ID, HIV/MusSkel/ Renal Diseases Flashcards
(158 cards)
1
Q
Sugical site infections are caused by which bacterias?
A
- MRSA - “superbug”
- Enterococci
- coliform
- clostridium perfringen
- P.aeruginosa
- candidia
- bacteroid fragilis
2
Q
Which SSIs present as peritonitis or abscess after GI surgery
A
- P.aeruginosa
- candidia
- bacteroid fragilis
3
Q
What are the Risk factors for SSIs
A
- Chronic illness
- Extremes of age
- Immunocompromise status
- DM
- Biofilm formation on prosthetics
- Virulent factors like capsule and enzymes produced by bugs
- Dirty surgical wounds with dead tissues
- Foreign objects
4
Q
How are SSIs diagnosed?
A
- Elevated WBCs
- Poor blood sugar control
- Elevated inflammatory markers e.g. C-reactive proteins
- Positive bacterial culture
5
Q
What is the gold standard for diagnosis of SSIs?
A
Positive bacterial culture
6
Q
Bloodstream infections are caused by?
A
- CV line
- Catheter-associated
- Blood products
7
Q
What are the s/s of bloodstream infectons?
A
- Nonspecific
- Fever, altered mental status
- Hemodynamic instability
8
Q
Bloodstream infections are diagnosed by? whatis the treatment?
A
DX: positive blood cultures
TX: Abx and antifungal
9
Q
Sepsis is?
A
Systemic inflammatory response- “cytokines storm”
10
Q
Souces of sepis include?
A
- Abscess
- Infective endocarditis
- Bowel perforation
- UTI
- Prosthetics
- Endometritis
11
Q
What are the signs and symptoms of sepsis?
A
- Fever, altered mental status,
- Septic shock
12
Q
What is the diagnosis and treatment of sepsis?
A
DX: cultures
TX: Abx
13
Q
This condition causes hyperactive muscle contractions
A
Tetanus
14
Q
1.Tetanus is caused by?
A
Clostridium tetani- Gram+, spore forming anaerobic bacilli
15
Q
Second most powerful toxin
A
Tetanospasmin
16
Q
What is the MOA of Tetanospasmin?
A
blocks glycine [inhibitory NT] release from spinal cord. Glycine is needed to inhibit muscle contraction. This leads to continuous, uncontrolled muscle contraction.
17
Q
Symptoms of tetanus include?
A
- Trismus (lockjaw) involves spasms of the jaw muscle and clenching of the teeth
- “Fixed smile” due to spasm of face muscles
- Opisthotonus involves muscle spasms that cause an arching of the back
- Spasmodic inhalation and seizures in the diaphragm and rib cage. This reduces ventilation leading to death
- Can be transmited by cutting umbilical cord with dirty instrument. Autoclave kills spores
18
Q
Describe the treatment and prevention of tetanus
A
- Sedatives, muscle relaxants, and penicillin are used in treatment
- Tetanus toxoid is used in vaccination
- TDaP 2, 4, 6 , 18 months and 5 years of age
- Td vaccine “Booster shot” every 10 years
19
Q
Early signs of tetanus are?
A
Spasm of jaw, facial and neck muscles (trismus/lockjaw, risus sardonicus)
20
Q
In tetanus motor neurons of the spinal cord (anterior horn and brainstem become hyperactive because?
A
Toxin specifically attacks inhibitory (Renshaw) cells.
21
Q
Typical pneumonia is caused by which bugs?
A
- Strep pneumoniae (adult)
- H. influenza
- S.aurus (hospitalized,)
- Klebsiella (alcoholic)
- PCP (HIV)
- Covid 19
22
Q
patient with typical pna presents with?
A
Shaking chill, high grade fever, SOB, productive cough
Ventilator-associated
23
Q
Atypical pna is caused by?
A
Mycoplasma pneumoniae “ wall-less”
“walking pnemonia”
24
Q
Patient with atypical pneumonia presents with?
A
Mild symptoms like:
- sore throat
- non-productive cough
- headache
- X-ray shows diffuse infiltrates. C “X-ray looks worst than patient”. Often called walking pneumonia
25
M. pneumoniae are resistant to penicillin because?
it has no cell wall
26
Atypical pna is diagnosed by?
Elevated titer of cold agglutinin **(IgM)**
27
What is the drug of choice for atypical pna?
Erythromycin or tetracyclin
28
The condition in the cxr is most likely caused by?
Mycoplasma pneumonia
29
What is the diagnosis for patient with this
TB- Microscope slide shows AFB
30
TB forms cavitations at the apex of lung as opposed to the base because?
They are obligate aerobes
31
Latent TB
No symptoms, patient may never even know they are infected
About 90% of people who carry latent tuberculosis will never develop an active infection
32
Symptoms of clinical TB
Fever, night sweats, weight loss , hemoptysis
33
\_\_\_\_\_\_\_\_\_\_\_ is used in TB immunization
1Attentuated M. bovis
34
Miliary tuberculosis is?
The development of active tubercles throughout the body leading to Death
35
Positive Montoux test shows?
−Recent immunization
−Previous tuberculin test
−Past exposure to M. tuberculosis
−Need further tests (chest x-ray, sputum for AFB)
−Negative in AIDS
36
ABX affected by resistant TB
INH,pyrazinamide , rifampin
37
The mage shows a patient with?
TB
Apical lesions - trade mark of Tuberculosis
38
Graft from one person to another, may be related or unrelated, cadeveric or live
Allograft
39
Graft from animal to human. Most commonly heart valves- leftlet of mitral valve.
Xenograft
40
Graft from one identical twin to another
Isograft
41
Graft from one part to another part of same individual
Autograft
42
Antibody mediated (type II) rejection. Occurs within minutes after transplant
Hyperacute rejection
43
Cell mediated rejection due to cytotoxic T-cells reacting against foreign MHC. Occurs days after transplantation. Reversible with immunosuppressants e.g. cyclosporine
Acute rejection
44
Rejection that is T-cell and antibody mediated vascular damage. Occurs months or years after transplant
Chronic rejection
45
Graft-versus-host disease is?
Grafted immunocompetent T cells vs. irradiated immunocompromised host resulting in severe organ dysfunction.
46
Elevated number of circulating leukocytes in blood
Leukemias
47
Describe the pathophysiology of leukemia
Normal bone marrow elements are “pushed out” with leukemic cells leading to a decrease production of normal WBC, RBC and platelets
Anemia, petechiae, bruises, bone pain, infection, fever
48
What are the signs and symptoms of leukemias
1. Anemia
2. petechiae
3. bruises
4. bone pain
5. infection
6. fever
49
Acute leukemias
1. Blasts predominate
2. Children or elderly
3. Excellent prognosis
4. Short and drastic course
5. **ALL:** Children; Most resp to chemo; Lympohoblasts (pre-B or pre-T)
6. **AML:** Myeloblasts
50
Chronic Leukemia
1. More mature cells
2. Middle life range
3. Longer, less devastating course
4. **CLL**: Lymphocytes; lymphadenopathy
5. CML: MC with Philadelphia chromosome; Myeloid stem cells “Blast crisis”
51
Rheumatoid Arthritis is?
* Chronic, destructive ,systemic inflammatory arthritis
* Characterized by symmetric involvement of both large and small joints.
* RA causes synovial hypertrophy and pannus formation with resultant erosion of adjacent cartilage, bone and tendons.
52
Rheumatoid arthritis is most common in?
female 20-40 age
53
RA has high incidence with _______ serotype
HLA-DR4
54
Pannus is
abnormal growth of fibrous tissues
55
Patient with RA complain of?
1. Insidious onset
2. Morning stiffness improves with use
3. Pain, warmth, swelling and decreased mobility
4. Polyarthropathy
5. Fatigue, anorexia, weight loss
56
Physical exam finding in RA
1. Wrist, metacarpophalangeal and proximal interphalangeal (PIP) joints, ankle, knees, shoulder, hip, elbow and cervical spine (C1, C2)
2. Distal interphlangeal joints (DIP) are spared in RA
3. Ulnar deviation of the fingers, swan neck deformities of digits
4. Extra-articular manifestations:
* Vasculitis, Subcutaneous nodules
* Pericarditis, pleuritis
* Carpal tunnel syndrome
57
Evaluation of RA
1. Rheumatoid factor (anti-Fc IgG antibody)
2. Elevated ESR
3. X-ray: narrowing of joint spaces and erosion, pannus formation
58
Treatment of RA
1. NSAIDs
2. Steroid
3. methotrexate
4. choroquine
5. gold
59
Describe the pathophys of OA
* Chronic, noninflammatory arthritis of movable joints
* Degenerative joint disease- “wear and tear arthritis”
* No systemic manifestation
* Deterioration of articular cartilage
* Osteophyte (bony spur) formation at joint surfaces.
60
Risk factors of OA
1. Family history
2. Obesity
3. Previous joint trauma
61
Patieent with OA will complain of?
1. Joint pain worsen by activity and weight bearing and relieved by rest
2. Crepitus
3. Decreased range of motion
62
Physical exam of a patient with OA will show?
1. Involvement of weight bearing joints (hip, knee, lumbar)
2. Also involve DIP, PIP and cervical
3. Stiffness and marked crepitus of the affected joints
63
Evaluation of OA
1. Normal ESR
2. X-ray: ulcerated cartilage, narrowing of joints spaces, osteophytes , dense subchondral bone
64
Treatment of OA will include?
1. Physical therapy
2. Weight reduction
3. NSAID
4. Intra-articular steroids for temporary relief
5. Replacement
65
Metabolic condition causing recurrent attack of acute monoaticular arthritis. It results from intra-articular deposition of uric acid crystals and is more common in men.
Gout
66
Hyperurecimia in gout is due to?
under excretion of uric acid
67
Patient with gout will complain of?
Recurrent attack of acute monoaticular arthritis, awakening the patient at night with excruciating joint pain
68
Physical exam of a patient with gout will show?
1. Involves big toe- podagra
2. Midfoot , knee, ankle, and wrist
3. Spares hip and shoulder
4. Red swollen and very tender affected joint
5. Chronic =\> tophi (chunks of uric acid crystals that accumulate in and around joints)
69
Evaluation of a patient with gout involves?
Joint fluid aspiration reveals needle shape crystals and elevated serum uric acid
70
What is the treatment of gout?
1. Uricosuric agent - probenecid
2. Steroid
3. Avoid thiazide/loop =\> hyperuricemia
4. Allopurinol (xanthine oxidase inhibitor)- C/I in acute attack
5. Colchicine
71
Drug induced autoimune disorder commonly in women (90%)
SLE
72
These 3 drugs can cause SLE
1. INH
2. procainamide
3. hydralazine
73
Patient with SLE will report what history
1. Fever
2. anorexia
3. weight loss
4. joint pain
5. photosensitivity
6. oral ulcer
74
physical exam of a patient with SLE will reveal?
1. Malar rash
2. joint tenderness and inflammation
3. pericarditis
4. pleuritis
5. neurological, renal and hematological abnormalities
75
Evaluation of SLE involves
1. Positive ANA (anti-nuclear antibody)
2. Anti-DNA and anti-SM antibodies
76
Treatement of SLE involves
NSAID
steroid
chloroquine
cyclophosphamide
77
A poorly characterized disease with excessive bone turnover
Paget’s disease
78
History and physical of paget's disease
1. Often asymptomatic
2. Deep bone pain
3. Tibial bowing, kyphosis and frequent fractures
4. large cranial diameter “frontal bossing”
79
X-ray in paget's desease will show?
1. Markedly expanded bony cortex
2. Increase density, bowing
80
This drug is the treatment for paget's desease
Calcitonin
81
Polymyalgia rheumatica is commonly seen in?
women
82
Patient with Polymyalgia rheumatica will report a history of?
1. Pain and stiffness of shoulder and pelvic girdle
2. Fever, weight loss, joint swelling
3. Great difficulty getting out of chair
83
Physical exam in Polymyalgia rheumatica reveals?
No weakness
84
Polymyalgia rheumatica Evaluation includes?
1. Anemia
2. Elevated ESR
85
Treatment of Polymyalgia rheumatica
Low-dose prednisone
86
Ankylosing Spondylitis is more common in?
Male
87
Ankylosing Spondylitis is associated with HLA ______ subtype
HLA B27 ( human leukocyte antigen B27)
88
Patient with ankylosing spondylitis presents with what history and physical findigs
1. Symmetrical involvement of spine and sacroiliac joint
2. Joint fusion (bamboo spine), uvetitis, aortic regurgitation
3. Shortness of breath: restrictive lung disease
89
Causes of Nephrolithiasis include?
1. Positive family history
2. Low fluid intake
3. Gout
4. RTA
5. Hyperparathyroidism
90
Types of stones in nephrolithiasis
1. Calcium oxalalate
2. Calcium phosphate
3. Triple phosphate “staghorn stone”
4. Uric acid
91
Radiolucent kidney stone
Uric acid
92
Kidney stone associated with UTI
Triple phosphate “staghorn stone”
93
Kidney stone in patient with primary hyperparathyroidism
Calcium phosphate
94
Radiopaque kidney stone formed in alkaline urine. It is idiopathic and the most common
Calcium oxalalate
95
Evaluation of Nephrolithiasis
1. Microscopic hematuria
2. Altered urinary pH
3. Plain X-ray
4. Abdominal U/S
5. IVP
6. CT
96
Treatment of Nephrolithiasis
1. Hydration
2. Analgesia
3. Lithotripsy
4. Neprolithotomoy
5. Thiazide diuretics (Lower Ca++ conc in urine) for prevention
97
What is the best test of renal function?
Creatinine clearance. It is approximately equals to GFR.
Creatinine clearance = ~GFR
98
What test distinguishes prerenal from renal failure?
The fractional excretion of filtered sodium – FEFNa.
Decreased= prerenal,
Elevated =renal failure
99
Glomerulonephritis
1. Post beta-streptococcal infection- Cross reaction of antibodies
2. Immune complex mediated
3. Hematuria, proteinuria, HTN and edema
4. Increase Cr
5. Red cell cast
6. Give steroid + immunosuppressive drugs
100
Nephrotic sydndrome
A.Proteinuria \> 3.5 g/day
B.Edema
C.Sodium retention
D.HTN
E.Hyperlipoproteinemia
F.Thromboembolic phenomenon and infections
101
Nephrotic sydndrome is caused by?
1. DM
2. Neoplasia
3. HIV
4. Preeclampsia
102
Goodpasture Syndrome
A.Hemoptysis and hematuria
B.Cross-reaction of antibodies
C.Progress to RF
103
Interstitial nephritis
A.Allergic reaction to drugs
B.Autoimmune e.g. lupus
C.Infiltrative diseases
104
Clinical presentation of Interstitial nephritis
1. Proteinuria
2. Decrease concentration ability
3. HTN
4. Reversible
105
Hereditary nephritis (Alport’s syndrome)
A.Also have deafness and ocular problems
B.HTN
C.RF
106
Treatment of Hereditary nephritis (Alport’s syndrome)
ACE inhibitor for some protection
107
This renal condition is autosomal dominant and accompany Berry's aneurysm that can cause SAH
Polycystic renal disease
108
Fanconi syndrome is associated with defects in PCT functions leading to?
1. Polyuria
2. Metabolic acidosis due to loss of HCO3
3. Skeletal muscle weakness due to loss of potassium
4. Dwarfism and osteomlacia due to loss of phosphorous
5. Vit-D resistant rickets
109
This complication of fanconi syndrom is due to decreased Phosphate reabsorption
Rickets
110
This complication of fanconi syndrom is due low HCO3- reabsorption
Metabolic acidosis (type-2 RTA)
111
This complication of fanconi syndrom is due low Early Na+ reabsorption
High Distal Na+ reabsorption =\>hypokalemia
112
This renal disorder is immune complex mediated and is ascociated with a p ost beta-streptococcal infection and red cell cast
Glomerulonephritis
113
This renal disorder is ascociated with Thromboembolic phenomenon and infections. It is caused by DM, neoplasm, HIV or preeclampsia.
Nephrotic sydndrome
114
Patient with this renal disorder present with Hemoptysis and hematuria. Its is ascociated with Cross-reaction of antibodies Progressing to RF
Goodpasture Syndrome
115
This renal disorder is ascociated with Allergic reaction to drugs, autoimune deseases such as lupus and infiltrative deseases. It is reversible
Interstitial nephritis
116
This renal disorder is accompanied with deafness and occular problems
Hereditary nephritis (Alport’s syndrome)
117
Pseudomembranous colitis
1. By clostridium difficile
2. Antibiotic-associated diarrhea
3. Clindamycin, cephalosporins, quinolones and penicillin kill normal flora then opportunistic like C.diff invade
4. 20% in hospitalized patient
5. New multiple drug resistant strains have emerged
6. F.C.diff produces two enterotoxins A and B
118
signs and symptoms of Pseudomembranous colitis
Diarrhea and abdominal pain and distension
119
Diagnosis of pseudomembranous coliis
1. Toxins in stool
2. Flexible sigmoidoscopy / colonoscopy
120
Treatment of Pseudomembranous colitis
1. D/C current antibiotic
2. Fluid and electrolyte balance
3. Oral vancomycin or metronidazole
121
CD4 count for AIDS
≤200
122
Normal CD4 count
500-1500
123
HIV Laboratory diagnosis
1. Look for antibodies against viral proteins
2. Presumptive Dx made with ELISA “RULE OUT test”
3. Positive results are then confirmed with Western blot assay “ RULE IN test”
4. HIV PCR / viral load tests
5. AIDS diagnosis £ 200 CD4 (N=500-1500)
124
During latent phase, HIV virus replicates in?
lymph node
125
Physical Examination in HIV
1. Low grade fever, night sweat, weight loss
2. Facial seborrhea
3. Diffuse lymphadenopathy (like Mono)
4. Splenomegaly
5. Oral candidiasis “thrush”
6. Herpes zoster infection
126
Clinical features of HIV
1. Asymptomatic
2. Persistent fevers and chill
3. Drenching night sweats
4. Fatigue, arthralgias, myalgias
5. Unintentional weight loss “HIV wasting syndrome”
6. Depression, apathy, as early signs of HIV-related encephalopathy
127
Bacterial Opportunistic infections in AIDS
−Tuberculosis, Mycobacterium avium-intracellulare
128
Virus Opportunistic infections in AIDS
−Herpes simplex, varicella-zoster virus, cytomegalovirus
129
Fungal Opportunistic infections in AIDS
−Thrush (candida) cryptococcosis , histoplasmosis, pneumocystis pneumonia
130
Protozan Opportunistic infections in AIDS
−Toxoplasmosis, cryptosporidiosis
131
Leading cause of death in HIV
Pneumocystis carinii
132
Most common complain in HIV
Fever
133
Most common finding with HIV patients presenting with headache, confusion and seizures
Toxoplasma -CT scan shows multiple ring-enhancing lesion
134
This drug is treatment for HIV patient presenting with headach and seizures
Pyrimethamine and sulfadiazine- lifelong
135
Diarhea in HIV patient caus be due to?
1. Cryptosporidium , microsporidium , giardia, E.histolytica
2. Colitis – CMV
3. Proctitis “ gay bowel syndrome” with treponema, HSV and gonorrhea
136
Fever in HIV patient
1. Most common complain
2. Blood culture should be drawn for bacteria, fungus, atypical mycobacterium (MAI) and CMV
3. Assume Lymphoma when organomegaly and marked lymphadenopathy present
137
Skin lesion in HIV patient
1. Pruritus and folliculitis common
2. Kaposi’s sarcoma–Nodular and dark purple lesions on head, neck, RT, GIT. Treat with interferon
138
This drug is used to treat Kaposi sarcoma in HIV
interferon
139
This drug is used to treat Candidal esophagitis “oral thrush” in HIV patients
fluconazole or ketokenazole
140
This drug is used to treat esophageal herpetic ulcers in HIV pts
acyclovir
141
This drug is used to treat Esophageal CMV ulcer ulcers in HIV pts
gancyclvir
142
This drug is used to treat Idiopathic HIV ulcer in HIV pts
oral prednisone
143
Dyspnea with progressive non-productive cough and diffuse interstitial infiltrates in a patient with HIV indicates?
a.Pneumocystis carinii pneumonia is leading cause of death
144
Causes of pulmonary distress in HIV
1. Pneumocystis carinii pneumonia is leading cause of death
2. Tuberculosis ( -ve tuberculin test)
3. Atypical mycobacteria – Mycobacterium Avium-Intracellulare (MAI)
4. Disseminated fungal disease (cryptococcus, histoplasma , coccidiodes)
145
CNS lesions in HIV
1. Toxoplasma
2. CNS lymphoma
3. HS encephalitis
4. CMV encephalitis
5. Mycobacterial or fungal brain abscesses
6. Cryptococcal meningitis
146
Headache and meningeal signs indicates
Cryptococcal meningitis
147
Dementia in HIV patient
1. Early HIV encephalopathy with depression and apathy
2. Paraparesis , incontinence and global dementia
148
This drug is used to treat blindness due to CMV retinitis in HIV patients
Gancyclovir
149
Hematological abnormalities in HIV
1. ITP like thrombocytopenia
2. Anemia of chronic disease
3. Lymphocytopenia
150
Reverse transcriptase inhibitor given for CD4\<500
Azidotheymidine (AZT)
151
HIV therapy
1. Azidotheymidine (AZT) with CD4 \< 500- Reverse transcriptase inhibitor
2. With CD4 \< 200 add pneumocystis prophylaxis- Trimethoprim-sulphamethoxazole
3. Vaccination for pneumococci, influenza and hepatitis
4. No live vaccine (polio, rubella) should be administered.
5. High risk of TB
152
Four Stages of Infection HIV:
1. Flu-like (acute)
2. Feeling Fine (Latent)
3. Falling Count
4. Final Crisis
153
Trismus
(lockjaw) involves spasms of the jaw muscle and clenching of the teeth
“Fixed smile” due to spasm of face muscles
154
Opisthotonus
involves muscle spasms that cause an arching of the back
155
how do we kill spores in hospital?
autoclave
heats 120-160 degrees celsius x 1 hour
156
diagnostic for c.diff?
Enterotoxins: Toxin A and Toxin B
157
treatment for pseudomembranous colitis / c.diff?
Oral Vanc or metronidazolej/flagyl
-dc current abx; fluid and electrolytes
158
