526 Infectious Disease Flashcards
what is hyperpyrexia
temperature over 41.5
what is fagets sign or sphygmothermic dissociation
elevated temperature with relative bradycardia
what are 2 common tropical diseases to be considered in a febrile patient with recent travel
malaria
dengue
what drug classes are commonly implicated in drug induced fevers
antihypertensives
antiarrhythmics
antibiotics
thryoid medication
antiepileptics
elevated lymphocytes in a febrile patient may indicate what
viral infection
elevated monocytes in a febrile patient may indicate what
mono
eosinophils in a febrile patient may indicate what
parasites
asthma or allergy
an elevated ESR >100 greatly increases possibility of what diseases in a febrile patient
osteomyelitis
endocarditis
temporal arteriris
rheumatological disease
at what temperature should fever always be aggressively treated
41 degrees or above
immunosuppressed patients should seek medical care for a fever above what
37.8
true or false: vertebral osteomyelitis with neuro symptoms can be treated as outpatient
false, it requires urgent hospitalization
what timelines define acute and chronic osteomyelitis
acute less than 2 weeks
chronic more than 3 months
what is the treatment for osteomyelitis once bone necrosis has occured
surgical debridement
what is the Cierny-Mader classification
to determine the extent of anatomic involvement of osteomyelitis to help determine treatment
which stage of osteomyelitis can be treated with antibiotics alone
stage 1
what are the 3 stages of the cierny mader classification
stage 1 - medullary
stage 2 - superficial
stage 3 - localized
stage 4 - diffuse
what symptoms would you suspect to see in osteomyelitis
localized pain, erythema, swelling, +/- fever
true or false: osteomyelitis of the hips, pelvis and spine are more likely to present as subacute with a dull persistent pain
true
what blood work should be completed for a suspected osteomyelitis
CBC with diff and CRP
when should blood cultures be obtained with osteomyelitis
vertebral osteomyelitis
or is febrile
what is used for the definitive diagnosis of osteomyelitis
bone biopsy
what is first line investigation for possible osteomyelitis? what is used if first line is inconclusive
first line is xray
mri if xray is unclear
true or false: wound biospy is just as useful as bone biopsy in determining causitive organism in osteomyelitis
false, bone biopsy is gold standard
what are the main differentials other than osteomyelitis that need to be ruled out
soft tissue infection
septic arthritis
when is surgical consultation needed for osteomyelitis
patient with vascular insufficiency
debridement or drainage needed
although ID should be consulted, what is typical first line treatment for osteomyelitis
vancomycin plus 3rd gen cephalosporin like ceftriaxone
how long are antibiotics usually given for osteomyelitis
6 weeks of IV abxw
what is the difference between lymphadenitis and suppurative lymphadenitis
lympadenitis is tender, warm, ertyhematous nodes
suppurative includes fluctuance
pain associated with a rapidly growing lymph node is usually a sign of what
infection
what does an enlarged virchow node indicate and where is the virchow node
left supraclavicular node
concern for malignancy within abdominal organs
unilateral or bilateral lymph nodes are more likely to be malignant
unilateral
what abdominal assessment should be completed with any upper lymphadenopathy below the neck?
check for splenomegaly and enlarged liver
how long should lymphadenopathy with no known cause by left for a period of observation
3-4 weeks
what is the acronym CHICAGO and what is it used for
Cancers
hypersensitivities
infections
connective tissue disease
atypical lymphoproliferative disorders
granulomatous lesions
other unusual causes
framework for differential for lymphadenopathy
right sided supraclavicular lymph nodes suggest pathology in the ____ and left sided suggest pathology in the ____
right - thoracic/lungs
left - abdominal/peritoneal
what is a sister mary joseph sign and what does it indicate
palpable nodes around the umbilicus. Sign of significant intra-abdominal lymphadenopathy, usually malignant
what conditions present with generalized lymphadenopathy, fever, fatigue, weight loss and night sweats
lymphoma and TB
what are shotty nodes, what do they indicate, when would you find them
inguinal nodes that are firm, not fixed and less than 1 cm
they are common in adults as a result of recurrent infection or injury in the feet and legs
what other organs are part of the lymph system and should be assessed with generalized lymphadenopathy
spleen and tonsils
true or false: sarcoidosis is an allergic reaction
false, it is an inflamatory
erythema nordosum, lymphadenopathy, and respiratory symptoms is indicative of what condition
sarcoidosis
a 20-30 year old black female patient with dry cough, shortness of breath and nodules on the shins is indicative of what disease
sarcoidosis
what are lupus pernio and when are they seen
raised purple lesions on tip of nose and across cheeks
with sarcoidosis
true or false: sarcoidosis only affects the lungs and skin
false, it can affect all systems throughout the body causing multiple different sequela
what is lofgrens syndrome
caused by sarcoidosis
includes: erythema nodosum, bilateral hilar lymphadenopathy, and polyarthralgia
what condition would cause an increased serum ACE and increased CA
sarcoidosis
how is sarcoidosis diagnosed
histology with skin biopsy or bronchoscopy
what is the difference between primary and post primary TB
primary is first occurence of TB and is usually not symptomatic
post primary is when TB is reactivated from not being treated and is usually symptomatic
how long after being infected with TB before a TST will be reactive
2-8 weeks
when measuring a TST test, what is measured?
mm of induration, not erythema
does a negative TST conclusively rule out TB
no, there are many causes for a false negative
true or false: having HIV or AIDs means you are more likely to have a false negative on the TST test
true
what is the two step method for a TST
if first reaction is + = infected
if first reaction is -, repeat test in 1-3 weeks
true or false, history of the BCG vaccine will not affect your TST result
false, it is variable and may or may not affect the result
is history of BCG vaccine a contraindication for the TST test
no
what is another diagnostic way to test for TB other than the TST
serum IGRAs
TST or IGRA is perferred testing method for children under 5
TST, there is little evidence on the IGRA for children under 5
true or false: IGRA or TST play a role in diagnosing active TB
false, they are screening test
true or false: CXR results may suggest TB but cannot be diagnostic
true
true or false: a positive AFB is diagnostic of TB
false, although strongly suggestive, it is not diagnostic
what is the test that is diagnostic for TB
positive culture
what are the most potent first line drugs in TB treatment
INH and rifampin
what is the major side effect associated with INH
hepatitis
what influenza type symptoms would warrant emergency referral
new onset confusion
CP
difficulty breathing
abdo pain
persistent vomiting
worsening symptoms
suspicion of epiglottis
how long does a fever associated with influenza usually last
2-3 days but can last as long as 8 days
amantadine and rimantadine are effective against what strain of influenza
influenza A
at what age can people start to recieve an annual influenza vaccine?
6 months or older
