ID Flashcards
(249 cards)
1
Q
What is a case series?
A
A descriptive study about a group of patients with the same disease or condition who all have the exposure of interest.
2
Q
What is a main weakness of a case series?
A
It does not contain a control group.
3
Q
What should antibiotic regimens for intrahepatic abscesses cover?
A
Both pyogenic and amoebic causes.
4
Q
True or False: Early acute bacterial conjunctivitis may not need antibiotics.
A
True.
5
Q
When is multidrug prophylaxis for HIV transmission prevention typically considered?
A
Within the first 72 hours after potential HIV exposure.
6
Q
What are three common features of shigella infection?
A
- Bloody diarrhea
- Abdominal cramps
- Fever
7
Q
When can symptoms of primary HIV infection begin after initial exposure?
A
Days after initial exposure and can last for several weeks.
8
Q
When should steroids be given in meningitis in regards to timing with antibiotics.
A
Prior to the first dose or at the same time as the first dose of antibiotics.
9
Q
How is an uncomplicated parapneumonic effusion typically treated?
A
(antibiotics)
10
Q
What diagnostics are recommended for suspected Bordetella pertussis in the first four weeks of symptoms?
A
PCR and culture.
11
Q
What are the most common pathogens in a pyogenic liver abscess?
A
- Enteric bacteria (especially E. Coli)
- Klebsiella
- Streptococcus species (especially Anginosus)
12
Q
True or False: If blood or synovial fluid culture for Neisseria gonorrhea are negative, disseminated gonococcal infection is likely ruled out.
A
False.
13
Q
What percentage of patients typically have positive cultures for urogenital, rectal, or pharyngeal cultures for Neisseria gonorrhea?
A
Roughly 50 to 80%.
14
Q
How long should long antimicrobial courses be for catheter-associated bacteremia?
A
4 to 6 weeks.
15
Q
What should adults who have previously received only the 23 valent pneumococcal polysaccharide vaccine (PPSV23) receive?
A
Either PCV15 or PCV20 at least one year after their last PPSV23 dose.
16
Q
What organisms typically cause cellulitis?
A
Streptococcal organisms, which are sensitive to penicillin.
17
Q
What should empiric iv abx therapy for post-neurosurgical meningitis cover?
A
- MRSA
- Coagulase negative staph
- Gram-negative bacilli (including pseudomonas)
18
Q
Are patients with cavitary TB typically smear positive or negative?
A
Positive.
19
Q
What defines neutropenia?
A
Absolute neutrophil count that is <500 or expected to fall below that value in next 48 hours.
20
Q
For chronic HBV patients that test negative for the E antigen, when is treatment recommended?
A
If the viral load is greater than 2000 IU/mL and the Ala is greater than twice the upper limit of normal.
21
Q
What are the typical treatments for moderate to severe vibrio parahaemolyticus infection?
A
- Doxycycline
- Fluoroquinolones
- Macrolides
22
Q
What common symptoms are associated with primary HIV infection?
A
- Fever
- Myalgias
- Rash
- Pharyngitis
- Oral or genital ulcers
23
Q
What is the initial step in the evaluation of olecranon bursitis?
A
Joint aspiration.
24
Q
What type of staining is Nocardia associated with?
A
Acid fast.
25
What should victims of sexual assault receive for prevention of trichomoniasis?
Metronidazole.
26
What indicates gas gangrene after a traumatic puncture of the skin?
Presence of tissue necrosis and crepitus.
27
What characterizes a complicated parapneumonic effusion?
An exudative effusion with a pH <7.2 or glucose less than 60.
28
When can administration of steroids be considered in bacterial meningitis?
In cases with purulent CSF and/or positive gram stain.
29
What type of bacteria is Nocardia?
Gram positive with branching filaments.
30
For severe shigella infection, when is the recommended 3-day course of fluoroquinolones extended?
For people with HIV coinfection or shigella dysenteriae type one infection.
31
What is the best test to confirm the clinical diagnosis of active pulmonary TB?
Sputum stain and culture.
32
Why are Tigecycline and Linezolid not appropriate therapies for MRSA bacteremia?
They have bacteriostatic as opposed to bactericidal activity against MRSA.
33
How long should prophylactic antibiotics be given to people with a history of rheumatic fever and carditis without valvular disease?
For 10 years after the last attack or until age 21, whichever is longer.
34
When is primary prophylaxis with TMP-SMX indicated?
When the CD4 count drops to less than 200.
35
What is the specificity and sensitivity of thin smears of peripheral blood for diagnosing malaria?
100% specific but not 100% sensitive.
36
What characterizes infection with Haemophilus ducreyi?
Painful, ragged appearing genital ulcers and tender suppurative inguinal lymphadenopathy.
37
What should be suspected if oropharyngeal candidiasis is associated with odynophagia or dysphagia?
Esophageal candidiasis.
38
What is the recommended treatment regimen for a patient with a port abscess and fungemia?
* Port removal
* Incision and drainage
* Antifungal therapy for at least 14 days after the first negative blood culture.
39
What antibiotics should a patient with a hepatic abscess receive?
Antibiotics that cover either a pyogenic or amoebic cause.
40
What causes a pale or dusky appearance of the skin in gas gangrene?
Small vessel thrombosis.
41
What should initial empiric coverage for toxic shock syndrome include?
* A carbapenem class of drug
* Clindamycin to cover for Group A strep and staph aureus
* Vancomycin
42
What are the typical classes of antibiotics for atypical bacteria?
* Macrolides
* Fluoroquinolones
* Tetracyclines
43
What antibiotics are typically used for anaerobes?
* Metronidazole
* Clindamycin
* Zosyn
* Carbapenems
* Amp-sulbactam
* Amoxicillin-clavulanate
44
What is the hierarchy of evidence for observational studies in order of ascending validity?
* Case series
* Case control study
* Cohort study
* Systematic review or meta-analysis of cohort studies.
45
When does cerebral toxoplasmosis generally occur?
When the CD4 count is below 200.
46
What is the ideal treatment for GAS pharyngitis?
Penicillin or azithromycin if allergic.
47
What are the symptoms of syphilis?
Low-grade constitutional symptoms with maculopapular rash on trunk, palms, and soles.
48
What did a retrospective study show about immediate lumbar puncture compared with CT scan before lumbar puncture?
It reduced mortality in meningitis.
49
What can the BK virus potentially cause in kidney transplant or immune-compromised patients?
Hemorrhagic cystitis.
50
What is required for parapneumonic effusions?
Diagnostic thoracentesis to determine further management.
51
What are typical symptoms of delayed onset prosthetic joint infections?
Often lack fever, leukocytosis, or local symptoms over the joint.
52
What typically characterizes early onset prosthetic joint infections?
Caused by Staphylococcus aureus and will typically show fever, leukocytosis, and symptoms over the joint.
53
What should empiric treatment for acute exacerbation of bronchiectasis cover?
* Haemophilus influenzae
* Moraxella catarrhalis
* Staph aureus
* Pseudomonas
54
What is the first-line therapy for severely symptomatic patients with shigella dysentery?
A 3-day course of a fluoroquinolone, such as ciprofloxacin.
55
What exceptions exist for treatment of asymptomatic pyuria?
* Pregnancy
* Before a urologic procedure
* 1-3 months after renal transplantation.
56
What are the three most common causes of immune thrombocytopenia in adults?
* HIV
* Hepatitis
57
What does sigmoidoscopy typically demonstrate in gastrointestinal CMV disease?
Severe colitis with multiple clean based ulcers
58
What is the indicated treatment for patients with catheter associated bacteremia?
Long antimicrobial courses of 4 to 6 weeks along with catheter removal if patient has persistent symptoms, bacteremia, fungemia, or evidence of endocarditis or suppurative thrombophlebitis
59
What are three common causes of immune thrombocytopenia in adults?
* HIV
* Hepatitis
* H. pylori
60
How is toxoplasmosis typically acquired?
From raw or undercooked meat or oocysts from cats
61
What is the strong association found between infections with streptococcus gallolyticus subsp gallolyticus?
Colon cancer
62
What is the next diagnostic step for suspected colon cancer?
Colonoscopy
63
When should a catheter be removed in cases of catheter associated bacteremia?
If the infection was caused by Staph aureus, Pseudomonas aeruginosa, or Candida species
64
What is the most common cause of septic arthritis?
Staphylococcus or streptococcus species affecting a single joint
65
What leukocyte count is consistent with prosthetic joint infection?
Greater than 1700 mm3
66
What is the highest risk for CMV infection in solid organ transplants?
When the transplant recipient is seronegative for CMV and the donor is seropositive
67
What prophylaxis is appropriate for an adult exposed to Neisseria meningitidis?
* Oral rifampin
* Oral ciprofloxacin
* Parenteral ceftriaxone
68
What do antibiotic lock solutions combine?
A highly concentrated antibiotic with an anticoagulant for local instillation into the catheter lumen
69
True or False: The genital urinary tract is a common site for extra pulmonary tuberculosis.
True
70
What is the next step for a patient with >3 tetanus vaccines and a clean wound less than 10 years since the last vaccine?
Supportive care, no vaccine is needed
71
What should be suspected if oropharyngeal Candidiasis is associated with odynophagia or dysphagia?
Esophageal Candidiasis
72
What are the treatment choices for invasive CMV disease?
* Intravenous ganciclovir
* Oral valganciclovir
73
What scoring system is used to estimate the risk for Group A strep infection in patients with pharyngitis?
4-point Centor scoring system
74
What does the presence of positive hepatitis B surface antigen and core antibodies with negative surface antibody and E antigen indicate?
Chronic hepatitis B infection
75
What CD4 count is typically associated with cerebral toxoplasmosis?
Below 200
76
What are the x-ray findings of a prosthetic joint infection?
Periprosthetic lucency and loosening of the tibial component
77
What does a holosystolic cardiac murmur at the apex in a young adult with a history of acute rheumatic fever indicate?
Mitral regurgitation
78
Which carbapenem does not cover Pseudomonas?
Ertapenem
79
What is the most common mode of transmission for Neisseria meningitidis?
Short ranged aerosolized secretions
80
What are common symptoms associated with primary HIV infection?
* Fever
* Myalgias
* Rash
* Pharyngitis
* Oral or genital ulcers
81
What is the presence of leukocytes greater than 1700 mm3 in the aspirate consistent with?
Prosthetic joint infection
82
What is recommended after four weeks of symptoms suspecting Bordetella pertussis?
Serologic testing
83
What should a patient with an unknown vaccine history and a dirty wound receive?
Tdap and immune globulin
84
What is the empiric treatment for pertussis if presented within three weeks of cough onset?
A 5 to 7 day course of a macrolide
85
What should broad spectrum treatment for a large abscess always include?
MRSA coverage
86
How does disseminated gonococcal infection typically present?
Transient systemic illness followed by gonococcal arthritis, which is typically monoarticular
87
What is the treatment for acute uncomplicated bronchitis?
Supportive care including albuterol if wheezing is present
88
What is the most common cause of pyogenic liver abscess?
Biliary disease, especially in diabetic patients
89
What effects do steroids have in adults with streptococcal pneumoniae meningitis?
Positive effects
90
When do early onset prosthetic joint infections typically occur?
Within 3 months of surgery
91
What is the incubation period for Shigella?
Typically from 1 to 7 days
92
What is the most appropriate regimen to initiate for suspected streptococcus pneumoniae meningitis?
Dexamethasone plus both vancomycin and ceftriaxone
93
What is the most effective therapy to reduce transmission of herpes simplex in recurrent outbreaks?
Daily suppressive therapy with oral Acyclovir, Famciclovir, or Valacyclovir
94
What does persistence or recurrence of UTI symptoms 1 to 2 weeks after treatment suggest?
Infection with antimicrobial resistant strain
95
What does Albendazole treat?
Echinococcus granulosus, a cestode that causes hydatid liver cysts
96
What is the initial treatment for the first episode of acute pericarditis?
Aspirin and colchicine
97
What is indicated for patients with a Centor score >2?
A rapid antigen test or throat culture for group A strep
98
What are the first steps for a patient with neutropenic fever?
* Obtain 2 sets of blood cultures
* Start empiric antibiotics
* Order imaging studies based on symptoms
99
How is streptococcus gallolyticus blood infection typically treated?
* Vancomycin
* Penicillin
* Ceftriaxone
100
What is the first line therapy for severely symptomatic patients with shigella dysentery?
A 3 day course of a fluoroquinolone
101
What does CMV retinitis usually cause?
Painless loss of vision with fluffy white retinal infiltrates but no significant vitreous inflammation
102
What is the recommended treatment regimen for a patient with a port abscess and fungemia?
* Port removal
* Incision and drainage
* Antifungal therapy for at least 14 days after the first negative blood culture
103
What should be repeated every 12 to 24 hours for a patient suspected of malaria?
Thick and thin smears until at least three smear sets have been evaluated
104
What is the appropriate empiric therapy for bacterial conjunctivitis in a contact lens wearer?
Fluoroquinolone eyedrops
105
What should be done if a heterophile antibody (Monospot) test for Epstein Barr is negative?
A repeat monospot test or EBV-specific serologic testing is warranted
106
What does the empiric IV antibiotic therapy for post neurosurgical meningitis cover?
* MRSA
* Coagulase negative staph
* Gram-negative bacilli including Pseudomonas
107
What is the treatment for a patient with a port abscess and fungemia?
* Port removal
* Incision and drainage
* Antifungal therapy for at least 14 days after the first negative blood culture
108
What is the significance of finding Gram negative intracellular diplococci in a college student?
It indicates infection with Neisseria meningitidis
109
What should adults who previously received only the 23 valent pneumococcal polysaccharide vaccine (PPSV23) receive?
Either PCV15 or PCV20 at least one year after their last PPSV23 dose
110
What injury is Unasyn known to cause?
Liver injury
111
What is the treatment regimen for patients with catheter related bloodstream infections if they have negative follow up cultures?
10 to 14 days of IV antibiotics or prompt resolution of symptoms following antibiotic administration
112
What should be done for patients with suspected endovascular focus of infection?
Obtain at least two sets of blood cultures before initiating antibiotic therapy
113
What type of bacteria typically infects patients with delayed onset prosthetic joint infection?
Low virulence bacteria such as coagulase negative Staphylococcus
114
What is polyarthralgia?
Polyarthralgia means there can be multiple joints affected
## Footnote
Although usually it is monoarticular in nature, the arthritis can also be migratory.
115
What should be done if a heterophile antibody (Monospot) test for Epstein Barr is negative in the first week?
A repeat Monospot test or EBV-specific serologic testing is warranted
## Footnote
No back content.
116
What is the broad-spectrum coverage for meningitis?
* Vancomycin: for resistant streptococcus
* Ceftriaxone: streptococcus species
* Ampicillin: for listeria
## Footnote
No back content.
117
What does sigmoidoscopy typically demonstrate in gastrointestinal CMV disease?
Severe colitis with multiple clean-based ulcers
## Footnote
No back content.
118
True or False: The tuberculin skin test can distinguish between latent and active TB infection.
False
## Footnote
Neither the tuberculin skin test nor the gamma interferon test can distinguish between latent and active TB infection.
119
What are common symptoms associated with primary HIV infection?
* Fever
* Myalgias
* Rash
* Pharyngitis
* Oral or genital ulcers
## Footnote
No back content.
120
What is indicated for patients with catheter-associated bacteremia?
Long antimicrobial courses of 4 to 6 weeks along with catheter removal if persistent symptoms, bacteremia, fungemia, or evidence of endocarditis or suppurative thrombophlebitis
## Footnote
No back content.
121
What is indicated for patients with catheter-related bacteremia who have a prosthetic heart valve?
Transesophageal echocardiogram (TEE)
## Footnote
No back content.
122
How are moderate to severe vibrio parahaemolyticus infections typically treated?
With doxycycline, fluoroquinolones, and macrolides
## Footnote
No back content.
123
What are the first-line antiviral therapies for chronic hepatitis B?
* Tenofovir
* Entecavir
## Footnote
No back content.
124
True or False: You should begin antiretroviral therapy regardless of CD4 count.
True
## Footnote
You should begin antiretroviral therapy regardless of CD4 count.
125
What should be done for people who have been sexually assaulted by someone with an unknown HIV status?
A 28-day course of multidrug antiretroviral therapy is indicated
## Footnote
No back content.
126
What usually causes acute bronchitis?
A respiratory virus, and in some cases, atypical bacteria
## Footnote
No back content.
127
True or False: The absence of redness over a skin lesion likely rules out cellulitis.
True
## Footnote
No back content.
128
What initial empiric coverage should be included for toxic shock syndrome?
A carbapenem class of drug, Clindamycin for Group A strep and Staph aureus, as well as Vancomycin
## Footnote
No back content.
129
What should empiric IV antibiotic therapy for post-neurosurgical meningitis cover?
* MRSA
* Coagulase-negative staph
* Gram-negative bacilli including pseudomonas
## Footnote
No back content.
130
What are common causes of bacterial conjunctivitis in adults in the US?
* Staph
* Strep
* Haemophilus
## Footnote
No back content.
131
What are the most common pathogens in a pyogenic liver abscess?
* Enteric bacteria, especially E. Coli
* Klebsiella
* Streptococcus species, especially Anginosus
## Footnote
No back content.
132
What should a patient with catheter-related blood stream infections receive if they have negative follow-up cultures?
10 to 14 days of IV antibiotics or prompt resolution of symptoms following antibiotic administration
## Footnote
No back content.
133
What is the empiric treatment for acute exacerbation of bronchiectasis?
An oral antibiotic such as a quinolone that covers Haemophilus influenzae, Moraxella catarrhalis, Staph aureus, or Pseudomonas
## Footnote
No back content.
134
What are examples of typical oral antibiotics used for MRSA treatment?
* Doxycycline
* Bactrim
* Linezolid
* Clindamycin
## Footnote
Doxycycline, Bactrim, Linezolid, and Clindamycin are examples of the typical oral antibiotics used for MRSA treatment.
135
What are the typical IV forms used for MRSA treatment?
* Vancomycin
* Daptomycin
## Footnote
No back content.
136
Common symptoms associated with primary HIV infection include?
Fever, myalgias, rash, pharyngitis, and oral or genital ulcers.
137
Is Bordetella pertussis a relatively common cause of persistent severe cough in adults?
True
138
Three common features of shigella infection are?
Bloody diarrhea, abdominal cramps, and fever.
139
What is the most likely organism to cause mild to moderate gastroenteritis following consumption of raw seafood?
Vibrio parahaemolyticus.
140
People with delayed onset prosthetic joint infection are typically infected with?
Low virulence bacteria such as coagulase negative Staphylococcus.
## Footnote
Results in patients typically being asymptomatic.
141
For a patient with catheter associated bacteremia, when should the catheter be removed?
If the infection was caused by Staph aureus, Pseudomonas aeruginosa, or Candida species.
142
How often should thick and thin smears be repeated for a patient suspected of malaria?
Every 12 to 24 hours until at least three smear sets have been evaluated.
143
People with a history of rheumatic heart disease and valvular sequelae should receive prophylactic antibiotics for how long?
10 years or until age 40, whichever is longer.
144
How is streptococcus gallolyticus blood infection typically treated?
With vancomycin, penicillin, or ceftriaxone.
145
What is the typical class of antibiotics used for a multi-drug resistant UTI?
Carbapenems.
146
Is infection with haemophilus ducreyi likely ruled out if there is more than one painful genital ulcer?
False
147
What clinical finding describes severe pain on the body with no obvious skin findings, fluctuance, or swelling?
Pain out of proportion to exam findings.
148
Septic arthritis of more than one joint in the context of pneumonia and endocarditis is most likely caused by?
Infection with Streptococcus pneumoniae.
149
What renal abnormality can TMP-SMX cause?
Decrease in creatinine clearance.
150
Is Vibrio parahaemolyticus a gram positive or negative organism?
Gram negative.
151
What is the most appropriate treatment for a pregnant woman with syphilis and serious penicillin allergy?
Penicillin using a desensitization protocol.
152
What pneumococcal vaccines should adults 65 and over receive?
PCV15 or PCV20.
153
What are the first steps for a patient with neutropenic fever?
Obtain 2 sets of blood cultures, start empiric antibiotics, and order imaging studies based on symptoms.
154
How should GAS pharyngitis ideally be treated?
With penicillin or azithromycin if allergic.
155
Can the Monospot test be negative in up to 25% of patients within the first week of infection?
Yes.
## Footnote
Warrants test to be repeated or serologic testing to be performed.
156
If a patient has >3 tetanus vaccines and a dirty wound and > 5 years since last vaccine, what is the next step?
Give tetanus vaccine only.
157
What is the only antibiotic proven to reduce the risk for relapse in patients with recurrent nonpurulent cellulitis?
Penicillin.
158
After a sexual assault, what should victims receive for prevention of trichomoniasis?
Metronidazole.
159
For a patient with RA presenting with septic arthritis, what is the first step?
Joint aspiration followed by broad spectrum antibiotics.
160
As the fever from disseminated gonococcal infection resolves, patients typically present with?
A triad of tenosynovitis, dermatitis, and polyarthralgia, or with frank arthritis.
161
Transmission for shigella typically happens in?
Overcrowded settings such as daycare centers.
162
What does a patient with fever, headache, and a stiff neck shortly after neurosurgery probably have?
Post neurosurgical meningitis.
163
What do case-control studies compare?
The characteristics of individuals who already have a particular disease with those who don't.
164
What is the most effective therapy to reduce transmission of herpes simplex in a patient with recurrent outbreaks?
Daily suppressive therapy with oral Acyclovir, Famciclovir, or Valacyclovir.
165
What is the first line treatment for Tinea corporis?
Topical azoles or allylamines such as terbinafine.
166
What is the next diagnostic step for infections with streptococcus gallolyticus subsp gallolyticus?
Colonoscopy.
167
Diarrhea associated with Giardia is watery and typically does not contain?
Blood or leukocytes.
168
What should be done for diagnosing malaria?
Thin smears of peripheral blood should be repeated.
169
How can UTIs that recur more than 1 month after an extensive abx course be treated?
With another short course of another first-line antibiotic.
170
Ocular toxoplasmosis in children and adults usually results in?
Retinochoroidal scars and may be subclinical.
171
When acute HIV infection is suspected, what testing is recommended?
HIV RNA testing.
172
What does CMV retinitis usually cause?
Painless loss of vision with fluffy white retinal infiltrates but no significant vitreous inflammation.
173
People with a history of rheumatic fever and carditis without valvular disease should receive prophylactic antibiotics for how long?
10 years after the last attack or until age 21, whichever is longer.
174
What usually causes erysipelas?
Group A streptococci or other beta hemolytic streptococci.
175
Are case series studies retrospective or prospective?
Retrospective.
176
What is the empiric treatment for acute exacerbation of bronchiectasis?
An oral antibiotic such as a quinolone that covers Haemophilus influenzae, Moraxella catarrhalis, Staph aureus, or Pseudomonas.
177
What are the most common pathogens in a pyogenic liver abscess?
Enteric bacteria, especially E. Coli, and Klebsiella, and Streptococcus species, especially Anginosus.
178
What types of antibiotics are typically used for Pseudomonas coverage?
Cefepime, Zosyn, aminoglycosides, carbapenems, fluoroquinolones.
179
What can confirm the diagnosis of esophageal/oral candidiasis?
Potassium hydroxide staining and culture of oral scrapings.
180
What is the hierarchy of evidence for observational studies in order of ascending validity?
Case series, case control study, cohort study, and systematic review or meta-analysis of cohort studies.
181
What is the initial treatment for the first episode of acute pericarditis?
Aspirin and colchicine.
182
If a patient has >3 tetanus vaccines and a dirty wound and < 5 years since last vaccine, what is the next step?
Supportive care, no vaccine needed.
183
What is the treatment choice for invasive CMV disease?
Either intravenous ganciclovir or oral valganciclovir.
184
What is the first line treatment in a patient with ESRD with MRSA bacteremia?
IV Vancomycin.
## Footnote
In patients on HD, vanc should be given after HD.
185
What is the recommended treatment regimen for a patient with a port abscess and fungemia?
Port removal, incision and drainage, and antifungal therapy for at least 14 days after the first negative blood culture.
186
What describes a cohort type of study?
Participants are classified into two groups: exposed and unexposed, and the incidence of the outcome of interest is compared.
187
What should an adult with persistent cough with severe coughing fits and vomiting be evaluated for?
Bordetella pertussis.
188
What does metronidazole cover?
Both anaerobes as well as Entamoeba histolytica.
189
What is the most useful diagnostic test for a patient with suspected prosthetic joint infection?
Aspiration of the joint.
190
What is the diagnosis for a patient from Central America with esophageal dysfunction, conduction abnormalities, and dilated cardiomyopathy?
Chagas Disease.
191
What is the diagnosis for an itchy, annular, red plaque in one or multiple areas on a person's body?
Tinea corporis.
192
If a patient receives the PCV15 vaccine, when should a dose of pneumococcal polysaccharide vaccine (PPSV23) be given?
Usually at least one year later.
193
What must a patient presenting with an infection from one or more sources after a recent hospitalization have?
Coverage for multidrug resistant pathogens.
194
What should raise suspicion for pertussis?
Severe and persistent paroxysmal coughing episodes after a phase of low grade fever and nasal congestion.
195
What is the empiric treatment for pertussis if they present within three weeks of cough onset?
A 5 to 7 day course of a macrolide.
196
For a patient with RA presenting with septic arthritis, what is the next appropriate step in management after joint aspiration?
Broad spectrum antibiotics.
197
What is recommended for diagnosing Bordetella pertussis in the first four weeks of symptoms?
PCR and culture are both recommended for diagnostics.
198
What can be considered for some cases of bacterial meningitis?
Administration of steroids.
199
What should be repeated for diagnosing malaria?
Thick and thin smears should be repeated every 12 to 24 hours until at least three smear sets have been evaluated.
200
When can administration of steroids be considered?
For some cases of bacterial meningitis including those with purulent CSF and/or positive gram stain.
201
What do case-control studies compare?
They compare the characteristics of individuals who already have a particular disease with those who don't.
202
How do case-control studies differ from case-series?
Case-control studies contain a control group.
203
What is colchicine typically used for?
Treatment of an acute gout flare.
204
What should be done for a patient with catheter-associated bacteremia?
The catheter should be removed if the infection was caused by staph aureus, pseudomonas aeruginosa, or candida species.
205
Is shigella diagnosed without bloody diarrhea?
False. Without bloody diarrhea, shigella is not the diagnosis.
206
Is involvement of more than one joint in septic arthritis common?
It is less common but may occur in patients with high-grade bacteremia including endocarditis or with underlying connective tissue diseases.
207
What is the post-exposure prophylaxis for gonorrhea and chlamydia after sexual assault?
Typically accomplished by administering ceftriaxone and doxycycline.
208
What was the traditional prophylaxis for gonorrhea and chlamydia as of 2022?
Traditionally it was ceftriaxone and azithromycin.
209
Are antibiotics recommended for acute bronchitis?
True, antibiotics are not recommended for acute bronchitis.
210
What can linezolid precipitate if given with an antidepressant?
Serotonin syndrome, especially with an SSRI.
211
What is the most appropriate initial management of a complicated parapneumonic effusion?
Pleural fluid drainage via tube thoracostomy.
212
What are the most common pathogens in a pyogenic liver abscess?
Enteric bacteria, especially E. Coli, Klebsiella, and streptococcus species, especially Anginosus.
213
What triad do patients with disseminated gonococcal infection typically present with?
Tenosynovitis, dermatitis, and polyarthralgia.
214
What important infectious agent should be ruled out in a patient from Mexico with chronic prostatitis?
Tuberculosis.
215
What is the diagnostic method for tuberculosis in this context?
Urine acid-fast bacillus smear and culture.
216
What should be given after the PCV15 vaccine?
A dose of pneumococcal polysaccharide vaccine (PPSV23) should also be given, usually at least one year later.
217
When is TEE indicated in patients with catheter-related bacteremia?
In patients with a prosthetic heart valve, pacemaker, implantable ICD, or persistent bacteremia or fungemia.
218
What is the most effective therapy to reduce transmission of herpes simplex?
Daily suppressive therapy with oral Acyclovir, Famciclovir, or Valacyclovir.
219
What is the association between streptococcus gallolyticus and colon cancer?
There is a strong association; the next diagnostic step is colonoscopy.
220
When is treatment recommended for chronic HBV patients who test negative for the E antigen?
If the viral load is greater than 2000 IU/mL and the Ala is greater than twice the upper limit of normal.
221
What is the treatment for a pregnant woman with syphilis and serious penicillin allergy?
Penicillin using a desensitization protocol.
222
How long should prophylactic antibiotics be given to people with a history of rheumatic heart disease?
For 10 years or until age 40, whichever is longer.
223
What is antibiotic lock therapy commonly considered for?
Adjunctive treatment of bacteremia associated with central venous catheters.
224
What neurologic effect do carbapenems have?
They lower the seizure threshold.
225
What should initial empiric coverage for toxic shock syndrome include?
A carbapenem class of drug, Clindamycin for Group A strep, and staph aureus, and vancomycin.
226
What should a patient with an unknown vaccine history and a dirty wound receive?
Tdap and immune globulin.
227
What are common causes of bacterial conjunctivitis in adults in the US?
Staph, strep, and haemophilus.
228
What usually causes acute bronchitis?
A respiratory virus, and in some cases, atypical bacteria such as chlamydia pneumonia, mycoplasma, or Bordetella pertussis.
229
What is the recommended vaccination for adults 65 and over?
Pneumococcal conjugate vaccines PCV15 or PCV20, especially for those with underlying conditions.
230
What is the classic sign of ocular toxoplasmosis?
A nidus of fluffy white necrotizing retinitis that is adjacent to a pigmented chorioretinal scar.
231
What is indicated for patients with a Centor score >2?
A rapid antigen test or throat culture.
232
What is the treatment for gastrointestinal CMV disease?
Sigmoidoscopy typically demonstrates severe colitis with multiple clean-based ulcers.
233
What is the common site of extrapulmonary tuberculosis?
The genitourinary tract.
234
What is the appropriate prophylaxis for an adult exposed to Neisseria meningitidis?
Oral rifampin, oral ciprofloxacin, or parenteral ceftriaxone.
235
What is the treatment for acute uncomplicated bronchitis?
Supportive care, including albuterol if wheezing is present.
236
What should be suspected if oropharyngeal Candidiasis is associated with odynophagia or dysphagia?
Esophageal Candidiasis.
237
What is characteristic of infection with haemophilus ducreyi?
Painful, ragged appearing genital ulcers and tender suppurative inguinal lymphadenopathy.
238
What is the purpose of the 4-point Centor scoring system?
To estimate the risk for Group A strep infection and determine if additional testing or treatment is needed.
239
What common physical exam finding is associated with gas gangrene and mesenteric ischemia?
Pain out of proportion to exam findings.
240
What should be done for patients with catheter-associated bacteremia?
Long antimicrobial courses of 4 to 6 weeks along with catheter removal are indicated if the patient has persistent symptoms, bacteremia, fungemia, or evidence of endocarditis or suppurative thrombophlebitis.
241
What are the typical forms for MRSA coverage?
Vancomycin and daptomycin are the typical IV forms for MRSA coverage.
242
What is the first-line option for treatment of acute uncomplicated cystitis?
Nitrofurantoin.
243
What is the treatment for primary HIV infection?
Symptoms can begin days after initial exposure and can last for several weeks, followed by a long asymptomatic period.
244
What is indicated for catheter associated bacteremia with persistent symptoms?
Long antimicrobial courses of 4 to 6 weeks along with catheter removal are indicated if the patient has persistent symptoms.
245
When is a TEE indicated in patients with catheter related bacteremia?
A TEE would be indicated in patients with catheter related bacteremia who have a prosthetic heart valve, pacemaker, implantable ICD, or persistent bacteremia.
246
When should antibiotic therapy for Group A strep infection be prescribed?
Antibiotic therapy for Group A strep infection should only be prescribed after a positive rapid antigen test or throat culture.
247
What should be done if a patient has an unknown vaccine status or less than 3 tetanus vaccines and a dirty wound?
The next step is to give the tetanus vaccine plus immune globulin; immune globulin is needed due to the dirty wound.
248
In what time frame can the Monospot test be negative in patients?
The Monospot (heterophile antibody) test can be negative in up to 25% of patients within the first week of the infection.
249
What should be done if the Monospot test is negative?
The test warrants being repeated or serologic testing to be performed.
