Infectious Disease Flashcards Preview

USMLE Step 3 > Infectious Disease > Flashcards

Flashcards in Infectious Disease Deck (319):
1

INTRAVENOUS treatment for MSSA

(bone, heart, skin, joint)

- oxacillin
- nafcillin
- cefazolin (1st gen cephalosporin)

2

ORAL treatment for MSSA

(bone, heart, skin, joint)

- dicloxacillin
- cephalexin (1st gen cephalosporin)

3

treatment for MINOR MRSA infection

(bone, heart, skin, joint)

- trimethoprim/sulfamethoxazole (TMP/SMX)
- clindamycin
- doxycycline

4

treatment for MAJOR MRSA infection

(bone, heart, skin, joint)

- vancomycin
- linezolid
- daptomycin
- ceftaroline
- tigecycline
- telavancin

5

adverse effect of linezolid

thrombocytopenia

6

adverse effect of daptomycin

myopathy (elevated CPK)

7

treatment of Staph aureus if penicillin allergy: RASH

(bone, heart, skin, joint)

cephalosporins

8

treatment of Staph aureus if penicillin allergy: ANAPHYLAXIS

(bone, heart, skin, joint)

- macrolides (azithromycin, clarithromycin)
- clindamycin

9

treatment of Staph aureus if penicillin allergy: MINOR INFECTION

(bone, heart, skin, joint)

- macrolides (azithromycin, clarithromycin)
- clindamycin
- trimethoprim/sulfamethoxazole (TMP/SMX)

10

treatment of Staph aureus if penicillin allergy: MAJOR INFECTION

(bone, heart, skin, joint)

- vancomycin
- linezolid
- daptomycin
- telavancin

11

can you use the same antibiotics for Staph as Streptococcus?

YES

12

antibiotics SPECIFIC for Streptococcus

- penicillin
- ampicillin
- amoxicillin

13

Gram-negative bacilli (rods)

- Escherichia coli
- Enterobacter
- Citrobacter
- Morganella
- Pseudomonas
- Serratia

14

antibiotic classes that are EQUAL in efficacy for treatment of Gram-NEGATIVE bacilli (rods)

1. cephalosporins
2. penicillins
3. monobactam
4. quinolones
5. aminoglycosides
6. carbapenems

15

ONLY carbapenem that does NOT cover Pseudomonas

ERTAPENEM

16

cover GNR and ALSO cover Streptococci and anaerobes

1. PIPERACILLIN
2. TICARCILLIN

17

EXCELLENT pneumococcal (Streptococcus pneumoniae) drugs

1. LEVOFLOXACIN
2. GEMIFLOXACIN
3. MOXIFLOXACIN

18

work SYNERGISTICALLY against Staph and Strep

AMINOGLYCOSIDES

19

EXCELLENT anaerobic coverage, and cover Strep and MSSA

CARBAPENEMS

20

covers MRSA and GNR

TIGECYCLINE

21

adverse effect of imipenem

SEIZURES

22

BEST medication for gastrointestinal anaerobes (Bacteroides)

metronidazole

23

can also be used for gastrointestinal anaerobes (Bacteroides)

- carbapenems
- piperacillin
- ticarcillin

24

ONLY cephalosporins that cover anaerobes

- CEFOXITIN
- CEFOTETAN

25

BEST medication for respiratory anaerobes (anaerobic Strep)

clindamycin

26

antibiotics with NO anaerobic coverage

- aminoglycosides
- aztreonam
- fluoroquinolones
- oxacillin
- nafcillin
- all cephalosporins EXCEPT cefoxitin and cefotetan

27

red, flushed skin (particularly on neck) from histamine release is d/t?

vancomycin

28

red man syndrome treatment

slow rate of vancomycin infusion

29

treatment for herpes simplex, and varicella zoster (all 3 are equal in efficacy)

1. acyclovir
2. valacyclovir
3. famciclovir

30

treatment for cytomegalovirus (CMV)

1. ganciclovir
2. valganciclovir
3. foscarnet

31

BEST long-term treatment for CMV RETINITIS

VALGANCICLOVIR

32

adverse effects of ganciclovir and valganciclovir

- neutropenia
- bone marrow suppression

33

adverse effect of foscarnet

renal toxicity

34

treatment for influenza A and B

- oseltamivir
- zanamivir

(neuraminidase inhibitors)

35

treatment for hepatitis C (in combination w/ interferon), and respiratory syncytial virus (RSV)

ribavirin

36

treatment for hepatitis B

- lamivudine
- interferon
- adefovir
- tenofovir
- entecavir
- telbivudine

37

treatment for oral and vaginal candidiasis (alternative to topical medications)

fluconazole

38

best treatment against Aspergillus

voriconazole

39

adverse effect of voriconazole

visual disturbance

40

EXCELLENT for neutropenic fever patients

- caspofungin
- micafungin
- anidulafungin

(echinocandins)

41

which antifungals do NOT cover Cryptococcus?

echinocandins

42

adverse effects of echinocandins?

NONE

43

effective against ALL Candida, Cryptococcus, and Aspergillus

amphotericin

44

superior to amphotericin in treatment of Aspergillus

voriconazole

45

superior to amphotericin in treatment of neutropenic fever

caspofungin

46

superior to amphotericin in treatment of Candida

fluconazole (same efficacy, but LESS adverse effects)

47

adverse effects of amphotericin

1. renal toxicity (increased creatinine)
2. hypOkalemia
3. metabolic acidosis
4. fever, shakes, chills

48

occurs in DIABETES, PVD, or both with an ULCER, or SOFT TISSUE infection

OSTEOMYELITIS

49

best INITIAL test for osteomyelitis

plain X-ray

50

best SECOND-line test for osteomyelitis

MRI

51

most ACCURATE test for osteomyelitis

bone BIOPSY and culture

52

EARLIEST finding of osteomyelitis on X-ray

periosteal elevation

53

what percentage of calcium of bone must be lost in osteomyelitis before the X-ray becomes abnormal?

50%

54

how much time will it take before X-ray becomes abnormal in osteomyelitis?

up to 2 weeks

55

is osteomyelitis associated with fracture?

NO

56

best method for following response to therapy of osteomyelitis

ESR (erythrocyte sedimentation rate)

57

osteomyelitis is MOST COMMONLY caused by

direct contiguous spread from overlying tissue

58

what do you do in osteomyelitis if ESR is still markedly elevated after 4-6 weeks of treatment?

continue treatment

59

MCC of osteomyelitis

Staphylococcus

60

treatment for osteomyelitis if Staphylococcus is sensitive

OXACILLIN, or NAFCILLIN for 4-6 WEEKS

61

treatment for osteomyelitis if Staphylococcus is resistant (MRSA)

VANCOMYCIN, LINEZOLID, or DAPTOMYCIN for 4-6 WEEKS

62

can you treat Staphylococcal osteomyelitis with PO antibiotics?

NO

63

Gram-negative bacilli that can cause osteomyelitis

- Salmonella
- Pseudomonas

64

ONLY form osteomyelitis that can be treated with PO antibiotics

Salmonella, and Pseudomonas osteomyelitis

65

- ITCHING and DRAINAGE from external auditory canal
- form of cellulitis of external auditory canal

otitis externa

66

otitis externa is associated with?

- SWIMMING
- FOREIGN OBJECTS

67

treatment for otitis externa

1. topical antibiotics
2. topical hydrocortisone (decreases swelling/itching)
3. acetic acid and water (reacidify ear)

68

OSTEOMYELITIS OF SKULL from Pseudomonas in patient with diabetes

malignant otitis externa

69

malignant otitis externa can cause

- brain abscess
- skull destruction

70

best INITIAL test of malignant otitis externa

SKULL X-RAY, or MRI

71

MOST ACCURATE TEST for malignant otitis externa

BIOPSY

72

treatment for malignant otitis externa

1. SURGICAL DEBRIDEMENT
2. ANTIPSEUDOMONAL ANTIBIOTICS

73

antipseudomonal antibiotics that can be used in malignant otitis externa

- ciprofloxacin
- piperacillin
- cefepime
- carbapenem
- aztreonam

74

key features of otitis media

- redness
- bulging
- decreased hearing
- loss of light reflex
- TM immobility

75

MOST SENSITIVE finding in otitis media

TM IMMOBILITY

76

diagnostic testing for otitis media

NONE, based on PE

77

best INITIAL treatment of otitis media

AMOXICILLIN for 7-10 days

78

MOST ACCURATE TEST for otitis media

tympanocentesis and aspirate of TM for culture

79

if otitis media does not begin improving after 3 days, what do you do?

switch antibiotics!

- amoxicillin/clavulanate
- cefdinir
- ceftibuten
- cefuroxime
- cefprozil
- cefpodoxime

80

nasal discharge, headache, facial tenderness, tooth pain, bad taste in mouth, decreased transillumination of sinuses

sinusitis

81

MCC of sinusitis

VIRAL

82

MCC of sinusitis that are NOT viral

1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Moraxella catarrhalis

83

best INITIAL test for sinusitis

X-ray

84

MOST ACCURATE TEST for sinusitis

sinus aspirate for culture

85

treatment for sinusitis

amoxicillin and INHALED STEROIDS

86

- pain/sore throat
- exudate
- adenopathy
- NO cough/hoarseness

pharyngitis

87

best INITIAL test for pharyngitis

RAPID STREP TEST

88

MOST ACCURATE TEST for pharyngitis

CULTURE

89

treatment for pharyngitis

PENICILLIN, or AMOXICILLIN

90

treatment for pharyngitis if penicillin allergy

azithromycin, or clarithromycin

91

- arthralgia
- myalgia
- cough
- headache
- fever
- sore throat
- feeling of tiredness

influenza

92

next best step to diagnose influenza

viral antigen detection

93

when should you treat influenza?

if patient presents within first 48 hours after onset of symptoms

94

what drug class works against BOTH influenza A and B?

neuraminidase inhibitors

95

treatment for influenza

- oseltamivir
- zanamivir

96

WRONG answers to treat influenza

- amantadine
- rimantadine

97

who should get vaccinated against influenza?

everyone

98

- most SUPERFICIAL bacterial skin infections
- weeping, crusting, oozing of skin
- Strep PYOGENES or Staph aureus

impetigo

99

treatment for impetigo

1. topical mupirocin
2. topical retapamulin

100

treatment for SEVERE impetigo

1. dicloxacillin
2. cephalexin

101

treatment for community-acquired MRSA impetigo

TMP/SMZ (trimethoprim/sulfamethoxazole)

102

treatment for impetigo if penicillin allergy: RASH

cephalosporins

103

treatment for impetigo if penicillin allergy: ANAPHYLAXIS

1. clindamycin
2. doxycycline
3. linezolid

104

treatment for impetigo if penicillin allergy: SEVERE INFECTION WITH ANAPHYLAXIS

1. vancomycin
2. telavancin
3. linezolid
4. daptomycin

105

- group A (PYOGENES) streptococcal infection of skin
- very bright red, hot
- often affects FACE

erysipelas

106

can erysipelas cause rheumatic fever?

NO, but it can cause glomerulonephritis

107

what can cause rheumatic fever and glomerulonephritis?

PHARYNGITIS

108

best INITIAL treatment for erysipelas

1. dicloxacillin
2. cephalexin

109

treatment for erysipelas if organism is CONFIRMED as group A beta hemolytic streptococci (Strep pyogenes)

PENICILLIN VK

110

- warm, red, swollen, tender skin
- usually presents in arm or leg

cellulitis

111

what should you order in a case of cellulitis of the leg?

LOWER EXTREMITY DOPPLER to exclude blood clot

112

treatment for cellulitis: MINOR disease

1. dicloxacillin PO
2. cephalexin PO

113

treatment for cellulitis: SEVERE disease

1. oxacillin IV
2. nafcillin IV
3. cefazolin IV

114

treatment for cellulitis if penicillin allergy: RASH

cephalosporins (cefazolin)

115

treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and MINOR disease

- macrolides
- clindamycin

116

treatment for cellulitis if penicillin allergy: ANAPHYLAXIS and SEVERE disease

1. vancomycin
2. linezolid
3. daptomycin

117

what skin infection does Staphylococcus epidermidis cause?

NONE

118

all skin infections can lead to?

post-streptococcal GLOMERULONEPHRITIS

(but NOT rheumatic fever)

119

Staph aureus-related skin infections beginning at the hair follicle

folliculitis

120

what is FOLLICulitis?

infected hair FOLLICle

121

what is a furuncle?

deep folliculitis

122

what is a Carbuncle?

a Cluster of furuncles

123

what is an abscess?

a collection of pus

124

diagnosis of folliculitis, furuncles, carbuncle, abscess

based on appearance

125

treatment for folliculitis/furuncles/carbuncles/abscesses: MINOR disease

1. dicloxacillin PO
2. cephalexin PO

126

treatment for folliculitis/furuncles/carbuncles/abscesses: SEVERE disease

1. oxacillin IV
2. nafcillin IV
3. cefazolin IV

127

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: RASH

cephalosporins (cefazolin)

128

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and MINOR disease

- macrolides
- clindamycin

129

treatment for folliculitis/furuncles/carbuncles/abscesses if penicillin allergy: ANAPHYLAXIS and SEVERE disease

1. vancomycin
2. linezolid
3. daptomycin

130

abscesses respond well to?

drainage

131

severe itching of scalp, dandruff, bald patches

fungal SKIN infection

132

thickened nails, yellow, cloudy, appear fragile and broken

onychomycosis

133

best INITIAL test for fungal skin/nail infections

KOH preparation

134

antifungal treatment if NO hair or nail involvement

(hint: 5 -azole's, and 2 others)

topical:
- clotrimAZOLE
- miconAZOLE
- ketoconAZOLE
- econAZOLE
- terconAZOLE
- nystatin
- ciclopirox

135

PO antifungal tx for scalp (tinea capitis), or nail (onychomycosis)

1. terbinafine
2. itraconazole
3. griseofulvin (for tinea capitis)

136

adverse effect of terbinafine

increased transaminases

137

less efficacious than terbinafine and itraconazole

griseofulvin

138

- URETHRAL DISCHARGE
+/- dysuria

urethritis

139

diagnostic testing for urethritis

- urethral swab (gram stain, WBC count, culture, DNA probe)
- nucleic acid amplification test (NAAT)

140

treatment for urethritis

2 medications: one for gonorrhea, one for chlamydia

141

1. polyarticular disease
2. petechial rash
3. tenosynovitis

disseminated gonorrhea

142

medications for gonorrhea in urethritis

- ceftriaxone IM
- cefpodoxime PO
- ciprofloxacin PO

143

treatment for gonorrhea if patient has urethritis and is PREGNANT

ceftriaxone IM

144

medications for chlamydia in urethritis

- azithromycin (SINGLE dose)
- doxycycline (for 1 week)

145

treatment for chlamydia if patient has urethritis and is PREGNANT

azithromycin

146

cervical discharge

cervicitis

147

diagnostic testing for cervicitis

- swab (gram stain, WBC count, culture, DNA probe)
- nucleic acid amplification test (NAAT)

148

is just as accurate as a speculum examination for cervicitis

nucleic acid amplification testing (NAAT)

149

treatment for cervicitis

2 medications: one for gonorrhea, one for chlamydia

150

medications for gonorrhea in cervicitis

- ceftriaxone IM
- cefpodoxime PO
- ciprofloxacin PO

151

treatment for gonorrhea if patient has cervicitis and is PREGNANT

ceftriaxone IM

152

medications for chlamydia in cervicitis

- azithromycin (SINGLE dose)
- doxycycline (for 1 week)

153

treatment for chlamydia if patient has cervicitis and is PREGNANT

azithromycin

154

- lower abdominal pain
- tenderness
- fever
- cervical motion tenderness
+/- dysuria
+/- vaginal discharge

pelvic inflammatory disease (PID)

155

measure of severity in pelvic inflammatory disease (PID)

leukocytosis

156

best INITIAL test for pelvic inflammatory disease (PID)

1. pregnancy test
2. cervical culture
3. NAAT (nucleic acid amplification testing)

157

MOST ACCURATE test for pelvic inflammatory disease (PID)

laparoscopy (rarely needed)

158

OUTPATIENT treatment for PID

ceftriaxone IM AND doxycycline PO

159

INPATIENT treatment for PID

cefoxitin IV AND doxycycline IV (and maybe metronidazole)

160

antibiotics safe in pregnancy

1. penicillins
2. cephalosporins
3. aztreonam
4. erythromycin
5. azithromycin

161

- extremely painful and tender testicle
- NORMAL position of testicle in scrotum

epididymo-orchitis

162

- extremely painful and tender testicle
- ELEVATED testicle in an ABNORMAL TRANSVERSE position

testicular torsion

163

treatment for epididymo-orchitis: if LESS THAN 35 years of age

ceftriaxone AND doxycycline

164

treatment for epididymo-orchitis: if MORE THAN 35 years of age

fluoroquinolone

165

PAINFUL ulcer caused by Haemophilus ducreyi

chancroid

166

best INITIAL test for chancroid

swab for gram stain and culture

167

treatment for chancroid

- ceftriaxone (single IM shot), OR
- azithromycin (single PO dose)

168

- LARGE TENDER NODES
- ulcer
- may develop suppurating, draining sinus tract

lymphogranuloma venereum (LGV)

169

diagnose lymphogranuloma venereum (LGV)

serology for Chlamydia trachomatis

170

treatment for lymphogranuloma venereum (LGV)

1. aspirate the bubo
2. doxycycline, OR azithromycin

171

clear vesicular lesions

HSV2 (herpes simplex virus 2; genital herpes)

172

treatment for HSV2

- acyclovir
- valacyclovir
- famciclovir
for 7-10 days

173

best INITIAL test if roofs come off of vesicles making etiology unclear

Tzanck prep

174

MOST ACCURATE test for HSV2

viral culture

175

cause of syphilis

Treponema pallidum

176

- PAINLESS, firm genital lesion
- painless inguinal adenopathy

syphilis

177

MOST ACCURATE test for PRIMARY syphilis

darkfield microscopy

178

symptoms of PRIMARY syphilis

- CHANCRE
- ADENOPATHY

179

treatment for PRIMARY syphilis

SINGLE IM shot of PENICILLIN

180

treatment for PRIMARY syphilis if penicillin allergy

doxycycline

181

- fever, headache, myalgia
- develops 24 hours after treatment of primary syphilis

Jarisch-Herxheimer reaction

182

symptoms of SECONDARY syphilis

- RASH
- MUCOUS PATCH
- ALOPECIA AREATA (bald patches)
- CONDYLOMATA LATA (warts on genitals)

183

INITIAL diagnostic test for SECONDARY syphilis

RPR and FTA

184

treatment for SECONDARY syphilis

SINGLE IM shot of PENICILLIN

185

treatment for SECONDARY syphilis if penicillin allergy

doxycycline

186

manifestations of TERTIARY syphilis

- TABES DORSALIS
- ARGYLL-ROBERTSON PUPIL
- GENERAL PARESIS (paralysis)
- gumma
- aortitis

187

INITIAL diagnostic test for TERTIARY syphilis

RPR and FTA

(FTA is more sensitive for neurosyphilis)

188

best INITIAL diagnostic test for NEUROsyphilis

LUMBAR PUNCTURE

189

treatment for TERTIARY syphilis

IV PENICILLIN

190

treatment for TERTIARY syphilis if penicillin allergy

desensitization to penicillin

191

beefy red genital lesion that ULCERATES

granuloma inguinale

192

diagnostic test for granuloma inguinale

biopsy

193

causative organism for granuloma inguinale

Klebsiella granulomatis

194

treatment for granuloma inguinale

- doxycycline
- TMP/SMX
- azithromycin

195

- urinary frequency
- urgency
- burning
- dysuria

cystitis

196

best INITIAL test for cystitis

urinalysis

197

MOST ACCURATE test for cystitis

urine culture

198

treatment for UNCOMPLICATED cystitis

fosfomycin, or nitrofurantoin PO for 3 days

199

treatment for UNCOMPLICATED cystitis if high resistance to TMP/SMX

- ciprofloxacin
- levofloxacin

200

treatment for COMPLICATED cystitis

- TMP/SMX
- ciprofloxacin

for 7 days

201

what qualifies as "complicated" cystitis?

- stone
- stricture
- tumor
- obstruction

202

should you treat asymptomatic bacteriuria?

NO

203

who should get treated for asymptomatic bacteriuria?

only PREGNANT women

204

- urinary frequency
- urgency
- burning
- dysuria
- FLANK PAIN and TENDERNESS

pyelonephritis

205

best INITIAL test for pyelonephritis

urinalysis

206

MOST ACCURATE test for pyelonephritis

urine culture

207

OUTpatient treatment for pyelonephritis

ciprofloxacin

208

INpatient treatment for pyelonephritis

- ceftriaxone
- ertapenem
- quinolones
- ampicillin
- gentamicin

209

why are sonography or CT scanning done in a patient with a UTI?

- to determine etiology
- if pyelonephritis; stone? stricture? tumor? obstruction?

210

think of this in a patient who does not respond to treatment AFTER 5-7 days

perinephric abscess

211

necessary diagnostic test for perinephric abscess

biopsy to determine microbe

212

treatment for perinephric abscess

quinolone AND staphylococcal coverage

(because treatment for GN bacteria selects out staphylococci)

213

positive NITRITES indicate

gram negative bacteria in urine

214

- frequency
- urgency
- dysuria
- PERINEAL or SACRAL PAIN
- prostate tenderness

prostatitis

215

best INITIAL test for prostatitis

urinalysis

216

MOST ACCURATE test for prostatitis

urine WBC's AFTER PROSTATE MASSAGE

217

treatment for ACUTE prostatitis

- ciprofloxacin
- TMP/SMX

FOR 2 WEEKS

218

treatment for CHRONIC prostatitis

- ciprofloxacin
- TMP/SMX

FOR 6 WEEKS

219

endocarditis is clinically diagnosed using

Duke's criteria

(2 MAJOR, or 5 minor criteria)

220

what are the 2 MAJOR criteria for Duke's criteria?

1. 2 positive blood cultures
2. abnormal echocardiogram

221

what are the minor criteria for Duke's criteria?

1. fever
2. presence of risk factors
3. vascular findings
4. immunologic findings
5. microbiologic findings

222

fever + murmur =

POSSIBLE endocarditis

(do blood cultures)

223

2 positive blood cultures + positive echo =

ENDOCARDITIS

224

next best step in patient with fever, and new murmur or change in murmur

blood cultures

225

next best step in patient with fever, a murmur (new or changed), and positive blood cultures

echocardiogram

226

most common causes of culture NEGATIVE endocarditis

Coxiella and Bartonella

227

is associated even more with colonic pathology than Streptococcus bovis

Clostridium septicum

228

most common organisms for bacterial endocarditis

1. Staph aureus
2. MRSA
3. Strep viridans group

229

best empiric therapy for endocarditis

vancomycin AND gentamicin in COMBINATION

(covers MC organisms)

for 4-6 weeks

230

if cause of endocarditis is Streptococcus bovis or Clostridium septicum, need to do what?

COLONOSCOPY

231

what are the indications for surgery (valve replacement) in endocarditis?

ANATOMIC DEFECTS

1. valve rupture
2. abscess
3. prosthetic valves
4. fungal endocarditis
5. embolic events even after abx

232

when do you start HAART?

1. CD4 count

233

adverse effect of NRTI (nucleoside reverse transcriptase inhibitors)

lactic acidosis

234

adverse effects of PI (protease inhibitors)

1. hypERglycemia
2. hypERlipidemia

235

adverse effect of NNRTI (nonnucleoside reverse transcriptase inhibitors): efavirenz

drowsiness

236

adverse effect of zidovudine

anemia

237

adverse effects of didanosine

1. pancreatitis
2. peripheral nEUropathy

238

adverse effects of stavudine

1. pancreatitis
2. peripheral nEUropathy

239

adverse effect of abacavir

rash

240

adverse effects of lamivudine

NONE

241

adverse effect of tenofovir

renal toxicity

242

adverse effect of indinavir

kidney stones

243

postexposure prophylaxis:

- needle-stick injury
- unprotected sex

HAART for ONE MONTH

(tenofovir, emtricitabine, AND integrase inhibitor, or protease inhibitor)

244

blocks CCR5 receptor of CD4 cell

maraviroc

245

which protease inhibitor inhibits the hepatic p450 system increasing blood levels of other PI's?

ritonavir

246

when do you start HIV meds in HIV+ pregnant women?

right away in first trimester

(regardless of CD4 count/viral load)

247

HIV+ with CD4 count

Pneumocystis jiroveci pneumonia (PCP)

248

best ppx for Pneumocystis jiroveci pneumonia (PCP)

TMP/SMX

249

ppx for Pneumocystis jiroveci pneumonia (PCP) if TMP/SMX causes RASH

- atovaquone
- dapsone

250

CANNOT be used for PCP ppx if G6PD deficiency

dapsone

251

HIV+ with CD4 count

Mycobacterium avium-intracellulare (MAI)

252

ppx for Mycobacterium avium-intracellulare (MAI)

azithromycin Qweekly

253

PCP presentation

1. SOB
2. dry cough
3. hypoxia
4. elevated LDH

254

best INITIAL test for PCP

CXR

(increased interstitial markings B/L)

255

MOST ACCURATE test for PCP

BAL

256

treatment for PCP

TMP/SMX IV

257

treatment for PCP if TMP/SMX causes RASH

pentamidine IV

258

when do you give steroids in PCP?

pO2 35

259

headache, N/V, FND in immunocompromised patient

toxoplasmosis

260

best INITIAL test for toxoplasmosis

CT head WITH contrast

("ring" enhancing lesions)

261

treatment for toxoplasmosis

pyrimethamine and sulfadiazine for 2 WEEKS

262

HIV with

cytomegalovirus (CMV) retinitis

263

treatment for CMV retinitis

- ganciclovir
- foscarnet

264

adverse effect of ganciclovir

low WBC's

265

adverse effect of foscarnet

high creatinine

266

maintenance therapy for CMV retinitis

valganciclovir PO LIFELONG, unless CD4 count increases

267

-

cryptococcal meningitis

268

best INITIAL test for cryptococcal meningitis

INDIA INK STAIN on CSF

269

MOST ACCURATE test for cryptococcal meningitis

cryptococcal antigen test

270

treatment for cryptococcal meningitis

- amphotericin and 5-FC (flucytosine)
- then LIFELONG fluconazole, unless CD4 count increases

271

- HIV and

progressive multifocal leukoencephalopathy (PML)

272

best INITIAL test for PML

head CT or MRI

273

MOST ACCURATE test for PML

PCR of CSF for JC virus

274

treatment for PML

- no specific treatment
- HAART

(will resolve when CD4 counts increases)

275

does NOT cover crytpococcus

caspofungin

276

- HIV with

Mycobacterium avium intracellulare (MAI)

277

diagnostic tests in order from least to most sensitive

LEAST sensitive= blood cultures
more sensitive= bone marrow biopsy
MOST sensitive= LIVER BIOPSY

278

treatment for Mycobacterium avium intracellulare (MAI)

clarithromycin AND ethambutol +/- rifabutin

279

animal exposure + jaundice + renal =

(fever, abdominal pain, muscle aches)

leptospirosis

280

treatment for leptospirosis

- ceftriaxone
- penicillin

281

- rabbits
- ulcer at site of contact
- enlarged lymph nodes
- conjunctivitis

tularemia

282

diagnose tularemia with

serology

283

treatment for tularemia

- gentamicin
- streptomycin

284

- thin-walled cysts, often calcified on CTH
- infected pork that's ingested

cysticercosis

285

treatment for cysticercosis

albendazole

286

camping/hiking + target-shaped rash =

- transmitted by Ixodes tick

Lyme disease

287

long-term manifestations/complications of Lyme disease

1. joints = LATE manifestation
2. cardiac = AV conduction block/defect
3. neurologic = 7th CN palsy (Bell's palsy)

288

diagnosis of Lyme disease

serology

289

treatment for Lyme disease: rash, joint, Bell's palsy

- doxycycline PO
- amoxicillin PO
- cefuroxime PO

290

treatment for Lyme disease: CNS, cardiac involvement

ceftriaxone IV

291

- also transmitted by Ixodes tick
- common in northeast
- HEMOLYTIC ANEMIA

babesiosis

292

diagnosis of babesiosis

- PBS
- PCR

293

treatment for babesiosis

- azithromycin
- atovaquone

294

- also transmitted by Ixodes tick
- NO RASH
- elevated LFT's
- THROMBOCYTOPENIA
- LEUKOPENIA

ehrlichia/anaplasma

295

diagnosis of ehrlichia/anaplasma

- PBS
- PCR

296

treatment for ehrlichia/anaplasma

doxycycline

297

- traveler returning from endemic area
- HEMOLYSIS
- GI COMPLAINTS

malaria

298

diagnosis of malaria

blood smear

299

treatment for malaria: ACUTE disease

- mefloquine
- atovaquone/proguanil
- quinine/doxycycline (severe cases)

300

prophylaxis for malaria:

- mefloquine (weekly)
- atovaquone/proguanil (daily)

301

- immunocompromised patients
- respiratory disease, can spread anywhere, usually skin or brain
- branching, gram positive filaments, weakly acid-fast

Nocardia

302

best INITIAL test for Nocardia

CXR

303

MOST ACCURATE test for Nocardia

culture

304

treatment for Nocardia

TMP/SMX

305

- normal immune system
- h/o facial/dental trauma
- branching, gram positive filaments

Actinomyces

306

diagnosis and confirmation of Actinomyces

1. gram stain
2. ANaerobic culture

307

treatment for Actinomyces

penicillin

308

- WET areas (river valleys)
- a/w bat droppings from caves
- palate and oral ulcers
- splenomegaly
- pancytopenia if there's bone dissemination

Histoplasmosis

309

best INITIAL test for Histoplasma

Histoplasma urine antigen

310

MOST ACCURATE test for Histoplasma

BIOPSY with culture

311

treatment for acute pulmonary disease d/t Histoplasma

none needed

312

treatment for disseminated Histoplasmosis

amphotericin

313

- VERY DRY areas (Arizona)
- joint pain
- erythema nodosum

Coccidioidomycosis

314

treatment for Coccidioidomycosis

itraconazole

315

- acute respiratory disease
- rural southeast
- BROAD BUDDING YEAST
- bone lesions are common

Blastomycosis

316

treatment for Blastomycosis

- amphotericin
- itraconazole

317

MOA of echinocandins

1,3-glucan inhibition in fungi ONLY

318

treatment for chronic hepatitis C

- boceprevir
- simeprevir
- sofosbuvir
- ledipasvir

(none used as a single agent)

319

which antiviral agents for chronic hepatitis C not to be combined with interferon?

- sofosbuvir
- ledipasvir