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267 Cards in this Set
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If you have a pt. with Staph A. in the bone, heart, joint, or skin...what would you consider ordering IV?
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IV: Naficillin/Oxicillian, Dicloxacillin or Cefazolin (1st)
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If you have a pt. with Staph A. in the bone, heart, joint, or skin...what would you consider ordering orally?
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Dicloxicillin
Cephlexin |
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If you have a pt. with a S.Aureus resistant bug what would you order for a severe infection?
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Severe---Vanc, Linezolid, Daptomycin, Tigecycline
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If you have a pt. with a S.Aureus resistant bug what would you order for a minor infection?
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Minor--Bactrim, Clindamycin
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If you have a pt. with a S.Aureus bug what would you order for a PCN allergic pt and they have a RASH?
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Cephalosporin
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If you have a pt. with a S.Aureus bug what would you order for a PCN allergic pt and they have a Anaphylaxis
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Macrolide (Azithromax, Clarithromycin); or Clindamycin
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If you have a pt. with a S.Aureus bug what would you order for a PCN allergic pt and they have a Severe infx?
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Vanc, Linezolid, Daptomycin
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If you have a pt. with a S.Aureus bug what would you order for a PCN allergic pt and they have a minor infx.
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Macrolide (azithromax, clarithromycin), Clindamycin
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If you have a pt. with a Strep. bug what would you order just STREp?
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PCN
Ampicillin Amoxicillin |
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If you have a pt. with a Gram negative bacilli bug E.coli, Enterbocter, citrobacter, morganella, pseudomonas, serratia and you want a cephalosporin?
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Cefepime
Ceftazdime |
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If you have a pt. with a Gram negative bacilli bug E.coli, Enterbocter, citrobacter, morganella, pseudomonas, serratia and you want a PCN?
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Piperacillin
Ticaricillin |
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If you have a pt. with a Gram negative bacilli bug E.coli, Enterbocter, citrobacter, morganella, pseudomonas, serratia and you want a Monobactam?
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Aztreonam
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If you have a pt. with a Gram negative bacilli bug E.coli, Enterbocter, citrobacter, morganella, pseudomonas, serratia and you want a Quinolong
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Cipro
Levoquin Gatiflox Moxiflox |
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If you have a pt. with a Gram negative bacilli bug E.coli, Enterbocter, citrobacter, morganella, pseudomonas, serratia and you want a Aminoglycoside?
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Gent
Amikacin Tobramycin |
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If you have a pt. with a Gram negative bacilli bug E.coli, Enterbocter, citrobacter, morganella, pseudomonas, serratia and you want a Carbapenems?
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Imipenem
Meropenem Ertapenem |
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Which is the only Carbepenem that doesn't cover psudomonas?
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Enterapenem
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Does pipericillian and ticaracillin cover strep and anaerobes too?
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YES
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What drugs are excellent against pneumococcal?
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Aminoglycosides---Levaquin, Gatifloxacin, Moxifloxacin
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What drugs are excellent against anaerobes and cover strep and MSSA?
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Carbepenems---Imipenem, Ertapenem, Meropenem
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What covers MRSA and is good against gram-neg bacilli (E.coli, Pseudomonas, serratia, Enterobacter, pseudomonas, morganella, citrobacter)
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Tiglecycline
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What drugs come to mind to treat GI anaerobes (bacteriodes)
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Metro (Flagyl
Pipercillin, Ticaricillin Carbepenems (imipenem, meropenem, ertrapenem) Cefoxitin and Cefotetan |
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What drugs come to mind to treat respiratoryI anaerobes ?
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Clindamycin
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What drugs come to mind that don't treat anaerobes
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aminoglycosides, aztreonam, fluorquinolones, aminoglycoside, oxacillin/nafacillin, cephalosporins except ceftetan and cefoxitin
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What drug would you give if you suspect a pt. has HSV, Varicella Zoster?
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Acyclovir, Famcyclovir, Valacyclovir
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What drug would you give if you suspect a pt. has CMV?
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Ganciclovir and Foscarnet
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What is the side effect to be aware of with Gancicyclovir?
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Neutropenia and BM suppression
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What is the side effect to be aware of with Foscarnet?
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Renal toxicity
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What do you treat a pt. with Influenza A and B?
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Oseltamivir and Zanamivir
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What do you treat a pt. with Hep C and RSV?
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Ribavirin
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What do you give a pt. to treat chronic Hep B?
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Lamivudine, Interferon, Adefovir, Entecavir, and Telbivudine
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What drug would you order to treat Candida or crypto orally or vaginally?
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Fluconazole
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What drug would you order that is similar to fluconazole but less easy to use?
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Itraconazole
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What drug covers ALL Candida incl Krusei or glabrata)?
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Voriconazole
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What is the side effect of voriconazole?
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Visual disturbance
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What si the drug you woudl order for neutropenic patients with a fungal problem?
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Echinocandins---Caspofungin, micafungin, anidulafungin
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Do echinofungins cover crypto?
(captofungin, micafungin, anirudofungin) |
No
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Do echinofungins have any human toxicity adverse effects?
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NO, b/c it acts on .4 glucan synthesis
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Why is ampohtericin good...what does it work on?
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Cryto, Candida, and Aspergillus
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When you want to treat Aspergillus, what drug would you order, and why?
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Voriconazole, b/c it's better than Ampho
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When you watn to treat a neutropenic pt. with a fungal prob. what will your order, and why?
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Echinocandins (Captofungin, micafungin, andirufungin), b/c it's better than Ampho
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when you want to treat Candida in a pt. which drug would you choose? Why?
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Fluconazole, b/c less s/e than Ampho
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Why is ampho so terrible?
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Nephorotox and Ototox
Hypokalemia Metabolic acidosis Fever, shakes, chills |
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What should you think of when you see a DM or PVD pt. with an ulcer or soft tissue infx.
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Osteomyelitis
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What would you order as the first initial test to diagnose Osteomyelitis?
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Xray
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Waht is the second line test to order in an osteo?
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MRI
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Why do you not see Osteomyelitis on a xray immediately?
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B/c you have to lose more than 50 percent of bone calcium before it shows up on xray
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What is the EARLIST finding of Osteo on an Xray?
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Periosteal elevation
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What is the MOST accurate dagnostic test for Osteomyelitis?
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Bx and Culture
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What should you measure to follow up therapy for osteomyelitis?
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ESR
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Why do you get a MRI vs Bone scan for Osteomyelitis?
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B/c bone scan doesn't tell if the infection is in the bone or soft tissue
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What is the most common way people get osteomylietis?
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Direct contiguous spread
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Which test has a better sensitivity MRI or Bone scan for Osteo?
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They both have equal sensitivity
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Which test has a better specificity MRI or Bone scan for Osteo?
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MRI
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When doing a culture is it okay to do a swab of the ulcer?
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NO
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How do you follow and make sure treatment is appropriate for osteomyelitis?
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Follow the ESR
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What is the most likely bug in a normal person with OSTEO?
What would you give as treatment? For how long? What if the bug is a resistant bug...what woudl you use for treatment? |
Staph A.
Nafacillin/Oxacillin, Dicloxacillin, or cefazolin 4-6 weeks MRSA==Vanc, Linezolid, Daptomycin, or Tigelcycline |
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Can you give oral ABx for Osteo?
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NO
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What is another cause of Osteo that occurs in sickle cell pt?
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Psuedomonoas or Salmonella
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What would you do to a pt. with pseudomonas or salmonella infx. causing osteo? What would you have to do first?
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Confirm with Bx and Clx that it is Osteo. b/c organism must be sensitive to ABx.
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What do you think of when you see an ear infection and swimming?
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Otitis externa
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what do you give to treat otitis externa?
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ofloxicin or polymyxin/neomycin
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why would you add an topic hydrocortisone to ofloxicin or polymyxin/neomycin mixture to treat otitis externa?
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hydrocortisone will decrease the itch and swelling
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what does swimming do to create otitis externa?
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strips the acidic enviornment from the external ear.
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what can you add to re-acidify the ear and help ieliminate the infection?
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acetic acid and water solution
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If you have a
DM pt. with an ear infection, what should you think of? |
Pseudomonas---malignant otitis externa
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Why is malignant otitis externa impt.?
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b/c it can extend to the skull and cause destruction
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How would you treat malignant otitis externa? what would you order first?
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xray of the skull
then order MRI for more accuracy, and to confirm do a bone bx and culture. |
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How do you treat malignant otitis externa?
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surgical debridement and
Abx against pseudomonals---pipercillin/ ticaricillan, azobactam, fluorquinolones, carbepenems, cefpime |
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When a pt. c/o decreased or muffled hearing, what should you consider?
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Otitis media
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what will you find on Physical for otitis media?
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redness, bulging of TM, decreased hearing, loss of light reflex, IMMOBILE TM
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What is the key thing to look for in otitis media?
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IMMOBILITY of the TM
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What should you give (medicine) first in otitis media? For how long?
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amoxicillin
7-10 days |
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What is the MOST accurate test to diagnose otitis media?
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Typanocentesis and aspirate of the TM for culture
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What should you do if after 3rd or 4th day of treatment of otitis media, amox is not working?
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Switch to
Amox-Clav (augmentin) Cefdinir Cefibuten Cefuroxime Cefprozil |
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What if you see a pt. with nasal discharge, HA, facial pain, and decrease transillumination , what are you thinking?
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Sinusitis
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What if you see a pt. with nasal discharge, HA, facial pain, and decrease transillumination , what are most likely organisms?
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S. pneum, M. CAtarhallis,
H. Influenza |
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What is the treatment for sinusitis?
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Amoxicillin for 7 days,
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What is the best initial diagnostic test for sinusitis?
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X-ray
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What is the MOST accurate diagnostic test for Sinustiis?
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sinus aspirate for culture
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What do you suspect if you look in the throat and you see exudates, LAD, and pt. c/o pain with no cough or hoarsness?
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Strep. pharyngitis (throat)
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What is the first test you would order?
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Rapid strep test
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What is the worry if the strep test comes back positive for GAS
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GN or RF
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What is the MOST accurate diagnostic test for Strep throat?
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Culture
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What do you treat with if your rapid strep test comes back positive?
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PCN or Amoxicillin
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What do you treat strep throat with if the pt. is PCN allergic?
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clarithromycin, or azithromax
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What if you see a pt. with arthralgia, myalgia, cough, HA, fever, sore throat and feeling of tiredness, what are you thinking?
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Influenza
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What is the next best step in diagnosing a pt with What if you see a pt. with arthralgia, myalgia, cough, HA, fever, sore throat and feeling of tiredness?
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Viral antigen detection of a Nasopharyngeal swab
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What do you treat at pt. with with arthralgia, myalgia, cough, HA, fever, sore throat and feeling of tiredness?
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oseltamivir or zanamivir if it's within 48 hours
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What is the most superficial bacterial skin infections?
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Impetigo
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What are the bugs involved in impetigo?
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Staph and strep pyogenes
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What are you thinking when you see weeping, crusting, adn oozing and honey colored lesions of the skin?
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Impetigo
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What is the treatment of Impetigo topically?
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Topical mupirocin or bacitracin
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What if there is severe impetigo what is treatment?
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Oral dicloxicillin or cephalexin
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What is treatment of Comm-acquired MRSA?
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Bactrim or Clinda
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What is the treatment in a pt. with Impetigo that is PCN allergic and has anaphylaxis?
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Azithromax/ Clarithromycin
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What is the treatment in a pt. with Impetigo that is PCN allergic and has Severe infx. and anaphylaxis?
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Vanc, Daptomycin, Linezolid
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What if there is a skin infx caused by GAS that is very bright red and hot..what are you thinking?
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Erisypelas
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Where is the most common site of seeing hot bright red eriysipelas?
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The face
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What do you do to diagnose erysipelas?
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Blood culture
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What is the treatment of Erisypelas initially?
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ORAL Dicloxacillin or Cephalexin
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What if the organism is def. GAS for Erisypelas and confirmed, what do you treat with ?
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PCN V K
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Can Erisypelas lead to RF ?
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NO, only pharyngitis caused by GAS
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Can Erysipelas lead to GN?
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Yes, both skin and Pharyngitis can lead to GN caused by GAS
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What if you see warm, tender, swollen, red skin on the arm or leg?
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Celllulitis
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What is the treatment in a pt. with Impetigo that is PCN allergic and has anaphylaxis?
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Azithromax/ Clarithromycin
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What is the treatment in a pt. with Impetigo that is PCN allergic and has Severe infx. and anaphylaxis?
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Vanc, Daptomycin, Linezolid
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What if there is a skin infx caused by GAS that is very bright red and hot..what are you thinking?
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Erisypelas
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Where is the most common site of seeing hot bright red eriysipelas?
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The face
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What do you do to diagnose erysipelas?
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Blood culture
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What is the treatment of Erisypelas initially?
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ORAL Dicloxacillin or Cephalexin
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What if the organism is def. GAS for Erisypelas and confirmed, what do you treat with ?
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PCN V K
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Can Erisypelas lead to RF ?
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NO, only pharyngitis caused by GAS
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Can Erysipelas lead to GN?
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Yes, both skin and Pharyngitis can lead to GN caused by GAS
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What if you see warm, tender, swollen, red skin on the arm or leg?
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Celllulitis
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What if you see cellulitis, what should you order?
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Lower extremity Doppler
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What are the bugs involved in cellulitis?
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Staph A. and Strep pyogenes
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What is the treatment for minor disease of cellulitis?
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ORAL Dicloxacillin or Cephalexin
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What is the treatment of severe cellulitis?
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Nafacillin/Oxacillin, Dicloxacillin or Cephzolin which are IV
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What is the treatment of Cellulitis if you have a PCN allergy and a RASH
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Treat with a cephalosporin
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What is the treatment of Cellulitis if you have a PCN allergy and anaphylaxis that is MINOR?
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Azithromycin/ Clarithromycin
clindamycin |
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What is the treatment of Cellulitis if you have a PCN allergy and anaphylaxis and SEVERE infection?
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Vanc, Linezolid, Daptomycin
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How do you treat folliculits, furuncles, carbuncles?
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Same as cellulitis
dicloxacillin or Cephalexin |
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What do you do to treat boils?
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Drain
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What is your fear with strep and skin infections?
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Can develop Post-strep GN
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What are you thinking if you see a skin infection with itching of scalp, or you see dandruff, or bald patches?
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Fungal infection
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What do you think of if you see thickened, yellow, fragile, and broken nails?
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Onuchomycosis
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What is the intial treatment for diagnosing fungal infections of the nail bed?
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KOH prep---place a scrapping on the slide adn warm it up ?
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What will you see on a KOH prep for a skin or nail infection?
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epithelial cells dissovle and the fungus remains on the slide
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What is the treatment of a fungal skin infection with NO hair or nail involved?
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Topical treatment----Clotrimazole, miconalzole, ketoconazole, econazole, terconazole, nystatin, ciclopirox
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Waht do you treat a fungal infection if the scalp or NAIL IS involved?
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Terbinafine
Itraconazole Griseofulvan |
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What test do you order if there is Terbinafine
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LFT
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What drug do you order for tinea capitis?
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Griseofulvan
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When considering urethritis, what must be present?
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discharge
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What is the best initial diagnostic test to diagnose urethral discharge?
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urethral swab for G-stain, culture, and DNA probe
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What is anotehr test to determine urethritis other than swab?
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Nucleic acid amplification
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What drugs would you order to cover urethritis?
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Ceftriaxone and
Azithromax or Doxy (7days) |
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Why do you order 2 drugs for urethritis?
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To cover for Gono and Chlamydid
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What oral drugs can you order for GONO?
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Cefixime or Cefpodoxime
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what oral drug can you order for chlamydia
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Doxy
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What drug would you give to treat GONO in a pregnant pt.
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IM Ceftriaxone
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What drug would you give to treat Chlamydia in a pregnant pt.
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Azithro
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What should you test for a pt. with recurrent Gono infections?
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Terminal complement defic
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What tests would you order if you see cervical discharge?
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CERVical swab for stain, culture and DNA probe
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What is the treatment for cervicitis?
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Treat with 2 drugs
Ceftriaxone and Azithromax (1 dose) or Doxy (7days) |
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What bugs are you covering when you treat for cervicitis/
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Gono and chlamydia
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What oral drugs can you give to treat GONO?
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Cefixime or Cepfodixime
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What oral drugs can you give to treat Chlamydia?
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Azithromax or DOxy
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What drugs would you give to treat a preg pt. with GONO?
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Ceftriaxone IM
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What drug would you give to treat a pregnant pt. with Chlamydia?
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Azithromax
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What tests would you order if you see lower abdominal pain, fever, Cervical motion tenderness and high WbC
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preg test
G & C culture swab for culture, gram stain, and DNA |
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What is the MOST accurate test for diagnosing PID?
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Laproscopy
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Most common STD that is a virus?
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HIV
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M/C STD that is a protozoa?
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Tric
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M/C STD that is a Bacteria?
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Chlamydia
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A pt. comes with lower abdominal pain, CMT, high wbc, and fever, what is the next best step?
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Urine preg test to r/o Ectopic preg
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What is the treatment for PID in an outpt. setting?
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Ceftriaxone IM and Doxy (oral for 7 days)
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What is the treatment for PID in an inpt. setting?
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Cefoxitin IV OR Cefotetan IV
and doxy ` |
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What Abx are safe to use in preg?
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PCN
Cephalosporin Aztreonam Erythromycin Azithromax |
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What is the difference btwn Epididymitis and Testicular torsion?
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Both come with painful tender testicle.
Epididymitis is in NORMAL position Torsion is in TRANSVERSE position |
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What is the treatment for Epididymitis in a <35 y/o pt.
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Ceftriaxone and Doxy
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What is the treatment for Epididymitis in a >35 y/o pt.
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Fluroquinolone
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There are 6 ulcerative genital diseases...they all have enlarged LN...what is more important with these diseases?
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Ulcers
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What are the 6 Ulcerative Genital diseases?
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1. Chancroid, LGV, HSV2, Syphillis, Granuloma Inguinale, Warts
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What is the causitive agent of chancroid and how does the ulcer present?
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H. Ducreyi
Ulcer= painful |
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What is the first test to do for Chanchroid?
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Swab for g-stain, culture, DNA probe
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What will you find on culture of a chanchroid?
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G-neg. coccobacilli
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What is the treatment of chanchroid?
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IM Ceftriaxone OR
Oral one dose Azithromax |
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What do you suspect when you see a genital ulcer with LARGE Tender nodes with a sinus tract?
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LGV
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what is the inital diagnostic study for diagnosing LGV?
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Culture for g-stain, culture, and DNA probe
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What will you find on culture for LGV?
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Chlamydia
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What is the treatment for LGV?
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Aspirate the Bubbo (large suppurating LN) and treat with Doxy (7 days)
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What if you see MULTIPLE vesicles on the genitals? What is the next step in management?
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think HSV2
Mgmt= Start treatment with Acyclovir, Valacyclovir, or Famicyclovir for 7-10 days |
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What if you find a pt. with MULTIPLE vesicle ulcer in genitalia and the roofs have come off, how do you diagnose the ulcer/
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tZANac prep
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What if a pt. comes with a painless genital ulcer that is firm, what is the pathogen?
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Treponema Pallidum
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What is the MOSt ACCURATE diagnostic test?
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Darkfield Microscopy
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What is the treatment of Chancre?
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IM one shot of PCN
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What if you see a chancre and the pt. is allergic to PCN?
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Give doxycycline
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What is you see Maculopapular rash with Palm and SOLE with a thick white flat and velvety patch on the genitals...what should you think??
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2ndary syphyllis
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What is the treatment of 2ndary syphyllis?
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IM PCN
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What if the pt. is allergic to PCN in 2ndary syphyllis?
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doxy
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What do you order if you see a pt. in the ER whose pupils accomodate but don't react or has general paresis?
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order RPR and FTA, lumber pucture for VDRL and FTA
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What is the treatment for tertiary neurosyphyllis?
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IV PCN
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What if a pt. is considered to have neurosyphyllis and is allergic to PCN, what should you do?
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Desensitize
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What if a pt. is preg and is allergic to PCN, what should you do?
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Desensitize
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What do you think of if you see a RED, BEEFY, genital lesion that ulcerates?
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Granuloma Inguinale
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What is the inital diagnostic test of granuloma Inguinale?
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Biopsy or Touch prep
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What is the treatment of Granuloma Inguinale?
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Doxy or Bactrim
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What is the treatment of Pediculosis and Scabies?
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Permethrin or Lindane
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What are these considered: Condyloma Accuminata
Molluscum Contagiousm Verracuous wart |
Warts
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How do you treat warts?
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By mechanically removing them
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What are the removal options of warts?
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surgery
Imiquimod (sloughs off the wart) Cryotherapy, larser removal and melting with podophylin |
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There are 3 animal borne disease...what are they?
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Leptosppirosis, Tularemia, and cysticercosis
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What do you suspect if you have animal exposure, jaundice, and renal involvment?
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Leptospirosis
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What do you think of if you see a pt. exposed to animals with abdominal pian and muscle aches and fever?
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Leptospirosis
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what do you diagnose leptospirosis with?
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Serology
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How do you treat this spirochete....leptospirosis?
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Ceftriaxone or PCN
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What do you think of if a pt. on vacation in the summer visits a friend with a rabbit. Latrer they develop an ulcer on his hands and enlarged LN. His eyes have conjunctivits...what do you diagnose with?
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Serology to look for Tularemia
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What is a precaution that must be taken if considering a pt. with Tularemia?
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don't take culture as it can be dangerous as the spores can cause pneumonia
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What are you thinking if you see a CT of the head with thin-walled cysts that are calcified after a pt. came from eating at a Barb-q
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Cystercercosis
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What do you treat cystercercosis with?
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Albendazole
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What do you treat a UTI with and for how long?
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3 days of Bactrim
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what if pt. has UTI and Allergic to sulfa, what woudl you order?
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Cipro or levaquin
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What if a pt. is DM, or has a stone or stricture and has a UTI what drug would you order? and for how long
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Bactrim for 7 days OR
Cipro for 7 days |
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What if you have UTI features with flank pain and tenderness,what would you do to diagnose it initally? what are you thinking?
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UA and Urine culture
Pyeloneph |
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What is the drug you would choose to treat pyeloneph as an outpt? What about inpt?
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Cipro---outpt
Amipcillin/Gent--inpt |
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what is a rare complication of pyelonephritis? When do you suspect it?
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Perinephritic abscess
suspect when a pt. does not respond to treatment after 5-7 days |
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what is the most accurate diagnostic test to determine perinephritc abscess?
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biopsy
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what do you order to treat perinephritic abscess?
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Quinolone and ADD staphy coverage like oxacillin or nafacillin
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What do you suspect if there if F. U. D. and perineal or sacral pain?
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Prostatitis
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How do you treat prostatitis?
How is treatment different for prostatis compared to cystitis? |
`ciproflox
you have to treat prostatis for a longer period of time |
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What is diagnostic for IE? how many major vs minor
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2 Major
1 major and 3 minor OR 5 minor |
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What is considered major for IE?
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2 positive BClx with staph, strep. V., strep bovis, enterococci, g. neg rods, candida
or HACKEK organisms or Abn. Echo---intracardiac mass or valvular beg Abscess or new dehiscence of prostheic valve |
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What is the first step to do if you see a fever and murmur or change in murmur?
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Blood cultures
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What do you do if you suspect IE and blood cultures are positive, what's next step?
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Echo
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What do you suspect if you have 2 positive blood cultures and a positive echo?
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Infective Endocarditis
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What is the treatment of IE?
for how long? |
Vanc and Gent for 4-6 weeks
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If the blood culture comes back positive for Strep Bovis what else should you do when diagnosising IE?
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Colonoscopy--Bovis has a high rish of colon pathology
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What is the strongest indication of surgery in IE?
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anatomic defects
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When do you order prophylaxis for endocarditis?
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prosthetic Valve
unrepaired CYANOTIC heart ds Previous endocarditis Transplant pt. who get valve ds. |
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What procedures need IE prophylaxis?
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Dental surgery with bleeding
Respt. tract surgery Surgery of infected skin |
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What drug would you give if you were to have dental surgery with bleeding and were going to give prophylaxis for IE?
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Amoxicillin
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What if you were to have dental surgery with bleeding and were going to give prophylaxis for IE but allergic to PCN?
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Clindamycin
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Do dental fillings need prophylaxis for IE?
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nO
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Do flexible scopes need prophylaxis for IE?
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NO
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Do OB/GYN procedures need prophylaxis for IE?
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NO
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Do urinary procedures need prophylaxis for IE?
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NO
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When do you start treatment for HIV/AIDS?
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CD4 <350
Symptomatic pt. with any CD4 Preg woman Needstick with Known HIV |
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What drugs do you start for HIV?
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Tenofovir,Emticitabin and
Efaveirenz OR AZT, Lamivudine, and Efaverins OR AZT, Lamivudine, and Ritonavir/Lopinavir |
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What is the adverse effect of AZT?
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Anemia
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What is the adverse effect of Didanosine
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Pancreatitis and Peripheral neuropathy
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What is the adverse effect of Stavdine
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Pancreatitis and peripheral neruopathy
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What is the adverse effect of Abacavir?
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Rash
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What is the adverse effect of Indinavir?
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Kidney stones
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What shoud you do if you get stuck by a needle infected with known HIV positive blood?
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tenofovir, entracibine, enfaveriz for 1 month
Basically HAART for 1 month |
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What shoud you do if you get your mucosal surfaces exposed with known HIV positive blood?
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Basically HAART for 1 month
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What shoud you do if you get your unprotected sexual contact wiht known HIV positive blood?
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HAART for 1 month
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what do you do if a pt. is already preg and taking HAART meds?
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cont. the meds
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what do you do if the pt. is preg. and her CD4< 350
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start meds (HAART)
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what do you do if the pt is preg and her CD4> 350 and low viral load?
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start HAART in 2nd or 3rd trimester
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When you see a pt. that is HIV and the CD4 is less than 200, what shoudl you do and why?
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Start Bactrim to prophy against PCP
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What if you have a pt. who is HIV and CD4 is less than 200 and you start Bactrim and they get a rash/
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Switch to Atovoquone or Dapsone
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What if you have a pt. who is HIV and has G6PD and CD4 is less than 200 and you start Bactrim and they get a rash/
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Don't use dapsone
Only try with Atovoquone |
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Wht do you do if you have a HIV pt. with CD4 < 50 for prophy?
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Start oral azithromax once a week for prophylaxis
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what do you do if you have an HIV pt. who has SOB, DRY cough, hypoxia for a few weeks, and looks ill with a high LDH?
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Initial= CXR
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HIV pt. who has SOB, DRY cough, hypoxia for a few weeks, and looks ill with a high LDH and a CXR shows increase interstial markings bilaterally?
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Do a BAL to look for PCP
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What would you treat with if you have HIV pt. who has SOB, DRY cough, hypoxia for a few weeks, and looks ill with a high LDH and a CXR shows increase interstial markings bilaterally?
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IV Bactrim
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What if you treat HIV pt. who has SOB, DRY cough, hypoxia for a few weeks, and looks ill with a high LDH and a CXR shows increase interstial markings bilaterally with Bactrim and they get a RASH, what do you do?
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IV pentamidine
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What do you treat MILd PCP with if pt. can't tolerate Bactrim?
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Atovoquone
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What is the difference in Dapsone and Atovoquone regarding PCP?
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Dapsone is only used for PROPHYlaxis and not treatment...doesn't come in IV
Atovoquone can be used for treatment and prophylaxis |
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What do you treat PCP with if it is severe...i.e. pO2<70 or
A-a gradient >35? |
Steroids
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You have an HIV pt. with ring enhancing lesion, what do you treat with? For how long? and what do you do to f/u?
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Pyrimethamie and
Sulfasdiazine for 2weeks F/U with Head CT |
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What if on f.u CT of a ring enhancing lesion in an HIV pt. treated with pyrimethamine and sulfadiazine the lesion doesn't decrease in size?
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think of lymphoma AND do a brain biopsy
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What do you suspect if a HIV pt. comes with CD4 < 50 AND blurry vision?
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CMV
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wHAT SHOULD you do to diagnose CMV in HIV pts?
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Dialated opthamologic exam --you see the lesions on exam
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What do you treat CMV in HIV pts?
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Ganciclovir or Foscarnet
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What is the maintenance therapy treatment for CMV?
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ORAL vanganciclovir
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What happens if you are treating a HIV pt. with HAART and their CD4 level raises and pt. is being treated for CMV?
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Stop the CMV medication
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What do you suspect if you see a HIV pt. with CD4<50 and fever and HA?
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Crypto
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What should you do to diagnose a HIV pt. with CD4<50 and fever and HA?
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lumbar puncture with India ink
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What is the most accurate test to diagnose Crypto?
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Crypto Antigentest
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What do you treat Crypto with initially?
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Ampho.
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Once you have started Ampho to treat crypto, what other drug should you add?
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Fluconazole
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Waht if you have an HIV pt. with FND and CD4< 50, and what is the first thing you will do?
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CT head or MRI
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When you do a CT head or MRI on a HIV pt. with FND and CD4< 50, what if you find no enhancing lesion, what do you suspect?
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PML
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What do you do if you have PML for treatment?
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nOthing, just cont. HAART therapy
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What if you find CD4<50 and fever, wt. loss and fatigue with anemia, what will you do ?
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BM biopsy or Liver BX
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What do you TREAT a pt. with a CD4<50 with fever, wt. loss and fatigue with anemia
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Clarithromycin and Ethambutol
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