Test 23 - IM Flashcards
Empiric antibiotic regimen for suspected meningitis in uncomplicated patient between 2-50 yrs
Vancomycin (strong gram +)
3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)
Bugs worried about for suspected meningitis in uncomplicated patient between 2-50 yrs
N. meningitidis
S. pneumo
Empiric antibiotic regimen for suspected meningitis in uncomplicated patient over 50 yrs
Vancomycin (strong gram +)
Ampicillin (for listeria mono)
3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)
Bugs worried about for suspected meningitis in uncomplicated patient over 50 yrs
N. meningitidis
S. pneumo
Listeria monocytogenes
Empiric antibiotic regimen for suspected meningitis in neurosurgery patient
Vancomycin (strong gram +)
3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)
Bugs worried about for suspected meningitis in neurosurgery patient
Gram Negative Rods
S. Aureus
Coagulase Negative Staph
Empiric antibiotic regimen for suspected meningitis in immunocompromised patient
Vancomycin (strong gram +)
3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)
Ampicillin (for listeria mono)
Bugs worried about for suspected meningitis in immunocompromised patient
N. meningitidis
S. pneumo
Listeria mono
gram neg rods
Empiric antibiotic regimen for suspected meningitis in patient w/ penetrating trauma to the skull
Gram Negative Rods
S. Aureus
Coagulase Negative Staph
Bugs worried about for suspected meningitis in patient w/ penetrating trauma to the skull
Vancomycin (strong gram +)
3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)
Diagnostic criteria for RLS (Restless Leg Syndrome)
- Urge to move legs -AND-
- One of the following
-unpleasant sensation in the legs that worsens with inactivity
-unpleasant sensation in the legs relieved by movement
unpleasant sensation in the legs that worsens at night
When considering RLS, have to rule out: (6)
Iron-deficiency anemia uremia DM MS, Parkinsons Pregnancy Drugs (antidepressants, metoclopramide)
Treatment mild/ intermittent RLS
- Iron supplementation if ferritin is less than 75 ug/L
- Supportive trt (massage, heat pad, exercise)
- Avoid aggravating factors (sleep deprivation, drugs)
Treatment severe/ persistant RLS
1st line: Dopamine agonists
Alt: Alpha-2-delta calcium channel ligands (ie gabapentin)
What is essential mixed cryoglobinemia?
MOA: circulating immune complexes that deposit in small to medium vessels and may be associated with low serum complement levels.
Symptoms: palpable purpurae, arthalgias and weakness or weight loss.
Labs: larger INR (takes longer to clot)
Extrahepatic manifestations of Hep C
Heme: essential mixed cryoglobinemia
Renal: Membranoproliferative GM
Skin: Porphyria cutanea tarda, lichen planus
Endocrine: Increased risk of diabetes
Clinical presenation of Hep C
- Fatigue
- Non-specific symtoms ( nausea, anorexia, myalgia, arthralgia, weakness, weight loss)
- Serum transaminases elevated 1/3 of time
- can progress to cirrhosis 20% of the time
- increased risk of hepatocellular carcinoma
What is porphyria cutaneous tarda?
Fragile skin, photosensitivity, vesicles and erosions on the dorsum of hand. Strongly correlated with HCV. If they have PCT they should be screened for HCV.
What is the glucocorticoid’s effect on blood cells?
- decrease eosinophils and lymphocytes
- increase neutrophil count by increasing bone marrow release and mobilizing the marginated neutrophil pool
Uthoff phenomenon
worsening of MS symptoms with heat
Lhermitte’s sign
Electric shock sensation down the spine or limbs when the neck is flexed. Seen in MS.
Diagnosis of MS
- ) T2 MRI showing the presence of cerebral and spinal plaques that are made up of clusters of demyelinated axons worsening over time.
- ) Lumbar puncture shows oligoclonal IgG bands in the CSF found in 95% of cases.
Presenting symptoms of MS
2 or more flare ups of:
- optic neuritis (painful loss of vision)
- diplopia
- sensory deficits
- motor weakness
- bowel and bladder dysfunction
cognitive deficits and depression are also often seen with MS
