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ID - ABIM

Wrong on Test

QuestionAnswer
hepatitis A vaccine should be given to whom? Any person traveling to South Asia, Africa, South and Central America
How to manage a patient who needs a hepatitis A vaccine, but has to leave the country in two weeks and is immunocompromised, has chronic medical conditions, is older than 40, or has chronic liver disease? Give hepatitis A vaccine and intramuscular immune globulin
When does arthritis come in the course of Lyme disease? Late manifestation, months two years after the infection
What is the initial test for Lyme disease? Enzyme immunoassay – sensitive but not specific
What is the next step if the enzyme immunoassay for Lyme disease is positive? Do Western blot for confirmation
In assessing for Lyme disease, what if a patient has a positive enzyme immunoassay and a negative Western blot? This is a negative result. Patient does not have Lyme disease.
If an enzyme immunoassay is positive and a Western blot IgM is positive, how to interpret? If IgM is positive, and symptoms are present for less than one month, this is diagnostic of an acute infection. If IgM Western blot is positive, but the patient has had more than 30 days of symptoms, this is a false positive result.
In a patient who has had Lyme disease in the past, who now has new onset arthritis, how would you diagnose Lyme arthritis? Detection of Borrelia bergdorferi synovial fluid or tissue.
How to treat a patient with Lyme disease ? 28 day course of doxycycline or amoxicillin
How to interpret the results of a positive Lyme enzyme immunoassay, a positive IgM Western blot, and a positive IgG Western blot? Acute Lyme infection, treat with doxycycline for 28 days
Which organism is more likely to be resistant to vancomycin? Enterococcus faecalis? Or enterococcus faecium? enterococcus faecium, Harder to treat.
how to treat Enterococcus faecalis endocarditis? Ampicillin in gentamicin
What is the standardized evaluation for encephalitis? Lumbar puncture, brain MRI, EEG
gram-negative bacillus, associated with liver disease, acquired from consumption of raw shellfish (such as oysters) or skin trauma incurred in contaminated warm (>20 °C [68.0 °F]) sea water or brackish water, Hemorrhagic bullae Vibrio vulnificus
How to treat Vibrio vulnificus doxycycline plus ceftazidime in addition to surgery
gram + bacillus, acquired by fisherman, fish and shellfish handlers, veterinarian, and butchers, painful localized violaceous cutaneous inf of the hand or fingers ( erysipeloid) develops at the site of trauma or a preexisting wound, no fever Erysipelothrix rhusiopathiae
gram-positive cocci in clusters MRSA Staph
NonTB acid fast org, skin inf develop at sites of skin injury that have been exposed to salt or fresh water, such as in fish tanks (fish tank granuloma). The upper extremity is often involved and lesions are usually papular before becoming ulcerative. Mycobacterium marinum
gram-positive, lancet-shaped diplococci Streptococcus pneumoniae (pneumococcus)
treatment of urethritis and cervicitis due to C. trachomatis Azithromycin
Treatment for diagnosis of neisseria gonorrhea If only N. gonorrhoeae is diagnosed, dual therapy with ceftriaxone and azithromycin is recommended because of the high incidence of concomitant infection with C. trachomatis.
a progressively rising fever accompanied by abdominal pain, initial constipation followed by diarrhea, and relative bradycardia; tender hepatosplenomegaly is common Salmonella typhi, typhoid fever
salmon-colored blanching maculopapular lesions on the trunk or abdominal wall, Infection by fecal-oral route either from food or water handled by asymptomatic carriers or by introduction of the organism into sewage-contaminated water systems Salmonella typhi, typhoid fever
direct contact with infected animals, ingestion of infected animal products, or inhalation. Fever occurs and is often intermittent or undulant. Arthralgia and arthritis, neurologic and psychiatric symptoms, and genitourinary involvement are also common Brucellosis
arenavirus endemic to Western Africa. Infection can be acquired after direct or indirect contact with infected rodent excreta. High fever, abdominal pain, and headache may progress to hemorrhagic manifestations Lhasa fever
spirochetes, occupational (farmers, abattoir workers, veterinarians) exposure, related to travel, acute fever, muscle pain (typically lumbar and calf regions), redness of the conjunctiva, and, occasionally, aseptic meningitis. Leptospirosis
Patients who have undergone transplantation are at high risk for ?? infection, especially during the first 6 to 12 months and after episodes of rejection requiring increased immunosuppression. Pneumocystis jirovecii
What is the drug of choice for candidemia? caspofungin, micafungin, anidulafungin
What can a camper do to protect herself from Giardia? Boil or filter water. Chlorination does not prevent infection.
What is the treatment of choice for coccidioidal meningitis? Fluconazole
pt w h/oHIV with headache, vomiting, change in mental status, coming back from travel in South America. CSF shows a lymphocytic predominance with high protein and low glucose. coccidioidal meningitis
Complement fixing IgG in CSF coccidioidal meningitis
What is the treatment for cutaneous anthrax? A fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin)or doxycycline
Patients with a cutaneous lesion that has a "coal-like" black eschar. Cutaneous anthrax, treat with cipro
First occurrence of mild to moderate Clostridium difficile diarrhea Oral metronidazole x 14 days
First occurrence of severe Clostridium difficile diarrhea Oral vancomycin x 14d
Second occurrence of mild to moderate Clostridium difficile diarrhea Oral metronidazole x 14 days
Second occurrence of severe Clostridium difficile diarrhea Oral vancomycin x 14d
Third occurrence of Clostridium difficile diarrhea Oral vancomycin tapered over 6 to 8 weeks.
A healthy patient has pulmonary symptoms and a nodule that is positive for Cryptococcus neoformans. What is the next step? What is the diagnosis? Next step is to do a lumbar puncture even if the patient does not have CNS symptoms. Treat with daily fluconazole for 6 to 12 months.
What to do for a patient in the ICU with asymptomatic candiduria Patient has an indwelling catheter, catheter should be removed and repeat urine sample after a few days. Only treat if patient is neutropenic or patient is undergoing a urinary tract. Treat with oral fluconazole.
What to do for an HIV-positive patient who needs the pneumococcal vaccine? The 13 valent first, followed eight weeks later by the 23 valent
What to do for an HIV-positive patient who needs the pneumococcal vaccine, but already received the 23 valent in the past? The 13 valent first, followed eight weeks later by the 23 talent again
Pseudohyphae and budding yeast forms Candida albicans
Branching hyphae with septations Aspergillus fumigatus
Large, round, budding yeast with broad base blastomyces dermatiditis
Rod, irregularly branched hyphae, no septations Mucor mycosis
Canada found in a sputum sample Likely colonization, not likely to cause primary pneumonia
A hospitalized patient treatment for pelvic inflammatory disease. What to give them? Cefoxitin or cefotetan plus doxycycline
What biotic for treatment of pelvic inflammatory disease in the outpatient setting? Ceftriaxone intramuscular injection x1, plus 14 day course of oral doxycycline
Banana shaped gametocyte within a red blood cell Malaria from Plasmodium falciparum
Patient with recent history of HIV dx (CD4<50) and start of anti-retro viral therapy. She now presents with fever, chills,'s, fatigue, weight loss. Also, LAD, HSM, elevated alkaline phosphatase She has immune reconstitution inflammatory syndrome. Tx with clarithromycin and ethambutol. continue anti-retro viral therapy
Patient is currently being treated for Lyme disease. Now presents with fever, leukopenia, thrombocytopenia. What is the diagnosis? How to treat? Co-infection with Anaplasma phagocytophilum. treat with doxycycline
Patient with hemolysis, jaundice, scleral icterus, splenomegaly, recently with transfusion pt got blood from someone who was later diagnosed with babesiosis (transmission by tick bite)
Patient who is negative for Epstein-Barr virus receives an organ one year ago from a donor who is seropositive for Epstein-Barr virus. What are they at risk for? Post transplant lymphoproliferative disease, can present with hilar lymphadenopathy with a singular enlarged lymph node
Patient who comes back from the Middle East five days ago now with a viral syndrome. Also has G.I. symptoms. Should have high clinical suspicion for middle East respiratory syndrome
What should you think about when you have a sputum Gram stain that is positive for both gram-positive and gram-negative bacteria of multiple morphologies? Think about anaerobic infection from aspiration of organisms in the oropharynx
Healthy adult patients is exposed to varicella zoster (chickenpox). what to treat with? What if the patient were immunocompromised – what to treat with? Healthy person – varicella vaccine within 3 to 5 days of exposure. Immunocompromised patients, who should not have live attenuated vaccine – give IV Ig within four days of exposure
Name the types of infection that require IV antibiotics CNS, staphylococcus aureus bacteremia, endocarditis, osteomyelitis
Aztreonam covers what organisms? Aerobic, gram-negative
Patients who had been in recent contact with a person that has active tuberculosis. PPD is 7 mm. What to do? This is a positive test, patient has latent tuberculosis, should be treated with isoniazid
Created by: christinapham