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224 Cards in this Set
- Front
- Back
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what is unique to junctional or ventricular rhythms
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no P before a QRS
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EKG of Left axis deviation
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upright QRS Lead I
downward QRS Lead aVF |
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EKG of right axis deviation
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downward QRS Lead I
upright QRS lead aVF |
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EKG normal axis deviation
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upright QRS leads I and aVF
"double thumbs up" sign |
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what is AV block
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PR interval > 200msec
or P wave with no QRS after |
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What is LBBB
and mnemonic |
QRS > 120msec
no R wave in V1 wide, tall R waves in I, V5, V6 WiLLiaM: W pattern of QRS in V1-V2, M pattern in V3-V6 |
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What is RBBB
and mnemonic |
QRS > 120msec
RSR' complex with wide R wave in V1 QRS with wide S wave in I, V5, V6 MaRRoW: M pattern of QRS in V1-V2, W pattern in V3-V6 |
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What is a long QT
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> 440msec
can predispose to ventricular tachyarrhythmias |
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what is a significant Q wave
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> 40msec or more than 1/3 of QRS amplitude
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Right atrial hypertrophy on EKG
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P-wave amplitude in lead II > 2.5mm
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Left atrial hypertrophy on EKG
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P-wave width in lead II > 120 msec
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how to diagnose LVH on EKG
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Cornell Criteria:
amplitude of R wave in aVL + amplitude of S wave in V1 > 24mm (males) or 20mm (females) |
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how to dx RVH on EKG
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right-axis deviation and R wave in V1 > 7mm
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how to manage AFib (mnemonic)
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ABCD
A: anticoagulate B: beta-blockers to control rate C: cardiovert/Calcium-channel blockers D: digoxin |
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what is used to determine systolic dysfunction
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low EF
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what must be present for dx of dilated cardiomyopathy?
what test is diagnostic? |
left ventricular dilation and systolic dysfunction (low EF)
Echo |
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what are the 2 most common causes of dilated cardiomyopathy
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ischemia and long-standing HTN
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Causes of dilated CM
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EtOH, wet beriberi, coxsackie virus, Chagas' dz, parasites, cocaine, doxorubicin, HIV and AZT use
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what can be heard on physical exam in dilated CM
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S3 gallop, and tricuspid and mitral regurgitation, cardiomegaly
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what are EKG changes in dilated CM
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non-specific ST-T changes, low-voltage QRS, sinus tachycardia, ectopy, LBBB is common
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what's seen on CXR in dilated CM
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enlarged, balloon-like heart,
pulmonary congestion |
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how to treat dilated CM
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-stop EtOH use
-treat CHF and prevent progression (diuretics, beta-blockers, ACE-i. Consider anti-coagulation to decrease thrombus risk -consider ICD if EF < 35% |
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when to consider ICD placement in dilated CM
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EF < 35%
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what is the basic overall charactersitics of hypertrophic CM
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involves the interventricular septum -> LV outflow obstruction and impaired blood ejection
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what is the congential form of hypertrophic CM
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idiopathic hypertrophic subaortic stenosis
-autosomal-dominant in 50% -most common cause of sudden cardiac death in young, healthy athletes in US |
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other causes of hypertrophic CM
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HTN and aortic stenosis
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what is heard on exam in hypetrophic CM
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mitral regurg, sustained apical impulse, S4, systolic ejection crescendo-decrescendo murmur louder with decreased preload (Valsalva, squatting)
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in hypetrophic CM,
what does the EKG show? what does the CXR show? |
EKG: may show LVH
CXR: Left atrial enlargement d/t mitral regurg |
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for hypetrophic CM,
what is medical therapy? what is surgical therapy? |
meds: beta-blockers first choice; then calcium-channel blockers
surg: for pts with IHSS, dual-chamber pacing, partial excision of interventricular septum, and ICD placement |
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definition of restrictive CM
-what is the cause |
decreased elasticity of myocardium -> impaired diastolic filling w/o significant systolic dysfunction (NL or slightly decreased EF)
-caused by infiltrative dz (sarcoid, hemochromatosis, amyloidosis) or scarring/fibrosis (d/t radiation or doxo) |
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What does CXR show?
what does Echo show? what does EKG show? |
CXR and Echo nondiagnostic
EKG: frequently shows LBBB Cardiac bx can reveal fibrosis or evidence of infiltration |
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how to treat restrictive CM
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symptomatic
meds: cautious use diuretics for fluid overload, vasodilators to decrease filling pressure, and anticoagulation if not contra-indicated |
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risk factors for CHF
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CAD, HTN, cardiomyopathy, valvular heart dz, DM
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definition of systolic HF?
pathophys? |
decreased EF (<50%)
increased LV end-diastolic volumes inadequate LV contractility or increased afterload |
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compensatory changes for systolic HF
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hypertophy and LV dilation
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mnemonic for CHF causes
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HEART FAILED
HTN Endocrine Anemia Rheumatic Heart dz Toxin Failure to take meds Arrhythmia Infection Lung (embolism) Electrolytes Diet (excess Na) |
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what is the most common cause of right-sided heart failure
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left-sided heart failure
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sx of systolic dysfunction in CHF
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chronic cough, fatigue, LE edema, orthopnea, PND, Cheyne-Stokes respirations +/or abd fullness
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in systolic HF,
CXR findings? Echo? EKG? |
CXR: cardiomegaly, cephalization of pulm vessels, pleural effusions, vascular plumpness, prominent hila
Echo: decreased EF, ventricular dilation EKG: nondiagnostic, MI or AFib may preced acute exacerbations |
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lab abnormalities in systolic HF
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BNP, increased creatinine, decreased sodium
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acute CHF mgt (mnemonic)
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LMNOP
Lasix Morphine Nitrates Oxygen Pulm ventilation |
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B-blocker use in systolic HF?
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not used during decompensated CHF, b/c can cause hypotension
-start once pt euvolemic and gradually titrate dose -used long-term in chronic CHF |
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what to watch for in spirinolactone and ACEi therapy in systolic HF
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hyperkalemia
and gynecomastia |
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when to consider anticoagulation in systolic HF
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-AFib
-EF < 30% -h/o previous embolic events |
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when to consider ICD
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EF < 30% and CAD
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definition of diastolic dysfunction in HF
charactersitics? |
decreased ventricular compliance and normal systolic fxn
-LV End-diastolic pressure increased, cardiac output normal, EF normal or increased |
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signs and symptoms of diastolc HF
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stable and unstable angina, SOB, DOE, arrhthymias, MI, HF, and sudden death
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trx of diastolic HF
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diuretics first-line
-maintain rate and BP control with B-blockers, ACEi, ARBs, calcium-channel blockers -digoxin not useful |
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risk factors for CAD
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age, male gender, hyperlipidemia, DM, HTN, obesity, FMHx, smoking,
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angina pectoris?
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substernal chest pain d/t myocardial ischemia
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what causes Prinzmetal's angina?
characteristics and EKG? |
vasospasm of coronary vessels
-affects young women at rest in early AM -ST-segment elevation but no elevation of cardiac enzymes |
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classic triad of angina pectoris
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substernal chest pain or pressure precipitated by exertion and relieved by rest or nitrates
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how to trx angina pectoris?
chronic trx? |
-aute Sx with O2, +/or IV nitroglycerin, IV morphine, IV B-blockers
-ACEiand nonDHP Calcium-channel blockers (dilt, verapamil) -chronic: nitrates, b-blockers, calcium-channel blockers -ASA decreases risk of MI -decrease risk factor: smoking, cholesterol, HTN |
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what is ACS?
what are examples? |
-spectrum of clinical syndromes caused by plaque disruption or vasospasm -> acute myocardial ischemia
NSTEMI/STEMI |
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unstable angina vs NSTEMI
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USA: myocardial ischemia, NO necrosis yet, but can progress
NSTEMI: myocardial necrosis with elevations in troponin I, T, or CK-MB |
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symptoms of unstable angina
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new onset, accelerating (with less exertion, lasts longer, less responsive to meds), or occurs at rest
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how to diagnose USA
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serial cardiac enzymes
-also need to risk stratify by TIMI (thrombolysis in Myocardial Infarction) |
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how to trx USA?
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ASA, clopidogrel (plavix), unfractionated heparin or enoxaparin, and glycoprotein IIb/IIIa inhibitors (abciximab)
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when to give heparin and revascularize (PCI/CABG) or angiography in USA
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chest pain refractory to med therapy, TIMI > 3, troponin elevation, ST changes > 1mm
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examples of glycoprotein IIa/IIIb inhibitors
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eptifibatide, tirofiban, abciximab
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best predictor of survival in STEMI
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left ventricular EF
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who can have atypical, silent MIs
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women, diabetics, elderly, postorthotopic heart transplants pts
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sequence of EKG changes in STEMI
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Peaked T-waves -> ST-segment elevation -> Q waves -> T-wave inversion -> ST-segment normalization -> T-wave normalization
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what leads point to lateral MI
to an anterior MI? |
Leads I, aVL, V5-V6
Leads V1-V4 |
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most common complication after acute MI
most common cause of death after acute MI |
arrhythmia
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other less common complications after acute MI
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reinfarction, LV wall rupture, VSD, pericarditis, papillary m rupture (w/MR), LV anuerysm or pseudoaneurysm, mural thrombi
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Dressler's syndrome
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autoimmune, 2-10 weeks post-MI
-fever, pericarditis, pleural effusion, leukocytosis, increase ESR |
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Six key meds for trx of STEMI
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ASA, B-blockers, Clopidogrel, morphine, nitrates, oxygen
(ABC, MNO) |
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when to use thrombolysis instead of PCI
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pt presents w/in 3 hours, can't do PCI w/in 90 mins, and no contraindications to thrombolysis
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what are contraindications to thrombolysis
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h/o hemorrhagic stroke or recent ischemic stroke, severe heart failure, cardiogenic shock
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long-term trx for STEMI
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ASA, ACEi, b-blockers, high-dose statins, clopidogrel (if PCI performed)
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indications for CABG (mnemonic)
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DUST
D-depressed ventricular fxn U-unable to do PCI (diffuse dz) S-stenosis of L main coronary T-triple vessel dz |
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xanthomas?
xantheleasmas? lipemia retinalis? |
-eruptive nodules in skin over tendons
-yellow fatty deposits in skin around eyes -creamy appearance of retinal vessels |
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how is hypercholesterolemia diagnosis made
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total serum cholesterol > 200mg/dL on 2 different occasions
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criteria for dyslipidemia
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LDL > 130
HDL < 40 |
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target LDL based on risk factors
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0-1 risk factors: < 160
>2 risk factors: < 130 CAD or risk equivalent: < 70 |
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definition of HTN
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systolic > 140
diastolic > 90 on 3 separate times |
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what is goal of HTN for diabetics and pts with renal dz
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< 130/80
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what is involved in the dx of HTN
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assess extent of end-organ damage:
-head CT +/or abd CT, UA, BUN/Cr, CBC, electrolytes |
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what is first-line therapy for essential HTN
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diuretics, ACEi, b-blockers (beneficial in pts with CAD)
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mnemonic for HTN trx
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ABCD
ACEi B-blockers Calcium-channel blockers Diuretics |
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What are the stages of HTN and their associated trx
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PreHTN: 120-139/80-89 (lifestyle changes)
Stage I: 140-159/90-99 (thiazide diuretics; maybe ACEi, b-blockers, CCB or a combo) Stage II: > 160/100 (2-drug combo, usually thiazide and ACEi or ARB, b-blocker, CCB) |
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causes of 2nd HTN (mnemonic)
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CHAPSO
Cushing's syndrome Hyperaldosteronism Aortic Coarctation Pheochromocytoma Stenosis of renal arteries (primary renal dz) OCPs |
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classic triad of hyperaldosteronism
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Conn's syndrome, cause of 2ndary HTN
-HTN -unexplained hypokalemia -metabolic alkalosis |
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hypertensive urgency?
hypertensive emergency? |
urgency: high BP w/mild-mod sx (HA, syncope, chest pain) and no end-organ damage
emergency: significantly high BP w/S&S of impending end-organ damage (ARF, intracranial hemorrhage, papilledema, ECG suggesting ischemia or pulm edema) |
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malignant HTN
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progressive renal failure +/or encephalopathy w/papilledema
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examples of hypertensive crises
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hypertensive urgency
hypertensive emergency Malignant HTN |
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how to trx hypertensive urgencies?
hypertensive emergencies? |
ORAL anti-hypertensives w/goal of lowering BP over 24-48 hours (b-blockers, clonidine, ACEi)
-IV meds to lower MAP no more than 25% over first 2 hours to avoid cerebral hypoperfusion and coronary insufficiency (labetalol, nitroprusside, nicardipine) |
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etiologies for pericarditis
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idiopathic, viral infection, TB, SLE, uremia, drugs, radiation, neoplasms, Dressler's syndrome (post-MI)
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mnemonic for signs of pericarditis
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PERICarditis
Pulsus Paradoxus ECG changes Rub Increased JVP Chest pain |
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main PE/symptom of pericarditis (and others)
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chest pain worse in supine position and with inspiration
-pleuritic chest pain, dyspnea, cough, fever |
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pulsus paradoxus?
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decrease in systolic BP > 10mm Hg on inspiration
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ECG changes in pericarditis
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PR-segment depression and diffuse ST-segment elevation followed by T-wave inversions
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what tests to diagnose pericarditis
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CXR, ECG, Echo to r/o MI and pneumonia
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how to trx pericarditis and its symptoms
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treat underlying cause: (steroids/immunosuppresants for SLE, dialysis for uremia)
trx symptoms: ASA for post-MI, ASA/NSAIDs for viral pericarditis |
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causes of pericarditis (mnemonic)
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CARDIAC RIND
Collagen vascular dz Aortic dissection Radiation Drugs Infections ARF (uremia) Cardiac (MI) Rheumatic fever Injury Neoplasms Dressler's syndrome |
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Beck's triad (and in what condition is it associated with)
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cardiac tamponade
-JVD, hypotension, distant heart sounds |
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symptoms/PE in cardiac tamponade
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Beck's triad (JVD, hypotension, distant heart sounds), narrow pulse pressure, pulsus paradoxus, Kussmaul's sign (JVD on inspiration)
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Kussmaul's sign
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JVD on inspiration
-seen in cardiac tamponade -sign of limited RV filling |
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in tamponade,
ECG findings? Echo findings? CXR findings? |
-electrical alternans (diagnostic)
-right atrial and ventricular diastolic collapse -enlarged, globular heart |
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trx for tamponade
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-aggressive volume expansion w/IVF
-urgent pericardiocentesis (aspirate will be nonclotting blood) -if decompensation, may need balloon pericardiotomy and pericardial window |
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physical exam of aortic stenosis
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pulsus parvus at tardus (weak, delayed carotid upstroke)
paradoxically split S2 sound (aortic closes after pulmonic valve) |
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aortic stenosis complications (mnemonic)
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ASC
Angina Syncope CHF |
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aortic stenosis:
dx? trx? |
-Echo
-interventional (balloon valvuloplasty to bridge to aortic valve replacement) |
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aortic regurgitation,
causes of acute cases? chronic cases? |
-infective endocarditis, aortic dissection, chest trauma
-valve malformations, collagen vascular disease, rheumatic fever |
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signs/sx of aortic regurg:
acute? chronic? |
-pulmonary congestion, cardiogenic shock, severe dyspnea
-slowly progressive disorder: dyspnea on exertion, orthopnea, PND |
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physical exam of aortic regurgitation
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3 murmurs and widened pulse pressure
-blowing diastolic murmur at left sternal border -mid-diastolic rumble (Austin-Flint murmur) -mid-systolic apical murmur |
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trx for aortic regurg
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vasodilator therapy with Calcium-channel blockers or ACEi
-once severe, valve replacement |
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causes of aortic regurg (mnemonic)
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CREAM
Congenital Rheumatic fever Endocarditis Aortic dissection/Aortic root dilatation Marfan's syndrome |
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how to diagnose aortic regurg and other signs involved in diagnosis
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widened pulse pressure
-head bob with heartbeat (de Musset's sign) -water-hammer pulse (Corrigan's sign) -femoral bruit heard with compression of fem artery 2/2 wide pulse pressure (Duroziez's sign) |
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most common etiology for mitral valve stenosis?
trx? |
rheumatic fever
-antiarrhythmic agents (digoxin, b-blockers) for symptomatic relief |
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sx associated with mitral valve stenosis
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dyspnea, orthopnea, PND to infective endocarditis and arrhythmias
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causes of mitral regurg
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rheumatic fever
chordae tendineae rupture after MI |
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diagnosis of mitral regurg"
CXR? Echo? |
-enlarged left atrium (at risk for AFib)
-regurgitant flow on Echo -angiography can assess severity of dz |
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trx for mitral regurg
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anti-arrhythmics if necessary
-nitrates and diuretics to decrease preload |
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mitral regurg murmur
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holosystolic murmur often radiating to axillae
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classic presentation of endocarditis (mnemonic)
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FAME
Fever Anemia (splenomegaly) Murmur (new onset) Emboli (systemic) |
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diagnosis of endocarditis
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3 sets of blood cultures (highly sensitive)
TEE (sensitive and specific) |
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risk factors for aortic aneurysm
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high cholesterol, HTN, other vascular dz, smoking, males (>females), age, positive FMHx
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signs of ruptured aortic aneurysm
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hypotension and severe, tearing abd pain radiating to back
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exam of aortic aneurysm
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pulsatile abd mass or abd bruits
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dx of aortic aneurysm
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abd U/S for dx or to follow over time
-CT as adjunct for precise anatomy |
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trx for aortic aneurysm
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in asymptomatic, monitoring for < 5cm
-abd: surgical repair > 5.5cm -thoracic: > 6cm -emergenct surgery for symptomatic or ruptured aneurysms |
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most common sites of origin for aortic dissection
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above aortic valve
distal to left subclavian artery |
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symptoms in ascending vs descending dissection
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ascending: sudden tearing/ripping pain in ant chest
descending: interscapular back pain |
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signs and symptoms of aortic dissection
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-usually hypertensive; if hypotensive think pericardial tamponade, hypovolemia from blood loss, acute MI from coronary artery involvement
-asymmetric pulses and BP -maybe signs of pericarditis/tamponade -aortic regurg mumur if aortic valve involved -neuro deficits if aortic arch or spinal arteries involved |
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when see neuro deficits in aortic dissection
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if aortic arch or spinal arteries involved
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what symptoms are indicative of aortic dissection
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asymmetric pulses and BP
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diagnostic tests for aortic dissectino
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CXR (widening of mediastinum, cardiomegaly or new left pleural effusion)
-ECG -CT angio gold standard -TEE (details of thoracic aorta, proximal coronary arteries, origins of arch vessels, presence of pericardial effusion, aortic valve integrity) |
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classifications of aortic dissection
|
DeBakey: I - both ascending and descending aorta
II - confined to ascending III- confined to descending Stanford: A - ascending B- all others |
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how to trx aortic dissections?
ascending vs descending? |
monitor and medically manage BP and heart rate; NOT use thrombolytics
-ascending: surgical emergency -descending: medically with BP and HR control |
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how to diagnose DVT and other tests involved
|
Doppler U/S
-spiral CT or V/Q scan to eval PE |
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trx for DVT
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initial anticoag with IV unfractionated heparin or SQ low-molecular-weight heparin followed by PO warfarin for total of 3-6 months
-IVC filter in pts with contraindications to anticoag |
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Leriche's syndrome
|
buttock claudication, decreased femoral pulses, male impotence
-associated with aorto-iliac disease in PVD |
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femoropopliteal dz
|
calf claudication, pulses below fem artery absent
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symptoms/exam of severe chronic ischemia
|
lack of blood perfusion -> muscle atrophy, pallor, cyanosis, hair loss, and gangrene/necrosis
|
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6 P's of acute ischemia
|
Pain
Pallor Pulselessness Paralysis Paresthesia Poikilothermia |
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at what ABI does rest pain occur
|
ABI < 0.4
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trx for PVD
|
-control underlying condition (DM, quit smoking, exercise)
-ASA, cilostazol (Pletal), thromboxane inhibitors to improve Sx (anticoag to prevent clots) -angioplasty and stents have variale success rate depending on occluded area -surgery (arterial bypass) or amputation when conservative trx fails |
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Cilostazol?
|
Pletal
PDE inhibitor acting on cAMP; arterial vasodilator, prevents platelet aggregation |
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definition of syncope
|
sudden, temporary loss of consciousness and postural tone d/t cerebral hypoperfusion
(cardiac and non-cardiac etiologies) |
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etiologies of syncope
|
cardiac: valvular lesions, arrhythmias, PE, cardiac tamponade, aortic dissection
noncardiac: orthostatic hypotension, TIA, metabolic abnormalities, vasovagal sx (micturition syncope) |
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diagnostic tools in syncope
|
Holter monitors/event recorders for arrhythmias,
Echo for structural abnormalities, stress tests for ischemia |
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|
what antibody markers are increased in latent HIV infection?
what viral antigen is increased in immunodeficiency state? |
anti-p24 Ab
anti-gp120Ab virus, p24 antigen |
|
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diagnostic tests in HIV (and their characteristics)
|
ELISA: anti-HIV Ab (high sensitivity, mod specificity)-can take up to 6 months to appear after exposure)
-Western Blot (high specificity, low sensitivity)-confirmatory |
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what's involved in baseline evaluation of HIV
|
HIV RNA PCR (viral load)
CD4+ count CXR, PPD Pap, VDRL/RPR serologies for CMV, hepatitis, toxo, VZV |
|
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microscopic appearance of candida?
|
pesudohyphae + budding yeasts
-germ tubes at 37C |
|
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microscopic appearance of aspergillus
|
45degree angle branching septate hyphae
-rare fruiting bodies |
|
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microscopic appearance of cryptococcus
|
5-10 micrometer yeasts with wide capsular halo
-narrow-based unequal budding -find with india ink |
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microscopic appearance of mucor
|
irregular broad (empty-looking) nonseptate hyphae, wide-angle branching
(atypical sinusitis) |
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how to trx candidal thrush
|
local:
nystatin suspension, clotrimazole tabs, PO azole (fluconazole) |
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risk factors for cryptococcal meningitis
|
AIDS and exposure to pigeon droppings
|
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how does crypto meningitis present
|
*absence of meningismus"
-fever, HA, impaired mentation |
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diagnostic tests for crypto meningitis
|
+ CSF crypto antigen test (highly sensitive and specific)
-india ink stain -fungal culture -LP (low glucose, high protein, high leukocyte ct with monocyte predominance) |
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how to treat crypto meningitis
|
IV amphotericin B + flucytosine x 2 weeks
-then, fluconazole 400mg x 8 weeks -lifelong maintenance therapy with fluconazole 200mg qD or until CD4 > 200 for > 6 mos |
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AIDS pathogens (mnemonic)
|
The Major Pathogens Concerning Complete T-Cell Collapse
Toxo MAC Candida Crypto TB CMV Cryptosporidium parvum |
|
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when to suspect PCP in HIV
|
HIV patient who presents w/nonproductive cough and dyspnea
|
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diagnostic tests for histo
|
urine and serum polysaccharide antigen test (most sensitive for initial dx)
|
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CXR findings of histo
|
diffuse nodular densities, focal infiltrate, cavity or hilar LAN (chronic infection usually cavitary)
|
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in what time frame does disseminated histo usually develop
|
w/in 14 days (and in immunocompromised hosts)
|
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presentation of disseminated histo
|
fever, LAN, wt loss, hepatosplenomegaly, nonproductive cough, pancytopenia
|
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trx for histo?
|
amphotericin B or ampho B liposomal
x3-10days followed by itraconazole x 12 wks -maintenance therapy iwth daily itraconazole |
|
|
risk factors for PCP
|
impaired cellular immunity
AIDS |
|
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clinical presentation of PCP
|
dyspnea on exertion, impaired oxygenation
fever, nonproductive cough, tachypnea, weight loss, fatigue |
|
|
CXR of PCP
|
diffuse bilateral interstitial infiltrates with a ground-glass appearance
(any presentation possible) |
|
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diagnostic tests for PCP
|
ABG to check PaO2 (b/c can present w/impaired oxygenation and DOE)
-cytology of induced sputum or bronchoscopy specimen w/silver stain and immunofluorescence |
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trx for PCP (two types)?
trx for those w/allergies to trx? |
-TMP-SMX x21 days
-Prednisone taper for those w/moderate to severe hypoxemia (PaO2 < 70mm or A-a gradient > 35) -Clindamycin and primaquine for those w/sulfa allergy |
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methods of transmission for CMV
|
sexual contact, breast milk, respiratory droplets (nursery or day care), blood transfusions
|
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risk factors for CMV reactivation
|
first 100 days s/p tissue or bone marrow transplant
-HIV positivity w/ CD4 < 100 or viral load > 10,000 |
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what orgs involved in AIDS cholangiopathy
|
CMV and microsporidia
|
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what is the risk with CMV retinitis?
-how does it look? -what's the presentation? |
-retinal detachment
-"pizza pie' retinopathy (painless, hemorrhages and fluffy or granular lesions around retinal vessels -floaters and visual field changes when CD4 < 50 |
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what is CNS presentation of CMV
|
polyradiculopathy, transverse myelitis, and subacute encephalitis
-when CD4 < 50 -periventricular calcifications |
|
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diagnostic tests in CMV?
trx? |
-PCR, tissue (virus isolation, culture)
-Ganciclovir (or foscarnet) -trx underlying dz if immunocompromised (i.e., increase CD4 to decrease risk of reinfection) |
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what patients get primary form of MAC?
secondary form of MAC? when does disseminated infection happen? |
-in apparently healthy nonsmokers
-preexisting pulmonary dz like COPD, TB, CF -AIDS w/ CD4 < 100 |
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what is clinical presentation of disseminated MAC
|
fever, weakness, wt loss in pts NOT on HAART or chemoprophylaxis for MAC
-hepatosplenomegaly and LAN occassionally seen |
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what are indications for chemoprophylaxis for MAC?
what is the chemoprophylaxis? |
HIV+ pts w/CD4 < 50 or AIDS-defining illness
-azithromycin |
|
|
diagnostic tests for MAC?
what does bone marrow/liver/intestine bx show? |
-blood cultures: + in 2-3weeks
-increased serum ALP and LDH -anemia, hypoalbuminemia -foamy macrophages with acid-fast bacilli |
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trx for MAC and duration?
prevention? |
Clarithromycin and ethambutol +/- rifabutin and HAART for 10 months or until CD4 > 100 for > 6 months
-weekly azithromycin when CD4 < 50 or if AIDS-defining opportunistic infectino |
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risk factors for toxo
|
raw or undercooked meat
changing cat litter |
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toxo reactivation occurs in which organs more than others
|
brain, liver, eye > heart, skin, GI, liver,
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how do CNS lesion present in toxo
|
HA, seizures, focal neuro deficits,
fever, altered mental status |
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two most likely differentials for ring-enhacing lesions in AIDS patients
|
toxo, CNS lymphoma
|
|
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diagnostic tests for toxo
|
PCR, serology
Head CT, MRI |
|
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What will Head CT show in toxo?
MRI? |
-multiple, isodense or hypodense, ring-enhacing mass lesions
-MRI: predilection for basal ganglia -mri more sensitive |
|
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trx for toxo
|
PO pyrimethamine, sulfadiazine, folate x 4-8 weeks
-followed by pyrimethamine, clinda, and folate until dz resolved clinically and radiographically |
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what is prophylaxis for toxo
|
TMP-SMX (Bactrim DS) or pyrimethamine + dpasone if CD4 < 100 and +IgG
|
|
|
what is the most common bacterial STD in US
|
Chlamydia
|
|
|
risk factors for chlamydia
|
unprotected sex, new or multiple partners, frequent douching
|
|
|
clinical presentation
and females vs males |
-urethritis, mucopurulent cervicitis, PID
-males: penile discharge, testicular tenderness -female: cervical/adnexal tenderness |
|
|
diagnostic tests
|
-Urine tests (PCR or ligase chain rxn)--rapid
-DNA probes and immunofluorescence--48-72 hours -gram stain of urethral or genital discharge may show PMNs, NO bacteria, b/c intracellular |
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trx for chlamydia
|
Doxycycline 100mg PO BID x7 days OR azithromycin 1g PO x 1 day
-use erythromycin in pregnant pts -treat sexual partners |
|
|
gram-negative diplococcus
|
gonorrhea
|
|
|
what areas can chlamydia infect?
gonorrhea? |
-genital tract, urethra, anus, eye
-any site in female repro tract; mainly urethra in men |
|
|
how can disseminated gonorrhea present
|
monoarticular septic arthritis, tenosynovitis, polyarthralgia, hemorrhagic painful pustules on erythematous bases, (rash)
|
|
|
clinical presentation of gonorrhea
|
greenish-yellow discharge, adnexal/pelvic pain, purulent urethral discharge in men
|
|
|
how to trx gonorrhea
|
Ceftriaxone IM
-treat for co-infection with chlamydia -treat sexual partners -condoms are effective prophylaxis |
|
|
time frame for syphillis stages
|
primary: 10-90 days after infection
secondary: 4-8 weeks after chancre |
|
|
characteristics of:
early latent syphilis late latent |
early: no Sx, + serology, 1st year of infection
late: no Sx, +/- serology, >1 yr of infection (1/3 progress to tertiary syphilis) |
|
|
characteristics of tertiary syphilis (main ones)
|
gummas, tabes dorsalis, argyll robertson pupil, aortic root aneurysms
|
|
|
what can cause false positive VDRL (mnemonic)
|
Viruses (mono, HSV, HIV, hepatitis)
Drugs/IV drugs Rheumatic fever/Rheum Arth SLE/Leprosy |
|
|
trx for syphilis: all three stages and latent
|
primary/secondary: Benzathine pencillin IM
(if allergy, tetra or doxycycline x 14 days) -neurosyphilis: Penicillin IV (if allergy, desensitize prior) -latent: pencillin once weekly x 3 weeks |
|
|
what can trx of syphilis result in
|
acut flulike illness: Jarisch-Herxheimer rxn
|
|
|
how can children present with UTI
|
bedwetting
|
|
|
what UTI bug causes increased pH
|
proteus
|
|
|
common UTI orgs (mnemonic)
|
SEEKS PP
Serratia E. coli Enterobacter Klebsiella S. saprophyticus Pseudomonas Proteus |
|
|
who is considered a high-risk pt and complicated in UTI?
|
high-risk: immunosuppresed, pregnant, DM
Complicated: men, urinary obstruction, renal transplant, catheters, instrumentation |
|
|
what bug should be covered for in urosepsis
-what is trx |
enterococcus
-IV cipro or Unasyn+gentamicin and hospital admission |
|
|
how to trx UTI in pregnancy?
|
-Bactrim, Nitrofurantoin or cephalexin x3 days
(document with urin cx 10 days after trx) -if infection recurs, put on prophylactic atbx for rest of pregnancy |
|
|
what is the most common serious medical complication in pregnancy
|
pyelo
|
|
|
how long treat pyelo
|
10-14 days outpatient trx with fluoroquinolone for mild cases
|
|
|
What 5 things used as criteria for SIRS/sepsis
|
fever
hypothermia tachypnea tachycardia leukocytosis |
|
|
what causes sepsis in gram-positive shock?
gram-negative? |
-2/2 fluid loss from exotoxins
-2/2 vasodilation from endotoxins (LPS) |
|
|
what causes warm shock?
cold shock? |
-septic shock
-CHF, cardiac hypovolemia |
|
|
what is DIC panel
|
fibrinogen
fibrin split products D-dimer |
|
|
which plasmodium causes most damage in malaria
|
P. falciparum (highest morbidity and mortality)
|
|
|
what is classic presentation of malaria
|
periodic attacks of sequential chills, fever and diaphoresis
-splenomegaly can happen 4+ days after onset of Sx |
|
|
what does CBC show in malaria
|
normochromic, normocytic anemia with reticulocytosis
|
|
|
how are P. vivax and P. ovale different
|
dormant liver hypnozoite forms resistant to chloraquine
-add primaquine |
|
|
what are complications of P. falciparum infection
|
-severe hemolytic anemia
-acute tubular necrosis and renal failure: from blackwater fever (dark urine d/t hemoglobinuria) |
|
|
what can happen in trx of acute EBV infection with ampicillin
|
prlonged, pruritic, drug-related maculopapular rash
|
|
|
what can cause infectious mono with negative heterophile and EBV Ab
|
CMV infection
|
|
|
what does CBC with diff show in mono
|
mild thrombocytopenia
relative lymphocytosis > 10% atypical T lymphocytes (lymphocytosis from B-cell proliferation) |
|
|
how can splenic rupture present in complicated mono
|
abd pain, referred shoulder pain, hemodynamic compromise
|
|
|
what is the most common cause of death in affected males with mono
|
fulminant hepatic necrosis
|
