Case Files 43-48 (J) Flashcards
The large local allergic reactions surrounding an insect sting is due to _____.
IgE mediated response (Type I hypersensitivity reaction). its natural history is 24-48 hours
What are the signs/symptoms of the local reaction to insect stings?
erythema, swelling, pain, and itching. Occurs immediately and resolve in a few hours. It is due to the venom itself causing a histamine reaction.
What is the treatment of choice for type I hypersensitivity reactions?
Oral steroids.
Signs/symptoms and treatment for anaphylaxis?
hypotension, airway edema, shock, and death
Treat with 0.3-0.5 mL of 1:1000 Epinephrine. Except the death. this won’t treat the death.
What is the treatment for a minor animal/human bite?
clean the site with soap and water, debride any devitalized tissue, irrigate with saline, and give a tetanus vaccine if not up to date.
What is the treatment for a minor animal/human bite?
Same as with a minor bite (clean the site with soap and water, debride any devitalized tissue, irrigate with saline, and give a tetanus vaccine if not up to date.) plus antibiotic prophylaxis using 5-7 days of augmentin. If cellulitis has started to develop (because they waited a couple of days to come in) then its a 7-14 day course of Augmentin.
What bacterium do you have to consider as possible sources of infections in human bites?
The usual Staph, Strep, and anaerobic species, PLUS Eikenella (the one likely to be tested)
What bacterium do you have to consider as possible sources of infections in dog/cat bites?
The usual Staph, Strep, and anaerobic species, PLUS pasteurella (the one likely to be tested)
What is a TIA?
a Transient Ischemic Attach. An episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia WITHOUT infarction. Symptoms last
What us a stroke?
Infarction of central nervous tissue. Symptoms by definition last >24 hours, though treatment is (hopefully) started sooner.
What are the risk factors for stroke?
HTN (most important), history of TIA, Diabetes, age, male, dyslipidemia, smoking
What are the two most common (testable) types of ischemic stroke?
Thrombotic (occluded due to atherosclerosis) or embolic (usually clots occasionally vegetations from infective endocarditis)
a 67 yo male presents with sudden onset aphasia, spatial neglect, and right sided hemiparesis. Which artery is occluded?
Left MCA. This is usually the dominant side of the brain and thus where Broca’s area is. remember that it will be contralateral hemiparesis.
What are the 2 most common (testable) types of stroke?
ischemic and Hemorrhagic
What is the initial test for a suspected stroke?
brain CT without contrast. It may not show ischemia for up to 72 hours but can quickly rule out a hemorrhage thus allowing the use of tPA
What secondary tests should be done for a stroke?
ECG to rule out MI or AFib as the cause of the stroke.
Blood glucose, CMP, creatinine, drug screen
What is the first step in treating a suspected stroke (ABCs have been done)?
If within 3-4 hours of the onset of symptoms and a hemorrhage has been ruled out treat with IV tPA. If between 4-48 hours give ASA, O2, and early mobilization. Be cautious of anti-hypertensives unless >220/120
You suspect a subarachnoid hemorrhage in a 84 yo woman but the CT without contrast does not show it. What is your next step?
Lumbar Puncture.
What is the long term preventive treatment post stroke?
unless a source of the embolism is found, put the pt on anti-platelet therapy.
A 39yo homeless, IV drug abuseing, man who has sex with men presents to the ED for fever, cough , and dyspnea. His chest has bilateral interstitial infiltrates on CXR. What is the most likely (on a test) cause of his pneumonia?
Dude has AIDS. these are the 3 “risk factors” for AIDS according to the NBME. on the test the AIDS related cause of pneumonia is Pneumocystic Jiroveci (Carinii)
What is the treatment of choice for P. Jiroveci?
trimethoprim-sulfamethoxazole (TMP-SMX)
Prophylactic treatment should be started on all patients with a Tcell count
What is the standard screening test for HIV?
ELISA assay. Positive assays are confirmed with Western Blot.
If a person comes back HIV positive what other tests should be drawn?
CD4 count, Viral load
The book says syphilis, Hep B/C, and G/C as well. Because, you know, they must be dirty.
What are some common AIDS defining diseases and opportunistic infections?
P. Jiroveci, TB, Candida (in places like esophagus and lungs), Kaposi Sarcoma, CMV retinits, and CNS lymphoma.
What is the first step in treating a newly diagnosed HIV patient?
refer them to a specialist.
What vaccines are contraindicated in HIV positive patients?
all live virus vaccines (including flu)
a 33yo man with no siginificant medical history presents with acute onset diarrhea, abdominal pain, hepatomegaly and jaundice about a month after traveling to central america. What is the most likely diagnosis?
Acute Hepatitis A.
If a patient is high in unconjugated (indirect) bilirubin, what are the likely sources?
Unconjugated bili means that the jaundice is pre-hepatic.
If mild think Gilbert syndrome,
If moderate-severe think hemolysis
What is Gilbert syndrome?
a genetic defect that affects glucuronidation of bilirubin in the liver.
What are the common causes of hemolysis?
spherocytosis, thalassemia, sickle cell, malaria, TTP, and HUS
If a patient is high in conjugated (direct) bilirubin, what are the likely sources?
Hepatitis (A,B,C,D or E), Alcohol abuse, or physical obstruction of the bile duct (bile stone or pancreatic cancer)
What is the cause of ~80% of hepatocellular carcinoma?
Hepatitis B
What are the signs/symptoms and mode of transmission of HepA?
S/SX: jaundice, fever, fatigue, abdominal pain, diarrhea, nausea, vomiting, RUQ pain.
Transmitted: contaminated food and water.
How can you tell if a Hep B infection is acute, chronic, or resolved?
by looking at the different serology markers.
HBsAg is + Acute, +Chronic, -resolved
Anti-HBsAg is -Acute, +Chronic, +resolved
HBeAG is + if infective
Hepatitis D requires what?
a coinfection with hepatitis B as it uses the viral envelope of Hep B.
