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doctors hospital infectious disease inservice review
doctors hospital infectious disease inservice review
127
Medical
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02/09/2015

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Term
Treatment for Lyme disease?
Definition
doxycycline or ceftriaxone
Term
non bullous impetigo treatment?
Definition
mupirocin
Term
salmonella gastroenteritis treated how?
Definition
usually self limiting only give antibiotics if severe or invasive (quinolone, macrolide, 3rd gen cef)
Term
most common cause of osteomyelitis in patient with a nail puncture?
Definition
Pseudomonas Note Staph is most common overall cause of osteomyelitis but this is exception
Term
How is diptheria treated?
Definition
anti diptheria antibodies, with metronidazole, or penicillin G or erythromycin
Term
How is pertussis treated? Are the contacts treated?
Definition
erythromycin for 14 days and treat contacts same way
Term
Treatment for legionaire's disease?
Definition
azythromycin or moxifloxacin
Term
What is first test in suspected legionaire's? Gold standard?
Definition
Urine antigen first, sputum culture gold std
Term
What is test of choice for diagnosing osteomyelitis? Definitive diagnosis?
Definition
MRI test of choice, Bone biopsy with gram staining definitive
Term
Organism causing cellulitis in someone with DMII or burns? Treatment in burn patients?
Definition
pseudomonas, treat with topical sulfadiazine or bacitracin
Term
How is tuleremia treated?
Definition
tetracycline or doxycycline
Term
what is prophylactic treatment for any cat bite? What organism are you worried about?
Definition
amoxicillin with clavulanate for Pasturella multicodia
Term
What are 2nd line prophylactic agents for any cate bite?
Definition
can use bactrim or doxy or cefuroxime or quinolone with either clindamycin or metronidazole for aneorobic coverage
Term
treatment for bacterial conjunctivitis?
Definition
topical macrolide or topical polymixin B
Term
treatment of acanthomeaba infection of eyes?
Definition
propamidine and polymixin opthalmic solution
Term
Treatment of a chalazion or hordeolum?
Definition
warm compresses and if no improvement referral to an opthomologist
Term
How is osteomyelitis treated?
Definition
surgical debridement and IV antibiotics for 6 weeks Note: if vertebral osteo treat for 8 weeks
Term
How is inhaled anthrax treated?
Definition
ciprofloxacin or doxycycline
Term
treatment of sporotrix?
Definition
itraconazole #1, may use lugols solution or sski which are iodine solutions
Term
Treatment of blastomycosis?
Definition
itraconazole
Term
treatment of histoplasmosis?
Definition
itraconazole
Term
treatment of coccidiomycosis?
Definition
itraconazole, fluconazole or ketoconazole are equal
Term
Treatment for systemic histoplasmosis, blastomycosis, coccicoidomycosis?
Definition
amphotericin
Term
Treatment of norcardia?
Definition
TMP-SMX
Term
Treatment of actinomyces?
Definition
penicillin G (SNAP = sulfas for nocardia and PCN for actinomyces)
Term
What type of bacteria is actinomyces?
Definition
gram + filamentous anearobic
Term
What type of bacteria is norcardia?
Definition
gram + weakly acid fast filamentous aerobic
Term
tx of toxic shock syndrome?
Definition
vanco + clindamycin
Term
suspect someone of having herpes because of vesicles and inguinal adenopathy next step?
Definition
skip Tzanck smear or any testing and treat immediately with acyclovir or valcyclovir
Term
tx of bartonella hensale?
Definition
z-pak #1 or doxy Note: typically is self-limiting, so do not need to treat unless severe infection
Term
peritonsillar abscess tx?
Definition
I&D + PO clindamycin
Term
Treatment of neurocystocercosis?
Definition
albendazole
Term
when to use steroids in tx pneumocystis?
Definition
Aa grad >35 or PaO2 <70mmHg
Term
tx of legionella pneumonia?
Definition
macrolides or quinolones
Term
tx of inpatient pneumonia (Not ICU pt)?
Definition
macrolide + ceftriaxone or respiratory quinolone alone
Term
tx of outpatient pneumonia?
Definition
macrolide or doxy
Term
tx of human bites?
Definition
amoxicillin/clavulanate
Term
coccidiomycosis triad?
Definition
lung skin and bone problems
Term
tx of candidia inf of nipple?
Definition
topical azole
Term
most common cause of cavernous sinus thrombosis?
Definition
S aureus
Term
drug to prophylax with for influenza?
Definition
oseltamivir if given within 72 hours
Term
2nd line tx for Pneumocystis?
Definition
dapsone and pyrimethamine 2nd line pentamidine is 3rd line Note: bactrim still #1 for treatment and prophylaxis
Term
tx of scabies?
Definition
5% pimethrin cream from neck down on 2 separate occassions
Term
HIV drug causing weird dreams?
Definition
efavirenz
Term
s aureus pneumonia most often occurs in who?
Definition
IV drug users, cystic fibrosis (<10yo), post viral inf, chronically ill
Term
Late post surgical incision infection (4-10 days) most likely caused by?
Definition
S aureus #1, Pseudomonas #2, E coli #3
Term
Early post surgical site incision infection (<72 hours) most likely caused by?
Definition
GAS or clostridium (if clostridium the infected site will have few leukocytes and mild erythema, but extreme pain compared to exam findings)
Term
empiric tx for infective endocarditis?
Definition
IV vancomycin
Term
Treatment of hepatitis C?
Definition
Unlikely to ask given that new treatments are out, but in case new meds are sofosbuvir and simeprevir adn old meds are interferon with ribavirin
Term
pt with SCD and osteomyelitis tx empirically with? to cover for?
Definition
Salmonella #1 and staph with vanco or nafcillin or cefazolin + aminoglycoside
Term
most common cause of osteomyelitis in SCD pt?
Definition
salmonella
Term
aminoglycoside side effect?
Definition
sensorineural hearing loss
Term
most common cause of meningitis <3 months?
Definition
GBS
Term
most common cause of meningitis 3 months to 9yrs?
Definition
S pneumoniae
Term
most common cause of meningitis 10-18?
Definition
N meningitidis
Term
most common cause of meningitis >18?
Definition
S pneumoniae
Term
tx of meningitis <3 months?
Definition
IV vancomycin, ampicillin, cefotaxime
Term
tx of meningitis 3 months to 50 yo?
Definition
IV vancomycin and cefotaxime
Term
tx of meningitis >50 yo?
Definition
IV 3rd gen ceph + vanco +ampicillin
Term
tx of meningitis in immunocompromised?
Definition
IV vanco, cefotazidime, ampicillin
Term
What is the role of steroids in meningitis?
Definition
used to prevent negative neurologic sequale of S pneumoniae meningitis. Note: give to all pts where S pneumoniae may be suspected
Term
tx of gonorrheal conjunctivitis?
Definition
IM ceftriaxone and topical erythromycin
Term
tx of otitis externa?
Definition
clean canal, topical cipro or acidic antibiotic + hydrocortisone cream
Term
most common cause of prosthetic valve endo?
Definition
s aureus
Term
tx of gonoccocal conjunctivitis in neonate?
Definition
oral penicillin or IM cef with topical erythromcyin eyedrops
Term
hemochromatosis is suscpetable to?
Definition
susceptable to iron loving bacteria: listeria, vibrio and yersina enterolytica
Term
tx for yersinia enterolytica?
Definition
ciprofloxacin or doxycycline
Term
tx of SBP?
Definition
3rd gen cef
Term
redman syndrome?
Definition
pruritus, redness above waist, hypotension, dyspnea associated with vancomycin... stop giving drug then readminster later at a slower rate
Term
Is lymphogranuloma venerum painless or painful lesion?
Definition
painless
Term
How is amebic liver dz tx?
Definition
metronidazole
Term
A pt with asplenia is at risk for what infection if bitten by a dog?
Definition
capnocytophaga
Term
A pt with asplenia has erythema chronica migrans and a severe hemolytic anemia and thrombocytopenia. What coinfection do they likely have?
Definition
babesia, asplenia predisposes to severe babesia infection, therefore if question looks like lyme dz but is very severe and they say pt had spleenectomy then suspect babesia
Term
intraleukocytic morulae are concerning for? How does rash on pt appear?
Definition
erlichosis and rash appears like lymes w/o central clearing
Term
what is the antibiotic of choice for prophylaxis against endocarditis?
Definition
amoxicillin
Term
what is the antibiotic of choice for prophylaxis against endocarditis when pt is unable to take PO med?
Definition
Either ampicillin or ceftriaxone or cefazolin
Term
What is the antibiotic of choice for prophylaxis against endocarditis when PCN allergic?
Definition
clindamycin or azithromycin or if can take cephalosporin cephalexin
Term
What are agents are used to treat CNS toxoplasmosis?
Definition
sulfadiazine and pyramethamine
Term
What agents are used to treat prophylax against toxoplasmosis?
Definition
tmp-SMX
Term
What are 4 common agent that inhibit dihydrofolate reductase, such that leucorvin (folinic acid) or folic acid should also be prescribed?
Definition
phenytoin, methotrexate, pyramethamine, trimethoprim
Term
How is MAC treated?
Definition
3 drug regimen: ethambutol, azithromycin or clarithromycin +/- rifampin or ribabutin
Term
What candidial species are resistant to the azole antifungals and require an echinocandin (caspofungin/micafungin)?
Definition
C. krusei and C. glabrata
Term
treatment of lymes dz causing bells palsy?
Definition
oral doxy Note: only give ceftriaxone if meningitis or heart block
Term
it is generally best to avoid treating travelers diarrhea, unless moderate or severe; however, what medications can be used?
Definition
quinolones (#1) or azithromycin Note: do not give antibx prophylaxis
Term
What antibiotics are recommended for treatment of vibrio cholarae/volnificus/parahemolyticus?
Definition
doxy or quinolone
Term
How is babesiosis treated?
Definition
Mild or moderate: azithromycin + atovaquone (preferred) or clindamycin + quinine and Severe: clindamycin + quinine
Term
treatment for N meningitidis meningitis?
Definition
ceftriaxone or cefotaxime. Remember the vanco is added only for possible penicillin resistant pneumococcal pneumonia not the neisseria
Term
Treatment for Allergic bronchopulmonary aspergillosis?
Definition
steroids + itraconazole
Term
Treatment of invasive aspergillosis?
Definition
voriconzale #1, but amphotericin can be used also
Term
Blood stream infection with which 2 bacterial species warrants a colonoscopy to r/u GI malignancy?
Definition
strep bovis, strep gallolyticus and clostridium septicum
Term
ribavirin is used in the treatment of which 2 viruses?
Definition
RSV and HCV Note: it is pregnancy category X
Term
How is typhoid treated?
Definition
floroquinolone or 3rd gen ceph
Term
best prophylactic med to chloroquine resistant areas when pt is pregnant?
Definition
mefloquine
Term
At what CD4 count do you prophylax against pcp? What med?
Definition
CD4 <200 with tmp-smx
Term
at what CD4 count do you prophylax against toxoplasmosis? What med?
Definition
CD4 <100 with tmp-smx
Term
At what CD4 count do you prophylax against MAC? What med?
Definition
CD4 <50 with azithromycin and continue until 3 months after CD4 count has been >100
Term
Which vaccines should be avoided in AIDS pts?
Definition
MMR, intranasal influenza, varicella, zoster, yellow fever. Note: all are live virus
Term
Penicillin is the TOC for all stages of syphillis. How should you treat your pt if they are PCN allergic (anaphyllactic) in primary, secondary and tertiary syphillis?
Definition
doxycycline in primary and secondary. Ceftriaxone in tertiary. Note: If PCN desensitization is answer for tertiary syphillis, this will be answer, even if ceftriaxone is a choice
Term
How is post-herpetic neuralgia managed acutely? And after 30 days?
Definition
opiates, tramadol, lidocaine patches acutely. Longterm consider TCA's or gabapentin
Term
Who is the zoster vaccine recommended in?
Definition
age >60, immunocompromised states (DM, renal failure, liver failure, severe COPD, etc...), HIV if CD4 >200
Term
Treatment for zoster should be administered within how many hours?
Definition
72 hrs with acyclovir, valcyclovir, etc...
Term
What fungus has narrow angle branching with septae? Which is wide angle and w/o septae?
Definition
aspergillous = narrow angle, septae. mucor = wide angle, NO septae (spagetti and meat ball appearance on microscopy)
Term
TOC for mucormycosis?
Definition
amphotericin
Term
Besides surgical consultation what are the treatment regimens in necrotizing fascitis?
Definition
Need to have MRSA coverage: vanco or dapto or linezolid. Also need gram neg and aneorobic coverage: cefepime + clindamycin or a carbapenem
Term
If cause of necrotizing fascitis is suspected to be from strep pyogenes or clostridial species what should treatment regimen be? Why?
Definition
PCN + clindamycin. Note: clindamycin translation of bacterial toxin protein
Term
treatment for yersinia pestis (plague)?
Definition
a tetracycline or streptomycin or quinolone
Term
If you suspect meningitis do you give antibiotics first, get imaging first or LP first?
Definition
always treat meningitis when suspected clinically before obtaining other tests
Term
If you suspect SBP do you give antibiotics first or obtain paracentesis first?
Definition
paracentesis first
Term
Who should receive prophylaxis for N meningitidis when exposed to someone that has it?
Definition
people in household, anyone handling respiratory secretions, i.e. intubating physician. Note: triage nurse, doctor who did spinal tap do NOT need it
Term
What drug is used for N meningitidis prophylaxis?
Definition
rifampin
Term
epididymitis in men <35 is most commonly caused by? And in men >35?
Definition
<35 is gonorrhea/chlamydia and >35 E. coli
Term
How is leptospirosis treated?
Definition
Doxy or PCN
Term
How is stronglyoides treated?
Definition
ivermectin #1, albendazole #2
Term
What are 3 painless ulcers caused by STD's?
Definition
syphillis, lymphogranuloma venereum, klebsiella granulomatosis
Term
How should the initial episode of C. diff be treated if it is mild to moderate?
Definition
PO metronidazole
Term
If the initial episode of C diff is severe w/o other organ failure how should it be treated?
Definition
PO vancomycin
Term
If the initial episode of C diff is severe with multiple organ failure how should it be treated?
Definition
PO vancomycin + IV metronidazole
Term
How should the first recurrence of C diff be treated?
Definition
same as initial episode and based on severity, i.e. if not severe infection and pt was treated before with PO metronidazole he can have that again, or if it was severe and he had PO vanco he should have that again
Term
How is Giardia treated?
Definition
metronidazole
Term
Treatment of cryptococcal meningitis?
Definition
amphotericin with flucytosine. Note: the only time on boards you will use flucytosine is for crypto!
Term
Treatment of reactive arthritis following a GI infection with either shigella, salmonella, camplobacter, etc...?
Definition
Give NSAIDS for diarrheal causes, can use antibiotics if a chlamydial GU infection is causing
Term
Treatment of Bacteroides infection in mouth?
Definition
Need aneorobic coverage: amoxicillin, clindamycin, ampicillin
Term
What medications are used to treat male UTI?
Definition
either bactrim or quinolone. Note: if male UTI you are treating prostatitis, course is minimum of 2-4 weeks
Term
Which antibx are safe to use for UTI in pregnancy?
Definition
nitrofurantoin, ampicillin, cephalosporins
Term
ESBL UTI is best treated with?
Definition
carabpenem
Term
the majority of pts with candiduria have catheters, which if removed tends to clear infection. If the infection does not clear with catheter removal or the pt is high risk (neutropenic) how should you treat them?
Definition
fluconazole #1
Term
Which antibx class is preferred for pyelonephritis in pregnancy?
Definition
cephalosporins w/ or w/o aminoglycoside
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