ID 4

Question 1

Found in Shellfish, patients present with Diarrhea and Bullous skin lesions. It can cause potentially fatal infection in patient with Chronic Liver Disease and Cirrhosis?

Answer 1

Vibrio Vulnificus.

Question 2

When is ppx for Lyme disease indicated?

Answer 2

When the tick has been attached for > 36hrs and medications needs to be started within 72 hrs (3 days)

Question 3

Management of Candidemia?

Answer 3

Removal and Catheter and Start IV Caspofungin

Question 4

Next step in management in a patient diagnosed with influenza, feels better then gets sick again?

Answer 4

This is Secondary Bacterial Pneumonia. Give

Ceftriaxone + Azithromycin (CAP Treatment )+ Vancomycin (Cover for MRSA PNA)

Question 5

Pt with Poor Oral hygiene or Recent Dental Work presents with swelling over the mandible for 3 months. The sinus tract extending into skin shows purulent and blood-tinge drainage. Next Step in management?

Answer 5

Actinomycoses

IV PCN for 6 weeks then Oral PCN for 6-12 months

Question 6

This occurs in Pts who are severely immunocompromised (Blood Cancer Patients on Induction Chemo, Bone Marrow Transplant Patients) They develop Refractory Fevers, Skin lesions and Pulmonary disease.
Inoculation occurs through breaks in the skin from soil or Tap water. Dx? Rx?

Answer 6

Fusariosis.

Amp. B +/- High Dose Vorioconazole.

They need to AVOID SOIL and TAP Water.

Question 7

What is the most sensitive way to Diagnosis Typhoid Fever (Fever, Relative Bradycardia, Bacteremia Abdominal pain, Rash, Contaminated food in Developed Country)?

Answer 7

Bone Marrow Cultures.

Rather than bodily cultures.

Bone Marrow Cultures remain positive several days after Abx has been started.

Question 8

1. Fever, Headache, Retro-Oribital Pain, Rash, and Body aches, leukopenia, thrombocytopenia and Elevated LFTs. Dx?
2. Fever, Myalgia, Headache, Abdominal Pain + Conjunctival injection. Dx?
3. Fever, Chills, Headache, Abdominal Pain, N/V, Splenomegaly, Hyperbili and Anemia and Thrombocytopenia?
4. Fever, Abdominal pain, N/V, Jaundice and Hepatomegaly. LFTs> 1000 U/L. Dx?

Answer 8

1. Dengue Fever
2. Leptospirosis.
3. Malaria
4. Acute Viral Hepatitis

Question 9

Next Step in management for a patient who was exposed to TB but TST remains negative?

Answer 9

Do a repeat TST in 8-12 weeks due to Window Period.

Question 10

Name the vomiting predominate Organisms (Pre-Formed Toxin)?

Answer 10

1. Staph (Potato Salad) 2. Bacillus (Fried Rice) 3. Norovirus (Cruise Ship)

Question 11

Common CD4 counts for these opportunistic infections:

1. TB
2. PCP
3. Histoplasmosis
4. Toxo
5. Mycobacterium Avium

Answer 11

1. Any CD4 count
2. CD4< 200
3. CD4 < 150
4. CD4 < 100
5. CD4 < 50

Question 12

Which abx are appropriate to help prevent Travelers diarrhea in a patient seeking travel?

Answer 12

Azithromycin, Fluoroquinolones, Rifixamin. They can self medicate at the onset of diarrhea.

Away For Relaxation

Question 13

Which patients require CT scan before LP? Name the steps in Management ?

Answer 13

AMS, Immunocompromised, CNS disease (Stroke,), Seizure, Papilledema or Focal Neurologic Deficit.

1. Get Blood Cultures.
2. Abx and Steroids PRIOR to CT
3. CT
4. LP

Question 14

1. Acute febrile illness (Fever, Myalgia, Rash Progression) following syphilis treatment with Penicillin G.
2. What is the recommended treatment for a patient with confirmed syphilis in the latent phase or unknown duration?

Answer 14

1. Jarisch-Herxheimer Reaction. Give Acetaminophen or NSAIDs. Usually resolves within 48 hrs.
2. Pen G weekly for 3 weeks. Doxy for Severe PCN Allergy. All other get single dose of PCN G.

Question 15

Treatment for Hospital Acquired Meningitis?

Answer 15

Cefepime/Ceftazidime/Meropenem. Work against Gram negative Organism and have good CNS penetration.

Question 16

1. Contact with infected animals (Rabbits). Pts present with Ulceroglandular disease with a single Erythematous papular skin ulcer, Central Eschar and Tender local lymphadenopathy.
2. Bites and Scratches from Domestic Pets (Cats.) Pt have localized cellulitis and regional lymphadenopathy
3. Travel to Texas with Rat exposure. Ot presents with Fever and Regional Lymphadenitis (Swollen/Painful !!!Nodules.) Dx?

Answer 16

1. Francisella Tularensis (Tularemia)
2. Pasteurella Multocida. Amoxicillin/Clavulanate
3. Yersinia Pestis ( Bubonic Plague- Bubo)

Question 17

Which medication is important to give in addition to abx in patients with suspected Acute Bacterial Meningitis caused my Strept Pneumoniae ?

Answer 17

Dexamethasone. If CSF or Blood Cultures show NONpenumoccoal organism than you can stop steroid.

Question 18

Recommended prophylatic treatment for people EXPOSED to Neisseria Meningititis ?

Answer 18

Rifampin, Ciprofloxacin or Ceftriaxone.

Question 19

1. Common nocosomial infections in Transplant patients within the first month of surgery?
2. When does CMV occur?
3. When does PCP occur?

Answer 19

1. VRE, MRSA, Candida and Pseudomonas (colonizes hospital equipment (Mechanical Ventilation.)
2. 1-6 months ( Place on Valganciclovir ppx)
3. 3-4 months ( place on Bactrim PPx)

Question 20

Give symptom of each stage:

1. Early localized Lyme disease
2. Early disseminated Lyme disease
3. Late Lyme Disease

Answer 20

1. Erythema migrans
2. CN palsy and/or Meningitis
3. Arthritis

Question 21

Pt with DM and multiple Admissions for Ketoacidiosis presents with Purulent Nasal Discharge, Congestion and Right Sided Periorbital Swelling and Tenderness. Dx? Test? Rx?

Answer 21

Mucormycosis

Biopsy

Surgical Debridement + IV Ampicillin.

Question 22

Presents in Asplenic Patients, Age > 50 or Immunocompromised. After travel to Endemic area and Can Occur after Receiving a Blood Transfusion. Dx? Test? Rx?

Answer 22

Babesiosis

Peripheral Smear

Azithromycin + Atovaquone

Question 23

Seen in patients who Garden/Landscape. Pt present with reddish nodules that later ulcerates and other nodules with ulcerations appear in area. Dx? Test? Rx?

Answer 23

Sporotrichosis

Culture

Itraconazole