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Clinical Science > Lecture 17: Doc I'm pretty sure it's ebola > Flashcards

Lecture 17: Doc I'm pretty sure it's ebola Flashcards

1
Q

What do patients with strep present with?

A

fever, sore throat, difficulty swallowing, swollen anterior lymph nodes, tonsillar pus

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2
Q

What group of strep infections can cause severe infections of the upper respiratory tract and skin?

A

Group A strep

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3
Q

In some cases what can group A strep lead to?

A

rheumatic fever, scarlet fever, pyelonephritis, toxic shock syndrome and necrotizing fasciitis

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4
Q

What are the pathogenic organisms that can infect the throat? throat culture needed

A

streptococci, gonococci, Neisseria meningitides, bordetella pertussis, corynebacteria diptherium

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5
Q

What are the certain circumstances that a throat culture may be needed?

A

severe or recurrent sore throat with systemic symptoms, if a patient has a negative rapid strep test but HCP wants to confirm, patient who may be a chronic strep carrier, patient who demonstrates complications of a GAS infection

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6
Q

What is different about a rapid strep test and a throat culture?

A

the procedure is the same but the specimen in a throat culture is labelled and sent off to lab for processing

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7
Q

What happens to a throat culture when it reaches the lab?

A

the culture is smeared on an agar (chocolate agar or streptococcus specific), gram-straining is performed and the culture is identified

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8
Q

What is a common fungal organism that can be found in a throat culture?

A

candida albicans- common in immunocompromised patients and is called thrush when it grows on the tongue

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9
Q

streptolysin O

A

a toxic protein to multiple types of cells (PMNs, RBCs, and platelets) and increases when the virulence of strep pyogenes

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10
Q

titer

A

different dilutions of serum are tested in mixture with a constant amount of antigen and greatest reacting dilution is taken as the measure of the titer

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11
Q

What can an ASO titer be used for?

A

used to detect recent infection with Group A Strep… these titers are drawn when a patient has possible systemic manifestations of a sequelae of group A strep infections like rheumatic fever, an undefined rash similar to scarlet fever, glomerulonephritis (strep causes injury to kidney glomerulus)

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12
Q

What is mono infections caused by?

A

Epstein-Barr virus

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13
Q

What can infectious mononucleosis cause?

A

fatigue, fever, sore throat, lymphadenopathy commonly bilateral posterior cervical, splenomegaly and hepatomegaly

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14
Q

What does a rapid mononucleosis test detect?

A

IgM antibodies to EBV which are usually present by day 6 of infection

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15
Q

What is the method for a rapid mono test?

A

Patient’s finger is cleaned with a sterile alcohol pad and wiped dry.
Using a lancet, whole blood is obtained from the finger.
The first drop is wiped off and the second drop is used to fill the well (approximately two drops)
Wait 5 minutes to read (may be longer based on test)

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16
Q

What can you measure to determine past or present antibodies to the Epstein-Barr virus?

A

IGG and IgM
IgM wanes three months after infection
IgG persists for life

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17
Q

What are the indications for wanting to test for Epstein Barr past and present antibodies?

A

Rapid mono testing not available
Suspicion of Epstein Barr but rapid test negative
To detect of acuity or timing of infection

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18
Q

What group of viruses does cytomegalovirus belong to?

A

same group as herpes simplex, EBV, varicella-zoster viruses

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19
Q

What does cytomegalovirus present like in children and young adults?

A

mono-like symptoms

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20
Q

What is the incubation period for cytomegalovirus?

A

60 days

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21
Q

What are the symptoms of influenza?

A 
fever-usually greater than 100
myalgias
cough
nasal congestion
sore throat
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22
Q

When is a rapid influenza test best used?

A

when the onset of symptoms was within 48-72 hours within presentations to medical provider for testing

23
Q

When is a rapid influenza test not recommended?

A

Not recommended if testing does not change the treatment regimen for the patient. Antivirals not indicated after 48-72 hour window of symptoms

24
Q

What are the advantages to a rapid influenza test?

A

Quick results ≈ 15 minutes
Available in most office, urgent care and emergency department settings
Patient can begin treatment with an antiviral immediately and self-quarantine.
Family members and contacts are made aware of their risk on contacting virus.

25
Q

What are the disadvantages of a rapid influenza test?

A

Sensitivities ≈ 50-70% (Specificities ≈ 90-95%)
Sensitivity higher in children than adults since children tend to shed the virus longer than adults.
Involves an uncomfortable nasopharyngeal sampling using swab (most common) or wash/aspirate (not usually done in primary care)
Poor technique can decrease sensitivity
HIGH FALSE NEGATIVES

26
Q

What do rapid influenza test kits typically contain?

A 
Nasopharyngeal swab
Pipette
Test strips of some form
An elution solution 
Control solutions to ensure test quality
27
Q

What are the influenza testing methods?

A

rapid test, viral culture, PCR/Molecular tests

28
Q

What are the advantages of a viral culture?

A

gold standard for diagnosis.. able to identify which virus (A, B or other) is causing the symptoms

29
Q

What are the advantages of PCR/Molecular tests?

A

high sensitivity, can differentiate between some influenza subtypes

30
Q

When is a sputum culture indicated?

A

patients with a cough, fever or abnormal chest x-ray finding

31
Q

What are the pathogenic organisms that can be found in a sputum culture?

A

bacterial organisms, fungal organisms, viral organisms

32
Q

What is the sputum culture procedure?

A

Give the patient a labeled sterile sputum culture container.
Morning specimens are best, when possible.
Have patient rinse mouth with water prior to performing culture but avoid antiseptic mouthwashes.
Remind patient to expectorate sputum from lungs and that saliva is not enough for accurate test.
Collect at least 1 tsp of sputum for culture.

33
Q

What happened to a sputum culture when the lab receives the specimen?

A

Gram stain performed
The sputum sample is then placed onto specific bacterial culture plates and incubated for identification 2-3 days later.
Drug sensitivity testing is then performed.
Can order fungal and viral cultures as indicated but this is less commonly done than bacterial cultures.
Fungal sputum cultures can take 6-8 weeks to analyze.

34
Q

What do people with pertussis suffer with?

A

inspiratory whoop, severe paroxysms (attacks or coughing fits), post cough emesis

35
Q

What should you not use when testing for pertussis?

A

a cotton or rayon swab

36
Q

What should you use when testing for pertussis?

A

a Dacron swab with a flexible shaft

37
Q

What is he transport media used for pertussis?

A

Regan-Lowe media

38
Q

What are the pertussis testing that are performed?

A

PCR of Bordetella pertussis and Culture of Bordetella pertussis

39
Q

What is a PCR of bordetella pertussis?

A

higher cost, not affected by previous antibiotic use, results available in 1-2 days

40
Q

What is the culture of Bordetella pertussis?

A

gold standard for diagnosis, 30-60% sensitivity (100% specificity), can take 7-10 days

41
Q

What is Respiratory Synctitial Virus?

A

a viral illness that is common in children and manifests with: upper and lower respiratory tract infection, fever, cough, respiratory distress, apnea

42
Q

Where are nasal secretions for RSV testing best obtained from?

A

through nasal wash or nasopharyngeal swab

43
Q

How are secretions for RSV testing analyzed?

A

many available rapid antigen tests with results in 30 minutes, cultures general take 4-14 says which is too long, PCR assays that test for multiple respiratory pathogens are available

44
Q

What are some of the tuberculosis manifestations?

A

cough, fever, weight loss, night sweats, fatigue, skeletal, gastrointestinal, and genitourinary manifestations

45
Q

Who should you test for tuberculosis screening?

A

person who have symptoms or are suspected of having tuberculosis (health care workers, HIV patients, recent immigrants, IV drug users, patients with known exposure to TB), persons at low risk of exposure (college entrants)

46
Q

What are the other names for a tuberculosis skin test?

A

TST, PPD- Purified Protein Derivative, Mantoux test, Tuberculin test, Tubersol

47
Q

How does a tuberculosis skin test?

A

Prepared through the growth of the Mycobacterium tuberculosis or Mycobacterium bovine in a liquid medium
The culture is then inactivated, usually through heat.
No mycobacterium remain, but the desired purified protein derivatives (PPD) are thoroughly tested to verify and ensure this.
These mycobacterial PPD antigens cause a delayed hypersensitivity reaction by the T lymphocytes in a person who has been exposed to TB (active or dormant)

48
Q

What is a negative TB reaction?

A

less than 5 mm

49
Q

In what individuals is a TB reaction size of greater or equal to 5 mm positive in?

A

HIV infection,
Close contact with + case
Immunosuppressed
CXR findings of old TB

50
Q

What individuals is a TB reaction size of greater than or equal to 10 positive in?

A

Children under 4
Foreigners from high-risk countries
IV drug users
Residents/employees in high-risk settings
Economically disadvantaged
Medical conditions associated with reactivation (cancer, diabetes, dialysis)

51
Q

What individuals is a TB reaction size of greater than or equal to 15 mm positive in?

A

Healthy, low-risk individuals over 4

52
Q

What are some false negatives that can occur in TB skin tests?

A

Recent infection

53
Q

What are some false positives that occur in TB skin tests?

A

Infection with nontuberculosis mycobacterium

Bacille Calmette-Guérin(BCG) vaccination (depending on age given)

Clinical Science (15 decks)

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