Small Group: Cellulitis, Necrotizing Fasciitis, Bacteremia, and Endocarditis

Question 1

What is “arteriovenous nicking on a fundoscopic exam”?

Answer 1

If a person has hypertension, then the pressure from the artery can occlude the vein and lead to an empty blip in the vein.

Question 2

___________ can often rupture and appear like cellulitis on the rear of the leg.

Answer 2

Baker’s cysts

Question 3

In addition to having a sharper border than that of cellulitis, erysipelas also is more common on ______________.

Answer 3

the upper body (while cellulitis is most common in the legs)

Question 4

What are the two kinds of necrotizing fasciitis?

Answer 4

Type I: polymicrobial

Type II: monomicrobial

Question 5

Up to ________ percent of patients with necrotizing fasciitis do not have an entry point.

Answer 5

50

Question 6

Extreme pain with a mild-appearing rash are suggestive of _______________.

Answer 6

necrotizing fasciitis

Question 7

What is the mortality of necrotizing fasciitis?

Answer 7

20% - 50%

Question 8

What antibiotics treat necrotizing fasciitis?

Answer 8

Augmentin (broad-spectrum) and clindamycin (to prevent the Eagle effect); if biopsy shows S. pyogenes only, then penicillin G can be used

Question 9

What are subconjunctival hemorrhages?

Answer 9

Little hemorrhages in the conjunctivae seen when the lower eyelid is lowered

Question 10

What is the useful distinction between CRP and ESR?

Answer 10

Elevated CRP indicates acute inflammation, while elevated ESR indicates chronic inflammation.

Question 11

What Gram-negative bacteria can cause endocarditis?

Answer 11

HACEK: 
Haemophilus
Actinobacilus
Cardiobacterium 
Eikenella
Kingella

Question 12

What are two causes of culture-negative endocarditis?

Answer 12

Coxiella

Brucella

Question 13

What is the first step in the development of most endocarditis?

Answer 13

Formation of a sterile fibrin mesh (from damage to the valve or non-laminar flow)

Question 14

Tricuspid/pulmonic vegetations will lead to ________________.

Answer 14

pulmonary emboli

Question 15

What are the distinctions between Janeway lesions and Osler nodes?

Answer 15

Janeway: painless and macular
Osler: tender and papular

Question 16

What renal problems can arise from mitral endocarditis?

Answer 16

Septic emboli can lead to renal abscesses.

Immune complexes can lead to glomerulonephritis.

Question 17

How long should antibiotics be given to someone with infectious endocarditis?

Answer 17

4 weeks; this is longer than in other infections, and the reason is that endocardial infections are partly protected from phagocytic cells due to their placement and encapsulation in fibrin clots.

Question 18

What are some indications for surgical treatment of endocarditis?

Answer 18

Fungal infection
Persistent bacteremia
Congestive heart failure 
No effective antibiotic therapy 
Valvular obstruction

Question 19

Roth spots are seen in _____________.

Answer 19

the retina