OMED Antibiotics and Infectious Diz

Question 1

Community acquired pneumonia-
hospital setting
non-hospital setting
beta-lactam allergy

Answer 1

hospital-ceftriaxone and azithromycin
non-hospital- azithromycin
CAP + beta lactam allergy- moxifloxacin

Question 2

health care associated pneumonia (one main treatment and two allergy alternates)

Answer 2

vanc + Pip Tazo
if vanc allergy –> linezolid
if Pip Tazo allergy –> merzopenim

Question 3

meningitis

Answer 3

ceftriaxone and vancomycin
+/- steroids (methylpred)
+/- ampicillin (if immunocomp)

Question 4

UTI

Answer 4

amoxicillin overall
if beta-lac allergic–> nitrofurantoin
TMP-SMX as absolute alternative

Question 5

cellulitis from strep

Answer 5

out patient–> amoxicillin

in-patient –> cetriaxone

Question 6

cellulitis from staph

Answer 6

clindamycin (1st)

vancomycin (2nd)

Question 7

2 + 1

Answer 7

DOMINANT HIV treatment: 1 NRTi + 2 NNRTi

NNRTi’s:
protease inhibitor- ritonavir
Entry inhibitor
fussion inhibitor

Question 8

HIV: pre-exposure

Answer 8

PrEP

emtricitabine + tenofavir (both NTRi)

Question 9

HIV: post-exposure

Answer 9

PEP

emtricitabine + tenofavir (both NTRi) +/- Raltegravir

Question 10

HIV pregnancy

Answer 10

2 + 1 +AZT (vertical transmission prophylaxis)

Question 11

Acute HIV flu: dx and tx

Answer 11

dx: PCR
tx: 2 + 1

ELISA will be negative

Question 12

HIV opportunistic infection: dx and tx

Answer 12

dx:
1. Elisa (+)–>
2. Western blot (+) –>
3. HIV viral count –>
4. CD4 count —>
5. genotype

tx: 2 + 1

Question 13

cd4 > 500

Answer 13

normal basically

Question 14

cd4 > 350

Answer 14

no prophylaxis

Question 15

cd4 < 200

Answer 15

PCP no sulfa allergies : TMP-SMX
PCP sulfa allergies: dapsone
PCP in G6PD pt: atovaquone

Question 16

cd4 < 100

Answer 16

toxo: pyrimethamine + leucovorin

Question 17

cd4 < 50

Answer 17

MAC: weekly azithromycin

Question 18

lobar pneumonia, caseating granulomas

Answer 18

primary TB infection

Question 19

hemoptysis, night sweats, weight loss, younger people or with RFs: initial steps

Answer 19

secondary TB (reactivation): CXR and AFB smear

1. CXR: if positive for TB, isolate pt
2. AFB smear

if both negative–> pt does not have TB

if positive: RIPE tx

Question 20

PPD negative

Answer 20

no further work up

Question 21

PPD positive

Answer 21

1. get CXR
2. negative CXR –> isoniazid + B6 for 9 months
3. positive CXR –> AFB smear
4. AFB positive –> active TB –> RIPE tx
5. AFB negative –> INH + B6 9 months

Question 22

PPD equal/above 10 mm: who

Answer 22

health care workers, prisoners, homelessness, travel

Question 23

PPD equal/above 15 mm: who

Answer 23

soccer mom, no rf’s

Question 24

PPD equal/above 5 mm: who

Answer 24

ppl with close contacts to others w/TB, immunocompromised, HIV, transplant, anargy

Question 25

what will cause interferon beta to have a false positive?

Answer 25

pts with BCG vaccine

Question 26

CXR is positive for TB but AFB smear is negative for TB: tx

Answer 26

latent TB: isoniazid + B6

Question 27

CXR positive for TB and AFB smear (+) for TB: tx

Answer 27

active TB: RIPE a. rifampin (red pee) b. isoniazid (neuropathies, give B6) c. pyrazinamide (hyperuricemia, gout) d. ethambutol (red/green color blindness)

Question 28

Fever + HA...+/- photophobia, phonophobia, N/V

Answer 28

brain inflammation: three things- | meningitis, abscess, encephalitis

Question 29

Fever + HA...+stiff leg + leg raise positive: causes

Answer 29

Bacterial meningitis: TB, RMSF, Lyme, Crypto, Viral

Question 30

Fever + HA + focal neurological deficit

Answer 30

abscess or cancer

Question 31

Fever + HA + AMS

Answer 31

encephalitis: a million causes. tx for all of them is the same- supportive, except for HSV

Question 32

FAILS mnemonic

Answer 32

the contraindications to lumbar puncture: ``` FND (focal neuro def) AMS (altered men stat) Immunosuppression Lesions Seizures ```

Question 33

FAILS (+)

Answer 33

FAILS+: order is 1. Blood cultures first 2. IV abx + steroids 3. CT scan 4. LP

Question 34

FAILS (-)

Answer 34

LP --> then ABX

Question 35

FAILS (+), CT (-): now what

Answer 35

LP

Question 36

LP: lots of PMNs, dx and tx

Answer 36

bacterial meningitis ceftriaxone, vancomycin, steroids, +/- ampicillin

Question 37

LP: no PMNs

Answer 37

consider something other than bacterial. c

Question 38

Brain abscess: tx

Answer 38

drain and abx

Question 39

LP: lymphocytes

Answer 39

encephalitis

Question 40

Encephalitis, HSV suspected

Answer 40

dx: HSV PCR tx: if HSV positive...acyclovir dx: if HSV PCR negative... tx: supportive

Question 41

skin with well demarcated area that is red, hot and tender

Answer 41

cellulitis

Question 42

skin with well demarcated area that is red, hot and tender with (+) abscess: toxic tx and non-toxic tx

Answer 42

Cellulitis, staph: toxic: pip/tazo+augmentin nontoxic: 1st gen cephalosporin

Question 43

skin with well demarcated area that is red, hot and tender with, superficial and no abscess: toxic tx and non-toxic tx

Answer 43

Cellulitis, strep: nontoxic: TMP-SMX (po), clindamycin toxic: vanc, linezolid, clindamycin

Question 44

wound with exposed bone, or recurrent/refractory cellulitis, or sinus tract: dx

Answer 44

suspect osteomyelitis: dx: 1st: xray 2nd: MRI if xray is neg.