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diseases that are infectious > Midterm Key Points > Flashcards

Midterm Key Points Flashcards

1
Q

Which 2 medications are only used for UTIs

A

Nitrofurantoin (macrobid)
Fosfomycin (Monurol)

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2
Q

Generally, what is metronidazole (flagyl) used for

A

“below the diaphragm” bacterial anaerobes (bacteriodes, Clostridium)

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3
Q

3 antibiotics with no oral absorption

A

fidaxomicin
vancomycin
rifaximin

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4
Q

what antibiotic is highly toxic and is the last resort drug for high resistant PEK and SPACE infections

A

polymixin/colistin

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5
Q

4 nephrotoxic antibiotics

A

vancomycin
colistin
aminoglycosides
Bactrim (crystalluria)

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6
Q

what antibiotics cover atypical bacteria

A

FQs
tetracyclines
macrolides

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7
Q

why is daptomycin not used for pneumonia

A

inactivated by lung surfactants

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8
Q

what antibiotic is associated with a high incidence of c.diff

A

clindamycin

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9
Q

what is clindamycin used for

A

gram positive cocci & oral anaerobes
-used as a topical for Gardenerella Vaginosis

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10
Q

S. Pneumo is building resistance to what antibiotic

A

Macrolides due to misuse in treating viral upper respiratory tract infections
-Also resistant Bactrim

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11
Q

what antibiotic has a high tissues absorption (loading dose req.), long half-life, and fights infection 1 wk after stop taking it

A

azithromycin

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12
Q

what 2 classes cause QT prolongation

A

macrolides and FQs

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13
Q

what 2 classes bind metals reducing absorption

A

FQs and tetracyclines

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14
Q

what antibiotic changes urine brown

A

nitrofurantoin

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15
Q

what antibiotic changes urine/tears red

A

rifamycins

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16
Q

what antibiotic turns feces red due to binding iron

A

cefdinir

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17
Q

what antibiotics are phototoxic and you should avoid use in children

A

FQs and tetracyclines

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18
Q

what antibiotics attain high tissue concentrations, poor blood concentration (not used for bacteremia)

A

Macrolides and tigecycline

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19
Q

What antibiotics are good for bacteremia because they are highly polar, attaining high blood concentrations but poor tissue concentration

A

aminoglycosides

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19
Q

t or f? less diarrhea for AMX than AMP due to more complete absorption;

A

true

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19
Q

what part of augmenting causes diarrhea

A

clavulanate

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20
Q

B-lactamase inhibitors with AMP/AMX gives coverage for

A

MSSA and B.fragilis

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21
Q

t or f? Because streptococci do not make B-lactamase, you can use Pen G/V and AMP/AMX

A

true

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22
Q

t or f? cephalosporins are not destroyed by Gram positive B-lactamase (only have penicillinases)

A

true

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23
Q

t or f? cephalosporins are sometimes destroyed by Gram negative B-lactamases

A

true

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24
Q

how do you overcome ESBL producing gram negative species that destroy all penicillins and cephalosporins

A

ESBL inhibitor avibactam

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25
Q

t or f? carbapenems are not destroyed by ESBL

A

true

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26
Q

how do you overcome carbapenemase KPC

A

carbapenemase inhibitor vaborbactam

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27
Q

How is MRSA resistant to B-lactam

A

due to destruction by penicillinase/cephalosporinase and non-binding to PBP2a

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28
Q

what is the only b-lactam that can bind PBP2a and work against MRSA

A

Ceftaroline

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29
Q

what is enterococcus resistant to

A

all cephalosporins and FQs

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30
Q

what is the preferred antibioitc for enterococcus

A

ampicillin

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31
Q

3 antibiotics that cover VRE

A

ampicillin
linezolid
daptomycin (cubicin)

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32
Q

what are options to cover MRSA

A

ceftaroline
glycopeptides/lipoglycopeptides
linezolid
cubicin
tetracyclines

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33
Q

what is used for CA-MRSA

A

TMP-SMX and clindamycin

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34
Q

What is used to cover MSSA to prevent resistance in other bacteria

A

narrow spectrum nafcillin and oxacillin

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35
Q

What antibiotics are options for SPACE

A

CIP/LVN
pip-tazo
ceftazidime
cefepime
carbapenems (except ertapenem)
aztreonam
colistin
aminoglycosides

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36
Q

what covers anaerobes except c.diff

A

MOX
pip-tazo
carbapenems

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37
Q

what are ADRs shared by all B-lactams

A

hypersensitivity/anaphylaxis
CDAD
seizures

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38
Q

what antibiotic interferes with bilirubin metabolism and causes biliary sludging

A

ceftriaxone (rocephin)

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39
Q

t or f? cefotaxime does not interfere with bilirubin metabolism and is less toxic in neonates than ceftriaxone

A

true

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40
Q

what antibiotics are CYP inducers of liver metabolism which may decrease blood levels of other drugs

A

rifamycins

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41
Q

what antibiotics are CYP substrates which may increase blood levels of other drugs

A

macrolides

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42
Q

t or f? probenecid increases blood levels of renal excreted drugs

A

true

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43
Q

t or f? most antibiotics are eliminated in urine

A

true

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44
Q

what antibiotics are primarily eliminated in the feces

A

moxifloxacin
nafcillin
macrolides
rifampin
clindamycin

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45
Q

what 3 antibiotics do you have to monitor serum levels because of nephrotoxicity

A

vancomycin
aminoglycosides
colistin

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46
Q

what antibiotics and mechanisms are bactericidal

A

cell wall inhibitors
lipopeptides
quiunolones
aminoglycosides
metronidazole

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47
Q

what antibiotics and mechanisms are bacteriostatic

A

folic acid inhibitors
most 30S/50S ribosome protein synthesis inhibitors except aminoglycosides

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48
Q

what skin microflora causes abscess (pus) furuncles (pus filled boil) carbuncles (cluster of boils) bullous impetigo/ecthyma and folliculitis

A

s. aureus

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49
Q

what are infections caused by GAS

A

impetigo/ecthyma, cellulitis, erysipelas, and necrotizing fasciitis (flesh eating bacteria)

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50
Q

what is a contagious SSSI cause of honey-colored crusted lesions around the mouth

A

impetigo

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51
Q

what bacteria cause human bite wound infections

A

eikenella and oral anaerobes

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52
Q

what bacteria cause animal bite wound infections

A

pasteurella and oral anaerobes

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53
Q

What bacteria may cause necrotizing fasciitis

A

GAS
Vibrio Vulnificus
Aeromonas

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54
Q

What bacteria may cause gangrene

A

clostridium perfringens

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55
Q

what bacteria cause burn wound infections

A

Gram positive cocci
Pseudomonas Aeruginosa

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56
Q

What bacteria causes “nail through shoe” infection and hot tub folliculitis

A

Pseudomonas

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57
Q

what bacteria may cause diabetic foot infections and bed sores

A

polymicrobial

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58
Q

Topical antibiotics

A

fusidic acid
mupirocin
retapamulin (MRSA)

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59
Q
A
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60
Q

what topical cream is used for burn wounds and is antipseudomonal

A

silver sulfadiazine

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60
Q

what are most bone and joint infections due to

A

skin microflora Gram Positive cocci (s.aureus most common)

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60
Q

t or f? large joint infections are more common than small joint infections

A

true

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61
Q

What are the two common bacterial causes of septic arthritis for IV drug abusers

A

S.aureus and Pseudomonas

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61
Q

What gene is common in Reiters arthritis

A

HLA-B27

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61
Q

what is the common bacterial cause of hardware associated arthritis

A

biofilm forming coagulase negative staph epidermidis

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61
Q

polyarthritis is most common in young adults due to

A

n. gonorrhoeae

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61
Q

What causes Reiters (reactive arthritis)

A

Campylobacter ad Chlamydia

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61
Q

what causes peritonitis

A

spillage of bowel into peritoneum

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62
Q

what bacteria cause intraabdominal infections

A

GI anaerobes like Bacteriodes, PEK (e.coli)
staph
strep
enterococcus

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62
Q

T or f? multiple pathogens are the cause of secondary peritonitis and often occurs in ruptured appendix

A

true

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62
Q

What patient profile is common for SBP

A

cirrhosis

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62
Q

what pathogen is most common in primary (spontaneous) peritonitis

A

e. coli

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63
Q

t or f? appendicitis is the most common etiology of intraabdominal infections

A

true

64
Q

t or f? gastroenteritis (stomach flu) often results in infectious diarrhea due to an infectious agent

A

true

65
Q

what bacteria causes most non-inflammatory diarrhea (travelers, watery)

A

e. coli (ETEC)

66
Q

Vibrio Cholera causes what kind of diarrhea by eating raw shellfish from Gulf of Mexico

A

watery non-inflammatory diarrhea

67
Q

Shigella causes what kind of diarrhea by fecal-oral transmission

A

watery (daycare diarrhea)

68
Q

what is most inflammatory diarrhea due to

A

Campylobacter jejuni

69
Q

what diarrhea is caused by Shiga Toxin E.coli O157:H7

A

inflammatory diarrhea

70
Q

what causes typhoid fever

A

salmonella typhi

71
Q

What antibiotics are used for diarrhea

A

FQs
azithromycin
rifaximin (e.coli only)

72
Q

what is the primary treatment goal for infectious diarrhea

A

fluid and electrolyte replacement

73
Q

what is common cause of viral GI infection in adults

A

Norovirus/Norwalk virus

74
Q

what is common cause of viral GI infection in children due to fecal oral transmission

A

rotavirus that has a vaccine available for immunity

75
Q

what is the cause of botulism and floppy baby syndrome after eating swollen cans/jars

A

Clostridium botulinum

76
Q

what is CDAD

A

c.diff associated diarrhea obtained by patients in medical facilities transmitted via spores by healthcare workers

77
Q

how to prevent CDAD

A

proper glove usage and avoiding antimotility agents like imodium

78
Q

if CDAD is untreated what can it lead to

A

toxic megacolon and colon rupture that leads to peritonits

79
Q

why is there high recurrence and relapse in C.diff

A

antibiotics do not work on c.diff spores

80
Q

what covers c.diff

A

oral vancomycin and fidaxomicin because they are not absorbed
metronidazole (disulfiram reaction with alcohol)

81
Q

what bacteria is cystitis and pyelonephritis usually due to

A

PEK (e.coli most common)

82
Q

what is considered the honeymoon bug and causes UTIs in young women

A

s. saprophyticus

83
Q

why are females more prone to UTIs

A

shorter urethra

84
Q

t or f? males always have a complicated UTI and sometimes due to enlarged prostate

A

true

85
Q

t or f? urinary catheter patients usually obtain UTI following catheterization

A

true

86
Q

what is used in diagnosis of UTI

A

midstream (clean catch) urine culture, leukocyte esterase, nitrate positive test

87
Q

what are 2 indicators of upper UTI (include pyelonephritis)

A

urinary casts
flank pain

88
Q

what covers UTIs

A

Bactrim
nitrofurantoin (macrobid)
fosfomycin (monurol)

89
Q

three most common pathogens for STIs

A

Chlamydia Trachomatis > Nesisseria gonorrhoeae > Trichomonas vaginalis

90
Q

t or f? C. trachomatis causes asymptomatic or mild infections that often go untreated (higher incidence rates)

A

true

91
Q

what can Chlamydia and Gonorrheae cause

A

Primarily: urethritis, cervicitis, PID
arthritis
conjunctivitis
pharyngitis

92
Q

t or f? PID arises during menstruation when GU bacteria can ascend to uterus

A

true

93
Q

What is trichomoniasis due to and the most common co infection with it

A

due to Trichomonas vaginalis (protozoa) and common co infection with gonorrhoeae

94
Q

what causes bacterial vaginosis

A

Gardenerella vaginalis overgrowth that produces fishy odor after antibiotic use

95
Q

what causes syphilis (genital ulcer disease)

A

Treponema pallidum (spirochete) obtained by sexual contact or mom to fetus (congenital)

96
Q

how do you treat syphilis

A

slow release benzathine Pen G (IM only)

97
Q

how can you prevent genital warts due to HPV

A

immunization with the HPV vaccine

98
Q

what are DNA viruses that cause disease and remain in the body dormant (latent) form for life

A

human herpesviruses (HHV)

99
Q

what can cause HHV infection to be reactivated (flare up)

A

stress or immune system suppression/deficiency

100
Q

what is the only vaccine available for a HHV

A

Varicella-Zoster Virus vaccine

101
Q

what causes mouth sores, genital ulcers, encephalitis, keratitis (corneal ulcers), hepatic whitlow (hand ulcers)

A

HSV

102
Q

what can cause post-herpatic neuralgia (stabbing pain) and ophthalmic zoster (corneal ulcers)

A

VZV Zoster

103
Q

what is the classic triad of epstein barr virus

A

splenomegaly
exudative pharyngitis
lymphadenopathy (swollen glands)

104
Q

t or f? reactivated EBV can cause lymphoma in HIV patients

A

true

105
Q

cytomegalovirus manifests mostly in immune deficient patients as what

A

retinitis or encephalitis

106
Q

Kaposis Sarcoma manifests mostly in immune system suppression/deficient patients as what

A

skin cancer (tumors)

107
Q

most HHV antivirals are nucleoside analogs that do what

A

inhibit viral DNA polymerase

108
Q

what 3 drugs are activated by
phosphorylation by HHV thymidine kinase inside infected host cell

A

acyclovir (ester prodrug = valacyclovir), penciclovir (famciclovir), and ganciclovir (valganciclovir)

109
Q

what prodrugs (preferred) are used to increase oral absorption and what are they metabolized by

A

ester prodrugs metabolized by serum esterase

110
Q

primary manifestation and transmission of HHV1/HSV1

A

herpes labialis (cold sores) transmitted through saliva and sore contact

111
Q

primary manifestation and transmission of HHV2/HSV2

A

genital herpes (ulcers) transmitted through sexual contact

112
Q

primary manifestation and transmission of HHV3/VZV

A

chicken pox (varicella)
shingles (zoster)
transmitted through respiratory secretions

113
Q

primary manifestation and transmission of HHV4/EBV

A

mononucleosis and lymphoma transmitted through respiratory secretions

114
Q

primary manifestation and transmission of HHV5/CMV

A

retinitis, encephalitis transmitted through bodily secretions

115
Q

primary manifestation and transmission of HHV6-7/CMV

A

roseola transmitted by respiratory secretions

116
Q

primary manifestation and transmission of HHV8/KSHV

A

Kaposis sarcoma (tumors) transmitted through bodily secretions

117
Q

3 most common pathogens causing meningitis

A

s. pneumo > n. meningitidis > H. flu

118
Q

what are classical signs of meningitis

A

fever
neck stiffness (nuchal rigidity)
headache
altered mental status

119
Q

what suggests meningitis due to n. meningitidis vs s. pneumo

A

skin lesions (purpura) suggests n. meningitidis and respiratory co-infection suggests s. pneumo

120
Q

t or f? s. pneumo does not possess B-lactamase so you can use penicillins without a B-lactamse inhibitor

A

true

121
Q

t or f? n. meningitidis and H. flu often have B-lactamase which is susceptible to ceftriaxone (adults) and cefotaxime (neonates)

A

true

122
Q

why is ceftriaxone and cefotaxime used in meningitis

A

because they have good CSF penetration

123
Q

why is dexamethasone used in meningitis

A

lower CNS inflammation

124
Q

what causes Bells palsy

A

HSV

125
Q

encephalitis is usually due to what viruses

A

HSV > VZV > CMV > west nile

126
Q

Most URTIs are due to viruses and transmitted by

A

respiratory aerosols

127
Q

what is the primary cause of rhinitis, colds, and pharyngitis

A

rhinovirus

128
Q

signs in influenza virus

A

dry cough, fever, risk of bacterial pneumonia

129
Q

signs in parainfluenza virus

A

croup, stridor in infants

130
Q

signs of cold

A

productive cough, mild to no fever

131
Q

antivirals used for the flu

A

neuraminidase inhibitors:
-zanamivir (Relenza, dry powder inhaled, bronchospasm problems)
-oseltamivir (Tamiflu, oral)

132
Q

how many strands does the flu vaccine cover and why does it require annual updates

A

2 A and 2 B strands and requires updates due to H antigen mutation (antigenic drift)

133
Q

otitis media (middle ear) is due to secondary bacterial infections by what 3 pathogens

A

s. pneumo
M. cat
H. flu

134
Q

why are children more prone to ear infections

A

because of their shorter eustachian tube

135
Q

t or f? rhinosinusitis is usually due to virus

A

true

136
Q

what causes epiglottitis and how to prevent it

A

H. flu and vaccine can help to prevent it

137
Q

what is epiglottitis and how to tell on an x-ray

A

inflammation of the epiglottis that can block the trachea
looks like a thumbs up on an x-ray

138
Q

complications of strep throat caused by s.pyogenes

A

scarlet fever and rheumatic fever

139
Q

streptococcus is often resistant to what antibiotics

A

macrolides
tetracyclines
cipro
bactrim

140
Q

pathogens that cause bronchitis

A

respiratory viruses > mycoplasma pneumoniae

141
Q

pathogens of chronic bronchitis

A

viruses
H.flu in smokers and patients with COPD

142
Q

cause and treatment/prophylaxis of bronchiolitis

A

Caused by RSV
treat with inhaled ribavirin (monitor for hemolytic anemia)
Prophylaxis with monoclonal antibody Palivizumab (synagis)

143
Q

pathogens causing community acquired pneumonia

A

S. pneumoniae > H.flu

144
Q

timeline for community acquired pneumoniae

A

< 48 hours after admission

145
Q

timeline for healthcare associated pneumonia

A

obtained in healthcare setting < 48 hours after admission

146
Q

Timeline difference for early and late onset hospital acquired pneumonia

A

early onset: >/= 48 hours after admission
late onset: >/= 120 hours after admission

147
Q

timeline for ventilator acquired pneumonia

A

> /= 48 hours after intubation

148
Q

what is typical pneumonia caused by

A

gram positive and gram negative bacteria

149
Q

what is atypical pneumonia caused by

A

atypical bacteria (chlamydophila, legionella, mycoplasma)
viruses
fungi

150
Q

what bacteria that cause respiratory tract infections is covered by macrolides

A

H. flu and M. cat

151
Q

what are the respiratory FQs

A

levofloxacin and moxifloxacin

152
Q

t or f? respiratory FQs cover atypical and most typical pneumonias (s. pneumo is CIP resistant)

A

true

153
Q

t or f? h. flu and M. cat susceptible to augmentin and 2-3 gen cephalosporins

A

true

154
Q

what pathogens are most causes of infective endocarditits

A

staphylococci > streptococci (viridans)

155
Q

t or f? highest infective endocarditis is in prosthetic valve (PVE) and IV drug abusers (MRSA and Pseudomonas)

A

true

156
Q

how does vegetation occur

A

bacteremic bacteria colonize cardiac lesion

157
Q

what is a hallmark of infective endocarditis

A

vegetation that results in continuous bacteremia

158
Q

t or f? vegetation can result in the release of septic emboli that can deposit in organs

A

true

159
Q

what are 4 signs of infective endocarditis

A

Janeway lesions, Roth spots, murmurs, and splinter hemorrhages

160
Q

what are some anti staphylococcal penicillins that cover staph/MSSA

A

oxacillin
nafcillin
oral dicloxacillin

161
Q

what can be added to treatments to cover biofilms

A

rifampin

162
Q

3 classical signs of sepsis

A

fever
chills
hypotension

163
Q

what is SIRS

A

systemic inflammatory response syndrome
2 or more signs/symptoms out of abnormal WBC/HR/RR/BT

164
Q

t or f? sepsis = SIRS + bacteremia (positive blood culture)

A

true

165
Q

t or f? sepsis most commonly arises from respiratory infections

A

true

166
Q

what are 5 complications of sepsis

A
  1. septic shock
  2. disseminated intravascular coagulation (DIC)
  3. acute respiratory distress syndrome (ARDS)
  4. low systemic vascular resistance (SVR)
  5. acute renal failure (ARF)
167
Q

what happens in septic shock

A

inadequate oxygen in tissue (hypoxia)

168
Q

what is disseminated intravascular coagulation (DIC)

A

impaired blood clotting leads to internal bleeding

169
Q

what is acute respiratory distress syndrome (ARDS)

A

impaired blood oxygenation leads to ischemia

170
Q

what is low systemic vascular resistance (SVR)

A

hypotension leads to ischemia

171
Q

what is acute renal failure (ARF)

A

kidney injury leads to fluid accumulation

172
Q

what medication is the gold standard for TB

A

rifampin

173
Q
A

diseases that are infectious (7 decks)

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