Infectious Disease

Question 1

rapidly progressive skin lesion that develops in to non-tender nodules with central necrosis (ulcer with black center)

Answer 1

• ecthyma gangrenosum, associated with pseudomonas aeruginosa bacteremia
• can be seen in pts who are immunocompromised, give antipseudomonal abx

Question 2

pt is newly diagnosed with HIV. Which Vaccines should they get?

Answer 2

• pneumococcal
• influenza
• maybe zoster if no evidence of disease or immunity

Question 3

pt is newly diagnosed with HIV. Which screening should they get?

Answer 3

• TB
• Varicella serology (if no hx of chicken pox or shingles)

Question 4

treatment of sepsis

Answer 4

1. IV volume resuscitation with crystalloid (isotonic saline , lactated ringers?)
2. abx
3. vasopressors if IV fluids dont work

Question 5

what causes metabolic acidosis in sepsis?

Answer 5

impaired and insufficient oxygen delivery to the peripheral tissues leads to an increase in production of lactic acid

Question 6

most common cause of pneumonia in young children with cystic fibrosis

Answer 6

staph aureus (esp in those with coexisting influenza infection)

• add vancomycin to pts with severe pna, frequent hospitalizations, or recurrent skin infections to cover for MRSA

Question 7

most common cause of pneumonia in pts 15 years and older with cystic fibrosis

Answer 7

pseudomonas

Question 8

infection with which organisms increases chance for colon cancer?

Answer 8

• streptococcus bovis
• clostridium septicum
• GET A COLONOSCOPY

Question 9

Pt with painless chancre and negative initial serologies for syphillis. what do you do?

Answer 9

empirically treat with penicillin

Question 10

treatment for candida albicans esophagitis in HIV + pt

Answer 10

2 weeks empiric oral fluconazole

Question 11

esophagitis in HIV positive patient with large, linear ulcers and intranuclear/intracytoplasmic inclusions

Answer 11

cytomegalovirus

Question 12

treatment for cytomegalovirus esophagitis

Answer 12

gancyclovir

Question 13

esophagitis in HIV positive patient with well circumscribed lesions/ulcers with intranuclear inclusions

Answer 13

HSV; treat with acyclovir

Question 14

pt who has HIV with cough, lymphadenopathy, hepatosplenomegaly, pancytopenia has which opportunistic infection?

Answer 14

histoplasmosis

Question 15

treatment for disseminated histoplasmosis?

Answer 15

amphotericin B acutely forllowed by itraconozole for maintenance therapy

Question 16

treatment for Cryptococcus species

Answer 16

flucytosine

Question 17

treatment for pinworm (enterobius vermicularis)?

Answer 17

pyrantel pamoate or albendazole

Question 18

what is ivermectin used to treat?

Answer 18

strongyloides (worm that enters through foot) infection and onchocerciasis (river blindness)

Question 19

characteristics of scabies bites

Answer 19

pruritic rash on flexor surfaces of the wrist, lateral fingerts, and in between fingers

Question 20

most common. cause of meningitis in adults

Answer 20

strep pneumonia

Question 21

most common. cause of meningitis in neonates

Answer 21

group B strep

Question 22

most common. cause of meningitis in pt with recent brain surgery or indwelling catheter

Answer 22

staphylococcus

Question 23

most common. cause of meningitis in immunocompromised or elderly

Answer 23

listeria

Question 24

most common. cause of meningitis in young adult with petechial rash

Answer 24

neisseria meningitidis

Question 25

• CSF findings show:
  
  • elevated protein
  • decresed glucose
  • 0 RBCs
  • WBC count not really elevated (75) and mostly lymphocytes

what is this infection?

Answer 25

lyme disease (Borrelia) or rocky mountain spotted fever (Rickettsia)

are exceptional bacteria in tha tthey only raise WBC count modestly and lymphocytes will predominate instead of neutrophils