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Clin Med IV: Emergency Medicine > EM Infectious Emergencies > Flashcards

EM Infectious Emergencies Flashcards

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1
Q

what is a life-threatening organ dysfunction due to dysregulated host response to infection

A

sepsis

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2
Q

what is lactate an indication of

A

hypoperfusion
- increased mortality

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3
Q

What are initial orders for sepsis

A

IV/O2/Monitor
IV fluids
CBC, CMP, PT/PTT, Lactate, cultures, procalcitonin, ABG/VBG

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3
Q

what does elevated procalcitonin correlate with

A

bacterial infections and sepsis
-acute phase reactant

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4
Q

What is a scoring tool for sepsis

A

qSOFA (Quick SOFA)
- AMS
- RR
- SBP < 100

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5
Q

What are exclusions for simple cellulitis

A

bite wounds
water exposure
post op wounds
immunocompromised wounds
locatoin
perianal/perirectal

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6
Q

What is a collection of purulent discharge, may be associated with opening in skin or from entry through hair follicle

A

abscess

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7
Q

what are exam findings for abscess

A

area of fluctuance
erythema
pain
US findings

pretty much always MRSA

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8
Q

What are risk factors for MRSA

A

IVDU
health care
homelessness
nursing home
incarceraton
multiple lesions

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9
Q

what covers MRSA

abx

A

Bactrim
Doxycycline
Clindamycin
Vanco

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10
Q

what is toxic shock associated with

A

tampon use
nasal packing
surgical wounds
postpartum infections

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11
Q

how does toxic shock present

A

erythematous rash which will dequamate on hand/feet
- sunburn-like rash
febrile and hypotensive

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12
Q

how is toxic shock treated

A

remove source of infection and start abx with CLindamycin and Vanco
- admit

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13
Q

how does necrotizing fasciitis spread

A

through muscle fascia, may have anesthesia of skin prior to necrosis
can extend into muscle or skin

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14
Q

how is necrotizing fasciitis diagnosed

a

A

air on imaging
finger test (numb area finger into wound)
check electrolytes

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15
Q

What is Fourniers Gangrene

A

necrotizing fascitits of perineum and most commonly involving scotum

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16
Q

what is the presentation of fourniers gangrene

A

severe pain that typically starts along anterior abdomen and can migrate to gluteus and genitals

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17
Q

what is erysipelas

A

infection of epidermis, upper dermis and lymphatics
m/c on face or LE

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18
Q

what is the presentation of anaplasmosis and ehrlichiosis

A

acute illness with fever, malaise, HA, chills, N/V, arthralgias
non-specific maculopapular rash, strawberry tongue, conjunctivitis, hepatosplenomegaly, neurologyic symptoms

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19
Q

when do symtpoms of ehrlichiosis (HME) occur

A

1-2 weeks after the bite

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20
Q

when do symptoms of anaplasmosis (HGA) occur

A

5.5 days

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21
Q

what is the treatment of anaplasmosis and ehrlichiosis

A

Doxycycline 100mg BID 5-7 days

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22
Q

how long does RMSF usually last

A

10-20 days
- pt becomes sick within 1 week after inoculation

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23
Q

what is the presentation of early disseminated Lyme

A

2-4 weeks after erythema migrans
can develop lymphocytic meningitis, carditis (AV nodal block), MSK invovlement, multiple erythema migrans lesions, lymphadenopathy, conjunctivitis, LFT abnormalalitis, proteinuria

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24
Q

what is the presentation of late/chronic lyme

A

intermitten monoarticular arthritis, neurologic disease (neuropathy, or encephalomyelitis)

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25
Q

what is the most common pathogen with infective endocarditis

A

streptococci or staphylococci

26
Q

what are risk factors for infective endocardidits

A

IVDU
immunocompromised
dental or surgical procedures
congenital or acquired heart disease

27
Q

what are janeway lesions

A

non-tender erythematous macules on palms or soles

28
Q

what are osler nodes

A

tender subQ nodules on finger/toes

29
Q

what is the diagnostic criteria for infective endocarditis

A

Duke Criteria
- 1 major, 3 minor

30
Q

what diagnostic test is necessary for dx of infective endocarditis

A

TEE

31
Q

what is the treatment of infective endocarditis

A

broad spectrum abx
- i.e. Vanco

32
Q

What is the presentation of infective carditis

A

fever, anorexia, malaise, HA, arthralgias, nigh wears, murmurs, petechiae, splinter hemorrhages, janeway lesions, oslers node

33
Q

what is the most common pathogen with UTI

A

E. coli

34
Q

what is the treatment of uncomplicated UTI

A

abx 3-5days
(Nitrofurantoin, Bactrim, Keflex)

35
Q

what are symptoms of upper urologic infection?

A

fever
severe pain
AMS
PG
Comorbiditis
N/V
flank pain

36
Q

what should be considered if a patient presents with UTI with fever or CVA tenderness

A

pyelonephritis

37
Q

what is the treatment of pyelonephritis

A

ciprofloxacin x 7d
consider one time IM dose ceftriaxone followed by Bactrim, augmentin, cefpodozime

38
Q

what is the presentation of prostatitis

A

pain with BM
difficulty with urination, frequency
pain with DRE

39
Q

what is the treatment of prostatisis

A

limited abx penetrate prostate tissue, will need longer course (4-6 weeks)
if non STI: Bactrim BID or Ciprofloxacin
if inpt: IV Cipro

40
Q

How is PEP started

A

3 drug regimen for 4 weeks
- start within first few hours after exposure

41
Q

what is the most common STI in the US

A

chlamydia

42
Q

what is the presentation of chlamydia

A

first - cath urine (m or f), or endocercial or urethral swab

43
Q

what is the treatment of chlamydia

A

doxycycline

44
Q

what is the treatment of Gonorrhea

A

High dose Ceftriaxone IM

45
Q

what is the presentation of herpes

A

genital ulcers, fever, lymphadenopathy, HA, dyuria

46
Q

how is herpes dx

A

clinical can confirm with viral swab

47
Q

what is the treatment of herpes

A

sitz baths for pain so they are able to urinate
acyclovir or valacyclovir

48
Q

how long after exposure will syphilis chancre form

A

4-12 weeks after exposure
resolves in 4-6 weeks

49
Q

what is the treatment of syphilis

A

penicillin G IM
for PCN allergic: doxyclicline

50
Q

What is the treatment of Neutropenic fever

A

empiric abx
fluids
admit

51
Q

What are do not miss back pain

A

cancer
AAA
Fracutre
infection
cord syndrome

52
Q

What are risk factors for spinal infections

A

IVDU, immunocompromised

53
Q

what is the presentation of spinal infection

A

fever + back pain, midline tenderness

54
Q

what is a inflammatory disease affecting leptomeninges

A

bacterial meningitis
m/c strepto and meningitides

55
Q

what is the presentation of bacterial meningitis

A

fever
nuchal rigidity
severe HA
AMS
N/V
seizures
aphasia
petechiae

56
Q

what is the treatment of bacterial meningitis

A

Rocephin
Vanco
Dex

57
Q

What is the classic triad of bacterial meningitis

A

fever
stiff neck
change in Mental status

58
Q

what is the diagnostic procedure of choice for bacterial meningitis

A

lumbar puncture

59
Q

What is the presentation of viral meningitis

A

febrile
no neurological dysfunction
HA
stiff neck
maculopapular rash
muscle aches
N/V
pharyngitis
fatigue

60
Q

What is the presentation of brain abscess

A

HA
fever
neck stuffness
focal neuro deficit
seizures
CN6 palsy secondary to elevated ICP

61
Q

what is the treatment of brain abscess

A

Vanco + Metronidazole(IV) + Ceftriaxone(IV)
4 - 8 weeks

62
Q
A
63
Q

what happens if brain abscess ruptures

A

patient dramatically declines

Clin Med IV: Emergency Medicine (18 decks)

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