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Master the Boards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

amoxicillin coverage

A 
HELPS
H.influ
E.coli
Listeria
Proteus
Salmonella
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2
Q

amoxicillin best initial tx for:

A
  • otitis media
  • dental infection and endocarditis prophylaxis
  • lyme disease
  • UTI in prego
  • listeria
  • entercoccal infections
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3
Q

penicillinase resistant pencillins

A

oxacillin
cloxacillin
dicloxacillin
nafcillin

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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)
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5
Q

methicillin ever the right answer

A

nooooooo

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6
Q

piperacillin, ticarcillin, azclocillin, mezlocillin best initial tx for

A
  • cholecystitis
  • ascending cholangitis
  • pyelonephritis
  • bacteremia
  • HAP and VAP
  • neutropenia and fever
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7
Q

only cephalosporin that covers MRSA

A

CEFTAROLINE

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8
Q

rash to pencillin, give….

A

cephalosporins

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9
Q

anaphylaxis to penicllin, give….

A

nON-beta lactam

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10
Q

first gen cephs 2 additional

A

cephadrine

cefadroxyl

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11
Q

first gen cephs for…

A
  • osteomyelitis
  • septic arthritis
  • cellulitis
  • endocarditis
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12
Q

2 second gen cephs which cover anaerobes

A

cefotetan

cefoxitin

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13
Q

second gen cephs, 3 additional

A

cefotetan
cefprozil
loracarbef

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14
Q

cefotetan

cefoxitin best initial tx for…

A

PID + doxycycline

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15
Q

side effects of:
cefotetan
cefoxitin

A

BLEEDING

DISULFIRAM like reaction

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16
Q

cefurozime, loracarbef, cefprozil, cefaclor tx for

A

RESPIRATORY infections

  • bronchitis
  • otitis media
  • sinusitis
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17
Q

ceftriaxone first line tx for

A
  • meningitis
  • CAP with macrocodes
  • gonorrhea
  • lyme disease
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18
Q

who to avoid ceftriaxone with…

A

NEONATES–impairs biliary metabolism

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19
Q

cefotaxime

A

instead of ceftriaxone in neonates

SBP

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20
Q

cefepime for:

A
  • neutropenia and fever

- VAP

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21
Q

carbapenems for…

A
  • neutropenia and fever
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22
Q

all carbapenems cover…. except….

A

PSEUDOMONAS, except ERTRAPENEM

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23
Q

morgonella and citrobacter

A

gram negative bacilli

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24
Q

fluoroquinolones for

A
  • best tx CAP
  • cipro- cystitis and pyelonephritis
  • diverticulitis and GI infections
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25
Q

what do fluoroquinolones have to be added with for GI infections

A

METRO

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26
Q

the one fluoroquinolone which can be a single agent in diverticulitis

A

MOXIFLOXACIN

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27
Q

aminoglycosides

A
  • NO EFFECT ON ANAEROBES
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28
Q

gatifloxacin

A

REMOVED– because caused GLUCOSE problems

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29
Q

doxycycline used for

A
  • chlamydia
  • lyme disease
  • rickettsia
  • MRSA of skin and soft tissue
  • primary and secondary syphilis second line
  • borrelia, ehrlichia, mycoplasma
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30
Q

TMP/SMX used for

A
  • cystitis
  • pneumocystitis pneumonia both tx and pro
  • MRSA cellulitis
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31
Q

first choice for mouth and GI abscess

A

beta lactam+ beta lactamse – since cover anaerobes

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32
Q

MRSA drugs

A
  • VANCIN: telavancin, dalbavancin, oritavancin
  • tedizolid
  • vanocmycin
  • linezolid
  • daptomycin: elevates CPK
  • tigecycline
  • ceftaroline
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33
Q

minor MRSA skin infections

A
  • TMP/SMX
  • clindamycin
  • doxy
  • linezolid
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34
Q

anaerobes above the diaphragm

A
  • penicillins

- clindamycin

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35
Q

anaerobes below the diaphragm

A
  • metro

- beta lactam/lactamase combinations

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36
Q

general anaerobe coverage

A
  • piperacillin
  • carbapenems
  • second gen cephalosporins
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37
Q

head CT first in meningitis if….

A
  • papilledema
  • seizures
  • focal neuro bsnormalities
  • confusion interfering with neurological exam
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38
Q

latex agglutination test

A

similar to gram stain
POSITIVE– very specific
NEGATIVE– chance they could still have it

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39
Q

using protein and glucose levels to guide tx decision

A

NEVER NEVER too nonspecific

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40
Q

tx meningitis

A

ceftriaxone, vancomycin, steroids

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41
Q

tx meningitis with listeria

A

ADD ampicillin

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42
Q

who is at risk for listeria meningitis

A
  • extremes of age: elderly and neonates

- IMMUNOcompromised: steroids/HIV/alcoholic/pregnant

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43
Q

first step for PC encephalitis

A

head CT first– because of the confusion

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44
Q

most accurate test for herpes encephalitis

A

PCR of CSF (more beneficial than brain biopsy)

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45
Q

if acyclovir fails in herpes encephalitis….

A

FOSCARNET

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46
Q

if patients creatinine elevates after tx with acyclovir

A

REDUCE dose of acyclovir and hydrate

since acyclovir is less nephrotoxic than foscarnet

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47
Q

most sensitive finding for otitis media

A

IMMOBILE TYMPANIC MEMBRANE

if have a mobile tympanic membrane will EXCLUDE otitis media

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48
Q

multiple recurrent otitis media, next best step….

A

tympanocentesis

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49
Q

tx of otitis media and sinusitis

A
  • amoxicillin (or oc-amox)
  • doxy
  • TMP/SMX
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50
Q

most accurate test for sinusitis

A

sinus biopsy or aspirate

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51
Q

culture nasal discharge for sinusitis?

A

NOOOOO WRONG WRONG WRONG

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52
Q

biopsy of sinusitis only needed if…

A
  • recurrent

- FAILED response to empiric tx

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53
Q

obvi PC of sinusitis… what next…

A

TREAT THEM! with co-amox + decongestant

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54
Q

pharyngitis with small vesicles

A

HSV– anterior pharynx

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55
Q

pharyngitis with ulcers

A

herpangina– posterior pharynx

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56
Q

anterior palatal petechiae

A

EBV

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57
Q

best initial test with strep throat

A

rapid strep test

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58
Q

tx of strep throat

A
  1. amoxicillin best initial
  2. cephalexin if rash allergy
    clindamycin or macrolide if anaphylaxis allergy
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59
Q

within 48hrs of influenza symptoms

A
  • oseltamivir
  • zanamivir
    (shorten the duration of influenza A and B symptoms)
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60
Q

diarrhea with shellfish and cruise ships

A

vibrio parahaemolyticus

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61
Q

diarrhea with shellfish, LIVER disease, SKIN lesions

A

vibrio vulnificus

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62
Q

diarrhea with HFE, blood transfusions

A

yersinia

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63
Q

best initial test for infectious diarrhea

A

blood and or/fecal leukocytes

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64
Q

what is better in dx of infectious diarrhea

A

FECAL LACTOFERRIN better than fecal leukocytes

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65
Q

most accurate test for infectious disease

A

stool culture

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66
Q

no blood or WBC’s in stool

A
  • viral
  • giardia
  • crypto
  • bacillius cereus
  • staph
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67
Q

wheezing, flushing, RAPIDLY rash after eating fish

A

scromboid poisoning

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68
Q

tx of scromboid poisoning

A

ANTIHISTAMINES

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69
Q

tx mild diarrhea

A

oral fluid replacement

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70
Q

severe diarrhea

A
  • hypotensive
  • tachycardic
  • fever
  • abdo pain
  • bloody diarrhea
  • metabolic acidosis
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71
Q

tx of severe diarrhea

A

fluid replacement and cipro

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72
Q

most accurate finding cause of infectious diarrhea

A

BLOOD IN STOOL= invasive pathogen

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73
Q

tx of viral, bacillus, staph diarrhea

A

fluid support as needed

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74
Q

hep C and acute presentation….

A

RARELY OCCURS

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75
Q

hepE is worst in….

A

PREGNANCY

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76
Q

rare complication of acute hepatitis

A

aplastic anaemia

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77
Q

highest likelihood of mortality with hepatitis…

A

INCREASE PT (Since more likely to go onto hepatic failure)

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78
Q

first serology parameter to be abnormal in hep B

A

hepB surface antigen

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79
Q

if patient doesn’t have with HepB serology= NO LONGER AT RISK OF TRANSMITTING

A

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)

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80
Q

HepB serology= active viral replication

A

hepE antigen

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81
Q

HepB serology= best response to anti-virals

A

hepE antigen

82
Q

what is more precise than hep B e antigen

A

hep B DNA viral load

83
Q

best indicator a pregnant woman will transmit infection to child

A

e antigen or DNA polyermase

e antigen= qualitative, DNA polyermase= quantitative

84
Q

most common transmission of hep B worldwife

A

VERTICAL TRANSMISSION

85
Q

chronic hepatitis

A

surface antigen for more than 6 months

86
Q

goal of chronic hepatitis tx

A
  • reduce DNA polymerase to undetectable levels

- convert those patients with e-antigen to having anti-hepatitis e-antibody

87
Q

if there is active viral replication….

A

FIBROSIS–> CIRRHOSIS

88
Q

ALT as indication of activity of chronic hepatitis

A

NOOOOOO bad indication, since can have significant infection with normal transaminase levels

89
Q

only form of acute hepatitis to be treated

A

acute hep C

90
Q

hep C

A
  • 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
Q

PC PID

A
  • lower abdo pain and tenderness
  • CERVICAL MOTION TENDERNESS
    EXCLUDE PREGNANCY
92
Q

cefixime for gonorrhea

A

NOOOOOOOO longer able to be used

93
Q

most accurate test for PID

A

LAPAROSCOPY, not cervical testing

94
Q

inpatient tx for PID

A
  • cefoxitin or cefotetan + doxycycline
95
Q

outpatient tx for PID

A
  • ceftriaxone + doxycycline (possible with metro)
96
Q

painless ulcer

97
Q

painful ulcer

98
Q

lymph nodes tender and suppurative

99
Q

vesicles before ulcer and painful

100
Q

dx for syphilis

A
  • dark field microscopy
  • VDRL or RPR
  • FTA or MHA-TP= confirmatory
101
Q

positive dark field….

A

NO FURTHER TESTING NECESSARY

102
Q

chancroid dx

A

stain and culture on special medi

103
Q

LGV dx

A

complement fixation titers in blood

NAAT on swab

104
Q

HSV dx

A

Tzank= best initial

viral culture= most accurate

105
Q

tx syphilis

A

single dose IM bezathine penicillin (doxy if allergies)

106
Q

tx chancroid

A

azithromycin (single dose)

107
Q

LGV tx

A

doxycycline

108
Q

HSV tx

A
  • acyclovir, valcyclovir, famciclovir

- foscarnet for acyclovir resistant herpes

109
Q

topical or oral acyclovir

110
Q

primary syphilis, HY description

A

indurated edges

111
Q

secondary syphilis 2 additional

A
  • alopecia areata

- mucous patches

112
Q

chancres in syphilis

A

HEAL SPONTANEOUSLY even without tx,

penicillin prevents later stages

113
Q

tertiary neuro syphilis

A
  • meningovascular- STROKE-from vasculitis
  • tabes dorsalis
  • general paresis– memory and personality changes
  • argyll robertson pupil
114
Q

negative FTA

A

EXCLUDES neurosyphilis

115
Q

false positive for VDRL/RPR

A
  • infection
  • older age
  • injection drug use
  • AIDS
  • malaria
  • APLS
  • endocarditis
116
Q

reliable titers for VDRL/RPR

A

greater than 1:8

117
Q

lower titers for VDRL/RPR

A

false positive

118
Q

1:32 or greater titers for VDRL/RPR

A

RARELY false positive

119
Q

tertiary syphilis tx

A

IV penicillin, desensitize if allergic

120
Q

2 times when desensitize for penicillin

A
  • neurosyphilis

- pregnant

121
Q

tx of garish herxheimer

A

aspirin

antipyretics

122
Q

tx condyloma accuminata

A
  • cryotherapy
  • surgery
  • podophyllin
  • imiquimod
123
Q

tx of crabs/ pediculosis

A

permethrin> lindane– less toxic

124
Q

scabies tx

A

permethrin

125
Q

tx widespread crusted/ hyperkeratotic scabies

A

ivermectin

126
Q

frequency

A

multiples episodes of micturition

127
Q

polyuria

A

increase in VOLUME of urine

128
Q

men with UTI—

A

ANATOMIC abnormalities

129
Q

best initial test UTI

A

urinalysis– more than 10 WBCs

130
Q

most accurate test UTI

A

urine culture

131
Q

tx UTI

A
  • nitrofurantoin

- TMP/SMX if low resistance

132
Q

uncomplicated cystitis tx

A

3 days nitrofurantoin

133
Q

anatomic abnormality/ complicated cystitis

A

7 days nitrofurantoin

134
Q

first line tx for pyelonephritis

A

CEFTRIAXONE

135
Q

empiric tx for pyelonehpritis

A

ampicillin and gentamicin– until culture is known

136
Q

outpatient tx pyelonephritis

A

ciprofloxacin

137
Q

how to improve dx of prostatitis with urine culture

A

prostatic massage

138
Q

timing for male UTI/ tx

139
Q

timing for prostatitis tx

140
Q

pyelonephritis that doesn’t resolve with appropriate tx OR persistent fever with tx

A

PERINEPHRIC ABSCESS

141
Q

tx of perinephric abscess

142
Q

complications of endocarditis

A
  • brain mycotic aneurysm
  • kidney: hematuria, GN
  • splenomegaly
  • septic emboli to lungs
143
Q

best initial tests for endocarditis

A
  • blood culture

- TEE> TTE

144
Q

most common bug in endocarditis with colon cancer

A

clostridium septicum

145
Q

empiric tx for endocarditis

A

vancomycin and gentamicin

146
Q

tx viridans strep

A

ceftriaxone for 4 weeks

147
Q

s.aureus (sensitive) endocarditis tx

A

oxacillin, nafcillin, cefazolin

148
Q

fungal endocarditis tx

A

amphotericin

remove valve

149
Q

staph epi or resistant staph endocarditis tx

A

vancomycin

150
Q

enterococci endocarditis tx

A

ampicillin and gentamicin

151
Q

number one indication for surgery in endocarditis

A

CHF from valve rupture

152
Q

prosthetic valve endocarditis with staph….

A

ADD RIFAMPIN

153
Q

most common HHACCEK B organisms

A
  1. coxiella

2. bartonella

154
Q

HHACCEK B

A 
Haemophilus arhorphilus
Haemophilus parainfluenzae
Actinobacillus
Cardiobacterium
Eikenella
Kingella
Bartonella
155
Q

prophylaxis for endocarditis– big indication

A

DENTAL WORK WITH BLOOD

156
Q

DO NOT need endocarditis prophylaxis for:

A
  • flexible endoscopy with bx
  • obs/gyn
  • urology
  • GI procedures, ERCP
  • valvular heart disease, MVP, even with murmur
  • mr, ms, ar, as, hocm, asd
157
Q

most common joint involved in lyme disease

158
Q

cardiac manifestation of lyme disease

A

transient AV block

159
Q

asymptomatic tick bite tx

160
Q

rash lyme tx

A

doxycycline

amoxicillin or cefuroxime

161
Q

joint, 7th CN palsy lyme tx

A

doxycycline

amoxicillin or cefuroxime

162
Q

cardiac and neuro findings (other than bells) lyme tx

A

IV ceftriaxone

163
Q

transmission of HIV mc–> least common

A
  1. mother to child: 25-30% perinatal transmission without meds
  2. anal sex
  3. NSI
  4. oral sex
  5. vaginal transmission
164
Q

best initial test for HIV

165
Q

confirmatory test for HIV

A

Western blot

166
Q

dx HIV in infants

A

PCR or viral culture

167
Q

treatment failure….

A

rising PCR-RNA viral load

168
Q

strongest indication for HAART is

A

CD4 less than 500

169
Q

atripla=

A

emtricitabine, tenofovir, efavirenz

170
Q

general rule for HIV

A

ACCEPTABLE to treat everyone, regardless of CD4 levels

171
Q

ritonavir use

A

BOOSTS darunavir or atazanavir levels

172
Q

do not use abacavir in patients with

A

HLA B5701 mutation

173
Q

what drug is given with elvitegravir

A

cobicistat: inhibits its metabolism, thus increasing its levels

174
Q

second line agents for HAART

A

entry inhibitors

integrase inhibitors

175
Q

entry inhibitors

A

enfurvirtide

maraviroc

176
Q

integrase inhibitors

A

raletgravir
dolutegravir
elvitegravir with cobicistat

177
Q

PEP for NSI without knowing HIV status

178
Q

PEPE for bite from person with HIV

179
Q

SE zidovudine

180
Q

SE stavudine and didanosine

A

peripheral neuropathy

pancreatitis

181
Q

SE abacavir

182
Q

SE protease inhibitors

A

hyperlipidemia

hyperglycemia

183
Q

SE indinavir

A

nephrolithiasis

184
Q

SE tenofovir

A

renal insufficiency

185
Q

one HAART cannot use in pregnancy

A

EFAVIRENZ!!!! since causes teratogenicity in animals

186
Q

patient on retrovirals at time of pregnancy

A

continue same medications, except switch efavirenz to protease inhibitors

187
Q

pregnant woman NOT on antiretrovirals with LOW CD4 and HIGH viral load

A

ASAP start HAART

continue after delivery

188
Q

pregnant woman NOT on antiretrovirals with HIGH CD4 and LOW viral load

A

ASAP start HAART

189
Q

intrapartum for baby

A

zidovudine, and for 6 weeks postpartum

190
Q

risk of transmission to baby if fully controlled HIV

A

less than 1%

191
Q

PC:

  • leucocytosis
  • LUQ pain
  • fever
A

splenic abscess associated with IE

192
Q

PC:

- lungs with nodular infiltrate and cavitation

A

septic pulmonary emboli– associated with IE and IVDU

193
Q

osteomyelitis with nail puncture

A

pseudomonas

194
Q

PC necrotiziing surgical infection

A

purulent gray cloudy discharge=

DISHWATER DRAINAGE

195
Q

PC:

  • increase transaminases
  • leucopenia
  • thrombocytopenia
A

ehrlichosis*** morulae

196
Q

other name for strep bovis

A

strep galloyticus biotype 1

197
Q

pneumatoceles

A

thin walled cavities a/w post viral pneumonia with S.aureus

198
Q

leukocytoclasic with kaposi’s

A 
new= violaceous
old= coalescent
199
Q

fear with ludwig’s

A

asphyxia–> death

200
Q

TSS can happen secondary to….

A

nasal packing

201
Q

PC sore throat with rash and diarrhea

A

PRIMARY HIV

202
Q

PC sore throat with exudates

Master the Boards (20 decks)

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