ID dump
I'm a Fun Guy
HIV
STIs Oh No!
Brain bad
100
A 34-year-old man presents with severe abdominal cramping and bloody diarrhea 3 days after attending a cookout. He is afebrile. Laboratory testing reveals thrombocytopenia, elevated creatinine, and schistocytes on peripheral blood smear.
What is the likely causative organism
What is Shiga toxin-producing E coli
STEC (classically E. coli O157:H7) can cause hemolytic uremic syndrome (HUS), characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Antibiotics and antimotility agents should be avoided because they may increase the risk of HUS or complications. Treatment is primarily supportive.
100
A 63-year-old ICU patient with a central venous catheter develops persistent fever. Blood cultures grow Candida albicans. He is hemodynamically stable and has no known metastatic complications.
What is the recommended initial antifungal treatment?
What is echinocandin (micafungin)
100
Patients with HIV and a CD4 count below this threshold are at increased risk for Pneumocystis jirovecii pneumonia (PJP)
What is 200 cells/uL
100
A 22-year-old sexually active woman presents with lower abdominal pain, cervical motion tenderness, and mucopurulent cervical discharge. She is afebrile, hemodynamically stable, and able to tolerate oral medications. Pregnancy testing is negative.
What is the recommended outpatient antibiotic regimen?
What is ceftriaxone 500 mg IM once + doxycycline 100 mg PO twice daily for 14 days + metronidazole 500 mg PO twice daily for 14 days?
PID is a clinical diagnosis, and empiric treatment should not be delayed while awaiting STI testing. Metronidazole provides anaerobic coverage and treats concurrent bacterial vaginosis.
100
A 24-year-old college student presents with fever, severe headache, neck stiffness, and a petechial rash. Lumbar puncture reveals neutrophilic pleocytosis, elevated protein, and decreased glucose.
What is the most likely causative organism?
What is Neisseria meningitidis?
Meningococcal meningitis classically presents with fever, meningismus, and petechial or purpuric rash.
200
A man with PUD tests positive for H Pylori. What is the treatment and duration?
What 14 day bismuth quad therapy with PPI, bismuth, tetracycline and metronidazole?
Confirm eradication at least 4 weeks after antibiotics, with PPIs withheld for 2 weeks before testing.
200
A 56 yo male with HTN, HLD and CKD presents to your office complaining of multiple "lumps" on his arm that started after he worked outside around the house. They have progressed upward on his arm.
What is the treatment for this?
What is Itraconazole?
Sporotrichosis causes nodular lymphangitis following inoculation from plant material. Itraconazole is the preferred treatment for uncomplicated lymphocutaneous disease.
200
An HIV patient with a CD4 count of 75 presents with headache and seizures. MRI reveals multiple ring-enhancing lesions in the basal ganglia.
what is cerebral toxoplasmosis
200
A 26-year-old sexually active man presents with acute onset of fever, severe left knee pain, and swelling. He reports migratory joint pain involving his wrists and ankles over the preceding week. Physical examination reveals a swollen, erythematous left knee and several small pustular lesions on his extremities.
Arthrocentesis reveals 65,000 WBCs/µL with 90% neutrophils. Synovial fluid Gram stain and cultures are negative. What is the diagnosis and treatment
What is disseminated gonococcal infection with septic arthritis, treated with ceftriaxone 1 g IV or IM every 24 hours?
Disseminated Neisseria gonorrhoeae classically presents with migratory polyarthralgia, tenosynovitis, and pustular skin lesions. Synovial fluid cultures are frequently negative. Joint drainage is also indicated for purulent arthritis.
200
A 68-year-old man presents with fever, altered mental status, and nuchal rigidity.
What is the appropriate empiric antibiotic regimen?
What is vancomycin + ceftriaxone + ampicillin?
Adults older than 50 require additional Listeria monocytogenes coverage with ampicillin. Dexamethasone should be administered before or with the first antibiotic dose when pneumococcal meningitis is suspected
300
A 55-year-old woman with a prosthetic aortic valve is scheduled for a dental extraction involving manipulation of gingival tissue. She has no penicillin allergy. What do you recommend for management?
What is amoxicillin 2 g orally 30–60 minutes before the procedure?
Antibiotic prophylaxis is recommended for selected high-risk cardiac conditions undergoing qualifying dental procedures, including prosthetic heart valves and prior infective endocarditis.
300
A 43-year-old man from Wisconsin presents with chronic cough, weight loss, and verrucous skin lesions. Chest imaging reveals a pulmonary infiltrate. Biopsy demonstrates thick-walled yeast with broad-based budding.
What is the causative organism?
What is Blastomyces dermatitidis?
Blastomycosis commonly involves the lungs and skin. Broad-based budding is the classic histologic clue.
300
An HIV patient diagnosed with PJP has a PaO2 of 62 mmHg on room air. This additional treatment is indicated.
What are systemic corticosteroids
300
A pregnant patient at 20 weeks' gestation is diagnosed with late latent syphilis. She reports a history of immediate anaphylaxis to penicillin. What is the next best step?
What is penicillin desensitization followed by benzathine penicillin G?
Penicillin is the only proven effective treatment for syphilis during pregnancy that reliably treats fetal infection and prevents congenital syphilis.
300
A 32-year-old man presents with fever, headache, and photophobia. CSF analysis reveals:
WBC: 180 cells/µL (85% lymphocytes)
Protein: 65 mg/dL
Glucose: 65 mg/dL (serum glucose 100 mg/dL)
Gram stain: Negative
What is the most likely type of meningitis?
What is viral meningitis?
Viral meningitis typically causes lymphocytic pleocytosis, mildly elevated protein, and normal CSF glucose.
400
A patient who lives in Vermont is planning a hiking trip. She is asking if she need prophylactic antibiotics to prevent Lyme disease. What are the 5 prophylaxis criteria for for lyme disease?
What is
Attached tick is an adult or nymphal Ixodes scapularis, Tick attached for >36 hours or engorged, Prophylaxis started within 72 hours of tick removal, local Borrelia burgdorferi infection rate >20%, no contraindication to doxy
400
A 52-year-old man undergoing chemotherapy for acute myeloid leukemia develops persistent fever despite broad-spectrum antibiotics. He is profoundly neutropenic. CT chest reveals pulmonary nodules surrounded by ground-glass attenuation.
What is the most likely diagnosis and preferred initial treatment?
What is invasive pulmonary aspergillosis treated with voriconazole?
Invasive aspergillosis occurs in patients with prolonged neutropenia or significant immunosuppression. Voriconazole and isavuconazole are preferred initial therapies.
400
Patient with CD4 of 42 complains of floaters. You see this on exam. What is this?
What is CMV retinitis
CD4 <50
400
A 35-year-old woman with no symptoms has a positive RPR and confirmatory treponemal test. She has no prior history of syphilis, and the timing of infection cannot be determined. What is the treatment?
What is benzathine penicillin G 2.4 million units IM weekly for 3 weeks?
Latent syphilis of unknown duration is treated as late latent syphilis, requiring three weekly doses.
400
A 55-year-old woman presents with fever, altered mental status, new-onset seizures, and personality changes. MRI demonstrates hyperintensity involving the temporal lobes. CSF reveals lymphocytic pleocytosis and elevated protein.
What is the most appropriate immediate treatment?
What is IV acyclovir?
HSV-1 encephalitis classically involves the temporal lobes. Empiric acyclovir should be initiated immediately without waiting for CSF HSV PCR results.
500
A 72-year-old woman develops profuse watery diarrhea and abdominal pain after receiving broad-spectrum antibiotics. Stool testing is positive for Clostridioides difficile. She is started on oral vancomycin but subsequently develops hypotension, abdominal distension, and ileus. CT abdomen reveals diffuse colonic wall thickening without perforation.
What is the most appropriate antibiotic regimen?
What is oral or nasogastric vancomycin 500 mg four times daily plus IV metronidazole 500 mg every 8 hours?
Fulminant C. difficile infection is defined by hypotension/shock, ileus, or megacolon. Treatment requires high-dose enteral vancomycin plus IV metronidazole. Rectal vancomycin should be considered when ileus is present, and early surgical consultation is important.
500
A 32-year-old man who recently moved from Arizona presents with several weeks of headache, fever, and neck stiffness. CSF demonstrates lymphocytic pleocytosis, elevated protein, low glucose, and eosinophils.
What is the most likely diagnosis?
What is coccidioidal meningitis?
Coccidioidal meningitis is a classic cause of chronic meningitis with CSF eosinophilia. Treatment typically requires long-term, often lifelong, fluconazole
500
A 39-year-old man with HIV (CD4 count 40) presents with progressive memory loss, ataxia, and right-sided weakness. MRI reveals asymmetric, nonenhancing white matter lesions without mass effect. CSF testing is positive for JC virus DNA.
What is Progressive multifocal leukoencephalopathy (PML)?
500
A patient presents with a painful genital ulcer with a ragged border and tender, suppurative inguinal lymphadenopathy. Testing for syphilis and HSV is negative. What is the diagnosis
What is chancroid caused by Haemophilus ducreyi?
You DuCreyi with a chancroid
500
A 58-year-old man presents with fever, severe headache, and neck stiffness. CSF demonstrates neutrophilic pleocytosis, low glucose, and elevated protein. Gram stain reveals gram-positive diplococci.
What adjunctive medication should be administered with the first dose of antibiotics to reduce neurologic complications?
What is IV dexamethasone?
Dexamethasone is most beneficial in pneumococcal meningitis and should be administered before or simultaneously with the first antibiotic dose.