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Infectious Disease Flashcards

1
Q

Bacteria covered by amoxicillin

A

HELPS

H. influenza, E. coli, Listeria, Proteus, and Salmonella

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2
Q

What is the only cephalosporin that covers MRSA?

A

Ceftaroline (5th generation)

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3
Q

What does methicillin sensitive mean?

A

That you can treat with oxacillin (methicillin is never used because it causes renal failure/allergic interstitial nephritis)

Methicillin sensitive also means cephalosporin sensative

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4
Q

Which cephalosporins cover anaerobes?

A

Cefotetan and Cefoxitin (2nd generation)

Best initial therapy for PID combined with doxycycline

SE = increased risk of bleeding (depletes prothrombin) and disulfiram-like reaction with alcohol

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5
Q

Why should you avoid giving ceftriaxone to neonates?

A

Neonates have inadequate biliary metabolism

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6
Q

Which carbapenem does not cover pseudomonas?

A

Ertapenem

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7
Q

Treatment for diverticulitis

A

Cipro-, gemi-, or levofloxacin + metronidazole

Moxifloxacin can be used as a single agent because it covers anaerobes

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8
Q

Treatment for CAP

A

Moxifloxacin (IV/PO - considered a “lazy choice”)

OR

Ceftriaxone + Azithromycin (IV)

OR

Azithromycin (PO)

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9
Q

Treatment for HCAP

A

Vancomycin + Pip/Tazo

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10
Q

Treatment for meningitis

A

ceftriaxone

+

vancomycin

+/- steroids

+/- ampicillin (immunocompromised for listeria coverage)

Note: steroids have only been proven to lower mortality with S pneumo infections, but this is empiric coverage

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11
Q

Treatment for UTI

A

amoxicillin (pregnant)

OR

nitrofurantoin

OR

TMP-SMX (not for pts with RF)

OR
ceftriaxone (IV)

OR
ciprofloxacin (only for ambulatory pyelonephritis)

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12
Q

Treatment for cellulitis

A

TMP-SMX

OR

Vancomycin

OR

Clindamycin

“Treat Vat Cellulitis”

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13
Q

Side effects of fluoroquinolones

A

Bone growth abnormalities in children and pregnant women

Tendonitis and Achilles tendon rupture

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14
Q

Indications for Aminoglycosides (gentamicin, tobramyin, amikacin)

A

Gram-negative bacilli (bowel, urine, bacteremia)

Synergistic with beta-lactam abx for enterococci and staph

No effect against anaerobes

SE = nephrotoxic and ototoxic

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15
Q

Adverse effects of doxycycline

A

Tooth discoloration (children)

Fanconi syndrome (Type II RTA - proximal)

photosensitivity

esophagitis/ulcer

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16
Q

Best initial therapy for Staph and Strep

A

Oxacillin

First generation cephalosporins: cefazolin, cephalexin

Fluoroquinolones

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17
Q

MRSA is best treated with

A

Vancomycin

Linezolid (reversible BM toxicity)

Daptomycin (elevated CPK)

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18
Q

Minor MRSA infections of the skin are treated with:

A

TMP/SMX

Clindamycin

Doxycycline

Linezolid

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19
Q

True/False

All the becta-lactam/beta-lactamase inhibitors cover anaerobes with equal efficacy to metronidazole

A

True

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20
Q

Gram-negative bacilli

A

Proteus

Pseudomonas

E. coli

Enterobacter

Citrobacter

Klebsiella

PPEECK

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21
Q

Anaerobic coverage

A

Above the diaphragm = penicillin or clindamycin

Abd/GI = metronidazole or beta-lactam/lactamase

Piperacillin, carbapenems, and second-generation cephalosporins also cover anaerobes

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22
Q

Most likely diagnosis for CNS infection with:

  1. Stiff neck, photophobia
  2. Confusion
  3. Focal neurological finding
A

Stiff neck, photophobia = meningitis

Confusion = encephalitis

Focal neurological finding = abscess

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23
Q

Causes of meningitis

A

Strep pneumonia (60%)

N meningitidis (15%)

group B strep (14%)

H influenza (7%)

Listeria (2%)

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24
Q

CSF:

cell count 1000s (neutrophils)

protein elevated

glucose decreased

A

Bacterial meningitis

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25
Difference in CSF evaluation between lyme, TB, and viral meningitis?
All have cell count of 10-100 with lymphocytic predominance All have negative stain and culture - Lyme (and Cryptococcus and Rickettsia) have possibly elevated protein and possibly decreased glucose - TB has **markedly elevated protein** with possibly low glucose - Viral has **normal levels of protein and glucose**
26
When is head CT the answer over LP for suspected menigitis?
When any of the following are present: Papilledema Seizures Focal neurological abnormalities Confusion interfering with the exam
27
When is bacterial antigen detection indicated?
AKA Latex Agglutination Test Used when the patient has received abx prior to the LP and the culture may be falsely negative
28
Risk factors for listeria meningitis
Elderly and Neonates Steroid use AIDS/HIV Alcoholism Pregnant
29
What is the most common neurological deficit of untreated bacterial meningitis?
Eighth cranial nerve deficit (deafness)
30
What is the most common cause of encephalitis?
HSV Because the most common presenting symptom is confusion, you must do a CT first (LP contraindicated) PCR of CSF is the most accurate test (even more accurate than a brain biopsy)
31
Best initial therapy for herpes encephalitis
Acyclovir (available IV) Foscarnet is used for acyclovir-resistant herpes
32
What is the best next step when a patient receiving acyclovir for herpes encephalitis experiences a rise in creatinine levels?
Reduce the dose of acyclovir and hydrate Acyclovir may occasionally be toxic if the medication precipitates in the tubules, but foscarnet has far more renal toxicity
33
What is the most sensitive physical finding for otitis media?
Immobility (a fully mobile tympanic membrane essentially excludes otitis media)
34
What is the next best step for otitis media if there are multiple recurrences or no response to multiple antibiotics? What about for sinusitis?
Remember that imaging is never the right answer for ID Otitis media = tympanocentesis Sinusitis = biopsy of sinuses
35
CENTOR Criteria
Cervical lymphadenopathy Tonsillar exudates History of fever Absence of cough
36
When can you treat the "flu" with oseltamivir or zanamivir?
AKA Tamiflu (neuraminidase inhibitors) Within the first 48 hours of symptoms
37
True/False Hep C often present with an acute infection
False It is usually found as a "silent" infection on blood tests or when patients present with cirrhosis
38
What types of hepatitis are acquired from food and water?
Hep A and E (you Ate hepatitis A; you Eat hepatitis E) Hep E is typically the worst in pregnancy, especially among patients from East Asia
39
During acute hepatitis, which lab value correlates the best with an increased likelihood of mortality?
Elevated PT = increased risk of fulminant hepatic failure and death
40
What is the best initial test for Hep A, C, D, and E?
IgM antibody for acute infection IgG antibody for resolution
41
What serology becomes abnormal first after acquiring hepatitis B infection?
surface antigen as long as surface antigen is present, there is still some viral replication potentially occurring
42
What serology correlates with the amount (quantitis) of active viral replication during hepatitis?
e-antigen directly correlated with the degree of DNA polymerase
43
What acute hepatitis gets medical therapy?
Only hepatitis C
44
Side effects of interferon
Arthralgia/myalgia Leukopenia and thrombocytopenia Depression and flu-like symptoms Not the best first choice for hepatitis
45
Goal of chronic hepatitis therapy
Reduce DNA polymerase to undetectable levels Convert patients with e-antigen to having anti-hepatitis e-antibody
46
Treatment for Hep C
Genotype 1 = ledipasvir and sofosbuvir Genotype 2 and 3 = sofosbuvir and ribavirin Remember, Hep C is the only acute hepatitis that is medically managed
47
Urethral discharge
Think Urethritis Although both urethritis and cysititis give dysuria with urinary frequency and burning, cystitis does not give urethral discharge
48
Intracellular gram-negative diplococci on urethral swab
Neisseria gonorrhea
49
What is the most accurate test for Gonorrhea or Chlamydia
Urethral culture, DNA probe, or NAAT *Other causes of urethritis are Mycoplasma genitalium and Ureaplasma (harder to test for)*
50
What must you do in every patient presenting with signs/symptoms of PID?
Exclude pregnancy first
51
Diagnostic tests for PID
Cervical swab for culture (not the most accurate test, but can be self-administered) DNA probe NAAT
52
The most accurate test for PID
Laparoscopy Only needed if the diagnosis is unclear, symptoms persist despite therapy, or there are recurrent episodes for unclear reasons
53
Inpatient vs Outpatient treatment for PID
Inpatient = Cefoxitin or cefotetan (2nd generation) with doxycycline Outpatient = Ceftriaxone and doxycycline (possibly with metronidazole)
54
How does the treatment for PID change if the patient has a history of anaphylaxis with penicillin?
Inpatient = clindamycin, gentamicin, and doxycycline Outpatient = levofloxacin and metronidazole
55
Presentations of STDs: 1. Painless Ulcer 2. Painful ulcer 3. Lymph nodes tender and suppurating 4. Vesicles prior to ulcer and painful
1. Syphilis 2. Chancroid (Haemophilus ducreyi) 3. Lymphogranuloma venereum 4. Herpes
56
What is the best test for syphilis? For herpes?
Syphilis: Dark-field microscopy (if positive, no further testing is needed), VDRL and RPR (75% sensitive in primary syphilis), FTA or MHA-TP (confirmatory) Herpes: Tzanck prep is the best initial test, viral culture is the most accurate
57
Treatment for: Syphilis Chancroid Lymphogranuloma venereum Herpes simplex
Syphilis - IM benzathine penicillin (doxy if allergic) Chancroid - Azithromycin Lymphogranuloma venereum - Doxycycline Herpes simplex - Acyclovir, valacyclovir, famciclovir (foscarnet for acyclovir-resistant herpes)
58
Rash (palms and soles) Alopecia areata Mucous patches Condylomata lata
Secondary syphilis
59
Loss of position and vibratory sense Incontinence Argyll Robertson pupil
Tertiary syphilis
60
What is the most sensitive test for neurosyphilis?
FTA is nearly 100% sensitive in CSF A negative FTA = "NOT neurosyphilis" A negative VDRL and RPR means nothing *FTA = fluorescent treponemal antibody*
61
Infection Older age IV drug use AIDs Malaria Antiphospholipid syndrome Endocarditis
Reasons for a false positive VDRL/RPR
62
Management for Jarisch-Herxheimer reaction
AKA fever and worse symptoms after treating someone for syphilis Give aspirin and antipyretics; it will pass
63
Diagnosis fo condylomata acuminata
AKA gentital warts Diagnosed based on visual appearance (biopsy, serology, stain, smear, and culture are all wrong answers)
64
Treatment for genital warts
Cryotherapy with liquid nitrogen Surgery for large warts Podophyllin or trichloroacetic acid Imiquimod
65
Treatment for crabs
AKA Pediculosis Treat with **permethrin**; lindane is equally effective, but more toxic
66
Treatment for scabies
Permethrin Widespread disease responds to ivermectin; severe disease needs repeat dosing
67
True/False Men with UTIs have anatomic abnormalitis much more often than women
True Best initial test = urinalysis with more than 10 WBCs Most accurate test = urine culture
68
Treatment for uncomplicated cystitis
Nifurantoin for 3 days (7 days if there is an anatomic abnormality)
69
Treatment for pyelo
Ceftriaxone or ertapenem (considered first-line when organism is known) Ampicillin and gentamicin until culture results are known Ciprofloxacin (oral for outpatient) *Any drug for gram-negative bacilli would be appropriate*
70
Treatment for chronic prostatitis?
Acute = same as for pyelo Chronic = ciprofloxacin or TMP-SMX for 6-8 weeks
71
Splinter hemorrhages Janeway lesions Osler nodes Roth spots in the eyes Hematuria Splenomegaly Septic emboli
Complications of endocarditis Fever + murmur = endocarditis
72
Diagnostic tests for endocarditis
Blood culture (95-99% sensitive) TTE (60% sensitive, but 95% specific) TEE (95% sensitive and specific)
73
What is the most appropriate next step in a patient treated for endocarditis that grew cultures for Clostridium septicum or Strep bovis?
Colonoscopy Both are associated with colonic pathology ranging from diverticuli to polyps to colon cancer (C septicum has the greatest association)
74
How to establish a diagnosis of culture negative endocarditis
1. Oscillating vegetation on echo 2. Three minor criteria: - Fever - Risk (IV drug use or prosthetic valve) - Signs of embolic phenomena
75
Best initial empiric therapy for endocarditis
Vancomycin and gentamicin
76
Treatment for endocarditis caused by: 1. Viridans strep 2. MSSA 3. Fungal 4. MRSA or Staph epi 5. Enterococci
1. Ceftriaxone for 4 weeks 2. Oxacillin, nafcillin, or cefazolin 3. Amphotericin and valve replacement 4. Vancomycin 5. Ampicillin and gentamicin
77
When is surgery the answer for endocarditis?
The single strongest indication is acute valve rupture and CHF
78
When should you add rifampin and/or aminoglycoside to the treatment of endocarditis?
Rifampin = for prosthetic valve endocarditis with Staph Aminoglycoside = for treatment resistant organisms
79
What are the most common causes of culture-negative endocarditis?
Coxiella and Bartonella
80
When is prophylaxis indicated for endocarditis?
1. Significant cardiac defect AND 2. Risk of bacteremia (dental work with blood, respiratory tract surgery) The best initial management is amoxicillin prior to the procedure
81
The most commonly affected joint in Lyme disease
The knee
82
The most common neurological manifestation of Lyme disease
7th cranial nerve/Bell palsy
83
Most common cardiac manifestation of Lyme disease
Transient AV block
84
When is serologic testing for Lyme disease essential
For all manifestations of Lyme disease except erythema migrans *Because most causes of Bell palsy, arthralgia, and AV block are NOT caused by Lyme*
85
Treatment for Lyme
Asymptomatic = none Rash = doxy or amox Joint or Bell palsy = doxy or amox Cardiac or neuro manifestations other than Bell palsy = IV ceftriaxone
86
VZV Herpes TB Oral and vaginal candidiasis Bacterial pneumonia Kaposi sarcoma
Infections you are at increased risk of with HIV despite having a CD4 count above 200
87
How to diagnose babies with HIV?
PCR or viral culture ELISA is unreliable in infants because maternal HIV antibodies may be present for up to 6 months
88
HIV treatment failure first manifests with a rising...
PCR-RNA viral load *Changes in CD4 lag behind*
89
Best initial choice of antiretroviral medication for HIV
Emtricitabine (NRTI), Tenofovir (NRTI), and Efavirenz (NNRTI) Combined in a single pill called Atripla
90
When is Ritonavir (PI) useful?
To boost the levels of other protease inhibitors
91
To prevent SJS, what genetic testing needs to be performed before starting Abacavir
HLA B5701
92
Pregnant patient presents with HIV (on Atripla). What action, if any, needs to be taken?
Continue same medications, except switch efavirenz (most NNRTIs are teratogenic) to a protease inhibitor The baby should receive zidovudine during delivery and for 6 weeks afterwards
93
When is Cesarean delivery indicated for HIV positive mothers?
When their viral load is above 1000 at the time of delivery

Step 2 CK (18 decks)

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