Brainscape's Knowledge GenomeTM

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


See full index

Thera VII > Final Questions > Flashcards

Final Questions Flashcards

1
Q

For SIRS, what does it need at least two or more of?

A

Temp > 38C or < 36C. HR > 90. RR > 20 or PaCO2 < 32 mmHg. WBC > 12,000 or < 4,000, or > 10% immature bands

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

What are the goals of initial resuscitation of hypoperfusion (first 6h) for sepsis/septic shock?

A

**MAP: > 65. CVP: 8-12. Urine output > 0.5 ml/kg/hr. Central venous oxygen saturation > 65

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

When giving hypoperfusion in sepsis/septic shock, when should you reduce the fluid administration rate?

A

If cardiac filling pressures increase w/o concurrent hemodynamic improvement

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

When are vasopressors used for severe sepsis/septic shock?

A

Only given after the patient fails to respond to fluid therapy. They are used to achieve a minimal perfusion pressure and maintain adequate flow. Goal MAP > 65

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

What are the two best vasopressor choices for septic shock?

A

Norepinephrine (1st) or Dopamine. These are both good at increasing MAP

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

Which corticosteroid is the best choice for septic shock when patient fails both fluid therapy AND pressor therapy?

A

Hydrocortisone IV < 300mg/day

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

What is a general assessment of meningitis CSF vs. normal CSF?

A

Higher pressure. Lower glucose (b/c of decreased oxygenation). Protein higher (b/c of edema). WBCs are high (b/c of infection)

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

What is the main type of bacteria causing meningitis in < 2 months of age?

A

GBS

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

What are the common causes of meningitis in patients 2-23 months of age?

A

Strep. pneumoniae. Some GBS and N. meningitidis

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

What are the common causes of meningitis in patients 2-34 years of age?

A

About the same between S. pneumoniae and N. meningitidis

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

What are the common causes of meningitis in patients 35+ years of age?

A

Primarily S. pneumoniae

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

Which antibiotics do not need inflammation to penetrate into CSF?

A

Rifampin, INH, Pyrazinamide (RIP). Metronidazole, Linezolid, Bactrim (MLB). Before choosing treatment, always check to see if there is inflammation or not

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

When treating empirically for meningitis in age < 1 month (covering GBS, E. coli, Listeria, Klebsiella), what are some choices?

A

Ampicillin + Gentamycin. OR. Ampicillin + Cefotaxime

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

When treating empirically for meningitis in patients 1-23 months, what are your primary choices?

A

Vancomycin + Cefotaxime/Ceftriaxone

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

When treating empirically for meningitis in patients 2-50 years, what are your primary choices?

A

Vancomycin + Cefotaxime/Ceftriaxone

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

When treating empirically for meningitis in patients 50+ years, what are your primary choices?

A

Vancomycin + Cefotaxime/Ceftriaxone +/- Ampicillin

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

What is the definitive therapy for meningitis caused by Strep pneumoniae?

A

If susceptible: Pen G or Ampicillin. Cefotaxime/Ceftriaxone. Vanco + Cefotaxime/Ceftriaxone. 10-14 days

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

What is the definitive therapy for meningitis caused by N. meningitidis?

A

Cefotaxime/Ceftriaxone. 7-10 days

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

What is the definitive therapy for meningitis caused by H. influenzae?

A

Cefotaxime/Ceftriaxone. 7-10 days

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

What is the definitive therapy for meningitis caused by GBS?

A

Pen G or Ampicillin +/- Aminoglycoside. 14-21 days

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

What is the o Abx prophylaxis (for family members, dorm-mates who are around an infected person) for meningitis?

A

Rifampin x2 days. Cipro x1 dose. Ceftriaxone x1 dose

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

What is the role of Dexamethasone as adjunctive therapy in meningitis treatment?

A

When you kill bacteria, all the junk inside the bacteria gets released and your immune system mounts a response to this and causes more inflammation. In the case of meningitis, this will cause more swelling/edema which is really bad. Therefore, give dexamethasone (steroid) to prevent this secondary response

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

How is Dexamethasone dosed in meningitis treatment?

A

Adults: 10mg Q6h x4 days. Kids: 0.15-0.25 mg/kg Q6h x2-4 days

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

What is Latent TB like?

A

Doesn’t feel sick. Not contagious. Needs LTBI treatment + PPD test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Active TB like?

A

Feels sick. Infectious. Needs antibiotic treatment. PPD not always positive

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

What can cause a false positive PPD test?

A

Currently active TB. Old. Decreased serum protein. SubQ injection instead of intradermal. On corticosteroids

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

What is the first line treatment of LTBI?

A

INH x9 months QD or 2x/week. Can also do a 6 month option

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

When is a TB patient no longer considered infectious?

A

ALL 3 must be met: 1) 3 consecutive negative smears, separated by 8-24 hrs. 2) Standard TB treatment for at least 2 weeks. 3) Clinical improvement

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

What is the usual dosing of Isoniazid (INH) like for TB?

A

Daily: 300mg. 2x/week or 3x/week: 900mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the usual dosing of Rifampin (RIF) like for TB?

A

Daily, 2x/week, 3x/week are all: 600mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which RIPE therapy does NOT need dose adjustment in CrCl < 30?

A

RIF and INH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which RIPE therapy does NOT need dose adjustment in hepatic failure?

A

EMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are some ADRs to look out for with RIF?

A

Orange discolor of body fluids. Hepatitis (increased w/ INH combo). Flu-like symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are some ADRs to look out for with INH?

A

Increased ALT/AST. Peripheral neuropathy. Lupus-like syndrome. Caution: monoamine/tyramine poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are some ADRs to look out for with PZA?

A

Photosensitivity. Urecemia. Non-gouty polyarthralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are some ADRs to look out for with EMB?

A

Optic neuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which RIPE therapy needs to be taken on an empty stomach?

A

RIF (take w/ full glass of water) and INH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which RIPE therapy needs to be taken with food?

A

PZE and EMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which RIPE therapy is avoided in children < 15 years?

A

Ethambutol (EMB) - visual acuity test is hard to perform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which RIPE therapy is avoided in pregnancy/breastfeeding individuals?

A

NO Pyrazinamide (PZA), only R/I/E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the risk factors for C. difficile disease?

A

Antibiotic exposure. Advanced age (5x higher > 65 years). Hospitalization or LTC. Acid-suppressing agents. GI surgery or GI procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Which antibiotics cause C. diff disease more frequently?

A

B-lactams, CEPHs (2nd/3rd gen). Clindamycin, Macrolides, FQs, TCN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How is Mild-Moderate CDI classified?

A

Non-bloody, water diarrhea (5-10 stools/day). Fever, abdominal cramp. WBC < 15,000. SCr < 1.5x premorbid level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How is Severe CDI classified?

A

Blood in stool, profuse watery diarrhea (> 10 stools/day). High fever (102-104F), severe abdominal pain and tenderness. WBC > 15,000. SCr > 1.5x premorbid level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the treatment for Mild-Moderate CDI?

A

Metronidazole 500mg PO TID x10-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the treatment for Severe CDI?

A

Vancomycin 125mg PO QID x10-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the treatment for Severe/Complicated (hypotension or shock, ileus, megacolon) CDI?

A

Vancomycin 500mg PO QID + Metronidazole 500mg IV Q8h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the antibiotic choices for 1st recurrence of CDI?

A

Either Metronidazole or Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the antibiotic choices for 2+ recurrence of CDI?

A

Pulse or taper Vancomycin. Metronidazole is discouraged (risk of peripheral neuropathy d/t cumulative neurotoxicity)

50
Q

How is Vancomycin tapered in recurrent CDI?

A

125mg PO BID x7 days, then QD x7 days, then Q2-3 days x2-8 weeks

51
Q

How is Vancomycin pulsed in recurrent CDI?

A

125, 250, or 500mg Q3 days x4-6 weeks

52
Q

What type of Microbiology is often found in Primary Peritonitis?

A

Mostly monomicrobial: E. coli, Klebsiella, Streptococcus (GAS, S. pneum). Anaerobes are RARE

53
Q

What is used for diagnosis of Primary Peritonitis?

A

WBC > 500 (best single predictor). Lactate > 25. pH > 7.4. Gram stain for organisms often negative

54
Q

What is first line therapy for Primary Peritonitis?

A

2nd or 3rd gen CEPHs: Cefoxitin, Cefotetan, Cefuroxime, Cefotaxime, Ceftriaxone. Can add Clindamycin or Metronidazole if suspect anaerobes

55
Q

What can be given to patients with Primary Peritonitis who have a PCN and CEPH allergy?

A

Vancomycin + Aztreonam

56
Q

What type of microbiology is often found in Secondary Peritonitis?

A

Polymicrobial: PEK (E. coli most common) and B. fragilis (most common anaerobe)

57
Q

What is done for the diagnosis of Secondary Peritonitis?

A

Exploratory laporatomy. Needle aspiration. Imaging studies. Blood cultures

58
Q

What is the general outline of Secondary Peritonitis treatment?

A

Surgery (necessary to correct underlying pathology). Antibiotic selection based on severity and if its community-acquired (narrow spectrum, monotherapy) or heath-care associated (more resistant bacteria, possible multidrug treatment)

59
Q

What are the treatment options for Secondary Peritonitis?

A

3rd gen CEPH + Metronidazole. OR. Ertapenem. OR. Zosyn +/- Aminoglycoside

60
Q

What are the treatment options for Secondary Peritonitis for patients w/ PCN and CEPH allergy?

A

Aztreonam + Metronidazole

61
Q

For IAI, what antibiotics with B. fragilis coverage do you NOT want to use?

A

Cefotetan/Cefoxitin, Clindamycin (NOT recommended d/t increased rates of resistance w/ B. fragilis)

62
Q

For IAI, when do you need Enterococci coverage?

A

NEED for HCA-IAI, particularly in patients with: Postop infection, received prior CEPH therapy, Immunocompromised, Have valvular heart disease. NOT routinely needed for CA-IAI

63
Q

What is the choice for empiric therapy if HCA-IAI when you want to cover for Enterococci?

A

Ampicillin. Zosyn. Vancomycin

64
Q

What is the first line treatment for Chlamydia?

A

Azithromycin 1g PO x1 dose. OR. Doxycyline 100mg PO BID x7 days

65
Q

What is the first line treatment for Gonorrhea?

A

Ceftriaxone 250mg IM x1 dose + Azithromycin 1g PO x1 dose or Doxycycline 100mg PO BID x7 days. Azithro or Doxy added d/t needing Chlamydia coverage as well

66
Q

What is the treatment for Gonorrhea when the patient has a CEPH allergy?

A

Azithromycin 2g PO once + test of cure in 1 week

67
Q

What is the first line treatment for Trichomonas vaginalis?

A

Metronidazole 2g PO x1 dose. OR. Tinidazole 2g PO x1 dose

68
Q

What are the alternative regimens for Trichomonas Vaginalis?

A

Metronidazole 500mg BID x7 days. Pregnant: Metronidazole 2g PO x1 dose

69
Q

What is the first line treatment for Bacterial Vaginosis?

A

Metronidazole 500mg BID x7 days. OR. Tinidazole 2g PO BID x2 days or 1g PO QD x5 days. Metronidazole gel 0.75%, 5g intravaginally QD x5 days. OR. Clindamycin cream 2%, 5g intravaginally QHS x7 days (not during 3rd trimester)

70
Q

What is the recommended treatment for Syphilis?

A

Penicillin G (Bicillin LA, NOT CR) 2.4 million units IM

71
Q

What is the treatment for Syphilis when the patient has a PCN allergy?

A

Doxycycline 100mg BID x14 days. OR. Ceftriaxone 1g IM/IV QD x8-10 days. OR. Azithromycin 2g PO single dose

72
Q

What is the patient-applied treatment for HPV?

A

Podofilox 0.5% solution or gel. OR. Imiquimod 5% cream

73
Q

What is the provider-administered treatment for HPV?

A

Cryotherapy. Podophyllin resin 10-25%. Trichloroacetic or Bichloroacetic acid 80-90%. Surgical removal

74
Q

Which bacterial STD is mostly symptomatic in females?

A

Chlamydia. Trichomonas. Bacterial Vaginosis

75
Q

Which bacterial STD is mostly symptomatic in males?

A

Gonorrhea

76
Q

Which bacterial STD has a fishy odor?

A

Trichomonas and Bacterial Vaginosis

77
Q

Which bacteria causes Bacterial Vaginosis?

A

Polymicrobial, mostly Gardnerella vaginalis

78
Q

Which bacteria causes Syphilis?

A

Trepnoema pallidum

79
Q

What tests are the best to indicate UTI (positive result)?

A

Leukocyte Esterase (LE) and WBC > 5-10,000 are the best indicators

80
Q

What are the first line treatment options for a UTI in pregnancy?

A

Nitrofurantoin 100mg PO BID x7 days. OR. B-Lactam (Augmentin) 500/125mg PO BID x7 days

81
Q

What are the first line treatment options for an uncomplicated UTI?

A

Nitrofurantoin 100mg PO BID x5 days. TMP/SMX 160/800mg PO BID x3 days

82
Q

Which antibiotics need to be avoided for UTI in pregnancy?

A

FQs and Tetracyclines d/t teratogenicity

83
Q

What are some alternative treatments for uncomplicated UTIs?

A

Fosfomycin 3g PO x1 dose. B-Lactam (Cefopodoxime (3rd gen; 100mg PO BID) or Augmentin). FQ (Cipro 250mg PO BID x3 days)

84
Q

What are the first line treatment options for a complicated Outpatient UTI?

A

Need antibiotic to get into urine AND blood. Bactrim +/- IV Ceftriaxone or IV AG x14 days. PO FQ +/- IV FQ or IV Ceftriaxone or IV AG x5-7 days

85
Q

What are the treatment options for a complicated Inpatient UTI?

A

FQ 400mg Q12h. OR. 3rd/4th gen CEPH. OR. AG + Ampicillin 2g IV Q6h

86
Q

For IE prophylaxis, what are the commonly used antibiotics?

A

Amoxicillin 2g PO 30-60 min prior to dental procedure

87
Q

For IE prophylaxis, what antibiotics are used in patients unable to take oral medications?

A

Cefazolin 1g IM/IV or Ampicillin 2g IM/IV 30-60 minutes prior to dental procedure

88
Q

For IE prophylaxis, what antibiotics are used when the patient is allergic to PCN?

A

Clindamycin 600mg PO/IV or Azithromycin 500mg 30-60 minutes prior to procedure

89
Q

What is the primary therapy for SSTI?

A

Incision and drainage

90
Q

When should an antibiotic be used for SSTI?

A

Progressing SSTI or if associated w/ cellulitis. Abscesses > 5cm. Signs and symptoms of systemic illness. Co-morbid conditions. Location where its hard to do I&D

91
Q

What are the antibiotic treatment choices for outpatient treatment of MRSA?

A

Clindamycin 150-450mg PO Q8h. Bactrim 800/160mg 1-2 tabs Q12h. Doxycycline 100mg Q12h x10 days. Rifampin 300mg PO Q8h (in combo with one of the above). Linezolid 600mg Q12h

92
Q

What is the first line empiric treatment for severe invasive SSTI?

A

Vancomycin (trough 15-20)

93
Q

What other treatment options are there for severe invasive SSTI besides vancomycin?

A

Daptomycin 6mg/kg IV Q24h. Linezolid 600mg IV Q12h. Synercid 7.5mg/kg IV Q8h. The above + AMG or RIF for synergy

94
Q

What are the treatment options for MRSA Pneumonia?

A

Vancomycin trough 15-20. NO Daptomycin or Tigecycline!

95
Q

What are the treatment options for MRSA bloodstream infections?

A

Vancomycin, Linezolid, Daptomycin. NO Tigecycline. Usually 14 day course, can be 4-6 weeks in complicated cases

96
Q

What are the treatment options for MRSA infections with possible endocarditis?

A

Vancomycin, Linezolid, Daptomycin. NO Tigecycline. Typical duration is 4-6 weeks

97
Q

When is IV treatment for cellulitis preferred?

A

If lesion rapidly spreading. If systemic response prominent. Significant comorbidities

98
Q

What medications are used for cellulitis caused by Strep or Staph aureus?

A

PO: Dicloxacillin or Cephalexin. IV: Oxacillin or Cefazolin

99
Q

What medications are used for cellulitis caused by Strep or Staph aureus in a patient with B-lactam allergy?

A

Clindamycin, Erythromycin (not really)

100
Q

What are the PO treatment options for cellulitis caused by CA-MRSA?

A

Bactrim, Doxycycline, Clindamycin

101
Q

What are the IV treatment options for cellulitis caused by CA-MRSA?

A

Vancomcyin, Linezolid, Daptomycin, Tigecycline, Telavancin

102
Q

What are the common causes of acute diabetic foot infections?

A

Typically monomicrobial: S. aureus, B-hemolytic strep (Groups A, B, C, G)

103
Q

What are the common causes of chronic diabetic foot infections?

A

Obligate anaerobes. Pseud. aeruginosa. MRSA. VRE

104
Q

What are the treatment options for Mild-Moderate diabetic foot infections?

A

Relatively narrow spectrum agent (cover aerobic GPC). Oral agent may be appropriate (especially with high bioavailability)

105
Q

What are the treatment options for severe chronic diabetic foot infections?

A

Cover GPC (including MRSA), GNR, and anaerobes. Give parenteral therapy (IV)

106
Q

What is look at for the sputum analysis for Pneumonia?

A

Squamous epithelial cells (reject sample if > 10). WBCs (> 25 reflects infection)

107
Q

What treatment is used for Pneumonia Group 1 (low risk = outpatient)?

A

First line (Macrolide or Doxycycline). or Telithromycin

108
Q

What treatment is used for Pneumonia Group 2 (moderate risk = outpatient)?

A

B-Lactam (oral or one time IV/IM ceftriaxone followed by oral) + Macrolide or Doxycycline

109
Q

What treatment is used for Pneumonia Group 3a (moderate/inpatient, w/ cardiopulmonary)?

A

IV B-Lactam + IV Macrolide or Doxycycline. OR. IV anti-pneumococcal or FQ

110
Q

What treatment is used for Pneumonia Group 3b (moderate/inpatient, w/o cardiopulmonary)?

A

IV Azithromycin alone (if macrolide intolerant, Doxycycline + B-lactam). OR. IV anti-pneumococcal or FQ

111
Q

What treatment is used for Pneumonia Group 4a (severe/inpatient, unlikely Pseudomonas)?

A

IV B-Lactam (3rd or 4th gen CEPH) + IV Macrolide or IV FQ

112
Q

What treatment is used for Pneumonia Group 4b (severe/inpatient, likely Psuedomonas)?

A

B-Lactam + AG/FQ + IV Macrolide

113
Q

When is it ok to switch a patient from IV to PO when treating pneumonia?

A

Review patient after 3 days IV. When stable and taking orals. After afebrile x24h and improving. Functional GI tract. No nausea/vomiting. Mentally alert/minimize aspiration risk

114
Q

What are the treatment choices for Legionella pneumophilia?

A

Azithromycin x3 weeks or IV Cipro x3 weeks

115
Q

What are the treatment choices for Early HAP/VAP?

A

B-Lactam (3rd gen CEPH or Amp/Sulbactam)

116
Q

What are the treatment options for Late HAP/VAP?

A

B-Lactam (Zosyn or Cefepime) +/- AG (P. aeruginosa suspicion) +/- Vancomycin (MRSA suspicion)

117
Q

Once culture is back and bacteria causing pneumonia is identified as S. pneumo, what are your treatment options?

A

PCN-susceptible (PCN, 2nd gen CEPH, Macro, Doxy). PCN-resistant (Vanco, Levofloxacin, Linezolid, Imipenem)

118
Q

Once culture is back and bacteria causing pneumonia is identified as H. influenzae, what are your treatment options?

A

B-lactamase negative (Amp 1-2g IV). B-lactamase positive (Cefuroxime, Bactrim IV, 3rd gen CEPH, Cipro)

119
Q

Once culture is back and bacteria causing pneumonia is identified as PEK, what are your treatment options?

A

3rd gen CEPH. Cipro

120
Q

Once culture is back and bacteria causing pneumonia is identified as Enterobacter, serratia, citrobacter, what are your treatment options?

A

Cipro or Bactrim or Imipenem

121
Q

Once culture is back and bacteria causing pneumonia is identified as P. aeruginosa, what are your treatment options?

A

AG (tobra, gent). Zosyn 4.5g. Ceftazidime, Cefepime, Cipro

122
Q

Once culture is back and bacteria causing pneumonia is identified as S. aureus, what are your treatment options?

A

MRSA (Vanco, Bactrim, NO Dapto). MSSA: Cefazolin, Oxacillin

Thera VII (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions