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most common cause of presence of visible blood in the stool days after eating food. what is the mechanism? STEC strain E. coli O157:H7 - vascular damage by producing a Shiga toxin
bloody stool, abdominal tenderness and leukocytosis, no fever - what organism? STEC strain E. coli O157:H7
symptoms occur less than 24 hours after ingestion - diarrhea, nausea, vomiting Bacillus cereus and Staphylococcus aureus toxins
foodborne gastroenteritis, stools are non bloody, and + fever - what organisms Campylobacter jejuni and Yersinia enterocolitica
most appropriate test to evaluate a possible tuberculous pleural effusion pleural fluid adenosine deaminase; > 70 units/L is highly specific for tuberculous effusion, whereas < 40 units/L all but excludes it
pleural fluid effusion has ADA > 70 - wtd. What if you do nothing? If pleural adenosine deaminase is elevated, empiric therapy for tuberculosis should be started and pleural biopsy should be performed; If left untreated, the effusion will resolve in 2-4mo, but then 65% will develop active TB in 5 years
how sensitive is a pleural fluid stain for acid fast bacilli if suspecting TB? how about a pleural fluid culture for acid fast bacilli? 5% and 24%. Don't use them. Use ADA instead.
how to tx bedbug bites topical steroids and antihistamines for symptomatic relief; will resolve spontaneously
ivermectin to treat what? parasites such as strongyloides and scabies, also topical shampoo for lice
first line to treat scabies permethrin
fever and constitutional symptoms 1 to 3 weeks after ingestion of contaminated food or water. Abdominal pain, cough, and chills, rose spot rash, faint salmon-colored macules on the trunk and abdomen, during the second week of illness. typhoid fever -The diagnosis is established by identifying Salmonella typhi in blood, urine, stool, or, occasionally, bone marrow.
pharyngitis and cervical lymphadenopathy. Malaise, headache, and low-grade fever often precede the development of these findings. Tender posterior cervical lymphadenopathy and generalized lymphadenopathy are common findings EBV - test with heterophile
if immunocompromised pt is exposed to varicella zoster active infection, what to do? how to monitor? immunocompromised or pregnant should receive a VZIG product or intravenous immune globulin within 96 hours of exposure. should be monitored for varicella for 28 days after exposure because the immune globulin may prolong the incubation period
what to recommend to a pt who gets recurrent UTI post coital The recommended prophylaxis against recurrent UTI is liberal fluid intake and postcoital voiding. Stop using spermicides. If this doesn't work, then post-coital cipro
Ceftaroline - what is it new β-lactam fifth-generation cephalosporin, works for MRSA and other aerobic and anaerobic gram-positive organisms and aerobic gram-negative bacteria, and it can be used for complicated soft tissue infections and community-acquired pneumonia.
ring enhancing brain lesions that are greater than 2.5 cm in diameter on neuroimaging - wtd should be excised or aspirated under CT guidance, sent for histology and culture
drug of choice for immunocompromised patients with invasive pulmonary aspergillosis Voriconazole
galactomannan antigen immunoassay non–culture-based method of diagnosing invasive aspergillosis
Standard treatment of the first time Clostridium difficile infection Oral metronidazole
Define severe Clostridium difficile infection. What to treat with? White blood cell count of 15,000 or greater, serum creatinine level greater than 1.5 times the baseline. Treat with oral vancomycin
Define complicated Clostridium difficile infection. What to treat with? Severe disease (15,000 WBC, serum creatinine >1.5 times baseline) as well as hypotension, ileum, megacolon. Treat with oral vancomycin and IV metronidazole.
When to switch a patient with chronic kidney disease from hydrochlorothiazide over to a Loop diuretic? When the patient is clinically volume overloaded and it looks like hydrochlorothiazide isn't working for them anymore
What is the formula for calculating the gap gap Expected bicarb = (calculated anion gap -12) + measured bicarb. Less than 22 means there is an additional non-gap metabolic acidosis; greater than 26 means there is an additional metabolic alkalosis.
Created by: christinapham