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IM EOR > Critical Care (7%) and ID (5%) > Flashcards

Critical Care (7%) and ID (5%) Flashcards

1
Q

EBV is ass’d with rash after what drugs?

A

Ampicillin, amoxicillin

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2
Q

Viral symptoms in patient with recent transplant

A

Cytomegalovirus – looks like GvH, but that’s not on the blueprint so consider this first

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3
Q

Buzzword: gray-white covering of posterior pharynx

A

(“Pseudomembrane”) –> diptheria

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4
Q

What are some complications of EBV?

A
  • Lymphomas (Hodgkin, Burkitt, CNS)
  • Nasopharyngeal carcinoma
  • Gastric carcinoma
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5
Q

Erythema migrans + recurrent arthritis

A

Consider lyme

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6
Q

How is Lyme diagnosed?

A

Western blot

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7
Q

How is Lyme treated?

A

Early = doxycycline; if CIx, use IV PCN G

Late = IV Doxy or ceftriaxone if considering a bacterial pathogen, if there are late neuro signs, or if there is minimal response to early treatment

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8
Q

Pulmonary s/sx + Ohio river valley, caves, bats, or birds

A

Histoplasmosis

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9
Q

Pulmonary s/sx + San Jaquin valley, AZ, UT, or NV

A

Coccidiomycosis

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10
Q

What is the MC HIV-related PNA?

A

Pneumocystis (jirovecii)

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11
Q

Tick bite +

  • Fever
  • Rash from feet up, blanching macules
  • April - September
A

RMSF, treat with doxy

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12
Q

Tick bite, Gram (-), targets endothelial cells

A

RMSF

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13
Q

Severe salmonellosis can be treated with

A

FQ or bactrim

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14
Q

Diarrheal illness ass’d with prisons, daycares, hospitals

A

Shigellosis

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15
Q

Treatment for suspected tetanus exposure

A

For puncture wound:

  • Airway
  • Benzos for spasms
  • Tetanus immune globin
  • Tetanus toxoid x 3
  • Metronidazole or PCN (stop toxin production, kill bact)
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16
Q

MRI showing ring-enhancing lesions in an immunocompromised patient exhibiting confusion

A

Toxoplasmosis

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17
Q

Tx for a patient with confusion, persistent HA, and MRI showing ring-enhancing lesions

A

Pyrimethamine + sulfadiazine (tx for toxoplasmosis)

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18
Q

Treatment for latent TB

A

Iso + Rifampin weekly x 3 months (12 doses)

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19
Q

Treatment for TB Disease

A

Isoniazid + ethambutol + rifampin + pyrazinamide

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20
Q

AEs associated with ethambutol

A

E = Eyes

Optic neuritis, red-green colorblindness

21
Q

AEs associated with rifampin

A

R = Renal impairment
Orange secretions
Flu-like symptoms
*Has the most drug interactions of the TB drugs

22
Q

AEs associated with isoniazid

A

I = Eyes, optic neuritis
Peripheral neuropathy
Hepatotoxicity

23
Q

AEs associated with pyrazinamide

A

Hepatotoxicity
Gout
GI effects

24
Q

Who gets treated for chickenpox, and with what?

A

13+ YO

  • Acyclovir if w/in 72 hours of onset
  • If resistant, use foscarnet
25
Q

What is Hutchinson’s sign?

A

Involvement of tip of nose in shingles infection; involves likely involvement of cornea, urgent ophthal referral

26
Q

Tx for uncomplicated candidiasis

A

1 dose fluconazole 150 mg PO

Can repeat dose after 72 hours if necessary

27
Q

Tx for Chlamydia

A

Doxy 100mg PO x 7 days (use 1 dose AZ in pregnancy; doxy preferable in other patients)
+
500mg IM ceftriaxone to cover for possible gonorrhea co-infection

28
Q

Tx for gonorrhea

A

500 mg IM ceftriaxone
+
Doxy 100mg PO x 7 days to cover for possible chlamydia co-infection; alt 1 dose AZ in pregnant patients (higher resistance tho)

29
Q

Buzzword: giant multinucleated cells on Tzank smear

A

HSV

30
Q

How is HSV diagnosed?

A

Viral culture from unroofing an unruptured vesicle

31
Q

Difference between chancre and chancroid, and disease associations?

A

Chancre is painless and associated with syphilis

Chancroid is painful and associated with granuloma inguinale (H ducreyi)

32
Q

How is syphilis diagnosed?

A

RPR (nontreponemal test, just indicates presence of IgM/G antibodies) MC to screen

–> Reflex to treponemal test

  • FTA-Abs
  • MHA-TP
  • TPPA
  • TP-EIA
  • CIA
33
Q

Differentiate morphology of chlamydia vs gonorrhea

A

Both are Gram (-)
Chlamydia is coccoid
Gonorrhea is diplococcoid

34
Q

Describe early manifestations of Lyme disease

A
  • Erythema migrans

- Nonspecific, viral-like symptoms (fatigue, anorexia, HA, neck stiffness, myalgia/arthralgia, fever, etc)

35
Q

Describe manifestations of early disseminated Lyme

A
  • May see multiple erythema migrans lesions
  • Neurologic symptoms:
      • Peripheral neuropathy
      • Radiculopathy
      • Uni/bilateral cranial nerve palsies (esp facial)
      • Mononeuropathy multiplex
      • Lymphocytic meningitis
  • Cardiac symptoms:
      • AV heart block (mild)
  • Ocular manifestations
36
Q

Describe late manifestations of Lyme disease

A

Intermittent arthritis, large joints, esp knee
Neuro: mononeuropathy multiplex
Encephalomyelitis
Subtle encephalopathy

37
Q

What is the most likely source of bleeding in a patient with melena, jaundice, and ascites?

A

Esophageal varices 2/2 portal HTN

38
Q

The anatomical location of bleeding in a patient who presents with melena is MC where?

A

Proximal to the ligament of Treitz

39
Q

The anatomical location of bleeding in a patient who presents with hematemesis is MC where?

A

Proximal to the ligament of Treitz

40
Q

The anatomical location of bleeding in a patient who presents with hematochezia is MC where?

A

Distal to the ligament of Treitz (unless it is massive upper GI bleeding)

41
Q

What is the MC cause of upper GI bleeding?

A

Peptic ulcer disease

Esophageal varices are close second

42
Q

What is the MC cause of lower GI bleeding?

A

Diverticulitis (sigmoid colon is MC location)

43
Q

What is the critical care treatment for a patient with significant GI bleed?

A
  • ABCs
  • Type and cross
  • 2 large bore IVs; IVF (but replace blood with blood: transfuse as needed)
  • NPO

Pharmacotherapy:

  • PPI
  • Octreotide (somatostatin analogue, used for variceal bleeding/cirrhosis)
  • IV ceftriaxone or an FQ
  • Immediate GI surg consult
44
Q

Why are IVF important in the critical care treatment of cardiac tamponade?

A

Must maintain sufficient preload to prevent RV collapse

45
Q

What is the critical care treatment of symptomatic CAD?

A 
MONA-BASH-C:
- Morphine
- O2
- Nitro
- ASA (325 acute, then 81mg)
- B-blocker (EXCEPT with R-sided infarct, but these patients should be in cath lab anyway!)
- ACE-i - reduce afterload
- Statin
- Heparin: stabilize potential thrombus
\+/- Clopidogrel: add clopidogrel if there is high sus this pain is CAD
46
Q

What is the management for a patient with NSTEMI and elevated troponins?

A

Urgent cath lab

47
Q

What is the management for a patient with NSTEMI and no elevation in troponins?

A

Serial troponins, observe overnight

  • If positive –> urgent cath lab
  • If negative, arrange elective stress test for the morning
  • — If positive: elective cath
  • — If negative: only way to truly r/o CAD is with cath, they can opt to do this or not
48
Q

What is the tx for angina that is worst in the morning/on waking, not associated with exertion

A

Prinzmetal angina: use CCB (no BB) and long-acting nitrates like amlodipine

49
Q

EKG changes including transient ST elevations, inverted U waves and angina in the early hours of the morning

A

Prinzmetal angina

IM EOR (8 decks)

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