Clinical Fever

Question 1

Bacteremia

Answer 1

Bacteria in blood

Question 2

Bacteremia source (3)

Answer 2

Anywhere, body infection (skin/lung/heart/bone), internal devices (catheter, IV)

Question 3

Septicemia progression (3)

Answer 3

Early bacteremia, Sepsis, Septic Shock with Organ Dysfxn (shut down)

Question 4

SOFA vs qSOFA (3)

Answer 4

SOFA: longer, nonspecific to sepsis, predicts death from infection
qSOFA: faster/bedside, specific to sepsis infection death, scores based on RR, Systolic BP and AMS

Question 5

Risk Factors for Sepsis (~7)

Answer 5

ICU, Bacteremia, older 65+, immunosuppressed (pneumonia,cancer), DM, Obesity, Hx of recent hospitalization with abx

Question 6

Main Sepsis Sx (11)

Answer 6

Signs of Infection, Hypotension, Abnormal temperature, High HR & RR, Hyperlactatemia (hypoperfusion/hypoxemia), High Glucose, High CRP, abnormal coagulation, platelet, WBC

Question 7

Septic Shock Sx Progression (4)

Answer 7

Warm flushed => Cool Skin Cyanosis => Hypoperfusion (AMS, restless, oliguria) => Later (absent bowel sounds)

Question 8

Staph Causes (2)

• related to
• MRSA less likely sx

Answer 8

Lack of skin integrity/infection, internal device (catheter, IV, cardiac or ortho device)

• Related to diabetic foot infection with MRSA
• MRSA less like to have joint infection

Question 9

Staph Symptoms (7)

Answer 9

Sensitive & Resistant
Septic Arthritis (joint pain)
Osteomyelitis (bone pain)
Endocarditis (tri)(fever/sweats)
Skin Infection (Abscesses)
-Erysipelas: super, well defined, red, no lymph
-Cellulitis: deep, more lymph, edema, indiscrete borders
Coagulase (+)
-Splenic Infarct (Abd pain, LUQ)
-Pyelonephritis/Renal infarct (Costovertebral tenderness)

Question 10

MRSA Risk Factors (7)

Answer 10

Long-term recurrent wounds, Immunocompromised, Hospital, Contact sports, Military, Prison, IV drug use

Question 11

Strep Pyrogenes (A)(4) Sx

Answer 11

Kids: Tonsillopharyngitis, Impetigo, scarlatiniform rash (sand paper), palatal petechiae/red tongue

Question 12

Strep Agalactiae (B) Sx (3/1)

Tx mom with penicillin

Answer 12

Kid: from mom (vagina), meningitis, sepsis, pneumonia
Pregnant: Infection (UTI, Bacteremia, Endometritis, Chorioamnionitis)

Question 13

Mycobacterium TB Sx (7)

Progression

Answer 13

Productive cough, blood streaked sputum, fever, fatigue, night sweats, apical rales (ghon complex on lung)

Latent in granuloma non transmissible => Reactive active bacteria due to low immune system

Question 14

TB Risk Factors
Dx (4)
Reactivation (2)
Resistance (4)

Answer 14

Dx: Close contact, Prison, Drug Use, Endemic Travel
Active: Immunosuppression or variation in endocrine/metabolic system
Resist: Endemic immigration, close contact, poor tx, noncompliance

Question 15

Influenza Sx
Systemic (6)
Resp (4)

Answer 15

Fever, Chills, malaise, HA, myalgia, GI in kids

Runny nose, congestion, pharyngitis, nonproductive cough

Question 16

Cytomegalovirus Sx

Infection (6)

Disease

Answer 16

Mimic mononucleosis (no pharyngeal, (-) heterophil abx)

Infection: rash, fever, malaise, abnormal WBC, abnormal liver fxn test, Compromised AIDS: inflammation of eye, GI, lung and brain (nerve)

Disease: Immunocompromised
same as above plus perinatal hearing loss and neuro defects (retardation, CNS calcifications motor disability, microcephaly), hepatosplenomegaly (jaundice), thrombocytopenia (purpura)

Question 17

Histoplasmosis

Risk (3)

Sx (10)

Answer 17

Risk: Bird/bat dropping, AIDS/compromised, Older with COPD

Sx: mimic influenza, or atypical pneumonia with fever, cough, chest pain (mimic TB)
-Disseminated: sudden, fever and multi organ involvement, mimic septic shock

Question 18

Coccidioidomycosis
Primary
Disseminated

Answer 18

Primary: arthralgia, erythema nodosum, mimic pneumo

Disseminated: meningitis, lung infiltrates, skin lesion and bone infection, lymphadenopathy

Question 19

Malaria (Plasmodium) Sx

Answer 19

Irregular/Regular Fever, HA, fatigue, malaise, splenomegaly (jaundice, anemia, hypotension)

Question 20

Multiple Myeloma Sx (5)

Answer 20

Lytic bone lesions, anemia, kidney failure, hypercalcemia, clonal plasma cells with monoclonal ig

Question 21

Kaposi Sarcoma
Related
Sx (3)

Answer 21

Herpes 8 and HIV related

Sx Purple nodules on skin/mucous membranes, Pulm sx (SOB, cough, hemoptysis), mimic melanoma

Question 22

Systemic Lupus Erythematosus Sx

Answer 22

Malar rash, Joint sx, Alopecia, Mucous lesions ,Raynaud, genreal fever, anorexia, cotton-wool spots, pericarditis/myocarditis, pleurisy

Question 23

Sjogren Syndrome Sx

Answer 23

Dry eye & dry mouth, enlarged parathryosi, pancrititis, pelurtitis, obstructino, vasculitis

Question 24

Sjogren associated Diseases

Answer 24

RA, SLE, Scleroderma, Polymyositis, biliary cirrhosis, Hashimoto, Polyarteritis, interstitial pulmonary fibrosis