Monday, September 9, 2013

1. Edema: 
-Decreased oncotic pressure (nephrotic, malnutrition, liver failure, protein losing enteropathy)
-Increased hydrostatic pressure (volume overload, CHF, cirrhosis, obstruction, hypothyroid)
-Increased permeability (sepsis, anaphylaxis, burns, SJS, angioedema)
2. In cases of bacteremia, odds of your blood cultures being positive are:
~67% x24 hours:
~94% x36 hours
~95% x48 hours
3. Probability of having meningitis:
-Definite: +LP culture/gram stain
-Probable: +blood culture AND CSF parameters: (WBC >5, glucose <40, or protein >100)
-Possible: -blood cultures AND CSF (WBC >100, gluc <40 or prot >100)
4. Lemieres's disease:
-Fusobacteria
-oropharynx-> burrows through neck tissues to IJ-> septic thrombophlebitis
-can cause cerebral infarcts somehow.
-Tx with 28 days of IV metronidazole
5. In someone with a L->R shunt, try to avoid giving oxygen. Oxygen will cause pulm vasodilation and systemic vasoconstriction and thus worsen the L to R shunt and hasten the onset of eisenmenger's. Goal sats will be high 80s/low 90s. Diurese a lot (lasix lasix lasix lasix). You will likely see pulmonary vascular markings on CXR.
6. Workup of UTI in a kid: when to get a renal/bladder u/s: 
 -Febrile UTI in a kid <24 mos
-Multiple febrile UTI
-Febrile UTI + fam hx of renal/bladder conditions (including HTN, FTT)
-Non-responsive to antibiotic treatment
7. Workup of UTI in a kid: when to get a VCUG: 
-Abnormalites found on renal/bladder u/s (hydronephrosis, scarring, high grade reflux, obstruction)
-Complex or atypical clinical sx
-Non-e.coli UTI
-Family history/recurrent/unresponsive to treatment.
8. Management of UTI in a kid:
-prophylactic abx only indicated in patients with grade 3-4 reflux.
-repeat cultures (i.e. post treatment) are not indicated unless they failed antibiotics
-UTI with fever in a <24 month old: treat with 7-14 days of antibiotics.
9. Charcot joints: damage to bone from loss of nerves: DM, syrinx/SC injury, B12 def, tabes dorsalis, peripheral nerve dx)
10. Uses of magnesium:
-torsades
-CP prophylaxis
-eclampsia (prev seizures, diuretic; not effective as tocolytic [cochrane])
-asthma (can also use terb, relaxes bronchial smooth mm)

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