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251 Cards in this Set
- Front
- Back
IV treatment of MSSA
|
Oxacillin/nafcillin, or cefazolin |
|
Oral treatment of MSSA
|
Dicloxacillin or cephalexin |
|
Treatment of severe MRSA infection
|
Vancomycin, linezolid, daptomycin, ceftaroline, tigecycline, telavancin |
|
Major side effect of linezolid |
Thrombocytopenia |
|
Major side effects of daptomycin |
Myopathy, rising CPK |
|
Telavancin origin and mechanism |
Acts as bactericidal LPS - binds peptidoglycan |
|
Alternative antibiotics to penicillin if anaphylaxis in history
|
Macrolides or clindamycin |
|
Linezolid mechanism |
Inhibits protein synthesis |
|
Antibiotics specific for Streptococcus |
Penicillin, ampicillin, amoxicillin |
|
Piperacillin/ticarcillin coverage |
Gram negative rods, streptococci, anaerobes |
|
Aminoglycoside coverage and use |
Works synergistically with other agents for Staph, enterococcus |
|
Tigecycline coverage |
Is weaker than other anti-MRSA agents |
|
Imipenem adverse effect |
Seizures |
|
Best antibiotic for abdominal anaerobes
|
Carbapenems, piperacillin, ticarcillin with equal efficacy |
|
Only cephalosporins that cover anaerobes
|
Cefoxitin and cefotetan (in cephamycin class) |
|
Best antibiotic for anaerobic Strep
|
Clindamycin
|
|
Best long term therapy for CMV retinitis
|
Valgancyclovir |
|
Gancyclovir/valgancyclovir adverse effects
|
Neutropenia, bone marrow suppression |
|
Foscarnet adverse effect
|
Renal toxicity |
|
Oral agents for hep C |
Boceprevir Simeprevir Sofosbuvir |
|
Hep C treatment that doesn't have to be combined with interferon
|
Sofosbuvir |
|
Oseltamavir and zanamivir mechanism |
Neuraminidase inhibitor |
|
Ribavirin uses |
RSV |
|
Ribavirin adverse effects |
Anemia |
|
Chronic hep B meds |
Interferon Adefovir Tenofovir Entecavir Telbivudine |
|
Echinodcandin mechanism |
1,3 glucose inhibition in fungi only |
|
Sofosbuvir mechanism |
RNA polymerase inhibitor |
|
Simeprevir, boceprevir, telaprevir mechanism |
(Hep C treatment) |
|
Which species of Candida is NOT vulnerable to fluconazole? |
Candida krusei, Candida glabrata |
|
Fluconazole uses |
Cryptococcus Oral/vaginal candidiasis |
|
Itraconazole indications |
Equal to fluconazole |
|
Best agent against Aspergillus |
Voriconazole |
|
Posaconazole coverage |
Mucormycosis or Mucorales |
|
What fungal infection do echinocandins NOT cover? |
Cryptococcus |
|
Examples of echinocandins |
Micafungin Anidulafungin |
|
Best antifungal for neutropenic fever |
Caspofungin (echinocandins) |
|
Echinocandin adverse effects |
None - inhibits 1,3 glucan synthesis step in fungi |
|
Azole antifungal mechanism |
Inhibits conversion of lanosterol to ergosterol |
|
Amphotericin coverage |
Cryptococcus Aspergillus |
|
2 main indications for Amphotericin |
Mucormycosis |
|
Amphotericin adverse effects |
Hypokalemia Metabolic acidosis Fever/chills |
|
Mechanism of renal toxicity in amphotericin |
|
|
What should you do if patient develops renal toxicity to amphotericin? |
Switch to liposomal amphotericin
|
|
Most accurate test for osteomyelitis
|
Bone biopsy and culture |
|
Earliest finding of osteomyelitis on X-ray
|
Periosteal elevation - takes two weeks |
|
How useful is a bone scan for osteomyelitis?
|
Not very - it is poor at distinguishing bone vs. soft tissue infection |
|
Best way to follow therapy effectiveness for osteomyelitis |
ESR |
|
When should you culture a draining sinus tract or ulcer? |
Never |
|
Time frame and route for treatment of Staph osteomyelitis |
IV only, 4-6 weeks |
|
Most common causes of Gram negative osteomyelitis
|
Pseudomonas |
|
Strategy for treatment of Gram negative osteomyelitis |
Must do bone biopsy and culture with sensitivites |
|
Diagnosis if pain with manipulation of tragus
|
Otitis externa |
|
Historical causes of otitis externa |
Foreign objects (cotton swabs, hearing aids) |
|
Diagnostic testing for otitis externa
|
Do NOT culture |
|
Treatment of otitis externa
|
Topical hydrocortisone Acetic acid solution to reacidify ear |
|
Pathology of malignant otitis externa |
Osteomyelitis of skull from Pseudomonas in diabetic |
|
Serious complications of malignant otitis externa |
Destruction of skull |
|
Diagnosis of malignant otitis externa |
MRI, bone biopsy |
|
Best initial test for malignant otitis externa |
CT/MRI |
|
Most accurate test for malignant otitis externa |
Bone biopsy |
|
Treatment of malignant otitis externa |
Antibiotics against Pseudomonas |
|
Most sensitive finding in otitis media |
Immobility of tympanic membrane |
|
Most accurate test for otitis media |
Only for recurrent or persistent cases |
|
What antibiotics to use for otitis media if failed therapy? |
If no improvement at 3 days |
|
Best initial test for sinusitis |
X-ray |
|
Most accurate test for sinusitis |
Sinus aspirate for culture |
|
Treatment of sinusitis |
Amoxicillin, inhaled steroids |
|
When to use Augementin for sinusitis |
Persistent despite one week of decongestants Purulent nasal discharge |
|
Most accurate test for Strep pharyngitis |
Culture |
|
Treatment of Strep pharyngitis if allergic to penicillin |
Cephalexin if allergy is rash |
|
Strongest indications for influenza vaccine |
CHF Dialysis Steroid use Health care workers Age >50 |
|
When is it ok to use live flu vaccine? |
Age <50, no medical problems |
|
Best initial treatment of impetigo |
Topical mupirocin or retapamulin |
|
Treatment of severe impetigo |
PO dicloxacillin or cephalexin
|
|
Treatment of impetigo if allergic to penicillin |
Doxycycline Linezolid |
|
Treatment of erysipelas |
Penicillin VK if confirmed group A Strep |
|
Retapamulin use |
Topical antibiotic only for impetigo |
|
Treatment of minor cellulitis |
PO dicloxacillin or cephalexin |
|
Treatment of severe cellulitis |
Oxacillin, nafcillin, or cefazolin IV |
|
Treatment of cellulitis if rash to penicillin |
Cefazolin, ceftaroline |
|
Size and classication of infected follicle |
Folliculitis --> furuncle --> carbuncle --> boil --> abscess |
|
Treatment of follicle infections |
Same as cellulitis; drains boils and abscesses |
|
Route for treatment of fungal skin infections |
Oral if scalp or nail |
|
Topical antifungals for skin infection
|
Clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin, ciclopirex |
|
PO antifungals for scalp/nail infection
|
Itraconazole Griseofulvin (less efficacy) |
|
Defining characteristic of urethritis |
Urethral discharge - even without dysuria |
|
Signs of disseminated gonorrhea
|
Petechial rash Tenosynovitis |
|
Best test for gonorrhea and chlamydia
|
Nucleic acid amplification test (NAAT)
|
|
Best measure of severity of pelvic imflammatory disease
|
Leukocytosis |
|
Best initial test for pelvic inflammatory disease
|
Pregnancy test, then cervical culture and NAAT |
|
Most accurate test for pelvic inflammatory disease
|
Laparoscopy |
|
Inpatient treatment of pelvic inflammatory disease |
Cefoxitin (or cefotetan) IV, doxycycline, with or without metronidazole |
|
Treatment of pelvic inflammatory disease if penicillin allergy |
Clindamycin and gentamicin |
|
How to collect sample for NAAT in gonorrhea/chlamydia
|
Women - Self-administered blind vaginal swab |
|
What antibiotics are safe to use in pregnancy?
|
Cephalosporins Aztreonam Erythromycin Azithromycin |
|
How can you differentiate epididymo-orchitis from testicular torsion
|
Abnormal testicular position (elevated, transverse) in torsion
|
|
Treatment of epididymo-orchitis |
If over 35 - fluoroquinolone |
|
Best initial test for chancroid |
Swab for Gram stain (Gram neg coccobacilli) and culture |
|
Culture medium for chancroid |
Nairobi medium or Mueller-Hinton agar |
|
Treatment of chancroid |
Single dose or IM ceftriaxone or oral azithromycin |
|
Cause of lymphogranuloma venereum |
Chlamydia trachomatis |
|
Diagnostic test for lymphogranuloma venereum |
Serology for Chlamydia trachomatis |
|
Treatment of lymphogranuloma venereum
|
Aspirate bubo, doxycycline or azithromycin |
|
Next best step if genital vesicles present
|
Treat - acyclovir 7-10 days |
|
Most accurate test for herpes |
Viral culture |
|
Treatment of acyclovir resistant herpes |
Foscarnet |
|
Patient with fever, headache, and myalgia 24 hours after treatment for early syphilis. What is the diagnosis?
|
Jarisch-Herxheimer reaction - due to release of pyrogens |
|
Treatment of Jarisch-Herxheimer reaction
|
Use aspirin Do not stop antibiotics |
|
Symptoms of secondary syphilis |
Mucous patch Alopecia areata Condyloma lata |
|
Initial diagnostic test for secondary syphilis
|
FTA (more sensitive than VDRL for neurosyphilis) |
|
Treatment of secondary syphilis
|
(Doxycycline if allergic) |
|
Symptoms of tertiary syphilis
|
Gummas Aortitis |
|
Initial diagnostic test for tertiary syphilis
|
RPR/FTA, lumbar puncture (VDRL and FTA) |
|
Treatment of tertiary syphilis |
IV penicillin |
|
Treatment of tertiary syphilis if penicillin allergy |
IV penicillin - must desensitize |
|
Presentation of granuloma inguinale |
Beefy red lesion that ulcerates |
|
What organism causes granuloma inguinale? |
Klebsiella granulomatis |
|
Diagnosis of granuloma inguinale |
Biopsy or touch prep - look for Donovan bodies |
|
Treatment of granuloma inguinale |
|
|
What part of the body is pediculosis most common on? |
Hair bearing areas - pubic and axilla |
|
Most common place on body to find scabies |
Web spaces |
|
Treatment of pediculosis
|
Pyrethrins Lindane |
|
Treatment of scabies |
Lindane Ivermectin |
|
Indications for imiquimod
|
Actinic keratosis Minor squamos cell carcinoma Venereal warts |
|
First line treatment for cystitis |
Bactrim for 3 days Levaquin/Cipro if >20% resistance Fosfomycin, Macrobid |
|
Definition of complicated cystitis |
Anatomic abnormality present - stone, stricture, tumor, etc. |
|
Treatment of complicated cystitis |
7 days Bactrim or Cipro |
|
Outpatient treatment of pyelonephritis |
Cipro |
|
Inpatient treatment of pyelonephritis
|
Ertapenem Fluoroquinolone Ampicillin/gentamicin |
|
Patient with pyelonephritis and no treatment response at 5-7 days. What is diagnosis and confirmation? |
Perinephric abscess - sonogram or CT to confirm |
|
What is best next step after diagnosis of perinephric abscess?
|
Biopsy - to guide therapy |
|
Empiric treatment of perinephric abscess
|
Add Staph coverage |
|
Best initial test for prostatitis |
UA |
|
Most accurate test for prostatitis |
Urine WBCs after prostate massage
|
|
Treatment for prostatitis
|
Cipro or Bactrim - 2 weeks for acute, 6 weeks for chronic |
|
Diagnostic criteria for infective endocarditis |
Must have either 2 major, 1 major + 3 minor, or 5 minor |
|
Duke's major criteria |
2. Abnormal echo |
|
Duke's minor criteria |
2. Risk factors 3. Vascular findings 4. Immune findings 5. Positive blood culture that doesn't meet major criterion |
|
Most common bugs in infective endocarditis |
Strep viridans Strep bovis/epidermis Enterococci Gram negative rods Candida HACEK organisms |
|
HACEK organisms in endocarditis |
Haemophilus aphrophilus/parainfluenzae Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eikenellla corrodens Kingella kingae |
|
Echo findings in endocarditis
|
Abscess, OR New partial dehiscence of prosthetic valve |
|
Risk factors for endocarditis
|
Structural heart disease Prosthetic valve Dental procedure with bleeding History of endocarditis |
|
Next best step if fever + new murmur |
If positive, do echo |
|
What are Janeway lesions?
|
Flat, painless lesions |
|
What are Osler nodes?
|
Raised and painful |
|
Diagnostic testing for infective endocarditis
|
If negative, then TEE |
|
Most common cause of culture negative endocarditis |
Coxiella and Bartonella |
|
What endocarditis bug is most closely associated with colonic pathology? |
Clostridium septicum, then Strep bovis |
|
Best empiric therapy for infective endocarditis |
Vancomycin + genamicin |
|
Length of treatment for endocarditis |
4-6 weeks |
|
Indications for surgery in infective endocarditis
|
Abscess Prosthetic valves Fungal endocarditis Embolic events once antibiotics have already been started |
|
Cardiac defects that require endocarditis prophylaxis |
Unrepaired cyanotic heart disease Previous endocarditis Transplant recipients who develop valvular disease |
|
Procedures that require endocarditis prophylaxis |
Respiratory tract surgery Surgery of infected skin |
|
Procedures that do not need endocarditis prophylaxis |
Dental fillings Flexible scopes OB/GYN procedures Urinary procedures |
|
Cardiac defects that do not require endocarditis prophylaxis
|
Mitral stenosis/regurge ASD/VSD Pacemaker/ICD MVP HOCM |
|
What antibiotics to use for endocarditis prophylaxis in dental procedures?
|
If allergic and rash - cephalexin If anaphylaxis - clindamycin or macrolide |
|
What antibiotics to use for endocarditis prophylaxis in skin procedures? |
If allergic, use vancomycin |
|
When to start therapy for HIV
|
If symptomatic with any CD4 count or viral load All pregnant women Needle stick scenario Optional at CD4 >500 |
|
Typical drug combo used in HAART
|
Tenofavir + emtricitabine + efavirenz/atazanavir/darunavir |
|
When to use ritonavir in HIV |
When using protease inhibitor (atazanavir, darunavir) in combination with tenofavir and emtricitabine - boosts protease inhibitor levels |
|
Raltegravir mechanism and use
|
Integrase inhibitor - use with two nucleosides |
|
Adverse effects or NRTIs as a class |
Lactic acidosis |
|
Adverse effects of protease inhibitors as a class |
Hyperglycemia, hyperlipidemia |
|
Name the NRTIs
|
Didanosine Stavudine Lamivudine Abacavir Emtricitabine Tenofavir |
|
Name the protease inhibitors for HIV |
Ritonavir Lopinavir Nelfinavir Saquinavir Darunavir Tipranavir Amprenavir Atazanavir |
|
Name the NNRTIs
|
Nevirapine Etravirine Rilpivirine |
|
Zidovudine adverse effect
|
|
|
Didanosine adverse effect
|
Peripheral neuropathy |
|
Stavudine adverse effects
|
Pancreatitis, neuropathy |
|
Abacavir adverse effects |
Rash |
|
Tenofavir adverse effects |
|
|
Indinavir adverse effects |
Kidney stones |
|
Efavirenz adverse effects |
Drowsiness |
|
Maraviroc mechanism |
Blocks CCR5 - prevents HIV entry into cell |
|
Management of exposure to HIV+ blood
|
HAART for 1 month |
|
Ritonavir mechanism
|
Inhibits hepatic p450 - blocks metabolism of other protease inhibitors |
|
Antiretroviral to avoid in pregnancy
|
Efavirenz |
|
Prophylaxis of PCP if bactrim allergy
|
Atovaquone or dapsone (not in G6PD deficiency) |
|
When to prophylax against Mycobacterium avium-intracellulare in HIV
|
CD4 <50 |
|
Antiobiotics for Mycobacterium avium-intracellulare prophylaxis in HIV
|
Azithromycin weekly |
|
Lab findings in PCP pneumonia
|
Increased LDH |
|
Most accurate test for PCP pneumonia |
Bronchoalveolar lavage |
|
Treatment of PCP pneumonia and alternate is allergic |
Allergy - IV pentamidine OR clinda + primaquine |
|
When to use steroids in PCP pneumonia
|
A-a gradient >35 |
|
Ganciclovir adverse effect
|
Low WBC |
|
Foscarnet adverse effect |
Elevated creatinine |
|
Best initial test for toxoplasmosis |
Head CT with contrast |
|
Management of toxoplasmosis |
Pyrimethamine and sulfadiazine for two weeks, then repeat CT |
|
Differentiation of toxoplasmosis from lymphoma in AIDS |
Treat toxo for 2 weeks then repeat head CT; if lesions shrink, is toxo; if not, biopsy for lymphoma |
|
Presentation of CMV in HIV
|
CD4 <50 and blurry vision |
|
Evaluation of CMV retinitis in HIV |
Dilated ophthalmologic exam - appearance of lesions |
|
Treatment of CMV retinitis
|
Ganciclovir or foscarnet |
|
Maintenance therapy for CMV in HIV |
Oral valganciclovir lifelong, unless CD4 rises with HAART |
|
Presentation of Cryptococcus in HIV |
CD4 <50, fever, headache |
|
LP findings in Cryptococcal meningitis |
Increased lymphocytes |
|
Most accurate test for Cryptococcal meningitis
|
Cryptococcal antigen test |
|
Treatment of cryptococcal meningitis |
Amphotericin + 5-FC, followed by fluconazole |
|
Maintenance therapy for Cryptococcus in HIV
|
Lifelong fluconazole, unless CD4 rises |
|
Presentation of progressive multifocal leukoencephalopathy
|
CD4 <50, focal neurological deficits |
|
Best initial test for progressive multifocal leukoencephalopathy
|
Head CT or MRI (no findings) |
|
Most accurate test for progressive multifocal leukoencephalopathy |
PCR of CSF for JC virus |
|
Treatment of progressive multifocal leukoencephalopathy
|
HAART - resolves when CD4 rises |
|
Presentation of Mycobacterium avium-intracellulare |
Anemia from bone marrow invasion |
|
Lab findings for hepatic involvement of Mycobacterium avium intracellulare
|
Increased alk phos and GGTP with normal bilirubin |
|
Relative sensitivities of tests for Mycobacterium avium intracellulare
|
Blood Cx < bone marrow < liver biopsy (most sensitive) |
|
Treatment of Mycobacterium avium intracellulare
|
Rifampin may be added |
|
Animal exposure + jaundice + renal involvement; what is diagnosis? |
Leptospirosis |
|
Treatment of leptospirosis
|
Ceftriaxone or penicillin |
|
Presentation of tularemia |
Conjunctivitis |
|
Diagnosis of tularemia |
Serology |
|
When to culture for tularemia |
Never - spores can cause severe pneumonia |
|
Treatment of tularemia |
Gentamicin or streptomycin |
|
CT findings in cysticercosis |
Thin-walled cysts in head, most often calcified
|
|
Treatment of cysticercosis
|
Albendazole, unless no active lesions - then anti-seizure meds if needed |
|
Treatment of CNS or cardiac Lyme disease |
Ceftriaxone IV |
|
Most common late manifestation of Lyme disease
|
Joint involvement |
|
Treatment of Lyme disease |
Doxycycline, amoxicillin, or cefuroxime |
|
Presentation of babesiosis |
Hemolytic anemia, severe in asplenic patients |
|
Diagnosis of Babesiosis
|
Or do PCR |
|
Treatment of babesiosis |
Azithromycin or atovaquone |
|
Presentation of Ehrlichia/Anaplasma |
Elevated LFTs, thrombocytopenia, leukopenia; NO rash |
|
Diagnosis of Ehrlichia
|
Or PCR |
|
Treatment of Ehrlichia |
Doxycycline |
|
Presentation of malaria |
GI complaints always present |
|
Treatment of acute malaria |
Quinine/doxycycline if severe |
|
Prophylaxis of malaria |
Mefloquine (weekly), or atovaquone/proguanil (daily) |
|
Mefloquine side effects
|
Sinus bradycardia QT prolongation |
|
Branching, Gram positive filaments, weakly acid fast; what bug?
|
Nocardia |
|
Most common sites of Nocardia infection
|
Most commonly disseminates to skin and brain |
|
Best initial test for Nocardia |
CXR |
|
Most accurate test for Nocardia
|
Culture |
|
Treatment of Nocardia |
Bactrim |
|
What history is typically present in Actinomyces infection?
|
Facial or dental trauma
|
|
Treatment of Actinomyces infection
|
Penicillin |
|
Difference in history between Nocardia and Actinomyces infection |
Actinomyces - normal immune system |
|
Diagnosis of Actinomyces
|
Gram stain, confirm with anaerobic culture |
|
Geographic location for Histoplasmosis infection
|
Wet areas - Ohio and Mississippi River Valleys |
|
Bat dropping association
|
Histoplasmosis |
|
Physical exam findings in histoplasmosis |
Palate/oral ulcers and splenomegaly |
|
Finding in disseminated histoplasmosis
|
Pancytopenia - invasion of bone marrow |
|
Best initial test for histoplasmosis
|
Histoplasmosis urine antigen
|
|
Most accurate test for histoplasmosis
|
Biopsy with culture |
|
Treatment of acute pulmonary histoplasmosis
|
Transient, requires no therapy
|
|
Treatment for disseminated histoplasmosis
|
Amphotericin |
|
Geographic location for coccidioidomycosis infection |
Very dry areas - Arizona |
|
Presentation of coccidioidomycosis
|
Joint pain, erythema nodosum |
|
Treatment of coccidioidomycosis
|
Itraconazole |
|
Geographic location of blastomycosis infection |
Rural southeast |
|
Histology of blastomycosis
|
Broad budding yeast |
|
Common site of extrapulmonary lesions in blastomycosis
|
Bone |
|
Treatment of blastomycosis |
Amphotericin or itraconazole |