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36 Cards in this Set
- Front
- Back
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What is Ludwig Angina? What causes it? How is it treated? |
Life-threatening cellulitis of floor of mouth extending into submandibular area. Caused by polymicrobial infxn after a dental procedure Trx = ABX + I&D + airway protection |
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How long should a patient w/ Mono refrain from sports? |
No non-contact sports for 3 wks No contact sports for 4 wks |
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What is the treatment for CA-pneumonia in adults? In Neonates? |
Healthy Adults - Azithro or Doxy alone Adults w/ chronic disease or ABX use in last 3 mths - β-lactam + Azithro or a Fluroquinolone Neonate - Amp + Gent |
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How do the PCV-13 and PPSC-23 pneumococcal vaccines differ? What are the indications for each? |
PCV-13 = conjugate vs PPSV-23 = polysaccharide PPSV-23 alone in pts age 19-64 w/ alcoholism, smoking, chronic heart/lung/liver disease PCV-13 + PPSV-23 in pts age ≥ 65 w/ immunocompromise, choclear implant, aspleenia, CSF leak |
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Where are the following fungal causes of pneumonia found geographically and what is trx for each? ... - Coccidioides - Histoplasmosis - Cryptococcus - Blastomyces - Paracoccidioides |
Coccidioides - Southwest US. Trx = Itra or Fluconazole Histo - MI and OH river valleys (espec. if spleunking or exposed to bat/birds). Trx = Itra Crypto - Worldwide, Immunocomp, bird exposure. Trx = Flucon Blasto - Midwest. Trx = Ampho B or Itra Paracoccidioides - South/central America. Trx = Itraconazole |
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What labs would you expect in PCP pneumonia? What is the trx? When should steroids be added to trx? |
Labs = CD4 < 200, ↑ LDH Trx = SMX-TMP * Add steroids if pO₂ < 70 on RA or A-a gradient >35 mmHg |
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What are the diagnostic criteria for ARDS? What mechanical vent settings are best for ARDS? |
CXR - diffuse pulm densities, Wedge pressure < 18 mmHg, PaO₂/FiO₂ < 200, No evidence of cardiac origin Vent - low TV and adequate PEEP |
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What are the pre-trx medications for increased ICP, pain, or excessive secretions that can be given prior to intubation? |
↑ ICP = Lidocaine
Pain = Fentanyl Secretions = Atropine |
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What are the indications for extubation? |
< - 30 cm H₂O Max Insp. Pressure Vital Capacity > 10 Minute Ventilation < 10 PaO₂/FiO₂ < 200 |
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What are the lab values needed to diagnosed DM type 2? |
- Symp + Random Glucose > 200 - Fasting Glucose > 126 - 2-hr oral GTT > 200 - HbA1c > 6.5% |
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What indicates resolution of DKA? Resolution of Hyperosmotic Coma? |
DKA - Anion gap closes Hyperosmotic Coma - plasma osmolarity returns to normal |
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What are the 2 different type of Diabetic Retinopathy? What is their mechanism, physical exam findings, and trx? |
Non-Proliferative - vessels are damaged leading to infarcts. Cause cotton-wool spots + hard exudates. Trx = RF modification Proliferative - New fragile vessels form at areas of infarct and are prone to hemorrhage. Same PE as Non-prolif + AV nicking + flame hemorrhages. Trx = panretinal photocoagulation + VEGF inhibitors |
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How often should a HbA1C be checked in a diabetic pt? Lipid panel? Dilated Eye Exam? |
HbA1C - check every 3 mths if not at goal and every 6 mths if at goal Lipid Panel & Dilated Eye Exam - every year |
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What class of Type 2 DM medication works by constitutively opening K+-ATP channels to increase Insulin release? What is its main SE? |
Sulfonyureas (Glimipride, Glyburide, Glipizide) & Meglitinides (-glinide) SE = Hypoglycemia |
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What class of Type 2 DM medication works by activating PPARγ to improve tissue uptake of glucose? What is its main SE? |
Thiazolidinediones (-glitazones) SE = edema that can exacerbate CHF |
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What class of Type 2 DM medication works by inhibiting a natural inhibtor of gliptin leading to improved glucose-responsive insulin release and delays gastric emptying? |
DPP-4 Inhibitors (-gliptins) |
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What class of Type 2 DM medication works by activating gliptin receptors leading to improved glucose-responsive insulin release and delaying gastric emptying? What is its main SE? |
GLP-1 Receptor Agonists (Exenatide, Liraglutide) SE = major GI |
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What class of Type 2 DM medication works by blocking absorption of carbs in the intestine? What is its main SE? What pt group should it be avoided in? |
α-glucosidase Inhibitor (Acarbose) SE = major GI, avoid in pts w/ bowel disease |
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What class of Type 2 DM medication works by augmenting insulin release, suppressing glucagon, and improving satiety by delaying gastric emptying? |
Amylin Analog (Pramlintide) |
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What type 2 DM medications are weight neutral or cause weight loss? |
Metformin DPP-4 Inhibitors GLP-1 Receptor Agonists SGLT-2, Acarbose |
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What 2 classes of Type 2 DM medications are safe to use in renal patients? |
TZD's DPP-4 Inhibitors |
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What are the different types of Basal Insulin? How often are each dosed? |
Long-Acting (Glargine, Detemir) - "peakless," dose 1x/day Intermediate-Acting (NPH) - duration of 12 hrs so dose 2x/day |
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What are the different types of Bolus Insulin? What are they specially used for? |
Rapid-Acting (Lispro, Aspart) Short-Acting (Regular) *Use in Insulin Pumps or IV insulin administration |
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What blood glucose value is a measure of basal insulin's efficacy? Of bolus insulin's efficacy? |
Basal - Fasting BG Bolus - Postprandial BG's |
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What are the criteria for diagnosis of Metabolic Syndrome? |
3/5 of the following.... - Abdominal Obesity - ↑ TG - ↓ HDL - BP > 130/85 - Abnormal Blood Glucose |
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What is Whipple's Triad? |
1) Symptoms of Hypoglycemia (especially after fasting or heavy exercise) 2) Glucose < 45 at any time 3) Relief of Symptoms w/ Glucose Administration |
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How does alcohol cause fasting hypoglycemia? |
uses up NADPH to detox alcohol thus causing decreased gluconeogenesis |
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Immunodeficiency that causes chronic Candidia albicans infections |
Chronic Mucocutaneous Candidiasis (T-cell dysfxn) |
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Immunodeficiency seen only in boys that causes recurrent bacterial infections after 6 mths of age. What causes this disorder? |
Bruton Agammaglobulinemia - Defective Tyrosine Kinase gene leading to low levels of all immunoglobulins |
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Immunodeficiency that causes recurrent sinus and lung infection in child with a history of atopy and asthma. What must you be careful when administering to these patients? |
Selective IgA Deficiency - Must wash RBC's before giving blood transfusion due to risk of anphylaxsis |
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What is the classic triad of SCID? What causes SCID? What would be seen on CXR? What preventative measure is contraindicated in these pts? |
Triad: 1) severe recurrent infxns, 2) Chronic Diarrhea, 3) Failure to Thrive Cause: Adenosine Deaminase deficiency leading to defective stem cell differentiation CXR: No thymic shadow Contraindication: No live vaccines |
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What are the features of Ataxia Teleangiectasia? What is deficient in these patients? What type of infxns are they prone to? |
ATAXIA Ataxia, Telangiectasias, Acute leukemia/lymphoma risk, X-ray sensitive, IgA def., AFP ↑ Deficiency: IgA and T cells Infections: sinus and lung infxns |
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What are features of Wiskott-Aldrich Syndrome? |
WAITER Wiskott Aldrich Immunodeficiency Thrombocytopenia and purpura Eczema Recurrent pyogenic infxns |
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What type of infections are Chronic Granulomatous Disease patients most susceptible to? |
Catalase-Positive Microbes, expecially Staph aureus & Aspergillus |
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What immunodeficiency causes giant cytoplasmic granules to form the PMNs as well recurrent respiratory and skin infections? What causes this? What other features are characteristic of this disease? |
Chediak-Higashi Syndrome - Cause = defective LYST gene = defective lysosomes - Features = Parial albinism + neuro d/o's |
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What immunodeficiency is caused by a defective STAT3 gene leading to impaired differentiation of Th₁₇ cells and impaired neutrophil recruitment leading to recurrent cold staph abcesses? What features are characteristic of this disease? What would you expect on labs? |
Hyper-IgE (Job) Syndrome - Features = Eczema + Coarse facial features + retatined primary teeth - Labs = High IgE and eosinophils |
