Bones and Bloods Flashcards
In pts with suspected osteomylitis with open wound that has a culture that grows out organism, why do you need a bone biopsy?
in patients with suspected osteomyelitis, the microbiologic isolates from cultures obtained from a wound or a draining sinus tract generally do not reliably correlate with the pathogen in the infected bone, with the occasional exception of Staphylococcus aureus.
A 25-year-old man is evaluated because of a 2-week history of purulent drainage from a small opening in a previously healed right lower extremity wound. Six months ago, the patient had an open comminuted fracture of the proximal tibia that was treated with internal fixation with a metal plate. He recovered well after surgery, with complete healing of his surgical incisions. He has otherwise felt well.
On physical examination, temperature is 37.2°C (98.9°F), blood pressure is 120/75 mm Hg, and respiration rate is 12/min. There is a well-healed surgical incision overlying the right tibia except for a 2-mm opening at the distal margin, with minimal surrounding erythema and slight purulent drainage. The remainder of the examination is normal.
Swab samples from the wound grow an Enterococcus species that is susceptible to all antibiotics tested.
Whats going on?
Pt had recent open fracture with repair… development of a draining sinus tract from the wound above a bone that underwent surgical instrumentation is highly suspicious for underlying contiguous osteomyelitis.
Next step: get bone biopsy
Aortic Stenosis
Quality: Crescendo-decrescendo, midsystolic
Best heard at: Base
radiates to: Carotids
Features: Single S2, pulsus parvus, S4
Hypertrophic obstructive cardiomyopathy
Crescendo, mid- or late systolic
Lower left sternal borde
radiates to: Carotids
Bifid carotid impulse; murmur decreases with passive leg elevation or handgrip, increases with Valsalva
Mitral regurgitation
Holo- or late systolic
Apex
radiates to: Axilla or back
Murmur increases with isometric exercise; best heard with patient in left lateral decubitus position
Mitral valve prolapse with mitral regurgitation
Late systolic
Apex
radaites to: Axilla
With Valsalva, midsystolic click and murmur move closer to S1, and murmur increases in intensity
Tricuspid regurgitation
Holosystolic
Lower left sternal border
radiates to: Lower right sternal border
Prominent v waves in neck; murmur increases with inspiration
Aortic regurgitation
Decrescendo
Second right or third to left intercostal space
no radiation
Widened pulse pressure, bounding carotid pulses; murmur best heard with patient in upright position, leaning forward, at end-expiration
Pulmonic regurgitation
Mid-diastolic
Upper left sternal border
radation: None
Loud S2 if pulmonary hypertension is present
Mitral stenosis
Low-pitched rumble
Apex
radiation: None
Murmur best heard with patient in left lateral decubitus position; opening snap
How is screening in type I and II diabetes pts different?
The recommended initial screening differs for patients with type 1 or type 2 diabetes mellitus. Patients with type 2 diabetes often experience a delay in diagnosis. As a result, these patients may already have diabetes-related complications at diagnosis. Therefore, screening for diabetic retinopathy, neuropathy, nephropathy, and dyslipidemia should be obtained once the diagnosis has been established.
When do you expect microvascular disease in type I DM patients?
What screening do you want to do at time of diagnosis?
Patients with type 1 diabetes are typically diagnosed at the time of disease onset based on the occurrence of symptomatic hyperglycemia or ketoacidosis. Since microvascular complications in patients with type 1 diabetes typically occur after the onset of puberty and/or 5 to 10 years after the initial diagnosis, screening for these complications is delayed until that time. Because patients with type 1 diabetes have a higher risk of early cardiovascular disease, screening is typically done early in the disease course.
* fasting lipid panel performed after puberty or at diagnosis if the diagnosis is established after puberty.
When do you screen type I DM for nephropathy?
When do you screen type I DM with dialated fundoscopic exam?
The ADA recommends screening for nephropathy (such as a urine albumin-creatinine ratio) once a patient with type 1 diabetes is 10 years of age or older and has been diagnosed with diabetes for 5 or more years.
The first dilated funduscopic examination should be obtained once the child is 10 years of age or older and has been diagnosed with type 1 diabetes for 3 to 5 years.
A 42-year-old woman is evaluated in the emergency department. She has a 2-day history of nonexertional chest pain. The pain is sharp, substernal, and worse when lying down or with deep breaths. She denies shortness of breath. Her symptoms were preceded by a recent upper respiratory tract infection.
On physical examination, temperature is 37.9°C (100.3°F), blood pressure is 165/90 mm Hg, pulse rate is 102/min, respiration rate is 18/min, and oxygen saturation is 96% on ambient air. The cardiopulmonary examination is normal as is the remainder of the physical examination. ECG shows diffuse ST elevations and chest xray shows pleural effusion
Dx and next step?
pericarditis!
NSAIDS is first step with colchicine
three key findings in pericarditis and treatement?
Diagnosis is most often made by confirming two of three classic findings: chest pain, often with a pleuritic component; friction rub; and diffuse ST-segment elevation on electrocardiography (ECG).
NSAIDS or ASA and then colchcine
