ID/Pulm Flashcards
Silicosis risks
sa blasting, stone cutting, quarry exposure, mining
beryllium risk
high tech electronics manufacturing
farmer lung
hypersensitivity pneumonitis from exposures to organic agricultural dusters, fungal spores, vegetable products, insect fragments, animal feces, etc
Higher risk oof 30 day mortality for PNA
Confusion
Uremia
RR > 30
Bun >20
Age > 65
Hypotension
Male
CHF or COPD
dx mumps
myalgia, fatigue, loss of appetite, fever, PAROTITIS, orchitis
orchitis complications –> infertility, meningitis, encephalitis
Measles dx
cough, coryza, conjunctivitis, Koplik spots
Abx choice in critically ill PNA
-lactam (CTX, cefotaxime) or Unsayn + macrolide
- macrolide alone
- macrolide + resp flouroquinolone
**steroids can improve LOS, duration abx, risk of ARDS
Tx of post-strep-glomerulonephritis
SUPPORTIVE
- HTN/edema> thiazide or loop diuretic
Treating strep or impetigo correctly does NOT prevent subsequent APSGN
indications for skin testing for PCN allergy
hx of hives or pruritic rash –> if negative, do amoxicillin challenge under observation
Malignant characteristics of pulm nodules
ground glass
>6mm
non-calcified
doubling in 1 mo
irregular or spiculated borders
Tx based on COPD GOLD stage
A- sama or saba
B- laba or lama
C- ICS
biomarkers for sarcoidosis?
none exist, but ACE might be elevated in 75% oof untreated patients
When to bx in sarcoidosis
only accessible/safe bx site if very symptomatic and tx is indicated
tx of sarcoidosis
1st line= steroids
2nd line- methotrexate, azathioprine, leflunomide, biologics
dx of sarcoidosis
1) compatible clinical and radiologic presentation (hilar adenopathy)
2) path w/ noncaseating granulomoas
3) exclusion with other diseases
dx COPD
FEV1/FVC <70 irreversible with bronchodilators
tx for acute rheumatic fever
NSAIDs
abx coverage for acute chest syndrome in sickle cell
cover for mycoplasma and chlamydophila w/ azithromycin and 3rd gen cephalosporin
indication for thrombolysis over anticoagulation in PE
hypotension
meningitis ppx
Cipro, azithro, CTX x1 day
or Rifampin x2 days
lights criteria
prot >0.5, LDH >0.6= EXudate=EXtra= high numbers
malignancy, PNA, viral illness, asbestos
cat scratch disease dx/tx
bartonella –> regionoal LAD
self limiting! do NOT I&D
lymes management
Stage 1= EM –> TREAT w/ doxy, no need to test
Late lyme (neurologic, 7th nerve palsy, cardiac A-V block, etc) –> test with ELISA, confirm with Western blot
Jarisch herxeimer reaction
Febrile prodrome from spirochete lysis at time of treatment
-RPR, lyme
- Tx= supportive, continue antibiotic
anti-HTNsive med that can have benefit in OSA
Spiro (diuretic + resistant HTN effect)
Tx of UTI in elderly
1= bactrim
2= nitrofurantoin if GFR> 40
Cipro only if high comomunity resistance to above
Antibitiotic for sinusitis
Augmentin. Previously Azithromycin but nw resistant.
Levo if allergic to PCN or chronic sinusitis
FIRST imaging for osteo
Xray, then MRI. Can do CT if MRI contraindicated
