MKSAP-4

Question 1

What should you do as far as diagnosis and treatment in a patient where you suspect viral meningitis, CSF cell analysis also shows viral,? HSV PCR on CSF negative

Answer 1

Repeat HSV PCR in 1 week

Also discontinue broad-spectrum antibiotics and continue only acyclovir

Question 2

UC a patient with suspected meningitis, the CSF profile indicates likely viral, they are presenting with parkinsonism type of symptoms like bradykinesia, tremors, which buggy suspecting?

Answer 2

West Nile West Nile West Nile West Nile West Nile

Basal ganglia involvement

Question 3

Treatment for CMV colitis

Answer 3

IV ganciclovir

Question 4

2nd stage of Lyme disease

Include duration and clinical presentation

EDIT

Answer 4

2 to 10 weeks

Can involve cranial nerve-any
Cranial nerve VII - Facial nerve is MC

Question 5

Treatment for mild CMV

Answer 5

Oral valganciclovir

Question 6

Aldazide intracellular inclusions On tissue biopsy, think

Answer 6

CMV

Question 7

West Nile, what are the clinical symptoms or physical presentation?

Treatment?

Answer 7

Parkinson symptoms like bradykinesia, tremors, myoclonus
Seizures
Coma
Flaccid paralysis
Maculopapular rash

Treatment: Supportive

Question 8

Guidelines for community-acquired pneumonia recommend starting Tamiflu and all adults with CAP And lab confirmed influenza for___duration of symptoms

Answer 8

Any Amount or duration of symptoms, just start the Tamiflu

Question 9

Risk factors for candidemia

Answer 9

Central venous or hemodialysis catheters

GI surgery

Broad-spectrum antimicrobial agents

Vent intubation for more than 3 days

ICU stay for more than 3 days

Transplant

Neutropenia

Question 10

When blood cultures are negative and you suspect Candida, what assay can be ordered?

Answer 10

Beta D glucan assay

Beta D glucan is a polysaccharide found in the walls of many fungal infections like Candida, Aspergillus, pneumocystis

Question 11

Disc cryptococcus occur in immunocompromised or immunocompetent patients primarily?

And which or consistent does it affect mainly?

Answer 11

Immunocompromise

cns

Question 12

Treatment for coccidiomycosis pulmonary Infection

Answer 12

Fluconazole

If does not respond, amphotericin B

Question 13

This bacterial meningitis can be indistinguishable from viral meningitis

Answer 13

Borrelia, Lyme disease

Question 14

First stage of Lyme disease

Include duration and clinical presentation

EDIT

Answer 14

Occurs week 1 through 4

Flulike illness
Erythema migrans rash

Question 15

Most common cause of viral meningitis

Answer 15

Enterovirus

Question 16

WHAT seasons as Lyme disease tend to occur

Answer 16

Summer and fall

Question 17

Why does West Nile cause flaccid paralysis

Answer 17

The encephalitis involves basal ganglia involvement

Question 18

What arthropod causes West Nile

Answer 18

Mosquito

Question 19

Can cephalosporins be taken in pregnancy

Answer 19

Yes

Question 20

Can Augmentin be taken in pregnancy

Answer 20

Yes

Question 21

Can nitrofurantoin be taken in pregnancy

Answer 21

No

Question 22

Can fosfomycin be taken in pregnancy

Answer 22

Yes

Question 23

___Antibiotic can cause rupture and dissection of the aorta, therefore should be avoided in patients who have aortic aneurysm or at risk for the aortic aneurysm

Answer 23

Fluoroquinolone

Question 24

Guidelines recommend___screening should be repeated in patients with HIV especially those CD4 count <200

Answer 24

TB

Question 25

On the MRI, when you see temporal lobe involvement consider___viral encephalitis When you see basal ganglia involvement consider___viral encephalitis

Answer 25

HSV-1 West Nile

Question 26

To diagnose West Nile, which 1 is better IgM or PCR? As in which 1 is more sensitive

Answer 26

West Nile IgM in the CSF or in the serum!!!! The PCR is not sensitive and it is clear by the time of clinical presentation

Question 27

Cryptosporidium treatment

Answer 27

Nitazoxanide

Question 28

Mode of transmission of Cryptosporidium

Answer 28

Swallowing contaminated water Avoid swimming pools in public

Question 29

When you suspect meningitis, bacterial, in a patient who recently went for CNS surgery, or lumbar puncture, or some kind of CNS device placed even from many years ago or recent, you should be covering them with these antibiotics

Answer 29

Vancomycin and cefepime

Question 30

MSSA osteomyelitis, antibiotic of regimen?

Answer 30

Surprisingly oral doxycycline for 6 weeks

Question 31

What is the HIV fourth-generation antibody antigen test do or test for?

Answer 31

p24 HIV antigen HIV 1/HIV-2 antibody detection

Question 32

**why fourth-generation HIV screening test falsely negative sometimes? What test should be performed next to evaluate for HIV**

Answer 32

Because of the very reduced window. Time from exposure to positive screening test IF THIS TEST ABOVE IS NEGATIVE...AND... IF YOU STILL HIGHLY SUSPECT HIV AND PATIENT COMES WITH FLU LIKE SYMPTOMS: HIV-1 RNA nucleic acid amplification test(VERY sensitive, can detect hiv as early as 10days after exposure)

Question 33

**Your fourth-generation HIV antibody antigen test tested positive What is the next step is for us diagnostics?**

Answer 33

HIV 1/HIV-2 antibody differentiation immunoassay If this, positive, that **confirms** HIV diagnosis

Question 34

You checked HIV screening with the fourth-generation antibody antigen test, it came out positive Then you did the HIV-1 HIV-2 antibody differentiation amino acid which came out negative What is the next diagnostic test or do stop here?

Answer 34

Next test is HIV RNA nucleic acid amplification test If positive then it confirms diagnosis If negative then the HIV antibody antigen test was falsely positive