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HPIM 19th ID > Approach to Acutely Ill Febrile Patient > Flashcards

Approach to Acutely Ill Febrile Patient Flashcards

1
Q

Fever may be absent

A

Elderly

Compromised host

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2
Q

Cultures in IE

A

3 sets

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3
Q

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

A

> 10(6) organisms/ml

10(4) in intact spleen

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4
Q

Howell-Jolly bodies

A

Asplenia

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5
Q

Course of management for meningitis

A

Blood culture > give antibiotics > imaging

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6
Q

Infections requiring rapid surgical intervention before other diagnostics or therapeutic interventions

A

Necrotizing fasciitis

Clostridial myonecrosis

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7
Q

Empirical treatment for sepsis without a clear focus

A

Vanco + Genta + Pip-Taz/Cefepime

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8
Q

Empiric DOC for meningococcemia

A

Penicillin
or
Ceftriaxone

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9
Q

May be used in fulminant meningococcemia

A

Protein C replacement

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10
Q

Empiric DOC for Erythroderma:TSSS

Group A Strep, Staph aureus

A

Vanco + Clinda

Debridement should be done

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11
Q

Empiric DOC for necrotizing fasciitis

Group A Strep, mixed aero/anaero

A

Penicillin + Clinda + Genta

If MRSA, Vanco over Pen

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12
Q

Empiric DOC for Clostridial myonecrosis

C.perfringes

A

Penicillin + Clinda

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13
Q

Empiric DOC for bacterial meningitis

S.pneumo, N.meningitidis

A

Ceftri + Vanco

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14
Q

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

A

Ampicillin for Listeria coverage

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15
Q

Improves meningitis outcomes in patients with

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

A

Dexamethasone

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16
Q

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

A

Vanco + Metro + Ceftri

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17
Q

Empiric DOC for cerebral malaria

P.falciparum

A

Quinine + Tetracycline

AVOID GLUCOCORTICOIDS

18
Q

Empiric DOC for Acute bacterial endocarditis

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

A

Cefti + Vanco

19
Q

Can present with intractable hypotension and multiorgan failure

A

Gram-Neg: Pseudomonas, E.coli

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

20
Q

Role of CRP and procalcitonin

A

Facilitate de-escalation of therapy NOT for diagnosis

21
Q

MC isolate in asplenic patients

A

Strep penumo

encapsulated organisms

22
Q

Characteristic of the rash of Meningococcemia

A

pink, BLANCHING, maculopapular becoming hemorrhagic forming petechiae

23
Q

Cutaneous manifestation of DIC

A

Purpura fulminans

24
Q

Causes of ecthyma gangrenosum

A

Septic shock caused by Pseudomonas or Aeromonas hydrophila

pts with neutropenia, extensive burns, hypogammglobulinemia

25
Q

Ingestion of contaminated shellfish

A

Vibrio vulnificus

26
Q

Distinguishes TSSS from other septic shock syndromes

A

Early renal failure precedes hypotension

27
Q

MC arboviral disease worldwide

28
Q

Risk factors for necrotizing fasciitis

A

DM
IV drug use
Peripheral vascular disease

29
Q

Characteristic of cutaneous manifestation of untreated necrotizing fasciitis

A

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

30
Q

Characteristic of cutaneous manifestation of clostridial myonecrosis

A

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

31
Q

Poor prognostic findings in Bac Men

A 
Coma
Hypotension
S.pneumo meningitis 
Respiratory distress
CSF glucose <0.6 mmol/ (<10 mg/dl)
CSF protein >2.5
WBC <5000/mcl
Na <135
32
Q

Usually from paranasal sinus infections

A

Subdural empyema

33
Q

Usually from facial or sphenoid sinus infection

A

Septic cavernous sinus thrombosis

34
Q

Usually from the ethoid or maxillary sinus infections

A

Septic thrombosis of the sup. sagittal sinus

35
Q

MC presentation of brain abscess

36
Q

Poor prognosis of brain abscess

A 
Fulminant course
Delayed diagnosis
Abscess rupture into the ventricles
Multiple abscesses
Abnormal neuro status at presentation
37
Q

Clinical findings in cerebral malaria

A 
High fever >40 C
Hypotension
Jaundice
ARDS
bleeding

Neuro: symmetric enceph, UMN dysfunction woth decorticate/decerebrate posturing

38
Q

Worse outcomes for spinal epidural abscesses

A

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

39
Q

Jugular septic thrombophlebitis caused by Fusobacterium necrophorum

A

Lemierre’s disease

40
Q

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

A

Rhinocerbral mucormycosis

41
Q

Hemorrhagic macules on palmes and soles of acute bacterial endocarditis

A

Janeway lesions

42
Q

MC findings in anthrax

A

Pulmo infiltrates, mediastinal widening, pleural effusion

HPIM 19th ID (16 decks)

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