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Emergency Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What does meningitis affect?

A

Arachnoid, subarachnoid space

CSF

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2
Q

Most Common Bacterial Culprits in Meningitis

A

Strep pneumo
N. meningitidis
H. influenza

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3
Q

Most Common Viral Culprits for Meningitis

A 
Enteroviruses
HSV
HIV
West Nile
VZV
Mumps
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4
Q

Most Common Fungal Culprit for Meningitis

A

Cryptococcus

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5
Q

NonInfectious Etiology of Meningitis

A 
Tumor
Trauma
Brain abscess
Subdural empyema
Pharmacologic reaction
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6
Q

Community Acquired Culprits of Meningitis

A

Strep pneumo
N. menigitidis
H. influenza
Listeria monocytogenes

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7
Q

Healthcare Acquired Culprits of Meningitis

A

Staph

Aerobic gram negative bacilli

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8
Q

Classic Triad of Meningitis

A

Fever
Nuchal rigidity
Change in mental status

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9
Q

Other Symptoms of Meningitis

A 
Intense headache
Photophobia
Lethargy
N/V
Joint pain
Seizures
Non-blanching petechial rash (N. meningitidis)
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10
Q

Red Flags for Diagnosing CNS Infections in the Elderly

A 
Behavioral changes
Personality changes
Seizures
Lack of other source of infection
Headache
Nuchal rigidity
Exposure to infected persons
Low threshold to do LP
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11
Q

Indications for Head CT Prior to LP

A 
Immunocompromised
Hx of seizure 1 week prior
Abnormal level of consciousness
Hx of CNS disease
Papilledema
Focal neurologic deficit
Possible focal infection
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12
Q

Meningitis Work Up

A

Blood cultures
CBC
Chem 7
CSF: cell count, gram stain, culture, glucose, protein

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13
Q

Treatment of Meningitis

A

Rocephin as soon as LP complete

Admit to hospital

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14
Q

Normal CSF Values

A 
Pressure: 70-180
Appearance: clear, colorless
Protein: 15-45 mg/100mL
Glucose: 50-80 mg/100mL
Cell count: 0-5 WBCs, no RBCs
Chloride: 110-125 mEq/L
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15
Q

Bacterial Meningitis in Pediatric Population

A

2 months-2 years

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16
Q

Clues of Meningitis in Infants

A

Irritability
Poor feeding
Paradoxical irritability

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17
Q

Most Common Etiologic Agents of Meningitis in Pediatrics

A

Strep pneumo
N. meningitidis
HIB (rare)
Neonates: gram negative and Group B strep

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18
Q

Primary prevention of Meningitis

A

S. penumoniae vaccine
HIB vaccine
Meningococcal vaccine

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19
Q

Define Encephalitis

A

Inflammation of the brain

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20
Q

Etiologic Agents for Encephalitis

A 
HSV-1
HSV-2
West Nile
CMV
Mumps
EBV
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21
Q

Difference Between Encephalitis and Meningitis

A 
Encephalitis has: Altered brain function
Personality changes
Paralysis
Hallucinations
Altered smell
Problems with speech
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22
Q

Symptoms of Encephalitis in Adults

A 
Flu like symptoms
Severe HA
Fever
Altered consciousness
Confusion
Agitation
Personality changes
Seizures
Loss of sensation
Paralysis
Muscle weakness
Hallucination
Double vision
Perception of foul smells
Speech/hearing problems
LOC
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23
Q

Symptoms of Encephalitis in Children

A 
Bulging fontanels
N/V
Body stiffness
Inconsolable crying
Paradoxical irritability
Poor feeding
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24
Q

Work Up of Encephalitis

A

Head CT and/or MRI
CBC
CMP
LP

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25
Q

Treatment of Encephalitis

A

Acyclovir q8h

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26
Q

Most Common Site of Septic Arthritis

A

Knee

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27
Q

Signs and Symptoms of Septic Arthritis

A 
Acute or subacute onset of pain
Erythema
Swelling
Limited joint motion
\+/- systemic symptoms
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28
Q

What should you send joint fluid for?

A 
Crystals
Glucose
Cell count
Culture + sensitivity
R/O gonorrhea
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29
Q

Treatment of Septic Arthritis

A

High dose IV antibiotics

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30
Q

Signs and Symptoms of Bacteremia

A 
Fever +/- chills
Rigors
Disorientation
Hypotension
Respiratory failure
Sepsis
Septic shock
Skin lesions
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31
Q

Treatment for Gram Positive Sepsis +/- Shock

A

Empiric: vancomycin
MSSA: PCN, nafcillin, oxacillin, vancomycin
MRSA: vancomycin, daptomycin

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32
Q

Treatment for Gram Negative Severe Sepsis +/- Shock

A

Gentamicin or tobramycin or amikacin
PLUS cefepime
+/- vancomycin

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33
Q

What needs to be ruled out and what test needs to be run for it in gram positive bacteremia?

A

TEE

Infective endocarditis

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34
Q

Signs and Symptoms of Sepsis/Septicemia

A 
Infection
General symptoms
Inflammatory symptoms
Hemodynamic symptoms
Poor urine output
Elevated creatinine
Elevated INR, PTT
Low platelets
Ileus
Elevated bilirubin
Elevated lactate
Decreased capillary refill
Arterial hypoxemia
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35
Q

General Symptoms with Infection for Sepsis

A 
Temp: 38.3+ or less than 36
HR: 90+
RR: 20+
AMS
Significant edema
Hyperglycemia without DM: 140+
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36
Q

Inflammatory Symptoms with Infection for Sepsis

A

WBC: 12K+ or less than 4K, left shift
Elevated CRP
Elevated procalcitonin

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37
Q

Hemodynamic Symptoms with Infection for Sepsis

A

Hypotension

Wide pulse pressure

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38
Q

Treatment of Sepsis

A

Supportive

Treat most likely source of infection

39
Q

3 Superficial Soft Tissue Infections that are Emergencies

A

Infection around the face and hand
Cellulitis in the presence of DM or PVD
Local infection with the presence of leukemia or HIV

40
Q

Define Cellulitis

A

Acute spreading infection of the skin to and through the dermis

41
Q

Drug of Choice for Cellulitis

A

Bactrim

Clindamycin

42
Q

Most Common Culprit of Impetigo

A

Strep

43
Q

Describe Impetigo

A

Small vesicles which rupture and form “honey-colored” crusts

44
Q

Treatment of Impetigo

A

Bactroban

45
Q

Define Endocarditis

A

Infection of the endothelial surface of the heart, most often the valves

46
Q

Patients at High Risk for Endocarditis

A

Previous valve damage
Valve replacement
History of IVDU
Poor dental health

47
Q

Symptoms of Subacute Endocarditis

A

Anorexia
Night sweats
Weight loss

48
Q

Presentation of Acute Endocarditis

A

Cardiac failure
Stroke
Cold extremity

49
Q

Cutaneous Lesions with Endocarditis

A

Conjunctival and palatal petechiae
Subungual hemorrhages
Oslers nodes
Janeway lesions

50
Q

Describe Oslers Nodes

A

Painful and erythematous nodules

Located on pulp of fingers and toes

51
Q

Describe Janeway Lesions

A

Erythematous, blanching macules
Nonpainful
Located on palms and soles

52
Q

Diagnostics for Endocarditis

A

TTE/TEE
Normocytic, normochromic anemia
Elevated ESR
Obtain blood cultures

53
Q

What does toxic shock syndrome result from?

A

Absorption of toxin from localized staph aureus colonization or infection

54
Q

Signs and Symptoms of Toxic Shock Syndrome (TSS)

A 
Fever: mild to 102.2+
Myalgias
Vomiting
Diarrhea
Pharyngitis
SBP less than 80 mmHg
Multiple organ failure
Diffuse, blanching, macular erythema
Pan-mucosal inflammation
55
Q

Labs that Represent Multiple Organ System Involvement

A 
Leukocytosis and thrombocytopenia
Elevated BUN and creatinine
Elevated LFTs and Bili
Sterile pyuria
Elevated CPK
Decrease serum albumin and total protein
Blood cultures NEGATIVE
Cultures of source
56
Q

Treatment of TSS

A

Supportive care

Prevent additional toxin production

57
Q

Culprit of Rocky Mountain Spotted Fever

A

Rickettsia rickettsi

58
Q

Symptoms of Rocky Mountain Spotted Fever

A 
Fever
Chills
Malaise
Myalgias
Severe frontal headache
59
Q

Rocky Mountain Spotted Fever: Days 2-5

A

Pink, macular rash on palms of hands, soles of feet, hands, feet, wrists, and ankles
24-48 hours: petechial, purpuric, gangrenous
Rash spreads centripetally
Diffuse edema

60
Q

Why diffuse edema in rocky mountain spotted fever?

A

Capillary leakage
Hypotension
Spenomegaly
Delirium

61
Q

Treatment for Rocky Mountain Spotted Fever

A

Tetracycline (TCN)
Doxycycline
Chloramphenicol (children)

62
Q

Spirochete that Causes Lyme Disease

A

Borrelia burgdorferi

63
Q

Stage I of Lyme Disease

A

Erythema migrans
Fever/chills
Malaise
Regional adenopathy

64
Q

Stage II of Lyme Disease

A

Days to weeks after infection
Multisystem involvement
Fatigue and lethargy

65
Q

Stage III of Lyme Disease

A

Lingers for months
Arthritis
Neuropathy
Acrodermatitis chronica atrophicans

66
Q

Treatment of Lyme Disease

A

Empirically while awaiting labs

Tetracycline x 30+ days

67
Q

When do malaria symptoms occur?

A

12-35 days after exposure

68
Q

Uncomplicated Malaria Case Symptoms

A 
Fever
Malaise
Myalgias
Arthralgias
Headache
Anemia
Elevated WBC
Low platelets
69
Q

Complicated Malaria Case Symptoms

A 
Fever
Anemia
Splenomegaly
Altered consciousness
Seizures
ARDS
Circulatory collapse
Metabolic acidosis
Renal failure
Liver failure
Coagulopathy
DIC
Intravascular hemolysis
Hypoglycemia
70
Q

PE Findings in Malaria

A 
Pallor
Petechiae
Jaundice
Hepatomegaly
Splenomegaly
Splenic rupture
71
Q

Treatment of Malaria

A

Consult CDC for treatment for region exposed

72
Q

Describe Clostridium Botulinum

A

Gram positive
Rod-shaped
Spore forming obligate anaerobic bacteria

73
Q

5 Forms of Botulism

A 
Foodborne
Infant
Wound
Adult enteric
Inhalation
74
Q

Presentation of Botulism

A 
Bilateral cranial neuropathies
Symmetric descending weakness
Absence of fever
Responsive
Normal/slow HR
Normal BP
No sensory deficits except blurred vision
75
Q

Botulism Testing in Infants

A

Evaluate stool for spores and toxin

76
Q

Botulism Testing in Foodborne Botulism

A

Serum analysis for toxin

77
Q

Botulism Testing for Wound Botulism

A

Culture positive
Negative serum assay
Anaerobic culture

78
Q

Botulism Testing for Adult Enteric Botulism

A

Evaluate stool for spores and toxin

79
Q

Treatment of Botulism

A

Admit to hospital
Monitor for respiratory failure
Antitoxin (1+ years)
Antibiotics (Wound)

80
Q

Antibiotics for Treatment of Botulism

A

PCN G

Metronidazole

81
Q

Transmission of Smallpox

A

Droplet
Contact
Airborne

82
Q

When does smallpox spread most rapidly?

A

Cool, dry winter

83
Q

Clinical Features of Smallpox

A

Non-specific prodrome
Rash prominent on face and extremities
Rash scabs over in 1-2 weeks
Synchronous onset

84
Q

Diagnosis of Smallpox

A

Appearance of rash

Culture of lesions: by immunized person, alert lab

85
Q

Control of Smallpox

A

Decontaminate
Prophylaxia
Vaccine
Contact/airborne isolation

86
Q

Treatment of Smallpox

A

Supportive
Isolate
Immunize contacts
Cidofovir

87
Q

Bacteria that Causes Anthrax

A

Bacillus anthracis

88
Q

3 Clinical Forms of Anthrax

A

Cutaneous
Inhalation
Gastrointestinal

89
Q

Clinical Course of Anthrax

A

Papule -> vesicular -> eschar

Edema, redness and/or necrosis

90
Q

Diagnostic Testing for Cutaneous Anthrax

A 
Gram stain, PCR, culture of vesicular fluid, exudate, or eschar
Blood culture (systemic symptoms)
Biopsy
91
Q

Clinical Presentation of Inhalation Anthrax

A 
Myalgia
Fatigue
Fever
\+/- respiratory symptoms
Hypoxia
Dyspnea
Rad evidence of mediastinal widening
Meningitis
92
Q

Clinical Presentation of Gastrointestinal Anthrax

A 
Abdominal distress
Bloody vomiting or diarrhea
Fever
Signs of septicemia
Oropharyngeal ulcerations
Cervical adenopathy
93
Q

Treatment of Anthrax

A

Ciprofloxacin

Doxycycline

Emergency Medicine (17 decks)

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