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Step III

Step III - ID

QuestionAnswer
What IV antibx can be used for MSSA? Naf/Ox/Dicloxacillin OR 1st gen ceph (cefazolin)
What oral antibx can be used for MSSA? Dicloxacillin OR 1st gen ceph (cephalexin)
What antibx can be used for severe MRSA infections? Vanc, daptomycin, linezolid, tigecycline
What antibx can be used for minor MRSA infections? TMP/SMZ, clinda
Pt has a staph infection and tells you that taking penicillin gives them a rash. What antibx can be used? cephalosporins
Pt has a staph infection and tells you that taking penicillin gives them anaphylaxis. What antibx can be used? Macrolides (azithro, clarithro) OR clinda
Pt has a severe staph infection and tells you that they are allergic to PCN. What antibx can be used? vanc, linezolid, daptomycin
Pt has a minor staph infection and tells you that they are allergic to PCN. What antibx can be used? macrolide (azithro, clarithro), clinda, TMP/SMZ
What antibx are specific for STREP? PCN, amox, ampicillin
Name some clinically important gram negative rods? E. coli, enterobacter, pseudomonas, serratia, citrobacter, morganella
Name two cephalosporins that can be used to treat GNR? cefipime, ceftazidime
Name two PCNs that can be used to treat GNR? piper-, ticar-
Name a monbactam that can be used to treat GNR? aztreonam
Name four quinolones that can be used to treat GNR? cipro-, fluoro-, gati-, moxi-
Name three aminoglycosides that can be used to treat GNR? genta-, tobra-, amikacin
Name three carbapenems that can be used to treat GNR? mero-, imi-, erta-
Which carbapenem DOES NOT cover pseudomonas? erta-
Which PCNs also cover strep and anaerobes? Ticar-, piper-
What fluoroquinolones are excellent for pneumococcus? levo-, gati-, moxi-
Which antibx drug class works synergistically with other agents to tx stap and strep? aminoglycosides
Which drug class are excellent in covering anaerobes, strep, and MSSA? carbapenems
Which antibx covers MRSA and can broadly be used against GNRs? tigecycline
When treating GI anaerobes what is the BEST antibx choice? metro
What other GI anaerobic antibx are equal in efficacy as metro? carbapenems, ticar-, piper-
What are the only two cephalosporins that can be used to tx anaerobes? cefotetan, cefoxitin
Name the class of anaerobes that infect the GI tract? bacteroides
What drug is the best for covering anaerobic strep lung infections? clinda
What two drugs can be used to tx CMV? ganciclovir, foscarnet
Name the adverse effects of ganciclovir? neutropenia, bone marrow suppresion
Name the adverse effect of foscarnet? renal toxicity
Name the two neuraminidase (-) that treat Influenza A and B? oseltamivir, zanamivir
Name the antiviral used to treat Hep C and RSV? ribavirin
What drug is used to tx chr. Hep B? Lamivudine, IFN, adeefovir, entecavir, telbivudine
Which antifungal has limited candida coverage? fluconazole
What antifungal covers ALL candida? Voriconazole
What is an AE of voriconazole? visual disturbances
What is the best agent against Aspergillus? voriconazole
Name the drugs of the echinocandins class? caspofungin, micafungin
The echinocandins are excellent for what type of pts? neutropenic fever
Why/how do echinocandins have no sig AE in humans? MOA (-) a 1,4 glucan synthx step that is not found in humans
Why use fluconazole instead of amphotericin for cryptococcus? less AE
What are the AE of amphotericin? renal tox (inc creatinine), fever, shakes, chills, HYPOkalemia, metabolic acidosis
Pt dx with osteomyelitis and started in antibx treatment. What can you measure to follow progression of treatment? ESR
What MUST you do to pt with osteomyelitis in order to apropriately treat with antibx? Bone bx and culture (DO not culture superficial wound, false rep of what org is causng infection inside)
MCC of osteomyelitis? staph
Other causes of osteomyelitis? pseudo, salmonella
Tx for osteomyelitis if staph? IV naf-, ox- for 4-6 wks; if MRSA IV vanc, linezolid, daptomycin (never use oral)
When is the only time you can use oral antibx for tx of osteomyelitis? salmonella/pseudo confirmed with bone bx and culture
What is the most sensitive presentation of otitis media? immobility of TM
Tx for OM? Amox 7-10 days
Best initial test for sinusitis? XR
MCC of sinusitis followed by other etios? MCC = viral; H. flu, S. pneu, M catarrhalis
When do you initiate antib tx for sinusitis? Antibx choice? fever, pain, peristent sx 7+days despite decongestants, purulent nasal DC; Amoxicillin
Best initial test for pharyngitis? rapid step
Most accurate test for pharyngitis? throat culture
Treatment for pharyngitis? amox, PCN
Tx for pharyngitis if pt allergic to PCN? azithromycin, clarithromycin
What anitvirals are ONLY effective against Influenza A? amantidine, rimantidine
What antibx are safe in pregnancy PCN, ceph, aztreonam, azithromycin, erythromycin
What antibx are used to tx epidydimo-orchitis in pts > 35 and <35yo >35: doxy, ceftriaxone <35: fluoroquinolone
What is the best initial test for dx chancroid Swab gram stain + cx
What organism is found in chancroid H. ducreyi (GN coccobacilli)
What medium is used to grow H. ducreyi Nairobi or Mueller Hinton agar
What is the tx for chancroid IM Ceftriaxone x1 OR PO azithromycin x1
MCC lymphogranuloma venereum C. trachomatis
Tx for LGV Doxy
Pt has vesicles on penis and you are certain it is HSV. Next best step Tx w/ acyclovir, valacyclovir, famciclovir 7-10days
What is the most accurate test for HSV Viral cx
What is the bug that causes syphilis T. pallidum
What is the most accurate test for dx primary syphilis Dark field miscroscopy (not VDRL or RPR)
Tx of primary syphilis IM PCN x1
Tx primary syphilis in PCN allergic pt doxy
Tx for secondary syphilis Same as primary (IM PCN or doxy)
Initial test for dx secondary syphilis RPR and FTA
Initial test for dx tertiary syphilis RPR and FTA, LP (RPR, VDRL of CSF)
Tx for tertiary syphilis IV PCN
When should you desensitize pts with PCN allergy Neurosyphilis and pregnant pts
Best initial dx test for granuloma inguinale Biopsy
Tx of granuloma inguinale TMP/SMX or doxy
What are the two major Duke’s criteria 2 positive blood cx + abnormal echo
Duke’s criteria are used to assess Infective endocarditis
What is needed from Duke’s criteria for dx of IE 2 major, 1 major + 3 minor, or 5 minor
What is the initial test for IE Blood cultures
What is the next test after blood cx for IE are positive Echo
Which type of echo is used first for evaluating IE TTE
What is the empiric tx for IE Vanc + gent 4-6wks
Which cardiac defects require IE prophylaxis Transplant valve dz, prosthetic valves, unrepaired cyanotic dz, prior IE
Which procedures requires IE prophylx Surgery infected skin, respiratory tract surgery, dental procedures that cause bleeding
What antibx can be used as prophylx for bleeding dental procedures Amox or clinda if PCN allergy
Animal exposure + jaundice + renal = Leptospirosis
Dx used for leptospirosis Serology
Tx for leptospirosis PCN or Ceftriaxone
Hunter, ulcer at site of contact with animal, enlarged lymph nodes, conjunctivitis. Dx Tularemia
Tx for tularemia I don’t know
Dx test for tularemia Serology
Ct head shows thin wall calcified cysts in pt that ate pork. Dx Cysticercosis
Tx of cysticercosus Albendazole
If question states camping and hiking what should first come to mind TICKS
What two things in question stem tells you without a doubt pt has Lyme dz Camping/hiking in Midwest/NE + target rash
Why would you not do serology testing in pt you suspect has Lyme dz Characteristic rash more specific than serology
Tx for Lyme dz PO Doxy; if in CNS/cardiac use IV Ceftriaxone
What is the MC late manifestation of Lyme dz Joint involvement
What is the MC cardiac sequelae of Lyme dz AV node block
What is the MC neurologic sequelae of Lyme dz 7th CN palsy (Bell’s)
Tx for rash, joint, Bell’s palsy in Lyme dz pt PO doxy or amox
What dz is also carried by Ixodes tick and present w/ hemolytic anemia Babesiosis
Dx test for babesia Peripheral smear to see tetrad organism inside RBCs or PCR
Tx for babesia Clinda + quinine
What dz is also carried by Ixodes tick and presents w/ elevated LFTs, low platelets, low WBCs Erlichiosis
Compared to Lyme dz what is different about presentation of Erlichiosis No rash
Dx test for erlichiosis Peripheral smear to see morulae organism inside WBCs or PCR
Tx for erlichiosis Doxy
Pt returned from trip abroad and has hemolysis plus GI complaints malaria
Dx test for malaria Blood smear
Tx for acute malaria Doxy + quinine
Prophylx for malaria mefloquine weekly or atovoquone/proguanil daily
What should pts be warned about when taking mefloquine Neuropsychiatric AE, bradycardia, QT prolongation
What respiratory bug has branching weakly acid fast and gram positive filaments Nocardia
What types of pts are infected by Nocardia Immunocompromised
Best initial study for Nocardia XR
Most accurate test for Nocardia Culture
Tx for Nocardia TMP/SMZ
What branching filamentous bacteria affects the respiratory system of immunocompetent pts Actinomyces
Where is actinomyces found Normal flora of mouth; can seed to systemic infection from facial/dental trauma
What is used to dx actinomyces Gram stain and anaerobic culture
Tx for Actinomyces PCN
Pt went to wet areas of Ohio/Mississippi river valley. Has palate/oral ulcers pancytopenia and splenomegaly. Dx Histoplasmosis
What other respiratory dz does Histoplasmosis mimic TB
What is the tx for acute respiratory dz caused by Histoplasmosis No therapy
What is the tx for disseminated histoplasmosis Amphotericin
Pt came from very dry area (Arizona) and c/o joint pain and erythema nodosum. Dx Coccidiomycoses
Tx for coccidiomycosis Intraconazole
Pt came from rural Southeast with pulmonary complaint and bone lesions Blastomycosis
Tx for blastomycosis Ampho or itraconazole
Created by: DrINFJ