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MTB Notes
MTB Notes
1. Most likely diagnosis for of urethritis, if pt. has urethral discharge Urethritis
2. Best initial test for urethritis Urethral swab for gram stain
Urine testing for nucleic acid amplification can also detect gonorrhea & chlamydia
Increased WBC + gram negative dipplococcis Neiseria gonorrhea
3. Most accurate test for urethritis Urethral culture, DNA probe, nucleic acid amplification
4. Treatment for gonorrhea: Ceftriaxone or cefixime
5. Treatment for chlamydia: Azithromycin or doxycycline
PID
1. Pt. that presents with symptoms of PID, next step I management urine B-hcg to exclude
pregnancy.
2. Diagnose PID with cervical swab for culute, dna probe, or nucleic acid amplification
3. Most accurate test for PID laparoscopy, but rarely needed. Needed onl ehrn diagnosis is
unclear, symptoms persist despite therapy, recurrent episodes for unclear reasons.
4. Treatment of PID (consists of gonorrhea + chlamydia):
Inpatient Cefotetan or cefoxitin + doxycycline
Outpatient Ceftriaxone + doxycycline (possibly metronidazole)
5. Patients with anaphylaxis to penicillin:
Inpatient Clindamycin, gentamycin, and doxycycline
Outpatient Levofloxacin + metronidazole
2. Chandroid
i. diagnose stain and culture on specialized media
ii. Treat with Single dose of Azithromycin
3. Lymphogranuloma venerum
i. diagnose Complement fixation titers in blood / Nucleic acid amplification on testing swab.
ii. Treat doxycycline
4. Herpes simplex:
i. Best initial test Tzanck prep
ii. Most accurate test Viral culture
iii. Treat Acyclovir, valacyclovir, famiclovir; Foscarnet for acyclovir resistant herpes.
UTI
Pyelonephritis
1. Best initial test urinalysis with more than 10WBC
2. Treatment 1. Ceftriaxone, ertapenem 2. Ampicillin and gentamycin 3. Ciprofloxacin (oral for
outpatient) (ceftriaxone is first for pyelonephritis)
Outpatient: Fluoroquinolones (ciprofloxacin, levofloxacin)
Inpatient: IV antibiotics (fluoroquinolone, aminoglycose +/- ampicillin)
Acute Prostratitis
Chronic Prostatis:Long term therapy with TMP-SMZ for 6-8 weeks is used for chronic prostatitis.
Endocarditis
1. Most diagnosis for endocarditis Fever + new murmur
2. Diagnosed Blood culture, Transthoracic echocardiogram, Transesophagel
echocardiogram.
3. Best initial therapy Vancomycin + gentamycin
Lyme disease
1. Diagnose- based on visual inspection of rash
2. Do serologic testing for manifestation of joint, neurologic and cardiac manifestation
3. Testing ith IgM, IgG, ELISA, Western blot, PCR.
4. Treatment:
Asymtoptomatic tick bite no treatment
Rash doxyxycline or amoxicillin or cefurime
Joint, 7th cranial nerve palsy Doxycyline, or amoxicillin or cefurime
Cardiac and neurologic manifestations other tha 7th nerve palsy IV ceftriaxone
HIV
1. Best initial test ELISA
2. Confirm with Western blot
3.Infected infants are diagnosed with PCR or viral culture.
Angioedema
1. Next step ensure airway prtection first
2. Best initial test decreased level of C2 and C4 in the complement pathway; deficiency of C1
esterase inhibitor
3. Treatment fresh frozen plasma or ecallinitide (ecallinitide is specific therapy for angioedema)
4. Long term management androgens: danazol and stanazol
IgA deficiency
These patients also present with sinopulmonary infections.
Presentation atopic disease, anaphylaxis to lood transfusions when blood is given from a pt. who
has normal levels of IgA, sprue like condition with malabsorption, Increase in risk of vitiligo, thyroiditis,
and RA.
Treat infections as thy arise, only use IgA deficient blood from donors.
Wiskott-Aldrich syndrome
This is an immunodeficiency with thrombocytopenia and eczema
Treatment Bone marroe transplantation only definitive treatment.