ABIM core scripts TEST QUIZ WITH
CORRECT ANSWERS
Aeromonas hydrophila - CORRECT ANSWERS-Found in aquatic environements
GNR
Tx: doxycycline plus ciprofloxacin or ceftriaxone
Anaplasmosis - CORRECT ANSWERS-Fever, headache, myalgia, N-V, LAD
Rash
Leukopenia, thrombocytopenia, transaminitis
Can be transmitted with Lyme
Tx: doxy
Babesiosis - CORRECT ANSWERS-Febrile illness, fevers chills headache, athralgias
Hemolytic anemia in susceptible patients ( Age > 50, asplenic, immunocompromised)
From tick bite OR blood transfusion
Tx: azithro + atovaquone OR IV clinadamycin & quinine
Botulism tx - CORRECT ANSWERS-equine antitoxin
Campylobacter tx - CORRECT ANSWERS-3 days azithromycin
Chagas disease - CORRECT ANSWERS-Phase 1: fevers and arthalgias
Phase 2: No symptoms
Phase 3: cardiomyopathy. LV apical aneurysm is pathognomonic for Chagas
In central & South America
Dengue fever - CORRECT ANSWERS-Severe headache/eye pain, platelet
consumption, elevated hematocrit, petechial rash, muscle pain and fever
Positive tourniquet test
Hemorrhagic fever: shock
Tx is supportive
Diagnosing mucormycosis - CORRECT ANSWERS-Tissue sample - biopsy; showing
hyphae
Tx: debridement & amphoteracin B
Disseminated gonorrhea tx - CORRECT ANSWERS-1g ceftriaxone IV daily x 7 days
,Dog bite & rabies - CORRECT ANSWERS-Observe the dog for 10 days
Enterobius vermicularis - CORRECT ANSWERS-Pinworm
Eggs laid in perianal folds
Come out at nighttime
Cause pruritus, scratching worsens spread
Tx: albendazole
Fusarium moniliforme presentation - CORRECT ANSWERS-Immunocompetant:
keratitis, onychomycosis, skin infections
Immunocompromised: fever, sinusitis, PNA, multiple painful erythematous nodules,
fungemia
Grows mold on skin bx or blood culture
Hep B treatment
when:
what: - CORRECT ANSWERS-When: >4 weeks duration (most people clear virus on
own)
coagulopathy, INR > 1.5
Severe jaundice, Br >10
Acute liver failure
What: tenofovir or entecavir
Leimerre's Syndrome - CORRECT ANSWERS-Recent sore throat, persistent fever,
neck pain and swelling, septic emboli involving IJ
Caused by anaerobe fusobacterium necrophorum
Leptospirosis - CORRECT ANSWERS-Seen in farmers, vets, those fresh water
swimming or rafting, some dog or rodent exposures
Symptoms: abrupt onset of fever, malaise, headache, conjunctival redness without
exudate, GI symptoms, HSM +/- LAD, myalgia, arthalgias, jaundice (Weil syndrome)
Tx: doxy or PCN
MAC - CORRECT ANSWERS-get for inhaled of aerosolized water
can get "hot tub lung" hypersensitivity pneumonitis
Malaria tx - CORRECT ANSWERS-No resistance: chloroquine
--> resistance in South America (northern regions), South Africa, Middle East, India
Mycobcaterium marinum - CORRECT ANSWERS-Appears similar to sporotrichosis with
lesions that migrate up lymphatics
Dx: culture or bx
Tx: mild - clarithro, doxy of TMP-SMX.
Severe - clarithro & ethambutol or rifampin
,Neurocysticercosis - CORRECT ANSWERS-Ingesting eggs in human feces
Dx based on imaging or serology
Tx:
1-2 cysts - albendazole & steroids
>2 cysts - albendazole, steroids & praziquantel
Nocardiosis - CORRECT ANSWERS-Pulmonary - fever, cough, hemoptysis. Commonly
disseminates from lung to CNS
Skin - ulcers, abscess, cellulitis
CNS - headache, focal deficits, seizures. Abscess on head imaging
Dx: acid fast, filamentous GPR
Tx with TMP-SMX
P. falciparum - CORRECT ANSWERS-Tertian fevers
Chloroquine resistance
Double headphone on smear, banana gametocytes
High level parasitism
P. vivax - CORRECT ANSWERS-Tertain fevers
Liver stage (requires primaquine or tafequinone for cure)
No chloroquine resistance
Parvovirus - CORRECT ANSWERS-Pregnant women - fetal loss & hydrops fetalis
Sickle cell: self limiting aplastic anemia, support with transfusions
Immunosuppressed - prolonged aplastic anemia - give IVIG
Pneumonic plague - CORRECT ANSWERS-bacteria Yersinia pestis
Sputum Gram stain (and possibly blood smear) may identify gram-negative coccobacilli
demonstrating the classic bipolar staining or "safety pin" shape
pulmonary involvement occurs through secondary hematogenous spread to the lungs
from a bubo or other source, primary pneumonic plague can occur after close contact
with another person with plague pneumonia, after animal exposure, or as a result of
intentional aerosol release for the purpose of terrorism
Tx gentamicin
posttransplant lymphoproliferative disorder (PTLD) - CORRECT ANSWERS-- fever,
pancytopenia, generalized lymphadenopathy, and hepatosplenomegaly
- risk is higher in patients with a history of pre-existing EBV infection treated with
lymphocyte-depleting agents and in those receiving sirolimus and tacrolimus compared
with those receiving mycophenolate and cyclosporine.
-PTLD can range from a benign monoclonal gammopathy to a malignant lymphoma.
- tx: decrease immunosupression; rituximab or chemo
PPD >10mm positive if - CORRECT ANSWERS-immigrant from endemic area
IVDA
Healthcare employees & residents
, At risk for TB re-activation
PPD >5mm positive if - CORRECT ANSWERS-HIV
Close contacts
Rabies ppx - CORRECT ANSWERS-Immediate for: bat, raccoon, fox, skunk
Observe animal for 10 days: dogs, cats, ferret
No ppx: rodents
Ring enhancing lesions in AIDS - CORRECT ANSWERS-Multiple - toxo
Single - primary CNS lymphoma
White matter lesions - PML
Schistosomiasis - CORRECT ANSWERS-Acute syndrome: fevers, urticarial lesions,
robust eosinophilia
Skin infection tx - CORRECT ANSWERS-Treat with antibiotics if:
abscess >2cm
surrounding cellulitis
Systemic symtpoms
neutropenia
no improvement post I&D
Tx: doxy or TMP-SMX (MRSA coverage)
Small pox exposure - CORRECT ANSWERS-Give vaccine (live) within 7 days
Unless the patient is severely immunodeficient (within 4 months of bone marrow
transplantation, HIV infection with CD4 cell counts <50/µL, or severe combined
immunodeficiency), the vaccine should be given.
If contraindicated, give immunoglobin
Sporothrichosis, Dx & Tx - CORRECT ANSWERS-Dx: Graim stains -fungal
Tx: itraconazole
Syphilis tx - CORRECT ANSWERS-PCN 2.4 mil until x1
Early latent 50,000 mil units PCN x1
Late latent 50,000 mil units PCN weekly x3 weeks
Neurosyphilis - aqueous PCN 18-24 million units/day IV 10-14 days. Repeat CSF q6
months until normal
Tetanus with wounds - CORRECT ANSWERS-. If given less than 3 lifetime doses :
- clean wound: toxoid injection
- crush wound, dirt/feces, puncture wound, or bullet : toxoid plus IG
If given at least 3 lifetime doses:
- clean wound: toxoid injection if last was > 10 years ago
CORRECT ANSWERS
Aeromonas hydrophila - CORRECT ANSWERS-Found in aquatic environements
GNR
Tx: doxycycline plus ciprofloxacin or ceftriaxone
Anaplasmosis - CORRECT ANSWERS-Fever, headache, myalgia, N-V, LAD
Rash
Leukopenia, thrombocytopenia, transaminitis
Can be transmitted with Lyme
Tx: doxy
Babesiosis - CORRECT ANSWERS-Febrile illness, fevers chills headache, athralgias
Hemolytic anemia in susceptible patients ( Age > 50, asplenic, immunocompromised)
From tick bite OR blood transfusion
Tx: azithro + atovaquone OR IV clinadamycin & quinine
Botulism tx - CORRECT ANSWERS-equine antitoxin
Campylobacter tx - CORRECT ANSWERS-3 days azithromycin
Chagas disease - CORRECT ANSWERS-Phase 1: fevers and arthalgias
Phase 2: No symptoms
Phase 3: cardiomyopathy. LV apical aneurysm is pathognomonic for Chagas
In central & South America
Dengue fever - CORRECT ANSWERS-Severe headache/eye pain, platelet
consumption, elevated hematocrit, petechial rash, muscle pain and fever
Positive tourniquet test
Hemorrhagic fever: shock
Tx is supportive
Diagnosing mucormycosis - CORRECT ANSWERS-Tissue sample - biopsy; showing
hyphae
Tx: debridement & amphoteracin B
Disseminated gonorrhea tx - CORRECT ANSWERS-1g ceftriaxone IV daily x 7 days
,Dog bite & rabies - CORRECT ANSWERS-Observe the dog for 10 days
Enterobius vermicularis - CORRECT ANSWERS-Pinworm
Eggs laid in perianal folds
Come out at nighttime
Cause pruritus, scratching worsens spread
Tx: albendazole
Fusarium moniliforme presentation - CORRECT ANSWERS-Immunocompetant:
keratitis, onychomycosis, skin infections
Immunocompromised: fever, sinusitis, PNA, multiple painful erythematous nodules,
fungemia
Grows mold on skin bx or blood culture
Hep B treatment
when:
what: - CORRECT ANSWERS-When: >4 weeks duration (most people clear virus on
own)
coagulopathy, INR > 1.5
Severe jaundice, Br >10
Acute liver failure
What: tenofovir or entecavir
Leimerre's Syndrome - CORRECT ANSWERS-Recent sore throat, persistent fever,
neck pain and swelling, septic emboli involving IJ
Caused by anaerobe fusobacterium necrophorum
Leptospirosis - CORRECT ANSWERS-Seen in farmers, vets, those fresh water
swimming or rafting, some dog or rodent exposures
Symptoms: abrupt onset of fever, malaise, headache, conjunctival redness without
exudate, GI symptoms, HSM +/- LAD, myalgia, arthalgias, jaundice (Weil syndrome)
Tx: doxy or PCN
MAC - CORRECT ANSWERS-get for inhaled of aerosolized water
can get "hot tub lung" hypersensitivity pneumonitis
Malaria tx - CORRECT ANSWERS-No resistance: chloroquine
--> resistance in South America (northern regions), South Africa, Middle East, India
Mycobcaterium marinum - CORRECT ANSWERS-Appears similar to sporotrichosis with
lesions that migrate up lymphatics
Dx: culture or bx
Tx: mild - clarithro, doxy of TMP-SMX.
Severe - clarithro & ethambutol or rifampin
,Neurocysticercosis - CORRECT ANSWERS-Ingesting eggs in human feces
Dx based on imaging or serology
Tx:
1-2 cysts - albendazole & steroids
>2 cysts - albendazole, steroids & praziquantel
Nocardiosis - CORRECT ANSWERS-Pulmonary - fever, cough, hemoptysis. Commonly
disseminates from lung to CNS
Skin - ulcers, abscess, cellulitis
CNS - headache, focal deficits, seizures. Abscess on head imaging
Dx: acid fast, filamentous GPR
Tx with TMP-SMX
P. falciparum - CORRECT ANSWERS-Tertian fevers
Chloroquine resistance
Double headphone on smear, banana gametocytes
High level parasitism
P. vivax - CORRECT ANSWERS-Tertain fevers
Liver stage (requires primaquine or tafequinone for cure)
No chloroquine resistance
Parvovirus - CORRECT ANSWERS-Pregnant women - fetal loss & hydrops fetalis
Sickle cell: self limiting aplastic anemia, support with transfusions
Immunosuppressed - prolonged aplastic anemia - give IVIG
Pneumonic plague - CORRECT ANSWERS-bacteria Yersinia pestis
Sputum Gram stain (and possibly blood smear) may identify gram-negative coccobacilli
demonstrating the classic bipolar staining or "safety pin" shape
pulmonary involvement occurs through secondary hematogenous spread to the lungs
from a bubo or other source, primary pneumonic plague can occur after close contact
with another person with plague pneumonia, after animal exposure, or as a result of
intentional aerosol release for the purpose of terrorism
Tx gentamicin
posttransplant lymphoproliferative disorder (PTLD) - CORRECT ANSWERS-- fever,
pancytopenia, generalized lymphadenopathy, and hepatosplenomegaly
- risk is higher in patients with a history of pre-existing EBV infection treated with
lymphocyte-depleting agents and in those receiving sirolimus and tacrolimus compared
with those receiving mycophenolate and cyclosporine.
-PTLD can range from a benign monoclonal gammopathy to a malignant lymphoma.
- tx: decrease immunosupression; rituximab or chemo
PPD >10mm positive if - CORRECT ANSWERS-immigrant from endemic area
IVDA
Healthcare employees & residents
, At risk for TB re-activation
PPD >5mm positive if - CORRECT ANSWERS-HIV
Close contacts
Rabies ppx - CORRECT ANSWERS-Immediate for: bat, raccoon, fox, skunk
Observe animal for 10 days: dogs, cats, ferret
No ppx: rodents
Ring enhancing lesions in AIDS - CORRECT ANSWERS-Multiple - toxo
Single - primary CNS lymphoma
White matter lesions - PML
Schistosomiasis - CORRECT ANSWERS-Acute syndrome: fevers, urticarial lesions,
robust eosinophilia
Skin infection tx - CORRECT ANSWERS-Treat with antibiotics if:
abscess >2cm
surrounding cellulitis
Systemic symtpoms
neutropenia
no improvement post I&D
Tx: doxy or TMP-SMX (MRSA coverage)
Small pox exposure - CORRECT ANSWERS-Give vaccine (live) within 7 days
Unless the patient is severely immunodeficient (within 4 months of bone marrow
transplantation, HIV infection with CD4 cell counts <50/µL, or severe combined
immunodeficiency), the vaccine should be given.
If contraindicated, give immunoglobin
Sporothrichosis, Dx & Tx - CORRECT ANSWERS-Dx: Graim stains -fungal
Tx: itraconazole
Syphilis tx - CORRECT ANSWERS-PCN 2.4 mil until x1
Early latent 50,000 mil units PCN x1
Late latent 50,000 mil units PCN weekly x3 weeks
Neurosyphilis - aqueous PCN 18-24 million units/day IV 10-14 days. Repeat CSF q6
months until normal
Tetanus with wounds - CORRECT ANSWERS-. If given less than 3 lifetime doses :
- clean wound: toxoid injection
- crush wound, dirt/feces, puncture wound, or bullet : toxoid plus IG
If given at least 3 lifetime doses:
- clean wound: toxoid injection if last was > 10 years ago
