Infectious Disease Flashcards
1
Q
`Treat MSSA with what IV antibiotics?
A
Oxacillin/nafcillin or cefazolin
2
Q
Treat MSSA with what oral abx?
A
Dicloxacillin or cephalexin
3
Q
Treat MRSA severe infection with one of these six abx:
A
Vancomycin Linezolid Daptomycin Ceftaroline Tigecycline Telavancin
4
Q
Treat a minor MRSA infecdtion with one of three abx:
A
TMP/SMX
Clindamycin
or Doxycycline
5
Q
Linezolid causes what adverse effect?
A
Thrombocytopenia
Interference with MAOI’s
6
Q
Daptomycin causes what adverse effect?
A
Myopathy, rising CPK
7
Q
Does Tedizolid affect platelets or MAOI’s?
A
NO
8
Q
Patients with a penicillin allergy and rash can safely receive
A
cephalosporins
9
Q
Which three medications are specific for streptococcus and will not treat staph?
A
Penicillin
Ampicillin
Amoxicillin
10
Q
The only carbapenem that does not cover pseudomonas is
A
Ertapenem
11
Q
Levofloxacin, gemifloxacin, and moxifloxacin are excellent ___ drugs
A
pneumococcal
12
Q
The four beta-lactam antibiotics are
A
penicillin
cephalosporin
carbapenem
monobactam
13
Q
Beta-lactamase inhibitors are
A
Clavulanate
Sulbactam
Tazobactam
Avibactam
14
Q
The best abx for abdominal anaerobes is
A
Metronidazole
15
Q
The only cephalosporins that cover anaerobes are
A
Cefoxitin and Cefotetan
16
Q
Treat red man syndrome associated with vancomycin use by
A
Slowing the rate of the infusion. No need to switch the medication!
17
Q
The best long-term therapy for CMV retinitis is
A
Valganciclovir
18
Q
Treat candidemia with
A
fluconazole or caspofungin
19
Q
The best agent for Aspergillus treatment is
A
Voriconazole (adverse effect is visual disturbance)
20
Q
All -azoles can cause ___ toxicity at high dose
A
liver
21
Q
Echinocandins do not cover
A
Cryptococcus
22
Q
Do echinocandins have adverse effects?
A
NO, because they attack the 1,3 glucan synthesis step which is not in humans
23
Q
Amphotericine is directly toxic to
A
renal tubules, resulting in renal tubular acidosis
24
Q
When renal toxicity from amphotericine is described, the answer is
A
switch to liposomal amphotericin
25
Best initial test for suspected osteomyelitis
plain x-ray
26
Best second test for suspected osteo (if x-ray is negative but there's clinical suspicion)
MRI
27
Most accurate test for osteo
bone biopsy and culture
28
The earliest finding of osteomyelitis on an x-ray is
periosteal elevation
29
How do you know how long to treat osteomyelitis?
Track the ESR!
| If it's still elevated after 4-6 weeks of therapy, surgical debridement might be needed
30
The most common cause of osteo is
staphylococcus
31
Can you use oral therapy for staphylococcal osteomyelitis?
NO! IV all the way
32
The only osteo that can be successfully treated with oral abx is caused by
salmonella and pseudomonas (gram negative)
33
To confirm osteo is caused by a gram negative organism is to do a
bone biopsy
34
Malignant otitis externa is really osteo of the
SKULL (freaky.)
35
Diagnose MOE with
MRI or bone biopsy/culture
36
Treat MOE with
surgical debridement and abx against pseudomonas
37
The "next step" in treatment of otitis media is
performing the most accurate test, tympanocentesis and aspirate of the TM for culture (RARELY necessary)
38
If diagnosis of influenza is unclear, the best next step is
viral rapid antigen detection testing of nasopharyngeal swab
39
Only use oseltamivir or zanamivir if the patient presents...
within 48 hours of onset of symptoms
40
For whom is the live attenuated flu vaccine (nasal inhalation) effective?
Those <50 without medical problems
41
Treat impetigo with
topical mupirocin or retapumulin; severe = oral dicloxacillin or cephalexin
42
Very bright red and hot skin =
Erysipelas (often on the face)
| Order blood cultures in CCS
43
Best initial treatment for erysipelas =
oral dicloxacillin or cephalexin (just like severe impetigo!)
44
If cellulitis is on the table, don't forget to rule out
clotting (DVT)
45
Fungi have ___ in their outer wall that is tougher than epithelial cells
chitin
46
Scalp or nail fungal infection should be treated with
oral antifungals (Terbinafine, itraconazole, griseofulvin)
47
Diagnostic testing for urethritis is either __ or __
urethral swab for gram stain etc
| Nucleic acid amplification testing
48
Treat urethritis and cervicitis with __ and __
ceftriaxone IM and azithromycin or doxycycline (not in pregnant patients)
49
The single best test for chlamydia and gonorrhea is
NAAT
50
A measure of the severity of pelvic inflammatory disease is
leukocytosis
51
The most important thing to do in a woman with lower abd pain/tenderness is
exclude ectopic pregnancy
52
Haemophilus ducreyi causes a ___ ulcer
painful
53
Best initial test for a chancroid (painful genital ulcer) is
swab for gram stain and culture
| Specialized medium is Nairobi or Mueller-Hinton agar
54
Treat chancroid with
IM shot of ceftriaxone OR a single dose of azithromycin
55
Lymphogranuloma Venereum (LGV) is caused by
chlamydia trachomatis
56
Treat LGV by
aspirating the bubo and giving doxycycline or azithromycin
57
What is a unique side effect of erythromycin?
Increases GI motility by increasing motilin release (causes nausea, vomiting, diarrhea)
58
Treat acyclovir-resistant herpes with
foscarnet (NOT ganciclovir!!)
59
The most accurate diagnostic test for syphilis is
Darkfield microscopic exam.
60
Symptoms of primary syphilis are
chancre and adenopathy
61
Sx of secondary syphilis are
Rash, mucous patch, alopecia areata, condylomata lata
62
Sx of tertiary syphilis are
Tabes dorsalis, Argyll-Robertson pupil, general paresis, and rarely a gumma or aortitis
63
Treat tertiary syphilis with
IV penicillin (desensitize if allergic)
64
Treat primary and secondary syph with
single IM shot of penicillin (doxycycline if allergic)
65
Jarisch-Herxheimer reaction is caused by
the release of pyrogens from the dying tremponemal. It's self-limiting
66
Treat Jarisch-Herxeimer rxn with
aspirin. continue penicillin
67
"Donovan bodies" =
```
Klebsiella granulomatis (Granuloma Inguinale)
Tx: Doxy, bactrim, or azithro
```
68
An immunostimulant that can be used to slough off benign warts is
Imiquimod
69
First line treatment of uncomplicated cystitis is
fosfomycin or nitrofurantoin orally for 3 days
70
If E. coli resistance is high in a case of cystitis, use
ciprofloxacin or levofloxacin
71
Complicated cystitis is treated with
7 days of bactrim or cipro. Complicated means anatomic abnormality is present
72
Only treat asymptomatic bacteriuria if the patient is
pregnant or getting urinary instrumentation
73
Nitrites=
gram negative bacteria in urine
74
A rare complication of pyelonephritis that doesn't respond to treatment after 5-7 days is
perinephric abscess
75
Boggy prostate =
prostatitis
| Tx: cipro or bactrim
76
Start therpay for HIV when CD4 is
500 without exception
77
-navir =
protease inhibitor
78
-gravir =
integrase inhibitors
79
Efavirenz is avoided in
Pregnancy and psychosis
80
Adverse effects of Tenofovir
RTA and Fanconi syndrome and decreased bone density
81
Abacavir fun fact
HLA-B *5701 mutation is a contraindication!
82
AE of Zidovdine
anemia
83
AE of didanosine and stavudine
pancreatitis and peripheral neuropathy
84
AE of Lamivudine
NONE
85
AE of indinavir
kidney stones
86
AE of all nucleoside reverse transcriptase inhibitors (-dine, abacavir, emtricitabine, tenofovir)
Lactic acidosis
87
AE of all protease inhibitors
hyperglycemia, hyperlipidemia
88
AE of NNRTI's (-vire/viri/vira)
drowsiness (avoid with mental illness)
89
Standard of care for HAART is
two nucleoside and an integrase inhibitor
90
Pre-Exposure Prophylaxis is
tenofovir and emtricitabine BEFORE exposure
91
Post-exposure prophylaxis for needle-stick injury in HIV patient is
ART for a month, starting within 72 hours of exposure
92
What is notable on labs in pneuocystis pnemonia?
increased LDH
93
Most accurate test for PCP is
bronchoalveolar lavage
94
Treat PCP pneumonia with
IV bactrim
| If there's a rash, use IV pentamidine or the combo of clinda + primaquine
95
Prophylaxis for PCP is
bactrim, or dapsone if there's a rash with bactrim
96
Do not use dapsone if there is a
G6PD deficiency!
97
HIV with CD4<50 and blurry vision =
CMV! Do a dilated optho exam , treat with ganciclovir or foscarnet
98
CSF of a patient with cryptococcus will show increased
lymphocytes.
99
Most accurate test for cryptococcus is
cryptococcal antigen gest
100
Treat crypto initially with ___ then __
amphotericin and 5-FC, then fluconazole
101
HIV and CD4<50 and focal neurological abnormalities
Progressive multifocal leukoencephalopathy, best test is CT or MRI
102
HIV and CD4<50 and wasting, weight loss, fever, fatigue =
Mycobacterium avium-intracellulare
| -anemia due to bone marrow invasion; test bone marrow or liver biopsy
103
Treat MAI with
clarithromycin and ethambutol
104
Minor Dukes criteria for IE is
fever >38 C, Risk factors, Vascular findings, Immunological findings, and microbiologic findings
105
Major Dukes criteria for IE =
```
two positive blood cultures
abnormal echocardiogram (intracardiac mass, valvular vegetation, abscess, or new partial dehiscence of prosthetic valve)
```
106
Fever + new murmur =
possible endocarditis; best next step is to do blood cultures!!
107
What are roth spots?
Retina spots a/w infective endocarditis
108
Culture negative endocarditis causes =
coxiella and bartonella
109
The only procedures that need prophylaxis for endocarditis are
dental procedures that cause bleeding (amoxicillin)
respiratory tract surgery
surgery of infected skin
110
Treat leptospirosis with
ceftriaxone or penicillin
111
Tularemia should be treated with
doxycycline, gentamicin, or streptomycin
112
Don't eat pork in Mexico, South America, Eastern Europe or India cuz of this
Cysticercosis; Treat with albendazole
113
"morulae" on peripheral blood smear (inclusion bodies in white cells ) =
Erhlichia/Anaplasma
