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Flashcards in Master the Boards: Infectious Disease Deck (62):
1

If a patient has a rash to penicillin then what antibx do you recommend?

If a patient has an anaphylactic reaction to penicillin then what antibx do you recommend?

Rash: Cephalosporin

Anaphylaxis: Non-beta-lactam

2

2nd gen cephs have added coverage to ______ compared to 1st gen cephs.

Added anaerobe and more gram-negative bacilli

3

Why should ceftriaxone be avoided in neonates?

What 3rd gen cephalosporin has Pseudomonal coverage?

Ceftriaxone may cause impaired bilirubin metabolism

Cefotaxime

4

Name a 4th gen ceph

Cefepime

5

What is an important adverse effect of cefoxitin and cefotetan?

Depletion of prothrombin and increased risk of bleeding

6

What unique coverage does aztreonam have?

Does it cross-react with penicillin?

Only gram-negative bacilli, including Pseudomonas

No cross-reaction with penicilllin

7

Fluoroquinolones have coverage of what bacteria?

Which fluoroquinolone also has anaerobic coverage?

Gram negative bacilli, including Pseudomonas

Moxifloxcin has anaerobe coverages (thus can be used as a single agent in the treatment of diverticulitis i.e metronidazole doesn't have to be added)

8

Do aminoglycosides have any anaerobic effect?

What are the major toxicities?

No.

Nephrotoxic, ototoxic

9

Cystitis in pregnant woman is best treated with _____.

NItrofurantoin

10

Fanconi Syndrome (Type II renal tubular acidosis proximal), photosensitivity, and esophagitis/ulcer are all adverse effects of _____.

Doxycycline

11

Patients allergic to penicillin but requiring treatment of syphillis may receive _________.

Doxycycline

12

What drug can cause both G6PD deficiency hemolysis and bone marrow suppresion?

Trimethoprim/Sulfamethoxazole

(BM suppression because it's a folate antagonist)

13

What are your choices for tx of MRSA (5)?

What if it was a minor skin infection?

Vancomycin
Linezolid
Daptomycin
Tigecycline
Ceftaroline

Minor skin infection: TMP/SMX, Clindamycin, Doxycycline, Linezolid

14

You're treating a MRSA patient and they develop elevated CPK levels, what are you treating with?

What if they showed signs of bone marrow toxicity?

Daptomycin: Elevated CPK

Linezolid: Reversible bone marrow toxicity

15

The presence of papilledema, seiures, focal neurologic deficits, or confusion should warrant what exam before conducting an LP in suspected meningitis?

CT head to r/o space-occupying lesion

16

What is empiric treatment of meningitis prior to knowledge of culture results?

What should be added to that therapy if the patient is neonate, old, immunocompromised, or pregnant?

Ceftriaxone, vancomycin, steroids

Add ampicillin for fear of Listeria infection

17

What is the most common neurological deficit in untreated bacterial meningitis?

CN 8 damage or deafness

18

Acyclovir has what adverse effect to keep in mind?

Renal toxicity since it precipitates in renal tubules

19

Is the radiologic test usually the answer in an ID question about the "most accurate test"?

No

20

Small vesicles or ulcers ID'd on exam of a patient with pharyngitis could move you towards what other two diagnoses?

HSV or Herpangina

21

Blood and WBC in stool in a patient with hemochromatosis or a recent blood transfusion may be cause by what pathogen?

Yersinia (has a high affinity for iron)

22

A patient eats some spoiled fish and develops wheezing, flushing, and a rash. What is the cause and what is the tx?

Scombroid
Anti-histamine

23

Elevation of which lab in hepatitis is associated with increased risk of mortality?

Prothrombin time (PT)

24

In addition to gram positive bacteria, what additional coverage to amoxicillin and ampicillin provide?

Other gram-negative bacilli

H. influenzae, E. coli, Listeria, Proteus, Salmonella

25

Does cystitis give urethral discharge?

No

26

A woman presents with symptoms of PID. What should you do before moving forward with treatment?

Rule out pregnancy

27

STD buzzwords

Painful ulcer

Chancroid (H. ducreyi)

28

STD buzzwords

Tender lymph nodes and suppurating

Lymphogranuloma venereum

29

Rank tests for determining syphilis based on accuracy or sensitivity

VDRL/RPR

30

Best initial test for determining HSV?

Most accurate?

Best initial: Tzanck smear

Most accurate: Viral culture

31

What diagnostic tests are used to confirm lymphogranuloma venereum?

Complement fixation titers in blood
Nucleic acid amplification testing on swab

32

Tx Chancroid

Azithromycin (single dose)

33

Tx Lymphogranuloma venereum

Doxycycline

34

Patients with syphilis are at greater risk for what vascular complication?

Aortic aneurysm and aortic regurgitation

35

What is the treatment of syphilis in each stage (primary, secondary, and tertiary) and how does it change if penicillin allergic?

Primary and secondary: single dose IM benzathine penicillin (Doxycycline if allergic)

Tertiary: IV penicillin (penicillin desensitization if allergic)

36

What is a Jarisch-Herxheimer reaction and what is treatment?

Fever and worsening of symptoms after treating syphilis patient with penicillin

Give aspirin and antipyretics, it will pass on its own

37

What causes condyloma acuminate?

aka genital warts

HPV

38

A patient comes in with intense itching at his pubis and axilla (hair-bearing regions). You suspect pediculosis (crabs). What is tx?

Permehrin
(Lindane can also be used but has more toxicity)

39

What presents in the web spaces of the fingers and toes and burrows in the skin? What must be done to confirm a diagnosis?
What is tx?

Scrape and magnify the burrows to dx

Treat with permethrin

40

A patient presents with likely pyelonephritis but fails to improve on antibx therapy. What should be the next test done?

Imaging using ultrasound or CT to evaluate for a perinephric abscess and if present it must be drained

41

What is the best initial therapy in suspected endocarditis prior to results of cultures?

Vancomycin and gentamicin

42

What is the treatment of Viridans Strep endocarditis?

Ceftriaxone

43

What is the treatment of Enterococci endocarditis?

Ampicillin and gentamicin

44

What drug should be added to the treatment of Staph endocarditis if there is a prosthetic valve involved?

Rifampin

45

When should surgery be considered in endocarditis (6)?

CHF or ruptured valve/chordae tendinae
Prosthetic valves
Fungal endocarditis
Abscess
AV block
Recurrent emboli while on tnibx

46

What is the most common agent responsible for culture-negative endocarditis?

What are the HACEK organisms?

MC: Coxiella (also Bartonella)

(Use ceftriazone for HACEK organisms)
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

47

What is endocarditis prophylaxis?

In what situations would you offer the prophylaxis?

Amoxicillin

Significant cardiac defect: previous endocarditis, prosthetic valve, recent cardiac txp, unrepaired cyanotic heart disease

Risk of bacteremia: Dental procedure W/ blood, respiratory tract surgery that produces bacteremia

48

What is the most common neurologic and cardiac manifestation, respectively, of Lyme disease?

Neurlogic: Bell's Plasy

Cardiac: AV block

49

What is generally the treatment of Lyme disease?

When it is advanced and involves cardiac or neurologic manifestations then what is tx?

Doxycycline

If advanced: IV ceftriaxone

50

Do patients with an asymptomatic tick bite receive ppx?

Generally no. They only receive a single dose of doxycyline if the tick was identified as Ixodes scapularis, the area is engorged, the tick was present on skin for 24-48 hours.

51

Is ELISA an effective test for evaluating HIV in neonates?

No. They need PCR or viral culture

52

What is the best initial test for detecting HIV infection? What is confirmatory?

Initial: ELISA

Confirmatory: Western Blot

53

Generally, what are each type of agent with the following names:

-navir
-udine/-bine

-navir: protease inhibitors
-udine/-bine: NRTIs

54

What are two entry inhibitors used in HIV?

What is an integrase inhibitor?

Entry inhibitors: Enfuvirtide, Maraviroc

Integrase inhibitor: Raltegravir

55

HIV adverse effect

Zidovudine

Anemia

56

HIV adverse effect

Stavudine and didanosine

Peripheral neuropathy and pancreatitis

57

HIV adverse effects

Abacavir

Hypersensitivity, Stevens-Johnson reaction

*Hypersensitivity is indicated by HLA B5701 status

58

HIV adverse effects

Protease inhibitors

Hyperlipidemia, Hyperglycemia

59

HIV adverse effects

Indinavir

Nephrolithiasis

60

HIV adverse effects

Tenofovir (NRTI)

Renal insufficiency

61

Can HIV medications generally be continued in pregnancy?

What is one drug avoided due to teratogenicity in animals?

Yes

Efavirenz is avoided (if already on prior to becoming pregnant then change to a protease inhibitor)

62

In what situations should a C-section be considered in an HIV positive pregnant woman?

If the CD4 count is 1000).

Zidovudine is given no matter what to reduce risk of vertical transmission