Infectious Diseases 1 Flashcards
1
Q
- A.A. is a 21-year-old college student who presents in
the clinic with penile discharge and burning with urination. He reports drinking too much the past weekend
(about 6 days ago) and having unprotected intercourse
with a woman he met at a party. A.A. is otherwise
healthy with no comorbidities, chronic medications,
or known drug allergies. A physical examination is
performed, and urethral discharge is noted. However,
testing for sexually transmitted infections (STIs) is not
immediately available. Which is the most appropriate
treatment recommendation for this patient?
A. Ceftriaxone 250 mg intramuscularly once.
B. Doxycycline 100 mg orally twice daily for 7 days
plus ceftriaxone 500 mg intramuscularly once.
C. Ceftriaxone 250 mg intramuscularly once plus
azithromycin 1 g orally once.
D. Ceftriaxone 500 mg intramuscularly once plus
doxycycline 1 g orally once
A
- Answer: B
This patient is at risk of multiple STIs, including gonorrhea
and chlamydia, given his history and clinical presentation.
Because testing is not immediately available, he should be
empirically treated for both gonorrhea (ceftriaxone 500 mg
intramuscularly once) and chlamydia (doxycycline 100 mg
orally twice daily for 7 days), making Answer B correct.
The previously recommended empiric treatment was ceftriaxone 250 mg intramuscularly once plus azithromycin
1 g orally once, but this recommendation changed in 2021
because of increased resistance (Answer C is incorrect).
Ceftriaxone alone would treat only gonorrhea, and 250 mg
is no longer the recommended dose; also, the patient needs
empiric treatment for chlamydia (Answer A is incorrect).
Answer D is incorrect because the doxycycline dose should
be 100 mg orally twice daily for 7 days
2
Q
- B.B. is a 20-year-old woman who presents to her
primary care provider with painful, ulcerative
lesions on her labia bilaterally. Her physician makes
the presumptive diagnosis of herpes labialis and
requests your opinion on treatment. Which is the most
appropriate therapy for this patient’s first episode?
A. Valacyclovir 1 g orally three times daily for 7
days.
B. Valganciclovir 900 mg orally once daily for 7
days.
C. Acyclovir 800 mg orally twice daily for 7 days.
D. Acyclovir 400 mg orally three times daily for 7
days
A
- Answer: D
For first episodes of herpes labialis, acyclovir 400 mg orally
three times daily is a reasonable first-line option (Answer
D is correct). Increasing the acyclovir dose to 800 mg is
not necessary (Answer C is incorrect), and the correct valacyclovir dose for HSV is 1 g orally twice daily (Answer
A is incorrect). Although valganciclovir is active against
HSV, its spectrum is broader than necessary (Answer B is
incorrect).
3
Q
- C.C. is a 30-year-old health care worker who is stuck
by a needle that was being used to perform a venipuncture in a known HIV-seropositive patient. Which
is the most important determinant with respect to the
efficacy of postexposure prophylaxis (PEP)?
A. The time elapsed since the needlestick injury
occurred.
B. The sex of the source patient.
C. The nonprescription drug history of the source
patient.
D. The source patient’s CD4+
cell count.
A
- Answer: A
One of the most critical factors involved in the efficacy of
PEP to prevent HIV infection is the time elapsed since the
actual exposure. The earlier the PEP is administered, the
greater the likelihood of efficacy (Answer A is correct).
Most experts agree that the use of PEP beyond 72 hours
of time zero is unlikely to reduce the risk of HIV transmission. The gender, medication history, and CD4+
cell
count of the source patient do not affect the efficacy of PEP
(Answers B, C, and D are incorrect)
4
Q
- D.D. is a 30-year-old African American man with
newly diagnosed HIV infection; his viral load is
250,000 copies/mL, and his CD4+
count is 220 cells/
mm3
. Which is the most appropriate next step in managing his disease?
A. Obtain a genotype.
B. Obtain a phenotype.
C. Administer hepatitis B virus (HBV) vaccine.
D. Administer influenza vaccine
A
- Answer: A
It is recommended to obtain a genotype for all patients
when they begin to receive HIV care, regardless of initiation of ART (Answer A is correct). A phenotypic resistance
test is reserved for patients with known or suspected complex drug resistance mutations (Answer B is incorrect).
Vaccinations are also important but would not be the first
priority (Answers C and D are incorrect).
5
Q
- E.E. is referred to the pharmacotherapy clinic for the
management of ongoing hyperlipidemia that has not
responded to 6 months of diet and exercise. He is
HIV seropositive and takes the following antiretroviral (ARV) regimen: tenofovir alafenamide fumarate/
emtricitabine plus darunavir/ritonavir. The only other
medications the patient currently takes are citalopram
for depression and zolpidem as needed for sleep. E.E.’s
primary care physician is concerned about his elevated
low-density lipoprotein cholesterol concentrations.
Which intervention is most appropriate currently?
A. Initiate therapy with pravastatin.
B. Initiate therapy with simvastatin.
C. Discontinue tenofovir alafenamide fumarate/
emtricitabine.
D. Continue lifestyle modifications only.
A
- Answer: A
Human immunodeficiency virus and certain ARV agents
have been associated with a propensity to induce hyperlipidemia. Typically, the management of hyperlipidemia in
patients with HIV infection is similar to that in uninfected
patients, except for certain limitations in the selection of
drug therapy with statins. Many of the statin agents will
interact with PIs, increasing the risk of rhabdomyolysis.
If statins are indicated to lower low-density lipoprotein
cholesterol, preferred agents include those with a lower
propensity for CYP interactions (e.g., pravastatin, atorvastatin, rosuvastatin; Answer A is correct; Answer B is
incorrect). Tenofovir alafenamide fumarate/emtricitabine
is likely contributing only minimally to the increased
lipids, so discontinuing it is not appropriate (Answer C is
incorrect). The patient should continue lifestyle modifications, but because this intervention has not worked over a
6-month period, a statin should be initiated (Answer D is
incorrect).
6
Q
- F.F. is a 26-year-old white man with HIV who presents
today to begin a new ARV regimen. The patient has not
previously been treated for HIV, and a genotypic resistance assay shows no resistance to any available ARV
medication; his viral load is 76,300 copies/mL, and his
CD4+
count is 355 cells/mm3
. The patient is a graduate student who has a hectic work and school life. F.F.
also has severe insomnia, which he attributes to “racing
thoughts.” He will consider only a once-daily regimen.
Which is the best once-daily option for this patient?
A. Emtricitabine/tenofovir disoproxil fumarate/
rilpivirine.
B. Emtricitabine/tenofovir disoproxil fumarate/
efavirenz.
Infectious Diseases I
ACCP/ASHP 2023 Ambulatory Care Pharmacy Preparatory Review and Recertification Course
1032
C. Emtricitabine/tenofovir alafenamide/bictegravir.
D. Emtricitabine/tenofovir alafenamide/cobicistat/
elvitegravir.
A
- Answer: C
Current guidelines recommend an INSTI plus a two-NRTI
backbone as initial treatment for HIV infection. Answer C,
emtricitabine/alafenamide/bictegravir, is therefore correct.
Emtricitabine/tenofovir DF/efavirenz and emtricitabine/
tenofovir DF/rilpivirine are listed as alternative agents, not
recommended agents, in the current guidelines (Answers A
and B are incorrect). In addition, the use of efavirenz is not
recommended in this patient because it might further exacerbate this patient’s difficulty sleeping; efavirenz has been
associated with vivid dreams and CNS disengagement.
Emtricitabine/tenofovir alafenamide fumarate/elvitegravir/cobicistat is an INSTI-based regimen, but this specific
regimen is not recommended as initial therapy because it
contains a boosting agent, which would place the patient
at a greater risk of drug-drug interactions (Answer D is
incorrect).
7
Q
- G.G. is a 49-year-old female renal transplant recipient
who presents to the clinic for a routine follow-up. She
has no food or drug allergies. G.G.’s allograft is functioning well, and she has not been treated for rejection.
Because the influenza season has just begun, which
is the most appropriate means of prevention for this
patient?
A. Oseltamivir 75 mg orally once daily for the duration of the influenza season.
B. Inactivated influenza vaccine (IIV) and oseltamivir 75 mg orally once daily for 2 weeks.
C. IIV.
D. Live attenuated influenza vaccine (LAIV)
A
- Answer: C
Vaccination is the most effective method for preventing
influenza (Answer A is incorrect). The inactivated vaccine is preferred for this patient because she is a transplant
recipient (Answer C is correct; Answer D is incorrect).
The use of oseltamivir for 2 weeks at the time of influenza vaccination (to provide protection until immunity is
established) can be considered if a patient has an influenza
exposure (Answer B is incorrect because the patient did not
report an influenza exposure)
8
Q
- H.H. is 62-year-old woman who presents to her primary care provider for an annual follow-up. She states
that she cannot recall ever having chickenpox or shingles. Which is the best option to prevent herpes zoster
in this patient?
A. Obtain assay for varicella zoster virus immunoglobulin G, and if negative result, give Varivax; if
positive result, give Zostavax.
B. Give Varivax.
C. Give Shingrix.
D. Give varicella zoster immune globulin (VariZIG).
A
- Answer: C
The ACIP guidelines recommend Shingrix for all patients
age 50 and older, regardless of herpes zoster history or
previous vaccination with Zostavax. (Answer C is correct).
It is thus unnecessary to obtain VZV serologic testing for
this patient, and Zostavax is also no longer available in the
United States (Answer A is incorrect). Varivax is recommended as a routine childhood vaccine, and it can be given
to certain immunocompromised patients who are VZV
negative (Answer B is incorrect). The VariZIG vaccine
is recommended only as PEP in high-risk VZV-negative
patients (Answer D is incorrect)
9
Q
- J.J. is a 22-year-old man with a 4-month history of
pain and itching on the toes of both feet, with noticeable peeling and scaling. In the past month, he has
lost both toenails from his great toes. J.J. is otherwise
in excellent health because he regularly competes in
amateur triathlons. His primary care provider diagnoses tinea pedis. Which is the most likely cause of this
patient’s infection?
A. Malassezia spp.
B. Dermatophytes.
C. Sporothrix schenckii.
D. Candida albicans
A
- Answer: B
Tinea pedis is a type of ringworm caused by the dermatophytes Trichophyton, Microsporum, and Epidermophyton
species (Answer B is correct). The other listed fungal
pathogens are not dermatophytes (Answers A, C, and D
are incorrect).
10
Q
- Which organism best fits the following description:
endemic in the Ohio and Mississippi River Valleys and
can manifest as an acute pulmonary, chronic pulmonary, or disseminated infection?
A. Blastomyces dermatitidis.
B. Histoplasma capsulatum.
C. Coccidioides immitis.
D. Coccidioides posadasii
A
- Answer: B
H. capsulatum is endemic in the Ohio and Mississippi
River valleys (Answer B is correct). B. dermatitidis is
endemic around the Great Lakes (Answer A is incorrect), whereas Coccidioides spp. are endemic in the desert
Southwest (Answers C and D are incorrect)
