ID 5

Question 1

Rx for Latent TB? (3)

Answer 1

1. Isoniazid + Rifapentine weekly for 3 months
2. Isoniazid for 6-9 months (Give Pyridoxine for Neuropathy)
3. Rifampin 4 months

Question 2

Pt presents with Poor Denal Hygiene, New Murmur and Enlarged Spleen? Next step in management?

Answer 2

Blood cultures + TTE for IE

Question 3

60 Y Man presents with Difficulty walking, Decreased Sensation and Weakness in lower extremities.
Pt also has Early Diastolic Murmur over Aortic area.
Dx? Test? Rx?

Answer 3

Dx: Tertiary Syphilis. Pt has Tabes Dorsalis with Cardiac Syphilis involvement.

Test: RPR (Chronic) will be negative but T. Pallidum is 100% Positive.

Rx: Neurosyphilis —> IV PCN for 10-14 days.

Question 4

Abx Commonly associated with C. Diff?

Answer 4

1. Fluoroquinolone
2. Clindamycin
3. Penicillin.

FCP Flush Clean Poop

Question 5

Pt from Laos presents with Abdominal Pain, Hx of PNA and Asthma. Eosinophilia 15%. Stool Studies Negative. Dx? Test? Rx?

Answer 5

Dx: Strongyloidiasis.

Rx: Check Serology, (ELISA IgG Antibody) or Duodenal Biopsy/Aspirate.

Stool cultures often negative.

Rx: Ivermectin, Albendazole.

Question 6

44 Yo M hx of HIV presents with fevers, progressive generalized fatigue, poor appetitie and marked weightloss over 2 months. Last CD4 count 6 months ago 90. Temp 101. BP 91/53 pulse 105. He has pale conjunctiva dry mucous membranes. CT Chest & Abdomen shows lucencies in skeleton and bulk mediastinal and abdominal lymphadenopathy.

What will bone marrow biopsy show?

Answer 6

Non-Hodgkin Lymphoma. (4% of HIV Patients ( with high viral load and low CD4 coun) have lymphoma at the time of diagnosis.)

Question 7

Pt who was swimming in Fresh Water presents with Fever and Eosinophilia, Urticiaria, Angioedema returning from Sub-Saharan Africa. Dx? Rx?

Answer 7

Schistosomiasis. (Katayama Fever) Steroids and Praziquantel - want to prevent longterm sequelae of hydronephrosis and bladder cancer.

Question 8

Can get it in the water and presents with nonspecific Gastrointestinal symptoms (Flatulence, Diarrhea, Lactose Intolerance, Malabsorption.)

Answer 8

Amebiasis

Question 9

Pt with a hx of breast cancer presents with 3 days fever, cough, bloody sputum, night sweats, R sided Pleuritic Chest Pain, Tachycardia and Generalized malaise. She is started on Vanc and Zoysn and fail to improve.

CT Scan shows 1-2 cm Nodular Lesions scatted throughout the lung with Surrounding Ground-Glass Attenuation.
Blood and Sputum Negative
Bronchoscopy and Broncholoalveolar Lavage are peformed for culture and cytology.

Next Step in management?

Answer 9

Voriconazole.

Question 10

1. Seen in asthma/CF patients, fever, wheezing, bronchial hyper-reactivity, productive cough with Brownish Mucous plugs and Hemoptysis. Dx? Rx?
2. Fungus Ball in Pre-Existing Lung Cavity, No Systemic Symptoms, Cavity remains Stable for Months. Dx? Rx?
3. > 1 Lung cavities in immunocompetent patients, Symptoms > 3 months. Diagnosed with IgA Aspergillus Antibodies. Dx? Rx?
4. Similar to Chronic PA with Shorter duration in Immunocompromised Patients. Dx? Rx?
5. Severly Immunocompromised Patients. CT can Shows Small nodules with/without cavitation Surrounded by Ground-gGass Infiltrate. Dx? Rx?

Answer 10

1. ABPA. Steroids + Itraconazole
2. Simple Aspergilloma. Asymptomatic No Rx. Others Surgical Resection
3. Chronic Cavitary PA. Itraconazole/ Voriconazole
4. Chronic Nectroziting PA. Voriconazole
5. Invasive Aspergillosis. Voriconazole

Question 11

Since most Patients Improve Clinically. What is the treatment for Hep B and when is it indicated?

Answer 11

Tenofovir, Entecovir.
1. > 4 weeks of symptoms, jaundice, bilirubin
4. INR
5. Acute Liver failure

Question 12

South Asia Travel, Fever, bacteremia, Relative Bradycardia, Abdominal pain with macular rash. Dx? Most Sensitive Test?

Answer 12

Typhoid Fever. Bone Marrow Culture.

Question 13

South Asia Travel, Fever, abdominal pain, malaise, HA, CONJUNCTIVAL Suffusion. Dx?

Answer 13

Leptospirosis

Question 14

What is the management of Unvaccinated Household contacts exposed to a Patient with Hep A.

Answer 14

HAV Vaccine to 12month to 40 yo. HAV vaccine and immunolgobuline to the babies, elders and immunocompromised.

Question 15

1. Common nosocomial infections that occur in the 1st month of transplant surgery?
2. Common infection that occurs between 1-6 months?
3. Common infection that occurs > 6 months.

Answer 15

1. VRE, Pseudomonas, MRSA
2. CMV
3. Nocardia.

Merge the CMV to the land of Nocardia

Question 16

1. 36 yo M wakes up with dyspnea, Non productive cough, fever, malaise. They are vacationing in Florida and staying in a old dusty rental. Last night they HAD SEX in the Hot Tub. CXR shows Interstitiial Infiltrate. Dx? Rx?
2. What other bacteria can infected people in the hot tub and what does it cause?

Answer 16

1. Nontuberculous mycobacteria Pneumonia (Hypersensitivity Pneumonitis (Mycobacterium Avium complex)
   Rx: Self limited and resolves with supportive care.
2. Pseudomonas: Hot tub folliculitis

Question 17

Which organism causes bacteremia and spontaneous gas gangrene in the Lower extremity without Hx of Trauma? What Pathology is it associated with?

Answer 17

Clostridium Septicum. GI tract Pathology - Spreads from GI to Blood. (Colon Cancer, IBD, Diverticulitis).

All Patients should undergo Colonoscopy.

Question 18

What infectious disease are IV Drug users at risk for developing? What is the common organism?

Answer 18

Infective Endocarditis caused by S. Aureus which is common on skin.

Strept is common in mouth/Oral.

Question 19

HIV Patient presents with Fever, cough, Chest pain, Weight loss, Headache, Night Sweats, Chills, Fatigue. LDH > and Hypoxemia seen on ABG. CXR shows Interstitial Infiltrated. Dx? Common Complication of this Dx?

Answer 19

PCP. Spontaneous Pneumothorax (Rupture of Cystic Lesions)

Question 20

Elderly nursing home resident presents with Confusion (Neurologic), HIGH Fever and bradycardia. He has Low Sodium, Low Platelets and Elevated AST and ALT on on labs.
He is started on Vanc and Zoysn but fails to respond.

Dx?
What confirms this diagnosis?
Rx?

Answer 20

1. Legionella Pneumonia
2. Urine Antigen and Respiratory Cultures
3. Respiratory Fluoroquinolones (Levofloxaxin) or Azithromycin

Question 21

What is the management of a Cat bite
1.Medication?
2. What if there is a PCN Allergy?
3. Vaccine?
4. Wound Closure?

Answer 21

1. Augmentin (Amoxicillin Clavulanic Acid). First Dose IV then ORAL for 3-5 days
2. Doxy or Bactrim if there is PCN Allergy
3. Vaccine only if due < 5 years Tetanus
4. Leave open and alllow to close with Secondary intent.

Question 22

Management of PCP:

1. Mild/Moderate?
2. Severe?

Answer 22

PCP. Mild (P02 > 70 mmhg) or ( moderate 60-70mmhg)

Bactrim BID x 21 d if allergic then Atovaquone

Severe < 50mmhg:

Bactrim IV q8 or Pentamidine (if allergic to Bactrim) + Steroids.

Question 23

What treatment is added to Secondary Bacterial Pneumonia?

Answer 23

Ceftriaxone and Azithromycin + Vancomycin (MRSA Coverage)

Question 24

Determine the cause of the Rash:

1. Young Patient with boy friend Develops rash after being given Amoxicillin.
2. Associated with Polyarteritis Nodosa and Palpable Purpura.
3. Pt travels to North Carolina develops Systemic Symptoms then Macular Petechial rash Several Days later.

Answer 24

1. Infectious mononucleosis
2. Chronic Hep B
3. Rocky Mountain Spotted Fever

Question 25

What is the difference in heart disease manifestations in Lyme disease and Chagas disease?

Answer 25

Lyme Carditis - AV Block Chagas Dz- Dilated Cardiomyopathy

Question 26

Young women presents fever, swollen joints in knee and wrist. She has pustular lesions on skin. 1. Dx? 2. Test? 3. Rx? 4. Concomitant Abx? 5. Who else do you want to treat?

Answer 26

1. Disseminated Gonococcal Infection. 2. Synovial fluid analysis (10,000-50,000) , blood cultures ( Maybe negative) Best test is Culture of Pharynx and Cervix, rectal, urethral) 3. IV Ceftriaxone, Can switch to oral Cefepime if there is improvement. 4. Azithromycin or Doxycycline for Chlamydia 5. All partners.

Question 27

Rx for Hospital Acquired Bacterial Meningitits?

Answer 27

Cefepime (Needed for Pseudomonal Coverage) and Vancomycin. Community Acquired ( S. Pnumonia) - Ceftriaxone.

Question 28

50 yo M presents with non healing skin lesion on R side that is draining purulent material, occaisional productive cough and foot pain. He travels to Mississipi once or twice per year. CT scan shows lytic lesions in mid foot. CXR shows patchy alveolar opacities in the R upper lung lobe. Dx?

Answer 28

Disseminated Blastomycosis. Blasto blast bones, balls (epididymo-orchitis) and kin

Question 29

What can happen in each stage of Lyme dz. 1. Early localized Dz? 2. Early disseminated Dz? 3. Late Lyme Dz?

Answer 29

1. Viral like Symptoms and Erythema Migrans 2. Acute Arthralgias, Lyme Carditis, Facial nerve Palsy 3. Arthritis in large joints.

Question 30

Young women traveling from the Carribean develops Persistent fever and unbearable pain in Shoulder, Left Elbow and Left Knee. She has swelling of the left elbow and left knee. Dx?

Answer 30

Chickungunya

Question 31

Associated with Rodents, Can cause cardiopulmonary syndrome and hemorrhaggic fever with renal syndrome. Dx?

Answer 31

Hantavirus. (Transittmed through Rodents)

Question 32

Associated with systemic disorders (IBD, Malignancy, Athropathies). Pt develops rapidly painful purulent ulcer with violaceous and underminded border. Dx?

Answer 32

Pyoderma gangrenosum.

Question 33

Occurs in non-chlorinated water. Associated with fishermen, oyster handlers, swimmers and aquarium workers. DX?

Answer 33

Mycobacterium Marinum.

Question 34

Associated with outbreaks at restaurants, health care settings and travel. Vomiting predominant gastroenteritis.

Answer 34

Norovirus.