Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Immunology And Infectious Diseases > Exam 3: Respiratory, UTI, C Diff, Vaccines > Flashcards

Exam 3: Respiratory, UTI, C Diff, Vaccines Flashcards

1
Q

What are some clinical presentations of sinusitis?

A

Purulent anterior nasal discharge, purulent posterior nasal discharge, nasal congestion/obstruction, facial fullness, decreased smell, fever

RARE: severe HA, ear pain/fullness, halitosis, dental pain, cough, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sinusitis is mostly viral/bacterial

A

Viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you treat sinusitis?

A

USE NON-Rx FIRST (ie. Netti pot)

Viral sinusitis: decongestants, irrigation, mucolytics
Bacterial sinusitis: NO decongestants or antihistamines
Corticosteroids: intranasal for allergic rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When are antibiotics used for sinusitis?

A

Persistent symptoms (>10 days) without improvement

Severe symptoms (>3 - 4 days) at the start of the illness
- Fever > 102F
- Purulent nasal discharge
- Facial pain

Worsening symptoms after a typical URI (viral, ~5 days) = double sickening!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the best antibiotic for sinusitis?

A

Amoxicillin/clavulanate (combo amoxicillin + beta lactamase inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some side effects of amoxicillin/clavulanate? (2)

A

Diarrhea
Rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Other than amoxicillin/clav, what options are there to treat sinusitis?

A

Fluoroquinolones (costly, more resistance)
Clindamycin + cefpodoxime/cefuroxime
Doxycycline (underrated!)
TMP/SMX or macrolides (questionable efficacy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the duration of antibiotics for sinusitis in adults? In kids?

A

Adults: 5-7 days
Kids: 10-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What duration indicates CHRONIC sinusitis?

A

Symptoms persist for 12+ weeks
Not infectious
Take cultures!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What TWO bugs are most covered by amoxicillin/clav?

A

S. Pneumoniae
H. Influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common virus to cause viral pharyngitis?
What is the most common bacteria to cause bacterial pharyngitis?

A

Virus = rhinovirus
Bacteria = Group A strep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name some clinical symptoms that indicate bacterial pharyngitis?

A

5-15 years old
Sudden sore throat
Fever
Headache
Tonsillary inflammation
Tender lymph nodes (cervical adenitis)
Palate petechiae
Season (winter/early spring)
History of exposure
Pink rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some post-pharyngitis complications?

A

Acute rheumatic fever
Peritonsillar abscess
Cervical lymphadenitis
Mastoiditis
Glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the drugs of choice for treating pharyngitis? (2)
What is the duration of treatment?

A

Penicillin VK or Amoxicillin
(Narrow spectrum of activity, well-tolerated, inexpensive)

10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Patient AJ comes into the clinic presenting with pharyngitis. AJ has a severe penicillin allergy. What treatments could you give them?

A

Clindamycin x 10 days
Azithromycin x 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the mild penicillin allergic alternative for pharyngitis?

A

Cephalexin x 10 days PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which otitis media patients should DEFINITELY be treated with antibiotics?

A

6 months - 12 years old with MODERATE to SEVERE pain OR fever >= 102.2
6 - 24 months with non-severe bilateral acute OM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the first line for otitis media treatment? What is the second line and when do we use it?

A

Amoxicillin 80-90 mg/kg per day / 2

If 30 days amox and unresponsive OR purulent conjunctivitis:

Amox/clav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is CURB-65? When do we use it?

A

To assess pneumonia severity

Confusion
Uremia (BUN 20+)
Respiratory rate 30+
Blood pressure (SBP<90 or DBP<60)
65 or over

0-1 = outpatient
2 = inpatient general floor
3+ = ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What bugs cause CAP?

A

S. Pneumoniae
H. Influenzae
Legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What treatments can we use if a patient w/ outpatient CAP is otherwise healthy?

A

PO Amoxicillin
PO Doxycycline
PO Macrolides (azithro/clarithro)

(ADAC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What comorbidities can complicate outpatient CAP?

A

Age < 2 or >65
Beta - lactam within prior 3 mo.
Alcohol abuse
Immunosuppression
Exposure to daycare
Cancer
Chronic respiratory disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What treatments are available for outpatient CAP if a patient has comorbidities?

A

**Amox/clav OR
**cephalosporin + Macrolides (azithro/clarithro)
Respiratory quinolones (levo/moxi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do we use to treat non-severe inpatient CAP?

A

IV beta-lactam (unasyn, ceftriaxone) + macrolide OR respiratory quinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What do we use to treat *severe* inpatient CAP?
IV beta-lactam + macrolide IV beta-lactam + respiratory quinolone Add anti-MRSA or anti-pseudomonal is shown in cultures
26
How long do we treat CAP?
Minimum 5 days, generally 7 days
27
______ culture and ________ sample should be ordered for all patients w/ anti-MRSA and anti-pseudomonal antibiotics ordered.
Blood culture and sputum samples
28
VAP occurs ___ hours or more after ventilator use
48 hrs
29
We use ____ antibiotics FIRST in HAP/VAP.
Empiric
30
When initiating HAP/VAP treatment, what are some indications to use broad-spectrum empiric therapy?
Late onset/risk factors for multi-drug resistant pathogens, prior antibiotic use, colonization, hospitalization, chronic care, immunosuppressive therapy
31
What 4 options are there for empiric HAP treatment initiation if NO MDR RISK?
Ceftriaxone Respiratory quinolone (levo/moxi) Unasyn Ertapenem
32
What options are there for empiric HAP treatment initiation if MDR RISK?
Vancomycin
33
Patient JT presents with HAP; blood future shows (+) for pseudomonas. What antibiotics can be used? [7] How many of them can be used at once?
Only use ONE antipseudomonal at once *Zosyn (pip/taz) *Cefepime or Ceftazidime Imipenem or Meropenem (reserved due to potency) Aztreonam (reserved for alt. combos) Cirpofloxacin (reserved for PO, renal risk) Aminoglycosides (adjunctive, renal risk) Polymixin B (renal risk, neurotoxicity, BM suppression, last line)
34
What is the duration of treatment for VAP and HAP?
7 days for both
35
Summarize outpatient and inpatient CAP 1st line treatments
OUT: Healthy: - Amoxicillin po OR - doxycycline OR macrolide Comorbid: - amox/clav OR - cephalosporin + macrolide (azithro/clarithro) OR - respiratory quinolone IN: Non-severe - IV beta-lactam + macrolide OR - respiratory quinolone Severe: - IV beta-lactam + macrolide OR - IV beta-lactam + respiratory quinolone
36
Differences between cystitis and pyelonephritis
Cystitis: dysuria, urgency, hematuria Pyelonephritis: cystitis + CVA pain/tenderness, fever, chills, N/V
37
What are some LAB FINDINGS indicating UTI?
pH ~6.0 WBC > 50 RBC ~20 Leukocyte esterase (+) Nitrite (+) Bacteria (+ GNR)
38
What is the treatment for ACUTE UNCOMPLICATED cystitis (not pyelo)?
Nitrofurantoin po bid x 5 days Bactrim po bid x 3 days (Beta lactams, fosfomycin, quinolones)
39
What is the treatment for OUTPATIENT ACUTE PYELONEPHRITIS?
Bactrim po bid x 14 days - ciprofloxacin 500 po bid x 7 days - quinolone once - IV beta-lactam then oral beta-lactam x 10-14 days (last line)
40
How do we change therapy for SEVERE acute pyelonephritis?
CHANGE TO IV! Symptoms of upper tract also being infected + systemic response
41
What is the treatment for INPATIENT ACUTE PYELONEPHRITIS?
IV extended spectrum beta-lactam (cefoxitin or cefepime) +/- aminoglycoside x 10-14 days - quinolone IV - aminoglycoside +/- ampicillin - carbapenem
42
In WHAT PATIENTS do we treat asymptomatic UTIs?
Pregnant Prior to invasive urinary tract procedure Prior to renal transplant
43
What treatments should we use for pregnant women with ASYMPTOMATIC UTIs?
Amox/clav x 7 days Cephalexin x 3-7 days - nitrofurantoin x 7 days (avoid if close to delivery) - amoxicillin x 7 days - Bactrim x 3 days (avoid in last trimester) - IV beta-lactams (cefazolin, ceftriaxone)
44
What drugs are contraindicated for UTI treatment in pregnant women?
Quinolones Doxycycline
45
What treatments are used for acute bacterial prostatitis in men? What is the duration?
Bactrim po bid - quinolones - gentamicin/ampicillin if infected by enterococcus Duration: 2-4 weeks
46
What treatments are used for chronic bacterial prostatitis in men? What is the duration?
Bactrim po bid - quinolones (quite common for chronic!) - suppressive therapy Duration: 4-6 weeks
47
How do we treat infectious diarrhea?
Supportive care = rehydration + electrolytes - mild/moderate = oral replacement - severe = IV fluids DON’T use antimotility
48
What are some risk factors for C. Diff?
ICU admission Tube feeding Acid suppressors Length of stay Immunocompromised Chemotherapy Antibiotics** GI Surgery Exposure 65 year or older ITALIC AGE 65
49
What are some high risk antibiotics for causing C.Diff?
Clindamycin Late-gen Cephalosporins Carbapenems Fluoroquinolones
50
What are some low risk antibiotics for causing C.Diff?
Vancomycin Aminoglycosides Metronidazole
51
What are the guidelines for non-severe, severe and fulminant C. Diff?
Non-severe = leukocytosis (WBC < 15k) AND SCr < 1.5 Severe = leukocytosis (WBC > 15k) OR SCr > 1.5 Fulminant = Hypotension/shock, ileus, megacolon
52
What are some NON-RX ways to manage C. Diff?
Avoid anti-motility agents Rehydration and replenish electrolytes D/C antibiotics if possible
53
What are the treatments for non-severe and severe C.Diff (same)? What is the treatment for fulminant?
Vancomycin 125 mg po QID x 10 days Fidoxomicin 200 mg po BID x 10 days Fulminant: vancomycin 500 mg po QID (+ metronidazole 500 mg IV for ileus)
54
Other than antibiotics, what treatment options are available for C. Diff?
Actoxumab/Bezlotoxumab (mAb) Fecal Microbiota Transplantation (FMT)
55
What are some LIVE vaccines?
Measles/mumps/rubella Varicella LAIV Polio Rotavirus ZVL (Zoster)
56
How many weeks apart should we space live vaccines if they aren’t given simultaneously?
28 days minimum interval
57
What vaccines are CONTRAINDICATED in pregnancy?
HPV LAIV MMR Varicella Zoster
58
What are some general vaccine interactions?
- chemotherapy = live vaccines should be given 2 weeks before or 3 months after - High dose corticosteroids (20 mg/d prednisone x 14+ days) may cause inadequate response from inactivated vaccines (If <14 days vaccinate right after D/C or wait 2 weeks. If >14 days, wait 1 month after D/C) - Do not administer IVIGs 14 days *after* live vaccines - Live viruses suppress TB skin tests
59
When is flu season?
October to March/April
60
What causes the flu vaccine to change yearly?
Antigenic DRIFT (gradual) Whereas antigenic SHIFT is drastic
61
For flu vaccines: ____ is recommended in ages >6 months. ____ is recommended in ages >18. ____ is recommended for healthy people ages 2 - 49.
IIV4 RIV4 LAIV4
62
Who should get the pneumococcal vaccine?
Age >65 Risk factors (ie. Sickle cell, Crohn’s, smoker)
63
PNEUMOCOCCAL Vaccine: ______ is for children. Otherwise adults can use ______ + _______ or only the _______.
Children = PCV13 PCV15 + PPSV23 OR PCV20
64
PCV15 should be followed up by PPSV23 after ___ year(s), unless the patient is immunocompromised/cochlear implant/CSF leak, then may get PPSV23 after ________.
1 year Immunocompromised = after 8 weeks
65
Tetanus should get boosted every __ years, every __ years if at risk and __ years after last dose in case of severe injury
10 years 5 years = at risk 1 year = severe injury
66
DTaP should be used up until age ____
7
67
What vaccines should pregnant women get?
IIV4 (IF FLU SEASON) COVID if full regimen not complete **TdaP (not Td!)
68
What is a major contraindication for the TdaP/DTaP vaccines?
History of encephalopathy within 7 days of pertussis vaccination
69
Who should receive the Zoster vaccine (RZV/Shingrix)? What is the course for this vaccine?
Age 50+, regardless of clinical history of herpes zoster or receipt of live herpes zoster vaccine (ZVL) [no longer available]. 2 doses separated by 2 to 6 months
70
Patient RV is bitten by a groundhog with rabies. What is the post-exposure prophylaxis?
1. Wound cleansing 2. Human Rabies IG at site x1 PLUS IM x1 on day 0 3. Rabies vaccine x 4 doses (day 0, 3, 7, 14) (Already received prophylactic? Only receive vaccine regimen)

Immunology And Infectious Diseases (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions