ID- Popcorn

Question 1

The following is the general “criteria” for what?

• Fever >38.3degC (100.9F)
• At least 3wks duration
• No dx after 3 outpt visits or 3 days of hospitalization

Answer 1

Fever of unknown origin

Question 2

What are the 3 MC etiologies of Fever of Unknown Origin (FUO)?

Answer 2

1. Infection
2. Malignancy
3. Connective Tissue Disease

Question 3

What is the #1 MC malignancy to cause FUO (fever of unknown origin)?

Answer 3

Lymphoma, especially non-hodgkins

Question 4

What is the main site of colonization of staphylococcal infections?

Answer 4

Nose

Question 5

Is staph aureus coagulase negative or positive

Answer 5

positive

(Staph epidermidis and staph saprophyticus are both coag neg)

Question 6

• Which staphylococcal strain is a frequent skin contaminant of blood cultures?
• What do you do to confirm whether a contaminant or a true cause of bacteremia?

Answer 6

• Staph epidermidis
• May have to draw from 2 sites

Question 7

Which bacteria causes infections of:

• Urine catheters
• IV lines
• Prosthetic joints/heart valves
• Dialysis catheters

Answer 7

Staph epidermidis

Question 8

Which staphylococcal strain is coagulase negative and is a leading cause of UTIs?

Answer 8

Staphylococcus saprophyticus

Question 9

What is the etiology of TSS?

Answer 9

Staph aureus

Question 10

Clinical presentation of what?

• Abrupt onset high fever
• Vomiting & watery diarrhea
• Sore throat, myalgias, h/a
• Hypotension with kidney and heart failure
• Diffuse macular erythematous rash and nonpurulent conjunctivitis
• Desquamation, esp. of palms & soles (late finding)

Answer 10

TSS

Question 11

Lab findings in TSS are consistent with what?

Answer 11

shock and organ failure

Question 12

What is empiric antibiotic tx for TSS?

Answer 12

Clindamycin + Vanco

(Also needs rapid rehydration–> 3L)

Question 13

What condition is caused by Staph aureus and is primarily in neonates 3-15 months old?

Answer 13

Staph Scalded Skin Syndrome (SSSS)

Question 14

Clinical presentation of which condition?

• Prodrome: fever, irritability
• Erythematous patches with large superficial fragile blisters
• When blisters rupture, skin appears red and scalded
• Nikolsky sign (only the first layer)

Answer 14

Staph Scalded Skin Syndrome (SSSS)

Question 15

Diagnosis of what?

• Clinical with cultures
• Skin biopsy shows intraepidermal cleavage without necrosis**

Answer 15

Staph Scalded Skin Syndrome (SSSS)

Question 16

What type of abx should be used to tx SSSS? If there is no response, what 2 meds should you consider?

Answer 16

• Penicillinase-resistant beta-lactam agents (Nafcillin)
• If no response, consider MRSA & tx with vancomycin

Question 17

Etiology of Anthrax?

Answer 17

Bacillus anthracis

Question 18

T/F: there has been bioterrorism w/ anthrax spores

Answer 18

True

Question 19

Hallmark of what condition?

• Painless eschar with extensive surrounding edema

(will be on exam)

Answer 19

Cutaneous clinical syndrome of Anthrax

Question 20

What causes:

• hemorrhagic mediastinitis
• occasionally necrotizing pneumonia
• Bacteremia

Answer 20

Inhalation clinical syndrome of Anthrax (the most dangerous form)

Question 21

Which clinical syndrome has a prodrome including sxs like hemoptysis and dyspnea and can resultmin death within days

Answer 21

INHALATION clinical syndrome of Anthrax

Question 22

What is seen on CXR of the inhaled form of Anthrax?

(will be on exam)

Answer 22

Widened mediastinum

Question 23

What is the GI form of Anthrax from?

Answer 23

consumptom of undercooked, infected meat from animals infected with anthrax

Question 24

Which infectious disease causes:

• Necrotic ulcers surrounded by extensive edema of infected intestinal segment and adjacent mesentery
• Can cause GI hemmorrhage

Answer 24

GI tract clinical syndrome of Anthrax

Question 25

How do you tx anthrax if it is **systemic w/ meningitis**?

Answer 25

* Report/consult public health department * **_Cipro + meropenem + Linezolid_** * Antitoxin * etc.

Question 26

How do you tx Anthrax that is systemic WITHOUT meningitis?

Answer 26

* Report/consult public health department * **_Cipro + Clinda_** * Antitoxin * etc.

Question 27

How do you treat cutaneous Anthrax?

Answer 27

* Report/consult public health department * _**Ciprofloxacin\*\***_ * Antitoxin * etc. \*\*\*definitely know abx- will be on exam\*\*\*

Question 28

Which type of anthrax has the highest mortality rate? (cutaneou, injection, GI, inhalation or anthrax meningitis)

Answer 28

* **Anthrax meningitis-** even with treatment, mortality is 100% * Inhalation is also very deadly with mortality rate of 45%

Question 29

What is post-exposure prophylaxis for patients exposed to **aerosolized** B. anthracis (anthrax)?

Answer 29

Start **Cipro** w/in 48hrs- treat for 60 days + 3 dose series of **Anthrax vaccine**

Question 30

What is usually transmitted by the infected saliva of a **bat, raccoon or skunk**?

Answer 30

**_Rabies_** (caused by rhabdovirus)

Question 31

Which infectious disease? ## Footnote * Virus travels in **nerves to the brain**, multiplies in brain, then travels along efferent nerves to **salivary glands** * Forms **_cytoplasmic inclusion bodie_**s – site of viral transcription & replication

Answer 31

Rabies

Question 32

What infectious disease causes **percussion myoedema** (mounding of the muscle at the percussion site)?

Answer 32

Rabies

Question 33

What are the two types of CNS presentations of Rabies? What do both forms progress to?

Answer 33

**•“furious” – encephalitic** **•“dumb” – paralytic** \*both forms progress to coma, ANS dysfunction, death

Question 34

"Furious" (encephalitic) or "dumb" (paralytic) form of rabies? * **MC** * **paranoia,** terror * **Hydrophobia** * unquenchable thirst * **oversalivating** * Death by **cardiac arrest**

Answer 34

Furious (Encephalitic) rabies

Question 35

"Furious" (encephalitic) or "dumb" (paralytic) form of rabies? * **gradual coma** * **_NO hydrophobia_** * **paralysis** * muscle weakness and loss of sensation * death

Answer 35

**_Paralytic rabies_** (this is less dramatic and usually longer course than furious rabies)

Question 36

How do you diagnose rabies? (4)

Answer 36

* test animal if possible * PCR of saliva * viral culture of saliva * Full thickness skin biopsy from posterior region of neck at hairline

Question 37

How do you prevent rabies? (this is the main tx)

Answer 37

Immunize household pets and ppl w/ signifcant animal exposure

Question 38

What is PEP and PrEP for rabies?

Answer 38

PEP= Human rabies immune globulin, Rabies vaccine PrEP= Human diploid cell vaccine