Infectious Disease Flashcards
1
Q
INTRAVENOUS treatment for MSSA
bone, heart, skin, joint
A
- oxacillin
- nafcillin
- cefazolin (1st gen cephalosporin)
2
Q
ORAL treatment for MSSA
bone, heart, skin, joint
A
- dicloxacillin
- cephalexin (1st gen cephalosporin)
3
Q
treatment for MINOR MRSA infection
bone, heart, skin, joint
A
- trimethoprim/sulfamethoxazole (TMP/SMX)
- clindamycin
- doxycycline
4
Q
treatment for MAJOR MRSA infection
bone, heart, skin, joint
A
- vancomycin
- linezolid
- daptomycin
- ceftaroline
- tigecycline
- telavancin
5
Q
adverse effect of linezolid
A
thrombocytopenia
6
Q
adverse effect of daptomycin
A
myopathy (elevated CPK)
7
Q
treatment of Staph aureus if penicillin allergy: RASH
bone, heart, skin, joint
A
cephalosporins
8
Q
treatment of Staph aureus if penicillin allergy: ANAPHYLAXIS
bone, heart, skin, joint
A
- macrolides (azithromycin, clarithromycin)
- clindamycin
9
Q
treatment of Staph aureus if penicillin allergy: MINOR INFECTION
(bone, heart, skin, joint)
A
- macrolides (azithromycin, clarithromycin)
- clindamycin
- trimethoprim/sulfamethoxazole (TMP/SMX)
10
Q
treatment of Staph aureus if penicillin allergy: MAJOR INFECTION
(bone, heart, skin, joint)
A
- vancomycin
- linezolid
- daptomycin
- telavancin
11
Q
can you use the same antibiotics for Staph as Streptococcus?
A
YES
12
Q
antibiotics SPECIFIC for Streptococcus
A
- penicillin
- ampicillin
- amoxicillin
13
Q
Gram-negative bacilli (rods)
A
- Escherichia coli
- Enterobacter
- Citrobacter
- Morganella
- Pseudomonas
- Serratia
14
Q
antibiotic classes that are EQUAL in efficacy for treatment of Gram-NEGATIVE bacilli (rods)
A
- cephalosporins
- penicillins
- monobactam
- quinolones
- aminoglycosides
- carbapenems
15
Q
ONLY carbapenem that does NOT cover Pseudomonas
A
ERTAPENEM
16
Q
cover GNR and ALSO cover Streptococci and anaerobes
A
- PIPERACILLIN
2. TICARCILLIN
17
Q
EXCELLENT pneumococcal (Streptococcus pneumoniae) drugs
A
- LEVOFLOXACIN
- GEMIFLOXACIN
- MOXIFLOXACIN
18
Q
work SYNERGISTICALLY against Staph and Strep
A
AMINOGLYCOSIDES
19
Q
EXCELLENT anaerobic coverage, and cover Strep and MSSA
A
CARBAPENEMS
20
Q
covers MRSA and GNR
A
TIGECYCLINE
21
Q
adverse effect of imipenem
A
SEIZURES
22
Q
BEST medication for gastrointestinal anaerobes (Bacteroides)
A
metronidazole
23
Q
can also be used for gastrointestinal anaerobes (Bacteroides)
A
- carbapenems
- piperacillin
- ticarcillin
24
Q
ONLY cephalosporins that cover anaerobes
A
- CEFOXITIN
- CEFOTETAN
25
BEST medication for respiratory anaerobes (anaerobic Strep)
clindamycin
26
antibiotics with NO anaerobic coverage
- aminoglycosides
- aztreonam
- fluoroquinolones
- oxacillin
- nafcillin
- all cephalosporins EXCEPT cefoxitin and cefotetan
27
red, flushed skin (particularly on neck) from histamine release is d/t?
vancomycin
28
red man syndrome treatment
slow rate of vancomycin infusion
29
treatment for herpes simplex, and varicella zoster (all 3 are equal in efficacy)
1. acyclovir
2. valacyclovir
3. famciclovir
30
treatment for cytomegalovirus (CMV)
1. ganciclovir
2. valganciclovir
3. foscarnet
31
BEST long-term treatment for CMV RETINITIS
VALGANCICLOVIR
32
adverse effects of ganciclovir and valganciclovir
- neutropenia
| - bone marrow suppression
33
adverse effect of foscarnet
renal toxicity
34
treatment for influenza A and B
- oseltamivir
- zanamivir
(neuraminidase inhibitors)
35
treatment for hepatitis C (in combination w/ interferon), and respiratory syncytial virus (RSV)
ribavirin
36
treatment for hepatitis B
- lamivudine
- interferon
- adefovir
- tenofovir
- entecavir
- telbivudine
37
treatment for oral and vaginal candidiasis (alternative to topical medications)
fluconazole
38
best treatment against Aspergillus
voriconazole
39
adverse effect of voriconazole
visual disturbance
40
EXCELLENT for neutropenic fever patients
- caspofungin
- micafungin
- anidulafungin
(echinocandins)
41
which antifungals do NOT cover Cryptococcus?
echinocandins
42
adverse effects of echinocandins?
NONE
43
effective against ALL Candida, Cryptococcus, and Aspergillus
amphotericin
44
superior to amphotericin in treatment of Aspergillus
voriconazole
45
superior to amphotericin in treatment of neutropenic fever
caspofungin
46
superior to amphotericin in treatment of Candida
fluconazole (same efficacy, but LESS adverse effects)
47
adverse effects of amphotericin
1. renal toxicity (increased creatinine)
2. hypOkalemia
3. metabolic acidosis
4. fever, shakes, chills
48
occurs in DIABETES, PVD, or both with an ULCER, or SOFT TISSUE infection
OSTEOMYELITIS
49
best INITIAL test for osteomyelitis
plain X-ray
50
best SECOND-line test for osteomyelitis
MRI
51
most ACCURATE test for osteomyelitis
bone BIOPSY and culture
52
EARLIEST finding of osteomyelitis on X-ray
periosteal elevation
53
what percentage of calcium of bone must be lost in osteomyelitis before the X-ray becomes abnormal?
50%
54
how much time will it take before X-ray becomes abnormal in osteomyelitis?
up to 2 weeks
55
is osteomyelitis associated with fracture?
NO
56
best method for following response to therapy of osteomyelitis
ESR (erythrocyte sedimentation rate)
57
osteomyelitis is MOST COMMONLY caused by
direct contiguous spread from overlying tissue
58
what do you do in osteomyelitis if ESR is still markedly elevated after 4-6 weeks of treatment?
continue treatment
59
MCC of osteomyelitis
Staphylococcus
60
treatment for osteomyelitis if Staphylococcus is sensitive
OXACILLIN, or NAFCILLIN for 4-6 WEEKS
61
treatment for osteomyelitis if Staphylococcus is resistant (MRSA)
VANCOMYCIN, LINEZOLID, or DAPTOMYCIN for 4-6 WEEKS
62
can you treat Staphylococcal osteomyelitis with PO antibiotics?
NO
63
Gram-negative bacilli that can cause osteomyelitis
- Salmonella
| - Pseudomonas
64
ONLY form osteomyelitis that can be treated with PO antibiotics
Salmonella, and Pseudomonas osteomyelitis
65
- ITCHING and DRAINAGE from external auditory canal
| - form of cellulitis of external auditory canal
otitis externa
66
otitis externa is associated with?
- SWIMMING
| - FOREIGN OBJECTS
67
treatment for otitis externa
1. topical antibiotics
2. topical hydrocortisone (decreases swelling/itching)
3. acetic acid and water (reacidify ear)
68
OSTEOMYELITIS OF SKULL from Pseudomonas in patient with diabetes
malignant otitis externa
69
malignant otitis externa can cause
- brain abscess
| - skull destruction
70
best INITIAL test of malignant otitis externa
SKULL X-RAY, or MRI
71
MOST ACCURATE TEST for malignant otitis externa
BIOPSY
72
treatment for malignant otitis externa
1. SURGICAL DEBRIDEMENT
| 2. ANTIPSEUDOMONAL ANTIBIOTICS
73
antipseudomonal antibiotics that can be used in malignant otitis externa
- ciprofloxacin
- piperacillin
- cefepime
- carbapenem
- aztreonam
74
key features of otitis media
- redness
- bulging
- decreased hearing
- loss of light reflex
- TM immobility
75
MOST SENSITIVE finding in otitis media
TM IMMOBILITY
76
diagnostic testing for otitis media
NONE, based on PE
77
best INITIAL treatment of otitis media
AMOXICILLIN for 7-10 days
78
MOST ACCURATE TEST for otitis media
tympanocentesis and aspirate of TM for culture
79
if otitis media does not begin improving after 3 days, what do you do?
switch antibiotics!
- amoxicillin/clavulanate
- cefdinir
- ceftibuten
- cefuroxime
- cefprozil
- cefpodoxime
80
nasal discharge, headache, facial tenderness, tooth pain, bad taste in mouth, decreased transillumination of sinuses
sinusitis
81
MCC of sinusitis
VIRAL
82
MCC of sinusitis that are NOT viral
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Moraxella catarrhalis
83
best INITIAL test for sinusitis
X-ray
84
MOST ACCURATE TEST for sinusitis
sinus aspirate for culture
85
treatment for sinusitis
amoxicillin and INHALED STEROIDS
86
- pain/sore throat
- exudate
- adenopathy
- NO cough/hoarseness
pharyngitis
87
best INITIAL test for pharyngitis
RAPID STREP TEST
88
MOST ACCURATE TEST for pharyngitis
CULTURE
89
treatment for pharyngitis
PENICILLIN, or AMOXICILLIN
90
treatment for pharyngitis if penicillin allergy
azithromycin, or clarithromycin
91
- arthralgia
- myalgia
- cough
- headache
- fever
- sore throat
- feeling of tiredness
influenza
92
next best step to diagnose influenza
viral antigen detection
93
when should you treat influenza?
if patient presents within first 48 hours after onset of symptoms
94
what drug class works against BOTH influenza A and B?
neuraminidase inhibitors
95
treatment for influenza
- oseltamivir
| - zanamivir
96
WRONG answers to treat influenza
- amantadine
| - rimantadine
97
who should get vaccinated against influenza?
everyone
98
- most SUPERFICIAL bacterial skin infections
- weeping, crusting, oozing of skin
- Strep PYOGENES or Staph aureus
impetigo
99
treatment for impetigo
1. topical mupirocin
| 2. topical retapamulin
100
treatment for SEVERE impetigo
1. dicloxacillin
| 2. cephalexin
101
treatment for community-acquired MRSA impetigo
TMP/SMZ (trimethoprim/sulfamethoxazole)
102
treatment for impetigo if penicillin allergy: RASH
cephalosporins
103
treatment for impetigo if penicillin allergy: ANAPHYLAXIS
1. clindamycin
2. doxycycline
3. linezolid
104
treatment for impetigo if penicillin allergy: SEVERE INFECTION WITH ANAPHYLAXIS
1. vancomycin
2. telavancin
3. linezolid
4. daptomycin
105
- group A (PYOGENES) streptococcal infection of skin
- very bright red, hot
- often affects FACE
erysipelas
106
can erysipelas cause rheumatic fever?
NO, but it can cause glomerulonephritis
107
what can cause rheumatic fever and glomerulonephritis?
PHARYNGITIS
108
best INITIAL treatment for erysipelas
1. dicloxacillin
| 2. cephalexin
109
treatment for erysipelas if organism is CONFIRMED as group A beta hemolytic streptococci (Strep pyogenes)
PENICILLIN VK
110
- warm, red, swollen, tender skin
| - usually presents in arm or leg
cellulitis
111
what should you order in a case of cellulitis of the leg?
LOWER EXTREMITY DOPPLER to exclude blood clot
112
treatment for cellulitis: MINOR disease
1. dicloxacillin PO
| 2. cephalexin PO
113
treatment for cellulitis: SEVERE disease
1. oxacillin IV
2. nafcillin IV
3. cefazolin IV
114
treatment for cellulitis if penicillin allergy: RASH
cephalosporins (cefazolin)
115
treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and MINOR disease
- macrolides
| - clindamycin
116
treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and SEVERE disease
1. vancomycin
2. linezolid
3. daptomycin
117
what skin infection does Staphylococcus epidermidis cause?
NONE
118
all skin infections can lead to?
post-streptococcal GLOMERULONEPHRITIS
| but NOT rheumatic fever
119
Staph aureus-related skin infections beginning at the hair follicle
folliculitis
120
what is FOLLICulitis?
infected hair FOLLICle
121
what is a furuncle?
deep folliculitis
122
what is a Carbuncle?
a Cluster of furuncles
123
what is an abscess?
a collection of pus
124
diagnosis of folliculitis, furuncles, carbuncle, abscess
based on appearance
125
treatment for folliculitis/furuncles/carbuncles/abscesses: MINOR disease
1. dicloxacillin PO
| 2. cephalexin PO
126
treatment for folliculitis/furuncles/carbuncles/abscesses: SEVERE disease
1. oxacillin IV
2. nafcillin IV
3. cefazolin IV
127
treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: RASH
cephalosporins (cefazolin)
128
treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and MINOR disease
- macrolides
| - clindamycin
129
treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and SEVERE disease
1. vancomycin
2. linezolid
3. daptomycin
130
abscesses respond well to?
drainage
131
severe itching of scalp, dandruff, bald patches
fungal SKIN infection
132
thickened nails, yellow, cloudy, appear fragile and broken
onychomycosis
133
best INITIAL test for fungal skin/nail infections
KOH preparation
134
antifungal treatment if NO hair or nail involvement
| hint: 5 -azole's, and 2 others
topical:
- clotrimAZOLE
- miconAZOLE
- ketoconAZOLE
- econAZOLE
- terconAZOLE
- nystatin
- ciclopirox
135
PO antifungal tx for scalp (tinea capitis), or nail (onychomycosis)
1. terbinafine
2. itraconazole
3. griseofulvin (for tinea capitis)
136
adverse effect of terbinafine
increased transaminases
137
less efficacious than terbinafine and itraconazole
griseofulvin
138
- URETHRAL DISCHARGE
| +/- dysuria
urethritis
139
diagnostic testing for urethritis
- urethral swab (gram stain, WBC count, culture, DNA probe)
| - nucleic acid amplification test (NAAT)
140
treatment for urethritis
2 medications: one for gonorrhea, one for chlamydia
141
1. polyarticular disease
2. petechial rash
3. tenosynovitis
disseminated gonorrhea
142
medications for gonorrhea in urethritis
- ceftriaxone IM
- cefpodoxime PO
- ciprofloxacin PO
143
treatment for gonorrhea if patient has urethritis and is PREGNANT
ceftriaxone IM
144
medications for chlamydia in urethritis
- azithromycin (SINGLE dose)
| - doxycycline (for 1 week)
145
treatment for chlamydia if patient has urethritis and is PREGNANT
azithromycin
146
cervical discharge
cervicitis
147
diagnostic testing for cervicitis
- swab (gram stain, WBC count, culture, DNA probe)
| - nucleic acid amplification test (NAAT)
148
is just as accurate as a speculum examination for cervicitis
nucleic acid amplification testing (NAAT)
149
treatment for cervicitis
2 medications: one for gonorrhea, one for chlamydia
150
medications for gonorrhea in cervicitis
- ceftriaxone IM
- cefpodoxime PO
- ciprofloxacin PO
151
treatment for gonorrhea if patient has cervicitis and is PREGNANT
ceftriaxone IM
152
medications for chlamydia in cervicitis
- azithromycin (SINGLE dose)
| - doxycycline (for 1 week)
153
treatment for chlamydia if patient has cervicitis and is PREGNANT
azithromycin
154
- lower abdominal pain
- tenderness
- fever
- cervical motion tenderness
+/- dysuria
+/- vaginal discharge
pelvic inflammatory disease (PID)
155
measure of severity in pelvic inflammatory disease (PID)
leukocytosis
156
best INITIAL test for pelvic inflammatory disease (PID)
1. pregnancy test
2. cervical culture
3. NAAT (nucleic acid amplification testing)
157
MOST ACCURATE test for pelvic inflammatory disease (PID)
laparoscopy (rarely needed)
158
OUTPATIENT treatment for PID
ceftriaxone IM AND doxycycline PO
159
INPATIENT treatment for PID
cefoxitin IV AND doxycycline IV (and maybe metronidazole)
160
antibiotics safe in pregnancy
1. penicillins
2. cephalosporins
3. aztreonam
4. erythromycin
5. azithromycin
161
- extremely painful and tender testicle
| - NORMAL position of testicle in scrotum
epididymo-orchitis
162
- extremely painful and tender testicle
| - ELEVATED testicle in an ABNORMAL TRANSVERSE position
testicular torsion
163
treatment for epididymo-orchitis: if LESS THAN 35 years of age
ceftriaxone AND doxycycline
164
treatment for epididymo-orchitis: if MORE THAN 35 years of age
fluoroquinolone
165
PAINFUL ulcer caused by Haemophilus ducreyi
chancroid
166
best INITIAL test for chancroid
swab for gram stain and culture
167
treatment for chancroid
- ceftriaxone (single IM shot), OR
| - azithromycin (single PO dose)
168
- LARGE TENDER NODES
- ulcer
- may develop suppurating, draining sinus tract
lymphogranuloma venereum (LGV)
169
diagnose lymphogranuloma venereum (LGV)
serology for Chlamydia trachomatis
170
treatment for lymphogranuloma venereum (LGV)
1. aspirate the bubo
| 2. doxycycline, OR azithromycin
171
clear vesicular lesions
HSV2 (herpes simplex virus 2; genital herpes)
172
treatment for HSV2
- acyclovir
- valacyclovir
- famciclovir
for 7-10 days
173
best INITIAL test if roofs come off of vesicles making etiology unclear
Tzanck prep
174
MOST ACCURATE test for HSV2
viral culture
175
cause of syphilis
Treponema pallidum
176
- PAINLESS, firm genital lesion
| - painless inguinal adenopathy
syphilis
177
MOST ACCURATE test for PRIMARY syphilis
darkfield microscopy
178
symptoms of PRIMARY syphilis
- CHANCRE
| - ADENOPATHY
179
treatment for PRIMARY syphilis
SINGLE IM shot of PENICILLIN
180
treatment for PRIMARY syphilis if penicillin allergy
doxycycline
181
- fever, headache, myalgia
| - develops 24 hours after treatment of primary syphilis
Jarisch-Herxheimer reaction
182
symptoms of SECONDARY syphilis
- RASH
- MUCOUS PATCH
- ALOPECIA AREATA (bald patches)
- CONDYLOMATA LATA (warts on genitals)
183
INITIAL diagnostic test for SECONDARY syphilis
RPR and FTA
184
treatment for SECONDARY syphilis
SINGLE IM shot of PENICILLIN
185
treatment for SECONDARY syphilis if penicillin allergy
doxycycline
186
manifestations of TERTIARY syphilis
- TABES DORSALIS
- ARGYLL-ROBERTSON PUPIL
- GENERAL PARESIS (paralysis)
- gumma
- aortitis
187
INITIAL diagnostic test for TERTIARY syphilis
RPR and FTA
| FTA is more sensitive for neurosyphilis
188
best INITIAL diagnostic test for NEUROsyphilis
LUMBAR PUNCTURE
189
treatment for TERTIARY syphilis
IV PENICILLIN
190
treatment for TERTIARY syphilis if penicillin allergy
desensitization to penicillin
191
beefy red genital lesion that ULCERATES
granuloma inguinale
192
diagnostic test for granuloma inguinale
biopsy
193
causative organism for granuloma inguinale
Klebsiella granulomatis
194
treatment for granuloma inguinale
- doxycycline
- TMP/SMX
- azithromycin
195
- urinary frequency
- urgency
- burning
- dysuria
cystitis
196
best INITIAL test for cystitis
urinalysis
197
MOST ACCURATE test for cystitis
urine culture
198
treatment for UNCOMPLICATED cystitis
fosfomycin, or nitrofurantoin PO for 3 days
199
treatment for UNCOMPLICATED cystitis if high resistance to TMP/SMX
- ciprofloxacin
| - levofloxacin
200
treatment for COMPLICATED cystitis
- TMP/SMX
- ciprofloxacin
for 7 days
201
what qualifies as "complicated" cystitis?
- stone
- stricture
- tumor
- obstruction
202
should you treat asymptomatic bacteriuria?
NO
203
who should get treated for asymptomatic bacteriuria?
only PREGNANT women
204
- urinary frequency
- urgency
- burning
- dysuria
- FLANK PAIN and TENDERNESS
pyelonephritis
205
best INITIAL test for pyelonephritis
urinalysis
206
MOST ACCURATE test for pyelonephritis
urine culture
207
OUTpatient treatment for pyelonephritis
ciprofloxacin
208
INpatient treatment for pyelonephritis
- ceftriaxone
- ertapenem
- quinolones
- ampicillin
- gentamicin
209
why are sonography or CT scanning done in a patient with a UTI?
- to determine etiology
| - if pyelonephritis; stone? stricture? tumor? obstruction?
210
think of this in a patient who does not respond to treatment AFTER 5-7 days
perinephric abscess
211
necessary diagnostic test for perinephric abscess
biopsy to determine microbe
212
treatment for perinephric abscess
quinolone AND staphylococcal coverage
| because treatment for GN bacteria selects out staphylococci
213
positive NITRITES indicate
gram negative bacteria in urine
214
- frequency
- urgency
- dysuria
- PERINEAL or SACRAL PAIN
- prostate tenderness
prostatitis
215
best INITIAL test for prostatitis
urinalysis
216
MOST ACCURATE test for prostatitis
urine WBC's AFTER PROSTATE MASSAGE
217
treatment for ACUTE prostatitis
- ciprofloxacin
- TMP/SMX
FOR 2 WEEKS
218
treatment for CHRONIC prostatitis
- ciprofloxacin
- TMP/SMX
FOR 6 WEEKS
219
endocarditis is clinically diagnosed using
Duke's criteria
| 2 MAJOR, or 5 minor criteria
220
what are the 2 MAJOR criteria for Duke's criteria?
1. 2 positive blood cultures
| 2. abnormal echocardiogram
221
what are the minor criteria for Duke's criteria?
1. fever
2. presence of risk factors
3. vascular findings
4. immunologic findings
5. microbiologic findings
222
fever + murmur =
POSSIBLE endocarditis
| do blood cultures
223
2 positive blood cultures + positive echo =
ENDOCARDITIS
224
next best step in patient with fever, and new murmur or change in murmur
blood cultures
225
next best step in patient with fever, a murmur (new or changed), and positive blood cultures
echocardiogram
226
most common causes of culture NEGATIVE endocarditis
Coxiella and Bartonella
227
is associated even more with colonic pathology than Streptococcus bovis
Clostridium septicum
228
most common organisms for bacterial endocarditis
1. Staph aureus
2. MRSA
3. Strep viridans group
229
best empiric therapy for endocarditis
vancomycin AND gentamicin in COMBINATION
(covers MC organisms)
for 4-6 weeks
230
if cause of endocarditis is Streptococcus bovis or Clostridium septicum, need to do what?
COLONOSCOPY
231
what are the indications for surgery (valve replacement) in endocarditis?
ANATOMIC DEFECTS
1. valve rupture
2. abscess
3. prosthetic valves
4. fungal endocarditis
5. embolic events even after abx
232
when do you start HAART?
1. CD4 count
233
adverse effect of NRTI (nucleoside reverse transcriptase inhibitors)
lactic acidosis
234
adverse effects of PI (protease inhibitors)
1. hypERglycemia
| 2. hypERlipidemia
235
adverse effect of NNRTI (nonnucleoside reverse transcriptase inhibitors): efavirenz
drowsiness
236
adverse effect of zidovudine
anemia
237
adverse effects of didanosine
1. pancreatitis
| 2. peripheral nEUropathy
238
adverse effects of stavudine
1. pancreatitis
| 2. peripheral nEUropathy
239
adverse effect of abacavir
rash
240
adverse effects of lamivudine
NONE
241
adverse effect of tenofovir
renal toxicity
242
adverse effect of indinavir
kidney stones
243
postexposure prophylaxis:
- needle-stick injury
- unprotected sex
HAART for ONE MONTH
| tenofovir, emtricitabine, AND integrase inhibitor, or protease inhibitor
244
blocks CCR5 receptor of CD4 cell
maraviroc
245
which protease inhibitor inhibits the hepatic p450 system increasing blood levels of other PI's?
ritonavir
246
when do you start HIV meds in HIV+ pregnant women?
right away in first trimester
| regardless of CD4 count/viral load
247
HIV+ with CD4 count
Pneumocystis jiroveci pneumonia (PCP)
248
best ppx for Pneumocystis jiroveci pneumonia (PCP)
TMP/SMX
249
ppx for Pneumocystis jiroveci pneumonia (PCP) if TMP/SMX causes RASH
- atovaquone
| - dapsone
250
CANNOT be used for PCP ppx if G6PD deficiency
dapsone
251
HIV+ with CD4 count
Mycobacterium avium-intracellulare (MAI)
252
ppx for Mycobacterium avium-intracellulare (MAI)
azithromycin Qweekly
253
PCP presentation
1. SOB
2. dry cough
3. hypoxia
4. elevated LDH
254
best INITIAL test for PCP
CXR
| increased interstitial markings B/L
255
MOST ACCURATE test for PCP
BAL
256
treatment for PCP
TMP/SMX IV
257
treatment for PCP if TMP/SMX causes RASH
pentamidine IV
258
when do you give steroids in PCP?
pO2 35
259
headache, N/V, FND in immunocompromised patient
toxoplasmosis
260
best INITIAL test for toxoplasmosis
CT head WITH contrast
| "ring" enhancing lesions
261
treatment for toxoplasmosis
pyrimethamine and sulfadiazine for 2 WEEKS
262
HIV with
cytomegalovirus (CMV) retinitis
263
treatment for CMV retinitis
- ganciclovir
| - foscarnet
264
adverse effect of ganciclovir
low WBC's
265
adverse effect of foscarnet
high creatinine
266
maintenance therapy for CMV retinitis
valganciclovir PO LIFELONG, unless CD4 count increases
267
best INITIAL test for cryptococcal meningitis
INDIA INK STAIN on CSF
268
MOST ACCURATE test for cryptococcal meningitis
cryptococcal antigen test
269
treatment for cryptococcal meningitis
- amphotericin and 5-FC (flucytosine)
| - then LIFELONG fluconazole, unless CD4 count increases
270
- HIV and
progressive multifocal leukoencephalopathy (PML)
271
best INITIAL test for PML
head CT or MRI
272
MOST ACCURATE test for PML
PCR of CSF for JC virus
273
treatment for PML
- no specific treatment
- HAART
(will resolve when CD4 counts increases)
274
does NOT cover crytpococcus
caspofungin
275
- HIV with
Mycobacterium avium intracellulare (MAI)
276
diagnostic tests in order from least to most sensitive
LEAST sensitive= blood cultures
more sensitive= bone marrow biopsy
MOST sensitive= LIVER BIOPSY
277
treatment for Mycobacterium avium intracellulare (MAI)
clarithromycin AND ethambutol +/- rifabutin
278
animal exposure + jaundice + renal =
| fever, abdominal pain, muscle aches
leptospirosis
279
treatment for leptospirosis
- ceftriaxone
| - penicillin
280
- rabbits
- ulcer at site of contact
- enlarged lymph nodes
- conjunctivitis
tularemia
281
diagnose tularemia with
serology
282
treatment for tularemia
- gentamicin
| - streptomycin
283
- thin-walled cysts, often calcified on CTH
| - infected pork that's ingested
cysticercosis
284
treatment for cysticercosis
albendazole
285
camping/hiking + target-shaped rash =
- transmitted by Ixodes tick
Lyme disease
286
long-term manifestations/complications of Lyme disease
1. joints = LATE manifestation
2. cardiac = AV conduction block/defect
3. neurologic = 7th CN palsy (Bell's palsy)
287
diagnosis of Lyme disease
serology
288
treatment for Lyme disease: rash, joint, Bell's palsy
- doxycycline PO
- amoxicillin PO
- cefuroxime PO
289
treatment for Lyme disease: CNS, cardiac involvement
ceftriaxone IV
290
- also transmitted by Ixodes tick
- common in northeast
- HEMOLYTIC ANEMIA
babesiosis
291
diagnosis of babesiosis
- PBS
| - PCR
292
treatment for babesiosis
- azithromycin
| - atovaquone
293
- also transmitted by Ixodes tick
- NO RASH
- elevated LFT's
- THROMBOCYTOPENIA
- LEUKOPENIA
ehrlichia/anaplasma
294
diagnosis of ehrlichia/anaplasma
- PBS
| - PCR
295
treatment for ehrlichia/anaplasma
doxycycline
296
- traveler returning from endemic area
- HEMOLYSIS
- GI COMPLAINTS
malaria
297
diagnosis of malaria
blood smear
298
treatment for malaria: ACUTE disease
- mefloquine
- atovaquone/proguanil
- quinine/doxycycline (severe cases)
299
prophylaxis for malaria:
- mefloquine (weekly)
| - atovaquone/proguanil (daily)
300
- immunocompromised patients
- respiratory disease, can spread anywhere, usually skin or brain
- branching, gram positive filaments, weakly acid-fast
Nocardia
301
best INITIAL test for Nocardia
CXR
302
MOST ACCURATE test for Nocardia
culture
303
treatment for Nocardia
TMP/SMX
304
- normal immune system
- h/o facial/dental trauma
- branching, gram positive filaments
Actinomyces
305
diagnosis and confirmation of Actinomyces
1. gram stain
| 2. ANaerobic culture
306
treatment for Actinomyces
penicillin
307
- WET areas (river valleys)
- a/w bat droppings from caves
- palate and oral ulcers
- splenomegaly
- pancytopenia if there's bone dissemination
Histoplasmosis
308
best INITIAL test for Histoplasma
Histoplasma urine antigen
309
MOST ACCURATE test for Histoplasma
BIOPSY with culture
310
treatment for acute pulmonary disease d/t Histoplasma
none needed
311
treatment for disseminated Histoplasmosis
amphotericin
312
- VERY DRY areas (Arizona)
- joint pain
- erythema nodosum
Coccidioidomycosis
313
treatment for Coccidioidomycosis
itraconazole
314
- acute respiratory disease
- rural southeast
- BROAD BUDDING YEAST
- bone lesions are common
Blastomycosis
315
treatment for Blastomycosis
- amphotericin
| - itraconazole
316
MOA of echinocandins
1,3-glucan inhibition in fungi ONLY
317
treatment for chronic hepatitis C
- boceprevir
- simeprevir
- sofosbuvir
- ledipasvir
(none used as a single agent)
318
which antiviral agents for chronic hepatitis C not to be combined with interferon?
- sofosbuvir
| - ledipasvir
319
Should pregnant woman recieve a live vaccine?
No, but household members can
320
Do you have to notify a school of a childs HIV status?
No
321
```
Tuberculosis skin
Interferon gamma releases
Smear microscopy
Sputum culture
Nucleic acid amplificatin
```
```
Tuberculosis skin
Interferon gamma released
Smear microscopy
Sputum culture
Nucleic acid amplificación
```
322
Sputum AFB is?
Cheap afb testing is specific so cannot rule out disease due ro low sensitivity and poor differentiation so can’t tell the difference between active and latent tb. If skin test is posiitve then do gold standard mycobacterium culture and naa testing( which is also very sensitive)
323
What does macular papular rash look like?
Check website and upload online
324
How long does it take for lyme disease to develop after being bit by a tick?
Lyme diease is transfered by ixodes tick after 36-38 hours. And wheele formation after engorged tick is a sign of infection. However, small bite with out engorged tick is not likely to result in lyme disease. So no intervention is needed
