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Internal Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

methicillin is not used because..

A

it causes allergic interstitial nephritis

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2
Q

penicillin used in tx for?

A 
otitis media
dental infection & endocarditis prophylaxis
lyme disease (rash)
UTI in pregnant women
listeria
enterocococcal infections
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3
Q

pipercillin, ticarcillin used in tx for?

A 
cholecystitis
ascending cholangitis
pyelonephritis
bacteremia
HCAP
VCAP
neutropenia & fever

-covers enterobacteria, pseudomonas, strep, anaerobes

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4
Q

penicillin rash vs anaphylaxis. what do you switch tx to?

A

cephalosporin

non-beta-lactam antibiotic

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5
Q

cefotetan & cefoxitin (2nd generation) tx & SE

A
  • tx PID (with doxycycline)

- SE: inc bleeding risk, disulfiram-like reaction

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6
Q

ceftriaxone use in tx for?

A
  • pneumococcus
  • meningitis
  • CAP
  • gonorrhea
  • lyme (involving heart & brain)

-avoid in neonates (imp oared biliary metabolism)

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7
Q

carbapenems covers which types of bacteria?

(imi, mero & doripenem

A
  • gram(-)bacilli
  • anaerobes
  • strep
  • staph
  • neutropenia & fever
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8
Q

aztreonam covers which types of bacteria?

A
  • gram(-) bacilli only
  • includes Pseudomonas

-no cross reactivity with penicillins

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9
Q

ciprofloxicin used in tx for?

A

cystitis
pyelonephritis
diverticulitis (+ metronidazole)
GI infections

-moxifloxicin = single agent for diverticulitis without metronidazole

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10
Q

floroquinolone SE?

cipro, gemi, levo and moxifloxacin

A
  • bone growth abnormalities in kids and pregnant women
  • tendonitis (achilles tendon rupture)

-contraindicated in children

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11
Q

amino glycosides used in tx for? SE?

gentamicin, tobramycin, amikacin

A
  • bowel, urine, bacteremia from gram (-)
  • synergisitic with beta-lactams against enterococci & staph

-SE: nephro & ototoxic

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12
Q

doxycycline uses? SE?

A
  • chlamydia
  • lyme (rash, joint, Cr VII palsy)
  • MRSA skin
  • rickettsia
  • syphilis (ONLY if allergic to penicillin)

-SE: tooth discoloration, Fanconi (type II RTA), photosensitivity

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13
Q

TMP-SMX uses? SE?

trimethoprim-sulfamethoxazole

A
  • cystitis
  • PCP tx & prophylaxis
  • MRSA cellulitis

-SE: rash, hemolysis (G6PD deficiency), marrow suppression (via folate antagonism)

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14
Q

nitrofurantoin use?

A

cystitis in pregnant women

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15
Q

staph & strep tx?

A
  • oxacillin/ nafcillin/ dicloxacillin
  • 1st gen cephalosporins: cefazolin, cephalexin
  • floroquinolones
  • macrolides (3rd line)
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16
Q

MRSA tx?

A
  • vancomycin
  • linezolid
  • daptomycin
  • tigecycline
  • ceftaroline

-minor MRSA infections: TMP-SMX, clindamycin, doxycycline

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17
Q

oral anaerobe tx?

A
  • penicillin (G, V, amp/ amoxicillin)
  • clindamycin
  • metronidazole (GI)
  • pipercillin, carbapenems, 2nd gen cephalosporins
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18
Q

meningitis vs encephalitis vs abscess = fever + headache +

A

meningitis: stiff neck, photophobia
encephalitis: confusion
abscess: focal neurologic deficit

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19
Q

bacterial meningitis causes?

A

-strep pneumo = most common

  • group B strep (neonates)
  • H flu (dec since vaccinations)
  • Neisseria meningitis
  • listeria (immunocompromised pts; requires ampicillin)
  • staph -after neurosurgery
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20
Q

meningitis in AIDS pts cause?

A

cryptococcus

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21
Q

meningits dx

A

lumbar puncture = most accurate

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22
Q

CSF dx? bacterial vs viral

A

bacterial: 1000s neutrophils, elevated protein (marked in TB), decreased glucose, positive gram stain (not in TB)
viral: lymphocytes, no change in protein or glucose

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23
Q

head CT before LP if?

A
  • papilledema
  • seizures
  • focal neurologic deficits
  • confusion

-start broad spectrum therapy before CT

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24
Q

bacterial antigen test used when?

A

-pts given antibiotics prior to LP

culture may be falsely negative

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25
Q

cryptococcal dx?

A
  • india ink

- cryptococcal antigen

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26
Q

meningitis tx?

A

ceftriaxone + vancomycin + steroids

-while waiting for culture and gram stain

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27
Q

dexamethasone use?

A
  • lowers mortality in strep pneumo
  • 1000s of neutrophils

-combined with ceftriaxone + vancomycin

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28
Q

ampicillin use in meningitis?

A

listeria infection

  • immunocompromised pts
  • can’t use cephalosporins
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29
Q

Neisseria meningitis close contacts tx?

A

rifampin or ciprofloxacin

  • those who kiss, share cigs/eating utensils, have major fluid contact
  • not HC workers
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30
Q

encephalitis cause & dx & tx

A
  • HSV = most common
  • dx: PCR of CSF
  • tx: acyclovir; foscarnet
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31
Q

acyclovir vs foscarnet

A
  • foscarnet has more nephrotoxicity than acyclovir
  • foscarnet used in acyclovir-resistant HSC
  • different MOAs
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32
Q

most sensitive PE finding of otitis media?

A

immobility of tympanic membrane

-other findings: redness, bulging, dec light reflex, fever

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33
Q

otitis media tx

A
  • amoxicillin

- usually self-resolving

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34
Q

pharyngitis px & dx

A

pain + nodes + exudate + fever + NO cough/ hoarseness

  • often Group A beta-hemolytic strep
  • dx: rapid strep test
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35
Q

other causes of pharyngitis?

A 
HSV
herpangina (coxsackie A)
diptheria
vincent angina
EBV
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36
Q

pharyngitis tx

A
  • penicillin or amoxicillin

- clindamycin or macrolide

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37
Q

influenza px

A
  • arthralgias/myalgias
  • cough
  • fever
  • headache
  • n/v (children)
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38
Q

influenza dx & tx

A

-dx: nasopharyngeal swab

  • tx: oseltamivir or zanamivir (within 48 hours; shorten duration)
  • symptomatic tx if >48 hours
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39
Q 
Associations for bacterial diarrhea:
salmonella
campylobacter
E coli 0157:H7
Shigella (shiga toxin)
vibro
yersinia
clostridium difficile
A 
poultry
Guillain-Barre Syndrome
HUS = fragment cells, low platelets, high BUN/ creatinine
HUS
shellfish & cruise ships
hemochromatosis, blood transfusions
antibiotcs
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40
Q

infectious diarrhea dx?

A

blood and/or fecal leukocytes = best initial

  • lactoferrin has a higher specificity
  • stool culture = most accurate
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41
Q

no blood or WBCs in infectious diarrhea

A 
viral
Giardia (camp/hiking)
cryptosporidosis (AIDS <100; AFS)
bacilllus cereus (preformed toxin)
staph (preformed toxin)
scombroid (found in fish; tx with antihistamine; rapid onset)
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42
Q

infectious diarrhea tx

A
  • fluids

- fluids + ciprofloxacin (severe)

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43
Q

Giardia diarrhea tx

A

metronidazole or tinidazole

-cipro does not cover it

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44
Q

cryptosporidiosis diarrhea tx

A

nitazoxanide & tx underlying AIDS

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45
Q

viral, b. cerus, staph diarrhea tx

A

fluid support

46
Q

hepatitis E

A
  • worst in pregnancy (fulminant hepatitis)
  • East Asia
  • feco-oral
47
Q

elevated PT time indicates?

A

60% of liver destruction

48
Q

PCR levels = amount of active viral replication

indicates…

A

indicates response to hepatitis therapy

49
Q

hepatitis B serologic patterns

A

HBsAg = acute/chronic infection; 1st to inc

HBeAg = acute, infectivity measure
HBcAb = IgM(acute) or IgG(resolved)
HBsAb = resolved
50
Q

HBV vaccination serology

A

HBsAb ONLY

-negative HBsAg, HBeAg, HBcAb

51
Q

HBV “window period” serology

A

HBcAg (IgM then IgG)

-negative HBsAg, HBeAg, HBsAb

52
Q

No HBsAg indicates

A

you can’t transmit infection

53
Q

e-antigen indicates

A
  • tx is needed since there is active disease replication
  • indicates transmissibility from pregnant woman to child

-whereas HBeAb does NOT require tx

54
Q

HAV & HEV tx?

A

none

55
Q

HBV tx?

A

acute: none
chronic: entecavir or adefovcir, tenofovir, lamivudine or telbivudine or interferon (IM) —monotherapy

56
Q

HCV tx?

A

interferon + ribavirin + telaprevir/boceprevir

57
Q

interferon SE

A
  • arthralgia/myalgia
  • leukopenia & thrombocytopenia
  • depression & flu-like symptoms
58
Q

ribavirin SE

A

anemia

59
Q

UTI dx?

A

urinanalysis –> shows inc WBCs

-microbe: E. coli

60
Q

UTI causes

A
  • stones
  • strictures
  • tumor
  • BPH
  • DB (dec effectiveness of WBCs)
  • foley catheter
  • neurogenic bladder
61
Q

UTIs in men due to?

A

anatomic abnormality

  • must image
  • best initial test: urinanalysis >10WBCs
  • most accurate: urine culture
62
Q

UTI tx

A
  • quinolones (cipro)
  • TMP-SMX
  • nitrofurantoin
  • cephalexin
  • 3 day tx
  • 7 day tx for anatomic abnormality –also need imaging
  • culture if recurring infection
63
Q

pyelonephritis tx

A
  • ampicillin + gentamicin (renal-excretion, thus good penetration of infection)
  • ciprofloxacin
  • must cover gram(-) bacilli

-imaging to look for anatomic abnormalities causing infection/ to prevent future infections

64
Q

unresolving pyelonephritis, next step?

A
  • sonogram or CT scan to look for perinephric abscess
  • drain
  • culture to guide therapy
65
Q

urethritis dx & microbes

A
  • men: urethral swab = best initial
  • women: self-administered vaginal swab

-nucleic acid amplification test (NAAT) = most accurate

  • for gonorrhea & chlamydia
  • also mycoplasma, ureaplasma
66
Q

urethritis tx

A
  • gonorrhea –cefixime (oral) or ceftriaxone (IM)

- chlamydia –azithromycin (oral) or doxycycline

67
Q

cervicits px & dx & tx

A
  • px: inflamed “strawberry” cervix
  • dx: self-administered swab for NAAT
  • tx: cefixime/ceftriaxone & azithromycin/doxycycline
68
Q

PID px

A
  • lower abdominal tenderness & pain
  • fever
  • cervical motion tenderness (via bimanual exam)

-EXCLUDE PREGNANCY FIRST with this px

69
Q

PID dx

A
  • cervical swab for culture & NAAT = most specific
  • laparoscopy = most accurate (rarely used)

-culture needed for gonorrhea (to determine resistance)

70
Q

PID tx inpatient

A

inpatient: cefoxitin or cefotetan (2nd gen cephalosporins) + doxycycline
- 2nd gen cephalosporins cover anaerobes
- clindamycin & gentamicin (for penicillin anaphylaxis)

71
Q

PID tx outpatient

A

ceftriaxone & doxycycline +/- metronidazole

-levofloxacin & metronidazole (for penicillin anaphylaxis)

72
Q

genital ulcer types:

  • painless
  • painful
  • LN tender & suppurating
  • vesicles prior to ulcer
A
  • syphilis
  • chancroid (H ducreyi)
  • lymphogranuloma venereum (Chlamydia)
  • HSV
73
Q

genital ulcer dx:

  • syphilis
  • chancroid
  • lymphogranuloma venerium
  • HSV
A
  • dark-field microscopy; VDRL, RPR; FTA
  • stain & culture (gram-)
  • complement fixation titers in blood
  • Tzanck prep, viral culture
74
Q

syphilis dx

A

-dark-field = most accurate bc actually see the organisms

  • VDRL or RPR = 75% sensitive (1/4 false negative)
  • FTA = confirmatory
75
Q

genital ulcer tx:

  • syphillis
  • chancroid
  • lymphogranuloma venereum
  • HSV
A
  • IM benzathine penicillin (doxy if allergic)
  • azithromycin (single dose)
  • doxycycline
  • acyclovir, valacyclovir, famciclovir; foscarnet
76
Q

secondary syphilis px

A
  • rash (palms & soles)
  • alopecia areata
  • mucous patches (mouth & genitals)
  • condylomata lata
77
Q

tertiary syphilis px

A
  • neurosyphilis
  • stroke from vasculitis
  • tabes dorsalis = loss of position & vibration sense, incontinence, cranial nerve
  • general paresis
  • Argyll Robertson pupil (reaction to accommodation, but not light)
  • aortitis
  • gummas
78
Q

false positive VDRL/RPR in?

A
  • antiphospholipid syndrome
  • endocarditis
  • malaria, AIDS, IV drug, infection, older age

-false positive often have lower titers

79
Q

Jarisch-Herxheimer reaction

A

=fever + headache + myalgias after syphilis tx

  • uncomfortable, but no danger to pt
  • give ASA & antipyretics

-desensitization for neurosyphilis & pregnant women

80
Q

condylomata acuminata microbe, px, tx

A
  • papillomavirus (HPV)
  • px: visual appearance of warts

-tx: cryotherapy with liquid nitrogen; surgery for large, podophyllin, imiquimod (gentle)

81
Q

crabs = pediculosis px, tx

A
  • hair-bearing areas (axilla, pubis)
  • itchy

-tx: permethrin (less SE than lindane)

82
Q

scabies px, tx

A
  • very small
  • b/t fingers, toes, elbows

-tx: permethrin, oral ivermectin

83
Q

endocarditis px & dx

A

-px: fever + new murmur

  • dx: blood cultures
  • echo only if (+)blood cultures (TTE) –> TEE if (-)TTE
84
Q

endocarditis complications:

A
  • splinter hemorrhages**
  • Janeway lesions (flat & painless)
  • Osler nodes (raised & painful)
  • Roth spots (back of eye)
  • mycotic aneurysm (embolic infection into brain)
  • GN & hematuria –>death
  • conjunctival petechiae
  • septic emboli to lungs
85
Q

empiric therapy for endocarditis

A

vancomycin + gentamicin

86
Q

viridans strep endocarditis tx

A

ceftriaxone or penicillin for 4 weeks

87
Q

stap aureus endocarditis tx

A

oxacillin, nafcillin, cefazolin

88
Q

fungal endocarditis tx

A

amphotericin & valve replacement

89
Q

MRAS/staph epidermidis endocarditis tx

A

vancomycin

90
Q

enterococci endocarditis tx

A

ampicillin & gentamicin

91
Q

surgery for endocarditis in cases of?

A

acute valve rupture

CHF

92
Q

most common culture negative endocarditis =

A

coxiella & bartonella

-not HACEK organisms

93
Q

endocarditis prophylaxis for:

A

cardiac defect + risk of bacteria

  • prosthetic valve, previous endocarditis, cardiac transplant, unrepaired cyanotic HD
  • dental work with blood, respiratory tract surgery
  • amoxicillin prior to procedure
  • clindamycin, azithromycin, clarithromycin
94
Q

tick must be attached for how long to get lyme disease?

A

24 hours

95
Q

most common joint affected by lyme disease?

A

knee

96
Q

neurologic manifestations of lyme disease?

A

bell’s palsy (face) or Cr VII

97
Q

cardiac manifestation of lyme disease (untreated)?

A

transient AV block = most common

-myocarditis, ventricular arrhythmia

98
Q

lyme disease tx

A

rash/joint/Cr VII –> doxycyline or amoxicillin

cardiac/neurologic –> IV ceftriaxone

99
Q

HIV dx

A
  • ELISA = best initial; very sensitive
  • western blot = confirmation

-viral culture in infants

100
Q

viral load testing via

A

PCR-RNA levels

  • measures response to therapy
  • dx in babies
101
Q

as viral load decreases, CD4 cells ______

A

increase

–> dec opportunistic infections

102
Q

HIV initial drug regimen

A

emtricitabine + tenofovir + efavirenz

  • 1 combo tablet
  • 3 drugs from 2 different classes (RTI, NRTI, PI)
103
Q

RTI (= nucleoside reverse transcriptase inhibitors) MOA

A
  • stop transcription of viral DNA in infected T cells

- “-vudines”

104
Q

NRTI MOA

A
  • stops viral transcription

- efavirenz > etravirine, nevirapine

105
Q

protease inhibitors

A
  • “-avirs”
  • AIDS virus drugs
  • cause hyperlipidemia & hyperglycemia
106
Q

entry inhibitors

A
  • enfuvirtide
  • maraviroc
  • blocks HIV from entering cell
  • works well in combo with other drugs
107
Q

integrase inhibitor

A
  • raltegravir

- virus already transcribed, but cannot enter T cell DNA material

108
Q 
SE:
zidovudine
stravudine & didanosine
abacavir
protease inhibitor
indinavir
tenofovir
A
  • macrocytic anemia
  • peripheral neuropathy & pancreatitis
  • hypersensitivity, Stevens-Johnson Reaction
  • hyperlipidemia & hyperglycemia
  • nephrolithiasis
  • renal insufficiency
109
Q

HIV drug avoided in pregnancy?

A

efavirenz (NRTI)

110
Q

baby of HIV mother.. tx?

A
  • zidovudine during delivery
  • for 6 weeks after delivery

-C section if viral load>1000

Internal Medicine (9 decks)

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