MKSAP: ID

Question 0

A

Answer 0

A

Question 0

5 Ssx of bacterial vaginosis?

Answer 0

1. Homogenous white discharge
2. Absence of vaginal erythema
3. Presence of clue cells
4. Vaginal pH > 4.5
5. Vaginal discharge with malodorous “fishy” odor

Question 1

Pt with recurrent GI and resp infections, what disease should you think about? Dx?

Answer 1

• think: common variable immunodeficiency (AKA acquired hypogammaglobulinemia)
• dx: measure serum IgG levels
• *recurrent GI infections especially with giardiasis!

Question 2

Three most common causes of vaginal discharge?

Answer 2

1. Candidal infection
2. Trichomonias
3. Bacterial vaginosis

Question 3

2 Tx options for candida vaginitis?

Answer 3

1. Intravaginal clotrimazole cream

2. Single oral dose of fluconazole

Question 4

Which two common infections cause cervicitis rather than vaginitis?

Answer 4

1. Chlaymidia

2. Gonorrhea

Question 5

What is drug fever and which commonly cause it?

Answer 5

• a prolonged fever caused by a medication, with no other obvious signs of inflammation
• antibiotics can cause this, esp beta-lactams

Question 6

Definition of systemic inflammatory response syndrome (SIRS)?

Answer 6

• presence of 2 or more of (in absence of a known cause):
  a) temp > 100F or < 96.8F
  b) heart rate > 90/min
  c) resp rate > 20/min, or PCO2 < 32
  d) leukocyte count > 12,000 or < 4,000 or > 10% bands

Question 7

Definition of sepsis?

Answer 7

-SIRS in response to confirmed infectious process

Question 8

Definition of severe sepsis?

Answer 8

-sepsis with organ dysfunction, hypoperfusion, or hypotension

Question 9

Septic shock definition?

Answer 9

• sepsis-induced hypotension or hypoperfusion abnormalities despite adequate fluid resuscitation
• this dx cannot be made until fluid resuscitation has been administered and the response has been evaluated!!

Question 10

What tx has shown to have the most impact on survival in a pt with severe sepsis?

Answer 10

-aggressive fluid resuscitation within 6 hrs!

Question 11

Prophylaxtic tx for an immunocomp, nonvaccinated pt exposed to the flu?

Answer 11

1. Zanamivir or oseltamivir

2. Inactivated flu vaccine

Question 12

What kind of drugs are oseltamivir and zanamivir? What are they used for?

Answer 12

• neuraminidase inhibitors
• both active against influenza A and B
• zanamivir can cause bronchospasm –> CONTRAINDICATED IN ASTHMA!!

Question 13

What influenza medication is contraindicated in asthmatic pts? Why?

Answer 13

• zanamivir

- may induce bronchospasm!

Question 14

Name 2 neuraminidase inhibitors that can be used for influenza?

Answer 14

1. Oseltamivir

2. Zanamivir

Question 15

Rhinitis medicamentosa? Tx?

Answer 15

• persistent rhinitis sx in a pt with chronic nasal decongestant spray use
• due to the rebound phenomenon
• tx: withdraw the decongestant and give nasal corticosteroid spray

Question 16

4 Ssx of bacterial rhinosinusitis?

Answer 16

1. Duration of the sx –> greater than 1 week + worsening sx after an initial improvement
2. Maxillary tenderness
3. Purulent drainage
4. Poor response to decongestants

Question 17

Tx for acute bacterial rhinosinusitis?

Answer 17

• 3 - 10 day course of narrow-spectrum antibiotics, such as:
  1) amoxicillin
  2) TMP-SMZ
  3) doxycycline

Question 18

Tx of acute pyelonephritis in a pt who is: compliant, can eat and drink, and not pregnant?

Answer 18

-oral levofloxacin

Question 19

What is the Tx for an uncomplicated UTI in a compliant, young, healthy, nonpregnant female?

Answer 19

-TMP-SMZ

Question 21

Oral antiviral agent used to tx uncomplicated genital herpes simplex virus?

Answer 21

-oral valacyclovir

Question 22

What is the most sensitive test to do in an HIV infection during the acute (early) stage?

Answer 22

-HIV viral load

Question 23

Progressive multifocal leukoencephalopathy: what is it? What is it caused by? What dies it lead to? Tx?

Answer 23

• opportunistic infection
• caused by polyomavirus JC
• leads to demyelination of the CNS –> causes progressive neurologic deficits
• tx: HAART tx

Question 24

What is the best solution to use to clean a catheter insertion site?

Answer 24

-chlorhexidine

Question 25

What IV catheter site is associated with a lower risk of infection?

Answer 25

-subclavian

Question 26

Best way to stop the spread of c. Diff from an infected pt?

Answer 26

- put the pt in contact isolation | - ALCOHOL RUBS are NOT effective for killing c. Diff!

Question 27

What contact precautions should a suspected or confirmed TB patient be tx with?

Answer 27

-airborne isolation + personal respirators for the hospital staff

Question 28

What is the best way to decrease the risk of UTIs from catheters?

Answer 28

- remove the catheter | - no other method (prophylactic antibiotics, disinfecting wash, etc) has been useful

Question 29

What helps prevent ventilator-associated pneumonia?

Answer 29

-keeping mechanically ventilated pts at 45* angle

Question 30

3 Cut-offs for induration from TB test? Who is in each group?

Answer 30

1. >5 mm --> highest risk, immunosuppresed, TB contacts, chest xray shows TB 2. >10 mm --> mid risk, immigrants, IV drug users, prisoners, health care workers, pts with chronic disease/malignancy 3. > 15 mm --> lowest risk, "normal" people

Question 31

What PPD cutt-off range are adolescents who are exposed to adults in high-risk category in?

Answer 31

-> 10

Question 32

What is the initial antiTB tx regime?

Answer 32

- 4 antiTB drugs (Rifampin, Isoniazide, Pyraznamide, Ethambutol) - the fourth drug may be stopped when the sensitivity results are back

Question 33

Latent TB tx?

Answer 33

-isoniazid for 9 mnths

Question 34

How does a prior vaccination with bCG affect the interpretation of a PPD?

Answer 34

- it does NOT change it! | - test is read as if the person does not have the vaccine!

Question 35

How does prednisone effect a PPD test?

Answer 35

- can cause a false-negative result! | - so test pt with PPD BEFORE starting prednisone!

Question 36

What is the best antibiotic tx for aspirate pneumonia? What are the common bugs involved?

Answer 36

- use: clindamycin | - bugs: anaerobes

Question 37

Reccomended tx for a pt with CAP who is being hospitalized?

Answer 37

Either: 1) IV beta-lactam plus IV or oral macrolide or doxy 2) IV fluoroquinolones

Question 38

What bug is likely to be the cause if there are extrapulmonary manifestations too?

Answer 38

-legionella

Question 39

What extrapulmonary manifestations are common with legionella pneumonia?

Answer 39

1. Hyponatremia 2. Azotemia 3. Elevated live enzymes 4. Elevated creatine kinase

Question 40

Which heart valve is the most susceptible to an abscess formation?

Answer 40

-the aortic valve and its adjacent ring

Question 41

What should be done first in a pt with a contiguous foot ulcer and possible bone involvement?

Answer 41

-bone bx with cultures before starting antibiotics!

Question 42

What imaging is preferred for the dx of osteomyelitis?

Answer 42

-MRI (best) or CT

Question 43

Tx for orthopedic implant-associated osteomyelitis?

Answer 43

- surgical debridement and removal of infected implant | - plus IV antibiotic

Question 44

What post surgery sx means the pt is more likely to have a periprosthetic infection?

Answer 44

- periosthetic pain | - those who are pain-free aftery surgery are less likely to become infected

Question 45

What could happen if an infected orthopedic implant is not removed?

Answer 45

-a biofilm can form & the bug will escape the hosts defenses!