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39 Cards in this Set
- Front
- Back
Rubella vs measles
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Both erythematous and maculopapular start on face and go to trunk and extremities.
Differences: Rubella- occipital and post. cervical lymphadenopathy. Adult women have arthritis. Measles (rubeola)- cough, coryza, conjunctivitis, and koplik spots. |
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Condylomata acuminata from HPV:
Tx |
3 treatment options:
1. chem: podophyllin (contraind in pregs), trichloracetic acid 2. immune therapy: imiquimod, alpha interferon 3. surgery: cryo, laser, excision |
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pt. has endocarditis from strep bovis. what other test should be performed?
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colonoscopy - bc. strep bovis is assoc.d w/ colorectal CA or uper GI CA
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histoplasmosis, coccidiodo, and blasto geography
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histo- SE USA
Cocci- SW USA blast - central |
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PCP :
- CD4 value -management if O2< 70mmHg or A-a > 35 - " " " " > "". |
- <200/microL
- TMP-SMX + prednisolone - TMP-SMX |
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MCC of osteomyelitis
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S aureus
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Babesiosis
-where found - features - definitive dx made w/ -Tx |
-NE USA
- no rash, hemolytic anemia and affects splenectomized pt.s, thrombocytopenia -Giemsa-stained thick and thin blood smear - quinine-clinda or atovaquone-azithro |
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cryptococcus neoformans
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encapsulated yeast commonly causes meningitis in HIV pt.
Tx w/ IV Ampho + oral flucytosine. once improvement then maintence therapy w/ fluconazole |
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Tx of CAP (= <48 hours in hosp):
1. outpt. 2. In pt. |
1. previously healthy and no abx in past 3 mo.s: Mac or doxy
or comorbidities or abx used in past 3 mo.s = respiratory fluoroquinolones ( levo or moxi) 2. azithro + ceftriaxone or resp fluoro |
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nocardia asteroides
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filamentous aerobic gram + soil bacterium that is partially acid-fast. -> lung cavitation in immunocompro pt.
-Tx : TMP-SMX |
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Tx of HAP (>48 hrs in hosp)
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DON'T GIVE MAC!
Antipseud beta lactam: Antispeudo pen: TCP+tazobactam/clavulinic acid or Antipseudo ceph= ceftazidime, or cefepime or carbepenem (imipenem (SE=seizures) meropenem, doripenem) |
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acute bacterial parotitis :
-physical presentation - who are prone to it - infectious agent -what can prevent this |
-painful swelling of parotid gland aggravated by chewing.
high fever, swollen parotid gland. - dehydrated postop pt.s and elderly -staph aureus - fluid hydration and oral hygiene pre- and post-op |
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Tx of VAP
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1. Antipseudo beta lactam (see HAP tx)
+ 2. 2nd antipseudo agent: aminogly (GNAT) or fluoroquinolone (cipro or levo) + 3. MRSA agent: Vanco or linezolid |
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syphillis Tx if allergic to penicillin
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oral azithromycin or doxycycline
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Lung abscess Tx
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clinda or pen
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PCP PNA Tx:
1. best initial 2. if toxicity from #1 3. Prophylaxis |
1. TMP-SMX
2. -pentamidine or -Clinda + primaquine (unless G6PD def) 3.-TMP-SMX or - Dapsone or Atovoquone |
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-sinusitis dx
-most accurate test -Tx |
-clinical dx
-sinus Bx or aspirate (don't do this unless recurrent infxn and not responding to abx) -amoxicillin, doxy, or TMP-SMX + decongestant |
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empiric Tx and cause of PNA in kids:
1. neonate 2. 1-4 mo.s 3. 4 mo.s - 4 yrs. 4. 5 - 15 yrs. |
1. Grp B strep > E coli, listeria, Chlam trach.
Tx. Amp + Gent ( +/- Vanc if MRSA is a concern. and for Chlam use erythro) 2. RSV, chlam trach, parainflu, bordetella, strep pneumo, staph. A Tx. Mac +/- cefotaxime 3. RSV, other virus (rhino, influ, parainflu, adeno, corona) Tx. Amox or Amp 4. strep pneu > myco, c. pneu, viruses Tx.(1) Amox +clarithro (or erythro) (2) Azithro (3) amox + doxy |
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Allergic bronchopulmonary aspergillosis (ABPA):
1. presentation 2. what do you see on CXR 3. main clue to make dx 4. most accurate dxic test 5. Tx |
1. similar to asthma with SOB, hemoptysis, cough, and wheezing
2. tram-track lines in bronchi (these are indicative of edema of bronchial wall and bronchiectasis) 3.elevated eosinphil count 4. elevated level of IgE, aspergillus precipitans in serum, and/or aspergillus-specific IgE and IgG 5. prednisone + itraconazole |
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PCP PNA
1. CXR 2. who to suspect 3. indicative lab finding |
1. interstitial infiltrates
2. CD4 < 200 or severely immunocompromised (ex. chemo) 3. LDH > 220 |
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differential dx for ground glass opacities(diffuse hazy infiltrate) on CXR?
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-interstitial pna (ex PCP)
- Pulm edema - pulm hemorrhage - hypersensitivity pneumonitis |
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1. Tx for Acute exacerbation of chronic bronchitis (AECB) (ie Acute bacteria exacerbation of COPD (ABEC))
2. Bronchiectasis 3. CF |
same causitive agents as sinusitus ( strep pneu, H. influ,
morax cat) Same Tx for 1-3: -Amox/clavulinic acid or -Macs or - 2nd or 3rd gen Cephs - Respiratory fluoroquinolones |
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A-a gradient = normally
pAO2= paO2 normally paCo2 normally PaO2/FiO2 (ie FiO2 ratio) |
pAO2 - paO2 = 5-15 mmHg
pAO2=150 - (PaCO2/0.8) paO2 = 90-100 mmHg PaCO2 = 40 mmHg PaO2/FiO2 (FiO2 is typically .21), <200 is ARDS, <300 = gas xchange deficit |
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ARDS (ie shock lung)
1. cause of it 2. CXR will show 3. Dx? 4.Tx |
1. diffuse lung injury from sepsis, aspiration, trauma, pancreatitis!, or trauma ->diffuse capillary leak
2. bilat infiltrates (looks like CHF but pressures are normal) 3. presumptive dx. PaO2/FiO2 <200 and PCWP <18 mmHg 4. intubation, mech venti w/ FiO2 < 60% to maintain SaO2 >90%, and >PEEP |
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Pharyngitis and tonsillar infxn Tx
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(only treat with (+) throat Cx in pharyngitis)
Amox (augmentin) or Pen -if allergic w/ rash: cephalexin -if anaphylaxis: clinda or Mac |
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1.trichinellosis presentation 1st symptom followed by
2. triad 3. other clues |
1. GI complaints
2. periorbital edema, myositis, eosinophelia 3. subungual spinter hemorrhages + conjunctival retinal hemorrhage |
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Pt. comes in w/ gono and chlam.
what are additional STDs should be screened for? |
HIV, syphilis, hep B, pap smear for cervical CA, and hep C (if Hx of drug use)
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UTI drugs:
1. recommended in pregs 2. contraindicated in pregs |
1. Nitrofurantoin, Amox, ceph
2. tetra, fluoro, TMP-SMX |
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HIV w/ painful swallowing and substernal burning.
1. what is it? 2. MCC and Tx 3. if doesn't resolve after #2? 4. possible other causative agents? |
1. esophagitis
2. Candida - fluconazole 3. esophagoscopy w/ cytology, Bx, an Cx 4. HSV or CMV |
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Pt.s dx.ed w/ HIV should be tested for
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1. HIV RNA levels
2. CD4 count 3. VDRL syph test 4. PPD skin test 5. Anti-Toxo Ab titer 6. Pneumococcal polysach vacc (unless CD4 <200) 7. Hep B and A (and vacc if negative) |
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Life-threatening rxns assoc.d w/ HIV therapy:
1. didanosine 2. abacavir 3. any of the NRTIs 4. any of the NNRTIs 5. liver failure 6. indinavir |
1. pancreatitis
2. hypersensitivity syndrome 3. lactic acidosis 4. Stevens-Johnson 5. nevirapine 6. crystal-induced nephropathy (needle-shaped crystals) |
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kid w/ unilateral inflamed fluctuant cervical lymph nodes
1. typical cause 2. Tx |
1. strep or staph infxn
2. incision and drainage + dicloxacillin (covers both) |
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Injx drug user, HIV +, fever, scattered crackles
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pulmonary infxn in the setting of IV drug abuse suggests septic embolism from infective endocard involving tricuspid value. Staph. A.
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Histoplasmosis:
1. endemic area 2. CD 4 3. S&S 4. Dx test 5. labs: 6. Tx |
1. Ohio river valley
2. <100 3. fever, wt. loss, night sweats, N&V, and cough , and SOB 4. Antigen in urine or serum 5. pancytopenia (if bone marrow involved), elevated LFT, elevated ferritin 6. Itraconazole |
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Person comes in w/ probable HSV encephalitis.
1. 1st step 2. next step |
1. IV acyclovir w/o delay
2. PCR of CSF looking for viral DNA |
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Healthcare worker exposed to HIV (percutaneous needle injury)
1.what do you do? |
1. draw blood for HIV serology and start antiretroviral therapy with 3 drugs immediately
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how do you remove a tick?
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take the mouth parts by tweezers and slowly remove it
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pt.s w/ hemachromatosis are vulnerable to what iron-loving bacteria?
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Listeria mono, Yersinia entero, and Vibrio vuln
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malig otitis ext (MOE)
1. presentation 2. what is seen upon examining ear 3. risk factors 4. causitive org 5. complications 6. Tx |
1. ear discharge and severe pain. pain radiates to TMJ and exacerbated by chewing
2. granulation tissue in ext aud. meatus 3. immunosuppressive conditions (DM) 4. pseudomonas aeruginosa 5. osteomyelitis of temporal bone and deafness 6. ceftazadime |