Pastest Flashcards
Use of plasma concentration measurement
- Assess prognosis
- Aid in clinical decision making of active vs. palliative treatment
- Determine need for specific antidote treatment
Plasma concentration measurement is useful in these drugs
(Pa-Pa-Theo-S-M-I-L-E)
Paraquat
Paracetamol
Theophylline
Salicylates
Methanol
Iron
Lithium
Ethylene glycol
Infective endocarditis MC causes
Staphylococcus aures and streptococci
IE most common location
Mitral valve
IE duration of treatment
4-6 weeks
Drug of choice for IE
NVE: Amoxicillin 2 g every 4 hours + Gentamicin 1 g every 12 hours
PVE: Vancomycin + Gentamicin + Rifampicin 300-600 mg every 12 hours
Staphylococcal, sensitive: Flucloxacillin
Probable/Confirmed MRSA: Vancomycin and Rifampicin
Streptococci, sensitive: Benzylpenicillin
Streptococci, resistant: Add Gentamicin
HACEK: Amoxicillin + Gentamicin
Infective endocarditis
Damaged or prosthetic heart valves
Streptococcal: More indolent presentation than staphylococcal
Right-sided staphylococcal endocarditis: More often in IV drug users
Pseudomonas aeruginosa: Requires surgical intervention
Non-infective causes: Marantic (Metatasis-related), Libman-Sacks (SLE-related)
Subacture or chronic: 3 sets of blood culture, at least 6 hours apart to confirm continuous bacteremia
Obtaining sample during pyrexia increases chance of (+) blood culture
If BC (-) > Serology for Coxiella or Bartonella > Serology for Chlamydia, Legionella and Mycoplasma > Serogology for Brucella if with history of exposure
Antibiotic prophylaxis NO LONGER ROUTINELY recommended for invasive procedures (Dental, GI, GU)
Duke’s Criteria for IE
Definite: TWO major or ONE major + THREE minor or FIVE minor
Possible: ONE major + ONE minor or THREE minor
MAJOR MICROBIOLOGICAL
- Typical MOs from 2 separate blood cultures
- MO consistent with IE from persistently (+) blood culture
- Single (+) blood culture for Coxiella burnetii or serology (+) for C. burnetii
MAJOR CARDIOLOGY
- New valvular regurgitation
- Positive echocardiogram
MINOR
- Predisposition to IE
- Fever
- Immunological phenomena
- Vascular phenomena
- Positive blood culture not meeting major criteria
Initial imaging of choice for IE
TTE
TOE if prosthetic valve or TTE is of poor quality, (+) or (-) in the context of continuing clinical suspicion
Primary Biliary Cholangitis
Autoimmune condition of the liver, strongly associated with other autoimmune disease such as RA, Sjorgen, CREST
Persistent inflammation > Destruction of small intrahepatic ducts > Small duct proliferation > Fibrosis > Cirrhosis
Hallmark: AntiMitochondrial Ab (AMA)
Increased ALP (Released by cells of the biliary tree and bile ducts)
Treatment of PBC
- Symptomatic and delay of progression
- Definitive: Liver transplantation and subsequent immunosuppression (Reserved for end stage disease or intractable pruritus)
- Pharmacological:
- Cholestyramine: Relief of pruritus
- Obeticholic acid: Mono if UDCA not tolerated or no response; Or combine (Improve prognosis or delay time to progression?)
Characteristic of ecstasy overdose
Thirst > Excessive drinking > Water intoxication > HPN and tachycardia, hyponatremia
Pupil dilatation
Prognosis with respect to hyperpyrexia/rhabdomyolysis highly dependent on time to presentation at the ED
GS for detecting renal artery stenosi
Renal arteriography
First-line non-invasive testing for renal artery stenosis
Duplex Doppler Ultrasound
Scleroderma renal crisis
Diagnosis of systemic sclerosis + recent use of corticosteroids + significant and rapid worsening of BP
DOC for HPN: ACE inhibitors
Where possible, limit corticosteroid dose to Prednisolone 15 mg/day or equivalent
Heyde’s syndrome
Association of angiodysplasia leading to colonic bleeding and aortic stenosis
Resistant to Amphotericin B
Aspergillus terreus
