1) Common radiographic views

2) Objects are clearest when ________ to film

3) when can´t you see borders? eg.

4) What is this image?

[image]

1) PA, AP, Oblique, Lateral

2) closest

3) when objects of same density adjacent. eg= pneumonia

4) pneumonia of the R lung

Radiographic appearance (color) of following objects:

air

fat

bone

metal

Calcium

Organs, Muscles, Soft Tissue

Shades of gray are referred to as ___________.

air - black

fat - black

bone - white

metal - white

Calcium - white

Organs, Muscles, Soft Tissue - shades of gray

Shades of gray are referred to as water density.

The more uptake of ______1_______ in a tissue, the whiter it appears in a radiograph, and this is called ______2_____.

This allows the viewer to detect subtle differences between _______3______ and between _______4_____.  It also allows a clear view of __5_____ and ___6_____. 

What are the two agents used to do this type of radiography?  What is the risk?

1)contrast media

2) enhancement

3) normal & abnormal soft tissue

4) organ &  surrounding tissue

5) arteries

6) veins

Iodinated high osmolar contrast agent & LOCA (low osmolar contrast agent).    LOCAs reduce risk of osmolar reactions that occured ith HOCA (7% - vomiting, pain, resp sx, hives, burning, nephropathy).

1) the injection of iodinated contrast media directly into vein or artery via needle/cathetar.

2) the injection of iodinated contrast media and/or air into a joint.  What is this process used to image?  This has become less important since the advent of what 2 processes?

3) the placement of contrast media into spinal subarchanoid space.  Usually via ________.  What procedures are less invasive?

1) angiography

2) arthrography.  Images multiple joints (rot cuff heridas, meniscus of knee).  CT & MRI.

3) myelography. via  lumbar puncture.  CT & MRI.

1) What contrast media is used to view the GI tract? 

2) administration (3)?

3) contraindication for this process.

1) Barium

2) p.o. for upper GI series; intestinal tube for small bowel series; enema for lower GI series

3) when the integrity of GI tract questioned....barium can leak into mediastinum and peritoneum.

Computed tomography (CT) involves ___1______ anatomy imaging in ____2__,  ___3____, and ESPECIALLY ___4___ planes.

The thickness of the axial images range from __ to ___; a thickness of ___ is used for lung and ab.

Name common indications for CT imaging.

Common areas scanned and what you look for in each.

Advantages  (3)

Disadvantages (2)

Computed tomography (CT) involves sectional anatomy imaging in sagittal, coronal, and especially axial planes.

The thickness of the axial images range from 1mm to 10mm. ; a thickness of 10mm is used for lung and ab.

Trauma, Intracranial hemorrhage suspect/known, ab injury, fracture detection/eval, spine, foreign bodies (esp in joints), Dx of 1º & 2º neoplasms (liver, renal, brain, bone, lung), tumor staging.

Commonly scanned areas are chest, ab, brain.

• chest: nodules/masses on CXR
• ab: calculi, suspected appendicitis, pancreatitis, malignancy
• brain: in ER, acute trauma

Noninavsice, dec motion artifact, good spatial resolution.

Expensive, limited availability.

Magnetic Resonance Imaging (MRI) is especially useful for displaying ___1___ & ___2____ imaging.  Its main strength is to detect contrast within ______3____ better than _4___ images and ___5____.

Test of choice for evaluating....

The major diff btwn MRI and CT is......

Contraindications (6)

disadvantages (3)

fMRI is good for...

1) coronal

2) sagittal

3)soft tissues

4)CT

5) radiographs

Test of choice for evaluating CNS & disc herniation.

in CT the pt is exposed to xrays and in MRI the pt is exposed to harmless magnetic fields.

Contraindications: claustrophobic pts (duration 30-40min), pregnancy, cerebral aneurysms clipped by ferromagnetic clips, pacemakers, inner ear implants, metallic foreign bodies in/around eye

disadvantages: more expensive than CT & limited availability & pt must remain still

fMRI (functional): cognitive tests

1) Ionizing radiation images (3)

2) non ionizing (2)

3) what are the two types of imaging techniques and give examples.

1) radiography, CT, Nuclear Scintigraphy

2) MRI, echocardiography

3) projection (xray) & tomography (cross sectional in MRI and CT).

[image]

deep inhale: should be able to count 9 ribs

What are the arrows?

What are the lines?

What is the pt's positioning?

[image]

Arrows are air.

Lines are fluid lines.

Pt is vertical.

Ultrasound uses _____1________ to produce realtime images.  This procedure is safe and involves no ___2_____ and is non- __3________. 

4) Two advantages:

5) used in to evaluate....

1) high frequency sound waves

2) radiation

3) invansive

4) inexpensive, portable

5) preganacy, ovaries, uterus, gallstones, liver masses, biliary tract abnormalities, vascular studies, pediatrics

nuclear imaging

1) affinity

2) tissue

Radiofrequency ablation of tumors

      Placement of vascular stents

      Percutaneous drainage of abcesses    

are all examples of....  

What is....

PET (Positron Emission Tomography)

1) glucose

2) tumors

1.                                         2.

[image][image]

3.  [image]

1) Massive cardiomegaly

2) pleural effusion

3) pneumothorax (collapsed lung)

Indications for Utilization of Diagnostic Studies

CD

MT

Prog

Prog

Fit

Confirm Dx

Monitor Therapy

Prognosis

Progression

Fitness

SEPS

Sensitivity

Specificity

Predictive Value

Efficiency

1) Define Sensitivity and Specificity of Diagnostic Test.

2) Draw a positive/negative test result table.

DISEASE

Present              Absent

TEST     +           ??                      ??

             -            ??                      ??

3) Calculate of predicitve values of a postive result and a negative result and the test efficiency.

Sensitivity: + test in diseased person (True Positive)...the ability of a test to detect disease and is expressed as the percentage of patients with disease in whom the test is positive

Specificity: - test in non-diseased person (true negative)...  the ability to detect absence of disease and is expressed as the percentage of patients without disease in whom the test is negative.

DISEASE

Present              Absent

TEST     +       true pos (TP)        false pos (FP)

             -       false neg (FN)       true neg (TN)

    __TP___ X 100

     TP + FP (all diseased pts)

     FN + TN (all well pts)

Efficiency of a Test Result (%)

[image]

Define Testing Variables:

Qualitative

Quantatative

Semi-Quantative

Reference Intervals (Ranges)

Precision

Accuracy

Qualitative - type

Quantatative - #s

semi quantative - # range

Reference Intervals (Normal Ranges): + 2 S.D. of normal healthy population

Precision - free of random error/ reproducability

Accuracy - closeness to true value

CBC Components and normal values.

Indications.

HIV indicator.

osis/ilia...penia

Reticulocyte Count

ESR, used after what? Specificity.

Complete Blood Count

Indications: Anemia, Infection, bleeding, bruising, leukemia

• WBC - total #  &  % WBCs.  4,800 and 10,800 cells per cubic millimeter. Differential...
  
  • Neutrophils (bacterial) are most common.
  • Lymphocytes (viral, lymph leukemia). CD4 decreases in HIV
  • monocytes (bacterial, TB, malaria, RMSF, mon leuk, chronic ulcerative colitis, reg enteritis)
  • Eosinophil (parasite, asthma, allergy)
  • Basophil (marrow leuk/lymphoma)
• RBC - 4.2 to 5.9 million cells/cmm
  • Hgb - Hemoglobin (anemia, carries O2). 14-18g/dL M; 12-16g/dL F.
    
  • Hct - Hematocrit (packed cell volume).  volume of RBCs. 42-52% M; 37-47% F
• Platelet (Thrombocyte count) 140,000 to 440,000 uL
  
  • Mean Platelet Volume (MVP) 7-11 fL
    

osis/ilia=increase

penia=decrease

Reticulocyte Count/1000 RBCs=how fast RBC made (indirect hematopoiesis)

ESR=Erythrocyte Sedimentation Rate=how far column of RBC fall in 1 hr.  After dx of RA, decr=flair up. UNSPECIFIC.

Coagulation Tests: Define the following:

1) PT.

Measures...

Used to monitor...

reported in...

normal value

therapeutic levels in pt on coumadin...

2) aPTT

Measures...

Used to monitor...

reported in...

normal value...

abnormal value in...

3) D-dimer

used commonly where? 

for what suspected conditions?

collection requirement

1) Prothrombin Time

• measures common pathway of coagulation
• monitors warafin (anticoagulants) therapy
• reported in INR (international normalized ratio):      pt result/control result
• norm=1.0
• 2.0-3.0 for pts on coumadin

2) Activated Partial Thromboplastin Time

• measures coagulation sequence
• monitored old heparin therapy, not common today
• reported in seconds
• norm=21-45 sec
• abnorm= pts with factor VIII deficiency-Hemophilia A is the most common type of hemophilia.  It is also known as factor VIII  deficiency or classic hemophilia. It is largely an inherited disorder in which one of the proteins needed to form blood clots is missing or reduced.

3)

• ER, and possibility of clot
• PE, DVT, Disseminated intravascular coagulation (DIC)...this is deadly
• blue top tube

Coomb´s Test - what is this?

1) DAT

2) IAT

clinical blood tests in immunohematology and commonly used in crossmatching transfusions

1) direct antiglobulin test - used to detect if antibodies of complement system factors have bound to RBC surface antigens

2) indirect antiglob test - used to detect antibody-antigen rxns & to detect very low conc of antibodies present in pt's plasma/serum before bld transfusion

Urinalysis

1) Macroscopic - physical characteristics

2) biochemical DIPSTICK- pH, SG (specific gravity), prot (albumin elev in kidney disease), glucose (not norm present - DM), ketones (not norm present - fat metabolism), blood, leukocyte esterase (inc WBC with UTI or kidney infection), nitrite, bilirubin

3) microscopic if (+) dipstick: casts, parasites, epithelial/tubular/renal cells, RBC, WBC, bacteria, crystals, mucus

Chemistry Tests:

1) Timing

2) Profiles

3) panels

1) must wait for the results.  Usually performed 1/wk.

2) done to diagnose a specific problem

3) screening test, inexpensive, single specimen for multiple analysis.

Cardiac Profile, Define Each component

1) Troponins

2) LDH

3) AST

4) Cholesterol

5) What is the cause of most heart attacks?

1) Troponins - complex of three regulatory proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. cardiac troponin I and T. A patient who had suffered from a myocardial infarction would have an area of damaged heart muscle and so would have elevated cardiac troponin levels in the blood. THIS HAS REPLACED LDH AND AST.

2) LDH - lactate dehydrogenase 2 normally greater than 1.  In a MI, it is flipped and 1>2.   total

3) AST - aspartate aminotransferase

4) Cholesterol - HDL (good), LDL (bad), ratio

5) hyperlipidemia

TSH (Thyroid stim hormone)

T3 - 10-15% circulating hormone

T4  - 85-90% circulating hormone

T7 - metabolic impact of thyroid hormone on body

Liver Function Tests, indiciations:

1) Enzymes

2) anabolism products

3) catabolism

1) high? released from damaged/dead cells of organs-->

2) not making proteins: TP (100+prot), Albumin, Globulins (A:G)

glucose (in liver as glycogen)

and lipids (chol in liver, steroid hormone component)

3) not clearing waste

Bilirubin: causes jaundice and dark urine.

Total and direct (conjugated) bilirubin

Renal Function Tests

1) urinalysis

2) electrolytes

3) BUN & creatinine

4) uric acid

5) Ca, P, and TP

6) Arterial Blood Gases

1) RBC, WBC, prtn, blood.  Culture if infection suspected.

2) Na, K, Cl, CO2, Ca, P, Mg. 

Kidney disease=retain exc fluid=dilute Na & Cl.

3) Blood test: (blood urea nitrogen) & creatinine accumulate in the body without proper excretion with normal functioning kidney

Creatinine: muscle metabolism product (constant rate) dependent of muscle mass of pt

bun:prot metabolism... formed in liver as ammonia then to kidneys for excretion

4) Purine metabolism.  Not excreted due to renal failure leads to hyperurecemia=kidney stones & gout

5) 50% blood Ca bound to protein. Ca filtered by normal kidney then reabsorbed into blood. P is 85% in bones.  If kidneys stop functioning, Ca not reabsorbed and excreted in urine...body degrades bones to get Ca and releases P at same time.

Renal Failure>excreted Ca>Decr blood Ca>decr TP>body degrades bones>Incr blood P

6)

pH=low

partial pressure (amount dissolved in bld): pCO2, pO2

HCO3 (bicarbonate)

Decr CO2 levels (Mostly in form of HCO3 controlled by kidney) = renal problems.

Ca/P Levels....

1) State the relatioship between Ca/P serum levels.

2) State the levels Ca/P (inc/decr) for the following diseases...

1) Ca in the blood is filtered by the kidneys (glomular filtration & tubular secretion) and then re-enters the blood. 50% Ca is free and 50% bound to TP. 85% P stored in bones.

What Biochemical profiles would you use to test renal function?

What are their components?

27 y/o

norm: albumin

slight incr: TP, T bili, AP

mod incr: LDH

incr: AST

acute viral hep

slight incr TP, norm albumin: incr in IgM (antibody response to virus).

slight incr T bili: total bilirubin: conjugated bilirubin elevated due to inadequate clearance

AP, LDH, AST released with hepatocyte death/damage.

12 y/o child

norm: Ca

incr: Phos, AP

growing kid

AP of bone origin.

85% Phos in bone

72 y/o F with breast CA

Norm: Glu, BUN, Chol, T Bili

Incr: Ca, Uric, AP, LDH, AST

decr: phos, TP, Alb

metastatic CA to bone

Incr Ca & Decr Phos = 85% P stored in bone.  Bone degrading, accumulating P & Ca in blood. Osteolytic CA lesions.

incr AP: bone origin (degradation)

decr prot & alb= diet related = wasting phenomanon

incr LDH, Uric= LDH found everywhere; Uric is product of purine metabolism.  high cell turnover due to tumor proliferation

50 y/o male

norm: Ca, Phos, BUN, Uric, TP, Alb, TBili, AP

mod incr: Glu

marked incr: Chol, LDH, AST

Acute MI

incr LDH (or myocard origin), AST= heart cell damage

elevated AST w/o AP/Tbili incr = myocard origin b/c AP not in heart.

incr glucose= stress rxn...monitor continuously to ensure it is not DM

57 y/o pt with HTN

Norm: Glu, Tbili, LDH, AST

Decr: Ca, TP, Alb

Slt incr: Chol

Mod Incr: Phos, AP

Incr: BUN, Uric

chronic renal failure with 2º hypoparathyroidism and renal osteodystrophy

Decr Ca, Incr Phos = renal failure.  Kidney tubules not letting Ca re-enter blood, instead it is excreting Ca and body degrades bone (incr P) to get Ca.   Also, decr Ca due to decr TP (50% Ca bound to TP).

Dec TP, Alb = spilling albumin into urine b/c damaged glomeruli.

Incr: uric & BUN = inability to excrete metabolic byproducts

Incr AP (bone origin) = renal osteodystrophy

Incr Chol: body response to increase proteins lost in urine

23 y/o female

slight incr: Glu, Chol, Tbili

Incr: AP

she's preggers

Incr Chol= incr steroids to maintain preggers

 incr AP (placental and liver origin) = liver origin in combo with incr Tbili....cholestasis of pregnancy.

Gluc = gestational DM?  Do more investigation.

41 y/o

Decr: Ca, Chol, TP, Alb

Incr: AP, LDH

Malabsorption

Low catabolic products: Chol, Alb (TP)

Decr Ca & TP = 50% Ca bound to TP.

Incr AP (bone) = bone metabolism to get Ca

Incr LDH (RBC origin) = megaloblastic anemia when no B12 absorbed in sm intestine.

84 y/o female

Decr: Ca, TP, Alb

Old age 

Ca levels related to TP and Alb.

Low TP and Alb = decr production of proteins by an old liver.

64 y/o male, PMI of MI

Slight Decr: Alb

Slight incr: Tbili

Mod Incr: Phos, BUN, Uric AP

Incr: LDH, AST

CHF with Prerenal azotemia

(high nitrogen wastes in blood due to bad renal filtration when vol/pressure of blood filtering through kidney drops...assoc with lack of urine)

Decr Alb = alb responsible for maintaining oncotic pressure of blood (reg blood volume)

Elev: uric, BUN, P = kidneys not excreting metabolic byproducts

Incr P= Incr AP (bone).

Incr LDH (liver), Tbili, AST = congestion in liver from inadequate pumping of heart

42 y/o female

 Mod Incr: Chol, Tbili, AST

Incr: AP

Acute lower biliary tract obstruction

Incr AST and mod AP elev without LDH incr = biliary tract obstruction.

Incr Tbili = obstruction

Incr chol = gallstones??  maybe the source of obstruction??

What is the worst pandemic of alltime?

What are its characteristics (then and now) that ID specialists must deal with?

HIV

Previously, as CD4 dropped, pts presented with all of these rare diseases that clinicians didn´t know how to treat (thrush, oral hairly leukoplakia, TB)

Now: non AIDS related events appear to be higher in treated HIV disease: CV disease, CA (non AIDS), bone fractures/osteopenia, liver failure, cognitive decline

Three Lines of Defense:

1) phys/chem: talk about skin

2) non specific:

phagocytes

NKC

Inflammation

Complement

Interferons

Fever

3) specific: cells and proteins involved: B (3), T (4)

The specific immune response has a ________.

Its protection is _______.

1) Phy/Chem barriers: skin*, tears, saliva, earwax, dig acid, mucus, vomiting, urination, defecation, resident bacteria

*skin* - dead layer inhospitiable, shedding, acidic pH (5-6)

2) non specific: will attack anything:

1. phagocytes: neutrophil & macro digest; eosinophils kill with dig enzymes
2. NK cells: chem to disintegrate cell membranes of tumors/virus cells
3. Inflammation: red, warm, swell (histamine release, blood vessel dialation), pain.  Attract phagos to eat complement-marked bacteria
4. Complement: group of plasma prot to enhance inflamm/phago; kill pathogens by punching holes in cell wall, entering, and exploding.
5. Interferons: stim prot production to interfere with viral reproduction
6. Fever: less hospitible to pathogens, fights infections

3) specific defenses:

• B cells (humoral/AMI immunity): 
  • plasmas: secrete antibodies
  • memory B cells: 2nd exposure, become plasmas
  • Ig: 5 types. Primary IgM rise on 1st exposure.  IgG lifelong responder upon 2nd exposure.
• T cells (Cell Mediated Immun)
  • helper T cells: spec/nonspec def by stimulating immune cells
  • cytotocix t cells
  • memory T: reactivate later with exposure to same antigen to form helper & cytotoxic Ts
  • Supressor Ts: suppress immune response after antigen destroyed

The specific immune response has a memory.

Its protection is general, not linked to site of infection.

What is the Dx (the answers have to do with immune responses)?

1) recurrent neisseria infections?  What is neisseria, what are two pathogens?

2) Flu-like symptoms could be due to non-measurable levels of ___________. (define the answer and decribe how it is used therapeutically)

1) Problem with complement system.

Neisseria are gram neg diplococci.

• N. gonorrhoeae (also called the gonococcus), which causes gonorrhoea.
• N. meningitidis (also called the meningococcus), one of the most common causes of bacterial meningitis and the causative agent of meningococcal septicaemia.

2) interferons - proteins produced to interfere with viral production. 

Therapeutics: alpha, beta, gamma to treat hairy cell leuko, aids sarcoma, gen warts, chronic granulomatou dis, laryngeal papillomatosis.

What therapeutic agent is used to treat hairy cell leukemia, AIDS-related Kaposi's sarcoma, laryngeal papillomatosis, genital warts, and chronic granulomatous disease. Side effects include black tarry stools, blood in the urine, confusion, and loss of balance

Forms of Immunity (2).

1) INNATE: genetic

2) ACQUIRED:

a) active: after exposure to antigen (natural or induced through vaccination)

b) passive: transfer of antibodies from another source (natural from mom to fetus OR induced when antibodies therapeutically administered as immunoglobulins.

3 techniques used to Dx infectious diseases:

1) visually method and 5 types (5).

gram stain (method, colors), acid fast (looks for..., color..., method), india ink (method, substance, magnification, look for...), KOH (for what, look for..., how does it work?), tzanck (method, used for, look for..., specificity)

2) host response:

blood: explain and 3 examples

inflammation: example

3) nucleotides

(be specific)

1. direct visualization: 2 sets of blood (4 bottles/10cc per bottle).
   
   • gram stain: positive=purple.  negative=red/pink (LPS holds crystal violet). Fixation>crystal violet>iodine>decolor>safranin counter stain
   • acid fast: mycobacteria appears pink.  LOOK FOR 10 Min under oil immersion.
   • india ink: CSF on slide, examine @100x, look for cryptococcus/yeast.
   • KOH - skin scrape/vag smear & 1 drp KOH. Look for fungus.  KOH partially dissolves host cells and bacteria, sparing fungi.
   • tzanck's - suspected herpes vesicle, nonspecific for which of 8 herpes viruses, scrape down to base of vesicle and stain, look for multinucleated giant cells.

2) clues produced by host response: obtain 2 sera: one when pt presents with 1st symptom and one later on to detect Ig response (IgM then IgG).

3) detection of specific microbial nucleotide sequences

1) What is a gram positive clustered cocci?

2) Radiograph: RUL infiltrate.  What do you order?  What is your Dx?  What is the pt's Hx?

3) Pt with HIV presenting with headache, meningitis.  You take what kind of sample.  What prep method? what do you look for?

4) what prep do you use to look for fungal forms?

5) Reccurent vesicles on the butt could be what?  What sample would you use?  What is the limitation of this prep method?

1) staph

2) order acid fast stain for mycobacteria (AFB).  Think TB if pt has Hx of travel of HIV.

3) CSF sample, india ink, look at 100x for cryptococcus

4) KOH - skin scrape or vaginal smear

5) Herpes: HSV1, 2, CMV, Epstein Barr, Varicella.  Use Tzancks prep...unspecific for which herpes.

1) Name 4 types of organisms that infect humans

2) Name 2 spirilla

3) Most common cause of bacterial pneumonia.  View on slide.  Treatment.

4) N. gonorrhae.  Pt presents with... Describe the microbe and where it lives.  What type of drug did it become resistant to?

1) Bacteria, Virus, Parasite, Fungi

2) Syphilis & Lyme

3) Streptococcus pneumonia gram pos diplococci.  Acute onset fevers, chills, cough.  Rust colored sputum.  Lobar infiltrate.

Treat with: cell wall, prot syn, DNA gyrase, B-lactamase inhibitors

4) Presents with dysuria and yellow urethral discharge.  Gram neg diplococci: intracellular within WBC.  Large surge of quinolone resistance (Ciproflaxin)

4) gram neg bacteria

Viruses

1) are what type of of parasites?  What does this specifically mean?

2) contain....

3) wrapped with....

4) may be covered with a....

5) name 2 common viral infections

1) Obligate intracellular parasites, depending on the host cells for protein synthesis and replication.

2) RNA or DNA

3) protein nucleocapsid

4) enveloped or non enveloped viruses

5) influenza & HSV 2

1) Pt presents with sudden onset of fever, myalgia, headache, cough.

What is the microbe?  Describe the microbe (nucleic acid, family, transmission, incubation, resolution).

2) Pt presents with a severe vesicular rash on the penis.  Several months later, pt comes to the office with a less severe vesicular rash on buttocks preceded by a tingling sensation.

What is the microbe and is its characteristic and nucleic acid?

3) In what type of pt would herpes zoster (Shingles) cross the midline?

1) Influenza RNA virus (seasonal flu).  Orthomyxovirus fam.  Airborne spread through the nose, settling in respiratory tract.  Incubation 24-48 hrs.  Resolution 4-7 days.

2) HSV 2 (genital).  DNA viruses (HSV 1 & 2).  Latent infections.

3) Immunocompromised pt.

Fungi:

1) name the two types?

how can you tell them apart miscroscopically?

Which usually only grow in immunocompromised pts?

2) Why don´t typical anitbiotics work as treatment?

3) decribe candida cells and 2 conditions it causes.  What type of cell prep do you use?  What are the causes of candida vaginal infection?

4) Describe the most effective mechanism of antifungals.

1) Yeast (single cell), molds (long filaments - IMMUNOCOMPOMISED pts)

2) fungal walls contain chitin - different cell wall that doesn't work with antibiotics

3) oval yeast with single bud (thrush, vaginits). KOH prep.

Vaginal yeast infection due to: high pH, DM, antibiotics.

4) exploits prescense of ergosterol in fungal cell membranes.

Parasites

 name the two types

1) single cell protozoa

&

multicellular metazoa (helminths/worms): roundworms, flukes, tapeworms

pt presents with foul smelling, watery vaginal discharge accompanied by itching and burning after being a little slut.

1) what condition/microbe do you suspect?  What type of microbe is this?

2) how do you confirm Dx?

3) treatment

1) Trichomoniasis caused by Trichomonas vaginalis, a urogenital parasitic protozoa.

2) wet mount

3) metronidazole

Fever:

1) What body systems should be checked upon PE?

2) lab studies

3) define fever of unknown origin FUO.  What are the big 3 origins of FUO?

1) Vitals, Skin (petechial, vesicular rash, migratory erythema), scalp, eyes, lymph nodes, mouth, lungs, heart, musculoskeletal, neuro

2) CBC, Urinalysis (with culture), radiographs, blood chem, LFT, Body Fluids

3) 101ºF,  >3wks, undiagnosed after 3 days in hospital/outpt visit.

Neoplasms

Collagen Vascular Disease

Drugs/PE