EM Infectious Emergencies

Question 1

what is a life-threatening organ dysfunction due to dysregulated host response to infection

Answer 1

sepsis

Question 2

what is lactate an indication of

Answer 2

hypoperfusion
- increased mortality

Question 3

What are initial orders for sepsis

Answer 3

IV/O2/Monitor
IV fluids
CBC, CMP, PT/PTT, Lactate, cultures, procalcitonin, ABG/VBG

Question 3

what does elevated procalcitonin correlate with

Answer 3

bacterial infections and sepsis
-acute phase reactant

Question 4

What is a scoring tool for sepsis

Answer 4

qSOFA (Quick SOFA)
- AMS
- RR
- SBP < 100

Question 5

What are exclusions for simple cellulitis

Answer 5

bite wounds
water exposure
post op wounds
immunocompromised wounds
locatoin
perianal/perirectal

Question 6

What is a collection of purulent discharge, may be associated with opening in skin or from entry through hair follicle

Answer 6

abscess

Question 7

what are exam findings for abscess

Answer 7

area of fluctuance
erythema
pain
US findings

pretty much always MRSA

Question 8

What are risk factors for MRSA

Answer 8

IVDU
health care
homelessness
nursing home
incarceraton
multiple lesions

Question 9

what covers MRSA

abx

Answer 9

Bactrim
Doxycycline
Clindamycin
Vanco

Question 10

what is toxic shock associated with

Answer 10

tampon use
nasal packing
surgical wounds
postpartum infections

Question 11

how does toxic shock present

Answer 11

erythematous rash which will dequamate on hand/feet
- sunburn-like rash
febrile and hypotensive

Question 12

how is toxic shock treated

Answer 12

remove source of infection and start abx with CLindamycin and Vanco
- admit

Question 13

how does necrotizing fasciitis spread

Answer 13

through muscle fascia, may have anesthesia of skin prior to necrosis
can extend into muscle or skin

Question 14

how is necrotizing fasciitis diagnosed

a

Answer 14

air on imaging
finger test (numb area finger into wound)
check electrolytes

Question 15

What is Fourniers Gangrene

Answer 15

necrotizing fascitits of perineum and most commonly involving scotum

Question 16

what is the presentation of fourniers gangrene

Answer 16

severe pain that typically starts along anterior abdomen and can migrate to gluteus and genitals

Question 17

what is erysipelas

Answer 17

infection of epidermis, upper dermis and lymphatics
m/c on face or LE

Question 18

what is the presentation of anaplasmosis and ehrlichiosis

Answer 18

acute illness with fever, malaise, HA, chills, N/V, arthralgias
non-specific maculopapular rash, strawberry tongue, conjunctivitis, hepatosplenomegaly, neurologyic symptoms

Question 19

when do symtpoms of ehrlichiosis (HME) occur

Answer 19

1-2 weeks after the bite

Question 20

when do symptoms of anaplasmosis (HGA) occur

Answer 20

5.5 days

Question 21

what is the treatment of anaplasmosis and ehrlichiosis

Answer 21

Doxycycline 100mg BID 5-7 days

Question 22

how long does RMSF usually last

Answer 22

10-20 days
- pt becomes sick within 1 week after inoculation

Question 23

what is the presentation of early disseminated Lyme

Answer 23

2-4 weeks after erythema migrans
can develop lymphocytic meningitis, carditis (AV nodal block), MSK invovlement, multiple erythema migrans lesions, lymphadenopathy, conjunctivitis, LFT abnormalalitis, proteinuria

Question 24

what is the presentation of late/chronic lyme

Answer 24

intermitten monoarticular arthritis, neurologic disease (neuropathy, or encephalomyelitis)

Question 25

what is the most common pathogen with infective endocarditis

Answer 25

streptococci or staphylococci

Question 26

what are risk factors for infective endocardidits

Answer 26

IVDU immunocompromised dental or surgical procedures congenital or acquired heart disease

Question 27

what are janeway lesions

Answer 27

non-tender erythematous macules on palms or soles

Question 28

what are osler nodes

Answer 28

tender subQ nodules on finger/toes

Question 29

what is the diagnostic criteria for infective endocarditis

Answer 29

Duke Criteria - 1 major, 3 minor

Question 30

what diagnostic test is necessary for dx of infective endocarditis

Answer 30

TEE

Question 31

what is the treatment of infective endocarditis

Answer 31

broad spectrum abx - i.e. Vanco

Question 32

What is the presentation of infective carditis

Answer 32

fever, anorexia, malaise, HA, arthralgias, nigh wears, murmurs, petechiae, splinter hemorrhages, janeway lesions, oslers node

Question 33

what is the most common pathogen with UTI

Answer 33

E. coli

Question 34

what is the treatment of uncomplicated UTI

Answer 34

abx 3-5days (Nitrofurantoin, Bactrim, Keflex)

Question 35

what are symptoms of upper urologic infection?

Answer 35

fever severe pain AMS PG Comorbiditis N/V flank pain

Question 36

what should be considered if a patient presents with UTI with fever or CVA tenderness

Answer 36

pyelonephritis

Question 37

what is the treatment of pyelonephritis

Answer 37

ciprofloxacin x 7d consider one time IM dose ceftriaxone followed by Bactrim, augmentin, cefpodozime

Question 38

what is the presentation of prostatitis

Answer 38

pain with BM difficulty with urination, frequency pain with DRE

Question 39

what is the treatment of prostatisis

Answer 39

limited abx penetrate prostate tissue, will need longer course (4-6 weeks) if non STI: Bactrim BID or Ciprofloxacin if inpt: IV Cipro

Question 40

How is PEP started

Answer 40

3 drug regimen for 4 weeks - start within first few hours after exposure

Question 41

what is the most common STI in the US

Answer 41

chlamydia

Question 42

what is the presentation of chlamydia

Answer 42

first - cath urine (m or f), or endocercial or urethral swab

Question 43

what is the treatment of chlamydia

Answer 43

doxycycline

Question 44

what is the treatment of Gonorrhea

Answer 44

High dose Ceftriaxone IM

Question 45

what is the presentation of herpes

Answer 45

genital ulcers, fever, lymphadenopathy, HA, dyuria

Question 46

how is herpes dx

Answer 46

clinical can confirm with viral swab

Question 47

what is the treatment of herpes

Answer 47

sitz baths for pain so they are able to urinate acyclovir or valacyclovir

Question 48

how long after exposure will syphilis chancre form

Answer 48

4-12 weeks after exposure resolves in 4-6 weeks

Question 49

what is the treatment of syphilis

Answer 49

penicillin G IM for PCN allergic: doxyclicline

Question 50

What is the treatment of Neutropenic fever

Answer 50

empiric abx fluids admit

Question 51

What are do not miss back pain

Answer 51

cancer AAA Fracutre infection cord syndrome

Question 52

What are risk factors for spinal infections

Answer 52

IVDU, immunocompromised

Question 53

what is the presentation of spinal infection

Answer 53

fever + back pain, midline tenderness

Question 54

what is a inflammatory disease affecting leptomeninges

Answer 54

bacterial meningitis m/c strepto and meningitides

Question 55

what is the presentation of bacterial meningitis

Answer 55

fever nuchal rigidity severe HA AMS N/V seizures aphasia petechiae

Question 56

what is the treatment of bacterial meningitis

Answer 56

Rocephin Vanco Dex

Question 57

What is the classic triad of bacterial meningitis

Answer 57

fever stiff neck change in Mental status

Question 58

what is the diagnostic procedure of choice for bacterial meningitis

Answer 58

lumbar puncture

Question 59

What is the presentation of viral meningitis

Answer 59

febrile no neurological dysfunction HA stiff neck maculopapular rash muscle aches N/V pharyngitis fatigue

Question 60

What is the presentation of brain abscess

Answer 60

HA fever neck stuffness focal neuro deficit seizures CN6 palsy secondary to elevated ICP

Question 61

what is the treatment of brain abscess

Answer 61

Vanco + Metronidazole(IV) + Ceftriaxone(IV) 4 - 8 weeks

Question 63

what happens if brain abscess ruptures

Answer 63

patient dramatically declines