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Royal College Exam > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

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1
Q

What are the durations of treatment for different pathogens causing bacterial meningitis?

A

S. pneumonia - 10-14 days
N. meningitidis - 7 days
L. monocytogenes - 21 days

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2
Q

Who gets chemoprophylaxis for N. meningitis and with what?

A

Who - household contacts, sharing sleeping arrangements, healthcare workers with intensive unprotected contact.

What - ceftriaxone 250 mg IM, rifampin 600 mg PO BID x 2d, ciprofloxacin 500 mg PO x 1

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3
Q

Who gets immunoprophylaxis for N. meningitis?

A

Household contacts, sharing sleeping arrangements.

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4
Q

Who gets empiric anaerobic coverage for aspiration pneumonia?

A

Feculent sputum, abscess, empyema.

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5
Q

What are risk factors for MRSA?

A

Healthcare - recent hospitalization, resident of LTC home, recent surgery, IHD
Other - HIV, IVDU, prior antibiotics.

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6
Q

What are risk factors for pseudomonas?

A

Healthcare (ICU stay, bedridden, invasive devices), prior use of broad-spectrum antibiotics in last 3 months, lung disease (CF, bronchiectasis, COPD exacerbations), immunocompromise (HIV, neutropenic, stem cell transplant).

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7
Q

What are the most specific tests for early HIV infection?

A

Genital ulcers > weight loss

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8
Q

How do define and treat severe pneumocystis pneumonia?

A

Severe: PaO2<70% or A-a gradient >35.

Treat:
Septra 15-20 mg/kg IV x 21d,
Prednisone 40 mg PO BID x 5d then 20 mg PO BID x 5d then 20 mg PO daily x 11d.

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9
Q

How do you treat toxoplasmosis in an HIV + patient?

A

Sulfadiazine and pyrimethamine (with leucovorin) for 6 weeks.

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10
Q

Who should be tested for latent TB?

A
  1. Contact with someone with active TB.
  2. Travelling to TB endemic country.
  3. Immigrant from TB endemic country.
  4. Health care workers.
  5. LTC home or prison resident.
  6. Homeless.
  7. Aboriginal.
  8. IV drug user.
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11
Q

Who tests positive with a TBST > 5 mm (six total)?

A
  1. HIV +
  2. Contact with infectious case in past 2 years.
  3. Fibronodular disease on CXR.
  4. Organ transplantation.
  5. ESRD.
  6. Drugs (TNF-alpha, steroids).
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12
Q

Who requires steroids as part of TB treatment?

A

TB meningitis and TB pericarditis.

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13
Q

What are 5 class one indications for early surgical intervention for infective endocarditis?

A
  1. Persistent fever or bacteremia >5-7d after appropriate antibiotics.
  2. Lt sided IE from S. aureus, fungus, or resistant organism.
  3. Valve dysfunction with signs of heart failure.
  4. Heart block, root/annular abscess, penetrating lesion.
  5. Infected PPM or ICD or lead.
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14
Q

Who should be considered for IE prophylaxis?

A
  1. Prior IE.
  2. Any prosthetic valve (including TAVR).
  3. Congenital heart disease (unrepaired, repaired within last 6 months, or repaired with residual deficits).
  4. Heart transplant with valvulopathy.
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15
Q

Name three populations who should get empiric antibiotics for bloody diarrhea.

A
  1. Sick immunocompromised.
  2. Immunocompetent with fever >38.5C and recent travel.
  3. Immunocompetent with signs of shigella dysentery (frequent scant movements, pain, tenesmus, fever).
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16
Q

What are the elements of treatment of necrotizing fasciitis?

A
  1. Urgent plastic surgery consult.
  2. Type I NF empiric tx: piptazo + vanco
  3. Type II NF empiric tx: clindamycin
  4. Consider IVIG if shock or pre-op
17
Q

What is the OVIVA trial?

A

Showed non-inferiority of oral vs intravenous antibiotics for bone and joint infections.

18
Q

What are the most sensitive and specific tests for malaria diagnosis?

A

Sensitive: No fever
Specific: High bilirubin, splenomegaly, low platelets, fever

19
Q

What degree of parasitemia constitutes severe malaria?

A

2%

20
Q

What are key features of dengue fever?

A

Fever, severe mylagias, retro-orbital pain, maculopapular rash, cytopenias, NSAIDs make symptoms worse.

21
Q

What are key features of chikungunya disease?

A

Fever, polyarthralgias, lymphopenia, maculopapular rash.

22
Q

What are key features of typhoid fever?

A

Flu like symptoms, rose spots, relative bradycardia, constipation, abdominal pain.

23
Q

How do you treat typhoid?

A

Uncomplicated: fluoroquinolone (resistance in Asia) or azithromycin.
Severe: Ceftriaxone.

24
Q

Which four diseases do you screen for before starting steroids?

A
  1. TB - prednisone > 15 mg/d >4 weeks and 1+ TB risk factors (r/o active, treat latent, INH x 9 mo).
  2. Hep B - prednisone > 7.5 mg/d.
  3. Pneumocystis - prednisone > 20 mg/d >4-8 weeks (Septra one DS daily)
  4. Strongyloides - anyone from endemic country.
25
Q

List 6 opportunistic infections occur at CD4 count <20

A
  1. Cutaneous Kaposi sarcoma.
  2. PJP.
  3. Endemic fungi (histo, coccidiosis, blasto).
  4. Non-endemic fungi (cryptococcus).
  5. HIV-myelopathy (paraplegia).
  6. Cancer (NHL, anal, vaginal, cervical, liver)
26
Q

What viral load count precludes vaginal delivery?

A

> 1000 copies/mL

27
Q

What are three features of tertiary syphilis?

A
  1. Cardiovascular - aortitis.
  2. Neurologic - tabes dorsalis, paresis.
  3. Gummatous disease.
28
Q

What is a classic finding of mucormycosis?

A

Black eschar in nasal mucosa or palate of a diabetic patient.

29
Q

What organism most likely causes invasive otitis externa?

A

Pseudomonas aeruginosa.

30
Q

Which patients get tetanus vaccine and immunoglobulin?

A

Vaccine: clean/minor wound with last vaccine unknown or >10 years ago, dirty and/or major wound with last vaccine unknown or >5 years ago.

Immunoglobulin: dirty and/or major wound with unknown vaccine status.

31
Q

How long does Lyme IgM convert to IgG?

A

30 days.

32
Q

How do you treat erythema migrans?

A

Doxycycline for 14 days.

33
Q

How do you treat ventriculitis?

A

Remove all hardware, place external drain, vanco + mero or ceftaz IV, treat for 10-14d (GP) or 21d (GN), new shunt inserted after 7-10d negative CSF cultures.

34
Q

List 4 ways to prevent ventilator-associated pneumonia.

A
  1. Bed 30-45 degrees.
  2. Sedation vacation daily.
  3. Oral care with chlorhexidine.
  4. Early mobilization.
35
Q

Which strains of candida are resistant to fluconazole?

A

C. krusei and C. glabrata.

36
Q

What are risk factors for listeriosis?

A
  1. Age>50
  2. Immunocompromise
  3. Alcoholic
  4. Pregnancy
  5. Diabetes
  6. ESRD
  7. Iron overload
  8. Active liver disease.
37
Q

What is the differential for leptomeningeal enhancement?

A

TB, sarcoid, mets

Royal College Exam (15 decks)

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