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Flashcards in ID Deck (75):
1

Antibiotic ladder

Penicillin -> Nafcillin -> Vancomycin -> Linezolid
Penicillin -> ampicillin/amoxicillin + b lactamase inhibitor-->piperacillin + beta lactamase inhibitor --> Meropenem

2

FQ

Cipro + Levo, mostly gram negatives (urinary)
Moxi, gram negatives and gram positives (respiratory)

3

Anaerobic treatment

Vagina and GI tract? Flagyl
Everything else? Clindamycin

4

Empiric treatment for cap

Ceftriaxone and azithromycin
or just azithromycin as OP

5

Empiric treatment for HCAP

Vancomycin and cefepime/zosyn

6

Empiric treatment for meningitis

Vanc + ceftriaxone
+steroids (if sick)
+ampicillin (if old, baby, chemo, HIV, transplant, on MAB)

7

Empiric treatment for UTI

Bactrim
Cipro
Ceftriaxone
Nitrofurantoin

8

Empiric treatment for cellulitis

Cephazolin
Bactrim
Clindamycin

9

How to diagnose HIV patients that present with flu like symptoms?

With a viral load ****

10

Treatment for HIV

2NRTIs + 1 of something else

11

Newborn prophylaxis for HIV

AZT within 12H of delivery for 6 weeks

12

Primary tuberculosis

Cavitary lesion in lower or middle lobes, asymptomatic, caseating granulomas

13

Secondary tuberculosis

Caseating granulomas in upper lobes, fever, hemoptysis, night sweats, weight loss.

14

Negative ppd?

Not exposed. Return in 2 weeks if in healthcare for another

15

Who is positive if PPD >5cm?

Immunosuppressed, steroids, HIV, transplant, very close contacts

16

Who is positive if PPD >10cm?

At risk: prisons, healthcare workers, homeless

17

Who is positive if PPD >15cm?

Don't test population, soccer moms

18

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.

19

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.

20

Major Duke Criteria

Major: Persistent bacteremia with endocarditis causing bug
New regurgitation murmur
Vegetation on echo

21

Minor Duke Criteria

Risk factors: IVDU, history of endocarditis, bad valve
Fever >38
Vascular Manifestations - septic emboli, stroke, splinter hemorrhages, janeway lesions
Rheumatologic manifestations- Osler nodes, roth spots, RF, glomerulonephritis

22

Acute endocarditis

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!

23

How to treat endocarditis

4-6 weeks of antibiotics
Surgery if CHF, >15mm vegetation or >10mm vegetation with emboli

24

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

25

How to treat native valve endocarditis?

Vancomycin (give daptomycin if vanc allergic)

26

How to treat prosthetic valve endocarditis if

Vanc + gentamycin + cefepime

27

How to treat prosthetic valve endocarditis if between 60 and 365 days?

Vanc + gent

28

How to treat prosthetic valve endocarditis if >365 days

Vanc + gent + ceftriaxone

29

How to treat subacute endocarditis

Gent + ceftriaxone.

30

Subacute endocarditis

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

31

When to give endocarditis prophylaxis

Bad valve + oral/throat surgery
Endocarditis in past
Congenital heart disease
prosthetic valve.

32

SIRS

T>38 T12 or 90
RR>20

33

Severe sepsis

End organ damage + SIRS

AMS, Increase in BUN/CR, increase in LFT

34

Sepsis

Sirs with source

35

Septic shock

Severe sepsis that doesn't improve with fluid

36

Early goal directed therapy for sepsis

CVP at 12 mmHG.
Urine output > .5cc/kg/hr
MAP>65
VO2 >70.

37

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

38

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.

39

When is it not safe to LP

Focal deficit, AMS, immunocompromised, mass lesion, seizures

40

Diagnosis if LP shows lymphocytosis?

Viral encephalitis

41

Diagnosis if LP shows thousands of Polys?

Bacterial meningitis, treat empirically with vancomycin, ceftriaxone, steroids +/- ampicillin

42

Diagnosis if LP is negative?

Crypto, lyme, rmsf, RB

43

Sign of cryptococcal meningitis?

Opening pressure >20, AIDS history, diagnose with cryptoantigen

44

Sign of RMSF

Fever, rash from arms -> trunk, camping with tick bite

45

Sign of Lyme

Tick targetoid rash, arrhythmias, arthralgias

46

Sign of TB

Night sweats, wt loss, hemoptysis

47

Sign of tertiary syphilis?

History of syphilis with any neuro symptoms warrants a CSF RPR or FTAABS

48

Cellulitis, treatment?

Signs: Rubor tumor dolor
Dx: clinical, culture, then rule out osteomyelitis with MRI/Xray
Treat with cephazolin

49

How to treat MRSA cellulitis

IV vancomycin followed by PO bactrim

50

Osteomyelitis

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

51

How to to treat osteomyelitis? Follow up?

Vancomycin and Zosyn, then treat based on sensitivity. Follow up with MRI and ESR/CRP

52

Gas gangrene

Infection with clostridium perfringens. Muddy wound, Crepitus. Diagnose with Xray

53

How to treat gas gangrene

Treat with clindamycin and penicillin after debridement, then hyperbaric O2

54

How to treat necrotizing fasciitis

Surgical emergency

55

Difference between bronchitis and pneumonia?

Both have cough, sputum, but only pneumonia has postive CXR findings.

56

Cap vs HCAP?

Cap if

57

Hospital acquired pneumonia treatment?

Vancomycin + zozyn

58

How to treat PCP

Bactrim + steroids

59

How long to treat complicated UTI?

10 days.

Complicated if male, north of bladder, anatomic defect

60

How to treat pyelonephritis?

IV ceftriaxone for 14 days.

61

How to diagnose primary syphilis?
Secondary?
Tertiary?

Darkfield microscopy
RPR FTA-ABs
RPR, LP RPR and FTA

62

Treatment for primary syphilis
Secondary
Tertiary

1 dose of PCN IM
I dose IM
14 days IV penicillin

63

How to treat syphilis if penicillin allergic?

Doxycycline

64

How to treat syphilis if penicillin allergic and pregnant?

Penicillin with epinephrine nearby!

65

Chancroid. Tx?

Caused by H ducreyii, gram negative bug with painful ulcer and lymhadenopathy. Treat with doxy or azithro

66

Herpes

Painful burning multiple vesicles on erythematous base
Dx with HSV PCR
Tx acyclovir

67

Molloscum contagiosum. Tx?

Multiple vesicles with central umbilication. Freeze them

68

How to treat otitis media?

Augmentin

69

How to treat otitis externa

Nothing, or acetic acid drops.

70

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.

71

How to treat sinusitis?

If greater than 7 days or has a cough, then amoxicillin
If

72

URI bugs

M. Catarrhalis, H. influenzae, S. pneumo

73

How to retrieve bug in ear?

Lidocaine, then retrieval

74

Choanal atresia

Big tonsils, snoring child, blue while resting, pink while crying.

75

How to treat prostate involved UTI

Cipro