IDBRInfectious Disease Board Review

A 43-year-old man is admitted with acute onset of right sided hemiplegia and dysarthria. He had been in excellent health until one month previously when he presented with shortness of breath and was diagnosed with acute pulmonary emboli and adenocarcinoma of the lung. He was begun on eliquis and chemotherapy was deferred pending genetic testing. The patient lives with his wife and 2 children in Ch...

A 58-year-old HIV- negative gay man is evaluated for PrEP. His past medical history is notable for hypertension, treated for over 10 years with an ACE inhibitor. He is asymptomatic and weighs 145 lbs. He is sexually active with multiple partners but “usually” practices safe sex. Lab studies reveal: HIV 4th generation test negative, HIV-1 RNA negative, CBC normal, creatinine 1.4 with a calculated c...

A 44-year-old man was diagnosed with Pneumocystis pneumonia as his AIDS-defining illness and begun on antiretroviral therapy with 2 nucleosides and an integrase inhibitor during his hospitalization. He stabilizes and follows up for repeated outpatient visits with an HIV RNA consistently <20 copies/ml and a CD4 cell count of 44 that increased to 163 (at 3 months), 232 (at 6 months), 242 (at 9 mo...

A 29-year-old man living with HIV on tenofovir alafenamide (TAF)/emtricitabine + dolutegravir (CD4 298, HIV RNA <20 cps/ml) develops pulmonary TB. The plan is to start empiric INH, RIF, PZA, and ETH pending mycobacterial susceptibilities. How do you manage his ART regimen? A. Continue current regimen B. Change dolutegravir to darunavir/ritonavir C. Change dolutegravir to elvitegravir D. Double...

A 56-year-old male with end-stage-renal disease due to hypertensive nephropathy is being evaluated for possible renal transplantation. Routine pre-transplant serologies were obtained, which were notable for a positive Interferon-Gamma Release Assay (IGRA) for Mycobacterium tuberculosis. The patient is asymptomatic and has never been treated for TB. Chest x-ray is normal. The patient has a suitable...

A 63-year-old male underwent allogeneic stem cell transplant for chronic myelogenous leukemia 120 days ago. He has had multiple episodes of acute graft-versus-host disease, for which he received multiple pulses of corticosteroids and remains on maintenance cyclosporine. His absolute neutrophil count hovers between 750 and 1000 cell/μL. He is receiving prophylactic doses of trimethoprim-sulfamethox...

A 42-year-old woman newly diagnosed with HIV (CD4 425, HIV RNA 73,000, genotype with wild-type virus) starts tenofovir alafenamide/emtricitabine/bictegravir and has the following virologic response: Weeks of Therapy HIV Viral Load 4 weeks HIV RNA 9,400 8 weeks HIV RNA 1,050 16 weeks HIV RNA 105 24 weeks HIV RNA 90 36 weeks HIV RNA 67 48 weeks HIV RNA 82 In addition to reinforcing adherence, what w...

A 36-year-old obese white man (BMI 34) recently diagnosed with HIV (CD4 560, HIV RNA 52,000) is recommended to start antiretroviral therapy but is concerned about weight gain. Which is true of antiretroviral-induced weight gain? A. Raltegravir is associated with more weight gain than dolutegravir B. Elvitegravir is associated with more weight gain than bictegravir C. Tenofovir AF is associated wit...

A 52-year-old woman with no prior medical conditions presents with a 6-month history of shortness of breath and cough. She has no fever, and her CBC and Chemistry panel is normal. Oxygen saturation on room air = 80%. She reports that she installed a hot tub at home which she uses daily; she has no other unusual exposures. If this syndrome is related to her hot tub, which of the following organisms...

A 62-year-old nurse presents to your clinic with a six-month history of pain and swelling involving her third finger. She has been treated sequentially with cephalexin, amoxicillin-clavulanate, and clindamycin without effect. She is an avid gardener and enjoys digging for clams in a marshy area near to her home. She admits to frequent abrasions and scratches. MRI has demonstrated diffuse soft tiss...

A 47-year-old female grew up in an impoverished farming community in Argentina. She moved to the United States when she was 16 years of age. Three years ago, she developed progressive dyspnea on exertion. A cardiac workup revealed a markedly enlarged heart, ejection fraction of 25%, and no obstruction of the coronary arteries by angiography. The most likely pathogen causing her cardiac disease, as...

A 62-year-old male was seen for low grade fever and weight loss over the past month. He had undergone aortic valve replacement in 2015 with a bioprosthesis. Transesophageal echocardiography found no evidence of endocarditis and routine blood cultures were negative. Mycobacterial blood cultures grew Mycobacterium chimaera. The patient lived in a rural area, drank well water and had a pond in this b...

A 37-year-old woman from New Jersey undergoes routine HIV testing with the following results: • HIV 4th generation test: Reactive (antibody positive + p24 antigen negative) • HIV-1/2 Supplemental Assay: HIV-1 antibody negative, HIV-2 antibody negative • HIV-1 RNA: <20 copies/ml What is the most likely interpretation of the results? A. She is a long-term non-progressor B. She has acute HIV-1 inf...

A 30-year-old female presents with a new diagnosis of smear-positive pulmonary TB. She is also found to have a new diagnosis of HIV. Labs show mild anemia, normal liver enzymes, CD4 cell count=25 cells/uL. Which is most appropriate approach to therapy: A. Start HIV treatment immediately, defer TB treatment B. Start TB treatment immediately, defer HIV treatment until after 6 months of TB treatment...

A 40-year-old female is admitted with a 3-week history of daily fever accompanied by a non-pruritic skin eruption. She was initially seen at a walk-in clinic 5 weeks ago for cough and given a 7-day course of Augmentin for bronchitis with resolution of respiratory symptoms. In the last 2 weeks she has developed diffuse arthritis of hands, knees, elbows, and ankles. Labs include WBC of 7.8 (82% seg,...

A 62-year-old man with a history of hypertension has taken HIV PrEP with tenofovir DF/emtricitabine for 5 years. His baseline creatinine clearance was 85 cc/min, but this has trended down with his latest creatinine clearance 55 cc/min (repeated at 60 cc/min). He is in a monogamous relationship with his partner who has HIV and is taking a bictegravir-based regimen with HIV RNA <20 for years. How...

This 52 minute session, called an HIV bootcamp, is taken from the extensive teaching material on the infectious disease board review website, available to persons who subscribe to the Home study course, the live or the virtual course. This lecture by Dr. Gulick is for physicians who need introductory material before progressing to more advanced topics likely to be on certifying or recertifying exa...

An 80-year-old resident of a nursing home has severe dementia, type 2 diabetes mellitus and a chronic indwelling Foley catheter which is in place to manage his persistent incontinence. He has no remarkable medical history and is quite healthy except for his dementia. He has received antibiotics for presumed urinary tract infection twice in the last year. The nursing home staff decided to obtain a...

A 42-year-old male presents with a deformed foot and draining sinuses. The patient is a native of Mexico, where he does manual labor. He noted the onset of persistent swelling 2 years earlier in Mexico after dropping a heavy wooden box on his foot. He received various treatments, but his foot has become more deformed. He is visiting family in the United States and comes to you for advice. He is af...

Two hours after eating at a hotel buffet in Hawaii, a 56-year-old man experiences abdominal pain, vomits once, and has one loose stool. Two days later he experiences numbness of his extremities, tongue, and throat. He finds that cold objects feel hot and hot objects feel cold, and his teeth feel numb and loose. He develops weakness, gait ataxia, and vertigo. He is hospitalized where he has a slow...

A 31-year-old woman is brought to the emergency department by her husband for fever and neurological symptoms. She was completely well until 3 days earlier, when she felt nauseated and vomited twice. During the next two days she had fever, felt “achy,” developed a headache, and continued to have nausea and vomiting. Upon awakening this morning, she complained of double vision, and her husband note...

An introduction to the Infectious Disease Board Review podcast by Dr. Henry Masur www.idbrcourse.org ©2024 Infectious Disease Board Review, LLC