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Medicine Boards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Treatment of latent TB (+duration)

  • HIV positive
  • HIV negative
A
  1. INH x 9 months (add pyridoxine)

2. INH x 6 months or Rifampin x 4 months

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2
Q

Treatment for active TB (with duration)

A

1st –> RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) x 8 weeks
–> Then isoniazid + rifampin x 4-7 months

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3
Q

What 3 criteria determine that TB patient is no longer infectious?

A
  1. Adequate tx for >2wks
  2. improved sx
  3. 3 consecutive negative sputum smears
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4
Q

What should you monitor if treating with pyrazinamide or ethambutol?

A
  • uric acid levels
  • visual acuity
  • color vision
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5
Q

Name 3 rapidgly growing myobacterium causing localized skin and soft tissue infections

A

Myobacterium abscessus/fortuitum/chelonae

occur after trauma, surgery, cosmetic procedures, pedicures, tattooing, body piercing

Source – contaminated, nonsterile water

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6
Q

Name two groups of people that may have pulmonary MAC infection? Where is infection usually localized?Name one group that may have disseminated MAC infection?

A

Pulm:

  1. middle aged - older adult male smoker with underlying lung disease –> CXR looks like pt with TB
  2. elderly, thin, white female, may have suggestion of connective tissue defect (scoliosis, pectus excavtum, MVP) with CXR showing RML or left lingular lobe infection

Dissem:
- HIV with CD4<50 not on MAC ppx

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7
Q

Most common form of meningitis in AIDS patient? How to treat it?

A

cryptococal meningitis
CD4<100
high opening CSF pressure
dx - cryptococcal Ag in CSF, or +CSF culture

Tx -
induction with amphotericin B + flucytosine
maintenance - fluconazole (for pts with AIDS until CD4>100 x over 3 months)

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8
Q

HIV post exposure prophylaxis treatment regimen? When to test for HIV ?

A
  • Start <72hr after exposure
  • 3 drug regimen: tenofovir + emtricitabine + either raltegravir or dolutegravir
  • HIV testing of the exposed person should be conducted at baseline, then 6 weeks, 12 weeks, and 5 months after exposure
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9
Q

Whats the HIV drug regimen for PrEP? What to test for before starting PrEP? What to monitor during PrEP?

A
  1. tenofovir + emtricitabine
  2. HIV, HBV, kidney function, pregnancy
  3. monitor Q3months - HIV, STIs, pregnancy, kidney function
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10
Q

Zika screening

  • asx preg
  • sx, non-preg
A
  • Asymptomatic, pregnant - may have been exposed, test IgM antibody
  • Symptomatic, non pregnant – NAAT (nucleic acid amplification testing) for dengue and Zika on serum, within 7 days of Sx onset
  • If >7days since Sx OR NAAT (-) then do IgM antibody testing
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11
Q

gram-negative coccobacillus with a “safety-pin” appearance (bipolar staining pattern)

  1. name organism
  2. clinical presentation
  3. treatment
A
  1. Yersenia Pestis (potentially lethal, ease of dissemination)
  2. Pulmonary involvement via - primary (via close contact) or via hematogenous spread to lungs from buo or other source
  3. Tx streptomycin or gentamicin.

Can also cause fever/diarrhea/RLQ pain = mimic appendicitis!

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12
Q

Which two types of malaria are the most severe/lethal? Where are they endemic?

A

P. falciparum – Africa

Plasmodium knowlesi – South and Southeast Asia

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13
Q

What is the most common cause of viral meningitis? treatment?

A

Enterovirus (may - november) – supportive treatment
HSV2 - year round

others…
HSV2 - supportive
VZV - IV acyclovir
West Nile Virus or St. Louis encephalitis - supportive

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14
Q

What is Neuroborreliosis? how do you treat it?

A
  • Facial nerve palsy (CN VII) + headache +/- nuchal rigidity (meningitis)
  • Neuroborreliosis occurs in 10% to 15% of patients with Lyme disease
  • Treatment IV ceftriaxone, cefotaxime, or penicillin (meningitis) – can defer Abx until LP obtained
  • Treatment PO doxy 14-28days if facial palsy (uni or bilateral)
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15
Q

Explain Syphillis Testing

- “reverse screening”- regular testing

A

Treponemal test = enzyme immunoassay
NONtreponemal test = Rapid plasma regain or Venereal Disease Research Laboratory

“reverse screening”

  1. EIA (+) and RPR/VDRL (-) = previously treated for syphillis***
  2. EIA (+) and RPR/VDRL (+) = new syphillis infection

***in this case should repeat treponemal test to confirm EIA (flourescent treponemal antibody test)

RPR and VDRL pearls:

  • often negative in primary infection
  • positive with high titers in secondary syphillis
  • positive with low titers in tertiary syphillis
  • **confirm positive EIA with FTA-ABS (fluorescent treponemal antibody absorptiontest) or TPPA (treponema pallidum particle agglutination assay)
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16
Q

explain 3 step screening test for HIV

A

1st – EIA for HIV antibody (HIV-1 and HIV-2) and HIV p14 antigen… if positive…
2nd – immunoassay to differentiate HIV-1 from HIV-2
&raquo_space; if either (+) - confirms HIV diagnosis
&raquo_space; if (-)/inconclusive - get NAAT
3rd – NAAT (+) = acute HIV, if NAAT (-) initial test was false positive

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17
Q

fresh water/pool swimming, then diarrhea, what caused it? Treatment?

A

Cryptosporidium - parasitic protozoan is tolerant to chlorine and can persist for days in a chlorinated pool (HIV at high risk)

Tx - supportive. If very symptomatic - Nitazoxanide

18
Q

Severe vs Fulminant C.diff? difference in treatment?

A

SEVERE = low albumin (<3) + WBC>15 or abdominal tenderness // Cr>1.5 + WBC>15
— Tx PO Vanc x 10 days

FULMINANT = severe + complications (ie. ileus, hypoTN, shock, toxic megacolon)
— Tx PO vanc + IV metronidazole q8h

19
Q

At what MIC level should you not use Vancomycin for MRSA infection and switch to Dapto? What type of of MRSA infection can you NOT use Dapto for?

A
  1. MIC > 2 (MIC 4-8 = intermediate sucept. but high treatment failure for MRSA)
  2. pneumonia b/c daptomycin is inactivated by surfactant
20
Q

When should rifampin be added to vancomycin?

A

prosthetic joint infection (osteo) with bacteremia - staph auerus - when hardware cannot be removed

21
Q

Nodular infection (cellulitis) of extremities (nodular) with exposure to fish tank/marine?

  1. name organism
  2. treatment
A
  1. myobacterium marinum
  2. MILD – clarithromycin OR Doxy or Bactrim
    SEVERE – clarithomycin + ethambutol OR rifampin
22
Q

Diarrheal illness after adopting pet reptile (snakes, turtles, iguanas, frogs, toads)

  1. organism
  2. clinical symptoms
A
  1. Nontyphoidal Salmonella
    - Transferred by animal feces to people OR via contaminated food (poultry, beef, eggs, milk)

2, Clinically - crampy abdominal pain, fever, nonbloody diarrhea, and vomiting.

23
Q

Treatment for PJP pneumonia? When would you add glucocorticoids?

A

3 weeks of

  • IV or PO bactrim (based on severity)
  • If sulfa allergy – IV pentamidine or IV clinda + PO primaquine

IF A-a>35mmHg or PO2 <70 = use glucocortioids within 72hr

24
Q

Treatment of toxoplasmosis in immune suppressed patient or HIV with CD4<200

A

sulfadiazine + pyrimethamine + folic acid (if you see multiple ring enhancing lesions on brain imaging). Biopsy if fail to respond within 2 weeks of empiric therapy.

25
Q

What agents can you use to treat CMV infection in posttransplant patient? How many days post transplant can you see CMV infectioN?

A

Usually >30 days post transplant

  • may need to reduce immunosuppressive therapy
  • IV ganciclovir
  • PO valganciclovir
  • PO foscarnet
  • IV cidofovir
26
Q

3 Most common drug types that cause FUO

A
  1. anticonvulstants (phenytoin, carbamazepine)
  2. Antibiotics (B-lactams, sulfonamides, nitrofurantoin)
  3. Allopurinol
27
Q

Rash starting on buccal mucosa and spreading out
Rash in same stages at any one time (ie. papule, vesicle, pustule, crust)
1. name organism/disease
2. treatment

A
  1. smallpox
  2. supportive, but recently tecovirimat has been approved
    * Post exposure vaccination with “vaccinia” within 7 days of exposure + close contacts (“ring vaccination”)
28
Q

What are 3 ways anthrax presents? classic CXR finding? gram stain? Prevention? Treatment?

A
  1. cutaneous, GI, inhalational
  2. widened mediastinum
  3. large gram positive bacilli
  4. postexposure vaccination + cipro for 60 days (or raxibacumab that neutralizes vacillus anthracis toxin)
  5. cutaneous – PO cipro. All else – IV cipro + 2 other antibiotics. Raxibacumab also approved for inhalational anthrax.
29
Q

Tularemia -

  1. clinical sx
  2. lab confirmation
  3. treatment
A
  1. cough/Sob/pleuritic cp – CXR infiltrate, hilar LN, pleural effusion
  2. 2 weeks after infection - IgG + IgM to Francisella Tularemia
  3. mild-mod = PO cipro or doxy. severe = streptomycin or gentamicin
30
Q

Botulism

  1. treatment
  2. clinical presentation
A
  1. Trivalent (types A,B,C) equine serum antitoxin ASAP to prevent progression, but cannot reverse existing paralysis
  2. “Five Ds” - Diplopia, Dysphonia, Dysarthria, Dysphagia, Descending Paralysis (starting with facial muscles)
31
Q

Explain testing for Zika

A

Within initial 2 weeks after symptom onset = reverse transcriptase PCR testing on serum and urine

> 2weeks = IgM antibody

32
Q

Tropical (hawaii) travel + conjuctival suffusion – whats the disease? treatment?

A

Leptospirosis (zoonosis caused by spirochete Leptospira interrogans) from exposure to animal urine/contaminated water or soil

Tx - supportive. if severe - doxycycline + penicillin

clinically = abrupt onset fever, rigors, myalgia, headache. Can also cause kidney failure, uveitis, respiratory failure, myocarditis, rhabdomyolysis.

33
Q

Treatment for Giardia

A

Metronidazole for 5-10 days
OR
Tinidazole

34
Q

Treatment for Amebiasis

A

Metronidazole + paromycin

35
Q

Length of treatment for:

  1. disseminated gonococcal infection
  2. epididymitis
A
  1. CTX for 7-14 days

2. CTX + azithro/doxy for 10 days

36
Q

PID treatment

  1. outpatient
  2. inpatient
A
  1. IM CTX x 1 + doxy x 14days +/- metronidazole

2. IV cefoxitin or cefotetan + doxy

37
Q

Treatment for primary herpes keratoconjunctivitis

A

topical trifluorothymidine, vidarabine, or acyclovir + optho referral

38
Q

What is Mediterranean Spotted Fever ? treatment?

A

fever, myalgia, and headache followed shortly by the appearance of a maculopapular and oftentimes petechial rash; a distinct black eschar is also classically present at the site of inoculation.

most severe of spotted fever group, can have vascular dissemination –> complications most commonly neuro

international travel - northern and southern Europe but also occurs in Africa, India, and the Middle East

Tx- doxy for 7-10 days

39
Q

Cyclospora infection

  • etiology
  • clinic presentation
  • treatment
A
  1. protozoan, acquired from eating fecal-contaminated food or water, or fresh produce imported from tropical areas. Edemic in Peru, Guatemala, Haiti, Nepal.
  2. abd pain, watery diarrhea, nausea anorexia, bloating, fatigue, flatulence, fever, malaise
  3. PO bactrim (TMP-SMZ)
40
Q

How do you treat carbapenem-resistant organisms? (pseudomonas)

A
  1. Ceftolozane-tazobactam = antipseudomonal + B-lactamase inhibitor - has activity vs. ESBL-producing-gram-negative organisms + carbapenem-resistant strains of psueodomonas.

for intra-abdominal must pair with metronidazole b/c lacks anaerobic activity

  1. Colistin - older, bactericidal vs. pan-resistant GN organism (even if carbapenem-resistant) but 50% get nephrotoxicity!
41
Q

What are some prophylactic meds post HSCT (hematopoietic stem cell transplant)?

A
  1. Posaconazole – candida, aspergillus
  2. TMP-SMZ – PJP pna
  3. Valganciclovir - CMV
  4. Acyclovir - HSV
42
Q

Treatment of TB meningitis

A

RIPE + Dexamethasone (decreases mortality, start concominantly)

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