ID Q's

Question 1

additional testing for newly diagnosed HIV

Answer 1

*IGRA or tuberculin skin test to look for latent TB
* NAAT for Chlamydia and Gonorrhoea
*RPR for syphillis
* Hep A, B and C

Question 2

HIV with reactivation of TB presentation

Answer 2

*fever, fatigue, cough, wt loss, night sweats
*productive cough > in am with bld streaks
*CXR upper lung cavitation

Question 3

which vaccines to avoid in pts who are immunosuppressed or taking immunosuppresants

Answer 3

*intranasal influenza
*oral typhoid
*MMR
*varicella

Question 4

Meningitis immunisation schedule

Answer 4

*1st does age 11-12 with a booster age 16
*also pts with asplenia, traveling to endemic countries, military recruits ,going to college age <2, exposure to community outbreak

Question 5

Trichinellosis

Answer 5

• from eating raw or undercooked meat esp pork
• periorbital odema, myositis, eosinophilia
• recent hx of travel to Mexico, China, Thailand, Argentina and parts of central Europe

Question 6

Pathergy test

Answer 6

used to diagnose Bechet’s disease ( recurrent genital, oral ulcers, skin rashes and nodules, uveitis)

Question 7

test for chancre

Answer 7

chancre is painless genital ulcer with indurated margins and clean base 2o 1o syphillis
*Ix:- treponemal fluorscent antibody test

Question 8

bacillary angiomatosis

Answer 8

• due to infection with bartonella
• fever, wt loss, fatigue, myalgia
  *multiple clustered violaceous papules, nodules in the skin
  see in immunosuppressed HIV with CD4 count <100

Question 9

legionnaire’s disease

Answer 9

*hx of recent travel - hotel stay
*high fever, bradycardia relative to fever, cough, confusion, GI symptoms
*hyponatremia, hepatic dysfunction
*urine Ag test, culture shows netrophilia but no organisms

Question 10

community acquired MRSA

Answer 10

*follows influenza more common in young and pts >65
*causes necrotising pneumonia
* fever, productive cough, hemoptysis, leukopenia
*multilobar cavitary infiltrates

Question 11

coccidioides

Answer 11

aka valley fever
*endemic in SW (arizona, california)
*c/o >1/52 hx fo resp symptoms
*community acquired pneumonia, arthralgia and erythema nodosum (erythematous tender nodules on the shins)

Question 12

condylomata acuminata

Answer 12

aka genital warts
*caused by HPV 6,11
*treament local application

Question 13

Kaposi Sarcoma

Answer 13

*due to HPV 8
*clusters of violaceous purple/brown flat papules along skin folds
* AIDS defining illness
* +lymphadenopathy and lymphedema
*indication to start antiretroviral treatment

Question 14

rhino-orbital-cerbral mucormycosis

Answer 14

• due to rhizomes
• seen in immunocompromised, poorly controlled DM
• foul nasal disharge, headache, fever, sinus pain
  *necrotic invasion of orbit, brain and local tissue
• Mgx:- debridement and amphotericin B

Question 15

mgx of shingles

Answer 15

antivirals –> acyclovir, vancyclovir

Question 15

blastomycosis

Answer 15

*endemic to south Mississippi valley
* mild/moderate pulmonary infection
*disseminates to skin, bone, prostate
* in skin forms heaped warty lesions
*affects both immunocompetent and immunocompromised

Question 16

influenza pneumonia

Answer 16

*complication of influenza seen in >65yrs, pts with other chronic illnesses
* acute worsening of dyspnoea and cough
*hypoxia
CXR:- bilateral diffuse interstitial infiltrates
*leucoytes <15,000
*

Question 17

acute bacterial conjunctivitis

Answer 17

*due to staph aureus
* conjunctival injection with purulent discharge

Question 18

legionnaire’s disease mgx

Answer 18

fluroquinolones e.g. levofloxacin
new macroliedes e.gs azithromycin, clarithromycin

Question 19

culture +ve infective endocarditis

Answer 19

*Staph aureus :–> IVDU, prosthetic valves
*staph epidermis,:-> indwelling vascular catheter
*strep viridian:- dental procedure
*enterococci:–> nosocomial UTI
*strep gallolyticus:–> colon cancer

Question 20

crytposporidiosis

Answer 20

• due to cryptosporidum parvum
  *faeco-oral transmission
• affects both immunocompromised and immunocompetent
  *common in pts with HIV
  *fever, adobo pain, profuse secretory diarrhea

Question 21

nocardiosis

Answer 21

• due to nocardia (g+ve, filamentous, partial acid fast bacteria)
  *symptoms may be confused with TB – fever, night sweats, wt loss, cough
• CXR:- alveolar infiltrates, nodules, cavitation
  *can disseminate to brain (abscess) and skin
  *Mgx:- TMP-SMX

Question 22

Hep B surface ab
Hep B core Abs
Hep B surface Ag interpretation

Answer 22

*Hep B surface abs –> pt is immune to hep b either through vaccination or previous infection
*Hep B core abs —> exposed to HBV either cleared or active
*Hep B surfacae Ag –> pt currently has HBV infection

Question 23

Hepatitis A IgG and IgM interpretation

Answer 23

• +ve Hep A IgG—> past infection or vaccination
  *+ve Hep A IgM –> acute or recent infection

Question 24

acute Hep A infection

Answer 24

* +ve Hep A IgM *raised hepatic transaminases * risky factors in hx * sexual or close contacts should have prophylactic vaccine if <41yrs and Hep A immunoglobulin if older

Question 25

vibrio vulnificus

Answer 25

*found in marine environment or eating contaminated shellfish *worse in pts with liver disease especially haemochromatosis *o/e mild cellulitis, necrotising fasciitis, hemorrhagic bullae, sepsis *empiricially treat as highly fatal

Question 26

Conditions that increase the risk for surgical site infection

Answer 26

*smoking *malnutrition/hypoalbuminaemia, obesity *uncontrolled DM *glucocorticoids, immunosuppressants *concurrent infection at distant site * advanced age

Question 27

Lemierre syndrome

Answer 27

*caused by Fusobacterium nephronicum *starts as a sore throat, pharyngitis/ tonsillitis ~1/52 *extends to neck tenderness and swelling of the sternocleidomastoid *internal jugular thrombosis —-> septic pulmonary emboli *

Question 28

candidaemia

Answer 28

*finding candida in bld culture is NEVER contamination *Mgx:- empirical anti fungal * remove any central venous catheter *evaluate for metastatic infection especially ophthalmologic review for endophthalmitis

Question 29

Diabetic foot infections

Answer 29

*in diabetics with poor glycaemic control, peripheral artery disease, peripheral neuropathy * superficial infection microbial *deep longstanding wound is usually polymicrobial *osteomyelitis is continguous spread