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MTU Core Rotation Exam > Essential Internal Med Diagnoses pt 1 > Flashcards

Essential Internal Med Diagnoses pt 1 Flashcards

1
Q

Definition, Etiology, risk factors, investigations and management of Bacterial Meningitis

A

Bacterial meningitis

definition: bacterial of the meninges

etiology: neonates- group B strep, e.coli, listeria

infants- strep pneumo/N.meningitiidis, Hib

young adults- strep pneumo, N.meningitidis

older adults- strep pneumno, N.meningitis, lsiteria.

Risk Factors: pts with splenectomy, sickle cell disease, CSF leak, cochlear implants, immunocompromised.

Investigations: Kernig’s sign, brudzinski’s sign, labs would be high WBC and PMN. LP

Management; ceftriaxone+vancomycin+steroids. +/-acyclovir if HSV concerns, add ampicillin if 65yo+. Vaccination.

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2
Q

symptoms of meningitis

A

fever, headache, confusion, photophobia, neck stiffness, rash.

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3
Q

what type of meningitis spcifically can show cavitation lesions in brain

A

tubucular meningitis

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4
Q

Glucose, protein, WBC and differential of bacterial, viral, fungal and TB positive LPs

A

Bacterial: low glucose, high protein, PMN >1000 WBC

viral: high/N glucose, normal protein, lymphocytic dominant
fungal: normal/low glucose, high protein, variable WBC profile.

TB: low glucose, high protein, variable WBC profile (COMPARED TO BACTERIAL WHICH HAS HIGH WBC PROFILE), and lymphocytic differential.

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5
Q

when to start empiric treatment without an LP

A
  • papilledema
  • immunocompromised
  • GCS<10
  • CNS Disease
  • Seizures

Focal neuro deficits

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6
Q

pain in hamstring with knee extension

A
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7
Q

hip flexure response to knee flexion

A

brudzinski’s sign

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8
Q

management of a viral meningitis

A

fluids, NSAIDs, opioids

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9
Q

classic triad of spinal epidural abscess

A

backpain + fever = neurological deficit

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10
Q

etiology, risk factors, investigations and management of spinal epidural abscess

A

etiology: staph from IVDU, endocarditis, UTI, lung infections

risk factors: immunocompromised, alcoholic, diabetics

investigations: stat MRI with contrast or CT with contrast, blood cultures, urinalysis + culture, sputum culture
management: empirc ABx (vancomycin+ ceftriaxone) neurosurgery decompression STAT

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11
Q

Transudative vs exudative pleural effusion and causes

A

pleural effusion: excess of fluid in the pleural space.

transudative process: leakage of fluid across an intact capillary barrier; effusion due to heart failure, nephrotic syndrome, cirrhosis with ascietes, peritoneal dialysis

  • fluid protein/serum protein <0.5
  • fluid protein/serum LDH <0.6
  • LDH <2/3 ULN

exudative process: leakage of fluid across a DAMAGED capillary barrier. mainly caused by pneumonia, cancer, PE, bacterial infection, connective tissue disease, chylothorax.

= PF/SP >0.5

  • PF/SLDH >0.6
  • LSH >2/3ULN
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12
Q

SYmptoms of pulmonary TB:

A

cough (2+ weeks), hemoptysis, fever, weightloss/anorexia, night sweats, LONG PRESENTATION

*extra-pulmonary TB: organ-specific findings, fever, weight loss, night sweats, swelling/pain, long presentaiton.

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13
Q

Treatment for TB And key side effects

A

RIPE:
rifampin: med interactions, rash, hepatitis

Isoniazid: hepatitis, peripheral neuropathy

Pyrazinamide: hepatitis, arthralgia, gout

ethambutamol: optic neuritis*

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14
Q

high risk factors for TB

A

AIDS/HIV

organ transplant

CKD with hemodialysis

silicosis

fibronodular disease

HandN cancers, recent TB ingections

TNF-inhibitors, DM, Corticosteroids, <4yo when infected.

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15
Q

management for latent TB

A

rifampin for 4 mo and isoniazid for 9mo

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16
Q

CAP organisms and treatments

A

strep pneumo, influenza, moraxella.

treatment: beta lacatam (cephalosporin, penecillin), and a macrolide (azithromycin or clarithromycin)

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17
Q

Atypical pneumo treatment

A

mycoplasma, legionella, chlamydiophilla

treatment: macrolide+fluroquinolone+tetracycline

azithro+cipro+doxycylcine

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18
Q

how is CAP pneumo treated differentely if in hospital with MRSA risk?

A

usually, you’d treate with cephalosproin(CFTX)+ macrolide like azithromycin. you’d also then add a fluoroquinolone (cipro)+ VANCOMYCIN/LINEZOLID and PIP/taz/meropenem

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19
Q

HAP organisms and treatment

A

MRSA, strep pneumo, PSEUDOMONAS, KLEBSIELLA, enterobacter, E/Coli

treatment; cftx+azithro+cipro + PIPTAZ+ VANCO+ meropenem

20
Q

specific valve problem associated with endocarditis

A

mitral regurgitation

21
Q

typical bacteria responsible for causing endocarditis

A

gram positives “sticky”

  • staph
  • strep
  • HALEK
22
Q

extra heart sound associated with mitral regurg from endocarditis

A

S3. pan systolic murmur

23
Q

definition, risk factors, etiology, symptoms and management of infective endocarditis

A

endocarditis def: infection of the endocardial surface of a heart valve or intracardiac device

risk factors: 65+, IVDU, immunocompromisation, MV prolpase, rheumatic heart disease, implanted device

etiology: infection by staph, strep, enterococci, or HACEK
symptoms: fever, chill, night sweats, anorexia, weight loss, CHF, new murmur

+ janeway lesions, roth spots, splinter hemorrhages, splenomegaly, petechie, osler nodes.

NEED ECHO FOR DIAGNOSIS

management: empiric antibiotics. surgery for valve dysfunction cuasing HF.

24
Q

what group of patients need prophylaxis before dental procedures?

A

people with artificial valves, CHD, or transplants need amoxicillin before dental procedures to prevent endocarditis.

25
Q

Outline the Duke criteria for endocarditis

A

Duke: 2 major or 1 major and 3 minor or 5 minor symptoms

major: lab evidence of infection, evidence of endocardial involvement
minor: predisposing heart condition or IVDU, fever, vascular phenomena (janeway lesions), immunologic phenomena (roth spots, osler nodes, glomerlonephritis), + blood cutlure that does not meet major criteria.

26
Q

marantic endocarditis

A

aka non -infective endocarditis. Defined as thrombi interwoven with strands of fibrin, immune complexes and mononuclear cells

etiology: cancer, APLA, SLE, RA, sepsis, burns
management: LMWH, treat underlying condition.

27
Q

HIV is an intracellular ___virus that infects ___ t cells, leading to depletion, resulting in an increased susceptibility to infections. Management is:

A

INTRACELLULAR RETROVIRUS THAT infects CD4+ T CELL

management: ARV therapy.

28
Q

Key opportunistic infections (“fever in an immunocompromised host” scheme) seen in individuals with HIV

A

pseudomonas

PJP

candida albicans

cryptococcus neoformans

toxoplasma gondii

29
Q

Key organisms contributing to UTI

A

e.coli, klebsiella, enterococcus, group B strep, pseudo, prosteus.

30
Q

management of uncomplicated UTI in males and females

A

fmeale: nitrofurantoin 5 days
males: amox-clav 7 days

31
Q

management of complicated UTI– what makes it complicated?

A

complicated= recurrent, anatomical abnormality, immunosuppression etc

  • you give it for longer

nitrofurantoin/macrobid for 14 days, or amox-clav for 14 days.

  • if it’s ESBL according to urinecultures, you may need an ertapenem
32
Q

how is antibiotic management different in pyelonephritis vs cystitis/uti?

A

uti- nitrofurantoin/macrobid or amox clav

pyelo: more serious with flank pain, fever, + dysuria. give levofloxacin+cefixime, or IV ceftriaxone+ gentamycin.

33
Q

key methods of how infection can spread into a joint

A
  1. hematogenous: most common- bacteremia associated with URTI, skin or GIT infection or invasive procedure. enters through metaphyseal /transphyseal vessels
  2. direct innoculation: joint contamination with a foreign object
  3. contiguous spread: osteomyelitis, often spreading through a growth plate.
34
Q

how to differentiate between septic arthritis and toxic synovitis

A

toxic synovitis has negative bacterial cultures in joint aspiration, but both have MAY have elevated CRP and elevated white count because of inflammation, but toxic synovitis may have normal CRP levels. You can manage TS with NSAIDs and no antibiotics.

35
Q

Hodgkin Lymphoma: malignant proliferation of B- Cells with ___-____ cells. Many of the time it’s asymptomatic, but organomegaly of the __ and ___ as well as ____ masses may be seen

A

Hodgkin Lymphoma: malignant proliferation of B- Cells with REED STERNBERG cells. Many of the time it’s asymptomatic, but organomegaly of the LIVER and SPLEEN as well as MEDIASTINAL masses may be seen

36
Q

age distribution in hodgkin vs nonH lymphoma.

A

hodgekins: Bimodal, very treatable.

NONHodgkins: older age, usually advanced and difficult to treat

37
Q

difference in which cell line are affected in hodgkins vs nonhodgkins

A

hodgkins: B cells
nonhodgkins: B and T cell lines.

38
Q

method of diagnosis of hodgkin or nonhodkin lymphomas

A

lymph node biopsy showing binucleated reed sternberg cells (hodgkin) or proliferation of lymphoid progrenitor or mature cells (nonhodkgkin)

39
Q

complications of acute leukemias

A

leukostasis (AML>ALL), DIC (AML>ALL), and tumor lysis syndrome (ALL>AML).

40
Q

Age; Adults

No lymphadenopathy

Auer rods on slide.

A

AML.

41
Q

Age affected: mostly children

  • accompanied by splenomegaly and lymphadenopathy.

no granules or auer rods on slide

A

ALL

42
Q

SOAP BRAIN MD- SLE symptosm

A

S = serositis

O = oral ulcers

A = arthritis

P = photosensitivity

B = blood disorder

R = renal disease

A = ANA positive

I = immunological disorder

N = neurological disease

M = malar rash

D = discoid rash

43
Q

Jaccouds arhtropathy findings

A

Jaccouds is seen in 35% of SLE patients, resulting in ulnar deviaiton of the fingers, swan neck/boutonnieres deformitiy, Z deformity and non-erosive subluxation.

44
Q

antibodies associated with SLE

A

ANA (90% in SLE, but not specific)

Anti-dsDNA

Anti-smith

Antiphospholipid antibody: TTP risk

45
Q

key medication for lupus

A

hydroxychloroquine

46
Q
A

MTU Core Rotation Exam (3 decks)

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