MEDS & INCUBATION

Question 1

Tuberculosis

Answer 1

-Mycobacterium tuberculosis
-2-12 weeks
-isoniazid w/ or w/o pyridoxine for 9 months
-rifampin for 4 months (alternative)
-active or extrapulmonary TB- isoniazid, rifampin, ethambutol, streptomycin, pyrazinamide

Question 2

Lyme Disease

Answer 2

-Borrelia burgdoferi NA
-B. afzelii and B. garinii in Europe
-3-30 days
-24-36 hour attachement
-Doxycycline within 72 hours of attachment

Question 3

Syphilis

Answer 3

-Treponema pallidum
-10-90 days, average 3 weeks
-Secondary- 4-10 weeks
-Tertiary- 3-15 years
-benzathine penicillin G IM 1x
-Latent > 1 year or tertiary- benzathine penicillin G 3x weekly
-neurosyphilis- benzathine penicillin G IV 10-14 days

Question 4

Rocky Spotted Mountain Fever

Answer 4

-Rickettsia rickettsii
-2-14 days
-6-10 hour attachment
-doxycycline

Question 5

Chlamydia

Answer 5

-Chlamydia trachomatis
-1-3 weeks
-Azithromycin 1 day or doxycycline 2x a day for 7 days

Question 6

Pelvic Inflammatory Disease

Answer 6

-Ceftriaxone and doxycycline +/- metronidazole

Question 7

Gonorrhea

Answer 7

-Neisseria gonorrhoeae
-1-14 days, average 2-5 days
-Ceftriazone and azithromycin
-epididymo-orchitis, prostatitis, and proctitis- Ceftriazone and doxycycline

Question 8

Leprosy

Answer 8

-Myobacterium leprae
-9 months-20 years, average 5 years
-Paucibacillary- dapsone, rifampicin 6 months
-Multibacillary- dapsone, rifampicin, clofazimine 12 months

Question 9

Cholera

Answer 9

-Vibrio cholerae
-1-5 days, 2-3 days average’
-Fluids and electrolyte replacement
-Doxycycline for symptoms

Question 10

Rheumatic Fever

Answer 10

-A. Streptococcus or group A strep and scarlet fever
-1-5 weeks after strep or scarlet fever
-treat symptoms and strep
-surgery for heart disease
-Prophylaxis- antibiotics for years

Question 11

Shigella

Answer 11

-Group A: S. dysenteriae
-Group B: S. flexneri
-Group C: S. boydii
-Group D: S. sonnei
-1-7 days, average 3
-azithromycin or ciprofloxacin

Question 12

Salmonella

Answer 12

-Salmonella bongori
-Salmonella enterica
-12-48 hours
-Fluoroquinolones-ciprofloxacin or levofloxacin
-Macrolides- azithromycin
-Cephalosporins- ceftriaxone or cefotazmine

Question 13

Diphtheria

Answer 13

-Corynebacterium diphtheriae
-2-5 days
-Horse serum and
-erythromycin or penicillin for 14 days
-intubation

Question 14

Tetanus

Answer 14

-Clostridium tetani
-3-21 days, average 10
-Cephalic- 1-2 days
-tetanus immune globulin
-wound care/antibiotics
-intubation
-benzodiazepine / neuromuscular blocking agents

Question 15

Botulism

Answer 15

-Clostridium botulinum
-6 hours-10 days, average 12-36 hours
- > 1 year- horse serum
- < 1 year- human derived immune globulin
-antibiotics for wound botulism
-intubation

Question 16

Campylobacter jejuni

Answer 16

-Campylobacter jejuni, Campylobacter coli
-1-7 days, average 3
-Azithromycin for 3 days
-Erythromycin 4x for 5 days

Question 17

Group A streptococcus

Answer 17

-Group A streptococcus (GAS)
-2-5 days
-Penicillins, amoxicillin, and cephalosporins
-PCN allergy- erythromycin, clindamycin, or macrolides

Question 18

Infective endocarditis

Answer 18

-Staphylococci and Streptococci -> Staphylococcus aureus, Streptococcus viridans
-HACEK- Haemophilus, Aggregatibacter, Cardiobacterium, Eikenell a, and Kingella
-short incubation
-empiric
-vancomycin and ceftriaxone or gentamycin

Question 19

Sepsis

Answer 19

-Gram negative or positive
-Aggressive fluid resuscitation
-CVP- 8-12, MAP > 65, O2 > 70% -> if not, vasopressor and inotropic support, norepinephrine, dopamine
-hypotensive after fluid resuscitation -> corticosteroid therapy
-Hmg < 7 -> transfuse packed RBCs
-platelets < 5,000 -> platelet transfusion
-glucose > 150 -> insulin therapy
-1. Ceftazidime OR cefepime OR doripenem IV (gram - treatment) AND
2. Daptomycin OR linezolid OR vancomycin (gram + treatment) 7-10 days

Question 20

MRSA

Answer 20

-surgical drainage
-narrow spectrum antimicrobial for purulent infections (after wound culture)
-antibiotics active against MRSA for pts with carbuncles or abscesses
-if pts do not respond to initial antibiotic -> modify therapy based on culture and susceptibility
-treat underlying condition (tinea pedis)
-restrict contact (sports competition) if wound cannot be covered
-elevated affected area

Question 21

HPV

Answer 21

-2 weeks to 8 months
-dsDNA
-trichloroacetic acid (TCA), bichloroacetic acid (BCA), cryotherapy with liquid nitrogen, surgical removal, curettage, or electrocautery
-podophyllotoxin or imiquimod cream
-Intraurethral, intravaginal, cervical, and intra-anal warts
MUST be removed
-HPV9 vaccine:
-children < 15- 2 doses before 12
-15 and older- 3 doses

Question 22

herpes simplex virus

Answer 22

-2-12 days, average 4
-acyclovir, valacyclovir
-famciclovir for resistance
-herpes meningitis- IV acyclovir
-can be used for prevention

Question 23

varicella zoster virus

Answer 23

-10-21 days, average 14-16
-calamine lotion for itching
-varicella pneumonia & encephalitis- acyclovir
-vaccine

Question 24

epstein barr virus

Answer 24

-HH4
-4-6 weeks
-supportive treatment

Question 25

acute cytomegalovirus (CMV)

Answer 25

-treatment is supportive??
-ganciclovir, valganciclovir, foscarnet

Question 26

Roseola Infantum

Answer 26

-6th disease, exanthem subitum
-human herpes virus 6 (HH6) but also can be HH7, enteroviruses or adenoviruses
-5-15 days
-supportive treatment

Question 27

HIV

Answer 27

-RNA
-HAART- bacavir OR abacavir/dolutegravir/lamivudine
-Truvada preexposure prophylaxis (PrEP)- tenofovir and emtricitabine