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Flashcards in Infectious Disease Deck (202):
1

amoxicillin coverage

HELPS
H.influ
E.coli
Listeria
Proteus
Salmonella

2

amoxicillin best initial tx for:

- otitis media
- dental infection and endocarditis prophylaxis
- lyme disease
- UTI in prego
- listeria
- entercoccal infections

3

penicillinase resistant pencillins

oxacillin
cloxacillin
dicloxacillin
nafcillin

4

penicillinase resistant pencillins best intial tx for:

- skin infections
- staph: endocarditis, meningitis, bacteremia
- osteomyelitis and septic arthritis (only when organism proven sensitive)

5

methicillin ever the right answer

nooooooo

6

piperacillin, ticarcillin, azclocillin, mezlocillin best initial tx for

- cholecystitis
- ascending cholangitis
- pyelonephritis
- bacteremia
- HAP and VAP
- neutropenia and fever

7

only cephalosporin that covers MRSA

CEFTAROLINE

8

rash to pencillin, give....

cephalosporins

9

anaphylaxis to penicllin, give....

nON-beta lactam

10

first gen cephs 2 additional

cephadrine
cefadroxyl

11

first gen cephs for...

- osteomyelitis
- septic arthritis
- cellulitis
- endocarditis

12

2 second gen cephs which cover anaerobes

cefotetan
cefoxitin

13

second gen cephs, 3 additional

cefotetan
cefprozil
loracarbef

14

cefotetan
cefoxitin best initial tx for...

PID + doxycycline

15

side effects of:
cefotetan
cefoxitin

BLEEDING
DISULFIRAM like reaction

16

cefurozime, loracarbef, cefprozil, cefaclor tx for

RESPIRATORY infections
- bronchitis
- otitis media
- sinusitis

17

ceftriaxone first line tx for

- meningitis
- CAP with macrocodes
- gonorrhea
- lyme disease

18

who to avoid ceftriaxone with...

NEONATES--impairs biliary metabolism

19

cefotaxime

instead of ceftriaxone in neonates
SBP

20

cefepime for:

- neutropenia and fever
- VAP

21

carbapenems for...

- neutropenia and fever

22

all carbapenems cover.... except....

PSEUDOMONAS, except ERTRAPENEM

23

morgonella and citrobacter

gram negative bacilli

24

fluoroquinolones for

- best tx CAP
- cipro- cystitis and pyelonephritis
- diverticulitis and GI infections

25

what do fluoroquinolones have to be added with for GI infections

METRO

26

the one fluoroquinolone which can be a single agent in diverticulitis

MOXIFLOXACIN

27

aminoglycosides

- NO EFFECT ON ANAEROBES

28

gatifloxacin

REMOVED-- because caused GLUCOSE problems

29

doxycycline used for

- chlamydia
- lyme disease
- rickettsia
- MRSA of skin and soft tissue
- primary and secondary syphilis second line
- borrelia, ehrlichia, mycoplasma

30

TMP/SMX used for

- cystitis
- pneumocystitis pneumonia both tx and pro
- MRSA cellulitis

31

first choice for mouth and GI abscess

beta lactam+ beta lactamse -- since cover anaerobes

32

MRSA drugs

- VANCIN: telavancin, dalbavancin, oritavancin
- tedizolid
- vanocmycin
- linezolid
- daptomycin: elevates CPK
- tigecycline
- ceftaroline

33

minor MRSA skin infections

- TMP/SMX
- clindamycin
- doxy
- linezolid

34

anaerobes above the diaphragm

- penicillins
- clindamycin

35

anaerobes below the diaphragm

- metro
- beta lactam/lactamase combinations

36

general anaerobe coverage

- piperacillin
- carbapenems
- second gen cephalosporins

37

head CT first in meningitis if....

- papilledema
- seizures
- focal neuro bsnormalities
- confusion interfering with neurological exam

38

latex agglutination test

similar to gram stain
POSITIVE-- very specific
NEGATIVE-- chance they could still have it

39

using protein and glucose levels to guide tx decision

NEVER NEVER too nonspecific

40

tx meningitis

ceftriaxone, vancomycin, steroids

41

tx meningitis with listeria

ADD ampicillin

42

who is at risk for listeria meningitis

- extremes of age: elderly and neonates
- IMMUNOcompromised: steroids/HIV/alcoholic/pregnant

43

first step for PC encephalitis

head CT first-- because of the confusion

44

most accurate test for herpes encephalitis

PCR of CSF (more beneficial than brain biopsy)

45

if acyclovir fails in herpes encephalitis....

FOSCARNET

46

if patients creatinine elevates after tx with acyclovir

REDUCE dose of acyclovir and hydrate
(since acyclovir is less nephrotoxic than foscarnet)

47

most sensitive finding for otitis media

IMMOBILE TYMPANIC MEMBRANE
(if have a mobile tympanic membrane will EXCLUDE otitis media)

48

multiple recurrent otitis media, next best step....

tympanocentesis

49

tx of otitis media and sinusitis

- amoxicillin (or oc-amox)
- doxy
- TMP/SMX

50

most accurate test for sinusitis

sinus biopsy or aspirate

51

culture nasal discharge for sinusitis?

NOOOOO WRONG WRONG WRONG

52

biopsy of sinusitis only needed if...

- recurrent
- FAILED response to empiric tx

53

obvi PC of sinusitis... what next...

TREAT THEM! with co-amox + decongestant

54

pharyngitis with small vesicles

HSV-- anterior pharynx

55

pharyngitis with ulcers

herpangina-- posterior pharynx

56

anterior palatal petechiae

EBV

57

best initial test with strep throat

rapid strep test

58

tx of strep throat

1. amoxicillin best initial
2. cephalexin if rash allergy
clindamycin or macrolide if anaphylaxis allergy

59

within 48hrs of influenza symptoms

- oseltamivir
- zanamivir
(shorten the duration of influenza A and B symptoms)

60

diarrhea with shellfish and cruise ships

vibrio parahaemolyticus

61

diarrhea with shellfish, LIVER disease, SKIN lesions

vibrio vulnificus

62

diarrhea with HFE, blood transfusions

yersinia

63

best initial test for infectious diarrhea

blood and or/fecal leukocytes

64

what is better in dx of infectious diarrhea

FECAL LACTOFERRIN better than fecal leukocytes

65

most accurate test for infectious disease

stool culture

66

no blood or WBC's in stool

- viral
-giardia
- crypto
- bacillius cereus
- staph

67

wheezing, flushing, RAPIDLY rash after eating fish

scromboid poisoning

68

tx of scromboid poisoning

ANTIHISTAMINES

69

tx mild diarrhea

oral fluid replacement

70

severe diarrhea

- hypotensive
- tachycardic
- fever
- abdo pain
- bloody diarrhea
- metabolic acidosis

71

tx of severe diarrhea

fluid replacement and cipro

72

most accurate finding cause of infectious diarrhea

BLOOD IN STOOL= invasive pathogen

73

tx of viral, bacillus, staph diarrhea

fluid support as needed

74

hep C and acute presentation....

RARELY OCCURS

75

hepE is worst in....

PREGNANCY

76

rare complication of acute hepatitis

aplastic anaemia

77

highest likelihood of mortality with hepatitis...

INCREASE PT (Since more likely to go onto hepatic failure)

78

first serology parameter to be abnormal in hep B

hepB surface antigen

79

if patient doesn't have with HepB serology= NO LONGER AT RISK OF TRANSMITTING

hepB surface antigen
(since transmissibility only stops when the DNA polymerase is gone, which can still be there when surface and e antigen antibodies appear)

80

HepB serology= active viral replication

hepE antigen

81

HepB serology= best response to anti-virals

hepE antigen

82

what is more precise than hep B e antigen

hep B DNA viral load

83

best indicator a pregnant woman will transmit infection to child

e antigen or DNA polyermase
(e antigen= qualitative, DNA polyermase= quantitative)

84

most common transmission of hep B worldwife

VERTICAL TRANSMISSION

85

chronic hepatitis

surface antigen for more than 6 months

86

goal of chronic hepatitis tx

- reduce DNA polymerase to undetectable levels
- convert those patients with e-antigen to having anti-hepatitis e-antibody

87

if there is active viral replication....

FIBROSIS--> CIRRHOSIS

88

ALT as indication of activity of chronic hepatitis

NOOOOOO bad indication, since can have significant infection with normal transaminase levels

89

only form of acute hepatitis to be treated

acute hep C

90

hep C

- do not test based only on risk factors
- anyone with high PCR RNA viral load needs treatment- genotype predicts the response to tx
- viral load assesses the effect of therapy
- liver biopsy-- extent of damage. if viral load is elevated, little use in doing a liver biopsy

91

PC PID

- lower abdo pain and tenderness
- CERVICAL MOTION TENDERNESS
EXCLUDE PREGNANCY

92

cefixime for gonorrhea

NOOOOOOOO longer able to be used

93

most accurate test for PID

LAPAROSCOPY, not cervical testing

94

inpatient tx for PID

- cefoxitin or cefotetan + doxycycline

95

outpatient tx for PID

- ceftriaxone + doxycycline (possible with metro)

96

painless ulcer

syphilis

97

painful ulcer

chancroid

98

lymph nodes tender and suppurative

LGV

99

vesicles before ulcer and painful

HSV

100

dx for syphilis

- dark field microscopy
- VDRL or RPR
- FTA or MHA-TP= confirmatory

101

positive dark field....

NO FURTHER TESTING NECESSARY

102

chancroid dx

stain and culture on special medi

103

LGV dx

complement fixation titers in blood
NAAT on swab

104

HSV dx

Tzank= best initial
viral culture= most accurate

105

tx syphilis

single dose IM bezathine penicillin (doxy if allergies)

106

tx chancroid

azithromycin (single dose)

107

LGV tx

doxycycline

108

HSV tx

- acyclovir, valcyclovir, famciclovir
- foscarnet for acyclovir resistant herpes

109

topical or oral acyclovir

ORAL

110

primary syphilis, HY description

indurated edges

111

secondary syphilis 2 additional

- alopecia areata
- mucous patches

112

chancres in syphilis

HEAL SPONTANEOUSLY even without tx,
penicillin prevents later stages

113

tertiary neuro syphilis

- meningovascular- STROKE-from vasculitis
- tabes dorsalis
- general paresis-- memory and personality changes
- argyll robertson pupil

114

negative FTA

EXCLUDES neurosyphilis

115

false positive for VDRL/RPR

- infection
- older age
- injection drug use
- AIDS
- malaria
- APLS
- endocarditis

116

reliable titers for VDRL/RPR

greater than 1:8

117

lower titers for VDRL/RPR

false positive

118

1:32 or greater titers for VDRL/RPR

RARELY false positive

119

tertiary syphilis tx

IV penicillin, desensitize if allergic

120

2 times when desensitize for penicillin

- neurosyphilis
- pregnant

121

tx of garish herxheimer

aspirin
antipyretics

122

tx condyloma accuminata

- cryotherapy
- surgery
- podophyllin
- imiquimod

123

tx of crabs/ pediculosis

permethrin> lindane-- less toxic

124

scabies tx

permethrin

125

tx widespread crusted/ hyperkeratotic scabies

ivermectin

126

frequency

multiples episodes of micturition

127

polyuria

increase in VOLUME of urine

128

men with UTI---

ANATOMIC abnormalities

129

best initial test UTI

urinalysis-- more than 10 WBCs

130

most accurate test UTI

urine culture

131

tx UTI

- nitrofurantoin
- TMP/SMX if low resistance

132

uncomplicated cystitis tx

3 days nitrofurantoin

133

anatomic abnormality/ complicated cystitis

7 days nitrofurantoin

134

first line tx for pyelonephritis

CEFTRIAXONE

135

empiric tx for pyelonehpritis

ampicillin and gentamicin-- until culture is known

136

outpatient tx pyelonephritis

ciprofloxacin

137

how to improve dx of prostatitis with urine culture

prostatic massage

138

timing for male UTI/ tx

7 days

139

timing for prostatitis tx

2-6 weeks

140

pyelonephritis that doesn't resolve with appropriate tx OR persistent fever with tx

PERINEPHRIC ABSCESS

141

tx of perinephric abscess

drainage

142

complications of endocarditis

- brain mycotic aneurysm
- kidney: hematuria, GN
- splenomegaly
- septic emboli to lungs

143

best initial tests for endocarditis

- blood culture
- TEE> TTE

144

most common bug in endocarditis with colon cancer

clostridium septicum

145

empiric tx for endocarditis

vancomycin and gentamicin

146

tx viridans strep

ceftriaxone for 4 weeks

147

s.aureus (sensitive) endocarditis tx

oxacillin, nafcillin, cefazolin

148

fungal endocarditis tx

amphotericin
remove valve

149

staph epi or resistant staph endocarditis tx

vancomycin

150

enterococci endocarditis tx

ampicillin and gentamicin

151

number one indication for surgery in endocarditis

CHF from valve rupture

152

prosthetic valve endocarditis with staph....

ADD RIFAMPIN

153

most common HHACCEK B organisms

1. coxiella
2. bartonella

154

HHACCEK B

Haemophilus arhorphilus
Haemophilus parainfluenzae
Actinobacillus
Cardiobacterium
Eikenella
Kingella
Bartonella

155

prophylaxis for endocarditis-- big indication

DENTAL WORK WITH BLOOD

156

DO NOT need endocarditis prophylaxis for:

- flexible endoscopy with bx
- obs/gyn
- urology
- GI procedures, ERCP
- valvular heart disease, MVP, even with murmur
- mr, ms, ar, as, hocm, asd

157

most common joint involved in lyme disease

KNEE

158

cardiac manifestation of lyme disease

transient AV block

159

asymptomatic tick bite tx

NOTHING

160

rash lyme tx

doxycycline
amoxicillin or cefuroxime

161

joint, 7th CN palsy lyme tx

doxycycline
amoxicillin or cefuroxime

162

cardiac and neuro findings (other than bells) lyme tx

IV ceftriaxone

163

transmission of HIV mc--> least common

1. mother to child: 25-30% perinatal transmission without meds
2. anal sex
3. NSI
4. oral sex
5. vaginal transmission

164

best initial test for HIV

ELISA

165

confirmatory test for HIV

Western blot

166

dx HIV in infants

PCR or viral culture

167

treatment failure....

rising PCR-RNA viral load

168

strongest indication for HAART is

CD4 less than 500

169

atripla=

emtricitabine, tenofovir, efavirenz

170

general rule for HIV

ACCEPTABLE to treat everyone, regardless of CD4 levels

171

ritonavir use

BOOSTS darunavir or atazanavir levels

172

do not use abacavir in patients with

HLA B5701 mutation

173

what drug is given with elvitegravir

cobicistat: inhibits its metabolism, thus increasing its levels

174

second line agents for HAART

entry inhibitors
integrase inhibitors

175

entry inhibitors

enfurvirtide
maraviroc

176

integrase inhibitors

raletgravir
dolutegravir
elvitegravir with cobicistat

177

PEP for NSI without knowing HIV status

NOPE

178

PEPE for bite from person with HIV

YES

179

SE zidovudine

anaemia

180

SE stavudine and didanosine

peripheral neuropathy
pancreatitis

181

SE abacavir

HSR
SJS

182

SE protease inhibitors

hyperlipidemia
hyperglycemia

183

SE indinavir

nephrolithiasis

184

SE tenofovir

renal insufficiency

185

one HAART cannot use in pregnancy

EFAVIRENZ!!!! since causes teratogenicity in animals

186

patient on retrovirals at time of pregnancy

continue same medications, except switch efavirenz to protease inhibitors

187

pregnant woman NOT on antiretrovirals with LOW CD4 and HIGH viral load

ASAP start HAART
continue after delivery

188

pregnant woman NOT on antiretrovirals with HIGH CD4 and LOW viral load

ASAP start HAART

189

intrapartum for baby

zidovudine, and for 6 weeks postpartum

190

risk of transmission to baby if fully controlled HIV

less than 1%

191

PC:
- leucocytosis
- LUQ pain
- fever

splenic abscess associated with IE

192

PC:
- lungs with nodular infiltrate and cavitation

septic pulmonary emboli-- associated with IE and IVDU

193

osteomyelitis with nail puncture

pseudomonas

194

PC necrotiziing surgical infection

purulent gray cloudy discharge=
DISHWATER DRAINAGE

195

PC:
- increase transaminases
- leucopenia
- thrombocytopenia

ehrlichosis*** morulae

196

other name for strep bovis

strep galloyticus biotype 1

197

pneumatoceles

thin walled cavities a/w post viral pneumonia with S.aureus

198

leukocytoclasic with kaposi's

new= violaceous
old= coalescent

199

fear with ludwig's

asphyxia--> death

200

TSS can happen secondary to....

nasal packing

201

PC sore throat with rash and diarrhea

PRIMARY HIV

202

PC sore throat with exudates

MONO