ID Flashcards
1
Q
If a patient has suspected or confirmed pneumococcal meningitis, what should be added to treatment regimen?
A
dexamethasone, 15 mins before Abx and continued for 4 days
2
Q
Empiric Abx for meningitis, immunocompetent
A
IV CTX and Vanc
3
Q
Empiric meningitis abx if > 50 or altered cell immunity
A
IV CTX, Vanc and Ampicillin
4
Q
Empiric Abx for meningitis if allergic to beta lactams
A
moxiflox instead of CTX
Bactrim instead of ampicillin
5
Q
Hosp acquired meningitis -tx?
A
IV Vanc and IV Cefepime (or mero)
6
Q
neurosurg procedures and meningitis tx?
A
IV Vanc + IV Cefepime or mero
7
Q
Brain abscess - diagnosis?
A
imaging, MRI preferred
8
Q
Brain abscess - treatment duration
A
4-8 weeks
9
Q
Brain abscess - size for excision or drainage?
A
> 2.5cm
10
Q
should you do an LP if patient has a brain abscess?
A
NO! increased intracranial pressure and risk of herniation
11
Q
how diagnose HSV encephalitis?
A
HSV PCR
12
Q
Treatment and duration for HSV encephalitis?
A
IV Acyclovir for 14-21 days
13
Q
West Nile dz - how diagnose?
A
serum and CSF IgM to WNV
do not order a culture, rarely positive
14
Q
west nile dz - treatment?
A
supportive
15
Q
Dx NMDA receptor encephalitis?
A
CSF Ab testing
16
Q
NMDA receptor encephalitis tx?
A
remove teratoma glucocorticoids rite cyclophosphamide IVIG
17
Q
do mild abscesses, furuncles and carbuncles require abx?
A
no
I+D is primary treatment
high value care
18
Q
should uninfected diabetic foot wounds be cultured or treated?
A
no
high value care
19
Q
Do patients with erythema migrans and compatible exposure history need lab testing prior to treatment?
A
no! treat with oral abx
high value care
20
Q
who needs follow up cultures after acute pyelo?
A
pregnant women
high value care
21
Q
should you treat candida in respiratory tract or urinary tract?
A
no, usually colonizer
only treat if suspect infection
high value care
22
Q
who needs a test of cure for chlamydia?
A
pregnant women
high value care
23
Q
who needs a test of cure for gonorrhea?
A
patients with pharyngeal gonorrhea treated with an alternate abx regimen
24
Q
most healthy patients with watery diarrhea for less than 3 days can be treated how?
A
fluid replacement and no abx
high value care
25
do most patients need treatment for salmonella diarrhea?
no if less than 50yo, supportive care
high value care
26
do most patients need treatment for ETEC diarrhea?
no usually self limited
high value care
27
What is the treatment for CAP in ICU
CTX or Unasyn + levoflox or macrolide
28
What bacteria should you consider as a causative organism in non healing ulcers
M fortuitum
rapidly growing, non-TB mycobacterium
need wound biopsy to diagnose
29
Treatment for uncomplicated pyelo
Cipro x 1 week
Levoflox x 5 days
can do outpatient if stable
30
pregnant patient with zika exposure - what's the next step?
zika igM ab
31
pna or flu sx and works as a vet
What is the diagnosis?
Coxiella burnetii - Q fever
vets, farmers, slaughterhouse
32
cat bite in a patient with recent MRSA infection
What is the treatment?
unasyn or zosyn or carbapenem + vanc for this patient
cat bites more dangerous than dog bites because they have sharp teeth
33
patient with ehrlichioisis type presentation but negative serologic testing
What is the diagnosis?
Ehrlichiosis
negative serology does not disprove illness
PCR may be diagnostic
sensitivity is low early in illness
dx with blood smear with morulae
34
new HIV diagnosis - next step
genotypic viral resistance testing
35
aseptic meningitis - most common cause?
herpes simplex
36
elevated glucose is more consistent with viral or bacterial meningitis
viral glucose >45
| bacterial glucose <40
37
what imaging is best to diagnose brain abscess?
MRI
38
skin ulcer with necrotic center in a patient with neutropenia?
ecthyma gangrenosum from pseudomonas or another bacteria
39
chronic nodular infection of distal extremities with exposure to fish tanks or marine environments
What is the diagnosis?
mycobacterium marinum
40
chronic nodular infection of distal extremities with exposure to plants/soil
What is the diagnosis?
sporotrichosis and nocardia
41
sepsis after a dog bite in an asplenic patient?
capnocytophaga canimorsus
42
treatment options for purulent cellulitis - mild to mod severity?
clinda
doxy
bactrim
43
impetigo treatment?
mupirocin or treat as nonpurulent cellulitis
44
erysipelas tx?
pcn or amox
| ctx if systemic signs
45
folliculitis tx?
often resolves spontaneously
topical mupirocin or clindamycin lotion
46
human bites - tx?
unasyn (amp-sulbactam)
47
animal bites - tx?
unasyn (amp-sulbactam) or augmentin
48
neutropenia - tx?
vancopime
49
nec fasc - tx?
imipenem
clinda
vanc
debridement
50
erythrasma
topical erythromycin, clarithromycin or clindamycin
51
workup of diabetic foot infection?
cultures from deep tissue curettage or biopsy
foot imaging
ABI
52
treatment for toxic shock syndrome?
empiric: clinda and carbapenem
MRSA: double cover
MSSA: clinda plus nafcillin
can also use IVIG
53
should you use steroids for Toxic shock syndrome?
no
don't be tricked!
54
Treatment for CAP according to boards basics?
healthy patient - doxy or macrolide
healthy patient with >25% macrolide resistance: resp quinolone or b-lactam and macrolide
comorbidities or abx use in last 3 months -> resp quinolone or b-lactam and macrolide
inpatient, non ICU: resp quinolone or b-lactam and macrolide
ICU : IV beta lactam + azithro or resp quinolone
55
CAP - outpatient treatment duration
5 days
don't be tricked!
56
Can you prescribe doxy for lyme to pregnant women?
no!
don't be tricked!
57
early lyme - how treat?
doxy for 10-21 days
58
lyme - late carditis or neurologic dz, treatment?
IV PCN or CTX for 28 days
59
how diagnose babesia?
wright or giemsa smear with tetrads in erythrocytes
can also do PCR for babesia DNA
60
how treat asymptomatic babesia?
monitoring for 3 months, if persistent after that treat with atovaquone plus azithro
61
how treat severe babesiosis?
clinda + quinine
62
how diagnose ehrlichia and anaplasma?
whole blood PCR
63
tx for ehrlichia and anaplasma?
doxycycline
64
tx for RMSF?
doxycycline
chloramphenicol if pregnant
no response in 72 hours suggests an alternate diagnosis
65
which patients with asymptomatic bactiuria should you treat?
pregnant
about to undergo invasive urological procedure
don't be tricked!
66
empiric uncomplicated UTI tx
3 days bactrim
5 days macrobid
one dose 3g fosfomycin
67
complicated UTI tx
7 to 14 days with FQ
68
pregnant womn with complicated uti
7 days of augmentin, macroid, cefpodox or cefixime, get a urine culture
69
pyelo tx
FQ
5 to 7 days uncomplicated
complicated 14 days
if coming from long term care facility treat for VRE and FQ-resistant GNRs
70
how can you diagnose TB meningitis
NAAT (nucleic acid amplification testing) of the CSF is highly specific
71
all patients who test positive for TB should be tested for what?
HIV
72
which patients should have drug susceptibility testing done on TB isolates?
all patients
73
if treating TB with pyrizanimide or ethambutol what additional testing is needed?
uric acid for pyrazinamide
visual acuity for ethambutol
74
fever, weight loss and night sweats and GI sx in an HIV pt with CD4 <50
MAC
tx: clarithromycin or azithromycin with ethambutol and rifampin or rifabutin
and susceptibility testing
75
gold standard to diagnose aspergillus infection?
deep tissue culture
76
treatment for aspergillosis
voriconazole
surgical resection if hemoptysis
ABPA with oral steroids
77
What is the treatment for patients with aspergillomas who are asymptomatic and have stable x rays?
no treatment
don't be tricked!
78
is candida in the blood ever a contaminant?
no
don't be tricked!
79
What is the treatment for candida
candidema: echinocandin (mica, caspofungin, anidulafungin)
fluc effective at preventing candida infections in neutropenic onc patients (doesn't prevent other fungal infections)
80
treatment for cryptococcus?
ampothericin B plus flucytosine for induction tx of meningitis and then fluconazole maintenance therapy
need maintenance therapy for patients with AIDS until CD4 >100 x 3 months and viral load is supporessed. Treat elevated intracranial pressure with serial therapeutic LPs or extraventricular drain placement t
81
What is the treatment for fulminant C Diff
Fulminant Clostridium difficile infections require oral vancomycin plus intravenous metronidazole; vancomycin enemas may also be added if ileus is present
82
what vaccines do patients with HIV need?
PCV13 and meningitis, then PPSV23
no live vaccines if CD4 <200
83
What is the treatment duration for VAP
7 days
84
What is the treatment for epididymitis
In older men and persons who practice insertive anal intercourse, infectious epididymitis should be treated with ceftriaxone and a fluoroquinolone, such as levofloxacin.
85
how long do HIV patients need to be on PCP ppx for?
Patients with HIV who are taking antiretroviral therapy and achieve CD4 cell counts greater than 200/µL for more than 3 months may safely discontinue prophylaxis for Pneumocystis jirovecii infection.
86
What is the treatment for cyclospora
bactrim
87
New brain mass in patient with AIDS - What is the diagnostic workup?
Stereotactic brain biopsy is the gold standard for the diagnosis of focal central nervous system (CNS) lesions in AIDS.
88
What is the treatment for chlamydia trachomitis?
azithro or doxy
89
what diagnosis should you consider in patients with recurrent gonococcal infections?
terminal component complement deficiency
don't be tricked!
90
how can you diagnose chlamydia or gonorrhea?
NAAT
91
What is the treatment for gonorrhea
CTX + Azithro or Doxy for chlamydia
10 days of tx for epididymitis in men <35yo
disseminated infection: 7-14 days of CTX
92
What is the treatment for PID
1 dose CTX
doxy +/- flagyl for 14 days
hospitalize if suspect abscess or if pregnant or unstable, etc. other general reasons to hospitalize
93
If a patient has a positive FTA-ABS for syphilis, will this become negative after treatment?
no! will remain positive indefinitely
don't be tricked!
94
What is the first step to diagnose syphilis?
RPR or VDRL
95
What is the second step to diagnose syphilis?
Fluorescent treponemal antibody absorption test (FTA-ABS) or treponema pallidum particle agglutination (TPPA) assay
96
Which patients with syphilis need an LP?
Primary or secondary syphilis and any neurologic sign or symptom
97
How do you diagnose neurosyphilis?
CSF lymps > 5
elevated CSF protein
positive CSF VDRL test
98
What is the treatment for primary syphilis?
1 dose IM benzathine PCN
99
What is the treatment for secondary syphilis
1 dose IM benzathine PCN
100
What is the treatment for early latent syphilis
1 dose IM benzathine PCN
101
What is the treatment for late latent syphilis or syphilis of unknown duration
3 weekly doses of IM benzathine PCN
102
What is the treatment for neurosyphilis
continuosu penicillin G (q4) for 10-14 days
103
if non-treponemal testing does NOT decrease by at least 4x in the 6-12 months post syphilis treatment what does that tell you?
treatment failure or reacquisition
don't be tricked!
104
is a positive HSV-2 Ab test useful?
no, only indicates prior infection
105
What is the treatment for genital herpes
acyclovir, famciclovir or valacyclovir for 7 to 10 days
106
What is the treatment for oral HSV
acyclovir, famciclovir or valacyclovir for 7 to 10 days
usually do not treat recurrent disease , can do suppressive therapy if > 6 episodes a year especially if patients are immunocompromised
107
does treatment of genital warts prevent transmission?
no
108
what organism can cause osteomyelitis after a dog or cat bite?
pasturella multocida
109
What is the treatment for osteomyelitis due to a hardware infection when the hardware can't be removed?
3-6 months of a fluoroquinolone and rifampin
110
should you obtain follow up MRIs for patients with osteo
no
don't be tricked!
111
What are common medications that cause fever of unknown origin?
allopurinol
anticonvulsants
antibiotics
112
patients deficient in what are at high risk of transfusion reactions?
IgA because they develop antibodies.
do not give these patients IVIG!
113
how long are patients with smallpox contagious until?
all scabs and crusts are shed
don't be tricked!
114
What is the treatment for small pox
tecovirimat
post exposure vaccination with vaccinia within 7 days of exposure and close monitoring
115
post exposure prophylaxis for anthrax?
vaccination and cipro for 60 days
116
What is the treatment for antrhax
cutaneous - oral cipro
all other forms: IV cipro and 2 add'l antibiotics
117
What is the treatment for plague
file this under 'could look up in a pinch'
streptomycin or gentamicin
118
what type of paralysis do you see in botulism
descending
119
how do you diagnose botulism
identifying the toxin in blood, stool or wound
120
What is the treatment for botulism
trivalent equine serum ASAP and respiratory support
121
What is the diagnosis?
Acute onset of fever with chills, biphasic fever pattern (“saddleback”), frontal headache, lumbosacral pain, extensor surface petechiae
Dengue fever
122
What is the diagnosis?
Fever (abrupt onset up to 40 °C [104 °F] with rigors with recrudescent episodes), rash, and small joint polyarthritis
Chikungunya fever
123
What is the diagnosis?
Prolonged fever, pulse-temperature dissociation, diarrhea or constipation, faint salmon-colored macules on the abdomen and trunk (“rose spots”)
typhoid fever
124
patient recently in hawaii working with animals - develops fever, conjunctival suffusion, rhabdo
What is the diagnosis?
leptospirosis
often self limited
can use PCN or doxy
125
What is the treatment for campylobacter
azithro or erythromycin
126
What is the treatment for yersinia
FQ or bactrim
127
What is the treatment for cholera
FQ or azithro
128
What is the treatment for cryptosporidium
supportive care
nitazoxanide for symptomatic patients
dx: modified acid fast stain, stool ag
* HIV patients are at high risk
129
what vaccines should not be given to post transplant patients receiving immunosuppression?
live vaccines
130
how should you treat HAP/VAP with MDROs?
If MDRO and MRSA risk factors are present, select two antibiotics of different classes with activity against Pseudomonas aer- uginosa (for example piperacillin-tazobactam plus gentamycin) and one drug with activity against MRSA (vancomycin or linezolid).
131
What is the treatment for IV catheter-related S. aureus bacteremia that clears within 72 hours without evidence of endocarditis or metastatic infection
10-14 days of oral abx
132
What is the treatment for complicated IV S. Aureus bacteremia?
4-6 weeks abx
133
what is post-exposure prophylaxis for HIV?
tenofovir, emtricitabine, and raltegravir for 4 weeks
Testing for HIV should be done immediately and at 6 weeks, 12 weeks, and 6 months.
134
how often should you screen adults at high risk for HIV
at least annually
135
What does a positive NAAT in the setting of a negative antibody for HIV test indicate?
acute HIV infection
136
what is the diagnostic criteria for AIDS?
CD4 <200 or presence of an AIDS defining illness
137
Should women with HIV breastfeed?
no
138
what is the prophylaxis for MAC in HIV patients
azithro if CD4 <50
139
Can HIV patients receive live vaccines?
yes if CD4 > 200
140
clues that a patient has PCP pna?
elevated LDH
immunocompromised
bilateral, fluffy infiltrates
141
What is the treatment for PCP pna?
3 weeks of;
oral bactrim for mild to mod pna
iv bactrim for mod to severe pna
glucocorticoids within 72 hours for A-a ≥35 mm Hg or arterial Po2 <70 mm Hg
IV pentamidine or IV clindamycin plus oral primaquine for patients with sulfa allergy
142
how do you diagnose toxo?
Select IgG serologic testing in patients with suspected toxoplasmosis and brain MRI or head CT for neurologic signs and symp- toms. Typical findings on imaging include multiple ring-enhancing lesions.
143
how do you diagnose progressive multifocal leukoencephalopathy?
brain biopsy
144
how treat toxoplasmosis
Select empiric treatment with sulfadiazine, pyrimethamine, and folic acid in patients with multiple ring-enhancing lesions, positive T. gondii serologic test results (IgG), and immune suppression (CD4 cell count <200/μL).
continue indefinitely
145
What additional precautions are needed for flu?
droplet in all hospitalized patients
146
young patients with zoster should be tested for what?
HIV
147
what is post-exposure prophylaxis for varicella?
give if VZV IgG negative
postexposure varicella vaccination is appropriate in immunocompetent persons, and varicella-zoster immune globulin should be used in immunocompromised adults and in pregnant women.
148
how do you diagnose EBV?
Select a Monospot test (heterophile antibody test), which is specific but not very sensitive early in disease. If the Monospot test is negative, repeat in 2 weeks or select EBV serology.
149
What is the treatment for mononucelosis
supportive
150
patient with Crohn's going to mexico - how prophylax against traveler's diarrhea?
cipro
