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Speciality Medicine > Lecture 10 (ID) > Flashcards

Lecture 10 (ID) Flashcards

1
Q

Stats
* ID accounted for up to how many visits to ED for children? Adults?

A
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2
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4
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5
Q

Skin and Soft Tissue Infections (SSTI)
* Results form what?
* What are the different types?

A

Results from microbial invasion of the skin and surrounding structures.
* Simple (uncomplicated): cellulitis or erysipelas
* Complicated (necrotizing)
* Suppurative (Purulent) vs nonsuppurative

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6
Q

Skin and Soft Tissue Infections (SSTI)
* MC pathogens? (3)
* Oral antibiotics to cover MRSA?(3)

A
  • Most common pathogen: MSSA/MRSA (75%) and beta hemolytic strep
  • Bactrium (Causes SJS), Clinda (Not good for older ppl dt dirreha), Doxy (photosen, Pt cannot have GERD or landscaper)
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7
Q

Cellulitis
* What are the sxs?
* Will usually involve what?

A
  • Hot to the touch , tender, erythematous, lymphangitis, lymphadenopathy. Inflammation of SQ tissue.
  • Will usually involve papules or pustules and is not well demarcated.
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8
Q

What is this?

A

Lymphangitis
* Must Hospitalize

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9
Q

What is this?

A

ERYSIPELAS-> Strep + type

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10
Q

Abscess
* What is it?
* may be associated with what?
* usually requires what?
* What is for most?

A
  • Collection of pus in subdermal space
  • May be associated with cellulitis but does not have to
  • Usually requires I&D with or without packing
  • Oral ABX therapy for most
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11
Q

Complicated cases of abcess will require parenteral ABX.
* What are reasons to switch? (4)

A
  • Systemic symptoms (SIRS criteria)
  • Rapid progression
  • Failure of outpatient therapy >48hrs
  • Proximity to indwelling device (vascular graft/artificial joint)
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12
Q

Abscess
* Simple abscesses should be what?
* They are not healed with what?
* Small uncomplicated abscesses without cellulitis (<2cm) usually txt?

A
  • Simple abscesses should be incised and drained.
  • They are not healed with only antibiotics.
  • Small uncomplicated abscesses without cellulitis (<2cm) usually do not require antibiotics
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13
Q

What do you do for this?
Have an increased risk of?

A
  • bactrium, penicllin+bactrim, Keflex+bactrim
  • Refer to OR
  • Increase risk with chron’s disease
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14
Q
  • Deep abscesses should be what?
  • When you evaluate anal, perirectal, rectal abscesses, be confident that there is no what?
A
  • Deep abscesses should be drained in the OR and the patient should be admitted for parenteral antibiotics.
  • When you evaluate anal, perirectal, rectal abscesses, be confident that there is no deep-space infection (do a rectal exam, palpate for induration, fullness, tenderness). If the abscess is deep, it is NOT an out-patient or ERprocedure
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15
Q

Staphylococcal Toxic Shock Syndrome (TSS)
* What organism?
* Happens in who?
* Where do have enterance?(4)

A
  • Ubiquitous organism: S. aureus
  • 30-50 % of healthy adults and children
  • Anterior nares, skin, vagina, and rectum
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16
Q

Staphylococcal Toxic Shock Syndrome (TSS)
* What causes disease?
* What does super antigens cause?

A
  • Toxic shock syndrome toxin-1 (TSST-1) and Staphylococcal enterotoxin B (A,C,D,E,H less)
  • Super antigens: cause an exaggerated, dysregulated hyperimmune cytokine response.
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17
Q

Staphylococcal Toxic Shock Syndrome (TSS)
* usually not what?
* _ infection

A
  • Usually not purulent, but desquamates
  • Multisystemic infection
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18
Q

Staph Toxic Shock Syndrome (TSS)
* 50% of what cases?
* Increase incidence with what?
* Can occur in children with what?

A
  • 50% non-menstrual cases
  • Increased incidence due to tampon (vaginal or nasal) use: higher absorbencies, used continuously for more days, and kept in longer
  • Can occur in children with nonsurgical skin lesions
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19
Q

Staph Toxic Shock Syndrome (TSS)
* What precedes the physcial findings?
* What are risk factors?

A
  • Pain usually precedes the physical findings
  • HIV, diabetes, cancer, ethanol abuse, and other chronic diseases
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20
Q

What is CDC difinition of TSS?

A
  • Fever: temperature greater than or equal to 102.0°F ( 38.9°C) AND
  • Rash: diffuse macular erythroderma AND
  • Hypotension: systolic blood pressure ≤90 mm Hg for adults or less than 5th percentile by age less than16 years; orthostatic drop in diastolic blood pressure ≥15 mm Hg from lying to sitting, orthostatic syncope, or orthostatic dizziness AND
  • Desquamation: 3-7 days after onset of illness, particularly on the palms and soles

ALL NEEDS TO BE THERE

Can have only some, and still treat-> should not wait for txt

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21
Q

Staph TSS- DDX
* Streptococcal TSS -
* Scarlet fever-
* Staph scalded skin syndrome-
* Meningococcal:
* Rocky Mountain Spotted Fever (RMSF):

A
  • Streptococcal TSS - identical or pain, necrotizing fasciitis
  • Scarlet fever- strawberry tongue, “sand paper rash”, pharyngitis
  • Staph scalded skin syndrome- bullae, sheet like desquamation acutely, more common in peds
  • Meningococcal: petechiae/ purpura
  • Rocky Mountain Spotted Fever (RMSF): rash is petechial, begins on extremities first, and occurs~ three days after fever begins
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22
Q

Staph TSS DDX
* Kawasaki disease-
* Dengue fever-
* Leptospirosis-
* Toxic epidermal necrolysis/ Stevens-Johnson syndrome-
* _ Syndrome
* _ exanthem

A
  • Kawasaki disease- more common in children
  • Dengue fever- endemic area, mosquito exposure
  • Leptospirosis- uncommon, work with soil and animals, no rash
  • Toxic epidermal necrolysis/ Stevens-Johnson syndrome- more diffuse, more mucus membrane involvement, history of medication use
  • Reyes Syndrome
  • Viral exanthem
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23
Q

What is this?

A
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24
Q

What is this?

A

Sunburn type rash that blanches; fades in 3 days with full-thickness desquamation especially palms and soles

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25
Q

Staph Toxic Shock Syndrome evaluation
* What do you need to order? (8)

A
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26
Q

Diagnosis/Treatment of Staph TSS
* What is not necessary but useful?
* Exploration of what?
* Admit?
* Call who?

A
  • Isolation of bacteria not necessary, but useful
  • Exploration of vagina, wounds
  • Admit ICU and treat for sepsis
  • Call ID
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27
Q

Diagnosis/Treatment of Staph TSS
* What is the aggressive management of shock?

A
  • 10-20 liters/ day
  • Anasarca possible (diffuse edema due to capillary leakage)-> this is due to the fluids so might need loop
  • Vasopressors if needed: norepinephrine DOC
  • Central venous monitoring
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28
Q

Treatment of Staph TSS
* What is the txt for empirical txt?
* What is the DOC if known culture?

A

4th gen-> nursing home+DM to cover pseduo

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29
Q

Streptococcus TSS

A
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30
Q

Streptococcus TSS
* MC organism?
* Emerging organism?
* Bacteria releases what?
* What are the portals of entry?

A
  • Etiology: S. pyogenes= Group A Streptococcus (GAS)
  • Emerging: S. suis
  • Bacteria releases superantigens
  • Skin, vagina, throat entry portals
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31
Q

Streptococcus TSS
* Isolation of what?
* Presents with what?

A
  • No portal site found in 45% of cases
  • Isolation of GAS (Group A Strep) from normally sterile site
  • Presents with usually Abrupt Pain

  • Staph – fever and desquamation
  • Strep – more of necrotizing fasciitis (mc from surgery and natural vag birth)
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32
Q

What is the Criteria for Strep TSS CDC?

A
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33
Q

What are the Strep TSS (GAS) risk factors? (6)

A
  • All ages, majority healthy
  • Surgery
  • Use of NSAIDs (marker of severe trauma or masking of symptoms)
  • Recent Varicella infection
  • Can cause symptoms indistinguishable from Staphylococcus TSS
  • Immunocompromised
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34
Q

Strep TSS with Necrotizing Fasciitis
* What is present?
* Widespread what?
* What is larger?
* What happens along fascial planes?

A
  • Pain
  • Widespread necrosis
  • Underlying area much larger than skin
  • Mushy, devitalized, necrotic tissue along fascial planes
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35
Q

Strep TSS Treatment
* What is the txt?

A
  • Initial antibiotics: same as for Staph TSS/ sepsis
  • Early surgical intervention with debridement
  • ICU
  • IV ABX

  • vancomycin and [ceftriaxone OR piperacillin/ tazobactam (Zosyn®) OR meropenem (Merrem®)or fluoroquinolone for pseudomonas]
  • For MRSA patients, vancomycin + clindamycin ORLinezolid *(Zyvox®) alone
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36
Q

Explain the difference?

A
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37
Q

Erythema multiforme
* What are these?
* What is the cause?
* You may see this rash in who?

A
  • These are typical target lesions with a bulls-eye appearance.
  • There are a variety of causes including infection, malignancy and drugs.
  • You may see this rash in pediatric viral illnesses.
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38
Q

“Staph” Scalded Skin Syndrome
* What age?
* How does it exist like a continuum?

A
  • Children less than 5 years old
  • Exists on a continuum – they may have just a few bullous lesions or they can have generalized exfoliation of all their skin

The mortality is about 5%

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39
Q

Staph Scalded Skin Syndrome
* Treat staph with that?
* Skin is treated as what?
* What should you do if this is drug induced?

A
  • Treat Staph with penicillinase-resistant penicillin.
  • Skin is treated as though it is a burn
  • If this is “drug induced,” the drug should be discontinued, and steroids may be helpful and antibiotics would not be given.
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40
Q

Nikolsky’s Sign
* What are common causes?

A
  • Allergic reaction (Toxic epidermal necrolysis)
  • Autoimmune condition (Pemphigus vulgaris)
  • Bacterial infection ( Scalded skin syndrome)

Separating tissue with pressure

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41
Q

Steven-Johnson Syndrome/Toxic Epidermal Necrolysis
* Both are typically triggered by what?
* Not separte, but what? Explain?

A

Both are typically triggered by medication reactions

Not separate -> both are continuum
* SJS is less severe (10% mortality) and less than 10% of skin involved
* TEN (50% mortality) – Lyell Syndrome - >30% of skin involvement

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42
Q

Steven-Johnson Syndrome/Toxic Epidermal Necrolysis
* Starts as what? Then what happens/
* Affects who?
* Pathophysiolgy similar to what?

A
  • Starts as fever and flu-like and then forms erosions (spread from face down involving mucus membranes/eyes/genitalia, but not always in this distribution)
  • Affects immunocompromised (HIV/SLE) and those with genetic mutation of HLA-B gene
  • Pathophysiology similar to a burn – no protective barrier, loss of fluids, infection possibility -> so treatment is essentially the same
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43
Q

SJS/TEN
* What are drugs that can cause this?(4)

A

Have walking pneum then have oral, genital lesions-> SJS

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44
Q

What is this?

A
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45
Q

SJS/TEN MANAGEMENT
* Withdrawl what?
* Admit to where?
* manage via what?
* What do you give?
* Debride what?
* tx what?

A
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46
Q

What are the 3 Types of Necrotizing Fasciitis?

A
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47
Q

Necrotizing Fasciitis
* Widespread what?
* What is the common organism? What is seen on x-ray?
* Usually direct what?

A
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48
Q

Necrotizing Fasciitis
* What are sxs?

A
  • Brawny edema, crepitance, brownish discoloration, malodorous serosanguinous discharge; bullae; air gangrene
  • Fever, tachycardia, multiple laboratory & metabolic abnormalities
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49
Q

What is going on here?

A

Left upper extremity necrotizing fasciitis in an IVDA. Cultures grew Streptococcus milleri and anaerobes (Prevotella species). Patient would grease, or lick, the needle before injection.

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50
Q

What is going on here?

A

Left lower extremity in a 56-year-old patient with alcoholism found comatose after binge drinking. Surgical drainage was performed to treat the pyomyositis-related, large, non–foul-smelling (sweetish) bullae. Gram staining showed the presence of gram-positive rods. Cultures revealed Clostridium perfringens. The diagnosis was clostridial myonecrosis.

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51
Q

Management of necrotizing fasciitis
* _
* What do you need to update?
* Abx?
* Surgical what?
* what type of situation?

A
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52
Q

West Nile (WN) Virus
* What is it caused by?
* What type of vector?

A
  • Japanese encephalitis virus antigenic complex, member of the family Flaviviridae
  • Mosquito vector with WN Virus incidence
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53
Q

West Nile (WN) Virus
* What are the sxs?

A
  • Flu- like syndrome: headache, body aches, fever
  • Meningitis, flaccid paralysis, muscle weakness
  • Rash in 25-30% of patients-> Indicative of less severe disease
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54
Q

What is West Nile (WN) Virus Differential Diagnosis ?

A
  • Dengue fever in endemic areas
  • St Louis Encephalitis->Less common cause of illness
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55
Q

West Nile (WN) Virus Diagnosis
* What do you get for dx?
* What does the CBC show?
* What do you get for neuro sxs?

A
  • IgM for WN Virus in serum or spinal fluid->Can be negative first 3 days
  • CBC with Diff: leukocyte counts mostly normal or elevated.
  • Spinal tap: for neuro symptoms
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56
Q

West Nile (WN) Virus Diagnosis
* What does the spinal tap show?

A
  • Pleocytosis (increased WBCs) and predominance of lymphocytes
  • Normal or elevated protein
  • Normal glucose
  • Normal or elevated opening pressure
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57
Q

West Nile (WN) Virus Diagnosis
* What type of treatment?
* Admit for what?

A
  • Supportive Treatment
  • Admit if toxic or unsure/ neurologic symptoms
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58
Q
A

Can confirm dx with Tzank prep and viral culture. Acyclovir should be started within 72 hours. May shorten course and may mitigate against post-herpetic neuralgia.

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59
Q

Herpes Zoster
* What is it?
* Rash is usually what?
* Complicated by what?
* Pain may appear when?
* Often in who?

A
  • Shingles-Reactivation of latent varicella virus
  • rash is (usually) in dermatomal distribution
  • complicated by post-herpetic neuralgia
  • Pain may appear before the rash and last months after rash clears -> post herpetic neuralgia – tx gabapentin, pregablin
  • Often immunocompromised: older, DM, HIV, stress, cancer
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60
Q

Herpes Zoster
* What sign can present?
* When and what do we do for disseminated disease?
* How do we dx it?

A
  • Hutchinson Sign: lesion on tip of nose (SIGNALS EYE INVOLVEMENT AS WELL)
  • Disseminated disease: immunocompromised→admit
  • Diagnosis via Viral Culture
61
Q

How do you txt herpes zoster?

A

Treatment: oral acyclovir 800 mg po 5x/day x 7 days (within 72hrs of onset) or IV and admit if immunocompromised
* Valacyclovir/Famcyclovir: dosed once or twice daily, depending on type
* May require ABX to prevent secondary infection
* Will also need steroids

62
Q

Disseminated Herpes Zoster
* Does not follow what?
* What is the txt?

A
63
Q

Infective Endocarditis
* Causes?
* What is the organism for IVDA? What can it cause?

A
64
Q

Infective Endocarditis
* What happens to the heart?

A
  • Valve leaflets destruction
  • Walls of the heart cavities
  • Tissue surrounding prosthetic heart valves

Reason why murmur shows up

65
Q

Endocarditis
* What are the two types?
* What are the sxs?
* What can happen to the body?
* What is common in young patients?

A

*CVA, ARTERIAL EMBOLI IN EXTREMITIES

66
Q
A
67
Q
A
68
Q

What are the Sign and symptoms of Infective endocarditis?

A
69
Q

Circulating Immune Complexes of infective FROM JANE
endo
* Petechiae
* Splinter hemorrhages
* Osler’s nodes
* Janeway lesions-septic emboli:
* _ _ in eye

A
70
Q

Petechiae
* What is it?

A
71
Q

What are these?

A

Osler Nodes & Janeway Lesions

72
Q

What is this?

A

Splinter hemorrhage

73
Q

What is this?

A
74
Q

Endocarditis Treatment
* What is the initial management?
* What do you need to collect?
* What dx tests? (2)
* Admit and call who?
* Look for what?

A
  • Initial Management: ABCs
  • Blood cultures x 3 in 24 hours
  • EKG and Echocardiogram
  • Admit and call cardiology
  • Look for distal emboli-> neck/back or lungs
75
Q

Endocarditis Treatment
* What are the abx?

A
  • Vancomycin, gentamicin and cephalosporin (4th gen) for empiric
  • Vancomycin alone if MRSA likely
  • Vancomycin DOC for suspected community or hospital-acquired ( G-) infections + gentamycin
  • For all above and prosthetic valves: add Rifampin
76
Q

Botulism
* What is it?
* What is going on with the spores?
* Irreversibly does what?
* What are the neurotoxins?

A
77
Q

Botulism
* Bacterium will not grow in what?
* HOWEVER, Toxin is resistant to what?
* Toxin can be what?
* Common in what?

A

Bacterium will not grow in pH<4.6 and will not generate toxin in acidic foods
* HOWEVER, Toxin is resistant to pH degradation
* Can be ingested, inhaled, injected
* Usually low acid content food, green beans, asparagus, tomatoes

78
Q

Botulism
* What are the 3 types of botulism?

A
  • Infant botulism (most common) - <14 days due to umbilical stump exposure
  • Adult enteric botulism
  • Wound botulism
79
Q

Botulism
* What type is most commonly ingested by humans? How? (4)

A

Type E most commonly ingested by humans
* Home canned foods
* Seafood
* Honey
* IVDA (black tar heroin)

80
Q

Botulism
* What are the sxs?

A
  • Early: Dry mouth, blurred vision, drooping eyelids, slurred speech, dysphagia, loss of pupillary reflexes, GI symptoms
  • Late: Respiratory failure, paralysis
  • No sensory disturbance or AMS, and usually no fever
  • Incubation: 4hrs-8 days
81
Q

Botulism
* how do you dx?
* What is the txt?
* What is key?

A
82
Q

Tetanus
* What is the organism? What are the characterisitcs?
* What are the exotoxins? What does it cause?

A
  • Clostridium tetani->Obligate Anaerobic, spore survives boiling temps
  • Exotoxins: tetanolysin and tetanospasmin
    * prevents release of inhibitory neurotransmitters: neuromuscular irritability and generalized spasms
    * spreads to peripheral and CNS
83
Q

Tetanus
* What makes it less sereve?

A

Less severe if previously vaccinated -> 2,4,6, 18 months then 5 yo-> every 10 years after that

84
Q

Tetanus
* how can you get it?(4)

A

Wounds, surgical procedures, abortion, neonates (umbilical stump), IVDA

85
Q

Tetanus
* What are the four types+sxs?

A
86
Q

Generalized Tetanus
* What happens to jaw?
* What happens to mouth?
* What are some resp issues?
* Anutomonic?

A
87
Q

Diagnosis of Tetanus
* What type of sx?
* What test can you do?
* _ dx

A
  • Clinical symptoms
  • Gag reflex test instead causes patient to bite tongue depressor
  • Clinical Diagnosis
88
Q

Tetanus
* What is the txt?

A
  • ABC’s
  • TIG
  • Muscle Relaxants (benzodiazepines)
  • ICU
89
Q

Treatment of severe tetanus (5 steps)

A
90
Q
A
91
Q

Rabies
* What is the organism?
* Endemic in who? list them

A
  • Bullet/rod shaped, single stranded –sense, unsegmented, enveloped RNA virus belonging to the Rhabdoviridae family.
  • Endemic in many wild animals
  • Major wildlife vectors: foxes, raccoons, skunks, coyotes, mongoose, bats, dogs, cats, sheep, horses
92
Q

Rabies
* What vectors are very rarely rabid or never rabid?
* Targets CNS by means of what?

A
  • Very rarely rabid or never rabid: squirrels, hamsters, guinea pigs, rabbits, gerbils, chipmunks, rats, mice, domesticated rabbits, small rodents
  • Targets CNS by means of peripheral nervous system through inflammatory response-> encephalomyelitis
93
Q

Rabies
* What are the sxs?

A
94
Q

Rabies
* how do you dx it?

A

Based on known animal bite and high level of suspicion; dx of exclusion
* PCR testing in CSF, blood, saliva, tears, tissues bx.

95
Q

Rabies
* how do you tx it?

A

Txt: Wound care- cleanse/irrigate (povidone, alcohol and soap solution <3hrs) followed by benzalkonium chloride or povidone-iodine
* Rabies Immune globulin ASAP along with rabies vaccine (4 in 14 d)
* Prophylactic measures for bats

96
Q
A
97
Q

Postexposure Prophylactic Therapy of rabies? (3)

A
  • Vigorous cleaning of wound with soap
  • Tetanus toxoid & antibiotics (Augmentin®) if they meet criteria
  • Rabies vaccine and IVIG if they meet criteria
98
Q

Human Bites
* Same txt applies to what?
* What is the organism?
* Present where?

A
  • Same treatment applies to saliva exposures to wound (trauma to face and oral cavity, licking of the wounds).
  • Eikenella corrodens – fastidious anaerobe
  • Present in majority of human mouths

  • See it frequently in the ER
99
Q

Human Bites
* What is the DOC?
* Eikenella is inherently resistant to what?

A
  • DOC – Augmentin – or any cephalosporin or tetracycline
  • Eikenella is inherently resistant to clindamycin and penicillins are not effective
100
Q

Stingray stings
* Typical for what?
* Remove what if present?
* Place extremity where and why?
* Cover for what?

A
101
Q

Malaria
* Transmitted by what?
* _ sporozoites
* Reproduction?

A
  • Transmitted by infected mosquito found in tropical and subtropical regions
  • Plasmodium sporozoites
  • Cyclic, complex reproduction inside liver, serum, RBCs
102
Q

Malaria
* Cyclic what?
* What are sxs?
* Unlikely what?

A
  • Cyclic chills and fever and sweating every 48-72 hours
  • Fever, malaise, myalgia, headache, chills; may have chest pain, cough, abdominal pain, diarrhea
  • Unlikely rash and lymphadenopathy
103
Q
A
104
Q

Make the Malaria Diagnosis
* Ask about what?
* What are the labs?

A
  • Ask about foreign travel
  • Labs: normochromic, normocytic anemia, hemolysis
105
Q

Make the Malaria Diagnosis
* What is on the peripheral blood smear? How do you collect the smears?

A

Peripheral blood smear to look for plasmodium organism: thick/ thin prep
* Smears every 6 to 12 hours for 48- 72 hours
* The first smear is positive in 95% of cases
* Ring forms” of Plasmodium trophozoites
* P. falciparum and P. vivax (2 most common ones)

106
Q
A

Malaria
* see the parasite in the red blood cells and identify the parasite: P. falciparum, P. vivax, P. ovale or P.malariae

107
Q

Malaria Treatment
* For severe?
* Self txt?
* Preg?
* Prophylaxis?
* other one?

A
108
Q

History
* What do you need to get with dirreaha?

A
109
Q
A
110
Q

What is AGE Physical ?

A
  • Hypotension or postural hypotension
  • Rebound
  • Melena, blood by history/ PE
  • High fever
  • Signs of dehydration
  • Altered mental status -> late sign
  • Consider hypovolemic shock (hemorrhagic and non-hemorrhagic
111
Q

AGE work up
* What is the work up?
* WHen do you get imaging?
* R/O what?

A
112
Q
A
113
Q

Treatment AGE
* What do you give for fever?
* What is diet?
* What do you give for pain?

A
  • Acetaminophen for fever
  • Clear liquids until symptoms better, BRAT diet
  • Pain: Ketorolac IM
114
Q

Treatment AGE
* What antiemetics?
* What fluids do you give?
* If abnormal, then order what?

A
  • Anti-emetics:
    * ondansetron (Zofran®)
    * Prochlorperazine (Compazine®)
    * Metoclopramide (Reglan®)
  • Fluids- 1 liter NS if healthy/ normal renal function
  • If abnormal labs, stabilize/ admit
115
Q

Lyme Borreliosis
* What is the organism?

A

Borrelia burgdorferi, a fastidious (cannot culture) spirochete

116
Q

Lyme Borreliosis
* Vector?
* Endemic where?
* Incidence peaks when?
* MC what?
* Need how long of exposure?

A
117
Q

Stage 1(Localized Infection)
* What are the sxs? When do they occur?

A
118
Q

Stage 2 (Disseminated Infection)
* What happens to skin?
* What happens systemic?

A

Hematogenous Spread
* Skin: Secondary annular skin lesions like primary lesion
* Systemic:fever, chills, arthralgias, malaise & fatigue

119
Q

Stage 2 (Disseminated Infection)
* Neuro?
* Cardiac?
* MSK?

A
  • Neurologic abnormalities: Bells’ palsy, headache, mild neck stiffness, meningitis
  • Cardiac abnormalities: Bradycardia, AV block
  • Musculoskeletal: pain, migratory in joints, tendons, bursae, muscles, or bones & without joint swelling
120
Q

Lyme Dz
* What is stage 3 sxs?

A
121
Q

Lyme Disease: Lab
* What are the lab dx for stage 1,2,3

A
122
Q
A
123
Q

Rocky Mountain Spotted Fever (RMFS)
* What is the organism?
* Second MC what?
* Hist of what?
* Transmitted by what? Spreads where?

A
  • Rickettsia rickettsii
  • Second most common tick borne-illness
  • History of tick bite, travel or outdoor activity
  • Transmitted by a tick & spread through lymphatics to pulmonary circulation then attaches & attack vascular endothelium
124
Q

RMSF
* Incubation period?
* What sxs?

A
125
Q

RMSF
* What happens during the first 3 days?
* What happens by day 3?

A
  • First 3 days, HA, fever, malaise, myalgias, nausea, vomiting, & anorexia
  • By day 3, develop rash on wrists & ankles, later on palms and soles, then spread over legs & trunk.
126
Q

RMSF
* look for what?
* What happens secondary to vascular damage?
* What are the focal neuro defects?

A

Look for tick, it is still likely present if Hx does not state removal
* Hypotensive, noncardiogenic PE, renal & hepatic injury & bleeding secondary to vascular damage
* Focal neurological defects: photophobia, confusion, lethargy, & encephalitis progressing to coma

127
Q

Skin Findings in RMSF
* Where does it start?
* later becomes what?
* Rash spreads where?
* How do you dx?

A
  • Blanching macules develop initially on wrists & ankles & then spread over palms and soles, then to legs and trunk.
  • Later becomes hemorrhagic & frequently petechial.
  • Rash spreads to palms & soles later
  • Diagnosis: Skin biopsy of rash or IFA 7- 14 days
128
Q

RMSF
* What tests can be done?

A
  • Indirect immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) or a PCR test
  • Not apparently evident on blood smear
129
Q

RMSF
* What is the txt?

A
  • Doxycycline 100 mg BID x 7 days or 2 days after fever normal – DOC even in pregnancy or lactation and <8yo.
  • In clinically mild or special cases such as pregnancy and lactation and <8yo, use chloramphenicol or cefuroxime or amoxicillin, but only with ID input
  • Treat before cultures are back
130
Q

Difference between RMSF and TSS?

A

RMSF starts in wrist and ankles

131
Q

STDs
* May be what?
* General course of care is what?
* What is the txt?

A
132
Q

STDs
* What test is there?
* What can you use for trich/yeast and BV?
* Must keep it in the ddx for who?
* Counsel who?
* Disseminated disease/PID will require what?

A
  • DNA/NAAT tests for GC and Chlamydia
  • Wet Prep for Trichomonas/Yeast/BV (clue cells)
  • Must keep it in differentials for infants and pharyngitis and conjunctivitis if patient has oral sex
  • Counsel sex partners to be treated as well
  • Disseminated disease/PID will require ID consult and admission for IV antibiotics
133
Q

Syphilis
* Think of it when see what?
* What is txt?

A
  • Think of it when see palmar/plantar rash and patient has painless lesion, typically 2-3 weeks after exposure.
  • Penicillin G 2.4mU single dose is not typically used
  • Current recommendation is oral amoxicillin for 10 days
134
Q

Disseminated GC
* Can be the cause of what?
* Petechial rash =

A
  • GC can also cause a septic arthritis in adolescents and young adults.
  • Petechial rash = meningococcemia
135
Q

Reiter Syndrome Reactive Arthritis
* What is the triad?

A
  • Arthritis
  • Urethritis
  • Conjunctivitis

cannot see, cannot pee, cannot climb up a tree

136
Q

Reiter Syndrome Reactive Arthritis
* Can be precipitated by what?
* Can be precipitated by what?

A
  • Can be precipitated by infection (Chlamydia, Salmonella, Shigella, Campylobacter)
  • Differentiate from GC (migratory arthritis
137
Q

Petechial Rashes/”Fever”(SERIOUS)
* If you see the patient early, there may be what?
* Patients with petechial rashes can what?
* Examine the skin of who?

A
  • If you see the patient early, there may be only one or two areas of small petechiae
  • “Patients with petechial rashes can die within hours”
  • Examine the skin of a febrile patient
138
Q

Henoch Schoenlein Purpura
* What is it?
* What is the triad?

A
139
Q

Henoch Schoenlein Purpura
* When/who?
* What is present

A
140
Q

Pemphigus Vulgaris
* What is this?
* What type of blistering?
* Bullous pemphigoid is similar but what?
* What is the txt?

A
  • Generalized, mucocutaneous, auto-immune, blistering eruption
  • Intraepidermal blistering
  • Bullous pemphigoid is similar but tends to occur in the elderly and has a better prognosis
  • Immunosuppressant/steroids
141
Q

What is the txt of anthrax?

A

Cipro + MRSA coverage

142
Q

Tinea
* Capitis – _ and txt with what?
* Dermatophyte infection (_ culture)
* Corporis –
* Cruris -
* Pedis –
* Manuum –

A
  • Capitis – head (scalp)-treated with oral griseofulvin
  • Dermatophyte infection (fungal culture)
  • Corporis – body
  • Cruris - crotch
  • Pedis – foot – “athlete’s foot”
  • Manuum – hand
143
Q

Tinea
* txt ?

A

Treated with anti-fungal agents such as clotrimazole, miconazole, ketoconazole

144
Q

Cutaneous larvae migrans
* What is it?
* What is the presentaiton?
* What is the txt?

A
145
Q

Candida
* What is the organism?
* See what?
* may see what?
* Oral candidias=
* txt with what?

A
146
Q

Infestations-Scabies
* What is the organism?
* Extrememly what?
* Comonly where?

A
  • Scabies-mites: Sarcoptes scabiei
  • Extremely itchy
  • Commonly hands, feet, flexor creases, umbilicus, groin, genitals
147
Q

Infestations-Scabies-mites
* What do you see?
* Tx with what?

A
  • Fine, erythematous, linear burrow, often seen best between the fingers
  • Treat with topical scabicides – permethrin (Nix)
148
Q

Pediculosis (Lice, Nits)
* Capitis?
* Pubis? Usually what?
* Corporis?

A
  • Capitis – head lice.
  • Pubis – usually sexually transmitted – affects pubic hair of the groin.
  • Corporis – body lice.
149
Q

Pediculosis (Lice, Nits)
* tx with what?
* Treat who?
* Wash what?

A
  • Treat with permethrin (nix) and again in 10 days (larvae hatch).
  • Treat all family contacts.
  • Wash all clothing, bed linen, etc.

Speciality Medicine (12 decks)

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