Test 2

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Answer

Rhinovirus

Picornaviridae family(hep a, polio); Icosahedral, + ssRNA; no capsule; Transmit: aerosol; prevelent: winter spring; Incu: 8-10hrs; Peak: 1-3 days; disease: nasopharyngitis, otitis media; Extreme: bronchitis

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Coronavirus

Coronavirdae family; Helical, enveloped, + ssRNA; Transmit: aerosol + fomites(can infect animals); Incu: 2-5 days; Syptoms: 1 wk; Nasopharyngitis, otitis nedia

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Pharyngitis

Most are viral: Corona, Rhino, adeno, CMV, flu, EBV, HSV, Coxsackie A; Bacterial caused: S. Pyogenes(most common), N. Gonno, C. diptheriae,; Presents: strawberry throat, erythema.

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S. Pyogenes - General(Stain, shape, respiration, etc.)

G+, diplococci, Faculatative;Group A(lansfield); Beta Hemolytic;

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S. Pyogenes - Virulence Factors

Streptolysin O(titer, lyses plts+wbc anerobically), S(lyses RBC aerobic), Streptokinase(thrombolytic), Hyaluronidase(chondrolytic), erythrogenic toxin(causes scarlet fever), M protein(resists phagocytosis, helps adhesion)

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S. Pyogenes - Pharyngitis

Affects: 1-15yo; Presents: erythema, pustules, petechiae(palate), cervical lyphadenopathy; Transmits: close contact, droplets; Incu: 1-4 days; Dx: SS, Rapid strept test(80%), Culture; Tx: 1st line: Pcn(amoxi+Clauv), 1,2gen ceph(ceclor); allegy:Macrolide

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S. Pyogenes - Acute glomerulonephritis

Non-Suppurative comp; 10 days after infection(resolved or not); 0-28%prevalance(children); men>females; 95% completely resolve(nephrotic syndrome), 1% permanant; Presents: azotemia(^BUN), HTN, olgria;

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S. Pyogenes - Rheumatic Fever

Non-Suppurative comp; Don't finish Ab; 2-4wks after infection; 4-9yo; females>males; 3% of Strept infections; Presents: carditis, arhtritis, erythema marginatum, Stenotic and insufficient mitral valve; Tx: High dose pen; secondary: ab up to life

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S. Pyogenes - clinical manifestations(supporative)

Scarlet fever - erythrogenic toxin causes rash(no palmar, plantar; 2-10yo; by day 2 rash; day 6 improve + peel; Pyodermal infections, Toxic Shock syndrome

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Pyodermal Infections

Staph or strept infection; crusty lesions; cellulitis(infect of subq, noninfectious); Impetigo(infectious); Tx: cephalexin, 2nd gen pen (dicloxacilin); allergy: clinda

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Acute otitis Media

Earache; children(2/3 by age 3); 40% viral(RSV+FLU); resp infection 4-7 days prior; causes: bct colony(S. pneumo, H. flu, M cat.); smoke, breast-rfeeding, tube dysf(x)'; pacifier, host immune defenses, genetics, cleft palate

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S. Pneumoniae - General(Stain, shape, respiration, etc.)

G+, diplococci, fac,; Causes: AOM(50% of bct caused), pneumonia, bct meningitis, sinusitis, bacteremia; Vaccine: ployvalent pneumoccocal vac.(65+ yo, splenectomy(sickle cell), immuno suppressed every 5 years.

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Acute Otitis Media - Treatment

Observe under 6 months, 6-2 years treat if ear pain+fever(uncertain); Amoxicillin, Bactrum, Azythomycin, Cefdinir(3rd) or cefuroxime(2nd) for 10 days

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S. Pneumonia - virulence factors

benign: hemolysin, protease, neuraminidase, hyaluronidase; Polysaccharide capsule(very virulent)

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Acute Epiglottitis - General(Signs&symptoms, prevelence, causes)

SS: fever, dysphagia, drooling, stridor; prevel: men, children, AA; Causes: H. flu B, S. pneumo, S. aureus, (strept group A,B,C&F)

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Acute Epiglottitis - treatment

1. Visualize stricture(x-ray, scope); 2. broad Ab:cefazoin(1st gen) or ampicilin and clavulanic acid 3. culture; 4: specific AB

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Acute Bronchitis - General(Signs&symptoms, prevalence, causes)

SS: fever, malaise, chest pain, no effusion(r/o pneumonia; prevel: winter months; Causes: mostly viral:corona, rhino, influ; Bct very rare: M. Pneumo(5%), C. Pneumo(5%), S. peneumo, H. flu(superimposed)

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Bronchiolitis - (Signs&symptoms, prevelence, causes)

SS: wheezing, nasal flaring, accessory muscles; Prevel: newborns and infants; Causes: mostly viral: RSV, Influ, parainflu, adeno; Bct: Atyp: myco, urea, chlamydia, special: pneumocystis

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RSV Bronchiolitis - General(virus shape, envelope, virulents, Diagnose, prevelence)

Helical, enveloped, -ssRNA; 75% causative of Bronciolitis; G, F protein: attachment; incu: 5 days; ELISA diagnosed; Prevel:winter, kids and immunocomp

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RSV Bronchiolitis - Treatment and prevention

respiratory support; fluid resucitation; bronchodilators; use to use ridivrin(stops RNA polymeerase); Ig for F protien(not standard); avoid crowded spaces, wash hands, no smoke

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Ambulatory Community Acquired Pneumonia - (Signs&symptoms, prevalence, causes)

SS:Dry cough, headache, malaise, dec. appetite, low fever; Prevel: prisons, college, military, not the old or young; Causes: M. pneumo(1), C. pneumo, Legionella, S. pneumo(3), viral(2).

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Ambulatory Community Acquired Pneumonia - Treatment

no comorbids: Azithro, clarithro, doxycycline,(anything broad enough to cover atypicals and strept). Comorbids: Levoquin, Arithro+Amoxicilin. (more strept coverage cause of increase likelyhood with comorbids.)

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Hospitolized Community Acquired Pneumonia - (Signs&symptoms, prevalence, causes)

SS: productive cough, yellow sputum, hemoptysis, respiratory difficulty; Prevel: young and old(immunocomprimised); Causes: S. pneumo, H. flu, Viral, S. aureus, M. Cat

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Hospitolized Community Acquired Pneumonia - Treatment

no comorbid: Rosephten(3rd)+Azithro; comorbid: levoquin; pneumovax: vac. against strept the most common cause of CAP; indicated for immunocomp., spleenectomy,

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Community Acquired Pneumonia(aspiration) - (Signs&symptoms, prevalence, causes)

SS: insidious, fever, cough, dragon breath, empyema(pus effusion); Prevel: decreased conciousness(druggies, drunks, strokes, seizures, peridontal disease); Causes: S. Pneumo, K. pneumo, peptostrept, bacteroides fragilis, fusobacterium nucleatum

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Community Acquired Pneumonia(aspiration) - Treatment

O2, pain meds, ^ CBC(left shift), BAL(culture); Drain empyema(culture), Clinda, PCN+ metronidazole(peptostrept), Unasyn(IV)/Augmentin(oral)

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Pneumonia-Nosocomial - General(Risk factors, Causes, Diagnosis)

RF: Exogenous(no hand washing), Patient(malnourished, immunocomp); Causes: Psedomonas, S. aureus(MS+MRSA), K. pneumo, E. Coli, Serratia marcrscens, H. Flu; Dx: blood cultures, o2 assess, BAL, PBS

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Pneumonia-Nosocomial - Treatment

NO MDR: ceftriaxone, Pipercillin/tazobactam, Levofloxacin; MDR: A(ceftazidime, cefepime, Pipercillin/tazobactam)+B(Levofloxacin, gentimicin, vacnomyocin)

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Risk factors for MDR

AB w/in last 90 days, Hospitolized > or = 5 days, from other health facility, high resistnace in community, immunosuppressed

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Salmonella

G- bacillus; bacteremia, Inflamed rrhea high ID; inc. risk: antacids; raw under cooked food, Summer months, pets & reptiles, contaminated H20; .

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Shigella

G- bacillus; inflamed rhea, shiga toxin; low ID, person to person, water and food borne; Flies, common in developing country

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Campylobacteria

G- rod, seagull shaped, inflamed rhea(intracellular); poultry contamination(livestock + pets); inc. in summer months(can live in wood)

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E. Coli

G - rod; 0157:H7 inflamed rhea; HUS; cholera like enterotoxin, children, shiga like toxin, travelers diarrhea(non inflamed

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Yersinia Enterocolitis

G - Bacillus; high ID; R sided abd pain; rare in us; children

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V. Cholerae

food and waterborne, cholera toxin, survive in ocean estuaries; seafood and shellfish; epidemics in India and Bangledesh; also seen in US

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Enteric Fever

S. Typhi and S. para typhi; typhoud fever; very ill: fevers chills, cough, lethargy, bloody rhea, abd distention, splenomegaly. rash on abd, positive blood cultures, leukocytosis;

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Antibiotic Associated Diarrhea

C. Diff G= sporeformer anerobic bacillus; toxin A enterotoxin(inflamed epithelium); Deadly(pseudomembranous colitis); vanco or metronidazole

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Norovirus

food and water borne; swimming pools and lakes; seafood; infected handlers; epidemic; mild, no Tx

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Rotovirus

Wheel like; 3-15 months; vommiting first then watery diarrhea; dehydration; resistant to hand-washing and many disinfectants; chlorine dactivates; problem: daycare

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Cytomegalovirus

HIV-Aids; 25% of diarrhea in HIV; abd pain, wgt loss, fever, watery diarrhea(inflamed); biopsy to confirm

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Amebiasis

giardia; gradual onset; cramps, pain, foul smell, fat in pp, RUQ pain; hepatomegaly; water contamination: west of mississippi(GR too)

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UTI - host contributing factors

vesiculoretero reflux; uncircumcised; neurological(caths); renal caliculi; tumors; preggers(hydronephrous; FB; infection at another site;

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UTI - bacterial factors

fimbrie, capsule, hemolysin, urease(stone)

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UTI - uncomplicated

not associated with any anatomic or structural deformity

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UTI - complicated

associated with anatomic or structural deformity

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UTI - community acquire

E. coli(80%); Staph sapro(10-15% women under 40yo); Proteus mirablilis

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Uncomplicated cystitis - treatment

Bactrum; Nitrofurantoin; Ciprofloxacin

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Pyelonephritis - treatment

ceftriaxone(best); levofloxacin(concentrates in kidneys and prostate); bactrum; siproflocacin

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Pyridium

symptomatic relief of pain, burning, urgency, frequency; analgeisa; contraindicated in renal insufficiency

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Peylonephritis in Preggers

Treat in hospitol; spontaneous respiratory distress; ancef then add gentimycin if needed; nitrofurantoin(macrobid); Amoxicillin

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Pernephric abcess

Rare; S. arueus, enterobacteriaceae); comes in with pyelo, abs don't help; CT or ultra; incise and drain

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