Diagnosis only exam 1 Flashcards
Staph skin
Culture of abscess (after its drained)
Staph osteomyelitis
Xray done first
Bone scan is a sensitive confirmatory step
culture purulent fluid after (if obtainable)
Toxic Shock syndrome
Clinical presentation + history
Scalded Skin syndrome
Clinical, confirm with skin biopsy and culture
Strep pyogenes pharyngitis
Dx is clinical only.
Do a rapid strep and throat culture
Otitis Media
Clinical.
Tympanogram optional.
Acute sinusitis
Clinical.
If not improving, order a CT prn
Pneumococcal pneumonia
- CXR gold standard. +- lobar consolidation effusion.
- but you can diagnose by clinical only
- sputum cx ordered only if comorbidities are there or if an inpatient
Bacillus anthracis
Culture
biopsy (of black eschar)
Gram stain (purple rods)
Nasal swab and CXR (for inhalation type)
LP if systemic (it can cause meningitis)
Listeriosis
Culture blood and CSF
this is listeria monocytogenes
pseudomonas aeruginosa
Culture.
If positive, may need hospitalization.
Corynebacterium dipltheriae
Clinical.
Culture confirms it.
N. meningococcal meningitis
Gram stain and culture:
Lumbar puncture CSF analysis
Blood
gram stain reveals pink diplocci shaped like kidney beans
N. gonorrhoeae
Grain stain and culture:
reveal intracellular diplococci (-)
urine
vaginal swab>urine swab for females
notify health dept
Bordetella Pertussis
Nasopharyngeal culture + clinical
Health department
Legionelle Pneumophilla
CXR - focal patchy infiltrates or consolidation
Antigen detection confirms (PCR of lower respiratory secretions, urine antigen, and respiratory tract fluid culture)
sputum grain shows nothing
*anti = bad, the legion from wow.
legionelle is an atypical thats why you cant gram stain
Klebsiella pneumoniae
CXR + sputum culture
Sensitivity testing
think drunk woman getting into fights (sensitive)
sputum b/c spits
CXR for all pneumoniae
Shigellosis
WBC in stools
organism isolated on a stool culture
Cholera
Stool culture
Non cholera vibrio
Stool culture
Typhoid fever (salmonella enterica)
Blood, stool, and urine culture will show salmonella
Enterocolitis (salmonella)
Stool culture
Francisella Tularensis Tularemia
Clinical only.
Confirmation is serologic tests of culture of ulcer/lymph node and blood aspirate
Fever of unknown origin noninfectious
CT disease, vasculitis, granulomatous disorders, giant cell arteritis, SLE, RA
Fever of unkn. Infectious
TB, cat scratch, EBV, shakes, chills
Fever. of unknown origin. Misc
Cirrhosis, Chrons, PE
Order what labs for fever of unknown origin
CBC with diff, peripheral smear, CMP, Hep ABC panel, ESR SED rate, UA and cx, blood cultures (3 different sites several hours apart), HIV serology, TB serology, CXR
Fever of unknown origin- differentiate between what 5 things
Classic, hospital aquired, IC, neutropenic, HIV related
What qualifiers diagnose someone w/ fever of unknown origin
Fever above 101.9 F and 38.3 C (oral)
Greater than 3 weeks
SIRS diagnosis
response to ischemia, infection, inflammation, trauma
Fever above 100.4 F, 38 C
Lower than 96.6 F, 36 C
HR greater than 90
RR greater than 20
WBC greater than 12,000 or less than 4000,
greater than 10% bands
Sepsis
qSOFA >=2
RR greater than 22
altered mentation
SBP less than 100
Warm flush skin, poor cap refill, cyanosis, mottling, altered mental status, absent bowel sounds
Mycopolasma pneumoniae
Chest auscultation clear
CXR: nonconsolidation. nondiagnostic patchy infiltrates
Clinical diagnosis + NP swab
*this is the less severe pneumonia in YA, so findings are less ‘severe’
Chlamydia trachomatis
no gram stain! no cell wall.
Screening + Cx
STD
Syphillis
Culture of ulcer to look for spirochetes (dark field microscopy)
Non-treponemal antibody tests (first line
RPR and VDRL
Tremonemal antibodies test - if above is positive, is confirmational
FTA-ABS is confirmational
Neurosyphillis
LP
RI: HIV man 45 yr old
Lyme disease
Erythema migrans/one late manifestation
AND lab confirmation
late manifestations (neuro, cardio, bacteremia, secondary skin lesions, MSK)
Leptospirosis
Serologic testing
Rocky mountain
Rickettsia rickettsii
Clinical + serological testing
Anaerobic gram positive
Clinical + gram stain + culture
CXR: aspiration pneumonia
-infiltrates, cavitation
-Lucency
- lung abscess
- Abdominal/pelvic CT
- -Intraabdominal abcess
Clostridial soft tissue infections
clinical, graim stain, culture
culture takes barely any time (6 hrs)
If negative, its not Clostridium
rem** Claw-stridium is a purple claw. so gram staining is useful here. looking for a purple rod.
Tetanus
clinical only
cultures do not work
Botulism
Culture (stool for ingested, wound for injected, any food source)
Toxic assays are done by the CDC
Pseudomembrane colitis
-1st Stool sample for toxin and fecal leukocytes
-2nd - colonscopy/sigmoidoscopy (it destroys the lining of the GI)
-imaging for ileus or distended colon
