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SBL Exam 2 > 7. Clinical Considerations in Fever > Flashcards

7. Clinical Considerations in Fever Flashcards

1
Q

what causes coccidiocomycosis?

A

infxn from inhaling C. immitis or C. posadasii

=mold in SW US, Mexico, Central/S. America

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2
Q

exposure to anopheline mosquitoes in malaria-endemic areas will present as

A

intermittent chills, fever, sweating

HA, myalgia, vomiting, splenomegaly

anemia, thrombocytopenia

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3
Q

what are characterisitcs of MRSA

A

often hospital acquired

common in immunocompromised pt

wound = localized erythema w/ induration & purulent drainage (abscess common)

Gram (+) cocci on stain; culture = (+)

(+) s. aureus –> focus on endocarditis, osteomyelitis and deep seated systemic infxns

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4
Q

compare and contrast erysipela & cellulitis in MRSA skin infxn

A

erysipela: superficial & well-defined borders

cellulitis: deep (dermis & subQ fat); edema, & swelling common

both: painful, warm, indurated, erythematous, nonlocalized & may include lymphangitis

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5
Q

What are significant characteristics of primary coccidiodomycosis

A

arthralgia w/ periarticular swelling of knees & ankles

erythema nodosum 2-20 days after onset

also nasopharyngitis (flu-like sxs

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6
Q

How does multiple myeloma present?

what do you use to diagnose?

A

=infiltration of bone marrow, bone destruction & paraprotein elaboration ==> lytic bone lesions –> bone pain (spine, ribs, proximal long bones)

symptoms of - anemia, kidney failure

soft tissue masses

LAB : monoclonal Ig in serum/urine

Biopsy: clonal plasma cell in bone marrow/tissue

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7
Q

what is the difference btn CMV infection and disease

A

infection= acute = detect viral protein (Ag) or NA in body fluid/tissue, regardless sxs

disease: CMV infection w/ signs/sxs; viral syndrome or tissue-invasive dz

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8
Q

What are complications of progressive histoplasmosis

A

fever, wt loss, prostration

dyspnea, cough

ulcer of mucous mem of oropharynx

HSM

adrenal insufficiency

GI- mimic IBD

CNS probs

(progressive seen in pt w/ HIV (<100 CD4) or impaired cellular immunity)

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9
Q

What are clinical manifestations of SLE (besides malar rash)

A

systemic sxs

alopecia (common)

raynaud phenomenon (20%)

joint symptoms w/ or w/o synovitis (90%) –> can lead to reversible swan-neck defromity (changes NOT on radiograph)

pericarditis

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10
Q

what are risk factors for community acquired MRSA?

(aggresive!)

A

contact sports

military

incarceration

inject drugs

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11
Q

What are the 3 subtypes of influenza

A

A & B - same symptoms (A = pandemic)

C - milder

(difficult to diagnose in absence of epidemic bc looks like other viral illnesses)

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12
Q

What can increase the change of GAS pharyngitis in children

A

scarlatiniform rash (sandpaper-like -attached pic)

palatal petechiae

tonsillar enlargement w/ or w/o exudate

vomiting

tender cervical LN

(but is not enough to Dx)

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13
Q

What is the cause of bacteremia in pregnant women

& how does it present

A

Strep agalactiae (Group B)

UTI, chorioamnionitis, postpartum endometritis

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14
Q

what are HIV patients with disseminated coccidiodomycosis likely to show?

(& list other sxs of disseminated coccidiodomycosis)

A

*pulmonary miliary inflitrates

mediastinal LN - LAD

meningitis (may result in chronic basilar meningitis)

productive cough, lung abscess/empyema, skin/bone infxn, lymphadenitis –> suppuration

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15
Q

Multiple myeloma is more prone to infxn by….

A

encapsulated organisms

Strep pneumonia & H. influenzae

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16
Q

what population is disseminated histoplasmosis disease present? what is the prognosis in these pts?

how do you Dx?

A

common in AIDs/immunocompromised pts –> poor prognosis

= fulminant –> stimulate septic shock

Dx: blood/bone marrow culture & urine polysac Ag

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17
Q

What are clincal manifestations of multiple myeloma

A

anemia sxs

bone pain & tenderness (back, hip, ribs)

lytic bone lesion

sx of kidney failure

soft tissue masses

neuropathy or spinal cord compression

increased susceptibility to infxn

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18
Q

what are risk factors for TB REACTIVATION

A

gastrectomy

silicosis

DM

HIV

immunosuppressive drugs

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19
Q

how do you differentiate ACUTE acquired CMV from infxous mono?

A

V similar!

but NO pharyngeal symps in ACUTE CMV

& (-) heterophile Ab

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20
Q

how does CMV infxn present in immunoCOMPROMISED pts

A

CMV retinitis w/ neovascular & prolif retinal lesions- cottage cheese & ketchup infiltrates upon fundoscopic exam

GI & hepatobiliary CMV w/ esophagitis, small bowl inflam

colitis

pneumonitis (transplant & AIDs pts)

neuro sxs: polyneuropahty, transverse myelitis, encephalitis

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21
Q

How can Staphylococcal infxns cause MSSA and MRSA or any infxn?

A

skin/soft tissue infxn

break in skin (erysipelas, folliculitis, cellulitis, trauma)

IV cath

cardiac devices

orthopedic hardware

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22
Q

describe latent TB and reactivation of TB

A

latent: bacilli contained w/i granulomata - NON-transmittable

reactivation when infected person’s immune fxn is compromised

= now active!

23
Q

why do you have kidney failure in multiple myeloma

A

light chain component deposited in tissues as amyloid

24
Q

how does the primary infection occur in TB

A

inhale droplet w/ tubercle bacilli

& subsequent lymphangitic & hematogenous spread before immunity develops

25
Q

What are clinical manifestations of Sjorgren’s syndrome

A

sicca sxs: dry eyes, mouth due to immune-mediated dysfxn of lacrimal and salivary glands

w/ or w/o RA

enlarged parotid gland

increased incidence of lympoma (NHL-maltoma)

26
Q

List Clinical Manifestations of Sepsis

A

arterial HYPOtenstion (sBP < 90; MAP <70)

Temp >38.3C or <36C ( >100.94F or <96.8F )

HR >90

tachypnea- RR >=20

27
Q

what is the bacteremia?
causes of bacteremia?

A

=abnormal presence of bacteria in blood stream

MOST COMMON causes:

  1. skin/soft tissue infxn
  2. central venous cath & other IV devices
  3. bone/joint infxn
  4. pneumonia
  5. endocarditis
28
Q

list the clinical manifestations of bacteremia

A

fever, fatigue, malaise

nausea/vomitting

loss of appetite, dehydration

myalgia/arthralgia

Lab : leukocytosis & left shift

29
Q

Staph infections are typically localized but how do you know it has become systemic?

A

bone/joint pain

30
Q

what is qSOFA?

(vs SOFA?)

A

predicts chance of sepsis -bedside scoring system based on:

resp rate >=22, altered mentation & sBP =< 100

(vs SOFA - organ dysfxn score - not diagnostic, time consuming)

31
Q

what are symptoms of systemic staph infections and what do they suggest

A

bone/joint pain (osteomyelitis, discitis, epidural abscess)

protracted fever/sweats - (endocarditis)

abd pain - (esp LUQ - splenic infxn)

costovertebral angle tenderness - (pyelonephritis, renal infarction or psoas abscess)

HA (meningitis, intracranial infxn, septic emboli)

32
Q

what are outside risk factors for TB

A

household exposure

incarceration

recreational/illicit drugs

travel to endemic areas

33
Q

if a pt presents w/ end-organ perfusion, what is going on?

what are these manifestations?

A

=Septic Shock

  • warm, flushed skin (early) –> cool (w/ progression of shock bc redirect blood flow to core)
  • decreased cap refill, cyanosis, mottling (red-purple blotching of skin)
  • altered mental status, obtundation, restless
  • oliguria/anuria
  • ileus/absent bowel sounds
34
Q
  • How does SLE present?*
  • what are serologic finding to Dx*
A

female, malar rash

anemia, leukopenia, thrombocytopenia

serology: (+) ANA, (+) anti-ds DNA & low complement (and (+) Smith)

35
Q

What is the significance of strep agalactiae (group B) in neonates & nonpregnant adults

A

neonates: most common manifestation of neonatal dz = bacteremia w/o focus, sepsis, pneumonia &/or meningitis
nonpregnant: MCC strep in adults; sepsis, soft tissue infxn, endocarditis and other focal infxn can manifest too

36
Q

What are lab findings in sepsis

(one is V important!)

A

HYPERLACTATEMIA -bc organ hypoperfusion in presence/absence of hypotension –> POOR PROGNOSIS

(lot of others..)

  • leukocytosis or -penia!/ thrombocytopenia
  • normal WBC (W/ DIFF will give more info!)
  • hyperglycemia (w/o diabetes)/hyperbilirubin
  • Increase plasma-CRP
  • arterial hypoxemia (<300)
  • acute oliguria
  • increase creatinine
37
Q

what are risk factors for sepsis?

A
  • ICU admission
  • bacteremia
  • >= 65 yo
  • immunosuppression
  • diabetes & obesity
  • CA
  • community acquired pneumonia
  • previous hospitalization (esp w/i 90 days)
38
Q

MRSA pearls

A

may complicate surgical incision

-diabetic foot infxn

joint (unusual) but if so = bacteremia, instrumentation or prosthetic joint

osteomyelitis - fixation device/prosthetic; hematogenous infxn (kids); nonhealing foot ulcer

39
Q

What are risk factors for drug resistance in TB

A

immigration from regions w/ drug-resisitant TB

close contant w/ person infected w/ drug-resisitant TB

unsuccessful prior anti-TB therapy

noncompliance

40
Q

what are the clinical manifestations of histoplasmosis

A

(most ppl asymptomatic!)

mild sxs: flu-like 1-4 days

severe: like atypical pneumonia w/ fever, cough and mild chest pain for 5-15 days

elderly w/ COPD: chronic progressive histoplasmosis

PE = normal

41
Q

What is the most common cause of tonsilopharyngitis in kids/teens

A

strep pyogenese

42
Q

Describe the clinical manifestation of acute malaria

A

prodrome - HA & fatigue –> irregular fever

w/o therapy fever becomes regular - (vivax & ovale = 48 hr cycles & malariae = 72 hr)

HA, malaise, myalgia, arthralgia, cough, chest pain, abd pain

anorexia, NVD

PE = anemia, jaundiace HSM, HYPOtension, seizures

43
Q

What are the 4 species of the genus repsonible for human malaria?

what is the severity of each

A

Plasmodium

  1. vivax- rarely severe
  2. malariae -not severe
  3. ovale- not severe

nearly all severe dz = 4. falciparum

44
Q

What is CMV infxn in immunoCOMPETENT pts characterized as

A

mononucleosis-like syndrome w/ NEG heterophil Ab

(can also occur post-splenectomy yrs later)

cutaneous rash common (compared to mono)

45
Q

what is the most common HIV-related malignancy?

& how does it present

A

= HHV-8 - Kaposi sarcoma

= red/purple/dark plaques/nodules on cutaneous/mucosal surface often on LE, face (noses), oral mucousa & genitalia

chronic kaposi: HIV infxn, high CD4 & low viral load

pul kaposi: SOB, cough, hemoptysis/chest pain ; could be asymptomatic and only show on radiograph!

46
Q

What are symptoms of monocleosis-like syndrome (CMV infxn) in immunoCOMPETANT pts

A

fever, malaise, myalgia, arthralgia

persistent splenomegaly, atypical lymphocytes,

abnormal liver fxn test

leukocytosis –> leukopenia

47
Q

Histoplasmosis is related to what region/animal

A

exposure to bird & bat droppings

river valley, esp Ohio river and Mississippi river valley

[. boards fav :).]

48
Q

what are characteristics of CMV

A

most - asymptomatic

increase prevalence w/ age, low SES, # sexual partners, Hx prior STI, employment in daycare

serious dz in immunocompromised pts

49
Q

What are the main symptoms & clinical manifestations of TB

A

most common: productive COUGH

hemoptysis

slowly progressive: malaise, anorexia, fatigue, wt loss, fever, night sweats

looks chronically ill

chest exam - nonspecific post-tussive apical rales

(be aware of atypical presentation in elderly and HIV pts)

50
Q

Differentiate multiple myeloma w/ waldenstrom macroglobulinemia

A

Waldenstrom - no lytic bone lesions!

*clinical pearl

51
Q

What are respiratory and systemic symptoms of the flu

A

resp: rhinorrhea, congestion, pharyngitis, hoarseness, nonproductive cough, substernal soreness
systemic: fever (3-5 days), chills, HA, malaise, myalgia

*may see GI symps in kids w/ flu-B

52
Q

how can CMV inclusion disease present in neonates

A
  • jaundice, HSM, thrombocytopenia, purpura,
  • microcephaly, periventricular CNS calcifications,
  • mental retardation & motor disability

*hearing loss - 50% symptomatic infants at birth

*most = asymptomatic BUT may get neurological deficits later in life (hearing loss/mental retardation)

53
Q

how/why does strep pyogenes present in neonates, kids/teens/ adults

A

neonates - maternal/fetal transmission

kids/teens - tonsilopharyngitis, impetigo; secondary bacterial skin infxn

adults - pharyngitis

SBL Exam 2 (8 decks)

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