ID 2

Question 1

What is the drug of choice for syphilis (primary, secondary, or early latent)?

Answer 1

Penicillin G benzathine 2.4 million units IM x 1

If pregnant or nonadherent, desensitize and treat with Bilin LA.

Question 2

What is the alternative treatment for syphilis if there is a beta-lactam allergy?

Answer 2

• Doxycycline 100 mg PO BID x 14 days
• Doxycycline 100 mg PO BID x 28 days for late latent

Doxycycline is used for patients who cannot take penicillin.

Question 3

What is the diagnosis for early latent syphilis?

Answer 3

• Positive non-treponemal test (RPR or VDRL)
• Treponemal assay

Early latent syphilis is asymptomatic and acquired within the past year.

Question 4

What is the treatment for neurosyphilis?

Answer 4

Penicillin G aqueous crystalline 3-4 million units IV Q4H x 10-14 days

Neurosyphilis can occur at any stage of the disease.

Question 5

What is the drug of choice for gonorrhea?

Answer 5

Ceftriaxone < 150 kg: 500 mg IM x 1

If chlamydia has not been excluded, add doxycycline.

Question 6

What is the treatment for chlamydia in non-pregnant patients?

Answer 6

Doxycycline 100 mg PO BID x 7 days

Pregnant patients should receive azithromycin 1 gram PO x 1.

Question 7

What is the treatment for bacterial vaginosis?

Answer 7

• Metronidazole 500 mg PO BID x 7 days
• Clindamycin 300 mg PO BID x 7 days
• Tinidazole 2g PO daily x 2 days

Metronidazole can also be used as a gel.

Question 8

What is the treatment for trichomoniasis in females?

Answer 8

Metronidazole 500 mg PO BID x 7 days

Males should take 2 grams PO x 1.

Question 9

What is the vaccine that reduces the risk of genital warts?

Answer 9

Gardasil

Gardasil also reduces the risk of cervical and other cancers.

Question 10

What is the topical treatment for genital warts?

Answer 10

Imiquimod cream (Aldara, Zyclara)

Apply 3x/week until cleared or for 16 weeks.

Question 11

True or false: Clindamycin ovules can weaken latex or rubber products.

Answer 11

TRUE

Alternative contraception methods should be used within 72 hours of clindamycin ovules.

Question 12

What is the purpose of perioperative antibiotic prophylaxis?

Answer 12

To reduce the risk of contamination and subsequent infection during surgical procedures

Local bacterial flora at the incision site can cause infections, necessitating the use of antibiotics.

Question 13

Which types of bacteria are common causes of infection at surgical sites?

Answer 13

• Staphylococci
• Streptococci
• Gram-negative organisms
• Anaerobic organisms

These bacteria can lead to infections, especially in intra-abdominal procedures.

Question 14

When should intravenous antibiotics be administered before surgery?

Answer 14

Within 60 minutes before the first incision

This timing ensures adequate tissue concentrations of the antibiotic.

Question 15

What is the recommended timing for administering quinolone or vancomycin antibiotics?

Answer 15

Start the infusion within 120 minutes before the first incision

This is crucial for achieving effective tissue concentrations.

Question 16

True or false: Additional doses of antibiotics may be needed during longer surgeries.

Answer 16

TRUE

Additional doses may be administered for surgeries lasting more than 4 hours or if there is major blood loss.

Question 17

What is the general guideline for post-operative antibiotic use?

Answer 17

Antibiotics are not usually needed; discontinue within 24 hours if used

This helps prevent unnecessary antibiotic exposure.

Question 18

What should be reviewed before understanding perioperative antibiotic prophylaxis?

Answer 18

Infectious Diseases I chapter

This chapter provides foundational knowledge on bacterial pathogens and antibiotic properties.

Question 19

What is the significance of drug half-life in perioperative antibiotic timing?

Answer 19

It helps determine the start time for antibiotics to ensure adequate tissue concentrations

Proper timing is essential for effective prophylaxis.

Question 20

What is the preferred regimen for perioperative antibiotics?

Answer 20

Cefazolin or cefuroxime

These are commonly used antibiotics for prophylaxis in surgical settings.

Question 21

What is the preferred prophylactic antibiotic for most surgeries to prevent methicillin-susceptible S. aureus (MSSA) and streptococcal infections?

Answer 21

Cefazolin or cefuroxime

These are first and second-generation cephalosporins, respectively.

Question 22

What is an alternative antibiotic if the patient has a beta-lactam allergy?

Answer 22

Clindamycin

Vancomycin is also an alternative if MRSA risk is present.

Question 23

In what type of surgeries is Cefazolin + metronidazole recommended?

Answer 23

Gastrointestinal surgeries

Other options include cefotetan, cefoxitin, or ampicillin/sulbactam.

Question 24

What is the duration of antibiotic treatment for N. meningitidis and H. influenzae in acute bacterial meningitis?

Answer 24

7 days

This duration is pathogen-dependent.

Question 25

What are the **classic symptoms** of meningitis?

Answer 25

* Fever * Headache * Nuchal rigidity * Altered mental status ## Footnote Other symptoms may include chills, vomiting, seizures, rash, and photophobia.

Question 26

What is the **recommended adult dose** of dexamethasone for meningitis treatment?

Answer 26

0.15 mg/kg IV Q6H ## Footnote This should be rounded to the nearest 10 mg and continued for 4 days.

Question 27

True or false: **Meningitis** is mostly caused by viral infections.

Answer 27

TRUE ## Footnote However, it can also be due to bacteria or fungi.

Question 28

What is the **risk factor** for meningitis due to Listeria monocytogenes?

Answer 28

* Neonates * Patients age > 50 * Immunocompromised patients ## Footnote These groups are at higher risk for Listeria infections.

Question 29

What is the **initial treatment** approach for suspected meningitis before lumbar puncture?

Answer 29

Start antibiotics immediately if LP is delayed ## Footnote It is preferable to perform the LP prior to starting antibiotics.

Question 30

What is the **empiric treatment duration** for S. pneumoniae in acute bacterial meningitis?

Answer 30

10 - 14 days ## Footnote This duration is based on the pathogen's susceptibility.

Question 31

What are the **most common bacteria** covered in empiric treatment for meningitis in most adult patients?

Answer 31

* Streptococcus pneumoniae * Neisseria meningitidis ## Footnote These bacteria are crucial for initial treatment in suspected meningitis cases.

Question 32

In which patient groups should **Listeria monocytogenes** coverage be added?

Answer 32

* Neonates * Age > 50 years * Immunocompromised patients ## Footnote Listeria coverage is essential due to the increased risk in these populations.

Question 33

What additional antibiotic should be added for **double coverage** of Streptococcus pneumoniae in patients ≥ 1-month-old?

Answer 33

Vancomycin ## Footnote This is recommended to ensure effective treatment against resistant strains.

Question 34

What is the recommended treatment for meningitis in patients **age > 50 years**?

Answer 34

* Ampicillin (for Listeria coverage) * Ceftriaxone or cefotaxime ## Footnote This combination addresses both common and specific pathogens in older adults.

Question 35

What should be avoided in **neonates** when treating meningitis?

Answer 35

Ceftriaxone ## Footnote Ceftriaxone can cause biliary sludging and kernicterus in this age group.

Question 36

What is the most common childhood infection in the United States requiring **antibiotic treatment**?

Answer 36

Acute otitis media (AOM) ## Footnote AOM is prevalent and often presents with rapid onset symptoms.

Question 37

What are common signs and symptoms of **Acute Otitis Media (AOM)**?

Answer 37

* Bulging tympanic membranes * Otorrhea * Otalgia * Fever * Crying and tugging or rubbing the ears ## Footnote These symptoms help in diagnosing AOM in children.

Question 38

True or false: Most cases of **AOM** are caused by viral infections.

Answer 38

TRUE ## Footnote Antibiotics are ineffective against viral infections, which are the majority.

Question 39

What are the typical bacterial pathogens causing **AOM**?

Answer 39

* S. pneumoniae * H. influenzae * Moraxella catarrhalis ## Footnote These bacteria are the primary culprits in bacterial AOM.

Question 40

When should **observation** be considered for non-severe AOM in children aged 6 months and older?

Answer 40

* Symptoms in one ear only (age 6-23 months) * Symptoms in one or both ears (age ≥ 2 years) ## Footnote Observation is an option if symptoms are mild and meet specific criteria.

Question 41

What is the first-line antibiotic treatment for **AOM** in children?

Answer 41

* High-dose amoxicillin * Amoxicillin/clavulanate ## Footnote High doses are necessary to effectively cover most strains of S. pneumoniae.

Question 42

What is the recommended duration of treatment with oral antibiotics for children **< 2 years** with AOM?

Answer 42

10 days ## Footnote This duration is crucial for effective treatment in younger children.

Question 43

In children with a non-severe **penicillin allergy**, what does the AAP recommend for AOM treatment?

Answer 43

Second- or third-generation cephalosporin ## Footnote This recommendation helps avoid cross-reactivity with penicillin.

Question 44

What is the **first-line treatment** for **Acute Otitis Media**?

Answer 44

* Amoxicillin: 90 mg/kg/day in 2 divided doses * Amoxicillin/clavulanate: 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate, in 2 divided doses ## Footnote Amoxicillin/clavulanate is preferred in patients who have received amoxicillin in the past 30 days.

Question 45

What are the **alternative treatments** for **mild penicillin allergy** in Acute Otitis Media?

Answer 45

* Cefdinir 14 mg/kg/day in 1 or 2 doses * Cefuroxime 30 mg/kg/day in 2 divided doses * Cefpodoxime 10 mg/kg/day in 2 divided doses ## Footnote These alternatives are used when patients have a mild allergy to penicillin.

Question 46

What should be done if there is **treatment failure** after 2-3 days for Acute Otitis Media?

Answer 46

* Amoxicillin/clavulanate (if amoxicillin was the initial therapy): 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate, in 2 divided doses * Ceftriaxone 50 mg/kg IM daily for 1 or 3 days ## Footnote Ceftriaxone is used for patients who do not improve after initial treatment.

Question 47

True or false: Most **upper respiratory tract infections** are caused by bacteria and require antibiotics.

Answer 47

FALSE ## Footnote The majority of upper respiratory tract infections are viral and antibiotics are not beneficial.

Question 48

What are the **criteria for anti-infective treatment** in **influenza**?

Answer 48

* Symptoms < 48 hours * Severe illness (e.g., hospitalized) * Symptoms plus risk factors for influenza complications ## Footnote Treatment options include symptomatic care with or without antiviral therapy.

Question 49

What are the **typical symptoms** of the **common cold**?

Answer 49

* Sneezing * Runny nose * Mild sore throat and/or cough * Congestion ## Footnote The common cold generally resolves in a few days without the need for antibiotics.

Question 50

What is the **typical etiology** of **pharyngitis**?

Answer 50

* Respiratory viruses * Group A Streptococcus (S. pyogenes) ## Footnote Symptoms include sore throat, fever, swollen lymph nodes, and white patches on the tonsils.

Question 51

What are the **treatment options** for **acute sinusitis**?

Answer 51

* Penicillin or amoxicillin * Mild penicillin allergy: 1 or 2nd generation cephalosporin * Severe reaction: macrolide (clarithromycin, azithromycin) or clindamycin ## Footnote Antibiotics can be used if symptoms worsen or do not improve.

Question 52

In the case of **acute sinusitis**, what indicates the need for antibiotics?

Answer 52

* ≥ 10 days of persistent symptoms * ≥ 3 days of severe symptoms (face pain, purulent nasal discharge, temperature > 102°F) * Worsening symptoms after initial improvement ## Footnote Treatment may include amoxicillin/clavulanate or symptomatic care.