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COMLEX 2 > OME Review > Flashcards

OME Review Flashcards

1
Q

What is empiric Abx therapy for inpatient and outpatient community acquired pneumonia?

A

Inpatient: ceftriaxone + azithromycin
Outpatient: azithromycin only
In case of life-threatening beta-lactam allergy: moxifloxacin

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2
Q

What is empiric Abx therapy for HCAP?

A

vancomycin + pip-tazo (if you can’t use vancomycin, use linezolid; if you can’t use pipTazo, use meropenem)

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3
Q

What is empiric Abx therapy for meningitis?

A

vancomycin, ceftriaxone (2g BID), methlyprednisone, +/- ampicillin if immunocompromised

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4
Q

What is the empiric Abx therapy for UTI outpatient? Pyelonephritis?

A

Outpatient: amoxicillin or nitrofurantoin if beta-lactam allergic (can use TMP-SMX, but it’s not better; DO NOT use ciprofloxacin)

Pyelo: ceftriaxone

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5
Q

What is the empiric Abx therapy for cellulitis?

A

Strep: outpatient: amoxicillin; inpatient: ceftriaxone

Staph: clindamycin, vancomycin

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6
Q

What is the general formula for treatment of HIV?

A

2+1, meaning 2 nucleotide reverse transcriptase inhibitors + 1 of something else (non-nucleotide reverse transcriptase inhibitor or protease inhibitor + ritonovir, or entry inhibitor, or fusion inhibitor)

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7
Q

What is PrEP?

A

Pre-exposure prophylaxis against HIV - Emtircitabine + Tenofavir

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8
Q

What is PEP?

A

post-exposure prophylaxis against HIV - Emtircitabine + Tenofavir still +/- raltegravir

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9
Q

What is used as vertical transmission prophylaxis in a pregnant patient with newly diagnosed HIV?

A

AZT

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10
Q

Path, Pt, Dx, and Tx of anti-retroviral syndrome

A

Path: acute HIV infection
Pt: “flu” with negative flu test, negative mono spot (ELISA will also be negative at this point)
Dx: PCR = viral load
Tx: anti-retrovirals = 2+1

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11
Q

What bug are you at risk for at a CD4 count of 200? What drug is used as prophylaxis against this?

A

PCP; TMP-SMX > dapsone > atovaquone

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12
Q

What bug are you at risk for at a CD4 count of 100? What drug is used as prophylaxis against this?

A

Toxo; TMP-SMX (so you’re good unless you couldn’t take TMP-SMX for prophylaxis against PCP, in which case you can use pyromethamine or leucovorin

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13
Q

What bug are you at risk for at a CD4 count of 50? What drug is used as prophylaxis against this?

A

MAC; Azithromycin weekly

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14
Q

If a PPD test for TB comes back as exposed, what is the next step in diagnosis? What are the possible outcomes of this next step?

A

CXR
If negative -> latent TB
If positive -> next step

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15
Q

What is the Abx treatment for latent TB?

A

Isoniazid + Vitamin B6 for 9 months

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16
Q

If a PPD test for TB comes back as exposed, and the CXR is positive, what is the next step in workup? What are the possible outcomes of this next step?

A

AFB smear
If negative -> latent TB (Tx with isoniazid + VitB6 for 9 months)
If positive -> RIPE Tx

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17
Q

What is RIPE treatment for active TB? What are their side effects?

A

Rifampin -> turns everything red (urine, tears, eyes, etc)
Isoniazid -> peripheral neuropathy (have to give VitB6)
Pyrazinamide -> hyperuricemia (gout)
Ethambutol -> eye problems (red-green color blindness)

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18
Q

What are the positive PPD testing cut offs for the varying groups of people?

A 
>/= 5mm -> close contacts, HIV/AIDs, chemo, transplant, anergy
>/= 10mm -> Healthcare workers, prison, homeless, travel to endemic areas
>/= 15mm -> soccer mom
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19
Q

What is the SIRS criteria?

A 
Need 2/4:
Temp > 38 or < 36
WBC > 12k or < 4k
HR > 90
RR > 20
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20
Q

What is the criteria for the diagnosis of sepsis?

A

SIRS 2/4 + source of infection

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21
Q

What is the difference between severe sepsis and septic shock?

A

severe sepsis: meets septic criteria + >/= 1 organ dysfunction (usually hypotension) that is responsive to fluid

septic shock: >/= 1 organ in dysfunction that is not responsive to fluids)

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22
Q

What is the diagnostic criteria for multi organ dysfunction?

A

> /= 2 organ dysfunctions not responsive to fluid (literally dying)

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23
Q

What are the goals of sepsis treatment?

A

CVP between 10-12
Urinary output >/= 0.5 cc/kg/hour
MAP >/= 65mmHg
Central venous O2 sat >/= 70%

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24
Q

What is the treatment of sepsis?

A
  1. fluids (2-3 L) and Abx
  2. Remove source of infection (foley, catheter, drain abscess, etc)
  3. vasopressors
25
Q

What symptoms/signs indicate that it is unsafe to do a LP? What is the next step when you determine it is unsafe to do a LP?

A

FND, AMS, immunosuppression, lesion, seizures

Give Abx + get a CT scan

26
Q

What signs on LP indicate bacterial meningitis?

A

1000s of PMNs

27
Q

What is the empiric treatment of bacterial meningitis?

A

ceftriaxone, vancomycin, steroids, +/- ampicillin for immunosuppression

28
Q

Meningitis Sx + fever, rash that moves from arms to trunk, patient has recently been camping - Dx?

A

Rocky Mountain Spotted Fever (look for Ab on CSF)

29
Q

Meningitis Sx + travel to Connecticut, targeted rash with arthralgias, arrhythmias - dx?

A

Lyme disease (look for Lyme Ab)

30
Q

Meningitis Sx + AIDS patient with fever and a headache, > 20 cm H2O opening pressure - Dx?

A

Crytptococcal meningitis (cryptococcal Ag; do not use India ink)

31
Q

Meningitis Sx + night sweats, weight loss, hemoptysis, and meningitis in a homeless person - dx?

A

TB (homeless, prison, endemic areas, etc)

32
Q

What other signs will you look for in a case of syphilis meningitis? How do you diagnose this?

A

primary = chancre
secondary = erythema multiforme
tertiary = any neuro sx
(CSF RPR or CSF Ab)

33
Q

What is the treatment for cryptococcal meningitis?

A

amphotericin

34
Q

What is the treatment for Rocky Mountain spotted fever meningitis?

A

ceftriaxone

35
Q

What is the treatment for lyme meningitis?

A

ceftriaxone

36
Q

What is the treatment for TB meningitis?

A

RIPE

37
Q

If you hear temporal lobe or hemorrhagic tap in relation to meningitis/encephalitis - what should you think of? How do you diagnosis? What is the tx?

A

HSV -> HSV PCR -> acyclovir

38
Q

path, pt, dx, and tx of cellulitis

A

Path: subq, staph, strep A
Pt: red, hot tender; well-demarcated; usually has site of entry
Dx: clinical
Tx: depends on organism and toxic vs nontoxic

39
Q

What is one way to differentiate between staph and strep as a cause of cellulitis?

A

Staph: grows in (forms abscess)
Strep: grows out (no formation of abscess)

40
Q

What is the treatment of cellulitis based on organism and toxic vs nontoxic?

A

Nontoxic:
Strep: 1st gen ceph (PO) (cephalexin or cephazolin)
Staph: TMP-SMX, clinda (PO)

Toxic: Pip/Tazo, Amp/Clav (IV)
Strep: Vanc, Linezolid, clinda (IV)

41
Q

path, pt, dx, tx, and f/u of osteomyelitis

A

Path: bone, hematogenous spread, direct innoculation
pt: wound probe done; recurrent/refractory cellulitis (cellulitis should be treated in 5-10 d)
dx: 1st X-ray (usually not positive until after 2 weeks0; 2nd MRI (best radiographic test); biopsy is the best test
Tx: debridement; 4-6 weeks of Abx
F/u: ESR, CRP

42
Q

path, pt, dx, and tx of gas gangrene

A

Path: clostridium perfringenes
Pt: penetrating wound that got contaminated; crepitus
Dx: X-ray that shows gas
Tx: debridement, penicillin + clinda

43
Q

path, pt, dx, and tx of necrotizing fasciitis

A

Path: strep, staph
Pt: cellulitis and something else (toxic, rapidly spreading, or failure of Abx, pain out of proportion, crepitus), blue-gray discoloration
Dx: 1st X-ray that shows gas
Tx: immediate surgical debridement, 3rd gen cephalosporin (ceftriaxone) + clinda + ampicillin

44
Q

What is the most common cause of osteomyelitis?

A

staph aureus

45
Q

What is the most common cause of osteomyelitis in a patient with sickle cell anemia?

A

salmonella

46
Q

What is the most common cause of osteomyelitis in a patient with a penetrating wound or snake bite?

A

pseudomonas

47
Q

What is the most common cause of osteomyelitis in a patient with a diabetic foot?

A

pseudomonas

48
Q

What is the most common cause of osteomyelitis in a patient with oysters or cirrhosis?

A

vibrio vulnificus

49
Q

What is the most common cause of osteomyelitis in a gardener?

A

sporothrix

50
Q

What are the most common causes of CAP?

A

S. pneumo (MC)
M. catarrhalis
H. flu (COPD or smokers)

Klebsiella (alcoholics)
S. areas (after viral illness)
Legionella (immunosuppressed)

51
Q

What is the treatment for CAP?

A

3rd gen cephalosporin + macrolide (azithromycin) or respiratory fluoroquinolone like moxifloxacin

52
Q

What are the 2 main causes of healthcare-associated pneumonia? What is the treatment?

A

pseudomonas
MRSA

Pip-tazo or cefepime
vancomycin

53
Q

What is the next step after a CXR is positive for a cavitary lesion? What are the 3 possible outcomes?

A

CT scan that will show:

  1. fungus
  2. TB
  3. abscess
54
Q

What is the treatment for a pulmonary abscess?

A

Does NOT need to be drained.

3rd gen ceph + clindamycin

55
Q

What is the treatment for bronchitis?

A

macrolide or doxycycline or respiratory fluoroquinolone like moxifloxacin

56
Q

What are the criteria for a complicated UTI?

A

P’s:

penis, plastic (catheter), procedure (urologic), pyelonephritis, pregnancy

57
Q

What is the treatment of urethritis?

A

ceftriaxone x 1 IM + azithromycin x 1 PO
OR doxycycline PO 7days

(considered STI, usually caused by gonorrhea/chlamydia)

58
Q

What are the treatment options for an uncomplicated and complicated cystitis?

A

TMP-SMX, nitrofurantoin, fosfomycin
complicated - 3 days
uncomplicated - 7 days

59
Q

What are the treatment options for pyelonephritis?

A

IV ceftriaxone or amp-sulbactam if hospitalized

ciprofloxacin if not hospitalized

COMLEX 2 (11 decks)

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