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Pseudogout associations
hemochromatosis, hyperparathyroidism, acromegaly, hypothyroidism
Gout crystals
negatively birefringent needles
Pseudogout crystals
positively birefringent needles
Vasculitis associated with chronic Hep B
polyarteritis nodosa
Vasculitis associated with chronic Hep C
cryoglobulinemia
Best blood test for polyarteritis nodosa
There is none. Get abdominal angiography first, then biopsy of muscle, skin, or sural nerve.
Churg-Strauss
vasculitis + eosinophilia + asthma
Takayasu\'s arteritis
young asian female with diminished pulses (usually preceeded by fatigue, weight loss, arthralgia, anemia, elevated ESR)
Best test for Takayasu\'s
aortic angiography or MRA
Bite cells on blood smear
G6PD
Burr/Spur cells on blood smear
liver disease
Acanthocytes on blood smear (looks like spur cell but with more rounded spurs)
liver disease, hypothyroidism, alcoholism
Basophilic stippling on blood smear
lead poisoning
Schistocytes on blood smear
TTP-HUS, DIC, prosthetic heart valve, malignant htn, sepsis
Target cells on blood smear
thalassemia, other hemoglobinopathies, liver disease
5 causes of microcytic anemia
iron deficiency, lead poisoning, anemia of chronic disease (but usually normocytic), thalassemia, sideroblastic anemia (can also have high MCV)
Antibody test for celiac disease
anti-endomysial, tissue transglutaminase (small bowel bx is best though)
Antibiotics for MRSA
IV: vanc, linezolid, daptomycin, tigecycline; if minor infection, can use oral: TMP/SMX, doxy, minocycline, or maybe clindamycin (there is inducible resistance to clinda though)
Antibiotics for MSSA
Oxacillin/nafcillin, dicloxacillin (IV and oral), cefazolin (IV), cephalexin (oral)
Can you use cephalosporins in pt allergic to PCN?
yes, if the rxn is rash only; no if pt has true anaphylaxis
Antibiotics to use for Staph with PCN allergy
cephalosporins if rash only; macrolides, clindamycin, vancomycin, linezolid, daptomycin, TMP/SMX
Antibiotics for strep
PCN, ampicillin, amoxicillin
Antibiotics for GNRs
Cephalosporins: cefepime, ceftazidime PCNs: piperacillin, ticaricillin Monobactam: Aztreonam Quinolones: cipro, levo, gati, moxi Aminoglycs: gentamicin, tobramycin, amikacin Carbapenems: imipenem, mero, erta
Limitation of ertapenem
does NOT cover pseudomonas
Piperacillin and ticarcillin
GNRs strep anaerobes
Carbapenems
good anaerobic coverage strep MSSA
Tigecycline
MRSA good GNR coverage
Anaerobes
-metronidazole is BEST for abdominal anaerobes (carbapenems, piperacillin, and ticarcillin have equal efficacy) -cefoxitin and cefotetan are the ONLY cephalosporins -respiratory anaerobes: clindamycin
Abx with NO anaerobic coverage
aminoglycs, aztreonam, fluoroquinolones, oxacillin/nafcillin, all cephalosporins EXCEPT cefoxitin and cefotetan
Red man syndrome
red, flushed skin from histamine release, associated with rapid infusion of vancomycin (so slow down the infusion rate)
Osteomyelitis
-most common is staph: oxacillin or nafcillin IV for 4-6 wks for MSSA; vanc, linezolid or dapto for MRSA -GNRs: salmonella or pseudomonas, can use orals, but must cx org. first and make sure it is sensitive (BONE bx and cx)
Cellulitis tx
-minor infection: oral dicloxacillin or cephalexin -severe: IV oxacillin, nafcillin or cefazolin -PCN allergy: if rash, then cephalosporin; if anaphylaxis, then vanc, linezolid, dapto (macrolides or clinda for minor infection)
Sequelae of strep infection
-throat: rheumatic fever AND glomerulonephritis -skin: ONLY glomerulonephritis
Gonorrhea tx
-ceftriaxone IM -cefixime oral -cefpodoxime oral -ciprofloxacin oral (2d line) -if pregnant, then ceftriaxone IM -ALSO treat for chlamydia
Chlamydia tx
-azithromycin (single dose) -doxycycline (for 1 wk) -if pregnant, then azithro -ALSO treat for gonorrhea
Recurrent gonorrhea associated with...
terminal complement deficiency (predisposes to any Neisseria infection)
PID tx
-outpatient: ceftriaxone (IM) and oral doxy -inpatient: cefoxitin or cefotetan IV + doxy + (maybe) metronidazole
Abx safe in pregnancy
-PCNs -cephalosporins -aztreonam -erythromycin -azithromycin
Epidydimo-orchitis tx
-if <35 yo, then ceftriaxone + doxy -if >35 yo, then fluoroquinolone
Chancroid
-PAINFUL ulcer caused by Hemophilus ducreyi -swab for gram stain and culture (on Nairobi medium or Mueller-Hinton agar) -treat with ceftriaxone IM or single dose azithromycin
What treats MRSA and VRE?
daptomycin
What binds toxin in gas gangrene?
clindamycin
Common bugs in dog bite
Capnocytophaga canimorsus (GNR) most common, Pasteurella multocida may be present in 25%, anaerobes
Bug that causes overwhelming sepsis in asplenics with dog bite
Capnocytophaga canimorsus
Typical bugs in cat bite
Pastuerella multocida, anaerobes
Typical bugs in reptile bite
Salmonella, Pseudomonas (snakes)
Treatment for animal bite
Amox/clavulanate PCN allergy: doxy OR TMP/SMX OR fluoroquinolone PLUS clinda for anaerobes Severe infxn: use IV (like unasyn) Duration: 3-5 days for prophy, 7-14 days for infection
Typical bugs in human bites
Eikenella corrodens, streptococci, staphylococci, Haemophilus species, and a multitude of anaerobes
Treatment for human bite
Same as animal bite but be careful tendons or bones not involved if clenched fist
Common bugs in diabetic foot ulcer
staphylococci, streptococci, enteric gram-negative rods, P. aeruginosa, and anaerobes
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