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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
Group A strep
MC cause of bacterial pharyngitis in kiddos | likely sx: scarlatiniform rash, palatal petechiae, tonsillary enlargement, vomiting, tender cervical nodes
26
Risk factors for TB
Household Incarceration Drug use Travel to endemic area
27
Main sx of TB
``` Productive cough hemoptysis Fatigue Weight loss Fever Night sweats ```
28
Latent TB (LTBI)
Bacilli are contained w/in granulomata | Non-transmissible but can be if it becomes active
29
Reactivation of TBI and RF
individuals immune system becomes weak and can't contain latent bacteria RF: gastrectomy, silicosis, DM, HIV, immunosuppression drugs
30
RF for drug resistant TB
interact w people who have it Unsuccesful prior TB tx Pt noncompliance
31
Which influenza type produces the mildest symptoms?
Influenza C
32
What are influenza pandemics normally due to?
Type A antigenic shifts
33
What are conditions that are suggestive of HIV?
Hairy leukoplakia on tongue Disseminated kaposi sarcoma Cutaneous bacillary angiomatosis Generalized LAD early in an infection
34
What is the biggest difference between CMV and infectious mono?
CMV doesn't present w pharyngeal sx normally
35
CMV seroprevalence increases w
``` Age Lower SES # of sex partners Hx of STI Employment in child care ```
36
CMV infection v CMV disease
Infection doesnt have to have symptoms | Disease has infection w signs and symptoms (viral or tissue-invasive)
37
Perinatal CMV infection sx (8)
Jaundice, HSM, thrombocytopenia, purpura, microcephaly, CNS calcifications, mental retardation, motor disability
38
Perinatal CMV acquired in what manner is likely to be benign?
Breast feeding or blood products
39
What does CMV look like in immunocompetent patients?
Mononucleosis but w negative heterophil antibodies Fever, malaise, myalgias, arthralgias, splenomegaly, atypical lymphocytes, abnormal liver fxn Cutaneous rashes
40
CMV in immunocompromised persons?
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
What are neurologic manifestations of CMV in immunocompromised persons?
Polyneuropathy, transverse myelitis, encephalitis
42
Histoplasmosis in immunocompromised v. immunocompetent persons?
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
Which pt can present with chronic progressive pulmonary histoplasmosis?
Older patients w COPD
44
How does progressive histoplasmosis affect the mucous membranes, liver, spleen, and GI system?
Ulcers on mucous membranes of oropharynx HSM GI can mimic IBD
45
What are some of the general sx of histoplasmosis?
Cough, dyspnea Fever, weight loss, prostration CNS invasion in 5-10% of pt
46
Sx of disseminated histoplasmosis?
Fever and multiple organ system involvement | Can be fulminant presentation looking like septic shock
47
What causes coccidioidomycosis?
Inhalation of coccidioides immitis or coccidioides posadasii (molds in soil of US, mexico, central and south america)
48
Primary coccidioidomycosis incubation period and symtpoms?
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
Which disease can cause erthyema nodosum 2-10 days after sx onset?
Primary Coccidioidomycosis
50
Disseminated coccidioidomycosis in immunocompromised pt
If untreated, can lead to fungemia with diffuse miliary infiltrates on CXR and an early death
51
General sx of disseminated coccidioidomycosis
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
General sx of plasmodium species malaria
Intermittent attack of fever, chills, and sweating | HA, mylagia, vomiting, splenomegaly, anemia, and thrombocytopenia
53
Which plasmodium species is responsible for most severe infections?
P falciparum (F=bad)
54
Which plasmodium species don't cause severe illness?
P ovale and P malariae
55
Acute malaria sx
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
Which plasmodium disease causes 48 hr cycles and which causes 72 hr cycles?
48 -p vivax and p ovale | 72 - P malariae

SBL Exam 2 (3 decks)

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