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1
Q

HLH clues

A

EBV associated
Elevated ferritin
Cytopenias

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2
Q

major criteria of stills disease

A

fever 39 greater than 1 week
arthralgia > 2 weeks
rash
WBC > 10m

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3
Q

minor criteria of stills disease

A

sore throat
LAD
HSM
Abnormal LFTs
negative ana and RF

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4
Q

bechet’s disease criteria

A

recurrent oral ulcers
recurrent genital ulcers
uveitis, retinitis, hypopyon
pathergy

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5
Q

malignancy associated with sweet syndrome

A

AML

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6
Q

pathology in sweets syndrome

A

neutrophilic infiltrate without vasculitis

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7
Q

GCA age distribution

A

older adults> 50 years old

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8
Q

clinical findings of GCA

A

fever
scalp or temporal artery tenderness
jaw claudication
amaurosis fugax/sudden vision loss
ESR > 100

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9
Q

takayasu epidemiology

A

young women
asian ancestry

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10
Q

clinical features of takayasu arteritis

A

fever, arthralgia
pain with palpation of carotid
decreased pulses
extremity claudication
TIAs

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11
Q

diagnosis of takayasu arteritis

A

arteriography

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12
Q

Lofgren syndrome

A

hilar LAD
acute arthritis
Erythema nodosum

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13
Q

biopsy in sarcoid

A

non caveating granulomas

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14
Q

CNS finding of sarcoid

A

aseptic meningitis with basilar enhancement

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15
Q

NODOSUM pneumonic

A

no cause
drugs: sulfa, penicillins
OCPs
Sarcoid
UC or Crohn’s
Microbes: EBV, Hep B/C, strep, mycoplasma, bartonella, TB, endemic fungi

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16
Q

kikuchi disease epidemiology

A

young women

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17
Q

clinical features of kikuchi disease

A

fever
cervical LAD (posterior and unilateral)
rash
asceptic meningitis
uveitis

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18
Q

pathology in kikuchi disease

A

necrotizing histiocytic infiltrate (no neutrophils) and fragments of nuclear debris

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19
Q

lab finding in kikuchi

A

atypical lymphocytes (mono like syndrome)

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20
Q

EGPA organs involved

A

lungs
skin
heart
GI tract
CNS

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21
Q

clinical clue for EGPA

A

tapering off steroids unmasks disease

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22
Q

ANCA in EGPA

A

p-ANCA

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23
Q

clinical triad of EGPA

A

allergic rhinitis
asthma
peripheral and lung eosinophilia

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24
Q

organ involvement in GPA

A

respiratory tract
eyes
lung
kidney

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25
Q

diagnosis of GPA

A

biopsy or p-ANCA

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26
Q

buzzwords for relapsing polychondritis

A

recurrent cellulitis/cartilage inflammation
saddle nose
cauliflower ear
sparing of ear lobe
parasternal joint involvement

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27
Q

contact precautions of flu

A

standard plus droplet

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28
Q

preferred diagnostic method for flu

A

PCR/NAAT

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29
Q

recommended flu medications for outpatients

A

osteltamivir, baloxivir, zanamivir and IV peramivir

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30
Q

recommended flu medication for inpatients

A

oseltamivir

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31
Q

cutoff window for hospitalized patients to get flu medication

A

none

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32
Q

oseltamivir safe in pregnancy?

A

yes

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33
Q

situation in which influenza PEP is indicated

A

nursing home outbreaks

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34
Q

adenovirus association with what mab

A

alemtuzumab

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35
Q

Hantavirus pulmonary syndrome labs in cardiopulmonary phase

A

thrombocytopenia
hemoconcentration
left shift with atypical lymphocytes
elevated PT
abnormal LFTs

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36
Q

pharyngitis and rash

A

HIV
secondary syphilis

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37
Q

pharyngitis after oral intercourse

A

gonorrhea
HSV-2

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38
Q

pharyngitis and conjunctivitis

A

adenovirus

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39
Q

Vincent’s angina

A

acute necrotizing ulcerative gingivitis
painful, sloughing of gingiva

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40
Q

clinical feature of Ludwig’s angina

A

woody induration of the neck

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41
Q

clinical feature of diptheria

A

bull neck

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42
Q

dose adjustments when using azoles with tac/cyclosporine/rapamycin

A

decrease tac dose by about 50%
will increase the tac levels

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43
Q

dose adjustements when using RIF and tacrolomus/cyclosporine/rapamycin

A

increase tac dose
decreases tac levels and can precipitate rejection

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44
Q

interaction between RIF and prednisone

A

increases prednisone level

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45
Q

management of Lyme carditis with heart block

A

don’t need permanent pacemaker, will resolve within several days of antibiotics

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46
Q

do you need lab testing for erythema migraines

A

no

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47
Q

Lyme testing in early infection

A

EIA/Serology can be negative in first 2-3 weeks of infection

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48
Q

prophylaxis for Lyme

A

give within 72 hours of tick exposure, 1 dose of 200 mg doxycycline

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49
Q

erythema migrans treatment

A

doxycycline x 10 d
amoxicillin or cefuroxime x 14 d

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50
Q

Lyme arthritis diagnosis

A

serology in blood is 100% sensitive
usually only test you need
can also use the PCR 100% specificity on synovial fluid

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51
Q

treatment of neurological Lyme without parenchymal disease

A

CTX, Cefotaxime, Penicillin or PO Doxycycline

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52
Q

treatment of Lyme carditis outpatient

A

ok for PO doxycycline

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53
Q

preferred testing for Lyme arthritis

A

serum ab testing

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54
Q

treatment of Lyme arthritis

A

po for 28 days

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55
Q

vaccine recommendation for persons getting cochlear implant

A

PCV 15 then PPV23 or PCV 20 given two weeks before surgery

56
Q

treatment of bartonella infection involving CNS

A

doxycycline + rifampin

57
Q

HIV + with bartonella treatment

A

doxy or erythromycin + rifamycin for 3 months

58
Q

two drugs that can cause pseudohyperaldosteronism

A

itraconazole and posaconazole

59
Q

option for PO step down therapy for candida krusei candidemia

A

voriconzole

60
Q

when should eye exam be performed in neutropenic patients with candidemia

A

within the first week after recovery from neutropenia

61
Q

what is the preferred test for diagnosis of chlamydia psittacosis pneumonia

62
Q

preferred treatment of chlamydia psittacosis

A

doxycycline
can use macrolides or FQ also

63
Q

what is the benefit of culture for legionella

A

can detect all species, urine antigen only specific for l. pneumophilia but can cross react with other serogroups

64
Q

tropical pulmonary eosinophilia can be seen with

A

wuchereria Bancroft or brugia Malay

65
Q

helminths that can cause loffler’s syndrome

A

ascaris
hookworms
strongyloides

66
Q

diagnosis of Whipple’s disease

A

duodenal biopsy PAS + stain
PCR - more common for culture negative IE

67
Q

triad in Whipple’s disease

A

weight loss, arthralgia, diarrhea

68
Q

treatment of Whipple’s disease

A

CTX or Mero plus co-trimixazole
HCQ + Doxycycline
1 year

69
Q

timing of acute rheumatic fever

A

19 days after GAS infection

70
Q

treatment of primary episode of ACR

A

IM benzathine penicillin x 1 or PO penicillin x 10d

71
Q

secondary ppx of ACR with carditis and valvular disease

A

IM benzathine weekly for 10 years or age 40 (whatever comes first) sometimes life long

72
Q

secondary ppx of ACR with carditis and no valvular disease

A

10 years or until age 21

73
Q

secondary ppx of ACR without carditis or valvular disease

A

5 years or until age 21

74
Q

flaccid paralysis involving cranial nerves with descending weakness

75
Q

treatment of botulism

A

antitoxin plus supportive care

76
Q

treatment of vibrio vulnificus

A

FQ plus 3rd generation cephalosporin

77
Q

treatment of bordatella pertussis

A

macrolide if within 3 weeks of symptom onset

78
Q

treatment time window of bordatella pertussis in infants or pregnant women

A

if within 6 weeks of symptoms

79
Q

PEP for bordatella

A

if within 3 weeks of contact, treat all household and contacts with risk of severe infection

80
Q

timing of SSPE

A

7 years after measles infection

81
Q

PEP for measles

A

non immune persons should get either MMR (within 72 hours) OR immunoglobulin within 6 days of exposure
don’t give both- will inactive each other

82
Q

meningococcemia ppx for pregnant women

A

ceftriaxone

83
Q

meningococcemia ppx

A

rifampin
ciprofloxacin
ceftriaxone
within 7d of exposure

84
Q

gram stain of burkholderia pseudomallei

A

aerobic GNR

85
Q

Chest imaging of melioidosis

A

diffuse military nodules that can cavitate

86
Q

treatment of burkholderia pseudomallei

A

carbapenems
ceftazidime
TMP-SMX

87
Q

duration of treatment for melioidosis

A

IV then transition to PO for 3 months

88
Q

salmon pink colonies

A

rhodococcus

89
Q

rhodococcus gram stain

A

gram positive coccobacillus

90
Q

lung findings of rhodococcus

A

cavitary
nodule
effusion
abscess

91
Q

m kansasii therapy

A

daily RIF/EMB/INH x 18 months

92
Q

heartland virus is what type of virus

A

phlebovirus

93
Q

treatment of erythema migraines in pregnancy

A

amoxicillin

94
Q

most common cause of fungal pericarditis

A

histoplasmosis

95
Q

major criteria for Acute Rheumatic Fever

A

Carditis
Polyarthritis
Syndeham Chorea
Erythema marginatum
Subcutaneous nodules

96
Q

two complications of ZIKA

A

Guillan barre syndrome
fetal malformations

97
Q

what is the only vector borne illness that can be transmitted sexually

98
Q

what type of virus is zika

A

flavivirus

99
Q

treatment of malaria in pregnancy

A

quinine or chloroquine

100
Q

3 side effects of mefloquine

A

vivid dreams
insomnia
dizziness

101
Q

side effect of polymyxin B

A

bronchospasm, neuromuscular blockade, seizures

102
Q

what is a significant DDI with imi-cilastatin-relebactam

A

valproid acid

103
Q

side effect of all azoles

A

teratogenic

104
Q

posaconazole side effect

A

pseudohyperaldosteronism
HTN, hypokalemia

105
Q

what antibiotic is least likely to be effective against DTR PsA

A

meropenem-vaborbactam

106
Q

what to consider for DTR PsA if they have gotten Ceftaz-Avi or Cef-Tazo prior

A

high chance of resistance, use different antibiotic

107
Q

mechanism of resistance to cefiderocol

A

mutations in iron transport proteins

108
Q

OXA-48 treatments

A

ceftaz-avi
cefiderocol

109
Q

NDM treatment

A

Cefiderocol
Combination of Ceftaz-Avi plus aztreonam

110
Q

KPC treatment

A

ceftaz-avi
mero-vabor
cefiderocol
imi-cil-rele

111
Q

what drug can you not use with KPC

A

ceftolozone-tazobactam

112
Q

CRAB therapy options

A

Unasyn in combination with
cefiderocol
minocycline/tigecycline
polymixins

113
Q

fluconazole resistant candidas

A

krusei
auris
haemulonii
sometimes glabrata

114
Q

what formulation of voriconzole to use in renal failure

A

PO, IV will accumulate in renal failure

115
Q

use of ISA in candidemia?

A

none, inferior to caspofungin

116
Q

false positive Crag can be seen with what three organisms

A

trichosporon
Rothia
Capnocytophaga

117
Q

MOA of azoles

A

binds to 14 alpha demethylase which inhibits synthesis of ergosterol from lanosterol during cell membrane production

118
Q

MOA of echinocandins

A

inhibits the synthesis of B 1,3 Glucan

119
Q

what mutation happens first in GCV and VGCV

120
Q

if there is a UL-97 mutation with GCV or VGCV, then what drugs will still be sensitive

A

cidofovir and foscarnet

121
Q

If there is resistance to UL-54 with GCV or VGCV, what drugs will be resistant also

122
Q

what drug to give with cidofovir to prevent renal toxicity

A

probenecid

123
Q

two side effects of foscarnet

A

electrolyte abnormalities (hypophos) with renal dysfunction
GU ulcerations

124
Q

Letermovir given with what three drugs can increase their levels

A

Cyclosporine
Tacrolimus
Sirolimus

125
Q

letermovir given with what drug can decrease its levels

A

voriconzole

126
Q

mechanism of lamivudine resistance in HBV

A

YMDD motif in viral DNA polymerase

127
Q

Neuraminidase inhibitor mechanism of resistance
if present, what drug to use?

A

H274Y
Baloxivir

128
Q

precautions for influenza

A

standard plus droplet

129
Q

preferred test for flu diagnosis

130
Q

additional testing site for IC hosts for flu

A

lower respiratory tract specimens

131
Q

exception to time limit on flu therapies

A

hospitalized or severe, progressive disease.
can give regardless of duration of symptoms

132
Q

recommended flu treatment for inpatients

A

ostelamivir

133
Q

CI to flu therapies in pregnant women?

134
Q

adenovirus in HSCT associated with what drug

A

alemtuzumab

IDBR (23 decks)

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