INFECTIOUS DISEASE

Question 1

FEVER COUGH CHEST PAIN

IV DRUG USER
ACUTE BACTERIAL ENDOCARDITIS

DXZ
PNA
BRONCHIECTASIS

SCENARIOS
UTI STREP FAECALIS
CRC STREP BOVIS D-HEMOLISIS
WITHIN 2 MOS VALVE REPLACEMENT S EPIDERMIDIS THEN STREP VIRIDANS (BIOFILM)

COMPLICATIONS:

CHF VALV DEGENERATE
GLOMERULONEPHRITIS
MICOTIC ANEURYSM
SPLENOMEGALY
RENAL INFARCT

VIRIDANS 4 WKS PCN
ENTEROCOCUS PCN AMOXIC X 6WKS
HACEK CEFTRIAXONE

CONSULT CARDIAC SURGEON
VEG 3CM 
ABSCESS VALVULAR RING MYOCARDIAL
RECURRENT EMBOLI
ACUTE CHF
FUNGAL 
PERSIST BC + WHILE ON ABx
LEAKING PROSTHESIS

Answer 1

ER FOCUSED PE
ORDER
CXR BL NODULAR LESIONS
B CS X 3 E/ 30 MINUTES
NAFCILLINA OXACILLINA X 4KS + GENTA X 2WKS
DO NOT WAIT FOR 2 BC++ / ECHO START ANTIBIOTICS 1 MINS AFTER THE THIRD BLOOD CULTURE
ACETAMINOPHEN FOR FEVER
COMPLETE PE IT WILL MOVE THE CLOCK FORWARD TO SEE ECHO
CBC ANEMIA NORMOCITIC

MOVE TO WARD/ICU
CARDIAC MONITOR
EKG 12 LEADS
BP MONITOR
CARDIAC ENZYMES 
STOCKING COMPRESSION
COAGULATION PROFILE INR PT PTT PLAT 

CHECK BLOOD RESULTS CS FOR SENSITIVITY DO CHANGE IF NEEDED
+ METHICILLIN SENSITIVE* STAPH AUREUS
VANCO+GENTA BACKUP FOR MRSA IVD USER

ECHO 2D: VEG TRIC + REGURGITATE
PE CARDIO CHEST FOLLOW UP
BMP CBC SED RATE CRP FOLLOW UP
THIS WILL ADVANCE THE CLOCK

BC FOLLOW SHOULD REMIT FROM BLOOD
FOLLOW VEGETATION ON ECHO-CARDIOGRAM
FOLLOW SED RATE TO DOWN AND UA TO CIRCULATING IC NEPHRITIS

DISCHARGE HOME FOLLOW UP 2 WKS
ORAL EQUIVALENTS
IN IVD USERS: HBSAG HCV HIV RPR

ADVISE NO ILLEGAL DRUG USE
REHABILITATION UNIT
PSYCHIATRY CONSULT

Question 2

PAIN AND SWELLING

CELLULITIS
DVT
LYMPHANGITIS
NECROTIZING FASCITIS

IN ALL LEG PAIN
ABI
DOPPLER ARTERIAL VENOUS
D DIMER
CXR EXTREMITY

DICLOXACILINA CEPHALEXINA E.g. RASH PCN MILD CASES

Answer 2

FOCUSED PE
IVA 
KETOROLAC / NAPROXENO
FAMOTIDINE
DOPPLER VENOUS US NO CLOT 
D DIMER 
CXR LOOKING FOR GAS GANGRENE OSTEO
COMPLETE PE CREPITUS PULSES 
MOVE THE CLOCK 

CULTURE SALINE SC 
BLOOD CULTURE FIRST
ADVANCE 1 MIN THE CLOCK
START EMPIRICALLY DO NOT WAIT RESULTS
ORDER
WARD 
ADA HBA1C ADJUST GLUCOSE NPH /METFORMIN
OXACILLIN NAFCILLINA E/ 4 HRS
ELEVATION
NEXT DAY ROUND CLOCK
CHECK FOR SENSITIVITY
REST
FOLLOW SEDIMENTATION RATES CBC /DAY
PE AT SOME POINTS WILL HELP YOU ADVANCE THE CLOCK WHILE MONITORING

ORAL EQUIVALENTS DIABETIC MEASURES
DISCHARGE HOME
FOLLOW UP 2 WK

Question 3

*RUQ

CHOLANGITIS
CBD
CHOLECYSTITIS
PANCREATITIS
HEPATITIS

Answer 3

ER FOCUS PE
WBC /DAY
BUN / 2 DYS
CREA / WKLY
SMA12- BILI
PAL
LIPASE/AMYLASE
TROPONIN I
EKG
CXR
IVA 
NSS
MORPHINE/PHENERGAN
BC X 3
NPO/TPN
RUQ AB US*
COMPLETE PE WILL ADVANCE CLOCK 
AMPICILLIN/SULBACTAM RIGHT AFTER BLOOD CULTURES

ADMIT TO WARD 
WHEN STABLE:
NEXT DAY ROUND CLOCK 10 AM 
ERCP* - SPHINCTEROTOMY -> SO COAGULATION  PROFILE TYPING + GASTROENTEROLOGY CONSULT
DAY 2 RECEIVE SENSITIVITIES
PIPERACILLIN / TAZOBACTAM
AMPICILLIN / SULBACTAM
TICARCILINA / CLAVULANATE

ALLERGIES PCN:
AZTREONAM
MTZ