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Brain Busting Bacteria
Shots, shots, shots, shots, shots, shots. EVERYBODY!
Other Flora and Fauna
Going Viral
This is your bug on drugs.
100
These are three of the main bugs most commonly implicated in acute otitis media.
What are Strep pneumoniae, nontypeable H. flu (think of it when a patient has conjunctivitis and AOM), moraxella catarrhalis, and group A strep?
100
These live attenuated vaccines should not be given to immunocompromised patients (Name at least 3).
MMR, Varicella, Rotavirus, live-attenuated influenza vaccine (LAIV), oral typhoid, yellow fever
100
This is the BEST next step for a patient who was hiking in Wisconsin and now presents with rash described as "target-like" in appearance.
What is treat Lyme disease? -This is Erythema migrans and is pathognomonic for Lye disease, so treat for Lyme disease! -No need to do any testing. -Treat with Doxycycline 100mg BID (or amoxicillin if <8y/o) for 14-21 days - Caused by spirochete, Borrelia Burgdorferi, carried by the Ixodes genus of ticks
100
This is the most likely virus causing diarrhea in a child who just returned from a Disney cruise on which 30% of the passengers have developed diarrhea.
What is norovirus?
100
This is the drug and route of choice in MRSA bacteremia.
What is vancomycin IV?
200
This is the most likely bacteria found in a culture of the bloody, greenish discharge from the eyes of a 4-day-old infant who was born at home and had minimal medical care.
What is N. gonorrhoeae? Conjunctivitis in neonates: - Within 48 hrs of birth - Chemical reaction to ophthalmic prophylaxis - 2-7 days after delivery - gonococcal conjunctivitis - 7-14 days after delivery - conjunctivitis due to Chlamydia trachomatis
200
A little boy wakes up in his room and finds a bat climbing his blinds. There is no visible evidence of a bite on the child. This is the next best step to take.
What is give rabies immunoglobulin and rabies vaccine ASAP?
200
This infection is spread via the fecal oral route and causes pruritus ani especially at night and in the early morning.
What is pinworm? - Itching at night because the females travel down the large bowel and to the perianal region at night to lay eggs. - Often spread at daycare or slumber parties, often via fomites - Patients often auto-inoculate (yuck) - Treat with pyrantel palmate or alendazole
200
A 17 year old, sexually active female presents with fever, new onset altered mental status, and smells burning rubber. This infection is causing her symptoms.
What is HSV? - Patient has HSV encephalitis - Often affects the temporal lobes, causes temporal seizures with olfactory auras - >60% have neurological sequelae - Treat with IV AcV
200
This treatment is indicated in a 17 y/o female patient diagnosed with gonorrhea?
What is treatment for gonorrhea and chlamydia, with: - Ceftriaxone 250 mg IM in a single dose PLUS - Azithromycin 1gm orally in a single dose OR doxycycline 100mg orally BID for 7 days - Sexual partners of patients with gonorrhea from the preceding 60 days should also be evaluated and treated
300
This gram positive organism is the most common cause of catheter-associated bacteremia.
What is staph epidermis. - Also the most common cause of post-operative infections secondary to foreign material (prosthetics, pace-makers, VP shunts) left in the body - Almost ALL methicillin resistant - Treat with Vanco +/- gent (serious infections) +/- rifampin (for prosthetic device infection)
300
This is the recommended treatment for the following scenario: An 11 y/o boy who ran away to join the circus is walking on a bed of rusty, dirty circus nails when he loses his balance and one punctures his foot. He has seen lots of doctors but has had poor continuity and has had 6 previous DTaP vaccines, the last being 6 years ago.
What is TDaP Immunization? - If clean wound and vaccines UTD (<10 years ago), no treatment - If wound is dirty and pt has <3 tetanus immunizations OR unknown give TIG and immunize (DTaP if <7 y/o or TDaP if >7 y/o) - If wound is dirty and immunizations are UTD (most recent <5 yrs ago), no treatment.
300
This is the infection in a caucasian 15 y/o boy presents with hyperpigmented scaly macules on his chest and back that worsen when he plays football in the hot sun.
What is Tinea versicolor? - Usually hypopigmented in darker skinned individuals, can be hyperpigmented in lighter skinned individuals - Often recurs in warm seasons
300
This virus often causes fever for 3-5 days then, after the patient defervesces, a maculopapular rash.
What is HHV-6 or exanthem subitum/roseola/sixth disease? - Is often associated with febrile seizures during the febrile stage
300
Coverage for these two organisms are the reason for adding ampicillin to a 3rd general cephalosporin in the treatment of meningitis.
What are listeria and enterococci?
400
This is the name of the syndrome and the bug causing the symptoms in a 6 year old girl with diarrhea, renal insufficiency, thrombocytopenia, and anemia with elevated haptoglobin.
What is HUS caused by E.Coli O157:H7? - Other than the above will usually present with purpura - Antibiotics are NOT beneficial, so DO NOT treat - Commonly found in undercooked beef and unpateurized milk or apple juice
400
A 3 year old patient presents with a cough, fever, and runny nose for 5 days. The patient's preschool is requiring that all students have TB testing before attending. This is the measurement (in mm) of the area of induration after 48-72 hrs that would indicate LTBI and a need for subsequent INH therapy
10 mm, as the patient is in a moderate risk group due to age (<4y/o) Measurements that indicate LTBI: - 5mm = HIV+, abnormal CXR, close contacts of documented TB infected individuals, severely immunocompromised - 10 mm = Homeless, travel to or birth in endemic area, IVDU but HIV-, prisoners, health care workers, nursing home pts and staff, diabetes or CRF, immunosuppressed, <4 y/o. - 15 mm = >/= 4 y/o and no clear risk factors
400
This is the likely congenital infection in infant in the NICU has microcephaly, chorioretinitis, and widespread parenchymal calcifications.
What is toxoplasmosis? - Don't eat raw or undercooked meat, stay out of the litter box - Possible fetal complications: Microcephaly, hydrocephalus, hepatosplenomegaly, maculopapular rash or thrombocytopenia purpura, chorioretinitis (as opposed to cataracts in rubella), diffuse calcifications in the cerebral parenchyma (as opposed to periventricular calcifications in CMV infection)
400
This is the most common presentation of untreated HIV-infected infants.
What is an AIDS-defining illness (PCP pneumonia), serious bacterial infection, or serious fungal infection.
400
These are 4 of the drugs that are effective in treating pseudomonas infections.
What are: - piperacillin-tazobactam (Zosyn) - ticarcillin-clavulanate, - ceftazidime or cefepime (but NOT ceftriaxone or cefotaxime) - aminoglycocides (ototoxic/nephrotoxic) - quinolones (-floxacins, not FDA approved if <18 y/o except in special cases) - imipenem or meropenem.
500
This is the bacteria that may cause fever to 105 degrees F, myalgia, rigors, pneumonia, and splenomegaly in a 13 year old girl who lives on the turkey farm that supplied Tater and Tot, the last two turkeys to be pardoned by President Obama.
What is chlamoydophila psittaci? - One of two main organisms to think about in a patient with pneumonia and splenomegaly. The other is Histoplasma.
500
These are at least one of the vaccines contraindicated in individuals with anaphylactic reactions to the following: 1. Egg antigens:? 2. Streptomycin, neomycin, polymyxin B:? 3. Neomycin:? 4. Gelatin:? (Get one of each or all of them for gelatin and I'll give you the points)
What is: 1. some influenza vaccines, yellow fever 2. IPV 3. MMR, varicella 4. MMR, varicella, yellow fever
500
Suspect this infection in a patient who just returned from a safari in central Africa and who presents in shock with fevers, stupor, hypoglycemia, renal failure, respiratory failure, metabolic acidosis, and severe anemia.
What is Malaria? - Specifically, cerebral malaria, which is often cause by P. falciparum and is often acquired in Africa - Treat with chloroquine if able (but often resistant) or atovaquone/proguanil - Prevent with good bug protection as well as ppx with chloroquine, atovaquone/proguanil, mefloquine, or doxycycline.
500
This is the likely viral etiology of post-infectious rheumatic disorder in a 9 y/o from the Ivory Coast after having a febrile illness with polyarthralgias a few months prior to the patient immigrating to the US.
What is chikungunya virus? - Caused by day-biting Aedes mosquitos, endemic in West Africa - Incubation period of 3-7 days - Present with fevers, polyarthralgia, and sometimes headache, conjunctivitis, nausea/vomiting, or rash initially - Can have musculoskeletal and/or rheumatic disorders lasting for months to years after - Diagnose by detecting virus-specific IgM or by PCR. - Supportive treatment.
500
These are the 3 of the 4 classes of antiretroviral drugs used in the treatment of HIV infection.
What are: - Reverse transcriptase inhibitors (NRTIs - faulty building blocks; NNRTIs - interfering binders) - Protease inhibitors - self explanatory - Integrase inhibitors - block the enzyme HIV uses to integrate vial genes into the host - Fusion inhibitors - Stop entry into host cell