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1
Q

What is staph epi associated with

A

Catheters
Prosthetic valves
Dialysis

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2
Q

Bacteria covered by amoxicillin

A 
H. influenzae
E. coli
Listeria
Proteus
Salmonella
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3
Q

What are the B-lactams

A

PCNs
Cephs
Carbapenems
Aztreonam

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4
Q

What PCNs the best initial therapy for

A 
Otitis media
Dental infection/Endocarditis PPx
Lyme limited to rash, joints, CN VII
UTI in pregnancy
L. monocytogenes
Enterococci
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5
Q

What are Ox/clox/diclox/naf used for

A

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

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6
Q

Anti-pseudomonal PCNs are best initial therapy for

A

Bacteremia
Febrile neutropenia

Cholecystitis
HAVP
Ascending cholangitis
Pyelonephritis

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7
Q

What do all cephalosporins cover

A 
Grp A, B, C strep
Viridans
E. coli
Klebsiella
P. mirabilis
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8
Q

What is resistant to all cephalosporins

A

Listeria
MRSA
Entercoccus

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9
Q

Rash to PCN then use

A

Cephalosporin

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10
Q

Anaphylaxis to PCN then use

A

Non-beta lactam ABX

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11
Q

Cephalosporin covering MRSA

A

Ceftaroline

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12
Q

AE Cefotetan, Cefoxitin

A

Deplete prothrombin

Increase bleeding risk

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13
Q

AE Ceftriaxone

A

Inadequate biliary metabolism

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14
Q

What doesn’t ertapenem cover

A

Pseudomonas

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15
Q

What is Aztreonam for

A

G- bacilli including pseudomonas

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16
Q

AE quinolones

A

Bone growth abnormalities

Tendonitis (achilles)

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17
Q

What is Doxy for

A

Chlamydia
Richettsia
Lyme

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18
Q

What is TMP/SMX for

A

Uncomplicated cystitis

PCP

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19
Q

First choice mouth and GI abscess

A

Beta lactam/Beta-lactamase combinations

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20
Q

Best initial therapy staph and strep

A

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

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21
Q

What does clindamycin cover

A

Anaerobes, staph, strep

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22
Q

What doesn’t clindamycin cover

A

Mycoplasma

Legionella

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23
Q

Best Rx MRSA

A 
Vanco
Linezolid
Dapto
Tigecycline
Ceftaroline
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24
Q

AE Linezolid

A

Reversible BM toxicity

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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

Step 2 CK (21 decks)

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