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1
Q

2 places to ignore candida

A

Sputum and urine

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2
Q

Treatment of Malaria

A

IV artesunate or IV quinidine

Exchange transfusion in severe cases

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3
Q

Contact + airbone precautions

A

VZV, ebola, smallpox, covid, MERS-COV

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4
Q

Dx of Blastomyces dermaitidis

A

Culture or antigen detection

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5
Q

Sx: Anaplasmosis
Intracellular:

A

Febrile illness
Granulocytes

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6
Q
A

Filamentous, branching Gram-positive rods
Note the long filaments as well as the beaded, “cocco-bacilli” appearance

  • Modified acid-fast stain-positive
  • On regular AFB stain, Nocardia is at best weakly positive
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7
Q

Meningititis with petechiae and palpable purpura

A

N meningititis

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8
Q
A

Coccidiodomycosis
Spherules with multiple endospores

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9
Q

____ isolation indicated for patients with suspected N meningitides

A

respiratory

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10
Q
A

Histoplasmosis
Small pink dots!
Small yeasts with narrow based budding grouped in clusters inside macrophages

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11
Q

Dx of Histoplasma

A

Culture or antigen detection

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12
Q

Empiric antibiotics for post neurosurgical brain abscesses:

A

Cefepime + metronidazole (or CNS penetrating carbapenem)
+ vancomycin

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13
Q

Risk factors for mucor (in addition to risk factors for aspergillus and candida)

A

Iron overload
Diabetes mellitus
Deferoxamine

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14
Q

3 diseases caused by Yernia pestis

A

Bubonic, septicemic or pneumonic plague

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15
Q
A

Coccidiodes in soil
Filamentous mycelia
Thin septate hyphae

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16
Q

Gas gangrene/ clostridial myonecrosis
Etiology

A

Necrotizing infection of muscles with gas formation

Traumatic from penetrating trauma/surgery or spontaneous (hematogenous spread) from GI tract

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17
Q

Tx of Histoplasma

A

Mild: none or itraconazole

Severe: ampho B then itraconazole

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18
Q

CSF WBC in encephalitis

A

Typically 5-1000 cells/uL

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19
Q

Endemic fungi + pneuomonia, fibrosing mediastinitis

A

Histoplasma

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20
Q

Posaconazole covers

A

Second line agent for most things

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21
Q

Spectrum of Cryptococcus in lung
Where does it spread?

A

Focal pneumonitis to ARDS
Brain to lead to meningitis

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22
Q

Round encapsulated yeast on India ink

A

Cryptococcosis

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23
Q

Nocardia

A

Starts in lungs then disseminates to other organs, most common is brain

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24
Q

Itraconazole AE

A

Heart failure, QTc prolongation, liver toxicity, pseudohyperaldosteronism, adrenal insufficiency

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25
Q

which endemic fungi has infectious cultures?

A

Coccidiodes
Alert lab!

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26
Q

Treatment of Invasive Aspergillus

A
  1. Voriconazole
    Alt:
    Posavuconazole if neuro tox or skin issues
    Isavuconazole if prolonged QT

Second line agents: echinocandins (caspo, micafungin) or amphotericin B

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27
Q
A

Aspergillus

Dicotimous branching (equally split)

Septated hyphae that branch at 45 degrees, and is visualized best with periodic acid-Schiff (PAS) or Gomori methenamine silver (GMS) staining

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28
Q

Intra-abdominal abscess treatment duration after drainage if uncomplicated

A

5 days

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29
Q
A

Pneumocystis pneumonia
Non-budding cyst
Oval, crescentric, collapsed or helmet shaped
(crushed ping-pong balls)

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30
Q

Giardiasis tx

A

Metronidazole

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31
Q

Endemic Fungi + broad-based budding yeast

A

Blastomyces dermaitidis

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32
Q

Tx of CMV esophagitis

A

Ganciclovir
(large, solitary, shallow ulcers)

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33
Q

Two things that are treated by Echninocandins

A
  1. Candida!
  2. Adjuvent therapy for aspergillus
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34
Q

Deep neck infection

A

Unasyn

If immunocompromised: cefepime + flagyl

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35
Q

Work-up for patient’s with Nocardia

A

Brain imaging due to frequency of CNS involvement

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36
Q

Which endemic fungi can act like sarcoid

A

HIstoplasma

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37
Q

COVID tx
1. no oxygen
2. oxygen
3. NIV/HFNC

A
  1. Remdesivir if high risk of progression
  2. Dexamethasone + Remdes
  3. Dexamethasone + toci or baricitinib + Remdez if immunoc

No Remdez if eGFR<30

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38
Q

Listeria meningitis is associated with increase rate of ___

A

Seizure, FND, papilledema

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39
Q

Endemic Fungi
Pneumonia + skin lesions + arthralgias + bone involvement + meningitis

A

Coccidiodes

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40
Q

Sx of Lyme disease

A

First stage: fever, erythema migrans (rash)
Second stage: multiple skin lesions, conjunctivitis, arthralgias, myalgias, headache, CN palsies
Third stage: arthritis, encephalopathy, peripheral neuropathy

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41
Q

Tx of coccidiodes

A

Mild: none
Mod: fluconazole
Severe: ampho-B-> fluconazole

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42
Q
A

Mucormycosis
Broad, ribbon-like with non-parallel cell walls
Hyphae may brand at obtuse angle

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43
Q

Tx Yersinia pestis

A

3 options for first line tx
1. Doxycycline
2. Aminoglycoside (streptomycin or gentamicin)
3. Fluoroquinolone (levofloxacin, cipro or moxi)

Monotherapy is fine unless bioterriosim, then use 2 or ask CDC

If pneumonia or plague, don’t use doxycycline (option 2 or 3 instead)

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44
Q

AE of echinocandins

A

Overall fine
Some drug interactions, LFTs, anaphylaxis, hypoK

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45
Q

What can form sulfur granules as it invades through tissue planes, causing cutaneous fistulas throughout the thoracic cage?

A

Actinomyces

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46
Q

Treatment of invasive candida

A

Echninocandins (caspo, mica or anidulafungin)

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47
Q

Droplet precautions
1. precaution
2. which bugs

A
  1. Private room preferred, surgical mask within 1 meter of patient, mask during patient transport

Vaxxed: Diphtheria, mumps, rubella, B pertussis
Influenza
H flu, N meningitidis, RSV

No vax: M pneumoniae, pneumonic plague, adenovirus, parvovirus B12, rhinovirus

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48
Q

2 abx with AE of cytopenias

A

Linezolid (thrombocytopenia)
TMP/SMX

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49
Q

Tx Lyme disease
3 options + one option if can’t take doxy or beta-lactams

A

Doxycycline, amoxicillin, or cefuroxime

Azithromycin is 2nd line for patients

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50
Q

Voriconazole
AE 4

A

QTc prolongation
Active hepatitis or severe liver dz
Skin/bone

Visual disturbances
Neurotoxicity

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51
Q

Tx of mucor

A

Surgical debridement is the mainstay of treatment along with adjuvant antifungal therapy.

Liposomal amphotericin-B is preferred; posaconazole and isavuconazole are second-line or step-down

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52
Q
A

Blastomycosis
Broad-based budding yeast

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53
Q

Risk factors for invasive candida

A
  1. Transplant recipients
  2. Cancer, especially chemotherapies with GI toxicity or hematologic malignancies
  3. ICU patients c CVC, TPN, ARF on HD, abdominal surgery (esp unfixed GI disruptions), colonization in multiple sites, MOF
54
Q

Rhombencephalitis (encephalitis of brain stem +/− cerebellum) can be seen in:

A
  1. Immunocompetent individuals who acquire Listeria through contaminated food
  2. HSV
  3. WNV
55
Q

Penicillin allergy
1. ___ of reported PCN allergies do not have true allergy
2. ___ of patients with true PCN allergies that will also react to cephalosporin or carbapenem
3. No cross reactivity with PCN and ____

A
  1. 90%
  2. <5%
  3. Aztreonam
56
Q

Soft tissue infection of head/neck

A

Tx with prolonged course of vancomycin + ceftriaxone
Add anaerobic coverage if dental source suspected

57
Q

MRI for WNV

A

Leptomeningeal enhancement

58
Q

CSF in TB

A

Low glucose
Elevated protein
Lymphocytic pleocytosis

59
Q

Which anti-fungal drugs bind ergosterol in the fungal cell membrane, inducing leakage of ions?

A

(polyenes): Amphotericin-B and nystatin

60
Q

Endemic Fungi
Pneumonia + skin lesions + osteomyelitis

A

Blastomyces dermaitidis

61
Q

Dx of candida on gram stain

A

Budding yeasts or pseudohyphae

62
Q
A

Mucormycosis
Broad, non-septate hyphae
Irregular branching with greater angle (usually close to 90 degress)

63
Q

Tx of invasive candida (1 med + 2 therapies)

A

Echinocandins (caspofungin) at first bc some forms of candida are resistant to fluconazole and voriconazole. You can switch to fluc if susceptible

Remove lines

Eye exam

64
Q

Isavuconazole uses

A

Can be first line for invasive aspergillosis

Combination med or step down for mucormycosis

Short QTc

65
Q

HAP tx
1. Low risk mortality, no MRSA risk
2. Low risk + MRSA
3. High mortality + recent IV abx (90D)

A
  1. cefepime, zosyn, imipenem, meropenem
  2. add vanc/linezolid
  3. Double anti-pseudomonal coverage (avoid using dual B-lactam)
    - add aztreonam, amikacin, gentamicin or tobra
66
Q

Sx Rocky mountain spotted F

A

Rash + febrile illness
Blanching, erythematous macules
Petechial, beings on hands/soles of feet

67
Q

Treatment of strongyloidiasis

A

Albendazole or ivermectin

68
Q

Sx Ehrlichiosis
Intracellular:

A

Febrile illness
Granulocytes

69
Q

Treatment of non-severe C diff and severe (WBC>15k, creatinine >1.5)

A

Fidaxomicin 200 mg 2 times daily
OR
oral vancomycin 125 mg 4 times daily

70
Q
A

Aspergillosis
Thin, septated hyphae with regular branching
Angle of branching is around 45 degrees

71
Q

Airborne precautions
1. type
2. bugs

A
  1. Negative pressure room, N95, minimize transport/mask patient
  2. TB and measles
72
Q

Chest CT: single or multiple nodules with or without cavitation. The “halo sign”- ground glass surrounding a nodule- is a classic finding

A

Invasive aspergillosis

73
Q

Contact precautions
1. Which precautions
2. Which bugs

A
  1. Gloves/gown, dedicated medical equipment. Private room or cohort

MDR (MRSA, VRE, ESBL)
C diff
E coli O157:H7
Enteric viral infections (norovirus)
Scabies

74
Q

Treatment of nec fas

A

MRSA treatment
AND carbapenem or β-lactam/β-lactamase inhibitor
AND clindamycin (if there is resistance to clindamycin, linezolid can be used)

75
Q

Which of the 5 tick-borne infections is not treated with doxycycline?

A

Babesiosis (atov + azith or quine + clinda)
4 doxy mono: ana, ehril, rmsf, lyme

76
Q

4 risk factors for aspergillus

A
  1. severe/prolonged neutropenia
  2. high-dose steroids
  3. transplant patients on immunos
  4. AIDS
77
Q

Non-septated hyphae that branch at 90°

A

Rhizopus and Mucor

78
Q

3 general classes of anti-fungal drugs

A
  1. Polyenes (ampho-B and nystatin)
  2. Azoles (vori, posa, itra, isa)
  3. Echinocandins (caspof, micaf)
79
Q

Tx Leptospira

A

Doxycycoline, penicillin or ceftriaxone

80
Q

Empiric antibiotics for community-acquired brain abscesses:

A

Cefotaxime
Ceftriaxone + metronidazole

81
Q

Tx Nocardia

82
Q

Treatment of severe pulmonary disease and Cryptococcosis meningitis

A

Induction with amphotericin B and flucytosine
Consolidation/maintenance with fluconazole

Alt: fluconazole can replace either induction med

May require serial LPs to maintain normal ICP

83
Q

Abx with AE of seizures

84
Q

Tx Babesiosis

A

Atovaquone + azithromycin
OR
Quinine + clindamycin

85
Q

Rose spots on trunk/abdomen, high fever without tachycardia, GI bleed (+ risk of perforation), aortitis

A

Typhoid fever secondary to Salmonella enterica

86
Q

Tx Anaplasmosis

A

Doxycycline

87
Q
A

Encapsulated yeast on India ink staining
Cryptococcosis

88
Q

Tx of Actinomyces

A

High dose penicillin

89
Q

Dx of Cryptococcosis

A
  • detection of organisms with India ink staining
  • cryptococcal antigen (blood or CSF), titer correlates with dz burden
  • culture from csf/blood or sputum
90
Q

Diagnosis of Coccidiodes immitis

A

Serology (IgM IgG) followed by complement fixation (titer)

91
Q

Posaconazole is similiar to voriconazole but ___

A

Better tolerated but alternative agent for everything except prophylaxis in cancer

Watch for drug-interactions (increases tacro/siro, ventetoclax, amio, CCB)

92
Q

Voriconazole is 1st line therapy and can also cover:

Doesn’t cover:

A

Invasive aspergillosis

  • candida as step-down
  • endemic fungi

Zygomycetes (mucorales)

93
Q

Fulminant C diff (shock, ileus or toxic megacolon)

A

Oral vancomycin 500 mg 4 times daily AND metronidazole 500 mg IV Q8 hr

If ileus, consider adding rectal vancomycin.

94
Q

3 times to use ampho-B
2 times it can be alt agent

A
  1. Mucormycosis
  2. Cryptococcocus (+flucytosine)
  3. Severe blasto or histo

Alt agent for:
1. Invasive asperilliosis
2. Candidemia without CNS involvement

95
Q

Isavuconazole is _____ than voriconazole (2) and causes fewer ____ than voriconazole

A

Broader spectrum of activity

More favorable safety profile

Fewer drug-drug interactions

But not yet studied v much

96
Q

Treatment of disseminated Mycobacterium avium complex (MAC)

A

Macrolide plus ethambutol

Options for macrolide: clarithromycin or azithromycin

Consider adding: Rifabutin if severe

97
Q

Infection from unpasteurized dairy

98
Q

Conditions that increase risk of cryptococcus infection

A
  1. Immunocompromised
  2. Chronic disease (cirrhosis, renal failure, chronic lung dz, diabetes, sarcoid, cushing)
  3. Malignancy
99
Q

Nocardia and Actinomyces are both filamentous, branching, gram positive rods, however unlikely Nocardia, Actinomyces are ____ and modified acid-fast ____

A

anaerobes
acid-fast negative

100
Q

Measures to reduce the risk of VAP

A

Early mobility
Head of bed to 30-45°
Daily sedation interruption and assessment for extubation
Use subglottic suction drainage if intubated >72 hr

Change the ventilator circuit if malfunctioning or visibly soiled only

101
Q
A

Candida
Budding yeast and pseudohyphae

102
Q

Prophylaxis for close contacts of N meningitides

A

Ciprofloxacin, rifampin, or ceftriaxone

103
Q

Treatment of mild to moderate pulmonary disease from Cryptococcosis

A

Fluconazole

104
Q

Febrile illness with ulcer at site of contaminantion and +LAD

A

Tuleremia
Animal workers

105
Q

Tx Tuleremia

A

Doxycycline
Aminoglycoside (streptomycin)

106
Q

CAP treatment if allergic to PCN

A

Respiratory fluoroquinolone + aztreonam

(Levofloxacin or moxifloxacin)

107
Q

Sx of Babesiosis

A

Febrile illness

If severe/immunoc: ARDS, DIC, CHD, ARF, liver injury, splenic rupture

108
Q

Tx RMSF

A

Doxycycline

109
Q

Filamentous, branching Gram-positive rods

110
Q

Pyomyositis

A

Necrotizing infection of muscles with purulence and abscess formation

111
Q

When do you need a anti-pseudomonal cephalosporin or CNS penetrating carbapenem in bacterial meningitis? 3 answers

A
  1. Head trauma (basilar skull fracture or penetrating trauma)
  2. Post-neurosurgery
  3. CSF shunt
112
Q

Itraconazole Indications

A

Blasto + histo: mild to mod, or step down after ampho if severe

113
Q

CAP treatment if prior pseudomonas or high risk for pseudmonas

A

Anti-pseudomonal B-lactam + cipro or levofloxacin

Options: zosyn, cefepime, meropenem, imipenem

114
Q

Tx of salmonella enterica or typhoid fever

A

Flouroquinolone (levofloxacin or ciprofloxacin)

Ceftriaxone if you need IV

115
Q

MRI for HSV encephalitis

A

Bitemporal enhancement
hemorrhage occurs late

116
Q

Gas gangrene/ clostridial myonecrosis
Treatment

A

Empiric antibiotics same as nec fas

Once clostridia are isolated via tissue or blood culture, treatment is with penicillin PLUS clindamycin OR tetracycline

117
Q

Empiric HAP or VAP: things to cover

A

S auerus + GNR including pseudomonas

118
Q

Tx of Blastomyces dermaitidis

A

Mild: itraconazole

Severe: ampho B-> itraconazole

CNS: ampho B-> voriconazole

119
Q

Tx encephalitis
1. HSV
2. VZV
3. CMV

A
  1. acyclovir
  2. acyclovir or ganciclovir
  3. ganciclovir or foscarnet
120
Q

Tx Ehrlichiosis

A

Doxycycline

121
Q

4 Amionoglycosides

A

Amikacin
Streptomycin
Tobramycin
Gentamicin

122
Q

3 times you can use streptomycin (aminoglycosides)

A

Tuleremia
Yersinia
Brucella (+doxy)

123
Q

Aminoglycosides (amikacin, tobra, gent) can be added to _____ for VAP with high mortality rate

A

Anti-pseudomonal beta-lactam

124
Q

3 Macrolides

A

Erythromycin (OG)
Azithromycin
Clarithromycin

125
Q

Azithromycin
- Lung things:
- Other

A
  1. MAC, CAP, legionella, H flu
  2. Lyme
126
Q

Clindamycin
- most important use:
- parasite use:
- bioterrioism use
- alternative tx for 2 things

A
  • anti-toxic for GAS, NF, clostrium
  • babesiosis c quinine
  • anthrax c cipro
  • PJP, PNA c cipro
127
Q

3 fluroquinolones

A

Ciprofloxacin
Levofloxacin
Moxifloxacin

128
Q
A

Aspergillosis
Acute-angle branching hyphae with septae

129
Q

Ciprofloxacin
2 uses with clindamycin:
2 forms of prophyalxis

A

PJP and anthrax
SBP and N meningitis

130
Q

Voriconazole’s complex pharmacokinetic properties and its extensive list of drug-drug interactions make therapeutic drug monitoring essential to ensure optimal treatment while mitigating toxicities.

A

A voriconazole plasma level concentration of 2.0 to 5.5 μg/mL is commonly recommended for invasive aspergillosis infection.

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