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USMLE Step 3 > Infectious Disease > Flashcards

Infectious Disease Flashcards

0
Q

Tx of MRSA?

A

Severe infxn: Any of:

  • Vancomycin
  • Linezolid (causes thrombocytopenia)
  • Daptomycin (causes myopathy and rising CPK)
  • Ceftaroline
  • Tigecycline
  • Telavancin (Vanco derivative w/ similar efficacy)

Minor infxn:

  • TMP/SMX
  • Clindamycin
  • Doxycycline
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1
Q

Tx of MSSA?

A

IV: Oxacillin/nafcillin or cefazolin (1st gen cephalosporin)

PO: Dicloxacillin or cephalexin (1st gen cephalosporin)

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2
Q

Tx of S. aureus w/ PCN allergy?

A

Rash: ok to use cephalosporins

Anaphylaxis: macrolides (Azithromycin, Clarithromycin) or Clindamycin

Severe infxn: Vanco, linezolid, daptomycin, telavancin

Minor infxn: Macrolides (azithromycin, clarithromycin), clindamycin, TMP/SMX

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3
Q

What Abx are SPECIFIC for Strep (v. Staph)?

A

PCN, ampicillin, amoxicillin

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4
Q

Name some GNRs

A

E. coli, Enterobacter, Citrobacter, Morganella, Pseudomonas, Serratia

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5
Q

What cephalosporins cover GNRs?

A

Cefipime (4th gen)

Ceftazidime (3rd gen)

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6
Q

What penicillins cover GNRs?

A

Piperacillin

Ticarcillin

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7
Q

What monobactams cover GNRs?

A

Aztreonam

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8
Q

What quinolones cover GNRs?

A

Ciprofloxacin
Levofloxacin
Moxifloxacin
Gemifloxacin

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9
Q

What aminoglycosides cover GNRs?

A

Gentamicin
Tobramycin
Amikacin

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10
Q

What carbapenems cover GNRs?

A

Imipenem
Meropenem
Ertapenem
Doripenem

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11
Q

What is the only carbapenem that does NOT cover Pseudomonas?

A

Ertapenem

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12
Q

What Abx cover GNRs, Strep AND anaerobes?

A

Piperacillin

Ticarcillin

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13
Q

What drugs cover GNRs AND are excellent pneumococcal Abx?

A

Levofloxacin
Gemifloxacin
Moxifloxacin

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14
Q

Which Abx work synergistically w/ other agents to treat Staph and Strep?

A

Aminoglycosides (e.g. Gentamicin, Tobramycin, Amikacin)

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15
Q

Which Abx are EXCELLENT antianaerobic meds and also cover Strep and MSSA?

A

Carbapenems (e.g. Imipenem, Meropenem, Ertapenem, Doripenem)

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16
Q

What is a quinolone for PNA?

A

Gemifloxacin

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17
Q

Which Abx covers MRSA and is broadly active against GNRs?

A

Tigecycline

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18
Q

What is THE best Abx for GI anaerobes (Bacteroides)?

A

Metronidazole

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19
Q

What Abx are equal in efficacy to Metronidazole for GI anaerobes?

A

Carbapenems (e.g. Imipenem, Meropenem, etc.)
Piperacillin
Ticarcillin

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20
Q

What are the only cephalosporins that cover GI anaerobes?

A

Cefoxitin

Cefotetan

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21
Q

What Abx is the best for “anaerobic strep?”

A

Clindamycin

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22
Q

What Abx have NO anaerobic coverage?

A

Aminoglycosides (e.g. Gentamicin, tobramycin, etc.)
Aztreonam
Fluoroquinolones
Oxacillin/nafcillin
All of the cephalosporins except Cefoxitin, Cefotetan

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23
Q

What 3 antivirals are used for HSV, VZV?

Equal in efficacy?

A

Acyclovir, Valacyclovir, Famciclovir

Yes, equal

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24
Q

What antivirals treat CMV?

Equal?

What else do they cover?

A

Valganciclovir, Ganciclovir, Foscarnet

Yes

HSV, VZV

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25
Q

What is the best long-term Tx for CMV retinitis?

A

Valganciclovir

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26
Q

What are the adverse FX of valganciclovir and ganciclovir?

A

neutropenia, BM suppression

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27
Q

What adverse effect does Foscarnet have?

A

renal toxicity

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28
Q

What antivirals treat influenza A & B?

Class?

A

Oseltamivir, Zanamivir

neuraminidase inhibitors

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29
Q

What does ribavirin treat?

A

Hep C (w/ IFN)

RSV

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30
Q

What antivirals treat chronic Hep B?

A 
Lamivudine
IFN
Adefovir
Tenofovir
Entecavir
Telbivudine
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31
Q

What does Fluconazole treat?

A

Candida (not C. krusei or C. glabrata)

Cryptococcus

oral and vaginal candidiasis as alternative to topical meds

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32
Q

What does Voriconazole cover?

Side effect?

A

All Candida, best agent against Aspergillus

SFX = visual disturbances

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33
Q
  1. Name some echinocandins.
  2. What are they good for?
  3. What are they NOT good for?
  4. Why no SFX?
A
  1. Caspofungin, Micafungin, Anidulafungin
  2. neutropenic fever patients (better than amphotericin b/c less mortality)
  3. Cryptococcus (no coverage)
  4. they affect 1,3 glucan synthesis step (does not exist in ppl)
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34
Q
  1. What drug is effective against ALL Candida, Cryptococcus, Aspergillus?
  2. What is better than this against Aspergillus?
  3. What is better than this in neutropenic fever?
  4. What is better against Candida?
A
  1. Amphotericin
  2. Voriconazole
  3. Caspofungin
  4. Fluconazole (less SFX)
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35
Q

SFX of Amphotericin

A
  • renal toxicity (incr Cr)
  • hypokalemia
  • metabolic acidosis
  • fever, shakes, chills
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36
Q

Tx of osteomyelitis?

A

Staph is still the most common cause of osteo.

  • If sensitive: Oxacillin or nafcillin IV x 4-6 weeks
  • If MRSA: Vancomycin, linezolid, or daptomycin (IV)

If GNR (e.g. Salmonella or Pseudomonas), oral Abx

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37
Q

Tx of otitis externa?

A

Topical Abx (e.g. Ofloxacin or polymyxin/neomycin)

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38
Q

Best initial Abx for otitis media?

If no improvement in 3 days?

A

Amoxicillin

One of: Amoxicillin-clavulanate, cefdinir, ceftibuten, cefuroxime, cefprozil, cefpodoxime

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39
Q

Tx of malignant otitis externa?

A

Surgical debridement + Abx against Pseudomonas (e.g. Ciprofloxacin, Piperacillin, Cefepime, Carbapenem, Aztreonam)

40
Q

Tx of sinusitis

A

Only if: fever + pain + persistant sxs despite 7 d of decongestant, purulent nasal dischg –> Amox x 7-10d and inhaled steroids

41
Q

Tx of pharyngitis?

A

PCN or amoxicillin (can reduce severity of sxs, decrease risk of rheumatic fever [if GAS])

If PCN allergy –> Azithromycin or clarithromycin

42
Q

Tx of influenza?

A

Oseltamivir or Zanamivir if pt presents w/i 1st 48 hrs after onset of sxs

43
Q

Tx of impetigo?

A

Topical mupirocin or retapamulin

-If severe: oral Dicloxicillin or cephalexin
-If MRSA: TMP/SMX
-If PCN allergy:
Rash: cephalosporins ok
anaphylaxis: Clindamycin, doxycycline, linezolid
severe infxn w/ anaphylaxis: vancomycin, telavancin, linezolid, daptomycin

44
Q

Tx of erysipelas?

A

Oral dicloxacillin or cephalexin

IF CONFIRMED AS GAS –> PCN VK

45
Q

Tx of cellulitis?

A

Minor: Dicloxacillin or cephalexin PO
Severe: Oxacillin, nafcillin, or cefazolin IV
PCN allergy:
-rash: cephalosporins (e.g. cefazolin)
-anaphylaxis: Vanco, linezolid, Daptomycin

46
Q

Tx of folliculitis/furuncles/carbuncles/boils?

A

same as cellulitis

47
Q

Tx of fungal infxn of skin or nails?

A

Skin (no hair or nail involvement:
-topical antifungals (e.g. Clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin, ciclopirox)

Hair or nail inv: Terbinafine (incr LFTs), Itraconazole, Griseofulvin

48
Q

Tx of urethritis & cervicitis?

A

2 meds (one for gonorrhea, one for chlamydia)

  • Gonorrhea: Ceftriaxone IM, cefpodoxime PO, ciprofloxacin PO (2nd line). Ceftriaxone IM if pregnant.
  • Chlamydia: Azithromycin (1 dose), Doxycycline (x 1 week). Azithromycin if pregnant.
49
Q

Tx of PID?

A

Outpt: Ceftriaxone (IM) + Doxycycline PO

Inpt: Cefoxitin IV + Doxycycline (+/- Metronidazole)

50
Q

Tx of epididymo-orchitis?

A

35 yo: Fluoroquinolone

51
Q

Tx of chancroid?

A

Ceftriaxone IM x 1 OR Azithromycin PO x 1

52
Q

Tx of LGV?

A

Doxycycline

Azithromycin

53
Q

Tx of HSV 2?

A

Acyclovir, Valacyclovir, or Famciclovir x 7-10 d

54
Q

Tx of syphilis (primary, secondary, and tertiary)?

A

Primary: PCN IM x 1, Doxycycline if PCN-allergic
Secondary: Same
Tertiary: PCN IV, desensitization if allergic

55
Q

Tx of granuloma inguinale?

A

Doxycycline, TMP/SMX, or Azithromycin

56
Q

Tx of pediculosis vs. scabies?

A

Pediculosis: Permethrin, pyrethrins, lindane

Scabies: Permethrin, lindane, ivermectin

57
Q

Tx of cystitis?

A

Uncomplicated: TMP/SMX PO x 3 d
-if resistance: Cipro or Levo

Complicated: TMP/SMX x 7 d or Ciprofloxacin

58
Q

Tx of pyelonephritis?

A

Outpt: Ciprofloxacin

Inpt: Ampicillin/Gentamicin

59
Q

Tx of perinephric abscess?

A

Quinolone & Staph coverage (e.g. oxacillin or nafcillin)

60
Q

Tx of prostatitis?

A

Ciprofloxacin

61
Q

Tx of infective endocarditis?

A

Vancomycin + Gentamicin x 4-6 weeks

62
Q

Prophylaxis for infective endocarditis pre-dental procedure w/ bleeding?

A

Amoxicillin

63
Q

What drugs are always a part of triple HAART?

A

One of:

  1. Tenofovir + emtricitabine + efavirenz
  2. Zidovudine + lamivudine + efavirenz
  3. Zidovudine + lamivudine + ritonavir/lopinavir
64
Q

Name some NRTIs.

Adverse FX of the class?

A

Zidovudine, Didanosine, Stavudine, Lamivudine, Abacavir, Emtricitabine, Tenofovir

SFX: Lactic acidosis

65
Q

SFX of Zidovudine?

66
Q

SFX of Didanosine?

A

Pancreatitis & peripheral neuropathy

67
Q

SFX of Stavudine?

A

Pancreatitis & neuropathy

68
Q

SFX of Abacavir?

69
Q

Name some protease inhibitors.

SFX of class?

A

Indinavir, Ritonavir, Lopinavir, Nelfinavir, Saquinavir, Darunavir, Tipranavir, Amprenavir, Atazanavir

SFX: hyperglycemia, hyperlipidemia

70
Q

Side effect of indinavir?

A

kidney stones

71
Q

Name some NNRTIs.

SFX of class?

A

Efavirenz, Nevirapine, Etravirine, Rilpivirine

SFX: Drowsiness (efavirenz), SJS!

72
Q

Tx of ppl w/ penetrating injury, exposure of mucosal surfaces, unprotected sex w/ HIV infected person/blood?

A

HAART x 1 mo

  • if asymptomatic, low viral load: 2 NRTIs
  • if high viral load, 2 NRTI + protease inhibitor

Start within 2 hours of exposure.

73
Q

Prophylaxis and Tx for PCP (<200 CD4 cells)?

74
Q

Prophylaxis for MAC (<50 CD4 cells)?

A

Azithromycin PO x 1 wk

75
Q

Tx of toxoplasmosis?

A

pyrimethamine + sulfadiazine x 2 weeks

76
Q

Tx of CMV (< 50 CD4 cells)?

A

Ganciclovir or Foscarnet

maintenance: Valganciclovir PO lifelong

77
Q

Tx of cryptococcus (CD4 < 50 cells)?

A

Amphotericin, then Fluconazole

78
Q

Tx of MAC?

PPX?

A

Clarithromycin + Ethambutol

PPX: Azithromycin

79
Q

Tx of Leptospirosis?

A

Ceftriaxone or PCN

80
Q

Tx of tularemia?

A

Bentamicin or Streptomycin

81
Q

Tx of cysticercosis?

A

Albendazole

82
Q

Tx of:

  1. acute Lyme
  2. Lyme –> rash, jt probs, Bells palsy
  3. Lyme –> CNS/heart inv
A
  1. Doxycycline
  2. Doxycycline or Amoxicillin PO
  3. Ceftriaxone IV
83
Q

Tx of babesiosis?

A

Azithromycin & Atovaquone

84
Q

Tx of ehrlichiosis?

A

Doxycycline

85
Q

Tx of malaria?

A

Acute: quinine & doxycycline

PPX: Mefloquine (weekly) or Atovaquone/Proquanil aka Malarone (daily)
Note: Malarone causes sinus bradycardia, QT prolongation, neuropsych sxs SFX

86
Q

Tx of nocardia?

87
Q

Tx of Actinomyces?

88
Q

Tx of coccidiomycosis

A

Itraconazole

89
Q

Tx of blastomycosis?

A

Amphotericin or Itraconazole

90
Q

Which Abx are a/w an increased risk of seizures?

A

beta lactams (penicillins, fluoroquinolones, cephalosporins, monobactams, carbapenems [esp imipenem])

91
Q

Tx of Sydenham’s chorea (complication of rheumatic fever)?

A
  • Penicillin PO x 10 days

- if PCN-allergic, weight-based Erythromycin divided into 2-4 doses

92
Q

Tx of diphtheria?

A

Diphtheria antitoxin ASAP!

93
Q

What risks w/ diphtheria antitoxin?

A

HSR, serum sickness, anaphylaxis (have epi on hand)

94
Q

Tx of mono?

A

Supportive care (acetaminophen, NSAIDs, fluids, rest, nutrition), observation, steroids for severe complications

95
Q

Tx of oral thrush (Candida)?

A

Clotrimazole troches or nystatin suspension

96
Q

Tx of candidal involvement of eye?

A

Amphotericin B, vitrectomy +/- Fluconazole

97
Q

Tx of rabies?

A

Once exposed, unvaccinated get IVIG and vaccine; previously immunized get IVIG only

Universally fatal once symptomatic

USMLE Step 3 (7 decks)

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