Brief Summary
This video covers high-yield infectious disease topics and provides answers to common exam questions. It focuses on various conditions, their causes, symptoms, diagnosis, and treatment. The video also includes explanations of important concepts like serologic tests for Hepatitis B, toxic shock syndrome, and pulmonary embolism.
- Key points include: Empiric treatment for human bite wounds, causative microorganism in an alcoholic sailor with high-grade fever, common causes of secondary bacterial pneumonia, diagnosis and treatment of splenic abscess, most frequently involved heart valve in bacterial endocarditis, common symptom of bacterial endocarditis, diagnosis and treatment of echinococcus granulosus infection, serologic test results in vaccinated and naturally immunized patients against Hepatitis B, diagnosis and treatment of disseminated gonococcal infection, diagnosis of mucor mycosis, diagnosis and treatment of viral encephalitis, recommended catheterization for patients with neurogenic bladder, causative organism in osteomyelitis after stepping on a rusty nail, treatment of Legionnaires' disease, management of subclinical hepatotoxicity during TB treatment, next step in management for suspected ventilator-associated pneumonia, diagnosis of disseminated Mycobacterium avium complex infection, management of dysphagia and substernal burning in HIV patients, interpretation of serologic tests for Hepatitis B, treatment of toxic shock syndrome, diagnosis and treatment of vertebral osteomyelitis, treatment of syphilis in pregnant patients with penicillin allergy, diagnosis and treatment of chronic bacterial prostatitis, diagnosis and treatment of invasive aspergillosis, treatment of cryptococcal meningoencephalitis, causative organism of perfused water diarrhea, treatment of croup, pathogens causing croup and epiglottitis, treatment of pyelonephritis in pregnant patients, treatment of uncomplicated outpatient and inpatient pyelonephritis, contraindications for breastfeeding, treatment of confirmed gonorrhea infection, condition indicated by a positive tourniquet test, prognostic marker for primary CNS lymphoma, next step in management for positive HCB antibodies, prophylactic medication for high-dose immunosuppression therapy, treatment of uncomplicated outpatient and inpatient community-acquired pneumonia, treatment of strep throat, situation where patients are infected with Pasteurella, treatment of acute bacterial rhinosinusitis, treatment of breastfeeding patient with Trichomonas vaginalis, next best step in ongoing dysuria despite azithromycin for non-gonococcal urethritis, diagnosis of cystitis with terminal hematuria and peripheral eosinophilia, confirming endotracheal tube placement, treatment of tension pneumothorax and simple pneumothorax, condition causing acute perioperative hypercapnic and hypoxic respiratory failure, organ most commonly causing laryngotracheaitis, treatment of laryngotracheaitis, organism causing bronchiolitis, prevention and treatment of bronchiolitis, most likely cause of recurrent pneumonia in an elderly smoker, best confirmatory test for recurrent pneumonia in an elderly smoker, diagnostic test of choice in a patient with renal failure and a modified Wells score greater than 4, asymptomatic asthma patients and abnormal PFTs, lung cancer associated with SIADH, next step in management for positive HCB antibodies, treatment of post-extubation stridor, predictors of 30-day mortality in pulmonary embolism, indication for inferior vena cava filter in a patient with pulmonary embolism, management of pulmonary embolism, risk factors for post-intensive care syndrome, management of post-intensive care syndrome, diagnosis and treatment of pulmonary contusions, guidelines for lung cancer screening, management of asthma patients based on pulmonary function test results, diagnostic criteria for ABPA, greatest risk factor for developing post-operative pulmonary complications, effect of atelectasis on A-a gradient, diagnostic features of tuberculosis pleural effusions, indications for glucocorticoid cessation, stop-bang survey for OSA, drug of choice in a patient with PE, most likely diagnosis of non-resolution of pneumonia in a patient with extensive smoking history, treatment of choice of acute bronchitis, signs of COPD exacerbation, diagnostic test of choice in an unstable patient with a suspected massive PE, Echo findings in a patient with a massive acute PE, decoupling in organ donation, lab tests done before and after initiation of TPN, major cause of hypoxemia in patients with COPD, popcorn calcifications or hamartomas, management of newborns with TTN, best initial steps in treating patients with isolated habitual snoring, diagnosis of painless hematochezia in a 2-year-old with a positive technetium 99m scan, location of technetium 99m concentration in patients with Meckel's diverticulum, treatment of choice of a pregnant patient with incidentally found gallstones, treatment of choice of a pregnant patient with symptoms of recurrent biliary colic or acute cholecystitis, treatment of an anal abscess, condition patients with anal abscesses are at greatest risk of developing, organism causing perfused water diarrhea due to germination of spores, condition resulting from injury to the vagus nerve during gastric surgery, next best step in a patient that swallowed a fish bone, first-line treatment for GERD in an infant with appropriate weight gain, diagnostic test of choice for pyloric stenosis, diagnosis of very umbilical abdominal pain and diarrhea after eating ice cream, diagnostic test of choice for pyloric stenosis, diagnosis of very umbilical abdominal pain and diarrhea after eating ice cream, next best step in a breastfed infant with FPIA, first step in a formula-fed infant with FPIA, prognosis for patients with FPIA, next best step in a patient with inconclusive ultrasound findings for acute cholecystitis, condition causing isolated gastric varices and left-sided partial hypertension and congestive splenomegaly, best next step in establishing a diagnosis of acute pancreatitis, next best step in management of a patient with clinical features of acute pancreatitis, elevated lipase, and normal abdominal ultrasound, diagnosis of a patient being treated for acute pancreatitis who develops fever, leukocytosis, hypotension, and right upper quadrant abdominal pain, standard composition of Angel feeding, best diagnostic test in a patient with rapid onset very umbilical pain, benign exam findings, anionic gap metabolic acidosis, and a recent MI, artery most commonly occluded in AMI or acute mesenteric ischemia, antihypertensives that can cause pancreatitis, underlying cause of eosinophilic esophagitis, treatment of choice for eosinophilic esophagitis, first step in management of infectious gastroenteritis, vitamin deficiencies seen in small intestinal bacterial overgrowth, diagnostic tests for SIBO, treatment of choice for SIBO, risk factors for SIBO, CT scan findings in a patient with colonic ischemia, first step in evaluation and management of chronic diarrhea, other tests to investigate the cause of chronic diarrhea, type of anemia most commonly seen in Celiac disease, stool osmotic gap in Celiac disease, GI endoscopy with biopsy findings in a patient with Celiac disease, diagnosis of a patient with a history of GERD who presents with dysphagia to solids, management of a patient with Celiac disease, most likely diagnosis in a patient with cirrhosis, mental status changes, and diffuse abdominal pain, how the following would be affected in a patient with SBP, next best step in management of a patient diagnosed with SBP, most likely diagnosis in a 62-year-old with occult GI bleeding and a small cherry red lesion seen on colonoscopy, conditions with higher bleeding rates in patients with angio dysplasia, reason insulin can be used to treat elevated triglyceride levels associated with pancreatitis, most commonly used calculation to predict 90-day mortality in patients with liver disease, values used to calculate the MELD score, most likely complication in a patient hospitalized due to a variceal bleed, management of patients with a variceal bleed, most common cause of ascites in the United States, how to calculate the SAAG gradient, condition indicated by a SAAG greater than 1.1, conditions associated with a SAAG greater than 1.1, conditions associated with a SAAG less than 1.1, tests done after 4 weeks of treatment to confirm H. pylori eradication, drugs most commonly used in triple therapy for H. pylori, true or false: breastfed infants have decreased stool frequency after the first month of life, electrolyte imbalances that facilitate hepatic encephalopathy precipitation, frequency of colonoscopy for patients with FAP, time frame for a second-look colonoscopy after piecemeal removal of polyps, time frame for repeat colonoscopy for certain polyp types, stimulant drugs used to treat ADHD, treatment of choice for leptospirosis, drugs of choice for endometriosis, antitussive that is a codeine analog and may cause serotonin syndrome, drugs that can cause digitalis toxicity, theoretic that can worsen or cause gout, drug that is a mucolytic and an antidote for acetaminophen overdose, condition that can present after 6 days of phenylephrine, drugs that can cause agranulocytosis, drugs that can cause photosensitivity, first-line treatment for bulimia, herbal supplements that can increase the risk of bleeding, antidiabetic that should be held before doing a CT with contrast, drug used in the management of chronic myeloid leukemia, antidote for warfarin, drug of choice for leishmaniasis, drugs that can cause pulmonary fibrosis, treatment of choice for pertussis, drugs that can cause drug-induced parkinsonism, first-line treatment for trigeminal neuralgia, antihypertensive agents safe to be used during pregnancy, signs of phenytoin toxicity, antianginal agent used to treat chronic exertional angina refractory to conventional medical therapy, management of HIT, treatment of choice for pyelonephritis, antidiabetic drugs that increase the risk of UTIs, first-line treatment for malignant hyperthermia, possible side effect of using statins and fibrates, treatment of choice for mastitis, treatment of choice for carcinoid syndrome, treatment of choice for close contacts of meningitis patients, drugs that can cause weight loss, treatment of choice for a UTI in a pregnant patient, treatment of a patient presenting with clinical features of beta-blocker overdose, treatment of choice for otitis externa, vaccine patients who take eculizumab should receive, mechanism of action of vincristine, treatment of choice for otitis media, class of drugs that cause cartilage damage, administration of sodium nitroprusside can cause the accumulation of what element, treatment of methemoglobinemia, first-line treatment for toxoplasmosis, potential side effect of using fibric acid derivatives and bile acid binding resins, next best step in a patient who is in anaphylactic shock and unresponsive to their first dose of epinephrine, early signs of toxicity with digoxin, treatment of choice for histoplasmosis, blastomycosis, sporotrichosis, and coccidiomycosis, antiretroviral that causes vivid dreams, treatment of choice for Entamoeba histolytica, is doxylamine more sedating than desloratadine, drug of choice for nightmares and PTSD, next best step in management of a patient with a breast biopsy that reveals LCIS, first-line therapy for premenstrual syndrome and premenstrual dysphoric disorder, patients with PMDD and PMS are at increased risk of developing which condition, most effective contraceptive method, diagnosis of a premenopausal woman with unilateral bloody nipple discharge, best breast imaging for a 31-year-old woman with a breast lump, when is nipple discharge considered pathologic, diagnosis of a 32-year-old female with maternal hot flashes, high FSH, low estrogen, and a negative pregnancy test, next step in management if a pap smear reveals HSIL, most common cause of irregular menstrual bleeding in adolescence, most common side effect of combined OCPs, first-line management for vulvodynia, condition presenting with monorail hypoestrogenism and a low BMI, risk factor associated with the highest increase in the risk of pelvic inflammatory disease, next best step in management of a patient with urge incontinence that does not improve with lifestyle modifications, true or false: left-sided ovarian torsion is more common, drugs that reduce the efficacy of OCPs, mechanism of action of ovulation induction agents letrozole and clomiphene, contraindications for progestin-releasing IUDs, contraindications for copper IUDs, post-exposure prophylaxis for syphilis, first step in infertility evaluation, screening recommendation for an 18-year-old sexually active woman, substance causing abdominal pain in primary dysmenorrhea, diagnosis of a postmenopausal woman with new onset pelvic pressure, uterine mass, and ascites, risk factors for gestational trophoblastic neoplasia, treatment of choice for vulvar lichen sclerosis, type of headache that is an absolute contraindication for combined OCPs, first-line contraceptive method for adolescence, diagnosis of an adolescent female with a single unilateral rubbery breast mass, treatment of choice for acute uterine bleeding in a hemodynamically stable patient, age cervical cancer screening is started in an immunocompetent sexually active woman, diagnosis of a patient two weeks post-hysterectomy with painless continuous clear vaginal discharge, first-line management for patients with symptomatic leiomyomas who wish to preserve fertility, diagnosis of a patient who received HCG treatment one week ago and presents with nausea, vomiting, abdominal pain, ascites, and bilaterally enlarged ovaries, vaginal pessary used to treat stress incontinence or pelvic organ prolapse, risk factors for vulvar cancer, age puberty is considered delayed in boys, age puberty is considered delayed in girls, condition associated with a delayed bone age on x-ray of the wrist, age patients with cryptorchidism should be referred for surgery, complications of cryptorchidism, initial test of choice for evaluating a testicular mass, management of a patient with a solid testicular mass, management of patients with balanitis, diabetes screen for a candidal infection, best way to assess for testicular injury, reflex classically absent in testicular torsion, age group prostate cancer screening is not recommended, benefits of neonatal circumcision, most frequent complication of TURP, management of priapism lasting greater than 4 hours, risk of which condition remains increased after orchopexy, how chronic prostatitis presents, treatment of chronic prostatitis or chronic pelvic pain syndrome, diagnosis of an African-American patient presenting with dark urine that stains positive with a Prussian blue stain, underlying cause of microcytic anemia in a patient with chronic kidney disease, most appropriate screening test in a preconception patient with a family history of thalassemia, way to distinguish between iron deficiency anemia and thalassemia, causes of iron deficiency anemia in young children, first marker of improvement after iron supplementation for iron deficiency anemia, hematologic pathology characterized by normocytic anemia with a low reticulocyte count in preterm infants, underlying cause of anemia in a patient with a history of gastrectomy, hematologic pathology characterized by normocytic anemia with a low reticulocyte count in preterm infants, underlying cause of anemia in a patient with a history of gastrectomy, recommended anticoagulation for a pulmonary embolism in a patient with severe renal insufficiency, class of anticoagulants used to treat HIT, treatment of tumor lysis syndrome, high red blood cell distribution, elevated MCHC, common symptoms of polycythemia, treatment of symptomatic neonates with polycythemia, recommended pharmacologic treatment for patients with cancer-related anorexia-cachexia syndrome, syndrome indicative of a vascular tumor and consumptive thrombocytopenia, exertional hemoglobinuria, how neoplastic cells appear on a PET scan with FDG, common complications of sickle cell disease, diagnosis of a child with a history of sickle cell disease presenting with hypovolemic shock, drug useful in the treatment of sickle cell anemia, most common cause of a pediatric stroke, most common cause of sepsis in patients with sickle cell disease, treatment of sepsis in patients with sickle cell disease, condition presenting at age 6 months to 4 years with acute onset of pain and symmetric swelling of the hands and feet, kidney impairment in patients with sickle cell disease, risk of sepsis in patients with splenectomy, most common complication of sickle cell trait, complications of chronic hemolytic anemia in sickle cell patients, treatment of severe vasoocclusive pain in patients with sickle cell disease, appropriate opioid for a child with a vasoocclusive crisis, diagnosis of a 5-day-old baby who did not receive perinatal care, diagnosis of an alcoholic patient bleeding from an IV site, screening tests for an elderly patient with chronic arm pain, anemia, and back pain, imaging performed for a patient diagnosed with multiple myeloma, diagnosis of a patient with a past medical history of Hodgkin lymphoma, diagnosis of a child with a family history of anemia, diagnosis of a child with scattered petechiae, isolated thrombocytopenia, and enlarged platelets, treatment of ITP, viruses to test for in an asymptomatic patient with idiopathic thrombocytopenic purpura, treatment of acute bleed in a patient with inhibitor development, presentation of TTP, treatment of TTP, presentation of acute iron poisoning, treatment of acute iron poisoning, most common cause of ascites in the United States, how to calculate the SAAG gradient, condition indicated by a SAAG greater than 1.1, conditions associated with a SAAG greater than 1.1, conditions associated with a SAAG less than 1.1, tests done after 4 weeks of treatment to confirm H. pylori eradication, drugs most commonly used in triple therapy for H. pylori, true or false: breastfed infants have decreased stool frequency after the first month of life, electrolyte imbalances that facilitate hepatic encephalopathy precipitation, frequency of colonoscopy for patients with FAP, time frame for a second-look colonoscopy after piecemeal removal of polyps, time frame for repeat colonoscopy for certain polyp types, stimulant drugs used to treat ADHD, treatment of choice for leptospirosis, drugs of choice for endometriosis, antitussive that is a codeine analog and may cause serotonin syndrome, drugs that can cause digitalis toxicity, theoretic that can worsen or cause gout, drug that is a mucolytic and an antidote for acetaminophen overdose, condition that can present after 6 days of phenylephrine, drugs that can cause agranulocytosis, drugs that can cause photosensitivity, first-line treatment for bulimia, herbal supplements that can increase the risk of bleeding, antidiabetic that should be held before doing a CT with contrast, drug used in the management of chronic myeloid leukemia, antidote for warfarin, drug of choice for leishmaniasis, drugs that can cause pulmonary fibrosis, treatment of choice for pertussis, drugs that can cause drug-induced parkinsonism, first-line treatment for trigeminal neuralgia, antihypertensive agents safe to be used during pregnancy, signs of phenytoin toxicity, antianginal agent used to treat chronic exertional angina refractory to conventional medical therapy, management of HIT, treatment of choice for pyelonephritis, antidiabetic drugs that increase the risk of UTIs, first-line treatment for malignant hyperthermia, possible side effect of using statins and fibrates, treatment of choice for mastitis, treatment of choice for carcinoid syndrome, treatment of choice for close contacts of meningitis patients, drugs that can cause weight loss, treatment of choice for a UTI in a pregnant patient, treatment of a patient presenting with clinical features of beta-blocker overdose, treatment of choice for otitis externa, vaccine patients who take eculizumab should receive, mechanism of action of vincristine, treatment of choice for otitis media, class of drugs that cause cartilage damage, administration of sodium nitroprusside can cause the accumulation of what element, treatment of methemoglobinemia, first-line treatment for toxoplasmosis, potential side effect of using fibric acid derivatives and bile acid binding resins, next best step in a patient who is in anaphylactic shock and unresponsive to their first dose of epinephrine, early signs of toxicity with digoxin, treatment of choice for histoplasmosis, blastomycosis, sporotrichosis, and coccidiomycosis, antiretroviral that causes vivid dreams, treatment of choice for Entamoeba histolytica, is doxylamine more sedating than desloratadine, drug of choice for nightmares and PTSD.
Human Bite Wounds
Human bite wounds are typically polymicrobial, containing both anaerobic and aerobic organisms. The recommended empiric treatment is Augmentin. These wounds are usually left open to drain and heal by secondary intention due to the increased risk of infection with closure.
Causative Microorganism in Alcoholic Sailor
An alcoholic sailor who develops a high-grade fever, erythema, and streaking erythema extending up the limb after cutting his foot while sailing in the ocean is likely infected with Vibrio vulnificus. This bacterium is found in marine environments and can cause severe disease, including rapidly progressive septicemia and necrotizing fasciitis. Infection is particularly common in patients with liver disease.
Secondary Bacterial Pneumonia
The two most common causes of secondary bacterial pneumonia are Streptococcus pneumoniae and Staphylococcus aureus. Patients typically present with worsening fever and pulmonary symptoms after initial symptomatic improvements.
Splenic Abscess
A patient with recently diagnosed infective endocarditis who presents with fever, left-sided chest or abdominal pain, left-sided pleural effusion, splenomegaly, and a splenic fluid collection on CT scan is likely suffering from a splenic abscess secondary to infective endocarditis. Splenic abscesses usually present with chills, fever, leukocytosis, and left upper quadrant abdominal pain. Treatment involves antibiotics and a splenectomy.
Bacterial Endocarditis
The mitral valve is the most frequently involved heart valve in bacterial endocarditis. In IV drug users, the tricuspid valve is most commonly affected, often associated with organisms like Staphylococcus aureus, Pseudomonas, and Candida. The most common symptom of bacterial endocarditis is fever. You can remember the signs and symptoms of bacterial endocarditis with the mnemonic "FROM JANE": Fever, Roth spots, Osler nodes, Murmur, Janeway lesions, Anemia, Nail bed hemorrhages, Emboli.
Echinococcus Granulosus Infection
A febrile farmer with right upper quadrant pain and a smooth round hepatic cyst with septations and eggshell calcifications on ultrasound is likely suffering from an Echinococcus granulosus infection. Patients with this infection can present with a lack of fever and cystic lesions. However, for an infection with Entamoeba histolytica, patients would be febrile with a smooth cystic subcapsular mass.
Hepatitis B Serologic Tests
This section explains how to interpret serologic tests for Hepatitis B. Remember the phrase "Antigens make you sick and easily spread the disease." Hepatitis B surface antigen indicates an active infection, while the E antigen signifies easy spread of the disease. Antibodies are the opposite of antigens. The surface antibody means you are immune, while the E antibody indicates low transmissibility. The core antibody signifies previous exposure to Hepatitis B.
Hepatitis B Serologic Test Results
This section provides a detailed explanation of the different serologic test results for Hepatitis B, including vaccinated, naturally immunized, and chronically infected patients. It emphasizes the importance of understanding the difference between antigens and antibodies and how they relate to the different stages of Hepatitis B infection.
Toxic Shock Syndrome
A hemodynamically unstable patient presenting with fever, vomiting, and a diffuse confluent macular papular rash on the trunk and extremities, who recently had anterior nasal packing for a nosebleed, is likely suffering from toxic shock syndrome. Staphylococcus aureus is the most common organism involved.
Vertebral Osteomyelitis
A patient with a recent UTI presenting with fever, back pain, focal tenderness over the L4-L5 vertebrae, and paravertebral muscle spasm is likely suffering from vertebral osteomyelitis. This can occur due to hematogenous spread of a UTI. Initial workup includes CBC, blood cultures, ESR, CRP, and plain spinal x-rays or MRI.
Syphilis in Pregnancy
The treatment of choice for syphilis in a pregnant patient with a penicillin allergy is intramuscular penicillin G. The patient needs to be desensitized to penicillin, as it is the preferred treatment for syphilis, even during pregnancy, regardless of drug allergies.
Chronic Bacterial Prostatitis
A patient presenting with recurrent UTIs for more than three months, transient improvement with antibiotics, and painful ejaculation, with urine culture showing E. coli, is likely suffering from chronic bacterial prostatitis. Treatment involves six weeks of fluoroquinolones or TMP-SMX.
Invasive Aspergillosis
An immunocompromised patient with fever, pleuritic chest pain, cough with hemoptysis, and CT showing cavitary nodules with surrounding ground-glass opacities is likely suffering from invasive aspergillosis. The treatment of choice is IV voriconazole.
Cryptococcal Meningoencephalitis
The recommended treatment for cryptococcal meningoencephalitis is amphotericin B plus flucytosine for more than two weeks until the patient is asymptomatic and has a negative CSF. After this, fluconazole should be given for more than a year.
Croup
Croup is most commonly caused by the parainfluenza virus. Patients typically present with inspiratory stridor, a barking cough, and hoarseness. Treatment depends on the severity of stridor. Mild cases without stridor at rest are treated with humidified air and possibly steroids. Moderate to severe cases with stridor at rest require steroids and nebulized epinephrine.
Epiglottitis
Epiglottitis is most commonly caused by Haemophilus influenzae. However, due to the Hib vaccine, other organisms can now cause this condition.
Pyelonephritis in Pregnancy
The treatment of choice for pyelonephritis in pregnant patients is IV ceftriaxone. While cephalexin and fosfomycin can be used, fluoroquinolones are contraindicated due to their teratogenic effects.
Uncomplicated Pyelonephritis
For uncomplicated outpatient pyelonephritis, oral fluoroquinolones like ciprofloxacin can be given. However, for uncomplicated inpatient pyelonephritis, IV ceftriaxone is preferred.
Contraindications for Breastfeeding
Breastfeeding is contraindicated in cases of active tuberculosis, maternal HIV infection, herpetic breast lesions, active varicella infection, chemotherapy or radiation therapy, active alcohol use, and galactosemia. Galactosemia is the only contraindication related to the infant.
Gonorrhea Infection
The recommended treatment for confirmed gonorrhea infection is a single dose of azithromycin and ceftriaxone.
Dengue Fever
A positive tourniquet test can indicate dengue fever. This test results in petechiae after blood pressure cuff inflation.
Primary CNS Lymphoma
The best prognostic marker for primary CNS lymphoma is the degree of immunosuppression or CD4 count.
Positive HCB Antibodies
The next step in management for a patient with positive HCB antibodies is HCV RNA testing. Hepatitis C antibodies can be positive in both acute and chronic phases of infection, previous infection, or simply a false positive.
Immunosuppression Therapy
Prophylactic medication for a patient beginning high-dose immunosuppression therapy following a renal transplant includes trimethoprim for PCP and ganciclovir or valganciclovir for CMV.
Community-Acquired Pneumonia
For uncomplicated outpatient treatment of community-acquired pneumonia, amoxicillin or doxycycline is given. For uncomplicated inpatient treatment, ceftriaxone and a macrolide like azithromycin or fluoroquinolone monotherapy are used.
Strep Throat
The treatment of choice for strep throat is a 10-day course of penicillin or amoxicillin, which helps prevent acute rheumatic fever. However, it does not prevent post-streptococcal glomerulonephritis.
Acute Bacterial Rhinosinusitis
Rhinosinusitis is more commonly caused by viral organisms and does not require antibiotic treatment. However, consider antibiotics if symptoms last longer than 10 days without improvement, are severe (fever greater than 102°F, purulent mucus, or facial pain for more than 3 days), or worsen after initial improvement. The treatment of choice for acute bacterial rhinosinusitis is oral antibiotics like amoxicillin.
Trichomonas Vaginalis
The treatment of choice for a breastfeeding patient with Trichomonas vaginalis is a single dose of oral metronidazole 2 grams. Discard breast milk for 24 hours after administration. Metronidazole can enter breast milk, causing loose stools and candidiasis in exposed infants. Treat the partner as well.
Non-Gonococcal Urethritis
The next best step in a patient with ongoing dysuria despite azithromycin for non-gonococcal urethritis is a repeat urethral fluid Gram stain. Other organisms can cause non-gonococcal urethritis that are not responsive to azithromycin.
Schistosomiasis
An immigrant from Africa who develops cystitis with dysuria, urinary frequency, terminal hematuria, and peripheral eosinophilia is likely suffering from schistosomiasis. This condition is most prevalent in Africa and is diagnosed with urine sediment microscopy to identify eggs. Treatment involves praziquantel.
Tension Pneumothorax vs. Simple Pneumothorax
A tension pneumothorax is treated with needle decompression, while a simple pneumothorax requires chest tube insertion.
Obstructive Sleep Apnea
Acute perioperative hypercapnic and hypoxic respiratory failure can occur due to obstructive sleep apnea, especially during procedures involving sedation, neuromuscular blockers, opioids, or anesthesia. This usually results from hypoventilation and is associated with respiratory acidosis.
Laryngotracheaitis
The parainfluenza virus is the most common cause of laryngotracheaitis. Patients typically present with inspiratory stridor, a barking cough, and hoarseness. Treatment depends on the presence of stridor at rest. Mild cases without stridor at rest are treated with humidified air and possibly steroids. Moderate to severe cases with stridor at rest require steroids and nebulized epinephrine.
Bronchiolitis
Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. Symptoms typically occur in the winter in children around 2 years old. They present with nasal congestion, rhinorrhea, coarse breath sounds, wheezing, and crackles. Patients with respiratory distress, apnea, hypoxia, or dehydration should be hospitalized. Contact and droplet precautions are used to prevent spread. Treatment is usually supportive with IV fluids, nasal bulb suctioning, and humidified oxygen.
Bronchogenic Carcinoma
The most likely cause of recurrent pneumonia in an elderly smoker is bronchogenic carcinoma. Other causes to consider include bronchial alveolar cell carcinoma, lymphoma, eosinophilic pneumonia, and BOOP.
Flexible Bronchoscopy
The best confirmatory test for recurrent pneumonia in an elderly smoker is a flexible bronchoscopy.
Ventilation-Perfusion Scan
The diagnostic test of choice for a patient with renal failure and a modified Wells score greater than 4 for suspected pulmonary embolism is a ventilation-perfusion scan. A CT angiogram is unsafe in hemodynamically unstable patients.
SIADH
Small cell carcinoma is the lung cancer associated with SIADH. Patients present with euvolemic hyponatremia (sodium less than 120). Treatment involves water restriction. Lithium can blunt the response of collecting tubule cells to ADH.
Acute Underlying Non-Opioid Related Disease Process
Increased respiratory drive in patients receiving chronic opioid therapy can suggest an acute underlying non-opioid related disease process. Opioid therapy causes respiratory depression, not an increase in respiratory drive.
Ventilator-Associated Pneumonia
Ventilator-associated pneumonia is a common complication of ARDS or ARDS. It is most commonly caused by microaspiration of oral or pharyngeal organisms. Patients present with fever, increased secretions, worsening pulmonary infiltrates, and increased requirements for ventilator support occurring more than 48 hours after mechanical ventilation.
Video Fluoroscopic Swallowing Study
A video fluoroscopic swallowing study is most helpful in diagnosing aspiration pneumonia in a patient with Parkinson's disease.
Post-Operative Hypoxemia
Common causes of post-operative hypoxemia include airway obstruction or edema, residual anesthetic effect, bronchospasm, pneumonia, atelectasis, and pulmonary embolism.
Solitary Pulmonary Nodule
A solitary pulmonary nodule greater than 3 centimeters is considered a mass. A solitary pulmonary nodule greater than 2 centimeters independently correlates with a greater than 50% chance of
