ABIM Internal Medicine Final Exam 2023

ABIM Internal Medicine Final Exam 2023 Bacterial meningitis - treatment in beta-lactam allergic patients - CORRECT ANSWERMoxifloxacin + Bactrim Brain abscess - treatment - CORRECT ANSWER-Cephalosporin + Flagyl Encephalitis, choreoathetosis, psychiatric symptoms, seizures, autonomic instability - CORRECT ANSWER-Autoimmune encephalitis Check anti-NMDA receptor antibody Organism - sepsis, cellulitis, hemorrhagic bullae, saltwater fish or shellfish, cirrhotic - CORRECT ANSWER-Vibrio vulnificus Organism - chronic nodular infection, fish tanks - CORRECT ANSWER-Mycobacterium marinum Organism - sepsis following dog bite, asplenic patient - CORRECT ANSWERCapnocytophaga canimorsus Organism - symmetric, pink-to-brown patches with thin scale in intertriginous areas - CORRECT ANSWER-Corynebacterium minutissimum causing erythrasma Treat with topical erythromycin, clarithromycin or clindamycin Organism - ecthyma gangrenosum in neutropenic patient - CORRECT ANSWERPseudomonas Organism - farm animal exposure, flu-like symptoms, atypical pneumonia - CORRECT ANSWER-Coxiella burnetti (Q fever) Organism - bird exposure, flu-like symptoms, atypical pneumonia - CORRECT ANSWER-Chlamydophila psittaci Organism - Ohio and Mississippi River Valleys, exposure to bird or bat droppings, patchy pneumonia, small narrow-based yeast - CORRECT ANSWER-Histoplasma Treat with itraconazole for mild disease Treat with amphotericin for severe disease Organism - Southwest US, pneumonia (may be cavitary), may have erythema nodosum, ↑eosinophils - CORRECT ANSWER-Coccidioides Treat with itraconazole for mild disease Treat with amphotericin for severe disease Organism - Ohio and Mississippi River Valleys, pneumonia (may be cavitary), may have skin pustules or warts, broad-based yeast - CORRECT ANSWER-Blastomycosis Treat with itraconazole for mild disease Treat with amphotericin for severe disease Organism - exposure to rabbits or rodents, fever, skin ulcers, pneumonia, lymphadenopathy (that may suppurate) - CORRECT ANSWER-Francisella tularemia Treat with streptomycin or gentamicin Lyme - within 30 days and erythema migrans present - CORRECT ANSWER-Treat without serologic confirmation if tick attached 36 hours Lyme - after 30 days with/without signs of disseminated Lyme Disease - CORRECT ANSWER-Obtain serologic confirmation ELISA -- if indeterminate -- Western blot Organism - tick exposure, flu-like illness, hemolytic anemia, kdiney failure, "Maltese cross" of intraerythrocytic parasites on peripheral blood smear - CORRECT ANSWERBabesia causing babesiosis Treat with atovaquone + azithromycin Organism - tick exposure, flu-like illness, elevated aminotransferases, lymphopenia, monocytopenia, "morulae" of clumps of organisms in lymphocytes - CORRECT ANSWER-Erhlichia causing erhlichiosis Treat with doxycycline Organism - tick exposure, flu-like illness, elevated aminotransferases, neutropenia, "morulae" of clumps of organisms in neutrophils - CORRECT ANSWER-Anaplasma causing anaplasmosis Treat with doxycycline Organism - tick exposure, severe headache, flu-like illness, rash from ankles and wrists spreading centripetally, may have DIC - CORRECT ANSWER-Rickettsia rickettsii causing Rocky Mountain Spotted Fever Treat with doxycycline (chloramphenicol if pregnant) Organism - gardener or landscaper, papule that progresses to similar lesions alone lymphatic channels - CORRECT ANSWER-Sporothrix schenckii causing sporotrichosis Treat with itraconazole Syphilis - indications for LP - CORRECT ANSWER-Tertiary syphilis CNS manifestations No response to treatment Syphilis - treatment - CORRECT ANSWER-Primary or secondary: 1 dose of IM benzathine penicillin Late latent or asymptomatic: 3 weekly doses of IM benzathine penicillin Tertiary (nonneurosyphilis): 3 weekly doses of IM benzathine penicillin Tertiary (neurosyphilis): IM benzathine penicillin q4h for 10-14 days Syphilis - treatment penicillin-allergic patients - CORRECT ANSWER-Nonpregnant patients may be treated with doxycycline Pregnant patients MUST be desensitized and treated with penicillin Syphilis - acute febrile illness within 24 hours of syphilis treatment - CORRECT ANSWER-Jarisch-Herxheimer reaction (not penicillin allergy) Organisms - sickle cell disease patient with osteomyelitis - CORRECT ANSWERSalmonella and S. aureus Organism - fever, severe back pain, rash first on buccal or pharyngeal mucosa spreading distally and centrifugally, rash all in the same stage - CORRECT ANSWERSmallpox Treatment is supportive, provide postexposure vaccination Organism - enlarging painless ulcer with black eschar, Gram positive bacilli on Gram stain, widened mediastinum on CXR - CORRECT ANSWER-Bacillus anthraxis causing anthrax Treat with IV ciprofloxacin + 2 other abx, provide postexposure vaccination Organism - exposure to fleas, swollen and infected lymph nodes (buboes), sepsis, DIC, multiorgan failure, "safety pin" shape on Gram stain - CORRECT ANSWER-Yersinia pestis causing plague Treat with streptomycin or gentamicin Organism - flaccid/descending paralysis, diplopia, dysphonia, dysarthria, dysphagia - CORRECT ANSWER-Clostridium botulinum causing botulism Treat with equine serum antitoxin and supportive care in ICU Organism - tropical areas,exposure to animal urine or contaminated water, flu-like illness, kidney failure, respiratory failure, rhabdomyolysis, "conjunctival suffusion" - CORRECT ANSWER-Leptospira interrogans causing leptospirosis Treat with doxycycline and penicillin, but most cases are self-limited HIV - preexposure prophylaxis - CORRECT ANSWER-Tenofovir + emtricitabine HIV - postexposure prophylaxis - CORRECT ANSWER-Tenofovir + emtricitabine + raltegravir for 4 weeks PJP - classification of severity - CORRECT ANSWER-Mild: A-a 35 mm Hg and PO2 70 Moderate: A-a 35-45 and PO2 70 Severe: A-a 45 and PO2 70 Mild PJP may treat with oral Bactrim Moderate-severe PJP treat with IV Bactrim and IV steroids Sulfa allergy: IV pentamidine Organism - immunocompromised patient, neurologic symptoms, mononucleosis-like syndrome, head imaging with ring-enhancing lesions - CORRECT ANSWERToxoplasma gondii Treat with sulfadiazine, pyrimethamine and folic acid