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Pneumolysin
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Non-protective inflammation
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Spirochetes
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Different from rickettsia
Includes:
Treponema pallidum- syphilis
Leptospira- Leptospirosis
Borrelia- Relapsing Fevers
Borrelia burgdorferi- Lyme Disease
Spirillim minus- Rate Bite Fever
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T Wave
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ventricular replorization
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Diphtheria
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Worst Corynebacteria
Spreads by respiratory droplets
Causes: psuedomembrane at back of throat (suffocation)
Has phospholipases to promote spread & increase vascular permeability
Phage encoded toxin: interferes w/ protein synthesis by inactivating EF-2 = necrotic cells that build up to form pseudomembrane
Pseudomembrane: fibrin, bacteria, epithelial & phagocytic cells
Toxin-mediated: can spread to heart affecting cardiac myocytes
Identified: selective cysteine-tellurite media-specific for Diph.
Vaccine: toxoid, immunologically active, non virulent toxin mimic
Series: DAaPT, acellular pertussis tetanus combo
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Lepromatous Leprosy
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Depressed cell-mediated response
Bacteremia w/ localization in nerves & skin
High number of organisms
Less nerve function loss
Also involves: testes, spleen, liver
Leonin facies
Acid fast tissue stain
Different organisms
Coller areas of skin loaded w/ different species
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M. kansasii
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Photochromagen
Non-pigmented colonies but turns bright yellow in light
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Brucella
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Bioterrorism
Small gram negative coccobacillus
Intracellular pathogen
Fastidious
Slow growing
Pass to humans through food direct contact
Most common strain: B. melitensis
Intermittent, undulating fevers of unknown origin
bone marrow & blood cultures are preferred
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Fusobacterium
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Gram Negative Bacilli
Pleiomorphic
Not uniform
Can be sole agent (can be seen in an empyema (pulmonary infection w/ effusion)
Disease: Lemierre\'s Syndrome
Colonies: nondescript
Strict anaerobes
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Clostridium difficile
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Mostly hospitalized patients
Antibiotic-assoc. diarrhea
Very resistant
Toxins produced cause diarrhea
Causes pseudomembranous colitis (extreme)- can see plaques on colon
Plaques preceded by diarrhea; associated w/ clindamycin use
Test: often, diarrhea treated by Metronidazole (anti-anaerobe) or Vancomycin (second line)
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Lactobacilli
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Non-spore Gram positive bacilli
Positive role: maintain acidity of vagina
Serves as defense
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Hematocrit (HCT) normal ranges
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40-50%
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QRS complex
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Depolarization of ventricles
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Rhodococcus
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Gram positive
Weakly acid fast bacilli
Can revert to coccoid forms
Common in animals & environment
Opportunistic lung infections (esp. AIDS, transplants)
Facultative intracellular pathogen-survives in macrophages
Leads to granuloma & abscess
Produces: slow-growing, mucoid salmon-colored colonies of R. equi on chocolate agar
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Corynebacterium
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Like bacillus
Found: skin, commensals of skin, contaminants of culture
Major example: Diphtheria-- there is vaccine
Gram positive, curved pleiomorphic rods
\"Chinese Letters\"; aka diphtheroids
Aerobic/facultative anaerobic
Grow on sheep blood agar
Catalase positive
Oxidase positive
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Listeria monocytogenes
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Gram positive bacilli/coccobacillis (oval organism)
Catalase positive
Motile
Esculin positive
Beta hemolytic
Habitat: refrigerator; multiply at 4 degrees C- food bourne
Epidemiology: asymptomatic, meningitis/sepsis in immunocompromised; neonatal infections (transplacental)
Genotype: determines strain similarity of seemingly related cases-restriction enzymes w/ electrophoresis
Pathogenesis: low temp., facultative intracellular pathogen (in macrophages), makes hemolysin (listeriolysin)-can open RBC, asymptomatic carriage reservoir
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Bacillus cereus
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Common in environment
Cause gastroenteritis, ocular infection (self-limiting)
Enterotoxins: heat stable (emetic) & heat labile (diarrheal)
IV catheter-related blood stream infection, endocarditis, meningitis
Usually immunocompromised, drug abusers
Must distinguish between contaminant of culture or cause of infection
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Prpionibacterium
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Non-spore Gram positive bacilli
Could be cause of acne
Don\'t usually cause infection
Can contaminate blood culture
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Pertussis Detection and Prevention
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Detection:
Nasopharyngeal swab
Bordet-Gengou or Regan-Lowe enriched horse blood-charcoal medium-- not used
Measure Ab titers
Main method: detection of symptoms
Prevention:
Acellular vaccine- DaPT
Older vaccine: did not provide specific antigens
Abs to toxins stop attachment
Adults: Tdap
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Pertussis Toxins
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Pertussis toxin: adherence
Adenyl cyclase/hemolysin: incr. cAMP, inhibits phagocytosis & monocyte migration
Lethal toxin: inflammation & local necrosis
Tracheal cytotoxin: Kills resp. epith. cells; stimulates release of IL-1
Endotoxin (LPS): activates alternate complement, cytokine release
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Listeriolysin
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Escape from phagosomes
Type: membrane disrupting
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Hemoglobian (Hgb) normal ranges
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13.5g/ dL
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P Wave
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depolarization of the atria
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Actinomyces israelii
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Non-spore forming Gram positive bacilli
Rods seem to branch off of each other
Slow growing
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Lemierre\'s Syndrome
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Fusobacterium in oral cavity
High mortality rate
Essential jugular vein thrombosis
Organism gets into tissue all the way down to jugular vein
High mortality rate
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Microaerophilic
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Cannot grow under atmospheric oxygen; must have reduced oxgygen
Ex: Campylobacter
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Enterotoxigenic E.coli (ETEC)
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Causes: secretory diarrhea
Labile toxin: related to cholera; does not secrete as much or grow as large of numbers; activates adenylate cyclase (incr. Na+ & Cl- permeability
Stable toxin: activates guanylate cyclase; decreases Na+ & Cl- absorption
Toxin coded by extragenomic plasmid DNA
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Clostridium botulinum
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Toxin is preformed
Causes flaccid paralysis so can\'t fire motor neurons
Progressive
Eventually diaphragm does not work
Select agent; requires license for lab
Food bourne toxin associates w/ other proteins in meal to prevent lysis/degradation in stomach
In vivo production only seen in infant botulism
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Anaerobic bacteria
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Some are obligate
Others are aerotolerant (can withstand some oxygen)
Lack cytochrome systems, superoxide dismutase and/or catalase
Categories: gram positive or negative
Rods or cocci
Ex: gram negative rods- part of normal flora, opportunists
Gram positive- also vary; part of normal flora
Most infections are MIXED
Will often see abscess formation
Habitat: mutliple, can be aspirated, oral cavity (esp. with poor dental hygiene), colon (disruption: pelvic inflammatory disease, endometritis), foot & decubitis ulcers
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Malaria (Plasmodium vivax)
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Host: erythrocytes
Attachment: Duffy blood group antigen
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Diphtheria toxin
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ADP-ribosylation of host elongation factor 2-- stops protein synthesis
Type of Toxin: A-B
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Rickettsia rickettsii
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Small, gram negative pleiomorphic obligate intracellular parasite
Causes RMSF
Life cycle in tick: go through ovary and have transovarial passage to wind up in gut of tick
Not common
Unlikely in winter
Chances increase in: children, men, whites, dog exposure, wood activities
Pathogenesis: contact w/ infected tick that must bite you, digest tissue to get to blood, and deposit R. rickettsii
Hallmarks: Perivascular infiltration w/ mononuclear cells, vascular necrosis, microinfarcts, thrombosis
Symptoms: incubation of 7 days; macular, papular, petechial rash, history of tick bite, fever, malaise, headache, myalgia, vomiting & abdominal pain, CNS problems (encephalitis which causes confusion, lethargy, seizures, coma or death)
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Rickettsia
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Includes rickettsia group which has rocky mountain spotted fever and the typhus group
Targets endothelial cells
Hallmarks: Rash, fever, headache (due to CNS involvement), thrombocytopenia and neutropenia
Dx: serological
Tx: Doxycycline
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Toxic Shock Toxin
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Non-protective inflammation
Type of Toxin: Superantigen
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Streptocacceae
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Family that includes streptococcus and enterococcus
Both form long chains
Enterococci is normal in stool; strep is not
Easily spread through aerosolization of S. pneumoniae in lungs or other kinds in stool
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TB prevention
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Decrease exposure
Air exchange to reduce organisms in air
UV irradiation
Chemoprophylaxis: after positive skin test- must rule out disease first then give Isoniazid (6-9 mo.)
BCG vaccine: can give positive skin test up to 10 yrs. after- against primary disease only
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Bacillus (general)
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Most serious: anthrax
Ubiquitous in soil
Gram positive rods; can be gram-variable
Form spores- resistant to radiation, chemicals, heat, dessication b/c has dipicolinic acid
Aerobic, can be facultative
Beta hemolytic
Motile
Large gray spreading beta hemolytic colonies
Catalase Positive
Note: non anthrax are not beta hemolytic or motile
Common environment commensals w/ occasional opportunistic infection
B. cereus are most important
B. antracis- other
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Cardiac Output formula
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CO= SV x HR
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Syphilis
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Spiral bacteria, too thin for gram stain, so identified by dark field microscopy
Mortality caused by cardiovascular & neurological disease
Congenitally transmitted & life-threatening to children born to infected mothers
Antibiotics have greatly decreased rates
US- highest syphilis rate of developed country; Alabama is #2
Highest rates in times of social upheaval & esp. in minorities
Rates increase in people of ages that are sexually active & in men
Infection: invades blood vessels, infects bl. vessels, causes lesions
First stage: infection of bl. vessels at site of invasion (see genital ulcers, painless)
Tissue reacts & dies, causes inflammatory response
Second Stage: bacteria disseminate throughout body, infecting bl. vessels (hallmark is rash of syphilis in places of lower temp. due to leaky bl. vessels), will resolve w/o therapy & enter latent phase
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Anaerobic tests and treatment
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Quick tests:
Aminoglycoside growth splitting bile esculin, which grows on bile
Gram stain
Tx:
Varies
Abscesses are drained; cannot just be treated w/ antibiotics
Mixed infections require a cocktail
Aminoglycosides are NOT effective
Antitoxins & antibiotics if active infection vs. intoxication
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Enterohemorrhagic E.coli (EHEC)
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Mild diarrhea; sometimes hemorrhagic colitis
5% hemolytic uremic syndrome-- causes death
Most common strain: O157:H7
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Necrotizing Fascitis
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Associated w/ Strep and Bacteroides fragilis
Once established, must be debrided
Lots of necrosis & tissue destruction
Some tx w/ hyperbaric chambers
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Mycobacteria
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Acid fast stain
Do not know species w/o further testing
Staining: defined by mycolic acids- unable to be decolorized by acid fast solution
Contains waxes
Obligate aerobes
Slow groing (eg TB)
Not designed to be pathogens
Usually infect immunocompromised
Live in amoeba or human macrophages
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Tuberculoid Leprosy
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Intact cell-mediated response to M. leprae
Grow in nerves in cooler parts of body; cause nerve damage; form granulomas
Not in tissue often
Cutaneous loss of sensation: discolored skin, loss of digits as result of loss of sensation (stupid choices)
Non-progressive disease
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Viridans streptococci
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Number of species that are similar
Alpha & Gamma hemolytic
Human host
Differentiate biochemically
Cause dental carries/tooth decay, GI malignancies or endocarditis
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Bacterial Cell Walls
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Gram positive: thick peptidoglycan layer
Gram negative: thin peptidoglycan layer, outer membrane
Mycobacterium: complex cell wall, outer membrane w/ mycolic acids, waxes, lipoarabinomannan (LAM), galactomannan
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T.E.D. Hose
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Heavy elastic socks-patient needs to be laying down-really tight, want to have no wrinkles-supine when putting them on- remove @ night
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Ischemia
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really pain, skin starts to "sluff off', treat like a burn
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Preload
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Amount of blood that enters the heart)
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Coagulase Positive Staphylococci
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S. aureus is only significant pathogen
Ferment mannitol
IgG binding protein (protein A)
Coagulase positive
Cell walls have teichoic acid
Common infections: bacteremia, vascular infections like endocarditis; skin & soft tissue infection like abscess; food poisoning; bone & joint infection; surgical site infections; sepsis (assoc. w/ multi organ failure)
Drug resistance: penicillin, methicillin, vancomycin...
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Hemolytic Uremic Syndrome
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Shiga-like toxin specific for removing single adenosine from 28S rRNA
Cell loses ability to product protein
Renal glomeruli are big targets for toxin
Kids: kidney trouble
Adults: thrombocytopenia
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Vibrio Cholerae (NOT Enterobacteriaceae)
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Causes: secretory diarrhea from adenylate cyclase activation of water & electrolyte secretion
Spread: contaminated water
Host protection: stomach acid; infectious dose is 10^7 organisms
Cholera Toxin: B subunit binds intestinal cells; A subunit irreversibly activates adenylate cyclase
Treatment: hydration
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Pathogenesis of Clostrida
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Pathogenesis: synergy b/t Clostridia & facultative organisms in an abscess b/c facultative reduces oxygen = better environment for anaerobe
Capsule = antiphagocytic
Toxin production
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Enterobacteriaceae Common Characteristics
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Gram Negative Rods
Rounded ends & straight parallel sides
Colony Morphology on Sheep blood agar: 2mm colonies, dull gray
Sometimes Present: hemolysis, mucoid, swarming, pigmented colonies
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What is the most common factor of cardiovascular diesease?
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hypertension
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Cardiac Catherization
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put through the femoral artery into the right atrium, checking for pressure. After care--watch for external bleeding, have to keep leg straight, make sure patient doesn't bend leg!!!!!!! Check to make sure they don't have any sort of dysrrthemias.
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What is a PTT?
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Partial thromobplastin time test, tells us about the body's ability to clot
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Oral hygiene and bacteria
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Can see Fusobacterium (long, pointy rods), Treponema (thin, wavy), Bacteroides
If don\'t clean mouth, crypts close up; byproducts of metabolism cause problems
Vigorous teeth brushing produces bacterial shower-- requires prophylaxis for mitral valve prolapse or heart valve problems
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Streptococcus pyogenes- Group A
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Gram positive cocci in long chains
Catalase negative
Beta hemolytic- caused by Streptolysin S
Bacitracin disk (A disk) susceptible
PYR positive- turns red
Diseases: pharyngitis can lead to rheumatic fever
Skin: erysipeals, impetigo, cellulitis- can lead to glomerulonephritis
Erysipelas: well demarcated
Cellulitis: soft borders
Pneumonia- very rare (Jim Henson)
Scarlet Fever: erythematous rash w/ prominence along axillary & inguinal creases (Pastia\'s lines)
Strawberry tongue
Virulence Factors: M-protein- antiphagocytic, lipoteichoic acid-aids adherence to tissues, protein F- binds fibronectin; Protein G-binds Fc portion of Abs & inactivates, DNPase-kills WBC
Test: 90% positive, swab, treat with antibiotics while waiting for results
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Toxic Shock Syndrome
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1980\'s: New tampon that grew S. aureus
S. aureus secreted TSS
Nonmenstrual: seen w/ wounds
Staph form is less deadly than Strep form
Manifestation: fever, malaise, feeling bad, rash like sunburn
After effects: desquamation esp. hands & feet
Potential consequences: multi-organ failure; immune system over activation = hypotensive
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Cardiovascular System Primary Function and what the heart needs to do (3)
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Primary function: transport oxygen to rest of bodyNeeds (3): 1. ability to generate and conduct electrical impules, 2. heart needs to be able to fill and empty properly, 3. Strong enough to contract
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Who is at risk for impaired skin intergirty?
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DVT patients
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Diagnosis of anaerobic infection
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Clinical sign: foul smell from short chain fatty acid byproducts of anaerobic metabolism
Proximity to mucosal surface
Gas in tissue
Abscess formation
Gram stain: often shows MIXED infection
Culture: should aspirate abscess
Media: complex but often use aminoglycosides to suppress facultative organisms that may be present b/c anaerobes are not susceptible
Grow in absence of O2
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Definition of Afterload
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Amount of resistance the heart has to pump against (plague build up--heart has to pump harder)
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What do treadmills do?
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Look at heart during exercise, what kind of electrical abnormalities do we see?
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Brawny Edema Definiton
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full of fluid, no pitting because it is so hard
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What is a PT?
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Prothroymbin test, tells us about the effects of Coumadin, and how lot it takes to clot
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TB disease morphology & colony morphology
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Disease: caseous necrosis, cavity can form after cleared, where organisms becomes aerosolized
Lab: M. tuberculosis - crunchy
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Arterial Clot vs. DVT clot skin color
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pale vs. red (getting engourged)
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Detection of genital mycoplasmas & ureaplasma
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M. hominis & ureaplasmas grow rapidly in specialized medium but they are fastidious
Serology is NOT useful
M. genitalium is slow growing
PCR used
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What level should the bed be at when checking for jugular vein distention?
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30-45 degress, or semi-fowler
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4 areas of the heart to listen to
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aortic, pulmonic, tricuspid, mitral valve
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Indications of decreased CO (7)
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1. HR would increase.2. BP would go down after a while.3. Decreased LOC, restlessness, anxiety, and confusion.4. Looks and is syonotic, not perfusing.5. O2 sats would drop. 6. As BP decreases, urine output would decrease7. edema in dependent areas
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Arterial Clot vs. DVT clot capillary reflex
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greater than 3 seconds, vs. no change
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Cardiac Output definition and normal range
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Tells us how efficient the pump is, the cardiac output is the amount of blood pumped per minute (3.5-8L)
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Stroke Volume definition and normal range
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amount of blood pumped for every beat of contraction (70 ML)
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What should the nurse feel for? Over what area?
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The nurse should feel for thrill (which sounds like a cat purring) over the PMI
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What should you feel the carotoid for?
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feel for a thrill, or a swishing sound which is called a BRUIT
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