Infectious Diseases I

Question 1

What types of HPV cause cervical, penile, vulvar, vaginal, anal, and oropharyngeal cancers?

Answer 1

Oncogenic types 16 and 18

Question 2

What types of HPV cause genital warts?

Answer 2

Nononcogenic types 6 and 11

Question 3

For who is the HPV vaccine recommended?

Answer 3

9-26 years (who have not completed the series)

Individuals 27-45 years - use shared decision-making

Question 4

What is the HPV vaccine series?

Answer 4

If started < 15 years = 2 doses given 6-12 months apart

If started 15-26 years = 3 doses (0, 1-2, and 6 months)

Question 5

What is the recommended treatment for uncomplicated gonorrhea infection?

Answer 5

If < 150 kg = ceftriaxone 500 mg IM x 1

If > 150 kg = ceftriaxone 1000 mg IM x 1

Question 6

What is an alternative treatment for uncomplicated gonorrhea infection?

Answer 6

Gentamicin 240 mg IM x 1
PLUS
Azithromycin 2 g PO x 1

Question 7

What is the recommended treatment for chlamydia infection?

Answer 7

Doxycycline 100 mg PO BID x 7 days

Question 8

What is an alternative treatment for chlamydia infection?

Answer 8

Azithromycin 1 g PO x 1

Question 9

How long should patients abstain from sexual activity after being treated for chlamydia?

Answer 9

7 days after last dose

Question 10

What is the recommended treatment for primary, secondary, and early latent syphilis?

Answer 10

Benzathine PCN G 2.4 million units IM x 1

Question 11

What alternatives can be used in PCN-allergic patients for treatment of primary, secondary, and early latent syphilis?

Answer 11

-Doxycycline 100 mg BID PO x 14 days
-Tetracycline 500 mg QID PO x 14 days
-Ceftriaxone 1 g daily IV/IM for 10 days

Question 12

What is the recommended treatment for late latent syphilis?

Answer 12

Benzathine PCN G 2.4 million units IM once weekly x 3 weeks

Question 13

What alternatives can be used in PCN-allergic patients for treatment of late latent syphilis?

Answer 13

-Doxycycline 100 mg BID PO x 28days
-Tetracycline 500 mg QID PO x 28days

Question 14

What is the recommended treatment for tertiary syphilis?

Answer 14

Benzathine PCN G 2.4 million units IM once weekly x 3 weeks

Question 15

What is the recommended treatment for neurosyphilis, ocular syphilis, and otosyphilis?

Answer 15

Aqueous crystalline PCN G 18-24 millions units/day - given as 3-4 million units IV every 4 hours or as a continuous infusion for 10-14 days

Question 16

What are recommended treatment options for first episode of genital herpes?

Answer 16

-Acyclovir 400 mg TID or 200 mg 5x/day
-Valacyclovir 1 g BID

Duration: 7-10 days

Question 17

What are recommended treatment options for subsequent episodes of genital herpes?

Answer 17

-Acyclovir 800 mg TID x 2 days OR 800 mg BID x 5 days
-Valacyclovir 500 mg BID x 3 days OR 1 g daily x 5 days

Question 18

What are recommended treatment options for suppression of genital herpes?

Answer 18

-Acyclovir 400 mg BID
-Valacyclovir 1 g daily

Question 19

What is recommended treatment for trichomoniasis?

Answer 19

Women: Metronidazole 500 mg BID x 7 days

Men: Metronidazole 2 g as single dose

Question 20

What patients are at high risk of HIV and should be screened?

Answer 20

-MSM
-Multiple sexual partners (men or women)
-Injection drug users

Question 21

What are symptoms of conversion syndrome (acute HIV infection)?

Answer 21

-Fever
-Rash
-Fatigue
-Malaise
-Lymphadenopathy

Question 22

What test should be performed before initiating any antiviral therapy that contains abacavir?

Answer 22

HLA-B*5701

Question 23

What medications are considered NRTIs?

Answer 23

Nucleoside:
-Emtricitabine
-Abacavir
-Lamivudine
-Zidovudine

Nucleotide:
-TDF
-TAF (lower renal and bone effects)

Question 24

What medications are considered NNRTIs?

Answer 24

-Nevirapine
-Efavirenz
-Etravirine
-Rilpivirine
-Doravirine

Question 25

What medications are considered protease inhibitors (PIs)?

Answer 25

-Darunavir -Atazanavir -Ritonavir (only used as a booster)

Question 26

What medication is considered a fusion inhibitor?

Answer 26

Enfuvirtide

Question 27

What medication is considered an attachment inhibitor?

Answer 27

Fostemasavir

Question 28

What medication is considered a co-receptor antagonist?

Answer 28

Maraviroc

Question 29

What medications are considered integrase strand transfer inhibitors (INSTIs)?

Answer 29

-Raltegravir -Dolutegravir -Elvitegravir -Bictegravir -Cabotegravir

Question 30

What medication is a pharmacokinetic booster?

Answer 30

Cobicistat

Question 31

What HIV treatment regimens are considered first-line for most patients?

Answer 31

INSTI-based regimens: -Dolutegravir/abacavir/lamivudine -Dolutegravir + TDF/emtricitabine -Dolutegravir + TAF/emtricitabine -Bictegravir/TAF/emtricitabine

Question 32

What HIV treatment regimen is recommended for patients who received cabotegravir for PrEP who do not undergo integrase inhibitor resistance testing?

Answer 32

Boosted darunavir + TDF or TAF + emtricitamine or lamivudine

Question 33

When is antiviral treatment for HIV considered a failure?

Answer 33

Viral load fails to become undetectable within 24 weeks of therapy OR When a previously undetectable viral load becomes detectable

Question 34

What vaccines are recommended for patients with HIV?

Answer 34

-MMR (if CD4 > 200) -Varicella (if CD4 > 200) -Hep A -Hep B -Pneumococcal **If received a dose of PCV13, can use either PPSV23 or PCV20 -Tdap -Influenza -HPV -Zoster

Question 35

How often should patients w/ HIV be screened for TB?

Answer 35

Annually

Question 36

When is primary prophylaxis for PJP indicated?

Answer 36

CD4 < 200 or < 14% of total lymphocyte count OR CD4 200-250 if ARV therapy initiation must be delayed and routine Cd4 monitoring is not possible Can discontinue when CD4 > 200 for at least 3 months

Question 37

What is the recommended regimen for primary prophylaxis of PJP?

Answer 37

Trimethoprim/sulfamethoxazole 1 DS tablet daily (preferred) or 1 SS tablet daily or 1 DS tablet three times weekly *Alternatives: dapsone, atovaquone, nebulized pentamidine

Question 38

What is the recommended regimen for treatment of PJP?

Answer 38

Trimethoprim/sulfamethoxazole 15-20 mg/kg IV for 21 days

Question 39

When is primary prophylaxis for toxoplasmosis indicated?

Answer 39

CD4 < 100

Question 40

What is the recommended regimen for primary prophylaxis of toxoplasmosis?

Answer 40

Trimethoprim/sulfamethoxazole 1 DS tablet daily Can discontinue when CD4 > 200 for at least 3 months

Question 41

When is primary prophylaxis for MAC indicated?

Answer 41

CD4 < 50

Question 42

What is the recommended regimen for primary prophylaxis of MAC?

Answer 42

Azithromycin 1200 mg once weekly or 600 mg twice weekly Can discontinue when CD4 > 100 for at least 6 months

Question 43

How soon should treatment be used following occupational exposure to HIV?

Answer 43

ASAP but at least within 72 hours Regimen: TDF/emtricitabine + raltegravir for 28 days

Question 44

What regimens are available for PrEP?

Answer 44

-TDF 300 mg + emtricitabine 200 mg daily (Truvada) -TAF 25 mg + emtricitabine 200 mg daily (Descovy)

Question 45

What is the time to protective effects for oral PrEP?

Answer 45

7 days for anal tissue 21 days for vaginal tissue

Question 46

How often should patients be screened for HIV when on PrEP

Answer 46

Every 3 months

Question 47

What patients should influenza treatment be considered for?

Answer 47

-High risk of complications w/ persistent illness and a positive test result > 48 hours after symptom onset -Confirmed or highly suspected influenza within 48 hours of symptoms onset who wish to shorten duration of illness or who are in contact with high-risk individuals

Question 48

Which influenza vaccines are recommended for patients 65 years+?

Answer 48

-HD-IIV -RIV -aIIV

Question 49

What is the recommended treatment for uncomplicated herpes zoster infection?

Answer 49

Acyclovir 800 mg PO five times daily for 7-10 days

Question 50

What is recommended for all patients when they begin to receive HIV care, regardless of initiation of ART?

Answer 50

Genotype testing