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  1. Diarrhea with blood and WBCs
    Salmonella, Campylobacter, EHEC, Shigella, Vibrio parahaemolyticus, Vibriovulnificus, Yerisinia, C dif
  2. Most common cause of bloody diarrhea
    Campylobacter
  3. HUS associated diarrheas
    • Ecoli 0157: H7
    • Shigella
  4. Source of Vibrio
    • V parahaemolyticus: shellfish and cruise ships
    • V vulnificus: shellfish, hx of liver disease, skin lesions
  5. Yersinia diarrhea risks
    High affinity for iron, so hemochromatosis and blood transfusions
  6. Stool lactoferrin
    Better sens and spec than stool leukocytes. Not as accurate as stool culture
  7. Diarrhea with no blood or WBCs
    • Viral
    • Giardia: camping, fresh water
    • Cryptosporidiosis: CD4 <100, modified acid fast
    • Bacillus cereus: with vomitting
    • Staph: with vomitting
  8. Scrombroid
    Fish food poisoning with allergic symptoms. Most rapid, wheezing, flushing, rash. Tx with antihistamines
  9. Diarrhea tx
    • Fluids
    • Severe: Ciprofloxacin
    • Giardia: metro, tinidazole
    • Cryptosporidiosis: tx AIDs, nitazoxanide
  10. Severe diarrhea
    • hypotension
    • tachycardia
    • fever
    • abd pain
    • bloody
    • met acidosis
  11. Hepatitis B DNA polymerase
    Quantatative form of e-antigen test
  12. Acute viral hepatitis tx
    Only tx hepC (rarely acute) with interferon and ribavirin
  13. Chronic HepB tx
    Entecavir, adefovir, lamivudine, telbivudine, interferon, or tenofivir. Interferon is not first choice bc injection and sides.
  14. Interferon sides
    • Arthralgias/myalgias
    • Leukopenia and thrombocytopenia
    • Depression
    • Flu like
  15. Chronic Hep C tx
    • If high PCR-RNA, interferon and ribavirin
    • Especially if fibrosis on bx
  16. Ribavirin sides
    Anemia
  17. Urethritis initial test and most accurate test, and others
    • -Urethral swab with gram stain: shows inc WBCs and intraceullar gram neg diplococci for N gonorrhea
    • -urethral cx, DNA probe, or nucleic acid amplification test for both.
    • -Urine testing for nucleic aci amplicfication for both
  18. Causes of urethritis
    • Gonorrhea
    • Chlamydia
    • Mycoplasma genitalium
    • Ureaplasma
  19. urethritis tx
    Cefixime or Ceftriaxone for gonorrhrea + azithromycin or doxycycline for chlamydia
  20. PID initial test and most accurate test
    • Cervical swab with culture, DNA probe, or nucleid acid amp
    • Laparoscopy
  21. PID tx
    • Inpt: Cefoxitin or cefotetan + doxy
    • Outpt: Ceftriaxone + doxy, +/- metro
    • Anaphylactic all to pen: inpt clinda+gent and outpt levofloxacin + metro
  22. Gential ulcer with:
    Painless
    Painful
    Tener LN and suppurative
    • Syphilis
    • Chancroud/Haemophilus ducreyi or HSV (vesicles)
    • LGV
  23. Dx test for genital ulcers:
    Syphilis
    H ducreyi
    LGV
    HSV
    • Dark field, vDRL, PRP, FTA or MHA-TP(confirmatory)
    • Stain and cx in special media
    • Blood complement fixation titers or swab nucleic acid amp
    • Tzanck is best initial. Cx is most accurate
  24. Tx for genital ulcers:
    Syphilis
    H ducreyi
    LGV
    HSV
    • 1 dose of IM benzathine pen or doxy if allergic
    • 1 dose azithro
    • Doxy
    • Acyclovir, valacyclovir, famciclovir. if resistant foscarnet
  25. False+ VDRL/RPR
    Infection, older, IVDU, AIDS, malaria, APL syndrome, endocarditis
  26. Tertiary syph tx
    IV pen. If allergic, desensitize.
  27. Imiquimod
    Local immunostimulant for condylomata acuminata which leads to sloughing off of the lesion
  28. Pediculosis
    • Crabs
    • Tx with permethrine. Lindane has same efficacy but more toxicity
  29. Scabies tx
    • permethrin
    • Ivermectin if widespread
  30. Beta lactams in pregnancy
    All are safe
  31. Cystitis tx
    • Bactrim (3 days if uncomplicated, 7 if anatomic)
    • Ciprofloxacin
    • Cephalexin
    • Nitrofurantoin esp if pregnant
  32. Pyelonephritis tx
    • Amp and gent
    • Cirpofloxacin
  33. Prostatitis tx
    • Acute: amp and gent
    • Chronic: 6-8wks of bactrim
  34. Imaging of pyelonephrtitis
    • Indicated once fever persists for 5-7d of tx.
    • U/S or CT
    • Drain abscess and culture
  35. Endocarditis tx
    • Empiric: vanc + gent
    • Virdans: 4 weeks ceftriaxone
    • Staph: Oxacillin, nafcillin, cefazolin. If prosthetic, add rifampin
    • Fungal: Amphotericin and valve replacement
    • Staph epidermidis or MRSA: Vanc + gent
    • Enterococci: Amp+ gent
    • HACEK: ceftriaxone
    • Resistance: Add aminoglycoside
    • Surgery if CHF, rupture, prosthetic, block, fungal, abscess, AV block, emboli which on abx
  36. HACEK
    • Haemophilus aphrophilus and parainfluenza
    • Actinobacilus
    • Cardiobacterium
    • Eikenella
    • Kingella
  37. Endocarditis ppx
    • Amox
    • If pen all, clinda, azithro, or clarithro
  38. Lyme rash timing and prevalence
    5-30days after tick bite. 85-90% of pts
  39. Lyme joint involvement
    • 60% of pts
    • Oligo
    • 24000 WBC in aspirate (nondistinguishing)
    • Knee most common
  40. Neuro Lyme
    • 10-15%
    • Bell palsy
    • Meningitis, encephalitis, CN palsy
  41. Cardiac lyme
    • 5-10%
    • AV block, Myocarditis, ventricular arrythmia
  42. Lyme tx
    • Rash: doxy or amox
    • Joint or bell: doxy or amox
    • Cardiac or neuro: IV ceftriaxone
    • Tick bite IDed as ixodes scapularis, attached longer than 24hrs, engorged, or endemic area: 1 dose of doxy
  43. Risk of transmission of HIV order
    perinatal, anal, needle stick, oral receptive, vaginal receptive, vaginal insertive
  44. CD4 >200 infections
    Shingles, HSV, TB, candidasis, bacterial pna
  45. HIV test
    • ELISA
    • confirmed by Western
    • infants - PCR or viral cx
  46. Tx of HIV
    • CD4 < 500, viral >100,000, or opportunistic infection
    • -emtricitabine (NRTI), tenofovir (NRTI), and efavirenz (nonNRTI)
    • -if resistant, 3 drugs with at least 2 classes of NRTIs, nonNRTIs, protease inh
    • -Then entry inhibitors (enfuvirtide or maraviroc) or integrase inh (raltegravir)
  47. Sides of HIV meds:
    Zidovudine
    Stavudine and didanosine
    Abacavir
    protease inh
    indinavir
    tenofovir
    efavirenz
    • Anemia
    • periph neuropathy, pancreatitis
    • hypersens, SJS
    • Hyperlipid, hyperglycemia
    • nephrolithiasis
    • renal insufficiency
    • teratogenic - use a protease inh instead
  48. Pregnant HIV tx
    • Efavirenz is teratogenic
    • Keep on other meds or start meds if indicated
    • If mom is fine, tx during 2nd and 3rd trimesters
    • Intrapartum +6 weeks zidovudine for baby
    • If CD4 <350 or viral >1000 - Csection
  49. Beta lactams
    • Penicillins,
    • cephalosporins,
    • carbapenema,
    • aztreonam.
  50. Bugs tx by pen
    • Strep viridans,
    • strep pyogenes,
    • oral anaerobes,
    • syphilis,
    • leptospira
  51. Bugs tx by amp and amox
    • All of pen plus
    • ecoli,
    • ┬ályme,
    • gram neg (HELPS) Hflu, Ecoli, Listeria, Proteus, Salmonella
  52. Amp/amox is best initial tx for
    • Otitis media
    • dental
    • endocarditis ppx,
    • limited lyme,
    • pregnant uti,
    • listeria,
    • enterococcal.
  53. Oxacillin, dicloxacillin, nafcillin are used for
    • Skin (cellulitis, impetigo, erysipelas),
    • staph (endocarditis, meningitis, bacteremia),
    • sensitive osteo or septic joint.
  54. Piperacillin, ticarcillin, azlocillin, mezlocillin bug and are best initial for
    • Gram neg (Ecoli, proteus) and pseudomonas.
    • Cholecystitis, asc cholangitis,
    • pyelo,
    • bacteremia,
    • hospital acquired pna,
    • neutropenia fever.
  55. Bugs resistant to all cephalosporins
    • Listeria,
    • mrsa,
    • enterococcus
  56. Bugs tx by all cephalosporins
    • Strep a, b, c, viridans,
    • Ecoli,
    • klebsiella,
    • proteus
  57. Pen allergy alternative
    • If rash, use cephalosporin.
    • If anaphylaxis, use non beta lactam abx
  58. First gen cephalosporin
    • Cefazolin,
    • ┬ácephalexin,
    • cephradrine,
    • cefadroxyl.
    • Staph, strep, Ecoli.
  59. 2nd gen ceph
    • Cefotetan,
    • cefoxitin,
    • cefaclor,
    • cefprozil,
    • cefuroxime,
    • loracarbef.
    • 1st+ better for anaerobes and gram neg. Most good for upper resp
  60. Cefotetan or cefoxitin
    • 2nd gen ceph.
    • Best initial for pid with doxy.
    • Inc bleeding risk and disulfiram like
  61. 3rd gen ceph
    • Cedtriaxone,
    • cefotaxime,
    • ceftazidime
  62. Ceftriaxone
    • 3rd gen.
    • First line for pneumococcus.
    • Meningitis,
    • comm pna with a macrolide,
    • gonorrhea,
    • lyme in heart or brain.
    • Neonates can't metabolize it in biliary.
  63. Cefotaxime
    • 3rd gen ceph.
    • Better in neonate.
    • Good for SBP
  64. Ceftazidime
    • 3rd gen cephalasporin.
    • Pseudomonal
  65. Cefepime
    • 4th gen cephalasporin.
    • Better at staph.
    • Used for neutropenia fever, vent pna
  66. Carbapenems
    • Imipenem, meropenem, ertapenem, doripenem.
    • Resistant gram neg. Neutropenia fever.
    • All but ertapenem cover pseudomonas.
  67. Aztreonam
    • Monobactam.
    • For gram neg incl pseudo.
    • No cross rxn with pen.
  68. meningitis bugs
    • Strep pneumo,
    • group b strep,
    • h flu,
    • neisseria,
    • listeria.
    • Staph if recent surgery
  69. Meningitis in cd4 <100
    Cryptococcus
  70. Csf cell count
    • Bacterial 1000s neutrophils.
    • Fungal and parasite, tb, and viral: 10-100s lymphocyte
  71. Latex agglutination test of csf
    • good specificity.
    • Add if got Abx before LP
  72. Highest csf protein
    Tb
  73. Meningitis initial tx
    • Cedtriaxone, vancomycin, steroids.
    • Steroids are effective in s pneumo.
    • Add ampicillin for listeria if baby, old, steroids, hiv, immunocomp, etoh, pregnant.
    • Add respiratory isolation if neisseria plus rifampin or ciprofloxacin to close contacts.
  74. Herpes encephalitis tx
    • Iv acyclovir.
    • If resistant foscarnet.
    • Foscarnet has more renal toxicity
  75. Otitis media tx
    • Amox.
    • Amox/clav.
    • Azithro or clarithromycin.
    • Cefuroxime or loracef.
    • Levofloxin.
    • If recurrences, also cx
  76. When to bx for sinusitis
    • Recurrent, no response.
    • Is the most accurate Dx test.
  77. Sinusitis first line
    • Amoxicillin, doxy, bactrim.
    • Also decongestant.
  78. Pharyngitis with membranous exudate
    • Diphtheria,
    • Vincent angina,
    • ebv
  79. Step pharyngitis tx
    • Amoxicillin or pen.
    • If all, cephalexin if rash and clindamycin or macrolide if anaphylaxis.
  80. Flu management
    • Within 48hrs: swab for antigen, oseltamivir or zanamivir.
    • Longer: symptomatic
  81. Aminoglycosides
    • Gentamicin
    • Tobramycin
    • Amikacin
  82. Aminoglycosides uses
    • Gram neg bacilli - bowel, urine, bacteremia
    • Synergy with beta lactam for enterococci and staph
    • No effect against anaerobes
  83. Aminoglycoside sides
    • Nephrotoxic
    • ototoxic
  84. Doxycycline uses
    • Chlamydia
    • lyme
    • Rickettsia
    • prim and sec syphilis
    • Borrelia, Ehrlichia, Mycoplasma
  85. Doxy sides
    • Tooth discoloration
    • Fanconi syndrome/Type 2 RTA
    • Photosens
    • Esophagitits
  86. Nitrofurantoin uses
    Cystitis in pregnant
  87. bactrim uses
    • Cystitis
    • PCP tx and ppx
    • MRSA skin, cellulitis
  88. bactrim sides
    • rash
    • G6PD def hemolysis
    • bone marrow supprression (bc folate antagonist)
  89. Beta lactamase
    adds coverage of MSSA
  90. MRSA tx
    • Vanc
    • Linezolid
    • Daptomycin
    • Tifecycline
    • Minor on skin: bactrim, clinda, doxy
  91. Linezolid side
    bone marrow toxicity
  92. Daptomycin sides
    elevated CPK
  93. Anaerobe tx
    • Above diaphragm: Pen, amp, amox, clinda
    • Below: metro
    • Also piperacillin, carbapenems, 2nd gen ceph
  94. Gram neg locals and tx
    • Bowel, URI, Liver
    • Quinolones
    • Aminoglycosides
    • Carbapenems
    • Piperacillin, ticarcillin
    • Aztreonam
    • cephalosporins

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