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ABIM Prep Flashcards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Patients who are undergoing cardiothoracic or orthopedic surgery should be screened for what?

A

Nasal carriage of S. aureus. If positive, decolonize

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2
Q

First line therapy for coccidiomycosis?

A

Fluconazole, may need for life if diagnosing with meningitis

Consider amphotericin B if not responding to azoles

May present as acute/chronic pulmonary infection, cutaneous infection, meningitis or MSK infection

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3
Q

Empiric therapy for severe CAP (requiring ICU admission)

A

1) Strep pneumo, h flu and gram-negative bacilli covera with a beta lactam (ampicillin-sulbactam, cefotaxime, ceftriaxone, ceftaroline) PLUS
2) Legionella coverage (macrolide or quinolone)

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4
Q

Studies for FUO (defined as fever for 3+ weeks, undiagnosed after two ambulatory visits)

A

CBC with diff, CMP, blood culture set x3, ESR, TB eval, HIV testing, consider imaging with CT of C/A/P

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5
Q

How to diagnose suspected invasive aspergillus infection

A

Serum galactomannan, if negative consider BAL/Bronchosocopy

Consider invasive aspergillus in patients with:

1) prolonged neutropenia
2) SCT/Solid organ transplant
3) Fever, cough, chest pain and hemoptysis with pulmonary infiltrates/wedge-shaped densities on imaging

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6
Q

Leptospiral meningitis diagnostic criteria

A

1) Biphasic illness (weeks after exposure)
2) Uveitis
3) rash
4) Conjunctival suffusion (key finding)
5) Sepsis
6) LAD
7) AKI
8) HSM

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7
Q

Rapidly growing, nontuberculous mycobacterial findings

A

Chronic, nonhealing wounds anywhere the bacteria has been introduced that do not respond to typical therapy for skin/soft tissue infection

1) Mycobacterium fortuitum (pedicures, freshwater footbath)
2) Mycobacterium abscessus
3) Mycobacterium chelonae

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8
Q

PID vs cervicitis therapy

A

PID: IM ceftriaxone and doxy
Cervicitis: IM ceftriaxone and azithromycin

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9
Q

PEP regimen for HIV exposure

A

Tenofovir, emtricitabine, and dolutegravir (or raltegravir) for 4 weeks

Test for HIV at time of exposure, 4-6 weeks later, and 3 months after exposure

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10
Q

Patients with selective IgA deficiency are susceptible to what infection?

A

Giardia lambila (suspect with chronic abdominal cramping, bloating and diarrhea (usually nonbloody))

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11
Q

Most common cause of viral meningitis? Seasonality?

A

Enteroviruses - Mary to November

If winter time, consider HSV2, especially if recurrent benign lymphocytic meningitis (aka Mollaret meningitis).

No need for acyclovir with HSV-2 meningitis, outcomes are usually favorable. Contrast with HSV-1 encephalitis, which requires prompt treatment

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12
Q

Most common cause of viral meningitis? Seasonality?

A

Enteroviruses - Mary to November

If winter time, consider HSV2, especially if recurrent benign lymphocytic meningitis (aka Mollaret meningitis).

No need for acyclovir with HSV-2 meningitis, outcomes are usually favorable

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13
Q

Features of Brucellosis

A

Animal reservoir (sheep/goats)

  • Mediterranean/Middle East
  • Sx: Fever, HA, myalgias, arthralgias, depression
  • Signs: HSM, LAD, Granulomas on reticuloendothelial tissues
  • May present as relapsing/chronic
  • Diagnosis: Serum agglutination (>1:160), Rose Bengal slide
  • Treatment: Doxycycline, rifampin, streptomycin (or gentamicin) for several weeks. Substitute ceftriaxone for streptomycin in neurobrucellosis
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14
Q

CSF findings in sporadic Creutzfeldt-Jakob disease (CJD)

A

Positive for total Tau or 14-3-3 protein

Consider with progressive cognitive decline and vision loss

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15
Q

CSF findings in sproadic Creutzfeldt-Jakob disease (CJD)

A

Positive for total Tau or 14-3-3 protein

Consider with progressive cognitive decline and vision loss

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16
Q

Babesiosis

A
  • Intraerythrocytic protozoan infection
  • Black-legged deer tick, seen in areas of Lyme
  • Sx: fever, fatigue, myalgia, jaundice, HSM
  • Findings: Hemolytic anemia (Not seen in HME/anaplasmosis), thrombocytopenia, AKI, ARDS, elevated liver enzymes
  • Maltese cross, get peripheral smear
  • Severe illness more likely in asplenia

Treatment: atovaquone and azithromycin
- if severe: Clinda + quinine +/- exchange transfusion (parasitemia >10%)

17
Q

Treatment for cyclospora parasitic infection

A

TMP-SMX DS x7-10d

Endemic in Peru, Guatemala, Haiti and Nepal
Modified acid-fast staining will demonstrate oocysts

18
Q

Treatment for cyclospora parasitic infection

A

TMP-SMX

19
Q

What screening test should be performed while taking Ethambutol?

A

Vision screening

Can cause optic neuritis affecting acuity and color vision

20
Q

Hepatitis A travel vaccination recommendations

A

Ideally 2-4 weeks before departure as a single dose

Can give a single dose any time before travel

A booster can be given between 6 and 18 months after the initial vaccination, provides up to 10 years of protection

21
Q

Hepatitis A travel vaccination recommendations

A

Ideally 2-4 weeks before departure as a single dose

Can give a single dose any time before travel

22
Q

ESBL MDR UTI - first line treatment

A

Carbapenem class

Sensitivities may indicate susceptibility to agents such as Pip-tazo, but the susceptibility breakpoint used does not often convey clinical success

23
Q

Monitoring parameters for daptomycin

A

Kidney function and CK level

24
Q

What should be added for treatment of osteomyelitis with residual hardware?

A

Rifampin

25
Q

Preventative therapies for OI after HSCT

A

1) TMP-SMX for toxo/PJP
2) Antifungal therapy with posaconazole or voriconazole for the first several months after HSCT
3) Test and treat for CMV or empiric valgancyclovir/ganciclovir, however monitoring preferred d/t side effects of antiviral therapy (neutropenia)

26
Q

Treatment for severe candidemia

A

Echinocandin

Fluconazole is good for prevention, not treatment of severe candidemia

Blood cultures with yeast are never a contaminant!
Risk factors:
- neutropenia
- malignancy and chemotherapy
- organ transplant
- intravascular catheters
- broad spectrum Abx
- HD
27
Q

Treatment for severe candidemia

A

Echinocandin

Blood cultures with yeast are never a contaminant,

Risk factors:

  • neutropenia
  • malignancy and chemotherapy
  • organ transplant
  • intravascular catheters
  • broad spectrum Abx
  • HD
28
Q

Treatment for histoplasmosis

A

1) Itraconazole (6-12 weeks)

2) For severe/disseminated infection: Liposomal amphotericin B

29
Q

Treatment for various bioterrorism agents (Anthrax, Smallpox, Plague, Tularemia)

A

Anthrax: ciprofloxacin, levofloxacin, moxifloxacin PLUS two additional agents

Smallpox: Supportive care +/- tecovirimat

Plague: Streptomycin/gentamicin

Botulism: Antitoxin, supportive care

Tularemia: Streptomycin/gentamicin or doxy/cipro if severe disease

30
Q

Banana-shaped gametocytes are indicative of what?

A

Plasmodium falciparum spp

High degree of parasitemia (along with Plasmodium knowlesi)

31
Q

CMV treatment in HSCT patients

A

Ganciclovir

Consider if >1 month since HSCT with non-specific symptoms (pneumonitis, esophagitis, colitis, hepatitis)

32
Q

Treatment duration for VAP

A

7 days

33
Q

Treatment for aeromonas hydrophila

A

Eval for nec fasc, provide GN coverage –> ciprofloxacin and doxycycline

34
Q

Preferred treatment for candida esophagitis

A

Oral fluconazole

Consider EGD if not responding to therapy

35
Q

Antibiotic duration for prevention of acute rheumatic fever if:

1) uncomplicated
2) with carditis, no valvular disease
3) with carditis and valvular disease

A

Treatment is penicillin G benzathine every 3-4 weeks

1) for 5 years or until age 21
2) for 10 years or until age 21
3) for 10 years or until age 40

*Note these treatments are for whatever duration is longer

36
Q

Treatment for candidal esophagitis and thrush with known HIV

A

Trial oral fluconazole x14-21 days

If not responding in 72 hours, schedule EGD for further evaluation (HSV, CMV)

37
Q

First line treatment for onychomycosis

A

Oral terbinafine (minimum 6 weeks)

Second line is itraconazole BID once weekly per month for two months (pulse therapy)

38
Q

Clinical presentations for

1) Blastomycosis
2) Histoplasmosis
3) Coccidiomycosis

A

1) Cutaneous plaques/ulcerations, bone lesions with sinus tracts, GU involvement, CNS (rare)
2) Hilar lymphadenopathy, HSM, Pancytopenia, Adrenal Insufficiency
3) Skin lesions, lymph node involvement, meningitis, osteoarticular involvement

39
Q

What causes a chronic, non-tender indurated facial mass in patient with diabetes/dental caries/malnutrition?

Treatment?

A

Cervicofacial actinomycosis

Mandible most commonly involved

Treat with penicillin

ABIM Prep Flashcards (12 decks)

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