Key findings, exam 1 Flashcards
Staph skin infection
MC: erythema, purulent drainage,
pustules, crusting, cellulitis, abcesses, folliculitis
Toxic Shock Syndrome
diffuse erythematous rash on palms and soles that desquamates
Tampon use, nasopharynx packing, wound or abcess
Sudden high onset fever, myalgia, watery diarrhea, hypotension
Low platelets and liver damage, confusion leads to renal damage, shock, syncope
Scalded Skin Syndrome
A small child or infant with
Widespread bullae with sloughing, fever
Staph food poisoning, timing
Exotoxin or food contamination
2-8 hours after ingestion
Coag neg staph infections
post op, prosthetics, catheters
Strep pyogenes pharyngitis
scarlet fever. Scarlet fever is a strawberry tongue, sandpaper rash that is diffuse erythematous rash resembling a sunburn with superimposed fine red papules that blanches. leaves desquamation behind after 2 to 5 days. face flushes with circumferential pallor
-tonsilar hypertropy and tonsillar exudate, beefy red uvula, palatal petechiae, cervical lumphadenopathy bilaterally
Impetigo - strep
A wresterler with a:
Focal, vesicular pustular lesions w/ honey colored crust and stuck on appearance
Erysipelas -strep or s aureus
Painful superficial cellulitis with dermal lymphatic involvement covering the face
Strep agalactiae
Group B strep.
Mother to infant through birth canal. Must take prophylactic PCN
10-30% asymptomatic carriers. Mom needs pregnancy screening before going to the hospital as it can cause neonatal sepsis.
OM - strep pneumo
2-14 year old
Erythematous, bulging tympanic membrane
Absent light reflex, poor mobility
Otalgia, hearing loss, loss of balance, fever, diarrhea
Otorrhea if ruptured
Acute sinusitis - strep pneumo
MC: starts as a viral infection
purulent rhinorrhea and sinus pressure. erythematous, swollen nasal turbinates and mucosa
Pneumococcal pneumonia
Rigor, rust colored sputum, pleuritic chest pain, lobar consolidation +- effusion on CXR
bronchial breath sounds early and then crackles in the lobe
Bacillus anthracis skin
onset within 2 weeks of exposure
painless black eschar
regional adenopathy exposure
Fever, headache
Bacillus anthracis ingestion
bloody diarrhea, ulcerations on mouth, GI obstruction and perforation
inadequately cooked meat
Ingested spores cause symptoms
Bacillus anthracis inhalation
first progression of flu like symptoms,
then chest pain, severe respiratory distress, acidemia,
meningitis, mediastinitis, pleural effusion
Bacillus cereus
RICE/LEFTOVERS
1-10 hours onset
watery diarrhea self limiting
Listeriosis (listeria monocytogenes)
Bacteremia, high fever, meningitis, dermatits
oculoglandular retinitis &lymph node enlargement,
Pseudomonas Aeruginosa
MC in Corneal ulcers in contact wearers, ICU pneumonia, osteochondritis
Healthy people get OE (otitis ext) UTI dermitis on bathing suit
IC people get pneumoniae (2nd MC), UTIs (3rd MC), bacteremia, sepsis, CF, burn patients, VAP
Its water related and it causes fever and green discharge
hot tub folliculitis 7-10 d
Cornebacterium diplitheriae
GRAY membrane covering tonsils and pharynx, nasal discharge, can spread to heart CNS and kidneys.
mild sore throat that progresses to toxemia and prostration (big fatigue)
CDC must provide a Diphlitheriae equine antitoxin
Neisseria meningococcal meningitidis
stiff neck, fever, HA, maculopapular rash, petechiae, photophobia, lethargy, change in mental status (not respond to verbal), + kernig and brudinski
can progress to fatal meningococcemia, lumbar puncture. prevent with Penbraya
Neisseria gonorrhoeae
○ May be asymptomatic (most of the time)
○ Yellow-green purulent discharge
○ Erythematous cervix (friable)
○ Infants conjunctiva discharge (culture if so)
○ Skin rashes, septic arthritis, conjunctivitis in newborns, prostatitis, PID, cervixitis, urethritis
Whooping Cough Bordetella Pertussis
○ MC in unvaccinated children
○ Aerosolized droplets. Incubation 7-14 d
-** Catarrhal -**
■ Insidious onset
■ Sneezing, coryza, cough
○** Paroxysmal**
■ Can be deadly
■ Worsening cough
■ Forceful coughing fits
■ Whooping gasps for breath
○** Convalescent**
■ Symptoms diminish
■ Cough may linger for months
Legionnaires disease
○ MC: CAP, IC, smokers, chronic lung disease, CPAP users
○ Contaminated aerosolized WATER SOURCES
○ Scant sputum production
○ Pleuritic chest pain
○ High fever
○ Toxic appearance
aerosolized water sources
scant sputum production, pleuritic chest pain, high fever. CXR shows focal patchy infiltrates or consolidation
Klebsiella pneumoniae
○ MC: ALCOHOLICS, DM, HIV
○ Severe pneumonia symptoms
■ SOB, pleuritic chest pain
■ RED CURRANT-JELLY SPUTUM
■ Can progress to lung abcess
○ Can cause UTIs as well
Travelers diarrhea
○ Presents during/shortly after travelling
○ Increased frequency, weight, and volume of stools
○ Urgent need to defecate (Tenesmus)
○ 4-5 water stools a day
○ Abdominal cramps/bloating
○ N/V
○ Fever
○ Main concern H20. +/- moderate-severe dehydration, persistent vomiting, or high fever
Campylobacter jejuni
○ Foodborne
○ Inflammatory (sometimes bloody) diarrhea, dysentery syndrome with cramps, fever, pain
Shigellosis
Inflammatory blood diarrhea
tenesmus
● Presentation:
○ Abrupt onset of diarrhea (often with blood and mucus), lower abdominal pain/cramping, tenesmus
○ Systemic: fever, chills, anorexia, malaise, HA
Cholera
● Presentation:
○ Presents after travelling to endemic area/contact with infected person
○ Acquired by ingestion of contaminated food/water
○ Sudden onset severe, voluminous diarrhea (liquid, gray, turbid, WITHOUT ODOR, blood, or pus)
○ RICE WATER STOOL
Non cholerae vibrio
cellulitis
○ Enteric illness: watery diarrhea, tenesmus, abdominal cramping
● V. parahaemolyticus
○ Japan/coastal US
○ Shellfish/contaminated seawater
● V. mimicus
● V. hollisae
salmonella Enterica
○ Typhoid fever -
Incubation stage is 5-14 days.
○ Prodromal stage is 7-10 days :
■ ABD pain, N/V
■ Sore throat, Cough, HA
■ Worsens after 10 days
○ Becomes —> exhaustion, N/V, abdominal pain, BLOODY PEA SOUP DIARRHEA, headaches, ROSE SPOTS, fever
Enterocolitis salmonella
○ Ingestion of infected eggs/poultry/chicken, raw milk, or meat
○ Direct contact with infected animals (TURTLES and REPTILES)
○ Nausea, crampy abdominal pain, inflammatory diarrhea (mucus/blood), fever
■ Sx start 12-48 hours after contact
turtles and reptiles. bloody inflammatory diarrhea and fever
Bubonic plague
○ Yersinia Pestis
RODENTS/bite of FLEAS. Only HumanXHuman during epidemic.
○ 3 forms
■ Bubonic plague (skin)
■ Pneumonic (lungs)
■ Septicemia (blood)
○ Profoundly ill: sudden onset high fever, malaise, severe myalgias, prostration
○ 1st- Axillary or inguinal lymphadenitis (BUBO), may be suppurative/draining
○ 2nd- Tachypnea, productive cough, BLOOD TINGED SPUTUM, cyanosis with pneumonia
○ 3rd- Hematogenous spread: toxic, comatose, purpuric spots (BLACK PLAGUE) on skin
Francisella Tularensis
most infectious bacteria known
CDC Cat A bioweapon
● Presentation: “rabbit disease”
○ RABBITS, rodents, and ticks
○ Fever, HA, nausea, prostration, regional lymphadenopathy
○ Papule progressing to ulcer at site of inoculation
○ Eschar is possible like anthrax but more localized and has different histories
Sepsis
Labs? Presentation? Progression?
○ Coincides with infectious source
■ Ex: cough with dyspnea=pneumonia
○ 1. Infection 2. Moves to blood 3. BV leaks are everywhere 4. Organ system dysfunction
○ Hypotension (systolic <90)
○ Fever >100.4 or <95
○ HR >90
○ RR >20
○ Signs of end organ perfusion
■ Warm/flushed skin
● Poor cap refill, cyanosis, mottling
■ Altered mental status
■ Absent bowel sounds
● qSOFA > or = 2 associated with poor outcomes
○ RR >22
○ Altered mentation
○ Systolic BP <100
Mycoplasma pneumoniae
● Presentation:
○ 2-3 week incubation
○ MC: fall, summer, young adults
○ WALKING PNEUMONIA
○ Gradual, milder
○ Scant sputum production
○ Cough
○ Often associated with pharyngitis and/or AOM
■ BULLOUS MYRINGITIS
○ Chest auscultation clear
○ CXR: nonconsolidation. nondiagnostic patchy infiltrates
Chlamydia pneumoniae
Second MC of atypical pneumoniae
Sx same as Mycoplasma pneumoniae
Chlamydia psittaci pneumoniae
○ 7-10 d incubation
○ BIRDS
○ “Atypical” pneumonia but more severe symptoms
○ Fever, chiIls, cough, HA
BIRDS
Atypical pneumonia but severe
Chlamydia trachomatis & any complications
○ MOST COMMON STD
○ Female: mucopurulent discharge, chandelier sign, urethritis, red/inflamed/friable cervix, PID (pelvic pain, dyspareunia, cervical motion tenderness)
○ Male: mucoid/watery urethral discharge, urethritis, prostatitis, dysuria, epididymitis (testicular pain, palpable/swollen epididymis)
○ Both genders: conjunctivitis, lymphogranuloma venereum
○ 7-14 day incubation
Pregnancy complications - PROM (premature rupture of the membranes)
Infertility (from PID)
Can be transmitted to newborn
Perihepatitis (Fitz Hugh-Curtis syndrome) – Clap gone wild
Haemophlus influenzae
- -colonize the upper respiratory tract in patients with COPD and frequently cause purulent bronchitis.
- -sinusitis, OM, respir. Tract infection
FUO
● Fever >101.9F or >38.3 C
● Oral is most accurate. Axillary adjust by one F
● >3 weeks
● Failure to make diagnosis after 1 week of inpatient investigation
● After that you should do a full PE on them daily to figure out etiology
● Differentiate: classic, hospital-acquired, IC/neutropenic, HIV-related
● Presentation:
○ Varies, obtain detailed HPI/ROS
○ Shaking chills: more likely infectious
SIRS
systemic inflammatory response syndrome.
Leads up to sepsis, but NOT sepsis.
● Presentation:
○ 2 or more:
■ Fever >100.4 (38C) or <96.8 (36C)
■ PaCO2 < 32 mmHg
■ HR >90
■ RR >20
■ Abnormal WBC
● >12,000
● <4,000
● >10% bands
○ Etiology: ischemia, infection, inflammation, trauma
Bacteremia
- Not fatal, means bacteria are in the blood.
- RI: 65+ yrs old
- During winter and spring
- Gram pos>Gram neg>fungi
Syphillis stages and primary presentation, and incubation, also state microorganism
spirochetes!
treponema pallidum
● Stages:
○ Early (primary and secondary) -> INFECTIOUS, first year
○ Latent -> symptom free (infectious within first year)
○ Tertiary (late) -> severe systemic symptoms, NON-CONTAGIOUS
○ Neurosyphilis and ocular syphilis
● Presentation:
○ 21 day incubation before symptoms
○ CHANCRE (painless ulcer) location:
■ MC: penis/labia
■ Cervix, anorectal region, oropharynx (where it can hide from plain site)
○ Nontender regional lymphadenopathy
○ Chancre has spontaneous healing
Secondary syphillis
-bacteria disseminate,
● Presentation:
○ Generalized maculopapular rash
○ Mucous membrane patches and ulcers
○ Condyloma lata
○ Meningitis
○ Iritis/visual disturbances
○ Hepatitis
○ Arthritis
○ Fever/generalized lymphadenopathy (LAN)
3rd stage of syphillis
Latent Stage (third stage, asymptomatic, contagious in 1st year)
Tertiary Syphillis
Tertiary syphilis – (late, non-contagious)
● Presentation:
○ Ocular sx
○ GUMMAS (skin and mucous membrane lesions)
○ Infiltrative tumors in the skin, bones, internal organs, liver
○ Bone lesions (bone pain)
○ Respiratory distress (gummas in lungs)
○ Liver disease/cirrhosis
○ Cardiovascular lesions
○ Aneurysms
○ Neurosyphilis (MC but can occur at any stage)
Neurosyphillis
● Asymptomatic neuroinvasion – asymptomatic CSF invasion
● Meningovascular syphilis- meningeal symptoms
● Tabes dorsalis – chronic progressive degen of posterior columns of spinal cord. Inability to walk in the dark, control bladder, parathesias, wide based gait
● General paresis – once cerebral cortex is infected
● Diagnose neurosyphilis w/ LP, tx same. RI: HIV, man 45yr old+
Borrelia burgdorferi, primary presentation
○ DEER TICK (ixodes)
○ MC : spring summer fall, NE and N. central US
○ Stage 1 (early localized): 4 weeks
■ 1 week after tick bite
■ Erythema migrans (BULLS EYE)
■ Flu-like symptoms
Borrelia Burgdorferri stage 2
○ Stage 2 (early disseminated):
■ Days-weeks after initial infection
■ Bacteremia
■ Secondary skin lesions/rash
■ Worsening flu-like symptoms
■ +/- cardiac involvement -arrythmia, heart block
■ +/- neuro manifestations – aseptic meningitis, facial palsy
Borrelia Burgdorferri stage 3
○ Stage 3 (late persistent)
■ Months-years after initial infection. Ok if untreated
■ MSK (60%)
■ Neuro
■ Skin
Leptospirosis
presentation, diagnosis, treatment
○ RAT URINE
○ Minor to fatal liver and kidney disease
● Diagnosis:
○ Serologic testing
● Treatment:
○ Doxycycline
Rickettsia rickettsii
● Presentation:
○ MC: NC, TN, OK, AK, MO. 73% mortality unless tx
○ WOOD/DOG TICK (dermacentor)
○ 2-14 days after tick bite
○ Fever, chills, HA, N/V, myalgias, insomnia, RASH
■ Faint macules progressing to papules, then to petechiae
■ Appears first on wrists and ankles then spreads centrally
Clostridial soft tissue infection
-gas gangrene. Lives in soil.
● Presentation:
○ Pain, edema, erythema, TISSUE CREPITUS, FOUL SMELLING
1.
Clostridial gastroenteritis
○ Found in feces, soil, air, and water
○ Mild gastroenteritis (watery diarrhea). Rare sx is fever and vomit
Clostridium Tetani
● Presentation:
○ Spores from C. tetani enter the body from wound, burn, IV drug use. It attaches to the peripheral nerve ending, causing muscle stimulation. Leads to tonic spasticity, and muscle rigidity. It CANNOT be neutralized once bound.
○ Incubation 5-30 d
○ Seen after injury, burn, or IV drug use
○ Jaw stiffness
○ Difficulty swallowing
○ Stiff neck, arms, or legs
○ Headache
○ Tonic muscle spasms
○ Trismus
○ Respiratory failure due to overstimulation (spasm of diaphragm/laryngeal spasm)
Botulism
● Presentation:
○ Can absorb many ways. Respiratory is synthesized, all other ways are natural. 8 subtypes of bolulinum
○ MC: home canned foods, commercial food, direct injection, wound
○ 18-36 hours after ingestion
○ N/V/abdominal cramps b4 neuro involvement
○ Neuro sx
■ Dry mouth, slurred speech, dysphagia
■ Blurry vision, drooping eyelids
■ Leads to diaphragm PARALYSIS (resp fail)
Pseudomembrane colitis
Overgrowth of organism because of antibiotic use. Found in soil. Water, pets, humans (asymptomatic). It produces a toxin.
● Presentation:
○ 5-10 DAYS AFTER ANTIBIOTIC USE but can take up to 2 months.
○ Diarrhea (frequent, watery, sometimes bloody)
○ Abdominal cramps, tenderness, bloating
Gardnerella (usually)
○ Asymptomatic often.
○ MC cause of vaginal discharge
○ Thin, off-white to grayish discharge
○ FISHY SMELL, elevated pH
