infectious Dz p 13 -22

Question 1

how would you treat thousands of neutrophils in CSF?

Answer 1

ceftriaxone, vancomycin, and steroids

Question 2

a pt suspected to have a bacterial meningitis but CSF result came out for negative for glucose and protein, would you still treat?

Answer 2

depends, if you see elevated white count in CSF, yes treat.

Question 3

most accurate diagnostic test for TB?

Answer 3

acid fast and culture on 3 high volume lumbar punctures

Question 4

what are the risk factors (six) for Listeria?

Answer 4

elderly, neonates, steroid use, AIDS/HIV, immunocompromised, including alcoholism, pregnant

Question 5

choice of antibiotics for Listeria?

Answer 5

ampicillin (Listeria is resistant to all cephalosporin)

Question 6

what do you mean by “close contact?”

Answer 6

household contacts, kissing, sharing cigarettes or eating utensils (routine school/work contact is not close contact)

Question 7

most common neurological deficit of untreated bacterial meningitis?

Answer 7

8th cranial nerve deficit or deafness

Question 8

best initial therapy for herpes encephalitis?

Answer 8

acyclovir

Question 9

limitations for famciclovir and valacyclovir?

Answer 9

not available as IV formulation

Question 10

a pt with herpes encephalitis was given acyclovir with no improvement, what is the best next step?

Answer 10

give foscarnet

Question 11

what is the most specific test for cryptococcus?

Answer 11

culture of the fungus

Question 12

explain the sensitivity and specificity of latex agglutination test

Answer 12

highly specific if you get positive result, but has low sensitivity, if negative, can not rule out the infection

Question 13

how do you diagnose viral meningitis?

Answer 13

dx of exclusion

Question 14

a pt comes with an acute fever, confusion. you suspect encephalitis, what is the most likely dx? what is your next best step?

Answer 14

herpes simplex, head CT

Question 15

a pt at a medicine floor has been treated with acyclovir for days, what side effect should you be worried about?

Answer 15

renal toxicity ,b/c acyclovir precipitates in the renal tubule

Question 16

what is the most sensitive physical finding for otitis media?

Answer 16

immobility

Question 17

what is the most accurate dx test for otitis media?

Answer 17

tympanocentesis for a sample of fluid for culture

Question 18

what is the best initial therapy for otitis media?

Answer 18

amoxicillin

Question 19

what type of antibiotic is contraindicated to child?

Answer 19

quinolones (cartilage damage)

Question 20

5 y/o kid with otitis media came back with no respond to the amoxicillin you gave a week ago, what is your next step?

Answer 20

give below antibiotics

• amoxicillin/clavulanate
• azithromycin, clarithromycin
• cefuroxime, loracarbef
• levofloxacin, gemifloxacin, moxifloxacin

Question 21

5 y/o kid with multiple recurrences of otitis media did not respond to multiple antibiotics, what is your next step?

Answer 21

tympanocentesis

Question 22

what are the 2 indications for a biopsy in sinusitis?

Answer 22

1. frequent infection

2. no response to different empiric therapies

Question 23

pt comes in with sx of pain on swallowing, enlarged lymph node, exudate in the pharynx fever most likely dx? why is it important to treat this pt?

Answer 23

strep pharyngitis, prevent rheumatic fever

Question 24

best initial therapy for strep pharyngitis?

Answer 24

penicillin or amoxicillin

Question 25

pt is allergic to penicillin, what is your alternatives?

Answer 25

if the rxn is only rash, use cephalexin, if the rxn is anaphylaxis, use clindamycin or macrolide

Question 26

a pt with pharyngitis is likely to have cough or hoarseness?

Answer 26

No

Question 27

a 30 y/o healthy male comes in with joint pain, cough, fever, headache/sore throat, nausea, vomiting, what is most appropriate next step in management?

Answer 27

depends on time, if within 48 hrs since the onset of symptoms --> perform a nasopharyngeal swab/wash to rapidly detect the antigen and give oseltamivir, zanamivir more than 48 hrs, symptomatic treatment only

Question 28

a pt who has hemochromatosis and frequent blood transfusion comes in with blood and white cells in stool, what is the likely causing agent?

Answer 28

Yersinia

Question 29

a 20 y/o male comes in with symptoms of bloody diarrhea who has been healthy. Blood work shows anemia, low platelet counts, and creatinine level of 2, you did some work-up and confirmed that E. coli is not the causing agent, what is the most likely causing this?

Answer 29

Shigella

Question 30

a 40 y/o female who had sushi last night comes in with sudden onset of wheezing, flushing, and rash, what is the dx? and how would you treat?

Answer 30

scombroid, treat with antihistamine

Question 31

which type of hepatitis is known to rarely present with an acute infection?

Answer 31

hepatitis C

Question 32

which 2 types of hepatitis are spread through food or water?

Answer 32

A and E You Ate hepatitis A You Eat hepatitis E

Question 33

name 9 symptoms of acute hepatitis

Answer 33

jaundice, fever, weight loss, fatigue, dark urine, hepatosplenomegaly, nausea, vomiting, abdominal pain

Question 34

name 3 diagnostic tests for acute hepatitis

Answer 34

1. inc direct bilirubin 2. inc ratio of ALT to AST 3. inc alkaline phsophatase

Question 35

what is the best initial diagnostic test for hepatitis?

Answer 35

IgM antibody for acute infection and IgG antibody for resolution of infection

Question 36

best test to assess disease activity of hep C

Answer 36

PCR for RNA level

Question 37

Dx? surface antigen + e-antigen + core antibody + for IgM or IgG surface antibody -

Answer 37

acute or chronic infection

Question 38

Dx? surface antigen - e-antigen - core antibody + for IgM then IgG surface antibody -

Answer 38

window period

Question 39

Dx? surface antigen - e-antigen - core antibody + for IgG surface antibody +

Answer 39

resovled, old, past infection

Question 40

what is the measure of actual viral partical?

Answer 40

surface antigen

Question 41

the presence of E-antigen indicates

Answer 41

high level of DNA polymerase activity

Question 42

True or false? PCR viral measure the DNA of hep B is the best initial diagnostic test

Answer 42

false

Question 43

what are the 2 most important parameters to assess the degree of infectivity?

Answer 43

hepatitis DNA viral load, e-antigen

Question 44

best treatment for hep A and E?

Answer 44

none, they resolve spontaneoulsy

Question 45

what is the % of acute hep B to become chronic?

Answer 45

10%

Question 46

True of false Only acute hep C gets medical therapy

Answer 46

true

Question 47

name 4 drugs for acute hep C

Answer 47

interferon, ribavirin, boceprevir, telaprevir

Question 48

side effects of interferon?

Answer 48

arthralgia, myalgia, leukopenia, thrombocytopenia, depression, flu-like symptoms

Question 49

2 goals of chronic hepatitis therapy

Answer 49

1. reduce DNA polymerase to undetectable levels | 2. convert those pts with e-antigen to having anti-hepatitis e-antibody

Question 50

True of false interferon is rarely used first line in hepatitis

Answer 50

True due to side effects