Infectious disease

Question 1

HIV: TX

Answer 1

2+1

2NRT-is + 1NNRT-i

Question 2

HIV: post exposure prophylaxis

Answer 2

emtricitabine + tenofavir

Question 3

HIV: vertical transmission prevention

Answer 3

AZT (25% chance of transmission if no AZT)

Question 4

Diagnosis of suspected early HIV

Answer 4

PCR for viral load

Question 5

Diagnosis of chronic HIV infection

Answer 5

ELISA for HIV antibodies and western blot for confirmation

Question 6

PCP: CD count and ppx

Answer 6

CD count <200

TMP-SMX or dapsone or atovaquine

Question 7

Toxo: CD count and ppx

Answer 7

CD count <100

Tx: TMP-SMX or pyramethamine +leucavorin

Question 8

MAC: CD count and ppx

Answer 8

CD count <50

tx: azithromycin weekly

Question 9

Only carbapenem that does not target pseudomonas

Answer 9

ertapenem

Question 10

Fluoroquinolones: side effects

Answer 10

bone growth abnormalities in children and pregnant women

tendonitis and achilles tendon rupture

Question 11

Empiric antibx tx for bowel perforation

Answer 11

metronidazole
or
pip-tazo
or
carbapenems
or 
2nd generation cephalosporins

Question 12

Trichinellosis: clinical time course

Answer 12

GI complaints followed by triad of periorbital edema, myositis (elevated CK), and eosinophilia

Question 13

torsades and HDS: TX

Answer 13

magnesium sulfate

Question 14

torsades and unstable: TX

Answer 14

immediate defibrillation

Question 15

Oxytocin toxicity effects

Answer 15

hypotension
hyponatremia
tachysystole (abnormally frequent uterine contractions)

Question 16

When not to initially do an LP

Answer 16

Fever
AMS
Immunocomrpomised
Lesion
Seizures

Question 17

Meningitis: etiologies and clinical features

Answer 17

typical bacterial (CSF with many PMNs): stiff neck +/- photo/phonophobia in s/o fever and HA

atypical bacterial: crypto, syphillis, lyme, rocky mountain spotted fever, TB

Question 18

Distinguishing features of cryptococcal meningitis

Answer 18

high opening pressure to LP in AIDS patient

Question 19

Staph cellulitis: TX

Answer 19

Toxic cases: vanc, linezolid, or clinda IV

Nontoxic cases: PO TMP-SMX or clinda

Question 20

Cellulitis in DM pt: TX

Answer 20

pip tazo AND vanc

Question 21

Strep cellulitis: TX

Answer 21

Toxic cases: pip-tazo, amp/clav

Nontoxic cases: 1st gen cephalosporin

Question 22

Radiographic tests for osteomyelitis

Answer 22

first Xray, if negative MRI

Question 23

Nec fascitis: Empiric tx

Answer 23

3rd gen cephalosporin + clindaa +ampicillin

Question 24

Diabetic foot with osteo: most likely organism(s)

Answer 24

polymicrobial, with staph a and pseudomonas likely

Question 25

A pt with cirrhosis who ate oysters on vaca and now has osteo =

Answer 25

vibrio fuhifrus

Question 26

Osteo post-op: most likely organism

Answer 26

pseudomonas

Question 27

Best test for C. Diff

Answer 27

stool antigen testing (either with PCR or immune assay)

Question 28

Imaging after seeing a cavitary lesion on CXR

Answer 28

CT scan to decide if abscess, TB, or fungus

Question 29

Lung abscess: TX

Answer 29

3rd gen cephalosporin + clinda | dont drain

Question 30

Bronchitis: TX

Answer 30

``` macrolide (azithro) or doxycycline or respiratory fluoroquinolone (moxi) ```

Question 31

Indications for steroids in tx of PCP

Answer 31

hypoxemic or low PaO2

Question 32

LDH elevated in what kind of pna

Answer 32

PCP

Question 33

CURB-65 vs PSI

Answer 33

CURB-65: does person need admission or not? PSI: what level of care does this person need?

Question 34

Urethritis =

Answer 34

STD (gon/chlam) until proven otherwise

Question 35

Complicated UTI: criteria

Answer 35

``` penis plastic (foley) procedure pyelo (pregnant) ```

Question 36

Duration of tx in urinary tract infection

Answer 36

uncomplicated: 3days complicated: 7days kidney: 10days perinephric abscess: 14days

Question 37

microscopy threshold for UTI

Answer 37

> 10WBC per hpf

Question 38

When to get urine culture

Answer 38

if patient is pregnant

Question 39

Asymptomatic screen for bacteruria for

Answer 39

pregnant women or someone undergoing a urologic procedure

Question 40

Asymptomatic of bacteruria in pregnant woman: TX

Answer 40

amoxicillin (nitrofurantoin if penicillin allergic)

Question 41

WBC casts in

Answer 41

AIN and pyelo

Question 42

Pyelonephritis: TX

Answer 42

single dose IV cipro and then bactrim PO if ambulatory IVceftriaxone in inpt

Question 43

Cystitis: TX

Answer 43

bactrim nitrofurantoin fosfomycin

Question 44

cystitis but has CKD: TX

Answer 44

nitrofurantoin

Question 45

Dx of primary vs secondary vs tertiary syphillis

Answer 45

primary: darkfield microscopy secondary: RPR, then FTA-abs tertiary: LP to do CSF RPR followed by FTA-abs

Question 46

Lymphogranuloma venerum: clinical features

Answer 46

Painless and singular ulcer (like syphillis) Tender lymphadenopathy (vs nontenderr LDN in syphillis) that may become suppurative and drain occur in immunocompromised Diagnose with NAAT Tx with doxy

Question 47

Chancroid: TX

Answer 47

azithro or cipro

Question 48

Genital/oral herpes: DX & TX

Answer 48

DX: PCR TX: acyclovir and valacyclovir

Question 49

Mastoiditis: clinical features

Answer 49

complication of otitis externa anteriorly rotated ear granulation tissue in ear canal swelling behind ear

Question 50

Bacterial sinusitis: TX

Answer 50

PCN or amox-clav

Question 51

Bacterial endocarditis: TX

Answer 51

Native valve: vanc prostethic valve <60d: vanc + gent + cefepime prosthetic valve >365d: vanc + gent +ceftriaxone Subacute bacterial endocarditis: gent and ceftriaxone

Question 52

bacterial endocarditis: TX if cant give vanc

Answer 52

daptomycin