BUN and Creatin (which are filter by the kidney will increase in levels which results in bone marrow compromise where WBCs are produced)
How does renal failure relate to immunocomprimization
recent super infection (body ran out of mature neutrophils so they are releasing the immature ones to try and compensate)
what do elevated BANDs indicate
infections (mature neutrophils)
what do elevated PMNs indiacte
cytotoxins, pyrogenic toxins, and exfoliative toxins
three types of toxins responsible for toxin mediated diseases
correlated with a shaved area where an infection was able to settle in around the hair follicle
I&D, hot packs, Bactram
treatment of folliculitis or furuncles or carbuncles
large and central infection around the hair follicle
multiple furuncles connected
common in breast feeding mothers; recomned to continue to breast feed
honey colored dried on region that start as pink vesicles
classicaly seen on childrens face
what is the Tx of cellulitis
mupirocin (mild) azithromycin (severe)
what is the Tx of impetigo
inflammation of the sweat gland
common hematologenous and contiguous spread; fever, bone pain, reductance to bear weight (increased ESR and blood culture)
starts in one area and seeds in a distal site (hips and knees are common places)
Treatment for osteomyelitis
blood cultures should be done at______different places and_____different times
endocarditis, IV drug users and hemodialysis
osteomyleitis is commonly seen with the following types of pts ______, ________. and _______
S. aureus is the most common cause of _________among children
infection of skeletal muscle
IV drug users, Tricuspid
Right sided endocarditis is common in ________and affects the ________valve
Left sided endocarditis is common in_________and affects the __________valve
High fever, hypotension, diffuses macular rash includes palms and soles with subsequent desquamation 1-2 weeks after disease onset
Tx for TSS
staphylcoccal scalded skin syndrome
local blisters to exfpliation of most of skins surface, fragile skin,tender, thick-walled fluid-filled bullae
nafcillin or oxacillin
treatment for SSSS
hand washing, isolation procedures, mupirocin tx (eliminate nasal carriage of S. aureus)
methods to prevent staphy aureus inx
usually post viral; pt present with fever, bloody sputum, midlungfield pneumatoceles or multiple patch pulmonary infiltrate
AST, ALT, GGT (asparate transaminase, alanine transaminase and gamma-glutamyl transferase)
liver enzyme (3)
15-30% of nosocomial endocarditis
Food poisoning; supportive therapy
A 35 yo F comes into the office after going to a loabor day picnic a few hours before. She is complaining of explosive N/V. BP= 98/62, Temp= 37.She said that she was a fan of the macaronia salad although it was not cold at all and was sitting in the sun.
how long does S. aureus food posoining last
staphylococcal scalded skin syndrome; nafcillin/oxacillin
A 3 mo infant comes into the clinic with perfuse blisters and exfoliation to most of the skin. The baby is obviosly in pain and is crying which get more aggitated upon touch. The mother denies any extreme heat exposure or sun.
coagulase negative staphylococci
less virulent than S. aureus; S. epidermidis , S. saprophyticus, S. lugdunensis and S. schleiferi
A 5-year-old boy fell off his bicycle 2 weeks ago and has stopped walking and complains of nonspecific pain in his leg. His mother reports that he apparently has had the flu, with fever and chills
A 40-year-old man, who suffered an open tibial fracture in a motor vehicle accident 6 months ago, presents with swelling and pain in his lower leg.
A 43-year-old white man presents with erythematous, folliculocentric papules in the beard region. He reports that he has dense terminal hairs in the beard region, which requires him to shave frequently. He noticed that some papules have coalesced to form a plaque. Physical examination reveals multiple erythematous papules around the hair follicles and an indurated plaque with overlying yellow crust
A 25-year-old woman presents with multiple painful, erythematous papules in the groin region of 1 week's duration. She reports that she had shaved in the groin area in preparation for an upcoming trip to the beach. Physical examination reveals multiple tender, erythematous, 3 mm to 5 mm folliculocentric papules and pustules in the groin and upper thighs.
A 28-year-old woman in her second postpartum week presents with recent-onset breast pain and a tender wedge-shaped area in one breast that feels firm, warm, and swollen, and appears erythematous. She has decreased milk output, flu-like symptoms, pyrexia of 100.4°F (38°C), and myalgia, in addition to feeling fatigued.
A 30-year-old woman with a history of mastitis presents with sharp shooting breast pain and an exquisitely tender, swollen, red, and warm fluctuant periareolar breast mass
A 5-year-old boy presents with superficial erosions and crust in the perioral region for three days. He is generally well with no recent history of fever, sore throat, nausea, diarrhea, or changes in appetite or energy level. There is a history of similar eruption in other children at his nursery
A 5-day-old newborn presents with a rapidly enlarging bulla with thin roof and a thin band of erythema around the bulla. The bulla is flaccid and contains clear fluid. Careful examination reveals an adjacent smaller bulla. The baby is well.
A 45-year-old man presents with acute onset of pain and redness of the skin of his lower extremity. Low-grade fever is present and the pretibial area is erythematous, edematous and tender.
A 31-year-old female presents with a 1-week history of fever, chills, fatigue and unilateral ankle pain. Her past medical history includes mitral valve prolapse (MVP) and hypothyroidism. She admits to infrequent IV heroin use and has a 10-pack-year history of smoking. Physical exam reveals temperature of 102°F (39ºC), regular heart rate 110 bpm, BP 110/70 mmHg, and respiration rate of 16 breaths per minute. Her cardiovascular exam reveals a grade 2/4 holosystolic murmur that is loudest at the right upper sternal border. Her right ankle appears red, warm and is very painful to dorsiflexion
A 32-year-old woman presents to the emergency room with complaints of fever, chills, headache, muscle aches, and shortness of breath over the past 48 hours. Two weeks prior to her symptoms, she had an uncomplicated vaginal delivery at term. She has no significant past medical history. No one else at home has been recently sick or traveled outside the country. On physical exam she is toxic, appearing with a temperature of 103.1°F (39.5°C). Her pulse rate is 132 bpm and her BP is 100/60 mmHg with a respiratory rate of 34 breaths/minute. A diffuse erythematous rash is noted on the upper and lower extremities. Breath sounds are diminished at the bases. The rest of the exam is noncontributory.
A 10-year-old female Pacific Islander presents with a 2-day history of fever and sore joints. Further questioning reveals that she had a sore throat 3 weeks ago but did not seek any medical help at this time. Her current illness began with fever and a sore and swollen right knee that was very painful. The following day her knee improved but her left elbow became sore and swollen. While in the waiting room her left knee is now also becoming sore and swollen
pharyngitis (GAS is rapid strep test comes back positive)
A 7-year-old girl presents with abrupt onset of fever, nausea, vomiting, and sore throat. The child denies cough, rhinorrhea, or nasal congestion. On physical exam, oral temperature is 101°F (38.5°C) and there is an exudative pharyngitis, with enlarged anterior cervical lymph nodes.
meningitis (Group B strep)
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.
empyema (GAS, Tx: vancomycin, drain the pleural effusion)
A 65-year-old man re-presents to his physician, following treatment for pneumonia, with fever, increasing breathlessness, and right-sided chest pain. He feels lethargic and has lost 4 kg in weight. He initially presented 3 weeks earlier with a productive cough and breathlessness. At that time, he was diagnosed with community-acquired pneumonia and treated with a course of oral antibiotics. He has a past medical history of poorly controlled type 2 DM. On examination, he is septic, with a temperature of 101.3°F (38.5°C), BP 90/60 mmHg, pulse rate 110 beats/minute, and respiratory rate 28 breaths/minute. He has dullness to percussion and decreased breath sounds at the right lung base. Chest radiograph demonstrates a loculated right pleural effusion. Laboratory examination reveals WBC 20 x 10^9/L. He undergoes ultrasound-guided thoracentesis (pleural aspiration) that shows a septated pleural effusion, and frank pus is aspirated.
CAP (vancomycin, GAS)
A 54-year-old smoker with multiple comorbidities (diabetes, hypertension, coronary artery disease) presents with a 2-day history of a productive cough with yellow sputum, chest tightness, and fever. Physical exam reveals a temperature of 101ºF (38.3ºC), BP of 150/95 mmHg, heart rate of 85 bpm, and a respiratory rate of 20 breaths per minute. His oxygen saturation is 95% at rest, lung sounds are distant, but clear, with crackles at the left base. CXR reveals a left lower lobe infiltrate
domesticated animals (cattle; contact with there milk or the animals can cause inx)
where do Group C strep usually acuse inX
meningitis amd sepsis in neonates, perpartum infections and fever in women
common manifestations of Group B strep
what acts as a superantigen in TSS
what is the gold standard test for pharyngitis
surgical debridement (be sure to culture and gram stain)
what is your first step in treating necrotizing fascitis
streptococcus, clostridia, Staphylococcous aureus
what all can contribute to necrotizing fascitis
cheeck and treat siblings/parents for asymptomatic presentations
If there is one child who persistently gets GAS strep throat what should be done
excess fluid fills up the space (50% of pneumoniae and
The mother of a 4-month-old infant reports that he has had 3 to 4 days of constipation. She states that the baby has had difficulty feeding over the past 24 hours and is unable to suck and swallow. She is also worried that he feels limp in her arms and appears to have a very weak cry.
A 34-year-old man presents with the acute onset of blurry vision, nausea, and vomiting. He notes weakness in his arms and trunk. He recently returned from Alaska. Of note, he recalls eating home-preserved fish while visiting a family friend.
A 72-year-old white male presents with a 5-day history of abdominal pain, nausea, severe diarrhea, fever and malaise. He was started on levofloxacin for community-acquired pneumonia 2 weeks prior with resolution of his pulmonary symptoms. Exam reveals a fever of 101°F (38.3°C) and mild abdominal distension with minimal tenderness. Laboratory tests reveal a peripheral WBC of 12,000/mm^3 and stool guaiac that is mildly positive for occult blood.
A 63-year-old man, recently returned from a trip to Haiti, presents to the emergency room complaining of persistent sore throat and difficulty swallowing. A rapid test for group A streptococcal antigens and a test for heterophile agglutinins are negative, and he receives oral amoxicillin and clavulanate potassium. On the fourth day of illness, the patient returns to the emergency room with chills, sweating, restlessness, difficulty swallowing and breathing, nausea, and vomiting. On examination, he is afebrile and has stridor and a swollen neck. Expiratory wheeze and diminished breath sounds in the left lung base are noted. Arterial pO2 is 88% on room air.
A 20-year-old woman with no significant past medical history presents with lower back pain, and bilateral foot and hand tingling. Her symptoms rapidly progress over 4 days to include lower extremity weakness to the point that she is unable to mobilize her lower extremities. She reports coryzal symptoms 2 weeks ago. On examination, she has 0/5 power in her lower extremity with areflexia, but despite the paresthesias, she does not have sensory deficits. Her aminotransferases are elevated and LP reveals mildly elevated protein with no cells and normal glucose. She weighs 70 kg and her admission vital capacity is 1300 mL, maximum inspiratory pressure is -30 cmH2O, and maximum expiratory pressure is 35 cmH2O.
A middle-aged man from Turkey presents with a painless eschar on his right middle finger. The surrounding area is notably edematous and he describes the initial lesion, starting 2 days ago, as a mildly pruritic vesicle. His symptoms have been accompanied by regional lymphadenopathy, low-grade fevers, and malaise. The patient is otherwise healthy, but frequently handles goat and sheep hides in preparation for sale abroad.
A 60-year-old man with a history of diabetes, hypercholesterolemia and heavy smoking for over 20 years presents giving a 3-week history of increasing pain in his left forefoot, which is affecting his ability to walk and is disrupting his sleep. On examination, his left foot is pale, cold, devoid of hair and his lateral 2 toes are dusky and discolored. No foot pulses are palpable and are only just detectable by Doppler probe.
A 56-year-old man with history of poorly controlled diabetes mellitus and alcoholism presents with severe scrotal pain and fever for 3 days. He denies perianal tenderness. His vital signs are blood pressure 125/60 mmHg, heart rate 120 beats per minute, respiratory rate 25 breaths per minute, and temperature 101.5°F (38.6°C). His scrotum is extremely tender, black, and malodorous. The adjacent perineal and femoral skin is crepitant
spleen help fight off _________bacteria
gram-positive diplocci,a hemolysis
what is the most common bacterial isolate from middle ear fluid in acute otitis media and sinusitis
menigiococcus, pneumococcus and H. influenzae
what should be immunized if you are without a spleen
what is the toxin produced for clostridium tetani
drum shaped, spore forming, anaerobinc gram positive rod that is commonly found in the soil
sustained facial muscle contraction, dyshpagia, neck stiffnes or pain, back muscle contraction, rigidity of abdominal wall and poximal limb muscles
TIG and metronidazole (bezodiazepine to control spasm)
Tx of tetanus
TDAP=adults (tetanus, diptheria and pertusis)
immunization of tetani
symmetric descending paralysis with early cranial nerve involvement
majority of cases follows septic abortion
combination of vancomycin and rifampin
GI, cutaneous, and inhalation
3 groups of anthrax
what is the drug of choice for prophylactic Tx of anthrax spores
PID(pelvic inflammatory disease)
infection spills out into the peritoneal cavity
what is the most common reportable infx diseases in the US
most common site of female gonorrheal infx is __________
staph, strep and GC
A 22year old female came into the office complaining of an inflammed elbow. The elbow is both rubor and calor with few other distinguishing features. She has no hx of arthritis and does not recall any physical injury to the pained area. She has been sexually active for awhile now and does not regullarly practice protected sex. What bacterial consideration would be made in this case?
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
ceftiraxone and azithromyscin
Tx for uncomplicated gonorrhea
if chlamydia is expected along with gonorrhea what should be the tx approach
PCN G or ceftiraxone (rifampin is an option to prevent spread through household)
Tx approach for treating neiserria menigiocoocs
airborn droplites of direct contact with fomites
how does H. influenzae spread
H. influenzae, epiglottitis
A 4-year-old boy presents to the ER with complaints of dysphagia, fever, drooling, and muffled voice. Symptoms have progressively worsened over the course of the day. He is toxic-appearing, and leans forward while sitting on his mother's lap. He is drooling, and speaks with a muffled "hot potato" voice. The parents deny trauma or evidence of foreign body ingestion. They have no recollection of the child receiving a (Hib) vaccine. What bacteria is to blame and the condition is what?
CAP, childhood otitis media, puerperal sepsis
what are some other clinical features common of nontypable H. influenzae
Tx of Hib infx
Tx of nontypable H. influenzae
dexamethasone (prevent hearing loss)
what should be added to Tx regimine in the case of childhood meningitis caused by Hib
what is the most common cause of gastroenteritis in the US
in the US, ingestion of contaminated _________accounts for about 50-60% of cases of C. jejuni
C. jejuni gastroenteritis
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.
fluid and electrolyte replacement (ciprofloxacin benefits <50% of pts indicated with high fever or bloody diarrhea or if it persisits for over a week)
Tx of campylobacteriosis
upper endoscopy (insures no cancer)
what should be done if stomach ulcers are suspected
urea breath test
what can be used to confirm eradication of H. pylori
pepto bismo (bismuth subsalicylate), metrondiazol and tetracycline combo (may also add prilosec)
Tx of H. pylori
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 with flecks of mucous 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.
what is the first thing to do to treat cholera
prolonged fever which presents with a rash "rose spots"
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.
hemolytic uremic syndrome
complications of shigellosis
what is an option to give to help bulk the stool
A 23-year-old woman presents with a 2-week history of bilateral, painful, swollen knees and tender erythematous lesions over her shins. She was previously well but recently had a prolonged bout of diarrhea associated with abdominal pain. The diarrhea lasted for 10 days, and she was having 8 blood-stained watery bowel movements every day. No family or friends were unwell. Her GI symptoms eventually settled without specific treatment. The joint pain started 1 week after the diarrhea settled and is associated with a tender rash on both shins.
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
Tx for pertussis
common infx after cat bite
A 42-year-old male presents with fever, myalgia and headache for 24 hours. He denies any SOB or cough. He has a history of hypertension and diabetes type 2 and works in construction.
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.
treatment for legionnaires' disease
E. coli 0157:H7 (EHEC)
what belongs to the pathotype entohemoragic (bloody diarrhea)
what type of infx should antibiotics not be used because of the increased risk for HUS
what is a common cause of ventilator associated pneumonia
sodium transport problem; mucous secretions, thick GI secretion
commonly causes hot-tub folliculitis
Txof P. aeruginosa
S. pneumoniae, H. influenzae and moraxella catarrhalis (Tx with augmentin)
most common causees of otits media
doripenem, imipenem and meropenem
what is effective against klebsiella