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SBL Exam 2 > 7. Clinical Considerations in Fever > Flashcards

7. Clinical Considerations in Fever Flashcards

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1
Q

what causes coccidiocomycosis?

A

infxn from inhaling C. immitis or C. posadasii

=mold in SW US, Mexico, Central/S. America

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2
Q

exposure to anopheline mosquitoes in malaria-endemic areas will present as

A

intermittent chills, fever, sweating

HA, myalgia, vomiting, splenomegaly

anemia, thrombocytopenia

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3
Q

what are characterisitcs of MRSA

A

often hospital acquired

common in immunocompromised pt

wound = localized erythema w/ induration & purulent drainage (abscess common)

Gram (+) cocci on stain; culture = (+)

(+) s. aureus –> focus on endocarditis, osteomyelitis and deep seated systemic infxns

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4
Q

compare and contrast erysipela & cellulitis in MRSA skin infxn

A

erysipela: superficial & well-defined borders

cellulitis: deep (dermis & subQ fat); edema, & swelling common

both: painful, warm, indurated, erythematous, nonlocalized & may include lymphangitis

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5
Q

What are significant characteristics of primary coccidiodomycosis

A

arthralgia w/ periarticular swelling of knees & ankles

erythema nodosum 2-20 days after onset

also nasopharyngitis (flu-like sxs

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6
Q

How does multiple myeloma present?

what do you use to diagnose?

A

=infiltration of bone marrow, bone destruction & paraprotein elaboration ==> lytic bone lesions –> bone pain (spine, ribs, proximal long bones)

symptoms of - anemia, kidney failure

soft tissue masses

LAB : monoclonal Ig in serum/urine

Biopsy: clonal plasma cell in bone marrow/tissue

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7
Q

what is the difference btn CMV infection and disease

A

infection= acute = detect viral protein (Ag) or NA in body fluid/tissue, regardless sxs

disease: CMV infection w/ signs/sxs; viral syndrome or tissue-invasive dz

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8
Q

What are complications of progressive histoplasmosis

A

fever, wt loss, prostration

dyspnea, cough

ulcer of mucous mem of oropharynx

HSM

adrenal insufficiency

GI- mimic IBD

CNS probs

(progressive seen in pt w/ HIV (<100 CD4) or impaired cellular immunity)

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9
Q

What are clinical manifestations of SLE (besides malar rash)

A

systemic sxs

alopecia (common)

raynaud phenomenon (20%)

joint symptoms w/ or w/o synovitis (90%) –> can lead to reversible swan-neck defromity (changes NOT on radiograph)

pericarditis

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10
Q

what are risk factors for community acquired MRSA?

(aggresive!)

A

contact sports

military

incarceration

inject drugs

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11
Q

What are the 3 subtypes of influenza

A

A & B - same symptoms (A = pandemic)

C - milder

(difficult to diagnose in absence of epidemic bc looks like other viral illnesses)

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12
Q

What can increase the change of GAS pharyngitis in children

A

scarlatiniform rash (sandpaper-like -attached pic)

palatal petechiae

tonsillar enlargement w/ or w/o exudate

vomiting

tender cervical LN

(but is not enough to Dx)

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13
Q

What is the cause of bacteremia in pregnant women

& how does it present

A

Strep agalactiae (Group B)

UTI, chorioamnionitis, postpartum endometritis

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14
Q

what are HIV patients with disseminated coccidiodomycosis likely to show?

(& list other sxs of disseminated coccidiodomycosis)

A

*pulmonary miliary inflitrates

mediastinal LN - LAD

meningitis (may result in chronic basilar meningitis)

productive cough, lung abscess/empyema, skin/bone infxn, lymphadenitis –> suppuration

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15
Q

Multiple myeloma is more prone to infxn by….

A

encapsulated organisms

Strep pneumonia & H. influenzae

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16
Q

what population is disseminated histoplasmosis disease present? what is the prognosis in these pts?

how do you Dx?

A

common in AIDs/immunocompromised pts –> poor prognosis

= fulminant –> stimulate septic shock

Dx: blood/bone marrow culture & urine polysac Ag

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17
Q

What are clincal manifestations of multiple myeloma

A

anemia sxs

bone pain & tenderness (back, hip, ribs)

lytic bone lesion

sx of kidney failure

soft tissue masses

neuropathy or spinal cord compression

increased susceptibility to infxn

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18
Q

what are risk factors for TB REACTIVATION

A

gastrectomy

silicosis

DM

HIV

immunosuppressive drugs

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19
Q

how do you differentiate ACUTE acquired CMV from infxous mono?

A

V similar!

but NO pharyngeal symps in ACUTE CMV

& (-) heterophile Ab

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20
Q

how does CMV infxn present in immunoCOMPROMISED pts

A

CMV retinitis w/ neovascular & prolif retinal lesions- cottage cheese & ketchup infiltrates upon fundoscopic exam

GI & hepatobiliary CMV w/ esophagitis, small bowl inflam

colitis

pneumonitis (transplant & AIDs pts)

neuro sxs: polyneuropahty, transverse myelitis, encephalitis

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21
Q

How can Staphylococcal infxns cause MSSA and MRSA or any infxn?

A

skin/soft tissue infxn

break in skin (erysipelas, folliculitis, cellulitis, trauma)

IV cath

cardiac devices

orthopedic hardware

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22
Q

describe latent TB and reactivation of TB

Study These Flashcards
A

latent: bacilli contained w/i granulomata - NON-transmittable

reactivation when infected person’s immune fxn is compromised

= now active!

23
Q

why do you have kidney failure in multiple myeloma

Study These Flashcards
A

light chain component deposited in tissues as amyloid

24
Q

how does the primary infection occur in TB

Study These Flashcards
A

inhale droplet w/ tubercle bacilli

& subsequent lymphangitic & hematogenous spread before immunity develops

25
***What are clinical manifestations of Sjorgren's syndrome***
***sicca sxs: dry eyes, mouth due to immune-mediated dysfxn of lacrimal and salivary glands*** ***w/ or w/o RA*** ***enlarged parotid gland*** *increased incidence of lympoma (NHL-maltoma)*
26
**List Clinical Manifestations of Sepsis**
**arterial HYPOtenstion (sBP \< 90; MAP \<70)** **Temp \>38.3C or \<36C ( \>100.94F or \<96.8F )** **HR \>90** **tachypnea- RR \>=20**
27
what is the bacteremia? causes of bacteremia?
=abnormal presence of bacteria in blood stream MOST COMMON causes: 1. skin/soft tissue infxn 2. central venous cath & other IV devices 3. bone/joint infxn 4. pneumonia 5. endocarditis
28
list the clinical manifestations of bacteremia
fever, fatigue, malaise nausea/vomitting loss of appetite, dehydration myalgia/arthralgia Lab : leukocytosis & left shift
29
Staph infections are typically localized but how do you know it has become systemic?
_bone/joint pain_
30
**what is qSOFA?** | (vs SOFA?)
**predicts chance of sepsis -bedside scoring system based on:** **resp rate \>=22, altered mentation & sBP =\< 100** (vs SOFA - organ dysfxn score - not diagnostic, time consuming)
31
what are symptoms of systemic staph infections and what do they suggest
bone/joint pain (osteomyelitis, discitis, epidural abscess) protracted fever/sweats - (endocarditis) abd pain - (esp LUQ - splenic infxn) costovertebral angle tenderness - (pyelonephritis, renal infarction or psoas abscess) HA (meningitis, intracranial infxn, septic emboli)
32
**what are outside risk factors for TB**
**household exposure** **incarceration** **recreational/illicit drugs** **travel to _endemic areas_**
33
**if a pt presents w/ end-organ perfusion, what is going on?** **what are these manifestations?**
**=Septic Shock** * **warm, flushed skin (early) --\> cool (w/ progression of shock bc redirect blood flow to core)** * **decreased cap refill, cyanosis, mottling (red-purple blotching of skin)** * **altered mental status, obtundation, restless** * **oliguria/anuria** * **ileus/absent bowel sounds**
34
* How does SLE present?* * what are serologic finding to Dx*
*female, malar rash* anemia, leukopenia, thrombocytopenia *serology: (+) ANA, (+) anti-ds DNA & low complement (and (+) Smith)*
35
What is the significance of strep agalactiae (group B) in neonates & nonpregnant adults
neonates: most common manifestation of neonatal dz = bacteremia w/o focus, sepsis, pneumonia &/or meningitis nonpregnant: _MCC strep in adults_; sepsis, soft tissue infxn, endocarditis and other focal infxn can manifest too
36
What are lab findings in sepsis ## Footnote **(one is V important!)**
**HYPERLACTATEMIA -**bc organ hypoperfusion in presence/absence of hypotension --\> POOR PROGNOSIS (lot of others..) * leukocytosis or -penia!/ thrombocytopenia * normal WBC (W/ DIFF will give more info!) * hyperglycemia (w/o diabetes)/hyperbilirubin * Increase plasma-CRP * arterial hypoxemia (\<300) * acute oliguria * increase creatinine
37
**what are risk factors for sepsis?**
* **ICU admission** * **bacteremia** * **\>= 65 yo** * **immunosuppression** * **diabetes & obesity** * **CA** * **community acquired pneumonia** * **previous hospitalization (esp w/i 90 days)**
38
MRSA pearls
may complicate surgical incision -diabetic foot infxn joint (unusual) but if so = bacteremia, instrumentation or prosthetic joint osteomyelitis - fixation device/prosthetic; hematogenous infxn (kids); nonhealing foot ulcer
39
**What are risk factors for _drug resistance_ in TB**
**immigration from regions w/ drug-resisitant TB** **close contant w/ person infected w/ drug-resisitant TB** **unsuccessful prior anti-TB therapy** **noncompliance**
40
what are the clinical manifestations of histoplasmosis
(most ppl asymptomatic!) mild sxs: flu-like 1-4 days severe: like atypical pneumonia w/ fever, cough and mild chest pain for 5-15 days elderly w/ COPD: chronic progressive histoplasmosis PE = normal
41
**What is the most common cause of tonsilopharyngitis in kids/teens**
**strep pyogenese**
42
**Describe the clinical manifestation of acute malaria**
**prodrome - HA & fatigue --\> irregular fever** **w/o therapy fever becomes regular - (vivax & ovale = 48 hr cycles & malariae = 72 hr)** **HA, malaise, myalgia, arthralgia, cough, chest pain, abd pain** **anorexia, NVD** **PE = anemia, jaundiace HSM, HYPOtension, seizures**
43
What are the 4 species of the genus repsonible for human malaria? what is the severity of each
Plasmodium 1. vivax- rarely severe 2. malariae -not severe 3. ovale- not severe nearly all severe dz = 4. falciparum
44
**What is CMV infxn in immunoCOMPETENT pts characterized as**
**mononucleosis-like syndrome w/ NEG heterophil Ab** (can also occur post-splenectomy yrs later) cutaneous rash common (compared to mono)
45
***what is the most common HIV-related malignancy?*** ***& how does it present***
**= HHV-8 - Kaposi sarcoma** **= red/purple/dark plaques/nodules on cutaneous/mucosal surface** *often on LE, face (noses), oral mucousa & genitalia* *chronic kaposi: HIV infxn, high CD4 & low viral load* pul kaposi: SOB, cough, hemoptysis/chest pain ; could be asymptomatic and only show on radiograph!
46
What are symptoms of monocleosis-like syndrome (CMV infxn) in immunoCOMPETANT pts
fever, malaise, myalgia, arthralgia persistent splenomegaly, atypical lymphocytes, abnormal liver fxn test leukocytosis --\> leukopenia
47
Histoplasmosis is related to what region/animal
exposure to bird & bat droppings river valley, esp Ohio river and Mississippi river valley [. boards fav :).]
48
what are characteristics of CMV
most - _asymptomatic_ increase prevalence w/ age, low SES, # sexual partners, Hx prior STI, employment in daycare serious dz in immunocompromised pts
49
**What are the main symptoms & clinical manifestations of TB**
**most common: productive COUGH** **hemoptysis** **slowly progressive: malaise, anorexia, fatigue, wt loss, fever, night sweats** **looks chronically ill** **chest exam -** nonspecific **post-tussive apical rales** **(be aware of atypical presentation in elderly and HIV pts)**
50
_Differentiate multiple myeloma w/ waldenstrom macroglobulinemia_
Waldenstrom - no lytic bone lesions! \*clinical pearl
51
What are respiratory and systemic symptoms of the flu
resp: rhinorrhea, congestion, pharyngitis, hoarseness, _nonproductive_ cough, substernal soreness systemic: fever (3-5 days), chills, HA, malaise, myalgia \*may see GI symps in kids w/ flu-B
52
**how can CMV inclusion disease present in neonates**
* _jaundice, HSM, thrombocytopenia, purpura,_ * _microcephaly, periventricular CNS calcifications,_ * _mental retardation & motor disability_ ## Footnote **\*hearing loss - 50% symptomatic infants at birth** **\*most = asymptomatic BUT may get neurological deficits later in life (hearing loss/mental retardation)**
53
how/why does strep pyogenes present in neonates, kids/teens/ adults
neonates - maternal/fetal transmission kids/teens - **tonsilopharyngitis**, impetigo; secondary bacterial skin infxn adults - pharyngitis

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