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Step 2 CK > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Drug of choice for Syphilis

A

Penicillin G

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2
Q

When you see Gram(+) cocci in clusters, what do you cover for?

A

MRSA

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3
Q

Treatment of choice for MRSA?

A

Vancomycin

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4
Q

Best antibiotic for Methicillin-Sensitive Staph Aureus?

A

Cefazoline

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5
Q

What bacteria to consider when seeing Gram(+) cocci in pairs and chains?

A

Streptococcus

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6
Q

Gram(+) bacilli seen in gastroenteritis and meningitis?

A

Listeria

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7
Q

Tx of choice for Bacillus anthracis?

A

Ciprofloxacin

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8
Q

Tx of choice for Actinomyces?

A

Penicillin

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9
Q

What organisms do Cephalosporin NOT cover?

A

LAME

  • Listeria
  • Atypicals
  • MRSA (except Cefazoline)
  • Enterococcus
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10
Q

What is Catalase positive, Coagulase positive cocci?

A

Staph Aureus

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11
Q

What are alpha-hemolytic Streptococcus?

A

Strep pneumo and Viridans

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12
Q

What are beta-hemolytic Streptococcus?

A

S. pyogenes and S. agalactiae

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13
Q

What are gamma-hemolytic streptococcus?

A

Enterococcus

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14
Q

What type of cocci is Enterococcus?

A

Gram positive in pairs and chains.

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15
Q

Enterococcus is not covered by ________.

A

Cephalosporins

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16
Q

Best Tx for group A strep

A

Penicillin

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17
Q

What anaerobes are resistant to penicillin?

A

Bacteroides spp.

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18
Q

How does actinomyces present?

A

Abscess in the mandible, oral lesions

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19
Q

Tx of choice for Listeria?

A

Ampicillin

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20
Q

What do you need to treat Staph aureus?

A

Beta lactamase inhibitors + Penicillins

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21
Q

When covering for cellulitis, you cover for what organisms?

A

Group A strep (pyogenes) and MSSA

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22
Q

Tx of choice for cellulitis

A

1st gen cephalosporins

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23
Q

Examples of 2nd gen cephalosporins

A

Cefoxitin and Cefotetan

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24
Q

The only cephalosporins that treat for anaerobes?

A

2nd generation cephalosporins:

Cephamycins:

  1. Cefoxitin
  2. Cefotetan
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25
Q

Which cephalosporin is effective in covering MRSA?

A

Ceftaroline (5th gen)

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26
Q

Which cephalosporins treat PID?

A

2nd generations cephalosporins

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27
Q

What does clindamycin cover?

A

Strep, Staph, and Anaerobes

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28
Q

Best substitute for penicillin if patient has PCN allergy.

A

Clindamycin

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29
Q

Metronidazole is best for what organisms?

(GET the Metro)

A

Giardia

Entamoeba

Trichomonas

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30
Q

What is the best Tx for recurrent C. diff?

A

Fidaxomicin

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31
Q

Best diagnostic test for C. diff?

A

ELIZA test for C. diff toxin

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32
Q

How effective is fecal transplant?

A

95% effective

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33
Q

What is the best Tx for SEVERE C. diff?

A

Oral Vancomycin

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34
Q

How do you define SEVERE C. diff?

A

Any ONE of the following:

  • WBC count over 15,000
  • Increase of Creatinine of 1.5 or more
  • over 60 y/o
  • albumin less than 2.5
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35
Q

What drug, apart from an antibiotic, causes C. diff?

A

Proton pump inhibitors

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36
Q

What antibiotics increase risk of C. diff?

A
  • Fluoroquinolones
  • Broad spectrum cephalosporins
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37
Q

Safer antibiotics that have a low risk of C. diff occurrence

A

Tetracycline, Macrolides, and Bactrim

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38
Q

What antibiotics can you give to treat atypicals in pneumonia?

A

Macrolides

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39
Q

Cross reactivity for penicillin allergy and cephalosporins is ____%

A

less than 5%

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40
Q

What is your Vanco MIC (Minimum inhibitory concentration) cutoff to determine you cannot use Vancomycin?

A

Over 2.0

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41
Q

Substitutes for Vanco for MRSA?

A
  • Daptomycin (Calcium paralyses cell)

SE: Myositis, neutralized by surfactants (cannot use for pneumonia)

For: cellulitis, right-sided endocarditis, skin infections, bacteremia

  • Linezolid (inhibit cell wall synthesis)

SE: cannot use with SSRI, serotonin syndrome risk

For: good for pneumonia

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42
Q

Difference between serotonin syndrome and NMS

A

Myoclonus and hyperreflexia in serotonin syndrome.

No myoclonus and HYPOreflexia in NMS.

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43
Q

Most common side effect of Vanco

A

Thrombocytopenia

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44
Q

Ceftaroline is used for:

A

Pneumonia and Cellulitis

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45
Q

Macrolides are used for:

A

MILD gram positive infections

GOOD for atypical infections

BAD for serious gram pos infections

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46
Q

What organism must you cover with neutropenic fever?

A

Pseudomonas

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47
Q

If person has infected chemotherapy line what antibiotic do you give?

A

Vancomycin

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48
Q

What antibiotics can cover pseudomonas?

A
  • Ceftazidime (3rd gen)
  • Cefepime (4th gen)
  • Pip/Taz
  • Ticarcillin/Sulbactam (Beta lactams)
  • Fluoroquinolones (ciprofloxacin is the best)
  • Aminoglycosides
  • Carbapenems (if with PCN allergy)
  • Aztreonam (if with PCN allergy)
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49
Q

What conditions should you be wary of Pseudomonas?

A

CF, bronchiectasis

diabetics with malignant otitis externa

hot tub folliculitis

puncture wounds (with a nail)

nosocomial infections

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50
Q

Most common side effects of fluoroquinolones:

A
  • tendinitis / tendon rupture
  • peripheral neuropathy
  • QT prolongation
  • C. diff
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51
Q

Ceftazidime (3rd gen) covers

A

gram negative but not gram positive (strep/staph)

but good for pseudomonas

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52
Q

Cefepime (4th gen) can cover:

A

gram pos and gram neg

pseudomonas

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53
Q

Ceftriaxone (3rd gen) covers:

A

Broad spectrum for gram neg (Neisseria, etc)

can also cover pneumococcus

not good for pseudomonas

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54
Q

Why must you be careful with aminoglycosides?

A

It is nephrotoxic and ototoxic

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55
Q

What antibiotics have good anaerobic coverage?

A

Metronidazole

Moxifloxacin

Carbapenems

Beta-lactamases (ampi/sulba)

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56
Q

Which carbapenem does not cover pseudomonas?

A

Ertapenem

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57
Q

Carbapenems cover mostly gram negs, pseudomonas (except ertapenem), and anaerobes except:

A

MRSA

Enterococcus faecium

Stenotrophomonas maltophila (can be covered by bactrim)

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58
Q

What do we use to treat extended spectrum beta lactamases (ESBLs),

highly resistant gram negs.

Examples: E. coli, Klebsiella

A

Carbapenems (ertapenem)

Tigecycline

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59
Q

We can treat carbapenemase Klebsiella with:

A

Tigecycline or

Ceftazidime/avibactam (new beta lactamase inhibitor)

These mostly used for complicated UTIs and intrabdominal

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60
Q

How to treat multi drug resistant (MDR) pseudomonas?

A

Ceftolozane/Tazobactam

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61
Q

Where is doxycycline used?

A

Early lyme disease

Rickettsia

Chlamydia

Ehrlichiosis

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62
Q

What are the side effects of doxycycline?

A

Photosensitivity, pill esophagitis (drink lots of water)

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63
Q

Bactrim mostly used for:

A

PCP

Uncomplicated cystitis

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64
Q

Side effects of bactrim:

A

rash

SJS

thrombocytopenia, anemia, pancytopenia

kernicterus

hyperkalemia

decreased creatinine clearance

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65
Q

Do not give Bactrim with:

A

Ace-inhibitor

ARB

spironolactone

(Inhibit RAAS) - you can get arrhythmias due to hyperkalemia

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66
Q

Age cut off for covering listeria in patient’s with meningitis?

A

Over 50 years old

(Give ampicillin for listeria)

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67
Q

Why give vancomycin in patient’s with meningitis?

A

20% of strep is penicillin resistant

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68
Q

What type of meningitis patients can get it from listeria?

A

HIV, steroids, lymphoma, leukemia, chemoTx, neonates and people over 50

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69
Q

How do you dx cryptococcal meningitis?

A

cryptococcal antigen

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70
Q

In patient’s with HIV and cryptococcal meningitis, what is Tx algorithm?

A

Treat with HAART lifelong then star with induction phase of antigungals:

such as amphotericin and flucytosine then maintain with

fluconazole until CD4 count is >100 for 3 months

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71
Q

Why give dexamethasone in strep meningitis?

A

Improves morbidity and mortality

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72
Q

Main causes of brain abscess in normal patient (non HIV): (organisms)

A

60-70% is Streptococcus

20-30% is Bacteroides

25-35% is Enterobacter

10% is Staphylococcus

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73
Q

Empiric Tx for brain abscess:

A

Penicillin (for the Strep, 60-70%) / or 3rd gen cephalosporin

Metronidazole (for the Bacteroides, 20-30%)

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74
Q

Main causes of brain abscess in HIV patients:

A

90% - Toxoplasmosis

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75
Q

How to Tx Toxo brain abscess in HIV patients

A

pyrimethamine and sulfadiazine for 10 days

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76
Q

If brain abscess comes from sinusitis infection, add ___ to treatment.

A

Add vancomycin (to cover MRSA)

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77
Q

With Herpes encephalitis, what happens if you have a negative PCR from your LP?

A

Repeat after 5 days, results may be negative in the early stages.

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78
Q

What indicates a West Nile encephalitis?

A

Happens in the summer

Lower extremity paralysis

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79
Q

First line Tx for otitis media?

A

Amoxicillin

then Augmentin or Macrolides

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80
Q

Sinusitis caused by:

A

90-98% caused by VIRUSES

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81
Q

When do you give antibiotics for sinusitis?

A

If symptoms persist for more than 10 days

if symptoms are severe (102 deg fever, facial pain for 3-4 consec days)

if symptoms worsen

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82
Q

Which organisms do you cover for sinusitis?

A
  1. Strep pneumo
  2. Haemophilus
  3. Morzaxella
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83
Q

Antibiotics for sinusitis?

A

Augmentin (covers for s. pneumo and haemophilus, moraxella)

Doxycycline or New fluoroquinolone (if with PCN allergy)

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84
Q

What is the life-threatening side effect of augmentin?

A

Fulminant hepatotoxicity (antidote is NAC)

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85
Q

Which antibiotics can cause QT prolongation?

A

Macrolides and Fluoroquinolones

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86
Q

CENTAUR Criteria for pharyngitis

A

Cervical lymphadenopathy

Tonsillar Exudates

Fever

Lack of cough

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87
Q

When do you do a CT for meningitis?

A

FMD

seizures

papilledema

severe AMS

immunocompromised

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88
Q

When do you start empiric abx for meningitis?

A

IMMEDIATELY

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89
Q

When you see gram pos bacilli in CSF which sbx do you give?

A

Ampicillin (for listeria)

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90
Q

How to treat TB meningitis?

A

RIPE + steroids

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91
Q

How to treat TB pericarditis?

A

RIPE + steroids

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92
Q

Antibiotic Tx for Meningitis?

A

Ceftriaxone + Vancomycin

(Strep pneumo + PCN resistant strep)

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93
Q

Tx for pharyngitis

A

Penicillin, ampicillin, amoxicillin

Macrolide, 1st gen ceph, clindamycin

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94
Q

CENTAUR for pharyngitis:

0-1 = ?

2-3 = ?

4 = ?

A

0-1 = do nothing

2-3 = rapid strep test

4 = treat

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95
Q

What drugs cover atypicals?

A

Fluoroquinolones

Macrolides

Doxycycline

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96
Q

What kind of rash do you see with coccidiomycoses?

A

Erythema nodosum

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97
Q

Tx for Chlamydia psittaci?

A

Doxycycline

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98
Q

Pneumonia with:

pancytopenia, hepatosplenomegaly, hilar lymphadenopathy, and NO RASH

A

Histoplasmosis

(Histoplasma capsulatum)

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99
Q

Tx for CAP pneumonia?

A

New fluoroquinolones

(covers atypicals and PCN resistant pneumococcus)

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100
Q

Why not give macrolide only for pneumonia?

A

Does not cover PCN resistant pneumococcus

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101
Q

When can you give Macrolide monotherapy for pneumonia patients?

A

young, healthy, no comorbidities

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102
Q

If pneumonia patient has QT prolongation problems, and you can’t give fluoroquinolones…

A

Give:

Ceftriaxone and Doxycycline

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103
Q

What are you covering in ventilator-assisted pneumonia?

A

Pseudomonas and MRSA

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104
Q

What pneumococcal vaccine do you give with patients >65 y/o or immunocompromised?

A

Give covalent 13 then PPSV 23 a year later

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105
Q

Pneumococcal vaccine in lung, cardiac, liver, alcohol, smokers, diabetics but <65?

A

PPSV 23

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106
Q

Pneumococcal vaccine in HIV, renal disease, hematological malignancies, transplant recipient, immunosuppressants, <65 y/o

A

Covalent 13 now, then PPSV 23, 8 weeks later

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107
Q
A
108
Q

Positive PPD and negative CXR, what do you give?

A

INH for 9 months

109
Q

When do you perform inteferon gamma releasing assay for Tb dx?

A

When the patient has had BCG vaccine.

110
Q

When do you NOT perform IFN-Y releasing assay?

A

In patient’s with HIV and CD4 count <200

111
Q

PPD cutoff for high-risk patient (close contact)

A

>5mm

112
Q

PPD cutoff for medium risk (healthcare worker, homeless, etc)

A

>10mm

113
Q

PPD cutoff for low-risk patient

A

>15mm

114
Q

Multiple recurrent Giardia infection signifies…

A

Common Variable Immunodeficiency (Ig deficiency)

115
Q

What is the most accurate diagnostic tool for Hepatocellular Ca?

A

Triple phase CT scan

116
Q

Best screening tool for HCC?

A

Ultrasound

(not AFP, only 80% reliable)

117
Q

Patient with chronic liver disease must be screened for ____.

A

Hepatocellular Carcinoma

118
Q

Treatment for Acute Hepatitis infection:

A

Supportive

119
Q

Treatment for Chronic Hep B

A

Tenofovir, Entecavir

120
Q

Common side effects of Tenofovir

A

Fanconi Syndrome and Osteoperosis

121
Q

Who gets screened for Hep C?

A

IV drug users and people born from 1945 - 1965.

122
Q

Most common treatment for Hep C?

A

For genotype 1 & 4:

Ledipasvir/Sofosbuvir regimen

Sofosbuvir/Velpatasvir regimen

For genotype 2 & 3:

Sofosbuvir and ribavirin

123
Q

What is best dx test for gonorrhea?

A

Nucleic acid amplification test

124
Q

Tx for gonorrhea:

A

IM ceftriaxone (PO no longer recommended)

125
Q

Tx for chlamydia:

A

one dose of PO azithromycin or

7 days of doxycycline

126
Q

When you diagnose gonorrhea, what do you treat for at the same time?

A

Chlamydia

127
Q

When you diagnose chlamydia, do you treat for gonorrhea as well?

A

NO

128
Q

Treatment for pelvic inflammatory disease (PID)?

A

Singe dose IM ceftriaxone and PO doxycycline for 2 weeks

129
Q
A
130
Q

What is screening for syphilis? Confirmatory?

A

Screening: VDRL, RPR

Confirmatory: FTA-ABS

131
Q

Best study for Herpes?

A

PCR

or

Direct flourescent antibody test on scrapings (not serum)

132
Q

If there is resistance to acyclovir et al, which do you use for herpes?

A

Foscarnet

133
Q

What is this?

A

Erythema multiforme

134
Q

Causes of this:

A

Most common: recurrent HSV

Sulfa drugs, phenytoin, NSAIDs

135
Q

What is this? (tender to touch)

A

Erythema nodosum

136
Q

When you see this with arthritis, plus b/l hilar lymphadenopathy,

what is the dx?

A

Sarcoidosis

137
Q

When you see this plus diarrhea, what is the dx?

A

IBD

138
Q

When you see this plus pneumonia, what is the dx?

A

Coccidiomycosis

139
Q

3 choices for the treatment of uncomplicated cystitis:

A

Nitrofurantoin

Bactrim

Fosfomycin

(cipro no longer recommended for uncomplicated)

140
Q

Tx for pyelonephritis:

A

Fluoroquinolone (except cipro - too broad)

Ampicillin

Gentamycin

3rd gen ceph. (ceftriaxone)

141
Q

Diff. pyelonephritis from cystitis:

A

fever, cva tenderness

142
Q

How many days of tx if complicated UTI?

A

14 days

143
Q

What Tx for UTI with ESBL? (extended spectrum beta lactamases)

A

Carbapenems

144
Q

First thing to check with male UTI?

A

Prostate

145
Q

For UTI with prostatitis, what is Tx?

A

Same Abx treatment but 4 weeks long.

(Fluoroqionolones with Bactrim)

146
Q

What is best Tx for UTI in pregnancy?

A

Augmentin (Amox+Clav)

Cefixime

Cofpodoxime

(Nitro is 2nd line) - can cause kernicterus

147
Q

Bactrim should not be used in pregnancy because of

A

kernicterus

148
Q

Antibiotic of choice for recurrent UTI

A

daily or postcoital Bactrim

149
Q

Why is nitro avoided in prostatitis?

A

Does not penetrate prostate

150
Q

Only reason to use foley catheters.

A

urinary retention

151
Q

What are you covering in PUSTULAR cellulitis?

A

MRSA

152
Q

Out-patient options for MRSA treatment (PO)

A

Bactrim

Linazolid

Doxycycline

153
Q

With diabetic ulcers/wounds, what organisms should you cover?

A

Pseudomonas, MRSA, and anaerobes

154
Q

Most common organism involved in cellulitis?

A

MSSA and Group A strep (pyogenes)

155
Q

Best Tx for non-pustular cellulitis:

A

Dicloxacillin or Cephalexin

156
Q

How to differentiate Chronic Venous stasis from cellulitis?

A

Cellulitis is never bilateral.

157
Q

Organisms in cat bites

A

Pasteurella

158
Q

Organisms in human/dog bites

A

Eikenella, fusobacterium

159
Q

Abx of choice for any bites:

A

Best: Augmentin (Amox+Clav)

Oral clindamycin plus fluoroquinolone (if with allergy)

Clinda + fluoroquinolone

Clinda + tetracycline

Clinda + Bactrim (for kids)

160
Q

Best treatment for necrotizing fasciitis

A

IMMEDIATE surgical debridement

161
Q

What is type 1 nec fasc?

A

Mixed flora

(aerobes and anaerobes)

162
Q

What is type 2 nec fasc?

A

One organism

(usually Group A strep)

163
Q

What is best treatment for infection of Group A strep?

A

Penicillin + Clindamycin

Clindamycin suppress toxin and kills non-replicating cells

164
Q

Best treatment for this?

A

Penicillin with clindamycin

165
Q

Treatment for Type 1 nec fasc

A

Vanco + clinda

and

pip/taz , cefepime/metro, or meropenem

(all this cover MRSA, pseudo, and anaerobes)

166
Q

Tx for vibrio vulnificus?

A

3rd gen ceph (ceftriaxone)

and

Doxy or cipro

167
Q

What is the best treatment for spontaneous bacterial peritonitis (SBP)?

A

Cefotaxime

or ceftriaxone

168
Q

Best workup for osteomyelitis?

A

MRI

CT (if with hardware)

169
Q

Do you treat osteomyelitis empirically?

A

No. Treat based on cultures of bone biopsy

170
Q

What’s the dx?

A

Osteomyelitis

171
Q

Tx for this:

A

Antibiotics based on cultures

172
Q

Dx for osteomyelitis?

A

MRI or CT or Xray then bone biopsy then culture/sensitivity

173
Q

Do you culture the pus in osteomyelitis?

A

No

174
Q

When can you treat OM (osteomyelitis) with oral meds?

A

When cultures are sensitive to cipro (fluoroquinolone) because they have good bioavailability

175
Q

Most common cause of septic arthritis

A

Staph aureus

176
Q

What makes an arthritis “septic”

A

White count >50,000, low glucose

cultures positive in 90% of cases

177
Q

When will septic arthritis have non-growing cultures?

A

Gonococcal arthritis

178
Q

Patient has CHF due to aortic regurg brought about by bact. endocarditis. Replace valve? (Y/N)

A

Yes

179
Q

Patient does not have CHF, but has aortic regurg brought about by bact. endocarditis. Replace valve? (Y/N)

A

No

180
Q

Most common organism for bacterial endocarditis in addicts:

A

Strep viridans

181
Q

Most common organism for bacterial endocarditis in prosthetic valve patients:

A

Staph epidermidis

182
Q

Most common organism in native endocarditis?

A

Viridans strep

183
Q

Tx for viridans endocarditis?

A

Penicillin for 4 weeks

or

Ceftriaxone + gentamycin for 2 weeks

or

Vanco if with PCN allergy

184
Q

What is the empiric regimen for bacterial endocarditis with prosthetic valve:

A

Vancomycin, Gentamycin, Rifampin

185
Q

Tx for endocarditis with MSSA:

A

Nafcillin + 5 days of gentamycin for 4-6 weeks

(gentamycin not used if with GFR < 50)

or

Cefazoline (now best) + gentamycin

186
Q

Tx for endocarditis with MRSA:

A

Vanco or dapto

(no need for genta)

187
Q

Tx for enterococcal endocarditis?

A

Penicillin or ampicillin

plus

gentamycin (continuously, not just for 5 days)

for 4-6 weeks

188
Q

1st episode of septic emboli with endocarditis (without treatment), is this grounds for surgery valve replacement?

A

No.

It has to be recurrent septic emboli even with treatment.

189
Q

Criteria for surgery of endocarditis:

A
  • CHF
  • recurrent emboli
  • regurg that affect hemodynamics
  • vegetation larger than 10 mm
  • fungal growth
  • recurrent bacterial infection/persistent bacteremia (>5days)
  • fistular abscess (heart block - PR prolongation is best sign for abscess)
190
Q

When does a patient need prophylactic antibiotics with endocarditis?

A
  • patients with prosthetic valves
  • hx of IE
  • most congenital malformations
  • dental procedures with bleeding expected
    *
191
Q

Dx?

How do you know?

A

Pericarditis

Diffuse ST elevations

PR depression

192
Q

What’s on the arrow?

A

PR depression

(seen in pericarditis)

193
Q

Tx for pericarditis?

A

NSAIDs and colchicine

194
Q

What is this?

A

Coxsackie B

195
Q

What is this?

A

Chagas, Toxoplasmosis

196
Q

What is this?

A

Non-specific ST-T wave change

197
Q

What so you see in Echo in myocarditis?

A

left ventricular systolic dysfunction

198
Q

Answer?

A

B. IV ceftriaxone

(Serious lyme disease - heart block, meningitis, etc)

199
Q

Dx?

A

Lyme disease with HEART BLOCK

(give ceftriaxone)

200
Q

Migratory polyarthritis seen in…

A

Lyme disease

201
Q

If you see this, what do you do? (next step)

A

Treat with doxycycline.

202
Q

What is the Dx?

A

Babesiosis

203
Q

Treatment for Babesiosis?

A

Oral atovaquone plus azithromycin for 7-10 days

204
Q

Tx for SEVERE babesiosis?

A

Clindamycin + quinine

205
Q

What is normal CD4 count?

A

700/mm3

206
Q

What is the answer?

A

C. PO bactrim + prednisone + HAART

207
Q

Diagnosis?

A

Pneumocystis pneumonia

208
Q

How to know if PCP is severe?

A

Severe:

PaO2 of <70 and

A-a gradient of >35mmhg

209
Q

Second-line options for PCP, if with sulfa allergy.

A

Primaquine + clindamycin

210
Q

What abx to give for prophylaxis for PCP?

A

Dapsone

211
Q

When do you give prophylaxis for PCP?

A

When CD count <200

212
Q

What’s the answer?

A

D. Gancyclovir (has CMV)

213
Q

Most common presentation of CMV?

A

Retinitis

214
Q

When will HIV patient get CMV? What CD4 count?

A

<50

215
Q

HIV patient unable to swallow with CD4 count <50. What is your Dx?

A

CMV

216
Q

Patient got biopsy of the colon and saw this. What is your Dx?

(patient has HIV and CD4 count is 37)

A

CMV

217
Q

Tx for CMV?

A

Valganciclovir

218
Q

Tx for CMV retinitis?

A

Intravitreal ganciclovir

219
Q

2nd line for ganciclovir (CMV tx)

A

Cidofovir or Foscarnet

220
Q

Side effect of ganciclovir?

A

Neutropenia

221
Q

Side effect of cidofovir or foscarnet?

A

Renal toxicity

222
Q

What is the prophylactic antibiotic of choice for HIV patients with CD4 count of <50?

A

Azithromycin 1200mg weekly

or

Clarithromycin 2x/day

(prophylaxis for MAC - mycobacterium avium complex)

223
Q

Treatment for MAC in HIV patients:

A

clarithromycin and ethambutol +/- rifabutin

224
Q

What is the answer?

A

C. Pyrimethamine and sulfadiazine

(toxoplasmosis)

225
Q

When does Toxo infect HIV patient? What CD4 count?

A

<100

226
Q

Where is CNS lymphoma most often seen?

A

Basal ganglia

227
Q

What if patient has sulfa allergy and has toxo?

A

Replace sulfadiazine with clindamycin

228
Q

What do you give to address bone marrow suppression of sulfadiazine?

A

Leucovorin

229
Q

Fill blank

A

Answer

230
Q

Prophylaxis for Toxo:

A

Bactrim

or

Dapsone with pyrimethamine

231
Q

Patient with HIV and CD4 count 58. Dx?

A

Toxo

232
Q

How to dx cryptococcal meningitis?

A

Cryptotoccal antigen in CSF via LP

233
Q

What pneumococcal vaccines do you give HIV patients?

A

PS13 first then PPV23 8 weeks later

234
Q

Fill blanks

A
235
Q

Fill blanks

A
236
Q

Fill blanks

A
237
Q

Fill blanks

A
238
Q

Answer?

A

C. HLA B5701

239
Q

Answer?

A
240
Q

What is the red blank?

A
241
Q

What is the red blank?

A
242
Q

What is the red blank?

A
243
Q

What is the red blank?

A
244
Q

Which ones do we use now?

A
245
Q

What adverse effect does AZT have?

A
246
Q

Fill blanks

A
247
Q

Adverse effects of Tenofovir?

A

Fanconi syndrome, osteoporosis

248
Q

Fill blanks

A

Inhibits P450 system (boosts effect)

249
Q

Fill blanks

A
250
Q

Most commonly used regimen for HIV therapy now:

A

2 nucleosides, 1 integrase inhibitor

251
Q

Best combination now?

A
252
Q

Which protease inhibitor (HIV drug) is a P450 inhibitor?

A

Ritonavir

253
Q

Patient with Lyme disease given amox, but still has fevers. Why?

A

The patient also has anaplasma

254
Q

Difference of Babesia from lyme?

A

Hemolytic anemia, jaundice, splenomegaly.

255
Q

Anaplasma symptoms:

A

Leukpenia, thrombocytopenia, Î LFTs

256
Q

Pre-exposure prophylaxis for HIV:

A

Tenofovir + Emtricitabine

257
Q

Which HIV drug should not be given to pregnant women?

A

Efavirenz (teratogenic)

258
Q

When do you start treating pregnant women with HIV to not pass it to the baby?

A

Right away

259
Q

What do you give to a newborn born to a mother with HIV?

A

Give AZT during delivery and for 6 weeks after delivery.

260
Q

When do you do C-section on pregnant woman with HIV?

A

IF viral load is >1000

261
Q

How to treat toxic shock syndrome?

A

Vancomycin and clindamycin

262
Q

How to treat leptospirosis?

A

Penicillin, ceftriaxone OR doxycycline

263
Q

Tx for plasm. falciparum malaria?

A

Mefloquine or atovaquone/proguanil

264
Q

Tx for non-plasm. falciparum malaria?

A

Chloroquine or primaquine

265
Q

Why not give quinine?

A

Cardiac arrhythmias

266
Q

Tx for postherpetic neuralgia?

A

TCAs (desipramine), Anticonvulsants (gabapentin/pregabalin)

267
Q
A

Step 2 CK (2 decks)

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