Infectious Diseases Flashcards
(212 cards)
1
Q
MSSA IV antibiotics
A
oxacillin/nafcillin or cefazolin (1st gen)
2
Q
MSSA oral antibiotics
A
dicloxacillin or cephalexin (1st gen)
3
Q
MRSA severe antibiotics
A
linezolid, vancomycin, daptomycin, ceftaroline, tigecycline, telavancin
4
Q
side effect of linezolid
A
thrombocytopenia
5
Q
side effect of daptomycin
A
myopathy, rise in CPK
6
Q
minor MRSA antibiotics
A
TMP/SMX, doxycyline, clindamycin
7
Q
rash with penicillin
A
cephalosporin
8
Q
anaphylaxis with penicillin
A
Macrolide (azithromycin, clarithromycin), clindamycin, TMP/SMX
9
Q
Streptococcus specific antibiotics
A
penicillin, ampicillin, amoxicillin
10
Q
cephalosporin against gram neg rods
A
cefepime, Ceftazidime
11
Q
penicillins against gram neg rods
A
piperacillin, ticarcillin
12
Q
monobactam against gram neg rods
A
aztreonam
13
Q
quinolones against gram neg rods
A
ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin
14
Q
aminoglycosides against gram neg rods
A
gentamycin, tobramycin, amikacin
15
Q
carbapenems against gram neg rods
A
imipenems, meropenem, ertapenem, doripenem
16
Q
ertapenem exception
A
doesn’t cover Pseudomonas
17
Q
alternative antibiotics equal in efficacy to metronidazole for abdominal aerobes
A
piperacillin, ticaracillin, carbapenem
18
Q
only cephalosporins covering anaerobes
A
cefoxitin and cefotetan
19
Q
best drug to cover anaerobic strep
A
clindamycin
20
Q
antibiotics with no anaerobic coverage
A
aminoglycosides, aztreonam, fluoroquinolones, oxacillin/nafcillin, and all cephalosporins except cefoxitin and cefotetans
21
Q
gemifloxacin
A
quinolone for pneumonia
22
Q
antibiotic that has excellent anaerobic coverage, cover streptococci and all MSSA
A
carbapenem
23
Q
antibiotics work synergistically with other agents to treat staph and strep
A
aminoglycosides
24
Q
covers MRSA and broadly active against gram neg rods
A
Tigecycline
25
antiviral against HSV and varicella
acyclovir, valacyclovir, famciclovir
26
antiviral against CMV
valganciclovir, ganciclovir, foscarnet
27
best long term therapy for CMV retinitis
valganciclovir
28
valganciclovir and ganciclovir adverse effects
neutropenia and bone marrow suppress
29
foscarnet adverse effects
renal toxicity
30
ribavirin used for antiviral treatment of what
hep c, RSV
31
lamivudine, interferon, adefovir, tenovir, entecavir, telbivudine is antiviral treatment of what
chronic hep b
32
treat candida (not candida krusei or candida glabrata), cryptococcus, oral and vaginal candidiasis
fluconazole
33
best agent against aspergillus
voriconazole; also covers all candida
34
SE of voriconazole
visual disturbance
35
neutropenic patient with fungal infection give what anti fungal
echinocandins (caspofungin, micafungin, anidulafungin)
36
what does echinocandins (caspofungin, micafungin, anidulafungin) not cover
cryptococcus
37
adverse effects of echinocandins
no adverse effect; echinocandins have no significant human toxicity bc they affect/inhibit 1,3 glucan synthesis step, which does not exist in humans
38
for candida which anti fungal is best
fluconazole and amphotericin is = in efficacy, but has much fewer adverse effects
39
adverse effects of amphotericin
renal toxicity (increased creatine), hypokalemia, mrtabolic acidosis, fever, chills, shakes
40
best initial and second line test and most accurate test
best initial: x-ray, second line: MRI, most accurate: bone biopsy and culture
41
how long does it take for abnormal X-ray from osteomyelitis
2 weeks; must lose more than 50% of calcium content of the bone before the x-ray becomes abnormal
42
involucrum and sequestrum on bone X-ray
abnormal new bone in the periosteum
43
earliest finding of osteomyelitis
periosteal elevation
44
best method of following a response to therapy
follow sedimentation rate
45
osteomyelitis most commonly caused by
direct contiguous spread from overlying tissue
46
how long to treat patient with no fever and normal wbc with osteomyelitis
if ESR is markedly elevated after 4-6 weeks of therapy, further treatment and possible surgical debridement is necessary
47
most common cause of osteomyelitis, how to treat
staph
IV only for 4-6 weeks
MSSA: oxacillin or nafcillin
MRSA: vancomycin, linezolid, or daptomycin
48
how to treat osteomyelitis for gram neg bacilli (salmonella, pseudomonas)
can treat with oral abc
confirm gram neg with bone biopsy
no urgency for treating chronic osteomyelitis; biopsy --> move clock forward --> treat what you find on culture
49
treatment of otitis externa
1) topical abx: ofloxacin or polymyxin/neomycin
2) hydrocortisone to reduce swelling and itching
3) acetic acid to reacidify the ear and eliminate the infection
50
malignant otitis externa
osteomyelitis of the skull from Pseudomonas in a patient with diabetes, can lead to brain abscess and destruction of the skull
51
treatment malignant otitis externa
treat like osteomyelitis: x-ray, mri, biopsy/culture; treat with surgical debridement and abx against Pseudomonas such as ciprofloxacin, piperacillin, cefepime, carbapenem, axtreonam
52
treatment otitis media
amoxicillin for 7-10 days; tympanocentesis and aspirate of tympanic membrane for culture
53
patient with otitis media no improvement with amoxicillin after 3 days
switch amoxicillin to amoxicillin-clavulante, cefdinir, ceftibuten, cefuroxime, cefprozil, cefpodoxime
54
most causes of sinusitis
viral some bacterial
55
bacterial causes of sinusitis
Strep pneumo, H. influenzae, Moraxella catarrhalis
56
best initial test, most accurate test for sinusitis
best initial test is x-ray, most accurate test is sinus aspirate for culture (more accurate than ct or mri)
57
treatment for sinusitis
inhaled steroids, amoxicillin 7-10 days if fever and pain or persistent symptoms despite 7 days of decongestants, purulent nasal discharge
58
hallmark streptococcal pharyngitis symptom
no cough/hoarseness, pain/sore throat, lymphadenopathy, exudate
59
treatment of strep throat
penicillin or amoxiciliin; if penicillin allergy than use azithromycin or clarithromycin
60
oseltamivir and zanamivir works against
influenza A and B within 48 hours of symptom onset
61
amantadine and rimantadine works against
influenza A only
62
influenza symptoms
cough, headache, myalgias, fever, sore throat, feelings of tiredness
63
diagnostic testing for influenza
viral antigen detection testing of nasopharyngeal swab
64
strongest indicators for influenza vaccination
CHF, COPD, dialysis patients, steroid use, health care workers, everyone >50
65
treatment of impetigo
topical mupirocin or retapamulin (mupirocin has greater activity against MRSA, bacitracin has less efficacy as a single agent)
66
community acquired MRSA impetigo
TMP/SMZ; clindamycin is sometimes useful
67
treatment of severe impetigo
oral dicloxacillin or cephalexin
68
treatment of impetigo with penicillin allergy: rash? anaphylaxis? sever infection with anaphylaxis?
rash: cephalosporin; anaphylaxis: clindamycin, doxycycline, linezolid; severe infection with anaphylaxis: vancomycin, telavancin, linezolid, daptomycin
69
erysipelas
group A pyogenes strep infection of the skin; skin is bright red and hot dilation of capillaries of the dermis; usually on face
70
management of erysipelas
on CCS order blood cultures (may be positive) on multiple choice go straight to treatment
71
treatment of erysipelas
oral dicloxacillin or cephalexin; if organism confirmed group A beta hemolytic strep may treat with penicillin VK
72
cause of cellulitis
strep pyogenes = straph aurea
73
treatment of cellulitis: minor, severe
minor disease: dicloxacillin or cephalexin orally; severe disease: oxacillin, nafcillin, or cefazolin IV
74
case of leg cellulitis
order doppler to rule out
75
folliculitis
skin infections caused by strep --> glomerulonephritis not rheumatic fever
76
best initial test of fungal infection of nail and skin
KOH prep
77
treatment of fungal infection of nail and skin
topical if no hair involvement: clotrimaxole, miconaxole, ketoconazole, econazole, terconazole, nystatin, or ciclopirox
oral for scalp (tinea capitis) or nail (onychomycosis): terbinafine, itraconazole, griseofulvin
78
side effect of terbinafine
causes increased LFTs
79
side effect of griseofulvin (tinea capitis)
has less efficacy than either terbinafine of itraconazole
80
discharge without dysuria..
| dysuria without discharge..
discharge without dysuria still urethritis
| dysuria without discharge does not necessarily have urethritis
81
treatment for urethritis
2 meds: gonorrhea and chlamydia
82
diagnostic testing for urethritis
1) urethral swab for gram stain, wbc cound, culture, dna probe
2) NAAT nucleic acid amplification test
83
gonorrhea meds
ceftriaxone IM, cefpodoxime oral, ciprofloxacin oral (2nd line)
84
chlamydia meds
azithromycin (single dose), doxycycline (for a week)
85
how to treat pregnant women with urethritis
1) IM ceftriaxone 2) azithromycin
86
diagnostic testing for PID
1) pregnancy test (r/o ectopic) 2) then cervical culture and DNA probe for chlamydia and gonorrhea
87
most accurate test for PID
laparoscopy; only done for recurrent or persistent infection despite therapy or for cases where diagnosis is not clear
88
inpatient treatment for PID
IV cefoxitin or cefotetan or metronidazole + doxycyline
89
outpatient treatment for PID
Ceftriaxone IM + doxycycline oral
90
antibiotics safe in pregnancy
penicillin, cephalosporin, aztreonam, erthromycin, azithromycin
91
painful and tender testicle with normal position in scrotum
epididymo-orchitis
92
treatment of epididymo-orchitis
35 years: fluoroquinolones
93
painful genital ulcer, best initial test?
chancroid (Haemophils ducreyi)
| best initial test is swab for gram stain (gram neg coccobacilli) and culture (Nairobi medium or Mueller-Hinton agar)
94
treatment of chancroid
single IM shot of ceftriaxone or single oral dose of azithromycin
95
large tender nodes in genital area, how to diagnose? treat?
Lymphogranuloma venereum, may develop a suppurating draining sinus tract
diagnose with serology for Chlamydia trachoma tis
treat with aspirate the bubo and then doxycycline azithromycin
96
patient presents with enlarged adenopathy in inguinal area and multiple clear vesicles on his penis, what's the next step in management?
treat with acyclovir, valacyclovir, or famciclovir for 7-10 days; when clear vesicles are present there is no need to do specific diagnostic test for herpes, if roof come off of vesicles and lesion becomes an ulcer of unclear etiology, the the best initial diagnostic test is Tzanck prep
97
most accurate test for herpes
viral culture
98
tx of herpes in pregnancy
acyclovir is safe in pregnancy; use if there is evidence of active lesions at 36 weeks
99
painless, firm genital lesion, painless inguinal adenopathy
syphilis
100
most accurate test in primary syphilis
darkfield microscopy (more sensitive than VDRL or RPR)
101
symptoms of primary syphilis
chancre, adenopathy
102
initial diagnostic test for primary syphilis
darkfield, then VDLR/RPR
103
treatment for primary syphilis
single IM shot of penicillin; if allergic use doxycycline
104
how to treat Jarish-Herxheimer treaction
fever, headache, myalgia developing 24 hours after treatment for early stage syphilis , release of pyrogens from dying treponemal --> treat with aspirin and continue treatment
105
symptoms of secondary syphilis
rash, mucous patch, alopecia areata, condyloma lata
106
initial test for secondary syphilis
RPR and FTA
107
treatment for secondary syphilis
single IM shot of penicillin, doxycycline if penicillin allergy
108
neurological involvement of tertiary syphilis
tabes dorsalis, argyll-robertson pupil, general paresis
109
initial diagnostic test for tertiary syphilis
RPR and FTA, lumbar puncture for neurosyphilis (test CSF with VDRL and FTA; CSF VDRL is only 50% sensitive)
110
treatment of tertiary syphilis
IV penicillin; if allergic DESENSITIZE
111
rare beefy red genital that ulcerates
granuloma inguinale
112
diagnostic test for granuloma inguinale
biopsy or touch prep, klebsiella granulomatis
113
treatment for granuloma inguinale
doxycycline, tmp/smx, or azithromycin
114
pediculosis vs. scabies
pediculosis is larger, in hair-bearing areas, such as pubic area or axilla, visible on surface
scabies is small, burrows in web spaces, scrape and magnify
115
treatment of scabies
permethrin, lindane, or ivermectin
116
treatment of pediculosis
permethrin, pyrethrins, or lindane
117
how are warts diagnosed?
by how they look
118
what is imiquimod?
immunostimulamt that leads to sloughing off of wart
119
what is podophyllin?
melts warts
120
complicated cystitis treatment
7 days of tmp/smx or ciprofloxacin
121
uncomplicated cystitis treatment
3 days of tmp/smx orally if e.coli resistance low in that area; if resistance is >20% than use ciprofloxacin
122
abx for pyelonephritis…outpatient? inpatient?
outpatient ciprofloxacin; inpatient use ampicillin/gentamycin
123
radiology testing and UTI
cystitis and pyelonephritis is diagnosed by radiologic study (sonogram or CT). sonogram and CT used to determine the etiology of UTI.
124
pyelonephritis patient not responding to treatment after 5-7 days, still febrile, abc on UA
perinephritic abscess; perform sonogram or CT of kidneys to find the collection; biopsy to determine microbiologic diagnosis
125
treatment of perinephritic absess?
quinolone and add staphylococcal coverage such as oxacillin or nafcillin, b/c tx with abc for gram neg organism preferentially selects out for staphylococci
126
best initial test for prostatitis
UA
127
most accurat test
Urine WBC after prostate massage
128
treatment of prostatitis
ciprofloxacin for extended period of time
129
duke's criteria
diagnosis of infective endocarditis (2 major, 1 major + 3 minor, or 5 minor criteria)
130
clinical suspicion for infective endocarditis neg cultures
HACEK organisms
131
fever + new murmur or change in murmur, next step
perform blood cultures
132
blood cultures positive in patient with fever + new murmur
perform EKG look for vegetations endocarditis
133
treatment for endocarditis
empiric therapy with vancomycin and gentimicin (covers MRSA, S. Aureus, viridans Streptococcus)
treatment is 4-6 weeks
134
indications for surgery (valve replacement with infective endocarditis)
anatomic defects
- valve rupture
- abscess
- prosthetic valve
- fungal endocarditis
- embolic events once already started on antibiotics
135
procedures that require abx prophylaxis for endocarditis
dental procedures that cause bleeding, respiratory tract surgery, surgery of infected skin
136
only cardiac defects that need prophylaxis
prosthetic valves, unrepaired cyanotic heart disease, previous endocarditis, transplant recipient who developed valve disease
137
side effect of NRTI
lactic acidosis (meds ending with -dine or -sine, -bine, -avir
138
side effect of protease inhibitor
hyperglycemia, hyperlipidemia (meds ending with -navir)
139
NNRTI side effects
drowsiness (efavirenz)
140
side effect of indinavir
kidney stones
141
side effect of zidovudine
anemia
142
side effect of didanosine
pancreatitis and peripheral neuropathy
143
side effect of abacavir
rash
144
side effect of stavudine
pancreatitis and neuropathy
145
needle stick injury with anyone exposed to HIV positive blood
HAART for a month
146
HIV perinatal transmission prevention
CD4500 start HAART immediately better than during 2nd and 3rd
147
when to start prophylaxis for PCP? with what?
CD4t use with G6PD deficiency)
148
MAI prophylaxis when and what?
when CD <50, use azithromycin one a week orally
149
how does PCP present
dry cough, SOB, hypoxia, increased LDH
150
best initial test for PCP
chest X-ray: will show increased interstitial markings bilaterally
151
most accurate test for PCP
bronchoalveolar lavage
152
treatment of PCP
IV tmp/smx
153
treating PCP develop rash
rash with tmp/smx; use IV pentamidine
154
treatment of mild PCP
atovaquone
155
if PCP is severe pO235
give steroids
156
best initial test for toxo
head CT with contrast
157
confirmatory test for toxo
treat with pyrimethamine and sulfadiazine for two weeks, repeat CT scan, if lesions are smaller, then this confirmatory, if lesions are unchanged --> do brain biopsy, most likely lymphoma
158
treatment of toxo
pyrimethamine and sulfadiazine for 2 weeks
159
how does CMV present
blurry vision in HIV patient with CD 4<50
160
how to diagnose CMV
dilated opthalmologic examination; diagnosed by appearance on dilated ophthalmologic examination
161
how does cryptococcus present in HIV patient
HIV and <50 CD4 cells with fever and headache, sometimes neck stiffness and photophoia
162
suspect cryptococcus, next step
lumbar puncture --look for increase level of lymphocytes in CSF
163
best initial test for cryptococcus
India ink tain
164
most accurate test for cryptococcus
cryptococcal antigen test
165
treatment of cryptococcus
treat initially with amphotericin followed by fluconazole (echinocandins -caspofungin do not cover cryptococcus)
166
best initial test for PML
head CT or MRI
167
how does PML present
HIV patient CD4<50 with focal neurological abnormalities
168
treatment of PML
treat with HAART, when CD4 rises, PML will resolve
169
MAI presentation
HIV patient, CD4<50, wasting with weight loss, fever, fatigue, anemia (invasion of the bone marrow), increased ALP and GGTP with normal bilirubin
170
diagnostic testing for MAI
bone marrow is more sensitive, liver biopsy is most sensitive, blood culture least sensitive
171
treatment of MAI
Clarithroymycin and ethambutol, prophylaxis with azithromycin
172
treatment of leptospirosis
diagnose with serology, treat with ceftriaxone or penicillin
173
animal exposure + jaundice + renal
leptospirosis (fever, abdominal pain, muscle ache)
174
ulcer at site of contact and enlarged lymph nodes, conjunctivitis, contact with small furry animal
tularemia
175
tx for tularemia
bentamicin or streptomycin
176
culture is dangerous for lab personnel, causes severe pneumonia
tularemia
177
treatment of cysticerosis
albendazole
178
CT scan of head shows thin-walled cysts, calcified
cysticerosis
179
how to diagnose leptospirosis
diagnose with serology
180
treatment of lyme disease with rash, joint, bell's palsy
oral doxycylien or amoxicillin
181
lyme disease with CNS or cardiac involvement
IV ceftriaxone
182
babesiosis transmitted by
ixodes tick
183
treatment of babesiosis
azithromycin or atovaquone
184
what is ehrlichia transmitted by
ixodes tick
185
how does ehrilichia present
NO RASH; elevated LFTs (ALT, AST), thrombocytopenia, leukopenia
186
how to treat ehrlichia
doxycycline
187
most common late manifestation of lyme disease
joint problems
188
diagnostic test for ehrlichia
peripheral blood smear looking for morulae (inclusion bodies in white cells) or PCR
189
hemolysis and GI complaints
malaria
190
how to treat acute malaria
quinine and doxycycline
191
prophylaxis for malaria
mefloquine (weekly) or atovaquone/proguanil
192
side effect of mefloquine
neuropsychiatric side effects, sinus bradycardia, and QT prolongation
193
nocardia affects who and where?
immunocompromised (leukemia, lymphoma, steroid use, HIV), may disseminate to any organ but skin and brain most common
194
best initial test, most accurate test for nocardia?
best initial test: chest x-ray
| most accurate test: culture
195
actinomyces affects who?
normal immune system, history of facial or dental trauma, actinomyces is part of normal mouth flora
196
how to diagnose actinomyces
gram stain and confirm with anaerobic culture
197
treatment of actinomyces
penicillin
198
presents as a viral syndrome, physical exam shows palate and oral ulcers and splenomegaly
histoplasmosis (disseminated disease can cause pancytopenia) anything TB can do, histoplasmosis can do
199
best diagnostic test for histoplasmosis
histoplasmosis urine antigen
200
most accurate test for histoplasmosis
biopsy with culture
201
treatment of acute pulmonary histoplasmosis disease
no therapy
202
treatment of disseminated histoplasmosis
amphotericin
203
where is histoplasmosis found?
ohio and mississippi river valleys
204
where is coccidiodomycosis found?
dry areas like arizona
205
presentation of coccidiodomycosis
respiratory disease with joint pain and erythema nodosum
206
treatment of coccidiodomycosis
itraconazole
207
treatment of coccidiodomycosis
itraconazole
208
broad budding yeast
blastomycosis
209
where does blastomycosis occur?
rural southeast
210
pulmonary disease with bone lesions
blastomycosis
211
treatment of blastomycosis?
amphotericin or itraconazole
212
branching, gram positive filaments that are weakly acid fast
nocardia
