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SBL (Skin, Blood, Lymph) Exam 1 and 2 > Lecture 23: Clinical Considerations in Fever > Flashcards

Lecture 23: Clinical Considerations in Fever Flashcards

1
Q

What is bacteremia and what kind of treatment does it require?

What can bacteremia cause if not treated properly?

A
  • abnormal presence of bacteria in the blood stream
  • requires empiric antibiotic treatment
  • can become early SEPSIS –> Sepsis –> Septic Shock
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2
Q

What is qSOFA and what three things is its scoring system based on?

A
  • easy bedside scoring system that helps predicts that chance of SEPSIS for pts. admitted to medical floor
    scoring: RR > 22/min, altered mentation, systolic blood pressure < 100 mmHg
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3
Q

What are these risk factors for?

ICU admission, bacteremia, age of 65

A

SEPSIS RISK FACTORS

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4
Q

What are four clinical manifestations of Sepsis?

A
  • arterial HYPOtension (SBP < 90, MAP < 70)
  • temperature > 38.3
  • HR > 90 bpm
  • RR > 20 breaths/min (tachypnea)
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5
Q

How does Septic Shock manifest clinically? (End-Organ manifestations)

A
  • skin starts out warm and flush but can cool (redirect blood flow to core organs)
  • leads to dec. capillary refill and cyanosis with altered mental state
  • ileus or absent bowel sounds are often end-stage signs of HYPOperfusion
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6
Q

What is a common lab finding in patients who are dealing with Sepsis?

A
  • HYPERLACTATEMIA
  • elevated serum lactate > 2 mmol/L can be a manifestation of organ hypoperfusion
  • elevated lactate lvls associated with POOR prognosis
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7
Q

MSSA and MRSA

What are they associated with clinically?

A
  • Staphylococcal Bacteremia (Methicillin Sensitive vs Resistant Staph Aureus)
  • associated with bone/joint pain, protracted fever, LUQ pain (splenic infact), costovertebral angle tenderness
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8
Q

Where is MRSA normally acquired and what does it look like?

What 3 things should be focused on if a culture is positive for S. aureus bacteremia?

A
  • often HOSPITAL acquired (affects multiple systems)
  • erythema with purulent drainage (ABSCESS FORMS)
    • pus has Gram (+) cocci in clusters
  • focus on: endocarditis, osteomyelitis, systemic infections
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9
Q

MRSA Erysipelas and Cellulitis

A

E: superficial skin infection, well-defined borders

C: deeper skin infection, edema/lymphangitis

E and C: painful, warm, nonlocalized, erythematous
- STAPH has more PUS than strep usually

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10
Q

What four community activities can increase the risk of community-acquired MRSA?

What is MRSA commonly implicated in?

A

contact sports, military service, incarceration, injection drug use

  • MRSA is commonly associated with DIABETIC FOOT INFECTIONS
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11
Q

What is Streptococcus Pyrogens (Group A) the most common cause of in children/adolescents and what test can detect it?

A
  • most common cause of TONSILLOPHARYNGITIS (bacterial pharyngitis)
  • causes pharyngitis in adults
  • use ELISA to test; if negative and you still believe infection, GET A THROAT CULTURE!
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12
Q

What does Streptococcus Agalactiae (Group B) cause in pregnant women and what is it the most common cause of in nonpregnant adults?

A

Pregnant: UTI, postpartum endometritis, bacteremia, chorioamnionitis

Nonpregnant: most common strep pathogen for ADULTS (bacteremia without a focus)

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13
Q

How is Tuberculosis commonly spread and what are 4 community risk factors for infection?

A
  • infection via airborne droplet inhalation

risk factors: household exposure, incarceration, drug use, travel to endemic area

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14
Q

What are they symptoms of?

Productive cough, hemoptysis, fatigue, weight loss, fever, night sweats?

What is the most common symptom of this infection?

A

Mycobacterium Tuberculosis

  • most common symptom is COUGH (patients also appear chronically ill –> occurs more in elderly and HIV (+) pts)
  • blood-streaked sputum also common
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15
Q

What are 5 risk factors for TB reactivation?

What can cause drug-resistant TB? (4)

A

gastrectomy, silicosis, diabetes mellitus, HIV, immunosuppressive drugs

DR: immigration from region with DRTB, close contact with patients with DRTB, unsuccessful anti-TB therapy, treatment noncompliance

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16
Q

What is Influenza, when is it most likely to infect, and what subtype is most common?

A
  • orthomyxovirus transmitted via respiratory droplet

usually occurs during the fall and winter seasons (hard to diagnose without epidemic)

  • Type A infections commonly cause pandemics (larger genetic reassortment; Type B is similar and Type C is milder)
17
Q

How is Acute Acquired CMV different than Infectious Mononucleosis?

A
  • very similar but PHARYNGEAL symptoms are UNUSUAL in Acute CMV
  • most CMV infections are asymptomatic
18
Q

How does CMV affect infants and neonates?

A
  • HEARING LOSS in > 50% who are symptomatic at birth, but most are asymptomatic (mental retardation and hearing loss can occur later in life)
  • jaundice, periventricular CNS calcifications, mental retardation, and motor disability are possible symptoms
19
Q

What test is negative in an immunocompetent person with CMV infection?

A
  • negative HETEROPHIL ANTIBODIES

- usually occurs with mononucleosis-like syndrome

20
Q

Where is Histoplasmosis infection commonly acquired, what is its most common clinical problem, and who is it commonly seen in?

A
  • exposure to bird/bat droppings along river valleys
  • respiratory illness is MOST COMMON problem, but most pts. are asymptomatic (looks like INFLUENZA)
  • disseminated infection common in pts. with underlying HIV infection (CD4 < 100)
21
Q

What problems does Coccidioidomycosis cause, what does it look like on chest radiograph, and where is it commonly acquired?

A
  • acute infection is INFLUENZA-like but can disseminate causing meningitis, bone lesions, soft tissue abscesses
  • Chest X-Ray varies from pneumonitis to cavitation
  • usually from molds in soil of Southwest US, Mexico and Central/South America
22
Q

What are two main symptoms of Primary Coccidioidomycosis? (A/EN)

A
  • arthralgia with periarticular swelling of knees/ankles

- erythema nodosum (2-20 days after symptoms)

23
Q

What does Disseminated Coccidioidomycosis look like in HIV patients?

A
  • often shows PULMONARY MILIARY (seed infiltrates) on chest radiograph
  • also has lymphadenopathy, meningitis, but SKIN LESIONS ARE UNCOMMON
24
Q

How is Malaria spread, what is the most severe strain, and how does it present acutely?

A
  • transmitted by bite from infected anopheline mosquito (see on thick or thin blood smears)
  • P. falciparum is responsible for nearly all severe disease (vivax, ovale, malariae aren’t as severe)
  • usually headaches/fatigue/irregular fever
    • (vivax/ovale - 48 hr cycle, malariae - 72 hour cycle)
25
Q

What infection are these symptoms of?

Anemia, jaundice, splenomegaly, mild hepatomegaly, hypotension, seizure?

A

ACUTE MALARIA

26
Q

What is Multiple Myeloma and what are its 4 main clinical manifestations?

What other disease is it similar to?

A
  • clonal plasma cells that infiltrate the bone marrow, cause bone destruction, and produce monoclonal immunoglobulins (occurs in adults 65+)
  • anemia, lytic bone lesions, kidney failure, soft tissue masses
  • similar to Waldenstrom’s Macroglobulinemia but WM does NOT have lytic bone lesions
27
Q

How does Multiple Myeloma cause renal failure and what infections does it put a patient at an increased risk for?

A
  • produces light chains that deposit in tissue as amyloid

- more prone to ENCAPSULATED infections, like Strep Pneumoniae and H. influenzae

28
Q

What is Kaposi Sarcoma and what does it look like?

A
  • MOST COMMON HIV-related MALIGNANCY (associated with HHV-8)
  • red/purple/dark plaques or nodules on cutaneous or mucosal surface
  • melanoma is in the DDx of Kaposi Sarcoma
29
Q

Who does Systemic Lupus Erythematous occur in, what are common symptoms of it, and what serological findings are associated with it?

A
  • occurs in young women usually

Symptoms: malar rash, Raynauds, alopecia, Joint issues (often earliest manifestation - Swan Neck deformities but erosion almost NEVER seen)

Serological: ANA (+), anti DS Ab (+), dec. serum complement

30
Q

How does Sjogren’s usually present and what is Secondary Sjogren’s associated with?

A
  • dryness of eyes/mouth (SICCA components) due to immune-mediated dysfunction of lacrimal/salivary glands
  • ropy secretions from eye, enlarged parotid, loss of taste and smell

Secondary Sjogrens - dryness AND rheumatoid arthritis

31
Q

What pulmonary and kidney manifestations can be seen in Sjogren’s Syndrome?

A

P: obstructive airway disease/interstitial lung disease IN ABSENCE of smoking

K: renal tubular acidosis and chronic interstitial nephritis

SBL (Skin, Blood, Lymph) Exam 1 and 2 (22 decks)

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