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1
Q

Penicillin coverage

A 
Strep viridans 
Strep pyrogenes 
Oral anaerobes 
Syphilis 
Leptospira
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2
Q

Amoxicillin/Amipcillin coverage

A

Penicillin coverage +

H. influenzae 
E. coli 
Listeria 
Proteus 
Salmonella
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3
Q

Uses for Amoxicillin/Ampicillin

A 
Otitis media 
Dental infection and endocarditis prophylaxis 
Lyme 
UTI in preggos 
Listeria infection 
Enterococcal infection
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4
Q

Penicillinase-resistant penicillins: oxacillin, cloxacillin, nafcillin coverage

A

Treat MSSA

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5
Q

Oxacillin, cloxacillin, nafcillin

A

Skin infections: cellulitis, impetigo, erysipelas

Endocarditis, meningitis, and bacteremia

Osteomyelitis and septic arthritis

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6
Q

Piperacillin, ticarcillin, azlocillin, mezlocillin coverage

A

Psuedomonal coverage!
enterobarteria group coverage, as well.

Require beta lactamase inhibitor

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7
Q

Piperacillin, ticarcillin, azlocillin, mezlocillin useage

A 
Cholecystitis and ascending cholangitis 
Pyelonephritis 
Bacteremia 
HAP and VAP 
Neutropenic fever
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8
Q

Methacillin toxicity

A

Methacillin should be replaced with oxacillin

Causes renal failure from allergic interstitial nephritis

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9
Q

First generation: Cefazolin, Cephalexin, Cephradrine, Cefadroxyl coverage

A 
Gram positive cocci and:
Proteus 
E. 
coli 
Klebsiella pneumonia
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10
Q

Second generation: Cefotetan, cefoxitin, cefaclor, cefprozil, cefuroxime, loracarbef coverage

A 
Gram positive cocci and:
Haemophilus influenza
Enterobacter 
Neisseria gonnorhea 
Proteus 
E. 
coli 
Klebsiella pneumonia 
Serratia
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11
Q

First generation cephalosporin uses

A

osteomyelitis
septic arthritis
endocarditis
cellulitis

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12
Q

Second generation cephalosporin uses

A

Cefotetan or cefoxitin: PID

All others: bronchitis, otitis media, sinusitis

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13
Q

Third generation: Ceftriaxone, Cefotaime, Ceftazidime

A

Serious gram negative coverage

First line for pneumococcus

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14
Q

Third generation uses:

A

Meningitis
CAP
Gonorrhea
Lyme in brain or heart

No ceftriaxone in neonates- impairs biliary metabolism

Cefotaxime: Neonates and SBP

Ceftazidime: psuedomonal coverage

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15
Q

Fourth generation: Cefepime

A

Better staph coverage than 3rd gen

Neutropenic fever
VAP

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16
Q

Ceftaroline

A

Only cephalosporin with MRSA coverage

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17
Q

AE of cephalosporin

A

Cefoxitin and cefotetan deplete prothrombin and increase risk of bleeding

Ceftriaxone- inadequate biliary metabolism

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18
Q

Aztreonam

A

No cross reaction with penicillin

Exclusively for gram -ve bacilli including Pseudomonas

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19
Q

Fluoroquinolones: cipro, levofloxacin, gemifloxacin

A

BEST therapy for CAP
Gram -ve coverage, including psuedomonals

Cipro: cystitis and pyelo

Diverticulitis and GI infections: good but need metronidazole for anaerobes, or moxifloxacin covers anaerobes

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20
Q

Aminoglycosides: gentamicin, tobramycin, amikacin

A

Gram -ve bacilli
Synergistic with beta-lactam for enterococci and staph

NO effect on anaerobes (need oxygen to work)
Nephrotoxic and ototoxic

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21
Q

Doxycycline

A 
Chlamydia 
Lyme diseae
Rickettsia 
MRSA- soft tissue infections 
Primary or secondary syphylis in allergic patient 
Borreila, Ehrlichia, mycoplasma
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22
Q

Doxycycline AE

A

Tooth discoloration in kiddos
Fanconi’s syndrome- RTA II
photosensitivity
esophagitis/ulcers

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23
Q

Trimethoprim/Sulfamethoxazole

A

Cystitis
Pneumocystis pneumonia tx and prophylaxis
MRSA-skin

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24
Q

Bactrim toxicity

A

hemolysis in G6PD

Bone marrow suppression- folate antagonist

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25
Q

Gram positive cocci: best initial therapy

A

oxcallin and friends

first gen cephalosporins: cefazolin, cephalexin

Flouroquinolones

Third line: macrocodes

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26
Q

MRSA serious infection: best initial agent

A 
Vancomycin 
Linezolid- causes reversible bone marrow toxicity 
Daptomycin- causes elevated CPK 
Tigecycline
Ceftaroline
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27
Q

MRSA minor infections: best initial agent

A

Bactrim
Clindamycin
Doxycycline
Linezolid

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28
Q

Anaerobes best initial thearpy

A

Oral/above diaphragm:

  • penicillin
  • clindamycin

Abdominal/GI:
Metronidazole
Zosyn

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29
Q

Gram -ve bacilli best initial therapy

A 
Quinolones 
Aminoglycosides 
Carbapenem
Zosyn
Aztreonam
Cephalosporins
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30
Q

Most common causes of meningitis

A
  1. S. pneumo
  2. N. meningitidis
  3. GBS
  4. H. influenzae
  5. Listeria
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31
Q

Meningitis with AIDS <100 CD4

A

cryptococcus

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32
Q

Meningitis with camping, erythema migraines, joint pain, facial palsy

A

Lyme

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33
Q

Meninigits with camping

Rash moves from arms and legs to trunk

A

Rocky mountain spotted fever

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34
Q

Meningitis with plum TB

A

TB

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35
Q

Meningitis with petechial rash

A

N. menigntiidis

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36
Q

Bacterial meningitis CSF

A

1000s PMN
elevated protein
decreased glucose

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37
Q

Cryptococcus/lyme/rikettsia csf

A

10s-100s lymphs
possibly elevated protein
possibly decreased glucose
negative stain and culture

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38
Q

TB csf

A

10s-100s lymph
markedly elevated protein
possibly low glucose
negative stain and culture

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39
Q

Viral csf

A

10s-100s lymph
normal protein
normal glucose
negative stain and culture

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40
Q

Initial treatment for CSF suggestive of bacterial meningitis

A

ceftriaxone
vancomycin
steriods- only useful in s. pneumo, but if WBC in CSF in 1000s give it

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41
Q

Listeria risk factors

A 
Elderly 
Neonate 
Steroid use 
AIDS/HIV
Immunocompromised 
Preggers

Listeria suspicion requires ampicilin

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42
Q

Additional management for N.meningitidis

A

Respiratory isolation

Rifampin, cipro, or ceftriaxone to close respiratory contacts

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43
Q

Most accurate test for herpes encephalitis

A

PCR of CSF

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44
Q

Most accurate diagnosis of sinusitis

A

Sinus biopsy or aspirate

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45
Q

Treat severe diarrhea with fluid and cipro

A 
hypotension 
tachycardia
fever
abdominal pain 
bloody diarrhea 
metabolic acidosis
46
Q

giardia tx

A

metronidazole

47
Q

cryptosporidosis

A

Tx AIDs, nitazoxanide

48
Q

Treatment for acute HBV, HEV, and HAV

49
Q

Treatment for acute HCV

A

Interferon, ribavarin, boceprevir/telaprevir

Decreases likelihood of developing chronic HCV

50
Q

Chronic HBV definition

A

persistant surface antigens for more than 6mo

51
Q

Treatment for Chronic HBV

A

If patient is HbeAg elevated with a positive and elevated DNA polymerase treat with entecavir, adefovir, lamivudine, telbivudine, IFN, tenofovir

52
Q

IFN AE

A

Arthralgia/myalgia
Leukopenia and thrombocytopenia
Depression and flu-like symptoms

53
Q

Goal of chronic hepatitis therapy

A

reduce DNA polymerase to undetectable levels

Convert those with e-antigen to having anti-hepatitis e antibody

54
Q

Treatment of chronic HCV

A

IFN, ribavarin, and broceprevir/telaprevir

55
Q

Painless genital ulcers with heaped up indurated edges

Painless adenopathy

A

Syphylis

Dx: Initial- VDRL/RPR
Best-FTA-ABS or dark field microscopy

Tx: Single dose of intramuscular benzathine penicillin or doxycycline

56
Q

Painful ulcer with deep purulent base and painful lymphadenopathy

A

Chancroid-Haemophilus ducreyi

Dx: stain and culture on chocolate agar

Tx: Azithromycin (single dose)

57
Q

Lymph nodes tender and suppurating

A

Lymphogranuloma venerum (chlamydia)

Dx: Complement fixation titers , nucleic acid amplification swab

Tx: Doxycycline

58
Q

Vesicles prior to ulcer and painful

A

HSV

Dx: Initial-Tznack stain
Best-viral culture
Diagnostic test not necessary

Tx: Acyclovir

59
Q

Rash-palms and soles
alopecia areata
Mucous patches
Condylomata lata

A

Secondary syphilis

60
Q

Meningovascular disease
Tabes dorsalis
Paresis
Argyll Robertson pupil

Aortitis- aortic regurg and aneurysm

Gummas

A

Tertiary syphilis

IV Penicillin

61
Q

False positive VDRL/RPR

A 
Infection 
Older age 
IVDU
Age
Malaria 
Antiphospholipid syndrome 
Endocarditis
62
Q

Symptoms of syphilis worsen with treatment

A

Jarisch-Herxhemier reactoin

Aspirin and antipyretics, will resolve spontaneously

63
Q

Itching in hair-bearing areas

Visible insects on surface

A

Pediculosis (Crabs)

Tx: permethrin, lindane equally efficacy, increased toxicity

64
Q

Tracking between fingers and toes

A

Scabies

Tx: permthrin or ivermectin for extensive disease

65
Q

Pyelonephritis treatment

A

Ampicllin and gentamicin, until culture results are known

66
Q

Acute Prostatitis treatment

A

Ampicillin and gentamicin, until culture results are known

67
Q

Chronic Prostatitis treatment

A

6-8 weeks for chronic prostatitis

68
Q

Infective endocarditis symptoms

A

New murmur + fever:

Splinter hemorrhages 
Janeway lesions
Osler nodes 
Roth spots
Brain-mycotic aneurysm 
Kidney- hematuria, glomerulonephritis 
Conjunctival petechiae 
Splenomeagly 
Septic emboli to lungs
69
Q

Initial treatment for infective endocarditis

A

vancomycin and gentamicin

70
Q

Indications for surgery on IE

A 
CHF or ruptured valve
Prosthetic valve
Fungal endocarditis 
Abscess 
AV block 
Recurrent emboli while on abx
71
Q

IE with strep viridans treatment

A

ceftriaxone 4 weeks

72
Q

S. Aureus (sensitive)

A

Oxacillin, naficllin, or cefazolin

Add rifampin if prosthetic valve

73
Q

Fungal

A

Amphotericin and valve replacement

74
Q

S. epi or MRSA

A

Vancomycin

Add rifampin if prosthetic valve

75
Q

Enterococci

A

Amp and gent

76
Q

Cause and treatment of culture negative endocarditis

A 
#1 Coxiella and Bartonella
Haemophilus aphrophilus 
Haemophilus parainfluenzae
Actinobacillus
Cardiobacterium 
Eikenella
Kingella

Treat all with ceftriaxone

77
Q

Prophylaxis for endocarditis

A
  1. SIGNIFICANT cardiac defect:
    - Prosthetic valve
    - previous endocarditis
    - cardiac transplant with valvulopathy
    - unrepaired cyanotic heard defect
  2. Risk of bacteremia:
    - Dental work with bleeding
    - Respiratory tract surgery producing bacteremia

Treat with amoxicillin

78
Q

Treatment of cardiac and neuro (not Bell’s palsy) manifestations of Lyme

A

IV ceftriaxaone

79
Q

Asymptomatic Tick prophylaxis

A

Ixodes scapularis is the tick
Tick >36 hours
Engorged tick
Endemic area

Prophylax with single dose of doxycycline

80
Q

HIV CD4>200 infections

A 
Shingles
HSV
TB
Candidiasis 
Bacterial pneumonia 
Karposi sarcoma
81
Q

How to diagnose infants with HIV

A

PCR or viral culture

maternal HIV antibodies present for 6mo

82
Q

When to initiate HIV treatment

A

CD4 < 500
Viral load >100000
Opportunistic infection

83
Q

Best initial HIV therapy

A

emtricitabine, tonfovir, efavirenz

84
Q

Protease inhibitors

85
Q

NRTI

A

-ine or -vir

86
Q

NNRTI

87
Q

Entry inhibitors

A

Enfuvirtide

Maraviroc

88
Q

Integrase inhibitor

A

Raltegravir

89
Q

Post-exposure prophylaxis HIV

A

4 weeks of combination therapy

bites count!

90
Q

Zidovudine AE

91
Q

Stavudine and didanosine AE

A

peripheral neuropathy and pancreatitis

92
Q

Abacavir AE

A

Hypersensitivity and SJS

Predict by HLA B5701 testing

93
Q

Protease inhibitor AE

A

Hyperlipidemia, hyperglycemia

94
Q

Indinavir AE

A

Nephrolithiasis

95
Q

Tenofovir AE

A

Renal insufficiency

96
Q

Efavirenz AE

A

Teratogenic

97
Q

Neonate prophylaxis postpartum

A

Zidovudine for 6 weeks after birth

98
Q

C-section guiedlines in HIV

A

CD4 < 350

Viral load >1000

99
Q

Treatment of Lyme in <8yo kiddos and preggos

A

Amoxicillin or cefuroxime

100
Q

Diarrhea, abdominal cramping

Ingestion of starchy food, such as rice

A

Bacillus cereus

101
Q

Vomiting, abdominal pain
+/- diarrhea
Rapid onset of symptoms

102
Q

Abdominal pain, watery diarrhea
Fever
Abx exposure

103
Q

Brief illness with watery diarrhea, cramps, and fever

Underooked or unrefridgerated food

A

C. perfringens

104
Q

Watery diarrhea, fever, abdominal pain and vomiting

Associated with undercooked poultry and eggs

A

Salmonella

Abx only for sever disease or immunocompromised

105
Q

Vomiting, diarrhea, abdominal pain
Ingestion of raw shellfish
May cause invasive life threatening disease in immuncompromised or person with liver disease

A

Vibrio vulnificus

106
Q

Watery diarrhea, may be bloody

Associated with undercooked beef or foods contaminated with bovine feces

107
Q

Bloody diarrhea with fever and bacteremia

Contaminated food and water-outside US

108
Q

Abdominal pain and bloody diarrhea
Associated with undercooked meat
Kiddos

A

Campylobacter

109
Q

Bloody diarrhea bugs

A

E.coli
Shigella
Campylobacter

110
Q

Treatment for pen-allergic syphilis

A

Doxycycline

Tertiary syphilis- ceftriaxone

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