Notes

Endocarditis

Etiology Acute S. aureus → Most common Normal valve IVDU → Tricuspid > Mitral > Aortic Pacemaker Strep pneumo Neisseria gonorrhoeae Subacute S. epidermis → Subacute in prosthetic valves, Pacemaker Viridans strep → Dental things, Respiratory biopsy Colonic pathology → if grows on culture → Perform Colonoscopy Strep bovis Clostridium septicum Eikenella...

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Urinary Tract Infection (UTI)

Etiology Organisms → SEEKS PP Serratia E coli → Most common Enterobacter Klebsiella S. saprophyticus Pseudomonas Proteus Defects Stone Stricture Tumor BPH Diabetes Foley Neurogenic bladder General Treatment Guidelines Pregnant (Asymptomatic bacteriuria or Symptomatic UTI) Amoxicillin → 3-7d Penicillin allergy → Nitrofurantoin Uncomplicated UTI TMP/SMX (if no CKD) Nitrofurantoin Fosfomycin Complicated...

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STDs

Urethritis Etiology Neisseria gonorrhea Chlamydia Mycoplasma genitalum Ureaplasma Presentation Dysurea Urethral discharge → Differentiate from cystitis Diagnosis Best initial → Urethral swab gram stain Intracellular diplococci → Gonorrhea NAAT → Nucleic acid amplification test ↑WBC Most accurate → Urethral culture Treatment Ceftriaxon (x1 IM) + Doxycycline (7d) Ceftriaxon (x1 IM) + Azithromycin (x1 PO)...

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Hepatitis

Acute Hepatitis Etiology Viral Hep B Hep C Hep D → Over Hep B Hep A → Food born Hep E → Food born, Pregnancy, Asians Drugs Alcohol Acetaminophen INH Methyldopa Presentation Jaudice Fever Weight loss Fatigue Dark urine Hepatosplenomegaly N/V Abdominal pain Diagnosis ↑ Direct bilirubin ↑ ALT > AST ↑...

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Infectious Diarrhea

Scombroid Fish poisoning Most rapid onset Wheezing, Flushing, Rash Treatment → Anihistamines Infectious Diarrhea Blood/WBC ⨁ Campylobacter Etiology Most common Food/Water Presentation Children/Young adults 7-10d Complication → Guillain-Barre Treatment → Ciprofloxacin, Azithromycin Salmonella Etiology Chicken, Egg Presentation Children/Elderly 2-5d Prodromal → Headache, Fever, Myalgia, Abdominal pain Complication Sepsis Sickle cell...

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Head/Neck Infections

Otitis Media Presentation Tympanic Redness Immobility → Most sensitive Bulging ↓ Light reflex Pain ↓Hearing Fever Diagnosis Most accurate → Tempanocentesis → Sample Recurrence No response to treatment Radiology is WRONG Treatment Best initial → Amoxicillin If no response Amoxicillin/clavulanate Azithromycin, Clarithromycin Cefuroxime Loracarbef Levofloxacin. Gemifloxacin, Moxifloxacin Sinusitis Etiology Acute (<1m) Viral S. pneumo...

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CNS Infections

Meningitis Etiology Viral Strep Pneumonia Group B H. Influenza Neisseria → Adolescent, Petechial rash Listeria → Immunocompromised Staph → After neurosurgery Cryptococcus → AIDS, High opening pressure Lyme → Camper, Tick, Target rash, Joint pain, Facial palsy Rickettsia → Camper, Tick, Rash from limbs to trunk TB → Pulmonary TB 0-6m 6m-6y 6-60y >60y GBS...

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Antibiotics

Beta-Lactams Penicillins Penicillin G, VK, Benzathine Ampicillin Amoxycillin H influenza E coli Listeria Proteus Salmonella Penicillinase-resistant penicillins Oxacillin Cloxacillin Dicloxacillin Nafcillin Piperacillin Ticarcillin Azlocillin Mezlocillin Cephalosporins 1st Gen Cefazolin Cephalexin Cephradrine Cefadroxyl 2nd Gen Cefotetan → Anaerobes Side effect → Bleeding, Disulfiram-like reaction Cefoxitin → Anaerobes Side effect → Bleeding, Disulfiram-like reaction Cefaclor → Respiratory infections...

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Doctor/Patient Relationship

Patient Not obligated to accept anyone Doctor can end doctor/patient relationship Must give patient enough time to find another doctor Small gifts not tied to a treatment request are ACCEPTABLE Romantic/sexual relationships are never acceptable Industry No gift is acceptable EVER Educational meals are not gifts and are acceptabe

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Confidentiality

Confidentiality CAN be broken if There is danger to others STDs HIV Airborne communicable disease (TB) Court order Confidentiality can NOT be broken for Employers HIV⨁ healthcare workers do NOT need to tell patients or employer Family Friends Government agencies Unless they have a warrant or subpoena from court

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Organ Donation

Payment for organ donation is unacceptable Payment for RENEWABLE organ donation is acceptable Sperm Eggs Consent for organ donation Physician can NOT ask for consent to donate organs Only organ donor network can ask Family can refuse donation even if patient has an organ donor card

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Consent

Consent Only adults can consent Each procedure needs individual consent Consent implied in emergency Person doing the procedure should get consent Telephone consent is valid Pregnant women can refuse treatment for unborn child For consent to be valid Adverse effects must be explained Alternatives must be explained Consequences of...

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