Medicine- Infectious Disease

Question 1

Pain, erythema, and swelling below the medial canthus of the left eye, along with purulent discharge from the lacrimal punctum… Dx?

Answer 1

acute dacryocystitis.

Question 2

1st line tx of acute dacryocystitis?

Answer 2

Oral antibiotics with gram-positive coverage, such as amoxicillin-clavulanate. (Warm compresses and NSAIDs are also used to decrease pain and inflammation)

Question 3

First-line treatment for patients with PCP who are allergic to sulfa drugs

Answer 3

IV clindamycin and oral primaquine

Question 4

The recommended empiric therapy for sepsis?

Answer 4

A regimen of intravenous vancomycin and ceftriaxone covers a broad spectrum of both gram-negative and gram-positive bacteria (including MRSA)

Question 5

Prophylactic medication of choice for a pregnant patient travelling to an area where P. falciparum is endemic and resistance to chloroquine is likely

Answer 5

1st choice = Mefloquine

Atovaquone-proguanil would be an equally viable prophylactic medication

Question 6

Which microorganism is often associated with insect bite infections and is the most common cause of erysipelas and lymphangitis.

Answer 6

Strep pyogenes

Question 7

Initial treatment for febrile neutropenia

Answer 7

monotherapy (anti-pseudomonal coverage) - Cefepime, meropenem and Pip-Tazo

Question 8

What is the next best test to confirm diagnosis in a patient with suspected primary syphilis and negative VDRL

Answer 8

FTA- ABS

Question 9

What type of conjunctivitis has unremitting discharge and reappears after wiping?

Answer 9

Bacterial conjunctivitis

Question 10

What pathogen is the most common cause of bacterial conjunctivitis in adults

Answer 10

Staph Aureus

Question 11

1st line treatment for penicillin sensitive ineffective endocarditis

Answer 11

IV aqueous penicillin G or IV ceftriaxone

Question 12

What are the risk factors for influenza complications and the treatment

Answer 12

Age >65, chronic medical conditions and pregnancy

oseltamivir regardless of symptom duration

Question 13

Manifestations of secondary syphillis

Answer 13

1. fever, malaise and sore throat
2. oral lesions (grey mucous patches)
3. raised grey genital papules (condylomata lata)
4. diffuse rash (palms and soles)
5. lymphadenopathy (epitrochlear) (sailors handshake)
6. hepatitis

Question 14

Meningococcal vaccination regular schedule?

Answer 14

1. primary vaccination at 11-12

2. booster at 16-21 (if primary was before 16)

Question 15

Contraindications to yellow fever vaccine

Answer 15

1. allergy to vaccine components (eg. eggs)
2. AIDs (CD4 <200), stem cell transplant, certain immunodeficiencies
3. Immunosuppressive therapy (eg, TNF antagonists, high dose steroids)

Question 16

Recommended Vaccines for chronic liver disease

Answer 16

HAV, HBV, Influenza, PPSV23 (then revaccinate at age 65 with PCV13 first then PPSV23) and Tdap

Question 17

Which patients are at highest risk for vertebral osteomyelitis

Answer 17

IVDU, Sickle cell patients and immunosuppressed patients

Question 18

Characteristic Features of “break-bone fever” (dengue).

Answer 18

1. Retro-orbital pain, fever, malaise, and myalgia
2. exanthem and lymphadenopathy
3. leukopenia and thrombocytopenia

Question 19

A common adverse effect of Idinavir

Answer 19

Urolithiasis (crystallization and stone formation) due to poor renal excretion

Question 20

First-line treatment of malignant otitis externa

Answer 20

High-dose IV ciprofloxacin

Question 21

With which risk factor are coagulase-negative staphylococci, such as S. epidermidis, most commonly associated?

Answer 21

S. epidermidis has the ability to adhere to foreign bodies (e.g., intravenous catheters, pacemakers, prosthetic heart valves) and subsequently form a biofilm.

Question 22

An odontogenic infection and swollen, tender neck in a diabetic patient likely indicates spread of the infection towards the soft tissue of the neck… dx?

Answer 22

Ludwig Angina

Question 23

1st line treatment for Otitis externa

Answer 23

Topical abx (fluoroquinolone) + steroids (can add acetic acid and water solution to help)

Question 24

What type organism causes infective endocarditis after exposure to a UTI

Answer 24

Enterococci

Question 25

What is the best form of diagnosis for PCP

Answer 25

Brochoalveolar lavage (dx requires respiratory sample using specialized stains under microscope)

Question 26

Etiology, manifestation and treatment of Cutaneous larva migrans

Answer 26

Hookworm (Anclystoma) - barefoot contact in contaminated sand or soil

LE intensely pruritic, migratory reddish brown-tracks

Ivermectin

Question 27

Indications for steroid use along with original treatment for PCP

Answer 27

PaO2 <70 or A-a gradient >35

Question 28

Urethritis with negative gram stain and culture

Answer 28

Chlamydia

Question 29

Lab findings in a patient with contracted Chickungunya fever

Answer 29

Lymphyocytopenia, thrombocytopenia and transaminitis

Question 30

What is the next best step in a patient who is recovering well from treatment with IV ceftriaxone being treated for acute pyelonephritis

Answer 30

Switch to oral TMP-SMX after 48hrs of improval and discharge

Question 31

Manifestations of Sporothrix infection

Answer 31

Skin papule –> ulceration with nonpurulent odorless drainage
proximal lesions along lymphatic drainage

Question 32

The dendritic corneal ulcer in this patient is a typical feature of which organism

Answer 32

Herpes simplex keratitis

Question 33

This diabetic patient presents with lower back pain, elevated ESR, and CRP. These features, together with the x-ray and MRI findings (bone destruction, sequestrum formation and periosteal reaction) indicate what and next best step?

Answer 33

Spondylodiscitis (vertebral osteomyelitis)

CT guided Bx to confirm

Question 34

The history of a painless penile lesion, followed by suppurative painful lymphadenopathy 2–4 weeks after the initial lesion has healed

Answer 34

Lymphogranuloma venereum.(serotypes L1, L2, and L3 of Chlamydia trachomatis)