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Senior - ID 3 > 18 - Pet and why ms booker hates them > Flashcards

18 - Pet and why ms booker hates them Flashcards

1
Q

Dog bite vs cat bite, which one is going to the hospital?

A

Cats almost always

Cat bites - 80% infection rate

Dog bites - 5% infection rate

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2
Q

Why are cats worse?

A

Their teeth are small and pointy

They can inject bacteria deep into the tissue

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3
Q

MC location for dog and cat bites?

A

The hand that feeds them

Dog - 50% of bites on hand
Cat - 63% of bites on hand

Next up
Cats - shoulder, arm, forearm 23%
Dogs - thigh and face/neck tied at 16%

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4
Q

History taking?

A

Yeah you need one, there are legal ramifications sometimes

Also if its not a domestic animal it may help to know what it was and the conditions

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5
Q

Physical?

A

Can be misleading

  • cat bites look innocuous
  • dog bites may leave foreign bodies/teeth etc imbedded
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6
Q

Labs and diagnostic studies?

A

Ms booker says they are generally not helpful

Having had a very bad infection (red streaks of death) previously from a dog bite, i assure you that a culture can be a very important thing for a complicated bite

Especially cats, those dirty mouthed shits

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7
Q

Tx for bites?

A

Copious irrigation of the wound
- isotonic NaCl

Treat for

  • polymicrobial coverage
    • esp staph and anaerobes
  • tetanus prophylaxis
  • rabies prophylaxis (situation dependent)
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8
Q

DOC for cat and dog bite?

A

Amoxicillin clavulante (augmentin)

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9
Q

MC pathogen in a cat bite?

A

Pasturella multocida

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10
Q

Surgical tx for bites?

A

Debridement - esp necrotic tissue

Primary vs 2ndary intent closure depends on the wound’s likelihood of infection

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11
Q

Primary v secondary closure?

A

Primary

  • well cleaned wounds
  • face (rarely gets infected)

Secondary

  • hands
  • lower extremeties

Delayed primary
- older than 6 hrs

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12
Q

Consults for bites?

A 
Plastic surgeon - disfiguring inj
Hand specialist - hands duh
Orthopedist - join inj
Neurosurgeon - skull
Vascular - neck wounds
ID - immunocompromised

These consults may be emergent

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13
Q

Complications for animal bites?

- big long list

A 
Meningitis
Sepsis
Septic arthritis
Osteomyelitis
Cellulitis
Wound infection
Face/neck deformities
Limb deformities
Limb loss
Pet going to “live on a farm”
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14
Q

Cat scratch fever?

A

Bartonella henselae

  • carried by cats and fleas
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15
Q

Cat scratch fever is the MC cause of?

A

Chronic adenopathy - kids

Regional adenopathy

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16
Q

Common complaints with cat scratch disease?

A

A cat scratch

Classic 
- rash (90%)
- lymhadenitis
FOUO (33%)
Fatigue (33%)

Rare
Parinaud oculoglandular syndrome
CNS findings

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17
Q

S/s (classic disease of cat scratch fever

A

Rash - 1 + red papules

  • 0.5cm or less
  • site of inoculation (cat)

Lymphadenitis - x 4-6 weeks

  • up to 1 yr
  • sinus track may form
  • axillary nods (MC)
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18
Q

What lymph nodes are MC affected with cat scratch fever?

A

Axillary
- cervical -> submandibular -> preauricular

1/2 of pts only have 1 node

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19
Q

S/s fever and fatigue?

A

Fever x 1-2 wks

fatigue - wks - months

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20
Q

Parinaud oculoglandular syndrome?

A

If the site of inoculation is

  • eyelid
  • conjunctiva

Can be lick, scratch or bite

Symptoms after a few weeks

  • nonpurulent conjunctivitis
  • ocular granuloma
  • preauricular adenopathy
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21
Q

Parinaud oculoglandular syndrome prognosis?

A
  • self resolve (months)

- no residual damage

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22
Q

Cat scratch disase CNS symtpoms?

A

Encephalitis

  • seizures
  • myelitis
  • peripheral neuropathy
  • retinitis
  • bell palsy
  • extremity weakness
Slow onset
Long recover (up to 1 yr)
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23
Q

Diagnosis for CSD?

A 
H and P 
Lymph node biopsy
Serology tests
- IFA
- antibody titer to bartonella
- indirect immunofluorescence (CDC)
- PCR
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24
Q

CSD tx?

A

If pt is immunocompetent

  • symptomatic only
    • usually self limited
    • macrolide (z-pack) if needed

Paringuad oculoglandular syndrome
- also self limited

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25
Q

Toxoplasmosis (toxoplasma gondii) is a?

A

Obligate intracellular parasite

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26
Q

What patients have a hard time w toxo?

A

Fetuses
Newborn
HIV

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27
Q

Toxo route?

A

Feces from acutely infected cats
Transported via lymphatics
Disseminated hematogenously throughout the body

28
Q

If a pt has toxo you should?

A

Screen their family

- esp pregos and immunocompromised

29
Q

If you arent one of the high risk pts? (Toxo)

A

Typically asymptomatic (80-90%)

30
Q

Immunosuppressed pts with toxo?

A

Rapidly progressive disease

  • fatal
  • toxoplasmic encephalitis (1-5% of AIDS pts)
31
Q

S/s of toxo in immunocompetent pt (i guess that unlucky 10%)

A 
Mononucleosis-like
Cervical lymphadenopathy
Fever
Malaise
Night sweats
Myalgias 
Pharyngitis
32
Q

Toxo s/s in imjunocompromised?

A

AIDS = toxoplasmic encephaltiis

Non AIDS

  • CNS disease (50%)
  • similar to immunocompetent s/s
  • myocarditis
  • pneumonitis
33
Q

MC manifestation of toxoplasmosis?

A

Toxoplasmic encephalitis (AIDS pts)

34
Q

Pt reports vision changes?

A

Could be CNS presentation of toxo in an immunocompromised pt

35
Q

Congenital toxo s/s?

A 
Most severe - early pregnancy
Often asymptomatic (67%)
Ocular involvement (15%)
Intracranial calcifications (10%)
36
Q

Congenital toxo at birth s/s?

A 
Anemia
Thrombocytopenia
Jaundice
Microcephaly 
Hydrocephalus
37
Q

Congenital toxo later presentation?

A 
Chorioretinitis (MC)
- 4yrs old
- blurred vision
- exudative bilateral retinal lesions
MR
Seizures
Visual defects
Spasticity
Severe neurological sequelae
38
Q

Countries where congenital toxo is a big deal?

A

South america

  • columbia
  • brazil
39
Q

Labs/diagnostics for toxo?

A

Toxoplasma organism

  • blood
  • body fluids
  • tissue
  • amniotic fluid
  • ELISA

Head CT
- cerebral toxo

Amniocentesis (20-24 wks)

40
Q

Toxo tx?

A

Asymoptomatic host?

  • no tx
  • <5 y/o is the exception

Other stuff is treated based on presentation

41
Q

Toxo chorioretinitis, congenital and pregnancy >18 wks tx?

A 
Pyrimethamine 
\+
Sulfadiazine
\+
Leucovorin
42
Q

Acute toxo in pregnancy < 18 wks?

A

Spiramycin

43
Q

AIDS toxo tx?

A 
Cerebral toxo (acute) and (suppression)
- pyrimethamine + sulfadizine + leucovorin
44
Q

Primary prophylaxis of toxo for AIDS pt?

A

Trimethoprim-sulfamethoxazole

45
Q

What causes fish tank granuloma?

A

Mycobacterium marinum

- atypical mycobacterium

46
Q

Who gets mycobacterium marinum?

A 
Skin trauma 
\+
Contact w
- aquarium
- salt water
- marine animals
47
Q

S/S of fish tank granuloma?

A 
Papule/nodule at site
- can ulcerate
Sporotrichotic type 
Pain/induration
Tenosynovitis/septic arthritis
48
Q

Systemic fish tank granuloma infection?

A

Rare except in immunocompromised

49
Q

Fish tank granuloma is best cultured, what will the results look like (for pos)?

A

Photochromogenic

  • dark - white
  • light - yellow
50
Q

False pos for fish tank granuloma?

A

PPD

51
Q

Abx for fish tank granuloma?

A

Clarithrymycin + ethambutol

Ethambutol + rifampin

Min 1 month - up to 6 months

52
Q

MC zoonosis in the world?

A

leptospirosis

53
Q

What causes leptospirosis?

A

Pathogenic spirochetes

- leptospira

54
Q

Though found w/w leptorspirosis is mostly concentrated in?

A

The tropics

55
Q

High risk areas for leptospirosis?

A 
India
Sri-lanka
Thailand
Vietnam
Malaysia
China
Seychelles
Caribbean
Brazil
Pacific islands
56
Q

Transmission of leptospirosis?

A

Acutely infected animal
- Direct contact w body fluid

Chronic carrier animal
- contaminated w urine

57
Q

High risk activities or leptospirosis?

A

Activities involving fresh water, soil and animals

  • hiking in jungle
  • kayaking
  • swimming
58
Q

Clinical syndromes of leptospirosis?

A 
Anicteric leptospirosis (90%)
- self limiting/mild
Icteric leptospirosis (weil disease)
- sever/multi organ
59
Q

What determines which condition will develop (lepto)

A
  • serovar involved
  • health
  • nutritional status
  • age (elderly)
  • immunocompromised
  • rapidity of tx
60
Q

S/s of ictric leptospirosis?

A
  • Multi-organ involvement
  • high temp (100-104)
  • rigors
  • sudden HA
  • N/V and diarrhea
  • anorexia
  • cough
  • pharyngitis
  • nonpuritic skin rash
  • muscle pain (classic)
61
Q

Anicteric leptospirosis s/s?

A
  • self limited

- mild flulike illness

62
Q

Gold standard lab for leptospirosis?

A

Isolation of leptospires
- human tissue/fluids
(Typically urine)

63
Q

Studies to determine the extent of organ involvement (lepto)?

A

CBC
Liver panel
Coagulation studies

64
Q

Leptospirosis tx?

A

Sever
- Penicillin G

Outpatient
- doxycycline

65
Q

Dont stop retrieving 🎼

A

Hold on to that feline 🎼

Senior - ID 3 (11 decks)

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