uworld deck 4 Flashcards
What are most common bugs w/ cellulitis?
Grp A strep, S. Aureus
Causes of cellulitis?
IV catheters, incisions, bites/wounds, also venous stasis, lymphedema, Diabetic ulcer
What is erysipelas?
ceullulitis confined to dermis and lymphatics, usually 2/2 GAS
How tx tetanus?
Admit to ICU, consider intubation, metronidazole or other ABX, Tetanus immune globulin, benzos for symptomatic tx
What bugs usually cause osteomyelitis?
S. aureus if catheter septicemia, coag - staph if prosthetic jonit, salmonella if sickle cell
What are risks for osteomyelitis?
open fx, DM, IV drug use, sepsis
How use of ESR and CRP in osteomyelitis?
Used only to trend tx effectiveness
Best studies for osteomyelitis?
Do MRI for dx and asses extent of disease, if cant do MRI, then do bone scan
How tx osteomyelitis?
Requires long term IV ABX (4-6 wks), based on cx, may require surgical debridement or amputation
What finding would r/o septic arthritis?
if painless ROM then septic arth unlikely
How get acute septic arthritis?
usually 2/2 hematog spread, can be direct spread from abscess
What are most common bugs for septic arthritis?
S. aureus most common, can also be strep. N. gonorrhea in young, Salmonella in sickle cell
Signs of septic arthritis on joint aspiration?
WBC>50,000, mostly segs, no crystals
How tx septic arthritis?
tx immediately with empiric ABX, vanc, G- coverage if concern for infxn of that type.
How does stage 1 of lyme disease px?
erythema migrans - lrg target shaped lesions, if more than 1 lesion then hematog spread present
How does stage 2 of lyme disease px?
early dissemination - HA, neck stiffness, Fvr/chills, fatigue. Late dissemin- encephalitis, meningitis, bilateral facial nerve palsy, AV block, pericarditis,
How tx lyme disease?
Tx w/ doxycycline, if allergic use amoxicillin or cefuroxime
What bug causes rockey mountain spotted fever?
rickettsiea ricketsiae an intracellular bacteria
What bug causes malaria?
plasmodium - vivax, ovale, falciparum, malariae
What is fvr pattern w/ malariae?
If falciparum, no pattern, if vivax/ovale 48 hr fvr ycle, malariae has 72 hr pattern
How dx malariae?
do giemsa stain of periph smear
How tx malaria?
If sensitive- chloroquine, if resistant then quinine and tetracycline or atovaquone-proguanil and mefloquine
What is rabies?
Viral encephalitis w/ pain @ bite, sore throat, fatigue, HA, N/V.
How does rabies encephalitis px?
confusion, combativeness, hyperactivity, fvr, seizures, hydrophobia
What are the types of aspergillus infxns?
allergic bronchopulmonary aspergillosis, pulmonary aspergilloma, invasive aspergillosis
What is ABPA?
type 1 hypersensitivity rxn that px w/ asthma and eosinophillia
What is pulmonary aspergilloma?
inhalation of spores in pts w/ hx of sarcoid, histo, TB, bronchiectasis
What is invasive aspergillosis?
hyphae invade lung leading to thrombosis and infxn. Mainly in AIDS patients
What is result of ascares infxn?
Can be asx, postprandial abd pain, vomiting, can get bowel, pancreatic, common bile duct obstrxn
How does diverticulitis px?
crampy ab pain, usually LLQ, w/ change in bowel habits
Best test for diverticulits?
best to do CT as is most sensitive & can detect complications like perfs and abscesses
Best test to asses concern for HUS?
need periph smear to look for schistocytes and incrsd retic
How manage HUS?
dont give ABX, platelet use is controversial as may worsen thrombosis
What is radiation proctitis?
Sx of diarrhea & tenesmus following radiation tx, px w/ mucosal telangiectasia and submucosal fibrosis on biopsy. Dx w/ flex sig
How manage salmonella gastroenteritis?
self limiting so only supportive care. Only tx aggressively if 50 y/o if have endovascular or bone prostehsis or if immunocomp
What are lab signs of hepatocellular injury?
Significant incrs in AST and ALT, ALT more specific to liver. Also see direct bili incrs and milk alk phos.
Effect of OCP on bile?
CAn get conj hyperbilirubinemia w/ incrs alk phos levels
How manage acute cholangitis?
Broad spec ABX w/ G+, G- and anaerobic coverage. Do ERCP to remove obstrxn
What level of TG necessary for pancreatitis?
TG must be >1000 for majority of cases
What should be done if evidence of pancreatic necrosis?
Tx w/ imipinem
How manage gastric ulcers?
All gastric ulcers should be biopsied
What are common causes of dyspepsia?
H. pylori and NSAIDS. If due to nsaids, tx by stopping tx
Colonoscopic findings of ischemic colitis?
segmenal, hemorrhagic, nodules w/ linear or circumferential ulceration
How manage pt following major upper GI bleed?
Need to do EGD to determine cause
What screening necessary in pt w/ Hep B?
periodic liver U/S to determine HCC
What antibody assoc w/ autoimmune hepatitis?
liver/kidney microsomal Ab, ANA, anti-smooth muscle Ab
How asses cause of ascites?
determine SAAG, (Serum Alb - Ascitic Alb), if >1.1 then due to portal htn
How manage hepatic encephalopathy?
start or increase dose of lactulose
How does hepatic encephalopathy px?
reversal of sleep-wake cycle, mild mental status changes, progression to irritability, confusion, slurred speech
What is hepatorenal failure?
devo of kidney failure in pts w/ portal htn & normal renal tubular fxn.
What is erythema nodosum?
Small painful nodules on anterior tibia typically, common cutaneous prob w/ IBD. More common with crohns.
What is microscopic colitis?
Chronic water diarrhea w/out bleeding, can be collagenous type or lymphocytic type. Tx w/ loperamide diphenoxylate, or bismuth subsalicylate
How evaluate dcrsd platelets?
First determine if due to dcrsd prodxn or Incrsd destrxn
Causes or dcrsd platelet prodxn?
Viral (HCV, HIV, EBV) chemo, MDS, etoh, fanconi, b12, folate
Causes of platelet destrxn.
Heparin (HIT) DIC, TTP, HUS, antiphospholipid syndrome, EDTA causes platelets to clump giving false dcrsd read.
What is the schilling test?
Determines cause of B12 deficiency (pernicious anemia vs malabsorption).
Effect of folate and b12 deficiency on CBC
Causes pancytopenia
Iron studies findings in anemia of chronic disease?
Low/nl mcv, low Fe, low transferrin/TIBC, Incrsd ferritin
What Is ARDS?
Injury to lung due to alveolar flooding, atelectasis, and svr O2 deficiency w/out HF. Px w/ acute onset bilateral opacities on cxr.
What are si/sx of ARDS?
Shob, tachypnea, Incrsd ox requirement,
How manage ARDS?
Usually reqs mech vent in ICU. Minimum of 5 PEEP. W/ adjusted fio2 requirements, Decrease o2 as able too and modest use of steroids
How does malignant otitis externa px?
Most often 2/2 P.A. infxn, px w/ ear pain w/ drainage, commonly have granulation tissue in ear canal. Can affect facial + other CN
Who is susceptible to rhizopus infxn?
poorly controlled diabetics, px w/ paranasal sinus infxn
What facotrs found w/ RA?
anti-ccp and rheumatoid factor
what is anti-dsDNA significant for?
highly specific for SLE
How do benzos intox px?
Like ETOH intox, slurred speech drowsiness, unsteady gate
What is a cataract?
progressive thickening of the lesn that leads to worsened vision. Px w/ blurred vision and glare
How does retinal detachment px?
“Curtain falling over eye” or obscurring of part of visual field.
How does macular degen px?
progressive, slow loss of vision if dry type of mac degen, will get wave lines or loss of central vision with wet type of mac degen
What causes myasthenia gravis?
Ab against post-synaptic Ach receptor.
What else must be assesed with Myasthenia Gravis?
Need chest CT to r/o thymoma
How do head and neck cancers px?
hard non-tender LN in submandibular or cervical region. Commonly in smokers
Si/Sx of allergic interstitial nephritis?
acute renal fail, arthralgia, rash, common w/ sulfa drugs, WBC casts of eosinophils, eosinophiluria
Si/Sx of PSGN?
hematuria, mild proteinuria, RBC casts + fluid retention w/ periorbital edema.
What is histoplasmosis?
dimorphic fungus found in Missouri+Ohio river valleys
How does disseminated histo present?
Low grade fvr, malaise, anorexia, weight loss, palatal ulcers. Also LAD, HSM, pancytopenia. Hilar LAD on CXR.
How does blastomycosis px?
rarely affects immunocompetent pts, px w/ multiple lung nodules or dense consolidation on cxr, see ulcerations of skin, verrucuous skin lesions, plaque like lesions on mucus membranes, osteolytic bone lesions
What are anti-influenza tx and how used?
oseltamivir + zanamavir r neuroaminidase inhibitors, must be started in first 48 hrs. Also rimantidine or amantadine for Influ A
How does toxic shock syndrome px?
mechanic hands (desquamation, includ palms/soles), fvr>102, hypotension, diffuse erythroderma, vomit/diarrhea, myalgia w/ incrsd CK, incrsd Cr, low platelets, Incrsd ALT/AST
How does SJS px?
prodrome of fvr + flu sx, then mucocutaneous erythematous + purpuric macules that necrose/slough
What is best screening test for androgen secreting neoplasm?
serum T + DHEAS, if incrsd androgens, w/ NL DHEAS, then ovary/testicle is source, if incrsd DHEAS, w/ nml T, then adrenal source
Lytes criteria?
Exudate if pleural Prot/ serum Prot>0.5, pleural LDH/serum LDH>0.6, pH<7.30,
normal pH of pleural fluid?
7.6
What is tennis elbow?
lateral epicondylitis due to repeated wrist extension and supination.
How tennis elbow px?
px w/ pain on lateral epicondyle thats worse w/ use, get degen of extensor carpi radialis brevis
What is risk fx after having ankylosing spondylitis for >2 decades?
incrsd risk for vertebral fx, px w/ sudden onset of svr back pain, can occur even w/ minimal trauma in presence of AS.
How vertebral fx pain diff from muscle spasm?
both acute in onset and can be severe but spasm tends to only last short time.
Si/sx of blastomycosis?
can be disseminated even in immunocompetent, lung infxn w/ widespread extrapulmonary disease, wartlike lesions, violaceous nodules, skin ulcers
What is lithium effects on endocrine system?
can cause hypothyroidism w/ goiter, also hypercalcemia, diabetes insipidus
Cause of hypercalcemia w/ low PTH?
malignancy, vit D toxicity, or granulomatous disease
Si/sx of upper airway obstrxn?
dysphagia, dyspnea, likely 2/2 to allergic rxn, stridor & harsh expiratory sound
Si/sx of intracranial htn?
diffuse HA, esp in AM, n/v, vision changes, papilledema, CN deficits, somnolence, confusion
tx for diabetic foot ulcer?
off loading (no weight on foot), debirdement, wound dressing, ABX, revasculariz if necessary, amputation
Cuase of low serum Ca and incrsd PO4?
chronic renal failure or primary hypoparathyroidism
Serum levels of Ca/PO4 w/ pagets?
Nml Ca and nml PO4, incrsd Alk Phos
What causes rickets?
low vitamin D levels in Kids -> low Ca and low Phos
Common cause of recurrent pneumonia?
alcohol intake px as recurrent RLL pneumo, recurrent pneumonia in same location more likely due to local obstrxn
Si/sx of aspiration pneumonia?
indolent course usually, foul smelling sputum, usually due to oral flora
How does acute viral myocarditis px?
URI followed by sudden onset of CHF, suggestive of dilated cardiomyopathy, due to dilated ventricles w/ hypokinesia
