step 2 Flashcards
(59 cards)
management of mucormycoses infection
diabetic with nasal black eschar with bleeding
- amphotericin B + surgical debridement
patient with active tB, most accurate diagnostic test
mycobacterium culture of sputum
treatment for active TB
rifampicin, isoniazide, pyrazinamide, ethambutal for 6 months followed by isoniazid + rifampicin for 4 months
treatment for latent TB
isoniazid + rifampicin/rifapentine for 3 months or rifampicin for 4 months
side effects of the following medications;
- rifampicin
- isoniazid
- ethambutol
- pyrazinamide
rifampicin - liver impairment, orange urine
isoniazid - hepatitis, peripheral neuopathy, lupus like syndrome
ethambutol - optic neuritis
pyrazinamide - hyperuricaemia or hepatitis
what medication should you co-prescribe when giving isoniazid
pyridoxine (B6) to prevent peripheral neuropathy
mycobacterium avium can occur in HIV patients with a CD4 count of what
< 50
patients not on highly active anti retroviral therapy for HIV should recieve what prophylaxis against mycobacterium
azithromycin
antibiotics for mycobacterium avium infection
macrolide + ethambutol +/- rifabutin
what might be present on labs of a patient with PJP infection
elevated LDH
elevated beta-D-glucan
would should be added to treatment regimen in a patient with PJP and Pa02 < 70 or A-a gradient >35
steroid taper to reduce inflammation and improve mortality
alternative abx regimen (from co-trim) in severe PJP
pentamidine or primaquine + clindamycin
best initial treatment for anthrax
ciprofloxacin or doxycycline + 1 or 2 other antibiotics
14 days if inhalation or cutaneous of the head, face, neck
7-10 days if other cutaneous locations
if cutaneous anthrax - post exposure prophylaxis with ciprofloxacin to prevent inhalation anthrax should be continued for 60 days
describe centor criteria for acute pahryngitis
if 4 -5 points then start abx
if 2-3 then rapid antigen test
fever
pustular tonsils
tender anterior cervical lymphadenopathy
lack of cough
age 3-14 yrs
complication of retropharyngeal abscess presenting with fever, chest pain and dyspnoea
necrotizing mediastinitis
treat with surgical drainage
what is ludwig angina
rapidly progressive cellulitis of the submanidibular space that may cause airway compromise from oedema
presnets with red, warm mouth, dysphagia, drooling and fever
caused by polymicrobials in the setting of poor dental hygiene
treat with IV abx and airway management
light criteria for pleural effusion
pleural protein + serum protein > 0.5
pleural LDH + serum LDH >0.6
pleural LDH > 2/3 upper limit normal
if 1 or more criteria met = exudate
causes of exudate pleural effusion
meets 1 or more light criteria
caused by increased vascular permeability
- infection
- malignancy
- autoimmune
- drugs
- haemothorax, chylothorax
- left side: pancreatitis, esophageal rupture
- right side: meigs syndrome, endometriosis
causes of transudate pleural effusion
doesnt meet any light criteria
increased in hydrostatic pressure or PCWP;
- heart failure
- ESRF
- PE (early)
decrease in oncotic pressure
- nephrotic syndrome
- cirrhosis
how would pleural effusion present on physical examination
dullness to percussion
reduced breath sounds
reduced vocal resonance
PH transudate vs exudate pleural effusion
transudate 7.4 - 7.55
exudate < 7.4
CXR confirms left sided pleural effusion measuing 4cm. what is the next step?
thoracentesis
required if new effusion and is >1cm
not required if bilateral or signs of CHF
features of complicated parapneumonic effusion and empyema vs simple parapneumonic effusion
simple parapneumonic effusion: PH > 7.2, glucose normal/increased, clear fluid
complicated: PH < 7.2, glucose decreased, no positive culture , cloudy
empyema: PH < 7.2, glucose decreased, growth of sputum culture, purulent
complicated and empyema require drainage
what size of pnuemothorax requires only observaion and 02
2cm or less
