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1
Q

Penicillin coverage

A 
Strep viridans 
Strep pyrogenes 
Oral anaerobes 
Syphilis 
Leptospira
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2
Q

Amoxicillin/Amipcillin coverage

A

Penicillin coverage +

H. influenzae 
E. coli 
Listeria 
Proteus 
Salmonella
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3
Q

Uses for Amoxicillin/Ampicillin

A 
Otitis media 
Dental infection and endocarditis prophylaxis 
Lyme 
UTI in preggos 
Listeria infection 
Enterococcal infection
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4
Q

Penicillinase-resistant penicillins: oxacillin, cloxacillin, nafcillin coverage

A

Treat MSSA

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5
Q

Oxacillin, cloxacillin, nafcillin

A

Skin infections: cellulitis, impetigo, erysipelas

Endocarditis, meningitis, and bacteremia

Osteomyelitis and septic arthritis

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6
Q

Piperacillin, ticarcillin, azlocillin, mezlocillin coverage

A

Psuedomonal coverage!
enterobarteria group coverage, as well.

Require beta lactamase inhibitor

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7
Q

Piperacillin, ticarcillin, azlocillin, mezlocillin useage

A 
Cholecystitis and ascending cholangitis 
Pyelonephritis 
Bacteremia 
HAP and VAP 
Neutropenic fever
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8
Q

Methacillin toxicity

A

Methacillin should be replaced with oxacillin

Causes renal failure from allergic interstitial nephritis

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9
Q

First generation: Cefazolin, Cephalexin, Cephradrine, Cefadroxyl coverage

A 
Gram positive cocci and:
Proteus 
E. 
coli 
Klebsiella pneumonia
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10
Q

Second generation: Cefotetan, cefoxitin, cefaclor, cefprozil, cefuroxime, loracarbef coverage

A 
Gram positive cocci and:
Haemophilus influenza
Enterobacter 
Neisseria gonnorhea 
Proteus 
E. 
coli 
Klebsiella pneumonia 
Serratia
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11
Q

First generation cephalosporin uses

A

osteomyelitis
septic arthritis
endocarditis
cellulitis

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12
Q

Second generation cephalosporin uses

A

Cefotetan or cefoxitin: PID

All others: bronchitis, otitis media, sinusitis

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13
Q

Third generation: Ceftriaxone, Cefotaime, Ceftazidime

A

Serious gram negative coverage

First line for pneumococcus

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14
Q

Third generation uses:

A

Meningitis
CAP
Gonorrhea
Lyme in brain or heart

No ceftriaxone in neonates- impairs biliary metabolism

Cefotaxime: Neonates and SBP

Ceftazidime: psuedomonal coverage

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15
Q

Fourth generation: Cefepime

A

Better staph coverage than 3rd gen

Neutropenic fever
VAP

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16
Q

Ceftaroline

A

Only cephalosporin with MRSA coverage

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17
Q

AE of cephalosporin

A

Cefoxitin and cefotetan deplete prothrombin and increase risk of bleeding

Ceftriaxone- inadequate biliary metabolism

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18
Q

Aztreonam

A

No cross reaction with penicillin

Exclusively for gram -ve bacilli including Pseudomonas

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19
Q

Fluoroquinolones: cipro, levofloxacin, gemifloxacin

A

BEST therapy for CAP
Gram -ve coverage, including psuedomonals

Cipro: cystitis and pyelo

Diverticulitis and GI infections: good but need metronidazole for anaerobes, or moxifloxacin covers anaerobes

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20
Q

Aminoglycosides: gentamicin, tobramycin, amikacin

A

Gram -ve bacilli
Synergistic with beta-lactam for enterococci and staph

NO effect on anaerobes (need oxygen to work)
Nephrotoxic and ototoxic

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21
Q

Doxycycline

A 
Chlamydia 
Lyme diseae
Rickettsia 
MRSA- soft tissue infections 
Primary or secondary syphylis in allergic patient 
Borreila, Ehrlichia, mycoplasma
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22
Q

Doxycycline AE

A

Tooth discoloration in kiddos
Fanconi’s syndrome- RTA II
photosensitivity
esophagitis/ulcers

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23
Q

Trimethoprim/Sulfamethoxazole

A

Cystitis
Pneumocystis pneumonia tx and prophylaxis
MRSA-skin

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24
Q

Bactrim toxicity

A

hemolysis in G6PD

Bone marrow suppression- folate antagonist

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25
Gram positive cocci: best initial therapy
oxcallin and friends first gen cephalosporins: cefazolin, cephalexin Flouroquinolones Third line: macrocodes
26
MRSA serious infection: best initial agent
``` Vancomycin Linezolid- causes reversible bone marrow toxicity Daptomycin- causes elevated CPK Tigecycline Ceftaroline ```
27
MRSA minor infections: best initial agent
Bactrim Clindamycin Doxycycline Linezolid
28
Anaerobes best initial thearpy
Oral/above diaphragm: - penicillin - clindamycin Abdominal/GI: Metronidazole Zosyn
29
Gram -ve bacilli best initial therapy
``` Quinolones Aminoglycosides Carbapenem Zosyn Aztreonam Cephalosporins ```
30
Most common causes of meningitis
1. S. pneumo 2. N. meningitidis 3. GBS 4. H. influenzae 5. Listeria
31
Meningitis with AIDS <100 CD4
cryptococcus
32
Meningitis with camping, erythema migraines, joint pain, facial palsy
Lyme
33
Meninigits with camping | Rash moves from arms and legs to trunk
Rocky mountain spotted fever
34
Meningitis with plum TB
TB
35
Meningitis with petechial rash
N. menigntiidis
36
Bacterial meningitis CSF
1000s PMN elevated protein decreased glucose
37
Cryptococcus/lyme/rikettsia csf
10s-100s lymphs possibly elevated protein possibly decreased glucose negative stain and culture
38
TB csf
10s-100s lymph markedly elevated protein possibly low glucose negative stain and culture
39
Viral csf
10s-100s lymph normal protein normal glucose negative stain and culture
40
Initial treatment for CSF suggestive of bacterial meningitis
ceftriaxone vancomycin steriods- only useful in s. pneumo, but if WBC in CSF in 1000s give it
41
Listeria risk factors
``` Elderly Neonate Steroid use AIDS/HIV Immunocompromised Preggers ``` Listeria suspicion requires ampicilin
42
Additional management for N.meningitidis
Respiratory isolation | Rifampin, cipro, or ceftriaxone to close respiratory contacts
43
Most accurate test for herpes encephalitis
PCR of CSF
44
Most accurate diagnosis of sinusitis
Sinus biopsy or aspirate
45
Treat severe diarrhea with fluid and cipro
``` hypotension tachycardia fever abdominal pain bloody diarrhea metabolic acidosis ```
46
giardia tx
metronidazole
47
cryptosporidosis
Tx AIDs, nitazoxanide
48
Treatment for acute HBV, HEV, and HAV
NONE
49
Treatment for acute HCV
Interferon, ribavarin, boceprevir/telaprevir Decreases likelihood of developing chronic HCV
50
Chronic HBV definition
persistant surface antigens for more than 6mo
51
Treatment for Chronic HBV
If patient is HbeAg elevated with a positive and elevated DNA polymerase treat with entecavir, adefovir, lamivudine, telbivudine, IFN, tenofovir
52
IFN AE
Arthralgia/myalgia Leukopenia and thrombocytopenia Depression and flu-like symptoms
53
Goal of chronic hepatitis therapy
reduce DNA polymerase to undetectable levels Convert those with e-antigen to having anti-hepatitis e antibody
54
Treatment of chronic HCV
IFN, ribavarin, and broceprevir/telaprevir
55
Painless genital ulcers with heaped up indurated edges Painless adenopathy
Syphylis Dx: Initial- VDRL/RPR Best-FTA-ABS or dark field microscopy Tx: Single dose of intramuscular benzathine penicillin or doxycycline
56
Painful ulcer with deep purulent base and painful lymphadenopathy
Chancroid-Haemophilus ducreyi Dx: stain and culture on chocolate agar Tx: Azithromycin (single dose)
57
Lymph nodes tender and suppurating
Lymphogranuloma venerum (chlamydia) Dx: Complement fixation titers , nucleic acid amplification swab Tx: Doxycycline
58
Vesicles prior to ulcer and painful
HSV Dx: Initial-Tznack stain Best-viral culture Diagnostic test not necessary Tx: Acyclovir
59
Rash-palms and soles alopecia areata Mucous patches Condylomata lata
Secondary syphilis
60
Meningovascular disease Tabes dorsalis Paresis Argyll Robertson pupil Aortitis- aortic regurg and aneurysm Gummas
Tertiary syphilis IV Penicillin
61
False positive VDRL/RPR
``` Infection Older age IVDU Age Malaria Antiphospholipid syndrome Endocarditis ```
62
Symptoms of syphilis worsen with treatment
Jarisch-Herxhemier reactoin | Aspirin and antipyretics, will resolve spontaneously
63
Itching in hair-bearing areas | Visible insects on surface
Pediculosis (Crabs) | Tx: permethrin, lindane equally efficacy, increased toxicity
64
Tracking between fingers and toes
Scabies | Tx: permthrin or ivermectin for extensive disease
65
Pyelonephritis treatment
Ampicllin and gentamicin, until culture results are known
66
Acute Prostatitis treatment
Ampicillin and gentamicin, until culture results are known
67
Chronic Prostatitis treatment
6-8 weeks for chronic prostatitis
68
Infective endocarditis symptoms
New murmur + fever: ``` Splinter hemorrhages Janeway lesions Osler nodes Roth spots Brain-mycotic aneurysm Kidney- hematuria, glomerulonephritis Conjunctival petechiae Splenomeagly Septic emboli to lungs ```
69
Initial treatment for infective endocarditis
vancomycin and gentamicin
70
Indications for surgery on IE
``` CHF or ruptured valve Prosthetic valve Fungal endocarditis Abscess AV block Recurrent emboli while on abx ```
71
IE with strep viridans treatment
ceftriaxone 4 weeks
72
S. Aureus (sensitive)
Oxacillin, naficllin, or cefazolin Add rifampin if prosthetic valve
73
Fungal
Amphotericin and valve replacement
74
S. epi or MRSA
Vancomycin Add rifampin if prosthetic valve
75
Enterococci
Amp and gent
76
Cause and treatment of culture negative endocarditis
``` #1 Coxiella and Bartonella Haemophilus aphrophilus Haemophilus parainfluenzae Actinobacillus Cardiobacterium Eikenella Kingella ``` Treat all with ceftriaxone
77
Prophylaxis for endocarditis
1. SIGNIFICANT cardiac defect: - Prosthetic valve - previous endocarditis - cardiac transplant with valvulopathy - unrepaired cyanotic heard defect 2. Risk of bacteremia: - Dental work with bleeding - Respiratory tract surgery producing bacteremia Treat with amoxicillin
78
Treatment of cardiac and neuro (not Bell's palsy) manifestations of Lyme
IV ceftriaxaone
79
Asymptomatic Tick prophylaxis
Ixodes scapularis is the tick Tick >36 hours Engorged tick Endemic area Prophylax with single dose of doxycycline
80
HIV CD4>200 infections
``` Shingles HSV TB Candidiasis Bacterial pneumonia Karposi sarcoma ```
81
How to diagnose infants with HIV
PCR or viral culture | maternal HIV antibodies present for 6mo
82
When to initiate HIV treatment
CD4 < 500 Viral load >100000 Opportunistic infection
83
Best initial HIV therapy
emtricitabine, tonfovir, efavirenz
84
Protease inhibitors
-navir
85
NRTI
-ine or -vir
86
NNRTI
-vir-
87
Entry inhibitors
Enfuvirtide | Maraviroc
88
Integrase inhibitor
Raltegravir
89
Post-exposure prophylaxis HIV
4 weeks of combination therapy bites count!
90
Zidovudine AE
anemia
91
Stavudine and didanosine AE
peripheral neuropathy and pancreatitis
92
Abacavir AE
Hypersensitivity and SJS | Predict by HLA B5701 testing
93
Protease inhibitor AE
Hyperlipidemia, hyperglycemia
94
Indinavir AE
Nephrolithiasis
95
Tenofovir AE
Renal insufficiency
96
Efavirenz AE
Teratogenic
97
Neonate prophylaxis postpartum
Zidovudine for 6 weeks after birth
98
C-section guiedlines in HIV
CD4 < 350 | Viral load >1000
99
Treatment of Lyme in <8yo kiddos and preggos
Amoxicillin or cefuroxime
100
Diarrhea, abdominal cramping | Ingestion of starchy food, such as rice
Bacillus cereus
101
Vomiting, abdominal pain +/- diarrhea Rapid onset of symptoms
S. aureus
102
Abdominal pain, watery diarrhea Fever Abx exposure
C. diff
103
Brief illness with watery diarrhea, cramps, and fever | Underooked or unrefridgerated food
C. perfringens
104
Watery diarrhea, fever, abdominal pain and vomiting | Associated with undercooked poultry and eggs
Salmonella Abx only for sever disease or immunocompromised
105
Vomiting, diarrhea, abdominal pain Ingestion of raw shellfish May cause invasive life threatening disease in immuncompromised or person with liver disease
Vibrio vulnificus
106
Watery diarrhea, may be bloody | Associated with undercooked beef or foods contaminated with bovine feces
E.coli
107
Bloody diarrhea with fever and bacteremia | Contaminated food and water-outside US
Shigella
108
Abdominal pain and bloody diarrhea Associated with undercooked meat Kiddos
Campylobacter
109
Bloody diarrhea bugs
E.coli Shigella Campylobacter
110
Treatment for pen-allergic syphilis
Doxycycline | Tertiary syphilis- ceftriaxone

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