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Step3 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

MSSA
IV
Oral

A

Iv: oxacillin/naffillin or cetazolin (1 st gen cephalosporin

Oral: dicloxacillin or cephalexin (1st gen)

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2
Q

Mrsa
severe infection
Minor infection

A

Severe infection : vancomycin, linelozid, daptomycin, ceftaroline, tigecycline, telavancin

Minor: TMP/Smx, clindamycn Or doxy

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3
Q

Linezolid s/e

A

Thrombocytopenia

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4
Q

Daptomycin s/e

A

Myopathy

Rising CPK

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5
Q

PCN allergy

Rash
Anaphylaxis
Severe infection
Minor infection

A

Rash; safe to use ceph
Anaphylaxis: macrolides ))(azithro, clarityromyxin) Or clindamycin

Severe: vanc, linezolid, daptomycin, televancin

Minor; macrolides like azithro, clarithro
Or clarithro,TMP/smx

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6
Q

Streptococcus meds

A

PCN
Amoxicillin
Ampicillin

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7
Q

Blue box

A

If the organism is sensitive, pxacillin and nafcillin are superior to vanc

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8
Q

Exceptions

A

Ertapanem is the only carbapanem that does not cover pseudomonas

Piperacillin and Ticarcillin also covèr streptococcus And anaerobes

Levofloxacin, gemifloxafin and moxifloxacin are excellent! Pneumococcal drugs

Aminoglycosides work Synergistically with other agents to treat Staphylococcus and enterococcus

Carbapanems are Excellent! anti anaerobic meds. They cover streptococcus and mssa

Tigecycline covers Mrsa and is broadly active against gram neg bacilli. Tigecycline is weaker than other Mrsa drugs

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9
Q

GI anaerobes (bacteroides)

A

Metronidazole is the Best! Med for abdominal anaerobes but carcapanems, pipercacillon, And ticarcillin are equal in efficacy compared to metronidazole

Climdamycin! Is the Best drug for anaerobic streptococcus

Meds with no anaerobic coverage: Aminoglycosides, Aztreonam, fluoroquinolones oxac/nafcillin and all cephalosporins except cefoxitin and cefotetAn

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10
Q

VAnco: red man syndrome

What to do

A

Slow the rAte or infusion

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11
Q

Antiviral agents

A

Acyclovir valcyclovir And famciclovir (herpes simplex , varicella) Are All equal in efficacy

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12
Q

CMV

A

Fiscarnet

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13
Q

CMV retinitis

A

Valganciclovir

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14
Q

Valganciclovir And gAnciclovir s/e

A

Neutropenia And bone marrow suppression

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15
Q

Foscarnet s/e

A

Renal toxicity

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16
Q

Chronic hep c oral agents

A

Simeprevir
Sofosbuvir
Ledipasvir
Boceprevir

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17
Q

Hep c treatment in combination with interferon

A

Ribavirin

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18
Q

Ribavirin s/e

A

Anemia

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19
Q

Chronic hep b meds

A 
Lamivudine
Interferon 
Adefovir
Tenofovir
Entecavir
Telbigudine
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20
Q

Itracanozole

A

Rarely the best initial therapy

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21
Q

Voriconazole

A

Best against Aspergillus

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22
Q

Voriconazole s/e

A

Some visual disturbance

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23
Q

Echinocandins like caspofungin
Micafungin
Anidulafungin

A

Excellent! Neutropenic fever patients

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24
Q

Fact about Echinocandins

A

They have no .s/e because they effect the 1,3 glucan synthesis step in fungi cell walls

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25
Q

Amphoterecin indications

A

Cryptococcus

Mucormycosis

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26
Q

Aspergillus

A

Voriconazole

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27
Q

Neutropenic fever pts

A

Echinocandins

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28
Q

Amphotericin s/e

A 
Renal toxicity (switch to liposomal amphotericin
Met acidosis 
Hypokalemia fever shakes and chills
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29
Q

Osteomyelitis what comorbodities?

A

Diabetes
Peripheral arterial disease
Or both with an ulcer or soft tissue infection

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30
Q

OSteomyelitis

Best initial
Best second
Most accurate

A

Plain x Ray
MRI

Bone biopsy and culture

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31
Q

Earliest finding on x Ray on osteomyelitis

A

Periosteal elevation

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32
Q

Osteomyelitis ccs

A

Move clock forward to get x Ray results unless they are negative

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33
Q

Osteomyelitis follows response to therapy

A

ESR

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34
Q

Greater sensitivity; mri or bone scan?

A

They are Equal!

MRI is way more specific though

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35
Q

Osteomyelitis treatment

A

Staphylococcus: most common
IV oxacillin or nafcillin
MRSA: vancomycin, linezolid, ceftaroline or Daptomycin

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36
Q

Osteomyelitis blue box

A

To treat osteomyelitis appropriately, a Bx or culture needs to be performed

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37
Q

Otitis externa

Swimmers eAr

A 
Ofloxacin
Ciprofloxacin
Polymyxin/neomycin 
\+
Topical hydrocortisone to decrease swelling 
\+ 
Acetic avid and water solution
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38
Q

Malignant otitis externa

Best initial test
Most accurate test

A

CT or mri

Biopsy

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39
Q

Otitis media

Best initial therapy m
Most accurate test

A

Amoxicillin 7-10 days

Tympanocentesis: rarely necessary

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40
Q

Otitis media

Ccs tip

A 
Move clock forward 3 days and if the infection is not improving ( switch to 
Amoxicillin- clavulanare
Cefdnor
Cefibuten
Cefuroxime
Cefprozil
Cedpodoxime
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41
Q

Otitis media

Ccs tip

A 
Move clock forward 3 days and if the infection is not improving ( switch to 
Amoxicillin- clavulanare (augmentin)
Cefdnor
Cefibuten
Cefuroxime
Cefprozil
Cedpodoxime
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42
Q

Sinusitis

Best initial test
Most accurate

A

X Ray

Sinus aspirate for culture

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43
Q

Pharyngitis symptoms

A

Sore throat or pain
Exudate
Adenopathy
No cough/hoarseness

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44
Q

Pharyngitis
Best initial test
Most accurate test

A

Rapid strep test

Culture

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45
Q

Influenza

Dx testing

A

Viral rapid antigen detection

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46
Q

Influenza vaccination

A

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

Important *** inhaled live attenuated vaccines for -<50

Egg allergy is no longer an absolute CI

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47
Q

Impetigo Tx

A

Mupirocin

RetApulin

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48
Q

Impetigo Tx Severe disease

A

Oral dicloxacillin

Cephalexin

49
Q

Impetigo Tx Ca-MSSA

A

TMP/SmX
Linezolid is def effective
Clinda is sometime useful

50
Q

Erysipelas

Best initial Tx
Confirmed

A

Oral dicloxacillin
Cephalexin

Penicillin VK

51
Q

Skin goes to kidney

Throat goes to kidneys and heart

A

Erysipelas—> glomerulonephritis

Pharyngitis—> glomerulonephritis and rheumatic fever

52
Q

Scalp antifungals

A

Terinafine- oncreased LFT
Itracanozole
Griseofulvin- less efficacy than the other two meds

53
Q

Urethritis

A

Discharge without dysuria

54
Q

Cystitis

A

Dysuria but no discharge

55
Q

Disseminated gonorrhea

A

Polyarticular disease
Petechial rash
Tenosynovitis

56
Q

Nucleic acid amplification test

A

Single best test for goborrhea and chlamydia

57
Q

PID

Measure of severity

A

Leukocytosis

58
Q

PID

Best initial test
Most accurate test

A

Pregnancy test then cervical cx then NAAT

Laporoscopy- rarely needed

59
Q

PID tc
OP
IP
PCN allergic

A

OP: IM Ceftriaxone and oral doxy
IP : iV cefoxitin and doxy
PCN allergic: Clindamycin and gentamicin

60
Q

Antibiotics safe in pregnancy

A 
PCNs
Cephalosporins
Aztreonam
Erythromycin 
Azithro
61
Q

Epididymo-orchitis

A

Extremely painful and tender testicle with a normal position in the scrotum

62
Q

Epididymo-orchitis Tx
>35
< 35

A

Fluoroquinolone

Ceftriaxone and doxycycline

63
Q

Chancroid

A

Haemophilus ducreyi

Best initial test is gram stain and cx

Tx: single I’m shot Ceftriaxone and single oral dose of azithro

64
Q

Lymphogranulosum venerum

A

Chlamydia trachomatos

Tx: aspirate the bubo. Treat with doxycycline or azithro

65
Q

Herpes simplex virus type 2

A

Multiple vesicles/—> acyclovir valcyclovir Or famcyclovir for 7-10 days

Acyclovir is safe in pregnancy—> use if active lesions at 36 weeks

Acyclovir resistant herpes—> foscarnet

Mostt accurate test: viral cx

66
Q

Primary Syphilis most accurate test

A

DArkfield microscopy

67
Q

Secondary syphilis

A

Rash
Mucous patch
Alopecia wrests
Condyloma Lata

Initial dx test: RPR and FTA

Tx: single im shot of pcn
If PCN allergic give doxycycline

68
Q

Tertiary syphilis

A

.dx: rpr And fta from a lumbar puncture

Tx: IV PCN
Desensitize if PCN allergic

69
Q

Desensitize for …

A

Neurosyphyllis

Pregnant women

70
Q

Grajuloma inguinale

A

Rare beefy red gebital lesion that ulcerates

Dx: biopsy or touch prep
Donovan bodies
Klebsiella granilomatis

Tx: doxy, TMP/smx, Or azithro

71
Q

Warts

A

Diagnosed by how they look. Caused by hpv

Ttx: meghanical removal

Imiquimod is an immunodtimulsnt that leads to sloughing off of the wart

72
Q

Uncomplicated cystitis tx

Complicated cystitis tx

A

Fosfomycin or nitrofurantoin x3 dsys

TMP/smx Or cipro x7 days

73
Q

IP

Op pyelonephritis

A

Cipro

Ceftriaxone 
Ertapanem
Ampicillin 
Quinolone 
Gentamicin
74
Q

Leukocyte esterase

A

Derived from granulocytic WBC and indirect evidence of the presence of bacteriuria

75
Q

Perinephric abscess tx

A

Quinolone and staph coverage lik oxacillin, nafcillin Or vancomycin

76
Q

Prostatitis

Best initial test
Most accurate test

Tx

A

UA

Urine wbc after prostate massage

Cipro Or TMP/smx x2 weeks for acute
x6 weeks for chronic

77
Q

Endocarditis

A

Fever + murmur= possible endocarditis—> do blood cultures!!

2 positive blood cultures + positive echo= endocarditis

78
Q

Endocarditis tx

A

Vancomycin + gentamicin for 4-6 weeks

79
Q

The Only! Cardiac defects that need prophylaxis

A

Prosthetic valves
Previous endocarditis
Unrepaired cyanotic heart disease
Transplant recipients

80
Q

The Only procedures that need Px

A

Dental procedures that cause bleeding—> amoxicillin

PCN allergic—> clindamycin

Respiratory tract Sx
Infected skin Sx

81
Q

The following procedures that do NOT need Ppx

A

Dental fillings
All ob/gyn procedures
All flexible scopes
Urinary procedures including cûystoscopy

82
Q

These cardiac defects do NOT need Ppx

A 
Aortic or mitral stenosis Or regurgitation
Atrial or ventricular septal defects
HOCM
MVP
Pacem
Implantable defibrillator
83
Q

HIV Tx

A

Trople HAART

Tenofovir + emtrocitabine + integrase inhibitor

Tenofovir + emtricitabine + efavirenz

Tenofovir + emtricitabine + atazanavir ( or darunavir) add small amount of ritonavir

84
Q

NRTIs s/e

A

Lactic acidosis

85
Q

Zidovudine s/e

A

Anemia

86
Q

Didanosine s/e

A

Pancreatitis and periphèral neuropathy

87
Q

Stavudine s/e

A

Pancreatitis and periphèral neuropathy

88
Q

AbAcavir s/.e

A

Rash

89
Q

Tenofovir s/e

A

Renal toxicity

90
Q

Protease inhibitors s/e

A

Gyperglycemia

Hyperlipideia

91
Q

Indinavir s/e

A

Kidney stone

92
Q

NNRTIs s/e

A

Drowsiness ( efavirenz)

93
Q

CCR-5

A

It acts as the attachment point for gp-120 to enter the cd4 cell

Maraviroc is the drug that blocks this

94
Q

Needle stick injury

A

HAART for one month

Tenofovir plus emtricitibane plus integrase ( raltegravir) or protease inhibitor

95
Q

Pregnancy and hiv

A

2 nrti (zidovudine and lamivudibe) with protease inhibitor

All hiv+ women at any cd4 or viral load need Tx
Start first trimester and continue

96
Q

PCP Ppx

A

TMP/smx

If there is a rash, switch to atovoquane or dapsone

97
Q

MAI

A

Azithro PO once a week

98
Q

PCP treatment not prophylaxis

A

TMP/smx
If rash—> iV pentamadine Or clindamycin with primaquine

Atovoquane—> mild pcp
Steroids if po2< 70 or A_l-a gradient >35

99
Q

Toxoplasmosis

A

Pyrethamine and sulfadiazine for /2 weeks

Lesions smaller?—> it’s toxo

Lesions unchanged—> brain biopsy—> lymphoma

100
Q

Ganciclovir

A

Low wbc

101
Q

Foscarnet

A

High creatinine

102
Q

CMV Tx

A

Ganxiclovir
Foscarnet

Maintenance therapy with oral vangicoclovir unless cd4 goes up with HAART

103
Q

Cryptococcus

A

Best initial test: India ink

Most accurate test: crypto antigen 95% sens and spec

Dx: amphotericin with 5- Fc
followed by fluconozaleg

104
Q

PML

A

~<50 cd4 cells with focal neurological abnormalities

Best initial test : CT or mri

Most accurate test: pcr of csf for JC virus

105
Q

MAI

A

Weight loss
Fever
Fatigue
**anemia

Hepatic involvement
Inc ALK phos
Inc ggp
Normal bilirubin

Bone marrow is more sensitive
Liver biopsy is most sensitive
Blood culture is least sensitive

Tx: clarithro and ethambutol
Ppx with azithro
Rifqbutin is sometimes arded

106
Q

Leptospirosis

A

Spirochete

Animal exposure + jaundice + renal= leptospirosis

Severe disease leads to ams

Tx Ceftriaxone or PCN

107
Q

Tularemia

A

Rabbits
Ulcer at the site of contact
Enlarged lymph nodes
Conjunctivitis

Dx with serology

Tx gentamicin or streptomycin

108
Q

Cystercicosis

A

T.solium

The ct will show thin walled cysts** that are calcified **

Ingested infected pork
Tx albendazole

109
Q

Lyme disease

A

Joint involvement is most common—> doxycycline, amoxicillin Or cefuroxime
Cardiac AV conduction or block —> Ceftriaxone
Neurological is Bell’s palsy or 7th cn palsy’s —> Ceftriaxone

110
Q

Babesiosis

A

Infects rbc, so affect spleen—-> hemolytic anemia! So Dx is with a peripheral smear or pct

Tx is with azithro and atovaquone

111
Q

ErlichiA/Anaplasma

A

No rash
Elevated lft
Thrombocytopenia
Leukopenia

Dx peripheral smear shows morulae
Or pcr

Tx doxycycline

112
Q

Malaria Tx and Ppx

A

Mefloquine
Atovoquone/Proguanil

Same drugs for Ppx

Mefloquine s/e :
Neuripsychatrucs/e
Sinus bradycardia
QT prolongation

113
Q

Nocardia

A

Respiratory
But it may disseminate to brain and skin

Best initial test is CXR
Most accurate test is culture

*weakly acid fast which shows branching gram positive filaments

Tx TMP/smx

114
Q

Actinomycetes

A
  • normal immune system

Hx of facial or dental trauma

Dx with gram stain and confirm with anaerobic culture

Tx PCN

115
Q

Histoplasmosis

A

Bad

Lung disease but does disseminate into bone marrow —> pancytopenia!

It’s associated with bat dropping in wet areas* Ohio and Mississippi River valleys

Palate and oral ulcers
Splenomegaly
Pancytopenia

Best initial test histoplasmosis urine antigen
Most accurate test biopsy with culture

Acute pulmonary disease is transient and needs no therapy
Disseminate disease/—> amphotericin

116
Q

Cocfidiomycosis

A

Acute respiratory disease
Joint pain
Eeythema nodosum

It’s found n very dry areas like anrizona

Tx itracanozole

117
Q

Blastomycosis

A

Broad budding yeast= Bone lesions= Blastomycosis

Tx amphotericin or itracanozole

118
Q

Toxo

Dx

A

Instead of treat and wait to see if it decreases in size, obtain toxoplasmosis serology ( IgG and IgM)

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