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MTB STEP 2 (R) > MTB 2 CK - Infectious > Flashcards

MTB 2 CK - Infectious Flashcards

1
Q

What abx do we use to tx oral anaerobes?

A

PCN G, V

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2
Q

Aminopenicillins (amp, amox) have more _____ coverage than PCN

A

Gram (-), enterics

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3
Q

Best initial therapy for endocarditis prophylaxis

A

Amox or amp

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4
Q

Best initial therapy for UTI in pregnant woman

A

Amox

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5
Q

What are pencillinase resistant PCN good at? Dicloxacillin, etc.

A

Killing S. aureus (not good at gram negatives or MRSA)

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6
Q

What are the anti-pseudomonal PCNs?

A

Ticarcillin, Piperacillin, etc.

Good for pseudomonas and anaerobes!!!

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7
Q

Best initial therapy for cholecystitis, ascending cholangitis, pyelonephritis?

A

Ticarcillin, piperacillin

*But usually not the answer when a single organism is known (too broad coverage)

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8
Q

What 3 bugs are resistant to cephalosporins?

A

Enterococcus
Listeria
MRSA

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9
Q

Cephalosporins with increased risk of bleeding

A

Cefotetan, cefoxitin

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10
Q

First line tx for S. pneumo meningitis

A

Ceftriaxone

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11
Q

Tx of Lyme involving the heart or brain

A

Ceftriaxone

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12
Q

Can’t give Ceftriaxone to…

A

neonates

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13
Q

Cefepime is good for

A

Staph, Pseudomonas, Gm (-)

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14
Q

What is cilastatin given with (kidney breakdown)

A

Imipenem

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15
Q

Aztreonam only covers

A

Gram (-) rods

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16
Q

Fluoroquinolones have poor coverage of…

A

Staph, strep, and anaerobes

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17
Q

FQ are good for…

A

pee, poo, bone, and intracellular pna

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18
Q

Give ____ with FQ for GI infections

A

Metronidazole to cover the anaerobes

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19
Q

Can’t give FQ to… and why…

A

Pregnant women, kids

Tendon rupture, bone growth abnormalities

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20
Q

Aminoglycosides get in the

A

poo, pee, blood

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21
Q

Aminoglycosides have good coverage of ___ and bad coverage of ___

A

gram (-) good

anaerobes bad

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22
Q

Clindamycin causes

A

C. dif

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23
Q

2nd line for staph/strep

A

Macrolides

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24
Q

First line Txs for MRSA

A

Vancomycin, Linezolid, Daptomycin, Tigecycline, Ceftaroline

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25
Q

Best initial tx for minor MRSA of the skin

A

TMP/SMX
Clindamycin
Doxycycline

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26
Q

2 best tx for GI anaerobes

A

Metronidazole

Beta-lactam/lactam combos

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27
Q

Only think S. aureus CNS infection in…

A

someone with recent NES

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28
Q

At what CD4 count do we see cryptococcal meningitis

A
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29
Q

When is it a TB CNS infection?

A

If they also have pulmonary TB

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30
Q

CSF cell count in cryptococcus, Lyme, or Ricketsial meningitis

A

10s-100s

Protein and glucose inconclusive

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31
Q

What will CSF studies show in TB meningitis?

A

markedly elevated protein

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32
Q

When do you do bacterial antigen detection in a CNS infection?

A

If antibiotics are given prior to LP/ culture

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33
Q

Prophylaxis for close contacts of patient with N. meningitides

A

Rifampin
Ciprofloxacin
Ceftriaxone

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34
Q

MCC meningitis 0-6mo

A

Listeria
GBS
E. coli

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35
Q

MCC meningitides 6mo-6yr

A

S. pneumo
H. flu
Enterovirus
N. meningitides

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36
Q

MCC meningitis 6-60yr

A

S. pneumo
Enterovirus
N. meningitides
HSV

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37
Q

MCC meningitis 60+yo

A 
S. pneumo
Listeria
N. meningitides
Listeria
Gram (-) rods
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38
Q

MCC encephalitis

A

HSV

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39
Q

When is the most accurate test for HSV a viral culture?

A

When it is a skin/genital infection

Otherwise, PCR is most accurate

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40
Q

Most sensitive finding in AOM? (if negative, no AOM)

A

Tympanic membrane immobility

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41
Q

When do you do tympanocentesis for AOM?

A

Recurrent or no response to MULTIPLE abx

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42
Q

For sinusisitis when is culture of nasal discharge the right answer?

A

NEVER

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43
Q

When do you do a CT of the sinuses for sinusitis?

A

When the dx is equivocal

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44
Q

Don’t forget mucormycosis

A

in chronic sinusitis in patients with DM or heme probs

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45
Q

MCC of bacterial pharyngitis

A

GAS, Neisseria gonorrhea, Mycoplasma pna, C. diptheria

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46
Q

MCC of viral pharyngitis

A

Rhino, Corona, Adeno, HSV, EBV, CMV, influenza, Coxsackie

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47
Q

Pharyngitis tx: rash to PCN/amox

A

GIve cephalexin

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48
Q

Pharyngitis tx: if bad reaction to PCN/amox

A

Clindamycin, macrolide

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49
Q

Why do we treat GAS?

A

To prevent rheumatic fever

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50
Q

When can you get the inactivated flu vaccine?

A

> 6mo

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51
Q

When can you get the live attenuated vaccine?

A

2-49yo

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52
Q

2 MCC of HUS

A

E. coli

Shigella

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53
Q

Yersinia (diarrhea) loves

A

iron (transfusions, hemochromatosis)

54
Q

How do you treat scombroid?

A

Antihistamines (looks like anaphylaxis to shellfish)

55
Q

In HBV, surface antigen indicates

A

continued carrier state

56
Q

What % of HBV becomes chronic?

A

10%

57
Q

What % of HCV becomes chronic?

A

a lot

58
Q

Best initial tx for urethritis

A

Ceftriaxone + Doxy/Azithro

59
Q

PID best first step

A

pregnancy test

60
Q

PID most accurate test

A

laparoscopy

61
Q

PID inpatient tx

A

Cefoxitin/Cefotetan + Doxy

62
Q

PID outpatient tx

A

Ceftriaxone + Doxycycline

(allergy) Levofloxacin + Metronidazole

63
Q

One painful genital ulcer

A

Chancroid (H. ducreyi)

64
Q

Syphilis screening test

A

VDRL, RPR

65
Q

Syphilis confirmatory test

A

FTA, MHA-TP

66
Q

Test for chancroid

A

Culture and stain

67
Q

Test for lymphogranuloma venereum

A

Complement fixation titers

Nucleic acid amplification

68
Q

Syphilis tx

A

IM PCN benzathine (1)

Doxycycline (PCN allergy)

69
Q

Chancroid tx

A

Azithromycin (1 dose)

70
Q

Lymphogranuloma venereum tx

A

Doxycycline

71
Q

Can HSV be a clinical dx?

A

YES! no Tzanck necessary

72
Q

TX secondary syph

A

IM PCN (one dose)

73
Q

TX tertiary syph

A

IV PCN

74
Q

Tests for genital warts

A

Biopsy, serology, stain, smear, culture—DON’T DO THESE!

75
Q

Pediculosis =

A

crabs

76
Q

Pediculosis tx

A

Permethrin

77
Q

Scabies next best step

A

scrape and magnify

78
Q

Scabies TX

A

Permethrin

79
Q

Ciprofloxacin in tx of UTI

A

reserved for complicated cases

80
Q

Pyelonephritis imaging

A

CT/US to rule out structural abnormalities

81
Q

How do we treat prostatitis?

A

Same abx as pyelonephritis

TMP-SMX 6-8wks if CHRONIC

82
Q

Pyelonephritis that does not resolve w/ appropriate tx

A

perinephric abscess (get US or CT)

83
Q

Fever + new murmur

A

endocarditis–> echo + blood cultures

84
Q

Roth spots

A

endocarditis

85
Q

Janeway lesions

A

endocarditis

86
Q

Osler nodes

A

endocarditis

87
Q

What if endocarditis is culture negative?

A 
HACEK
Oscillating vegetations on echo 
\+
1. Fever >100.4
2. RF of IVDA, prosthetic valve, etc
3. Signs of emboli
88
Q

MCC of culture negative endocarditis

A

Coxiella

Bartonella

89
Q

Best tx of endocarditis?

A

Vancomycin + Gentamycin

90
Q

Best tx of endocarditis w/ HACEK?

A

Ceftriaxone

91
Q

Endocarditis prophylaxis is needed when…

A

SIGNIFICANT cardiac defect
+
Risk of bacteremia with procedure

–>Amoxicillin

92
Q

Joint fluid aspiration cell count in Lymes

A

25,000

oligoarthritis

93
Q

What neuro manifestations are seen with Lymes?

A

meningitis, encephalitis, CN palsies

94
Q

What cardiac manifestations are seen w/ Lyme?

A

Myocarditis

Third degree AV block (ventricular arrhythmia)

95
Q

Secondary lyme

A

(early disseminated) migratory polyarthropathy, Bell’s meningitis, myocarditis, AV block

96
Q

Tertiary llyme

A

arthritis

subacute encephalitis

97
Q

Are diagnostic tests needed to treat Lyme?

A

NO

98
Q

HIV risk of transmission

A

Perinatally > anal sex > needle stick > oral sex > vaginal sex

99
Q

Infections at CD4 >200

A

Shingles, HSV, TB
Oral, vaginal candidiasis
Bacterial pneumonia
Kaposi’s

100
Q

2 prophylaxis for HIV

A

PCP–TMP-SMX @

101
Q

PCP prophylaxis: sulfa allergy

A

Dapsone

Atovoquone

102
Q

PCP prophylaxis: sulfa allergy & G6PD

A

Atovoquone

103
Q

Toxoplasmosis prophylaxis?

A

TMP-SMX–already on it

104
Q

Anemia w/ HIV tx

A

Zidovudine (AZT)

105
Q

Peripheral neuropathy/pancreatitis w/ HIV tx

A

Stavudine

Didanosine

106
Q

HSR, Steven Johnson reaction w/ HIV tx

A

Abacavir

107
Q

Hyperlipidemia, hyperglycemia w/ HIV tx

A

Protease (-)

108
Q

Kidney stone w/ HIV tx

A

Indinavir

109
Q

Renal insufficiency w/ HIV tx

A

Tenofovir

110
Q

HIV med CI in pregnancy

A

Efavirenz

111
Q

Best HIV test for an infant?

A

PCR or viral culture

112
Q

First sign of tx failure in HIV

A

rising PCR-RNA level

113
Q

C-section indicated in HIV when…

A

CD4 1000

114
Q

Discuss FQ or macrolides in tx of otitis media

A

Can be used, would expand coverage against atypicals like mycoplasma, intracellulars, etc.

But no greater EFFICACY than amoxicillin

115
Q

Best initial therapy for AOM

A

Amoxicillin + Decongestant

116
Q

Sore throat + COUGH

A

Bronchitis or pneumonia!!!!!!!!!!!!!!!!!!!!!!! NOT pharyngitis!
Cough= lung problem!!!!!

117
Q

Hoarseness means

A

a laryngitis

118
Q

GAS pharyngitis can cause…

A

glomerulonephritis and rheumatic fever

119
Q

GAS skin infections can cause

A

only glomerulonephritis

120
Q

GAS TX

A

Penicillin

121
Q

Amantadine and Memantine are only good for

A

Influenza A

122
Q

Oseltamavir is good for

A

both influenza A and B

123
Q

MCC of needed liver transplant in the US

A

chronic HCV

124
Q

Chronicity of hepatitis is based on which test?

A

surface antigen

125
Q

Old, healed, past, cured hepatitis has what markesr

A

core and surface antiBODY

126
Q

e antigen determines in HBV

A

the degree of transmission

127
Q

IFN MC adverse effect

A

flu-like symptoms

128
Q

MC adverse effect of Ribavirin

A

red cell aplasia

129
Q

TX for HCV

A

IFN and Ribavirin

130
Q

TX for HBV

A

IFN OR Lamivudine OR Inticavir OR Edefavir

MTB STEP 2 (R) (12 decks)

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