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SBL Exam 2 > Fever > Flashcards

Fever Flashcards

1
Q

What are the most common sources of bacteremia?

A 
Skin and ST infections 
Central venous catheters and other intravascular devices
Bone and joint infections
Pneumonia
Endocarditis
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2
Q

Clinical manifestations of bacteremia

A 
Fever
Fatigue and malaise 
NV
loss of appetite 
Dehydration 
Myalgia and arthralgia
Lab evidence of leukocytosis and left shift hemogram
Needs empiric ab tx
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3
Q

What is septicemia?

A

Inflammatory response to bacteremia

Early sepsis -> sepsis -> septic shock

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4
Q

SOFA for sepsis

A

Organ dysfunction score! Identifies pt who have high risk of dying from infection

not diagnostic and does not identify if organ dysfunction is due to infection

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5
Q

qSOFA for sepsis

A

Based on RR >22/min, altered mentation, and systolic BP <100 mmHg

Predicts chance of sepsis in pt admitted

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6
Q

What are 8 risk factors for sepsis?

A 
ICU admission
Bacteremia
Age >65
Immunosuppression
DM and obesity 
Cancer 
CAP
Previous hospitalizations
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7
Q

Clinical manifestations of sepsis

A 
Symptoms and signs specific to infectious source
Arterial hypotension of SBP <100 mmHg
Temp >38.3 or <36
HR >90 BPM
RR >20
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8
Q

What are signs of end organ perfusion abnormalities?

A

warm, flushed skin in the beginning that progresses to cool due to redirection of blood flow
Decreased cap refill, cyanosis, mottling
altered mental status, obtundation, oliguria, anuria
Absent bowel sounds/ileus

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9
Q

Lab eval for sepsis

A 
Leukocytosis or leukopenia
Normal WBC w/ >10% immature 
Hyperglycemia w no DM
Plasma CRP >2 standard dev above normal value
Arterial hypoxemia
Acute oliguri
Creatinine increase >0.5 mg/dL
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10
Q

How do you get a staph infection?

A

skin or soft tissue infection due to a break in skin integrity, IV catheters, cardiac devices, orthopedic hardware

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11
Q

Sx of a systemic staph infection

A 
Bone or joint pain
Fever or sweats (endocarditis)
Abd pain (LUQ)
CVA tenderness 
HA
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12
Q

MRSA

A

hospitial acquired and involved in long term, recurrent wounds
Common in immunocompromised
Local erythema w induration and pus

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13
Q

Is MRSA gram + or -?

A

Gram positive cocci in clusters

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14
Q

What should you focus on in culture positive s. aureus bactermia?

A

Endocarditis, osteomyelitis, and deep seated systemic infections (epidural abscess, discitis, abscess formation)

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15
Q

Erysipelas

A

superficial skin infection associated w staph.

well defined borders

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16
Q

Cellulitis

A

Deeper skin infection w dermis and subQ fat

associated w lymphangitis, edema, swelling

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17
Q

Erysipelas and cellulitis have what features in common?

A

Painful, warm, indurated, erythematous, non-localized

Can have lymphangitis

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18
Q

risk factors for community acquired MRSA

A

Contact sports
Military
Incarceration
IV drugs

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19
Q

MRSA is common in what situations?

A

Surgical incisions

Diabetic foot infections

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20
Q

What are unusual MRSA infections?

A

Joint infections (bacteremia or instrumentation usually)

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21
Q

What is osteomyelitis due to MRSA associated with?

A

Fixation device, prosthesis, hematogenous infection in kids, nonhealing foot ulcers in pt w DM or peripheral artery dz

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22
Q

Group B Strep in neonates

A

In utero or passage through vagina

presents as bacteremia w/o focus, sepsis, pneumonia, or meningitis

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23
Q

Group B strep in pregnant women

A

UTI
Chorioamnionitis
Postpartum endometriosis
Bacteremia

24
Q

Group B strep in non pregnant adults

A

MC strep pathogen inadults
Bacteremia w/o focus!!!
Sepsis, ST infection, endocarditis

25
Q

Group A strep

A

MC cause of bacterial pharyngitis in kiddos

likely sx: scarlatiniform rash, palatal petechiae, tonsillary enlargement, vomiting, tender cervical nodes

26
Q

Risk factors for TB

A

Household
Incarceration
Drug use
Travel to endemic area

27
Q

Main sx of TB

A 
Productive cough
hemoptysis
Fatigue
Weight loss
Fever
Night sweats
28
Q

Latent TB (LTBI)

A

Bacilli are contained w/in granulomata

Non-transmissible but can be if it becomes active

29
Q

Reactivation of TBI and RF

A

individuals immune system becomes weak and can’t contain latent bacteria
RF: gastrectomy, silicosis, DM, HIV, immunosuppression drugs

30
Q

RF for drug resistant TB

A

interact w people who have it
Unsuccesful prior TB tx
Pt noncompliance

31
Q

Which influenza type produces the mildest symptoms?

A

Influenza C

32
Q

What are influenza pandemics normally due to?

A

Type A antigenic shifts

33
Q

What are conditions that are suggestive of HIV?

A

Hairy leukoplakia on tongue
Disseminated kaposi sarcoma
Cutaneous bacillary angiomatosis
Generalized LAD early in an infection

34
Q

What is the biggest difference between CMV and infectious mono?

A

CMV doesn’t present w pharyngeal sx normally

35
Q

CMV seroprevalence increases w

A 
Age
Lower SES
# of sex partners
Hx of STI
Employment in child care
36
Q

CMV infection v CMV disease

A

Infection doesnt have to have symptoms

Disease has infection w signs and symptoms (viral or tissue-invasive)

37
Q

Perinatal CMV infection sx (8)

A

Jaundice, HSM, thrombocytopenia, purpura, microcephaly, CNS calcifications, mental retardation, motor disability

38
Q

Perinatal CMV acquired in what manner is likely to be benign?

A

Breast feeding or blood products

39
Q

What does CMV look like in immunocompetent patients?

A

Mononucleosis but w negative heterophil antibodies
Fever, malaise, myalgias, arthralgias, splenomegaly, atypical lymphocytes, abnormal liver fxn
Cutaneous rashes

40
Q

CMV in immunocompromised persons?

A

CMV retinitis in advanced aids
Aids/high dose chemo can lead to GI and hepatobiliary CMV w esophagitis, small bowel inflamm., colitis, or cholangiopathy
Transplants/AIDs- pneumonitis

41
Q

What are neurologic manifestations of CMV in immunocompromised persons?

A

Polyneuropathy, transverse myelitis, encephalitis

42
Q

Histoplasmosis in immunocompromised v. immunocompetent persons?

A

Immunocompromised can become dissemninated and lead to a poor prognosis (dx w blood and bone marrow cultures). CD4 is normally <100
Immunocompetent is asymptomatic or a mild respiratory illness

43
Q

Which pt can present with chronic progressive pulmonary histoplasmosis?

A

Older patients w COPD

44
Q

How does progressive histoplasmosis affect the mucous membranes, liver, spleen, and GI system?

A

Ulcers on mucous membranes of oropharynx
HSM
GI can mimic IBD

45
Q

What are some of the general sx of histoplasmosis?

A

Cough, dyspnea
Fever, weight loss, prostration
CNS invasion in 5-10% of pt

46
Q

Sx of disseminated histoplasmosis?

A

Fever and multiple organ system involvement

Can be fulminant presentation looking like septic shock

47
Q

What causes coccidioidomycosis?

A

Inhalation of coccidioides immitis or coccidioides posadasii (molds in soil of US, mexico, central and south america)

48
Q

Primary coccidioidomycosis incubation period and symtpoms?

A

incubates 10-30 days
Sx in 40% of pt, and are nasopharyngitis with fever and chills.
Arthralgias (esp knees and ankles)
Can cause CAP in endemic areas

49
Q

Which disease can cause erthyema nodosum 2-10 days after sx onset?

A

Primary Coccidioidomycosis

50
Q

Disseminated coccidioidomycosis in immunocompromised pt

A

If untreated, can lead to fungemia with diffuse miliary infiltrates on CXR and an early death

51
Q

General sx of disseminated coccidioidomycosis

A

Productive cough
enlarged mediastinal LN
Lung abscesses, empyema
Skin and bone infections
Meningitis that can result in chronic basilar meningitis
Subcutaneous abscesses and verrucous skin lesions
Lymphadenitis progressing to suppuration

52
Q

General sx of plasmodium species malaria

A

Intermittent attack of fever, chills, and sweating

HA, mylagia, vomiting, splenomegaly, anemia, and thrombocytopenia

53
Q

Which plasmodium species is responsible for most severe infections?

A

P falciparum (F=bad)

54
Q

Which plasmodium species don’t cause severe illness?

A

P ovale and P malariae

55
Q

Acute malaria sx

A

Prodrome of HA and fatigue, followed by fever.
W/o tx, fever becomes regular (48 or 72 hr cycles)
Myalgia, arthralgia, chest and abd pain, anorexia, N/V

56
Q

Which plasmodium disease causes 48 hr cycles and which causes 72 hr cycles?

A

48 -p vivax and p ovale

72 - P malariae

SBL Exam 2 (3 decks)

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