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Flashcards in Infectious Diseases Deck (97)
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1

factitious fever - findings

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

2

which drugs can cause malignant hyperthermia?

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

3

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

4

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

risk of malignant hyperthermia

5

MC offending agents in neuroleptic malignant syndrome

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

6

in whom has neuroleptic malignant syndrome been reported in?

Parkinson pts who abruptly discontinue levodopa or anticholinergic therapy

7

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

shivering
hyperreflexia
myoclonus
ataxia

8

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

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

9

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)

10

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)

11

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

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

12

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

13

blood transfusion in shock pts?

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

14

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

none - there is no benefit of one over the other

15

MC vasopressor used in septic shock

norepinephrine - potent vasocontrictor that reverses the endotoxin-induced vasodilation

16

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

17

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

18

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)

19

severe sepsis - definition

sepsis associated w/ organ dysfunction, hypoperfusion or hypotension

20

septic shock - definition

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

21

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

22

complications of untreated group A strep infection

peritonsillar abscess
poststreptococcal GN
rheumatic fever

23

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

24

next best step if you suspect peritonsillar abscess?

emergency ENT consultation

25

treatment of peritonsillar abscess

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

26

can you recommend echinacea for prevention of URIs?

no - studies have failed to show consistent benefit

27

MCC of otitis media

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

28

first line antibiotic for tx. of otitis media

amoxicillin
- oral macrolides in penicillin allergic pts

29

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

30

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