ID Flashcards
Bugs covered by penicillin (5)
Viridans S pyro Oral anaerobes Syphilis Leptospira
What is the most accurate test for an infectious disease?
Culture
Bacteria covered by amoxicillin
HELPS
H flu, E. coli, Listeria, Proteus, Salmonella
When something is Methicillin resistant/sensitive, what do you give instead and why?
Oxacillin
Methicillin causes renal failure from allergic interstitial nephritis
If a patient has a rash with penicillin, what do you use instead?
Cephalosporins
If a patient has anaphylaxis to penicillin, use what instead?
Non beta lactam Abx
What are the 1st gen cephalosporins (4)
Cefazolin
Cephalexin
Cephradrine
Cefadroxyl
What are the 2nd gen cephalosporins (4)
Cefotetan (anaerobe coverage)
Cefoxitin (anaerobe coverage)
Cefaclor
Cefuroxime
3rd gen cephalosporins (3)
Ceftriaxone (do not give in neonates) Cefotaxime Ceftazidime (covers pseudomonas)
4th gen cephalosporins (1)
Cefepime (superior staph coverage)
5th gen cephalosporins (1)
Ceftaroline (gram - bacilli, MRSA, NOT pseudomonas!)
2 major cephalosporin drug reactions
Cefoxitin/Cefotetan: deplete PT = increased bleeding risk
Ceftriaxone: inadequate biliary metabolism
What is the primary coverage of carbapenems?
Which does not cover pseudomonas?
Gram - bacilli
Ertapenem
What drug is a monobactam?
What is the use?
Does it cross react with penicillin?
Aztreonam
Gram -
No
What is the best therapy for CAP?
What are some side effects of these meds (2)?
Fluoroquniolones
Bone growth abnormalities, tendonitis
What do aminoglycocides not work on?
What are side effects? (2)
Anaerobes
Nephrotoxic, ototoxic
What is the single indication of Nitofurantoin?
Cystitis esp in pregnant women
What are 4 drugs for MRSA?
What are 4 drugs for MRSA of the skin?
Telavancin, Dalbavancin, Tedizolid, Oritavancin
TMP/SMX, Clinda, Doxy, Linezolid
What drugs cover the gram -s?
Quinolones Aminoglycosides Carbapenems Piperacillin, Ticarcillin Aztreonam Cephalosporins
What is the best initial test for CNS infection?
Accurate?
LP
LP
What does a high cell count and neutrophils mean on LP?
What does normal protein and glucose on LP mean?
Crazy high protein?
What does a positive stain and culture on LP mean?
Bacterial meningitis
Viral meningitis
TB meningitis
Bacterial meningitis
When do you get a head CT before an LP?
Papilledema
Seizures
Focal neuro issues
Confusing interfering with neuro exam
If there is a contraindication to immediate LP,, what is the best initial step?
Abx
When is a bacterial antigen detection test useful?
Only if positive (highly specific)
What is the most specific test for TB meningitis?
Lyme/Rickettsia?
Crypto?
Viral?
Acid fast + culture on 3 high volume LPs
Specific serologic tests + ELISA + WBlot/PCR
Antigen test + Culture > India Ink
Dx of exclusion
Treatment for bacterial meningitis?
Addition if immunocomprised (and why)?
Neisseria additions?
Ceftriaxone + Vanc + Steroids
Ampicillin (listeria)
Respiratory isolation + Rifampin/Cipro/Ceftriaxone for close contacts
What is the most common neuro deficit of untreated bacterial meningitis?
8th CN deficit or deafness
What is the most common cause of encephalitis? What is the first step? What is the most accurate test? What is the best initial therapy? What is the treatment for resistance? What is the concern with both meds?
HSV Head CT PCR of CSF Acyclovir Foscarnet Renal toxicity (reduce dose + hydrate)
What is the most sensitive finding for otitis media?
What is the most accurate test?
What is the best initial therapy?
Immobility
Tympanocentesis
Amoxicillin
What are the 1st line treatments for otitis and sinusitis? (3)
Amox + Clauvonic Acid
Doxy
TMP/SMX
What is the best initial test for pharyngitis? What should you get if it is positive? What is the initial treatment? What if there is a rash? A real allergy?
Rapid strep test Pharyngeal culture Penicillin or Amoxicillin Cephalexin Clinda or Macrolide
How do you treat the flu before 48 hours vs after?
Before: Ostelmavir/Zanamivir neuraminidase inhibitors
After: symptomatic tx only
What is the best initial test for infectious diarrhea?
What are 2 possible next tests?
What is most accurate?
Blood/fecal leukocytes
Lactoferrin > fecal leukocytes
Stool culture
What is scombroid?
How do you treat?
Rapid onset wheezing/flushing/rash found in fish
antihistamines
What is the most accurate determine factor for etiology of infectious diarrhea?
Blood in stool: salmonella/shigella/yersinia/e coli
Which is the worst hepatitis if pregnant?
Hep E
What lab finding is very concerning in hepatitis?
Elevated PT
What is the first abnormality after HepB infection?
What correlates with active viral replication?
What indicates a patient is no longer at risk for transmitting?
What indicates that treatment is necessary?
HbS antigen
HbE antigen
No HbS antigen present
HbE antigen
Any time that HbE antigen is the answer, you can use ____ instead. X is qualitative, Y is quantitative
DNA polymerase
HbE antigen
DNA poly
How is HepB transmitted worldwide most commonly?
Perinatal
How do you treat HCV type 1?
2?
3?
1: ledipasvir + sofosbuvir
2/3: ribavirin + sofosbuvir
What Abx have the greatest efficacy compared to other classes?
Beta lactams (penicillins, cephalosporins, carbapenems, aztreonam)
What is a key difference in presentation of urethritis vs cystitis?
Only urethritis has discharge
What is the best urethritis initial test?
What are the most accurate GC tests?
Urethral swab for gram stain
NAAT/DNA probe/urethral culture
What is a strawberry cervix classic for?
How do you treat?
Cervicitis
Ceftriaxone + azythromycin
What is the most accurate test for PID?
What is the inpatient treatment?
What is the outpatient treatment?
Laparoscopy
Cefoxitin or Cefotetan + Doxy
Ceftriaxone + Doxy
Painless genital ulcer?
Painful ulcer?
Tender lymph nodes?
Painful vesicles?
Syphilis
H ducreyi
L Venerum
HSV
Test for syphilis?
H ducreyi?
L Venereum?
HSV?
Dark field micro > VDRL –> FTA
Stain + special culture
NAAT = compliment fixation titers
Tzanck–> Viral culture
Treat syphilis?
H ducreyi?
L Venereum?
HSV?
IM Benzathine penicillin –> doxy
Azythromycin
Doxy
Acyclovir/Valay/Fam –> Foscarnet
What is the Jarisch Herxheimer rxn?
How do you treat?
Fever and worsening Sx after treatment
ASA + anti fever meds
How do you treat pediculosis?
Permethrin
How do you treat scabies?
Permethrin
What is the best initial test for UTI?
Accurate?
UA with >10WBCs
Urine culture
What is the treatment course for an uncomplicated cystitis?
Complicated?
3 days
7 days
What is a great way to increase the diagnostic yield of a urine culture in suspected prostatitis?
Prostate massage
What are 4 unique symptoms of endocarditis?
Splinter hemorrhage Janeway lesions (flat, painless) Osler nodes (raised, painful) Roth spots
What is the best initial test for endocarditis?
Blood culture (sensitive)
TTE (specific)
TEE (sens + spec)
How do you agnostic culture negative endocarditis?
Vegetation on ECHO
Fever >38C
Risk factor (drugs, valve)
Signs of embolism
How do you treat endocarditis empirically? Viridians? S arueus? Fungal? S epi or MRSA? Enterococcus?
Vanc + Gent Ceftriaxone x4 weeks Oxacillin/nafcillin/cefazolin Amphoteracin + valve replacement Vanc Amp + gent
What features of endocarditis suggest valve replacement for treatment (2)?
Acute valve rupture
CHF
What are the 2 most common causes of culture negative endocarditis?
What are 6 other causes?
Coxiella > Bartonella
HHACEK
What is the best endocarditis prophylaxis?
What is the best if allergic?
Amoxicillin
Clinda/azythromycin/clarythromycin
What is the most common cardiac abnormality with Lyme disease?
Transient AV block
How do you treat Lyme?
What if there is joint involvement or CN7 issues?
What if there are cardiac or other neuro issues?
Doxy or amox or ceuroxime
“”
IV Ceftriaxone
What are 4 reasons to give prophylactic doxy within 72 hours of a tick bite?
Ixodes clearly identified
Tick attached for 24-48 hours
Engorged nymph stage tick
Endemic area
What is the best initial HIV test?
Confirmatory test?
Infant test?
ELISA
Western Blot
PCR or viral culture
What is the best initial HIV cocktail?
Emtricitabine
Tenofovir
Efavirenz
What are the 4 NNRTIs?
Efavirenz
Etravirine
Nevirapine
Rilpivirine
What do protease inhibitors end with?
-navir
What are the integrase inhibitors?
Raltegravir
-gravir
What is unique about Abacavir?
Ritonavir?
Elvitegravir?
Enfuviritide/Maraviroc?
Dangerous with HLA-B4701 mutation
Boosts Darunavir/Atazanavir levels
Metabolism inhibited by Cobicistat (boosts levels)
Entry inhibitors
What does AZT cause? Stavudine/Didanosine? Protease inhibitors? Indinavir? Tenofovir?
Anemia Peripheral neuropathy/pancreatitis HLD/DM Nephrolithiasis Renal insufficiency
What is the only HIV med that should be avoided in pregnancy?
What should the baby get intrapartum?
At what level is a Csection performed?
What does the baby get after birth and for how long?
Efavirenz
AZT
Viral load >1000
AZT –> 6 weeks