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WorksheetsExam 5 - meningitis, STI, HIV, TB
Total questions: 34
Worksheet time: 2hrs 42mins
Which STI is incorrectly matched to its primary causative pathogen?
Chlamydia - Chlamydia trachomatis
Gonorrhea - Neisseria meningitidis
Pelvic Inflammatory Disease - Chlamydia sp. + Neisseria sp.
Syphilis - Treponema pallidum
TJ is a 24 yr old presenting with cervicitis who is tested with a bacterial dual NAAT vaginal swab. Which two conditions is TJ most likely being tested for?
Bacterial vaginosis and trichomoniasis
Syphilis and Chlamydia
Gonorrhea and Chlamydia
Trichomoniasis and chlamydia
TJ's NAAT for Chlamydia shows up as positive, all other tests negative. Which of the following is not implicated in Chlamydia?
Cervicitis
Pelvic Inflammatory Disease
Infertility
Ano-rectal infection
FB has tested positive for both gonorrhea and chlamydia on the dual NAAT. They are experiencing uncomplicated moderate urethritis with inflammation and pain. FB is unlikely to be adherent to anything over once a day. How should they be treated? Weight: 180 lbs
Doxycycline 100 mg BID + Ceftriaxone 500 mg IM x1
Azithromycin 1000 mg po x1 + Ceftriaxone 500 mg IM x1
Ceftriaxone 1000 mg IM x1 + Azithromycin 1000 mg po x1
Ceftriaxone 1000 mg IM x1 + Ceftriaxone 500 mg IM x1
Which of the following are true of Gonorrhea or Neisseria gonorrhoeae?
Activates major inflammatory cascade similarly to Chlamydia
One of the major causes of septic joints in younger adults
Can often be treated with fluoroquinolones
If present during birth, apply prophylactic erythromycin ophthalmic ointment to the baby's eyes
On rotation, you're involved in a team evaluating a patient for pelvic inflammatory disease. You're able to positively identify cervical motion tenderness and abnormal discharge along with some hyperthermia. The physician would like to hold antibiotics until they have the gold standard - positive ultrasound or biopsy. What do you say?
The patient is qualified to receive ceftriaxone+doxycycline+metronidazole empirically while waiting on those tests
Good idea, let's also draw a CRP/ESR and get a vaginal WBC sample
We have everything we need, start Vanc + Zosyn
Discharge the patient, nothing seems wrong
Which two of the following are true of bacterial vaginosis (BV)?
Typically caused by abnormal microbes for the vaginal area
Diagnosed by presence of clue cells on gram stain
Treated with topical/systemic fluconazole
Treated with topical/systemic metronidazole
What is true of trichomoniasis?
Could be treated with a single oral metronidazole dose in some patients
Diagnosed by NAAT
All sexual partners who may have it must be treated at the same time
Could be treated with a single oral fluconazole dose
What are the pathogens of concern in neonatal (<1 mo) meningitis?
Escherichia coli
Streptococcus pneumoniae
Streptococcus agalactiae (GBS)
Oxacillin-resistant Staphylococcus aureus (MRSA)
A patient is admitted with meningitis. They are 66 years old and are up to date on recent vaccines - including a recent PCV15, PPSV23, and meningococcal shots. They are negative for recent trauma and surgery. What is the most likely bacterial pathogen for this patient?
MRSA
Staphylococcus pneumoniae
Listeria monocytogenes
Haemophilus influenzae type B
What is the suspected most common bacterial cause of general community-acquired meningitis?
Streptoccocus pneumoniae
MRSA
Pseudomonas aeruginosa
HSV
What type of meningitis is most implicated by the following lumbar puncture (LP) results?
Opening pressure elevated --- WBC leukocytosis with neutrophilic pleocytosis
Protein elevated --- glucose 60 mg/dl
Blood glucose 180 mg/dl
Bacterial
Viral
Fungal
Amoebic
A neonate has developed suspected bacterial meningitis. The care team wasn't able to get a vaginal GBS colonization test, but empiric bread spectrum treatment is needed anyway. What two regimens could you start them on?
Ampicillin + Gentamicin
Ampicillin + Cefotaxime
Vancomycin + Zosyn
Vancomycin + Rifampin
A 21 year old is admitted for traumatic head trauma requiring neurosurgery. They develop post-surgery bacterial meningitis. The care team has identified risk factors for possible MDR Klebsiella. What empiric treatment should they be started on?
Vancomycin + Zosyn
Vancomycin + Meropenem
Ampicilllin + gentamicin
Ceftriaxone + Cefotaxime
What is the best time to give a dose of corticosteroids for bacterial meningitis?
Upon presentation or first suspecting meningitis
When the patient is showing clinical improvement
When the 3rd-7th doses of antibiotics are given
When the first dose of antibiotic is given
An inpatient with HSV encephalitis has been prescribed acyclovir IV 10 mg/kg q8h. What should the care team be watchful for?
Obstructive AKI
Burning Mouth Syndrome
Altered mental status
Burning Man Syndrome
How is vulvovaginal candidiasis treated?
Oral fluconazole tablets, typically one dose
Nystatin 5000 units/day swish & spit
Ibrexafungerp in all patients who aren't allergic
Sirolimus topical cream applied to the area TID
Which of the following are Treponemal-specific tests?
RPR
VDRL
TPA
TP-PA
What description best matches primary syphilis?
Infection of the subendothelium, presence of a single ulcer
Dissemination through lymph and blood vessels
Gummatous disease
Presence of paresis and tabes dorsalis
What best describes secondary syphlis?
Dissemination through the lymph and blood after ~4-10 weeks
Dissemination to the cardiovascular system
Presence of general paresis and tabes dorsalis
Persistent infection lasting 10-30 yrs
What syphilis-suspected patient would best qualify for a lumbar puncture?
Joey, who is presenting for triple-presentation of chlamydia, gonorrhea, and with secondary syphilis
Evan, being seen for med rec on HIV meds and notes a single genital ulcer
Karl, who had a genital ulcer a couple weeks ago and is now having some hearing problems
Michael, who received a penicillin G benzathine IM shot a few days ago
What is the purpose of giving probenecid with penicillin for syphilis?
Inhibiting bacterial beta lactamase
Inhibiting tubular secretion
Increasing meningeal permeability
Directly attacking bacteria
Alek is a 32 year old presenting with secondary syphilis. He previously had a single genital ulcer a few months ago but is now presenting with body rash, including on their palms and soles. What treatment is best for Alek?
Penicillin G Benzathine IT x1
Penicillin G Benzathine IM x1
Penicillin G benzathine IV x1
Penicillin G IV 6 doses per day for 10 days
Which statement regarding HIV pathology is incorrect?
gp120 and gp41 on the envelope interact with R5 and X4 on CD4 cells
Most strains start off using the R5 receptor and will switch to X4
pol is used to evade lymphocyte recognition of the virions
gp proteins on the envelope are responsible for virion to CD4 cell interaction
Your friend/classmate Jamie comes into your rotation site. Jamie's been the victim of a needle stick while caring for an HIV suspected patient yesterday. They would like to be tested for HIV. What should you do to help them?
Take an ELISA test and send them out
Their practice site is unlikely to require the patient to get an HIV test, so it's important to test Jamie now
Take a viral load/NAT test now, they can probably get the results before they leave the clinic.
Advise them to find a at-home HIV antibody test. They can come in later for a Western Blot staining
Which patient is incorrectly using a test for HIV based on the information given?
Julius, who visited a clinic for an ELISA test after realizing they were exposed to HIV 5 weeks ago
Marisol, who is getting a blood antibody test to keep up with work site requirements
Klay, who opened a prepackaged needle and stuck himself before preparing an admixture for an HIV + patient
Ian, who used oral swab POCT for HIV in case they were exposed at least two weeks ago
Select all of the following that are likely in the primary/acute HIV syndrome.
10% asymptomatic and will not have a clinical viral syndrome
Swollen lymph nodes, headaches, muscle and joint aches
Disseminated rash, malaise, hepatosplenomegaly
Coagulopathy and ascites
Which of the following are short-term goals of HIV treament?
1 log drop of viremia in the first 4-6 weeks
Viral undetectability of <50 c/ml, normally within 12-24 weeks
Increasing CD4 lymphocyte count, minimum >200 c/mm3
Increasing quality of life and minimizing toxicity
Emilia is a woman with HIV who was started on Emtricitabine + Abacavir + Dolutegravir 8 days ago. She has developed a full body rash and respiratory depression, warranting an emergency department visit. What is this attributable to?
Emtricitabine
HIV flare
Abacavir
Darunavir
What drug cannot be abruptly discontinued in HIV-HBV coinfection due to Hep B flare?
Emtricitabine
Indinavir
Efavirenz
Nevirapine
You're in the middle of a med rec with your patient Maeve who has been taking Tenofovir (disoproxil fumarate) + Zidovudine + Darunavir for a while now. They said they've been having good results on their viral tests, but their osteomalacia tests have been getting worse. Their doctor also told them they are losing a lot of electrolytes and other materials in their urine. What drug is this most attributable to?
Zidovudine
Tenofovir
Daltegravir
Darunavir
Jason is an HIV patient who now requires hemodialysis due to renal dysfunction. Which NRTI was purposely studied in hemodialysis to ensure its dosing would not need to be adjusted in HD?
Emtricitabine
Lamivudine
Tenofovir
Abacavir
Your patient AD is identified for empiric treatment of PCP due to a CD4 count <200, increased LDH, fever, productive cough, and a history of a slow onset. AD is currently experiencing moderate symptoms and has a sulfa allergy. While waiting on respiratory staining and a direct fluorescent antibody test, what treatment can you start them on?
Sulfamethoxazole-trimethoprim 7.5 mg/kg BID
Clindamycin 450 mg po q8h + Primaquine 30 mg po qd
Emtricitabine 200 mg po qd
Sulfamethoxazole-trimethoprim 20 mg/kg qd
A patient presents to your ED with suspected Pneumocystis jiroveci pneumonia. They have a productive cough that has increased over the past few days, leukocytosis, fever, and a positive DFA. Their CXR is positive for ground glass appearance. Their current PaO2 is under 70 mmHg. Their weight is 100 kg. What should you treat them with?
SMX/TMP 1875/375 mg IV 4 times/day
plus glucocorticoid
SMX/TMP 800/160 mg DS tablets TID
SMX/TMP 1500mg IV qd plus glucocorticoid
