Infectious

Question 1

Ehrlichosis

Answer 1

Midwest and Delaware
Lone Star tick
Nonspecific febrile illness, skin rash, GI
Doxycycline treatment

Question 2

Rocky Mountain Spotted Fever

Answer 2

Southeast/Midcentral states

Non-specific febrile illness, muscle pain, rash that starts small and is very red with spread over a few days into macropapular rash

IgG antibodies may take a week to show up, serial testing needed

Treat with doxycycline even if pediatric or pregnant

Question 3

Lyme Disease

Answer 3

Northeast, mid-atlantic, upper mid-west
3 stages
-early localized (bulls eye rash), flu like symptoms
-early disseminated (neuro and cardiac, menningitis)
-Late persistant (arthirits, polyneuropathy, months later)

Treat with Doxycycline (IgM test may take weeks and ELISA can be positive for years)
If pediatric or pregnant - treat with amoxicillin

Severe symptoms, use ceftriaxone

Question 4

Babesiosis

Answer 4

rare and life-threatening infection of the red blood cells that’s usually spread by ticks

flu-like symptoms, such as fever, chills, sweats, headache, body aches, loss of appetite, nausea, or fatigue, can cause hemolytic anemia

quinine and clindamycin or a combination of atovaquone and azithromycin

Question 5

Zika Virus

Answer 5

20% develop symptoms
-fever, diffuse pruritic rash, neurologic symptoms
PCR test available
Biggest risk is travel to endemic area (mosquito transmitted)

Question 6

Yellow Fever

Answer 6

Results in hepatitis
mosquito transmitted
non-specifc febrile illness, conjunctiva, gignivitis, liver pain, elevated liver panels
AST more than twice ALT is red flag

Question 7

Infectious Mono

Answer 7

Sore throat, fever, cervical lymphadenopathy, fatigue
Test again in 7-10 days (early negative is common)
Always strep screen
Supportive care, no contact sports for at least 3-4 weeks
Abx if severe rash develops

Question 8

Reportable STIs

Answer 8

Chlamydia
Syphillis
Gonorrhea

Question 9

Gonorrhea

Answer 9

Ceftriaxone 250mg IM once

Plus Azithromycin 1g PO or Doxycycline for 7 days

Question 10

Gonorrhea Symptoms

Answer 10

Purulent urethral discharge in men

Often asymptomatic in women

Question 11

Chlamydial Presentation

Answer 11

Usually asymptomatic
Vaginal discharge, burning with urination
Testicle edema
Rectal discharge

May lead to PID

Question 12

Syphilis Presentation

Answer 12

Infectious lesions (chancres) usually painless
Secondary syphilis = macules and papules on trunk, etc
Condylomata lata - raised flat gray papular lesions

Treated with Penicillin G

Question 13

Chancroid

Answer 13

Painful genital ulceration and inflammatory adenopathy

Treat with single dose azithromycin 1gm oral OR ceftriaxone 250mg IM or 3 day Cipro