Infectious disease

Question 1

What are the treatment recommendations for acute bacterial sinusitis?

Answer 1

There is general agreement that patients with a duration of symptoms of at least 10 days without improvement should be treated with antibiotics, including both children and adults (SOR C). One set of guidelines calls for empiric treatment with amoxicillin alone; another recommends going directly to amoxicillin/clavulanate.

Question 2

What should be monitored in a patient on IV vancomycin for MRSA?

Answer 2

Trough serum levels of vancomycin, b/c if it dips then can lead to bacterial resistance

Question 3

What is the treatment for acute parotitis?

*Often caused by dehydration

Answer 3

Empiric treatment is directed toward gram-positive and anaerobic organisms, with the most common pathogen being Staphylococcus. Augmentin is a good choice. Treatment should be followed up with cultures. Administration of sialagogues such as lemon drops may be helpful, as well as parotid gland massage.

Question 4

What are the recommendations for 23-valent pneumococcal polysaccharide vaccination?

Answer 4

All patients 65 and over should receive one dose. All persons between the ages of 19 and 64 who smoke should receive this vaccine also. One-time revaccination after 5 years is recommended for persons with chronic renal failure, asplenia (functional or anatomic), or other immunocompromising conditions.

Question 5

What is a good choice of antibiotic for nursing-home acquired pneumonia?

Answer 5

In the absence of collectible or diagnostic sputum Gram stains or cultures, empiric therapy must cover Strep pneumoniae, Staph aureus, H. influenzae, and gram-negative bacteria. Levofloxacin is the best single agent for providing coverage against this spectrum of organisms.

Question 6

What does a positive PPD 10 days following a negative PPD indicate?

Answer 6

A positive result on the second, but the not the first, step of a two-step Mantoux tuberculin skin test indicates long-standing, latent infection.

Question 7

What should be done for a patient with known exposure to hepatitis B?

Answer 7

Administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine now

Question 8

What medication is best for increasing BP in a septic patient after fluid resuscitation?

Answer 8

Norepinephrine (Levophed)

Question 9

What fluoroquinolone is not indicated for the treatment of UTI?

Answer 9

Moxifloxacin attains inadequate urinary concentrations and should not be used in the management of urinary tract infections.

Question 10

How is scabies primarily transmitted?

Answer 10

Through direct contact. Transmission through clothing or bedding is infrequent.

Question 11

What anticholingeric agent has been shown to help with symptoms of the common cold?

Answer 11

Ipratropium is the only nasally inhaled anticholinergic recommended for treatment of cough and rhinorrhea caused by the common cold (does not help with nasal stuffiness though).

Question 12

What antibiotic is recommended for the treatment of bacterial lung abscesses?

Answer 12

Clindamycin (treats pulmonary anaerobes as well as Staph and Klebsiella)

Question 13

What are the treatment recommendations for severe vs mild/moderate C. diff infection if it’s the patient’s first infection?

Answer 13

Oral vancomycin for severe, oral metronidazole for mild/moderate.

Question 14

In a patient with pneumonia and sepsis secondary to influenza, what is the preferred treatment?

Answer 14

Oseltamivir, ceftriaxone, azithromycin, and vancomycin for viral and bacterial coverage including MRSA.

Question 15

What IV drug is effective against C. diff?

Answer 15

IV metronidazole. IV vancomycin does not get to the colon effectively. Vancomycin and fidaxomicin should be given orally (metronidazole, vancomycin and fidaxomicin are the only 3 antibiotics shown to be effective against C. diff)

Question 16

What is the appropriate management if a patient has been bitten by a tick in areas where Lyme disease is endemic?

Answer 16

In areas where there is at least a 20% rate of tick infection, as single 200 mg dose of doxycycline within 72 hours of tick removal is appropriate as prophylaxis for Lyme disease if the tick is engorged or is suspected to have been attached for at least 36 hours.

Question 17

What is the preferred treatment for Campylobacter infection?

Answer 17

Azithromycin 500 mg daily for 3 days

Question 18

How are Salmonella diarrheal infections treated?

Answer 18

Non-severe Salmonella infection and are otherwise healthy is no treatment. Patients with high-risk conditions that predispose to bacteremia, and those with severe diarrhea, fever, and systemic toxicity or positive blood cultures should be treated with levofloxacin,
500 mg once daily for 7–10 days (or another fluoroquinolone in an equivalent dosage), or with a slow IV of ceftriaxone, 1–2 g once daily for 7–10 days (14 days in patients with immunosuppression).