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132 Cards in this Set
- Front
- Back
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Question
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Answer
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IV abx for MSSA
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oxacillin/nafcillin dicloxacillin cefazolin
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oral abx for MSSA
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dicloxacillin cephalexin
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abx for severe MRSA infx
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vanc linezolin daptomycin tigecycline
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abx for minor MRSA infx
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bactrim clindamycin
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abx to use for Staph if penicillin allergy causes rash
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cephalosporins
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abx to use for Staph if penicillin causes anaphylaxis
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macrolides (azithromycin, clarithromycin) or clindamycin
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abx to use for severe Staph infx if penicillin allergy
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vanc linezolid daptomycin
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abxt to use for minor staph infx if penicillin allergy
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macrolides (azithromycin, clarithromycin), clindamycin, bactrim
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what is the only carabapenem that doesn't cover pseudomonas
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ertapenem
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which 2 abx cover strep and anaerobes on top of gram negs
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piperacillin and ticarcillin (penicillins)
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which abx works synergistically with other drugs to treat staph and strep
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aminoglycosides
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name a GI anaerobe
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bacteroides
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what is the best abx for abdominal anaerobes
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metro
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what three meds are almost equal to metro in their coverage of abdominal anaerobes
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carbepenems piperacillin ticarcillin
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name the only two cephalosporins that cover anaerobes
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cefoxitin cefotetan
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name a resp anaerobe
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anaerobic strep
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what is the best abx for anaerobic strep
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clindamycin
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what should you do if someone gets red man syndrome from vanc
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slow the infusion
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3 abx used for herpes simplex and varicella zoster
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acyclovir valacyclovir famciclovir
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2 abx that cover CMV, herpes simplex, and zoster
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ganciclovir foscarnet
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adverse effect of ganciclovir
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neutropenia and BM suppression
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adverse effect of foscarnet
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renal toxicity
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2 abx for influenza A and B
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oseltamivir zanamivir
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abx for hep C (w/ interferon) and RSV
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ribavirin
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5 meds for chronic hep B
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lamivudine interreron adefovir entecavir telbivudine
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treatment for candida and cryptococcus
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fluconazole
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coveral all candida; best agent for Aspergillus
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voriconazole
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adverse effect of voriconazole
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visual disturbance
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fungal treatment for neutropenic patients
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echinocandins (caspofungin, micafungin, anidulafungin)
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adverse effect of echinocandins
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none
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adverse effects of amphotericin
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renal toxicity hypokalemia met acidosis fever, shakes, chills
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best initial test to dx osteo
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xray
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best second line image if high clinical suspicion of osteo and xray is negative
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MRI
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earliest xray finding seen in osteo
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elevated periosteum
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gold standard to dx osteo
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bone bx and cx
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best way to follow response to therapy for osteo
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ESR
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most common organism causing osteo
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staph
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2 gram neg bacilli that can cause osteo
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salmonella pseudomonas
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should you get a cx of pus in otitis externa
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no
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tx for otitis externa
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topical abx - ofloxacin or polymixin/neomycin hydrocortisone to decrease itching
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what is malignant otitis externa
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osteomyelitis of the skull from pseudomonas
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how do you dx malignant otitis externa
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like osteo - xray, mri, bone biopsy/cx
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how do you treat malignant otitis externa
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surgical debridement and abx against pseudomonas
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what is the most sensitive test for otitis media
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bulging membrane - if it moves, it's not otitis media
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best initial therapy for otitis media
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amoxicillin for 7-10 days
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what should you do if otitis media is recurrent or fails medical therapy
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tympanocentesis
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If otitis media fails to improve after 3 days on amoxicillin, switch to..
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amoxicillin-clavulanate cefdinir ceftibuten cefuroxime cefprozil
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the 3 bugs that cause otitis media and sinusitus
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S pneumoniae H influenzae M catarrhalis
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treatment for sinusitis
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same as otitis media: amoxicillin
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best initial imaging for sinusitis
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xray
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most accurate test for dx sinusitis
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sinus aspirate for cx
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do you need to do further testing if rapid strep is negative in an adult
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no. it's sensitive enough
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tx for strep pharyngitis
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penicillin or amoxicillin
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how to tx strep pharyngitis if penicillin allergy
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azithromycin or clarithromycin
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dx test for influenza?
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viral antigen detection from nasopharyngeal swab
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when is the correct time to use oseltamivir or zanamivir on a Pt with influenza A or B
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within 48 hrs of symptom onset
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who should get vaccinated against influenza
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COPD CHF dialysis steroid use health care workers everyone >50
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weeping, oozing, honey-colored lesions...name the organisms
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(impetigo) strep staph
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tx for mild impetigo
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mupirocin or bacitracin
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tx for severe impetigo
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oral dicloxacillin or cephalexin
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tx for impetigo if CA-MRSA
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bactrim
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very bright red skin and hot skin...often affecting the face
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erysipelas
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best initial treatment for someone with bright red, hot skin probably on face
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oral dicloxacillin or cephalexin (same as for severe impetigo)
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can skin infx cause rheumatic fever and glomerulonephritis like strep throat can?
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no, just glomerulonephritis but not rheumatic fever
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warm, tender, red, hot skin usually on leg or arm
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cellulitis
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what should you order if cellulitis presents on leg
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doppler (r/o DVT)
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2 organisms that cause cellulitis
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staph and strep
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tx for mild cellulitis
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oral dicloxacillin or cephalexin (same as for severe impetigo or erysipelas)
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tx for severe cellulitis
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IV oxacillin, nafcillin, or cefazolin
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what skin infx is caused by staph epidermidis
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none. nml skin flora
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treatment for folliculits
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same as for cellulitis (minor: dicloxacillin or cephalexin oral; sever: oxacillin, nafcillin, or cefazolin IV). you can drain boils
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best initial test for fungal infx of skin
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KOH prep: scrape skin or nail put on slide with KOH and acid heat slide (epi's dissolve)
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tx of fungal infx of skin if no hair or nail involvement
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clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin or ciclopirox
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tx of tinea capitis or onychomycosis
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terbinafine itraconazole
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someone with tinea capitis comes in with elevated LFT's. dx?
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terbinafine use
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best initial test for urethritis
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urethral swab for gram stain, cx, DNA probe
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tx of urethritis
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one drug against gonorrhea (ceftriaxone IM (pregnant), cefixime PO, cefpodoxime PO) and one against chlamydia (azithromycin x1 (prego) or doxy x1wk)
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what should you test for in someone who gets recurrent urethritis
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terminal complement deficiency - thet get recurrent neisseria infx (genital or CNS)
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how do you tx cervicitis
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same as for urethritis: one drug against gonorrhea (ceftriaxone IM (pregnant), cefixime PO, cefpodoxime PO) and one against chlamydia (azithromycin x1 (prego) or doxy x1wk)
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best initial test for PID
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beta hcg, cervical cx, and DNA probe for chlamydia and gonorrhea
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tx for PID as outpatient
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ceftriaxone IM and doxy oral
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tx for PID as inpatient
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cefoxitin IV (or cefotetan) and doxy
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5 abx safe in pregnancy
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penicillins cephalosporins aztreonam erythrocmycin azithromycin
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difference in presentation of epidydimo-orchitis vs testicular torsion
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in testicular torsion the testicle is elevated and in transverse position
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tx for epidydimo-orchitis
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<35: ceftriaxone and doxy >35: fluoroquinolone
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dz and organism associated with painful genital ulcer
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chancroid
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best initial tx for chancroid
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swab for gram stain and cx
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findings on swab stain of someone with painful genital ulcer
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(chancroid) gram neg coccobacilli
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tx for chancroid
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ceftriaxone IM x1 or azithromycin oral x1
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genital ulcer + lg tender lymph nodes (buboes - may develope draining sinus tract)
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lymphogranuloma venererum
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work-up and tx for LGV
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serology for chlamydia aspirate LN (buboes) tx with doxy
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dx and tx of man with vesicles on penis and lg inguinal lymph nodes
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HSV2 acyclovir, valacyclovir, or famciclovir for 7-10 days (don't need to confirm herpes if vesicles present)
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organism responsible for painless, firm genital lesion and painless adenopathy
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(syphillis) treponema pallidum
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most accurate test to dx primary syphillis
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dark field microscopy
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symptoms and tx for primary syphillis
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chancre (firm, painless genital lesion) and LAD tx: penicillin IM x1
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sx and secondary syphillis
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sx: rash, mucous patch, alopecia areata, condylomata lata
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initial dx test for secondary syph
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RPR and FTA
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tx for secondary syph
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penecillin IM x1
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sx of tertiary syphillis
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tabes dorsalis, argyll-robertson pupil, general paresis, gumma, aortitis
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initial dx test for tertiary syph
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RPR and FTA (LP for neurosyph - test CSF for VDRL and FTA)
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tx of tertiary syph
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penicllin IV
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if Pt is allergic to penicillin, desensitize is the right answer in these two scenarios...
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neurosyphillis pregnant
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beefy red genital lesion that ulcerates
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granuloma inguinale
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initial dx test for beefy red genital lesion that ulcerates
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(granuloma inguinale) bx
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tx for beefy red genital lesion that ulcerates
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(granuloma inguinale) doxy or bactrim
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what's the difference between pediculosis and scabies
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scabies are smaller and burrow in the web spaces. pediculosis are in the hair (axilla and groin) and are visible to naked eye
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tx for scabies or pediculosis
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permethrin or lindane
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how are warts diagnosed
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visually
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5 options for treating warts
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surgically imiquimod (immunostimulant) cryotherapy laser removal melting with podophylin
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tx of uncomplicated cystitis
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bactrim PO x3 days
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tx of complicated UTI
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bactrim or cipro x7 days
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what makes a UTI complicated
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anatomic abnormality (stone, stricture, tumor, obstruction)
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who should be treated for asymptomatic bacteriuria
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only pregnant women
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tx for pyelo
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outpatient: cipro inpatient: amp/gent
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nitrites on UA indicate what
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gram neg bacteria
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what should you do if pyelo is not responding to tx after 5-7 days
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CT or US to look for perinephric abscess
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most accurate dx test for perinephric abscess
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bx
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tx of perinephric abscess
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quinolone AND staph coverage (oxacillin or nafcillin)
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tx of prostatits
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cipro for a long time
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how many of the duke's criteria are necessary to diagnose endocarditis
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2 major, 1 major + 3 minor, or 5 minor
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what are the 2 major risk factors for endocarditis
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+ blood cx abn echo
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what are the 5 minor criteria for endocarditis
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fever >38 lifestyle risk factors vascular findings immunologic findings + blood cx but not common organism
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5 lifestyle risk factors for endocarditis
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IV drug use structural heart dz prosthetic valve dental procedures w/ bleeding h/o endocarditis
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5 vascular findings in endocarditis
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janeway lesion septic pulmonary infarcts arterial emboli mycotic aneurysm conjunctival hemorrhage
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3 immunologic findings in endocarditis
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roth spots (retina) osler nodes (raised, painful, pea-shaped) glomerulonephritis
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first step if fever and new heart murmer or change in murmer
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blood cx, THEN echo
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best empiric tx of endocarditis
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vanc and gent together x4-6 weeks
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what should you do if blood cx is positive for strep bovis
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colonoscopy
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the only 4 cardiac defects that require endocarditis ppx
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prosthetic valve unrepaired cyanotic heart dz previous endocarditis transplant Pt w/ valve dz
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the only 3 procedures that need endocarditis ppx
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dental that causes bleeding (amoxicillin) resp tract surgery surgery of infected skin
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which abx should you use to ppx treat for endocarditis in someone getting surgery on their gums
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amoxicillin
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