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1
Q

Gram + - subgroups

A
  1. cocci
  2. Robs (bacilli)
  3. branching filaments
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2
Q

gram + branching filaments - bugs (and characteristics)

A
  1. Actinomyces - anaerobe, not acid fast

2. Nocardia - aerobe, acid fast

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3
Q

gram + robs - bugs (and characteristics)

A
  1. Clostiridium - spore forming, anaerobe
  2. Bacillus - spore forming, aerobe
  3. Listeria - no spore forming, tumbling motile, aerobe
  4. corynobacterium - no spore forming, non-motile,
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4
Q

gram + cocci are divided to (and characteristics)

A
  1. staphylococcus (cat+, clusters)

2. streptococcus (cat-, chains)

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5
Q

staphylococcus - bugs

A

ALL CAT+, CLUSTERS

  1. S. aureus
  2. S. epidermidis
  3. S. saprophyticus
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6
Q

streptococci are divided into subgroups according to (and the meaning)

A

hemolysis

  1. partially hemolysis (α)
  2. complete hemolysis (clear) (β)
  3. no hemolysis (γ)
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7
Q

β hemolytic streptococci - bugs and groups

A
  1. S pyogens (group A)

2. S. agalactiae (group B)

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8
Q

γ hemolytic streptococci - bugs and groups

A
  1. enterococcus (E. faecalis, E. feacium) - Group D,

2. Nonenterococcus (Streptococcus bovis)

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9
Q

α hemolytic streptococci - bugs (and characteristics)

A
  1. S. pneumoniae

2. Viridaans streptococci (eg. S. mutans, S. sanguinis, S. mitis)

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10
Q

S. pneumoniae - clinical manifestation

A

A. MCC OF: 1. Meningitis 2. Otitis media (in children)
3. Pneumonia 4. Sinusitis
B. Sepsis in sickle cell and splenectomy

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11
Q

Enterococci can cause

A

I. UTI
2. biliary tract infection
3. sabacute endocarditis
(following GI/GU procedures)

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12
Q

actinomyces vs Nocardia according to clinical manifestations

A

Acinomyces –> oral/facial abscess that drain through sinus tracts, PID with intrauterine device
Nocardia –> pulmonary infections in immunocompromised and cutaneous infection after trauma in immunocompoment

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13
Q

actinomyces vs Nocardia according to treatment

A

MNEMONIC: SNAP –> Sulfa - Nocardia / Actinom - Penicillin
Acinomyces –> penicillin
Nocardia –> sulfonamides

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14
Q

Gram (-) - subgroups

A
  1. diplococci
  2. coccoid robs (cocciobacilly)
  3. robs
  4. oxidase (+) comma shaped robs
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15
Q

Gram (-) - subgroups - diplococci - bugs

A
  1. Neisseria meningitis
  2. Neisseria gonorrhoeae
  3. Moraxella catarrhalis
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16
Q

Gram (-) - subgroups - coccoid robs - bugs?

A
  1. haemophilus infleunzae
  2. Pasteurella
  3. Brucella
  4. Bordetella pertusis
  5. Francicella tularencis
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17
Q

Gram (-) - subgroups - oxidase +, comma shape

A
  1. Campylobacter jejuni (grows in 42c, oxidase +, comma shape)
  2. Vibrio cholera (grows in alkaline media, oxidase +, comma shape)
  3. Helicobacter pylori (produces urease, oxidase +, comma shape, catalase +)
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18
Q

Gram (-) stain robs are divided to (only the groups)

A
  1. Lactose fermeter

2. Lactose nonfermenter

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19
Q

Gram (-) stain robs Lactose nonfermenter bugs

A
  1. Salmonela
  2. Proteus
  3. Yersinia
  4. Shigella
  5. pseudomonas
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20
Q

Gram (-) stain robs - lactose fermenter bugs

A
  1. klebsiella
  2. E. coil
  3. Enterobacter
  4. citrobacter
  5. others
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21
Q

neisseria gonococci vs neisseria meningitis - prevention

A

neisseria gonococci –> condoms (for STD), erythromycin ointment (neonatal transmision)
neisseria meningitis –> Rifampin, ciprofloxacin or ceftriaxone prophylaxis in close contacts

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22
Q

neisseria gonococci vs neisseria meningitis - treatment

A

neisseria gonococci –> ceftriaxone + (azithromycin or doxycycline) for possible chlamydial coinfection
neisseria meningitis –> ceftraxone or penicillin G

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23
Q

ciprofloxacini used for

A

cystitis and pyelonephritis

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24
Q

Fluoroquinolones - diverticulitis and GI infections

A
  1. moxifloxacin alone (it cover anaerobes)

2. ciprofloxacin, gemifloxacin and levofloxacin must be combined with metronidazole because they dont covers anaerobles

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25
Q

Fluoroquinolone that covers anaerobes

A

moxifloxacin

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26
Q

Anaerobes - drugs

A

oral (above the diaphragm):
1. penicillin G or VK, ampicillin or amoxicillin
2. clindamycin
Abdominal / GI
1. metronidazole
2. beta lactam/lactamase combination
PIPERACILLIN, CARBAPENE,S AND 2ND GENERATION CEPH ALSO COVER ANAEROBES

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27
Q

Gram (-) bacilli are covered by

A
  1. quinolones
  2. aminoglycosides
  3. carbepens
  4. peperacillin, ticarcillin
  5. aztreonam
  6. cephalosporins
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28
Q

common cause of meningitis in newborn (0-6months) (in order)

A
  1. Group B streptococci
  2. E. coli
  3. Listeria
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29
Q

common cause of meningitis in children (6months-6yr) (in order)

A
  1. S. pneumoniae
  2. N. meningitis
  3. H. influenzae type B
  4. Enteroviruses
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30
Q

common cause of meningitis in 6-60 years (in order)

A
  1. S. pneumoniae
  2. N. meningitis (1st in teens)
  3. Enteroviruses
  4. HSV
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31
Q

common cause of meningitis in 60+ (in order)

A
  1. S. pneumoniae
  2. Gram - robs
  3. Listeria
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32
Q

common cause of pneumonia in neonates (less than 4 weeks)

A
  1. S. agalactiae

2. E. coli

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33
Q

common cause of pneumonia in children (4wks - 18yr) (in order)

A
  1. viruses (RSV)
  2. mycoplasma
  3. C. trachomatis (infants - 3 years)
  4. C. pneumoniae (school-aged children)
    S. pneumoniae
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34
Q

common cause of pneumonia in adults (18-40yr) (in order)

A
  1. mycoplasma
  2. C. pneumoniae
  3. S. pneumoniae
  4. viruses (eg. influenza)
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35
Q

common cause of pneumonia in adults (40-65yr) (in order)

A
  1. S. pneumoniae
  2. H. infuenzae
  3. Anaerobes
  4. viruses
    5, Mycoplasma
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36
Q

common cause of pneumonia in elderly (in order)

A
  1. S. pneumoniae
  2. Influenza virus
  3. Anaerobes
  4. H Influenzae
  5. Gram (-) robs
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37
Q

CATALASE + organism - examples

A

PLACESS (+ nocardia, H. pylori, B. cepacia

  1. Staphylococci 2. E-coli 3. Candida
  2. Serratia 5. Listeria 6. Aspergillus
  3. Pseudomonas 8. Nocardia
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38
Q

staphylococcus aureus can cause …. (categories and manifestations

A

A. inflammatory disea: 1. skin infection 2. organ abscesses
3. pneumonia 4. endocarditis 5. osteomyelitis
B. Toxin mediated disease: 1. TSST-1 –> Toxic shock syndrome 2. Exfoliative –> scalded skin syndrome
3. enterotoxin –> rapid onset food poisoning
C. MRSA infection: serious nosocomial and community-acquired infections

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39
Q

Toxic shock syndrome - is associated with (situations)

A
  1. S. aureus –> vaginal tampons, nasal packing

2. S. pyogenes –> painful skin infection

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40
Q

diptheria - symptoms

A
  1. pseudomembranous pharyngitis (grayish-white membrane)
  2. Lymphadenopathy (bull neck)
  3. myocaridits
  4. arrhythmia
  5. demyelination/paralysis of peripheral nerves
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41
Q

spore forming bacteria - bugs and diseases

A
  1. Bacillus antrhacis –> antrax
  2. Bacillus cereus –> Food poisoning
  3. Clostiridium botulinum –> botulism
  4. Clostiridium difficile –> Antibiotic associated colitis
  5. Clostiridium perfingess –> gas gangrene, food poisoning
  6. Clostiridium tetani –> tetanus
  7. Coxiella burnetii –> Q fever
42
Q

Clostiridia - toxins

A
  1. Clostiridium tetani –> tetanospasmin
  2. Clostiridium botulinum –> Botulinum toxin
  3. Clostiridium perfringens –> Alpha toxin, head labile enterotoxin
  4. Clostiridium difficile –> Toxin A (eneterotoxin), Toxin B (cytotoxin)
43
Q

cutaneous antrhax?

A

painless, papule surrounded by vesicle –> ulcer with black eschar, (painless, pencrotic) –> uncommonly progress to bactremia and death

44
Q

pulmonary antrhax? / aka?

A

inhalation of spores –> flu like symptoms that rapidly progress to fever, pulmonary hemorrhage, mediastinitis and shock. aka: woolsorter’s disease

45
Q

Listeria monocytogenes can cause

A
  1. in pregnant –> amnionitis, septicemia, spontaneous abortion
  2. newborns –> granulomatosis infantiseptica, neonatal meningitis
  3. immunocompromised patients –> meningitis
  4. healthy individuals –> mild gastroenteritis
46
Q

Nontypeable of H. infl stains are the MCC of

A

A. mucosal infection:

  1. otitis media
  2. conjunctivitis
  3. bronhitis
47
Q

en-capsuled type B H. influenza causes

A

invasive infection:

  1. meningitis
  2. acute epiglottitis (children)
  3. septic arthritis
  4. sepsis
48
Q

risk factors for Legionnaires’s disease

A
  1. Cigarette smoking
  2. alcoholics
  3. chronic lung disease
  4. immunosuppressed states
49
Q

pseudomonas aeroginosa - manifestations (and associated conditions)

A
  1. Pneumonia (Cystic fibrosis, mechanical ventilation)
  2. otitis externa - swimmer’s ear (diabetes)
  3. UTI (hospital patients)
  4. ecthyma gangrenosum (immunocompromised patients)
  5. sepsis
  6. osteomyelitis (eg. puncture wounds, drug use)
  7. wound infection (burn victim)
  8. hot tub folliculitis (water)
    9 nosocomial infections (catheter equipment)
50
Q

Pseudomonas aeroginosa - mechanism of action

A

produce

  1. endotoxin –> fever + shock
  2. exotoxin A –> inactivates EF-2
  3. pyocacin –> generates ROS
51
Q

E. coli - presentation

A
  1. EIEC –> dysentery with white blood cells, fever
  2. ETEC –> traveler’s diarrhea (watery)
  3. EPEC –> watery diarrhea, usually in children
  4. EHEC –> dysentery, hemolytic uremic syndrome
52
Q

Klebsiella - clinical manifestation (and situations)

A
  1. lobar pneumonia (and bronchopneumonia) (in alcoholics, diabetes)
  2. UTI (nosocomial)
  3. Abscess in Lung and liver
53
Q

Campylobacter jejuni - clinical manifestations

A
  1. Major cause of bloody diarrhea (especially in children)
  2. Guillain-Barre syndrome
  3. reactive arthritis
54
Q

Salmonella typhi vs other salmonella vs shigella - GI manifestation

A

Salmonella typhi –> constipation, followed by diarrhea
other salmonella –>bloody diarrhea
shigella –> bloody diarrhea (bacillary dysentery)

55
Q

Penicillin G vs V

A

Penicillin G –> IV and IM form

Penicillin V –> Oral

56
Q

Penicillin G and V - clinical use

A

gram + cocci and robs, gram (-) cocci, spirochetes:

  1. gram (+) organisms (S. pneumoniae, S.pygoenes, Actinomyces)
  2. gram (-) cocci (mainly N. meningitidis)
  3. spirochetes (mainly T. pallidum)
57
Q

aminopenicillins (amoxicillin, ampicillin) - clinical use

A 
extended spectrum penicillin:
1. H. infl   2. H. pylori  3. E. coli 
4. Listeria  5. Proteus  6. Salmonella
7. Shigella  8.  Entetococci 
MNEMONIC : HHELPSS + enterococci
58
Q

Penicillinase-resistant penicillins - drugs and clinical use

A
  1. Dicloxacillin2. Nafcillin 3. Oxacillin 4. Methcillin

S. aureus (except MRSA)

59
Q

Antipseudomonals - drugs / clinical use

A

Piperacillin, Ticarcillin

  1. psudomonas spp and gram-negative robs
  2. gram (-) robs
60
Q

β-lactamase inhibitors - use

A

often added to penicillin antibiotics to protect the antibiotic from destruction by β-lactamase (penicillinase)

61
Q

Cephalosporins - drugs

A

1st generation –> cefazolin, cephalexin
2nd generation –> cefoxitin, cefaclor, cefuroxamine
3rd generation –> ceftriaxone, cefotaxime, ceftazidime
4th generation –> cefepime
5th generation –> ceftraroline

62
Q

organisms typically not covered by Cephalosporins?

A

mnemonic: LAME
Listeria, Atypicals (Chlamydia, Mycoplasma) MRSA, Entrococci
exception. Ceftaroline (5th) covers MRSA

63
Q

1st generation cephalosporins - drugs and clinical use

A 
cefazolin, cephalexin 
1. gram + cocci 
2. Proteus
3. E. coli
4. Klebsiella 
cefazolin used prior to surgery to prevent S. aureus wound infection
64
Q

2nd generation - drugs and clinical use

A

cefoxitin, cefaclor, cefuroxamine

  1. like 1st generation (gram + cocci, proteus, E.coli, Klebsiella)
  2. H. infuenzae
  3. Enterobacter aerogenes
  4. Neisseria spp
  5. Serratia marcescens
65
Q

3rd generation - drugs and clinical use

A

ceftriaxone, cefotaxime, ceftazidime
serious gram (-) infections resistant to other β-lactams
- ceftriaxone –> meningitis, gonnorrhea, disseminated Lyme disease
- Ceftazimide –> Pseudomonas

66
Q

4th generation - drugs and clinical use

A

cefepime
gram (-) organism, with high activity against Pseudomonas
2. gram (+)

67
Q

5th generation - drugs and clinical use

A 
ceftaroline
1. broad gram (+)
2. borad gram (-)
INCLUDING MRSA 
DOES NTO COVER PSEUDOMONAS
68
Q

Cephalosporins - toxicity

A
  1. hypersensitivity reactions
  2. autoimmune hemolytic anemia
  3. disulfiram-like reaction
  4. vitamin K deficiency
  5. exhibit cross-reactivity with penicillins
  6. Increases aminoglycosides mediated nephrotoxicity
69
Q

Carbapenems - drugs

A
  1. Imipenem
  2. Meropenem
  3. Doripenem (newer)
  4. Ertapenem (newer)
70
Q

Carbapenems - clinical use

A
  1. Gram (+) cocci
  2. Gram (-) robs
  3. anaerobes
    WIDE spectrum but significant side effects limit use of life threatening infection or after other drugs have failed
    Ertapenem has limited pseudomonas coverage
71
Q

Carbapenems - toxicity

A
  1. GI distress
  2. skin rash
  3. CNS toxicity (seizurs) at high plasma levels (less risk with meropenem)
72
Q

Monobactams (Aztreonam) - clinical use

A
  1. Gram (-) robs ONLY (no anaerobesm no gram (+))

For penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides

73
Q

Monobactams (Aztreonam) - side effects

A

usually nontoxin –> occasional GI upset

74
Q

Vancomycin - clinical use

A 
gram (+)  bugs only:
serious Multidrug resistance organisms, including:
- MRSA 
- S. epidermidis 
- Clostiridium difficle (oral)
- Enterococcus species
75
Q

Vancomycin - toxicity

A

well tolerated

  1. nephrotoxicity
  2. ototoxicity
  3. thrombophlebitis
  4. red man syndrom (diffuse flushing)
76
Q

red man syndrom - appearance, caused by, solution

A
  • diffuse flushing
  • it is caused by vancomycin
  • pretreatment with antihistamines and slow infusion rate
77
Q

Fluroroquinolones - drug that i not -floxacin

78
Q

Fluororoquinolones - clinical use

A
  1. gram (-) robs of urinary and GI tracts (including Pseudomonas)
  2. Neisseria
  3. some gram (+)
79
Q

Fluororoquinolones - toxicity

A
  1. GI upset
  2. superinfections
  3. skin rash
    4 .headache/dizziness
  4. leg cramps and myalgias (less commonly)
  5. Prolonged QT
  6. tendonitis or tendon rupture (if >60 or prednisone)
  7. contraindicated in pregnancy, nursing mothers, children under eighteen –> possible damage to cartilage
80
Q

metronidazole - clinical use

A
  1. Giardia
  2. Entamoeba
  3. Trichomonas vaginalis
  4. Garndenella vaginalis
  5. Anaerobes (Bacteroides, C. difficile)
  6. H. pylori
81
Q

metronidazole - adverse effects

A
  1. Disulfiram-like reaction (severe flushing, tachycardia, hypertension) with alcohol
  2. headache
  3. metallic taste
82
Q

Daptomycin - clinical use

A
  1. S. aureus SKIN infection (esp MRSA)
  2. bacteremia
  3. endocarditis
  4. VRE
83
Q

Daptomycin - toxicity

A
  1. Myopathy

2. rhabdomyolysis

84
Q

Antimicrobial therapy - protein synthesis - divisions and drugs

A

50S –> 1. Chloramphenicol 2. Clindamycin 3. Linezolid 4. Macrolides 5. Streptogramins
30S –> 1. aminoglycosides 2. Tetracyclines

85
Q

50S –> 1. Chloramphenicol 2. Clindamycin 3. Linezolid 4. Macrolides 5. Streptogramins
30S –> 1. aminoglycosides 2. Tetracyclines

A
  1. Gentamycin
  2. Neomycin
  3. Amikacin
  4. Tobramycin
  5. Streptomycin
86
Q

Aminoglycosides - clinical use

A
  1. severe gram (-) rob infection
  2. Synergistic with β-lactam antibiotics
  3. Neomycin for bowel surgery
87
Q

Aminoglycosides - side effects

A
  1. nephrotoxicity (worse with cephalosporins)
  2. Neuromascular blockage
  3. Ototoxicity (esp with loop diuretics)
  4. Teratogen
88
Q

Tetracyclines - clinical use

A
  1. Borrelia bugdorferi
  2. M. pneumoniae
  3. Rickettsia
  4. Chlamydia
  5. acne
  6. Ehrichiosis/Anaplasmosis
  7. Q fever
89
Q

Tetracyclines - toxicity

A
  1. GI distress
  2. discoloration of teeth and inhibition of bone growth in children
  3. photosensitivity
  4. Contraindicated in pregnancy
90
Q

chloramphenicol - clinical use

A
  1. meningitis (H. infl, N. meningitis, S. pneumoniae)
  2. Rocky Montain spoted fever (R. ricketsi)
    Limited use owing to toxicities but often still used in developing countries (low cost)
91
Q

chloramphenicol - toxicity

A
  1. anemia (dose dependent)
  2. aplastic anemia (dose independent)
  3. gray baby syndrome
92
Q

Clindamycin - clinical use

A
  1. anaerobic infections in aspiration pneumonia, lung abscess, oral infection
  2. invasive A streptococcal infection
  3. Gardenella vaginalis
93
Q

Clindamycin - toxicity

A
  1. pseudomembranous colitis
  2. fever
  3. diarrhea
94
Q

Linezolid - clinical use

A

gram (+) species MRSA and VRE

95
Q

Linezolid - toxicity

A
  1. bone marrow suppression (esp thrmbocytopenia)
  2. peripheral neuropathy
  3. seretonin syndrome
96
Q

Macrolides - drugs

A
  1. Azythromycin
  2. Clarithromycin
  3. Erythromycin
97
Q

Macrolides - clinical use

A
  1. Atypical pneumonias (Mycoplasma, chlamydia, legionalla
  2. STI (chlamydia)
  3. Gram (+) cocci (streptococcal infections in patients allergic to penicillin)
  4. B. pertusis
98
Q

Macrolides - side effects

A
  1. GI uspet 2
  2. Arrhytmia (long QT)
  3. Acute cholestatic hepatitis
  4. Rash
  5. eosinophilia
  6. increased serum levels of theophyllines, oral anticoagulants
  7. inhibit P-450 (clarithromycin and erythrmicycin)
  8. contraindicated in pregnancy (embryotoxic)
99
Q

Antimicrobial therapy - Folic acid synthesis - drugs

A
  1. Sulfonamides: a. sulfadiazine b. sulfamethoxazole (SMX)
    c. sulfisoxazole
  2. Trimethoprim (or pyrimethamine)
  3. dapsone
100
Q

Sulfonamides - toxicity

A
  1. hypersensitivity 2. G6PD hemolysis
  2. nephrotoxicity (tumbulointestinal nephritis)
  3. photosensitivity 5. kernicterus (infants)
  4. displace other drug from albumin (eg. warfarin)
101
Q

Treatment of highly resistant bacteria

A

MRSA: vancomycin, daptomycin (esp skin), linezolid, tigecycline, ceftaroline
VRE: linezolid and streptogramins (quinupristin, dalfopristin)
Multidrug-resistant P. aeruginosa: polymixins B and E (Colistin)
Multidrug-resistant Acinetobacter baumannii: polymixins B and E (Colistin)

Infectious diseases (13 decks)

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