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Flashcards in Infectious Disease Deck (97):
1

IV treatment for MSSA

Oxacillin, nafcillin, cefazolin

2

Oral treatment for MSSA

Dicloxacillin, cephalexin

3

Severe MRSA infection tx

Vancomycin, Linezolid, Daptomycin, Tigecycline, Ceftaroline, Telavancin

4

Major SE of LInezolid

Thrombocytopenia

5

Major SE of daptomycin

Myopathy and rising CK

6

Minor MRSA infection tx

TMP/SMX, clindamycin, doxycyline

7

In patients with an anaphylactic penicillin allergy what antibxs can you use?

Macrolides (e.g. azithromycin, clarithromycin)
Clindamycin

8

In patients with severe infection and a penicillin allergy what alternate antibiotics can be used?

Vancomycin, daptomycin, linezolid, telavancin

9

In patients with mild infection and penicillin allergy what alternate antibiotics can be used?

Macrolides (e.g. azithromcyin, clindamycin)
Clindamycin
TMP/SMX

10

Which penicillin medications are specific for Streptococcus?

Amoxicillin, Ampicillin, Penicillin

11

What are options from each of the below classes for the treatment of gram negative bacilli?

Cephalosporins
Penicillins
Monobactam
Quinolones
Aminoglcyosides
Carbapenems

Cephalosporins: cefepime, ceftazidime
Penicillins: piperacillin, ticarcillin
Monobactam: aztreonam
Quinolones: cipro, levo, moxi, gemifloxa
Aminoglycosides: gentamicin, tobramycin amikacin
Carbapenems: imipenem, meropenem, ertapenem, doripenem

12

In addition to gram negative bacilli what else do piperacillin and ticaricillin cover?

Streptococci
Anaerobes

13

What is the only carbapenem which doesn't cover Pseudomonas?

Ertapenem

14

What class of antibiotics generally offers great pneumococcal coverage?

Quinolones

15

Best med for gastrointestinal anaerobes

Metronidazole

16

What are the only cephalosporins which cover anaerobes?

Cefoxitin
Cefotetan

17

Major SE of imipenem

Seizures

18

What is the best drug for anaerobic strep?

Clindamycin

19

Tx options for CMV

Valganciclovir, ganciclovir, foscarnet

20

Major SE of valganciclovir and ganciclovir

BM suppression

21

Major SE of foscarnet

Renal toxicity

22

Agents for chronic HCV

Simeprevir, boceprevir, sofosbuvir, ledipasvir
Ribavirin

23

Major SE of ribavirin

Anemia

24

Treatment options for HBV

Lamividuine, interferon, adefovir, tenofovir, entecavir, telbivudine

25

What pathogens is fluconazole effective against?

Candida (most of them)
Cryptococcus

26

What is the best agent for Aspergillus?
What is its major SE?

Voriconazole
Visual disturbance

27

What -conazole also covers mucormycosis or Mucorales?

Posaconazole

28

What are examples of echinocandins?

Caspofungin, micafungin anidulafungin

29

In patients with neutropenic fever requiring antifungal coverage what class is a great option?

Echinocandins

30

Because of toxicity there are fewer true uses for amphotericin even though it has great coverage. What are its remaining uses?

Cryptococcus
Mucormycosis

31

What are the adverse effects of amphotericin?

Renal toxicity
Hypokalemia
Metabolic acidosis
Fever, shakes, chills

32

In a patient with mucormycosis (who needs amphotericin) but has renal toxicity due to it what is an option moving forward?

Liposomal amphotericin

33

What is the best initial test for osteomyelitis?

X-ray
(Even though an MRI would be better you should get an X-ray first)

34

What is the earliest finding of osteomyelitis on Xray?

Periosteal elevation

35

What can you use as a gauge to know how long to treat osteomyelitis?

ESR

*Many patients will become afebrile and have normal WBC so this is useful to use

36

Can you use oral antibiotics for Staph osteomyelitis?
What form can you use oral antibiotics for?

No
Can only use oral for Salmonella or Pseudomonas but even then these pathogens need to be bone biopsy/culture confirmed

37

For otitis externa what topical antibx are used?
What is used to decrease swelling and itching?
What is used to reacidify the ear?

Topicals: oxfloxacin, ciprofloxacin, polymyxin/neomycin
Decreased swelling/itching: topical hydrocortisone
Reacidify: acetic acid and water solution

38

How is malignant otitis externa treated?

Treat this like osteomyelitis of the skull
Surgical debridement and anti-Pseudomonal antibiotics

39

Best initial test in sinusitis?
Most accurate test?

Initial: X-ray
Accurate: Sinus aspirate for culture

40

There is a live attenuated influenza vaccine and an injected inactivated virus. In what situations should both be used?

50 or with COPD, CHF, dialysis, steroid use, or health care workers should get inactivated virus

41

Treatment of impetigo
Mild/Moderate
Severe
Community-acquired MRSA

Mild/Mod: Topical mupirocin or retapamulin
Severe: Oral dicloxacillin or cephalexin
CA-MRSA: TMP-SMX

42

Best initial treatment of erysipelas
What if the organism is confirmed as group A beta hemolytic Strep?

Initial: oral dicloxacillin or cephalexin
If confirmed GAS: penicillin VK

43

Treatment of cellulitis (or folliculitis, furuncle, carbuncle, boil)

Mild
Severe

Mild: dicloxacillin or cephalexin orally
Severe: oxacillin, nafcillin, cefazolin IV

44

What is the best initial test of fungal infections in skin or nails?

KOH prep

45

What topical antifungals are used for fungal infections which don't involve the hair or nails?

Clotrimazole and many other -azoles
Nystatin, ciclopirox

46

What oral antifungals are used for treatment of tinea capitis or onychomycosis?

Terbinafine
Itraconazole
Griseofulvin (more so for tinea capitis)

47

In patients with urethritis what two meds should you give?

Ceftriaxone IM
Azithromycin or doxycycline

48

In patients with recurrent Gonorrhea infections what should they be tested for?

Terminal complement deficiency

49

What diagnostic tests should be done for urethritis?

Urethral swab and culture
Nucleic acid amplification tests

50

What is treatment for PID (outpatient and inpatient)?

OP: IM ceftriaxone and oral doxy
IP: IV cefoxitin and doxy

51

What is treatment of PIID in pregnant women?

Clindamycin and gentamicin

52

How does epididymo-orchitis differ from testicular torsion?
What is appropriate treatment (hint it depends on age)?

Both have exquisitely painful testicles but epididymo-orchitis has a normal testicular position

35: fluoroquinolone

53

Haemophilus ducreyi causes _____. This ulcer is (painful/painless)

Chancroid
Painful ulcer

54

Treatment of chancroid

Single shot IM ceftriaxone or singe dose azithromycin

55

How does lymphogranuloma venerum present?

An ulcer with large tender nodes near it (often called "buboes" which may also have a draining sinus tract

56

What is the cause of lymphgranuloma venerum?

Chlamydia trachomatis

57

What is treatment of lymphgranuloma venerum?

Aspirate the buboes and treat with doxycycline or azithromycin

58

What is the most accurate test for syphilis?

Darkfield microscopy

59

What is treatment for primary syphilis?
What is the Jarisch-Herxheimer reaction?
What is it's treatment?

Penicillin
Fever, myalgia, headache which may begin after starting to treat primary symphilis
Self-limiting, can provide aspirin

60

What are the initial tests of choice in secondary syphilis?

RPR and FTA

61

What is treatment of tertiary syphilis?

IV penicillin (as opposed to IM penicillin for primary and secondary)

62

What is the best initial test for primary syphilis?

Darkfield microscopy
Then consider VDRL/RPR

63

How does granuloma inguinale present?
What causes it and what may be seen on diagnostics?
What is tx?

Red, beefy genital lesion that ulcerates
Klebsiella granulomatis; may see "Donovan bodies" on touch prep
Doxycycline, TMP/SMX, or azithromcyin

64

What is the difference in presentation of crabs (pediculosis) and scabies?

Crabs is larger and may be in hair-bearing areas like pubis and axilla

Scabies burrows in web spaces

65

How are all warts treated?

Mechanical removal

66

What is treatment for uncomplicated cystitis?

What if there is evidence of E. coli resistance?

Nitrofurantoin or fosfomycin orally

If E. coli resistance evident then ciprofloxacin or levofloxacin

67

How is complicated cystitis treated?

TMP/SMX or ciprofloxacin

68

What is OP treatment for pyelonephritis?

IP?

OP: Ciprofloxacin

IP: Ceftriaxone, ertapenem, quinolones, ampicillin, or gentamicin

69

Patient with pyelonephritis fails to improve after 7 days. What do you suspect?
How should you treat?

Perinephric abscess
Quinolone and add staphylococcal coverage

70

What is the most accurate test for prostatitis?
Tx?

WBC in urine after prostate massage
Ciprofloxacin or TMP/SMX

71

If a patient is culture-negative for suspected infective endocarditis does that necessarily mean there aren't any bacteria causing it?

No; HACEK organisms commonly appear as culture negative

72

What are HACEK?

Haemophilus aphrophilus/parainfluenzae
Actinobacillus
Cardiobacterium hominus
Eikenella corrodens
Kingella kingae

73

What are the most common organisms causing culture-negative infective endocarditis?

Coxiella and Bartonella

*It's actually not the HACEK organisms

74

What is the most common bacteria associated with colonic pathology-related infective endocarditis?

Clostridium septicum

*It's actually not Strep bovis

75

What is best empiric therapy for infective endocarditis?

Vancomycin and gentamicin

76

What are the only types of procedures which need endocarditis prophylaxis? What is given as ppx?

Dental procedures which cause bleeding
Respiratory tract surgery
Surgery of infected skin

Amoxicillin

77

What are the only cardiac defects which require endocarditis prophylaxis?

Prosthetic valves
Unrepaired cyanotic heart disease
Previous endocarditis
Transplant recipients developing valve disease

78

In surgical procedures of infected skin what agent should be given for endocarditis ppx?

Cephalexin

79

Is HIV therapy ever optional?

Yes actually, if CD4 count above 500

80

Adverse effect of nucleoside reverse transcriptase inhibitors (-dines/bines)

Lactic acidosis

81

Adverse effect of Ziduvidine

Lactic acidosis
Anemia

82

Adverse effect of Didanosine

Lactic acidosis
Pancreatitis
Peripheral neuropathy

83

Adverse effect of Stavudine

Lactic acidosis
Pancreatitis
Neuropathy

84

Adverse effect of Abacavir

Lactic acidosis
Rash

85

Adverse effect of Tenofovir

Lactic acidosis
Renal toxicity

86

What are adverse effects of protease inhibitor class of HIV meds?

Hyperglycemia
Hyperlipidemia

87

Adverse effect of Indinavir

Hyperglycemia
Hyperlipidemia
Crystal-induced nephropathy (kidney stones)

88

What are adverse effects of non-nucleoside reverse transcriptase inhibitors?

Drowsiness (specifically efavirenz)

89

MOA maraviroc

Blocks CCR5 receptor and inhibits entry of HIV into cells

90

What is tx of a needle-stick injury in an employee working with an HIV-positive patient?

HAART therapy for one month

91

What are HIV patients at risk for with CD4

Pneumocystis jiroveci (PCP PNA)
TMP/SMX is first-line
(If allergy then atovaquone or dapsone)
(Aerosolized pentamidine has poor efficacy)

92

In HIV patients with CD4 count

MAC
Azithromycin weekly

93

In HIV patients with PCP PNA which is severe (PaO2 35) what else should be given?

Steroids

94

HIV pt presents with HA/N/V and ring-enhancing lesions on CTH. Dx? Tx?

Toxoplasmosis gondii
Pyrimethanmine and sulfadiazine

95

HIV pt with CD4

CMV
Tx: ganciclovir or foscarnet; maintenance lifelong therapy with oral valganciclovir

96

HIV pt with CD4

Cryptococcal meningitis (Dx with India Ink stain and/or Cryptococcal antigen)
Tx: amphotericin and 5-FU followed by fluconazole

97

HIV pt with CD4

MAC
Dx with BM testing or liver biopsy (most sensitive)
Tx: Clarithromycin and ethambutol; rifampin sometimes added

*(Azithromycin is for ppx)