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Step 2 CK > Infectious Disease > Flashcards

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
Q

Difference in CSF evaluation between lyme, TB, and viral meningitis?

A

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
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26
Q

When is head CT the answer over LP for suspected menigitis?

A

When any of the following are present:

Papilledema

Seizures

Focal neurological abnormalities

Confusion interfering with the exam

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27
Q

When is bacterial antigen detection indicated?

A

AKA Latex Agglutination Test

Used when the patient has received abx prior to the LP and the culture may be falsely negative

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28
Q

Risk factors for listeria meningitis

A

Elderly and Neonates

Steroid use

AIDS/HIV

Alcoholism

Pregnant

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29
Q

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

A

Eighth cranial nerve deficit (deafness)

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30
Q

What is the most common cause of encephalitis?

A

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)

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31
Q

Best initial therapy for herpes encephalitis

A

Acyclovir (available IV)

Foscarnet is used for acyclovir-resistant herpes

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32
Q

What is the best next step when a patient receiving acyclovir for herpes encephalitis experiences a rise in creatinine levels?

A

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

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33
Q

What is the most sensitive physical finding for otitis media?

A

Immobility (a fully mobile tympanic membrane essentially excludes otitis media)

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34
Q

What is the next best step for otitis media if there are multiple recurrences or no response to multiple antibiotics?

What about for sinusitis?

A

Remember that imaging is never the right answer for ID

Otitis media = tympanocentesis

Sinusitis = biopsy of sinuses

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35
Q

CENTOR Criteria

A

Cervical lymphadenopathy

Tonsillar exudates

History of fever

Absence of cough

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36
Q

When can you treat the “flu” with oseltamivir or zanamivir?

A

AKA Tamiflu (neuraminidase inhibitors)

Within the first 48 hours of symptoms

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37
Q

True/False

Hep C often present with an acute infection

A

False

It is usually found as a “silent” infection on blood tests or when patients present with cirrhosis

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38
Q

What types of hepatitis are acquired from food and water?

A

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
Q

During acute hepatitis, which lab value correlates the best with an increased likelihood of mortality?

A

Elevated PT = increased risk of fulminant hepatic failure and death

40
Q

What is the best initial test for Hep A, C, D, and E?

A

IgM antibody for acute infection

IgG antibody for resolution

41
Q

What serology becomes abnormal first after acquiring hepatitis B infection?

A

surface antigen

as long as surface antigen is present, there is still some viral replication potentially occurring

42
Q

What serology correlates with the amount (quantitis) of active viral replication during hepatitis?

A

e-antigen

directly correlated with the degree of DNA polymerase

43
Q

What acute hepatitis gets medical therapy?

A

Only hepatitis C

44
Q

Side effects of interferon

A

Arthralgia/myalgia

Leukopenia and thrombocytopenia

Depression and flu-like symptoms

Not the best first choice for hepatitis

45
Q

Goal of chronic hepatitis therapy

A

Reduce DNA polymerase to undetectable levels

Convert patients with e-antigen to having anti-hepatitis e-antibody

46
Q

Treatment for Hep C

A

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
Q

Urethral discharge

A

Think Urethritis

Although both urethritis and cysititis give dysuria with urinary frequency and burning, cystitis does not give urethral discharge

48
Q

Intracellular gram-negative diplococci on urethral swab

A

Neisseria gonorrhea

49
Q

What is the most accurate test for Gonorrhea or Chlamydia

A

Urethral culture, DNA probe, or NAAT

Other causes of urethritis are Mycoplasma genitalium and Ureaplasma (harder to test for)

50
Q

What must you do in every patient presenting with signs/symptoms of PID?

A

Exclude pregnancy first

51
Q

Diagnostic tests for PID

A

Cervical swab for culture (not the most accurate test, but can be self-administered)

DNA probe

NAAT

52
Q

The most accurate test for PID

A

Laparoscopy

Only needed if the diagnosis is unclear, symptoms persist despite therapy, or there are recurrent episodes for unclear reasons

53
Q

Inpatient vs Outpatient treatment for PID

A

Inpatient = Cefoxitin or cefotetan (2nd generation) with doxycycline

Outpatient = Ceftriaxone and doxycycline (possibly with metronidazole)

54
Q

How does the treatment for PID change if the patient has a history of anaphylaxis with penicillin?

A

Inpatient = clindamycin, gentamicin, and doxycycline

Outpatient = levofloxacin and metronidazole

55
Q

Presentations of STDs:

  1. Painless Ulcer
  2. Painful ulcer
  3. Lymph nodes tender and suppurating
  4. Vesicles prior to ulcer and painful
A
  1. Syphilis
  2. Chancroid (Haemophilus ducreyi)
  3. Lymphogranuloma venereum
  4. Herpes
56
Q

What is the best test for syphilis?

For herpes?

A

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
Q

Treatment for:

Syphilis

Chancroid

Lymphogranuloma venereum

Herpes simplex

A

Syphilis - IM benzathine penicillin (doxy if allergic)

Chancroid - Azithromycin

Lymphogranuloma venereum - Doxycycline

Herpes simplex - Acyclovir, valacyclovir, famciclovir (foscarnet for acyclovir-resistant herpes)

58
Q

Rash (palms and soles)

Alopecia areata

Mucous patches

Condylomata lata

A

Secondary syphilis

59
Q

Loss of position and vibratory sense

Incontinence

Argyll Robertson pupil

A

Tertiary syphilis

60
Q

What is the most sensitive test for neurosyphilis?

A

FTA is nearly 100% sensitive in CSF

A negative FTA = “NOT neurosyphilis”

A negative VDRL and RPR means nothing

FTA = fluorescent treponemal antibody

61
Q

Infection

Older age

IV drug use

AIDs

Malaria

Antiphospholipid syndrome

Endocarditis

A

Reasons for a false positive VDRL/RPR

62
Q

Management for Jarisch-Herxheimer reaction

A

AKA fever and worse symptoms after treating someone for syphilis

Give aspirin and antipyretics; it will pass

63
Q

Diagnosis fo condylomata acuminata

A

AKA gentital warts

Diagnosed based on visual appearance (biopsy, serology, stain, smear, and culture are all wrong answers)

64
Q

Treatment for genital warts

A

Cryotherapy with liquid nitrogen

Surgery for large warts

Podophyllin or trichloroacetic acid

Imiquimod

65
Q

Treatment for crabs

A

AKA Pediculosis

Treat with permethrin; lindane is equally effective, but more toxic

66
Q

Treatment for scabies

A

Permethrin

Widespread disease responds to ivermectin; severe disease needs repeat dosing

67
Q

True/False

Men with UTIs have anatomic abnormalitis much more often than women

A

True

Best initial test = urinalysis with more than 10 WBCs

Most accurate test = urine culture

68
Q

Treatment for uncomplicated cystitis

A

Nifurantoin for 3 days (7 days if there is an anatomic abnormality)

69
Q

Treatment for pyelo

A

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
Q

Treatment for chronic prostatitis?

A

Acute = same as for pyelo

Chronic = ciprofloxacin or TMP-SMX for 6-8 weeks

71
Q

Splinter hemorrhages

Janeway lesions

Osler nodes

Roth spots in the eyes

Hematuria

Splenomegaly

Septic emboli

A

Complications of endocarditis

Fever + murmur = endocarditis

72
Q

Diagnostic tests for endocarditis

A

Blood culture (95-99% sensitive)

TTE (60% sensitive, but 95% specific)

TEE (95% sensitive and specific)

73
Q

What is the most appropriate next step in a patient treated for endocarditis that grew cultures for Clostridium septicum or Strep bovis?

A

Colonoscopy

Both are associated with colonic pathology ranging from diverticuli to polyps to colon cancer (C septicum has the greatest association)

74
Q

How to establish a diagnosis of culture negative endocarditis

A
  1. Oscillating vegetation on echo
  2. Three minor criteria:
    - Fever
    - Risk (IV drug use or prosthetic valve)
    - Signs of embolic phenomena
75
Q

Best initial empiric therapy for endocarditis

A

Vancomycin and gentamicin

76
Q

Treatment for endocarditis caused by:

  1. Viridans strep
  2. MSSA
  3. Fungal
  4. MRSA or Staph epi
  5. Enterococci
A
  1. Ceftriaxone for 4 weeks
  2. Oxacillin, nafcillin, or cefazolin
  3. Amphotericin and valve replacement
  4. Vancomycin
  5. Ampicillin and gentamicin
77
Q

When is surgery the answer for endocarditis?

A

The single strongest indication is acute valve rupture and CHF

78
Q

When should you add rifampin and/or aminoglycoside to the treatment of endocarditis?

A

Rifampin = for prosthetic valve endocarditis with Staph

Aminoglycoside = for treatment resistant organisms

79
Q

What are the most common causes of culture-negative endocarditis?

A

Coxiella and Bartonella

80
Q

When is prophylaxis indicated for endocarditis?

A
  1. Significant cardiac defect

AND

  1. Risk of bacteremia (dental work with blood, respiratory tract surgery)

The best initial management is amoxicillin prior to the procedure

81
Q

The most commonly affected joint in Lyme disease

A

The knee

82
Q

The most common neurological manifestation of Lyme disease

A

7th cranial nerve/Bell palsy

83
Q

Most common cardiac manifestation of Lyme disease

A

Transient AV block

84
Q

When is serologic testing for Lyme disease essential

A

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
Q

Treatment for Lyme

A

Asymptomatic = none

Rash = doxy or amox

Joint or Bell palsy = doxy or amox

Cardiac or neuro manifestations other than Bell palsy = IV ceftriaxone

86
Q

VZV

Herpes

TB

Oral and vaginal candidiasis

Bacterial pneumonia

Kaposi sarcoma

A

Infections you are at increased risk of with HIV despite having a CD4 count above 200

87
Q

How to diagnose babies with HIV?

A

PCR or viral culture

ELISA is unreliable in infants because maternal HIV antibodies may be present for up to 6 months

88
Q

HIV treatment failure first manifests with a rising…

A

PCR-RNA viral load

Changes in CD4 lag behind

89
Q

Best initial choice of antiretroviral medication for HIV

A

Emtricitabine (NRTI), Tenofovir (NRTI), and Efavirenz (NNRTI)

Combined in a single pill called Atripla

90
Q

When is Ritonavir (PI) useful?

A

To boost the levels of other protease inhibitors

91
Q

To prevent SJS, what genetic testing needs to be performed before starting Abacavir

A

HLA B5701

92
Q

Pregnant patient presents with HIV (on Atripla). What action, if any, needs to be taken?

A

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
Q

When is Cesarean delivery indicated for HIV positive mothers?

A

When their viral load is above 1000 at the time of delivery

Step 2 CK (18 decks)

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