ID BOARD REVIEWID BOARD REVIEW

James Hinchey MD PhD MSW James Hinchey MD PhD MSW MPH JD BA SOBMPH JD BA SOB

What do they like to ask?

•HIV- opportunistic infections

•Rabies

•Diarrhea-infectious

•Ticks, worms, parasites

•Syphilis

Which of the following infectious Which of the following infectious agents is thought to be the most agents is thought to be the most common cause of Bell Palsy?common cause of Bell Palsy?

A.A. Borrelia bugdorferiBorrelia bugdorferi

B.B. Epstein-Barr virusEpstein-Barr virus

C.C. Herpes simplex virusHerpes simplex virus

D.D. Mycobacterium tuberculosisMycobacterium tuberculosis

E.E. Varicella-zoster virusVaricella-zoster virus

Which of the following infectious Which of the following infectious agents is thought to be the most agents is thought to be the most common cause of Bell Palsy?common cause of Bell Palsy?

A.A. Borrelia bugdorferiBorrelia bugdorferi

B.B. Epstein-Barr virusEpstein-Barr virus

C.C. Herpes simplex virusHerpes simplex virus

D.D. Mycobacterium tuberculosisMycobacterium tuberculosis

E.E. Varicella-zoster virusVaricella-zoster virus

Herpes simplex virusHerpes simplex virus

• Type 1 mostly oral, Type 2 primarily genitalType 1 mostly oral, Type 2 primarily genital prodrome of pain and hyperesthesiaprodrome of pain and hyperesthesia• Painful vesicles on an erythematous base crust and Painful vesicles on an erythematous base crust and

heal in 10-14 daysheal in 10-14 days• recurrences in immunocompromised, prolonged recurrences in immunocompromised, prolonged

sunlight exposure, stresssunlight exposure, stress• Bells Palsy: Ddx- HIV, Lyme disease, TB, temporal Bells Palsy: Ddx- HIV, Lyme disease, TB, temporal

bone trauma, mumps, Mycoplasma pneumonia, bone trauma, mumps, Mycoplasma pneumonia, leprosy, sjogren’s, sarcoidosis; leprosy, sjogren’s, sarcoidosis; HSV most frequently HSV most frequently associatedassociated

• antivirals in primary infection to decrease viral antivirals in primary infection to decrease viral shedding and shorten duration of symptoms NOT to shedding and shorten duration of symptoms NOT to prevent recurrenceprevent recurrence

• long term suppressive therapy in those with severe long term suppressive therapy in those with severe and frequent recurrencesand frequent recurrences

• IV abx and admission for HSV encephalitisIV abx and admission for HSV encephalitis

73 yr old woman p/w nausea and vomiting that 73 yr old woman p/w nausea and vomiting that began suddenly that afternoon. She was fine in began suddenly that afternoon. She was fine in the morning and went to a church picnic. 3 the morning and went to a church picnic. 3 hours later she developed her current symptoms. hours later she developed her current symptoms. She asked a friend to take her to he hospital, but She asked a friend to take her to he hospital, but her friend had also become ill. She recalls that her friend had also become ill. She recalls that they ate barbecued chicken, spinach salad, they ate barbecued chicken, spinach salad, potato salad and some cookies.on exam, she potato salad and some cookies.on exam, she appears weak and dehydrarted. She has no appears weak and dehydrarted. She has no fever, and her stool tests hem-occult negative. fever, and her stool tests hem-occult negative. What organism is the most likely cause of her What organism is the most likely cause of her symptoms?symptoms?A.A. Campylobacter jejuniCampylobacter jejuni

B.B. Clostridium perfringensClostridium perfringens

C.C. Salmonella typhimuriumSalmonella typhimurium

D.D. Shigella flexneriShigella flexneri

E.E. Staphylococcus aureusStaphylococcus aureus

73 yr old woman p/w nausea and vomiting that 73 yr old woman p/w nausea and vomiting that began suddenly that afternoon. She was fine in began suddenly that afternoon. She was fine in the morning and went to a church picnic. 3 the morning and went to a church picnic. 3 hours later she developed her current symptoms. hours later she developed her current symptoms. She asked a friend to take her to he hospital, but She asked a friend to take her to he hospital, but her friend had also become ill. She recalls that her friend had also become ill. She recalls that they ate barbecued chicken, spinach salad, they ate barbecued chicken, spinach salad, potato salad and some cookies.on exam, she potato salad and some cookies.on exam, she appears weak and dehydrarted. She has no appears weak and dehydrarted. She has no fever, and her stool tests hem-occult negative. fever, and her stool tests hem-occult negative. What organism is the most likely cause of her What organism is the most likely cause of her symptoms?symptoms?A.A. Campylobacter jejuniCampylobacter jejuni

B.B. Clostridium perfringensClostridium perfringens

C.C. Salmonella typhimuriumSalmonella typhimurium

D.D. Shigella flexneriShigella flexneri

E.E. Staphylococcus aureusStaphylococcus aureus

35 yo male with 12 hour history of severe 35 yo male with 12 hour history of severe abdominal cramping, nausea and loose watery abdominal cramping, nausea and loose watery stools, no fever no vomiting no travel-12 hours stools, no fever no vomiting no travel-12 hours earlier he had eaten turkey left out at room earlier he had eaten turkey left out at room temperature-what is them most likely etiologytemperature-what is them most likely etiology

A.A. Campylobacter jejuniCampylobacter jejuni

B.B. Clostridium perfringensClostridium perfringens

C.C. Salmonella typhimuriumSalmonella typhimurium

D.D. Shigella flexneriShigella flexneri

E.E. Staphylococcus aureusStaphylococcus aureus

35 yo male with 12 hour history of severe 35 yo male with 12 hour history of severe abdominal cramping, nausea and loose watery abdominal cramping, nausea and loose watery stools, no fever no vomiting no travel-12 hours stools, no fever no vomiting no travel-12 hours earlier he had eaten turkey left out at room earlier he had eaten turkey left out at room temperature-what is them most likely etiologytemperature-what is them most likely etiology

A.A. Campylobacter jejuniCampylobacter jejuni

B.B. Clostridium perfringensClostridium perfringens

C.C. Salmonella typhimuriumSalmonella typhimurium

D.D. Shigella flexneriShigella flexneri

E.E. Staphylococcus aureusStaphylococcus aureus

Staphylococcus AureusStaphylococcus Aureus

• 2 or more persons with same illness and common food 2 or more persons with same illness and common food exposure- foodborne infectionexposure- foodborne infection

• Staph aureus (primarily upper GI symptoms), Staph aureus (primarily upper GI symptoms), short short incubation period (1-6 hrs),incubation period (1-6 hrs), preformed enterotoxin, preformed enterotoxin, unrefrigerated meats, potato/egg salad, cream unrefrigerated meats, potato/egg salad, cream pastries, severe sudden vomiting, pastries, severe sudden vomiting,

• Campylobacter, Salmonella, Shigella - clinically Campylobacter, Salmonella, Shigella - clinically indistinguishable, diarrheal illness 1-3 days after indistinguishable, diarrheal illness 1-3 days after exposure (multiply in stomach), self-limited but exposure (multiply in stomach), self-limited but usually treated with fluoroquinoloneusually treated with fluoroquinolone

• Clostridium perfringens- watery diarrhea, symptoms Clostridium perfringens- watery diarrhea, symptoms within 24 hrs, precooked meats allowed to thaw within 24 hrs, precooked meats allowed to thaw before cooking, self-limitedbefore cooking, self-limited

DiarrheaDiarrhea• ...which is mucoid bloody + high fever + febrile seizure in infant ...which is mucoid bloody + high fever + febrile seizure in infant

shigellashigella• ……in patient with pet turtle or iguana in patient with pet turtle or iguana salmonella salmonella• ……in patient without spleen or with sickle cell in patient without spleen or with sickle cell salmonella salmonella• ……and pseudoappendicitis presentation and pseudoappendicitis presentation yersinia yersinia• ……& fecal WBCs after poultry or eggs & fecal WBCs after poultry or eggs salmonella, campylobacter salmonella, campylobacter• ……after poultry or meat, after poultry or meat, nono fecal WBCs fecal WBCs Clostridium perfringesClostridium perfringes• ……profuse and watery after antibiotic profuse and watery after antibiotic C Clostridium difficilelostridium difficile• ……after potato salad or mayonnaise after potato salad or mayonnaise Staphylococcus aureusStaphylococcus aureus• ……after fried rice after fried rice Bacillus cereusBacillus cereus• ……after raw oysters after raw oysters Vibrio choleraVibrio cholera• ……after drinking from mountain stream after drinking from mountain stream Giardia lambliaGiardia lamblia• ……in AIDS patient in AIDS patient isospora or cryptosporidium isospora or cryptosporidium• ……and hemolytic-uremic syndrome or TTP and hemolytic-uremic syndrome or TTP E. coliE. coli 0157:H7 0157:H7

Assuming the patient is a resident of North Assuming the patient is a resident of North America and has never been immunized against America and has never been immunized against rabies, in which of the following situations are rabies, in which of the following situations are rabies immune globulin and rabies vaccine series rabies immune globulin and rabies vaccine series clearly indicated?clearly indicated?

A.A. Patient bitten by a chipmunk that Patient bitten by a chipmunk that escapesescapes

B.B. Patient bitten by a neighborhood dog Patient bitten by a neighborhood dog that has been captured and quarantinedthat has been captured and quarantined

C.C. Patient bitten by the family dogPatient bitten by the family dog

D.D. Patient scratched by a bat that was in Patient scratched by a bat that was in his home, and the bat escapeshis home, and the bat escapes

E.E. Patient who sees a bat in her backyard Patient who sees a bat in her backyard and is not aware of any contactand is not aware of any contact

Assuming the patient is a resident of North Assuming the patient is a resident of North America and has never been immunized against America and has never been immunized against rabies, in which of the following situations are rabies, in which of the following situations are rabies immune globulin and rabies vaccine series rabies immune globulin and rabies vaccine series clearly indicated?clearly indicated?

A.A. Patient bitten by a chipmunk that escapesPatient bitten by a chipmunk that escapes

B.B. Patient bitten by a neighborhood dog that Patient bitten by a neighborhood dog that has been captured and quarantinedhas been captured and quarantined

C.C. Patient bitten by the family dogPatient bitten by the family dog

D.D. Patient scratched by a bat that was in Patient scratched by a bat that was in his home, and the bat escapeshis home, and the bat escapes

E.E. Patient who sees a bat in her backyard and Patient who sees a bat in her backyard and is not aware of any contactis not aware of any contact

RabiesRabies

• Bat main vector in US; most without documented bite, Bat main vector in US; most without documented bite, so any exposure to saliva or mucous membranes so any exposure to saliva or mucous membranes indication for treatment, unless captured, sacrificed indication for treatment, unless captured, sacrificed (Negri bodies)(Negri bodies)

• Dog main vector in world Dog main vector in world • Prodrome: excitement, opithotonus, hydrophobia, Prodrome: excitement, opithotonus, hydrophobia,

salivation, lacrimation, ataxiasalivation, lacrimation, ataxia• In US rabies rare in caninesIn US rabies rare in canines• Bites from rodents (chipmunks, squirrels, hamsters, Bites from rodents (chipmunks, squirrels, hamsters,

guinea pigs, etc) not indication for vaccineguinea pigs, etc) not indication for vaccine• Rabies postesposure prophylaxis: human rabies Rabies postesposure prophylaxis: human rabies

immune globulin (HRIG) + human diploid cell vaccine immune globulin (HRIG) + human diploid cell vaccine (HDCV) in deltoid days 0, 3, 7, 14, and 28 (HDCV) in deltoid days 0, 3, 7, 14, and 28

Which of the following is the most common initial Which of the following is the most common initial neurologic manifestation of diphtheria?neurologic manifestation of diphtheria?

A.A. Bells palsyBells palsyB.B. Lower extremety weaknessLower extremety weaknessC.C. Diplopia, blurred vision and Diplopia, blurred vision and

photophobiaphotophobiaD.D. Paralysis of palate musclesParalysis of palate musclesE.E. trismustrismus

Which of the following is the most common initial Which of the following is the most common initial neurologic manifestation of diphtheria?neurologic manifestation of diphtheria?

A.A. Bells palsyBells palsyB.B. Lower extremety weaknessLower extremety weaknessC.C. Diplopia, blurred vision and Diplopia, blurred vision and

photophobiaphotophobiaD.D.Paralysis of palate musclesParalysis of palate musclesE.E. trismustrismus

• Diphtheria disrupts protein synthesis causes demylination- producing a peripheral neuropthy

Palate muscles are most commonly affected- usually does not cause bells palsy

• Trismus- tetanus

• Diplopia, blurred vision, photophobia think botulism

A 75 yr old man p/w fever and ear pain. He has had A 75 yr old man p/w fever and ear pain. He has had the earache for several weeks and has been treating the earache for several weeks and has been treating it at home with warm mineral oil. On further it at home with warm mineral oil. On further questioning, he says that he is diabetic and that his questioning, he says that he is diabetic and that his sugars are running higher than normal. Exam is sugars are running higher than normal. Exam is normal except for the ear which has granualation normal except for the ear which has granualation tissue on the floor of the external auditory canal. The tissue on the floor of the external auditory canal. The most likely pathogen causing this infection is:most likely pathogen causing this infection is:

A.A. Aspergillus sp.Aspergillus sp.

B.B. Candida speciesCandida species

C.C. Pseudomonas aeruginosaPseudomonas aeruginosa

D.D. Staphylococcus epidermidisStaphylococcus epidermidis

E.E. Streptococcus pneumoniaeStreptococcus pneumoniae

A 75 yr old man p/w fever and ear pain. He has had A 75 yr old man p/w fever and ear pain. He has had the earache for several weeks and has been treating the earache for several weeks and has been treating it at home with warm mineral oil. On further it at home with warm mineral oil. On further questioning, he says that he is diabetic and that his questioning, he says that he is diabetic and that his sugars are running higher than normal. Exam is sugars are running higher than normal. Exam is normal except for the ear which has granualation normal except for the ear which has granualation tissue on the floor of the external auditory canal. The tissue on the floor of the external auditory canal. The most likely pathogen causing this infection is:most likely pathogen causing this infection is:

A.A. Aspergillus sp.Aspergillus sp.

B.B. Candida speciesCandida species

C.C. Pseudomonas aeruginosaPseudomonas aeruginosa

D.D. Staphylococcus epidermidisStaphylococcus epidermidis

E.E. Streptococcus pneumoniaeStreptococcus pneumoniae

Malignant otitis externaMalignant otitis externa• Seen in elderly, diabetics, HIV, Seen in elderly, diabetics, HIV,

immunocompromised, immunocompromised, persistent otitis externa persistent otitis externa (failing 2-3 weeks of Abx)(failing 2-3 weeks of Abx)

• Pseudomonas, aspergillus, Pseudomonas, aspergillus, Staph, StrepStaph, Strep

• Otalgia/otorrhea, cranial nerve Otalgia/otorrhea, cranial nerve involvement with progression, involvement with progression, HA, neck pain, fever, AMSHA, neck pain, fever, AMS

• Management: Radiographic Management: Radiographic imaging, admission parenteral imaging, admission parenteral antibiotics, possibly surgicalantibiotics, possibly surgical debridementdebridement

24 year old man with no PMH p/w 5 days of 24 year old man with no PMH p/w 5 days of nonprod cough, fever, sob, and DOE, the patient nonprod cough, fever, sob, and DOE, the patient is thin has multiple enlarged cervical lymph is thin has multiple enlarged cervical lymph nodes, bilateral ronchi on pulmonary exam, a nodes, bilateral ronchi on pulmonary exam, a temperature of 40.1 and O2 sat of 83% on room temperature of 40.1 and O2 sat of 83% on room air. He is admitted to the hospital. Which of the air. He is admitted to the hospital. Which of the following is the most appropriate choice for following is the most appropriate choice for empiric antibiotics?empiric antibiotics?

A.A. Ceftriaxone and Ceftriaxone and azithromycinazithromycin

B.B. LevofloxacinLevofloxacin

C.C. Levofloxacin and bactrimLevofloxacin and bactrim

D.D. MetronidrazoleMetronidrazole

E.E. BactrimBactrim

24 year old man with no PMH p/w 5 days of 24 year old man with no PMH p/w 5 days of nonprod cough, fever, sob, and DOE, the patient nonprod cough, fever, sob, and DOE, the patient is thin has multiple enlarged cervical lymph is thin has multiple enlarged cervical lymph nodes, bilateral ronchi on pulmonary exam, a nodes, bilateral ronchi on pulmonary exam, a temperature of 40.1 and O2 sat of 83% on room temperature of 40.1 and O2 sat of 83% on room air. He is admitted to the hospital. Which of the air. He is admitted to the hospital. Which of the following is the most appropriate choice for following is the most appropriate choice for empiric antibiotics?empiric antibiotics?

A.A. Ceftriaxone and Ceftriaxone and azithromycinazithromycin

B.B. LevofloxacinLevofloxacin

C.C. Levofloxacin and bactrimLevofloxacin and bactrim

D.D. MetronidrazoleMetronidrazole

E.E. BactrimBactrim

PCPPCP

• PPneumoneumoCCystis ystis PPneumonia caused by neumonia caused by pneumocystis jirovecipneumocystis jiroveci

• Chest pain, cough, dyspnea, scant sputum, Chest pain, cough, dyspnea, scant sputum, high fever, hypoxia, A-a gradient, CXR- high fever, hypoxia, A-a gradient, CXR- bilat interstitial infiltratesbilat interstitial infiltrates

• Most common opportunistic infxn in those Most common opportunistic infxn in those with HIVwith HIV

• Rx: CAP coverage + PCP coverage: Rx: CAP coverage + PCP coverage: bactrim, pentamidine, clindamycin + bactrim, pentamidine, clindamycin + primaquine primaquine

In adults with suspected meningitis which of In adults with suspected meningitis which of the following clinical features at the following clinical features at presentation is most likely to predict presentation is most likely to predict abnormal findings on head CT scan?abnormal findings on head CT scan?

A.A. FeverFever

B.B. HeadacheHeadache

C.C. Immunocompromised stateImmunocompromised state

D.D. PhotophobiaPhotophobia

E.E. Stiff neckStiff neck

In adults with suspected meningitis which of In adults with suspected meningitis which of the following clinical features at presentation the following clinical features at presentation is most likely to predict abnormal findings on is most likely to predict abnormal findings on head CT scan?head CT scan?

A.A. FeverFever

B.B. HeadacheHeadache

C.C. Immunocompromised stateImmunocompromised state

D.D. PhotophobiaPhotophobia

E.E. Stiff neckStiff neck

• Study of 235 patients CT before LPStudy of 235 patients CT before LP

• Clinical features assoc with abnormal Clinical features assoc with abnormal CT: age>60, immunocompromised CT: age>60, immunocompromised state, h/o CNS disease, h/o seizure state, h/o CNS disease, h/o seizure within 1 wk of presentationwithin 1 wk of presentation

• Neuro signs associated with abnormal Neuro signs associated with abnormal CT: abnormal level of consciousness, CT: abnormal level of consciousness, inability to answer 2 consecutive inability to answer 2 consecutive commands, gaze palsy, abnl visual commands, gaze palsy, abnl visual fields, facial palsy, arm drift, leg drift, fields, facial palsy, arm drift, leg drift, abnl languageabnl language

The organism most commonly The organism most commonly occurring in puerperal mastitis is:occurring in puerperal mastitis is:

A.A. Bacteroides fragilisBacteroides fragilis

B.B. Candida AlbicansCandida Albicans

C.C. Escherichia coliEscherichia coli

D.D. Staphylococcus aureusStaphylococcus aureus

E.E. StreptococciStreptococci

8. The organism most commonly 8. The organism most commonly occurring in puerperal mastitis is:occurring in puerperal mastitis is:

A.A. Bacteroides fragilisBacteroides fragilis

B.B. Candida AlbicansCandida Albicans

C.C. Escherichia coliEscherichia coli

D.D.Staphylococcus aureusStaphylococcus aureus

E.E. StreptococciStreptococci

Puerperal MastitisPuerperal Mastitis• Inflammation of breast typically in Inflammation of breast typically in

immediate postpartum period but immediate postpartum period but also with teeth eruption in infantsalso with teeth eruption in infants

• Blockage of ducts by overgrowth Blockage of ducts by overgrowth of bacteria in nutirent-rich breast of bacteria in nutirent-rich breast milkmilk

• Staph, E coli, StrepStaph, E coli, Strep• Vague symptoms: myalgia, Vague symptoms: myalgia,

fevers, chills, flu-like sxfevers, chills, flu-like sx• Rx: breast emptying, skin Rx: breast emptying, skin

cleansing, analgesia, abx, cleansing, analgesia, abx, breastfeeding can continuebreastfeeding can continue

• If fails therapy, consider If fails therapy, consider abscess/polymicrobial abscess/polymicrobial infxn/carcinoma, do ultrasoundinfxn/carcinoma, do ultrasound

Which of the following Which of the following statements regarding anthrax statements regarding anthrax is correct?is correct?A.A. Aerobic blood culture growth of gram - cocci Aerobic blood culture growth of gram - cocci

suggests systemic anthraxsuggests systemic anthrax

B.B. Cutaneous anthrax, although uncomfortable, is Cutaneous anthrax, although uncomfortable, is usually self-limited and does not require therapyusually self-limited and does not require therapy

C.C. Inhalational anthrax is initially a flu-like illness Inhalational anthrax is initially a flu-like illness that deteriorates into septic shock within 24-48 that deteriorates into septic shock within 24-48 hrs of symptom onsethrs of symptom onset

D.D. Only known samples are in repositories in Russia Only known samples are in repositories in Russia and USand US

E.E. Treatment of choice for all types is ceftriaxoneTreatment of choice for all types is ceftriaxone

Which of the following Which of the following statements regarding anthrax statements regarding anthrax is correct?is correct?A.A. Aerobic blood culture growth of gram - cocci Aerobic blood culture growth of gram - cocci

suggests systemic anthraxsuggests systemic anthrax

B.B. Cutaneous anthrax, although uncomfortable, is Cutaneous anthrax, although uncomfortable, is usually self-limited and does not require therapyusually self-limited and does not require therapy

C.C. Inhalational anthrax is initially a flu-like Inhalational anthrax is initially a flu-like illness that deteriorates into septic shock illness that deteriorates into septic shock within 24-48 hrs of symptom onsetwithin 24-48 hrs of symptom onset

D.D. Only known samples are in repositories in Russia Only known samples are in repositories in Russia and USand US

E.E. Treatment of choice for all types is ceftriaxoneTreatment of choice for all types is ceftriaxone

AnthraxAnthrax• Woolsorter’s diseaseWoolsorter’s disease• Manifestation depends on how spores enter Manifestation depends on how spores enter

body: Skin, GI, Inhalational (most lethal)body: Skin, GI, Inhalational (most lethal)• Cutaneous(1-5days) papule->vesicle->escharCutaneous(1-5days) papule->vesicle->eschar• GI(2-5days) n/v, mesenteric adenitis-> GI(2-5days) n/v, mesenteric adenitis->

hematemesis, ascites, abd. pain-> shockhematemesis, ascites, abd. pain-> shock• Inhalation(1-6days) ->Flu like illness ->within Inhalation(1-6days) ->Flu like illness ->within

24-48 hours sepsis, shock, hemorrhagic 24-48 hours sepsis, shock, hemorrhagic mediastinitis, resp failuremediastinitis, resp failure

• CXR: mediastinal widening, hilar adenopathyCXR: mediastinal widening, hilar adenopathy• Gm + bacilli, serology, cipro or doxy, vaccineGm + bacilli, serology, cipro or doxy, vaccine

AnthraxAnthrax

Cutaneous AnthraxCutaneous Anthrax

A 22 year old man p/w headache, stiff A 22 year old man p/w headache, stiff neck, and fever. An immediate LP reveals neck, and fever. An immediate LP reveals cloudy CSF. What is the appropriate cloudy CSF. What is the appropriate treatment?treatment?

A.A. Dexamethasone only until gram stain of Dexamethasone only until gram stain of fluid is availablefluid is available

B.B. Intrathecal antibioticsIntrathecal antibioticsC.C. Intravenous antibioticsIntravenous antibioticsD.D. Intravenous dexamethasone followed by Intravenous dexamethasone followed by

antibioticsantibioticsE.E. IVIG followed by antibioticsIVIG followed by antibiotics

A 22 year old man p/w headache, stiff A 22 year old man p/w headache, stiff neck, and fever. An immediate LP reveals neck, and fever. An immediate LP reveals cloudy CSF. What is the appropriate cloudy CSF. What is the appropriate treatment?treatment?

A.A. Dexamethasone only until gram stain of Dexamethasone only until gram stain of fluid is availablefluid is available

B.B. Intrathecal antibioticsIntrathecal antibioticsC.C. Intravenous antibioticsIntravenous antibioticsD.D. Intravenous dexamethasone Intravenous dexamethasone

followed by antibioticsfollowed by antibioticsE.E. IVIG followed by antibioticsIVIG followed by antibiotics

MeningitisMeningitis

• high mortality rate, survivors may have high mortality rate, survivors may have long-term neurological sequelaelong-term neurological sequelae

• 10 mg of dexamethasone 15-20 min 10 mg of dexamethasone 15-20 min before antibiotic reduces morbidity and before antibiotic reduces morbidity and mortality (steroids cont. Q6 x 4 days)mortality (steroids cont. Q6 x 4 days)

• Gans study: dex reduced mortality rate in Gans study: dex reduced mortality rate in pneumococcal meningitis by 50%pneumococcal meningitis by 50%

• Not shown to reduce neurologic sequelaeNot shown to reduce neurologic sequelae• Not shown to provide benefit in Not shown to provide benefit in

meningococcal meningitismeningococcal meningitis

Which of the following Which of the following statements regarding bite statements regarding bite wounds is correct?wounds is correct?

A.A. Cat bites are most commonly polymicrobialCat bites are most commonly polymicrobialB.B. Cat bites do not require prophylactic unless Cat bites do not require prophylactic unless

there is a foreign body in the woundthere is a foreign body in the woundC.C. Mammal bites are not tetanus-prone Mammal bites are not tetanus-prone

woundswoundsD.D. Only 5-6% of dog bites ultimately become Only 5-6% of dog bites ultimately become

infected without treatmentinfected without treatmentE.E. Pasturella multocida Pasturella multocida is frequently the sole is frequently the sole

pathogen in infected dog bitespathogen in infected dog bites

Which of the following Which of the following statements regarding bite statements regarding bite wounds is correct?wounds is correct?A.A. Cat bites are most commonly polymicrobialCat bites are most commonly polymicrobialB.B. Cat bites do not require prophylactic unless Cat bites do not require prophylactic unless

there is a foreign body in the woundthere is a foreign body in the woundC.C. Mammal bites are not tetanus-prone Mammal bites are not tetanus-prone

woundswoundsD.D. Only 5-6% of dog bites ultimately Only 5-6% of dog bites ultimately

become infected without treatmentbecome infected without treatmentE.E. Pasturella multocida Pasturella multocida is frequently the sole is frequently the sole

pathogen in infected dog bitespathogen in infected dog bites

Mammalian Bites / DOGMammalian Bites / DOG

• Least infectiveLeast infective• Most commonly Most commonly

polymicrobialpolymicrobial• Pasteurella multocidaPasteurella multocida• RX: prophylactic RX: prophylactic

antibiotics not routinely antibiotics not routinely recommended except recommended except for for immunocompromised immunocompromised or bites to hand: PCN, or bites to hand: PCN, augmentin, doxyaugmentin, doxy

Mammalian Bites / CatMammalian Bites / Cat

• More infective More infective (30-80%)(30-80%)

• PasteurellaPasteurella

• Same AbxSame Abx

Human BiteHuman Bite

• Clenched fistClenched fist

• Consider in Consider in genital woundsgenital wounds

• Most infectiveMost infective

• Eichenella Eichenella corrodenscorrodens

• PCN, AugmentinPCN, Augmentin

Which of the following statements Which of the following statements regarding Rocky Mountain Spotted Fever regarding Rocky Mountain Spotted Fever in children is correct?in children is correct?

A.A. CSF pleocytosis is commonly presentCSF pleocytosis is commonly present

B.B. IV Clindamycin is the treatment of choiceIV Clindamycin is the treatment of choice

C.C. Most cases are diagnosed in the western Most cases are diagnosed in the western USUS

D.D. Most commonly seen in adolescentsMost commonly seen in adolescents

E.E. Rash is initially petechial and becomes Rash is initially petechial and becomes purpuricpurpuric

Which of the following statements Which of the following statements regarding Rocky Mountain Spotted Fever regarding Rocky Mountain Spotted Fever in children is correct?in children is correct?

A.A. CSF pleocytosis is commonly presentCSF pleocytosis is commonly present

B.B. IV Clindamycin is the treatment of choiceIV Clindamycin is the treatment of choice

C.C. Most cases are diagnosed in the western USMost cases are diagnosed in the western US

D.D. Most commonly seen in adolescentsMost commonly seen in adolescents

E.E. Rash is initially petechial and becomes Rash is initially petechial and becomes purpuricpurpuric

Rocky Mountain Spotted FeverRocky Mountain Spotted Fever• most common rickettsial disease in USmost common rickettsial disease in US• Endemic in Endemic in southeastsoutheast US US• Most common age 5-9Most common age 5-9, least common 10-29, least common 10-29• fever, rash, tick exposure (~50% don’t recall) fever, rash, tick exposure (~50% don’t recall) malaise, malaise,

headacheheadache, fever, myalgias, abdominal pain, , fever, myalgias, abdominal pain, • rash initially blanching becomes petechial starts on ankles and rash initially blanching becomes petechial starts on ankles and

wrists, wrists, spreads inwardsspreads inwards• Lab: nml WBC, left shift, mild anemia, Lab: nml WBC, left shift, mild anemia, moderate moderate

thrombocytopenia, CSF pleocytosisthrombocytopenia, CSF pleocytosis• Clue = clinically no URI sx’s, no N/V, prodrome and Clue = clinically no URI sx’s, no N/V, prodrome and

labslabs– Also seen in ErlichiosisAlso seen in Erlichiosis

• Dx: Dx: Clinical! Don’t wait for serologiesClinical! Don’t wait for serologies • Rx: Tetracycline, chloramphenicolRx: Tetracycline, chloramphenicol

Lyme DiseaseLyme Disease• Borrelia burgdorferi (spirochete)Borrelia burgdorferi (spirochete)• Txmitted by bites of Ixodes ticksTxmitted by bites of Ixodes ticks• Tick reservoir = rodents, rabbit, deerTick reservoir = rodents, rabbit, deer• Less than 30% of pts recall tick biteLess than 30% of pts recall tick bite• Fever, myalgias, arthralgias, HA, Bells PalsyFever, myalgias, arthralgias, HA, Bells Palsy• Erythema chronicum migrans – annular, erythematous Erythema chronicum migrans – annular, erythematous

lesion with central clearing as it spreads (spares palm and lesion with central clearing as it spreads (spares palm and sole)sole)

• 3 stages:3 stages:ｷｷｷｷ Stage I: ECM (60 – 80%), viral symptomsStage I: ECM (60 – 80%), viral symptomsｷｷｷｷ Stage II: neurologic (neuritis, Bell’s palsy), cardiac (nodal heart Stage II: neurologic (neuritis, Bell’s palsy), cardiac (nodal heart

block)block)ｷｷｷｷ Stage III: chronic arthritis, myocarditis, encephalopathyStage III: chronic arthritis, myocarditis, encephalopathy

• ELISA (screening – sensitive, not specific), Western Blot (dx)ELISA (screening – sensitive, not specific), Western Blot (dx)• Rx: doxy, erythro, amox, ceftriaxoneRx: doxy, erythro, amox, ceftriaxone

Infection with which of the following Infection with which of the following helminths is known to cause a fatal helminths is known to cause a fatal hyperinfection in immunocompromised pts?hyperinfection in immunocompromised pts?

A.A. Ascarsis lumbricoidesAscarsis lumbricoides

B.B. Enterobius vermicularisEnterobius vermicularis

C.C. Necator americanusNecator americanus

D.D. Strongyloides stercoralisStrongyloides stercoralis

E.E. Trichuris trichiuraTrichuris trichiura

F.F. SridharSridhar BasarvajuBasarvaju

Infection with which of the following Infection with which of the following helminths is known to cause a fatal helminths is known to cause a fatal hyperinfection in immunocompromised pts?hyperinfection in immunocompromised pts?

A.A. Ascarsis lumbricoidesAscarsis lumbricoides

B.B. Enterobius vermicularisEnterobius vermicularis

C.C. Necator americanusNecator americanus

D.D.Strongyloides stercoralisStrongyloides stercoralis

E.E. Trichuris trichiuraTrichuris trichiura

F.F. SridharSridhar BasarvajuBasarvaju

Strongyloides stercoralisStrongyloides stercoralis

• Nematode resides in small Nematode resides in small intestineintestine

• Skin (pruritis, erythematous Skin (pruritis, erythematous rash)-> lungs (cough, rash)-> lungs (cough, dyspnea, pna) -> intestinal dyspnea, pna) -> intestinal (most asymptomatic, diarrhea)(most asymptomatic, diarrhea)

• Can produce infective larva Can produce infective larva internally and cause internally and cause autoinfectionautoinfection

• Hyperinfection syndrome in Hyperinfection syndrome in pts who already have pts who already have established Strongyloides established Strongyloides infxn who become infxn who become immunocompromised -> immunocompromised -> septicemia, pneumonia, septicemia, pneumonia, meinigitis, ileusmeinigitis, ileus

• Eosinophilia may be lost in Eosinophilia may be lost in immunocompromisedimmunocompromised

• Ascarsis lumbricoides- Ascarsis lumbricoides- acquired by egg ingestion, acquired by egg ingestion, Loeffler- eosinophilic Loeffler- eosinophilic pneumonitis, intestinal pneumonitis, intestinal obstructionobstruction

• Enterobius vermicularisEnterobius vermicularis- - pinworms, perianal pruritispinworms, perianal pruritis

• Necator americanusNecator americanus- - hookworm, intestinal hookworm, intestinal mucosa-> blood loss, anemia mucosa-> blood loss, anemia -> eggs in stool, larvae in -> eggs in stool, larvae in soil hook onto barefootsoil hook onto barefoot

• Trichuris trichiura- Trichuris trichiura- whipworm, ingestion of whipworm, ingestion of contaminated food/water, contaminated food/water, massive infestation-> blood massive infestation-> blood loss, anemialoss, anemia

Which of the following is TRUE of the Which of the following is TRUE of the majority of Toxic Shock Syndrome (TSS) majority of Toxic Shock Syndrome (TSS) cases?cases?

A.A. They are all unrelated to menses and They are all unrelated to menses and cross all segments of societycross all segments of society

B.B. They have gram positive rods on They have gram positive rods on blood cultureblood culture

C.C. They have a diffuse, painful, sunburn They have a diffuse, painful, sunburn like rash that results in bullaelike rash that results in bullae

D.D. They are associated with They are associated with hyperkalemia and hypercalcemiahyperkalemia and hypercalcemia

Which of the following is TRUE of the Which of the following is TRUE of the majority of Toxic Shock Syndrome (TSS) majority of Toxic Shock Syndrome (TSS) cases?cases?

A.A. They are all unrelated to menses They are all unrelated to menses and cross all segments of societyand cross all segments of society

B.B. They have gram positive rods on They have gram positive rods on blood cultureblood culture

C.C. They have a diffuse, painful, sunburn They have a diffuse, painful, sunburn like rash that results in bullaelike rash that results in bullae

D.D. They are associated with They are associated with hyperkalemia and hypercalcemiahyperkalemia and hypercalcemia

Toxic Shock syndromeToxic Shock syndrome• Acute onset multisystem disease Acute onset multisystem disease

(Involvement of at least three:Renal, (Involvement of at least three:Renal, hepatic, heme, GI, musculoskeletal, CNS)hepatic, heme, GI, musculoskeletal, CNS)

• Staph aureus exotoxinStaph aureus exotoxin• Prolonged tampon use, packed surgical Prolonged tampon use, packed surgical

wounds, nasal packingwounds, nasal packing• Menstruating females, post partum, 1/3 Menstruating females, post partum, 1/3

malesmales• Fever, hypotensionFever, hypotension• Rash: diffuse erythroderma (“painless” Rash: diffuse erythroderma (“painless”

sunburn), blanching, nonpruritic --> sunburn), blanching, nonpruritic --> desquamationdesquamation

• Rx: fluids, remove source, abxRx: fluids, remove source, abx

Which of the following tick-bourne Which of the following tick-bourne illnesses requires only symptomatic illnesses requires only symptomatic therapytherapy

A.A. BabesiosisBabesiosis

B.B. Colorado Tick feverColorado Tick fever

C.C. Relapsing feverRelapsing fever

D.D.Rocky Mountain spotted feverRocky Mountain spotted fever

E.E. Lyme diseaseLyme disease

Which of the following tick-bourne Which of the following tick-bourne illnesses requires only symptomatic illnesses requires only symptomatic therapytherapy

A.A. BabesiosisBabesiosis

B.B.Colorado Tick feverColorado Tick fever

C.C. Relapsing feverRelapsing fever

D.D.Rocky Mountain spotted feverRocky Mountain spotted fever

E.E. Lyme diseaseLyme disease

• Colorado Tick fever- Viral infection- HA photophobia- supportive care-self limited resolves 2-3 weeks

• Babesiosis- protazoan parasite- clinda and quinine-exchange transfusion for severe case

• Lyme Dz- treat with doxycyline or tetracycline

• Rocky mountain spotted fever-Rickettsia –tetracycline or chloramphenicol

Which is the most accurate way to Which is the most accurate way to diagnosis PCP in Pt with HIV?diagnosis PCP in Pt with HIV?

A.A. ABGABG

B.B. CXRCXR

C.C. VQ scanVQ scan

D.D.Gallium scan of chestGallium scan of chest

E.E. Indirect Immunoflorescent stain Indirect Immunoflorescent stain of sputumof sputum

Which is the most accurate way to Which is the most accurate way to diagnosis PCP in Pt with HIV?diagnosis PCP in Pt with HIV?

A.A. ABGABG

B.B. CXRCXR

C.C. VQ scanVQ scan

D.D.Gallium scan of chestGallium scan of chest

E.E. Indirect Immunoflorescent Indirect Immunoflorescent stain of sputumstain of sputum

PCP

•Most common OI in pts with AIDS

•CXR may be normal

•ABG normally high A-a gradient but not specific for PCP

•Gallium and VQ scans are not specific

•Bronchoscopy is effective but invasive –sputum is highly specific and non invasive

Which of the following statements best Which of the following statements best describes rabies?describes rabies?

A.A. Acute Rickettsial disease of the CNS spread Acute Rickettsial disease of the CNS spread centripetally through peripheral nerves centripetally through peripheral nerves

B.B. Acute Rickettsial disease of the CNS with an Acute Rickettsial disease of the CNS with an incubation period of 10 days to 1 yearincubation period of 10 days to 1 year

C.C. Acute viral illness of the CNS that affects all Acute viral illness of the CNS that affects all mammals mammals

D.D. Acute viral illness of the CNS that affects all Acute viral illness of the CNS that affects all mammals except rodentsmammals except rodents

E.E. Acute Rickettsial disease of the CNS spread Acute Rickettsial disease of the CNS spread centripetally through lymphaticscentripetally through lymphatics

18. Which of the following statements 18. Which of the following statements best describes rabies?best describes rabies?

A.A. Acute Rickettsial disease of the CNS spread Acute Rickettsial disease of the CNS spread centripetally through peripheral nerves centripetally through peripheral nerves

B.B. Acute Rickettsial disease of the CNS with an Acute Rickettsial disease of the CNS with an incubation period of 10 days to 1 yearincubation period of 10 days to 1 year

C.C. Acute viral illness of the CNS that Acute viral illness of the CNS that affects all mammals affects all mammals

D.D. Acute viral illness of the CNS that affects all Acute viral illness of the CNS that affects all mammals except rodentsmammals except rodents

E.E. Acute Rickettsial disease of the CNS spread Acute Rickettsial disease of the CNS spread centripetally through lymphaticscentripetally through lymphatics

Rabies

•Acute viral illness- affects all mammals

• -spread through saliva

• -spreads through peripheral nerves-centrally

•Average incubation 30-60 days

35 yo male with painless hematuria 35 yo male with painless hematuria after returning from North Africa has after returning from North Africa has whatwhat

A.A. Entamoeba histolyticaEntamoeba histolytica

B.B. Leishmania donovaniLeishmania donovani

C.C. Plasmodium malariaePlasmodium malariae

D.D.Schistosoma haematobiumSchistosoma haematobium

E.E. Trympanosoma brucei Trympanosoma brucei rhodesienserhodesiense

35 yo male with painless hematuria 35 yo male with painless hematuria after returning from North Africa has after returning from North Africa has whatwhat

A.A. Entamoeba histolyticaEntamoeba histolytica

B.B. Leishmania donovaniLeishmania donovani

C.C. Plasmodium malariaePlasmodium malariae

D.D.Schistosoma haematobiumSchistosoma haematobium

E.E. Trympanosoma brucei Trympanosoma brucei rhodesienserhodesiense

•Schistasoma-Africa, India, Portugal-Can migrate to venules in bladderCauses hematuria dx with eggs in urine

•Trichamonas- vaginitis, urithritis prostatitis

•Entomoeba-bloody diarrhea- liver abscess

•Leishmania-hepatomegaly splenomegaly

•Trypanosoma- african sleeping sickness

62 yo male BIB EMS- wife says confused- 62 yo male BIB EMS- wife says confused- hypothermic 35.5, Bp 77/30- lungs clear abdomen hypothermic 35.5, Bp 77/30- lungs clear abdomen normal non focal neuro exam-extremity exam normal non focal neuro exam-extremity exam shows-see pic-with crepitance halfway up leg- which shows-see pic-with crepitance halfway up leg- which antibiotic should be orderedantibiotic should be ordered

A.A. Cefazolin and PCNCefazolin and PCN

B.B. CiproCipro

C.C. Clinda and PCNClinda and PCN

D.D.MetronidazoleMetronidazole

E.E. VancoVanco

62 yo male BIB EMS- wife says confused- 62 yo male BIB EMS- wife says confused- hypothermic 35.5, Bp 77/30- lungs clear abdomen hypothermic 35.5, Bp 77/30- lungs clear abdomen normal non focal neuro exam-extremity exam normal non focal neuro exam-extremity exam shows-see pic-with crepitance halfway up leg- which shows-see pic-with crepitance halfway up leg- which antibiotic should be orderedantibiotic should be ordered

A.A. Cefazolin and PCNCefazolin and PCN

B.B. CiproCipro

C.C.Clinda and PCNClinda and PCN

D.D.MetronidazoleMetronidazole

E.E. VancoVanco

Gas Gangrene

• Surgical debridement critical-Fluid resusitation

• Usually Polymicrobial infection-can be group A strep along- needs broad coverage

• Cefazolin with PCN does not cover Gm negatives, nor does vancomycin

• Clindamycin is believed to decrease toxin production as well

Which organism causes a Which organism causes a characteristic rash with a “slapped characteristic rash with a “slapped cheek” appearancecheek” appearance

A.A. Coxasackie virusCoxasackie virus

B.B. Group A beta hemolytic strepGroup A beta hemolytic strep

C.C. Human herpes virus CHuman herpes virus C

D.D.Parvovirus B19 Parvovirus B19

E.E. Varicella VirusVaricella Virus

Which organism causes a Which organism causes a characteristic rash with a “slapped characteristic rash with a “slapped cheek” appearancecheek” appearance

A.A. Coxasackie virusCoxasackie virus

B.B. Group A beta hemolytic strepGroup A beta hemolytic strep

C.C. Human herpes virus CHuman herpes virus C

D.D.Parvovirus B19 Parvovirus B19

E.E. Varicella VirusVaricella Virus

Infectious rash descriptions

•Slapped Cheek= Parvovirus B19

•Dew drop on rose petal= varicella

•Circumoral pallor and sandpaper rash=scarlet fever with Group A strep

•Oral and palmar vesicles Coxasackie- Hand foot and mouth disease

•HHV6 = roseola-

21 yo female presents with red hot painful right 21 yo female presents with red hot painful right ankle- had similar pain in left wrist 2 days earlier- a ankle- had similar pain in left wrist 2 days earlier- a pustular lesion is noted in the web spaces on her pustular lesion is noted in the web spaces on her hand. A culture from which of the following sites is hand. A culture from which of the following sites is likely to reveal the causative organismlikely to reveal the causative organism

A.A. Ankle synovial fluidAnkle synovial fluid

B.B. bloodblood

C.C. genitaliagenitalia

D.D.Leading edge of the cellulitisLeading edge of the cellulitis

E.E. PustulePustule

21 yo female presents with red hot painful right 21 yo female presents with red hot painful right ankle- had similar pain in left wrist 2 days earlier- a ankle- had similar pain in left wrist 2 days earlier- a pustular lesion is noted in the web spaces on her pustular lesion is noted in the web spaces on her hand. A culture from which of the following sites is hand. A culture from which of the following sites is likely to reveal the causative organismlikely to reveal the causative organism

A.A. Ankle synovial fluidAnkle synovial fluid

B.B. bloodblood

C.C.genitaliagenitalia

D.D.Leading edge of the cellulitisLeading edge of the cellulitis

E.E. PustulePustule

Arthritis-Dermititis syndrome from dissemintaed GC

•More common in women- migratory arthritis- tenosynovitis with pustules lesion son extremeties

•Synovial fluid cx + 50% of the time- Cervical Cx + 75-90% of time

Which of the following reguarding Pneumonia in HIV Which of the following reguarding Pneumonia in HIV + patients is correct?+ patients is correct?

A.A. Haemophilus is an uncommon causeHaemophilus is an uncommon causeB.B. Opportunistic infections are common with Opportunistic infections are common with

CD4 less than 1000CD4 less than 1000C.C. Pt with HIV and bacterial PNA have a higher Pt with HIV and bacterial PNA have a higher

mortality ratemortality rateD.D. Pt with HIV and bacterial PNA typically present Pt with HIV and bacterial PNA typically present

with sign and symptoms similar to with sign and symptoms similar to seronegative patientsseronegative patients

E.E. PCP occurs more commonly than bacterial PCP occurs more commonly than bacterial PNAPNA

Which of the following regarding Pneumonia in HIV Which of the following regarding Pneumonia in HIV + patients is correct?+ patients is correct?

A.A. Haemophilus is an uncommon causeHaemophilus is an uncommon causeB.B. Opportunistic infections are common with Opportunistic infections are common with

CD4 less than 1000CD4 less than 1000C.C. Pt with HIV and bacterial PNA have a higher Pt with HIV and bacterial PNA have a higher

mortality ratemortality rateD.D. Pt with HIV and bacterial PNA typically Pt with HIV and bacterial PNA typically

present with sign and symptoms similar present with sign and symptoms similar to seronegative patientsto seronegative patients

E.E. PCP occurs more commonly than bacterial PCP occurs more commonly than bacterial PNAPNA

HIV and PNA

•HIV pt have higher rates of bacterial pna but same mortality

•Bacterial pneumonia is more common than PCP

•Pt with CD4 count greater than 800 rarely get opportunistic infections

•Usually present in similar manner to seronegative pts

Which of the following manifestation of syphilis Which of the following manifestation of syphilis appears only after 20 yes of infection?appears only after 20 yes of infection?

A.A. Aortic dzAortic dz

B.B. Aseptic menigitisAseptic menigitis

C.C. chancrechancre

D.D.Menigovascualar syphilisMenigovascualar syphilis

E.E. neurosyphilisneurosyphilis

Which of the following manifestation of syphilis Which of the following manifestation of syphilis appears only after 20 yes of infection?appears only after 20 yes of infection?

A.A.Aortic dzAortic dz

B.B. Aseptic menigitisAseptic menigitis

C.C. chancrechancre

D.D.Menigovascualar syphilisMenigovascualar syphilis

E.E. neurosyphilisneurosyphilis

Syphilis

• Chancre- painless papule- hallmark of primary syphilis

• 2ndary syphilis 4-10 weeks- macular rash- trunk extremities- palms + soles oral lesions grey painless ulcers

• Tertiary syphilis-untreated for years- 2 types-neurosyphilis after 10 yrs-meningovascualar vasculitis of vertebral or spinal vessels or tabetic syphilis-demylination and ataxia

• Cardiovascular only after 20-40 yrs usually thoracic aorta- aortiv valve insufficiency

Which of the following animals is least likely to Which of the following animals is least likely to transmit rabiestransmit rabies

A.A. chipmunkchipmunk

B.B. cowcow

C.C. GroundhogGroundhog

D.D. racoonracoon

E.E. skunkskunk

Which of the following animals is least likely to Which of the following animals is least likely to transmit rabiestransmit rabies

A.A.chipmunkchipmunk

B.B. cowcow

C.C. GroundhogGroundhog

D.D. racoonracoon

E.E. skunkskunk

More rabies

•Can affect all mammals including cows

•Very rare in rabbits and small rodents (rats, mice, chipmunks) considered safe

•Larger Rodents beavers, groundhogs do carry rabies

Which of the following is true of acute rheumatic Which of the following is true of acute rheumatic fever?fever?

A.A. Caused by group B strepCaused by group B strep

B.B. Fever is a major diagnostic criteriaFever is a major diagnostic criteria

C.C. Occurs during the coarse of acute strep Occurs during the coarse of acute strep infectioninfection

D.D. Affect primarily lower socioeconomic Affect primarily lower socioeconomic groupsgroups

E.E. Steroids my be useful in treating carditis Steroids my be useful in treating carditis

Which of the following is true of acute rheumatic Which of the following is true of acute rheumatic fever?fever?

A.A. Caused by group B strepCaused by group B strep

B.B. Fever is a major diagnostic criteriaFever is a major diagnostic criteria

C.C. Occurs during the coarse of acute strep Occurs during the coarse of acute strep infectioninfection

D.D. Affect primarily lower socioeconomic Affect primarily lower socioeconomic groupsgroups

E.E. Steroids my be useful in treating Steroids my be useful in treating carditiscarditis

Rheumatic Fever

•3-4 weeks after Group A strep infection

• Jones criteria-major- Joints-polyrthritis, Carditis, Nodules- subcutaneous , erythema marginatum, chorea

•Fever is one of the minor criteria

•Tx PCN, aspirin for arthritis and steroids for carditis

41 yo female presents with 2 large fleshy, flat, 41 yo female presents with 2 large fleshy, flat, painless, moist, pearly grey, pale lesions on either painless, moist, pearly grey, pale lesions on either side of her anus the most likely diagnosis is?side of her anus the most likely diagnosis is?

A.A. ChancroidChancroid

B.B. Condyloma acuminataCondyloma acuminata

C.C. Gonococcal proctitisGonococcal proctitis

D.D.Granuloma inguinaleGranuloma inguinale

E.E. Secondary syphilisSecondary syphilis

41 yo female presents with 2 large fleshy, flat, 41 yo female presents with 2 large fleshy, flat, painless, moist, pearly grey, pale lesions on either painless, moist, pearly grey, pale lesions on either side of her anus the most likely diagnosis is?side of her anus the most likely diagnosis is?

A.A. ChancroidChancroid

B.B. Condyloma acuminataCondyloma acuminata

C.C. Gonococcal proctitisGonococcal proctitis

D.D.Granuloma inguinaleGranuloma inguinale

E.E.Secondary syphilisSecondary syphilis

STD’s

• Condyloma lata-secondary syphilis- typically-large painless flat topped lesions-typically in anogenital region

• Condyloma acuminata- genital warts – HPV – pink to grey keritanized with papilliform growths

• Gonococcal proctitis- tenismus, anal itching and yellow discharge

• Granuloma inguinale- bacterial infection with Calymmatobacterium granulomatis-painless papules beefy red ulcers with rolled edges

• Chancroid- Heomophilus Ducreyi- painful genital ulcer-