Septicemic
  4. Oropharyngeal
148
Q

What is best diagnostic tool for tularemia?

A

PCR of any fluid

149
Q

What is treatment for tularemia?

A

Streptomycin or gentamicin for 7-14 days

150
Q

What is prophylaxis for tularemia exposure?

A

Doxycycline or Ciprofloxacin for 14 days

151
Q

What are four viral hemorrhagic virus families that can be used in bioterrorism?

A

Flaviviridae
Filoviridae
Arenaviridae
Bunyaviridae

152
Q

What is fever cycle in malaria?

A

Every 48-72 hrs

153
Q

What % parasitemia in malaria is associated with increased rates of altered mental status, DIC, hepatic failure, acute hemolysis?

154
Q

Which two malaria species have the highest disease severity?

A

P. flaciparum

P. knowlesi

155
Q

Which malaria species have high rates of relapse?

A

P. vivax
P. ovale
P. malariae

156
Q

Which malaria species is not found in Africa?

A

P. knowlesi because no macaque monkeys in Africa

157
Q

What antimalarial prophylaxis can be given to pregnant women?

A

Chloroquine

158
Q

How is dengue fever transmitted?

159
Q

What is “saddleback” pattern mean for dengue fever?

A

2 febrile periods with a time in between afebrile

160
Q

When is IVIG recommended for post exposure for hepatitis A?

A

< 12 months old
Immunocompromised state
Unvaccinated

161
Q

What is the cause of endemic or murine typhus?

A

Rickettsia typhi

162
Q

What is the treatment for Rickettsial typhus?

A

Doxycycline

163
Q

How do people contract brucellosis?

A

Contaminated milk or meat
Direct inoculation via skin wounds or mucous membranes
Exposure to domestic animals giving birth

164
Q

What is treatment of brucellosis?

A

Combo doxycycline, streptomycin and rifampin

165
Q

What patients is penicillium marneffei a problem?

166
Q

What bacteria is associated with diarrhea and exposure to a puppy or kitten with diarrhea?

A

Campylobacter

167
Q

What bacteria is associated with diarrhea and chitterlings (pork intestines)?

168
Q

Which bacteria is associated with diarrhea and cruise ship?

169
Q

What organism can cause diarrhea associated with untreated fresh water or contaminated shellfish?

A

Aeromonas

Plesiomonas

170
Q

What bacteria cause bloody stools?

A 
Shigella
Campylobacter
STEC
Salmonella
Entamoeba
171
Q

What bacteria can cause diarrhea with symptoms that mimic appendicitis?

172
Q

What organisms commonly cause diarrhea associated with daycare centers?

A

Shigella
Rotavirus
Norovirus
Giardia

173
Q

Which diarrheal pathogen is associated with Guillain Barre syndrome?

A

Campylobacter

174
Q

What is recommended treatment for campylobacter?

A

Only if severe

Azithromycin or erythromycin

175
Q

What is treatment of Shigellosis?

A

ALL require 5 days fluoroquinolone - high rate of shedding

176
Q

What is a known endovascular complication associated with Salmonella diarrhea?

177
Q

When should antibiotics be given for Salmonella diarrhea?

A
  1. Younger than 6 months old or older than 50 yo
  2. Presence of prosthetic heart valves or joints
  3. Co morbidities such as sickle cell, uremia, malignancy
  4. Severe atherosclerotic disease
  5. Impaired cellular immunity
178
Q

How long is fecal shedding of salmonella?

179
Q

What is treatment for salmonella?

A

Fluoroquinolone 5-7 days

180
Q

Which vibrio species is associated with raw shellfish?

A

Vibrio parahaemolyticus

181
Q

If patient unable to take PO abx, what IV medication should be given to treat C diff?

A

Flagyl - IV vanco does not penetrate the colon

182
Q

Which patients are at increased risk for developing severe infection from Giardia?

A

Hypogammaglobulinemia

183
Q

What is preferred diagnostic test for Giardia?

A

Stool antigen immunoassay

184
Q

What biliary complication can be seen with HIV and cryptosporidium?

A

Acalculous cholecystitis

185
Q

How do you diagnose cryptosporidium?

A

Acid fast stain of stool
Or
Serologic assay of stool

186
Q

What is treatment of cryptosporidium?

A

If immunocompetent usually unnecessary

Nitrazoxanide if severe

187
Q

What is treatment of amebiasis?

A

Metronidazole plus paromycin or iodoquinol

188
Q

When is CMV infection most likely post transplant?

A

2 weeks - 4 months

189
Q

What is the most common consequence of EBV infection in post transplant patients?

A

PTLD - more common in solid organ transplants

190
Q

What complication does BK virus cause in kidney transplant?

A

Ureteral strictures and nephropathy

191
Q

What complication is BK virus associated with in HSCT patients?

A

Hemorrhagic cystitis

192
Q

What type of paralysis is seen with tick paralysis?

A

Ascending paralysis mostly affecting large muscles

193
Q

What is typical presentation of paralytic shellfish poisoning?

A

Within a few hours of ingestion First tingling of the lips and mouth, then parasthesias of the fingers and toes, then loss of control of arms and legs and eventually can look control of trunk muscles/respiratory distress

194
Q

What finding can be seen in the urine for a transplant patient with BK virus nephropathy?

A

Decoy cells in urine

195
Q

What statin is usually used for HIV patients if needed?

A

Atorvastatin

196
Q

What timeframe after transplant do patients tend to get pneumocystis jirovecii infection?

A

Usually late phase > 100 days

197
Q

When do transplant patients tend to get CMV infections?

A

Middle period (30-100 days) or late phase >100 days

198
Q

When do post transplant patients tend to get VZV infection?

A

Late phase > 100 days

199
Q

When do past transplant patients tend to get HSV infections?

A

Early or post engraftment phase < 30 days

200
Q

Which organisms is the most common cause of invasive fungal infection post transplant?

A

Asperguillosis

201
Q

Which type of transplant is at risk for cryptococcous infection ?

A

Solid organ. Rare in HSCT

202
Q

What timeframe do you start reimmunizing post HSCT patients?

A

6-12 months

203
Q

What timeframe can you give live vaccines (VZV/MMR) to post HSCT patients?

A

After 24 months if no GVHD

204
Q

How long after transplant is ganiciclovir or valganciclovir given for CMV prophylaxis?

A

3-4 months

205
Q

How long after transplant is bactrim given for PCP prophylaxis?

206
Q

How many CFU are required for diagnosis of CAUTI?

A

> 1000 (10^3) - single catheter urine specimen or midstream void of catheter removed

207
Q

What is the timeframe after a surgery does an infection of the soft tissue around incision considered a surgical site infection/hospital acquired infection?

A

30 days

1 year if implanted device

208
Q

How long should you provide prophylactic antibiotics after surgery?

A

No longer than 24 hrs

209
Q

Which type of antiseptic is preferred prior to surgery?

A

Chlorhexidine

210
Q

How long should you treat VAP?

211
Q

How often do you need change a transparent dressing to prevent a CLABSI?

212
Q

What MIC for vancomycin should you consider alternative agents?

A

> 2

Clindamycin or linezid is for PNA and daptomycin for bloodstream

213
Q

If ESBL infection present when should tigecycline not be used as a mono therapy?

A

If bacteremia present

214
Q

If actinobactor UTI multi drug resistance present, is tigecycline or minecycline preferred?

A

Minocycline - higher urinary concentrations

215
Q

Which 4 heart conditions typically require antibiotic prophylaxis to prevent infective endocarditis?

A
  1. Prosthetic cardiac valve
  2. Previous history of infective endocarditis
  3. Unrepaired Cyanotic heart disease including palliative shunts and conduit
  4. Cardiac transplant patients with valvulopathy
216
Q

What are primary antibiotic regimens for endocarditis prophylaxis?

A
  1. Amoxicillin 2g or 50/kg
  2. Cephalexin 2g or 50/kg
  3. Clindamycin 600 mg or 20/kg
  4. Azithromycin or clarithromycin 500mg or 15/kg

IV - ampicillin, Ceftriaxone, cefazolin or clindamycin

217
Q

Do patients need abx prophylaxis for endocarditis if undergoing EGD/colonoscopy?

A

No

Not for GU procedures either

218
Q

What drug is approved for pre exposure prophylaxis of HIV in individuals with high risk sexual behavior?

A

Emtricitabine/tenofovir

219
Q

How soon after HIV infection does acute retroviral syndrome occur?

220
Q

What is best test for diagnosing acute retroviral syndrome?

A

Nucleic acid amplification test

221
Q

At what CD4 count do you initiate bactrim prophylaxis for PCP in HIV patients?

A

<200

Bactrim DS daily or three times per week

222
Q

At what CD4 count do you begin to see toxoplasmosis infections in HIV patients?

A

<100

Bactrim is prophylaxis

223
Q

At what CD4 count do you initiate Azithromycin for MAC in HIV patients?

224
Q

What PPD size is positive in an HIV patient?

225
Q

Which HIV drugs are associated with higher rates of lipodystrophy?

A

Zidovidine

Stavudine

226
Q

What timeframe do you see immune reconstitution inflammatory syndrome after initiation of ART in HIV patients?

A

Few weeks to a few monthsp

227
Q

What is treatment of IRIS in HIV?

A

Continue ART
Treat underlying infections
Steroids

228
Q

What CD4 count is cryptococcal infections most likely to occur in HIV patients?

229
Q

What PaO2 in ambient air should you start corticosteroids as adjuvant treatment for PCP pneumonia in AIDS?

230
Q

What is treatment of toxoplasmosis?

A

Pyrimethamine plus sulfadiazine or clindamycin

231
Q

What CD4 count do you start to have CMV infections in HIV?

232
Q

What is the most common manifestation of bartonella infection in AIDS patients?

A

Bacillary angiomatosis

233
Q

Which drugs are non nucleoside reverse transcriptase inhibitors?

A

Efavirenz
Etravirine
Nevirapine
Rilpivirine

234
Q

What is preferred initial treatment for HIV?

A

Tenofovir (NRTI)
Emtricitaine (NRTI)
Efavirenz (NNRTI)

235
Q

What HIV medication is associated with neural tube defects if given during pregnancy?

236
Q

What drug boosts the effect of protease inhibitors?

237
Q

Which HIV drugs are given in place of efavirenz?

A

Raltegravir (integrase inhibitor)

Atazanavir or darunavir (protease inhibitors)

238
Q

Which HIV class of drug should not be given with lovastatin or simvastatin?

A

Protease inhibitors

239
Q

Which HIV drug should not be given with PPI?

A

Atazanavir

240
Q

What is referred treatment regimen for HIV pregnant women?

A

Lamivudine
Lopinavir/ritonavir
Zidovudine

241
Q

Which influenza subtype do antigenic shifts occur?

242
Q

How many outbreaks per year do you need before starting suppressive therapy for HSV?

A

> 6 or severe outbreaks or immunocompromised

243
Q

What is a rare hematologist complication of valacyclovir in patients with AIDS?

244
Q

How soon should acyclovir be started for treatment of VZV infections?

A

Within 24 hrs of the onset of lesions

245
Q

Which carbapenum has lowest risk for causing seizures?

246
Q

What is common complication of tigecycline?

A

Pancreatitis

247
Q

What monitoring needs to be done for daptomycin use?

A

CK levels - can cause rhabdomyolysis

248
Q

What is serious side effect of telavancin?

A

Nephrotoxicity

249
Q

What neurological side effect can occur with linezolid?

A

Peripheral or optic neuropathy

250
Q

What organism is doripenum more active against than imipenum and meripenum?

A

Pseudomonas

251
Q

What type of infection could one use colistin?

A

MDR gram negative bacteria

252
Q

What are major side effects of colistin?

A

Neurotoxicity

Nephrotoxicity

253
Q

What are absolute contraindications to hyperbaric oxygen treatment?

A

Untreated pneumothorax

Recent chemo with doxorubicin or cisplatin

254
Q

What is reservoir for schistomatosis?

255
Q

What disease is thalidomide still used to treat?

A

Leprosy/Hansen disease

256
Q

What gram negative cocci causes a pneumonia?

257
Q

What pneumonia organism has salmon colored sputum and pneumatoceles?

A

Staph aureus

258
Q

What is Loeffler syndrome?

A

Eosinophilic pneumonia due to helminth infection

259
Q 
What is cause of:
Spontaneous pneumothorax
Lytic bone lesions
DI
Young male smoker
A

Langerhans cell histiocytosis

260
Q 
What causes:
Non smoking female
Long bone pain
Intermittent hemoptysis
Clubbing
Pain with palpation anterior shins
A

Adenocarcinoma with hypertrophic osteoarthropathy - treat cancer and use NSAIDS

Internal Medicine (12 decks)

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