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USMLE S2CK > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

what are first line oral and IV antibiotics for MSSA?

A

oral: dicloxacillin, cephalexin, cefadroxil
intravenous: oxacillin, nafcillin, cefazolin

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2
Q

what are first line oral and intravenous antibiotics for MRSA?

A

oral: linezolid, septrin, doxycycline

IV: vancomycin, linezolid, daptomycin, ceftaroline, oritavancin, telavancin, dalbavancin

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3
Q

adverse effects of linezolid?

A

thrombocytopenia

interaction with MOA-I

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4
Q

adverse effects of daptomycin?

A

increases serum CK

not effective against LRTI

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5
Q

how do you treat minor skin/soft tissue infections of MRSA?

A

septrin, doxy, clindamycin, linezolid

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6
Q

what is amoxicillin used as first-line therapy for?

A
  • otitis media
  • endocarditis prophylaxis in dental infection
  • UTIs in pregnancy (or nitrofurantoin)
  • lyme disease (limited to rash, arthralgia and CN VII involvement)
  • listeria monocytogenes
  • enterococcus infection
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7
Q

which is the only cefalosporin that will cover MRSA?

A

ceftaroline

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8
Q

which groups of bacteria are resistant to cephalosporins?

A

MRSA (only caftaroline works), ESBLs, listeria, enterococcus

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9
Q

how do you treat ESBLs?

what is the second-line?

A

carbapenems

polymixin is used if the ESBL is resistant to carbapenems. care for nephrotoxicity

also cephalosporins with beta-lactamase combinations:

  • ceftolazone/tazobactam
  • ceftazidime/avibactam
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10
Q

if your patient has a rash to penicillins, are cephalosporins safe for use?

A

yes

only if the reaction is anaphylaxis will you have to avoid cephalosporins (should use non-beta-lactam antibiotics for these)

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11
Q

what infections is defaloxacin used for?

A

MRSA skin infections

Gram-negative rods

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12
Q

what is the first-line for CAP?

A

third-generation cephalosporins with macrolide

cefotaxime/ceftriaxone + erythro/clarithro/azithro

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13
Q

what is the treatment for Lyme disease involving the brain/heart?

A

ceftriaxone

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14
Q

what is the first-line for gonorrhoea?

A

ceftriaxone

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15
Q

which population do you have to avoid ceftriaxone and why?

A

neonates due to impaired biliary metabolism

use cefotaxime instead

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16
Q

what is the difference in treating ventilator-associated pneumonia versus normal CAP?

A

use ceftaroline (4th gen) as is has better coverage against staphylococcus

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17
Q

how is ertapenem different from the other carbapenem antibiotics?

A

does not have any anti-pseudomonal coverage

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18
Q

in diverticulitis, which is the best floroquinolone? what do you have to consider for the others?

A

moxifloxacin is the only one that covers anaerobes and can be used as a single agent

cipro/levo/gemi - need to add metronidazole

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19
Q

which antibiotics are associated with achilles tendonitis/tendon rupture?

A

fluroquinolones

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20
Q

which antibiotics are associated with bone growth abnormalities in children and pregnant women?

A

fluroquinolones

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21
Q

what is the treatment for syphillis in pen-allergy?

A

doxycycline

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22
Q

what are the most common gram-negative bacteria?

A
  • E coli
  • Klebsiella
  • Proteus
  • Pseudomonas
  • Citrobacter
  • Enterobacter
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23
Q

in what setting would you get a staphylococcus meningitis?

A

following neurosurgery

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24
Q

what are the typical organisms for bacterial meningitis?

A

streptococcus pneumoniae, haemophillus, neisseria, listeria

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25
Q

what are the precautions that must be taken for somebody with Neisseria infection?

A

rifampin, ciprofloxacin or ceftriaxone for close contacts

respiratory isolation

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26
Q

what is the most rapid onset gastroenteritis that is associated with wheeze and flushing?

A

scromboid, found in fish

treat with antihistamines

27
Q

which pathogens give bloody stool appearance?

A

E coli, shigella, campylobacter, yersinia

28
Q

how do you treat cryptosporidia diarrhoea?

A

treat the underlying AIDS

nitazoxanide

29
Q

what is the nucleic acid structure of HBV and HCV?

A

HBV - DNA

HCV - RNA

30
Q

how do you treat hepatitis C?

A

sofosbuvir and ledipasvir for genotype 1

31
Q

what are the side-effects of interferon?

A

myalgia + athralgia

leukopenia + thrombocytopenia

flu-like symptoms, depression

32
Q

which antiviral covers all genotypes of HCV?

A

velpatasvir

33
Q

in hepatitis C, what is the relevance of the following tests:

  • PCR/viral load
  • genotype
  • liver biopsy
A
  • PCR - anyone with a detectable viral load needs treatment
  • genotype - predicts the response for treatment.
    • Genotype 1 is treated with sofosbuvir and ledipasvir
    • all genotype can be treated with sofosbuvir and velpatasvir
  • liver biopsy - assess the extent of fibrosis. if they have detectable viral load then you do not need liver biopsy as you will treat with antivirals anyway
34
Q

what is the difference in treatment between older and younger men with epididymoorchitis?

A

younger - ceftriaxone and doxycycline

older - septrin or a quinolone (as if it were a UTI)

35
Q

what is the treatment for PID as inpatient and outpatient?

A

IP: cefoxitin and doxycycline

OP: ceftriaxone and doxycycline (with metronidazole)

pen-allergic: levofloxacin and metronidazole

36
Q

what is the treatment for lymphogranuloma venerium and chancroid?

A

LGV - doxycycline

chancroid - azithromycin

37
Q

which cerebral infection in immunocompromised patients is associated with indolent presentation, no meningism and elevated CSF pressure?

A

cryptococcus

diagnosed with CSF serology, india ink stain or culture on Sabouraud medium

38
Q

which species are viridans group streptococcus?

A

S sanguinis, S milleri, S mitis, S mutans, S sobrinus, S oralis

39
Q

which are the common live vaccines?

A

varicella and zoster, intranasal influenza, MMR

40
Q

what are elevated LDH levels in pneumonia significant for?

A

PCP pneumonia

41
Q

what pathogen causes ecthema gangrenosum?

invasion of the vasculra media and adventitia leading to ischaemic necrosis, indurated pustules/bullae and eventually gangrenous ulcers

A

pseudomonas aeruginosa

only in immunocompromised individuals

42
Q

what is the treatment for HIV cryptococcal meningitis?

A

initial: amphotericin B and flucytosine (2 weeks)
maintenance: fluconazole (8 weeks)

43
Q

what is the finding on urinalysis that would suggest proteus infection?

A

urinary pH > 8

44
Q

a fungal infection in the southwestern US, lung, skin and meningies

A

coccidiodiomycosis

45
Q

a fungal infection from the Great Lakes, Mississippi river and Ohio river basins presenting with lung, skin and lytic bone lesions?

A

Blastomycosis

46
Q

what antimicrobials and at what CD4 level should be started in HIV for prophyaxis against opportunistic infections?

A

200 - septrin for PCP

150 - itraconizole for histoplasmosis (endemic area)

100 - septrin for toxoplasma gondii (or pyrimethamine/leucovorin)

50 - azithromycin for MAC

47
Q

what is the emergency treatment for bacterial meningitis?

when would you add ampicillin?

A

ceftriaxone, vancomycin and steroids

age > 50 or risk factors for listeria

48
Q

who needs a sequential pneumococcal vaccine and who gets the PCV23 alone?

A

healthy, younger than 65 gets PCV23 only

sequential:

  • older than 65
  • CSF leaks, cochlear implants
  • immunosupressed, sickle cell disease, asplenia
  • CKD
49
Q

how do you treat Norcardia?

when do you need to add something to standard therapy?

A

septrin usually for 6-12 months

surgical drainage of the abscess

if CNS involvement, add carbapenem

50
Q

endocarditis + colonic neoplasia

A

Strep gallolyticus (S bovis type 1)

51
Q

opportunistic infection giving cough, dyspnoea, mucocutaneous lesions/mouth ulcers, infiltrates in the lung, lymphadenopathy and hepatosplenomegaly, pancytopenia

how do you treat it?

A

histoplasmosis

IV amphotericin B for 2 weeks then maintenance therapy with itraconazole for 1 year

52
Q

how do you treat actinomyces?

A

penicillin for 2-6 month

53
Q

periorbital oedema, myositis and eosinophillia

A

trichinellosis

54
Q

when is doxycycline contraindicated?

what can you give for lyme disease instead?

A

children younger than 8

pregnant or lactating women

55
Q

skin papule that ruptures with nonpurulent, odorless discharge then leading to further lesions around the proximal lymphatic drainage?

what’s the treatment?

A

sporothrix schenckii

itraconazole 3-6 months

56
Q

what commonly causes erysipelas?

A

Group A strep (pyogenes)

57
Q

what causes epidydimoorchitis in men > 35 years most commonly?

A

E coli

58
Q

how do you manage a tick that is still attached to the patient?

A

remove with forceps as close to the skin as possible

if tick is on for >36 hours then give antimicrobial prophylaxis with single dose doxycycline

59
Q

chronic, slow-growing, non-tender mass near the mandible with multiple sinus tracts draining yellow granules

how do you treat?

A

actinomyces

penicillin 2-6 months, ?surgery

60
Q

how do you diagnose babesiosis?

A

blood film microscopy looking for intracellular Maltese cross protozoon

61
Q

what reaction to tuberculin skin test in HIV is considered positive?

A

> 5 mm in all patients

treat with 9 months isoniazid-pyridoxine for latent TB

treat with RIPE for active TB (symptoms, radiologic findings on CXR)

62
Q

what are the prophylactic medications for malaria?

A
  • mefloquine
  • atovaquone-proguanil
  • doxycycline

to be given 2 weeks before going and up to 4 weeks after return

63
Q

what is the treatment for latent tuberculosis?

A

isoniazid for 9 months

give pyridoxine as well to prevent peripheral neuropathy

64
Q

who should you treat for TB if induration is 5-10 mm

A

HIV positive

immunosuppressed/organ transplant

known recent TB exposure or signs of healed TB on CXR

USMLE S2CK (6 decks)

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