Diseases Quiz 1 Flashcards
Strep viridans subacute infectious endocarditis
Catalase -; alpha-hemolytic; bacitracin resistant
Most common cause of community caused subacute endocarditis
Most often affects the mitral and aortic valves
Signs and sx: fever, anemia, arrhythmias, abdominal pain, petechiae, septic emboli, Roth’s spots, splinter hemorrhages, and splenomegaly.
Duke Criteria (2 major; 1 major and 3 minor; or 5 minor)
Major = positive blood culture (2 draws); evidence of endocardial involvement
Minor = fever; positive blood culture (1 draw); immunological evidence (i.e. roth spots, osler’s nodes, rhematoid factor); vascular phenomenal (arterial emboli, janeway lesions), and predisposition.
Site of infection is generally through mouth (dental procedure)
Rx: 1.) Ampicillin + sulbactam + gent/tobra
2.) Vanco + ceftri or gent/tobra
Staph Aureus Acute Infectious Endocarditis
Gram +, catalase +, coagulase +, facultative anaerobe,
Virulence factors: biofilms, capsule, adhesins, and pathogenicity islands which contain info for methicillin resistance. Protein A (binds FC portion of IgG, coagulase, hemolysins and leukocidins, hylauronidase, staphylokinase, lipase.
Most common cause of nosocomial and IV drug user endocarditis
Signs and sx: fever, anemia, arrhythmias, abdominal pain, petechiae, septic emboli, Roth’s spots, splinter hemorrhages, and splenomegaly.
Duke Criteria: (2 major; 1 major and 3 minor; or 5 minor)
Major = positive blood culture (2 draws); evidence of endocardial involvement
Minor = fever; positive blood culture (1 draw); immunological evidence (i.e. roth spots, osler’s nodes, rhematoid factor); vascular phenomenal (arterial emboli, janeway lesions), and predisposition.
Rx: 1.)Nafcillin/dicloxicillin/oxacillin +/- gentamycin or tobraycin
2.) Vanco + gent/tobra
Enterococcus species endocarditis
3rd major cause; usually preceded by bacteremia
Most frequently found following gu procedures in older men and ob procedures in younger women.
Virulence factors: pili, surface proteins, proteases and hyaluronidases.
Usually resistant to penicillin and carbapenems
Rheumatic Heart Disease
Following Strep. pyogenes pharyngitis in genetically predisposed individuals (people who make antibodies to Meromysin (M) protein.
Presentation: Mitral stenosis following pharyngitis w/ rash is a definitive clinical indicator
Damage due to type 2 hypersensitivity
Risk: strep throat (prolonged/untreated); prior case of rheumatic fever; ages 5-15 years old.
Sx: Usually appear 2 to 4 weeks after strep infx; pain and swelling in large joints; fever; weakness; muscle aches; SOB; chest pain
Dx: blood tests; throat culture; echo; CXR; EKG
Rx: Penicillin G; Aspirin; Steroids; Rest
Myocarditis
Inflammation of the myocardium. Usually caused by a viral infx (Coxsackievirus B and Adenovirus(children).
Sx: Chest pain, heart failure, and abnormal heart rhythms possible.
Cause of sudden death in children
Coxsackievirus B
ssRNA + (group IV); nonsegmented; icosahedral; nonenveloped; picornavirus; enterovirus
Cause of Myocarditis and Pericarditis
Palm and sole rash
Also HFM disease
Pericarditis
Inflammation of the pericardium. Typically an acute infection. Usually caused by a viral infx ( Cox A&B; Echovirus, and influenza.
Higher incidence in summer months (enterovirus peaks)
Sx: chest pain associated w/ irritated layers of the pericardium rubbing against each other.
Rocky Mountain Spotted Fever
Causative agent: Rickettsia rickettsii (dermacantor wood or dog tick) –> intracellular
Sx: fever, headache, abdominal pain, vomiting, and muscle pain. A rash may develop (hands and soles)
Rx: Doxycyline
Endemic areas are Oklahoma and eastward.
Pathology: Tick bite (carried by dogs, rodents), infx and proliferation in endothelial cells –> inflammation of endothelial cells of small blood vessels –> maculopapular rash of palms and soles spreading to the trunk –> widespread vasculitis –> headache and CNS changes, renal damage –> death.
COPD
Imaging: Flat diaphragms, hyper-expanded lungs, barrel chest, radiolucent lungs
Diaphragm paralysis
Imaging: Inspiration and expiration films or fluoroscopic evaluation (sniff test)
Tracheal deviation
Most common cause is goiter.
If can’t confirm w/ physical exam –> CT/MRI
Lymph node enlargement
Usually not visible on CXR
DDX: metastatic disease; lymphoma; reactive lymph nodes from infx (TB); granluomatous disease (sarcoidosis)
Congestive Heart Failure
Early pulmonary edema is interstitial Late pulmonary edema is alveolar Pleural effusions are common Cardiomegaily is often seen Kerley's B lines or septal lines are strongly suggestive
Pneumothorax (PTX)
Air between parietal and visceral pleura.
Seen in 30-40% of patients w/ blunt chest trauma, usually associated w/ rib fx
May be spontaenous or iatrogenic.
Tension PTX can be life threatening –> air accumulates due to one way valve mechanisms, causing increased pressure w/ vena cava compression and impaired venous return.
CXR findings: Sharp line = visceral pleura. No lung markings lateral.
Pulmonary Embolus
Clot in Pulmonary Artery.
3rd most common cause of CV death
Difficult to dx
CXR: Hampton’s hump: wedge-shaped opacity corresponding to lung infact
Westermark’s sign: relative oligemia
CT: dark grey w/ contrast in pulmonary arteries.
Aortic Dissection
Most common aortic emergency requiring immediate surgery
Tear in intimal layer of vessel separates intima from media or adventitia, causing a false channel. Eventually can burst.
Sx: Severe pain w/ tearing or ripping quality.
Risk factors: -HTN, Marfans or Ehlers-Danlos, cocaine, pregnancy.
CXR: wide mediastinum, abnormal arch configuraiton. L>R pleural effusion.
CT: Tubular bisected appearance of aorta. Often spiraled.
Ascending: surgical emergency, descending = medical mangagement.
Ectopia cordis
A failure in lateral folding.
Heart outside the thoracic cavity.
Congenital umbilical hernia
A failure in lateral folding
A defect in the muscle and CT or the anterior abdominal wall resulting in the protrusion of intestine and greater omentum through the defect
Skin and superficial fascia cover protruding mass usually located above or below the umbilicus
