ID and lymphatics

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176 Terms

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lymphatic system

vascular network of tissues and organs that produce, store, and carry WBCs that fight infections and other diseases

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lymph nodes

small, bean-shaped organs that filter substances in your body

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divider of anterior/posterior cervical lymph nodes

sternocleidomastoid

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strep lymphadenopathy

anterior cervical

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mono lymphadenopathy

posterior cervical

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L side enlarged supraclavicular lymphadenopathy

abdominal pathologies/cancer

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important ID history questions

sick contacts, length of fever, high of fever, hiking, travel, associated symptoms, symptom onset

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lymphadenopathy

enlarged lymph nodes to greater than 1cm

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streaking direction

towards lymph nodes

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important pmhx questions

recurrent infections, non-healing lesions, TB/HIV hx, malignancy, cardiac/renal disease, immunization

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important surgical hx questions

breast surgery, organ transplant, node biopsy

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lymphedema

buildup of lymph on one side/compartment of the body

DO NOT take BP on that side

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important fhx questions

malignancy, anemia, ID, TB, hemophilia, thyroid, cancer

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important social hx questions

TRAVEL, recreational drugs (esp IV), sexual/occupational history

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to note when palpating lymph nodes

enlargement, consistency, mobility, tenderness, size, warmth

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hard lymph node

could indicate malignancy

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tender lymph node

could indicate inflammatory process

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rapid enlargement of lymph nodes

could indicate malignancy

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slow enlargement of lymph nodes

could be a benign process

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lymph node size

less than 1 cm

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order of PE on head

occipital, post auricular, preauricular, tonsillar, submandibular, submental nodes

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order of PE on neck

anterior cervical, posterior cervical, supraclavicular, infraclavicular nodes

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enlargement of submandibular/submental nodes

salivary stones

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splenomegaly

palpable spleen in left upper quadrant

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botulism HPI

diplopia, dry mouth, dysphagia, dysphonia

recent ingestion of home-canned/smoked foods, honey in children <2

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botulism PE

pupils fixed and dilated, ptosis (droopy eyelid), normal mental fxn

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phonation CN

CN 9

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splenomegaly common condition

mono

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tetanus

caused by tetanospasmin neurotoxin, clostridium tetani (g+ rod found in soil)

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tetanus HPI

wound with possible contamination, lock jaw, spasms, trismus, dysphagia, irritability

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tetanus PE

neck stiffness, hyperreflexia, painful convulsions, muscle spasms

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tetanus prevention

dtap/tdap vaccine

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diptheria HPI

sore throat, nasal discharge, hoarseness, malaise, fever, myocarditis, neuropathy

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tetanus vs botulism

tetanus more spastic, botulism more floppy

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diptheria PE

grey membrane covering tonsils and pharynx

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rheumatic fever

immune process complication of GABHS

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rheumatic fever HPI/PE

2-3 weeks after GBS, rash

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rheumatic fever CASES criteria

carditis, arthritis, subcutaneous nodules, erythema marginatum, syndenham’s chorea

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rheumatic fever FRAPP criteria

fever, raised ESR/CRP, arthralgia, prolonged PR interval, previous RF

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rheumatic fever major and minor criteria for dx

2 major or 1 major/2 minor

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erythema marginatum

well delineated linear rash associated with rheumatic fever

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chlamydia

STI MC reported in US, F>M

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chlamydia social hx/ risks

new sexual partners, more than one sexual partner, hx of STIs, inconsistent use of condoms, MSM, WSW, co-infection with gonorrhea

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chlamydia sx in females

mucopurulent endocervical discharge, dysuria, urinary frequency

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chlamydia sx in males

epididymitis, prostatitis

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epididymitis

unilateral testicular pain, tenderness, hydrocele, swelling

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prostatitis

dysuria, pain with ejaculation, pelvic pain

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chlamydia dx in females

should be doing speculum exam

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chlamydia PE

vaginal/penile discharge, lymphogranuloma venereum

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chandelier sign

intense pain with gentle cervical manipulation upon exam

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c. diff

antibiotic induced diarrhea

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c. diff hx questions

recent abx/hospitalization, use of glucocorticoids

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c. diff sx

watery diarrhea with ≥3 stools in 24 hours, foul smelling diarrhea, low grade fever, abdominal pain

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c. diff PE

maybe hypotension, decreased bowel sounds, abdominal pain

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c. diff complications

ileus and megacolon

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shigellosis

closely related to e. coli, transmitted via fecal oral

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shigellosis hx

sexual practices/shigella outbreaks, anal intercourse (genital or oral), secondary household transmission

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shigellosis HPI

sx within 12-48 hours, fever and constitutional symptoms, watery diarrhea that becomes bloody, tenesmus

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tenesmus

urge to defecate but cant

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shigellosis PE

may appear dehydrated, turgor, pale oral mucosa

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campylobacter jejuni

MCC of acute gastroenteritis

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campylobacter jejuni sources

chicken, non-pasteurized dairy products, produce, seafood, untreated water

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campylobacter jejuni HPI

recent consumption of raw/uncooked poltry or eating something that touched it, seafood, meat, produce, animal contact, drinking untreated water

symptoms within 2-5 days

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campylobacter jejuni sx

within 2-5 days

fever, HA, myalgia, malaise within 12-48 hours before diarrhea

diarrhea may be bloody, abdominal pain, fever

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campylobacter jejuni PE

often normal, maybe dehydration

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campylobacter jejuni tx

fluids/electrolytes

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typhoidal salmonella

anaerobic g- bacilli MC in contaminated food/water

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typhoid fever incubation

7-14 days

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typhoidal salmonella HPI

fever, abdominal pain, headache, chills, anorexia, sweating, cough, malaise, nausea, vomiting, maybe diarrhea

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typhoidal salmonella PE

rash of rose spots, hepatosplenomegaly, epistaxis, intestinal perf/GI hemorrhage

meningitis/GB in 2-40%

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typhoidal salmonella hx clue

typhoid fever in travelers with febrile illness

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nontyphoidal salmonellosis

foodborne illness from eggs, poultry, undercooked meat, dairy, manufactured foods, fresh produce

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nontyphoidal salmonella social hx

repitle contact

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nontyphoidal salmonellosis HPI

sx within 6-72 hours

gastroenteritis, NV, NON BLOODY diarrhea, abdominal cramping, fever

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nontyphoidal salmonella PE

dehydration

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cholera

acute diarrheal illness caused by vibrio cholerae

infection acquired by ingestion of contaminated food/water

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cholera COD

severe hypovolemia

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cholera HPI

recent travel to 3rd world countries, natural disasters

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cholera sx

sudden onset severe frequent watery diarrhea

stool is gray, turbid, without fecal odor, blood, or pus

“rice water stool”

rapid development of hypotension, dehydration

may have vomiting, muscle cramps, weakness

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cholera PE

dehydration, hypotension, dry mucous membranes, decreased turgor

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rocky mountain spotted fever

caused by rickettsia rickettsii ticks

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rocky mountain spotted fever locations

NC, TN, OK, AK, MS

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rocky mountain spotted fever HPI

systemic illness, fever, chills, HA, NV, rash

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rocky mountain spotted fever PE

hepatosplenomegaly, delirium, seizures, polyarticular arthritis, myocarditis

rash begins on wrists and ankles, involves palms and soles, spreads to arms, legs, and trunk

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lym disease

caused by borrelia burgdorferi, tick bite

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MC location of lyme disease

CT, DE, DC, MA, MD, ME, MN, NH, NJ, NY, PE, RI, VT, VA, WV, WI

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lyme disease HPI

HA, stiff neck, myalgias, rash, travel to epidemic area

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lyme disease PE

erythema migrans (target lesion)

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coronavirus

viral illness caused by SARS-COV2c

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coronavirus transmission

respiratory droplets

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coronavirus progression

ARDS → hypercoagulable state → massive organ failure

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coronavirus HPI

fever, dry cough, myalgias, anosmia, fatigue, NV

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coronavirus PE

fever, tachycardia, hypoxia

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influenza

viral illness with A, B, C types

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flu A subtypes

H1N1, H1N2 H3N2

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flu transmission

respiratory droplets

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flu HPI

sick contacts, contagious 24 hours prior to symptoms

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flu sx

fever, chills, sore throat, cough, HA, myalgia

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flu PE

fever, tachycardia, lungs normal or rales if viral PNA

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HIV

retrovirus that infects CD4+ T-helper lymphocytes, macrophages, and dendritic cells