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SBL Test 2 > Tyler: Fever > Flashcards

Tyler: Fever Flashcards

1
Q
  1. What is bacteremia?
  2. Treatment?
  3. Symptoms?
A
  1. Bacteria in blood stream, MC due to skin and ST infections, central venous catheters, etc
  2. Empiric ABX
  3. Fever, fatigue, N/V, decreased appetite, dehydration and myalgia
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2
Q

What is septicemia?

A
  • Early sepsis = bacteremia + inflammation
  • Sepsis = organ dysfunction
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3
Q

RF for septicemia?

A
  1. ICU admission
  2. >65 YO
  3. Bacteremia
  4. Immunosuppressed
  5. DB/ obesity
  6. Cancer
  7. Community acquired pneumonia
  8. Previous hospitilizations
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4
Q

Signs of septicemia

A

Look for signs of infectious source

  1. Hypotension (SBP <90 or MAP <70)
  2. Temp >38.3 or <36C
  3. HR = >90 beats/min
  4. Tachypnea and RR >20 breaths/minute
  5. Organ dysfunction (hypoperfusion)
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5
Q

What labs will you see in septicemia?

What sign is assx with poor prognosis?

A
  1. Leukocytosis or bands >10%
  2. Hyperglycemia
  3. ↑ CRP
  4. Arterial hypoxemia
  5. Oliguria
  6. ↑ Cr
  7. INR >1.5; PTT >60 seconds
  8. Thrombocytopenia, hyperbilirubin, hyperlactatemia (manifestation of organ hypoperfusion = poor prognosis)
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6
Q

Staphylococcus bacterial infection

Progression of symptoms

A
  1. Starts with skin or ST infection (may be due to implanted devices, catheters, orthopedic hardware)
  2. Systemic =>
    1. Bone/joint pain
    2. Protracted fever + sweating;
    3. LUQ abd pain,
    4. CV angle tenderness,
    5. HA
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7
Q

What are the types of Staphylococcal bacteremia?

A
  1. MSSA (Methicillin sensitive staph aureus)
  2. MRSA (Methicillin resistant staph. aureus)
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8
Q

What is MRSA (Methicilin Resistant Staph Aureus) infection?

A

MRSA is often d/t hospital acquired infections (long-term, recurrent wounds) in immunocompromised, affecting multiple systems.

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9
Q

Describe the wounds seen in MRSA

A
  • Localized erythema + induration + pus (has gram-+ cocci in clusters).
  • Abscesses will often form.
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10
Q

Culture (+) S. aureus bacteremia (MRSA) should focus on what?

A
  • 1. Endocarditis
  • 2. Osteomyelolitis
  • 3. Deep systemic infections (epidural abscess, discitis, abcess formation)
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11
Q

RF for community-acquried MRSA infection

A
    1. Contact sports
    1. Military service
    1. Incarceration
    1. IV drug use
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12
Q

MRSA

  1. Think MRSA in the following situations:
  2. Are joint infections common?
  3. Ostemeomyolitis due to MRSA is associated with what?
A
  1. Think MRSA if..
    1. Infected surgical incisions
    2. Diabatic foot infections
  2. No, they’re unusual. But if they occur, they are associated with [bacteremia or native/prosethic joint].
  3. Fixation device/prosthesis, hematagenous infection in children or nonhealing foot ulcers in DB pts/ peripheral arterial disease
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13
Q

What skin lesions occur in MRSA?

A
    1. Erysipelas: superficial, well demarcated, not much puss (minimal lymphagenitis)
    1. Cellulitis: pussy, swollen, violaceous
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14
Q

Group A streptococcal (pyogenes) bacteremia

What symptoms does it cause in children/adolescents and in adults

A

Group A strep => URI and tonsillopharyngitis.

  • Children/adolescents =
    • MCC of tonillopharyngitis
    • Impetigo
    • Skin infection
  • Adult =
    • Pharyngitis
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15
Q

Group B streptococcal (aggalactactiae) bacteremia

  • Who does it MC affect and what are the symptoms?
A
  1. Neonates = bacteremia without a focus, sepsis, pneumo or meningitis
  2. PG women = bacteremia, UTI, chorioamnionitis, post-partum endometrisis
  3. Non-PG adults = most common strep pathogens in adults
    1. bacteremia without focus
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16
Q

What rash can you see in Group A strep infection?

A

Scarlatiniform rash

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17
Q

Mycobacterium TB

Symptoms

A
  1. Cough = MC symptom
  2. Blood-streaked sputum
  3. Constituonal sx: Fatigue, WL, Night sweats, Fever
  4. Pt is chronically ill.
  5. Atypical sx more common in elderly and HIV pts
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18
Q

RF for M. TB infection

A
  • 1. Household exposure
  • 2. Incarceration
  • 3. Recreational/illicit drug use
  • 4. Travel to endemic area
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19
Q

How does primary and latent M.TB infection occur?

A

Primary: person to person (airborne)

Latent: bacilli are in granulomata

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20
Q

What are RF for reactivation of a latent M.TB infection?

A
  1. Gastrectomy
  2. Silicosis
  3. DM
  4. HIV
  5. Immunosuppresion
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21
Q

Influenza

  1. Symptoms
    1. How do they occur
A
  1. Fever (3-5 days), chills, malaise, cough, arthralgias, myalgias + respiratory sx
    1. ​If Influenza B = GI sx
  2. Most often occur as epidemics/pandemics in the fall/winter.
    1. Influenza A MC occurs as a part of pademic with antigenic shift
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22
Q

HIV

Symptoms

What complications can occur?

A
  • Sweats, diarrhea, WL and wasting
  • Complications
    1. Opportunistic infections due to decreased cellularity
    2. Aggressive cancers (NHL)
    3. Neuro sx (dementia, asepetic meningitis, neuropathy
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23
Q

What conditions are highly suggestive of HIV infection?

A
    1. Hairy leukopenias of tongue
    1. Disseminated Kaposi sarcoma
    1. Cutaneous bacillary angiomatosis
    1. Generalized LAD early in infection
24
Q

What are AIDs definiing illness?

A
  1. Pneumocystitis jivrocvi
  2. Mult. recurrent bacterial infections
  3. Lymphoma
  4. Kaposi
  5. CMV
  6. Coccidiomyocosis
  7. M. TB at any site
25
Q

CMV

  1. Symptoms
  2. Increases with what factors?
A
  1. Most asymptomatic, but acute acquired is similar to infectious mono without pharyngeal symptoms
  2. Age, lower SES, number of sexual partners, hx of STI, employment in child day cares.
26
Q

What is the difference between CMV infection and disease?

A

CMV infection = virus in tissue/serum; not always sx

CMV disease = show symptoms

27
Q

How does CMV present in perinatal?

A

Get via breastfeeding. Most infected neonates are asx. Other

  1. Jaundice
  2. Hepatosplenomegaly
  3. Thrombocytopenia
  4. Purpura
  5. Microcephaly
  6. Periventricular CNS calcifications
  7. Mentral retardation
  8. Hearing loss >50%
28
Q

How does CMV present in immunocompetant?

A
  1. EBV like, but heterophile (-)
  2. Often occurs post-splenectomy
  3. Cutaneous rash = common.
  4. Leukopenia => leukocytosis
29
Q

How does CMV present in immunocompromnised?

A

Often focus on GI/hepatobilliary

  • Retinitis *
  • Small bowl inflammation*/
  • Pneumonitis
  • Neuro sx (encephalitis and transverse myelitis)
30
Q

Complications of CMV

A
    1. Mucosal GI damage
    1. Encephalitis
    1. Severe hepatitis
    1. GB-syndrome
    1. Pericarditis/myocaridits
31
Q

What to remember about Histoplasmosis, according to Dr. Tyler (4)?

A
  1. Most patients are asymptomatic
  2. Most common clinical problem = respiratory illness
  3. Most likely to cause disseminated disease in HIV pts with CD4+ < 100 (immunocompromised patient)
  4. Chronic progressive pulmonary histoplasmosis can occur in older patients with COPD.
32
Q

Disseminated coccidioidomycosis occurs in who and what sx do you see?

A
  1. HIV patients
  2. Miliary infiltrates + LAD + meningitis (skin lesions are uncommon)
33
Q

Common symptoms in Primary Coccidioidomycosis

A
  1. Incubation period = 10-30 days
  2. Sx = usually respiratory (40%)
    1. NAsopharyngitis + fever + chills
    2. Common cause of CAP
    3. Erythema nodosum
34
Q

What type of malaria is MC for all severe disaeses?

Symptoms?

A
  1. P. falciparum via mosquitos
  2. Attacks of chills, fever and sweating
    1. without therapy, fever becomes regular
35
Q

What malignancies are most often assx with fever?

A

1. Multiple myeloma

2. Kaposi sarcoma

36
Q

What is Multiple Myeloma?

Common symptoms/signs in Multiple Myeloma

A
  • Malignancy of HSC terminally differenaited as plasma cells, MC in pts >65YO.
  • Sx= CRABS
    • Bone pain (spin, ribs, proximal long bones)
    • Ig in serum/urine
    • Anemia
37
Q

Kaposi sarcoma is due to ____ and MC occurs in _____

How do lesions present?

A
  • HHV-8
  • HIV patients
  • Red, purple, dark plaques or nodules on skin/mucosa
38
Q

What immunological causes cause fever?

A

1. SLE

2. Sjrogens

39
Q

Who does SLE MC occur in?

A

young women

40
Q

What can cause intermittant fevers + pharyngitis + myalgias + stomach pain + LAD?

A

Infection

    1. Infectious mono
    1. CMV
    1. Streptococcal pharyngitis
    1. Acute HIV
41
Q

What is ESSENTIAL to ask about in a person with fever?

A
    1. Age
    1. Localizing sx
    1. WL
    1. Joint pain
    1. IV drug use
    1. Immunsuppresion, hx of cancer, meds, travel.
42
Q
  1. What is considered a fever?
  2. Physiologically, how does a fever occur?
A
  1. Elevated body temp >38.3
  2. Pyogenic cytokines act on the hypothalamus and create an new elevated “set point” of body temperature
43
Q

In what conditions is the fever pattern important to consider?

A
    1. Relapsing fever in malaria
    1. Borreliosis
    1. Lymphoma (esp Hodgkins)
44
Q

What is a FUO (fever of undetermined origin)?

A

Unexplained fever >38.3 on several occasions for at least 3 weeks in a patient WITHOUT neutropenia or immunosuppresion.

45
Q

In HIV+ ppl, fever can be due to…

A
    1. Lymphoma
    1. Disseminated Mycobacterium acium
    1. Pneucystis jirovecii
    1. CMV
    1. Disseminated histoplasmosis
46
Q

What mode of checking temp is most accurate?

A

Rectal

47
Q

Increase in temperature (fever) is common in what conditions in a female?

A

1. Ovulation

2. Menstrual cycle

3. 1st trimester of PG

48
Q

What are important complications of sepsis?

A
  1. DIC
  2. Kidney/liver hypoperfusion
  3. ARDS
49
Q

How to manage septic shock?

A
    1. Restore perfusion
    1. Adequate O2
    1. Come up with goal-directed therapy protocol early
    1. ID and tx infection: use broad-band ABX initially => narrow ABX based on cultures.
    1. Replete fluids
50
Q

Central venous catheter infection can be d/t ________ and has a higher risk of infection if is placed ________, compared to ______

A
  1. MRSA
  2. Femoral site
  3. Subclavian/internal jugular
51
Q

When should a central line be removed?

A
  1. Purulence at exit site
  2. If staph aureus, gram (-) rod, candida is ID’d.
  3. Persistent bacteremia; septic thromboplebitis, endocarditis, metastatic abcesses
52
Q

What is essential to diagnose healthcare assx infections?

A
  1. Acquired during course of treatment for other condtions more than 48 hours after admission
  2. Most are preventable; hand washing is most effective!
53
Q
  1. Healthcare-assx infections are usually d/t ______.
  2. What is key to prevent?
  3. Often occur in what type of patients?
A
  1. Devices for diagnosing, monitoring or therapy such as IV catheters
  2. Proper sterilization of equipment
  3. Critically ill patients in hospital for long time and on broad-spectrum ABX.
54
Q

What finding is key to dx pneumocystitis, a opportunistic AIDS infection?

A

Diffuse interstitial infiltrate shaped lk bat/butterfly wings on CXR

55
Q

Which test is used to dx and confirm HIV?

A
  • Dx = HIV Ab via ELISA
  • Confirm dx = Western blot
56
Q

What T-cell count can AIDS be made?

A

< 200/uL

57
Q

Long duration of fever + WL + fatigue + cough with hemoptysis after incarceration

Dx?

A

TB

SBL Test 2 (11 decks)

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