ID and lymphatics

lymphatic system

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

lymph nodes

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

divider of anterior/posterior cervical lymph nodes

sternocleidomastoid

strep lymphadenopathy

anterior cervical

mono lymphadenopathy

posterior cervical

L side enlarged supraclavicular lymphadenopathy

abdominal pathologies/cancer

important ID history questions

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

lymphadenopathy

enlarged lymph nodes to greater than 1cm

streaking direction

towards lymph nodes

important pmhx questions

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

important surgical hx questions

breast surgery, organ transplant, node biopsy

lymphedema

buildup of lymph on one side/compartment of the body

DO NOT take BP on that side

important fhx questions

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

important social hx questions

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

to note when palpating lymph nodes

enlargement, consistency, mobility, tenderness, size, warmth

hard lymph node

could indicate malignancy

tender lymph node

could indicate inflammatory process

rapid enlargement of lymph nodes

could indicate malignancy

slow enlargement of lymph nodes

could be a benign process

lymph node size

less than 1 cm

order of PE on head

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

order of PE on neck

anterior cervical, posterior cervical, supraclavicular, infraclavicular nodes

enlargement of submandibular/submental nodes

salivary stones

splenomegaly

palpable spleen in left upper quadrant

botulism HPI

diplopia, dry mouth, dysphagia, dysphonia

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

botulism PE

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

phonation CN

CN 9

splenomegaly common condition

mono

tetanus

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

tetanus HPI

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

tetanus PE

neck stiffness, hyperreflexia, painful convulsions, muscle spasms

tetanus prevention

dtap/tdap vaccine

diptheria HPI

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

tetanus vs botulism

tetanus more spastic, botulism more floppy

diptheria PE

grey membrane covering tonsils and pharynx

rheumatic fever

immune process complication of GABHS

rheumatic fever HPI/PE

2-3 weeks after GBS, rash

rheumatic fever CASES criteria

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

rheumatic fever FRAPP criteria

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

rheumatic fever major and minor criteria for dx

2 major or 1 major/2 minor

erythema marginatum

well delineated linear rash associated with rheumatic fever

chlamydia

STI MC reported in US, F>M

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

chlamydia sx in females

mucopurulent endocervical discharge, dysuria, urinary frequency

chlamydia sx in males

epididymitis, prostatitis

epididymitis

unilateral testicular pain, tenderness, hydrocele, swelling

prostatitis

dysuria, pain with ejaculation, pelvic pain

chlamydia dx in females

should be doing speculum exam

chlamydia PE

vaginal/penile discharge, lymphogranuloma venereum

chandelier sign

intense pain with gentle cervical manipulation upon exam

c. diff

antibiotic induced diarrhea

c. diff hx questions

recent abx/hospitalization, use of glucocorticoids

c. diff sx

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

c. diff PE

maybe hypotension, decreased bowel sounds, abdominal pain

c. diff complications

ileus and megacolon

shigellosis

closely related to e. coli, transmitted via fecal oral

shigellosis hx

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

shigellosis HPI

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

tenesmus

urge to defecate but cant

shigellosis PE

may appear dehydrated, turgor, pale oral mucosa

campylobacter jejuni

MCC of acute gastroenteritis

campylobacter jejuni sources

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

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

campylobacter jejuni sx

within 2-5 days

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

diarrhea may be bloody, abdominal pain, fever

campylobacter jejuni PE

often normal, maybe dehydration

campylobacter jejuni tx

fluids/electrolytes

typhoidal salmonella

anaerobic g- bacilli MC in contaminated food/water

typhoid fever incubation

7-14 days

typhoidal salmonella HPI

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

typhoidal salmonella PE

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

meningitis/GB in 2-40%

typhoidal salmonella hx clue

typhoid fever in travelers with febrile illness

nontyphoidal salmonellosis

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

nontyphoidal salmonella social hx

repitle contact

nontyphoidal salmonellosis HPI

sx within 6-72 hours

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

nontyphoidal salmonella PE

dehydration

cholera

acute diarrheal illness caused by vibrio cholerae

infection acquired by ingestion of contaminated food/water

cholera COD

severe hypovolemia

cholera HPI

recent travel to 3rd world countries, natural disasters

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

cholera PE

dehydration, hypotension, dry mucous membranes, decreased turgor

rocky mountain spotted fever

caused by rickettsia rickettsii ticks

rocky mountain spotted fever locations

NC, TN, OK, AK, MS

rocky mountain spotted fever HPI

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

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

lym disease

caused by borrelia burgdorferi, tick bite

MC location of lyme disease

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

lyme disease HPI

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

lyme disease PE

erythema migrans (target lesion)

coronavirus

viral illness caused by SARS-COV2c

coronavirus transmission

respiratory droplets

coronavirus progression

ARDS → hypercoagulable state → massive organ failure

coronavirus HPI

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

coronavirus PE

fever, tachycardia, hypoxia

influenza

viral illness with A, B, C types

flu A subtypes

H1N1, H1N2 H3N2

flu transmission

respiratory droplets

flu HPI

sick contacts, contagious 24 hours prior to symptoms

flu sx

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

flu PE

fever, tachycardia, lungs normal or rales if viral PNA

HIV

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