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Step 2CK > Master the Boards: Infectious Disease > Flashcards

Master the Boards: Infectious Disease Flashcards

1
Q

If a patient has a rash to penicillin then what antibx do you recommend?

If a patient has an anaphylactic reaction to penicillin then what antibx do you recommend?

A

Rash: Cephalosporin

Anaphylaxis: Non-beta-lactam

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2
Q

2nd gen cephs have added coverage to ______ compared to 1st gen cephs.

A

Added anaerobe and more gram-negative bacilli

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3
Q

Why should ceftriaxone be avoided in neonates?

What 3rd gen cephalosporin has Pseudomonal coverage?

A

Ceftriaxone may cause impaired bilirubin metabolism

Cefotaxime

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4
Q

Name a 4th gen ceph

A

Cefepime

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5
Q

What is an important adverse effect of cefoxitin and cefotetan?

A

Depletion of prothrombin and increased risk of bleeding

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6
Q

What unique coverage does aztreonam have?

Does it cross-react with penicillin?

A

Only gram-negative bacilli, including Pseudomonas

No cross-reaction with penicilllin

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7
Q

Fluoroquinolones have coverage of what bacteria?

Which fluoroquinolone also has anaerobic coverage?

A

Gram negative bacilli, including Pseudomonas

Moxifloxcin has anaerobe coverages (thus can be used as a single agent in the treatment of diverticulitis i.e metronidazole doesn’t have to be added)

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8
Q

Do aminoglycosides have any anaerobic effect?

What are the major toxicities?

A

No.

Nephrotoxic, ototoxic

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9
Q

Cystitis in pregnant woman is best treated with _____.

A

NItrofurantoin

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10
Q

Fanconi Syndrome (Type II renal tubular acidosis proximal), photosensitivity, and esophagitis/ulcer are all adverse effects of _____.

A

Doxycycline

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11
Q

Patients allergic to penicillin but requiring treatment of syphillis may receive _________.

A

Doxycycline

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12
Q

What drug can cause both G6PD deficiency hemolysis and bone marrow suppresion?

A

Trimethoprim/Sulfamethoxazole

BM suppression because it’s a folate antagonist

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13
Q

What are your choices for tx of MRSA (5)?

What if it was a minor skin infection?

A 
Vancomycin
Linezolid
Daptomycin
Tigecycline
Ceftaroline

Minor skin infection: TMP/SMX, Clindamycin, Doxycycline, Linezolid

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14
Q

You’re treating a MRSA patient and they develop elevated CPK levels, what are you treating with?

What if they showed signs of bone marrow toxicity?

A

Daptomycin: Elevated CPK

Linezolid: Reversible bone marrow toxicity

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15
Q

The presence of papilledema, seiures, focal neurologic deficits, or confusion should warrant what exam before conducting an LP in suspected meningitis?

A

CT head to r/o space-occupying lesion

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16
Q

What is empiric treatment of meningitis prior to knowledge of culture results?

What should be added to that therapy if the patient is neonate, old, immunocompromised, or pregnant?

A

Ceftriaxone, vancomycin, steroids

Add ampicillin for fear of Listeria infection

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17
Q

What is the most common neurological deficit in untreated bacterial meningitis?

A

CN 8 damage or deafness

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18
Q

Acyclovir has what adverse effect to keep in mind?

A

Renal toxicity since it precipitates in renal tubules

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19
Q

Is the radiologic test usually the answer in an ID question about the “most accurate test”?

A

No

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20
Q

Small vesicles or ulcers ID’d on exam of a patient with pharyngitis could move you towards what other two diagnoses?

A

HSV or Herpangina

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21
Q

Blood and WBC in stool in a patient with hemochromatosis or a recent blood transfusion may be cause by what pathogen?

A

Yersinia (has a high affinity for iron)

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22
Q

A patient eats some spoiled fish and develops wheezing, flushing, and a rash. What is the cause and what is the tx?

A

Scombroid

Anti-histamine

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23
Q

Elevation of which lab in hepatitis is associated with increased risk of mortality?

A

Prothrombin time (PT)

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24
Q

In addition to gram positive bacteria, what additional coverage to amoxicillin and ampicillin provide?

A

Other gram-negative bacilli

H. influenzae, E. coli, Listeria, Proteus, Salmonella

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25
Q

Does cystitis give urethral discharge?

A

No

26
Q

A woman presents with symptoms of PID. What should you do before moving forward with treatment?

A

Rule out pregnancy

27
Q

STD buzzwords

Painful ulcer

A

Chancroid (H. ducreyi)

28
Q

STD buzzwords

Tender lymph nodes and suppurating

A

Lymphogranuloma venereum

29
Q

Rank tests for determining syphilis based on accuracy or sensitivity

A

VDRL/RPR

30
Q

Best initial test for determining HSV?

Most accurate?

A

Best initial: Tzanck smear

Most accurate: Viral culture

31
Q

What diagnostic tests are used to confirm lymphogranuloma venereum?

A

Complement fixation titers in blood

Nucleic acid amplification testing on swab

32
Q

Tx Chancroid

A

Azithromycin (single dose)

33
Q

Tx Lymphogranuloma venereum

A

Doxycycline

34
Q

Patients with syphilis are at greater risk for what vascular complication?

A

Aortic aneurysm and aortic regurgitation

35
Q

What is the treatment of syphilis in each stage (primary, secondary, and tertiary) and how does it change if penicillin allergic?

A

Primary and secondary: single dose IM benzathine penicillin (Doxycycline if allergic)

Tertiary: IV penicillin (penicillin desensitization if allergic)

36
Q

What is a Jarisch-Herxheimer reaction and what is treatment?

A

Fever and worsening of symptoms after treating syphilis patient with penicillin

Give aspirin and antipyretics, it will pass on its own

37
Q

What causes condyloma acuminate?

A

aka genital warts

HPV

38
Q

A patient comes in with intense itching at his pubis and axilla (hair-bearing regions). You suspect pediculosis (crabs). What is tx?

A

Permehrin

Lindane can also be used but has more toxicity

39
Q

What presents in the web spaces of the fingers and toes and burrows in the skin? What must be done to confirm a diagnosis?
What is tx?

A

Scrape and magnify the burrows to dx

Treat with permethrin

40
Q

A patient presents with likely pyelonephritis but fails to improve on antibx therapy. What should be the next test done?

A

Imaging using ultrasound or CT to evaluate for a perinephric abscess and if present it must be drained

41
Q

What is the best initial therapy in suspected endocarditis prior to results of cultures?

A

Vancomycin and gentamicin

42
Q

What is the treatment of Viridans Strep endocarditis?

A

Ceftriaxone

43
Q

What is the treatment of Enterococci endocarditis?

A

Ampicillin and gentamicin

44
Q

What drug should be added to the treatment of Staph endocarditis if there is a prosthetic valve involved?

A

Rifampin

45
Q

When should surgery be considered in endocarditis (6)?

A 
CHF or ruptured valve/chordae tendinae
Prosthetic valves
Fungal endocarditis
Abscess
AV block
Recurrent emboli while on tnibx
46
Q

What is the most common agent responsible for culture-negative endocarditis?

What are the HACEK organisms?

A

MC: Coxiella (also Bartonella)

```
Use ceftriazone for HACEK organisms
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
~~~

47
Q

What is endocarditis prophylaxis?

In what situations would you offer the prophylaxis?

A

Amoxicillin

Significant cardiac defect: previous endocarditis, prosthetic valve, recent cardiac txp, unrepaired cyanotic heart disease

Risk of bacteremia: Dental procedure W/ blood, respiratory tract surgery that produces bacteremia

48
Q

What is the most common neurologic and cardiac manifestation, respectively, of Lyme disease?

A

Neurlogic: Bell’s Plasy

Cardiac: AV block

49
Q

What is generally the treatment of Lyme disease?

When it is advanced and involves cardiac or neurologic manifestations then what is tx?

A

Doxycycline

If advanced: IV ceftriaxone

50
Q

Do patients with an asymptomatic tick bite receive ppx?

A

Generally no. They only receive a single dose of doxycyline if the tick was identified as Ixodes scapularis, the area is engorged, the tick was present on skin for 24-48 hours.

51
Q

Is ELISA an effective test for evaluating HIV in neonates?

A

No. They need PCR or viral culture

52
Q

What is the best initial test for detecting HIV infection? What is confirmatory?

A

Initial: ELISA

Confirmatory: Western Blot

53
Q

Generally, what are each type of agent with the following names:

  • navir
  • udine/-bine
A
  • navir: protease inhibitors

- udine/-bine: NRTIs

54
Q

What are two entry inhibitors used in HIV?

What is an integrase inhibitor?

A

Entry inhibitors: Enfuvirtide, Maraviroc

Integrase inhibitor: Raltegravir

55
Q

HIV adverse effect

Zidovudine

A

Anemia

56
Q

HIV adverse effect

Stavudine and didanosine

A

Peripheral neuropathy and pancreatitis

57
Q

HIV adverse effects

Abacavir

A

Hypersensitivity, Stevens-Johnson reaction

*Hypersensitivity is indicated by HLA B5701 status

58
Q

HIV adverse effects

Protease inhibitors

A

Hyperlipidemia, Hyperglycemia

59
Q

HIV adverse effects

Indinavir

A

Nephrolithiasis

60
Q

HIV adverse effects

Tenofovir (NRTI)

A

Renal insufficiency

61
Q

Can HIV medications generally be continued in pregnancy?

What is one drug avoided due to teratogenicity in animals?

A

Yes

Efavirenz is avoided (if already on prior to becoming pregnant then change to a protease inhibitor)

62
Q

In what situations should a C-section be considered in an HIV positive pregnant woman?

A

If the CD4 count is 1000).

Zidovudine is given no matter what to reduce risk of vertical transmission

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