Infectious Diseases - StepUp

Question 1

most effective imaging study for dx osteomyelitis?

Answer 1

MRI

Question 2

most direct and accurate means of dx. osteomyelitis?

Answer 2

needle aspiration/bone biopsy w/ culture

Question 3

what tests are useful for monitoring response to therapy in osteomyelitis?

Answer 3

ESR and CRP - nonspecific for diagnosis

Question 4

earliest tests for dx. of osteomyelitis?

Answer 4

technetium bone scan

MRI

Question 5

Treatment of Osteomyelitis

Answer 5

1. oxacillin or vancomycin (MRSA)
2. plus aminoglycoside or 3rd gen. cephalosporin
3. surgical debridement (esp. adults)

Question 6

patient presents with swollen, tender erythematous knee joint with a limited ROM

Answer 6

septic arthritis

Question 7

what test do you do in all cases of septic arthritis?

Answer 7

joint aspiration and analysis of synovial fluid

- WBC count > 50 000 and > 80% PMNs

Question 8

what lab tests would support dx. of septic arthritis?

Answer 8

1. blood cultures - positive in > 50 %
2. leukocytosis
3. elevated ESR and CRP
4. CT/MRI - if sacroiliac or facet joints involved

Question 9

most important test to confirm clinical suspicion of Lyme disease?

Answer 9

serology - ELISA for IgM and IgG antibodies; Western Blot to confirm

Question 10

first line therapy for early Lyme disease

Answer 10

oral Doxycycline for 21 days (10 days if confined to skin)

Amoxicillin for pregnant pts and children < 12 yo

Question 11

first line therapy for serious neurological and cardiac manifestations of Lyme disease

Answer 11

IV Ceftriaxone for 4 weeks

Question 12

MC neurological complication of Lyme disease

Answer 12

bilateral Bell’s Palsy

Question 13

MC cardiac complication of Lyme disease

Answer 13

AV block

Question 14

when is C-section indicated in AIDs pregnant patient?

Answer 14

if viral load is > 1000 copies

if CD4 count is > 500 and viral load is < 1000, C/S not necessary

Question 15

best indicator of immune status in HIV/AIDs

Answer 15

cd4 cell count

Question 16

prophylaxis for PCP pneumonia in AIDs

Answer 16

TMP-SMX when CDC < 200

Question 17

prophylaxis for TB in AIDs

Answer 17

yearly PPD - if positive PPD, isoniazid + pyridoxine

Question 18

prophylaxis for MAC in AIDs

Answer 18

when CDC < 100

clarithromycin or azithromycin

Question 19

prophylaxis for toxoplasma in AIDs

Answer 19

when CDC < 100

TMP-SMX

Question 20

which vaccines should all HIV-positive pts get?

Answer 20

pneumococcal
influenza
hepatitis B

Question 21

uses of CD4 cell count monitoring

Answer 21

1. when to start prophylaxis
2. when to start HAART
3. adequacy of response to HAART

Question 22

best method of assessing response to therapy in HIV/AIDs

Answer 22

HIV viral load

Question 23

test used to screen for HIV

Answer 23

ELISA

Question 24

confirmation test for HIV

Answer 24

Western blot