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1
Q

Bugs covered by penicillin (5)

A 
Viridans 
S pyro
Oral anaerobes
Syphilis
Leptospira
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2
Q

What is the most accurate test for an infectious disease?

A

Culture

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3
Q

Bacteria covered by amoxicillin

A

HELPS

H flu, E. coli, Listeria, Proteus, Salmonella

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4
Q

When something is Methicillin resistant/sensitive, what do you give instead and why?

A

Oxacillin

Methicillin causes renal failure from allergic interstitial nephritis

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5
Q

If a patient has a rash with penicillin, what do you use instead?

A

Cephalosporins

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6
Q

If a patient has anaphylaxis to penicillin, use what instead?

A

Non beta lactam Abx

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7
Q

What are the 1st gen cephalosporins (4)

A

Cefazolin
Cephalexin
Cephradrine
Cefadroxyl

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8
Q

What are the 2nd gen cephalosporins (4)

A

Cefotetan (anaerobe coverage)
Cefoxitin (anaerobe coverage)
Cefaclor
Cefuroxime

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9
Q

3rd gen cephalosporins (3)

A 
Ceftriaxone (do not give in neonates)
Cefotaxime
Ceftazidime (covers pseudomonas)
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10
Q

4th gen cephalosporins (1)

A

Cefepime (superior staph coverage)

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11
Q

5th gen cephalosporins (1)

A

Ceftaroline (gram - bacilli, MRSA, NOT pseudomonas!)

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12
Q

2 major cephalosporin drug reactions

A

Cefoxitin/Cefotetan: deplete PT = increased bleeding risk

Ceftriaxone: inadequate biliary metabolism

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13
Q

What is the primary coverage of carbapenems?

Which does not cover pseudomonas?

A

Gram - bacilli

Ertapenem

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14
Q

What drug is a monobactam?
What is the use?
Does it cross react with penicillin?

A

Aztreonam
Gram -
No

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15
Q

What is the best therapy for CAP?

What are some side effects of these meds (2)?

A

Fluoroquniolones

Bone growth abnormalities, tendonitis

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16
Q

What do aminoglycocides not work on?

What are side effects? (2)

A

Anaerobes

Nephrotoxic, ototoxic

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17
Q

What is the single indication of Nitofurantoin?

A

Cystitis esp in pregnant women

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18
Q

What are 4 drugs for MRSA?

What are 4 drugs for MRSA of the skin?

A

Telavancin, Dalbavancin, Tedizolid, Oritavancin

TMP/SMX, Clinda, Doxy, Linezolid

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19
Q

What drugs cover the gram -s?

A 
Quinolones
Aminoglycosides
Carbapenems
Piperacillin, Ticarcillin
Aztreonam
Cephalosporins
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20
Q

What is the best initial test for CNS infection?

Accurate?

A

LP

LP

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21
Q

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?

A

Bacterial meningitis
Viral meningitis
TB meningitis
Bacterial meningitis

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22
Q

When do you get a head CT before an LP?

A

Papilledema
Seizures
Focal neuro issues
Confusing interfering with neuro exam

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23
Q

If there is a contraindication to immediate LP,, what is the best initial step?

A

Abx

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24
Q

When is a bacterial antigen detection test useful?

A

Only if positive (highly specific)

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25
Q

What is the most specific test for TB meningitis?
Lyme/Rickettsia?
Crypto?
Viral?

A

Acid fast + culture on 3 high volume LPs
Specific serologic tests + ELISA + WBlot/PCR
Antigen test + Culture > India Ink
Dx of exclusion

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26
Q

Treatment for bacterial meningitis?
Addition if immunocomprised (and why)?
Neisseria additions?

A

Ceftriaxone + Vanc + Steroids
Ampicillin (listeria)
Respiratory isolation + Rifampin/Cipro/Ceftriaxone for close contacts

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27
Q

What is the most common neuro deficit of untreated bacterial meningitis?

A

8th CN deficit or deafness

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28
Q 
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?
A 
HSV
Head CT
PCR of CSF
Acyclovir
Foscarnet
Renal toxicity (reduce dose + hydrate)
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29
Q

What is the most sensitive finding for otitis media?
What is the most accurate test?
What is the best initial therapy?

A

Immobility
Tympanocentesis
Amoxicillin

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30
Q

What are the 1st line treatments for otitis and sinusitis? (3)

A

Amox + Clauvonic Acid
Doxy
TMP/SMX

31
Q 
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?
A 
Rapid strep test
Pharyngeal culture
Penicillin or Amoxicillin
Cephalexin
Clinda or Macrolide
32
Q

How do you treat the flu before 48 hours vs after?

A

Before: Ostelmavir/Zanamivir neuraminidase inhibitors
After: symptomatic tx only

33
Q

What is the best initial test for infectious diarrhea?
What are 2 possible next tests?
What is most accurate?

A

Blood/fecal leukocytes
Lactoferrin > fecal leukocytes
Stool culture

34
Q

What is scombroid?

How do you treat?

A

Rapid onset wheezing/flushing/rash found in fish

antihistamines

35
Q

What is the most accurate determine factor for etiology of infectious diarrhea?

A

Blood in stool: salmonella/shigella/yersinia/e coli

36
Q

Which is the worst hepatitis if pregnant?

A

Hep E

37
Q

What lab finding is very concerning in hepatitis?

A

Elevated PT

38
Q

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?

A

HbS antigen
HbE antigen
No HbS antigen present
HbE antigen

39
Q

Any time that HbE antigen is the answer, you can use ____ instead. X is qualitative, Y is quantitative

A

DNA polymerase
HbE antigen
DNA poly

40
Q

How is HepB transmitted worldwide most commonly?

A

Perinatal

41
Q

How do you treat HCV type 1?
2?
3?

A

1: ledipasvir + sofosbuvir

2/3: ribavirin + sofosbuvir

42
Q

What Abx have the greatest efficacy compared to other classes?

A

Beta lactams (penicillins, cephalosporins, carbapenems, aztreonam)

43
Q

What is a key difference in presentation of urethritis vs cystitis?

A

Only urethritis has discharge

44
Q

What is the best urethritis initial test?

What are the most accurate GC tests?

A

Urethral swab for gram stain

NAAT/DNA probe/urethral culture

45
Q

What is a strawberry cervix classic for?

How do you treat?

A

Cervicitis

Ceftriaxone + azythromycin

46
Q

What is the most accurate test for PID?
What is the inpatient treatment?
What is the outpatient treatment?

A

Laparoscopy
Cefoxitin or Cefotetan + Doxy
Ceftriaxone + Doxy

47
Q

Painless genital ulcer?
Painful ulcer?
Tender lymph nodes?
Painful vesicles?

A

Syphilis
H ducreyi
L Venerum
HSV

48
Q

Test for syphilis?
H ducreyi?
L Venereum?
HSV?

A

Dark field micro > VDRL –> FTA
Stain + special culture
NAAT = compliment fixation titers
Tzanck–> Viral culture

49
Q

Treat syphilis?
H ducreyi?
L Venereum?
HSV?

A

IM Benzathine penicillin –> doxy
Azythromycin
Doxy
Acyclovir/Valay/Fam –> Foscarnet

50
Q

What is the Jarisch Herxheimer rxn?

How do you treat?

A

Fever and worsening Sx after treatment

ASA + anti fever meds

51
Q

How do you treat pediculosis?

A

Permethrin

52
Q

How do you treat scabies?

A

Permethrin

53
Q

What is the best initial test for UTI?

Accurate?

A

UA with >10WBCs

Urine culture

54
Q

What is the treatment course for an uncomplicated cystitis?

Complicated?

A

3 days

7 days

55
Q

What is a great way to increase the diagnostic yield of a urine culture in suspected prostatitis?

A

Prostate massage

56
Q

What are 4 unique symptoms of endocarditis?

A 
Splinter hemorrhage
Janeway lesions (flat, painless)
Osler nodes (raised, painful)
Roth spots
57
Q

What is the best initial test for endocarditis?

A

Blood culture (sensitive)
TTE (specific)
TEE (sens + spec)

58
Q

How do you agnostic culture negative endocarditis?

A

Vegetation on ECHO
Fever >38C
Risk factor (drugs, valve)
Signs of embolism

59
Q 
How do you treat endocarditis empirically?
Viridians?
S arueus?
Fungal?
S epi or MRSA?
Enterococcus?
A 
Vanc + Gent
Ceftriaxone x4 weeks
Oxacillin/nafcillin/cefazolin 
Amphoteracin + valve replacement
Vanc
Amp + gent
60
Q

What features of endocarditis suggest valve replacement for treatment (2)?

A

Acute valve rupture

CHF

61
Q

What are the 2 most common causes of culture negative endocarditis?
What are 6 other causes?

A

Coxiella > Bartonella

HHACEK

62
Q

What is the best endocarditis prophylaxis?

What is the best if allergic?

A

Amoxicillin

Clinda/azythromycin/clarythromycin

63
Q

What is the most common cardiac abnormality with Lyme disease?

A

Transient AV block

64
Q

How do you treat Lyme?
What if there is joint involvement or CN7 issues?
What if there are cardiac or other neuro issues?

A

Doxy or amox or ceuroxime
“”
IV Ceftriaxone

65
Q

What are 4 reasons to give prophylactic doxy within 72 hours of a tick bite?

A

Ixodes clearly identified
Tick attached for 24-48 hours
Engorged nymph stage tick
Endemic area

66
Q

What is the best initial HIV test?
Confirmatory test?
Infant test?

A

ELISA
Western Blot
PCR or viral culture

67
Q

What is the best initial HIV cocktail?

A

Emtricitabine
Tenofovir
Efavirenz

68
Q

What are the 4 NNRTIs?

A

Efavirenz
Etravirine
Nevirapine
Rilpivirine

69
Q

What do protease inhibitors end with?

A

-navir

70
Q

What are the integrase inhibitors?

A

Raltegravir

-gravir

71
Q

What is unique about Abacavir?
Ritonavir?
Elvitegravir?
Enfuviritide/Maraviroc?

A

Dangerous with HLA-B4701 mutation
Boosts Darunavir/Atazanavir levels
Metabolism inhibited by Cobicistat (boosts levels)
Entry inhibitors

72
Q 
What does AZT cause?
Stavudine/Didanosine?
Protease inhibitors?
Indinavir?
Tenofovir?
A 
Anemia
Peripheral neuropathy/pancreatitis
HLD/DM
Nephrolithiasis
Renal insufficiency
73
Q

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?

A

Efavirenz
AZT
Viral load >1000
AZT –> 6 weeks

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