MTB Flashcards
Penicillin (G, VK, Benzathine)
Viridans, Strep pyogenes, oral anaerobes, syphilis, listeria
Bacteria covered by amoxicillin
HELPS
H influenza, Ecoli, Listeria, Proteus, Salmonella
Ampicillin and amoxicillin covers
Same as penicillin, as well as Ecoli, Lyme, and a few other gram - bacilli
Pencillin is the best initial therapy for
Otits media, dental infection and endocarditis prophylaxis, Lyme disease limited to rash, joint, or seventh CN involvement, UTI in pregnant women, listeria, and enterococcal infections
PRPs (oxacillin, clox sculpin, dicloxacillin, and nafcillin) treats
Skin infections (impetigo, erysipelas, and cellulitis)
Endocarditis, meningitis, and bacteremia from staph
Osteomyelitis and septic arthritis only when the organism is proven sensitive
Not active against MRSA or enterococcus
fever, headache, nausea, vomiting, stiff neck, photophobia, meningismus
Meningitis
fever, HA, N/V, confusion
Encephalitis
fever, HA, N/V, focal neuro findings
Abscess
When is a head CT the BEST initial test?
when any of the following is present: papilledema, seizures, focal neuro findings, and confusion interfering with neuro exam
If there is a contraindication to IMMEDIATE LP, what should you do?
antibiotics
When is a bacterial antigen test indicated?
when the patient has received antibiotics prior to LP and culture may be falsely negative
Most accurate diagnostic test for TB?
acid fast stain and culture on 3 high volume lumbar punctures.
Most accurate diagnostic test for Lyme/Rickettsia?
Serology, ELISA, Western blot, PCR
Most accurate diagnostic test for Cryptococcus?
India ink is 60-70% sensitive. Crypto antigen is more than 95% sensitive and specific
Best initial treatment for bacterial meningitis?
Ceftriaxone, Vanco, Steroids
Treatment is based on cell count.
Add ampicillin if immunocompromised for Listeria
RF for Listeria?
Elderly, neonates, steroid use, HIV/AIDS, immunocompromised including alcoholics, Pregnant
Resistant to ALL cephalosporins, but sensitive to penicillins.
Neisseria Meningitis Management?
Respiratory isolation
Rifampin, Cipro, Ceftriaxone to close contacts to decerase nasopharyngeal carriage
What’s the most common neuro deficit of untreated bacterial meningitis?
CN 8 nerve deficit or deafness
Most common cause of encephalitis?
Herpes Simplex
Most accurate test of Herpes encephalitis?
PCR of CSF
Initial test for patient presenting with encephalitis?
CT of head
Treatment of Herpes encephalitis?
Acyclovir.
Foscarnet for acyclovir resistant herpes
Most sensitive finding for Otitis Media?
Immobility
Most accurate diagnostic test for otitis media?
Tympanocentesis for sample of fluid for culture
Choose this answer if there are MULTIPLE RECURRENCES or if there’s no response to antibiotics.
Best initial therapy for Otitis Media?
Amoxicillin
If no response to amox, give:
Amox/Clavulanate
Azithromycin, Clarithromycin
Cefuroxime, Loracarbef
Levofloxacin, Gemifloxacin, Moxifloxacin
When to do a biopsy in sinusitis?
Infection frequently reoccurs
No response to different empiric therapies
Findings of Pharyngitis?
Pain on swallowing enlarged LN in neck exudate in pharynx fever no cough and no hoarseness
Best initial test for Pharyngitis?
Rapid strep test
If negative, and patient presents with findings of pharyngitis, treat with antibiotics until culture comes back
Treatment of Pharyngitis?
- Penicillin or amoxicillin is the best initial therapy
- Penicillin allergic treated with cephalexin if reaction is only a rash. if allergy is anaphylaxis, use clindamycin or macrolide.
Treatment of Influenza?
< 48 hours of Sx: oseltamivir, zanamivir
> 48 hours of Sx: Symptomatic treatment only. Analgesics, rest, antipyretics, hydration.
Causes of Blood and WBCS in stool?
Salmonella: poultry
Camplyobacter: most common cause, a/w GBS
Ecoli 0157 H7: HUS
Shigella: 2nd most common, a/w HUS
Vibrio parahemolyticus: shellfish and cruise ships
Vibrio vulnificus: shellfish, hx of liver disease, skin lesions
Yersinia: high affinity for iron, hemochromatosis, blood transfusions
C. dif: WBC/RBC In stool
Best initial test for infectious diarrhea?
Blood and/or fecal leukocytes
Most accurate test for infectious diarrhea?
Stool culture
Causes of infectious diarrhea without blood/wbc in stool?
Viral
Giardia: camping/hiking and unfiltered fresh water
Cryptosporidiosis: AIDS with less than 100 CD4; detect with modified acid fast stain
Bacillus Cereus: vomiting
Staph Aureus: vomiting
Treatment for infectious diarrhea?
Mild: oral fluid replacement
severe: oral fluid replacement + oral antibiotics such as ciprofloxacin
What becomes abnormal first, after acquiring Hep B infection?
Surface antigen
What is the most direct correlate with the amount, or quantity of active viral replication?
e Antigen- directly correlated with DNA polymerase
What indicates that a patient is no longer a risk for transmitting infection to another person (active infection resolved)?
No surface antigen found
What is the best indication of the need for treatment with anti-viral medication in chronic disease?
e Antigen
Best indicator that a pregnant won an will transmit infection to her child?
e Antigen
Acute Hep C treatment?
Interferon, Ribavarin, and either bocprevir or telaprevir
Chronic Hep C treatment?
and ONE of the following: entecavir, adefovir, lamovudine, telbivudine, interferon, or tenofovir
Interferon is not best first choice due to adverse effects
A/E of interferon?
Arthralgias/Myalgias
Leukopenia and thrombocytopenia
Depression and flu-like Sx
Goal of chronic hep therapy?
reduce DNA polymerase to undetectable levels
convert those patients with e-Antigen to having anti-hepatitis e antibody
A/E of ribavarin?
Anemia
