Antibiotics

Question 1

What is the treatment for bacterial meningitis in neonate ( < 28 days)
and what want to cover?

Answer 1

** “CVA”** for meningitis in first 28 days of life
Cefotaxime + Vancomycin + Ampicillin
Cefotaxime covers GBS/Strep pneumo/Neisseria
Vancomycin covers MRSA
Ampicillin covers Listeria

Question 2

Why Ceftiraxone is C/I in neonates?

and what is the alternative?

Answer 2

causes biliary sludge

alternative: ampicillin + Gentamicin

Question 3

Tx for meningitis in elderly pts ( > 50yo)?

Answer 3

** “CVA”** for meningitis in first 28 days of life + > 50 yrs
Cefotaxime + Vancomycin + Ampicillin
Cefotaxime covers GBS/Strep pneumo/Neisseria
Vancomycin covers MRSA
Ampicillin covers Listeria

Question 4

Strep pneumo Meningitis, Tx?

Answer 4

Ceftriaxone + Vancomycin + Steroids (“CVS”)

Question 5

MCC meningitis in adults 18-65 yo?

Answer 5

Strep.pneumo

Question 6

Hospital-acquired or post-neurosurgical procedure bacterial meningitis

Pathogens and Tx?

Answer 6

Ceftazidime or cefepime + vancomycin

Psuadomoans + MRSA
Ceftazidime- the only 3rd generation the cover psuedomonas
Cefepime- 4th generation

Question 7

Headache + nuchal rigidity + fever. LP shows gram-positive diplococci + neutrophil predominance

most likley pathogen?
Tx?

Answer 7

Strep. pneumo meningitis

Treatment- Ceftriaxone + Vancomycin + IV Steroids (“CVS”)

Question 8

IV pt has severe headache + nuchal rigidity + papilledema.

Dx?
Tx?

Answer 8

Cryptococcal meningitis- Cryptococcus
Tx- Amphotericin B + flucytosine

Question 9

Which pathogen ??
IV Pt present with meningtisis is charactirezid by ↑↑ significantly elevated opening pressure
WBC with lymphocyte predominance + ↓ glucose + ↑protein

and how do we the diagnosis?

Answer 9

Cryptococcus

Diagnosis test- CSF antigen test (highly sensitive and specific)&raquo_space; Latex agglutination assay or India ink stain

Question 10

MOA amphotericin B?

Answer 10

binds ergosterol → makes holes in fungal membrane

Question 11

MOA flucytosine?

Answer 11

Inhibits thymidylate synthase

Question 12

What is the maintanace therapy in croptoccocus meningitis?

Answer 12

Fluconazole until symptoms resolve + CD4 >100 for >1y

Question 13

HIV + CD4 < 250 + lives in AZ

patohgen and PPx

Answer 13

Coccidioidomycosis

prophylaxis- Itraconazole

Question 14

HIV + CD4 < 200

Pathogen and ppx

Answer 14

Pneumocystis jirovecii

TMP-SMX or pentamidine (HY alternative) or dapsone (HY alternative) or atovaquone

Question 15

HIV + CD4 < 150 + lives in KY
pathogen and prophylaxis

Answer 15

Histoplasmosis

PPx- Itraconazole

Question 16

HIV + CD4 < 50
pathogen and propylaxis

Answer 16

Mycobacterium avium complex (MAC)

PPx- none

Question 17

Pt on chemotherapy develops fever + WBC count is 2000
Neutropenic fever
possible microbe and Tx

Answer 17

Pseudomonas + MRSA

Tx: Ceftazidime (or Cefepime) + Vancomycin

Question 18

Tx for pt with seizures due to neurocysticercosis

Answer 18

Phenytoin

Question 19

HIV + headache + nuchal rigidity. LP shows lymphocytic pleocytosis. Imaging shows enhancement at base of brain (or in basilar cisterns)

Dx?

Answer 19

Tuberculous meningitis

Question 20

most common cause of cellulitis?

Tx?

Answer 20

Staph aureus
Tx- Clindamycin or TMP-SMX or Cephalexin

Question 21

Most common cause o Erysipelas?

Answer 21

Strep pyogenes
(GAS)

Question 22

well-circumscribed + elevated + face + abnormal vitals

Cellulitis or erysipelas?

Answer 22

Erysipelas

Question 23

blanching borders + on lower extremities + normal vitals

Cellulitis or erysipelas?

Answer 23

Cellulitis

Question 24

Recent hot-tub exposure with Folliculitis.
pathogen?

Answer 24

Pseudomonas folliculitis

Question 25

Empiric Tx for animal or human bites?

Answer 25

Amox-Clav

Question 26

Empiric Tx for community-acquired PNA?

Answer 26

Macrolide (Azithromycin) or Doxycycline "(Medical Doctor)"

Question 27

Tx for HAP if pt is allergic to PCN?

Answer 27

Fleuroquinolone (moxifloxacin or levofloxacin)

Question 28

Microbe if pt has HAP + CXR shows cavitary infiltrate? Pathogen? Tx

Answer 28

**MRSA** Tx- Clindamycin or Vanc or Linezolid

Question 29

Tx for 7 yo M with bullseye rash?

Answer 29

Lyme **Amoxicillin** ## Footnote Always give amoxicillin in children < 8yo -- NO Doxycycline!

Question 30

Pt from **North Carolina** has severe headache + T of 39. PEx shows rash on palms and soles + PLT - 75,000 What is the most likely pathopen? Tx?

Answer 30

Rocky Mountain Spotted Fever- Rickettsia rickettsii Tx- Doxycycline

Question 31

23 yo non-pregnant woman has suprapubic pain + urinary frequency + urgency + burning on urination. Dx? Pathogen? Tx?

Answer 31

Cystitis (UTI) E.coli (most common) Tx- Nitrofurantoin or ciprofloxacin or TMP-SMX or Fosfomycin

Question 32

Tx for UTI in pregnant women?

Answer 32

**Nitrofurantoin** or Fosfomycin ## Footnote Do not give cipro or TMP-SMX d/t teratogenic effects

Question 33

Treatment for Pelylonephritis?

Answer 33

**Ceftriaxone** or fluoroquinolone 2nd best | do not give FQ to pregnant patients!

Question 34

Which Abx will not begiven to pregnent pt

Answer 34

cipro or TMP-SMX d/t teratogenic effects Flueroquinolone

Question 35

31 yo F develops fever + uterine tenderness 2 days after having C-section Dx? Tx?

Answer 35

Endometritis Tx- **ECG** = Endometritis tx with Clindamycin + Gentamicin

Question 36

33 yo F in active labor + T is 39 + fetal HR is 190 bpm Dx? Tx?

Answer 36

Chorioamnionitis- Fetal tachy + maternal fever Tx- Ampicillin + Gentamicin

Question 37

Tx for Latent TB?

Answer 37

Isoniazid for 9 months + B6

Question 38

Treatment for PID inf.

Answer 38

Azithromycin (or Doxy) + Ceftriaxone Chlamydia + Gonorrhea

Question 39

in PID Tx if only Chlamydia is detected? Tx if only Gonorrhea is detected?

Answer 39

Tx if only Chlamydia is detected- Azithromycin or Doxy Tx if only Gonorrhea is detected- Azithromycin (or Doxy) + Ceftriaxone

Question 40

21 yo F has RUQ pain + history of PID Dx?

Answer 40

Perihepatitis aka Fitz-Hugh-Curtis syndrome

Question 41

Female has off-white/gray vaginal discharge with fishy odor Pathogen? Labs? Tx?

Answer 41

Gardnerella vaginosis PH ? 4.5 Clue cells Tx- Metronidazole or clindamycin

Question 42

Female has frothy yellow-green that is malodorous Pathogen? Labs? Tx?

Answer 42

Trichomonas vaginosis labs- PH > 4.5 Motile trichomonas Tx- Metronidazole for patient + partner

Question 43

Pt on CTx (i.e. ICH) + neutropenia + eosinophilia + cough + hemoptysis Pathogen? Labs? Tx?

Answer 43

Aspergillus Histo- acute angle at 45 degree Tx- Voriconazole

Question 44

Pt with uncontrolled DM + glucose in hundreds + facial pain Pathogen? Labs (Histo)? Tx?

Answer 44

Mucor or Rhizopus Histo- Budding at 90º angles Tx- Surgical debridement + liposomal Amp B

Question 45

Tx for tinea

Answer 45

**Tinea corporis** = topical antifungal (“—azole”) **Tinea capitis and tinea unguium** = terbinafine or griseofulvin (oral antifungals)

Question 46

Microbes a/w tinea?

Answer 46

Trichophyton, Microsporum, Epidermophyton

Question 47

Tx for syphilis in pt’s allergic to PCN?

Answer 47

Macrolide (AZT) or doxycycline

Question 48

Tx for syphilis in pt with PCN allergy who is pregnant or has neurosyphilis?

Answer 48

Desensitization then penicillin

Question 49

Tx for GI infections (e.g. diverticulitis, appendicitis, cholecystitis)?

Answer 49

“MAG” = Metronidazole + Amoxicillin + Gentamicin “MC” = Metronidazole + Cipro

Question 50

Tx of gastroenteritis (e.g. Salmonella or Shigella)?

Answer 50

**Fluoroquinolone** or macrolide

Question 51

Tx options for malaria

Answer 51

Mefloquine - most common PPx Atovaquone + Proguanil Artemether + lumefantrine Primaquine = to kill hypnozoites, which cause latent malaria

Question 52

Which Tx against maleria have high resistance?

Answer 52

Chloroquine

Question 53

Whic Tx for malaria can cuse latent maleria?

Answer 53

Primaquine

Question 54

What must be check before prescribing primaquine?

Answer 54

G6PD deficiency

Question 55

Microbes a/w hypnozoites?

Answer 55

Plasmodium vivax and Plasmodium ovale

Question 56

PPx for malaria?

Answer 56

Mefloquine