step 3(icbcc)

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  1. Cystitis
    Presents:Diagnosis: Treatment: 
    •  Presents:Urinary (Frequency, Urgency, Burning, Dysuria)
    • Ds: UA/UC (Elevated WBC's, Nitrates indicate G- infection, UC showing > 100,000 colonies per ml)
    • Rx:Uncomplicated: Give 3 days trimethoprim/sulfamethoxazole (aka Bactrim) or quinolone (floxacin drugs)Diabetes: Treat for 7 days** Do not use quinolones in pregnancy**
  2. Pyelonephritis
    • UTI Symptoms of frequency, urgency and dysuria plus flank pain and tenerness.
    • Diagnosis: UA/UC
    • Treatment: Outpatient treatment: Ciproloxacin
    • Inpatient treatment : ampicillin/getamicin
  3. Perinephric absccess
    Rare complication of pyelonephritis: Look for a patient who does not respond to tx after 5-7 days. Perform sonogram or CT to look for collection.Most accurate diagnostic test: BiopsyTx: quinolone (floxacin durgs) and add staph coverage with oxacillin of nafcillin
  4. Prostatitis
    • Presentation: Frequency, Urgency, Dysuria and perineal or sacral pain.
    • Exam: Tenderness and boginess of the prostate on DRE
    • Tx: Ciprofloxacin for an extended period of time
  5. Infective Endocarditis
    • Duke's Criteria (Meeting 2 major, 1 major and 3 minor, 5 minor)Fever + New Murmur = Do Blood Cultures. If Blood Cultures Positive = Echo to look for vegitations.
    • Diagnosis is made by 2 positive blood cultures and + Echo
    • Treatment: vancomycin and getamicin for 4-6 weeks** If cultures grow Strep Bovis do Colonoscopy***
  6. Endocarditis Prophylaxis
    • Cardiac Defects That Need Prophylaxis:- Prosthetic valves;-Unrepaired cyanotic heart dz;-Previous endocarditis;-Transplant patients who develop valve dz
    • Procedures that Need Prophylaxis- Dental procedures that cause bleeding (amoxicillin)- Respiratory Tract surgery- Surgery on infected skin
  7. HIV/AIDS Management #1
    When To Start HAART Therapy:- CD4 Count < 350- Symptomatic patients with any CD4 count or viral load- Pregnant Women (- If pt already on HAART continue therapy- If found to be HIV positive (1. CD4 <500 start HAART, 2. CD 4 > 500 and viral load low Use HAART 2nd and 3rd tri)- Needle stick scenario where patient is known to be HIV positive (HAART for a month)
  8. HIV Med Side Effects: NRTI
    Zidovudine - Luekopenia, anemia, GI side effectsDidanosine - Pancreatitis, peripheral neuropathyStavudine - Peripheral neuropathyLamivudine - NoneEmtricitabine - few side effectsAbacavir - Hypersentitivity that occurs in first 6 weeks (rash, fever, nausea/vomiting - stop medication and never restarted)Zalcitabine - Pancreatitis, peripheral neuropathy, lactic acidosis
  9. HIV Med Side Effects: Protease Inhibitors
    • Hyperlipidemia, hyperglycemia and elevated liver enzymes for all
    • Nelfinavir - GI
    • Indinavir - Nephrolithiasis,hyperbilirubinemia
    • Ritonivir - Severe GI
    • Saquinavir - GI
    • Lopinavir/Ritonavir - Diarrhea
    • Atazanavir - Diarrhea
  10. HIV Med Side Effects: NNRTI
    • Efavirenz**** Contraindicated in pregnancy
    • Nevirapine - Rash, hetatotoxicity
    • Delavirdine - Rash
  11. HIV Prophylaxis
    • PCP Pneumonia (CD4 < 200)- TMP/SMX (Bactrim)
    • -If rash with Bactrim switch to atovoquone or dapsone
    • Mycobacterium Avium Intracellulare ( CD4 < 50)- Azithromycin once a week orally
  12. HIV Infections: PCP Pneumonia
    • Symptoms: Dyspnea, dry cough, hypoxia, increased LDH
    • Get: Chest x-ray increased interstitial markings bilaterally
    • Most Accurate Test: Bronchoalveolar lavage
    • Treatment: IV TMP/SMX (Bactrim) or IV PentamidineIf severe then give steriods
  13. HIV Infections: Toxoplasmosis
    • Look for headache, nausea, and vomiting and focal neurologic findings
    • - Best initial test: head CT with contrast showing "ring" or contrast enhancing lesions
    • Tx: Pyrimethamine and sulfadiazine for 2 weeks and then repeat the CT scan. If lesions unchanged in size or bigger then do biopsy and is most likely lymphoma.
  14. HIV Infections: Cytomegalovirus
    • HIV with CD4 < 50 and blurry vision.
    • Perform optho exam
    • Tx: ganciclovir or foscarnetLifelong maintenance therapy with oral valganciclovir unless CD4 goes up with HAART
  15. HIV Infections: Cryptococcus
    • HIV and CD4 < 50 with fever and headache.
    • Diagnosis: Perform LP looking for increased lymphocytes in CSF.
    • Diagnosis: Best Initial is India Ink Stain, most specific is cryptococcal antigen test
    • Tx: Amphotericin followed by fluconazole.
  16. HIV Complication: Progressive Multifocal Leukoenchephalopthay
    • HIV and CD4 < 50 cells and focal neurological abnormalities
    • Best Initial Test: Head CT or MRI with lesions that do not show ring enhancement and no mass effect.
    • Tx: No specific therapy, treat with HAART
  17. HIV Infections: Mycobacterium Avium Intracellulare
    • HIV and CD < 50. Weight loss, fever and fatigue. Anemia.
    • Diagnostic testing: Bone marrow is more sensitive.
    • Liver Biopsy is the most sensitive and blood culture is least sensitiive
    • Tx: clarithromycin and ethambutol
  18. Animal Borne Dz: Leptospirosis
    • A spirochete (causes Animal + Jaundice + Renal)
    • Symptoms: Fever, abdominal pain, muscle aches
    • Diagnose with serology (looking for antibodies in the blood)
    • Tx: Ceftriaxone or penicillin
  19. Animal Borne Dz: Tularemia
    • Transmission: Rabbits
    • Ulcer at the site of contacts and enlarged lymph nodes. May also have conjunctivitis.
    • Diagnosis: Serology
  20. Animal Borne Dz: Cysticercosis
    • Transmitted from infected pork (Mexico, South America, Eastern Europe, India)
    • CT scan of the head will show thin-walled cysts which are most often calcified. 
    • Tx: Albendazole
  21. Tick-Borne Disease: Lyme Dz
    • Recent camper or hiker
    • erythema migrans with bulls eye rash
    • caused by Borrelia burgdorferi
    • Tx with doxycycline history and rash is enough for treatment. A but rash must be 5 cm wide or bigger.
    • Long Term Comlications- Joint, Cardiac, Nerulogical (Specifically 7th nerve palsy)
  22. Babesiossis
    • Same tick vector as lyme dz- manifests with hemolytic anemia and is severe in asplenic individuals
    • Dx: Peripheral smear looking for tetrads of intraerythrocytic rings or do PCR
  23. Ehrlichia
    • Same tick vector as lyme dz
    • - Elevated LFT's, thrombocytopenia and leukopenia
    • Dx: peripheral smear looking for "morulae"
    • Tx: doxycycline
  24. Malaria
    Look for a traveler who presents with hemolysis
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step 3(icbcc)
2013-01-12 22:43:29

infectious dzs
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