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MTB > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

MSSA IV antibiotics

A

oxacillin/nafcillin or cefazolin (1st gen)

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2
Q

MSSA oral antibiotics

A

dicloxacillin or cephalexin (1st gen)

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3
Q

MRSA severe antibiotics

A

linezolid, vancomycin, daptomycin, ceftaroline, tigecycline, telavancin

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4
Q

side effect of linezolid

A

thrombocytopenia

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5
Q

side effect of daptomycin

A

myopathy, rise in CPK

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6
Q

minor MRSA antibiotics

A

TMP/SMX, doxycyline, clindamycin

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7
Q

rash with penicillin

A

cephalosporin

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8
Q

anaphylaxis with penicillin

A

Macrolide (azithromycin, clarithromycin), clindamycin, TMP/SMX

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9
Q

Streptococcus specific antibiotics

A

penicillin, ampicillin, amoxicillin

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10
Q

cephalosporin against gram neg rods

A

cefepime, Ceftazidime

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11
Q

penicillins against gram neg rods

A

piperacillin, ticarcillin

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12
Q

monobactam against gram neg rods

A

aztreonam

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13
Q

quinolones against gram neg rods

A

ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin

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14
Q

aminoglycosides against gram neg rods

A

gentamycin, tobramycin, amikacin

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15
Q

carbapenems against gram neg rods

A

imipenems, meropenem, ertapenem, doripenem

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16
Q

ertapenem exception

A

doesn’t cover Pseudomonas

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17
Q

alternative antibiotics equal in efficacy to metronidazole for abdominal aerobes

A

piperacillin, ticaracillin, carbapenem

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18
Q

only cephalosporins covering anaerobes

A

cefoxitin and cefotetan

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19
Q

best drug to cover anaerobic strep

A

clindamycin

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20
Q

antibiotics with no anaerobic coverage

A

aminoglycosides, aztreonam, fluoroquinolones, oxacillin/nafcillin, and all cephalosporins except cefoxitin and cefotetans

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21
Q

gemifloxacin

A

quinolone for pneumonia

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22
Q

antibiotic that has excellent anaerobic coverage, cover streptococci and all MSSA

A

carbapenem

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23
Q

antibiotics work synergistically with other agents to treat staph and strep

A

aminoglycosides

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24
Q

covers MRSA and broadly active against gram neg rods

A

Tigecycline

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25
Q

antiviral against HSV and varicella

A

acyclovir, valacyclovir, famciclovir

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26
Q

antiviral against CMV

A

valganciclovir, ganciclovir, foscarnet

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27
Q

best long term therapy for CMV retinitis

A

valganciclovir

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28
Q

valganciclovir and ganciclovir adverse effects

A

neutropenia and bone marrow suppress

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29
Q

foscarnet adverse effects

A

renal toxicity

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30
Q

ribavirin used for antiviral treatment of what

A

hep c, RSV

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31
Q

lamivudine, interferon, adefovir, tenovir, entecavir, telbivudine is antiviral treatment of what

A

chronic hep b

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32
Q

treat candida (not candida krusei or candida glabrata), cryptococcus, oral and vaginal candidiasis

A

fluconazole

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33
Q

best agent against aspergillus

A

voriconazole; also covers all candida

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34
Q

SE of voriconazole

A

visual disturbance

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35
Q

neutropenic patient with fungal infection give what anti fungal

A

echinocandins (caspofungin, micafungin, anidulafungin)

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36
Q

what does echinocandins (caspofungin, micafungin, anidulafungin) not cover

A

cryptococcus

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37
Q

adverse effects of echinocandins

A

no adverse effect; echinocandins have no significant human toxicity bc they affect/inhibit 1,3 glucan synthesis step, which does not exist in humans

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38
Q

for candida which anti fungal is best

A

fluconazole and amphotericin is = in efficacy, but has much fewer adverse effects

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39
Q

adverse effects of amphotericin

A

renal toxicity (increased creatine), hypokalemia, mrtabolic acidosis, fever, chills, shakes

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40
Q

best initial and second line test and most accurate test

A

best initial: x-ray, second line: MRI, most accurate: bone biopsy and culture

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41
Q

how long does it take for abnormal X-ray from osteomyelitis

A

2 weeks; must lose more than 50% of calcium content of the bone before the x-ray becomes abnormal

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42
Q

involucrum and sequestrum on bone X-ray

A

abnormal new bone in the periosteum

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43
Q

earliest finding of osteomyelitis

A

periosteal elevation

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44
Q

best method of following a response to therapy

A

follow sedimentation rate

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45
Q

osteomyelitis most commonly caused by

A

direct contiguous spread from overlying tissue

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46
Q

how long to treat patient with no fever and normal wbc with osteomyelitis

A

if ESR is markedly elevated after 4-6 weeks of therapy, further treatment and possible surgical debridement is necessary

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47
Q

most common cause of osteomyelitis, how to treat

A

staph
IV only for 4-6 weeks
MSSA: oxacillin or nafcillin
MRSA: vancomycin, linezolid, or daptomycin

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48
Q

how to treat osteomyelitis for gram neg bacilli (salmonella, pseudomonas)

A

can treat with oral abc
confirm gram neg with bone biopsy
no urgency for treating chronic osteomyelitis; biopsy –> move clock forward –> treat what you find on culture

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49
Q

treatment of otitis externa

A

1) topical abx: ofloxacin or polymyxin/neomycin
2) hydrocortisone to reduce swelling and itching
3) acetic acid to reacidify the ear and eliminate the infection

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50
Q

malignant otitis externa

A

osteomyelitis of the skull from Pseudomonas in a patient with diabetes, can lead to brain abscess and destruction of the skull

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51
Q

treatment malignant otitis externa

A

treat like osteomyelitis: x-ray, mri, biopsy/culture; treat with surgical debridement and abx against Pseudomonas such as ciprofloxacin, piperacillin, cefepime, carbapenem, axtreonam

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52
Q

treatment otitis media

A

amoxicillin for 7-10 days; tympanocentesis and aspirate of tympanic membrane for culture

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53
Q

patient with otitis media no improvement with amoxicillin after 3 days

A

switch amoxicillin to amoxicillin-clavulante, cefdinir, ceftibuten, cefuroxime, cefprozil, cefpodoxime

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54
Q

most causes of sinusitis

A

viral some bacterial

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55
Q

bacterial causes of sinusitis

A

Strep pneumo, H. influenzae, Moraxella catarrhalis

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56
Q

best initial test, most accurate test for sinusitis

A

best initial test is x-ray, most accurate test is sinus aspirate for culture (more accurate than ct or mri)

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57
Q

treatment for sinusitis

A

inhaled steroids, amoxicillin 7-10 days if fever and pain or persistent symptoms despite 7 days of decongestants, purulent nasal discharge

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58
Q

hallmark streptococcal pharyngitis symptom

A

no cough/hoarseness, pain/sore throat, lymphadenopathy, exudate

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59
Q

treatment of strep throat

A

penicillin or amoxiciliin; if penicillin allergy than use azithromycin or clarithromycin

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60
Q

oseltamivir and zanamivir works against

A

influenza A and B within 48 hours of symptom onset

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61
Q

amantadine and rimantadine works against

A

influenza A only

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62
Q

influenza symptoms

A

cough, headache, myalgias, fever, sore throat, feelings of tiredness

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63
Q

diagnostic testing for influenza

A

viral antigen detection testing of nasopharyngeal swab

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64
Q

strongest indicators for influenza vaccination

A

CHF, COPD, dialysis patients, steroid use, health care workers, everyone >50

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65
Q

treatment of impetigo

A

topical mupirocin or retapamulin (mupirocin has greater activity against MRSA, bacitracin has less efficacy as a single agent)

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66
Q

community acquired MRSA impetigo

A

TMP/SMZ; clindamycin is sometimes useful

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67
Q

treatment of severe impetigo

A

oral dicloxacillin or cephalexin

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68
Q

treatment of impetigo with penicillin allergy: rash? anaphylaxis? sever infection with anaphylaxis?

A

rash: cephalosporin; anaphylaxis: clindamycin, doxycycline, linezolid; severe infection with anaphylaxis: vancomycin, telavancin, linezolid, daptomycin

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69
Q

erysipelas

A

group A pyogenes strep infection of the skin; skin is bright red and hot dilation of capillaries of the dermis; usually on face

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70
Q

management of erysipelas

A

on CCS order blood cultures (may be positive) on multiple choice go straight to treatment

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71
Q

treatment of erysipelas

A

oral dicloxacillin or cephalexin; if organism confirmed group A beta hemolytic strep may treat with penicillin VK

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72
Q

cause of cellulitis

A

strep pyogenes = straph aurea

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73
Q

treatment of cellulitis: minor, severe

A

minor disease: dicloxacillin or cephalexin orally; severe disease: oxacillin, nafcillin, or cefazolin IV

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74
Q

case of leg cellulitis

A

order doppler to rule out

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75
Q

folliculitis<abscess

A

skin infections caused by strep –> glomerulonephritis not rheumatic fever

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76
Q

best initial test of fungal infection of nail and skin

A

KOH prep

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77
Q

treatment of fungal infection of nail and skin

A

topical if no hair involvement: clotrimaxole, miconaxole, ketoconazole, econazole, terconazole, nystatin, or ciclopirox
oral for scalp (tinea capitis) or nail (onychomycosis): terbinafine, itraconazole, griseofulvin

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78
Q

side effect of terbinafine

A

causes increased LFTs

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79
Q

side effect of griseofulvin (tinea capitis)

A

has less efficacy than either terbinafine of itraconazole

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80
Q

discharge without dysuria..

dysuria without discharge..

A

discharge without dysuria still urethritis

dysuria without discharge does not necessarily have urethritis

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81
Q

treatment for urethritis

A

2 meds: gonorrhea and chlamydia

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82
Q

diagnostic testing for urethritis

A

1) urethral swab for gram stain, wbc cound, culture, dna probe
2) NAAT nucleic acid amplification test

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83
Q

gonorrhea meds

A

ceftriaxone IM, cefpodoxime oral, ciprofloxacin oral (2nd line)

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84
Q

chlamydia meds

A

azithromycin (single dose), doxycycline (for a week)

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85
Q

how to treat pregnant women with urethritis

A

1) IM ceftriaxone 2) azithromycin

86
Q

diagnostic testing for PID

A

1) pregnancy test (r/o ectopic) 2) then cervical culture and DNA probe for chlamydia and gonorrhea

87
Q

most accurate test for PID

A

laparoscopy; only done for recurrent or persistent infection despite therapy or for cases where diagnosis is not clear

88
Q

inpatient treatment for PID

A

IV cefoxitin or cefotetan or metronidazole + doxycyline

89
Q

outpatient treatment for PID

A

Ceftriaxone IM + doxycycline oral

90
Q

antibiotics safe in pregnancy

A

penicillin, cephalosporin, aztreonam, erthromycin, azithromycin

91
Q

painful and tender testicle with normal position in scrotum

A

epididymo-orchitis

92
Q

treatment of epididymo-orchitis

A

35 years: fluoroquinolones

93
Q

painful genital ulcer, best initial test?

A

chancroid (Haemophils ducreyi)

best initial test is swab for gram stain (gram neg coccobacilli) and culture (Nairobi medium or Mueller-Hinton agar)

94
Q

treatment of chancroid

A

single IM shot of ceftriaxone or single oral dose of azithromycin

95
Q

large tender nodes in genital area, how to diagnose? treat?

A

Lymphogranuloma venereum, may develop a suppurating draining sinus tract
diagnose with serology for Chlamydia trachoma tis
treat with aspirate the bubo and then doxycycline azithromycin

96
Q

patient presents with enlarged adenopathy in inguinal area and multiple clear vesicles on his penis, what’s the next step in management?

A

treat with acyclovir, valacyclovir, or famciclovir for 7-10 days; when clear vesicles are present there is no need to do specific diagnostic test for herpes, if roof come off of vesicles and lesion becomes an ulcer of unclear etiology, the the best initial diagnostic test is Tzanck prep

97
Q

most accurate test for herpes

A

viral culture

98
Q

tx of herpes in pregnancy

A

acyclovir is safe in pregnancy; use if there is evidence of active lesions at 36 weeks

99
Q

painless, firm genital lesion, painless inguinal adenopathy

A

syphilis

100
Q

most accurate test in primary syphilis

A

darkfield microscopy (more sensitive than VDRL or RPR)

101
Q

symptoms of primary syphilis

A

chancre, adenopathy

102
Q

initial diagnostic test for primary syphilis

A

darkfield, then VDLR/RPR

103
Q

treatment for primary syphilis

A

single IM shot of penicillin; if allergic use doxycycline

104
Q

how to treat Jarish-Herxheimer treaction

A

fever, headache, myalgia developing 24 hours after treatment for early stage syphilis , release of pyrogens from dying treponemal –> treat with aspirin and continue treatment

105
Q

symptoms of secondary syphilis

A

rash, mucous patch, alopecia areata, condyloma lata

106
Q

initial test for secondary syphilis

A

RPR and FTA

107
Q

treatment for secondary syphilis

A

single IM shot of penicillin, doxycycline if penicillin allergy

108
Q

neurological involvement of tertiary syphilis

A

tabes dorsalis, argyll-robertson pupil, general paresis

109
Q

initial diagnostic test for tertiary syphilis

A

RPR and FTA, lumbar puncture for neurosyphilis (test CSF with VDRL and FTA; CSF VDRL is only 50% sensitive)

110
Q

treatment of tertiary syphilis

A

IV penicillin; if allergic DESENSITIZE

111
Q

rare beefy red genital that ulcerates

A

granuloma inguinale

112
Q

diagnostic test for granuloma inguinale

A

biopsy or touch prep, klebsiella granulomatis

113
Q

treatment for granuloma inguinale

A

doxycycline, tmp/smx, or azithromycin

114
Q

pediculosis vs. scabies

A

pediculosis is larger, in hair-bearing areas, such as pubic area or axilla, visible on surface

scabies is small, burrows in web spaces, scrape and magnify

115
Q

treatment of scabies

A

permethrin, lindane, or ivermectin

116
Q

treatment of pediculosis

A

permethrin, pyrethrins, or lindane

117
Q

how are warts diagnosed?

A

by how they look

118
Q

what is imiquimod?

A

immunostimulamt that leads to sloughing off of wart

119
Q

what is podophyllin?

A

melts warts

120
Q

complicated cystitis treatment

A

7 days of tmp/smx or ciprofloxacin

121
Q

uncomplicated cystitis treatment

A

3 days of tmp/smx orally if e.coli resistance low in that area; if resistance is >20% than use ciprofloxacin

122
Q

abx for pyelonephritis…outpatient? inpatient?

A

outpatient ciprofloxacin; inpatient use ampicillin/gentamycin

123
Q

radiology testing and UTI

A

cystitis and pyelonephritis is diagnosed by radiologic study (sonogram or CT). sonogram and CT used to determine the etiology of UTI.

124
Q

pyelonephritis patient not responding to treatment after 5-7 days, still febrile, abc on UA

A

perinephritic abscess; perform sonogram or CT of kidneys to find the collection; biopsy to determine microbiologic diagnosis

125
Q

treatment of perinephritic absess?

A

quinolone and add staphylococcal coverage such as oxacillin or nafcillin, b/c tx with abc for gram neg organism preferentially selects out for staphylococci

126
Q

best initial test for prostatitis

A

UA

127
Q

most accurat test

A

Urine WBC after prostate massage

128
Q

treatment of prostatitis

A

ciprofloxacin for extended period of time

129
Q

duke’s criteria

A

diagnosis of infective endocarditis (2 major, 1 major + 3 minor, or 5 minor criteria)

130
Q

clinical suspicion for infective endocarditis neg cultures

A

HACEK organisms

131
Q

fever + new murmur or change in murmur, next step

A

perform blood cultures

132
Q

blood cultures positive in patient with fever + new murmur

A

perform EKG look for vegetations endocarditis

133
Q

treatment for endocarditis

A

empiric therapy with vancomycin and gentimicin (covers MRSA, S. Aureus, viridans Streptococcus)
treatment is 4-6 weeks

134
Q

indications for surgery (valve replacement with infective endocarditis)

A

anatomic defects

  • valve rupture
  • abscess
  • prosthetic valve
  • fungal endocarditis
  • embolic events once already started on antibiotics
135
Q

procedures that require abx prophylaxis for endocarditis

A

dental procedures that cause bleeding, respiratory tract surgery, surgery of infected skin

136
Q

only cardiac defects that need prophylaxis

A

prosthetic valves, unrepaired cyanotic heart disease, previous endocarditis, transplant recipient who developed valve disease

137
Q

side effect of NRTI

A

lactic acidosis (meds ending with -dine or -sine, -bine, -avir

138
Q

side effect of protease inhibitor

A

hyperglycemia, hyperlipidemia (meds ending with -navir)

139
Q

NNRTI side effects

A

drowsiness (efavirenz)

140
Q

side effect of indinavir

A

kidney stones

141
Q

side effect of zidovudine

A

anemia

142
Q

side effect of didanosine

A

pancreatitis and peripheral neuropathy

143
Q

side effect of abacavir

A

rash

144
Q

side effect of stavudine

A

pancreatitis and neuropathy

145
Q

needle stick injury with anyone exposed to HIV positive blood

A

HAART for a month

146
Q

HIV perinatal transmission prevention

A

CD4500 start HAART immediately better than during 2nd and 3rd

147
Q

when to start prophylaxis for PCP? with what?

A

CD4t use with G6PD deficiency)

148
Q

MAI prophylaxis when and what?

A

when CD <50, use azithromycin one a week orally

149
Q

how does PCP present

A

dry cough, SOB, hypoxia, increased LDH

150
Q

best initial test for PCP

A

chest X-ray: will show increased interstitial markings bilaterally

151
Q

most accurate test for PCP

A

bronchoalveolar lavage

152
Q

treatment of PCP

A

IV tmp/smx

153
Q

treating PCP develop rash

A

rash with tmp/smx; use IV pentamidine

154
Q

treatment of mild PCP

A

atovaquone

155
Q

if PCP is severe pO235

A

give steroids

156
Q

best initial test for toxo

A

head CT with contrast

157
Q

confirmatory test for toxo

A

treat with pyrimethamine and sulfadiazine for two weeks, repeat CT scan, if lesions are smaller, then this confirmatory, if lesions are unchanged –> do brain biopsy, most likely lymphoma

158
Q

treatment of toxo

A

pyrimethamine and sulfadiazine for 2 weeks

159
Q

how does CMV present

A

blurry vision in HIV patient with CD 4<50

160
Q

how to diagnose CMV

A

dilated opthalmologic examination; diagnosed by appearance on dilated ophthalmologic examination

161
Q

how does cryptococcus present in HIV patient

A

HIV and <50 CD4 cells with fever and headache, sometimes neck stiffness and photophoia

162
Q

suspect cryptococcus, next step

A

lumbar puncture –look for increase level of lymphocytes in CSF

163
Q

best initial test for cryptococcus

A

India ink tain

164
Q

most accurate test for cryptococcus

A

cryptococcal antigen test

165
Q

treatment of cryptococcus

A

treat initially with amphotericin followed by fluconazole (echinocandins -caspofungin do not cover cryptococcus)

166
Q

best initial test for PML

A

head CT or MRI

167
Q

how does PML present

A

HIV patient CD4<50 with focal neurological abnormalities

168
Q

treatment of PML

A

treat with HAART, when CD4 rises, PML will resolve

169
Q

MAI presentation

A

HIV patient, CD4<50, wasting with weight loss, fever, fatigue, anemia (invasion of the bone marrow), increased ALP and GGTP with normal bilirubin

170
Q

diagnostic testing for MAI

A

bone marrow is more sensitive, liver biopsy is most sensitive, blood culture least sensitive

171
Q

treatment of MAI

A

Clarithroymycin and ethambutol, prophylaxis with azithromycin

172
Q

treatment of leptospirosis

A

diagnose with serology, treat with ceftriaxone or penicillin

173
Q

animal exposure + jaundice + renal

A

leptospirosis (fever, abdominal pain, muscle ache)

174
Q

ulcer at site of contact and enlarged lymph nodes, conjunctivitis, contact with small furry animal

A

tularemia

175
Q

tx for tularemia

A

bentamicin or streptomycin

176
Q

culture is dangerous for lab personnel, causes severe pneumonia

A

tularemia

177
Q

treatment of cysticerosis

A

albendazole

178
Q

CT scan of head shows thin-walled cysts, calcified

A

cysticerosis

179
Q

how to diagnose leptospirosis

A

diagnose with serology

180
Q

treatment of lyme disease with rash, joint, bell’s palsy

A

oral doxycylien or amoxicillin

181
Q

lyme disease with CNS or cardiac involvement

A

IV ceftriaxone

182
Q

babesiosis transmitted by

A

ixodes tick

183
Q

treatment of babesiosis

A

azithromycin or atovaquone

184
Q

what is ehrlichia transmitted by

A

ixodes tick

185
Q

how does ehrilichia present

A

NO RASH; elevated LFTs (ALT, AST), thrombocytopenia, leukopenia

186
Q

how to treat ehrlichia

A

doxycycline

187
Q

most common late manifestation of lyme disease

A

joint problems

188
Q

diagnostic test for ehrlichia

A

peripheral blood smear looking for morulae (inclusion bodies in white cells) or PCR

189
Q

hemolysis and GI complaints

A

malaria

190
Q

how to treat acute malaria

A

quinine and doxycycline

191
Q

prophylaxis for malaria

A

mefloquine (weekly) or atovaquone/proguanil

192
Q

side effect of mefloquine

A

neuropsychiatric side effects, sinus bradycardia, and QT prolongation

193
Q

nocardia affects who and where?

A

immunocompromised (leukemia, lymphoma, steroid use, HIV), may disseminate to any organ but skin and brain most common

194
Q

best initial test, most accurate test for nocardia?

A

best initial test: chest x-ray

most accurate test: culture

195
Q

actinomyces affects who?

A

normal immune system, history of facial or dental trauma, actinomyces is part of normal mouth flora

196
Q

how to diagnose actinomyces

A

gram stain and confirm with anaerobic culture

197
Q

treatment of actinomyces

A

penicillin

198
Q

presents as a viral syndrome, physical exam shows palate and oral ulcers and splenomegaly

A

histoplasmosis (disseminated disease can cause pancytopenia) anything TB can do, histoplasmosis can do

199
Q

best diagnostic test for histoplasmosis

A

histoplasmosis urine antigen

200
Q

most accurate test for histoplasmosis

A

biopsy with culture

201
Q

treatment of acute pulmonary histoplasmosis disease

A

no therapy

202
Q

treatment of disseminated histoplasmosis

A

amphotericin

203
Q

where is histoplasmosis found?

A

ohio and mississippi river valleys

204
Q

where is coccidiodomycosis found?

A

dry areas like arizona

205
Q

presentation of coccidiodomycosis

A

respiratory disease with joint pain and erythema nodosum

206
Q

treatment of coccidiodomycosis

A

itraconazole

207
Q

treatment of coccidiodomycosis

A

itraconazole

208
Q

broad budding yeast

A

blastomycosis

209
Q

where does blastomycosis occur?

A

rural southeast

210
Q

pulmonary disease with bone lesions

A

blastomycosis

211
Q

treatment of blastomycosis?

A

amphotericin or itraconazole

212
Q

branching, gram positive filaments that are weakly acid fast

A

nocardia

MTB (1 decks)

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