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268 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is characterized by: High fever, profound hypotension, diffuse erythroderma, mucous membrane hyperemia, pharyngitis, diarrhea, and constitutional sxs?
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Toxic Shock syndrome
- severe life threatening syndrome. P. 999 |
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What organism is isolated in 98% of women with toxic shoch syndrome?
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Staphylococcus Aureus
p. 999 |
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What are the following?
-currently menstruating - cutaneous lesions - recent surgery -postpartum/post abortion - (in small part) sinusitis, IUD, and pharyngitis... |
Toxic Shock syndrome
p. 999 |
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Is the following patient a probable infx with TSS or confirmed?
- temperature of 102.3 - skin dry and flaking on the palms of hands and soles of feet. - painful, red rash - systolic BP <90 - diarrhea and vomiting since the onset of illness, elevated CK and transaminitis- both > 3 times NML - labs negative for RMSF, Lyme, measles, TCx, CSF cx |
Probable, if the rash was painless, it would constitute Confirmed...
- list: Table 145-1, p. 1000 |
1. fever > 102.
2. Rash: diffuse, macular erythroderma (painless) 3. Desquamation of the skin on palms and soles 4. HoTn: systolic <90, tilts >15mmHg 5. MultiSystem involvement: - GI: V/D - Muscular: CK >2x's NML - Renal: BUN/Cr > 2x's NML, urine sediment/pyuria w/o UTI - Mucous Membranes: pissed - Hepatic: levels > 2x's NML - hematologic: Plt count <100,000 - CNS: disorientation, no Focal findings 6. Labs: CSF, Serum- neg for other badness |
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Just for fun...what are the 6 biological properties leading to TSS?
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1. induce fever directly thru its effects on the hypothalmus or directly via interleukin-1
2. promote T-lymphocytes "superantigenization" and overstimulation 3. induce interferon production 4. enhance delayed hypersensitivity 5. suppress neutrophil migration and immunoglobulin secretion 6. enhance host susceptibility to endotoxins p. 1000 |
- these guys are just the type to ask a question like this ya know!
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Acute renal failure from TSS is from what?
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Acute tubular necrosis...
- p. 1000 |
Renal failure is 2/2:
-volume depletion -HoTn - rhabdo - direct damage from toxic mediators |
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What do you consider in patients with unexplained febrile illness associated with erythroderma, HoTn, and diffuse organ pathology?
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Toxic Shock Syndrome
p. 1000* |
- sxs associated w/surgery: develop w/in 2 days
- sxs associated w/menstruation 3-5 days |
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How do you identify "mild" toxic shock syndrome and how can it be treated?
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- fever, chills, myalgias, abdominal pain, ST, N/V/D. No HoTn and MC this is self-limited illness.
p. 1000 |
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T/F: SEVERE toxic shock syndrome is an acute onset of multisystem disease w/sxs, signs, and laboratory value abnormalities reflecting multiple organ involvement.
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True
p. 1000 |
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What is the MC complaint of patients with TSS
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headache
'p. 1000 |
fever chills MC appear 4 days prior to presentation. Extremity pain MC starts proximal.
first three pargraphs: p. 1001 |
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What is an absolute contraindication to the administration of IV immunoglobulin in the tx of TSS?
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Immunoglobulin A deficiency
p. 1002 |
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What can occur in patients who are not treated with B-lactamase-stable antimicrobial drugs?
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Recurrence of Disease
p. 1002 |
the initial episode is MC the most severe, though deaths have occurred w/recurrence
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What is similiar to Toxic Shock Syndrome, but is associated with soft tissue infection?
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Streptococcal Toxic Shock Syndrome
Cx MC + for Strep Pyogenes (GAS). Also labeled: Flesheating bacteria p. 1002 |
MC group A strep infx labeled as Group A strep TSS are: streptococcal necrotizing fasciitis and streptococcal myositis.
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What is the most powerful and most predominant exotoxin capable of producing severe acidosis, shock and multiorgan system failure and is associated with Streptococcal TSS?
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Streptococcal Pyogenic Exotoxin A. Also called
SCARLET FEVER TOXIN p. 1002 |
- I know of no possible way to emphasize table 145-4, so review it on page 1002
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What the portals of entry in Streptococcal Toxic Shock Syndrome?
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1. Skin
2. Pharynx 3. Mucosa 4. Vagina -- in 50% of the cases of streptococcal toxic shock syndrome-- MC this is not identifiable p. 1003 |
MC infx begins at the site of minor trauma, even w/o disruption skin disruptions: burns, lacerations, abrasions, hematomas, minor non-penetrating, s/p surgeries and ortho procedures, postpartum and varicella or flu
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What infx process is being thought about when examining someone whose soft tissue pain is out of proportion to physical exam and they have a fever?
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Strep Toxic Shock Syndrome
p. 1003 |
Pain is usually abrupt in onset and severe, and may be proceeded by local tenderness or physical findings
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What is a physical examination finding in Strep TSS that heralds' an ominous sign?
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vesicles and bullae w/progression to violacous or blue discoloration
p. 1003 |
- Eevated WBC's with bandemia (40-50%)
- Transaminitis - DIC- may develop - Elevated CK- if soft tissue is necritizing - 60% blood cx +; 90% tissue + cx |
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Streptococcal Toxic Shock Syndrome: While abx therapies are important, what is also a great priority and ABSOLUTELY necessary?
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- surgical debridement
p. 1003 |
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infective endocarditis MC occurs in those with predisposing factors and MC in this age group?
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> 60 y/o
p. 1042 |
predisposing concerns: invasive medical devices- heart valves, hemodialysis, IV catheters, intracardiac devices
Mortality in missed dx: 100% |
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What is the MC valve effected by infective endocarditis?
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Mitral Valve
followed by: aoritc, tricuspid, and then pulmonic p. 1042 |
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Other than congenital anomalies, what additional risk factors exist for endocarditis?
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- IV drug users
- indwelling IV catheter use - poor dentition - infx with HIV p. 1042 |
- for native valve issues, MITRAL VALVE PROLAPSE IS THE GREATEST RISK
- followed by aortic stenosis and then rheumatic heart dz (Rheum. Heart Dz=leading risk factor in developed world) |
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What are the following w/regard to infective endocarditis:
- cormobidities - abnormal mental status - CHF - bacterial etiology *(other than strep viridans, Staph A) - medical therapy w/o valve surgery |
Factors associated with mortality in Left side heart failure
- p. 1042 |
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What valve is MC associated with endocarditis in IV drug users?
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Tricuspid valve
p. 1042 |
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Right sided infective endocarditis in IV drug users, what are predictive of poor outcomes?
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- Large vegitation size and fungal organisms
p. 1042 |
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T/F: There is NO significant risk difference in bioprosthetic and mechanical heart valves in infective endocarditis.
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True
p. 1042 |
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Define early infective endocarditis. Define Late infective endocarditis. Who is at greater risk?
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- early: w/in 60 days post op valve replacement (healthcare acquired)
- late: >60 days postop valave replacement (community acquired) - the greatest risk of mortality is associated with healthcare acquired...2/2 the greater virulence of organisms. p. 1042 |
READ PATHOPHYSIOLOLGY AND MICROBIOLOGY OF INFECTIVE ENDOCARDITIS...p. 1042-1043
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What is the single MC cause of bacterial endocarditis?
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Staph aureus
p. 1043 |
In those who are NOT IV drug users as well as those with native valve endocarditis:
1. Staph A 2. Streptococci 3. Enterococci |
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HACEK organisms, what are these and what is unique wbout these in infective endocarditis and the results of cultures?
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H- Haemophilus Influenza
A- Actinobacillus C- Cardiobacterium E- Eikenella K- Kingella - also consider Bartonella, Coxiella - Blood cultures can be negative, even w/o prior abx use. 1043 |
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The mycotic illnesses are MC associated with very large vegitations and thrombotic emboli. What two fungal infx are the MC?
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1. Aspergillus
2. Candida Albicans p. 1043 |
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What is the MC organism isolate from prosthetic heart valves? (contaminated during the perioperative period)
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- Staph epidermidis
p. 1043 |
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What is the single MC sign and symptom of infective endocarditis?
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Fever
p. 1043- however, this may be absent in: elderly, those who are on abx, antipyretic, severe CHF, renal failure, or immunosuppression. |
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T/F: Heart murmurs, if present in infective endocarditis, are useful and are MC regurgitant in nature.
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True
p. 1043 |
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What is the MC central nervous system complication of infective endocarditis?
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Middle cerebral artery embolic stroke
p. 1043 |
tho friable vegitations can break free embolize ANYWHERE
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What are osler nodes?
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-small tender subcutaneous nodules on the pads of the fingers or toes that last for only hours or days
p. 1044 |
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What are janeway lesions?
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small hemorrhagic painless plaques on the palms and soles
p. 1044 |
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T/F: Even the suspicion for endocarditis requires admission to the hospital.
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True.
p. 1044 |
- the necessary requirements for dxz require time to optain: echo, cultures, clinical observation...
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T/F: An IV drug user who has a fever should be admitted to the hospital to be worked up further for bacteremia and endocarditis- clinical findings cannot rule all this out.
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True
p. 1044 |
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What should be done with a patient who has a fever and hx of prosthetic heat valve?
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Admission to the hospital.
p. 1044 |
- increased risk endocarditis as well as increased risk associated with morbidity and mortality
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Duke Criteria has a sensitive of 90% in the dx of what?
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infective endocarditis
p. 1044 |
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What are the major duke criteria when dx w/infective endocarditis?
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1. positive blood cultures for infective endocarditis (should be from 2 separate cxs)
2. evidence of echocardiographic involvement p. 1044 |
Definitive IE:
two major criteria One major + 3 minor five minor criteria Possible infective endocarditis: one major and one minor criteria three minor criteria Rejected: - firm alternate dx - resolution of manifestations of endocarditis, w/abx for 4 days or less - no pathologic evidence of infective endocarditis at surgery or autopsy - does not meet jones criteria for endocarditis |
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What are the minor criteria for infective endocarditis?
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1. predisposition (valve, IV drugs)
2. Fever (>100.4F) 3. Vascular Phenomena: emboli, janeway lesions 4. Immunologic Phenomena: glomerular nephritis, osler nodes, Rhem. Fever 5. Microbiologic evidence: +blood cx, but does not meet major criteria 6. Echo w/minor findings |
Definitive IE:
two major criteria One major + 3 minor five minor criteria Possible infective endocarditis: one major and one minor criteria three minor criteria Rejected: - firm alternate dx - resolution of manifestations of endocarditis, w/abx for 4 days or less - no pathologic evidence of infective endocarditis at surgery or autopsy - does not meet jones criteria for endocarditis |
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What has greater snesitivity and specificity for valvular anomalies, TEE or TTE? (in infective endocarditis)
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Transesophageal Echo (TEE)
p. 1045 |
- It is a must in those who have prosthetic heart valves
- those in who TTE images are likely to be poor - those w/intermediate to high clinical probability of endocarditis. |
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Patients with endocarditis may present 4 ways clinically?
- tho there are certainly more ways, what are the four listed in the book? |
1. respiratory compromise 2/2 decreased cardiac output- 2/2 vavlular defects
2. diminished pulmonary capacity (pulmonary emboli) 3. AMS 4. Acidemia (related to central nervous system emboli and/or sepsis) p. 1045 |
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What should be avoided in Native Valve endocarditis because it is not beneficial and may actually be harmful?
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Anticoagulation
p. 1045 |
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What should be done w/suspected endocarditis after obtaining cultures?
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Empiric abx tx
- see Table 150-5, p. 1045 |
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What empiric tx should be provided for native valve endocarditis?
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- Vancomycin
and - An Aminoglycoside and - Rifampin p. 1045 |
MC duration of therapy...
4-6 weeks |
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Is prophylaxis therapy against endocarditis indicated for the following: MVP, pacemaker, hypertrophic cardiomyopathy, physiologic murmurs, primary coronary artery bypass surgery or angioplasty, or previous surgical repair of atrial septal defect, ventricular septal defect, or patent ductus arteriosis.
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No
p. 1046 |
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T/F: No need for abx prophylaxis before dental procedures that involve manipulation of gingival tissue to the periapical region of the teeth or perforation of the oral mucosa.
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False, these individuals need abx prophylaxis
p. 1046 |
Abx indications, Table 150-7, p. 1046
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Is prophylactic abx tx needed for high risk patients who desire tattoo or body piercing?
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-yes.
- however, it is not needed for non-dental procedures, local injections, laceration sutures, IV line placement, blood draws, ET tube placement, endoscopy, vaginal delivery, urethral catherization, uterine dilation and currettage. p. 1046 |
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What do the following have in common:
1. Prosthetic heart valves 2. Prosthetic material used for valve repair 3. Hx of previous infective endocarditis 4. Unrepaired cyanotic congenital heart disease 5. Repaired congenital heart defect w/prosthetic material or device 6. Repaired congential heart disease w/residual defects 7. Cardiac transplant recipients w/valve regurge due to structural abnormalities |
High Risk Conditions for Endocarditis
p. 1046 |
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What is the option in tx for a patient w/MRSA associated endocarditis?
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Vancomycin or Clindamycin
p. 1046 |
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Where is the US is Tetanus most prevalent?
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- California
- Texas - Florida p. 1047 - MC sites world wide: Africa and Asia |
only 30% of those >70 y/o are adequately immune.
increasing in those 20-59 y/o and IV drug users (as well as DM patients) |
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Where is clostridium tetani, anerobic spore gram + rod MC found?
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- soil
- animal feces - contaminated skin - contaminated heroin p. 1047 |
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What environments favor the growth of the vegetative, toxin producing form of clostridium tetani?
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1. presence of crushed, devitalized tissue
2. a foreign body or 3. the development of an infection p. 1047 |
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What are the two exotoxins produced by Clostridium Tetani? Which of the two is worse?
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- Tetanolysin and Tetanospasmin
- tetanospasmin is most responsible for clinical manifestations, and is one of the most potent toxins known p. 1047 |
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What infx source is responsible for generalized muscle rigidity, violent muscular contractions, and autonomic nervous system instability?
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Clostridim Tentani
p. 1047 |
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T/F: There is always a source of injury associated w/C. Tetani.
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False
- in 10% of cases no wound is identified p. 1047 |
- Can develop after surgery, otitis media, abortion, and in IV drug users and in neonates via infx of the umbilical stump
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What is the incubation period of C. Tetani?
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<24 hrs to 1 month
p. 1047 |
- shorter incubation, the worse the prognosis
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The are three different forms of tetanus: generalized, cephalic, and local. What is the MC?
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Generalized, 80% of the cases
p. 1047 |
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What is the most frequently presenting complaint of a patient with Generalized C. Tetani?
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pain and stiffness in the masseter muscle (LockJaw)
p. 1047 |
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T/F: Patients remain conscious until respiratory compromise when generalized c.tetani.
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True
p. 1047 |
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Disturbances in autonomic nervous system in the 2nd week of C. Tetani infx are:
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1. tachycardia
2. labile HTN 3. profuse sweating 4. hyperpyrexia 5. increased urinary excretion of catecholamines p. 1047 |
- contractions: 3-4 weeks, recovery: months- depends on regrowth of nerve terminals
-rhabdomyolysis and long bone fx will often occur 2/2 to violent muscle contractions |
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12 day old infant is brought to you by a her mother. The mother is a hippie and used a dula to manage the birth at home. The baby weak, irritable and has difficulty with suck and feeds. You also notice d/c from the site of the unbilical stump w/d/c that MOP has been treating with an ointment made by a friend. WTF is the dx?
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Neonatal Tetanus
p. 1047 |
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A patient with otitis media lateral complains of bizarre cranial nerve deficits that seem to be progressive and most pronounced over the cranial nerve 7 (facial). What is the dx, and carries a poor prognosis?
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C. Tetani
p. 1048 |
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How is tetanus dx?
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clinically
p. 1048 |
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What MC mimics the clinical picture of tetani?
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Strychnine poisoning
p. 1048 - pesticide used for rodents |
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What tx neutralizes circulating tetanospamin and toxin in a wound, but not the toxin that is already afixed in the nervous system?
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Human Tetanus Immunoglobulin (TIG)
p. 1048 |
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The TIG (tetanous immunoglobulin) how does effectively work as a tx?
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- it does not ameliorate the clinical sxs, but it does reduce mortality
p. 1048 |
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At least a portion of the TIG tx for tetanous should be administered into the site of the wound (or around). When is it administered?
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- prior to wound debridement or irrigation 2/2 to the risk that exotoxin may be released during wound manipulation.
p. 1048 |
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Abx are not necessary for tetanous infx. However, if one is given, what is the abx of choice?
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Metronidazole
- p. 1048 |
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Why do you not give PCN to to tetanus patients?
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DO NOT GIVE PCN to tetanus patients because it is a centrally acting GABA antagonist that may potentiate the effects of tetanospasmin.
p. 1048 |
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Why is Midazolam the agent of choice for IV relaxation in Tetanus?
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Because the water soluble agent is safer. The propylene glycol vehicle of the other benxo treatments can lead to metabolic acidosis.
p. 1048 |
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What treatment can be given to inhibit the release of epi and norepi from adrenal glands and adrenergic nerve terminals, eliminating catecholamine excess in tetanus?
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Magnesium Sulfate
p. 1048 |
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What is Tdap?
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Tetanus Toxoid
reduced diphtheria toxoid acellular pertussis vaccine p. 1049 |
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What is the following animal risk exposure with regard to rabies prophylaxis:
squirrels hamsters guinea pigs gerbils chipmunks rats mice domesticated rabbits "other small rodents" |
rarely rabid and therfore ALMOST NEVER require prophylaxis
p. 1050 |
Animal reservoirs for rabies are found almost everywhere except great Britain, Hawaii, Australia and Antarctica
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What are the means by which rabies is transmitted (5)?
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1. bite, saliva
2. aerosol transmission during spelunking 3. exposure while working in a lab 4. infected organ transplant 5. improperly inactive vaccine p. 1050 |
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What factors play a role in innoculation with rabies (4)
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1. bite vs scratch
2. depth of bite 3. number of bites (multiples= high risk) 4. location of the wounds |
- bites from bats, 80% infx in humans
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T/F: Preexposure prophylaxis does NOT eliminate the need for additional therapy after rabies exposure, but simplifies the postexposure prophylaxis by eliminating the need for human rabies immunoglobulin (HRIG) by reducing the number of doses of vaccine required.
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True
p. 1050 |
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Rabies exposure prophylaxis guide: Continuous exposure risk, research lab. What is done with these guys.
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Testing every 6 months
p. 1051 |
table 152-4
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Rabies exposure prophylaxis guide: Frequent exposure risk, animal control, vet. What gets done w/these guys?
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Testing for rabies every 2 yrs
p. 1051 |
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Rabies exposure prophylaxis guide: Infrequent, but more common than population at large, vets in low risk areas. What gets done w/these guys?
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Primary course, no serologic testing or booster immunization.
p. 1051 |
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Rabies exposure prophylaxis guide. Rare population risk, what of these guys: rare/episodic risk. What gets done with these guys>
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No immunizations necessary
p. 1051 |
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How is bite exposure defined, for the purposes of rabies postexposure prophylaxis?
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penetration of the skin by teeth of an animal
p. 1052 |
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What bite sites carry the highest risk of of rabies, though the site itself does not determine tx?
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- hands and face
p. 1052 |
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Do the non-bite exposure to rabies carry a high risk of rabies?
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No
- in fact rabies infection following anything other than bite is rare p 1052 |
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An unattended child is found in a room where a bat is discovered and it is uncertain how long or what happened, does the child get postexposure rabies prophylaxis?
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Yes
- someone who fell asleep and discovered a bat in the room - unwitnessed child and bat interaction/exposure - mentally disabled person in the room w/a bat p. 1052 |
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T/F: An individuals w/non-intact skin or mucous membrane exposure to infective saliva from patients w/rabies should receive post-exposure prophylaxis.
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True
p. 1053 |
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What does rabies postexposure prohylaxis consist of?
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HRIG (w/in 24 hrs) and five doses of rabies vaccine over 28 day period.
p. 1053 |
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What is a contraindication for the use of PCECV?
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(Purified chick embryo cell culture vaccine)- for rabies prophylaxis...Severe Egg Allergy
p. 1053 |
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T/F: Rabies prophylaxis should be interrupted because of local or mild systemic adverse rxn, which is noted for causing rabid anaphyaxis if not careful.
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False, it should not be d/c'd for mild rxn.
p. 1053 |
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What is provided for Rabies Prophylaxis prior to providing postexposure prophylaxis, because failure to provide it can lead to failure of tx and ultimately rabies?
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HRIG- human rabies immunoglobulin
p. 1053 |
HRIG should NEVER be administered in the same syringe or in the same anatomic site as the vaccine!!!!
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What is the dose and duration, according to ACIP 2009, of post exposure tx for rabies>
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four, 1 mL doses to previously unvaccinated persons w/no immunosuppression
p. 1054 |
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Immunocompromised individuals, how do they get treated after exposure to rabies?
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Rabies vaccine is an inactivated virus, therefore there is no greater risk. However, ACIP recommends an additional dose (1mL x 5 doses)
p. 1054 |
Immunosuppressive agents should not be administered during postexposure prophyalaxis, unless they are essential for tx of other conditions.
p. 1054 |
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What medication can adversely effect the antibody response of HDCV in the tx of rabies?
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Malaria medications: Chlorquine phosphate, mefloquine, etc.
p. 1054 |
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T/F: A person who is bitten or scratched by an animal in an area w/endemic rabies should receive appropriate postexposure prophylaxis if injury has occurred w/the known incubation period.
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True
p. 1054 |
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Is pregnancy a contraindication to HRIG or postexposure prophylaxis?
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- no
p. 1055 |
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How is HRIG dosed?
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Postexposure propylaxis is dosed by weight.
p. 1055 |
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What are regarded as pathognomonic signs of rabies?
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hydrophobia and aerophobia in the presence of encephalitis/disease
p. 1055 |
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What disease process is it when mental status and CSF are NML, tetanus or rabies?
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Tetanus
p. 1055 |
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Why are steroid contraindicated in the treatment of rabies?
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It has been found to shorten viral incubation period and increase mortality
p. 1056 |
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What are the five species of malaria?
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Plasmodium...
- Vivax - Ovale - Malariae - Falciparum- most deadly - Knowles p. 1056 |
falciparum- becoming more resistant toantimalarial medications
the vector is becoming more resistant to insecticides |
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Read pathophys of disease for malaria- p. 1057
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Really!!!
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What is the MC vector for malarai?
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Anopheles mosquito
p. 1057 |
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What are the sxs associated with Malaria?
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The hallmark of malaria is PERIODIC fevers, w/a prodrome of malaise, myalgia, headache, low grade fevers often w/chills.
- In some patients the HA, chest pain, cough, abdominal pain, arthralgias, or diarrhea may be prominent. p. 1058 |
- can also progress to: high fevers, tachycardia, nausea, orthostatic dizziness, and extreme weakness. After a few hours the fever abates and the patient develops diaphoresis and exhaustion
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What form of malaria will often lack CLASSIC paroxysms (also lacking in those w/those who received chemoprophylaxis)
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- Plasmodia Falciparum
p. 1058 |
- patients are often acutely ill w/high fevers, tachycardia, tachypnea. Spleenomegaly and abdominal tenderness- common in advanced disease
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What are signs of cerebral malaria?
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- fever
- mlaraia parasitemia - and coma/AMS p. 1058 |
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While there are no PE findings suggestive of malaria: fever, tachycardia and tachypnea (RBC destruction, etc); what are late findings?
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Abdominal tenderness and spleenomegaly
p. 1058 |
- any malaria infx can cause: hemolysis, spleenic enlargement, occasionally, spleenic rupture
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LP is often indicated to r/o meningits. WOW! What do you suppose that the CSF may seem like?
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- slightly high opening pressures
- elevated protein concentrations in the CSF - mild pleocytosis p. 1058 |
Other life threatening complications: acute pulmonary edema, renal failure, and severe metabolic abnormalities, lactic acidosis, and PROFOUND hypoglycemia.
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Who is at greatest risk associated with malaria, due to falciparum (3)?
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1. The very young
2. The very old 3. Prego's p.1058 |
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How is the definitive dx established in Malaria?
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visualization of parasites on Field or Giemsa Stained thick and thin blood smears
p. 1058 |
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T/F: In the treatment of Malaria, though a high index of suspicion, a negative parasitemia is reason enough to withhold tx.
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FALSE: failure to detect parasitemia is not a reason to withhold tx. Parasitemia fluctuates and is highest during chills and fevers
p. 1060 |
FYI: Why is great care taken in making the slides? Debri can cause a false positive report
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|
|
How often is the first malraia smear positive?
|
90% of the cases
p. 1060 |
-if negative, repeat slides twice daily for 2-3 days to adequately exclude
|
|
|
When getting a blood smear for Malaria, what are the two major questions that need to be answered?
|
1. What is the degree of parasitemia
2. Does the malaria infx consist of Plasmodia Falciparum p. 1060 |
|
|
|
What is a done daily to determine the efficacy of treatment for malaria?
|
- peripheral smears
p. 1060 |
|
|
|
What should be thought about in any patient coming from asia w/a high parasite burden resembling P. Malariae?
|
Plasmodium Knowles
p. 1060 |
|
|
|
T/F: While COMBINATION therapy is the standard, to obtimize efficacy one should wait until dx is confirmed to tx.
|
False: treat prior to the results.
p. 1060 |
|
|
|
What is the drug used in the US to treat malaria?
|
IV quinidine
p. 1060 |
It has enhanced activity P. Falciparum, vs quinine
|
|
|
What therapy do you tx someone with who is at risk of developing cardiotoxicity while being treated with quinidine for Malaria?
|
Quinine
- have to contact CDC to get p. 1060 |
|
|
|
What is the drug of choice for Malaria tx, according to the WHO?
|
IV Artesunate
p. 1061 |
|
|
|
Artesunate is a potent and rapidly effective drug in the treatment of malaria. What are its two great limitations?
|
1. Lack of availability
2. Short half life, so it must be paired with another malaria tx to increase its effectiveness and reduce the risk of resistance. p. 1061 |
|
|
|
Patients w/Malaria need tx: admission to the hospital, and unless one is certain has chloroquine resistant P.Falciparum, they are initiated on what meds?
|
1. quinine and doxycycline
or 2. atorvaquone-proguanil p. 1061 |
|
|
|
What antibiotic can be substituted for doxycycline in the tx for Malaria, when Doxy is contraindicated?
|
Clindamycin
|
|
|
|
What is the drug of choice in the tx of P. Ovale, P. Vivax, and P. Malariae?
|
Chloroquine
-Parasite load should be reduced w/in 24-48 hrs. p. 1062 |
- terminal tx is needed w/primequine, clinical relapse can occur. However, do NOT use in G6PD def.- hemolysis can insue
|
|
|
T/F: Despite tx w/both chloroquine and primequine, clincal relapse may still occur.
|
True
p. 1062 |
|
|
|
T/F: Glucocorticoids are of no benefit in the treatment of cerebral edema and therefore should not be used.
|
True
p. 1062 |
|
|
|
What is the common SE risk associated with Quinidine and Quinine tx?
|
Hypoglycemia
- it causes increase in insulin release . p. 1062 |
|
|
|
T/F: Once P. Falciparum is excluded, most patients can be treated outpatiently.
|
True
p. 1062 |
EXCEPT: infants and pregos-always get admitted to hospital
|
|
|
What is a significant risk for a fatal malaria infx?
|
Failure to take chemoprophylaxis.
p. 1062 |
|
|
|
What should be considered in any individual w/undifferentiated syndrome of: fever, headache, myalgias, malaise, and weakness?
|
Zoonotic illness
p. 1070 |
What is the MC vector for zoonotic illness worldwide?
-tick |
|
|
What are the four steps regarded as optimal for tick removal?
|
1. Viscious lidocaine to numb the site and kill the tick
2. Fine tipped tweezers or forceps, grasp the tick's head and gentley pull upward 3. removal all tick parts 4. After removal- cleanse and disinfect site completely. p. 1071 |
|
|
|
What is the most severe form of tick borne illness in the US, w/peak incidence of: April -September?
|
Rocky Mtn Spotted Fever
p. 1071 |
Early signs: fever, HA, myalgia/malaise
Late Signs: lymph.,abd pain, N/V/D, hepatospleenomegaly,HA, conjunctivitis, confusion, meningismus, renal failure, respiratory failure and myocarditis. |
|
|
Lab values are generally non-specific in this disease, but the following combo may be helpful: neutropenia, thrombocytopenia, elevated LFT's, hyponatremia?
|
Rocky Mtn Spotted Fever
p. 1072 |
|
|
|
What is the MC vector borne illness in the US?
|
Lyme Disease
p. 1072 |
peak occurrence: summer months
Risk of infx s/p bite: low Risk is proportional to lenght of time the tick feeds on host |
|
|
What is the risk to a host, for lyme disease, if the tick is in contact for < 72 hrs?
|
Virtually no risk
1073 |
In fact there is only a 25% risk if the tick is in place for >72hrs
|
|
|
What is the MC neurologic complication associated w/Lyme disease (occurring in teh second stage of illness)
|
Unilateral or Bilateral Facial Nerve Palsy
p. 1073 |
|
|
|
What is the lab of choice often used for Lyme dz?
|
PCR or Western Blot test
- what is the tx in primary and secondary stage of dz? |
Doxycycline, Amoxicillin, cefuroxime, ceftriaxone, or e-mycin.
p. 1073 |
|
|
Why is prophylactic tx for lyme disease rarely encouraged (2)?
|
1. disease is rare
2. tx may slow immune response p. 1073 |
-but a single dose of 200 mg Doxycycline given w/in 72hrs of the deer tick bite can prevent lyme disease
|
|
|
How is tuleremia contracted (2)?
|
1. Tick bite from infected vector
2. through open wounds while dressing an infected zoonotic host p. 1074 |
|
|
|
What form of tuleremia is the most common of the (5)ulcerglandular, glandular, typhoidal, pneumonic, and oropharyngeal?
|
Ulcerglandular
- ulcer at site of tick bite, painful regional adenopathy, p. 1074 |
- glandular, painful adenopathy, no ulcer
- typhoidal- fever, chills, cephalgia, and abd pain - orophayngeal and pneumonic is 2/2 to inhaltion and direct innoculation. |
|
|
Zoonotic encephalitis, what do the CT and CSF findings look like?
|
a. CT looks NML
b. CSF: slight elevation in opening pressures, increased proteins, NML glucose, predominence of lymphocytes. p. 1074 |
|
|
|
What should you consider in someone who has prolonged exudative pharyngitis, esp when: systemic sxs, leukocytosis, and is refractory to standard antistreptococcal therapy?
|
Possible Zoonotic Origin or atypical pharyngitis
p. 1075 |
- pets may need tx as well as other family members
|
|
|
A slaughter house worker reports to you with c/o: cough, hoarseness, and wheezing. You get an x-ray that shows peritracheal and hilar lymphadenopathy. What do tx with?
|
Doxycycline and Rifampin x 6 weeks, this is Brucellosis
p. 1075 |
|
|
|
What is called "parrot fever" and is often acquired from inhalation of domesticated bird crap that is aerosolized?
|
Psittacosis
p. 1075- tx with tetracyclines. |
|
|
|
Q fever- what is it?
|
A ricketssial infx acquired by aerosol inhalation rather than arthropod vector.
p. 1075 |
|
|
|
With regard to Q-fever, how is it transferred aerosolized?
|
urine, products of after birth and feces>
p. 1076 |
|
|
|
What are some of the systemic/organ effects of q-fever and how is it treated?
|
- pulmonary infiltrates
- myocarditis - endocarditis - granulomatous hepatitis - tx: Doxycycline, should be w/in the first 3 days of illness p. 1076 |
|
|
|
Where is pasteurella obtained and how tx'd?
|
- norma flora of cats and dogs
- tx w/augmentin, tetracycline, PCN and 3rd generation cephalosporin p. 1076 |
|
|
|
What is Melioidosis? How treated?
|
Gram Neg: Pseudomonas- particularly Burkholderia. Manifests as pneumonia w/or w/o septicemia. Tx: Doxy or bactrim
p.1076 |
|
|
|
Hantavirus- what contaminants cause the spread of disease, how?
|
primary vector is the deer mouse.
- urine, feces dried and aerosolized, but also can be from bite p. 1077 |
|
|
|
What is the MC presentation of acute hanta virus illness?
|
- prediliction for the kidneys: which presents w/acute renal failure and concurrent thrombocytopenia, occular abnormalities as well as flu like sxs.
p. 1077 |
|
|
|
A patient is presented to you after camping in cabin in woods. Over the past few days seemed to have allergies or the flu, but today is hypoxic, hypotense, tachycardic, and ABG PH is 7.25, w/low bicarb. CXR: pulmonary edema. What is it, how treated?
|
- Hanta Virus
- supportive and maybe: inhaled ribovirin p. 1077 |
50-70+% mortality
|
|
|
What are the two principle cutaneous fungal infx MC affecting dog, cat ownders and veterinarians?
|
- Blastomyces Dermatitis (cutaneous blastomycosis)
- Sporothrix Schenkii (sporotrichosis) MC occurring at the site of innoculation p. 1077 |
|
|
|
T/F: the treatment for cutaneous anthrax is the same for systemic, which helps to prevent the progression of disease.
|
FALSE: the treatment, while the same, has no impact on the progression to systemic dz.
(truth, it is MC self-resolving) p. 1077 |
|
|
|
What is commonly the only indicator of zoonotic illness in a pet owner?
|
Eosinophilia...since MC these are subclinical sxs.
p. 1078 |
|
|
|
An ELISA test in a child w/fever, cough, and nonspecfic rash confirms + toxocara canis. What is the tx?
|
Albendazole or Mebendazole
p. 1078 |
|
|
|
Dipydoasis is a tapeworm to both dogs and cats that can sometimes effect children. How treated?
|
Praziquantel or niclosamide
p. 1079 |
|
|
|
What protozoan can be transmitted: by ingestion or uncooked or raw meat, by ingestion of oocyts from cat and wild animal feces and transplacentally?
|
Toxoplasmosis Gondii
p. 1079 |
Placental transmission can cause:
-retinochoroiditis -hydrocephalus -hepatospleenomegaly -thrombocytopenia only occurs in 10% of cases |
|
|
What are the two most common bacterial illnesses that are acquired in immunocompromised by their pets?
|
Campylobacter and Salmonella
p. 1080 |
|
|
|
Beta lactams and glycopeptide abx's, where do they work? Bacteriocidal or bacteriostatic?
|
Betalactams: (PCN & Cephalosporins)- PCN binding proteins
Glycopeptides: bind to terminal dipeptide- cross linking structures in peptidoglycan wall- loss of wall integrity - most commonly this is bactericidal. |
PCN/cephalosporins
glycopeptides: Vancoymicin and Daptomycin |
|
|
Protein synthesis inhibitor abx's, how do they work? And where do they work?
|
Bind to ribosomes w/in the bacteria:
Aminoglycosides and Tetracyclines: 30s Ribosomal subunit Macrolides and Clindamycin: 50s ribosomal subunit |
1. Aminoglycosides and Tetracyclines
2. Macrolides and Clindamycin 3. Linezolid* |
|
|
What are some NUCLEIC ACID INHIBITORS? How do they work?
|
1. Fluorquinolones
2. Rifampin 3. Nitrofurantoin - Fluoroquinolones: inhibit DNA gyrase, the enzyme responsible for the uncoiling and recoiling of DNA for transcription p. 1103 |
-Rifampin- broad spec that is active against gram +, - and mycobacteria.
Rifampin: inhibits RNA synthesis Nitro: damages DNA |
|
|
Dosing on abx is based on guidelines that do not take into account issues regarding penetration to the site of infx. What are some conditions that inhibit penetration of abx med? What do you do?
|
Abscess, meninigits, endocarditis, and osteomyelitis.
Give highest concentration of the drug recommended. p. 1106 |
|
|
|
Renal disease patients often require drug dose adjustments. However, this is most common in IV than in PO meds, why?
|
Toxic drug accumulation is less likey because PO doses are already generally at the lower end of the dose range.
p. 1106 |
|
|
|
What abx drugs are more likely to have biliary complications (ie. are biliary cleared) (3)
|
1. Clindamycin
2. Metronidazole 3. Nafcillin, Oxacillin p. 1106 |
|
|
|
Allergic reactions to abx
1. Are they dose related 2. Are they predictable in anyway 3. Can they be studied effectively in animals |
1. No, allergi rxns are not dose related
2. Allergic rxns are not predictable 3. cannot be studied in animals p. 1106 |
- p. 1106, adverse effects section table 158-4, 158-5
|
|
|
What are the two mechanisms for drug interactions?
|
1. Inhibition of absorption or oral abxs
2. slow metabolism of other drugs by inhibition of the CYP-450 enzyme in the liver. p. 1107 |
1. Ex of inhibition of absorption: Tetracycline and Fluorquinolones in presence of Calcium, Magnesium, and Iron
2. Slow metabolism: cipro, clarithromycin, bactrim |
|
|
What is the primary action of antifungal agents?
|
- decreasing cell wall integrity
p. 1107 |
|
|
|
How does Amphotericin-B work?
|
- increases cell wall permeability
p. 1107 |
|
|
|
Triazole antifungals, how do they work?>
|
Block ergosterol synthesis by inhibition of a fungal cytochrome P-450 dependent enzyme.
|
|
|
|
Capsofungin, how does it work?
|
Blocks B-glucan synthesis, destroying cell wall integrity.
p. 1107 |
|
|
|
Why is liposomal Amphotericin B (AmBisome) becoming the antifungal drug of choice?
|
- lower rate of infusion rxns and lower rate renal dysfunction.
p. 1107-1108 |
|
|
|
What drug can cause reversible bone marrow suppression, leukopenia, and thrombocytopenia?
|
Flucytosine
p. 1109 |
|
|
|
What are the drugs of choice for HSV and Cytomegalovirus?
|
Acyclovir and ganciclovir
p. 1109 |
large oral doses are ncessary for to achieve blood and tissue concentration to inhibit viral replication. (IV is ideal)
|
|
|
What are the prodrugs that are often added to acyclovir and ganciclovir, that help with GI absorption, finally removed from the Liver into the drug?
|
- Valacyclovir
- Famciclovir - Valganciclovir p. 1109 |
|
|
|
What is a common adverse effect of antiretroviral therapy, that can lead to sxs: anorexia, fatigue, weightloss, confusion and loss of energy?
|
Lactic Acidosis
p. 1111 |
- resolution is slow, even after cessation. Lactactic acid levels will need to be trended frequently to ensure resolution.
|
|
|
What antiviral drug causes hypersensitivity syndrome?
|
Abacavir (Ziagen)
p. 1111 |
rash and other systemic complaints
- will resolve once meds stopped. |
|
|
What can/often does happen to a patient that experiences hypersensitivity syndrome when taking Ziagen, stops the meds, improves, but then takes the meds again?
|
- Life threatening cardiovascular and respiratory insufficiency
p. 1111 |
|
|
|
What is the overall exposure risk to infx agents (high,moderate,low or very low): diarrhea, URI, non-infectious illness- injuries and flares of chronic dz
|
High
p. 1080 |
|
|
|
What is the overall exposure risk to infx agents (high,moderate,low or very low): dengue fever, chikungunya, enterovirus, AGE, giardiasis, Hep A, salmonellosis, STD, shigellosis
|
Moderate
p. 1080 |
|
|
|
What is the overall exposure risk to infx agents (high,moderate,low or very low): amebiasis, ascariasis, measles, mumps, enterobiasis, scabies, TB, typhoid, and Hep B
|
Low Risk
p. 1080 |
|
|
|
What is the overall exposure risk to infx agents (high,moderate,low or very low): HIV, anthrax, chagas dz, hemorrhagic fevers, pertusis, plague, typhus and hookworm
|
very low risk
p. 1080 |
|
|
|
When should you suspect a biologic terrorist threat, as a cause of disease?
|
1. divergence of dz from typical epidemiologic area
2. atypical number of patients presenting with similar clinical syndromes p. 1080 |
|
|
|
What is the most important tropical emergency that can be reduced by chemoprohylaxis?
|
Malaria
p. 1080 |
Still a risk with chemoprophylaxis. Remember this reduces, not eliminates, malaria risk
|
|
|
Febrile individual w/altered mental status (tho fever not always present 2/2 to use of antipyretics), whatcha think'n
|
Malaria or Meningitis
-treat empirically p. 1080 |
Dude!!! Look at the charts, p. 1081
|
|
|
A patient w/a fever s/p tropical travel have what until proven otherwise?
|
Malaria
p. 1082 |
|
|
|
You have a patient who a sick, with an elevated eosinophil count > 500/mm^3. What is the problem?
|
Helminth infx (worms)
p. 1082 |
|
|
|
What illness will MC cause a "classic triad" of fever, spleenomegaly, and thrombocytopenia?"
|
- Malaria
p. 1082 |
Thick and Thin Blood Smears
|
|
|
T/F: Dengue fever may be contracted more than once!!!
|
True: none of the four strains offers cross protective immunity
p. 1082 |
|
|
|
What is a tropical illness that is the most serious febrile illness developing 2 weeks after travel; fever, HA, N/V, myalgias, rash...w/petechial hemorrhages indistinguishable from Meninococcemia?
|
Dengue fever
p. 1082 |
- after defervescence, a fine , pale morbilliform rash develops on the trunk and spreads tom extremities
|
|
|
5 y/o who had fever, bodyaches for 6 days, when the fever broke. But, the child seems to be in shock. Petechial rash all over, bloody nose is noted, w/o overt signs of trauma. CXR: Pleural effusions and CBC reveals thrombocytopenia, tho HCT is elevated. What is up with this kid?
|
Dengue Hemorrhagic fever
-supportive care |
Septic shock: abdominal pain, severe vomiting, AMS, and alternating fever and hypothermia. ELISA Test can help.
|
|
|
What is a common cause of fever lasting > 10 days, once malaria has been ruled out?
|
Typhoid Fever
- Salmonella Typhi and S. Paratyphi p. 1082 |
Also called enteric fever. Caused by food contaminated by feces or urine
|
|
|
Bradycardia relative to a fever is classic for what?
|
Typhoid fever
p. 1082 |
read about this: p. 1082-1084, clinical signs "rose spots"
|
|
|
What occurs MC after floods, where patients have high fever, severe HA, chills, myalgias, hepatitis, and Conjunctival Injections w/o purulent d/c?
|
Leptospirosis (Weil Dz)
p. 1085 |
|
|
|
A young man who was helping a group of people displaced from their homes after a natural disaster is brought to you w/c/o fever, chills, HA, Myalgias, abdominal pain, and jaundice. Noted recently to have AMS. + evidence of meningitis. What is the most important abx tx?
|
IV doxycycline 100 mg bid - until spirochetes are no longer in the blood.
- this is Relapsing Fever p. 1085 |
This is caused by a spiral shaped bacteria (Borrelia species) transmitted by ticks or lice.
|
|
|
What is the MC cause of Acute Hemorrhagic fever in temperate climates?
|
Meisseria Meningitidis
p. 1085 |
|
|
|
What three things must happen for suspected viral hemorrhagic fever in viral hemorrhagic fever?
|
1. Negative pressure room
2. high efficiency particulate arresting respirators 3. gloves and gowns p. 1085 |
|
|
|
This tickborne viral illness is common in Africa, E. Europe, Asia, and the Middle East-esp Turkey, what is it?
|
Crimean Congo Hemorrhagic Fever
p. 1085 |
- commonly effected groups: farmers and healthcare workers
|
|
|
Patient presents with hx: fever, HA, myalgias, dizziness, mental confusion. W/in 3 days after sx onset the pt develops evidence of atraumatic epistaxis and melana w/tender hepatomegaly.
|
Crimean-Congo Hemorrhagic Fever
p. 1085 |
Hemorrhage sites MC:
- nose: epistaxis - GI: hematemsis, melana - uterus: menometrorrhagia - urinary: hematuria - Resp tract: hemoptysis |
|
|
What is the tx for Crimean-Congo?
|
- mainly supportive
- in severe cases only, Ribovirin IV. Mild cases- no. p. 1086 |
|
|
|
What presents as a triad of Jaundice, Black Emesis, and Albuminuria?
|
YELLOW FEVER
p. 1086 |
tx is supportive and mainly geared toward fluid replacement and mgt of hematologic complications
|
|
|
21 y/o M is presented to you after returning from W. Africa 2.5 weeks ago. 2 wks s/p he returned, developed FLS, including: fever, myalgias, HA, Sore throat w/yellow white exudates, retrosternal CP, back pain, abd pain, and myalgias. But over last few days, T103, worsening ST, N/V/D and NO energy to move. Toxic appearance, unable to move. What is it?
|
Lassa Fever
p. 1086 |
- from bush rats.
almost exclusively W. Africa, unless imported by travelers. |
|
|
Lassa fever is Highly contagious. How?
|
- close contact:
- blood - body fluids p. 1086 |
|
|
|
How do you confirm Lassa Fever?
How do you confirm Crimean Congo? |
LASSA: ELISA test
CRIMEAN CONGO:IgM antibodies to be detected by ELISA or PCR p. 1085 |
|
|
|
CNS involvement w/fever in traveler's returning from malaria-endemic regions require what?
|
Emergency Presumptive Treatment for both Malaria and Bacterial Meningitis
p. 1086 |
|
|
|
What are the five tropical infectious sources of SEVERE HA and Fever?
|
1. Malaria
2. Rickettsial Dz 3. Dengue Fever 4. Typhoid Fever 5. Human African Trypanosmiasis p. 1086 |
|
|
|
What is the DDx in patients with fever and CNS involvement?
|
- Meningitis
- Rabies - Malaria - TB - typhoid fever - rickettsial infection - as well as viral encephalitis: Japanese and West Nile virus sources p. 1086 |
|
|
|
Why is Japanese Encephalitis rare in most traveler's? If fatal, how soon after contracting illness do people die?
|
- the vector for japanese encephalitis is native to rural rice paddy fields.
- people, if they die, will die in 10 days p. 1086 |
|
|
|
Who is the definitive host of tinea solium?
|
Humans
- actual the pig is the intermediate host. p. 1086 |
|
|
|
What is the leading cause of adult onset seizures in the US?
|
Neurocysticercosis
p. 1086 |
|
|
|
What is provided to a patient with calcific changes on non-con CT suspected as being neurocysticercosis, w/evidence of encephalitis, hydrocephalus and vasculitis?
|
- praziquantel
- steroids (steroids are to prevent inflammation as cysts involute) p. 1086 |
|
|
|
What is transmitted by the Tsetse fly, causing a painless chancre that grows and then resolves. The pt develops fevers, not responsive to antimalarial agents, Malaise, rash, wasting, and CNS involvement: behavior/neuro change, coma and death?
|
Human African Trypanosomiasis (African Sleeping Sickness)
p. 1087 |
Complications: hemolysis, anemia, pancarditis, meningoencephalitis
|
|
|
What is chagas disease?
|
American Trypanosomiasis (protozoan T.Cruzi), spread by the kissing bug (reduviid). Acute ilness. The causes nerve damage over years that leads to heart and GI damage.
|
- can also be provided via blood transfusion, laboratory accidents, as well as congenitally.
|
|
|
What is the leading cause of CHF in the latin world?
|
Chagas induced heart disease
p. 1087 |
Heart complications:
- myocarditis - dysrhythmias - cardiomyopathy - sudden death |
|
|
When dx someone with leishmaniasis, what is needed for definitive dx?
|
isolating motile extracellular parasites aspirated from bone marrow, spleen, or lymph nodes, or on smears or secretions taken from ulcer edge by punch bx.
p. 1087 |
PCR can be used for speciation
|
|
|
What is the cause of: fever, weightloss, hepatospleenomegaly, pancytopenia, and hypergammaglobulinemia? Fatality from this is MC 2/2 secondary infx: TB, PNA, or dysentary.
|
- Visceral Leishmaniasis
p. 1087 |
|
|
|
What is the MC site of chronic mucocutaneous leishmaniasis?
|
mucous membranes of the nose and mouth
p. 1087 |
|
|
|
Pt w/exposure to freshwater in S. Amerca, c/o GI sxs: diarrhea, hepatospleenomegaly, hypereosinophilia; as well as HA, cough, urticaria. Patient reports noticing an itching rash that lasted a few days shortly after swimming.
|
Schistosomiasis (Snail Fever)
p. 1088 |
Innoculation is commonly through wet, intact skin or through ingestion.
- can happen w/only seconds of exposure. READ P. 1088 |
|
|
You are stationed in SE Asia. 60 y/o M is presented who has had anorexia, diarrhea. TTP over the RUQ and appears jaundiced. JVP is at the angle of the mandible, and his abdomen is greatly distended. Lungs sounds diminished, but clear, and he has a Murmur. LFT's and Eosinophilia. Admits to no special diet, since getting sick off sushi 30+ yrs ago. What is going on?
|
Chinese Liver fluke
p. 1088 |
Tx Prazequantel
|
|
|
What organisms MC cause Dysentary>
|
1. Shigella
2. Salmonella 3. Campylobacter 4. Aeromonas 5. E. Coli 6. E. Hystolitica -these are toxigenic and invasive organisms. p. 1088 |
|
|
|
What is Amebiasis?
|
Entomamoeba Hystolytica
p. 1088 |
|
|
|
Who is at the greatest risk of exposure to Entamoega Histolytica?
|
- Peace Corps travelers- to Asia, Africa, and Latin America
- Most Severe: children, elderly, and pregnant women p. 1089 |
|
|
|
A child who is crying a lot, w/flatus as well as foul-smelling watery diarrhea. Social hx" daycare. No surgeries and no special diet. Whatcha think'n
|
Giardia Lamblia
p. 1089 |
ingested parasites reside in the duodenum causing malabsorption, from destruction of the microvilli obstruction.
|
|
|
A pt is presented to you following a flood and damge to town. This patient has profuse, painless, watery diarrhea (which appear as rice water), vomiting, leg cramps, and occasionally fever. The patient appears dehydrated. The patient is not malnourished and has significant illnesses. Takes HCTZ and Nexium. Why is this a concern?
|
nexium causes achlorhydria
and HCTZ- causes electrolyte problem: hypokalemia p. 1089 |
Treat w/lots of fluids
|
|
|
What parasitic infx can cause a cough, 2/2 to fecal oral transmission, that later leads to bowel obstruction?
|
Ascaris Lumbricoides
p. 1090 |
Tx: mebendazole, albendazole, ivermectin
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What nematode parasite of the large intestine is distributed globally, tho more heavily in the tropics. Not transmissible from person to person. heavy infestations cause bloody diarrhea and rectal prolapse.
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Trichuris Trichiura
(Whipworm) p. 1090 |
Tx: mebendazole, albendazole
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What parasitic infx causes chronic, severe anemia in children. Cutaneously, called cutaneous larva migrans.
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Ancyclostmoma Duodenale
Necator Americanus p. 1090 |
Tx: mebendazole, albendazole, Pyrantel Pamoate
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What are the MC causes of traveler associated skin dz 3)
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1. exacerbation of a previous condition (atopic dermatitis, psoriasis)
2. envirnomental conditions (photosensitivity, contact dermatitis) 3. infective organisms causing infestations or infections. p. 1091 |
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What are the top 10 tropical travel dermatoses requiring specific therapy?
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1. cutaneous larva migrans
2. pyodermas due to staph or strep 3. ecthyma 4. arthropod reactive dermatoses 5. myiasis 6. tungiasis 7. urticaria 8. Febrile syndrome w/rash 9. cutaneous leishmaniasis 10. Scabies 11. Fungal infx... I'm not joking...the bold says 10, lists 11. Weird p. 1091 |
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What illness is caused by OnchocercaVolvulus, nematode, transmitted by the black fly.
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River blindness
p. 1091 |
- Early Tx: prevents blindness
found near fast moving rivers in Central and South America as well as equatorial Africa |
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What causes leopard skin changes, chronic pruritis, as well as edema?
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Onchocerciasis
p. 1091 |
Treatment is repeated doses of ivermectin
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What is the most important cause of chronic skin ulceration in the world and is spread by sand flies in latin america, middle east and asia?
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Cutaneous leishmaniasis
p. 1092 |
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Elephantiasis. What is that?
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Frequent bouts of fevers, coined filariasis fevers. Caused by WUCHERERIA BANCROFTI- which causes chronic lymangitis/damage, and MC unilateral limb damage.
p. 1092 |
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What is one of the first priorities of a traveler (particularly international) who comes with respiratory problem?
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-isolation: need to be sure not TB, SARS, Influenza
p. 1092 |
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What is SARS?
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Severe Acute Respiratory Syndrome
p. 1092 |
- a traveler from high risk areas should watch their health for 10 days. Fever AND respiratory sxs should seek tx.
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What are the two MC helminths that can cause pulmonary sxs?
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Ascaris Lumbricoidis
and Strongyloides p. 1093 |
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The risk to an exposed health care provider is based on what 5 things?
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1. route of exposure
2. concentration of (#of) pathogens in infx material 3. infx characteristics (virility of the pathogen) 4. the volume (dose) of infx material 5. immunocompetence of the individual exposed p. 1093 |
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What infx control practices are designed to prevent transmission of dz?
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infection control
p. 1093 |
-handwashing
- PPE - cleaning, disinfecting and sterilizing pt care equipment and environmental surfaces - decontamination and laundering or soiled uniforms, clothing, and pt linens - disposal of needles and sharps, and infectious waste - appropriate patient location |
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What does a complete infection control program consist of?
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-administrative controls
-equipment engineering -work practice controls -education of the work force -medical mgt p. 1093 |
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What system of controls for protection of employees: organizes, defines, and directs infection control activities
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Administrative controls
p. 1094 |
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What system of controls for protection of employees: serves to reduce employee exposure by removing the hazard or isolating the health care provider from exposure?
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Equipment controls
p. 1094 |
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What system of controls for protection of employees: serves to modify the performance of a task to minimize exposure to blood and blood containing body fluids and infx material?
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Work practice controls
p. 1094 |
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What system of controls for protection of employees: inform the agents of infx dz, epidemiology, methods of dz transmission, dz signs and sxs and risky work activities, risk reduction, etc.
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Education of the work force
p. 1094 |
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What system of controls for protection of employees: provides vaccinations, acute postexposure prophylaxis, infx disease counseling.
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medical mgt
p. 1094 |
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Why is f/u essential for dermal exposures to healthcare/other workers?
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When the dermal exposure is blood or other potentially infectious material and the skin is NOT intact.
p. 1095 |
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T/F: direct assays for HIV RNA, HCV RNA, are recommended following exposure.
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False. What is recommended is getting conset to test blood of source and testing blood of exposed.
p. 1095 |
see chart p. 1096, 157-7
see also: p. 1098, 157-11 for HIV PEP,expanded version |
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When are standard precautions carried out?
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in the care of all patients
p. 1098 |
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Why is it sometimes necessary to wash your hands when performing a procedure on differing parts of the same person?
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To avoid cross contamination of differing sites.
p. 1099 |
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Why do you replace a soiled gown as soon as possible?
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Because barrier protection is lost when the garment is saturated.
p. 1099 |
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Name some airborne spread diseases (3listed in book)
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-Rubeola (Measles)
-Varicella (including disseminated Zoster) -Tuberculosis p. 1099 |
- it also applies to small particule residue (5 micrometers or smaller) of evaporated droplets that remain suspended air and can be spread over great distances.
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Define Isolation in the ED (for airborne isolation precautions):
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airborne infection isolation requires:
1. monitored negative air pressure in relation to surrounding areas 2. 6-12 air changes per hr 3. d/c of the room air to the outdoors of high effiency filtration of the air before circulated to other areas in the hospital. p. 1099 |
- personalized filtered masks are a must as well.
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What precautions are used when the patient is suspected of having a serious illness transmittable by large droplets (>5macrometers in size) that can be generated by the patient during talking, sneezing, coughing or during the performance of procedures,
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-droplet precautions
p. 1099 |
- their own room when possible
- if not possible, keep 3 ft from others and the other person must hav infx w/same microbe-visitors should be 3 ft away when possible - mask must be worn by pt when in company of visitors p. 1099 |
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Droplet precautions: when is N95 necessary>
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Healthcare workers should wear N95 or higher during procedures are aerosolized, such as suctioning
p. 1099 |
Droplet spread disease:
- H.Influenzae - N. Meningiditis - Diphtheria - Mycoplasma - Pertussis - Pneumonic Plague - Streptococcal - adenovirus - influenza - Mumps - ParvoVirus B19 - Rubella |
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Contact precautions, what are these for?
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Disease spread by contact with the patient, or items in teh patients room.
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- C. Diff
- E. Coli 0157:H7 - Shigella - HepA - Rotavirus - RSV - Parainfluenza Virus - Diphtheria (skin) - HSV - Impetigo - Pediculosis - Scabies - Staph Furunculosis - Zoster - table 157-15 |
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What is the primary cause of TB in humans?
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Mycobacterium Tuberculosis
- mycobacterium africanum - m. bovis - m. microti can all cause tho p. 1100 |
- Negative pressure rooms and Ultraviolet light
- vaccination development/PPD tests - N95 mask etc ANYONE w/risk factors or sxs thought to be c/w this: airborne infx isolation room |
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What is the MC vaccine preventable death in children?
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Rubeola (measles)
p. 1100 |
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How is the transmission of measles?
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Person to person via droplet
p. 1100 |
- isolation helps in preventing spread, but ideally: immunizations is the primary means of prevention
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If someone who works in your hospital did not have their immunizations for measles, how long after exposure do you have to provide vaccine to prevent dz?
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72 hrs
p 1100 |
If > 72 hrs, provide IG, it can be given 6 days after. But this is temporary
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Mumps, how is it spread?
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Airborne, droplet spread (contact w/infected droplet)
p. 1100 |
Isolation ideal- but not always able to prevent new cases.
No benefit IG w/Mumps. Vaccine may help |
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T/F: Transmission of Varicella (VZV) can occur by respiratory droplets, direct contact, inhalation of from vesicular fluid of skin lesions.
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True
p. 1101 |
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How long do you hav after exposure for VZV to provide IG?
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96 hrs.
p. 1101 |
- temporary measure.
- healthcare works w/o immunity are potentially infective for 10-21 days (even if receiving VZVIG) |
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How old should someone be to receive the VZV?
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>/= 60 y/o
p. 1101 |
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What are the peak seasons for the flu?
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December to March
p. 1101 |
CBC recommends N95 respirator for protection
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How long does FLu shot immunization last? when is it most effective?
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Only last 1 yr
- most effecive when 2-4 month before the season p. 1101 |
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What is the drug of choice in the tx of H1N1 Flu?
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Oseltamivir
p. 1101 |
> 1 y/o, sxs no longer than 2 days
- approved for Flu A/B and H1N1 |
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What is the leading cause of meningitis in the US
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- Neisseria Meningiditis
Since reductions in the following: - Strep Pneumo - H. Influenzae p. 1101 |
_ highest risk healthcare exposure:
mouth to mouth resusc. and even intubation. |
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Gram neg diplococci, Whatcha think'n?
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N. Meningiditis
p. 1102 |
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How long can adult lice live off a person?
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2 days
p. 1102 |
-contact w/person to person
- contact with sheets, bed linen. clothing, brushes, etc. _scabies same, but can live 3 days |
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Latex gloves causing inhaltion exposure, how?
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Cornstarch powder on the gloves to making donning easy.
p. 1102 |
read risk factors for allergy: p. 1102, 2nd column
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