ID

Question 1

What type of disease is Lyme disease?

Answer 1

Tick-borne spirochetal disease

Caused by Borrelia burgdorferi

Question 2

What are the initial symptoms of Lyme disease?

Answer 2

Fever, myalgias, arthralgias, circular rash (erythema migrans)

Initial symptoms can vary among patients

Question 3

How does cardiac involvement manifest in Lyme disease?

Answer 3

Conduction disease, arrhythmias, myocarditis, pericarditis, pericardial effusion

Affected patients can experience first-, second-, or third-degree atrioventricular block

Question 4

Where is the conduction disturbance typically located in Lyme disease-related heart block?

Answer 4

At or above the atrioventricular node

This disturbance is generally reversible with antibiotic treatment

Question 5

What antibiotic is used for Lyme disease-related heart block with junctional escape?

Answer 5

Intravenous ceftriaxone

Antibiotic therapy is crucial for treatment

Question 6

What is the duration of antibiotic treatment for Lyme disease after switching from intravenous to oral antibiotics?

Answer 6

14 to 21 days

This duration is necessary to ensure complete treatment

Question 7

Which antibiotics are used to treat early, nondisseminated Lyme disease?

Answer 7

Oral doxycycline, oral amoxicillin

These antibiotics are effective for conditions like erythema migrans

Question 8

Do most patients with Lyme-related conduction defects require a permanent pacemaker?

Answer 8

No

Most patients do not need one if appropriately treated

Question 9

When is a temporary pacemaker appropriate in Lyme disease cases?

Answer 9

In cases of hemodynamic instability or unstable escape rhythms

This approach is reserved for specific critical situations

Question 10

What is Clostridioides difficile?

Answer 10

A gram-positive, spore-forming bacterium that can cause antibiotic-associated diarrhea and colitis.

Clostridioides difficile was previously known as Clostridium difficile.

Question 11

What are the primary risk factors for Clostridioides difficile infection?

Answer 11

• Recent antibiotic use

High-risk antibiotics (odds ratio ≥ 5)
Clindamycin
Cephalosporins
Fluoroquinolones

Moderate risk antibiotics (odds ratio 1 to 5)
Penicillin
Macrolides

• Hospitalization
• Advanced age
• Immunocompromised state
• Gastrointestinal surgery
• Proton pump inhibitor use

These factors increase susceptibility to C. difficile due to disruption of normal gut flora.

Question 12

How is Clostridioides difficile transmitted?

Answer 12

Through the fecal-oral route, often via contaminated surfaces or hands.

The spores are hardy and can survive in the environment for long periods.

Question 13

What are the common clinical manifestations of Clostridioides difficile infection?

Answer 13

• Watery diarrhea
• Abdominal pain
• Fever
• Nausea
• Loss of appetite

Symptoms can range from mild diarrhea to severe colitis.

Question 14

What diagnostic tests are used for Clostridioides difficile infection?

Answer 14

• Enzyme immunoassays (EIAs) for toxins A and B
• Nucleic acid amplification tests (NAATs)
• Stool culture

NAATs are more sensitive but may detect non-toxigenic strains.

Question 15

What is the first-line treatment for mild to moderate Clostridioides difficile infection?

Answer 15

Oral vancomycin or oral fidaxomicin.

Metronidazole is no longer recommended as first-line therapy due to lower efficacy.

Question 16

What is a potential complication of severe Clostridioides difficile infection?

Answer 16

Toxic megacolon or bowel perforation.

These complications can be life-threatening and require surgical intervention.

Question 17

What is the recurrence rate of Clostridioides difficile infections?

Answer 17

Approximately 20% to 30% after initial treatment.

Recurrence may be due to incomplete eradication or reinfection.

Question 18

What preventive measures can be taken to reduce the risk of Clostridioides difficile infection?

Answer 18

• Judicious use of antibiotics
• Hand hygiene
• Environmental cleaning
• Isolation of infected patients

These measures are critical in hospital settings to prevent outbreaks.

Question 19

True or False: Clostridioides difficile is a common cause of healthcare-associated infections.

Answer 19

True

C. difficile is one of the most common causes of healthcare-associated diarrhea.

Question 20

What is the classification for nonsevere CDI based on leukocytosis and serum creatinine levels?

Answer 20

Leukocytosis < 15,000 cells/mm3 and serum creatinine < 1.5 mg/dL

Question 21

What defines severe CDI?

Answer 21

Leukocytosis ≥ 15,000 cells/mm3 or serum creatinine ≥ 1.5 mg/dL

Question 22

What criteria must be met for a diagnosis of fulminant CDI?

Answer 22

≥ 1 criteria of severe CDI plus hypotension, shock, ileus, and/or toxic megacolon

Question 23

What is the treatment indication for symptomatic patients with CDI?

Answer 23

Antibiotic treatment is indicated and should be guided by severity

Question 24

Do asymptomatic carriers of CDI require antibiotic therapy?

Answer 24

No, asymptomatic carriers do not require antibiotic therapy

Question 25

When is fecal microbiota transplantation indicated?

Answer 25

In recurrent CDI, severe CDI, or fulminant CDI refractory to antibiotic therapy

Question 26

What are the first-line treatment options for nonsevere or severe CDI?

Answer 26

* Oral fidaxomicin * Oral vancomycin

Question 27

What is the second-line treatment for nonsevere CDI if first-line options are unavailable?

Answer 27

Oral metronidazole

Question 28

What is the first-line treatment for fulminant CDI?

Answer 28

High-dose oral vancomycin

Question 29

What should be considered adding for fulminant CDI in patients with paralytic ileus?

Answer 29

Vancomycin enemas

Question 30

What is the recommended treatment for the first recurrence of CDI if the initial episode was treated with standard-dose vancomycin?

Answer 30

* Oral fidaxomicin * Tapered and pulsed oral vancomycin

Question 31

What is the treatment for subsequent recurrences of CDI?

Answer 31

* Oral fidaxomicin * Standard-dose oral vancomycin followed by oral rifaximin * Tapered and pulsed oral vancomycin

Question 32

What are the indications for surgical intervention in CDI?

Answer 32

* Critically ill patients with severe CDI or fulminant CDI refractory to antibiotic therapy * Factors associated with increased mortality * Complications like toxic megacolon, ischemia, or bowel perforation

Question 33

What surgical procedures may be performed for severe CDI?

Answer 33

* Total colectomy with end ileostomy and stapled rectal stump * Diverting loop ileostomy with colonic lavage followed by intraluminal vancomycin administration

Question 34

What is the preferred first-line therapy for initial C. difficile infection according to the Infectious Diseases Society of America?

Answer 34

Oral fidaxomicin

Question 35

What is an acceptable alternative to fidaxomicin for initial C. difficile infection treatment?

Answer 35

Oral vancomycin

Question 36

What are the current recommendations for influenza therapy?

Answer 36

Oral oseltamivir, inhaled zanamivir, intravenous peramivir ## Footnote These treatments are used to manage influenza symptoms and reduce the duration of illness.

Question 37

How should oseltamivir be dosed for the treatment of influenza?

Answer 37

Twice daily for 5 days ## Footnote This dosing is recommended for effective treatment of influenza symptoms.

Question 38

What is the prophylactic dosing for oseltamivir?

Answer 38

Once daily for those with a history of influenza exposure ## Footnote This is to prevent the onset of influenza in at-risk individuals.

Question 39

For which patients is intravenous peramivir most appropriate?

Answer 39

Hospitalized patients ## Footnote Intravenous administration is used for patients who are unable to take oral medications.

Question 40

Fill in the blank: Oseltamivir can be used for _______ in those with a history of influenza exposure.

Answer 40

prophylaxis ## Footnote This refers to preventive treatment to avoid influenza infection.

Question 41

List common symptoms of adenovirus infections.

Answer 41

* Fever * Pharyngitis * Cough

Question 42

What additional symptoms may be associated with adenovirus infections?

Answer 42

* Gastrointestinal symptoms * Conjunctivitis

Question 43

Is severe pneumonia common in immunocompetent adults due to adenovirus?

Answer 43

No, severe pneumonia is rare

Question 44

In which settings is adenovirus highly associated with outbreaks?

Answer 44

Military settings worldwide

Question 45

What is the recommended treatment for patients with an initial episode of mild or severe C. difficile infection?

Answer 45

Oral vancomycin or oral fidaxomicin ## Footnote Metronidazole may be used as an alternative if the primary medications are not available.

Question 46

What alternative medication can be used for C. difficile infection if vancomycin or fidaxomicin is unavailable?

Answer 46

Metronidazole ## Footnote This is considered an alternative treatment option.

Question 47

What is the recommended treatment for recurrence of C. difficile infection after initial therapy with oral vancomycin?

Answer 47

Oral fidaxomicin or a prolonged tapered, pulsed course of vancomycin ## Footnote This recommendation is based on the recurrence after a standard 10-day course.