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96 Cards in this Set
- Front
- Back
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What disease is associated with conjuntivitis and acute URI?
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Adenovirus
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What is name of the MOST common virus for common cold?
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Rhinovirus
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What cause of pneumonia or pharyngitis is a obligate intercelluar parasite?
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Chlamydia
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What causes atypical pneumonia, bronchitis, bullous myringitis and pharyngitis?
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Mycoplasma pneumoniae
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What is waldeyers ring?
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palatine tonsils, adenoids and longual tonsis. Common site for lymphoma
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What causes ginigivits, stomatitis, and pharyngitis?
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herpes symplex
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What diseases commonly cause splenomegaly, rash, diffuse lymphadenopath and possible hepatomegaly?
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EBV and Cytomegalovirus
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RSV causes....
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Bronchiolitis
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Varicella causes...
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Chicken pox
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Measles and rubella cause
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Pharingitis and RASH
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Coxsackie A causes
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herpangina (back of throat)
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What are causes of trenchmouth (sore throat, ulcers and foul breath?)
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Spirochetes and Fusobacterium
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What are noninfectios causes of sore throat?
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Trauma, dryness, allergies, GERD. lukemia and lymphoma
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What is the centor criteria for group a strep?
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Fever greater than 100.4F
Tender Anterior Cervical Lymph Nodes LACK of cough Pharyngeal exudate |
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What is the PPV for the centur criteria gor GABHS?
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60%
Negative predictive values is 80% |
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What do hoarsness and cough help EXCLUDE?
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GABHS
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What does long hx of sore through suggest?
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abcess
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What sx are associated with viral pharyngitis/tonsilitus?
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rhinorrhea, croupy cough, laryngitis
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how do viral sor thrroughts often start (feeling)
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"scratchy"
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What criteria are strep until proven otherwise in children?>
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HA, N/V and abdominal pain with a sore throat
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How does influenza present
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headache
myalgias and fever over 104 with a dry cough |
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True or False, strep is known to be recurrent
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True
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If a pt has a hx of rhumatic fever, what will you do after treating their strep
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reculture to make sure it is gone
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True or False, Gonorrhea pharyngitis is asymptomatic
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true
and you will need a specific, seperate swab to test |
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True or False. Even 1 does of a meidcation can give a false negative with strep
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True
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What disease that has a vaccine available (if not given) can produce pharyngitis?
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diptheria
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Stridor, drooling and respirator difficulties in a patient 2-7 years old that is accompanied by fever suggest what?
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Eppiglittitis. DO NOT LOOK IN THROAT
This is a pediatric emergency, call an anesthesiologist |
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Muffled HOT potato voice is seen with...
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peritonsillar abcess and lingual tonsilitis
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Lingual tonsillitis may also have pain where?
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hyoid bone
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peritonisllar abcess may have pain that is worsened by what?
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rotating the head to the involved side
May also have deviated uvula |
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Mono typically involves what nodes?
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Posterior cervical but can also include inguinal and axillary
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Exudate on pharynx and tonsils are commonly seen in what diseases?
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strep
mono GC (gonococcus aka gonorrhea) |
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A gray adherent pseudomembranous tonsilar covering suggests...
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diptheria
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Petechia on palate, white coat on tongue, followed in 2 days by strawberry red tong with sandpaper skin suggests
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Scarlet fever
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What is the gold standard for strep dx?
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Throat culture
High speciaficity and low fals positive rate, but negatives need to be cultured in children or adolescents |
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What is the most common cause of epiglottitis
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Haemophilus influenzae
HiB shot takes care of this |
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What is the contact/spread method for strep and what is the incubation period? How long is the course of the disease
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Droplets, 1-4 days incubation
3-5 day course |
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Is strep common under the age of 3 years?
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No it is rare
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Of the following complications of strep, which CANNOT be prevented by antibiotics:
A) Rheumatic Fever B) Poststrep Glomular Nephritis C) Supprative Conditions (-"itis and 2ndary infections) |
Post strep glomular nephritis is not preventable with antibiotics :( it can present 1-3 weeks post infection
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Describe progression of scarlet fever rash...
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Develops secondary to erythrogenc toxins from strep.
Day 1-2: rash starts on trunk and spreads to extremitis, NOT on feet and hands Days 2-5 Rash fades Feet and hands peel anytime between then to weeks later |
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How do you use centor criteria to determine testing or treatment?
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<2 prob don't need testing or treatment
>2 do rapid strep and follow up culture in kiddos/adolescents if negative Rhumatic fever can be prevented even if treatment is postponed for up to 9 days after onset |
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What age factors contribute to centor criteria?
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Added/decreased risk of strep for age
3-14 +1 15-44 0 >45 -1 |
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When can PT go back to school if the have streo?
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24hrs after antibiotic begun
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Recommended drug/duration for strep tx?
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3-6 days Azithromycin
10 days Penicillin (Tx of choice) Can give ammox to little ones because it tastes better Also there is little resistance to PCN or Cephalosporins to GABHS |
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Why are sulfas and tetracycleins not recommended for GABHS?
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They don't prevent Rhumatic Fever
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What patient education should be done with strep patients?
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Tell them to take all of their meds even if they feel better
Saltwater gargels, tylenol and hard candy can help with Sx. no ASA |
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Should you do follow up testing for strep?
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If non RF patient, it is not necessay if there is clinical resolution of symptopms
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What are the tonsilectomy indications?
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3 episodes in 3 years
5 episodes in 2 years or 7+ in 1 year |
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What is the causitive agent in MONO
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Epstein barr
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What is the transmission of MONO and incubation period?
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saliva
4-8 weeks |
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What are the sx of mono?
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Fever
Malaise/fatigue Sore throat/dyspepsia Lymphadenopathy Splenomegaly hepatitis acute lymphocytosis with atypical cells + Monospot |
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How may patients with mono will also have strep?
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1/3
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What are the lab findings for MONO?
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elevated ALT and AST (liver)
Toatl WBC between 12,000-18,000 and usuall >50% are atypical |
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When can patients with mono resume sporting activities?
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3 weeks for noncontact
4 weeks for contact concern with splenic rupture |
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Left Shift in leukocytes indicates what infection type?
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bacterial
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What drug causes a rash when given to a patient with mono?
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Ampicillin or amoxicillin
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What nerves provide sensory input to the pharynx?
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9th and 10th
they also innervate larynx, middle ear and auditory canals and can have referred pain |
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Big picture signs and sx of VIRAL pharyngitis/tonsillitis...
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no fever
conjunctivitis, coryza, cough or diarrhea perceived "scratchy" sensation ulcerations or vesicles like from herpes, coxsackie, or varicela hepatosplenomegaly or diffuse lymphadenopathe as in momo and EBV/CMV Lukopenia and atypical lymphs as in mono |
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Big picture signs and sx of Bacterial pharyngitis/tonsillitis...
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Fever>100
Tender Ant. Cervical L. Nodes NO cough, conjunctivits, or coryza Pharyngotonsiallar exudates Odynophagia (painful swallowing) Scarlitiniform rash leukocytosis with left shift |
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Define Dysuria
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Dysuria—Painful or difficult urination. May be caused by vaginitis, cystitis, prostatitis,
appendicitis, urethritis, medications, etc. |
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Define Bacturia
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pesence of bacteria in the urine
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Define Pyuria
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The presence of white blood cells in the urine. Consistant with infection
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Define Relapse
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Recurrence of bacteriuria with the original isolate within 2 weeks after termination of
therapy |
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Define reinfection
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Recurrence of bacteriuria with a new organism.
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Define Complicated UTI
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A UTI that involves symptoms of upper tract infection, such as fever,
nausea & flank pain, OR one that is associated with an underlying condition that may increase the risk of treatment failure (anyone that is NOT young nonpregnant healthy woman is complicated) |
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Define UTI
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Urinary Tract Infection—Implies infection anywhere in the urinary tract, ie bladder,
prostate, kidney. |
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Define cystitis
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Clinical syndrome caused by infection of the bladder epithelium
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Define Pyelonephritis
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Can be acute or chronic:
Acute pyelonephritis —Clinical syndrome caused by infection of the renal parenchyma. Chronic pyelonephritis—Inflammation and scarring of the kidney parenchyma caused by persistent or repeated infection. It occurs most commonly in children with severe vesicoureteral reflux and UTIs. |
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What are the bodies natural defenses against UTI?
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A normal micturition frequency and complete bladder emptying
Anatomically: mucopolysaccharide lining of the bladder which is antibacterial and antiadherent, angled ureterocystic junction that helps prevent urinary reflux, and urethral length |
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What does the location/character of the discomfort tell you about a UTI??
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Flank pain=pyelonephritis
External irritation from urine passing over inflamed introital tissue +/- itching=vaginitis Burning in urethra on urination=cystitis or urethritis Flank pain colicky & radiating to groin=stone |
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What does the Duration of symptoms of a UTI tell you?
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Symptoms lasting longer than seven days suggest pyelonephritis, non-bacterial urethritis, or
vaginitis. |
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What are the Associated symptoms of a UTI?
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Systemic toxicity (high fever, vomiting) increases suspicion of pyelonephritis. The presence
of a vaginal discharge suggests the possibility of vaginitis or pelvic inflammatory disease. Penile discharge suggests a urethritis from STD’s. |
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Why is it important to ask a patient with a suspected UTI if they have had any antibiotics/illnesses lately?
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Partially treated UTI may be difficult to diagnose in the event the patient has tried home
therapy with “antibiotics left over.” Any recent antibiotics might mean the organism is resistant. |
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Why is it important to ask UTI patients if there been similar symptoms in the past?
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Women may report a history of frequent UTI. Discovering the last episode may establish
whether relapse or reinfection has occurred. |
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What 2 chronic disease contribute to UTIs and what should you be concerned with?
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Diabetes and Sickle Cell
Diabetics with bacteriuria have a higher incidence of pyelonephritis and are more likely to have complications of renal invasion of infection, such as perinephric abscesses and renal papillary necrosis. Patients with sickle cell disease and those with a history of over-use of non-steroidal anti-inflammatory agents are predisposed to papillary necrosis and ureteral obstruction subsequent to the tissue sloughing. |
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What vitals wold you expect with a UTI?
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Tachycardia, hypotension, or altered mental status suggests sepsis or volume depletion.
Fever is more often associated with pyelonephritis. |
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Costovertebral angle (CVA) tenderness is often seen in what disorder?
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pyelonephritis.
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What are the key features to the abdominal exam for a UTI?
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Palpate Kidneys (should be negative finding) if enlarged indicates polycystic kidney or severe
hydronephrosis. Normally bladder nonpercussable unless >150 ml urine present |
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What are you looking for in male genital exam for UTI?
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Examination of the male genitalia focuses on the prostate, testes, epididymis, and urethral
meatus. Tenderness, edema, erythema, or discharge maybe noted. |
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Should you do a pelvic with a female with suspected UTI?
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Not generally, however In females, a pelvic examination should be considered if there is a history of vaginal discharge
or odor, pain with intercourse, itching, or discomfort externally on urination. Significant pelvic or abdominal pain would also warrant a pelvic exam. Urethritis secondary to a venereal pathogen (N. gonorrhea, Chlamydia trachomatis) may coexist with pelvic inflammatory disease. |
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What prototype patient would you expect to have a cystocele or urethrocele?
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Older females with a history of
incontinence and multiple pregnancies |
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What is the presentation of Acute Cystits?
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dysuria, urgency, frequency, suprapubic pain, & sometimes gross
hematuria |
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When is acute cysticis common and often asymptomatic?
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Pregnancy
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how does Acute pyelonephritis present?
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temperature >101, chills, and flank pain in
addition to the dysuria, frequency & urgency Often; N/V, malaise, and myalgia |
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When is Pyelonephritis is a serious infection?
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In elderly- can cause sepsis
and kiddos <3- can cause early renal failure |
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How does Nephrolithiasis or ureterolithiasis (stones) present?
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dysuria & hematuria,
but their flank pain is colicy and extreme. It radiates to the groin if stone is in the ureter. |
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How would the UA look with and Upper UTI (Acute pyelonephritis)?
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UA: PYURIA AND BACTERIURIA
AND WHITE CELL CASTS WHITE CELL CASTS WHITE CELL CASTS WHITE CELL CASTS KEY! *CVA tenderness |
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How would a UA look in CYSTITIS
(LOWER UTI)? |
PYURIA AND BACTERIURIA
*suprapubic pain |
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What would the UA show in a patient with URETHRITIS - CHLAMYDIA?
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UA: PYURIA WITHOUT
BACTERIURIA, *Ask about new sexual partners |
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How would you diagnoses URETHRITIS - GONOCOCCAL
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UA: PYURIA WITHOUT, BACTERIURIA
GRAM STAIN: GRAM NEGATIVE INTRACELLULAR DIPLOCOCCI *CERVICAL OR PENILE DISCHARGE would tip you off! |
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What lab values would you see with PROSTATITIS?
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UA: PYURIA AND BACTERIURIA
CBC: LEUKOCYTOSIS & L SHIFT |
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What would you expect to fine on physical exam with PROSTATITIS?
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EXQUISITELY TENDER
PROSTATE; perineal or suprapubic pain |
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How does EPIDIDYMITIS present? What should you consider testing for?
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ENLARGEMENT OF THE
EPIDIDYMIS; GC/Claymid. |
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How do stones present?
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FLANK PAIN THAT MAY
RADIATE TO THE GROIN & IS SEVERE & COLICKY; HEMATURIA; DYSURIA; GRAVEL MAY BE SEEN IN THE URINE |
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What would you expect from the UA in a person with stones?
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UA: HEMATURIA WITHOUT
BACTERIURIA UNLESS ALSO INFECTED |
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Can you treat a woman over the phone for a UTI?
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Yes
dysuria and frequency without vaginal discharge or irritation raises the probability of UTI to >90% |
