Infectious Disease EM

Question 1

What is the continuation levels of sepsis?

Answer 1

Infection –> Sepsis –> Septic Shock –> MODS

Question 2

What is sepsis?

Answer 2

“Life threatening organ dysfunction due to a dysregulated host response to infection”

Question 3

What are the initial orders when working up sepsis?

Answer 3

• IV/O2/Fluids
• IV fluids - 30mL/kg
• Goal is for MAP > 65
• Labs: CBC, CMP, PT/PTT, D-dimer?, lactate, cultures (blood and urine), ABG/VBG, procalcitonin

Question 4

When giving a pressor in sepsis what is the pressor of choice?

Answer 4

• Noriepinephrine

Question 5

What lab is typically ordered in the work-up of sepsis because it correlates with bacterial infections and sepsis?

Answer 5

Procalcitonin

Question 6

What broad spectrum antibiotics are used in sepsis?

What if there is concern for pseudomonas?

Answer 6

Vancomycin with either cefriaxone or zosyn

Vancomycin with ceftazidime or imipenem

Question 7

What are the exam findings associated with abscesses?

Answer 7

• Area of fluctuance
• Erythema (typically localized)
• Pain
• US findings (white wall around black pocket)

Question 8

What is a carbuncle?

Answer 8

A collection of abscesses

Question 9

Sesquipedalian

Answer 9

A foot and half long

Long winded

Question 10

Abstruse

Answer 10

Difficult to understand

Question 11

Schadenfreude

Answer 11

Pleasure from other disfortune

Question 12

Posthumous

Answer 12

Praise after death

Question 13

Euouae

Answer 13

A term in medevil music

Question 14

What antibiotics cover MRSA?

Answer 14

• Bactrim
• Doxycycline
• Clindamycin
• Vanco

Question 15

Toxic shock is a toxin mediated illness secondary to what pathogens?

What is it associated with?

Answer 15

Staph or Strep

Tampons, nasal packing, surgical wounds, postpartum infection

Question 16

What is Fournier’s Gangrene?

Answer 16

Nec Fasciitis of the perineum, m/c involving the scrotum

Question 17

What tick borne disease can present with vasculitis?

Answer 17

Rocky Mountain Spotted Fever

Question 18

What are some late symptoms of Rocky Mountain Spotted Fever?

Answer 18

AMS, meningismus

Question 19

What arrhythmia is associated with Lyme Disease?

What is the treatment?

Answer 19

3rd Degree Heart Block

Admitted for Doxy and Observation until resolved

Question 20

What two patient groups are at high risk for endocarditis?

Answer 20

• IVDU
• Congenital Valvulopathies

Question 21

What broad spectrum antibiotic is used to treat endocarditis?

Answer 21

Vancomycin

Question 22

A simple UTI is usually caused by what pathogen?

Answer 22

E. coli

Question 23

What pain medicine should be given for kidney stones?

Answer 23

Ketoralac (Toradol)

Question 24

What antibiotic is used to treat chlamydia?

What about Gonorrhea?

Are you treating for both?

Answer 24

Doxycycline

Ceftriaxone IM

Yes

Question 25

What absolute neutrophil count defines neutropenic fever?

Answer 25

ANC < 1000

People get antsy when its less than 500

Question 26

A 19 year old female presents to the emergency department with fever, nuchal rigidity, and headache. After obtaining cultures the decision to treat with broad-spectrum antibiotics is made. When do you start steriods in relation to the antibiotics?

Why are you giving steroids?

Answer 26

Prior

To lyse the bacterial cells

Question 27

Are the symptoms related to a brain abscess more focal?

Answer 27

Yes, what can differentiate an abscess from meningitis or encephalitis