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Acute Care 1 > Burns Derm Infect HIV > Flashcards

Burns Derm Infect HIV Flashcards

1
Q

Influenza treatment and PPX

A

Tx: Tamiflu 75 mg BID x 5 days
PPX: Tamiflu 75 mg daily x 10 days
RENAL ADJUSTMENT

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2
Q

Post flu PNA causes and Tx

A

causes: STREP PNA; hib or atypicals
Tx: anti pneumococcal BL (ceftriaxone, cefotaxime, ceftaroline, Unasyn) + Azithro/Levaquin

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3
Q

CO risk factors and lab findings

A

burns in closed area, building w/ poor ventilation, vehicle exhaust in closed area.
Labs: severe acidosis, carboxyhemoglobin > 10 (25 is severe, > 40 is fatal)

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4
Q

CO treatment

A

High flow 100% FiO2
Hyperbaric: severe acidosis, carboxyhemoglobin > 25%, neuro s/s, shock s/s

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5
Q

cellulitis causes and presentation

Red flags

A

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

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6
Q

Cellulitis Tx

A

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

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7
Q

Presentation of erysipelas

A

more superficial w/ more clearly demarcated margins
-LL, face and ears
-lymph involvement and streaking more common

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8
Q

Folliculitis vs furunculosis vs carbunculosis
Causes and Tx

A

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

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9
Q

Nec fasc causes and s/s

A

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

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10
Q

Nec fasc Tx

A
  1. Vanc + BL/BL-ase inhib
  2. carbapenem & fluoro OR aminoglycoside + clinda

surgical debridement/consult, ID consult

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11
Q

Graves causes and Tx

A

Autoimmune TSH receptor antibodies stimulating the thyroid hormone synthesis and secretion along w/ thyroid tissue growth

Tx: BB, radioactive iodine, surgery

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12
Q

RA causes and Dx

A

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

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13
Q

SLE cause and s/s

A

Chronic inflammatory disease of unknown cause. Women > men

S/S: malar rash, photosens, discoid rash, fatigue, wt loss, fever, oral ulcers, alopecia

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14
Q

SLE Dx and Tx

A

(+) 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

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15
Q

Myasthenia Gravis cause and s/s

A

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

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16
Q

MG Dx

A

-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

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17
Q

MG Tx

A

Mild I and II: pyridostigmine

Mod III:
-pyridostigmine, IS meds, steroids

Severe IV and V
-vent
-PLEX
-IVIG + HD steroids

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18
Q

MS causes and risk

A

Multifocal areas of demyelination w/ loss of oligodendrocytes and astroglial scarring. Axon injury.

females 20-40

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19
Q

MS Tx

A

Acute relapse w/ worsening
-methlypred
-PLEX

Relapsing
-interferon

Secondary
-methylpred

Primary progressive
-ocrelizumab

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20
Q

Hashimoto’s causes, Dx and Tx

A

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

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21
Q

Guillan Barre causes and symptoms

A

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

22
Q

GB Dx and Tx

A

-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

23
Q

Psoriasis Tx

A

Plaques
-topical steroids, vit D
-photo, MTX, biologics, cyclosporine

Guttate
-photo
-MTX, oral retinoid, cyclosporine

Pustular
-oral retinoid
-re-PUVA

24
Q

Sjogrens definition and symptoms

A

Chronic autoimmune lymphocytic infiltration into lacrimal and salivary glands
S/S: dry eyes/mouth, fatigue, vasculitis, dental caries

25
Q

Sjogrens Dx and Tx

A

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

26
Q

Meningitis causes and Tx

A

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

27
Q

brain abscess risk factors and Tx

A

Chronic infection of para-meningeal structures, LS endocarditis, congenital cyanotic HD, or IS pts

Vanc
High dose flagyl
3rd gen ceph

28
Q

CAP immunocompetent Tx

A

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

29
Q

CAP immunocompromised Tx

A

IS should be covered for PJP

Consider CMV in intersitial pneumonitits

30
Q

HAP and VAP causes and Tx

A

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

31
Q

Endocarditis Tx

staph, strep, enterococcus

A

PCN OR 3rd gen ceph OR dapto, w or wo aminoglycoside OR glycopeptide/zyvox

High drug concentrations and LT IV therapy

32
Q

IV catheters caused and Tx

A

coag neg staph most common

Remove line
Vanc if coag neg staph
Nafcillin for s aureus

33
Q

Intra-abdominal infection Tx

A

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

34
Q

UTI causes and Tx

A

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

35
Q

Extended catheter or manipulations

A

Suspect enterococcal infections

Initial: ampicillin, piperacillin or vanc

Remove/change catheter, then short course fluconazole

36
Q

cutaneous infections

A

-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

37
Q

IS or neutropenic patients

A

Broad spectrum
-3rd/4th ceph + aminoglycoside or fluoro
-carbapenem
-Zosyn
+ vanc of GP likely

38
Q

1st degree burn description and Tx

A

Pain, dry, erythema, no blister, superficial

39
Q

2nd degree burn

A

Very painful, moist, scattered or grouped blisters, mild-mod swelling

40
Q

3rd degree burn

A

Usually not painful (nerve damage), dry, leathery, pearly/waxy, full thickness to skin/muscle or fat/bone

41
Q

Fluid replacement requirements in burn pts

A

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

42
Q

ETT indications for burn pts

A

burn in confined space, burn to face or neck, singed face/nose hair, dark soot in or around mouth/face

43
Q

Transport criteria for burn pts

A

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

44
Q

Timeline for HIV infection

A

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

45
Q

3 stages of HIV

A

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

46
Q

Types of HIV testing and when can be done

A

-Antibody tests: 23-90 days s/p exposure

-Antigen/antibody: 18-45 days

-NATs: recent exposure. 10-33 days

47
Q

Types of infections based on CD4 count and PPX

A

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

48
Q

toxoplasmosis causes and Tx

A

undercooked meat and cat feces

-pyremthamine/leucovorin/ sulfadiazine

49
Q

cryptosporidiosis

A

Parasite from feces, swimming pools and lakes

fluids and nitazoxanide

50
Q

disseminated MAC

A

Bacteria from soil and water, gardening/outdoor work

azithro, ethambutol and rifampin

Acute Care 1 (2 decks)

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