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Stuff to Look for on ECG

Q1S3T3: Pathognomonic for Cor Pulmonale, right heart fialure. Elevated Q and S in relevant leads, but inverted T.

First through Sixth Diseases

Number	Other names for the disease	Etiology(ies)	Descriptions (see below)/Image
First disease	Rubeola, Measles, Hard measles, 14-day measles, Morbilli	Measles virus	Description, Images
Second disease	Scarlet Fever, Scarlatina	Streptococcus pyogenes	Description, Images (case)
Third disease	Rubella, German measles, 3-day measles	Rubella virus	Description, Images
Fourth disease	Filatow-Dukes' Disease, Staphylococcal Scalded Skin Syndrome, Ritter's disease	Some say the disease does not exist1. Others believe it is due to Staphylococcus aureus strains that make epidermolytic (exfoliative) toxin2,3	Description
Fifth disease	Erythema infectiosum	Erythrovirus (Parvovirus) B19	Description, rash
Sixth disease	Exanthem subitum, Roseola infantum, "Sudden Rash", rose rash of infants, 3-day fever	Human Herpes Virus 6B or Human Herpes Virus 7	Description, Images

Treatment for Acute Food Poisoning, Possible Salmonella

Acute:

Ondansetron 4mg IV

IVF bolus

CBC, CMP, Stool Culture

Chronic:

Cipro 500 BID x 5 days

Merbentyl = Dicycloverine (anti-cholinergic) po tds x 5days

Panadol

Flu vs Cold

Sneezing, Stuffy nose, sore throat and PRODUCTIVE cough common to Cold (Rhinovirus), not Flu (Influenza A, B or C).Otherwise Flu is typically more severe.

Murmurs

Bicuspid aortic valve: prominent ejection click followed by a mid-systolic murmur best heard over the right second intercostal space.

Ventricular Septal Defect causes loud holosystolic murmur best heard over third and fourth spaces on the right hand side.

Mitral Valve Prolapse (MVP): Mid-systolic Click with short late Systolic Murmur heard best at the apex. Disappears with squatting due to increase in venous return = preload. Echocardiogram to confirm.

Mitral regurgitation: increases with squatting, heard best at apex.

Mitral Stenosis often secondary to Rheumatic heart disease. Diastolic with presystolic accentuation.

Major causes of cardiac death

Coronary Artery Disease

Cardiomyopathy
-Hypertrophic Cardiomyopathy (1 in 500)
Arrhythmia
-Long QT Syndrome (1 in 2500)
Congenital Heart Defect

Juxtaglomerular cells

release renin

Histoplasmosis

Dimorphic: mold in cold, heat in yeast

Dz spread by bats especially in caves

Invades macrophages

Transmission through respiratory states

Hepatosplenomegaly

Hilar calcifications

May mimic tuberculosis (cacti from the TB Ranch video)

Erythema nodosum

Histology of macrophages with oval bodies (canary in Macrophage cage)

Disseminated disease in immunocompromised pts

----Severe systemic dz rx: amphotericin B

Dx: Serum Rapid Ag test

Dx: Urine rapid Ag test

Rx for Local or mild dz: -conazole

Smaller than an RBC

Blastomycosis

Dimorphic: mold in cold, heat in yeast (Dimorphic butterfly)

Dx with urine antigen test (Rver is Yellow like Urine)

systemic dz affects skin and bones

Bone involvement: osteomyelitis (stone is cracked)

Immunocompromised (Statue has cane)

Rx: Amphotericin for disseminated dz (Frogs)

Distributed: Great lakes and Ohio river valley (River Valley in Background, soldier with Map)

Itraconazole for local infections (pine cones)

Broad-based budding , same size as RBC (Pairs of Cannon balls)

Transmission: inhalation, aerosolized spores (Smoke from cannon)

Lesions or cavities in lungs (lung cavitation in ground)

Chest X ray has patchy alveolar infiltrate (Hazy Valley)

Coccidioidomycosis

Radiographic images may show nothing, cavities or nodules

Cocci forms spherules filled with endospores in lungs

Treat local lung infexction with -conazoles

Clinically looks like pneumonia: cough, fever, arthralgias

Cocci associated with erythema nodosum

Transmission: spores in dust

Cocci spherules larger than RBCs

Cocci is dimorphic

Immunocompromised

Skin and lungs common sites of infection

Disseminates to bone of immunocompromised

Earthquakes are risk factor

Amphotericin for disseminated dz

Southwestern United states distribution

Can induce disseminated meningitis in immunocompromised

Paracoccidiococcus

Rx: Itraconazole for mild infections

Distribution: South America

Transmission: respiratory droplets

Mucocutaneous lesions (bad teeth,)

Dimorphic: mold in cold, heat in yeast (Dimorphic butterfly)

Cervical, axial, inguinal lymphadenopathy (white beaded dread locks)

Progresses to lungs, causing lung granulomas (medallions over lungs)

Yeast form looks like a "Captain's wheel"

Amphotericin for serious dz

Larger than RBCs

Malasezzia furfur

Rx: selenium sulfide, brand: Selsun Blue

Flourishes in heat, humidity, sweating

Hypo-,hyperpigmented skin patches, located on back and chest

spaghetti-and-meatball appearance on KOH preparation of skin scrapings

Fungemia in neonates receiving lipid infusions or catheter TPN

Confined to stratum corneum, (Mnem: Californians Like Girls in String Bikinis: Corneum, Lucidum, Granulosum, Spinosum, Basale)

Acid from lipid degradation damages melanocytes

Dermatophytes

Wood's lamp used to Dx Derm. Microsporum (Wooden lamps in the trees)

Dxed with KOH on skin scrapings (Microsporum Munchkin using KOH salt shaker )

Tinea Capitis on head/scalp (especilly athletes, headband)

Dermatophytes can cause tinea

Tinea corporis on body

Pruritic (itchy) lesions

Tinea cruris "Jock itch in groin

Tinea pedis athlete's foot on feet

Animals can be source of transmission

Rx: topical azoles (Pine cones in the trees)

Also causes onychomycosis (Nail-biting Wizard of Onychomycosis)

Rx for onychomycosis: Terbinafine and griseofulvin (Wizard's Turban, Wizard holding can of grease)

Trichophyton, Epidermophyton, Microsporum (Three Munchkins)

Infects the skin

Sporothrix Schenckii

Cigar-shaped yeast

Ascending lymphadenitis

Dimorphic: mold in cold, heat in yeast (Dimorphic butterfly)

Hyphae are thin and branched

Causes rose-gardener's dz

Spores enter body through cuts

Found on tree bark, brushes, plants

Alternative Lymphocutaneous Rx: Saturated potassium iodide

Lymphocutaneous sporotrichosis Rx of choice: itraconazole

Menstrual Cycle Chart

Trematodes aka Flukes

Freshwater Snails are always intermediate hosts, but spread through water
Chlonorchis sinensis = chinese liver fluke Cholangiocarcinoma Biliary fibrosis (Sea gull = gull bladder, rocks = pigmented gall stones) Intermediate host: snails Pigmented gallstones Operculated eggs on O&P (eggs with little yamakah hats) Rx: Praziquantel
Paragonimus westermani (pinguin exhibit) Consumption of raw or undercooked crab meat with larvae Rx: Praziquantel Operculated eggs on O&P Intermediate host: snails Chronic cough with bloody sputum
Schistosoma haematobium Swimmers at risk (freshwater transmission) Bladder cancer risk, can see bladder thickening Intermediate host: snails Rx: Praziquantel Hematuria Large terminal spine
Schistosoma japonicum (Small spine), mansoni (large lateral spine) (See red fish) Portal hypertension (crack to port hole) migrate against portal flow Jaundice (Japanese tourist has on yellow coat)

Cestodes

Taenia solium



Echinococcus granulosus

Cestodes
	Taenia solium (sun and SOLd sign) Hooks only on T. solium heads seen on stool O&P (only seen on T. solium, hooks on tent) Pigs serve as intermediate hosts Rx: Praziquantel, Albendazole (with neurocystericosis) Eggs transmitted by water contaminated with feces (cheese-wheels fallen in the poop water) Neurocystericosis causes seizures, CT of head has swiss cheese (seizure) appearance (carousel cheese-head)
	Taenia saginata Cattle serve as intermediate hosts Rx: Praziquantel, Albendazole (with neurocystericosis) Eggs transmitted by water contaminated with feces (cheese-wheels fallen in the poop water) Neurocystericosis causes seizures, CT of head has swiss cheese (seizure) appearance (carousel cheese-head)
	Echinococcus granulosus (cocker-spaniel) Hydatid cyst in liver Transmitted by dog feces Dogs definitive host, sheep intermediate host (sheep dog) Cyst rupture causes anaphylaxis and acute abdomen Eggshell calcifications in cyst on liver CT Eosinophilia (Phil the sling-shot kid) Rx: Praziquantel (Prizes, Pretzel), Albendazole
	Diphylobothrium latum: fish tapeworm (guy running for bahthroom) --Rx: Niclosamide (nickle to use portapotty) --Cobalamin = B12 deficiency (Cobalt blue firework) --Longest tapeworm (toilet paper around leg) --Proglottid segments seen on stool O&P (segments of toilet paper in mud)

Tissue Nematodes

Wucheria bancroftii = Witch Spread: moquito vector, common in Africa Eosinophilia = pink marbles Organisms seen on thick blood smear =blood on hat Cough from filiariae in lungs Lymphadenopathy = puffed sleeves Rx: Diethylcarbamazine = magazine Elephantiasis from long-standing lymphedema = Elephant-like legs
Dracunculus medinensis Spread by water with Copepods containing larvae Adult females spread from painful skin ulcer
L. Loa Deer flies vector Adult worms migrate across conjunctiva Rx: diethylcarbamazine, or albendazole Local subcutaneous swellings Eosinophilia
Onchocerca volvulus Black fly vector Rx: Ivermectin microfilariae seen in skin biopsy under microscope Microfilariae seen in eye and can cause blindness Hypo and Hyperpigmented spots in onchodermatitis Eosinophilia Toxocara canis Ocular larva migrans lead to blindness Transmitted by consuming food containing dog and cat feces Rx: Albendazole Eosinophilia

Intestinal Nematodes

Can all be treated with -bendazoles
Enterobius vermicularis = pinworm female worms migrate to anus and lay eggs Transmitted fecal-oral route Associated with low-hygiene children Scotch tape test Rx: Pyrantel pamoate Rx: Albendazole
Ancyclostoma duodenale & Necator americanus = hook worms (One Character: American Dude) Causes iron deficiency anemia Eggs in the stool High eosinophil count Rx: pyrantel pamoate, albendazole Spread through soles of the feet
Ascaris lumbricoides (Character made of lumber) Larva go from gut to blood stream to lungs, mature in small intestine. Most likely to cause respiratory sxx Ascaris can obstruct the ileocecal valve Eggs found in stool High eosinophil count
Strongyloides sterconalis Penetrates the soles of the feet Travels from blood to lungs to GI (arrow) Adults can also nest eggs in intestine Dx: only larvae found in stool (eggs are in intestinal wall eosinophilia Rx: Ivermectin or Albendazole
Trichinella spiralis Sx: vomiting, periorbital edema, fever Larvae enter blood stream Larvae form Cysts taken orally through undercooked meat, esp pork muscle inflammation and myalgia from cyst invasion Rx: Albendazole

Trichomonas

See also Vaginitis Differential.

Yellow-green vaginal discharge

Motile trophozoite form seen on wet mount

Cervicitis "strawberry cervix"

Vaginal pH is 4.5 and above

Sx: burning, itching, smelly discharge

Sexually transmitted

Rx: metronidazole, both partners

(note the flagellum on Trichomonas organism around 10 o'clock above the word "Yeast".)

Keyword: Trichomoniasis

Leishmaniasis

Sandfly vector

Leishmania braziliensis: cutaneous leishmaniasis, vertebrate host

-----Rx: Stibugluconate

L. donovani causes visceral leishmaniasis, Black fever, kala-azar

-----Amastigote is intracellular form, invades macrophages

-----Rx: Amphotericin B

-----Bone marrow affected: pancytopenia

-----Hepatosplenomegaly

Plasmodium

Blood stain and Giemsa stain to see merozoites in RBCs

Anopheles mosquitos carry sporozoites

Sporozoites mature to trophozoites in liver

Schizont develops from trophozoites, splits into merozoites, bursts hepatocytes, infects RBCs

Ring form of immature schizont in RBCs

Merozoites can form gametocytes, these reinfect mosquitos

Vivax and ovale spp:

----Hypnozoites in hepatocytes

----Tertian (48 hr) fever cycle

----Rx: primaquinone

----Rx: chloroquine

----Rx for chloroquine resistant: Mefloquine

Plasmodium malariae:

----Quartan (72 hr) fever cycle

----Rx: chloroquine

----Rx for chloroquine resistant: Atovaquone and proguanil

Plasmodium falciparum:

----Parasitized RBCs occlude blood vessels to kidneys and lungs

----Cerebral malaria

----Sickle cell disease is protective

----Rx: artemisins and quinidine

----Side effect of quinidine is cynchonism: tinnitus, deafness, photophobia

----Artesunate and Quinidine delivered IV for severe infection