Step3 38 Flashcards
Antibiotic treatment for skin infections
Cellulitis: GAS + MSSA
Non-purulent: Clindamycin, amoxicillin + TMP-SMX, amoxi +doxy or linezolind
Purulent: (GAS + MRSA)
Clinda, TMP-SMX, Doxy, Linezolid
SEVERE:
IV vanc or clynda, (doxy or TMP)
Ventilation settings for a patient with ARDS.
What is the goal?
Ventilation (CO2)
Low tidal volume: 6-8 cc/kg
RR: <35
Oxygenation
High PEEP: 10-20 mmH2O
Plateau pressure: <30
High O2: Up to 60% of FiO2
GOAL:
PaO2: 55-80
SatO2: 88-95%
When do you initiate an extubation trial
When the patient has:
Good ventilation: pH >7.25
Good oxygenation:
PEEP < 8 mmH20 (no need to go <5)
FiO2: <40%
Improvement of the underlying cause
Hemodynamic stability
Ability to initiate spontaneous breathing (breathing trial)
Treatment for subclinical hypothyroidism
Q: 6001
or pg 1
When is abdominal imaging indicated in a patient with C. diff infection?
Evidence of severe disease:
WBC >15000
Creatinine >1.5
Fulminant:
Apparent shock
Ileus
Severe abdominal pain
If there is evidence of perforation or toxic megacolon, surgical management is indicated
Hormone levels in functional amenorrhea
Secondary to stress (eg. anorexia, exercise, chronic illness)
Elevated ghrelin, NPT, CRH, GABA, N-endorphins, and low leptin inhibit GnRH…. then everything else is low
Low GnRH, FSH, LH, estrogen
Treatment for osteoporosis/osteopenia in patients with functional amenorrhea
Weight gain
Decreased exercise (vs. increase in regular osteoporosis)
Vitamin D supplementation
If treatment fails… estrogen supplementation may be indicated
Acalculous cholecystitis
Risk factors
Critically ill patients, decreased motility (no obstruction)
Fever, abdominal pain, jaundice, the elevation of LFTs, bilirubin, and ALP
Treat with:
Antibiotics
Cholescystostomy (drain)
Cholecystectomy if perforation
Normal Non-stress test vs. non-reactive
2 accelerations lasting >15sec in 20min
>15pbm if >32 weeks
>10pbm if <32 weeks
Non-reactive:
Insufficient accelerations in 40min period
Perform biophysically profile
Causes of a non-reactive result during a fetal non-stress test
Baby is sleeping
Fetal acidemia
<32 weeks gestation
Maternal sedation, smoking
Biophysical profile
Parameters and interpretation
TWO POINTS EACH Fetal tone Breathing Movements Amniotic fluid Non-stress testing
8-10: reassuring
6: if pregnancy is at term, deliver
0-4: emergency, deliver is the cause can not be explained or corrected
Medications to prevent Opioid-induced constipation
Senna/docusate
Laxative: lactulose
Methylnaltrexone is not used for prevention
Active vs. Latent TB on x-ray
Latent: fibronodular scar with calcification, no lymphadenopathies or infiltrates
Active: infiltrate, pleural effusion, cavitation, hilar lymphadenopathies
Treatment for latent TB
Isoniazid + rifapentine: 3 months (not good for HIV patients
Rifampin: 6-9 months
Isoniazid: 4 months
Active: combination (4) for 6 months
Approach to uterine inversion
Stop oxytocin (need to relax uterus to reposition)
Watch for atony and severe hypotension
Treat atony with: Uterine massage Uterotonics again (misoprostol, methylergonovine) Packing and balloon Uterine artery embolization (if stable) Emergency laparotomy if unstable
Uterine atony management
Treat atony with: Uterine massage Uterotonics again (misoprostol, methylergonovine) Packing and balloon Uterine artery embolization (if stable) Emergency laparotomy if unstable
Management of hospital delirium
Reduce noise, increase lightning during the day
Have someone familiar in the room
Avoid room changes
Decrease polypharmacy
Early mobilization, little use of physical restraints
Early volume repletion for patients with dehydration
Hearing and visual aids
Aggressive chronic disease management
Electrolyte and metabolic surveillance
Indication for Fibrinogen administration in CID
Cryoprecipitate when Fibrinogen <100
Heparin-induced thrombocytopenia type 1
Thrombocytopenia <2 days of Heparin treatment
Nadir of 100000
Heparin-induced thrombocytopenia type 1 vs. type 2 treatment
Type 1:
No treatment needed
Type 2
Heparin discontinuation
Platelet 4 antibody testing
Alternative: argatrovan, vivalidurin
Endocrine manifestation of molar pregnancy. Why?
Hyperthyroidism
The alpha unit of hCG is similar to TSH and stimulates hormone production
Clinical presentation of molar pregnancy and management
Extremely elevated hCG
Exaggerated pregnancy symptoms
Hyperemesis gravidarium
Preeclampsia
Uterus bigger than gestational age
Hyperthyroidism
Abnormal bleeding
Extreme ages <15 or >35
Management:
Dilatation and curetage
Contraception for >6 months
Beta-blocker if hyperthyroidism
Frailty
Definition
Clinical presentation
Assessment
Management
Progressive vulnerability to adverse outcomes
Fatigue Resistance (weakness, decrease motor strength) Ambulatory dysfunction Illnesses (>5) Loss of weight
Review daily activities
Lab testing (to rule out anything)
Mobility test: get up and go
Structured exercise program
Nutrition and Vit. D
Eliminate unnecessary medications
Risk factors for mucormycosis
Diabetic (especially ketoacidosis)
Hematologic malignancies with bonemarrow transplant
Patients that easily develop hypophosphatemia during hospitalization. Why? Clinical manifestations
Alcoholics
Phosphate is usually depleted due to malnutrition.
When patients receive glucose, insulin production increases, and PO4 is driven to the intracellular space.
Weakness, hyporeflexia, paresthesias, ileus, metabolic encephalopathy when PO4 is <1
Risk and protective factors of epithelial ovarian cancer
Nullyparity Infertility Hormone replacement therapy Early menarche, late menopause BRCA 1 and 2 mutation Family history Lynch sd. PCOS
PROTECTIVE: OCPs Breastfeeding Multiparity Salpingoophorectomy
Clinical presentation and management of Splenic sequestration in sickle cell
Left abdominal pain
Acute splenomegaly
Anemia
Hypotension
Begin with isotonic fluids, follow with RBC transfusion to baseline. (DONT OVER TRANSFUSE)
Approach to a patient with symptoms of BPH
Prostate palpation
Neuro (perineal reflexes, sensation)
PSA
UA (look for signs of infection or bladder cancer)
If everything is normal, start a-blocker (finasteride)
Pupil in anterior uveitis vs. acute angle-closure glaucoma
Anterior uveitis: usually miotic
Acute angle-closure glaucoma: mild dilatation
What is important about the prevalence of a positive HLA-B27 marker
90% of people with Ankylosing spondylitis have it
Only 5% with it, have Ankylosing spondylitis
This means a positive test doesn’t mean you have if you don’t have symptoms
Relationship with marker and severity in RA
Having positive markers makes the disease worse.
Positive CCP is associated with more aggressive disease
Seronegative RA is less aggressive
Definition and causes of neonatal polycythemia
Ht: >66% or Hb: >22 mg/dl
Causes:
Increased erythropoiesis: maternal diabetes, maternal hypertension, smoking, IUGR
Endocrine: baby hyper or hypo tyroid
Genetics: Trisomy 16, 18, 21
Erythrocyte transfusion: twin-twin transfusion, delay clamping
Etiology of otitis externa
Pseudomonas (most common)
S. aureus
Treatment of acute otitis externa
Topical antibiotics (eg. ciprofloxacin +/- steroids)
ofloxacin
or
cipro/dexa
