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Infectious Disease Flashcards

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1
Q

methicillin is not used because..

A

it causes allergic interstitial nephritis

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2
Q

penicillin used in tx for?

A 
otitis media
dental infection & endocarditis prophylaxis
lyme disease (rash)
UTI in pregnant women
listeria
enterocococcal infections
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3
Q

pipercillin, ticarcillin used in tx for?

A 
cholecystitis
ascending cholangitis
pyelonephritis
bacteremia
HCAP
VCAP
neutropenia & fever

-covers enterobacteria, pseudomonas, strep, anaerobes

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4
Q

penicillin rash vs anaphylaxis. what do you switch tx to?

A

cephalosporin

non-beta-lactam antibiotic

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5
Q

cefotetan & cefoxitin (2nd generation) tx & SE

A
  • tx PID (with doxycycline)

- SE: inc bleeding risk, disulfiram-like reaction

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6
Q

ceftriaxone use in tx for?

A
  • pneumococcus
  • meningitis
  • CAP
  • gonorrhea
  • lyme (involving heart & brain)

-avoid in neonates (imp oared biliary metabolism)

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7
Q

carbapenems covers which types of bacteria?

(imi, mero & doripenem

A
  • gram(-)bacilli
  • anaerobes
  • strep
  • staph
  • neutropenia & fever
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8
Q

aztreonam covers which types of bacteria?

A
  • gram(-) bacilli only
  • includes Pseudomonas

-no cross reactivity with penicillins

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9
Q

ciprofloxicin used in tx for?

A

cystitis
pyelonephritis
diverticulitis (+ metronidazole)
GI infections

-moxifloxicin = single agent for diverticulitis without metronidazole

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10
Q

floroquinolone SE?

cipro, gemi, levo and moxifloxacin

A
  • bone growth abnormalities in kids and pregnant women
  • tendonitis (achilles tendon rupture)

-contraindicated in children

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11
Q

amino glycosides used in tx for? SE?

gentamicin, tobramycin, amikacin

A
  • bowel, urine, bacteremia from gram (-)
  • synergisitic with beta-lactams against enterococci & staph

-SE: nephro & ototoxic

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12
Q

doxycycline uses? SE?

A
  • chlamydia
  • lyme (rash, joint, Cr VII palsy)
  • MRSA skin
  • rickettsia
  • syphilis (ONLY if allergic to penicillin)

-SE: tooth discoloration, Fanconi (type II RTA), photosensitivity

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13
Q

TMP-SMX uses? SE?

trimethoprim-sulfamethoxazole

A
  • cystitis
  • PCP tx & prophylaxis
  • MRSA cellulitis

-SE: rash, hemolysis (G6PD deficiency), marrow suppression (via folate antagonism)

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14
Q

nitrofurantoin use?

A

cystitis in pregnant women

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15
Q

staph & strep tx?

A
  • oxacillin/ nafcillin/ dicloxacillin
  • 1st gen cephalosporins: cefazolin, cephalexin
  • floroquinolones
  • macrolides (3rd line)
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16
Q

MRSA tx?

A
  • vancomycin
  • linezolid
  • daptomycin
  • tigecycline
  • ceftaroline

-minor MRSA infections: TMP-SMX, clindamycin, doxycycline

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17
Q

oral anaerobe tx?

A
  • penicillin (G, V, amp/ amoxicillin)
  • clindamycin
  • metronidazole (GI)
  • pipercillin, carbapenems, 2nd gen cephalosporins
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18
Q

meningitis vs encephalitis vs abscess = fever + headache +

A

meningitis: stiff neck, photophobia
encephalitis: confusion
abscess: focal neurologic deficit

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19
Q

bacterial meningitis causes?

A

-strep pneumo = most common

  • group B strep (neonates)
  • H flu (dec since vaccinations)
  • Neisseria meningitis
  • listeria (immunocompromised pts; requires ampicillin)
  • staph -after neurosurgery
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20
Q

meningitis in AIDS pts cause?

A

cryptococcus

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21
Q

meningits dx

A

lumbar puncture = most accurate

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22
Q

CSF dx? bacterial vs viral

A

bacterial: 1000s neutrophils, elevated protein (marked in TB), decreased glucose, positive gram stain (not in TB)
viral: lymphocytes, no change in protein or glucose

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23
Q

head CT before LP if?

A
  • papilledema
  • seizures
  • focal neurologic deficits
  • confusion

-start broad spectrum therapy before CT

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24
Q

bacterial antigen test used when?

A

-pts given antibiotics prior to LP

culture may be falsely negative

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25
cryptococcal dx?
- india ink | - cryptococcal antigen
26
meningitis tx?
ceftriaxone + vancomycin + steroids -while waiting for culture and gram stain
27
dexamethasone use?
- lowers mortality in strep pneumo - 1000s of neutrophils -combined with ceftriaxone + vancomycin
28
ampicillin use in meningitis?
listeria infection - immunocompromised pts - can't use cephalosporins
29
Neisseria meningitis close contacts tx?
rifampin or ciprofloxacin - those who kiss, share cigs/eating utensils, have major fluid contact - not HC workers
30
encephalitis cause & dx & tx
- HSV = most common - dx: PCR of CSF - tx: acyclovir; foscarnet
31
acyclovir vs foscarnet
- foscarnet has more nephrotoxicity than acyclovir - foscarnet used in acyclovir-resistant HSC - different MOAs
32
most sensitive PE finding of otitis media?
immobility of tympanic membrane -other findings: redness, bulging, dec light reflex, fever
33
otitis media tx
- amoxicillin | - usually self-resolving
34
pharyngitis px & dx
pain + nodes + exudate + fever + NO cough/ hoarseness - often Group A beta-hemolytic strep - dx: rapid strep test
35
other causes of pharyngitis?
``` HSV herpangina (coxsackie A) diptheria vincent angina EBV ```
36
pharyngitis tx
- penicillin or amoxicillin | - clindamycin or macrolide
37
influenza px
- arthralgias/myalgias - cough - fever - headache - n/v (children)
38
influenza dx & tx
-dx: nasopharyngeal swab - tx: oseltamivir or zanamivir (within 48 hours; shorten duration) - symptomatic tx if >48 hours
39
``` Associations for bacterial diarrhea: salmonella campylobacter E coli 0157:H7 Shigella (shiga toxin) vibro yersinia clostridium difficile ```
``` poultry Guillain-Barre Syndrome HUS = fragment cells, low platelets, high BUN/ creatinine HUS shellfish & cruise ships hemochromatosis, blood transfusions antibiotcs ```
40
infectious diarrhea dx?
blood and/or fecal leukocytes = best initial - lactoferrin has a higher specificity - stool culture = most accurate
41
no blood or WBCs in infectious diarrhea
``` viral Giardia (camp/hiking) cryptosporidosis (AIDS <100; AFS) bacilllus cereus (preformed toxin) staph (preformed toxin) scombroid (found in fish; tx with antihistamine; rapid onset) ```
42
infectious diarrhea tx
- fluids | - fluids + ciprofloxacin (severe)
43
Giardia diarrhea tx
metronidazole or tinidazole -cipro does not cover it
44
cryptosporidiosis diarrhea tx
nitazoxanide & tx underlying AIDS
45
viral, b. cerus, staph diarrhea tx
fluid support
46
hepatitis E
- worst in pregnancy (fulminant hepatitis) - East Asia - feco-oral
47
elevated PT time indicates?
60% of liver destruction
48
PCR levels = amount of active viral replication | indicates...
indicates response to hepatitis therapy
49
hepatitis B serologic patterns
HBsAg = acute/chronic infection; 1st to inc ``` HBeAg = acute, infectivity measure HBcAb = IgM(acute) or IgG(resolved) HBsAb = resolved ```
50
HBV vaccination serology
HBsAb ONLY -negative HBsAg, HBeAg, HBcAb
51
HBV "window period" serology
HBcAg (IgM then IgG) -negative HBsAg, HBeAg, HBsAb
52
No HBsAg indicates
you can't transmit infection
53
e-antigen indicates
- tx is needed since there is active disease replication - indicates transmissibility from pregnant woman to child -whereas HBeAb does NOT require tx
54
HAV & HEV tx?
none
55
HBV tx?
acute: none chronic: entecavir or adefovcir, tenofovir, lamivudine or telbivudine or interferon (IM) ---monotherapy
56
HCV tx?
interferon + ribavirin + telaprevir/boceprevir
57
interferon SE
- arthralgia/myalgia - leukopenia & thrombocytopenia - depression & flu-like symptoms
58
ribavirin SE
anemia
59
UTI dx?
urinanalysis --> shows inc WBCs -microbe: E. coli
60
UTI causes
- stones - strictures - tumor - BPH - DB (dec effectiveness of WBCs) - foley catheter - neurogenic bladder
61
UTIs in men due to?
anatomic abnormality - must image - best initial test: urinanalysis >10WBCs - most accurate: urine culture
62
UTI tx
- quinolones (cipro) - TMP-SMX - nitrofurantoin - cephalexin - 3 day tx - 7 day tx for anatomic abnormality --also need imaging - culture if recurring infection
63
pyelonephritis tx
- ampicillin + gentamicin (renal-excretion, thus good penetration of infection) - ciprofloxacin - must cover gram(-) bacilli -imaging to look for anatomic abnormalities causing infection/ to prevent future infections
64
unresolving pyelonephritis, next step?
- sonogram or CT scan to look for perinephric abscess - drain - culture to guide therapy
65
urethritis dx & microbes
- men: urethral swab = best initial - women: self-administered vaginal swab -nucleic acid amplification test (NAAT) = most accurate - for gonorrhea & chlamydia - also mycoplasma, ureaplasma
66
urethritis tx
- gonorrhea --cefixime (oral) or ceftriaxone (IM) | - chlamydia --azithromycin (oral) or doxycycline
67
cervicits px & dx & tx
- px: inflamed "strawberry" cervix - dx: self-administered swab for NAAT - tx: cefixime/ceftriaxone & azithromycin/doxycycline
68
PID px
- lower abdominal tenderness & pain - fever - cervical motion tenderness (via bimanual exam) -EXCLUDE PREGNANCY FIRST with this px
69
PID dx
- cervical swab for culture & NAAT = most specific - laparoscopy = most accurate (rarely used) -culture needed for gonorrhea (to determine resistance)
70
PID tx inpatient
inpatient: cefoxitin or cefotetan (2nd gen cephalosporins) + doxycycline - 2nd gen cephalosporins cover anaerobes - clindamycin & gentamicin (for penicillin anaphylaxis)
71
PID tx outpatient
ceftriaxone & doxycycline +/- metronidazole -levofloxacin & metronidazole (for penicillin anaphylaxis)
72
genital ulcer types: - painless - painful - LN tender & suppurating - vesicles prior to ulcer
- syphilis - chancroid (H ducreyi) - lymphogranuloma venereum (Chlamydia) - HSV
73
genital ulcer dx: - syphilis - chancroid - lymphogranuloma venerium - HSV
- dark-field microscopy; VDRL, RPR; FTA - stain & culture (gram-) - complement fixation titers in blood - Tzanck prep, viral culture
74
syphilis dx
-dark-field = most accurate bc actually see the organisms - VDRL or RPR = 75% sensitive (1/4 false negative) - FTA = confirmatory
75
genital ulcer tx: - syphillis - chancroid - lymphogranuloma venereum - HSV
- IM benzathine penicillin (doxy if allergic) - azithromycin (single dose) - doxycycline - acyclovir, valacyclovir, famciclovir; foscarnet
76
secondary syphilis px
- rash (palms & soles) - alopecia areata - mucous patches (mouth & genitals) - condylomata lata
77
tertiary syphilis px
- neurosyphilis - stroke from vasculitis - tabes dorsalis = loss of position & vibration sense, incontinence, cranial nerve - general paresis - Argyll Robertson pupil (reaction to accommodation, but not light) - aortitis - gummas
78
false positive VDRL/RPR in?
- antiphospholipid syndrome - endocarditis - malaria, AIDS, IV drug, infection, older age -false positive often have lower titers
79
Jarisch-Herxheimer reaction
=fever + headache + myalgias after syphilis tx - uncomfortable, but no danger to pt - give ASA & antipyretics -desensitization for neurosyphilis & pregnant women
80
condylomata acuminata microbe, px, tx
- papillomavirus (HPV) - px: visual appearance of warts -tx: cryotherapy with liquid nitrogen; surgery for large, podophyllin, imiquimod (gentle)
81
crabs = pediculosis px, tx
- hair-bearing areas (axilla, pubis) - itchy -tx: permethrin (less SE than lindane)
82
scabies px, tx
- very small - b/t fingers, toes, elbows -tx: permethrin, oral ivermectin
83
endocarditis px & dx
-px: fever + new murmur - dx: blood cultures - echo only if (+)blood cultures (TTE) --> TEE if (-)TTE
84
endocarditis complications:
- splinter hemorrhages** - Janeway lesions (flat & painless) - Osler nodes (raised & painful) - Roth spots (back of eye) - mycotic aneurysm (embolic infection into brain) - GN & hematuria -->death - conjunctival petechiae - septic emboli to lungs
85
empiric therapy for endocarditis
vancomycin + gentamicin
86
viridans strep endocarditis tx
ceftriaxone or penicillin for 4 weeks
87
stap aureus endocarditis tx
oxacillin, nafcillin, cefazolin
88
fungal endocarditis tx
amphotericin & valve replacement
89
MRAS/staph epidermidis endocarditis tx
vancomycin
90
enterococci endocarditis tx
ampicillin & gentamicin
91
surgery for endocarditis in cases of?
acute valve rupture | CHF
92
most common culture negative endocarditis =
**coxiella & bartonella** -not HACEK organisms
93
endocarditis prophylaxis for:
cardiac defect + risk of bacteria - prosthetic valve, previous endocarditis, cardiac transplant, unrepaired cyanotic HD - dental work with blood, respiratory tract surgery - amoxicillin prior to procedure - clindamycin, azithromycin, clarithromycin
94
tick must be attached for how long to get lyme disease?
24 hours
95
most common joint affected by lyme disease?
knee
96
neurologic manifestations of lyme disease?
bell's palsy (face) or Cr VII
97
cardiac manifestation of lyme disease (untreated)?
transient AV block = most common -myocarditis, ventricular arrhythmia
98
lyme disease tx
rash/joint/Cr VII --> doxycyline or amoxicillin cardiac/neurologic --> IV ceftriaxone
99
HIV dx
- ELISA = best initial; very sensitive - western blot = confirmation -viral culture in infants
100
viral load testing via
PCR-RNA levels - measures response to therapy - dx in babies
101
as viral load decreases, CD4 cells ______
increase --> dec opportunistic infections
102
HIV initial drug regimen
emtricitabine + tenofovir + efavirenz - 1 combo tablet - 3 drugs from 2 different classes (RTI, NRTI, PI)
103
RTI (= nucleoside reverse transcriptase inhibitors) MOA
- stop transcription of viral DNA in infected T cells | - "-vudines"
104
NRTI MOA
- stops viral transcription | - efavirenz > etravirine, nevirapine
105
protease inhibitors
- "-avirs" - AIDS virus drugs - cause hyperlipidemia & hyperglycemia
106
entry inhibitors
- enfuvirtide - maraviroc - blocks HIV from entering cell - works well in combo with other drugs
107
integrase inhibitor
- raltegravir | - virus already transcribed, but cannot enter T cell DNA material
108
``` SE: zidovudine stravudine & didanosine abacavir protease inhibitor indinavir tenofovir ```
- macrocytic anemia - peripheral neuropathy & pancreatitis - hypersensitivity, Stevens-Johnson Reaction - hyperlipidemia & hyperglycemia - nephrolithiasis - renal insufficiency
109
HIV drug avoided in pregnancy?
efavirenz (NRTI)
110
baby of HIV mother.. tx?
- zidovudine during delivery - for 6 weeks after delivery -C section if viral load>1000

Internal Medicine (9 decks)

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