5 Infectious Patalim Pearls

Question 1

risk factors for developing cellulitis and erysipelas

Answer 1

lymphedema
skin breakdown/site of entry
venous insufficiency
leg edema
obesty
neutropenia
immunocompromise
hypogammaglobulinemia
chronic renal disease
cirrhosis

Question 2

signs specific for erysipelas

Answer 2

butterfly pattern
millian ear sign

peau d’ orange - both ceelulitis and erysipelas

Question 3

this classically associated with necrotizing soft tissue infection

Answer 3

severe pain, anxiety, and diaphoresis

Question 4

gold standard in diagnosis and treatment of necrotizing soft tissue infection

Answer 4

surgery
mortality skyrockets if debridment is delayed >24 hours

Question 5

single most important feature to make diagnosis early in necrotizing fasciitis

Answer 5

pain out of proportion

Question 6

hard signs of necrotizing fasciitis

Answer 6

crepitus, skin necrosis, bullae, hypotension, gas on xray

Question 7

most reliable sign of necrosis on CT

Answer 7

non-enhancing deep tissues

Question 8

aka Durand-Nicolas-Favre disease

Answer 8

LGV

Question 9

more serious influenza

Answer 9

Influenza A

Question 10

Risk factors for severe influenza

Answer 10

children younger than 2y
adults ≥65
comorbid
immunosuppresion
pregnancy
<19y receiving long-term aspirin
morbid obesity

Question 11

HSV1 resides in

Answer 11

trigeminal ganglila

HSV 2 resides in sacral ganglia

Question 12

hallmark of HSV encephalitis

Answer 12

acute onset of fever and neurologic symptoms

Question 13

independent predictors of a poort outcome for patients with HSV encephalitis

Answer 13

GCS ≤6
FOCAL cns LESIONS
INCREASED PATIENT AGE
start of antiviral thearpy >4 days after onset of symptoms

Question 14

varicella zoster IG is limited to

Answer 14

postexposure prophylaxis of nonimmune pregnant women and the severely immunosuppresed

Question 15

often a clue to an immmuodefficient condition

Answer 15

herpes zoster involveing more than three dermatomes

Question 16

varicella, acyclovir and antivirals decrase the number of lesions and shorten the course if started within

Answer 16

24 hours of rash onset

Question 17

herpes zoster, start antiviral wihtin

Answer 17

72 hours of rsh onset
start >72 hours if vesicles are still present or patient is immunocompromised

Question 18

HIV: seroconversion and detectable antiresponse at

Answer 18

3-8 weeks

Question 19

treatment of cyrptococoosis

Answer 19

amphotericin B
+ flucytocine

Question 20

most common complaint in tetanus

Answer 20

pain and stiffness in the masster muscles (lockjaw)

Question 21

preferred agent for muscle relaxation in tetanus

Answer 21

midazolam (water-solubble agent)

lorazepam and diazepam may result in metabolic acidosis secondary to propylene glycol vehicle

Question 22

DOC in uncomplicated malaria

Answer 22

artemisinin-containing combination therapies
artemether-lumefrantine
artesunate-amodiaqune

Question 23

antimalarial for sevre (complicated) malaria

Answer 23

artesunate
or quinidine gluconate
PLUS
doxycyline
or clindamycin (in children <8y)

Question 24

reversal of hot and colod sensation

Answer 24

ciguera toxin (most common in barracuda)

Question 25

tx in ciguera toxin

Answer 25

supportive care
high-dose atropine for bradycardia
IV manitol for severe neurologic sympotoms

Question 26

toxin in pufferfish

Answer 26

tetrodotoxin

Question 27

tx in pufferfish intoxication

Answer 27

emergent supportive care
anticholinesterase such as neostigmein and edrophoneium

Question 28

toxin in tuna

Answer 28

scombroid (histamine

Question 29

most characteristic component of secondary stage of lyme disease

Answer 29

multiple annular/target shaped sin findigns

Question 30

most common neurologic symptom of secndary stage of lyme disease

Answer 30

development of cranial neuritis, most oftenunilateral or bilateral facial nerve palsy

Question 31

classic presentaiton of yellow fever

Answer 31

triad of
jaundice
black emesis
albuminuria

death in 7-10 days after onset

Question 32

most common cause of acute themorrhagic fever in temperate climates

Answer 32

neissereia minengitidis

Question 33

preferred HIV postexposure prohylaxis

Answer 33

tenofovir 300 mg + emtriciabine 200 mg OD
PLUS
raltegravir 400,g IBID or dolutegravir 50 mg OD
FOR 28 DAYS