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Office oral boards > Infections and antibiotics > Flashcards

Infections and antibiotics Flashcards

1
Q

How do you treat gonorrhea

A

Ceftriaxone 500mg IM x1 dose
Ceftriaxone 1000mg IM x1 dose if kg >150

Post exposure Doxy can be used for pts at increased risk of Gonorrhea/syphilis

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2
Q

How do you treat chlamydia

A

Doxycycline 100mg PO BID x7 days

Pregnant:
Azithromycin 1g PO x1 day
Amoxicillin 500mg TID x7 days

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3
Q

How do you treat endometritis/ PID

A

Outpatient:
Ceftriaxone 500mg (1g if >150kg) IM
PLUS
Doxycycline 100mg BID x14 days
PLUS
Metronidazole 500mg BID x14 days

Inpatient:
Ceftriaxone 1g IV q 24hrs
PLUS
Doxycycline 100mg PO/IV BID
PLUS
Metronidazole 500mg PO/IV BID

OR

Cefoxitin 2g IV q6 hrs

OR

Cefotetan 2g IV BID
PLUS
Doxycycline 100mg PO/IV BID

Then transition to flagyl and doxy for 14 days PO

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4
Q

How do you treat BV

A

Metronidazole 500mg PO BID x7 days
OR
Clindamycin 2% cream 5g per vagina qHS x7 days
OR
Metronidazole gel 0.75% 5g per vagina qHS x5 days

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5
Q

How do you treat UTI (cystitis)

A

Trimethoprim + Sulfamethoxazole 100/800mg BID x3 days
OR
Nitrofurantoin 100mg BID x7 days
OR
Fosfomycin 3g PO x1
Give quinolones only if no other alternatives

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6
Q

How do you treat pyelonephritis

A

Ceftiaxone 1g IV x1 then PO meds for 7 days

Outpatient:
Ciprofloxacin 500mg PO BID x7 days
Add meds if quinolone resistance >10%

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7
Q

How do you treat syphilis

A

Primary, secondary and early latent:
Benzathine penicillin 2.4mU IM x1

Late latent, unknown:
Benzathine PCN 2.4mU IM q weekly x3 if prior negative status not confirmed

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8
Q

How do you diagnose PID

A

Sexually active woman with risk of STDs and pelvic low abdominal pain and no other cause or tenderness of cervix, uterus, or adnexa

Additional criteria:
- Temp >101
- mucopurulent discharge
- WBC on saline prep
- Elevated ESR
- Elevated CRP
- +GC/Cl

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9
Q

What are the criteria for inpatient tx of PID

A

Surgical emergency not excluded
TOA
Pregnancy
No response to oral therapy/ failed outpatient therapy
Acute peritoneal signs, N/V, high fever
Noncompliance or intolerance of tx

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10
Q

What are options for HIV prevention (PreP)

A

Pre-exposure ppx
Emtricitabine 300mg/ Tenofovir 200mg Daily

  1. Comprehensive prevention strategy:
    - Consistent daily use
    - safe sex precautions
    - STD screening
    - Regular HIV testing
  2. Testing prior to initiation
    - HIV negative documented
    - Defer initiation if concerns for acute HIV infection
    - Hep B neg
    - Hep B vaccine offered
    - Creatinine clearance >60
  3. HIV testing q 3months
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11
Q

What are the risks or PreP

A

If HIV positive during use, resistance to tx
Hep B positive– acute flare, hepatic injury
Lactic acidosis
Severe hepatomegaly/steatosis

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12
Q

What is PEP

A

Postexposure ppx for HIV

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13
Q

How does syphilis present

A

Caused by treponema palladium
- contagious during 1st and 2nd stage and in 1st year of latent stage

Primary: 9-90 days
- painless chancre

Secondary: 6wks to 6mo
- Condylomata lata, maculopapular rash, lymphadenopathy

Latent stage: follows untreated 2nd stage and can last 2-20 years (early latent <1yr, late latent >1yr)
- not infections sexually but can transmit to fetus

Tertiary:
- Gumma, cardiac lesions, tabes dorsalis, Argyll-Robinson pupil

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14
Q

What are causes of false positive RPR

A

Autoimmune disease or positive ANA
History of malaria
History of smallpox or varicella
HIV
Pregnancy
Mycoplasma pneumonia
Elderly
IV drug use

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15
Q

Monitoring of syphilis treatment

A

Non-specific tests typically return to zero
- 4-fold titer decline at 3 months
- 8-fold titer decline at 6 months
- Baseline/nonreactive at 12 months

Specific tests typically remain positive for life

Any 4 fold increase means treatment failure
Follow up titers at 6, 12, 24 months. Test for HIV

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16
Q

Jarisch-Herxheimer reaction:

A

Acute febrile reaction

Occurs in primary and early latent phase

Presents: fever, headache, arthralgia, myalgias, increased rash
Onset at 4-6 hrs post treatment
Duration 24 hrs
Release of treponema endotoxins
Not a penicillin allergy
May cause PTL and fetal distress

17
Q

Differential of vulvar ulcer

A

HSV
Syphilis
Chancroid
Lymphogranuloma venerum
Granuloma inguinale
Bechet’s
Vulvar carcinoma

18
Q

How do you treat a Bartholin’s gland abscess

A

treat with incision and drainage followed by a word catheter

Recurrence: marsupialization

Excise or biopsy in pts >40 to rule out adenocarcinoma

Cultures recommended due to MRSA

19
Q

What is the most common pathogen in bartholin’s cyst

A

E. coli

Should also test for GC/Cl (NAAT)

20
Q

When do you prescribe antibiotics for Bartholin’s cyst

A

Recurrent abscess
Extensive surrounding cellulitis
Pregnant
Immunocompromised
Risk of MRSA
Culture +MRSA
Signs of systemic disease

21
Q

What is the normal pH of the vagina

A

4.5

22
Q

What tests are available for vaginitis screening

A

pH, 10% KOH, wet prep with NS, commercial tests

23
Q

What are the diagnostics of BV:

A

pH >4.5
Microscopy: clue cells (20% of epithelial cells)
Positive whiff test

24
Q

What are the diagnostics of candidiasis

A

pH 4.0-4.5
Microscopy: candida (with KOH wet mount– budding yeast, psuedohyphae, hyphae)
Negative whiff test

25
Q

What is a normal pH and microscopy

A

pH 4.0-4.5
Microscopy: lactobacillus, absent white cells
Whiff test negative

26
Q

What are diagnostics of trich

A

pH 5.0- 6.0
Microscopy: motile trichomonads
Whiff test positive or negative

27
Q

What is a uncomplicated yeast infection and what is the tx

A

Infrequent/sporadic episodes
Mild-mod symptoms
C. albicans
Non-immunocompromised

Tx with vaginal azole or oral fluconazole

28
Q

What is a complicated yeast infection and what is the tx

A

Recurrent (4 or more episodes/yr)
Severe symptoms
Non-albicans yeast (suspected or proven)
DM, immunocompromised (HIV, steroids, debilitated)

Tx: yeast specification necessary

Non albicans: 600mg boric acid x14 days qHS

Severe: topical intravaginal azoles for 10-14 days or 3 doses of 150mg fluconazole q 3 days

Recurrent: fluconazole 150mg PO q 3 days x3, then suppressive therapy with 150mg fluconazole PO weekly x6 months OR topical clotrimazole 500mg weekly for 6 months

29
Q

What are Amsel’s criteria

A

Diagnosis of BV (3 of 4)
- pH >4.5
- positive amine test (whiff test)
- Homogenous thin discharge coats vaginal walls
- 20% clue cells (vaginal epithelial cells studded with bacteria)
- Multiple POC tests and NAATs

30
Q

What are the risks of BV

A
  • PTL/PPROM
  • PID
  • post procedural GYN infections
  • STI acquisition

TX: oral or vaginal metronidazole or clindamycin

31
Q

What is the tx of recurrent BV

A

3 documented infections in 1 year
- After 7-14 days of initial therapy , twice weekly metronidazole gel for 6 months

32
Q

How do you diagnose trichomonads

A

NAAT testing preferred
Trish on wet mount
Increased pH

Tx: flagyl 500mg BID x7 days
Retest in 3 months

33
Q

How do you diagnose Tuberculosis

A

PPD: administered intradermally
- eval 48 hrs later, if >10mm abnormal

IGRAs (interferon gamma release assay)
- Blood test for dx of latent TB

CXR:
- Apical cavitation
- Hilar adenopathy

Endometrial bx
- Longhand giant cells on histology
- Mycobacterium tuberculosis on culture

34
Q

What is the tx of TB

A

Isoniazid
Rifampin
Ethambutol (if isoniazid resistance)
Supplement with Vit B6 to reduce risk of neurotoxicity with isoniazid

Office oral boards (18 decks)

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