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USMLE S2CK > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

(64 cards)

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1
Q

what are first line oral and IV antibiotics for MSSA?

A

oral: dicloxacillin, cephalexin, cefadroxil
intravenous: oxacillin, nafcillin, cefazolin

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2
Q

what are first line oral and intravenous antibiotics for MRSA?

A

oral: linezolid, septrin, doxycycline

IV: vancomycin, linezolid, daptomycin, ceftaroline, oritavancin, telavancin, dalbavancin

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3
Q

adverse effects of linezolid?

A

thrombocytopenia

interaction with MOA-I

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4
Q

adverse effects of daptomycin?

A

increases serum CK

not effective against LRTI

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5
Q

how do you treat minor skin/soft tissue infections of MRSA?

A

septrin, doxy, clindamycin, linezolid

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6
Q

what is amoxicillin used as first-line therapy for?

A
  • otitis media
  • endocarditis prophylaxis in dental infection
  • UTIs in pregnancy (or nitrofurantoin)
  • lyme disease (limited to rash, arthralgia and CN VII involvement)
  • listeria monocytogenes
  • enterococcus infection
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7
Q

which is the only cefalosporin that will cover MRSA?

A

ceftaroline

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8
Q

which groups of bacteria are resistant to cephalosporins?

A

MRSA (only caftaroline works), ESBLs, listeria, enterococcus

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9
Q

how do you treat ESBLs?

what is the second-line?

A

carbapenems

polymixin is used if the ESBL is resistant to carbapenems. care for nephrotoxicity

also cephalosporins with beta-lactamase combinations:

  • ceftolazone/tazobactam
  • ceftazidime/avibactam
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10
Q

if your patient has a rash to penicillins, are cephalosporins safe for use?

A

yes

only if the reaction is anaphylaxis will you have to avoid cephalosporins (should use non-beta-lactam antibiotics for these)

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11
Q

what infections is defaloxacin used for?

A

MRSA skin infections

Gram-negative rods

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12
Q

what is the first-line for CAP?

A

third-generation cephalosporins with macrolide

cefotaxime/ceftriaxone + erythro/clarithro/azithro

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13
Q

what is the treatment for Lyme disease involving the brain/heart?

A

ceftriaxone

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14
Q

what is the first-line for gonorrhoea?

A

ceftriaxone

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15
Q

which population do you have to avoid ceftriaxone and why?

A

neonates due to impaired biliary metabolism

use cefotaxime instead

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16
Q

what is the difference in treating ventilator-associated pneumonia versus normal CAP?

A

use ceftaroline (4th gen) as is has better coverage against staphylococcus

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17
Q

how is ertapenem different from the other carbapenem antibiotics?

A

does not have any anti-pseudomonal coverage

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18
Q

in diverticulitis, which is the best floroquinolone? what do you have to consider for the others?

A

moxifloxacin is the only one that covers anaerobes and can be used as a single agent

cipro/levo/gemi - need to add metronidazole

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19
Q

which antibiotics are associated with achilles tendonitis/tendon rupture?

A

fluroquinolones

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20
Q

which antibiotics are associated with bone growth abnormalities in children and pregnant women?

A

fluroquinolones

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21
Q

what is the treatment for syphillis in pen-allergy?

A

doxycycline

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22
Q

what are the most common gram-negative bacteria?

A
  • E coli
  • Klebsiella
  • Proteus
  • Pseudomonas
  • Citrobacter
  • Enterobacter
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23
Q

in what setting would you get a staphylococcus meningitis?

A

following neurosurgery

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24
Q

what are the typical organisms for bacterial meningitis?

A

streptococcus pneumoniae, haemophillus, neisseria, listeria

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25
what are the precautions that must be taken for somebody with *Neisseria* infection?
rifampin, ciprofloxacin or ceftriaxone for **close contacts** respiratory isolation
26
what is the most rapid onset gastroenteritis that is associated with wheeze and flushing?
scromboid, found in fish treat with antihistamines
27
which pathogens give bloody stool appearance?
*E coli, shigella, campylobacter, yersinia*
28
how do you treat cryptosporidia diarrhoea?
treat the underlying AIDS ## Footnote **nitazoxanide**
29
what is the nucleic acid structure of HBV and HCV?
HBV - DNA HCV - RNA
30
how do you treat hepatitis C?
sofosbuvir and ledipasvir for genotype 1
31
what are the side-effects of interferon?
myalgia + athralgia leukopenia + thrombocytopenia flu-like symptoms, depression
32
which antiviral covers all genotypes of HCV?
velpatasvir
33
in hepatitis C, what is the relevance of the following tests: * PCR/viral load * genotype * liver biopsy
* PCR - anyone with a detectable viral load needs treatment * genotype - predicts the response for treatment. * Genotype 1 is treated with sofosbuvir and ledipasvir * all genotype can be treated with sofosbuvir and velpatasvir * liver biopsy - assess the extent of fibrosis. if they have detectable viral load then you do not need liver biopsy as you will treat with antivirals anyway
34
what is the difference in treatment between older and younger men with epididymoorchitis?
younger - ceftriaxone and doxycycline older - septrin or a quinolone (as if it were a UTI)
35
what is the treatment for PID as inpatient and outpatient?
IP: cefoxitin and doxycycline OP: ceftriaxone and doxycycline (with metronidazole) pen-allergic: levofloxacin and metronidazole
36
what is the treatment for lymphogranuloma venerium and chancroid?
LGV - doxycycline chancroid - azithromycin
37
which cerebral infection in immunocompromised patients is associated with indolent presentation, no meningism and elevated CSF pressure?
cryptococcus diagnosed with CSF serology, india ink stain or culture on Sabouraud medium
38
which species are viridans group streptococcus?
*S sanguinis, S milleri, S mitis, S mutans, S sobrinus, S oralis*
39
which are the common live vaccines?
varicella and zoster, intranasal influenza, MMR
40
what are elevated LDH levels in pneumonia significant for?
PCP pneumonia
41
what pathogen causes **ecthema gangrenosum**? invasion of the vasculra media and adventitia leading to ischaemic necrosis, indurated pustules/bullae and eventually gangrenous ulcers
*pseudomonas aeruginosa* only in immunocompromised individuals
42
what is the treatment for HIV cryptococcal meningitis?
initial: amphotericin B and flucytosine (2 weeks) maintenance: fluconazole (8 weeks)
43
what is the finding on urinalysis that would suggest *proteus* infection?
urinary pH \> 8
44
a fungal infection in the southwestern US, lung, skin and meningies
coccidiodiomycosis
45
a fungal infection from the Great Lakes, Mississippi river and Ohio river basins presenting with lung, skin and lytic bone lesions?
Blastomycosis
46
what antimicrobials and at what CD4 level should be started in HIV for prophyaxis against opportunistic infections?
200 - septrin for PCP 150 - itraconizole for histoplasmosis (endemic area) 100 - septrin for *toxoplasma gondii* (or pyrimethamine/leucovorin) 50 - azithromycin for MAC
47
what is the emergency treatment for bacterial meningitis? when would you add ampicillin?
ceftriaxone, vancomycin and steroids age \> 50 or risk factors for *listeria*
48
who needs a sequential pneumococcal vaccine and who gets the PCV23 alone?
healthy, younger than 65 gets PCV23 only **sequential:** * older than 65 * CSF leaks, cochlear implants * immunosupressed, sickle cell disease, asplenia * CKD
49
how do you treat *Norcardia?* when do you need to add something to standard therapy?
septrin usually for 6-12 months surgical drainage of the abscess if CNS involvement, add carbapenem
50
endocarditis + colonic neoplasia
*Strep gallolyticus* (*S bovis* type 1)
51
opportunistic infection giving cough, dyspnoea, mucocutaneous lesions/mouth ulcers, infiltrates in the lung, lymphadenopathy and hepatosplenomegaly, pancytopenia how do you treat it?
histoplasmosis IV amphotericin B for 2 weeks then maintenance therapy with itraconazole for 1 year
52
how do you treat actinomyces?
penicillin for 2-6 month
53
periorbital oedema, myositis and eosinophillia
trichinellosis
54
when is doxycycline contraindicated? what can you give for lyme disease instead?
children younger than 8 pregnant or lactating women
55
skin papule that ruptures with nonpurulent, odorless discharge then leading to further lesions around the proximal lymphatic drainage? what's the treatment?
*sporothrix schenckii* itraconazole 3-6 months
56
what commonly causes erysipelas?
Group A strep (*pyogenes*)
57
what causes epidydimoorchitis in men \> 35 years most commonly?
*E coli*
58
how do you manage a tick that is still attached to the patient?
remove with forceps as close to the skin as possible if tick is on for \>36 hours then give antimicrobial prophylaxis with **single dose doxycycline**
59
chronic, slow-growing, non-tender mass near the mandible with multiple sinus tracts draining yellow granules how do you treat?
actinomyces penicillin 2-6 months, ?surgery
60
how do you diagnose babesiosis?
blood film microscopy looking for intracellular Maltese cross protozoon
61
what reaction to tuberculin skin test in HIV is considered positive?
\> 5 mm in all patients treat with 9 months isoniazid-pyridoxine for latent TB treat with RIPE for active TB (symptoms, radiologic findings on CXR)
62
what are the prophylactic medications for malaria?
* mefloquine * atovaquone-proguanil * doxycycline to be given 2 weeks before going and up to 4 weeks after return
63
what is the treatment for latent tuberculosis?
isoniazid for 9 months give pyridoxine as well to prevent peripheral neuropathy
64
who should you treat for TB if induration is 5-10 mm
HIV positive immunosuppressed/organ transplant known recent TB exposure or signs of healed TB on CXR

USMLE S2CK (6 decks)

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