Aaaaazzzzz 3

Front 1

What organism causes infection in Bone, Heart, Skin, and Joint?

Back 1

Staph Aureus causes infection in Bone, Heart, Skin, and Joint

Front 2

MSSA Tx?

Back 2

MSSA - Sensitive - Tx = IV - Oxacillin/nafcillin, dicloxacillin, or cefazolin (1g Cephalosporin), Oral - Dicloxacillin or cephalexin (1g cephalosporin)

Front 3

MRSA Tx?

Back 3

MRSA - Resistant - Severe - Vancomycin, linezolid daptomycin, or tigecycline. Minor - Trimethoprim/sulfamethoxazole (TMP/SMX), clindamycin

Front 4

Penicillin allergy Staph aureus Tx - Rash? Anaphylaxis? Severe? Minor infection?

Back 4

Penicillin allergy Staph Aureus Tx - Rash (cephalosporins), Anaphylaxis - Macrolides '(azithromycin, clarithromycin) or clindamycin', Severe - (Vancomycin, linezolid, daptomycin), Minor 'Macrolides(azithromycin, clarithromycin), clindamycin, TMP/SMX'

Front 5

Penicillin allergy Staph aureus Tx - Rash?

Back 5

Penicillin allergy Staph Aureus Tx - Rash (cephalosporins)

Front 6

Penicillin allergy Staph aureus Tx - Anaphylaxis?

Back 6

Penicillin allergy Staph Aureus Tx - Anaphylaxis = Macrolides (azithromycin, clarithromycin) or clindamycin

Front 7

Penicillin allergy Staph aureus Tx - Severe?

Back 7

Penicillin allergy Staph Aureus Tx - Severe (Vancomycin, linezolid, daptomycin)

Front 8

Penicillin allergy Staph aureus Tx - Minor infection?

Back 8

Penicillin allergy Staph Aureus Tx - Minor = Macrolides (azithromycin, clarithromycin), clindamycin, TMP/SMX

Front 9

Strep Tx?

Back 9

All Staph Aureus Tx + Penicillin, Ampicillin, Amoxicillin

Front 10

Gram-Negative Bacilli?

Back 10

Gram-Negative Bacilli - Rods - E. Coli, Enterobacter, Citrobacter, Morganella, Pseudomonas, Serratia

Front 11

Gram-Negative Bacilli - Tx?

Back 11

Gram-Negative Bacilli - Rods - Tx - Cephalosporins (Cefepime, Ceftazidime), Penicillins (Piperacillin, Ticarcillin), Monobactam (Aztreonam), Quinolones (Ciprofloxacin, Levofloxacin, Gatifloxacin, Moxifloxacin), Aminoglycosides (Gentamicin, Tobramycin, Amikacin), Carbapenems (Imipenem, Meropenem, Ertapenem)

Front 12

What class is Ertapenem? How is it unique?

Back 12

Ertapenem is Carbapenem. It does Not cover Pseudomonas

Front 13

What class are Piperacillin and Ticarcillin? How are they unique?

Back 13

Piperacillin and Ticarcillin are Penicillins. They cover Gram Negative, Strep, and Anaerobes

Front 14

What organisms are Gastrointestinal anaerobes?

Back 14

Gastrointestinal anaerobes are Bacteroides

Front 15

Best Tx for abdominal anaerobes? What other medications has equal efficacy?

Back 15

Best Tx for abdominal anaerobes is Metronidazole. Carbapenems, Piperacillin, and Ticarcillin are equal in efficacy

Front 16

What are the only Cephalosporins that cover Anaerobes?

Back 16

Cefoxitin and Cefotetan are the only Cephalosporins that cover Anaerobes

Front 17

Best Tx for Respiratory anaerobes?

Back 17

Clindamycin is best drug for Respiratory Anaerobic Strep

Front 18

What medications with No anaerobic coverage?

Back 18

Medications with No anaerobic coverage are Aminoglycosides, Aztreonam, Fluoroquinolones Oxacillin/Nafcillin, and all the Cephalosporins except Cefoxitin and Cefotetan

Front 19

On Vancomycin, red skin develop on the neck. Dx? Tx?

Back 19

Vancomycin causing red skin on neck is Red Man Syndrome, flushed skin from histamine release. It occurs in rapid infusion, slow the rate of infusion.

Front 20

Herpes simplex and Varicella zoster Tx?

Back 20

Acyclovir, Valacyclovir, Famciclovir are Herpes simplex, and Varicella zoster tx.

Front 21

CMV Tx?

Back 21

Cytomegalovirus CMV is treated by Ganciclovir and Foscarnet (they also cover Herpes simplex and Varicella)

Front 22

What is Adverse Effect of Ganciclovir?

Back 22

Ganciclovir adverse effects is Neutropenia and Bone Marrow Suppression

Front 23

What is Adverse Effect of Foscarnet?

Back 23

Foscarnet adverse effect is Renal Toxicity

Front 24

What are treatment of Influenza A and B? What class of drug?

Back 24

Influenza A and B tx are Neuraminidase inhibitors - Oseltamivir and Zanamivir

Front 25

What is the Hepatitis C tx?

Back 25

Hepatitis C Tx is Ribavirin and Interferon

Front 26

What is the Respiratory Syncytial Virus tx?

Back 26

Respiratory Syncytial Virus RSV tx is Ribavirin

Front 27

What are Chronic Hepatitis B tx?

Back 27

Chronic Hepatitis B Tx - Lamivudine, Interferon, Adefovir, Entecavir, and Telbivudine.

Front 28

Tx for Candida (not Candida krusei or Candida glabrata), Cryptococcus, oral and vaginal candidiasis?

Back 28

Fluconazole is Tx for Candida (not Candida krusei or Candida glabrata), Cryptococcus, oral and vaginal candidiasis as alternative to topical medications

Front 29

Medication Largely equal to Fluconazole, but less easy to use. Rarely the best initial tx for anything.

Back 29

Itraconazole is largely equal to Fluconazole

Front 30

Medication that Covers all Candida, Best agent against Aspergillus? Adverse Effect?

Back 30

Voriconazole Covers all Candida, best agent against Aspergillus. Adverse effect - Some Visual disturbance

Front 31

What class of antifungal agent is excellent for neutropenic fever patient? What medications? Adverse effect?

Back 31

Echinocandins are excellent for Neutropenic fever patients. Echinocandins are Caspofungin, Micafungin, Anidulafungin. Does Not Cover Cryptococcus. No Adverse effect because inhibit 1,4 glucan synthesis step, which is not exist in human.

Front 32

What antifungal is effective against all Candida, Cryptococcus, and Aspergillus? Adverse Effects?

Back 32

Amphotericin effective against all Candida, Cryptococcus, and Aspergillus. Adverse effects - Renal Toxicity (increased creatinine), Hypokalemia, Metabolic Acidosis, Fever, Shakes, Chills. So, other agents are better Voriconazole for Aspergillus, Caspofungin for Neutropenic fever, and Fluconazole for Candida.

Front 33

What can Fluconazole Tx? AE?

Back 33

Fluconazole is Tx for Candida (not Candida krusei or Candida glabrata), Cryptococcus, oral and vaginal candidiasis

Front 34

What can Voriconazole Tx? AE?

Back 34

Voriconazole Covers all Candida, best agent against Aspergillus. Adverse effect - Some Visual disturbance

Front 35

What can Echinocandins Tx? AE?

Back 35

Echinocandins are excellent for Neutropenic fever patients. Echinocandins are Caspofungin, Micafungin, Anidulafungin. Does Not Cover Cryptococcus. No Adverse effect because inhibit 1,4 glucan synthesis step, which is not exist in human.

Front 36

What can Amphotericin Tx? AE?

Back 36

Amphotericin effective against all Candida, Cryptococcus, and Aspergillus. Adverse effects - Renal Toxicity (increased creatinine), Hypokalemia, Metabolic Acidosis, Fever, Shakes, Chills. So, other agents are better Voriconazole for Aspergillus, Caspofungin for Neutropenic fever, and Fluconazole for Candida.

Front 37

What types of patients have osteomyelitis?

Back 37

Osteomyelitis usually presents with Diabetes, Peripheral Vascular Disease, or both with an ulcer or soft tissue infection.

Front 38

Suspected osteomyelitis, Initial test? Second line test?

Back 38

Suspected osteomyelitis, Best Initial test is Plain X-ray, Best Second-line test is MRI if X-ray negative

Front 39

What is the earliest finding of Osteomyelitis on an Xray?

Back 39

Periosteal elevation is the earliest finding of osteomyelitis on Xray

Front 40

Osteomyelitis Most Accurate test?

Back 40

Osteomyelitis Most Accurate test are Bone Biopsy and Culture.

Front 41

Most common way of getting osteomyelitis?

Back 41

Most common way of getting osteomyelitis is Direct Continguous Spread from overlying tissue

Front 42

For osteomyelitis, what test has more sensitivity, MRI or Bone scan?

Back 42

For osteomyelitis, MRI and Bone scan has Equal sensitivity

Front 43

How to know Osteomyelitis Responsiveness to treatment and how long to treat?

Back 43

ESR is Osteomyelitis Responsiveness to treatment and how long to treat.

Front 44

Most common cause of osteomyelitis? Tx?

Back 44

Most common cause of Osteomyelitis is Staph. MSSA - IV Oxacillin or Nafcillin 4-6 wks, MRSA - IV Vancomycin, Daptomycin, Linezolid.

Front 45

What are less common casue of Osteomyelitis?

Back 45

Gram Negative Bacilli (Salmonella and Pseudomonas) are less common cause of Osteomyelitis. Treat with Oral antibiotics. Need to confirm Gram Negative with Bone Biopsy and sensitivity.

Front 46

Itching and Drainage from external auditory canal. Dx? Cause? Lx? Tx?

Back 46

Itching and Drainage from External auditory canal is Otitis Externa. It is Cellulitis of skin of external auditory canal. Difficult to visualize Tympanic membrane cuz of swelling of canal. Painful when tragus manipulated. Associated with Swimming, and Foreign objects.. No test. Tx - Topical antibiotic, Ofloxacin or polymyxin-neomycin. Add Topical Hydrocortisone to decrease swelling and itching. Adding Acetic Acid and Water Solution.

Front 47

What is Malignant Otitis Externa? Cause? Initial and Accurate Lx? Tx?

Back 47

Malignant Otitis Externa is Osteomyelitis of Skull from Pseudomonas in Diabetic. Extremely serious disease cuz lead to brain abscess and destruction of skull. Best Initial test - Skull Xray or MRI, Most Accurate test - Biopsy. Tx - surgical debridement and antibiotics active against Pseudomonas (Piperacillin, cefepime, carbapenem, aztreonam, .)

Front 48

What is Otitis Media Presentation? Most sensitive finding? Initial and Accurate Lx? Tx?

Back 48

Otitis Media presents with Redness, Bulging, Decreased hearing, Loss of light Reflex, Immobility of Tympanic membrane. Immobility of Tympanic Membrane is most sensitive. Initial Tx is Amoxicillin 7-10 days. Most accurate test is Tympanocentesis and Aspirate of Tympanic membrane for culture - only for persistent case

Front 49

Persistent Otitis Media with Amoxicillin Tx. Next step?

Back 49

Otitis Media persist with Amoxicillin Tx 7-10 days, do Most Accurate test is Tympanocentesis and Aspirate of Tympanic membrane for culture - only for persistent case

Front 50

Otitis Media treated with Amoxicillin for 3 days not improving. Next step?

Back 50

Otitis Media not improving on amoxicillin for 3 days switch to Amoxicillin-Clavulanate, Cefdinir3, Ceftibuten3, Cefuroxime2, or Cefprozil2.

Front 51

Nasal discharge, headache, facial tenderness, teeth pain, bad taste in the mouth, and decreased transillumination of sinuses. Dx? Cause? Lx? Tx?

Back 51

Sinusitis presents with Nasal discharge, headache, facial tenderness, teeth pain, bad taste in the mouth, and decreased trasillumination of sinuses. Cause most by viral, but bacterial causes are same as otitis media - S pneumoniae, H influenzae, and M catarrhalis. Best initial test is Xray, Most accurate test is Sinus aspirate for culture. Tx same as Otitis media, use Amoxicillin if pt has Fever and pain, persistent symptoms despite 7 days of decongestants, and purulent nasal disharge.

Front 52

What is the cause of Sinusitis?

Back 52

Sinusitis mostly Caused by viral, but bacterial causes are same as otitis media - S pneumoniae, H influenzae, and M catarrhalis

Front 53

What are the causes of Otitis media?

Back 53

Sinusitis mostly Caused by viral, but bacterial causes are same as otitis media - S pneumoniae, H influenzae, and M catarrhalis

Front 54

Throat pain, sore throat, exudate, adenopathy. Dx? initial and most accurate Lx? Tx?

Back 54

Pharyngitis presents with Throat pain sore throat, exudate, and adenopathy. Initial Lx is Rapid Strep test for Group A Strep, which can lead to Rheumatic fever or Glomerulonephritis. Most accurate Lx is Culture. Tx - Penicillin or Amoxicillin. Penicillin allergy - use Azithromycin or Clarithromycin.

Front 55

Arthralgia, myalgia, cough, headache, fever, sore throat, and feeling of tiredness. Dx? Lx? Tx? Prevention?

Back 55

Influenza presents with Arthralgia, myalgia, cough, headache, fever, sore throat, and feeling of tiredness. Lx is Viral Antigen Detection testing of a nasopharyngeal swab. Tx - Oseltamivir or Zanamivir within first 48 hours after onset of symptoms. These are neuraminidase inhibitors for influenza A and B. Amantadine and Rimantadine will work for Influenza A.

Front 56

Weeping, Crusting, Oozing skin infection. Dx? Cause? Lx? Tx?

Back 56

Impetigo presents with Honey colored Weeping, Crusting, Oozing skin infection. Impetigo Strep Pyogenes or Staph Aureus infecting Epidermal layer of skin. Tx - Topical Mupirocin or Bacitracin (Mupirocin works better on MRSA). Severe disease - Oral Dicloxacillin or Cephalexin. Community-acquired MRSA - TMP-SMZ, Clindamycin is sometimes useful. Penicillin allergy - Rash - Cephalosporins, Penicillin Anaphylaxis - Macrolides or Clindamycin, Penicillin allergy Severe infection with Anaphylaxis - Vancomycin, Linezolid, Daptomycin.

Front 57

Very bright red and hot skin infection. Dx? Cause? Lx? Tx?

Back 57

Erysipelas present with Very bright red and hot skin infection due to dilation of capillaries of dermis. Cause by Group A, Pyogenes, Strep infection. Blood culture may be positive. Initial Tx - Oral Dicloxacillin or Cephalexin. If organism is Confirmed as Group A Beta Hemolytic Step - Tx - Penicillin VK.

Front 58

Warm, red, swollen, tender skin. Dx? Cause? Lx? Tx?

Back 58

Cellulitis presents with Warm, red, swollen, tender skin. Casuse by Stap Aureus and Strep Pyogenes. Lx - for cellulitis in a leg - do Lower Extremity Doppler to exclude Blood Clot. Tx - Minor dz - Dicloxacillin or Cephalexin orally. Tx - Severe dz - Oxacillin, Nafcillin, or Cefazolin IV. Tx Penicillin allergy - Rash - Cephalosporins, like Cefazolin. Tx Penicillin Anaphylaxis - Vancomycin, Linezolid, or Daptomycin. Tx Anaphylaxis minor infections - Macrolides or Clindamycin can be useful.

Front 59

What skin infection does Staph Epidermidis cause?

Back 59

Staph Epidermidis Does Not cause skin infection

Front 60

What are the skin infection beginning at hair follicle? Cause? Tx?

Back 60

Staph Aureus related skin infections beginning at hair follicle are Folliculitis < Furuncles < Carbuncles < Boils. Folliculitis is smallest and most minor. Abscess is largest. Tx - same antibiotics with Cellulitis. Tx - Minor dz - Dicloxacillin or Cephalexin orally. Tx - Severe dz - Oxacillin, Nafcillin, or Cefazolin IV. Tx Penicillin allergy - Rash - Cephalosporins, like Cefazolin. Tx Penicillin Anaphylaxis - Vancomycin, Linezolid, or Daptomycin. Tx Anaphylaxis minor infections - Macrolides or Clindamycin can be useful. Boil respond to Drainage. Post-strep complication is Glomerulonephritis, not Rheumatic fever.

Front 61

What is post skin infection complication?

Back 61

Post Strep skin infection can cause Glomerulonephritis, Not Rheumatic Fever

Front 62

Severe itching of scalp, dandruff, and bald patches. Dx? Lx? Tx?

Back 62

Fungal infections of skin is Severe itching of scalp, dandruff, and bald patches. Lx - KOH prep of skin or nail scraping. Tx - Topical antifungal medication if No Hair or Nail involvement - Clotrimazole, Miconazole, Ketoconazole, Econazole, Terconazole, Nystatin, or Ciclopirox. Tx - Scalp - Tinea Capitis or Nail - Onychomycosis - Terbinafine -AE Increased Liver fx test, Itraconazole, Griseofulvan for Tinea Capitis - less efficacy than Terbinafine or Itraconazole

Front 63

Nail Thickened, yellow, cloudy, and appear fragile and broken. Dx? Lx? Tx?

Back 63

Onychomycosis, fungal infection - Nail Thickened, yellow, cloudy, and appear fragile and broken. Lx - KOH prep of skin or nail scraping. Tx - Topical antifungal medication if No Hair or Nail involvement - Clotrimazole, Miconazole, Ketoconazole, Econazole, Terconazole, Nystatin, or Ciclopirox. Tx - Scalp - Tinea Capitis or Nail - Onychomycosis - Terbinafine -AE Increased Liver fx test, Itraconazole, Griseofulvan for Tinea Capitis - less efficacy than Terbinafine or Itraconazole

Front 64

What kind of medications are Terbinafine, Itraconazole, and Griseofulvan? What are their Adverse Effect?

Back 64

Terbinafine, Itraconazole, and Griseofulvan are Oral Antifungals. Terbinafine - Increased liver fx test, Itraconazole - none, Griseofulvan for Tinea Capitis - less efficacy than either Terbinafine or Itraconazole

Front 65

What is dysuria symptoms?

Back 65

Dysuria symptoms are frequency, urgency, and burning.