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61 Cards in this Set

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A 27 yo female presents with a hx of fever of 40 C, chills, hematuria and CVA tenderness. She has spina bifida and an indwelling urinary catheter.What is a likely diagnosis? What is a possible organism?
Pyelonephritis probably due to the indwelling catheter. If she has had several of these in the past she is at risk for resistant organisms, reflux kidney damage and chronic pyelonephritis
A gram - organism

This is a complicated UTI. They results due to stones, catheter,renal problems, renal transplant, anatonic disorder, increased post void residual urine.

Types of organism: E. Coli,Klebseilla, Serratia, Proteus, Providencia, Also but less common, Gram + cocci such as group B strep and enterococci
A 24 yo female presents with a c/o dysuria, frequency, urgency and hematuria. No fever, chills or flank pain
What is a likely diagnosis?
Acute Hemorrhagic Cystitis
Treatment of UTI

3 day course of antibiotic such as

TMP- SMX

Quinilone

E. Coli most likely organism
Fever of Unknown Origin

Temperature > 38.3 C ( 101.0 F) for 3 weeks and unable to diagnose even with 1 week in the hospital.

Causes:

Classic

Nosocomial

Neutropenic

HIV associated

Drug induced
Carbuncle:
A network of furuncles connected by sinus tracts
Cellulitis:
Cellulitis: Painful, erythematous infection of deep skin with poorly demarcated borders
Erysipelas:
Fiery red, painful infection of superficial skin with sharply demarcated borders
Folliculitis:
Papular or pustular inflammation of hair follicles
Furuncle:
Painful, firm or fluctuant abscess originating from a hair follicle
most likely organism in dog or cat bite
pasturella multicida
most likely organism in human bite
eikenella corrodens
most likely organism in inpetigo
s. aureus
s. pyogenes
Treatment of of MRSA

Community Acquired

Sulfa, tetracycline, clindamycin

Hospital Acquired

Vancomycin
Erysipelas

also known as St. Anthony's fire

Presents as an intensely erythematous infection with clearly demarcated raised margins, and often with associated lymphatic streaking

Common sites are the legs and face

caused almost exclusively by beta- hemolytic streptococcus
Sepsis

Systemic inflammatory response to infection

Can lead to hypotension and organ failure

Hypotension means systolic BP < 90 or a decrease by 40 mm Hg

Main need vasopressors to maintain perfusion of organs

+ blood cultures are essential for dx of sepsis often associate with elevated WBC and left shift

Broad spectrum antibiotics started until
Osteomyelitis 3 types
3 types

Acute hematogenous spread

Due to contiguous spread as from an ulcer/fracture

Associated with vascular disease (PVD, DM)
Necrotizing Fasciitis

AKA: gas gangrene

Polymicrobial and include both anaerobic and aerobic bacteria esp. Group A Strep

An ID emergency that refers to widespread destruction of deep subcutaneous tissue and fascia – spares muscle and skin

Can lead to multiorgan failure

25% morbidity

X-ray can show gas in soft tissue

Tx aggressive debridement and antibiotic and hemodynamic stabilization
Infectious Endocarditis
Infectious endocarditis

Fever

Pathologic murmur ( holosystolic or diastolic)

Evidence of embolic disease such as splinter hemorrhages in the nail

Petechiae/ecchymosis- conjunctivae,palate, extremities

Roth spots on the fundi
Myocarditis / Pericarditis

Caused by numerous Viruses, bacteria, fungi, parasites, Rickettsia and chlamydia

Myocarditis: damage to the myocardium by direct microbial action or action by toxin

Fever, arthralgias, myalgia and chest pain

Pericarditis infection of the pericardium

Fever, chest pain, weight loss,night sweats and cough
A 24 yo podiatry student has a 3 days hx of a hacking cough productive of white mucus. He also has malaise, fever, body aches. On exam the patient has a fever of 102.2F and you hear scattered rales in the left lung base.

What is a likely diagnosis?
Mycoplasm Pneumonia

Classic symptoms with occasional rash, serous otitis media and joint aches.

Common in young people in colleges and universities

Treatment with Macrolides and Quinilones
Question

A 55 yo female develops a productive cough of rust colored sputum, congestion, fever and chills. She also has pleuritic chest pain. On exam she is tachypneic at a rate of 40 / minute. CXR infiltration in the RLL.

What is the diagnosis?
Pneumonia

Strep Pneumoniae

Community Acquired

The elderly or debilitated patient willl have an atypical presentation
Tinea Versicolor

caused by the yeast- Malassezia furfur

Generally oval or irregularly-shaped spots of 1/4 to 1 inch in diameter

Dark tan or pink in color – may be hypopigmented

Treatment with antifungal medication – Selsun blue for the hair is also helpful in conjunction
Herpes Simplex I

Oral lesion

Transmission by direct contact

Antiviral agents control outbreaks and decrease shedding
Herpes Zoster

Infection along the dermatome

Associated with previous chicken pox

Vaccine now available – 60% protection
Lyme Disease
Lyme Disease

Multisystem infection cause by spirochete: Borrelia burgdorferi

Spread by the deer tick ( ixodes)

Early localized – erythema chronicum migrans with myalgias for 3 to 32 days

Early treatment: Doxycycline or Amoxicillin

Early diagnosis may be
oxoplasmosis

caused by the protozoa Toxoplasma gondii,

one of the most common zoonoses. T

the parasite undergoes sexual reproduction in cats and is excreted as an unsporulated oocyst. After two to three days, the oocysts develop spores that are infective.

Risk factors:direct contact with cat feces (e.g., cleaning the litter box, gardening in feces-contaminated soil), and consumption of undercooked meat.

asymptomatic, but patients may develop cervical lymphadenopathy and a mononucleosis-like illness that is generally self-limited. Rarely, acute infection in pregnant women, especially during the first trimester,

can cause serious congenital infection. I

it can also cause severe disease in immunocompromised persons.
Campylobacteriosis and Salmonellosis

Most common bacterial infections associated

Many animals, including cats and dogs

Salmonella is also common in cats, dogs, chicks, ducklings, and reptiles, such as turtles and iguanas. Pet rodents also

cause more than 200,000 cases of gastroenteritis per year..
Cat-Scratch Disease

.Exposure to young cats or cats with fleas is a risk factor for infection

Bartonella henselae

The clinical manifestations of infection are an inoculation lesion at the point of injury and inflammation of nearby lymph nodes several weeks later
Psittacosis

also known as parrot fever

caused by Chlamydophila (formerly Chlamydia) psittaci

most resulted from exposure to infected pet birds, usually cockatiels, parakeets, parrots, and macaws.

Exposure to feces or nasal secretions of infected birds can result in human infection

it can progress to a significant pneumonia that usually responds to doxycycline (Vibramycin) or macrolides
Meningitis

Inflammation of the meninges

Triad of symtoms:Fever, Nuchal Rigidity and Mental Status Changes but occurs in < 50%

Occasionally with a purpuric rash

A medical emergency – associated with bacteremia

Lumbar puncture should be performed.

May be caused by many agests- most common S. pnmeumoniae, Neisseria meningitis, H. influenza – all with polysaccharide capsule which protects against complement mediated cell lysis

Treatment with antibiotics and dexamethasone to decrease IC pressure
Sinusitis

Acute sinusitis is defined pathologically by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than four weeks.

Associated with sinus tenderness and congestion often >7 to 10 days

Viral or bacterial - 50 percent of people with a clinical diagnosis of acute sinusitis have bacterial sinus infection

Treatment is supportive with nasal decongestant. Nasal steroids are beneficial. Antibiotics are used sparingly in severe conditions
Pharyngitis/tonsillitis

Inflammation of the pharynx or tonsils

Approximately 30 to 65 percent of pharyngitis cases are idiopathic, and 30 to 60 percent have a viral etiology (rhinovirus, adenovirus and many others).

Bacteria are responsible for approximately 5 to 10 percent of pharyngitis cases, with group A beta- hemolytic streptococci being the most common bacterial etiology

Other bacteria that occasionally cause pharyngitis include groups C and G streptococci, Neisseria gonorrhoeae, Mycoplasma pneumoniae, Chlamydia pneumoniae and Arcanobacterium haemolyticus
Strep Pharyngitis
spread by direct person-to-person contact, through droplets of saliva or nasal secretions

a temperature higher than 38.5°C (101.3°F)

specificity of throat culture :99 %, 76 to 99% percent in office settings

Rapid strep:specificity >95 %,sensitivity of only 76 to 87 %

penicillin -the drug of choice for the treatment

persist for up to 15 days on unrinsed toothbrushes and removable orthodontic appliances
Complications of Group A Beta-Hemolytic Streptococcal Pharyngitis

Nonsuppurative complications:

Rheumatic fever

Poststreptococcal glomerulonephritis

Suppurative complications

Cervical Lymphadenitis

Peritonsillar or retropharyngeal abscess

sinusitis

Mastoiditis

Otitis media

Meningitis

Bacteremia

Endocarditis

Pneumonia
Otitis Media

Fluid in the middle ear associated with infection

Most commonly in young children – peak 6 to 36 months.

Common bacteria:

Strep pneumoniae

H. Influenza

M. catarrhalis

Tx: antibiotics on occasion myringotomy tubes are indicated. Antibiotic use is controversial

When amoxicillin is used, the dose should be 80–90 mg/kg/day
Pathophysiology

Usually following viral URI

Secrtions and inflammation -occlusion of the eustachian tubes.

negative pressure is generated and causes a serous effusion.

Effusion causes bacterial growth

Can cause perforation of the tympanic membrane or extension into the adjacent mastoid air cells
Otitis Externa

Inflammation or infection of the external auditory canal

50 % percent of bacterial cases involve Pseudomonas aeruginosa, followed in incidence by Staphylococcus aureus and then various aerobic and anaerobic bacteria

Types:

Diffuse Otitis External – swimmer’s ear

Necrotizing Otitis Externa

Can spread to the bone

Tx: neosporin otic or quinolone otic but necrotizing OE requires PO antibiotic such as quinolone
Infectious Mononucleosis

Caused by the Epstein Barr virus

Infection in adolescents associated with fever, pharyngitis and lymphadenopathy. Also with hepatomegally and spleenomegally

highest rates in persons 10 to 19 years of age

Clinical symptoms occur in 50% of cases

90 to 97% of adults seroconverted at an earlier stage in life
Pneumonias
Symptoms: fever, cough, dyspnea, chest discomfort
Pneumonias Tx
Tx with oral antibiotics, rest and fluid

May require oxygen

Can cause pulmonary abscess or empyemia
Gastroenteritis

Inflammation of the GI tract

Refers to an enteric infection associated with vomiting with or without diarrhea

May be viral or food poisoning

Norwalk virus – 40% of cases
Treatment of Diarrhea

Fluid and electrolyte Replacement

Antimotility agents

Loperamide- imodium

Not with high fever or bloody stool- may delay clearance of bacteria

Antibiotics generally not given
C. Diff

Pseudomembranous Colitis

Often associate with antibiotic use

Classic symptoms – fever, leukocytosis, crampy abdominal pain, watery diarrhea

ELISA and latex agglutination tests are most commonly used to detect toxin

Fecal leukocytes

Tx with Metronidazole or vancomycin

Easily spreads through the hospital – hand washing imperative
Giardia lamblia

Most frequently isolated intestional parasite in the US

Transmission through contaminated water and person to person

Testing: Giardia antigen stool assay or microscopic evaluation

Tx: Metronidazole
Syphillis

T. pallidum – a spirochete

Decline in cases since 1991

Incubation period 10 to 90 days

Primary causes chancres and adenopathy

Secondary – disseminated throughout the body and associated with a rash

Latent- silent

Latent or Tertiary- 30% of patients neuro symptoms i.e dementia posterior column disease

TX: Penicillin DOC
Chlamydia

C.trachomatis

PID in women and urethritis in men

Men may have a clear discharge with dysuria while women may have no symptoms at all

May lead to infertility

Treatment with azithromycin or doxycycline
Gonorrhea

Gram negative diplococcus

Causes greenish discharge in men and PI D. women may be asymptomatic in women.

Can also cause exudative pharyngitis

Treat with Ceftriaxone 250 mg Im but also treat for chlamydia and treat partner.
Herpes Simplex 2

Causes Genital viral infection 70 to 95% of the time

Resembles Herpes 1

Associated with skin to skin contact

20% of young adults infected

Recurrent infections usually with a prodrome of fever, itch, tingling

Regional lymphadenopathy

Tx with antiviral medication
Prostatitis

90% of men with symptoms of prostatitis have nonbacterial conditions

When bacteria are present

Febrile

Pyuria and bacteruria

Dysuria

Swollen prostate – EXTREAMLY tender

Treatment with antibiotics: Bactrim

May be difficult to eradicate causing chronic prostatitis
Cystitis

Bladder infection

dysuria, frequency, urgency

Bacteria, RBC and WBC found after clean catch urine. Occasionally nitrites also found.

E.coli most common organism

Others: Klebseilla, Proteus mirabilis, enterobacter

Tx with antibiotics
Pyelonephritis

Bacterial infection of the kidney and renal pelvis

Associated with fever, flank pain and pyuria

Risk: female, sexual intercourse, Hx of UTI, Diaphram contraceptive,postmenopausal state, catheters, pregnancy

80% E. Coli also Klebsiella and Proteus

Tx with antibiotics
Parasites of the Alimentary Tract

Types

Nematoda or Roundworms: Ascaris, Pin Worms, Whipworm

Platyhelminths or Flatworms :

Tapeworms

Blood Flukes: Schistosoma types

Intestinal Flukes

Liver Flukes

Most people asymptomatic or non specific complaints
Leishmaniasis

Leishmania donovani Kala- azar

a systemic illness

Spread by the bite of the sandfly – Phlebotomus

Leads to glomerulonephritis

Fever, chills, weight loss and organomegally

Other types of Leishmania cause cutaneous and mucocutaneous problems
Malaria

Flu like illness caused by 4 species of the protozoan genus Plasmodium

P. falciparum

P. vivax

P. ovale

P. malaria

Spread by the anopheles mosquito

Prevention

Mosquito avoidance

DEET in concentrations of 15 to 35 %

Medication
West Nile Virus

Spread by the bite of the mosquito – they bite and infect birds and so other mosquitos become infected when they bite the birds

female Culex pipiens mosquitoes and it can be transmitted from mother to child

Virus- belong to the genus Flavivirus within the family Flaviviridae.

Infection may be asymptomatic or lead to meningits / encephalitis

Best prevention- mosquito control
Rabies

Most deadly disease transmitted from animal to humans

Rhabdoviridae family

Fatal

Pre exposure vaccine for animal handlers such as vets and spelunkers

Unprovoked attacks suggest rabies.

Treatment with Rabies immunglobulin
A 32 yo female presents with c/o fever, headache, malaise, fever and lymphadenopathy. She admits to having unprotected sex with a bisexual male
Acute Retroviral syndrome and the symptoms above are most common. May also have rash, nausea and vomiting. Up to 50% of patients have a sever headache and signs similar to meningitis. The best test to do is an HIV RNA test because the HIV EIA and western blot may be negative.
Prevention of Perinatal Transmission of HIV
Treatment

Oral Zidovudine initiated at 14 to 34 weeks of gestation to end of pregnancy

IV Zidovudine during labor and delivery

Oral for first 6 weeks of newborn’s life
PCP Pneumonia

Pneumocystis pneumonia

DOE, non productive cough, weight loss and fever, LAB: low LDH

Treatment:

Bactrim, dapsone, Pentamidine, Atovaquone

Steroids if hypoxic

40% have a second episodes within 18 months

Prophylaxis: CD4 < 200 or episodes or oral candida, or episode of PCP
Toxoplasma gondii

Can cause single or multiple lesions in the brain

A protozoan pathogen

Most common cause of brain lesions

CD4 is usually < 100

Treatment: pyrimethamine, sulfadiazine,folinic acid

Single lesion may be lymphoma so a biopsy is indicated. This has a poor prognosis
It is January and a 73 yo males presents with sudden onset of headache,fever, chills, and body aches. He also has sore throat, cough, congestion and malaise. On exam he is ill with a fever, tachpnea and tachycardia. He has scattered rhonchi in the lungs. He has no hx of any vaccines in recent years.

What is a likely diagnosis?
This appears to be influenza A

Headache is a common symptom