Diagnosis only exam 1

Question 1

Staph skin

Answer 1

Culture of abscess (after its drained)

Question 2

Staph osteomyelitis

Answer 2

Xray done first
Bone scan is a sensitive confirmatory step
culture purulent fluid after (if obtainable)

Question 3

Toxic Shock syndrome

Answer 3

Clinical presentation + history

Question 4

Scalded Skin syndrome

Answer 4

Clinical, confirm with skin biopsy and culture

Question 5

Strep pyogenes pharyngitis

Answer 5

Dx is clinical only.
Do a rapid strep and throat culture

Question 6

Otitis Media

Answer 6

Clinical.
Tympanogram optional.

Question 7

Acute sinusitis

Answer 7

Clinical.
If not improving, order a CT prn

Question 8

Pneumococcal pneumonia

Answer 8

• CXR gold standard. +- lobar consolidation effusion.
• but you can diagnose by clinical only
• sputum cx ordered only if comorbidities are there or if an inpatient

Question 9

Bacillus anthracis

Answer 9

Culture
biopsy (of black eschar)
Gram stain (purple rods)
Nasal swab and CXR (for inhalation type)
LP if systemic (it can cause meningitis)

Question 10

Listeriosis

Answer 10

Culture blood and CSF

this is listeria monocytogenes

Question 11

pseudomonas aeruginosa

Answer 11

Culture.
If positive, may need hospitalization.

Question 12

Corynebacterium dipltheriae

Answer 12

Clinical.
Culture confirms it.

Question 13

N. meningococcal meningitis

Answer 13

Gram stain and culture:
Lumbar puncture CSF analysis
Blood

gram stain reveals pink diplocci shaped like kidney beans

Question 14

N. gonorrhoeae

Answer 14

Grain stain and culture:
reveal intracellular diplococci (-)
urine
vaginal swab>urine swab for females
notify health dept

Question 15

Bordetella Pertussis

Answer 15

Nasopharyngeal culture + clinical
Health department

Question 16

Legionelle Pneumophilla

Answer 16

CXR - focal patchy infiltrates or consolidation
Antigen detection confirms (PCR of lower respiratory secretions, urine antigen, and respiratory tract fluid culture)

sputum grain shows nothing

*anti = bad, the legion from wow.
legionelle is an atypical thats why you cant gram stain

Question 17

Klebsiella pneumoniae

Answer 17

CXR + sputum culture
Sensitivity testing

think drunk woman getting into fights (sensitive)
sputum b/c spits

CXR for all pneumoniae

Question 18

Shigellosis

Answer 18

WBC in stools
organism isolated on a stool culture

Question 19

Cholera

Answer 19

Stool culture

Question 20

Non cholera vibrio

Answer 20

Stool culture

Question 21

Typhoid fever (salmonella enterica)

Answer 21

Blood, stool, and urine culture will show salmonella

Question 22

Enterocolitis (salmonella)

Answer 22

Stool culture

Question 23

Francisella Tularensis Tularemia

Answer 23

Clinical only.
Confirmation is serologic tests of culture of ulcer/lymph node and blood aspirate

Question 24

Fever of unknown origin noninfectious

Answer 24

CT disease, vasculitis, granulomatous disorders, giant cell arteritis, SLE, RA

Question 25

Fever of unkn. Infectious

Answer 25

TB, cat scratch, EBV, shakes, chills

Question 26

Fever. of unknown origin. Misc

Answer 26

Cirrhosis, Chrons, PE

Question 27

Order what labs for fever of unknown origin

Answer 27

CBC with diff, peripheral smear, CMP, Hep ABC panel, ESR SED rate, UA and cx, blood cultures (3 different sites several hours apart), HIV serology, TB serology, CXR

Question 28

Fever of unknown origin- differentiate between what 5 things

Answer 28

Classic, hospital aquired, IC, neutropenic, HIV related

Question 29

What qualifiers diagnose someone w/ fever of unknown origin

Answer 29

Fever above 101.9 F and 38.3 C (oral)
Greater than 3 weeks

Question 30

SIRS diagnosis

Answer 30

response to ischemia, infection, inflammation, trauma
Fever above 100.4 F, 38 C
Lower than 96.6 F, 36 C
HR greater than 90
RR greater than 20
WBC greater than 12,000 or less than 4000,
greater than 10% bands

Question 31

Sepsis

Answer 31

qSOFA >=2
RR greater than 22
altered mentation
SBP less than 100
Warm flush skin, poor cap refill, cyanosis, mottling, altered mental status, absent bowel sounds

Question 32

Mycopolasma pneumoniae

Answer 32

Chest auscultation clear
CXR: nonconsolidation. nondiagnostic patchy infiltrates
Clinical diagnosis + NP swab

*this is the less severe pneumonia in YA, so findings are less ‘severe’

Question 33

Chlamydia trachomatis

Answer 33

no gram stain! no cell wall.
Screening + Cx

STD

Question 34

Syphillis

Answer 34

Culture of ulcer to look for spirochetes (dark field microscopy)
Non-treponemal antibody tests (first line
RPR and VDRL
Tremonemal antibodies test - if above is positive, is confirmational
FTA-ABS is confirmational

Question 35

Neurosyphillis

Answer 35

LP
RI: HIV man 45 yr old

Question 36

Lyme disease

Answer 36

Erythema migrans/one late manifestation
AND lab confirmation

late manifestations (neuro, cardio, bacteremia, secondary skin lesions, MSK)

Question 37

Leptospirosis

Answer 37

Serologic testing

Question 38

Rocky mountain
Rickettsia rickettsii

Answer 38

Clinical + serological testing

Question 39

Anaerobic gram positive

Answer 39

Clinical + gram stain + culture
CXR: aspiration pneumonia
-infiltrates, cavitation
-Lucency
- lung abscess

• Abdominal/pelvic CT
• -Intraabdominal abcess

Question 40

Clostridial soft tissue infections

Answer 40

clinical, graim stain, culture
culture takes barely any time (6 hrs)
If negative, its not Clostridium

rem** Claw-stridium is a purple claw. so gram staining is useful here. looking for a purple rod.

Question 41

Tetanus

Answer 41

clinical only
cultures do not work

Question 42

Botulism

Answer 42

Culture (stool for ingested, wound for injected, any food source)
Toxic assays are done by the CDC

Question 43

Pseudomembrane colitis

Answer 43

-1st Stool sample for toxin and fecal leukocytes
-2nd - colonscopy/sigmoidoscopy (it destroys the lining of the GI)
-imaging for ileus or distended colon