Travel
Parasites
Empiric
Syphilis
Fungal
100
30M recent vacation to the caribbean presents with fever, malaise, retro-orbital pain, myalgia, severe lumbar pain. PE shows petechial rash to the antecubital fossa after blood pressure is taken. What is the vector?
Aedes aegypti, Aedes albopictus
100
A 24yo man presents to his PCP with a 3d history of foul-smelling diarrhea. He reports going camping with friends last week. They bathed in the nearby creek and ate fish they caught. They also cooked soup over a fire and ate smores. He reports multiple insect/mosquito bites. He states he developed abdominal bloating and diarrhea the day after he returned. His partner, one of the other campers, is also ill. Dx?
Giardia lamblia
100
45-year-old patient whose wife has acute HepA infection. Treatment?
1 dose hepA vaccine and immunoglobulin
100
Primary syphilis in HIV-infected individuals is more likely to have this distinguishing clinical feature
Multiple chancres
100
Disseminated candida infection with CNS involvement. Antifungal coverage?
amphotericin B (with flucytosine) or an azole rather than an echinocandin (poor CNS penetration)
200
30M recent travel to Puerto Rico presents with fever, scleral icterus, renal failure, pulmonary hemorrhage and red eye. Diagnosis?
Leptospirosis
200
Most common parasitic infection causing blindness (2nd among all infectious blindness causes). Dx?
Onchocerca volvulus
200
Patient with suspected meningitis following neurosurgical procedure. Empiric treatment?
Vanc AND ceftazidime or cefepime or meropenem
200
74 year old male here to establish care, Syphilis screen showed positive EIA, RPR 1:16, and a positive TP-PA. Most recent previous RPR 3 years ago, nonreactive. Treatment:
Benzathine PCN 2.4 million units IM weekly x 3
200
Candida isolate on sputum culture. Treatment of choice?
none, contaminate
300
30F with recent travel to Arkansas 1 month ago presents with intermittent fevers, malaise, headaches. Diagnosis?
Malaria
300
Diarrhea, appendicitis, liver abscesses, toxic megacolon. Dx?
Entamoeba histolytica
300
40 year old healthy male with CAP. Outpatient empiric treatment?
amox, doxy or macrolide if pseudomonas resistance <25%
300
30 year old patient undergoing treatment for syphilis and develops fever, hypotension and worsening rash after beginning PCN yesterday. Tx?
Jarisch-Herxheimer reaction: NSAIDs, Tylenol
300
Patient hiking in Missouri 4 weeks ago presents with skin finding below, osteomyelitis of the skull and cough. Describe the pathogen.
Blastomycosis: broad-based, single budding with a refractile cell wall
400
30M recent travel to the Caribbean presents with fever, malaise, arthralgia, headache. PE shows symmetrical inflammatory arthritis and synovitis. Most likely diagnosis?
Chikungunya
400
26F with progressive weakness, fatigue, and abdominal discomfort. Lived in Japan for 1 year. Ate raw/undercooked fish, beef, and snails. Labs show macrocytic anemia. Dx?
Diphyllobothrium latum
400
Name 5 antibiotics that cover pseudomonas.
Zosyn, Cefepime, Meropenem, Imipenem, Tobra/Gent, amikacin, Aztreonam, Levo/Ciprofloxacin, ceftazidime, ceftolozane/tazobactam, fosfomycin
400
What testing would show adequate response to treatment for syphilis?
4 fold decline in nontreponemal titer (RPR, VRDL), or seroconversion (nonreactive testing)
400
Treatment of choice for asymptomatic aspergilloma
No definitive treatment
500
30M recent travel to Namibia and then to Angola unexpectedly presents with fever, malaise, N/V. PE notable for jaundice. He is bradycardic and febrile to 103. What is the infection and what is the name of this sign?
Yellow fever, Faget’s sign
500
Most common causes of seizure disorder worldwide
Neurocysticercosis aka larval cyst of Taenia solium
500
Neutropenic fever with ANC<100 and neutropenia greater than 10 days. Empiric treatment?
antipseudomonal beta lactam, carbapenem or Zosyn
500
40M with blurry vision R eye, R pupil 2mm, L pupil 3mm. R pupil no change with light. RPR: 1:32, positive TP-EIA. Lumbar puncture VDRL negative, CSF WBC 10, protein 100. Treatment?
PCN G q4 hours for 10-14 days
500
Patient newly diagnosed with HIV and cryptococcus. When should ART be initiated?
2-10 weeks for prevention of IRIS