Awesome Review Flashcards
Broad Spectrum Abx for Prosthetic Valve Endocarditis
Vancomycin Rifampin Gentamycin
Broad Spectrum Abx for Native Valve or IVDA Endocarditis
Vancomycin Gentamycin
Indications for Surgery in Endocarditis
Severe CHF, persistent bacteremia (blood cultures positive after 7 days), recurrent emboli, valve abscess, large fungal vegetation
Abx Ppx for Endocarditis
High Risk Conditions and High Risk Procedures
Amoxicillin 2 grams PO 1 hour before
If PCN allergy- Azithromycin or Clindamycin
What is considered high risk condition needing Endocarditis prophylaxis? (5)
Prosthetic Valve
History of IE
History of Congenital Heart Disease repair within 6 months or with prosthesis/patch
History of unrepaired shunted congential Heart Disease
Heart Transplant with valvular disorders
Abx in Suspected Meningits if head trauma or neurosurgery
Vancomycin Cefepime (cover for pseudomonas)
Abx in Suspected Meningitis if > 50 yo
Ampicillin Ceftriaxone Vancomycin (in case it’s resistant)
If you see RBCs in Lumbar Puncture, wtd?
Thinks HSV encephalitis and start IV Acyclovir
Dx: PCR of CSF
If you are Suspecting Strep Pneumo Meningitis, what else do you give (15 minutes before Abx)
Dexamethasone!
Pneumococcal meningitis can cause hearing loss and seizure
What the eff is Mollaret’s Meningitis?
Benign and recurrent Lymphocytic meningitis caused by HSV-2
Multiple episodes, lethargy with meningeal signs
Diagnose West Nile Encephalitis
Absent Deep Tendon Reflexes!
West Nile virus IgM antibody in CSF
If you suspect NMDA Encephalitis, what’s next?
Check Ultrasound Abdomen to look for ovarian teratoma and remove it!
Treat complicated UTI with ESBL
Forfomycin x 1 dose
How do you treat STI?
Chlamydia or Gonorrhea
Ceftriaxone 250 mg IM and Azithromycin 1 gram
If Ceftriaxone or Azithromycin doesn’t work for sexually transmitted disease (urethral discharge) what is it?
Mycoplasma Genitalium
Give Moxifloxacin
Why is Trichomonas tricky?
Strawberry cervix
Give Flagyl 2 grams x 1 dose or Tinidazole 2 grams x 1 dose
Test of cure in 3 months
AND treat partner (tricky to find that partner- Slut!)
Treat pregnant candidiasis
Topical Clotrimazole for 3-7 days
(Not preggo- fluconazole 150 mg x 1 dose
How to treat Lymphogranuloma Venereum or Granuloma inguinale (klebsiella granulomatis) ?
Doxy 100 mg BID x 21 days
Complication of Erysipelas
Endocarditis!
Organism in sickle cell Osteomyelitis
Salmonella
What if it seems like Vancomycin isn’t working? (Although it worked in the past?)
Check Epsilon (e test) to accurately measure MIC If > 2, vancomycin is useless- use Dapto instead
Horrible complication of infectious Mononucleosis?
Splenic rupture!
How do you save the day by picking up inhalational Anthrax?
CXR with widened mediastinum and pleural effusions
Blood Test for PCP?
Beta D glucan test
Treating cryptococcal meningitis with HIV?
LP to alleviate pressure
Amphotericin B and 5 Flucytosine induction and switch to long term fluconazole
Treating MAI or Mycobacteria marinum?
Clarithromycin, Ethambutol, +/- Rifabutin
What ART med causes Fanconi Syndrome?
Tenofovir
HIV patient needs a statin, which one?
Pravastatin
Earliest change seen in HIV therapy failure
Increasing viral load
Diagnose and treat:
Painful genital ulcers
Tender Inguinal suppurative lymphadenopathy
Microscopy- schools of fish or box car = gram neg bacillus
Haemophilus ducreyi
Ceftriaxone 250mg X 1
Azithromycin 1 gram X 1
Erythromycin 500 mg QID X 7 days
What organism causes Lymphogranuloma venereum?
Chlamydia trachomatis
What organism causes Granuloma Inguinale?
Microscopy- Donovan bodies (bipolar safety pin shaped intracytoplasmic inclusions)
Klebsiella granulomatis
Looks horrible!
How to treat early latent syphillis?
Benz penicillin 2.4 million units X 1
How to treat late latent syphilis?
2.4 million units weekly X 3
Diagnose and Treat: Macular Rash, starting at distal extremities and progressing centrally, becoming petechial. Thrombocytopenia and transaminitis, lymphocyte predominant …
CAMPING
Rocky Mountain Spotted Fever
Doxycycline/Tetracycline
Chloramphenicol in pregnancy
Difference btwn Ehrlichiosis and Anaplasmosis?
Ehrlichiosis is Human Monocytic ehrlichiosis via Lone Star Tick
Anaplasmosis is Human Granulocytic Anaplasmosis via Ixodes tick and have morulae (basophilic inclusion bodies made of bacteria clusters)
Diagnose and Treat:
Fever, HA, myalgia, arthalgia, meningismus, leukopenia, thrombocytopenia, transaminitis
CAMPING
Ehrlichia
Diagnose and Treat:
HA, fatigue, myalgias
hemolytic anemi, transaminitis, thrombocytopenia,
Maltese cross/tetrads in RBCs
Giemsa stain showing trophozoite ring inside RBC
Babesiosis via Ixodes Tick
Mild-Moderate: Atovaquone and Azithromycin
Severe: Quinine and Clindamycin x 6 weeks
Patient with Early Disseminated Lyme but with 2nd or 3rd degree heart block, OR meningitis, treatment?
IV
Ceftriaxone or Penicillin G
If only 1st degree heart block or cranial nerve palsy- PO Doxy is fine
How to treat Post Lyme Disease/Chronic Lyme?
S/Sx: fatigue, insomnia, diffuse pain, malaise
Supportive care
SSTI Organism and Tx?
Liver Disease/transplant, exposure to saltwater/freshwater and seafood
HEMORRHAGIC BULLAE
Vibrio Vulnificus
3rd gen cephalosporin or Tetracycline/Gentamicin
SSTI Organism and Tx?
Ulcerative papular lesions, ascending lymphatic spread
Swimming instructor or fish tank cleaner
Mycobacterium Marinum
Clarithromycin and Ethambutol and/or Rifabutin
SSTI Organism and Tx?
Multiple nodules on forearm along lymph channels
Florist/Gardener
Sporothrix schenkii
If Local- Itraconazole
If Disseminated- Amphotericin B
SSTI Organism and Tx?
Folliculitic Rash, history of jacuzzi/hot tub
Pseudomonas aeruginoas
SELF LIMITED
ONLY Pseudomonas you don’t treat
SSTI Organism associated with cats?
SSTI Organism associated with dogs, especially asplenic patients?
Pasteurella multocida (Augmentin) Capnocytophagia canimorsus
Diagnose and Next Step?
Hyperesthesia over right forehead and single vesicular lesion on erythematous base on tip of right side of nose
Herpes Zoster with Hutchinson Sign
Worried about Zoster Opthalmicus and refer to Opthalmologist for emergency
Treat Post Herpetic Neuralgia
Desipramine
Type of isolation for single dermatome Herpes?
Type of isolation for more than 2 dermatomes Herpes?
Contact
Contact and Airborne
Western United States/British Columbia causing Tick Borne Relapsing Fever
Borrelia hermsii
MC organism after a fist fight?
Eikenella Corrodens
Diagnose and Treat:
Frontal HA, Retro-orbital pain, myalgia, arthalgia, spontaneous bleeding (purpura, melena or conjunctival injection), faint morbiliform rash on trunk
Leukopenia, thrombocytopenia, transaminitis
Dengue hemorrhagic Fever via IgM/IgG or reverse transcriptase PCR
Supportive treatment
Patient with neutropenic fever and need to cover antifungal infection (ie invasive aspergillius)
Voriconazole
Which anti fungal has shown to improve mortality when prophylaxed in patient with post chemotherapy neutropenia?
Posaconazole
What organism?
Posttransplant lymphoproliferative disease causing fever, lymphadenopathy and extranodal mass
EBV
Halo Sign on CT Chest
Dense core and rim of ground glass appearance
Aspergillosis
Blood test for Aspergillosis?
Galactomannan
Blood test for PCP?
Beta D-Glucan
Post-transplant prophylaxis for CMV
Valganciclovir for 1 year
Organism and Treatment?
Thin Wall cavity in lung, Nodular lesion on skin, Ring enhancing lesion in brain, filamentous, branching gram positive
Nocardia
Sulfonamides/Bactrim
Diagnose and Treat:
Inhaled causing dyspnea, hemorrhagic meningitis, hemorrhagic lymphadenitis, CXR with widened mediastinum and pleural effusions
(Box Car Bacilli- gram positive)
Anthrax- Bacillus Anthracis
Tx: Fluoroquinolone or PCN
Bioterrorism Organism and Tx?
Gram Negative Coccobacilli
Skin Contact or aerozolized causing splenomegaly, hepatitis, Lymphadenopathy with fever, sweats
Brucellosis
Doxy
Bioterrorism Disease and Tx?
Rickettsia
Inhaled causing atypical PNA, HA, fevers
from contaminated soil and animal products
Q fever
Doxy
Bioterrorism Organism and Tx?
Fever, Hepatitis/Jaundice, AMS, Renal Failure, ecchymosis, liver hemorrhage, conjunctiva suffusion
sewage worker or Veteranarian (or TMNT!)
Leptospirosis via rodents
Doxy
Bioterrorism Organism and Tx?
Fever, HA, Splenomegaly, erythematous lesions
Butcher, fisherman
Erysipelothrix
Doxy
Which organisms need droplet precautions?
Neisseria, Influenza, Plague
Which organisms need airborne precautions?
Herpes Zoster more than 2 dermatomes, Measles, Varicella, MERS, MTB
Screening test for HIV
HIV 1/2 antigen/antibody combination immunoassay and p24 antigen
Note: p24 antigen is positive 1 week before immunoassay
Confirmatory test for HIV
HIV 1/2 antibody differentiation immunoassay
If negative, check NAAT (nucleic acid amplification test)
Prophylaxis if CD4
PCP, give Bactrim, Dapsone of Atovaquone
Prophylaxis if CD4
Toxoplasmosis, give Bactrim
Prophylaxis if CD 4
Mycobacterium Avium Complex, give Azithromycin
Name 3 diseases that cause ring enhancing lesions
Toxoplasmosis, Brain Abscess, Lymphoma
Pre exposure prophylaxis
Tenofovir and Emtrictabine (Truvada)
Best inhaled steroid to use in HIV Asthmatic?
Beclamethasone
Best HIV medication to use along with Hepatitis C therapy?
Raltegravir
Side Effect of Pyrazinamide
Hyperuricemia and GOUT
Side Effect of Rifampin
Rash
Drug Interactions
Hepatotoxicity
Orange secretions
Side Effect of Isoniazid
Hepatotoxicity
Peripheral Neuropathy
Lupus like Syndrome
Monoamine poisoning
Side Effect of Ethambutol
Retrobulbar neuritis
Decreased red green color discrimination
