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Step 3 > Infectious Diseas > Flashcards

Infectious Diseas Flashcards

0
Q

Antibiotics for MRSA

A

Severe infection: Vancomycin, linezolid (Thrombocytopenia), daptomycin (myopathy & inc CPK), ceftaroline, tigacycline, or telavancin.

Minor infection: TMP/SMX, Clindamycin, Doxacycline.

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1
Q

Antibiotics for MSSA

A

IV: oxacillin/naficillin, or cefazolin (1st generation cephalosporin)

Oral: dicloxacillin or cephalexin (1st generation cephalosporin)

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2
Q

Antibiotics for MSSA/MRSA if penicillin allergy

A

Rash: cephalosporin

Anaphylaxis: Macrolides (azithromycin, clarithromycin) or clindamycin.

Severe infection: Vancomycin, linezolid, daptomycin, telavancin

Minor infection: Macrolides (azithromycin, clarithromycin) or clindamycin, TMP/SMX.

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3
Q

Antibiotics for Streptococcus

A

All Staph abx +:

Penicillin, Ampicillin, Amoxacillin

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4
Q

A quinolone used to treat pneumonia

A

Gemifloxacin

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5
Q

Adverse effect of Daptomycin

A

Myopathy

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6
Q

Adverse effect of Linezolid

A

Thrombocytopenia

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7
Q

Adverse effect of Imipenem

A

Seizures

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8
Q

Only carbapenem that dosent cover pseudomonas

A

Ertapenem

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9
Q

Antibiotics that cover Gram negative bacilli (rods): E. coli, Enterobacter, Citrobacter, Morganella, Pseudomonas, Serratia

A

Cephalosporin: cefepime, ceftazidime
Penicillin: Pipracillin, Ticarcillin
Monobactam: Aztreonam
Quinolones: Ciprofloxacin, Levofloxacillin, Moxifloxacin, Gemifloxacin
Aminoglycosides: Gentamicin, Tobramycin, Amixacin
Carbapenems: Imipenem, Meropenem, Ertapenem, Doripenem.

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10
Q

Quinolones that have excellent pseudomonal coverage

A

Levofloxacin, gemifloxacin, moxifloxacin

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11
Q

Carbapenem coverage

A

Excellent antianaerobic coverage, cover streptococci and all MSSA

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12
Q

Tigecycline coverage

A

MRSA and broadly active against gram (-) bacilli (E.coli, Enterobacter, Citrobacter, Morganella, Pseudomonas, Serratia)

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13
Q

Best antibiotic for abdominal anaerobic infection

A

Metronidazole

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14
Q

Only cephalosporins that cover anaerobes

A

Cefoxitin and cefotetan

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15
Q

Antibiotics other than Metronidazole that cover anaerobic GI infection

A

Carbepenem, pipracillin and ticracillin

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16
Q

Best antibiotic for anaerobic strep

A

Clindamycin

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17
Q

Antibiotics with NO anaerobic coverage

A

Aminoglycosides (Gentamycin, Tobromycin, Amikacin), Aztreonam, Fluoroquinolones, Oxacillin/Naficillin and all the cephalosporins except cefoxitin and cefotetan.

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18
Q

What is “Red Man Syndrome”, what antibiotic is it associated with? How do you treat it?

A
  • Red, flushed skin from Histamine release caused by rapid infusion of Vancomycin.
  • Slow down rate of infusion
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19
Q

Antiviral agents used to treat Herpes simplex and Varicella zoster

A

Acyclovir, valacyclovir, famciclovir

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20
Q

Best long term antibiotic for CMV retinitis

A

Valganciclovir

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21
Q

CMV antibiotics

A

Valganciclovir, ganciclovir and foscarnet

- these also cover herpes simplx and varicella zoster.

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22
Q

Adverse effect of Valganciclovir and Ganciclovir

A

Neutropenia and Bone marrow suppression

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23
Q

Adverse effect of Foscarnet

A

Renal toxicity

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24
Q

Antiviral to treat Influenza A and B

A

Oseltamivir and zanamivir (neuroaminidase inhibitors)

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25
Q

Treatment for chronic hepatitis B

A

Lamivudine, interferon, adefovir, tenofovir, entecavir, and telbivudine

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26
Q

Ribavirin is used to treat

A

Hepatitis C (with Interferon), and RSV

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27
Q

Antifungal agent to treat Candida (except Candida krusei or Candida glabrata) and Cryptococcus

A

Fluconazole

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28
Q

Antifungal that is largely equal to Fluconazole but rarely used b/c less easy to use

A

Itraconazole

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29
Q

Best antifungal agent against Aspergillus and also covers all candida including side effect

A

Voriconazole

- Adverse effect: visual disturbances

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30
Q

Echinocandins

1) 3 agents
2) Uses
3) Adverse effects

A
  • Caspofungin, micafungin, anidulafungin
  • Excellent for Neutropenic fever (better than amphotericin - less mortality)
  • Doesnt cover Cryptococcus
  • Adverse effects: no significant human toxicity b/c inhibit 1,3 glucan synthesis step (doesnt exist in humans)
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31
Q

Amphotericin coverage

A

All Candida, Cryptococcus, Aspergillus

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32
Q

Amphotericin adverse side effects

A

Renal toxicity (inc Cr)
Hypokalemia
Metabolic acidosis
Fever, shakes, chills

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33
Q

Patients at risk of Osteomyelitis

A

1) Diabetic patients w/ulcer or soft tissue infection
2) PVD patients w/ulcer or soft tissue infection
3) Patients with direct trauma
4) History of orthopedic surgery

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34
Q

Best initial test when suspecting osteomyelitis

A

Plain X-ray (must lose >50% of bone Ca contentbefore x-ray becomes abnormal, may take up to 2 wks to see changes)

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35
Q

Best 2nd-line test if there is high suspicion for osteomyelitis and x-ray is negative

A

MRI

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36
Q

Most accurate test for osteomyelitis (not initial test)

A

Bone biopsy and culture

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37
Q

What is the earliest finding of osteomyelitis on x-ray?

A

Periosteal elevation

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38
Q

What is the best method to follow response to osteomyelitis treatment?

A

Sedimentation rate

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39
Q

Most common cause of osteomyelitis

A

Direct contiguous spread from overlying tissue.

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40
Q

Most common organism causing osteomyelitis

A

Staphylococcus

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41
Q

Treatment of Staph osteomyelitis

A

MSSA: Oxacillin or Naficillin IV for 4-6 wks
MRSA: Vancomycin, Linezolid, or Daptomycin IV for 4-6 wks.

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42
Q

Treatment of gram - bacilli (Salmonella and Pseudomonas) osteomyelits

A
  • Can be treated with oral abx
  • confirm G- w/bone biopsy
  • There is no urgency in treating chronic osteomyelitis, can obtain biopsy prior to treatment.
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43
Q

Presentation of Otitis Externa

A

Itching and drainage from external auditory canal. Pain when manipulating tragus. Tympanic membrane often difficult to visualize bc of canal swelling.

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44
Q

Causes of Otitis externa?

A

1) Swimming (causes washing out of the acidic environment found in the external auditory canal)
2) Foreign objects (cotton swabs, hearing aids)

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45
Q

Diagnosis of Otitis externa

A

only exam. No tests or cultures needed

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46
Q

Treatment of Otitis externa

A

1) Topical antibiotics- ofloxacin or polymyxin/neomycin
2) Topical hydrocortisone to reduce swelling and itching
3) Acetic acid and water solution to reacidify ear can help eliminate infection.

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47
Q

What is malignant otitis externa?

A

Osteomyelitis of the skull from pseudomonas in diabetic patients.

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48
Q

Possible complication of malignant otitis externa

A

Brain abscess and skull destruction

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49
Q

Diagnosis and treatment of Malignant otitis externa

A

Treat like osteomyelitis: x-ray (best initial), MRI (2nd if x-ray negative), bone biopsy/culture (most accurate)
Treat with surgical debridement and abx against pseudomonas such as ciprofloxacin, pipracillin, cefepime, carbapenem or aztreonam

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50
Q

Findings in Otitis Media

A

Redness, bulging, decreased/muffled hearing, loss of light reflex, immobility of tympanic membrane (most sensitive)

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51
Q

Treatment of Otitis media

A

Best initial: Amoxicillin for 7-10d

  • For recurrent or persistent cases perform tympanocentesis and aspirate tympanic membrane for culture (most accurate test)
  • If no improvement w/amoxicillin after 3d switch to: amoxicillin-clavulanate, cefdinir, ceftibuten, cefuroxime, cefprozil, cefpodoxime.
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52
Q

Sinusitis symptoms

A

Nasal discharge, HA, facial tenderness, tooth pain, bad taste in mouth, and decreased transillumination of the sinuses.

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53
Q

Organisms causing sinusitis

A 
most common: viral
bacterial causes (same as otitis media): Strep. pneumonia, H. influenza, moraxella catarrhalis
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54
Q

Best initial test for sinusitis

A

x-ray

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55
Q

Most accurate test for sinusitis

A

Sinus aspirate for culture

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56
Q

Treatment for Sinusitis

A

Same as otitis media and add inhaled steroids.
Use Amoxicillin if:
- fever and pain
- persistent symptoms despite 7d of decongestants
- and purulent nasal discharge

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57
Q

Pharyngitis diagnostic symptoms

A

Pain/sore throat, exudate, adenopathy, No cough/hoarseness.

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58
Q

Best initial test for Pharingitis

A

Rapid strep test (will tell you if organism is group A strep that may lead to rheumatic fever and glomerulonephritis)

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59
Q

Treatment for pharingitis

A

PCN or amoxicillin

if PCN allergy: use azithromycin or clarithromycin

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60
Q

Influenza symptoms

A

Arthralgia, myalgia, cough, HA, fever, sore throat, fatigue

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61
Q

Influenza diagnosis

A

Viral antigen detection testing of nasopharyngeal swab

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62
Q

Influenza treatment

A

Oseltamivir or zanamivir if pt presents w/in 48hrs of symptom onset
Note: Amantadine and rimantadine only effective against Influenza A.

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63
Q

Indications for Influenza vaccination

A

COPD, CHF, dialysis patients, steroid use, health care workers, everyone>50

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64
Q

What is Impetigo and symptoms

A

Most superficial of the bacterial skin infections.

Weeping, crusting and oozing of the skin, honey colored lesions

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65
Q

Organisms causing Impetigo

A

strep pyogenes or staph aureus.

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66
Q

Impetigo treatment

A

Topical mupirocin or retapamulin
if severe: oral dicloxacillin or cephalexin
if community acquired MRSA: TMP/SMX, clindamycin

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67
Q

What organism cause erysipelas?

A

Group A (pyogenes) strep

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68
Q

Symptoms of Erysipelas

A

bright, red and hot skin (due to capillary dilation of dermis from local release of inflammatory mediators) - often face involved.

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69
Q

Best initial treatment of erysipelas

A

Oral dicloxacillin or cephalexin

if organism confirmed as group A beta hemolytic strep can treat with PCN VK

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70
Q

Cellulitis symptoms

A

warm, red, swollen, tender skin

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71
Q

Diagnostic tests for cellulitis

A

lower extremity doppler to exclude blood clot

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72
Q

Organisms causing cellulitis

A

staph aureus and strep pyogenes (equally)

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73
Q

Cellultis treatment

A

Minor: Dicloxacillin or cephalexin oral
Severe: Oxacillin, Naficillin, or cefazolin IV

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74
Q

Onychomycosis symptoms

A

thickened, yellow, cloudy, fragile and/or broken nails.

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75
Q

Best initial test for fungal infections of skin and nails

A

KOH preparation (when combine KOH with acid and skin or nail scrapping, epithelial cells dissolve and fungal form visible on slide)

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76
Q

Tinea Capitis (scalp fungal infection) and Onycomycosis treatments

A

Terbinafine, Itraconazole or Griseofulvin (tinea capitis) (ALL ORAL)

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77
Q

Adverse effect of Terbinafine

A

increased liver function tests

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78
Q

Topical antifungal medications (if no hair or nail involvement)

A

Clotrimazole, miconazole, ketoconazole, terconazole, nystatin, or ciclopirox

79
Q

Diagnostic symptom of Urethritis

A

Urethral discharge. May also have dysuria, frequency, urgency and burning.

80
Q

Diagnostic tests for urethritis

A

Urethral swab for gram stain, WBC count, culture and DNA probe. Nucleic acid amplification tests (NAATs) are highly effective as well.

81
Q

Urethritis treatment

A 
Treat for both gonorrhea and chlamydia
ceftriaxone IM (Gonorrhea) + Azithromycin single dose (Chlamydia)
82
Q

Gonorrhea medications

A

Ceftriaxone IM, cefepime oral, cefodoxime oral, ciprofloxacin (2nd line)

83
Q

Gonorrhea medication in pregnancy

A

Ceftriaxone IM

84
Q

Chlamydia medications

A

Azithromycin (Single dose), doxycycline (for a wk)

85
Q

Chlamydia medication in pregnancy

A

Azithromycin

86
Q

Triad of disseminated gonorrhea

A

Polyarticular disease
Petechial rash
Tenosynovitis.

87
Q

Single best test for both Gonorrhea and Chlamydia

A

NAAT - Nucleic acid amplification test (“DNA probe”)

can be done on voided urine for men or blind vaginal swab in women

88
Q

Symptoms of PID

A

Lower abdominal pain, tenderness, fever, and cervical motion tenderness.

89
Q

Best initial test for PID

A

Pregnancy test - need to exclude ectopic pregnancy.

Then cervical culture and DNA probe (NAAT) for chlamydia and gonorrhea.

90
Q

Most accurate test for PID

A

Laproscopy

91
Q

PID treatment

A

Outpatient: ceftriaxone IM (Gonorrhea) + Doxacycline (oral)
Inpatient: Cefoxitin (IV) or Cefotetan + Doxycycline and possibly metronidazole.

92
Q

Antibiotics that are safe in pregnancy

A

PCNs, Cephalosporins, Aztreonam, Erythromycin, Azithromycin

93
Q

Presentation of Epididymo-orchitis

A

Extremely painful and tender testicle with a normal position in the scrotum

94
Q

Presentation of testicular torsion

A

Elevated testicle in an abnormal transverse position

95
Q

Treatment of Epididymo-orchitis in M<35yrs

A

Ceftriaxone + Doxycycline

96
Q

Treatment of Epididymo-orchitis in M>35yrs

A

Fluoroquinolone

97
Q

What is chancroid and responsible organism

A

Painful ulcer

Haemophilus ducreyi

98
Q

Best initial test for chancroid

A

swab for gram stain (G - coccobacilli) and culture on Nairobi medium or Mueller Hinton Agar (Haemophilus ducreyi)

99
Q

Treatment for Chancroid

A

Single IM shot of ceftiaxone or single oral dose of azithromycin (treat H. ducreyi)

100
Q

What is lymphogranuloma venerum (LGV) and responsible organism

A

Stage 1: self-limited painless ulcer 3–12d after infection
Stage 2: 10–30d spread of infection to LNs causing enlarged painful LNs (buboes).
Caused by Chlamydia trachomatis

101
Q

Best diagnostic test for Lymphogranuloma venerum

A

Serology for Chlamydia trachomatis

102
Q

Treatment for Lymphogranuloma venerum

A 
Aspirate bubo (enlarged LN)
Treat with Azithromycin or Doxycycline
103
Q

Presentation of HSV2 (genital herpes)

A

Clear vesicular lesions on penis +/- enlarged adenopathy in inguinal area.

104
Q

Diagnosis of HSV2 (genital herpes)

A

No specific test required, diagnosis based on multiple vesicles, begin treatment. If unclear etiology then Tzanck prep

105
Q

Treatment of HSV2

A

Acyclovir, Valacyclovir or Famciclovir for 7-10d

106
Q

Most accurate test for Herpes

A

Viral culture

107
Q

Treatment of Acyclovir resistant herpes

A

Foscarnet

108
Q

Treatment of Herpes in pregnancy (especially with active lesions >36wks)

A

Acyclovir

109
Q

Responsible pathogen for syphilis

A

Treponema pallidum

110
Q

Presentation of Primary Syphilis

A

Painless, firm genital lesion (Chancre) + painless inguinal adenopathy

111
Q

Initial Diagnostic test for Primary Syphilis

A

Dark field microscopy (Most accurate test) then VDRL/RPR

112
Q

Treatment of Primary syphilis

A

single IM shot of PCN

If PCN allergy: Doxyxycline

113
Q

What is Jarisch-Herxheimer reaction?

A

Fever, HA and myalgia that develop 24hrs after initiation of treatment for early stage syphilis. It is benign, self limited rxn caused by release of pyrogens from dying treponemal.

114
Q

Treatment of Jarisch Herxheimer rxn?

A

Aspirin and continue syphilis treatment

115
Q

Symptoms of secondary syphilis

A

Rash, mucous patch, alopecia areata, condylomata lata

116
Q

Best initial diagnostic test for secondary syphilis

A

RPR and FTA

117
Q

Treatment of Secondary Syphilis

A

Single IM shot of PCN.

Doxyxlicline for PCN allergy.

118
Q

Symptoms of tertiary syphilis

A

Neurological involvement: Tabes dorsalis, Argyll Robertson pupil, general paresis, rarely a gumma or aortitis.

119
Q

What is Tabes dorsalis

A

Symptoms in tertiary Syphilis.

Demyelination of dorsal columns of spinal cord (proprioception, vibration, and discriminative touch).

120
Q

What are Argyll Robertson pupils

A

“Prostitute’s Pupil”. Bilateral small pupils that reduce in size when patient focuses on a near object (accommodate), but do not constrict when exposed to bright light (do not “react” to light).
Highly specific of neurosyphilis.
pupils that “accommodate but do not react”

121
Q

Initial diagnostic test for tertiary syphilis

A

RPR and FTA. Lumbar puncture for neurosyphilis (test CSF with VDRL and FTA)

122
Q

Treatment of tertiary syphilis

A

IV PCN.

if PCN allergic - desensitize.

123
Q

What is Grauloma Inguinale and organism?

A

Rare, beefy red genital lesion that ulcerates. Klebsiella granulomatis

124
Q

Best diagnostic test for granuloma inguinale

A

Biopsy or “touch prep” for klebsiella granulomatis

125
Q

Treatment for granuloma inguinale

A

Doxycycline, TMP/SMX or azithromyxin

126
Q

What is pediculosis?

A

Infestation of hair bearing areas (pubic area, or axilla) with the louse (lice)

127
Q

Treatment of pediculosis

A

permethrin, pyrethrins or lindane

128
Q

What is scabies?

A

contagious skin infection caused by the mite Sarcoptes scabiei. Burrows in web spaces

129
Q

Treatment of scabies

A

permethrin, lindane or ivermectin

130
Q

What is condylomata acuminata?

A

Genital warts caused by HPV types 6 and 11.

131
Q

What is Molluscu, contagiosum?

A

warts. viral infection of the skin sometimes called water warts caused by a DNA poxvirus called the molluscum contagiosum virus (MCV).

132
Q

Treatment of all Warts

A

surgical removal if large.
Imiquimod is an immunostimulator that leads to sloughing off of the wart.
Cryotherapy, laser removal and melting with podophyllin are other options

133
Q

Symptoms of Cystitis

A

Urinary frequency, urgency, burning, dysuria, suprapubic tenderness

134
Q

Best initial test for cystitis

A

Urinalysis

135
Q

Most accurate test for cystitis

A

urine culture

136
Q

Treatment of uncomplicated cystitis

A

TMP/SMX orally for 3d

if E.coli resistance in the area >20% use ciprofloxacin or levofloxacin

137
Q

Treatment of complicated cystitis

A

7d of TMP/SMX OR CIPROFLOXACIN

138
Q

What is complicated cystitis?

A

presence of anatomic abnormality such as tumor, stone, stricture, or obstruction.

139
Q

How should be treated for asymptomatic bacteriuria?

A

Only pregnant women

140
Q

Symptoms of Pyelonephritis

A

Urinary frequency, urgency, dysuria, burning, fever, flank pain and tenderness.

141
Q

Diagnostic test for pyelonephritis

A

Urinalysis and urine culture

142
Q

Treatment for Pyelonephritis

A

outpatient: ciprofloxacin
Inpatient: ampicillin/gentamicin

143
Q

What is perinephric abscess?

A

rare complication of pyelonephritis. suspect when patient with pyelonephritis does not respond to treatment after 5-7d

144
Q

Diagnosis of peinephric abscess

A

sonogram or CT of kidneys then biopsy to determine microbiologic diagnosis to guide treatment

145
Q

Treatment of perinephric abscess

A

quinolone + staph coverage (oxacillin or naficillin)

146
Q

Symptoms of Prostatitis

A

frequency, urgency, dysuria and perineal or sacral pain. prostate tenderness or “boggy” on examination.

147
Q

Best initial test for prostatitis

A

urinalysis

148
Q

Most accurate test for prostatitis

A

Urine WBCs after prostate massage

149
Q

Treatment of Prostatitis

A

Ciprofloxacin for extended period

150
Q

What is urine leukocyte esterase indicative of?

A

LE is derived from granulocytic WBCs an serves as indirect evidance of bacteriuria

151
Q

What is urine nitrite indicative of?

A

indicative of G- bacteria

152
Q

Diagnosis of infective endocarditis?

A

Dukes criteria (2 major, 1 major + 3 minor or 5 minor criteria)

153
Q

What are Dukes major criteria for infective endocarditis?

A

1) 2 positive blood cultures with either S.aureus, viritans strep, strep bovis/epidermis, enterococci, G- rods or candida.
2) Abnormal echo showing:
- Intracardiac mass or valvular vegetation OR
- Abscess OR
- New partial dehiscence of prosthetic valve

154
Q

What are Dukes minor criteria for infective endocarditis?

A

1) Fever >38C
2) Presence of risk factors: IVDU, structural heart disease, prosthetic valve, Dental procedure involving bleeding, Hx. of endocarditis.
3) Vascular findings: Janeway lesions, septic emboli infarcts, arterial emboli, mycotic aneurysm, conjunctival hemorrhage.
4) Immunological findings: Roth spots (retina), Osler’s nodes, GN
5) Microbiologic criteria: + blood cultures that dosent meet major criteria

155
Q

Patient with fever + new murmur, whats next best step?

A

Blood cultures. if cultures are positive then perform echo to look for vegitations

156
Q

What are janeway lesions

A

flat, painless lesions in hands and feet seen in infective endocarditis

157
Q

What are Osler’s nodes?

A

raised, painful and pea shaped lesions seen in infective endocarditis

158
Q

What are Splinter hemorrhages?

A

Hemorrhages seen under fingernails in infective endocarditis.

159
Q

Best empiric treatment for Infective endocarditis

A

Vancomycin + Gentamicin for 4-6 wks (will cover most common organisms: S.aureus, MRSA, and viridans group strep)

160
Q

Cardiac defects that require endocarditis prophalaxis

A

1) Prosthetic valves
2) Unrepaired cyanotic heart disease
3) Previous endocarditis
4) Transplant recipients who develop valve disease

161
Q

Antibiotic of choice for endocarditis prophalaxis

A

Amoxicillin. Use clindamycin for PCN allergy.

162
Q

When to start HIV/AIDS therapy?

A

1) CD4 <500
2) Symptomatic patientswith any CD4 count or viral load
3) Pregnant women
4) Needle stick scenario, when patient is known to be HIV +

163
Q

Which are the triple highly active antiretroviral therapy (HAART)

A

1) Tenofovir + emtricitabine + efavirenz (1 pill for all)
2) Zidovudine + lamivudine + efavirenz
3) Zidovudine + lamivudine + ritonavir/lopinavir

164
Q

What are the nucleoside reverse transcriptase inhibitors and adverse effects of the class?

A

Zidovudine, Didanosine, Dtavudine, Lamivudine, Abacavir, Emtricitabine, Tenofovir.
Adverse effects of the class: LACTIC ACIDOSIS.

165
Q

Zidovudine

A

Nucleoside reverse transcriptase inhibitor.

Adverse effect: Anemia

166
Q

Didanosine

A

Nucleoside reverse transcriptase inhibitor

Adverse effect: Pancreatitis and peripheral neuropathy

167
Q

Stavudine

A

Nucleoside reverse transcriptase inhibitor

Adverse effect: Pancreatitis and neuropathy

168
Q

Lamivudine

A

Nucleoside reverse transcriptase inhibitor.

No known adverse effects.

169
Q

Abacavir

A

Nucleoside reverse transcriptase inhibitor

Adverse effect: Rash

170
Q

Protease inhibitors medications and class adverse effect

A

Indinavir, Ritonavir, Lopinavir, Nelfinavir, Saquinavir, Darunavir, Tipranavir,Amprenavir, Atazanavir.
Class adverse effect: Hyperglycemia and hyperlipidemia

171
Q

Nonnucleaside Reverse Transcriptase Inhibitors and class adverse effect

A

Efavirenz, Nevirapine, Etravirine, Rilpivirine

Class adverse effect: Drowsiness

172
Q

Indinavir

A

Protease inhibitor

Adverse effect: Kidney stones.

173
Q

Postexposure prophalaxis (Needle-stick injury)

A

HAART for 1 month

174
Q

PCP prophylaxis

A

CD4<200

TMP/SMX for prophlyaxis (if causes rash switch to atovaquone or dapsone)

175
Q

Mycobacterium Avium Intracellulare (MAI)

A

<50 CD4 cells

use azithromycin once a wk orally.

176
Q

PCP infection presentation

A

SOB, dry cough, hypoxia and increased LDH.

177
Q

Best initial test for PCP

A

X-ray will show increased interstitial marking bilaterally

178
Q

Most accurate test for PCP

A

Bronchoalveolar lavage

179
Q

Treatment of PCP

A

IV TMP/SMX (if rash then IV pentamidine)

if PCP is severe (pO235) then add steroids.

180
Q

Toxoplasmosis presentation

A

HA/N/V and focal neurologic findings.

181
Q

Best initial test for toxoplasmosis

A

Head CT with contrast (show ring enhancing lesions)

182
Q

Toxoplasmosis treatment

A

Pyrimethamine and sulfadiazine for 2 wks then repeat CT, if lesions are not smaller then perform brain biopsy - most likely lymphoma.

183
Q

CMV presentation in HIV

A

<50 CD4 and blurry vision

184
Q

Treatment of CMV in HIV

A

Ganciclovir or foscarnet then continue wit maintenance therapy with oral valganciclovir lifelong unless CD4 increases with HAART therapy

185
Q

Cryptococcus presentation in HIV

A

<50 CD4 with fever and HA +/- neck stiffness and photophobia

186
Q

Cryptococcus diagnosis

A

LP will show increased leuokocytes

187
Q

Cryptococcus most accurate test

A

Cryptcoccal antigen test

188
Q

Cryptococcus best initial test

A

LP with India Ink stain

189
Q

Cryptococcus treatment

A

initially amphotericin followed by fluconazole.

Continue fluconazole lifelong unless CD4 increases.

190
Q

Presentation of Progressive Multifocal Leukoencephalopathy (PML)

A

<50 CD4 with focal neurologic abnormalities

191
Q

Best initial test for PML

A

Head CT or MRI (lesions do not show ring enhancement or mass effect)

192
Q

PML treatment

A

No specific treatment. treat with HAART, PML will resolve if CD4 increases

193
Q

Mycobacterium Avium Intracellulare (MAI) presentation

A

<50 CD4, weight loss, fever and fatigue, often anemia from BM invasion. increased Alkaline phosphatase and GGTP with a normal Bilirubin is chracteristic of liver involvment.

194
Q

MAI diagnosis

A

BM is more sensitive. Liver biopsy is most sensitive. blood culture is least sensitive.

195
Q

Treatment of MAI

A

Clarithromycin and ethambutal.

Prophalaxis with azithromycin.

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