MKSAP18 - Infectious Disease UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Risk factors of candidemia? - CORRECT ANSWER - Central venous catheters
Broad-spectrum ABX
ICU or mechanical ventilation for 3 days
Intraabdominal surgery
Trauma
Burns
TPN
Transplant
Treatment of Candidemia? - CORRECT ANSWER - Echinocandin (capsofungin,
mycafungin, anidulafungin) and removal of intravascular devices if possible.
Treatment of candidal choreoretinitis, endophthalmitis, or candidal CNS infection? - CORRECT
ANSWER - Echinocandins have poor penetration in the eye and CNS, so Amphotericin B
or azoles should be used.
Concern about Candida glabrata or krusei? - CORRECT ANSWER - They are resistant to
azoles so need treated with echinocandin or amphotericin.
Duration of treatment of uncomplicated candidemia? - CORRECT ANSWER - 14 days
from first negative blood culture
Duration of treatment for complicated candidemia? - CORRECT ANSWER - 14-42 days
from first negative blood culture
,Can candidemia be considered contaminant? - CORRECT ANSWER - No! Associated
with 30-40% mortality.
Rate of blood culture positivity for patients with invasive candidal infection? - CORRECT
ANSWER - 40-60%
Very important to consider risk factors for candidemia
Rapid diagnostic testing for culture-negative candidemia? - CORRECT ANSWER - 1, 3 -
beta - D - glucan
or
T2 magnetic resonance assay of whole blood (can even be used in patients that have already
initiated treatment)
Candida grew in induced respiratory sputum. How to treat? - CORRECT ANSWER -
Don't. Almost always represents colonization in the lungs, not infection.
Candida grew on urine culture. Treatment? - CORRECT ANSWER - Don't treat unless
truly symptomatic and thought attributable to candida. Usually represents colonization.
-If asymptomatic candiduria, do not treat unless high risk for dissemination: tx w fluconazole or
amphotericin B for 7 days
-neutropenia
-urologic procedure
-Renal transplant no longer a strict recommendation for tx but should be considered if shortly
after transplant or if ureteral stents are in place
-Treat symptomatic cystitis w fluconazole. If Candida glabrata use amphotericin B or
flucytosine. For Candida krusei use amphotericin B. 7-day course.
,-Treat candidal pyelonephritis w the same agents as cystitis.
Consideration in patient with persistent symptomatic candiduria? - CORRECT ANSWER -
Fungal ball? Get imaging. If present, surgical removal.
True/False: candida isolated from the respiratory or urinary tract usually represent colonization
and require no treatment? - CORRECT ANSWER - True
Most common patient population to develop invasive pulmonary aspergillosis? - CORRECT
ANSWER - Immunosuppressed patients who are neutropenic or are HSCT patients.
Risk factors for invasive aspergillosis? - CORRECT ANSWER - Major
-Neutropenia
-Solid organ transplant
-GVHD
-CMV reactivation
-HSCT
-Systemic steroids >1mg/kd/d or ICS
-Hematologic malignancies
Minor
-COPD on steroids
-Cirrhosis
-Burns
-Immunosuppressants
-HIV with CD4<50
-IVDA
, Describe angioinvasive dissemination of aspergillus - CORRECT ANSWER - 1.
aspergillus enters respiratory tract
2. enters circulatory system (angioinvasion)
3. formation of fungal septic emboli allow dissemination
Most common manifestation of angioinvasive aspergillosis? - CORRECT ANSWER -
Angioinvasive pulmonary disease
Can also cause sinusitis, brain abscess, endocarditis, and osteomyelitis
True/False: frequently, fever is the only feature present in angioinvasive aspergillosis? -
CORRECT ANSWER - True
All symptoms are non-specific for invasive aspergillosis
-dry cough, fever, pleurisy, SOB, scant hemoptysis
CXR findings in invasive pulmonary aspergillosis? - CORRECT ANSWER - potentially
normal in early disease
may show infiltrates, infarction, or nodules
cavitary disease is a late manifestation
True/False: blood cultures results of invasive aspergillosus is usually negative? - CORRECT
ANSWER - True
If angioinvasive aspergillosus is suspected, what test should be ordered? - CORRECT
ANSWER - Serum galactomannan
ACTUAL Exam Questions and CORRECT
Answers
Risk factors of candidemia? - CORRECT ANSWER - Central venous catheters
Broad-spectrum ABX
ICU or mechanical ventilation for 3 days
Intraabdominal surgery
Trauma
Burns
TPN
Transplant
Treatment of Candidemia? - CORRECT ANSWER - Echinocandin (capsofungin,
mycafungin, anidulafungin) and removal of intravascular devices if possible.
Treatment of candidal choreoretinitis, endophthalmitis, or candidal CNS infection? - CORRECT
ANSWER - Echinocandins have poor penetration in the eye and CNS, so Amphotericin B
or azoles should be used.
Concern about Candida glabrata or krusei? - CORRECT ANSWER - They are resistant to
azoles so need treated with echinocandin or amphotericin.
Duration of treatment of uncomplicated candidemia? - CORRECT ANSWER - 14 days
from first negative blood culture
Duration of treatment for complicated candidemia? - CORRECT ANSWER - 14-42 days
from first negative blood culture
,Can candidemia be considered contaminant? - CORRECT ANSWER - No! Associated
with 30-40% mortality.
Rate of blood culture positivity for patients with invasive candidal infection? - CORRECT
ANSWER - 40-60%
Very important to consider risk factors for candidemia
Rapid diagnostic testing for culture-negative candidemia? - CORRECT ANSWER - 1, 3 -
beta - D - glucan
or
T2 magnetic resonance assay of whole blood (can even be used in patients that have already
initiated treatment)
Candida grew in induced respiratory sputum. How to treat? - CORRECT ANSWER -
Don't. Almost always represents colonization in the lungs, not infection.
Candida grew on urine culture. Treatment? - CORRECT ANSWER - Don't treat unless
truly symptomatic and thought attributable to candida. Usually represents colonization.
-If asymptomatic candiduria, do not treat unless high risk for dissemination: tx w fluconazole or
amphotericin B for 7 days
-neutropenia
-urologic procedure
-Renal transplant no longer a strict recommendation for tx but should be considered if shortly
after transplant or if ureteral stents are in place
-Treat symptomatic cystitis w fluconazole. If Candida glabrata use amphotericin B or
flucytosine. For Candida krusei use amphotericin B. 7-day course.
,-Treat candidal pyelonephritis w the same agents as cystitis.
Consideration in patient with persistent symptomatic candiduria? - CORRECT ANSWER -
Fungal ball? Get imaging. If present, surgical removal.
True/False: candida isolated from the respiratory or urinary tract usually represent colonization
and require no treatment? - CORRECT ANSWER - True
Most common patient population to develop invasive pulmonary aspergillosis? - CORRECT
ANSWER - Immunosuppressed patients who are neutropenic or are HSCT patients.
Risk factors for invasive aspergillosis? - CORRECT ANSWER - Major
-Neutropenia
-Solid organ transplant
-GVHD
-CMV reactivation
-HSCT
-Systemic steroids >1mg/kd/d or ICS
-Hematologic malignancies
Minor
-COPD on steroids
-Cirrhosis
-Burns
-Immunosuppressants
-HIV with CD4<50
-IVDA
, Describe angioinvasive dissemination of aspergillus - CORRECT ANSWER - 1.
aspergillus enters respiratory tract
2. enters circulatory system (angioinvasion)
3. formation of fungal septic emboli allow dissemination
Most common manifestation of angioinvasive aspergillosis? - CORRECT ANSWER -
Angioinvasive pulmonary disease
Can also cause sinusitis, brain abscess, endocarditis, and osteomyelitis
True/False: frequently, fever is the only feature present in angioinvasive aspergillosis? -
CORRECT ANSWER - True
All symptoms are non-specific for invasive aspergillosis
-dry cough, fever, pleurisy, SOB, scant hemoptysis
CXR findings in invasive pulmonary aspergillosis? - CORRECT ANSWER - potentially
normal in early disease
may show infiltrates, infarction, or nodules
cavitary disease is a late manifestation
True/False: blood cultures results of invasive aspergillosus is usually negative? - CORRECT
ANSWER - True
If angioinvasive aspergillosus is suspected, what test should be ordered? - CORRECT
ANSWER - Serum galactomannan
