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137 Cards in this Set
- Front
- Back
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*** |