Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N810 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

UTI Facts

A
  • Cystitis: Infection of bladder (lower urinary tract)
  • Pyelonephritis: Infection of the kidney (Upper UT)
  • UTI is 2nd most common UT problem in children, behind enuresis
  • 2nd only to URI as most common infection in adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

UTI S/S

A
  • Dysuria
  • Frequency
  • Urgency
  • Suprapubic pain
  • Hematuria
  • Fever
  • ** May be asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pyelonephritis S/S

A
  • May or may not have s/s or UTI
  • Fever and chills
  • Flank pain
  • CVAT
  • N/V
  • Presentation may mimic PID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Honeymoon Cystitis

A
  • UTI during or shortly after a honeymoon or vacation

- Sexual activity can push bacteria back into urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

UTI Diagnosis

A
  • 75-95% of cystitis and pyelo- is E. coli
  • UA for pyuria - present in almost all women with acute cystitis or pyelo-
  • WBC casts are pathognomic for pyelonephritis
  • Hematuria is NOT a predictor of complication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Enterobacteriaceae

A
  • Group of gram-negative rods

- Salmonella, E. coli, Y. pestis, Klebsiella, and shigella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pyuria

A
  • presence of pus (leukocytes and WBC)

- Alone is asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Urine volume

A
  • Normal=600-1500mL
  • Polyuria= >2L
  • Oliguria= <200mL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Polyuria causes

A
  • DM
  • DI
  • Polycystic kidney
  • CRF
  • Diuretics
  • IV NaCl or glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Oliguria causes

A
  • Dehydration
  • Renal ischemia
  • Acute tubular necrosis
  • Obstruction
  • ARF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Urine color: Yellow

A
  • Normal: Pale-light amber
  • Milky: UTI
  • Orange urine
  • Meds: rifampin, sulfasalazine, phenazopyridine, some laxatives, some chemo
  • Hx: Blockage, infection or Dz of the liver or bile duct –> Esp. w/ light colored stools, dehydration, fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Urine color: Blue or Green

A
  • Blue or green:
  • Dyes: food dyes, kidney/bladder tests
  • Meds: amitriptyline, indomethacin, propofol
  • Hx: Hypercalcemia, “blue diaper syndrome” (rare); UTI caused by pseudomonas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Urine color: Orange

A
  • Orange urine
  • Meds: rifampin, sulfasalazine, phenazopyridine, some laxatives, some chemo
  • Hx: Blockage, infection or Dz of the liver or bile duct –> Esp. w/ light colored stools, dehydration, fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Urine color: Dark amber or Tea-colored

A
  • Liver dysfunction
  • Increased muscle damage –> adverse Rx to statin, hepatitis, rhadomyolysis
  • Food: Large amounts of fava beans, rhubarb, or aloe
  • Meds: antimalarial drugs, metronidazole, nitrofurantoin, laxatives containing cascara or senna, and methocarbamol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Urine color: red or pink

A
  • blood
  • secondary to UTI, BPH, neoplasms, cystic kidneys, long-distance running, renal calculi
  • Food: beets, blackberries, and rhubarb
  • Meds: rifampin, laxatives containing senna
    Toxins: chronic lead or mercury poisoning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Urine pH

A
  • Normal: 4.6-8
  • Acidic pH: Ketosis*, starvation, fever, acidosis, UTI E. coli
  • Alkaline: strict vegetarian, systemic alkalosis, UTI proteus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Urine Odor

A
  • Normal: little to no odor
  • Highly concentrated: ammonia
  • Food/meds: asparagus, vitamins (esp. B6)
  • Pathologic:
  • acute liver failure, UTI, dehydration, DKA, metabolic disorders
  • Maple sugar urine disease (Branched-Chain Ketoaciduria): body has trouble breaking down amino acids
  • rectovaginal fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Urine specific gravity

A
  • Normal: 1.002-1.030
  • High SG: Adrenal insufficiency; hepatorenal syndrome, CHF, dehydration; glycosuria; renal artery stenosis; shock; SIADH
  • Low: DI, Renal failure; pyelonephritis, acute tubular necrosis, psychogenic polydipsia; hypoaldosteronism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prerenal ARF

A
  • most common type of ARF
  • can be a complication of almost any disease, condition, or medication that causes a decrease in the normal amoutn of blood volume
  • Blood loss, hypotension, sepsis, ACE’s, NSAID’s, severe dehydration or burns, pancreatitis and liver Dz
  • Tx: Correct the cause
  • Often reverses itself in 2-3d
  • If left untreated, can lead to intrinsic acute renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Renal Failure (AKA renal insufficiency or chronic renal insufficiency)

A
  • 2 types:
    1) Acute: 2/t acute kidney injury
    2) Chronic: 2/t chronic kidney Dz
    Detected by:
  • Elevated serum creatinine and decrease in GFR
  • S/S: abnormal fluids levels; deranged acid-base balance; abnormal K, Ca, and Phos; hematuria; anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Postrenal failure

A
  • occurs when there is an obstruction, causing waste to build up
  • Causes: Calculi; BPH; neurologic insult to the spinal nerve or neurologic disorders (Parkinson’s, CVA, MS); blood clots; neoplasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Proteinuria causes

A
  • Prerenal: heavy exercises, fever, HTN, multiple myeloma, eclampsia
  • Renal: acute/chronic glomerulonephritis, renal tubular dysfunction, polycystic kidney, nephrotic syndrome
  • Post renal: acute/chronic cystitis, tuberculosis cystitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Microalbuminuria

A
  • ** Cannot be detected by dipstick
  • Detected by 24hr specimen
  • Most common risks: DM & HTN
  • Other risks: meds, trauma, toxins, infections, immune disorders, obesity, age >65, family Hx, preeclampsia, race & ethnicity
  • Increased production of proteins can cause it: multiple myeloma, amyloidosis
  • ** Orthostatic proteinuria: more proteinuria standing than lying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bence-Jones proteins

A
  • A type of proteinuria usually associated with multiple myeloma
  • detected in 24hr specimen
  • can also occur with: amyloidosis; CLL; lymphoma
25
Q

Creatinine

A
  • Waste product of muscle metabolism

- Produced from creatine, which is important in energy production

26
Q

BUN

A
  • Measures the amount of nitrogen in blood that comes from the waste product urea
  • a by-product of protein metabolism, made in the liver, and excreted through kidneys
  • High: HF, dehydration, high protein diet
  • Low: Liver Dz or damage, 2nd or 3rd trimester of pregnancy
27
Q

Microscopic exam of urine

A
  • RBC’s
  • Inflammation, injury, or Dz in kidney or UT
  • Can be a contaminant from hemorrhoids or menstruation
  • WBC
  • infection or inflammation
  • Epithelial cells
  • from bladder or external urethra
  • Microorganisms
  • bacteria, yeast, trichomonads
  • Casts
  • Identified by substances in them: RBC, WBC, hyaline casts
  • Crystals
  • formed in excessively alkaline or acidic urine, temperature also promotes formation
28
Q

UA Dipstick analysis

A
  • Glucose
  • Ketones
  • Hgb
  • Leukocyte esterase: suggests WBCs in urine
  • Nitrites: evidence of bacteria
  • Bilirubin/urobilinogen: liver Dz or RBC breakdown
29
Q

UTI Treatment

A
  • TMP-SMX DS 160/800mg PO q12hr
  • Bactrim, septra
  • Avoid if prevalence of resistance is >20%
  • Avoid if patient has taken TMP-SMX for cystitis in 3mo
  • Nitrofurantoin: 100mg PO q12hr x 5d
  • Macrobid, Macrodantin
  • Fosfoycin trometamol: 3g PO x1 dose
  • Monurol
  • Not as effective as others
30
Q

UTI Alternative treatment

A

If TMP-SMX, nitrofurantoin, and fosfomycin can not be used, move to fluoroquinolones

31
Q

How to ease dysuria

A
  • Phenazopyridine (Pyridium)
  • Treats symptoms
  • NO effect of infection
  • Turns urine BRIGHT orange
  • Take with lots of water
  • Limits doses, may mask worsening infection
  • Do not prescribe for more than 2 days
32
Q

UTI Special populations

A
  • DM more prone to UTI
  • Pregnancy is a risk factor for UTI
  • Due to the protective effect of estrogen, after menopause, women are more prone to UTI
33
Q

UTI Follow-Up

A
  • Urine Culture

- Not needed unless patient has s/s after 48-72hrs of ABX or recurrent symptoms within a few weeks of treatment

34
Q

Tickborne Dz Facts

A
  • Anaplasmosis –> Black-legged Dz: Northeast, upper midwest, & Pacific coast
  • Babesiosis –> Black-legged tick: Eastern US
  • Ehrlichiosis –> Lone Star tick: south-central and eastern US
  • Lyme Dz –> Black-legged tick: Northeastern, upper midwest, and pacific coast
  • Rickettsia –> Gulf Coast Tick
  • Rocky Mountain Spotted Fever –> American dog tick, Rocky mountain wood tick, & brown dog tick in US
  • Souther tick-associated rash illness (STARI) –> lone star tick: southeastern and eastern US
  • Tickborne relapsing fever (TBRF) –> soft ticks
  • Tularemia –> dog tick, wood tick, and lone star tick: throughout US
  • 36D Rickettsiosis –> Pacific coast tick
35
Q

STARI

A
  • STARI
  • Rash: red, expanding bulls-eye lesion that develops around bite
  • Appears within 7d of bite (shorter onset than lyme)
  • c/o fever, fatigue, HA, and myalgia (less likely to have other s/s than lyme)
  • Redness at bite does not necessarily indicate infection
  • pts. more likely to recall bite
  • Same Tx as lyme with faster recovery
36
Q

Lyme Dz

A
  • Erythema migrans (“bulls-eye” rash)
  • – Occurs in about 70-80%
  • – begins at the site of tick bite in 3-30d (~7d)
  • Rash expands over several days (more likely to have multiple lesions than with STARI)
  • May measure up to 30cm (12in)
  • Usually feels warm to touch
  • Rarely itchy or painful
  • May appear on any part of body
37
Q

STARI/ Lyme Tx

A
  • Usually same regimen as lyme
    1) Doxycycline 100mg PO BID x 12-21d
    2) Amoxicillin 500mg PO TID x 14-21d
    3) Ceftin (cefuroxime axetil) 500mg PO BID x 14-21d
  • For Lyme with Neuro s/s:
  • Ceftriaxone IV
  • PCN IV
38
Q

Lyme: Early Localized stage (3-30d after bite)

A
  • EM Rash
  • Fatigue, chills, fever, HA, muscle and joint aches, and lymphadenopathy (HIV, mono, both have similar s/s)
  • REMEMBER, some people may not develop rash, and some people have tick bite with no lyme Dz
    ns and dizziness
39
Q

Lyme: Early disseminated stage (days-to-weeks after bite)

A
  • If untreated, may spread systemically and produce intermittent s/s
  • Additional EM lesions
  • Severe HA and nuchal rigidity (meningitis)
  • Pain and swelling in large joints
  • shooting pains that may interfere with sleep
  • Heart palpitations
40
Q

Lyme: Late Disseminated stage (months-to-years after bite)

A
  • ~60% have intermittent bouts of arthritis, with severe joint pain and swelling
  • Large joints most often affected, particularly knees
  • ~5% may develop chronic neurologic s/s
  • – shooting pains, numbness/tingling in hands or feet, & problems with short-term memory
41
Q

Complications of Lyme: Post-treatment Lyme disease syndrome (PTLDS)

A

~10-20% have s/s that last for months-to-years after treatment

  • S/S: muscle/joint aches; cognitive defects; sleep disturbance; fatigue
  • May be caused by autoimmune disorder
42
Q

Other complications of Lyme

A
  • Chronic joint inflammation (knees)
  • Lymphocytic meningitis
  • Neuritis
  • Myocarditis
  • Transient AV blocks
  • Neurologic s/s (fascial palsy, neuropathy)
  • Cognitive defects (impaired memory)
43
Q

Staphylococcus aureus facts

A
  • Community-acquired MRSA (CA-MRSA, CMRSA)
  • Hospital-acquired or health-care-acquired MRSA (HA-MRSA or HMRSA
  • epidemic MRSA (EMRSA)
44
Q

MRSA colonization

A
  • Individuals can serve as a reservoir
  • The anterior nares are the most common site
  • If the nares are colonized, transmission can be spread more readily with URI or sinus infection
45
Q

MRSA Treatment wound

A
  • If a patient has a fluctuant or purulent SSTI:
  • Should have I&D
  • Send debrided material for culture
  • I&D may be sufficient for abscess I&D + ABX
46
Q

MRSA Treatment PO

A
  • Unknown what is best choice
  • Clindamycin 300-450mg PO q6-8hr
  • TMP-SMX x2 DS tabs PO q12hr
  • AVOID tetracyclines
  • Linezolid ONLY for patients who can’t take clinda or TMP-SMX
  • – Costly; high toxicity
47
Q

Alternative MRSA Tx

A
  • Rifampin
  • Shows great activity vs. MRSA
  • Used in combination with first line agents
  • Use of rifampin alone is contraindicated (rapid development of resistance
  • Fluoroquinolones
  • ABSOLUTELY contraindicated
  • Highly resistant to cipro
  • MRSA fluoroquinolone resistance prevalent in many regions of US
48
Q

Community-Acquired Pneumonia (CAP)

A
  • Prevention
  • Pneumococcal vaccine
  • Influenza vaccine
  • Who should get vaccine?
  • 65+ yo
  • High risk patients age 2-64; chronic illnesses, Heart, lung Dz, HIV, Immunocompromised, smokers
49
Q

PNA Vaccine

A
  • Pneumococcal polysaccharide (PPSV23)
  • 1 or two doses between ages 19-64 with other risk factors
  • 1 dose at 65
  • Pneumococcal 13-valent conjugate (PCV13)
  • 1 dose
50
Q

CAP Fact Dx

A
  • ONLY definitive way to diagnose PNA is with CXR
51
Q

CAP Predicting mortality

A
  • Pneumonia severity index (PSI) - more complex
  • CURB-65 –> Assign one point for each variable
  • Confusion
  • Uremia: BUN >20
  • Respiratory rate >30
  • low Blood pressure: SBP 65
  • **CRB-65 can be used in community
  • ** Hospitalize for 2-3pts.
  • SMART-COP –> CXR, tachypnea, O2 sats, RR, BP, Albumin, mental status, ABG
52
Q

Reasons to admit for CAP

A
  • Complication of PNA: sepsis; cavitary PNA;
  • Exacerbation of underlying Dz: COPD
  • Inability to reliably take meds or follow-up
  • Multiple risk factors: COPD, heart dz, smoking, etc.
53
Q

CAP most common organism

A
  • Streptococcus pneumoniae
54
Q

When to culture sputum?

A
  • Before ABX given
  • Hx of travel
  • Hx of MRSA
55
Q

CAP Epidemiology

A
  • Hx of COPD or HIV=increased risk
  • High fever >104, male sex, multilobar involvement, GI and neurologic abnormalities–> Associated with Legionella
  • Presentation more subtle in older adults
  • ** If AMS in older adult, always get UA and CXR
  • REMEMBER influenza often overlaps
56
Q

CAP Treatment: Outpatient

A
  • Patient previously healthy, no ABX in last 3mo, & no risk factors for drug resistant S. Pneumoniae
  • Macrolide
  • ** Azithromycin 250mg: 500mg day 1, 250mg x4d; Clarithromycin or erythromycin
  • – Now commonly given 500mg Azithromycin PO qd x3d
  • ** Doxycycline: BID
57
Q

CAP Treatment: Outpatient with comorbidities

A
  • A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin)
  • A beta-lactam: (1st: high-dose amoxicillin, augmentin, 2nd: ceftriaxone, cefpodoxime, or cefuroxime) PLUS a macrolide (azithromycin, clarithromycin, erythromycin)
58
Q

CAP Outpatient follow-up

A

1) In office in 2-5d

2) Follow-up CXR in 6-8wk

59
Q

Risk factors for Penicillin-resistant PNA

A
  • Age >65, beta-lactam or macrolide therapy in past 6mo, ETOH, medical comorbidities, immunosuppressive illness or therapy; exposure to child in day care center

N810 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions