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SBL Exam 2 (Compilation) > Clinical Considerations in Fever > Flashcards

Clinical Considerations in Fever Flashcards

1
Q

What is the SOFA criteria?

A

it is an organ dysfunction score

it is NOT diagnostic of sepsis

Helps to identify patients who potentially have a high risk of dying from infection

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2
Q

What is the qSOFA criteria?

A

Predicts chance of sepsis in patients admitted to medical floor

based on:

RR >22/min

AMS

Systolic BP <100mmHg

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3
Q

What are some sepsis risk factors?

A

ICU admission

bacteremia

age <65y/o

Immunosuppression

DM and obesity

cancer

CAP

previous hospitalizations in last 90 days requiring ABx therapy

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4
Q

What are the clinical manifestations of sepsis

A

S/S specific to infectious source

arterial hypotension (SBP <90, MAP <70)

Temperature >38.3 or <36

HR >90bpm

tachypnea, RR >20bpm

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5
Q

What is end-organ manifestations of sepsis

A

Warm, flushed skin transitioning to cool as blood flow is redirected

decreased cap refill, cyanosis, mottling

AMS, obtunded/restless, oliguria/anuria

ileus/absent bowel sounds

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6
Q

What is a key hallmark lab in sepsis?

A

Hyperlactatemia

serum lactate elevated >2mmol/L as a sign of hypoperfusion and a sign of a poor prognosis

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7
Q

Where are staphylococcal infections likely to arise?

A

skin and soft tissue breaks

IV/PICC lines, central lines, permanent catheters

Pacers, AICDs

joint and spine hardware

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8
Q

What are some signs of staphylococcal infections?

A

bone/joint pain, fever, abdominal pain, CVA tenderness, HA

All depends on where the infection is located

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9
Q

MRSA is common in which populations?

A

Immunocompromised patients

typically effect multiple systems and will have wounds with pus

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10
Q

What is erysipelas?

What is cellulitis?

A

superficial skin infections with well defined boarders

deeper skin infection involving dermis and subQ fat with lymphangitis, edema

both are warm, painful, can be strep or staph related

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11
Q

What are risk factors for community acquired MRSA infections?

A

contact sports

military service

incarceration

injection drug use

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12
Q

What are some clinical pearls for MRSA?

A

may complicate surgical incisions

implicated in diabetic foot ulcers

joint infections are unusual but can occur

osteomyelitis usually associated with prosthesis, hematogenous infections in kids, or nonhealing foot ulcers

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13
Q

What does streptococcus pyogenes cause?

Who is most affected?

A

causes tonsilpharyngitis commonly in children and adolescents

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14
Q

What does streptococcus agalactiae cause in pregnant women?

A

UTI

chorioamnionitis

postpartum endometritis

bacteremia

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15
Q

What is the most common cause of bacterial pharyngitis in children and adolescents?

A

Streptococcus pyogenes

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16
Q

What are the main symptoms of tuberculosis?

A

productive cough

hemoptysis

fatigue

weight loss

fever

night sweats

17
Q

What are the risk factors for acquisition of tuberculosis?

A

household exposure

incarceration

drug use

travel to endemic areas

note: latent TB can reactivate if immune system is weakened

18
Q

What are the risk factors for reactivation of TB?

A

gastrectomy

silicosis

DM

HIV

immunosuppressive drugs

19
Q

What are risk factors for drug resistance?

A

immigration from areas with drug resistant TB

close contact with pt’s infected with DR TB

unsuccessful prior anti-TB therapy

noncompliance with treatment

20
Q

What are the clinical manifestations of TB?

A

cough, productive and blood-streaked (unlikely to be frank blood)

slowly progressing constitutional symptoms

chronically ill appearance

chest exam nonspecific, post-tussive apical rales are classic

atypical presentations common in elderly/HIV pts

21
Q

What kind of virus is Influenza?

What are the three types?

Which type is most likely to cause pandemics?

A

Orthomyxovirus, spread by resp. droplets

A, B and C with C being milder

Type A can undergo antigenic shift and is most likely to cause pandemics

22
Q

How does acute acquired CMV compare to mononucleosis caused by EBV?

A

CMV unlikely to cause pharyngeal symptoms

23
Q

Describe acute CMV infection

A

virus isolation or detection of viral proteins or nucleic acid in any body fluid or tissue specimen regardless of signs or symptoms

24
Q

Describe CMV disease

A

evidence of CMV based on signs or symptoms

may manifest as a viral syndrome or as a tissue-invasive disease

course and prognosis is different than acute

25
Q

What symptoms do you see with perinatal CMV disease?

A

jaundice

hepatosplenomegaly

thrombocytopenia

purpura

microcephaly

CNS calcifications

MR

motor disability

hearing loss in 50%

most asymptomatic at birth, but may develop sx later on

26
Q

A CMV infection in an immunocompetent person will look like mononucleosis but will have (positive or negative) heterophil Ab?

A

Negative heterophil Ab

27
Q

What are the key symptoms we should know related to primary coccidioidomycosis?

A

Arthralgias with periarticular swelling of knees and ankles

Erythema nodosum within 2-20 days after symptoms onset

28
Q

What is a key feature of disseminated coccidioidomycosis in patients with HIV?

A

more often show pulmonary miliary infiltrates, LAD, and meningitis

rarely skin lesions

29
Q

What are the symptoms of acute malaria?

A

HA, fatigue, cyclic fevers, myalgias, cough, chest pain, abdominal pain, anorexia, n/v/d, Sz

48 hour cycles for P. vivax and P. ovale

72 hour cycles for P. malariae

30
Q

What are some physical exam findings for malaria?

A

anemia

jaundice

hepatosplenomegaly

hypotension

Sz

31
Q

How do you tell the difference between Multiple Myeloma and Waldenström’s macroglobulinemia?

A

they are similar but WM will NOT have lytic bone lesions

32
Q

What are the clinical manifestations of Multiple Myeloma?

A

Sx of anemia

bone pain

lytic bone lesions

kidney failure

soft tissue masses

(CRAB-hyperCalcemia, Renal abn, Anemia, Bone lytic lesions)

33
Q

What is the most common HIV-related malignancy?

A

Kaposi Sarcoma

related to HHV-8 infection

red, purple lesions or nodules on cutaneous and mucosal surfaces

34
Q

What are the sicca components of Sjögren’s Syndrome?

A

dry eyes and mouth with or without other AI diseases, like RA or other CT diseases

35
Q
A

SBL Exam 2 (Compilation) (8 decks)

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