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Internal Medicine > ID > Flashcards

ID Flashcards

1
Q

UTI in a female - what bacteria are responsible? What is different about proteus?

A

80% are E. coli
Rest include proteus, klebsiella, staph saprophyticus, enterococcus, candida, pseudomonas, staph, citreus

Proteus and Klebsiella alkalinize urine, ph>8, and raise risk for struvite stones/calculi

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2
Q

What is the treatment for uncomplicated cystitis

A

Nitrofurantoin x 5 days
TMP-SMX x 3 days
Fosfomycin x1 or ciprofloxacin x3 if resistant or allergy

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3
Q

What is the treatment for complicated cystitis

A

FQ 5-14 days

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4
Q

What is the treatment for pyelonephritis

A

FQ as outpatient (cipro, levo)

IV FQ or aminoglycoside as inpatient

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5
Q

How do you diagnose and treat listeria meningitis?

A

Gram positive bacilli

Tx with ampicillin

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6
Q

When do you treat sinusitis with antibiotics? Which antibiotics?

A

3-4 days of severe symptoms (fever, purulent drainage, facial pain), worsening of sx initially improving after URI, or symptoms not improving after 10 days

If abx: amox-clavulanate or doxycycline

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7
Q

What the the Centor criteria and what do they predict?

A

Temp >38.1100.5, tonsillar exudates, tender cervical lymphadenopathy, absence of cough

With all four, 40% chance of having group A beta-hemolytic strep pharyngitis

Proceed to rapid antigen detection test or throat culture

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8
Q

How do you treat otitis externa?

A

Neomycin, polymyxin B, and hydrocortisone topical for 7-10 days

If granulation tissue – malignant otitis externa, pseudomonas likely, tx with ciprofloxacin or other anti-pseudomonal abxan

If antibiotic - amoxicillin or azithromycin

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9
Q

Lemierre syndrome

A

Septic thrombosis of jugular vein
Pharyngitis, persistent fever, neck pain, septic pulmonary emboli
Diagnose by CT neck with contrast

Tx with penicillin with beta-lactalmase inhibitor or carbapenem

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10
Q

What should be used to treat pseudomonas-suspected pneumonia?

A

beta-lactam and aminoglycoside

Piperacillin-tazobactam (zosyn) and amikacin

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11
Q

How do you decide where to treat pneumonia?

A

CURB65 - confusion, BUN, resp >30, systolic <90/diastolic <60, age >65

If two criteria - admit to hospital
If 3 criteria - admit to ICU, mortality >20%

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12
Q

What is the treatment for outpatient community acquired pneumonia?

A

If risk factor for resistant S pneumo (age >65, recent abx, comorbidities, alcoholism, peds exposure, immunocompromise): respiratory quinolone (moxi, levo) or betalactam + macrolide (azithromycin)

If no risk factors: azithromycin macrolide, as it covers susceptible S pneumo, H flu, mycoplasma, and chlamydiophila. If need second-line, doxycycline.

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13
Q

What is the treatment for bacteremic susceptible pneumococcal pneumonia?

A

Start with IV ceftriaxone; if improving, oral amoxicillin to complete 7 days of therapy.

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14
Q

How do you interpret the tuberculin skin test?

A

5mm or greater: positive in HIV positive, recent exposure to active TB, organ transplant or immunosuppressed

10mm or greater: positive for high risk (IVDU, high prevalence country, jail, nursing home, health care)

15mm or greater: positive for person with no risk factors

If positive, CXR

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15
Q

What is the treatment for latent TB?

A

Isoniazid for 9 months

May reduce risk of active disease by 90%

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16
Q

What is the treatment for active TB?

A

2 months of RIPE; 7 months if isoniazid and rifampin

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17
Q

When is prophylactic antibiotics before dental procedure required? What drug is used? What about if the patient is penicillin-allergic?

A

Prosthetic heart valves
Prior infective endocarditis
Unrepaired congenital heart disease or recently repaired, or with remaining abnormalities
Heart transplant patients with valvulopathy
Dental procedure involving manipulation of gingival tissue, perforation or oral mucosa, or periapical region of teeth

NOT indicated in native valve abnormalities

Tx with amoxicillin or clindamycin if allergic

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18
Q

What do you treat MRSA endocarditis with? MSSA endocarditis?

A

MSSA: nafcillin, oxacillin
MRSA: IV vancomycin or daptomycin

19
Q

What is empiric therapy for pyelonephritis?

A

FQ (ciprofloxacin)
Extended-spectrum cephalosporin
Aminoglycoside

For 7-14 days

20
Q

What is the definition of recurrent UTI? How do you treat it?

A

≥2 infections in six months or ≥3 infections in one year

Post-coital ciprofloxacin prophylaxis, discontinue spermicide use

21
Q

What is the treatment for prostatitis?

A

FQ (ciprofloxacin)
TMP-SMX
Doxycycline

(usually caused by e coli)

22
Q

What is the treatment for epididymitis?

A

If sexually active, <35YO - ceftriaxone and doxy/azithromycin

(for chlamydia and gonorrhoeae)

23
Q

Chancroid

A

Single or multiple painful ulcers, ragged border, granulomatous base, purulent exudate

24
Q

Syphilis primary lesion

A

Single, painless ulcer, raised border

25
Q

What is the fundoscopic appearance of CMV retinitis?

A

Fluffy, yellow-white retinal lesions, +/- intraretinal hemorrhage

Tx with gancyclovir, foscarnet, or valgancyclovir and HAART

26
Q

What are the screening recommendations for HIV?

A

All patients bw 13 and 75 should be tested at least one by antibody/p24 antigen testing
If risk factors, annual testing

27
Q

What are guidelines for fluids, antibiotics, pressors and steroids for sepsis?

A

Early fluid resuscitation with crystalloid, 500-1000 ml bolus to MAP of 65 and CVP of 8-12
Antibiotics empirically within 1 hour
Pressors for septic shock: SIRS, organ dysfunction, hypotension non-responsive to 1L fluids
IV hydrocortisone if hypotension responds poorly to fluids and vasopressors

28
Q

What are three ways to prevent ventilator associated pneumonia?

A

Head of the bed at 30 degrees
Daily assessment of patient readiness to wean from vent
Chlorhexidine mouthwash

29
Q

Which bugs are responsible for osteomyelitis after puncture wounds?

A

Pseudomonas and staph aureus

30
Q

How do you treat PCP?

A

TMP-SMX

With steroids if impaired oxygenation <92%

31
Q

What is empiric therapy for a central line infection?

A

Vancomycin

covers coag negative staph and staph aureus
If severely ill, also add cefriaxone, ceftazidime or cefepime for gram negative and pseudomoas

32
Q

What antibiotics have anti-pseudomonal activity?

A

Ceftazidime, Cefepime (4th gen cephalosporin)
Merepenem, Imipenem (Carbapenems - NOT erta)
Piperacillin/Tazobactam (anti-pseudo penicillin)
Aztreonam
FQ - Cipro and Levo, NOT moxi
Aminoglycosides (Amikacin > Tobramycin > Gentamicin)

33
Q

When do you empirically cover for pseudomonas, and how do you cover?

A

Immunocompromise, cystic fibrosis, burn patient, any nosocomial (line, ventilator, catheter related)

Double coverage – a beta-lactam plus either Fluoroquinolone or Aminoglycoside. Use Aztreonam if PCN-allergic

34
Q

How do you treat community-acquired pneumonia?

A

Azithromycin (Macrolide) as single-agent therapy
Combine with ceftriaxone to cover strep pneumo resistance

OR

Levofloxacin or Moxifloxacin

Consider vancomycin or linezolid if suspect MRSA

35
Q

How do you treat HCAP?

A

Anti-MRSA antibiotic: Vancomycin or Linezolid
Antipseudomonal Beta-Lactam: Ceftazadime, Cefepime, Piperacillin/Tazobactam, Imipenem, Meropenem, Aztreonam if allergy.

*For severely ill patients, or if high risk of resistant gram negative infection, also consider addition of “double coverage” with Antipseudomonal Fluoroquinolone (Ciprofloxacin or Levofloxacin), or Aminoglycoside.

36
Q

How do you treat aspiration pneumonia?

A

Levofloxacin + Metronidazole

Clindamycin (add Levofloxacin if concern for community-acquired pneumonia)

Ampicillin/Sulbactam

37
Q

What is the causative agent of erysipelas, and how is it treated?

A

Group A strep
IV cefriaxone or cefazolin
If without systemic symptoms, amoxicillin

38
Q

Erysipelas

A

Strep pyogenes

Infection of superficial dermis. Rapid spread, demarcated edges

39
Q

Cellulitis

A

S pyogenes or MSSA, MRSA

Deep dermis and subcutaneous infection. Flat edges, poor demarcation, indolent course.

Treat with TMP-SMX or cephalexin; clindamycin to cover MRSA

40
Q

Endocarditis associated with prosthetic valves, catheters, or pacemakers

A

S aureus

Coag negative staph

41
Q

Endocarditis associated with dental procedures

A

viridans group strep (sanguinis)

42
Q

Endocarditis associated with nosocomial UTI

A

enterococcus

43
Q

Endocarditis associated with IBD

A

S bovis

44
Q

Endocarditis associated with IVDU

A

s aureus

Internal Medicine (4 decks)

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