ID Flashcards by Mike Baird

Bugs covered by penicillin (5)

Viridans 
S pyro
Oral anaerobes
Syphilis
Leptospira

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What is the most accurate test for an infectious disease?

Culture

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Bacteria covered by amoxicillin

HELPS

H flu, E. coli, Listeria, Proteus, Salmonella

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When something is Methicillin resistant/sensitive, what do you give instead and why?

Oxacillin

Methicillin causes renal failure from allergic interstitial nephritis

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If a patient has a rash with penicillin, what do you use instead?

Cephalosporins

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If a patient has anaphylaxis to penicillin, use what instead?

Non beta lactam Abx

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What are the 1st gen cephalosporins (4)

Cefazolin
Cephalexin
Cephradrine
Cefadroxyl

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What are the 2nd gen cephalosporins (4)

Cefotetan (anaerobe coverage)
Cefoxitin (anaerobe coverage)
Cefaclor
Cefuroxime

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3rd gen cephalosporins (3)

Ceftriaxone (do not give in neonates)
Cefotaxime
Ceftazidime (covers pseudomonas)

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4th gen cephalosporins (1)

Cefepime (superior staph coverage)

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5th gen cephalosporins (1)

Ceftaroline (gram - bacilli, MRSA, NOT pseudomonas!)

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2 major cephalosporin drug reactions

Cefoxitin/Cefotetan: deplete PT = increased bleeding risk

Ceftriaxone: inadequate biliary metabolism

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What is the primary coverage of carbapenems?

Which does not cover pseudomonas?

Gram - bacilli

Ertapenem

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What drug is a monobactam?
What is the use?
Does it cross react with penicillin?

Aztreonam
Gram -
No

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What is the best therapy for CAP?

What are some side effects of these meds (2)?

Fluoroquniolones

Bone growth abnormalities, tendonitis

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What do aminoglycocides not work on?

What are side effects? (2)

Anaerobes

Nephrotoxic, ototoxic

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What is the single indication of Nitofurantoin?

Cystitis esp in pregnant women

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What are 4 drugs for MRSA?

What are 4 drugs for MRSA of the skin?

Telavancin, Dalbavancin, Tedizolid, Oritavancin

TMP/SMX, Clinda, Doxy, Linezolid

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What drugs cover the gram -s?

Quinolones
Aminoglycosides
Carbapenems
Piperacillin, Ticarcillin
Aztreonam
Cephalosporins

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What is the best initial test for CNS infection?

Accurate?

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What does a high cell count and neutrophils mean on LP?
What does normal protein and glucose on LP mean?
Crazy high protein?
What does a positive stain and culture on LP mean?

Bacterial meningitis
Viral meningitis
TB meningitis
Bacterial meningitis

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When do you get a head CT before an LP?

Papilledema
Seizures
Focal neuro issues
Confusing interfering with neuro exam

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If there is a contraindication to immediate LP,, what is the best initial step?

Abx

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When is a bacterial antigen detection test useful?

Only if positive (highly specific)

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What is the most specific test for TB meningitis? Lyme/Rickettsia? Crypto? Viral?

Acid fast + culture on 3 high volume LPs Specific serologic tests + ELISA + WBlot/PCR Antigen test + Culture > India Ink Dx of exclusion

Treatment for bacterial meningitis? Addition if immunocomprised (and why)? Neisseria additions?

Ceftriaxone + Vanc + Steroids Ampicillin (listeria) Respiratory isolation + Rifampin/Cipro/Ceftriaxone for close contacts

What is the most common neuro deficit of untreated bacterial meningitis?

8th CN deficit or deafness

``` What is the most common cause of encephalitis? What is the first step? What is the most accurate test? What is the best initial therapy? What is the treatment for resistance? What is the concern with both meds? ```

``` HSV Head CT PCR of CSF Acyclovir Foscarnet Renal toxicity (reduce dose + hydrate) ```

What is the most sensitive finding for otitis media? What is the most accurate test? What is the best initial therapy?

Immobility Tympanocentesis Amoxicillin

What are the 1st line treatments for otitis and sinusitis? (3)

Amox + Clauvonic Acid Doxy TMP/SMX

``` What is the best initial test for pharyngitis? What should you get if it is positive? What is the initial treatment? What if there is a rash? A real allergy? ```

``` Rapid strep test Pharyngeal culture Penicillin or Amoxicillin Cephalexin Clinda or Macrolide ```

How do you treat the flu before 48 hours vs after?

Before: Ostelmavir/Zanamivir neuraminidase inhibitors After: symptomatic tx only

What is the best initial test for infectious diarrhea? What are 2 possible next tests? What is most accurate?

Blood/fecal leukocytes Lactoferrin > fecal leukocytes Stool culture

What is scombroid? | How do you treat?

Rapid onset wheezing/flushing/rash found in fish | antihistamines

What is the most accurate determine factor for etiology of infectious diarrhea?

Blood in stool: salmonella/shigella/yersinia/e coli

Which is the worst hepatitis if pregnant?

Hep E

What lab finding is very concerning in hepatitis?

Elevated PT

What is the first abnormality after HepB infection? What correlates with active viral replication? What indicates a patient is no longer at risk for transmitting? What indicates that treatment is necessary?

HbS antigen HbE antigen No HbS antigen present HbE antigen

Any time that HbE antigen is the answer, you can use ____ instead. X is qualitative, Y is quantitative

DNA polymerase HbE antigen DNA poly

How is HepB transmitted worldwide most commonly?

Perinatal

How do you treat HCV type 1? 2? 3?

1: ledipasvir + sofosbuvir | 2/3: ribavirin + sofosbuvir

What Abx have the greatest efficacy compared to other classes?

Beta lactams (penicillins, cephalosporins, carbapenems, aztreonam)

What is a key difference in presentation of urethritis vs cystitis?

Only urethritis has discharge

What is the best urethritis initial test? | What are the most accurate GC tests?

Urethral swab for gram stain | NAAT/DNA probe/urethral culture

What is a strawberry cervix classic for? | How do you treat?

Cervicitis | Ceftriaxone + azythromycin

What is the most accurate test for PID? What is the inpatient treatment? What is the outpatient treatment?

Laparoscopy Cefoxitin or Cefotetan + Doxy Ceftriaxone + Doxy

Painless genital ulcer? Painful ulcer? Tender lymph nodes? Painful vesicles?

Syphilis H ducreyi L Venerum HSV

Test for syphilis? H ducreyi? L Venereum? HSV?

Dark field micro > VDRL --> FTA Stain + special culture NAAT = compliment fixation titers Tzanck--> Viral culture

Treat syphilis? H ducreyi? L Venereum? HSV?

IM Benzathine penicillin --> doxy Azythromycin Doxy Acyclovir/Valay/Fam --> Foscarnet

What is the Jarisch Herxheimer rxn? | How do you treat?

Fever and worsening Sx after treatment | ASA + anti fever meds

How do you treat pediculosis?

Permethrin

How do you treat scabies?

Permethrin

What is the best initial test for UTI? | Accurate?

UA with >10WBCs | Urine culture

What is the treatment course for an uncomplicated cystitis? | Complicated?

3 days | 7 days

What is a great way to increase the diagnostic yield of a urine culture in suspected prostatitis?

Prostate massage

What are 4 unique symptoms of endocarditis?

``` Splinter hemorrhage Janeway lesions (flat, painless) Osler nodes (raised, painful) Roth spots ```

What is the best initial test for endocarditis?

Blood culture (sensitive) TTE (specific) TEE (sens + spec)

How do you agnostic culture negative endocarditis?

Vegetation on ECHO Fever >38C Risk factor (drugs, valve) Signs of embolism

``` How do you treat endocarditis empirically? Viridians? S arueus? Fungal? S epi or MRSA? Enterococcus? ```

``` Vanc + Gent Ceftriaxone x4 weeks Oxacillin/nafcillin/cefazolin Amphoteracin + valve replacement Vanc Amp + gent ```

What features of endocarditis suggest valve replacement for treatment (2)?

Acute valve rupture | CHF

What are the 2 most common causes of culture negative endocarditis? What are 6 other causes?

Coxiella > Bartonella | HHACEK

What is the best endocarditis prophylaxis? | What is the best if allergic?

Amoxicillin | Clinda/azythromycin/clarythromycin

What is the most common cardiac abnormality with Lyme disease?

Transient AV block

How do you treat Lyme? What if there is joint involvement or CN7 issues? What if there are cardiac or other neuro issues?

Doxy or amox or ceuroxime "" IV Ceftriaxone

What are 4 reasons to give prophylactic doxy within 72 hours of a tick bite?

Ixodes clearly identified Tick attached for 24-48 hours Engorged nymph stage tick Endemic area

What is the best initial HIV test? Confirmatory test? Infant test?

ELISA Western Blot PCR or viral culture

What is the best initial HIV cocktail?

Emtricitabine Tenofovir Efavirenz

What are the 4 NNRTIs?

Efavirenz Etravirine Nevirapine Rilpivirine

What do protease inhibitors end with?

-navir

What are the integrase inhibitors?

Raltegravir | -gravir

What is unique about Abacavir? Ritonavir? Elvitegravir? Enfuviritide/Maraviroc?

Dangerous with HLA-B4701 mutation Boosts Darunavir/Atazanavir levels Metabolism inhibited by Cobicistat (boosts levels) Entry inhibitors

``` What does AZT cause? Stavudine/Didanosine? Protease inhibitors? Indinavir? Tenofovir? ```

``` Anemia Peripheral neuropathy/pancreatitis HLD/DM Nephrolithiasis Renal insufficiency ```

What is the only HIV med that should be avoided in pregnancy? What should the baby get intrapartum? At what level is a Csection performed? What does the baby get after birth and for how long?

Efavirenz AZT Viral load >1000 AZT --> 6 weeks

ID Flashcards

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