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113 Cards in this Set
- Front
- Back
Which blood products do not carry the risk of HIV and hepatitis because they are heat treated?
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albumin and serum globulins
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Who gets CMV-negative blood?
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low birth-weight infants, bone marrow transplant pts and other transplant pts
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What is the number one cause of death from transfusion reaction?
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Clerical error leading to ABO incompatibility
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Stored blood is low in ____ causing a left-shift
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2,3 DPG
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Back pain, chills, tachycardia, fever, hemoglobinuria in pt that has been transfused. May present as diffuse bleeding in anesthetized patient.
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acute hemolysis (ABO incompatibility, antibody mediated)
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What is the treatment for acute hemolysis (ABO incompatibility)
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fluids, diruetics, HCO3-, pressors, histamine blockers
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What is the most common transfusion reaction and what is the pathophys?
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febrile nonhemolytic transfusion reaction. recipient antibody reaction against WBCs in donor blood
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What is the treatment for febrile nonhemolytic transfusion reaction?
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stop transfusion and use WBC filters for subsequent transfusions
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Anaphylaxis after transfusion. What is usually the pathophys?a and was is the tx?
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Usually IgG against IgA in IgA-deficient patient. Tx: fluids, Lasix, pressors, steroids, epi, histamin blockers
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What is the pathophys of transfusion related acute lung injury (TRALI)?
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antibodies to recipient's WBCs, clot in pulmonary capillaries
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Dilutional thrombocytopenia occurs after transfusion of ___ units of PRBCs.
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10
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What electrolyte abnormality can occur with massive transfusion?
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hypocalcemia
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Antiplatelet antibodies develop in ___% of pts after 10-20 platelet transfusions
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20
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Hetastarch (Hespan) can be used up to ___ L without the risk of bleeding complications.
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1
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Most common bacterial contaminate of transfused blood?
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GNRs usually e. coli
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Most common blood product source of contamination?
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platelets (not refrigerated)
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What parasitic disease can be transmitted with blood transfusion?
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chagas disease
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What is the most common blood type?
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O+
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Predominant release of proinflammatory cytokines (IL-2, INF-gamma). Involved in cell-mediated responses
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Th1 helper T cells (CD4)
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Predominant release of anti-inflammatory cytokines (IL-4 -> inhibits macrophages). Involved in atopy and allergic responses.
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Th2 helper T cells (CD4)
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IL-___ causes B-cell maturation into plasma cells (antibody secreting).
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4
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IL-___ causes maturation of cytotoxic T cells
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2
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Recognize and attack non-self antigens attached to MHC class I receptors (e.g. viral gene products)
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Cytotoxic T cells (CD8)
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Infections associated with defects in ___ immunity - intracellular pathogens (TB, viruses)
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cell-mediated
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Can increase T-cell mediated immunity.
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Nucleotides
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What are the types of MHC class I
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A, B and C
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What are the types of MHC class II
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DR, DP and DQ
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CD8 cell activation. Present on all nucleated cells. Single chain with 5 domains. Target for cytotoxic T cells.
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MHC class I
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CD4-cell activation. Present on B cells, dendrites, monocytes, and antigen-presenting cells. 2 chains with 4 domains each. Activator for helper T cells. Stimulate antibody formation.
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MHC class II
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___ infection - endogenous viral proteins produce, are bound to class I MHC, go to cell surface, and are recognized by CD8 cytotoxic T cells
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Viral
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___ infection - endocytosis, proteins get bound to MHC class II molecules, go to cell surface, recognized by CD4 helper T cells -> B cells which have already bound to the antigen are then activated by the CD4 helper T cells; they then produce the antibody to that antigen and are transformed to plasma cells and memory B cells.
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Bacterial
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Not restricted by MHC, do not require previous exposure. Not considered T or B cells. Recognize cells that lack self-MHC. Part of the body's natural immunosurveillance for cancer.
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Natural killer cells
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Initial antibody made after exposure to antigen. Is the largest antibody, having 5 domains (10 binding sites).
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IgM
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Most abundant antibody in body. Responsible for secondary immune response. Can cross the placenta and provides protection in newborn period.
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IgG
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Found in secretions, in Peyer's patches in gut, and in breast milk; helps prevent microbial adherence and invasion in gut.
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IgA
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Membrane-bound receptor on B-cells (serves as an antigen receptor). Which Ab?
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IgD
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Allergic reactions, parasite infections. Which Ab?
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IgE
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Which antibodies fix complement?
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IgM and IgG (requires 2 IgGs or 1 IgM)
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Immediate hypersensitivity-reaction. IgE mediated; mast and basophils release histamine, serotonin and bradykinin. Example include bee stings, peanuts, hay fever.
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Type I
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Hypersensitivity reaction where IgG or IgM reacts with cell-bound antigen. Examples include ABO blood type incompatibility, Graves disease, MG, ITP.
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Type II
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Hypersensitivity reaction that involves immune complex deposition. Examples include: serum sickness, rheumatoid arthritis and SLE
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Type III
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Delayed-type hypersensitivity. Antigen stimulation of perviously sensitized T-cells. Examples include: TB skin test, contact dermatitis.
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Type IV
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Converts lymphocytes to lymphokine-activated killer cells by enhancing their immune response to tumor. Also converts lymphocytes into tumor-infiltrating lymphocytes. Has been shown to be successful for melanoma.
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IL-2
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What is a tetanus-prone wound?
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>6 hrs old; obvious contamination and devitalized tissue; crush; burn; frostbite, or missile injury
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When to give tetanus toxoid or tetanus immune globulin
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Non-tetanus prone wound - give toxoid only if pt has received <3 doses or tetanus status unknown.
Tetanus prone wound - always give toxoid unless pt has had >3 doses and it has been <5 years Tetanus immune globulin is for tetanus prone wounds in non-immunized pt or immunization status unknown. |
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What is the most common immune deficiency?
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malnutrition
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Which part of the GI tract is virtually sterile; some GPCs, some yeast?
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stomach
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Which part of the GI tract has 10^5 bacteria, mostly GPCs?
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proximal small bowel
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Which part of the GI tract has 10^7 bacteria, mostly GPCs, GPRs, GNRs?
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distal small bowel
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Which part of the GI tract has 10^11 bacteria, almost all anaerobes, some GNRs, GPCs?
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colon
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What are the most common organisms in the GI tract?
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anaerobes
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What is the most common anaerobe in the colon?
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bacteroides fragilis
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What is the most common aerobic bacteria in the colon?
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E. coli
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How does e coli trigger the release of TNF-a from macrophages and activate complement and coagulation cascade?
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endotoxin (lipopolysaccharide lipid A) is released
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What is the optimal glucose level in a septic patient?
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100-120
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How is c diff colitis diagnosed?
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fecal leukocytes in stool, C. difficile toxin
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What is tx for c diff?
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oral vancomycin or flagyl; IV - flagyl; lactobacillus can also help; stop other abx or change them
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___% of abdominal abscesses have anaerobes; ___% of abdominal abscesses have both anaerobic and aerobic bacteria
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90, 80
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Tx for abdominal abscess?
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drainage
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Abscesses usually occur how many days after an operation?
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7-10
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When do you start abx for an abscess?
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pts with DM, cellulitis, clinical signs of sepsis, fever, elevated WBC or with bioprosthetic hardware
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Wound infection percentage for a clean operation (ie hernia)?
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2%
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Wound infection percentage for a clean contaminated procedure (ie elective colon resection with prepped bowel)
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3%-5%
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Wound infection percentage for a contaminated procedure such as a GSW to colon with repair?
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5%-10%
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Most common organism overall in surgical wound infections?
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s. aureus
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How to tell the difference between staphlococcus aureus and staphlococcus epidermidis?
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s aureus is coagulase positive
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What is the most common GNR in surgical wound infections?
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E. coli
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What is the most common anaerobe in surgical wound infections?
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B. fragilus
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>___ bacteria needed for wound infection; less bacteria needed if foreign body present.
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10^5
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Which bacteria in infection?
Recovery from tissue indicates necrosis or abscess (only grows in low redox state). Also implies translocation from gut. |
B. fragilis
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Which two types of bacteria can produce an invasive soft tissue infection that can be present within hours postoperatively (produce exotoxins)
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Clostridium perfringens and beta hemolytic strep
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Most common nonsurgical infection?
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UTI (most commonly E. coli)
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Leading cause of infectious death after surgery?
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nosocomial pneumonia
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2 most common organisms in ICU pneumonia?
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#1 s. aureus, #2 pseudomonas
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#1 class of organismis in ICU pneumonia?
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GNRs
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Top three organisms in line infections
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S. epi, S aureus, yeast
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Top three causes of necrotizing soft tissue infections
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Beta-hemolytic streptococcus (group A), C. perfringens and mixed organisms
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What are the following signs and symptoms of:
White blood cell count 20K Thin, gray drainage Edema of entire limb Hyponatremia Skin blistering/sloughing crepitus pain out of proportion to skin findings sepsis |
Necrotizing Soft Tissue Infection
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Tx for necrotizing soft tissue infections?
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early debridement, high dose PCN
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Myonecrosis, gas gangrene and gram stain showing GPRs without WBCs.
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C. perfringens
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Pulmonary sx most common; can cause tortuous abscess in cervical, thoracic and abdominal areas. What type of infection and what is the tx?
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Actinomyces. Tx: drainage and penicillin G
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Pulmonary and CNS sx most common. Tx is drainage and Bactrim. What is the organism?
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Nocardia
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Pulmonary sx most common. Mississippi and Ohio river valleys. What is the organism and what is the tx?
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Histoplasmosis. Amphotericin for severe infections
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Pulmonary sx in the Southwest. What is the diagnosis and what is the tx?
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Coccidioidomycosis. Amphotericin for severe infections
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What fungal infection has CNS symptoms most common and what is the tx?
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Cryptococcus. Amphotericin for severe infections
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What is the tx for candida infections?
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fluconazole (some Candida resistant), amphotericin for severe infections
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What is diagnostic of SBP?
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PMNs > 500 cells/cc (fluid cultures negative in many cases)
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SBP is monobacterial, what are the top 3?
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50% e coli, 30% streptococcus, 10% Klebsiella
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Tx for SBP?
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ceftriaxone or other 3rd generation cephalosporin
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If pt with SBP is not getting better on abx or if cultures are polymicrobial?
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need to rule out intra-abdominal source (diverticular abscess, perforation)
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Which abx for short term prophylaxis against SBP?
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Fluoroquinolone
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What is the cause of SBP?
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decreased host defenses (intrahepatic shunting, impaired bactericidal activity in ascites); not due to transmucosal migration
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What is the cause of secondary bacterial peritonitis?
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intra-abdominal source (transmucosal migration, perforated viscus)
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What are the most common organisms in secondary bacterial peritonitis?
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B. fragilis, E. coli, Enterococcus
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What is the tx for secondary bacterial peritonitis?
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Usually need laparotomy to find source
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Seroconversion after HIV exposure occurs in ___ weeks
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6-12
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What 2 drugs can help decrease seroconversion of HIV after exposure? Should be given within 1-2 hours of exposure.
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AZT and lamivudine
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2 most common reasons for laparotomy in HIV patients?
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opportunistic infections (CMV most common), neoplastic disease (respectively)
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Most common intestinal manifestation of AIDS. Can present with pain, bleeding or perforation.
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CMV colitis
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Lymphoma in HIV patients occurs most commonly which two locations?
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stomach, rectum
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Name two causes of upper GI bleeding in HIV patients?
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Kaposi's sarcoma, lymphoma
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Name three causes of lower GI bleeding in HIV patients?
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CMV, bacterial, HSV
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Tx of brown recluse spider bite?
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dapsone initially, may need resection of area and skin graft for large ulcers later
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Tx for acute septic arthritis?
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drainage, 3rd-generation cephalosporin and vancomycin until cultures show organism
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Tx for diabetic foot infection?
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broad-sprectrum abx (Unasyn, Zosyn)
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What bacteria is found only in human bites; can cause permanent joint injury?
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Eikenella
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What bacteria is found in cat and dog bites?
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Paseurella multocida
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What is the tx for cat/dog/human bites?
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broad-spectrum abx (Augmentin)
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What are the 2 bacteria usually found in furuncles (boil)?
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S. epidermidis or S. aureus
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What is a carbuncle?
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A multiloculated furuncle
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What are the two most common bacteria in peritoneal dialysis catheter infections?
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s. aureus and s. epidermidis
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Tx for peritoneal dialysis catheter infection?
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intraperitoneal vancomycin and gentamicin; increased dwell time and intraperitoneal heparin
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Need removal of peritoneal dialysis catheter for which type of infections?
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all fungal, TB and pseudomonas infections
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