Infectious Disease Flashcards
0
Q
What is the goal of tx in HIV?
A
Reduce viral load to less than 50 copies
1
Q
What is the initial tx regimen for HIV?
A
2 NRTIs plus either 1 NNRTI or a protease inhibitor
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
3
Q
What is recommended for all HIV patients?
A
Pneumococcal vaccine
4
Q
What should be done after diagnosing HIV and starting therapy?
A
Obtain the HIV genotype
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
6
Q
What is the tx for P. jirovecii?
A
Single strength TMP-SMX
Dapsone
Pentamidine
Atovaquone
7
Q
When do you discontinue prophylaxis for P. jirovecii?
A
When CD4 count is greater than 200 for over 3 months
8
Q
What is the tx for MAC?
A
Weekly azithromycin
9
Q
When does prophylaxis for MAC begin?
A
When CD4 is below 100
10
Q
When do you discontinue prophylaxis for MAC?
A
When CD4 count is greater than 100 for more than 6 months
11
Q
When do you get prophylaxis doe Toxoplasmosis?
A
When cd4 count is less than 100 and there is positive IgG abs
12
Q
What is the tx for toxoplasmosis?
A
Double strength TMP-SMX
Sulfadiazine and pyrimethamine
Dapsone
13
Q
What is the prophylactic treatment of TB for HIV?
A
INH for 9 months
Or
Rifampin for 4 months
14
Q
What is the prophylactic tx for candidiasis?
A
Fluconazole
Nystatin swish and swallow
15
Q
What is the tx for HSV in HIV?
A
Daily acyclovir, famciclovir, valacyclovir
16
Q
When do you give pneumococcal vaccine to HIV patients?
A
Every 5 years while CD4 is greater than 200
17
Q
How do you treat cryptococcal meningitis?
A
Amphotericin B and flucytosine
18
Q
How do you treat Nocardia?
A
Bactrim
19
Q
How do you tx strep. Pneumo meningitis?
A
Ceftriaxone + vanc
20
Q
What is the the tx for an epidural abscess?
A
Vanc (broad spectrum antibiotics tht cover MRSA)
Surgical drainage
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
22
Q
How do you diagnose Lyme disease?
A
ELISA and western blot
23
Q
What should advanced Lyme disease be treated with?
A
Ceftriaxone
24
What is the tx for Rocky Mountain spotted fever?
Doxycycline
25
What is the tx for Rocky Mountain spotted fever in pregnant women?
Chloramphenicol
26
How is diagnosis of Rocky Mountain spotted fever confirmed?
Bx and indirect immunofluroescence of a skin lesion
27
What is the treatment for mild blastomycosis?
Oral intraconazole
28
What is the tx for severe blasto or in immune compromised patients?
IV ampho B
29
What is the tx for p.jirovecii?
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
```
30
What is the next step in evaluating someone with probably pseudo tumor cerebri?
CT or MRI to exclude masses
31
What is the diagnostic test for legionella?
Urine antigen test
32
What is the tx for mycoplasma?
Macrolides or fluoroquinolones
33
What is the tx for mastitis?
Cephalexin or dicloxacillin
34
What is the tx for mastitis in women with HIV, incarcerated of I long term care facility (at risk for MRSA)?
Clindamycin
TMP-SMX
Vanc
35
What is the diagnostic test for a VIPoma?
VIP level
| Ct or MRI to locate the tumor
36
What is the tx of VIPoma ?
IVF
Octreotide or loperamide to slow diarrhea
Surgery
37
What is the tx of a peritonei load abscess?
Needle aspiration
| IV antibiotics
38
What is the tx for enterobiasis?
Albendazole or mebendazole
39
What is the second line tx for enterobiasis?
Pyrantel pamoate
40
What is the major complication from IV acyclovir?
Renal tubular obstruction from acyclovir crystallizing in the tubules because of low urine solubility
41
What is the tx of actinomyces?
High dose Penicillin for 12 weeks
42
What is the tx for actinomyces in patients allergic to penicillin?
Clindamycin
43
What is the tx of Nocardia?
TMP-SMX
44
How do you diagnose trachoma?
Giemsa stain of corneal scrapings
45
How do you diagnose herpes keratitis?
Fluorescein stain that reveals dendritic pattern
46
How do you assess orbital cellulitis?
Blood and tissue culture
| CT
47
What is the tx for orbital cellulitis?
Admit and give IV antibiotics (vanc + ceftriaxone)
48
What should diabetics and immunocompromised patients be treated with in orbital cellulitis?
Amphotericin B and surgical debridement
49
What is the tx of trachoma?
Oral azithromycin
Topical tetracycline
Erythromycin
For 3-4 weeks
50
What is the tx of gonorrheal eye infection?
IM ceftriaxone
| PO cipro or ofloxacin
51
What is the tx for fever in a neutropenia patient?
IV empiric antibiotics with anti pseudomonals
52
How do you diagnose neisseria eye infection?
Gram stain
53
What is the drug of choice for malignant otitis externa?
Cipro
54
What is the tx for histoplasmosis
Itraconazole
55
What is th tx for disseminated histoplasmosis?
Amphotericin B X 14 days followed by itraconazole for a year or longer
56
What is the tx for Legionella?
Macrolides
| Fluoroquinolones
57
How do you dx legionella?
Urine test
| Grows in charcoal yeast extract with iron and cysteine
58
What drugs should you tell patients not to take 48 hours before a stress test?
Bb
CCB
Nitrates
59
What is the tx for a cat bite?
Augmentin for pastuerella
60
What is the test of choice for osteomyelitis?
MRI - shows increased signal in the bone marrow and soft tissue
61
What is the tx of osteomyelitis?
Surgical debridement
| IV antibiotics X 4-6 weeks (clindamycin + cipro)
62
How do you diagnose primary syphilis?
Dark field microscopy
63
What is fluconazole used for?
Candida
| Prophylaxis against cryptococcus and coccidiodes
64
What is the tx of oral candidiasis in HIV patients?
Oral fluconazole
65
How do you diagnose a retroperitoneal bleed?
CT of abdomen and pelvis without contrast
66
What is the tx of a retroperitoneal bleed?
IVF, transfusion, bed rest
| Decompression if have neuro sx
67
How do you confirm diagnosis of vertebral osteomyelitis?
CT guided aspiration and culture
68
What are the steps in managing a diaphragmatic hernia?
Intubation
OG tube to keep bowel decompressed against lung
Umbilical arterial line placement
69
What is the antibiotic choice for patients with meningitis over 50?
Cefepime
Vanc
Ampicillin
70
What are the antibiotics for neurosurgery/shunt?
Vanc plus cefepime
71
What antibiotics should you administer with penetrating skull trauma?
Vanc plus cefepime
72
How do you diagnose measles?
PCR
73
What do you do if someone is suspected of measles?
Put them in isolation in a negative air pressure room and wear and N95 mask
74
What is the tx for measles?
Supportive + vitamin A
75
How do you diagnose malaria?
Do giemsa or wright-stained thick and thin blood films
76
What is the first line prophylaxis toward chloroquine resistant malaria?
Mefloquine
77
What is the tx for babesiosis?
Atovaquone + azithromycin
78
What is the tx for impetigo?
Topical mupirocin or oral erythromycin
79
What is the gold standard HIV test from birth until 18 months?
PCR
80
What is the tx for bordetella pertussis?
Erythromycin for 14 days and close contacts
81
How do diagnose bordetella?
Cultures
82
Who should get RSV prophylaxis?
Children less than 2 years old in the winter who are high risk
83
What is th tx for Nocardia?
Bactrim
84
What is the tx for primary syphilis in a patient who is allergic to penicillin?
Doxycycline for 14 days
85
What is the tx for secondary syphilis in a patient who is allergic to penicillin?
Doxycycline for 14 days
86
What is the tx for latent syphilis?
IM pen G X 3 doses
87
What is the treatment for tertiary syphilis?
IV pen G for 14 days
88
What is the tx for tertiary syphilis in a patient who is allergic to penicillin?
Ceftriaxone for 14 days
89
What is the tx for latent syphilis in a patient who is allergic to penicillin?
Doxycycline X 28 days
90
What is the tx for bacillary angiomatosis?
Oral erythromycin
91
What is the tx of scarlet fever?
Pen V
92
What are tx options for scarlet fever in patients allergic to penicillin?
Clindamycin
Erythromycin
Cefazolin
Cephalexin
93
How do you diagnose histoplasmosis ?
Urine or serum antigen
94
What is the tx for for pertussis prophylaxis in patients less than 1 month?
Azithromycin for 5 days
95
What is the tx for for pertussis prophylaxis in patients more than 1 month?
Azithromycin for 5 days
Clarithromycin for 7
Or erythromycin for 14
96
What is neutropenic fever?
Fever of 101.3 or over 100.4 for over an hour in a neutropenic patient (ANC less than 1500)
97
What is the tx for low risk, clinically stable patients?
Outpatient oral antibiotics: cipro + augmentin
98
What is the tx for moderate-severe neutropenic fever?
hospital admit with IV antibiotics with anti pseudomonals + vanc if suspected catheter related or skin infections.
99
What do you add if neutropenic fever persists for more than 72 hours?
Add antifungals
100
What is fever of unknown origin?
A temperature over 100.9 for 3 weeks that remains undisguised following 3 outpatient visits or 3 days hospitalization
101
What should be done early in the work up of FUO?
CT abdomen, chest, pelvis
102
What is the tx for FUO.
Stop unnecessary meds
103
What is the tx of viral conjunctivitis?
Cold/warm compresses +\- antihistamine or decon drops
104
What is the tx for herpes zoster opthalmicus?
High dose acyclovir
105
What should be ordered if you suspect malaria ?
Thick and thin blood smears
106
What is the gold standard test for pneumonia?
CXR
107
Which organisms causing pneumonia can be checked for with a urine antigen test?
Legionella and s. pneumo
108
What is the tx for postherpetic neuralgia?
amitryptiline or nortriptyline
109
What is the tx for cat scratch disease?
Azithromycin for 5 days
110
What is the prophylaxis for TB if have a positive PPD test?
INH for 9 months
Alternative: INH for 6 months
Rifampin for 4 months
111
What is the tx for orbital cellulitis?
IV Vanc and ceftriaxone
112
What is the next step in diagnosing infective endocarditis after a physical exam?
Obtain serial blood cultures from 3 sites over an hour before giving antibiotics
113
What is the tx for MAC?
Clarithromycin + ethambutol
114
What is the diagnostic test for babesiosis?
Thick and thin blood smear with giemsa stain
115
What is the tx for babesiosis?
Clindamycin + quinine
Or
Azithromycin + atovaquone
116
What is the empiric antibiotic of choice for someone suspected of IE?
Vancomycin
117
Which organisms is ampicillin-sulbactam recommended for?
HÁČEK orgs
| Enterococci
118
What organism is pen G the drug of choice for when relating to heart valves?
Strep Viridans
119
What is the tx for pyelo in a pregnant woman?
IV ceftriaxone +\- gentamicin or aztreonam
120
How do you diagnose leprosy?
Skin bx
121
What is the tx for ehrlichosis?
Doxycycline
