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ABIM > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

MCC bacterial endocarditis

A

staph aureus

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2
Q

Native valve endocarditis

A

Staph aureus, strep bovix, strep gp D (enterococci) -> Vanco/gentamycin empiric

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3
Q

Prosthetic valve

A

staph epi, streptococci, G neg fungi -> vanco, rifampin (clears sticky bugs - staph epi), gentamycin

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4
Q

IVDU

A

staph aur, enteroccus, g neg strep viridans -> vanco + gentamycin

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5
Q

Indications for endocarditis surgery

A

Severe CHF - bacteremia x 6 days (if repeat bcx 48 hrs +, cont abx, repeat ctx, recurrent emboli, valve abscess, large fungal vegetation

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6
Q

Rt sided endocarditis with septic emboli - abx?

A

Daptomycin

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7
Q

Pt with sympt endocarditis - bctx done, vanco/gent started - 72hrs later bctx + strept sens to PCN - abx changed to PCN - gnet d/c’d - reepat bctx still + 24hrs later wtd?

A

continue abx, repeat bctx in 48hrs

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8
Q

IVDA rec with fever, cough hempotysis, pleuritis CP - II/VI SEM - 2-3 nodules on CXR - dx?

A

Rt sided endocarditis -> vanc/gent

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9
Q

Pt fever, +BCtx for clostr sept/ Strep bovis - wtd

A

Colonoscopy r/o malignancy

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10
Q

IVDA suspected for endocarditis vanc/gent started - ctx +PCN enterocci - vanc stopped - pcn started but then with prurtis swelling lip swelling - wtd?

A

D/C PCN start vanc

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11
Q

Vanc develops itching/redness

A

redman’s - slow IV infusion +- benadryl

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12
Q

Pt s/p TURP 2 wks later with fever growing enterococci

A

older men, AV>MV, more CHF less embolic events, more conduction defects - don’t use ceftriaxone (doesn’t kill)

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13
Q

Valve replacement

A

NOT in pt febrile on abx - mild AR EF 60% - BUN cr 25/2 -> immune complex phenomenon - see splinter hemorrhage, janeway lesion, roth spots

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14
Q

Pt treated for endocardtisi defervesces and WBC dec bu twith 1st deg AVB - concerned?

A

yes - r/o valvular abscess - TEE

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15
Q

Pt on imipenum/cilastatin for nosocomial infxn h/o seizure d/o - has dz - related to imipenum?

A

Yes - inc’d incidence of seizures at higher doses

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16
Q

Endocarditis ppx only for high risk procedures in high risk conditions…

A

High risk condition - ALL prosthetic valve, prev h/o endocarditis, congential heart dz, unrepaired CHD, repaired CHD within 6 months, post tx heart WITH valvular dz, repaired CHD with prostesis or patch (forever)
High Risk procedure - likely to cause bleeding->endocarditis - dental extraction, periodontal procedures, root canal, implants
NOT HIGH RISK - GI/GU (only if risk of mucosal damage
Low risk conidtions - ASD secundum, 6 months after repair of ASD/VSD/PDA, prev CABG/HOCM, PPM, MVP with murmur MS/AS, fxn murmur
Low risk procedures - cavity filling, endotrach intub, bronch all GI/GU, vaginal hyterectomy, D/C C section, IUD, cath, circumcision

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17
Q

Endocarditis ppx

A

Amox 2g po 1 hr prior, if no PO then amp IV, PCN all - azithro, post procedure - > NOTHING

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18
Q

Pt witih PDA going for cystoscopy

A

NO ppx

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19
Q

Pt with bacteremia s aur due to IV line - vanc started wtc

A

TTE - neg tx x 2 weeks, + tx 4-6 weeks

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20
Q

Pt with susp diverticulitis pw f/c/abd pain - 3 days later temp 101, catheter site clean wbc 17K - wtd

A

vanc/imipenum

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21
Q

obesity with vanc

A

1.5g IV q12h

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22
Q

Surgical site infxn ppx

A

IV abx 1 hr prior to surgery/24 hrs after

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23
Q

35yo IVDA fever/chills wit hmurmur, vegetation on TV bctx MRSA - tx?

A

Daptomycin

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24
Q

Empiric tx meningitis

A

Head trauma/NSx - staph aur MRSA, S pneumo, G neg bacilli - vanc + ceftazidme
60yo Listeria, S pneumo, neisseria -> Ampicicillin (listeria), CFTtx (S pneumo), Vanco (MRSA)
15yo - S.pneuo, neisseria, h flu -> Ceftriaxone
2 month - strep agalactiae, E. Coli, Listeria - Ceftx + ampilcillin (listeria)

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25
Q

Normal CSF

A

<5cells, lymph, Gluc 40-80, Protein 15-45

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26
Q

Bacteria CSF

A

10-100K cells, PMNs, dec gluc, inc protein, inc opening pressure

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27
Q

West nile CSF

A

10-1K cells, Lymph, dec gluc, inc protein, muscle wk, rash, dec DTR

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28
Q

TB CSF

A

10-1K, lymph, dec gluc, very inc protein,

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29
Q

Aseptic CSF

A

10-2K, lympoh normal gluc, inc to normal protein, enterovirus, OKT3, NSAIDS, bactrim

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30
Q

Early bacterial CSF

A

10-1K, lymphs > PMN, dec gluc, inc protein, CSDF to ser glu <0.4

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31
Q

Encephalitis CSDF

A

1-2K, lymph, normal gluc, normal to inc protein

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32
Q

HSV enceph CSF

A

1-2K, lymph, N gluc, n to inc protein, +RBC 1:1 ratio

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33
Q

70yo Pt with DM p.w mental status change spinal tap with many WBCs mainly PMN G stain neg ctx pending wtc

A

ceeftx + vanc cover resistant strep pneumo + ampicillin cover listeria

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34
Q

55yo post renal tx on steroids pw fever, neck stiffness with g po rods diphteroids in csf; PMN 65% and lymphs 35% - dx?

A

Listeria - tx ampicillin + gentamycin (bactrim if PCN all)

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35
Q

24yo M neck pain, h/a, neck sign + spinal tap WBC 105, lymphs no RBC gluc 50 - cause?

A

entero/echo virus meningitis

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36
Q

Causes of aseptic meningitis

A

OKT3 ab, NSAID, bactrim, echo/enterovirus

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37
Q

70yo COPD PNA twice in 1 year p/w cough, fever, chills, MS change - WBC 17 PMN, LLL consolidation, CTH no bleed - spinal tap WBC >20K, PMN, dec gluc, inc protein, gram stain cocci in pairs - wtd?

A

empiric thx - ceftriaxone + vancomycin + dexamethasone

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38
Q

37yo woman solid organ tx couple weeks later with diarrhea/low grade fever then photophobia, h/a confusion - temp 102, CSDF 250WBC 55% PMN, gluc 35 - g stain neg - empiric tx?

A

ceftriaxone + ampicillin (listeria)

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39
Q

Pt with meningitis - LP WBC 75, gluc 28, elev protein - elev OP - crypt ag neg, g stain neg - tx for?

A

bacterial meningitis empirically

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40
Q

16yo MS change, fever BP 80/60 - exam midline scar abdomen - lab leukocytosis - h/o MVA 2ya splenectomy

A

organism - s pneumo (capsule)

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41
Q

Meningitis by h&P - wtd

A

IV abx - do not wait!

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42
Q

Pt with h/a x 2 days - now dizzy, lethargic - meningieal + sign - 7th episode in 6 years dx - CSDF granular cells?

A

beningn recurrent lymphocytic meningitis - HSV-2 - supportive care only (antivirals no benefit) - Mollarett’s meningitis

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43
Q

Fever, h/a, vom/seizure - smelling fishy odor/burning rubber, auditory hallucination - MR brian hyper intensity temporal lobe -> EEG sharp and slow waves temporal lobe - LP WBC 200 lymphs, gluc 45, protein 75 RBC 65! dx?

A

Herpes encelphalitis - IV acyclovir

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44
Q

70yo h/a, fever x 5 days, confused, ocular pain, diplopia - hiking partner similar sx which resolved - mild neck signs + or focal wk one side body DTR absent - LP WBC 55, 100% lymph, protein 90 gluc 50 wtd

A

WNV IgM ab check - prognostic factor is age - >75 is bad

Reservoir - birds, transmitting agent=mosquitos

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45
Q

Pt fever h/a x 2 days - neck stiffness WBC 8800 68% PMNs - 8% bands - spinal tap WBC 85 54% PMN 33 lymph RBC 0 - gluc 26, protein 68

A

early bacterial meningitis

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46
Q

20yo F college with tonic clonic sz - h/a and strange behavior x 1 week with anxiety/paranoid behavior, no psych/drug abuse hx - orthostatic hypotension, choreform movements difficulty choosing words - CSF 40WBC 96% lymph, 3 RBC, gluc 62, protein 30 CTH normal - tx’d for HSV enceph no improvement HSV PCR neg - dx?

A

NMDA rct encephalitis

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47
Q

H/A confusion, petechial maculopapular rash - CT neg, LP WBC >2K - PMN and low gluc - G stain G neg diplococci - meningiococcal meningitis - tx with ceftx 3 days later hypotensive shock

A

b/l adrenal hemorrhage -> IV hydrocortisone

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48
Q

Who to PPX for meningitis

A

prophylax day care/nursery school contacts, household contacts

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49
Q

How to PPX meningitis

A 
rifampin 600po BID x 2 days
If no rifampin cipro x 1 dose
If on OCP - change contraception while on rifampin
If preg ceftx 250mg IM x 1
Droplet precautions
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50
Q

Pt tx’d for meningiococcal meningitis since yesterday - how long continue isolation

A

D/C isolation now

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51
Q

52yo M p/w h/a - fever/neck signs - spinal tap elev open press, WBC 45 lymphs, protein 52, gluc 65, abx coverage for strep pneumo and hsv - 2 days later ctx neg, HSV pcr neg

A

d/c all meds and d/c home

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52
Q

HSV-2 causes…

A

aseptic meningitis - and can be accomopanied by gential ulcers and HSV-1 encephalitis

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53
Q

UTI

A

cystitis -> mostly ecoli - young women, staph saprophyticus, epi
Pyelonephritis
Catheter relted
Prostatis

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54
Q

Uncomplicated cystitis

A

3 days nitrofurantoin/bactrim/cipro - if sx persist >3 days c/s tx x 7 days

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55
Q

Cystitis in pregnancy

A

nitrofunatoin or amoxicillin x 7 days

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56
Q

Asx bacteruria in pregnancy

A

TREAT

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57
Q

Asx bacteriuria in DM

A

DO NOT TX

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58
Q

Asx bacteriuria post transplant

A

TREAT

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59
Q

Asx funguria with foley

A

DO NOT TREAT

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60
Q

asx bacteriria in foley

A

DO NOT TREAT

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61
Q

Recurrent cystitis

A

c/s and tx then suppressive regimen (bactrim/cipro)

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62
Q

Pyelonephritis

A

chills, fever, flank pain, tenderness, inc WBC urine

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63
Q

24yo F fever, chills, flank pain dysuria inc freq urin - +flank tenderness, +u/a 40WBC

A

tx cipro 7-10 days (quinolong)
if preg - admit and start ceftriaxone or amp + gent
If still temp in 3 days - renal US r/o structural abn
PCN allergy - aztreonam

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64
Q

32yo flnak pain, UA WBC >20 with many bacteria temp 102, HR 110 - started on amp-sulbactam - 3 days later pt eating/ambulating temp 99 HR 86 - grows ESBL E.coli and BCtx g neg rod -

A

still ok to d/c change to amox-clavulanate (augmentin)

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65
Q

Elderly male dysuria inc freq, tender prostate

A

Acute prostatitis - E.Coli

Tx: bactrim or quinalone (cipro) 4-6 wks

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66
Q

NH pt with foley and recurrent UTI - ppx?

A

nothing effective

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67
Q

Pt with foley - urosepsis -

A

change foley, start abx

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68
Q

NH pt with stroke, chronic foley with urosepsis several times/year - minimize risk of UTI?

A

close drainage catheter system

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69
Q

When is foley justified in elderly pt to promote healing

A

Stage IV sacral ulcer

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70
Q

STD - Gonnococcus, Chlamydia

A

no ulcer, no adenopathy, +discharge

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71
Q

Gonococcus

A

tx ceftriaxone

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72
Q

Chlamydia

A

Tx doxycycline or azithro

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73
Q

GC & Chlamydia

A

ceftriaxone + azithro 1gm or Azithro 2g one dose

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74
Q

Presentation GC/Chylamydia

A

urethritis, epidiymitis, mucopurulent cervicitis, dysuria, pyuria without bacteriuira, PID, diss gonococcal infxn (DIG)

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75
Q

24yo F college student sexually active with fever, chills.n,v x 3 days no vaginal d/c, tmep 102, HR 106, MM dry, left flank tenderness, mild suprapubic tenderness - no cervical motion tenderness - preg test neg

A

Admit - bctx, tx with IV cipro or bactrim

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76
Q

Vaginitis - Trichomonas

A

yellow d/c, strawberry cervix, pH>5

tx - metroniidazole 2g x 1 dose -> TX PARTNER

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77
Q

Bacterial vaginosis (gardnerella)

A

think d/c, clue cells, fishy odor pH>5
Tx Metronidazole x 7 days (whole garden - tx many days) - or metronid gel x 5 days, or clinda cream x 7 days - DO NOT TX PARTNER

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78
Q

Candidiasis

A

not smelling, thick white d/c
Tx - fluconazole 150 x1, topical clomazole x 3-7 days
tx partner only if balantitis present

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79
Q

pt with scanty foul smelling dc OTC vag azole and oral fluconazole don’t work - wtd?

A

NOT Candidasis - treat for gardenerella/trichomonas with flagyl or clinda po or cream - check vaginal pH - if scraping bleeding - chlamydia

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80
Q

Pt with dysuria - d/c on exam - UA WBC and clue cells - tx?

A

metronidazole (bacterial vaginosis)

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81
Q

PID

A

lower abd pain, CMT, adnexal tenderness, mucopurulent d/c, uterine tenderness
Etiolgoy - Neiseria gonorrhea, chlamydia, vaginal anaeroboes

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82
Q

Complications of PID

A

infertility, ectopic preg, perihepatitis, tuboovarian abscess

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83
Q

Tx of PID

A

Outpt - Ceftx 250 IM, dox 100 bid x 2 weeks (PCN ofloxacin +clinda/flagyl)
Inpt - vomiting/sev pain - cefoxitin/cefotetan + doxy 100mg bid x 2 weeks (PCN allergy - clinda/flagyl + genta + doxy)

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84
Q

25yo F p/w progressie lower abd pain for past 4 days with nausea, vomiting, fever - denies dysuria or flank pain - temp 101, HR 100 lower abd tenderness - cervical d/c and CMT on exam - WBC 17, 70% pmn - ctx P

A

Admit and tx with IV cefoxitin iv doxy for PID (not tolerating PO)

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85
Q

24 yo sexually active man with uretheral d/c - given ceftx 250 x 1 and d/c 10 days later with uretheral d/c - wtc?

A

chlymida (gonnorrhea treated) - doxy 100 bid x 7 days or aithro 1g x 1 - always tx for both gonorrhea and chylamydia
Gonorreha (2-6 day incubation)
Chlymydia (1-4 wk incubation)

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86
Q

Young woman on OCP, sexually active with yellow mucoid dc - exam non-tender but bleeding and cervix erythematous swollen - smear with wbc bacteria no hypahe - organism?

A

Chlamydia

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87
Q

20 yo F dysuria x 1 week - no fever or flank pain - pelvic exam no CMT no bacteriuria, wbc 20/hpf pyuria

A

dx chlamydia - check urine nucleic acid

tx doxycycline or azithro

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88
Q

Repeat chylmydia test

A

false + (test neg after 3 weeks)

>3 weeks - true positive retreat pt and partner

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89
Q

Student on spring break - p.w tenderness in posterior testes 1 week later - striping of urethra with d/c

A

chlamydia epidiymitis - tx azithro

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90
Q

24yo F sexually active pain on movement of wrist joint - single pustular lesion on dorsum of hang, swollen right knee - greatest yield of culture from…

A

cervical culture or history

do not need parents permission to tx STD

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91
Q

Gay pt c/o constipation, pain on defication and generlized wk - ulcer in perieal area - ulcer in anal canal on anoscopy - dx?

A

HSV

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92
Q

Pt with acute testicular pain - h/o several sexual encounters - no truam - US normal - dx of epidiymitis - organism?

A

35yo E.Coli, entero

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93
Q

Uncircumcised pt wit pearly penile papules wtd?

A

do nothing

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94
Q

Genital ulcers

A

HSV, syphilis, H ducreyi, Lymphogranuloma venerium, granuloma inguinale

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95
Q

Pt with painful ulcers - started as grouped vesicles - lymph nodes +- -> fever, h/a, myalgias

A 
HSV (DNA virus)
Tx - 1st episoe - acyclovir x 10 days
2nd -> acyclovir x 5 days
recurrent >6/year - acyclovir ppx
severe dz - iv acyclovir - reduces duration of sx and asympt viral shedding
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96
Q

Pt w/ painful genital ulcers, irreg borders initially started as tenderpapules painful adenopathy fluctulant -> rupture - schools of fish/boxcar - GRAM NEG Bacillus

A

H. ducrey -

tx - ceftrx 250 IM x1 or azithro 1gm x1 or erythro 500 x 7 days

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97
Q

Pt with PAINLESS gential ulcer - disappears in 1 week - 2-6 weeks later LAD - buboes, fistulae rectal scaring

A 
Lymphogranulum venerum (LGV) - Chylymia tracho
tx - Doxy 100mg bid x 21 days
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98
Q

Pt with terrible looking PAINLESS ulcers on penis + LAD looks like penile CA

A

Granuluoma Infuinale - klebsiella granulomatis
Micro: Donovan bodies - bipolar safety pin intracytoplasmic inclusions
Tx - Doxy x 21 days or bactrim/erythro

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99
Q

Young woman 4 montsh ago with PAINLESS genital ulcer - dark field +, RPR neg at time - tx’d with PCN now p/w sever small ulcer - tender RPR 1:8 -

A

has herpes infxn - acyclovir

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100
Q

Asx pt RPR screening 1:8 postive FTA +

A

If pt RPR neg last year->early latent syphilis-> benz PCN 2.4 mu x1
If Pt RPR neg >1 yr ago -> late latent syphilis - 2.4 mill units wk x 3

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101
Q

Pt with painless genital ulcer raised with indurated margin and clean base wtd?

A

Dark field microscopy

tx - benz PCN 2.4 units x1 or doxy x 14 days

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102
Q

Pt with fever h/a generalized adenopathy, maculopap rash palms/soles, ele ast/alt alk phos, hereophile Ag neg, elisa neg, HIV RNA <50 wtd

A

VDRL/RPR to r/o 2ndary syphilus - FTA+ for life
tx - Benz PCN 2.4 mu x 1
if repeat VDRL titer dec 4 fold tx sucess
If repeat VDRL inc/stay same -> LP to r/o neural sypilis

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103
Q

40yo for regular checkup - pupils 4mm when figer to nose, eyes converge and pupils 3mm, flashing light left pupil doesn’t constrict - Arygl robertson pupil

A

Spinal tap VDRL r/o neuro syphilus

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104
Q

Spinal tap WBC 410 lymph VDRL +, high protein, gluc 60 - wtd?

A

PCN G 2m units Q4h x 2 weeks
If PCN allergic - desensitize in ICU
repeat spinal tap q6m till WBC normal

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105
Q

Pt dx with syphilis started on PCN couple hours later with HA/fever, myalgias - BP 90/70, HR 104

A

Jarisch Herxheimer rxn - wtd?

Bed rest, ASA, continue PCN (NOT ANAPHYLAXIS)

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106
Q

45yo M h/a, difficulty walking, imbalance, fever double vision - HIV CD4 395, VL<24 dx?

A

neurospyphilis - spinal tap VDRL

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107
Q

Tick borne

A

RMSF, Lyme, Erlichia (anaplasma), babesia, Tularemia, STARI (southern tick associated rash illness)
ONLY ONE WITHOUT RASH COMMON IS ERLICHIA**

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108
Q

22yo N carolina camp c/o h/a, fever, myalgia 3 days later macular rash extremities - next day petechial

A

NMSF - doxycycline/tetracycline

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109
Q

57yo M cramping p/w complaint of h/a, fever, myalgias can’t recall tick bite - exam low grade temp, mild confusion no rash - WBC 2.5, Hg 13, plt 60 AST/ALT eleve 150/120 - cause?

A

Erlichia - anaplasma - only one without common rash!

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110
Q

Pt vacationing nantucket/long island p.w fever, shaking chills, drenching sweats NO RASH - blood smear ring forms, maltese cross, tetrads - Hg dec inc retic (hemolysis) dx?

A

Babesia
Tx - mild form - Azithro + atoquone
Severe - Quinine + clindamycin

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111
Q

Pt at MD office in NJ with skin lesionon thigh, erythematous lesion w/ central clearing - lesion smaller few days ago dx?

A

erythema migrans - secondary lyme (serology not reliable - clinical dx)
Tx - doxy, if preg then amox (fever, h/a LAD, arthralgia)

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112
Q

Pt fishing onnantucket - rash on leg which disappeared few days later - 2 wks later pt with dizziness - ii/iii heart block

A

Lyme secondary - cardiac
Tx: PCN/Ceftx (NO DOXY)
Cardiac I/II/III heart block
Neuro: aseptic meningitis, bell’s palsy, foot drop

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113
Q

Pt with disseminated or late stage lyme usually has…

A

western blot IgG banding+ > 5 bands

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114
Q

22yo wk left foot, no trauma - hiking several weeks ago with as rash cleared in few days doesn’t recall tick bite - dec power L foot, dec reflexes L foot dx?

A

Foot drop 2/2 lyme dz stage II

Stage II months to years later - presents as monoarticular arthritis or chronic neuro sx

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115
Q

Pt hiking in NE on friday, found tick monday - no rash no sx

A

> 24hr with tick - doxycycline even if asx

if < 24 hrs with tick can observe if asx

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116
Q

Pt hiking NE for bird watching - p/w facial palsy - cluster of vesicular eruption over auditory canal - dx?

A

Herpes zoster - DNA virus

tx - acyclovir

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117
Q

40yo F refereed with rash, central clearing - tx’d with doxy x 3 weeks - rath better but then malaise - to urgent care center repeat doxy x 2 week - f/u at MD office - 7/10 IgG bands _ and all bands + IgM

A

Post lyme syndrome - takes 6 months for sx to resolve

Tx - reassure do not retreat

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118
Q

Pt p.w tick attached - wtd?

A

place forceps at base of tick and lift gently

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119
Q

22yo Pt hiking in wisconsin - to ED with new onset weakness, DTR absent, denies tick bite - wtd?

A

search scalp for tick - tick paralysis better in hours once tick removed

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120
Q

Elderly pt with fiery red, well demarcated cellulits on face

A

Erysipelas - strep - cocci in chains
Tx - PCN
Complication - endocarditis

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121
Q

Female from singapore, honey crusted lesions mouth and chin - dx?

A

Staph infxn - impetigo

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122
Q

Strep throat complication

A

Acute glomerular nephritis

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123
Q

Pt with cellulits of leg, started on cephalosporin 1st gen - 72hr later cellulitis worse no brawny edema or bullous lesions, no DM wtd?

A

D/C cephaloporin and start bactrim, vanc or clinda

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124
Q

32yo cellulits on left leg wtd?

A

bactrim and cephalexin (cover MRSA and strep)

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125
Q

Invasive MRSA commonlypresents as ?

A

Bacteremia

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126
Q

Daptomycin used for G pos organisms including MRSA (not for PNA) - what to follow in pt on dapto?

A

CPK weekly

127
Q

Pt with venacaval filter placed - 48hrs later p/w erythema at inciision site diffuse rash hypocalcemia, hyponatremia, inc Cr dec BP, fever - wound gram stain neg

A

Toxic shock syndrome
Strep - early onset 24hrs - culture usually neg
Tx - surgical debridement - PCN+clindamycin

128
Q

Pt slipped and hit leg on bed railing in hospital, or Pt fishing and scraped arm 2 days later BRAWNY edema and severe tenderness with erythema - next day BULLOUS lesions - aspiration of bullae -> G+ cocci - started on IV abx - Pt hypotensive - on clinda and 1st gen cephalosporin

A

dx? Group A strep necrotizing fascitis
WTD?
Surgical consult!
MRI scan to confirm (best for soft tissues)

129
Q

Least likely cause of toxic shock syndrome

A

nursing home pt wearing diapers

caused by tampons, post op wound, breast implants, nasal packing

130
Q

Pt Gulf coast/florida (warm waters) p.w cellulitis with hemorrhagic bullae and necrosis +LN dx?

A

Vibrio vulnificurous (loves iron) - liver tx patients at inc risk with raw shell fish
tx - aggressive debridement
3rd gen ceph or tetracyclin/gentamycin

131
Q

Pt (fish tank clenaer/swimming instructor) - p.w non-healing skin ulceration - started as single lesion on hand now multiple lesions forearm - bx AFB + dx?

A

Mycobacterium Marinum

Tx - Clarithromycin+ethambutol +- rifabutin

132
Q

Pt with cut while in fresh water now leg swollen, septic and has h/o ETOH LIVER DZ - what is bacteria?

A

Aeropronas hyophillia

133
Q

Florist/gardener p/w multiple nodules on hand and formarm - lymphatic channels - dx?

A

Sporotrichosis - sporothrix schenkii
Tx: local dz - itraconazole
Disseminated - amphot B (DM transplant pts)

134
Q

Pt p/w folliculitic rash - h/o Jacuzzi/bath tub - dx?

A

hot tub rash - pseduomonas - improperly chlorinated hot tub

Tx - self limited no tx needed

135
Q

Pt with cough, CXR infiltrated with thin walled cavity - indoor hot tub 3 days/wk dx?

A

MAI - Hot tub lung - avoid hot tubs

136
Q

Pt on chemo becomes neutropnic - develops cellulitis black lesion with central ulceration - dx?

A

Ecythema gangrenosum 2/2 pseduomonas

Tx - anti pseduomonal b lactam + aminoglycoside/cipro or imipenum (collistin/polymysin)

137
Q

Least likely about pseudomonas

A

CANNOT BE TREATED WITH AMP-sulbactam
(can cause malig otitis externa in DM, osteomyelitis in nail pct, endocarditis in IVDA, sepsis in neutropenic, ecthema gangrenosum, hot tub folliculitis)

138
Q

50yo HIV p.w vesicular lesions on one side of face including ext aud cana with burnign pain - scrapings with multinucleate giant cells wtd?

A

IV Acyclovir

139
Q

Pt p/w burning sensation over R forehead x 36hr - hyperesthesia over R forehead and single vesicular lesion on erythematous base on tip of R nose - what is WORST complication

A

Zoster ophtalmicus - Optho referral

slit lamp no corneal invovlment - started on valacyclovir - continues to have pain -> start prednsone

140
Q

Post herpetic neuralgia tx

A

Desipramine>gabapentin

141
Q

Isolation for herpes zoster?

A

Single dermatome - contact isolation

2 or > then contact and airborne

142
Q

Herpes zoster with single rash

A

72hrs supportive care
>72hr and HIV treat
>72 hr Age>50 if new lesions appearing only then tx

143
Q

65yo M herpes zoster vaccine - precautions for caregivers that never had chicken pox?

A

None

144
Q

Non-Tb mycobacteria

A

MAC/Kansasii - common lung infx - hot tub lung
Abscessu/chelonae.fortuitum - water use, cutaneous/implnat infxn osteomylelits
Marinum - fresh and salt water

145
Q

Non-healing cellulitis or infxn post breast implant -

A

M. Absessus

146
Q

Non-healing cellulitis in pt with pedicure

A

Marinum, Fortuitum

147
Q

Small Pox

A

Pharynx/face->extremities and trunk
Rash-> Vesicles-> pustules evolve CONcurrently
contagious, until all scabs formed and fall off, direct contacts with fever need quarantine, vaccine available

148
Q

Chicken pox

A

Chest and back
Rash->vesicles-> pustules evolve in crops, diff stages
contagious, until all scabs formed and fall off, direct contacts with fever need quarantine, vaccine available

149
Q

24yo brings 5yo daughter with small pox - she is worried about 20yo son who si scheduled for chemo for leukemia - new PA can’t remember if he had small pox as child - wtd?

A

Child with immune def -> VZIG (highest risk)
Pregnant mother-> check titer if VZIG low - tx for symptoms
PA - check titer and vaccine if neg

150
Q

Pt with lesions on extremities in diff stages (vesicle, pustule, escar) MC complication

A

PNA

151
Q

Nurse/resp therapist with vesicular lesions on finger with erythema.tenderness - pet kitten at home

A

Herpetic whitlow - HSV -> tx with acyclovir

152
Q

Young pt fever, malise sore throat followed by vsicular lesion on tongue, buccal mucosa -> later with painful vesicle lesions on dorsum of hand and foot

A

hand foot mouth dz -> coxsaxie virus

153
Q

Pustules on palms after petting at fair or wild dog - dx?

A

Monkey pox

154
Q

Week after hiking and staying at high elevation cabin NW - recurrent feverwith h/a, myalgia, arthralgia, chills, vom, abd pain - dx?

A

Borrelia hermsii (tick born illness in W US)

155
Q

SW pt p.w sudden resp failure, pulm edema and inc’d HCT

A

Hanta virus - yosemete

156
Q

Pt bit by cat - wtd?

A

Augmentin (Amox/clav) - pasterella multiloci + anaerobies (also for human and dog bites)

157
Q

Pt h/o splenectomy for ITP plays with pet dog sustains scratch/ac - hypotensive next AM dx?

A

Septic shock 2/2 CAPNOCYTOPHAGA CARNIMORSUS

158
Q

Pt with tooth ace, +submandicbular LN PCN allergic wtd?

A

Clindamycin

159
Q

Pt with cat pw pustular lesion on hand and tender LN in axilla dx?

A

Cat scratch dz -> Bartonella Hansleae

Tx Doxy/erythro

160
Q

HIV pt with multiple nodular lesions on extremities - ASTinc ALT inc, bx -> modifed silver stain +, warthin starry organisms+ - liver peliosis hepatis (cystic spaces with blood)

A

Dx bacillary angiomatosis -> bartonella henslae

Tx - doxy/erythro

161
Q

Pt with HIV, T cells 150/cm homeless - lives in shelters and streets - with itching and excoriations of skin - pt disheveled - AST/ALT ELEVATED, spiking temp - holosystolic murmur at apex dx?

A

Bartonellosis endocarditis - trench fever 2/2 bartonalla quintana

162
Q

Rabies vaccin/immune globulin for…

A 
dog bite
bat bite/scratch
fox bite
racoon bite
NOT rat bite
163
Q

Pt with dog bite in mexico - rabies vaccine 1 year ago

A

Vaccine x 2 doses (no HRIG)

164
Q

Malaria - P. Falciparum

A

resistant almost everywhere

165
Q

Malaria P. falciparum sensitive and others

A

caribbean, central america, near east

166
Q

Malaria ppx

A

1 wk prior and 4 weeks after return arrival - mefloquine, atovaquine, chloroquine

167
Q

Malaria tx

A

Quinine + doxy
Atovaquone/proguanil or cloroquine + primaquine
quinine gluconate+clinda
or arteminiin-amodiquine

168
Q

Look at red book pg 239

A

Malaria endemic areas and other endemic dz

169
Q

PT returns from nigeria trip - 2 wks later c/o shaking chills/fever, drenchign sweats then comatosed - retic 4% - gametocytes and dx cerebral malaria

A

Quinidine gluconate and doxy

170
Q

Pt fever chills after nigeria 4 weeks ago - most sensitive test fo rmalaria

A

Ag base malaria rapid dx test

Best tx - artemether-lumefantrine (less s/e)

171
Q

Pt did not take mefloquine for ppx now with malaria - wtd?

A

malarone (atovaquone/Proguanil)

mefloquone can’t be used with cardiac conduction dz

172
Q

Pt ER in NY with fever, rash mylagias retro orb h/a - vacation in florida keys, temp 101, HR 95 - faint MORBILLIFORM rash on trunck, few petechiea - plt 55K, WBC 4.5 - dx?

A

Dengue (bone breaking fever - hemorrhagic fever, mosquito borne, low plts, plasma leakage, low BP - n/v/f/diarrhea/GIB

173
Q

Pt with lower abd pain, pelvic exam adnexal tenderness, cervical motion tenderness retained IUD wtd?

A

remove iud, ampilcillin/PCN

174
Q

Actinomyces

A

sulfur granules, branching filaments

175
Q

Pt with extensive dental caries p/w tenderness over mandible - diff opening mough, brawn edema over upper neck with tenderness dx?

A

Ludwigs angina
etio - peptostreptococcus, mixed anarobes
Tx - Amoxicillin-clavulante/amp-sulbactam

176
Q

Neutropenic fever
bugs - staph au
Pseudomonas
aspergillus

A

absolue PMN<500 sp.p chemo p/w fever,
start on GCSF - cover G neg/pseudomonas - B lactam (ceftazidime or cefepime with amionglycoside
OR imipenum -
Add Vanc
Spikes on 7th day still - Amphotericin B - if renal failure voriconazole

177
Q

Which antifungal improve mortality for ppx post chemo neutropenia

A

Posaconazole (noxafil)

178
Q

Tx infections

A

4 month - fungal - cryptococcus

179
Q

complication of BK virus

A

BK virus nephropathy

180
Q

Pt s/p chemo - neutropenia and fever - pt started on vanc, primaxin 5 days later still fever - LLL infiltrate dense core gg appearaance with halo sign - dx?

A

Aspergilllosis - amphotericin B

if Cr elev - voriconazole

181
Q

what is + in aspergillosis infxn pt

A

Serum galactomannan (aspergillous antigen - can be tested for as screen)

182
Q

55yo renal tx - rejection 2 weeks later on immunosupp drugs - tacrolimus added - several months after - GG intranuclear inclusions in urine

A

BK virus - ground glass intranuclear inclusions urine

183
Q

2 months post tx pt with fever, cough not responding to levofloxacin x 1 week - PO2 65, CXR b/l infiltrates - CMV+ b4 tx - lung bx - intracytoplasmic inlusions - dx/tx?

A

Ganciclovir, CMV immuneglobulin

184
Q

Norcardia

A

lung skin, brain lesions - branchig/filiment, gram +, weakly acid fast
tx: sulfonamides - TMP-SMZ - if Cr increases this is NOT RENAL COMPROMISE

185
Q

HIV pt 25 t cells VL 22K p/w fever/cough CXR thin walled cavity in RLL - BAL grows CMW, candida, HSV, norcardia - tx pt with…

A

Bactrim for norcardia

186
Q

Pt with liver tx on high dose steroids and immunosuppresves - or SLE pt on steroids cough, fever, n/v - skin with nodular lesion - CXR nodular lesion - CT brain ring enhancing lesion

A

Nocardia

187
Q

Osteomyelitis

A

hematogenous - long bones (children), vertebrae (adults)-tx with nafcillin
Contiguuous spread/DM foot - polymicrobial - broad spec abx
Prothetic implants - staph epi -> vanc, gent, refampin (sticky)
Necrotic bone (sequestrum)->chronic osteo->debridement (will return with just abx)
Sickle cell witih osteo -> salmonella>staph

188
Q

MCC osteomyelitis in US

A

Staph aureus

189
Q

Older adult with bacteremia p/w fever, lower back ache, point tenderness on spine

A

verebral osteomyelitis

tx - bctx, imagaing ct/mri, abx for 4-6 weeks

190
Q

How to dx infection prosthetic hip 3 months post op

A

CT guided asp and culture

191
Q

Pt with UTI, BCtx pos - Tx with IV abx, on TLC, 3 days later spiking temp, confused - hyper-reflexia in lower extrem and hyporeflexia in UE - CSF gluc 80, protein 295, WBC 75 60% pmn - dx?

A

Spinal epidural abscess

192
Q

pt s/p chemo, no hs mets, recovering from neurtropenia with high fever - nodules on liver in CT dx?

A

hepatosphere candidiasis

193
Q

Pt poorly controlled DM with bloodly nasal d/c - BLACK NECROTIC SPOT ON NOSE - rednes one ye - bx of lesion - FILAMENTS BRANCHING right angles

A

Murcormycosis

Tx: surgical debridement + amphotericin B

194
Q

Pt with CRF on HD with recurrent staph aureus infxn - MRSA infxn from infected catheters - sucessfully treated with vancomycin IV in past - recent infection with staph not responding to vanc x 3 days

A

do epsilon e test measure MIC - if >2 then GISA or Vanc insensitive staph ->
tx Linezolid or quinupristin/dalfoprisitn

195
Q

Pt started on abx for pos bctx enterobacter - pt defervesces, feels better on 6th day spiking - pt ctx positive for enterobacter now resistant to abx

A

what abx? cephalosporin

196
Q

Pt with enterobacter infxn sensitive to cephalosporins - few days later enterobacter now resistant - what happened?

A

Plasma mediated resistance - ESBL mutans

tx - meropenum>imipenum>ertapenum (low threshold for resistance)

197
Q

Pt growing ESBL klebsiella resitant to impipenum - wtc

A

polymyxin (elev cr)

198
Q

Pt with UTI with ESBL sensitive only to colisint and tigecycline wtd?

A

Colistin only - tigecycline does NOT penetrate GU tract

199
Q

Best management for stenotrophonas (xanthomonas) maltophilia

A

bactrim

200
Q

What organism can be treated with abx without d/c central line?

A

staph epi (only remove for g neg rods)

201
Q

Best way to do BCx on pt with central line

A

timed pair BCtx from both peripheral blood and catheter

202
Q

Pt in ICU starts spiking temp of 102F, abx started, TLC changed over guide wire and tip sent for ctx - next day tip ctx grows Gram neg rods sensitive to Abx - pt better temp 100.5 wtd

A

REPLACE central line with fresh stick - continue abx

203
Q

Pt in ICU with central line > 3 days ago with high fever and sepsis

A

dx - nosocomial line sepsis - d/c line and start vancomycin and amionglycoside

204
Q

Best way to prevent central line infection

A

maximum barrier protection while insertion

205
Q

Best way to prevent nosocomial infection outbreaks

A

hand washing

206
Q

best way to prevent vent associated PNA

A

elevation of bed 45 deg,

207
Q

15yo pw low fever, sore throat fatigue myalgia and cervical LAD - petetchiae on palate no phalangial lesions - monospot neg for heterphile abs - wtc

A

check EBV viral caspid antigen (VCA IgM)

208
Q

Ampilcillin taken -> gets morbilliform rash - organism?

A

EBV - hypersensitivity rxn to abx - only occurs in presense of EBV infxn though…false neg monospot

209
Q

pt withi +LN, monospot +, inc SOB, large tonsils - wtd

A

steroids…

210
Q

Pt with infectious mono and LUQ pain wtd?

A

CT scan stat - splentic rupture

splenectomy

211
Q

Pt in MICU on IV TPN x days with fever, chills opthalmitis - etology?

A

candida - chromium deficiency

212
Q

Candida in BAL

A

DO NOT TX

213
Q

Asymptomatic Cadiduria

A

DO NOT TX

214
Q

Asymptomatic candida in blood

A

TREAT THIS!!

215
Q

Pt grows candida in blood, fluconazole d/c’d 2 weeks ago wtd?

A

start caspofungin

216
Q

Anthrax

A

Skin form - necrotizing form rare - animal hides
GI - ingestion with sever diarrhea
Inhalational - non-sp sx, h/a, chills vomm, sob, hemorrhagic meningitis pre-terminal - CXR with widened mediastinum (spores taken up by lymphocytes) - preterminal

217
Q

Anthrax tx

A

Flouroquiniolone or PCN

218
Q

Anthrax other characteristics

A 
NO person to person tx
Isolation NOT required - 
BCtx - gram + bacilli
PPX effective one day after exposure
Vaccine available for military
219
Q

Farmer goes hunting for raabits and gets tick bites, p/w ulcers, fever, chills, myalgias and PNAA - tender inguinal and fem LN and cojuncitvitis - g neg pleomorphic organisms - dx?

A

Tularemia - wound bx or serology - ulceroglandular fever

tx - streptomycin x 7 to 10 days

220
Q

Good saritan removes dead deer from highway i ARK/Oklahoma - couple days later with tender erythemaous papule, ulcerated with black eschar - organism?

A

Francisilla Turaemus (tularemia)

221
Q

45yo h/a, cough, myalgias - temp 101.5 - cxr with RL infiltrate - watching US open in NYC - two other ppl had similar sx

A

Tularemia (infiltrate)

222
Q

2 days after superbowl - inc’d pts a/w fever, cough, chest pain hemosptysi and prostaration - several died 24hrs after admission - dx?

A

Plague
Yersenia Persisitis
Bubonic (LN), Septicemic(causes DIC), Pneumonic (lungs)
Speads airborn droplets, close contact (also sexual)
Tx - doxycylcine, erythro, streptomycin (also for exposed close contacts)
Droplet isolation

223
Q

Which most commonly aeorsolized

A

Coxiella burnetii (Q fever)

224
Q

Rancher with fever, culture neg endocarditis - cryolobulins pos and HCV neg - dx?

A

Brucella - musc pain, sweating, fever, cryoglob +, endocarditis (neg ctx)
brucellosis - from unpaturized mild - ranchers infected animals
Tx tetracyclines, rifampin, streptomycin, aminoglycosides

225
Q

Q fever infected most likely by…

A

Vets, abattoir workers in queensland (Q fever), farmers handling infected goat, sheep, cattle
Q fever - coxiella burnetti (ricksettia)
URI, fever, myalgias, headache
Tx - doxycycline, tetracycline, cipro

226
Q

Young male with fever, myalgias, petechial rash after rafting trip PR, costa rica - icteric, mildly elev LFT with high T bili dx?

A

Leptospirosis - mildly elev transaminases and D bili 5-10x normal

227
Q

Most likely inhaled with atypical PNA/h/a, fever

A

Q fever

228
Q

MC with contaminated soil and animal products

A

Q fever

229
Q

Caused by rikettsia

A

Q-fever

230
Q

Skin contact or aerosolized -> RE system - splenomegaly, hepatitis, LN+ fever and drnching sweat - dx?

A

Brucellosis

231
Q

Gram neg coccobacilli

A

Brucellosis

232
Q

Sewage worker contact - fever hep, jaundice, liver hemorrhage, CONJUNCTIVAL SUFFUSION

A

Leptospirosis

233
Q

Vet with fever - mental status change, jaunce renal failure, ecchymosis

A

Leptospirosis

234
Q

Doxycycline

A

Q fever, burcellosis, leptospriosis, erysipelothrix

235
Q

Buchter with fever, palpable spleen tip

A

brucellosis

236
Q

Fisherman or fish handler with burnign or throbbing pain with erythem lesion on finger

A

erysipelothrix

237
Q

Pt walks on beach in west florida pw red eyes, SOB, no wheeze or rohonci - dead fish on beach - dx?

A

Redtide bloom - Karenia brevis (algae)

238
Q

Pt p/w diarrhea, fever, non-productive cough with HYPONATREMIA - drinks from TAP water

A

Legioniella -

tx quinolones - levoflox, azithro

239
Q

sewage worker who hunts deer adn squirrel p/w fever, fatigue, abd pain and gen aches - CONJUNCTIVAL SUFFUSION - scrapes on hands, no ulers - CPK 765, mild ast alt elev, Bili 6.8 (elev), BUN/Cr 110/8

A

Dx? Leptospirosis

Tx: Doxycycline

240
Q

21yo Iraq or afghan vet p/w 3cm lesion on arm, ulcerated with irrreg margins, eschar, surr erythema

A

Cutaneous Leismeniasis

Tx: fluconazole

241
Q

40yo immigrant rural turkey/middle east with enlarged liver - dx?

A

Hydratid cyst (echinnococcus)

242
Q

CMV colits isolation

A

none

243
Q

MRSA isolation

A

contact

244
Q

VRSA,VRE isolation

A

contact

245
Q

HZV 1 dermatome isolation

A

contact

246
Q

HZV >2 derm isolation

A

contact AND airborne

247
Q

C diff isolation

A

contact

248
Q

scabies isolation

A

contact

249
Q

Measles isolation

A

airborne

250
Q

Varicella isolation

A

contact AND airborne

251
Q

MTB isolation

A

airborne

252
Q

Neisseria isolation

A

dropelt

253
Q

Influenza isolation

A

droplet

254
Q

Plague isolation

A

droplet

255
Q

HIV mother to child transmission

A

mainly during deliver
Post partum breast feeding
<2% with ART

256
Q

Occupation risk exposure - high risk

A

1 protease inhibitor + 2NRTIs

257
Q

Pt with HIV on ART undetctable VL now preg - WTD

A

continue ART to term - NO efavinanz

258
Q

If HIV pt wants to breast feed

A

continue ART maintain undetect VL to prevent baby transission

259
Q

Pt p/w fever sore throat rash 3 wks after high risk sex encounter - LAD (cervical , SM with apthous ulcers - atypical lymphs on smear - HIV neg - monospot/heterophiel Ab neg - wtd?

A

HIV RNA PCR r/o acute retroviral syndrome

260
Q

Nurse with needle stick pt with HIV or high risk for HIV

A

baseline HIV elsia - start 1 protease inhib + 2 NRTI x 4 weeks - repeat HIV test if neg d/c meds

261
Q

Sexual assult victim by IVDA unknown HIV status 24 hrs ago

A

offer 1 protease inhib + 2 NRTI

262
Q

Opp infxn >200 T cells

A 
CAP - S pneumon
PP+ Tx PPD > 5mm  with INH x 9 months
Kaposi's sarcoma - dark bronish plaues on legs, pulm inviltrate - pulm nodules - purple red on bronch
HHSV8
Lymphoma
263
Q

Opp Infxn < 200 T cells

A

Pneumocystis Jirovechi PNA - dry cough > 1 wk, grad onset progresssive - ABG with hypoxiemia
ele LDH, CXR b/l intersitial infiltrate or PTX
Dx - sputum silver methanamine +
BAL with stain
Tx - Bactrim (allergy - IV pentamidine or clina + primaquin)
If PaO2<70 add STEROIDS

264
Q

Best test for suspected mild to mod dz PJP

A

check serum B D glucan

265
Q

Bactrim effect on Cr

A

goes up, does not dec renal clearance - continue bactrim if Cr increases (dec’d tubular clearance of Cr by trimethopram)

266
Q

Pt with PJP on bactrim with rash and spikign tmep - wtd

A

change bactrim to IV pentamidin or clinda + primaquine

267
Q

Pt on bactrim with rxn

A

change to dapsone or atoquaone

268
Q

Which drug covers both PJP ppx and sec ppx for toxo

A

dapsone + pymethamine

269
Q

Candidasis

A

oropharyngeal - white patchs
Tx Fluconazole
recurrent on fluconazole - use itraconazole

270
Q

HIV with T cell 55 - severe heart burn

A

empiric fluconazole for susp esoph candidasis - if no response upper endscopy - r/o CV or HSV or candidial esophagitsi

271
Q

<100 t cells - h/a copel weeks not relleived with analgesics - CTH neg - wtz

A

SP to r/o crytococal meningitis - spinal fluid - india ink + = crypt Ag +
Tx: Amphotericine 5 + 5FC -> fluconazole long term

272
Q

< 50 t cells - MAI

A

fevers, hepatomeg, LAD - elev alk phos (vit D def), bctx + AFB
Tx: clarithro/ethamburol +- rifabuin

273
Q

<25 tcells

A

CMV retinitis - blurring vision

Tx Gancyclovir, cidofovir, foscarnet

274
Q

<25 cells

A

progressive MF leukoencephalopathy - JC virus, use of natalizumab or efalizumab, rituximab, infliximab

275
Q

PPx vs OI’s

A

<50 cells - MAI - azithro or clarithro

276
Q

Pt with T cells 25 started on HAART - 6 months later T cells 150

A

d/c azithro for MAI ppx (not < 50)

277
Q

Pt 4 motnsh later t cells 250

A

d/c bactrim for PJP ppx

278
Q

Which finding r/o crypto meningitis

A

neg crypt antigen in CSF

279
Q

Ring enhancing lesions

A

Toxo
brian abscess
lymphoma

280
Q

Pt with HIV T cells 25 h/a and one sided WK - CT scan ring enhancing lesion wtd?

A

tx for presumptive TOXO - sulfadiazine/pyrimethamine - repeat CT 2-3 weeks if no change bx lesion

281
Q

CNS lymptoma

A

T cells < 50 - EBV ag +,

282
Q

HIV pt T cell < 45 - VL 150K wk left leg - CT scan ring enhancing lesion, CMV +

A

NOT CMV (biventricular enhancement should be there)
could be
toxo, lymphoma, brain abscess

283
Q

Middle ages latin american immigarant living in US recent onset Seizures - CT multiple cystic lesions with calcifications mild hydroceph

A

Neurocystercircosis - Taenea soliens

Tx: Phenytoin (cyerco serolody)

284
Q

Hog farmer with fever, myalgia - periorobital edema, spinter/conjuntival hemorrhages - muslce tenderness no murmur - EOS 8%, LDH 400, CPK 7000

A

Dx tes t- Muscle bx, trichinella Ab (bear meat)

285
Q

MCC PNA HIV CD4 150

A

Strep Pneumo

286
Q

Pt dx HIV VL 105K asx started on regimennelfinavir, lamivudine, stavudine and bactrim - what else to start

A

Azithro or clarithro for MAI ppx

287
Q

Indications for ART therapy for HIV

A 
VL>100K
T Cell <500
Acute retroviral syndrome
Opportunistic Infections
Pregnancy
288
Q

Protease Inhib - main s/e Lipodystrophy

A 
Darunavir
Lopinavir
Atazanavir - in indir bili
Indiavir - kidney stones
Ritonavir - boosting agent, inc TGA, chol
289
Q

NRTI - lactic acidosis, CAD, nypersensitiv rxn, neuropathy

A 
Tenofovir - renal insuffiency
Emtricitabine
Zidovudine AZT - anemia, inc MCV, neutropenia
Abacavir
Lamivudine
290
Q

NNRTI

A

Efavirenz
Nevirapine - steven johnsons, liver tox
Entravirine - CNS effuects, conf, abn dreams, agitiation

291
Q

Integrase Inhibitors

A

Raltegravir

292
Q

Combinations of HIV drugs

A

2 NRTI + PI/Integ Inhib

2 NRTI + NNRTI

293
Q

PI S/E

A

HLD, insulin resistance, lipodystrophy, liver tox

294
Q

What drug causes bone marrow suppression?

A

Zidovudine (AZT)

295
Q

Best statin for HLD with HIV

A

Pravastatin, or atorvastatin

296
Q

What statin to NEVER use

A

Simvastatin (inc levels HIV drugs)

297
Q

Best drug for insulin resistance

A

Glitazones

298
Q

Best inh steroid for HIV asthma

A

Beclamethasone

299
Q

Best HIV med with HCV therapy

A

Raltegravir

300
Q

What drug causes renal insuff (HIV drug)

A

Tenofovir

301
Q

HIV pt on ART with indinavir, Zidovudine, lamivudine x 3 years - noted bufalo hump - pt obeese - all may be abn except

A

cortisol (lipds, glucose adn weight abn)

302
Q

HIV pt with anorexia, wt loss, lethargy dizziness - hyperpig of skin, BP low, HR orthostatic, Na 135, K 5 dx?

A

Addison’s dz (Ag/ab HIV)

303
Q

33 yo F HIV p/w nausea and back pain - started o stavudine, lamivudine indinavir - left flank tenderness - elev cr, K, RBC in urine - wtd?

A

Indinavir - kidney stones

304
Q

Immune reconstitution syndrome -

A

pt with adv HIV low t cells high VL - start on ART - react to latent pathogens - inflamation - continue ART

305
Q

Pt with T cells 25, VL 250K, start ed on ART - 3 weeks later with cervical LAD

A

immune reconstitution to MAI/TB

306
Q

HIV survelilence

A

VL q month till VL <50 within 6 months

307
Q

HIV VL note dropping

A

Reason?
Non-adherence
or Resistant virus - check HIV genotyping

308
Q

Earliest change to see in HIV therapy failure

A

rise in VL

309
Q

Earliest OI in AIDS (not aids def lesion)

A

Oral thrush

310
Q

Pt dx with HIV started on Norvir, Indinavir, AZT, epivir 4 months later VL <50, T cell 500 - pulm TV dv and started on rifampin, ethambutol and PZA - VL 2 months later 15K - explanation?

A

pt adherance - rifampin dec level of PI - change rifampin to rifabutin or change PI to NNRTI + NRTI

311
Q

Pt dx with TB start on 4 anti TB - found to be HIV + - when to start ART?

A

within 2 to 4 weeks

312
Q

Labs/onitorsing

A

HIV VL, T cells, RPR, Hep panel, PPD, Tox, LFTs
Vacc - HAV, HBC, flu, pnumovax, inactiv poli, Tdt
NO LIVE VACCines

313
Q

Live vaccines

A

Oral polio
MMR
Varicella
Yellow fever

ABIM (14 decks)

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