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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

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2
Q

Empiric Abx for meningitis, immunocompetent

A

IV CTX and Vanc

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3
Q

Empiric meningitis abx if > 50 or altered cell immunity

A

IV CTX, Vanc and Ampicillin

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4
Q

Empiric Abx for meningitis if allergic to beta lactams

A

moxiflox instead of CTX

Bactrim instead of ampicillin

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5
Q

Hosp acquired meningitis -tx?

A

IV Vanc and IV Cefepime (or mero)

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6
Q

neurosurg procedures and meningitis tx?

A

IV Vanc + IV Cefepime or mero

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7
Q

Brain abscess - diagnosis?

A

imaging, MRI preferred

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8
Q

Brain abscess - treatment duration

A

4-8 weeks

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9
Q

Brain abscess - size for excision or drainage?

A

> 2.5cm

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10
Q

should you do an LP if patient has a brain abscess?

A

NO! increased intracranial pressure and risk of herniation

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11
Q

how diagnose HSV encephalitis?

A

HSV PCR

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12
Q

Treatment and duration for HSV encephalitis?

A

IV Acyclovir for 14-21 days

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13
Q

West Nile dz - how diagnose?

A

serum and CSF IgM to WNV

do not order a culture, rarely positive

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14
Q

west nile dz - treatment?

A

supportive

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15
Q

Dx NMDA receptor encephalitis?

A

CSF Ab testing

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16
Q

NMDA receptor encephalitis tx?

A 
remove teratoma
glucocorticoids
rite
cyclophosphamide
IVIG
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17
Q

do mild abscesses, furuncles and carbuncles require abx?

A

no

I+D is primary treatment

high value care

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18
Q

should uninfected diabetic foot wounds be cultured or treated?

A

no

high value care

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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

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20
Q

who needs follow up cultures after acute pyelo?

A

pregnant women

high value care

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21
Q

should you treat candida in respiratory tract or urinary tract?

A

no, usually colonizer
only treat if suspect infection

high value care

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22
Q

who needs a test of cure for chlamydia?

A

pregnant women

high value care

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23
Q

who needs a test of cure for gonorrhea?

A

patients with pharyngeal gonorrhea treated with an alternate abx regimen

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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

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25
Q

do most patients need treatment for salmonella diarrhea?

A

no if less than 50yo, supportive care

high value care

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26
Q

do most patients need treatment for ETEC diarrhea?

A

no usually self limited

high value care

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27
Q

What is the treatment for CAP in ICU

A

CTX or Unasyn + levoflox or macrolide

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28
Q

What bacteria should you consider as a causative organism in non healing ulcers

A

M fortuitum
rapidly growing, non-TB mycobacterium

need wound biopsy to diagnose

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29
Q

Treatment for uncomplicated pyelo

A

Cipro x 1 week
Levoflox x 5 days

can do outpatient if stable

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30
Q

pregnant patient with zika exposure - what’s the next step?

A

zika igM ab

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31
Q

pna or flu sx and works as a vet

What is the diagnosis?

A

Coxiella burnetii - Q fever

vets, farmers, slaughterhouse

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32
Q

cat bite in a patient with recent MRSA infection

What is the treatment?

A

unasyn or zosyn or carbapenem + vanc for this patient

cat bites more dangerous than dog bites because they have sharp teeth

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33
Q

patient with ehrlichioisis type presentation but negative serologic testing

What is the diagnosis?

A

Ehrlichiosis

negative serology does not disprove illness

PCR may be diagnostic
sensitivity is low early in illness

dx with blood smear with morulae

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34
Q

new HIV diagnosis - next step

A

genotypic viral resistance testing

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35
Q

aseptic meningitis - most common cause?

A

herpes simplex

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36
Q

elevated glucose is more consistent with viral or bacterial meningitis

A

viral glucose >45

bacterial glucose <40

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37
Q

what imaging is best to diagnose brain abscess?

A

MRI

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38
Q

skin ulcer with necrotic center in a patient with neutropenia?

A

ecthyma gangrenosum from pseudomonas or another bacteria

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39
Q

chronic nodular infection of distal extremities with exposure to fish tanks or marine environments

What is the diagnosis?

A

mycobacterium marinum

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40
Q

chronic nodular infection of distal extremities with exposure to plants/soil

What is the diagnosis?

A

sporotrichosis and nocardia

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41
Q

sepsis after a dog bite in an asplenic patient?

A

capnocytophaga canimorsus

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42
Q

treatment options for purulent cellulitis - mild to mod severity?

A

clinda
doxy
bactrim

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43
Q

impetigo treatment?

A

mupirocin or treat as nonpurulent cellulitis

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44
Q

erysipelas tx?

A

pcn or amox

ctx if systemic signs

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45
Q

folliculitis tx?

A

often resolves spontaneously

topical mupirocin or clindamycin lotion

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46
Q

human bites - tx?

A

unasyn (amp-sulbactam)

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47
Q

animal bites - tx?

A

unasyn (amp-sulbactam) or augmentin

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48
Q

neutropenia - tx?

A

vancopime

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49
Q

nec fasc - tx?

A

imipenem
clinda
vanc

debridement

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50
Q

erythrasma

A

topical erythromycin, clarithromycin or clindamycin

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51
Q

workup of diabetic foot infection?

A

cultures from deep tissue curettage or biopsy
foot imaging
ABI

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52
Q

treatment for toxic shock syndrome?

A

empiric: clinda and carbapenem

MRSA: double cover

MSSA: clinda plus nafcillin

can also use IVIG

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53
Q

should you use steroids for Toxic shock syndrome?

A

no

don’t be tricked!

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54
Q

Treatment for CAP according to boards basics?

A

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

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55
Q

CAP - outpatient treatment duration

A

5 days

don’t be tricked!

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56
Q

Can you prescribe doxy for lyme to pregnant women?

A

no!

don’t be tricked!

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57
Q

early lyme - how treat?

A

doxy for 10-21 days

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58
Q

lyme - late carditis or neurologic dz, treatment?

A

IV PCN or CTX for 28 days

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59
Q

how diagnose babesia?

A

wright or giemsa smear with tetrads in erythrocytes

can also do PCR for babesia DNA

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60
Q

how treat asymptomatic babesia?

A

monitoring for 3 months, if persistent after that treat with atovaquone plus azithro

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61
Q

how treat severe babesiosis?

A

clinda + quinine

62
Q

how diagnose ehrlichia and anaplasma?

A

whole blood PCR

63
Q

tx for ehrlichia and anaplasma?

A

doxycycline

64
Q

tx for RMSF?

A

doxycycline

chloramphenicol if pregnant

no response in 72 hours suggests an alternate diagnosis

65
Q

which patients with asymptomatic bactiuria should you treat?

A

pregnant

about to undergo invasive urological procedure

don’t be tricked!

66
Q

empiric uncomplicated UTI tx

A

3 days bactrim
5 days macrobid
one dose 3g fosfomycin

67
Q

complicated UTI tx

A

7 to 14 days with FQ

68
Q

pregnant womn with complicated uti

A

7 days of augmentin, macroid, cefpodox or cefixime, get a urine culture

69
Q

pyelo tx

A

FQ
5 to 7 days uncomplicated
complicated 14 days

if coming from long term care facility treat for VRE and FQ-resistant GNRs

70
Q

how can you diagnose TB meningitis

A

NAAT (nucleic acid amplification testing) of the CSF is highly specific

71
Q

all patients who test positive for TB should be tested for what?

A

HIV

72
Q

which patients should have drug susceptibility testing done on TB isolates?

A

all patients

73
Q

if treating TB with pyrizanimide or ethambutol what additional testing is needed?

A

uric acid for pyrazinamide

visual acuity for ethambutol

74
Q

fever, weight loss and night sweats and GI sx in an HIV pt with CD4 <50

A

MAC

tx: clarithromycin or azithromycin with ethambutol and rifampin or rifabutin

and susceptibility testing

75
Q

gold standard to diagnose aspergillus infection?

A

deep tissue culture

76
Q

treatment for aspergillosis

A

voriconazole

surgical resection if hemoptysis

ABPA with oral steroids

77
Q

What is the treatment for patients with aspergillomas who are asymptomatic and have stable x rays?

A

no treatment

don’t be tricked!

78
Q

is candida in the blood ever a contaminant?

A

no

don’t be tricked!

79
Q

What is the treatment for candida

A

candidema: echinocandin (mica, caspofungin, anidulafungin)

fluc effective at preventing candida infections in neutropenic onc patients (doesn’t prevent other fungal infections)

80
Q

treatment for cryptococcus?

A

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
Q

What is the treatment for fulminant C Diff

A

Fulminant Clostridium difficile infections require oral vancomycin plus intravenous metronidazole; vancomycin enemas may also be added if ileus is present

82
Q

what vaccines do patients with HIV need?

A

PCV13 and meningitis, then PPSV23

no live vaccines if CD4 <200

83
Q

What is the treatment duration for VAP

A

7 days

84
Q

What is the treatment for epididymitis

A

In older men and persons who practice insertive anal intercourse, infectious epididymitis should be treated with ceftriaxone and a fluoroquinolone, such as levofloxacin.

85
Q

how long do HIV patients need to be on PCP ppx for?

A

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
Q

What is the treatment for cyclospora

A

bactrim

87
Q

New brain mass in patient with AIDS - What is the diagnostic workup?

A

Stereotactic brain biopsy is the gold standard for the diagnosis of focal central nervous system (CNS) lesions in AIDS.

88
Q

What is the treatment for chlamydia trachomitis?

A

azithro or doxy

89
Q

what diagnosis should you consider in patients with recurrent gonococcal infections?

A

terminal component complement deficiency

don’t be tricked!

90
Q

how can you diagnose chlamydia or gonorrhea?

A

NAAT

91
Q

What is the treatment for gonorrhea

A

CTX + Azithro or Doxy for chlamydia

10 days of tx for epididymitis in men <35yo

disseminated infection: 7-14 days of CTX

92
Q

What is the treatment for PID

A

1 dose CTX

doxy +/- flagyl for 14 days

hospitalize if suspect abscess or if pregnant or unstable, etc. other general reasons to hospitalize

93
Q

If a patient has a positive FTA-ABS for syphilis, will this become negative after treatment?

A

no! will remain positive indefinitely

don’t be tricked!

94
Q

What is the first step to diagnose syphilis?

A

RPR or VDRL

95
Q

What is the second step to diagnose syphilis?

A

Fluorescent treponemal antibody absorption test (FTA-ABS) or treponema pallidum particle agglutination (TPPA) assay

96
Q

Which patients with syphilis need an LP?

A

Primary or secondary syphilis and any neurologic sign or symptom

97
Q

How do you diagnose neurosyphilis?

A

CSF lymps > 5
elevated CSF protein
positive CSF VDRL test

98
Q

What is the treatment for primary syphilis?

A

1 dose IM benzathine PCN

99
Q

What is the treatment for secondary syphilis

A

1 dose IM benzathine PCN

100
Q

What is the treatment for early latent syphilis

A

1 dose IM benzathine PCN

101
Q

What is the treatment for late latent syphilis or syphilis of unknown duration

A

3 weekly doses of IM benzathine PCN

102
Q

What is the treatment for neurosyphilis

A

continuosu penicillin G (q4) for 10-14 days

103
Q

if non-treponemal testing does NOT decrease by at least 4x in the 6-12 months post syphilis treatment what does that tell you?

A

treatment failure or reacquisition

don’t be tricked!

104
Q

is a positive HSV-2 Ab test useful?

A

no, only indicates prior infection

105
Q

What is the treatment for genital herpes

A

acyclovir, famciclovir or valacyclovir for 7 to 10 days

106
Q

What is the treatment for oral HSV

A

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
Q

does treatment of genital warts prevent transmission?

A

no

108
Q

what organism can cause osteomyelitis after a dog or cat bite?

A

pasturella multocida

109
Q

What is the treatment for osteomyelitis due to a hardware infection when the hardware can’t be removed?

A

3-6 months of a fluoroquinolone and rifampin

110
Q

should you obtain follow up MRIs for patients with osteo

A

no

don’t be tricked!

111
Q

What are common medications that cause fever of unknown origin?

A

allopurinol
anticonvulsants
antibiotics

112
Q

patients deficient in what are at high risk of transfusion reactions?

A

IgA because they develop antibodies.

do not give these patients IVIG!

113
Q

how long are patients with smallpox contagious until?

A

all scabs and crusts are shed

don’t be tricked!

114
Q

What is the treatment for small pox

A

tecovirimat

post exposure vaccination with vaccinia within 7 days of exposure and close monitoring

115
Q

post exposure prophylaxis for anthrax?

A

vaccination and cipro for 60 days

116
Q

What is the treatment for antrhax

A

cutaneous - oral cipro

all other forms: IV cipro and 2 add’l antibiotics

117
Q

What is the treatment for plague

A

file this under ‘could look up in a pinch’

streptomycin or gentamicin

118
Q

what type of paralysis do you see in botulism

A

descending

119
Q

how do you diagnose botulism

A

identifying the toxin in blood, stool or wound

120
Q

What is the treatment for botulism

A

trivalent equine serum ASAP and respiratory support

121
Q

What is the diagnosis?

Acute onset of fever with chills, biphasic fever pattern (“saddleback”), frontal headache, lumbosacral pain, extensor surface petechiae

A

Dengue fever

122
Q

What is the diagnosis?

Fever (abrupt onset up to 40 °C [104 °F] with rigors with recrudescent episodes), rash, and small joint polyarthritis

A

Chikungunya fever

123
Q

What is the diagnosis?

Prolonged fever, pulse-temperature dissociation, diarrhea or constipation, faint salmon-colored macules on the abdomen and trunk (“rose spots”)

A

typhoid fever

124
Q

patient recently in hawaii working with animals - develops fever, conjunctival suffusion, rhabdo

What is the diagnosis?

A

leptospirosis

often self limited

can use PCN or doxy

125
Q

What is the treatment for campylobacter

A

azithro or erythromycin

126
Q

What is the treatment for yersinia

A

FQ or bactrim

127
Q

What is the treatment for cholera

A

FQ or azithro

128
Q

What is the treatment for cryptosporidium

A

supportive care

nitazoxanide for symptomatic patients

dx: modified acid fast stain, stool ag
* HIV patients are at high risk

129
Q

what vaccines should not be given to post transplant patients receiving immunosuppression?

A

live vaccines

130
Q

how should you treat HAP/VAP with MDROs?

A

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
Q

What is the treatment for IV catheter-related S. aureus bacteremia that clears within 72 hours without evidence of endocarditis or metastatic infection

A

10-14 days of oral abx

132
Q

What is the treatment for complicated IV S. Aureus bacteremia?

A

4-6 weeks abx

133
Q

what is post-exposure prophylaxis for HIV?

A

tenofovir, emtricitabine, and raltegravir for 4 weeks

Testing for HIV should be done immediately and at 6 weeks, 12 weeks, and 6 months.

134
Q

how often should you screen adults at high risk for HIV

A

at least annually

135
Q

What does a positive NAAT in the setting of a negative antibody for HIV test indicate?

A

acute HIV infection

136
Q

what is the diagnostic criteria for AIDS?

A

CD4 <200 or presence of an AIDS defining illness

137
Q

Should women with HIV breastfeed?

A

no

138
Q

what is the prophylaxis for MAC in HIV patients

A

azithro if CD4 <50

139
Q

Can HIV patients receive live vaccines?

A

yes if CD4 > 200

140
Q

clues that a patient has PCP pna?

A

elevated LDH

immunocompromised

bilateral, fluffy infiltrates

141
Q

What is the treatment for PCP pna?

A

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
Q

how do you diagnose toxo?

A

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
Q

how do you diagnose progressive multifocal leukoencephalopathy?

A

brain biopsy

144
Q

how treat toxoplasmosis

A

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
Q

What additional precautions are needed for flu?

A

droplet in all hospitalized patients

146
Q

young patients with zoster should be tested for what?

A

HIV

147
Q

what is post-exposure prophylaxis for varicella?

A

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
Q

how do you diagnose EBV?

A

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
Q

What is the treatment for mononucelosis

A

supportive

150
Q

patient with Crohn’s going to mexico - how prophylax against traveler’s diarrhea?

A

cipro

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