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Infectious disease Flashcards

1
Q

How to reduce surgical site infection

A

Evaluate for staph aureus nasal carriage 2 weeks before surgery and decolonize if positive (most surgical site infections are due to s. aureus). If positive, patients need preoperative decolonization.

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2
Q

Preoperative antibiotic prophylaxis for surgical site infection

A
  • Cefazolin 1-2 hours before incision (unless MRSA nasal carriage, then vanc)
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3
Q

Coccidoidomycosis clinical features

A

similar to TB + peripheral eosinophilia + California

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4
Q

Coccidoidomycosis treatment

A

fluconazole

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5
Q

Empiric CAP treatment in patient requiring ICU

A

Use agent active against legionella (macrolide or quinolone) instead of atypical coverage

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6
Q

B-lactams

A

ampicillin-sulbactam
cefotaxime
ceftriaxone
ceftaroline

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7
Q

pseudomonal RF’s

A

Health care interaction

Previous antibiotic use

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8
Q

Workup of fever of unknown origin

A 
(TB, bacteremia, HIV, abdominal infection)
CBC, CMP
3 blood culture sets
Urine culture
ESR
TB testing
HIV
CT abdomen
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9
Q

Criteria for Fever uf unknown origin

A

Fever of 100.9 or greater for 3 or more weeks undiagnosed after 2 visits in the ambulatory setting

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10
Q

Leptospirosis clinical features

A

Hawaii + uveitis + rash + sepsis + LAD + kidney injury + HSM

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11
Q

What is acute retroviral syndrome?

A

Acute symptomatic illness when patients develop HIV

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12
Q

Management of complicated fulminant (severe) C diff infection

A

Oral vanc + IV flagyl (reduced absorption)

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13
Q

Severe c diff defined as

A

serum Cr >1.5 or WBC >15

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14
Q

complicated fulminant c diff defined as

A

Complicated by ileus, hypotension, shock, or toxic megacolon

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15
Q

Post lyme disease syndrome clinical features

A

Persistent fatigue + headache + myalgia + arthralgia following lyme disease treatment

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16
Q

hallmark of babesiosis

A

hemolytic anemia

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17
Q

presentation of late stage lyme disease

A

inflammatory arthritis involving larger joints

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18
Q

presentation of mycobacterium fortuitum

A

Chronic, non healing ulcers and wounds that don’t respond to antibiotics

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19
Q

most common cause of pulmonary disease from NTM

A

MAC (mycobacterium avium complex)

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20
Q

Leprosy clinical features

A

chronic skin lesions + sensory loss in extremities

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21
Q

PID features

A

lower abdominal pain + vaginal discharge

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22
Q

Outpatient/ED treatment of PID

A

Single dose of IM CTX + oral doxycycline for 14 days

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23
Q

Only indications for treating ASB

A

1) Pregnancy

2) medical clearance before an invasive urologic procedure

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24
Q

Postexposure prophylaxis and testing for person who has needle stick from HIV positive patient (components)

A
  • 3 drug regimen for 1 month
    Tenofovir + emtricitabine + either dolutegravir or raltegravir
  • test immediately, 4-6 weeks later, and 3 months after exposure
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25
Q

management of acute, uncomplicated pyelo with transient bacteremia

A

Complete oral antibiotic course outpatient

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26
Q

patient groups susceptible to giardia

A

1) Selective IgA deficiency

* **Preschool

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27
Q

Salmonella features

A

most common cause of foodborne illness + non bloody diarrhea + self-limited

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28
Q

Listeria clinical features

A

headache + fever + non bloody watery diarrhea + pain in muscles and joints

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29
Q

How to test for possible Zika exposure

A

If exposure more than 2 weeks previously, test for IgM antibodies

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30
Q

Most frequent manifestation of Zika in newborne

A

microcephaly

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31
Q

Management of pregnant woman with proven zika

A

Serial US q3-4 weeks

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32
Q

What is Ramsay Hunt syndrome + pathogen

A

Ear pain + vesicular rash in the external ear + ipsilateral peripheral facial palsy + deafness
(reactivation of herpes zoster in the geniculate ganglion)

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33
Q

Problem with live attenuated zoster vaccine

A

Has 64% efficacy that decreases to 36% after 6 years

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34
Q

Bell palsy clinical features

A

Isolated paralysis of the facial nerve + complete unilateral facial paralysis

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35
Q

Cause of bell Palsy

A

HSV 1

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36
Q

Features of Q fever pneumonia

A
  • exposure to livestock/farm animals (farmers, veterinarians, and abattoir workers)
  • mild pneumonia
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37
Q

Infection and clinical features associated with chlamydia psitacci infection

A
  • Psittacosis
  • PNA associated with abrupt onset of fever + HA + dry cough
  • inhalation of dried bird droppings
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38
Q

Clinical features + reservoir of infection due to yersinia pestis

A
  • Pneumonic plague
  • rodent exposure
  • sudden high fever + pleuritic chest pain + productive cough + hemoptysis + (patients are very very sick)
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39
Q

Antibiotics for an infected cat bite

A

Unasyn + vanc IF RF’s for MRSA (pus forming) (infections are caused by both organisms from animals mouth flora and the host’s skin flora)

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40
Q

Ehrlichiosis infection clinical features

A

Febrile illness + leukopenia + thrombocytopenia + elevated liver enzymes

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41
Q

Management of health care-associated ventriculitis (after neurosurgery)

A

Remove ventricular device

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42
Q

Treatment of disseminated histo

A

Liposomal amphotericin B

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43
Q

Signs of disseminated histo

A

Oral ulcerations + hepatosplenomegaly + pancytopenia

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44
Q

empyema diagnosis

A

thora with purulent or foul-smelling material OR a positive gram stain

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45
Q

organism causing most malaria

A

Plasmodium falciparum

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46
Q

typhoid fever clinical features

A

Fever + diarrhea + transient small blanching skin lesions (rose spots)

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47
Q

leptospirosis presentation

A

Fever + myalgias + HA + conjunctival suffusion (conjunctival injection without exudate)

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48
Q

When you should never use daptomycin

A

lung pathogens (binds to surfactant)

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49
Q

Initial management of new diagnosis of HIV

A
  • Viral load
  • Genotypic viral resistance testing
  • Start HAART as soon as patient is ready
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50
Q

Most common causes of meningitis during different seasons

A 
Enterovirus = May-November
Winter = HSV-2
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51
Q

CSF findings in viral meningitis

A

Normal glucose
Lymphocytic pleocytosis (High WBC’s in CSF)
Mildly elevated protein level

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52
Q

Management of patient testing positive for hep B surface antigen + negative for hep B surface antibody

A

Patient has had HBV infection and would have no benefit from immunization with HBV vaccine

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53
Q

What is neuroborreliosis

A

sequela of lyme disease due to CNS involvement (nuchal rigidity, headache, facial nerve involvement)

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54
Q

Management of lyme disease with CNS features

A

LP before treatment

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55
Q

Treatment of neuroborreliosis

A

parenteral therapy – CTX, cefotaxime or penicillin

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56
Q

Management of anthrax exposure

A

IF no known direct exposure, no need to test or quarantine (don’t need to separate members of household)

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57
Q

Postexposure ppx for anthrax

A

ABX for 60 days (cipro, levo, or doxy)

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58
Q

Prep administration and components

A

Tenofovir + emtricitabine once daily

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59
Q

PREP monitoring

A

need to check kidney function

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60
Q

Indications for amputation with diabetic foot infections

A
  • persistent sepsis
  • not tolerating antibiotics
  • progressive bone destruction despite therapy
  • bone destruction compromising mechanical integrity of the foot
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61
Q

management of patient with positive treponemal serology and negative nontreponemal test (RPR)

A

no treatment (this is successfully treated syphilis)

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62
Q

nontreponemal test

A

RPR

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63
Q

Leading cause of swimming pool-related outbreaks of diarrheal illness

A

cryptosporidium

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64
Q

How to reduce central line associated infections

A
  • assess daily for continued necessity

- NO routine replacement of central lines

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65
Q

Treatment of cyclospora infection

A

Oral bactrim

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66
Q

Management of HIV meds in pregnant woman

A

Continue same regimen

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67
Q

Hep A vaccination protocol

A

Single injection 2-4 weeks before travel to an endemic region (but single dose at any time before travel provides adequate protection)

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68
Q

management of ESBL UTI

A

Carbapenems (even if culture suggests some sensitivity to zoey or other antibiotic, this is low sensitivity)

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69
Q

monitoring for daptomycin

A

Weekly creatinine + CK

should discontinue statin

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70
Q

Cause of kaposi sarcoma

A

HHV type 8

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71
Q

Treatment for kaposi

A

ART
Local therapies (RT, intralesional chemo, cryotherapy, retinoids)
Chemo or INF

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72
Q

Treatment of MSSA osteoporosis associated with orthopedic hardware

A

IF hardware can’t be removed –> Rifampin (synergistic) + anti staphylococcal agent (cefazolin)

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73
Q

When to treat animal bites

A
  • immunosuppressed patients (cirrhotics, asplenia)
  • wound with edema
  • venous insufficiency
  • crush injury
  • wound involving joint or bone
  • deep puncture wound
  • face, genitalia, or hand involvement
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74
Q

Antibiotic used for multi-drug resistant intra-abdominal infection

A

Ceftolozane-tazobactam and colistine

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75
Q

Antibiotic used for UTI’s caused by multidrug-resistant organisms

A

Fosfomycin

76
Q

When to treat influenza with tamiflu

A

IF hospitalized or outpatient w/ severe or progressive illness –> as soon as possible regardless of illness duration
IF otherwise healthy –> only if started within 48 hours of symptom onset

77
Q

Board answer to additional study needed for urosepsis

A

kidney ultrasound or CT with contrast if Cr okay

78
Q

Test results in Acute HIV

A
  • Negative antibody differentiation immunoassay (prior to antibody development)
  • positive HIV-1 nucleic acid amplification test
79
Q

What is urethritis?

A

Dysuria + purulent discharge,

80
Q

Treatment of urethritis

A

Empiric ceftriaxone + azithromycin

81
Q

Prophylaxis for transplant patients

A

Bactrim
Posaconazole
*Acyclovir while neutropenic

82
Q

Why acyclovir is given for transplant patients during periods of neutropenia

A

Reduce reactivation of HSV

83
Q

Preferred agent for antibacterial prophylaxis during neutropenia and why

A

Cipro (active against most gram-negative bacteria)

84
Q

Treatment of TB meningitis

A

RIPE + dexamethasone (mortality benefit)

85
Q

Most common causes of chronic meningitis

A

TB and cryptococcus

86
Q

When to suspect TB meningitis

A
  • endemic country (eg mexico) **lymphocytic meningitis (high lymphocytes in CSF)
  • *cranial neuropathies + VERY low CSF glucose level
  • Acid-fast bacilli stains and cultures are insensitive and may take up to 6 weeks to grow
87
Q

Treatment for latent TB

A
  • INH + rifapentine once weekly for 3 months
  • 4 months of rifampin
  • 3 months of INH + rifampin daily
88
Q

treatment of gonorrhea

A

CTX + single dose of azithromycin (even if chlamydia negative due to growing resistance to CTX)

89
Q

Finding on blood stain with babesiosis

A

intraerythrocytic tetrad forms (maltese cross)

90
Q

Finding on blood stain with anaplasmosis and ehrlichiosis

A

Morulae (basophilic inclusion bodies)

91
Q

Examples of TMAS

92
Q

Oral antibiotics that can be used for osteo

A

Ciprofloxacin

  • Metronidazole
  • both have excellent bioavailability and will penetrate bone adequately
93
Q

Management of candidemia

A

Empiric treatment ASAP with echinocandin (anidulafungin, caspofungin, or micafungin) (high mortality rate)

  • deescalate to fluconazole if susceptible for 14 day course
  • receive CVC
94
Q

recommended duration of treatment for vertebral osteo

95
Q

Caveat about meningococcal vaccine

A

Quadrivalent vaccine doesn’t include serogroup B, which accounts for 40% of meningitis, so could still have meningitis despite being vaccinated

96
Q

Niesseria bacterial type

A

Gram-negative diplococci

97
Q

Treatment of proctitis in patient at risk for sexually transmitted infections

A

CTX + doxycycline (often due to chlamydia and gonorrhea, and HSV)

98
Q

Presentation of CMV

A

thrombocytopenia + organ-specific disease (CMV pneumonia, colitis, esophagitis, hepatitis)

99
Q

Empiric treatment of CMV

A

Ganciclovir

100
Q

How to determine risk of CMV in transplant patient

A

Serologic status of donor and recipient (high if donor or recipient are seropositive)

101
Q

CMV pneumonia on CXR

A

diffuse bilateral lung involvement

102
Q

Mortality/prognosis of CMV pneumonia

A

Poor prognosis, significant mortality

103
Q

Management of MRSA bacteremia when vanc resistant

A

daptomycin

104
Q

Management of patient with terminal complement deficiency

A

Meningococcal vaccination
Pneumococcal vaccination
Haemophilus influenza vaccine

105
Q

management of mild, non purulent cellulitis

A

Clindamycin
Penicillin
Cephalexin
Dicloxacillli

106
Q

organism in mild, non purulent cellulitis

A

streptococci

107
Q

Clinical features of chronic granulomatous disease (CGD)

A

Recurrent or severe infections with aspergillum, staph aureus, nocardia, serratia

108
Q

mycobacterium marinum clinical features

A

Granulomatous + skin infection (violaceous or erythematous papule or nodule that may ulcerate)

109
Q

When bactrim can be discontinued for PCP prophylaxis

A

CD4>200 for more than 3 months

110
Q

antibiotic duration for VAP

111
Q

Anti-NMDA receptor encephalitis presentation

A
  • Altered mood and behavior (psychosis) + seizures
  • teratoma
  • choreoathetosis
112
Q

First step with patient presenting with TB

A

Obtain sputum for AFB’s and culture BEFORE starting abx (need to perform susceptibility testing because resistance is increasing to isoniazid and rifampin)

113
Q

Treatment + duration for active TB

A

RIPE for 8 weeks, then continue INH and rifampin for 18 weeks

114
Q

Animals carrying nontyphoidal salmonella

A

Reptiles, amphibians

115
Q

Management of persistent staph aureus bacteremia

A

Eval for source control issue (endocarditis, osteo, intra-abdominal infection) –> TTE, CT abdomen

116
Q

Preferred antibiotic for MSSA

117
Q

Management of aeromonos hydrophila

A
  • surgery

- gram negative abx (doxycycline + ciprofloxacin)

118
Q

When is bacterial transmission likely to occur with tick bites?

A

Only after 36 hours

119
Q

Management of smallpox exposure

A

Vaccinia immunization

120
Q

Next step for young patient with herpes zoster

A

Test for HIV

121
Q

Sporadic creutzfeldt-jakob disease clinical features

A

Rapid progression of apparent dementia + ataxia + myoclonus + MRI abnormalities

122
Q

CSF finding for creutzfeldt-jakob

A

14-3-3 T-tau protein

123
Q

IDSA recommended antibiotic course for uncomplicated CAP

A

5-7 days (assuming defervescence for 48h and not validated if pseudomonas or staph RF’s)

124
Q

Initial imaging for suspected osteo

A 
Plain radiography (low sensitivity but high specificity)
- Then MRI after if plain radiography negative
125
Q

Workup of osteo if MRI contraindicated

A

Contrast-enhanced CT

126
Q

Treatment of EHEC and why

A

Supportive (antibiotics will increase risk of HUS)

127
Q

HUS presentation

A

MAHA + thrombocytopenia + kidney injury + more common in kids than adults

128
Q

Prevalence of latent CMV in adults

A

60-90% (this is why disease reactivation is so common)

129
Q

Highest risk of CMV scenario in transplant recipient

A

seronegative recipient receives organ from seropositive donor

130
Q

CMV presentation

A

retinitis + pneumonitis + hepatitis + bone marrow suppression + colitis with bloody diarrhea + esophagitis + adrenalitis

131
Q

First-line agent for CMV

A

valganciclovir

132
Q

Evaluation of surgical site infection

A

Gram stain and culture of incision site drainage

133
Q

Treatment of choice for cryptococcal meningitis

A

Liposomal amphotericin B + flucytosine

134
Q

Treatment of oropharyngeal candidiasis + duration

A

Oral fluconazole (regardless of whether it extends into esophageus. If it does, need longer course (14-21 days)

135
Q

Presentation of acute kidney infarction

A

flank pain or generalize abdominal Pain = N/V + hematuria + often cardioembolic from AF + wedge shaped perfusion defect on CT

136
Q

Diagnosis of genital herpes

A

Nucleic acid amplification testing for HSV-1 and HSV-2

137
Q

Treatment of nec fasc due to group A strep

A

Combined penicillin + clindamycin after surgical debridement

138
Q

Toxic shock syndrome presentation

A

Hypotension + multiorgan involvement (kidney, liver, bone marrow (thrombocytopenia)).

139
Q

Mediterranean spotted fever presentation

A

Fever + myalgia + HA + maculopapular and petechial rash

***black eschar at site of inoculation

140
Q

Treatment of mediterranean spotted fever

A

7-10 day course of doxy

141
Q

Clinical features of post transplant lymphoproliferative disorder

A

transplant patient who a few years after develops fever + pancytopenia + generalized lymphadenopathy + HSM

142
Q

Pathogen in post transplant lymphoproliferative disorder

143
Q

RF’s for post transplant lymphoproliferative disorder

A
  • pre-existing EBV infection

- receiving sirolimus and tacrolimus compared to MMF and cyclosporine

144
Q

When to think about PTLD

A

fever + LAD or extra nodal mass

145
Q

PTLD treatment

A

Reduce immunosuppression
Rituximab (B-cell mediated)
Or other chemo

146
Q

Worst infection to complicate transplantation

147
Q

BK virus reactivation presentation

A

Gradual, asymptomatic increase in serum creatinine

148
Q

Treatment of purulent skin infection (abscess or furuncle) with systemic signs of infection

A

IF systemic signs of infection –> I&D + bactrim or doxy (MRSA coverage)
IF mild and no signs of systemic infection –> just I&D per IDSA but there is evidence for antibiotics

149
Q

What is a furuncle?

A

Purulent skin infection

150
Q

patients for whom TST of 5 mm or greater should be considered positive

A

HIV
Recent known contact with person with active TB
Transplant patients
Immunosuppressed (TNF alpha antagonist or greater than pred 15 mg daily)

151
Q

patients for whom TST of 10 mm or greater should be considered positive

A
  • Person from endemic country
  • IV drug user
  • Residents or employees of high risk congregate settings (prisons and jails, nursing homes, other long-term facilities, hospitals or clinics, shelters)
152
Q

latent TB treatment

A

INH + pyridoxine

153
Q

Management + treatment of recurrent cystitis in women

A
  • Urine culture (May be relapse or reinfection, most recurrences are reinfections (new bug))
  • Cipro + levo
154
Q

Definition of recurrent UTI

A

3 in past 12 months or 2 in past 6 months

155
Q

Treatment of mucormycosis

A

Liposomal amphotericin B

156
Q

Abx for purulent skin infection (MRSA coverage)

A

Doxy

Bactrim

157
Q

What is a furuncle?

A

Purulent skin infection

158
Q

MSSA management in setting of orthopedic hardware

A

cefazolin + rifampin (synergistic)

159
Q

Who needs to be quarantined from anthrax

A

Only people with direct exposure

160
Q

CMV prophylaxis during transplant

A

Valganciclovir

161
Q

When Cdiff typically occurs during transplant period

A

Early, first month

162
Q

When CMV infection typically occurs

A

“middle” period, 1-6 months after transplantation

163
Q

Presentation of Polyoma BK virus

A

Nephropathy + later than first month after transplantation

164
Q

Management of polyoma BK nephropathy

A

Reduce immunosuppression to minimum level necessary to avoid rejection

165
Q

First line treatment for pneumonic plague

A

Streptomcyin or gentamicin

166
Q

pneumonic plague clinical features

A
  • outbreaks among a group of people

- severe pneumonia with hemoptysis

167
Q

Gram staining + staining of pneumonic plague

A
  • gram-negative coccobacilli

- bipolar staining

168
Q

Management of suspected pseudomonas

A

Dual therapy – antipseudomonal B-lactam (zosyn, cefepime or meropenem) + quinolone or aminoglycoside

169
Q

When to suspect pseudomonas

A
  • immunocompromised patients

- underlying structural lung disease (bronchiectasis or CF)

170
Q

Preferred antibiotic for recurrent cystitis for which patient has received abx within the past 3 months OR in places where bactrim resistance rates are high

A
  • quinolone – cipro BID for 7 days (not first line due to SE’s + rising resistance)
171
Q

Preferred abx for cyclospora

172
Q

Cyclospora clinical features

A
  • parasite typically acquired after consumption of fecal-contaminated food or water or fresh produce, particularly in developing world
  • crampy abdominal pain, anorexia, bloating, decreased appetite, fatigue, fever/malaise/nausea/diarrhea
173
Q

When it is safe to stop taking bactrim in HIV

A

CD4 count greater than 200 for more than 3 months

174
Q

Aminoglycoside contraindication

A

Kidney disease

175
Q

Post transplant lymphoproliferative disorder timeframe

A
  • years after transplant
176
Q

Indications for MRSA coverage with animal bites

A
  • MRSA RF’s in patient (previous MRSA infection or colonization)
  • local MRSA prevalence is high
  • pus forming
177
Q

Management of smallpox exposure

A
  • vaccinia immunization (even if immunocompromised, only don’t give if severely immunodeficient)
178
Q

Small pox vaccination

A
  • we don’t vaccinate kids against smallpox anymore because it’s been declared eradicated so most of the population is not immune
179
Q

Treatment of severe CDiff

A
  • oral vancomycin (same as nonsecure)
180
Q

Severe Cdiff vs. fulminant CDiff

A
  • Severe = AKI or white count greater than 15K

- Fulminant = complicated by ileum, hypotension, shock, or toxic megacolon

181
Q

Preferred treatment of candida esophagitis

A
  • fluconazole
    (not nystatin swish and spit)
    *Regardless of oral or esophageal involvement, esophageal just warrants a more prolonged treatment course (2 weeks rather than 1)
182
Q

Cause of Ramsay Hunt syndrome

A

Varicella-zoster

183
Q

Outpatient abx prophylaxis after HSCT and cell count recovery

A

Antifungal – Posaconazole (risk of invasive fungal infection remains elevated even after recovery of neutrophils for the first few months)
Bactrim
*Don’t need to continue acyclovir.

184
Q

Use of valganciclovir during HSCT

A

Prevent or treat CMV infection

185
Q

Why don’t we prophylax for CMV?

A
  • leukopenia is an SE of valganciclovir, so better to monitor for CMV and start therapy when indicated

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