Transcript ID BOARD REVIEW

ID BOARD REVIEW
James Hinchey MD PhD MSW MPH
JD BA SOB
What do they like to ask?
• HIV- opportunistic infections
• Rabies
• Diarrhea-infectious
• Ticks, worms, parasites
• Syphilis
Which of the following infectious agents is
thought to be the most common cause of
Bell Palsy?
A. Borrelia bugdorferi
B. Epstein-Barr virus
C. Herpes simplex virus
D. Mycobacterium tuberculosis
E. Varicella-zoster virus
Which of the following infectious agents is
thought to be the most common cause of
Bell Palsy?
A. Borrelia bugdorferi
B. Epstein-Barr virus
C. Herpes simplex virus
D. Mycobacterium tuberculosis
E. Varicella-zoster virus
Herpes simplex virus
• Type 1 mostly oral, Type 2 primarily genital
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prodrome of pain and hyperesthesia
Painful vesicles on an erythematous base crust and heal
in 10-14 days
recurrences in immunocompromised, prolonged sunlight
exposure, stress
Bells Palsy: Ddx- HIV, Lyme disease, TB, temporal bone
trauma, mumps, Mycoplasma pneumonia, leprosy,
sjogren’s, sarcoidosis; HSV most frequently
associated
antivirals in primary infection to decrease viral shedding
and shorten duration of symptoms NOT to prevent
recurrence
long term suppressive therapy in those with severe and
frequent recurrences
IV abx and admission for HSV encephalitis
73 yr old woman p/w nausea and vomiting that began
suddenly that afternoon. She was fine in the morning
and went to a church picnic. 3 hours later she
developed her current symptoms. She asked a friend to
take her to he hospital, but her friend had also become
ill. She recalls that they ate barbecued chicken, spinach
salad, potato salad and some cookies.on exam, she
appears weak and dehydrarted. She has no fever, and
her stool tests hem-occult negative. What organism is
the most likely cause of her symptoms?
A.
B.
C.
D.
E.
Campylobacter jejuni
Clostridium perfringens
Salmonella typhimurium
Shigella flexneri
Staphylococcus aureus
73 yr old woman p/w nausea and vomiting that began
suddenly that afternoon. She was fine in the morning
and went to a church picnic. 3 hours later she
developed her current symptoms. She asked a friend to
take her to he hospital, but her friend had also become
ill. She recalls that they ate barbecued chicken, spinach
salad, potato salad and some cookies.on exam, she
appears weak and dehydrarted. She has no fever, and
her stool tests hem-occult negative. What organism is
the most likely cause of her symptoms?
A.
B.
C.
D.
E.
Campylobacter jejuni
Clostridium perfringens
Salmonella typhimurium
Shigella flexneri
Staphylococcus aureus
35 yo male with 12 hour history of severe abdominal
cramping, nausea and loose watery stools, no fever no
vomiting no travel-12 hours earlier he had eaten turkey
left out at room temperature-what is them most likely
etiology
A.
B.
C.
D.
E.
Campylobacter jejuni
Clostridium perfringens
Salmonella typhimurium
Shigella flexneri
Staphylococcus aureus
35 yo male with 12 hour history of severe abdominal
cramping, nausea and loose watery stools, no fever no
vomiting no travel-12 hours earlier he had eaten turkey
left out at room temperature-what is them most likely
etiology
A.
B.
C.
D.
E.
Campylobacter jejuni
Clostridium perfringens
Salmonella typhimurium
Shigella flexneri
Staphylococcus aureus
Staphylococcus Aureus
• 2 or more persons with same illness and common food
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exposure- foodborne infection
Staph aureus (primarily upper GI symptoms), short
incubation period (1-6 hrs), preformed enterotoxin,
unrefrigerated meats, potato/egg salad, cream pastries,
severe sudden vomiting,
Campylobacter, Salmonella, Shigella - clinically
indistinguishable, diarrheal illness 1-3 days after
exposure (multiply in stomach), self-limited but usually
treated with fluoroquinolone
Clostridium perfringens- watery diarrhea, symptoms
within 24 hrs, precooked meats allowed to thaw before
cooking, self-limited
Diarrhea
• ...which is mucoid bloody + high fever + febrile seizure in infant 
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shigella
…in patient with pet turtle or iguana  salmonella
…in patient without spleen or with sickle cell  salmonella
…and pseudoappendicitis presentation  yersinia
…& fecal WBCs after poultry or eggs  salmonella, campylobacter
…after poultry or meat, no fecal WBCs  Clostridium perfringes
…profuse and watery after antibiotic  Clostridium difficile
…after potato salad or mayonnaise  Staphylococcus aureus
…after fried rice  Bacillus cereus
…after raw oysters  Vibrio cholera
…after drinking from mountain stream  Giardia lamblia
…in AIDS patient  isospora or cryptosporidium
…and hemolytic-uremic syndrome or TTP  E. coli 0157:H7
Assuming the patient is a resident of North America and
has never been immunized against rabies, in which of
the following situations are rabies immune globulin and
rabies vaccine series clearly indicated?
A. Patient bitten by a chipmunk that escapes
B. Patient bitten by a neighborhood dog that
C.
D.
E.
has been captured and quarantined
Patient bitten by the family dog
Patient scratched by a bat that was in his
home, and the bat escapes
Patient who sees a bat in her backyard and
is not aware of any contact
Assuming the patient is a resident of North America and
has never been immunized against rabies, in which of
the following situations are rabies immune globulin and
rabies vaccine series clearly indicated?
A. Patient bitten by a chipmunk that escapes
B. Patient bitten by a neighborhood dog that
C.
D.
E.
has been captured and quarantined
Patient bitten by the family dog
Patient scratched by a bat that was in
his home, and the bat escapes
Patient who sees a bat in her backyard and
is not aware of any contact
Rabies
• Bat main vector in US; most without documented bite,
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so any exposure to saliva or mucous membranes
indication for treatment, unless captured, sacrificed
(Negri bodies)
Dog main vector in world
Prodrome: excitement, opithotonus, hydrophobia,
salivation, lacrimation, ataxia
In US rabies rare in canines
Bites from rodents (chipmunks, squirrels, hamsters,
guinea pigs, etc) not indication for vaccine
Rabies postesposure prophylaxis: human rabies immune
globulin (HRIG) + human diploid cell vaccine (HDCV) in
deltoid days 0, 3, 7, 14, and 28
Which of the following is the most common initial
neurologic manifestation of diphtheria?
A. Bells palsy
B. Lower extremety weakness
C. Diplopia, blurred vision and
photophobia
D. Paralysis of palate muscles
E. trismus
Which of the following is the most common initial
neurologic manifestation of diphtheria?
A. Bells palsy
B. Lower extremety weakness
C. Diplopia, blurred vision and
photophobia
D. Paralysis of palate muscles
E. trismus
• Diphtheria disrupts protein synthesis causes
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demylination- producing a peripheral neuropthy
Palate muscles are most commonly affectedusually does not cause bells palsy
Trismus- tetanus
Diplopia, blurred vision, photophobia think
botulism
A 75 yr old man p/w fever and ear pain. He has had the
earache for several weeks and has been treating it at home
with warm mineral oil. On further questioning, he says that
he is diabetic and that his sugars are running higher than
normal. Exam is normal except for the ear which has
granualation tissue on the floor of the external auditory
canal. The most likely pathogen causing this infection is:
A.
B.
C.
D.
E.
Aspergillus sp.
Candida species
Pseudomonas aeruginosa
Staphylococcus epidermidis
Streptococcus pneumoniae
A 75 yr old man p/w fever and ear pain. He has had the
earache for several weeks and has been treating it at home
with warm mineral oil. On further questioning, he says that
he is diabetic and that his sugars are running higher than
normal. Exam is normal except for the ear which has
granualation tissue on the floor of the external auditory
canal. The most likely pathogen causing this infection is:
A.
B.
C.
D.
E.
Aspergillus sp.
Candida species
Pseudomonas aeruginosa
Staphylococcus epidermidis
Streptococcus pneumoniae
Malignant otitis externa
• Seen in elderly, diabetics, HIV,
immunocompromised, persistent
otitis externa (failing 2-3 weeks
of Abx)
• Pseudomonas, aspergillus, Staph,
Strep
• Otalgia/otorrhea, cranial nerve
involvement with progression,
HA, neck pain, fever, AMS
• Management: Radiographic
imaging, admission parenteral
antibiotics, possibly surgical
debridement
24 year old man with no PMH p/w 5 days of nonprod
cough, fever, sob, and DOE, the patient is thin has
multiple enlarged cervical lymph nodes, bilateral ronchi
on pulmonary exam, a temperature of 40.1 and O2 sat
of 83% on room air. He is admitted to the hospital.
Which of the following is the most appropriate choice
for empiric antibiotics?
A.
B.
C.
D.
E.
Ceftriaxone and azithromycin
Levofloxacin
Levofloxacin and bactrim
Metronidrazole
Bactrim
24 year old man with no PMH p/w 5 days of nonprod
cough, fever, sob, and DOE, the patient is thin has
multiple enlarged cervical lymph nodes, bilateral ronchi
on pulmonary exam, a temperature of 40.1 and O2 sat
of 83% on room air. He is admitted to the hospital.
Which of the following is the most appropriate choice
for empiric antibiotics?
A.
B.
C.
D.
E.
Ceftriaxone and azithromycin
Levofloxacin
Levofloxacin and bactrim
Metronidrazole
Bactrim
PCP
• PneumoCystis Pneumonia caused by
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pneumocystis jiroveci
Chest pain, cough, dyspnea, scant sputum, high
fever, hypoxia, A-a gradient, CXR- bilat
interstitial infiltrates
Most common opportunistic infxn in those with
HIV
Rx: CAP coverage + PCP coverage: bactrim,
pentamidine, clindamycin + primaquine
In adults with suspected meningitis which of the
following clinical features at presentation is most
likely to predict abnormal findings on head CT
scan?
A. Fever
B. Headache
C. Immunocompromised state
D. Photophobia
E. Stiff neck
In adults with suspected meningitis which of the
following clinical features at presentation is most
likely to predict abnormal findings on head CT
scan?
A. Fever
B. Headache
C. Immunocompromised state
D. Photophobia
E. Stiff neck
• Study of 235 patients CT before LP
• Clinical features assoc with abnormal CT:
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age>60, immunocompromised state, h/o CNS
disease, h/o seizure within 1 wk of
presentation
Neuro signs associated with abnormal CT:
abnormal level of consciousness, inability to
answer 2 consecutive commands, gaze palsy,
abnl visual fields, facial palsy, arm drift, leg
drift, abnl language
The organism most commonly
occurring in puerperal mastitis is:
A. Bacteroides fragilis
B. Candida Albicans
C. Escherichia coli
D. Staphylococcus aureus
E. Streptococci
8. The organism most commonly
occurring in puerperal mastitis is:
A. Bacteroides fragilis
B. Candida Albicans
C. Escherichia coli
D. Staphylococcus aureus
E. Streptococci
Puerperal Mastitis
• Inflammation of breast typically in
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immediate postpartum period but
also with teeth eruption in infants
Blockage of ducts by overgrowth of
bacteria in nutirent-rich breast milk
Staph, E coli, Strep
Vague symptoms: myalgia, fevers,
chills, flu-like sx
Rx: breast emptying, skin cleansing,
analgesia, abx, breastfeeding can
continue
If fails therapy, consider
abscess/polymicrobial
infxn/carcinoma, do ultrasound
Which of the following statements
regarding anthrax is correct?
A. Aerobic blood culture growth of gram - cocci suggests
B.
C.
D.
E.
systemic anthrax
Cutaneous anthrax, although uncomfortable, is usually
self-limited and does not require therapy
Inhalational anthrax is initially a flu-like illness that
deteriorates into septic shock within 24-48 hrs of
symptom onset
Only known samples are in repositories in Russia and
US
Treatment of choice for all types is ceftriaxone
Which of the following statements
regarding anthrax is correct?
A. Aerobic blood culture growth of gram - cocci suggests
B.
C.
D.
E.
systemic anthrax
Cutaneous anthrax, although uncomfortable, is usually
self-limited and does not require therapy
Inhalational anthrax is initially a flu-like illness
that deteriorates into septic shock within 24-48
hrs of symptom onset
Only known samples are in repositories in Russia and
US
Treatment of choice for all types is ceftriaxone
Anthrax
• Woolsorter’s disease
• Manifestation depends on how spores enter
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body: Skin, GI, Inhalational (most lethal)
Cutaneous(1-5days) papule->vesicle->eschar
GI(2-5days) n/v, mesenteric adenitis->
hematemesis, ascites, abd. pain-> shock
Inhalation(1-6days) ->Flu like illness ->within
24-48 hours sepsis, shock, hemorrhagic
mediastinitis, resp failure
CXR: mediastinal widening, hilar adenopathy
Gm + bacilli, serology, cipro or doxy, vaccine
Anthrax
Cutaneous Anthrax
A 22 year old man p/w headache, stiff neck,
and fever. An immediate LP reveals cloudy
CSF. What is the appropriate treatment?
A. Dexamethasone only until gram stain of fluid is
B.
C.
D.
E.
available
Intrathecal antibiotics
Intravenous antibiotics
Intravenous dexamethasone followed by
antibiotics
IVIG followed by antibiotics
A 22 year old man p/w headache, stiff neck,
and fever. An immediate LP reveals cloudy
CSF. What is the appropriate treatment?
A. Dexamethasone only until gram stain of fluid is
B.
C.
D.
E.
available
Intrathecal antibiotics
Intravenous antibiotics
Intravenous dexamethasone followed by
antibiotics
IVIG followed by antibiotics
Meningitis
• high mortality rate, survivors may have long•
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term neurological sequelae
10 mg of dexamethasone 15-20 min before
antibiotic reduces morbidity and mortality
(steroids cont. Q6 x 4 days)
Gans study: dex reduced mortality rate in
pneumococcal meningitis by 50%
Not shown to reduce neurologic sequelae
Not shown to provide benefit in meningococcal
meningitis
Which of the following statements
regarding bite wounds is correct?
A. Cat bites are most commonly polymicrobial
B. Cat bites do not require prophylactic unless
C.
D.
E.
there is a foreign body in the wound
Mammal bites are not tetanus-prone wounds
Only 5-6% of dog bites ultimately become
infected without treatment
Pasturella multocida is frequently the sole
pathogen in infected dog bites
Which of the following statements
regarding bite wounds is correct?
A. Cat bites are most commonly polymicrobial
B. Cat bites do not require prophylactic unless
C.
D.
E.
there is a foreign body in the wound
Mammal bites are not tetanus-prone
wounds
Only 5-6% of dog bites ultimately
become infected without treatment
Pasturella multocida is frequently the sole
pathogen in infected dog bites
Mammalian Bites / DOG
• Least infective
• Most commonly
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polymicrobial
Pasteurella multocida
RX: prophylactic
antibiotics not routinely
recommended except for
immunocompromised or
bites to hand: PCN,
augmentin, doxy
Mammalian Bites / Cat
• More infective
(30-80%)
• Pasteurella
• Same Abx
Human Bite
• Clenched fist
• Consider in genital
wounds
• Most infective
• Eichenella
corrodens
• PCN, Augmentin
Which of the following statements regarding
Rocky Mountain Spotted Fever in children is
correct?
A.
B.
C.
D.
E.
CSF pleocytosis is commonly present
IV Clindamycin is the treatment of choice
Most cases are diagnosed in the western US
Most commonly seen in adolescents
Rash is initially petechial and becomes purpuric
Which of the following statements regarding
Rocky Mountain Spotted Fever in children is
correct?
A.
B.
C.
D.
E.
CSF pleocytosis is commonly present
IV Clindamycin is the treatment of choice
Most cases are diagnosed in the western US
Most commonly seen in adolescents
Rash is initially petechial and becomes purpuric
Rocky Mountain Spotted Fever
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most common rickettsial disease in US
Endemic in southeast US
Most common age 5-9, least common 10-29
fever, rash, tick exposure (~50% don’t recall)  malaise,
headache, fever, myalgias, abdominal pain,
rash initially blanching becomes petechial starts on ankles and
wrists, spreads inwards
Lab: nml WBC, left shift, mild anemia, moderate
thrombocytopenia, CSF pleocytosis
Clue = clinically no URI sx’s, no N/V, prodrome and labs
– Also seen in Erlichiosis
Dx: Clinical! Don’t wait for serologies
Rx: Tetracycline, chloramphenicol
Lyme Disease
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Borrelia burgdorferi (spirochete)
Txmitted by bites of Ixodes ticks
Tick reservoir = rodents, rabbit, deer
Less than 30% of pts recall tick bite
Fever, myalgias, arthralgias, HA, Bells Palsy
Erythema chronicum migrans – annular, erythematous lesion with
central clearing as it spreads (spares palm and sole)
• 3 stages:
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Stage I: ECM (60 – 80%), viral symptoms
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Stage II: neurologic (neuritis, Bell’s palsy), cardiac (nodal
heart block)
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Stage III: chronic arthritis, myocarditis, encephalopathy
• ELISA (screening – sensitive, not specific), Western Blot (dx)
• Rx: doxy, erythro, amox, ceftriaxone
Infection with which of the following helminths is
known to cause a fatal hyperinfection in
immunocompromised pts?
A. Ascarsis lumbricoides
B. Enterobius vermicularis
C. Necator americanus
D. Strongyloides stercoralis
E. Trichuris trichiura
F. Sridhar Basarvaju
Infection with which of the following helminths is
known to cause a fatal hyperinfection in
immunocompromised pts?
A. Ascarsis lumbricoides
B. Enterobius vermicularis
C. Necator americanus
D. Strongyloides stercoralis
E. Trichuris trichiura
F. Sridhar Basarvaju
Strongyloides stercoralis
• Nematode resides in small
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intestine
Skin (pruritis, erythematous rash)> lungs (cough, dyspnea, pna) ->
intestinal (most asymptomatic,
diarrhea)
Can produce infective larva
internally and cause
autoinfection
Hyperinfection syndrome in pts
who already have established
Strongyloides infxn who become
immunocompromised ->
septicemia, pneumonia, meinigitis,
ileus
Eosinophilia may be lost in
immunocompromised
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Ascarsis lumbricoides- acquired
by egg ingestion, Loefflereosinophilic pneumonitis,
intestinal obstruction
Enterobius vermicularispinworms, perianal pruritis
Necator americanus-
hookworm, intestinal mucosa> blood loss, anemia -> eggs
in stool, larvae in soil hook
onto barefoot
Trichuris trichiura- whipworm,
ingestion of contaminated
food/water, massive
infestation-> blood loss,
anemia
Which of the following is TRUE of the majority
of Toxic Shock Syndrome (TSS) cases?
A. They are all unrelated to menses and cross
B.
C.
D.
all segments of society
They have gram positive rods on blood
culture
They have a diffuse, painful, sunburn like
rash that results in bullae
They are associated with hyperkalemia and
hypercalcemia
Which of the following is TRUE of the majority
of Toxic Shock Syndrome (TSS) cases?
A. They are all unrelated to menses and
B.
C.
D.
cross all segments of society
They have gram positive rods on blood
culture
They have a diffuse, painful, sunburn like
rash that results in bullae
They are associated with hyperkalemia and
hypercalcemia
Toxic Shock syndrome
• Acute onset multisystem disease (Involvement
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of at least three:Renal, hepatic, heme, GI,
musculoskeletal, CNS)
Staph aureus exotoxin
Prolonged tampon use, packed surgical wounds,
nasal packing
Menstruating females, post partum, 1/3 males
Fever, hypotension
Rash: diffuse erythroderma (“painless”
sunburn), blanching, nonpruritic -->
desquamation
Rx: fluids, remove source, abx
Which of the following tick-bourne illnesses
requires only symptomatic therapy
A. Babesiosis
B. Colorado Tick fever
C. Relapsing fever
D. Rocky Mountain spotted fever
E. Lyme disease
Which of the following tick-bourne illnesses
requires only symptomatic therapy
A. Babesiosis
B. Colorado Tick fever
C. Relapsing fever
D. Rocky Mountain spotted fever
E. Lyme disease
• Colorado Tick fever- Viral infection- HA
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photophobia- supportive care-self limited
resolves 2-3 weeks
Babesiosis- protazoan parasite- clinda and
quinine-exchange transfusion for severe case
Lyme Dz- treat with doxycyline or tetracycline
Rocky mountain spotted fever-Rickettsia –
tetracycline or chloramphenicol
Which is the most accurate way to diagnosis
PCP in Pt with HIV?
A. ABG
B. CXR
C. VQ scan
D. Gallium scan of chest
E. Indirect Immunoflorescent stain of
sputum
Which is the most accurate way to diagnosis
PCP in Pt with HIV?
A. ABG
B. CXR
C. VQ scan
D. Gallium scan of chest
E. Indirect Immunoflorescent stain
of sputum
PCP
• Most common OI in pts with AIDS
• CXR may be normal
• ABG normally high A-a gradient but not
specific for PCP
• Gallium and VQ scans are not specific
• Bronchoscopy is effective but invasive –
sputum is highly specific and non invasive
Which of the following statements best
describes rabies?
A. Acute Rickettsial disease of the CNS spread
B.
C.
D.
E.
centripetally through peripheral nerves
Acute Rickettsial disease of the CNS with an
incubation period of 10 days to 1 year
Acute viral illness of the CNS that affects all
mammals
Acute viral illness of the CNS that affects all
mammals except rodents
Acute Rickettsial disease of the CNS spread
centripetally through lymphatics
18. Which of the following statements best
describes rabies?
A. Acute Rickettsial disease of the CNS spread
B.
C.
D.
E.
centripetally through peripheral nerves
Acute Rickettsial disease of the CNS with an
incubation period of 10 days to 1 year
Acute viral illness of the CNS that affects all
mammals
Acute viral illness of the CNS that affects all
mammals except rodents
Acute Rickettsial disease of the CNS spread
centripetally through lymphatics
Rabies
• Acute viral illness- affects all mammals
• -spread through saliva
• -spreads through peripheral nervescentrally
• Average incubation 30-60 days
35 yo male with painless hematuria after
returning from North Africa has what
A. Entamoeba histolytica
B. Leishmania donovani
C. Plasmodium malariae
D. Schistosoma haematobium
E. Trympanosoma brucei rhodesiense
35 yo male with painless hematuria after
returning from North Africa has what
A. Entamoeba histolytica
B. Leishmania donovani
C. Plasmodium malariae
D. Schistosoma haematobium
E. Trympanosoma brucei rhodesiense
• Schistasoma-Africa, India, PortugalCan migrate to venules in bladder
Causes hematuria dx with eggs in urine
• Trichamonas- vaginitis, urithritis prostatitis
• Entomoeba-bloody diarrhea- liver abscess
• Leishmania-hepatomegaly splenomegaly
• Trypanosoma- african sleeping sickness
62 yo male BIB EMS- wife says confused- hypothermic
35.5, Bp 77/30- lungs clear abdomen normal non focal
neuro exam-extremity exam shows-see pic-with crepitance
halfway up leg- which antibiotic should be ordered
A. Cefazolin and PCN
B. Cipro
C. Clinda and PCN
D. Metronidazole
E. Vanco
62 yo male BIB EMS- wife says confused- hypothermic
35.5, Bp 77/30- lungs clear abdomen normal non focal
neuro exam-extremity exam shows-see pic-with crepitance
halfway up leg- which antibiotic should be ordered
A. Cefazolin and PCN
B. Cipro
C. Clinda and PCN
D. Metronidazole
E. Vanco
Gas Gangrene
• Surgical debridement critical-Fluid resusitation
• Usually Polymicrobial infection-can be group A
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strep along- needs broad coverage
Cefazolin with PCN does not cover Gm
negatives, nor does vancomycin
Clindamycin is believed to decrease toxin
production as well
Which organism causes a characteristic
rash with a “slapped cheek” appearance
A. Coxasackie virus
B. Group A beta hemolytic strep
C. Human herpes virus C
D. Parvovirus B19
E. Varicella Virus
Which organism causes a characteristic rash
with a “slapped cheek” appearance
A. Coxasackie virus
B. Group A beta hemolytic strep
C. Human herpes virus C
D. Parvovirus B19
E. Varicella Virus
Infectious rash descriptions
• Slapped Cheek= Parvovirus B19
• Dew drop on rose petal= varicella
• Circumoral pallor and sandpaper
rash=scarlet fever with Group A strep
• Oral and palmar vesicles Coxasackie- Hand
foot and mouth disease
• HHV6 = roseola-
21 yo female presents with red hot painful right ankle- had
similar pain in left wrist 2 days earlier- a pustular lesion is
noted in the web spaces on her hand. A culture from which
of the following sites is likely to reveal the causative
organism
A. Ankle synovial fluid
B. blood
C. genitalia
D. Leading edge of the cellulitis
E. Pustule
21 yo female presents with red hot painful right ankle- had
similar pain in left wrist 2 days earlier- a pustular lesion is
noted in the web spaces on her hand. A culture from which
of the following sites is likely to reveal the causative
organism
A. Ankle synovial fluid
B. blood
C. genitalia
D. Leading edge of the cellulitis
E. Pustule
Arthritis-Dermititis syndrome from
dissemintaed GC
• More common in women- migratory
arthritis- tenosynovitis with pustules lesion
son extremeties
• Synovial fluid cx + 50% of the timeCervical Cx + 75-90% of time
Which of the following reguarding Pneumonia in HIV +
patients is correct?
A. Haemophilus is an uncommon cause
B. Opportunistic infections are common with CD4 less
than 1000
C. Pt with HIV and bacterial PNA have a higher
mortality rate
D. Pt with HIV and bacterial PNA typically present
with sign and symptoms similar to seronegative
patients
E. PCP occurs more commonly than bacterial PNA
Which of the following regarding Pneumonia in HIV +
patients is correct?
A. Haemophilus is an uncommon cause
B. Opportunistic infections are common with CD4 less
than 1000
C. Pt with HIV and bacterial PNA have a higher
mortality rate
D. Pt with HIV and bacterial PNA typically
present with sign and symptoms similar to
seronegative patients
E. PCP occurs more commonly than bacterial PNA
HIV and PNA
• HIV pt have higher rates of bacterial pna
but same mortality
• Bacterial pneumonia is more common than
PCP
• Pt with CD4 count greater than 800 rarely
get opportunistic infections
• Usually present in similar manner to
seronegative pts
Which of the following manifestation of syphilis appears
only after 20 yes of infection?
A. Aortic dz
B. Aseptic menigitis
C. chancre
D. Menigovascualar syphilis
E. neurosyphilis
Which of the following manifestation of syphilis appears
only after 20 yes of infection?
A. Aortic dz
B. Aseptic menigitis
C. chancre
D. Menigovascualar syphilis
E. neurosyphilis
Syphilis
• Chancre- painless papule- hallmark of primary
•
•
•
syphilis
2ndary syphilis 4-10 weeks- macular rash- trunk
 extremities- palms + soles oral lesions grey
painless ulcers
Tertiary syphilis-untreated for years- 2 typesneurosyphilis after 10 yrs-meningovascualar
vasculitis of vertebral or spinal vessels or tabetic
syphilis-demylination and ataxia
Cardiovascular only after 20-40 yrs usually
thoracic aorta- aortiv valve insufficiency
Which of the following animals is least likely to transmit
rabies
A. chipmunk
B. cow
C. Groundhog
D. racoon
E. skunk
Which of the following animals is least likely to transmit
rabies
A. chipmunk
B. cow
C. Groundhog
D. racoon
E. skunk
More rabies
• Can affect all mammals including cows
• Very rare in rabbits and small rodents
(rats, mice, chipmunks) considered safe
• Larger Rodents beavers, groundhogs do
carry rabies
Which of the following is true of acute rheumatic fever?
A. Caused by group B strep
B. Fever is a major diagnostic criteria
C. Occurs during the coarse of acute strep
D.
E.
infection
Affect primarily lower socioeconomic groups
Steroids my be useful in treating carditis
Which of the following is true of acute rheumatic fever?
A. Caused by group B strep
B. Fever is a major diagnostic criteria
C. Occurs during the coarse of acute strep
D.
E.
infection
Affect primarily lower socioeconomic groups
Steroids my be useful in treating
carditis
Rheumatic Fever
• 3-4 weeks after Group A strep infection
• Jones criteria-major- Joints-polyrthritis,
Carditis, Nodules- subcutaneous ,
erythema marginatum, chorea
• Fever is one of the minor criteria
• Tx PCN, aspirin for arthritis and steroids
for carditis
41 yo female presents with 2 large fleshy, flat, painless,
moist, pearly grey, pale lesions on either side of her anus
the most likely diagnosis is?
A. Chancroid
B. Condyloma acuminata
C. Gonococcal proctitis
D. Granuloma inguinale
E. Secondary syphilis
41 yo female presents with 2 large fleshy, flat, painless,
moist, pearly grey, pale lesions on either side of her anus
the most likely diagnosis is?
A. Chancroid
B. Condyloma acuminata
C. Gonococcal proctitis
D. Granuloma inguinale
E. Secondary syphilis
STD’s
• Condyloma lata-secondary syphilis- typically-large
•
•
•
•
painless flat topped lesions-typically in anogenital region
Condyloma acuminata- genital warts – HPV – pink to
grey keritanized with papilliform growths
Gonococcal proctitis- tenismus, anal itching and yellow
discharge
Granuloma inguinale- bacterial infection with
Calymmatobacterium granulomatis-painless papules
beefy red ulcers with rolled edges
Chancroid- Heomophilus Ducreyi- painful genital ulcer-