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Medicine > ID > Flashcards

ID Flashcards

1
Q

how is vanc dosed?

A

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

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2
Q

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

A

penicillins have good anaerobic coverage - Ampicillin Amoxicillin Piperacillin

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3
Q

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

A

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

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4
Q

___ 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

A

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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5
Q

antibiotic prophylaxis based on CD4 count in HIV

CD4v200
what if sulfa allergy? G6PD?

CD4v100

CD4v50

A

v200 PCP - TMPSMX then Dapsone then Atovaquone

  • Dapsone if sulfa allergy
  • Atovaquone if G6PD

v100 Toxoplasma - TMPSMX

v50 MAC - Azythromycin

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6
Q

PCP pneumonia on imaging (in HIV pt with CD4v200)

different from ARDS?

A

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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7
Q

treat oral vs esophageal thrush

A

nystatin swish/spit ok for oral

esophageal needs po fluconazole

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8
Q

HIV screen consists of ___
if positive, confirmed by ___

viral load? cd4 count?

A

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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9
Q

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

A

add Prednisone if O2 Sats really Low

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10
Q

Kaposi Sarcoma
bug
treat

A

HHV-8

treat AIDS with haart

if kaposi sarcoma refractory can resort to local then systemic chemo

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11
Q

HHV-6 causes

A

HHV-6 - Roseola in children

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12
Q

fevers neurologic deficits lymphadenopathy in AIDS
patient

suspect what bug
what cd4 count

A

Toxoplasma

CD4v100

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13
Q

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

A

HIV RNA viral load

rule out Acute RetroViral Syndrome

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

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14
Q

when is HIV RNA viral load the best diagnostic test?

A

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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15
Q

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

A

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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16
Q

a positive ppd should at least prompt suspicion for

A

Positive PPD at Least rule out Latent TB

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17
Q

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

A

empiric therapy for MDR TB

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

RPE and some other stuff…

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18
Q

active TB gets ____

A

Active TB gets RIPE B6

rifampin isoniazid pyrazinamide (and B6) and ethambutol

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19
Q

side effects of RIPE for TB

A

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

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20
Q

3 steps as you rule out / diagnose TB

A

isolate
cxr
afb sputum

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21
Q

diagnosis for caseating vs noncaseating granulomas in the lung

A

caseating - TB

non-caseating - sarcoid

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22
Q

cavitary lung lesion on cxr

ddx is __ vs __

how do you know

A

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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23
Q

PPD warranting further investigation in a very low risk patient

A

^15mm ppd

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

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24
Q

sepsis

severe sepsis

septic shock

multiorgan dysfunction syndrome

A

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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25
Q

empiric coverage for meningitis

in immunocompetent adult

in immunocompromised adult

A

ceftriaxone vancomycin dexamethasone

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

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26
Q

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

A

T…

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27
Q

fever ams fnds ring enhancing brain lesion on head ct think

next step

A

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)

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28
Q

blood in spinal tap is excellent clue for

A

HSV encephalitis

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29
Q

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

A

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

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30
Q

pick the meningitis bug

  • most common
  • college student rapid 24hr deterioration petechial rash
  • unimmunized peds
  • neonate
  • elderly
  • immunocompromised
A 
strep pneumo - most common
n meningitis - college rapid petechiae
unimm peds - h flu b
neonate - gbs listeria ecoli
elderly - listeria
immunocompromised - listeria
31
Q

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

A

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

32
Q

emprically treat contacts of n.meningitis meningitis college with ___

A

po Rifampin

ceftriaxone and vanc are iv

33
Q

temporal lobe is mentioned in relation to brain inflammation, think

A

HSV encephalitis

34
Q

initial imaging for suspected osteomyelitis

A

xray

then mri if xray normal but still high suspicion

35
Q

when to biopsy osteomyelitis vs treat empirically

A

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

treat empirically if toxic

36
Q

substitutes for pip-tazo if worried about kidneys

A

cefipime and metronidazole
or
levofloxacin and metronidazole

same anti-pseudomonal and anaerobic coverage

37
Q

clindamycin covers

ampicillin-sulbactam covers

A

clindamycin - MSSA GAS Anaerobes

unasyn - MSSA some GNRs but not pseudomonas and Anaerobes

38
Q

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

A

scabies

transmission between family members and linear furrows in webs of fingers

39
Q

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

A

scabies
topical permethrin first line

oral ivermectin backup first line but not v15kg patient

topical lindane 2nd line because neurotoxic side effect

40
Q

smoking and COPD pneumonia what bug to think

A

strep pneumo regardless of risk factors

H flu for PNA smoker COPD

41
Q

when is staph aureus a probable CAP bug

A

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

42
Q

multifocal pneumonia suggests this bug

A

staph aureus

multifocal pneumonia

43
Q

gram negative rods in PNA think what bugs

A

h flu (coccobacilli… COPDers)

pseudomonas (VAP)

44
Q

when is vanc pip-tazo your regimen for PNA

A

if HAP

need pseudomonas coverage

45
Q

sounds like uti but tender prostate

dx
tx

A

prostatitis

tmpsmx or fluoroquinolone

46
Q

GPCs on gram stain of urine

treat

A

ampicillin

ceftriaxone does not cover enterococcus

47
Q

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

A

Ciprofloxacin

48
Q

why not nitrofurantoin for pyelo

A

does not penetrate renal parenchyma well

49
Q

pyelo worsening despite appropriate GNR coverage, still GNRs in urine

next step? why?

A

CT or Ultrasound abdomen

likely abscess

50
Q

how long to treat male outpatient uti

A

7 day course of abx (male uti is complicated)

cipro levo nitro tmpsmx amox-clav doesn’t matter

51
Q

how long to treat uncomplicated female outpatient uti

A

3 day course of abx (male uti is complicated)

cipro levo nitro tmpsmx amox-clav doesn’t matter

52
Q

treat asymptomatic bacteruria in pregnancy with

A

amoxicillin cephalexin or nitrofurantoin

53
Q

single painful genital ulcer with lymphadenopathy dx

A

H. Ducreyi Chancroid

54
Q

multiple shallow genital uclers with roofs on an erythematous base dx

A

herpes simplex virus

55
Q

painless genital ulcer with lymphadenopathy dx

A

primary syphilis

56
Q

targetoid lesions on arms legs trunk including palms and soles

dx
tx
if allergic to that one
if allergic and pregnant

A

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

57
Q

gancyclovir is used to treat ___

A

gancyclovir for CMV

58
Q

treat acyclovir resistant HSV

A

foscarnet

acyclovir resistant will also be valacyclovir resistant

59
Q

treat shingles aka vzv aka hhv3

A

PO Acyclovir

60
Q

treat zoster opthalmacus with PO or IV Acyclovir?

A

PO acyclovir for zoster opthalmacus

iv acyclovir for herpes Encephalitis

61
Q

treat h.ducreyi chancroid

A

PO Azythromycin

62
Q

treat recurrent unilateral epistaxis

A

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

63
Q

tf

rhinoplasty for recurrent epistaxis

A

F

rhinoplasty for deviated septum or perforate septum, not bleeding

64
Q

pt with likely strep, rapid swab or treat empirically?

A

rapid swab… don’t treat strep empirically

65
Q

treat otitis externa with systemic toxic effects

A

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

66
Q

fever iv drug use new murmur think

A

infective endocarditis

fever
iv drug use
new murmur

67
Q

bug in infective endocarditis

A

staph aureus

68
Q

empiric antibiotics for endocarditis

bugs

A

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

69
Q

antibiotic ppx for prosthetic valve endocarditis eg if having dental or throat procedure

what bug are you watching out for

A

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

70
Q

most common bug in infective endocarditis

A

staph aureus
infective endocarditis

this is why vanc is the backbone of empiric coverage

71
Q

if you see strep bovis bacteremia or endocarditis, get ___

A

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

72
Q

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

A

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

73
Q

suspect prosthetic valve endocarditis, next step?

A

TEE

Medicine (13 decks)

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