Infectious Disease Flashcards
1
Q
IV treatment for MSSA
A
Oxacillin, nafcillin, cefazolin
2
Q
Oral treatment for MSSA
A
Dicloxacillin, cephalexin
3
Q
Severe MRSA infection tx
A
Vancomycin, Linezolid, Daptomycin, Tigecycline, Ceftaroline, Telavancin
4
Q
Major SE of LInezolid
A
Thrombocytopenia
5
Q
Major SE of daptomycin
A
Myopathy and rising CK
6
Q
Minor MRSA infection tx
A
TMP/SMX, clindamycin, doxycyline
7
Q
In patients with an anaphylactic penicillin allergy what antibxs can you use?
A
Macrolides (e.g. azithromycin, clarithromycin)
Clindamycin
8
Q
In patients with severe infection and a penicillin allergy what alternate antibiotics can be used?
A
Vancomycin, daptomycin, linezolid, telavancin
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
10
Q
Which penicillin medications are specific for Streptococcus?
A
Amoxicillin, Ampicillin, Penicillin
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
12
Q
In addition to gram negative bacilli what else do piperacillin and ticaricillin cover?
A
Streptococci
Anaerobes
13
Q
What is the only carbapenem which doesn’t cover Pseudomonas?
A
Ertapenem
14
Q
What class of antibiotics generally offers great pneumococcal coverage?
A
Quinolones
15
Q
Best med for gastrointestinal anaerobes
A
Metronidazole
16
Q
What are the only cephalosporins which cover anaerobes?
A
Cefoxitin
Cefotetan
17
Q
Major SE of imipenem
A
Seizures
18
Q
What is the best drug for anaerobic strep?
A
Clindamycin
19
Q
Tx options for CMV
A
Valganciclovir, ganciclovir, foscarnet
20
Q
Major SE of valganciclovir and ganciclovir
A
BM suppression
21
Q
Major SE of foscarnet
A
Renal toxicity
22
Q
Agents for chronic HCV
A
Simeprevir, boceprevir, sofosbuvir, ledipasvir
Ribavirin
23
Q
Major SE of ribavirin
A
Anemia
24
Q
Treatment options for HBV
A
Lamividuine, interferon, adefovir, tenofovir, entecavir, telbivudine
25
What pathogens is fluconazole effective against?
Candida (most of them)
| Cryptococcus
26
What is the best agent for Aspergillus?
| What is its major SE?
Voriconazole
| Visual disturbance
27
What -conazole also covers mucormycosis or Mucorales?
Posaconazole
28
What are examples of echinocandins?
Caspofungin, micafungin anidulafungin
29
In patients with neutropenic fever requiring antifungal coverage what class is a great option?
Echinocandins
30
Because of toxicity there are fewer true uses for amphotericin even though it has great coverage. What are its remaining uses?
Cryptococcus
| Mucormycosis
31
What are the adverse effects of amphotericin?
Renal toxicity
Hypokalemia
Metabolic acidosis
Fever, shakes, chills
32
In a patient with mucormycosis (who needs amphotericin) but has renal toxicity due to it what is an option moving forward?
Liposomal amphotericin
33
What is the best initial test for osteomyelitis?
X-ray
| Even though an MRI would be better you should get an X-ray first
34
What is the earliest finding of osteomyelitis on Xray?
Periosteal elevation
35
What can you use as a gauge to know how long to treat osteomyelitis?
ESR
*Many patients will become afebrile and have normal WBC so this is useful to use
36
Can you use oral antibiotics for Staph osteomyelitis?
| What form can you use oral antibiotics for?
No
| Can only use oral for Salmonella or Pseudomonas but even then these pathogens need to be bone biopsy/culture confirmed
37
For otitis externa what topical antibx are used?
What is used to decrease swelling and itching?
What is used to reacidify the ear?
Topicals: oxfloxacin, ciprofloxacin, polymyxin/neomycin
Decreased swelling/itching: topical hydrocortisone
Reacidify: acetic acid and water solution
38
How is malignant otitis externa treated?
Treat this like osteomyelitis of the skull
| Surgical debridement and anti-Pseudomonal antibiotics
39
Best initial test in sinusitis?
| Most accurate test?
Initial: X-ray
Accurate: Sinus aspirate for culture
40
There is a live attenuated influenza vaccine and an injected inactivated virus. In what situations should both be used?
50 or with COPD, CHF, dialysis, steroid use, or health care workers should get inactivated virus
41
Treatment of impetigo
Mild/Moderate
Severe
Community-acquired MRSA
Mild/Mod: Topical mupirocin or retapamulin
Severe: Oral dicloxacillin or cephalexin
CA-MRSA: TMP-SMX
42
Best initial treatment of erysipelas
| What if the organism is confirmed as group A beta hemolytic Strep?
Initial: oral dicloxacillin or cephalexin
| If confirmed GAS: penicillin VK
43
Treatment of cellulitis (or folliculitis, furuncle, carbuncle, boil)
Mild
Severe
Mild: dicloxacillin or cephalexin orally
Severe: oxacillin, nafcillin, cefazolin IV
44
What is the best initial test of fungal infections in skin or nails?
KOH prep
45
What topical antifungals are used for fungal infections which don't involve the hair or nails?
Clotrimazole and many other -azoles
| Nystatin, ciclopirox
46
What oral antifungals are used for treatment of tinea capitis or onychomycosis?
Terbinafine
Itraconazole
Griseofulvin (more so for tinea capitis)
47
In patients with urethritis what two meds should you give?
Ceftriaxone IM
| Azithromycin or doxycycline
48
In patients with recurrent Gonorrhea infections what should they be tested for?
Terminal complement deficiency
49
What diagnostic tests should be done for urethritis?
Urethral swab and culture
| Nucleic acid amplification tests
50
What is treatment for PID (outpatient and inpatient)?
OP: IM ceftriaxone and oral doxy
IP: IV cefoxitin and doxy
51
What is treatment of PIID in pregnant women?
Clindamycin and gentamicin
52
How does epididymo-orchitis differ from testicular torsion?
| What is appropriate treatment (hint it depends on age)?
Both have exquisitely painful testicles but epididymo-orchitis has a normal testicular position
35: fluoroquinolone
53
Haemophilus ducreyi causes _____. This ulcer is (painful/painless)
Chancroid
| Painful ulcer
54
Treatment of chancroid
Single shot IM ceftriaxone or singe dose azithromycin
55
How does lymphogranuloma venerum present?
An ulcer with large tender nodes near it (often called "buboes" which may also have a draining sinus tract
56
What is the cause of lymphgranuloma venerum?
Chlamydia trachomatis
57
What is treatment of lymphgranuloma venerum?
Aspirate the buboes and treat with doxycycline or azithromycin
58
What is the most accurate test for syphilis?
Darkfield microscopy
59
What is treatment for primary syphilis?
What is the Jarisch-Herxheimer reaction?
What is it's treatment?
Penicillin
Fever, myalgia, headache which may begin after starting to treat primary symphilis
Self-limiting, can provide aspirin
60
What are the initial tests of choice in secondary syphilis?
RPR and FTA
61
What is treatment of tertiary syphilis?
IV penicillin (as opposed to IM penicillin for primary and secondary)
62
What is the best initial test for primary syphilis?
Darkfield microscopy
| Then consider VDRL/RPR
63
How does granuloma inguinale present?
What causes it and what may be seen on diagnostics?
What is tx?
Red, beefy genital lesion that ulcerates
Klebsiella granulomatis; may see "Donovan bodies" on touch prep
Doxycycline, TMP/SMX, or azithromcyin
64
What is the difference in presentation of crabs (pediculosis) and scabies?
Crabs is larger and may be in hair-bearing areas like pubis and axilla
Scabies burrows in web spaces
65
How are all warts treated?
Mechanical removal
66
What is treatment for uncomplicated cystitis?
What if there is evidence of E. coli resistance?
Nitrofurantoin or fosfomycin orally
If E. coli resistance evident then ciprofloxacin or levofloxacin
67
How is complicated cystitis treated?
TMP/SMX or ciprofloxacin
68
What is OP treatment for pyelonephritis?
IP?
OP: Ciprofloxacin
IP: Ceftriaxone, ertapenem, quinolones, ampicillin, or gentamicin
69
Patient with pyelonephritis fails to improve after 7 days. What do you suspect?
How should you treat?
Perinephric abscess
| Quinolone and add staphylococcal coverage
70
What is the most accurate test for prostatitis?
| Tx?
WBC in urine after prostate massage
| Ciprofloxacin or TMP/SMX
71
If a patient is culture-negative for suspected infective endocarditis does that necessarily mean there aren't any bacteria causing it?
No; HACEK organisms commonly appear as culture negative
72
What are HACEK?
```
Haemophilus aphrophilus/parainfluenzae
Actinobacillus
Cardiobacterium hominus
Eikenella corrodens
Kingella kingae
```
73
What are the most common organisms causing culture-negative infective endocarditis?
Coxiella and Bartonella
*It's actually not the HACEK organisms
74
What is the most common bacteria associated with colonic pathology-related infective endocarditis?
Clostridium septicum
*It's actually not Strep bovis
75
What is best empiric therapy for infective endocarditis?
Vancomycin and gentamicin
76
What are the only types of procedures which need endocarditis prophylaxis? What is given as ppx?
Dental procedures which cause bleeding
Respiratory tract surgery
Surgery of infected skin
Amoxicillin
77
What are the only cardiac defects which require endocarditis prophylaxis?
Prosthetic valves
Unrepaired cyanotic heart disease
Previous endocarditis
Transplant recipients developing valve disease
78
In surgical procedures of infected skin what agent should be given for endocarditis ppx?
Cephalexin
79
Is HIV therapy ever optional?
Yes actually, if CD4 count above 500
80
Adverse effect of nucleoside reverse transcriptase inhibitors (-dines/bines)
Lactic acidosis
81
Adverse effect of Ziduvidine
Lactic acidosis
| Anemia
82
Adverse effect of Didanosine
Lactic acidosis
Pancreatitis
Peripheral neuropathy
83
Adverse effect of Stavudine
Lactic acidosis
Pancreatitis
Neuropathy
84
Adverse effect of Abacavir
Lactic acidosis
| Rash
85
Adverse effect of Tenofovir
Lactic acidosis
| Renal toxicity
86
What are adverse effects of protease inhibitor class of HIV meds?
Hyperglycemia
| Hyperlipidemia
87
Adverse effect of Indinavir
Hyperglycemia
Hyperlipidemia
Crystal-induced nephropathy (kidney stones)
88
What are adverse effects of non-nucleoside reverse transcriptase inhibitors?
Drowsiness (specifically efavirenz)
89
MOA maraviroc
Blocks CCR5 receptor and inhibits entry of HIV into cells
90
What is tx of a needle-stick injury in an employee working with an HIV-positive patient?
HAART therapy for one month
91
What are HIV patients at risk for with CD4
Pneumocystis jiroveci (PCP PNA)
TMP/SMX is first-line
(If allergy then atovaquone or dapsone)
(Aerosolized pentamidine has poor efficacy)
92
In HIV patients with CD4 count
MAC
| Azithromycin weekly
93
In HIV patients with PCP PNA which is severe (PaO2 35) what else should be given?
Steroids
94
HIV pt presents with HA/N/V and ring-enhancing lesions on CTH. Dx? Tx?
Toxoplasmosis gondii
| Pyrimethanmine and sulfadiazine
95
HIV pt with CD4
CMV
| Tx: ganciclovir or foscarnet; maintenance lifelong therapy with oral valganciclovir
96
HIV pt with CD4
```
Cryptococcal meningitis (Dx with India Ink stain and/or Cryptococcal antigen)
Tx: amphotericin and 5-FU followed by fluconazole
```
97
HIV pt with CD4
MAC
Dx with BM testing or liver biopsy (most sensitive)
Tx: Clarithromycin and ethambutol; rifampin sometimes added
*(Azithromycin is for ppx)
