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MTB Step 3 > 1) MTB ID > Flashcards

1) MTB ID Flashcards

1
Q

Antibiotics for MSSA IV?

A

oxacillin/nafcillin or cefazolin

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2
Q

Antibiotics for MSSA oral?

A

dicloxacillin or cepalexin

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3
Q

Antibiotics for MRSA, severe infection?

A

vancomycin, linezolid, daptomycin, ceftaroline, tigecycline or telavancin

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4
Q

Linezolid causes

A

thrombocytopenia

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5
Q

daptomycin causes

A

myopathy and rising CPK

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6
Q

Antibiotics for MRSA, minor infection?

A

TMP/SMX
clindamycin
doxycycline

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7
Q

Antibiotics to use with penicillin allergy

A

cephalosporins with rash

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8
Q

Antibiotics for staph with anaphylaxis?

A

Macrolides (azithromycin, clarithromycin) or clindamycin

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9
Q

Antibiotics for severe infection and penicillin allergy?

A

vancomycin, linezolid, daptomycin, telavancin

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10
Q

Antibiotics for minor staph infection penicillin anaphylaxis allergy?

A

macrolides (azithromycin, clarithromycin), clindamycin, TMP/SMX

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11
Q

What is telavancin?

A

bacterial lipopolysaccharide

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12
Q

What is the mechanism for telavancin?

A

It inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of the peptidoglycan in the growing cell wall

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13
Q

What is the mechanism for ceftaroline?

A

inhibits cell wall growth by binding the penicillin binding protein

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14
Q

Linezolid mechanism

A

inhibits protein synthesis

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15
Q

TMP/SMX mechanism

A

folate antagonist

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16
Q

Medications specific for streptococcus

A

penicillin, ampicillin, amoxicillin

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17
Q

What are the gram negative bacilli?

A 
Escherichia coli
Enterobacter
Citrobacter
morganella
pseudomonas
serratia
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18
Q

Cephalosporins gram negative

A

cefepime

ceftazidime

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19
Q

penicillins gram negative

A

piperacillin

ticarcillin

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20
Q

monobactam gram negative

A

aztreonam

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21
Q

Quinolones gram negative

A

ciprofloxacin
levofloxacin
moxifloxacin
gemifloxacin

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22
Q

Aminoglycosides gram negative

A

gentamicin
tobramycin
amikacin

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23
Q

Carbapenems gram negative

A

Imipenem
meropenem
ertapenem
doripenem

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24
Q

Only carbapenem that does not cover pseudomonas?

A

ertapenem

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25
Q

Piperacillin and ticarcillin also cover

A

streptococci and anaerobes

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26
Q

levofloxacin, gemifloxacin and moxifloxacin

A

excellent pneumococcal drugs

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27
Q

aminoglycosides

A

work synergistically with other agents to treat staph and enterococcus

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28
Q

Carbapenems cover

A

streptococcus and all MSSA

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29
Q

Tigecycline covers

A

MRSA, active gram negative, weaker than other anti-MRSA

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30
Q

4 classes of beta lactam antibiotics

A

penicillin
cephalosporins
carbapenem
monobactam

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31
Q

best medication for abdominal anaerobes

A

metronidazole

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32
Q

Carbapenems
piperacillin
ticarcillin

A

equal in efficacy for abdominal anaerobes compared to metronidazole

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33
Q

cefoxitin

cefotetan

A

only cephalosporins that cover anaerobes

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34
Q

respiratory anaerobes

A

clindamycin

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35
Q

Medications with no anaerobic coverage

A 
aminoglycosides
aztreonam 
fluroquinolones
oxacillin/nafcillin
cephalosporins except cefoxitin and cefotetan
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36
Q

What 3 agents can you choose from for herpes simplex, varicella zoster?

A

acyclovir
valacyclovir
famciclovir

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37
Q

valganciclovir
ganciclovir
foscarnet
coverage?

A

CMV and herpes simplex and varicella

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38
Q

what is the best long term therapy for CMV retinitis?

A

valganciclovir

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39
Q

adverse effects of valganciclovir and ganciclovir?

A

neutropenia and bone marrow suppression

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40
Q

adverse effects of foscarnet

A

renal toxicity

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41
Q

What are the oral agents for chronic hepatitis C?

A

telaprevir
boceprevir
simeprevir
sofosbuvir

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42
Q

which oral agent for chronic hepatitis C does not need to be combined with interferon?

A

sofosbuvir

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43
Q

Treatment for influenza A and B

A

oseltamivir

zanamivir

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44
Q

Ribavirin is used for

A
  • Hepatitis C in combination with interferon.

- RSV

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45
Q

What does ribavirin cause?

A

anemia

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46
Q

What are the treatment options for chronic hepatits B?

A 
lamivudine
interferon
adefovir
tenofovir 
entecavir 
telbivudine
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47
Q

What is the mechanism for sofosbuvir?

A

RNA polymerase inhibitor

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48
Q

What is the mechanism for simeprevir, boceprevir, telaprevir?

A

protease inhibitor that prevent viral maturation by inhibiting protein synthesis

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49
Q

Fluconazole treatment?

A

candida, cryptococcus, oral and vaginal candidiasis

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50
Q

Fluconazole will not treat what types of candida?

A

candida krusei or glabrata

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51
Q

Itraconazole

A

equal to fluconazole but less easy to use, rarely the best initial therapy

52
Q

Voriconazole covers

A

all candida

53
Q

What is the best agent for aspergillus?

A

Voriconazole

54
Q

What is the adverse effect of voriconazole?

A

some visual disturbance

55
Q

posaconazole covers

A

mucormycosis or mucorales

56
Q

What are the echinocandins?

A

caspofungin
micafungin
anidulafungin

57
Q

What is the echinocandins excellent for?

A

neutropenic fever

58
Q

Echinocandins does not cover?

A

Cryptococcus

59
Q

How does echinocandins compare to amphotericin for neutropenia and fever?

A

echinocandins are better with less mortality

60
Q

What are the adverse effects for echinocandins?

A

they have no significant human toxicity because they affect / inhibit the 1,3 glucan synthesis

61
Q

What is the mechanism for azole antifungals?

A

inhibits conversion of lanosterol to ergosterol (major component of the cell wall of fungi)

62
Q

Amphotericin is effective against what?

A

all candida, cryptococcus, and aspergillus

63
Q

What are the last 2 main indications for amphotericin?

A

cryptococcus

mucormycosis

64
Q

Aspergillus treatment?

A

voriconazole

65
Q

neutropenic fever

A

caspofungin

66
Q

adverse effects of amphotericin?

A

renal toxicity - increased creatinine, hypokalemia, metabolic acidosis, fever, shakes, chills

67
Q

Amphotericin is directly toxic to?

A

distal tubules results in RTA

68
Q

What does distal RTA damage result in?

A

excess potassium and magnesium loss and hydrogen ion retention

69
Q

What is the diagnostic test for osteomyelitis?

A 
initial = x-ray
2nd = MRI
accurate = bone biopsy and culture
70
Q

Abnormal bone on x-ray=

A

must lose more than 50 percent of the calcium

71
Q

earliest finding of osteomyelitis on an x-ray?

A

periosteal elevation

72
Q

What is the best way to follow osteomyelitis response to therapy?

A

Sedimentation rate

73
Q

What is the most common cause of osteomyelitis?

A

direct contiguous spread from overlying tissue

74
Q

Sensitivity of MRI or bone scan?

A

they are equal in sensitivity

75
Q

What does the sensitivity of MRI or bone scan in osteomyelitis mean?

A

that osteomyelitis can be excluded if they are normal

76
Q

What is the difference between MRI or the bone scan in osteomyelitis?

A

MRI is far more specific

77
Q

What is MRI based on?

A

Water content

78
Q

Nuclear bone scan is based on what?

A

osteoblasts depositing technetium in tissue

79
Q

How long to treat osteomyelitis with no fever and a normal white cell count?

A

sedimentation rate, elevated after 4-6 weeks then further treatment and possible surgical debridement

80
Q

most common cause of osteomyelitis

A

staphylococcus

81
Q

treatment for osteomyelitis

A

oxacillin or nafcillin IV for 4-6 weeks

82
Q

MRSA is treated with

A

vancomycin, linezolid, ceftaroline or daptomycin

83
Q

What are the other causes osteomyelitis?

A

gram negative bacilli = salmonella and pseudomonas

84
Q

What is the only form of osteomyelitis that can be successfully treated with oral antibiotics?

A

salmonella and pseudomonas

85
Q

What must be done before treating orally?

A

bone biopsy

86
Q

What is the treatment plan for chronic osteomyelitis?

A

you can obtain the biopsy, move the clock forward and treat what you find on the culture

87
Q

How does otitis externa present?

A

with itching and drainage from the external auditory canal

88
Q

What is otitis externa a form of?

A

its a form of cellulitis of the skin of the external auditory canal

89
Q

What is otitis externa associated with?

A

swimming

90
Q

Why is otitis externa associated with swimming?

A

it washes out the acidic environment normally found in the external auditory canal

91
Q

Any diagnostic test for otits externa?

A

no specific tests

diagnosis is based on exam

92
Q

What is the treatment for otitis externa?

A

ofloxacin
ciprofloxacin
polymyxin/neomycin
- add topical hydrocortisone to decrease swelling and itching

93
Q

If the otitis externa topical treatment what else might be added?

A

adding acetic acid and water soulution to reacidify the ear can help eliminate the infection

94
Q

What is the function of cerumen?

A

make the external auditory canal acidic

95
Q

what is the function of acid wax in the ear?

A

acid wax suppresses bacteria - cerumen blocks water and pseudomonas likes to grow in water

96
Q

What is malignant otitis externa?

A

its really osteomyelitis of the skull from pseudomonas in a patient with diabetes

97
Q

What might otitis externa lead to?

A

it might lead to a brain abscess and destruction of the skull

98
Q

What is the diagnostic test for malignant otitis externa?

A

initial is CT or MRI

99
Q

What is the most accurate test for malignant otitis externa?

A

biopsy

100
Q

What is the treatment for malignant otitis externa?

A

surgical debridement and antibiotics active against pseudomonas

101
Q

What are some antibiotics active against Pseudomonas?

A 
ciprofloxacin
piperacillin
cefepime
carbapenem
aztreonam
102
Q

How do quinolone antibiotics work?

A

by inhibiting DNA gyrase (topoisomerase)

103
Q

DNA gyrase

A

unwinds DNA so it can be replicated

104
Q

What are the key features of otitis media?

A 
redness
bulging
decreased hearing 
loss of light reflex
immobility of the tympanic membrane
105
Q

Diagnostic testing for otitis media?

A

no radiologic test

106
Q

What is the best initial treatment for otitis media?

A

amoxicillin for 7-10 days

longer for younger patients and shorter for older patients

107
Q

What is the next step after amoxicillin for otitis media?

A

perform the most accurate = tympanocentesis and aspirate of the tympanic membrane for culture - rarely necessary

108
Q

What is otitis media caused by?

A

Caused by swelling of the Eustachian tube - narrowest portion - isthmus - becomes inflammed, it blocks the egress of secretions

109
Q

What are the most common causes of otitis media?

A

pneumococcus
nontypeable Haemophilus
Moraxella

110
Q

What do you do if otitis media does not improve on amoxicillin after 3 days?

A 
amoxicillin-clavulanate
cefdinir
ceftibuten
cefuroxime
cefprozil
cefpodoxime
111
Q

What are the causes of sinusitis?

A

Viral is most common

Bacterial are streptococcus pneumoniae, H. influenzae and Moraxella catarrhalis

112
Q

What is the diagnostic test for sinusitis?

A

X-ray

113
Q

What is the most accurate test for sinusitis?

A

sinus aspirate for culture

114
Q

What is the treatment for sinusitis?

A

amoxicillin/clavulanate if there is fever and pain, symp despite 7 days of decongestants and purulent nasal discharge

115
Q

What do you add for sinusitis?

A

add inhaled steroids

116
Q

What is clavulanic acid?

A

beta lactamase inhibitor

117
Q

What is the mechanism for clavulanic acid?

A

the enzyme destrys the clavulanic acid instead of the penicilllin

118
Q

What is the diagnosis for pharyngitis?

A

pain/sore throat, exudate, adenopathy, no cough/hoarseness

119
Q

What is the diagnositic test for pharyngitis?

A

rapid strep test

120
Q

What is the most accurate test for pharyngitis?

A

culture

121
Q

What is the treatment for pharyngitis?

A

-penicillin or amoxicillin

122
Q

What is the treatment for pharyngitis in a penicillin allergy patient?

A

azithromycin
clarithromycin
-use cephalexin if allergy is a just a rash

123
Q

Patient presentation for influenza

A 
arthralgia
myalgia
cough 
headache
fever
sore throat
feeling of tiredness
124
Q

What is the diagnostic test for influenza?

A

viral rapid antigen detection - testing a nasopharyngeal swab

125
Q

What is the treatment for influenza?

A

oseltamivir or zanamivir

MTB Step 3 (1 decks)

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