RE: LeoThread 2025-04-13 20:15

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Nearly endless #threadstorm of #medicine facts, based on notes from a question bank, starting below (check back to this same threadstorm for continuous updates)

leofinance
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  • PICC (peripherally inserted central catheters) can cause sepsis → if it’s a likely cause, remove it and administer systemic IV
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  • PICC line bacteria requiring removal → Staph aureus, Pseudomonas aeruginosa, drug-resistant G- bacilli, Candida
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  • Cefepime or piperacillin-tazobactam plus vancomycin can be used for broad-spectrum coverage until susceptibilities return; 7-10 days for uncomplicated infections with negative repeat blood culture;
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if gram-negative, vancomycin can be removed (daptomycin in case vancomycin-resistant)

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  • -penems can be used for critically ill patients or multidrug-resistant organisms
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  • Pharyngeal or genital gonorrhea (symptomatic or asymptomatic) is treated with ceftriaxone (single intramuscular dose); other cephalosporins are not recommended
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  • Chlamydia and gonorrhea are diagnosed via NAAT via urine sample
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  • Use ceftriaxone and doxycycline only if concomitant chlamydia is not excluded (chlamydia is treated with doxycycline, or if pregnant, azithromycin; 7 days)
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  • Chlamydia psittaci → interstitial pneumonia (interstitial infiltrates on CXR, fever, coughing) after exposure to birds / parrots; treat empirically with doxycycline, macrolides, or fluoroquinolones x 10-14 days
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  • Coxiella burnetii (Q fever) → pneumonia via aerosols inhaled from farm animals (cattle, sheep, goats)
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  • Hantavirus → severe cardiopulmonary distress (ARDS, thrombocytopenia, hemoconcentration), associated with rodent urine/feces
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  • Rhodococcus equi → G+ coccobacillus associated with horses, seen in immunocompromise / HIV; CXR shows pulmonary nodule or cavitary lesion
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  • Ventilator-associated pneumonia (VAP) requires empiric therapy for Staph aureus (MRSA), Pseudomonas aeruginosa, G- bacilli; treat empirically with Vancomycin + Zosyn if no risk factors for antimicrobial resistance
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  • Antibiotic-resistant organisms may be present in patients with recent IV abx use (within 90 days), prolonged hospitalization >5 days before diagnosis of VAP, septic shock,
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dialysis before VAP → use 2 antipseudomonal agents (i.e. B lactam + fluoroquinolone) plus vancomycin

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  • Ertapenem = G- activity, but not antipseudomonal + not effective against MRSA
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  • For monogamous HIV patients with undetectable viral load for 6+ months, no additional prophylaxis for the partner, nor or condom use, is indicated; just continue antiretroviral therapy
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  • PrEP (pre-exposure prophylaxis; 2 pills on day of exposure + 1 pill on each of subsequent 2 days) can be used if HIV positive individual is not on antiretroviral therapy or has a viral count
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  • Posttreatment Lyme disease syndrome (PTLDS) → continued nonspecific constitutional symptoms after treatment of Lyme disease (doxycycline x 10 days); manage with reassurance, supportive care, serial reevaluations
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  • Neurocognitive symptoms in PTLDS does not require lumbar puncture in absence of objective focal neurologic deficits
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  • Pulse oximetry measurements can be inaccurate if perfusion to the site of measurement is poor / vasocontriction (i.e. on a finger with someone with Raynaud phenomenon), skin pigmentation, nail polish, or motion →
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consider pulse oximetry measurements via earlobe

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  • Indications for arterial blood gas measurements (for measurement of arterial carbon dioxide): COPD/asthma exacerbations, mental status change, bicarbonate level changes, low expiratory volume, acute hypoxia
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  • For suspected occupational lung disease, clinician should obtain Safety Data Sheet from the workplace to identify the offending substance
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  • Acute occupational lung disease can present as reactive airway dysfunction (type of irritant-induced asthma) = 3+ months of wheezing, dyspnea,
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with airway testing showing decreased FEV1 (exhaled volume rate) and decreased FEV1/FVC ratio, both of which improve with a bronchodilator

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  • If FEV1 <60% or <1.5 liters in reactive airway, do NOT give methacholine challenge (high risk of excess bronchoconstriction)
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  • Suspected diffuse parenchymal lung disease (inspiratory dry crackles, bibasilar infiltrates, restrictive pattern = reduced lung volume, reduced CO2 diffusion capacity, normal FEV1/FVC)
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can be diagnosed and differentiated with high-resolution CT Chest

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  • Pulmonary embolism (and venous thromboembolism) in pregnant women should be treated with low molecular weight heparin; direct oral anticoagulants do cross the placenta but are not recommended because their effects in pregnancy are unknown
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  • Warfarin is not recommended in pregnancy except for patients with mechanical heart valves (dose <5 g daily) due to teratogenicity, spontaneous abortion, bleeding of the fetus, and neurodevelopmental delays
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  • Compared to low molecular weight heparin, heparin has higher risk of osteoporosis with fractures, thrombocytopenia, and requires more blood monitoring (via partial thromboplasmin time)
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  • Rapid respiratory deterioration can be initially assessed with bedside point of care thoracic ultrasonography to find pneumothorax, pleural effusion, heart failure, or pneumonia
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  • Paralytic cisatracurium can be used in acute respiratory distress syndrome (after pain control and sedation) to reduce movements, agitation, and asynchrony with the ventilator, thus
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decreasing ventilation-assiociated lung injuries, improving oxygenation, and reducing mortality

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  • Obesity hypoventilation syndrome +/- hypoxia due to other causes (look for obese patient with hypoxia + hypercapnia, able to follow commands) should be treated first with BiPAP first, then
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CPAP on an ambulatory basis after outpatient confirmatory testing for obstructive sleep apnea with polysomnography is completed

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  • Acute obesity hypoventilation syndrome with lack of wakeful state may require intubation (must be able to follow commands to use BiPAP)
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  • Acetazolamide can be used as adjuvant therapy for refractory obesity hypoventilation syndrome
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  • Roflumilast is an adjunct therapy for patients with recurrent COPD exacerbations and/or bronchitis-like symptoms, to be used with pulmonary rehabilitation (COPD severity group E based on GOLD criteria),
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when standard therapy with LABA (long-acting B agonist), LAMA (long acting muscarinic antagonist), and inhaled glucocorticoid are insufficient

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  • Horner Syndrome = ptosis of eyelid, miosis, anhidrosis
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  • Pancoast Syndrome = chest mass (usually non-small cell lung cancer in smokers) in superior sulcus on lung causing compression of nerves leading to Horner Syndrome + shoulder and arm pain with weakness and muscle atrophy;
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  • Suspected pancoast tumor should be evaluated first with a CT Chest, then with PET/CT with biopsy for definitive diagnosis
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  • Infected peripheral line with suspected sepsis → start treatment with empiric vancomycin; MRSA → continue vancomycin; MSSA → switch to cephalosporin or penicillinase-resistant pencillin (ie oxacillin)
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  • All confirmed staph aureus cases must undergo TTE; TEE may be skipped if the infection is uncomplicated with low risk of endocarditis
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  • Higher risk of endocarditis → mechanical heart valve, hemodialysis, repeat positive blood cultures, recurrent fever, signs of endocarditis, continued presence of focus of infection
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  • CAP (community-acquired pneumonia) with ongoing fever despite abx → insufficient antibiotic coverage or improper source controlled
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  • MRSA pneumonia can lead to empyemas and necrotizing pneumonias
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  • If secondary pneumonia is suspected (i.e. improves in hospitalization then worsens again), can broaden coverage (vancomycin + cefepime)
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  • First-time, non-severe clostridium dificile colitis (WBC <15k, Cr <1.5) can be treated with oral vancomycin or oral fidaxomycin; oral metronidazole is 2nd line if the prior tow are unavailable / allergy
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  • C diff risk factors → antibiotics, GI surgery, inflammatory bowel disease, chemotherapy, age, PPIs
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  • Fulminant c diff infection can be managed with oral vancomycin + IV metronidazole + surgery evaluation (fulminant = shock, ileus, megacolon)
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  • Recurrent c diff infections → consider fecal microbiota transplant
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  • Secondary syphilis (rash, systemic symptoms, LAD especially epitrochlear, high RPR titer) → single dose of IM benzathine penicillin; repeat testing in 6 + 12 months
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  • Late latent syphilis, or syphilis of unknown duration → 3 weekly IM injections of benzathine pencillin
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  • History of STD within the past year → doxycycline postexposure prophylaxis (200 mg one time within 72 hrs)
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  • Doxycycline and ceftriaxone can be considered for syphilis if there is a pencillin allergy, or neurosyphilis is present
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  • Necrotizing fasciitis of unknown origin → empiric treatment with vancomycin / daptomycin / linezolid + piperacillin-tazobactam / carbapenem / ceftriaxone with metronidazole / fluoroquinolone with metronidazole
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  • Vibrio vulnificus (associated with seafood or injury in seawater) necrotizing fasciitis (hemorrhaghic bullous lesions; G- bacillus) → ceftazidime + doxycycline
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  • MRSA toxic shock → vancomycin + clindamycin
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  • MSSA infection of prosthetic joint → nafcillin + rifampin
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  • GAS (strep pyogenes) → pencillin + clindamycin (pencillin alone works, but clinda also suppresses toxin production)
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  • Recurrent Neisseria infections (i.e. disseminated gonorrhea / arthritis, meningococcal meningitis) or Neisseria in multiple family members → test for terminal complement deficiency with hemolytic complement (CH50) level
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  • Terminal complement deficiency (membrane attack complex, C5 to C9) → gives conjugate + serogroup B meningococcal vaccines
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  • Idiopathic CD4 lymphopenia → increased risk for same opportunistic infections as in HIV/AIDS
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  • Selective IgA deficiency → recurrent sinus or pulmonary infections; most common primary immunodeficiency
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  • Blastomycosis → round budding yeast with broad base; primary pulmonary infection (can also have skin, bone, joint, urinary manifestations); Mississipi + Ohio River valleys; treat with -azole antifungal
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  • Coccidiodomycosis → spherules; primary pulmonary infection (can also have skin, meningeal, musculoskeletal manifestations); Central + South America + texas, Arizona, New Mexico
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  • Candida → G+ budding yeast cells / pseudohyphae; usually colonizers, not primary infection
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  • Mucormycosis → broad, nonseptate hyphae with acute-angle branches; immunocompromised patients (neutropenia, DM, acidosis); rhinocerebral, pulmonary, abd/GI/pelvic, primary cutaneous, disseminated forms
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  • Lyme disease (Borrelia burgdorferi) causing facial nerve palsy → treat with doxycycline (ceftriaxone can be used if meningoencephalitis or myelitis are present)
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  • Do NOT treat Lyme-induced facial nerve palsy with prednisone (shown to have no effect or detrimental effect → only use if Lyme is excluded)
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  • Lyme IgM + very early; IgG + after 4 weeks and negative IgG after this excludes Lyme
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  • Enterohemorrhagic E Coli (O157:H7) → Shiga toxin → hemolytic uremic syndrome → bloody diarrhea with low Hct, low PLT, high Cr (microangiopathic hemoyltic anemia, thrombocytopenia, kidney injury); undercooked burgers, lakes
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  • Cyclospora → tropical or subtropical fresh produce; oocysts; watery diarrhea
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  • Giardia lamblia → watery greasy foul-smelling diarrhea; cysts from infected animals into food/water
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  • Norovirus → watery diarrhea; most common gastroenteritis
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Hello there pretending. I don't know what's the plan here, but this obviously silly spam and reward harvesting.

Nothing personal. But I'm not cool with this. Put some effort, talk to people, you know... be SOCIAL.

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Hi Mr. Meno, it is not spam, these are my typed notes from medical texts. You may not find it valuable, but someone else did.

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I'm not sure a thread storm is the best way to share notes. Try a single long-form post people can actually reference, perhaps? But then again, how do your notes foster community engagement?

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