Axon
07-08-2005, 02:39 PM
1496
Pt.with HIV in damp house in NORTHEAST texas & comes in with a lesion on his hand that is green and puffs up like a mushroom. He has fever, headache, malaise, myalgia, abdominal pain, and chills--common symptoms. Last week, he is starting to get LUNG problems. (BIG HINT: A bird pooped in his eyeball a few weeks ago). Bug and Drug...please?
Histoplasma capsulatum is a dimorphic fungus that remains in a mycelial form at ambient temperatures and grows as yeast at body temperature in mammals. Although the fungus can be found in temperate climates throughout the world, it is endemic to the Ohio, Missouri, and Mississippi River valleys in the United States. Internationally, the fungus is predominantly found in river valleys between latitudes 45° north and 30° south in North and Central America. This one is hard to identify cause it spread EVERYWHERE in the immunocompromised. Give Ketoconazole (Nizoral) a broad-spectrum antifungal agent; inhibits synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death. Drug of choice for mildly symptomatic or prolonged acute pulmonary histoplasmosis. Yuck!
1497
To answer some people, I only post stuff reported to be stressed by my students after taking the test. So don't be afraid, my posts are harmless...sorry I don't write more, I am watching a lot of movies during my 3 week vacation. I just saw movie "Friday Night Lights"...and "White Noise"...both pretty good. Anyhow, Tuberculosis (TB) is the most common cause of infection-related death worldwide. Many versions of the test have many questions on it. But it is a hard non specific dx with multiple symptoms. The drugs used and side effects can make a whole new USMLE Step 1A. But...TB occurs when individuals inhale bacteria aerosolized by infected persons. The organism is slow growing and tolerates the intracellular environment, where it may remain metabolically inert for years before reactivation and disease. There is a FORM of TB, that make MILIARY TYPE. What type of spread (abcde choices) does it work by?
a) Lymphohematogenous dissemination. Tubercular meningitis also may result from hematogenous dissemination. The only evidence of infection is a positive tuberculin skin test (TST) result.
KNOW that Endobronchial TB with enlargement of lymph nodes: This is the most common variety of pulmonary TB. Symptoms are the result of impingement on various structures by the enlarged lymph nodes. Persistent cough may be indicative of bronchial obstruction, while difficulty in swallowing may result from esophageal compression. Vocal cord paralysis may be suggested by hoarseness or difficulty breathing. DON'T just look for the BUZZWORDS like night sweats, spitting blood, etc.
KNOW that Reactivation TB: This condition usually has a subacute presentation with weight loss, fever, cough, and, rarely, hemoptysis. Reactivation TB typically occurs in older children and adolescents. The condition is more common in patients who acquire TB when older than 7 years. HEMOPTYSIS is not common. OLDER PEOPLE...
THIS WAS ASKED: KNOW that Tubercular meningitis: Three stages of tubercular meningitis have been identified.
· Stage 1: No focal or generalized neurologic signs are present. Possibly, only nonspecific behavioral abnormalities are found.
· Stage 2: This stage is characterized by the presence of nuchal rigidity, altered deep tendon reflexes, lethargy, and/or cranial nerve palsies. Tubercular meningitis most often affects the sixth cranial nerve, resulting in lateral rectus palsy. This is due to the pressure of the thick basilar inflammatory exudates on the cranial nerves or to hydrocephalus. The third, fourth, and seventh cranial nerves also may be affected. Funduscopic changes may include papilledema and the presence of choroid tubercles, which should be sought carefully.
· Stage 3: This final stage comprises major neurologic defects, including coma, seizures, and abnormal movements (eg, choreoathetosis, paresis, paralysis of one or more extremities). In the terminal phase, decerebrate or decorticate posturing, opisthotonus, and/or death may occur. Patients with tuberculomas or tubercular brain abscesses may present with focal neurologic signs. Spinal cord disease may result in the acute development of spinal block or a transverse myelitis–like syndrome. A slowly ascending paralysis may develop over several months to years.
KNOW HIV is one of the most significant risk factors for TB infection.
KNOW Steroid therapy, cancer chemotherapy, and hematologic malignancies increase the risk of TB.
KNOW that culture of mycobacterium is the definitive method to detect bacilli. M tuberculosis is a slow-growing organism, a period of 6-8 weeks is required for colonies to appear on conventional culture media.
KNOW Chest radiograph (CXR) is a classic diagnostic tool when evaluating patients for pulmonary TB.
WOW! This was the most typing of a concept I wrote to date!
1498 a
Drugs for TB: There are so many....What is a typical regimen. You will be asked...
a) Current recommendations for the treatment of pulmonary TB include a 6-month course of INH and rifampin, supplemented during the first 2 months with pyrazinamide. Ethambutol (or streptomycin in children too young to be monitored for visual acuity) may need to be included in the initial regimen until the results of drug susceptibility studies are available. Drug susceptibility studies may not be required if the risk of drug resistance is not significant. Significant risk factors include residence in a community with greater than 4% primary resistance to INH, history of previous treatment with anti-TB drugs, history of exposure to a drug-resistant case, and origin in a country with a high prevalence of drug resistance. The purpose of this recommendation is to decrease the development of MDR-TB in areas where primary INH resistance is increased. TB is a USA most feared disease...
1498 b
KNOW TB is confused with Blastomycosis...Do you know the clues?
a) Broad based Buds (This is one case where Buzzwords help). KNOW how this dx. like different from TB. The diagnosis of blastomycosis can be made by growth of the fungus in a culture of sputum, tracheal aspirates, bronchoalveolar lavage fluid, tissue biopsy specimens, cerebrospinal fluid, or urine.
KNOW Chest radiography: The chest radiograph is abnormal in two thirds of cases and may reveal alveolar or masslike infiltrates, reticulonodular pattern, pleural effusion, and, rarely, cavitation.
KNOW blastomycosis is recognized increasingly in immunocompromised hosts, especially AIDS patients.
KNOW Amphotericin B remains the antifungal agent with the most success against B dermatitidis. Cumulative doses less than 1 g have resulted in cure without relapse in 70-91% of adult cases of blastomycosis. A recent retrospective study of blastomycosis cases in Mississippi reported a cure rate of 86.5% and a relapse rate of only 3.9% for patients treated with amphotericin.
1499
OK, quickie...Amphotericin B is often used in stuff like Blasto. What are the contraindictions to use?
a) one important one asked is renal failure limits the use of amphotericin B.
1500
(Hey another nice round number!) Does anyone know why my posts in the download section stopped at 1331?
Anyways, HERPES II especially is a BIG QUESTION SOURCE. So, first off, don't confuse Herpes with Syphillis. Herpes genital sores are painFUL. First Q: After infection, where does Herpes II travel to and become latent?
a) Virions travel from the initial site of infection to the sensory dorsal root ganglion, where latency is established.
Pt.with HIV in damp house in NORTHEAST texas & comes in with a lesion on his hand that is green and puffs up like a mushroom. He has fever, headache, malaise, myalgia, abdominal pain, and chills--common symptoms. Last week, he is starting to get LUNG problems. (BIG HINT: A bird pooped in his eyeball a few weeks ago). Bug and Drug...please?
Histoplasma capsulatum is a dimorphic fungus that remains in a mycelial form at ambient temperatures and grows as yeast at body temperature in mammals. Although the fungus can be found in temperate climates throughout the world, it is endemic to the Ohio, Missouri, and Mississippi River valleys in the United States. Internationally, the fungus is predominantly found in river valleys between latitudes 45° north and 30° south in North and Central America. This one is hard to identify cause it spread EVERYWHERE in the immunocompromised. Give Ketoconazole (Nizoral) a broad-spectrum antifungal agent; inhibits synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death. Drug of choice for mildly symptomatic or prolonged acute pulmonary histoplasmosis. Yuck!
1497
To answer some people, I only post stuff reported to be stressed by my students after taking the test. So don't be afraid, my posts are harmless...sorry I don't write more, I am watching a lot of movies during my 3 week vacation. I just saw movie "Friday Night Lights"...and "White Noise"...both pretty good. Anyhow, Tuberculosis (TB) is the most common cause of infection-related death worldwide. Many versions of the test have many questions on it. But it is a hard non specific dx with multiple symptoms. The drugs used and side effects can make a whole new USMLE Step 1A. But...TB occurs when individuals inhale bacteria aerosolized by infected persons. The organism is slow growing and tolerates the intracellular environment, where it may remain metabolically inert for years before reactivation and disease. There is a FORM of TB, that make MILIARY TYPE. What type of spread (abcde choices) does it work by?
a) Lymphohematogenous dissemination. Tubercular meningitis also may result from hematogenous dissemination. The only evidence of infection is a positive tuberculin skin test (TST) result.
KNOW that Endobronchial TB with enlargement of lymph nodes: This is the most common variety of pulmonary TB. Symptoms are the result of impingement on various structures by the enlarged lymph nodes. Persistent cough may be indicative of bronchial obstruction, while difficulty in swallowing may result from esophageal compression. Vocal cord paralysis may be suggested by hoarseness or difficulty breathing. DON'T just look for the BUZZWORDS like night sweats, spitting blood, etc.
KNOW that Reactivation TB: This condition usually has a subacute presentation with weight loss, fever, cough, and, rarely, hemoptysis. Reactivation TB typically occurs in older children and adolescents. The condition is more common in patients who acquire TB when older than 7 years. HEMOPTYSIS is not common. OLDER PEOPLE...
THIS WAS ASKED: KNOW that Tubercular meningitis: Three stages of tubercular meningitis have been identified.
· Stage 1: No focal or generalized neurologic signs are present. Possibly, only nonspecific behavioral abnormalities are found.
· Stage 2: This stage is characterized by the presence of nuchal rigidity, altered deep tendon reflexes, lethargy, and/or cranial nerve palsies. Tubercular meningitis most often affects the sixth cranial nerve, resulting in lateral rectus palsy. This is due to the pressure of the thick basilar inflammatory exudates on the cranial nerves or to hydrocephalus. The third, fourth, and seventh cranial nerves also may be affected. Funduscopic changes may include papilledema and the presence of choroid tubercles, which should be sought carefully.
· Stage 3: This final stage comprises major neurologic defects, including coma, seizures, and abnormal movements (eg, choreoathetosis, paresis, paralysis of one or more extremities). In the terminal phase, decerebrate or decorticate posturing, opisthotonus, and/or death may occur. Patients with tuberculomas or tubercular brain abscesses may present with focal neurologic signs. Spinal cord disease may result in the acute development of spinal block or a transverse myelitis–like syndrome. A slowly ascending paralysis may develop over several months to years.
KNOW HIV is one of the most significant risk factors for TB infection.
KNOW Steroid therapy, cancer chemotherapy, and hematologic malignancies increase the risk of TB.
KNOW that culture of mycobacterium is the definitive method to detect bacilli. M tuberculosis is a slow-growing organism, a period of 6-8 weeks is required for colonies to appear on conventional culture media.
KNOW Chest radiograph (CXR) is a classic diagnostic tool when evaluating patients for pulmonary TB.
WOW! This was the most typing of a concept I wrote to date!
1498 a
Drugs for TB: There are so many....What is a typical regimen. You will be asked...
a) Current recommendations for the treatment of pulmonary TB include a 6-month course of INH and rifampin, supplemented during the first 2 months with pyrazinamide. Ethambutol (or streptomycin in children too young to be monitored for visual acuity) may need to be included in the initial regimen until the results of drug susceptibility studies are available. Drug susceptibility studies may not be required if the risk of drug resistance is not significant. Significant risk factors include residence in a community with greater than 4% primary resistance to INH, history of previous treatment with anti-TB drugs, history of exposure to a drug-resistant case, and origin in a country with a high prevalence of drug resistance. The purpose of this recommendation is to decrease the development of MDR-TB in areas where primary INH resistance is increased. TB is a USA most feared disease...
1498 b
KNOW TB is confused with Blastomycosis...Do you know the clues?
a) Broad based Buds (This is one case where Buzzwords help). KNOW how this dx. like different from TB. The diagnosis of blastomycosis can be made by growth of the fungus in a culture of sputum, tracheal aspirates, bronchoalveolar lavage fluid, tissue biopsy specimens, cerebrospinal fluid, or urine.
KNOW Chest radiography: The chest radiograph is abnormal in two thirds of cases and may reveal alveolar or masslike infiltrates, reticulonodular pattern, pleural effusion, and, rarely, cavitation.
KNOW blastomycosis is recognized increasingly in immunocompromised hosts, especially AIDS patients.
KNOW Amphotericin B remains the antifungal agent with the most success against B dermatitidis. Cumulative doses less than 1 g have resulted in cure without relapse in 70-91% of adult cases of blastomycosis. A recent retrospective study of blastomycosis cases in Mississippi reported a cure rate of 86.5% and a relapse rate of only 3.9% for patients treated with amphotericin.
1499
OK, quickie...Amphotericin B is often used in stuff like Blasto. What are the contraindictions to use?
a) one important one asked is renal failure limits the use of amphotericin B.
1500
(Hey another nice round number!) Does anyone know why my posts in the download section stopped at 1331?
Anyways, HERPES II especially is a BIG QUESTION SOURCE. So, first off, don't confuse Herpes with Syphillis. Herpes genital sores are painFUL. First Q: After infection, where does Herpes II travel to and become latent?
a) Virions travel from the initial site of infection to the sensory dorsal root ganglion, where latency is established.