Bugs & Drugs
True or false - yeast in 1/2 blood cultures is a contaminant and should not be treated
FALSE
Yeast in a blood culture is never considered a contaminant and warrants further investigation plus an ID consult
How often is HCC screening performed and by what method?
q6monthly, U/S (+/-AFP in some guidelines)
What is the first step of treating hyperkalemia (>6.5)?
Stabilize the myocardium (calcium gluconate)
Name a partial opioid agonist
Buprenorphine
2 common antimicrobials for VRE in our centre
Daptomycin
Linzeolid
What 2 diuretic medications are used in fluid management of a cirrhotic and at what optimal ratio are they prescribed?
Spironolactone, furosemide
5:2
Name 3 types of vascular access in a dialysis patient
Temporary dialysis catheter, tunneled dialysis catheter, AV fistula, vascular graft
What is an iatrogenic complication of normal saline?
Hyperchloremic metabolic acidosis (non-anion gap)
How would you dose ceftriaxone for bacterial meningitis?
Ceftriaxone 2g IV q12h
Name 4 physical exam findings from the hands of a cirrhotic patient
Clubbing, Terry's nails, Dupuytren's contracture, palmar erythema, asterixis, muscle wasting, spider angiomas
Name 3 methods to excrete potassium after shifting
1. Diuretics (lasix)
2. Binding resins (kayexalate)
3. Dialysis (if refractory)
What is "triple therapy" for HRS?
Albumin
Octreotide
Midodrine
At what CD4 count do you provide prophylaxis against PJP in an HIV patient?
<200
You suspected a variceal bleed in your cirrhotic patient. Which three medications should you start?
Pantoprazole IV
Octreotide
Ceftriaxone
What are the the 5 ACUTE indications to initiate hemodialysis?
Refractory to medical management:
1. Acidosis, 2. Electrolytes (hyperK), 3. Ingestion (toxins, overdose). 4. Overload (pulmonary edema), 5. Uremia
At what CD4 count do you provide prophylaxis against MAC in an HIV patient?
<50
Name 3 opportunistic fungal infections in HIV
Blastomycosis, candidiasis, coccidiomycosis, histoplasmosis, penicilliosis, PJP, sporotrichosis
How is SBP diagnosed on ascitic fluid analysis and what is the treatment?
PMNs 250 mm3
Positive culture (do not wait for culture to treat!)
Absence of secondary causes (e.g., bowel perforation)
Tx: Ceftriaxone x 7 days
Name 5 ECG changes in hyperkalemia
Peaked T waves, flat Ps, PR prolongation, wide QRS, bradycardia, sine wave, v fib, asystole
How do you diagnose PD peritonitis?
WBC 100 cells/mm3
Effluent culture positive
Clinical symptoms