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Duke PA Infectious Disease Emergencies

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Question
Answer
what is the mortality rate of sepsis/septic shock   40-50%  
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presence of infection + systemic response   sepsis  
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sepsis (presence of infection + systemic response), + one or more sepsis related organ dysfunctions   severe sepsis  
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sepsis (presence of infection + systemic response) + hypotension + tissue hypoperfusion   septic shock  
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remote tissue inflammation, vasodilation, increased microvascular permeability, leukocyte accumulation, temp >38 or <36, HR >90, RR >20 or PaCO2 <32, WBC >12,00 or <4,00 or >10 percent bands   SIRS (Systemic Inflammatory Response Syndrome)  
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bacteria commonly involved in sepsis   E.coli, S. pneumoniae, S. aureus, Multidrug resistant gram negatives (Pseudomonas, Acinetobacter, Proteus, Klebsiella, Enterobacter), Group A strep, anaerobics  
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labs to get in the w/u of sepsis   CBC, chems (LFTs, bicarb, creatinine), PT/PTT, Lactate  
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an important marker of global tissue hypoxia   lactate  
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additional labs to evaluate source of sepsis   blood cultures, UA,urine C & S, CXR, discharge from lesions, sterile fluids if suspected  
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treatment priorities for sepsis   oxygen, aggressive fluid replacement, vasopressors (dopamine, dobutamine, norepi, vasopressin)  
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empiric broad spectrum antibiotics used in sepsis   3rd gen cephalosporins + aminoglycoside (ceftazidime and gentamycin), +/- vancomycin (MRSA)/clindamycin (anerobes)  
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recombinant human activated protein C, only FDA approved drug used solely for the treatment of sepsis in the adult patient with high risk of death. only for use in the ICU   Xigris  
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viral meningitis mortality is low except for __   HSV  
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what is the classic triad of meningitis   fever, stiff neck and altered mental status (present in 2/3 of meningitis pts)  
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special tests for meningitis   Brudzinski's and Kernig's  
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CSF tube #1 is used for what purpose   appearance; cell count & diff  
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CSF tube #2 is used for what purpose   glucose and protein  
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CSF tube #3 is used for what purpose   gram stain and culture  
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CSF tube #4 is used for what purpose   repeat cell count with differential  
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empiric treatment for bacterial meningitis   begin antibiotics immediately (ceftriaxone or cefotoaxime 2 g IV and vanc. add ampicillin for pts <3months/>55 and or immunocomp  
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what do you add to empiric therapy for meningitis if HSV is suspected   acyclovir  
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what do you give concurrently with empiric antibiotics when treating bacterial meningitis   dexamethasone, continue for 4 days  
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supportive care for bacterial meningitis   hydration, pain meds, anticonv, antiemtics  
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signs of meningococcemia is typical meningitis plus   petechial rash, hypotension, shock/sepsis  
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etoh abuse and pneumonia what organism   klebsiella, gram neg bac, H. flu  
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health care associated pneumonia   pseudomonas, MRSA  
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what is the PORT score   Pneumonia Patient Outcomes Research Team study (pneumonia severity index), based on age, nursing home status, coexisting illnesses, physical exam, lab, radiographic findings  
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outpatient antibiotics for pneumonia   azithro, doxy, levo, cefpodoxime+azithro  
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inpatient regmines for pneumonia   ceftriaxone+azithro, resp fluoroq, +/- vanc  
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who are the high risk TB patients   elderly/nursing home, immingrants, HIV, ETOH/drugs, residents/staff of prisons or shelters  
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most commonly seen in acute endocarditis   S. aureus  
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endocarditis bacteremic symptoms   chills, fever, nausea, fatigue  
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endocarditis cardiac symptoms   tachy, new murmurs, CHF  
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endocarditis embolic symptoms   stroke, pneumo, renal sequelae  
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cutaneous findings of endocarditis   petechiae, splinter hem, osler nodes, janeway lesions, roth spots  
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most common etiology of UTI   E. coli  
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what patients with cystitis should get a urine culture   anyone who is not a healthy young female  
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what is the duration of treatment for uncomplicated cystitis in non-pregnant women/men   3-5 days  
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what is the duration of treatment for uncomplicated cystitis in children, preg women, and complicated infections in everyone else   7-10 days  
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antibiotics for cysitis   tmp/smz, nitrofurantoin, quinolones, cephalexin  
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treatment for pyelonephritis   cipro 7-10 days, levo for 7 days, augmentin 10 days, cephalexin 10 days  
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etiology of impetigo   group A strep, or S. aureus  
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treatment of impetigo   cephalexin, diclox, mupirocin, retapamulin  
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superficial cellulitis with lymphatic involvement   erysipelas  
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etiology of erysipelas   GABHS  
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spreading, edematous inflammation of dermis and subQ tissue   cellulitis  
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etiologies of cellulitis   GABHS, S. aureus, gram neg bac, anaerobes in DM/PVD, bites, mycobacteria  
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outpatient treatment for cellulitis   cephalexin, diclox, augmentin, doxy, minocycline, (MRSA-tmp/smx-bactrim or clinda  
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inpatient treatment for cellulitis   IV clinda, IV vanc +/- cefazolin  
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treatment of a fresh bite <24 hours old   exploration/irrigation/immobilization, primary closure if face/head/neck, tetanus/rabies prophylaxis  
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prophylactic antibiotics for fresh bite   augmentin, moxifloxacin, clindamycin + ciprofloxacin  
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most common travel related infection   malaria  
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incubation of malaria in returning travelers   varies from <2 weeks to >6 weeks  
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Necrotizing soft tissue infxns: etiologies   GAS, C. perfringens, MRSA  
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Necrotizing soft tissue infxns: tx   IV vancomycin + IV clindamycin + IV piperacillin/tazobactam  
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Pneumonia: worrisome S/S   RR >30; HR >125; SBP <90  
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most common organism in bite infxn   Human: Strep spp; cat (80% become infected): pasteurella  
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