Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
76 Cards in this Set
- Front
- Back
|
Some clues in PMH with possible associations to Gout.
|
Genetic enzyme defects
lead poisoning psoriasis hemolytic anemia tumor, obesity kidney stones / renal disease |
|
|
Medications w/ possible contributions to Gouty attack.
|
Diuretics
low dose ASA TB meds warfarin |
|
|
Social history considerations w/ possible contributions to Gouty attack
|
Diets high in:
Red wine Organ meat lard seafood |
|
|
Physical exam symptoms and signs of gout.
|
Intense pain out of proportion
non-pitting edema at site tophi sticking out guarded ROM erythema, calor, edema |
|
|
Xray findings of Gout
|
Martel's Sign**: expansile lesion w/ overhanging osseous margin.
Also: lace pattern + round osseous erosions w/ sclerotic margin |
|
|
Which lab finding is mandatory for diagnosis of gout?
|
Joint aspirate: negatively birefringent needle shaped monosodium urate crystals.
-->bright yellow when parallel to axis of lens -->blue when perpendicular to axis of lens |
|
|
What is the correlating serum uric acid levels with gout?
|
Serum uric acid >7.5mg/dL
|
|
|
Metabolic gout:
definition, percentage, diagnosis |
Uric Acid Overproduction = 10% pts
-->secondary to enzyme defect, tumor, psoriasis, hemolytic anemia -->Dx: Uric Acid level > 600mg in 24hr Prevention: ALLOPURINOL -100-600mg qd -blocks xanthine oxidase |
|
|
Renal Gout:
definition, percentage, diagnosis |
Uric Acid Undersecretion: 90% pts
-->relative deficit in renal excretion Prevention: PROBENECID -250mg bid x 1 wk; then 500 PO bid |
|
|
Treatment of acute gout.
|
Indomethacin: 50mg q8
colchicine: 0.5-1.0mg initially; 0.5mg q1 hour until GI symptoms or pain relief |
|
|
ESR: definition, normal/abnormal levels
|
Erythrocyte sedimentation rate (ESR)
-->Westergren method: measures distance erythrocytes fall in 1 hr Normal < 20mm/hr Severe > 60mm/hr *increased in any inflammatory state w/ incr. fibrinogen |
|
|
C-Reactive Protein (CRP)
-definition -normal level |
Normal: < 0.6mg/dL
measure liver protein that is only present in acute inflammation. Also incr. in: RA, Malignancy, MI, SLE, pregnancy |
|
|
Nutrition Analysis
-Albumin |
normal level between 3.6 + 5g/dL
-decr. w/ inflammation + malnutrition |
|
|
Wound Culture + Sensitivity: time frame
-Gram stain -preliminary -final |
Gram stain: usually w/in 24hrs
Prelim: w/in 48hrs = Gm stain + shape Final: w/in 72 hrs + get sensitivities |
|
|
Bone Cultures:
how do you perform this? what does it indicate? |
Should be drawn from 2 sites
20 minutes apart indicates bacteremia/septicemia |
|
|
Bone Scans:
4 imaging intervals/phases |
Immediate (1-3 secs): arteriogram
Blood pool (3-5 mins): blood pool in capillaries + veins Delayed (2-4hrs): incr. specific to patterns + pathology 4th phase: increasingly specific |
|
|
Technetium-99 Bone scan
-binds to what? -Measures what? -half-life? |
binds calcium hydroxyapatite + measures osteoblast/osteoclast activity.
Half-life: 6 hrs |
|
|
What is the renal prophylaxis day before and day of surgery?
|
Mucomyst 600mg q 12hr
|
|
|
Cellulitis pattern on Bone scan.
|
Focal uptake in blood pool
negative in delayed phase |
|
|
OM pattern on bone scan
|
Diffuse uptake in blood pool
Hot increase uptake in delayed phase |
|
|
How specific / sensitive are bone scans according to literature
|
45% specificity
86% sensitivity per Termaat |
|
|
What are CT scans?
|
Computed tomography: radiograph altered by computer to highlight specific "windows"
-->isolate soft tissue or different aspects of bone |
|
|
What do you see in soft tissue infection and OM on CT scan
|
Soft tissue infection: exact locations and anatomy of abnormal soft tissue
OM: incr. density in marrow |
|
|
What is a PET scan?
|
Positron emission tomography:
Tracer is injected into patient releases radioactive positrons positrons collide w/ electrons produce gamma rays |
|
|
How sensitive + specific is a PET scan according to the literature
|
>90% sensitivity + specificity per Termaat
|
|
|
Common bug in:
Cellulitis w/ open wound |
Staph aureus (if no streaking present)
Strept (if streaking present) *monomicrobial |
|
|
Common bug in:
Infected ulcer in Abx naive pt |
SA, strep
*polymicrobial |
|
|
Common bug in:
Chronically infected ulcer in Abx naive pt |
SA, strep
enterobacter *polymicrobial |
|
|
Common bug in:
Macerated infected ulcer |
pseudomonas
*polymicrobial |
|
|
Common bug in:
Chronic, non-healing ulcer w/ prolonged Abx therapy |
SA, MRSA
Staph epi Enterococci, VRE Diptheroids Enterobacter Pseudomonas Extended GNR *polymicrobial |
|
|
Fetid foot w/ necrosis + gangrene
|
Resistant Gm (+) cocci
Mixed GNR Anaerobes *polymicrobial |
|
|
Common bug in:
OM w/ hemodialysis |
SA
Enterobacter Pseudomonas |
|
|
Common bug in:
Pressure ulcer |
Gm (-)
|
|
|
Human mouth pathogens
|
Haemophilus
Actinobacillus Cardiobaterium hominis Eikenella Corrodens, Kingella kingae |
|
|
Common bug in:
Water exposure |
Vibrio
Aeromonas hydrophilia Mycobacterium |
|
|
Common bug in:
Puncture through shoe |
Pseudomonas
|
|
|
Common bug in:
Any dirt/soil |
Clostridium
|
|
|
Common bug in:
Cat Bite Dog bite |
Cats: Pasteurella multocida
Dogs: Strept viridans, Capnocytophaga canimorsus |
|
|
Common bug in:
Immunocompromised pts |
gram negatives
|
|
|
Common bug in:
Septic bursitis |
SA
|
|
|
Common bug in:
Foul smelling discharge |
Anaerobes
|
|
|
Common bug in:
Creamy yellow discharge |
SA
|
|
|
Common bug in:
White discharge |
Staph epi
|
|
|
What are some drugs from each generation of PCNs?
|
1st: Pen V + G
2nd: Dicloxacillin, nafcillin, oxacillin 3rd: amoxiciliin, ampicillin 4th: augmentin, unasyn, zosyn, timentin |
|
|
What are some drugs from each generation of Cephalosporins?
|
1st: Keflex, ancef
2nd: Ceftin, Mefoxin 3nd: Fortaz, Rocephin, cefobid 4th: Maxipime |
|
|
What are some drugs from each generation of quinolones?
|
2nd: Cipro
3rd: Levo 4th: Tequin, Avelox |
|
|
What are some macrolide drugs?
|
Zithromax
Erythromycin |
|
|
What are some carbapenem drugs?
|
Invanz
Primaxin |
|
|
What are some Aminoglycoside drugs?
|
Gentamycin
Tobramycin |
|
|
What are some tetracyclines drugs?
|
minocycline
doxycycline tetracycline |
|
|
Therapeutic dosing for:
1. Diclox 2. Nafcillin |
1. Diclox: 250mg q6 (PO)
2. Nafcillin: 1-2g q4 (IV) |
|
|
Therapeutic dosing for:
1. Amoxiciliin 2. Ampicillin |
1. Amoxicillin: 500mg q8 (PO)
2. Ampicillin: 1g q4-6 (IV) |
|
|
Therapeutic dosing for:
1. Augmentin 2. Timentin |
1. Augmentin: 875mg q12 (PO)
2. Timentin: 3.1g q6 (IV) |
|
|
Therapeutic dosing for:
1. Unasyn 2. Zosyn |
1. Unasyn: 3g q6 (IV)
2. Zosyn: 4.5g q6 (IV) |
|
|
Therapeutic dosing for:
1. Keflex: 2. Ancef: |
1. Keflex: 500mg q8 or 750mg bid (PO)
2. Ancef: 1g q8 (IV) |
|
|
Therapeutic dosing for:
1. Ceftin 2. Zinacef |
1. Ceftin: 500mg q12 (PO)
2. Zinacef: 1. 5g q8 (IV) |
|
|
Therapeutic dosing for:
1. Rocephin 2. Fortaz 3. Cefobid |
1. Rocephin: 1g q24 (IV)
2. Fortaz: 1g q 8 (IV) 3. Cefobid: 2g q12 (IV) |
|
|
Therapeutic dosing for:
1. Maxipime |
1. Maxipime: 2g q12 (IV)
|
|
|
Therapeutic dosing for:
1. Cipro 2. Levo 3. Tequin |
1. Cipro: 750mg q 12 PO/400mg q12 IV
2. Levo: 500mg q24 PO/IV 3. Tequin: 400 q12 PO/IV |
|
|
Therapeutic dosing for:
1. Zithromax 2. Erythromycin |
1. Zithromycin: 500mg 1st day, 250mg qd (upto 5 days)
2. Erythromycin: 500mg q 6 PO |
|
|
Therapeutic dosing for:
1. Invanz 2. Primaxin |
1. Invanz: 1g q24 (IV)
2. Primaxin: 500mg q8 (IV) |
|
|
Therapeutic dosing for:
1. Tobramycin 2. Gentamycin |
1. Tobramycin: 3-5mg/kg/day
2. Gentamycin: 3-5mg/kg/day |
|
|
Therapeutic dosing for:
1. Minocycline 2. Doxycycline 3. Tetracycline |
1. Minocycline: 100mg q 12 PO/IV
2. Doxycycline: 100mg q 24 PO 3. Tetracycline: 500mg q 6 PO |
|
|
Therapeutic dosing for:
1. Bactrim DS 2. Aztreonam |
1. Bactrim DS: 160/800mg q 24 PO
2. Aztreonam: 1g q8 IV |
|
|
Therapeutic dosing for:
1. Vancomycin 2. Clindamycin |
1. Vancomycin: 1g q12 IV
2. Clindamycin: 600mg q8 IV; 300mg q6 PO |
|
|
Therapeutic dosing for:
1. Zyvox 2. Cubicin |
1. Zyvox: 600mg q12 PO/IV
2. Cubicin: 4mg/kg q12 IV |
|
|
Therapeutic dosing for:
1. Synercid 2. Flagyl |
1. Synercid: 7.5mg/kg q8 IV
2. Flagyl: 500mg q8 PO |
|
|
Therapeutic dosing for:
1. Rifampin 2. Tygacil |
1. Rifampin: 300mg q12 PO/IV
2. Tygacil: 100mg loading; 50mg q12 IV |
|
|
ABCDE's of the primary trauma survey.
|
A- airway
B - breathing C- circulation D- Deficits (neurological) AVPU -->alert, verbal, painful, unresponsive E- Exposure |
|
|
Tetanus is from this bacteria.
What does it look like? What does it do? |
Tetanus: Clostridium tetani
-->racquet-shaped Gm (+) bacillus -->releases pre-sympathetic blockade |
|
|
Triad of tetanus symptoms.
|
Trismus, risus sardonicus, aphagia
|
|
|
Characteristics of a Tetanus prone-wound.
|
greater than 6 hrs old
constitutional signs deep devitalized tissue contamination traumatic MOI |
|
|
Doses of:
Toxoid TIG (Tetanus immunoglobulin) |
Toxoid: 0.5ml
TIG: 250-300units |
|
|
Treat Pt w/ unknown tetanus status:
1. Clean wound 2. Tetanus-prone wound |
1. Give toxoid; hold TIG
2. Give both |
|
|
Treat Pt w/ incomplete tetanus status:
1. Clean wound 2. Tetanus-prone wound *means no booster w/in 5 yrs |
1. Give toxoid; hold TIG
2. Give both |
|
|
Treat Pt w/ complete tetanus status:
1. Clean wound 2. Tetanus-prone wound *means + booster w/ in 5 years |
1. hold all
2. hold all |
