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Emergency Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

(93 cards)

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1
Q

What does meningitis affect?

A

Arachnoid, subarachnoid space

CSF

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2
Q

Most Common Bacterial Culprits in Meningitis

A

Strep pneumo
N. meningitidis
H. influenza

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3
Q

Most Common Viral Culprits for Meningitis

A 
Enteroviruses
HSV
HIV
West Nile
VZV
Mumps
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4
Q

Most Common Fungal Culprit for Meningitis

A

Cryptococcus

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5
Q

NonInfectious Etiology of Meningitis

A 
Tumor
Trauma
Brain abscess
Subdural empyema
Pharmacologic reaction
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6
Q

Community Acquired Culprits of Meningitis

A

Strep pneumo
N. menigitidis
H. influenza
Listeria monocytogenes

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7
Q

Healthcare Acquired Culprits of Meningitis

A

Staph

Aerobic gram negative bacilli

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8
Q

Classic Triad of Meningitis

A

Fever
Nuchal rigidity
Change in mental status

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9
Q

Other Symptoms of Meningitis

A 
Intense headache
Photophobia
Lethargy
N/V
Joint pain
Seizures
Non-blanching petechial rash (N. meningitidis)
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10
Q

Red Flags for Diagnosing CNS Infections in the Elderly

A 
Behavioral changes
Personality changes
Seizures
Lack of other source of infection
Headache
Nuchal rigidity
Exposure to infected persons
Low threshold to do LP
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11
Q

Indications for Head CT Prior to LP

A 
Immunocompromised
Hx of seizure 1 week prior
Abnormal level of consciousness
Hx of CNS disease
Papilledema
Focal neurologic deficit
Possible focal infection
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12
Q

Meningitis Work Up

A

Blood cultures
CBC
Chem 7
CSF: cell count, gram stain, culture, glucose, protein

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13
Q

Treatment of Meningitis

A

Rocephin as soon as LP complete

Admit to hospital

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14
Q

Normal CSF Values

A 
Pressure: 70-180
Appearance: clear, colorless
Protein: 15-45 mg/100mL
Glucose: 50-80 mg/100mL
Cell count: 0-5 WBCs, no RBCs
Chloride: 110-125 mEq/L
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15
Q

Bacterial Meningitis in Pediatric Population

A

2 months-2 years

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16
Q

Clues of Meningitis in Infants

A

Irritability
Poor feeding
Paradoxical irritability

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17
Q

Most Common Etiologic Agents of Meningitis in Pediatrics

A

Strep pneumo
N. meningitidis
HIB (rare)
Neonates: gram negative and Group B strep

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18
Q

Primary prevention of Meningitis

A

S. penumoniae vaccine
HIB vaccine
Meningococcal vaccine

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19
Q

Define Encephalitis

A

Inflammation of the brain

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20
Q

Etiologic Agents for Encephalitis

A 
HSV-1
HSV-2
West Nile
CMV
Mumps
EBV
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21
Q

Difference Between Encephalitis and Meningitis

A 
Encephalitis has: Altered brain function
Personality changes
Paralysis
Hallucinations
Altered smell
Problems with speech
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22
Q

Symptoms of Encephalitis in Adults

A 
Flu like symptoms
Severe HA
Fever
Altered consciousness
Confusion
Agitation
Personality changes
Seizures
Loss of sensation
Paralysis
Muscle weakness
Hallucination
Double vision
Perception of foul smells
Speech/hearing problems
LOC
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23
Q

Symptoms of Encephalitis in Children

A 
Bulging fontanels
N/V
Body stiffness
Inconsolable crying
Paradoxical irritability
Poor feeding
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24
Q

Work Up of Encephalitis

A

Head CT and/or MRI
CBC
CMP
LP

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25
Treatment of Encephalitis
Acyclovir q8h
26
Most Common Site of Septic Arthritis
Knee
27
Signs and Symptoms of Septic Arthritis
``` Acute or subacute onset of pain Erythema Swelling Limited joint motion +/- systemic symptoms ```
28
What should you send joint fluid for?
``` Crystals Glucose Cell count Culture + sensitivity R/O gonorrhea ```
29
Treatment of Septic Arthritis
High dose IV antibiotics
30
Signs and Symptoms of Bacteremia
``` Fever +/- chills Rigors Disorientation Hypotension Respiratory failure Sepsis Septic shock Skin lesions ```
31
Treatment for Gram Positive Sepsis +/- Shock
Empiric: vancomycin MSSA: PCN, nafcillin, oxacillin, vancomycin MRSA: vancomycin, daptomycin
32
Treatment for Gram Negative Severe Sepsis +/- Shock
Gentamicin or tobramycin or amikacin PLUS cefepime +/- vancomycin
33
What needs to be ruled out and what test needs to be run for it in gram positive bacteremia?
TEE | Infective endocarditis
34
Signs and Symptoms of Sepsis/Septicemia
``` Infection General symptoms Inflammatory symptoms Hemodynamic symptoms Poor urine output Elevated creatinine Elevated INR, PTT Low platelets Ileus Elevated bilirubin Elevated lactate Decreased capillary refill Arterial hypoxemia ```
35
General Symptoms with Infection for Sepsis
``` Temp: 38.3+ or less than 36 HR: 90+ RR: 20+ AMS Significant edema Hyperglycemia without DM: 140+ ```
36
Inflammatory Symptoms with Infection for Sepsis
WBC: 12K+ or less than 4K, left shift Elevated CRP Elevated procalcitonin
37
Hemodynamic Symptoms with Infection for Sepsis
Hypotension | Wide pulse pressure
38
Treatment of Sepsis
Supportive | Treat most likely source of infection
39
3 Superficial Soft Tissue Infections that are Emergencies
Infection around the face and hand Cellulitis in the presence of DM or PVD Local infection with the presence of leukemia or HIV
40
Define Cellulitis
Acute spreading infection of the skin to and through the dermis
41
Drug of Choice for Cellulitis
Bactrim | Clindamycin
42
Most Common Culprit of Impetigo
Strep
43
Describe Impetigo
Small vesicles which rupture and form "honey-colored" crusts
44
Treatment of Impetigo
Bactroban
45
Define Endocarditis
Infection of the endothelial surface of the heart, most often the valves
46
Patients at High Risk for Endocarditis
Previous valve damage Valve replacement History of IVDU Poor dental health
47
Symptoms of Subacute Endocarditis
Anorexia Night sweats Weight loss
48
Presentation of Acute Endocarditis
Cardiac failure Stroke Cold extremity
49
Cutaneous Lesions with Endocarditis
Conjunctival and palatal petechiae Subungual hemorrhages Oslers nodes Janeway lesions
50
Describe Oslers Nodes
Painful and erythematous nodules | Located on pulp of fingers and toes
51
Describe Janeway Lesions
Erythematous, blanching macules Nonpainful Located on palms and soles
52
Diagnostics for Endocarditis
TTE/TEE Normocytic, normochromic anemia Elevated ESR Obtain blood cultures
53
What does toxic shock syndrome result from?
Absorption of toxin from localized staph aureus colonization or infection
54
Signs and Symptoms of Toxic Shock Syndrome (TSS)
``` Fever: mild to 102.2+ Myalgias Vomiting Diarrhea Pharyngitis SBP less than 80 mmHg Multiple organ failure Diffuse, blanching, macular erythema Pan-mucosal inflammation ```
55
Labs that Represent Multiple Organ System Involvement
``` Leukocytosis and thrombocytopenia Elevated BUN and creatinine Elevated LFTs and Bili Sterile pyuria Elevated CPK Decrease serum albumin and total protein Blood cultures NEGATIVE Cultures of source ```
56
Treatment of TSS
Supportive care | Prevent additional toxin production
57
Culprit of Rocky Mountain Spotted Fever
Rickettsia rickettsi
58
Symptoms of Rocky Mountain Spotted Fever
``` Fever Chills Malaise Myalgias Severe frontal headache ```
59
Rocky Mountain Spotted Fever: Days 2-5
Pink, macular rash on palms of hands, soles of feet, hands, feet, wrists, and ankles 24-48 hours: petechial, purpuric, gangrenous Rash spreads centripetally Diffuse edema
60
Why diffuse edema in rocky mountain spotted fever?
Capillary leakage Hypotension Spenomegaly Delirium
61
Treatment for Rocky Mountain Spotted Fever
Tetracycline (TCN) Doxycycline Chloramphenicol (children)
62
Spirochete that Causes Lyme Disease
Borrelia burgdorferi
63
Stage I of Lyme Disease
Erythema migrans Fever/chills Malaise Regional adenopathy
64
Stage II of Lyme Disease
Days to weeks after infection Multisystem involvement Fatigue and lethargy
65
Stage III of Lyme Disease
Lingers for months Arthritis Neuropathy Acrodermatitis chronica atrophicans
66
Treatment of Lyme Disease
Empirically while awaiting labs | Tetracycline x 30+ days
67
When do malaria symptoms occur?
12-35 days after exposure
68
Uncomplicated Malaria Case Symptoms
``` Fever Malaise Myalgias Arthralgias Headache Anemia Elevated WBC Low platelets ```
69
Complicated Malaria Case Symptoms
``` Fever Anemia Splenomegaly Altered consciousness Seizures ARDS Circulatory collapse Metabolic acidosis Renal failure Liver failure Coagulopathy DIC Intravascular hemolysis Hypoglycemia ```
70
PE Findings in Malaria
``` Pallor Petechiae Jaundice Hepatomegaly Splenomegaly Splenic rupture ```
71
Treatment of Malaria
Consult CDC for treatment for region exposed
72
Describe Clostridium Botulinum
Gram positive Rod-shaped Spore forming obligate anaerobic bacteria
73
5 Forms of Botulism
``` Foodborne Infant Wound Adult enteric Inhalation ```
74
Presentation of Botulism
``` Bilateral cranial neuropathies Symmetric descending weakness Absence of fever Responsive Normal/slow HR Normal BP No sensory deficits except blurred vision ```
75
Botulism Testing in Infants
Evaluate stool for spores and toxin
76
Botulism Testing in Foodborne Botulism
Serum analysis for toxin
77
Botulism Testing for Wound Botulism
Culture positive Negative serum assay Anaerobic culture
78
Botulism Testing for Adult Enteric Botulism
Evaluate stool for spores and toxin
79
Treatment of Botulism
Admit to hospital Monitor for respiratory failure Antitoxin (1+ years) Antibiotics (Wound)
80
Antibiotics for Treatment of Botulism
PCN G | Metronidazole
81
Transmission of Smallpox
Droplet Contact Airborne
82
When does smallpox spread most rapidly?
Cool, dry winter
83
Clinical Features of Smallpox
Non-specific prodrome Rash prominent on face and extremities Rash scabs over in 1-2 weeks Synchronous onset
84
Diagnosis of Smallpox
Appearance of rash | Culture of lesions: by immunized person, alert lab
85
Control of Smallpox
Decontaminate Prophylaxia Vaccine Contact/airborne isolation
86
Treatment of Smallpox
Supportive Isolate Immunize contacts Cidofovir
87
Bacteria that Causes Anthrax
Bacillus anthracis
88
3 Clinical Forms of Anthrax
Cutaneous Inhalation Gastrointestinal
89
Clinical Course of Anthrax
Papule -> vesicular -> eschar | Edema, redness and/or necrosis
90
Diagnostic Testing for Cutaneous Anthrax
``` Gram stain, PCR, culture of vesicular fluid, exudate, or eschar Blood culture (systemic symptoms) Biopsy ```
91
Clinical Presentation of Inhalation Anthrax
``` Myalgia Fatigue Fever +/- respiratory symptoms Hypoxia Dyspnea Rad evidence of mediastinal widening Meningitis ```
92
Clinical Presentation of Gastrointestinal Anthrax
``` Abdominal distress Bloody vomiting or diarrhea Fever Signs of septicemia Oropharyngeal ulcerations Cervical adenopathy ```
93
Treatment of Anthrax
Ciprofloxacin | Doxycycline

Emergency Medicine (17 decks)

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