Burns Derm Infect HIV Flashcards
Influenza treatment and PPX
Tx: Tamiflu 75 mg BID x 5 days
PPX: Tamiflu 75 mg daily x 10 days
RENAL ADJUSTMENT
Post flu PNA causes and Tx
causes: STREP PNA; hib or atypicals
Tx: anti pneumococcal BL (ceftriaxone, cefotaxime, ceftaroline, Unasyn) + Azithro/Levaquin
CO risk factors and lab findings
burns in closed area, building w/ poor ventilation, vehicle exhaust in closed area.
Labs: severe acidosis, carboxyhemoglobin > 10 (25 is severe, > 40 is fatal)
CO treatment
High flow 100% FiO2
Hyperbaric: severe acidosis, carboxyhemoglobin > 25%, neuro s/s, shock s/s
cellulitis causes and presentation
Red flags
Acute diffuse, inflammation of skin and subq structures w/ erythema, edema, leukocyte infiltration
causes: staph, strep, h influenza
Red flags: sepsis, s/s compartment syndrome, cutaneous necrosis, closed space like a hand, Triangle of death, IS or DM
Cellulitis Tx
outpt: elevation, heat, NSAIDS.
-10-14 days of clinda, doxy, Bactrim DS
-reasess in 48 hours
Emergent:
-Facial = Vanc or dapto/zyvox
-general = Vanc or -penem
Presentation of erysipelas
more superficial w/ more clearly demarcated margins
-LL, face and ears
-lymph involvement and streaking more common
Folliculitis vs furunculosis vs carbunculosis
Causes and Tx
caused by staph
folic: topical 5% benzoyl peroxide or clinda gel x 10 days
Non febrile, < 5 cm: I&D, hot packs
Non febrile > 5 cm: Bactrim 2 tabs x 10 days, or clinda/doxy, hot packs
Febrile and/or many boils: Bactrim 2 tabs + rifampin 300 BID x 10 days
Nec fasc causes and s/s
causes: Anaerobic bacteria w/ aerobic GN bacteria. GA hemolytic strep and s. aureus
S/S: sudden out of proportion onset of pain, pain progresses to anesthesia, quick spread of erythema, skin changes to dusky/purple color, can see yellow-green necrotic fascia. Gas production, foul discharge and bullae formation
Nec fasc Tx
- Vanc + BL/BL-ase inhib
- carbapenem & fluoro OR aminoglycoside + clinda
surgical debridement/consult, ID consult
Graves causes and Tx
Autoimmune TSH receptor antibodies stimulating the thyroid hormone synthesis and secretion along w/ thyroid tissue growth
Tx: BB, radioactive iodine, surgery
RA causes and Dx
Symmetrical inflammatory peripheral polyarthritis r/I stretching of tendons/ligaments and destruction of joints through erosion of cartilage and bone in 3+ joints. Morning stiffness
Dx: Rh factor, CCP, CRP/ESR, XR
SLE cause and s/s
Chronic inflammatory disease of unknown cause. Women > men
S/S: malar rash, photosens, discoid rash, fatigue, wt loss, fever, oral ulcers, alopecia
SLE Dx and Tx
(+) ANA, dsDNA, smith antigen
-CBC low, PTT bleeding, BUN high, CXR CM or pleural eff
Joints: NSAIDS, lifestyle changes, steroids
Mucocutaneous: supportive, hydroxychloroquine, steroids
Lupus nephritis: CTX, pred, hydroxy
Neuropsych: CTX, pred
Myasthenia Gravis cause and s/s
Fluctuating degree and combination of weakness in ocular, bulbar, limb and resp muscles d/t anti-body mediated T cell dependent attack at ACh proteins in the postsynaptic membrane at NM junction
Fatigue that improves with rest
MG Dx
-Serum ACh receptor antibody
-Muscle specific tyrosine kinase antibody
-TSH, T3/T4
-CT chest: assess for thymoma
-PFTs and NIF
-ice pack test: ptosis immediately assessed
-edrophonium test: prolongs presence of ACh and will improve muscle strength
MG Tx
Mild I and II: pyridostigmine
Mod III:
-pyridostigmine, IS meds, steroids
Severe IV and V
-vent
-PLEX
-IVIG + HD steroids
MS causes and risk
Multifocal areas of demyelination w/ loss of oligodendrocytes and astroglial scarring. Axon injury.
females 20-40
MS Tx
Acute relapse w/ worsening
-methlypred
-PLEX
Relapsing
-interferon
Secondary
-methylpred
Primary progressive
-ocrelizumab
Hashimoto’s causes, Dx and Tx
Most common HOthyroid.
Autoimmune destruction of thyroid gland through apoptosis of thyroid epithelial cells. Lymphocytic infiltration of thyroid gland
Dx: TSH, T4, cholesterol. antithyroid peroxidase antibodies
Tx: levothyroxine
Guillan Barre causes and symptoms
Acute monophasic paralyzing illness usually provoked by preceding infection. Immune response that attacks nerves/myelin/axon
S/S: ascending symmetrical muscle weaknes, resp distress, speech/swallowing problems, areflexia/hyporeflexia, facial weakness
GB Dx and Tx
-nerve conduction studies
-LP: high protein, normal cell count
-LFTs: high AST/ALT
-spirometry: low VC
-antiganglioside antibody
PLEX +/- IVIG x 5 days depending on renal function
Psoriasis Tx
Plaques
-topical steroids, vit D
-photo, MTX, biologics, cyclosporine
Guttate
-photo
-MTX, oral retinoid, cyclosporine
Pustular
-oral retinoid
-re-PUVA
Sjogrens definition and symptoms
Chronic autoimmune lymphocytic infiltration into lacrimal and salivary glands
S/S: dry eyes/mouth, fatigue, vasculitis, dental caries
Sjogrens Dx and Tx
Schirmer test: measure tears
Anti-60kD Ro & anti-LA: antibodies +
Salivary gland Bx
Lissamine green test: ocular score of 3 or >
Eyes: fake tears, CSC drops
Mouth: fake saliva, cholinergics
Fatigue: check TSH, fibromyalgia, depression
MSK: Tylenol, NSAIDS
Vasculitis: steroids
-IVIG x 5 days
Meningitis causes and Tx
Community cases caused by s. pneumoniae and n. meningitidis
-3rd gen ceph
Adjunct dex .15 mg/kg to decrease M&M
-PCN resist: add vanc
-Neonates, infants, old need coverage for listeria w/ Ampcillin
-If n. megingitdis: all HCW w/ contact need ppx
brain abscess risk factors and Tx
Chronic infection of para-meningeal structures, LS endocarditis, congenital cyanotic HD, or IS pts
Vanc
High dose flagyl
3rd gen ceph
CAP immunocompetent Tx
BL + macrolide/fluoro
PCN allergy: resp fluoro and aztreonam
ASP: add clindamycin
Psueodmonas risk: zoysn, cefepime, imipenem or merrem
MRSA risk: add vanc. Zyvox if vanc allergy
CAP immunocompromised Tx
IS should be covered for PJP
Consider CMV in intersitial pneumonitits
HAP and VAP causes and Tx
Causes: staph aureus and GN organisms
3rd or 4th gen ceph, BL or carbapenem + fluoro/aminoglycoside
-Consider pseudomonas and cover for it
-Risk steno maltophilia: add Bactrim
Endocarditis Tx
staph, strep, enterococcus
PCN OR 3rd gen ceph OR dapto, w or wo aminoglycoside OR glycopeptide/zyvox
High drug concentrations and LT IV therapy
IV catheters caused and Tx
coag neg staph most common
Remove line
Vanc if coag neg staph
Nafcillin for s aureus
Intra-abdominal infection Tx
CONSULT SURGERY
Comm Acq: BL/BL-ase combo and carbapenems as monotherapy OR ceph/fluoro with flagyl
Antifungal coverage IF
-isolated fungi w/ CM conditions
-postop or recurrent infxns
UTI causes and Tx
GN enteric bacteria
Most hospitalized pts w/ bacteria w/ catheter do not have pyuria or symptoms so bacteria will usually resolve w/ removal
Upper UTI ALWAYS merit abx.
-3rd gen ceph
-aminoglycosides
-Zosyn
-bactrim
Extended catheter or manipulations
Suspect enterococcal infections
Initial: ampicillin, piperacillin or vanc
Remove/change catheter, then short course fluconazole
cutaneous infections
-s. aureus or GAB-hemolytic strep most common
-h. finfluenzae in facial/orbital cellulitis
-rapid post-op infections should consider clostridium perfringes or strep. Pyogenes = debride and antimicrobial
Postop: PCN-G wwo clinda
Dapto for bactericidal properties
IS or neutropenic patients
Broad spectrum
-3rd/4th ceph + aminoglycoside or fluoro
-carbapenem
-Zosyn
+ vanc of GP likely
1st degree burn description and Tx
Pain, dry, erythema, no blister, superficial
2nd degree burn
Very painful, moist, scattered or grouped blisters, mild-mod swelling
3rd degree burn
Usually not painful (nerve damage), dry, leathery, pearly/waxy, full thickness to skin/muscle or fat/bone
Fluid replacement requirements in burn pts
4 mL/Kg * TBSA burn = 24 hr requirement
FROM BURN:
1/2 in first 8 hrs
1/4 in second 8 hrs
1/4 in 3rd 8 hrs
ETT indications for burn pts
burn in confined space, burn to face or neck, singed face/nose hair, dark soot in or around mouth/face
Transport criteria for burn pts
i. > 10% 2/3rd if 10 < or < 50
ii. More than 20% 2/3rd
iii. 2/3rd to feet, face, hands, genitalia or crosses major joints
iv. > 5% 3rd in any age group
v. Any electrical burn
vi. Chemical burns w/ functional impairment
vii. Any burn w/ associated inhalation injury
viii. Current hospital doesn’t have management or knowledge, pts w/ preexisting med complications
ix. Any concurrent trauma or abuse suspected
Timeline for HIV infection
Day 0 = inoculated
Day 8 = highly sensitive antigen tests (+), viral load rapid increase
Week 2-4 = early antibody formation, HIGH viral load, HIGH transmission
Week 10-24 = viral load drops low, antibody tests (+). SEROCONVERSION COMPLETE
3 stages of HIV
Stage 1: acute
-Most contagious, mimics flu s/s
Stage 2: chronic
-Asymtpomatic/latent, less viral shedding, if Tx started can prevent progression, CD4 counts drop if not treated, nonspecific s/s
Stage 3: AIDS
-Viral load increases, more contagious, can start treatment here
-Dx: CD4 < 200, (+) OI
Types of HIV testing and when can be done
-Antibody tests: 23-90 days s/p exposure
-Antigen/antibody: 18-45 days
-NATs: recent exposure. 10-33 days
Types of infections based on CD4 count and PPX
200-500: shingles, thrush, skin, bacterial sinus and lung, TB
< 200: PCP, NHL
-Bactrim DS daily OR mepron, dapsone
< 100: MAC, toxoplasmosis
< 50: CMV
-azithro 1200 weekly OR clarithromycin 500 BID OR 600 x 2 weekly
toxoplasmosis causes and Tx
undercooked meat and cat feces
-pyremthamine/leucovorin/ sulfadiazine
cryptosporidiosis
Parasite from feces, swimming pools and lakes
fluids and nitazoxanide
disseminated MAC
Bacteria from soil and water, gardening/outdoor work
azithro, ethambutol and rifampin
