Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
Q

What do we use to treat severe inpatient CAP?

A

IV beta-lactam + macrolide
IV beta-lactam + respiratory quinolone

Add anti-MRSA or anti-pseudomonal is shown in cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How long do we treat CAP?

A

Minimum 5 days, generally 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

______ culture and ________ sample should be ordered for all patients w/ anti-MRSA and anti-pseudomonal antibiotics ordered.

A

Blood culture and sputum samples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

VAP occurs ___ hours or more after ventilator use

A

48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

We use ____ antibiotics FIRST in HAP/VAP.

A

Empiric

30
Q

When initiating HAP/VAP treatment, what are some indications to use broad-spectrum empiric therapy?

A

Late onset/risk factors for multi-drug resistant pathogens, prior antibiotic use, colonization, hospitalization, chronic care, immunosuppressive therapy

31
Q

What 4 options are there for empiric HAP treatment initiation if NO MDR RISK?

A

Ceftriaxone
Respiratory quinolone (levo/moxi)
Unasyn
Ertapenem

32
Q

What options are there for empiric HAP treatment initiation if MDR RISK?

A

Vancomycin

33
Q

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?

A

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
Q

What is the duration of treatment for VAP and HAP?

A

7 days for both

35
Q

Summarize outpatient and inpatient CAP 1st line treatments

A

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
Q

Differences between cystitis and pyelonephritis

A

Cystitis: dysuria, urgency, hematuria
Pyelonephritis: cystitis + CVA pain/tenderness, fever, chills, N/V

37
Q

What are some LAB FINDINGS indicating UTI?

A

pH ~6.0
WBC > 50
RBC ~20
Leukocyte esterase (+)
Nitrite (+)
Bacteria (+ GNR)

38
Q

What is the treatment for ACUTE UNCOMPLICATED cystitis (not pyelo)?

A

Nitrofurantoin po bid x 5 days
Bactrim po bid x 3 days

(Beta lactams, fosfomycin, quinolones)

39
Q

What is the treatment for OUTPATIENT ACUTE PYELONEPHRITIS?

A

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
Q

How do we change therapy for SEVERE acute pyelonephritis?

A

CHANGE TO IV!

Symptoms of upper tract also being infected + systemic response

41
Q

What is the treatment for INPATIENT ACUTE PYELONEPHRITIS?

A

IV extended spectrum beta-lactam (cefoxitin or cefepime) +/- aminoglycoside x 10-14 days

  • quinolone IV
  • aminoglycoside +/- ampicillin
  • carbapenem
42
Q

In WHAT PATIENTS do we treat asymptomatic UTIs?

A

Pregnant
Prior to invasive urinary tract procedure
Prior to renal transplant

43
Q

What treatments should we use for pregnant women with ASYMPTOMATIC UTIs?

A

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
Q

What drugs are contraindicated for UTI treatment in pregnant women?

A

Quinolones
Doxycycline

45
Q

What treatments are used for acute bacterial prostatitis in men? What is the duration?

A

Bactrim po bid
- quinolones
- gentamicin/ampicillin if infected by enterococcus

Duration: 2-4 weeks

46
Q

What treatments are used for chronic bacterial prostatitis in men? What is the duration?

A

Bactrim po bid
- quinolones (quite common for chronic!)
- suppressive therapy

Duration: 4-6 weeks

47
Q

How do we treat infectious diarrhea?

A

Supportive care = rehydration + electrolytes
- mild/moderate = oral replacement
- severe = IV fluids

DON’T use antimotility

48
Q

What are some risk factors for C. Diff?

A

ICU admission
Tube feeding
Acid suppressors
Length of stay
Immunocompromised
Chemotherapy

Antibiotics**
GI Surgery
Exposure
65 year or older

ITALIC AGE 65

49
Q

What are some high risk antibiotics for causing C.Diff?

A

Clindamycin
Late-gen Cephalosporins
Carbapenems
Fluoroquinolones

50
Q

What are some low risk antibiotics for causing C.Diff?

A

Vancomycin
Aminoglycosides
Metronidazole

51
Q

What are the guidelines for non-severe, severe and fulminant C. Diff?

A

Non-severe = leukocytosis (WBC < 15k) AND SCr < 1.5
Severe = leukocytosis (WBC > 15k) OR SCr > 1.5
Fulminant = Hypotension/shock, ileus, megacolon

52
Q

What are some NON-RX ways to manage C. Diff?

A

Avoid anti-motility agents
Rehydration and replenish electrolytes
D/C antibiotics if possible

53
Q

What are the treatments for non-severe and severe C.Diff (same)? What is the treatment for fulminant?

A

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
Q

Other than antibiotics, what treatment options are available for C. Diff?

A

Actoxumab/Bezlotoxumab (mAb)

Fecal Microbiota Transplantation (FMT)

55
Q

What are some LIVE vaccines?

A

Measles/mumps/rubella
Varicella
LAIV
Polio
Rotavirus
ZVL (Zoster)

56
Q

How many weeks apart should we space live vaccines if they aren’t given simultaneously?

A

28 days minimum interval

57
Q

What vaccines are CONTRAINDICATED in pregnancy?

A

HPV
LAIV
MMR
Varicella
Zoster

58
Q

What are some general vaccine interactions?

A
  • 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
Q

When is flu season?

A

October to March/April

60
Q

What causes the flu vaccine to change yearly?

A

Antigenic DRIFT (gradual)

Whereas antigenic SHIFT is drastic

61
Q

For flu vaccines: ____ is recommended in ages >6 months. ____ is recommended in ages >18. ____ is recommended for healthy people ages 2 - 49.

A

IIV4
RIV4
LAIV4

62
Q

Who should get the pneumococcal vaccine?

A

Age >65
Risk factors (ie. Sickle cell, Crohn’s, smoker)

63
Q

PNEUMOCOCCAL Vaccine: ______ is for children. Otherwise adults can use ______ + _______ or only the _______.

A

Children = PCV13

PCV15 + PPSV23
OR
PCV20

64
Q

PCV15 should be followed up by PPSV23 after ___ year(s), unless the patient is immunocompromised/cochlear implant/CSF leak, then may get PPSV23 after ________.

A

1 year

Immunocompromised = after 8 weeks

65
Q

Tetanus should get boosted every __ years, every __ years if at risk and __ years after last dose in case of severe injury

A

10 years
5 years = at risk
1 year = severe injury

66
Q

DTaP should be used up until age ____

A

7

67
Q

What vaccines should pregnant women get?

A

IIV4 (IF FLU SEASON)
COVID if full regimen not complete
**TdaP (not Td!)

68
Q

What is a major contraindication for the TdaP/DTaP vaccines?

A

History of encephalopathy within 7 days of pertussis vaccination

69
Q

Who should receive the Zoster vaccine (RZV/Shingrix)? What is the course for this vaccine?

A

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
Q

Patient RV is bitten by a groundhog with rabies. What is the post-exposure prophylaxis?

A
  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.
© 2024 Bold Learning Solutions. Terms and Conditions