Foils Flashcards
Rocky Mountain spotted fever
Tick bourne
Ricekettsia rickettsia
April September (Spring)
Children < 15
Southeast US
Fever, HA, myalgia
Small pink macule –> petechiae, purpura wrists/ankles –> trunk (spares face)
Normal WBC, left, shift, mild anemia, moderate thrombocytopenia, hyponatremia
Tx: doxycycline
Complications (due to vasculitis) - DIC, loss of limbs, CNS, lungs, kidneys
Guillain-Barre
Auto-immune demyelination
30-40 y/o
Weakness (progressive ascending), areflexia, paresthesia
Often preceded by viral illness
Associated with campylobacter and flu vaccine
Loss of DTRs
Respiratory failure can develop
Autonomic instability (vs tick paralysis)
CSF: increased protein
Tx: admit, airway support, plasmapheresis, IVIG
Strychnine
Rodenticide - white, odorless, bitter crystalline powder
Muscle spasms
Seizures, mydriasis, exophthalmos, nystagmus
Tachycardia, HTN, tachypnea, SOB, cyanosis, trismus, risus sardonicus, opisthitonus
Tx: supportive
Henoch-Schonlein Purpura (HSP)
Immune mediated vasculitis (most common acute vasculitis affecting children)
Age 2-11, whites, winter, male
Preceding strep or GI infection (salmonella, shigella)
Abdominal pain (colicky, ileoilial intussusception), GI bleed, hematuria, palpable purpura (dependent areas, extensor surfaces), migratory large joint arthritis
4-6 week illness
Tx: supportive, steroids if renal manifestations (40%)
Normal platelets and coags
Ransons criteria
GLOWS - glucose > 200, LDH > 350, older age > 55, WBC > 16, SGPT (AST) >250
BOB CHF - base defecit > 4, pO2 < 60, calcium < 8, BUN increase > 5, Hct drop > 10%, fluid deficit > 6L
Jones criteria
GABS
3-4 weeks after infection
Major: migratory polyarthritis, carditis, subQ nodules (back of wrist, elbow, front of knees), erythema marginatum, sydenham chorea
Minor: fever, arthralgia, history of RF, prolonged PT, elevate ESR/CRP, GABS infection
Diptheria
Club shaped gram + bacillus
Respiratory droplets
** pseudomembrane** exotoxin-induced necrosis
“Bull neck”
Heart (myocarditis), CNS (neuropathy), kidneys, liver
Tx: equine serum diphtheria antitoxin + erythromycin/PCN
Give antibiotics to carriers
Pertussis
Bortadella pertussis - toxin mediated
URI, 2 wks (catarrhal phase) –> 2-4 weeks paroxysmal coughing spasms (inspiratory whoop only 1/3rd), post-tussive emesis followed by milder cough for months
Adults = primary reservoir, children = greatest risk
Vaccine
Mucous plugs, secondary bacterial infections, increased intrathoracic pressure (rectal prolapse, ruptured diaphragm, hernias)
Tx: erythromycin, TMP/SMX, isolation
Chemophrophylaxis for household contacts
Babesiosis
Tick bourne
Hemolytic anemia
Tx: atorvaquone + azithromycin
CO poisoning
Leading cause of toxic death
Shifts oxyhemoglobin dissociation curve to the left (inhibits release of O2 from Hgb)
Colorless, odorless
Incomplete combustion of fuel
Scenarios: cooking with grill without ventilation, car engine in enclosed space, furnace
HA, nausea, confusion, coma, sz, no cyanosis
Looks like “flu” but no fever and dog is sick too
Crosses placenta
Pulse Ox normal, PaO2 normal, measure carboxyhemoglobin (levels don’t predict toxicity)
1/2 life: 5 hours (RA), 1.5 hours (100% O2), 20 min (HBO) - may prevent delayed neuropsychiatric syndrome
Hydrogen sulfide poisoning
Scenarios: oil refinery, hot asphalt, sewage, mines
Rotten egg odor
Tx: remove from source, 100% oxygen, methylene blue in cyanide antidote kit –> binds to methemoglobin
Brown-Sequard
Unilateral cord injury Penetrating trauma Crossed below level of injury Ipsilateral weakness and loss of position/vibration Contralateral loss of pain/temp
Erythema nodosum
Painful, non-ulcerative on anterior tibias, arms, trunks
Drug reaction, systemic infection (TB/fungal), sarcoid, IBD, malignancy
Common in women 30-50 y/o
Resolves in 3-6 weeks
Crohns disease
Full thickness wall involvement (mouth to anus)
“skip lesions”
Gross blood < 50%
Granulomatous
Fistula formation
Increase oxalate absorption leads to calcium oxalate –> kidney stones
Ulcerative colitis
Colon involvement (not small bowel), continuous
Blood diarrhea
Toxic megacolon
Mucosal and submucosal layers only (not full thickness)
Risk of colon cancer increases 30 fold
Behcets disease
Vasculitis - diffuse involvement Eyes - uveitis Mouth - aphthous ulcers Skin - pustules/folliculitis Lung aneurysms --> lung hemorrhage Joints - arthritis CNS - headaches, confusion, strokes, personality changes, aseptic meningitis Genitals - painful ulcers GI - ulcers from mouth to anus (similar to Crohns)
Juvenile Rheumatoid arthritis (JRA)
Pain, swelling, morning stiffness > 6 weeks
Fever, LAD, trunkal rash
Uveitis, growth problems
Carcinoid syndrome
GI tumors: small bowel, appendix, stomach, colon, liver (or lung)
Secretes serotonin, prostaglandins
Skin flushing, diarrhea, hypotension, vasodilation, edema, ascites, bronchoconstriction
Tx: octreotide
Hypokelemia periodic paralysis
Hereditary: autosomal dominant
Avoid high-carbohydrate/sodium diet
Thyrotoxicosis: young Asian males, onset after exercise
EKG changes: decreased Twaves, U wave, ventricular dysrhythmias
Replete both K (orally) and Mg + beta-blocker
SLE
Female, African-american, multi-organ autoimmune
Fever, joint pain, rash
Butterfly facial rash (malar)
Discoid lupus: scaly, raised plaques on face, head, neck
Renal: nephritis, proteinuria, nephrotic syndrome, CRF
Cardiac: pericarditis, myocarditis, effusions, tamponade
Pulm: pleural effusions, pleurisy, pneumonitis, infarcts:
GI: oral and nasal lesions, GI vasculitis
Heme: anemia, thrombocytopenia, auto-splenectomy thrombosis
Neuro: sz, CVA, psychosis, migraines, neuropathy, transverse myelitis
Dx: ANA (most sensitive), anti-dsDNA (most specific)
Tx: severe with steroids
Sarcoidosis
Non-infectious, non-caseating multi-system granulomatous disease
African-american adult females
Bilateral *hilar adenopathy, pulmonary infiltrates, ocular and skin lesions (waxy violacious papules)
*Hypercalcemia, anemia, eosinophilia, elevated ACE
Tx: steroids
Dressler’s syndrome
Pericarditis 2-8 wks post-MI
Fever, leukocytosis, friction rub, pericardial and pleural effusions
Tx: NSAIDs, +/- steroids
Kawasaki Disease
Mucocutaneous LN syndrome
Age 2-5, males, Asian
Major criteria (fever > 5 days + 4): bilateral conjunctiva, strawberry tongue/fissured lips, desquamation of swelling of fingers/toes, erythematous rash (starts on palms/soles), enlarged cervical LNs
Minor criteria: elevated WBC, elevated ESR, elevated platelets
coronary artery aneurysms
Tx: aspirin, IVIG
Rubeola
3 C’s - cough, coryza, conjunctivitis
Koplick spots: buccal mucous (before rash), non-tender, tiny white spots (“grains of salt”
Maculopapular, moribilliform rash, head –> feet
Complications: encephalitis, PNA, OM, conjunctivitis
Not a TORCH infection