Infectious Disease

Question 0

What are other options for cystitis due to resistant organisms?

Answer 0

Nitrofurantoin

Amox-clav

Question 1

What is fosfomycin?

Answer 1

May be used for infections resistant to TMP-SMX and cipro
- phosphonic acid derivative that inhibits cell wall synthesis
3g*1 or 3g q2days * 3 doses; or 3g q72 hours

Question 2

What is the definition of disseminated zoster?

Answer 2

lesions outside the primary dermatomes

commonly cited as 20 lesions outside the primary or adjacent dermatomes

Question 3

What are the infection precautions for varicella-zoster?

Answer 3

Primary varicella - airborne and contact
Disseminated zoster - airborne and contact
Localized zoster - airborne and contact until disseminated disease ruled out and then started
Health care workers caring for patient should be immune

Question 4

What is the timeline for HIV infection?

Answer 4

T3-38 weeks for seroconversion
T 8 years AIDS if untreated
T 1.3 years AIDS to death without Rx

CD4> 500 –> mostly normal
CD4<200 dramatic increase in opportunistic infections

absolute lymph count < 1000 suggests CD4< 200

Question 5

What are the tests for HIV?

Answer 5

ELISA - sensitive
Western Blot - sensitive and specific

Rapid HIV = pretty accurate

Question 6

What are the neurological complications of HIV?

Answer 6

HIV dementia
toxoplasma gondii
C-neoformans
lymphoma

Question 7

What is the presentation of toxoplasmosis? Dx? Mgmt?

Answer 7

most common cause of focal encephalitis in AIDS
headache, focal findings, seizure, fever, AMS

Non-contrast CT head: multiple subcortical lesions
Contrast CT: ring enhancing lesions with surrounding edema

Admit, pyrimethamine and sulfadiazine, folic acid and steriods

Question 8

What is the presentation of cryptococcosis? Dx? Mgmt?

Answer 8

focal disease or diffuse meningoencephalitis

dx: lp with crypto antigen testing - nearly 100% sensitivity and specificity

CSF pressure > 25mmHG= drain until less than 20

mgmt: amphotericin B

Question 9

What are the findings in pneumocystis jiroveci? Mgmt?

Answer 9

fever, SOB, cough, fatigue

CXR fluffy infiltrates or negative
hypoxia esp on exertion
High LDH

Rx: TMP/Sulfa IV or po
steroids if PaO2<70 mmHg or A-a>35

Question 10

What is Kaposi Sarcoma?

Answer 10

painless, raised brown black spots on face, chest, oral cavity

associated with AIDS

Rx cryo or radiation

Question 11

What are occupational risk factors for HIV transmission due to needle stick injury?

Answer 11

deep injury
visible blood on device
needle from vein or artery
late stage

Question 12

How is toxin mediated diarrhea distinguished from invasive bacterial infection?

Answer 12

toxin is acute onset

invasive bacterial infection is gradual onset and systemic symptoms

Question 13

Buzz words:

S aureus =
Bacillus cereus =
Enterogenic E. coli =
Clostridium perfringens =
Scombroid =

Answer 13

S aureus = eggs/mayo
Bacillus cereus = fried rice
Enterogenic E. coli = travellor’s diarrhea
Clostridium perfringens = meat/poultry
Scombroid = dark meat fish = histamine reaction
ciguatera = carnivorous fish = neuro stuff

Question 14

Invasive bacterial infections - give 4 examples and sources

Answer 14

salmonella = undercooked eggs/chicken
shigella
campylobacter = chicken
yersinia =

Question 15

antibiotics will shorten the course of moderate-severe diarrhea by … days

Answer 15

1-2

Question 16

Avoid antibiotics and antimotility agents in … or … patients with grossly … diarrhea. IT may increase their risk of …

Answer 16

kids
elderly
bloody
HUS

Question 17

Vaccine for cholera is available but booster required every

Answer 17

6 months

Question 18

Which bacteria causes botulism?

Answer 18

clostridium botulinum anaerobic spore forming bacillus found in the soil

toxin inhibits release of acetylcholine

Question 19

Describe clinical presentation of botulism.

Answer 19

paralytic disease
diplopia, droopy eyes, dilated pupils, dry mouth, dysphonia, dysarthria

no mental status change or sensory symptoms (motor only)
may get respiratory paralysis

Question 20

What are the symptoms of infant botulism?

Answer 20

poor feeding
weak cry
poor head control
loss of facial expression

Question 21

Wound botulism is caused by…

Answer 21

black tar heroin
skin popping
dirty wound

Question 22

LGV (lymphgranuloma venereum) is caused by … and appears as …

Answer 22

chlamydia trachomatis

vesicular lesion or ulcer spreading to nodes (inguinal buboes)

Question 23

What do the skin lesions of disseminated GC look like?

Answer 23

gunmetal grey small pustules esp hand/finger

do pelvic exam

also looks for tenosynovitis, septic arthritis

Question 24

Gonococcus on microscopy is

Answer 24

gram negative intracellular diplococci

Question 25

Mycobacterium avium intracellulare = Mycobacterium marinum = Mycobacterium kansasii = mycobacterium ulcerans =

Answer 25

Myco avium intracellulare = AIDS, immunosuppression causes lung disease and bone marrow suppression Marinum = skin infections, fish handlers, aquariums kansasii = lung dz ulcerans = skin ulcers

Question 26

Primary TB can look like any ... or can be ... Reactivation TB typically has ... lesions. Ghon complex = Ranke complex =

Answer 26

pneumonia, apical apical calcified primary focus calcified primary focus and calcified hilar lymph node

Question 27

What antibiotic for cellulitis, not commonly used, can be prescribed for staph and strep infections?

Answer 27

cefadroxil 1g po daily or 500mg po bid

Question 28

Outpatient UTI w/o oral antibiotic options?

Answer 28

fosfomycin 3g dissolved in 3-4oz water po