Term
|
Definition
Infect the epidermis.
Pt: Children with itchy scalp.
Nits are white eggs on hair.
Sharing hats/combs spreads.
Dx: inspection
Tx: permethrin shampoo |
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Term
|
Definition
Infects the epidermis.
Pt: Itchy skin 2/2 feces and eggs allergy.
Multiple household members have itch and rash.
Dx: scrape furrows and microscopic visualization
Tx: permethrin cream |
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Term
|
Definition
Infection of hypodermis.
Bug: strep pyogenes (GAS)
Pt: "Honey-colored crust"
Dx: gram stain +/- culture
Tx: amoxicillin or 1st gen ceph |
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Term
|
Definition
Pt: Itchy feet, discoloration of skin.
Dx: KOH prep, best test is culture
TX:
1. if hair/nail involvement - PO antifungals for months
2. no hair/nail - topical antifungals for weeks (terbinifine) |
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Term
|
Definition
Infest the SubQ tissues.
Pt: red, painful, hot area, where skin has been broken (trauma, ulcer, shaving, etc.)
Bug: usually gram pos cocci
Dx: clinical, but must rule out osteo with XRay (good) or MRI (best).
Do not do culture here or bone scan.
Tx: GPC - usually 1st gen ceph
If possible MRSA - IV vanc and PO bactrim |
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Term
|
Definition
Bone infection with fever and bone pain.
Pt: direct inoculation (trauma), or indirect (heme spread)
Dx: XRay specific, bone scan if no overlying inflammation, MRI sensitive (best), culture 1x only (this hurts)
Tx: Vanc and Zosyn IV, f/u with culture specific therapy for 4-6 wk
Track with ESR, CRP, or MRIs for resolution. |
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Term
|
Definition
Bug: C. Perfringes
Pt: dirty or muddy wounds, crepitus on palpation
Dx: Xray - shows gas bisecting tissues
Tx: this is an EMERGENCY!!! - surgery, debridement, broad spectrum abx, penicillin + clinda, possibly hyperbaric O2 |
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Term
|
Definition
Pt: looks like rapidly expanding cellulitis, or pain out of proportion to exam. Look for diabetics, blue-grey discoloration meaning necrosis.
Dx: surgical specimin
Tx: this is an EMERGENCY!! - debridement, amputation, braod spectrum abx, hyperbaric O2 |
|
|
Term
|
Definition
Alarm Sx's?
NO: cellulitis -> r/o osteo with XR -> if neg, start abx and watch for improvement, OR get MRI -> if osteo, get bx
YES (dirty wound, crepitus): gas gangrene -> XR look for gas -> debride, penecillin + clinda, hyperbaric O2
YES (sinus draining tract, able to probe bone): osteomyelitis -> obtain XR -> start vanc/zosyn 4-6wk -> track with ESR/CRP/MRIs
YES (pain out of proportion, too sick): nec fasciitis -> need surgical sample -> debride, amputate, broad spectrum abx, hyperbaric O2 |
|
|
Term
| Common Organisms of Skin Infections |
|
Definition
Most common - staph aureus
Sickle cell osteo - salmonella
Penetrating shoe - pseudomonas
Erysipiloid reaction (raised red patches on skin of face and legs commonly) - strep pyogenes (GAS)
Periph vasc disease/DM - polymicrobial |
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|
Term
|
Definition
Pt: fever and cough, +sputum production, neg CXR
Dx: neg CXR, SpO2
Tx: azithromycin OR FQ (moxi) |
|
|
Term
|
Definition
Pt: fever and cough, foul sputum, possibly hemoptysis, +CXR with cavitary lesion
Dx: CXR, SpO2, f/u up CT scan to differentiate b/w TB vs fungal ball vs abscess
Tx: abx +/- I&D |
|
|
Term
|
Definition
Pt: fever and cough, +sputum production, +CXR
Dx: CXR with consolidation, SpO2
Tx: 3rd gen ceph + macrolide OR vanc + zosyn OR |
|
|
Term
| Community Acquired Pneumonia |
|
Definition
No health care exposure for >90 days
Pneumonia <48 hours of admission
Bug: strep pneumo (MC),
m. catarrhalis,
h. flu - COPD/smokers,
klebsiella - alcoholics,
staph aureus - from previous viral illness
Tx: 3rd gen ceph + macrolide OR FQuinolone (moxiflox) |
|
|
Term
| Healthcare Associated Pneumonia |
|
Definition
<90 days from hospital, living in nursing home, >48 hours after admission
Bug: GNR, especially pseudomonas
MRSA
Tx: MRSA - vanc
pseudomonas - pip/tazo |
|
|
Term
| Immunosupressed Pneumonia |
|
Definition
Bug: fungal infections, TB, PCP
PCP Dx: BAL, or induced sputum, then silver stain
Tx: IV Bactrim with steroids!! |
|
|
Term
| Complicated UTI vs uncomplicated |
|
Definition
1. male
2. infection above the bladder
3. indwelling foley
4. anatomical defect
If uncomplicated, tx with PO abx x3d.
If complicated, tx with PO abx x10d. |
|
|
Term
|
Definition
Path: STD
Bug: G/C
Pt: discharge from urethra
Dx: Swab - DNA Gc/Chlam OR urinary antigen for chlam
Tx: ceftriaxone IM x1 - gon
Doxy x7d - chlam |
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|
Term
|
Definition
Pt: not sick, asx screen for cystoscopy or pregnancy
Dx: screened, U/A and cx
Tx: nitrofurantoin for scope or pregnancy, otherwise no tx needed |
|
|
Term
|
Definition
Bladder infection
Pt: urgency, frequency, dysuria
Dx: U/A and cx
Tx: Bactrim, cipro, FQ, OR nitro
Uncomp: 3d PO
Complicated: 10d PO |
|
|
Term
|
Definition
Infection of ureter or 1 kidney
Pt: urgency, frequency, dysuria, fevers, chills, n/v, CVA tenderness
Dx: U/A, cx, WBC casts!
Tx: IV ceftriaxone x14days, admission to monitor for signs of abscess formation |
|
|
Term
|
Definition
Pyelo that doesn't improve in 48 hours after treatment
Dx: non-con CT, or U/S if pregnant
Tx: I&D |
|
|
Term
| Types of Microcytic Anemia |
|
Definition
1. Iron Deficiency
2. Sideroblastic
3. Thalassemia (alpha and beta)
4. Anemia of Chronic Disease
Get a Ferritin first. Then Iron level, percent sat, and TIBC next. |
|
|
Term
| Types of Macrocytic Anemia |
|
Definition
A. Nonmegaloblastic
1. Liver disease (cirrhosis)
2. Alcohol
3. Metabolic Syndromes (ie. Lesch-Nyan)
4. Medications (AZT, 5-FU, Ara-c)
B. Megaloblastic (5 or more lobes PMNs)
1. Folate Deficiency
2. B12 Deficiency
Get B12, folate, and MMA levels. Don't get homocysteine levels. |
|
|
Term
| Types of Normocytic Anemia |
|
Definition
A. Hemorrhagic anemia
B. Hemolytic anemia
1. Sickle Cell
2. Autoimmune (warm and cold)
3. Hereditary Spherocytosis
4. G6PD deficiency
5. Paroxysmal Nocturnal Hemoglobinuria
Get Tbili, Dbili, LDH, haptoglobin. All elevated except hapto (decreased) in hemolysis. |
|
|
Term
|
Definition
Macrocytic, megaloblastic anemia
Path: leafy greens, stores for 3-6 weeks, pregnant woman increases demands for folate
Pt: anemia, tea and toast diet
Dx: low folate, normal methylmalonic acid (MMA), high homocysteine (doesn't matter)
Tx: folate |
|
|
Term
|
Definition
Macrocytic, megaloblastic anemia
Path: animal products, stores for 3-10 years
Pt: anemia, strict vegan with no doctor visits for 10 years, pernicious anemia (IgA attacks intrinsic-factor-producing parietal cells), terminal ileum compromise (ie. Crohn's), gastric bypass
Dx: low B12, high methylmalonic acid (MMA), high homocysteine (doesn't matter)
Tx: B12 IM (if GI problems exist) or PO (if no GI problems) |
|
|
Term
|
Definition
Microcytic anemia
Path: decrased iron
Pt: old man with +FOBT (blood loss), young woman with menometrorrhagia (blood loss), gastrectomy (poor absorption)
Dx: Ferritin low, iron low, TIBC high
Tx: give iron, takes 3-6 weeks to fix anemai, takes 3-6 months to fix stores |
|
|
Term
| Anemia of Chronic Inflammation |
|
Definition
Microcytic anemia
Path: inflammation
Pt: chronic autoimmune disease
Dx: ferritin high, iron low, TIBC low
Tx: treat underlying disease, anti-inflammatories, +/- erythropoetin (EPO) |
|
|
Term
|
Definition
microcytic anemia
Path: globin
Pt: minor - asx
major - sick
Dx: ferritin normal, iron normal, TIBC normal... so get hemoglobic electrophoresis which shows:
1. if positive - beta thal
2. if negative - alpha thal (dx of exclusion)
Tx: minor - none; major - transfused with 350mg iron (that's a lot of iron!) + deferoxamine to chelate
a2b2 - HgbA1 (normal)
a2d2 - HgbA2
a2gam2 - HbgF (fetal) |
|
|
Term
|
Definition
microcytic anemia
Path: irreversible - cancer, myelodysplastic syndrome, B6 def.
reversible - alcohol, high lead, low copper
Pt:
Dx: iron high, ferritin and TIBC can vary, Bone Marrow Bx shows ringed sideroblasts (iron in mitochondira)
Tx: 1. try to treat B6 or cancer
2. avoid lead and EtOH, give copper |
|
|
Term
|
Definition
Normocytic anemia
Path: AR HgbSS, sicling of RBCs in response to acidosis, hypoxia, and dehydration
Pt: pain crisis = vasoocclusive disease, acute chest = MI, acute brain = CVA, priapism
Dx: 1st Hgb electrophoresis shows HgbSS
acute crisis - sickles on a smear
Tx: hydroxyurea increases HgbF, IVF, O2, pain control
exchange transfusion for acute "MI" "CVA" or priapism |
|
|
Term
|
Definition
Path: decreased G6PD
Pt: Mediterranean man with anemia or jaundice taking fava beans, dapsone, atovoquone, or infection
Dx: G6PD levels 6-8 weeks after crisis is over; newer RBCs will have sufficient G6PD, so levels will be WNL during event
Tx: avoid oxidant stress |
|
|
Term
|
Definition
Path: spectrin, ankyrin, pallidin faulty
Pt: hemolysis and spherocytes
Dx: osmotic fragility test
Tx: splenectomy and post-splenectomy vaccinations |
|
|
Term
| Autoimmune Hemolytic anemia |
|
Definition
Coombs Test!
IgM+ - Cold
Ass/w mycoplasma and mononucleosis (M's)
Tx: avoid cold
IgG+ - Warm
Ass/w cancers and AI diseases
Tx: meds that treat AI like steroids or -mabs like Eculizumab |
|
|
Term
| Paroxysmal Nocturnal Hemoglobinuria |
|
Definition
Path: lack PIG-A (in RBCs which defends against compliment cascade and MAC complex formation)
Pt: nighttime - hypoventilation -> hypoxemia and acidosis -> more susceptible to complement attack
Dx: flow cytometry looking for monoclonal expansion of CD55-
Tx: supportive, or stem cell transplant if severe |
|
|
Term
|
Definition
1. Penicillins
a. penicillin (G, VK, benzathine)
b. ampicillin
c. amoxicillin (HELPS - h flu, e coli, listeria, proteus, salmonella)
2. Cephalosporins
a. cefazolin, cephalexin
b. cefotetan (aner), cefoxitin (aner), cefuroxime
c. ceftriaxone, ceftazidime, cefataxime
d. cefepime (VAP)
e. ceftaroline (MRSA, not pseudomonas)
3. Carbapenems
a. imipenem, meropenem, ertapenem, doripenem (all 4 neutropenic fever)
4. Aztreonam
a. monobactam class (GN and pseudomonas) |
|
|
Term
|
Definition
cipro, gemi, levo, moxi
for HCAP
cipro for cystitis
moxi for diverticulitis |
|
|
Term
|
Definition
gentamycin, tobramycin, amikacin
for GNR
nephro and ototox |
|
|
Term
|
Definition
for: chlamydia
lyme not involving brain/heart (3rd gen ceph)
rickettsia
MRSA cellulitis
1 and 2 syphilis (if pen allergic)
borrelia, erlichia, mycoplasma
TOX: tooth discoloration, bone growth abnormalities, photosensitivity, teratogen, fanconi syndrome (RTA type 2), GI distress |
|
|
Term
| Bactrim (trimethaprim/sulfamethoxazole) |
|
Definition
for: cystitis, MRSA cellulitis
TOX: rash, hemolysis with G6PD deficiency, BM suppression |
|
|
Term
|
Definition
Bugs: Strep pneumo, Neisseria men (rash, teen), GBS, h flu, listeria. Rare = TB (pulm TB), RMSF (rash from extrem to trunk), lyme (targetoid rash, camping in NE), cryptococcus (AIDS, CD4 <50, high opening pressure, dx with crypt antigen, NO INDIA INK), syphilis (dx with CSF-RPR or treponema antigen)
Pt: fever, headache, stiff neck, photophobia
Dx: 1)LP then abs OR 2)abx then CT scan if LP is unsafe
Tx: ceftriaxone and vanc and steroids +/- ampicillin if immunosuppressed
crypto - amphotericin B
RMSF/lyme - ceftriaxone and doxy
TB - RIPE therapy |
|
|
Term
|
Definition
Pt: fever headache and focal neurologic deficit
Dx: CT showing mass lesion. Either toxo or not (AIDS with previous toxo antibody). If not, brain bx for ca or abscess.
Tx: 1. toxo - treat toxo and rescan in 6 wks
2. cancer - chemo and rad
3. abscess - drain and abx |
|
|
Term
|
Definition
Path: viral, only HSV is treatable
Pt: fever, headache, altered mental status
Dx: "temporal lobe" or "hemorrhagic tap" pointing towards HSV; must confirm with HSV-PCR
Tx: acyclovir or foscarnet if resistant
TXO: acyclovir trashes kidneys |
|
|
Term
|
Definition
Focal neurologic deficit
Altered mental status
Immunosuppressed
Lesion at the site
Seizures |
|
|
Term
|
Definition
bacterial - thousands of PMNs (neutophils), high protein, low glucose
TB - very high protein
crypto/lyme/rickettsia/viral - nothing |
|
|
Term
|
Definition
Bugs: strep p, m. catarhals, h flu
Path: middle ear infx
Pt: unilateral, no pain on pinna, loss of light reflex
Dx: pneumatic insuflation
Tx: amoxicillin, add clavulanate if failure occurs, try macrolide if that fails |
|
|
Term
|
Definition
Path: outer ear infection
Bugs: pseudomons - swimmers ear, staph a. - qtips or fingers
Pt: unilateral pain with pinna pull
Dx: erythematous ear, clinical
Tx: none! (if not, cipro ear drops work fine) |
|
|
Term
|
Definition
Path: URI bugs in sinuses
Pt: congestion with b/l purulent nasal discharge, facial tap -> pain
Dx: sinus aspirate or biopsy (only do this if initial tx fails)
Tx: >7 days or cough - amox (bacterial)
<7 days and no cough - watch and wait (viral) |
|
|
Term
|
Definition
Path: strep A, or viral
Pt: sore throat, pain on swallowing, exudates, swollen tonsils, >10 days is bacterial
Dx: 1. Centor criteria: no cough, yes exudates, yes fever, yes cervical lymph nodes, age <15 +1, age >15 -1
2. rapid strep (specific)
3. cx
Tx: amox if bacterial, wait if viral
Complications: rheumatic fever in child, PSGN in kidneys at any age |
|
|
Term
|
Definition
Pt: cough, fever, headache, sore throat, joint or mm pain, n/v and diarrhea
Dx: <48 hours do nasopharyngeal swab
Tx: <48 hours - oseltamivir, zanamivir
>48 hours - symptomatic |
|
|
Term
|
Definition
Path: big tonsils
Pt: snoring child, blue at rest, pink up when crying
Dx: pass an NG tube, use fiberoptic scope
Tx: surgical resection |
|
|
Term
| Infectious Diarrhea Causes |
|
Definition
Enterotoxic: C diff - abx, v. cholera - rice water stools, ETEC - traveler's diarrhea, S aureus - egg salad/mayo, b. cereus - reheated rice, giardia - lake swimmers
Invasive: Campylobacter - MCC, EHEC 0157:H7 - HUS, shigella - HUS, salmonella - raw eggs/chicken, yersinia - loves iron as in hemochromatosis or blood transfusions
Dx: stool RBC, stool WBC, lactoferrin is better answer than stool WBC, most accurate is stool cx |
|
|
Term
|
Definition
Acute:
Path: staph a, strep p, CHF, new vegitations persistent bacteremia
Dx: blood cx until they clear, TEE
Tx: empiric abx with native valve - vanc only
prosthetic valves <60 days ago - vanc, gent, cefipine
prosthetic valve >1 year - vanc, gent, ceftriaxone
prosthetic valve in b/w - vanc and gent
Subtle:
Path: HACEK organisms, fevers, non-toxic, rheum findings
Dx: blood cx until +, TTE
Tx: no abx until +cx arrive |
|
|
Term
|
Definition
Cause bacterial endocarditis:
Haemophilus aphrophilus
Haemophilus parainfluenzae
Actinobacillus
Cardiobacterium
Eikenella
Kingella
(Caxiella and Baronella are MCC of cx-neg endocarditis)
Tx: all with ceftriaxone |
|
|
Term
| Indications for Surgery for Endocarditis |
|
Definition
1. CHF with ruptured valve or chordae
2. prosthetic valves
3. fungal infx
4. abscess
5. AV block
6. recurrent emboli while on abx |
|
|
Term
| Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) |
|
Definition
zidovudine (***give to baby intrapartum x6wk)
didanosine
stavudine
lamivudine
emtricitabine
abacavir
tenofovir |
|
|
Term
| Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) |
|
Definition
efavirenz (***teratogen)
etravirine
nevirapine
rilpivirine |
|
|
Term
|
Definition
darunavir
atazanavir
ritonavir (*** boosts other PIs)
sawuinavir
felfinavir
amprenavir
fosamprenavir
lopinavir
indinavir
tipranavir |
|
|
Term
| Best started triple therapy for HIV |
|
Definition
1. emtricitabine (NRTI)
2. tenofovir (NRTI)
3. efavirenz (NNRTI) |
|
|
Term
| Adverse effects of HIV drugs |
|
Definition
zidovudine - anemia
stavudine or didanosine - peripheral neuruopathy and pancreatitis
abacavir (HLA B5701) - hypersensitivity and Steven Johnsons
all protease inhibitors - hyperlip, hyperglycemia
indinavir - nephrolithiasis
tenofovir - renal insufficiency |
|
|
Term
|
Definition
Path: drug reaction or C1 esterase deficiency
Pt: swelling of the face, tounge, eyes, airway, rash, but no itching
Dx: clinical
Tx: protect airway, STEROIDS DON'T WORK, histamine antagonists
acute therapy with FFP or ECALLANTIDE
-C1 esterase inhibitor deficiency |
|
|
Term
|
Definition
Path: histamine release from immediate hypersensitivity
Pt: Rash and hypotension
Dx: don't dx, just treat
Tx: IM 1:1000 epinephrine for hypotension, steroids, histamine antagonists (H1 blocker like Benedryl, or H2 blocker like ranitidine) |
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