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STEP 3 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What abx to give for MSSA?

A

IV- oxacillin/nafcillin, or cephazolin

Oral- dicloxacillin or cephalexin

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2
Q

What abx to give for MRSA?

A

Severe infection- vancomycin, linezolid

Minor infection- TMP/SMX, clinda

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3
Q

If patient has rash to penicillin, what is the alternative?

A

cephalosporin

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4
Q

If patient has anaphylaxis to penicillin, what is the alternative?

A

Macrolides (azithromycin, clarithromycin) or clindamycin

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5
Q

What abx are specific for streptococcus?

A

Penicillin, Ampicillin, Amoxicillin

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6
Q

What abx are “excellent” for pneumococcus?

A

Levofloxacin, gemifloxacin, moxifloxacin

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7
Q

What abx is the best gastrointestinal anaerobes?

A

metronidazole

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8
Q

What is the best abx for respiratory anaerobes?

A

Clinda

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9
Q

What are the drugs for herpes simplex and varicella?

A

acyclovir, valacyclovir, famciclovir

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10
Q

What oral agents are for chronic Hep C?

A

telaprevir, boceprevir, simeprivier, sofobuvir

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11
Q

What is the best therapy for chronic CMV retinitis?

A

Valganciclovir

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12
Q

What antibiotics are given for Candida and cryptococcus?

A

fluconazole

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13
Q

What is the 1st and 2nd test for diagnosing osteomyelitis?

A

Best inital- xray

Best second- MRI

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14
Q

What is the most accurate test for diagnosing osteomyelitis?

A

bone biopsy and culture

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15
Q

What is the treatment for osteomyelitis?

A

Staph

  • 4-6 IV oxacillin or nafcillin if sensitive
  • if MRSA- vancomycin, linezolid,
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16
Q

What is the treatment for otitis externa?

A

topical hydrocortisone

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17
Q

What is the best initial diagnostic test for malignant otitis externa?

A

CT or MRI

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18
Q

What is the most accurate diagnostic test for malignant otitis externa?

A

biopsy

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19
Q

What is the treatment for malignant otitis externa?

A

surgical debridement and abx against pseudomonas

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20
Q

What is the best initial therapy for otitis media?

A

amoxicillin

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21
Q

If there is persistent otitis media, what is the most accurate test to do?

A

tympanocentesis and aspirate of tympanic membrane

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22
Q

What is the best initial test for sinusitis?

A

xray

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23
Q

What is the most accurate test for sinusitis??

A

sinus aspirate for culture

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24
Q

If there is fever/pain, persistent symptoms, or purulent nasal discharge for sinusitis, what medication should they be given?

A

amoxicillin/clavulanate

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25
Q

Best initial test for pharyngitis?

A

rapid step test

- if negative, no further testing

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26
Q

What is most accurate test for pharyngitis?

A

culture

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27
Q

What is the treatment for pharyngitis?

A

penicillin or amoxicillin

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28
Q

What is the diagnostic test for influenza?

A

viral rapid antigen detection

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29
Q

What is the treatment for flu?

A

oseltamivir, zanamivir

- must be given within the first 48 hours

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30
Q

If a patient is less than 50 years old and healthy, what type of flu vaccine do you give?

A

Live attenuated

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31
Q

If a patient is greater than 50 years old and has COPD, CHF, on dialysis, steroids, healthcare worke, what type of flu vaccine do you give?

A

inactivated virus

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32
Q

What is the presentation for impetigo?

A

weepin, crusting, oozing skin, caused by staph aureus

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33
Q

What is the treatment for impetigo?

A

topical mupirocin or retapamulin
severe disease- oral dicloxacillin or cephalexin
Comunity acquired MRSA- TMP/SMZ

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34
Q

What is the offending agent for erysipelas?

A

Group A (pyogenes) strep

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35
Q

What is the best initial treatment for erysipelas?

A

Oral dicloxicillin or cephalexin

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36
Q

What other test should you order when cellulitis is present?

A

lower extremity doppler

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37
Q

What is the treatment for minor cellulitis?

A

dicloxacillin or cephalexin orally

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38
Q

What is the treatment for severe cellulitis?

A

oxacillin, nafcillin, cefazolin

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39
Q

Best initial test for fungal infection of skin or nails?

A

KOH preparation

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40
Q

What is the treatment for fungal infection of skin and nails?

A 
topical antifungals(clotrimazole, miconazole, ketoconazole, 
- oral antifungal if scalp or nail involvement
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41
Q

What is the diagnostic test for urethritis?

A

Urethral swab for Gram stain, WBC, culture, NAATs(Nuclear Amplification test)

42
Q

What is the treatment for urethritis?

A

Should be with 2 meds, active against both:
gonorrhea (ceftriaxone IM)
chalmydia (azithromycin or doxycyline)
- very often present as a co-infection

43
Q

What is the single best test for both chlamydia and gonorrhea?

A

NAAT test (Nucleic acid amplification test)

44
Q

What is the best initial test for pelvic inflammatory disease?

A 
pregnancy test (must exclude ectopic pregnancy)
then do cervical culture and NAAT test
45
Q

What is the most accurate test for diagnosing PID?

A

Laparoscopy

46
Q

What is the treatment for PID?

A

Outpatient: ceftriaxone (IM) and doxycycline (oral)
Inpatient: cefoxitin (IV) and doxycycline

47
Q

How does epididymo-orchitis present?

A

painful testicular with NORMAL position

48
Q

What is the treatment for epididymo-orchitis?

A

< 35 yo- ceftriaxone and doxycycline

> 35 yo- fluoroquinolone

49
Q

How does a chancroid present?

A

painful ulcer on genitalia

50
Q

What is the best initial test for chancroid?

A

Swab for gram stain and culture

51
Q

What is the treatment for chancroid?

A

IM ceftriaxone or single dose of azithyromycin

52
Q

What is the treatment for HSV-2?

A

acyclovir, valacyclovir, famciclovir 7-10 days

53
Q

What is the best initial test for genital herpes?

A

Tzanck prep

54
Q

What is the most accurate test for herpes?

A

viral culture

55
Q

What is the most accurate diagnostic test for syphilis?

A

darkfield microscopy

56
Q

What are the features of primary syphilis?

A

chancre, adenopathy

57
Q

What is the initial diagnostic test for primary syphilis?

A

darkfield, then VDRL/RPR

58
Q

What is the treatment for primary syphilis?

A

Single IM shot of penicillin
- Some patients will have Jarisch-Herxheimer reaction (fever, HA, myalgia 24 hours after treatment, this is benign self limited rxn)

59
Q

What are the features of secondary syphilis?

A

rash, condylomata lata, mucous patch

60
Q

What is the best initial test for secondary syphilis?

A

RPR and FTA

61
Q

What is the treatment for secondary syphilis?

A

single IM shot of penicillin

62
Q

What are the features of tertiary syphilis?

A

tabes dorsalis, Argyll-Robertson pupil, paresis

63
Q

What is the initial diagnostic test for tertiary syphilis?

A

RPR, FTA, lumbar puncture (neurosyphilis)

64
Q

What is the treatment for tertiary syphilis?

A

IV penicillin

65
Q

What is the initial test for cystitis(UTI)?

A

urinalysis

66
Q

What is the most accurate test for cystitis?

A

urine culture

67
Q

What is the treatment for uncomplicated(no anatomic abnormality present such as stone, stricture, obstruction) UTI?

A

TMP/SMX orally for 3 days if E. Coli resistance is low in that area. If resistance is >20%, use….
cipro or levofloxacin

68
Q

What is the treatment for complicated(anatomic abnormality present such as stone, stricture, obstruction) UTI?

A

7 days of TMP/SMX

69
Q

What do you do if a pregnant woman has asymptomatic bacteriuria?

A

treat with abx

70
Q

What additional features are present with pyelonephritis?

A

flank pain, tenderness

71
Q

What is the diagnostic test for pyelonephritis?

A

UA, UC

72
Q

What is the treatment for pyelonephritis?

A

ciprofloxacin (outpatient)

73
Q

What does that patient have that does not respond to treatment for cystitis after 5-7 days?

A

perinephric abscess

  • Biopsy is the only way to direct abx therapy
  • Treat with quinolone and add staph coverage
74
Q

What are the characteristics of prostatitis?

A

frequency, urgency, dysuria, perineal/sacral pain’ prostate is boggy on exam

75
Q

What is the best initial test for prostatitis?

A

UA

76
Q

What is the most accurate test for prostatitis?

A

urine WBCs after prostate massage

77
Q

What is the treatment for prostatitis?

A

Cipro or TMP/SMX

78
Q

If patient has a fever and a heart murmur, what is the next best step?

A

order Blood cultures

79
Q

If blood cultures are positive in patient with fever and a new heart murmur, what is the next test to order?

A

echocardiogram

80
Q

What is the best empiric therapy for endocarditis?

A

Vanc + gentamycin

81
Q

If patient has diagnosis of endocarditis and they have speciation of strep bovis or clostridium septicum, what is the next step?

A

Order colonoscopy

82
Q

What procedures need prophylaxis with people at risk for endocarditis?

A

dental procedures that cause bleeding, use amoxicillin

83
Q

When to start HIV therapy?

A
  • CD4 < 500
  • symptomatic patients regardless of CD4 count
  • pregnant women
  • needle stick
84
Q

What are the meds for HIV?

A

HAART(Highly Active Antiretroviral Therapy)

- Tenofovir, emtricitabine, and efavirenz

85
Q

What is the side effect of zidovudine?

A

anemia

86
Q

What is the side effect of didanosine?

A

pancreatitis, peripheral neuropathy

87
Q

What is the side effect of tenofovir?

A

renal toxicity

88
Q

What is the side effect of stavudine?

A

pancreatitis, neuropathy

89
Q

What to do with a needle stick injury with HIV?

A

HAART for 1 month

90
Q

Should HIV+ pregnant women be on HAART?

A

Yes, all of them

91
Q

What is the prophylaxis for pneumocystis jiroveci pneumonia in an HIV patient?

A

TMP/SMX

- this is with CD4 count < 200

92
Q

What is the prophylaxis for mycobacterium avium intracellulare in an HIV patient?

A

azithromycin

- this is with CD4 count < 50

93
Q

How do you treat PCP in HIV patient?

A

IV TMP/SMX

94
Q

What is the best initial test for toxoplasmosis in patient with HIV?

A

CT with contrast showing ring enhancing lesions

95
Q

What is the treatment for toxoplasmosis in a HIV patient?

A

pyrimethamine and sulfadiazine for 2 weeks

96
Q

What is the best initial test for cryptococcus in patient with HIV?

A

India ink stain with LP

97
Q

What is the most accurate test cryptococcus in patient with HIV?

A

crypotococcal antigen test

98
Q

How do you treat cryptococcus in patient with HIV?

A

amphoteracin and 5-FC followed by fluconazole

99
Q

What is the best initial test for progressive multifocal leukoencephalopathy in patient with HIV?

A

CT or MRI of head

100
Q

What is the diagnostic test for mycobacterium avium intracellulare?

A

bone marrow biopsy, liver biopsy is most sensitive

101
Q

How to treat MAI in patient with HIV?

A

Clarithyromycin and ethambutol

STEP 3 (8 decks)

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