key: cord-0035072-q2ps8hp8 authors: Houser, Christine M. title: General Infectious Disease Question and Answer Items date: 2014-06-30 journal: Pediatric Infectious Disease DOI: 10.1007/978-1-4939-1329-9_3 sha: a9752e4ba5b05d1fd57f378374307775af0b6b10 doc_id: 35072 cord_uid: q2ps8hp8 An overview of the general pediatric infectious disease topics necessary for ward knowledge, clinical acumen in practice, and board examination preparation is presented in an easy-to-study question & answer format. When is toxoplasmosis typically transmitted to a fetus (under what conditions)? When the mother has a primary infection Transmission of toxoplasmosis is most likely in what part of pregnancy? Late (14 % fi rst trimester, 60 % third trimester) Congenital toxoplasmosis is generally most severe when acquired during what trimester? The fi rst (the earlier the infection, the greater the effect, in general) No -at least 75 % are asymptomatic What two organs does congenital toxoplasmosis prefer? Eyes & CNS Is congenital toxoplasmosis more or less common in preemies? More What is the "classic triad" of symptomatic congenital toxoplasmosis? What is the main natural reservoir for toxoplasmosis? In addition to cat feces, where else might someone encounter toxoplasmosis? 1. Undercooked meat (especially pork) and eggs 2. Unpasteurized milk 3. Transfusions (of blood products including WBCs) When an adult is infected with toxoplasmosis, how do they present? (2 possibilities) Albendazole , mebendazole , or ivermectin " Staccato cough " -fi rst 2 months of life -no fever -tachypnea = What is the buzzword for Chlamydia pneumoniae infection on micro examination? How is chlamydial pneumonia treated? Erythromycin (or other macrolide) Can chlamydial pneumonia be seen in adolescents/adults? Yes (it is another atypical along with mycoplasma) How is chlamydial pneumonia defi nitely diagnosed? Immunofl uorescent antibodies Imagine fl uorescent pink " Chlams " glowing in the dark What is the name of the only rickettsial disease that causes pneumonia but no rash ? A patient who presents with headache and a rash that moves inward from the extremities may have what serious infectious disease ? How is the rash of Rocky Mountain spotted fever described ? What is the treatment of choice for RMSF ( Rocky Mountain spotted fever )? Why is it alright to use doxycycline in a child less than 9 years old if you are treating RMSF? (Cost-benefi t) 1. Risk of death vs. risk of tooth staining 2. Tooth staining is unlikely with short-term use anyway What is a good way to remember the rash pattern for RMSF ? If you were rock climbing in the Rockies , you would probably get some petechiae on your hands & feet In case of doxycycline allergy, what alternative medication can be used to treat RMSF? How can CMV be transmitted to a neonate? 1. Transplacentally with maternal infection (usually primary infection) 2. At delivery with maternal cervical colonization 3. Breast milk 4. Blood transfusion If a pregnant mother contracts CMV, is she likely to notice the infection? Usually noticed, but not always reported (nonspecifi c malaise-type illness) What percentage of asymptomatically CMV-infected neonates develops serious visual, hearing, or cognitive impairments by age 2 years? About 10 % What is "classic CMV inclusion disease?" (6 components -One big thing Two small things Two sensory issues One lab thing) 1. IUGR 2. HSM (with jaundice & high LFTs) 3. Thrombocytopenia 4. Microcephaly 5. Sensorineural hearing defi cit 6. Chorioretinitis 1 -2 % of births ! Can a fetus contract CMV from a maternal reactivation of the disease? Yes, but very rare What are the signifi cant teratogenic effects of primary rubella infection? (4 groups) 1. CV/heart problems (PDA & pulmonary artery stenosis) 2. Sensorineural hearing loss 3. Cataracts/glaucoma 4. IUGR What percentage of rubella -exposed infants seems normal at birth ? > 50 % Rubella-exposed infants are at risk for late-developing problems in what four organ systems? 1. Special senses (hearing defi cit) 2. CNS -(MR, autism, etc.) 3. Endocrine (DM & thyroid dz) 4. Immune system (dyscrasias) If a pregnant mother contracts CMV, what tends to happen to the fetus even if it does not become infected? Low birth weight/SGA CMV is very common in the USA. Its effect in pregnant is unusual, though, because maternal infection during what part of pregnancy most often causes fetal infection? What is the long-term complication rate for infants born with symptomatic CMV infection ? High ! 40 -90 % What is the probability that an infant infected with CMV will be symptomatic ? 10 % are symptomatic What intestinal parasite is associated with bloody , mucous -y diarrhea and tenesmus ? Eosinophilia is a clue to look for in what type of infection? What is toxocara canis (in very general terms)? A dog parasite (worm) that sometimes accidentally ends up in a person (wrong host) What types of problems/symptoms can toxocara canis cause? • Pulmonary wheezing • GI -hepatomegaly and/or abdominal pain How can you remember that metronidazole treats Entamoeba histolytica ? Picture a " hysterical amoeba " riding the metro to destruction (another option is tinidazole) What other parasitic infection featuring bad diarrhea is treatable with metronidazole? What is the best way to treat scabies in children ? How do you identify scabies as the cause of a patient's itching? Look for long, narrow burrows at edges of clothing and intertriginous areas How can you differentiate CMV from toxoplasmosis on head CT? Both cause calcifi cations but CMV is periventricular (toxo is diffusely spread throughout) How can you remember that metronidazole ( Flagyl ® ) treats trichomonas ? They are " fl agellated " organisms (sounds like Flagyl ® !) If a patient is found to have trichomonas, how many people need to be treated? The patient & all sexual contacts Although current literature suggests that this medication is fi ne in some stages of pregnancy, for the boards , "can you use metronidazole in pregnancy?" No (Ob/gyns do use it, though, so don't panic if you see this in real life) What is the histological / micro buzzword that tells you that a patient has bacterial vaginosis ? " Clue cells " (Cells that have little bits of stuff hanging from the edges of their membranes) What kind of discharge is expected with bacterial vaginosis ? ( aka " Gardnerella "because it is usually the dominant organism ) Thin & gray (can be copious) What do you expect to see on exam of a patient with trichomonas ? ( 2 " buzz phrases ") 1. Strawberry cervix 2. Yellow , frothy discharge Mnemonic: The little whips make the discharge frothy, and cause petechiae on the cervix (the petechiae are the strawberry seeds) What is the name of the organism causing "cat scratch fever?" How is cat scratch fever usually treated? Self-limitedusually supportive care only If a patient has unusually severe cat scratch fever, or is immunocompromised, how could you try to treat the infection? (which medication?) How would you know that a patient's cat scratch fever is unusually severe? (2 items) & Hepatosplenomegaly What is the buzzword description for Haemophilus infl uenza on micro examination ? " Gram-negative pleiomorphic organisms " Although H. fl u is much less common in the USA due to immunization, which populations are likely to get it? Yes -it prevents spread of the organism (asymptomatic individuals may still spread it) What two animals are the typical carriers for salmonella? Chickens & Humans (domesticated turtles can also occasionally be a source) Vomiting , fever , and bloody loose stools 1 -2 days after a group picnic is a likely vignette for what infection ? Should salmonella be routinely treated with antibiotics? No -It is likely to cause a carrier state When might you treat salmonella enteritis with an antibiotic? To identify an infant at risk for congenital syphilis , should you test the mother , the infant , or either one ? The mother (infant serum or cord blood is not suffi cient) If a mother is known to have had syphilis but it was treated prior to pregnancy with erythromycin, is congenital syphilis still a concern? Yes -Any non-penicillin treatment regimen is suspect If an infant is born whose mother's HIV status is unknown, what should you recommend? HIV testing after counseling + consent of mother (some states allow testing without consent, but the above is preferred) In which body systems does adenovirus cause infection? If children or adults are exposed to an active case of diphtheria , but have previously been fully immunized , should anything be done ? Is diphtheria still endemic in some parts of the world ? Yes -In most of the developing world What are the four common forms of diphtheria ? Which neonates are at greatest risk for developing a brain abscess after meningitis ? Those who had gram -negative meningitis In general, what two organisms are most commonly found in brain abscesses? (all ages) Staph & Abscesses in the frontal lobes of the brain usually develop from what source ? About what percentage of children with congenital cyanotic heart disease will develop a brain abscess ? After having a brain abscess , what proportion of kids will have some long -term neurological problems ? What procedure must not be performed on patients with brain abscesses ? (it is a space-occupying lesion and there is a risk of hemiation) For patients who can talk, what is the most common complaint associated with a brain abscess? Headache +/− fever + a focal neurological complaint = How long should an exposed , varicella susceptible individual be isolated ? ( if hospitalized ) Who usually has more severe disease , the index case , or the secondary cases , in varicella infections ? In current practice , which patient groups should not receive varicella vaccine ? ( 3 ) 1. Infants < 1 year 2. Immunocompromised ( but some HIV + should get it ) 3. Pregnant women 4. Patients with malignancies of the blood / bone marrow or lymphatic system 5. Recently received blood products ( up to 11 months prior ) A second dose ( the regimen is now two doses , to minimize declining immunity after vaccination ) If a varicella non-immune patient is exposed to varicella, but cannot receive the vaccine, what other prevention strategy should be considered? During what portion of pregnancy can varicella cause birth defects ? Between the 8th and 20th weeks What three symptoms characterize " croup ?" How is " spasmodic croup " different from regular croup ? During what season is croup most often seen? Winter What is the typical age & gender for a croup patient ? < 3 years (usually 2) and male What is the buzzword for croup on X -ray , and why does it occur ? • " Steeple sign " • Subglottic narrowing due to infl ammation near the cricoid What diagnostics are useful for croup patients ? ( 2 ) In addition to "steeple sign", what else should you be looking for on X-ray if you suspect croup? What other infectious disease sometimes co-occurs with Ehrlichiosis? What is the most common chief complaint in children presenting with Ehrlichiosis ? Which patients are at special risk for more severe Ehrlichiosis? Asplenic & immunocompromised patients (RMSF-type presentation) Where does CMV hide when it is in a latent stage ? What is the hallmark of CMV infection on microscopic exam ? ( 2 ) In utero CMV infection is the most common cause of which congenital problem ? Which body systems can CMV affectespecially in the immunocompromised? ( Paromomycin +/− azithromycin is still sometimes used , but is less effective than nitazoxanide ) Apple cider (unless it is pasteurized -crypto lives well in apple cider for a month!) (Remember that EHEC is in apple juice ) How can public or private water supplies be protected from cryptosporidial contamination ? How is cryptosporidiosis defi nitively diagnosed? Oocysts in stool (often hard to fi nd, must send 3 specimens from 3 different days, minimum) Which viral group most commonly causes hand-foot-mouth disease? What feature of hand-foot-mouth causes the biggest problem? "Vesiculoulcerative" stomatitis -may produce dehydration What is the usual pattern for development of hand-foot-mouth diseases? Oral ulcers, Medical professionals are at risk for herpes in unusual locations if they fail to use universal precautions. What is the most common site for the " occupationally exposed " to have a lesion ? What sport is associated with herpes outbreaks on unusual portions of the body ? Since botulism is caused by a bacterium, why don't we treat it with antibiotics? (3 reasons) 1. The toxin is the problem, not the bacteria 2. Killing the spores may result in increased toxin release in the gut (infant botulism) 3. Some antibiotics actually make the effects of the toxin worse If you give the " tensilon test " to a botulism patient , will it be positive ? (tensilon inhibits acetylcholinesterase, but that doesn't help if there's no ACh) Preformed toxin is ingested (usually from canned goods) Spores are ingested , these grow in the gut , then release toxin (Doesn't happen in older children, because gut fl ora prevent signifi cant growth by the botulinum spores) An infant with poor feeding , ptosis , and / or descending paralysis most likely has what disorder ? If an infant ' s mother has a history of syphilis -properly treated -does the newborn infant require treatment ? Nobut IgG titers should be followed & they should fall over time if the antibodies came from the mom If a mother is being treated with penicillin for syphilis , will her in utero fetus be treated at the same time ? Yes -PCN crosses the p la c e n ta ! A newborn with a maculopapular rash , hepatosplenomegaly , and " peeling skin ," is likely to have what disorder ? Which test is more specifi c and reliable when you are looking for possible syphilis -VDRL or FTA -Abs ? FTA -Abs -(fl uorescent treponemal antigen antibodies -this test remains positive for life) If a patient sustains a "dirty wound," how do you know whether a tetanus booster is needed? If it is more than 5 years from the child's most recent booster (or original immunization) a booster is needed In addition to obviously dirty wounds , what three other important categories of wounds are considered to be dirty ? If a child has a "clean" wound, how do you know whether a tetanus booster is required? What bacterium is especially associated with hemolytic uremic syndrome ( HUS )? Mumps What is the " formal name " for roseola ? ( it ' s often listed this way in answer choices ) HHV -6 (Human herpesvirus type 6) What is the typical pattern seen in roseola infection ( usual clinical course )? What is the formal name for the type of measles associated with birth defects? Rubella -also known as German measles Mnemonic: Imagine an infant speaking German wearing a "bell" that hangs over her heart. The bell is to warn others when she's coming, because she often bumps into things, due to poor vision (cataracts) If a pregnant mother is found to be measles (rubella) non-immune, should you give the vaccine? If the patient was bitten by a domestic animal, should rabies prevention treatment be started? No, if 1. the animal has proof of immunization or 2. the animal can be observed for signs of illness for 10 days, and 3. the bite was not to the head (a bite on the head would require treatment, even if the animal is being observed) If a child is bitten by a possibly rabid animal, how should the child be treated? 1. Human rabies immunoglobulin is injected at the site of the bite 2. Series of 4 rabies vaccinations should be started (note that this is a CHANGE from the previous 5) 3. Wash & debride wound Why are unprovoked animal bites more worrisome for rabies, than those that occur when the patient was interacting with the animal? Unprovoked = higher probability the animal is rabid Why are bites that occurred in areas closer to the brain more likely to cause problems, in terms of rabies? The virus migrates along the nerves to the brain -the shorter the distance, the faster it arrives! Is rabies common in animals in other parts of the world? YES -very common! Are travelers at increased risk for rabies, if they are not specifi cally working with animals? YES -dogs are the most common source for rabies amongst travelers & contact with animals in public areas is enough to contract the disease! If a patient returns after a trip, and was bitten by a dog but didn't receive rabies prophylaxis, should you still give it? The incubation can sometimes last a long time, and even partial immunization increases chances of survival If your patient contracts rabies, can it be treated? Not really -There are some experimental protocols, but it is essentially 100 % fatal What is the histopathological "buzzword" for rabies infection in the CNS? "Negri bodies" are seen -dark inclusions in brain neurons Why is the treatment length so long, when inhalational anthrax is possible? Because spores stuck in the lung sometimes don't start growing for a long time after they are inhaled - The 60 days is to try to be sure antibiotic is present if they do! Why is anthrax vaccination recommended for patients with pulmonary anthrax or inhaled exposure to anthrax? The same reason -Just in case a spore sits in the lung a long time before starting to develop, the body's immune system would be ready What is the issue, currently, with immunizing children following an aerosol anthrax exposure? Which antibiotic is preferred for a pregnant or breast feeding mother, who may have been exposed to anthrax? How are children usually exposed to tuberculosis? How does tuberculosis usually manifest itself in children? Usually it doesn't! (asymptomatic) No -But if it does , the problem is usually in the lower lobe (not upper lobe) What is the name of the stuff used for the PPD ? ( Popular test item !) There is a certain patient group for whom you should not prescribe ethambutol. What group is it? Children too young to be tested for color vision Actinomyces ( yuck !) What have Chlamydia species been redesignated? Are Chlamydia psittaci pneumonia patients ill appearing? Yes, defi nitely ( Rigors , high temp , myalgias -not like " walking pneumonia ") Are Chlamydia pneumoniae patients usually very ill? Nowheezing is common, but not very ill What is the classic presentation of chlamydia pneumonia in infants? Afebrile infant with a "staccato cough" A child presents with fever , headache , increased LFTs. The history involves exposure to pet mammals and water that the animals have been in or near. What is the diagnosis ? What is the connection between the animals, water, and leptospirosis infection? Leptospirosis from the animal's urine gets into the water Yersinia enterocolitica has a thing for iron!) Olive oil overlay is needed to grow out the blood culture ( in addition to Sabouraud ' s medium ) A string is swallowed -long enough to end up in the duodenum -while the remainder stays exterior. Giardia adhere to the string , which is microscopically inspected after is it taken out . Technically , is metronidazole FDA approved for Giardia treatment in kids ? No (but still an okay answer on the boards if no good alternatives given) An immigrant child presents with heart block + cardiomyopathy. What ID cause should you consider? What are the three main differences between protozoa and helminths ( aka " worms ")? If a patient has been given VZIG prophylactically, & is in the hospital, how long will you need to keep the patient in isolation? 28 days! (days 8-21 only if the patient was exposed but not given VZIG) Which chicken pox complication are pregnant patients especially likely to develop ? Yesand should be if she is exposed & seronegative Acyclovir prophylaxis ( 7 days ) may also be given How long can you give varicella zoster IG after exposure ? Which neonates are at risk for severe varicella zoster infection ? Those whose moms developed chicken pox in a 7-day window -5 days before delivery to 2 days after If a mom developed chicken pox 6 days before delivery , should you treat the infant as high risk for VZ ? ( popular test item !) What should you do for an infant whose mom developed Varicella zoster in the critical 7-day window? What is the classic skin fi nding for infants exposed to varicella zoster in utero ? Cicatricial skin scarring ( popular test item !) What is the other name for Rubella? German measles Red rash + lymph nodes in a ring from ear to ear (postauricularsuboccipital LAD) If a patient is exposed to rubeola / measles , what can you do to prevent infection in an unimmunized patient ? Measles is most severe in which nutritionally challenged patient population ? ( popular test item !) Koplik spots on the oral mucosa go with which infectious disease? Mnemonic: Think of a " weasel " in a " cop ' s " uniform lick ing a child's cheek to remember that Koplik spots go with measles. Does rubella also have a special kind of spot? What kind of infl ammatory process does RSV cause in the lung? If a child requires prophylaxis for RSV , what is given ? ( popular test item !) No -Recent studies showed no effect What sort of infection does parainfl uenza virus usually cause? Which types of infl uenza are the main causes for concern ? A + B Amantadine/rimantadine are mainly effective against which sorts of infl uenza? Type A What is the best way to prevent infl uenza infection ? Is immunization against infl uenza recommended for children < 9 years old ? ( popular test item !) What is the infl uenza immunization schedule for kids < 9 years ? The newer neuraminidase anti-infl uenza drugs are effective against which infl uenza types(s)? Both A + B (but they're not wildly effective -best when used early in the infection) For which age groups are the two neuraminidase anti-infl uenza drugs recommended? (different for each drug) Oseltamivir (Tamifl u ® )treatment from 14 days old prophylaxis from 3 months old Zanamivir(Relenza ® )treatment from 7 years old prophylaxis from 5 years old What contraindication to the use of zanamivir (Relenza ® ) should you screen for? On the board exam , which infectious agent causes hand -foot -mouth disease ? (can also be enterovirus, but not usually) In infants, hand-foot-mouth disease also sometimes affects what part of the body? What happens in hand -foot -mouth disease ? - Scarlet fever -increased erythema in the creases of fl exor surfaces An immigrant child from Haiti presents with an asymmetric fl accid paralysis , loss of DTRs , and a fever. What is the disorder ? Does the paralysis that accompanies polio develop slowly or rapidly ? To qualify as a case of polio , there must be neurological defi cits after what length of time ? If a human is infected with rabies , will he/she develop hydrophobia ( fear of water ) like animals do ? Yesperceiving food or water causes larynx / pharynx spasms -that ' s why infected animals / humans fear them How is rabies defi nitively diagnosed ? Nerve biopsy from the " nape of neck " ( back of neck ) shows " Negri bodies " What is the risk of rabies from bites of fox , skunk or bats in the USA ? High -assume they ' re rabid (unless you catch them and check their brains) If a domestic pet is not rabies immunized , and it bites someone , does the person need all of the rabies shots ? No -observe the animal for 10 daysif it remains well it doesn ' t have rabies ( The exception is a high-risk bite to face or neck -start immunizations !) If rabies prophylaxis is indicated , what do you give ? Is it alright to give rabies IgG and rabies vaccine at the same site on the body ? ( popular test item !) An adolescent from the South western USA presents with a pneumonia that develops after a fl u-like illness. It sounds like Staph pneumonia superinfection, except that the vignette includes the hematocrit (high), platelets (low), and albumin (low). What is it? How is HIV most commonly transmitted in the developing world , and often in the US , as well ? When did the USA begin effective HIV screening of the blood supply ? When does most vertical HIV ( mother to infant ) transmission occur ? Is it alright for HIV + moms to breast feed ? How is spread of HIV to health care workers prevented ? In a boards vignette , you are given a patient who has just been diagnosed with TB. What other test would you like to do ? ( popular test item !) A sickle cell patient develops an aplastic crisis. What virus is likely to be responsible ? Are hemophiliacs in the pediatric population likely to be HIV infected ? Repeat the PCR -Two are required to confi rm the diagnosis What do you need to confi rm that the infant is not HIV infected? Requires two negative HIV PCRs, at least 1 month apart, in an infant 6 months of age or older OR At least two negative PCR results in an infant 4 months or older, who is not breast feeding (fi rst test must be from after 1 month old) Infants of HIV positive mothers should also be serologically screened for what additional disorders? Yes -to a few percent !!! What two feeding practices must HIV positive mothers be warned against , to reduce chances of postnatal HIV transmission ? Yes! Start zidovudine as soon as possible after birth! Begin cART (combined antiretroviral therapy) when the infant is older, even if initial testing is negative By what age should an infant begin on a combination HIV treatment regimen? Current research indicates beginning before 12 weeks of age provides important health & developmental benefi ts! (In some cases, cART is started much earlier, but safety & outcome data is limited. Functional "HIV cure" has been reported in one child whose cART was begun at 30 h) After the age of 1 year , what should guide your decision as to whether PCP prophylaxis is needed or not ? CD4 criteria for severe immunosuppression (<500 aged 1 thru 5 years) (<200 older than 5 years) The children aged 1 -5 years must keep their count at or above 500 for 3 months to discontinue prophylaxis If your patient needs TMP/SMX prophylaxis for PCP, but can't tolerate it, what alternative medication can be used? Dapsone -check for G6PD defi ciency before you use! Atovaquone is also an option The " D ' s " go with the " P ' s ," ( as in " poopy diaper !") The hypersensitivity reaction consists of a fl u -like illness and rash -giving the med again after this reaction = death Mnemonic : Sudden death will take you " aback " ( shock you )! ( popular test item !) If a health care worker is exposed to bloody fl uid , and the skin exposed was not completely intact , should the healthcare worker take post -exposure prophylaxis ? ( popular test item !) What is the main antiretroviral given to pregnant women ? How should antiretroviral medication be given during labor and delivery ( PO , IM , IV , PR )? Nothing -Positive bone scan supports osteomyelitis but can also indicate malignancy , fracture , etc . Which other radiological study is also highly sensitive for detecting osteomyelitis , but more specifi c than a bone scan ? How should you identify the causative organism in osteomyelitis? If an osteomyelitis is draining pus through a fi stula , can you use a culture and sensitivity of the fl uid to identify the organism ? ( popular test item !) No -Oddly enough , it will not consistently grow out the correct ( causative ) organism Deafness (about 10 %) When is Neisseria meningitidis a highly virulent infection ? Where is Coxiella burnetii ( Q fever ) most common in the USA ? ( popular test item !) Which animals are the most likely sources for Q fever ? ( popular test item !) How can you remember the unusual source for some cases of Q fever? Think of standing in a "queue" to give birth -this reminds you of the placenta How bleak is the prognosis in pediatric myocarditis? It depends on the cause, but complete recovery may occur in up to 50 % of cases do humans get the short tapeworms? -the kind that infect dogs & cats? From dog/cat fl eas A boards vignette tells you that your patient has just reached the point with HIV where antiretrovirals need to be started. Should you start treatment with a single drug or multiple drugs ?Multidrug " cART " -Stands for " combination A nti R etroviral T herapy " ( sometimes abbreviated ARV for AntiRetroViral therapy ) ( start with three ) ( In the USA , testing for resistance is recommended ) How do you know which combinations of antiretrovirals are UNacceptable ?( 2 rules ) ZDV / D4T is wrong ! All cART regimens include a " dual " nucleoside / nucleotide reverse transcriptase inhibitor , a two -drug combination referred to as the " backbone ." Which combination is acceptable for children in any age group ?Zidovudine + At what age may abacavir replace zidovudine ? Leptospirosis is usually treated with PCN. What other antibiotic is also effective ?When in doubt , which antibiotic group is most likely to be the cause of ear or kidney damage ?( popular test item !) What is the " post -antibiotic effect " seen in Gram-negative bacteria ? Why is the " post -antibiotic effect " important ? What is a cheap , but good , osteomyelitis treatment ? ( actually , give the top three !) A classic boards presentation for neurosyphilis is a young person with ___________? What unusual reaction sometimes occurs with fi rst-time treatment of syphilis?Jarisch-Herxheimer (myalgias, fever, chills, back pain) (especially common in pregnant patients)A young adult / adolescent presents complaining of eye pain and decreased acuity , bilaterally , with no history of trauma. What diagnosis should you consider ? Both of the STDs with "granuloma" in the name require 21 days of treatment.What are the two disorders?• For treatment to be effective, patients with lice will also need to _______? Which patients are most likely to develop (infectious) proctitis?Those who engage in receptive anal intercourseWhat are the symptoms of proctitis?Anorectal pain, discharge, and tenesmusWhat are the usual pathogens in sexually acquired infectious proctitis?N. gonorrhea C. trachomatis T. pallidum HSV (LGV is also possible)How is sexually transmitted proctitis treated?Same as urethritis -Ceftriaxone 250 mg + Doxycycline × 7 days (If HSV then acyclovir) (If syphilis then PCN)How are the symptoms of proctocolitis different from those of proctitis?The colon is involved, so they have diarrhea and crampsAre the organisms involved in proctocolitis the same as those involved in proctitis?No -They are typically invasive diarrheas like Entamoeba or ShigellaCan Giardia be an STD? Yes, in those who practice oral-anal sex Which patient group is most often affected in hepatitis E outbreak?Young males (15-35 years old)