Awesome Review Flashcards by Alpa Patel

Broad Spectrum Abx for Prosthetic Valve Endocarditis

Vancomycin Rifampin Gentamycin

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Broad Spectrum Abx for Native Valve or IVDA Endocarditis

Vancomycin Gentamycin

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Indications for Surgery in Endocarditis

Severe CHF, persistent bacteremia (blood cultures positive after 7 days), recurrent emboli, valve abscess, large fungal vegetation

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Abx Ppx for Endocarditis

High Risk Conditions and High Risk Procedures
Amoxicillin 2 grams PO 1 hour before
If PCN allergy- Azithromycin or Clindamycin

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What is considered high risk condition needing Endocarditis prophylaxis? (5)

Prosthetic Valve
History of IE
History of Congenital Heart Disease repair within 6 months or with prosthesis/patch
History of unrepaired shunted congential Heart Disease
Heart Transplant with valvular disorders

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Abx in Suspected Meningits if head trauma or neurosurgery

Vancomycin Cefepime (cover for pseudomonas)

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Abx in Suspected Meningitis if > 50 yo

Ampicillin Ceftriaxone Vancomycin (in case it’s resistant)

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If you see RBCs in Lumbar Puncture, wtd?

Thinks HSV encephalitis and start IV Acyclovir

Dx: PCR of CSF

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If you are Suspecting Strep Pneumo Meningitis, what else do you give (15 minutes before Abx)

Dexamethasone!

Pneumococcal meningitis can cause hearing loss and seizure

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What the eff is Mollaret’s Meningitis?

Benign and recurrent Lymphocytic meningitis caused by HSV-2

Multiple episodes, lethargy with meningeal signs

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Diagnose West Nile Encephalitis

Absent Deep Tendon Reflexes!

West Nile virus IgM antibody in CSF

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If you suspect NMDA Encephalitis, what’s next?

Check Ultrasound Abdomen to look for ovarian teratoma and remove it!

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Treat complicated UTI with ESBL

Forfomycin x 1 dose

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How do you treat STI?

Chlamydia or Gonorrhea

Ceftriaxone 250 mg IM and Azithromycin 1 gram

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If Ceftriaxone or Azithromycin doesn’t work for sexually transmitted disease (urethral discharge) what is it?

Mycoplasma Genitalium

Give Moxifloxacin

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Why is Trichomonas tricky?

Strawberry cervix
Give Flagyl 2 grams x 1 dose or Tinidazole 2 grams x 1 dose
Test of cure in 3 months
AND treat partner (tricky to find that partner- Slut!)

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Treat pregnant candidiasis

Topical Clotrimazole for 3-7 days

(Not preggo- fluconazole 150 mg x 1 dose

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How to treat Lymphogranuloma Venereum or Granuloma inguinale (klebsiella granulomatis) ?

Doxy 100 mg BID x 21 days

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Complication of Erysipelas

Endocarditis!

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Organism in sickle cell Osteomyelitis

Salmonella

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What if it seems like Vancomycin isn’t working? (Although it worked in the past?)

Check Epsilon (e test) to accurately measure MIC
If > 2, vancomycin is useless- use Dapto instead

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Horrible complication of infectious Mononucleosis?

Splenic rupture!

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How do you save the day by picking up inhalational Anthrax?

CXR with widened mediastinum and pleural effusions

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Blood Test for PCP?

Beta D glucan test

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Treating cryptococcal meningitis with HIV?

LP to alleviate pressure | Amphotericin B and 5 Flucytosine induction and switch to long term fluconazole

Treating MAI or Mycobacteria marinum?

Clarithromycin, Ethambutol, +/- Rifabutin

What ART med causes Fanconi Syndrome?

Tenofovir

HIV patient needs a statin, which one?

Pravastatin

Earliest change seen in HIV therapy failure

Increasing viral load

Diagnose and treat: Painful genital ulcers Tender Inguinal suppurative lymphadenopathy Microscopy- schools of fish or box car = gram neg bacillus

Haemophilus ducreyi Ceftriaxone 250mg X 1 Azithromycin 1 gram X 1 Erythromycin 500 mg QID X 7 days

What organism causes Lymphogranuloma venereum?

Chlamydia trachomatis

What organism causes Granuloma Inguinale? Microscopy- Donovan bodies (bipolar safety pin shaped intracytoplasmic inclusions)

Klebsiella granulomatis | Looks horrible!

How to treat early latent syphillis?

Benz penicillin 2.4 million units X 1

How to treat late latent syphilis?

2.4 million units weekly X 3

Diagnose and Treat: Macular Rash, starting at distal extremities and progressing centrally, becoming petechial. Thrombocytopenia and transaminitis, lymphocyte predominant ... CAMPING

Rocky Mountain Spotted Fever Doxycycline/Tetracycline Chloramphenicol in pregnancy

Difference btwn Ehrlichiosis and Anaplasmosis?

Ehrlichiosis is Human Monocytic ehrlichiosis via Lone Star Tick Anaplasmosis is Human Granulocytic Anaplasmosis via Ixodes tick and have morulae (basophilic inclusion bodies made of bacteria clusters)

Diagnose and Treat: Fever, HA, myalgia, arthalgia, meningismus, leukopenia, thrombocytopenia, transaminitis CAMPING

Ehrlichia

Diagnose and Treat: HA, fatigue, myalgias hemolytic anemi, transaminitis, thrombocytopenia, Maltese cross/tetrads in RBCs Giemsa stain showing trophozoite ring inside RBC

Babesiosis via Ixodes Tick Mild-Moderate: Atovaquone and Azithromycin Severe: Quinine and Clindamycin x 6 weeks

Patient with Early Disseminated Lyme but with 2nd or 3rd degree heart block, OR meningitis, treatment?

IV Ceftriaxone or Penicillin G If only 1st degree heart block or cranial nerve palsy- PO Doxy is fine

How to treat Post Lyme Disease/Chronic Lyme? | S/Sx: fatigue, insomnia, diffuse pain, malaise

Supportive care

SSTI Organism and Tx? Liver Disease/transplant, exposure to saltwater/freshwater and seafood HEMORRHAGIC BULLAE

Vibrio Vulnificus | 3rd gen cephalosporin or Tetracycline/Gentamicin

SSTI Organism and Tx? Ulcerative papular lesions, ascending lymphatic spread Swimming instructor or fish tank cleaner

Mycobacterium Marinum | Clarithromycin and Ethambutol and/or Rifabutin

SSTI Organism and Tx? Multiple nodules on forearm along lymph channels Florist/Gardener

Sporothrix schenkii If Local- Itraconazole If Disseminated- Amphotericin B

SSTI Organism and Tx? | Folliculitic Rash, history of jacuzzi/hot tub

Pseudomonas aeruginoas SELF LIMITED ONLY Pseudomonas you don't treat

SSTI Organism associated with cats? | SSTI Organism associated with dogs, especially asplenic patients?

``` Pasteurella multocida (Augmentin) Capnocytophagia canimorsus ```

Diagnose and Next Step? | Hyperesthesia over right forehead and single vesicular lesion on erythematous base on tip of right side of nose

Herpes Zoster with Hutchinson Sign | Worried about Zoster Opthalmicus and refer to Opthalmologist for emergency

Treat Post Herpetic Neuralgia

Desipramine

Type of isolation for single dermatome Herpes? | Type of isolation for more than 2 dermatomes Herpes?

Contact | Contact and Airborne

Western United States/British Columbia causing Tick Borne Relapsing Fever

Borrelia hermsii

MC organism after a fist fight?

Eikenella Corrodens

Diagnose and Treat: Frontal HA, Retro-orbital pain, myalgia, arthalgia, spontaneous bleeding (purpura, melena or conjunctival injection), faint morbiliform rash on trunk Leukopenia, thrombocytopenia, transaminitis

Dengue hemorrhagic Fever via IgM/IgG or reverse transcriptase PCR Supportive treatment

Patient with neutropenic fever and need to cover antifungal infection (ie invasive aspergillius)

Voriconazole

Which anti fungal has shown to improve mortality when prophylaxed in patient with post chemotherapy neutropenia?

Posaconazole

What organism? | Posttransplant lymphoproliferative disease causing fever, lymphadenopathy and extranodal mass

EBV

Halo Sign on CT Chest | Dense core and rim of ground glass appearance

Aspergillosis

Blood test for Aspergillosis?

Galactomannan

Blood test for PCP?

Beta D-Glucan

Post-transplant prophylaxis for CMV

Valganciclovir for 1 year

Organism and Treatment? | Thin Wall cavity in lung, Nodular lesion on skin, Ring enhancing lesion in brain, filamentous, branching gram positive

Nocardia | Sulfonamides/Bactrim

Diagnose and Treat: Inhaled causing dyspnea, hemorrhagic meningitis, hemorrhagic lymphadenitis, CXR with widened mediastinum and pleural effusions (Box Car Bacilli- gram positive)

Anthrax- Bacillus Anthracis | Tx: Fluoroquinolone or PCN

Bioterrorism Organism and Tx? Gram Negative Coccobacilli Skin Contact or aerozolized causing splenomegaly, hepatitis, Lymphadenopathy with fever, sweats

Brucellosis | Doxy

Bioterrorism Disease and Tx? Rickettsia Inhaled causing atypical PNA, HA, fevers from contaminated soil and animal products

Q fever | Doxy

Bioterrorism Organism and Tx? Fever, Hepatitis/Jaundice, AMS, Renal Failure, ecchymosis, liver hemorrhage, conjunctiva suffusion sewage worker or Veteranarian (or TMNT!)

Leptospirosis via rodents | Doxy

Bioterrorism Organism and Tx? Fever, HA, Splenomegaly, erythematous lesions Butcher, fisherman

Erysipelothrix | Doxy

Which organisms need droplet precautions?

Neisseria, Influenza, Plague

Which organisms need airborne precautions?

Herpes Zoster more than 2 dermatomes, Measles, Varicella, MERS, MTB

Screening test for HIV

HIV 1/2 antigen/antibody combination immunoassay and p24 antigen Note: p24 antigen is positive 1 week before immunoassay

Confirmatory test for HIV

HIV 1/2 antibody differentiation immunoassay | If negative, check NAAT (nucleic acid amplification test)

Prophylaxis if CD4

PCP, give Bactrim, Dapsone of Atovaquone

Prophylaxis if CD4

Toxoplasmosis, give Bactrim

Prophylaxis if CD 4

Mycobacterium Avium Complex, give Azithromycin

Name 3 diseases that cause ring enhancing lesions

Toxoplasmosis, Brain Abscess, Lymphoma

Pre exposure prophylaxis

Tenofovir and Emtrictabine (Truvada)

Best inhaled steroid to use in HIV Asthmatic?

Beclamethasone

Best HIV medication to use along with Hepatitis C therapy?

Raltegravir

Side Effect of Pyrazinamide

Hyperuricemia and GOUT

Side Effect of Rifampin

Rash Drug Interactions Hepatotoxicity Orange secretions

Side Effect of Isoniazid

Hepatotoxicity Peripheral Neuropathy Lupus like Syndrome Monoamine poisoning

Side Effect of Ethambutol

Retrobulbar neuritis | Decreased red green color discrimination

Awesome Review Flashcards

(79 cards)