Exam 2, Lobo lectures Flashcards
What are the three most common URI bacterias?
strep pneumo (#1 most common), haemophilus influenza and moxarella catarhalis- these commonly travel though your sinuses and give you sinusitis, otitis media or CAM pneumonia
Haemophilus influenza is seen most commonly in who for URIs?
People with COPD- people who smoke
Haemophilus influenza thrives well where?
Blood agar plates, it likes blood
Moxarella catarhalis is seen often in what kind of infection?
otitis media
What percentage of pharyngitis is viral?
90%
Which meds work well for viral sinusitis?
antiinflammatories (NSAIDs), antihistamines (for congestion) like sudafed and benadryl= they treat the symptoms
What ingredients in cough syrup help with the symptoms?
Dextromethorphan and Codeine
What is the most common culprit for bronchiolitis in children?
RSV
What is HCAP? What is VAP?
HCAP= pneumonias you get in the hospital, VAP= pneumonia you get when on an ventilator
CAP often precedes what?
often a precedes a viral infection (influenzae)
What are the types of bacterial pneumonias you often get after a viral infection?
Pneumococcus or Staph A
What are the symptoms of atypical pneumonia?
Present subacutely, fatigue, SOB, not clearly from the lungs, non-productive cough, interstitial pattern on xray, more generalized symptoms instead of pulmonary symptoms
What are three common atypical pneumonias?
Mycoplasma, Chlamydia and Legionella
Which antibiotics treat atypical pneumonia?
Azithromyacin and the quinolones Levo and Moxa. Doxycycline can also be used because it is less expensive, but the others work better.
What are the symptoms and bacteria of typical pneumonia?
Strep pneumoniae, pulmonary symptoms (cough, pluritic chest pain), chest pain, rusty sputum (rusty because of blood), xray shows lobe infiltrates. Klebsiella (alcoholics, curant jelly sputum)
Which pneumonia can present as typical or atypical?
legionella
What is a good antibiotic for strep pneumo?
Ceftriaxone, (2nd and 3rd generation cephalosporins), Levofloxacin, Moxafloxacin (quinolones), Penicillin G (will probably miss 60-70% of them though)
Which antibiotic travels less to the head than ceftriaxone?
vancomycin
How does strep pass through the body to form meningitis?
travels through cribiform plate and causes meningitis
What is the most common bacteria for meningitis?
strep pneumo
Does sound travel faster in a healthy or consolidated lung?
consolidated
How many pneumococcal vaccines are there? What kind of organisms do they cover?
2 vaccines for pneumococcus= capsulated organism
23 serotypes in the pneumococcal vaccine cover what percentage of the bacteria?
85%
What does rhonchi sound like?
wind blowing through a tube
During a pleural effusion, what will percussion sound like?
dull
Soft and muted lung sounds are?
vesicular
If legionella is found in the hospital, what should you think of?
problems with the water supply in the hospital
If someone has upper resp symptoms, myalgias and athralgias, what kind of test should they get?
should get a nasal swab to rule out influenzae
What kind of test is more sensitive than a nasal swab?
Nasal flushes are better than nasal swabs, they PCR the results. Nasal swabs aren’t as sensitive.
Why might older people have more immunity towards h. flu than younger people?
older people may have pre-existing immunity to h. flu- and then they get the vaccine so their immunity is stronger than young healthy people
Why do we get the flu vaccine annually?
Antigenic drift= happens on continuous basis, which is why we need to get the flu vaccine annually and not just once or twice, every year they have to decide which strands to put in the vaccine
What is an antigenic drift?
A mechanism for variation in viruses that involves the accumulation of mutations within the genes that code for antibody-binding sites. This results in a new strain of virus particles which cannot be inhibited as effectively by the antibodies that were originally targeted against previous strains, making it easier for the virus to spread throughout a partially immune population. Antigenic drift occurs in both influenza A and influenza B viruses.
What syndrome could you get from being vaccinated?
guillan barre syndrome
If you get the flu, what are you at risk of getting? (you’re also at risk for it when getting the vaccine as well)
GBS-just getting the flu itself you’re 10x at higher risk for getting GBS than if you get the vaccine
What kind of vaccines do not have eggs in them?
re-combinant vaccines
Adenovirus typically causes what?
conjunctivitis and hemorrhagic cystitis
What is included in the flu vaccine every year?
Far east most popular virus, and last year’s most popular strand
What are you at higher risk for when you have HIV?
you are at increased risk for PCP/PCJ (presents like atypical pneumonia)
What labs will be increased and decreased in someone who has HIV and PCP/PCJ?
LDH will be up (in PCP it will go up significantly) and neutropenia will be present
How do you treat someone who has HIV and PCP/PCJ?
treatment for this will be bactrum, use it IV
What infections are fatal for people without spleens?
When you don’t have a spleen (it’s basically one big lymph node), encapsulated organisms, and Capnocytophaga (from a dog bite)
What is the most common way to get TB?
Being/living/being born in a foreign country
How is small bowel diarrhea different from large bowel?
more mucusy diarrhea from small bowel
What are the most common sources to get diarrhea?
Most common sources: Other people, food and water
What is the most common cause of diarrhea in children as well as travelor’s diarrhea?
Enterotoxigenic Escherichia coli (ETEC)
If the only symptom of ETEC is diarrhea how do you treat it? What if bloody diarrhea is present?
If JUST diarrhea is present, most of the time you don’t require treatment, just stay hydrated and wait for it to pass. Fevers, blood and mucus in stool, abdominal cramping= have them take antibiotics.
What are some of the most common sources for shiga toxin?
The most common sources for Shiga toxin are the bacteria S. dysenteriae and the Shigatoxigenic group of Escherichia coli (STEC), which includes serotypes O157:H7, O104:H4, and other enterohemorrhagic E. coli (EHEC).
E.coli with serotype 0157 H7 can lead to what kinds of problems?
Infection may lead to hemorrhagic diarrhea and to kidney failure. It also may lead to HUS (hemolytic-uremic syndrome).
What is hemolytic-uremic syndrome?
disease characterized by hemolytic anemia, acute kidney failure (uremia), and a low platelet count (thrombocytopenia). It predominantly, but not exclusively, affects children. Most cases are preceded by an episode of infectious, sometimes bloody, diarrhea acquired as a foodborne illness or from a contaminated water supply and caused by E. coli O157:H7, although Shigella, Campylobacter and a variety of viruses have also been implicated.
You should not take antibiotics for HUS or e.coli contaminated meat because…?
If you give antibiotics, the toxin hops over to your normal bacteria and infects that.
Salmonella can cause what conditions?
typhoid and gastroenteritis
What are the risk factors for C Diff?
antibiotics (even for UTI’s and sinusitis) it takes a while to normalize the flora in your body, and c diff can take over, people in hospitals (workers and patients) often get this
What kind of medications slow down your gut?
Opioids, leading to constipation
What is toxic megacolon?
Toxic megacolon (megacolon toxicum) is an acute form of colonic distension. It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.
What are the different tests for c diff?
Tests for C. Diff= cytotoxin assay, but it is only 70% sensitive, and it is complicated to do. The most sensitive test is culturing. PCRs are expensive but they are the best. GDH Elisa is performed and if it’s positive a PCR is performed.
What type of antibiotic is good used rectally?
Vancomycin is good rectally so it can reach the colon, if you take it orally, the gut is slow so it won’t reach it quickly
What is gel electrophoresis?
Gel electrophoresis is a method for separation and analysis of macromolecules (DNA, RNA and proteins) and their fragments, based on their size and charge.
What is the most toxic C Diff strain?
NAP1 strain
What test can detect NAP1, the most toxic C diff strain?
PCR
What is the treatment for NAP1 C diff strain? Why does this treatment work well?
Metronidazole is the treatment. In order to kill toxin, you need to get to the lumen of the intestines, and metro is absorbed well in the gut. It may not get to the colon though if the ileus is slow or obstructed.
How long does it take for your normal colonic flora to get back to normal after illness and antibiotics?
6-8 weeks
What medication works just as well as vancomycin for C Diff but recurrence will more likely happen?
-Fidaxomicin works just as well as vancomycin, but recurrence is more likely to happen if you give them fidaxomicin.
What is the most important thing to do to prevent C Diff? What will not work?
Most important thing one can do is handwashing to prevent C Diff (alcohol does not work!!!)
What is the most common area in the hospital for C Diff?
-Neonatal unit= They don’t get it until they are older though because they don’t have the receptors for the toxin yet
How do you treat people who have recurrent C Diff problems?
-Fecal transplants are the best way for people who have recurrent problems, 60-75% effective, it can also be transplanted straight to the colon instead of through the mouth (ugh gross)
What does botulism do to the nerves?
-Botulism= paralyzes the nerves, -Dysphagia, dysphonia, extremities get weak- bulk of cases come from alaska, they eat a lot of fermented fish, it goes in a ziplock bag and they let it sit there for a while and then they eat it
Which bacteria causes a lot of diarrhea but it takes longer to pick up?
-Clostridium perfringens= causes a lot of diarrhea, takes longer to pick up, around 24 hours
What kind of bacteria comes from refried beans?
Bacillus Cereus
Which food poisoning resembles gram negative rods and resembles an allergic reaction?
Scombroid food poisoning is a foodborne illness that results from eating spoiled (decayed) fish. Along with ciguatera, it is listed as a common type of seafood poisoning. It is gram negative rods.
However, it is often missed because it resembles an allergic reaction. It is like eating a big bowl of histamines.
What food poisoning produces a neurotoxin and is found in seafood?
-Dinflagellates= from eating seafood, they produce a neurotoxin, pufferfish also gives these dinoflagellates
What percentage of people with cellulitis have staph A? What are the symptoms?
Cellulitis= 30-40% of them have staph A. Edema, dry skin, look between the toes, they travel up the lymphatics
How do you tell the difference between venous insufficiency and cellulitis?
Venous insufficiency= they look dark red, and it won’t be painful, so sometimes it looks like cellulitis, if you keep the legs elevated than 5-10 mins later it will go away, obviously this doesn’t occur with cellulitis
What is necrotizing fasciaitis and who do you see it in?
Fasciaitis- bacteria/fungus travels really quickly all the way to the fascia, the area above gets gangrene and it is necrotizing fasciaitis! You can die from this. Diabetics and people with bad vascularity this is more common. You can see a lot of inflammation but they won’t be having any pain. Call a surgeon immediately. Chunks of skin have to be taken out.
What is fournier’s gangrene?
necrotizing fasciaitis seen in the groin, most commonly in men
Necrotizing fasciatis as deep as the bone is called what? How do you treat this condition?
Osteomyelitis! Chronic osteomyelitis= surgical disease. When bone gets infected, part of the bone dies because it doesn’t get blood supply. Surgeon scrapes it and it doesn’t bleed. We have to get rid of this, it is sequestrum. You cannot sterilize it. You need to remove it. Once its gone, you then need to give them antibiotics.
What is an antibiotic that targets skin problems?
Cellulitis, strep and staph A= use clindamycin
What kind of scan for bone works better than a bone scan?
MRI
Why is an MRI good for diabetics with feet problems?
diabetics feet get misshapen, an MRI is good for this…. do not do it if they are on antibiotics.
What is the treatment for chronic osteomyelitis?
needs a surgeon. Long course of antibiotics, 6 weeks or longer. If peripheral pulses are not felt you NEED a surgeon. You need to monitor everyone, with or without peripheral pulses. You need to see if they have blood supply it is the most common thing missed.