MKSAP-3

Question 1

Most common bugs that cause empyema, classes as an

Answer 1

Anaerobe
Streptococcal

Question 2

___Microns considered large droplet nuclei

Answer 2

> 5

Question 3

___Microns considered small droplet nuclei

Answer 3

<5

Question 4

Which droplets are considered for airborne precautions, size wise?

Answer 4

Small droplet

Question 5

Precautions are needed for patient who comes in with shingles?

In this scenario:
Immunocompetent patient
Immunocompromised patient

Answer 5

Just contact precautions

Contact and airborne

Question 6

Droplet precautions are used for___large/small droplet

Answer 6

Large

Question 7

Diagnostic regimen for flu-preferred

Answer 7

PCR

Question 8

With this IDSA guidelines recommend for initiating antiviral for patient in regards to flu who are hospitalized, diagnostics pending

Answer 8

You have an adult who is hospitalized for positive flu test for suspected flu, regardless of illness duration, start the Tamiflu or antiviral

Because of high risk of fluid complications

Question 9

In which patient’s show to adhere to the 48-hour role for Tamiflu

Answer 9

Otherwise healthy nonimmunocompromised OUT-patients, not at risk for serious complications, not in touch with people in the household who may be immunocompromised

Question 10

What are the alternatives to Tamiflu

Answer 10

Intranasal Zanamavir

IV peramivir

One-time single dose of baloxavir

Question 11

Mode of transmission of leptospirosis

Answer 11

Road into urine contact or ingestion of contaminated water food

Question 12

How does leptospirosis present?

Answer 12

Self-limited biphasic febrile illness 2 more severe-will disease

Impacts liver, kidney, pulmonary, multisystem failure, conjunctival erythema, pain in lower back and calf muscles

Question 13

Travelers from this area___get fever coming from dengue most commonly!

Answer 13

South America

Other: Caribbean, Pacific Islands, Southeast Asia, parts of Africa

Question 14

Clinical presentation of dengue

Answer 14

Abrupt onset fever, headache

Retro-orbital pain

Myalgia, arthralgia, low back pain-break bone fever

Positive tourniquet test- Once blood pressure cuff is on-patient developed petechiae on that arm

Question 15

Lab findings and dengue

Answer 15

Thrombocytopenia
Leukopenia
Elevated LFT

Question 16

Ampicillin is added for suspected meningitis in this age group

Answer 16

50 or older

Question 17

When giving steroid and meningitis, how should to be given?

Answer 17

Give Decadron with first dose of antibiotics

Once strep pneumo has been ruled out, discontinue to immediately, otherwise increases mortality especially in patients with Listeria

Question 18

Patient with suspected meningitis, CSF has yet to show HSV, CSF has very high protein and very low glucose, should acyclovir be continued?

Answer 18

No

Question 19

And HIV, antiretroviral therapy should be started at___CD4 count

Answer 19

Any-CD4 count in a patient with confirmed HIV!

Guidelines a within 2 Weeks or same day of diagnosis

Question 20

How screen for HIV

Answer 20

Fourth-generation HIV 1/2 antigen antibody combination immunoassay

This man confirmatory antibody differentiation assay

This is a recommended two-step screening, do not do Western blot anymore

Question 21

Live virus vaccines should be avoided in HIV patients with CD4 count this or under

Answer 21

200

Question 22

Treatment block for disseminated histoplasmosis

Answer 22

Amphotericin B

If clinical getting better on amphotericin B, switch to itraconazole to finish therapy

Question 23

Symptoms of disseminated histoplasmosis

Answer 23

Pneumonia-see bilateral infiltrates on chest imaging

Hepatosplenomegaly, you will see thrombocytopenia and even anemia

Septic shock

Question 24

Surprisingly this can be because of histoplasmosis

Answer 24

TNF alpha medications like infliximab, adalimumab

So we will consider patients who have treatment for Crohn’s, UC, rheumatoid arthritis

Question 25

when is vertebral biopsy the first Step before starting antibiotics for vertebral discitis osteomyelitis?

Answer 25

When blood cultures have been negative Hemodynamically unstable/septic shock Epidural abscess present Neurological deficit starting

Question 26

when is vertebral biopsy the SECOND Step AFTER starting antibiotics for vertebral discitis osteomyelitis?

Answer 26

Hemodynamically unstable/septic shock Epidural abscess present Neurological deficit starting (If patient is febrile, not still an indication to start antibiotics!)

Question 27

Most common bugs for vertebral osteomyelitis

Answer 27

Staph aureus Streptococcus Enterobacter Candida

Question 28

Other than Campylobacter, which other infections can trigger Guillain-Barré?

Answer 28

Zika virus HIV CMV

Question 29

What is the solution to women with recurrent cystitis over no cause?

Answer 29

First-line is self treatment with a short course regimen i.e. nitrofurantoin Indication is 3 or more UTI within 12 months

Question 30

What you do for postcoital UTI? And woman who gets them very often

Answer 30

Single dose postcoital antibiotics

Question 31

What are other causes of UTIs N/A premenopausal woman?

Answer 31

Delayed urinary habits Douching Spermicide use or diaphragm use Sexual activity