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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