Micro - PUO + endocarditis

Question 1

Definition fo PUO

Answer 1

> 38.3C for 3 weeks despite 1 week of Ix

Question 2

8 causes of a “classical PUO”

Answer 2

• Endocarditis
• ABSCESSES
• TB
• Returning traveller: malaria
• HIV
• CTD/vasculitis
• Malignancy
• Complicated UTI

Question 3

4 diseases which present with fever in a returning traveller within 7-10 days of return

Answer 3

Malaria
Dengue
Diarrhoeal disease
Typhoid

Question 4

Which cause of fever in a returning traveller will present at 3 weeks from return?

Answer 4

Brucellosis

Question 5

Name 4 commonest causes of fever in a returning traveller, which may present with a rash?

Answer 5

Malaria
Dengue
Rickettsia
Typhoid

Question 6

Cause of ‘spotted fever’

Tx of spotted fever?

Answer 6

Rickettsia

Tx with DOXYCYCLINE

Question 7

E.g.s of healthcare associated PUO?

Answer 7

Lines (biofilms)
Catheter -->UTI
Bedsores
Ventilation assoc pneumonia
Post-surgical (wound infection)

C Diff colitis

Question 8

what kinda organisms tend to cause hospital acquired pneumonia?

Answer 8

Gram - species, as these colonise the skin more in hospital

Question 9

Immune-deficient PUO: which patients tend to be affected by this?

Answer 9

BMT patients

Question 10

Infective causes of immune-deficient PUO

Answer 10

CMV (post transplant)

TB

Question 11

Risk factors for neutropenic fever?

Answer 11

Aspergillus spp infection

• Lines
• Chemo/BMT
• IRIS syndrome

Question 12

which particular infection do we majorly worry about in neutropenic fever?

Answer 12

Aspergillus spp

Question 13

In HIV patients, what lab investigation is particularly important to know which infections they are susceptible to?

Answer 13

CD4 count

Question 14

in a patient with CD4 count of <200, which 3 infections are they particularly susceptible to?

Answer 14

• Cryptococcus
• PCP
• Disseminated mycobacterium avium complex

Question 15

characteristic features of PCP?

Answer 15

Desaturating on exercise

- CXR is deceivingly ok

Question 16

PUO in pt who has returned from Malaysia. What infection do we need to consider?

Answer 16

Histoplasmosis

Question 17

Useful lab tests in a patient with PUO?

Answer 17

Blood cultures x3
Returning traveller: blood film
HIV TEST!!!!!!
Rapid Ag test
FBC, CRP, LFTs

Question 18

If eosinophils are high.. think of…?

Answer 18

worms:
- schistosomiasis
- Filaria
- Strongloides

Question 19

Gram - coccobacillus + unpasteurised milk ingestion

Answer 19

Brucellosis

Question 20

Immediate mx of neutropenic fever

Answer 20

Empirical antibiotics + BCs

Question 21

A dimorphic fungus from Malaysia

Answer 21

histoplasmosis

Question 22

fever + murmur + splenomegaly…?

Answer 22

infective endocarditis!

Question 23

Oslers nodes vs Janeway lesions

Answer 23

Oslers nodes: small and painful nodules

Janeway lesions: painless macules

Question 24

Renal complications of infective endocarditis

Answer 24

• Glomerulonephritis
• Abscess
• Infarction

Question 25

Top 3 pathogens in infective endocarditis

Answer 25

Strep viridans
Staph Aureus
Staph epidermis

Question 26

In patients with a prosthetic valve, what is the most common pathogen causing IE?

Answer 26

Staph epidermis (coagulase negative staph)

Question 27

What are the “major criteria” for diagnosing IE?

Answer 27

1) 2x BCs with +ve microorg that is typical of IE

2) Echo findings: new regurgitation/abscess/oscillating mass on valve

Question 28

“minor criteria” for diagnosing IE? (name 4, don’t bother with the +ve BC and echo findings which don’t satisfy the major criteria)

Answer 28

1) fever
2) Oslers nodes/janeway lesions
3) Predisposing <3 prob/IVDU
4) vascular ting: major arterial emboli/pulmonary infarcts

Question 29

Tx of MSSA endocarditis?

Answer 29

Fluclox for 4-6 weeks

Question 30

Tx of MRSA endocarditis

Answer 30

Vanc + gent

Question 31

Tx of strep viridian’s endocarditis

Answer 31

Benzylpenicillin + gentamicin

Question 32

Tx of enterococcal endocarditis

Answer 32

Ampicillin + gentamicin