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Diarrhea with blood and WBCs
Salmonella, Campylobacter, EHEC, Shigella, Vibrio parahaemolyticus, Vibriovulnificus, Yerisinia, C dif
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Most common cause of bloody diarrhea
Campylobacter
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Source of Vibrio
- V parahaemolyticus: shellfish and cruise ships
- V vulnificus: shellfish, hx of liver disease, skin lesions
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Yersinia diarrhea risks
High affinity for iron, so hemochromatosis and blood transfusions
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Stool lactoferrin
Better sens and spec than stool leukocytes. Not as accurate as stool culture
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Diarrhea with no blood or WBCs
- Viral
- Giardia: camping, fresh water
- Cryptosporidiosis: CD4 <100, modified acid fast
- Bacillus cereus: with vomitting
- Staph: with vomitting
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Scrombroid
Fish food poisoning with allergic symptoms. Most rapid, wheezing, flushing, rash. Tx with antihistamines
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Diarrhea tx
- Fluids
- Severe: Ciprofloxacin
- Giardia: metro, tinidazole
- Cryptosporidiosis: tx AIDs, nitazoxanide
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Severe diarrhea
- hypotension
- tachycardia
- fever
- abd pain
- bloody
- met acidosis
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Hepatitis B DNA polymerase
Quantatative form of e-antigen test
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Acute viral hepatitis tx
Only tx hepC (rarely acute) with interferon and ribavirin
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Chronic HepB tx
Entecavir, adefovir, lamivudine, telbivudine, interferon, or tenofivir. Interferon is not first choice bc injection and sides.
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Interferon sides
- Arthralgias/myalgias
- Leukopenia and thrombocytopenia
- Depression
- Flu like
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Chronic Hep C tx
- If high PCR-RNA, interferon and ribavirin
- Especially if fibrosis on bx
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Urethritis initial test and most accurate test, and others
- -Urethral swab with gram stain: shows inc WBCs and intraceullar gram neg diplococci for N gonorrhea
- -urethral cx, DNA probe, or nucleic acid amplification test for both.
- -Urine testing for nucleic aci amplicfication for both
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Causes of urethritis
- Gonorrhea
- Chlamydia
- Mycoplasma genitalium
- Ureaplasma
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urethritis tx
Cefixime or Ceftriaxone for gonorrhrea + azithromycin or doxycycline for chlamydia
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PID initial test and most accurate test
- Cervical swab with culture, DNA probe, or nucleid acid amp
- Laparoscopy
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PID tx
- Inpt: Cefoxitin or cefotetan + doxy
- Outpt: Ceftriaxone + doxy, +/- metro
- Anaphylactic all to pen: inpt clinda+gent and outpt levofloxacin + metro
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Gential ulcer with:
- Painless
- Painful
- Tener LN and suppurative
- Syphilis
- Chancroud/Haemophilus ducreyi or HSV (vesicles)
- LGV
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Dx test for genital ulcers:
- Syphilis
- H ducreyi
- LGV
- HSV
- Dark field, vDRL, PRP, FTA or MHA-TP(confirmatory)
- Stain and cx in special media
- Blood complement fixation titers or swab nucleic acid amp
- Tzanck is best initial. Cx is most accurate
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Tx for genital ulcers:
- Syphilis
- H ducreyi
- LGV
- HSV
- 1 dose of IM benzathine pen or doxy if allergic
- 1 dose azithro
- Doxy
- Acyclovir, valacyclovir, famciclovir. if resistant foscarnet
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False+ VDRL/RPR
Infection, older, IVDU, AIDS, malaria, APL syndrome, endocarditis
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Tertiary syph tx
IV pen. If allergic, desensitize.
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Imiquimod
Local immunostimulant for condylomata acuminata which leads to sloughing off of the lesion
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Pediculosis
- Crabs
- Tx with permethrine. Lindane has same efficacy but more toxicity
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Scabies tx
- permethrin
- Ivermectin if widespread
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Beta lactams in pregnancy
All are safe
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Cystitis tx
- Bactrim (3 days if uncomplicated, 7 if anatomic)
- Ciprofloxacin
- Cephalexin
- Nitrofurantoin esp if pregnant
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Pyelonephritis tx
- Amp and gent
- Cirpofloxacin
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Prostatitis tx
- Acute: amp and gent
- Chronic: 6-8wks of bactrim
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