View Full Version : Int Med chat: Infectious Diseases

04-06-2005, 08:30 PM
dua_frank has joined the chat.
[persianprincess] i have a ques
[persianprincess] do u know how to moderate forums
[restlesseye] persian princess?
[restlesseye] you have to be setup to moderate by a supermoderator
[cbuck] hello
[andy1240] hi
[andy1240] no one here?
[chandra] hello
[chandra] anyone here
[chandra] persianprincess
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[lanny] hi guys
[samantha] hi lanny dua
[megs] hi you all
[dua_frank] hi lanny and sammy
[samantha] hi megs
[lanny] hi sammy
[dua_frank] so inf diseases today
[lanny] yep
[megs] hi all
lenhoxung has left the chat.
[dua_frank] hi megs
[dua_frank] expanding erythematous lesions with a pale centre, dx?
[lanny] lyme dz erytema marginatum
[dua_frank] right
[dua_frank] what is the diff between stage 1 2 & 3 of lyme disease?
[dua_frank] waky waky
[samantha] development of symptoms dua
megs has left the chat.
[dua_frank] all stages have symptoms sammy
[dua_frank] the difference is dissemination
[dua_frank] 1 has only skin lesions
[dua_frank] with fever malaise and fatigue
[samantha] from the time of tick bite and CNS and cardiac manifestations
[dua_frank] 2 has dissemination in all organs
[samantha] ok
[dua_frank] 3 is just persistant infection last for more than 2-3 years causing chronic erosive arthritis
[dua_frank] dx tests?
[samantha] Elisa with western blot
[dua_frank] right
lanny has left the chat.
[dua_frank] pregnant patient with rash joint and bells palsy of lyme, rx?
[samantha] amoxicillin
[megs] agree
[dua_frank] right also same in kids
[dua_frank] how about adult non pregnant?
[megs] then doxy
[dua_frank] right
[dua_frank] how about pregnant lymes with cardiac and neuro involement?
[megs] newborn with purulent conjuctivitis...delivery occured at home...what is dx...??? 1. clamidiya..2. gonococci...3.chemical conjuctivitis???
[megs] ceftriaxone dua
[dua_frank] clamydia
[lanny] chemical
[dua_frank] yes iv cef or pen
[dua_frank] same in non pregnant by the way
[megs] nope its gonococcal
[megs] why clamidiya dua???
[dua_frank] gono?:O
[lanny] oh cause its purulent
[dua_frank] i remember it that way
[dua_frank] maybe its gono
[megs] sorry i fergot to tell u 1 point delivery 2 days back..???
[dua_frank] i know it was some infection
[lanny] ye
[lanny] s timing is important
[megs] if gonococcal it occurs in..2..4 days of delivery
[megs] clamidiyal...7..10 days/...
[megs] sorry guys lol
[lanny] no prob
[dua_frank] :gun at megs
[samantha] :gu
[megs] hiv pt with cd4 count50..having dysphagia.....how will u treat him...???1. acyclovir.2.gancyclovir,3.flucanazol4. foscarnet???
[dua_frank] megs i don't think chlamydia causing that in newborn at all
[megs] ok guys dont shot at me any more i am dead now lol
[dua_frank] since urethreal purulant discharge is by gonococcal infect
[dua_frank] lymph venerum by chlamy causes bubos and scars
[samantha] gancyclovir
[megs] ok guys dont shot at me any more i am dead now lol
[megs] what about trachoma dua???
[samantha] lol not at you megs at usmle
[dua_frank] sammy be nice, don't shoot at megs
[dua_frank] :P
[megs] nope sammy ...the ans is flucanozole...
[dua_frank] trachoma happens in eyes megs not genitalia
[dua_frank] won't affect the newborn right?
[dua_frank] its candida isn't it?
[megs] what causes trachoma dua???
[megs] isnt it a clamidiyal species??
[dua_frank] yes ofcourse megs
[dua_frank] but i didn't hear trachoma in new born
[lanny] chlammydia trachomatis
[dua_frank] that too from delivery mom having lymp venerum
[dua_frank] if its possible, then maybe it makes sense
[samantha] ok megs candidia is the commonest so fluconazole
[megs] i did not said trachoma in newborn dua i said conjunctivitis
[megs] yes sammy
[lanny] the strain of chlammydia trachomatis is diff
[dua_frank] ahhhhhhhh tricky megs :P
[megs] clamidiya can cause a lot to eye...mild conjuctivitis to vision loss
[dua_frank] yes its the mc cause of blindness
[lanny] yes megs usu in developing countries
[megs] what is ludwigs angina???
[dua_frank] so if its within 2 days its due to mom's genital tract havign gono infection
[megs] what is vincent angina???
[megs] whats the diff bet these 2 angina???
[dua_frank] serous sac in neck
[dua_frank] ludwigs i think
[dua_frank] vincent is that infection
[dua_frank] ulcers in mouth
[megs] nope dua...occumulation of pus in the floor of mouth..is ludwigs angina..can spread downwords to cause tracheal compression
[dua_frank] ok
[dua_frank] any infective cause of that megs?
[dua_frank] particular infection i mean
[megs] and vincent is due to borelia vincenti..necrotising ulcerative gingivitis
[dua_frank] ok
[megs] ludvigs is due to streptococci
[megs] anaerobic i guess...but will cq
[dua_frank] ok
[dua_frank] thanks
[dua_frank] nice qs both
[megs] yes it is due to anaerobes
[dua_frank] rx of severe blastomycosis ?
[megs] i.v amphotericin dua??
[dua_frank] right
[dua_frank] mild blasto?
[dua_frank] mcc of HIV?
[megs] hiv2
[dua_frank] most common cause megs
[dua_frank] or risk
[megs] ok...drug abuse
[megs] homosexuality 2nd common
[dua_frank] right
[dua_frank] rx of pn carinni pancreatitis?
[megs] pentamidine???
[megs] dunno just guessing
[lanny] megs homosexuality is not a cause of HIV
[dua_frank] yes right
[dua_frank] pn carrinni rash rx?
[lanny] HIV is predom seen in homosex cause of blood and wemen contact
[dua_frank] and with pneumonia that is
[megs] sorry...i mean to say unprotected sex
[lanny] ok megs
[dua_frank] risk homosexually as 2nd cause is right
[dua_frank] IV drug abuse being first
[dua_frank] mcc of pneumonia in aids?
[lanny] right dua
[lanny] strep pneum
[dua_frank] correct lanny
[megs] agree lanny
[dua_frank] mcc of pneumonia in HIV?
[lanny] strep
[megs] stept pneumonia
[dua_frank] nope now its pneu carinnii
[megs] why dua??
[dua_frank] kaplan q bank q
[dua_frank] i dunno megs, i read it so sharing with you all
[lanny] no dua its still strep
[dua_frank] rx of CMV retinitis?
[lanny] gancyclovir
[samantha] foscarnet?
[dua_frank] right
[dua_frank] gan
[samantha] ok
[megs] painless genital ulce punched out with rollig edges..and indurated base..whta dx????
[dua_frank] if resistant to gan?
[lanny] foscarnet is second choice sam
[dua_frank] basal call ca
[megs] if resistant then foscarnet
[dua_frank] yes megs
[megs] ans my q
[samantha] squamous?
[samantha] ok lanny
[dua_frank] side effect of gan?
[lanny] retinitis
[dua_frank] it treats cmv retinitis lanny
[dua_frank] neutropenia
[dua_frank] SE of foscarnet?
[lanny] oh sorry
[lanny] its leukopenia
[lanny] nephrotoxic is foscarnet
[dua_frank] right lanny
[samantha] yup lanny
[samantha] megs ans to your q?
[dua_frank] rx of toxo?
[megs] syphilis sammy
[samantha] ulcer?
[dua_frank] syphillis???
[lanny] penicillin
[megs] toxo traet with pyromethamine sulfadiazine
[dua_frank] yes
[samantha] agree megs
[lanny] rememebr not spiramycin megs
[megs] yes lanny
[dua_frank] megs it looks like basal cell ca to me
[dua_frank] isn't chancre rubbery and round?
[megs] basal cell...on genital dua???
[dua_frank] well nude sunbathing maybe :P
[megs] lol
[lanny] lol lol lol dua
[megs] dua punched out...
[dua_frank] lol
[samantha] lol lol
[dua_frank] oh ok
[megs] punched out is key word i guess
[samantha] :o got it
[dua_frank] thanks
[dua_frank] clear base is bcc?
[lanny] megs whats the answer
[samantha] usually squamous in vulva
[samantha] is
[samantha] squamous cell ca i mean
[megs] i i said it is syphilitic ulcer
[samantha] alright megs got it
[dua_frank] meningitis in AIDS, mcc?
[samantha] strep pneumonia
[megs] strep pneum
[dua_frank] yes
[dua_frank] not crypto?
[lanny] possible but not mc
[dua_frank] ok
[dua_frank] rx for crypto menin?
[megs] what is tr of cryptococcal meningitis???
[samantha] if it said ring enhancing then it is toxo or crypto?
[lanny] toxo
[samantha] yup
[dua_frank] iv amph then oral fluco life long :P
[megs] ring enhancing lesion for toxo
[samantha] rt megs
[megs] what is induction phase in treatment of cryptococosis???
[dua_frank] cd count <500, which infection more common, MAI, candida or pne carinii?
[megs] pne. carini dua...
[dua_frank] candida megs
[dua_frank] pn <400
[dua_frank] MAI<50
[lanny] P carinii
[megs] OK...DUA
[dua_frank] others below 50?
[lanny] MAI is below 50
dr._braniac has left the chat.
[lanny] candida nad p carinii is 500 or less
[dua_frank] cmv and crypto
[lanny] all except live
[megs] i guess MMR can be given
[samantha] < 200 is pneumo
[samantha] pneumocystis
[lanny] yes MMR is ok
[dua_frank] yes sorry pn less than 200
[dua_frank] not 400
[dua_frank] <100?
[megs] yes dua
[dua_frank] toxo
[megs] less than 100 is toxo
[lanny] toxo is < 100
[samantha] yup
[megs] pt came with diry laceration due to road side accident...tt give 5 yrs back...will u vaccinate for tt???
[samantha] and both crypto's also <100
[lanny] all dirty wound need vacc
[dua_frank] yeah you give toxoid
[dua_frank] plus ig serum
[megs] yes
[samantha] yes give toxoid and immunoglobulin
[dua_frank] when do you start antiretroviral rx? tell me ideal viral load level and cd count
[megs] do we really give immunoglobulin for dirty wound..dont think so???
[dua_frank] yeah we do
[lanny] t cell < 350 load 55 000
[megs] virral load more tha 55000 and cd4 less than 350
[dua_frank] cd<500 and viral load>10000
[megs] dua its kaplan
[dua_frank] so is mine megs :(
[megs] dua>>> lol
[megs] majority carries the law lanny and me same
[megs] lol
[megs] i want to clear one thing with tetanus
[megs] tetanus immunoglobulin is not given for dirty wound in every pt
[lanny] in dirty wound megs yu cannot give ig if the pt had more than 3 tet vaccin lifetime
[megs] it is given to those with no priar history of vaccination
[dua_frank] oh ig
[megs] yes lanny
[dua_frank] i thought you asked toxoid
[dua_frank] you're right
[dua_frank] oxford says viral loads range 5-30,000 and cd<500
[megs] toxoid is given to all
[lanny] toxoid is given in all dirty wounds dua
[lanny] even clean ones too
[dua_frank] yes agree
[dua_frank] what about to those who have a clean wound, who had taken toxoid less than 5 years back?
[dua_frank] what will do in them?
[megs] will not vaccinate the
[megs] if clean wound
[dua_frank] ok
[lanny] not give
[dua_frank] if dirty?
[lanny] give if only > 10 yrs
[megs] agree lanny
[megs] so dont give just clean the wound properly if vaccination...given less than 5 yrs
[samantha] rt
[megs] imagine in india we give t.t for every injury if prv. vacination is less than 6 months... lol
[dua_frank] if dirty ig alone?
[dua_frank] megs true :))
[lanny] yes megs but it has to be the last dose of vascc was given less than 5 yrs
[dua_frank] lol
[megs] agree lanny
[samantha] if dirty then give tetanus toxoid even if vaccinated less than 5 yrs?
[lanny] tet vacc is given every 10 yrs ususally
[megs] yes
[lanny] so in an average adult at least 3 vacc should have been given
[megs] but if dirty wound then give if more than 5 yrs but less than 10
[lanny] thats how i remember 3 yrs
[lanny] sorry 3 times
[dua_frank] what is the routine treatment for non pregnant hiv patient?
[dua_frank] tell me the drug combo
[samantha] ok
[samantha] megs
[megs] he he
[megs] i will something diff...
[dua_frank] hehe megs
[megs] just keep in mind one imp thing
[samantha] what?
[megs] now a days nevirapine is used for transplacental prevention of hiv
[megs] just keep that in corner of u r mind
[dua_frank] instead of azt megs?
[lanny] its the only prot inhib thats used right?
[dua_frank] ok so they have shifted from nucleoside to non nucleoside reverse transcriptase inhibts
[lanny] dua i think its an addition
[dua_frank] maybe because of lesser side effects
[lanny] AZT is still used in my center today
[megs] not really instead of AZT......BUT it is more effective to prevent HIV to BABY DURING DELIVERY...i mean intrapartem
[dua_frank] but megs pregnancy is a state for monotherapy
[dua_frank] you dont' give more than one drug
chandra has left the chat.
[megs] dua it is used when pt do not foolw up with u since begining???
[dua_frank] checking
[megs] so if the q is A LADY COME WITH LABOURPAINS WITH HIV..POSITIVE STATUTS..no priar hiv treatment taken...what will u give her at the time of delivery to prevent hiv to baby???
[dua_frank] oh ok
[dua_frank] got it now
[megs] then the ans is NEVIRAPINE
[dua_frank] thanks
[megs] otherwise GOLDSTANDERD IS azt
[dua_frank] coz its a very potent anti HIV agen
[dua_frank] the most potent
[dua_frank] two NS and one PI
[dua_frank] right
[dua_frank] important
[dua_frank] after delivery she can be given 3 drugs right?
[dua_frank] but during preg only azt
chandra has left the chat.
[dua_frank] right
[megs] if her CD 4 count is more than 500...then no need to give AZT after delivery
[dua_frank] yes
[dua_frank] good point
[megs] in pt with primary syphilis ..he is allergic to penicillis how wi;ll u treat???
[dua_frank] erythro
[lanny] eryth
[samantha] give small dose to induce tolerance
[megs] COUGHT U ....he he...which drug u will give..1.tera2. erythro3. amox4.desensitisation5. doxy
[lanny] desens in preg
[megs] he he all wrong
[megs] including me
[dua_frank] why not erythro?
[megs] i was badly wrong too...when i solved this q
[dua_frank] as far as i know you can give either
[megs] i duno that dua but ans is doxy
[megs] i cq kaplan too
[megs] and kaplan also says doxy
[dua_frank] too many bloody discrepancies
[dua_frank] :an
[dua_frank] checking again :an
[megs] I ALREADY SAID I dunno
[megs] but kaplan and uw agree so it must be right
[snow] hi all
[lanny] hi snow
[megs] otherwise for other infection we generally preferr erythro if aalergic to penicillin
[lanny] agree megs this is why i remembered it
[snow] what's being discussed?
[lanny] step 2 inf dz
[snow] ok, thnx
[dua_frank] how about if the patient was with teriary syphillis
[dua_frank] oxford says doxy does not mention erythro
[dua_frank] hi snow
[snow] hi frank
[lanny] well dua that clears it
[megs] then we do desensitization dua
[lanny] so it is confoirmed UW kaplan and oxford
[dua_frank] right megs
[dua_frank] yes lanny, i guess erythro for other pen allergic infections
[lanny] dua what oxford book is that whats the title...
[lanny] agree dua
[dua_frank] we're in a fix if they say pen allergic syphillitic pregnant woman though
[lanny] then desens and give pen
[dua_frank] oxford handbook of clinical medicine, its a pocket book
[megs] so just rememder doxy..an exception for pencillin substitute instead of erythro insyphilis
[lanny] oh i have it ok
[dua_frank] ok
[lanny] i have the3rd ed
[dua_frank] its a quick reference for me whenever there are such controversies
[lanny] what the latest ed?
[dua_frank] mine's 5th
[dua_frank] 5th is latest
[megs] in pt of gas gangrene what rx??/we give
[samantha] because doxy is broad spectrum
[dua_frank] pens
[samantha] penicillin
[megs] yes ..if allergic to penicillin???
[dua_frank] clindamycin
[samantha] and 100% oxygen?
[megs] yes
[dua_frank] we need to remember substitute drugs for pen in diff conditions
[megs] why clinda here...not erythro
[dua_frank] we know about syphillis and gas gangrene now
[dua_frank] any others we can think of?
[dua_frank] erythro in lyme?
[samantha] rt
[samantha] dua
[megs] agree dua
[dua_frank] also iv cef in lyme cardiac and neuro involvement
[samantha] rt'
[lanny] but gas gangrene is caused by anaerobes
[lanny] so metro is first choice
[lanny] clinda second
[dua_frank] erythro or doxy only for stages without cardiac and neuro involvenment
[dua_frank] are you sure lanny?
[megs] lanny..might be right
[dua_frank] gas gangrene is by clostridia
[dua_frank] not by anerobes i think
[dua_frank] clost perfringens
[dua_frank] i think you are thinking about pseudomembranous colitis
[dua_frank] where clinda is used too
[dua_frank] there yes mertro doc
[snow] ok..mini harrison says clind + pen
[samantha] agree dua
[lanny] clostridia is the cause of gas gangred
[snow] for gas gangrene
[dua_frank] there is a mini harrisons too now? *)
[lanny] toxins are prod in anaerobic conds
[lanny] which are bad to tissues
chandra has left the chat.
[dua_frank] clost itself is bad for the tissues lanny, nothing to do with anerobes
[dua_frank] it causes nectrotising destruction of muscles by fast production
[dua_frank] by gas production i mean
[lanny] but still clinda nad metro is used not sure about pen will chk
[dua_frank] clinda in case of pen allergy lanny
[dua_frank] high dose pen is the doc with surgical debridement and amputation even sometimes
[megs] metro is also used..but...as a third or fourth regard
[dua_frank] rx of MAI?
[lanny] ok thx dua
[megs] but clinda is first...just cq out e med article
[lanny] agree megs i thought clinda is first
[dua_frank] book says 80% of times its clost perfringens
[dua_frank] second common org is strep pyogenes
[dua_frank] welcome lanny
[dua_frank] anerobes might be the rest of the tiny percent organism causes
[lanny] well in a case like this lets al chk later and keep it in back of head in the test
[dua_frank] yes
[dua_frank] or clarithro
[dua_frank] or rifabutin
[lanny] maybe we can get gram stain..etc to direct us as to trt..
[megs] ohh yes
[dua_frank] but these are prophylaxis megs
[megs] agree dua
[dua_frank] the drugs for rx are clarithro+ethambutol+rifabutin
[dua_frank] not azithro alone
[dua_frank] 3 drug combo
[dua_frank] much like tb
[dua_frank] but different drugs
[lanny] prophyl of MAI is rifampin
[dua_frank] yes lanny rifabutin
[lanny] sorry rifabutin
[dua_frank] so i guess as soon as a patient is cd<50 they give rifabutin?
[lanny] yes dua
[lanny] for prvtion its added to regimen
[dua_frank] ok nice to know
[dua_frank] the sicker you get, the more meds they give you
[dua_frank] if you don't die of aids, you'll definitely die of SE of drugs lol
[lanny] at that point pt is hospitalized
[megs] HE HE DUA
[dua_frank] no wonder they say AIDS= Anxiety induced death sentence
[lanny] but with all the recent new combos you dont see these stages nowadays
[dua_frank] yeah thats good lanny, its a bad disease
[lanny] remember life expect of a pt with HIV diag now who start trt and compliant is like life expect in a non HIV individual
[megs] i will tell offender u tell me organism for diarrhoea...??
[dua_frank] nice
[megs] ok
[dua_frank] ok
[megs] reheated rice...
[dua_frank] bacillus cereus
[megs] easy..
[lanny] bacillus cereus
[megs] water...??
rsandhu has left the chat.
[dua_frank] salmonella?
[megs] in usa???water
[lanny] vibrio
[megs] giardia
[dua_frank] yikes :(
[megs] vibrio not in usa
[megs] milk???
[lanny] listeria
[dua_frank] brucellosis
[megs] listeria cause diarrea??
[dua_frank] meningitis
[megs] i asked only diarrhoeal disease
[megs] milk...and poultry???
[lanny] yes listeria does
[dua_frank] campy?
[megs] salmonella camphy
[samantha] salmonella
[dua_frank] ok
[lanny] camp jejuni
[megs] yes
[dua_frank] mcc of lung abscess?
[megs] anaerobes
[dua_frank] right
[dua_frank] usually in alcholics with bad teeth :)
[dua_frank] bad teeth harbor anerobes
[dua_frank] and alcoholics have increased incidence of aspirations
[dua_frank] both leading to lung abscess
[lanny] dua im leaving now will see you all tom plz post todays thanks all
[dua_frank] tell me noninfectious causes of lung cavities
[dua_frank] will do, welcome, bye, nite nite
[megs] cancer
[dua_frank] right
[dua_frank] pulmonary infarction and wegeners
[megs] cyst
[megs] ok dua
[dua_frank] sane rx as gas gangrene here
[dua_frank] pen or clinda
[megs] ok
[dua_frank] so we know 4 conditions
[dua_frank] gas gangrene/lung ab
[dua_frank] with clinda
[dua_frank] lyme with erythro
[dua_frank] syphillis with doxy
[megs] yes dua
[samantha] in chloroquine resistant malaria what do we use?
[dua_frank] good our list is increasing :)
[megs] hehe
[dua_frank] mefloquin?
[samantha] correct dua
[dua_frank] for prophylaxis of malaria?
[megs] malaria prophylaxis
[samantha] what are the tick bourne infections?
[dua_frank] hehe megs
[dua_frank] lyme
[dua_frank] rocky mountan
[megs] babesisis
[dua_frank] epidemic typhus?
[samantha] babeisiosis and erlichiosis also
[dua_frank] no thats louse or flea
[dua_frank] i think
[samantha] rt dua and megs
[samantha] not typhus
[samantha] i think
[dua_frank] yeah
[megs] no typhus is either mite flea or
[megs] lice
[dua_frank] ok
[dua_frank] mcc of pnemonia in copd?
[megs] step pneumoniae
[samantha] clamydia trauchomatis causes what inf?
[dua_frank] trachoma
[megs] trachoma...and LGV
[dua_frank] non gono urethritis too
[megs] difff serotypes
[samantha] rt megs
[samantha] dua yes
[dua_frank] rx of that?
[dua_frank] yes srep
[dua_frank] in alcoholics and diabetics/
[dua_frank] ?
[megs] dua didnt get u??
[dua_frank] pneumonia megs
[samantha] klebsiella?
[dua_frank] mcc?
[megs] penicillin and clinda..??
[dua_frank] doxy for rx of chlamydia
[megs] OOOPS
[dua_frank] gram neg infections sammy
[samantha] for LGV?
[dua_frank] kleb is associated with both yes
[megs] in whom mycoplasma is common???
[samantha] ok dua
[megs] i mean mycoplasma pneumonia
[dua_frank] ok pneumonia in neutropenic and long antibiotic use mcc?
[dua_frank] community acquired
[megs] legienella??
[dua_frank] colleges maybe
[samantha] in young teens?
[dua_frank] fungal and aspergillus
[megs] ohh
[dua_frank] hospital acquired pneumonias mcc?
[megs] speudomonal
[megs] pseudo
[dua_frank] staph aureus and gram neg
[samantha] agree dua
[megs] ohh
[dua_frank] pseudo in neutropenic patients causes meningitis i think
[dua_frank] and ear infections
[dua_frank] swimmers ear
[dua_frank] right?
[samantha] in pts with intubation etc it is pseudomonas
[samantha] instrumentation
[dua_frank] causes somethign in renal transplant patients too
[megs] no speudo for pt on respirator or ventilator
[dua_frank] maybe pneumonias
[megs] i mean pseudo
[samantha] rt megs
[dua_frank] oh right megs
[dua_frank] i remember now
[dua_frank] legionella in acs :)
[dua_frank] we're doing good :)
[dua_frank] rx of myco pneu?
[megs] dua dont think staph is no.1 cause for hospital aquired..
[megs] are u sure??/
[samantha] doxy dua
[dua_frank] yeah megs
[megs] mycoplasma doxy
[dua_frank] erythro
[samantha] rt dua
snow has left the chat.
[dua_frank] or doxy
[dua_frank] both are right
[megs] ok gals got to go
[dua_frank] all macrolides
[megs] bye all
[dua_frank] bye megs
[megs] good night'
[dua_frank] good night
megs has left the chat.
[dua_frank] dx for mycoplasma?
[samantha] forgot dua
[dua_frank] cold agglutinins initial
[dua_frank] and best test culture
[dua_frank] of sputum
[samantha] ok dua
[dua_frank] rx of pnenonias in drug abusers?
[dua_frank] iv drug abusers
[samantha] penicillin
[snow] nafcillin
[dua_frank] vancomycin
[dua_frank] its usually MRSA
[samantha] because it is staph aureus?
[dua_frank] others naficillin or oxacillin yes
[dua_frank] yes sammy, its MRSA
[dua_frank] methicillin resistant
[samantha] so vanco
[samantha] dua
[dua_frank] mcc of community acquired pneu?
[dua_frank] yes
[samantha] clamydia
[dua_frank] strep pneuno
[samantha] mycoplasma ?
[dua_frank] rx of hemophilus inf pne?
[samantha] amoxicillin
[samantha] is it rt dua?
[dua_frank] yes or cefuroxime
[dua_frank] yes
[dua_frank] rx for kleb pnu?
[samantha] community aquired not sure dua
[dua_frank] its strep pneumo sammy
[samantha] thanx dua
[dua_frank] ceph with or without aminoglycoside
[dua_frank] rx of legionella?
[samantha] erythro
[dua_frank] right iv
[samantha] ok
[dua_frank] h influ goes with smokers
[dua_frank] kleb with alcoholics
[samantha] ok dua
[snow] mcc of pneumonia in HIV pt with cd4<200?
[dua_frank] 72 y/o man, smoker with diarrhea, with confusion, dx?
[dua_frank] pn carinii
[snow] yes
[snow] 1st choice txt?
[dua_frank] smtx pyrimethamine?
[dua_frank] sulfadizine
[snow] TMP-SMZ
[dua_frank] oh
[snow] if allergic to sulfa?
[dua_frank] pentamidine?
[snow] yep
[samantha] tx is diff from prophylaxsis
[dua_frank] what was sulfadizine and pyrimithamine for?
[dua_frank] toxo?
[samantha] yes
[samantha] du
[samantha] dua
[snow] i think..not sure
[snow] back to the 72 yr old man
[dua_frank] yeah
[dua_frank] yes old man
[dua_frank] whats he got?
[snow] is the pt dehydrated
[dua_frank] thanks sammy, yes its toxo
[dua_frank] i keep confusing them both
[dua_frank] shall we stop?
[dua_frank] for today
[dua_frank] or continue?
[samantha] dua TMP adn Sulfa is prophylaxisis
[samantha] for both toxo and pneumo cystis carinii
[dua_frank] yes right
[dua_frank] but as rx for pn carinnii
[dua_frank] and rx for toxo is that sulfadiazine and pyrimithamine
[samantha] correct
[dua_frank] current jelly sputum?
[snow] klebsiella
[dua_frank] that old man had legionella
[dua_frank] remember pneumonia, diarrhea and mental confusion for legionella
[snow] ok
[dua_frank] right kleb
[dua_frank] snow when are you taking your exam?
[samantha] what is the catch there dua
[snow] in 2 months
[dua_frank] you might think of some GI infection or CNS problem
[samantha] for legionella it is the diarrhoea rt
[dua_frank] its a lung infection causing mental confusion and dirrhea
[dua_frank] yes
[samantha] ok'
[dua_frank] which of these lung infections
[dua_frank] causes an A-a gradient to be high?
[dua_frank] waky waky
[samantha] dunno dua
[snow] thinking..
[snow] any clues?
[dua_frank] pneu carinnii
[samantha] why dua?
[dua_frank] they might give you a picture with A-a gradient
[dua_frank] and low Pa02 levels
[samantha] ok
[dua_frank] high Ph and high Pco2 level
[dua_frank] meaning that infection affected gas exchange sammy
[samantha] ok it has to be pneumo carini
[dua_frank] o2 cannot pass through until inflammation is relieved by steroids
[dua_frank] right
[samantha] yup
[dua_frank] and also give tmx sulp combo
[snow] ok
[samantha] thanx for the point dua
[dua_frank] welcome
[dua_frank] to be here or not to be, that is the q :P
[samantha] ok shall we quit foe today?
[dua_frank] ok
[dua_frank] see you tomorrow
[dua_frank] bye
[samantha] i can be for somemore if u want
[samantha] alright dua tom is fine
[snow] see u all tomorrow..thanks
[dua_frank] infectious is too big to complete today
[dua_frank] welcome snow
[dua_frank] see you tomorrow, bye :)
[samantha] yes bye dua and snow
[snow] g'nite frank and samantha
[samantha] bye
snow has left the chat.
samantha has left the chat.

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