ID

Question 1

Treatment for gonorrhea/chlamydia

Answer 1

Gon - ctx
Chlam- azithro or doxy (not if preg)

Question 2

Tx for genital hsv

Answer 2

Valacyclovir
If resistant (via cx), foscarnet

Question 3

Initial test for syphilis

Answer 3

Darkfield microscopy (more sens than vdrl or rpr)

But use rpr and fta for secondary or tertiary

Question 4

Best initial test for OM

Answer 4

X-ray, then mri if negative but high suspicion

Esr to monitor response to tx

Question 5

Skin infxns

Answer 5

• impetigo - most superficial, strep pyog or staph, tx topical mupirocin etc, oral diclox or cephalexin if severe
• erysipelas - GAS (pyog), oral diclox or keflex, dermis
• cellulitis - diclox, keflex, augmenting or oxacillin/nafcillin/unasyn if severe
• infxn hair follicle: folliculitis <furuncle<carbuncle<boil - tx is same as cellulitis
• fungal - topical unless scalp or nail, then oral terbinafine, itraconazole

Question 6

UTI tx

Answer 6

If uncomplicated: fosfomycin, nitrofur, bactrim 3d, quinolone if ecoli resistance or severe

Complicated (stone etc) - bactrim or cipro 7d

Question 7

Best initial dx test for prostatitis

Answer 7

UA

Tx cipro or bactrim for at least two weeks

Question 8

Endocarditis criteria

Answer 8

Duke - 2 major, 1 major 3 minor or 5 minor

Major: 2 pos bcx and abnormal echo
Minor: fever, risk fx, vascular findings (eg janeway, infarcts, emboli), immuno findings (Roth, osler, glomeruloneph), pos bcx with diff org or only 1

Question 9

Fever and murmur, think…

Answer 9

IE. Get blood cx, then echo (tte, then tee if tte neg)

Question 10

IE tx

Answer 10

Vanc and gent 4-6 wks to cover most common orgs (strep viridans, staph aureus, mrsa)

Question 11

Nocardia dx and tx

Answer 11

Dx - initial is cxr, then culture

Tx - bactrim or imipenem

Question 12

Actinomyces

Answer 12

Oral flora so get through dental or face trauma

Tx is pcn

Question 13

Histo vs blasto vs coccidio

Answer 13

Histo - initial is lung, viral like sx, don’t need to treat; dissem goes to marrow —> pancytopenia, dx with urine and serum ag and tx with amphotericin then itraconazole

Blasto - SE, bone and skin lesions, tx antifúngica

Coccidio - dry areas like az, joint pain and erythema nodosum, dx with sputum cx and serology, tx flucon or ampho if severe

Question 14

ABPA

Answer 14

Asthma and CF
Brown mucus plugs
Tx oral pred

Question 15

Tx for Candida auris

Answer 15

Echinocandins

Question 16

Ehrlichia/anaplasma sx and tx

Answer 16

Sx - elevated Alt and ast, thrombocytopenia, leukopenia

Tx - doxy

Question 17

Complications of mucor vs actinomycosis

Answer 17

M- cerebral venous thrombosis
A- fistulous tracrs, abscesses etc

Question 18

CSF analysis for meng

Answer 18

Bacterial - glucose low, protein high, wbc>1000; tx ctx and vanc, add amp for listeria in older pt
Viral - glucose nml (40-70), protein low, wbc 10-500
Gbs - high protein, low wbc
Cryptococcus - high opening pressure, low gluc, high protein, low wbc with mostly lymphs, usu in aids, may have lesions that look like molluscum, tx ampho B and flucytosine for two or more weeks until sx abate and CSF sterilized, then high dose flucon for 8 weeks, then low dose flucon for a yr to prevent recurrence, dc thereafter if cd4>100 and vl undetectable for three mo

Question 19

Acute rheumatic fever tx

Answer 19

Monthly pcn
Sx migratory poly arthritis after pharyngitis

Question 20

Pna tx

Answer 20

Cap, outpt - amox, cefurox
Hap - ctx, add vanc and azithro if severe
Atypical - azithro

Question 21

Beta lactamase inhib adds coverage for

Answer 21

Staph (not mrsa) and gram neg rods

Question 22

Treatments for infection in CF

Answer 22

Mild - macrolide, bactrim, cipro
Pseudomonas or staph - vanc (mrsa) plus tobramycin/amikacin (psa) or ceftaz/cefe for psa
Resistant - inhaled tobra

Question 23

Tick paralysis

Answer 23

Neurotoxins in tick saliva —> fatigue prodrome, then ataxia and ascending paralysis over hours and absent dtr’s

Tx: remove the tick

Question 24

How to dx and tx schistosomiasis

Answer 24

Eggs in urine sed
Praziquantel

Question 25

Tx for zoster

Answer 25

If within 72hrs of rash, valacyclovir x7-10d (have to dose acyclovir too frequently)

If more than 72 hrs, supportive

Question 26

Biopsy lymph nodes after EBV if they fail to resolve after…

Answer 26

3-4 weeks

Question 27

Diphtheria dx and tx

Answer 27

Dx - culture respiratory secretions or toxin assay; presents with fever, Malas, sore throat and gray pseudo membrane, complications, include myocarditis, neuritis, kidney disease

Tx - erythromycin or pcn, antitoxin if severe

Question 28

Hep B lab results

Answer 28

Acute infection: sAg, eAg (contagious) rise with igm anti-core

Then antic sticks around and igg antic develops with antis and antie in recovery phase

If vax, have antis
If recovered, have antic and antis igg

Chronic carriers have sAg and igg antic

Question 29

Acute bacterial rhinosinusitis aka sinus infxn tx

Answer 29

Amox clav x5-7d

Alt is doxy or fluoroquin

Question 30

PEP for meningitis

Answer 30

Assume neisseria meng and give close contacts rifampin, ctx or cipro

Question 31

When does Giardia present?

Answer 31

Weeks after exposure

Question 32

Most common cause of rhinosinusitis

Answer 32

Viral!

Question 33

Why do we not give abx for bloody diarrhea if child looks well?

Answer 33

Likely bacterial but abx increase risk of hus if stec

Question 34

Treatment of PCP

Answer 34

Bactrim, po if o2>70, otherwise iv + steroids

Question 35

Hip effusion - positioning?

Answer 35

Keep hip flexed and externally rotated, eg synovitis or septic arthritis

Question 36

Elevated adenosine deaminase, think…

Answer 36

TB