Infectious Diseases Flashcards
(101 cards)
1
Q
What abx to give for MSSA?
A
IV- oxacillin/nafcillin, or cephazolin
Oral- dicloxacillin or cephalexin
2
Q
What abx to give for MRSA?
A
Severe infection- vancomycin, linezolid
Minor infection- TMP/SMX, clinda
3
Q
If patient has rash to penicillin, what is the alternative?
A
cephalosporin
4
Q
If patient has anaphylaxis to penicillin, what is the alternative?
A
Macrolides (azithromycin, clarithromycin) or clindamycin
5
Q
What abx are specific for streptococcus?
A
Penicillin, Ampicillin, Amoxicillin
6
Q
What abx are “excellent” for pneumococcus?
A
Levofloxacin, gemifloxacin, moxifloxacin
7
Q
What abx is the best gastrointestinal anaerobes?
A
metronidazole
8
Q
What is the best abx for respiratory anaerobes?
A
Clinda
9
Q
What are the drugs for herpes simplex and varicella?
A
acyclovir, valacyclovir, famciclovir
10
Q
What oral agents are for chronic Hep C?
A
telaprevir, boceprevir, simeprivier, sofobuvir
11
Q
What is the best therapy for chronic CMV retinitis?
A
Valganciclovir
12
Q
What antibiotics are given for Candida and cryptococcus?
A
fluconazole
13
Q
What is the 1st and 2nd test for diagnosing osteomyelitis?
A
Best inital- xray
Best second- MRI
14
Q
What is the most accurate test for diagnosing osteomyelitis?
A
bone biopsy and culture
15
Q
What is the treatment for osteomyelitis?
A
Staph
- 4-6 IV oxacillin or nafcillin if sensitive
- if MRSA- vancomycin, linezolid,
16
Q
What is the treatment for otitis externa?
A
topical hydrocortisone
17
Q
What is the best initial diagnostic test for malignant otitis externa?
A
CT or MRI
18
Q
What is the most accurate diagnostic test for malignant otitis externa?
A
biopsy
19
Q
What is the treatment for malignant otitis externa?
A
surgical debridement and abx against pseudomonas
20
Q
What is the best initial therapy for otitis media?
A
amoxicillin
21
Q
If there is persistent otitis media, what is the most accurate test to do?
A
tympanocentesis and aspirate of tympanic membrane
22
Q
What is the best initial test for sinusitis?
A
xray
23
Q
What is the most accurate test for sinusitis??
A
sinus aspirate for culture
24
Q
If there is fever/pain, persistent symptoms, or purulent nasal discharge for sinusitis, what medication should they be given?
A
amoxicillin/clavulanate
25
Best initial test for pharyngitis?
rapid step test
| - if negative, no further testing
26
What is most accurate test for pharyngitis?
culture
27
What is the treatment for pharyngitis?
penicillin or amoxicillin
28
What is the diagnostic test for influenza?
viral rapid antigen detection
29
What is the treatment for flu?
oseltamivir, zanamivir
| - must be given within the first 48 hours
30
If a patient is less than 50 years old and healthy, what type of flu vaccine do you give?
Live attenuated
31
If a patient is greater than 50 years old and has COPD, CHF, on dialysis, steroids, healthcare worke, what type of flu vaccine do you give?
inactivated virus
32
What is the presentation for impetigo?
weepin, crusting, oozing skin, caused by staph aureus
33
What is the treatment for impetigo?
topical mupirocin or retapamulin
severe disease- oral dicloxacillin or cephalexin
Comunity acquired MRSA- TMP/SMZ
34
What is the offending agent for erysipelas?
Group A (pyogenes) strep
35
What is the best initial treatment for erysipelas?
Oral dicloxicillin or cephalexin
36
What other test should you order when cellulitis is present?
lower extremity doppler
37
What is the treatment for minor cellulitis?
dicloxacillin or cephalexin orally
38
What is the treatment for severe cellulitis?
oxacillin, nafcillin, cefazolin
39
Best initial test for fungal infection of skin or nails?
KOH preparation
40
What is the treatment for fungal infection of skin and nails?
```
topical antifungals(clotrimazole, miconazole, ketoconazole,
- oral antifungal if scalp or nail involvement
```
41
What is the diagnostic test for urethritis?
Urethral swab for Gram stain, WBC, culture, NAATs(Nuclear Amplification test)
42
What is the treatment for urethritis?
Should be with 2 meds, active against both:
gonorrhea (ceftriaxone IM)
chalmydia (azithromycin or doxycyline)
- very often present as a co-infection
43
What is the single best test for both chlamydia and gonorrhea?
NAAT test (Nucleic acid amplification test)
44
What is the best initial test for pelvic inflammatory disease?
```
pregnancy test (must exclude ectopic pregnancy)
then do cervical culture and NAAT test
```
45
What is the most accurate test for diagnosing PID?
Laparoscopy
46
What is the treatment for PID?
Outpatient: ceftriaxone (IM) and doxycycline (oral)
Inpatient: cefoxitin (IV) and doxycycline
47
How does epididymo-orchitis present?
painful testicular with NORMAL position
48
What is the treatment for epididymo-orchitis?
< 35 yo- ceftriaxone and doxycycline
| > 35 yo- fluoroquinolone
49
How does a chancroid present?
painful ulcer on genitalia
50
What is the best initial test for chancroid?
Swab for gram stain and culture
51
What is the treatment for chancroid?
IM ceftriaxone or single dose of azithyromycin
52
What is the treatment for HSV-2?
acyclovir, valacyclovir, famciclovir 7-10 days
53
What is the best initial test for genital herpes?
Tzanck prep
54
What is the most accurate test for herpes?
viral culture
55
What is the most accurate diagnostic test for syphilis?
darkfield microscopy
56
What are the features of primary syphilis?
chancre, adenopathy
57
What is the initial diagnostic test for primary syphilis?
darkfield, then VDRL/RPR
58
What is the treatment for primary syphilis?
Single IM shot of penicillin
- Some patients will have Jarisch-Herxheimer reaction (fever, HA, myalgia 24 hours after treatment, this is benign self limited rxn)
59
What are the features of secondary syphilis?
rash, condylomata lata, mucous patch
60
What is the best initial test for secondary syphilis?
RPR and FTA
61
What is the treatment for secondary syphilis?
single IM shot of penicillin
62
What are the features of tertiary syphilis?
tabes dorsalis, Argyll-Robertson pupil, paresis
63
What is the initial diagnostic test for tertiary syphilis?
RPR, FTA, lumbar puncture (neurosyphilis)
64
What is the treatment for tertiary syphilis?
IV penicillin
65
What is the initial test for cystitis(UTI)?
urinalysis
66
What is the most accurate test for cystitis?
urine culture
67
What is the treatment for uncomplicated(no anatomic abnormality present such as stone, stricture, obstruction) UTI?
TMP/SMX orally for 3 days if E. Coli resistance is low in that area. If resistance is >20%, use....
cipro or levofloxacin
68
What is the treatment for complicated(anatomic abnormality present such as stone, stricture, obstruction) UTI?
7 days of TMP/SMX
69
What do you do if a pregnant woman has asymptomatic bacteriuria?
treat with abx
70
What additional features are present with pyelonephritis?
flank pain, tenderness
71
What is the diagnostic test for pyelonephritis?
UA, UC
72
What is the treatment for pyelonephritis?
ciprofloxacin (outpatient)
73
What does that patient have that does not respond to treatment for cystitis after 5-7 days?
perinephric abscess
- Biopsy is the only way to direct abx therapy
- Treat with quinolone and add staph coverage
74
What are the characteristics of prostatitis?
frequency, urgency, dysuria, perineal/sacral pain' prostate is boggy on exam
75
What is the best initial test for prostatitis?
UA
76
What is the most accurate test for prostatitis?
urine WBCs after prostate massage
77
What is the treatment for prostatitis?
Cipro or TMP/SMX
78
If patient has a fever and a heart murmur, what is the next best step?
order Blood cultures
79
If blood cultures are positive in patient with fever and a new heart murmur, what is the next test to order?
echocardiogram
80
What is the best empiric therapy for endocarditis?
Vanc + gentamycin
81
If patient has diagnosis of endocarditis and they have speciation of strep bovis or clostridium septicum, what is the next step?
Order colonoscopy
82
What procedures need prophylaxis with people at risk for endocarditis?
dental procedures that cause bleeding, use amoxicillin
83
When to start HIV therapy?
- CD4 < 500
- symptomatic patients regardless of CD4 count
- pregnant women
- needle stick
84
What are the meds for HIV?
HAART(Highly Active Antiretroviral Therapy)
| - Tenofovir, emtricitabine, and efavirenz
85
What is the side effect of zidovudine?
anemia
86
What is the side effect of didanosine?
pancreatitis, peripheral neuropathy
87
What is the side effect of tenofovir?
renal toxicity
88
What is the side effect of stavudine?
pancreatitis, neuropathy
89
What to do with a needle stick injury with HIV?
HAART for 1 month
90
Should HIV+ pregnant women be on HAART?
Yes, all of them
91
What is the prophylaxis for pneumocystis jiroveci pneumonia in an HIV patient?
TMP/SMX
| - this is with CD4 count < 200
92
What is the prophylaxis for mycobacterium avium intracellulare in an HIV patient?
azithromycin
| - this is with CD4 count < 50
93
How do you treat PCP in HIV patient?
IV TMP/SMX
94
What is the best initial test for toxoplasmosis in patient with HIV?
CT with contrast showing ring enhancing lesions
95
What is the treatment for toxoplasmosis in a HIV patient?
pyrimethamine and sulfadiazine for 2 weeks
96
What is the best initial test for cryptococcus in patient with HIV?
India ink stain with LP
97
What is the most accurate test cryptococcus in patient with HIV?
crypotococcal antigen test
98
How do you treat cryptococcus in patient with HIV?
amphoteracin and 5-FC followed by fluconazole
99
What is the best initial test for progressive multifocal leukoencephalopathy in patient with HIV?
CT or MRI of head
100
What is the diagnostic test for mycobacterium avium intracellulare?
bone marrow biopsy, liver biopsy is most sensitive
101
How to treat MAI in patient with HIV?
Clarithyromycin and ethambutol
