Essential Internal Med Diagnoses pt 1

Question 1

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

Answer 1

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.

Question 2

symptoms of meningitis

Answer 2

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

Question 3

what type of meningitis spcifically can show cavitation lesions in brain

Answer 3

tubucular meningitis

Question 4

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

Answer 4

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.

Question 5

when to start empiric treatment without an LP

Answer 5

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

Focal neuro deficits

Question 6

pain in hamstring with knee extension

Question 7

hip flexure response to knee flexion

Answer 7

brudzinski’s sign

Question 8

management of a viral meningitis

Answer 8

fluids, NSAIDs, opioids

Question 9

classic triad of spinal epidural abscess

Answer 9

backpain + fever = neurological deficit

Question 10

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

Answer 10

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

Question 11

Transudative vs exudative pleural effusion and causes

Answer 11

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

Question 12

SYmptoms of pulmonary TB:

Answer 12

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.

Question 13

Treatment for TB And key side effects

Answer 13

RIPE:
rifampin: med interactions, rash, hepatitis

Isoniazid: hepatitis, peripheral neuropathy

Pyrazinamide: hepatitis, arthralgia, gout

ethambutamol: optic neuritis*

Question 14

high risk factors for TB

Answer 14

AIDS/HIV

organ transplant

CKD with hemodialysis

silicosis

fibronodular disease

HandN cancers, recent TB ingections

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

Question 15

management for latent TB

Answer 15

rifampin for 4 mo and isoniazid for 9mo

Question 16

CAP organisms and treatments

Answer 16

strep pneumo, influenza, moraxella.

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

Question 17

Atypical pneumo treatment

Answer 17

mycoplasma, legionella, chlamydiophilla

treatment: macrolide+fluroquinolone+tetracycline

azithro+cipro+doxycylcine

Question 18

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

Answer 18

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

Question 19

HAP organisms and treatment

Answer 19

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

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

Question 20

specific valve problem associated with endocarditis

Answer 20

mitral regurgitation

Question 21

typical bacteria responsible for causing endocarditis

Answer 21

gram positives “sticky”

• staph
• strep
• HALEK

Question 22

extra heart sound associated with mitral regurg from endocarditis

Answer 22

S3. pan systolic murmur

Question 23

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

Answer 23

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.

Question 24

what group of patients need prophylaxis before dental procedures?

Answer 24

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

Question 25

Outline the Duke criteria for endocarditis

Answer 25

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.

Question 26

marantic endocarditis

Answer 26

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.

Question 27

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

Answer 27

INTRACELLULAR RETROVIRUS THAT infects CD4+ T CELL management: ARV therapy.

Question 28

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

Answer 28

pseudomonas PJP candida albicans cryptococcus neoformans toxoplasma gondii

Question 29

Key organisms contributing to UTI

Answer 29

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

Question 30

management of uncomplicated UTI in males and females

Answer 30

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

Question 31

management of complicated UTI-- what makes it complicated?

Answer 31

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

Question 32

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

Answer 32

uti- nitrofurantoin/macrobid or amox clav pyelo: more serious with flank pain, fever, + dysuria. give levofloxacin+cefixime, or IV ceftriaxone+ gentamycin.

Question 33

key methods of how infection can spread into a joint

Answer 33

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.

Question 34

how to differentiate between septic arthritis and toxic synovitis

Answer 34

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.

Question 35

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

Answer 35

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

Question 36

age distribution in hodgkin vs nonH lymphoma.

Answer 36

hodgekins: Bimodal, very treatable. NONHodgkins: older age, usually advanced and difficult to treat

Question 37

difference in which cell line are affected in hodgkins vs nonhodgkins

Answer 37

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

Question 38

method of diagnosis of hodgkin or nonhodkin lymphomas

Answer 38

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

Question 39

complications of acute leukemias

Answer 39

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

Question 40

Age; Adults No lymphadenopathy Auer rods on slide.

Answer 40

AML.

Question 41

Age affected: mostly children - accompanied by splenomegaly and lymphadenopathy. no granules or auer rods on slide

Answer 41

ALL

Question 42

SOAP BRAIN MD- SLE symptosm

Answer 42

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

Question 43

Jaccouds arhtropathy findings

Answer 43

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.

Question 44

antibodies associated with SLE

Answer 44

ANA (90% in SLE, but not specific) Anti-dsDNA Anti-smith Antiphospholipid antibody: TTP risk

Question 45

key medication for lupus

Answer 45

hydroxychloroquine