Miscellaneous Infections

Question 1

Non-tender, erythematous macules on palms and soles

Answer 1

Janeway lesions in infectious endocarditis

Peripheral embolization

Question 2

Painful purple nodes on fingertips and toes

Answer 2

Osler’s nodes

Immunologic response in infectious endocarditis

Question 3

Duke criteria for infectious endocarditis

Answer 3

2 major, or 1 major + 3 minor, or 5 minor:
MAJOR:
1) at least 2 separate +bcx for typical organism, persistent bacteremia with any organism, or single +bcx of C burnetii
2) Evidence of endocardial involvement (TTE or new murmur)
MINOR:
- Fever
- Vascular: septic emboli, septic infarcts, mycotic aneurysm, Janeway lesions
- Immunologic: glomerulonephritis, Osler nodes, Roth spots
- Predisposing risk factors
- Other microbiological evidenc

Question 4

Osteomyelitis bug if no risk factors

Answer 4

S aureus

Question 5

Osteomyelitis bug if IV drug use

Answer 5

S aureus or Pseudomonas

Question 6

Osteomyelitis drug if sickle cell disease

Answer 6

Salmonella

Question 7

Osteomyelitis bug if hip replacement

Answer 7

Staph epi

Question 8

Osteomyelitis bug if foot puncture wound

Answer 8

Pseudomonas (especially through sole of shoe… moist environment)

Staph aureus too

Question 9

Osteomyelitis bug if diabetic

Answer 9

Polymicrobial, pseudomonas, S aureus, strep, anaerobes

Question 10

Localized bone pain and tenderness

Answer 10

Vertebral osteomyelitis

Question 11

Complications of chronic osteomyelitis with draining sinus

Answer 11

Squamous cell carcinoma (Marjolin ulcer)

Question 12

Reddish-brown lesions under nail beds

Answer 12

Splinter hemorrhages (of infectious endocarditis)

Question 13

Bug in infectious endocarditis from IVDU

And how to treat?

Answer 13

Staph aureus
Most commonly tricuspid valve

Treat with empiric VANCOMYCIN!

Question 14

Bug in infectious endocarditis after dental procedures

Native valve

Answer 14

Strep viridans group (eg strep mutans, mitis, oralis, sobrinus, milleri, sanguinis)

Or eikenella corrodens (poor dentitiion)

Question 15

Bug in prosthetic valve endocarditis

Or in dwelling IV catheter

Answer 15

Staph epidermis (coag-negative staph)

Question 16

What if endocarditis is strep bovis?

Answer 16

Get colonoscopy! (Coexisting GI malignancy)

Question 17

S/p Surgical wound infection, sinusitis, or septorhinoplasty
Diffuse macular erythroderma (looks like sunburn)
Fever, hypotension, AMS

Answer 17

TSS due to staph aureus

Question 18

How to treat strep viridans (mutans) endocarditis?

Answer 18

IV penicillin G or IV ceftriaxone

Question 19

Empiric therapy for human bite wound?

Answer 19

Polymicrobial infection w/ aerobic, anaerobic

Empiric tx with amox-clav
Clinda not good enough for gram negs

Question 20

What drug to use for neutropenic fever?

Answer 20

Must cover pseudomonas: cefepime or pip-tazo

Add vanc if suspect line infection or if septic shock develops

Question 21

For neutropenic fever: what drug to add if no improvement after 72hr on antibiotics?

Answer 21

Amphotericin B

Question 22

Bug in infectious endocarditis after procedural manipulation of urinary tract

Answer 22

Enterococcus

Question 23

What is most common valvular abnormality in pts with infective endocarditis?

Answer 23

Mitral valve prolapse (+coexisting mitral regurgitation)

Question 24

Lungs: nodular infiltrate with cavitation in peripheral lungs

Answer 24

Embolization from infectious endocarditis

Question 25

Abx for neutropenic fever

Answer 25

Anti-pseudomonal (cefepime, pip-tazo). Or meropenem etc

And don’t do rectal exam!