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135 Cards in this Set
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What are clinical features of someone that overdoses on antimuscarninc drugs?
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CNS:
1) delirium 2) hallucinations 3) seizures 4) coma cardiovascular: 1) tachycardia 2) hypertension 3) hyperthermia from loss of thermoregulatory sweating Other: 1) mydriasis 2) decreased bowel sounds 3) urinary retention |
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What are the interventions for antimuscarinic drugs?
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1) control hyperthermia
2) physostigmine may be useful, but not for tricyclic OD |
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What are clinical features of cholinomimetic drug OD?
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CNS:
1) anxiety 2) agitation 3) seizures 4) coma Other 1) bradycardia or tachycardia 2) pinpoint pupils 3) salivation 4) sweating 5) hyperactive bowel 6) muscle fasiculations followed by paralysis |
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How is cholinomimetic OD managed?
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1) support respiration
2) atropine and pralidoxime 3) decontaminate |
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What are clinical features of opioid OD?
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CNS:
1) lethargy 2) sedation 3) coma Other 1) bradycardia 2) hypotension 3) pinpoint pupils 4) cool skin 5) decreased bowel sounds 6) flaccid muscles |
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How is an opioid OD managed?
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1) airway and respiratory support
2) naloxone |
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how does someone present with salicylate OD?
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CNS:
1) confusion 2) lethargy 3) coma 4) seizures Other: 1) hyperventilation 2) hyperthermia 3) dehydration 4) hypokalemia 5) anion gap metabolic acidosis |
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How is salicylate poisoning managed?
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1) correct acidosis, fluid and electrolytes
2) alkaline diuresis 3) hemodialysis to aid elmination |
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How do people with sedative-hypnotic OD present?
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CNS:
1) disinhibition initially 2) lethargy later 3) stupor 4) coma other: 1) nystagmus 2) decreased muscle tone 3) hypothermia 4) miotic pupils 5) hypotension 6) decreased bowel sounds with severe OD |
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How is a sedative-hypnotic OD managed?
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1) airway and respiratory support
2) flumazenil for benzo |
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What are presenting features of stimulant (amphetamine, cocaine, phencyclidine) OD?
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CNS:
1) agitation 2) anxiety 3) seizures Other: 1) hypertension 2) tachycardia 3) arrythmias 4) mydriasis 5) skin warm and sweaty 6) hyperthermia 7) increased muscle tone 8) rhabdomyolysis |
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On eye exam of someone with PCP OD what is seen?
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1) horizontal and vertical nystagmus
2) mydriasis |
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How does someone with TCA OD present? What are the 3 C's of TCA OD?
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Antimuscarinic effects:
1) delerium 2) hallucinations 3) seizures 4) hyperthermia 5) mydriasis 3 Cs: 1) coma 2) convulsions 3) cardiac toxicity (QRS prolonged, arrythmias, hypotension) |
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How is TCA OD managed?
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1) control seizures
2) correct acidosis and cardiotoxicity with ventilation 3) NaHCO3 4) norepinephrine for hypotension 5) control hyperthermia |
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What are toxic features of acetaminophen?
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1) mild anorexia
2) nausea 3) vomiting 4) delayed jaundice 5) hepatic and renal failure |
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What are toxic features of ethylene glycol? what part of exam is normal?
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1) renal failure
2) crystals in urine 3) increased anion and osmolar gaps 4) initial CNS excitation 5) eye exam normal |
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What are toxic features of botulism?
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1) dysphagia
2) dysarthria 3) ptosis 4) opthalmoplegia 5) muscle weakness |
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What are toxic features of CO poisoning?
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1) coma
2) metabolic acidosis 3) retinal hemorrhages |
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What are toxic features of cyanide posioning?
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1) bitter almond odor
2) seizures 3) coma 4) abnormal EEG |
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What are toxic features of iron poisoning?
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1) bloody diarrhea
2) coma 3) radiopaque material in gut 4) increase leukocytes 5) hyperglycemia |
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What are toxic features of lead poisoning?
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1) abdominal pain
2) hypertension 3) seizures 4) muscle weakness 5) metallic taste 6) anorexia 7) encephalopathy 8) delayed motor neuropathy 9) renal and reproductive changes |
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What are toxic features of LSD?
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1) hallucinations
2) dilated pupils 3) hypertension |
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What are toxic features of mercury?
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1) ARF
2) tremor 3) salivation 4) gingivitis 5) colitis 6) erethism (fits of crying and irrational behavior) 7) nephrotic syndrome |
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What are toxic features of methanol?
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1) rapid respiratory failure
2) visual symptoms 3) increased osmolar gap 4) metabolic acidosis |
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What are toxic features of mushrooms (amanita phalloides type)?
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1) nausea and vomiting after 8 hours
2) delayed hepatic and renal failure |
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What are toxic effect of phencyclidine (PCP)?
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1) coma with eyes open
2) horizontal and vertical nystagmus 3) hyperacusis |
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What is the antidote for acetaminophen?
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acetylcysteine
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What is antidote of cholinesterase inhibitors?
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atropine
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what is antidote of membrane-depressant cardiotoxic drugs like quinidine and TCAs?
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NaHCO3
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what is antidote for flouride and calcium channel blockers?
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calcium
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what is antidote for iron salts?
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deferoxamine
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What is antidote for digoxin and related cardiac glycosides?
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1) normalize K+
2) lidocaine 3) anti-dig Fab fragments (anti-dig antibody) 4) Mg2+ |
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what is antidote for caffiene, theophylline, and metaproterenol?
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esmolol (beta 1 selective blocker)
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what is antidote for methanol and ethylene glycol poisoning?
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1) ethanol
2) fomepizole |
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What is antidote for benzos and zolpidem?
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flumazenil
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what is antidote for beta adrenoceptor blockers?
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glucagon
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what is antidote suggested for muscarinic blockers but not TCAs?
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physostigmine
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What is antidote for organophosphate inhibitors?
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pralidoxime
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what drugs have a large Vd and make dialysis less effective?
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1) antidepressants
2) antimalarials |
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What are drugs that have a low Vd and dialysis can be used?
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1) lithium
2) phenytoin 3) salicylates |
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when the capacity of the liver to metabolize a drug is maxed out what happens to kinetics of drug metabolism?
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first order (constant half life) becomes zero-order (variable half life) kinetics
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hypotension with bradycardia occurs with what drugs?
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1) Ca channel blockers
2) beta-blockers 3) sedative-hypnotics |
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hypotension with tachycardia occurs with what drugs?
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1) TCA
2) phenothiazines 3) theophylline |
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Which drugs are more likely to cause hyperthermia? hypothermia?
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hyperthermia:
1) antimuscarinics 2) salicylates 3) sympathomimetics hypothermia: 1) ethanol 2) CNS depressants |
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What should always be given to a camotose patient out of fear of brain damage?
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1) always give IV 50% dextrose because they may have hypoglycemia
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What is the osmolar gap? what is equation? what is normal value?
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1) the difference between measured serum osmolarity and the osmolarity predicted by measured serum concentrations of sodium, glucose and BUN
2) gap = Osm (measured) - ((2[Na])+([glucose]/18)+([BUN]/3)) 3) gap is normally 0 |
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what are several drugs that can increase the anion gap?
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1) cyanide
2) ethanol 3) ethylene glycol 4) ibprofen 5) INH 6) Fe2+ 7) methanol 8) phenelzine 9) salicylates 10) tranylcypromine 11) valproic acid 12) verapamil |
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what are some drugs that cause hyperkalemia?
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1) beta-adrenoceptor blockers
2) digitalis 3) fluoride 4) lithium 5) K+ sparing diuretics |
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What are some drugs that cause hypokalemia?
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1) barium
2) beta-adrenoceptor agonists 3) methylxanthines 4) most diuretics 5) toluene |
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alkalizing the urine can be effective in treating which ODs?
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1) fluoride
2) INH 3) fluoroquinolones 4) phenobarbital 5) salicylates Note this effective for drugs that are weak acids |
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Urinary acidifcation can useful to help with eliminate what drugs?
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1) amphetamines
2) nicotine 3) phencyclidine (PCP) Note: good for drugs that are weak bases |
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Antidote used for lead poisoning
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Dimercaprol, EDTA
Note: also use succimer and pencillamine |
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Antidote used for cyanide poisoning
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Nitrites
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Antidote used for organophosphate/anticholinesterase poisoning
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Atropine, pralidoxime (2-PAM)
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Antidote for arsenic, mercury, lead, and gold poisoning
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Dimercaprol
Note: also use succimer Note: for Mg only use succimer or dimercaprol |
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Antidote used in poisonings: copper (Wilson's disease), lead, mercury, and arsenic
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Penicillamine
Note: Trientine is new treatment for wilson's disease |
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Antidote used for heparin overdose
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Protamine
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Antidote used for warfarin toxicity
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Vitamin K and Fresh frozen plasma (FFP)
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Antidote for tissue plasminogen activator (t-PA), streptokinase
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Aminocaproic acid
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Antidote used for opioid toxicity
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Naloxone (IV), naltrexone (PO)
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Antidote used for tricyclic antidepressants (TCA)
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Sodium bicarbonate
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Antidote used for digitalis toxicity
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Digibind (also need to d/c digoxin, normalize K+, and lidocaine if pt. Is arrhythmic)
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Antidote used for beta agonist toxicity (eg. Metaproterenol)
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Esmolol
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Antidote for methotrexate toxicity
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Leucovorin
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Antidote for beta-blockers and hypoglycemia
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Glucagon
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Antidote useful for some drug induced Torsade de pointes
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Magnesium sulfate
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Antidote for hyperkalemia
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sodium polystyrene sulfonate (Kayexalate)
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A 20 yr old man presents with fever of 10 hours, chills and severe headache. He developed purpuric rash after admission. He has low WBC, increased BUN and low platelets. Neck was also stiff. What does he have?
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N meningitidis
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What are features of N meningitis? what type of capsule does it have?
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1) gram - cocci
2) diplococci 3) coffee bean shaped 4) LOS associated endotoxin in capsule |
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What are serotypes of N meningitidis? which is there no vaccine for why?
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1) vaccines for : A, C, Y, W-135
2) no vaccine for: B because it has a sialic polymer which is on endogenous cells |
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a bacteria isolated that is round is oxidase positive and is able to ferments glucose and maltose but not lactose. what is it bitch?
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N meningitidis
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What are the carriers for N meningitidis? How is it spread?
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1) humans
2) person to person spread |
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A person lacking which complements is prone to infection with what infection?
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lack terminal complements (C5-C9) susceptible to N meningitidis
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What allows N meningitidis to colonize the nasopharynx?
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1) pili
2) IgA protease |
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What property allows N meningitidis to evade phagocytosis?
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polysaccharide capsule
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What is associated with thrombocytopenia, DIC and subsequently purpura in N meningitidis? what other symptom do they soon develop?
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1) LOS-associated endotoxin
2) hypotension |
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possible complications of this disease include mental retardation, deafness, hemiparesis when infection is localized to CNS. What is cause? If organism is in blood what can happen?
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1) meningococcal meniningitis
2) if in blood can lead to arthritis, and limb necrosis |
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A child has sudden deficiency of cortisol and aldosterone and purpuric rash. What do you suspect sac o shit?
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1) waterhouse-friderchesen syndrome secondary to meningococcal infection
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How is N meningitidis treated? what is drug for prophylaxis?
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1) penicillin G
2) prophylaxis is rifampin |
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4 week old child has had fever, poor feeding and irritability. he just had a seizure. child was born vaginally and has nuchal rigidity with acidosis. PMN's are increased. What do you suspect?
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S agalactiae (GBS) type III meningitis
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What are features of S agalactiae?
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1) gram + cocci in chains
2) group B 3) type III capsule |
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organism shows beta-hemolysis and is catalase negative. What differentiates this bacteria from the other member of the beta hemolytic group?
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1) S agalactiae bacitracinn resistant
2) S pyogenes bacitracin sensitive |
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The CAMP test is used for what bacteria?
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1) S agalactiae
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What are a few risk factors for a mother infecting her child with S agalactiae?
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1) delivery <37 weeks
2) premature rupture of membranes 3) deficient maternal antibody to the capsular type of GBS |
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What does GBS cause in a newborn?
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1) sepsis
2) pneumonia 3) meningitis |
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what are common early onset neonatal symptoms with S agalactiae? (1-7 days post birth)
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1) pneumonia
2) bacteremia |
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late-onset disease with S agalactiae is characterized how? (1 week to 3 months post birth) If it is a severe infection what can occur?
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1) predominately meningitis
2) sometimes significant bacteremia 3) If severe: a. permanent hearing loss b. global brain injury c. mental retardation |
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A 68 yo diabetic has a skin and soft tissue infection, bacteremia, septic arthritis and endocarditis. Generally this infection only occurs in newborns that have a vaginal delivery. what is it?
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S agalactiae
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What is the major virulence factor of S agalactiae? How is it treated?
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1) type III capsular polysaccharide
2) Penicillin G |
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A 70 yo man presents with fever, headache, and confusion. He has been taking prednisone. He is unable to answer questions and is agitated. He has nuchal rigidity and leukocytosis with left shift. MRI shows meningeal enhancement. what is cause?
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Listeria moncytogenes
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What are features of L monocytogenes? are they aerobic or anearobic?
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1) gram +
2) small (non-spore forming) rod with round ends 3) facultative anearobic |
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A bacteria is grown on blood agar and shows a narrow zone of beta hemolysis. It is also shown to have tumbling motility?
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L monocytogenes
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How is L monocytogenes spread? What does it cause? What are reservoirs?
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1) food borne illness in adults
2) meningitis in children 3) soil and animals are reservoirs 4) found in processed meats and soft cheeses |
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A bacteria is determined to be intracellular. It has it has phospholipase and propels itself between cells by an actin tail. what is organism? what is its beta-hemolysin called?
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1) L monocytogenes
2) listeriolysin O |
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How is L monocytogenes treated?
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1) AMPICILLIN or penicillin with an aminoglycoside
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how can L monocytogenes be spread to newborn? what does newborn develop within 5 days? after 5 days?
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1) pregnant women carry in large bowel and vagina
2) vertical transmission 3) <5 days = develop sepsis and meningitis 4) >5 days = meningitis |
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what is the most common bacterial meningitis in a transplant patient?
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L moncytogenes
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A person that is immunocompetent and not >65 will experience what with L monocytogenes infection?
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acute febrile gastroenteritis with:
1) fever 2) diarrhea 3) vomiting 4) nausea |
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Something has caused fever, headache, stiff neck and photophobia at a summer camp in 20 campers. Kernig is negative but there is mild nuchal rigidity. what could they have?
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Echovirus type 9
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echovirus type 9 is also known as?
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enteroviral meningitis
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What are 4 virus groups that belong to the picornovirdae family?
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1) poliovirus
2) Nonpolioviruses: a. coxsackie A and B b. Echovirus c. new enteroviruses 3) hepatovirus 4) rhinoviruses |
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What are features of echovirus?
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1) ether resistant
2) non-enveloped 3) cubic symmetry 4) +ssRNA |
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How are enteroviruses different from rhinoviruses based on acid resistance and density?
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1) enteroviruses = acid stable and low density
2) rhinoviruses = acid labile and higher density. they also multiply better at 33C |
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when are enteroviral illnesses most common throughout year? How are they transmitted?
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1) summer and fall
2) person to person or fecal oral |
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When infection with enterovirus has occurred where do they first multiply? what happens a few days later?
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1) oropharynx and small intestine
2) viremia |
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How is aseptic meningitis different from bacterial meningitis?
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1) aseptic is milder
2) it has headache, fever, general illness, less nuchal rigidity and usually doe not require hospitalization |
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What does poliovirus (types 1-3) cause?
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1) aseptic meningitis
2) paralysis 3) encephalitic disease |
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What are diseases of coxsackie A virus? serotypes for important disease!
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1) acute hemorrhagic conjuncitivitis (type 24 variant)
2) aseptic meningitis 3) hand foot mouth disease (types 5, 10, 16) 4) myopericarditis (types 4, 16) |
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child presents with sore throat, painful oral ulcers, diarrhea, and non-itchy rash followed by blisters on palms and soles. what is cause?
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Hand-foot-mouth disease from coxsackie A or echovirus
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What does coxsackie B virus cause?
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1) pleurodynia
2) pericarditis, myocarditis 3) aseptic meningitis 4) severe systemic infection in infants, meningoencephalitis and myocarditis 5) Exanthem, hepatitis, diarrhea |
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Echoviruses can cause what diseases?
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1) aseptic meningitis
2) exanthem 3) hand-foot-mouth disease 4) pericarditis and myocarditis |
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A 70 year old transient is brought in with a fever, and worsening headaches. He has nausea, vomiting and diarrhea. He sleeps outside with insects because it is hot. He has a fine tremor of extremities. He has leukocytosis, and hyponatremia. what could it be?
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St Louis encephalitis virus
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arboviruses are members of 3 families. what are they and what are features of each?
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1) bunyvirdae
a. spherical enveloped virus b. triple-segmented, circular, single stranded, negative sense 2) togavirdae a. enveloped b. +ssRNA 3) flaviviruses a. same as toga |
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What viruses are part of togavirus family? where in world is each found? what do all three cause?
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1) eastern equine encephalitis = americas
2) western equine ecephalitis = north america 3) venezuelan equine encephalitis = americas Note: all 3 cause encephalitis |
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What are important flaviviruses? Where is each found?
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1) Dengue = tropic and world wide
2) yellow fever = africa, S america 3) St Louis enecephalitis = americas 4) Japanese encephalitis = india, china, japan and SE asia |
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Where do arboviruses typically reside in nature?
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1) woodland habitats where there are mosquitos and vertebrae hosts in summer months
2) associated with trash-filled drainage systems and artificial containers |
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Culex tarsalis transmits what virus?
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St. louis virus in western and central US
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arbovirses initially localize in the vascular endothelium of the reticuloendothelial system. When primary viremia occurs where do they go?
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spread to endothelial cells of small blood vessels in brain and choroid plexus
Note: this leads to damage mainly through virus-antibody complexes that trigger complement activation and leads to DIC |
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How is arboviral infection diagnosed?
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IgM and IgG based assays
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What are complications of St Louis virus?
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1) cranial nerve palsies
2) hemiparesis 3) convulsions 4) high case fatality rate |
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A 50 yo man has a fever and headache. family has noticed changes in personality. He is more irritable and unable to perform daily activities. He has left sided weakness and a recent seizure. MRI shows hemorrhagic necrosis in right temporal lobe. What is cause?
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HSV1
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What are features of HSV1?
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1) icosahedral nucleocapsid
2) linear dsDNA with lipoprotein envelope |
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Oral herpes is caused primarily by? venereal herpes is caused primarily by?
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1) HSV1
2) HSV2 |
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where in the brain does HSV1 have affinity for? what type of damage is seen?
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1) temporal lobe
2) hemorrhage and necrosis |
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What is the most sensitive method for detecting HSV encephalitis?
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PCR of HSV DNA
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A queer named Aaron brown comes in with fever, severe headache and mental status changes. These changes have been progressive over 2 weeks. He has nuchal rigidity and positive kernig. WBCs are low with left shift. latex agglutination demonstrates what?
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Cryptococcus neoformans
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What are features of C neoformans? Is it dimorphic?
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1) yeast-like fungus (not dimorphic)
2) oval budding yeast 3) thick gelatinous capsule |
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What stain is used on CSF for C neoformans? test is serum and CSF test is used? C neoformans is grown on what agar?
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1) india ink
2) latex agglutination of polysaccharide capsule 3) Sabourard-dextrose agar |
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What are biochemical reactions that are indicative of C neoformans?
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1) urease positive
2) phenol oxidase 3) oxidizes certain sugars and KNO3 |
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What thing in nature is C neoformans associated with?
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bird (pigeon) droppings
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Non-immunocompromised person acquires C neoformans and is symptomatic. What are findings?
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1) pneumonitis
2) fever 3) chills 4) cough 5) SOB 6) granulomatous inflammation |
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At what CD4 count can someone get C neoformans?
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<100
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When in the CNS where does C neoformans accumulate?
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1) pervascular areas of cortical gray matter
2) without cell mediated immunity they accumulate in the brain parenchyma |
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Someone presents with acneiform (nodular) or molluscum-like lesions, ulcers and subcutaneous tumor-like masses. Gomori methenamine silver stain reveals what?
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C neoformans
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How is C neoformans treated?
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1) amphotericin B for acute meningitis and pneumonia
2) flucytosine can be added |
