Infectious Disease

Question 1

MSSA IV and oral treatment

Answer 1

IV: oxacillin/nafcillin; cefazolin
Oral: dicloxacillin; cephalexin

Question 2

Severe MRSA treatment

Answer 2

Vancomycin, daptomycin, ceftaroline, tigecycline, linezolid, telavancin

Question 3

SE of linezolid

Answer 3

Thrombocytopenia

Question 4

SE of daptomycin

Answer 4

Myopathy and elevated CPK

Question 5

Minor MRSA treatment

Answer 5

TMP/SMX, clindamycin, doxycyline

Question 6

If a patient presents with infection best treated with penicillin but allergy includes rash is it safe to use cephalosporins?

Answer 6

Yes

Question 7

In patients with anaphylactic penicillin allergies what are appropriate options for treatment?

Answer 7

Macrolides (azithromycin, clarithromycin)

Clindamycin

Question 8

MOA of TMP/SMX

Answer 8

Folate antagonist

Question 9

What are three specific medications used to treat Streptococcus but not Staphylococcus? (Hint: all from same family)

Answer 9

Penicillin, Amoxicillin, Ampicillin

Question 10

What class of antibiotics are great at treating pneumococcus?

Answer 10

Fluoroquinolones

Question 11

SE of imipneme

Answer 11

Seizures

Question 12

What cephalosporins offer good gram negative rod coverage?

Answer 12

Cefepime

Ceftazidime

Question 13

What is the best antibx for abdominal anaerobes?

Answer 13

Metronidazole

Question 14

What are the only cephalosporins which cover anaerobes?

Answer 14

Cefoxitin

Cefotetan

Question 15

What antibx is the best for respiratory anaerobes?

Answer 15

Clindamycin

Question 16

Best therapy for CMV retinitis

Answer 16

Valganciclovir

Question 17

SE of foscarnet

Answer 17

Renal toxicity

Question 18

SE of valganciclovir and ganciclovir

Answer 18

Neutropenia and BM suppression

Question 19

What are simeprevir, boceprevir, sofosbuvir, and ledipasvir used for?

Answer 19

Chronic hepatitis C

Question 20

What medication is used in combination with IFN to treat HCV?

Answer 20

Ribavirin

Question 21

SE of ribavirin

Answer 21

Anemia

Question 22

What are lamivudine, IFN, adefovir, tenofovir, entecavir, and telbivudine used to treat?

Answer 22

Chronic hepatitis B

Question 23

What can be used to Candidiasis, Cryptococcus, and as an alternative to oral and vaginal candidiasis?

Answer 23

Fluconazole

Question 24

What medication is best for coverage against Aspergillus?

Answer 24

Voriconazole

Question 25

SE of voriconazole

Answer 25

Visual disturbance

Question 26

What class of medication (and list examples) are great for neutropenic fever patients?

Answer 26

Echinocandins (inhibit 1,3 glucan synthesis step of fungi) | E.g. caspofungin, micafungin, and anidulafungin

Question 27

How do -azole antifungals work?

Answer 27

Inhibit step turning lanosterol to ergosterol which leads to more permeable fungal cell membrane

Question 28

Amphotericin is effective against a wide variety of fungi but due to significant toxicity it has only two main uses currently, what are they?

Answer 28

Cryptococcus | Mucomycosis

Question 29

SE of amphotericin

Answer 29

Renal toxicity (directly toxic to distal tubules leading to distal RTA causing K and Mg loss which leads to H+ retention) Hypokalemia Metabolic acidosis Fever/shakes/chills

Question 30

Best initial test for osteomyelitis | Most accurate test

Answer 30

Initial: X-ray (2nd is MRI) Accurate: bone bx and culture

Question 31

What is the earliest finding of osteomyelitis on X-ray?

Answer 31

Periosteal elevation

Question 32

Patient with osteomyelitis come in and you decide to culture the visible sinus tract and ulcer. Good idea?

Answer 32

No! You should never culture the ulcer or sinus tract

Question 33

What should you be trending as you treat osteomyelitis to know response to therapy?

Answer 33

ESR; if still elevated then continue treating since majority of patients won't be febrile or have elevated WBC

Question 34

Otitis externa is best treated how? | What adjunctive medications can assist?

Answer 34

Topical antibx (ofloxacin, ciprofloxacin, or polymyxin/neomycin) Topical hydrocortisone: reduces swelling and itching Acetic acid and water solution reacidifies ear to eliminate infection

Question 35

How is malignant otitis externa different than simple otitis externa?

Answer 35

Very different. Malignant is basicallt osteomyelitis of skull often occurring in diabetics and caused by Pseudomonas

Question 36

Tx of malignant otitis externa

Answer 36

Surgical debridement and antibix against Pseudomonas

Question 37

Best initial test for sinusitis

Answer 37

Xray

Question 38

Most accurate test for sinusitis

Answer 38

Sinus aspirate for culture

Question 39

Tx of Strep pharyngitis

Answer 39

Penicillin or amoxicillin | If allergic then azithromycin or clarithromycin

Question 40

If dx of influenza is unclear what test can you do?

Answer 40

Viral rapid antigen detection

Question 41

Which influenza treatment works for both strains A and B?

Answer 41

Oseltamivir and Zanamivir (if symptoms started with last 48 hrs)

Question 42

When is the inactivated influenza vaccine indicated?

Answer 42

>50 years old and with illness

Question 43

Tx impetigo

Answer 43

Topical mupirocin or retapamulin Severe disease: oral dicloxacillin or cephalexin

Question 44

What presents with skin infection where the skin becomes red and hot and often occurs on the face? Tx?

Answer 44

Erysipelas | Oral dicloxacillin or cephalexin

Question 45

What are sequela of erysipelas or pharyngitis caused by Strep?

Answer 45

Erysipelas: Strep glomerulonephritis Pharyngitis: Strep glomerulonephritis and/or Rheumatic fever

Question 46

When considering LE cellulitis what else should you order?

Answer 46

Dopplers to rule out DVT

Question 47

How is cellulitis treated?

Answer 47

Minor: dicloxacillin or cephalexin orally Severe: oxacillin, nafcillin, or cefazolin

Question 48

How are folliculitis, furuncles, carbuncles, and boils treated?

Answer 48

Same as cellulitis but possibly drainage if gets too large