Board Vitals Infectious Disease Flashcards
(231 cards)
1
Q
What is the drug of choice to treat non-severe Clostridium difficile infection?
A
Oral fidaxomicin (less recurrence than oral vancomycin)
2
Q
Which drug is preferred in non-severe Clostridium difficile infection - oral vancomycin or oral fidaxomicin?
A
Oral fidaxomicin (less recurrence than oral vancomycin)
3
Q
What is the treatment of severe babeosis?
A
- IV azithromycin + oral atovaquone
- IV clindamycin + oral quinine
4
Q
What is the treatment of mild babeosis?
A
- Oral azithromycin + atovaquone
- Oral clindamycin + quinine
5
Q
How long do you treat babeosis for?
A
7 - 10 days
6
Q
Microscopy shows a ring with pale blue cytoplasm and red dots - what is the organism?
A
Babesia microti
7
Q
What should you do if a patient with babeosis is not responding to standard therapy?
A
Evaluate for co-infection such as Lyme disease or human granulocytic anaplasmosis.
8
Q
What should you do if a patient with severe babeosis has persistent symptoms with severe hemolysis with hemoglobin less than 10 g/dL or organ impairment?
A
Exchange transfusion (reduces parasitemia)
9
Q
What is the treatment for erythema nodosum (early Lyme disease)?
A
Oral doxycycline
10
Q
What is the treatment for Rocky Mountain Spotter Fever?
A
Oral doxycycline
11
Q
What is the treatment for human monocytic ehrlichiosis?
A
Oral doxycycline
12
Q
What is the treatment for human granulocytic anaplasmosis (HGA)?
A
Oral doxycycline
13
Q
How do you treat antibiotic-associated diarrhea?
A
Stopping the antibiotics
14
Q
What types of markers are involved in patients developing exudative effusions?
A
Pro-inflammatory cytokines like interleukin-8 (IL-8)
15
Q
Does thrombopoietin play a role in the pathogenesis of parapneumonic effusions?
A
No
16
Q
Patient presents with a mass that has the following histologic features: clonal B-cell pattern with basophilic cytoplasm in a “starry sky” pattern, positive CD20, and Ki-67 proliferation index of 90 - 100%.
Diagnosis?
A
Burkitt lymphoma
17
Q
What increases the risk of Burkitt lymphoma in HIV patients?
A
Epstein-Barr virus co-infection
18
Q
What is the second most common form of lymphoma in HIV patients?
A
Burkitt lymphoma
19
Q
Patient with HIV present with fevers, abdominal pain, diarrhea, and weight loss along with a palpable abdominal mass; along with Epstein Barr infection.
Diagnosis?
A
Burkitt lymphoma
20
Q
Is cytomegalovirus (CMV) a known risk factor for malignancy in patients with HIV infection?
A
No
21
Q
What does cytomegalovirus (CMV) typically cause in HIV patients with low CD4 counts?
A
CMV pneumonia
CMV retinitis
22
Q
Which virus is associated with Kaposi sarcoma in HIV patients?
A
Human herpes virus 8 (HHV-8)
23
Q
What does a biopsy of Kaposi sarcoma show?
A
Lymphocytes (T-cells fighting infection)
24
Q
Patient with HIV presents with purple, red and pink papular lesions on face, chest and legs.
What is the diagnosis?
A
Kaposi sarcoma
25
What is the treatment for CMV retinitis?
Intraocular antivirals
Systemic foscarnet, cidofovir, or ganciclovir
26
What increases the risk of anogenital cancer in HIV patients?
Human papilloma virus
27
What increases the risk of cervical cancer in HIV patients?
Human papilloma virus
28
Is contamination of meat with E. Coli more common or Shigella?
E. Coli
29
Patient presents with bloody diarrhea and abdominal cramping after eating rare hamburgers.
Which infectious agent is the likely cause of symptoms?
Escherichia Coli (E. Coli)
30
Which region is Histoplasmosis associated with?
Ohia and Mississippi River Valleys
31
Small budding yeast structures on Wright-Giemsa stain.
Diagnosis?
Histoplasmosis (histoplasma capsulatum)
32
Broad budding yeast structures on biopsy.
Diagnosis?
Blastomycosis (blastomyces)
33
Which has hilar lymphadenopathy - blastomycosis or histoplasmosis?
Histoplasmosis
34
Which is associated with immunosuppression - blastomycosis or histoplasmosis?
Histoplasmosis
35
Which is associated with immunosuppression - coccidioidomycosis or histoplasmosis?
Both
36
Which is associated with immunosuppression - blastomycosis or coccidioidomycosis?
Coccidioidomycosis
37
Budding yeast in the form of a "pilot's wheel" on biopsy.
Diagnosis?
Paracoccidioides
38
Septate hyphae that branch out at acute angles on biopsy?
Aspergillus
39
How do you confirm candidal vulvovaginitis?
Wet mount with KOH
40
When would you do a fungal culture for a patient with candidal vulvovaginitis?
In treatment-resistant cases
41
Which cephalosporins have good pseudomonas aeruginosa coverage?
Ceftazidime (3rd generation)
Cefepime (4th generation)
42
Does ceftazidime go into the CSF?
Yes
43
What is the empiric regimen for bacterial meningitis in an immunocompetent adult?
- 3rd generation cephalosporin
- Ampicillin
- Vancomycin
44
Which organism causes Lyme disease?
Borrelia burgdorferi
45
What is the treatment of symptomatic Lyme disease?
Ceftriaxone 2 gram IV daily
46
What is the treatment of asymptomatic Lyme disease?
Oral doxycycline
Oral cefuroxime
47
Can isoniazid-induced vitamin B6 deficiency cause sideroblastic anemia?
Yes
48
How is dengue fever confirmed?
Serology antibody test
49
How is a diagnosis of cutaneous anthrax confirmed?
Tissue biopsy with gram stain, culture and immunochemical stain
50
Which infection does a Tzanck test confirm?
HSV-1 or HSV-2
51
What should you do after a positive tuberculosis skin test in an asymptomatic patient?
Interferon-gamma release assay (IGRA)
52
Can a tuberculosis skin test be positive without a patient having mycobacterium tubercolosis infection?
Yes - they can have a non-tuberculous mycobacterial infection.
53
Which organism causes leprosy?
Mycobacterium leprae
54
Patient from Brazil, India, or somewhere in Africa presents with round, dry, scaling, hypopigmented macule with erythematous border on forearm; biopsy shows acid-fast bacilli.
Diagnosis?
Leprosy (mycobacterium leprae)
55
Is peripheral neuropathy common in leprosy?
Yes
56
Which antifungal agent has poor activity against aspergillosis?
Amphotericin B
57
What is the treatment of choice for aspergillosis?
Voriconazole
58
What is the treatment of choice for strongyloidiasis?
Ivermectin
59
What is the first step of management in severe sepsis with hypotension?
IV fluids for volume resuscitation
60
Within what time period of being diagnosed with severe sepsis/septic shock should antibiotics be given?
Within 1 hour
61
What is the most common cause of pericarditis in HIV patients in developing countries?
Tuberculosis
62
What are the most common causes of pericarditis in immunocompetent patients?
- Coxsackieviruses
- Echoviruses
63
Patient develops complete heart block after camping trip in Connecticut.
Diagnosis?
Lyme carditis
64
What is the treatment of Lyme carditis?
IV ceftriaxone
65
What rash is associated with Lyme disease?
Erythema Migrans rash (target shape)
66
Is life-threatening arrhythmia common in Lyme disease?
No
67
Can isoniazid cause drug induced lupus?
Yes
68
Are anti histone antibodies usually present in drug induced lupus?
Yes
69
Patient has been drinking unpasteurized milk - presents with fevers, fatigue, night sweats, knee pain and stiffness.
Diagnosis?
Brucellosis
70
What is the treatment of brucellosis?
Doxycyclin and rifampin/streptomycin/gentamicin
71
How long is the treatment for brucellosis?
6 weeks
72
At what CD4 count is trimethoprim-sulfamethoxazole recommended for HIV patients to prevent pneumocystis pneumonia?
200 cells/microL or less
73
What medication is recommended for HIV positive patients who test positive for Coccidioides?
Fluconazole
74
Is staphlococcus aureus catalase positive or catalase negative?
Catalase-positive
75
Is streptococcus pneumoniae an alpha-hemolytic or beta-hemolytic pathogen?
Alpha-hemolytic
76
Is streptococcus anginosus an alpha-hemolytic or beta-hemolytic pathogen?
Beta-hemolytic
77
Is streptococcus viridans an alpha-hemolytic or beta-hemolytic pathogen?
Alpha-hemolytic
78
Is enterococcus faecalis a gram-negative or gram-positive pathogen?
Gram positive
79
Is enterococcus faecalis a coccus or bacillus?
Coccus (diplococci)
80
How many drugs are usually given for HIV prophylaxis?
3 drugs
81
Patient needs to present within what time period to get HIV prophylaxis?
72 hours
82
Which two drugs are the base for all post-exposure prophylaxis (PEP) for HIV?
Tenofovir
Emtricitabine
83
Is Nevirapine recommended as part of post-exposure prophylaxis for HIV?
No
84
Is Zidovudine usually added to Tenofovir or Emtricitabine for post-exposure prophylaxis for HIV?
No (it's another nucleoside reverse transcriptase inhibitor so not appropriate as a single agent or in addition to the other two)
85
What should you do in case of isolated fevers in asplenic patients?
Admit and treat as an early sign of sepsis
86
What virus causes herpes labialis?
Herpes simplex virus type 1
87
What is the treatment of choice for herpes simplex type 1?
Acyclovir
88
Is hospitalization a risk factor for getting a MRSA infection?
Yes
89
Is long-term steroid use a risk factor for getting a MRSA infection?
No
90
Is diabetes mellitus a risk factor for getting a MRSA infection?
No
91
Antibiotic use within what time period is a risk factor for getting a MRSA infection?
6 months
92
Patient has high-stepping gait and miotic pupils that accommodate when focusing on an object but do not constrict to light.
Diagnosis?
Neurosyphilis
93
How is neurosyphilis treated?
IV penicillin for 10 - 14 days
94
Patient hiking in Oklahoma or Missouri - present with fever, low CBC counts, and high LFTs.
Diagnosis?
Ehrlichiosis
95
What organism causes ehrlichiosis?
Ehrlichia chaffeensis
96
What is the vector for ehrlichiosis?
Amblyomma americanum
97
What disease is associated with intracytoplasmic inclusions or morulae in neutrophils on Buffy coat examination?
Ehrlichia chaffeensis
98
What is the vector for Rocky Mountain Spotted Fever?
Dermacentor variabilis
99
What should you do if you see necrotic tissue?
Surgical debridement
100
What is the treatment of cryptococcal meningitis?
Amphotericin B and flucytosine for 10 - 14 days followed by fluconazole maintenance therapy.
101
Influenza immunization is conferred by antibodies to what?
Hemagglutinin
Neuraminidase
102
What lung findings can be found in cases of infective endocarditis?
Septic emboli
103
Patient vacationed in Arizona and presented with fever, cough, shortness of breath, arthralgias, erythema nodosum and erythema multiforme.
Diagnosis?
Coccidiomycosis
104
Culture shows branching, filamentous, acid-fast gram-positive rod.
Diagnosis?
Nocardia
105
Is gardening a risk factor for nocardiosis?
Yes
106
Is recent dental surgery a risk factor for nocardiosis?
No
107
Is history of abdominal surgery a risk factor for nocardiosis?
No
108
Is tobacco use a risk factor for nocardiosis?
No
109
Can any antibiotic precipitate a clostridium difficile infection?
Yes
110
What is the first line treatment of allergic bronchopulmonary aspergillosis?
Oral glucocorticoids
111
Are antifungal therapies the first line treatment of allergic bronchopulmonary aspergillosis?
No
112
How are relapsing or persistent cases of allergic bronchopulmonary aspergillosis treated?
Combination of glucocorticoids and anti-fungals
113
10-20 micron trophozoites and oval-shaped cysts.
Organism?
Giardia lamblia
114
Cysts and trophozoites with ingested erythrocytes.
Organism?
Entamoeba histolytica
115
Oocysts that are 4 - 6 micron in diameter.
Organism?
Cryptosporidium
116
Oxidase and catalase-positive curved rods.
Organism?
Campylobacter
117
Oxidase-negative and catalase-positive bacilli.
Organism?
Escherichia coli
118
HIV patient with CD4 count < 100, with multiple ring-enhancing lesions on MRI brain and symptoms of encephalitis.
Diagnosis?
Toxoplasma gondii
119
In a patient who has traveled to South America, presenting with hepatomegaly, bradyarrhythmias, heart block, and dilated cardiomyopathy - what diagnosis would you suspect?
Chagas disease
120
What is the treatment of Chagas disease?
- Benznidazole
- Nifurtimox
121
What is the first line treatment of Kawasaki disease?
IV immunoglobulin
122
Which medication is used in the treatment of systemic candidiasis in immunocompromised patients?
Voriconazole
123
What is the treatment of asymptomatic latent syphilis?
IM penicillin G
124
Is a fungus with a ergosterol mutation susceptible to Amphotericin B?
No
125
Which antifungal works by disrupting fungal cell wall synthesis by its ability to bind to sterols, specifically ergosterol?
Amphotericin B
126
Patient presents with patchy, hypopigmented rash with raised borders and hair loss, along with granuloma formation within dermal nerves.
Diagnosis?
Leprosy
127
What is the treatment of actinomycosis?
Penicillin
128
What is the most common cause (organisim) of bacterial parotitis in adults?
Staphylococcus aureus
129
Can you give pyrazinamide in pregnancy?
No
130
Which two drugs are discontinued after 2 months in the treatment of active tuberculosis?
Ethambutol and pyrazinamide
131
Which two drugs are continued for an additional 4 months after the initial 2 month long, 4 drug treatment of active tuberculosis?
Isoniazid and rifampin
132
What is the most common causative organism of peritonsillar abscesses?
Streptococcus pyogenes (group A beta-hemolytic streptococcus)
133
What organism causes cat scratch disease?
Bartonella hensalae
134
Are kittens or older cats more likely to spread bartonella hensalae (cat scratch disease)?
Kittens
135
Patient presents with regional lymphadenopathy after being in contact with a kitten.
Diagnosis?
Cat scratch disease
136
What is the treatment of cat scratch disease?
Azithromycin
137
What is the treatment of cat scratch disease, in patients with serious complications or those who are immunocompromised?
Azithromycin + rifampin
138
Plasmodium reproduces in what part of the human body?
Liver
139
What is the treatment of acute bacterial rhinosinusitis?
Amoxicillin-clavulanate for 7 days
140
Which organism is responsible for rheumatic fever?
Group A streptococcus
141
Which organism usually causes infective endocarditis in patients who have colon cancer?
Streptococcus gallolyticus (S. bovis)
142
What kind of virus is coxsackievirus?
Picornavirus
143
Can picornaviruses cause pericarditis or myocarditis?
Yes
144
Do togaviruses cause pericarditis or myocarditis?
No
145
Do paramyxoviruses cause pericarditis or myocarditis?
No
146
Do flaviviruses cause pericarditis or myocarditis?
No
147
Is the severity of second dengue infection dependent on the viral load?
No
148
Which virus commonly has antigenic shift?
Influenza
149
Which condition is known as "breakbone fever"?
Dengue
150
What is the most severe manifestation of Dengue fever called?
Dengue hemorrhagic fever
151
Patient presents with fever, along with purpura, petechiae, hepatomegaly, and circulatory failure/shock that follows resolution of initial fever by several days.
Diagnosis?
Dengue hemorrhagic fever
152
What is the treatment of strongyloides stercoralis?
Ivermectin
153
What is the treatment of amyloidosis?
Melphalan and dexamethasone
154
Which HPV subtypes are associated with plantar warts?
1, 2 and 4
155
Which HPV subtypes are associated with flat warts?
3 and 10
156
Which HPV subtypes are associated with anogenital warts?
6 and 11
157
Which HPV subtypes are associated with common warts?
2 and 4
158
Which HPV subtypes are associated with epidermodysplasia verruciformis?
5 and 8
159
Which HPV subtypes are associated with squamous cell carcinomas of the upper aerodigestive tract?
16,18, 31 and 33
160
Which gram positive bacteria cause infective endocarditis and can synthesize dextrans from sucrose?
Streptococcus viridans
161
What is the adherence site of streptococcus viridans when they cause infective endocarditis?
Fibrin platelet aggregates
162
What percentage of endocarditis on normal valves is caused by streptococcus viridans?
40 - 60%
163
What does crepitus in a soft tissue infection indicate?
Possible necrotizing fasciitis
164
What is the treatment of necrotizing fasciitis?
Surgical debridement
165
CD14 is expressed by which cells?
Macrophages
166
Which toxins in C. Diff infection cause disruption of Rho-protein-mediated pathways that maintain cytoskeleton structure?
Toxin A and Toxin B
167
Which toxin in C. Diff is more potent, Toxin A or Toxin B?
Toxin B
168
Which is the preferred confirmatory test for cryptococcal meningitis?
Cryptococcal antigen detection
169
Patient with AIDS presents with ring-enhancing lesions on CT head and trophozoites on bronchoalveolar lavage.
Diagnosis?
Toxoplasmosis
170
What ophthalmology condition can toxoplasmosis lead to?
Necrotizing chorioretinitis
171
What is the treatment of necrotizing chorioretinitis?
Sulfadiazine
Pyrimethamine
172
Should partners of patients with syphilis also be treated for syphilis even if serological studies are negative?
Yes - if exposure is within last 3 months
173
Can patients decompensating with influenza have a secondary bacterial infection?
Yes
174
Which organism causes African sleeping sickness?
Trypanosoma brucei rhodesiense
Trypanosoma brucei gambiense
175
What is the vector for African sleeping sickness?
Tsetse fly
176
Patient returns from Africa, and has a chancre on arm, and presents with non-specific symptoms (headache, fever, joint pain) followed by neurologic symptoms including personality changes and mental status changes.
Diagnosis?
African sleeping sickness
177
What can be used for Rocky Mountain Spotted Fever if doxycycline is contra-indicated?
Chloramphenicol
178
Which factor drives formation of caseating granulomas in tuberculosis?
Cord factor
179
Which vaccine needs to be given before - the PCV15 or the PPSV23?
PCV15
180
Which 3 antibiotics are first line treatment for simple soft tissue infections (cellulitis)?
- Cephalexin
- Cafedroxil
- Clindamycin
181
What are the preferred antibiotics for Legionella infection?
- Azithromycin
- Levofloxacin
182
What organism typically causes toxic shock syndrome?
Staphylococcus aureus
Group A streptococci
183
Hypotension and macular rash that involves palms and soles. Labs with multiorgan failure and coagulopathy.
Diagnosis?
Toxic shock syndrome
184
Which STD classically presents with tenosynovitis, dermatitis, and polyarthralgia?
Disseminated gonococcal infection
185
What is the treatment of disseminated gonococcal infection?
Ceftriaxone
186
Oral lichen planus is most commonly associated with which infection?
Hepatitis C
187
Which obligate intracellular organism causes pneumonia?
Chlamydia pneumoniae
188
What is the treatment of pneumonia caused by chlamydia pneumoniae?
Azithromycin
189
What is the treatment of pneumonia caused by chlamydia pneumoniae?
Azithromycin
190
Can doxycycline be used in pregnancy?
No
191
What should the MIC of vancomycin be to consider a different treatment therapy?
More than or equal to 2
192
Structural alteration of enzymes involved in RNA synthesis is the mechanism of resistance to which TB drug?
Rifampin
193
Structural alterations of the DNA gyrase (enzymes to wind and unwind DNA) are responsible for resistance to which class of antibiotics?
Fluroquinolones
194
What is the treatment of bacterial meningitis?
- Ceftriaxone
- Ampicillin
- Vancomycin
- Dexamethasone
195
What is ampicillin coverage needed for in bacterial meningitis?
Listeria monocytogenes
196
Do patients with HIV have a higher risk of squamous cell carcinoma?
Yes
197
Does the prophylaxis for anthrax include vaccination?
Yes
198
Is strongyloidiasis or hookworm infestation more common in the United States?
Strongyloidiasis
199
What is the distinguishing feature between infection with acanthamoeba and Naegleria fowleri since they both cause encephalitis?
Naegleria fowleri infection causes olfactory disturbance.
200
Is babesiosis transmitted by deer ticks or dog ticks?
Deer ticks
201
Is Rocky Mountain Spotted fever transmitted by deer ticks or dog ticks?
Dog ticks
202
Within what time period onset of symptoms can oseltamivir be initiated for influenza?
48 hours
203
What is the dose of oseltamivir for influenza?
75 mg p.o. twice a day
204
Which cytokine stimulates the formation of Langerhans' multinucleated giant cells associated with tuberculosis mycobacterium infection?
Type II interferon
205
How is anthrax transmitted?
Inhalation
206
What is the treatment of cat scratch disease?
Azithromycin
207
What is the treatment of choice for CMV retinitis?
Ganciclovir
208
Patient with HIV presents with blurred vision and floaters. Slit lamp examination shows fine stellate keratic precipitates on the cornea.
Diagnosis?
CMV retinitis
209
What is the treatment of pubic lice?
Topical permethrin
210
Which HIV patients need prophylaxis for Pneumocystis jirovecii?
Those with CD4 count less than 200 cells/microL
211
What does Actinomyces israelii look like on gram stain?
Gram positive bacilli
212
Which has higher yield in osteomyelitis - bone biopsy or blood culture?
Bone biopsy
213
What adverse effect can the combination of vancomycin and piperacillin-tazobactam lead to?
Nephrotoxicity
214
What is the initial empiric antibiotic therapy for osteomyelitis?
Vancomycin and cefepime
215
Which organism is responsible for 50% of the infections caused by dog bites?
Pasteurella multocida
216
Capnocytophaga canimorsus is associated with dog bites but more common in immunocompromised patients.
True or false?
True
217
How do you test for herpes simplex in asymptomatic patients?
HSV serology
218
What is the treatment of fulminant C. Diff infection (causing toxic megacolon)?
Oral vancomycin 500 mg QID + IV metronidazole 500 mg q8h
219
Spherules containing endospores
Coccidioidomycosis
220
Which group of bacteria have "fried egg shaped" colonies?
Mycoplasma
221
Which condition has fevers, throat pain, respiratory distress and cavitary lesions; along with thrombosis?
Lemierre's syndrome
222
What causes Lemierre's syndrome?
Fusobacterium necrophorum
223
What is the initial therapy of lyme disease?
Doxycycline for 28 days
224
When is ceftriaxone used in lyme disease?
- Failure to respond to initial therapy
- Lyme encephalitis
- Lyme carditis
225
What is the empiric treatment of complicated UTI with sepsis?
Vancomycin and carbapenem
226
What is the most common cause of vaginitis in women of child bearing age?
Bacterial vaginosis
227
Diagnosis in sexually active woman with malodorous, off-white/grey discharge?
Bacterial vaginosis
228
What are vaginal epithelial cells covered with coccobacilli?
Clue cells
229
What is the treatment of bacterial vaginosis?
Metronidazole
230
Aspergillosis species can predispose to which type of cancer?
Hepatocellular carcinoma
231
What sometimes needs to be done for severe babesiosis in addition to antibiotics?
Exchange transfusion
