Surgery +

Question 1

Prosthetic joint infections in the first 3 months after surgery-early onset- r due to which organisms?
Delayed PIJ is due to?
Late onset PIJ is due to?

Answer 1

• Early onset PIJ- virulent organisms eg. Staph aureus, pseudomonas
• delayed- 3-12 months- less virulent eg. CONS commonly staph epidermidis
• late onset- >12months- hematogenous spread from distant infections

Question 2

A 48yr old man sustained a small cut while sailing a boat on an ocean. A few hrs later he developed fever, chills, throbbing pain at the area and hemorrhagic bullae . He was recently diagnosed with hereditary hemochromatosis with liver function derangement. The most likely causative agent is? Suggestive features? Rx?

Answer 2

Vibrio vulnificus

• marine environment ( eating oysters is also a predisposing factor), liver disease especially hemochromatosis as iron acts as a good catalyst, development of sxs within few hours
• Rx - iv ceftriaxone + doxycycline

Question 3

Antibiotics contraindicated in a pt with aortic aneurysm ( or predisposing diseases like marfan, ehler danlos)

Answer 3

Fluoroquinolones - collagen degradation effect.

Question 4

A pt developed a large abrasion on her rt ankle after falling off her bike. 3 days later she noticed painful erythematous streaks around the aberration extending towards the knee.
Dx?
Common organisms?
Rn

Answer 4

Acute infectious lymphangitis.
Methicillin sensitive staph, strept pyogenes
- empiric cephalexin will do

Question 5

In a pt with diabetic foot ulcer where the bone underneath can b palpated with a sterile probe, the next step in the mx is?
A) swab n culture from the wound base
B) bone biopsy

Answer 5

B. Bone biopsy- to confirm osteomyelitis

Question 6

A guy came after developing painful papulopustular nodules on the bilateral lower extremities. He went on a hiking trip to new Mexico and swam in a heated hotel pool.
Most likely cause of his lesions?

Answer 6

Pseudomonas ( hot tub folliculitis)

Question 7

In a suspected ventilator associated pneumonia after obtaining cxr what should b done before initiating empiric abx?

Answer 7

Respiratory tract sampling

Question 8

Lamierre syndrome is?

C/f? Causative o/m? Rx?

Answer 8

It’s invasion of lateral pharyngeal space thru the lymphatic system usually following tonsillitis or pharyngitis causing internal jugular vein thrombosis. Infected thromboemboli can spread to the lungs - cxr- pulmonary nodules.

• fever, chills, dysphagia, neck pain after a prolonged ( eg a weeklong) tonsillitis
• Rx - antibiotics iv, surgical if not responding.

Question 9

A 45 yr old man comes after he noticed streaks of bright red blood in his sputum during repeated harsh coughs this morning. He has had 3wks of nasal congestion, progressive cough. P/E- boggy nasal mucosa, erythematous posterior oropharynx. He has lymphocyte predominant leukocytosis
Dx?

Answer 9

Pertussis- >2wks cough, vigorous cough with posttussive hemoptysis, lymphocytosis

Question 10

Rx of MAC

Answer 10

Macrolide based combination therapy- macrolides + Ethambutol

Question 11

When do u give prophylaxis against toxo n cmv in hiv pts?

Answer 11

Toxo- CD4<100

CMV- u don’t give prophylaxis regardless of the cd4 count. (It’s given for transplant recipients)

Question 12

Can pts with HIV b given the live attenuated vaccines( mmr, varicella)?

Answer 12

Yes, if their CD4 count is above 200 ( immunocompetent enough to clear the attenuated infection)

Question 13

What is the most common valvular abnormality(which valve) detected in pts with IE?

Answer 13

Mitral valve disease ( prolapse with coexisting regurgitation)

Question 14

A 40yr old HIV pt with CD4 count of 80 came with constitutional sxs, disseminated disease involving the respiratory, reticuloendothelial, mucocutaneous systems. Has hx of travel to Missouri. Most likely Dx? How is the dx made? Rx?

Answer 14

Histoplasmosis- CD4 <100, sxs like disseminated TB ( but cutaneous involvement is less common in TB), epidemiology

• serum or urine histoplasma antigen.( fugal culture takes 4-6wks so we don’t use it)
• amphotericin B
• can also resemble sarcoidosis- hilar LAP, erythema nodosum (in endemic areas like Mississippi).

Question 15

A 38yr old man comes with itchy lesions on his rt index finger, a nodular lesion draining odorless discharge. He later noticed similar lesions on the rt forearm. He works as a landscaper.
Most likely Dx?
Occupations associated?

Answer 15

Sporothricosis
Gardeners and landscapers
- decaying plant matter n soil are where the fungus lives in

Question 16

An elliptical violet colored skin lesion in a patient with advanced AIDS most likely represents?

Answer 16

Kaposi sarcoma

Question 17

Pneumococcal vaccines recommendation for adults

• PPSV23 alone
• sequential PCV13 + PPSV23

Answer 17

• PPSV23 alone- age 19-64-chronic lung, heart, liver disease; DM; current smoker; alcoholic
• sequential PCV13 + PPSV23
  1) age 19-64 with very high risk=> CSF leak, cochlear implant; sickle cell disease, asplenia; immunocompromised eg HIV; CKD
  2) age>65

Question 18

Tdap Vs Td vaccines for adults

Answer 18

After the age of 18, every adult should receive Td( tetanus diphtheria toxoid) every 10yrs but as a one time does in place of Td, an adult should receive Tdap( tetanus diphtheria pertussis) especially pregnants.

Question 19

Influenza vaccine is given annually to all adults; which form is it?

Answer 19

Im! Not intranasal

Question 20

A 31 yr old presented with CAP like sxs and joint pain; has erythematous tender nodules on the bilateral shins. He just got back to Connecticut from desert training in Arizona
Dx?

Answer 20

Coccidiodes- CAP, erythema nodosum, Arizona, Connecticut

Question 21

Dx of leprosy is made by?

Answer 21

Biopsy from the active edge of the lesion

Question 22

Rx of px n lactating mothers with early localized Lyme disease is?

Answer 22

Amoxicillin

Question 23

The most common cause of bacterial conjunctivitis in adults is?

Answer 23

Staph aureus.

- chlamydia n gonococcal infections usually occur with concomitant genital infections

Question 24

A 32 yr old man had viral hepatitis testing 2yrs back after having had sxs of acute hepatitis with positive results for hep BsAg, negative for all other Ags n Abs. He has been asymptomatic since then. Current hep B serology is most likely to show?
HepBsAg, HepBsAb, hepBcoreAb

Answer 24

HepBsAg- negative
HepBsAb- positive
hepBcoreAb- positive
As 95% of acute hepB infections r self limited.

Question 25

A 32 yr old is found to have a positive serologic test for for hepC antibody. What should b the next step in the mx?

Answer 25

Confirmatory molecular test for the presence of circulating hepC RNA.
Because half of hepC infections may clear spontaneously.

Question 26

A guy from Wisconsin has Mild pulmonary sxs ( pts can also have PTB like sxs and CXR May show pulmonary infiltrates n lytic bone lesions) with well circumscribed verrucous nodules and plaques. scrapings from the lesion show yeast.
Dx?

Answer 26

Blastomycosis- May resemble TB, Histoplasmosis ;

But, verrucous skin n lytic bone lesions, Wisconsin r suggestive of blastomycosis

Question 27

Neurocysticercosis is acquired by?

Answer 27

Ingestion of parasite eggs ( undercooked pork meat)

Question 28

A 19 yr old girl came with sore throat and lower abdominal discomfort. She also has polyarthralgia She’s sexually active and has 2 new sexual partners. P/E- erythematous tonsils with no exudate. Lower abdomen is tender to deep palpation. Pustular rash is seen over the trunk. The most likely causative agent is?

Answer 28

N. Gonorrhoeae