Infectious 3

Question 1

What to do for patients with positive serology and negative PCR for HCV?

Answer 1

repeat serology–If positive–indicate the previous infection

Question 2

Positive serology and negative PCR?

Answer 2

Recent infection

Question 3

Right side IE complication?

Answer 3

Rare peripheral symptom
Common septic PE
HF is not common
Often lack audible murmur

Question 4

Cause of post influenza bacterial pnumonia?

Answer 4

S, Pneumonia

CA-MRSA

Question 5

S, Pneumonia?

Answer 5

MCC(especially age >65)
Rare in young
Lobar pattern

Question 6

CA-MRSA?

Answer 6

MCC in young adult
Rapid,diffiuze necrotising pnumonia
Multiple cavitary lesions, pulmonary infiltrate
Leukopenia

Question 7

Other screening to do inpatient with gonococcal urethritis?

Answer 7

HIV
HBV
Syphilis serology(But if positive no need for additional Tx, ceftriaxone treat it)

Question 8

Hydatid cyst of the liver?

Answer 8

Unilocular(Echinococcus granulosus)
Multilocular(Echinococcus Multilocularis)
Usually asymptomatic
can involve any organ
Contact with a dog is a risk(it is a carrier)
Eggshell calcification cyst in the liver is diagnostic
Albendazole is the treatment with surgery
Is spilled during surgery it can cause anaphylaxis

Question 9

What to do inpatient with active CMV infection(e.g colitis)

Answer 9

Retinal examination

Question 10

How to diagnose CMG organ(GI and other ) infection?

Answer 10

Tissue biopsy

viremia not diagnostic

Question 11

C.trachomatis infection?

Answer 11

Treat with azithromycin
Partner with contact in last 60 days should be screened and treated
Reinfection is common

Question 12

The HACEK group of bacteria?

Answer 12

1) Include (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species)
2) Are a small, heterogeneous group of fastidious, gram-negative bacteria
3) Frequently colonize the oropharynx and
4) Have long been recognized as a cause of infective endocarditis(<3 %)

Question 13

Coccidiosis?

Answer 13

Inhalation of arthroconidia
SW USA(Arizona,California)
Pneumonia
Artheralgia
Erythema nodusum
Erythema multiform

Question 14

diagnosis?

Answer 14

serology

Culture

Question 15

Managment?

Answer 15

In healthy–Just do a follow-up
Inpatient with underlying disease–Dissemination(bone, CNS and skin is common)–Need antifungal(ketoconazole,fluconazole)

Question 16

Cutaneous larva migrant cause?

Answer 16

hookworm larva
Human is incidental host
Contact with the ground by barefoot is the risk
from dog or cat

Question 17

CM?

Answer 17

Primarily affect LE
Cutaneous(deep involvement is rare)
erythematous pruritic papule at the site of entry
Intensely pruritic, migrating serpiginous reddish-brown track

Question 18

Diagnosis?

Answer 18

Clinical

eosinophil is normal

Question 19

Managment?

Answer 19

Ivermectin

Question 20

Risk for legionella pnumonia?

Answer 20

Water contact within last 2 week

Question 21

CM?

Answer 21

Fever >39
Relative bradycardia
Neurologic symptom(confusion)
GI symptom (Diarrhea)
Unresponsive to BL and AG antibiotic

Question 22

Laboratory?

Answer 22

Hyponatremia
Hepatic dysfunction
Hematuria and protinuria
sputum gram stain show many or small microorganisms

Question 23

Diagnosis?

Answer 23

Urine Ag test

Culture(charcoal yeast extract)

Question 24

Managment?

Answer 24

Macrolide/FQ

Question 25

Prophylaxis for travelers?

Answer 25

HAV vacine Typhoid vaccine atovaquone-proguanil, doxycycline, or mefloquine > 2 weeks prior, stay and 4 weeks after return

Question 26

mefloquine S/E?

Answer 26

Neuropsychiatric (anxiety, depression and restlessness)

Question 27

EHEC?

Answer 27

``` MCC of bloody diarrhea without fever Shiga toxin(pathogenesis and diagnosis) Caused by eating uncooked beef Tx--Supportive AB- Not recomended B/C of it increase risk of HUS ```

Question 28

Bloody diarrhea with fever etiology?

Answer 28

C.Jujuni Nontyphidal salmonella L.Monocytinogen

Question 29

B.Cerus diarrhea?

Answer 29

Reheated rice Due to preformed enterotoxine Resolve within 48 Hr Vomiting more predominate(1-6hr)

Question 30

epidemiology of chikungunya fever?

Answer 30

T & ST parts of C/S America Asia and Africa | Transmited by Aedes mosquito(also D & Z)

Question 31

CM?

Answer 31

``` IP(3-7) day Flu-like symptoms Sever polyarthralgia(usually present) Maculopapular rash LDP Conjunctivitis Low PLT and Lymphopenia Elevated TA ```

Question 32

Managment?

Answer 32

supportive | methotrexate if develop chronic arthralgia(>50 % develop it)

Question 33

Secondary syphilis?

Answer 33

``` Centrifugal rash involves palm and sole LDP(epitrochlear is pathognomic) C.Latum(gray genital papule) Oral lesion' hepatitis ```

Question 34

Differential?

Answer 34

``` RMSF(centripetal rash) Endemic Typus(spares hand and palm) ```

Question 35

Treatment?

Answer 35

1 dose penicillin

Question 36

the first thing to do inpatient suspected of IE?

Answer 36

Blood sample from 3 different puncture site

Question 37

What to do in patients Negativ TST?

Answer 37

No additional test | But in case of a positive repeat test

Question 38

Meningiococus for HIV aptient?

Answer 38

vaccinate and give every 5 years as a booster

Question 39

etiology of acute epididymitis?

Answer 39

AGE <35(N.G and C.T), More STI related | Age >35(choliform bacteria like E.Coli),More Obstraction related