Exam Flashcards
Ventilator associated pneumonia
מונשמים נוטים לפתח לקת ריאות מכיוון שהטובוס פוגע במנגנון ההגנה נגד מיקרואספרציות, רוב המקרים מתפתחים בחמשת הימים הראשונים.
המחוללים העיקריים: מחוללים עיקריים מהקהילה
בנוסף חיידקים עמידים, כולל פסאודומונס, MRSA, אצינטובטר, חידדקים גרם שליליים ESBL.
Community acquired pneumonia CAP
המחוללים העיקריים מהקהילה
(Streptococcus pneumoniae (two thirds))|
haemophilus influenzae
mycoplasma pneumoniae
chlamydia pneumonia
legionella
chlamydia pisttaci
coxiella burnetti
enteric gram negative bacteria
pseudomonas aeruginosa
staphylococcus aureus
anaerobes
respiratory viruses.
Empiric treatment of VAP
AB that covers Pseudomonas, MRSA, and gram negative bacteria.
Vancomycin
Ceftazidime (third generation cephalosporin)
Levofloxacin (fluoroquinolone for covering legionella)
MRSA pneumonia AB coverage
seven to 21 days of intravenous vancomycin or linezolid, or clindamycin (600 mg orally or intravenously three times per day) if the strain is susceptible.
EBV Infectious mononucleosis
common in childhood and adolescence.
in developing contries the the encounter of the infection happens at earlier stages.
in adolescent 75% of the patients will develop Infectious mononucleosis.
the virus is transmitted by saliva.
symptoms are un specific, including myalgia, weakness, fever.
lymphadenopathy and pharyngitis appear in the first two weeks of the disease.
splenomegaly may appear in the second or third week.
treatment with penicillin may cause macular rash, not associated with allergy to penicillin in the future.
in lap: lymphocytosis (with atypical lymphocytes), thrombocytopenia, hemolytic anemia, elevated liver enzymes.
the diagnosis is done by serological markers.
EBV is associated with different neoplasm including, hodgkins and NH lymphoma, burkitts lymphoma (15%), Nasopharyngeal carcinoma.
in AIDS- EBV is associated with 100% of primary CNS lymphoma.
Incidentaloma
Should be evaluated if:
Characteristics of malignancy, including a size greater than 4 cm, radiodensity more than 20 hounsfiels (HU).
Endocrinological evaluation must be done prior to any intervention, including:
24h urine collection for catecholamines (or metanephrines in plasma), 2 test for cushing and aldosteron/renin test.
In case more than 4 cm, sex hormones should also be tested.
CSF in bacterial meningitis
Bacterial meningitis:
WBC > 1000, usually with neutrophilic predominance.
CSF protein concentration above 250 mg/dl
Glucose concentration below 45 mg/dl
Clinical Triade of meningitis
Nuchal rigidity
Fever
Mental status change
Indication for CT scan before LP when meningitis is suspected
1- Immunocompromised state (HIV, immunosuppressive therapy, solid organ or hematopoietic cell transplantation).
2- History of CNS disease (mass lesion, stroke, focal infection).
3- new onset seizure (within one week of presentation).
4- papiledema.
5- Abnormal level of consciousness
6- focal neurologic deficit
Pathogens in community acquired bacterial meningitis
The major causes of community-acquired bacterial meningitis in adults in developed countries are Streptococcus pneumoniae, Neisseria meningitidis, and, primarily in patients over 50 years of age or those who have deficiencies in cell-mediated immunity, Listeria monocytogenes
Listeria monocytogenes in Meningitis
- Affects older adults and neonates
- Site of entry: GI or placenta
- predisposition: Defects in cell-mediated immunity (eg, glucocorticoids, transplantation [especially renal transplantation]), pregnancy, liver disease, alcoholism, malignancy
Listeria AB treatment in invasive disease such as CNS infection and Bacteremia.
1- ampicillin or penicillin, each combined with gentamicin.
- Alternatives to ampicillin or penicillin:
- trimethoprim-sulfamethoxazole (TMP-SMX)
Poor prognostic factors in AML (6)
1- Age > 60
2- Karnofsky score (performance score) <60
3- MDR-1 positive phenotype
4- other heamatological disorder, MDS, Myeloproliferative, therapy related AML.
5- Karyotypic abnormalities, -5, -7, t (6,9).
6- FLT3/ITD mutation
Favorable prognostic factors in AML (6)
1- AGE<50
2- Karnofsky score >60
3- MDR-1 negative phenotype
4- No other hematological disorder, or prior chemo/radiotherapy.
5- karyotype: t(8,21), t(15/17), t(16,16) inv16.
6- NPM1 mutation
% of patients who need ICD implantation after TAVI
10%
IgA nephropathy epidemiology
2
- Most common lesion found to cause primary glomerulonephritis throughout most developed countries.
- 2:1 male-to-female predominance
IgA nephropathy- Clinical features
3
1- 40-50 % with one or recurrent episodes of gross hematuria, often accompanying an upper respiratory infection.
2- 30 to 40 percent have microscopic hematuria and usually mild proteinuria and are incidentally detected on a routine examination or during a diagnostic evaluation for chronic kidney disease.
3- 30-40 percent present with either nephrotic syndrome or an acute, rapidly progressive glomerulonephritis characterized by edema, hypertension, and renal insufficiency as well as hematuria
IgA nephropathy Diagnosis
The diagnosis can be confirmed only by kidney biopsy with immunofluorescence or immunoperoxidase studies for IgA deposits.
