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Week 2 Emergency Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Meningitis Etiologies

Bacterial

Viral

Fungal

Noninfectious

Community-acquired

Healthcare-associated

A

Bacterial: Strep pneumo, N. meningitis, H. flu

Viral: Enterovirus, HSV, HIV, West Nile, VZV, mumps

Fungal: Cryptococcus MC

Noninfectious: tumor, trauma, brain abscess, subdural empyema, pharmacologic reaction

Community-acquired: S. pneumo, N. meningitides, H. flu, Listeria

Healthcare-associated: Staph and aerobic gram-negative bacilli

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2
Q

Meningitis Symptoms

A

Abrupt onset, intense HA

Classic triad: Fever, nuchal rigidity, AMS

Photophobia, lethargy, N/V, joint pain

Petechial rash (non-blanching) associated with N. meningitidis

Seizures - bad sign, be concerned for encephalitis too

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3
Q

CNS Infections in Elderly - Red Flags

A

Often lack fever; often present with delirium w/ any infection

Behavioral/personality changes

Seizures

Lack of source for other infections

HA, nuchal rigidity, exposure to infected

Low threshold to do LP

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4
Q

Head CT with LP

A

Immunocompromised

Hx seizure w/in 1 week presentation

Neurologic abnormalities: abnormal LOC, CNS disease, papilledema, focal neuro deficit

Mandatory in all patient with possible focal infection

With meningitis, w/o papilledema or focal neuro sx do the LP immediately

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5
Q

Meningitis Workup and Treatment

A

Treatment: 2g IV q12h Rocephin immediately after LP, admit

Workup: Blood cultures, CBC, Chem 7, CSF

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6
Q

Encephalitis

A

Inflammation of the brain

MC viral - HSV 1&2 - rapidly progress and life-threatening

  • also west nile, CMV, mumps, EBV

Have to have altered neurologic findings to call it encephalitis

-personality change, paralysis, hallucination, altered smell, speech issues

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7
Q

Pediatrics and Meningitis

A

Bacterial MC between 2 months-2 years

Irritability and poor feeding may be only signs in young infants

Paradoxical irritability - crying worsens when held - suggests meningitis

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8
Q

Meningitis Etiology in Peds

A

Strep penumo

Neisseria meningitidis

H. influenzae type B - rare now w/ vaccine

Neonates: think group B strep

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9
Q

Encephalitis symptoms

A

Minor: may just have flu-like symptoms

Severe: Ha, AMS, confusion, fever, agitation, neuro changes

Severe in kids: bulging fontanels, N/V, body stiffness, paradoxical crying, poor feeding, inconsolable

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10
Q

Workup and Treatment of Encephalitis

A

CT/MRI

CBC, CMP

LP - PCR for HSV1, serology

-rbcs in nontraumatic CSF tap are HSV until proven otherwise

Treat: Acyclovir 10 mg/kg IV q8h - empiric HSV treatment

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11
Q

Septic Arthritis

A

Medical emergency - destroy joint in 12-24 hours; asymmetric

Acute/subacute pain, erythema, swelling, limited joint motion, systemic sx

Joint tap shows >40,000 wbc - r/o gonorrhea

Gram stain unless gonorrhea - wont show up

-get cervical, urethral, rectal GC culture if suspected

Tx: high-dose IV antibiotics

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12
Q

Bacteremia

A

Fever, chils, rigors, disorientation, hypotension, respiratory failure

Source of infection from respiratory, central venous catheters, UTI, GI tract, biliary tract, skin, soft tissues

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13
Q

Gram Negative Bacteremia

A

25-50% all blood stream infections

More sick than gram +

Treatment for severe: gentamicin/tobramycin/amikacin + cefepime (antipseudomonal cephalosporin)

Consider vanco until culture come back

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14
Q

Gram Positive Bacteremia

A

Staphylococcus aureus is leading cause

Empiric treatment: vancomycin

  • MSSA - PCN, nafcillin/oxacillin, vanco
  • MRSA - vancomycin or daptomycin

r/o infective endocarditis with transesophageal echo

IVDA makes you more concerned for staph

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15
Q

Sepsis

A

Infection + other general symptoms (fever, HOTN, tachypnea, AMS, edema, hyperglycemia w/o DM (>140))

Have HOTN with wide pulse pressure

Poor urine output, elevated creatinine INR and PTT, low platelets

Ileus, elevated bilirubin, elevated lactate, decrease cap refill

Treat: supportive and empiric abx

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16
Q

Cellulitis

A

Emergent if: around face/hand, cellulitis w/ DM or PVD, or local infection with leukemia or HIV

Cellulitis: affects skin through dermis

All cellulitis/folliculitis/furunculosis is MRSA until proven otherwise - bactrim DOC, Clinda 2nd line

17
Q

Impetigo

A

Superficial skin infection MC in kids

Commonly due to strep, maybe staph

Treat with bactrim

18
Q

Endocarditis - high risk

A

IVDA

Previous valve surgery/abnormal valve (regurgitant)

Poor dental health - source

Present with night sweats, anorexia, weight loss

Also present with cardiac failure, stroke (septic emboli), cold extremity from emboli

19
Q

Endocarditis - Valve MC affected with IVDA

A

Tricuspid valve

Often present with bilateral embolic pneumonia

Often lack the right-sided murmur

20
Q

Endocarditis Characteristics

A

Cutaneous lesion: conjunctival and palatal petechia, splinter hemorrhages, Osler (finger/toes) and Janeway (palms/soles) lesions

Roth spots (pale ovals w/ hemorrhage around) on dilated eye exam near optic disk

May have normocytic, normochromic anemia

Get trans-esophageal echocardiogram to see valvular vegetation

21
Q

Toxic Shock Syndrome

A

Absorption of toxin from localized staph aureus infection

Short prodrome: fever, myalgias, V/D, pharyngitis

Rapidly develops fulminate shock and fever w/ multiple organ failure

Diffuse blanching macular erythema w/ pan-mucosal inflammation - fades in 2-3 days

Desquamation of hands and feet 5-12 days after rash disappears

22
Q

Hallmark Labs for TSS

A

Negative blood cultures

Elevated CPK

Sterile pyuria

23
Q

Rocky Mountain Spotted Fever

A

Rickettsia Rickettsi

Fever, chills, malaise, myalgias, frontal HA

Pink macular rash on palms/soles, wrists and ankles on 5th day - becomes petechial, purpuric, and spreads over 24-48 hours

24
Q

Lyme Disease

A

Borrelia burgdorferi

Erythema migrans - rash w/ central clearing = target lesion

Fatigue, lethargy persists for months/years

Arthritis, neuropathy for years after

25
Q

Malaria

A

Sx 12-35 days after exposure - depend on parasite load

Fever, malaise, myalgias, arthralgias, HA

Anemia, elevated wbc, low platelets

AMS, splenomegaly, seizures, ARDS, organ failure w/ severe case

26
Q

Botulism

A

Caused by Clostridium botulinum infection

Gram-positive, rod-shaped spore forming obligate anaerobe

Bilateral cranial neuropathies w/ symmetric descending weakness; no fever, pt remains responsive w/o sensory deficits

May have blurred vision

Treatment: 2 botulism-a antitoxin therapies (equine >1 yo; immune globin <1yo)

PCN G, flagyl for wound botulism

27
Q

Smallpox Clinical Features

A

12-day incubation

Non-specific prodrome 2-4 days

Multilocular vesicles on face and extremities that scab over in 1-2 weeks

Synchronous onset of rash: starts on face, hits the palms and soles; greater on the back with deep lesions

28
Q

Cutaneous Anthrax

A

Papule that progresses through vesicular stage to depressed black, necrotic ulcer (eschar)

Edema, redness, necrosis w/o ulceration may also occur

1-12 day incubation

Gram stain, PCR, Blood cultures, and biopsy for diagnosis

29
Q

Inhalational Anthrax

A

Prodrome of viral-like illness w/ myalgia, fatigue, fever

Followed by hypoxia and dyspnea

CXR/CT shows widened mediastinal from hilar adenopathy

Common to have meningitis as well

30
Q

Gastrointestinal Anthrax

A

Abdominal distress w/ bloody emesis or diarrhea

Followed by fever and septicemia; +/- oropharyngeal ulceration, cervical adenopathy, fever

Occurs after ingestion of contaminated meat

1-7 day incubation

31
Q

Anthrax Treatment

A

Adults: Cipro or Doxy for 60 days

Kids: Cipro or Doxy - dose depends on age; for 60 days

-In children, do not give more than 1g daily

32
Q
A
  1. Inconclusive: high neutrophils indicates bacterial meningitis is possible
  2. Bacterial meningitis
  3. Normal: CSF wbc 75% blood
  4. Viral: moderate increase in wbc w/ neutrophil% <60-70

Week 2 Emergency Medicine (9 decks)

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