Infectious disease 1

Question 1

Treatment for baby with congenital toxoplasmosis

Answer 1

Pyrimethamine + Sulfadiazine + Folate (1 year)

Question 2

How to diagnose baby with congenital Toxoplasmosis

Answer 2

Serum Serology (IgM) against too

Question 3

What does congenital rubella look like

Answer 3

1) Blueberry muffin spots
2) Cataracts
3) Hearing loss
4) Heart Defects

Question 4

Key features of Congenital Toxoplasmosis

Answer 4

1) Diffuse intracranial calcifications
2) hydrocephalus
3) Chorioretinitis

Question 5

What does a baby with congenital Syphilis look like

Answer 5

4 Ss
Saber shins
Saddle nose
Sniffles
HutchinsonS teeth

Question 6

What do you do when a healthcare worker has potential TB exposure

Answer 6

Do TB skin test or Interferon gamma release assay

IF negative, repeat in 6-8 weeks. To ensure transmission did not occur.

Question 7

What should you be concerned about when interpreting CSF, for suspected material meningitis, if you already started empirical abx

Answer 7

Stain and culture of CSF might be negative.

Question 8

What is the defining brain imaging finding of Congenital CMV

Answer 8

Periventricular calcifications

Question 9

What is HIV post exposure PPX regimen?

How soon after exposure do you want to start pox?

How long do you treat?

Answer 9

TENofovir
EMTireitabine
RALtegravir

Within 1-2 hours of exposure. (But can up to 3 days/72hrs)

X 1 month.
(Retest for HIV in 6-8 weeks to ensure seroconversion did not happen)

Question 10

Who gets invasive pulmonary aspergillosis

Answer 10

Immunocompromised (organ tranplane, corticosteroids, HIV)

Question 11

What is the classic chest MRI finding of Invasive Pulmonary Aspergillosis

Answer 11

Nodules/Cavitary lesion +/- air fluid levels surrounded by halo or ground glass opacity.

Question 12

Treatment of Invasive Pulmonary Aspergillosis

Answer 12

IV Voriconazole

Question 13

What causes Chagas disease and what type of bug is it?

Answer 13

T. Cruzi. Protozoa

Question 14

What are the two organs that are mainly affected by Chagas?

What are the specific consequences to these two organs?

Answer 14

1) Heart: 
Heart failure R>L
Apical Ventricular aneurysm 
Mural thrombus
Fibrosis leading to conduction defect
2) GI
esophageal and colon dilation

Question 15

What are the symptoms of Diphtheria?

Answer 15

1. Non specific- fever, malaise, sore throat
2. Pharyngitis - grey patches and pseudomembrane that BLEED when scraped off.
   3) Cervical lymphadenopathy
   4) Toxin mediated damage to:
   Heart
   Kidney
   Brain (Neuritis)

Question 16

What are the three organs that Diptheria toxin damages?

Answer 16

Heart (HF and heart block)
Kidney
Brain (Neuritis)

Question 17

What patient population gets Diphtheria?

Answer 17

Unvaccinated (Tdap/Dtap prevents it).

Question 18

How do you diagnose Diphtheria?

Answer 18

First: PCR for bacterial toxin
Confirm: with Culture of Respiratory secretions.

Question 19

How do you treat Diphtheria?

Answer 19

Erythromycin or Penicillin G

Add Diphtheria anti-toxin if severe.

Question 20

PPD for TB is positive when >5 in what population?

Answer 20

1) HIV positive
2) Immunocompromised/organ transplant
3) Recent contact with TB positive person

Question 21

PPD for TB is positive when >10 in what population?

Answer 21

1) Homeless
2) Prison population
3) IVDU
4) < 5 years immigrated from TB endemic region
5) Healthcare worker

Question 22

What size ppd in mm is considered positive for non high risk group.

Answer 22

15 mm

Question 23

What is the preferred test for latent TB

Answer 23

PPD

or

Interferon Gamma release assay

Question 24

How does BCG (TB vaccine) mess up TB testing

Answer 24

PPD is not accurate. Interferon gamma release assay is dx text of choice in dx latent TB in pt with BCG vaccine.

Question 25

What test do you order if PPD or Interferon gamma release assay is positive?

Answer 25

1) CXR to rule out active TB | 2) IF CXR positive, get sputum X3 for stain and culture.

Question 26

What is the best initial test to diagnose active TB?

Answer 26

CXR

Question 27

After CXR, what test confirms Active TB?

Answer 27

Sputum smear and culture. | Obtain 3 samples (8-12 hours apart, 1 from morning)

Question 28

What is a surrogate marker for infectivity in active TB?

Answer 28

Sputum smear for acid fast bacilli. IF negative x 3 then NOT INFECTIVE.

Question 29

What do you do if you suspect active TB but sputum smear is negative x 3 for acid fast bacilli?

Answer 29

TRX empirically. negative smear does not rule out active TB.

Question 30

Does a healthcare worker with latent TB, have any work restrictions?

Answer 30

NO

Question 31

How do you define Latent TB vs Active TB?

Answer 31

Latent = + PPR or + Interferon gamma release assay BUT with negative CXR and NO symptoms. Active = + CXR or+ smear or + culture (gold standard but takes 3-8 weeks)

Question 32

What is serum sickness like illness? What are the three hallmark symptoms?

Answer 32

type 3 hypersensitivity rxn that occurs when Ab-Ag complexes form and deposit in the body. 1) Fever 2) Polyarthritis 3) Rash

Question 33

What are the two classic precipitants to serum sickness like illness?

Answer 33

Acute Hep B infection Abx

Question 34

What is the classic presentation of Hand-foot-mouth disease?

Answer 34

1) PAINFUL oral ulcers and vesicles (key characteristic) | 2) painful/non itchy vesicles/papules/macules on PALMES< SOLES and +/- Buttox

Question 35

What bug causes Hand-Foot-Mouth disease? How is it spread?

Answer 35

Coxsackievirus Spread by contact with respiratory or vesicular secretions AND fecal oral.