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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
What antivirals treat CMV? Equal? What else do they cover?
Valganciclovir, Ganciclovir, Foscarnet Yes HSV, VZV
25
What is the best long-term Tx for CMV retinitis?
Valganciclovir
26
What are the adverse FX of valganciclovir and ganciclovir?
neutropenia, BM suppression
27
What adverse effect does Foscarnet have?
renal toxicity
28
What antivirals treat influenza A & B? Class?
Oseltamivir, Zanamivir neuraminidase inhibitors
29
What does ribavirin treat?
Hep C (w/ IFN) RSV
30
What antivirals treat chronic Hep B?
``` Lamivudine IFN Adefovir Tenofovir Entecavir Telbivudine ```
31
What does Fluconazole treat?
Candida (not C. krusei or C. glabrata) Cryptococcus oral and vaginal candidiasis as alternative to topical meds
32
What does Voriconazole cover? Side effect?
All Candida, best agent against Aspergillus SFX = visual disturbances
33
1. Name some echinocandins. 2. What are they good for? 3. What are they NOT good for? 4. Why no SFX?
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)
34
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?
1. Amphotericin 2. Voriconazole 3. Caspofungin 4. Fluconazole (less SFX)
35
SFX of Amphotericin
- renal toxicity (incr Cr) - hypokalemia - metabolic acidosis - fever, shakes, chills
36
Tx of osteomyelitis?
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
37
Tx of otitis externa?
Topical Abx (e.g. Ofloxacin or polymyxin/neomycin)
38
Best initial Abx for otitis media? If no improvement in 3 days?
Amoxicillin One of: Amoxicillin-clavulanate, cefdinir, ceftibuten, cefuroxime, cefprozil, cefpodoxime
39
Tx of malignant otitis externa?
Surgical debridement + Abx against Pseudomonas (e.g. Ciprofloxacin, Piperacillin, Cefepime, Carbapenem, Aztreonam)
40
Tx of sinusitis
Only if: fever + pain + persistant sxs despite 7 d of decongestant, purulent nasal dischg --> Amox x 7-10d and inhaled steroids
41
Tx of pharyngitis?
PCN or amoxicillin (can reduce severity of sxs, decrease risk of rheumatic fever [if GAS]) If PCN allergy --> Azithromycin or clarithromycin
42
Tx of influenza?
Oseltamivir or Zanamivir if pt presents w/i 1st 48 hrs after onset of sxs
43
Tx of impetigo?
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
Tx of erysipelas?
Oral dicloxacillin or cephalexin IF CONFIRMED AS GAS --> PCN VK
45
Tx of cellulitis?
Minor: Dicloxacillin or cephalexin PO Severe: Oxacillin, nafcillin, or cefazolin IV PCN allergy: -rash: cephalosporins (e.g. cefazolin) -anaphylaxis: Vanco, linezolid, Daptomycin
46
Tx of folliculitis/furuncles/carbuncles/boils?
same as cellulitis
47
Tx of fungal infxn of skin or nails?
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
Tx of urethritis & cervicitis?
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
Tx of PID?
Outpt: Ceftriaxone (IM) + Doxycycline PO Inpt: Cefoxitin IV + Doxycycline (+/- Metronidazole)
50
Tx of epididymo-orchitis?
35 yo: Fluoroquinolone
51
Tx of chancroid?
Ceftriaxone IM x 1 OR Azithromycin PO x 1
52
Tx of LGV?
Doxycycline | Azithromycin
53
Tx of HSV 2?
Acyclovir, Valacyclovir, or Famciclovir x 7-10 d
54
Tx of syphilis (primary, secondary, and tertiary)?
Primary: PCN IM x 1, Doxycycline if PCN-allergic Secondary: Same Tertiary: PCN IV, desensitization if allergic
55
Tx of granuloma inguinale?
Doxycycline, TMP/SMX, or Azithromycin
56
Tx of pediculosis vs. scabies?
Pediculosis: Permethrin, pyrethrins, lindane Scabies: Permethrin, lindane, ivermectin
57
Tx of cystitis?
Uncomplicated: TMP/SMX PO x 3 d -if resistance: Cipro or Levo Complicated: TMP/SMX x 7 d or Ciprofloxacin
58
Tx of pyelonephritis?
Outpt: Ciprofloxacin Inpt: Ampicillin/Gentamicin
59
Tx of perinephric abscess?
Quinolone & Staph coverage (e.g. oxacillin or nafcillin)
60
Tx of prostatitis?
Ciprofloxacin
61
Tx of infective endocarditis?
Vancomycin + Gentamicin x 4-6 weeks
62
Prophylaxis for infective endocarditis pre-dental procedure w/ bleeding?
Amoxicillin
63
What drugs are always a part of triple HAART?
One of: 1. Tenofovir + emtricitabine + efavirenz 2. Zidovudine + lamivudine + efavirenz 3. Zidovudine + lamivudine + ritonavir/lopinavir
64
Name some NRTIs. Adverse FX of the class?
Zidovudine, Didanosine, Stavudine, Lamivudine, Abacavir, Emtricitabine, Tenofovir SFX: Lactic acidosis
65
SFX of Zidovudine?
Anemia
66
SFX of Didanosine?
Pancreatitis & peripheral neuropathy
67
SFX of Stavudine?
Pancreatitis & neuropathy
68
SFX of Abacavir?
Rash
69
Name some protease inhibitors. SFX of class?
Indinavir, Ritonavir, Lopinavir, Nelfinavir, Saquinavir, Darunavir, Tipranavir, Amprenavir, Atazanavir SFX: hyperglycemia, hyperlipidemia
70
Side effect of indinavir?
kidney stones
71
Name some NNRTIs. SFX of class?
Efavirenz, Nevirapine, Etravirine, Rilpivirine SFX: Drowsiness (efavirenz), SJS!
72
Tx of ppl w/ penetrating injury, exposure of mucosal surfaces, unprotected sex w/ HIV infected person/blood?
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
Prophylaxis and Tx for PCP (<200 CD4 cells)?
TMP/SMX
74
Prophylaxis for MAC (<50 CD4 cells)?
Azithromycin PO x 1 wk
75
Tx of toxoplasmosis?
pyrimethamine + sulfadiazine x 2 weeks
76
Tx of CMV (< 50 CD4 cells)?
Ganciclovir or Foscarnet maintenance: Valganciclovir PO lifelong
77
Tx of cryptococcus (CD4 < 50 cells)?
Amphotericin, then Fluconazole
78
Tx of MAC? PPX?
Clarithromycin + Ethambutol PPX: Azithromycin
79
Tx of Leptospirosis?
Ceftriaxone or PCN
80
Tx of tularemia?
Bentamicin or Streptomycin
81
Tx of cysticercosis?
Albendazole
82
Tx of: 1. acute Lyme 2. Lyme --> rash, jt probs, Bells palsy 3. Lyme --> CNS/heart inv
1. Doxycycline 2. Doxycycline or Amoxicillin PO 3. Ceftriaxone IV
83
Tx of babesiosis?
Azithromycin & Atovaquone
84
Tx of ehrlichiosis?
Doxycycline
85
Tx of malaria?
Acute: quinine & doxycycline PPX: Mefloquine (weekly) or Atovaquone/Proquanil aka Malarone (daily) Note: Malarone causes sinus bradycardia, QT prolongation, neuropsych sxs SFX
86
Tx of nocardia?
TMP/SMX
87
Tx of Actinomyces?
PCN
88
Tx of coccidiomycosis
Itraconazole
89
Tx of blastomycosis?
Amphotericin or Itraconazole
90
Which Abx are a/w an increased risk of seizures?
beta lactams (penicillins, fluoroquinolones, cephalosporins, monobactams, carbapenems [esp imipenem])
91
Tx of Sydenham's chorea (complication of rheumatic fever)?
- Penicillin PO x 10 days | - if PCN-allergic, weight-based Erythromycin divided into 2-4 doses
92
Tx of diphtheria?
Diphtheria antitoxin ASAP!
93
What risks w/ diphtheria antitoxin?
HSR, serum sickness, anaphylaxis (have epi on hand)
94
Tx of mono?
Supportive care (acetaminophen, NSAIDs, fluids, rest, nutrition), observation, steroids for severe complications
95
Tx of oral thrush (Candida)?
Clotrimazole troches or nystatin suspension
96
Tx of candidal involvement of eye?
Amphotericin B, vitrectomy +/- Fluconazole
97
Tx of rabies?
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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