IDIS Flashcards by Tiffany Reid

Leading cross of tooth loss in children?

Adults?

Debra carries

Periodontal disease

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Dental carries can be caused by:

Strep mutans 
S. sobrinus
Lactobacillus casei
Actinomyces 
Bifidobacterium
Low pH tolerant strep

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Red gums
Swelling
Bleeding with trauma
No pain

Gingivitis

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Fever
Malaise
Painful gingiva
Necrotic gray-black ulcers
Easy to remove gray pseudomembrane

Trench mouth

Acute necrotizing ulcerative gingivitis

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Fever
Painful ulcers
Swelling of lower face and neck
Oropharynx involved
Difficulty speaking or swallowing

Vincent’s angina

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Aggressive periodontitis causes

Aggregatibacter actinomycetemcomitans
Or
Eikenella corrodens in concert with Fusobacterium nucleatum

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Abscess at end of tooth root
Extension of dental carry
Pain in and around tooth 
Tapping the tooth hurts 
swelling at site

Dentoalveolar abscess

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Abscess along tooth root
Pain in and around tooth
Tapping the tooth hurts
swelling at site

Periodontal abscess

*patient will also have periodontal disease

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Severely ill
Tongue moved up and back
Pain with tongue movement 
Fever
Trismus (lock jaw)
Severe dysphagia 
Drooling
Swelling under chin
Floor of mouth tenderness

Ludwig’s angina

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Causes of Ludwig’s angina

Staph
Strep
Bacteroides (anaerobe, bad breath)
Fusobacterium (anaerobe, bad breath)

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Causes of stomatitis (inflammation of the mouth and tongue)

HSV1 and 2

Candida albicans

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Painful sores in mouth
Fever
Transmission: mucous membranes, saliva, skin
Tzanck +

HSV 1

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Painful sores in mouth
Fever
Transmission: oral sex
Tzanck +

HSV2

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Creamy white plaques in mouth
Hard to remove
Inflamed base can bleed

Candida albicans

-Type: Pseudomembranous thrush

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Redness in any part of ora mucosa
Acute or chronic
Shiny red tongue
No pseudomembrane

Candida albicans

-Type: erythematous

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Spots on cheek, angle of mouth, or on tongue
Does not rub off
Can become malignant
Chronic

Candida albicans

-Type: leukoplakia (hyperplastic)

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Spots on lateral borders of the tongue
EBV
Cowdry type A inclusions

Ora hairy leukoplakia

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Spots on angles of the mouth

Candida albicans usually, but if there is yellow crusting think Staph aureus

Angular cheilitis

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Myalgia
Headache
Malaise
Fever
Anorexia
Swollen and tender salivary glands - jelly-like feel, not warm
Sometimes earache

Mumps
Viral parotitis
-paramyxovirus, RNA, enveloped

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Swelling of salivary glands
Warm skin
Chewing hurts
Massage –> purulent discharge

Acute bacterial parotitis

Staph aureus

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Infectious causes of esophagitis

Candida albicans (most common)
CMV
HSV
HIV
VZV

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White plaques or pale yellow plaques on esophagus
Raw base
Usually also have thrush

Candida albicans caused esophagitis

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Abrupt onset of small vesicles, which later form volcano like lesions with raised edges.
Multinucleated giant cells

HSV caused esophagitis

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Gradual onset of a single large ulcer or multiple discrete lesions at the distal end of the esophagus
Only in IC patients

CMV caused esophagitis

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Multiple thrush like lesions Later you see giant deep ulcers Fistula formation, perforation, hemorrhage, or superinfections can occur

HIV caused esophagitis

Esophagitis that looks like chicken pox or shingles

VZV

Gastric vs. duodenal ulcers

Gastric hurts when you eat | Duodenal feels better when you eat

Main cause of PUD and chronic active gastritis

H. pylori

``` Pain in stomach, can travel to back Burning, gnawing, sore, vague discomfort Nausea, vomiting Belching without relief Can have hematemesis or melena ```

Chronic active gastritis

``` Fecal oral transmission No chronic carrier state Fever Malaise Jaundice Clay colored stools Dark urine ⬆️ ALT, AST, bili RUQ pain ```

HEV and HAV

Hepatitis virus not endemic to the US (Look for history of travel) Higher mortality rate especially for pregnant women

HEV

+ IgM for HAV indicates what? | + IgG?

Acute infection | Previous infection

DNA virus 80% of primary HCC is associated with this virus Sex transmission is most common

HBV

RNA virus Chronic is more common in this virus Percutaneous transmission is most common

HCV

HBsAg Anti-HBc IgM HBeAg

Acute HBV

Anti-HBc IgM | +/- HBeAg and Anti-HBe

Window HBV

Anti-HBs Anti-HBc IgG Anti-HBe

Early convalescent HBV

Anti-HBc IgG | Anti-HBe

Late convalescent HBV

HBsAg (for 6 months) Anti-HBc IgG Anti-HBe

Chronic persistent HBV

HBsAg (for 6 months) Anti-HBc IgG HBeAg

Chronic active HBV

Anti-HBs

Vaccinated for HBV

Rapid onset of projectile vomiting Little or no diarrhea Mayo, dairy products, salted foods Gram + coccus

Staph aureus | food poisoning

``` Nausea Vomiting Little or no diarrhea Fried rice Heat stable + rod ```

Type I Bacillus cereus Food poisoning

Profuse diarrhea Little or no vomiting Meat, milk, fish, vegetables Heat labile + rod

Type II Bacillus cereus Food poisoning

Abd cramps Meats,meat products, gravy Gram + rod Anaerobe

Clostridium perfringens Food poisoning *most common cause of food poisoning

Short incubation times No Fever Absence of fecal leukocytes

Food poisoning

``` Fever Nausea Abd pain Vomiting Watery diarrhea Invades small intestine ```

Viral gastroenteritis

Viral gastroenteritis causes

1. Rotavirus-naked ds RNA, infants, winter diarrhea 2. Norovirus-(most common), naked ss RNA, winter vomiting 3. Astrovirus-naked ss RNA, winter (vomiting uncommon) 4. Adenovirus-ds DNA, like rotavirus but in older infants, can cause intussusception 5. Sapovirus-like norovirus but less common

Bacterial gastroenteritis causes

E. coli Vibrio parahaemolyticus Vibrio cholerae

``` Large volume diarrhea Abd cramps Vomiting is less common No fecal leukocytes No invasion of small intestine ```

Bacterial gastroenteritis - non-inflammatory

``` LT and ST toxins Abrupt onset 24 hours Watery diarrhea Travelers diarrhea (most common cause) ```

ETEC | Enterotoxigenic E. coli

``` Adhere Mucus Cytotoxin Small and large intestine Several days Watery diarrhea Travelers diarrhea ```

EAEC | Enteroaggregative E. coli

``` Attaching-effacing histopathology No toxin Mild diarrhea in infants <6 months Several days Watery diarrhea Travelers diarrhea ```

EPEC | Enteropathogenic E. coli

Can only grow on TCBS agar

Vibrio - cholerae is yellow - parahaemolyticus is green *oxidase + gram - rod, halophilic

``` Explosive diarrhea Headache Fever Cramps Nausea Vomiting Raw shellfish ```

Vibrio parahaemolyticus

Abrupt onset of rice water stools | Slightly curve gram - rod

Vibrio cholerae

Yellowish plaques on colon with colonoscopy Usually diarrhea but can be constipated Diffuse severe abd pain, distension, guarding Hypoactive bowel sounds Blood leukocytosis PCR or glutamate dehydrogenase test on feces

C. diff colitis

Fever Abd pain Pain will attempting to defecate Tenesmus

Invasive gastroenteritis

3 most common causes of of invasive gastroenteritis? | Others?

Campylobacter *most common Shigella Salmonella (Others: EHEC, EIEC, Yersinia enterocolitica, entamoeba histolytica)

The leading cause of bacterial diarrheal disease is ___

Campylobacteriosis

``` Peri umbilical cramping Intense abd pain Malaise Myalgia Headache Vomiting Watery diarrhea Leukocytes in stool S, comma, or seagull shaped bacteria Darting motility ```

Campylobacter | Colitis

``` Malaise Fever Abd cramps Tenesmus Bloody stools Fecal leukocytes ```

Campylobacter IBD *indistinguishable from shigella, salmonella, and E. coli

Media for campylobacter

Campy-BAP | Skirrow

``` Non motile Doesn't ferment lactose Gram - rod Fever Abd pain Watery diarrhea for 2 days then dysentery and tenesmus S-S agar Fecal leukocytes ```

Shigella sonnei *most common | Shigella flexneri

Motile Does not ferment lactose Gram - rod From food or animals

Salmonellosis

Enteric fevers

S. typhi S. paratyphi A S. Schottmuelleri S. Hirschfeldii *non enteric fevers are named S. enterica

``` Nausea Abd cramps Vomiting Nonbloody diarrhea Fever Headache Myalgia 2d-1w Food ingestion ```

Salmonellosis | Enteritis

Fever for a week or two Then diarrhea Can go to liver, spleen, bone marrow

Salmonellosis | Enteric fever

Severe cramps abd pain Watery diarrhea followed by bloody diarrhea No Fever Sorbitol MacConkey plates (does not ferment sorbitol so it will be white)

Hemorrhagic colitis | EHEC

Watery diarrhea that can occasionally result in dysenteric stools Not much if any fever

EIEC

``` Diarrhea Occasionally bloody stools Abd pain Fever Nausea Vomiting *pharyngitis ```

Yersinia enterocolitica

``` RLQ pain Fever Vomiting Leukocytosis Mild diarrhea Colonizes ileum and appendix ```

Pseudoappendicitis | Yersinia enterocolitica

``` Bullseye appearance on CIN agar Does not ferment lactose Urease + Gram - rod Motile at 25C but NOT 37C ```

Yersinia enterocolitica

Intracytoplasmic RBCs is pathognomonic for___

Entamoeba histolytica

``` Diarrhea Abd cramps Vomiting Tenesmus Flask shaped ulcers Anchovy paste appearance of aspirations ```

Amebiasis | Entamoeba histolytica