What is the dose for epinephrine for anaphylaxis (IM)?
0.3-0.5 mg for a 1 mg/mL formulation. Repeat q5-15 min as needed
What is the pattern of homocysteine and MMA in folate and B12 deficiency?
Homocysteine elevated in both
MMA only elevated in B12 deficiency
What is the initial treatment and doses of a 60M who presents with meningitis of unknown etiology (microbiology wise)?
Dexamethasone 10 mg IV q6h (0.15 mg/kg per dose q6h) for 2-4 days (first or WITH first dose of antibiotics)
Ceftriaxone 2g IV q12 h (give first)
Vancomycin 750 mg in q6h (load and maintenance according to kg)
Ampicillin 2g Iv q4h
Acyclovir 10 mg/kg IV q8h
What three beta blockers are used in chf?
Bisoprolol, carvedilol, long acting metoprolol
What is a paradoxically split S2 and which conditions is it seen in?
S2 is split in expiration (P2 then A2 closes second) and no split in inspiration.
Seen in conditions that prolong LV emptying like severe aortic stenosis and LBBB and HOCM
What time from last drink can someone experience alcohol withdrawal seizures?
6-48 hours
What time from last drink can alcohol hallucinosis develop?
12-24 hours
What time since the last drink can alcohol withdrawal delirium develop?
72-96 hours
GABA is an excitatory or inhibitory neurotransmitter?
Inhibitory
SPICE HAM organisms are which?
Serratia Providencia Indolent + proteus Citrobacter Enterobacter Hafnia Acinetobacter Morganella
What antibiotics should be used for SPICE HAM organisms?
Carbapenums
Septra
Fluroquinolones
Aminoglycosides (if sensitive)
ESBL E.coli or Klebsiella should be treated with what antibiotics?
Carbapenums
Septra
Fluoroquinolones
Aminoglycosides (if sensitive)
What antibiotics cover MRSA
Vancomycin Doxycycline (tetracycline) Septra Clindamycin Linezolid Daptomycin Ceftobiprole (5th generation cephalosporin)
What antibiotics cover pseudomonas?
Pip tazo Ceftazidime (3rd gen cephalosporin) Cefepime (4th gen cephalosporin) Meropenum Imipenum Cipro flows in Aminoglycosides Aztreonam Colistin
What covers enterococcus bacteria?
Vancomycin (except if it’s VRE)
Linezolid
Daptomycin
In general (there are exceptions), which bugs ARE NOT covered by cephalosporins?
Listeria
Atypicals (mycoplasma/chlamydia)
MRSA
Enterococcus
What are the 5 minor criteria for duke’s criteria of IE?
- Predisposition such as heart condition or IVDU
- Fever > 38
- Vascular phenomena
- Immunologic phenomena
- Positive blood culture not meeting major criteria (excluded single positive cultures for cons or other organisms that don’t cause endocarditis)
What are the 4 immunologic phenomena that count as part of duke phenomena (IE)
- Glomerulonephritis
- Osler node
- Roth spots
- Positive RF
What are the major criteria from Duke Criteria (IE)?
- Persistently positive blood cultures for organisms typical for IE from 2 separate blood cultures (>12 h apart)
- Coxiella burnetii positive blood culture
- Echo showing mass/vegetation, paravalvular abscess, new or worsening valvular regurgitation, valve dehiscence
What cardiac conditions have a positive Kussmaul’s sign?
Constrictive pericarditis Restrictive cardiomyopathy Right ventricular myocardial infarction Massive pulmonary embolism Severe pulmonary hypertension Right heart failure Right-sides cardiac tumors Superior vena cava obstruction
What is the first line treatment of hypertrophic cardiomyopathy?
Beta blockers
Avoid hyovolemia as well
What CD4 count should you start prophylaxis for PJP in HIV infected individuals?
What do you use for prophylaxis?
- <200
- Septra 1 DS or SS Po fab daily
Alternatives:
- septra 1 DS M/W/F
- dapsone (not in G6PD of if SJS to septra. Okay if Sulfa allergy)
- Atovaquone
- aerosalized pentamidine monthly
What level of CD4 should you start prophylaxis for toxoplasma and what do you use?
- <100
- Septra 1 DS Po daily or dapsone or atovaquone +/- pyrimethamine/leucovorin
Alternatives include septra 1 DS MWF or septra 1 SS daily
What level of CD4 should you start prophylaxis for MAC and what do you use?
- <50
- Azithro my in 1200 mg Po weekly or clarithro my in 500 mg Po bid
Alternative is rifabutin
