Infectious Disease III Flashcards
What is the recommended hepatitis A vaccine schedule for adults who are not immunized?
Recommended for men who have sex with men, IV drug users, traveler’s to endemic areas, and those with chronic liver disease
What is the recommended meningococcal vaccine schedule for normal risk patients?
primary vaccine preferably at age 11-12; booster at age 16-21
What is the recommended prophylaxis for an unvaccinated healthcare worker that is exposed to blood from a hepatitis B positive patient?
hepatitis B vaccine and hepatitis B immune globulin
the next two doses of the HBV vaccine can be administered according to standard schedule; those who are adequately immunized do not require any post-exposure prophylaxis
What is the recommended tetanus prophylaxis in an adult that stepped on a rusty nail? He received a 3-dose primary tetanus vaccination as a child (> 10 years ago).
Tetanus toxoid-containing vaccine
no tetanus immune globulin is needed
What is the recommended tetanus prophylaxis in an adult that suffers a severe wound after stepping on rusty nails? He is uncertain of his vaccination history.
Tetanus toxoid-containing vaccine and tetanus immune globulin
What is the recommended tetanus vaccine schedule for adults with an unknown vaccination history?
Tdap once as a substitute for Td booster, then Td every 10 years
What is the recommended treatment for a middle-aged patient that presents with symptoms related to influenza for 4 days?
Symptomatic treatment
treatment with anti-virals (e.g. oseltamivir) is only recommended for those who present within 48 hours or those with other risk factors (age > 65, chronic medical conditions)
What is the recommended treatment for a patient with suspected Entamoeba histolytica liver abscess?
metronidazole and a luminal agent (e.g. paromomycin)
cyst drainage is not typically recommended
What is the recommended treatment for Legionnaire’s disease?
macrolides or respiratory fluoroquinolones (e.g. levofloxacin, moxifloxacin)
What is the recommended treatment for mucormycosis?
surgical debridement, liposomal amphotericin B, and elimination of promoting factors
What is the recommended treatment for patients with cryptococcal meningoencephalitis?
amphotericin B plus flucytosine, followed by fluconazole
What is the recommended treatment for patients with disseminated histoplasmosis?
IV Amphotericin B (1-2 weeks), followed by oral itraconazole (> 1 year)
in patients with mild disease (e.g. immunocompetent individuals), itraconazole therapy may be adequate
What is the recommended treatment for patients with mild leprosy?
Dapsone and rifampin
may add clofazimine for patients with extensive lesions
What is the recommended treatment for patients with toxoplasmosis?
sulfadiazine and pyrimethamine
What is the recommended treatment for primary syphilis in a non-pregnant patient with a severe penicillin allergy (e.g. anaphylaxis)?
Oral doxycycline
a 4-fold decrease in antibody titers at 6-12 months indicates treatment success; patients with tertiary syphilis and penicillin allergy should receive ceftriaxone rather than penicillin or doxycycline
What is the recommended treatment for sporotrichosis?
Oral itraconazole (3 - 6 months)
What is the test of choice to confirm the diagnosis of chlamydial urethritis?
Nucleic acid amplification test
What is the treatment of choice for an HIV patient with Pneumocystis pneumonia and a PaO2 of 54 mmHg (normal 75-105 mmHg)?
Trimethoprim-sulfamethoxazole and corticosteroids
corticosteroids are indicated for patients with PCP if SaO2 < 92%, PaO2 < 70 mmHg, A-a gradient > 35 mmHg on room air
What is the treatment of choice for patients with suspected nocardiasis?
Trimethoprim-sulfamethoxazole
What is the typical empiric treatment for patients with human bite wounds?
Amoxicillin-clavulanate
human bite wounds are often polymicrobrial with both aerobic and anaerobic oral organisms; surgical debridement is usually necessary and wounds are typically left open to drain and heal by secondary intention (higher risk of infection with closure)
What microorganism is associated with acute epididymitis in older men (age > 35)?
E. coli
typically presents with unilateral testicular pain that is classically relieved by lifting the testicles (Prehn’s sign); epididymitis is usually secondary to bacteruria from bladder outlet obstruction in older patients (versus STIs in younger patients)
What neurological side effect is associated with isoniazid use?
Peripheral neuropathy
secondary to pyridoxine deficiency
What prophylactic medications should be initiated in a patient who is beginning high-dose immunosuppression therapy following a renal transplant?
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What prophylactic medications should be initiated in a patient who is beginning high-dose immunosuppression therapy following a renal transplant?
- TMP-SMX (for PCP)
- ganciclovir or valganclovir (for CMV)
fungal prophylaxis may be required in other solid organ transplants (e.g. lung, liver); typically not needed for renal transplant
What screening test(s) for STDs should be offered to an asymptomatic 22-year-old male that is not yet sexually active?
HIV screening (p24 antigen and HIV antibody tests)
plasma HIV RNA testing is recommended for individuals with negative serologic tests and high clinical suspicion of acute HIV; testing for HSV, gonorrhea, syphilis, etc. is not needed in this sexually inactive, asymptomatic patient
What systemic mycoses are endemic to the Mississippi and Ohio River basins?
Histoplasma and Blastomyces
“HistOH, BlastOH = H2O = river basins”
What systemic mycoses are endemic to the Southwestern U.S.?
Coccidioides
also known as “desert rheumatism”, thus think of dry areas (e.g. Southern California, Arizona)
What type of cancer is associated with Streptococcus gallolyticus infection?
Colorectal cancer
previously known as S. bovis; Clostridium septicum is also associated with colon cancer
What type of catheterization is recommended for patients with neurogenic bladder to reduce the risk of catheter-associated UTI?
Clean intermittent catheterization
i.e. insertion/removal of a clean urinary catheter every 4 - 6 hours; can be performed by patient or caregiver
What type of tick is responsible for spreading babesia?
Ixodes scapularis
this tick also spreads Borrelia burgdorferi (Lyme disease) and Anaplasma phagocytophilum (human granulocytic anaplasmosis)
What valvular dysfunction is most likely to be detected in a patient with a history of a “heart murmur” that develops infective endocarditis?
Mitral regurgitation
mitral valve disease (usually MVP) is the most common valvular abnormality detected in patients with IE
What viral testing should be offered to a patient with fever, arthralgias, lymphadenopathy, prolonged diarrhea, and mucosal ulcerations?
HIV testing
acute HIV infection can present with a mononucleosis-like syndrome with GI symptoms, skin rash, mucosal ulcers, and prolonged diarrhea
When should a patient visiting a malaria endemic country take chemoprophylactics (e.g. mefloquine)?
> 2 weeks prior to travel, during the stay, and 4 weeks after returning
Which heart valve is most frequently involved in bacterial endocarditis in IV drug users?
Tricuspid valve
associated with S. aureus, Pseudomonas, and Candida
Which heart valve is most frequently involved in bacterial endocarditis?
Mitral valve
Why is empiric antibiotic therapy avoided in patients with suspected enterohemorrhagic E. coli (EHEC) infection?
May increase risk of HUS
