Clinical Manifestations in Fever Flashcards
What is bacteremia?
Abnormal presence of bacteria in bloodstream
What notable lab results are found with bacteremia?
Leukocytosis and left shift
Early sepsis is derived from?
Bacteremia and inflammatory responses
What does SOFA help identify?
Patients who potentially have a high risk of dying from infection
What does qSOFA predict?
Chance of sepsis for patients admitted
What is qSOFA scored on?
1) Respiratory rate ≥ 22/minute
2) Altered mental state
3) Systolic blood pressure ≤100 mmHg
What are the clinical manifestations of sepsis?
1) Arterial hypotension
2) High or low temperature
3) Tachycardia
4) Tachypnea
How may the skin present in the early phases of sepsis?
As sepsis progresses to shock, what happens to the skin and why?
1) Warm, flushed
2) Becomes cool due to redirection of blood flow to core organs
What may indicate septic shock?
Decreased capillary refill, cyanosis, or mottling
What GI manifestations are often an end-stage sign of hypoperfusion?
Ileus or absent bowel sounds
What happens to the serum lactate levels in organ hypoperfusion?
Elevated (Hyperlactatemia)
Staphylococcal infections are due to?
Skin or soft tissue infections
Bone or joint pain due to systemic staphylococcal infections usually suggests?
1) Vertebral osteomyelitis
2) Septic arthritis
Protracted fever and/or sweats due to systemic staphylococcal infections usually suggests?
Endocarditis
Abdominal pain, particularly the LUQ, due to systemic staphylococcal infections usually suggests?
Splenic infarction
Costovertebral angle tenderness due to systemic staphylococcal infections usually suggests?
1) Pyelonephritis
2) Renal infarction
3) Psoas abscess
Headaches due to systemic staphylococcal infections usually suggests?
1) Meningitis
2) Intracranial infection
3) Septic emboli
Methicillin-Resistant Staphylococcus Aureus (MRSA) gram stain of pus shows?
Gram-positive cocci in clusters
Culture positive s. aureus bacteremia should always focus on?
1) Endocarditis
2) Osteomyelitis
3) Deep-seated systemic infections
What category of MRSA skin infections is superficial, usually has well-defined borders, and has minimal lymphangitis?
Which is a deeper skin infection involving dermis and subcutaneous fat and has more propensity to lymphangitis, edema, swelling?
1) Erysipelas
2) Cellulitis
What are risk factors for community-acquired MRSA infections?
1) Contact sports
2) Military service
3) Incarceration
4) Injection drug use
MRSA is commonly involved in what infections?
Diabetic foot infections
What is the most common cause of tonsillopharyngitis in children?
Streptococcus pyogenes (Group A)
Pregnant women are highly susceptible to what bacteria as it causes UTIs, chorioamnionitis, and postpartum endometritis?
Streptococcus agalactiae (Group B)
What rash is characteristic of Streptococcus pyogenes?
Scarlatiniform rash
When does latent tuberculosis infection occur?
How does it spread from person to person in this stage?
1) When bacilli are contained within granulomas
2) It can’t, its non-transmissible
How can TB become reactivated?
Patients immune system becomes weakened and can’t contain latent bacteria anymore
What are risk factors for reactivation of TB?
1) Gastrectomy
2) Silicosis
3) Diabetes mellitus
4) HIV
5) Immunosuppressive drugs
What are risk factors for drug resistance to TB?
1) Immigration from regions with drug-resistant tuberculosis
2) Close contact with patients infected with drug-resistant tuberculosis
3) Unsuccessful prior anti-tuberculosis therapy
4) Patient noncompliance with treatment
What are common symptoms of TB infection?
What is classical heard on auscultation?
1) Cough and blood-streaked sputum
2) Posttussive apical rales
What type of virus is influenza?
How is it spread?
1) Orthomyxovirus
2) Respiratory droplets
Which subtypes of influenza produce identical clinical symptoms?
Which produces milder disease?
1) Types A and B
2) Types C
What are influenza pandemics usually due to?
Type A infections with
major antigenic shift
What are some respiratory symptoms seen in influenza?
1) Rhinorrhea
2) Congestion
3) Pharyngitis
4) Hoarseness
5) Nonproductive cough
6) Substernal soreness
When are gastrointestinal symptoms and signs due to influenza most common?
Young children with influenza B virus infections
How long does fever typically last with influenza?
What may be a marker of secondary complications?
1) 3-5 days
2) Leukocytosis
Acute acquired Cytomegalovirus infection presents similar to what other infection?
However, it differs in what ways?
1) Infectious mononucleosis
2) Pharyngeal symptoms is unusual in Acute CMV
How can CMV infection and disease be used synonymously?
They can’t, not all patients with infection develop disease
Perinatal and CMV inclusion disease can cause what at birth?
What may ensule later in life?
1) Hearing loss
2) Neurologic deficits
How does CMV infection in immunocompetent persons present?
Mononucleosis-like syndrome with negative heterophile antibodies
What neuro complications can arise from CMV?
What cardio problems?
Hematological problems?
Liver problems?
1) Encephalitis and Guillain-Barre
2) Pericarditis and myocarditis
3) Thrombocytopenia
4) Hepatitis
What is the most common clinical problem of histoplasmosis?
Disseminated disease is common in?
Chronic progressive pulmonary histoplasmosis occurs in older patients with?
1) Respiratory illness
2) Immunosuppressed states such as HIV/AIDS
3) COPD
Mild symptomatic illness from histoplasmosis presents as?
More severe illness from histoplasmosis presents as?
1) Influenza-like illness, often lasting 1–4 days
2) Atypical pneumonia, with fever, cough, and mild central chest pain for 5–15 days
What type of coccidioidomycosis infection results in influenza- like illness with malaise, fever, backache, headache, and cough?
Which results in meningitis, arthralgias, bone lesions, or skin and soft tissue abscesses?
1) Primary acute infection
2) Dissemination
Coccidioidomycosis infection results from inhalation of?
Coccidioides immitis or Coccidioides posadasii
What are hallmarks of primary coccidioidomycosis infection?
1) Arthralgias with periarticular swelling of knees and ankles
2) Erythema nodosum
Disseminated coccidioidomycosis in HIV-infected patients more often shows?
1) Pulmonary miliary infiltrates
2) LAD
3) Meningitis
What is the mode of transmission for malaria?
Bite of infected female anopheline mosquitoes
Which plasmodium species is responsible for nearly all severe disease?
P falciparum
What does acute malaria typically begin with?
Headache and fatigue followed by fever
P vivax and P ovale have a fever cycle of?
P malariae has a fever cycle of?
1) 48 hours
2) 72 hours
Bone pain, often in the spine, ribs, or proximal long bones is characteristic of what malignacy?
Multiple myeloma
Myeloma is a malignancy of?
Hematopoietic stem cells terminally differentiated as plasma cells
Waldenström’s macroglobulinemia is similar to multiple myeloma but will have absence of?
Lytic bone lesions
What leads to kidney failure in multiple myeloma?
Light chain components of Igs
Why are Myeloma patients are especially prone to infections from Streptococcus pneumoniae and Haemophilus influenzae?
They are encapsulated organisms
What are the clinical manifestations of multiple myeloma?
1) Symptoms of anemia
2) Lytic bone lesions
3) Symptoms of kidney failure
4) Soft tissue masses
What is the most common HIV-related malignancy?
Kaposi Sarcoma
What cutaneous or mucosal symptoms are present with Kaposi Sarcoma?
Red/purple plaques or nodules
What are common symptoms of Sjögren’s Syndrome?
What other condition can it occur with?
1) Dryness of eyes and dry mouth (sicca component)
2) Rheumatoid arthritis
What causes the dryness of the eyes and mouth in Sjögren’s Syndrome?
Immune-mediated dysfunction of the lacrimal and salivary glands
