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Step 2 High Yield > Infectious Disease > Flashcards

Infectious Disease Flashcards

0
Q

What is the goal of tx in HIV?

A

Reduce viral load to less than 50 copies

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1
Q

What is the initial tx regimen for HIV?

A

2 NRTIs plus either 1 NNRTI or a protease inhibitor

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2
Q

How often do you monitor viral load after therapy?

A

Every month until you reach goal and then every 3-6 months after that

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3
Q

What is recommended for all HIV patients?

A

Pneumococcal vaccine

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4
Q

What should be done after diagnosing HIV and starting therapy?

A

Obtain the HIV genotype

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5
Q

What is the best step after HIV exposure?

A

Begin antiretroviral therapy immediately with a base 2 drug regimen or an expanded regimen of 3 or more drugs in 4 weeks

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6
Q

What is the tx for P. jirovecii?

A

Single strength TMP-SMX
Dapsone
Pentamidine
Atovaquone

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7
Q

When do you discontinue prophylaxis for P. jirovecii?

A

When CD4 count is greater than 200 for over 3 months

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8
Q

What is the tx for MAC?

A

Weekly azithromycin

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9
Q

When does prophylaxis for MAC begin?

A

When CD4 is below 100

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10
Q

When do you discontinue prophylaxis for MAC?

A

When CD4 count is greater than 100 for more than 6 months

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11
Q

When do you get prophylaxis doe Toxoplasmosis?

A

When cd4 count is less than 100 and there is positive IgG abs

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12
Q

What is the tx for toxoplasmosis?

A

Double strength TMP-SMX
Sulfadiazine and pyrimethamine
Dapsone

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13
Q

What is the prophylactic treatment of TB for HIV?

A

INH for 9 months
Or
Rifampin for 4 months

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14
Q

What is the prophylactic tx for candidiasis?

A

Fluconazole

Nystatin swish and swallow

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15
Q

What is the tx for HSV in HIV?

A

Daily acyclovir, famciclovir, valacyclovir

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16
Q

When do you give pneumococcal vaccine to HIV patients?

A

Every 5 years while CD4 is greater than 200

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17
Q

How do you treat cryptococcal meningitis?

A

Amphotericin B and flucytosine

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18
Q

How do you treat Nocardia?

A

Bactrim

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19
Q

How do you tx strep. Pneumo meningitis?

A

Ceftriaxone + vanc

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20
Q

What is the the tx for an epidural abscess?

A

Vanc (broad spectrum antibiotics tht cover MRSA)

Surgical drainage

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21
Q

What is the tx for Lyme Disease?

A

Doxycycline
Or if less than 8 years old - amoxicillin

Artificial tears and eye patching at night for Bell’s palsy

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22
Q

How do you diagnose Lyme disease?

A

ELISA and western blot

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23
Q

What should advanced Lyme disease be treated with?

A

Ceftriaxone

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24
Q

What is the tx for Rocky Mountain spotted fever?

A

Doxycycline

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25
Q

What is the tx for Rocky Mountain spotted fever in pregnant women?

A

Chloramphenicol

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26
Q

How is diagnosis of Rocky Mountain spotted fever confirmed?

A

Bx and indirect immunofluroescence of a skin lesion

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27
Q

What is the treatment for mild blastomycosis?

A

Oral intraconazole

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28
Q

What is the tx for severe blasto or in immune compromised patients?

A

IV ampho B

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29
Q

What is the tx for p.jirovecii?

A

TMP SMX for 21 days
Prednisone taper for patients with severe hypoxemia (PaO2 les than 70 or Aa gradient greater than 35)

Also,
Pentamidine IV
Clindamycin + primaquine
Dapsone + TMP
Oral atovaquone
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30
Q

What is the next step in evaluating someone with probably pseudo tumor cerebri?

A

CT or MRI to exclude masses

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31
Q

What is the diagnostic test for legionella?

A

Urine antigen test

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32
Q

What is the tx for mycoplasma?

A

Macrolides or fluoroquinolones

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33
Q

What is the tx for mastitis?

A

Cephalexin or dicloxacillin

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34
Q

What is the tx for mastitis in women with HIV, incarcerated of I long term care facility (at risk for MRSA)?

A

Clindamycin
TMP-SMX
Vanc

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35
Q

What is the diagnostic test for a VIPoma?

A

VIP level

Ct or MRI to locate the tumor

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36
Q

What is the tx of VIPoma ?

A

IVF
Octreotide or loperamide to slow diarrhea
Surgery

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37
Q

What is the tx of a peritonei load abscess?

A

Needle aspiration

IV antibiotics

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38
Q

What is the tx for enterobiasis?

A

Albendazole or mebendazole

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39
Q

What is the second line tx for enterobiasis?

A

Pyrantel pamoate

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40
Q

What is the major complication from IV acyclovir?

A

Renal tubular obstruction from acyclovir crystallizing in the tubules because of low urine solubility

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41
Q

What is the tx of actinomyces?

A

High dose Penicillin for 12 weeks

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42
Q

What is the tx for actinomyces in patients allergic to penicillin?

A

Clindamycin

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43
Q

What is the tx of Nocardia?

A

TMP-SMX

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44
Q

How do you diagnose trachoma?

A

Giemsa stain of corneal scrapings

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45
Q

How do you diagnose herpes keratitis?

A

Fluorescein stain that reveals dendritic pattern

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46
Q

How do you assess orbital cellulitis?

A

Blood and tissue culture

CT

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47
Q

What is the tx for orbital cellulitis?

A

Admit and give IV antibiotics (vanc + ceftriaxone)

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48
Q

What should diabetics and immunocompromised patients be treated with in orbital cellulitis?

A

Amphotericin B and surgical debridement

49
Q

What is the tx of trachoma?

A

Oral azithromycin
Topical tetracycline
Erythromycin
For 3-4 weeks

50
Q

What is the tx of gonorrheal eye infection?

A

IM ceftriaxone

PO cipro or ofloxacin

51
Q

What is the tx for fever in a neutropenia patient?

A

IV empiric antibiotics with anti pseudomonals

52
Q

How do you diagnose neisseria eye infection?

A

Gram stain

53
Q

What is the drug of choice for malignant otitis externa?

A

Cipro

54
Q

What is the tx for histoplasmosis

A

Itraconazole

55
Q

What is th tx for disseminated histoplasmosis?

A

Amphotericin B X 14 days followed by itraconazole for a year or longer

56
Q

What is the tx for Legionella?

A

Macrolides

Fluoroquinolones

57
Q

How do you dx legionella?

A

Urine test

Grows in charcoal yeast extract with iron and cysteine

58
Q

What drugs should you tell patients not to take 48 hours before a stress test?

A

Bb
CCB
Nitrates

59
Q

What is the tx for a cat bite?

A

Augmentin for pastuerella

60
Q

What is the test of choice for osteomyelitis?

A

MRI - shows increased signal in the bone marrow and soft tissue

61
Q

What is the tx of osteomyelitis?

A

Surgical debridement

IV antibiotics X 4-6 weeks (clindamycin + cipro)

62
Q

How do you diagnose primary syphilis?

A

Dark field microscopy

63
Q

What is fluconazole used for?

A

Candida

Prophylaxis against cryptococcus and coccidiodes

64
Q

What is the tx of oral candidiasis in HIV patients?

A

Oral fluconazole

65
Q

How do you diagnose a retroperitoneal bleed?

A

CT of abdomen and pelvis without contrast

66
Q

What is the tx of a retroperitoneal bleed?

A

IVF, transfusion, bed rest

Decompression if have neuro sx

67
Q

How do you confirm diagnosis of vertebral osteomyelitis?

A

CT guided aspiration and culture

68
Q

What are the steps in managing a diaphragmatic hernia?

A

Intubation
OG tube to keep bowel decompressed against lung
Umbilical arterial line placement

69
Q

What is the antibiotic choice for patients with meningitis over 50?

A

Cefepime
Vanc
Ampicillin

70
Q

What are the antibiotics for neurosurgery/shunt?

A

Vanc plus cefepime

71
Q

What antibiotics should you administer with penetrating skull trauma?

A

Vanc plus cefepime

72
Q

How do you diagnose measles?

A

PCR

73
Q

What do you do if someone is suspected of measles?

A

Put them in isolation in a negative air pressure room and wear and N95 mask

74
Q

What is the tx for measles?

A

Supportive + vitamin A

75
Q

How do you diagnose malaria?

A

Do giemsa or wright-stained thick and thin blood films

76
Q

What is the first line prophylaxis toward chloroquine resistant malaria?

A

Mefloquine

77
Q

What is the tx for babesiosis?

A

Atovaquone + azithromycin

78
Q

What is the tx for impetigo?

A

Topical mupirocin or oral erythromycin

79
Q

What is the gold standard HIV test from birth until 18 months?

A

PCR

80
Q

What is the tx for bordetella pertussis?

A

Erythromycin for 14 days and close contacts

81
Q

How do diagnose bordetella?

A

Cultures

82
Q

Who should get RSV prophylaxis?

A

Children less than 2 years old in the winter who are high risk

83
Q

What is th tx for Nocardia?

A

Bactrim

84
Q

What is the tx for primary syphilis in a patient who is allergic to penicillin?

A

Doxycycline for 14 days

85
Q

What is the tx for secondary syphilis in a patient who is allergic to penicillin?

A

Doxycycline for 14 days

86
Q

What is the tx for latent syphilis?

A

IM pen G X 3 doses

87
Q

What is the treatment for tertiary syphilis?

A

IV pen G for 14 days

88
Q

What is the tx for tertiary syphilis in a patient who is allergic to penicillin?

A

Ceftriaxone for 14 days

89
Q

What is the tx for latent syphilis in a patient who is allergic to penicillin?

A

Doxycycline X 28 days

90
Q

What is the tx for bacillary angiomatosis?

A

Oral erythromycin

91
Q

What is the tx of scarlet fever?

A

Pen V

92
Q

What are tx options for scarlet fever in patients allergic to penicillin?

A

Clindamycin
Erythromycin
Cefazolin
Cephalexin

93
Q

How do you diagnose histoplasmosis ?

A

Urine or serum antigen

94
Q

What is the tx for for pertussis prophylaxis in patients less than 1 month?

A

Azithromycin for 5 days

95
Q

What is the tx for for pertussis prophylaxis in patients more than 1 month?

A

Azithromycin for 5 days
Clarithromycin for 7
Or erythromycin for 14

96
Q

What is neutropenic fever?

A

Fever of 101.3 or over 100.4 for over an hour in a neutropenic patient (ANC less than 1500)

97
Q

What is the tx for low risk, clinically stable patients?

A

Outpatient oral antibiotics: cipro + augmentin

98
Q

What is the tx for moderate-severe neutropenic fever?

A

hospital admit with IV antibiotics with anti pseudomonals + vanc if suspected catheter related or skin infections.

99
Q

What do you add if neutropenic fever persists for more than 72 hours?

A

Add antifungals

100
Q

What is fever of unknown origin?

A

A temperature over 100.9 for 3 weeks that remains undisguised following 3 outpatient visits or 3 days hospitalization

101
Q

What should be done early in the work up of FUO?

A

CT abdomen, chest, pelvis

102
Q

What is the tx for FUO.

A

Stop unnecessary meds

103
Q

What is the tx of viral conjunctivitis?

A

Cold/warm compresses +- antihistamine or decon drops

104
Q

What is the tx for herpes zoster opthalmicus?

A

High dose acyclovir

105
Q

What should be ordered if you suspect malaria ?

A

Thick and thin blood smears

106
Q

What is the gold standard test for pneumonia?

A

CXR

107
Q

Which organisms causing pneumonia can be checked for with a urine antigen test?

A

Legionella and s. pneumo

108
Q

What is the tx for postherpetic neuralgia?

A

amitryptiline or nortriptyline

109
Q

What is the tx for cat scratch disease?

A

Azithromycin for 5 days

110
Q

What is the prophylaxis for TB if have a positive PPD test?

A

INH for 9 months

Alternative: INH for 6 months
Rifampin for 4 months

111
Q

What is the tx for orbital cellulitis?

A

IV Vanc and ceftriaxone

112
Q

What is the next step in diagnosing infective endocarditis after a physical exam?

A

Obtain serial blood cultures from 3 sites over an hour before giving antibiotics

113
Q

What is the tx for MAC?

A

Clarithromycin + ethambutol

114
Q

What is the diagnostic test for babesiosis?

A

Thick and thin blood smear with giemsa stain

115
Q

What is the tx for babesiosis?

A

Clindamycin + quinine
Or
Azithromycin + atovaquone

116
Q

What is the empiric antibiotic of choice for someone suspected of IE?

A

Vancomycin

117
Q

Which organisms is ampicillin-sulbactam recommended for?

A

HÁČEK orgs

Enterococci

118
Q

What organism is pen G the drug of choice for when relating to heart valves?

A

Strep Viridans

119
Q

What is the tx for pyelo in a pregnant woman?

A

IV ceftriaxone +- gentamicin or aztreonam

120
Q

How do you diagnose leprosy?

A

Skin bx

121
Q

What is the tx for ehrlichosis?

A

Doxycycline

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