Clinical Med Test 1
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monkey93063 on September 1, 2010
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250 terms
Terms | Definitions |
|---|---|
 S. aureus | normal human flora |
| S. Aureus is found in | Anterior nares, skin, vagina, axilla, perineum, oropharynx |
| What percentage of healthy people are colonized with S. aureus | 25-50% persistently or transiently |
| What population is at higher risk | IDDM, HIV, IV drug users, Dialysis (renal failure), Skin damage, in dwelling foreign bodies, impaired leukoctye function, skin disfunction (eczema) |
| Nosocomial and community infections associated with S. aureus are | MRSA |
| S. Aureus is coagulase ____________ | positive |
| Innoculation & colonization occurs | through open skin or adherence to tissue |
| S. aureus evades host response via | an antiphagocytic polysaccharid microcapsule and can survive intracellularly |
| S. aureus host response is | PMN's |
| 3 toxins that mediate S. aureus | cytotoxins, pyrogenic toxins, exfoliative toxins |
| What antibodies are protective against toxin-mediated staph illness | antitoxin antibodies |
| What superantigens cause multisystem disease | enterotoxins and TSS (TSS-1) |
| Name 8 skin infections associated with S. aureus | folliculitis, furuncles, carbuncles, mastitis, impetigo, cellulitis, hidradenitis superativa, surgical wound sites |
| Tx for folliculitis, furuncles and carbuncles | I & D, Hot packs, rarely meds, bactrim |
| Tx for mastitis | No MRSA - dicloxacillin MRSA - Bactrim or clindamycin |
| Tx for impetigo | mupirocin ointment preferred or azithromycin |
| Tx for Cellulitis | PCN G or dicloxacillin |
| Tx for Hidradenitis Superativa | Base on culture and sensitivity |
| Tx for surgical wound infections | Culture, start on Bactrim or IV Vancomycin |
| Name 2 musculoskeletal S. Aureus infx | Osteomyelitis and pyomyositis |
| How does osteomyelitis spread | hematogenous and contiguous also vertebral in pts. w/ endocarditis, hemodialysis, IV drug use, or DM |
| osteomyelitis hematogenous symptoms | fever, bone pain, reluctance to bear weight, elevated ESR, +blood cultures, leukocytosis |
| Osteomyelitis vertebral symptoms | Intense back pain, fever, possible neuro compromise |
| Osteomyelitis contiguous symptoms | exposure of bone, draining fistulous tract, faiure to heal, and continued drainage |
| S. aureus is the most common cause of _____ in children | septic arthritis |
| S. aureus septic arthritis in adults is associated w/ _____ or _____ | trauma or hematogenous dissemination |
| Pyomyositis is | Infx of skeletal muscle can be caused by S. aureus |
| Pyomyositis is prevelent in | tropical climates in compromised pts. (HIV) |
| Symptoms of pyomyositis | fever, swelling, and pain over involved muscle |
| Tx of pyomyositis | nafcillin, oxacillin IV, or cefazolin IV (if sensitive) / if MRSA - Vancomycin IV |
| Respiriatory infx assoc. with S. aureus | nosocomial and community aquired pneumonia also bacteremia and sepsis |
| S. Aureus resp infx in infant symptoms | fever, dyspnea, resp failure, pneumatoceles on CXR, pnuemothorax and empyema |
| S. Aureus resp infx in intubated ICU pts. symptoms | purulent sputum, fever, pulmonary infiltrates on CXR, resp. distress |
| Community aquired pneumonia is usually | postviral (often after influenza) |
| Symptoms of community aquired pneumonia | fever, bloody sputum, midlungfield pneumatoceles or multiple patchy infiltrates |
| Tx for pneumonia | nafcillin or oxacillin IV, or vancomycin IV |
| S. aureus Bacteremia and Sepsis is often associated with | DM, HIV, renal insufficiency which increase risk of complications |
| bacteremia and sepsis can seed the lung as often as | 31% |
| Indigenous organisms on skin | Staphylococcus epidermidis, Corynebacterium species |
| Other indigenous organisms | Streptococci viridans, Enteric (aerobes and anaerobes) in colon |
| Pathogenic organisms associated with acute illnesses | Viruses, Chlamydia, Rickettsia |
| Other pathogenic organisms | Brucella,Salmonella species, Neisseria gonorhoeae, Mycobacterium tuberculosis |
| Transient organisms | Neisseria meningitidis |
| Physical barriers | Skin, Mucous membranes |
| Functional barriers | muscular protection of glottis & bladder neck |
| Type of barrier failure | Herpetic whitlow, Endocarditis, Bacterial colonization at sterile sites |
| Endocarditis is caused by | Staph aureus (IV drug use), Strep virdans (throat) |
| Herpetic whitlow | Broken skin comes incontact with herpes simplex virus |
| What sterile sites get infected by bacteria | Catheters, Endotracheal tubes |
| PMNs | Polymorphic neutrophils |
| Neutropenia | Decrease in neutrophils, (bone marrow failure, leukemia) |
| Abnormalities in neutrophils | genetic, NADPH, Lazy leukocyte syndrome |
| What is a monocyte | Macrophage in tissue |
| Organisms resistant to phagocytosis | Salmonella, Legionella, Mycobacterium |
| Types of tests | Wet mount (vaginal secretions), Blood cultures, Gram stains (pos or neg), Antigen tests |
| Empirical treatment | Diagnosis is uncertain but antibiotics still given before test results are in |
| Prophylaxis | Treatment given to avoid infections |
| What is prophylaxis usually used for | Given before surgery |
| 3 ways to take Tx | PO, IV, IM |
| 2 drugs that can cause renal dysfunction | Aminoglycosides, Amphotericin B |
| Main adult vaccines given (5) | Tetanus, Diptheria, Rubella, Mumps, Measles |
| Main elderly vaccines given (2) | Pneumococcal , Influenza |
| Main traveler vaccines given (3) | Yellow fever, Typhoid , Hep A |
| Universal vaccines given (2)* | Hep B, Varicella |
| Main vaccines for an asplenic person (2) | Pneumococcal, Meningicoccal |
| Risk factors for infection() | Diabetes, Alcoholism, IV drug use, Homosexuality, Occupational exposure, Internal prostheses, Granulocytopenia, Corticosteroids, Neurologic deficits, Age |
| Nosocomial infx | Infection acquired after 2 or more days in a hospital |
| Types of organisms that cause nosocomial infx | Enteric gram negative rods, E.coli, Klebsiella, Pseudomonas aeruginosa |
| Pneumococcus in gram _____ and shaped in ______ | (+) coccus chains |
| Pneumococcus colonizes | 5-10% of healthy adults and 20-40% of children |
| Pneumococcus is ____ hemolytic | a-hemolytic |
| Pneumococcus persists | 4-6 weeks up to 6 months |
| Pneumococcus is transmitted via | droplet |
| Pneumococcus is | encapsulated |
| Pneumococcus risk factors | Populated areas, (dorms, barracks, etc), previous resp insult (smoking, pollution, allergies), anatomical disruption, defects in antibody production, splenic function, poor nutrition, age, DM, etc. |
| Pneumococcal infx include | otitis media, sinusitis, pneumonia, meningitis |
| Most common bacterial isolate from middle ear fluid in acute otitis media and sinusitis | pneumococcus |
| Pneumonia symptoms | fever, cough, and sputum, shaking chills |
| Pneumonia labs include | CXR, luekocytosis, (PMN neutrophils), gram stain (+) diplococci, sputum culture |
| Tx for pneumococcal infx | PCN G, can also use amoxicillin |
| Prevent pneumococcal infx via | pneumococcal vaccine |
| Clostridium Tetani produces_____ that causes_____ | the toxin tetanospasmin/neurological disorder w/ increased muscle tone and spasms |
| Clostridium Tetani is______shaped and lives ______ | spore forming anaerobic gram (+) rod/ in the soil |
| Clostridium Tetani primarily effects | inadequately immunized nonwhites and elderly |
| Clostridium Tetani invades through | puncture wound |
| Rigidity in Clostridium Tetani is the result of | increased resting firing rate of alpha motor neurons (resulting from blockage of inhibitory neurotransmitters) |
| Clostridium Tetani binds to ______ and travels on nerves | peripheral motor neurons |
| Tetanus appears | 7 days after injury |
| Tetanus clinical features | Trismus (lock jaw), afebrile, paroxysmal spasms, mentation is clear, cyanosis and ventilatory compromise, autonomic dysfuntion |
| Local tetanus | only muscles near the wound are affected |
| neonatal tetanus | usually fatal if not treated, contamination of umbilical cord stump, or children of unimmunized mothers |
| Tx of tetanus | cardiac monitor, supportive care in quiet ICU, PCN or metronidazole, human tetanus immunoglobulin, valium, immunize those in recovery |
| Prevent tetanus | vaccination |
| Staphylcoccus aureus: invasion of host | Invasion: S. aureus uses a antiphagocytic polysaccharide microcapsule Host Response: PMN's |
| Component of normal human flora: ant. Nares, skin, vagina, axilla, perineum | Staphylcoccus aureus |
| what causes people to be high risk for folliculitus, furuncles & carbuncles? | Those w frequent skin disruption (i.e. eczema), Impaired leukocyte function , Indwelling foreign bodiesIv drug users, IDDM, HIV, Dialysis, Skin Damage |
| Impetigo Tx | Mupirocin ointment 2% tid, alternative: Azithromycin |
| Cellulitis Tx | PCN G 1-2 million U IV or Dicloxacillin 500 mg po q 6 h |
| A 32 african american female presents with deep seeded absesses in her groin area.there is also comedomes that have tracts connecting them to each other She has a some scar tissue but the disease hasn't progressed that far what disease does she have, and what Tx do you use? | Hidradenitis Suppurativa TX based on Culture, TMP-SMX DS 1-2 tabs po bid or IV vancomycin Surgical wound infx (last resort) |
| Septic Arthritis | S. aureus septic arthritis in adults associated with trauma, OR hematogenous dissemination |
| Pyomyositis Tx | Nafcillin/oxacillin IV or Cefazolin IV If sensitive-- Vancomycin if MRSA |
| p.s Immunocomprimised patients are more succesptible | Pyomyositis |
| Fever, Dyspnea, respiratory failure; Pneumatoceles on CXR; Pneumothorax & empyema | Respiratory tract infx w/ S. aureus in Newborns and infants |
| Intubated patients in ICU; Purulent sputum, fever, pulmonary infiltrates on CXR, respiratory distress | Nosocomial Pneumonia (HAP) |
| Bacteremia and Sepsis: Places of infection | Bones, Joints, kidneys and lungs are most common infx; 31% chance of seeding in lung |
| Those at hight risk for bacteremia and sepsis are? | DM, HIV and renal insufficiency often seen in association w. S. aureus bacteremia & increase risk of complications |
| 4 Types of Infective endocarditis (s. aureus) | Rt. Sided endocarditis-Lt sided native- valve endocarditis-Prosthetic valve endocarditis- Nosocomial Endocarditis. |
| High fever, toxic appearance, pleuritic chest pain, purulent sputum (?bloody); CXR septic emboli: small peripheral circular lesions that may cavitate; IV Drug use puts you at higher risk | 1. Rt sided endocarditis |
| this disease also has a high mortality rate especially if early postoperative period | 3. Prostetic valve endocarditis |
| 15-30% OF S. aureus endocarditis cases- Due to increased use of IV devices--patients often critically ill before infx. | 4. Nosocomial Endocardidtis |
| What treatments are used for a person with TSS? | Supportive, remove tampons, debride, antibiotics: nafcillin or axacillin or if MRSA the can use VANCOMYCIN + IV immunoglobulin |
| what disease does she have? | Toxin-mediated S. aureus disease |
| what treatment should you use? | Staphylococcal scalded skin syndrome (SSSS) |
| S. aureus coagulase positive: More acute disease with localized and systemic manifestations; Rapidly progressive; Often need to remove prosthetic | Prosthetic device S. aureus infx |
| remember to think E.COLI | Urinary Tract Infection |
| If sensitive to methicillin what other Txs can you use? | Nafcillin or oxacillin (alternative Cefazonil, vancomycin) |
| If sensitive to PCN what other Txs can you use? | alternative Nafcillin or oxacillin, cefazolin, vancomycin |
| Resistant to methicillin what other Txs can you use? | Vancomycin (alternative TMP-SMX, minocycline, ciprofloxacin, levofloxacin, etc......... |
| If sensitivity not known, drug of choice???? | Vancomycin |
| OTHER STAPH INFXS | Less Virulent than S. aureus; S. epidermidis > prosthetic devices; S. saphrophyticus > UTI's; S. lugunesis and S. schleiferi > serious infx- native-valve endocarditis & osteomyelitis; |
| ___ is a disease caused by neisseria gonorrhoeae. It is gram ___, ___, and ____. | gram-; nonmotile; non-spore forming |
| Neisseria gonorrhoeae, under a microscope would appear____. | to be in pairs, shaped like coffee beans |
| ___ is the most common reportable infx disease in the US | gonorrhea |
| Gonococcus can be described as GNID. What does this mean? | Gram-negative, Intracellular, Diplococci |
| A male presents with burning, urgency and frequency. He most likely has ____. | urethritis--> GC |
| A female presents with burning, urgency and frequency. She most likely has ____. | UTI caused by e.coli |
| 325,000 cases of gonococcus were reported in 2006. 75% of those cases were in the age group ___ to ___. | 20-24 years old |
| The highest risk group for gonococcus is ____. | sexually active 15-29 y/o |
| If you have gonorrhea, there is a increased chance of acquiring ____. | HIV |
| A man presents with urethritis, a yellow, purulent urethral d/c and dysuria. He may have ____. | urethritis--> GC ("the clap") |
| GC had an incubation period of ____. | 2-6 days |
| Complications of male urethritis includes _______. | epididymitis, prostatitis, penile edema, abscess or fistulae, seminal vesiculitis, and balaitis (uncircumcised) |
| ___ of women with GC are asymptomatic or have few symptoms. | 1/2 |
| Most common site of involvement for women with GC is ___. | endocervix (80-90%) |
| Incubation period for female GC is ____. | 10 days |
| Women who have GC usually have _____ as well. | chlamydia trachomatis (up to 40%) |
| If a pregnant pt contracts GC in their ___ trimester it can cause fetal death. | 1st |
| If a pregnant pt contracts GC in their ___ trimester, it can cause prolonged rupture to membranes, premature delivery, chorioamnionitis, neonatal sepsis or death. | 3rd |
| _____ is the most common form of GC in newborns. It can be prevented prophylactically with _____. | Opthalmia neonatorum; erythromycin ointment |
| ____ is GC that disseminates and settles in one or two joints (ex. Knees, wrists, ankles, and elbows) | GC arthritis |
| Dx for GC the lab is looking for ____ from urethral d/c (male) or endocervical d/c (female) | intracellular gram-negative diplococci |
| Tx for GC is _____. | ceftriaxone + azithromycin (for clamydia) |
| ___ is the most common cause of bacterial meningitis in American children since H.flu vaccine | meningicoccus |
| 3 syndroms of meningicoccus are: | 1. meningitis 2. minigitis with meningococemia 3. meningococcemia w. out signs of meningitis |
| There are a approximately ___ cases of niesseria meningitidis per year | 2500 |
| Tx of niesseria meningitidis is ____ or ____ | aqueous PCN G is tx of choice OR ceftriaxone |
| Prevention for niesseria meningitidis includes _____ or _____. | rifampin (cetriaxone or ciprofloxacin- close contacts) and vaccine (use in addition to AB prophylactically) |
| _____ is a small, gram-negative, pleomorphic coccobacillus with some strains having a polysaccharide capsule, serotyped A-F | Haemophilus influenzae (H.flu) |
| The most clinically relative type of H.flu is ___ | B (Hib)- infants and children < 6 y/o |
| _____ of H.flu are unencapsulated and cause disease by locally invading mucosal surfaces. These strains colonize the upper respiratory tract of up to 75% of healthy adults | nontypable strains |
| H.flu is spread by _____, ____ or ____. | airborne droplets, direct contact w. fomites, or secretions |
| Those at risk for Hib are ______ | most unvaccinated or underimmunized children |
| Complications of Hib include _____, ____, ____, _____ and _____. | meningitis, epiglotitis, cellulitis, pneumonia, and osteomyelitis |
| A 35-year-old white man presents with a history of unprotected insertive anal sex with 2 male partners and a 3-day history of urethral irritation, dysuria, and purulent discharge at the meatus. Dx: _____ | gonococcus |
| A 24-year-old black woman presents with a history of unprotected vaginal sex with one male partner who told her that he had purulent urethral discharge that was treated as gonorrhea 1 week ago. The woman has had some increased vaginal discharge and pain with intercourse. Dx: ____ | gonococcus |
| A 1-month-old girl presents to her general practitioner with a high fever that has lasted 24 hours, feeding difficulties, and irritability. Examination reveals altered mental status and a bulging fontanel. | bacterial meningitis |
| An 18-year-old male student presents with severe headache and fever that he has had for 3 days. Examination reveals fever, photophobia, and neck stiffness. | bacterial meningitis |
| A pt is diagnosed with Hib. They have developed _____, which includes hearing loss and a chance of death. | meningitis |
| A pt is diagnosed with Hib. He now has a soar throat, dysphagia, drooling, and airway obstruction. He is most likely experiencing an ______ complication | epiglotittis |
| ____ h.flu can cause community pnemonia in adults (esp COPD or AIDs) | notypbalbe |
| To dx h.flu you should ____ | gram stain and culture |
| Tx of Hib is _____ | ceftriaxone (in children who develop meningitis give dexamethasone to prevent hearing loss) |
| Tx of nontypable h.flu is ______ | TMP-SMX (will produce b-lactamase so cant use PCN), or Augmentum |
| Tx of mild infx in adult of H.flu is _____ | oral amoxacillin or augmentum |
| To prevent Hib you _____ | vaccinate as a child |
| _____ bacteria is the most common bacterial cause of gastroenteritis in the US (c.jejuni). U.S. ingestion of contaminated poultry accounts for 50-60% of cases and is usually caused by the ingestion of raw or undercooked food products or direct contact with infected animals. | camplyobacteriosis |
| A 16-year-old boy presents with abdominal pain and diarrhea. Two days earlier, he attended a picnic where he ate undercooked chicken. He has been having about 8 bowel movements a day of moderate volume diarrhea with no gross blood. He has severe abdominal cramping. He has a low-grade fever and mild tachycardia. His physical exam is unremarkable except for abdominal tenderness, which is most significant in the RLQ. Dx _____ | camplyobacteria infx |
| Camplyobacterial infx can cause ____, ____, ____, or ____. | gastroenteritis, extraintestinal infx, disseminated disease, or local suppurative complications |
| Gastroenteritis has an incubation period of ______. Pt will present with fever, headache, myalgia and malaise. After 12-24 hrs they will present with ____. Most cases are self-limited. | 2-4 days; bloody diarrhea with mucus and high leukocytes |
| Campylobacteria infxs can cause _____ in immunocompromised pts and can result in seeding of many organs and fetal death. | extraintestinal infx |
| Campylobacteria infxs can cause _____ in pts with AIDs or hypogammaglobulinemia. It is a severe, persistent, disease. | disseminated disease |
| To Dx a campylobacteria infx you should _____. | culture stool, blood or other specimen on special media |
| Tx for campylobacterial infxs includes ____, _____ and ____. | fluid and electrolyte replacement!; avoid antimotility agents, antibiotics (erythromycin or ciprofloxacin- AB benefit less than half of pts) |
| Helicobacter pylori produces _____. | spiral urease |
| ____ is often the cause of gastric and duodenal ulcers | h. pylori |
| _____ reverses the process of ulcers | eradication of h.pylori |
| The best dx of h.pylori is ______. If the pt cannont afford/insurance won't cover, use ______ instead. | upper endoscopy; GI barium radiography |
| While an upper endoscopy or GI barium works best to detect H.pylori, you can also ______. | check for antibodies, rapid usease test of antral biopsy, histology from biopsy, culture, urea breath test, stool antigen |
| Tx for H.pylori is ____ and ____ | tx of PUD (ulcer); eradicate h.pylori through triple or quadriple therapy |
| Antibiotic tx for h.plyori can be: | 1.) rabeprozole + amoxicillin + clarithromycin + tinidazole OR 2.) bismuth (pepto-bismol) + metronidazole + tetracycline |
| A 3-year-old boy is brought to the health post in a rural Zimbabwean village by his distraught mother. The child started to have diarrhea 20 hours ago, and the volume has increased rapidly, so that now there is almost a continuous passage of thin yellow stools into the bed. Initially the child was taking fluids but is now drowsy and unresponsive. On examination, the radial pulse is impalpable, blood pressure unrecordable, and the eyes are sunken. The capillary return is 5 seconds and skin turgor poor. The mother notes that the child has not urinated for 12 hours. The mother also reports that several members of her family and others in the village are also ill with a similar illness and that 3 children have already died. Dx:______ | cholera |
| A 37-year-old Indian woman is referred urgently to the local ER, having collapsed in the toilet during a flight she had taken from India, where she had been visiting relatives in a rural village. Other passengers state that she returned to the toilet 3 to 4 times per hour initially and then locked herself in there for the remainder of the flight. On arrival she is talking but is mildly confused, with a pulse of 130 bpm and BP of 90/50 mmHg. Her mucous membranes are dry and skin turgor is poor. She is almost continually passing thin, pale, cloudy yellow stools without blood or mucus. Dx: _____ | cholera |
| Cholera is spread by _____ | fecal contamination of water and food sources. You must ingest a large amount of the organism |
| Cholera has an incubation period of 24-48 hrs and can cause death within hours. The classic sign for this disease is _____. | "rice-water" stools (gray, cloudy fluid with flecks of mucus), almost constant |
| Dx for cholera is ______. | stool cultures on selective medium |
| Tx of cholera is ____ and _____. | replacement of fluids and electrolytes!!; antibiotics (doxycycline, ciprofloxacin, erythromycin or azithromycin) |
| Salmonellosis is ingested and will penetrate the ______ and traverse the _____. | small intestine mucosa; intestinal layer |
| ____ and ____ (salmonellosis) survive within macrophages and disseminate throughout the body via lymphatics | s.typhi and s.paratyphi |
| ____ salmonellae will lead to gastroenterits (n/v, diarrhea, abdominal cramping). Most often will clear in 3-7 days on own. Tx for young, old or immunocompromised is _____. | gatroenteritis; AB-ciprofloxacin |
| A 25-year-old male is admitted to the internal medicine department complaining of high fever that has lasted for 12 days. He has recently returned from traveling in Nepal and India. On his last day in New Delhi he had an acute episode of watery diarrhea that lasted 24 hours and subsided without treatment. Two weeks after his return he started to feel feverish with headaches and anorexia. His temperature rose to 103°F (39.4°C) and his headache and general fatigue worsened. He visited the ER, where his general check-up and CBC was normal. He was discharged home with a diagnosis of viral infection and not prescribed antibiotics. After 4 days with no improvement and appearance of dry cough, he was sent again to the hospital and was admitted. His past vaccine history included routine childhood vaccination and hepatitis A, B, and typhoid vaccine (Vi vaccine) before departing on his trip. | typhoid fever |
| Incubatoin time for typhoid fever is _____ | 3-21 days |
| The "key symptom" for typhoid fever is _____ and _____. | PROLONGED FEVER and "rose spot" rase |
| Dx for typhoid fever is ______ | cultures of blood, stool, or other specimens |
| Tx for typhoid fever is ____ | many AB are effective |
| A 12-year-old boy presents with a 1-week history of sudden-onset watery diarrhea while visiting relatives in Dakar, Bangladesh. On his return to the US, he developed abdominal cramps, fever, and bloody diarrhea. He is febrile, with a temperature of 101.2°F (38.5°C). The mucous membranes are dry, and there is reduced skin turgor; his pulse is 100 beats/minute and BP is 110/70 mmHg with a 10 mmHg postural drop. | shigella |
| Shingella is transmitted ____ | fecal-oral (food, water, flies and fomites) |
| ____ can be asymptomatic or present as fever, fever+diarrhea, may progress to blood diarrhea and dysentery (bloody/bacterial diarrhea) | shingella |
| Dx of shingella is ______ | stool cultures (increase leukocytes and antigen detection for shigella toxin) |
| Without tx for shigella, fever will last ____ and diarrhea will last ____ | 3-4 days; 1-2 weeks |
| The only time you would actually test for shigella is if you see ______ or _____. | colon dilation, perforation and death; Hemolytic Uremic Syndrome (HUS)- oliguria, drop in hematocirt, renal failure |
| Tx for shigella is ____, ____ and _____. | rehydration and supportive measure, NO antimotility agents, antibiotics (ex ciprofloxacin) |
| A 30-year-old man presents with abrupt onset of fever, myalgia, and headache. Shortly after first feeling unwell, he noticed a painful swelling in his right groin. Two days previously he had returned home from a camping expedition in New Mexico. Toward the end of his trip, he noticed several small bites on his legs, and these have been intensely itchy. On examination he appears unwell and has a temperature of 103°F (39.4°C). Movement of his right leg is limited by the painful swelling in his groin, and he walks with a limp. On the examination couch he is holding his leg flexed and in external rotation. The groin swelling is 5 cm long and tender to touch; it does not appear fluctuant. The overlying skin is warm and erythematous with some surrounding edema. Dx: ______ | yersiniosis |
| Bordetell pertussis is also known as _____ | whooping cough |
| A 12-month-old female infant presents with spasmodic cough, cyanosis around her lips and fingers during coughing, and posttussive vomiting. Her parents report that she has had a cold for approximately 3 weeks, and her appetite has decreased. The infant's mother reports that she herself has been coughing for 6 weeks. The infant's immunization records are incomplete. Dx: ______ | bordetella pertussis (whooping cough) |
| Bordetella attaches to ______ and produces toxins | epithelial cells of nasopharynx |
| Bordetella's "key symptom" is _______ | persistent cough (>2 weeks) |
| The two phases of bordetella are _____ and ______. | catarrhal phase and paraxysmal phase |
| The ____ phase of of bordetella is often similar to the common cold and lasts 1-2 weeks | catarrhal |
| The ____ phase of bordetella lasts for 2-4 weeks and presents as a spasmodic cough (fits of 5-10 coughs) that is worse at night. Vomiting or "whoop" may follow a coughing fit. Apnea and cyanosis can occur. Pts become fatigued | paraxysmal |
| Dx of pertussis is done by ____, _____ or ____. | cultures of nasopharyngeal secretion, PCR, serology |
| Tx for pertussis is _____ | erythromycin, clarithromycin or azithromycin (can use TMP-SMX for severe cases) |
| A 28 y/o presents to the ER with a cat biten her left hand. She said her cat had bit her last night. She complains of painful inflammation around the bite. There is also a purulent d/c.Dx:_____ | pasteurella multocida |
| When someone presents with an infx cat bite, you should also consider ______. | bartonella henselae (cat scratch disease) and francisella tularensis (rabbit bite) |
| Tx for pasteurella is ________. | augmentin |
| A 55-year-old female with a history of tobacco use (40-pack years) presents with fever, dyspnea and a productive cough of thick yellow sputum for 3 days. She also reports a headache with some nausea and vomiting for the last 24 hours. She travels frequently, and was most recently attending a conference in Boston, MA for 5 days. Dx: ______ | legionella |
| Legionella is found in ________ | fresh water and human-contructed water sources (transmitted via aspiration mostly) |
| Risk factors for legionella is ____, ____ and _____. | chronic lung disease, smoking, elderly/immunosuppressed |
| _____ is associated with Legionella and presents as flu-like illness with an incubation period of 24-48hrs (malaise, fatigue, myalgias and fever). It is self-limited and recover in a few days | pontiac fever |
| Dx of legionnairs disease is ____, ____, ___ or _____. | sputum or bronchoalveolar samples, cultures, antibody testing, urinary antigen assay (fast, easy, cheap) |
| Tx for legionnaire's disease ____ | several options (FQ, azithromycin, bactrim) |
| With legionnaires disease, if it goes untreated, mortality approaches ____% among compromised hosts who do not receive timely therapy | 80 |
| A 42-year-old man presents with a 48-hour history of bloody diarrhea. He has been opening his bowel 6 to 8 times per day and has associated nausea, lethargy, and generalized abdominal discomfort. There is no recent travel history. He lives with his wife and 2 children, who are all well. They had a meal in a restaurant 5 days ago, when he ate a beef burger and French fries. A friend who was with them ate the same meal and has developed similar symptoms. Exam shows a low-grade pyrexia (99.5°F (37.5°C)) but is otherwise unremarkable. CBC reveals a raised white cell count (15,000/mm^3). Dx: ____ | e.coli |
| A 21-year-old woman presents with profuse watery diarrhea 15 to 20 times per day. There is associated nausea, anorexia, and lethargy. She returned 4 days ago from Kenya, where she had tried many local delicacies, often from street vendors. On exam she has dry mucous membranes and reduced skin turgor. She is hypotensive (blood pressure 95/50 mmHg) and tachycardic (pulse 110 bpm). Abdominal exam is unremarkable. She responds well to intravenous fluid replacement, with resolution of her symptoms within 48 hours. Dx: _____ | e.coli |
| There are two types of e.coli. ____ and ____. | shiga toxin-producing e.coli (STEC)and enterohemorrhagic e.coli (EHEC) |
| E.coli can be transmitted from _____ or _____. | food and water; person-to-person |
| The most common source of e.coli is _____. | ground beef |
| _____ e.coli is also known as traveler's diarrhea | enterotoxigenic (ETEC) |
| ____ e.coli is important cause of infant diarrhea | enteropathogenic (EPEC) |
| ____ e.coli is inflammatory colitis (EIEC) | enteroinvasive |
| ___ and ___ e.coli presents as prolonged watery diarrhea | enteroaggregative and diffusely adherent (EAEC/DAEC) |
| Dx for e.coli is only necessary when looking for ______ | EHEC (enterohemorrhagic)- bloody diarrhea (screen for e.coli strains) |
| Tx for e.coli includes ___, ___, and ___ | replacement of water and electrolytes!!, avoid antibiotics in EHEC (HUS) and avoid antimotility agents |
| Pseudomonas aeruginosa like ___ enviroments | moist |
| Risk factors for pseudomonas aeruginosa includes ____, ____ or ____. | disruption of cutaneous or mucosal barriers (burns or trauma), immunosppression, distruption of normal bacterial flora |
| Pseudomonas aeruginosa often causes _____, especially in pts with AIDs, COPD, or CHF | ventilator-associated pneumonia |
| Pseudomonas aeruginosa can cause RTI's such ____, ___, ___, and ___ | ventilator-associated pneumonia, p pneumonia, sepsis, chronic respriatory infx (cystic fibrosis), (as well as..... bacteremia, endocarditis, CNS info, ear infx, eye infx, bone and joint infx, UTI's, SSTI- burns and skin break down, hot-tub folliculitis) |
| Tx for p.aeruginosa is _____ | ceftazidime (and many others...) |
| A 25-year-old white woman presents to the office with malodorous vaginal discharge and pruritus for the last 15 days. She reports the smell is worse after intercourse and the discharge is white. She is in a stable monogamous relationship and has never been pregnant. She denies any significant medical or gynecological history. She reports this is the first time she has had these symptoms and is worried about STDs. Physical examination shows a white discharge in the posterior vaginal fornix, but there is no vaginal erythema or bleeding. Dx: ____ | gardnerella vaginalis |
| Gardnerella has the "key symptoms" of ____, ___, ____ and ____. | malodorous, slightly increased d/c; moderate white or gray vaginal d/c; not much tissue inflammation; clue cells (dots) |
| An easy way to dx gardnerella is _____ and ____ | look for clue cells and "whiff test" |
| Tx for gardnerella is ____ | metronidazole (or others) |
| Moraxella catarrhalis is part of our normal flora of ______. Infx rates peak at ____ | upper airway; late winter/early spring |
| Top three culprits for a bacterial ear infx include ___, ___ and ____ | strep pneumonea, h.flu, and moraxella catarrhalis |
| Clinical features of moraxella catarrhalis includes ___, ___, ____ and ___ | otitis media, sinusitis, purulent tracheobronchitis and pneumonia |
| To dx m. catarrhalis _____ | gram stain and culture |
| To tx for m. catarrhalis ____ | several options including Augmentum |
| Klebsiella is usually found in pts that are ____ or ___ | immunocompromised or alcoholics |
| Klebsiella often causes ____ | pneumonia |
| If a pt have a pneumonia from klebsiella, that will usually have ___, ___, and ___ | underlying disease (alcoholism, DM, COPD), purulent sputum production and pulmonary infiltrates |
| Klebsiella is tx by ___ | doripenem, imipenem, meropenum (produces b-lactamase so resistant to many AB- esp PCN) |
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