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300 Cards in this Set
- Front
- Back
Treatment for Lyme disease if 1st degree AV block? |
doxy Note: only treat 2nd/3rd degree AV block with ceftriaxone |
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non bullous impetigo treatment?
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mupirocin
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salmonella gastroenteritis treated how?
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usually self limiting only give antibiotics if severe or invasive (quinolone, macrolide, 3rd gen cef)
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most common cause of osteomyelitis in patient with a nail puncture?
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Pseudomonas Note Staph is most common overall cause of osteomyelitis but this is exception
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How is diptheria treated?
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anti diptheria antibodies, with metronidazole, or penicillin G or erythromycin
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How is pertussis treated? Are the contacts treated?
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erythromycin for 14 days and treat contacts same way
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Treatment for legionaire's disease?
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azythromycin or moxifloxacin
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What is first test in suspected legionaire's? Gold standard?
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Urine antigen first, sputum culture gold std
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Organism causing cellulitis in someone with DMII or burns? Treatment in burn patients?
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pseudomonas, treat with topical sulfadiazine or bacitracin
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How is tuleremia treated?
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tetracycline or doxycycline
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what is prophylactic treatment for any cat bite? What organism are you worried about?
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amoxicillin with clavulanate for Pasturella multicodia
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What are 2nd line prophylactic agents for any cate bite?
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can use bactrim or doxy or cefuroxime or quinolone with either clindamycin or metronidazole for aneorobic coverage
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treatment for bacterial conjunctivitis?
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topical macrolide or topical polymixin B
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treatment of acanthomeaba infection of eyes?
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propamidine and polymixin opthalmic solution
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Treatment of a chalazion or hordeolum?
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warm compresses and if no improvement referral to an opthomologist
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How is osteomyelitis treated?
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surgical debridement and IV antibiotics for 6 weeks Note: if vertebral osteo treat for 8 weeks |
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How is inhaled anthrax treated? What are characteristics of organism? |
1) ciprofloxacin or doxycycline 2) gram + aerobic bacillis, nonmotile, boxcar shape |
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treatment of sporotrix?
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itraconazole #1, may use lugols solution or sski which are iodine solutions
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Treatment of blastomycosis?
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itraconazole
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treatment of histoplasmosis?
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itraconazole
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treatment of coccidiomycosis?
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itraconazole, fluconazole or ketoconazole are equal
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Treatment for systemic histoplasmosis, blastomycosis, coccicoidomycosis?
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amphotericin
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Treatment of norcardia?
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TMP-SMX
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Treatment of actinomyces?
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penicillin G (SNAP = sulfas for nocardia and PCN for actinomyces)
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What type of bacteria is actinomyces?
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gram + filamentous anearobic
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What type of bacteria is norcardia?
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gram + weakly acid fast filamentous aerobic |
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What 2 organisms predominately cause toxic shock syndrome? How is it treated empirically? |
1) Staph aureus and GAS 2) vanco or PCN and add clindamycin to either of these to prevent toxin formation |
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suspect someone of having herpes because of vesicles and inguinal adenopathy next step? |
skip Tzanck smear or any testing and treat immediately with acyclovir or valcyclovir |
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tx of bartonella hensale?
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z-pak #1 or doxy Note: typically is self-limiting, so do not need to treat unless severe infection
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peritonsillar abscess tx?
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I&D + PO clindamycin
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Treatment of neurocystocercosis?
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albendazole
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when to use steroids in tx pneumocystis?
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Aa grad >35 or PaO2 <70mmHg
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tx of legionella pneumonia?
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macrolides or quinolones
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tx of inpatient pneumonia (Not ICU pt)?
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macrolide + ceftriaxone or respiratory quinolone alone
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tx of outpatient pneumonia in healthy patient vs pt with comorbidity's (diabetes, malignancy, etc...)
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healthy = macrolide or doxy
unhealthy = respiratory quinolone or macrolide + beta-lactam Remember: tx duration is 7 days |
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tx of human bites?
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amoxicillin/clavulanate
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coccidiomycosis triad?
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lung skin and bone problems
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tx of candidia inf of nipple?
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topical azole
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most common cause of cavernous sinus thrombosis?
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S aureus
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drug to prophylax with for influenza?
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oseltamivir if given within 72 hours
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2nd line tx for Pneumocystis?
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dapsone and pyrimethamine 2nd line pentamidine is 3rd line Note: bactrim still #1 for treatment and prophylaxis
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tx of scabies?
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5% pimethrin cream from neck down on 2 separate occassions
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HIV drug causing weird dreams?
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efavirenz
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s aureus pneumonia most often occurs in who?
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IV drug users, cystic fibrosis (<10yo), post viral inf, chronically ill
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Late post surgical incision infection (4-10 days) most likely caused by?
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S aureus #1, Pseudomonas #2, E coli #3
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Early post surgical site incision infection (<72 hours) most likely caused by?
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GAS or clostridium (if clostridium the infected site will have few leukocytes and mild erythema, but extreme pain compared to exam findings)
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empiric tx for infective endocarditis?
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IV vancomycin
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Treatment of hepatitis C?
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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
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pt with SCD and osteomyelitis tx empirically with? to cover for?
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Salmonella #1 and staph with vanco or nafcillin or cefazolin + aminoglycoside
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most common cause of osteomyelitis in SCD pt?
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salmonella
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aminoglycoside side effect?
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sensorineural hearing loss
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most common cause of meningitis <3 months?
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GBS
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most common cause of meningitis 3 months to 9yrs?
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S pneumoniae
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most common cause of meningitis 10-18?
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N meningitidis
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most common cause of meningitis >18?
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S pneumoniae
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tx of meningitis <3 months?
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IV vancomycin, ampicillin, ceftriaxone
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tx of meningitis 3 months to 50 yo?
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IV vancomycin and ceftriaxone
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tx of meningitis >50 yo?
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IV 3rd gen ceph + vanco +ampicillin
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tx of meningitis in immunocompromised?
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IV vanco, cefotazidime, ampicillin
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What is the role of steroids in meningitis?
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used to prevent negative neurologic sequale of S pneumoniae meningitis. Note: give to all pts where S pneumoniae may be suspected
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tx of gonorrheal conjunctivitis?
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IM ceftriaxone and topical erythromycin
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tx of otitis externa?
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clean canal, topical cipro or acidic antibiotic + hydrocortisone cream
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most common cause of prosthetic valve endo?
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s aureus
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tx of gonoccocal conjunctivitis in neonate?
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oral penicillin or IM cef with topical erythromcyin eyedrops
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hemochromatosis is suscpetable to?
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susceptable to iron loving bacteria: listeria, vibrio and yersina enterolytica
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tx for yersinia enterolytica?
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ciprofloxacin or doxycycline
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tx of SBP?
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3rd gen cef
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redman syndrome?
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pruritus, redness above waist, hypotension, dyspnea associated with vancomycin... stop giving drug then readminster later at a slower rate
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Is lymphogranuloma venerum painless or painful lesion?
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painless
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How is amebic liver dz tx?
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metronidazole
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A pt with asplenia is at risk for what infection if bitten by a dog?
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capnocytophaga
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A pt with asplenia has erythema chronica migrans and a severe hemolytic anemia and thrombocytopenia. What coinfection do they likely have?
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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
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intraleukocytic morulae are concerning for? How does rash on pt appear?
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erlichosis and rash appears like lymes w/o central clearing
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what is the antibiotic of choice for prophylaxis against endocarditis?
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amoxicillin
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what is the antibiotic of choice for prophylaxis against endocarditis when pt is unable to take PO med?
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Either ampicillin or ceftriaxone or cefazolin
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What is the antibiotic of choice for prophylaxis against endocarditis when PCN allergic?
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clindamycin or azithromycin or if can take cephalosporin cephalexin
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What are agents are used to treat CNS toxoplasmosis?
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sulfadiazine and pyramethamine
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What agents are used to treat prophylax against toxoplasmosis?
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tmp-SMX |
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What are 4 common agent that inhibit dihydrofolate reductase, such that leucorvin (folinic acid) or folic acid should also be prescribed?
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phenytoin, methotrexate, pyramethamine, trimethoprim
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How is MAC treated?
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3 drug regimen: ethambutol, azithromycin or clarithromycin +/- rifampin or ribabutin
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What candidial species are resistant to the azole antifungals and require an echinocandin (caspofungin/micafungin)?
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C. krusei and C. glabrata
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treatment of lymes dz causing bells palsy?
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oral doxy Note: only give ceftriaxone if meningitis or heart block
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it is generally best to avoid treating travelers diarrhea, unless moderate or severe; however, what medications can be used?
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quinolones (#1) or azithromycin Note: do not give antibx prophylaxis
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What antibiotics are recommended for treatment of vibrio cholarae/volnificus/parahemolyticus?
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doxy or quinolone
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How is babesiosis treated?
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Mild or moderate: azithromycin + atovaquone (preferred) or clindamycin + quinine and Severe: clindamycin + quinine
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treatment for N meningitidis meningitis?
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ceftriaxone or cefotaxime. Remember the vanco is added only for possible penicillin resistant pneumococcal pneumonia not the neisseria
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Treatment for Allergic bronchopulmonary aspergillosis?
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steroids + itraconazole
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Treatment of invasive aspergillosis?
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voriconzale #1, but amphotericin can be used also
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Blood stream infection with which 2 bacterial species warrants a colonoscopy to r/u GI malignancy?
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strep bovis, strep gallolyticus and clostridium septicum
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ribavirin is used in the treatment of which 2 viruses?
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RSV and HCV Note: it is pregnancy category X
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How is typhoid treated?
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floroquinolone or 3rd gen ceph
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best prophylactic med to chloroquine resistant areas when pt is pregnant?
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mefloquine
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At what CD4 count do you prophylax against pcp? What med?
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CD4 <200 with tmp-smx
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at what CD4 count do you prophylax against toxoplasmosis? What med?
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CD4 <100 with tmp-smx
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At what CD4 count do you prophylax against MAC? What med?
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CD4 <50 with azithromycin and continue until 3 months after CD4 count has been >100 |
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Which vaccines should be avoided in AIDS pts?
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MMR, intranasal influenza, varicella, zoster, yellow fever, bcg, typhoid, sabin polio, small pox. Note: all are live virus |
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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? |
doxycycline in primary and secondary. Ceftriaxone in tertiary. Note: If PCN desensitization is answer choice for tertiary syphillis, this will be answer, even if ceftriaxone is a choice |
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How is post-herpetic neuralgia managed acutely? And after 30 days? |
opiates, tramadol, lidocaine patches acutely. Longterm consider TCA's or gabapentin
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Who is the zoster vaccine recommended in?
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age >60, immunocompromised states (DM, renal failure, liver failure, severe COPD, etc...), HIV if CD4 >200
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Treatment for zoster should be administered within how many hours?
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72 hrs with acyclovir, valcyclovir, etc... |
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What fungus has narrow angle branching with septae? Which is wide angle and w/o septae? |
aspergillous = narrow angle, septae. mucor = wide angle, NO septae (spagetti and meat ball appearance on microscopy) |
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TOC for mucormycosis? |
amphotericin, need to debride |
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Besides surgical consultation what are the treatment regimens in necrotizing fascitis?
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Need to have MRSA coverage: vanco or dapto or linezolid. Also need gram neg and aneorobic coverage: cefepime + clindamycin or a carbapenem |
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If cause of necrotizing fascitis is suspected to be from strep pyogenes or clostridial species what should treatment regimen be? Why? |
PCN + clindamycin. Note: clindamycin translation of bacterial toxin protein |
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treatment for yersinia pestis (plague)? What are characteristics of the organism? |
1) a tetracycline or streptomycin or quinolone 2) gram negative, safety pin shape Note: px people with a quinolone or doxy |
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If you suspect meningitis do you give antibiotics first, get imaging first or LP first? |
always treat meningitis when suspected clinically before obtaining other tests
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If you suspect SBP do you give antibiotics first or obtain paracentesis first?
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paracentesis first
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Who should receive prophylaxis for N meningitidis when exposed to someone that has it?
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people in household, anyone handling respiratory secretions, i.e. intubating physician. Note: triage nurse, doctor who did spinal tap do NOT need it
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What drug is used for N meningitidis prophylaxis?
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rifampin
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epididymitis in men <35 is most commonly caused by? And in men >35?
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<35 is gonorrhea/chlamydia and >35 E. coli |
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How is leptospirosis treated?
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Doxy or PCN or ceftriaxone |
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How is stronglyoides treated? |
ivermectin #1, albendazole #2
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What are 3 painless ulcers caused by STD's?
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syphillis, lymphogranuloma venereum, klebsiella granulomatosis
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How should the initial episode of C. diff be treated if it is mild to moderate?
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PO metronidazole
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If the initial episode of C diff is severe w/o other organ failure how should it be treated?
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PO vancomycin
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If the initial episode of C diff is severe with multiple organ failure how should it be treated?
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PO vancomycin + IV metronidazole
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How should the first recurrence of C diff be treated?
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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
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How is Giardia treated?
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metronidazole
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Treatment of cryptococcal meningitis?
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amphotericin with flucytosine. Note: the only time on boards you will use flucytosine is for crypto! |
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Treatment of reactive arthritis following a GI infection with either shigella, salmonella, camplobacter, etc...? |
Give NSAIDS for diarrheal causes, can use antibiotics if a chlamydial GU infection is causing
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Treatment of Bacteroides infection in mouth?
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Need aneorobic coverage: amoxicillin, clindamycin, ampicillin
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What medications are used to treat male UTI?
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either bactrim or quinolone. Note: if male UTI you are treating prostatitis, course is minimum of 2-4 weeks
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Which antibx are safe to use for UTI in pregnancy?
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nitrofurantoin, ampicillin, cephalosporins
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ESBL UTI is best treated with?
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carabpenem
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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?
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fluconazole #1
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Which antibx class is preferred for pyelonephritis in pregnancy?
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cephalosporins w/ or w/o aminoglycoside
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What is test of choice for diagnosing osteomyelitis? Definitive diagnosis?
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"MRI test of choice, Bone biopsy with gram staining definitive |
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Treatment for Whipples dz? What are characteristics of the organism? |
1) rocephin or IV PCN initially followed by 1 year of bactrim PO 2) Gram + rod that is PAS positive |
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When should postcoital antibxs be given? |
Give when >/= to 2 infections in 6 months or >/= to 3 infections in 12 months Use bactrim, cipro, nitrofurantoin, keflex |
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Staph saprophyticus UTI is found most commonly in what population? What are characteristics of the organism that distinguish it from other staph species? |
1) young women 2) gram positive coagulase negative |
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What type of penicillin is used for primary and secondary syphillis? |
IM 2.4M units of benzathine PCN |
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What type of PCN is used for neurosyphillis? |
Aqueous crystalline penicillin G 18-24 million units divided into 3-4 million units IV q4h or continuous infusion for 10-14 days |
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Treatment of chancroid? Organism that causes? What are characteristics of organism? |
1) macrolide or ceftriaxone 2) haemophylus ducreyi 3) fastidious gram-negative coccobacillus |
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HPV strains more commonly causing warts? strains more commonly causing cancer? |
6 and 11 = warts 16 and 18 = cervical CA |
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How does ebola present? |
1) Begins with flu like symptoms: fevers, malaise, arthragias 2) followed by diarrhea and abd pain, CP, SOB, confusion, hemotypsis Note: ~7 days in pts develop maculopapular rash and/or petichae and subconjunctival bleeding |
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Treatment of aeromonas hydrophilia? Characteristics of organism? |
1) bactrim or quinolone or 3rd gen ceph 2) GNR, oxidase positive, facultative aneorobe, beta-lactamase producer |
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treatment of RMSF? Characteristics of organism? |
1) doxycycline 2) Gram neg coccobacillis |
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what type of organism is babesia? How is treated? |
1) protozoan 2) first-line is quinine plus clindamycin but can use atovaquone plus azithromycin |
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How is babesia diagnosed? |
1) maltese cross on PBS 2) PCR |
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What are the indications to px someone for infective endocarditis? |
1) mechanical/prosthetic valve 2) congenital heart dz (repaired and unrepaired) 3) prior episode of endocarditis 4) heart transplant with valvulopathy |
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Treatment of botulinum toxin? |
Immune globulin |
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Leptospirosis is what type of organism? How is it treated? |
1) spirochete found mainly in tropic 2/2 dog urine contaminated water 2) PCN or doxy, if severe use ceftriaxone |
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How is candidemia treated in non-neutropenic pt and in neutropenic pt? |
1) fluconazole, unless severe then echinocandin 2) if neutropenic use echinocandin or voriconazole |
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How is candidial meningitis or endopthalmitis treated? |
voriconazole, remember that echinocandins can't penetrate cns |
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honey moon cystitis caused by? |
staph saprophyticus, associated with condom use |
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How does hanta virus present? what are some lab findings? |
1) fever, rash, myalgias and develop ARDS within 10 days 2) thrombocytopenia, elevated hct Note: known as the 4 corners dz: AZ, CO, UT, NM |
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diertle stain is used for? |
It is a silver stain used for organisms like syphillis, klebsiella, bartonella henslae |
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vibrio volnificus and aeromonas hydrophilia both have a similar presentation How can you differentiate them? |
based on where they were acquired 1) vibrio = salt water 2) aeromonas = fresh water |
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treatment of latent TB? |
INH x9 months or INH + rifapentine for 3 months or rifampin for 4 months or INH and rifampin for 4 months |
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treatment of active TB? |
4 drug combo x2 months (INH, rifampin, pyrazinamide, ethambutol) followed by 6 months of INH and rifampin |
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Treatment for acute prostatitis? |
Quinolone or bactrim Remember presents with flu like symptoms: fevers, chills, myalgias |
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Treatment for chronic prostatitis? |
Treat with quinolone has better prostate penetration than bactrim Remember presents with recurrent dysuria NOT like acute |
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Which medications can cause renal stones? |
sulfamethoxazole, methotrexate, IV acyclovir, sulfadiazine, IV ativan, Indinavir |
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What are renal side effects of trimethoprim in the kidney? |
1) inhibits secretion of Cr in PCT, so get small rise in Cr 2) causes RTA type 4 |
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Define neutropenia! |
ANC <1500 = mild ANC <1000 = moderate ANC <500 = severe |
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First line treatment for neutropenic fever? What bug are you concerned for initially to always? |
carbapenem, cefepime, zosyn Want pseudomonal coverage initially |
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What are indications to broaden coverage in neutropenic fever? |
Add vanco with pseudomonal coverage initially if: H/O MRSA hypotension, shock strong evidence of line infection cellulitis |
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Treatment for neutropenic fever at presentation? If still spiking fevers after 48 hours? If still spiking fevers after 5-7 days? |
Initially antipseudomonal: carbapenem, zosyn, cefepime After 48 hours cover MRSA: vanco, daptomycin, linezolid After 5-7 days cover fungal: caspofungin, amphotericin, voriconizole |
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Treat asymptomatic bacturia in who? |
1) pts undergoing undergoing urologic procedure 2) neutropenic pts 3) pregnant pts |
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Who is intranasal influenza vaccine indicated in? |
ages 2-49 It is live virus |
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Who is intranasal influenza vaccine contraindicated in? |
CD4 <200 chronic cardiopulmonary disesases, CKD, DM Prior guillan Barre Pregnancy Note: inactive vaccine can be given to people >6 months old |
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Symptoms and diagnosis of enterobius vermicularis? |
anal pruritus at night diagnosis with scotch tape test TOC is albendazole Note: this is a pinworm |
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TOC in acute otitis media? |
amoxicillin ampicillin if amoxicillin fails |
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Treatment of crusted scabies? |
PO ivermectin with topical permethrin Note: this disease is not alway pruritic, but is more extensive and has a psoriatic look occurring in elderly and AIDS pts |
|
Treatment of mild-moderate rosacea? |
topical metronidazole |
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Treatment of severe papulopustular rosacea? |
a tetracycline (doxy or minocycline) can use erythromycin also |
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How does Malazzesia Furfur present and how would you treat it? |
hypo/hyperpigmented patches of skin TOC is topical agents: -azole, terbenifine, selenium sulfide |
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How does Malazzesia Furfur look on microscopy? |
spagetti and meat balls Remember: also known as Tinea versicoler |
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what are centors criteria |
fever tender LAD tonsillar exudates absent cough Note: if 2-3 present get rapid strep, if all 4 just treat w/o testing, <2 seek other cause |
|
What are the 4 gram + rods classes? |
Listeria Cornybacterium Bacillus (anthrax, cereus) Clostrdium |
|
Skin manifestations of HCV? |
Porphyria cutanea tarda Lichen planus Leukocytoclastic 2/2 cryoglobulinemia |
|
Skin diseases causes by HIV? |
sudden severe psoriasis severe seborrheic dermatitis |
|
treatment for dermatitis herpetaformis |
dapsone |
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Erythematous pruritic rash in intertriginous areas that turns red with woods lamp? |
erythrasma from Cornybacterium minitissimum |
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treatment of malignant otitis externa in a diabetic? |
cipro or rocephin, caused by pseudomonas, develop bony erosions and nerve palsies |
|
Thumb print sign on lateral X-ray? Steeples sign on X-ray? |
thumbprint = epiglottitis (haemophylus) Steeples = croup (paramyxovirus) |
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Treatment of epiglottis empirically? |
vanco and rocephin Though haemophylus is main cause, staph (MRSA) and strep species can also cause |
|
sensitivity of rapid strep test? Is there a need to get throat culture in adults? |
85-90% and given that incidence is <10% in adults no need to get culture if rapid test negative, just assume not strep |
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A patient has hives with eggs, can they get prophyllaxis with flu vaccine(s)? |
Yes but need observation period of 30 minutes after administering Note: the live attenuated forms except one (RIV) have egg components and so does the nasal live form |
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Can a pt with angioedema or anaphylaxis to eggs get influenza vaccine? |
Yes but use the Recombinant-hemagluttonin Influenza Vaccine (RIV) |
|
bacteria that are red or stain red? |
Mycobacterium (red snapper) Nocardia (gram +, weakly acid fast) serratia (red pigment) |
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Routine vaccines in pregnancy? |
attenuated influenza and Tdap Special circumstance vaccines: hepB or A, pneumoccal, hemophylus, meningococcus, rhogam |
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Signs of bacterial vaginosis and treatment? |
2/2 gardnerella vaginalis pH >4.5, clue cells (stippled epithelial cells), whiff test positive, thin gray dc, fishy smell Note: absence of symptoms treat with metronidazole or clindamyin (aneorobic) |
|
Signs of trichomonas and treatment? |
yellow-green malodorous dc, vaginal inflammation and pain Treat pt and partner with metronidazole |
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Signs of candidal vaginitis and treatment? |
thick cottage cheesy white nastiness with vaginal inflammation and pain pH normal (<4.5) with signifcant prurititus Treat with topical or PO -azole |
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Tetrad of whipples disease? |
abdominal pain, arthralgias, diarrhea, weight loss Note: PAS foamy macrophages |
|
rust colored sputum is? currant jelly sputum is? |
rust = strep pneumoniae currant jelly = klebsiella |
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recurrent proteus UTI's are associated with? |
recurrent renal stones |
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beef red painful urogenital lesion showing school of fish on microscopy? Treatment? |
Chancroid: hemophilous ducreyi macrolide or rocephin |
|
Lab findings in RMSF? |
thrombocytopenia, increased LFT's, elevated PT/PTT |
|
buffy coat stain is for? |
anaplasma |
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lab findings in erlichia/anaplasma? |
thrombocytopenia, leukopenia, increased LFT's Note: RMSF and Lyme will not cause leukopenia so this a clue to what pt has |
|
maltese cross indicative of? |
babesia |
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Duke criteria? |
Diagnosis with 2 major or 1 major + 3 minor or all 5 minor Major Criteria: + blood cx, endocardial involvement or veg on imaging Minor Criteria: predisposing condition (cardiac lesion/material or IVDA); fever; embolic phenom; Immunologic phenom (glomerulonephritis, skin lesions, etc...); + blood cx not meeting major criteria |
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skin findings in infective endocarditis? What is seen on retinal exam of pt with endocarditis? |
janeway lesions = nontender osler nodes = tender Roth spot in retina |
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first line treatment for rhinosinusitis 2/2 bacterial cause? what can be used if PCN allergy? |
amoxicillin-clavulanate #1 cover with doxy or respiratory quinolone (moxifloxicin or levaquin) Note: other meds like macrolides, bactrim have higher rates of resistance |
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Indications for treatment of rhinosinusitis with antibiotic? |
symptoms >10 days severe symptoms fever (>102) with facial pain >3days, worsening symptoms >5 days after an initially improving viral infection |
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How does bacterial keratitis present, who is at risk and how is it treated? |
seen typically in contact pts wearing contact lenses that develop conjunctivitis, mucopurulent dc, photosensitivity and corneal ulceration with florescin dye TOC is topical quinolone |
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what are 2 antibiotics that can cause vision changes? |
ethambutol - color vision changes linezolid - foggy vision and optic disc edema |
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buffy coat stain for? |
erlichia and anaplasma |
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hanta virus presents with? transmitted via? |
hemoptysis and renal failure rodent urine |
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how can hanta virus be distinguished from pneumonic form of plaque based on labs? |
hanta virus has elevated hematocrit which is unique for this infection |
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features of leptospirosis? |
subconjunctival hemorrhage/suffusion jaundice (weils syndrome) liver failure |
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Diagnostic features to know for EBV? |
+heterophile antibody atypical lymphocytes - contain foamy like cytoplasm |
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Side effect of INH? Medication to give to prevent? |
peripheral neuropathy Pyridoxine |
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Most common cause of endocarditis <2 months after valve surgery? Most common >2 months? |
<2 months Staph aureus >2 months Strep viridian's |
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Most common cause of otitis exeterna in diabetic? |
pseudomonas Note: should be hospitalized for IV antipseudomonal drug (zosyn, cefepime) |
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2 infections that pts should not breast feed if they have? |
TB, HIV |
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Indications for both Tdap and Tetanus Ig? |
<3 total immunizations unkwown if they have had 3 serious wounds |
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What should be done for a pt with a clean would in terms of tetanous vaccine and Ig if they had 3 vaccines, the last being 8 years ago? |
If <10 years nothing and wound is clean nothing Note: If wound is dirty then need Tdap if >5 years since last vaccine, otherwise if <5 years needs nothing |
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Age to use DTdap? Age to use Tdap? |
DTap if <7 Tdap if >7 |
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skin infection in people that handle fish or have fish tanks think? |
mycobacterium marinum |
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Do you prophylax people from others with pulmonary anthrax? |
no it is not spread person to person, only from powder source |
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what is the difference between bubonic plague and respiratory plague in regards to isolation? |
bubonic = no isolation pneumonic = isolation |
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sickle cell pt with red cell aplasia likely caused by? |
parvovirus b19 |
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post transplant infections <1 month |
staph and pseudomonas or other common organisms like C diff, enterococcus |
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post transplant infections 1-6 months |
cmv, pcp, hsv, tb, hsv, bk virus, listeria, nocardia, toxo |
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post transplant infections >4 months |
crytpococcus |
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pt with confusion and fevers. EEG shows temporal lobe abnormalities. Think? |
HSV |
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young pt with fevers and confusion presents. LP shows hemorrhagic tap. think? |
HSV |
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HSV1 more likely to cause what CNS disease? HSV2 more likely to cause what CNS disease? |
HSV1 = encephalitis (cold sore) HSV2 = meningitis (std) |
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features on exam that should make you concerned for syphillis in a young pt? |
alopecia hearing loss |
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Most specific test for syphillis in the CSF? |
VDRL, not very sensitive in CSF but highly speicific. Opposite that of blood. |
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palatal ulcer in AIDS pt think? palatal petichiae? Ulcerative lesions on soft palate? |
histoplasmosis = palatal ulcer EBV = palatal petechiae Coxsackie = ulcerative lesion on soft palate |
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Community outbreak of watery diarrhea with protozoa that is partially acid fast positive? |
Cryptosporidium parvum |
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food outbreak of watery diarrhea with protozoa this acid fast positive? |
cyclospora Note: cyclospora causes smaller food outbreaks, where cryptosporidium causes large community outbreaks |
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Should you diagnose tularemia with biopsy of lymph node? |
no there is risk of aerosolizing |
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Drugs that can be used to prophylaxis a pt with meningococcal meningitis? which med if pt is pregnant? |
rifampin ceftriaxone = if pregnant cipro |
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How is paralysis in botulism present that distinguishes it from GBS? |
typically cranial nerve dysfxn first: dysphagia, dysphonia, diplopia |
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conjunctivitis after swimming in a pool? |
adenovirus |
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Rheumatic fever develops after what forms of strep infection? |
only pharyngeal form Note: can develop glomerulonephritis with either skin or pharyngeal infection with GAS |
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Liver forms of malaria? |
vivox and ovale (vodka goes to liver) |
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cell type seen on blood smear diagnostic for P falciparum? |
banana gametocyte |
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Drugs that need to be continued for 4 weeks after returning home for malaria px? |
chloroquine, mefloquine, doxy Note: only need to continue atorvaquine/proguanil 1 week and 2 weeks for primaquine |
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Rubella and Rubeola are also known as? |
Rubella = german measles Rubeola = regular measles |
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How can measles be distinguished from german measles? |
german measles = rash that starts on face and spreads down with posterior cervical LAD measles = koplik spots, diffuse erythematous rash, conjunctivitis |
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when can a pt with shingles return to work? |
no need to be off, keep covered and avoid critical care pts or transplant units |
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Most common cause of indwelling catheter or prosthetic material infections? |
staph epidermidis |
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Oral agents for MRSA? |
clindamycin tmp-smx (skin and soft tissue, not lung) linezolid doxycycline |
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IV agents for MRSA? |
vanco linezolid (can be used in lung, soft tissue infections) daptomycin (can't treat lung because it is inactivated by surfactant, but is better for blood stream infections because it is large molecule) ceftaroline (5th gen cef) Tigecycline (skin and soft tissue infections only) |
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Why is the D-zone test done? |
used to determine resistance to erythromycin/clindamycin in staph species, and therefore need to treat with TMP/SMX |
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who should receive the strep pneumonia PPSV23 vaccine? |
age 19-64 if they have heart, lung, liver dz or dm or current smoker or alcoholic |
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who should get sequential PPSV13 then PPSV23 pneumovax? |
age >65 age 19-64 if they have asplenia, are immunocompromised, or have ckd |
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how often should a pt get a booster for tetanus? what type should they get? |
every 10 years need Td, but need to substitute Tdap one time for pertusis coverage |
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How long after a pt has a TB exposure should a PPD be performed? |
perform at time of exposure, if negative need to repeat in 8-12 weeks |
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syndrome when herpes zoster affects trigemminal V1 branch? Next step in management? |
Hutchinson syndrome urgent optho consult If optho not available use topical steroid drops |
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what is india ink used to check for in the csf? |
crypto |
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treatment of crypto meningitis when there is high opening pressure? |
in addition to amphotericin need to do serial LP's or VP shunt to reduce pressure |
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an immigrant from central or south america that presents with new onset seizures, be concerned for? |
neurocysterocosis caused by Taenia solium a tapeworm |
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presentation of dengue fever? |
fever, retro-orbital pain, myalgias, arthralgias, epistaxis (thrombocytopenia) AKA: break bone fever |
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trypanosoma cruzi is transmitted by what? Causes what? Disease is known as? |
Reduvid bug (kissing bug) dilated cardiomopathy Chagas disease |
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lemiere's syndrome is? |
Fusobacterium necrophorum forms abscess in neck that penetrates jugular vein |
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ludwigs angina is? |
submandibular space infection, often caused by GAS |
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what test is recommended in all MRSA bacteremia pts? |
at least TTE, consider TEE |
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Treatment of meningitis in a recent neurosurgical procedure, penetrating skull wound or a VPshunt? |
cefepime and vancomycin |
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treatment of meningitis in an immunocompromised pt? |
vanco, cefepime, ampicillin |
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what is the best way to slow the number of new cases with outbreak of influenza in a nursing? |
ostelmavir for all residents and vaccinate those who have not yet received |
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signs of secondary syphillis? |
flu like illness moth eaten alopecia macular papular diffuse rash involving palms and soles (nickel and dime lesions) hepatitis |
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skin rash following an HSV infection? |
erythema multiforme |
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hbv vasculitis? HBV renal disease? |
PAN membranous nephropathy |
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older female with NO smoking hx and acid fast organism on BAL? |
MAC causing pneumonia AKA: lady windem |
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infections associated with hot tubs? |
pseudomonal folliculitis legionella pneumonia MAC |
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diagnosis of acute retroviral syndrome? |
HIV RNA |
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Organisms causing PNA and spleenomegaly? |
chlamydia psittaci coxiella burnetti |
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which infection causes a descending paralysis? Ascending paralysis? |
botulinum = descending ascending = tick paralysis |
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DOC in tx of malaria in pregnancy? |
mefloquine |
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skin rash with flower petal shape? |
tinea corporis |
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presentation of tuleremia? |
central papular-ulcerative lesion that forms central eschar and has tender LAD, will have fevers |
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Jones Criteria for rheumatic fever? |
Major: carditis, migratory arthritis, subQ nodules, sydhams chorea Minor: fevers, prolonged PR, elevated ESR/CRP, arthralgias |
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2 forms of disseminated gonnococcus? |
purlent arthritis alone w/o skin lesions triad of migratory assymetric polyarthritis, tensynovitis, painless pustular lesions |
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HBV serum sickness presentation? |
urticaria, prurititus, symmetric arthritis, fever |
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donovan bodies are seen in what disease? |
granuloma inguinale Klebsiella granulomatosis |
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Treatment regimens of necrotizing pancreatitis? |
carbapenem alone quinolone + metronidazole |
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triple therapy for h pylori |
PPI + clarithromycin + amoxicillin for 10-14 days Note: substitute metronidazole for amox if PCN allergic |
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quadruple therapy for h pylori? |
bismuth + PPI + metronidazole + tetracycline for 10-14 days Note: only use if pt fails triple therapy or if metronidazole or macrolide resistant strain |
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If testing for H pylori on EGD with biopsy is negative what is next step? |
get another test, want 2 negatives to rule out even with negative EGD Urea breath test, stool antigen |
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A pt is treated for H pylori, what are reasons to repeat testing to detect clearance? |
still symptomatic H pylori ulcer concern for MALT or adenocarcinoma Do not routinely repeat for clearance in pt that was diagnosed with urea breath test or stool antigen |
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Post Herpetic Neuralgia treatment? Treatment for trigeminal neuralgia? |
PNH = gabapentin or pregabalin TN = carbamazapine |
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Treatment of Pacemaker lead infection? Device pocket infection? |
In both instances need to remove leads and generator. If only pocket infection, treat with antibiotics for 10-14 days, if cultures negative replace PM If vegetation seen on PM lead or valve will need 4-6 weeks antibiotics with repeat cultures being negative before reinsertion |
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If blood cultures are positive in a patient with suspected PM infection at pocket site or on wires what is next step? |
TEE to look for vegetations on leads and valves |
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Metronidazole and clindamycin are typically used for aneorobic infections. Which is used for respiratory and oral infections and which is used more for lower GI pathology? Why? |
Clindamycin = upper/lower respiratory system and oral cavity Metronidazole good for lower GI tract. It lacks ability to cover for any aerobic or microareophillic bacteria found in many abscesses. Need to combine with something like a PCN |
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if a patient is intubated and grows candida on sputum cx, what are indications to treat it? |
if immunocompromised if there is a distant source of infection with candida (i.e. septic joint, etc...) Remember candida lung infections occur in immunocompetent people via hematogenous spread NOT through aspiration |
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Organisms causing ventilator associated PNA? |
MRSA MSSA Pseudomonas Acinetobacter Stenotrophomonas |
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Who should be treated for TB if the PPD shows >/= 5mm induration? |
exposure to known contact HIV or transplant patient Anyone on immunosuppressive therapy CXR findings consistent with prior TB |
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Who should be treated for TB if the PPD shows >/= 10mm induration? |
Hospital employees IVDU People at higher risk for reactivation: DM, ESRD, etc... Immigrants from known areas with TB if <5 years since arrival |
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Who should be treated for TB if the PPD shows >/= 15mm induration? |
Everyone not listed in the 5 and 10mm range, i.e. healthy and non-immigrants |
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Main side effects of INH? |
hepatitis (stop indefinitely if transaminases increase >3x upper limits of normal) neuropathy |
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A patient is still having some symptoms after being treated for H pylori with triple therapy. Next step? |
get test to document current infection (stool antigen or Hydrogen breath test, not serology) then start Quadruple therapy |
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What test should generally be avoided in diagnosing H pylori if patient is on a ppi? |
hydrogen breath test, ppi should be held 2 weeks prior to testing |
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What patients are at risk for bacterial overgrowth? How is it treated? |
scleroderma, gastroparesis, surgical obstruction, meckels diverticulum rifaxamin or ampicillin or metronidazole + cephalosporin |
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how is bacterial overgrowth diagnosed? |
hydrogen breath test gold standard is jejunal aspirate showing >10^5 bacteria per mL |
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Diagnosis of peritoneal dialysis peritonitis? |
Suggest by peritoneal WBCs >100 or 50% neutrophilic predominance in fluid Gram stain usually negative but culture positive ~90% of time |
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How should peritoneal dialysis peritonitis be treated? |
with intraperitoneal vancomycin and a 3rd or 4th generation cephalosporin or gentamicin |
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What is the most common organism to cause peritoneal dialysis catheter related peritonitis? |
Staph, but need to treat for gram negatives also |
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what procedures are considered high risk and mandate patients with risk factors for endocarditis receive prophylaxis before the procedure? |
prophylaxis is needed if patient has an active infection in some other portion of the body, i.e. UTI, colitis, abscess, etc... Dental procedure involving gingiva or periapical region of teeth Respiratory tract procedure if biopsy is to be performed Note: all other GI and GU procedures are consider low risk and you don't px |
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A patient presents with variceal bleeding how should you manage from an ID standpoint? |
>20% of pts presenting with variceal bleed have sbp; therefore, start quinolone or ceftriaxone. Continue for 7 days |
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How do the esophageal ulcers on EGD appear with CMV vs HSV? |
CMV = Deep, volcano-like, linear, raised borders. Treat with IV ganciclovir HSV = shallow, circumscribed extreme pain. Treat with IV acyclovir |
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When can empiric therapy with fluconazole be used in the treatment of odynophagia/dysphagia in a patient with AIDS? |
Only treat empirically if thrush is seen If no thrush is present ~20% of time, need to get EGD to rule out CMV/HSV/malignancy If no improvement with empiric fluconazole get EGD |
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What areas are the following Schistomasiasis found: japonicium, mansoni, hematobium? |
japonicium = SE asia Mansoni = africa and south america Hematobium = south america |
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Side effect of amphotericin in the kidney? |
RTA 1 |