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Master the Boards > MTB - Infectious Disease > Flashcards

MTB - Infectious Disease Flashcards

1
Q

Main body areas affected by staph.aureus infection

A

bone, heart, skin, joint

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2
Q

DOC: sensitive staph. aureus (MSSA)

A

IV: oxacillin/nafcillin or cefazolin (first gen ceph)
oral: dicloxacillin or cephalexin (first gen ceph)

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3
Q

DOC: MRSA - severe infection

A

vancomycin, linezolin, daptomycin, ceftaroline, tigecycline or telavancin

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4
Q

televancin

A

vancomycin derivative w/ similar efficacy

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5
Q

DOC: minor MRSA infection

A

TMP-SMX, clindamycin, doxycycline

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6
Q

penicillin allergy (tx of staph aureus)

A

rash - cephalosporins safe
anaphylaxis - macrolides or clindamycin
if severe infection –> vancomycin, linezolid, daptomycin, telavancin

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7
Q

which antibiotics are specific for streptococcus?

A

penicillin
ampicillin
amoxicillin

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8
Q

which drug class works synergistically with other agents to tx. staph and strep?

A

aminoglycosides

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9
Q

which drugs are excellent anti-anaerobic medications?

A

carbapenems

- also cover all strep and all MSSA

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10
Q

tigecycline

A

MRSA

broad action against gram negative bacilli

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11
Q

which drugs are excellent pneumococcal drugs?

A

levofloxacin, gemifloxacin, moxifloxacin

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12
Q

Piperacillin/ Ticarcillin

A

cover gram negative rods, streptococci and anaerobes

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13
Q

Only carbapenem that does not cover pseudomonas

A

ertapenam

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14
Q

DOC: abdominal anaerobes

A

metronidazole

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15
Q

only cephalosporins that cover anaerobes

A

cefoxitin, cefotetan

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16
Q

which other drug classes have equal efficiacy to metronidazole for abdominal anaerobes

A

carbapenems
piperacillin
ticarcillin

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17
Q

DOC: respiratory anaerobes (resp strep)

A

clindamycin

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18
Q

medications with NO anaerobic coverage

A 
aminoglycosides
aztreonam
FQs
oxacillin/nafcillin
all cephalosporins
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19
Q

s/e: daptomycin

A

myopathy

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20
Q

s/e: linezolid

A

low platelets

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21
Q

s/e: imipenem

A

seizures

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22
Q

s/e: vancomycin

A

red man syndrome –> red, flushed skin from histamine release due to rapid infusion rates. If this happens - slow the infusion rate down (no need to switch medications)

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23
Q

Tx. herpes simplex, varicella zoster

A

acyclovir, valacyclovir, famciclovir

- all are equal in efficacy

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24
Q

Tx. CMV

A

valganciclovir, ganciclovir, foscarnet

  • equal in efficacy
  • also cover HSV and VZV
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25
Q

best long term therapy for CMV retinitis

A

valganciclovir

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26
Q

s/e: valganciclovir and ganciclovir

A

bone marrow suppresion, neutropenia

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27
Q

s/e: foscarnet

A

renal toxicity

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28
Q

tx. infuenza A and B

A

oseltamavir and zanamavir (neuraminidase inhibitors)

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29
Q

Tx. Hepatitis C and RSV

A

ribavirin

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30
Q

Fluconazole - what does it cover?

A

candida (oral and vaginal), cryptococcus

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31
Q

Itraconazole

A

same as fluconazole but harder to use therefore, rarely initial therapy for anything

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32
Q

what drug covers all the candida species?

A

voriconazole

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33
Q

best agent against aspergillus?

A

voriconazole

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34
Q

s/e: voriconazole

A

visual disturbances

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35
Q

Echinocandins

A

caspofungin, micafungin, anidulafungin

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36
Q

What are the echinocandins useful for?

A

neutropenic fever patients (less mortality than amphotericin) but do NOT cover cryptococcus

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37
Q

a/e: echinocandins

A

none - affect/inhibit 1,3 glucan synthesis which does not exist in humans

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38
Q

what drug is effective against all candida, cryptococcus and aspergillus?

A

amphotericin

- but basically there is a drug from above classes that is better or equal to with less side effects

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39
Q

s/e: amphotericin

A

renal toxicity
hypokalemia
metabolic acidosis
fever, shakes, chills

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40
Q

best initial test in suspected osteomyelitis?

A

Plain X-Ray

although may take up to 2 weeks before changes are seen

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41
Q

best 2nd line test of osteomyelitis (i.e. negative XR but high clinical suspicion)

A

MRI

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42
Q

most accurate test for osteomyelitis?

A

bone biopsy and culture

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43
Q

earliest finding of osteomyelitis in XR

A

elevation of periosteum

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44
Q

best method for following response to therapy in osteomyelitis

A

ESR

- if still elevated after 4-6 weeks of therapy, further treatment or surgical debridement may be necessary

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45
Q

MCC of osteomyelitis

A

continguous spread from overlying tissue

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46
Q

which test is more superior in osteomyelitis - MRI vs. bone scan?

A

MRI

- they have equal sensitivity but MRI is far more specific

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47
Q

in osteomyelitis, is culturing the sinus tract or ulcer beneficial?

A

no - you should not do this

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48
Q

MCC osteomyelitis

A

staphylococcus

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49
Q

Tx. osteomyelitis

A

if sensitive: IV oxacillin or nafcillin for 4-6 weeks
if MRSA: vanco, linezolid or daptomycin
–> ORAL therapy is never appropriate

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50
Q

what must be done prior to initiating treatment for osteomyelitis?

A

bone biopsy/culture

- no urgency in treating chronic osteomyelitis; obtain biospy, move clock forward and tx. what you find on culture

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51
Q

which type of osteomyelitis can be treated with oral drugs?

A

pseudomonas or salmonella osteomyelitis

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52
Q

patient comes in with itching and drainage from the external auditory canal; on physical exam, his ear is painful to manipulation - likely dx?

A

otitis externa

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53
Q

Dx. otitis externa

A

physical exam - no culture

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54
Q

Tx. otitis externa

A
  1. topical antibiotics - ofloxacin or polymyxin/neomycin
  2. add topical hydrocortisone (helps swelling/itching)
  3. add acetic acid/water solution to reacidify
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55
Q

malignant otitis externa

A

osteomyelitis of the skull caused by pseudomonas in a patient with diabetes

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56
Q

dx. malignant otitis externa

A

tx. like osteomyelitis (XR, MRI, bone biopsy/culture)

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57
Q

tx. malignant otitis externa

A

surgical debridement

antibiotics -> cipro, piperacillin, cefipime, carbapenem, aztreonam

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58
Q

most sensitive finding of otitis media

A

immobility of tympanic membrane

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59
Q

CF: otitis media

A 
redness
bulging TM
decreased hearing
absent light reflex
decreased mobility of TM
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60
Q

best initial therapy otitis media

A

amoxicillin, 7-10 days

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61
Q

recurrent or persistent otitis media - management?

A

tympanocentesis and aspirate of TM for culture

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62
Q

CCS otitis media

A

advance clock 3 days - if infection not improving, switch amoxicillin to: amoxi-clav, cefdinir, ceftibuten, cefuroxime, cefprozil, cefpodoxime

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63
Q

best initial test: sinusitis

A

sinus XR

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64
Q

most accurate test: sinusitis

A

sinus aspirate for culture

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65
Q

when should you use antibiotics to treat sinusitis?

A
  • fever and pain
  • persistent sx. despite 7d of decongestants
  • purulent nasal d/c
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66
Q

organisms that cause sinusitis (and otitis media)

A

Strep pneumo
H.flu
Moraxella catarrhalis

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67
Q

tx. sinusitis

A

first sx –> decongestants

second –> amoxicillin + inhaled steroids

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68
Q

CF: pharyngitis

A

pain/sore throat
exudates
adenopathy
no cough/hoarseness

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69
Q

best initial test: pharyngitis

A

rapid strep test

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70
Q

tx. pharyngitis

A

amoxicillin/penicillin

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71
Q

tx. pharyngitis is allergic to penicillin

A

azithromycin or clarithromycin

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72
Q

next best step in patient that has influenza symptoms

A

viral antigen detection of nasopharyngeal swab

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73
Q

tx, influenza

A

oseltamavir or zanamavir - if pt presents w/in 48 hr onset of symptoms. If not - symptomatic therapy

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74
Q

Impetigo - organisms

A

strep pyogenes or staph aureus

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75
Q

what is impetigo?

A

superficial bacterial skin infection (epidermal layer)

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76
Q

CF: impetigo

A

weeping,”honey” crusting and oozing of the skin

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77
Q

tx. impetigo

A

topical mupirocin or retapamulin

severe? oral dicloxacillin or cephalexin

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78
Q

community acquired MRSA impetigo

A

TMP/SMX

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79
Q

erysipelas

A

group A (pyogenes) strep infection; MC location - face

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80
Q

Dx. testing in erysipelas

A

order blood cultures on CCS but single best answer: start treatment

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81
Q

best initial therapy: erysipelas

A

oral dicloxacillin or cephalexin

- if confirmed group A strep: penicillin VK

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82
Q

can erysipelas lead to rheumatic fever?

A

no - only glomerulonephritis

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83
Q

if there is cellulitis of the leg - what should you order?

A

LE Doppler to exclude a blood clot

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84
Q

MCC of cellulitis

A

staphylococcus aureus and streptococcus pyogenes

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85
Q

Tx. cellulitis (minor dz)

A

PO - dicloxacillin or cephalexin

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86
Q

Tx. cellulitis (severe dz)

A

oxacillin, nafcillin or cefazolin IV

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87
Q

T/F: does staph epidermidis cause skin infections - if true, which one?

A

false - normal skin flora

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88
Q

folliculitis

A

staph infection of hair follicle

increasing in size: furuncle < carbuncle < boil < abscess

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89
Q

Tx. folliculitis/furuncles/carbuncles/boils

A

same as for cellulitis
PO - dicloxacillin or cephalexin
IV - oxacillin, nafcillin or cefazolin

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90
Q

best initial test for fungal infection of the skin

A

KOH preparation

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91
Q

Tx. fungal skin infection (no hair or nail involvement)

A

clotrimazole, miconazole, ketoconazole, nystatin, ciclopirox etc

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92
Q

Tx. fungal skin infection involving hair (scalp) or nails

A

PO anti-fungals –> terbenafine, itraconazole or griseofulvin

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93
Q

s/e terbinafine

A

elevated LFTs

94
Q

urethral discharge is always a sign of….

A

urethritis

+/- dysuric symptoms

95
Q

Dx. testing urethritis

A

urethral swab - gram stain, WBC, culture, DNA probe

NAAT

96
Q

Tx. urethritis

A

two drugs - need to target gonorrhea and chlamydia

  1. Ceftriaxon IM or PO Cefpodoxime
  2. Azithromycin (single dose) or doxycycline 7d
97
Q

patient is presenting with recurrent episodes of gonorrhea - what should they be tested for?

A

terminal complement deficiency

98
Q

CF: disseminated gonorrhea

A
  1. petechial skin rash
  2. polyarticular disease
  3. tenosynovitis
99
Q

single best test for both gonorrhea or chlamydia

A

NAAT

- blind swab for NAAT is just as accurate as speculum examination

100
Q

Tx. cervicitis

A

exactly same as urethritis - cover for gonorrhea and chlamydia

  1. Ceftriaxon IM or PO Cefpodoxime
  2. Azithromycin (single dose) or doxycycline 7d
101
Q

Pt presents with lower abdominal pain, tenderness, fever, dysuria, discharge and cervical motion tenderness - you suspect?

A

pelvic inflammatory disease

102
Q

in PID - what test is a measure of severity of the disease?

A

WBC count - leukocytosis

103
Q

best initial test in suspected PID

A

pregnancy test –> cervical culture –> DNA probe

104
Q

most accurate test for dx of PID

A

laparoscopy –> only done for recurrent or persistent infection despite therapy

105
Q

what kind of specimens can you use for NAAT?

A

men - urine

women - blind vaginal swab

106
Q

Outpatient Tx. PID

A

IM Ceftriaxone

Doxycycline PO

107
Q

Inpatient Tx. PID

A

IV Cefoxitin or Cefotetan
PO doxycycline
+/- Metronidazole

108
Q

What abx are safe in pregnancy?

A 
Penicillins
Cephalosporins
Aztreonam
Erythromycin
Azithromycin
109
Q

Male pt presents with painful and tender testicle w/ normal position of testicle in scrotum - dx?

A

epididymo-orchitis

110
Q

Tx. Epididymo-orchitis

A

< 35: Ceftriaxone + Doxy

> 35: FQs

111
Q

best initial test for chancroid

A

swab for gram stain (gram neg.) and culture (medium: Nairobi or Mueller-Hinton medium)

112
Q

Tx. chancroid

A

single dose of either: IM Ceftriaxone or PO Azithromycin

113
Q

CF: lymphogranuloma venereum

A

genital ulcer + large, tender LN that may develop suppurating, draining sinus tracts

114
Q

Dx. lymphogranuloma venereum

A

serology for Chlamydia trachomatis

115
Q

Tx. lymphogranuloma venereum

A

Doxycycline or Azithromycin

116
Q

clear vesicular lesions on genitals - dx?

A

Herpes simplex virus

117
Q

Next best step in management in pt who presents with multiple, clear vesicular lesions on genitals

A

Antivirals for 7-10d

acyclovir, valacyclovir or famciclovir

118
Q

which anti-viral is safe to use in pregnancy?

A

acyclovir

- use in pregnancy if evidence of active lesions at 36 weeks

119
Q

when would you do a Tzanck prep?

A

If patient has multiple vesicular genital lesions that have become ulcers

120
Q

most accurate test for herpes

A

viral culture

121
Q

acyclovir resistant herpes is treated with…

A

foscarnet

122
Q

most accurate test in primary syphillis

A

darkfield microscopy

123
Q

initial diagnostic test in primary syphillis

A

darkfield then VDRL/RPR

124
Q

Tx. primary syphillis

A

single IM dose of penicillin

penicillin allergy? doxycycline

125
Q

Jarisch-Herxheimer reaction

A

patients being treated for primary syphillis may develop fever, headache and myalgia 24 hours after starting treatment; it is self-limiting; tx. w/ aspirin

126
Q

CF: secondary syphillis

A

rash
mucous patches
alopecia areata
condyloma lata

127
Q

initial dx. test in secondary syphillis

A

RPR and FTA

128
Q

Tx. secondary syphyllis

A

single IM dose of penicillin

doxy for pen-allergic pts

129
Q

when do you do desensitization for tx. of a syphillis patient?

A

pregnancy

neurosyphilis

130
Q

initial dx. test in tertiary syphillis

A

RPR or FTA

LP for neurosyphilis

131
Q

Tx. tertiary syphilis

A

IV penicillin

desensitize if pen-allergic

132
Q

which test is more sensitive for neurosyphillis?

A

FTA > VDRL

133
Q

granuloma inguinale

A

cause: Klebsiella granulomatis

beefy red genital lesion that ulcerates

134
Q

dx. granuloma inguinale

A

biopsy or touch prep

135
Q

tx. granuloma inguinale

A

doxycycline, TMP/SMX or azithromycin

136
Q

best initial test for cystitis

A

urinalysis

137
Q

most accurate test for cystitis

A

urine culture

138
Q

Tx. uncomplicated cystitis

A

PO TMP/SMX 3d; if E.coli resistance 20% - Cipro or Levofloxacin

139
Q

Tx. complicated cystitis

A

7d TMP/SMX or Ciprofloxacin

140
Q

what is complicated cystitis?

A

means there is an anatomic abnormality such as a stone, stricture, tumor or obstruction

141
Q

who should get an USG if they have cystitis?

A

Men - it is unusual for a male patient to have a UTI in absence of anatomic abnormality

142
Q

does everyone need a urine culture if you suspect cystitis?

A

No - clear symptoms + leukocytes on U/A –> go straight to treatment for 3d

143
Q

Tx. outpatient pyelonephritis

A

Ciprofloxacin

144
Q

Tx. inpatient pyelonephritis

A

ampicillin / gentamicin

145
Q

nitrites on U/A are indicative of…

A

gram negative infection

146
Q

a patient with diagnosed pyelonephritis is not responding to tx. with antibiotics after 7 days - what should you be considering?

A

pyelonephric abscess

147
Q

Initial test in suspected pyelonephric abscess

A

CT scan or USG

148
Q

Tx. pyelonephric abscess

A

quinolone and staph coverage (oxacillin/nafcillin)

149
Q

prostatitis - best initial test

A

urinalysis

150
Q

prostatitis - most accurate test

A

WBCs on U/A after prostate massage

151
Q

Tx. prostatitis

A

ciprofloxacin - extended period of time

152
Q

how many Duke’s criteria do you need to dx. infectious endocarditis?

A

2 major
1 major + 3 minor
5 minor

153
Q

Duke’s Major Criteria (2)

A
  1. Two positive blood cultures

2. Abnormal echo

154
Q

Duke’s Minor Criteria (5)

A
  1. Fever > 38.5
  2. Presence of RFs: IVDA, structural heart dz, prosthetic valves, dental procedures, positive history
  3. vascular findings
  4. immunologic findings
  5. positive blood culture
155
Q

Next best step in patient with fever + new or changing heart murmur

A

blood culture

- if positive –> do an ECHO

156
Q

best empiric therapy - infective endocarditis

A

Vancomycin + Gentamicin for 4-6 weeks

157
Q

patient with infective endocarditis, blood cultures grow S. bovis - what test should be done?

A

colonoscopy

- S.bovis is assoc. w/ colonic pathology

158
Q

When do you consider valve replacement as a tx. for infective endocarditis?

A
  1. anatomic defects
    - valve rupture
    - abscess
    - prosthetic valves
  2. fungal infections
  3. embolic events ones started on abx
159
Q

which cardiac defects need endocarditis prophylaxis?

A
  1. prosthetic valves
  2. unrepaired cyanotic heart dz
  3. previous endocarditis
  4. transplant recipients who develop valve dz
160
Q

which procedures need endocarditis prophylaxis?

A
  1. dental procedures that cause bleeding
  2. respiratory tract surgery
  3. surgery of infected skin
161
Q

DOC: endocarditis prophylaxis

A

amoxicillin

162
Q

when should you start HAART therapy?

A
  1. CDC < 500
  2. symptomatic regardless of CDC
  3. pregnancy
  4. needle stick scenario w/ HIV positive patient
163
Q

S/E: NRTIs

A

lactic acidosis

164
Q

S/E: protease inhibitors

A

hyperglycemia

hyperlipidemia

165
Q

S/E: NNRTIs

A

drowsiness

166
Q

s/e: zidovudine

A

anemia

167
Q

s/e: didanosine

A

pancreatitis

peripheral neuropathy

168
Q

s/e: stavudine

A

pancreatitis

peripheral neuropathy

169
Q

s/e: abacavir

A

rash

170
Q

s/e: indinavir

A

kidney stones

171
Q

post-exposure prophylaxis (HIV)

A

i.e. needlestick, mucosal exposure or unprotected sex

Tx. HAART for one month

172
Q

when do you start prophylaxis for PCP in HIV + and what do you use?

A

CDC < 200
Tx. TMP/SMX
- use atovaquone or dapsone if rash develops

173
Q

MAC prophylaxis in HIV +

A

CDC < 50

Tx. PO azithromycin, once weekly

174
Q

what opportunistic infection presents w/ SOB, dry cough, hypoxia and increased LDH?

A

PCP

175
Q

best initial test for PCP?

A

CXR (increased interstitial markings)

176
Q

most accurate test for PCP?

A

broncheoalveolar lavage

177
Q

best initial tx. for PCP?

A

IV TMP/SMX
if rash - use IV pentamidine
mild cases? IV atovaquone

178
Q

Tx. severe PCP (pO2 < 70 and A-a gradient > 35)

A

IV TMP/SMX plus steroids

179
Q

HIV+ pt presents with headache, nausea, vomiting and focal neuro findings - you suspect…and order what test first?

A

toxoplasmosis

best initial test - head CT w/ contrast

180
Q

Tx. toxoplasmosis

A

pyrimethamine and sulfadiazine for 2 weeks

repeat head CT - if lesions smaller confirmation of toxo; if unchanged - biopsy needed

181
Q

HIV pt with a CDC < 50 presents with blurry vision - what are you concerned about? best initial test?

A

CMV retinitis

- performed dilated ophtho examination

182
Q

Tx. CMV retinitis

A

ganciclovir or foscarnet

maintenance therapy w/ valganciclovir is lifelong

183
Q

HIV pt with CDC < 50 presents with fever and headache - which diagnostic test should you do? best initial vs. most accurate?

A

Lumbar puncture - increased lymphocytes
best initial = india ink stain
most accurate = cryptococcus antigen test

184
Q

Tx. cryptococcus in HIV pt

A

Amphotericin followed by lifelong fluconazole

185
Q

Patient with exposure to food and animal urine presents with fever, abdominal pain and muscles aches. He has jaundice. Dx?

A

Leptospirosis

186
Q

Tx. leptospirosis

A

ceftriaxone or penicillin

187
Q

A rabbit hunter presents to you with enlarged LNs, conjunctivitis and a large ulcer on his hand. Dx?

A

Tularemia

188
Q

Dx test and Tx. of tularemia

A

Serology

Tx. bentamicin or streptomycin

189
Q

Management in patient with characteristic erythema migrans rash

A

Tx. with doxycycline w/o further testing

190
Q

MC late manifestation of Lyme dz

A

joint dz

191
Q

MC cardiac manifestation of Lyme dz

A

AV conduction block/defect

192
Q

MC neurologic manifestation of Lyme dz

A

7th CN palsy

193
Q

Tx, rash, joint dz or Bell’s palsy as a complication of Lyme dz

A

PO doxycycline or amoxicillin

194
Q

Tx. CNS or cardiac involvement as a result of Lyme dz

A

IV ceftriaxone

195
Q

Patient presents to you after a camping trip with hemolytic anemia - dz?

A

Babesiosis

196
Q

Dx. babesiosis

A
  1. peripheral blood smear
    - tetrads of intraerythrocytic ring forms
  2. PCR
197
Q

Tx. babesiosis

A

azithromycin and atovaquone

198
Q

Patient comes back from a camping trip with elevated LFTs, thrombocytopenia and leukopenia - dz?

A

Ehrlichia

199
Q

Dx. Ehrlichia

A

peripheral blood smear

- morulae (inclusion bodies in WBCs)

200
Q

Tx. ehrlichia

A

doxycycline

201
Q

Tx. acute malaria

A

quinine + doxycycline

202
Q

Prophylaxis for malaria

A
  1. Weekly Mefloquine

2. Daily Atovaquone/Proguanil

203
Q

S/e: mefloquine

A

neuropsychiatric s/e
sinus bradycardia
QT prolongation

204
Q

branching gram positive filaments that are weakly acid fast

A

Nocardia

205
Q

Tx. Nocardia

A

TMP/SMX

206
Q

best initial test / most accurate test - Nocardia

A

best initial = CXR

most accurate = culture

207
Q

gram positive branching, filamentous bacteria that growns on anaerobic culture

A

Actinomyces

- look for pt w/ history of dental or facial trauma

208
Q

Tx. actinomyces

A

penicillin

209
Q

Patient who was just bat cave exploring in Ohio presents with a viral-like syndrome along with oral ulcers and splenomegaly - dx?

A

histoplasmosis

210
Q

best initial test - histoplasmosis

A

urine antigen test

211
Q

most accurate test - histoplasmosis

A

biopsy + culture

212
Q

Tx histoplasmosis

A

acute pulmonary dz - no tx

disseminated dz - amphotericin

213
Q

Acute resp illness that causes joint pain and erythema nodosum - dry areas like Arizona

A

Coccidioidomycosis

214
Q

Tx. coccidioidomycosis

A

itraconazole

215
Q

Acute pulm dz that may have bone lesions; Broad budding yeast from the rural southeast

A

Blastomycosis

216
Q

Tx. blastomycosis

A

amphotericin or itraconazole

217
Q

how can you identify traumatic LP?

A

RBC > 6000/mm3 without xanthochromia

elevated WBC - 1:750-1000 RBCs

218
Q

CSF WBC:RBC ratio < 0.01

A

100% negative predictive value for meningitis`

219
Q

treatment of pregnant woman with chlamydia

A

erythromycin base 500 mg QID for 7d

amoxicillin 500 mg PO TID for 7d

220
Q

chemoprophylaxis of meningococcal meningitis

A
  1. Rifampin 600 mg PO bid for 4 doses

2. Ciprofloxacin 500 mg PO single dose

221
Q

Which drug(s) does Rifampin interfere with?

A

steroids ex. OCP (decreases levels) - use an alternative

222
Q

post-exposure prophylaxis of health care workers exposed to contagious patient with TB

A
  1. immediate placement of PPD
    - baseline immunologic status
  2. repeat PPD test after three months
    - check for any changes due to recent exposure
223
Q

tick paralysis

A

progressive ascending paralysis that occurs over matter of hours/days; fever and pupillary abnormalities are uncommon

224
Q

management: tick paralysis

A

removal of tick - substantial improvement in paresis w/in hours

225
Q

ecythema gangrenosum

A

lesions of skin/mucous membranes that rapidly worsen and evolve into nodular patches marked by hemorrhage, ulceration and necrosis; caused by pseudomonas invasion of media and adventitia of arteries and veins followed by ischemic necrosis

226
Q

Tx. pseudomonas bacteremia

A
  1. aminoglycoside (tobramycin, amikacin) + piperacillin

2. antipseudomonal cephalosporin (ceftazidime, cefipime)

227
Q

tx. herpes zoster

A

oral acyclovir, 800 mg 5x/day
steroids may help accelerate healing time but should not be used in patients with other comorbidities (diabeter, osteoporosis, HTN, glaucoma)

228
Q

do patients with herpes zoster need to be placed in isolation?

A

if immunocompetent with localized case - no!

contact precautions recommended for hospitalized patients, pts with disseminated zoster or immunocompromised pts

229
Q

tx. postherpetic neuralgia

A

TCAs (desimipramine, amitriptyline)
topical capsaicin
gabapentin
long acting oxycodone

230
Q

cause of HIV lipodystrophy

A

dyslipidemia

insulin resistance

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