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137 Cards in this Set

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MSSA antibiotics (IV)
Oxacillin/nafcillin
dicoxacillin
or cephalasporin
MSSA antibiotics (oral)
Diclocacillin or
cephalexin (first gen cephalosporin)
MRSA antibiotics for severe infection
Vancomycin
Lenozolid
Daptomycin
tigecyline
MRSA antibiotics for minor infection
TMP/SMX
Clindamycin
Penicillin allergy (rash)
use cephalosporins
Penicillin allergy: anaphylaxis
macrolides (azithromycin, clarithromycin) or clindamycin
Penicillin allergy: Severe infection
vancomycin
linezolid
daptomycin
Antibiotics that cover strep and staph
Penicillin
ampicillin
amoxicillin
Carbapenam that does not cover pseudomonas
ertapenem
__________ work synergistically with other agents to treat staph/strep
aminoglycosides
________ are excellent anti-anaerobic medications

They cover _______ and ______
carbapenems

stretptococci and MSSA
Best medication for abdominal anaerobes
metronidazole
The only cephalosporins that cover anaerobic strep (2)
cefoxitin
cefotetan
The best drug for anaerobic strep
clindamycin
adverse effects of ganciclovir
neutropenia and bone marrow suppression
adverse effects of foscarnet
renal toxicity
Influenza a and b drugs
oseltamivir
zanamivir
Ribvarin- used with
hep C (with interferon)
RSV
Chronic hep B drugs
Lamivudine
inerferon
adefovir
entecavir
telbivudine
Fluconazole- used for
candida
cryptococcus
oral and vaginal candidiasis as an alternative to topicals
Itraconazole
Largely equal to fluconazole but less easy to use
Voriconazole (covers ?)
Covers ALL candida (even krusei and glabrata)
caspofungin, micafungin, andidulafungin
excellent for neutropenic fever
does NOT cover cryptococcus
lower mortality than amphotericin
NO adverse effects!
amphotericin, effective against
effective against all candida, cryptococcus, and aspergillus
amphotericin, side effects
renal toxicity
hypokalemia
metabolic acidosis
fevers, shakes, chills
conditions that increase risk for osteomylitis
diabetes
peripheral vascular disease
direct trauma and hx of orthopedic surgery
Osteomylitis: best initial test and best second line (if first line is neg)
Plain x-ray
MRI
Earliest finding of osteomyelitis on xray
periosteal elevation
Osteomyelitis: Most accurate diagnostic
bone biopsy and culture
Osteomylitis: Staphylococcus (MCC) treatment
oxacillin or nafcillin IV x 4-6 wks
Osteomyelitis: salmonella and pseudomonas
ONLY form that can be tx'd with oral!
CONFIRM with culture before treating
Malignant otitis externa, definition
osteomyelitis of the skull from pseudomonas, in a diabetes
Malignant otitis externa: 1. best initial test 2. most accurate
1. MRI or skull Xray
2. Biopsy
The most sensitive physical exam finding for Otitis Media
immobility of the tympanic membrane
Otitis media: best initial treatment
amoxicillin 7-10 days (longer for younger; shorter for older)
Otitis media: next step (in recurrent cases)
perform the most accurate test: tympanocentesis and aspirate of the membrane for culture
Otitis media, if infection doesn't improve after amoxicillin
amoxicillin-clavulanate
cefdinir
ceftibuten
cefuroxime
cefprozil
Sinusitis : best initial test, most accurate
xray, sinus aspirate for culture
Pharyngitis, presentation
pain/sore throat
exudate
adenopathy
NO COUGH/HOARSENESS
pharyngitis diagnostics; initial
most accurate
rapid strep test
culture
Pharyngitis: treatment
penicillin or amoxicillin

if pcn allergy: azithromycin or clarithromycin
influenza: diagnostic testing
viral antigen detection testing of a nasopharnygeal swab
influenza: treatment
if within 48 hours then ostelamivir or zanamivir

(amantadine and rimantidine only effective against influenza a)
who gets vaccinated against influenza (6 groups)
1. COPDers
2. CHF
3. dialysis patient
4. steroid use
5. health care workers
6. everyone > 50
Impetigo: presentation
sweeping, crusting, and oozing of the skin
honey color lesion
impetigo: treatment
topical mupirocin or bacitracin
Severe; oral dicloxacillin or cephalexin
TMP-SMX
erysipelas: presentation and diagnosis
bright red and hot skin, usually in the face
blood cultures can be skipped
erysipelas: treatment
initial: oral dicloxacillin or cephalexin

if group A beta- penicillin VK
complications of erysipelas
glomerulonephritis only
complications of pharyngitis
glomerulonephritis AND rheumatic fever
test to order with a case of cellulitis in a leg
doppler
causes of cellulitis
staphylococcus aureus and streptococcus pyogeneslitis
treatment of cellulitis
dicloxacillin or cephalexin (minor)
oxacilli, nafcillin or cefazolin IV (major)
cephalosporins (pcn allergy rash)
vancomycein, linezolid, or daptomycin (pcn anaphylaxis)
staph aureus related skin infections in order of size (smallest to largest)
folliculitis
furuncles
carbuncles
boils
abscess
fungal infections of skin and nails (best initial diagnostic test)
1. KOH preparation
medications for tinea capitis
terbinafine (increased lfts)
itraconazole
griseofulvan (least efficacious)
Treatment for pregnant patients with gonorrhea
cefrtiaxone im and azithromycin
Measure of severity of PID
leukocytosis
PID : best initial test
PT, then cervical culture and chlamydia and gonorrhea dna probe
PID: Most accurate test
laparoscopy -only done for recurrent or persistent infection
PID treatment
outpatient: ceftriaxone (IM) and doxycycline (oral

inpatient: Cefoxitin (IV) and doxycycline and maybe metronidazole
Antibiotics that are safe in pregnancy (5)
Penicillins
Cephalosporins
Aztreonam
Erythromycin
Azithromycin
epidydimo-orchitis treatment
< 35 years of age: Ceftriaxone and doxycycline

>35 floroquinolone
Chancroid best initial diagnostic test
swab for gram stain (gm neg coccobacilli) and culture (nairobi medium)
Chancroid treatment
single IM shot of ceftriaxone
singe oral doze of azithromycin
Primary syphilis; symptoms/treatment
chancre, adenopathy; single IM shot of penicillin (doxycyline for pcn allergy)
Secondary syphilis: symptoms/treatment
rash, mucous patch, alopecia areata, condylomata lata
single IM shot of penicillin (doxycycline)
tertiary syphilis: symptoms
tabes dorsalis
Argyll-Robertson pupil
general paresis
rarely a gumma or aortis
Tertiary syphilis, initial diagnostic test
RPR
FTA
lumbar puncture for neurosyphilis
tertiary syphilis: treatment
IV penicillin
Desensitize if pcn allergy
When is desensitization the answer for penicillin allergy
neurosyphilis
pregnant women
asymptomatic bacteriuria treatment
only treat pregnant women
UTI treatment
ciprofloxacin for outpatient treatment
ampicillin/gentamicin for inpatient
dysuria+white cells in urine+suprapubic tenderness=
cystitis
Dysuria + white cells in urine + flank pain+ fever=
pyelonephritis
Perinephric abscess: presentation
patient with pyelonephritis who does not respond to treatment after 5-7 days
Perinehpric abscess: diagnostics (initial and most accurate)
sonogram or CT
biopsy
perinephric abscess treatment
quinolone
add staph coverage (oxacillin or nafcillin)
prostatitis presentation
frequency, urgency, dysuria and perineal or sacral pain

"boggy" prostate on exam
prostatitis treatment
ciprofloxacin
Major Jones criteria for endocarditis
intracardiac mass or valvular vegetation

abscess

new partial dehiscence of prosthetic valve
Minor jones criteria for endocarditis
IV drug use
structural heart disease
prosthetic heart valve
dental procedures involving bleeding
history of endocarditis
positive blood culture
Janeway lestions
Septic pulmonary infarcts
arterial emboli
mycotic aneurysm
conjunctival hemorrhage
Risk factors for endocarditis
prosthetic heart valve
injection drug use
dental procedures that cause bleeding
previous endocarditis
unrepaired cyanotic heart disease
2 positive blood culture+positive echo=
endocarditis
Best empiric therapy for endocarditis
vancomycin and gentamicin
Cardiac defects that need prophylaxis
Prosthetic valves
unrepaired cyanotic heart disease
previous endocarditis
transplant recipients who develop valve disease
The only procedures that need prophylaxis and abx to use
Dental procedures that cause bleeding
Respiratory tract surgery
surgery of infected skin

amoxicillin (clindamycin for pcn allergy)
adverse effects of nucleoside reverse transcriptase inhibitors
lactic acidosis
adverse effects of protease inhibitors
hyperglycemia
hyperlipidemia
indinavir side effect
kidney stones
needle stick injury treatment
HAART for one month
< 200 CD4 cells
TMP/SMX for PCP (or atovoquone or dapsone if sulfa allergy)
PCP presentation
SOB
dry cough
hypoxia
increased LDH
PCP diagnostic: initial and best
chest x-ray- increased interstitial markings bilaterally

bronchoalveolar lavage
PCP treatment
IV tmp/smx
atovoquone for mild pneumocystis
severe PCP
= po2 <70 or A-a gradient >35
give steroids
toxoplasmosis presentation
headache, nausea, vomiting, focal neurological findings
Toxoplasmosis: treatment
pyrimethamine and sulfadiazine for 2 weeks and repeat CT
If toxoplasmosis does not respond to meds, its probably ________
lymphoma
HIV with <50 CD4 and blurry vision
CMV
CMV treatment
CMV maintenance therapy
ganciclovir or foscarnet

oral valganciclovir lifelong (or until CD4 goes up)
most accurate test for cryptococcus
cryptococcal antigen test
cryptococcus treatment and lifelong maintenance
amphotericin and fluconazole
Progressive multifocal leukoencephalopathy, presentation
HIV, CD4 <50, focal neurologic abnormalities
Progressive multifocal leukoencephalopathy,, treatment
no specific tx, tx with HAART
Mycobacterium Avium intracellulare presentation
HIV, <50 CD4 cells, weight loss, fever, and fatigue, anemia from invasion of bone marrow

increase ALP and GGTP with normal bilirubin
MAI treatment
clarithromycin and ethambutol
animal exposure+jaundice+renal=
leptospirosis
Leptospirosis, presentation
fever, abdominal pain, and muscle aches with a history of animal exposure
leptospirosis, treatment
ceftriaxone or penicillin
Tularemia, presentation
contact with rabbits, ulcer at the site of contact and enlarged lymph nodes
conjunctivitis
***note, taking a culture is dangerous!
cysticercosis, presentation
thin walled cysts on CT scan which are calcified
animal exposure+jaundice+renal=
leptospirosis
Leptospirosis, presentation
fever, abdominal pain, and muscle aches with a history of animal exposure
leptospirosis, treatment
ceftriaxone or penicillin
Tularemia, presentation
contact with rabbits, ulcer at the site of contact and enlarged lymph nodes
conjunctivitis
***note, taking a culture is dangerous!
cysticercosis, presentation
thin walled cysts on CT scan which are calcified
history of eating infected pork (in Mexico, South America, Eastern Europe, India)
Lyme disease, most common late manifestation
joint involvement
Lyme disease, most common cardiac manifestation
AV conduction block/defect
Lyme disease, most common neurologic manifestation
7th cranial nerve palsy (Bell's)
Lyme disease, treatment (rash, joint, bell's palsy)
oral doxycycline or amoxicillin
Lyme disease, treatment (CNS or cardiac involvement)
IV ceftriaxone
babesiosis, presentation
hemolytic anemia in pt with hx of northeast
Babesiosis, treatment
clindamycin and quinine
Nocardia, presentation
immunocompromised people with respiratory/pulmonary disease
may disseminate to any organ
Nocardia, diagnostic test (initial and best)
chest x ray
culture
Nocardia, treatment
tmp/smx
histoplasmosis, presentation
history of wet areas (Ohio/ Mississippi)
bat droppings from a cave
palate and oral ulcers
splenomegaly
pancytopenia
histoplasmosis, treatment
NONE for acute pulmonary disease
disseminated-amphotericin
coccidiodidomycosis, presentation and treatment
joint pain and erythema nodosum
itraconazole
Blastomycosis,
broad budding yeast
bone lesions
rural southeast
blastomycosis treatment
amphotericin or itraconazole
Anaphylaxis treatment
subcutaneous epinephrine
corticosteroids
diphenhydramine or hydroxzine
andioedema
sudden swelling of the face, palate, tongue, and airway in association with minor trauma to the face or hands OR
ingestion of ACEI
angioedema diagnostics
finding low levels C2 and C4 in the complement pathway
angioedema treatment
infusion of fresh frozen plasma (acute)
androgens danazol and stanazol (chronic)
common variable immunodeficiency (CVID) presentation
presents in both men and women, possibly only as an adult
recurrent epsiodes of sinopulmonary infections
***spruelike abdominal disorder***