Term
| 5 high risk groups for getting acute diarrhea |
|
Definition
travelers
consumers of certain foods
immunodeficiency
daycare attendees and family members
institutionalized people |
|
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Term
Acute diarrhea:
__% of travelers to latin america, africa, and asia will get travelers diarrhea
Foods that cause diarrhea:
1. ___ - caused by chickens, mayo, cream, eggs, seafood
2. ___ - chicken
3. ___ - chicken
4. ___ - undercooked hamburger
5. ___ - friend rice, or other reheated food
6. ___ - mayo or creams
7. ___ - uncooked foods or soft cheeses
common opportunistic infections (5)
daycare attendees are prone to (4) |
|
Definition
40%
1. salmonella
2. campylobacter
3. shigella
4. enterohemorrhagic e. coli
5. bacillus cereus
6. staph aureus
7. listeria
myocbacterium, CMV, adenovirus, herpes simplex, crypto
daycare attendees: shigella, giardia, crypto, rotavirus |
|
|
Term
Systemic manifestations of acute diarrhea:
1. Reiter's syndrome (arthritis, uveitis, and conjunctivitis) (4 species)
2. autoimmune thyroiditis, pericarditis, and glomerulnephritis (1)
3. HUS (2)
4. Post-infectious IBS - all species |
|
Definition
1. Reiters - salmonella, campylobacter, shigella, yersinia
2. yersinia
3. shigella and hemorrhagic e. coli
|
|
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Term
| what 4 severe systemic infections can be manifested by acute diarrhea? |
|
Definition
viral hepatitis
listeriosis
legionellosis
toxic shock syndrome |
|
|
Term
| most common cause of non-infectious acute diarrhea? |
|
Definition
|
|
Term
| DDx for new daily persistent HA |
|
Definition
Primary: migranous
tension type
Secondary: SAH, lower CSF volume, Raised CSF pressure, posttraumatic HA, chronic meningitis |
|
|
Term
Classification of chronic daily headache
1. >4 h daily (4)
2. <4 h daily (4)
3. secondary - lots
prevention for these HAs? |
|
Definition
1. >4h - chronic migraine, chronic tension-type, hemicrania continua, new daily persistent HA
2. chronic cluster, chronic paroxysmal hemicrania, SUNCT/SUNA, hypnic HA
3. Secondary - posttraumatic (head injury, iatrogenic, post-infection), inflammatory (giant cell arteritis, sarcoid. Behcet's), chronic CNS infection, med overuse
Prevention: tricyclics - amitriptline or doxepin 1 mg/kg given 12 hours before waking
|
|
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Term
| Sx that suggest a HA has a serious underlying cause |
|
Definition
worst HA ever
first severe HA
subacute worsening over days to weeks
abnormal neuro exam
fever/systemic sx
vomiting preceding HA
pain induced by bending, lifting, coughing
pain that disrupts sleep or is present immediately upon wakening
known systemic illness
>55 y/o
pain associated with local tenderness |
|
|
Term
Organisms that cause bloody diarrhea
Organisms that cause non-blody diarrhea |
|
Definition
C diff (sometimes) - 1-3 days
Hemorrhagic e. coli - 12-72 h
Salmonella, campylobacter, aeromonas, vibrio parahemolyticus, yersinia - 12h-11d
shigella, enteroinvasive e.coli, entameba histolytica - 12h-8d
Non-bloody: bacillus cereus, staph aureus 1-8h
clostridium perfringens - 8-24h
vibrio cholerae, enterotoxic e. cli, klebsiella, aeromonas - 8-72 h
enteropathogenic and enteroadherent e.coli, giardia, crypto, helminths - 1-8 d
c. diff (sometimes) - 1-3 d
rotavirus, norwalk virus - 1-3 d |
|
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Term
| indications for evaluation for tx for diarrhea |
|
Definition
profuse diarrhea w/ dehydration
grossly bloody stools
fever >38.5C
>48h duration w/o improvement
recent abx
new community outbreak
severe abd pain in pt >50
>70 y/o
immunocompromised |
|
|
Term
| 5 organisms to consider for persistent diarrhea |
|
Definition
giardia
c. diff
entameba histolytica
crypto
campylobacter |
|
|
Term
Diarrhea tx:
for dysentery
for gardia |
|
Definition
dysentery: cipro
giardia: metronidazole
immunocompromised, mechanical heart valves, recent vascular grafts, and elderly all need abx no matter what causative organism is |
|
|
Term
| Tx algorithm for infectious diarrhea |
|
Definition
mild (unrestricted) -- fluids
Moderate (activities altered) w/o fever, blood, WBC, immunocompromised, or elderly -- fluids + antidiarrheals
Moderate WITH fever, blood, WBC, immunocompromised, or elderly -- fluids, stool microbiology, abx
Severe (incapacitated) - stool microbiology, abx, fluids |
|
|
Term
ACute sinusitis in child (<4 weeks)
1. mst common sinus involved?
2. non-infectious causes (4)
3. most common cause?
4. 3 bacterial causes. what sx distinguish bacterial?
5. life threatening complications?
6. ___ is the imaging study of choice
7. tx? |
|
Definition
1. maxillary
2. barotrauma, allergic rhinitis, chemical irritants, nasotracheal intubation
3. viral (most common),
4. bacteria - h. flu, s. pneumoniae, moraxella catarhrhalis
- upper molar pain, halitosis, sx >7 days suggest bacterial
5. meningitis, epidural abscess, cerebral abscess
6.CT
7. tx: usually none - oral or topical decongestants, nasal lavage, nasal glucocorticoids, abx (amoxicillin) if >7 days for adults or >14 days for kids |
|
|
Term
Chronic sinusititis:
1. >__ weeks
2. almost alawys requires what tx? |
|
Definition
1. >12 weeks
2. endoscopic surgery. also 3-4 weeks abx, topical glucocorticoids, irrigation |
|
|
Term
Acute Otitis Media:
1. usually follows URI. Most common organisms?
2. tx? |
|
Definition
1. RSV, flu, rhinovirus, enterovirus. S. pneumoniae, H. flu, M. catarrhalis
2. Tx: usually clear in 1 week w/o abx. Infants <6 ms need amoxicillin |
|
|
Term
Pharyngitis:
1. what organism is most concerning?
2. what organism is most common?
3. what is most common amount 5-15 y/o but uncommon <3 y/o?
4. Work up should include what tests?
5. tx? |
|
Definition
1. GABHS (s. pyogenes)
2. viral - rhinovirus/coronavirus
3. GABHS - usually exudative
4. workup: Monospot and rapid strep test
5. Tx: abx (penicillin/amoxicillin) only for bacteria confirmed by testing. amantadine, rimantadine, zamaivir or aseltamivir for viral
|
|
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Term
| fever + tonsillar swelling + exudeate + enlarged tender angterior cervical nodes + absence of cough or coryza? |
|
Definition
| strep pyogenes (GABHS) - tx with penicilin V or amoxicillin |
|
|
Term
Laryngitis:
1. most common cause?
2. sx?
3. tx: |
|
Definition
1. URI caused by firus - rhinovirus, flu, parainfluenza, coxsackie, adenovirus, coronavirus, RSV
2. sx: hoarseness, reduced vocal pitch, aphonia, rhinorrhea, nasal congestion, cough, sore throat
3. Tx: Humidification and voice rest. No abx unless it's trep |
|
|
Term
Epiglottitis:
1. Most common cause?
2. most common cause in vaccinated people?
3. sx?
4. oropharyngeal exam shows what?
5. tx - what is the first concern? |
|
Definition
1. h. flu type B - can be immunized against
2. group A strep
3. sx: sitting forward and drooling, high fever, sore throat, tachy, inspiratory stridor, chest wall retractions
4. oropharyngeal exam: injection much less severe than expected, suggesting that obstruction is lower
5. tx: secure airway, epiglottic specimen, blood cultures, abx (Ampicillin + beta lactamase inhibitor for 7-10 days. family members need rifampin + vaccine
|
|
|
Term
Abdominal pain:
1. if intra-adominal hemorrhage - do what?
2. what 2 exams are mandatory in every pt with abd pain? |
|
Definition
1. go straight to OR
2. pelvic and rectal
3. |
|
|
Term
Abdominal pain by quadrant:
RUQ
epigastric
LUQ
RLQ
periumbilical
LLQ
Diffuse |
|
Definition
RUQ: cholecysitis, cholangitis, pancreatitis, pneumonia, pleuriy, subdiaphragmatic abscess, hepatitis, Budd-Chiari syndrome
Epigastric: PUD, gastritis, GERD, pancreatitis, MI, pericarditis, ruptured AAA, esophagitis
LUQ: splenic infarct, splenic rupture, splenic abscess, gastritis, gastric ulcer, pancreatitis, subdiaphragmatic abscess
RLQ: appendicitis, salpingitis, inguinal hernia, ectopic pregnancy, nephrolithiasis, IBD, mesentery lymphadenitis, typhlitis
Periumbilical: early appendicitis, gastroenteritis, bowel obstruction, ruptured AAA
LLQ: diverticulitis, salpingitis, inguinal hernia, ectopic pregnancy, nephrolithiasis, IBS, IBD
Diffuse: Gastroenteritis, DM, malaria, mesenteric ischemia, bowel obstruction, IBS, peritonitis, Familial meiterranean fever, metabolic disease, psych disease
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Term
Suspected meningitis:
1. Start ___ if you think a pt has it
2. If pt has had recent head trauma, immunocompromised, known malignant lesions, focal neuro findings, do ___ before LP
3. if pt has LOC, seizures, or focal neuro deficits, they need to be evaluated for __ or ___
4. most common organisms: ____ if >20 y/o, ____ in 2-20 y/o, 2 other common organisms?
5. sx?
6. dx? |
|
Definition
1. abx
2. Ct or MRI
3. bacterial meningitis or viral meningoencephalitis - these signs are not in viral meninigitis
4. S. pneumonia >20 y/o, N. meningitidis 2-20 y/o, GABHS and listeria monocytogenes
5. sx: classic triad: fever, HA, nuchal rigidity
n/v, photophobia, coma, lethargy, meningococcemia rash (petechiae)
6. dx: blood cultures, LP, biopsy rash |
|
|
Term
What disease?
diffuse maculopapular rash that becomes petechial and appears on trunk, LE, mucus membranes, conjunctiva, and palms and soles |
|
Definition
|
|
Term
abx for bacterial meningitis
1. Infants < 1mo-3 mos
2. immunocompentent 3mos-55 y/o
3. >55 y/o, alcoholic, or diseased
4. severe cases |
|
Definition
1. infants <1 mo: ampicillin + cefotaxime
2. Immunocompetent >3 mos-55 y/o: cefotaxime + vanc
3. adults >55 y/o or any age with alcoholism or debilitating disease: amp + cefotaxime
4. severe cases: amp + vac + cefazidime |
|
|
Term
| CSF abnormalities in bacterial meningitis |
|
Definition
1. Opening pressure >180 mmHg
2. WBC 10-10K
3. RBC absent
4. Glucose <2.2 mmol/L
5. CSF/serum glucose <0.4
6. protein >0.45
7. gram +
8. + latex agglutination in s. pneumonia, n.meningitidis, h. flu, e. coli, GABHS
9. Limulus lysate + in gram neg |
|
|
Term
What drug causes each rxn?
1. general seizures, neuro complictions, HA, stroke, SAH
2. impaired thinking, concentration, perceptual and psychomotor fxn. conjunctival injection, tachy, angina, significant decrease in pulm capatcity, decreased testosterone and sperm count and mobility, impaired fetal growth. withdrawal sx
3. HA, difficulty concentrating, diminished appetite, abd pain, v/d, disordered sleep, paranoia, agression, psychosis, rotten teeth, htn, arrhtythmia, SAH, stroke, convulsions, coma
4. tachy, HTN, pupil dilation, tremor, hyperpyrexia, perceptual and mood changes, synesthesias, 12-18 hr effects. Most common medical emergency is a "bad trip", increased risk of psychosis, decreased memory, problem solving, abstract thinking
5. agitation, excitement, impaired motor coordination, dysarthria, analgesia, nystagmus, flushing, diaphoresis, hyperacusis, distorted body image, disorganized thinking, feelings f estrangement, salivation, vomiting, myoclonus, fever, stupor, compa, resp distress |
|
Definition
1. cocaine
2. marijuana
3. meth
4. LSD
5. PCP |
|
|
Term
FUO:
1. 2 common infections
2. tx? |
|
Definition
1. candida and aspergillus
2. vanc + ceftazidime or aminoglycoside
avoid NSAIDS & glucocorticoids bc they can mask sx |
|
|
Term
calculation of Aboslute Neutrophil Count (ANC)
when < 1000?
when <500?
when <200? |
|
Definition
ANC = WBC x (% neutrophils + % bands)
<1000 - increased susceptibility to infection
<500 - conrol of endogenous microflora is impaired
<200 - inflammatory process is absent |
|
|
Term
Ascites:
1. 4 most common causes
2. SAAG
3. tx?
4. tx for refractory ascites? |
|
Definition
cirrhosis, CHS, nephrosis, disseminated carcinomatosis
2. SAAG - serum albumin ascites gradient - >1.1 g/dl = uncomplicated cirrhotic ascites. <1.1 suggest it's not due to portal htn
3. tx: paracentesis w/ ablumin
+ spironolactone and furosemide and low sodium diet
4. refractory - TIPS, another paracentesis, liver transplant |
|
|
Term
What disease state based on characteristics of ascites fluid?
1. straw or bile-colored. low protein. >1.1 SAAG, 1% RBC, low WBC
2. straw, hemorrhagic, mucinous, or chylous. protein >25. <1.1 SAAG, 20% RBC, >1000 WBC
3. clear, turbic, hmorrhagic, or chylous. >25 protein. <1.1 SAAG. 7% RBC, >1000 WBC
4. straw-colored, 15-33 protein. >1.1, 10%, <1000 WBC
5. straw colored or chylous. <25 protein, <1.1 SAAG. RBC rare. <250 WBC
6. turbid, hemorrhagic, chylous. >25 protein. <1.1 SAAG. variable WBC and RBC |
|
Definition
1. cirrhosis
2. neoplasm
3. TB
4.CHF
5. nephrosis
6. pancreatic |
|
|
Term
| What do you do if you suspect acute liver disease (<6 mos) and ALT is very high and Alk phos is high? |
|
Definition
Tests: IgM, anti-HAV, HbsAg, IgM anti-HBc, Anti-HCV, ANA, SMA, monospot, cerulopasmin, alcohol and drug hx,
liver bx if dx still unclear |
|
|
Term
| What do you do for acute <6 mos liver disease iwth very high alk phos and GGT and high ALT? |
|
Definition
AMA
Drug and alochol Hx
US/MRI
MRCP/ERCP
liver bx if still unclear |
|
|
Term
Chronic >6 mos liver disease
ALT very high, alk phos high |
|
Definition
HBsAg, antiHCV, Fe sat, ferritin, ceruloplasmin, AT, ANA, SMA, US, Alcohol hx
bx if still unclear |
|
|
Term
chronic >6 mos liver disease
Alk phos and GGT very high
ALT high |
|
Definition
drug and alc hx
AMA
P-ANCA
US
MRCP/ERCP
bx if stil unclear |
|
|
Term
| 2 main causes of hypercalcemia |
|
Definition
hyperparathyroidism (fluctuations in PTH and no chance in Ca)
cancer (high Ca, low PTH)
other causes: Familial hypercalciuric hypercalcemia, Vit D, HCTZ
tx; Hydration, diuresis, Ca restriciton |
|
|
Term
|
Definition
Vit D deficiency - most common
pancreatitis, Mg deficiency (alcoholism), hypoalbuminemia, hypoparathyroid |
|
|
Term
| causes of hypomagnesemia & hypermagnesemia |
|
Definition
Hypo - HYPERaldosteronism
Hyper - HYPOaldosteronism
|
|
|
Term
| causes of hypo and hyperphosphatemia |
|
Definition
increased: excessive intake, renal failure , vit D intox, hypoparathyroid
hypophosphatemia: resp alkalosis due to hyperventilation, DKA, hyperparathyroidism |
|
|
Term
Acute Renal failure causes:
1. prerenal (4)
2. Intrinsic
3. postrenal (2) |
|
Definition
1. Prerenal - hypovolemia, decreased CO, decreased effective circulating volume (CHF, liver failure), emapired renal autoregulation (NSAIDs, ACE-I, ARBs, Cyclosporine)
2. Intrinsic - glomeruloneprhitis, tubular (ischemia, sepsis, neprhotoxic, vascular)
3. Postrenal - bladder outlet obstruction, bilateral pelvoureteral obstruction
|
|
|
Term
What kind of renal failure?
1. WBC or hyaline casts?
2. RBC casts or RBC
3. WBC casts or WBC
4. Renal tubular epithelial ells or casts or pigmented casts
5. granular casts
6. eosinophiluria
7. crystalluria |
|
Definition
1. prerenal, ambolism, thormbosis, HUS, TTP, scleroderma
2. GN, vasculitis, malignant HTn,
3. GN, interstitial nephritis, pyelonephritis, allograft regection, malignant infiltration
4. ATN, tubulointerstitial neprhitis, acute cellular allograft rejection, myoglobinuria, hemoglobinuria
5. ATN, GN, vasculitis, interstitial nephritis
6. AIN, atheroembolic disease
7. acute uric acid nephropathy, calcium oxalate, drugs or toxins |
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