OME Review Flashcards
What is empiric Abx therapy for inpatient and outpatient community acquired pneumonia?
Inpatient: ceftriaxone + azithromycin
Outpatient: azithromycin only
In case of life-threatening beta-lactam allergy: moxifloxacin
What is empiric Abx therapy for HCAP?
vancomycin + pip-tazo (if you can’t use vancomycin, use linezolid; if you can’t use pipTazo, use meropenem)
What is empiric Abx therapy for meningitis?
vancomycin, ceftriaxone (2g BID), methlyprednisone, +/- ampicillin if immunocompromised
What is the empiric Abx therapy for UTI outpatient? Pyelonephritis?
Outpatient: amoxicillin or nitrofurantoin if beta-lactam allergic (can use TMP-SMX, but it’s not better; DO NOT use ciprofloxacin)
Pyelo: ceftriaxone
What is the empiric Abx therapy for cellulitis?
Strep: outpatient: amoxicillin; inpatient: ceftriaxone
Staph: clindamycin, vancomycin
What is the general formula for treatment of HIV?
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)
What is PrEP?
Pre-exposure prophylaxis against HIV - Emtircitabine + Tenofavir
What is PEP?
post-exposure prophylaxis against HIV - Emtircitabine + Tenofavir still +/- raltegravir
What is used as vertical transmission prophylaxis in a pregnant patient with newly diagnosed HIV?
AZT
Path, Pt, Dx, and Tx of anti-retroviral syndrome
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
What bug are you at risk for at a CD4 count of 200? What drug is used as prophylaxis against this?
PCP; TMP-SMX > dapsone > atovaquone
What bug are you at risk for at a CD4 count of 100? What drug is used as prophylaxis against this?
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
What bug are you at risk for at a CD4 count of 50? What drug is used as prophylaxis against this?
MAC; Azithromycin weekly
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?
CXR
If negative -> latent TB
If positive -> next step
What is the Abx treatment for latent TB?
Isoniazid + Vitamin B6 for 9 months
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?
AFB smear
If negative -> latent TB (Tx with isoniazid + VitB6 for 9 months)
If positive -> RIPE Tx
What is RIPE treatment for active TB? What are their side effects?
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)
What are the positive PPD testing cut offs for the varying groups of people?
>/= 5mm -> close contacts, HIV/AIDs, chemo, transplant, anergy >/= 10mm -> Healthcare workers, prison, homeless, travel to endemic areas >/= 15mm -> soccer mom
What is the SIRS criteria?
Need 2/4: Temp > 38 or < 36 WBC > 12k or < 4k HR > 90 RR > 20
What is the criteria for the diagnosis of sepsis?
SIRS 2/4 + source of infection
What is the difference between severe sepsis and septic shock?
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)
What is the diagnostic criteria for multi organ dysfunction?
> /= 2 organ dysfunctions not responsive to fluid (literally dying)
What are the goals of sepsis treatment?
CVP between 10-12
Urinary output >/= 0.5 cc/kg/hour
MAP >/= 65mmHg
Central venous O2 sat >/= 70%
What is the treatment of sepsis?
- fluids (2-3 L) and Abx
- Remove source of infection (foley, catheter, drain abscess, etc)
- vasopressors
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?
FND, AMS, immunosuppression, lesion, seizures
Give Abx + get a CT scan
What signs on LP indicate bacterial meningitis?
1000s of PMNs
What is the empiric treatment of bacterial meningitis?
ceftriaxone, vancomycin, steroids, +/- ampicillin for immunosuppression
Meningitis Sx + fever, rash that moves from arms to trunk, patient has recently been camping - Dx?
Rocky Mountain Spotted Fever (look for Ab on CSF)
Meningitis Sx + travel to Connecticut, targeted rash with arthralgias, arrhythmias - dx?
Lyme disease (look for Lyme Ab)
Meningitis Sx + AIDS patient with fever and a headache, > 20 cm H2O opening pressure - Dx?
Crytptococcal meningitis (cryptococcal Ag; do not use India ink)
Meningitis Sx + night sweats, weight loss, hemoptysis, and meningitis in a homeless person - dx?
TB (homeless, prison, endemic areas, etc)
What other signs will you look for in a case of syphilis meningitis? How do you diagnose this?
primary = chancre
secondary = erythema multiforme
tertiary = any neuro sx
(CSF RPR or CSF Ab)
What is the treatment for cryptococcal meningitis?
amphotericin
What is the treatment for Rocky Mountain spotted fever meningitis?
ceftriaxone
What is the treatment for lyme meningitis?
ceftriaxone
What is the treatment for TB meningitis?
RIPE
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?
HSV -> HSV PCR -> acyclovir
path, pt, dx, and tx of cellulitis
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
What is one way to differentiate between staph and strep as a cause of cellulitis?
Staph: grows in (forms abscess)
Strep: grows out (no formation of abscess)
What is the treatment of cellulitis based on organism and toxic vs nontoxic?
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)
path, pt, dx, tx, and f/u of osteomyelitis
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
path, pt, dx, and tx of gas gangrene
Path: clostridium perfringenes
Pt: penetrating wound that got contaminated; crepitus
Dx: X-ray that shows gas
Tx: debridement, penicillin + clinda
path, pt, dx, and tx of necrotizing fasciitis
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
What is the most common cause of osteomyelitis?
staph aureus
What is the most common cause of osteomyelitis in a patient with sickle cell anemia?
salmonella
What is the most common cause of osteomyelitis in a patient with a penetrating wound or snake bite?
pseudomonas
What is the most common cause of osteomyelitis in a patient with a diabetic foot?
pseudomonas
What is the most common cause of osteomyelitis in a patient with oysters or cirrhosis?
vibrio vulnificus
What is the most common cause of osteomyelitis in a gardener?
sporothrix
What are the most common causes of CAP?
S. pneumo (MC)
M. catarrhalis
H. flu (COPD or smokers)
Klebsiella (alcoholics)
S. areas (after viral illness)
Legionella (immunosuppressed)
What is the treatment for CAP?
3rd gen cephalosporin + macrolide (azithromycin) or respiratory fluoroquinolone like moxifloxacin
What are the 2 main causes of healthcare-associated pneumonia? What is the treatment?
pseudomonas
MRSA
Pip-tazo or cefepime
vancomycin
What is the next step after a CXR is positive for a cavitary lesion? What are the 3 possible outcomes?
CT scan that will show:
- fungus
- TB
- abscess
What is the treatment for a pulmonary abscess?
Does NOT need to be drained.
3rd gen ceph + clindamycin
What is the treatment for bronchitis?
macrolide or doxycycline or respiratory fluoroquinolone like moxifloxacin
What are the criteria for a complicated UTI?
P’s:
penis, plastic (catheter), procedure (urologic), pyelonephritis, pregnancy
What is the treatment of urethritis?
ceftriaxone x 1 IM + azithromycin x 1 PO
OR doxycycline PO 7days
(considered STI, usually caused by gonorrhea/chlamydia)
What are the treatment options for an uncomplicated and complicated cystitis?
TMP-SMX, nitrofurantoin, fosfomycin
complicated - 3 days
uncomplicated - 7 days
What are the treatment options for pyelonephritis?
IV ceftriaxone or amp-sulbactam if hospitalized
ciprofloxacin if not hospitalized
