ID2 Flashcards
1
Q
Hep C RNA or DNA
A
RNA
2
Q
azole order of drug interactions
A
voriconazole
itraconazole
fluconazle
posaconazole
3
Q
Hep D RNA DNA
A
incomplere RNA requires HBV for replication
4
Q
TX of meningitis in >50 years
A
vanco plus ampicillin plus cefotaxime or ceftriaxone
5
Q
vaccinated HBV serology
A
HBsAb
6
Q
PCP contagious?
A
NO
7
Q
Echinocandins MOA
A
Beta-1,3-glucan synthesis inhibitors
8
Q
Hep C tx drug Class
A
NS34a protease inhibitors
Ns5B protease inhibitors
Ns5A
9
Q
Acute IE
- onset
- mortality
- symptoms
- clinical finding
A
fulminant
< 6 weeks
high fever >101
elevated WBC
10
Q
Kernig Sign sensitivity and specificity?
A
Low
High
11
Q
major symptoms of interferons
A
flu like symptoms
12
Q
When to initiate steroid in meningitis
A
first dose 10-20 mins before intial antibiotic
not recommended if pt has recieved antibiotics
13
Q
is immunity to viruses lifelong?
A
yes
14
Q
which drugs inhibit HBV and HIV RT
A
Emtricitabine
lamivudine
Tenofovir
15
Q
how does RNA retrovirus attach to cell
A
gp 12o
gp41
16
Q
E. coli & kelbsiella meningitis tx and duration
A
3rd gen ceph
21 days
17
Q
voriconazole SE
A
blurred vision
photosensitivity
18
Q
whatis immune reconstitiution inflammatory syndrome
A
successful restoration of immune system amy lead to exaggerated immune attack on other microorganisms
19
Q
Possible IE DX
A
clinical criteria
1 major and 1 minor criteria
3 minor
20
Q
Hep B RNA or DNA
A
DNA
21
Q
Cryptococcosis treatment
A
AmB + flucytosine
-induction
fluconazole
-chronic
22
Q
are posaconazole po and IV interchangable
A
NO
23
Q
WBC in meningitis bacterial vs viral
A
1000-5000
100-500
24
Q
Coccidiodomycosis treatment
A
AmB
mild: fluconazole
chronic: fluconazole
25
AmB MOA
bind to ergosterol, increase cell permeability causing leaking of cell contents and cell death
26
Which 3 s&S of meningitis indicate lumbar puncture
HA
fever
neck stiffness
27
as HIV replication increases CD4?
decreases
28
Cleared HBV serology
HBsAB
| HBcAB
29
role of M2 protein
allows genome release within cells
30
HACEK stand for?
```
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella
```
31
Subacute IE
- onset
- mortality
- symptoms
- cause
slow, indolent
>6 weeks
low grade fever, night sweats, weight loss, myalgia, fatigue
prior valve disease
32
Types of opportunistic mycoses
Aspergillosis
Candida
Cryptococcosis
Mucormycosis
33
which is the only fungal infection with primary prophylaxis
PCP
34
Adjust for renal impairment in echinocandins
NO
35
signs of meningitis in elderly
| 2
symtoms absent
| more sublte
36
HEV acute or chronic
Acute
37
Mac contagious?
unlikely
38
AmB SE
nephrotixicity
electrolyte wasting
infusion related toxicity
39
duration of secondary toxo prophylaxis
cd4 >200 x6 months
40
DNA virus CMV prefferred
Ganciclovir
Valganciclovir
Cidofovir
Letermovir
41
HIV NRTI ending
- vir
| - ine
42
MAC primary prophylaxis indication and DOC
cd4 <50
| Azithromycin
43
s. agalactiae meningitis tx and duration
ampicillin or pen G
| 14-21 days
44
Infection process
| 6
```
adsorption
penetration & uncoating
replicate, trancription, translate
assembly
release new virus
secondary infection
```
45
HDV acute or chronic
acute then chrnoic
46
Velpatasvir/sofosbuvir/voxilaprevir indication
only patients who have failed newer DAAs
47
Mucormycosis treatment
correct underlying cause (DM) and AmB
| posaconazole
48
what is viral hepatitis?
inflammation of the liver from hep A,b,c,d,e virus
49
Meningitis N. meningitis tx and duration
3rd gen ceph
| 7 days
50
Caspofungin Cyp450?
not and inducer or inhibitor
| w/ strong inducer inc. dose
51
protease endings
-navir
52
Protein in CSF bacterial vs viral
>150
| 50-100
53
TEE mean?
Transesophageal echocardiogram
54
Glecaprevir/Pibrentasvir genotype coverage
1-6
55
DX signs in IE
| 5
```
heart murmur
clubbing in extremeties
roth's spot
osler's nodes
embolic phenomena
```
56
TTE better at seeing?
right-sided infection
57
2 Hep that have fecal-oral transmission
A, E
58
MOA Maraviroc
drupts HIV adsoprtion via CCR5
59
Gram + bacilli in meningitis
L. monocytogenes
60
Gram - cocci in meningitis
N. meningitidis
61
when to avoid IV posaconazole
eGFR 50
62
TTE poor visual in?
| 3
obese
pulmonary disease
chest wall deformity
63
Chemorophylaxis in meningitis for H. influenzae type B
Rifampin only
64
CSF appearance of Bacterial vs viral
cloudy
| clear to cloudy
65
which systemic mycosis causes more fatalities
candida
66
azole major class SE
hepatoxicity
67
which NRTI has SE of sensory neuropathy and pancreatitis
stavudine
| didanosine
68
primary prophylaxis for PCP
bactrim
69
Which Hepatitis needs HBV
D
70
what to avoid when combo NRTI
overlapping additonal toxicity
overlapping metabolic activation
same analog of a base
71
which immune system produces interferons
cellualr immune system
| via Th1
72
which side of the heart in IE is most common for structural heart disease or valve replacement
left
73
Flucytosine mucormycosis?
no activity
| used as adjuvant
74
Glucose in CSF:Blood bacterial vs viral
<40 2:3
| <40
75
3 viruses most common cause of viral hepatitis
A,b,c
76
Toxoplasmosis most common cause
reactivation of latent tissue cysts
77
azoles d-d intx
fluconazole has the weakest interactions
78
TX of meningitis in head trauma, CSF shunt, neurosurgery
vanco plus cefepime, ceftazidime, or meropenem
79
options for an anaphylacoid PCN allergy for IE
allergy consult
--desentization
vancomycin
daptomycin
80
S&S of meningitis
| 7
```
HA
fever
Neck stiffness
altered mental status
photophobia
seizures
abnormal CNS findings
```
81
What does HBsAg mean and its significance
hep B surface antigen
| indicates infection
82
Pathogens in subacute IE
| 3
Viridians group strep (mouth pathogens)
* S. mitis, S. mutans, S. sanguinis, S. salivarus
Strep bovis
Coagulase-negative staph
83
primary prophylaxis for toxo and duration
Bactrim
| cd4 >200x3 months
84
influenza tx drug class
M2 blockers
| Neurmainidase inhibition
85
CD4 <50 OI
MAC
86
Glecaprevir/Pibrentasvir drug avoidance
ethinyl estradiol
87
Types of primary fungal infections
Blastomycosis
Histoplasmosis
Coccidiodomycosis
88
Blastomycosis when spreads causes
skin and bone lesions
89
fluconazole active against?
Candida
cryptococcal
coccidioidomycosis
90
H. influenzae meningitis tx and duration
3rd gen ceph
| 7 days
91
TTE mean?
transthoracic echocardiogram
92
Ledipasvir/Sofosbuvir drug interaction
antacids: separate by 4 hours
H2 blocker: same time or 3 hours
PPI: same time or empty stomach
93
Corticosteroid meningitis indication
adults w/ pneumococcal meningitis
| infants >6 weeks and children w/ H. influenzae type b meningitis
94
Sources of infection in meningitis
| 4
Contiguous spread
hematogenous
direct inoculation
reactivation of latent disease
95
source of MAC
water
dust
soil
bird poop
96
voriconazole counsel
fatty food inhibit absorption
| take on empty stomach 1-2 hours before or after meal
97
P. aeruginosa meningitis tx and duration
ceftazidime
cefepime
meropenem
21 days
98
Echinocandins SE
well tolerated
inc. liver enzymes
flushing w/ infusion
99
Which valve on the right side most common in IE
Tricuspid
100
Hep A acute or chronic
acute
101
Interferon spectrum
most RNA/DNA and tertrviruses
102
Voriconazole steady state
reached in 1 hour if loading dose given
103
HBcAb mean and significane
Hep B core antibody
| appears at symptoms onset and persists for life
104
most common cause of IE
s. auerus
105
MOA of enfuvirtide
prevents intramolecular folding of gp41 that is required for virus fusion
106
NNRTI indication
HIV 1
107
What is the brudzinski sign
Flexion of the neck results in involuntary knee and hip flexion
108
Hep E RNa or DNA
RNA
109
MOA of interferon
```
inhibit:
penetration/uncoating
transcription/translatioin
protein glycosylation
activate NK
```
110
labs in IE
| 6
```
leukocytosis
anemia
ESR
RF
SCr
positive blood cultures
```
111
Which NRTI work on Hep B and HIV
```
Tenofovir
Entecavir
Lamivudine
Adefovir
Telvivudine
```
112
Signs of meningitis in children
| 2
irritability
| poor feeding
113
combo w/ flucytosine for blastomycoses
itraconazole
114
Blastomycosis treatment
AmB for severe
| itraconzaole once stable and if mild-mod
115
Retroviruses
HIV 1,2
116
RNA viruses
influenza
RSV
Hep C
117
Enterococcus in IE?
E. facealis
| E. faecium
118
TX MAC general
| duration
2+ agents for resistance
3 drug if cd4 <50 and no ART
indefinite
x12 months and cd4 >100 and asymptomatic
119
NNRTIs in the middle
-vir-
120
Definite IE Dx
```
pathological criteria
clinical criteria
2 major criteria
1 major and 3 minor
5 minor
```
121
histoplasmosis treatment
itraconazole with LD
122
CD4 <200 OI
PCP
123
NRTI indication
HIV 1 and 2
124
function of LTR
used for integration into host genome by viralintegrase
125
what 2 drugs do you use to kill biofilm on prosthetic valves
Rifampin
| gentamicin
126
Ledipasvir/Sofosbuvir genotype coverage
1,4,5,6
127
What is the Kernig Sign
* The hip is flexed to 90 degrees and teh clinician attempts to straighten the knee
* pain limits extension of the knee
128
who to give primary prophylaxis for toxo
+ antibody
| cd4 <100
129
IDU tend to include which valve for IE
tricuspid
130
do NNRTI require phosphoylation
no
131
Meningitis chemoprophylaxis indication
those in close contact with an infected patient
132
HBeAg mean and its significance
Hep B early antigen
| indicate active viral replication
133
Pathogens in acute IE
| 4
staph. aureus
Strep pneumoniae
Strep pyogenes
Neisseria gonohoeae
134
Gram - bacilli in meningitis
| 3
Enterbacteriacease
-community
P. aeruginosa and acinetobacter
-healthcare
135
which drugs antagonize integrase to prevent splicing of HIV DNA into host DNA
raltegravir
dolutegravir
elvitegravir
136
Risk Factors for IE
| 5
```
structural heart disease
IV drug use
prosthetic/mechanical devices
poor dention
central venous catheter
```
137
what WBC is most commonly found in bacterial meningitis
neutrophils
138
itraconazole counsel
take with a full meal
| NO PPIs
139
L. monocytogenes meningitis tx and duration
ampicillin
pen G
>21 days
140
HBV tx drug class
DNA polyermase inhibitor
| RNA polyermase inhbitor
141
Combo w/ flucytosine for meningitis
amphotericin
142
Rejected IE DX
alternate DX
| resolution of syndrome
143
Velpatasvir/Sofosbuvir genotype coverage
1-6
144
HCV acute or chronic
chronic
145
TX of meningitis in 1 month-2 years
vanco plus cefotaxine or ceftriaxone
146
Hep B acute or chornic
acute then chronic
147
Should you empircally treat with PCN for IE?
NO not until MIC is known
148
chemoprphylaxis in meningitis for N. meningitidis
Rifampin
Cipro
Ceftriaxone
149
For staphylococci for non-IDU which therapy should you avoid
Nafcillin + gentamicin
| -more nephrotoxicity
150
DNA viruses
Hep B
CMV
VZV
HSV
151
chronic viral hepatitis strains
B,C,D
152
Brudzinkski sign sensitivity and specificity?
Low
| High
153
which valve on the left side most common in IE
mitral
154
Which pathogen is associated with colon cancer
S. gallolyticus
| formerly S. bovis
155
Aspergillious treatment
voiconazole DOC
156
HBC PCR significance
quantifies presence of HBV DNA
157
integrase endings
-gravir
158
TX of meningitis in 2 years-50 years
Vanco plus cefotaxime or ceftriaxone
159
coccidioidomycosis other name
valley fever
160
flucytosine major SE
bone marrow suppression
161
NNRTI 1st gen vs 2nd gen
1st: butterfly like
2nd: horse shoe
162
Anidulafungin d-d intx
minimal
163
which azole has the broadest activity
posaconazole
164
Gram - in IE?
Pseudomonas
165
Acute HBV serology
HBsAg
HBcAb
HBcAb
166
Palivizumab MOA and indication
passive immunization for RSV
167
Acute hepatitis strains?
A,D, E
168
what wBC is most commonly found in bacterial meningitis
lymphocytes
169
CD4 50-100 OI
CMV
cryptosporidiosis
toxiplasmosis
170
interferon MOA
activates cytotoxic t cells, NK cells, and macrophages
171
Hep A RNA or DNA
RNA
172
order from outer to inner name the meninges
Dura mater
arachnoid mater
pia mater
173
posaconazole counsel
400% inc. absorption with fatty food
174
posaconazole dosing
2-4 dosess/day
| more frequent gives better serum levels
175
TX of meningitis in <1 month
Ampicillin plus aminoglycoside or cefotaxime
176
secondary prophylaxis for PCP how long to treat
unil cd4 >200x3 months
177
HBsAb mean and its significane
Hep B surface antibody
immunity to HBV
-passive or active
178
MOA of HIV protease
cleaves gag-pol polyprotein producing RT, HIV protease, integrase, structural proteins
179
Fungi in IE?
candida
| aspergillius
180
Which side of the heart in IE is most common for IDU
right
181
which drug class cause fat redistribution and hyperlipdiemia
HIV protease
182
chronic HBV serology
HBsAg
| HBcAb
183
HIV entry inhibitors
enfuvirtide
| maraviroc
184
Gram + cocci in meningitis
| 3
S. pneumoniae
-community
S. aureus and CoNS
-Healthcare
185
DNA virus HSV/VZV preffered
Acyclovir
valacyclovir
penciclovir
famciclovir
186
Can TTE dianose
no not good enough image
187
azole MOA
block ergosterol synthesis via 14-a-demethylase inhibitors
188
HIV tx drug class
NRTI
| NNRTI
189
Micafungin cyp450
not inducer/inhibitor
| not substrate
190
S. pneumoniae meningitis tx and duration
vanco and 3rd gen ceph
| 10-14 days
191
HBV treatment
```
interferon-a
preferred:
-entacavir
-Tenofovir
Non-preferred:
-Lamivudine
-Adefovir
-Telbivudine
```
192
can different viruses produce the same disease symptoms
yes
