Test 3 Flashcards
Clostridioides difficile infection
Clostridiodes difficile is transmitted via fecal-oral route. Ingested spores germinate in the colon to become fully functional bacilli and may proliferate unchecked when the normal colonic flora is disrupted (eg, antibiotic use). Profuse watery diarrhea (greater than or equal to 3 loose stools/24 hr) is the hallmark of C difficile infection.
Animal and human bite injuries
Risk factors for infection after mammalian bite wounds include cat or human bites (except to the face), bites on the extremities, or bites that are > 12 hours old. Wounds with any of these features should be left open to heal by secondary intention. Mammalian bites to the face, including those from cats or humans, can be sutured unless they are > 24 hours old.
Patient safety
Ensuring the safety of patients and staff in the ED is essential for effective patient care. This requires the presence of adequate security personnel and protocols for managing agitated patients and visitors. Medications (bdz and antipsychotics) are reserved for situations in which nonpharmacologic interventions fail to de-escalate an agitated patient.
Amenorrhea
Primary ovarian insufficiency (POI) is the loss of ovarian function in patients age < 40 and typically presents with infertility and/or secondary amenorrhea. Diagnosis is confirmed by an elevated FSH level and a low estrogen level. Patient with POI undergo testing for adrenal antibodies, thyroid-stimulating hormone, and karyotype analysis.
Syphilis
Penicillin is the first-line antibiotic for patients with syphilis during pregnancy. Patients with a penicillin allergy require penicillin desensitization prior to initiating treatment.
Second line abx for non-pregnant pt with syphilis: azithromycin, erythromycin, ceftriaxone, doxycycline
Bipolar disorder
Hypomania is frequently associated with impulsivity, poor judgement, and risky behavior. Early recognition of hypomanic states and a gentle exploration of these patients’ motives may be necessary to help them avoid making impulsive decisions they may later regret.
Cholangiocarcinoma
Porcelain gallbladder is often found incidentally on imaging and is associated with an increased risk of gallbladder cancer. Patients with punctate calcifications or symptoms of biliary colic are usually referred for prophylactic cholecystectomy to reduce cancer risk.
Aortic aneurysm
Cigarette smoking is strongly associated with abdominal aortic aneurysm (AAA) formation, expansion, and rupture. It is the most important modifiable risk factor to reduce the likelihood of aneurysm expansion in patients with AAA.
Narcolepsy
Modafinil is generally considered first line pharmacotherapy for narcolepsy, and has good effectiveness with a tolerable side effect profile and low abuse potential. Older stimulants such as methylphenidate may also be useful. Behavioral interventions such as good sleep hygiene and scheduled naps are also recommended.
Cataplexy (CP) is the sudden loss of muscle tone triggered by strong emotions and is a common symptom of narcolepsy. Stimulant medications may mildly improve the symptoms but are often insufficient, especially if there is a significant safety risk. Other medications for CP include serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants, and sodium oxybate (abuse potential and restrictive regulations).
Chicken pox
The varicella-zoster virus (VZV) vaccine can be administered safely to immunocompetent patients with household contacts who are immunocompromised. Although transmission of VZV by a vaccine-related rash is rare, vaccinated individuals should be monitored for a rash and isolated if one develops.
Gonococcal infection
Disseminated gonococcal infection typically presents with purulent monoarthritis or the triad of polyarthralgia, tenosynovitis, and dermatitis (pustular lesions on the distal extremities). Diagnosis is typically made presumptively by nucleic acid amplification testing of a urogenital sample.
Uncomplicated urogenital Neisseria gonorrhoeae infection with negative Chlamydia testing should treated with ceftriaxone monotherapy. Those with gonorrhea who have positive or uncertain Chalmydia status require dual therapy with ceftriaxone plus doxycycline to ensure adequate coverage against potential Chalmydia coinfection. Macrolide in the absence of gonorrhea.
Renal calculi
Stones <5 mm usually pass spontaneously. Stones up to 10 mm can be given a trial of medical therapy (gentle hydration, pain control, alpha blockers) and do not require hospital admission if symptoms are controlled. Indications for removal are stones greater than or equal to 10 mm, persistent pain, acute renal failure, or urinary tract infection. Antibiotics are indicated in the presence of infection.
