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29 Cards in this Set
- Front
- Back
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The treatment of severe sepsis should be based on ... |
Efficient resuscitation Effective antimicrobial therapy Elimination of secondary infections Euglycemia Early targeted and specific drug therapy Establishment of therapeutic goals |
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What is the most common agent implicated in acute bacterial meningitis |
Streptococcus pneumoniae |
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What is the goal BP in hypertensive subjects with diabetes mellitus and/or chronic kidney disease |
<130/80mmHg |
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Bilateral small kidneys in a patient with azotemia confirms ... |
Chronic renal failure |
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What is the principal mechanism of bicarbonate reabsorption |
In the proximal tubule through Na+ H+ exchanger activity |
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CSF findings - Bacterial meningitis |
Predominantly PMN Low glucose High protein Gram stain positive |
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CSF findings - Viral meningitis |
Predominantly mononuclear High glucose High protein Negative gram stain |
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CSF findings - Mycobacterial/fungal |
Predominantly mononuclear Low glucose High protein Negative gram stain |
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5 leading causes of cerebrovascular disease (stroke) |
Embolism Atherosclerotic disease Lacunar infarcts Hypertensive haemorrhage Rupture aneurysms/AV malformation |
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Major risk factors for cerebrovascular disease |
Hypertension Hypercholesterolemia Smoking Cardiovascular disease (esp. AF or recent MI) Advanced age Diabetes mellitus Migraines OCP |
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What investigations can help you differentiate ARF from CKD? |
Urinary sediment Acute interstitial nephritis - RBC and WBC casts whereas CKD has broad casts Significant anaemia, hyperphosphatemia, hypocalcaemia and changes of renal osteodystrophy suggest CKD Demonstration of shrunken/small kidneys on ultrasound or CT |
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How do NSAIDs cause acute renal failure? |
NSAIDs inhibit cyclooxygenase (COX) - enzyme responsible for synthesising prostaglandins from arachidonic acid Intrarenal production of prostaglandins (PGE2) contributes to the maintenance of renal blood flow and GFR. NSAIDs have the potential to signficantly lower RBF and GFR in certain states - e.g. hypovolemia, lips, nephrotic syndrome to produce ARF An acute interstitial nephritis associated with nephrotic syndrome may occur |
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What class of antihypertensive agents is contraindicated in patients with bilateral renal artery stenosis
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ACE inhibitors (--> marked decrease in the efferent arterial pressure --> decrease in renal perfusion --> decreased GFR) |
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Headaches in an elderly patient should always alert one to the possibility of what rheumatologic disease ? |
Temporal (giant cell) arteritis Especially if continuous, throbbing and unilateral. Can result in irreversible monocular blindness if not treated. |
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Symptoms of temporal giant cell arteritis |
Headache (unilateral, throbbing, continuous) Claudication of jaw Transient loss of vision, visual field defects, diplopia Symptoms of polymyalgia rheumatics Tender, swollen, red nodular temporal artery with decreased pulsation on palpation Fever Weight loss |
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3 main categories of diabetes mellitus |
Type 1 Type 2 Gestational diabetes |
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Describe type 1 DM |
Autoimmune destruction of the pancreatic beta cells leading to absolute insulin deficiency Typically diagnosed before 30 |
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Major characteristics of type 2 DM |
Insulin resistance and relative insulin deficiency Most patients are obese Diagnosed in adulthood |
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2 sets of criteria used to diagnose DM |
Casual plasma glucose - >200mg/dL OR Fasting plasma glucose - >126 |
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Classical symptoms of DM |
Polyuria Polydipsia Unexplained weight loss |
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Staphylococcus saprophyticus is commonly associated with what infectious problem |
UTIs in young women |
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What organisms are likely to cause chronic UTIs with pH >7.5 |
Organisms that are urease-producers Proteus |
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Linear calcifications seen in the wall of the urinary bladder are indicative of what chronic infection |
Schistosoma haematobium |
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Most common use of non epidemic viral encephalitis |
Herpes simplex type 1 |
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Manifestations of SIRS |
Temp >38 or <36 RR >20 HR >90 WBC count >12,000 cells or <4000 cells |
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What species of malaria is associated with cyclic fevers ever 72 hours |
Plasmodium malariae |
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Which species of malaria has 48 hour fever cycles |
P vivax P ovale and P. falciparum |
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What species of malaria are responsible for late relapses |
P. vivax and P. ovale - have exoerythrocytic stages in the liver |
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An immigrant from mexico presents with seizure disorder and has multiple small ring-like lesions on head CT. What's the Dx |
Neurocysticercosis Invasion of the CVS by larvae of the pork tapeworm T. solium |
