Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
308 Cards in this Set
- Front
- Back
|
What are the principles of answering Infectious Diseases questions?
|
Principles of answering Infectious Diseases Questions are 1. Radiologic test is Never 'Most Accurate test', 2. Risk factors Not as important as Individual Presentation, 3. Beta-Lactam antibiotics have Greater Efficacy than other classes.
|
|
|
What is the overview of Antibiotic classes?
|
Overview of Antibiotic Classes are 1 Beta-Lactam, 2 Fluoroquinolones, 3 Aminoglycosides, 4 Doxycycline, 5 Trimethoprim-Sulfamethoxazole, and 6 BetaLactam-BetaLactamase Combinations
|
|
|
What are Beta-lactam antibiotics?
|
Beta-lactam antibiotics are 1 Penicillins, 2 Cephalosporins, 3 Carbapenems, and 4 Aztreonam
|
|
|
What class of medications are Penicillins, Cephalosporins, Carbapenems, and Aztreonam?
|
Penicillins, Cephalosporins, Carbapenems, and Aztreonam are Beta-lactam antibiotics
|
|
|
What class of medications is Penicillins?
|
Penicillins, Cephalosporins, Carbapenems, and Aztreonam are Beta-lactam antibiotics
|
|
|
What class of medications is Cephalosporins?
|
Penicillins, Cephalosporins, Carbapenems, and Aztreonam are Beta-lactam antibiotics
|
|
|
What class of medications is Carbapenems?
|
Penicillins, Cephalosporins, Carbapenems, and Aztreonam are Beta-lactam antibiotics
|
|
|
What class of medications is Aztreonam?
|
Penicillins, Cephalosporins, Carbapenems, and Aztreonam are Beta-lactam antibiotics
|
|
|
What are various Penicillins?
|
1 Penicillin have G, VK, and benzathine form. 2 Ampicillin and Amoxicillin. 3 Penicillinase-Resistant Penicillins PRPs are Oxacillin, Cloxacillin, Dicloxacillin, and Nafcillin. 4 Piperacillin, Ticarcillin, Azlocillin, and Mezlocillin - Broad Spectrum use. Almost always combine with Beta-Lactamase Inhibitor (Tazobactam or Clavulanic acid)
|
|
|
What forms of Penicillins are there? what do they Tx?
|
AAA - Penicillin have G, VK, and benzathine form. They Tx 1 Viridans group Strep, 2 Strep Pyogenes, 3 Oral Anaerobes, 4 Syphilis, and 5 Leptospira. BBB - Additional Penicillins are Ampicillin and Amoxicillin. Ampicillin and Amoxicillin cover the organisms as penicillins, as well as 1 E coli, 2 Lyme disease, and 3 a few other Gram Negative Bacilli. CCC - Penicillinase-Resistant Penicillins PRPs are Oxacillin, Cloxacillin, Dicloxacillin, and Nafcillin. DDD - Piperacillin, Ticarcillin, Azlocillin, and Mezlocillin Tx Gram Negative Bacilli (eg E coli, Proteus) from Large Enterobacteriaciae group as well as Pseudomonads. They are Broad Spectrum use. Best Initial Tx for 1 Cholecystitis and Ascending Cholangitis, 2 Pyelonephritis, 3 Bacteremia, 4 Hospital-acquired and Ventilator-associated Pneumonia, 5 Neutropenia and Fever. Almost always combine with Beta-Lactamase Inhibitor (Tazobactam or Clavulanic acid)
|
|
|
What are available Penicillins?
|
Available Pencillins are Penicillin (G, VK, Benzathine), Ampicillin, and Amoxicillin
|
|
|
What Gram Negative bacteria covered by Amoxicillin?
|
Gram Negative covered by Amoxicillin are HELPS - H Influenza, E coli, Listeria, Proteus, and Salmonella.
|
|
|
What are Pencillins Best Initial Tx for?
|
Penicillins are Best Initial Tx for 1 Otitis Media, 2 Dental infection and Endocarditis prophylaxis, 3 Lyme disease limited to rash, joint, or seventh cranial nerve involvement, 4 Urinary tract infection UTI in pregnant women, 5 Listeria monocytogenes, and 6 Enterococcal infections.
|
|
|
What are Penicillinase-Resistant penicillins?
|
Penicillinase-Resistant Penicillins PRPs are Oxacillin, Cloxacillin, Dicloxacillin, and Nafcillin.
|
|
|
What do Penicillinase-Resistant penicillins Tx?
|
Penicillinase-Resistant penicillins Tx 1 Skin infections (Cellulitis, Impetigo, Erysipelas), 2 Endocarditis, Meningitis, and Bacteremia from Staph, 3 Osteomyelitis and Septic arthritis only when the organism is proven sensitive. They are Not active against Methicillin-Resistant Staph Aureus (MRSA) or Enterococcus.
|
|
|
What does Methicillin Sensitive or Resistant really means?
|
Methicillin Sensitive or Resistant really means Oxacillin Sensitive or Resistant
|
|
|
When is Methicillin the Right answer?
|
Methicillin is Never the right answer. It causes Renal Failure from Allergic Interstitial Nephritis
|
|
|
What do Piperacillin, Ticarcillin, Azlocillin, and Mezlocillin Tx? What Best Initial Tx for?
|
Piperacillin, Ticarcillin, Azlocillin, and Mezlocillin Tx Gram Negative Bacilli (eg E coli, Proteus) from Large Enterobacteriaciae group as well as Pseudomonads. Best Initial Tx for 1 Cholecystitis and Ascending Cholangitis, 2 Pyelonephritis, 3 Bacteremia, 4 Hospital-acquired and Ventilator-associated Pneumonia, 5 Neutropenia and Fever. Almost always combine with Beta-Lactamase Inhibitor (Tazobactam or Clavulanic acid). Not for use in single organism in Strep and Anaerobes.
|
|
|
What Cephalosporins cover? When to use?
|
Cephalosporins cover Group A, B, C Strep, Viridans group Strep, E coli, Klebsiella, and Proteus Mirabilis. Use when Rash to Penicillin and No Anaphylaxis.
|
|
|
What organisms are Resistant to all Cephalosporins?
|
Cephalosporins resistant organisms are Listeria, MRSA, and Enterococcus
|
|
|
Anaphylaxis to Penicillin Tx?
|
Penicillin Anaphylaxis use Non-Beta-Lactam antibiotic
|
|
|
What are First generation Cephalosporins? Tx?
|
First generation Cephalosporins are 1 Cefazolin, 2 Cephalexin, 3 Cephradrine, and 4 Cefadroxyl. CS 1g Tx - 1 MSSA Staph, 2 Strep (except Enterococcus), 3 Some Gram Negative Bacilli (E coli, but NOT Pseudomonas), 4 Osteomyelitis, Septic Arthritis, Endocarditis, Cellulitis
|
|
|
What is Methicillin Sensitive equal?
|
Methicillin Sensitive = Oxacillin Sensitive = Cephalosporin Sensitive
|
|
|
What are Second generation Cephalosporins? Tx?
|
Second generation Cephalosporins are 1 Cefotetan, 2 Cefoxitin, 3 Cefaclor, 4 Cefprozil, 5 Cefuroxime, 6 Loracarbef. CS 1g coverage + Anaerobes + More Gram Negative Bacilli
|
|
|
What class is Cefotetan or Cefoxitin in? What dz is Cefotetan or Cefoxitin Best Initial Tx? AE?
|
Cefotetan or Cefoxitin are Cefalosporin 2g. Cefotetan or Cefoxitin is Best Initial Tx for Pelvic Inflammatory dz (PID) combined with Doxycycline. Cefotetan and Cefoxitin Increase Risk of Bleeding and Give a Disulfiramlike Reaction with Alcohol.
|
|
|
What class is Cefaclor, Cefprozil, Cefuroxime, and Loracarbef? Tx for?
|
Cefaclor, Cefprozil, Cefuroxime, and Loracarbef are Cefalosporin 2g. They Tx Respiratory Infections (Bronchitis, Otitis Media, and Sinusitis)
|
|
|
What are Third generation Cephalosporins? Tx?
|
Third generation Cephalosporins are Ceftriaxone, Cefotaxime, Ceftazidime.
|
|
|
What class is Ceftriaxone? Tx for? AE?
|
Ceftriaxone is Cephalosporin 3g. Ceftriaxone is First-line for 1 Pneumococcus (including Partially Insensitive Organisms), 2 Meningitis, 3 Community-Acquired Pneumonia (in Combination with Macrolides), 4 Gonorrhea, 5 Lyme involving the Heart or Brain. Avoid Ceftriaxone in Neonates because of Impaired Biliary Metabolism.
|
|
|
What class is Cefotaxime? Tx for? AE?
|
Cefotaxime is Cephalosporin 3g. Cefotaxime is 1 Superior to Ceftriaxone in Neonates, and 2 Tx Spontaneous Bacterial Peritonitis.
|
|
|
What are Fourth generation Cephalosporins? Tx?
|
Fourth generation Cephalosporins is Cefepime. Cefepime has Better Staph Coverage compared with CS 3g. Cefepime Tx 1 Neutropenia and Fever, 2 Ventilator-Associated Pneumonia.
|
|
|
What class is Cefepime? Tx for?
|
Cefepime is Cephalosporin 4g. Cefepime has Better Staph Coverage compared with CS 3g. Cefepime Tx 1 Neutropenia and Fever, 2 Ventilator-Associated Pneumonia.
|
|
|
What class is Ceftazidime? Tx for? AE?
|
Ceftazidime has Pseudomonal Coverage
|
|
|
What class is Cefazolin?
|
Cefazolin is Cephalosporin 1g.
|
|
|
What class is Cephalexin?
|
Cephalexin is Cephalosporin 1g.
|
|
|
What class is Cephradrine?
|
Cephradrine is Cephalosporin 1g.
|
|
|
What class is Cefadroxyl?
|
Cefadroxyl is Cephalosporin 1g.
|
|
|
What class is Cefotetan?
|
Cefotetan is Cephalosporin 2g.
|
|
|
What class is Cefoxitine?
|
Cefoxitine is Cephalosporin 2g.
|
|
|
What class is Cefaclor?
|
Cefaclor is Cephalosporin 2g.
|
|
|
What class is Cefprozil?
|
Cefprozil is Cephalosporin 2g.
|
|
|
What class is Cefuroxime?
|
Cefuroxime is Cephalosporin 2g.
|
|
|
What class is Loracarbef?
|
Loracarbef is Cephalosporin 2g.
|
|
|
What class is Ceftriaxone?
|
Ceftriaxone is Cephalosporin 3g.
|
|
|
What class is Cefotaxime?
|
Cefoaxime is Cephalosporin 3g.
|
|
|
What class is Ceftazidime?
|
Ceftazidime is Cephalosporin 3g.
|
|
|
What class is Cefepime?
|
Cefepime is Cephalosporin 4g.
|
|
|
What is Cephalosporins Adverse Effect? What med generation?
|
Cefoxitine and Cefotetan are 2g Deplete Prothrombin and Increase Risk of Bleeding. Ceftriaxone 3g cause Inadequate Biliary Metabolism.
|
|
|
What are Carbapenems med? Tx?
|
Carbapenems are 1 Imipenem, 2 Meropenem, 3 Ertapenem, 4 Doripenem. Carbapenems cover Gram Negative Bacilli, including many that are Resistant, Anaerobes, Strep, and Staph. Tx Neutropenia and Fever.
|
|
|
What is unique about Ertapenem?
|
Ertapenem is the only Carbapenems that does NOT cover Pseudomonas.
|
|
|
What is Monobactam med? Tx?
|
Aztrenam is the only Monobactam. Tx Exclusively for Gram Negative Bacilli (Include Pseudomonas). No Cross-Reaction with Penicillin
|
|
|
What are Fluoroquinolones med? Tx?
|
Fluoroquinolones are 1 Ciprofloxacin, 2 Gemifloxacin, 3 Levofloxacin, 4 Moxifloxacin. Fluoroquinolones are 1 Best Tx for Community-Acquired Pneumonia (include Penicillin-Resistant Pneumococcus), 2 Gram Negative Bacilli (include Pseudomonads), 3 Ciprofloxacin for Cystitis and Pyelonephritis (Moxifloxacin will not enter urine in High Concentration), 4 Diverticulitis and GI infection (but Ciprofloxacin, Gemifloxacin, and Levofloxacin must Combined with Metronidazole because they Do NOT cover Anaerobes (except Moxifloxacin - Moxifloxacin can be used as Single agent for Diverticulitis).
|
|
|
What is AE of Fluoroquinolones?
|
Quinolones cause 1 Bone Growth Abnormalities in Children and Preg women, 2 Tendonitis and Achilles Tendon Rupture, 3 Gatifloxacin Removed because Glucose Abnormalities
|
|
|
What are Aminoglycosides med? Tx? AE?
|
Aminoglycosides are 1 Gentamicin, 2 Tobramycin, and 3 Amikacin. Aminoglycosides Tx 1 Gram Negative Bacilli (Bowel, Urine, Bacteremia), 2 Synergistic with Beta-Lactam antibiotics for enterococci and Staph, 3 No Effect Against Anaerobes (since they Need Oxygen to work). Aminoglycosides AE Nephrotoxic and Ototoxic.
|
|
|
What is Doxycycline Tx for? AE?
|
Doxycycline is Tx for 1 Chlamydia, 2 Lyme dz (limited to Rash, Joint, or Seventh Cranial Nerve Palsy), 3 Rickettsia, 4 Primary and Secondary Syphilis in those Allergic to Penicillin, 5 Borrelia, Ehrlichia, and Mycoplasma. AE - 1 Tooth Discoloration (Children), 2 Fanconi Syndrome (Type 2 RTA Proximal), 3 Photosensitivity, 4 Esophagitis-Ulcer
|
|
|
What is Trimethoprim-Sulfamethoxazole Tx for? AE?
|
Trimethoprim-Sulfamethoxazole is Tx for 1 Cystitis, 2 Pneumocystis Pneumonia Tx and Prophylaxis, 3 MRSA of Skin and Soft Tissue (Cellulitis). AE - 1 Rash, 2 Hemolysis with G6PD deficiency, 3 Bone Marrow Suppression (it is Folate Antagonist)
|
|
|
What are BetaLactam-BetaLactamase Combinations?
|
BetaLactam-BetaLactamase Combinations are 1 Amoxicillin-Clavulanate, 2 Ticarcillin-Clavulanate, 3 Ampicillin-Sulbactam, 4 Piperacillin-Tazobactam. Beta Lactamase Adds Coverage against Sensitive Staph to these agents.
|
|
|
What are Gram Positive Cocci?
|
Gram Positive Cocci are Staph and Strep
|
|
|
What is the Best Initial Tx for Gram Positive Cocci?
|
The Best Initial Tx for Gram Positive Cocci (Staph and Strep) are 1 Oxacillin, Cloxacillin, Dicloxacillin, Nafcillin, 2 First Generation Cephalosporins (Cefazolin, Cephalexin), 3 Fluoroquinolones, 4 Macrolides (Azithromycin, Clarithromycin, Erythromycin) are Third-line agents because they have Less Efficacy than Oxacillin or Cephalosporins and Erythromycin is More Toxic.
|
|
|
What are Methicillin Resistant Staph Tx?
|
Methicillin-Oxacillin Resistant Staph is Best Tx with 1 Vancomycin, 2 Linezolid (Reversible Bone Marrow Toxicity), 3 Daptomycin (Elevated CPK), 4 Tigecycline
|
|
|
What are Minor MRSA infections of Skin Tx?
|
Minor MRSA infections of Skin Tx are 1 TMP-SMX, 2 Clindamycin, 3 Doxycycline
|
|
|
What are Anaerobes Tx?
|
Anaerobes Tx 1 Oral - Above Diaphragm - Penicillin (G, VK, Ampicillin, Amoxicillin), and Clindamycin, 2 ABdominal-GastroIntestinal - Metronidazole. 3 Pipercillin, Carbapenems, and Second Generation Cephalosporins also Cover Anaerobes.
|
|
|
What are Gram Negative Bacilli?
|
Gram Negative Bacilli are 1 E Coli, 2 Klebsiella, 3 Proteus, 4 Pseudomonas, 5 Enterobacter, 6 Citrobacter
|
|
|
What kind of infection do Gram Negative Bacilli cause? Tx?
|
Gram Negative Bacilli (1 E Coli, 2 Klebsiella, 3 Proteus, 4 Pseudomonas, 5 Enterobacter, 6 Citrobacter) cause infections of 1 Bowel (Peritonitis, Diverticulitis), 2 Urinary Tract (Pyelonephritis), and 3 Liver (Cholecystitis, Cholangitis). Gram Negative Bacilli Tx are 1 Quinolones, 2 Aminoglycosides, 3 Carbapenems, 4 Piperacillin, Ticarcillin, 5 Aztreonam, 6 Cephalosporins.
|
|
|
What are general presentation of CNS infections?
|
General presentation of CNS infections may have 1 Fever, 2 Headache, 3 Nausea, 4 Vomiting, 5 Seizure
|
|
|
Symptoms of Stiff Neck, Photophobia, Meningismus. Most likely Dx?
|
Symptoms of Stiff Neck, Photophobia, Meningismus. Most likely Dx - Meningitis
|
|
|
Symptoms of Confusion. Most likely Dx?
|
Symptoms of Confusion. Most likely Dx - Encephalitis
|
|
|
Symptoms of Focal Neurological Findings. Most likely Dx?
|
Symptoms of Focal Neurological Findings. Most likely Dx - Abscess
|
|
|
What are most common causes of Meningitis?
|
Most common causes of Meningitis are 1 Strep Pneumonia (60perc), 2 Group B Strep (14perc), 3 H Influenzae (7perc), 4 Neisseria Meningitidis (15perc), 5 Listeria (2perc). Staph - Recent Neurosurgery.
|
|
|
What presentations to look for in Meningitis?
|
In Meningitis, look for 1 Fever, 2 Headache, 3 Neck Stiffness (Nuchal Rigidity), and 4 Photophobia. Bacterial meningitis over several hours. Focal Neurological abnormalities in 30 perc. With Confusion, do CT or Lumbar Puncture. Cryptococcal meningitis present for Several Weeks.
|
|
|
AIDS with Less than 100 CD4 cell per uL. Most Likely Dx?
|
AIDS with Less than 100 CD4 cell per uL. Most Likely Dx - Cryptococcus
|
|
|
1 Camper-Hiker, 2 Rash Shaped like a Target, 3 Joint pain, 4 Facial Palsy. Most Likely Dx?
|
1 Camper-Hiker, 2 Rash Shaped like a Target, 3 Joint pain, 4 Facial Palsy. Most Likely Dx - Lyme disease. Tick remembered in 20 perc.
|
|
|
1 Camper-hiker, 2 Rash Moves from Arms-Legs to Trunk. Most Likely Dx?
|
1 Camper-hiker, 2 Rash Moves from Arms-Legs to Trunk. Most Likely Dx - Rocky Mountain Spotted Fever (Rickettsia). Tick remembered in 60 perc.
|
|
|
Pulmonary TB in 85 perc. Most Likely Dx?
|
Pulmonary TB in 85 perc. Most Likely Dx - Tuberculosis
|
|
|
No Presentation. Most Likely Dx?
|
No Presentation. Most Likely Dx - Viral.
|
|
|
1 Adolescent, 2 Petechial Rash. Most Likely Dx?
|
1 Adolescent, 2 Petechial Rash. Most Likely Dx - Neisseria
|
|
|
Meningitis suspected. Best initial and Most Accurate Lx?
|
Meningitis suspected. Best initial and Most Accurate Lx are Lumbar Puncture for both.
|
|
|
Bacterial Meningitis. CSF evaluation?
|
Bacterial Meningitis. CSF evaluation - Cell Counts 1000s Neutrophils, Protein Level Elevated, Glucose Level Decreased, Stain 50 to 70 perc, Culutre 90 perc.
|
|
|
Cryptococcus Meningitis. CSF evaluation?
|
Cryptococcus, Lyme, Rickettsia Meningitis. CSF evaluation - Cell Counts 10 to 100s Lymphocytes, Protein Level Possibly Elevated, Glucose Level Possibly Decreased, Stain and Culutre Negative.
|
|
|
Lyme Meningitis. CSF evaluation?
|
Cryptococcus, Lyme, Rickettsia Meningitis. CSF evaluation - Cell Counts 10 to 100s Lymphocytes, Protein Level Possibly Elevated, Glucose Level Possibly Decreased, Stain and Culutre Negative.
|
|
|
Rickettsia Meningitis. CSF evaluation?
|
Cryptococcus, Lyme, Rickettsia Meningitis. CSF evaluation - Cell Counts 10 to 100s Lymphocytes, Protein Level Possibly Elevated, Glucose Level Possibly Decreased, Stain and Culutre Negative.
|
|
|
Tuberculosis Meningitis. CSF evaluation?
|
Tuberculosis Meningitis. CSF evaluation - Cell Counts 10 to 100s Lymphocytes, Protein Level Markedly Elevated, Glucose Level May be Low, Stain and Culutre Negative.
|
|
|
Viral Meningitis. CSF evaluation?
|
Tuberculosis Meningitis. CSF evaluation - Cell Counts 10 to 100s Lymphocytes, Protein Level Usually Normal, Glucose Level Usually Normal, Stain and Culutre Negative.
|
|
|
In suspected Meningitis, When is Head CT the Best Initial Lx?
|
In suspected Meningitis, Head CT the Best Initial Lx when any of these present - 1 Papilledema, 2 Seizures, 3 Focal Neurological Abnormalities, 4 Confusion interfering with Neurological Exam
|
|
|
In suspected Meningitis, When Immediate Lumber Puncture is ContraIndicated, Next Step?
|
In suspected Meningitis, When Immediate Lumber Puncture is ContraIndicated, Next Step - Give Antibiotics (better to Tx and Decrease Accuracy of a test than risk Permanent Brain Damage)
|
|
|
What is Latex Agglutination Test? When is it Indicated?
|
Latex Agglutination Test is same as Bacterial Antigen Detection. They are similar to Gram Stain. If Antigen detection is Positive, they are Extremely Specific (SPin - pos In). Indicated when Pt has Received Antibiotics Prior to Lumbar Puncture and Culutre may be Falsely Negative.
|
|
|
Tuberculosis Meningitis. Most Accurate Lx?
|
Tuberculosis Meningitis. Most Accurate Lx - Acid Fast Stain and Culture on 3 High-Volume Lumbar Puncture Centrifuged. TB has Highest CSF Protein level.
|
|
|
Lyme Meningitis. Most Accurate Lx?
|
Lyme and Rickettsia Meningitis. Most Accurate Lx - 1 Specific Serologic Testing, 2 ELISA, 3 Western Blot, 4 PCR.
|
|
|
Rickettsia Meningitis. Most Accurate Lx?
|
Lyme and Rickettsia Meningitis. Most Accurate Lx - 1 Specific Serologic Testing, 2 ELISA, 3 Western Blot, 4 PCR.
|
|
|
Cryptococcus Meningitis. Most Accurate Lx?
|
Cryptococcus Meningitis. Most Accurate Lx - India Ink is 60-70 perc Sensitive. Cryptococcal Antigen is more than 95 perc Sensitive and Specific
|
|
|
Viral Meningitis. Most Accurate Lx?
|
Viral Meningitis. Diagnosis of Exclusion.
|
|
|
Bacterial Meningitis. Best Initial Tx? What is the Tx based on?
|
Bacterial Meningitis. Best Initial Tx - 1 Ceftriaxone, 2 Vancomycin, and 3 Steroids. Tx based on Cell Count and Neutrophils (Culture takes 2-3 days. Gram Stain is Good if Positive. Protein and Glucose Levels NonSpecific.)
|
|
|
Thousands of Neutrophils on CSF. Tx?
|
Thousands of Neutrophils on CSF. Tx - 1 Ceftriaxone, 2 Vancomycin, and 3 Steroid. Add Ampicillin if Immunocompromised for Listeria.
|
|
|
What are the Risk Factors for Listeria?
|
Risk Factors for Listeria - 1 Elderly, 2 Neonates, 3 Steroid use, 4 AIDS or HIV, 5 Immunocompromised (including Alcoholism), 6 Pregnant.
|
|
|
What med is Listeria Resistant? Sensitive?
|
Listeria Resistant to All Cephalosporins. Sensitive to Penicillins
|
|
|
Neisseria Meningitidis. Additional Management?
|
Neisseria Meningitidis. Additional Management - 1 Respiratory Isolation, 2 Rifampin or Ciprofloxacin to Close Contacts to Decrease Nasopharyngeal Carriage. Close Contact - Naspharyngeal fluid contact, eating utensil sharing, sharing cigarettes
|
|
|
What is the Most Common Neurological Deficit of UnTx Bacterial Meningitis?
|
Most Common Neurological Deficit of UnTx Bacterial Meningitis - Eighth Cranial Nerve Deficit or Deafness
|
|
|
Acute Onset of Fever and Confusion. Dx? Most Common Cause? Lx Initial and Most Accurate? Tx?
|
Acute Onset of Fever and Confusion. Dx - Encephalitis. Most Common Cause - Herpes Simplex. Lx Initial - Head CT for Confusion and Lx Most Accurate - PCR of CSF (Brain Biopsy less accurate). Tx - Acyclovir is Best Initial Tx. Famciclovir and Valacyclovir are Not Available as IV. Foscarnet - Acyclovir-Resistant Herpes.
|
|
|
For Herpes infection, when to use PCR of CSF? Tzanck prep? Viral Culture?
|
For Herpes infection, Use PCR of CSF - Herpes Simplex Encepalitis. Tzanck prep - Initial test on a Genital Ulcerative lesion. Viral Culture - Most Accurate test of Genital or Skin Lesions.
|
|
|
Herpes Encephalitis Confirmed by PCR. After 4 days of Acyclovir, pt Creatinine level begins to Rise. Next Step?
|
Herpes Encephalitis Confirmed by PCR. After 4 days of Acyclovir, pt Creatinine level begins to Rise. Next Step - Reduce Acyclovir-Resistant Herpes and Hydrate. Famciclovir and Valacyclovir are Insufficient for Herpes Encephalitis. Foscarnet has far more Renal Toxicity.
|
|
|
Redness, Immobility, Bulging, and a Decreased Light Reflex of Tympanic membrane. Dx? Most Accurate Lx? When to do Most Accurate Lx? Tx?
|
Redness, Immobility, Bulging, and a Decreased Light Reflex of Tympanic membrane. Dx - Otitis Media. Pain is common. Decreased Hearing and Fever also occur. Most Accurate Lx - Tympanocentesis if 1 Multiple Recurrences or 2 No Response to Multiple Antibiotics. Best Initial Tx - Amoxicillin. If No Response to Amoxicillin, 1 Amoxicillin-Clavulanate, 2 Azithromycin, Clarithromycin, 3 Cefuroxime, Loracarbef, 4 Levofloxacin, Gemifloxacin, Moxifloxacin
|
|
|
What is Otitis Media Presentation?
|
Otitis Media presents with 1 Redness, 2 Immobility, 3 Bulging, and a 4 Decreased Light Reflex of Tympanic membrane. 5 Pain is common. 6 Decreased Hearing and 7 Fever also occur.
|
|
|
What is Most Sensitive Physical finding for Otitis Media?
|
Most Sensitive Physical finding for Otitis Media - Immobility of Tympanic membrane.
|
|
|
Otitis Media Tx with Amoxicillin. Next Step? Tx in Children?
|
No Response to Amoxicillin, next step - 1 Amoxicillin-Clavulanate, 2 Azithromycin, Clarithromycin, 3 Cefuroxime, Loracarbef, 4 Levofloxacin, Gemifloxacin, Moxifloxacin (Quinolones are Relatively Contraindicated in Children)
|
|
|
Facial pain, Discolored Nasal Discharge, Bad Taste in the Mouth, and Fever. Dx? Most Accurate Lx? Next Step?
|
Facial pain, Discolored Nasal Discharge, Bad Taste in the Mouth, and Fever. Dx - Sinusitis. Most Accurate Lx - Sinus Biopsy or Aspirate. Next Step - Amoxicillin and Decongestant. Amoxicillin, Doxycycline, and TMP-SMX are First line Tx for both Otitis and Sinusitis. Imaging is done if Dx is Equivocal. Decongestant - Promote Sinus Drainage.
|
|
|
When to do Biopsy in Sinusitis?
|
Biopsy in Sinusitis if 1 Infection Frequently Recurs, 2 No Response to Different Empiric Therapies.
|
|
|
What are the first line therapy for both Otitis and Sinusitis?
|
The first line therapy for both Otitis and Sinusitis are 1 Amoxicillin, 2 Doxycycline, and 3 TMP-SMX
|
|
|
What is the purpose of Decongestant? Used in what Dx?
|
Decongestant is used in all cases to promote Sinus Drainage in Sinusitis.
|
|
|
1 Pain on Swallowing, 2 Enlarged Lymph Node in the Neck, 3 Exudate in pharynx, and 4 Fever. No Cough, nor Hoarseness. Dx? Most likely Cause? Lx? Tx?
|
1 Pain on Swallowing, 2 Enlarged Lymph Node in the Neck, 3 Exudate in pharynx, and 4 Fever. No Cough, nor Hoarseness. Dx - Pharyngitis. Most likely Cause - Strep exceeds 90perc. Lx - Best Initial Lx - Rapid Strep Test for Group A Beta Hemolytic Strep. Positive Rapid Strep test = Positive Pharyngeal Culture. Tx - Amoxicillin is Best Initial. Penicillin Allergic pt with Rash - Tx Cephalexin. Penicillin Allergic pt with Anaphylaxis - Tx Clindamycin or Macrolide.
|
|
|
Small Vesicles or Ulcers. Suggested Dx?
|
Small Vesicles or Ulcers. Suggested Dx - 1 HSV or 2 Herpangina
|
|
|
Membranous Exudates. Suggested Dx?
|
Membranous Exudates. Suggested Dx - 1 Diphtheria, 2 Vincent Angina, or 3 EBV
|
|
|
Pharyngitis Presentation? Most likely Cause? Lx - Best Initial Lx? Tx? Penicillin Allergic pt Tx?
|
Pharyngitis presents with - 1 Pain on Swallowing, 2 Enlarged Lymph Node in the Neck, 3 Exudate in pharynx, and 4 Fever. No Cough, nor Hoarseness. Most likely Cause - Strep exceeds 90perc. Lx - Best Initial Lx - Rapid Strep Test for Group A Beta Hemolytic Strep. Positive Rapid Strep test = Positive Pharyngeal Culture. Tx - Amoxicillin is Best Initial. Penicillin Allergic pt with Rash - Tx Cephalexin. Penicillin Allergic pt with Anaphylaxis - Tx Clindamycin or Macrolide.
|
|
|
Why is Strep Pharyngitis Tx to Prevent?
|
Strep Pharyngitis Tx to Prevent Rheumatic Fever.
|
|
|
1 Arthralgias-Myalgias, 2 Cough, 3 Fever, 4 Headache and Sore Throat, 5 Nausea, Vomiting, or Diarrhea, especially in Children. Dx? Next Step? Tx?
|
1 Arthralgias-Myalgias, 2 Cough, 3 Fever, 4 Headache and Sore Throat, 5 Nausea, Vomiting, or Diarrhea, especially in Children. Dx - InFLUenza. Next Step - within 48 hrs since onset of symptoms - Perform a Nasopharyngeal Swab or Wash to Rapidly Detect Antigen Associated with Influenza. Tx - Less than 48 hrs of symptoms - 1 Oseltamivir, 2 Zanamivir - Neuraminidase inhibitors (shorten duration of symptoms - tx influenza A and B). Tx - More than 48 hrs of symptoms - Symptomatic Tx - 1 Analgesics, 2 Rest, 3 Antipyretics, 4 Hydration.
|
|
|
What is presentation of Influenza. Next Step? Tx?
|
Influenza presents with - 1 Arthralgias-Myalgias, 2 Cough, 3 Fever, 4 Headache and Sore Throat, 5 Nausea, Vomiting, or Diarrhea, especially in Children. Dx - InFLUenza. Next Step - within 48 hrs since onset of symptoms - Perform a Nasopharyngeal Swab or Wash to Rapidly Detect Antigen Associated with Influenza. Tx - Less than 48 hrs of symptoms - 1 Oseltamivir, 2 Zanamivir - Neuraminidase inhibitors (shorten duration of symptoms - tx influenza A and B). Tx - More than 48 hrs of symptoms - Symptomatic Tx - 1 Analgesics, 2 Rest, 3 Antipyretics, 4 Hydration.
|
|
|
What is Important Marker of Infectious Diarrhea? What Infectious Diarrhea cause has Blood and WBC in Stool? Best Initial Lx? Most Accurate Lx? Tx?
|
Important Marker of Infectious Diarrhea - Blood and WBC in Stool. Infectious Diarrhea cause with Blood and WBC in Stool - 1 Salmonella-Poultry, 2 Campylobacter-most common cause, asso with GBS, 3 E Coli 0157-H7 - Hemolytic Uremic Syndrome (HUS), 4 Shigella - Second Most Common asso with HUS, 5 Vibrio Parahaemolyticus - Shellfish and Cruise ships, 6 Vibrio Vulnificus - Shellfish, History of Liver Disease, Skin lesions, 7 Yersinia - High Affinity for Iron, Hemochromatosis, Blood Transfusions, 8 Clostridium Difficile - White and Red Cells in Stool. Best Initial Lx - Blood and_or Fecal Leukocytes. Lactoferrin is better than Fecal Leukocytes. Most Accurate Lx - Stool Culture. Tx - mild disease - Oral Fluid Replacement, Tx - Severe disease - Fluid Replacement and Oral Antibiotics, such as Ciprofloxacin.
|
|
|
What Infectious Diarrhea cause with No Blood or WBC in Stool? Tx?
|
Infectious Diarrhea cause with No Blood or WBC in Stool - 1 Viral, 2 Giardia - Camping-Hiking and Unfiltered Fresh Water, 3 Cryptosporidiosis - AIDS with less than 100 CD4 cells, detect with Modified Acid Fast Stain, 4 Bacillus Cereus - Vomiting, 5 Staph - Vomiting. Tx - mild disease - Oral Fluid Replacement, Tx - Severe disease - Fluid Replacement and Oral Antibiotics, such as Ciprofloxacin.
|
|
|
What is Scombroid? Presentation? Tx?
|
Scombroid is fish poisoning. 1 Most Rapid Onset, 2 Wheezing, Flushing, Rash, 3 Found in Fish. Tx - Antihistamines
|
|
|
What is Severe Infectious Diarrhea?
|
Severe Infectious Diarrhea - 1 Hypotension, 2 Tachycardia, 3 Fever, 4 Abdominal Pain, 5 Bloody Diarrhea, 6 Metabolic Acidosis
|
|
|
Giardia diarrhea Tx?
|
Giardia Diarrhea Tx - 1 Metronidazole, 2 Tinidazole
|
|
|
Cryptosporidiosis diarrhea Tx?
|
Cryptosporidiosis Diarrhea Tx - 1 Underlying AIDS, 2 Nitazoxanide
|
|
|
Viral Diarrhea Tx?
|
Viral Diarrhea Tx - Fluid Support as Needed
|
|
|
B Cereus and Staph Diarrhea Tx?
|
B Cereus and Staph Diarrhea Tx - Fluid Support as Needed
|
|
|
What is most cases of Acute Hepatitis from?
|
Most cases of Acute Hepatitis is from Hepatitis A or B.
|
|
|
What Hepatitis is Rarely presents with An Acute infection?
|
Hepatitis Rarely presents with An Acute infection is Hepatitis C.
|
|
|
What Hepatitis Exists Exclusively in presents of another Hepatitis?
|
Hepatitis D Exists Exclusively in Active Viral Replication of Hepatitis B.
|
|
|
What Hepatitis is Worst in Pregnancy?
|
Hepatitis Worst in Pregnancy is Hepatitis E, especially among East Asian patients.
|
|
|
When is Hepatitis E the worse?
|
Hepatitis E is the worse in Pregnancy.
|
|
|
What Hepatitis transmit through Sex, Blood, Perinatal (Parenteral)?
|
Hepatitis transmit through Sex, Blood, Perinatal (Parenteral) are Hepatitis 1 B, 2 C, and 3 D.
|
|
|
How is Hepatitis B transmitted?
|
Hepatitis B transmitted by 1 Sex, 2 Blood, 3 Perinatal (Parenteral)
|
|
|
How is Hepatitis C transmitted?
|
Hepatitis C transmitted by 1 Sex, 2 Blood, 3 Perinatal (Parenteral)
|
|
|
How is Hepatitis D transmitted?
|
Hepatitis D transmitted by 1 Sex, 2 Blood, 3 Perinatal (Parenteral)
|
|
|
What Hepatitis is transmitted by Food and Water (Enteric)?
|
Hepatitis transmitted by Food and Water (Enteric) is Hepatitis 1 A and 2 E
|
|
|
How is Hepatitis A transmitted?
|
Hepatitis A transmitted by 1 Food, and 2 Water (Enteric). Ate Hep A, Eat Hep E
|
|
|
How is Hepatitis E transmitted?
|
Hepatitis E transmitted by 1 Food, and 2 Water (Enteric). Ate Hep A, Eat Hep E
|
|
|
Acute Hepatitis Px? Lx? Tx?
|
Acute Hepatitis Px - All forms of Acute Hepatitis Present with - 1 Jaundice, 2 Fever, Weight Loss, and Fatigue, 3 Dark Urine, 4 Hepatosplenomegaly, 5 Nausea, Vomiting, Abdominal Pain. Lx - 1 Increased Direct Bilirubin, 2 Increased Ratio of Alanine Aminotransferase (ALT) to Aspartate Aminotransferase (AST), 3 Increased Alkaline Phosphatase. Tx - Only Hepatitis C - Interferon and Ribavirin to Decrease developing Chronic infection.
|
|
|
What do all forms of Acute Hepatitis Present with?
|
All forms of Acute Hepatitis Present with - 1 Jaundice, 2 Fever, Weight Loss, and Fatigue, 3 Dark Urine, 4 Hepatosplenomegaly, 5 Nausea, Vomiting, Abdominal Pain.
|
|
|
In Acute Hepatitis Lx, What correlates Best with an Increased Likelihood of Mortality?
|
In Acute Hepatitis Lx, an Increased Likelihood of Mortality correlates Best with Prothrombin Time PT. Elevated PT Increased risk of Fulminant Hepatic Failure and Death.
|
|
|
Hepatitis A, C, D, and E. Lx - Best Initial?
|
Hepatitis A, C, D, and E. Lx - Best Initial - IgM Antibody for Acute Infection, and IgG Antibody to detect Resolution of Infection.
|
|
|
Hepatitis C, Lx to assess Disease Activity?
|
Hepatitis C, Lx to assess Disease Activity - PCR for RNA level for Amount of Active Viral Replication. RNA decrease with Tx improvement.
|
|
|
Hepatitis B, What Lx markers to look for?
|
Hepatitis B, Lx Markers to look for 1 Surface Antigen, 2 e-Antigen, 3 Core Antibody, and 4 Surface Antibody
|
|
|
Hepatitis B, Lx Serologic Pattern for Acute or Chronic Infection? Resolved, Old, Past Infection? Vaccination? Window Period?
|
Hepatitis B, Lx for Acute or Chronic Infection - 1 Positive Surface Antigen, 2 Positive e-Antigen, 3 Positive IgM or IgG Core Antibody, 4 Negative Surface Antibody. Resolved, Old, Past Infection - 1 Negative Surface Antigen, 2 Negative e-Antigen, 3 Positive IgG Core Antibody, 4 Positive Surface Antibody. Vaccination - 1 Negative Surface Antigen, 2 Negative e-Antigen, 3 Negative Core Antibody, 4 Positive Surface Antibody. Window Period - 1 Negative Surface Antigen, 2 Negative e-Antigen, 3 Positive IgM, then IgG Core Antibody, 4 Negative Surface Antibody.
|
|
|
Hepatitis B, Lx Serologic Pattern for Acute or Chronic Infection?
|
Hepatitis B, Lx for Acute or Chronic Infection - 1 Positive Surface Antigen, 2 Positive e-Antigen, 3 Positive IgM or IgG Core Antibody, 4 Negative Surface Antibody.
|
|
|
Hepatitis B, Lx Serologic Pattern for Resolved, Old, Past Infection?
|
Hepatitis B, Lx for Resolved, Old, Past Infection - 1 Negative Surface Antigen, 2 Negative e-Antigen, 3 Positive IgG Core Antibody, 4 Positive Surface Antibody.
|
|
|
Hepatitis B, Lx Serologic Pattern for Vaccination?
|
Hepatitis B, Lx for Vaccination - 1 Negative Surface Antigen, 2 Negative e-Antigen, 3 Negative Core Antibody, 4 Positive Surface Antibody.
|
|
|
Hepatitis B, Lx Serologic Pattern for Window Period?
|
Hepatitis B, Lx for Window Period - 1 Negative Surface Antigen, 2 Negative e-Antigen, 3 Positive IgM, then IgG Core Antibody, 4 Negative Surface Antibody.
|
|
|
In Hepatitis B, what serologic marker will become Abnormal First after Acquiring infection?
|
In Hepatitis B, serologic marker will become Abnormal First after Acquiring infection - Surface Antigen - a Measure of Actual Viral Particles - Viral Replication or Infection. Bilirubin, ALT, and Antibody production are a Measure of Bodys Response to infection.
|
|
|
In Hepatitis B, what serologic marker is Most Direct Correlate with Amount, or Quantity of Active Viral Replication?
|
In Hepatitis B, serologic marker is Most Direct Correlate with Amount, or Quantity of Active Viral Replication - e-Antigen - High level of DNA Polymerase activity.
|
|
|
In Hepatitis B, what marker indicates that a patient is No Longer a risk for transmitting infection to another person?
|
In Hepatitis B, what marker indicates that a patient is No Longer a risk for transmitting infection to another person (Active Infection Resolved) - No Surface Antigen. Tranmissibility Ceases when DNA Polymerase Ceases, Not when Surface Antibody appears. Jaundice (Increased Bilirubin) and Elevated ALT will Normalize long before Viral Replication Stops. e-Antibody will appear Prior to Resolution of all DNA Polymerase activity - Acute infection is Moving toward Resolution, but Does Not prove resolution has Occured
|
|
|
In Hepatitis B, what is the Best indication of the Need for Tx with Antiviral Medications in Chronic disease?
|
In Hepatitis B, the Best indication of the Need for Tx with Antiviral Medications in Chronic disease - e-Antigen - the person Most likely to benefit from antiviral med has the Greatest Degree of Active Viral Replication. E-Antigen is Strongest indicator of Active Viral Replication. Although Surface Antigen means there is at Least some Active disease, it might be on the way to spontaneous resolution and would not benefit. Everyone with e-Antigen also has Surface Antigen. The person with Worst Disease (highest DNA Polymerase) will benefit the most from Tx.
|
|
|
In Hepatitis B, what is the Best indication that a Pregnant Woman will Transmit infection to her child?
|
In Hepatitis B, the Best indication that a Pregnant Woman will Transmit infection to her child - e-Antigen - Qualitative test of DNA Polymerase presence. Pregnant woman is Positive Surface Antigen and Negative e-Antigen, only 10 perc of children will become infected. When Both Surface Antigen and e-Antigen are Positive, 90 perc of children will be infected at birth. Perinatal Transmission is Most Common method of Transmission Worldwide.
|
|
|
What Hepatitis Resolve Spontaneously?
|
Hepatitis Resolve Spontaneously - Hep 1 A and 2 E Resolve Spontaneously over a Few Weeks and are almost always Benign. Hep B becomes Chronic in 10 perc of patients and no form treatment helps. Only Acute Hepatitis C get medical Tx.
|
|
|
What is a Rare complication of Acute Hepatitis?
|
A Rare complication of Acute Hepatitis - Aplastic Anemia.
|
|
|
p21
|
|
|
|
What is definition of Chronicity? Which Hepatitis?
|
For Hepatitis B, Chronicity is define as Persistence of Surface Antigen for More than 6 Months.
|
|
|
In Hepatitis B, what is Chronicity? When to Tx? Tx? AE?
|
In Hepatitis B, Chronicity is define as Persistence of Surface Antigen for More than 6 months. If these pt are Positive for e-Antigen with an Elevated level of DNA Polymerase, Tx is any of 1 Entecavir, 2 Adefovir, 3 Lamivudine, 4 Telbivudine, 5 Interferon, or 6 Tenofovir. Interferon has Most Adverse Effect - so Not First Choice.
|
|
|
Interferon AE?
|
Interferon AE - 1 Arthralgia-Myalgia, 2 Leukopenia and Thrombocytopenia, 3 Depression and Flu-like Symptoms.
|
|
|
What is the Goal of Chronic Hepatitis Tx?
|
Goal of Chronic Hepatitis Tx - 1 Reduce DNA Polymerase to Undetectable levels, 2 Convert those pt with e-Antigen to having Anti-Hepatitis e-Antibody.
|
|
|
What is the Role of Liver Biopsy?
|
Liver Biopsy showing Presence of Fibrosis is a Strong Indication to Begin Therapy for either Hepatitis B or C right away. If there is Active Viral Replication, Fibrosis will Progress to Cirrhosis. Cirrhosis is Not Reversible.
|
|
|
What cause Liver Cirrhosis?
|
Liver Fibrosis with Active Viral Replication will Progress to Cirrhosis. Cirrhosis is Not Reversible.
|
|
|
How to figure out Chronicity in Hepatitis C? Tx? Tx Goal?
|
There is No way to determine the duration of infection with Hepatitis C. Most pt Do Not have Acute Symptoms. If PCR-RNA Viral Load is Elevated, pt should be Treated with Interferon and Ribavirin. If there is Fibrosis on Liver Biopsy, Initiating Tx becomes more Urgent to Prevent Permanent Hepatic Insufficiency. The Goal of Tx is to Achieve an Undetectable Viral Load.
|
|
|
p22
|
|
|
|
Urethritis and Cystitis - Similarity? Difference?
|
Urethritis and Cystitis - Similarity is 1 Dysuria (Frequency and Burning). Difference - Cystitis Does Not have Urethral Discharge.
|
|
|
Urethritis - Lx Initial? Most Accurate? Causes? Tx?
|
Urethritis - Lx Initial - Urethral Swab for Gram Stain, Urine testing for nucleic Acid Amplification (detects Gonorrhea and Chlamydia). Increased WBC. Intracellular Gram Negative Diplococci is Neisseria Gonorrhea to Initiate Tx. Lx Most Accurate - Urethral Culture, DNA probe, or Nucleic Acid Amplification test for N. Gonorrhea and Chlamydia Trachomatis. Other causes - Mycoplasma Genitalium and Ureaplasma. Tx Cefixime and Azithromycin, or Ceftriaxone and Doxycycline. Lx and Tx identical to Cervicitis.
|
|
|
Cervicitis - Px? Lx? Tx?
|
Cervicitis - PX Cervical Discharge and Inflamed Strawberry Cervix. Lx Initial - Urethral Swab for Gram Stain, Urine testing for nucleic Acid Amplification (detects Gonorrhea and Chlamydia). Increased WBC. Intracellular Gram Negative Diplococci is Neisseria Gonorrhea to Initiate Tx. Lx Most Accurate - Urethral Culture, DNA probe, or Nucleic Acid Amplification test for N. Gonorrhea and Chlamydia Trachomatis. Other causes - Mycoplasma Genitalium and Ureaplasma. Tx Cefixime and Azithromycin, or Ceftriaxone and Doxycycline. Lx and Tx identical to Urethritis.
|
|
|
PID Px? Lx Initial? Most Accurate? Tx?
|
Pelvic Inflammatory Disease PID Px 1 Lower Abdominal Tenderness, 2 Lower Abdominal Pain, 3 Fever, 4 Cervical Motion Tenderness, 5 Leukocytosis. Lx Exclude Pregnancy, Cervical Swab for Culture, DNA Probe, or Nucleic Acid Amplification is done to Confirm Etiology of PID. Most Accurate Lx is Laparoscopy needed only if Dx Unclear, Symptoms Persist with Tx, or Recurrent Episodes for Unclear Reasons. Tx combination of Gonorrhea and Chlamydia. Inpatient Tx - Cefoxitin, or Cefotetan combined with Doxycycline. Outpatient Tx - Ceftriaxone and Doxycycline (possibly with Metronidazole).Pt with Anaphylaxis to Penicillin - Levofloxacin and Metronidazole as Outpatient, or Clindamycin and gentamicin as Inpatient. Quinolones are Not the Initial Tx due to Resistance.
|
|
|
Ulcerative Genital Disease Px - Painless Ulcer. Dx?
|
Ulcerative Genital Disease Px - Painless Ulcer. Dx - Syphilis
|
|
|
Ulcerative Genital Disease Px - Painful Ulcer. Dx?
|
Ulcerative Genital Disease Px - Painful Ulcer. Dx - Chancroid (Haemophilus Ducreyi)
|
|
|
Ulcerative Genital Disease Px - Lymph Nodes Tender and Suppurating. Dx?
|
Ulcerative Genital Disease Px - Lymph Nodes Tender and Suppurating. Dx - Lymphogranuloma Venereum.
|
|
|
Ulcerative Genital Disease Px - Vesicles prior to ulcer and Painful. Dx?
|
Ulcerative Genital Disease Px - Vesicles prior to ulcer and Painful. Dx - Herpes Simplex
|
|
|
Syphilis Lx?
|
Syphilis Lx - 1 Dark-field microscopy, 2 VDRL or RPR (75 perc sensitive in Primary syphilis), 3 FTA or MHA-TP (Confirmatory)
|
|
|
Chancroid Lx?
|
Chancroid (Haemophilus Ducreyi) Lx - Stain and Culture on Specialized media
|
|
|
Lymphogranuloma Venereum Lx?
|
Lymphogranuloma Venereum Lx - 1 Complement Fixation titers in blood, 2 Nucleic acid amplification testing on Swab.
|
|
|
Herpes Simplex Lx?
|
Herpes Simplex Lx - 1 Tzanck prep is Best Initial, 2 Viral Culture is Most Accurate test
|
|
|
Dark-field Microscopy is Positive. Dx?
|
Dark-field Microscopy is Positive for Spirochetes. Dx - Syphilis - no further testing is necessary
|
|
|
Another name for Haemophilus Ducreyi?
|
Another name for Haemophilus Ducreyi - Chancroid
|
|
|
Another name for Chancroid?
|
Another name for Chancroid - Haemophilus Ducreyi
|
|
|
Syphilis Tx?
|
Syphilis Tx - 1 Single dose of Intramuscular Benzathine Penicillin, 2 Doxycycline if Penicillin Allergic
|
|
|
Chancroid Tx?
|
Chancroid (Haemophilus Ducreyi) Tx - Azithromycin (single dose)
|
|
|
Lymphogranuloma Venereum Tx?
|
Lymphogranuloma Venereum Tx - Doxycycline
|
|
|
Herpes Simplex Tx?
|
Herpes Simplex Tx - 1 Acyclovir, Valacylovir, Famciclovir, 2 Foscarnet for Acyclovir-Resistant Herpes
|
|
|
A woman presents with Multiple Painful Genital Vesicles. Next Step?
|
A woman presents with Multiple Painful Genital Vesicles. Next Step - no Lx is necessary - Acyclovir, Famciclovir, or Valacyclovir. Topical Acyclovir is useless. Viral Culture is Most Accurate Lx.
|
|
|
Syphilis - Primary Px?
|
Syphilis - Primary Px - 1 Painless Genital Ulcer with Heaped-Up Indurated Edges (it becomes Painful if it becomes Secondarily Infected with Bacteria), 2 Painless Adenopathy
|
|
|
Syphilis - Secondary Px?
|
Syphilis - Secondary Px - 1 Rash (palm and soles), 2 Alopecia Areata, 3 Mucous Patches, 4 Condylomata Lata.
|
|
|
Syphilis - Tertiary Px?
|
Syphilis - Tertiary Px - 1 Neurosyphilis (aaa Meningovascular - Stroke from Vasculitis, bbb Tabes Dorsalis - loss of position and vibratory sense, incontinence, cranial nerve, ccc General Paresis - memory and personality changes, ddd Argyll Robertson Pupil), 2 Aortitis - aortic regurgitation, aortic aneurysm, 3 Gummas - skin and bone lesions
|
|
|
Neurosyphilis Px?
|
Neurosyphilis Px - 1 Meningovascular - Stroke from Vasculitis, 2 Tabes Dorsalis - loss of position and vibratory sense, incontinence, cranial nerve, 3 General Paresis - memory and personality changes, 4 Argyll Robertson Pupil
|
|
|
Sensitivity of Lx by Syphilis stages?
|
Sensitivity of Lx by Syphilis stages - Lx 1 VDRL or RPR, 2 FTA-ABS. VDRL or RPR 75-85 perc Sensitive for Primary Syphilis. Both test for all other stages are more than 95 perc.
|
|
|
False Positive VDRL or RPR. Pt?
|
False Positive VDRL or RPR. Pt - 1 Infection, 2 Old Age, 3 Injection Drug use and AIDS, 4 Malaria, 5 Antiphospholipid syndrome, and 6 Endocarditis
|
|
|
Syphilis - When is Titers of VDRL or RPR reliable?
|
Syphilis - When is Titers of VDRL or RPR reliable greater than 1 to 8. Lower titer is more often Falsely Positive. High Titers (greater than 1 to 32) are Rarely False Positive.
|
|
|
Syphilis Tx by stage?
|
Syphilis Tx - Primary and Secondary - 1 Single Intramuscular Injection of Penicillin. 2 Oral Doxycycline if Penicillin Allergic. Tertiary Syphilis - intravenous Penicillin. Desensitize to Penicillin if Penicillin Allergic.
|
|
|
What is Jarisch-Herxheimer Reaction?
|
Jarisch-Herxheimer Reaction - In Syphilis - 1 Fever and worse symptoms after Tx, 2 Give Aspirin and Antipyretics, it will Pass
|
|
|
Neurosyphilis and Pregnant Women. Tx?
|
Neurosyphilis and Pregnant Women. Tx - Desensitization
|
|
|
What is Genital Warts medical name?
|
Genital Warts is Condylomata Acuminata
|
|
|
What is Condylomata Acuminata common name?
|
Condylomata Acuminata is Genital Warts
|
|
|
What is the cause of Condylomata Acuminata? Lx? Tx?
|
Condylomata Acuminata caused by Papillomavirus. Lx - Dx by visual appearance. Tx - Remove by Cryotherapy with liquid Nitrogen, Surgery for large ones, Laser, or Melting them with Podophyllin, or Trichloroacetic Acid. Imiquimod is locally applied Immunostimulant that leads to Sloughing off of lesion.
|
|
|
What is Pediculosis common name?
|
Pediculosis is Crabs
|
|
|
What is Crabs medical name?
|
Crabs medical name is Pediculosis.
|
|
|
Pediculosis - Px?
|
Pediculosis - Px - 1 Found on Hair-Bearing areas (axilla, pubis), 2 Causes Itching, 3 Visible on Surface. Tx - 1 Permethrin, 2 Lindane is More Toxic.
|
|
|
Scabies Px? Lx? Tx?
|
Scabies Px - 1 Found in Web Spaces between fingers and toes or at elbows, 2 Found around Nipples or Near genitals, 3 Burrows visible (they dig) but smaller than Pediculosis. Lx - Scrape and magnify. Tx - Permethrin, Widespread disease responds to Ivermectin (severe disease needs repeat dosing)
|
|
|
UTI - Px? Lx? Cause? Risk Factors? Tx?
|
UTI - Px - 1 Dysuria (frequency, urgency, burning) and 2 Fever. Lx - Increased WBC in 1 Cystitis, 2 Pyelonephritis, 3 Acute Prostatitis, and 4 Perinephric Abscess. Cause - E Coli. Risk Factors - aaa Anatomic Defects - 1 Stones, 2 Strictures, 3 Tumor or Prostate Hypertrophy, 4 Diabetes. bbb Obstruction or Foreign Body in urinary system (Foley Catheter is Foreign body, Neurogenic bladder is Obstruction). Tx - Quinolones are Best Initial.
|
|
|
UTI Risk Factors?
|
UTI Risk Factors - aaa Anatomic Defects - 1 Stones, 2 Strictures, 3 Tumor or Prostate Hypertrophy, 4 Diabetes. bbb Obstruction or Foreign Body in urinary system (Foley Catheter is Foreign body, Neurogenic bladder is Obstruction).
|
|
|
What is the difference between Urinary Frequency and Polyuria?
|
Urinary Frequency means multiple episodes of micturation. Polyuria is an Increase in Volume of Urine.
|
|
|
Cystitis Px? Lx Best Initial and Most Accurate? Tx?
|
Cystitis Px - 1 Dysuria, 2 Suprapubic Pain or Discomfort, 3 Mild or absent Fever. Lx Best Initial - Urinalysis with More than 10 WBC. Lx Most Accurate - Urine Culture. Tx - 1 Trimethoprim-Sulfamethoxazole TMP-SMZ if local Resistance is Low, 2 Ciprofloxacin, 3 Cephalexin, 4 Nitrofurantoin especially in Pregnant women.
|
|
|
Women and Men. Who have more UTI?
|
Women and Men. More UTI in Women. Men with UTI have Anatomic Abnormalities much more often than Women.
|
|
|
How is Beta-Lactam in Pregnancy?
|
All Beta-lactam Antibiotics are considered Safe in Pregnancy.
|
|
|
36 year old generally healthy woman comes to office with Urinary frequency and burning. Urinalysis shows more than 50 WBC per high power field. Next Step?
|
36 year old generally healthy woman comes to office with Urinary frequency and burning. Urinalysis shows more than 50 WBC per high power field. Next Step - TMP-SMZ for 3 days (symptoms of cystitis is clear and WBC+ in urine, no need for Urine Culture or imaging studies.) Urine Culture and imaging are done if there are Frequent Episodes of Cystitis or Failure to respond to Tx. Seven Days if Anatomic Abnormality.
|
|
|
Pyelonephritis Px? Lx? Tx?
|
Pyelonephritis Px - 1 Dysuria, 2 Flank or Costovertebral Angle Tenderness, 3 High Fever, 4 Abdominal Pain Occasionally due to Inflamed Kidney. Lx - UA shows Increased WBC, Imaging studies (CT or Sonogram) if there is Anatomic Abnormality causing infection. Tx - 1 Ampicillin and Gentamicin until Culture results are known, 2 Ciprofloxacin. Any drugs for Gram Negative Bacilli would be Effective for Pyelonephritis.
|
|
|
Acute Prostatitis - Px? Lx? Tx?
|
Acute Prostatitis - Px - 1 Dysuria, 2 Perineal Pain, 3 Tender Prostate. Lx - diagnostic yield of Urine Culture is greatly Increased with Prostate Massage. Tx - same as Pyelonephritis - 1 Ampicillin and Gentamicin until Culture results are known, 2 Ciprofloxacin. Long-Term Tx wiht TMP-SMZ for 6 to 8 weeks is used for Chronic Prostatitis.
|
|
|
Perinephric Abscess Px? Lx? Tx?
|
Perinephric Abscess Px - Pyelonephritis that Does Not Resolve with Appropriate Tx. Lx Failure of an infection to resolve is often Anatomic Problem. Pyelonephritis associated with Persistent Fever after 5 to 7 days of Tx, perform an Imaging study (Sonogram or CT). Tx - Drainage of fluid collection is Mandatory. Culture of Infected fluid is essential to guide Tx.
|
|
|
Endocarditis Definition? Cause and Risk factors? Lx?
|
Endocarditis Definition - Infection of Heart Valve leading to Fever and a Murmur. Cause - Rare to have Endocarditis develop on Normal Heart Valves with exception of Injection Drug Users (Staph Aureus). Risk is directly Proportional to degree of Valve Damage. Regurgitant and Stenotic lesions confer Increased Risk. Prosthetic Valves associated with Highest Risk. Mouth or Respiratory Tract Surgery has Risk in Severe Valvular Disorder (Artificial Valve or Cyanotic Heart Disease). Endoscopy has no risk even with biopsy. Lx - Vegetation on Echocardiogram and Positive Blood Cultures.
|
|
|
Fever and New Murmur or Change in a Murmur. Dx?
|
Fever and New Murmur or Change in a Murmur. Dx - Endocarditis
|
|
|
Complications of Endocarditis?
|
Complications of Endocarditis - 1 Splinter Hemorrhages, 2 Janeway lesions (flat and painless), 3 Osler Nodes (raised and painful), 4 Roth spots in eyes, 5 Brain (mycotic aneurysm), 6 Kidney (Hematuria, glomerulonephritis), 7 Conjunctival Petechiae, 8 Splenomegaly, 9 Septic Emboli to Lungs.
|
|
|
Endocarditis Definition? Cause and Risk factors? Lx?
|
Endocarditis Lx Best Initial - 1 Blood Culture (95 to 99 perc sensitive), 2 Transthoracic Echocardiogram (60 perc sensitive and 95 perc specific), 3 Transesophageal Echocardiogram (95 perc sensitive and specific)
|
|
|
Strep Bovis in blood culture. Next step?
|
Strep Bovis in blood culture. Next step - colonoscopy.
|
|
|
How to Establish a Culture Negative Endocarditis? Tx of Resistant Organisms?
|
Culture Negative Endocarditis diagnosis is based on 1 Oscillating Vegetation on Echocardiography, 2 Three Minor Criteria (Fever, Risk such as Injection Drug Use or Prosthetic Valve, 3 Signs of Embolic Phenomena). Tx - Best Initial Empiric Vancomycin and Gentamicin. When Culture results available, Tx specific organism (1 Viridans Strep - Ceftriaxone for four wks, 2 Stap Aureus Sensitive - Oxacillin, Nafcillin, or Cefazolin, 3 Fungal - Amphotericin and Valve Replacement, 4 Staph Epidermidis or Resistant Staph - Vancomycin and Gentamicin, 5 Enterococci - Ampicillin and Gentamicin). Tx of Resistant Organisms - Add an Aminoglycoside and Extend Duration of Tx.
|
|
|
Endocarditis Culture. Possible Organisms? Tx?
|
Endocarditis Culture. Possible Organisms and Tx - 1 Viridans Strep - Ceftriaxone for four wks, 2 Stap Aureus Sensitive - Oxacillin, Nafcillin, or Cefazolin, 3 Fungal - Amphotericin and Valve Replacement, 4 Staph Epidermidis or Resistant Staph - Vancomycin and Gentamicin, 5 Enterococci - Ampicillin and Gentamicin
|
|
|
Endocarditis with Culture Result - Viridans Strep?
|
Endocarditis with Culture Result - Viridans Strep - Ceftriaxone for four wks
|
|
|
Endocarditis with Culture Result - Staph Aureus Sensitive?
|
Endocarditis with Culture Result - Stap Aureus Sensitive - Oxacillin, Nafcillin, or Cefazolin
|
|
|
Endocarditis with Culture Result - Fungal?
|
Fungal - Amphotericin and Valve Replacement
|
|
|
Endocarditis with Culture Result - Staph Epidermidis or Resistant Staph?
|
Endocarditis with Culture Result - Staph Epidermidis or Resistant Staph - Vancomycin and Gentamicin
|
|
|
Endocarditis with Culture Result - Enterococci?
|
Endocarditis with Culture Result - Enterococci - Ampicillin and Gentamicin
|
|
|
When is Surgery required for Endocarditis?
|
Surgery required for Endocarditis - 1 CHF or Ruptured Valve or Chordae Tendineae, 2 Prosthetic Valves, 3 Fungal Endocarditis, 4 Abscess, 5 AV block, 6 Recurrent Emboli while on Antibiotics
|
|
|
Prosthetic Valve ENdocarditis with Staph. Tx?
|
Prosthetic Valve ENdocarditis with Staph. Tx - Add Rifampin
|
|
|
What is Single Strongest indication for Surgery in Endocarditis?
|
Single Strongest indication for Surgery in Endocarditis - Acute Valve Rupture and CHF.
|
|
|
What Organisms are difficult to culture in Endocarditis? Tx?
|
Organisms are difficult to culture in Endocarditis - HACEK - 1 Haemophilus Aphrophilus, 2 Haemophilus Parainfluenza, 3 Actinobacillus, 4 Cardiobacterium, 5 Eikenella, 6 Kingella. Tx for HACEK - Ceftriaxone.
|
|
|
What is Endocarditis Prophylaxis feature? Tx?
|
Endocarditis Prophylaxis feature - 1 Significant Cardiac Defect (Prosthetic Valve, Previous Endocarditis, Cardiac Transplant recipient with valvulopathy, Unrepaired Cyanotic heart disease), and 2 Risk of Bacteremia (Dental work with Blood, Respiratory tract surgery that produces Bacteremia). Tx - Amoxicillin prior to Procedure. Penicillin Allergic - Clindaymycin, Azithromycin, or Clarithromycin.
|
|
|
Procedures and Anatomic Abnormalities that Do Not need Endocarditis Prophylaxis?
|
Procedures and Anatomic Abnormalities that Do Not need Endocarditis Prophylaxis - 1 Flexible Endoscopies, even with biopsy, 2 Obstetrical and Gynecologic procedures, 3 Urology procedures (including Prostate biopsy), 4 GI procedures including ERCP, 5 Valvular heart disease including mitral valve prolapse, even with a murmur, 6 Mitral Regurgitation, Mitral Stenosis, Aortic Regurgitation, Aortic Stenosis, HOCM, Atrial Septal Defect
|
|
|
What is the cause of Lyme Disease? Px? Complication? Where does it occur?
|
Lyme Disease cause by Spirochete Borrelia Burgdorferi. Transmitted by Deer Tick Ixodes Scapularis. Requires 24 to 48 hour Tick attachment. Px - Fever and a Rash (Erythema Migrans - like a Target - round red lesion with pale are in center). Untreated infection can recur as 1 Joint Pain, 2 Cardiac disease, or 3 Neurological disease. Typically occurs in Northeast states - Connecticut, Massachusetts, New York, and New Jersey.
|
|
|
Lyme Disease Px?
|
Lyme Disease Px - 1 Fever, 2 a Rash (Erythema Migrans - like a Target - round red lesion with pale are in center), 3 Joint Pain (most common long term manifestation - oligoarthritis. 25k WBC per microL), 4 Neurological Manifestations (10 to 15 perc pt. CnS or PNS - Meningitis, Encephalitis, or Cranial Nerve Palsy), 5 Cardiac (damage myocardium or pericardium - myocarditis or ventricular arrhythmia)
|
|
|
What is most commonly affected in Lyme Disease for Joint, Neurological, Cardiac?
|
Most commonly affected in Lyme Disease - Joint is Knee, Neurological is Seventh Cranial Nerve or Bell Palsy, Cardiac is Transient AV block
|
|
|
Lyme Disease Lx?
|
Lyme Disease Lx - a rash consistent with Lyme does Not need confirmatory testing with serology to initiate tx. Serology testing for other manifestyations - Joint, Neurologic, and Cardiac. Lx - 1 IgM, 2 IgG, 3 ELISA, 4 Western blot, and 5 PCR testing.
|
|
|
Lyme Disease Tx?
|
Lyme Disease Tx - 1 Asymptomatic Tick Bite - No Treatment routinely for most, 2 Rash Doxycycline, or Amoxicillin, 3 Joint, Seventh Cranial Nerve Palsy - Doxycycline, or Amoxicillin, 4 Cardiac and Neurologic Manifestations other than Seventh Cranial Nerve Palsy - Intravenous Ceftriaxone.
|
|
|
When to Tx Asymptomatic Tick Bite for Lyme Disease?
|
When to Tx Asymptomatic Tick Bite for Lyme Disease - 1 Ixodes Scapularis identified as tick causing bite, 2 Tick attached for longer than 24 to 48 hours, 3 Engorged Nymph-stage tick, 4 Endemic area. Tx - Single dose of Doxycycline within 72 hours of tick bite
|
|
|
What is HIV? Pathology?
|
HIV is a Retrovirus infecting CD4 (T-Helper) cell. CD4 cells drop from Normal Level of 600 to 1000 per microL at a Rate of 50 to 100 per year in Untreated. Depletion of CD4 cell count takes 5 to 10 years before clinical manifestations. Depletion of CD4 count leads to Opportunitic infections that lead to illness.
|
|
|
How is HIV transmitted?
|
HIV transmitted - 1 Infection Drug use with Contaminated needles, 2 Sex, particularly men with men, 3 Transfusion (extremely rare since 1985), 4 Perinatal, 5 Needle Stick or Blood-Contaminated sharp instrument injury
|
|
|
Risk of Transmission of HIV without Prophylactic Tx for various situation?
|
Risk of Transmission of HIV without Prophylactic Tx - 1 Vaginal Tramission - 1 in 3k to 1 in 10k for sertive Intercourse, 1 in 1k for Receptive Intercourse, 2 Oral Sex - 1 in 1k for receptive fellatio with ejaculation, unclear for insertive fellatio or cunnilingus, 3 Needle stick injury - 1 in 300, 4 Anal Sex - 1 in 100 for receptive anal intercourse, 5 Mother to child - 25 to 30 perc Perinatal Transmission without medication
|
|
|
Risk of Transmission of HIV without Prophylactic Tx for various situation?
|
Risk of Transmission of HIV without Prophylactic Tx - 1 Vaginal Tramission - 1 in 3k to 1 in 10k for sertive Intercourse, 1 in 1k for Receptive Intercourse
|
|
|
Risk of Transmission of HIV without Prophylactic Tx for Vaginal transmission?
|
Risk of Transmission of HIV without Prophylactic Tx - 1 Vaginal Tramission - 1 in 3k to 1 in 10k for sertive Intercourse, 1 in 1k for Receptive Intercourse, 2 Oral Sex - 1 in 1k for receptive fellatio with ejaculation, unclear for insertive fellatio or cunnilingus, 3 Needle stick injury - 1 in 300, 4 Anal Sex - 1 in 100 for receptive anal intercourse, 5 Mother to child - 25 to 30 perc Perinatal Transmission without medication
|
|
|
Risk of Transmission of HIV without Prophylactic Tx for Oral Sex?
|
Risk of Transmission of HIV without Prophylactic Tx - 2 Oral Sex - 1 in 1k for receptive fellatio with ejaculation, unclear for insertive fellatio or cunnilingus
|
|
|
Risk of Transmission of HIV without Prophylactic Tx for Needle Stick Injury?
|
Risk of Transmission of HIV without Prophylactic Tx - 3 Needle stick injury - 1 in 300
|
|
|
Risk of Transmission of HIV without Prophylactic Tx for Anal Sex?
|
Risk of Transmission of HIV without Prophylactic Tx - 4 Anal Sex - 1 in 100 for receptive anal intercourse
|
|
|
Risk of Transmission of HIV without Prophylactic Tx for Mother to Child?
|
Risk of Transmission of HIV without Prophylactic Tx - 5 Mother to child - 25 to 30 perc Perinatal Transmission without medication
|
|
|
What is Cell Affected by HIV? What is that cell Normal level? How much does this cell goes down without Tx? How many year before these cell are deleted?
|
Cell Affected by HIV - CD4. CD4 cell Normal level 600 to 1k per micrL. CD4 cell goes down without Tx at a rate of 50 to 100 per year without Tx. 5 to 10 years before these CD4 cell are deleted. Low CD4 count leads to Opportunistic Infections and illness.
|
|
|
Does Kissing transmit HIV?
|
Kissing Does Not transmit HIV
|
|
|
When is HIV profound Immunosuppression?
|
HIV profound Immunosuppression - CD4 below 50 microL
|
|
|
When does PCP occurs in HIV?
|
PCP occurs in HIV - CD4 below 200 microL or under 14 perc
|
|
|
What infections occur Frequently with HIV CD4 above 200 microL?
|
Infections occur Frequently with HIV CD4 above 200 microL - 1 Varicella Zoster (shingles), 2 Herpes Simplex, 3 Tuberculosis, 4 Oral and Vaginal Candidiasis, 5 Bacterial Pneumonia
|
|
|
HIV Lx Initial? Confirmation? Infant Lx?
|
HIV Lx Initial - ELISA, Confirmed - Western Blot. Infected Infants Lx - PCR or Viral Culture. Maternal HIV Antibodies present for up to 6 months - Unreliable ELISA.
|
|
|
What is HIV Viral Load Testing name?
|
HIV Viral Load Testing name - PCR-RNA level
|
|
|
What is HIV Viral Resistance Testing name?
|
HIV Viral Resistance Testing name - Genotyping
|
|
|
What is HIV PCR-RNA level testing for?
|
HIV PCR-RNA level testing for Viral Load
|
|
|
What is HIV Genotyping testing for?
|
HIV Genotyping testing for Viral Resistance
|
|
|
How is HIV Viral Load tested? Useful for?
|
HIV Viral Load tested with PCR-RNA level. Viral Load is Useful for 1 Measure Response to Tx (Decreasing levels are good), 2 Dtect Tx Failure (Rising levels are Bad), 3 Diagnose HIV in babies. Goal Tx is to Drive Down Viral Load. Undetectable levels (below 50 per microL) indicate that CD4 will Most Likely Rise, Opportunistic infections rarely occur.
|
|
|
What is HIV Viral Resistance test? Useful for?
|
HIV Viral Resistance test is Genotyping. Useful for 1 Done prior to Initiating Antiretroviral medications, 2 Evidence of Tx failure (to guides the choice of med to select 3 drugs from 2 different classes virus is susceptible)
|
|
|
How is HIV Tx Failure first manifests?
|
HIV Tx Failure first manifests with a Rising PCR-RNA viral load.
|
|
|
When is HIV Tx initiated? What is Strongest Indication for Antiretroviral medication?
|
HIV Tx initiated when 1 CD4 Drops below 500 per microL in Asymptomatic pt, or 2 Viral Load is Very High (Greater than 100k per microL), or 3 Opportunistic Infection occurs. Strongest Indication for Antiretroviral medication is CD4 Below 350 per microL.
|
|
|
What is HIV Tx Best Initial Drug regimen?
|
HIV Tx Best Initial Drug regimen is Combination - 1 Emtricitabine, 2 Tenofovir, and 3 Efavirenz. They are in a Single dose - Atripla.
|
|
|
How to detect HIV Tx failure?
|
HIV Tx failure dectected by 1 a Rising Viral Load or Failure of Viral Load to Suppress to Undetectable levels, 2 CD4 count will Decrease or Fail to Rise (CD4 count lag behind viral load testing)
|
|
|
What is HIV TX Alternative Drug Regimen?
|
HIV TX Alternative Drug Regimen is 3 First Line drugs from 2 different classes (1 Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI, 2 Non-Nucleoside RTI, 3 Protease Inhibitors).
|
|
|
What is NRTI?
|
NRTI is First Line 1 Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI
|
|
|
What is NNRTI?
|
NNRTI is First Line 2 Non-Nucleoside RTI
|
|
|
What are the classes of AntiRetroviral for HIV?
|
Antiretroviral for HIV classes - First line 1 NRTI Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI, 2 NNRTI Non-Nucleoside RTI, 3 Protease Inhibitors. Second line 1 Entry Inhibitors, 2 Integrase Inhibitor
|
|
|
What drug class is Zidovudine?
|
Zidovudine is 1 NRTI Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI
|
|
|
What drug class is Didanosine?
|
Didanosine is 1 NRTI Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI
|
|
|
What drug class is Stavudine?
|
Stavudine is 1 NRTI Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI
|
|
|
What drug class is Lamivudine?
|
Lamivudine is 1 NRTI Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI
|
|
|
What drug class is Emtricitabine?
|
Emtricitabine is 1 NRTI Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI
|
|
|
What drug class is Abacavir?
|
Abacavir is 1 NRTI Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI
|
|
|
What drug class is Tenofovir?
|
Tenofovir is 1 NRTI Nucleoside and Nucleotide Reverse Transcriptase Inhibitors RTI
|
|
|
What drug class is Efavirenz?
|
Efavirenz is 2 NNRTI Non-Nucleoside RTI
|
|
|
What drug class is Etravirine?
|
Etravirine is 2 NNRTI Non-Nucleoside RTI
|
|
|
What drug class is Nevirapine?
|
Nevirapine is 2 NNRTI Non-Nucleoside RTI
|
|
|
What drug class is Ritonavir?
|
Ritonavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Saquinavir?
|
Saquinavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Nelfinavir?
|
Nelfinavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Amprenavir?
|
Amprenavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Fosamprenavir?
|
Fosamprenavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Lopinavir?
|
Lopinavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Atazanavir?
|
Atazanavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Indinavir?
|
Indinavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Tipranavir?
|
Tipranavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Darunavir?
|
Darunavir is 3 PI Protease Inhibitors
|
|
|
What drug class is Enfuvirtide?
|
Enfuvirtide is Second Line 1 Entry Inhibitors
|
|
|
What drug class is Maraviroc?
|
Maraviroc is Second Line 1 Entry Inhibitors
|
|
|
What drug class is Raltegravir?
|
Raltegravir is Second Line 2 Integrase Inhibitor
|
|
|
What are Situations requiring HIV Post Exposure Prophylaxis? Tx?
|
Situations requiring HIV Post Exposure Prophylaxis PEP - 1 All Significant Needle Stick injuries, and 2 Sexual Exposures, 3 HIV person Bite - given 4 wks of Tx Best Initial regimen (1 Emtricitabine, 2 Tenofovir, and 3 Efavirenz). If Resistance, Alternative Regimen with 3 First Line drugs from 2 classes. Urine and stool Exposure do Not need PEP, unless there is Blood. No PEP if Needle stick from HIV sttus unknown.
|
|
|
What is Adverse Effect of Zidovudine?
|
Adverse Effect of Zidovudine - Anemia
|
|
|
What is Adverse Effect of Stavudine?
|
Adverse Effect of Stavudine and Didanosine - 1 Peripheral Neuropathy and 2 Pancreatitis
|
|
|
What is Adverse Effect of Didanosine?
|
Adverse Effect of Stavudine and Didanosine - 1 Peripheral Neuropathy and 2 Pancreatitis
|
|
|
What is Adverse Effect of Abacavir?
|
Adverse Effect of Abacavir - 1 Hypersensitivity, 2 Stevens-Johnson reaction
|
|
|
What is Adverse Effect of Protease Inhibitors? What med are Protease Inhibitors?
|
Adverse Effect of Protease Inhibitors - 1 Hyperlipidemia, 2 Hyperglycemia. HIV First Line Protease Inhibitors - 1 Ritonavir, 2 Saquinavir, 3 Nelfinavir, 4 Amprenavir, 5 Fosamprenavir, 6 Lopinavir, 7 Atazanavir, 8 Indinavir, 9 Tipranavir, 10 Darunavir
|
|
|
What is Adverse Effect of Indinavir?
|
Adverse Effect of Indinavir - Nephrolithiasis
|
|
|
What is Adverse Effect of Tenofovir?
|
Adverse Effect of Tenofovir - Renal Insufficiency
|
|
|
What are med in NRTI?
|
NRTI are HIV First Line Nucleoside and Nucleotide Reverse Transciptase Inhibitors - 1 Zidovudine, 2 Didanosine, 3 Stavudine, 4 Lamivudine, 5 Emtricitabine, 6 Abacavir, 7 Tenofovir
|
|
|
What are med in NNRTI?
|
NNRTI are HIV First Line Non-Nucleoside Reverse Transciptase Inhibitors - 1 Efavirenz, 2 Etravirine, 3 Nevirapine
|
|
|
What are med in Protease Inhibitor?
|
HIV First Line Protease Inhibitors - 1 Ritonavir, 2 Saquinavir, 3 Nelfinavir, 4 Amprenavir, 5 Fosamprenavir, 6 Lopinavir, 7 Atazanavir, 8 Indinavir, 9 Tipranavir, 10 Darunavir
|
|
|
What are med in Entry Inhibitors?
|
HIV Second Line Entry Inhibitors - 1Enfuvirtide, 2 Maraviroc
|
|
|
What are med in Integrase Inhibitor?
|
HIV Second Line Integrase Inhibitor - 1 Raltegravir
|
|
|
What HIV med should be Avoided in Pregnancy? What to switch with?
|
HIV med should be Avoided in Pregnancy - Efavirenz (Teratogenic). Protease Inhibitors are Safe Alternative.
|
|
|
Indications for Antiretrovirals during Pregnancy?
|
Indications for Antiretrovirals during Pregnancy - 1 Pt on Antiretrovirals at time of Pregnancy - Continue same meds, except switch Efavirenz to a Protease Inhibitor, 2 Not on Antiretrovirals, CD 4 Low or Viral Load High - Initiate Antiretrovirals immediately, 3 Not on Antiretrovirals, CD4 High and Viral Load Low - Antiretrovirals during Second and Third Trimesters, Stopping them in Mother After Birth. Baby Should receive Zidovudine During Delivery (Intrapartum) and for 6 Weeks afterward to help Prevent Transmission.
|
|
|
Indications for Antiretrovirals during Pregnancy - Pt on Antiretrovirals at time of Pregnancy?
|
Indications for Antiretrovirals during Pregnancy - 1 Pt on Antiretrovirals at time of Pregnancy - Continue same meds, except switch Efavirenz to a Protease Inhibitor
|
|
|
Indications for Antiretrovirals during Pregnancy - Not on Antiretrovirals, CD 4 Low or Viral Load High?
|
Indications for Antiretrovirals during Pregnancy - 2 Not on Antiretrovirals, CD 4 Low or Viral Load High - Initiate Antiretrovirals immediately
|
|
|
Indications for Antiretrovirals during Pregnancy - Not on Antiretrovirals, CD4 High and Viral Load Low?
|
Indications for Antiretrovirals during Pregnancy - 3 Not on Antiretrovirals, CD4 High and Viral Load Low - Antiretrovirals during Second and Third Trimesters, Stopping them in Mother After Birth.
|
|
|
Indications for Antiretrovirals during Pregnancy - for Baby?
|
Indications for Antiretrovirals during Pregnancy - Baby Should receive Zidovudine During Delivery (Intrapartum) and for 6 Weeks afterward to help Prevent Transmission.
|
|
|
HIV Positive Mother. What is consider Low CD4?
|
HIV Positive Mother. Low CD4 - Below 350
|
|
|
HIV Positive Mother. What is consider High Viral Load?
|
HIV Positive Mother. High Viral Load - Above 1000 per microL
|
|
|
When is the most common HIV transmission from mom to child in Pregnancy?
|
Most common HIV transmission from mom to child in Pregnancy - During Delivery. Make sure Viral Load is Controlled by time of Parturition. If Viral Load is Above 1000 microL, Perform Cesarean Delivery. Intrapartum Antiretrovirals with Zidovudine Routinely administered in Every Pregnant HIV pt.
|
|
|
What is fully controlled HIV in Pregnancy? Rate of Transmission to Child?
|
Fully controlled HIV in Pregnancy - Viral Load Undetectable. Rate of Transmission to Child - Less than 1 percent.
|
|
|
HIV mom delivery method? Why?
|
HIV mom delivery method - Cesarean Delivery to Prevent Transmission of Virus if CD4 is Low (Below 350) or Viral Load is High (Pregancy Viral Load Above 1000 per microL) at the Time of Delivery. Delivery has Most Transmission.
|
