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Medicine Clerkship > ID > Flashcards

ID Flashcards

1
Q

Antibiotic ladder

A

Penicillin -> Nafcillin -> Vancomycin -> Linezolid

Penicillin -> ampicillin/amoxicillin + b lactamase inhibitor–>piperacillin + beta lactamase inhibitor –> Meropenem

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2
Q

FQ

A

Cipro + Levo, mostly gram negatives (urinary)

Moxi, gram negatives and gram positives (respiratory)

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3
Q

Anaerobic treatment

A

Vagina and GI tract? Flagyl

Everything else? Clindamycin

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4
Q

Empiric treatment for cap

A

Ceftriaxone and azithromycin

or just azithromycin as OP

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5
Q

Empiric treatment for HCAP

A

Vancomycin and cefepime/zosyn

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6
Q

Empiric treatment for meningitis

A

Vanc + ceftriaxone
+steroids (if sick)
+ampicillin (if old, baby, chemo, HIV, transplant, on MAB)

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7
Q

Empiric treatment for UTI

A

Bactrim
Cipro
Ceftriaxone
Nitrofurantoin

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8
Q

Empiric treatment for cellulitis

A

Cephazolin
Bactrim
Clindamycin

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9
Q

How to diagnose HIV patients that present with flu like symptoms?

A

With a viral load **

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10
Q

Treatment for HIV

A

2NRTIs + 1 of something else

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11
Q

Newborn prophylaxis for HIV

A

AZT within 12H of delivery for 6 weeks

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12
Q

Primary tuberculosis

A

Cavitary lesion in lower or middle lobes, asymptomatic, caseating granulomas

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13
Q

Secondary tuberculosis

A

Caseating granulomas in upper lobes, fever, hemoptysis, night sweats, weight loss.

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14
Q

Negative ppd?

A

Not exposed. Return in 2 weeks if in healthcare for another

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15
Q

Who is positive if PPD >5cm?

A

Immunosuppressed, steroids, HIV, transplant, very close contacts

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16
Q

Who is positive if PPD >10cm?

A

At risk: prisons, healthcare workers, homeless

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17
Q

Who is positive if PPD >15cm?

A

Don’t test population, soccer moms

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18
Q

What to do if PPD positive?

A

CXR, if negative, then exposed, give INH and B6
If positive, then AFB. If negative give INH and B6
If positive, give RIPE.

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19
Q

How to evaluate somebody with signs and symptoms of TB?

A

CXR, AFB + Cx,

If both negative Not TB, but do NAAT to make sure
If both positive TB, give RIPE.

If CXR positive, but AFB negative, latent, give INH and B6.

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20
Q

Major Duke Criteria

A

Major: Persistent bacteremia with endocarditis causing bug
New regurgitation murmur
Vegetation on echo

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21
Q

Minor Duke Criteria

A

Risk factors: IVDU, history of endocarditis, bad valve
Fever >38
Vascular Manifestations - septic emboli, stroke, splinter hemorrhages, janeway lesions
Rheumatologic manifestations- Osler nodes, roth spots, RF, glomerulonephritis

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22
Q

Acute endocarditis

A

Caused by staph mostly (sometimes strep pneumo)
Patient is bacteremic and toxic with CHS and no rheum findings. Dx with blood cultures, treat until negative.
Diagnose with ECHO!

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23
Q

How to treat endocarditis

A

4-6 weeks of antibiotics

Surgery if CHF, >15mm vegetation or >10mm vegetation with emboli

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24
Q

When to do surgery for endocarditis?

A

If patient has CHF, if there is a vegetation >15mm, or if there is a vegetation >10 MM that has emboli

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25
Q

How to treat native valve endocarditis?

A

Vancomycin (give daptomycin if vanc allergic)

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26
Q

How to treat prosthetic valve endocarditis if

A

Vanc + gentamycin + cefepime

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27
Q

How to treat prosthetic valve endocarditis if between 60 and 365 days?

A

Vanc + gent

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28
Q

How to treat prosthetic valve endocarditis if >365 days

A

Vanc + gent + ceftriaxone

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29
Q

How to treat subacute endocarditis

A

Gent + ceftriaxone.

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30
Q

Subacute endocarditis

A

Usually with hacek organisms, patient has low grade fevers with rheumatologic manifestations. Blood cultures until positive, then give abx. TTE if questionable, if positive, then do TEE

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31
Q

When to give endocarditis prophylaxis

A

Bad valve + oral/throat surgery
Endocarditis in past
Congenital heart disease
prosthetic valve.

32
Q

SIRS

A

T>38 T12 or 90

RR>20

33
Q

Severe sepsis

A

End organ damage + SIRS

AMS, Increase in BUN/CR, increase in LFT

34
Q

Sepsis

A

Sirs with source

35
Q

Septic shock

A

Severe sepsis that doesn’t improve with fluid

36
Q

Early goal directed therapy for sepsis

A

CVP at 12 mmHG.
Urine output > .5cc/kg/hr
MAP>65
VO2 >70.

37
Q

Three causes of fever and headache?

A

Meningitis - bacterial, TB, RMSF, lyme, crypto, viral
Abscess- Rule out cancer, + focal neuro deficit
Encephalitis - west nile, st louis, EEE + AMS

38
Q

How to work up fever and headache?

A

Get an LP if safe, if unsafe do a CT scan. If CT scan is negative for mass lesion, do an LP. If CT is positive for mass lesion, then test for HIV and toxo.

39
Q

When is it not safe to LP

A

Focal deficit, AMS, immunocompromised, mass lesion, seizures

40
Q

Diagnosis if LP shows lymphocytosis?

A

Viral encephalitis

41
Q

Diagnosis if LP shows thousands of Polys?

A

Bacterial meningitis, treat empirically with vancomycin, ceftriaxone, steroids +/- ampicillin

42
Q

Diagnosis if LP is negative?

A

Crypto, lyme, rmsf, RB

43
Q

Sign of cryptococcal meningitis?

A

Opening pressure >20, AIDS history, diagnose with cryptoantigen

44
Q

Sign of RMSF

A

Fever, rash from arms -> trunk, camping with tick bite

45
Q

Sign of Lyme

A

Tick targetoid rash, arrhythmias, arthralgias

46
Q

Sign of TB

A

Night sweats, wt loss, hemoptysis

47
Q

Sign of tertiary syphilis?

A

History of syphilis with any neuro symptoms warrants a CSF RPR or FTAABS

48
Q

Cellulitis, treatment?

A

Signs: Rubor tumor dolor
Dx: clinical, culture, then rule out osteomyelitis with MRI/Xray
Treat with cephazolin

49
Q

How to treat MRSA cellulitis

A

IV vancomycin followed by PO bactrim

50
Q

Osteomyelitis

A

Bone infection with pain and fever caused by direct deep inoculation or by hematogenous spreading

Diagnose with Xray, bone scan, MRI

Culture once for bug and sensitivity

51
Q

How to to treat osteomyelitis? Follow up?

A

Vancomycin and Zosyn, then treat based on sensitivity. Follow up with MRI and ESR/CRP

52
Q

Gas gangrene

A

Infection with clostridium perfringens. Muddy wound, Crepitus. Diagnose with Xray

53
Q

How to treat gas gangrene

A

Treat with clindamycin and penicillin after debridement, then hyperbaric O2

54
Q

How to treat necrotizing fasciitis

A

Surgical emergency

55
Q

Difference between bronchitis and pneumonia?

A

Both have cough, sputum, but only pneumonia has postive CXR findings.

56
Q

Cap vs HCAP?

57
Q

Hospital acquired pneumonia treatment?

A

Vancomycin + zozyn

58
Q

How to treat PCP

A

Bactrim + steroids

59
Q

How long to treat complicated UTI?

A

10 days.

Complicated if male, north of bladder, anatomic defect

60
Q

How to treat pyelonephritis?

A

IV ceftriaxone for 14 days.

61
Q

How to diagnose primary syphilis?
Secondary?
Tertiary?

A

Darkfield microscopy
RPR FTA-ABs
RPR, LP RPR and FTA

62
Q

Treatment for primary syphilis
Secondary
Tertiary

A

1 dose of PCN IM
I dose IM
14 days IV penicillin

63
Q

How to treat syphilis if penicillin allergic?

A

Doxycycline

64
Q

How to treat syphilis if penicillin allergic and pregnant?

A

Penicillin with epinephrine nearby!

65
Q

Chancroid. Tx?

A

Caused by H ducreyii, gram negative bug with painful ulcer and lymhadenopathy. Treat with doxy or azithro

66
Q

Herpes

A

Painful burning multiple vesicles on erythematous base
Dx with HSV PCR
Tx acyclovir

67
Q

Molloscum contagiosum. Tx?

A

Multiple vesicles with central umbilication. Freeze them

68
Q

How to treat otitis media?

69
Q

How to treat otitis externa

A

Nothing, or acetic acid drops.

70
Q

How to distinguish otitis media vs otitis externa based on exam alone

A

Externa has pain with pinna pull.

Also otitis media has a rigid tympanic membrane with insufflation.

71
Q

How to treat sinusitis?

A

If greater than 7 days or has a cough, then amoxicillin

If

72
Q

URI bugs

A

M. Catarrhalis, H. influenzae, S. pneumo

73
Q

How to retrieve bug in ear?

A

Lidocaine, then retrieval

74
Q

Choanal atresia

A

Big tonsils, snoring child, blue while resting, pink while crying.

75
Q

How to treat prostate involved UTI

Medicine Clerkship (12 decks)

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