IDS

Question 1

Etiology of bact men

First 2 months of life (and some into month 3)

Answer 1

represent maternal vaginal flora—

group B Streptococcus, E.coli, Listeria

Question 2

Etiology of bact men

Age 2 months to 12 years—

Answer 2

S. pneumoniae (peaks in first 2 years), N. meningitidis

Question 3

MC spread of BM

Answer 3

Most from hematogenous spread, initially from bacterial colonization of nasopharynx,
and a prior or current viral infection may enhance pathogenicity

Question 4

Prevention of BM

Chemoprophylaxis with______for N. meningitidis and HiB, but not for
S. pneumoniae

Answer 4

rifampin

Question 5

• Initially may mimic a viral disease (nonspecific)

* Any organ can be affected by vasculitis and thromboembolic disease

Answer 5

Acute Meningococcemia

Question 6

Characteristic mengingococcal rash

Answer 6

Characteristic meningococcal rash (black central arch and surrounding ring or erythema)
often seen before more serious signs develop

Question 7

Tx of meningo

Answer 7

• Need high dose IV penicillin ASAP

Question 8

Viral men

______ most common presentation is cerebellar ataxia and acute encephalitis

Answer 8

Varicella zoster:

Question 9

_____ mumps: mild but with 8th-nerve damage

Answer 9

Epstein-Barr virus (EBV),

Question 10

Viruses causing exanthems

Answer 10

Exanthems, especially echovirus and coxsackie, varicella, measles, and rubella

Question 11

Best test for Viral Men

Answer 11

– PCR of CSF is the best test.

Question 12

Cause—Bordetella pertussis

− Coughing adolescents and adults are major reservoirs

Answer 12

PERTUSSIS

Question 13

Stages of pertussis

—coldlike symptoms (rhinorrhea, conjunctival injection, cough

Answer 13

Catarrhal phase (2 weeks)

Question 14

Stages of pertussis

__________—increasing to severe coughing paroxysms, inspiratory
“whoop” and facial petechiae; post-tussive emesis

Answer 14

Paroxysmal phase (2–5 weeks)

Question 15

Stages of pertussis

_________ ≥ 2 weeks of gradual resolution of cough

Answer 15

Convalescent phase

Question 16

Gold standard for pertussis Dx

Answer 16

Gold standard is PCR of nasopharyngeal aspirate 2–4 weeks after onset of cough,
or a culture

Question 17

Tx of Pertussis

Answer 17

Always treat if suspected or confirmed: erythromycin for 14 days (other macrolides
with similar results) only decreases infectious period of patient

Question 18

− Most common cause of lymphadenitis lasting >3 weeks
– Cutaneous inoculation (arthropod borne by cat flea); kittens transmit better than
cats

Answer 18

Bartonella (Cat-Scratch Disease)

Question 19

Pathognomonic sign of Bartonella (Cat-Scratch Disease)

Answer 19

One or more 3- to 5-mm red to white papules along the linear scratch
plus hallmark: chronic regional lymphadenitis

Question 20

Tissue Dx of Cat scrath disease

Answer 20

Tissue: PCR and Warthin-Starry stain (shows gram-negative bacilli)

Question 21

Tx of Cat scrath disease

Answer 21

Treatment—Antibiotics not used as there is a discordance between in vitro and in
vivo activity (use only for severe hospitalized cases) (usually self-limiting and resolves
in 2–4 months); aspiration of large and painful lesions

Question 22

Most common vector-borne disease in the United States

Answer 22

Borrelia burgdorferi

Question 23

SSX of Lyme disease

Answer 23

history of tick bite is helpful but absent in most; tick is small and often not seen by human eye; history of being in the woods or mountains should give suspicion

Question 24

Early local findings of Lyme

Answer 24

Local: erythema migrans

Question 25

often called “bulls-eye” rash;

Answer 25

target lesion (must be >10 cm in diameter)

Question 26

Natural course of erythema migrans

Answer 26

without treatment, lesion resolves in 1–2 weeks

Question 27

Early disseminated: secondary lesions of Lyme

Answer 27

smaller than the primary + constitutional symptoms + lymphadenopathy; uveitis and Bell palsy (may be only finding); carditis (myocarditis, heart block); CNS findings (neuropathy, aseptic meningitis

Question 28

Late Lyme disease manifestations

Answer 28

arthritis weeks to months later; affecting large joints, more likely to be chronic in adults

Question 29

Dx of Lyme

Answer 29

– No definitive tests | – Primarily clinical and based on history + rash

Question 30

Confirmatory of Lyme

Answer 30

Quantitative ELISA test and confirmatory Western blot if the ELISA is positive or equivocal

Question 31

Tx of Lyme

Answer 31

Doxycycline 14–21 days (patients >8 years old); amoxicillin (patients age <8 years)

Question 32

Tx of Lyme with meningitis or carditis (heart block)

Answer 32

Ceftriaxone

Question 33

Tx of Lyme with Bell palsy

Answer 33

Doxycycline or amoxicillin

Question 34

Consider in differential diagnosis of fever, headache, and rash in summer months, especially after tick exposure

Answer 34

Rickettsia Rickettsii

Question 35

Characteristic of rash of Ricketsia

Answer 35

``` After third day—skin rash º Extremities first (palms, soles) º Spreads rapidly º Becomes petechial/hemorrhagic º Palpable purpura ```

Question 36

Cx of ricketsia

Answer 36

Vascular obstruction, due to vasculitis and thromboses, leads to gangrene

Question 37

Tx of ricketsia

Answer 37

Treatment—doxycycline or tetracycline in all patients regardless of age (chloramphenicol in allergy only)