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ID Exam 3 Flashcards

1
Q

CAP definition

A

pneumonia that developed outside of hospital or within first 48 hours of hospital admission

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2
Q

Severe CAP major criteria

A

(need 1)
1. septic shock requiring vasopressors
2. respiratory failure requiring mechanical ventilation

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3
Q

Severe CAP minor criteria

A

(need ≥ 3)
1. resp rate ≥ 30
2. multilobar infiltrates
3. confusion
4. BUN ≥ 20 (uremia)
5. leukopenia (wbc < 4000)
6. temp < 36
7. thrombocytopenia ( < 100,000 plts)
8. hypotension requiring fluids

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4
Q

CURB-65

A

C = confusion
U = uremia (BUN > 19)
R = resp rate ≥ 30
B = BP <90/<60
Age ≥ 65

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5
Q

CAP outpatient empiric therapy:
healthy adults without comorbidities or risk factors

A
  1. amoxicillin 1g PO q8h
  2. doxycycline 100mg PO BID
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6
Q

CAP outpatient empiric therapy:
adults with comorbidities

A

monotherapy:
levofloxacin 750mg PO daily
moxifloxacin 400mg PO daily

combo therapy:
beta-lactam + macrolide or doxycycline
(beta lactams recommended: amoxicillin, cefpodoxime, cefuroxime)

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7
Q

Non-severe CAP inpatient empiric therapy (no MRSA/pseudomonas risk factors)

A

monotherapy:
levofloxacin 750mg PO daily
moxifloxacin 400mg PO daily

combo therapy:
beta-lactam + macrolide

*beta-lactams recommended
unasyn 1.5-3gm IV q6h
ceftriaxone 1-2gm IV q24h

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8
Q

Severe CAP inpatient empiric therapy (no MRSA/pseudomonas risk factors)

A

Combo therapy options:

  1. FQ + beta-lactam
  2. macrolide + beta-lactam

*beta-lactams recommended:
unasyn 1.5-3gm IV q6h
ceftriaxone 1-2gm IV q24h

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9
Q

MRSA risk factors

A
  1. 2-14 days post influenza
  2. previous MRSA respiratory infection
  3. previous hospitalization and use of IV antibiotics within last 90 days
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10
Q

MRSA coverage options

A
  1. Vancomycin target AUC 400-600
  2. Linezolid 600mg IV/PO q12h
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11
Q

Pseudomonas risk factors

A
  1. Previous p. aeruginosa respiratory infection
  2. previous hospitalization and use of IV antibiotics within last 90 days
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12
Q

Pseudomonas coverage options

A
  1. Zosyn 4.5 gm IV q6h
  2. Cefepime 2gm IV q8h
  3. Meropenem 1gm IV q8h
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13
Q

Acute pharyngitis common pathogens

A
  1. respiratory viruses - rhinovirus, coronavirus, adenovirus
  2. streptococcus pyogenes (group A)
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14
Q

Acute pharyngitis treatment (for streptococcus pyogenes)

A
  1. penicillin VK 250mg PO TID or 500 mg PO BID
  2. Amoxicillin 500mg PO TID or 875 mg BID

x10 days

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15
Q

Most common respiratory pathogens

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catarrhalis
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16
Q

Chronic bronchitis - acute exacerbation treatment options

A
  1. Amox/clav 875/125mg PO BID
  2. Cefuroxime 500mg PO BID
  3. Cefpodoxime 200mg PO BID

x 5-7 days

If risk for P. aeruginosa: Levofloxacin 750mg PO daily

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17
Q

Acute bacterial rhinosinusitis first-line treatment

A

Amox/clav 500/125mg PO TID or 875/125mg PO BID x 5-7 days

-MRSA risk: add doxycycline or TMP/SMX
-Pseudomonas risk: add levofloxacin

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18
Q

Genitourinary infections risk factors

A
  1. urologic instrumentation and catheterization
  2. anatomical abnormality of urinary tract (i.e. obstruction commonly due to calculi)
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19
Q

What is the most common causative pathogen of UTIs?

A

E. coli

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20
Q

Which Abx are only used for uncomplicated UTIs due to not reaching good systemic concentrations?

A

Nitrofurantoin and fosfomycin

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21
Q

Empiric inpatient UTI treatment

A
  1. ampicillin 2 g IV q6h + gentamicin 5mg/kg q24h
  2. cefazolin 1-2 g IV q8h + gentamicin 5mg/kg q24h
  3. Ceftriaxone 1-2 g IV q24h
  4. Cefepime 1g IV q8-12h
  5. Gentamicin 5mg/kg IV q24h

for gentamicin - use AdjBW

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22
Q

Treatment duration for complicated UTI

A

7-14 days

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23
Q

Definition of recurrent UTI

A

-3 or more infections in 1 year
-2 of more infections in 6 months

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24
Q

What pathogen causes “walking pneumonia”?

A

Mycoplasma pneumoniae

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25
Q

What might be used as prophylactic Abx for recurrent UTIs?

A

nitrofurantoin
fosfomycin

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26
Q

Osteomyelitis empiric antibiotic options

A

C - ciprofloxacin
C - cefepime
C - cefazolin
C - ceftriaxone

L - levofloxacin
A - ampicillin/sulbactam
M - meropenem
P - pip/tazo

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27
Q

Osteomyelitis general duration

28
Q

Treatment duration: Vertebral osteomyelitis due to MRSA

29
Q

Treatment duration: DFI osteomyelitis with complete resection of all infected bone/tissue

30
Q

Treatment duration: DFI osteomyelitis with resection of all osteomyelitis, soft tissue infection remains

31
Q

Treatment duration: DFI osteomyelitis with resection performed, but osteomyelitis still remains

32
Q

Treatment duration: DFI osteomyelitis with no resection

33
Q

Treatment duration: septic arthritis with S. aureus or GNRs

34
Q

Treatment duration: septic arthritis with streptococci

35
Q

Treatment duration: septic arthritis with N. gonorrhoeae

36
Q

What is the most common causative pathogen of bone/joint infections

37
Q

What is the most common CF mutation?

38
Q

What is the sweat chloride test and how can it diagnose CF?

A

It tests the amount of chloride in someone’s sweat, and a value of ≥ 60 mEq/L is indicative of CF

39
Q

Which class of CF mutations are the hardest to treat and why?

A

Class I - nonsense mutations meaning no CFTR protein is made at all, also means more severe symptoms

40
Q

Ivacaftor MOA

A

Binds to CFTR to stabilize it in the open state, so Cl- can flow through - it “opens the door”

41
Q

Ivacaftor clinical pearls

A
  1. Take with fatty foods
  2. LFTs monitored every 3 months
  3. Eye exam yearly
  4. Dose adjustment for hepatic impairment
  5. CYP 3A substrate
42
Q

HAP empiric therapy

A

MSSA + Pseudomonas coverage:
1. Zosyn
2. Cefepime
3. Imipenem
4. Meropenem
5. Levofloxacin

+ MRSA coverage if needed:
1. Vancomycin
2. Linezolid

*if at high risk for mortality, pick two agents from the first list

43
Q

VAP empiric therapy

A

Need MRSA and Pseudomonas coverage
1. Zosyn
2. Cefepime
3. Imipenem
4. Meropenem
5. Levofloxacin
6. Tobramycin/Amikacin
+
Vancomycin or Linezolid

44
Q

Osteomyelitis - dalbavancin 2-dose strategy

A

Dalbavancin 1500mg IV on days 1 and 8 - provides 6-8 weeks of coverage

45
Q

When is rifampin added to treatment for prosthetic joint infection?

A
  1. debridement and retention of prosthetic
  2. 1-stage exchange
46
Q

PJI treatment duration - debridement and retention of prosthesis

A

pathogen-directed treatment + rifampin = 2-6 weeks
oral treatment + rifampin = 3-6 months

47
Q

PJI treatment duration - 1 stage exchange

A

pathogen-directed treatment + rifampin = 2-6 weeks
oral treatment + rifampin = 3 months

48
Q

PJI treatment duration - 2 stage exchange

A

pathogen-directed treatment x 4-6 weeks

49
Q

PJI treatment duration - amputation with complete removal of infected bone

A

pathogen-directed treatment x 24-48 hours

50
Q

Non-purulent SSTIs

A

cellulitis
erysipelas

51
Q

SSTIs classifications (mild, moderate, severe)

A

mild - no systemic signs, only localized
moderate - systemic signs of infection
severe - meets SIRS criteria (≥ 2)

52
Q

SIRS criteria

A

-Temp > 38 or < 36
-HR > 90 bpm
-RR > 24 bpm
-WBC > 12K or <4K

53
Q

Non-purulent SSTIs - mild treatment options

A

oral
-Penicillin VK
-Cephalosporin
-Clindamycin
x 5 days

54
Q

Non-purulent SSTIs - moderate treatment options

A

IV
-penicillin
-ceftriaxone
-cefazolin
-clindamycin
x 5 days

55
Q

Non-purulent SSTIs - severe treatment options

A
  1. surgical inspection + debridement
  2. empiric abx:
    -vancomycin + piperacillin/tazobactam
  3. C/S
56
Q

Purulent SSTIs

A
  1. abscesses: collection of pus within dermis and deeper skin tissues
  2. furuncles (boils): small abscess that forms around hair follicle
  3. carbuncles: infection involving several adjacent follicles
57
Q

Purulent SSTIs mild treatment

A

incision and drainage

58
Q

Purulent SSTIs moderate treatment

A

first: I+D and C+S
empiric therapy:
TMP/SMX or doxycycline (MRSA)
Dicloxacillin or cephalexin (MSSA)

59
Q

Purulent SSTIs severe treatment

A

first: I+D and C+S
empiric therapy:
-Vancomycin, daptomycin, linezolid (MRSA)
-Nafcillin, cefazolin, clindamycin (MSSA)

60
Q

Necrotizing fasciitis treatment

A

in order:
1. surgical inspection + debridement
2. empiric therapy: vancomycin + zosyn
3. C/S:
S. pyogenes: PCN + clindamycin
polymicrobial: vancomycin + zosyn

61
Q

Impetigo - few lesions treatment

A

topical - mupirocin x 5 days

62
Q

Animal/human bites DOC

63
Q

When do we NOT use amoxicillin in pediatric acute otitis media?

A

-Known resistance
-Treatment failure
-Amoxicillin in last 30 days
-Allergy
-Concurrent conjunctivitis

64
Q

Amoxicillin dose for acute otitis media

A

80-90 mg/kg/day divided q12h x 5-10 days

65
Q

When are tympanostomy tubes indicated?

A

in recurrent AOM:
-3 or more episodes in < 6mo
-4 or more episodes in < 12 mo

66
Q

Orkambi is approved for what type of mutation?

A

F508del homozygous

67
Q

Trikafta is approved for what type of mutation?

A

at least one F508del mutation

P3 Therapeutics (20 decks)

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