ID Flashcards
What is the treatment for candidiasis?
Candidal esophagitis requires systemic therapy (as opposed to thrush which can be treated with topical swish and spit antifungal preparations).
What is the treatment for malignant otitis externa?
Malignant otitis externa as evidenced by the discharge, granulation tissue within the ear canal, fever, and pain on pulling the tragus.
Associated with an immunocompromised state, such as diabetes.
Otitis externa is often pseudomonal–> oral ciprofloxacin.
What is the treatment for herpes virus?
Acyclovir
If resistant to that then.. foscarnet
What is a positive PPD test for immunocompromised patient?
cutoff for patients with HIV/AIDS, transplant patients, chronic steroid use, and close contacts to patients with TB is >/= 5 mm. The next step after a positive PPD is the chest X-ray.
What should you do with pyelonephritis that does not improve with antibiotics?
If a patient with pyelonephritis does not show any signs of improvement at 48 hours (such as decrease in leukocytosis or resolution of fevers), imaging should be undertakne to evaluate for the presence of an abscess.
What is the treatment for mild community acquired pneumonia?
Mild community-acquired pneumonia can be treated with oral antibiotics - macrolide (clarithromycin, azithromycin), beta-lactam with inhibitor, or a fluroquinolone (levofloxaci)
What is the best test for diagnosing endocarditis?
Best test is transesophageal echocardiogram (TEE)
but do Transthoracic echocardiogram (TTE) if you have low pretest probability and want to rule out endocarditis.
How does (Haemophilus ducreyi) present?
A single painful ulcer with inguinal lymphadenopathy is chancroid
What is the treatment for pneumocystitis jiroveci pneumonia?
TMP/SMX. If there is profound hypoxia, steroids should also be given.
indications for endocarditis prophylaxis
surgery (mouth and throat) and a bad valve (prosthetic, congenital heart, or history of endocarditis).
Amoxicillin is the antibiotic you’d like to use
Allergic to penicillins, you can use cephalexin
If anaphylactic reaction (no penicillins or cephalosporins)
then use clindamycin and macrolides
How is osteomyelitis treated?
XRay–> MRI–> bone biopsy
Treating osteomyelitis without a biopsy is the right answer only when they are toxic.
What is the empiric therapy for bacterial meningitis?
Empiric therapy for bacterial meningitis includes ceftriaxone, vancomycin, and dexamethasone. Ampicillin should be added if immunocompromised.
Ring-enhancing brain lesions with a positive HIV should prompt suspicion for
toxoplasmosis- treat with Sulfadiazine, pyrimethamine, and folinic acid
Male UTIs treatment
Male UTIs are complicated UTIs by definition. They require 7 days of antimicrobial therapy.
Most commmon bug causing pneumonia in a COPD patient?
Pneumonia in a patient with COPD and smoking history should prompt suspicion for Haemophilus influenzae.
K.pneumoniae is associated with alcoholics and currant-jelly sputum.
S.aureus is associated with pneumonias following viral illnesses.
The most common organism is Streptococcus pneumoniae (regardless of risk factors).
M.catarrhalis is a common organism for sinusitis and pulmonary infections.
PCP prophylaxis?
CD4 Count <200 needs PCP prophylaxis TMP/SMX > dapsone > atovaquone.
What is the treatment for bronchitis?
Low fever, sputum production, and cough but no findings on chest xray–> bronchitis
Tx w/ tetracycline (doxy) or macrolide (azithromycin)
What is the outpatient management for pyelonephritis?
if not bad pyelo the no need to admit
treat w/ fluoroquinolone (ciprofloxacin)
How do you treat asymptomatic UTI in pregnant woman?
oral amoxicillin
Recheck culture in 2 weeks to confirm eradication
What is acute prostatitis?
Sounds like a UTI but w/ tender prostate/
Treat w/ TMP/SMX or fluoroquinolone
How to treat severe pyelonephritis?
Get cultures first AND THEN start pt on IV ceftriaxone
What antibiotics should be used for ascending cholangitis?
Intra abdominal infections require gram negative and anaerobic coverage.
Examples:
Ciprofloxacin for gram (-) coverage
Metronidazole for anaerobic coverage
What is the treatment for syphilis?
Treatment of choice is penicillin
if minor allergy or pregnant–> desensitize to pen and then give it
If anaphylaxis to pen–> Doxycycline (unless pregnant)
- can’t give doxy to pregnant *
How do you know when antibiotic is not effective (ie bacteria is resistant to it)?
If mean inhibitor concentration MIC >2
ex: if MIC for vanco is 2.5 then switch it to daptomycin to tx endocarditis
What is the treatment for endocarditis?
Acute endocarditis w/ staph–> empriric Vancomycin only
Vancomycin+ gentamycin+ Cefepime for new valve <60 days old
Vancomycin+gentamycin+ceftriaxone for old valve > 365 days old
Subacute endocarditis- No empiric antibiotics until (+) culture and then start specific antibiotic
meningitis empiric antibiotics
Neonates < 1month of age: ampicillin and cefotaxime
Children to Adults < 50 years of age: ceftriaxone and vancomycin
Adults >50 years of age: ceftriaxone, vancomycin, and ampicillin
Drug of choice for endocarditis prophylaxis for dental procedures
Amoxicillin
Treatment for Hepatitis C
Direct-acting antivirals (DAAs)
Patient should be tested for NS5A resistance-associated substitutions
Organophosphate toxicity treatment
Organophosphate toxicity leads to the inhibition of acetylcholinesterase and overstimulation of the parasympathetic nervous system. The treatment for organophosphate toxicity is the combination of atropine and pralidoxime.
AIDS patients CD4 and CD8 counts
Normally, there are more CD4 cells than CD8 cells
In AIDS the CD4:CD8 ratio is typically less than 1 since CD4 T cells are targeted by the virus
Diagnosis of bacterial vaginosis?
Amsel Criteria for Diagnosis of BV (at least three criteria must be present)
1) Thin, grayish discharge smoothly coats vaginal walls
2) Vaginal pH >4.5
3) Positive whiff (amine) test
4) Clue cells on wet mount
Antidotes to Heavy Metal Toxicities: Copper
Penicillamine, trientine
Antidotes to Heavy Metal Toxicities: Iron
Deferoxamine, deferasirox, deferiprone
Antidotes to Heavy Metal Toxicities: Lead, Mercury, Arsenic
Dimercaprol, succimer
Treatment for amyotrophic lateral sclerosis (ALS)
Neurodegenerative disease characterized by lower and upper motor neuron signs (wrist drop, diff swallowing, muscle atrophy, clonus, hyperreflexia)
Treated with riluzole (decreases presynaptic glutamate release)
Pheochromocytoma
Catecholamine secreting tumor that arises from the chromaffin cells of the adrenal medulla Classic triad: 1) Tachycardia 2) Headaches 3) Diaphoresis
Dx: serum or urine metanephrines.
Pheochromocytoma has classically been associated with:
Von Hippel-Lindau syndrome, multiple endocrine neoplasia types 2A and 2B, and neurofibromatosis type 1
Wernicke encephalopathy
Chronic alcohol abuse, nystagmus, and confusion. WE is caused by thiamine (vitamin B1) deficiency, Wet & Dry beriberi
Wet beriberi- dilated high-output cardiomyopathy and heart failure
Dry beriberi- distal peripheral polyneuropathy
milk-alkali syndrome
Hypercalcemia due to repeated ingestion of calcium and absorbable alkali such as calcium carbonate, or excess milk consumption
“bones, stones, groans, and psychiatric overtones”
QT-interval shortening and J-wave or Osborn wave on ECG
Patient with multiple aneurysms in the mesenteric and renal arteries
They have Polyarteritis nodosa (PAN)
PAN can be acquired as a complication of hepatitis B (HBV)
Most autoimmune disorders are characterized by what type of hypersensitivity?
Type II hypersensitivity reactions occur when preformed antibodies bind to antigens in the body.
Type III hypersensitivity
Type III hypersensitivity involves aggregates of antibody-antigen complexes that initiate an inflammatory response. An example is systemic lupus erythematosus.
Type IV hypersensitivity
Type IV hypersensitivity is characterized by cell mediated immunity. It results in a delayed hypersensitivity reaction. An example is contact dermatitis or PPD test.
Serologic panel for HBV Susceptible
Negative hepatitis B surface antigen (HBsAg)
anti-HBc
anti-HBs
Serologic panel for HBV Immune (infected then recovered):
HBsAg (–)
anti-Hbc (+)
anti-HBs (+)
Serologic panel for HBV Immune (Vaccined):
HBsAg (–)
anti-Hbc (–)
anti-HBs (+)
Serologic panel for HBV Acute infection:
HBsAg (+)
anti-HBc (+)
IgM anti-HBc (+)
anti-HBs (–)
Serologic panel for HBV Chronic infection:
HBsAg (+)
anti-Hbc (+)
IgM anti-HBc (–)
anti-HBs (–)
Treatment for Pseudomonas aeruginosa infections
aerobic gram-negative rod that is non-lactose fermenting and oxidase positive
Aminoglycoside plus extended spectrum penicillin
Aspiration pneumonia
Usually due to anaerobes
Peptostreptococcus, Fusobacterium nucleatum, Prevotella spp., Bacteroides melaninogenicus, and other Bacteroides species.
Salmonella enterica typhimurium
Lactose-negative, hydrogen sulfide-producing gram-negative bacteria
Transmitted through contaminated food
Fever, diarrhea that can contain red blood cells and abdominal cramps 12-72 hours after infection
Pediculus humanus capitis.
Head lice
Pityrosporum ovale
Malassezia
Sarcoptes
Sarcoptes scabiei- scabies that dig into stratum corneum layer to lay eggs
Trichinella spiralis
nematode parasite transmitted through undercooked meat (especially pork)
Causes trichinosis- fever, vomiting, nausea, periorbital edema, and muscle aches
Trichosporon asahii
“white piedra”
nodules along hair shaft
gritty nodules that are easily removed
Common laboratory findings in acute osteomyelitis
Leukocytosis, elevated C-reactive protein, and elevated erythrocyte sedimentation rate
Blood cultures are only positive in approximately 50% of infections.
Name of infection caused by Corynebacterium minutissimum?
Erythrasma -which is minimally scaling hyperpigmented thin plaque in skin folds. Coral-red fluorescence under Wood’s lamp
Tx: Topical anti-bacterial agents
Treatment for Gas gangrene secondary to C perfringens
IV clindamycin
Prophylactic treatment for close contacts of pt diagnosed with Neisseria meningitidis
Rifampin (don’t use in pregnancy)
Ceftriaxone- Safe during pregnancy
Ciprofloxacin
Pneumococcal 23 vaccination recommendations
≥ 65 years
Younger with high risk (COPD, asthma, diabetes, active smoker)
Purified Protein Derivative (PPD) Testing
< 5 mm
HIV infected patients with close contact with an individual with active, contagious disease
Purified Protein Derivative (PPD) Testing
≥ 5 mm
- HIV infection.
- Abnormal chest x-ray with findings consistent with pervious TB infection.
- Immunosuppressed patients (prolonged steroid use, chemotherapy, organ transplant, TNF-alpha blocker use)
- Close contact with an individual with active, contagious disease
Purified Protein Derivative (PPD) Testing
≥ 10 mm
- Children < 4 years old
- Foreign born in a country with TB incidence > 25/100,000
- Residents and employees of high risk environments including healthcare facilities, long term care facilities, jails, and prisons
- Individuals with clinical conditions that increase risk including IV drug abuse, dialysis, diabetes, underweight, and certain malignancies
Purified Protein Derivative (PPD) Testing
≥ 15 mm
Healthy individuals, ≥ 4 years, without risk factors and low likelihood of active TB
If positive PPD but negative chest xray
Latent TB
treat with isoniazid for 9 months
Antibiotic prophylaxis for travelers’ diarrhea
only recommended for patients who are at high risk of health-related complications (use rifaximim)
Otherwise use no antibiotic just bismuth subsalicylate is recommended
Method for detecting semen from vagina
Alkaline phosphatase assay detects the presence of semen in vaginal samples up to 72 hours following a sexual assault.
Wood’s ultraviolet light lamp is a sensitive but nonspecific method for detecting semen.
First line blood pressure medications for African Americans in the absence of proteinuria
Calcium channel blocker or thiazide diuretic
Retinopathy specific to Diabetics
Neovascularization
Retinopathy specific to HTN
Arteriovenous nicking
can occur in both diabetic and hypertensive retinopathy
Cotton wool spots, retinal hemorrhage, and microaneurysm
Post-exposure rabies vaccination
Exposure involving small rodents (squirrels, hamsters, guinea pigs, rats, mice, gerbils, chipmunks, and rabbits) does not require treatment
