deck 31 Flashcards
pathophys of acute massive PE
abrupt increase in RA pressure –> decreased venous return to LA –> decreased CO + hypotension + obstructive shock
acute HIV infection
mononucleosis like syndrome consisting of fever + night sweats + lymphadenopathy + arthralgias + diarrhea
indications for antimicrobial prophylaxis for tick bites
1) adult tick or nymphal exodus scapularis
2) tick attached for longer than 36 hours or engorged
3) prophylaxis started within 3 days of tick removal
other meds that can cause hearing loss
aspirin + loop diuretics
indications for hep c screening
1) injection drugs
2) needlestick
3) blood transfusion before 1992
chlamydia on testing
Culture-negative
won’t show up as bacteria on UA
most common valvular abnormality detected in patients with infective endocarditis
mitral valve disease (usually MVP w/ coexisting mitral regurgitation)
nasal polyps associated with
chronic rhino sinusitis
asthma
aspirin-exacerbated respiratory disease (AERD)
nasal polyp presentation
bilateral nasal obstruction + nasal discharge + anosmia
Aspirin exacerbated respiratory disease (AERD)
- asthma, chronic rhino sinusitis with nasal polyposis and bronchospasm or nasal congestion following ingestion of aspirin or NSAIDS.
malignant (necrotizing) otitis externa (MOE)
severe infection of external auditory canal and base of skull usually caused by pseudomonas aeruginosa
- usually happens in old people with bad diabetes
- presents with severe pain + purulent drainage with a sense of fullness
abx with good pseudomonal coverage
ciprofloxacin
most common cause of hearing loss in AIDS patients
- serous otitis media (presence of middle ear effusion without signs of infection)
(lymphadenopathy or lymphomas cause auditory tube dysfunction) - leads to conductive hearing loss
treatment for syphilis patient with penicillin allergy
doxy
problem with monospot
25% false-negative rate during first week of illness
common complaint with presbycusis
difficulty hearing in crowded or noisy environments
- high-pitched noises or voices
heamophilus ducreyi presentation
papule that progresses to an ulcer
labs in endocarditis
normocytic anemia + high ESR
RF can be positive
diagnosis of histoplasma
urine or serum antigen assay
vaccines for patients with chronic liver disease
hep A,B, PPSV23, Tdap
potential complication of upper GI endoscopy
aspiration pneumonia due to anaerobes
other vibrio vulnificus infection
Often cause wound infections that can be mild, but may develop rapid-onset, severe necrotizing fasciitis with hemorrhagic bulls lesions and septic shock. Patients with liver disease are at high risk.
treatment of choice for pregnant and lactating patients with early localized lyme disease
amoxicillin (can’t give CTX because it’s only IV and would require hospitalization and exposure to other microbes)
pyelo usually caused by…
e coli
treatment of uncomplicated pyelo
fluoroquinolone
definition of complicated UTI
diabetes, urinary obstruction/hardware, renal failure, immunosuppression, hospital-acquired
treatment of complicated pyelo
IV fluoroquinolone, aminoglycoside, extended spectrum beta-lactam/cephalosporin
preferred initial treatment for uncomplicated BPH
alpha-1 blockers (5-alpha-reductase inhibitors have a much slower onset)
diagnosis of testicular mass
painless hard mass in testicle + US suggesting cancer
management of testicular mass
radical orchiectomy (kill first, investigate later) + also remove cord
acute urinary retention pathophys
- obstruction, neurogenic bladder, or detrusor muscle under activity in elderly (most often obstruction due to BPH or prostate cancer) leads to acute inability to void.
achilles tendon reflex caveat
can be decrease or even absent with age, so can be normal in many elderly patients
major concerning drugs that can interact with sildenafil
nitrates or alpha-blockers
most important RF for bladder cancer
smoking
BPH and hematuria?
BPH can cause hematuria
other RF’s for bladder cancer
- painters, metal workers
- chronic cystitis
- cyclophosphamide
- pelvic radiation exposure
other features of prostatitis
urgency, hesitancy
hematospermia, pain w/ ejaculation
usually no history of UTI
urine culture w/ prostatitis and UA
sterile and negative
prostate tenderness with prostatits
none or mild
treatment of chronic prostatits
- fluorquinolones
- alpha blockers
- 5-alpha-reducatase inhibitors (finasteride)
1st line for patients with ED 2/2 cardiovascular disease
PDE-5 inhibitors (sildenafil)
testing for patients with BPH and lower urinary tract symptoms (frequency, nocturia, hesitancy)
UA to rule out hematuria and infection
PSA (unless predicted life expectancy is less than 10 years)
leydig cell tumor features
- increased estrogen production
- most common type of testicular sex cord stroll tumors
- principle source of testosterone and are capable of estrogen production due to increased aromatase expression
torus palatinus etiology
congenital
physical exam findings suggesting allergic rhinitis
1) allergic shiners (infraorbital edema and darkening)
2) dennie-morgan lines (prominent lines on lower eyelids)
3) allergic salute (transverse nasal crease)
4) pale, bluish, enlarged turbinates
5) pharyngeal cobblestoning
6) “allergic facies” (high-arched palate, open-mouth breathing)
pharyngeal cobblestoning suggests either…
asthma or allergic rhinitis
typical history with TMJ disorder
nocturnal teeth grinding
initial treatment of TMJ disorder
nighttime bite guard, surgical intervention sometimes necessary
