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Step III
Step III - ID
| Question | Answer |
|---|---|
| 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