R&E F,G,H part Flashcards
dx or imaging soft tissue lesion how
MRI
inflammatory vs non-inflammatory joint disease on history
inflam =
- swelling with the pain
- constitutional symptoms (fever, anorexia, fatigue)
- morning stiffness 30 min + morning pain
- wake up at night
- better with mobility
vertebral fracture management
- rule out pathology
- send home with tylenol
rhabdomyolysis triad
- generalized weakness
- myalgias
- dark urine
dx of bone tumors is done how
XR
shoulder dislocation most common type
anterior (90%)
shoulder dislocation associated problems
- Bony Bankart (fracture of anterior glenoid rim)
- Hill-Sachs impression fracture (posterior humeral head)
osteosarcoma most common site
distal femur
osteosarcoma most common age of presentation
10-20 yo
Ewing sarcoma what bones
diaphyseal bones
- femur
- tibia
- humerus
Ewing sarcoma most common age of presentation
10-20 yo
Ewing sarcoma pathology
large soft tissue reaction
Ewing sarcoma how good XR is
not the best bc underestimates the large soft tissue reaction
chondrosarcoma what bones
- hip
- shoulder
- proximal long bones
chondrosarcoma common age of pres
40-60 yo
chondrosarcoma appearance on XR
lytic lesions often with fracture
osteoporosis who do you treat
high risk patients
osteoporosis def of high risk patients
either of
- had >1 non vertebral fragility fracture
- has had 1 vertebral or hip fracture
inflammatory vs non inflam joint disease on PE
inflammatory = -pain worse with rest -warm -PIPs non inflammatory = -cold deformed -DIP
how to treat inflammatory joint disease like RA
anti-inflammatories
- steroids
- immune modulation
- DMARD (like methotrexate)
how to treat non inflam joint disease like OA
analgesics (acetaminophen, topical NSAID)
febrile neutropenia def
- fever (>38.3 once or >38 twice on 1 hour+ inteval)
- ANC<500
feb neut management and why
- emergency IV Abx. want to cover gram+ and gram-
- blood culture
- CXR
how do you take the temperature in feb neut
NOT RECTAL. anything else
feb neut: management if fever persists or recurs after droping
suspect fungal infection
most common UTI bacteria
E.coli
rule in tx UTIs and how do you treat
TX ONLY IF SYMPTOMATIC
-Septra (sulfamethoxazole-trimethroprim)
strep throat management and why
- ALWAYS tx with Abx
- bc can progress to rheumatic fever
rheumatic fever is what
- type 2 hypersensitivity reaction
- caused by molecular mimicry
management of fever in returning traveller
suspect malaria***
(Dengue if SE Asia)
-even if fever with something else (don’t forget there’s fever so don’t think of another disease before malaria)
important parasite to avoid in pregnancy, why and how
- toxoplasma
- because crosses the placenta
- avoid changing cat litter boxes
maternal-fetal transmission main organisms
TORCH
- toxoplasma
- (others like varicella)
- rubella
- cytomegalovirus
- herpes and HIV
only DROP FORM Abx (2 names) you can give for otitis externa
fluoroquinolones (ciprofloxacin)
why can’t give DROP FORM Abx other than fluoroquinolones (ciprofloxacin) in otitis externa
if there’s tympanic membrane perforation that you saw or didn’t see, giving will cause
treatment of otitis media
amoxicillin per os
a patient has a positive PPD test for TB: next step in management
CXR
latent TB (TB infection): risk of converting to tuberculosis (active TB) and specific case
- 10%
- >10% if have HIV
latent TB (TB infection treatment)
optional isoniazid for 9 mo or rifampin 4 mo
how UTIs are diagnosed
- leukocyte esterase
- nitrites
meningitis signs on PE
- neck stiffness
- Brudzinski’s sign
- Kernig’s sign
lumbar puncture of a bacterial meningitis and how it compares to LP for viral meningitis
- increased pressure (not in viral)
- WBCs present
- protein present (not in viral)
- low glucose (not in viral)
- VIRAL = ONLY HAS WBCs*
meningitis treatment
- cefotaxime or ceftriaxone AND vancomycin if older than 1 mo
- cefotaxime or ceftriaxone and AMPICILLIN if <1 mo
- *IV dexamethasone (CS) as adjuvant therapy in certain cases to decrease brain inflamamtion and prevent neurological damage
when give IV dexamethasone as adjuvant tx in meningitis and why
- Strep pneumo in adult
- H influenza in kid
- GEL (GBS (like agalactiae), E.coli, Listeria) in <1 mo
- to decrease brain inflamamtion and prevent neurological damage*
when do you administer the adjuvant IV dexomethasone in meningitis if needed
before taking the Abx (cef + amp or vanco) or in the 20 mins after
brain function in meningitis how is it affected
is normal (only altered mental status if late meningitis)
encephalitis difference with meningitis
causes altered brain function
- personality change
- sensory dysfunction
- motor dysfunction
HIV initial symptoms
- initially infection to lymph nodes
- then get a secondary viremia (mono-like ilness) = maculopapular rash, myalgia, headache, hepatohsplenomegaly, etc.)
treatment of HIV (to everyone)
HAART
definition of AIDS
CD4 count below 200
AIDS = at risk for what infections and problems
- All infections
- pneumocystis jeroveci pneumonia (especially neonates)
- lymphocytic interstitial pneumonia
- HIV nephropathy
- HIV dementia
infection routes for HIV
most common to least common
- blood transfusion
- perinatal exposure
- needlestick injury
- breastfeeding
pt vomiting + has non bloody (watery) diarrhea: think what infection
norovirus (cruise ship virus)
pt has non bloody (watery) diarrhea but NOT vomiting: think what infection
- rotavirus
- ETEC (enterotoxic E.coli)
- vibrio
pt has bloody diarrhea: think what infection
SSCYE + 1 parasite
- shigella spp
- salmonella spp
- yersinia enterocolitica
- campylobacter jejuni
- EHEC (E.coli O157)
- entamoeba histolytica
HPV infection different symptoms depending on type of HPV
can get any of these
- warts (molluscum)
- cervical cancer
HPV types that give warts
6 and 11
HPV types that give cervical cancer1
16 and 18
herpes ulcers vs syphilis chancres how to differentiate
- herpes ulcer is painful
- syphilis chancre is painless
bacterial meningitis LP (CSF content)
- 1000-5000 cells (high cell count)
- 1.0 to 5.0 g/L prot (high protein)
- glucose <2.5 (low glucose)
- CSF:serum glucose ratio <0.4 (decreased)
viral meningitis LP (CSF content)
- <1000 cells
- <1.0 g/L prot
- normal glucose (3.0 to 5.0)
- normal CSF:serum glucose ratio (0.4)
hepA symptoms
- jaundice
- liver inflammation
hepA transmission
fecal-oral
hepA vaccine exists yes or no
yes. vaccine available for hepA
hepB symptoms
have some prodromal symptoms (before the high LFTs = liver function tests) and then the actual symptoms (when high LFTs):
- jaundice
- fatigue
- dark urine
- abdominal pain
hepB transmission
body fluids (note: 30% risk with a needlestick) -note: survives long time on surfaces
hepB vaccine yes or no
yes. vaccine available for hepB
hepC symptoms
- 80% are asymptomatic
- mild symptoms
risk with hepC and how you act to reduce it
- risk of developing chronic cirrhosis
- so treat with direct acting antiviral
hepC transmission
-body fluids (note: 3% risk with needlestick injury)
hepC vaccine yes or no
NO. no vaccine for hepC
in what pts are live vaccines (varicella, MMR, etc.) contraindicated
- immunocompromised
- pregnant
vaccines that the immunocompromised and pregnant pts must have
mnemonic: rotating (rotavirus) chickens (chickenpox) on poles (polio) does not give tuberculosis (BCG vaccine) or autism
(MMR)
structure of the hepB virus + diff in Abs our bodies make for the two
has surface Ags (Abs to this will ELIMINATE the virus and stay for life) + core Ags (Abs for these are just there but don’t do anything and also stay for life)
positive for sAg indicates what in hepB
you’re infected (acute or chronic)
positive for sAb indicates what in hepB
resolved acute infection (resolved bc you were able to make sAb)
positive for cAg indicates what in hepB
you’re infected acutely (it hasn’t been long since you got infected) bc
hepB: sAg, sAb, cAb and cAg in the vaccinated (vaccination = give surface antigen bc we want sAb (the efficient Ab) to be produced)
- sAg negative
- sAb positive
- cAg negative
3 tests for hepB
- surface Ags
- surface Abs (Abs to the surface Ag)
- core Abs (Abs to the core Ag)
- NO CORE Ag TEST*
how the 3 tests for hepB + total core Abs (includes IgG cAb) evolve with time when you get acute hepatitis B (infection in adult life, unprotected sex for example)
- sAg up then back down
- cAb IgM up a bit later then back down too
- Total cAb (IgM + IgG) goes up with cAb IgM and present for life (bc IgG stays)
- sAb goes up and stays for life (after cAb IgM down) IS PRESENT ONLY AFTER INFECTION
how the 3 tests for hepB + total core Abs (includes IgG cAb) evolve with time when you get chronic hepatitis B (infection perinatally)
- sAg up and there for life
- then cAb IgM up and then down
- Total cAb (IgM + IgG) goes up with cAb IgM and present for life (bc IgG stays)
how the 3 tests for hepB differ for chronic hepB vs acute hepB
- acute = sAg will go up then back down
chronic = sAg stays up for life - acute = sAb will go up late and stay for life. chronic = sAb never appears bc immune system can’t clear the sAg
*but both have cAb go up and stay for life (and IgM back down long term)
what tests do you order to know if a patient is currently infected with hepB (acute or chronic, doesn’t matter)
sAg
what tests do you order to know if a patient has ever been exposed to hepatitis B
total cAb
what test do you order to know if a patient is immune to hepB (means acute and healed it. you’re not immune if chronically infected)
sAb
what test do you order to know if a patient has ACUTE HEP B INFECTION SPECIFICALLY (want to discriminate acute vs chronic)
cAb IgM*
-NOT sAg bc is always there with chronic
what is the Ab to hepB that gives you immunity to hepB
sAb
meaning of sAg-, sAb- and cAb-
no prior exposure
meaning of sAg-, sAb+, cAb-
vaccination (vaccine only has sAg in it bc anws it is the sAb that gives you immunity)
(IMPORTANT) meaning of sAg-, sAb+, cAb+
resolved acute infection
meaning of sAg+, sAb-, cAb+
acute or chronic infection (sAb- bc only have sAb AFTER acute infection and not during acute)
if you got a sAg+, sAb-, cAb+, how will you differentiate the acute infection from the chronic infection
by knowing if cAb IgM is + (acute) or - (chronic)
if a needle contains hepB, hepC or HIV what is the respective risk ok getting infected in a needlestick injury with a needle containing one of these
- hepB: 30%
- hepC: 3%
- HIV: 0.3%
Parkland formula to estimate how much fluid you need to give a burn patient within the first 24 hours + over what time interval specifically
4 x m (kg) x % of TBSA (burnt) = V to give (in mL)
- half in first 8 hours
- half in next 16 hours
how to estimate TBSA burnt in a burn injury
- arm = 9% each
- leg = 18% each
- torso = 18%
- back = 18%
- head = 9%
- palm = 1%
SIRS definition
2 of these 4 criteria
- temp <36 or >38
- PaCO2 <32 or RR>20
- WBCs <4000 or >12000 or >10% band neutrophils
- HR>90
chronic granulomatous disease is what
deficiency in NAPDH oxidase in phagocytes
CGD susceptibility to which bacteria
- aspergillus
- burkholderia
- strep
- nocardia
CGD what to be careful about
infected patient may have no fever and no leukocytosis because the signaling is impaired (CGD affects inflammatory cells)
can’t rule out infection if no fever or leukocytosis
most common food allergen + other one common too
- milk #1
- raw egg (but cooked = no allergy bc no more allergens)
milk allergy appears when during life usually
children under 1 yo
actual most common allergies in children and adults as taught in the lectures
- peanut in children (is a legume, grows in ground) and tree nut is #2 (grows in trees)
- shellfish in adult #1 and tree nut #2
ddx of child <1 yo with a rash
- VIRAL INFECTION
- milk allergy
anaphylaxis definition
allergic rxn involving at least 2 systems
treatment of anaphylaxis
IM epipnephrine
GVHD happens when
in allogeneic tissue transplant (allogeneic = healthy person to someone with disease).
*most often in HSCT hematopoietic stem cell transplant
treatment of GVHD
steroids
DLBCL (diffuse large B cell lymphoma) treatment (is the tx for non-Hodgkin lymphomas in general)
CHOP
- cyclohosphamide
- doxorubicin
- vincristine
- prednisone
Hodgkin’s lymphoma tx
ABVD
- adriamycin (doxorubicin)
- bleomycin
- vinblastine
- dacarbazine
