Flashcards in ID Deck (75):
Penicillin -> Nafcillin -> Vancomycin -> Linezolid
Penicillin -> ampicillin/amoxicillin + b lactamase inhibitor-->piperacillin + beta lactamase inhibitor --> Meropenem
Cipro + Levo, mostly gram negatives (urinary)
Moxi, gram negatives and gram positives (respiratory)
Vagina and GI tract? Flagyl
Everything else? Clindamycin
Empiric treatment for cap
Ceftriaxone and azithromycin
or just azithromycin as OP
Empiric treatment for HCAP
Vancomycin and cefepime/zosyn
Empiric treatment for meningitis
Vanc + ceftriaxone
+steroids (if sick)
+ampicillin (if old, baby, chemo, HIV, transplant, on MAB)
Empiric treatment for UTI
Empiric treatment for cellulitis
How to diagnose HIV patients that present with flu like symptoms?
With a viral load ****
Treatment for HIV
2NRTIs + 1 of something else
Newborn prophylaxis for HIV
AZT within 12H of delivery for 6 weeks
Cavitary lesion in lower or middle lobes, asymptomatic, caseating granulomas
Caseating granulomas in upper lobes, fever, hemoptysis, night sweats, weight loss.
Not exposed. Return in 2 weeks if in healthcare for another
Who is positive if PPD >5cm?
Immunosuppressed, steroids, HIV, transplant, very close contacts
Who is positive if PPD >10cm?
At risk: prisons, healthcare workers, homeless
Who is positive if PPD >15cm?
Don't test population, soccer moms
What to do if PPD positive?
CXR, if negative, then exposed, give INH and B6
If positive, then AFB. If negative give INH and B6
If positive, give RIPE.
How to evaluate somebody with signs and symptoms of TB?
CXR, AFB + Cx,
If both negative Not TB, but do NAAT to make sure
If both positive TB, give RIPE.
If CXR positive, but AFB negative, latent, give INH and B6.
Major Duke Criteria
Major: Persistent bacteremia with endocarditis causing bug
New regurgitation murmur
Vegetation on echo
Minor Duke Criteria
Risk factors: IVDU, history of endocarditis, bad valve
Vascular Manifestations - septic emboli, stroke, splinter hemorrhages, janeway lesions
Rheumatologic manifestations- Osler nodes, roth spots, RF, glomerulonephritis
Caused by staph mostly (sometimes strep pneumo)
Patient is bacteremic and toxic with CHS and no rheum findings. Dx with blood cultures, treat until negative.
Diagnose with ECHO!
How to treat endocarditis
4-6 weeks of antibiotics
Surgery if CHF, >15mm vegetation or >10mm vegetation with emboli
When to do surgery for endocarditis?
If patient has CHF, if there is a vegetation >15mm, or if there is a vegetation >10 MM that has emboli
How to treat native valve endocarditis?
Vancomycin (give daptomycin if vanc allergic)
How to treat prosthetic valve endocarditis if
Vanc + gentamycin + cefepime
How to treat prosthetic valve endocarditis if between 60 and 365 days?
Vanc + gent
How to treat prosthetic valve endocarditis if >365 days
Vanc + gent + ceftriaxone
How to treat subacute endocarditis
Gent + ceftriaxone.
Usually with hacek organisms, patient has low grade fevers with rheumatologic manifestations. Blood cultures until positive, then give abx. TTE if questionable, if positive, then do TEE
When to give endocarditis prophylaxis
Bad valve + oral/throat surgery
Endocarditis in past
Congenital heart disease
T>38 T12 or 90
End organ damage + SIRS
AMS, Increase in BUN/CR, increase in LFT
Sirs with source
Severe sepsis that doesn't improve with fluid
Early goal directed therapy for sepsis
CVP at 12 mmHG.
Urine output > .5cc/kg/hr
Three causes of fever and headache?
Meningitis - bacterial, TB, RMSF, lyme, crypto, viral
Abscess- Rule out cancer, + focal neuro deficit
Encephalitis - west nile, st louis, EEE + AMS
How to work up fever and headache?
Get an LP if safe, if unsafe do a CT scan. If CT scan is negative for mass lesion, do an LP. If CT is positive for mass lesion, then test for HIV and toxo.
When is it not safe to LP
Focal deficit, AMS, immunocompromised, mass lesion, seizures
Diagnosis if LP shows lymphocytosis?
Diagnosis if LP shows thousands of Polys?
Bacterial meningitis, treat empirically with vancomycin, ceftriaxone, steroids +/- ampicillin
Diagnosis if LP is negative?
Crypto, lyme, rmsf, RB
Sign of cryptococcal meningitis?
Opening pressure >20, AIDS history, diagnose with cryptoantigen
Sign of RMSF
Fever, rash from arms -> trunk, camping with tick bite
Sign of Lyme
Tick targetoid rash, arrhythmias, arthralgias
Sign of TB
Night sweats, wt loss, hemoptysis
Sign of tertiary syphilis?
History of syphilis with any neuro symptoms warrants a CSF RPR or FTAABS
Signs: Rubor tumor dolor
Dx: clinical, culture, then rule out osteomyelitis with MRI/Xray
Treat with cephazolin
How to treat MRSA cellulitis
IV vancomycin followed by PO bactrim
Bone infection with pain and fever caused by direct deep inoculation or by hematogenous spreading
Diagnose with Xray, bone scan, MRI
Culture once for bug and sensitivity
How to to treat osteomyelitis? Follow up?
Vancomycin and Zosyn, then treat based on sensitivity. Follow up with MRI and ESR/CRP
Infection with clostridium perfringens. Muddy wound, Crepitus. Diagnose with Xray
How to treat gas gangrene
Treat with clindamycin and penicillin after debridement, then hyperbaric O2
How to treat necrotizing fasciitis
Difference between bronchitis and pneumonia?
Both have cough, sputum, but only pneumonia has postive CXR findings.
Cap vs HCAP?
Hospital acquired pneumonia treatment?
Vancomycin + zozyn
How to treat PCP
Bactrim + steroids
How long to treat complicated UTI?
Complicated if male, north of bladder, anatomic defect
How to treat pyelonephritis?
IV ceftriaxone for 14 days.
How to diagnose primary syphilis?
RPR, LP RPR and FTA
Treatment for primary syphilis
1 dose of PCN IM
I dose IM
14 days IV penicillin
How to treat syphilis if penicillin allergic?
How to treat syphilis if penicillin allergic and pregnant?
Penicillin with epinephrine nearby!
Caused by H ducreyii, gram negative bug with painful ulcer and lymhadenopathy. Treat with doxy or azithro
Painful burning multiple vesicles on erythematous base
Dx with HSV PCR
Molloscum contagiosum. Tx?
Multiple vesicles with central umbilication. Freeze them
How to treat otitis media?
How to treat otitis externa
Nothing, or acetic acid drops.
How to distinguish otitis media vs otitis externa based on exam alone
Externa has pain with pinna pull.
Also otitis media has a rigid tympanic membrane with insufflation.
How to treat sinusitis?
If greater than 7 days or has a cough, then amoxicillin
M. Catarrhalis, H. influenzae, S. pneumo
How to retrieve bug in ear?
Lidocaine, then retrieval
Big tonsils, snoring child, blue while resting, pink while crying.