Infectious Diseases Flashcards Preview

MKSAP - Internal > Infectious Diseases > Flashcards

Flashcards in Infectious Diseases Deck (97)
Loading flashcards...

factitious fever - findings

young woman pt
fever diary - unusual fever patterns (very high or brief spikes), absent diurnal variation
rapid defervescence w/o chills


which drugs can cause malignant hyperthermia?

1. inhalational anesthetics - halothane, isoflurane, enflurane etc
2. depolarizing mm relaxants - succinylcholine, decamethonium


pt develops sustained muscle contractions, skeletal mm rigidity, elevated CK and acute renal failure, tachycardia, hypercarbia, hypertension, hyperthermia, tachypneas and cardiac arrhythmias a few hours after general anesthesia...diagnosis?

malignant hyperthermia


what can you suspect in a pt w/ a family history of problems during anesthesia?

risk of malignant hyperthermia


MC offending agents in neuroleptic malignant syndrome

haloperidol, fluphenazine
- can occur after all D2-receptor antagonists, usually soon after starting or with dose escalation


in whom has neuroleptic malignant syndrome been reported in?

Parkinson pts who abruptly discontinue levodopa or anticholinergic therapy


compared to neuroleptic malignant syndrome, what findings are unique to serotonin syndrome?



what is always next best step in septic pts with identified source of infection?

remove source of infection - indwelling catheters, drain abscess, surgical debridement


when can you use drotrecogin alfa (activated protein C)?

in severe sepsis or septic shock - APACHE score > 25 or two or more sepsis-induced organ dysfunctions (recently, shown to have no survival benefit, taken off market in 2011)


when should you consider using vasopressors in shock?

if fluid challenge fails to achieve a mean arterial pressure > 65 mmHg despite adequate fluid resuscitation (4-6L w/in 6 hours)


in pts with severe sepsis, what intervention will most likely improve survival?

aggressive fluid resuscitation w/ reduction of lactic acidosis w/in 6 hours


reasonable goals for fluid resuscitation (4)

1. SCVO2 atleast 70%
2. CVP of 8-12 mmHg
3. MAP > 65 mmHg
4. urine output atleast 0.5 ml/kg/hr


blood transfusion in shock pts?

transfusion threshold of 7g/dl is acceptable, conservative approach


for IV fluid resuscitation in shock, which is better...colloid or crystalloid solutions?

none - there is no benefit of one over the other


MC vasopressor used in septic shock

norepinephrine - potent vasocontrictor that reverses the endotoxin-induced vasodilation


role of Dopamine in shock

DA is a useful vasopressor - do not use low dose DA (no benefit on renal or other clinical outcomes)
s/e: tachycardia, arrhythmias


drotrecogin alfa (protein C) therapy should be considered in patients with the following criteria (3)

1. septic shock requiring vasopressors/fluids
2. sepsis-induced ARDS requiring mechanical ventilation
3. any two sepsis-damaged organs


diagnostic criteria for sepsis (2)

1. culture proven infection/visual ID of infection
2. evidence of systemic response to infection (fever, HR, RR, elevated WBC w/ immature band forms)


severe sepsis - definition

sepsis associated w/ organ dysfunction, hypoperfusion or hypotension


septic shock - definition

subset of severe sepsis; sepsis-induced hypotension despite adequate fluid resuscitation plus presence of perfusion abnormalities (i.e. lactic acidosis)


definition of SIRS (systemic inflammatory response syndrome)

atleast TWO of the following:
1. fever > 38 or < 36
2. HR > 90/min
3. RR > 20/min or PCO2 < 32 mmHg
4. WBC > 12000 or < 4000 or > 12% band forms


complications of untreated group A strep infection

peritonsillar abscess
poststreptococcal GN
rheumatic fever


pt presents with sore throat not improving on antibiotics, fever, dysphagia, pooling of saliva and drooling, muffled voice and deviation of uvula - probable diagnosis?

peritonsillar abscess


next best step if you suspect peritonsillar abscess?

emergency ENT consultation


treatment of peritonsillar abscess

needle drainage or surgical incision
antibiotics - ampicillin/sulbactam or parenteral penicillin G + metronidazole


can you recommend echinacea for prevention of URIs?

no - studies have failed to show consistent benefit


MCC of otitis media

strep.pneumo (followed by H.influenza and Staph aureus, Moraxella)


first line antibiotic for tx. of otitis media

- oral macrolides in penicillin allergic pts


if sx of otitis media do not improve w/in 48-72 hrs of amoxicillin use, what should you do?

initiate amoxicillin-clavulanate, cefuroxime or ceftriaxone


Centor criteria for pharyngitis

estimate the probability of presence of group A strep infection
1. fever
2. tonsillar exudates
3. tender anterior cervical LAD
4. absence of cough
- 0-1 points: no testing or tx
- 2 points: rapid strep test
- 3-4 points: throat culture if neg. rapid strep test; empiric ab therapy