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Clinical Questions Flashcards

1
Q

What bugs are you concerned about with meninnitis in neonates, age >50 years old, and immunocompromised?

A

Streptococcue pneumoniae
Neisseria menditidis
Listeria monocytogenes

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2
Q

What would be the empiric treatment of meningitis in neonates?

A

Listeria + Streptocossus pneumoniae coverage

Ampicillin + Cefotaxime (no cetriaxone)

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3
Q

What would be the empiric treatment of meningitis in a 4 year old patient?

A

Double coverage of Streptococcus pneumoniae when patients are greater than 1 month old

Cetriaxone + Vancomycin

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4
Q

What would be the empiric treatment of meningitis in a 56 year old male?

A

Ampicillin (Listeria)
+
Cetriaxone (Strep)
+
Vanco (Strep)

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5
Q

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?

A

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.

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6
Q

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?

A

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

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7
Q

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?

A

Treat with Amoxicillin 90 mg/kg/day in 2 divided doses

450 mg PO BID x 10 days

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8
Q

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?

A

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

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9
Q

A 17 year old patient presents with nasal congestion that is greenish/yellow and purulent for 3 days. What is your recommendation?

A

Treat with augmentin

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10
Q

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?

A

Augmentin for 5-7 days

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11
Q

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?

A

Beta-lactam + Macrolide

Ceftriaxone + Azithromycin

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12
Q

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?

A

This patient would be “healthy”

Doxycycline monotherapy
or
Macrolide monotherapy

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13
Q

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?

A

Cefepime + Vancomycin

**psuedomonas + MRSA coverage, no increased risk of 2 anti-psuedo

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14
Q

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?

A

Rifampin
Isoniazide + Pyridoxine
Pyrazinamide
Ethambutol

x 2 months, then RI for 4 months

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15
Q

A patient is diagnosised with spontaneous bacterial peritonitis. What is the drug of choice?

A

Ceftriaxone for 5-7 days

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16
Q

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?

A

Imetigo
Mupirocin

oral coverage of MSSA - cephalexin

17
Q

A patient presents with purulent abscess on his arm. His symptoms include fever and chills. What treatment should be given?

A

MRSA coverage!! Not related to diabetes.

Doxycycline or Bactrim

18
Q

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?

A

Nitrofurantion X 5 days
Fosmycin X 1 dose

NOT bactrim because of salf allergy

19
Q

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?

A

Bactrim DS BID X 3 days
Fosfomycin x 1

NOT Nitrofurantoin because of CrCl < 60

20
Q

A 24 year old pregnant female patient presents to your clinic with dysuria and nocturia.

PMH: anxiety
Medications: Prozac

What treatment would you recommend?

A

She is pregnant so the 1st line therapies are NOT recommended.

Amoxicillin
Cephalexin

21
Q

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?

A

Pyelonephritis!

Ciprofloxacin x 7 days
Levofloxacin x 5 days

***not moxifloxacin!!!!!

22
Q

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?

A

Complicated UTI
go straight to FQ

Cipro or Levo
** NOT moxifloxacin!!!!

Dysuria: Phenazopyridine (Pyridium)

23
Q

A patient is diagnosed with c diff for the first time. No comordibities or PMH. What are some recommendations?

A

Fidaxomicin BID
Oral Vanco QID
Metronidazole TID

24
Q

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?

A

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

25
Q

A patient is diagnosed when syphillus because of a spirochete that appeared. What would the treatment regmin recommendation be?

A

Penicillin G benzathine 2.4 million units x1

26
Q

A patient is diagnosised with syphyllis from a standard STI testing. They had no symptoms. What is the recommended regimen?

A

Penicillin G benzathine 2.4 million units weekly for 3 weeks

27
Q

A 17 year old male patient is diagnosed with gonorrhea at his follow up visit. He has no PMH. No other STIs were excluded. What is the recommended treatment?

A

Ceftriaxone (Gonorrhea)
Doxycycline (Chlamydia)

28
Q

A 17 year old pregnant female patient is diagnosed with gonorrhea at her follow up visit. She has no PMH. No other STIs were excluded. What is the recommended treatment?

A

Cefriaxone (Gonorrhea)
Azithromycin (Chlamydia)

***do not use doxycycline in pregnant patients (:

29
Q

A female presents with trichomoniasis. What would your treatment recommendation be?

A

Metronidazole

30
Q

What is the treatment recommendation for Lyme Disease?

A

Doxycycline

31
Q

A HIV patient with CD4 count of 170. What prophylactic treatment should you start?

A

Bactrim for PJP and Toxo

32
Q

When should prophylaxis start in a HIV patient to prevent mycobacterium avium complex (MAC)? What is the prophylactic drug of choice?

A

CD4 < 50
Azithromycin

33
Q

What is the treatment regimin for toxoplasmosis gondii encephalitis in an HIV patient?

A

Pyrimethamine
Leucovorin
Sulfadiazine

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