MTB Infectious Disease Flashcards
What is the treatment for MRSA
Vancomycin
Linezolid
Daptomycin
What is the treatment for cellulits
minor dz: dicloxacillin or cephalexin
Pen allergic: macrolides or clindamycin
Severe dz: Oxacillin, nafcillin, cefazolin
Pen allergic: Vancomycin or Daptomycin
What is the treatment for gonorhea or chlamydia
Always treat both as it is a common co-infection
- ceftriaxone for gonorrhea (can use cipro)
- Azithromycin for chlamydia
What antibiotics are safe in pregnancy
Penicillin Cephalosporins aztreonam Erythromycin Azythromycin
What is the treatment for syphilis
2.4 million units IM of Penicillin G benazathine
What is the treatment for syphilis in the penicillin allergic patient
Doxycycline 100mg PO q12hrs x 14 days
For pregnancy or tertiary syphilis the only treatment is penicillin desensitization
What is the treatment for a Jarisch-Herxheimer reaction
aspirin and continue treatment against syphilis
What test should be run for suspected syphilis if an RPR or VDRL is negative
Darkfield microscopy
25% of RPR and VDRL are negative
What symptoms are present with cystitis
Dysuria
WBC in Urine
Suprapubic tenderness
What symptoms are present with pyelonephritis
Dysuria
WBC in Urine
Flank pain
Fever
What should be considered when a pyelonephritis does not respond to treatment
Perinephric abscess
How is endocarditis diagnosed clinically
Presence of:
- 2 Major criteria or,
- 1 Major and 3 minor criteria or,
- 5 minor criteria
What are the major Criteria associated with Dukes classification of Infective Endocarditis
2) Abnormal Echocardiagram
- Intracardiac mass
- abcess
- partial dehiscence of prosthetic valve
What are the minor Criteria associated with Dukes classification of Infective Endocarditis
- Fever > 38c
- Presence of risk factors
- Vascular findings
- Immunological findings
- Microbiological findings insufficient for a major criteria
What are the vascular findings associated with infective endocarditis
- Janeway lesions (flat and painless in hands and feet)
- Septic pulmonary infarct
- arterial emboli
- mycotic aneurism
- Conjonctival Hemorhage
What are the immunological findings associated with Infective Endocarditis
- Roth Spots (Retina)
- Osler Nodes (raised, painful, pea shaped)
- glomerular nephritis
When should therapy for HIV be started
- CD4 < 500
- Symptomatic patients
- Pregnant Women
- Needle stick by known HIV positive pt
What is the recommended therapy for starting a patient with HIV
HAART (one of the following combinations)
- Tenofovir + entricitabine + efavirenz (single pill combination)
- Zidovudine + lamuvudine + efavirenze
- Zidovudine + lamuvudine + ritonavir/lopinavir
*** Never use AZT (zidovudine) as a mono therapy
What are the adverse effects of NRTI class
lactic acidosis
What are the adverse effects of Protease Inhibitors
hyperglycemia
hyperlipidemia
What are the adverse effects of NNRTI class
drowsiness
What are the adverse effects of zidovudine
anemia
What are the adverse effects of didanosine
pancreatitis
neuropathy
What are the adverse effects of stavudine
pancreatitis
neuropathy
What are the adverse effects of abacavir
rash
What are the adverse effects of indinavir
kidney stones
Name the NRTI’s
zidovudine didanosine stavudine lamivudine abacavir emtricitabine tenofovir
Name the Protease Inhibitors
Indinavir ritonavir lopinavir Nelfinavir Saquinavir Darunavir Tipranavir Amprenavir Atazanavir
Name the NNRTI’s
Efavirenz
Nevirapine
Etravirine
Rilpivirine
What is the treatment for post exposure prophylaxis to to HIV
HAART for one month
If a pt is diagnosed as HIV positive during the routine pregnancy and is not currently on treatment what options are available
- CD4 < 500: start HAART
2. CD4 > 500 and low viral load: HAART immediately is better than waiting to 2nd or 3rd trimester
When should prophylaxis be initiated for HIV positive patients
CD4 < 200: TMP/SMX against Pneumocystis Jiroveci Pneumonia
CD4 <50: Azithromycin once a week against Myconacterium avium Intracellular
How will an HIV + patient present when infected with PCP
Shortness of breath
Dry cough
Hypoxia
Increased LDH
How is PCP diagnosed
Bronchoalvolar lavage
CXR will demonstrate increased interstitial markings bilaterally
What should be considered in an HIV patient with nausea, vomiting, headache and focal neurological deficits?
Toxoplasmosis
PML (progressive multifocal leukoencepholapathy)
Contrast head CT will show Ring enhancing lesions in Toxoplasmosis
What treatment is needed for an HIV patient with a CD4 count < 50 that presents with blurry vision?
Patient requires dilated opthomalogic evaluation
If treatment is needed for CMV use valgancyclovir
If an HIV patient presents to the ER with fever, headache and stiff neck what is the next course of action
Lumbar puncture.
- India Ink initially (60% sensitive)
- Cryptococcal Antigen test (95% sensitive)
If positive treat with Amphotericin B followed by fluconazole
What are the opportunistic infections associated with HIV
CD4 < 300: Candidal Esophogitis
CD4 < 200: (PCP) Pneumocystis Jiroveci Pneumonia
CD4 <50: CMV, Mycobacterium avium Intracellular
