Uworld Infectious Disease 10/6/2018

Question 1

6 year old with CF has pneumonia and clubbing of the digits with a fever. What is the most likely causative organism

Answer 1

Staphylococcus. YES Pseudomonas pneumonia is more for CF, BUT age matters here. Staph Aureus is most common before the age of 20.

Question 2

7 year old boy has malaise and head ache 2 weeks after a hiking trip and a tick bite. Rash has a red ring. What is the tx and why

Answer 2

AMOXICILLIN - because he is less than 8 years, and you cant use doxy in <8 kids and pregnancy.

Question 3

Steps with VAP/Aspiration Pneumo

Answer 3

1) CXR
2) LRT sampling
3) Empiric antibiotics.

Question 4

40 year old man has 2 weks of fever, malaaise, and 5 lbs weight loss. Has an asymptomatic MVP. He travels a lot. He has decreased breath sounds in lower left lung field, and 2/6 systolic murmur at apex. Labs who WBC 27000, Netup 60%, Bands 15%. IMaging shows left pleural effusion and splenic fluid collection.

Answer 4

INfective endocarditis which is causing a SPLENIC ABSCESS. Think IE because of the previously compromised valve.

Question 5

38 F has 7 days of fatigue and headache thats getting worse. He has NO confusion, personality chages, or FND. She has thrush, bilateral papilledema, but MRI is NORMAL. What test would confirm

Answer 5

Cryptococcal antigen testing of CSF.

Question 6

What are features of Cryptococcus Meningoencephalitis

Answer 6

HA, fever, over 2 weeks, papilledema, NORMAL brain MRI, HIV with CD4 <100

Question 7

Initial Tx of Cryptococcal Meningoencephalitis

Answer 7

Amphoterecin B with FLucytosine

Question 8

Maintence of Cryptococcal meningoencephalitis

Answer 8

Fluconazole

Question 9

Pregnant patient at 10 weeks has malodorous discharge. Its gray, coats the walls, and shows numerous epithelial cells with bacteria. What is the best management, and what is it

Answer 9

Oral Metronidazol - she has bacterial Vaginosis.

Question 10

Presentation of Plasmodium vivax aka malaria

Answer 10

CYCLIC Fevers, hepatosplenomegaly, and anemia.

Question 11

Some features of Inf. Mono

Answer 11

PROLONGED fever, sore throath, jaundice, LAD, leukopenia, thrombocytopenia.

Question 12

When do you NOT give Yellow Fever vaccination when they are traveleing.

Answer 12

Allergy to eggs, Immunocompromised <200 CD4, or under immunosupressive therapy like steroids or TNF antagonists, like methotrexate.

Question 13

Kid has Septic Arthiritis - hip pain with high fever, hypotensive, and leukocytosis
What do you do FIRST

Answer 13

Atherocentesis. THEN empiric antibiotics.

Question 14

What would be the ABX for a kid with septic arthiritis, when they are <3 months old

Answer 14

Nafcillin or vancomycin + Gentamicin or Cefotaxime. Need coverage for Staph, GBS, AND g - bacilli.

Question 15

Abx for kid with Septic arthiritis when >3 mo

Answer 15

Nafcillin, Clindamycin, Cefazolin, or Vancomycin. You are just blocking Staph and Strep Species.

Question 16

What would be the work up for an HIV patient with Nonbloody Diarrhea.

Answer 16

Stool exam for ova, eggs, parasites, cultur, C Diff and Acid Fast stain for Cryptosporidium

Question 17

What would be dx in a HIV patient with bloody Diarrhea.

Answer 17

CMV

Question 18

What would be causes of bloody diarrhea in a regular patient

Answer 18

Campylobacter, Shigella, E Coli

Question 19

What is the dx if the patient has pneumonia WITH diarrhea? and what is teh tx

Answer 19

Legionella - Fluroquinolone or macrolide

Question 20

What bug causes erysepalus, and what feature differs it from cellulitis

Answer 20

Step Pyogenes, and the swelling has sharply demarcated edges, with rapid onset. Would affect outer ear.

Question 21

What causes Cellulitis, and what feature

Answer 21

Deep dermis and fat effect, flat edges, POOR demarcation. Fever comes later.

Question 22

What would be he dx in akid with muffled speaking, neck pain, swelling on both tonsils with exudates, a WIDENED PREVERTEBRAL SPACE

Answer 22

Retropharyngeal abcscess

Question 23

When would you have to desensitize patients to penicillin when they have a syphillis infection?

Answer 23

When doxy is inieffective and effecting the CNS, or are pregnant,

Question 24

When would you do a CT with a dx of Pyelonephritis

Answer 24

When theres no change with treatement in 72 hours.

Question 25

How would you differentiate Babesiosis from Lyme disease when diagnosing effects from a tick bite

Answer 25

In babeiosis, they will mention something about the spleen, with anemia and thrombocytopenia, increased BR. Dx with Blood smear.

Lyme - would have the characteristic rash, possibly with lymphadenopathy. Would NOT have anemia

Question 26

Young mand has RUQ pain, bloody diarrhea, that resolved spontaneously, came back from mexico, and silght eosinophelia. He has a liver cyst. WHAT DO YOU GIVE

Answer 26

Metronidazole - he has Entomeaba hystolytica.

Question 27

What is another word for “Mycobacterial Infection” thats NOT Pneumonia?

Answer 27

TB

Question 28

Why would you still give an older adult today hepatitis A vaccine?

Answer 28

Kids werent given hep a vaccins until 2006.

Question 29

Patient with hemochromatosis was sailing at sea, and cut his foot. He cleaned it as much as he could but now has severe cellulitis, bullous lesions around the wound, and sepsis. What is the MOST LIKELY cause?

Answer 29

Vibrio Vulnificus

Question 30

Tx for VIbrio Vulnificus

Answer 30

IV ceftriaxone and Doxy

Question 31

Patient has necrotizing fasciitis when working on a boat. How do you know its Vibrio Vulnificus instead of Staph or Strep?

Answer 31

Vibrio caused Necrotizing Fasciits happens within a few HOURS. Staph/Strep takes a few days.

Question 32

What tx is for CMV?

Answer 32

GANcyclovir. NOT Acyclovir