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Infectious Disease > Essentials of Diagnosis > Flashcards

Essentials of Diagnosis Flashcards

1
Q

Fever of Unknown Origin

A
  • Illness of at least 3 weeks duration
  • Fever over 38.3C on several occasions
  • Diagnosis has not been made after 3 outpatient visits or 3 days of hospitalization
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2
Q

Bacteremia

A
  • A bacterial invasion into blood circulation.
  • Can occur when you brush your teeth, pick a scab, or squeeze a zit
  • May result from any type of dental or surgical procedure.
  • May or may not cause any symptoms, depending on whether the organism was able to replicate themselves in the blood stream.
  • May progress to septicemia, especially if an individual has a weakened immune system.
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3
Q

Septic Shock

A
  • Hypotension, tachycardia, oliguria, altered mental status
  • Peripheral hypoperfusion and impaired oxygen delivery
  • Occurs secondary to bacteremia caused by e.coli, klebsiella, proteus, and pseudomonas
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4
Q

Nosocomial Infections

A
  • Health care-associated infections that are acquired during the course of receiving health care treatment for other conditions
  • Infections not present or incubating at the time of hospital admission
  • Develop 48 hours or more after admission
  • Most are preventable, esp via hand washing
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5
Q

Bacterial Endocarditis

A
  • Fever
  • Preexisting organic heart lesion
  • Positive blood cultures
  • Evidence of vegetation on echocardiography
  • New or changing heart murmur
  • Evidence of systemic emboli
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6
Q

Kawasaki Disease

A
  • Fever, conjunctivitis, oral mucosal changes, rash, cervical lymphadenopathy, peripheral extremity changes
  • Elevated ESR and CRP levels
  • Occurs in Asians or native Pacific Islanders btw 3mo-5yo
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7
Q

Rubella (German Measles)

A
  • Exposure 14-21 days before onset
  • Arthralgia, particularly in young women
  • No prodrome in kids; mild prodrome in adults
  • Mild symptoms (fever, malaise, coryza) coinciding with eruption
  • Posterior cervical and postauricular lymphadenopathy 5-10 days before rash
  • Fine maculopapular rash of 3 days duration; fact to trunk to extremities
  • Leukopenia, thrombocytopenia
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8
Q

Rocky Mountain Spotted Fever

A
  • Exposure to tick bite in an endemic area
  • An influenza-like prodome followed by chills, fever, severe headache, and myalgias; occasionally, delirium and coma
  • Red macular rash appears btw 2nd and 6th days of fever, first on the wrists and ankles and then spreading centrally; it may become petechial
  • Serial serologic examinations by indirect fluorescent antibody confirm the diagnosis retrospectively
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9
Q

Roseola (Exanthem Subitum or Fifth Disease)

A
  • Sudden onset of high fever
  • No diagnostic signs
  • Development of rash as fever breaks after 3-4 days
  • Caused by HHV 6
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10
Q

Erythema infectiosum (Sixth Disease)

A
  • Fiery red “slapped cheek” appearance
  • Circumoral pallor
  • Subsequent lacy, maculopapular rash on trunk and limbs after fever and systemic symptoms
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11
Q

Lyme Disease

A
  • Erythema migrans, a flat or slightly raised red lesion that expands with central clearing
  • Headache or stiff neck
  • Arthralgias, arthritis, and myalgias; arthritis is often chronic and recurrent
  • Wide geographic distribution, with most of the US cases in the Northeast, mid-Atlantic, upper Midwest, and Pacific coastal regions
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12
Q

Toxic Shock Syndrome

A
  • Abrupt onset of high fever, vomiting, watery diarrhea
  • A diffuse macular erythematous rash and nonpurulent conjunctivitis
  • Desquamation of palms and soles common during recovery
  • Blood cultures are negative
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13
Q

Rubeola (Measles)

A
  • Exposure 10-14 days before onset in an unvaccinated patient
  • Prodrome of fever, coryza, cough, conjunctivitis, malaise, irritability, photophobia, and Koplik spots
  • Rash: brick red, irregular, maculopapular; onset 3-4 days after onset of prodrome; begins on face and proceeds “downward and outward”, affecting the palms and soles last
  • Leukopenia
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14
Q

Varicella (Chickenpox) & Herpes Zoster (Shingles)

A
  • Exposure 14-21 days before onset
  • Fever and malaise just before eruption
  • Rash: pruritic, centrifugal, papular, changing to vesicular (“dewdrops on a rose petal”), pustular, and finally crusting
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15
Q

Endemic Flea-Borne Typhus

A
  • Gradual onset, less severe symptoms, and shorter duration of illness than epidemic typhus (7-10 days vs 10-14 days)
  • Fever, headache, chills
  • Maculopapular rash concentrated on the trunk
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16
Q

Epidemic Louse-Borne Typhus

A
  • Prodrome of headache, then chills and fever
  • Severe, intractable headaches, prostration, persisting high fever
  • Macular rash appearing on the 4th-7th days on the trunk and in the axillae, spreading to the rest of the body but sparing the face, palms, and soles
  • Diagnosis confirmed by specific antibodies, using complement fixation, microagglutination, or immunofluorescence
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17
Q

Scarlet Fever

A
  • Caused by group A beta-hemolytic streptococcus
  • A diffusely erythematous rash resembling a sunburn, with superimposed fine red papules; most intense on the groin and axillas; branches on pressure
  • Flushed face, circumoral pallor, the tongue is coated with enlarged red papillae (strawberry tongue)
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18
Q

Haemophilus Pneumonia

A
  • May be seen in the elderly
  • Shoulde be considered in patients with chronic lung disease, sickle cell disease, or immunocompromised disorders
  • Routine vaccination of children has reduced the incidence in peds population
  • Either a gradual progression of disease with low-grade fever and sputum production or occasionally have the sudden onset of chest pain, dyspnea, and sputum production
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19
Q

Legionella Pneumonia

A
  • Patients are often immunocompromised, smokers, or have chronic lung disease
  • No seasonality, so is a more prominent cause of pneumonia in the summer
  • Scant sputum production, pleuritic chest pain, toxic appearance
  • Chest radiograph: focal patchy infiltrates or consolidation
  • Gram stain of sputum: polymorphonuclear leukocytes and no organisms
  • Commonly complicated by GI symptoms (abd pain, vomiting, and diarrhea)
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20
Q

Klebsiella Pneumonia

A
  • May occur in compromised patients: patients at risk of aspiration, alcoholics, the elderly, and other patients with chronic lung disease
  • Acute onset of severe disease with fever, rigors, and chest pain
  • Herpes labialis is occasionally associted
  • May develop abscesses, but more commonly have a lobar infiltrate
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21
Q

Pneumococcal Pneumonia

A
  • Productive cough, fever, rigors, dyspnea, early pleuritic chest pain
  • Consolidating lobar pneumonia on chest radiograph
  • Gram positive diplococci on gram stain of sputum
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22
Q

Mycoplasmal Pneumonia

A

-Occurs year round, tends to cluster in epidemics every 4-8 years
-Subacute respiratory illness with cough, sore throat, and headache
-Retrosternal chest pain
-

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23
Q

Hantaviruses

A
  • Transmitted by rodents and cause two clinical syndromes
  • Hemorrhagic fever with renal syndrome (HFRS): mild to severe illness
  • Hantavirus pulmonary syndrome (HPS): 40% mortality rate
  • Ribavirin is used with some success in HFRS
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24
Q

Tuberculosis

A
  • Fatigue, weight loss, fever, night sweats, and productive cough
  • Risk factors for acquisition of infection: household exposure, incarceration, drug use, travel to an endemic area
  • Chest radiograph: pulmonary opacities, most often apical
  • Acid-fast bacilli on smear of sputum or sputum culture positive for M tuberculosis
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25
Q

Influenza

A
  • Cases usually in epidemic pattern
  • Abrupt onset with fever, chills, malaise, cough, coryza, and myalgias
  • Aching, fever, and prostration out of proporiton to catarrhal symptoms
  • Leukopenia
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26
Q

Pertussis

A
  • Predominantly in infants under 2 years; adolescents and adults are important reservoirs of infection
  • Two-week prodromal catarrhal stage of malaise, cough, coryza, and anorexia
  • Paroxysmal cough ending in a high-pitched inspiratory “whoop”
  • Absolute lymphocytosis, often striking; culture confirms diagnosis
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27
Q

Mumps

A
  • Exposure 14-21 days before onset
  • Painful, swollen salivary glands, usually parotid
  • Frequent involvement of testes, pancreas, and meninges in unvaccinated individuals
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28
Q

Coccidiomycosis

A
  • Influenza-like illness with malaise, fever, backache, headache, and cough
  • Erythema nodosum common with acute infection
  • Dissemination may result in meningitis, bony lesions, or skin and soft tissue abscesses
  • Chest radiograph findings vary from pneumonitis to cavitation
  • Serologic tests useful; spherules containing endospores demonstrable in sputum or tissues
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29
Q

Psittacosis

A
  • Fever, chills, and cough; headache common
  • Atypical pneumonia with slightly delayed appearance of signs and symptoms
  • Contact with infected bird 7-15 days previously
  • Isolation of chlamydiae or rising titer of complement fixing antibodies
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30
Q

Diphtheria

A
  • Tenacious gray membrane at portal of entry in pharynx
  • Sore throat, nasal discharge, hoarseness, malaise, fever
  • Myocarditis, neuropathy
  • Culture confirms the diagnosis
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31
Q

Severe Acute Respiratory Syndrome (SARS)

A
  • Severe respiratory symptoms (cough, difficulty breathing) with fever over 38C
  • Suspected exposure during the 10 days prior to illness
  • Laboratory testing for the probably etiological agent, a coronavirus, is under development
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32
Q

Anthrax

A

-Appropriate epidemiologic setting (eg exposure to animals or animal hides, or potential exposure from an act of bioterrorism)

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33
Q

Tularemia

A
  • History of contact with rabbits, other rodents, and biting arthopods (eg, ticks in summer) in endemic area
  • Fever, headache, nausea, and prostration
  • Papule progressing to ulcer at site of inoculation
  • Enlarged regional lymph nodes
  • Serologic tests or culture of ulcer, lymph node aspirate, or blood confirm the diagnosis
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34
Q

Dengue

A
  • Travel or residence in an endemic area
  • First infection (first episode) results in non-specific rash and fever; retro-orbital pain, severe myalgia, and arthalgia may occur
  • Subsequent infection with a different (heterotypic) serotype of dengue may result in dengue hemorrhagic fever (thrombocytopenia, bleeding, plasma leak syndrome); this may progress to shock
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35
Q

Plague

A
  • History of exposure to rodents in endemic area
  • Sudden onset of high fever, malaise, muscular pains, and prostration
  • Axillary or inguinal lymphadenitis (bubo)
  • Bacteremia, pneumonitis, and meningitis may occur
  • Positive smear and culture from bubo and positive blood culture
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36
Q

Cat Scratch Disease

A
  • A papule or ulcer developing at inoculation site within a few days
  • Fever, headache, and malaise 1-3 weeks later
  • Enlarged, tender, suppurative regional lymph nodes
  • History of getting scratched or bit from a cat
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37
Q

Toxoplasmosis

A
  • Infection confirmed by isolation of toxoplasma gondii or identification of tachyzoites in tissue or body fluids
  • PRIMARY INFECTION: fever, malaise, headache, sore thraot; lymphadenoapthy, positive IgG and IgM serologic tests
  • CONGENITAL INFECTION: follows acute infection of seronegative mothers and leads to CNS abnormalities and retinochoroiditis
  • INFECTION IN IMMUNOCOMPROMISED: Reactivation leads to encephalitis, retinochoroiditis, pneumonitis, myocarditis; positive IgG but negative IgM serolgoic tests
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38
Q

Malaria

A
  • Residence or exposure in a malaria-endemic area
  • Intermittent attacks of chills, fever, and sweating
  • Headache, myalgia, vomiting, splenomegaly; anemia, thrombocytopenia
  • Intraerythrocytic parasites identified in thick or thin blood smears
  • Complications of falciparum malaria: cerebral malaria, severe anemia, hypotension, noncardiogenic pulmonary edema, acute kidney failure, hypoglycemia, acidosis, and hemolysis
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39
Q

Typhoid Fever

A
  • Gradual onset of malaise, headache, nausea, vomiting, abdominal pain
  • Rose spots, relative bradycardia, splenomegaly, and abdominal distention or tenderness
  • Slow (stepladder) rise of fever to maximum and then slow return to normal
  • Leukopenia; blood, stool, and urine culture positive for salmonella
40
Q

Cholera

A
  • History of travel in endemic area or contact with infected person
  • Voluminous diarrhea
  • Stool is liquid, gray, turbid, and without fecal odor, blood, or pus (“rice water stool”)
  • Rapid development of marked dehydration
  • Positive stool cultures and agglutination of vibrios with specific sera
41
Q

Enterohemorrhagic E.coli

A
  • Can cause hemolytic-uremic syndrome (HUS) so don’t give abx
  • Hx of consumption of fresh produce and undercooked ground beef
  • Grossly bloody diarrhea
  • Significant abdominal pain, fecal leukocytes
  • Fever is NOT common
42
Q

Giardiasis

A
  • Acute diarrhea may be profuse and watery
  • Chronic diarrhea with greasy, malodorous stools
  • Abdominal cramps, distention, flatulence, and malaise
  • Cysts or trophozoites in stools
43
Q

Shigella

A
  • Cramps and bloody diarrhea
  • High fever, malaise, convulsions
  • Pus and blood in diarrheal stools examined microscopically
  • Diagnosis confirmed by stool culture
44
Q

Salmonella

A
  • Nausea, vomiting, headache, meningismus
  • Fever, diarrhea, abdominal pain
  • Culture or organism from stool, blood, or other specimens
45
Q

Viral gastroenteritis

A
  • Rotavirus: a 2-3 day prodrome of fever and vomiting is followed by nonbloody diarrhea lasting for 1-4 days; leading cause of dehydrating gastroenteritis in children
  • Norovirus: short symptomatic illness, high frequency of vomiting, absence of bacterial pathogens in stool samples, more common in adults
46
Q

Traveler’s Diarrhea

A
  • Usually a benign, self limited disease occurring about one week into travel
  • Prophylaxis not recommended unless there is a comorbid disease (IBS, HIV, immunosuppressive medication)
  • Single-dose therapy of fluoroquinolone usually effective if significant symptoms develop
47
Q

Amebiasis

A
  • Organisms or antigen present in stools or abscess aspirate
  • Positive serologic tests with colitis or hepatic abscess, but these may represent prior infections
  • Mild to moderate colitis with recurrent diarrhea
  • Severe colitis including bloody diarrhea, fever, and abdominal pain, with potential progression to hemorrhage or perforation
  • Hepatic abscess with fever, hepatomegaly, and abdominal pain
48
Q

C.difficile

A
  • Major cause of hospital-acquired infectious diarrhea
  • Associated w abx use (aminopenicillins, fluoroquinolones, clindamycin)
  • Malaise, watery diarrhea, lower abdominal pain and tenderness, and low grade fever
  • Mild peripheral leukocytosis and occult blood loss
49
Q

Campylobacter

A
  • Outbreaks associated with consumption of raw milk
  • Fever, abdominal pain, and diarrhea characterized by loose, watery, or bloody stools
  • Self-limited, but can be shortened with azithromycin or ciprofloxacin
50
Q

Cystitis

A
  • Irritative voiding symptoms
  • Patient usually afebrile
  • Positive urine culture; blood cultures may also be positive
  • Usually due to e.coli
51
Q

Pyelonephritis

A
  • Fever
  • Flank pain
  • Irritative voiding symptoms
  • Positive urine culture
52
Q

Ascariasis

A
  • Transient cough, urticaria, pulmonary infiltrates, eosinophilia
  • Nonspecific abdominal symptoms
  • Eggs in stool; adult worms occasionally passed
53
Q

Enterobiasis

A
  • Nocturnal perianal pruritis

- Identification of eggs or adult worms in perianal skin or in stool via tape test

54
Q

Trichinosis

A
  • Ingestion of inadequately cooked pork or game
  • Transient intestinal symptoms followed by fever, myalgias, and periorbital edema
  • Eosinophilia and elevated muscle enzymes
55
Q

Tapeworms

A
  • Mild abdominal pain; passage of worm segments (taeniasis)
  • Focal seizures, headaches (neurocysticercosis)
  • Cysticerci present in biopsy specimens, on plain films (as calcified masses), or on CT scan or MRI
  • Proglottids and eggs in feces; specific antibodies in serum or CSF
  • Pigs = taenia solium
  • T solium is the most common helminth infection of the CNS and a leading cause of acquired epilepsy in the world
56
Q

Cysticercosis

A
  • Exposure to T solium through fecal contamination of food
  • Seizures, headache, and other findings of a focal CNS lesion
  • Brain imaging shows cysts; positive serologic tests
57
Q

Cutaneous Larva Migrans

A
  • Intensely pruritic erythematous papules, usually on the hands or feet; a few days later, serpiginous tracks mark the course
  • In US, infections common in southeastern US, especially in children
  • From the larvae of dog and cat hookworms
58
Q

Hookworms

A
  • Transient pruritic skin rash and pulmonary symptoms
  • Anorexia, diarrhea, abdominal discomfort
  • Iron deficiency anemia
  • Characteristic eggs and occult blood in the stool
59
Q

Scabies

A
  • Generalized very severe itching
  • Pruritic burrows, vesicles and pustules, especially on finger webs and in wrist creases
  • Mites, ova, and brown dots of feces visible microscopically
  • Red papules or nodules on the scrotum and on the penile glans and shaft are pathognomonic
60
Q

Shistosomiasis

A
  • History of fresh water exposure in an endemic area
  • Acute schistosomiasis: fever, headache, myalgias, cough, urticaria, diarrhea, and eosinophilia
  • Intestinal schistosomiasis: abdominal pain, diarrhea, and hepatomegaly, progressing to anorexia, weight loss, and features of portal hypertension
  • Urinary schistosomiasis: hematuria and dysuria, progressing to hydroureter, hydronephrosis, and urinary infections
  • Diagnosis based on characteristic eggs in feces or urine; biopsy of rectal or bladder mucosa; positive serology
61
Q

Blastomycosis

A
  • Occurs more often in men in south central and midwestern US; usually occurs in the immunocompetent
  • Chronic pulmonary infection
  • Cough, moderate fever, dyspnea, and chest pain
  • Riased, verrucous cutaneous lesions present in disseminated blastomycosis
  • Radiologic studies: airspace consolidation or masses
62
Q

Mucormycosis

A
  • Seen in immunocompromised or post-transplant

- Invasive disease of the sinuses, orbits, and lungs may occur

63
Q

Candidiasis

A
  • Common normal flora but opportunistic pathogen
  • Gastrointestinal mucosal disease, particularly esophagitis, most common
  • Intravenous catheter-associated fungemia occurs in patients who have sustained cutaneous or mucosal injury, undergone instrumentation, or received broad-spectrum antibiotics
64
Q

Cryptococcosis

A
  • Most common cause of fungal meningitis
  • Predisposing factors: hematologic cancer chemotherapy, Hodgkin lymphoma, corticosteroid therapy, transplant recipients, TNF inhibitor therapy, HIV infection
  • Symptoms of headache, abnormal mental status; meningismus seen occasionally, though rarely in HIV-infected patients
  • Demonstration of capsular polysaccharide antigen in CSF is diagnostic
65
Q

Histoplasmosis

A
  • Epidemiologically linked to bird droppings and bat exposure; common along river valleys (esp Ohio River and Mississippi River valleys)
  • Most patients asymptomatic; respiratory illness most common clinical problem
  • Widespread disease especially common in AIDS or other immunosuppressed states, with poor prognosis
  • Biopsy of affected organs with culture or urinary polysaccharide antigen most useful in disseminated disease
66
Q

Purulent (bacterial) Meningitis

A
  • Headache, fever, sensorineural disturbances, neck and back stiffness, CSF abnormalities
  • Usually seek medical attention within hours or 1-2 days after onset of symptoms
67
Q

Asceptic Meningitis

A
  • Headache, fever, sensorineural disturbances, neck and back stiffness, CSF abnormalities
  • More benign and self-limited syndrome than purulent meningitis
  • Can be viral in etiology, occurring as a secondary illness, or drug-induced
68
Q

Meningococcal Meningitis

A
  • Fever, headache, vomiting, confusion, delirium, convulsions
  • Petechial rash of skin and mucous membranes
  • Neck and back stiffness
69
Q

Encephalitis

A
  • Usually viral in etiology

- Produces disturbances of the sensorium and seizures

70
Q

Brain abscess

A
  • Presents as a space occupying lesion
  • Vomiting, fever, change of mental status, or focal neurologic manifestations
  • Lumbar puncture should NOT be performed
71
Q

Rabies

A
  • History of an animal bite
  • Paresthesia, hydrophobia, rage alternating with calm
  • Convulsions, paralysis, thick tenacious saliva
72
Q

Poliomyelitis

A
  • Incubation period 9-12 days from exposure
  • Muscle weakness, headache, stiff neck, fever, nausea and vomiting, sore throat
  • Lower motor neuron lesion (flaccid paralysis) with decreased deep tendon reflexes and muscle wasting
  • Cerebrospinal fluid shows lymphocytic pleocytosis but rarely over 500/mcL
73
Q

Botulism

A
  • History of recent ingestion of home-canned or smoked foods or of injection drug use and demonstration of toxin in serum or food
  • Sudden onset of diplopia, dry mouth, dysphagia, dysphonia, and muscle weakness progressing to respiratory paralysis
  • Pupils are fixed and dilated in most cases
74
Q

Tetanus

A
  • History of wound and possible contamination
  • Jaw stiffness followed by spasms of jaw muscles (trismus)
  • Stiffness of the neck and other muscles, dysphagia, irritability, hyperreflexia
  • Finally, painful convulsions precipitated by minimal stimuli
75
Q

West Nile Virus

A
  • Prodrome of fever, nausea, vomiting, weakness, or lethargy, and diarrhea
  • Neurologic signs and symptoms develop rapidly
76
Q

Syphilis

A
  • PRIMARY SYPHILIS: chancre: painless ulcer with clean base and firm indurated borders; regional lymphadenopathy
  • SECONDARY SYPHILIS: diffuse macular, papular, pustular rash that may include palms and soles. Painless, silvery ulcerations of mucous membrane with surrounding erythema. Generalized lymphadenoapthy, mild constitutional symptoms
  • TERTIARY SYPHILIS: gummatous lesions involving skin, bones, and viscera; CV disease, CNS and ocular syndromes
77
Q

Gonorrhea

A
  • Purulent and profuse urethral discharge, especially in men, with dysuria, yielding positive smear
  • Men: epididymitis, prostatitis, periurethral inflammation, proctitis
  • Women: cervicitis with purulent discharge, or asymptomatic, yielding positive culture; vaginitis, salpingitis, proctitis also occur
  • Fever, rash, tenosynovitis, and arthritis with disseminated disease
  • Gram negative intracellular diplococci seen in a smear or cultured from any site, particularly the urethra, cervix, pharynx, and rectum
78
Q

Genital Herpes

A
  • Recurrent small grouped vesicles on an erythematous base, especially in the orolabial and genital areas
  • May follow minor infections, trauma, stress, or sun exposure; regional lymph nodes may be swollen and tender
  • Viral cultures and direct fluorescent antibody tests are positive
79
Q

Chancroid

A
  • Vesicopustule that breaks down to form a painful, soft ulcer with a necrotic base, surrounding erythema, and undermined edges
  • Unilateral adenitis that consists of tender, matted nodes of moderate size wtih overlying erythema
80
Q

Granuloma Inguinale

A
  • Donovan bodies on Wright stain
  • Lesions on the skin or mucous membranes of the genitalia or perineal area; relatively painless infiltrated nodules that soon slough; a shallow, sharply demarcated ulcer forms, with a beefy-red friable base of granulation tissue
81
Q

Lymphogranuloma Venereum

A
  • Evanescent primary genital lesion
  • Lymph node enlargement, softening, and suppuration, with draining sinuses
  • Proctitis and rental stricture in women or in MSM pop
  • Positive complement fixation test
82
Q

Chlamydia

A
  • A common cause of urethritis, cervicitis, and post-gonococcal urethritis
  • Diagnosis made by nucleic acid amplification of urine or swab specimen
83
Q

Human Papillomavirus

A
  • Verrucous papules anywhere on the skin or mucous membranes, usually no larger than 1 cm in diameter
  • Prolonged incubation period
  • Recurrences are frequent
84
Q

Streptococcal Skin Infections

A
  • Impetigo: a focal, vesicular, pustular lesion with a thick, amber colored crust with a “stuck on appearance
  • Erysipelas: a painful superficial cellulitis that frequently involves the face; well demarcated, and affects skin with impaired lymphatic drainage
  • PCN is drug of choice
85
Q

Staphylococcal Skin Infections (MSSA/MRSA)

A
  • Localized erythema with induration and purulent drainage
  • Abscess formation
  • Folliculitis commonly observed
  • Gram stain of pus with gram-positive cocci in clusters; cultures usually positive
86
Q

Gas Gangrene

A
  • Sudden onset of pain and edema in an area of wound contamination
  • Prostration and systemic toxicity
  • Brown to blood-tinged watery exudate, with skin discoloration of surrounding area
  • Gas in the tissue by palpation or radiograph
  • Gram positive rods in culture or smear of exudate
87
Q

Necrotizing Fasciitis

A
  • Group A streptococcal infection
  • Rapidly spreading infection involving the fascia of deep muscle
  • Clinical presentation mimicking cellulitis, but the presence of systemic toxicity and severe pain, which may be followed by anesthesia
88
Q

Osteomyelitis

A
  • Predominantly caused by staph aureus
  • Hematogenous spread of long bones (kids)
  • Contiguous focus of infection or open wound (diabetics)
  • Acute infection with abrupt development of local symptoms and systemic toxicity OR indolent with insidious onset of vague pain over the site of infection progressing to local tenderness and constitutional symptoms
89
Q

Non-Joint Bacterial Infection Arthritis

A
  • Acute parvovirus B19 and Hep B infections can mimic RA, but is self-limiting
  • Chronic infection with Hep C is associated with arthralgia
  • Mycobacterium arthritis is monoarticular and lasts weeks to months
  • Late lyme disease can include monoarticular and migratory arthritis
90
Q

Septic Arthritis (Gonococcal)

A
  • Prodromal migratory arthralgias
  • Tenosynovitis is the most common sign
  • Purulent monoarthritis in 50%
  • Characteristic skin lesions
  • Most common in young women during menses or pregnancy
  • Dramatic response to antibiotics (azithromycin and a 3rd gen ceph)
91
Q

Septic Arthritis (Non-gonococcal)

A
  • Acute onset of inflammatory monoarticular arthritis, most often in large weight-bearing joints and wrists
  • Common risk factors include previous joint damage and injection drug use
  • Infection with causative organisms commonly found elsewhere in body
  • Joint effusions are usually large, with white blood counts commonly over 50,000/mcL
92
Q

Pneumocystis Pneumonia

A
  • Fever, dyspnea, nonproductive cough
  • Bilateral diffuse interstitial disease without hilar adenopathy by chest radiograph
  • Bibasilar crackles on auscultation in many cases; others have no findings
  • Reduced partial pressure of O2
  • P jiroveci in sputum, bronchoalveolar lavage fluid, or lung tissue
93
Q

Cryptosporidiosis

A
  • Watery diarrhea lasting from 5-10 days
  • Accompanying abdominal pain and cramps, nausea, vomiting, and fever
  • Relapses may follow initial resolution of symptoms
94
Q

Cytomegalovirus Retinitis

A

-Fundoscopy reveals neovascular, proliferative lesions (“pizza-pie” retinopathy)

95
Q

Kaposi Sarcoma

A
  • Lesions may appear anywhere, including eyelids, conjunctiva, pinnae, palate, and toe webs
  • Purplish, nonblanching lesions that can be papular or nodular; appear more brown in dark-skinned individuals
  • Most often seen on the palate in the mouth
96
Q

Cryptococcal Meningitis

A
  • Fever and headache
  • Few have meningismus
  • Positive serum CRAG
97
Q

Oral Hairy Leukoplakia

A
  • Caused by EBV
  • A white lesion on the lateral aspect of the tongue that may be flat or slightly raised; usually corrugated, and has vertical parallel lines with fine or thick “hairy” projections

Infectious Disease (8 decks)

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