Infectious Pathology

Question 1

Drug class most commonly associated with hypersensitivtiy reactions

Answer 1

PCNs

Question 2

Should cephalosporins be used in a patient with ANAPHYLACTIC reaction to PCNs?

Answer 2

No

Question 3

Aztreonam definition

Answer 3

IV beta lactam antibiotic that is primarily gram negative aerobes only including pseudomonas and enterobacteriae, used most often in patients with PCN allergies, renal insufficiency, those who cannot tolerate aminoglycosides

Question 4

Polymyxin definition

Answer 4

Most often used topical for infections of eye, ear, and skin, may be part of triple therapy ointment with neomycin and bacitracin

Question 5

Vancomycin spectrum and adverse effects

Answer 5

Gram positive only including MRSA (IV) and C diff colitis (oral route), adverse effects include red man syndrome (flushing and pruritis due to histamine release), ototoxicity, and nephrotoxicity

Question 6

Drug of choice for lymphogranuloma venereum

Answer 6

Doxycycline (doxy is drug of choice for all chlamydia)

Question 7

Drug of choice for mycoplasma pneumoniae

Answer 7

Azithromycin or doxycycline

Question 8

Drug of choice for cholera

Answer 8

Doxycycline

Question 9

Drug of choice for cat scratch fever

Answer 9

Azithromycin first line, doxycycline

Question 10

Adverse reactions to macrolides

Answer 10

GI upset, ototoxicity, prolonged QT interval

Question 11

Clindamycin adverse effect

Answer 11

C diff colitis

Question 12

Drug of choice for rocky mountain spotted fever during pregnancy

Answer 12

Chloramphenicol (yeah I know, despite the whole gray baby thing…)

Question 13

Drug that can be used to treat MRSA and VRE

Answer 13

Linezolid

Question 14

C diff treatment

Answer 14

Metronidazole

Question 15

Things that metronidazole treats

Answer 15

C diff, BV, giardia, trich, h pylori, added to PID sometimes

Question 16

Quinupristin/dalfopristin function

Answer 16

MRSA, VRSA, VRE coverage, given IV

Question 17

Tetanus management

Answer 17

Metronidazole plus IM Tetanus immune globulin, benzos to reduce spasms and respiroatry support if needed

Question 18

Tetanus prophylaxis if previously vaccinated vs never vaccinated

Answer 18

Previously vaccinated: Tdap (preferred) or Td booster every 10 years or major or dirty wounds occuring >5 years since last booster
Never vacicnated: tetanus immune globulin plus initiation of tetanus toxoid vaccine, 2nd dose 4-8 weeks laer and a 3rd 6-12 months later

Question 19

Tdap booster schedule

Answer 19

At 11-12 years of age, given 10 year intervals after that or sooner if major injury and booster was 5 years ago or longer, recommended once during every pregnancy

Question 20

Clostridium perfringens management

Answer 20

Surgical debridement plus antibiotics IV penicillin plus clindamycin

Question 21

Management of foodborne botulism vs wound botulism

Answer 21

Antitoxin first line therapy in foodborne with no antibiotics or if infantile, if wound based then antitoxin plus penicillin

Question 22

Diphtheria management

Answer 22

Antitoxin plus either erythromycin or PCN

Question 23

Gonococcal arthritis first line treatment vs urethritis and cervicitis

Answer 23

IV ceftriaxone, ceftriaxone 250 im plus either doxy or azithro

Question 24

Lymphogranuloma venereum vs chancroid presentation

Answer 24

Lymphogranuloma is PAINLESS at site of inoculation followed by painful inguinal lymphadenopathy (buboes), chancroid is caused by hemophilus ducreyi and is painful genital ulcer followed by painful inguinal lymphadenopathy (buboes)

Question 25

Severe invasive or life threatening candida infection treatment (ex - endocarditis)

Answer 25

Iv amphotericin B

Question 26

Most common cause of fungal meningitis

Answer 26

Cryptococcosis, from bird or pigeon droppings and most common in immunocompromised HIV patients with CD4 <100

Question 27

Histoplasmosis vs coccidiomycosis

Answer 27

Found in soil containing bird and bat feces in mississippi and ohio river valleys, aids defining illness and most patients are asymptomatic otherwise Found in southwestern US from inhalation of spores, causes mild flu illness or valley fever

Question 28

MAC definition

Answer 28

Spread from water to soil and seen in immunocompromised patients or those with underlying pulmonary disease, treated with clarithromycin plus ethambutol plus rifampin (REC)

Question 29

Pinworm Enterobiasis treatment

Answer 29

Mebendazole, pyrantel preferred in pregnancy

Question 30

Ascariasis diagnosis and treatment

Answer 30

Stool ova and parasite, mebendazole or pyrantel preferred in pregnancy

Question 31

Trichonosis diagnosis and treatmnet

Answer 31

Eosinophilia, elevated creatinine kinase, managed with mebendazole

Question 32

Hookworm (Necator americanus) diagnosis and treatment

Answer 32

Eosinophilia, iron deficiency anemia, mebendazle or pyrantel preferred in pregnancy

Question 33

Malaria first line treatment

Answer 33

Chloroquine, hydroxychloroquine is alternative

Question 34

Malaria treatment in chloroquine resistant regions

Answer 34

Artemisnin or atovaquone proguanil

Question 35

Babesiosis management

Answer 35

Atovaquone plus azithromycin

Question 36

Toxoplasmosis definiton

Answer 36

Infection by toxoplasma gondii, most common cns infection in patients with AIDS not on medication, obtained from soil or cat litter, see enchpalitis especially when CD4 <100, diagnosed clinically but neuroimaging may show nonspecific multiple ring ehancing lesions (also seen in CNS lymphoma), managed with sulfadiazine, bactrim is first line prophylaxis

Question 37

Chancroid treatment

Answer 37

azithromycin

Question 38

2ndary and 3iary syphilis presentation

Answer 38

2nday may occur few weeks to 6 months after initial symptoms, maculopapular diffuse bilateral rash involving palsm and soles common, condyloma lata involving mucus membranes or other moist areas present, and some systemic symtpoms 3iary may occur 1-20 years later after latent infection and is either gummatous granulomas, neurosyphilis (tabes dorsalis leading to ataxia, areflexia, burning pain, weakness), argyll robertson pupil

Question 39

Diagnosis of syphilis

Answer 39

Non treponemal test screening, RPR or VDRL, if positive must be confirmed by FTA-ABS

Question 40

Late or severe management of lyme disease

Answer 40

IV ceftriaxone

Question 41

Lyme disease diagnosis

Answer 41

Clinical first line, serologic testing elisa followed by western blot if elisa posotive

Question 42

Acanthamoeba keratitis definition

Answer 42

Seen in contact lens wearers, presents with ocular pain, photophobia, conjunctival injection, partial or complete ring infiltrate of corneal stroma (physical exam findings)

Question 43

Test of choice for HSV1 and gold standard test

Answer 43

PCR, HSV1 serology

Question 44

The most common cause of encephailitis in the US

Answer 44

HSV-1 encephalitis

Question 45

Test of choice for epstein barr virus, peripheral smear finding

Answer 45

Heterophile antibody (monospot), peripheral smear may show atypical lymphocytes

Question 46

Most common congenital viral infection and what is the treatment of it in any situation

Answer 46

CMV, ganciclovir

Question 47

Varicella diagnosis and treatment

Answer 47

Usually clinical but PCR can be performed Symptomatic treatment in 12 or younger, acyclovir in 13 or older or immunocompromised because of varicella pneumonia leading to mortality and morbidity in adutls

Question 48

Post exposure prophylaxis treatment of varicella

Answer 48

Varicella zoster imune globulin

Question 49

Herpes zoster diagnosis and treatment

Answer 49

Clinical but PCR can be performed Acyclovir

Question 50

Post exposure prophylaxis of herpes zoste

Answer 50

Varicella zoster immune globulin for people exposed to shinles who are immunocompromised

Question 51

Hutchinson's sign

Answer 51

Vesicles on side or tip of nose which ahve high correlation with occular involvmeent of herpes zoster infection due to nasociliary branch of CN V, herpes zoster ophthalmicus

Question 52

Herpes zoster oticus definition

Answer 52

Ramsay hunt syndrome, reactivation of varicella zoster in facial nerve CN VII, see ipsalateral facial paralysis plus ear pain plus vesicles in auditory canal or auricle, treated with valacyclovir plus prednisone

Question 53

AIDS is a cd4 count below

Answer 53

200