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Residency > Infectious > Flashcards

Infectious Flashcards

1
Q

improvements cap 1 wk- 4wks-6wks-3mos-6mospoppy

A

1 week - FEVER should have resolved
4 weeks - CHEST PAIN and SPUTUM PRODUCTION should have substantially reduced
6 weeks - COUGH and BREATHLESSNESS should have substantially reduced
3 months - most SYMPTOMS should have resolved BUT FATIGUE may still be present
6 months - most people will feel back to NORMAL

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2
Q

repeat cxr cap when?

A

4-6wks

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3
Q

ptb tx for cat 1new? cat 1a-bone joint meninge? cat 2retreatment? cat 2a retreatment?

A

Category 1 - New Cases of all forms of TB (except Meninges, Bone, and Joints): 2HRZE/4HR - 6 months total

Category 1a - New Cases TB of the Meninges, Bone, and Joints): 2HRZE/10HR - 12 months total

Category 2 - Retreatment cases of all forms of TB (except Meninges, Bone, and Joints): 2HRZES/1HRZE/5HRE - 8 months total

Category 2a - Retreatment cases of of TB of Meninges, Bone, and Joints): 2HRZES/1HRZE/9HRE - 12 months total

  • TB 2016, CPG, p94 -
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4
Q

tb tx regimen: renal? dm? pregnant? compensated cirrhosis? decompensated cirrhosis? sot low risk? sot high risk?

A

> What is the recommended treatment regimen for patients with CKD?

ANSWER: Same with the general population but with dose adjustment of Ethambutol and Pyrazinamide depending on the EGFR. For HD patients, give HRZE post HD.

DM - same with general population

Pregant - same with general population

Compensated Liver Cirrhosis - DO NOT GIVE PYRAZINAMIDE: 2HRSE/6HR or 2HSE/10HE or 9HRE

Decompensated Liver Cirrhosis: Refer to specialized center for 2nd Line Drugs

Post-SOT recipients without risk factor of drug resistance (mild, non-cavitary, non-miliary, not-extra-pulmonary, and clinically diagnosed): 2HEZ/12-18HE, avoid RIFAMPICIN due to interaction with immunosuppresive drugs

Post-SOT recipients, severe cases (disseminated, cavitary, bacteriologically positive): 2HRZE/4-9HR… Just monitor the drug level of the immunosuppresive drugs

  • TB 2016, CPG, pp152-163 -
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5
Q

1st line tx uncomplicated uti

A

nictrofurantoin monohydrate/macrocrystals 100mg bid x 7 days; fosfomycin 3g single dose

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6
Q

treatment cryptococcal meningitis

A
  • Induction: Ampho B (0.7-1.0 mg/kg) + Fluco 800 PO/IV ODx 2 weeks or until cultures are negative
  • Consilidation: Fluco 400 PO/IV OD for at least 8 weeks
  • Maintenance: Fluco 200 PO OD for at least 1 year until there is reconstitution of symptoms- Fungal Culture after 2 weeks to ensure clearance - CALAS and CSF India Ink SHOULD NOT BE USED to monitor response to treatment
  • Monitor Ampho B’s dose dependent nephrotoxicity and electrolyte imbalance
  • Monitor Fluco’s hepatotoxicity
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7
Q

urine ph indication for imaging in uti

A

7.0

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8
Q

duration of retreatment for uti with recurrence

A
  • 2 weeks: absence of urologic abnormality

- 4-6 weeks: symptoms recus and whose Urine CS shows the same organism as the initial infecting organism

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9
Q

complicated uti definition

A
  • Functional or anatomic ABNORMALITY of urinary tract or kidneys

OR

  • Underlying disease that INTERFERES with host defense mechanisms

OR

  • Condition that increases the RISK of persistent infection and/or treatment failure
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10
Q

significant bacteruria

A

complicated uti >100, 000 cfu clean catch urine;

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11
Q

What is the treatment regimen of choice for Toxoplasmosis Encephalitis in HIV?

A

ANSWER: S-P-F ( Sulfadiazine, Pyrimethamine, and Folinic Acid or Leucovorin)

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12
Q

Duration of treatment
CAP

In general

A

Low risk: 5-7 days

Moderate risk: 7-10 days

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13
Q

Duration of treatment
CAP

MSSA Comunity acquired

A

Non bacteremic - 7-14 days

Bacteremic - upto 21 days

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14
Q

Duration of treatment
CAP

MRSA Community acquired

A

Nonbacteremic - 7-21 days

Bacteremic - upto 28 days

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15
Q

Duration of treatment
CAP

Pseudomonas

A

Nonbacteremic - 14 - 21 days

Bacteremic - upto 28 days

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16
Q

Duration of treatment
CAP

Legionella

A

14- 21 days

10 days (azalides)

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17
Q

Duration of treatment
CAP

Mycoplasma and chlamydophila

A

10-14 days

18
Q

To Remember - NRTI:

A

All NRTIs end with BINE, DINE except for tenofOVIR and abaCAVAR

NRTIs
zidovuDINE
lamiviDINE
emcitraBINE
tenofOVIR
abacAVIR
19
Q

To remember nnrti

A

All NNRTIs have VIR in the middle of their names

NNRTIs
neVIRapine
efaVIRenz
etraVIRine
rilpiVIRine
20
Q

To Remember - PI:

A

All PIs end with NAVIR

PIs
ritoNAVIR
atazaNAVIR
daruNAVIR
lopiNAVIR
21
Q

To Remember - InteGrase Inhibtor:

A

All inteGrase inhibitors end with GRAVIR

InteGrase Inhibitors
ralteGRAVIR
elviteGRAVIR
doluteGRAVIR

22
Q

Entry inhibitors antiretrovirals

A

For Entry Inhibitors, no pattern:

Maraviroc
Enfuviritide

23
Q

What is the typical ALTERNATIVE treatment for PCP (especially if TMP-SMX cannot be tolerated)?

A

ANSWER: Clindamycin + Primaquine

24
Q

Test to monitor treatment response and to rule out pcp pneumonia

A
  1. Diagnosis
    - Chest Xray - can be normal in the course but typically shows BILATERAL FLUFFY INFILTRATES
  • Chest HRCT - can demonstrate typical ground glass opacities and a normal finding is sufficient for ruling out
  • Specialized stain (Methenamine Silver Stain) when available ***but cant be used to rule out
  • LDH - elevated level can provide supporting evidence of PCP and can be used to MONITOR TREATMENT RESPONSE
25
Q

Antibiotics for pcp

A
  1. Treatment
    - TMP-SMX is the drug of choice
    Dose: 800/160 or double strength, 2 tablets TID x 21 days **and continue prophylaxis at 1 tab once until CD4 is consistently above 200 for at least 3 months
    **     If IV is available, 5 mg/kg (TMP based) q8
  • Alternative: Clindamycin + Primaquine (do G6PD testing prior to initiation)
26
Q

When to use steroids in pcp

A
  1. Adjunctive Treatment
    - Steroid should be started if PaO2 is <70 mmHg or alveolar-arteriolar gradient is >35 mmHg
    - Prednisone PO is given x 21 days:
    40 mg BID x 5 days
    40 mg OD x 5 days
    20 mg OD x 11 days
27
Q

How to assess treatment response in pcp

A
  1. Treatment response
    - Continuous pulse oximeter, serial ABG, ans serum LDH can be used to gauge treatmenr response
    - PATIENT SHOULD REMAIN IN THE HOSPITAL FOR AT LEAST 72 HOURS, even in the presence of dramatic clinical improvement, DUE TO RISK OF ARDS
28
Q

Vivid dreams and depression are side effects of which ARV?

A

ANSWER: EFAVIRENZ

Vivid Dreams tends to disappear after several weeeks of treatment.
This ARV is contraindicated to patients with psychiatric condition such as depression

29
Q

Which ARV is contraindicated in patients with renal impairment?

A

ANSWER: TENOFOVIR

Tenofovir is primarily eliminated by kidneys, and renal impairment including a Fanconi-like syndrome with hypophosphatemia may occur.

30
Q

Which ARV is associated with FATAL hypersensitivity reaction?

A

ANSWER: ABACAVIR

Fatal hypersensitivity may occur with intake of Abacavir. Abacavir hypersensitivuty occurs with a higher frequency in patients who are HLA-B50701-positive.

31
Q

Which ARV is associated with anemia, granulocytopenia and lactic acidosis?

A

ANSWER: ZIDOVUDINE

32
Q

Which ARV is associated with flare of hepatitis in HBV-coinfected patients when the drug is discontinued?

A

ANSWER: LAMIVUDINE

33
Q

> To prevent IRIS, which 3 infections should be treated first before starting ARV in a newly diagnosed HIV patient?

A

ANSWER: Cryptococcal meningitis, CMV Infection, and TB

34
Q

TREAT THESE INFECTIONS for a specific duration prior to initiating ARV

A

Cryptococcal meningitis - at least 5 weeks
CMV - at least 2 weeks
TB - at least 2 weeks

35
Q

> What is the recommended treatment for newly diagnosed HIV?

A

ANSWER: Combination ARV. At least 3 drugs to prevent drug resistance. Current recommendation states that there must be dual NRTI (2 NRTI.

  1. NNRTI Based: 1 NNRTI + 2 NRTI
    efaVIRenz + tenOVIR + emcitraBINE
  2. PI Based: 1 PI + 2 NRTI
    atazaNAVIR/ritoNAVIR + tenOVIR + emcitraBINE
    daruNAVIR/ritoNAVIR + tenOVIR + emcitraBINE
  3. InteGrase Inhibitor Based: 1 II + 2 NRTI
    doluteGRAVIR + tenOVIR + emcitraBINE
    ralteGRAVIR + tenOVIR + emcitraBINE
36
Q

> Which vaccine will you not administer if the patient has EGG allergy?

A

ANSWER: INFLUENZA VACCINE

VACCINES that are contraindicated to some food allergy:

Varicella, Herpes Zoster, and MMR - GELATIN

Influenza - EGG

Hepatitis A - Yeast

Hepatitis B - Baker’s Yeast

37
Q

> What is the Gold Standard in diagnosis of Leptospirosis?

A

ANSWER: Culture and Isolation
***But Microagglutination Test (MAT), specifically, a four-fold rise of the titer from acute to convalescent sera is still confirmatory.

Culture and isolation remains the GOLD standard BUT is time-consuming, labor-intensive, requires 6 to 8 weeks for the result, needs darkfield microscopy and has low diagnostic yield.

Microagglutination Test (MAT) - a four-fold rise of the titer from acute to convalescent sera is confirmatory of the diagnosis. It is highly sensitive and specific BUT time-consuming and hazardous to perform because of the risk of exposure to the live antigen. Cross-reactions may occur with syphilis, viral hepatitis, HIV, relapsing fever, Lyme’s disease, legionellosis and autoimmune diseases.1 In endemic areas like the Philippines, a single titer of at least 1:1600 in symptomatic patients is indicative of leptospirosis

38
Q

Which human intestinal nematodes can be treated with IVERMECTIN?

A

ANSWER: Strongyloidiasis (first line), Ascariasis, and Trichuriasis

39
Q

What is the treatment for Capillariasis?

A

ANSWER: Albendazole

40
Q

General Rule for the Treatment of Helmithns

A

ALL intestinal NEMATODES can be treated with ALBENDAZOLE

Most intestinal NEMATODES can be treated with MEBENDAZOLE except Strongyloides and Capillariasis

Filariasis, Loiasis, and Oncocerciasis can be treated with DEC (Diethylcarbamezine)

ALL TREMATODES (or Flukes) are treated with PRAZIQUANTEL

ALL CESTODES are treated with PRAZIQUANTEL

Residency (6 decks)

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