Infectious Disease

Question 1

What is the fever requirements for a neutropenic fever?

Answer 1

single oral temp of 101 or higher

temp of 100.4 sustained for longer than 1 hour (aka 2 temps taken 1 hour apart over 100.4)

Question 2

Which of the superficial veins is phlebitis most commonly affected?

Answer 2

great saphenous vein

Question 3

What pathogens are associated with acute necrotizing ulcerative gingivitis?

Answer 3

Anaerobic fusobacterium and spirochetes (Borellia sp.) are the predominant bacterial organisms involved

Question 4

Oral ulcers with an overlying grayish pseudomembrane and a punched-out appearance are also characteristic. Patients often exhibit fever, malaise, and regional lymphadenopathy and describe foul-smelling breath and a metallic taste in their mouth. What dx? What is the tx?

Answer 4

acute necrotizing ulcerative gingivitis (ANUG)

warm saline irrigation of the mouth and antibiotics with oropharyngeal coverage (penicillin, clindamycin, or metronidazole). Hydrogen peroxide or chlorhexidine oral rinses are also useful. Advanced disease requires consultation with an oral surgeon for dental extraction

Question 5

HIV+ pt, who is currently not receiving tx. Presents with widespread disseminated disease. What is the most likely dx? What is the tx?

Answer 5

Mycobacterium avium complex (MAC)

azithor OR clarithromycin
PLUS
ethambutol and rifabutin

Question 6

What is the most frequently isolated organism in acute suppurative parotitis?

Answer 6

staph aureus

Question 7

Question that mentions hiking or spending time outdoors with typical flu-like symptoms, including a gradual presentation of fever, malaise, fatigue, headache, anorexia, and myalgias in the coastal northeast or upper midwest. What pathogen? _____ is diagnostic

Answer 7

Babesia microti

blood smear

Question 8

What is this finding called? What dx?

Answer 8

Blood smear is diagnostic and will show the intraerythrocytic parasites on Giemsa staining.

Rings will be seen that are vacuolated, pleomorphic, or pyriform. Infected red blood cells do not enlarge and do not produce pigment. They will classically appear in a tetrad form known as a “Maltese cross.” Diagnosis can also be made by PCR, which is more sensitive than blood smear testing

Babesia microti carried by deer ticks

Question 9

tick born disease that presents with abrupt onset of fever, HA, myalgias and shaking chills. Leukopenia, thrombocytopenia and elevated LFTs. What dx? What are the vectors?

Answer 9

ehrlichiosis

Question 10

What are the 5 drugs/classes that provide ORAL coverage against MRSA?

Answer 10

bactrim
rifampin
clinda
tetracyclines
linezolid

Question 11

Which of the following tick-borne illnesses is most associated with skin ulcers and lymphadenopathy?

Answer 11

tularemia

Question 12

____ daily for ____ months is a treatment option for latent tuberculosis (TB) infection.

Answer 12

Rifampin daily for 4 months

Question 13

_____ and ______ are known adverse effects of daptomycin, and thus, ______ levels should be monitored

Answer 13

Myopathy and rhabdomyolysis

creatine kinase

Question 14

What organ is involved in the life cycle of malaria in humans?

Answer 14

liver

Question 15

Taenia solium, what is the common name? What does it the name of the dx?

Answer 15

pork tapeworm

neurocysticerosis

Question 16

An MRI of the head shows multiple calcified cysts in the parieto-occipital region, what type of worm? What is the dx?

Answer 16

Taenia solium, the pork tapeworm

neurocysticerosis

Question 17

What CD4 count are HIV+ pts most likely to develop PJP?

Answer 17

CD4 count less than 200

Question 18

How do you definitively dx PJP?

Answer 18

staining or PCR testing of sputum samples or bronchial lavages

Question 19

HIV+, with dry cough, dyspnea, weight loss, and fever that has been gradually worsening over the past month. What dx?

Answer 19

Pneumocystis jirovecii pneumonia (PJP)

classic “bat wing” appearance on CXR

Question 20

What are the 3 risk factors for candidemia?

Answer 20

include ICU admission, immunosuppression, and injection drug use

candidemia is presence of Candida species in the blood

Question 21

What is the recommended initial antifungal therapy for candidemia?

Answer 21

echinocandin

Question 22

Schistosoma organisms are associated with what organisms? What is the tx?

Answer 22

Common endemic areas include sub-Saharan Africa, South America, Southeast Asia, and the Caribbean. The parasite is carried by freshwater snails and is capable of penetrating intact human skin

Question 23

What is the tx for Schistosoma organisms?

Answer 23

praziquantel

Question 24

Started as a single bump on his right forearm that has been oozing fluid. Now progress up the lymph channel. No fever. Pt is a gardener/ag worker. What dx? What tx?

Answer 24

sporotrichosis

a fungal infection transmitted by inoculation into the skin with the fungus Sporothrix schenckii.

prick caused by a rose bush thorn

Tx: itraconazole

Question 25

What FDA boxed warning is associated with oral ketoconazole?

Answer 25

Hepatotoxicity and QT prolongation.

Question 26

What is one serious complication of diphtheria?

Answer 26

myocarditis

Question 27

What is the most effective antimicrobial pharmacological treatment for tetanus?

Answer 27

metro

Question 28

What are 2 additional lab findings that would help a PA clue into Rocky Mountain Spotted Fever?

Answer 28

thrombocytopenia and hyponatremia

Question 29

What is second line for Rocky Mountain Spotted Fever in a pt with a CI to tetracyclines?

Answer 29

chloramphenicol

Question 30

What type of infection is a known trigger for SJS?

Answer 30

Mycoplasma pneumoniae

Question 31

What STIs has the highest rate of cotransmission with HIV infection?

Answer 31

Treponema pallidum

Question 32

What type of "animal" transmits Dengue fever? What country has the highest rate of infection?

Answer 32

Aedes aegypti mosquito. Travelers returning from Africa, the Americas, and the Indian subcontinent tend to have classic dengue, with PERU having one of the highest rates of dengue in the world

Question 33

_______ manifests as sudden onset of high fever with retro-orbital headache, nausea, vomiting, severe myalgias, and a rash. What is the tx?

Answer 33

Dengue fever supportive care

Question 34

Measurement of what 2 labs can be used to monitor the progression of the Acute rheumatic fever (ARF)?

Answer 34

C-reactive protein or ESR

Question 35

What is the tx for latent TB in patient with reduced liver function?

Answer 35

*Rifampin* Isoniazid is hepatotoxic

Question 36

What is the important age to remember that determines treatment for botulism?

Answer 36

less than 1 year old = tx is human-derived botulism immune globin older than 1 year old = tx is equire serum botulism antitoxin

Question 37

What is the treatment for MAC?

Answer 37

Macrolide-based multidrug regimen (e.g., azithromycin, rifampin, and ethambutol).