Clinical Manifestations in Fever

Question 1

What is bacteremia?

Answer 1

abnormal presence of bacteria in blood stream

Question 2

Most common sources of bacteremia

Answer 2

skin and soft tissue infections, catheters, bone and joint infections, endocarditis, pneumonia

Question 3

Clinical manifestations of bacteremia

Answer 3

fever, fatigue, nausea, vomiting, dehydration, leukocytosis and L shift on hemogram

Question 4

Definition of septicemia

Answer 4

derived from bacteremia or inflammatory responses and can progress to early sepsis, sepsis, and/or septic shock; organ dysfunction

Question 5

Sepsis determination - SOFA

Answer 5

lengthy, time consuming organ dysfunction score

Question 6

Sepsis determination - qSOFA

Answer 6

based on resp rate, altered mental status, BP <100 mmHg; predicts chance os sepsis for patients admitted to the medical floor

Question 7

Sepsis risk factors

Answer 7

ICU admission, bacteremia, age>65yo, immunosupression, diabetes and obesity, CA, CA-pneumonia, previous hospitalizations requiring abx therapy

Question 8

Clinical manifestations of sepsis

Answer 8

sxs and signs specific to infectious source, arterial hypotension (SBP < 90 mmHg, MAP < 70), temp >38.3 or <36, HR >90 bpm, tachypnea

Question 9

End-Organ manifestations of sepis

Answer 9

warm, flushed skin, skin may become cool, decreased cap refill, cyanosis, altered mental status, restlessness, oliguria, anuria, ileus or absent bowel sounds

Question 10

Lab eval in sepsis

Answer 10

leukocytosis or leukopenia, hyperglycemia, arterial hypoxemia, acute oliguria, Cr increase, coag abnormalities, thrombocytopenia, hyperlactemia, hyperbilirubinemia

Question 11

Diagnosis of sepsis

Answer 11

H&P, clinical reasoning, evidence based medicine

Question 12

Staphylococcal bacteremia caused by what organisms

Answer 12

Methicillin sensitive S. aureus (MSSA), Methicillin resistant S. aureus (MRSA)

Question 13

Staph infections are commonly due to…

Answer 13

breaks in skin integrity, IV catheters, pacer, ortho hardware

Question 14

Signs and sxs of systemic staph ifx

Answer 14

bone or joint pain, protracted fever and/or sweats, abdominal pain, CVA tenderness, HA

Question 15

Appearance of MRSA infected wounds

Answer 15

erythema with induration and purulent drainage

Question 16

S. aureus bacteremia can lead to what complications

Answer 16

endocarditis, osteomyelitis, deep-seated systemic infections

Question 17

Erysipelas

Answer 17

superficial skin infx with well-defined borders

Question 18

Cellulitis

Answer 18

deeper skin infx involving dermis and subQ fat with indiscrete borders; propensity to lymphangitis, edema, swelling

Question 19

Risk factors for community-acquired MRSA

Answer 19

contact sports, military service, incarceration, injection drug use

Question 20

S. pyogenes causes what infections

Answer 20

tonsillopharyngitis (most common cause in children), impetigo, pharyngitis

Question 21

S. agalactiae causes what infections in pregnant persons

Answer 21

UTI, chorioamnionitis, postpartum endometritis, bacteremia

Question 22

S. agalactiae causes what infections in nonpregnant adults

Answer 22

sepsis, soft tissue infections, endocarditis, other focal infections

Question 23

Most common cause of bacterial pharyngitis in children

Answer 23

S. pyogenes

Question 24

Scarlatiniform rash

Answer 24

“sandpaper” rash appreciated with palpation

Question 25

Tuberculosis

Answer 25

occurs with airborne droplets containing viable bacilli and subsequent lymphangitic and hematogenous spread

Question 26

Main sxs of mycobacterium tuberculosis

Answer 26

productive cough, hemoptysis, fatigue, weight loss, fever, night sweats

Question 27

Risk factors for mycobacterium TB

Answer 27

household exposure, incarceration, rec drug use, travel to endemic area

Question 28

Latent TB infection

Answer 28

bacilli contained within granuloma, non-transmissible while latent but may become reactivated

Question 29

Risk factors for TB reactivation

Answer 29

gastrectomy, silicosis, DM, HIV, immunosuppressive drugs

Question 30

Risk factors for drug resistance

Answer 30

immigration from regions with drug-resistant TB, close pt contact, unsuccessful therapy, pt noncompliance

Question 31

Clinical manifestations of TB

Answer 31

cough, blood-streaked sputum, pt appears chronically ill, post-tussive apical rales, malaise, anorexia, wt loss, fever, night sweats

Question 32

Influenza virus category

Answer 32

orthomyxovirus transmitted by respiratory droplets

Question 33

Systemic symptoms of influenza

Answer 33

fever, chils, HA, malaise, myalgias

Question 34

Resp symptoms of influenza

Answer 34

rhinorrhea, congestion, pharyngitis, hoarseness, nonproductive cough, substernal soreness

Question 35

Cytomegalovirus infection

Answer 35

virus isolation or detection in body fluid regardless of symptoms

Question 36

Cytomegalovirus disease

Answer 36

evidence of CMV infection with attributal symptoms or signs, may manifest as viral or tissue-invasive disease

Question 37

Perinatal CMV prevents as...

Answer 37

jaudice, hepatosplenomegaly, thrombocytopenia, purpura, microcephaly, periventricular CNS calcifications, mental retardation

Question 38

Complications of perinatal CMV

Answer 38

hearing loss, neuro deficits

Question 39

How is perinatal CMV acquired?

Answer 39

breast feeding, blood products

Question 40

CMV presents similarly to what other infection in immunocompetent persons?

Answer 40

mononucleosis - fever, malaise, myalgias, arthalgias, splenomegaly, lymphocytes, abn LFT

Question 41

CMV presentation in immunocompromised persons

Answer 41

retinitis, esophagitis, colitis, pneumonitis, neuro manifestations

Question 42

Complications of CMV

Answer 42

mucosal GI damage, encephalitis, severe hepatitis, thrombocytopenia, Guillain-Barré, pericarditis, myocarditis

Question 43

Histoplasmosis is common in what areas of the US

Answer 43

Ohio river and Mississippi River valleys

Question 44

Clinical manifestations of Histo

Answer 44

influenza-like illness, atypical pneumonia with fever and cough, typically normal, PE usually normal

Question 45

Coccidioidomycosis primary infection

Answer 45

influenza-like illness with malaise, fever, backache, HA, and cough

Question 46

Coccidioidomycosis dissemination

Answer 46

results in meningitis, arthralgias, bone lesions, skin and soft tissue abscesses

Question 47

Coccidioidomycosis infections result from what organisms?

Answer 47

Coccidioides immitis, Coccidioides posadasii

Question 48

Where areas of the world are Coccidioides species common in?

Answer 48

SW US, Mexico, Central and South America

Question 49

Primary coccidioidomycosis incubation period

Answer 49

10-30 days

Question 50

Coccidioidomycosis sxs

Answer 50

nasopharyngitis with fever and chills, arthalgias with periarticular swelling of knees and ankles, erythema nodosum

Question 51

Disseminated coccidioidomycosis sxs

Answer 51

productive cough, enlarged mediastinal lymph nodes, lung abscesses, skin and bone infections, chronic basilar meningitis, subQ abscesses

Question 52

Disseminated coccidiodomycosis in HIV pts

Answer 52

pulmonary miliary infiltrates, LAD, meningitis

Question 53

Species of Plasmodium responsible for malaria

Answer 53

P vivax, malariae, ovale, falciparum

Question 54

Plasmodium responsible for severe disease

Answer 54

P. falciparum

Question 55

Acute malaria sxs

Answer 55

prodrome followed by fever, HA, malaise, myalgias, cough, anorexia, N/V/D

Question 56

Plasmodium that causes 48 hour fever cycles

Answer 56

P vivax and ovale

Question 57

Plasmodium that causes 72 hour fever cycles

Answer 57

P malariae

Question 58

Malaria signs and sxs

Answer 58

anemia, jaundice, splenomegaly, mild hepatomegaly, hypotension, seizure

Question 59

Most common HIV related malignancy

Answer 59

Kaposi sarcoma