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Step 2 CK Master the Boards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Which cephalosporins are good at covering pelvic inflammatory disease along with doxycycline?

A

Cefotetan and cefoxitin (2nd gen) with anaerobic and some more gram negative coverage

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2
Q

3rd generation: ceftriaxone and cefotaxime. compare and contrast

A

both can cross BBB so good against CNS infections

  • ceftriaxone is first line for pneumococcus
  • cefotaxime is only better than ceftriaxone in neonates bc neonates have poor glucuronidation activity which ceftriaxone requires but not cefotaxime; similiarly cefotaxime is DOC for SBP
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3
Q

Which cephalosporin has anti-pseudomonal coverage

A

ceftazidime

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4
Q

Cefoxitin and cefotetan both 2nd gen is assoc with increased risk of bleeding, why?

A

deplete prothrombin (PT)

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5
Q

Carbapenems (imipenem, meropenem, ertapenem, doripenem) have anti-pseudomonal coverage except which one

A

ertapenem

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6
Q

name the monobactam that is exclusively for gram negative with pseudomonal coverage and has no cross rxns with penicillin

A

aztreonam

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7
Q

Fluoroquinolones should be avoided in children and pregnant ppl b/c?

A

bone growth abnormalities

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8
Q

Which class of abx is assoc with tendonitis and achilles tendon rupture

A

fluoroquinolones by inhibiting osteoblast/osteoclasts

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9
Q

Fluoroquinolone has great gram neg coverage and can be used for diverticulitis and GI infections. Most require metronidazole to cover anaerobes as well. Which fluoroquinolone has its own anaerobic activity?

A

moxifloxacin can be given as a single agent with metronidazole in diverticulitis and GI infections

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10
Q

Aminoglycosides are nephrotoxic and ototoxic. They have gram neg activity and synergistic with beta lactam ab for some gram positive. Any anaerobic coverage?

A

NO b/c require O2 to function

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11
Q

Penicillin is the DOC for syphillis. What if the pt is allergic?

A

Aminoglycosides are 2nd choice

***only desensitize to penicillin in someone whos allergic if the someone has CNS syphilis or is pregnant.

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12
Q

Doxycycline is good for Lyme disease limited to rash, joint, or CNVII palsy. What’s the abx if pt has CNS and heart symptoms?

A

ceftriaxone

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13
Q

DOC for pregnant ladies with UTI

A

nitrofurantoin

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14
Q

List 4 side effects of doxycycline

A
  • tooth discoloration (children)
  • Fanconi syndrome (type II RTA)
  • photosensitivity
  • esophagitis/ulcer
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15
Q

ABX that can cover MRSA

A
  • vancomycin
  • linezolid (side effect: plt inhibition)
  • daptomycin (side effect: increase CK; not good for lung infections b/c pH inactivates it)
  • tigecycline
  • ceftaroline
  • tmp/smx
  • clindamycin
  • doxycycline
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16
Q

Gram negative bacilli (e. coli, klebsiella, proteus, pseudomonas, enterobacter, citrobacter) cause infections of the bowel (peritonitis, diverticulitis), UTI and liver (cholecystitis, cholangitis). List the 6 groups of abx that cover GRAM-NEGATIVE bacilli

A
  • quinolones
  • aminoglycosides
  • carbapenems
  • piperacillin, ticarcillin
  • aztreonams
  • cephalosporins
17
Q

How to treat bacterial meningitis?

A

ceftriaxone, vancomycin, dexamethasone

dependent on CSF cell count as cx take time to come back

18
Q

Which meningitis is assoc with the highest level of CSF protein?

A

TB meningitis (glucose can be low too)

19
Q

Most common cause of bacterial meningitis in adults vs neonates

A

adults - s. pneumo

neonates - Group B strep

20
Q

Fever, headache neck stiffness + AIDS with CD4 cells

A

cryptococcal meningitis (usu slow, several wks of symptoms)
best initial: india ink stain
most accurate: cryptococcal antigen

21
Q

Fever, headache neck stiffness + camper/hiker, rash shaped like a target, joint pain, facial nerve palsy and tick bike

A

Lyme disease (CNS) so treat with ceftriaxone

22
Q

Fever, headache neck stiffness + camper/hiker, rash that moves from extremities to trunk, tick bite

A

Rickettsia so treat with doxycycline even in children

23
Q

Fever, headache neck stiffness in adolescent with petechial rash

A

neisseria meningitidis
pt will need resp isolation
give ppx to close contacts: can give rifampin, cipro or ceftriaxone

24
Q

Which bacteria is assoc with meningitis after neurosurgery

A

staph aureus

25
Q

LP is best initial and most accurate test for meningitis. When do you do CT of head before LP?

A

When there are signs of increased ICP or possibility of a space occupying lesion that may cause herniation during LP. When pt has papilledema, seizures, focal neurologic abnormalities, confusion.

26
Q

If there’s contraindication to immediate LP in someone with meningitis, do what first then?

A

treat with abx b/c without treatment can lead to permanent brain damage. Then do CT before LP

27
Q

Most accurate test for TB meningitis

A

-requires 3 high volume LPs to do acid fast stain and cultures

28
Q

Most accurate test for lyme and ricketssia meningitis

A

serologic testing, ELISA, western blot, PCR

29
Q

Best initial treatment for bacterial meningitis are ceftriaxone, vancomycin and dexamethasone. When do you add ampicillin.

A

When you suspect listeria as well esp in ppl at high risk like the elderly, immunocompromised (AIDS/HIV, steroids use, cancer), neonates, pregnant, alcoholics.

30
Q

acute onset of fever and confusion –> encephalitis –> most common cause? What should be done initially? What’s most accurate test? How to treat?

A

most common cause of acute encephalitis herpes simplex. Do head CT first due to presence of confusion. Most accurate test is PCR. Treatment is IV acyclovir (thymidine kinase inhibitor)

31
Q

When do you use iv foscarnet over iv acyclovir (the #1 choice) for herpes encephalitis?

A

acyclovir-resistant herpes

32
Q

If someone on IV acyclovir has renal toxicity, what should you do? Should you switch to foscarnet?

A

decrease dose but continue with iv acyclovir with some hydration. DO NOT switch to foscarnet as foscarnet is even more renally toxic.

33
Q

How does acyclovir cause renal toxcitiy

A

crystal-induced nephropathy as it precipitates in the renal tubules and can cause renal tubule obstruction

34
Q

What is the most common neurologic deficit of untreated bacterial meningitis?

A

CNVIII

35
Q

Strep pharyngitis can be treated first-line with penicillin or amoxicillin. If allergic to penicillin, give?

A

if allergy is just a rash, can try cephalexin (1st gen)

if allergy is anaphylaxis, can try clindamycin or macrolide

36
Q

Flu can be treated if presented in less than 48 hours of symptoms can be given neuramindase inhibitors, such as

A

oseltamivir

zanamivir

Step 2 CK Master the Boards (2 decks)

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