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1
Q

Initial antibiotics for endocarditis with prosthetic valve

A

Vanco
Gent
Rifampin

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2
Q

antibiotics for endocarditis with prosthetic valve and MSSA sensitivity

A

Ceftriaxone/nafcillin
Gent
Rifampin

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3
Q

antibiotics for endocarditis with prosthetic valve and MRSA sensitivity

A

Vanco
Gent
Rifampin

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4
Q

antibiotics for endocarditis with prosthetic valve and PCN sensitive streptococcus

A

Ceftriaxone / nafcillin

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5
Q

antibiotics for endocarditis with prosthetic valve for PCN resistant streptococcus

A

Ceftriaxone

Gent

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6
Q

Initial antibiotics for endocarditis in native valve or IVDU

A

Vanco

Gent

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7
Q

antibiotics for endocarditis in native valve or IVDU with MSSA sensitivities

A

Ceftriaxone / nafcillin

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8
Q

antibiotics for endocarditis in native valve or IVDU with MRSA sensitivities

A

Vanco

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9
Q

antibiotics for endocarditis in native valve or IVDU with PCN sensitive streptococcus

A

Ceftriaxone / nafcillin

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10
Q

antibiotics for endocarditis in native valve or IVDU with PCN resistant streptococcus

A

Ceftriaxone

Gent

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11
Q

5 Indications for surgery when there is endocarditis

A 
Severe CHF
Persistent bacteremia (repeat blood Cx in 7 days +? That is time for surgery)
Recurrent emboli
Valve abscess 
Large fungal vegetation
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12
Q

Medication used in RIGHT side endocarditis with septic emboli

A

Daptomycin

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13
Q

Side effects of linezolid

A 
Thrombocytopenia 
Neutropenia
Serotonin syndromes
Lactic acidosis 
Optic neuritis
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14
Q

Enterococcus Infective endocarditis usually affects which valve

A

Aortic

Lower mortality

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15
Q

Endocarditis affecting which valve is associated with conduction defects?

A

Aortic

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16
Q

Replace valve if endocarditis causes the following:

A

Severe CHF not responsive to medical Rx
Severe aortic regurgitation
Valvular abscess

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17
Q

Patient with endocarditis develops first degree heart block - next step?

A

TEE r/o valvular abscess

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18
Q

Antibiotic prophylaxis for these following six patient conditions

A 
Prev endocarditis 
Congenital heart disease
Repaired CHD within 6 mo
Repaired CHD w/prosthesis or patch or residual defect 
All prosthetic valves
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19
Q

High risk procedures that need endocarditis prophylaxis consideration

A

Dental procedures involving bleeding and increased risk of inducing bacteremia

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20
Q

Antibiotic of choice for endocarditis prophylaxis

A

Amoxicillin 2g one hr prior

IV ampicillin

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21
Q

Antibiotic of choice for endocarditis prophylaxis if PCN allergic

A

Azithromycin or Clindamycin

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22
Q

Post procedure antibiotics for endocarditis prophylaxis

A

Nothing

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23
Q

Patient with staph aureus BACTEREMIA - what next ?

A

Reflex TEE

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24
Q

Echo neg for vegetation and antibiotics given for staph aureus bacteremia but blood cx positive after 72 hours on antibiotics

A

Continue antibiotics X 4 weeks

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25
Echo neg for vegetation and antibiotics given for staph aureus bacteremia but blood cx negative in
Continue antibiotics X 2 weeks
26
Echo neg for vegetation and antibiotics given for staph aureus bacteremia but blood cx positive in immunocompromised patient
Continue antibiotics X 4 weeks
27
Echo neg for vegetation and antibiotics given for staph aureus bacteremia but blood cx positive in patient with prosthetic valve or cardiac device or arthroplasty
Continue antibiotics x 4 weeks
28
Echo POSITIVE for vegetation and antibiotics given for staph aureus bacteremia how long do u continue antibiotics
6-8 weeks
29
What other medication is good for right sided endocarditis in IVDU if no vanco available
Daptomycin
30
Empiric treatment of meningitis if + head trauma (organism and Med)
MRSA S. Pneumo GNR Vanco Cefepime
31
Empiric treatment for meningitis for patient >FIFTY (50) Name organism and Medication
Listeria S. Pneumo N. Meningitidis Ampicillin Ceftriaxone Vanco
32
Empiric treatment for meningitis in a teenager / young adult Name organism and Medication
S. Pneumo N. Meningitidis H. Influenza Ceftriaxone
33
Empiric treatment for meningitis for a baby Name organism and Medication
S. Agalactiae Listeria E. Coli Ceftriaxone Ampicillin
34
Best treatment for confirmed listeria meningitis
Ampicillin and gentamicin | Synergistic
35
If PCN resistant S. Pneumo suspected in meningitis what is replacement Med for ceftriaxone ?
Vanco + rifampin instead
36
Eponym for benign recurrent lymphocytic meningitis. What causes it? Treatment?
Mollert's meningitis HSV2 Supportive Rx (no antiviral)
37
Confirmation for and treatment of herpes encephalitis ?
CSF PCR | IV acyclovir
38
Deep tendon reflexes absent in a patient with suspected meningitis of what cause?
West Nile virus | Test IgM antibiodies
39
Most important prognostic factor for west Nike virus ?
Age >75
40
Suspect HSV meningitis s/ Rx but HSV PCR negative and pt now with choreaform movements
NMDA receptor encephalitis Rule out ovarian teratoma
41
What trophozoite can invade cribiform plate when u are swimming in lake? Treatment!?
Naeglaria fowleri Miltifosinefrom CDC
42
Patient with confirmed meningococcal meningitis who to prophylaxis and with which antibiotic
Household contacts Day care/nursery contacts Rifampin 600 BID X 2 days (jealous drug like St. John's wort) If no rifampin, cipro X 1 dose If pregnant - ceftriaxone 250 mg X 1 dose
43
Precautions for meningococcal meningitis
DROPLET precaution X 24 hrs while on antibiotics
44
How to treat recurrent UTIs after coitus
Daily bactrim
45
Treatment of Asymptomatic bacterURIA only for ...
Pregnant women | Post transplant patient
46
Treatment for complicated uti with ESBL
PO phoshomycin x 3 days | If no improvement give meropenam
47
Which HSV causes meningitis and encephalitis
2 meningitis | 1 encephalitis
48
Treatment for uncomplicated cystitis
Bactrim Or Cipro Or Nitrofurantoin X THREE (3) days
49
Symptoms of uncool cares cystitis persist after 3 days of antibiotics, what next
Get culture and sensitivity | Treat for SEVEN (7) days
50
Treatment for cystitis In Pregnancy
Nitrofurantoin Or Amoxicillin X SEVEN (7) days However according to MKSAP Nitrofurantoin is contraindicated in 3rd trimester (#21)
51
Treatment for uncomplicated pyelonephritis
Fluoroquinolone X 7-10 days
52
Treatment for pyelo when pregnant
Admit IV ceftriaxone Or IV ampicillin and gentamicin
53
Treatment for pregnant lady with pyelonephritis and PCN allergy
Aztreonam
54
Treatment for prostatitis
Flouroquinolone X 4-6 WEEKS
55
Treatment for gonorrhea
Ceftriaxone 250 mg IM X 1
56
Treatment for chlamydia
Azithromycin 1 g X 1 day Or Doxycycline 100 BID X 7 days
57
Strawberry cervix seen - what is organism and how to treat
Anaerobic trichomonas Metronidazole 2g ONCE
58
Treatment for Candidiasis in pregnant female
Topical clotrimazole X SEVEN 7 days
59
Cause of and treatment for bacterial vaginosis
Gardenerella Metronidazole 500 BID X SEVEN 7 days Or Metro gel 0.75% X FIVE 5 days Or Clindamycin cream 2% daily X SEVEN 7 days
60
Which test is used to detect chlamydia
Urine PCR
61
When should you recheck for chlamydia reinfection if you treated it recently ?
Check after 3 weeks post treatment
62
Treatment for mycoplasma genitalium?
Moxifloxacin
63
Most common organism for epididymitis?
35 ecoli enterobacter
64
Treatment for epididymitis
35 levofloxacin
65
Genital herpes treatment for first attack; second attack and frequent recurrences
First - acyclovir X 10 days Second - acyclovir X 5 days Recurrent - acyclovir prophylaxis indefinitely
66
Treatment for haemophilus ducreyi
Ceftriaxone 250 mg IM X 1 Or Azithromycin 1 g X 1 Or Erythromycin 500 QID X 7 days
67
Which gram negative bacillus is described as "school of fish" or "box car appearance"
Haemophilus ducreyi
68
Painless ulcer causing buboes fistulas and rectal scarring
Lymphgranuloma venereum (chlamydia)
69
Treatment for lymphgranuloma venereum
Doxycycline 100 BID X 21 days
70
Painless ulcers that look like carcinoma of the penis revealing Donovan bodies (bipolar safety pin intracytoplasmic inclusions)
Granuloma inguinale | Klebsiella granulomatis
71
Treatment for granuloma inguinale
Doxycycline 100 BID X 21 days Or Bactrim Or Erythromycin
72
RPR negative one year ago now 1:8 what to do
Early latent syphilis Rx Benz PCN 2.4 million units ONCE
73
RPR negative >1 year ago now 1:8 what to do
Late latent syphilis Rx Benz PCN 2.4 million units WEEKLY X 3
74
Test preferred to be used to check for secondary syphilis
VDRL / RPR because FTA positive for life
75
If you suspect neurosyphilis but spinal tap VDRL negative but WBC super high what do you do?
Treat as if positive with PCN G 2 million units q4 hours X 2 weeks
76
Patient has neurosyphilis but is PCN allergic what now?
Desensitize and recheck spinal tap q6 months till WBC CSF normalize
77
Patient experiences jarisch herxheimer reaction what to do?
Continue PCN for syphilis Rx Bedrest Aspirin
78
Illness to treat with doxycycline (Name five)
``` Chlamydia RMSF Lyme's disease Anaplasma Ehrlichia Lymphgranuloma venereum (chlamydia) Granuloma inguinale (kleb) Cat scratch disease (bartonella henslae) Plague Leptospirosis Brucellosis Q fever ```
79
Treatment for tick borne illness associated with Maltese cross or tetrads under microscope
Mild babesia Atoquavone Azithromycin Severe babesia Quinine Clindamycin
80
Name of rash for stage 1 Lyme
Erythema chronicum migrans
81
Stage 2 Lyme heart block treatment
Ceftriaxone X 10-28 days
82
72 hours after hiking you found a tick but u have no rash and no other symptoms do you treat?
Yes, doxycycline 200 mg ONCE
83
How to treat tick induced paralysis
Remove the tick
84
Must follow which lab test weekly when on daptomycin?
CPK
85
Best imaging for confirming necrotizing fasciitis
MRI
86
Treatment for vibrio vulnificus
Aggressive debridement IV cephalosporin 3rd gen Or Tetracycline/Gentamicin
87
Treatment for fish tank cleaner with mycobacterium marinum
Clarithromycin Ethambutol +/- Rifabutin
88
Treatment for rose gardener with sporotrichosis
Itraconazole Or Amphoteric in B if disseminated
89
Treatment for pseudomonas associated hot tub folliculitis
Nothing | Self limited
90
Patient using indoor hot tub now with cough and CXR with thin walled cavities
MAI causing hypersensitivity pneumonitis
91
Neutropenia patient with black central ulceration and cellulitis - worry about what?
Ecthyma gangrenosum caused by pseudomonas
92
Antibiotics for pseudomonas (4)
Zosyn Ceftazidime Cefepime Meropenem
93
What kind of isolation for herpes zoster?
``` 1 dermatome (contact) 2+ dermatomes (contact)(airborne) ``` But if patient is immunocompromised contact and airborne no matter what
94
Treatment for post heretic neuralgia
Desipramine > gabapentin / pregabalin
95
Single dermatomal rash herpes zoster with symptoms >72 hours - to treat or not to treat
Treat with acyclovir / valacyclovir / famciclovir only if >50 with new lesions appearing or with immunosuppression (HIV on steroids or TNFs)
96
Shingles vaccine recommended by CDC starting at what age?
60
97
How to differentiate smallpox from chickenpox on physical exam
Smallpox crops all same age Chickenpox crops all different stages
98
Isolation for chickenpox
Contact | Airborne
99
Pregnant mom with chickenpox kid 1. What to do for immunosuppression kid 2 and her and yourself ?
Immunosuppressed kid 2 needs VZIG Check titers in pregnant mom and yourself If low, pregnant mom gets VZIG and treatment for symptoms If low, you get vaccine
100
Dx for Pustules on hands after letting them touch monkey at a fair or touching a wild dog
Monkey pox
101
Hand foot mouth disease is caused by what?
Coxsackie virus A
102
Rat feces aerosolized in south west USA now everyone had incr hematocrit and resp failure from what ?
Hanta virus
103
Man with NO prior vaccinations gets bitten by a bat - what next ?
Rabies immune globulin now Rabies vaccine now, day 3, day 7 and day 21
104
Man with all prior vaccinations gets bitten by a bat - what next?
Rabies vaccine now and on day 3
105
P falciparum prophylaxis
Mefloquine 1 week prior to departure and 4 weeks after landing back in USA Or Atovaquone/proguanil 1 DAY prior to departure and 1 week after landing back in USA
106
Malaria treatment of p falciparum
Quinine Doxy Or Atovaquone Proguanil Or Quinidine Clinda Or Artemisinin Amodiaquine
107
Mosquito bite in the Florida Keys area what illness are you worried about
Dengue Fever Rash Anemia Thrombocytopenia
108
Dental caries Tender mandible Brawny edema Neck tenderness What is the eponym for this condition
Ludwig angina Caused by peptostreptococcus + anaerobes
109
Treatment of lugwig angina
Amox/clav Or Amp/sulbac
110
Neutropenia fever - what medications to start empirically?
Cefepime or Meropenem If IV line + or fever >3d Vanco If fever >7d Voriconazole
111
Anti fungal shown to improve mortality when given prophylactically to Pts with post chemo Neutropenia
Posaconazole
112
Treatment of aspergillosis
Voriconazole
113
Treatment for weakly acid fast gram + filament and branching agent that affects the skin lungs and brain
Nocardia Rx bactrim
114
Beta D glucan used to rule out what?
PCP
115
Galactomanin used to rule out what?
Aspergillosis
116
Empiric treatment for osteomyelitis with prosthetic joint implant
Vanco Gent Rifampin
117
Mucormycosis with right angle branching filaments in a poorly controlled diabetic pt - how to treat?
Surgical debridement | Amphotericin B
118
Name three medications that can treat hospital grade MRSA
Vanco Daptomycin Quinupristine/dalfopristin
119
Treatment for ESBL
Fosfomycin Or Meropenem Or Tigecycline (not good for urine) Or Colistin (polymyxin)
120
Treatment for stenotrophomonas because it causes high mortality in cystic fibrosis patients
Bactrim
121
Which organism can be treated with antibiotics WITHOUT d/c of central line?
Staph epi
122
You suspect mono in a young patient but monospot negative for heteropjile antibodies - what now?
Monospot insensitive Use EBV viral capsid antigen (VCA IgM)
123
Monospot + with enlarging tonsils and shortness of breath - what Med to give ?
Steroids
124
Name gram positive rods
``` Bacillus anthracis Clostridium Corynebacterium Listeria Mycobacterium Proprionibacterium ```
125
Treatment of anthrax
PCN Or Fluoroquinolone
126
Isolation precaution for person infected with anthrax
None Not transmissible via person to person
127
Hunter of rabbits develops tender nodes and ulcers and pneumonia. How to treat ?
Rx tularemia with streptomycin X 7-10 days
128
Isolation for plague
Droplet
129
What is the culprit in culture negative endocarditis with positive cryoglobulins but hep C negativity
Brucella
130
Patient from Middle East with enlarged liver - you are suspicious for ?
Hydatid cysts from Echinococcus granulosus
131
Young veteran returns with ulcerated lesions with eschar and erythema around arms - what do you suspect
Cutaneous leishmaniasis
132
Isolation for neissieria, influenza and plague
Standard | Droplet
133
Isolation for MTB
Standard | Airborne
134
Isolation for varicella
Standard Contact Airborne
135
Isolation for measles
Standard | Airborne
136
Isolation for scabies
Standard | Contact
137
Isolation for c diff
Standard | Contact
138
Isolation for HSV one dermatome
Standard | Contact
139
Isolation for HSV >2 dermatomes
Standard Contact Airborne
140
Isolation for MRSA And VRE
Standard | Contact
141
ELISA + but western blot negative for HIV - what to tell patient with no symptoms
HIV negative ELISA is like ANA Western blot is like anti smith
142
Symptomatic with cough lymphadenopathy and aphthous ulcers but ELISA for HIV and monospot negative - what to do ?
Check HIV RNA PCR for viral load r/o acute viral syndrome
143
Nurse with needle stick by HIV positive patient - what is empiric treatment
Get baseline ELISA Raltegravir + 2 NRTIs Recheck HIV in 4 weeks Negative ? Stop meds .
144
Positive PPD if HIV + is how much induration
5mm
145
TREATMENT of PCP with sulfa allergy
Cannot give bactrim Clinda Primaquine
146
Addition of what medication for PCP treatment if PaO2
Steroids
147
Creatinine rises while on bactrim - what to do?
Normal Trimethoprim inhibits tubular secretion Continue medication
148
PROPHYLAXIS of PCP with sulfa allergy
Dapsone Or Atovaquone
149
How to treat toxoplasmosis
Sulfadiazine | Pyrimethamine
150
Treatment for recurrent candidiasis on fluconazole
Itraconazole suspension Or Caspofungin
151
Treatment for cryptococcal meningitis in HIV + patient with CD4
Amphotericin B Flucytosine Then switch to fluconazole
152
Treatment of CMV retinitis in HIV patient with CD4
Ganciclovir Or Foscarnet Or Cidofovir
153
PML caused by
JC virus
154
``` Name the associated CD4 counts with these infections: PCP Esophageal candidiasis Cryptococcal meningitis MAI CMV ```
PCP and esophageal candidiasis
155
Name PPX and treatment of PCP
PPX Bactrim Dapsone Atovaquone Rx Bactrim Clindamycin + primaquine
156
PPX and RX of MAI
PPX Azithromycin Rx Clarithromycin Ethambutol +\- Rifabutin
157
Best statin for HIV hypercholesterolemia
Pravastatin
158
Avoid which statin in HIV patients
Simvastatin
159
Best drug for insulin resistance : hyperglycemia in HIV patients
Metformin (watch for lactic acidosis with NRTIs)
160
Best Med to use in HIV and hepatitis C
Raltegravir | Integrase inhibitor
161
Which drugs are jealous drugs
Rifampin | St. John's wort
162
Which drugs increase drug toxicity because they inhibit p450
These drugs like to parrrtayy Grapefruit juice Itraconazole Ketoconazole
163
Patient diagnosed with HIV and cryptococcal meningitis - which to treat first
Cryptococcal meningitis Then ~5 weeks later start HAART
164
Patient diagnosed with HIV and TB which to treat first?
Treat both immediately
165
What CD4 count do you start to treat HIV?
if HIV positive treat regardless of CD4 count
166
Name five (5) live vaccines we should AVOID in Pregnancy and HIV + patients
``` Intranasal influenza Oral polio MMR Varicella HZV Yellow fever ```

Infectious Disease (1 decks)

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