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40 Cards in this Set
- Front
- Back
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normal flora of:
- skin - nose - oropharynx - dental plaque - colon - vagina |
- skin: S. epidermidis
- nose: S. epidermidis, colonized by S.aureus - oropharynx: S.viridans - dental plaque: S.mutans - colon: B.fragilis > E.coli - vagina: Lactobacillus, colonized by E.coli and group B strep Neonates deliverd by cesarean section have no flora but are rapidly colonized after birth - and thus need Vit.K supplementation |
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Causes of Pneumonia in:
- neonates (<4wk) - children (4wk-18yr) - adults (18-40yrs) - adults (40-65yrs) - elderly |
NEONATES
- Group B strep - E.coli CHILDREN (4wk-18yr) - RSV, Mycoplasma, Chlamydia pneumoniae, S.pneumoniae (Runts May Cough Sputum) Adults (18-40yr): Mycoplasma, C.pneumoniae, S.pneumoniae Adults (40-65yr): S.pneumonaie, H.influenzae, Anaerobes, Viruses, Mycoplasma Elderly: S.pneumonaie, Viruses, Anaerobes, H.influenzae, gram negative rods |
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which bugs are most common for these special subsets of pneumonias:
- nosocomial (hosp-acquired) - immunocompromised - aspiration - alcoholic/IVDU - post-viral |
NOSOCOMIAL
- Staphylococcus - gram neg rods IMMUNOCOMPROMISED - Staphylococcus - gram-negative rods - fungi - viruses - Pneumocystis jiroveci - with HIV Aspiration - anaerobes Acoholic/IVDU - S.pneumoniae - Klebsiella - Staphyloccus Postviral - staphylococcus - H.influenzae Atypical - Mycoplasma - Legionella - Chlamydia |
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common causes of meningitis
- newborns (0-6 mo) - children (6 mo - 6 yrs) - 6-60 yrs - 60+ yrs |
MENINGITIS
Newborns: Group B (S.agalactacai) (tx: ampiclillin), E.coli (tx: ampicillin), Listeria Children (6mo-6yrs): S. pneumoniae, N.meningitidis, H.influenzae type B (but incidence has decreased greatly with introduction of vaccine in last 10-15 yrs), Enteroviruses 6-60yrs N.meningitidis, Enteroviruses, S.pneumonaie, HSV 60+ yrs: S.pneumonaie, Gram negative rods, Listeria |
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causes of viral meningitis
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enteroviruses (esp. coxsackievirus)
HSV HIV West Nile virus VZV |
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Causes of meningitis in HIV
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cryptococcus
CMV toxoplasmosis (brain abscess) JC virus (PML) |
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CSF findings in bacterial meningitis
- pressure - major cell type - protein increased or decreased - glucose increased or decreased - appearance of CSF |
BACTERIAL meningitis
- increased pressure - increaed PMNs - increased protein - DECREASED glucose - opaque appearance |
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Fungal/TB meningitis
- pressure - major cell type - protein increased or decreased - glucose increased or decreased - appearance of CSF |
FUNGAL/TB meningitis
- increased pressure - increased LYMPHOCYTES - increased protein - DECREASED glucose - CLEAR CSF |
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Viral CSF findings in meningitis
- pressure - cell type - protein - glucose |
VIRAL MENINGITIS
- normal/increased pressure - increased lymphocytes - normal protein - normal sugar - clear CSF |
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meningoencephalitis - CSF findings
- lymphocytes? - protein? - glucose? |
Meningoencephalitis
- increased lymphocytes - increased protein - normal/increased glucose |
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osteomyelitis - what is the causative bug in each population:
- most people - sexually active - diabetic and drug addicts - sickle cell - prosthetic replacement - vertebral - cat and dog bites or scratches |
most people - S.aureus
sexually active: N.gonorrheae (septic arthritis more common) diabetics and drug addicts - pseudomonas sickle cell - Salmonella prosthetic replacement - S.aureus and S.epidermidis vertebral - M.tuberculosis (Pott's disease) cat and dog bites or scratches - Pastuerella multocida NOTE: assume S.aureus for osteomyelitis if no other information most osteomyelitis occurs in children elevated CRP and ESR classic but nonspecific |
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Urinary tract infections
- causes in abulatory and hospitalized - epi - predisposing factors - other |
Most common causes in non-hospitalized:
- E.coli (50-80%) - Klebsiella (10%) S.saprophyticus (10-30%) - 2nd most common cause of UTI in young, sexually active, preambulatory women Hospital - E.coli, Proteus, Klebsiella, Serratia, Pseudomonas Epi: - women:men = 10:1 - more common in women because of SHORT URETHRA COLONIZED BY FECAL FLORA!!! predisposing factors: - flow obstruction - kidney surgery - catheterization - gynecologic abnormalities - diabetes - pregnancy NOTE: - UTIs most caused by ascending infections - male babies often have congenital defects if getting UTIs - elderly males with enlarged prostates - PRESENTATION: dysuria, frequency, urgency, suprapubic pain PYELONEPHRITIS: fever, chills, flank pain, CVS tenderness (white blood cell casts are pathognemonic!! |
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UTI bugs - describe each
- Serratia marcescens - S.saprophyticus - E.coli - Enterobacter cloacae - Klebsiella pneumoniae - Proetus mirabilis - Pseudomonas aeruginosa |
Serratia marcescens
- some strains produce a red pigment - often nosocomial and drug resistant S.saprophyticus - 2nd leading cause of comm-acq'd UTI in sexually active women E.coli - leading cause of UTI - colonies show metallic sheen on EMB agar E.cloacae - often nosocomial and drug resistant Klebsiella pneumoniae - large mucoid capsule and viscous colonies Proteus mirabilis - motility causes "swarming" on agar - produces urease - associated with STRUVITE stones Pseudomonas aeruginosa - blue-green pigment and fruity odor - usually nosocomial - drug-resistant |
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TORCHES Infections
- transmiteed in utero OR during vaginal birth |
Toxoplasma gondii
Rubella CMV HIV HSV-2 Syphilis |
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Toxoplasma gondii
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- CHORIORETINITIS, INTRACRANIAL CALCIFICATIONS, HYDROCEPHALUS
- may be asymptomatic at birth |
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Rubella
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- deafness, cataracts, heart defects (PDA, pulmonary artery stenosis) and mental retardation
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CMV
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- petechial rash, intracranial calcifications, mental retardation, hepatosplenomegaly, microcephaly, jaundice, 90% aymptomatic at birth
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HIV
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- hepatosplenomegaly
- neurologic abnormalities - frequent infections |
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HSV-2
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encephalitis
conjunctivitis vesicular skin lesions often asymptomatic at birth |
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Syphilis
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cutaneous lesions
- hepatosplenomegaly - jaundice - saddle nose - saber shins - Hutchinson teeth - CN VIII deafness - rhinitis ("snuffles") |
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3 other important congenital infections not included in TORCHES
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Listeria
E.coli Group B strep - can be acquired placentally or from birth canal |
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viral encephalitis
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fever
ha mental status changes --> coma increased lymphocytes normal glucose normal/slightly elevated protein most commonly arthropod-borne HSV - most common cause in US |
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Gonorrhea
- causes? |
urethritis
cervicitis PID prostatitis epididymitis arthritis CREAMY PURULENT DISCHARGE |
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primary syphilis
- causes what? |
painless chancre
(NOTE: as opposed to painful genital ulcers in genital herpes (HSV2) or H.ducreyi) |
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secondary syphilis
- causes what? |
fever
lymphadenopathy skin rashes condyloma lata |
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tertiary syphillis
- causes what? |
gummas
tabes dorsalis general paresis aortitis Argyll Robertson pupil |
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genital herpes
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painful penile, vulvar, or cervical ulcers
can cause systemic sx's such as - fever - ha - myalgia |
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chlamydia
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urethritis
cervicitis conjunctivitis Reiter's syndrome PID due to C.trachomatis D-K!!! |
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lymphogranuloma venereum
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ulcers
lymphadenopathy rectal strictures genital elephantiasis due to C.trachomatis L1-L3!!! |
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trichomoniasis
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vaginitis
strawberry-colored mucosa - due to trichomonas vaginalis |
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AIDS
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opportunistic infections
Kaposi's sarcoma lymphoma |
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condyloma accuminata
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genital warts
koilocytes HPV 6 and 11 |
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hepatitis B
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jaundice
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chancroid
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Painful genital ulcer (like ulcer of herpes - NOT like painLESS chancre of primary syphilis)
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bacterial vaginosis
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noninflammatory
MALODOROUS discharge (fishy smell) positive whiff test clue cells (vaginal epithelial cells covered with bacteria) - due to Gardnerella vaginalis |
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pelvic inflammatory disease
- bugs - sx's - conditions it includes |
bugs
- C.trachomatis (subacute, often undiagnosed) - N.gonorrhoeae (acute, high fever) C.trachomatis is MOST COMMON STD in US cervical motion tenderness (chandelier sign) purulent cervical discharge may include - salpingitis (risk factor for ectopic pregnancy, infertility, chronic pelvic pain, adhesions) - endometritis - hydrosalpinx - tubo-ovarian abscess other STDs icnlude: - Gardnerella (cue cells) - Trichomonas (motile on wet prep) |
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nosocomial infections - name the bug for each risk factor:
- newborn nursery - urinary catheterization - respiratory therapy equiptment - work in renal dialysis unit - hyperalimentation - water aerosols |
- newborn nursery: CMV, RSV
- urinary catheterization: E.coli, Proteus mirabilis - Respiratory therapry equiptment: Pseudomonas aeruginosa - work in renal dialysis unit: HBV - hyperalimentation: Candida albicans - water aerosols: Legionella |
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2 most common causes of nosocomial infections
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E.coli (UTI)
S.aureus (wound infection) |
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bug implicated when AIR or BURNS are involved
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Pseudomonas!
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bug hints
1. pus, empyema, abscess? 2. pediatric infection? 3. pneumonia in CF, burn infection? 4. branching rods in oral infection? 5. traumatic open wound? 6. surgical wound? 7. dog or cat bite? 8. currant jelly sputum? 9. sepsis/meningitis in newborn? |
1. pus, empynema, abscess - S.aureus
2. pediatric infection - H.influenzae (including epiglottitis) 3. pneumonia in CF, burn infection - Pseudomonas aeruginosa 4. Branching rods in oral infection - actinomyces israelii 5. traumatic open wound - Clostridium perfringes 6. surgical wound - S.aureus 7. Dog or cat bite - Pasteurella multocida 8. currant jelly sputum - Klebsiella 9. Sepsis/meningitis in newborn - group B strep |
