UWorld Flashcards
Lyme disease tx in pregnant vs not?
Regular-Doxy
Pregnant-Amoxicillin
Common skin infections, 3 types and pathogens
Erysipelas- strep pyogenes
Cellulitis-S. pyogenes, MSSA
Abscess- MSSA, MRSA
Primary CNS lymphoma is seen w/ what? And strongly related to what?
Whats a good prognostic indicator?
HIV infections and strongly related to EBV
Best prognostic indicator is increase in CD4 or immunity getting better
Emotional lability, irregular rapid jerking movements of the face, hands and feet, some murmur in 8yo.
Think?
Acute rheumatic fever
Sydenham chorea
From untreated Strep Pharyngitis
Tx of uncomplicated pneumonia in children
- Preschool or focal lung findings, organism, tx?
- Older, w/ bilateral lung findings, organisms, tx?
Preschool/focal lung
- Strep pneumo
- Amoxicillin
Older, w/ bilateral lung
- Mycoplasma pneumoniae
- Azithromycin
How to decrease risk of Cdiff?
PPI
PPI alter colonic flora
Rabies prophylaxis guidelines for
- Pre-exposure
- Post-exposure previously unvaccinated
- *Post exposure previously vaccinated
Pre-exposure
-Vaccine series
Post-exposure prophylaxis previously unvaccinated
-Vaccine and Immunoglobulin
Post-exposure previously vaccinated
*Rabies vaccine
C dif tx for:
Initial
Recurrence:
Multiple recurrences:
Fulminant
Initial:
PO vanc
Recurrence:
PO vanc again, but prolonged
Multiple recurrences:
Fecal transplant
Fulminant (hypotension/shock/ileus/megacolon):
-Metronidazole IV +++ Vanc PO
Fever, hypotension, swelling and erythema of left leg after puncture would w/ wood splinter. Leg more painful to palpation than expected after visual inspection.
Dx?
Cause?
Tx?
Necrotizing fasciitis
Strep pyogenes
Surgical debridement
Most serious complication of diphtheria?
Myocarditis
Erythromycin or penicillin
Papules with central umbilication in untreated HIV pt?
How do you diagnose?
Cutaneous cryptococcosis
Biopsy lesion
Cleaning fish tank, gets cut and rapidly progressive cellulitis w/ hemorrhagic bullous lesions, and septic shock.
Dx?
Vibro vulnificus
Epiglotittis is a life threatening infection typically caused by
H. influenza
Health care worker has +TB sin test, but -CXR, can they work?
They have latent TB
Latent TB is not infectious.
They can work w/o restrictions
Only tx latent TB if pt is immunocompromised, inmate or work at high risk places
Cat scratch disease Tx?
Azithromycin
Acute cystitis Tx first line?
How about in pregnancy?
4 options
TMP/SMX first line
Fofomycin
Nitrofurintoin
Cephalexin
Amoxicillin Calvulanate
50 yo MALE with 3 mo, hx of urinary frequency, urgency, pelvic pain w/ urine leukocytes and bacteruria.
Dx?
Tx? for how long?
Bacterial prostatitis
Fluroquinolone or TMP/SMX
For 6 WEEKS
-has to be long course
When do you give oseltamivir for influenza?
If symptoms started <48hrs ago
OR
Immunocompromised, or >65yo
Pt w/ manifestations of meningitis, fever, headache, photophobia, nuchal rigidity, and/or signs of encephalitis, such as confusion, focal neurologic findings (hyperreflexia), in Aug after summer camp.
Dx?
What other organisms?
West Nile Virus
Its a viral meningoencephalitis picture:
Entero-coxsakie
Herpes
Arboviruses- west nile
Most common cause of cellulitis
Strep pyogenes
Varicella-zoster virus precautions in the hospital?
Localized- standard, cover lesion
Disseminated: contact and airborne precautions
What is ovarian hyperstimulation syndrome?
Serious complication of ovulation induction therapy for infertility
pts develop enlarged ovaries, ascites, hemoconcentration, and multi organ failure
How to work up palpable breast mass in women?
Age <30: u/s then mammogram
Age>30: mammogram +/- u/s
What is associated with the highest risk for PID?
Having multiple sexual partners
What is associated with the highest risk for PID?
Having multiple sexual partners
Tx for primary dysmenorrhea?
First try NSAIDs like naproxen (especially in non-sexually active) then try OCPs
Lobular carcinoma in situ
What is it?
What is the risk?
What do you do if you find it on needle biopsy?
NONmalignant lesion that’s incidental finding on mammogram
- Having it may increase risk of other cancers, but its not malignant on its own
- Do excisional biopsy
Pelvic pain, dyschezia (pain w/ BM), rectovaginal nodularity and ovarian mass?
Endometriosis
Treatment of acute uterine bleeding?
OCPs w/ high dose estrogen
In D+C, the endometrium is surgically removed, only done when pt is unstable
Most effective contraceptive?
Progestin subdermal implant, then IUDs
Acute prostatitis vs chronic bacterial prostatitis vs chronic pelvic pain syndrome?
Acute: fever, dysuria, pain, warm tender prostate
Chronic bacterial prostatitis: >20 leuks in urine after prostate massage, w/ bacterial growth on culture
Chronic prostatitis/chronic pelvic pain syndrome: >20leuks, but ASEPTIC culture
Scrotal pain, swelling, tenderness, otherwise normal.
Dx?
Cause?
Tx?
Epididymitis
Gonorrhea or chlamydia
Tx w/ abx
Pt was hit in the balls, has quite a bit of bruising and selling, otherwise normal.
Next step?
Get u/s just to make sure there’s no vascular injury
CYP450 inducers can do what w/ OCPs?
Decrease their efficacy, accidental pregnancies
Most common viral sexually transmitted disease?
How do you tx it?
Conddylomata acuminata by HPV
Tx w/ trichloroacetic acid (if internal) podophyllin if external
Pt is drooling, afraid to drink water, fever, throat pain, went to a cave?
Dx?
Tx?
Rabies
Hydrophobia is pathognomonic for rabies-water triggers pharyngeal spasms
Once symptoms show, its palliative care; give Ig and vaccine prior
Immune reconstitution inflammatory syndrome?
Cause?
Tx?
Usually in pt w/ HIV and TB, being started on both meds.
The immunity comes back and pt has an overabundant inflammatory response, fever/chill etc
Symptomatic treatment only, don’t stop AART or RIPE
Acute HepB progression to chronic hepatitis risk?
What age range do you worry about?
Very low >5% in adults
20-50% in ages 1-5, so you vaccinate for Hep b
Acute hepatitis B management
AST/ALT >1,200, positive for HepB antigen, hemodynamically stable.
What do you do?
Hep B hepatitis resolves spontaneously in most people
No need to start antiviral therapy.
Follow up with serial lab testing as outpatient
When to give tetanus toxoid vs immunoglobulin?
Unimmunized, uncertain or <3 tetanus doses w/ clean or minor wounds get toxoid only
If wound is deep or dirty, give toxoid+immunoglobulin
Most common adverse reaction that occurs with transfusion??
How do you prevent it?
Febrile nonhemolytic transfusion reaction
1-6hrs after starting
Due to left over leuk derbis in donor red cell concentrate
Prevent by leukoreduction, when its washed out more
What do you do if pt refuses testing for HIV after nurse accidentally sticks herself w/ needle?
HIV prophylaxis for nurse
Pt w/ suspected PCP, how do you diagnose?
Sputum sample culture
If no growth, do BAL
Pts with PCP pneumonia should receive corticosteroids in addition to antimicrobials if ABG shows….
Alvelolar arterial O2 gradient >35
or
Arterial oxygen tension<70
Treatment of syphilis by stage
Primary
Secondary
Early latent <12mo
Late latent>12mo
Unknown duration
Neurosyphilis
Congenital
Primary, secondary: single dose IM penicillin G
Late latent/unknown: IM penicillin for 3 WEEKS
Neuro and congenital: Penicillin IV
Patients with syphilis who have neurologic signs or symptoms require…
LP to r/o neurosyphillis
Fever, HA, erythematous macular and/or petechial rash on wrists and ankles of child who went to NC for trip.
Dx?
Tx?
Rocky mountain spotted fever
Doxy
Untreated Chlamydia trachomatis infection during pregnancy causes what for
Mom?
Baby?
Preterm/preterm rupture/labor
Neonatal pneumonia and blindness
Lyme arthritis treatment?
Prognosis?
Doxycycline or amoxicillin for 1 month
Will recover fully
1st and second line for Otitis media?
Amoxicillin
if fails, do amoxicillin calvulanate
Most common pathogens for otitis media in order (3)?
What about otitis conjunctivitis syndrome?
Strep pneumo
Non typeable H. flu
Moraxella
Otitis conjunctiviits is from H. flu
Patients with suspected pulmonary tuberculosis who have abnormal chest imaging should get what test to confirm dx of active TB?
If that’s positive or negative?
Sputum acid fast bacilli smear and culture
if positive= active TB
if neg= NAAT, mycobacterial cultures need to be done to r/o active TB
Postexposure prophylaxis when do you start?
When is pcr test reliable?
Less than 74 hrs after exposure
After 1-4 wks pcr test is reliable
Empiric tx for CAP?
Ceftriaxone and azithromycin
or
just levo
Active TB treatment?
RIPE for 2 months, isoniazid+rifampin for 9-12months
if meningitis, steroid for 8 weeks
30yo fever, nuchal rigidity, vomiting, yellow-white nodules near optic disc on fundoscopy, exposure to immigrant from asia and cats.
Dx?
Tuberculous meningitis
Breastfeeding contraindications
For mom and baby?
Mom: Active TB **HIV Herpetic breast lesions Active varicella Chemo/radiation Active substance use disorder
Baby:
Galactosemia
HIV management during pregnancy
Antepartum
Intra
Post
Breastfeeding?
Antepartum:
-Continue ART, 3 agents
Intra:
- ART+Zidovudine for c-section
- ART for vaginal
Post:
-Zidovudine or if viral load is really high, multidrug ART
DONT breastfeed during pregnancy. Not even on therapy regardless of viral load.
Pt is exposed to person w/ meningococcal meningitis.
What’s the next step?
What’s the exception to this?
Rifampin
*If pt is taking OCP’s give ciprofloxacin or ceftriaxone instead
When do you give ciprofloxacin for meningococcal meningitis exposure?
If pt is on OCPs
Urgency incontinence
Cause?
Tx?
-Lifestyle vs meds?
Sudden urge to urinate caused by detrusor muscle overactivity
- Bladder training
- Antimusccarinics like oxybutynin, tolterodine, solifenacin
Pt has positive Hep C antibody but no symptoms what do you do next?
Need more testing to confirm diagnosis
Get HCV RNA in blood
Centor criteria
- Used to predict likelihood of strep pharyngitis
- Criteria: tonsillar exudates, tender anterior cervical lymphadenopathy, fever, absence of cough
- <3, likely have viral, tx symptomatically
- > 3, should get rapid antigen test for strep and tx w/ oral penicillin, cephalosporin if allergic
How to define recurrent UTIs? How do you tx?
> 2 in 6 months or >3 in 1 year
-Antibiotic prophylaxis postcital
Emergency contraception meds?
Ulipristal
Levonorgestrel (planB)
Sexual assault victims should get what empiric abx?
Azithromycin, ceftriaxone, metronidazole,
HIV prophylaxis as well, up to 72 hrs after
HCP needle stick from HIV positive pt, but patient’s viral load is undetectable.
What do you do?
HIV prophylaxis w/ meds
Single, rubbery, mobile breast mass in adolescents?
Fibroadenoma
Pt calls on the phone w/ complains of 2 day hx burning w/ urination, cloudy urine. Hx of uncompliated cystitis a year ago No other sx.
What do you need to tell them?
Prescribe TMP/SMX, this history over the phone is enough.
No need for UA
When does pap screening start? How about chlamydia and gonorrhea testing?
Pap for only >21 years
Gonorrhea/Chlamydia ANY AGE thats sexually active
True or False:
Administering antipyretics prior to vaccination prevents high fevers.
False,
Dont take tylenol before shots
When do you need to do surgical tx for cryptorchidism?
If not descended after 6 months
Tx for coxsackievirus viral meningeoencephalitis?
If you suspect viral meningitis, give empiric acyclovir
Steroids are only for pneumococcal meningitis
Absolute contraindications for OCPs?
Migrane w/ aura
> 15 cigs per day for age >35!!
Antiphospholipid-antibody
lots of other stuffs too
First line therapy for premenstrual syndrome/premenstrual dysphoric disorder?
SSRIs
Postmenopausal woman, new onset pelvic pressure/pain, uterine mass, ascites. Hx of tamoxifen use for breast cancer.
Dx?
Uterine sarcoma
Tamoxifien increases risk
What do you give for any mammalian bites?
Amoxicillin calvulanate
-especially cat or human bites
Months after a vaginal delivery, patient has abnormal vaginal bleeding, enlarged uterus, vascular lesion in vaginal and positive UPT.
Dx?
Pathology?
Gestational trophoblastic neoplasia
aka
Choriocarcinoma
-Neoplasm that results form malignant transformation of the chorionic villi or trophoblast, can follow molar or normal pregnancies
Sarcoma botryoides
Vaginal sarcoma present in infants with ‘cluster of grapes’ appearance
When do mammograms start?
50
then every 2 years
What is the mid-urethral sling procedure used for vs pessary?
Mid-urethral sling is for stress incontinence
Pessary is for pelvic organ prolapse
Vulvodynia
What is it?
Chronic raw, burning vulvar pain in the absence of a specific disorder
Prepubertal girl has intermittent vaginal bleeding, chronic malodorous vaginal discharge.
Dx?
Foreign body
Thin, white, wrinkled skin over labia majora/minora, atrophic changes, excoriations, erosions, severe puritis
Dx?
Tx?
Lichen sclerosus
Topical corticosteroids
Tx for priapism?
2
Aspiration of corpora cavernosa
Injection of alpha agonist like phenylephrine
Pt w/ hx IVDU, has 10 day hx fatigue, now has fever, AMS, oral petechiae, holosystolic murmur, neck stiffness.
Dx?
Mycotic aneurysm
Septic embolization and localized vessel destruction caused an aneurysm that burst
Homosexual women have increased risk of?
BV-its passed through vaginal fluid
And increased risk of cervical cancer—due to lack of vaccine/screening
Pt had flu like illness, treated symptomatically, then develops fever, sinus pain, purulent discharge.
Dx?
Tx?
Acute bacterial rhinosinusitis
Amoxicillin-calvulanate
Rectocele are caused by?
Tx?
Pelvic organ prolapse
Tx w/ pessary placement
Most common complication of prostate resction?
Retrograde ejaculation
What causes erysipelas?
Group A strep
DKA pt, has fever, HA, purulent nasal discharge and necrosis of nasal turbinate.
Dx?
Tx?
Mucormycosis
Amphotericin B
How does tamoxifen work?
Estrogen receptor agonist at endometrium and can lead to hyperplasia/cancer.
But antagonist at breast
First step in evaluating postmenopausal bleeding?
Endometrial biopsy
Pearly penil papules
What do you do about them?
Normal variant. Reassurance
How to dx condylomata acuminata?
Shave biopsy
Pt moved to us from Ghana 2 yrs ago. Now has increased urgency, dysuria, blood in urine.
No help w/ abx
What’s the next step?
What’s the differential?
Urine sediment microscopy
Urinary schistosomiasis
-chronic infection causes bladder scarring and inflammation, can be anemic coz of chronic blood loss
Postmenopausal F has bilateral clear yellow nipple discharge, only with manipulation. All labs, u/s and mammogram are negative. She takes soy and Vit E supplements.
Dx?
What do you do?
Benign and physiologic
Reassurance
Phytoestrogens (soy) and vit E DONT cause nipple discharge
Serum sickness and HepB
-Mediated by?
Immune complex mediated hypersensitivity rxn
Circulating antibodies combine w/ antigen and overload normal clearance mechanism
Seen as prodrome in HepB
Perinatal hepatitis B infection
-What vaccines/immunoglobulins do you give and when?
Everyone gets HepB vaccine at birth
If baby has it already, they still get the vaccine AND Immunoglobulin
vaccines at 0,2,6months
Young patient has a wide range of nonspecific symptoms
- Significant weight loss
- Fever
- Myalgias etc
What do you need to check first?
HIV
What is herpangina?
What causes it?
Vesicles/ulcer on posterior soft palate, usually kids
Caused by coxsakie A
Functional constipation in toilet training child, keeps getting UTI’s.
What do you do to tx?
Give laxatives
Fecal retention causes rectal distension, obstruction of bladder, stagnant urine, promotes microbial growth–>pyelo
Cryptococcal meningoencephalitis
CD4?
LP?
Features?
Pt is treated but develops increasing nausea, headaches etc. What do you do?
How long should this pt be treated for?
CD4<100
Elevated opening pressure >250
Low leuks w/ lymphocytic predominance
May have papular lesions looking like molluscum contagiosum
Increasing nausea/HA due to fungus taking up too much space and increasing ICP. Do serial LPs
Pt w/ crypto has to be treated for a year on po fluconazole, while starting AART
Staph aureus bacteremia pt being treated w/ vanc has intermittent back pain.
Think of?
How to dx?
Metastatic infections of spine like osteomyelitis or epidural abscess
Dx w/ spinal mri
Pt is on cipro after UTI, now has C.diff. Tx?
Stop cipro
Start Vanc and TMP/SMX
Fever, chest pain, hemoptysis in neutropenic pt on levo, tmp-smx, vanc and fluconazole.
Has cavitary nodules w/ surrounding ground glass opacities.
Dx?
Aspergillus
Pt coming back from India has fever, muscle aches, petechiae, elevated liver enzymes.
Dx?
What are they at risk for?
Dengue hemorrhagic fever
At risk for circulatory collapse
Empiric therapy for CF pt w/ pneumonia like sx?
Vanc and Cefepine+Amikacin
Staph and two to cover pseudomonas
How to treat trichomoniasis in breastfeeding?
Metronidazole single dose
Express and discard milk for 24hrs after
Pathophysiology of toxic shock syndrome vs septic shock?
TSS:
Wide spread activation of T cells by bacterial EOXtoxin leading to massive release of cytokines/ usually staph
Septic: Bacterial cell lysis and endotoxin circulation
8yoM fever, tonsillar exudates, tender anterior cervical lymphadenopathy and palatal pettechiae.
Dx?
Tx?
Duration? Why is it this long?
Strep pharyngitis
Penicillin for 19 days to prevent acute rheumatic fever
Infections due to human bites.
Organism?
Tx?
Eikenella corrodens
Amoxicillin/calvulanat
Gram neg, anerobe
When is exercise contraindicated in pregnancy?
What exercise should be avoided in all cases
Placenta previa
Cerclage placement
Dont: Scuba dive, contact sports, skydiving, exercise with fall risk
When to change antiepileptics in pregnancy?
Only change 6months PRIOR to conception.
Once pregnant, DO NOT change meds.
How do you check for neural tube defects?
Alpha Fetoprotein and anatomy ultrasound
What is the Kleihauer Betke test for ?
- Determines the amount of fetomaternal blood mixing
- Determines the amount of Rho-Gam to be given
What do you do for subchorionic hematomas? What are the patients at increased risk for?
Expectant management
Complications
- spontaneous abortion
- abruptio placentae
- PPROM
- preterm delivery
What else can you treat BV w/ other than metronidazole?
Clindamycin
What can BV increase risk of in pregnancy?
preterm, pprom, chorio, endometritis,
First maneuver to do in shoulder dystocia?
Hyperflex maternal legs at the hip
Scalp swelling after birth that crosses suture lines.
Dx?
Tx?
Caput succedaneum
Resolves spontaneously
Pregnant pts with sickle cell disease.
What are they at increased risk for?
Increased risk of vaso occlusive episodes during pregnancy
-Eg acute sickle hepatic crises
Tx for pregnant patient that’s acutely manic?
Haldol
22yo comes in after elective termination of pregnancy at outside facility w/
- Fever, tachycardia, hypotension, lower abd pain, mucopurulent cervical discharge.
- U/s has echogenic mass in endometrial cavity
Dx?
Tx?
Septic abortion
IV Empiric abx
Suction and curettage
Abx choice for postpartum endometritis?
Clindamycin plus gentamicin
Common side effects of OCPs?
Breakthrough bleeding
Breast tenderness
Nausea
NOT weight gain.
When do you give Rh-Gam?
What if the pt had a previous pregnancy when she got Rh-D-Gam?
At 28 weeks AND postpartum
Regardless
Pt has a hx of preeclampsia, how do you prophylax and when?
Aspirin starting at 12 weeks
Pt has a hx of preeclampsia, how do you prophylax and when?
Aspirin starting at 12 weeks
Bariatric surgery and pregnancy?
Delay pregnancy for at least a year after sugery
-Surgery can cause some nutritional deficiencies
Pregnancy pt has slightly elevated AFPs.
Next step?
Obstetric transabdominal ultrasound
Normal amniotic fluid index?
Causes for polyhydramnios?
24
GI atresia, anencephaly, diabetes, multiple gest etc
Diabetes mellitus can do what to amniotic fluid index?
Polyhydramnios >24cm
Prognosis for Cerclage placement in pt w/ prolapsing amniotic membrane?
poor
Multiparus pt has increased vaginal bleeding 20min after vacuum assisted delivery. Intact placenta delivery.
Uterine fundus is soft and palpated 3cm above the umbilicus. Fist-sized clots extruding from vagina.
Dx?
Tx (2)?
Uterine atony
Uterine massage and oxytocin
What is pemphigoid getationis?
Pregnancy related autoimmune disease, typically abdominal pruritis, rash around umbilicus
Pregnant pt has focal abdominal pruritis, no rash, all labs normal.
Dx?
Pregnancy induced pruritis
What’s pylephlebitis? When does it occur?
Infective portal vein thrombosis
-Complication of untreated appendicitis or other intraabdominal/pelvic infections
Third trimester painful vaginal bleeding, tender rigid uterus, late decelerations
Dx?
Abruptio placentae
If pt got Rh-Gam, but ended up making antibodies for the next pregnancy. What happened?
Not enough Rh-Gam was given to begin with
Pregnant pt has worsening headache, papiledema, right sided weakness/blurry vision..
Dx?
Tx?
Central venous sinus thrombosis
LMW heparin
What is contraindicated in placenta previa? (2)
Digital cervical exam
Vaginal delivery
Immediately postpartum, pt has hypoxemia, hypotension, hematuria.
Dx?
Amniotic fluid embolism
Full blown DIC and everything
Pt in 1st trimester w/ family hx of breast ca has complex ovarian mass w/ septations that has grown to >13cm in size.
What do you do?
Surgical removal at 2nd trimester
Mass>10 is at risk for torsion, description is likely ca
Prenatal screening basics
Initial visit
24-28wks
36-38wks
Initial:
-All infections, pap, baseline cbc, RhD
24-28:
- Anemia
- Gestational diabetes
36-38:
-GBS
What happens in gestational thrombocytopenia?
Benign
Asymptomatic thrombocytopenia during pregnancy that should resolve.
Expectant management
14wks preg pt has urine culture that grew GBS. No UTI symptoms now.
What do you do?
Treat w/ ampicillin now
AND
treat again intrapartum
Pt is getting HD and IV iron. Little into it, he is hypotensive, muffeled heart sounds, wheezing, tachycardic, flushed, pitting edema.
Dx?
Anaphylaxis from IV iron
What are the severe features of preeclampsia?
When does this occur?
SBP>160;DBP>110 Thrombocytopenia Increasing creatinine Increasing LFTs Pulmonary edema Visual or cerebral sx
From after 20wks gestation to 12 weeks postpartum
When do you give oxytocin to aid active labor?
If no cervical change or inadequate contractions in 2hrs after cervix has dilated to 6cm
Stimulant medications for ADHD and substance use/abuse?
Current research says stimulant meds for ADHD does NOT increase risk for substance use or abuse
even in pts with some social use
Single item screening for alcohol?
How many times in the past year have you had 5 (4 for F) or more drinks in a day?
Anorexic pt admitted for unstable vitals, gets IV nutrition, now has dyspnea, orthopnea, crackles at bases, and pitting edema.
Dx?
What do you do?
Refeeding syndrome
-Replace electrolytes like Phosphorous and potassium
When is RhoGam given postpartum?
Up to 72 hrs after delivery
Reversed or absent umbilical artery end diastolic flow suggests…?
Placental insufficiency and impending fetal hypoxia
—Indication for Delivery!
What do you want to look for before giving varenicline?
Psych history
Next step when you suspect preeclampsia or HELLP in postpartum like days after?
Mag
Pyoderma grangrenosm
- vs ecthyma grangrenosum
- vs clostridial myonecrosis
Pyoderma grangrenosm-seen in IBD, painful
Ecthyma-with pseduomonas, PAINLESS, tx w/ iv abx
Clostridial myonecrosis aka as gangrene, painful, needs SURGERY
Empiric tx for neonate presenting with fever, unspecified lethargy etc?
What do you cover?
Ampicillin plus gentamicin/cefotaxime
Listeria, E coli
Ceftriaxone and sulfonamides should be avoided in neonates.
Why?
They can cause hyperbilirubinemia and kernicteris
Asymptomatic bacteriuria is common in elderly women.
What do you do?
Nothing.
Only tx if symptomatic
Giardia
When do you tx?
Who has restrictions in activity?
Treat only symptomatic pts w/ metro, not anyone who tested +
All symptomatic pts should stay away from recreational water venues/bodies
Pt is + for N.Gonorrheae and - for Chlamydia.
How do you treat?
Ceftriaxone+Azithromycin
- Azithromycin is to limit ceftriaxone abx resistance
- If pt only had chlamydia, you’d only give Azithromycin or doxy ONLY
Young with history of
- Inconsistent condom use
- Painless pustules on distal extremities
- Swelling and pain w/ passive extension of hands
- Multiple joint pains
Dx?
Disseminated gonococcal infection
- Dermatitis
- Tenosynovitis
- Polyarthralgia
Tx of Mono?
When do you admit?
Supportive, some NSAIDs mostly
-If tonsils swell and pt can’t breathe, admit, give IV steroid
CT imaging findings in congenital CMV vs toxo?
What else can they have?
CMV-periventricular calcifications
Toxo-Intracerebral calcifications
They both can have hearing loss, lesions, hepatosplenomegaly
Congenital sensorineural hearing loss, PDA, cataracts, low weight, microcephaly, purpuric lesions.
Dx?
Congenital Rubella
What is HIV associated lipodystrophy?
Metabolic issues secondary to anti-retroviral therapy
TB exposure at work.
Next step?
TB exposure at home, positive interferon, neg CXR, exposure strain resistant to isoniazid.
Next step?
- Skin test, retest 8-10 weeks
2. Rifampin 4-6 months
Most common cause of traveler’s diarrhea?
Enterotoxigenic Ecoli
Virologic failure in HIV?
Viral load should be <200w/in 6 months
HIV associated thrombocytopenia (HIV-TP).
What is it?
What do you do?
Low platelets seen w/ HIV+, no real symptoms. Just tx w/ ART for HIV
Isoniazid side effects (2)
Hepatotoxic-asymptomatic, self resolving
Neuropathy
Gonococcal vs non gonococcal urethritis.
Organism?
Gram stain will show?
Treatment?
Gonococcal: Neisseria, purulent, stain has diplococci, tx w/ ceftriaxone and azithro
Non-gonococcal: chlamydia, trich; watery, stain has neutrophils/wbs no organisms, tx w/ azithromycin
