Infectious Diseases - MTB Flashcards

Question

Cefotaxime: uses

Answer 1

- superior to ceftriaxone in neonates | - spontaneous bacterial peritonitis

Answer 2

Pseudomonal coverage

Answer 3

- 1st cephalosporin to cover MRSA

Answer 4

- 4th generation cephalosporin - has better Staph coverage compared to 3rd gen cephalosporins - used to treat neutropenia and fever - ventilator associated pneumonia

Answer 5

Deplete prothrombin and increase risk of bleeding

Answer 6

Imipenem Meropenem Ertapenem Doripenem

Answer 7

inhibit cell wall synthesis by binding to penicillin binding proteins

Answer 8

Gram (-) bacilli, including many that are resistant, anaerobes, streptococci, and staphylococci - used to treat neutropenia and fever

Answer 9

- does not cover Pseudomonas

Answer 10

- only drug in the class of monobactams - exclusively for gram- negative bacilli including Pseudomonas - no cross reaction w/ penicillin

Answer 11

* * block DNA topoisomerases - Ciprofloxacin - Gemifloxacin - Levofloxacin - Moxifloxacin

Answer 12

Fluoroquinolones (e.g ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin)

Answer 13

- gram negative rods for urinary and GI tracts (including Pseudomonas) - best tx for CAP - Neisseria - Some gram positive organisms

Answer 14

- Diverticulitis and GI infxns (must be combined w metronidazole) b/c they don't cover anaerobes - MOXIFLOXACIN can be used as single agent for diverticulitis and doesn't need metronidazole - CIPROFLOXACIN for cystitis and pyelonephritis

Answer 15

- BONE GROWTH ABNORMALITIES: in children and pregnant women - TENDONITIS and Achilles tendon rupture - Gatifloxacin removed b/c glucose abnormalities

Answer 16

Gentamicin, Tobramycin, Amikacin * inhibit formation of initiation complex and cause misreading of mRNA * require oxygen for uptake thus ineffective w/ anaerobes

Answer 17

- gram (-) bacilli (urine, bowel, bacteremia) - synergistic w/ B-lactam antibiotics for enterococci and staphylococci - not effective against anaerobes since need to oxygen to work - NEPHROTOXIC AND OTOTOXIC

Answer 18

Bacteriostatic: bind to 30S and prevent attachment to aminoacyl-tRNA - fecally eliminated and can be used in patients w/ renal failure

Answer 19

- Chlamydia - Lyme disease limited to rash, joint or CN VII palsy - Ricksettia - MRSA of skin and soft tissue - Primary and secondary syphillis in those allergic to penicillin - Borrelia, Ehrlichia, and Mycoplasma

Answer 20

- Tooth discoloration (children) - Fanconi syndrome (type II RTA proximal) - Photosensitivity - Esophagitis/ulcer

Answer 21

Cystitis especially in pregnant women

Answer 22

- Cystitis - Pneumocystis pneumonia treatment and prophylaxis - MRSA of skin and soft tissue (cellulitis)

Answer 23

- Rash - Hemolysis (with G6PD deficiency) - Bone marrow suppression (b/c folate antagonist)

Answer 24

- Amoxicillin/clavulanate - Ticarcillin/ clavulanate - Ampicillin/ Sulbactam - Piperacillin/Tazobactam

Answer 25

- against sensitive staphylococci to these agents - cover anaerobes - first choice for mouth and GI abscess

Answer 26

- Oxacillin, Cloxacillin, Dicloxacillin, Nafcillin - 1st gen cephalosporins: cefazolin, cephalexin - Fluoroquinolones - Macrolides (e.g. azithromycin, erythromycin) - 3rd line

Answer 27

Best treated with: - vancomycin - linezolid: reversible bone marrow toxicity - daptomycin: elevated CPK - tigecycline - ceftraroline

Answer 28

- TMP/SMX - Clindamycin - Doxycycline - Linezolid

Answer 29

Oral (above diaphragm) - Penicillin (G, VK, ampicillin, amoxicillin) - Clindamycin Abdominal/ gastrointestinal - Metronidazole, beta-lactam/lactamase combinations

Answer 30

- cause infections of bowel (peritonitis, diverticulitis) - urinary tract (pyelonephritis) - liver (cholecystis, cholangitis)

Answer 31

- Quinolones - Aminoglycosides - Carbapenems - Piperacillin, Ticarcillin - Aztreonam - Cephalosporins

Answer 32

- Quinolones - Aminoglycoside - Carbapenems - Piperacillin, Ticarcillin - Aztreonam - Cephalosporin

Answer 33

Meningitis

Answer 34

Encephalitis

Answer 35

- infection or inflammation of covering or meninges of CNS

Answer 36

- S. pneumonia (60%) - Group B Strep (14%) - Haemophilus influenzae (7%) - N. meningitides (15%) - Listeria (2)

Answer 37

- Fever, headache, neck stiffness (nuchal rigidity) and photophobia

Answer 38

Cryptococcus

Answer 39

Lyme disease

Answer 40

Rocky Mountain spotted fever (Ricksettia)

Answer 41

Tuberculosis

Answer 42

Lumbar puncture

Answer 43

- 1000s, neutrophils - elevated protein - decreased glucose - stain: 50 - 70% - culture: 90%

Answer 44

- 10s - 100s lymphocytes - possibly elevated protein - possibly decreased glucose - negative stain and culture

Answer 45

- 10s - 100s lymphocytes - markedly elevated protein - may be low glucose - negative stain and culture

Answer 46

- 10s - 100s lymphocytes - usually normal protein - usually normal glucose - negative stain and culture

Answer 47

Head CT prior to an LP only if there is the possibility that a space occupying lesion may cause herniation

Answer 48

- Papilledema (blurred, fuzzy disc margin from intracranial pressure) - Seizures - Focal neurological abnormalities - Confusion interfering w/ neuro examination

Answer 49

Antibiotics

Answer 50

- similar to gram stain - antigen detection methods are positive, they are specific - if antigen detection methods are negative, person could still have infecition

Answer 51

Pt has received antibiotic prior to LP and culture may be falsely negative

Answer 52

- Acid fast stain and cx on 3 high volume LP - centrifuge the specimen to concentrate the organisms - has highest CSF protein level

Answer 53

Specific serologic testing ELISA Western blot PCR

Answer 54

``` India ink (60 - 70% sensitive) Cryptococcal antigen is more than 95% and specific ```

Answer 55

Generally a diagnosis of exclusion

Answer 56

- Ceftriaxone, vancomycin, and steroids * **base your treatment answer on cell count*** * *** Gram stain is good if positive, protein and glucose levels are too nonspecific ****

Answer 57

Ceftriaxone, Vancomycin, and Steroids | - add ampicillin if immunocompromised for Listeria

Answer 58

- resistant to all cephalosporins but sensitive to penicillins - add ampicillin to ceftriaxone and vancomycin if case describes risk factors for Listeria

Answer 59

- Elderly - Neonates - Steroid use - AIDS or HIV - Immunocompromised - Pregnant

Answer 60

- ceftriaxone - respiratory isolation - rifampin, ciprofloxacin, or ceftriaxone to close contacts (household contacts, kissing, or sharing cigarettes, or eating) to decrease nasopharyngeal carriage

Answer 61

Ceftriaxone, vancomycin, and steroids

Answer 62

Eighth cranial nerve deficit or deafness

Answer 63

- acute onset of fever and confusion - herpes simplex is by far the most common cause - must do head CT first b/c of presence of confusion

Answer 64

PCR of CSF | ** blood serology from routine cold sore, genital herpes, or encephaltis**

Answer 65

Acyclovir - best initial therapy for herpes encephalitis ** Foscarnet used in acyclovir-resistant herpes**

Answer 66

Reduce the dose of acyclovir and hydrate | -- can't use foscarnet because has more renal toxicity

Answer 67

- presents with redness, immobility, bulging, and decreased light reflex of tympanic membrane - pain is common - decreased hearing and fever also occur

Answer 68

Immobility | - fully mobile TM essentially excludes otitis media

Answer 69

- Tympanocentesis - if there are multiple recurrents or if no response to multiple abx

Answer 70

Amoxicillin (best initial therapy)

Answer 71

- Amoxicillin/ clavulanate - Azithromycin, clarithromycin - Cefuroxime, loracabef - Levofloxacin, gemifloxacin, moxifloxacin

Answer 72

Sinus biopsy or aspirate - need microbiological diagnosis for treatment - ** never culture nasal discharge **

Answer 73

- infection frequently recurs | - no response to different empiric therapies

Answer 74

Amoxicillin/clavulanic acid and decongestant | ** Amox/Clav, doxycycline, and TMP-SMX**

Answer 75

Presents w/ - pain on swallowing - enlarged lymph node in neck - exudate in the pharynx - fever - no cough and no hoarness * * when these features are present, likelihood of step exceeds 90%**

Answer 76

- Rapid strep test * when criteria suggesting infection are present, abx are needed until culture * * Positive strep test = positive pharyngeal culture

Answer 77

HSV or herpangina

Answer 78

Diphtheria Vincent angina EBV

Answer 79

1. Penicillin or AMOXICILLIN (best initial therapy) 2. Penicillin allergic pts are treated w/ cephalexin if reaction is only a rash. If allergy is anaphylaxis, use clindamycin or macrolide

Answer 80

to prevent rheumatic fever

Answer 81

Presents w/ - arthralgia/myalgia - cough - fever - headache and sore throat - nausea, vomiting, or diarrhea esp in children

Answer 82

Depends on time course from presentation | - if within 48 hrs: perform nasopharyngeal swab or wash to detect the antigen associated w/ influenza

Answer 83

- < 48 hrs: oseltamivir, zanamivir * neuraminidase inhibitors shorten duration of symptoms * * treat both influenza A and B - > 48 hrs: symptomatic treatment only

Answer 84

Salmonella

Answer 85

Campylobacter

Answer 86

E.coli 0157:H7

Answer 87

Vibrio parahaemolyticus

Answer 88

Vibrio vulnificus

Answer 89

C. difficile

Answer 90

Test for blood and leukocytes | - lactoferrin >> fecal leukocytes

Answer 91

- Viral - Giardia - Cryptosporidiosis - Bacillus cereus - Staphylococcus

Answer 92

- Camping/hiking and unfiltered fresh water

Answer 93

unbloody infectious diarrhea | - AIDS less than 100 CD4 cells; detect w/ modified acid fast stain

Answer 94

- most rapid onset on diarrhea - wheezing, flushing, rash - found in fish - treat with antihistamines

Answer 95

Oral fluid replacement

Answer 96

Metronidazole, tinidazole

Answer 97

Treat underlying AIDS, nitazoxanide

Answer 98

Fluid support as needed

Answer 99

Fluid support as needed

Answer 100

- infection of inflammation of liver

Answer 101

- rarely presents w/ an acute infection and is found as a "silent" infection on blood tests or when patients present with cirrhosis - transmitted via sex, perinatal, or blood

Answer 102

- exists exclusively in those who have active viral replication of Hep B - transmitted via sex, perinatal, or blood

Answer 103

- transmitted via food and water

Answer 104

- typically the worst in pregnancy, esp among patients from East Asia - transmitted via food and water

Answer 105

- jaundice - fever, weight loss, and fatigue - dark urine - hepatosplenomegaly - nausea, vomiting, and abdominal test

Answer 106

- increased direct bilirubin - increased ratio of ALT to AST - increased alkaline phosphatase

Answer 107

Prothrombin time | - if elevated, there is markedly increased risk of fulminant hepatic failure and death

Answer 108

IgM antibody for acute infection | IgG anitbody to detect of resolution of infection

Answer 109

- assessed w/ PCR for RNA level, which tells the amount of active viral replication - PCR are the 1st change as indication of improvement w/ treatment

Answer 110

- positive HBsAg - positive HBeAg - positive IgM or IgF - negative HBsAb

Answer 111

- negative HBsAg - negative HBeAg - positive IgG - positive HBsAb

Answer 112

- negative HBsAg - negative HBeAg - negative core antibody - positive HBsAb

Answer 113

- negative HBsAg - negative HBeAg - positive IgM, then IgG - negative HBsAB

Answer 114

Surface antigen

Answer 115

Envelope antigen

Answer 116

No surface antigen | - as long as surface antigen is present, there is still replication

Answer 117

Hep B e-antigen | - strongest indicator of active viral replication

Answer 118

E-antigen | - perinatal transmission is the most common method of transmission worldwide

Answer 119

- Hep A and E resolve spontaneously - Hep B becomes chronic in 10% of patients - Hep C trated w/ interferon, ribavirin and boceprevir, telaprevir

Answer 120

- if patients have (+) e-antigen and elevated DNA polymerase treat w/ entec

Answer 121

- Athralgia/myalgia - Leukopenia - Depression and flu-like symptoms

Answer 122

- Reduce DNA polymerase to undetectable levels | - Convert those patients with e-antigen to having anti-hepaitis e-antibody

Answer 123

If there is active viral replication, fibrosis will progress to cirrhosis

Answer 124

- No way to determine duration of infection - most patients don't have acute symptoms - goal of therapy is undetectable viral load

Answer 125

- look for urethral disharge | - give dysuria w/ urinary frequency and burning]

Answer 126

- NO urethral discharge | - give dysuria w/ urinary frequency and burning

Answer 127

- Urethral swab for Gram stain - urine testing for nucleic amplification can detect gonorrhea and chlamydia -

Answer 128

Urine culture, DNA probe or nucleic acid amplifications for chlamydia and gonorrhea

Answer 129

- Gonorrhea/chlamydia - Mycoplasma genitalium - Ureaplasma

Answer 130

- causes gonorrhea | - treat with cefixime or ceftriaxone (3rd cephalosporins)

Answer 131

- azithromycin | - doxycycline

Answer 132

- presents with cervical discharge and inflamed "strawberry" cervix on physical exam - do nucleic acid amplfication

Answer 133

- cannot be used alone | - must use with azithromycin or doxycycline

Answer 134

Presents with - lower abdominal tenderness - lower abdominal pain - fever - cervical motion tenderness - leukocytosis

Answer 135

- must exclude pregnancy in a woman with lower abdominal pain or tenderness or cervical motion tenderness

Answer 136

- Cervical swab for culture, DNA probe, or nucleic amplification confirm PID etiology - need to clarify need to treat STD

Answer 137

- Laparoscopy | * * rarely needed -- only if diagnosis is unclear

Answer 138

- combination of meds for gonorrhea and chlamydia Inpatient: cefoxitin or cefotetan combined w/ doxycycline Outpatient: cefriaxone and doxycycline (possibly w/ metronidazole)

Answer 139

Levofloxacin and metronidazole for outpatient tx Clindamycin, gentamicin, and doxycycline as inpatient

Answer 140

Chancroid (Haemophilus ducreyi)

Answer 141

Lymphogranuloma venerum

Answer 142

Herpes simplex

Answer 143

- Dark-field microscopy - VDRL or RPR (75% sensitive) - FTA or MHA-TP (confirmatory)

Answer 144

Stain and culture on specialized media

Answer 145

Complement fixation titers in blood | Nucleic acid amplification testing on swab

Answer 146

Tzanck prep is the best initial test | Viral culture is the most accurate tests

Answer 147

Single dose of IM bethazine penicillin | Doxycycline if penicillin allergic

Answer 148

Azithromycin (single dose)

Answer 149

Doxycycline

Answer 150

Acyclovir, valacyclovir, famicyclovir | ** Foscarnet for acyclovir-resistant herpes

Answer 151

Oral acyclovir - - topical acyclovir is worthless - - viral culture is necessary if presentation is clear

Answer 152

- painless genital ulcer w/ heaped indurated edges (it becomes painful if it becomes secondarily infected w. bacteria) - painless adenopathy

Answer 153

- rash (palms and soles) - alopecia areta - mucous patches - condylomata lata

Answer 154

NEUROSYPHILLIS - Meningovascular (stroke from vasculitis) - Tabes dorsalis (loss of position and vibratory sense) - General paresis (memory and personality changes) - Argyll Robertson pupil ( reacts to accomodation, but not light) AORTITIS (Aortic regurgitation, aortic aneurysm) GUMMAS (skin and bone lesions)

Answer 155

- infection - older age - injection drug use and AIDS - malaria - antiphospholipid syndrome - endocarditis

Answer 156

- Single IM injection of penicillin | - Oral doxycycline if penicillin allergic

Answer 157

IV penicillin | - desensitize to penicillin if penicillin allergic

Answer 158

- fever and worse symptoms after treatment | - give aspirin and antipyretics; it will pass

Answer 159

- from papillomavirus - diagnosed on visual appearance - tx w/ cryotherapy w/ liquid nitrogen, surgery for large ones, or "melting" them podophllin or trichloroacetic acid - imiquimod = locally applied immunostimulant that leads to sloughing off the lesion

Answer 160

- found on hair-bearing areas (axilla, pubis) - causes itching - visible on the surface - treat w/ premethrin; lindane is equal in efficacy, but more toxic

Answer 161

- found in WEB SPACES btwn fingers and toes at or at elbows or genitalia - found around the nipples or near the genitals - BURROWS visible (they dig) but smaller than pediculosis - SCRAPE and magnify - Treat w/ PREMETHRIN - Widespread disease is "crusted" or hyperkeratotic and responds to ivermectin; server disease needs repeat dosing

Answer 162

- can present with DYSURIA (frequency, urgency, burning) and a FEVER - U/A shows INCREASED WBCs - E.coli is most common cause

Answer 163

Quinolones are best initial therapy

Answer 164

- Stones - Strictures - Tumor or prostate hypertrophy - Diabetes - Foreign body (including foley catheter) - Neurogenic bladder

Answer 165

- multiple episodes of micturation

Answer 166

increase in the volume of urine

Answer 167

presents w/ dysuria - SUPRAPUBIC PAIN/ discomfort - mild or absent fever

Answer 168

- Urinanalysis with more than 10 WBCs

Answer 169

Urine culture

Answer 170

- NITROFURANTOIN or fosfomycin - TMP/SMX (Bactrim) if local resistance is low - Ciprofloxacin - reserved from routine use to avoid resistance - Cefixime

Answer 171

Nitrofurantoin for 3 days - 3 days is enough for uncomplicated cystitis - 7 days if there is anatomic anatomic abnormality is found

Answer 172

dysuria with - flank or CVA tenderenss - high fever - occasionally with abdominal pain from inflamed kidney

Answer 173

U/A shows increased WBCs | CT or U/S are done to show anatomic abnormality

Answer 174

- Ceftriaxone, ertapenem - AMPICILLIN and GENTAMICIN until cx results are known - Ciprofloxacin (for outpatient treatment)

Answer 175

presents with dysuria with - perineal pain - tender prostate on examination

Answer 176

Prostate massage aided urine culture - treat the same as you would pyelonephritis - ceftriaxone, ertapenem - ampicillin and gentamicin - ciprofloxacin

Answer 177

Long term therapy w/ TMP-SMX for 6-8 weeks

Answer 178

- look for pyelonephritis that doesnt resolve with appropriate therapy - if pyelonephritis is associated with persistent fever after 5-7 days of therapy, perform imaging study (e.g. CT or U/S) - MUST DRAIN ABSCESS

Answer 179

- infection of valve of heart leading to fever and a murmur | - diagnosed with vegetations seen on echo and positive blood cultures

Answer 180

- risk of endocarditis is proportional to damage of valves

Answer 181

- Prosthetic valves have highest risk - Regurgitant and stenotic lesions have increased rect - Bacteremia caused by injection drug users and S. aureus - Dental procedures offer mildly increased, but small risk

Answer 182

- fever | - new murmur or change in murmur

Answer 183

- Splinter hemorrhages - Janeway lesions (flat and painless) - Osler nodes (raised and painful) - Roth spots in eyes - Brain (mycotic aneurysm) - Kidney (hematuria, glomerulonephritis) - Conjunctival petechiae - Splenomegaly - Septic emboli to lungs

Answer 184

Blood culture (BEST INITIAL TEST) TTE TEE EKG (may show AV block if dissection into conduction system)

Answer 185

Colonoscopy | - S. bovis associated with colonic pathology (diverticulitis to polyps to colon cancer)

Answer 186

1. Oscillating vegetation 2. Three minor criteria - Fever > 100.3 F - Risk of injection drug use or prosthetic valve - Signs of embolic phenomena

Answer 187

Vancomycin and gentamicin

Answer 188

Ceftriaxone for 4 weeks

Answer 189

Oxacillin, nafcillin, or cefazolin

Answer 190

Vancomycin

Answer 191

Ampicillin and gentamicin

Answer 192

- Add aminoglycoside and extend duration of treatment

Answer 193

- CHF or ruptured valve - Prosthetic valves - Fungal endocarditis - Abscess - AV block - Recurrent emboli while on antibiotics

Answer 194

Add rifampin

Answer 195

``` HACEK - Haemophilus aphrophilus - Haemophilys parainfluenzae - Actinobacillus Cardiobacteruium - Eikenella - Kingella ```

Answer 196

CHF and acute valve rupture

Answer 197

Coxiella | Bartonella

Answer 198

1. SIGNIFICANT HEART DEFECT - Prosthetic valve - Previous endocarditis - Cardiac transplant recipient w/ valvuloplasty - Unrepaired cyanotic disease 2. RISK OF BACTEREMIA - Dental work WITH BLOOD - Respiratory tract surgery that produces bacteremia

Answer 199

Amoxicillin prior to procedure | - if patient is penicillin allergic, use clindamycin, azithromycin or clarithromycin

Answer 200

- Flexible endoscopies even w/ bx - Ob/Gyn proceudures - Uro procedures - Gi prodecures including ERCP - Valvular heart disease including MVP even w/ murmur - MR, MS, AR AS, HOCM, and atrial septal defect

Answer 201

- arthropod-borne disease from the spirochete Boriella burdorferi. - results most often in a fever and a rash - untreated infxn can recur as joint pain, cardiac disease, or neuro disease

Answer 202

- transmitted by deer tick (Ixodes scapularis) typically in northeast (CT, MA, NY, NJ) - most don't notice tick bite - patient recall being outdoors (hiking or camping) - tick must be attached for > 24 hrs to transmit organism -

Answer 203

RASH: 5 - 14 days after bite as target lesion (red round lesion with pale area in center) JOINT PAIN: - knee most common joint. - joint fluid has about 25,000 WBCs NEURO: - meningitis, encephalitis, or cranial nerve palsy CARDIAC: - damage to myocardium or pericardium (e.g myocarditis or ventricular arrhythmia)

Answer 204

Bell palsy or seventh cranial palsy

Answer 205

Transient AV block

Answer 206

- typical target rash is enough to start treatment | - serological testing is enough for joint, neuro, or cardiac manifestations

Answer 207

No treatment routinely

Answer 208

Doxycycline | Amoxicillin or cefuroxime

Answer 209

Doxycycline | Amoxicillin or cefuroxime

Answer 210

Intravenous ceftriaxone

Answer 211

- if no Lyme symptoms, then no treatment

Answer 212

- Ixodes scapularis clearly identified as tick cause of bite - Tick attached longer than 24 - 48 hrs - Engorged nypmh-stage tick - Endemic area

Answer 213

- retrovirus infecting CD4 cell - drop from 600 - 1000 at a rate of 50 to 100 per year in untreated persion - depletion of CD4 cell count takes btwn 5- 10 years

Answer 214

Transmitted through - injection drug use with contaminated needles - sex, particuarly MSM - transfusion (extremely rare since 1985) - perinatal - needlestick or blood-contaminated sharp instrument injury

Answer 215

- infections occur w/ profound immunosuppression when CD4 count fall below 50/ microL - PCP occurs below 200 / microL or under 14% -

Answer 216

- Varicella zoster (shingles) - Herpes simplex - Tuberculosis - Oral and vaginal candidiasis - Bacterial pneumonia - Kaposi sarcoma

Answer 217

ELISA test | - positive test confirmed with Western blot testing

Answer 218

- ELISA Test (Confirmed w. Western blot testing) | - Infected infants diagnosed with PCR or viral culture

Answer 219

Infected infants diagnosed with PCR or viral culture | - ELISA testing is unreliable b/c maternal HIV Ab may be present for up to 6 months

Answer 220

- Measure response to therapy (decreasing levels are good) - Detect treatment failure (rising levels are bad) - Diagnose HIV in babies

Answer 221

To drive viral load to undetectable (< 50 cells / micro L) | - CD4 counts have more chance to r

Infectious Diseases - MTB Flashcards

(254 cards)