MTB 2 CK - Infectious Flashcards
What abx do we use to tx oral anaerobes?
PCN G, V
Aminopenicillins (amp, amox) have more _____ coverage than PCN
Gram (-), enterics
Best initial therapy for endocarditis prophylaxis
Amox or amp
Best initial therapy for UTI in pregnant woman
Amox
What are pencillinase resistant PCN good at? Dicloxacillin, etc.
Killing S. aureus (not good at gram negatives or MRSA)
What are the anti-pseudomonal PCNs?
Ticarcillin, Piperacillin, etc.
Good for pseudomonas and anaerobes!!!
Best initial therapy for cholecystitis, ascending cholangitis, pyelonephritis?
Ticarcillin, piperacillin
*But usually not the answer when a single organism is known (too broad coverage)
What 3 bugs are resistant to cephalosporins?
Enterococcus
Listeria
MRSA
Cephalosporins with increased risk of bleeding
Cefotetan, cefoxitin
First line tx for S. pneumo meningitis
Ceftriaxone
Tx of Lyme involving the heart or brain
Ceftriaxone
Can’t give Ceftriaxone to…
neonates
Cefepime is good for
Staph, Pseudomonas, Gm (-)
What is cilastatin given with (kidney breakdown)
Imipenem
Aztreonam only covers
Gram (-) rods
Fluoroquinolones have poor coverage of…
Staph, strep, and anaerobes
FQ are good for…
pee, poo, bone, and intracellular pna
Give ____ with FQ for GI infections
Metronidazole to cover the anaerobes
Can’t give FQ to… and why…
Pregnant women, kids
Tendon rupture, bone growth abnormalities
Aminoglycosides get in the
poo, pee, blood
Aminoglycosides have good coverage of ___ and bad coverage of ___
gram (-) good
anaerobes bad
Clindamycin causes
C. dif
2nd line for staph/strep
Macrolides
First line Txs for MRSA
Vancomycin, Linezolid, Daptomycin, Tigecycline, Ceftaroline
Best initial tx for minor MRSA of the skin
TMP/SMX
Clindamycin
Doxycycline
2 best tx for GI anaerobes
Metronidazole
Beta-lactam/lactam combos
Only think S. aureus CNS infection in…
someone with recent NES
At what CD4 count do we see cryptococcal meningitis
When is it a TB CNS infection?
If they also have pulmonary TB
CSF cell count in cryptococcus, Lyme, or Ricketsial meningitis
10s-100s
Protein and glucose inconclusive
What will CSF studies show in TB meningitis?
markedly elevated protein
When do you do bacterial antigen detection in a CNS infection?
If antibiotics are given prior to LP/ culture
Prophylaxis for close contacts of patient with N. meningitides
Rifampin
Ciprofloxacin
Ceftriaxone
MCC meningitis 0-6mo
Listeria
GBS
E. coli
MCC meningitides 6mo-6yr
S. pneumo
H. flu
Enterovirus
N. meningitides
MCC meningitis 6-60yr
S. pneumo
Enterovirus
N. meningitides
HSV
MCC meningitis 60+yo
S. pneumo Listeria N. meningitides Listeria Gram (-) rods
MCC encephalitis
HSV
When is the most accurate test for HSV a viral culture?
When it is a skin/genital infection
Otherwise, PCR is most accurate
Most sensitive finding in AOM? (if negative, no AOM)
Tympanic membrane immobility
When do you do tympanocentesis for AOM?
Recurrent or no response to MULTIPLE abx
For sinusisitis when is culture of nasal discharge the right answer?
NEVER
When do you do a CT of the sinuses for sinusitis?
When the dx is equivocal
Don’t forget mucormycosis
in chronic sinusitis in patients with DM or heme probs
MCC of bacterial pharyngitis
GAS, Neisseria gonorrhea, Mycoplasma pna, C. diptheria
MCC of viral pharyngitis
Rhino, Corona, Adeno, HSV, EBV, CMV, influenza, Coxsackie
Pharyngitis tx: rash to PCN/amox
GIve cephalexin
Pharyngitis tx: if bad reaction to PCN/amox
Clindamycin, macrolide
Why do we treat GAS?
To prevent rheumatic fever
When can you get the inactivated flu vaccine?
> 6mo
When can you get the live attenuated vaccine?
2-49yo
2 MCC of HUS
E. coli
Shigella
Yersinia (diarrhea) loves
iron (transfusions, hemochromatosis)
How do you treat scombroid?
Antihistamines (looks like anaphylaxis to shellfish)
In HBV, surface antigen indicates
continued carrier state
What % of HBV becomes chronic?
10%
What % of HCV becomes chronic?
a lot
Best initial tx for urethritis
Ceftriaxone + Doxy/Azithro
PID best first step
pregnancy test
PID most accurate test
laparoscopy
PID inpatient tx
Cefoxitin/Cefotetan + Doxy
PID outpatient tx
Ceftriaxone + Doxycycline
(allergy) Levofloxacin + Metronidazole
One painful genital ulcer
Chancroid (H. ducreyi)
Syphilis screening test
VDRL, RPR
Syphilis confirmatory test
FTA, MHA-TP
Test for chancroid
Culture and stain
Test for lymphogranuloma venereum
Complement fixation titers
Nucleic acid amplification
Syphilis tx
IM PCN benzathine (1)
Doxycycline (PCN allergy)
Chancroid tx
Azithromycin (1 dose)
Lymphogranuloma venereum tx
Doxycycline
Can HSV be a clinical dx?
YES! no Tzanck necessary
TX secondary syph
IM PCN (one dose)
TX tertiary syph
IV PCN
Tests for genital warts
Biopsy, serology, stain, smear, culture—DON’T DO THESE!
Pediculosis =
crabs
Pediculosis tx
Permethrin
Scabies next best step
scrape and magnify
Scabies TX
Permethrin
Ciprofloxacin in tx of UTI
reserved for complicated cases
Pyelonephritis imaging
CT/US to rule out structural abnormalities
How do we treat prostatitis?
Same abx as pyelonephritis
TMP-SMX 6-8wks if CHRONIC
Pyelonephritis that does not resolve w/ appropriate tx
perinephric abscess (get US or CT)
Fever + new murmur
endocarditis–> echo + blood cultures
Roth spots
endocarditis
Janeway lesions
endocarditis
Osler nodes
endocarditis
What if endocarditis is culture negative?
HACEK Oscillating vegetations on echo \+ 1. Fever >100.4 2. RF of IVDA, prosthetic valve, etc 3. Signs of emboli
MCC of culture negative endocarditis
Coxiella
Bartonella
Best tx of endocarditis?
Vancomycin + Gentamycin
Best tx of endocarditis w/ HACEK?
Ceftriaxone
Endocarditis prophylaxis is needed when…
SIGNIFICANT cardiac defect
+
Risk of bacteremia with procedure
–>Amoxicillin
Joint fluid aspiration cell count in Lymes
25,000
oligoarthritis
What neuro manifestations are seen with Lymes?
meningitis, encephalitis, CN palsies
What cardiac manifestations are seen w/ Lyme?
Myocarditis
Third degree AV block (ventricular arrhythmia)
Secondary lyme
(early disseminated) migratory polyarthropathy, Bell’s meningitis, myocarditis, AV block
Tertiary llyme
arthritis
subacute encephalitis
Are diagnostic tests needed to treat Lyme?
NO
HIV risk of transmission
Perinatally > anal sex > needle stick > oral sex > vaginal sex
Infections at CD4 >200
Shingles, HSV, TB
Oral, vaginal candidiasis
Bacterial pneumonia
Kaposi’s
2 prophylaxis for HIV
PCP–TMP-SMX @
PCP prophylaxis: sulfa allergy
Dapsone
Atovoquone
PCP prophylaxis: sulfa allergy & G6PD
Atovoquone
Toxoplasmosis prophylaxis?
TMP-SMX–already on it
Anemia w/ HIV tx
Zidovudine (AZT)
Peripheral neuropathy/pancreatitis w/ HIV tx
Stavudine
Didanosine
HSR, Steven Johnson reaction w/ HIV tx
Abacavir
Hyperlipidemia, hyperglycemia w/ HIV tx
Protease (-)
Kidney stone w/ HIV tx
Indinavir
Renal insufficiency w/ HIV tx
Tenofovir
HIV med CI in pregnancy
Efavirenz
Best HIV test for an infant?
PCR or viral culture
First sign of tx failure in HIV
rising PCR-RNA level
C-section indicated in HIV when…
CD4 1000
Discuss FQ or macrolides in tx of otitis media
Can be used, would expand coverage against atypicals like mycoplasma, intracellulars, etc.
But no greater EFFICACY than amoxicillin
Best initial therapy for AOM
Amoxicillin + Decongestant
Sore throat + COUGH
Bronchitis or pneumonia!!!!!!!!!!!!!!!!!!!!!!! NOT pharyngitis!
Cough= lung problem!!!!!
Hoarseness means
a laryngitis
GAS pharyngitis can cause…
glomerulonephritis and rheumatic fever
GAS skin infections can cause
only glomerulonephritis
GAS TX
Penicillin
Amantadine and Memantine are only good for
Influenza A
Oseltamavir is good for
both influenza A and B
MCC of needed liver transplant in the US
chronic HCV
Chronicity of hepatitis is based on which test?
surface antigen
Old, healed, past, cured hepatitis has what markesr
core and surface antiBODY
e antigen determines in HBV
the degree of transmission
IFN MC adverse effect
flu-like symptoms
MC adverse effect of Ribavirin
red cell aplasia
TX for HCV
IFN and Ribavirin
TX for HBV
IFN OR Lamivudine OR Inticavir OR Edefavir