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Step 3 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

IV treatment for MSSA

A

Oxacillin, nafcillin, cefazolin

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2
Q

Oral treatment for MSSA

A

Dicloxacillin, cephalexin

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3
Q

Severe MRSA infection tx

A

Vancomycin, Linezolid, Daptomycin, Tigecycline, Ceftaroline, Telavancin

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4
Q

Major SE of LInezolid

A

Thrombocytopenia

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5
Q

Major SE of daptomycin

A

Myopathy and rising CK

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6
Q

Minor MRSA infection tx

A

TMP/SMX, clindamycin, doxycyline

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7
Q

In patients with an anaphylactic penicillin allergy what antibxs can you use?

A

Macrolides (e.g. azithromycin, clarithromycin)

Clindamycin

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8
Q

In patients with severe infection and a penicillin allergy what alternate antibiotics can be used?

A

Vancomycin, daptomycin, linezolid, telavancin

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9
Q

In patients with mild infection and penicillin allergy what alternate antibiotics can be used?

A

Macrolides (e.g. azithromcyin, clindamycin)
Clindamycin
TMP/SMX

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10
Q

Which penicillin medications are specific for Streptococcus?

A

Amoxicillin, Ampicillin, Penicillin

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11
Q

What are options from each of the below classes for the treatment of gram negative bacilli?

Cephalosporins
Penicillins
Monobactam
Quinolones
Aminoglcyosides
Carbapenems
A

Cephalosporins: cefepime, ceftazidime
Penicillins: piperacillin, ticarcillin
Monobactam: aztreonam
Quinolones: cipro, levo, moxi, gemifloxa
Aminoglycosides: gentamicin, tobramycin amikacin
Carbapenems: imipenem, meropenem, ertapenem, doripenem

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12
Q

In addition to gram negative bacilli what else do piperacillin and ticaricillin cover?

A

Streptococci

Anaerobes

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13
Q

What is the only carbapenem which doesn’t cover Pseudomonas?

A

Ertapenem

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14
Q

What class of antibiotics generally offers great pneumococcal coverage?

A

Quinolones

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15
Q

Best med for gastrointestinal anaerobes

A

Metronidazole

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16
Q

What are the only cephalosporins which cover anaerobes?

A

Cefoxitin

Cefotetan

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17
Q

Major SE of imipenem

A

Seizures

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18
Q

What is the best drug for anaerobic strep?

A

Clindamycin

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19
Q

Tx options for CMV

A

Valganciclovir, ganciclovir, foscarnet

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20
Q

Major SE of valganciclovir and ganciclovir

A

BM suppression

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21
Q

Major SE of foscarnet

A

Renal toxicity

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22
Q

Agents for chronic HCV

A

Simeprevir, boceprevir, sofosbuvir, ledipasvir

Ribavirin

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23
Q

Major SE of ribavirin

A

Anemia

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24
Q

Treatment options for HBV

A

Lamividuine, interferon, adefovir, tenofovir, entecavir, telbivudine

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25
Q

What pathogens is fluconazole effective against?

A

Candida (most of them)

Cryptococcus

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26
Q

What is the best agent for Aspergillus?

What is its major SE?

A

Voriconazole

Visual disturbance

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27
Q

What -conazole also covers mucormycosis or Mucorales?

A

Posaconazole

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28
Q

What are examples of echinocandins?

A

Caspofungin, micafungin anidulafungin

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29
Q

In patients with neutropenic fever requiring antifungal coverage what class is a great option?

A

Echinocandins

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30
Q

Because of toxicity there are fewer true uses for amphotericin even though it has great coverage. What are its remaining uses?

A

Cryptococcus

Mucormycosis

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31
Q

What are the adverse effects of amphotericin?

A

Renal toxicity
Hypokalemia
Metabolic acidosis
Fever, shakes, chills

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32
Q

In a patient with mucormycosis (who needs amphotericin) but has renal toxicity due to it what is an option moving forward?

A

Liposomal amphotericin

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33
Q

What is the best initial test for osteomyelitis?

A

X-ray

Even though an MRI would be better you should get an X-ray first

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34
Q

What is the earliest finding of osteomyelitis on Xray?

A

Periosteal elevation

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35
Q

What can you use as a gauge to know how long to treat osteomyelitis?

A

ESR

*Many patients will become afebrile and have normal WBC so this is useful to use

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36
Q

Can you use oral antibiotics for Staph osteomyelitis?

What form can you use oral antibiotics for?

A

No

Can only use oral for Salmonella or Pseudomonas but even then these pathogens need to be bone biopsy/culture confirmed

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37
Q

For otitis externa what topical antibx are used?
What is used to decrease swelling and itching?
What is used to reacidify the ear?

A

Topicals: oxfloxacin, ciprofloxacin, polymyxin/neomycin
Decreased swelling/itching: topical hydrocortisone
Reacidify: acetic acid and water solution

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38
Q

How is malignant otitis externa treated?

A

Treat this like osteomyelitis of the skull

Surgical debridement and anti-Pseudomonal antibiotics

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39
Q

Best initial test in sinusitis?

Most accurate test?

A

Initial: X-ray
Accurate: Sinus aspirate for culture

40
Q

There is a live attenuated influenza vaccine and an injected inactivated virus. In what situations should both be used?

A

50 or with COPD, CHF, dialysis, steroid use, or health care workers should get inactivated virus

41
Q

Treatment of impetigo
Mild/Moderate
Severe
Community-acquired MRSA

A

Mild/Mod: Topical mupirocin or retapamulin
Severe: Oral dicloxacillin or cephalexin
CA-MRSA: TMP-SMX

42
Q

Best initial treatment of erysipelas

What if the organism is confirmed as group A beta hemolytic Strep?

A

Initial: oral dicloxacillin or cephalexin

If confirmed GAS: penicillin VK

43
Q

Treatment of cellulitis (or folliculitis, furuncle, carbuncle, boil)

Mild
Severe

A

Mild: dicloxacillin or cephalexin orally
Severe: oxacillin, nafcillin, cefazolin IV

44
Q

What is the best initial test of fungal infections in skin or nails?

A

KOH prep

45
Q

What topical antifungals are used for fungal infections which don’t involve the hair or nails?

A

Clotrimazole and many other -azoles

Nystatin, ciclopirox

46
Q

What oral antifungals are used for treatment of tinea capitis or onychomycosis?

A

Terbinafine
Itraconazole
Griseofulvin (more so for tinea capitis)

47
Q

In patients with urethritis what two meds should you give?

A

Ceftriaxone IM

Azithromycin or doxycycline

48
Q

In patients with recurrent Gonorrhea infections what should they be tested for?

A

Terminal complement deficiency

49
Q

What diagnostic tests should be done for urethritis?

A

Urethral swab and culture

Nucleic acid amplification tests

50
Q

What is treatment for PID (outpatient and inpatient)?

A

OP: IM ceftriaxone and oral doxy
IP: IV cefoxitin and doxy

51
Q

What is treatment of PIID in pregnant women?

A

Clindamycin and gentamicin

52
Q

How does epididymo-orchitis differ from testicular torsion?

What is appropriate treatment (hint it depends on age)?

A

Both have exquisitely painful testicles but epididymo-orchitis has a normal testicular position

35: fluoroquinolone

53
Q

Haemophilus ducreyi causes _____. This ulcer is (painful/painless)

A

Chancroid

Painful ulcer

54
Q

Treatment of chancroid

A

Single shot IM ceftriaxone or singe dose azithromycin

55
Q

How does lymphogranuloma venerum present?

A

An ulcer with large tender nodes near it (often called “buboes” which may also have a draining sinus tract

56
Q

What is the cause of lymphgranuloma venerum?

A

Chlamydia trachomatis

57
Q

What is treatment of lymphgranuloma venerum?

A

Aspirate the buboes and treat with doxycycline or azithromycin

58
Q

What is the most accurate test for syphilis?

A

Darkfield microscopy

59
Q

What is treatment for primary syphilis?
What is the Jarisch-Herxheimer reaction?
What is it’s treatment?

A

Penicillin
Fever, myalgia, headache which may begin after starting to treat primary symphilis
Self-limiting, can provide aspirin

60
Q

What are the initial tests of choice in secondary syphilis?

A

RPR and FTA

61
Q

What is treatment of tertiary syphilis?

A

IV penicillin (as opposed to IM penicillin for primary and secondary)

62
Q

What is the best initial test for primary syphilis?

A

Darkfield microscopy

Then consider VDRL/RPR

63
Q

How does granuloma inguinale present?
What causes it and what may be seen on diagnostics?
What is tx?

A

Red, beefy genital lesion that ulcerates
Klebsiella granulomatis; may see “Donovan bodies” on touch prep
Doxycycline, TMP/SMX, or azithromcyin

64
Q

What is the difference in presentation of crabs (pediculosis) and scabies?

A

Crabs is larger and may be in hair-bearing areas like pubis and axilla

Scabies burrows in web spaces

65
Q

How are all warts treated?

A

Mechanical removal

66
Q

What is treatment for uncomplicated cystitis?

What if there is evidence of E. coli resistance?

A

Nitrofurantoin or fosfomycin orally

If E. coli resistance evident then ciprofloxacin or levofloxacin

67
Q

How is complicated cystitis treated?

A

TMP/SMX or ciprofloxacin

68
Q

What is OP treatment for pyelonephritis?

IP?

A

OP: Ciprofloxacin

IP: Ceftriaxone, ertapenem, quinolones, ampicillin, or gentamicin

69
Q

Patient with pyelonephritis fails to improve after 7 days. What do you suspect?
How should you treat?

A

Perinephric abscess

Quinolone and add staphylococcal coverage

70
Q

What is the most accurate test for prostatitis?

Tx?

A

WBC in urine after prostate massage

Ciprofloxacin or TMP/SMX

71
Q

If a patient is culture-negative for suspected infective endocarditis does that necessarily mean there aren’t any bacteria causing it?

A

No; HACEK organisms commonly appear as culture negative

72
Q

What are HACEK?

A 
Haemophilus aphrophilus/parainfluenzae
Actinobacillus
Cardiobacterium hominus
Eikenella corrodens
Kingella kingae
73
Q

What are the most common organisms causing culture-negative infective endocarditis?

A

Coxiella and Bartonella

*It’s actually not the HACEK organisms

74
Q

What is the most common bacteria associated with colonic pathology-related infective endocarditis?

A

Clostridium septicum

*It’s actually not Strep bovis

75
Q

What is best empiric therapy for infective endocarditis?

A

Vancomycin and gentamicin

76
Q

What are the only types of procedures which need endocarditis prophylaxis? What is given as ppx?

A

Dental procedures which cause bleeding
Respiratory tract surgery
Surgery of infected skin

Amoxicillin

77
Q

What are the only cardiac defects which require endocarditis prophylaxis?

A

Prosthetic valves
Unrepaired cyanotic heart disease
Previous endocarditis
Transplant recipients developing valve disease

78
Q

In surgical procedures of infected skin what agent should be given for endocarditis ppx?

A

Cephalexin

79
Q

Is HIV therapy ever optional?

A

Yes actually, if CD4 count above 500

80
Q

Adverse effect of nucleoside reverse transcriptase inhibitors (-dines/bines)

A

Lactic acidosis

81
Q

Adverse effect of Ziduvidine

A

Lactic acidosis

Anemia

82
Q

Adverse effect of Didanosine

A

Lactic acidosis
Pancreatitis
Peripheral neuropathy

83
Q

Adverse effect of Stavudine

A

Lactic acidosis
Pancreatitis
Neuropathy

84
Q

Adverse effect of Abacavir

A

Lactic acidosis

Rash

85
Q

Adverse effect of Tenofovir

A

Lactic acidosis

Renal toxicity

86
Q

What are adverse effects of protease inhibitor class of HIV meds?

A

Hyperglycemia

Hyperlipidemia

87
Q

Adverse effect of Indinavir

A

Hyperglycemia
Hyperlipidemia
Crystal-induced nephropathy (kidney stones)

88
Q

What are adverse effects of non-nucleoside reverse transcriptase inhibitors?

A

Drowsiness (specifically efavirenz)

89
Q

MOA maraviroc

A

Blocks CCR5 receptor and inhibits entry of HIV into cells

90
Q

What is tx of a needle-stick injury in an employee working with an HIV-positive patient?

A

HAART therapy for one month

91
Q

What are HIV patients at risk for with CD4

A

Pneumocystis jiroveci (PCP PNA)
TMP/SMX is first-line
(If allergy then atovaquone or dapsone)
(Aerosolized pentamidine has poor efficacy)

92
Q

In HIV patients with CD4 count

A

MAC

Azithromycin weekly

93
Q

In HIV patients with PCP PNA which is severe (PaO2 35) what else should be given?

A

Steroids

94
Q

HIV pt presents with HA/N/V and ring-enhancing lesions on CTH. Dx? Tx?

A

Toxoplasmosis gondii

Pyrimethanmine and sulfadiazine

95
Q

HIV pt with CD4

A

CMV

Tx: ganciclovir or foscarnet; maintenance lifelong therapy with oral valganciclovir

96
Q

HIV pt with CD4

A 
Cryptococcal meningitis (Dx with India Ink stain and/or Cryptococcal antigen)
Tx: amphotericin and 5-FU followed by fluconazole
97
Q

HIV pt with CD4

A

MAC
Dx with BM testing or liver biopsy (most sensitive)
Tx: Clarithromycin and ethambutol; rifampin sometimes added

*(Azithromycin is for ppx)

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