ID

Question 1

Penicillin coverage?

Answer 1

Penicillin (G, VK, benzathine):
Viridans group strept
Strept. Pyogenes
Oral anaerobes
Syphilis 
Leptospira

Ampicillin / amoxicillin:
Penicillins + E. Coli + Lyme dz

*Amoxcillin HELPS!
H. Influenzae
E. Coli
Listeria
Proteus
Salmonella

Question 2

Penicillins are best initial Rx in what Dz?

Answer 2

Otitis media 
Dental + endocarditis prophylaxis 
Lyme dz (only rash, joint, 7CN).
UTI in pregnant 
Listeria monocytogenes
Enterococcal infections

Question 3

Penicillinase-resistant penicillins?

Answer 3

Oxacillin
Cloxacillin
Dicloxacillin
Naficillin

Question 4

Beta-lactam AB groups?

Answer 4

Penicillins
Cephalosporins
Carbapenems
Aztreonam

Question 5

Methicillin sensitive organism are sensitive to oxacillin. (T or F)

Answer 5

True. And vise versa.

Question 6

Penicillins that cover pseudomonas?

Answer 6

Pipracillin
Ticarcillin
Azlocillin
Mezlocillin

Question 7

Pseudomonas covering penicillin are eat initial Rx for what Dz?

Answer 7

Cholecystits and ascending cholangitis.
Pyelonephritis.
HAP and VAP.
Febrile neutropenia.

Question 8

What cephalosporin covers MRSA?

Answer 8

Cetfaroline

Question 9

Agents that cover MRSA?

Answer 9

Vancomycin 
Daptomycin
Cetfaroline. 
Linezolid. 
Trdizolid. 
Tigecycline. 
Dalbavancin. 
Telavancin.

Question 10

Cross-reaction between penicillin and cephalosporins (T or F)

Answer 10

True.

Very small

Question 11

Organisms sensitive to all cephalosporins?

Answer 11

Group A,B,C strept. 
Viridans group strept. 
E. Coli. 
Klebsiella. 
Proteus mirabilis.

Question 12

Organisms resistant to all cephalosporins?

Answer 12

Listeria
MRSA
Enterococcus.

Question 13

Patient with rash to penicillin?

Answer 13

Use cephalosporins.

Question 14

Patient with anaphylaxis after penicillin?

Answer 14

Use non-Beta-lactam

Question 15

What are the 1stG cephalosporins?

Answer 15

Cefazolin.
Cephalexin.
Cephradrine.
Cefadroxyl.

Question 16

What are 2ndG cephalosporins?

Answer 16

Cefotetan
Cefoxitin
Cefaclor
Cefprozil
Cefuroxime
Loracarbef

Question 17

1stG cephalosporins Rx?

Answer 17

Staph (Methicillin sensitive)
Strept
G-ve bacilli not (Not pseudomonas)
Osteomyelitis + septic arthritis. 
Endocarditis 
Cellulitis.

Question 18

What cephalosporins cover anaerobes?

Answer 18

Cefotetan.

Cefoxitin

Question 19

Best initial Rx for PID?

Answer 19

Cefotetan / Cefoxitin + doxycycline.

Question 20

SE of cefotetan / Cefoxitin?

Answer 20

Bleeding

Disulfiram like reaction (w/ alcohol).

Question 21

What are the 3rdG cephalosporins?

Answer 21

Ceftriaxone
Cefotaxime
Ceftazidime

Question 22

When to avoid ceftriaxone?

Answer 22

Neonates > impaired biliary metabolism.

Question 23

When to use cefotaxime instead of ceftriaxone?

Answer 23

Neonates.

Spontaneous bacterial peritonitis.

Question 24

What 3G cephalosporins has pseudomonal coverage?

Answer 24

Ceftazidime

Question 25

What is infective endocarditis?

Answer 25

Valvular infection leading two fever and murmur.

Question 26

What are the risks to developing infective endocarditis?

Answer 26

1. Prosthetic valve. 2. Valvular disease. 3. IV drug user.

Question 27

What are the complications of infective endocarditis?

Answer 27

1. Splinter hemorrhage, janeway lesions, Osler nodes. 2. Roth spots + conjunctival petechiae. 3. Septic emboli to lung. 4. Mycotic aneurysm of brain. 5. Kidney = glomerulonephritis. 6. Splenomegy

Question 28

What is the best initial test for infective endocarditis?

Answer 28

1. Blood Cx | 2. Echo (transthoracic 100% specific)

Question 29

Blood Cx of IE shows strept. Bovis or C. Septicum? (Next step)

Answer 29

R/o colonic pathology via colonoscopy?

Question 30

How to Dx IE if blood Cx is negative?

Answer 30

1. Vegetations on echo 2. 3 minor criteria: Fever > 38 High risk patient (prosthetic valve / IV drug) Signs of embolic phenomena

Question 31

Best initial treatment for infective endocarditis?

Answer 31

Empiric therapy of vancomycin and gentamicin.

Question 32

When is surgery the answer for infective endocarditis?

Answer 32

1. CHF 2. AV block 3. Fungal infection 4. Abscess 5. Recurrent emboli while on Rx

Question 33

What is the most common cause of culture negative infective endocarditis?

Answer 33

Coxiella.

Question 34

What are the e-Hack organisms of IE?

Answer 34

``` Eikenella H. Aphrophilus H. Parainfluenza Actinobacillus Kingella ```

Question 35

Rx of e-Hack IE?

Answer 35

Ceftriaxone

Question 36

When to prophylax against IE?

Answer 36

Heart defect + dental / resp surgery. ``` Heart defects: Prosthetic valve. Hx of IE. Cardiac transplant w/valve Dz Untreated cyanotic heart dz. ```

Question 37

What to use for prophylaxis of IE?

Answer 37

Amoxicillin | If allergic: macrolide