Infections

Question 1

What are five common infections caused by Strep pneumoniae

Answer 1

-itis problems (MOBS CAP)

Meningitis
Otitis media
Bronchitis
Sinusitis

CAP

Question 2

Good antibiotic options for treating acute otitis media or sinusitis

Answer 2

Usually caused by gram positive

Amoxicillin
Augmentin
Bactrim

Question 3

Good antibiotic options for treatment of acute endocartitis

Answer 3

Vancomycin + Ceftriaxone

Treating Staph aureus

Question 4

Good antibiotic option for treating peritonitis due to ruptured viscus

Answer 4

Usually caused by Coliforms or Bacteroides fragilis

Treat with metronidazole plus cephalosporin (3rd generation)
or
Piperacillin/tazobactam (Zosyn)

Question 5

Good antibiotic option for treatment of intra-abdominal infections

Answer 5

Usually treating E. coli, Klebsiella, bacteroides fragilis, or Enterococci

Cefuroxime or Ceftriaxone
Ciprofloxacin/Levofloxacin

Plus metronidazole

Question 6

Good antibiotic option for the treatment of cellulitis

Answer 6

Usually caused by Staph aureus or Group A Strep

1st generation cephalosporin (cefazolin)
Vancomycin - should be used based on local incidence of MRSA
Clindamycin
Linezolid

Question 7

Good antibiotic option for treating sepsis

Answer 7

Could be any pathogen

Vancomycin plus 3rd or 4th generation cephalosporin
or
Zosyn
or
Imipenem
or
Meropenem

Question 8

Antibiotic of choice when treating Staph, strep, gram negative rods

Answer 8

Cefazolin

Question 9

Antibiotic of choice when treating MRSA

Answer 9

Vancomycin

Question 10

Symptoms of Gonorrhea

Answer 10

Often asymptomatic

Similarities between men and women:
Dysuria
Urinary frequency
Mucopurulent discharge (green with women, white/yellowish with men)

In Women:
Labial pain and swelling
Lower abd pain
Fever
Dysmenorrhea

Question 11

Diagnostics and treatment of Gonorrhea

Answer 11

NAAT (Nucleic Acid amplification test) - urine test

Treatment:
Ceftriaxone 1g IM x1
If concern for Chlamydia as well: Doxycycline 100mg PO BID x7 days
Need to report to health department

Question 12

What is the bacteria that causes syphilis

Answer 12

Treponema pallidum

Question 13

Diagnostic and treatment for syphilis

Answer 13

Diagnostic testing: VDRL or RPR
If this comes back positive:
—Treponema pallidum particle agglutination assay (TP-PA)
—Fluorescent treponemal antibody absorption (FTA-ABS)

Treatment:
Primary/secondary:
Benzathine Penicillin G 2.4 million units IM x1

Tertiary:
Benzathine Penicillin G 2.4 million units IM weekly x3 weeks
Report to the health department

Question 14

What is the most common STD?

Answer 14

Chlamydia

Question 15

What are the causes of dyspareunia?

Answer 15

Dyspareunia - painful intercourse

Chlamydia
Trichamonas
Menopause
Pelvic Inflammatory Disease (PID)

Question 16

Treatment for Chlamydia

Answer 16

Azithromycin 1 gram PO x1
or
Doxycycline 100mg PO BID x7 days
Report to the health department

Question 17

What is vulvovaginitis and how does it present clinically?

Answer 17

Inflammation or infection of the vulva and vagina
Trichomoniasis, bacterial vaginosis and candidiasis are commonly responsible for vulvovaginitis
—Trich is the only one sexually transmitted

Trichomoniasis: Malodorous, frothy, yellowish-greenish discharge, pruritus, petechiae (strawberry patches) on cervix and vaginal walls, dyspareunia, dysuria

Bacterial vaginosis: Water, gray, fishy-smelling discharge, vaginal spotting

Candidiasis: Thick, white, curd like discharge: vulvovaginal erythema with pruritus

Question 18

Diagnostics for vulvovaginitis

Answer 18

Can use NAAT

If you use microscopic wet-prep
Trich: Normal saline mix shows trichomonads
BV: Normal saline mix shows clue cells
Candidiasis: KOH mix shows pseudo hyphae

Question 19

Treatment for vulvovaginitis

Answer 19

Trich: Metronidazole 2g PO x1 or 500mg PO BID x7 days depending on how bad

BV: Metronidazole 500mg PO BID x7 days
or
Metronidazole gel 0.75% applicator intravaginally daily x5 days

Candidiasis: Miconazole intravaginally x7 days
Clotrimazole intravaginally

Question 20

Difference between syphilis and chanroid ulcer

Answer 20

Syphilis is painless
Chanroid is painful - often not seen in women

Question 21

Treatment for chancroid

Answer 21

Azithromycin 1g PO x1
or
Ceftriaxone 250mg IM x1