Clinical Questions Flashcards
What bugs are you concerned about with meninnitis in neonates, age >50 years old, and immunocompromised?
Streptococcue pneumoniae
Neisseria menditidis
Listeria monocytogenes
What would be the empiric treatment of meningitis in neonates?
Listeria + Streptocossus pneumoniae coverage
Ampicillin + Cefotaxime (no cetriaxone)
What would be the empiric treatment of meningitis in a 4 year old patient?
Double coverage of Streptococcus pneumoniae when patients are greater than 1 month old
Cetriaxone + Vancomycin
What would be the empiric treatment of meningitis in a 56 year old male?
Ampicillin (Listeria)
+
Cetriaxone (Strep)
+
Vanco (Strep)
What would you recommend in a patient that is two years old and 20 kg with ear pain in both ears and fever of 38 degrees C going on for 24 hours?
Observation for 2-3 days
This is none severe AOM. If ear pain (otalgia) goes on for more than 48 hours then you should treat.
What would you recommend in a patient that is 15 months old and 15 kg with ear pain in both ears and fever of 38 degrees C going on for 24 hours?
Treat with Amoxicillin 90 mg/kg/day in 2 divided doses
675 mg PO BID x 10 days
Patient is < 2 years old with pain in BOTH
What would you recommend in a patient that is 5 months old and 10 kg presenting with tugging of ears and fever of 38 degrees C going on for 24 hours?
Treat with Amoxicillin 90 mg/kg/day in 2 divided doses
450 mg PO BID x 10 days
What would you recommend in a patient that is 7 years old and 45 kg presenting with otorrhea and fever of 40 degrees C going on for 24 hours?
Treat with Amoxicillin 90 mg/kg/day in 2 divided doses
2000 mg PO BID x 5-7 days
***if the child was 2-5 years it would be 7 days
A 17 year old patient presents with nasal congestion that is greenish/yellow and purulent for 3 days. What is your recommendation?
Treat with augmentin
A COPD patient presents to the ER with increase sputum purulence and worsened shortness of breath over tha past 24 hours. What antibiotic (if any) would you recommend?
Augmentin for 5-7 days
A patient presents to the ER with shortness of breath and rales. Chest xray showed CAP. Past medical history indicates COPD and diabetes. Patient has to be admitted for treatment of symptoms of CAP. What treatment do you recommend?
Beta-lactam + Macrolide
Ceftriaxone + Azithromycin
A 45 yo patient presents to your outpatient clinic with shortness of breath and rales. Chest xray showed CAP. Past medical history indicates anxiety and depression. This patient is allergic to penicillin (hives). What treatment do you recommend?
This patient would be “healthy”
Doxycycline monotherapy
or
Macrolide monotherapy
A patient who has been in the hospital for > 48 hours develops shortness of breath and tachypnea. Chest xray showed HAP. This patient has never received IV antibiotics before. MRSA prevalance in the hospital is unknown. What would your recommendation be?
Cefepime + Vancomycin
**psuedomonas + MRSA coverage, no increased risk of 2 anti-psuedo
A patient presents with chronic cough and night sweats for over 2 weeks. The patient’s AFB smear is positive for M tuberculosis. What treatment regimen do you recommend?
Rifampin
Isoniazide + Pyridoxine
Pyrazinamide
Ethambutol
x 2 months, then RI for 4 months
A patient is diagnosised with spontaneous bacterial peritonitis. What is the drug of choice?
Ceftriaxone for 5-7 days
A patient presents with honey colored crusts around their mouth. What is this condition called and what topical treatment could you recommend? If multiple lesions, what oral treatment could be used?
Imetigo
Mupirocin
oral coverage of MSSA - cephalexin
A patient presents with purulent abscess on his arm. His symptoms include fever and chills. What treatment should be given?
MRSA coverage!! Not related to diabetes.
Doxycycline or Bactrim
A female patient presents to your clinic with dysuria and nocturia.
PMH: schizophrenia, depression
Medications: Seroquel, Zyban
Allergies: sulfa and penicillin
What treatment would you recommend?
Nitrofurantion X 5 days
Fosmycin X 1 dose
NOT bactrim because of salf allergy
A 72 year old female patient presents to your clinic with dysuria and nocturia.
PMH: CKD (CrCl 45 mL/min), HTN
Medications: Innovace, Procardia XL
Allergies: penicillin
What treatment would you recommend?
Bactrim DS BID X 3 days
Fosfomycin x 1
NOT Nitrofurantoin because of CrCl < 60
A 24 year old pregnant female patient presents to your clinic with dysuria and nocturia.
PMH: anxiety
Medications: Prozac
What treatment would you recommend?
She is pregnant so the 1st line therapies are NOT recommended.
Amoxicillin
Cephalexin
A 32 female patient presents to you clinic with adominal and flank pain for the past 2 days. All resistance levels are very low in this area. What is the diagnosis and treatment?
Pyelonephritis!
Ciprofloxacin x 7 days
Levofloxacin x 5 days
***not moxifloxacin!!!!!
A 24 year old male patient presents to your clinic with dysuria and nocturia.
PMH: depression and anxiety
Medications: Prozac
What treatment would you recommend for the potential infection? What treatment can help with the dysuria?
Complicated UTI
go straight to FQ
Cipro or Levo
** NOT moxifloxacin!!!!
Dysuria: Phenazopyridine (Pyridium)
A patient is diagnosed with c diff for the first time. No comordibities or PMH. What are some recommendations?
Fidaxomicin BID
Oral Vanco QID
Metronidazole TID
A patient is diagnosed with c diff for the 2nd time in the last year. They previously received Vancomycin for the last infection. Is Vancomycin at the same regimen appropriate?
This patient has some adherence issues with the last regimen. What would be the BEST option?
No, you can go the standard regimen PLUS a prolonged pulse course afterwards
FDX BID is the beset for bad adherence vs
metronidazole TID or Vanco QID
