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Flashcards in MTB 2 CK - Infectious Deck (130):
1

What abx do we use to tx oral anaerobes?

PCN G, V

2

Aminopenicillins (amp, amox) have more _____ coverage than PCN

Gram (-), enterics

3

Best initial therapy for endocarditis prophylaxis

Amox or amp

4

Best initial therapy for UTI in pregnant woman

Amox

5

What are pencillinase resistant PCN good at? Dicloxacillin, etc.

Killing S. aureus (not good at gram negatives or MRSA)

6

What are the anti-pseudomonal PCNs?

Ticarcillin, Piperacillin, etc.

Good for pseudomonas and anaerobes!!!

7

Best initial therapy for cholecystitis, ascending cholangitis, pyelonephritis?

Ticarcillin, piperacillin
*But usually not the answer when a single organism is known (too broad coverage)

8

What 3 bugs are resistant to cephalosporins?

Enterococcus
Listeria
MRSA

9

Cephalosporins with increased risk of bleeding

Cefotetan, cefoxitin

10

First line tx for S. pneumo meningitis

Ceftriaxone

11

Tx of Lyme involving the heart or brain

Ceftriaxone

12

Can't give Ceftriaxone to...

neonates

13

Cefepime is good for

Staph, Pseudomonas, Gm (-)

14

What is cilastatin given with (kidney breakdown)

Imipenem

15

Aztreonam only covers

Gram (-) rods

16

Fluoroquinolones have poor coverage of...

Staph, strep, and anaerobes

17

FQ are good for...

pee, poo, bone, and intracellular pna

18

Give ____ with FQ for GI infections

Metronidazole to cover the anaerobes

19

Can't give FQ to... and why...

Pregnant women, kids
Tendon rupture, bone growth abnormalities

20

Aminoglycosides get in the

poo, pee, blood

21

Aminoglycosides have good coverage of ___ and bad coverage of ___

gram (-) good
anaerobes bad

22

Clindamycin causes

C. dif

23

2nd line for staph/strep

Macrolides

24

First line Txs for MRSA

Vancomycin, Linezolid, Daptomycin, Tigecycline, Ceftaroline

25

Best initial tx for minor MRSA of the skin

TMP/SMX
Clindamycin
Doxycycline

26

2 best tx for GI anaerobes

Metronidazole
Beta-lactam/lactam combos

27

Only think S. aureus CNS infection in...

someone with recent NES

28

At what CD4 count do we see cryptococcal meningitis

29

When is it a TB CNS infection?

If they also have pulmonary TB

30

CSF cell count in cryptococcus, Lyme, or Ricketsial meningitis

10s-100s
Protein and glucose inconclusive

31

What will CSF studies show in TB meningitis?

markedly elevated protein

32

When do you do bacterial antigen detection in a CNS infection?

If antibiotics are given prior to LP/ culture

33

Prophylaxis for close contacts of patient with N. meningitides

Rifampin
Ciprofloxacin
Ceftriaxone

34

MCC meningitis 0-6mo

Listeria
GBS
E. coli

35

MCC meningitides 6mo-6yr

S. pneumo
H. flu
Enterovirus
N. meningitides

36

MCC meningitis 6-60yr

S. pneumo
Enterovirus
N. meningitides
HSV

37

MCC meningitis 60+yo

S. pneumo
Listeria
N. meningitides
Listeria
Gram (-) rods

38

MCC encephalitis

HSV

39

When is the most accurate test for HSV a viral culture?

When it is a skin/genital infection
Otherwise, PCR is most accurate

40

Most sensitive finding in AOM? (if negative, no AOM)

Tympanic membrane immobility

41

When do you do tympanocentesis for AOM?

Recurrent or no response to MULTIPLE abx

42

For sinusisitis when is culture of nasal discharge the right answer?

NEVER

43

When do you do a CT of the sinuses for sinusitis?

When the dx is equivocal

44

Don't forget mucormycosis

in chronic sinusitis in patients with DM or heme probs

45

MCC of bacterial pharyngitis

GAS, Neisseria gonorrhea, Mycoplasma pna, C. diptheria

46

MCC of viral pharyngitis

Rhino, Corona, Adeno, HSV, EBV, CMV, influenza, Coxsackie

47

Pharyngitis tx: rash to PCN/amox

GIve cephalexin

48

Pharyngitis tx: if bad reaction to PCN/amox

Clindamycin, macrolide

49

Why do we treat GAS?

To prevent rheumatic fever

50

When can you get the inactivated flu vaccine?

>6mo

51

When can you get the live attenuated vaccine?

2-49yo

52

2 MCC of HUS

E. coli
Shigella

53

Yersinia (diarrhea) loves

iron (transfusions, hemochromatosis)

54

How do you treat scombroid?

Antihistamines (looks like anaphylaxis to shellfish)

55

In HBV, surface antigen indicates

continued carrier state

56

What % of HBV becomes chronic?

10%

57

What % of HCV becomes chronic?

a lot

58

Best initial tx for urethritis

Ceftriaxone + Doxy/Azithro

59

PID best first step

pregnancy test

60

PID most accurate test

laparoscopy

61

PID inpatient tx

Cefoxitin/Cefotetan + Doxy

62

PID outpatient tx

Ceftriaxone + Doxycycline
(allergy) Levofloxacin + Metronidazole

63

One painful genital ulcer

Chancroid (H. ducreyi)

64

Syphilis screening test

VDRL, RPR

65

Syphilis confirmatory test

FTA, MHA-TP

66

Test for chancroid

Culture and stain

67

Test for lymphogranuloma venereum

Complement fixation titers
Nucleic acid amplification

68

Syphilis tx

IM PCN benzathine (1)
Doxycycline (PCN allergy)

69

Chancroid tx

Azithromycin (1 dose)

70

Lymphogranuloma venereum tx

Doxycycline

71

Can HSV be a clinical dx?

YES! no Tzanck necessary

72

TX secondary syph

IM PCN (one dose)

73

TX tertiary syph

IV PCN

74

Tests for genital warts

Biopsy, serology, stain, smear, culture---DON'T DO THESE!

75

Pediculosis =

crabs

76

Pediculosis tx

Permethrin

77

Scabies next best step

scrape and magnify

78

Scabies TX

Permethrin

79

Ciprofloxacin in tx of UTI

reserved for complicated cases

80

Pyelonephritis imaging

CT/US to rule out structural abnormalities

81

How do we treat prostatitis?

Same abx as pyelonephritis
TMP-SMX 6-8wks if CHRONIC

82

Pyelonephritis that does not resolve w/ appropriate tx

perinephric abscess (get US or CT)

83

Fever + new murmur

endocarditis--> echo + blood cultures

84

Roth spots

endocarditis

85

Janeway lesions

endocarditis

86

Osler nodes

endocarditis

87

What if endocarditis is culture negative?

HACEK
Oscillating vegetations on echo
+
1. Fever >100.4
2. RF of IVDA, prosthetic valve, etc
3. Signs of emboli

88

MCC of culture negative endocarditis

Coxiella
Bartonella

89

Best tx of endocarditis?

Vancomycin + Gentamycin

90

Best tx of endocarditis w/ HACEK?

Ceftriaxone

91

Endocarditis prophylaxis is needed when...

SIGNIFICANT cardiac defect
+
Risk of bacteremia with procedure

-->Amoxicillin

92

Joint fluid aspiration cell count in Lymes

25,000
oligoarthritis

93

What neuro manifestations are seen with Lymes?

meningitis, encephalitis, CN palsies

94

What cardiac manifestations are seen w/ Lyme?

Myocarditis
Third degree AV block (ventricular arrhythmia)

95

Secondary lyme

(early disseminated) migratory polyarthropathy, Bell's meningitis, myocarditis, AV block

96

Tertiary llyme

arthritis
subacute encephalitis

97

Are diagnostic tests needed to treat Lyme?

NO

98

HIV risk of transmission

Perinatally > anal sex > needle stick > oral sex > vaginal sex

99

Infections at CD4 >200

Shingles, HSV, TB
Oral, vaginal candidiasis
Bacterial pneumonia
Kaposi's

100

2 prophylaxis for HIV

PCP--TMP-SMX @

101

PCP prophylaxis: sulfa allergy

Dapsone
Atovoquone

102

PCP prophylaxis: sulfa allergy & G6PD

Atovoquone

103

Toxoplasmosis prophylaxis?

TMP-SMX--already on it

104

Anemia w/ HIV tx

Zidovudine (AZT)

105

Peripheral neuropathy/pancreatitis w/ HIV tx

Stavudine
Didanosine

106

HSR, Steven Johnson reaction w/ HIV tx

Abacavir

107

Hyperlipidemia, hyperglycemia w/ HIV tx

Protease (-)

108

Kidney stone w/ HIV tx

Indinavir

109

Renal insufficiency w/ HIV tx

Tenofovir

110

HIV med CI in pregnancy

Efavirenz

111

Best HIV test for an infant?

PCR or viral culture

112

First sign of tx failure in HIV

rising PCR-RNA level

113

C-section indicated in HIV when...

CD4 1000

114

Discuss FQ or macrolides in tx of otitis media

Can be used, would expand coverage against atypicals like mycoplasma, intracellulars, etc.

But no greater EFFICACY than amoxicillin

115

Best initial therapy for AOM

Amoxicillin + Decongestant

116

Sore throat + COUGH

Bronchitis or pneumonia!!!!!!!!!!!!!!!!!!!!!!! NOT pharyngitis!
Cough= lung problem!!!!!

117

Hoarseness means

a laryngitis

118

GAS pharyngitis can cause...

glomerulonephritis and rheumatic fever

119

GAS skin infections can cause

only glomerulonephritis

120

GAS TX

Penicillin

121

Amantadine and Memantine are only good for

Influenza A

122

Oseltamavir is good for

both influenza A and B

123

MCC of needed liver transplant in the US

chronic HCV

124

Chronicity of hepatitis is based on which test?

surface antigen

125

Old, healed, past, cured hepatitis has what markesr

core and surface antiBODY

126

e antigen determines in HBV

the degree of transmission

127

IFN MC adverse effect

flu-like symptoms

128

MC adverse effect of Ribavirin

red cell aplasia

129

TX for HCV

IFN and Ribavirin

130

TX for HBV

IFN OR Lamivudine OR Inticavir OR Edefavir