IDMM investigations (3) Flashcards Preview

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Flashcards in IDMM investigations (3) Deck (37):
1

what categories of inquiry make up a thorough physical exam?

1. presenting complaint/HPI
2. past medical Hx
3. vaccinations
4. travel/immigration
5. assessment of risk behaviors
6. animal/pet/occupation/environmental exposures
7. meds (current and past) *antibiotic exposure in the last 6 months

2

what elements/systems must be examined on a thorough physical exam?

1. general appearance
2. CV/hemodynamic status
3. skin
4. lymph nodes
5. eyes
6. respiratory
7. abdomen
8. genital exam
9. MSK

3

what is noted within HPI

duration

constitutional symptoms (associated)

fever/chills/rigors/night sweats etc...

weight loss

provocation/palliation

4

physical exam: general appearance

body habitus

urgency

distress

LOC

5

physical exam: CV/hemodynamic status

BP

perfusion

murmurs

6

physical exam: skin

color
cyanosis
rash
scars
wounds
peripheral stigmata for deeper infections

7

physical exam: lymph nodes

lymphadenopathy
cervical, inguinal, axillary, extremity

8

physical exam: eyes

conjunctivitis
drainage
cellulitis (orbital, preorbital)
fundoscopic examinations

9

physical exam: respiratory

respiratory rate
auscultation (wheezes, crackles)
percussion resonance

10

physical exam: abdomen

tenderness
hepatosplenomegaly

11

physical exam: genital exam

genital/anal lesions
abnormal discharge
inguinal adenopathy

12

physical exam: MSK

joints
spine (movement, tenderness, swelling)

13

list the 5 sites of infection

1. SST
2. respiratory
3. GI tract (most in lower but some in upper)
4. genitourinary tract
5. sterile site

14

what can be tested for on a blood test?

WBC
hemoglobin
platelets
liver function tests

15

what does elevated WBC in a blood test indicate?

broad stimulation of immune response

16

what two factors on blood tests may be elevated in inflammation?

C reactive protein

erythrocyte sedimentation rate (ESR)

17

why do we we blood tests for procalcitonin?

it is released in response to bacterial toxins but downregulated in viral infections

helps differentiate cause of infection

18

what are the "acute phase reactants?"

what are they used for?

(on blood tests)

acute phase reactants = CRP and ESR

used for diagnosis of rheumatological conditions or for monitoring inflammation

19

what factors are assessed in urinalysis

1. inflammation: WBCs, RBCs, leukocyte esterase
2. presence of bacteria: microscopy, nitrite

20

list indications for urinalysis

1. complicated infection
2. atypical symptoms
3. failure to respond to therapy
4. recurrent symptoms less than one month after previous

21

how are urine cultures quantified?

by CFU (colony forming units)

this is unlike other cultures

the test is significant if >100 000 CFU/mL (+symptomatic +pyuria)

mixed infections are rare

22

list the specimen types used in microbiologic analysis

virus
typical bacteria
atypical bacteria
fungi
parasite

23

what are the two diagnostic methods for microbiological analysis

1. microscopy
2. gram stain

24

are gram stains done on urine or stool

no

25

what is the purpose of microscopy

can ID all groups of pathogens, based on stains, size, shapes

26

what is the purpose of gram stain

MOST IMPORTANT

automatically performed on respiratory and wound tissue/fluid samples and blood samples

can indicate presence of inflammation, amount of organisms and presumptive ID

27

what are some limitations of susceptibility testing

1. breakpoints can be unclear
2. in vitro may not predict final outcome in vivo (due to pharmacodynamic and pharmacokinetics)
3. MIC measurements are not always reliable
4. other host factors (i.e immune system)

28

on which tissues is gram staining used?

NOT on stool
NOT on urine

yes on respiratory (though often contaminated with oral flora), SST, genital and sterile site samples

29

on which tissues is culture and sensitivity used?

on all tissues, though less on genital

30

on what suspected pathogen samples is microscopy used?

NOT on viruses

yes to bacteria, atypical bacteria, fungi and parasites

31

on what suspected pathogen samples is culture used?

sometimes on viruses
yes on bacteria, atypical bacteria and fungi
NOT on parasites

32

on what suspected pathogen samples if nucleic acid testing used?

YES on viruses
sometimes on bacteria/atypical bacteria
NOT on fungi or parasites

33

on what suspected pathogen samples if antigen testing used

sometimes on viruses, atypical bacteria, fungi and parasites

NOT on typical bacteria

34

on what suspected pathogen samples is serology testing used?

YES on viruses
NOT on bacteria
sometimes on atypical bacteria, fungi, parasites

35

what is the nucleic acid amplification test

it is a molecular identification method
PCR = one quick method to test for nucleic acids

advantages = sensitive, specific, quick

disadvantages = limited to specific target, may not detect viable organisms and expensive

36

list some antigen detection methods

ELISA
EIA
western blot
cytotoxin assays

advantages = quick, specific

disadvantages = poor sensitivity, limited to specific target, may not detect viable organism

37

list some antibody detection methods

serology
IGRA
TB skin test