Blood count characteristics of pt w malaria?
Symptoms of malaria that are not hematologic?
Malaria -> anemia, often thrombocytopenia
Other problems: acute renal failure, cognitive issues (coma/depressed consciousness)
Remember that it can also be asymptomatic - though pts who are asx are generally those living in the endemic areas.
Which Plasmodium is the most dangerous?
What are the severe complications it can cause?
Which Plasmodia types sleep in the liver?
Where in the world is malaria NOT found?
Most dang = Falciparum
Complications: acute renal failure, CNS changes (coma)
Sleep in liver: vivax and ovale (all have 5 letters). It is the Hyponozoite form that hangs out in the liver (hypno sounds like something that makes you sleep)
Malaria does not exist in N America and Europe.
Post-tussive emesis in a child: characteristic of what disease?
Whooping cough. The cough is so irritating that the kids barf.
NOT characteristic of strep throat (strep = abrupt onset, fever 102, red tonsils with tonsillar exudate, enlarged/tender cervical LNs)
2 tests for strep throat (group A strep pharyngitis)?
-Rapid strep test (quick)
-Culture (gold standard but slower)
Influenza vaccine is effective in what % of patients?
In what patient populations is it less effective?
Who should not get the live vaccine?
Effective in 75% overall
Less effective in immunocompromised, elderly
Immunocompromised should not have the live vaccine (tell them not to do the intranasal one)
How do we differentiate between bronchitis and pneumonia?
If CXR is normal or there is peribronchial cuffing --> bronchitis.
If CXR has infiltrates --> pneumonia (need to treat)
A few things on CXR that may make you concerned for something other than bronchitis or pneumonia (what are you concerned about with these findings?:
Kerley B lines
Granuloma/cavitation/upper lobe involvement
Multiple round abscesses
Kerley B lines - L sided heart failure
Granuloma/cavitation/upper lobe involvement - TB
Multiple round abscesses - staph (from bacteremia, endocarditis?)
If you think a pt has bronchitis and not pneumonia, what can you offer them that are not abx, but that may make them feel like you are actually helping them and not just denying them drugs?
-sudafed (for congestion)
-hot water gargle
-Ibuprofen (for aches)
-Dextromethrphan/codeine (for night time coughing)
-inhaler (for asthma/ wheezing)
-offer to see back if things change/they don't get better
Is ceftriaxone by itself adequate for community-acquired pneunomia?
Yes it is.
It covers Gram Positives and Gram Negatives, but not Atypicals
But that is ok for community-acquired pneumonia.
(atypicals = mycoplasma, legionella, chlamydophila)
If we are treating someone with community-acquired pneumonia with ceftriaxone, what should we add for a hospitalized pt with pneumonia? why?
for coverage of the atypicals (mycoplasma, legionella, chlamydophila)
What is wrong with using Levofloxacin for community-acquired pneumonia?
Technically could give this by itself to hosp patients. Covers gram positives, gram negatives and atypicals
However: too broad. Covers pseudomonas, don’t need to cover in this case.
(Levofloxacin = quinolone)
What is wrong with using Ciprofloxacin for community-acquired pneumonia?
Does not cover staph or strep pneumo (gram positives)
Only covers gram negatives.
What is wrong with using Meropenem for community-acquired pneumonia?
Meropenem = big gun against resistant gram negatives like pseudomonas.
Try to save it for those uses.
But in this case it doesn't cover what we need: does not cover atypicals.
What two drug classes (plus one other drug) cover the atypicals (mycoplasma, legionella, chlamydophila)?
covered by any quinolone, macrolide or tetracycline.
Aspiration pneumonia: what bugs are more likely to be present than in normal community-acquired pneumonia?
What drugs would we add to cover these bugs?
More oral flora
Anaerobic organisms: Fusobacteria, Prevotella, Peptostreptococcus
Add Metronidazole, Clindamycin, or a beta-lactamase inhibitor.
What should we give a 23 year old woman with a suspected uncomplicated UTI?
3 days of trimethoprim-sulfamethoxazole (Bactrim)
What should we give a 23 year old man with a suspected uncomplicated UTI?
Look for STIs
Men less likely to get UTIs - they have a longer urethra.
Rather than just treating for a UTI (Bactrim), test for GC/CT.
Treatment for chlamydia?
Always treat for gonorrhea as well: ceftriaxone.