Infectious disease

Question 1

how long should you avoid sports with EBV

Answer 1

> 3weeks; heterophile can be positive for up to a year and spleen is palpable only when its 2 or 3x normal

Question 2

symptoms of parvovirus B19 in adults

Answer 2

1. nonspecific rash
2. polyarticular, symmetric arthritis involving peripheral joints including MCP, PIP, wrist, knees, and ankles
3. fatigue
4. fever
5. diarrhea

Question 3

agents that can cause a viral arthritis

Answer 3

hepatitis B and C, HIV, rubella

Question 4

Tx of PPD+ pts? regular and HIV+

Answer 4

isoniazid and pyridoxine for 9 months; pyridoxine for protection again neuropathy caused by isoniazid; needs greater than 5mm of induration in HIV pts and greater thn 10mm (recent immigrants, iv drugss, hospitals, prisons, nursing homes, homeless shelters, reactivation co morbidities, kids15mm in everyone else

Question 5

symptoms of bartonella infection

Answer 5

bacillary angiomatosis in immunocompromised and pts have cutaneous and visceral angioma-like blood vessel ggrowths; Abx for tx

nonspecific symptoms: fever, wt loss, malaise, abd pain & characteristic lesions of skin and viscera - classsic cutaneous lesions are large pedunculated exophyticc papule with a collarette of scale that resembles a large pyogenic granuloma or cherry angioma

Question 6

PCP pna tx mild and mod/sever

Answer 6

IV TMP-SMX for all cases; possible outpt oral if very mild disease; add corticosteroids if PaO235

Question 7

organism in osteomyelitis after a puncture wound

Answer 7

pseudomonas

Question 8

most ocmmon cause of pna in nursing homes

Answer 8

step pneumoniae

Question 9

most common pneumonia in those with neurologic disorders

Answer 9

advanced dementia, parkinson’s disease, and stroke (think aspiration pneumonia)

Question 10

indications for meningococcal vaccine

Answer 10

1. primary vaccine: age 11-12 (or13-18 if previously not vaccinated), optional at age 19-21 (if not previously vaccinated) for high risk pts and first year college students entering residential housing
2. booster: age 16-21 if primary vaccine before 16th bday
3. age>21 consider if at high risk (complement deficiency, asplenia, hiv, exposure to community outbreak, travel to hyperendemic/epidemic countries, military recruits

Question 11

live attenuated vaccines (6)

Answer 11

polio, MMR, rotavirus, influenza, yellow fever, varicella zoster

Question 12

causes of esophagitis in HIV and what CD4 count:

Answer 12

candida, hsv(vesicles and round/ovoid ulcers, CMV (deep, linear ulcers), idiopathic/aphthous

Question 13

tx for syphilis and penicillin allergy

Answer 13

doxycycline, for tertiary use ceftriaxone, for pregnancy desensitize with penicillin first

Question 14

symptoms of malaria

Answer 14

cyclical fever with constitutional nonspecific signs and gastrointestinal manifestations with anemia and thromocytopenia on lab

Question 15

common life threatening side effects of HIV therapy

1. didanosine
2. abacavir
3. NRTIs
4. NNRTIs
5. nevirapine
6. idinavir
7. efavirenz, what class?

Answer 15

1. didanosine= pancreatitis
2. abacavir= hypersensitivity syndrome, lactic acidosis, hepatitis
3. NRTI= lactic acidosis
4. NNRTI= stevens-johnson syndrome
5. nevirapine= liver failure
6. idinavir= crystal-induced nephropathy
7. efavirenz = NNRTI, vivid dreams and hallucinations in 50% of patients

Question 16

vaccines for asplenic adult pts and when you should get them

Answer 16

1. pneumococcus: PCV13 and PPSV23 (revaccination with PPSV23 5 years later and age 65)
2. h.influenzae: 1 dose
3. meningococcal and every 5 years
4. influenza: inactivated annually
5. HAV, HBV, Tdap once as a substitue for Td and Tc every 10 years

** when considering splenectomy administer 14 days before or 14 days after the surgery

Question 17

endocarditis associated with UTIs

Answer 17

enterococcus faecalis

Question 18

opportunic infection prophylaxis in HIV

Answer 18

1. PCP

Question 19

cirteria for lyme disease prophylaxis; must meet all 5

Answer 19

1. tick is adult or nymphal ixodes/deer tick
2. attached >36hrs or engorged
3. no c/i to doxy (20% infection rate
4. prophylaxis started within 72 hours of tick removal

Question 20

symtoms of a necrotizing surgical site infection

Answer 20

• pain, edema, erythema spreading beyond site
• systemic symptoms
• parasthesias/anethesia at edges of wound
• purulent, cloudy-gray discharge (“dishwater drainage”)
• subQ gas or crepitus

Question 21

elichiosis, vector, endemic region, symptoms, lab abn, tx

Answer 21

lone star deer tick, southeast and south central US, acute febril illness with AMS and no rash, thrombocytopenia and leukopenia, doxycycline

Question 22

what is ecythema gangrenosum and what organism is it associated with

Answer 22

P. aeruginosa - lesions typically present with small erythematous macule that progresses to a larger nontender lesion with nodules with central necrosis; its caused by bacteria infiltrating media and adventitia of blood vessels

Question 23

why would there be blood in the CSF of a HSV encephalitis patient

Answer 23

if there’s frontotemporal destruction

Question 24

strep pharyngitis and impetigo are associated with what complications

Answer 24

strep pharyngitis = rheumatic fever

impetigo = post strep glomerulonephritis

Question 25

Drug-induced esphagitis is caused by:

Answer 25

tetracyclines, aspirin and other NSAIDs, alendronate, KCL, quinidine, and iron

Question 26

Tx for cat bite wounds:

Answer 26

amox/clav for 5 days (for pasturella), p. multocida is resistant to erythromycin 50% of the time

Question 27

how does osteomyelitis spread in those with arterial insufficieny? how about it kids?

Answer 27

contiguously, not through lymphatics or hematogenous (this is for kids)

Question 28

What do blood cultures show in disseminated gonococcal infection

Answer 28

Can be negative due to fastidious nature of infection