ID Flashcards by william hennrikus

how is vanc dosed?

by weight
15mg/kg
check trough before 4th dose to check for ss level and needed adjustment

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other than clindamycin and metronizaole, another class with good anaerobic coverage?

penicillins have good anaerobic coverage - Ampicillin Amoxicillin Piperacillin

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perioperative abx target __ and __ which require __ class such as __

periop abx target GAS Pyogenes and Staph Aureus (skin flora) which require 1st Gen Cephalosporin such as Cefazolin

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___ is used for empiric coverage when suspicion for a toxin mediated condition like Staph Scalded Skin Syndrome or Gas Gangrene… also used as empiric coverage for MRSA Skin Infections as an outpatient

Clindamycin
is used for empiric coverage when suspicion for a toxin mediated condition like Staph Scalded Skin Syndrome or Gas Gangrene… also used as empiric coverage for MRSA Skin Infections as an outpatient

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antibiotic prophylaxis based on CD4 count in HIV

CD4v200
what if sulfa allergy? G6PD?

CD4v100

CD4v50

v200 PCP - TMPSMX then Dapsone then Atovaquone

Dapsone if sulfa allergy
Atovaquone if G6PD

v100 Toxoplasma - TMPSMX

v50 MAC - Azythromycin

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PCP pneumonia on imaging (in HIV pt with CD4v200)

different from ARDS?

diffuse bilateral infiltrates / interstitial infiltrates / fluffy opacities… no definitive consolidation

similar to ARDS, look for clues in history and physical and workup

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treat oral vs esophageal thrush

nystatin swish/spit ok for oral

esophageal needs po fluconazole

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HIV screen consists of ___
if positive, confirmed by ___

viral load? cd4 count?

HIV screen consists of ELIZA for HIV antibodies

if positive, confirmed by Western Blot… or newer tests with Antibody Differentiation

viral load and cd4 both to inform treatment After diagnosis has been made by ELIZA and Western or Ab Diff

viral load afterward to assess acute retroviral syndrome and monitor efficacy of haart treatment

cd4 count for need for prophylaxis

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when to add Prednisone to TMPSMX for PCP pneumonia in an AIDS patient

add Prednisone if O2 Sats really Low

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Kaposi Sarcoma
bug
treat

HHV-8

treat AIDS with haart

if kaposi sarcoma refractory can resort to local then systemic chemo

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HHV-6 causes

HHV-6 - Roseola in children

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fevers neurologic deficits lymphadenopathy in AIDS
patient

suspect what bug
what cd4 count

Toxoplasma

CD4v100

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young guy with risky sexual history multiple partners poor protection, but negative HIV tests to date, with symptoms sounding like mono, strep throat, or flu (sore throat, cervical lymphadenopathy, headache fever muscle aches, faint maculopapular rash on trunk and abdomen

best test
diagnosis

HIV RNA viral load

rule out Acute RetroViral Syndrome

(may be mono flu strep throat, but high risk pt)

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when is HIV RNA viral load the best diagnostic test?

rule out Acute RetroViral Syndrom

eg sounds like mono flu strep throat, but high risk pt by sexual history

eg young guy with risky sexual history multiple partners poor protection, but negative HIV tests to date, with symptoms sounding like mono, strep throat, or flu (sore throat, cervical lymphadenopathy, headache fever muscle aches, faint maculopapular rash on trunk and abdomen

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homeless guy or jail guy with cough otherwise stable, has scarring in upper lung zones on cxr, negative AFB sputum stain, positive PPD

diagnosis
need CT
treat if never treated
treat if treated before

latent TB
cough
positive cxr without active disease
POSITIVE PPD

no need for CT, signs good enough… maybe get CT if ppd negative and still don’t know what it is

give Isoniazid and B6 if never treated

reassurance if never treated before

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a positive ppd should at least prompt suspicion for

Positive PPD at Least rule out Latent TB

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streptomycin, hydrazide, rifampin, pyrazinamide, ethambutol, moxifloxacin, clycloserine treat

empiric therapy for MDR TB

streptomycin, hydrazide, rifampin, pyrazinamide, ethambutol, moxifloxacin, clycloserine

RPE and some other stuff…

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active TB gets ____

Active TB gets RIPE B6

rifampin isoniazid pyrazinamide (and B6) and ethambutol

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side effects of RIPE for TB

Rifampin - red bodily fluids
Isoniazid - peripheral neuropathy (so give with B6)
Pyrazinamide - renal failure
Ethambutol - eyethambutol blurry and discolored vision

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3 steps as you rule out / diagnose TB

isolate
cxr
afb sputum

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diagnosis for caseating vs noncaseating granulomas in the lung

caseating - TB

non-caseating - sarcoid

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cavitary lung lesion on cxr

ddx is __ vs __

how do you know

cavitary lung lesion is TB or Abscess

if risk factors for TB, thinking TB

if no risk factors for TB and super sick, thinking abscess

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PPD warranting further investigation in a very low risk patient

^15mm ppd

to investigate further (cxr) in pt with no risk factors for tb

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sepsis

severe sepsis

septic shock

multiorgan dysfunction syndrome

sepsis is 2+ T^38v36 HR^90 RR^20 WBC^12v4 with source

severe sepsis is above with Fluid responsive Hypotension

septic shock is non-fluid responsive hypotension needing Pressors or single organ hypoperfusion (eg elevated creatinine)

multiorgan dysfunction syndrome is what it sounds like, due to hypoperfusion

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empiric coverage for meningitis in immunocompetent adult in immunocompromised adult

ceftriaxone vancomycin dexamethasone | ampicillin ceftriaxone vancomycin dexamethasone elderly neonate on monoclonal antibody chemotherapy for HIV

TF Pyrimethamine and Sulfadiazine with Folinic Acid is equivalent to Trimethoprim and Sulfamethoxazole for HIV Toxoplasmosis

T...

fever ams fnds ring enhancing brain lesion on head ct think next step

cancer or abscess or toxoplasma if HIV biopsy to diff abscess from cancer and need for abx vs chemo if hiv treat empirically for toxo (Pyrimethamine and Sulfadiazine with Folinic Acid is equivalent to Trimethoprim and Sulfamethoxazole)

blood in spinal tap is excellent clue for

HSV encephalitis

CSF antibodies are useful for ___ in setting of long-term encephalitis with immunocompromise

CSF antibodies are useful for Cryptococcus in setting of long-term encephalitis with immunocompromise

pick the meningitis bug - most common - college student rapid 24hr deterioration petechial rash - unimmunized peds - neonate - elderly - immunocompromised

``` strep pneumo - most common n meningitis - college rapid petechiae unimm peds - h flu b neonate - gbs listeria ecoli elderly - listeria immunocompromised - listeria ```

on the test, ___ is the only thing penicillin will treat

on the test, Syphilis is the only thing penicillin will treat

emprically treat contacts of n.meningitis meningitis college with ___

po Rifampin | ceftriaxone and vanc are iv

temporal lobe is mentioned in relation to brain inflammation, think

HSV encephalitis

initial imaging for suspected osteomyelitis

xray | then mri if xray normal but still high suspicion

when to biopsy osteomyelitis vs treat empirically

biopsy if nontoxic and stable, to get good culture sensitivity for directed antibiotics treat empirically if toxic

substitutes for pip-tazo if worried about kidneys

cefipime and metronidazole or levofloxacin and metronidazole same anti-pseudomonal and anaerobic coverage

clindamycin covers ampicillin-sulbactam covers

clindamycin - MSSA GAS Anaerobes unasyn - MSSA some GNRs but not pseudomonas and Anaerobes

topical permethrin first line oral ivermectin backup first line but not v15kg patient topical lindane 2nd line because neurotoxic side effect what are we treating

scabies | transmission between family members and linear furrows in webs of fingers

transmission between family members and linear furrows in webs of fingers think treat

scabies topical permethrin first line oral ivermectin backup first line but not v15kg patient topical lindane 2nd line because neurotoxic side effect

smoking and COPD pneumonia what bug to think

strep pneumo regardless of risk factors | H flu for PNA smoker COPD

when is staph aureus a probable CAP bug

staph aureus in CAP Following Viral Illness... strep pneumo still most common here but include staph on ddx especially if refractory to usual abx regimen

multifocal pneumonia suggests this bug

staph aureus | multifocal pneumonia

gram negative rods in PNA think what bugs

h flu (coccobacilli... COPDers) pseudomonas (VAP)

when is vanc pip-tazo your regimen for PNA

if HAP | need pseudomonas coverage

sounds like uti but tender prostate dx tx

prostatitis | tmpsmx or fluoroquinolone

GPCs on gram stain of urine | treat

ampicillin | ceftriaxone does not cover enterococcus

treat Outpatinet Pyelonephritis (not that bad pyelo) - no aki, mild fever and wbc, can tolerate meds

Ciprofloxacin

why not nitrofurantoin for pyelo

does not penetrate renal parenchyma well

pyelo worsening despite appropriate GNR coverage, still GNRs in urine next step? why?

CT or Ultrasound abdomen | likely abscess

how long to treat male outpatient uti

7 day course of abx (male uti is complicated) | cipro levo nitro tmpsmx amox-clav doesn't matter

how long to treat uncomplicated female outpatient uti

3 day course of abx (male uti is complicated) | cipro levo nitro tmpsmx amox-clav doesn't matter

treat asymptomatic bacteruria in pregnancy with

amoxicillin cephalexin or nitrofurantoin

single painful genital ulcer with lymphadenopathy dx

H. Ducreyi Chancroid

multiple shallow genital uclers with roofs on an erythematous base dx

herpes simplex virus

painless genital ulcer with lymphadenopathy dx

primary syphilis

targetoid lesions on arms legs trunk including palms and soles dx tx if allergic to that one if allergic and pregnant

secondary syphilis penicillin doxycycline if allergic pinicillin desensitization of pregnant (doxy teratogenic)

gancyclovir is used to treat ___

gancyclovir for CMV

treat acyclovir resistant HSV

foscarnet | acyclovir resistant will also be valacyclovir resistant

treat shingles aka vzv aka hhv3

PO Acyclovir

treat zoster opthalmacus with PO or IV Acyclovir?

PO acyclovir for zoster opthalmacus iv acyclovir for herpes Encephalitis

treat h.ducreyi chancroid

PO Azythromycin

treat recurrent unilateral epistaxis

nitrate ablation of anterior blood vessels (cannot nitrate ablate posterior bleeds that present bilaterally)

tf | rhinoplasty for recurrent epistaxis

F | rhinoplasty for deviated septum or perforate septum, not bleeding

pt with likely strep, rapid swab or treat empirically?

rapid swab... don't treat strep empirically

treat otitis externa with systemic toxic effects

oral/IV ciprofloxacin (must cover pseudomonas for otitis... so usual ent amoxicillin-clavalunate not enough... this is Malignant Otitis media (systemic toxic signs) so typical neomycin drops not enough either) oral if osteomyelitis probable eg pain with chewing iv if systemic toxicity

fever iv drug use new murmur think

infective endocarditis fever iv drug use new murmur

bug in infective endocarditis

staph aureus

empiric antibiotics for endocarditis bugs

vanc gent cefipime for new valve v60 days old vanc gent ceftriaxone for old valve ^365 days old (vanc and gent plus cefipime for new valve vs ceftriaxone for old valve) bugs are staph aureus strep strep pseudomonas

antibiotic ppx for prosthetic valve endocarditis eg if having dental or throat procedure what bug are you watching out for

AMOXICILLIN if allergic, CEPHALEXIN (only 1-3% cross-allergy with penicillin.... unless anaphylactic then avoid entirely) so if anaphylactic, CLINDAMYCIN or other macrolide ppx against STREP VIRIDANS

most common bug in infective endocarditis

staph aureus infective endocarditis this is why vanc is the backbone of empiric coverage

if you see strep bovis bacteremia or endocarditis, get ___

strep bovis bacteremia or endocarditis get COLONOSCOPY (assoc s bovis w colon cancer)

staph aureaus endocarditis with mean inhibitory concentration ^2 refractory to Vanc next step

switch to Daptomycin inhibitory concentration ^2 is not sensitive to vanc, use dapto.... if v2 can continue vanc for longer if not responding immediatly in first few days

suspect prosthetic valve endocarditis, next step?

TEE