ID General

Question 1

When should you start HIV screening?

Answer 1

DC- 13-65 yrly

CDC- 15-65

Question 2

What is the the most common non-tuberculous pulmonary mycobacterial infection?

Answer 2

M. kansasii

Question 3

What is IRIS?

Answer 3

Severe decline in clinical status after ART initiation despite improved immune function due to inflammatory response against infectious agent

Question 4

How often should you do cervical ca screening in HIV infected women?

Answer 4

2x a yr when first HIV +

Then yearly if normal and no change in sexual partner, use of safe sexual practices, no history of sexual abuse, and no symptoms

Question 5

Fever

Answer 5

> 37.2 C (98.9 F) in the morning and 37.7 C (99.9 F) in the evening + ↑ hypothal set point

Question 6

FUP

Answer 6

Fever > 38.3 C (101 F) & illness lasting 3 weeks & no known immunocompromise

Question 7

Endocarditis

Answer 7

infection of the endocardial surface of the heart (includes valves, septal defects and mural endocardium)

Question 8

Endarteritis

Answer 8

infection of arterial endothelium (includes infected aneurysms, AV fistulae)

Question 9

What factors predispose immunocompromised pts to infection?

Answer 9

Neutropenia and defects in the phagocytic defenses

Defects in cellular immunity

Defects in humoral immunity

Question 10

What pt pop typically has neutropenia and defects in the phagocytic defenses

Answer 10

pts post chemotherapy or other myelosuppressive therapy

bone marrow transplant recipients

acute leukemics

Question 11

What ANC level is risk of infection significant?

Answer 11

<500

Question 12

In neutropenia and defects in the phagocytic defense pts, what organisms typically colonize skin?

Answer 12

Staph, Gram negatives, fungi

Question 13

In neutropenia and defects in the phagocytic defense pts, what organisms typically colonize oropharynx?

Answer 13

oral candidiasis, HSV

Question 14

In neutropenia and defects in the phagocytic defense pts, what organisms typically colonize lungs?

Answer 14

bacterial/fungal pneumonias

Question 15

In neutropenia and defects in the phagocytic defense pts, what organisms typically colonize colon/perianal area?

Answer 15

abscesses

Question 16

Pt pop CI to get live vaccines (MMR, varicella, ZVL)

Answer 16

preg women and immunosupp pts (Must have CD4 >200)

Question 17

What vaccines should a pt who is 19-49 yrs old have?

Answer 17

influenza

Tdap or Td

MMR (if born in 1957 or later)

Varicella

Question 18

What is cut off for MMR requirement

Answer 18

if born before 1957 don’t need it (assumed you got the dz)

if born in 1957 or later must get vaccine

Question 19

What pt pop should get high dose and adjuvant vaccine of influenza?

Answer 19

> 65 and HIV +

Question 20

Severe egg allergy w/ influenza vac

Answer 20

administer in an observed setting

Question 21

HPV vaccine recommendation

Answer 21

start age 9-14
female by age 26
male by age 22

Question 22

What vaccines should pts who are 65 and above get?

Answer 22

Influenza

Tdap or Td

Varicella

RZV (preferred) OR ZVL

PCV13

PPSV23

Question 23

What vaccines should pts who are 50-64 yrs old get?

Answer 23

influenza

Tdap or Td

MMR (if born in 1957 or later)

Varicella

RZV (preferred) OR ZVL

Question 24

What vaccines should preg pts get?

Answer 24

influenza and tdap or Td

Question 25

What vaccines should immunocomp pts get?

Answer 25

``` flu Tdap HPV (up to age 26) PCV 13 PPSV23 Hib ```

Question 26

What vaccines should HIV pts get?

Answer 26

``` flu Tdap MMR and varicella (unless CD4 <200) HPV (up to age 26) PCV 13 PPSV23 Hep B MenACWY ```

Question 27

What vaccines should MSM get?

Answer 27

``` flu Tdap MMR and varicella RZV or ZVL (if >50) HPV (up to age 26) PCV 13 PPSV23 Hep A Hep B ```

Question 28

What vaccines should health care personnel get?

Answer 28

``` flu Tdap MMR Varicella RZV or ZVL (if >50) HPV (up to 26 female and 21 male) Hep B ```

Question 29

What age group can varicella immunity be assumed for even if vaccination status is unknown?

Answer 29

born in US before 1980

Question 30

When can you give ZVL?

Answer 30

>60 yo but RZV is preferred

Question 31

What is PCV13 and PPSV23 vaccine recommendation?

Answer 31

>65 yo PCV13 first then 1 yr later PPSV23 If RF can give PPSV23 <65

Question 32

When is Hib vaccine indicated?

Answer 32

Aspenia (if elective surg give 2 wks before) Hematopoetic stem cell transplant (HSCT)

Question 33

SIRS criteria

Answer 33

2 or more of the following: Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F) Heart rate > 90/min Respiratory rate >20/min or arterial carbon dioxide (PaCO2) < 32 mm Hg WBC >12,000/μL or < 4,000/μL or >10% immature [band] forms

Question 34

What is the significance of elevated lactate?

Answer 34

Lactate is a byproduct of anaerobic metabolism. Cells go into anaerobic metabolism when there is not enough oxygen to complete aerobic metabolism. Lactic acidosis (inc lactate) is a sign of hypoperfusion and hypooxygenation