MTB 1 Flashcards
What does PCN cover
Viridans group strep Strep pyogenes Oral anaerobes Syphilis Leptospira
What does Amoxicillin and Amp cover
PCN drugs + HELPS H.influenzae E.Coli Listeria Proteus Salmonella Lyme Dz
AE of Methicillin
Renal Failure from AIN
Pt w rash to PCN - TX?
Cephalosporins
Pt w anaphylaxis to PCN - TX?
Non-beta-lactam
Vanco
Linezolid
Daptomycin
AE of Cefotetan and cefoxitin
Increased risk of bleeding
Disulfiramlike Rxn w Alcohol
Cephalosporins that cover Pseudomonas
Ceftazidime
Cefepime
Why do avoid ceftriaxone in neonates
impaired biliary metabolism
AEs of Doxycycline
Tooth discoloration - children
Fanconi syndrome - Type II RTA proximal
Photosensitivity
Esophagitis/ulcer
TMP-SMX AEs
Rash
Hemolysis
Bone marrow suppression
Folate antagonist
MCC meningitis w recent neurosurgery
Staph
Meningitis in camper/hiker w centripetal rash and tick
RMSF
What is a centripetal rash
Involves wrists, ankles, moves from arms/legs to trunk
Meningitis - best initial test
LP
Meningitis - Most accurate test
LP
Meningitis - LP in Bacterial
Glucose = Low
Protein =High
Cell count = 1000s, Neutrophils
Meningitis - LP in Cryptococcus, Lyme, Rickettsia
Glucose = Possibly Low
Protein = Normal, Possibly High
Cell count = 10s-100s, Lymphocytes
No stain/culture
Meningitis - LP in TB
Glucose = May be low
Protein = VERY High
Cell count = 10-100s Lymphocytes
Meningitis - LP in Viral
Glucose = Normal
Protein = Normal
Cell count = 10-100s Lymphocytes
Meningitis TX w head CT if:
- Papilledema
- Seizures
- Focal neuro changes
- Confusion
Meningitis pt with CI to LP - next best step?
ABX
Testing for Lyme and Rickettsia
Serology w ELISA, Western blot, PCR
Best initial TX for bacterial meningitis
Ceftriaxone
Vanco
Steroids
Why steroids in bacterial meningitis
Lower mortality in Strep Pneumo pts
TX for Meningitis + 1000s neutrophils on CSF
Ceftriaxone
Vanco
Steroids
When do we add Ampicilin in meningitis
Immunocompromised for Listeria
- Elderly
- Neonates
- Steroid use
- HIV
- Pregnant
TX for Listeria
Sensitive to PCN
Resistant to ALL cephalosporins
TX for TB meningitis
Extend TX + steroids
Neisseria meningitis TX
Respiratory isolation Rifampin/cIpro to close contacts - Household contacts - Kissing - Cig sharing - Utensils - HCW w exposure to resp secretions
Pt w fever, HA, stiff neck, photophobia, weakness of arm and leg - left. Next best step?
Ceftiraxone, Vanco, Steroids
- LP
- ABX
- CT head
MC neuro deficit of untreated bacterial meningitis
8th CN deficit
Deafness
What is seen on CT for brain abscess
Ring/contrast enhancing lesion
IF Ring/contrast enhancing lesion on CT AND HIV + , next step
TX for Toxo for 2 weeks w Pyrimethazine and sulfsalazine
Repeat CT 2 wks - if same, BX
DDX: Toxo or Lymphoma
IF Ring/contrast enhancing lesion on CT AND HIV - , next step
BX
DDX: Cancer, Infxn
Most accurate test Herpes Encephalitis
PCR of CSF
Best initial therapy for Herpes Encephalitis
Acyclovir
Best initial therapy for Herpes Encephalitis Resistant to Acyclovir
Foscarnet
Malignant Otitis Externa seen in ? Etiology?
Elderly pts
Diabetics
Pseudomonal Infxn on External Auditory Canal (EAC)
MOE presentation and TX
Severe Ear pain Discharge Low grade fever Granulation tissue in EAC TX: Cipro
Best initial therapy for otitis media
Amoxicillin
Most Accurate diagnositic test for OM
Tympanocentesis
- done with multiple recurrences
If OM pt not responding to Amoxicillin
Amox/Clauv
Azithromycin, Clarithromycin
Cefuroxime, Loracarbef
FQ
Most Accurate Dx test for sinusitis
Sinus BX or Aspirate
When is sinus BX done in sinusitis
Recurrent
No response to empiric tx
First line agents for otitis and sinusitis
Amoxcillin
Doxycycline
TMP-SMX
Tx for rhizopus and mucormycosis
Surgical Debridement
Ampho B
Presentation of Strep pharyngitis
Pain w swallowing LA -neck Exudate - whitish, scrapes off Fever NO cough, NO hoarseness
Laryngitis presentation
Hoaresness
Cough
Best initial test pharyngitis
Rapid Strep test
Pharyngitis + vesicles or ulcers
HSV
Herpangia
Pharyngitis + membranous exudate
diphtheria
EBV
Vincent angina
TX for Pharyngitis
- Amoxcillin or PCN
- Cephalexin - PCN allergic w rash
Clindamycin or macrolide - PCN allergic w anaphylaxis