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Step 2 CK > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Things that dont grow on culture?

A

pneumocystis, syphilis.

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2
Q

Bacteria covered by amoxicillin

HELPS

A 
H.flu
E.coli
Listeria
Proteus
Salmonella
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3
Q

only cephalosporin that will cover MRSA?

A

ceftaroline

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4
Q

drugs that cover MRSA?

A

vanc, dapto, ceftaroline, linezolid

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5
Q

what 3 organisms are resistant to all forms of cephalosporins?

A

Listeria, MRSA, Enterococcus

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6
Q

why avoid ceftriaone in neonates?

A

impaired biliary metabolism

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7
Q

what cephalosporin covers pseudomonas?

A

ceftazidime

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8
Q

carbapenams are highly active against?

A

gram negative bacilli

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9
Q

side effects of quinolones?

A

bone growth abnormalities

tendonitis and achilles tendon rupture

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10
Q

moxifloxacin can be used as a single agent against?

A

diverticulitis/GI infections (vs other quinolones that need to be paired with metronidazole)

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11
Q

what antibiotic can lead to Fanconi syndome (type II RTA)

A

doxycycline

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12
Q

minor MRSA infection of skin are treated with?

A

TMP/SMX
Clinda
Doxy
Linezolid

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13
Q

all of the ______ abx cover anearobes with equal efficacy to metronidazole?

A

lactam/beta-lactamase inhibitors

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14
Q

meningitis in those with recent neurosurgery?

A

staph aureus

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15
Q

meningitis with CD 4<100 ?

A

cryptococcus

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16
Q

camper/hiker meningitis?

A

lyme

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17
Q

what will cell count look like on LP for crypto, lyme, rickettsia, TB, viral?

A

10s-100s. lymphocytes

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18
Q

How can you differentiate TB from others with protein level on LP?

A

TB protein- markedly elevated

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19
Q

Answer head CT before LP whenever these signs are present??

A

papilledema, seizure, focal neuro abnml, confusion, blurred disc

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20
Q

if contraindication to immediate LP, what do you do first?

A

abx

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21
Q

when are bacterial antigen tests indicated in terms of meningitis?

A

patient received abx prior to LP and culture might be falsely negative

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22
Q

most accurate test for TB meningitis?

A

acid fast stain and culture on 3 high volume LPs with centrifuge to concentrate organisms due to high protein load

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23
Q

test for lyme and rickettsia meningitis?

A

serologic testing- ELISA, western blot, PCR

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24
Q

Most accurate test for crypto in descending order?

A

culture > antigen > india ink

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25
Q

How to treat meningitis if 1,000 of PMNs and on CSF?

A

ceftriaxone, vanc, steroids. add amp if immunocompromised.

(steroids- dexamethasone)- has only been shown to lower mortality in S. pneumoniae infection but still give them because we wont have culture!

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26
Q

additional treatment considerations for neisseria meningitidis patients?

A

rifampin, cipro, ceftriaxone for close contacts (those with major contact- household, kissing, sharing things- not classmates)

respiratory isolation

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27
Q

most common neuro deficit in untreated bacterial meningitis?

A

VIII CN deficit or deafness

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28
Q

Most common cause of encephalitis?

A

HSV

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29
Q

most accurate diagnostic test for HSV?

A

PCR of CSF

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30
Q

what is used for acyclovir resistant herpes meningitis?

A

Foscarnet

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31
Q

what should you do if a patient with HSV enceph on acyclovir gets a creatinine bump?

A

lower acyclovir dose and hydrate!

(foscarnet is more toxic to kidney)

valacyclovir and famciclovir are PO and not good enough for Enceph

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32
Q

when is tympanocentesis indicated for otitis media

A

multiple recurrences or no response to multiple abx

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33
Q

what is never the answer to “most accurate test” in ID questions?

A

Radiology!

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34
Q

most accurate test for sinus infection?

A

sinus biopsy or aspirate

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35
Q

should you ever culture nasal discharge for sinusitis?

A

NO!! (most common wrong answer)

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36
Q

What do you use for strep pharyngitis is allergy to penicillin is anaphylaxis?

A

clinda or a macrolide

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37
Q

Association with Yersinia infectious diarrhea?

A

Yersinia has a high association for iron (hemochromatosis- blood transfusions)

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38
Q

Best initial test for infectious diarrhea?

A

blood and or fecal leukocytes

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39
Q

what is more sensitive- stool lactoferrin or stool leukocytes?

A

stool lactoferrin (choose this if its an answer choice)

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40
Q

scombroid? found in? treat with?

A

most rapid onset of non-bloody diarrhea. wheezing, flushing, rash, found in fish, treat with antihistamine

41
Q

Giardia treatment?

A

metronidazole, tinidazole

42
Q

cryptosporidiosis tx?

A

treat AIDS, nitazoxanide

43
Q

Hep D exists exclusively in those with?

A

Hep B

44
Q

Which Hep rarely presents with acute infection- but is found incidentally on blood tests

A

C

45
Q

What abnormal lab test correlates best with increased likelihood of mortality?

A

Prothrombin Time

46
Q

what lab marker becomes abnormal first in hep B?

A

Surface antigen

47
Q

e-antigen for Hep B indicates a high level of?

A

DNA polymerase activity

48
Q

what lab marker indicates that a patient is no longer at risk for transmiting hep B infection?

A

No surface antigen found

49
Q

what lab marker is best indication for needed treatment with antiviral meds for hep B?

A

e-antigen

50
Q

best indicator that a pregnant woman will transmit hep B to her child?

A
  1. Hep B viral load (more precise)

and

e-antigen (DNA polymerase)

51
Q

chronicity of hep B is defined as?

A

persistence of surface antigen > 6 months

52
Q

adverse effects of interferon

A

arthralgia/myalgia
leukopenia and thrombocytopenia
depression and flu

(interferon is never the first right choice because it an injection and SE)

53
Q

Ribavirin causes?

A

anemia

54
Q

should you test for Hep C based on risk factors?

A

NO

55
Q

What is the only acute viral hepatitis infection that needs treatment?

A

Hep C

56
Q

What predicts response to therapy in Hep C?

A

genotype

57
Q

how to differentiate urethritis and cystitis?

A

both have urinary frequency and burning. cystitis does not have urethral discharge

58
Q

what is the most accurate test for PID?

A

laparoscopy (although you diagnose with cervical swab)

59
Q

What is the most sensitive test of CSF for neurosyphilis?

A

FTA!!

60
Q

does a negative FTA of CSF exclude neurosyphilis?

A

yes

61
Q

Does a negatie VDRL/RPR of CSF exclude syphilis?

A

NOoo

62
Q

Titers of VDRL or RPR are reliable at greater than ___?

A

1:8

63
Q

What can give you a false positive VDRL/RPR?

A

infection, older age, IV drug use, AIDS, malaria, antiphospholipid, endocarditis

64
Q

Jarisch-Herxheimer rxn?

A

fever and worse symptoms after treatment for syphilis

Give ASA and antipyretics- it will pass

65
Q

If patients with tertiary syphilis are allergic to penicillin what do you do? exception?

A

desensitize. Not in pregnant women!

66
Q

how to diagnose condyloma accuminata?

A

PE- physical appearance

67
Q

Imiquimod and pdophyllin (trichloroacetic acid) are both used for?)

A

HPV warts

68
Q

how do you treat crabs?

A

permethrin

69
Q

best initial therapy for pyelo?

A

ceftriaxone

70
Q

what do you treat pyelo with until urine culture results are known?

A

amp and gent

71
Q

diagnostic yield of a urine culture for prostatitis is greatly increased with?

A

prostate massage

72
Q

how to treat prostatitis?

A

6-8 weeks of ciprofloxacin or TMP/SMX

73
Q

fever and heart murmur =

A

endocarditis

74
Q

Man comes in to ED with fever and murmur and blood cultures grow Clostridium Septicum. What should you do next?

A

Colonoscopy- Clostridium Septicum has more of an association with colon cancer than Strep Bovis

75
Q

Best initial empiric therapy for endocarditis?

A

Vanc and Gent

76
Q

treatment of viridans strep endocarditis?

A

ceftriaxone for 4 weeks

77
Q

treatment of staph aureus endocarditis (sensitive)

A

oxacillin, naf, cefazolin

78
Q

fungal endocarditis treatment?

A

amphotericin and valve replacement

79
Q

staph epidermidis or resistant staph aureus treatment for endocarditis?

A

Vancomycin

80
Q

Treatment for enterococcus endocarditis?

A

amp and gent

81
Q

when is surgery the answer for endocarditis management?

A

CHF from ruptured valve or cordae tendineae, prosthetic valves, fungal endo, abscess, AV block, recurrent emboli while on abx

82
Q

What drug should you add for a prosthetic valve endocarditis infected with Staph?

A

Rifampin

83
Q

most common cause of culture negative endocarditis?

A

Coxiella

84
Q

single strongest indication for surgery with endocarditis is?

A

valve rupture with CHF

85
Q

How do you treat the HACEK organisms?

A

Ceftriaxone

86
Q

Best management for endocarditis prophylaxis?

A

amoxicillin prior to procedure

87
Q

If the patient is penicillin allergic- what is the best prophylaxis for endocarditis?

A

clindamycin, azithromycin, clarithromycin

88
Q

Is valvular heart disease- including mitral valve prolapse a reason to give prophylaxis for endocarditis?

A

No

89
Q

When is a single dose of doxy indicated for tick bite?

A

-If within 72 hours of tick bite- you can identify ixodes scapularis clearly as identifying cause, tick is attached for longer than 24 hours, engorged tick on skin, endemic area

90
Q

how do you diagnose HIV in babies?

A

viral load. ELISA unreliable because of maternal antibodies.

91
Q

what antiretroviral is contraindicated in pregnancy?

A

efavirenz

92
Q

Management of anaphylactic reaction?

A

epinephrine, antihistamines s(H1-blocker) and ranitidine (H2 blocker), Glucocorticoids- methylprednisolone or hydrocortisone, emergent airway protection if needed

93
Q

Hereditary angioedema does not respond to what management?

A

glucocorticoids

94
Q

best test for angioedema diagnosis?

A

C2 and C4. Deficiency of C1 esterase inhibitor

95
Q

Specific therapy for angioedema?

A

FFP or Ecallantide

Long term with androgens (danazol or stanazol)

96
Q

CVID gives a marked increase in a patients risk of?

A

lymphoma

97
Q

recurrent skin infections with staph indicates what syndrome?

A

Hyper IgE

98
Q

only definitive treatment for Wiskott-Aldrich syndrome?

A

bone marrow transplant

Step 2 CK (26 decks)

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