Infectious Disease Flashcards
1
Q
A 2011 trial showed that ________ courses of antibiotics led to increased risk of C Diff.
A
longer
Particularly longer than 7 days.
2
Q
Studies have shown that treating uncomplicated PNA with 5 days compared to 10 days led to what differences?
A
Fewer adverse effects and lower mortality in the short course group
3
Q
Even complicated UTIs can be treated with as few as ______ days of antibiotics.
A
5
Studies exclude urologic abnormalities.
4
Q
A study by Yahav showed that ___ days of antibiotics was just as safe as 14 in treating GNR bacteremia.
A
7
5
Q
Don’t forget to add __________ when people have fever and rash.
A
doxycycline
This is commonly forgotten in coverage.
6
Q
What is the most common tic-borne illness of NC?
A
Ehrlichia
7
Q
The classic manifestations of Ehrlichia are what?
A
- Myalgias
- Fever
- Vomiting
- Maculopapular rash
- CNS involvement (either meningitis or nerve palsy)
- ARDS
- Pancytopenia
- Hyponatremia
8
Q
Acute serology in tic-borne illness is unhelpful. Why?
A
Positive serology could be old. Negative serology could be too early.
You need to get convalescent serum to confirm diagnosis.
9
Q
What physical exam findings should you look for in those with concern for fungal infections?
A
- Oropharyngeal (black spots or erythema on the roof of the mouth, sinus pain)
- Skin (erythematous papules)
- Lung (invasive pulmonary diseases)
10
Q
The risk of dying from sepsis goes up ____-fold after age 65.
A
13
11
Q
Bloody diarrhea and seizures are associated with what pathogen?
A
Shigella
12
Q
The most common AIDS-defining illness is _________.
A
PCP
Second most common is esophageal candidiasis.
13
Q
What two treatments (drugs) should you start for PCP pneumonia if diagnosed in the ED?
A
Bactrim (it’s for treatment and PPX) and steroids if they are hypoxic with PaO2 70 mm Hg or less on RA
14
Q
Which AIDS medication can cause bone marrow suppression?
A
Zidovudine
15
Q
Other than infections, what can cause diarrhea in AIDS patients?
A
Medications
Ritonavir frequently causes diarrhea. You still need to rule common opportunistic pathogens but keep this in mind, especially if someone looks well and has negative workup.
16
Q
AIDS patients with symptoms of esophagitis should undergo what initial management step?
A
Empiric fluconazole treatment
Esophageal candidiasis is the most common cause of odynophagia in AIDS patients, so treating them with fluconazole and having follow up endoscopy if they fail to improve is reasonable.
17
Q
After a high-risk HIV exposure – such as unprotected sex or a needle stick with someone known to have HIV – what regimen is recommended?
A
A three=drug regimen for 28 days
18
Q
The Deertick is scientifically called _____________.
A
Ixodes scapularis
Also called blacklegged tick
19
Q
Which tick caries RMSF?
A
Dermacentor (aka wood tick)
20
Q
Review qSOFA.
A
The Quick Sepsis-Related (or Sequential) Organ Failure Assessment score is used to predict outcomes in sepsis.
Patients get 1 point for each of the following:
RR >22
AMS
SBP < 100
A score of 2 or greater predicts worse outcomes and longer ICU stay.
21
Q
The most typical second-line pressor in septic shock is _____________.
A
vasopressin
0.04 U/min
22
Q
How does meningococcal meningitis usually start?
A
As a mild URI
23
Q
What is meningitis dosing of ceftriaxone?
A
100 mg/kg
24
Q
TB usually affects the __________ of the lungs.
A
apices
25
Other than babies and adults who eat canned food, what population is at risk of botulism?
IV drug users
26
What is pylephlebitis?
Thrombophlebitis of the portal vein
27
Review common organisms that cause infection in human bites (three specific bacteria and one group).
Eikenella
Staphylococcus aureus
Streptococcus viridans
Anaerobic bacteria
28
Seborrheic dermatitis is caused by which organism?
Malassezia
29
True or false: adult seborrheic dermatitis is usually fixed with a single treatment.
False
It is a chronic, relapsing disorder in adulthood and usually requires re-treatment.
30
HIV can cause abnormalities in which cell lines?
All cell lines
HAART usually is successful in treating HIV-associated anemia, thrombocytopenia, and leukopenia.
31
People typically achieve undetectable HIV viral load after _____ months of HAART.
6 months
32
True or false: all patients with zoster should be on airborne precautions.
False
Only those with disseminated zoster (two or more non-adjacent dermatomes).
33
Most US cases of rabies are caused by what animal?
Bats
34
What incubation period does rabies have?
20-90 days (hence rabies vaccination)
35
What is involved in rabies prophylaxis?
Rabies immune globulin on day 0 and vaccine on days 0, 3, 7, and 14
36
Babesiosis is treated with what?
Atovaquone and macrolide
37
Why do you need to ask about swimming in rashes?
Pseudomonas hot tub folliculitis
Only treat immunocompromised hosts
38
Human bites are likely to get infected with what organism?
Eikenella
39
Deer tick are also called what?
Ixodes
40
What tick transmits alpha gal allergy?
Lone Star ticks
41
What drug is best for Aeromonas hydrophila?
Ciprofloxacin
42
True or false: There is no acute form of HCV.
False
Acute HCV presents with abdominal pain, malaise, and severe transaminitis -- often in the high hundreds. Notably, the HCV Ab test will not be positive for the first several weeks of the infection, only the RNA PCR.
43
Review the two types of necrotizing fasciitis and the organisms that cause each.
- Type I: occurs in people with many medical comorbidities and is polymicrobial, can present with crepitus (C. perfringens, Bacteroides, S. aureus, Group A Strep)
- Type II: occurs in healthy people with antecedent trauma (Group A Strep)
44
Other than the B6-preventable side effects of neuropathy and seizure, what is an important side effect of isoniazid?
Hepatotoxicity
Most people who take isoniazid have transaminitis in the 30-100 range but it is self-limiting. They can continue taking isoniazid.
45
True or false: HPV vaccine is inactivated.
False
It's a live vaccine.
46
Scabies is caused by what organism?
Sarcoptes scabiei
This is a mite.
47
How can scabies be diagnosed?
Light microscopy of skin scrapings
48
What is the treatment for scabies?
Topical 5% permethrin
One dose left on for 6-12 hours is usually sufficient, but can be repeated weekly if live mites are observed.
49
Compared to viral arthritis, rheumatic fever affects the _______ joints.
larger
Viral arthritis (such as Parvovirus) are more likely to affect the PIPs, whereas rheumatic fever is more likely to affect the knees.
50
Patients who are started on HAART while they have an active infection (such as TB) are at increased risk of _____________.
immune reconstitution inflammatory syndrome (IRIS)
Treat this with symptom control unless they are unstable, which you can then start a steroid taper.
51
Review the stages of syphilis by symptom and timeline.
Incubation period:
- No symptoms
- 10 to 90 days after infection
Primary:
- Painless chancre with indurated borders
- Heals in 3-6 weeks
Secondary:
- Nonpruritic rash that spreads from trunk to hands and feet. Fever. Chills. Headache. Condyloma lata.
- Occurs 3-6 weeks after chancre heals.
Latent stage:
- Asymptomatic
- May last years
Tertiary syphilis:
- Neurosyphilis (Argyll-Roberston pupils, tables dorsalis neuropathy, dementia). Meningitis. Aortitis.
- Can be years or even decades after secondary syphilis.
52
Review the treatment of syphilis.
Penicillin G 2.4 million units once weekly for three weeks
Be sure they follow up to ensure negative testing.
53
What is the treatment for vaginal candidiasis?
Fluconazole oral 150 mg x1
54
What's the difference between a chancre and a chancroid?
A chancre is a painless indurated ulcer that is caused by Treponema pallidum. A chancroid is a painful, pustulent indurated ulcer that is caused by Haemophilus ducreyi.
55
The two treatments that are available for genital warts are _____________.
podophyllix and imiquimod
56
What is the treatment for lymphogranuloma venereum?
21 days of doxycycline 100 mg BID (longer than the course for cervicitis [7 days] or PID [14 days])
57
What are the types of tests for C difficile that you might see?
- PCR test for the toxin-producing gene
- Antigen assay for toxins A and B
58
List the antibiotics that are high and low inducers of C difficile.
High:
- Clindamycin
- Fluoroquinolones
- 3rd and 4th generation cephalosporins
- Carbapenems
- Monobactams
Low:
- Bactrim
- Doxycycline
- Macrolides
- Aminoglycosides
59
True or false: those with HCV need to wear condoms to prevent transmission.
False
The rates of sexual transmission of HCV are so low that condoms are not needed.
60
Which women should be screened for asymptomatic Chlamydia?
- All sexually active women younger than 25
- Pregnant women
61
In addition to honey and canned foods ingestion, ______________ is a risk factor for young children to develop botulism.
living on a dusty farm (where soil is turned often and spores can be aerosolized)
62
Clostridium botulinum works by _________________-.
releasing a toxin that inhibits presynaptic acetylcholine release
63
An infant presents with botulism. In addition to supportive care, what treatment can you offer?
Botulism immune globulin
64
Rubeola is also known as _____________.
Measles
65
The two childhood viral illnesses that cause fever and then rash are ______________.
Parvovirus (fifth disease) and Roseola (HHV6 or sixth disease)
66
Review the diagnostic criteria for acute rheumatic fever.
It requires two major or one major and two minor criteria.
Major:
- Joints (migratory arthritis)
- Myocarditis
- Nodules in the skin
- Erythema marginatum
- Sydenham chorea
Minor:
- Fever
- Arthralgias
- Elevated CRP/ESR
- PR prolongation
67
True or false: children with acute rheumatic fever who have Sydenham chorea should receive penicillin for 3-6 months.
False
Children should be given long-term penicillin until ADULTHOOD to prevent secondary recurrence.
68
True or false: children of pregnant women should not be given live vaccines like MMRV until after the mother delivers.
False
69
In addition to tick presence less than 36 hours, you can also assess the likelihood of pathogen transmission by ____________.
engorgement status of the tick
If a tick is non-engorged then the risk of transmission is even lower.
70
Review the three treatment regimens for meningococcus prophylaxis.
- Rifampin 500 mg BID for 2 days
- Ciprofloxacin 500 mg x1
- CTX 250 mg x1
Rifampins interact with OCPs so use either of the second two in women taking OCPs.
71
HPV vaccines are warranted for all women ________.
ages 11-26
72
Zoster is indicated for all adults older than _______.
50
73
Administration of ____________ to someone with EBV is likely to cause a rash.
amoxicillin
74
The best research on COVID and remdesivir shows what?
That remdesivir shortens hospitalizations
75
What criteria are needed for tocilizumab or baricitinib?
Worsening disease and CRP greater than 75 mg/dl
76
An August 2021 trial showed what about the preemptive use of VTE dose of anticoagulation in COVID showed what?
That non-critically ill people had increased survival and reduced use of cardiovascular and respiratory support with full dose anticoagulation.
The effect was most pronounced in those with very elevated d dimers
77
What labs are needed for the inpatient management of COVID 19?
HFP (because remdesivir is contraindicated in those with liver injury)
BMP (renal function needed for meds)
Type and screen (because they’re on anticoagulation)
PT/PTT (again they’re going to be on anticoagulation)
D-dimer, CRP, LDH (gauging severity of disease and trending to help diagnose PEs that present later)
78
When can airborne precautions be discontinued in those with mild COVID, sever COVID, and immunocompromised?
- Mild-moderate COVID: 10 days from last positive test
- Severe disease or immunocompromised: 21 days from positive test
Note: there’s a dot phrase (COVID STOP ISOLATION, or something like that)
79
Which type of infection precaution is needed for meningitis?
Droplet
80
When are steroids indicated in those with PCP?
When PaO2 is less than 70 or A-a is greater than 35
81
The only sensory deficit present in those with botulism is _______________.
blurry vision
Botox affects only motor neurons. Sensory nerves will not be affected. Vision is affected only because the ciliary muscles of the eye are paralyzed.
82
Those with botulism should not be treated with antibiotics because _____________.
lysis of bacteria increases toxin release
83
The rash associated with Parvovirus is _____________.
erythema infectiosum (Fifth disease)
This is a rash that starts on the face and spreads caudally in a reticular fashion.
84
The rash caused by HHV6 is called _____________.
Roseola
This starts on the trunk and spreads to the face, usually after the fever.
85
What is the treatment for post-streptococcal glomerulonephritis?
Supportive therapy (usually salt restriction +/- diuretics)
Antibiotics are not indicated.
86
How long after infection does PSGN occur?
1-2 weeks after pharyngitis or 3-6 weeks after SSTI.
87
The most common cause of death in measles is ____________.
pneumonia
88
What organisms are associated with type 1 and type 2 necrotizing fasciitis?
Type 1: polymicrobial (GAS, Clostridia, Bacteroides, Enterococcus)
Type 2: GAS
89
LLQ pain, bloody diarrhea, and vesicles on anal exam suggest what diagnosis?
HSV proctitis
90
The technical name for pinworms is what?
Enterobius vermicularis (treated with albendazole)
91
Recurrent fever and pleuritic chest pain are typical of ______________.
familial Mediterranean fever
92
Review the treatment of rabies exposure.
- Rabies immunoglobulin near the wound on day of presentation
- Rabies vaccine on days 0, 3, 7, and 14
93
True or false: crows are a common source of rabies.
False
Rabies is a mammal-only virus.
94
Bacteremia and sepsis after a dog bite is most likely from what organism?
Capnocytophaga canimorsus
This is a gram-negative rod that causes blisters and fulminant organ failure after dog bites. Those who are immunocompromised are at increased risk.
95
The treatment for vaginal candidiasis?
Diflucan (oral fluconazole) 150 mg x1
96
Explain the diagnostic tests for EBV.
EBV antibodies and PCR are most sensitive and specific, but they take longer than heterophile antibodies and are not as widely available. The heterophile is thus first line.
Note: the heterophile antibodies is only 75% sensitive within the first week.
97
The inclusion bodies in neurons of those with rabies are called ____________.
Negri bodies
98
Rabies is most concerning with bites to which part of the body?
The head and neck
Remember that rabies travels neuron-by-neuron to the brain. The closer it is to the brain, the more dangerous it is.
99
Which fluoroquinolones do not work against Pseudomonas?
Levofloxacin and moxifloxacin
100
Which fungi is endemic in the Ohio River Valley?
Histoplasma
("Think OHIstO.")
101
Those with Lyme disease are at risk of which ocular complication?
Keratitis
With paralysis of the facial nerve, the eyelids fail to keep the eye moist.
102
What is the prophylactic dose of doxycycline for Lyme disease (when indicated, of course)?
200 mg x1 within 72 hours
103
Tetanus immune globulin is only indicated in patients _____________.
who have not completed a primary series of tetanus immunization
If a person has completed their primary series, they do not need tetanus IG even if they have large, dirty wounds.
104
__________ is usually the first symptom of tetanus.
Trismus
105
The PPD test has what eponym?
Mantoux test
106
Bacterial vaginosis is diagnosed by what criteria?
Amsel:
- Thin, white discharge
- Clue cells
- Vaginal pH > 4.5
- Fishy odor
107
What might you see on the US of a child w/ Kawasaki?
Hydrops of the gallbladder
108
What are mycotic aneurysms?
Aneurysms that result from septic emboli
109
What tick carriers Ehrlichiosis?
Amblyomma americanum (aka Lone Star Tick)
110
Smallpox is caused by what virus?
Variola major
111
Airborne precautions for shingles are indicated in what two patient populations?
Disseminated VZV
Immunocompromised hosts (even with local disease)
112
What is the typical incubation period for malaria?
12-14 days
113
When does chorea develop in rheumatic fever?
1-8 months after the infection
114
Proctitis in the setting of anal receptive intercourse could be due to what STIs?
HSV, Gonorrhea, or Chlamydia
Treat like you would PID.
115
Classically, scabies spares what areas?
The back and the head
Though it does present on the head in kids.
116
What is the name of the organism that causes scabies?
Sarcoptes scabiei
117
Petechiae after running a BP cuff is what sign?
Rumpel-Leede sign -- a finding in RMSF
118
In addition to palsy of the 7th cranial nerve, Lyme disease can also cause palsy of which nerve?
CN VI
119
In which stage of syphilis can testing be negative?
Primary (painless chancre stage)
The first 1-4 weeks can be negative.
120
In addition to S. epidermidis, list two other species that are highly likely to be contaminate.
Bacillus
Propionibacterium
121
What class of antibiotics covers Eikenella?
Fluroquinolones
122
What is the treatment for botulism?
Supportive care
123
The most common bacteria in those with neutropenic fever is what?
S. epidermidis
124
Why should you consider treatment of whooping cough with antibiotics?
Antibiotics have been shown to decrease the transmission of the bacteria to others.
125
What is the PMN count for peritonitis in PD?
50 cells/mm3
126
How long does a peritoneal dialysate need to dwell before sampling?
2 hours
127
What is the timeline for treating active TB?
RIPE for two months then RI for four months
128
A patient presents with seizures, asymmetric flaccid paralysis, and fever in July. Pathogen?
West Nile encephaliitis
129
The most common pathogen for AOM in vaccinated people is _____________.
S. pneumoniae (still)
130
The two most common viral causes of myocarditis are ____________.
Parvovirus B19 and Coxsackie virus
131
What is the most sensitive test for Lyme meningitis.
Borrelia Ab
132
The pathogen that causes Chagas disease is _________________________.
Trypanosoma cruzi
133
Review the treatment of malaria from South America, Africa/Asia, and complicated cases.
SA: chloroquine
Africa/Asia: artemeter or atovaquone or quinidine + doxy
Complicated: artesunate or IV quinidine
134
The initial test for Malaria is ____________.
thick and thin smear
135
What antibiotic treats toxic shock syndrome?
Clindamycin (because of the exotoxin process)
136
Elevated _______ (a blood test) is suggestive of PJP.
LDH
137
The initial treatment for all amebic liver abscesses is ________________.
antibiotics (Flagyl)
Drainage is reserved for refractory cases.
138
What is the empiric treatment regimen for neonatal meningitis?
Ampicilin and either cefotaxime or gentamicin
139
True or false: rash is uncommon in Erhlichiosis.
True
140
The antibiotic of choice for pregnant patients with ETEC is what?
Azithromycin
141
What is scrofula?
TB cervical lymphadenitis
142
True or false: S. aureus in blood cultures is frequently a contaminant.
False
It can be a contaminant, but it is much less likely than S. epidermidis to be a contaminant and should be consideref a true positive.
143
What are the most sensitive and specific UA findings for UTI?
- LE is the most sensitive (83%)
- Nitrites are the most specific (98%)
The reason that nitrites are the most specific are that the enzyme nitrate reductase (which is found in Gram-negative bacteria) needs to act on urinary nitrates for 6 hours to convert it to nitrites.
144
Early-onset neonatal sepsis happens before ____________.
7 days
145
Review the three types of necrotizing fasciitis.
I: Polymicrobial, usually affecting older and immunocompromised hosts
II: GAS
III: Gas-producing organisms (often Clostridioides)
146
Which species of malaria have dormant cycles?
Plasmodium ovale and Plasmodium vivax
(think of an EGG lyiing dormant to reVIVe later)
147
What is the CDC-recommended PEP for healthcare workers exposed to HIV?
Tenofovir, emtricitabine, and raltegravir
Start ASAP. Do not start 72 hours or more after exposure.
148
The old-fashioned name for the rash caused by HHV6 is _____________.
Roseola (fever resolves -> rash)
149
What non-antibiotic therapies can you give in toxic shock?
IVIG
150
What are the two major Duke criteria for endocarditis?
Presence of vegetation on echo
Positive blood culture with a typical organism or persistent positive blood culture with any organism
151
Which antibiotics treat cholera?
Doxycycline (the preferred agent) as well as macrolides and fluoroquinoloness
Only give abx in moderate to severe cases.
152
What infection causes severe myalgias termed "break-bone fever"?
Dengue
153
What tropical illness has a short incubation period (4-7 days)?
Dengue
154
Dengue causes fever, severe myalgias, vomiting, and ______________.
retro-orbital headache
155
The classic triad of malaria is _______________.
fever, thrombocytopenia, and splenomegaly
156
Antibiotic of choice for tularemia?
Streptomicin
157
What is the usual progression of giardia?
Acute diarrhea at the time of infection followed by progressive weight loss and malabsorption
158
What is the usual progression of giardia?
Acute diarrhea at the time of infection followed by progressive weight loss and malabsorption
159
What is the treatment for coccidiodes?
Fluconazole
160
True or false: fluconazole is the first-line treatment for Sporothrix schenkii.
False
Itraconazole
161
What is the average incubation period for Sporotrichosis?
3 weeks
162
Oseltamivir only works in the first _______ hours of symptoms.
48
163
The most common form of extrapulmonary TB is ___________.
lymphadenitis
164
What are the criteria for ppx rifampin in contacts of N. meningitidis?
Anyone with direct contact with droplets (e.g., suctioning a patient, intubating a patient) or those with prolonged contact (> 8 hours).
165
True or false: E. histolytica hepatic abscesses require drainage as part of the first line therapy.
False
Metronidazole is first-line. Drainage is indicated only in treatment failure.
166
Which of the bloodborne pathogens has the highest conversion rate?
HBV -- up to 50% among needle sharing!
167
Which ticks do Anaplasmosis and Ehrlichiosis come from?
Anaplasmosis: Deer tick (Ixodes scapularis)
Ehrlichiosis: Lone Star tick (Amblyomma americanum)
"Dear Ana..."
168
What are the options for outpatient CAP therapy (2019 IDSA update)?
Healthy and younger than 65: any one of the three options below
- Amoxicillin
- Doxycycline
- Azithromycin (but less effective secondary to resistance)
Unhealthy or older than 65: either option
- (Augmentin or cefidinir) and (doxycycline or azithromycin)
- Fluoroquinolone
169
The drug of choice for well-appearing SSSS is ____________.
dicloxacillin
170
True or false: in AIDS patients, cryptococcal serum antigen is as sensitive as CSF antigen in diagnosing meningitis.
True
171
Which antibiotics are recommended first-line in elderly epididymitis?
Fluoroquinolones
172
What is the confirmatory test for HIV?
Western blot
Ag is preliminary.
173
According to a 2019 update, what are the three agents for treatment of CAP in healthy adults younger than 65?
Amoxicillin (high dose)
Doxycycline
Azithromycin (in areas with low S. pneumoniae resistance)
174
The biggest risk factor for meningitis from West Nile is _______________.
advanced age
175
What sexual act has the least risk for HIV transmission?
Oral
176
What infection can cause cholangiocarcinoma?
Clonorchis sinensis (liver fluke)
177
What is the management for a patient with a CENTOR of 4-5 but negative rapid Strep?
Await culture
Even patients with high CENTOR scores have GAS only about 30% of the time, so empiric antibiotics are not warranted.
178
Antibiotic choice for GAS pharyngitis with anaphylaxis to beta lactams?
Clindamycin or azithromycin
179
Review the pathophysiology of histamine fish poisoning.
Inadequate fish refrigeration causes proliferation of bacteria on the surface of the fish. These bacteria decarboxylate histadine, leading to histamine. People present almost likee anaphylaxis: flushing, vomiting, and with abdominal pain. They generally resolve on their own very rapidly.
180
What are the three trials that showed no benefit between usual care and EGDT?
PROCESS
ARISE
PROMISE
181
What is triple therapy for H pylori?
Amoxicillin
Clarithromycin
PPI
182
Although most effective if given within 2 days, patients can still be given Tamiflu up to ____ days of symptoms.
5
183
How do the warts from HPV differ from those of syphilis?
Condyloma acuminata are flat, plaque-like
Condyloma lata are elevated
184
What infection other than E coli and Shigella can produce HUS?
S. pneumoniae
185
Disseminated _____________ can cause acral lesions that are pustular and flexor tenosynovitis.
gonorrhea
186
Which two strains of malaria require additional medications to treat dormant hepatic forms (hypnozoites)?
P. vivax and P. falciparum
187
Rubeola is also called ___________.
measles
188
Shedding of the proximal nail (often seen in Coxsackie virus infections) is called what?
Onychomadesis
189
In addition to aquaphobia and AMS, rabies also causes what symptoms?
Viral prodrome -- fever, myalgias
190
What is the current treatment for latent TB?
Isoniazid and rifampin x 3 months
191
After how many days of illness will heterophile testing be positive in EBV?
Usually after the second week of illness
Prior to then, some hospitals will have Ag testing.
192
What rash is associated with EBV?
Papular acrodermatitis (Gianotti-Crosti)
193
How does Entamoeba coli present?
Trick question: it is a non-pathogenic species that is frequently mistaken for Entamoeba histolytica on stool studies by doctors. It does not warrant treatment.
194
Other than contaminated streams, giardia can also come from where?
Daycare
195
What is the minimum age for prescribing oseltamivir?
2 weeks old
196
True or false: offer oseltamivir to household contacts who are high-risk.
True
197
What is the max symptom duration that can receive oseltamivir (per the boards)?
48 hours
198
Review triple therapy and quadruple therapy.
Triple:
- Clathrithromycin
- Amoxicillin
- PPI
Quadruple (for recurrence or concern for resistance to macrolide):
- Tetracycline
- Metronidazole
- PPI
- Bismuth subsalicylate
199
What organism is likely to cause rapid fatal sepsis from a dog bite?
Capnocytophagia canimorsus
200
What is the first line treatment for inpatient pediatric CAP?
Ampicillin
201
At what age do you switch from the neonatal amp/gent to childhood vanc/cef for meningitis?
1 month
"AMp under A Month"
202
Which cells get infected in EBV?
B lymphocytes (leading to increased number of T lymphocytes)
203
What two treatments are first line for tinea capitis?
Oral terbinafine and oral griseofulvin
204
Up to how long after a potential rabies infection should you treat for rabies?
90 days
205
What worm can infect the eye?
Loa loa
206
What syndrome does onchocerciasis cause?
African river blindness
207
First-line antifungal for coccidiodes?
Fluconazole
208
True or false: Zosyn and vancomycin is the treatment of choice for meningitis in the immunocompromised.
False
Zosyn doesn't cross the BBB well and is not recommended for any type of meningitis.
209
When is Lyme disease treated with IV ceftriaxone?
When it is disseminated -- cardiac involvement, meningoencephalitis
210
What is the treatment for eczema herpeticum?
Acyclovir and clindamycin
It’s thought that HSV lesions get superinfected with GPCs.
211
What is the antibiotic choice for saltwater wounds?
Cipro or doxy
212
What bacteria causes fishtank granuloma?
Mycobacterium marinarum
213
Which pneumonia "classically" presents with sudden onset chills and cough?
S pneumoniae
214
True or false: bed bugs can be treated with permethrin.
False
They live in the house and only come out at night. There's nothing to kill on the skin.
215
Which Coronovirus variant has a higher case-fatality rate, SARS or MERS?
MERS, by a significant margin
216
Review the Duke criteria for endocarditis.
You need either 2 major, 1 major + 3 minor, or 5 minor criteria for a diagnosis:
Major:
- 2 positive cultures with a typical organism
- Positive echo
Minor:
- Predisposing condition (IVDU, prosthetic valve)
- Fever
- Immunologic phenomena (Janeway lesions, Osler nodes)
- Positive culture not meeting major criteria
- Echo not definitively positive but with potentially concerning features
217
What is the pathophysiology of RMSF? That is, by what mechanism does the infection cause symptoms?
It leads to vasculitis with microinfarction in the skin, lungs, brain.
218
Empirically, Macrobid is only for patients with cystitis who have ___________.
no medical complications that would make it "complicated cystitis"
If they are complicated (e.g., elderly, diabetic, immunocompromised) then they should receive a cephalosporin.
