Infectious Disease Flashcards Preview

American Board of Internal Medicine > Infectious Disease > Flashcards

Flashcards in Infectious Disease Deck (61):
1

What are first- and second-line antibiotic for MSSA endocarditis?

1. PCNs like oxacillin or nafcillin
2. Cephalosporins

2

What is narrow antibiotic coverage for E. coli bacteremia?

Ampicillin

3

What scoring system is used for patients with CAP that you consider for hospitalization?

CURB-65
*Confusion
*Uremia >20
*Respiration > 30
*BP < 90/60
*Age > 65

--One point each
0-1 outpatient management
>2 hospitalization

4

What are two classes of influenza antivirals? What are their caveats?

Adamantanes - Influenza B/C and Avian resistant
a. Amantadine - renally cleared
b. Rimantadine - hepatically cleared

Neuraminidases
a. Zanamivir - bronchospasm
b. Oseltamivir - influenza A resistant

5

1. What is the route of Zanamivir?
2. What are contraindications for Zanamivir (2)?

1. Inhaled
2. a. Reactive airways
b. Younger than 7yo

6

1. List key features of Bacterial Vaginosis (5)
2. What is treatment?

1. Bacterial vaginosis
a. White noninflammatory discharge
b. Smoothly coats vaginal wall
c. Clue cells
d. pH > 4.5
e. Fishy order after KOH

1. Metronidazole 500 BID x 7d (PO or PV)

7

Describe airborne precautions and give indications (4)

Airborne - isolate room, filtering face masks
a. TB
b. Measles
c. Varicella
d. Disseminated Zoster

8

Describe droplet precautions and give indications (2)

Droplet - masks when within 3 feet
a. Neisseria meningitidis
b. Influenza

9

Which influenza antivirals are contraindicated in pregnancy?

1. Amantadine and Rimantadine are teratogenic

10

Contrast Acyclovir and Valacyclovir:
1. Route
2. Bioavailability
3. Clearance mode

1. Topical/PO/IV vs. PO
2. 10-20% vs. 60% (via PO)
2. Both renally cleared

11

If HSV is resistant to Acyclovir (or its related drugs), what are alternatives (2)?

1. Foscarnet
2. Cidofovir

12

What drugs treat Cytomegalovirus (5)?

1. Ganciclovir
2. Valganciclovir
3. Foscarnet
4. Cidofovir
5. Fomivirsen

13

List adverse effects of Ganciclovir (6)

1. Neutropenia
2. Thrombocytopenia
3. Renal insufficiency
4. CNS disorders
5. Teratogenicity
6. Carcinogenic

14

What are common pathogens for meningitis and their preferred antibiotic treatments (5)?

1. Strep Pneumo - Vanco + Ceph 3rd
2. Neisseria - Ceph 3rd
3. Listeria - Amp or PCN-G
4. Step Agal - Amp or PCN-G
5. H. Infl B - Ceph 3rd

15

With brain abscesses, why is Metronidazole and 3rd-generation Cephalosporins used (3)?

For gram negative bacilli:
1. Bacteroides (GNR, occasionally motile, mucosal anaerobe)
2. E. coli
3. Pseudomonas

16

List the cephalosporin generations and their indications (4)

FIRST GENERATION - MSSA, strep
- Cephalexin PO
- Cefazolin IV

SECOND GENERATION - fair strep, fair staph, okay coliforms, ++Anaerobes
- Cefoletan
- Cefoxitin

THIRD GENERATION
- Ceftriaxone - GNR coliforms, good strep, okay MSSA, NOT pseudomonas, NOT enterococcus
- Ceftazidine - GNR INCLUDING pseduomonas, NOT strep/staph

FOURTH GENERATION
- Cefipime - GNR (pseudomonas) okay MSSA, strep

17

1. Which organism is attributed mostly to cat bites?
2. Which organism is attributed mostly to dogs?
3. Which organism is attributed mostly to humans?

1. Pasteurella multocida (also dogs)
2. Capnocytophaga canimorsus (also cats)
3. a. Eikenella corrodens
b. Fusobacterium

**Any also may have Staph Aureus

18

What are possible PO treatments for bites (2)?

1. Amoxicillin-clavulanate
2. Trimethoprim-Sulfamethoxazole + Clindamycin

19

How does on malaria parasite differ from the others (2 ways)?

Plasmodium falciparum:
- adherent RBC cause organ dysfx esp.CNS
- high paracetemia >5%

P. ovale, P. vivax and P. malariae to not cause adherent RBC, thus patients appear less sick. Also do not cause high parasitemia.

20

How does Clindamycin help with cellulitis (2)?

1. Especially with strep pyogenes, it decreases toxic forming bacteria
2. Covers staph, strep and anaerobes

21

Which antiretroviral medication is the only medication that is contraindicated in pregnancy? What does it cause?

Efavirenz - neural tube defects

22

1. What class of bacteria is Listeria?
2. What is found in CSF with Listeria?
3. What is appropriate treatment for Listeria meningitis? Alternative?

1. GPR
2. >25% monos
3. a. Ampicillin/PCN -PLUS- Gentamicin
b. TMP-SMX

23

1. What is treatment for Legionella?
2. What is treatment for severe Legionella?

1. Fluoroquinolone -OR- Azithromycin
2. Above -PLUS- Rifampin

24

1. What is first-line treatment for Aspergillus?
2. What is second-line treatment?

1. Voriconazole
2. Amphotericin

25

1. What are treatment options for Cryptococcus (2)?
2. What is a procedural treatment?

1. a. Amphotericin + Flucytosine
b. Voriconazole > Fluconazole

2. CSF drain if pressure greater 250 and AMS

26

What are treatment for the following, in severely sick and non-life threatening?
1. Blastomyces
2. Histoplasma
3. Coccidioides

1. Amphotericin then Itraconazole
2. Amphotericin then Itraconazole
3. Amphotericin then FLUCONAZOLE

27

1. What type of osteomyelitis occurs in Sickle Cell?
2. What type of osteomyelitis occurs in HD patient?

1. Salmonella and Staph Aureus
2. Pseudomonas

28

Of the third and fourth generation cephalosporins, which do and do not treat Pseudomonas?

THIRD GENERATION
- Ceftriaxone - GNR coliforms, good strep, okay MSSA, NOT pseudomonas
- Ceftazidine - GNR INCLUDING pseduomonas, NOT strep/staph

FOURTH GENERATION
- Cefipime - GNR (pseudomonas) okay MSSA, strep

29

1. What is Hypersensitivity Pneumonitis?
2. How is it treated?
3. If patient appears clinically sicker, what would be used (2)?

1. Extrinsic allergic alveolitis caused by Mycobacterium Avium Complex (MAC) usually manifests as "hot tub lung"
2. Corticosteroids after TWO sputums
3. Ethambutol, Rifampin and Clarithromycin

30

What appears in brain biopsy following rabies?

Negri bodies - eosinophilic cytoplasmic inclusions

31

1. What does a low CH50 suggest?
2. What past medical history is provided?

1. Terminal Complement Syndrome
2. Recurrent meningococcal meningitis, disseminated gonococcal infection

32

What is empiric treatment for adult meningitis (3)? Provide targets pathogens.

1. Ceftriaxone - Neisseria, H.influ, strep pneumo
2. Vancomycin - resist strep pneumo (not MRSA)
3. Ampicillin - Listeria

33

What is the triple treatment for Toxoplasmosis (3)?

1. Pyrimethamine
2. Leucovorin
3. Sulfadiazine or Clindamycin

34

1. When a groin rash does not respond to Clotrimazole, what is an alternate diagnosis?
2. How is it diagnosed?
3. How is it treated?

1. Erythrasma - Corini Bacterium
2. Coral red fluorescence with Wood's lamp
3. Erythromicin

35

How does MRSA pneumonia appear on CT?

Multiple cavitary lesions

36

1. How does anthrax appear on CXR?
2. How does anthrax appear on culture?
3. How is anthrax treated (2)?

1. Widened mediastinum
2. a. Fluoroquinolone or Doxycycline
b. Plus two additiona agents

37

1. How does Babesiosis appear on culture?
2. How is Babesiosis contracted?
3. How is Babesiosis treated (2)?

1. Maltese cross
2. Ixodes ticks
3. a. Atovaquone -plus- Azithromycin
b. (severe) Clindamycin -plus- Quinine

38

1. How is Coxiella Burnetti contracted?
2. How is it treated (2)?

1. Farms and barns
2. Doxycycline -plus- Hydroxychloroquine

39

1. If you see "macular star" think...
2. ...and treat with... (2).

1. Bartonella (cat scratch)
2. Doxycycline and Rifampin

40

What are the preferred treatment (3) and duration for uncomplicated cystitis?

1. Nitrofurantoin x 5d
2. Bactrim x 3d
3. Fosfomycin x 1d

41

Which gastrointestinal pathogen is associated with Guillain-Barre?

Campylobacter jejuni

42

1. In general, what is the indication for Daptomycin?
2. In which clinical scenario is Daptomcin considered inappropriate, and why?

1. Resistant GPC
2. Nosocomial MRSA pneumonia - inactivated in lung parenchyma

43

What is the difference in activity between Ertapenem and Imipenem?

Imipenem has better gram-negative activity

*Both have broad-range activity

44

Who should receive HIV testing (3)?

1. All patients 13-64
2. Persons starting TB treatment
3. Persons seeking STD treatment

45

Which live vaccines are contraindicated in HIV patients (7)?

1. Live attenuated influenza
2. Varicella or Zoster (CD4 < 200)
3. Vaccinia (smallpox)
4. Live oral polio
5. Measles (CD4 < 200)
6. Yellow Fever
7. Typhoid

46

What is the preferred HAART regimen?

2 NRTI (nucleoside reverse trans inhib) -plus-
- NNRTI (non-nucleoside reverse trans inhib)
- PI (protease inhibitor)
- INSTI (integrase strand transfer inhib)

47

1. Poor adherence with which HIV medications (2) can lead HIV resistance?
2. Resistance via what mutation?

1. NNRTIs:
a. Efavirenz
b. Nevirapine
2. K103N mutation

48

Which HIV medication interacts with a proton pump inhibitor?

Atazanavir (protease inhibitor)

49

Which HIV medication leads to renal insufficiency?

Tenofovir (NRTI)

50

What are two criteria for treating asymptomatic HIV patients for latent tuberculosis?

1. PPD >=5mm
2. Contact with active TB

51

In HIV patients, when should prophylaxis begin for:
1. Pneumocystis pneumonia (2)
2. Toxoplasma encephalitis (2)
3. Disseminated MAC (1)

**Provide drug name

1. a. CD4 < 200
b. Oropharyngeal candiasis
**TMP-SMX

2. a. CD4 < 100 -and-
b. Toxoplasma IgG positive
**TMP-SMX

3. CD4 < 50
**Azithromycin

52

When should steroids be added to TMP-SMX in treatment for PCP (2)?

1. PaO2 < 70
2. A-a gradient > 35 (Palv - Part)

53

1. What is Immune Reconstitution Syndrome?
2. What is treatment for Immune Reconstitution Syndrome?

1. Lymph rxn following HIV treatment
2. Corticosteroids

54

Which women should be screened for Chlamydia (3)?

1. Pregnant
2. Sexually active less than 25
3. Sexually active greater than 25 with new partners

55

1. How is Trichomonas different than Bacterial Vaginosis (3)?
2. How is it treated?

1. Trichomonas:
- STD
- Treat partners
- Strawberry cervix
2. Metronidazole 2 gram x 1, consider 7d

56

1. What defines "complicated" vaginal candiasis (3)?
2. How is treatment different?

1. a. Recurrent
b. Non-albicans
c. Abnormal host (DM, HIV...)

2. Two week induction with 6 month maintenance

57

What pathogens should be considered for subacute or chronic meningitis (2)?

1. Cryptococcus
2. Syphilis

58

What are CNS features of West Nile virus (4)?

1. Tremors
2. Myoclonus
3. Parkinsonism
4. Poliomyelitis-like flaccid paralysis

59

Contrast perianal and perirectal abscesses

Both with rectal pain but
1. Perianal
- superficial without systemic findings
- treat with I&D

2. Perirectal
- fevers, leukocytosis, fistula formation
- treat with surgical exploration and debridement

60

What is a form of recurrent meningitis?

Recurrent Lymphocytic Meningitis from HSV2

61

1. What are indications for Caspofungin (4)?
2. What type of infection is not appropriate?

1. Candidemia
2. Esophageal candida
3. Invasive Aspergillosis
4. Febrile Neutropenia

***Not for CNS infections