INFECTIOUS DISEASE EMERGENCIES

Question 1

What is the difference b/t sepsis and sirs?

Answer 1

systemic inflammatory response to to infection (if none found = sirs)

Question 2

Jon has an abscess and becomes hypotensive. Blood cultures show positive for bacteria and fluid challenges are ineffective. What is happening

Answer 2

septic shock

Question 3

What are the symptoms of septic shock?

Answer 3

fever, HR>90,RR>20, alt MS, distributive shock, lactic acidosis, oliguria

Question 4

How is septic shock treated?

Answer 4

ABC, O2 (hypoxemia), Fluids (shock), ABX (Empiric Vanc + G- coverage like Ceftriaxone), gross infection removal (catheter, abscess, etc.)

Question 5

A 7 year old boy is brought to your clinic. His mother says he woke up with a headache, fever and started throwing up. He has petechia on his chest and is complaining of a sore neck. You tell mom its a viral infection based on what you think is a viral exanthem and that he needs plenty of rest and fluids to counter the vomiting. 2 hours later you get a call from a local ED. The doc tells you that you might want to get a lawyer because the kid you just saw is dead. What was this and what should you have done?

Answer 5

Acute meningococcemia : Neisseria Meningitidis
-TX ABC, O2 (hypoxemia), Fluids (shock), ABX (Empiric Vanc + G- coverage like Ceftriaxone), gross infection removal (catheter, abscess, etc.)

Question 6

Lafonda has had the same tampon in for 3 weeks. She is hypotensive, has erytheroderma (including her palms and soles), petechia, bullae and swelling. What is going on?

Answer 6

Toxic Shock from Staph exotoxin. TX w/ vanc and clinda.

Question 7

When is HIV typically symptomatic

Answer 7

CD4<500

Question 8

An HIV patient presents with fever, dyspnea on exertion and a dry cough. What do you suspect, how does the CXR appear and how will you treat?

Answer 8

PCP pneumonia
bilateral interstitial patchiness
TX Bactrim

Question 9

An HIV patient presents with fever, HA, and meningeal signs. What do you suspect, how will you know and how will you treat?

Answer 9

Cryptococcus meningitis
CSF = CrAg
Ampho B

Question 10

An HIV patient presents with fever, HA, altered mental status, seizures and focal deficits. What could cause this? What diagnostics could you use? How would you treat it?

Answer 10

Toxoplasmosis
Toxo titer/CT: multiple ring enhanced lesions
TX Pyrimethamine, sulfadiazine

Question 11

An HIV patient is complaining of seeing floaters, blurred vision and flashing in his visual field. What could this be and how would you treat it?

Answer 11

CMV retinitis

valgancyclovir

Question 12

Pt presents with purulent arthritis in the left knee and right wrist, fevers and myalgias and you notice purulent skin lesions on the knees, wrists and ankles….what is this?

Answer 12

Disseminated gonococcemia: Bacteremic spread of STD N. gonorrhea
TX: Ceftriaxone + azith or doxy

Question 13

A man comes to your clinic with a red, swollen and painful right knee. You have ruled out gout….what is this? TX?

Answer 13

Nongonoccocal septic arthritis

Tx Vanco if G+, Ceftazadine if G-.

Question 14

A college age woman comes to clinic with symmetric arthritis in elbows and knees and a rash. What do you suspect? TX?

Answer 14

Viral arthritis: parvo/Hep b or C/EBV
Does not lead to chronic arthritis, <6weeks duration. DX complete work up to find causative agent, but TX is symptomatic.

Question 15

A woman comes to clinic complaining of arthritis of her right shoulder and her left TMJ. You do a full work up and find her serology is positive for lyme disease. What is the treatment?

Answer 15

28 days doxy

Question 16

James cut his foot with an axe. The cut went all the way to the bone. He was treated at the ED, but is back in clinic now with increased pain, redness and welling. On x-ray you see subperiostial abnormality and lucency. What do you suspect?

Answer 16

Osteomyelitis
DX blood cultures, bone biopsy
TX surgical debride, ABX.

Question 17

Tony was in a nasty motorcycle wreck a week ago. You are reevaluating a his leg wound and you notice that the overlying skin is purple, blistering and seems to have gas underneath it. He has a fever and seems to have more pain than the wound should be causing. What is this? TX?

Answer 17

Gas gangrene most likely from C. perfringens

TX w/ Clinda + PCN

Question 18

What color, viscosity, WBC, PMN %, culture, protein, and glucose is normal joint fluid?

Answer 18

color clear
viscosity high
WBC <25
culture negative
protein low/ 1-2
glucose about the same as blood

Question 19

You tap a joint and its mostly translucent and yellow. The mucin clot test shows a very low viscosity, wbc count is b/t 100-100000, PMN % is moderately elevated at 50, culture is negative, protein is mildly elevated and glucose is slightly lower than blood. What is this?

Answer 19

Inflammatory

Question 20

You tap a joint and the fluid is opaque, yellow/green, of variable viscosity, WBC is b/t 15k to 100k, PMN% is high at >75, culture is positive, protein is mildly elevated and glucose is well below blood glucose. What is this?

Answer 20

Septic

Question 21

You tap a joint and fluid is red/bloody, viscosity is variable, WBC is mildly elevated (

Answer 21

Hemorrhagic

Question 22

T/F: crystals are a normal finding in joint taps.

Answer 22

False

Question 23

describe gout crystals

Answer 23

monosodium urate crystals= birefringent needle shaped, yellow and strong/ “negative birefringent”

Question 24

describe pseudogout crystals

Answer 24

calcium pyrophosphate dihydrate crystals (CPPD)= rhomboid, blue, birefringent