MKSAP-1

Question 1

typical organisms for CLABSI infections MC-ly

Answer 1

Klebsiella
Ecoli

Question 2

which organisms for clabsi are ok to keep catheter ie catheter salvage (they lock catheter and give strongly concentrated Abx)

Answer 2

Ecoli
Klebsiella
Coag NEG staph
enterobacter

Question 3

which organisms for clabsi require catheter REMOVAL

Answer 3

MRSA
pseudomonas
drug resistant Gram neg
Candida/fungal

Question 4

for uncomplicated CLABSI, what is the duration of treatment?

Answer 4

7-14 days

Question 5

patient 54 F PMH of HTN, comes with Flu+, what is treatment and WHY?

Answer 5

supportive care NO TAMIFLU!

no tamiflu bcs patient is not immunocompromised, not pregnant, no list of comorbidities! NO TAMIFLU!!!

Question 6

patient who had unprotected sex came in with strange discharge and was tested positive urine for Gonorrhea negative for chlamydia
Tx and duration?

Answer 6

Tx with rocephin ONLY 1x dose

since chlamydia HAS BEEN EXCLUDED dont tx! otherwise if NOT EXCLUDED** then treat with 7day course of doxy

Question 7

name a Community acquired Pneumonia but when patient is exposed to birds

how to dx?

Tx and duration?

Answer 7

Chlamydia psitasii
aka
parrot fever

PCR to dx

10-14day doxy or azith or fluoroquinolone

Question 8

Coxiella burnetti mode of infection and what host?

Answer 8

q-fever

you are a farmer who inhaled infectious aerosols…from amniotic fluid…you got goats and sheep and cattle

Question 9

inhaled rodent urine can cause ___ Bug and ____ organ system complication

Answer 9

Hantavirus
ARDS

Question 10

patient 43M PMH of HTN, MM, 1 day duration with symptoms, comes with fevers, chills, myalgias, rhinorrhea, what is TREATMENT? and WHY?

Answer 10

Tamiflu

high risk of complications from flu so give tamiflu

otherwise if young and not immunocompromised then DONT GIVE TAMIFLU

Question 11

induction tx cryptococal

Answer 11

amphotericin B and flucytosine

Question 12

consodication tx for cryptococcal

Answer 12

fluconazole

Question 13

maintenance tx for cryptococcal

Answer 13

fluconazole lower dose

Question 14

demographic affected by cryptococcal infection

Answer 14

Immunocompromised
Organ transplant/stem cell transplant
DM
HIV

Question 15

which WBC is increased in Cryptococcal infx on CSF?

protein level __
Glucose level ___
Opening pressure

Answer 15

Lymphocytes

Increased
Low-normal
Elevated

Question 16

what will decr morbidity/mortality in cryptococcal infection? (outside of obvious antifungals)

Answer 16

multiple LPs if needed to help ease out the high intracranial pressure

Question 17

who are the beta hemolytics?

Answer 17

Group a strep (pyogenes)
Strep agalaciaew

Question 18

who is the alpha hemolytic?

Answer 18

Strep PNEUMO
strep viridans

Question 19

is erysipelas non-purluent cellulitis?

Answer 19

YES YES YES

Question 20

Which bug is considered non-purulent for cellulitis

Answer 20

Beta hemolytic strep

strep pyo
agalactiae

Question 21

which bug is purulent for cellulitis

Answer 21

MRSA

Question 22

Nec fasch physical RED flag findings

and which part of skin is involved

Answer 22

Bullae
Induration
Crepitus
PAIN BEYOND PROPORTION
dusky skin

it has reached the fascia and muscle

Question 23

patient went to sauna and now has papulopustulear eruthematous rash on his butt, what is Tx?
no sirs criteria

Answer 23

OBS FOR 7 to10 days!—supposedly

this is a “hot tub” rash with pseudomonas

Question 24

what to do: post anthrax exposure in an asymptomatic patient with clean XRay
*****

Answer 24

Anthrax vaccine
DOXY (or fluoroq) for 1.5months!!!

Question 25

Cytomegalovirus infection can cause ____ in immunocompromised persons

Answer 25

retinitis, pneumonitis, hepatitis, bone marrow suppression, colitis, esophagitis, and adrenalitis

Question 26

Post organ transplant, Polyomavirus like BK virus affects this organ in ___ way Polyomavirus like JC virus Affects this organ in ___ way

Answer 26

Kidney: interstitial neprhitis CNS: multifocal leukoencephalopathy, seizures, coma

Question 27

CVID (Common variable immunodeficiency) ___ Ig deficiency ____ bugs likely to infect ___ symptoms/organ systems affected in patient

Answer 27

IgG Encapsulated like Pneumococcal, tetanus (therefore wont make immunoglobulins to these) lots of upper and lower respiratory infections

Question 28

mucocutaneous candidiiasis think ___ immunodeficiency with ___ lung infection

Answer 28

SCID: Severe combined immunodeficiency PJP

Question 29

Measles vaccine is ___ live or not?

Answer 29

LIVE!

Question 30

MC causing discitis, vertebral osteo

Answer 30

staph, MRSA or MSSA

Question 31

treat Vibrio vulnificus–associated necrotizing fasciitis

Answer 31

Doxycycline with 3rd gen cefph (ceftazidime)

Question 32

WHERE and MODE of acquiring: Vibrio vulnificus–associated necrotizing fasciitis

Answer 32

@ warm water, gulf of mexico you ate RAW shellfish, oyster OR had skin trauma

Question 33

broad spectrum nec fasch abx

Answer 33

Vanc/linezolid/dapto + either: roceph and flagyl fluoroquin and flagyl zosyn merrem

Question 34

A personal history of recurrent Neisseria infection or a history of Neisseria infections among multiple family members is an indication to screen for _____ and what is the solution?

Answer 34

terminal complement deficiency by measuring total hemolytic complement (CH50) level. SPECIAL TYPE OF MENINGOCOCCALS**serogroup B meningococal vaccine and conjugate meningococcal vaccine

Question 35

treatment of choice and duration for facial nerve palsy caused by Lyme

Answer 35

doxy 2-3wks

Question 36

blastomyces found in this regino

Answer 36

missisippi ohio river also: wisconsin, minnesota

Question 37

coccidioides found in this region

Answer 37

arizona new mexico texas north mexico

Question 38

how does coccidioides present clinically

Answer 38

MSK infection meniningitis acute on chronic pulm infection

Question 39

blastomycosisi MODE of transmission Tx

Answer 39

exposure to soil--->you Breath in the Budding yeast, also bones and joints Itraconzaole