ID

Question 1

HUS

Answer 1

Insult to kidneys caused by shiga toxin (EHEC)
pallor, fatigue, bruising, edema
Hemolytic anema
thrombocytopenia
AKI
decreased haptoglobin

Tx: Fluids, transfusion, dialysis

Question 2

Zika Syndrome

Answer 2

Zika virus targets neuroprogenitor cells
Microcephaly, spasticity, seizures, ocular abnormalities
Imagining: Cortical thinning, ventriculomegaly, calcifications

Question 3

Tetanus prophylaxis

Answer 3

Dirty/Severe wound: 
   Tetanus within 5 years?: Nothing
   Tetanus at some point?: Single dose Tdap
   No tetanus: TIG + Single dose Tdap
Clean/Minor wound:
   Tetanus within 10 years?: Nothing
   Tetanus at some point: Single dose Tdap
   No tetanus: Single dose Tdap

Question 4

Syphilis Treatment

Answer 4

Primary and Secondary: Penicillin G 1 dose or Doxycycline for 14 days
Asymptomatic: Penicillin G 3 doses or Doxy for 28 days
Tertiary: Penicillin G 14 days or Ceftriaxone 14 days.

Question 5

Periventricular Calcifications in the Neonate

Answer 5

CMV

Question 6

Parenchymal Calcifications in the Neonate

Answer 6

Toxoplasmosis

Question 7

Neonatal Herpes Simplex

Answer 7

Skin, mouth eyes: keratitis, mucocunatneous lesions
CNS: temporal hemorrage/edema, seizures
Disseminated: Hepatitis, sepsis, pneumonia

Tx: Acyclovir

Question 8

HIV Associated Neurocognitive Disorder

Answer 8

Cognitive impairments in multiple domains, mood and behavior changes. MRI shows diffuse white matter changes. CD4 <200

Question 9

Progressive Multifocal Leukoencephalopathy

Answer 9

JC virus, usually in the setting of HIV/AIDS. Altered mental status, motor deficits, ataxia, vision abnormalities. MRI asymmetric white matter changes.

Question 10

Erysipelas vs Cellulitis

Answer 10

Cellulitis onset over days, deeper layers of the dermis, flat edges of swelling with poor demarcation. +/- drainage.

Erysipelas: Sudden onset, involves more superficial dermis, raised edges of swelling with demarcation.

Question 11

Lyme Disease

Answer 11

Initial phases: Doxy or Amoxicillin (children less than 8 and pregnant women)

If +Heart Block: IV Ceftriaxone

Question 12

Cryptococcus neoformans

Answer 12

HA, N/V, confusion, abducens nerve palsy (elevated ICP), scattered umbilicated papules.

Clogs arachnoid vili, increasing intracranial pressure.

Question 13

Suspected Meningitis Plan

Answer 13

CT, LP, BC, Abx.

Infants do not need CT prior to LP

Question 14

Causative organisms of diarrhea in AIDS

Answer 14

Cryptosporidium: Low-grade fever, severe watery diarrhea, low-grade fevers

Microsporidium: watery, crampy, weight loss, fever is rare

MAC: Watery, high fever

CMV: Frequent small volume diarrhea, Hematochezia, abdominal pain, low-grade fever, weight loss.

Question 15

Shigella

Answer 15

Raid onset, high fever
Abdominal pain, watery diarrhea with mucus +/- blood
+/- Seizures in children

Tx: fluids, Abx if immunocompromised, bacteremic, or severely ill.

Question 16

Early congenital syphilis

Answer 16

HSM, Jaundice, IUGR, snuffles, desquamating/bullous rash, abnormal long bones on X-ray.

Question 17

Pinworms

Answer 17

Kids, perianal itching, tape test, mature worms can migrate to the vagina and cause vulvovaginitis.

Question 18

Cryptosporidium diarrhea

Answer 18

Low-grade fever with profuse watery diarrhea

Question 19

Microsporidium diarrhea

Answer 19

Watery, crampy, weight loss, usually no fever

Question 20

MAC diarrhea

Answer 20

Watery, high fever

Question 21

CMV diarrhea

Answer 21

Frequent small volume stools, hematochezia, abdominal pain, low-grade fever, weight loss

Question 22

Chlamydia trachomatis

Answer 22

Conjunctival injection, inflamed tarsals, and pale follicles.

Spreads in unsanitary and crowded conditions. Can lead to blindness.

Tx: Azithromycin

Question 23

Bacillary Angiomatosis

Answer 23

Bright red, firm, friable, exophytic nodules in an HIV+ patient. Caused by Bartonella.

Tx: Erythromycin

Question 24

Bacterial Conjunctivitis tx

Answer 24

Erythromycin, polymyxin, or azithromycin drops

If contacts, fluoroquinolone drops.

Question 25

Viral Conjunctivitis tx

Answer 25

Warm or cold compresses +/- antihistamine

Question 26

Allergic Conjunctivitis tx

Answer 26

Antihistamine (+mast cell stabilizer for persistent symptoms)

Question 27

Fever and splenomegaly in the setting of infection (chole/endocarditis)

Answer 27

Splenic Abscess | More likely in immunocompromised or DM

Question 28

Nasal mass in a Chinese individual

Answer 28

Nasopharyngeal carcinoma, caused by reactivation of EBV

Question 29

HIV+ Pregnancy

Answer 29

Triple antiretroviral therapy and neonatal zidovudine | C section if viral load >1000

Question 30

C diff risks

Answer 30

Abx, PPIs

Question 31

Treatment of active Toxoplasma encephalitis

Answer 31

Pyrimethamine and sulfadiazine

Question 32

Puncture wound infection

Answer 32

Pseudomonas

Question 33

Intense pain to light tough in an elderly or immunocompromised person.

Answer 33

Zoster

Question 34

Chronic osteomyelitis

Answer 34

following acute phase (fevers, erythema), persistent pain, swelling, chronic wound, sinus tract, nonunion of fracture. Surgical debridement and abx

Question 35

Ecthyma gangrenosum

Answer 35

Rare pseudomonas infection. Found in immunocompromised patients. Rapid onset of indurated macules and papules that can become ulcerated. Due to bacteremia.

Question 36

Syphilis

Answer 36

Primary: chancre Secondary: fever, malaise, widespread lymphadenopathy, diffuse maculopapular rash beginning on the trunk and spreading to the extremities including palms and soles. Can have oral lesions. Dx: serology (nontreponemal (RPR) and treponemal (ELISA))

Question 37

Otitis externa tx

Answer 37

cipro

Question 38

Congenital Rubella

Answer 38

PDA, cataracts, sensorineural hearing loss

Question 39

Congenital CMV

Answer 39

chorioretinitis, periventricular calcifications

Question 40

Prosthetic joint infections

Answer 40

less than 3mo post op: S aureus, Gm- rods, anaerobes 3-12 months post op: other staph species, enterococci 12+ months post op: S. aureus, Gm- rods, streptococci

Question 41

Grey watery discharge from a surgical site

Answer 41

Necrotizing surgical site infection | debridement and abx

Question 42

Varicella post exposure prophylaxis

Answer 42

``` Previous Hx of Varicella or 2 doses of vaccine? Yes: Observe No: Immunocompetent? Yes: Varicella vaccine No: Varicella Ab ```

Question 43

Travelers diarrhea

Answer 43

usually e coli but if prolonged consider C. parvum (even in immunocompetent), cyclospora, and giardia.

Question 44

Invasive Aspergillosis

Answer 44

``` Immunocompromised patients Fever, chest pain, hemoptysis Pulmonary nodules with "halo sign" Dx: cultures and cell wall biomarkers Tx: Voriconazole ```

Question 45

PCP

Answer 45

Dyspnea, nonproductive cough, fever | Bilateral diffuse ground glass appearance on xray

Question 46

High lymphocyte count in pleural effusion

Answer 46

possible TB

Question 47

The greatest risk of TPN

Answer 47

Central line infection

Question 48

High lymphocytes and protein on CSF

Answer 48

Tuberculosis

Question 49

Severe diarrhea and rash in a post BMT patient

Answer 49

GVHD

Question 50

Breast abscess

Answer 50

Presents like a clogged lactiferous duct but more common in the lateral portions of the breast. Fluctuant mass with lymphadenopathy. Drain and abx Clogged lactiferous ducts have no LAD.

Question 51

New born with microcephaly, HSM, jaundice and petechiae.

Answer 51

CMV Mother likely had a short term illness during pregnancy periventricular calcification