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SBL Exam 2 > Fever - Tyler > Flashcards

Fever - Tyler Flashcards

1
Q

abnormal presence of bacteria in blood

A

bacteremia

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2
Q

what are the most common source of bacteremia?

A
  • skin and soft tissue infections
  • central venous catherters and other IV devices
  • bone and joint infections
  • pneumonia
  • endocarditis
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3
Q

what are the clinical manifestations of bacteremia?

A
  • fever
  • fatigue, malaise
  • N/V
  • loss of appetite
  • dehydration
  • myalgias, arthralgias
  • leukocytosis and left shift
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4
Q

what is the definition of early sepsis?

A

an inflammatory response to bacteremia

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5
Q

what is a SOFA score?

A

organ dysfunction score, but lengthy and time-consuming

score based on:

  • resp rarate >22/min
  • altered mentation
  • systolic bp <100
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6
Q
  • arterial hypotension (<90/70)
  • temp >36 C
  • HR >90bpm
  • tachypnea, resp rate >20/min
A

clinical manifestation of sepsis

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7
Q
  • warm, flushed skin
  • as sepsis progresses to shock, skin may become cool d/t redirection of blood to organs
  • decreased cap refil, cyanosis, or mottling
  • altered mental status, obtundation, restlessness
  • ileus or absent bowel sounds
A

end-organ manifestations

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8
Q
  • leukocytosis >12k, or leukopenia
  • normal WBC with greater than 10% immature forms
  • hyperglycemia w/out diabetes
  • plasma C-reactive protein 2 std above normal
  • arterial hypoxemia
  • acute oliguria
  • creatinine increase
A

lab eval in sepsis

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9
Q
  • coagulation abnormalities
  • thrombocytopenia
  • hyperbilirubinemia
  • hyperlactatemia** -> elevated serum lactate can be manifestation of organ hypoperfusion
A

sepsis

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10
Q

most common bacterial infection?

A

staph, strep

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11
Q

most common viral infections?

A
  • influenza
  • HIV
  • CMV
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12
Q

most common fungal infections?

A

coccidiomycosis, histoplasmosis

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13
Q

what does mycobacterium cause?

A

Tb

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14
Q

what do the plasmodium species cause?

A

malaria

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15
Q

skin or soft tissue infection:

  • breaks in skin integrity (erysipelas, folliculitis, cellulitis, trauma)
  • IV catheters
  • cardiac devices
  • orthopedic hardware
A

staph infections

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16
Q

systemic infections (30%):

  • bone or joint pain (back pain -> vertebral osteomyelitis, discitis or abscess) or septic arthritis
  • protracted fever/sweats
  • abd pain (LUQ -> splenic infarction)
  • CVA tenderness -> pyelonephritis, renal infarct, psoas abscess
  • HA -> meningitis, septic emboli
A

staph

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17
Q

common in immunocompromised host

  • wounds have localize erythema with induration and purulent drainage (abscess formation)
  • gam stain of pus shows gram-POS cocci in clusters
A

MRSA

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18
Q

what should s.aureus bacteremia ALWAYS focus on?

A

endocarditis, osteomyelitis, deep-seated systemic infections (epidural abscess)

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19
Q

superficial skin infection

  • usually with well-defined borders
  • minimal lymphangitis
A

erysipelas

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20
Q

deeper skin infection involving the dermis and subQ fat

  • more propensity for lymphangitis, edema, swelling
  • looks warm/swollen
A

cellulitis

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21
Q

painful, warm, indurated, erythematous, non-localized

  • may be accompanied by lymphangitis
  • distinguishing strep v staph can be difficult (staph may have more purulence)
A

erysipelas and cellulitis

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22
Q

commonly implicated in diabetic foot infections

  • infection ay complicate surgical incisions
  • joint infections are unusual, but when they do occur, usually associated with bacteremia or instrumentation (aspiration, injection, arthroscopy)
  • osteomyelitis d/t MRSA may be assoc with fixation device or prosthesis, hematogenous infection in children, or non-healing foot ulcers in diabetics
A

MRSA

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23
Q

what is the most common cause of tonsillopharyngitis?

A

strep pyogenes

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24
Q

what is the most common manifestations of neonatal disease?

A

bacteremia without a focus, sepsis, pneumonia, or meningitis

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25
Q

what are the three most common manifestations of streptococcal bacteremia in pregnant women?

A
  • uTI
  • chorioamnionitis
  • postpartum endometriosis
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26
Q

what are the most common manifestations of streptococcal bacteremia in non-pregnant adults?

A
  • bacteremia without a focus

- sepsis, soft tissue infections, endocarditis

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27
Q

most common cause of bacterial pharyngitis in children and adolescents

A

strep pyogenes (group A strep)

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28
Q

what are common sx of group A strep pharyngitis?

A
  • scarlatiniform rash
  • palatal petechiae
  • tonsilar enlargement
  • vomiting
  • tender cervical LN’s
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29
Q

what organism causes:

  • productive cough
  • hemoptysis
  • fatigue
  • weight loss
  • fever
  • night sweats
A

mycobacterium tuberculosis

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30
Q

primary infection of which organism:
- occurs with inhalation of airborne droplets containing viable tubercle bacili and subsequent lymphagitic and hematogenous spread before immunity develops

A

Tb

- up to 1/3 of cases are from primary infection acquired by person-person transmission

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31
Q

occurs when bacili are contained within granulomata
- non-transmissible while latent, but may become active disease if the infected person’s immune function becomes impaired

A

latent Tb (LTBI)

32
Q

may occur if the individual’s immune system becomes weak and no longer is able to contain the latent bacteria
- the bacteria then becomes active; they overwhelm the immune process and active infection ocurs

A

reactivation of Tb

33
Q

what are risk factors for reactivation of Tb?

A
  • gastrectomy
  • silicosis
  • diabetes mellitus
  • HIV
  • immunosuppressive drugs
34
Q

what is the most common sx of Tb?

A

cough

  • blood-streaked sputum is common, frank hemoptysis is rare
  • post-tussive apical rales are classic PE finding
35
Q

what are the slowly progressive sx of Tb?

A

malaise, anorexia, weight loss, fever, night sweats

- pts appear chronically ill

36
Q

onset of fever, chills, malaise, cough, arthralgia, myalgia

  • 3 subtypes (types A and B produce identical sx)
  • GI sx may occur, particularly among children with type B
A

influenza

- leukocytosis may be a marker of secondary complications

37
Q

pandemics usually due to which type of influeza?

A

A with major antigenic shift

38
Q

transmitted through sexual contact, parenteral exposure to infected blood, or perinatal exposure

  • sx: sweats, diarrhea, weight loss, wasting
  • neurologic sx: dementia, aseptic meningitis, neuropathy
A

HIV

  • opportunistic infections d/t diminished cellular immunity
  • aggressive cancers, esp NHL
39
Q

these conditions are highly suggestive of what infection?

  • hairy leukoplakia of the tongue
  • disseminated kaposi sarcoma (HHV-8)
  • cutaneous bacillary angiomatosis
  • generalized lyphadenopathy
A

HIV

40
Q
  • multiple, or recurrent bacterial infections
  • pneumocystic jirovecii pneumonia
  • kaposi sarcoma
  • lymphoma
  • CMV infection
  • histoplasmosis
  • coccidiomycosis
  • cryptococcosis
  • extrapulmonary
  • mycobacterium Tb or ANY site
A

AIDS-defining illnesses

41
Q

most infections are asymptomatic

  • seroprevalence increases with: age, lower socioecon status, hx of STI, employment in daycare center)
  • similar to infectious mononucleosis, but not usually pharyngeal sx
A

CMV

- not all pts with infections dvlp disease!

42
Q

virus isolation or detection of viral proteins (Ags) or nucleic acid in any body fluid or tissue specimen regardless of sx

A

CMV infection

43
Q
  • evidence of CMV infection with attributable sx
  • may manifest as either a viral syndrome (fever, malaise, leukopenia, neutropenia, atypical lymphocytosis, thrombocytopenia) or as a tissue-invasive disease
A

CMV disease

44
Q
  • jaundice, heptasplenomegaly, thrombocytopenia, purpura, microcephaly, periventricular CNS calcifications, mental retardation, motor disability
  • hearing loss in >50% of infants who have sx at birth
  • most are asymptomatic, but neurologic deficits may ensue later in life (hearing loss, mental retardation)
A

CMV inclusion disease due to perinatal infection

- infection acquired thru breast feeding or blood products typically shows a benign clinical course

45
Q

mono-like syndrome with negetive heterophil Abs

  • cutaneous rash is common
  • mono-like syndrome can occur post-splenectomy, often years later
  • fever, malaise, myalgia/arthraligia, splenomegaly, atypical lymphocytes, abnl liver function tests
  • leokopenia is followed by leukocytosis
A

CMV infection in immunocompetent person

46
Q

when is CMV retinitis usually seen?

- neovascular and proliferative retinal lesions

A

advanced AIDS

47
Q

when is GI and hepatobiliary CMV, with esophagitis, small bowel inflam, colitis, cholangiopathy seen?

A

AIDS or with high-dose chemo

48
Q

when is pneumonitis seen in CMV?

A

transplant recipients (2-6 months after) and AIDS

49
Q

what are the complications of mucosal gastrointestinal damage?

A
  • mucosal GI damage
  • encephalitis
  • severe hepatitis
  • thrombocytopenia
  • guillain-Barre synd
  • pericarditis
  • myocarditis
50
Q

exposure to bird/bat droppings; common along river valleys

  • most pts asymptomatic, resp illness mc problem
  • common in AIDS or immunosuppressed
  • influenza-like illness, lasts 1-4 days
  • more severe illness presents as atypical pneunomia (fever, cough, mild central chest pain 5-15 days)
A

histoplasmosis

51
Q

what cultures/tests are helpful in dx of disseminated histoplasmosis dz?

A
  • blood, bone marrow cultures

- urine polysaccharide Ag

52
Q

when is progressive disseminated histoplasmosis usually seen?

A

pts with underlying HIV (with CD4 counts <100)

53
Q

when is chronic progressive pulmonary histoplasmosis seen?

A

older patients with chronic obstructive pulmonary disease

54
Q

what are the complications of progressive histoplasmosis?

A
  • fever, weight loss, prostration
  • dyspnea, cough
  • ulcers of the oropharyx
  • hepatosplenomegaly
  • GI involvement may mimic IBD
  • CNS invastion in 5-10% of individuals
55
Q

what are the complications of disseminated histoplasmosis?

A
    • occurs mainly in immunocompromised pts**
  • fever and multiple organ system involvement
  • may simulate septic shock
56
Q

influenza-like illness with malaise, fever, backache, headache, and cough

  • might see meningitis, arthralgia, bone lesions, skin/soft tissue abscess
  • infection results from inhalation of molds that grow in SW US
A

coccidioidomycosis

57
Q

incubation period 10-30 days

  • 40% have respiratory sx
  • nasopharyngitis with fever and chills
  • common (unrecognized) cause of community-acquired pneumonia
  • arthralgia with perarticular swelling of knees and ankles
  • erythema nodosum can dvlp 2-20 days after sx onset
  • persistent pulmonary lesions in 5%
A

primary coccicioidomycosis

58
Q

can involve any organ

  • productive cough
  • enlarged mediastinal LNs
  • lung abscesses, empyema
  • meningitis in 30-50%, may result in chronic basilar meningitis
  • lymphadenitis
  • HIV-infected pts more often show miliary infiltrates, lymphadenopathy, meningitis, but skin lesions are uncommon
A

disseminated coccidioidomycosis

59
Q

intermittent attacks of chills, fever, sweating

  • HA, myalgia, vomiting, splenomegaly, anemia, thrombocytopenia
  • intra-ethrythocytic parasites identified in thick or thin blood smears
A

plasmodium species-malaria

- anopheline mosquitoes!

60
Q

what 4 plasmodium species responsible for human malaria?

A
  • p. vivax
  • p. malariae
  • p. ovale
  • p. falciparum
61
Q

which plasmodium species is responsible for nearly all severe disease?

A

falciparum

62
Q

which plasmodium species rarely causes severe disease?

A

vivax

- ovale and malariae generally do not cause severe illness either

63
Q

begins with prodrome of HA, fatigue, followed by fever

  • fevers may become irregular without tx
  • 48 hr cycles for vivax and ovale
  • 72 hr cycles for malariae
A

acute malaria

64
Q
  • anemia
  • jaundice
  • splenomegaly
  • mild hepatomegaly
  • hypotension
  • seizure
A

PE findings malaria

65
Q

bone pain, often in the spine, ribs, or proximal long bones

  • monoclonal Ig in serum or urine
  • clonal plasma cells in bone marrow or tissue bx
  • organ damage d/t plasma cells (bones, kidneys)
  • characterized by infiltration of bone marrow, bone destruction, and paraprotein elaboration
  • lytic bone lesions
  • soft tissue masses
A

multiple myeloma

- ** Waldenstrom’s macroglobulinemia is similar, but will NOT have lytic bone lesions**

66
Q

what leads to kidney failure in MM?

A

light chain components of Ig accumulate

- may also be deposited in tissues as amyloid, worsening kidney failure and causing systemic symptoms

67
Q

myeloma pts are especially prone to infections with what?

- occurs most commonly in adults >65

A

encapsulated orgs

- strep pneumo, h. influenzae

68
Q

HHV-8 infection, most common HIV-related malignancy

- red, purple or dark plaques/nodules on cutaneous or mucosal surfaces

A

kaposi sarcoma

69
Q

sarcoma that can present with SOA, cough, hemoptysis, or chest pain
- may be asymptmatic, appearing only on CXR

A

pulmonary kaposi sarcoma

70
Q

sarcoma that can develop in pts with HIV infection, high CD4 counts, low viral loads
- potential for clinically aggressive diease

A

chronic kaposi sarcoma

71
Q

what is the ddx for kaposi sarcoma?

A

melanoma

72
Q

occurs mainly in young women

  • rash over areas exposed to sunlight (malar rash)
  • joint sx in 90% of pts often earliest sx
  • anemia, leukopenia, thrombocytopenia
  • glomerulonephritis, CNS disease, antiphospholipid Abs are major sources of disease morbidity
  • fever, malaise, weight loss, alopecia
  • Raynaud phenomenon in 20% of pts
A

SLE

73
Q

what are the serologic findings of SLE?

A
  • ANA 100%
  • anti-dsDNA Abs 67%
  • low serum complement levels
74
Q

what are the ocular findings of SLE?

A
  • blurring of vision
  • conjunctivitis
  • cotton-wool spots of retina
75
Q

what are the cardiac findings of SLE?

A
  • pericardium is affected
  • heart failure
  • cardiac arrhythmias
76
Q

what are the pulmonary findings of SLE?

A
  • pleurisy
  • pleural effusion
  • bronchopneumonia
  • pneumonitis
  • restrictive lung dz
77
Q

dryness of eyes and mouth (sicca)

  • chronic enlargement of parotid glands
  • xerostomia causes dysphagia
  • Rh factor and antinuclear Abs common
  • increased incidence of lymphoma
  • can occur in isolation “primary” or in association with another rheumatic dz
  • pancreatitis, pleuritis, obstructive airways
  • neuropsychiatric dysfunction
  • rental tubular acidosis (type 1, distal)
A

sjogrens

SBL Exam 2 (13 decks)

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