Term
2 abx associated with ototoxicity
1) causes permanent SNHL
2) causes transient vestibular dysfunction (dizziness) |
|
Definition
1) aminoglycosides (gentamicin)
2) minocycline |
|
|
Term
| 2 Abx associated with nephrotoxicity |
|
Definition
Aminoglycosides (gentamicin)
Vancomycin |
|
|
Term
Abx associated wtih color side effects:
1) can cause red man syndrome, a histamine reaction
2) can cause red lobster syndrome when dye is renally excreted
3) can cause discolored teeth
4) can cause jaundice in babies- contrainndicated in 3rd trimester and babies |
|
Definition
1) Vanc
2) rifampin
3) tetracyclines
4) sulfonamides |
|
|
Term
| Abx that are contraindicated in pregnancy |
|
Definition
FAST abx:
Fluoroquinolones (tendon issues)
Aminoglycosides (CNS issues)
Sulfonamides (kernicterus)
Tetracyclines (tooth/bone problems) |
|
|
Term
Classifications of hypersensitivity reactions to abx:
1) serum sickness
2) True allergic reaction (anaphylaxis, urticaria)
3) delayed hypersensitivty reaction. includes SJS and TEN
4) bone marrow suppression |
|
Definition
1) serum sickness = type III
2) true allergy = type I
3) delayed hypersensitivity, SJS, TEN: type IV
4) bone marrow suppression - type II |
|
|
Term
| In questions regarding a penicillin allergy, when is it ok to use a cephalosporin? |
|
Definition
If pt had maculopapular rash w/ PCN, ok to use a cephalosporoin.
if pt had anaphylactic reaction to PCN, don't use any B lactam, including cephalosporins |
|
|
Term
| On test, if you need to use an antibiotic, what are the best 2 choices for first line treatment for just about anything? |
|
Definition
|
|
Term
| What are the natural penicillins and what are their 2 indications? |
|
Definition
Penicillin G (IV)
Penicillin VK (oral)
benzathin penicillin (IM)
use for strep throat or syphilis |
|
|
Term
| What are the aminopenicillins and what are they used for? |
|
Definition
ampicillin (IV)
amxocillin (PO)
Gram + and gram - coverage
used for sinusitis, URI, otitis media, endocarditis prophylaxis for dental procedures |
|
|
Term
| What are the agumented pencillins and what are they used for? |
|
Definition
Augmentin PO
ampicillin/sulbactam (Unasyn) IV
cover gram +, gram -, and anaerobes
used for URI, otitis media, sinusitis, dental infections, skin/soft tissue infections, animal bites |
|
|
Term
| what are the anti-staph penicillins and what are they used for |
|
Definition
Nafcillin (IV)
dicloxacillin (PO)
used for methicillin-susceptible infections of the skin/soft tissue like non-MRSA abscesses |
|
|
Term
| Names & indications (4) of 1st gen cephalosporins |
|
Definition
IV: cefazolin (ancef)
oral: cephalexin (keflex)
1st line for skin infx
strep in PCN allergy
UTI in pregnancy
perioperative infection prophy |
|
|
Term
| Names & indications (2) of 2nd gen cephalosporins |
|
Definition
cefuroxime (ceftin) oral and IV
AOM, sinusitis in PCN allergy |
|
|
Term
| Names & indications (4) of 3rd gen cephalosporins |
|
Definition
Orals: cefdinir adnd cefpodoxime -->> will NEVER be the test answer
IV/IM: ceftriaxone
Used for CAP, meningitis, gonorrhea, abdominopelvic infections (pyelo, diverticulitis) |
|
|
Term
| Names & indications (2) of 4th gen cephalosporins |
|
Definition
cefepime, cefazidime
resistant infections and pseudomonas |
|
|
Term
name of 5th gen cephalosporin.
this is the only ceph w/ ___ coverage |
|
Definition
|
|
Term
Glycopeptide abx
1) name
2) ADRs
3) Uses |
|
Definition
vancomycin
ADR: oto, neprhotox, Red Man syndrome
Uses: resistant c diff and MRSA --> only two to know for test |
|
|
Term
Tetracyclines
1) ADRS
2) contraindications
3) Uses |
|
Definition
ADRs: photosensitivity, dental discoloration
CI: pregnancy, kids <8 y/o
Use: URI, CAP, tick-borne illnesses, 2nd line for GYN infx
Doxy will be a common test answer |
|
|
Term
Macrolides
1) Names
2) ADRs
3) uses |
|
Definition
azithromycin, erythromycin, clarithromycin
ADRs: QT prolongation, metallic taste, NVD
uses: Chlamydia, legionella, mycoplasma, H pylori, shigella, campylobacter, pertussis
NOT for use in uncomplication URI/sinusitis |
|
|
Term
Licosamide abs
1) name (1)
2) ADR
3) Uses |
|
Definition
Clindamycin
ADR: C diff. generally safer to use in kids than older adults
use in beta-lactam alelrgy for strep or skin infections |
|
|
Term
Aminoglycosides
1) Names
2) uses |
|
Definition
Gentamicin, Tobramycin
use in pseudomonas or eye infections |
|
|
Term
Floroquinoloes (floxacins)
1) ADRs
2) Contraindications
3) when to use
4) resp vs abdominopelvics |
|
Definition
ADR: QT prolongation, arthropathy, tendinopathy
CI: kids <18 y/o, use w/ amiodarone (Qt prolongation)
Use in COMPLICATED URI, UTI, GI infecction
do not use routinely
Respiratory: levaquin, moxifloxacin
abdominopelvis: cipro (also optho) |
|
|
Term
Bactrim
1) MOA: inhibits ___ synthesis
2) ADR
3) Uses |
|
Definition
inhibits folate synthesis
ADR: increases INR (caution w/ coumadin), increases potassium (caution w/ ACE/ARB)
Use: PCP pneumonia, MRSA, UTI |
|
|
Term
Nitroimidazole (metronidazole)
1) ADR
2) Uses |
|
Definition
ADR: disulfuram rxn, fetotoxic in first trimester
Uses: BV, c diff, giardia, trichomonas, abdominopelvic infections in general |
|
|
Term
Which abx would you use for strep?
1) first line
2) PCN allergy
3) B-lactam allergy |
|
Definition
1) penicillin VK
2) Cephalexinn
3) clindamycin if beta-lactam allergy |
|
|
Term
|
Definition
|
|
Term
Skin infection:
1) first line treatment
2) first line if PCN allergy
3) Others |
|
Definition
1) dicloxacillin or augmentin
2) cefalexin
3) clindamycin, bactrim, doxy |
|
|
Term
Sinusitis
1) First line treatment
2) options if PCN allergy
3) complicated infections |
|
Definition
Augmentin
cefuroxime or doxy
levaquin or moxifloxacin |
|
|
Term
| Lyme disease treatment in kid <8 y/o and adults |
|
Definition
kids: amoxicillin
adults: doxy |
|
|
Term
UTI Treatment
1) first line optiosn
2) if complicated |
|
Definition
first line: cephalexin, bactrim, or macrobid
cipro only if complicated |
|
|
Term
| Gonhorrhea/chlamydia treatment |
|
Definition
Ceftriaxone 250mg IM x1 AND azithromycin 1g PO x1
use doxy bid x 7d if azithromycin allergy |
|
|
Term
TB treatment:
1) latent TB
2) active |
|
Definition
1) Latent: INH x9 months, administer w/ B6
2) Active: 4 drugs for 2 months, then 2 drugs for 4 months (RIPE drugs)
rifampin, INH, prazinamide, ethambutol x8 weeks
THEN
INh and rifampin for another 4 months |
|
|
Term
| What to know about amphotericin B |
|
Definition
used for really really bad fungal infections
won't be test answer
NEPHROTOXICITY |
|
|
Term
Fungal infections
1) drug (1) for oral fungal infection (thrush)
2) drug (4) for skin infections
3) topical drug (4) for vaginal infections
4) Oral drug of choice for vaginal infection |
|
Definition
1) nystatin
2) clotrimazole, econazole, miconazole
3) nystatin, miconazole, terconazole, tioconazole
4) fluconazole |
|
|
Term
| How to treat vaginal candidiasis in pregnancy? |
|
Definition
topical antifingal (miconazole)
NEVER use diflucan |
|
|
Term
|
Definition
onychomycosis
hepatotoxicity (monitor LFTs) |
|
|
Term
| MRSA treatment in outpt setting (3) |
|
Definition
Bactrim
Clinda
doxy + minocycline |
|
|
Term
| At what CD4 count do AIDS pts become susceptible to opportunistic infections? |
|
Definition
|
|
Term
| A 46 year old patient with HIV presents with 2-3 week histry of dyspnea, nonproductive cough, and weight loss. they just developed fever today. Labs show CD 4 count of 152. PaO2 is <70 mmHg.CXR shows interstitial infiltrate. Dx abd tx? |
|
Definition
Pneumocystis jyrovecii (fungal) pneumonia
Dx via PCR
Tx: Bactrim and 21 day prednisone taper
Prednisone bc PaO2 is low, and this is from inflammation in the lungs |
|
|
Term
| Pt w/ recent abx use presents with severe odonyphagia. they refuse to eat due to pain w/ swallowing. Dx, workup, and tx? |
|
Definition
esophageal candidiasis.
dx via EGD
Tx: IV fluconazole (won't be able to swallow pills) |
|
|
Term
Malaria:
Strains: Plasmodium vivax; malariae; ovale; knowleski; falciparum
1) most virulent strain
2) Most common 2 strains in US
3) transmitted by what type of mosquito
4) how to dx
5) tx/prophy
6) Symptoms |
|
Definition
1) falciparum most virulent
2) falciparum and vivax most common in US
3) Anopheles mosquito
4) dx with thick/thin blood microscopy smears, though PCR becoming more common
5) tx AND prophyx: Atovaquone-proguanil. if pt positive, always refer to ID.
6) Sx: periodic chills, fever, sweats, HA, myalgia, splenomegaly |
|
|
Term
|
Definition
Start w/in 3 days of rash onset, ideally
mid/moderate: valacyclovir or famciclovir Oral
Severe: IV acyclovir |
|
|
Term
| Zoster vaccine recommendations |
|
Definition
zostavax single dose for all immunocompetent pts >50-60 y/o, INCLUDING those with a previous episode of zoster
Live attenuated vaccine so do not use in immunocompromised |
|
|
Term
32 year old male presents with rash, mucocutaneous ulceration, fever, malaise, sore throat, and LAD. What test should be done at this point?
-monospot
-HIV western blot
-HIV EIA
-CMV
-strep swab |
|
Definition
Enzyme immunoassay (EIA) test for HIV
Western blot is no longer routinely used
Mucocutaneous ulceration is distinctive feature
many have rash
may sound like mono but 90% of patients have been exposed to mono by age 18, so any adult with mono-like symptoms should be tested for HIV |
|
|
Term
HIV:
1) when to do PCR
2) CDC recs on screening
3) High risk patients should be screened how often?
4) Treatment |
|
Definition
1) Do PCR to measure viral load in acute illness or neonates
2) Screening: NOT risk-based. All patients 13-64 y/o, all patients starting tx for TB, all patients seeking treatment for STDs, all pregnant women.
3) >1x/year
4) Truvada (Emtricitabine + Tenofovir)- a nucleoside reverse transcriptase inhibitor PLUS a protease inhibitor (darunavir) |
|
|
Term
Opportunistic infections w/ HIV:
1) PCP pneumonia. occurs w/ CD4 count <___. Treated with ____.
2) Toxoplasmosis. Occurs with CD4 count <___. treated with ____.
3) Mycobacterium avium. Occurs with CD4 count <___. treated with ____. |
|
Definition
1) PCP: CD4 <200. Bactrim
2) Toxoplasmosis: CD4 <100. Bactrim
3) MAC: CD4 <50. Azithromycin |
|
|
Term
| If question is asking about a spirochete, what are the only two possible diseases to think about? |
|
Definition
|
|
Term
Lyme:
1) name of spirochete
2) name of tick
3) stage 1 symptoms
4) Stage 2 symptoms
5) Stage 3 symptoms
6) Dx via
7) tx |
|
Definition
1) borrelia burgdorferi
2) Ixodes
3) Stage 1: erythema migranes, fever, chills, arthralgia
4) Stage 2: cardiac symptoms, possible bilateral bell's palsy
5) stage 3: chronic arthritis, monoarticular large joint
6) Dx via antibody assay, however, if high suspicious, just treat
7) For 14-21 days- Doxy if >8 y/o, amoxicillin or cefuroxime if <8 y/o |
|
|
Term
| A patient presents with flu like symptoms for 3 days. Today, they noticed a red macular rash on their wrists and ankles. They admit to going hiking 2 weeks ago and getting a tick bit. What is the causative organism and treatment? |
|
Definition
RMSF- ricketssia ricketsii
Doxy for everyone (even kids) EXCEPT pregnant women get chloramphenicol |
|
|
Term
Gonorrhea:
1) Sx in men vs women?
2) organism - key word to know
3) dx
4) tx |
|
Definition
profuse discharge in men. usually asymptomatic in women but can have PID
Gram negative diplococcic
Nucleic acid amplification testing (NAAT)
Ceftriaxone 250mg IM x1 PLUS Azithromycin 1g PO x1 |
|
|
Term
| Most common reportable STD for men and women |
|
Definition
|
|
Term
| Pt w/ STD symptoms that tests negative for GC/Chlamydia... think what organism? |
|
Definition
|
|
Term
| Chlamydia treatment if macrolide allergy |
|
Definition
|
|
Term
Syphilis:
1) organism
2) symptoms primary, secondary, and tertiary
3) early vs late latent syphilis
4) Dx
5) Tx |
|
Definition
1) treponema pallidum "corkscrew spirochete"
2) Primary: painless ulcer (chancre)
secondary: generalized maculopapular rash (bronze color)
Tertiary: neurosyphilis - deafness, paresthesias, weakness, argyle-Robertson pupils
3) early latent: no symptoms, + test, exposed <1 year ago
late latent: no symptoms, + test, exposed >1 year ago
4) Dx: RPR first, confirm with TP-PA (particle agglutinin) or TP_EIA (enzyme immunoassay)
4) TX: penicillin G x1. ceftriaxone or doxy of PCN alelrgy |
|
|
Term
| Two infectious causes of Bell's Palsy? |
|
Definition
|
|
Term
|
Definition
Tzank smear of mucocutaneous lesion
PCR is more sensitive test of choice. |
|
|
Term
| Most common NON-reportable STD |
|
Definition
|
|
Term
HPV:
1) Two most high risk types
2) term used for anorectal warts caused by HPV. long term concern with this?
3) tx
4) vaccine is approved for what age group? |
|
Definition
1) 16 and 18
2) Condyloma accuminata- squamous cell carcinoma
3) TX; Imiquimod (pt administered), cryotherpay, etc
4) 9-26 y/o. ideally start BEFORE first sexual contact. |
|
|
Term
Osteomyelitis:
1) most common causative organism
2) most sensitive imaging test
3) Workup
4) Tx |
|
Definition
1) S. Aureus
2) MRI
3) Blood cultures and bone bx to determine organism, always r/o cancer, esp in kids
4) Tx: 4-6 weeks of abx, dependent on organism (probably vanc) |
|
|
Term
Septic arthritis:
1) Most common organism overall
2) Most common organism in younger patients
2) always r/o what?
3) tx? |
|
Definition
1) s. aureus
2) N. gonorrhea
3) r/o endocarditis
4) IV abx - anti-staph or ceftriaxone + doxy if gonorrhea |
|
|
Term
| IV drug user presents with septic appearance and CHF symptoms. exam reveals a murmur, janeway lesions and osler's nodes. where is the endocarditis and what is the organism? |
|
Definition
right-sided endocarditis in IV drug users
staph aureus |
|
|
Term
| a patient presents with FUO and flu-like symptoms over the past few weeks. they have a murmur, janeway lesions, and oslers nodes. what is the dx and probable organism |
|
Definition
| sub-acute endocarditis. strep or enterococci |
|
|
Term
| Who gets prophylaxis for endocarditis and what is the recommended drug? |
|
Definition
patients with prosthetic heart valve
previous endocarditis
congenital heart disease
heart transplant
amoxicillin or cephalexin 2g PO x1 an hour prior to a dental procedure |
|
|
Term
| Best imaging test for endocarditis? |
|
Definition
|
|
Term
Meningitis
1) 2 most common organisms
2) Workup
3) Tx |
|
Definition
1) S. Pneumonia (worst) and N. meningitides (most common)
2) blood cultures and LP for everyone. CT scan if seizures, head trauma, etc
3) T: Ceftriaxone + Vanc + dexamethasone (steroid reduces ICP) |
|
|
Term
| What findings on CSF interpretation should make you think bacterial infection vs virus? |
|
Definition
high opening pressure
high cell count (100's to 1000's)
low glucose (bc bacteria eats glucose) |
|
|
Term
| Patient presents with acute delirium. they were diagnosed with shingles 2 days ago. dx? tx? |
|
Definition
VZV encephalitis
IV acyclovir |
|
|
Term
| For skin infx, as a general rule, diffuse infections like cellulitis and erisypelas are caused by ____. localized infections like an abscess are caused by ____. |
|
Definition
|
|
Term
Skin infections:
1) presents with fever, chills, streaking erythema and induration
2) presents with glistening, demarcated, very erythematous area that came on with rapid onset.
3) Presents as firm, tender, erythematous nodule
4) Presents with fever, chills, streaking erythema but also pt appears toxic and pain is out of proportion to exam |
|
Definition
1) cellulitis
2) Erysipelas
3) abscess/furuncle
4) necrotizing fasciitis |
|
|
Term
| On the exam, what phrases should make you think an abscess is likely MRSA? |
|
Definition
necrotic top
recurrent infection
other family members have it |
|
|
Term
2 Categories of infectious diarrhea:
1) characterized by large volume, watery stool. No blood or PMNs. +mucus. may have other flu-like symptoms. Includes what organisms?
2) Characterized by small volume, frequent, bloody, mucusy stools. abundant PMNs, fever, chills, abd pain. organisms? |
|
Definition
1) Non-inflammatory: viruses, some bacteria (staph, b. cereus, cholera), protozoal infections (giardia, crypto)
2) Inflammatory: e. coli, c diff, shigella, campylobacter, salmonella
No anti-peristaltics for inflammatory diarrhea. ok for non-inflammatory |
|
|
Term
| acquired via contaminated food or water, this is the most common cause of gastroenteritis in the US. Kids usually present with N/V and adults usually get diarrhea. lasts 1-3 days. dx and tx? |
|
Definition
|
|
Term
| transmitted by infected food or water. occurs in the US most commonly with the ingestion of shellfish. presents with RICE WATER STOOL. dx and tx? |
|
Definition
cholera
tx: supportive. can use doxy or azithromycin in kids and pregnancy |
|
|
Term
| Most common parasitic etiology of infectioius diarrhea in US. 2/3 of cases are asymptomatic but may cause acute watery diarrhea or chronic malabsorption. dx with stool antigen test (immunoassay). dx and tx? |
|
Definition
| giardiea. tx: metronidazole |
|
|
Term
| causes large volume diarrhea, similar to cholera. diagnosed with stool antigen test (immunoassay). should be referred to ID. |
|
Definition
|
|
Term
| causes bloody diarrhea and abdominal pain, often febrile. can cause hemolytic-uremic syndrome (acute renal failure, thrombocytopenia, and hemolytic anemia). diagnosed by stool culture and fecal toxin testing or stool PCR. dx and tx? |
|
Definition
E. Coli 0157:H7
Tx; Supportive (abx are controversial) |
|
|
Term
| testing and tx for c diff? |
|
Definition
dx: c. diff toxin assay or PCR of stool
tx: metronidazole (mild) or ORAL Vanc (mod/severe) |
|
|
Term
| presents with sudden onset blood diarrhea, abd pain, tenesmus, toxicity. associated with daycare centers. tx and dx? |
|
Definition
Shigella
tx: Azithromycin (kids) or fluoroquinolones (adults) |
|
|
Term
Most common bacterial cause of infectious diarrhea- gram neg S shaped rod.
presents with fever, water/bloody diarrhea, abdom pain. Associated with poorly cooked chicken. dx and tx? |
|
Definition
campylobacter
tx: Azithromycin |
|
|
Term
presents with fever, blood diarrhea, abdominal pain.
associated with undercooked eggs and reptiles (pt may say they have a pet turtle). dx and tx? |
|
Definition
|
|
Term
| caused by salmonella, associated w/ fever, HA, GI symptoms in a returning traveler? |
|
Definition
typhoid fever (s. typhi)
Tx: cipro |
|
|
Term
|
Definition
Amoxicillin or augmentin
doxy or levaqin for PCN allergy |
|
|
Term
|
Definition
amoxicillin or augmentin
cephalosporin (any) for PCN allergy |
|
|
Term
|
Definition
Penicillin V or amoxicillin x10 days
PCN Allergy: cephalexin, clinda, or clarithromycin for 10 days OR z pack |
|
|
Term
| General skin infection treatment (including animal bites) |
|
Definition
|
|
Term
| MRSA skin infections (outpatient) treatment |
|
Definition
|
|
Term
|
Definition
|
|
