Approach to Acutely Ill Febrile Patient

Question 1

Fever may be absent

Answer 1

Elderly

Compromised host

Question 2

Cultures in IE

Answer 2

3 sets

Question 3

Organisms to detect presence of bacteria by buffy coat exam in asplenic patients

Answer 3

> 10(6) organisms/ml

10(4) in intact spleen

Question 4

Howell-Jolly bodies

Answer 4

Asplenia

Question 5

Course of management for meningitis

Answer 5

Blood culture > give antibiotics > imaging

Question 6

Infections requiring rapid surgical intervention before other diagnostics or therapeutic interventions

Answer 6

Necrotizing fasciitis

Clostridial myonecrosis

Question 7

Empirical treatment for sepsis without a clear focus

Answer 7

Vanco + Genta + Pip-Taz/Cefepime

Question 8

Empiric DOC for meningococcemia

Answer 8

Penicillin
or
Ceftriaxone

Question 9

May be used in fulminant meningococcemia

Answer 9

Protein C replacement

Question 10

Empiric DOC for Erythroderma:TSSS

Group A Strep, Staph aureus

Answer 10

Vanco + Clinda

Debridement should be done

Question 11

Empiric DOC for necrotizing fasciitis

Group A Strep, mixed aero/anaero

Answer 11

Penicillin + Clinda + Genta

If MRSA, Vanco over Pen

Question 12

Empiric DOC for Clostridial myonecrosis

C.perfringes

Answer 12

Penicillin + Clinda

Question 13

Empiric DOC for bacterial meningitis

S.pneumo, N.meningitidis

Answer 13

Ceftri + Vanco

Question 14

Treatment for Bacterial meningitis in patients >50 years old or with comorbid disease

Answer 14

Ampicillin for Listeria coverage

Question 15

Improves meningitis outcomes in patients with

pneumococcal meningitis
cloudy CSF
positive CSF Gram’s stain
CSF leukocytes >1000/mcL

Answer 15

Dexamethasone

Question 16

Empiric DOC with brain abscess, suppurative intracranial infections
(Strep spp, Staph spp, anaerobes, gram-neg)

Answer 16

Vanco + Metro + Ceftri

Question 17

Empiric DOC for cerebral malaria

P.falciparum

Answer 17

Quinine + Tetracycline

AVOID GLUCOCORTICOIDS

Question 18

Empiric DOC for Acute bacterial endocarditis

S.pneumo, B-hemolytic strep, HACEK, Neisseria spp, S.pneumo

Answer 18

Cefti + Vanco

Question 19

Can present with intractable hypotension and multiorgan failure

Answer 19

Gram-Neg: Pseudomonas, E.coli

Gram-Pos: S.aureus, Group A strep)

Question 20

Role of CRP and procalcitonin

Answer 20

Facilitate de-escalation of therapy NOT for diagnosis

Question 21

MC isolate in asplenic patients

Answer 21

Strep penumo

encapsulated organisms

Question 22

Characteristic of the rash of Meningococcemia

Answer 22

pink, BLANCHING, maculopapular becoming hemorrhagic forming petechiae

Question 23

Cutaneous manifestation of DIC

Answer 23

Purpura fulminans

Question 24

Causes of ecthyma gangrenosum

Answer 24

Septic shock caused by Pseudomonas or Aeromonas hydrophila

pts with neutropenia, extensive burns, hypogammglobulinemia

Question 25

Ingestion of contaminated shellfish

Answer 25

Vibrio vulnificus

Question 26

Distinguishes TSSS from other septic shock syndromes

Answer 26

Early renal failure precedes hypotension

Question 27

MC arboviral disease worldwide

Answer 27

Dengue

Question 28

Risk factors for necrotizing fasciitis

Answer 28

DM IV drug use Peripheral vascular disease

Question 29

Characteristic of cutaneous manifestation of untreated necrotizing fasciitis

Answer 29

Blue-gray patches on skin in 36 hours, cutaneous bullae and necrosis develop after 3-5 days

Question 30

Characteristic of cutaneous manifestation of clostridial myonecrosis

Answer 30

Bronze-brown, mottled, edematous, bullous lesions with SEROSANGUINOUS drainage and a MOUSY or sweet odor, (+) crepitus

Question 31

Poor prognostic findings in Bac Men

Answer 31

``` Coma Hypotension S.pneumo meningitis Respiratory distress CSF glucose <0.6 mmol/ (<10 mg/dl) CSF protein >2.5 WBC <5000/mcl Na <135 ```

Question 32

Usually from paranasal sinus infections

Answer 32

Subdural empyema

Question 33

Usually from facial or sphenoid sinus infection

Answer 33

Septic cavernous sinus thrombosis

Question 34

Usually from the ethoid or maxillary sinus infections

Answer 34

Septic thrombosis of the sup. sagittal sinus

Question 35

MC presentation of brain abscess

Answer 35

Headache

Question 36

Poor prognosis of brain abscess

Answer 36

``` Fulminant course Delayed diagnosis Abscess rupture into the ventricles Multiple abscesses Abnormal neuro status at presentation ```

Question 37

Clinical findings in cerebral malaria

Answer 37

``` High fever >40 C Hypotension Jaundice ARDS bleeding ``` Neuro: symmetric enceph, UMN dysfunction woth decorticate/decerebrate posturing

Question 38

Worse outcomes for spinal epidural abscesses

Answer 38

MRSA Higher vertebral level Impaired neuro status at presentation DORSAL than ventral location

Question 39

Jugular septic thrombophlebitis caused by Fusobacterium necrophorum

Answer 39

Lemierre’s disease

Question 40

DM + dusky or necrotic nasal turbinates + necrotic hard palate lesions

Answer 40

Rhinocerbral mucormycosis

Question 41

Hemorrhagic macules on palmes and soles of acute bacterial endocarditis

Answer 41

Janeway lesions

Question 42

MC findings in anthrax

Answer 42

Pulmo infiltrates, mediastinal widening, pleural effusion