Infectious Disease Flashcards
1
Q
amoxicillin coverage
A
HELPS H.influ E.coli Listeria Proteus Salmonella
2
Q
amoxicillin best initial tx for:
A
- otitis media
- dental infection and endocarditis prophylaxis
- lyme disease
- UTI in prego
- listeria
- entercoccal infections
3
Q
penicillinase resistant pencillins
A
oxacillin
cloxacillin
dicloxacillin
nafcillin
4
Q
penicillinase resistant pencillins best intial tx for:
A
- skin infections
- staph: endocarditis, meningitis, bacteremia
- osteomyelitis and septic arthritis (only when organism proven sensitive)
5
Q
methicillin ever the right answer
A
nooooooo
6
Q
piperacillin, ticarcillin, azclocillin, mezlocillin best initial tx for
A
- cholecystitis
- ascending cholangitis
- pyelonephritis
- bacteremia
- HAP and VAP
- neutropenia and fever
7
Q
only cephalosporin that covers MRSA
A
CEFTAROLINE
8
Q
rash to pencillin, give….
A
cephalosporins
9
Q
anaphylaxis to penicllin, give….
A
nON-beta lactam
10
Q
first gen cephs 2 additional
A
cephadrine
cefadroxyl
11
Q
first gen cephs for…
A
- osteomyelitis
- septic arthritis
- cellulitis
- endocarditis
12
Q
2 second gen cephs which cover anaerobes
A
cefotetan
cefoxitin
13
Q
second gen cephs, 3 additional
A
cefotetan
cefprozil
loracarbef
14
Q
cefotetan
cefoxitin best initial tx for…
A
PID + doxycycline
15
Q
side effects of:
cefotetan
cefoxitin
A
BLEEDING
DISULFIRAM like reaction
16
Q
cefurozime, loracarbef, cefprozil, cefaclor tx for
A
RESPIRATORY infections
- bronchitis
- otitis media
- sinusitis
17
Q
ceftriaxone first line tx for
A
- meningitis
- CAP with macrocodes
- gonorrhea
- lyme disease
18
Q
who to avoid ceftriaxone with…
A
NEONATES–impairs biliary metabolism
19
Q
cefotaxime
A
instead of ceftriaxone in neonates
SBP
20
Q
cefepime for:
A
- neutropenia and fever
- VAP
21
Q
carbapenems for…
A
- neutropenia and fever
22
Q
all carbapenems cover…. except….
A
PSEUDOMONAS, except ERTRAPENEM
23
Q
morgonella and citrobacter
A
gram negative bacilli
24
Q
fluoroquinolones for
A
- best tx CAP
- cipro- cystitis and pyelonephritis
- diverticulitis and GI infections
25
what do fluoroquinolones have to be added with for GI infections
METRO
26
the one fluoroquinolone which can be a single agent in diverticulitis
MOXIFLOXACIN
27
aminoglycosides
- NO EFFECT ON ANAEROBES
28
gatifloxacin
REMOVED-- because caused GLUCOSE problems
29
doxycycline used for
- chlamydia
- lyme disease
- rickettsia
- MRSA of skin and soft tissue
- primary and secondary syphilis second line
- borrelia, ehrlichia, mycoplasma
30
TMP/SMX used for
- cystitis
- pneumocystitis pneumonia both tx and pro
- MRSA cellulitis
31
first choice for mouth and GI abscess
beta lactam+ beta lactamse -- since cover anaerobes
32
MRSA drugs
- VANCIN: telavancin, dalbavancin, oritavancin
- tedizolid
- vanocmycin
- linezolid
- daptomycin: elevates CPK
- tigecycline
- ceftaroline
33
minor MRSA skin infections
- TMP/SMX
- clindamycin
- doxy
- linezolid
34
anaerobes above the diaphragm
- penicillins
| - clindamycin
35
anaerobes below the diaphragm
- metro
| - beta lactam/lactamase combinations
36
general anaerobe coverage
- piperacillin
- carbapenems
- second gen cephalosporins
37
head CT first in meningitis if....
- papilledema
- seizures
- focal neuro bsnormalities
- confusion interfering with neurological exam
38
latex agglutination test
similar to gram stain
POSITIVE-- very specific
NEGATIVE-- chance they could still have it
39
using protein and glucose levels to guide tx decision
NEVER NEVER too nonspecific
40
tx meningitis
ceftriaxone, vancomycin, steroids
41
tx meningitis with listeria
ADD ampicillin
42
who is at risk for listeria meningitis
- extremes of age: elderly and neonates
| - IMMUNOcompromised: steroids/HIV/alcoholic/pregnant
43
first step for PC encephalitis
head CT first-- because of the confusion
44
most accurate test for herpes encephalitis
PCR of CSF (more beneficial than brain biopsy)
45
if acyclovir fails in herpes encephalitis....
FOSCARNET
46
if patients creatinine elevates after tx with acyclovir
REDUCE dose of acyclovir and hydrate
| since acyclovir is less nephrotoxic than foscarnet
47
most sensitive finding for otitis media
IMMOBILE TYMPANIC MEMBRANE
| if have a mobile tympanic membrane will EXCLUDE otitis media
48
multiple recurrent otitis media, next best step....
tympanocentesis
49
tx of otitis media and sinusitis
- amoxicillin (or oc-amox)
- doxy
- TMP/SMX
50
most accurate test for sinusitis
sinus biopsy or aspirate
51
culture nasal discharge for sinusitis?
NOOOOO WRONG WRONG WRONG
52
biopsy of sinusitis only needed if...
- recurrent
| - FAILED response to empiric tx
53
obvi PC of sinusitis... what next...
TREAT THEM! with co-amox + decongestant
54
pharyngitis with small vesicles
HSV-- anterior pharynx
55
pharyngitis with ulcers
herpangina-- posterior pharynx
56
anterior palatal petechiae
EBV
57
best initial test with strep throat
rapid strep test
58
tx of strep throat
1. amoxicillin best initial
2. cephalexin if rash allergy
clindamycin or macrolide if anaphylaxis allergy
59
within 48hrs of influenza symptoms
- oseltamivir
- zanamivir
(shorten the duration of influenza A and B symptoms)
60
diarrhea with shellfish and cruise ships
vibrio parahaemolyticus
61
diarrhea with shellfish, LIVER disease, SKIN lesions
vibrio vulnificus
62
diarrhea with HFE, blood transfusions
yersinia
63
best initial test for infectious diarrhea
blood and or/fecal leukocytes
64
what is better in dx of infectious diarrhea
FECAL LACTOFERRIN better than fecal leukocytes
65
most accurate test for infectious disease
stool culture
66
no blood or WBC's in stool
- viral
- giardia
- crypto
- bacillius cereus
- staph
67
wheezing, flushing, RAPIDLY rash after eating fish
scromboid poisoning
68
tx of scromboid poisoning
ANTIHISTAMINES
69
tx mild diarrhea
oral fluid replacement
70
severe diarrhea
- hypotensive
- tachycardic
- fever
- abdo pain
- bloody diarrhea
- metabolic acidosis
71
tx of severe diarrhea
fluid replacement and cipro
72
most accurate finding cause of infectious diarrhea
BLOOD IN STOOL= invasive pathogen
73
tx of viral, bacillus, staph diarrhea
fluid support as needed
74
hep C and acute presentation....
RARELY OCCURS
75
hepE is worst in....
PREGNANCY
76
rare complication of acute hepatitis
aplastic anaemia
77
highest likelihood of mortality with hepatitis...
INCREASE PT (Since more likely to go onto hepatic failure)
78
first serology parameter to be abnormal in hep B
hepB surface antigen
79
if patient doesn't have with HepB serology= NO LONGER AT RISK OF TRANSMITTING
hepB surface antigen
(since transmissibility only stops when the DNA polymerase is gone, which can still be there when surface and e antigen antibodies appear)
80
HepB serology= active viral replication
hepE antigen
81
HepB serology= best response to anti-virals
hepE antigen
82
what is more precise than hep B e antigen
hep B DNA viral load
83
best indicator a pregnant woman will transmit infection to child
e antigen or DNA polyermase
| e antigen= qualitative, DNA polyermase= quantitative
84
most common transmission of hep B worldwife
VERTICAL TRANSMISSION
85
chronic hepatitis
surface antigen for more than 6 months
86
goal of chronic hepatitis tx
- reduce DNA polymerase to undetectable levels
| - convert those patients with e-antigen to having anti-hepatitis e-antibody
87
if there is active viral replication....
FIBROSIS--> CIRRHOSIS
88
ALT as indication of activity of chronic hepatitis
NOOOOOO bad indication, since can have significant infection with normal transaminase levels
89
only form of acute hepatitis to be treated
acute hep C
90
hep C
- do not test based only on risk factors
- anyone with high PCR RNA viral load needs treatment- genotype predicts the response to tx
- viral load assesses the effect of therapy
- liver biopsy-- extent of damage. if viral load is elevated, little use in doing a liver biopsy
91
PC PID
- lower abdo pain and tenderness
- CERVICAL MOTION TENDERNESS
EXCLUDE PREGNANCY
92
cefixime for gonorrhea
NOOOOOOOO longer able to be used
93
most accurate test for PID
LAPAROSCOPY, not cervical testing
94
inpatient tx for PID
- cefoxitin or cefotetan + doxycycline
95
outpatient tx for PID
- ceftriaxone + doxycycline (possible with metro)
96
painless ulcer
syphilis
97
painful ulcer
chancroid
98
lymph nodes tender and suppurative
LGV
99
vesicles before ulcer and painful
HSV
100
dx for syphilis
- dark field microscopy
- VDRL or RPR
- FTA or MHA-TP= confirmatory
101
positive dark field....
NO FURTHER TESTING NECESSARY
102
chancroid dx
stain and culture on special medi
103
LGV dx
complement fixation titers in blood
| NAAT on swab
104
HSV dx
Tzank= best initial
| viral culture= most accurate
105
tx syphilis
single dose IM bezathine penicillin (doxy if allergies)
106
tx chancroid
azithromycin (single dose)
107
LGV tx
doxycycline
108
HSV tx
- acyclovir, valcyclovir, famciclovir
| - foscarnet for acyclovir resistant herpes
109
topical or oral acyclovir
ORAL
110
primary syphilis, HY description
indurated edges
111
secondary syphilis 2 additional
- alopecia areata
| - mucous patches
112
chancres in syphilis
HEAL SPONTANEOUSLY even without tx,
| penicillin prevents later stages
113
tertiary neuro syphilis
- meningovascular- STROKE-from vasculitis
- tabes dorsalis
- general paresis-- memory and personality changes
- argyll robertson pupil
114
negative FTA
EXCLUDES neurosyphilis
115
false positive for VDRL/RPR
- infection
- older age
- injection drug use
- AIDS
- malaria
- APLS
- endocarditis
116
reliable titers for VDRL/RPR
greater than 1:8
117
lower titers for VDRL/RPR
false positive
118
1:32 or greater titers for VDRL/RPR
RARELY false positive
119
tertiary syphilis tx
IV penicillin, desensitize if allergic
120
2 times when desensitize for penicillin
- neurosyphilis
| - pregnant
121
tx of garish herxheimer
aspirin
| antipyretics
122
tx condyloma accuminata
- cryotherapy
- surgery
- podophyllin
- imiquimod
123
tx of crabs/ pediculosis
permethrin> lindane-- less toxic
124
scabies tx
permethrin
125
tx widespread crusted/ hyperkeratotic scabies
ivermectin
126
frequency
multiples episodes of micturition
127
polyuria
increase in VOLUME of urine
128
men with UTI---
ANATOMIC abnormalities
129
best initial test UTI
urinalysis-- more than 10 WBCs
130
most accurate test UTI
urine culture
131
tx UTI
- nitrofurantoin
| - TMP/SMX if low resistance
132
uncomplicated cystitis tx
3 days nitrofurantoin
133
anatomic abnormality/ complicated cystitis
7 days nitrofurantoin
134
first line tx for pyelonephritis
CEFTRIAXONE
135
empiric tx for pyelonehpritis
ampicillin and gentamicin-- until culture is known
136
outpatient tx pyelonephritis
ciprofloxacin
137
how to improve dx of prostatitis with urine culture
prostatic massage
138
timing for male UTI/ tx
7 days
139
timing for prostatitis tx
2-6 weeks
140
pyelonephritis that doesn't resolve with appropriate tx OR persistent fever with tx
PERINEPHRIC ABSCESS
141
tx of perinephric abscess
drainage
142
complications of endocarditis
- brain mycotic aneurysm
- kidney: hematuria, GN
- splenomegaly
- septic emboli to lungs
143
best initial tests for endocarditis
- blood culture
| - TEE> TTE
144
most common bug in endocarditis with colon cancer
clostridium septicum
145
empiric tx for endocarditis
vancomycin and gentamicin
146
tx viridans strep
ceftriaxone for 4 weeks
147
s.aureus (sensitive) endocarditis tx
oxacillin, nafcillin, cefazolin
148
fungal endocarditis tx
amphotericin
| remove valve
149
staph epi or resistant staph endocarditis tx
vancomycin
150
enterococci endocarditis tx
ampicillin and gentamicin
151
number one indication for surgery in endocarditis
CHF from valve rupture
152
prosthetic valve endocarditis with staph....
ADD RIFAMPIN
153
most common HHACCEK B organisms
1. coxiella
| 2. bartonella
154
HHACCEK B
```
Haemophilus arhorphilus
Haemophilus parainfluenzae
Actinobacillus
Cardiobacterium
Eikenella
Kingella
Bartonella
```
155
prophylaxis for endocarditis-- big indication
DENTAL WORK WITH BLOOD
156
DO NOT need endocarditis prophylaxis for:
- flexible endoscopy with bx
- obs/gyn
- urology
- GI procedures, ERCP
- valvular heart disease, MVP, even with murmur
- mr, ms, ar, as, hocm, asd
157
most common joint involved in lyme disease
KNEE
158
cardiac manifestation of lyme disease
transient AV block
159
asymptomatic tick bite tx
NOTHING
160
rash lyme tx
doxycycline
| amoxicillin or cefuroxime
161
joint, 7th CN palsy lyme tx
doxycycline
| amoxicillin or cefuroxime
162
cardiac and neuro findings (other than bells) lyme tx
IV ceftriaxone
163
transmission of HIV mc--> least common
1. mother to child: 25-30% perinatal transmission without meds
2. anal sex
3. NSI
4. oral sex
5. vaginal transmission
164
best initial test for HIV
ELISA
165
confirmatory test for HIV
Western blot
166
dx HIV in infants
PCR or viral culture
167
treatment failure....
rising PCR-RNA viral load
168
strongest indication for HAART is
CD4 less than 500
169
atripla=
emtricitabine, tenofovir, efavirenz
170
general rule for HIV
ACCEPTABLE to treat everyone, regardless of CD4 levels
171
ritonavir use
BOOSTS darunavir or atazanavir levels
172
do not use abacavir in patients with
HLA B5701 mutation
173
what drug is given with elvitegravir
cobicistat: inhibits its metabolism, thus increasing its levels
174
second line agents for HAART
entry inhibitors
| integrase inhibitors
175
entry inhibitors
enfurvirtide
| maraviroc
176
integrase inhibitors
raletgravir
dolutegravir
elvitegravir with cobicistat
177
PEP for NSI without knowing HIV status
NOPE
178
PEPE for bite from person with HIV
YES
179
SE zidovudine
anaemia
180
SE stavudine and didanosine
peripheral neuropathy
| pancreatitis
181
SE abacavir
HSR
| SJS
182
SE protease inhibitors
hyperlipidemia
| hyperglycemia
183
SE indinavir
nephrolithiasis
184
SE tenofovir
renal insufficiency
185
one HAART cannot use in pregnancy
EFAVIRENZ!!!! since causes teratogenicity in animals
186
patient on retrovirals at time of pregnancy
continue same medications, except switch efavirenz to protease inhibitors
187
pregnant woman NOT on antiretrovirals with LOW CD4 and HIGH viral load
ASAP start HAART
| continue after delivery
188
pregnant woman NOT on antiretrovirals with HIGH CD4 and LOW viral load
ASAP start HAART
189
intrapartum for baby
zidovudine, and for 6 weeks postpartum
190
risk of transmission to baby if fully controlled HIV
less than 1%
191
PC:
- leucocytosis
- LUQ pain
- fever
splenic abscess associated with IE
192
PC:
| - lungs with nodular infiltrate and cavitation
septic pulmonary emboli-- associated with IE and IVDU
193
osteomyelitis with nail puncture
pseudomonas
194
PC necrotiziing surgical infection
purulent gray cloudy discharge=
| DISHWATER DRAINAGE
195
PC:
- increase transaminases
- leucopenia
- thrombocytopenia
ehrlichosis*** morulae
196
other name for strep bovis
strep galloyticus biotype 1
197
pneumatoceles
thin walled cavities a/w post viral pneumonia with S.aureus
198
leukocytoclasic with kaposi's
```
new= violaceous
old= coalescent
```
199
fear with ludwig's
asphyxia--> death
200
TSS can happen secondary to....
nasal packing
201
PC sore throat with rash and diarrhea
PRIMARY HIV
202
PC sore throat with exudates
MONO
