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59 Cards in this Set

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one of the most common problems resulting from meningitis is ___________. anyone who has had meningitis should take a _________.
hearing loss

hearing test
complications of meningitis

__________
1. babyish behavior
2. forgetting recently learned skills
3. reverting to bed-wetting

___________
1.lethargy
2.recurring headaches
3.difficulty concentrating
4.short term memory loss
5.clumsiness
6.balance problems
7.depression
young children

older people
organism - peak age incidence - gram stain

_______ - neonates - G- rods
_______ - infants & children - G- coccobacili
_______ - adolescents - G- diplococci
_______ - older adults/children - G+ cocci in chains
E. coli
H. flu
Neiseria meningitis
Strep pneumo
CSF Examination

low Glu = _______

N Glu = _______
bacterial or TB

viral
Meningitis is diagnosed by a __________, in which a small amount of fluid is collected from the spinal column

_________ meningitis is less common, but more serious

viral meningitis usually requires no treatment beyond __________

Most patients make a full recovery from meningitis. A small number of infected people end up with __________ loss or brain damage
lumbar puncture

bacterial

painkillers

hearing or vision
Otitis Media - Classification
________ OM - rapid onset of signs & sx, < 3 wk course
________ OM - 3 wks to 3 mos
________ OM - 3 mos or longer
Acute

Subacute

Chronic
Otitis Media

___________ - 30-35%
H. influenzae - 20-25%
M. catarrhalis - 10-15%
Group A strep - 2-4%
Infants with higher incidence of gram negative bacilli (________, ________)
S. pneumoniae

H. flu, E. coli
Antibiotics
First line
_______ - 60-90 mg/kg divided tid
______ - B lactam stable
_______ - B lactam stable
Bactrim, Pediazole
*Amoxil*

Ceftin

Augmentin
Obstruction of sinus ostia
Viral
Atopic
Developmental
Traumatic
Toxic (e.g., smoke)
Overgrowth of microbes
Pathogens
Endogenous flora
Pathogenesis of Sinusitis
Sinusitis Pathogens (3)

Medical Treatment (4)

Surgical Tx - rarely needed
trephination
sinusotomy
sinusectomy
strep pneumo, H. flu, M. catarrhalis

observation, sx treatment, decongestants, Abs
Most common ulcerative lesion of oral cavity
Recurrent, painful ulcers
Confined to soft mucosa
Subdivided into three types:
Minor aphthae
Major aphthae
Herpetiform aphthae
Recurrent Aphthous Stomatitis(RAS)
Herpesvirus Infection: Primary Infection
Herpetic ______________
_______ patients
Often ____________
May be associated with _______, ________, ________
Vesicles-ulcers-crusting
Anywhere in the oral cavity
gingivostomatitis

Younger

asymptomatic

fever, chills, malaise
Pharyngitis
May be of bacterial or viral origin
Most common cause is ______; most common agent is _________
Self-limiting; usually lasts 3-4 days
_________ is the primary bacterial pathogen, in 1/3 cases - early detection reduces incidence of acute rheumatic fever and post streptococcal pharyngitis
viral

rhinovirus

GABHS
Pharyngitis S/S:
Inflammation of the pharynx and lymphoid tissue results in fever, sore throat, malaise, and rhinorrhea
There is usually a lack of ______

Classic triad of findings for Group A strep pharyngitis include:
__________
__________
__________(in absence of significant cough)
cough

High fever
Tonsillar exudates
Anterior cervical adenopathy
Pharyngitis TX:
__________ treatment – includes salt-water gargles, acetaminophen, cool-mist humidification, and throat lozenges
Antibiotics treatment is necessary to treat proven strep infections
_____________ million units as a single dose, is optimal therapy
For pen – allergic pts, ____________ x 10 days or __________ x 3 days
Symptomatic

Benzathine penicillin G 1.2

erythromycin 500mg po QID

Azithromycin 500mg po qd
Haemophylus influenzae type B
Reddened, markedly edematous supraglottic structures
Edema with marked infiltrate of neutrophyls with or without microabscess formation
Acute Epiglottitis
Ludwig's Angina:
1. ________, not abscess
2. Limited to ___ space
3. Foul serosanguinous fluid, no frank purulence
4. Fascia, muscle, connective tissue involvement, sparing glands
5. _______ spread rather than lymphatic spread

Tender, firm anterior neck edema without fluctuance
“________” voice, drooling
Tachypnea, dyspnea, stridor
Cellulitis

SM

Direct

Hot potato
Polymicrobial Infective Endocarditis
__________ is the predominant risk factor
younger age (mean 36.5 years)
2/3 were _____
______-sided cardiac involvement in > 60%
___________ more frequent than S. aureus
1/3 of patients died
mortality rate is 4x higher for pure _____-sides vs pure right-sided endocarditis
IV drug use

male

right

streptococci

left
prosthetic cardiac valve
prior episodes of endocarditis
complex congenital cardiac defect
surgically constructed systemic-pulmonary shunts or conduits
High risk for endocarditis
Standard general prophylaxis - __________
Unable to take oral meds - ___________
Allergic to penicilin - clindamycin, cephalexin, azithromycin, clarithromycin
Allergic to penicillin and unable to take oral medications - _________, cefazolin
amoxicillin

ampicillin

clindamycin
Most cases of acute myocarditis are clinically silent
60% of pts had antecedent ________ symptoms
Large number identified by heart failure symptoms
35% of pts with myocarditis and HF have _________
May mimic an acute MI with ventricular dysfunction, ischemic chest pain, ECG evidence of injury or ______
flulike

chest pain

Q waves
Treatment
majority of patients have a self-limited disease
management of ____ dysfunction similar to other forms of CHF
_______ may intensify inflammatory response
consider __________ to prevent thromboemboli
consider ____________ for complete AV block
LV

exercise

anticoagulation

temporary pacer
Cellulitis

___________ - typically follows an innocuous or unrecognized injury; inflammation is diffuse, spreading along tissue planes

____________ - usually associated with wound or penetrating trauma; localized abscess become surrounded by cellulitis
group A streptococci

staphylococcus aureus
Admission Criteria for Cellulitis:
_________ on patient’s face or hand
Area of skin involvement _____ of limb or torso, or _____ of body surface
Coexisting morbidity (diabetes, heart failure, renal failure, generalized edema)
Edge of cellulitis advancing at rate exceeding _______ per hour
History of saphenous venectomy, pelvic surgery, pelvic irradiation, or neoplastic pelvic lymph nodes (with lower extremity cellulitis)
Immunosuppression
Intolerance of oral or IM antibiotic therapy
Lack of response after 72 hours of oral therapy
Noncompliance with medication and follow-up visits
Purpuric or petechial rash, numbness at skin surface, or impaired tendon or nerve function
shock or disseminated intravascular coagulation
Signs and symptoms suggestive of bacteremia
Total WBC < 1000 / uL
Animal bite

>50%

>10%

5cm or 2 in
Necrotizing Fasciitis management
Immediate ___________ is critical and life saving
empiric antibiotics to cover anaerobes, gram negative bacilli, streptococci, and Staph aureus:
______+______+______+______
________+________
monotherapy with ________
antibiotics for a minimum of ______
surgical debridement

pen+metronidazole+clindamycin+ceftriaxone

vancomycin+chloramphenicol

imipenem

3 wks
Myonecrosis (Gas Gangrene)
a pure ______________ infection
gas in a gangrenous muscle group
incubation period of hours to days
local edema and pain accompanied by fever and tachycardia
discharge is serosanguinous, dirty, and foul
_________ (3-4 million U q4h) or ____________
surgical removal of infected muscle
Clostridium perfringens

pen G

chloramphenicol
Pneumonia

common incubation periods are: RSV ____ days; influenza ____ hours

most types of _________ pneumonia can be cured within 1 to 2 weeks. _______ pneumonia may last longer. _________ pneumonia may take 4 to 6 weeks to resolve completely
4-6

18-72

bacterial

Viral

Mycoplasmal
S/S pneumonia

________ – shaking chills, high fever, sweating, chest pain, cough
________ – dry cough, headache, fever, muscle pain, fatigue
________ – mild symptoms similar to bacteria/viruses
________ – mild symptoms most common in school-age children
_______ – few, if any symptoms
___________ – cough that doesn’t go away, fever and trouble breathing
Bacteria

Viruses

Mycoplasma

Chlamydia

Fungi

Pneumocystis carinii
age 65 or older.
Very young children
have certain diseases
smoke, or abuse alcohol or drugs
exposure to certain chemicals or pollutants
live in certain parts of the country
Pneumonia Risks
Viral or Bacterial?

Onset: usually gradual
Myalgia: often prominent
Cough: nonproductive, often hoarse
Pleurisy: rare

Onset: sudden
Myalgia: not prominent
Cough: productive
Pleurisy: frequent
Viral

Bacterial
Bronchopneumonia
Extremes of _____
Staph, Strep, Pneumo & H. influenza
_______ consolidation – not limited to lobes.
Suppurative inflammation
Usually ________
_______ lobes common
age

Patchy

bilateral

Lower
Which type of pneumonia?

Extremes of age.
Secondary.
Both genders.
Staph, Strep, H.infl.
Patchy consolidation
Around Small airway
Not limited by anatomic boundaries.
Usually bilateral*
bronchopneumonia
Which type of pneumonia?

Middle age – 20-50
Primary in a healthy
males common.
95% pneumoc (Klebs.)
Entire lobe consolidation
Diffuse
Limited by anatomic boundaries.
Usually unilateral*
lobar pneumonia
Which type of pneumonia?

In healthy adults
Gram positive.
*Streptococcus pneumoniae (90%)
Strep. Pyogenes, Staph, H. influenzae and Klebsiella in elderly or with COPD
Community acquired pneumonia
Which type of pneumonia?

In *sick patients.
gram-negative bacilli
*Pseudomonas aeruginosa, Escherichia coli, Enterobacter, Proteus, and Klebsiella
Nosocomial pneumonia
__________: Infection of hair follicles
usually _________ folliculitis
Clinical presentation
follicle-centred pustules
e.g. in scalp, groin, beard & moustache (sycosis barbae)
Mostly (95%) due to ___________
Treatment: oral ____________
Folliculitis

pustular

Staphylococcus aureus

flucloxacillin
Other pyogenic skin infections

__________ - form of deep folliculitis.
_________ - multiple abscesses in close apposition with interconnecting sinuses.
__________ - Skin infection arising from nail

Treatment: Oral ____________
Furunculosis

Carbuncle

Acute paronychia

flucloxacillin
_________: Superficial infection
usually __________ but can also involve Streptococcus pyogenes
Friable, golden crusts over erythematous skin.
Treatment: Topical _______ or _______ 7-10d
Oral ___________ or ___________ if widespread or unresponsive
Impetigo

staphylococcal

fucidin or mupirocin

flucloxacillin or erythomycin
__________: Well-demarcated cellulitis with fever and malaise
acute __________ infection
__________ common
upper dermal _______ lifts epidermis except where staked down by hair follicles or sweat glands
leads to the typical “___________” appearance
Treatment: __________
Erysipelas

streptococcal

bacteremia

edema

peau d'orange

penicillin V
Tetanus
Cause: neurotoxin from ____________
spores in soil, animal faeces
introduced into wound, germinate, release bacteria, produce a neurotoxin
selectively blocks inhibitory nerve transmission from spinal cord to muscles, muscles go into severe spasm
in developing countries, tetanus frequently causes death in neonates when __________ infected
Clostridium tetani

umbilicus
Tetanus Clinical features:
begins with mild spasms in the jaw muscles (_______)
rigidity rapidly develops in the chest, back and abdominal muscles and sometimes the laryngeal muscles (which then interferes with _________)
muscular seizures (________) cause sudden, powerful, and painful contraction of muscle groups.
fractures and muscle tears can occur
trismus

breathing

tetany
Tetanus Treatment:
_________, _________, & _________ in ICU
without treatment, 1 in 3 adults die, 2 in 3 neonates

Prevention
active immunization in childhood: ____ x3
boosters every ___ years as Td shots, especially after risky wound
wound cleaning and debridement
passive immunization if tetanus-prone wound in unprotected patient
intubate, paralyze and sedate

DTP

10
Acute Osteomyelitis Organism

Staphylococus aureus
Streptococcus pyogenes
Streptococcus pneumoniae

Haemophilus influenzae (50% < 4 y)
E .coli
Pseudomonas aeruginosa,
Proteus mirabilis
Gram +

Gram -
Acute Osteomyelitis Clinical Features

severe pain
reluctant to move
Fever, malaise
commonly thoracolumbar spine--backache
history of UTI or urological procedure
Old, diabetic, immunocompromised
adults
Acute Osteomyelitis Clinical Features

failure to thrive, drowsy, irritable
metaphyseal tenderness
decrease ROM
commonest around the knee
infants
Acute Septic Arthritis

Route of Infection
_________ invasion: penetrating wound, intra articular injection, arthroscopy
eruption of ________
_________

Organisms (4)
direct

bone abscess

hematogenous

Staphylococus aureus
Haemophilus influenzae
Streptococcus pyogenes
Escherichia coli
Labs:
CBC , ESR
Mantoux

Xray:
soft tissue swelling
periarticular osteoporosis
joint appear washed out
articular space narrowing

Joint aspiration:
AFP identified in 10-20%
culture +ve in 50%
Tuberculosis
TB Tx:
chemotherapy
_________, _________, and _________6-12 month
rest and splintage
operative drainage rarely necessary
ethambutol, rifampicin and isoniazid
______ are one of the most common type of infections in humans (second only to respiratory infections). UTI can occur when bacteria (commonly _______ from the digestive tract) gets into the urethral opening and travels up the urethra towards the bladder. If the infection progresses, the bacteria can reach up into the kidneys causing damage to the ________
UTI are much more common in _______
UTI's

E. coli

nephrons

women
Diarrhea
Increase in daily stool weight above ______
Increase in frequency, fluidity or amount
Differentiate from incontinence and IBS
Acute lasts less than ______ days
Chronic lasts more than ______ weeks
200gm

7 - 14

2 - 3
Acute Diarrhea
INFLAMMATORY

Fever & bloody with __________, volume ____/ 24 hr secondary to colonic damage
*Shigella, Salmonella, Amebiasis, C.diff, E coli 0157:H7 toxin, Ischemia, UC, Crohn’s, Cytomegalovirus
Leukocytes

<1 L
Acute Diarrhea
Non-INFLAMMATORY
Watery with _____, volume ___/24hr secondary to small intestine disease
*Norwalk & Rota virus, entrotoxins as Giardia, Staph aureus, Cholera, E coli, Bile acid, Laxatives, Malabsorption
N/V

>1 L
Management

Inflammatory
__________ agents are avoided
Moderate to severe cases; start empiric Abx: ________,________,________
Always treat: C diff, Amebiasis, Enteric fever, Shigella, STDs

Non-inflammatory
___________ is most important
__________ offers relief, Anticholinergic contraindicated for _________
Always treat: Cholera, Giardiasis, Traveler’s diarrhea
Antidiarrheal

Ciprofloxacin, TMP-SMA, Erythromycin

Rehydration

Loperamide

megacolon
Stool volume decreases with fasting
Common causes
Lactose intolerance
Sorbitol
Laxatives
Antacids
Osmotic diarrhea
Increased intestinal secretion or decreased absorption with > 1 L diarrhea
Little change with fasting
Endocrine diseases
Secretory diarrhea
Fever , hematochezia and abdominal pain
Causes:
Ulcerative colitis
Crohn’s disease
Microscopic colitis
Radiation enteritis
Malignancy
Inflammatory diarrhea
Wt loss, anemia, vitamin deficiency with fecal fat > 7 - 10 g/24 Hs
Causes:
Tropical sprue
Whipple’s disease
Pancreatitis
Bacterial overgrowth
vagotomy , diabetes
Malabsorption
_________ infectious agents:
Giardia
Entamoeba histolytica
Cyclospora

______ related infections:
Cytomegalovirus
Cryptosporidium
Chronic

AIDS
Charachterised by systemic disease or prior abdominal surgery
Diabetes Mellitus
Hyperthyroidism
Irritable bowel syndrome
Motility disorders