Strep inf

Question 1

how is Gr A beta-hemolytic strep throat transmitted

Answer 1

air-bourne secretions

Question 2

4 symptoms of strep throat

Answer 2

fever, tender cervical lymphadenopathy, odynophagia (pain swallowing), possible nausea

Question 3

with what pattern rash does scarlet fever present

Answer 3

similar to a sunburn - superimposed fine papules, mostly in groin and axilla, blanchable, fades 2-5 days with peeling

Question 4

3 HEENT findings for scarlet fever

Answer 4

face flushed, circumoral pallor, enlarged papillae on tongue

Question 5

Ddx for scarlet fever (3)

Answer 5

viral, HIV, diptheria, GC pharyngitis, retropharyngeal abscess

Question 6

what is the sensitivity for blood agar culture of strep throat, what is 2nd choice for testing

Answer 6

80-90%, 2nd choice rapid strep test

Question 7

first DOC for strep throat

Answer 7

benzathine (pen G) 1.2mu IM

Question 8

alternative tx of strep throat (3)

Answer 8

Pen Vk (500mg QID x 10days), Amoxicillin (>500mg BID x 10days), clarithromycin (if PCN allergic)

Question 9

how often do strep infections become rheumatic fever

Answer 9

3%

Question 10

what test should be ordered for rheumatic fever

Answer 10

ASO (stretolysin O titer) to show if recent strep inf (2-4 weeks ago) caused symptoms of rheumatic fever (lattice rash, joint pain)

Question 11

what org causes impetigo

Answer 11

tropical: strep. temperate: staph. but, often co-inf

Question 12

Ddx for impetigo (3)

Answer 12

acute allergic dermatitis, HSV, contact dermatitis

Question 13

tx for impetigo

Answer 13

wash off crust, then apply mupirocin (Bactroban), retapamulin (Altabax) topicals

Question 14

tx for impetigo that is rampant or near the eyes

Answer 14

systemic: cephalexin (Keflex, 250mg BID) or doxycycline (Vibramycin 100mg BID)

Question 15

reason for recurrent impetigo

Answer 15

CA-MRSA

Question 16

tx for Erysipelas of face or with fever (OR subsequent joint inf)

Answer 16

parenteral PCN

Question 17

tx of necrotizing fasciitis

Answer 17

surgical debridement and beta-lactams

Question 18

what condition is a complication of Scarlet Fever

Answer 18

Strep TSS (pyogenic erythrotoxin causes massive release of inflammatory cytokines)

Question 19

prognosis for Strep TSS

Answer 19

skin, soft tissue inflammation, ARDS, renal failure, 80% mortality

Question 20

tx for Strep TSS

Answer 20

beta lactams, ALSO! test contacts for reservoir status