Infectious disease

Question 1

HepB vs HepA clinical manifestation

Answer 1

HepB > extrahepatic manifestations such as symmetrical arthralgia/arthritis, macular rash, thrombocytopenia

Question 2

Fever, sore throat, exudate, maculopapular rash on extremities, negative strep throat

Answer 2

Arcanobacterium Haemolyticum

Question 3

Viral syndrome, unilateral upper extremity weakness, dysphasia

Answer 3

Acute flaccid myelitis (enterococcus D68)

Question 4

Testing for CGD

Answer 4

DHR test (dihydrorhodamine test)

Question 5

PCP prophylaxis

Answer 5

Bactrim, pentamidine, atovaquone, dapsone

Question 6

Antibiotic prophylaxis for dental procedure

Answer 6

Prosthetic heart valves, previous IE, unrepaired cyanotic heart, repaired heart with residual defects, valvulopathy in transplanted heart, and first 6 months of a completely repaired heart with prosthetic material (NOT repaired VSD)

Question 7

Peripartum maternal chickenpox infection

Answer 7

IgG if 5 days prior or 2 days after delivery

Question 8

Early HIV confirmatory test

Answer 8

HIV RNA testing (Western blot, HIV p24 Ag, and HIV Ab are all poor in AIDS or acute HIV)

Question 9

Reye syndrome organisms

Answer 9

VZV and flu, especially with salicylate use

Question 10

4 week old presents with lethargy, poor feeding, and decrease tone. Admitted for rule out sepsis, got Amp/Gent/Acyclovir, then within 30 minutes developed respiratory arrest requiring mechanical ventilation. What happened?

Answer 10

Clostridium botulinum infection (aminoglycoside caused bacterial lysis release toxin)

Question 11

Recurrent infections and elevated IgE

Answer 11

Dz: Job syndrome ()

Question 12

Erythematous tonsils with membrane formation and petechiae at the junction of hard and soft palate (infx?)

Answer 12

Epstein-Barr virus

Question 13

Ulcerative appearance and a small number of vesicular lesions covering the buccal mucosa and tongue (infx?)

Answer 13

Varicella

Question 14

Mom with poor prenatal care gives birth to baby with severe malformation of both lower extremities and microphthalmia (dz?)

Answer 14

Congenital varicella syndrome (aka. varicella embryopathy). Path = maternal varicella infection before 20 weeks of gestation, Clx = severe limb malformation, cicatrix (dermatomal “zigzag” scarring), CNS/ocular abnormalities (microphthalmia, cataracts, chorioretinitis, and/or optic atrophy.

Question 15

SLE and recurrent pyogenic infections

Answer 15

C2 complement deficiency = increase risk for strep, h. flu, and neisseria meningitidis infections. VS C5-9 and properdin deficiency = fulminent menigicoccus disease

Question 16

Painful, inflamed, shallow ulcer on penis associated with grayish fibrinous membrane and ragged, undermined borders on the foreskin

Answer 16

Chancroid. Path- Haemophilus ducreyi (DO CRY = painful); Clx - with bubo (painful unilateral inguinal lymphadenitis).

VS lymphogranuloma venereum (erosive, painLESS papilla then ulcers on shaft of penis with painful lymphadenopathy)

VS syphilitic chancre (indurated, punched-out, painLESS ulcer with slightly elevated margins)

VS granuloma inguinale aka Donovanosis by klebsiella granulomatis (painLESS beefy red ulcers that bleed)

Question 17

Penetrating eye trauma with ring abscess formation

Answer 17

B cereus (treat with IV and intravitreous vancomycin). Pseudomonas and proteus also present with ring abscess formation. vs. Acanthamoeba (contact lens and swimming)

Question 18

Most common cause of serosanguinous/bloody vaginal discharge and vulvovaginitis

Answer 18

Shigella flexneri/sonnei and group A strep

Question 19

Tenosynovitis, dermatitis, and polyarthralgia

Answer 19

Arthritis-dermatitis syndrome by disseminated gonorrhea infection (vs. chlamydia reactive arthritis = arthritis, urethritis, conjunctivitis/uveitis = cant’s see, can’t pee, cant’ climb a fucking tree)

Question 20

Fever, fatigue, myalgias, headache, and rash (erythematous, maculopapular, and petechial rash includes trunk and most prominent on wrists, ankles, palms, and soles)

Answer 20

Rocky Mountain Spotted Feer

Question 21

Rocky mountain spotted fever lab findings

Answer 21

Hyponatremia (endothelial damage => vasculitis => leakage), thrombocytopenia, leukopenia, anemia, elevated transaminases

Question 22

PANDAS

Answer 22

Pediatric Autoimmune Neuropsychiatric disorder associated with group A Streptococci

Question 23

Airborne pathogens

Answer 23

Measles, mumps, TB

Question 24

Congenital syphilis (Clx)

Answer 24

IUGR, hydrops (also parvovirus), skeletal changes, rash on hands and sole, hepatomegaly, jaundice, rhinitis/snuffles with adjacent bone/cartilage destruction

Question 25

Congenital syphilis bone findings

Answer 25

osteochondritis and periostitis of metaphysis and diaphysis, irregular bands of demineralization, focal circumscribed areas of bony destruction, Wimberger sign (destruction of the medial aspect of the proximal tibial metaphysis), painful and refused movement of involved bone (pseudoparalysis of Parrot)

Question 26

Fever, headache, stomachache, sore throat, then 2 days later develops fine reddish-pink, papular rash on face, trunk, UE, and thighs, but spares palms and soles

Answer 26

Scarlet fever (also circumoral pallor)

Question 27

Fever, headache, chills, malaise, with ulcerated lesion and tender local lymphadenopathy. Recent tick bite.

Answer 27

Francisella tularensis, treat with aminoglycosides

Question 28

Unilateral conjunctival erythema without discharge or pain, ipsilateral preauricular lymphadenopathy, unilateral conjunctival granuloma (dz and tx)

Answer 28

Parinaud oculoglandular syndrome by Bartonella henselae, can give azithromycin for hasten resolution

Question 29

Perceptual distortions of size/shape/colors/spatial relationships

Answer 29

"Alice in Wonderland syndrome" associated with infectious mononucleosis, migrainous ischemia, encephalitis, epilepsy, trauma

Question 30

Fever, arthralgia, sudden onset pruritic erythematous symmetrical swelling of hands and feet that is well-demarcated at the wrist and ankles. Also with painful pruritic papules, petechiae, and purpura of hands and feet.

Answer 30

Papular purpuric gloves and socks syndrome (PPGSS) by parvovirus B19 => infectious thus be careful about close contact with preggos

Question 31

Late finding of acute rheumatic fever

Answer 31

Chorea (months after initial infection vs other findings within weeks)

Question 32

Colchicine (uses)

Answer 32

1st line treatment for familial mediterranean fever (prevents development of amyloidosis). Also prophylaxis in PFAPA if unresponsive to cimetidine or who have bad oral aphthae.

Question 33

Clostridium septicum (dz)

Answer 33

Sepsis in cyclical neutropenia

Question 34

Retorpharyngeal abscess tx

Answer 34

Unasyn

Question 35

Fever, cough, and now rapidly evolving difficulty swallowing, chapped lips with oral mucosal erosions and sloughing, injected conjunctivae, and a few papulovesicles (dz)

Answer 35

Mycoplasma-induced rash and mucositis (MIRM) Staph is more impetigo and STTS would have more sunburn-like rash with less mucosal involvement

Question 36

Malaria prophylaxis

Answer 36

Chloroquine, doxyxycline, atovaquone/proguanil, mefloquine