Infectious Disease

Question 1

What causes mononucleosis?

Answer 1

Epstein-Barr Virus (HHV 4)

Question 2

Signs/symptoms of mononucleosis

Answer 2

1. Fever
2. Sore throat
3. Posterior cervical lymphadenopathy
4. Splenomegaly (+/-)
   Also: malaise, myalgias, hepatomegaly

Question 3

Petechial rash seen in 5% of mono, especially if given:

Answer 3

Amoxicillin

Question 4

Diagnosis of mononucleosis

Answer 4

1. Heterophile monospot Ab test
2. Peripheral smear - 50% lymphocytes with > 10% atypical lymphocytes
3. High LFTs

Question 5

Management of mononucleosis

Answer 5

Supportive
Rest, analgesics, antipyretics
Symptoms may last for months
Avoid contact/trauma for at least 1 month

Question 6

Borrelia burgdorferi

Answer 6

Lyme disease

Spread by deer tick

Question 7

Lyme disease is most common in the:

Answer 7

Spring and summer

Question 8

The highest likelihood of transmission for lyme disease is if the tick is engorged and/or has been attached for at least ____ hours

Answer 8

72

Question 9

Expanding, warm, annular, erythematous rash. Classically seen with central clearing or “bulls eye” appearance within a month of tick bite

Answer 9

Lyme disease

Question 10

Rash from lyme disease may be accompanied with viral-like syndrome, including:

Answer 10

HA
Fever
Malaise
Lymphadenopathy

Question 11

Primary symptoms that can be seen with early disseminated lyme disease

Answer 11

1. rheumatologic arthritis (esp at large joints)
2. Neurologic symptoms - HA, meningitis, weakness, Bells palsy, neuropathy
3. Cardiac - AV block, pericarditis

Question 12

Diagnosis of lyme disease

Answer 12

1. Clinical - pts with erythema migrans are often seronegative in early stage
2. Serologic testing - ELISA followed by western blot if ELISA positive
   False positive ELISA - syphillis

Question 13

Management of lyme disease:

Answer 13

Early disease - doxycycline

Late/Severe disease - IV ceftriaxone

Question 14

Lyme Dz prophylaxis

Answer 14

Doxycycline 200 mg x 1 dose within 72 hours of tick removal if tick is present for > 36 hours.

Question 15

Signs/Symptoms of HIV

Answer 15

Fever
Malaise
Generalized rash
Generalized lymphadenopathy

Question 16

AIDS is defined as a CD4 count < _______ cells/uL

Answer 16

200

Question 17

HIV wasting syndrome

Answer 17

Chronic diarrhea and weight loss

Question 18

Diagnosis of AIDS

Answer 18

1. Antibody testing - ELISA followed by Western Blot (confirmatory test)
2. Rapid testing - blood or saliva
3. HIV RNA viral load - used to monitor treatment effectiveness

Question 19

Treatment regimens for HIV

Answer 19

1. NNRTI + 2 NRTIs or
2. PI + 2 NRTIs or
3. INSTI + 2 NRTIs

Question 20

Post exposure prophylaxis for HIV

Answer 20

Raltegravir/Dolutegravir + Tenofovir + Emtricitabine

Question 21

Influenza __ is associated with more severe, extensive outbreaks

Answer 21

A

Question 22

Spreads primarily via airborne respiratory secretions

Answer 22

Influenza

Question 23

Abrupt onset of a white range of symptoms: headache, fever, chills, malaise, URI symptoms, pharyngitis, pneumonia

Answer 23

Influenza

Question 24

Diagnosis of influenza

Answer 24

1. Usually clinical

2. Rapid influenza test (nasal swab)

Question 25

Management of influenza

Answer 25

1. Supportive is mainstay in healthy pts | 2. Tamiflu in needed in pts with high risk of complications (best if initiated within 48 hours of onset of sx)

Question 26

Signs/Symptoms of bacterial meningitis

Answer 26

1. Fever/chills (95%) 2. HA/nuchal rigidity, photosensitivity, N/V 3. AMS, seizures

Question 27

Kernig's sign

Answer 27

Inability to straighten knee with hip flexion | meningitis

Question 28

Brudzinski's sign

Answer 28

Neck flexion produces knee/hip flexion | Meningitis

Question 29

Diagnosis of menigitis

Answer 29

1. Lumbar puncture - definitive diagnosis | 2. Head CT scan - done to r/o mass effect before LP if high risk

Question 30

LP results for bacterial meningitis

Answer 30

High neutrophils, low glucose, high total protein

Question 31

For bacterial meningitis, do not wait to start

Answer 31

Empiric abx!

Question 32

Treatment for bacterial meningitis if < 1 month old:

Answer 32

Ampicillin + Cefotaxime

Question 33

Treatment for bacterial meningitis if 1 mo - 18 years

Answer 33

Ceftriaxone + Vancomycin

Question 34

Treatment for bacterial meningitis if 18 y - 50 y

Answer 34

Ceftriaxone + Vancomycin

Question 35

Treatment for bacterial meningitis if > 50 y/o

Answer 35

Ampicillin + Ceftriaxone

Question 36

Meningitis post exposure prophylaxis

Answer 36

Ciprofloxacin 500 mg PO x 1 dose

Question 37

Diagnosis of viral meningitis:

Answer 37

1. CSF analysis - most important to differentiate 2. MRI 3. Serologies, viral cultures

Question 38

Management of viral meningitis

Answer 38

Supportive care | Antipyretics, IV fluids, antiemetics

Question 39

Most common source of salmonellosis

Answer 39

``` Poultry products (dairy, meat, eggs) Exotic pets (reptiles, turtles) ```

Question 40

Salmonella gastroenteritis

Answer 40

Abdominal pain Fever, cramping Vomiting, mucus + blood diarrhea

Question 41

Management of salmonella

Answer 41

Fluids | +/- fluoroquinolones, ceftriaxone if severe

Question 42

Lower abdominal pain, high fever, tenesmus, explosive watery diarrhea (mucoid, bloody)

Answer 42

Shigellosis

Question 43

Severe cases of shigellosis may lead to:

Answer 43

Toxic megacolon

Question 44

Shigellosis can result in neurologic manifestations especially in young children, such as

Answer 44

Febrile seizures

Question 45

Diagnosis of Shigellosis

Answer 45

1. Stool cultures, fecal WBC/RBCs 2. CBC (WBC > 50,000) 3. Sigmoidoscopy - punctate areas of ulceration

Question 46

Management of shigellosis

Answer 46

Fluids | TMP-SMX if severe, fluoroquinolones