Step3 28 Flashcards
Presentation of Cryptococcal meningitis
HIV patient, exposure to pigeon dropping
Signs of intracranial pressure: nausea, vomiting, headache, papilledema
Fever
CSF analysis of cryptococcal infection
Elevated opening pressure: >250-300
Leukocyte count: <50 (lymphocytic predominance)
Elevated proteins
Low glucose
Treatment of Cryptococcal meningitis
Amphotericin B + flucytosine
First Aid:
Amphotericin B + flucytosine for 2 weeks then fluconazole for 8 weeks or treat until CD4 >100
Serial lumbar puncture to decrease intracranial pressure (yeast and capsule polysaccharides clog the arachnoid villi)
Things that cause serotonin sd
SSRI, NSRI, TCAs use or overdose
Interaction SSRI + MAO inhibitor (eg. phenelzine)
Drug abuse: NDMA
Serotonin syndrome presentation
Mental status changes: anxiety, agitation, delirium
Autonomic dysregulation: diaphoresis, hyperthermia, tachycardia, hypertension, vomiting diarrhea
Neuromuscular hyperactivity: myoclonus, tremor, hyperreflexia
Washout period to change from SSRI to MAOI
2 weeks
Unless fluoxetine…. wait 5 weeks
MAOI names
Phenelzine
Selegiline
Tranylcypromine
Serotonin sd. vs Neuroleptic malignant sd
Serotonin sd:
SSRI, SRNI, TCAs
SSRI combine with MAOI
Neuroleptic:
Antipsychotics
Serotonin: NEUROLOGIC HYPERACTIVITY (not present in NMS) Autonomic dysfunction: tachycardia hypertension, hyperthermia, diarrhea, diaphoresis Mental status changes: anxiety, agitation
Neuroleptic Fever Autonomic instability Muscle rigidity, CK elevation Delirium
Relative risk formula
a/a+b dived by c/c+d
Incidence of exposed people with disease compared to people exposed without it
Cohort vs. Case-control
COHORT: Picks risk factors and looks for the outcome
Prospective: patient with or without risk factors and follow to see who developed the disease. Look for disease incidence
Retrospective: same… (but in the past)
CASE-CONTROL: Selects outcome and looks for risk factors (Eg. Patients with heart disease vs. No heart disease and see if they had a bad diet)
Patients with the disease compared to patients without it and their relationship with the risk factor
Contraindication to kidney donation (9)
<18 years Inability to make an informed decision Uncontrolled hypertension, diabetes, HIV Acute infection Uncontrolled psychiatric illness Suspicion of coercion Suspicion of financial transaction Active or partially treated cancer Current substance abuse
Management of cholinergic intoxication
Supportive (oxygen, fluids, intubation)
Atropine or pralidoxime
Activated charcoal if <1hr
Other symptoms present in organophosphate poisoning
Muscle weakness
Paralysis
Fasciculation
CNS depression
Coma
Seizure
Cardiotoxicity in Trastuzumab vs. Anthraciclyne
Trastuzumab:
Decrease myocyte contraction (dormant cell)
Usually asymptomatic, can lead to heart failure
Reversible when the medication stops
Not dose-dependant
Anthracycline:
Destruction of myocyte
Dose dependant
Not reversible due to myocyte destruction
What is effect modification
When an external variable has an effect on the outcome.
Stratifying the sample helps to see if there is a significant association
If you stratify and note that there is no significant association, it means there is cofounding
