infections

Question 1

calcific periarthritis

Answer 1

calcifications near joint. Not infection. Treat with NSAIDS

Question 2

Sweets syndrome

Answer 2

acute febrile neutrophilic dermatosis

Question 3

mycobacterium culture

Answer 3

Ziehl-Neelsen stain and culture at 28-32C in Lowenstein Jensen medium

Question 4

fungi culture

Answer 4

• K-OH prep (enhance with chlorazol black Estain)

- periodic acid-Schiff stain

Question 5

herpes culture

Answer 5

tzank smear (giant cells)

Question 6

antibiotics perioperative indications

Answer 6

> 2 hour case

Question 7

flouroquinolone complication

Answer 7

tenosynovitis, especially >60 years old or h/o steroid use

Question 8

onychomycosis treatment

Answer 8

distal 1/4 nail -> topical ciclopirox
1/2-3/4 dermatophyte -> oral terbiafine 6 weeks or fluconazole
total nail involved/recurrent -> topical and systemic treatment with surgical avulsion

Question 9

candida treatment

Answer 9

itrazonazole

Question 10

septic arthritis bacteria

Answer 10

• s. aureus and s. pyogenes most common
• adolescent then concern N gonorrhea
• treat with I&D and 2-4 weeks of IV antibiotics

Question 11

fight bite

Answer 11

strep, staph, eikenella

anaerobic (provotella, fusobacterium)

Question 12

cat bites

Answer 12

• 30-50% infected
• Pasturella
• Treat with unasyn/augmentin (in penicillin allergy then bactrim and clindamycin)

Question 13

antibiotics to avoid in kids

Answer 13

doxycycline and fluoroquinolones

Question 14

necrotizing fasciitis

Answer 14

20% amputation rate
- group b hemolytic strep
treat with penicillin G and clindamycin
high risks if:
CRP > 150     4pts
WBC < 15      0 pts
Hgb > 13.5     0 pts
Na < 135         2 pts
Glu > 180        1 pts
low <5 points
moderate 6-7 points
high >8 points

Question 15

mycobacterium marinum

Answer 15

caseating and noncaseating granulomas

treat with 16 weeks - 2 years clarthromycin, sulfonamids, bactrim, ethambutol and/or rifampin

Question 16

herpes simplex

Answer 16

I cold sores
II genital
valtrex can help if within 48 hours

Question 17

sporotrix

Answer 17

gardeners (roses)
nodular lesions along lymphatics
filamentous hyphae on PA strain
treat with potassium iodide

Question 18

aeromonas hydrophilia

Answer 18

leeches and cat fish sting

Question 19

gram - anaerobic rods

Answer 19

bactrim, cipro, ceftriaxone

Question 20

MRSA

Answer 20

most common community acquired infection

Question 21

deep spaces

Answer 21

middle metacarpal to fascia is separated by a fascial band called the mid-palmar septum.

Question 22

flouroquinolone complications

Answer 22

• collagen-associated complications include aortic aneurysm, retinal detachment, tendinopathy/rupture
• inhibit tendon cell proliferation via moducation of inflammatory mediators and upregulation of metalloproeinases.
• occur within 1 month of use
• increased risk in men, >60 years, chronic renal disease, organ transplant, or use with steroids, statins or aromatase inhibitors

Question 23

lyme diesese

Answer 23

• spirochete Borrelia burgdorferi, transmitted through the bite of a tick
• characteristic erythema migrans rash that begins at the site of the bite and expands, often with central clearing resulting in a target or “bulls-eye” appearance. The rash may be accompanied by fever, chills, headache, fatigue, muscle and joint aches, and lymphadenopathy.
• If untreated, patients may go on to develop headaches, joint pain/swelling (typically affecting larger joints), facial palsy, heart palpitations, and/or intermittent musculoskeletal and nerve pain.
• Doxycycline 100mg twice daily for 10-21 days is the preferred treatment in adults.

Question 24

Rocky Mountain Spotted Fever (RMSF)

Answer 24

• Rickettsia rickettsii is transmitted by ticks
• headache, fever, and often a rash. The rash associated with RMSF often appears as small disseminated dots or hemorages, but can often be larger splotches.

Question 25

babesiosis

Answer 25

• Babesia microti causes another tick-borne illness

Question 26

tularemia

Answer 26

• Francisella tularensis
• carried by rabbits and can be transmitted to humans by ticks
• high fever
• skin ulceration where bite occurred and lymphadenopathy

Question 27

ehrlichiosis

Answer 27

• Ehrlichia chaffeensis
• Tick bites are the primary route of infection in humans. People with ehrlichiosis will often have fever, chills, headache, muscle aches, and sometimes upset stomach
• A rash may be present 1/3 of the time; red splotches or pinpoint dots

Question 28

quaternary ammonium solution sterilization

Answer 28

• used in developing countries
• inexpensive, low chemical method
• may not kill mycobacterium
• more effective sterilization uses ethylene oxide or autoclaving

Question 29

west nile virus

Answer 29

a mosquito borne disease, has become endemic in the 48 contiguous United States. It is most prevalent during the months of July to September. The incubation period is two to fourteen days; the condition may be mild or asymptomatic in up to 60 percent of patients. Typical symptoms include the sudden onset of a headache, fever, malaise, chills, vomiting, and eye pain lasting a few days. As these symptoms abate, a painless, diffuse, maculopapular rash may appear on the chest, back, and arms. Extrapyramidal symptoms, similar to Parkinsonism, are fairly common. A minority of patients develop an asymmetric flaccid paralysis, usually evident within 48 hours of the onset of symptoms. In rare instances, diaphragmatic and intercostal paralysis may produce respiratory failure. Diagnosis is made by the presence of IgM antibody in the serum or cerebrospinal fluid of affected individuals. Treatment is expectant.

It is estimated that only 37% of affected individuals are symptom-free at one year following the acute illness. For those who develop acute flaccid paralysis, one-third will recover almost normal strength, one-third will have some improvement, and one-third will have no improvement. Virtually all motor recovery appears to occur within the first six to eight months.

Question 30

cat scratch disease

Answer 30

• bartonella henselae
• cat bite or scratch
• fever, headache, fatigue, poor appetite, lymphadenopathy
• cultures may be negative, IgM antibody titers and PCR diagnostic
• may resolve spontaneously, can treat with azithromycin

Question 31

aeromonas hydrophilia

Answer 31

common in leaches. Treat prophylactically with ciprofloxacin or bactrim

Question 32

erysipeloid (fish handlers disease)

Answer 32

• caused by erysipelothrix rhusiopathiae
• gram + rod
• occur from open wound contact with fish
• bright red, itchy, painful rash with clear blisters
• lymphadenopathy
• can get endocarditis
• treat with penicillin