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High Yield 2 Flashcards

1
Q

What antiarrhythmics

  1. Prolongs action potential and refractory period
  2. shortens action potential and repolarization
A
  1. Class Ia (procainamide, quindine), Class III (amiodarone, sotalol)
  2. Class Ib (lidocaine)
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2
Q

intermittent pain and tingling sensation in arm, occasional swelling of arm on abduction, loss of radial pulse when head turned to affected side
DX and TX?

A

thoracic outlet syndrome- idiopathic compression of brachial plexus, subclavian artery or vein

DX: + Adson test- loss of radial pulse when turning head to affected side

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3
Q

What are possible complications of the following:

  1. Entamoeba histolytica
  2. Acanthamoeba lentica
A
  1. live abscesses

2. keratits in contact lens wearers (cornea stromal rings infiltrates)

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4
Q

how do you dx ARDS

A
  1. SEVERE refractory hypoxemia (PaO2/FI02 is less than 200mmHg that is not responsive to 100% O2)
  2. bilateral pulmonary infiltrates on CXR (white out pattern)
  3. PCWP less than 18mmHg (no cardiogenic pulm. edema)
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5
Q

MOA of antiemetics

  1. Ondansetron
  2. Promethazine, prochloreperazine, metoclopramide
  3. diphenhydramine, meclizine
A
  1. serotonin antagonists (blocks receptors)
  2. Dopamine blockers (blocks CNS dopamine receptors)
  3. antihistamine/anticholinergics (works on brains control of N/V/dizziness)
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6
Q
  • Acute digoxin toxicity directly causes __ electrolyte abnormality
  • __ electrolyte abnormality increases risk for acute dig. toxicity
A

HyperK

HypoK

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7
Q

What organism and tx for the following osteomyelitis?

  1. Newborn <4months:
  2. > 4 months:
  3. Sickle cell:
  4. Puncture wound:
A

*Treat 4-6 weeks w/ at least 2 weeks IV

  1. GBS- Tx: Nafcillin + 3rd gen cephalosporin
  2. S. aureus- Tx: MSSA- Nafcillin (or Oxacillin) or Cefazolin (ancef), MRSA- Vanco
  3. Salmonella- Tx: <18= Ceftriaxone, >18- Ciprofloxacin
  4. Pseduomonas- Tx: Ciprofloxacin
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8
Q

What are the following eye findings associated with:

  1. Drussen spots
  2. AV nicking, w/ copper or silver wiring
  3. teardrop or irregularly shaped pupil
  4. fleshy, triangular shaped growing mass on nasal side of eye
  5. yellow elevated nodule on nasal side of sclera that doesn’t grow
  6. red-rim crusting and eyelid flaking
  7. Arterial narrowing
  8. Flame shaped hemorrhages, cotton wool spots
  9. yellow spots w/ sharp margins often circinate
  10. fluffy gray-white spots
  11. clumping of brown-colored pigment cells in the anterior vitreous humor (tobacco dust)
  12. ciliary injectio, limbic flushing
  13. cupping of optic nerve, Steamy cornea, hard eye to palpation, halos around lights
  14. pale retina with cherry red macula (red spot), box car appearance of retinal vessels
  15. extensive retinal hemorrhages “blood and thunder” appearance, optic disc swelling
A
  1. macular degeneration
  2. Stage II hypertensive retinopathy
  3. Globe rupture
  4. pterygium
  5. pinguecula
  6. Blepharitis
  7. Stage I hypertensive retinopathy (copper= moderate, silver= severe)
  8. Stage III hypertensive retinopathy, DM retinopathy
  9. hard exudates
  10. cotton wool spots
  11. Retinal detachment (+ Shafer’s sign)
  12. Keratitis (corneal/ulcer) and Uveitis (iritis)
  13. Narrow angle closure glaucoma
  14. CRAO
  15. CRVO
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9
Q

SE of mannitol and acetazolamide

A

*act on PCT

Mannitol- pulmonary edema

Acetazolamide: kidney stones, hyperchloremic metabolic acidosis

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10
Q

SE of K+ sparing diuretics and special uses

A
  1. HyperK
  2. metabolic acidosis
  3. gynecomastia

Use: CHF and hyperaldosteronism

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11
Q

SE of sulfonamides (bactrim)

A
  1. Kernicterus if afer 2nd trimester
  2. sulfa allergy
  3. hemolysis if G6PD def.
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12
Q

SE of clindamycin

A
  1. C. diff
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13
Q

Severe, sudden unilateral ocular pain, steamy cornea, halo around lights, tunnel vision, mid-dilated fixed nonreactive pupil, hard eye, cupping of optic nerve
TX?

A

Acute angle closure glaucoma

TX:
1. Lower IOP (acetazolamide IV**, mannitol or topical BB)
2nd- open angle w/ cholinergics (pilocarpine or carbachol drops)-
3. Definitive tx= peripheral iridotomy

**AVOID anticholinergics and sympathomimetics

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14
Q

SE of Macrolides

A
  1. GI upset
  2. prolonged QT
  3. CP450 inhibition
  4. muscle toxicity w/ Niacin or statins
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15
Q

What tests correct with Mixing study

A
  1. Hemophilia A, B,
  2. vW disease
  3. Advanced liver dz
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16
Q

A patient is having a cervical biopsy in follow up to an abnormal pap. What is the correct management?

  1. LSIL (CIN I)
  2. HSIL (CIN II, CIN III)
A
  1. Observe if <21 or LEEP, cold knife cervical conization

2. excision (LEEP, cold knife cerivical conization) or ablation

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17
Q

Tx of:

  1. Hemophilia A (8)
  2. Hemophlia B (9)
  3. vW disease Type I
  4. vW disease Type II
  5. vW disease Type III
A
  1. Factor VIII concentrates or desmopressin
  2. Factor IX infusion
  3. mild- no tx, moderate: desmopressin, severe: DDAVP or FVIII concentrates
  4. DDAVP (vWF + Factor VIII prior to procedures)
  5. vWF + Factor VIII (DDAVP NOT HELPFUL)
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18
Q

What is Conn’s disease and how do you tx

A
  1. adrenal aldosteronoma that secrets aldosterone autonomously, causing hyperaldosteronism (HyperNa, hypoK)

TX: spironolactone*

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19
Q

Tx:

  1. TTP
  2. ITP
  3. HUS
  4. DIC
A
  1. plasmaphoresis–> steroids if severe–> splenectomy
  2. Kids: observe–> IVIG, Adults: steroids–> IVIG–> splenectomy
  3. Observe–> plamsapheresis +/- FFP (NO ABX)
  4. Reverse underlying cause +/- platelet transfunsion <20,000, +/- FFP
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20
Q

Follicular phase is __ dominant
Luteal phase is __ dominant

  1. __ causes follicular and egg maturation
  2. __ stimulates the maturing follicle to produce estrogen
  3. __ builds up the endometrial lining
  4. __ causes ovulation
  5. the coprus luteum secretes ___
  6. __ stimulates menstruation
A

F: Estrogen
L: Progesterone

  1. increased FSH: causes follicular and egg maturation
  2. Increased LH: stimulates the maturing follicle to produce estrogen
  3. estrogen: builds up the endometrial lining
  4. LH surge: causes ovulation
  5. the coprus luteum secretes: progesterone* and estrogen to maintain endometrial lining
  6. corpus luteum degeneration causing a fall in progesterone and estrogen levels: stimulates menstruation
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21
Q

Serology for

  1. Chronic Hep B infection
  2. Distant resolved Heb B infection
  3. acute viral hepatitis
  4. Window period of HepB
  5. Hep B vaccination
A
    • HBsAg, - HBsAb, +HBcAb IgG, - HBe
    • HBsAg, + HBsAb, + HBcAb IgG,
    • HBsAg, - HBsAb, + HBcAb IgM , + HBeAg
  4. only + HBcAb IgM
  5. only + HBsAb
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22
Q

What fx?

  1. distal radius fx w/ dorsal angulation
  2. distal radius fx w/ ventral angulation
  3. prox. ulnar fx w/ anterior radial head dislocation
  4. mid-distal radial fx w/ dislocation of distal radioulnar joint
  5. Radial styloid fracture
  6. Ulnar shaft fx
A
  1. Colles
  2. Smiths
    * C and S associated w/ EPL rupture
  3. Monteggia fx
  4. Galeazzi fx
  5. Hutchinson fx or Chauffeur’s fx
  6. Nightstick fx
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23
Q

SE of Vancomycin

A
  1. Red man syndrome
  2. Ototoxic
  3. nephrotoxic
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24
Q

treatment of:

  1. restless leg syndrome
  2. ALS
  3. Guillain Barre
  4. Myasthenia Gravis
  5. Trigeminal neuralgia
  6. idiopathic intracranial HTN
  7. Dermatitis herpetiformis
  8. Parkinsons
A
  1. dopamine agonists ex. Pramipexole, ropinirole +/- gabapentin +/- iron supp.
  2. Riluzole (reduces progression for 6 mon.)
  3. Plasmapheresis, IVIG (prednisone is contraindicated)
  4. acteylcholinesterase inhibitor: pyridostigmine or neostigmine, (plasmapheresis or IVIG for myasthenic crisis)
  5. carbamazepine, gabapentin
  6. acetazolamide
  7. Dapsone + GF diet
  8. Levodopa/carbidopa– use benztropine in younger pts with predominantly tremor
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25
Q

Tx of

  1. Cryptococcosis
  2. Histoplasmosis
  3. Pneumocystis (PCP PNA)
  4. Brucellosis
  5. Q fever (coxiella burnetii)
  6. Plaque (Yersinia pestis)
  7. Camplyobacter
A
  1. Amp B + Flucystone x2wks followed by fuconazole x 10 wks
  2. Itraconazole or AmpB if severe
  3. Bactrim +/- prednisone (Dapsone-trimethoprim if sulfa allergy)
  4. Rifmapin + Doxy
  5. Doxy
  6. Streptomycin or gentamicin
  7. Erythromycin
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26
Q

What Abx can cause photosensitivity

A
  1. Tetracyclines
  2. FQ
  3. sulfonamides (bactrim)
  4. Pyrazinamide
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27
Q

What is the following:

  1. caused by decreased insulin sensitivity due to the nightly surge in glucagon and cortisol during nighttime fasting
  2. caused by nocturnal hypoglycemia followed by a rebound early morning hyperglycemia
  3. caused by progressive rise of serum glucose from bedtime to morning when the evening NPH dose is administer before dinner
  4. Hypoglycemia in the morning at 8am upon awakening due to insulin surge
A
  1. Dawn phenomenon
  2. Somogyi Effect
  3. Insulin waning
  4. Insulinoma
28
Q

SE of tetracyclines

A
  1. GI
  2. stains teeth
  3. hepatotoxic
  4. photosensitivity
  • don’t give to preg. or <8y/o
  • don’t give with diary products, Ca, Al, Mg or Iron
29
Q

What is the following associated with?

  1. increased GGT and ALP
  2. ALT >1000
  3. ALT> 1000 and + smooth Ab
  4. AST: ALT >2
  5. AST: ALT >2:1, with levels <500
A
  1. cholestasis- gallstones in biliary tree
  2. viral, toxic or acute inflammatory hepatitis
  3. autoimmune hepatitis
  4. alcohol hepatitis
  5. chronic hepatitis
30
Q

What are the following vertebrae findings associated w/

  1. Squaring vertebrae
  2. H- shaped vertebrae
  3. Wedge shaped vertebral bodies
  4. slipping of vertebrae over another
  5. defect fracture of pars interticularis
  6. narrowing of spinal canal
A
  1. Ankylosing spondylitis (bamboo)
  2. Sickle cell
  3. vertebral fx
  4. spondylolisthesis
  5. spondylolysis
  6. spinal stenosis
31
Q

Digoxin is ___ inotrope, ___ chronotrope, ___ dromotrope

A

Positive inotrope= increase contraction
Negative chronotrope=decrease HR
Negative dromotrope= slows conduction velocity

32
Q

MC cause of endocarditis and tx

  1. acute bacterial endocarditits (nl valves)
  2. Subacute endocardititis (abnl valve)
  3. . Post op prosthetic valve infective endocarditis
  4. IVDU endocardititis
A

MC Valve: M>A>P>T, except IVDU TV is MC

  1. S. aureus- Tx: Nafcillin (or Vanco if MRSA) + Gentamicin x 4-6wks
  2. Streptococcus viridans- Tx: PCN or Ampicillin + Gent.
  3. Staphylococcus epidermis- TX: Vancomycin + Gent. + Rifampin
  4. MRSA- TX: Vancomycin + Gent.
33
Q

What type of fx?

  1. transverse avulsion fx at base (tuberosity) of 5th metatarsal
  2. disruption bwtn articulation of metatarsals and their respective cuneiforms w/ fx at base of 2nd metatarsal bone
  3. transverse fx through diaphysis of 5th metatarsal
  4. spiral prox. fibular fx w/ distal medial malleolar fx and/or deltoid ligament rupture
A
  1. PseudoJones fx
  2. Lisfranc injury w/ associated Fleck fx
  3. Jones fx
  4. Maisonneuve fx
34
Q

what organisms?

  1. increased UTI in young, sexually active females
  2. MC in overall
  3. indwelling cath
A
  1. Staphylococus saprophyticus
  2. E. coli
  3. Enterococci
35
Q

Describe Weber and Rinne for conductive and sensorineural hearing loss

A

Conductive (MC= cerumen impaction)

  • Weber= lateralizes to affected ear
  • Rinne= BC greater than AC (Neg)

SN (MC= presbyacusis)

  • Weber= lateralizes to NORMAL ear
  • Rinne= AC > BC (NORMAL)
36
Q

Describe

  1. Epidural bleed
  2. Subdural bleed
  3. Subarachnoid bleed
A
  1. Middle meningeal artery, temporal bone fx, lucid interval, convex (lens), does not cross suture lines
  2. cortical bridging veins, blunt trauma in elderly, concave (crescent), can cross suture lines
  3. arterial bleed, MC berry aneurysm rupture or AVM, thunderclap HA, meningeal sx, bleeding in subarachnoid, Xanthochromia in LP
37
Q

DX:

  1. fever cough, anorexia, light red to pink spotted maculopapular rash with photosensitivity and arthritis
  2. cough, runny nose and conjuncitivitis –> brick-red rash starting on face and spreading to trunk
A
  1. Rubella (3 day rash)

2. Rubeola

38
Q

What is :

  1. Caplan syndrome
  2. Sturge Weber Syndrome
A
  1. RA + coal workers pneumoconiosis

2. Port wine stain of face + seizures + mental retardation + cerebral tumors

39
Q

DX and tx

  1. at cold deli meats and unpasteurized dairy products–> bactermia, premature labor, still birth
  2. ate raw shellfish or contaminated water–> grey diarrhea w/ no smell, pus or blood
  3. ate fried rice–> diarrhea, vomiting
  4. ate dairy, meat, eggs, or exotic pets (reptiles ex. turtles)–> cough, sore throat, pea green/brown diarrhea, intractable fever and brady
A
  1. Listeriosis- tx: IV amp (+gent if CNS)
  2. Vibrio cholerae- tx: fluids +/- tetracyclines
  3. Bacillus cereus- tx. supportive
  4. Thyoid (enteric) ofever or salmonella- tx: fluids +/- fluoroquinolones
40
Q

Tx:

  1. Idiopathic Pulmonary HTN
  2. stable, wide-complex tachycardia
  3. stable narrow complex tachycardia w/ regular rhythm (SVT)
  4. rate control w/ stable, Aflutter and Afib w/ RVR
  5. WPW
  6. atrial and ventricular arrhythmias
A
  1. CCB**, phosphodiesterase inhibitors
  2. Amiodarone*, lidocaine, procainamide
  3. Adenosine–>, BB or CCB
  4. Valsalva, CCB or BB
  5. Procainamide
  6. Class Ia antiarrhythmics
41
Q

Tx of

  1. empiric meningitis of unknown organism
  2. medical tx for prolactinomas
A
  1. IV Vanco + IV ceftriaxone

2. dopamin agonists: Bromocriptine, cabergoline

42
Q

SE of loop diuretics and special uses

A
  1. HypoK
  2. HypoCa
  3. HypoMg
  4. Hypochloremic metabolic alkalosis
  5. HypoNa (less than thiazides)
  6. Hyperglycemia
  7. hyperuricemia- caution in gout
  8. Ototoxicity
  9. Sulfa allery

Use for HyperCa

43
Q

Findings associated w/:

  1. Legg-Calves-Perthes
  2. Slipped capital femoral epiphysis
A
  1. widening of cartilage space early or + crescent sign late on XR, painless limp worse at end of day, loss of abduction and internal rotation–> tx: observation
  2. hip, thigh, knee pain w/ limp, external rotation affected, femoral head epiphysis slips posterior and inferior at growth plate–> tx: ORIF
44
Q
  1. cell wall synthesis inhibitors
  2. protein synthesis inhibitors
  3. DNA or RNA synthesis inhibitors
  4. inhibitors of essential metabolites
A
  1. PCNs, cephalosporins, vanco
  2. Macrolides, tetracyclines, cindamycin, AG,
  3. FQ, Metronidazole, daptomycin
  4. Bactrim, Nitrofurantoin
45
Q

What nerve is affected?

  1. tarsal tunnel syndrome
  2. carpal tunnel syndrome
  3. cubital tunnel syndrome
  4. Foot drop
  5. wrist drop
  6. Volkmann ischemic contracture
  7. loss of deltoid sensation
A
  1. posterior tibial nerve compression
  2. median nerve compression
  3. ulnar nerve compression (+ froments sign)
  4. peroneal nerve
  5. radial nerve
  6. median nerve and brachial artery injury (MC in supracondylar humerus fx)
  7. axillary nerve
46
Q

What is Dukes Criteria

A

DX endocarditis: 2 Major or 1 Major and 3 minor or 5 minor

Major:

  1. Bacteremia: 2 + BC
    • Echo
  3. New valvular regurg.

Minor:

  1. Predisposing condition
  2. Fever
  3. Vascular and embolic phenomena
  4. Immunologic phenomena (osler nodes, roth, + RF, AGN)
    • BC
  6. worsening of existing murmur
47
Q

Tx of

  1. MC cause of CAP
  2. mycoplasma PNA
  3. PCP PNA
  4. Aspiration PNA
  5. MC cause of HAP
  6. Inpatient CAP
A
  1. Strep. pneumo- Tx: macrolid or doxy
  2. Macrolides
  3. Bactrim +/- prednisone if hypoxic (dapsone-trimethoprim if sulfa allergy)
  4. Anaerobes- Clinda or Metronidzole or augmentin
  5. Pseudomonas- Tx: Zosyn + Gent. or FQ
  6. cephtriaxone + azithro or FQ
48
Q

What tests do you do to dx the following:

  1. Hereditary spherocytosis
  2. vW deficiency
  3. Pernicious anemia
  4. Paroxysmal nocturnal hemooglobinuria
A
  1. Osmotic fragility test
  2. Ristocetin activity test (Abx that causes platelet aggregation in vitro- hypoactivity and decreased platelet activtiy-vW def.
  3. Schilling test
  4. Flow cytometry testing
49
Q

TX of:

  1. poison ivy
  2. Tinea capitus
  3. pityriasis versicolor
  4. Seborrheic dermititis
  5. Lyphogranuloma venereum
  6. Dyshidrosis (lateral tense, tapioca vesicles)
  7. psoriasis
  8. Vitiligo
  9. Impetigo
  10. onychomycosis
  11. pemphigus vulagaris
  12. bullous pemphigoid
  13. pyoderma gangrenosum
A
  1. Diphenhydramine + topical steroid
  2. oral griseofulvin
  3. topical antifungals: Selenium sulfide, sodium sulfacetamide, zinc pyrithione
  4. topical antifungals: Selenium sulfide, sodium sulfacetamide, zinc pyrithione
  5. azithro or doxy (genital/rectal lesions 2/2 Chlamydia)
  6. topical steroids
  7. topical steroids–> phototherapy, UVB–> methotrexate
  8. topical steroids, calcineurin inhibitors
  9. Mupirocin topically
  10. itraconazole and terbinafine
  11. HD steroids–> methotrexate
  12. systemic steroids
  13. topical steroids HD
50
Q

SE of metronidazole

A
  1. Avoid ETOH during and 48 hr after
  2. disulfiram rxn
  3. neurotoxicity
  4. metalic taste
51
Q

Tx of:

  1. Uncomplicated cystitis
  2. Complicated cystitis (males, DM, anatomic abnormality)
  3. Pregnant cysitits
  4. Pyelonephritis
  5. acute prostatitis <35y/o
  6. acute prostatitis >35yo
  7. chronic prostatitis
A
  1. Nitrofurantoinx 5-7d, FQ x3d, Bactrim x3d
  2. FQ PO or IV, Aminoglycosides x7-14d
  3. Amoxicillin or Nitrofurantoin
  4. FQ PO or IV, or Aminoglyocsided x14d
  5. Ceftriaxone + doxy (or azithro)
  6. FQ or Bactrim 4-6 wks
  7. FQ or Bactrim 6-12 wks–> TURP if refractory
52
Q

Triad of endometriosis

A
  1. cyclic premenstrual pelvic pain
  2. Dysmenorrhea
  3. Dyschezia
53
Q

Golfers elbow vs Tennis elbow

A

Golfer: Medial epicondylitis

  • Pronator teres-flexor carpi radialis
  • Pain w/ wrist FLEXION against resistance and pulling

Tennis: Lateral epicondylitis

  • ECRB
  • Pain w/ wrist EXTENSION against resistance, and gripping
54
Q

When are the following indicated:

  1. Chest tube thoracostomy
  2. Insertion of needle followed by chest tube
  3. observation and O2
A
  1. pneumothorax >25-30 percent
  2. tension pneumo
  3. small pneumothorax less than 20 percent
55
Q

What type of FU?

  1. ASC-H
  2. LSIL or CIN I
  3. HSIL (CIN II, CIN III, carcinoma in situ)
A
  1. Colposcopy
  2. if 25-29: Colposcopy w/ biopsy
    if 30+: HPV Neg–> repeat cytology in yr, HPV+–> colposcopy w/ biopsy
  3. colposcopy w/ biopsy
56
Q

What is Centor Criteria

A 
"LEAF"
L-LAD (cervical)
E-Exudates on pharynx or tonils
A-Absence of Cough
F- Fever greater than 38C/100.4F

0-1: no abx or culture needed
2-3: throat culture
4-5: give Abx

57
Q

SE of FQ

A
  1. Tendon rupture ( damage to articular cartilage)- do not give if <18 or pregnant)
  2. exacerbates Myasthenia gravis
  3. prolong QT
  4. photosensitivity
58
Q

SE of PCN and cephalosporins

A
  1. hyersensitivity rxns (anapylaxis)
  2. nephrotoxicity (interstitla nephritis)
  3. Disulfriam w/ ceph. 2nd/3rd gen.

Augmentin has highest occurence of diarrhea

59
Q

What disease are associated with erythema nodosum

A
  1. Sarcoidosis,
  2. Coccidioidines
  3. OCP, pregnancy
  4. IBD
60
Q
  1. MAOI + tyramine-containing food–>
  2. MAOI + SSRI –>
  3. MAOI + TCA –>
A
  1. hypertensive crisis
  2. serotonin syndrome
  3. delirium and HTN

ex. Phenelzine (Nardil), Selegiline

61
Q

What do the EKG changes mean?

  1. T wave inversion or flattening, short QT, scooped downward sloping ST segments, junction rhythms
  2. electric alternans w/ low voltage
  3. Prolong PR and QT, Ron T phenomenon, torsades, wide QRS
  4. T wave flattening, prominent U wave
  5. tall peaked T waves, QR short, wide QRS, P wave flattening
  6. Osborn waves (J waves)
A
  1. Digitails effect
  2. Pericarditis
  3. hypoMg
  4. HypoK
  5. HyperK
  6. severe hypothermia
62
Q

SE of thiazide diuretics and special uses

A
  1. HypoNa (more than loops)
  2. HypoK
  3. HyperCa*
  4. Hyperglycemia
  5. Hyperuricemia- caution in gout
  6. sulfa allergy

Use: nephrogenic DI

63
Q

Tx of:

  1. Macular degeneration
  2. orbital floor blowout fracture
A
  1. Vit. A, C, E, and zinc slow progression–> Bevacizumab–> laser photcoagulation
  2. nasal decongestants, avoid blowing nowse, corticosteroids, Abx
64
Q

What type of FU?

ASC-US in someone 25 or older or less than 21

A
  1. 25+:
    HPV neg= repeat PAP and HPV in 3 yrs
    HPV pos= colposcopy w/ biopsy or
    Repeat PAP in 1 yr

if less than 21= repeat pap 1 yr

65
Q

Tx of following septic arthritis:

  1. Gram + Cocci
  2. Gram - Cocci
  3. Gram - Rods
  4. No organism
A

*Arthrotomy w/ joint drainage + Abx 2-4 weeks:

  1. Nafcillin (vanco if MRSA)
  2. Ceftriaxone
  3. Ceftriaxone + Gent.
  4. Nafcillin (or vanco) + Ceftriaxone

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