Extra-Pulmonary Infections

Question 1

Seizures in meningitis should prompt investigation for what two pathogens?

Answer 1

Listeria or HSV

Question 2

Indications for head CT prior to LP

Answer 2

1. Immunosuppression.
2. Hx CNS disease
3. New seizures within 1 week
4. Papilledema
5. Focal neuro deficits
6. Altered mentation

Question 3

Empiric antibiotics for bacterial meningitis in routine patient?

Answer 3

Vanc + Ceftriaxone

Question 4

Empiric antibiotics for bacterial meningitis in >50yo or pregnant?

Answer 4

Vanc + Ceftriaxone.
Add ampicillin for Listeria.

Question 5

Empiric antibiotics for bacterial meningitis in immunosuppressed patient?

Answer 5

Vanc + Ceftriaxone/Merrem + Ampicillin

Question 6

Empiric antibiotics for bacterial meningitis in post-neurosurgical patient?

Answer 6

Vanc + Cefepime/Ceftazidime/Merrem

Question 7

Indications for steroids in bacterial meningitis?

Answer 7

Give empirically. Continue if hearing loss, FND, S Pneumo (mortality benefit).

Question 8

Difference in symptoms between aseptic meningitis vs viral encephalitis?

Answer 8

Viral encepalitis has altered mentation. Aseptic meningitis has fever but normal mentation.

Question 9

Which lobe is classically hit by HSV encephalitis?

Answer 9

Temporal lobe with edema or hemorrhage.

Question 10

Dx HSV Meningitis?

Answer 10

HSV PCR in CSF

Question 11

Tx (HSV Meningitis)?

Answer 11

Acyclovir x 2-3 weeks IV (no PO)

Question 12

Patient population sensitive to West Nile encephalitis?

Answer 12

> 50yo or immunosuppressed

Question 13

Sx WNV Encephaliits?

Answer 13

fever, occular disease, encephalitis

Question 14

Dx (WNV Encephalitis)?

Answer 14

CXR / Serum WNV IgM. PCR is not any good.

Question 15

Presentation of WNV Encephalitis that is unique to WNV?

Answer 15

Acute Flaccid Paralysis

Question 16

Most common bugs causing brain abscess?

Answer 16

staph, strep, anaerobes

Question 17

Immunosuppressed patient with brain abscess. What bacteria?

Answer 17

Toxo, listeria, nocardia, aspergillus, fungi

Question 18

Empiric antibitoics for brain abscess?

Answer 18

vanc + flagyl + ceftriaxone/cefepime/cefotaxime.
Cefepime if recent CNS procedures or hematogenous spread from GI/Liver abscess

Question 19

Imaging modality of choice for brain abscess?

Answer 19

MRI. Look at T1.

Question 20

Worse potential spaces to have head/neck infections?

Answer 20

danger space, prevertebral space.

Question 21

An infection in which potential space in the head/neck causes Ludwig’s Angina?

Answer 21

Submandibular space

Question 22

Woody induration of a protruding tongue is suspicious for what disease?

Answer 22

Submandibular space infection, AKA Ludwig’s Angina.

Question 23

Infection of what space causes Lemierre’s syndrome?

Answer 23

Para-pharyngeal space or Lateral-pharyngeal space

Question 24

Septic thrombophlebitis of the jugular vein causes infection of what space in the head/neck?

Answer 24

Para-pharyngeal space or lateral-pharyngeal space. Lemierre’s Syndrome.

Question 25

Most common bacteria causing Lemierre's Syndrome?

Answer 25

Fusiform Necrophorum. Infection of Para-pharyngeal space or lateral-pharyngeal space.

Question 26

Most common mechanism of retropharyngeal space / danger space infection?

Answer 26

penetrating trauma (chicken bone, instrumentation, tooth infection).

Question 27

Retropharyngeal / danger space infections spread where?

Answer 27

pleural or pericardial spaces (Descending necrotizing mediastinitis)

Question 28

Treatment of retropharyngeal / danger space infection in immunocompotent?

Answer 28

Augmentin / Rocephin+Flagyl / Clinda+Levaquin. Add vanco or linezolid if MRSA needed.

Question 29

Treatment of retropharyngeal / danger space infection in immunosuppressed?

Answer 29

Cefepime+Flagyl / Merrem / Zosyn. Add vanco or linezolid if MRSA needed.

Question 30

LRINEC score for what disease?

Answer 30

Laboratory Risk Indicator for NECROTIZING FASCIITIS.

Question 31

Usual etiology of Staph Toxic Shock Syndrome?

Answer 31

Women with nasal packing or tampons.

Question 32

Usual etiology of Strep Toxic Shock Syndrome?

Answer 32

Men=Women. Trauma, NSAIDs, post-partum.

Question 33

Desquamation of palms & soles, 1-2 weeks after infection with Toxic Shock Syndrome. What is the bacteria?

Answer 33

Staph

Question 34

Treatment of Staph Toxic Shock Syndrome?

Answer 34

Remove foreigh body. Clinda. Vanc or nafcillin. No controlled trials of IVIG.

Question 35

Treatment of Strep Toxic Shock Syndrome?

Answer 35

Surgical debridement. PCN-G + Clinda. IVIG based on limited data.

Question 36

Antibitoics for gas gangrene?

Answer 36

PCN-G + Clindamycin

Question 37

Bacteria causing gas gangrene?

Answer 37

Clostridium Perfringes or Clostridium Septicum.

Question 38

Clostridium Septicum bacteria coming from what other disease?

Answer 38

Colon cancer.

Question 39

Symptoms of wound botulism?

Answer 39

Diplopia, ptosis, descending paralysis, respiratory failure.

Question 40

Difference in symptoms between wound botulism vs myasthenia gravis?

Answer 40

Wound botulism has dilated pupils & no fluctuating muscle weakness or fatiguability.

Question 41

Treatment of wound botulism?

Answer 41

Antitoxin. Debridement. PCN-G (Flagyl 2nd line). Avoid aminoglycosides; it can worsen neuromuscular blockade.