ID

Question 1

Who should get HAV vaccine?

Answer 1

MSM
HBV, HCV pts
IVDU

Question 2

What vaccines should HIV pt get?

Answer 2

PCV 13 then PPSV23 8 wks later and every 5y
Live vaccines only if cd4>200 and no AIDS defining illness
Hep a

Question 3

Corynebacterium diphtheriae causes what

Answer 3

It releases diphtheria toxin which is life threatening and causes URI symp
If high suspicion then give diphtheria antitoxin (horse serum) to avoid myocarditis, neuritis, and nephreitis but risk of anaphylaxis in 10%

Question 4

Severe pain, erythema fever, hypotension after wood splinter may be due to which organism/disease?

Answer 4

Gp a strep/nec fasciitis

Question 5

Most common organism in bloodstream inf is

Answer 5

Staph epidermidis

Question 6

Nec fasciitis treatment involves

Answer 6

Broad abx - zosyn, vanc, clinda and urgent surgical debridement before imaging

Question 7

Tx of giardia or amoeba infection

Answer 7

Flagyl

Also the inf is not assoc w eosinophilia

Question 8

Tx of parasitic inf like roundworm, hookworm etc. NOT amoeba

Answer 8

Albendazole or mebendazole

Question 9

Rubella vs rubeola vs roseola

Answer 9

Rubella - 3 day german measles - maculopap rash that begins in face and spreads caudually and disapears in 5 days, may have cough, co
May be assoc w arthritis. quick progression.

Roseola - high fever that resolves and followed by rosy nonpruritic rash on trunk spreading to extremities

Rubeola - is measles - 3 c’s cough coryza conjunctivitis, koplik spots and sick appearing

Question 10

When do u start steroids for PCP? What a-a gradient and what pao2?

Answer 10

A-a gradient 35

Pao2 70

Question 11

Which types of abx incr risk for seiZures?

Answer 11

Pcns, cephalosporins, IMIPENEM, fluoroquinolonrs

Question 12

hydroPhobia, f/drool, dysphagia, ataxia!! Started one week ago with throat pain and hx of caves exploring

Answer 12

Rabies!!!! Vs epiglottitis is more acute and have stridor

Hydrophobia bc water triggers pharyngeal spasms

Once pt develops symptoms death is common… Only tx is palliative

Question 13

Do u give zoster vaccine to those who have had zoster?

Answer 13

Yes if >60. 5% chance reactivation

Question 14

Iris - immune reconstitution syndrome treatment

Answer 14

Worsening of hiv symp after starting haart due to rapid immune response. Since it is self limited there is no treatment and just continue haart. Unless there is severe organ dysfunction

Question 15

What is considered severe c diff?

Answer 15

Wbc>15, cr >1.5x baseline, high fever and can consider oral vanco as first tx

If severe an high wbc>20 and lactic acidosis and ileus than may need colectomy

frequent relapses- consider fidaxomicin and fecal transplant

Question 16

Progressive neuro deficits in someone w aids whohas brain bx of oligodendrocytes with intranuclear inclusions, demyelination, astrogliosis is due to? Tx?

Answer 16

pmL - progressive multifocal leukoencephalopthy due to jc virus 4% aids. Tx is HAART.

Wo tx majority of ppl will die in 3-6mo

Question 17

Who is supposed to get abx ppx for meningococcal meningitis exposure? 
Intubator?
Ambulance driver?
Coworker?
Child care center worker?
Family in home?

What is tx?

Answer 17

Anyone with close contact with secretions- intubator, family, child care

Not coworker, not ambulance driver, not coworker

Rifampin q12h for 4 doses. Could also use one time dose of cipro and ceft

Question 18

Ppd cutoffs for 5, 10, 15 mm?

Tx for latent tb?

Answer 18

5 - hiv or immunocomp or recent contact w active tb

10 - healthcare, recent immigrant, ivdu

15 no risk factors

Tx with 9 mo inh or 4 mo rifampin

Question 19

What is gold standard to diagnose active tb?

Answer 19

Sputum studies - 3 specimens 8-24 hrs apart with at least a morning specimen. For those who cant give sample then sputum induction with aerosolized hypertonic saline

If they have three neg sputums but still have high suspicion then get BAL

Question 20

3 negative afbs even with symptoms of tb mean

Answer 20

Noninfectious but should still tx them bc afb sputum has low sensitivity

Question 21

Immunocomp pt wih cough, cp, fever, and headache with nasal bleeding!!!

Answer 21

Invasive aspergillosos!! Will also see pulm lobe infitrate!!

Question 22

Tropical travel and come back wih fever, myagia, headache, LAD, pharyngeal edema, hemorrhagic tendoncies like petechiae after tournequet and elevated liver enz

Answer 22

Dengue fever

Bc of incr capillary permeability, incr risk of circulatory collapse, pleural eff, ascites

Question 23

If you are exposed to someone w tb and get ppd and its neg, what is next step?

Answer 23

Get ppd in 3 mo

Question 24

What type of contact precautions needed for herpes zoster?

Answer 24

Airbone and contact until lesions are crusted over

Question 25

What is best screening test for hiv?

Answer 25

Hiv p24 ag and ab screen not hiv rna

Question 26

Hiv pt w dysphagia/n/v/epigastric pain and also eye involvement and pain w white lesions in eye into vitreous Tx?

Answer 26

Candidiasis disseminated causing candida endopthalmitis Tx w vitrectomy and amphotericin b Note that ketoconazole isnt strong enough

Question 27

What is best indicator of pts current immune status? Of their prognosis?

Answer 27

Cd4. Prognosis by viral load

Question 28

Pt w recent abx for uti now w neck pain and stiffness and csf w high protein, low glc, leukocytes in CSF w high neutrophils but neg gram stain and cx has

Answer 28

Bacterial meningitis!! Gram stain has lower yield if recent abx Not aseptic viral meningitis

Question 29

Hiv pt cd4 600 and low viral load is prego. On haart. Anychanges to haart if they are prego?

Answer 29

No change bc current regimen working And pt can get vaginal delivery unless vira load >1000 and they should get csection

Question 30

Rabies exposure but got rabies vaccine a year ago. Next step

Answer 30

Give rabies vaccineX 2 days If no vaccine before give both rabies ivig and vaccine (x 4)

Question 31

Hiv pt w painful swallowing a egd shows biopsy w giant ulcer and NO viruses Next tx is

Answer 31

Steroids!!! Aphthous ulcer If cmv or hsv would see virus!!

Question 32

Hiv pt w syphillis and neuro complaints has csf neg for neurosyphillis, how much duration tx should he get?

Answer 32

Penicillin g qweek for 3 wks bc he has latent syphillis - likely >12 months infected If less than 12 mo, then just one time dose

Question 33

Syphillis pt receives pcn and within 24 hrs has fever, mailase, headache, what is this and hoe to prevent?

Answer 33

Jarish hercheimer rxn and due to rapid spirochete lysis and cannot prevent

Question 34

Teenage boy w hx of multiple ona and sbo comes in a pna/green sputum. What does he have an what tx?

Answer 34

Cf and pna likely pseudomonas and staph Need to cover two pseudomonal ie cefepime and amikacin it zosyn or penem

Question 35

Guy w urethritis gram stain shows many neutrophils (diagnostic) but no organisms!! Means which organism?

Answer 35

Chlam!!!! If gonorrhea would see dipplococci Tx w doxy it azithro If pt had gonorrhea need to tx ceft and cover for chlam too In those who dont get better tx w flagyl bc trichomonas can also cause

Question 36

Healthcare worker exposed to someone w tb. When to check ppd?

Answer 36

Now for baseline and then in 3 mo

Question 37

Pt w mono w rash after abx. Txv

Answer 37

Just supportive No steroid!

Question 38

If seborrheic dermatitis throughout face, body, chest next test is

Answer 38

Hiv test !!!! See in severe sevorhejc dermatitis Dont do fungal cx of skin scraping