ID

Question 0

SIRS criteria

Answer 0

WBC count 12
T 38C (100.4F)
RR >22 or PaCO2 90

Question 1

Liebermeister’s Rule

Answer 1

Each degree increase in temp Celsius –> an 8 beat increase per minute in heart rate

Question 2

Septic shock

Answer 2

Severe sepsis req’ing pressures to maintain adequate perfusion

Question 3

Severe sepsis

Answer 3

Sepsis +

1 indication of end organ damage:

• HYPOTENSION - Systolic bp 40 points below patients baseline
• Lactate >4
• AMS
• Renal failure
• Hyperglycemia in a pt who is not diabetic

Question 4

Tx of sepsis

Answer 4

Initiate early antibiotics and aggressive fluid resuscitation

• Vanco
• Zosyn
• In HCAP add Levo (750 mg IV) to provide double pseudomonas coverage
• In urosepsis - ceftriaxone (1 g IV/day) better option
• For meningitis - Vanco + Ceftriaxone (2g IV/day)

Question 5

Who’s at risk for HCAP

Answer 5

• Two day hospital admission over the last 3 months
• Lives in along term care facility
• Out pt antibiotics or chemotx in last 30 days
• Dialysis pts

Question 6

In original sepsis protocol pts got

Answer 6

X more fluids

Question 7

Tx of otitis externa

Answer 7

Cortisporin otic: neomycin, polymixin b, hydrocortisone

Question 8

Tx of whooping cough

Answer 8

IV macrolide

To prevent transmission to others

Question 9

Rocky Mountain spotted fever

Answer 9

Doxycycline - ok in peds at recommended dose and duration

Encephalitis, myocarditis, renal failure, pulm infiltrates and respiratory failure can occur

Question 10

Scabies

Answer 10

Permethrin

Question 11

Impetigo: tx

Answer 11

Topical antibiotic,

Ie mupirocin

Us staph or strep

Question 12

Coccidiomycosis

Answer 12

Southwestern US
Soil exposure
Arizona

Question 13

Histoplasmosis

Answer 13

Ohio River Valley ans Mississppi

Question 14

Ehrlichiosis

Answer 14

X

Question 15

Otitis externa

Answer 15

Tx corticosporin otic (neomycin, polymixin B and hydrocortisone) SUSPENSION rather than solution as it is less ototoxic

Is severe and ear canal is swollen shut, use wick or gauze to deliver topical antibiotic deep

Typical organism pseudomonas or staph aureus, MRSA unusual

Question 16

Malignant otitis externa

Answer 16

MCC pseudomonas

Tx: oral fluoroquinolones

Seen in immunocompromised pts, most commonly diabetics, HIV and elderly

Persistent symptoms of otitis externa despite tx should raise suspicion for this dz

Can invade skull base and affect CNs, Facial N affected first

Question 17

Ocular HSV

Answer 17

Dendrite lesion on fluroscein stain
Requires topical ophthalmic therapy - trifluridine 1%

Hutchinsons sign

If skin lesions present also tx with acyclovir

Question 18

Chalazion

Answer 18

Inner surface of eyelid

May need antibiotics and I&D

Question 19

ANTHRAX : TX

Answer 19

post-exposure prophylaxis
doxycycline or ciprofloxacin x60 days

amoxicillin in kids, pregnant/lactating women exposed to susceptible strains

monoclonal antibody available

Question 20

encephalitis

Answer 20

infection of brain parenchyma
can present with focal neurologic findings: aphasia, seizure, hallucinations, motor weakness

mcc HSV

dx: based on CSF analysis from LP

CT head warranted but negative

Question 21

meningitis

Answer 21

infection of the meninges of brain and spinal cord

most common bacterial etiology:
strep pneumo - adults
Neisseria meningitidis - kids
consider Listeria monocytogenes in elderly and immunocompromised pts

most commonly implicated virus is enterovirus

pts at highest risk of developing are at extremes of age, those with ENT infections, chronically ill and immunosupressed, and those who use EtOH and cigarettes

outbreaks have been found among persons in crowded living conditions such as dorms or barracks and in poverty stricken areas

dx: based on CSF analysis from LP - low glucose, high protein

CT head warranted but negative

Question 22

Pericarditis

Answer 22

ST:T wave if ratio >25%, then it’s 85% sn for pericarditis

As opposed to early repol