ID 1 Flashcards
what are 2 common causes of acute viral rhinosinusitis
rhinovirus
parainfluenza virus
coronavirus
some bacterial
tx of acute viral rhinosinusitis
supportive: NSAIDs, saline washes, fluids, decongestants
*s/s>10 days, abx indicated
spread and incubation of influenza
spread- droplet
incubation- 1-4 days
influenza s/s include…
fever, chills, malaise, myalgia, URI s/s, non-productive cough
GI symtoms- influenza B
influenza dx
rapid tests
PCR- most sensitive
CBC
low O2
influenza tx
supportive
antivirals within 48 hrs
neuraminidase inhibitors (A&B)
if exposed to influenza, may tx with this within 48 hrs of exposure
chemoprophylaxis: oseltamivir or baloxavir
this syndrome is associated with giving aspirin with acute viral illnesses and may lead to progressive liver failure and encephalopathy
reye syndrome
s/s of this disease include grouped vesicles on erythematous base
HSV-1 and HSV-2
primary infection of HSV-1
Adults-tonsillopharyngitis
Children- gingivostomatitis
most asymtpomatic
HSV-2 primary infection s/s
dysuria
tender lymphadenopathy
systemic symptoms- fever, HA
Dx of HSV 1 and 2
PCR
serology
Tzanck smear
clinical
tx of HSV-1 and HSV-2
oral antivirals- valacylovir, acyclovir, famicilovir
varicella zoster transmission and incubation
transmission- contact, droplet, airborne
incubation- 10-21 days
when is chickenpox contagious
48 hrs before rash onset–> crusting of lesions
s/s of varicella zoster
fever, malaise, headache
rash:
- pruritic
- face–> trunk
- variable stages at once
- dew drop on rose petal
dx of varicella
clinical
PCR
serology
Tzanck smear
tx of varicella zoster
<12- supportive
>12- acyclovir
herpes zoster s/s
rash- unilateral vesicular dermatomal
erythematous papules–> grouped vesicles/ bullae–> pustular
this complication of shingles affects the facial nerve and leads to:
auditory and oral lesions
loss of taste
ipsilateral facial palsy
HL, tinnitus, vertigo
Ramsey Hunt syndrome
tx of ramsey hunt syndrome
antivirals and prednison
tx of herpes zoster
antivirals
analgesics
corticosteroids
tx of PHN
gabapentin
lidocaine
tricyclic antidepressants
capsaicin cream
HPV transmission and incubation
transmission- direct contact
incubation- 2-18 mo
what are 3 presentations of HPV
common wart (verruca vulgaris)
genital wart (condyloma)
plantar wart (verruca plantaris)
tx of HPV
common and plantar- cryotherapy, salicylic acid
genital- podophyllum resin, imiquimod, sinecatechins, cryotherapy, removal
Epstein-Barr virus (HHV-4) transmission and incubation
transmission- saliva, genital secretions
incubation- 30-50 days
s/s of epstein-barr (HHV-4)
- enlarged tonsils and exudates
- pharyngeal petechiae
- lymphadenopathy (cervical)
- Hoagand sign- transient upper lid edema
- splenomeagly and hepatomeagly
- maculopapular rash
dx of epstein barr virus (HHV-4)
heterophile antibody
EBV specific antibodies (IgM and IgG)
periopheral smear–> downey cells
tx of epstein-barr (HHV-4)
supportive- steroids for airway, fluid, analgesics
erythema infectiosum (5th disease) cause
parovirus B19
erythema infectiosum (5th disease) transmission and incubation
transmission- respiratory secretions and blood transfusions
incubation- 4-14 days
s/s of erythema infectiosum
prodrome- pharyngitis, conjunctivitis, fever, myalgias
rash- 2-5 later
* “slapped cheek” appearance
* symmetric maculopapular rash
* lacy reticulated rash
tx of erythema infectiosum
supportive- antipyretics, hydration
mumps cause
paramyxovirus
spread and incubation of mumps
transmission- repiratory secretions, droplets, saliva
incubation- 12-25 days
s/s of this disease includes:
* parotid tenderness/ facial edema
* orchitis- testicular swelling
* oophrotitis- lower abd pain
* pacreatitis- esp in children
mumps
mumps dx
leukopenia
lymphocytosis
elevated serum amylase
elevated IgM
tx of mumps
supportive- cold compress, analgesics, BR
what is the cause of rubeola (measles)
paramyxovirus
what is the transmission and incubation of rubeola (measles)
transmission- droplet and airborne
* contagious: 5 days before s/s- 4 days after rash
incubation- 6-21 days
s/s of rubeola
prodrome- 3 Cs: cough, coryza, conjunctivitis
enanthem- Koplik spots
exanthem- brick red starts at neckline and moves down and out
tx of rubeola
supportive- antipyretics, hydration, vit A, isolation
cause of rubella
togavirus
rubella incubation time
14-21 days
* contagious- 1 wk before rash–> 15 days after rash
rubella s/s
prodrome
* lymphadenopathy, fever, malaise
enanthem
* forchheimer spots
exanthem
* pink rash starts on face and spreads to trunk and extremities
rubella tx
supportive- anitpyretics, hydration
roseola (6th disease) cause
HHV-6 or HHV-7
s/s of roseola (6th disease)
prodrome
* high fever, OM, conjunctivitis
enanthem
* nagayama spots
exanthem
* rose colored rash starts on tunk and spreads toward face
tx of roseola
supportive- antipyretics, hydration
this is common s/s of primary infection of what disease?
mononucleosis- exudative tonsillopharyngitis and cervical lymphadenopathy
CMV (HHV-5)
CMV (HHV-5) secondary s/s
colitis
* diarrhea, n/v, abd pain
retinitis
* fluffy, yellow/ white retinal lesions, granular appearance, intraretinal hemorrhage
esophagitis
* odynophagia, dysphagia, large superifical ulcers
pneumonitis
* common post transplant
dx of CMV
tissue biopsy
serology (IgM, IgG)
CMV (HHV-5) tx
primary- supportive
* pregnancy- high dose valacylovir
severe or reactivation- antiviral therapy (ganciclovir)
s/s of congenital CMV
SNHL
eye involvement- cataracts, glaucoma
heart defects
blueberry muffin like hemorrhagic purpuric eruptions
dx of congenital CMV
PCR
tx of congenital CMV
life threatening- IV ganciclovir
non-life threatening- valganciclovir
rabies cause
rhabdovirus–> encephalitis of gray matter
s/s of this disease includes:
* prodrome- aerophobia, hydrophobia, pain, fever, n/v
* CNS stage- encephalitic or paralytic
* coma, ANS dysfunction, death
rabies
dx of rabies
PCR
skin biopsy
after death–> negri bodies
rabies tx
wound care
post exposure prophylaxis- HDCV on days 0, 3, 7, and 14 + immune globulin day 0
west nile virus cause and incubation
arbovirus/ flavivirus
arthropod borne
2-14 days
s/s of this viral illness include:
* fever and flu like s/s
* meningitis
* encephalitis: AMS, tremor, seizure, CN palsy
west nile virus
dx of west nile virus
serology- IgM ELISA in serum or CSF
west nile virus tx
supportive
if severe–> hospitalize
ebola cause
filoviridae
transmission and incubation of ebola
transmission- contact with bodily fluids and skin
incubation- 2-21 days
these s/s describe what disease?
stage 1/ nonspecific febrile illness
* HA
* weakness, dizziness
* fatigue
* myalgia or arthralgia
stage 2
* abd pain, n/v, diarrhea
* ecephalitis
* hypovolemic shock
* hemorrhagic symptoms
ebola
ebola dx
PCR
IgM ELISA
ebola tx
supportive
zika cause
flavivirus
zika virus transmission and incubation
transmission- mosquitoes, maternal-fetal, sexual, blood
incubation- 2-14 days
these are s/s of what viral illness?
* pruritic rash on face, trunk, extremities, palms and soles
* arthralgia and myalgia
* conjunctivitis
* HA
* hyperreflexia
zika
dx of zika
PCR- if 7 days post-exposure
serology IgM- if 7+ days after exposure
tx of zika
supportive
what kind of shock is sepsis?
distributive
list the qSOFA criteria
- BP- systolic < or equal to 100 mmHg
- AMS
- RR- > or equal to 22 breaths/ min
(at least 2 of the following)
list the SIRs criteria
- temp- >100.4 (38) or <96.8 (36)
- HR- >90 bpm
- RR- >20 breaths/min or PaCO2 <32 mmHg
- WBC- >12,000 or <4,000
(at least 2 of the following)
sepsis management steps
- fluids
- vasopressives- NE, vasopressin, epi
- broad spectrum abx
- 2 sets of blood cultures from 2 different sites
these conditions are complications of GAS pharyngitis
scarlet fever/ rheumatic fever
this condition leads to a rash that is diffusely erythematous with red papules with a sandpaper consistency. Strawberry tongue may be present.
scarlet fever
dx of rheumatic fever
Jones criteria
what are the requirements of the jones criteria?
major
* polyarthritis
* carditis
* chorea
* rash
minor
* fever
* arthralgia
* inflammatory markers
* PR segment prolongation
tx of scarlet fever/ rheumatic fever
penicillin
recurrent- prophylaxis for 5 yrs
skin and soft tissue infection progression
folliculitis–> furuncles–> carbuncle–> deep abscess involving muscle or fascia–> necrotizing fascitis
dx of skin and soft tissue infection
culture of wound
blood cultures (if systemic infection s/s)
* bactremia–> blood cultures every 24-48 hrs
tx of purulent skin and soft tissue infection
I&D
oral dicloxacillin or clindamycin
MRSA-clindamycin, bactrim, doxycycline
tx of nonpurulent skin and soft tissue infection
oral abx- amoxicillin, cephalexin, clindamycin
IV abx- nafcillin, cefazolin, vancomycin, daptomycin
what are the 3 main causes of osteomyelitis
- hematogenous (bactremia)
- contiguous focus (trauma/ injury)
- vascular insufficiency
RFs for hematogenous osteomyelitis
injection drug user
sickle cell anemia
older pts
s/s of this type of osteomyelitis include:
* sudden onset of high fever
* chills
* pain
* tenderness of involved bone
hematogenous (bacteremia)
s/s of this type of osteomyelitis include:
* localized signs of inflammation
* absent fever or signs of toxicitiy
contiguous focus
s/s of this type of osteomyelitis include:
* absent bone pain
* absent fever
vascular insufficiency
bedside signs of vascular insufficiency osteomyelitis include…
- probe advances to the bone
- ulcer area > 2cm x 2 cm
dx of osteomyelitis
- definitive- isolation from sample
- initial- x-ray
- most sensitive- CT
- epidural abscess- MRI
if vertebral osteomyelitis, suspect _________
epidural abscess
tx of osteomyelitis
prolonged IV abx- cefazolin, nafcillin, oxacillin
MRSA- IV vancomycin or daptomycin
staphylococcal bacteremia may suggest _______
endocarditis
dx of staphylococcal bacteremia
transesophageal echocardiogram to r/o endocarditis
tx of staph bacteremia
IV vancomycin or daptomycin
s/s of this disease include:
* acute onset high fever
* n/v, watery diarrhea
* sore throat, myalgia, HA
* macular erythematous rash, desquamation of palms and soles
* nonpurulent conjunctivitis
* hypotension
toxic shock syndrome
dx of toxic shock
blood cultures- will be negative since it is due to toxins, not infection
tx of toxic shock syndrome
- remove source
- rapid rehydration
- anti-staph therapy
- manage organ failure
- IV clindamycin, IV immune globulin
this infection is typically due to intravascular devices, prosthetic devices, or wound infection following cardiothoracic surgery
coagulase-negative staphylococci
s/s of coagulase-negative staphylococci
purulent serosanguineous drainage
erythema
pain at site of foregin body
tx of coagulase- negative staphylococi
remove device
cause of tetanus
clostridium tetani–> neurotoxin tetanospasmin
tetanus incubation
5 days- 15 weeks
eary s/s of tetanus
pain and tingling
spasticity of nearby muscles
jaw or neck stiffness
dysphagia
irritability
late s/s of tetanus
hyperreflexia,
asphyxia and apnea
spasms of jaw muscles–> trismus
fascial muscle spasm–> risus sardonicus
spasm of muscles of abd, neck and back–> opisthotonos
tx of tetanus
IM human tetanus immune globulin within 24 hrs
debride wound
IV or PO metronidazole (or PCN)
BR, no light or noise, sedation, paralysis, nutrition
botulism cause
clostridium botulinum–> botulism toxin
3 common souces of botulism
- foodborne- canned, smoked, vacuum packed
- infant ingestion of honey
- wound- injection drug users
s/s of this condition includes:
* symmetric descending flaccid paralysis–> respiratory failure or death
* visual disturbances- ptosis, dipolpia, ect..
* dry mouth, dysphagia, dysphonia
botulism
dx of botulism
toxin found in serum
tx of botulism
contact state health department
airway
equine serum heptavalent botulism antitoxin
fluids
diphtheria cause
corynebacterium diphtheria
s/s of this condition includes:
* tenacious gray membrane that covers tonsils and pharynx (appears stuck on)
* laryngeal infection
* nasal drainage
* myocarditis and neuropathy
diphtheria
dx of diphtheria
clinical
culture
PCR
prevention of diphtheria
if exposed… get booster
tx of diphtheria
removal of membrane and antitoxin from horse serum from CDC
PCN or erythromycin
listeriosis cause
listeria monocytogenes
contaminated foods- unpaseurized dairy, hot dogs, deli meat, cantaloupes, soft cheeses
5 types of listeriosis
- pregnancy infections
- granulomatosis infantisepticum
- bacteremia
- meningitis
- focal infections
dx of listeriosis if suspecting meningitis
lumar puncture–> elevated neutrophils and proteins
tx of listeriosis
IV ampicillin
cause of pertussis (whooping cough)
bordetella perussis
transmission and incubation of pertussis
transmission- respiratory droplets
incubation- 7-17 days
what are the 3 stages of pertusis?
- catarrhal stage
- paroxysmal stage
- convalescent stage
s/s of catarrhal stage of pertussis
insidious cough
lacrimation
sneezing
coryza
anorexia and malaise
night cough (diurnal)
s/s of paroxysmal stage of pertussis
rapid consecutive coughing
deep high pitched inspiration (whoop)
s/s of convalescent stage of pertussis
decrease in frequency and severity of paroxysms of cough
dx of pertussis
isolating organism from nasopharyngeal culture
prevention of pertussis post-exposure
prophylaxis with oral macrolide (erythromycin)
tx of pertussis
azithromycin, clarithromycin, bactrim
tx of sinusitis, otitis, or resp. infections due to h. flu
oral amoxicillin or augmentin
tx of epiglottitis (due to h flu)
IV ceftriaxone
PCN allergy–> fluoroquinolone
what causes salmonellosis?
ingestion of s enterica
dx of typhoid fever
blood culture
s/s of typhoid fever
abd pain and constipation
fever- ascends in stepwise fashion
splenomeagly, bradycaria and meningismus
rash- rose spots during second wk
tx of typhoid fever
azithromycin or ceftriaxone
what are 3 presentations of salmonellosis?
typhoid fever
acute enterocolitis
septicemic
what is the MC form of salmonellosis?
acute enterocolitis
dx of acute enterocolitits
culture from stool
tx of acute enterocolitis
self limited
if complications–> ciprofloxacin or levofloxacin
transmission of shigellosis
fecal-oral
ingestion of contaminated foods
person to person
s/s of this illness include:
stool mixed w/ blood and mucus
abrupt onset diarrhea
tenesmus (cramping rectal pain)
shigellosis
tx of shigellosis
self-limited
tx dehydration and hypotension
severe- fluoroquinolones or ceftriaxone
s/s of cholera
*rice water stool
turbid, gray, watery, large volume stools
may have blood or pus
dehydration and hypotension
dx of cholera
stool culture
tx of cholera
fluid replacement via oral or IV fluids
antimicrobials- tetracyclines, macrolides, fluoroquinolones
tx of campylobacter jejuni
self limited
hydration and electrolytes
severe- azithromycin, ciprofloxacin, levofloxacin
incubation of plague
2-8 days
s/s of plague
buboes, pneumonia, meningitis
high fever, delirium, severe myalgias
purpuric spots
dx of plague
smears from buboes
tx of plague
fluoroquinolones, aminoglycosides or doxycycline
s/s of what disease cause:
penile- dysuria, milky discharge, yellow discharge
rectal- proctitis (men who have sex w/ men)
pharynx infections
cervicovaginal infections- dysuria, inflammation of bartholin glands, increased vaginal discharge
gonococcal infections
dx of gonoccocal infections
nucleic acid amplification tests
disseminated gonococcal infection s/s
- purulent arthritis
- triad- rash, tenosynovitis, polyarthralgia (arthtitis dermatitis syndrome)
- bacteremia, meningitis, endocarditits
- conjunctivitis
tx of gonococcal infection
IM ceftriaxone
chlamydia- add doxycycline
pregnant- azithromycin
cause of chancroid
haemophilys ducreyi (G- bacillus)
s/s of chancroid
- vesiculopustule–> painful soft ulcer w/ necrotic base and erythema
- unilateral lymphadenitits
- fever, chills, malaise
tx of chancroid
azithromycin or ceftriaxone
cause of cat scratch disease
bartonella henselae
tx of cat scratch disease
self limited
lymphadentitis- azithromycin
what are 2 common presentations of chlamydia?
- lymphogranuloma venereum
- urethritis and cervicitis
s/s of this presentation of chlamydia include:
* papular or ulcerative lesion
* 1-4 wks post-exposure- inguinal or femoral buboes, may have sinuses
* proctocolitits- MC in pts receiving anal sex
lymphogranuloma venereum
dx of lymphogranuloma venereum chlamydia
nucleic acid amplification test (NAAT)
tx of lymphogranuloma venereum chlamydia
doxycycline
pregnant- erythromycin or azithromycin
s/s of this type of chlamydia include:
* less painful and more watery discharge
* cervicitis, PID, salpingitis, abd pain w/ sex, bleeding between periods
urethritis and cervicitis
dx of urethritis and cervicitis chlamydia
highly sensitive nucleic acid amplification test (NAAT)
tx of urethritis and cervicitis
doxycycline
pregnant- azithromycin or levofloxacin
screen for HIV, gonorrhea and syphilis
