Step 3 7 Flashcards by Ned Jones

valvular disease workup

echo
left heart cath
EKG
CXR

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AS management

Diuretics

Consult cardiology for valve replacement

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dilated cardiomyopathy management

ACEi/ARB
Betablocker
if HR > 70 still, add ivabradine
spironolactone

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HOCM management

Betablocker

Diuretics

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kussmaul sign

increase in JVP on inhalation

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tamponade presentation

SOB + hypotension + JVD + clear lungs

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what echo will show with tamponade

diastolic collapse of RA and RV

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long-term therapy for pericardial tamponade

pericardial window placement

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treatment of constrictive pericarditis

surgically remove pericardium

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thoracic dissection management

EKG
CXR
CT angiography/MRA/TEE
ICU transfer
Consult surgery
Betablocker
then nitroprusside to control BP

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PAD management

Aspirin
Cilostazol
Vorapaxar
BP control with ACEi
Statins to target LDL < 100
Exercise as tolerated
IF signs of gangrene OR pain at rest → surgical bypass
Consider:
Pentoxifylline (marginally effective)

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hemodynamic instability on CCS

SBP less than 90, CHF, AMS, chest pain

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rate control meds in AFib

BB (metoprolol, carvedilol) or Non-DHP CCB (diltiazem) or digoxin

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reversal drug for dabigatran

idarucizumab

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VASc in CHADS-VASc

Vascular disease
Age 65-74
Female sex

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NOACs

Xa inhibitors (rivaroxiban, edoxaban, apixaban)
Direct thrombin inhibitor (dabigatran)

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CHADS

CHF
HTN
Age over 75
DM
Stroke/TIA

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treatment of bleeding for patient on warfarin

FFP

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reversal drug for Xa inhibitors

andexanet

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benefit of NOACs over warfarin

NOACs prevent more strokes, cause less intracranial bleeding, and decrease mortality more, and treat DVT/PE

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drug selection in rate control for AF

if hyperthyroid/ischemic heart disease/migraines/Graves/pheochromocytoma → BB
if comorbid COPD/asthma → CCB
if borderline hypotension → Digoxin

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MAT management

FIRST: Oxygen
Diltiazem
Palliative care consult

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gamma gap meaning and definition

difference between total serum protein and serum albumin.

4 g/dL.

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gamma gap differential

blood cell dyscrasias or viral infections, e.g., multiple myeloma, monoclonal gammopathy of unknown significance, or acute HIV infection

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antiarrhythmics for VT

amiodarone, lidocaine, procainamide, magnesium

syncope orders

``` Chem 7 Telemetry Oximeter CBC EKG CT head If ventricular dysrhythmia diagnosed, consult cardiology for ICD If chest pain → CK-MB/troponin If murmur on exam → TTE If focal deficits on neuro exam OR seizure described → EEG ```

second set of workup for syncope if first negative

holter repeat CK-MB and troponin Urine and blood tox

third set of orders for syncope workup

tilt table testing | EP testing

MSSA oral options

cephalexin, dicloxacillin

MSSA IV options

oxacillin/nafcillin, cefazolin

daptomycin SE's

myopathy, rising CK

minor MRSA infection options

bacrim, clindamycin, doxycyline

MRSA infection in patient with penicillin alergy

RASH: cephalosporins Anaphylaxis: clindamycin or linezolid Severe infection: Vanc, linezolid, dapto Minor infection: macrolides, clinda, bactrim

meds with activity against strep

penicillin, ampicillin, amoxicillin

big gun for pseudomonas coverage

polymyxin/colistin

beta lactamase inhibitors

clavulanate | sulbactam/tazobactam/avibactam

cephalosporins with anaerobe coverage

cefoxitin, cefotetan

best long-term therapy fo CMV retinitis

valganciclovir

Influenza meds

oseltamivir zanamivir peramivir

ribavirin use

refractory hep C (causes anemia)

aspergillus treatment

voriconazole

best antifungal in neutropenic fever

Echinocandins

OM clinical features

(DM + PAD) + (Ulcer or soft tissue infection)

osteomyelitis management

Bone biopsy/aspiration or culture (whether under CT guidance or during surgery (to guide treatment) Ortho consult ID consult (dispo, vascular access, OP antibiotic coordination) Plastics consult if skin flap may be needed ABX → base on cultures, thus wait until biopsy or specimens from I&D obtained. IF SIRSY → blood culture Monitor sed rate to guide antibiotic duration

otitis externa management

ofloxacin, ciprofloxacin, or polymyxin/neomycin topical hydrocortisone acetic acid and water solution

malignant otitis externa management

surgical debridement

treatment of refractory otitis media

cephalosporin or augmentin

most accurate test for sinusitis

sinus aspirate for culture

indications for influenza vaccination + approach

- COPD, CHF, dialysis, steroids, health care workers, everyone over 50 - inhaled live attenuated for anyone under 50

impetigo treatment

if mild --> mupirocin or retapamulin | if severe --> oral dicloxacillin or cephalexin

cellulitis management

If diabetic, venous insufficiency, or lymphedema, → consider X-ray, then possible MRI for OM. If lower extremity → US for DVT If persistent systemic symptoms after 48 hrs → consider X-ray, then possible MRI for OM PLUS US for abscess

size of hair follicle infections

folliculitis, furuncle, carbuncle, boil

workup of fungal infection of skin and nails

KOH prep

dysuria, discharge management

If dysuria or discharge or both: → NAAT on urine sample if positive → CTX IM + azithromycin single dose PO.

epididymitis treatment

>35 → CTX + doxycyline | <35 → fluoroquinolone

genital herpes management

Treat empirically with acyclovir x 7 days IF recurrent → daily suppressive therapy IF refractory → foscarnet

treatment of primary/secondary syphilis if penicillin allergic

doxycycline

granuloma inguinale diagnosis

biopsy or touch prep

treatment of granuloma inguinale

doxy, TMP/SMX, azithromycin

pediculosis

mite that lives in hair-bearing areas, such as pubic hair or axilla

UTI SYSTEM

if positive for symptoms (dysuria, urinary frequency or urgency, suprapubic pain, hematuria, fevers, chills, flank pain) OR a man → UA + gram stain → assess for pyuria + bacteriuria → assess complicated/uncomplicated... uncomplicated → fosfomycin or nitrofurantoin x 3 days (if resistance to e coli low, if high, then quinolone) complicated → culture --> TMP/SMX or ciprofloxacin x 7 days

pyelo management

UA + culture Outpatient → ciprofloxacin Inpatient → CTX, quinolones, ampicillin, gentamicin

perinephric abscess

quinolone + oxacillin/nafcillin/vancomycin

prostatitis management

Cipro or TMP/SMX x 2 weeks (acute) or 6 (chronic)

HAART combinations

lamivudine + abacavir + integrase inhibitor tenofovir + emtricitabine + integrase inhibitor tenofovir + emtricitabine + atazanavir/darunavir

tenofovir AE's

RTA, fanconi syndrome, osteopenia

what to test for before starting abacavir

HLAB5701

drugs that constitute prep

tenofovir + emtricitabine