Lab Med Microbiology

cardio, croup and epi

outer most sac surrounding of the heart

pericardium

inflammation of the pericardium disease

infectious pericarditis

what is the most common cause of pericarditis

coxackie virus

what is dresslers syndrome

sudden onset of pericarditis weeks after a MI due to an autoimmune response

s/sx of pericardititis

pleuritic chest pain that worsens when laying down

improves with leaning forwards

pericardial friction rub

scratchy murmur

dx of pericarditis

diffuse ST segment elevations and PR depressions

tx of pericardtis

NSAIDS

colchicine

name of the thick heart muscle

myocardium

inflammation of the myocardium (disease)

infectious myocarditis

most common cause of infectious myocarditis

coxsacki virus

s/sx of myocarditis

young healthy person w a viral URI 1-2 ago and has a sudden onset fever and heart failure

Right HF in myocarditis sx

JVD, edema, hepatosplenomegaly

left HF in myocarditis

crackles, orthopnea, dyspnea, pink sputum

dx of myocarditis

BIOPSY = GOLD STANDARD

elevated inflam markers (CRP,ESR)

elevated troponin

tx of myocarditis

supportive care and heart failure management

inner most lining of the heart muscle

endocardium

bacterial infection of the endocardium (valves)

infectious endocarditis

most common cause of infectious endocarditis

what valve does it effect

staph aureus

mitral valve

inf endocarditis; IV drug user

what bacteria causes it

what valve does it effect

staph aureus

tricuspid valve

inf endocarditis; subacute damaged valves

what bacteria causes it

what pts do we see it in

strep viridians

pts w poor dentition or already damaged valves

infect endocarditis; pts w prosthetic valves

what bactera causes it

strep epidermis

infect endocarditis; pts w colorectal cancer

what bactera causes it

strep bovis

s/sx of infectious endocarditis

FROM JANE

F - fever

R - rothspots

O - osler nodes

M - murmur

J- janeway lesions
A- arrythmias
N - nail bed hemorrhages
E - emboli

what are oslers nodes

painful nodes on the fingers and toes

what are the TWO most common murmurs in IV drug users with endocarditis

mitral regurgitation

tricuspid regurgitation

what are janeway lesions

painless macules on the palms and solves

what is the most common block assocated with infec endocarditis

first degree AV block

tx for infectious endocarditis

vancomycin and cephalosporin
OR

nafcillin and oxacillin

what test is used to rapidly identify TB

acid fast staining

two ways to do a respiratory sputum test

nasal swab

sputum sample

most common cause of CAP

strep pneumo

most common cause of HAP

psuedomonas

what bacteria’s are identified as typical pneumonia

strep pneumo (MCC)

h. influenza

staph aureus

klebsiella pneumo

what bacterias are atypical pneumonia

(wont grow on gram stain or be treated w B lactams)

mycoplasm pneumo (MCC)

chlamydia pneumo

legionella pneumo

signs of a typical pneumonia

sudden onset

productive cough

high fever

signs of atypical pneumoia

insidious onset

dry cough

low grade fever

extra pulmonary findings

takes days to weeks

what do we find on a pneumonia physical exam

DC BITE

Dullness to percussion

crackles

bronchial breath sounds

increased breath sounds

tactile fremitis

egophony (e sounds like an a)

dx for pneumonia

1st line = chest x ray

sputum culture

what findings so you see on an atypical pneumo CXR

ground glass, interstitial infiltrates (Bilateral)

what findings so you see on a typical pneumo CXR

lobar consolidations (unilateral)

typical strep pneumo findings

diffuse body rigors
blood tinged/rust color sputum

gram + dipplococi

typical h influenza findings

elderly pt with respiratory issues

(COPD, asthma)

typical staph aureus findings

pt with acquired pneumonia after recovering from the flu

typical klebsiella findings

chronic alcoholics

currant jelly sputum

cavitary lesions on CXR

Atypical mycoplasma findings

young healthy people

skin rashes

cold agglutination hemolytic anemia

Atypical chlamydia findings

staccto cough in infants/kids

with a short cough w inhalation btwn each cough

Atypical legionella findings

pt exposed to contaminated water

excessive diarrhea - leads to hyponatremia

inflammation of the supraglottis and epiglottis

epiglottis

most common cause of epiglottis

h influenza and seen in unvaccinated people

s/sx of epiglottitis

very high fever, droopling, tripoding, stridor

dx of epiglottitis

lateral neck XR shows thumbpring sign

Laryngoscope (GOLD STANDARD)

tx for epiglottiis

ceftriaxone

inflammation of the larynx, trachea and subglottic airway

croup aka larynogotracheitis

mcc of croup

parainfluenza

s/sx of croup

URI symptoms

seal like barking cough

stridor

dx of croup

AP nexk XR shows steeple sign t

tx of croup

all receive steroids

if stridor at rest then give nebulized epi FIRST

if NO stridor at rest then only steroids

inflammation of the small airways (bronchioles)

broncholitis

mcc of bronchiolitis

RSV and seen in kids under 2y/o

s/sx of bronchiolitis

lots of nasal congestion

wheezing

dx of bronchiloitis

clinical

tx of bronchiolitis

nasal suction

supportive care

high flow nasal cannula if o2 below 90%

whistling sound heard during inspiration

stridor

rattling sound like air moving out of a bag during expiration

wheezing

pertussis (whooping cough) def

highly contagious infection causing systemic infections

Preventable w TDAP or DTAP

3 phases of pertussis explained

1. catarrhal - URI symptoms for 2 weeks

2. paryxysmal - severe coughing, inspiratory whoop and vomiting

3. convalescent - healing phase

most infective stage of pertussis

catarrhal phase

dx and tx of pertussus

dx clinical

tx axithromycin
PERTUSSY GETS THE ZUSSY

TB s/sx

fever, extreme weight loss, productive cough, chills/night sweats

screening for TB

TB skin test

IGRA (GOLD STANDARD)

dx of TB

CXR shows caseating granulomas

consolidations in upper lung apices t

tx of pertussus

RIPE

Rifampin, isonazid, pyranizamind, ethambutol

important to remember w TB skin test

pts w past TB or vacinated will show a FALSE POSITIVE

primary TB def

initial infection

bacteria is inhaled

immune system creates Ghon complex so bact is alive but dormant

latent TB def

pt is not infectious but still has TB bc of ghon complex

secondary TB def

immune system is distressed and ghon complex bursts allowing the bacteria to spread

what part of RIPE causes red/orange body secretions

rifampin

what part of RIPE can cause peripheral neuopathy

isonazid

what part of RIPE can cause photosensitive rash

Pyrazinamide

what part of RIPE can cause eye issues

ethambutol

what do we give a pt w latent TB

rifampin or isonazid for 4 months

influenza infection def w s/sx

highly contagious airbone disease

s/sx abrupt onset, diffuse muscle aches, fevers, URI

dx and tx of influenza

respiratory swab

oseltamivir (tamiflu) if Sx onset is Under 48 hours

4 stool testing dx

1. stool PCR

2. Stool culture

3. Ova and parasite

4. fecal occult blood

stool pcr tests for..

tests for DNA of bacteria

stool culture tests for..

bacteria growth on an agar plate

ova and parasite tests for..

ova and parasite eggs

fecal occult blood tests for

hidden blood aka colon cancer or GI bleeds

2 diarrheal illnesses and 1st line for BOTH

non bloody

bloody

HYDRATION

staph aureus (non bloody inf)

milk mayo eggs salads creams

tx. oral hydration

cholera (non bloody inf)

a country w poor water sanitation and hit w a natural disaster

diarrhea is described as rice water w a fishy smell

tx. hydration but tetracyclines (doxy) if severe

C diff (non bloody inf)

pt on clindamycin / pseudomembranous clotits on boards

tx. VANCO

2nd line - fidaxomycin

bacillus cereus (non bloody inf)

reheated fried rice

tx. oral hydration

norovirus (non bloody)

places w packed people (cruise ships)

tx. oral hydration

MCC of norovirus

adult gastroenteritis

rotavirus (non bloody inf)

unvacc kids w extreme diarrhea

tx. oral hydration

enterotoxigenic e coli (non bloody)

AKA travelers diarrhea seen in internation travel

tx. oral hydration

vibrio vilnificus (non bloody inf)

from eating bad seafood/fish or ocean water into a cut

tx. oral hydration

giardia (non bloody inf)

back packing diarrhea - in hitchhickers that drink water from springs and ponds

greasy and foul smelling

tx metronidazole or tinidazole

shingella (bloody inf)

kids in daycare who have bloody diarrhea and seizures

tx azithromycin