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Master the Boards Step 3 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

`Treat MSSA with what IV antibiotics?

A

Oxacillin/nafcillin or cefazolin

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2
Q

Treat MSSA with what oral abx?

A

Dicloxacillin or cephalexin

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3
Q

Treat MRSA severe infection with one of these six abx:

A 
Vancomycin
Linezolid
Daptomycin
Ceftaroline
Tigecycline
Telavancin
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4
Q

Treat a minor MRSA infecdtion with one of three abx:

A

TMP/SMX
Clindamycin
or Doxycycline

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5
Q

Linezolid causes what adverse effect?

A

Thrombocytopenia

Interference with MAOI’s

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6
Q

Daptomycin causes what adverse effect?

A

Myopathy, rising CPK

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7
Q

Does Tedizolid affect platelets or MAOI’s?

A

NO

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8
Q

Patients with a penicillin allergy and rash can safely receive

A

cephalosporins

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9
Q

Which three medications are specific for streptococcus and will not treat staph?

A

Penicillin
Ampicillin
Amoxicillin

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10
Q

The only carbapenem that does not cover pseudomonas is

A

Ertapenem

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11
Q

Levofloxacin, gemifloxacin, and moxifloxacin are excellent ___ drugs

A

pneumococcal

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12
Q

The four beta-lactam antibiotics are

A

penicillin
cephalosporin
carbapenem
monobactam

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13
Q

Beta-lactamase inhibitors are

A

Clavulanate
Sulbactam
Tazobactam
Avibactam

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14
Q

The best abx for abdominal anaerobes is

A

Metronidazole

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15
Q

The only cephalosporins that cover anaerobes are

A

Cefoxitin and Cefotetan

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16
Q

Treat red man syndrome associated with vancomycin use by

A

Slowing the rate of the infusion. No need to switch the medication!

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17
Q

The best long-term therapy for CMV retinitis is

A

Valganciclovir

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18
Q

Treat candidemia with

A

fluconazole or caspofungin

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19
Q

The best agent for Aspergillus treatment is

A

Voriconazole (adverse effect is visual disturbance)

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20
Q

All -azoles can cause ___ toxicity at high dose

A

liver

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21
Q

Echinocandins do not cover

A

Cryptococcus

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22
Q

Do echinocandins have adverse effects?

A

NO, because they attack the 1,3 glucan synthesis step which is not in humans

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23
Q

Amphotericine is directly toxic to

A

renal tubules, resulting in renal tubular acidosis

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24
Q

When renal toxicity from amphotericine is described, the answer is

A

switch to liposomal amphotericin

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25
Q

Best initial test for suspected osteomyelitis

A

plain x-ray

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26
Q

Best second test for suspected osteo (if x-ray is negative but there’s clinical suspicion)

A

MRI

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27
Q

Most accurate test for osteo

A

bone biopsy and culture

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28
Q

The earliest finding of osteomyelitis on an x-ray is

A

periosteal elevation

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29
Q

How do you know how long to treat osteomyelitis?

A

Track the ESR!

If it’s still elevated after 4-6 weeks of therapy, surgical debridement might be needed

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30
Q

The most common cause of osteo is

A

staphylococcus

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31
Q

Can you use oral therapy for staphylococcal osteomyelitis?

A

NO! IV all the way

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32
Q

The only osteo that can be successfully treated with oral abx is caused by

A

salmonella and pseudomonas (gram negative)

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33
Q

To confirm osteo is caused by a gram negative organism is to do a

A

bone biopsy

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34
Q

Malignant otitis externa is really osteo of the

A

SKULL (freaky.)

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35
Q

Diagnose MOE with

A

MRI or bone biopsy/culture

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36
Q

Treat MOE with

A

surgical debridement and abx against pseudomonas

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37
Q

The “next step” in treatment of otitis media is

A

performing the most accurate test, tympanocentesis and aspirate of the TM for culture (RARELY necessary)

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38
Q

If diagnosis of influenza is unclear, the best next step is

A

viral rapid antigen detection testing of nasopharyngeal swab

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39
Q

Only use oseltamivir or zanamivir if the patient presents…

A

within 48 hours of onset of symptoms

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40
Q

For whom is the live attenuated flu vaccine (nasal inhalation) effective?

A

Those <50 without medical problems

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41
Q

Treat impetigo with

A

topical mupirocin or retapumulin; severe = oral dicloxacillin or cephalexin

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42
Q

Very bright red and hot skin =

A

Erysipelas (often on the face)

Order blood cultures in CCS

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43
Q

Best initial treatment for erysipelas =

A

oral dicloxacillin or cephalexin (just like severe impetigo!)

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44
Q

If cellulitis is on the table, don’t forget to rule out

A

clotting (DVT)

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45
Q

Fungi have ___ in their outer wall that is tougher than epithelial cells

A

chitin

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46
Q

Scalp or nail fungal infection should be treated with

A

oral antifungals (Terbinafine, itraconazole, griseofulvin)

47
Q

Diagnostic testing for urethritis is either __ or __

A

urethral swab for gram stain etc

Nucleic acid amplification testing

48
Q

Treat urethritis and cervicitis with __ and __

A

ceftriaxone IM and azithromycin or doxycycline (not in pregnant patients)

49
Q

The single best test for chlamydia and gonorrhea is

A

NAAT

50
Q

A measure of the severity of pelvic inflammatory disease is

A

leukocytosis

51
Q

The most important thing to do in a woman with lower abd pain/tenderness is

A

exclude ectopic pregnancy

52
Q

Haemophilus ducreyi causes a ___ ulcer

A

painful

53
Q

Best initial test for a chancroid (painful genital ulcer) is

A

swab for gram stain and culture

Specialized medium is Nairobi or Mueller-Hinton agar

54
Q

Treat chancroid with

A

IM shot of ceftriaxone OR a single dose of azithromycin

55
Q

Lymphogranuloma Venereum (LGV) is caused by

A

chlamydia trachomatis

56
Q

Treat LGV by

A

aspirating the bubo and giving doxycycline or azithromycin

57
Q

What is a unique side effect of erythromycin?

A

Increases GI motility by increasing motilin release (causes nausea, vomiting, diarrhea)

58
Q

Treat acyclovir-resistant herpes with

A

foscarnet (NOT ganciclovir!!)

59
Q

The most accurate diagnostic test for syphilis is

A

Darkfield microscopic exam.

60
Q

Symptoms of primary syphilis are

A

chancre and adenopathy

61
Q

Sx of secondary syphilis are

A

Rash, mucous patch, alopecia areata, condylomata lata

62
Q

Sx of tertiary syphilis are

A

Tabes dorsalis, Argyll-Robertson pupil, general paresis, and rarely a gumma or aortitis

63
Q

Treat tertiary syphilis with

A

IV penicillin (desensitize if allergic)

64
Q

Treat primary and secondary syph with

A

single IM shot of penicillin (doxycycline if allergic)

65
Q

Jarisch-Herxheimer reaction is caused by

A

the release of pyrogens from the dying tremponemal. It’s self-limiting

66
Q

Treat Jarisch-Herxeimer rxn with

A

aspirin. continue penicillin

67
Q

“Donovan bodies” =

A 
Klebsiella granulomatis (Granuloma Inguinale)
Tx: Doxy, bactrim, or azithro
68
Q

An immunostimulant that can be used to slough off benign warts is

A

Imiquimod

69
Q

First line treatment of uncomplicated cystitis is

A

fosfomycin or nitrofurantoin orally for 3 days

70
Q

If E. coli resistance is high in a case of cystitis, use

A

ciprofloxacin or levofloxacin

71
Q

Complicated cystitis is treated with

A

7 days of bactrim or cipro. Complicated means anatomic abnormality is present

72
Q

Only treat asymptomatic bacteriuria if the patient is

A

pregnant or getting urinary instrumentation

73
Q

Nitrites=

A

gram negative bacteria in urine

74
Q

A rare complication of pyelonephritis that doesn’t respond to treatment after 5-7 days is

A

perinephric abscess

75
Q

Boggy prostate =

A

prostatitis

Tx: cipro or bactrim

76
Q

Start therpay for HIV when CD4 is

A

500 without exception

77
Q

-navir =

A

protease inhibitor

78
Q

-gravir =

A

integrase inhibitors

79
Q

Efavirenz is avoided in

A

Pregnancy and psychosis

80
Q

Adverse effects of Tenofovir

A

RTA and Fanconi syndrome and decreased bone density

81
Q

Abacavir fun fact

A

HLA-B *5701 mutation is a contraindication!

82
Q

AE of Zidovdine

A

anemia

83
Q

AE of didanosine and stavudine

A

pancreatitis and peripheral neuropathy

84
Q

AE of Lamivudine

A

NONE

85
Q

AE of indinavir

A

kidney stones

86
Q

AE of all nucleoside reverse transcriptase inhibitors (-dine, abacavir, emtricitabine, tenofovir)

A

Lactic acidosis

87
Q

AE of all protease inhibitors

A

hyperglycemia, hyperlipidemia

88
Q

AE of NNRTI’s (-vire/viri/vira)

A

drowsiness (avoid with mental illness)

89
Q

Standard of care for HAART is

A

two nucleoside and an integrase inhibitor

90
Q

Pre-Exposure Prophylaxis is

A

tenofovir and emtricitabine BEFORE exposure

91
Q

Post-exposure prophylaxis for needle-stick injury in HIV patient is

A

ART for a month, starting within 72 hours of exposure

92
Q

What is notable on labs in pneuocystis pnemonia?

A

increased LDH

93
Q

Most accurate test for PCP is

A

bronchoalveolar lavage

94
Q

Treat PCP pneumonia with

A

IV bactrim

If there’s a rash, use IV pentamidine or the combo of clinda + primaquine

95
Q

Prophylaxis for PCP is

A

bactrim, or dapsone if there’s a rash with bactrim

96
Q

Do not use dapsone if there is a

A

G6PD deficiency!

97
Q

HIV with CD4<50 and blurry vision =

A

CMV! Do a dilated optho exam , treat with ganciclovir or foscarnet

98
Q

CSF of a patient with cryptococcus will show increased

A

lymphocytes.

99
Q

Most accurate test for cryptococcus is

A

cryptococcal antigen gest

100
Q

Treat crypto initially with ___ then __

A

amphotericin and 5-FC, then fluconazole

101
Q

HIV and CD4<50 and focal neurological abnormalities

A

Progressive multifocal leukoencephalopathy, best test is CT or MRI

102
Q

HIV and CD4<50 and wasting, weight loss, fever, fatigue =

A

Mycobacterium avium-intracellulare

-anemia due to bone marrow invasion; test bone marrow or liver biopsy

103
Q

Treat MAI with

A

clarithromycin and ethambutol

104
Q

Minor Dukes criteria for IE is

A

fever >38 C, Risk factors, Vascular findings, Immunological findings, and microbiologic findings

105
Q

Major Dukes criteria for IE =

A 
two positive blood cultures
abnormal echocardiogram (intracardiac mass, valvular vegetation, abscess, or new partial dehiscence of prosthetic valve)
106
Q

Fever + new murmur =

A

possible endocarditis; best next step is to do blood cultures!!

107
Q

What are roth spots?

A

Retina spots a/w infective endocarditis

108
Q

Culture negative endocarditis causes =

A

coxiella and bartonella

109
Q

The only procedures that need prophylaxis for endocarditis are

A

dental procedures that cause bleeding (amoxicillin)
respiratory tract surgery
surgery of infected skin

110
Q

Treat leptospirosis with

A

ceftriaxone or penicillin

111
Q

Tularemia should be treated with

A

doxycycline, gentamicin, or streptomycin

112
Q

Don’t eat pork in Mexico, South America, Eastern Europe or India cuz of this

A

Cysticercosis; Treat with albendazole

113
Q

“morulae” on peripheral blood smear (inclusion bodies in white cells ) =

A

Erhlichia/Anaplasma

Master the Boards Step 3 (19 decks)

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