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Flashcards in ID Deck (280):
1

What is staph epi associated with

Catheters
Prosthetic valves
Dialysis

2

Bacteria covered by amoxicillin

H. influenzae
E. coli
Listeria
Proteus
Salmonella

3

What are the B-lactams

PCNs
Cephs
Carbapenems
Aztreonam

4

What PCNs the best initial therapy for

Otitis media
Dental infection/Endocarditis PPx
Lyme limited to rash, joints, CN VII
UTI in pregnancy
L. monocytogenes
Enterococci

5

What are Ox/clox/diclox/naf used for

Skin infections
Staph Endocarditis/Meningitis/Bacteremia
Sensitive osteomylitis and septic arthritis

6

Anti-pseudomonal PCNs are best initial therapy for

Bacteremia
Febrile neutropenia

Cholecystitis
HAVP
Ascending cholangitis
Pyelonephritis

7

What do all cephalosporins cover

Grp A, B, C strep
Viridans
E. coli
Klebsiella
P. mirabilis

8

What is resistant to all cephalosporins

Listeria
MRSA
Entercoccus

9

Rash to PCN then use

Cephalosporin

10

Anaphylaxis to PCN then use

Non-beta lactam ABX

11

Cephalosporin covering MRSA

Ceftaroline

12

AE Cefotetan, Cefoxitin

Deplete prothrombin
Increase bleeding risk

13

AE Ceftriaxone

Inadequate biliary metabolism

14

What doesn't ertapenem cover

Pseudomonas

15

What is Aztreonam for

G- bacilli including pseudomonas

16

AE quinolones

Bone growth abnormalities
Tendonitis (achilles)

17

What is Doxy for

Chlamydia
Richettsia
Lyme

18

What is TMP/SMX for

Uncomplicated cystitis
PCP

19

First choice mouth and GI abscess

Beta lactam/Beta-lactamase combinations

20

Best initial therapy staph and strep

Ox/Clox/Diclox/Naf
Cephazolin, Cephalexin (PCN rash)
Fluoroquinolones
Macrolides (PCN anaphylaxis)

21

What does clindamycin cover

Anaerobes, staph, strep

22

What doesn't clindamycin cover

Mycoplasma
Legionella

23

Best Rx MRSA

Vanco
Linezolid
Dapto
Tigecycline
Ceftaroline

24

AE Linezolid

Reversible BM toxicity

25

AE Daptomycin

Elevated CPK

26

Coverage for Tigecycline

G-
Anaerobes
MRSA

27

Minor MRSA skin infections are treated with

TMP/SMX
Clindamycin
Doxy
Linezolid

28

Anaerobe coverage above diaphragm

Clindamycin = #1
PCN
Carbapenems
Cefoxitin
Cefotetan

29

Anaerobe coverage in ABD/GI

Metro
Beta lactam/Beta-lactamase combinations

30

G- bacilli coverage

Quinolones
Aminoglycosides
Carbapenems
Pipercillin, Ticarcillin
Aztreonam
Cephalosporines 3rd/4th

All 80-90% effective

31

Main G- bacilli (Anaerobes)

E. coli
Klebsiella
Proteus
Pseudomonas
Enterobacter
Citrobacter
Morganella
Serratia

32

What do all CNS infections present with

HA
Fever
N/V
All can give seizures

33

Most likely Dx stiff neck, photophobia, meningismus

Meningitis

34

Most likely Dx confusion w/ HA/Fever

Encephalitis

35

Most likely Dx focal neuro signs w/ HA/Fever

Abscess

36

MC organism in meningitis

S. pneumo

37

MC organism in meningitis in adolescents

N. meningitides

38

First step in suspected meningitis pt w/ confusion/focal deficits

CT before LP

39

Most accurate test meningitis

CSF Cx via LP

40

Most sensitive test meningitis

CSF protein

41

Best initial test for meningitis

LP

42

What says whether or not to treat in meningitis

CSF cell count

43

Organism in meningitis w/ AIDS

Cryptococcus

44

Organism in meningitis w/ hiker, target rash

Lyme

45

Organism in meningitis w/ hiker moving rash

RMSF

46

Organism in meningitis w/ pulm TB

TB

47

Organism in meningitis w/ adolescent, petechial rash

Neisseria

48

Rx cryptococcal meningitis

Amphoteracin B until Ag decreases
Fluconazole for life if T cells don't rise

49

Rx Lyme meningitis

Ceftriaxone

50

Rx RMSF meningitis

Doxy

51

Rx TB meningitis

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

Plus steroids

52

Defining CSF feature bacterial meningitis

Cell count in 1000s w/ neutrophils

53

Defining CSF feature TB meningitis

Tons of protein

54

Neonatal meningitis etiology

S. galactiae

55

Neurosurg meningitis etiology

S. aureus

56

When is Head CT better than LP for initial test

Possibility of space-occupying lesion causing herniation

57

What sx mean do head CT before LP in meningitis

Papilledema
Seizures
Focal neuro deficits
Confusion

58

Meningitis management when there is contraindication to LP

ABX immediately

59

When do you do bacterial Ag detection test

When ABX is given before LP so Cx may be falsely -ve

60

Dx test for TB meningitis

Acid fast stain and Cx on 3 high volume LPs

61

Dx test for Lyme and Rickettsia meningitis

Serology
ELISA
Western blot
PCR

62

Dx test for Cryptococcal meningitis

India ink
Crypt Ag

63

Dx test for Viral meningitis

Dx of exclusion
No Rx

64

Best initial Rx bacterial meningitis

Ceftriaxone
Vanco
Steroids

65

When to add ampicillin to bacterial meningitis regimen

Immunocompromised for Listeria

66

Risk factors for Listeria meningitis

Elderly
Neonates
Immunicompromised
- Alcoholism
- Steroids
- HIV/AIDS
- Pregnancy

67

Most important step in N. meningitidis management

Respiratory Isolation

68

Close contact ABX for N. meningitidis

Rifampin
Cipro
Ceftriaxone

69

What is "close contact"

Dorms
Barracks
No spleen
Steroids

70

Most common neuro defect in untreated bacterial meningitis

CN VIII deficit (deafness)

71

MCC encephalitis

Herpes simplex

72

Best initial test for encephalitis

Head CT

73

Most accurate test for herpes encephalitis

PCR

74

Best initial test genital herpes

Tzanck

75

Most accurate test genital herpes

Viral Cx

76

Best initial therapy for herpes encephalitis

Acyclovir

77

Acyclovir resistant herpes encephalitis Rx

Foscarnet

78

Steps to therapy of ring-enhancing brain abscess in HIV+

Pyramithamine + Sulfadiazine for toxo
No response = lymphoma
Bx

79

Steps to therapy of ring-enhancing brain abscess in HIV-

Brain Bx

80

Presentation of otitis media

Redness
Immobility
Bulging
Decreased light reflex

81

Most sensitive physical finding for otitis media

Immobility

82

Most accurate Dx test for otitis media

Tympanocentesis
- Esp. recurrences or non-responsive to ABX

83

Best initial therapy for otitis media

Amoxicillin

84

Alternate therapy for otitis media if amox fails

Amox/clavulanate
Azithro, clarithro
Cefuroxime, Loracarbef
Levo, Gemi, Moxi - NOT in children

85

Organisms in sinusitis

S. pneumo - 40%
H. influenzae - 30%
M. cattharalis - 20%

86

Most accurate test for sinusitis Dx

Bx

87

When to do sinusitis Bx

Recurring
No response to different empiric

88

First line therapy for sinusitis

Amox/Clav
Doxy
TMP/SMX

89

Best initial therapy for otitis and sinusitis

Amoxicillin

90

Presentation of Pharyngitis

Pain on swallowing
Enlarged LNs
Exudate
Fever

91

Important negatives in pharyngitis

Cough
Hoarseness

92

MC organism in pharyngitis

Strep (Group A beta hemolytic)

93

Best initial test for strep pharyngitis

Rapid strep test
This is equivalent to +ve pharyngeal Cx

94

What can untreated strep pharyngitis lead to

Rheumatic fever and Glomerulonephritis

95

Small pharyngeal vesicles or ulcers

HSV or herpangina

96

Membranous exudates on pharynx

Diptheria
Vincent angina
EBV

97

Best initial therapy for strep pharyngitis

PCN or Amox

98

Rx strep pharyngitis for PCN allergy

Cephalexin if rash
Clinda or Macrolide if anaphylaxis

99

Criteria for Influenzae vaccination

> 50
Chronic lung/heart disease
Preg 2nd/3rd trimester
Nursing home
Health-care worker
Immunosuppressed

100

Presentation of influenzae

Arthralgias/Myalgias
Cough
Fever
HA/sore throat
N/V/D

101

Most important next step within 48hrs of influenza presentation

Nasopharyngeal swab to detect Ag

102

Rx within 48hrs of Sx

Oseltamivir
Zanamivir

103

Rx more than 48hrs of Sx

Sx treatment only

104

#1 cause of blood/WBCs in stool

Campylibacter

105

Causes of infectious diarrhea with blood/WBCs in stool

Salmonella
Campylobacter
E. coli 0157:H7
Shigella
V. parahemolyticus
V. vulnificus
Yersinia
C. diff
Entamoeba hystolytica

106

Causes of HUS

E. coli 0157:H7
Shigella

107

Associations with yersinia

Hemochromatosis
Blood transfusions

108

Association with campylobacter

GBS

109

Association with V. parahemolyticus

Shellfish
Cruise ships

110

Association with V. vulnificus

Shellfish
Liver disease
Skin lesions

111

Features of HUS

Hemolysis
↑ Cr
↓ Platelets

112

Causes of infectious diarrhea without blood/WBCs in stool

Viral
Giardia
Cryptosporidiosis
B. cereus
Staph

113

Association with giardia

Camping/hiking
Unfiltered fresh water
Looks like fat malabsorption

114

Association with cryptosporidiosis

AIDS CD4

115

Association with B. cereus and staph

Vomitting

116

Best Dx test for giardia

1 stool ELISA Ag

117

Features of scromboid

Most rapid onset
Wheezing, flushing, rash
Found in fish
Treat with antihistamines

118

Rx infectious diarrhea

Mild - oral fluid replacement
Severe - Fluid replacement and oral ABX (quinolones)

119

What is "severe" diarrhea

Hypotension
Tachy
Fever
ABD pain
Bloody diarrhea
Metab acidosis

120

Rx giardia diarrhea

Metro
Tinidazile

121

Rx cryptosporidiosis diarrhea

Treat underlying AIDS
Nitazoxanide

122

Rx Viral diarrhea

Fluid support

123

Rx B. cereus diarrhea

Fluid support

124

Rx protocol for C. diff

Metro
Get's better → Gets again → Metro again
Doesn't get better → Vanco

125

Who is at worst risk for Hep E

Pregnant

126

Route of transmission Hep B, C, D

Sex
Blood
Perinatal

127

Route of transmission of Hep A, E

Food and water

128

Dx tests for hepatitis

Increased direct bili
Increased ALT/AST ratio
Increased ALP

129

Rare complication of acute hepatitis

Aplastic anemia

130

MCC liver transplant

Hep C (not for long)

131

Most likely correlated with increased mortality in Hep

Elevated PT

132

Best Dx test Hep A, C, D, E

IgM - acute
IgG - resolution

133

How is disease activity in Hep C assessed

PCR for RNA level

134

First serum abnormality in Hep B

sAg

135

Which serum value is associated with viral replication in Hep B

eAg
ie. can transmit

136

Which serum value is associated with resolution of active Hep B infection

No sAg

137

Best indication for need for Rx w/antivirals for chronic Hep B

eAg

138

Best indication that pregnant mother will transmit Hep B to child

eAg

139

Serology in Hep B vaccinated

sAb

140

Serology in Hep B window

cAb (IgM then IgG)

141

Serology in old/resolved Hep B

cAb
sAb

142

Serology in Acute or chronic Hep B

sAg
eAg (+/- in chronic)
cAb (IgM or IgG)

143

Rate of conversion of Acute to Chronic Hep B

In 10% of pts

144

Rx acute Hep C

IFN
Ribavirin
Boceprevir or Telaprevir

145

What is chronic Hep B

sAg present for > 6mos

146

Rx eAg w/ elevated DNA pol

One of:
Entecavir
Adefovir
Lamivudine
Telbivudine
IFN
Tenofovir

147

AE IFN

Arthralgia/myalgia
Leukopenia and thrombocytopenia
Depression and flu-like Sx

148

Goal of chronic hep Rx

Reduce DNA pol to undetectable
Conver eAg to eAb

149

Why do liver Bx in hep B or C

Presence of fibrosis is strong indication to start therapy
Fibrosis progresses to cirrhosis in acute viral replication

150

AE ribavirin

Red cell anemia

151

Goal of therapy in chronic Hep C

Undetectable VL

152

Difference between cystitis and urethritis

Cystitis doesn't have discharge
Both have frequency, urgency, burning

153

Best initial test for urethritis

Swab for Gram stain

154

Most accurate test for urethritis

Urethral Cx, DNA probe or nucleic acid amplification for gonorrhea and chlamydia

155

Best drug combo for urethritis

Cefixime (gonorrhea)
Azithromycin (chlamydia)

156

Alternative drug combo for urethritis

Ceftriaxone (gonorrhea)
Doxy (chlamydia)

157

Presentation of cervicitis

Discharge
Strawberry cervix

Testing and treatment identical to urethritis

158

PID presentation

Lower ABD tenderness
Cervical motion tenderness
Leukocytosis
Fever

159

First thing to do in pt w/ cervical motion tenderness

Check for ectopic pregnancy

160

Dx test in PID

Cervical swab for Cx
DNA probe
Nucleic acid amplification

161

Most accurate test for PID

Laparoscopy (only if Dx unclear)

162

Features of disseminated gonorrhea

Tenosynovitis
Polyarticular
Petechial lesions

163

Inpatient PID Rx

Cefoxitin or Cefotetan w/ Doxy

164

Outpatient PID Rx

Ceftriaxone and Doxy (+/- metro)

165

Inpatient PID PCN anaphylaxis Rx

Clinda and Genta and Doxy

166

Outpatient PID PCN anaphylaxis Rx

Levo and Metro

167

Common feature of all ulcerative genital lesions

Inguinal lymphadenopathy

168

Most likely STD with painless ulcer

Syphilis

169

Most likely STD with single painful ulcer

Chancroid

170

Most likely STD with tender LNs and pus

Lymphogranuloma venereum

171

Most likely STD with vesciles before multiple painful ulcers

Herpes simplex

172

Best initial test Syphilis (most sensitive)

Dark field microscopy for spirochetes

173

Secondary Dx test in syphilis

VDRL/RPR

174

Confirmatory (best) test for Syphilis

FTA/MHA-TP

175

Dx test for chancroid

Stain and Cx

176

Dx test for Lymphogranuloma venereum

Complement fixation titers in blood
Nucleic acid amplification on swab

177

Best initial test for herpes simplex

Tzanck

178

Most accurate test for herpes simplex

Viral Cx

179

Next step in pt with painful genital vesicles

Immediate Rx oral acyclovir
No need for Dx test

180

Important points about granulareum inguinale

Bx
Sulfa drugs
Donovan body

181

Appearance of primary syphilis

Heaped-up indurated edges
Painless adenopathy

182

Secondary syphilis features

Rash on palms and soles
Alopecia areata
Mucous patches
Condyloma lata

183

Pityriasis rosacea features

Herald patch
Not palms and soles
VDRL/RPR negative

184

Most common manifestations of tertiary syphilis

Neuro
- Meningovascular
- Tabes dorsalis
- Paresis
- Argyl-Robertson pupil

185

Rare manifestations of tertiary syphilis

Aortitis
Gummas

186

Things that cause false positive VDRL/RPR

Infection
Older
IVDU
AIDS
Malaria
APL
Endocarditis

187

Rx primary and secondary syphilis

IM PCN
Oral doxy if allergic

188

Rx tertiary syphilis

IV PCN
Desensitize if allergic

189

Rx Jarish-Herxheimer rxn

Aspirin
Antipyretics

190

Rx neurosyphilis in pregnancy

PCN
Desensitize if allergic

191

What causes condyloma acuminata

Papillomavirus

192

Dx condyloma acuminata

Visual

193

Rx condyloma acuminata

Remove
- Cryotherapy (liquid nitrogen)
- Surgery
- Melt (podophyllin or trichloroacetic acid)
- Imiquimod (sloughs off)

194

Important points about Pediculosis (crabs)

On hair-bearing areas
Itchy
Visible
Rx Permethrin

195

Important points about Scabies

Found in web spaces, elbows, genitals, nipples
Burrows visible
Scrape and magnify
Rx Permethrin
Rx widespread (crusted)/or keratotic w/ ivermectin

196

MCC UTI

E. coli

197

Best initial therapy for pyelo

Quinolones

198

When do you image in UTI

Men
Reccurent/failure to respond
ie. Foreign body/obstruction (complicated)

199

Best initial test for cystitis

U/A w/ >10 WBCs

200

Most accurate test for cystitis

Urine Cx

201

When do you look for bacteria in urine

Pregnancy

202

Rx uncomplicated cystitis

Nitrofurantoin or Fosfomycin
TMP/SMX x3 days if uncomplicated, 7 if it is complicated
Cipro in resistant areas
Cefixime

203

Rx male cystitis

TMP/SMX 10-14 days

204

Rx Pregnant cystitis

Nitrofurantoin/Amox/Macrodantin for 10-14 days

205

What is pyelonephritis

Dysuria with:
- Flank/CVA tenderness
- Fever
- ABD pain from inflamed kidney

206

First like Rx pyelonephritis

Ceftriaxone

207

What works for pyelo

G- bacilli drugs
- Ertapenem
- Ampi + Genta (emperic)
- Cipro oral for outpatient

208

Most accurate Dx test for pyelo

Bx

209

What is acute prostatitis

Dysuria w/:
- Perineal pain
- Tender prostate

210

Increase yield for urine cx in acute prostatitis

Prostate massage

211

Long term therapy for chronic prostatitis

TMP/SMX 6-8wks

212

Rx acute prostatitis

Same as pyelo
G- bacilli drugs
- Ertapenem
- Ampi + Genta (emperic)
- Cipro oral for outpatient

213

How to know if there's a pyelonephric abscess

Pyelo doesn't resolve
Persistent fever after 5-7 days of therapy

214

Most important step in pyelonephric abscess

Drainage then Cx

215

When to suspect endocarditis

Fever + Murmur

216

MCC death in untreated endocarditis

Infectious glomerulonephritis

217

Best initial test for endocarditis

Blood Cx

218

Other options to Dx endocarditis

TTE
TEE

219

Next step after finding strep bovis endocarditis

Colonoscopy

220

Diagnosing Cx neg endocarditis

Oscillating vegetation on echo
3 minor criteria
- Fever
- Risk factor
- Embolic phenomena

221

Best empiric Rx endocarditis

Vanco and Genta

222

How long are endocarditis Rx regimens

4 weeks

223

How do you treat resistant endocarditis

Add aminoglycoside and extend to 6 weeks

224

Rx viridans endocarditis

Ceftriaxone or PCN

225

Rx S. aureus endocarditis

Ox/Naf or cefazoline

226

Rx Staph epi or resistant staph endocarditis

Vanco

227

Rx enterococci endocarditis

Ampi and genta

228

When is surgery the answer for endocarditis

CHF!!
Prosthetic valves
Fungal
Abscess
AV block
Recurrent emboli while on ABX

229

What is added to regimen with prosthetic valve endocarditis with staph

Rifampin

230

MCC culture neg endocarditis

Coxiella
Also bartonella

231

Other Cx neg endocarditis organisms

HACEK

232

Rx for HACEK endocarditis

Ceftriaxone

233

Who gets endocarditis prophylaxis

Significant cardiac defect
AND
Risk of bacteremia (bloody surgery)

234

What is given for endocarditis PPx

Amox 1hr prior
Allergy - Clinda, azithro or clarithro
GI procedure - Amp or Vanco

235

Cause of Lyme disease

Borrelia burgdorferi

236

Most common manifestation of Lyme

Rash and fever

237

MC joint complication of Lyme

Knee

238

MC heart complication of Lyme

AV block

239

MC neuro complication of lyme

CN VII palsy (can be B/L)

240

Vector for Lyme

Ixodes scapularis (deer tick)

241

Prevalence of presentation in untreated Lyme

90% rash
60% joint
10-15% neuro
4-10% heart

242

Dx Lyme

Nothing if lesion is typical
Straight to Rx

243

Dx lyme for other manifestations w/o rash

Serology
IgM, IgG, ELISA, Western blot, PCR

244

Rx Lyme w/ just rash or w/ joint/CN VII

Doxy
Amox or Cefuroxime

245

Rx cardiac or other neuro in Lyme

IV ceftriaxone

246

Rx ASx tick bite

NOTHING

247

:Lyme PPx

1 dose doxy within 72hrs

248

Who gets lyme PPx

Ixodes scapularis clearly identified
Tick attached > 24-48hrs
Engorged tick
Endemic area

249

How long does CD4 depletion take before Sx

5-10yrs

250

Viral load is inversely proportional to

Rate at which T cells drop

251

ONLY routine PPx in AIDS

CD4

252

PPx in AIDS regardless of T cell count

PPD >5mm = INH 9 mos
Flu and Pneumococcal vaccines

253

Does kissing transmit HIV

NO

254

Infections CD4 200-500

Candidiasis
Zoster
Kaposi
TB
HSV
PN

255

Infections CD4

PCP

256

Infections CD4

Toxo

257

Infections CD4

MAC
CMV
- Ganciclovir
- Foscarnet

258

First manifestation of HIV Rx failure

Rising VL

259

Best initial test for HIV

ELISA
Confirmed with Western blot

260

Dx HIV infected infants

PCR or viral Cx

261

When to start HIV Rx

CD4 100,000
Opportunistic infection

262

Best initial Rx HIV

Emtricitabine + Tenofovir + Efavirenz

263

HIV regimen skeleton

2 NRTI + 1 PI or efavirenz

264

Meds for multi-class drug resistance

Entry inhibitors
- Enfuvirtide
- Maraviroc
Integrase inhibitor
-Raltegravir

265

What does Ritonavir boost

Darunavir
Atazanavir

266

Postexposure PPx (including bites)

4 weeks combination therapy

267

What predics abacavir hypersensitivity

HLA B5701

268

AE Zidovudine

Anemia

269

AE Stavudine and Didanosine

Peripheral neuropathy
Pancreatitis

270

AE Abacavir

Hypersensitivity
Steven-Johnson

271

AE Protease inhibitors

Hyperlipidemia
Hyperglycemia

272

AE Indinavir

Nephrolithiasis

273

AE Tenofovir

Renal insufficiency

274

Perinatal PPx HIV+ already on antiretrovirals

Continue regimen

275

Perinatal PPx HIV+ not on antiretrovirals

Give antiretrovirals as if they weren't pregnant

276

Perinatal PPx HIV+ High CD4, Low VL

Antiretrovirals for entire pregnancy
Stop after delivery

277

Perinatal PPx HIV+ Low CD4, High VL

Antiretrovirals for entire pregnancy
Continue after delivery

278

Only retroviral contraindicated in pregnancy

Efavirenz

279

When to do C-section in HIV mother

CD4 1000

280

What intrapartum antiretroviral is given to every HIV+ pregnant pt

Zidovudine