SSTI + bones + HIV + tb

Question 1

erypsiela
-layers and organism

Answer 1

• epidermis and dermis
• GAS

Question 1

impetigo caused by which organism

Answer 1

staph aureus

Question 2

cellulitis

Answer 2

• GAS
• epidermis, dermis, SC

Question 3

if severe purulent infection , if mssa , tx with what ?

Answer 3

cefazolin

Question 4

if moderate purulent infection, if mssa , tx with what ? if mrsa tx with what ?

Answer 4

cefalexin , tmp smx

Question 5

mild non purulent SSTI tx ?

Answer 5

oral cephalexin

Question 6

moderate non purulent SSTI tx ?

Answer 6

IV cefazolin

Question 7

recurrent cellultitis trial - possible suggestions ? ( 2)

Answer 7

1. daily oral pnc if have more > 3 cxellulitis in a year ( oral pnc daily) despite controlling other factors ( i.e. revasc , wound care, foot wear, compression, tinea)
2. compression stocking = first lne prevention for chronic leg edema and recurrent cellulitis

Question 8

toxic shock syndrome 2/2 to what ?

Answer 8

1. 2/2 to strep group A&raquo_space;
2. rarely S aureus ( with nasal packing, tampons)

Question 9

tx of toxic shock syndrome

Answer 9

beta lactam + clinda

Question 10

diagnostic criteria for toxic shock syndrome

Answer 10

Diagnostic Criteria:
* Hypotension(sBP<90)AND
* IsolationofGASfromnormallysterile site
AND at least two of the following:
– Renalimpairment(Cr>177)
– Coagulopathy(plt<100orDIC)
– Liverfxabnormality(ALT/AST/Tbili2X Upper limit of normal)
– ARDS
– Generalizederythematousmacularrash that may desquamate

Question 11

funky management tss

Answer 11

IVIG
hyperbaric o2

Question 12

chemoprophylaxis tss ?

Answer 12

cephalexin 10 day

Question 13

when to add metornidazole for OM treatment ?

Answer 13

non vertebral OM suspected in sacrum

Question 14

tx duration for non vertebral osteomyelitis

Answer 14

6 weeks from last debridement if residual infection if non hematogenous |
4-6 weeks if hematogenous
or 48H post complete source control

Question 15

the most impt sign to know if ulcer is infected ?

Answer 15

pain in chronic wound

Question 16

arterial vs venous chronc wouds. which one is lateral, which one is medial

Answer 16

art : lateral
venous : medial

Question 17

gold stand to dx OM ?

Answer 17

bone biopsy

Question 18

what arer high LR signs of OM in db patient

Answer 18

1. bone to probe
2. bone exposure
3. ulcer >2 cm
4. high CRP

Question 19

meds for pjp
other meds and when to avoid those meds

Answer 19

tmp smx 1 ds po daily
dapsone ( but avoid if sjs ten)
atovaquone ( to give if sjs ten)

Question 20

at what levle of cd4 do we worry about pjp

Answer 20

<200

Question 21

worry about toxoplasma what level of cd4
tx?

Answer 21

100
tmp smx

Question 22

how long do you continue toxoplasma and mac tx ?

Answer 22

until cd3 count stabilizes for 3 months

Question 23

mac
- cd4 levels and tx

Answer 23

-< 50 and tx= azithro/claritrhro

Question 24

severe PJP implies what exactly

Answer 24

• Moderate – Severe PJP: PaO2 <% 70 or A-a gradient ≥35mmHg

Question 25

tx for actual pjp

Answer 25

tmp smx +/- pred if severe

Question 26

tx for actual toxoplasma

Answer 26

sulfadiazine + pyrimethamine
or even tmp smx

Question 27

tx for actual mac

Answer 27

clarithromycin + ethambutol
azithromycin + ethambutol

Question 28

cd4 count at which tb can happen ?

Answer 28

any levels

Question 29

intrapartum vs HIV
- if VL > 1000 or levels are unknown near delviery , what are your recommendations

Answer 29

IV Zidovudine ( AZT) + c/s

Question 30

if VL suppressed intrapartum, do we need to do a c/s

Answer 30

no

Question 31

postpatum care regarding kid
- if suppressed 4 months within deliviery
- if not suppressed at birth

Answer 31

• AZT x 4 weeks
• 3 drug ART presumptively

Question 32

PrEP HIV combo

Answer 32

• tdf + ftc
• taf + ftc
• cab

Question 33

within how long to start PEP

Answer 33

72H

Question 34

what do you give in PEP

Answer 34

TDF+ FTC + DOL
TDF + FTC + RAL

Question 35

how long after in PEP do you check for HIV serology again

Answer 35

3 months to make sure no serovongersion

Question 36

how long treat PEP ?

Answer 36

28 days

Question 37

first line regimens for latent tb

Answer 37

rifampin 4M DIE
rifapentin + isoniazide weekly 3M

Question 38

what’s you cocktail for active tb tx

Answer 38

ripe and drop e when get susceptibility
- RIP x 2 months and then c ontinue INH and rifam for 4 months

Question 39

3 tb meds safe in pregnancy. what about the 4th

Answer 39

rifampin, isonizide , ethambutol

pza only added if extensivce disease, smear pulnmonary diseas,e disseminated tb , intolerance of other agents

Question 40

do you tx latent tb in pregnancy . exceptions ? regimen?

Answer 40

no after delivery
unless high risk of tb regimens
use 4R regimen

Question 41

latent tb + hiv regimens

Answer 41

1. rifampentin+inonizide weekly x 3 M
2. isoniazide + rifampin daily 3MN

Question 42

when should you avoid initiation of art in art naive patients and wait how long and what to add
- why ?

Answer 42

tb meningitis, defer for 8 weeks
addd steroids for tb meningitis
- risk fo iris ( especially if low cd, high viral load, disseminated tb)