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3rd Year (Step 2) > ID 2 > Flashcards

ID 2 Flashcards

1
Q

Best initial Tx for Staph & Strep (gram-pos cocci)?

A
  • Oxacillin, Cloxaxillin, Dicloxacillin, Nafcillin
  • 1st-gen cephalosporins: Cefazolin, Cephalexin
  • Fluoroquinolones
  • Macrolides (3rd line b/c less efficacious)
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2
Q

MRSA – Tx?

A

Vancomycin

  • Linezolid
  • Daptomycin (elevated CPK)
  • Tigecycline
  • Ceftaroline
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3
Q

Minor MRSA infections of the skin – Tx?

A
  • TMP/SMX
  • Clindamycin
  • Doxycycline
  • Linezolid
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4
Q

Anaerobes above the diaphragm (oral) – Tx?

A
  • Penicillin (G, VK, Ampicillin, Amoxicillin)

- Clindamycin

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5
Q

Abdominal/GI Anaerobes – Tx?

A
  • Metronidazole

- Β-lactam/Beta-lactamase combo

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6
Q

What types of organisms tend to infect the bowel (diverticulitis, peritonitis)?

A

Gram-negative Bacilli (rods)

- E. coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Citrobacter

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7
Q

What types of organisms tend to infect the urinary tract (pyelonephritis)?

A

Gram-negative Bacilli (rods)

- E. coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Citrobacter

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8
Q

Most common causes of meningitis?

A
  • Strep pneumonia (60%)
  • Neisseria meningitidis (15%)
  • Group B streptococci (14%)
  • H. influenza (7%)
  • Listeria (2%)
  • Sstaph in those w/ recent neurosurgery
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9
Q

Name the agents that cover gram-negative bacilli?

A
  • Quinolones
  • Aminoglycosides
  • Carbapenems
  • Piperacillin, Ticarcillin
  • Aztreonam
  • Cephalosporins
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10
Q

What types of organisms tend to infect the liver (cholecystitis, cholangitis)?

A

Gram-negative Bacilli (rods)- E. coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Citrobacter

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11
Q

Meningitis in patients w/ recent neurosurgery – organism?

A

Staphylococcus

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12
Q

Meningitis “classic” presentation?

A

Fever, headache, neck stiffness (nuchal rigidity), photophobia

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13
Q

Meningitis – most likely organism?Camper/hiker, rash moves from arms/legs to trunk

A

Rocky Mountain Spotted Fever (Rickettsiae)(tick remembered in 60%)

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14
Q

Meningitis – most likely organism?Adolescent, petechial rash

A

Neisseria

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15
Q

When is head CT necessary prior to LP in a possible meningitis patient?

A

Only when possibility of space-occupying lesion, if 1 of following is present:- Papilledema- Seizures- Focal neurological abnormalities- Confusion interfering w/ neuro exam

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16
Q

What test to use in meningitis to Dx organism if the patient has already received ABX?

A

Bacterial Antigen Detection (Latex Agglutination)– Very specific if positive

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17
Q

Which meningitis has highest CSF protein level?

A

TB(Dx = acid-fast stain & culture on 3 CSF samples b/c of low sensitivity)

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18
Q

Dx tests for Lyme/Rickettsiae meningitis?

A

ELISA, Western Blot, PCR

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19
Q

Dx tests for Cryptococcus?

A
  • India ink (60-70% sensitive)- Cryptococcal antigen is > 95% sensitive & specific
20
Q

Meningitis in AIDS pt w/ CD4 < 100 cells/microL – organism?

A

Cryptococcus

21
Q

What add’l management must happen for Neisseria meningitidis meningitis?

A

Respiratory isolation- Rifampin, ciprofloxacin, or ceftriaxone to the close contacts to decrease nasopharyngeal carriage

22
Q

Most common neurological deficit of untreated bacterial meningitis?

A

8th cranial nerve deficit or deafness

23
Q

Most common cause of encephalitis?

A

Herpes simplex

24
Q

Encephalitis “classic” presentation?

A

Acute onset of fever & confusion

25
Herpes encephalitis -- best initial therapy? If this doesn't work?
Acyclovir, IV(fam/valacyclovir not available IV)- Foscarnet is best for Acyclovir-resistant herpes
26
Otitis Media -- presentation?
Redness, immobility, bulging, & dec'd light reflex of tympanic membrane- Pain is common- Dec'd hearing & fever also occur
27
When would biopsy be needed for sinusitis?
- Infection frequently occurs | - No response to different empiric therapies
28
Pharyngitis -- presentation?
- Pain on swallowing - Enlarged lymph node in neck - Exudate in pharynx - Fever- No cough & No hoarseness * if these are present, likelihood of streptococcal pharyngitis is > 90%
29
Pharyngitis -- Tx?
Penicillin or Amoxicillin = best Tx - PCN allergy = give Cephalexin if just Rash - PCN allergy = give Clindamycin or Macrolide if Anaphylaxis
30
Dx?Pharyngitis w/ small vesicle or ulcers
HSV or herpangina
31
Dx?Pharyngitis w/ membranous exudates
Diptheria, Vincent angina, or EBV
32
Flu -- Tx?
< 48 hrs Sx = Oseltamivir, Zanamivir | > 48 hrs Sx = Symptomatic Tx only
33
Name the Obligate Anaerobes
Clostridium, Bacteroides, Actinomyces - Lack catalase &/or superoxide dismutase, making them susceptible to oxidative damage. - Aminoglycosides don't work b/c need O2 to enter bacterial cell. "Can't Breathe Air"
34
Macrolides (Azithromycin, Clarithromycin) -- uses?
- Atypical pneumonias (Mycoplasma, Legionella, Chlamydia) - STDs (Chlamydia) - Gram positive cocci if allergic to Penicillin (Strep)
35
Clindamycin -- uses?
- Anaerobic infections in aspiration pneumonia or lung abscesses (Bacteroides, Clostridium) - Anaerobic oral infections (Actinomyces)
36
Bactrim (TMP/SMX) -- uses?
Gram positive, gram negative - UTIs/Cystitis - Shigella, Salmonella - PCP (Tx & proph) - MRSA of skin & soft tissue - Nocardia - Chlamydia
37
Fluoroquinolones -- uses?
- Gram-negative rods of urinary & GI tracts (including pseudomonas), & some gram positive organisms. - Neisseria - CAP (esp if penicillin resistant)
38
When do you add Ampicillin onto normal meningitis Tx?
- > 50 yrs. old- EtOH abuse- Immunocompromised host- Pregnancy
39
Name 5 Aminoglycosides
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
40
Name 4 Tetracyclines
Tetracycline, Doxycycline, Demeclocycline, Minocycline
41
Tetracycline that is fecally eliminated & can be used in renal failure?
Doxycycline
42
Tetracyclines -- use?
- Tick-borne illnesses (Borrelia/Rickettsiae/Ehrlichia) - M. pneumoniae- Ability to accumulate intracellularly makes it effective against Rickettsiae & Chlamydia - Primary & secondary syphilis in those allergic to PCN - Demeclocycline -- SIADH (acts as ADH-antag)
43
When is Aztreonam indicated for use?
For penicillin-allergic patients & those w/ renal insufficiency who cannot tolerate Aminoglycosides. Covers gram negatives, not gram positives or anaerobes.
44
What drug is indicated both for penicillin-allergic patients & those w/ renal insufficiency who cannot tolerate Aminoglycosides?
Aztreonam
45
Aztreonam -- AEs?
Usually nontoxic -- GI upset occasionally
46
Vancomycin -- uses?
Gram positives only. | Serious, amultidrug-resistant organisms such as MRSA, Enterococci, & Clostridium dificile
47
Aminoglycosides -- uses?
Serious gram-negative rod infections. Synergistic with β-lactam antibiotics. Neomycin for bowel surgery.

3rd Year (Step 2) (44 decks)

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