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Infectious disease > MTB infectious disease > Flashcards

MTB infectious disease Flashcards

1
Q

What type of hepatitis is treated, acute or chronic hep A,B or C?

A

Acute hep C

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2
Q

What is the treatment for acute Hep C?

A

interferon
Ribaviron
Boceprevir or Telaprevir
(BIRT)

Treatment decreases the likelihood of developing chronic hepatitis C

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3
Q

What is the criteria for dx of chronic Hep B?

What are the treatment options (6)?

A 
Presence of surface Ag >6  mo 
If e-Ag is present and DNA polymerase is elevated treat with ONE of the following
1. Entecavir
2. Adefovir
3. Lamivudine
4. Telbivudine
5. Interferon 
6. Tenofovir
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4
Q

What are the side effects of interferon?

A

arthralgia/myalgia
leukopenia and thrombocytopenia
depression and flu-like symptoms

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5
Q

What is the goal of chronic hep therapy?

A
  • reduce DNA polymerase levels to undetectable levels

- convert someone who is e-Ag positive to anti-hepatitis e-Ab

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6
Q

What is the role of liver biopsy in hepatitis management?

A

Presence of fibrosis indicates need to start treatment immediately for hep B or C

if there is active viral replication, fibrosis will progress to cirrhosis which is not reversible

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7
Q

Do most people have symptoms with acute hepatitis C infection?

A

No

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8
Q

How do you treat genotype 1 hepatitis C?

How are other genotypes treated?

A

Genotype 1: ledipasvir/sofosbuvir (Harvoni) - orally x12 weeks

Other: Sofosbuvir (Sovaldi) and ribavirin orally

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9
Q

What is the goal of treatment of Hep C?

A

achieve undetectable viral load

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10
Q

How do you treat hep C that has failed other treatments?

A

interferon

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11
Q

What is the only type of acute hepatitis that is treated?

A

acute hepatitis C

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12
Q

What is a major side effect of Ribavirin?

A

anemia

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13
Q

Everyone born between ____ and ____ must be tested for hepatitis C.

A

1945 and 1965

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14
Q

What are the cure rates for hep C?

A

exceeding 90%

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15
Q

What is one way to differentiate between urethritis and cystitis?

A

urethral discharge

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16
Q

What are 4 causes of urethritis?

A

gonorrhea
chlamydia
mycoplasma genitalium
ureaplasma

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17
Q

What are the 3 most accurate tests for gonorrhea/chlamydia?

A

urethral culture
DNA probe
NAAT

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18
Q

What is the treatment for cervicitis?

A

azithromycin and ceftriaxone as a single dose

azithromycin and doxycycline have equivalent efficacy - but doxy is harder to use

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19
Q

What are the 5 presenting sx of someone with PID?

A
  • lower abdominal tenderness
  • lower abdominal pain
  • fever
  • cervical motion tenderness
  • leukocytosis
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20
Q

What is the most accurate testing for PID?

A

Laparoscopy - only do this if the dx is unclear, sx persist despite tx, recurrent episodes for unclear reasons

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21
Q

What test can be done to confirm the dx of PID?

A

cervical swab for culture, DNA probe, or NAAT

These tests will clarify the need to treat the partner for an STD

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22
Q

What are the inpatient and outpatient treatments for PID?
What organisms are being targeted when treating for PID?
If pt is allergic to PCN (anaphylaxis), what can be used?

A

inpatient: Cefoxitin or cefotetan + doxy
outpatient: ceftriaxone and doxy - possibly with metronidazole
treatment is targeting chlamydia and gonorrhea
allergy to PCN
- inpatient: clindamycin, doxycycline, gentemycin
- outpatient: levoquin and metronidazole

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23
Q

A pt presents with tender lymph nodes that are suppurating, what is the most likely dx?

A

lymphogranuloma venereum

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24
Q

What are dx tests are performed to dx syphilis?

A

Dark-field microscopy –> if this is positive for spirochetes, no further testing is needed.
VDRL or RPR - 75% sensitive in primary syphilis
FTA (fluorescent treponemal antibody absorption test) or MHA-TP (microhemagglutination test for treponemal pallidum) - confirmatory

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25
Q

What dx test is used for chancroid?

A

stain and culture on specialized media

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26
Q

What dx is used for lymphogranuloma venereum?

A

complement fixation titers in blood

NAAT pm swab

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27
Q

What dx test is used for herpes simplex?

  • what is the best initial test
  • what is the most accurate test
A

Tzanck prep - best initial test

viral culture is most accurate

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28
Q

What is the treatment for syphilis? (1)

What if they are allergic to the initial tx?

A

intramuscular benzathine PCN

If allergic: Doxycycline

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29
Q

What is the treatment for Chancroid?

What organism is being targeted?

A

tx: azithromycin - single dose
org: Haemophilus ducreyi

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30
Q

What is the treatment for lymphogranuloma venereum?

A

Docycycline

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31
Q

What is the tx for herpes simplex?

What is the treatment if resistant to first line therapy?

A

acyclovir
valacyclovir
famcyclovir
- Foscarnet for acyclovir-resistant herpes

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32
Q

If VDRL or RPR are negative - does this rule out neurosyphilis?

A

nope!

33
Q

What is the most sensitive test for dx neurosyphilis?

A

FTA

- if this is negative, it means the person does not have neurosyphilis

34
Q

What are 7 causes of false positive VDRL/RPR?

A
  1. infection
  2. older age
  3. injection drug use
  4. AIDS
  5. malaria
  6. antiphospholipid syndrome
  7. endocarditis
35
Q

What is the treatment for all stages of syphilis? What if the pt is allergic?

A
  • primary and secondary syphilis - tx = PCN IM or doxycycline if allergic
  • tertiary syphilis tx = PCN IM or desensitize to PCN if PCN allergic.
36
Q

What is the treatment for neurosyphilis in a pregnant women?

A

Desensitization

37
Q

What rxn can occur within the first 24 hours following treatment of syphilis?

A

Jarisch-Herxheimer rxn

fever and worse sx after tx
give aspirin and antipyretics –> it will pass

38
Q

What is the viral etiology of genital warts?

A

papilllomavirus

39
Q

How is condylomata acuminata dx?

A

visual appearance

- NOT biopsy, serology, stain, smear, or culture

40
Q

What are the uses of Imiquimod?

A
  • genital warts
  • actinic keratosis
  • basal cell cancer
    it is an immunostimulant that leads to the slough off of the lesion
    it does not burn or damage skin
41
Q

What are 3 ways to treat genital warts?

A
  • cryotherapy - liquid nitrogen
  • surgery
  • podophyllin
  • trichloacetic acid
  • Imiquimod - immunostimulant that leads to the sloughing off of the lesion
42
Q

What 2 treatments are available for pediculosis (crabs)?

A
  • permethrin - first line

- lindane - more toxic

43
Q

What is the treatment for scabies?

A
  • permethrin

- ivermectin - is used for widespread disease and severe disease which needs repeat dosing

44
Q

What is the best initial treatment for pyelonephritis?

A

quinolones

45
Q

What are the presenting sx of cystitis?

A

dysuria
suprapubic pain/discomfort
mild or absent fever

46
Q

What is the best initial test for UTI?

What is the most accurate test?

A

initial: UA with >10 WBC
accurate: urine culture

note: when the sx are clear for cystitis and there are WBCs in the urine –> just treat - no need for urine culture or imaging

47
Q

List 5 meds that can be used to tx cystitis.

A
  1. Nitrofurantoin –> uncomplicated tx for 3 days, if anatomic abnormality tx for 7 days
  2. fosfomycin
  3. TMP/SMX
  4. ciprofloxacin - not used routinely in order to avoid resistance
  5. cefixime
48
Q

When should you do a urine culture or imaging with cystitis?

A

When there are frequent episodes that do not respond to treatment

49
Q

What are teh presenting sx of pyelonephritis?

A
  • flank or costovertebral tenderness
  • high fever
  • may have abdominal pain d/t inflamed kidney
  • UA shows increased WBCs
  • perform CT or sonogram to check for anatomical abnormalities
50
Q

What meds can be used to tx pyelonephritis?

A
  • ceftriaxone or ertapenem –> ceftriaxone is the first tx for pyelonephritis
  • until culture is known - ampicillin and gentamicin
  • ciprofloxacin - oral for outpatient tx

Any group of drugs for gram negative bacilli would be effective for pyelonephritis

51
Q

How do you increase the dx yield of urine culture with acute prostatitis?

A

prostate massage

52
Q

What is the tx for prostatitis?

A

Same tx used for pyelonephritis
6-8 wks of ciprofloxacin or TMP/SMX for acute prostatitis

The difference between pyelonephritis tx and prostatitis tx is time. Pyelo tx = 7 days of TMP./SMX, cipro or fluoroquinolones.
Prostatitis is for 6-8 weeks depending on the chronicity

53
Q

The degree of endocarditis is proportional to what?

A

the degree of damaged valve.

54
Q

What kind of valve is associated with the most severe endocarditis?

A

prosthetic valves

55
Q

How would you treat endocarditis caused by

  • Strep viridens
  • S. aureus (susceptible)
  • Fungal
  • S. epi or resistant staph
  • Enterococci
A 
viridens - ceftriaxone x 4 wks 
aureus - oxacillin, nafcillin, cefazolin
Fungal - amphotericin and valve replacement 
epi or resistant staph - vancomycin 
Enterococci - ampicillin and gentimicin
56
Q

How do you treat a tx resistant endocarditis?

A

aminoglycoside and extend the duration of treatment

57
Q

What treatment is added for prosthetic valve endocarditis with staph?

A

rifampin

58
Q

When is surgery needed to tx endocarditis?

A
  • CHF from ruptured valve or chordae tendineae
  • Prosthetic valves
  • Fungal endocarditis
  • abscess
  • AV block
  • recurrent emboli with abx
59
Q

What organisms are difficult to grow in regular media and cause culture negative endocarditis?

What are the 2 most common causes of culture negative endocarditis?

How do you treat infection with these orgs?

A

HACEK

  • Haemophilus aphrophilus
  • Haemophilus parainfluenza
  • Actinobacillus
  • Cardiobacterium
  • Eikenella
  • Kingella

Most common = coxiella and Bartonella

Tx = Ceftriaxone

60
Q

What meds are used to prophylax a patient for endocarditis?

A
  • amoxicillin - prior to surgery

- if allergic - clindamycin, azithromycin, clarithromycin

61
Q

What is the causative organism of Lyme disease?

A

borrelia burgdorferi - carried by the ixoides scapularis deer tick

62
Q

What joint is most commonly affected in lyme disease?

A

Knee

63
Q

What are 3 neurological manifestations of lyme disease?

A
  • meningitis
  • encephalitis
  • cranial nerve palsy = most common neuro presentation 7th CN or Bell’s palsy
64
Q

What is the most common cardiac manifestation of lyme disease?

A

transient AV block

65
Q

What 5 serologic tests can be used to test for lyme?

A

IgG, IgM, ELISA, western blot, PCR testing

66
Q

What is the treatment for the following presentations of lyme disease

  • rash
  • joint, nerve palsy
  • cardiac and neuro manifestations other than 7th cranial nerve
A

Rash - doxycycline, Amoxicillin or cefuroxime
Joint/7th cranial nerve palsy - Doxycycline, Amoxicillin or cefuroxime
Cardiac/neuro other than 7th CN palsy - IV ceftriaxone

67
Q

What is the initial and what is the confirmatory test for HIV in an adult?

A

initial test: ELISA
confirmatory: Western Blot

Infant - PCR or viral culture. ELISA is not accurate b/c mom’s antibodies can be present in infant up to 6 months following delivery.

68
Q

What are 3 ways in which viral load testing by PCR-RNA is helpful in HIV dx?

A
  1. measure response to tx
  2. detect tx failure
  3. Dx HIV in babies

Goal is to drive levels below 50 microliters - this is a good indication that CD4 levels will rise

Life expectancy of someone with undetectable levels of HIV virus is the same as someone not infected with HIV

69
Q

When should you do genotyping/viral resistance testing of a pt infected with HIV?

How many medications and from how many different classes of medications should be used to treat HIV?

A
  • prior to tx start
  • when pt is not responding to tx

3 meds from 2 different classes.

70
Q

List 3 different reasons for which HIV treatment would be started.

A
  1. CD4 count below 500 in asymptomatic pt
  2. Very high viral load >100,000
  3. Opportunistic infections are present

Antiretroviral meds are acceptable to start even if CD4 count is above 500

Note: CD4 count rising lags behind decrease in viral load

71
Q

What is the best treatment to start in an HIV pt?

What is an alternate to this, if the pt is resistant?

A

Atripla = emtricitabine, tenofovir, efavirenz

Either: atazanavir, darunavir, raltegravir combined with emtricitabine/tenofovir

72
Q

What med is given to boost levels of darunavir or atazanavir?

A

Ritonivir

73
Q

What are the 3 classes of the first line antiretroviral medications?

A
  • Nucleoside and nucleotide reverse transcriptase inhibitors
  • Non-nucleoside RTI
  • Protease inhibitor
74
Q

What are the 2 classes of 2nd line HIV antiretrovirals?

A 
- Entry inhibitors 
       Enfuvirtide
       Maraviroc
- Integrase inhibitor 
       Raltegravir 
       Dolutegravir 
       Elvitegravir with cobicistat (cobicistat inhibits the metabolism of elvitegravir - increases levels)
75
Q

What is the postexposure prophylaxis regimen for someone with a significant HIV needle stick or sexual exposure?

A

combo therapy x 4 weeks

76
Q

List the adverse effects of the following meds

  • Zidovudine
  • Stavudine and didanosine
  • Abacavir
  • Protease inhibitor
  • indinavir
  • Tenofovir
A
  • Zidovudine –> anemia
  • Stavudine and didanosine –> peripheral neuropathy and pancreatitis
  • Abacavir –> hypersensitivity (determined by HLA B5701), SJS
  • Protease inhibitor –> hyperlipidemia, hyperglycemia
  • Indinavir –> Nephrolithiasis
  • Tenofovir –> Renal insufficiency
77
Q

What antiretroviral should be avoided in pregnancy?

What are the treatment guidelines for a pregnant HIV + mother?

A

No Efavirenz - teratogenic in animals –> replace with protease inhibitor

  • Mom needs to be on treatment throughout pregnancy regardless of viral load and CD4 count - to prevent perinatal transmission
  • Administer Zidovudine during delivery
  • make sure viral load is controlled by time of parturition
  • must do C-section if viral load is >1000
  • CD4 count and viral load have no bearing on HIV treatment of pregnant woman - always always always treat with antiretrovirals
78
Q

What med should an infant born to a mother positive for HIV be given and for how long?

A

Zidovudine during delivery and for 6 weeks following delivery.

Infectious disease (5 decks)

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