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37 Cards in this Set
- Front
- Back
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PE finding pathognomonic for chronic osteo |
draining sinus tract |
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preferred imaging technique for diagnosing osteomyelitis? |
MRI (sens, but not fully specific) -f/u MRI's generally not necessary CT scan if contraindicated |
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gold standard for diagnosing osteomyelitis? |
Bone bx (open or needle asp) |
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Signs predictive of contiguous osteomyelitis in DM foot ulcers? |
> 2 cm 2 weeks or longer Visible bone or + probe-to-bone (no need to image) |
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How to improve outcome in DM foot ulcer? |
early debridement before abx revascularization glucose control wound management |
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Abx choice for DM foot ulcer emperically? |
i. vanco + GN coverage ii.(cef / cipro / levo) + (clinda / metro) iii. Beta lactamase inh + cerbapenem tx for 6 weeks |
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vertebral osteo, dx? |
ESR/CRP Blood Cx If blood cx neg, do CT-guided percutaneous needle aspirate biopsy and culture |
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vertebral osteo, tx? |
empiric regimen: vanco + broad-spectrum antibiotic against gram-negative bacilli, - 6-8 wks at least - no oral unless cipro sensitive organism, or chronic suppressive tx with retained hardware - surgery not required unless abscess or unstable spine |
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== Fever of Unknown Origin === |
== Fever of Unknown Origin === |
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Classic FUO |
T > 38C > 3 weeks 3 days of hospital dx or 2 OP visits |
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HC-Associated FUO |
T > 38C > 3 days in hosp pt no infection on admission |
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Immune-def FUO? |
> 38C > 3 days 48 hrs incubation of cultures with nothing + |
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HIV FUO? |
T > 38C > 3 weeks OP, > 3 days IP |
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fever-free intervals of at least 14 days occur in patients with recurrent fever of unknown origin What to consider? |
Hereditary periodic fever syndromes: - hyperimmunoglobulin D syndrome, - TNFreceptor-1–associated periodic syndrome - Muckle-Wells syndrome, - familial Mediterranean fever |
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dshj |
hkjh |
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hjk |
jhk |
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=== PRIMARY IMMUNODEFICIENCY ==== |
=== PRIMARY IMMUNODEFICIENCY ==== |
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selective IgA deficiency, sx |
- chronic or recurrent respiratory tract infections, atopic disorders, and an increased frequency of autoimmune disorders - may have anaphylactic rxn to blood trf => give washed RBCs |
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What is Common variable immunodeficiency (CVID) ? |
- impaired B cell differentiation and defective immunoglobulin production |
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CVID sx? |
chronic lung diseases, AI disorders, malabsorption, recurrent infections, and lymphoma, - response to vaccination is poor or absent. - Sinopulmonary infections, ear infections, and conjunctivitis - caused by pneumococci |
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CVID dx? |
measure IgG, IgA, IgM - response to vaccination should be tested by determining the response to protein- and polysaccharide-based vaccines [unless IgG already < 200] |
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CVID tx? |
IG replacement - avoid ppx abx unless chronic lung dz or on steroids or immunosuppressives |
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i. Deficiencies of C3, factor H, factor I, and properdin are associated with? ii. Deficiency of the terminal complement components C5, C6, C7, and C8 ? |
i. severe infection from encap org ie. S. pneumo ii. nesserial infectional (meningo / gono) cocci |
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d |
j |
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most common autoimmune disorder in patients with complement deficiencies |
SLE |
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if complement pathway defect is suspected, patients should be tested for |
- total hemolytic complement (CH50). - If the serum CH50 concentration is very low or undetectable, specific complement components should be measured. |
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management of pt with complement deficiencies? |
Vaccination Give all routine vacc including meningo, pvax, H. flu. |
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kjl |
;lkj |
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BIOTERRORISM |
== BIOTERRORISM === |
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dx of anthrax? |
PCR) of blood, tissue, or fluid samples. The presence of mediastinal widening on a chest radiograph or CT scan is suggestive of inhalational anthrax |
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Anthrax, tx? |
Cipro or doxy + 1 or 2 other abx (PCN, carbap, etc), 60 days total |
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tx for smallpox |
Give vaccine is exposed within 3 days
- cidofovir may have some therapeutic efficacy |
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Yersinia Plague, tx? gram stain and appearance? |
streptomycin and gent alt: doxy and fluroquino 10 days tx, resp droplet precuations bipolar staining Gram-negative bacillus giving the appearance of a closed “safety pin” is virtually pathognomonic |
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botulism signs? |
classic triad of (1) descending flaccid paralysis with prominent bulbar signs (diplopia, dysarthria, dysphonia, and dysphagia), (2) normal body temperature (3) normal mental status. |
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botulism tx |
supportive care and the early administration of an equine-derived trivalent antitoxin |
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tularemia sx? |
abrupt-onset fever, chills, myalgia, and anorexia
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Tularemia treatment of choice
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streptomycin or gentamicin for 7 to 14 days
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