Toxic Traits
Uninvited Guests
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Rash Decisions
100
This disease may begin with generalized erythroderma, high fever, sore throat or skin rash. Desquamation of the palms and soles is a late finding.
What is Toxic Shock
100
This intensely pruritic mite infestation is classically worse at night and favors the interdigital web spaces, axillae, and the flexor surfaces of the wrists.
AND
What is the treatment?
What is scabies?
What is Permethrin 5% Cream?
This topical neurotoxin works by keeping neuronal sodium channels open, paralyzing the parasite.
Must be applied to all areas of the body from the neck down and washed off after 8–14 hours.
100
In a patient with cirrhosis and ascites, Spontaneous Bacterial Peritonitis (SBP) is officially diagnosed when the ascitic fluid absolute neutrophil count (ANC) reaches or exceeds this specific number.
What is 250 cells/mm³ (or cells/µL)?
100
Endemic to the American Southwest, this viral syndrome is transmitted via the inhalation of aerosolized rodent feces and classically presents with a flu-like prodrome followed rapidly by severe, non-cardiogenic pulmonary edema.
What is Hantavirus?
100
What is erysipelas?
Rx: PCN / Cephalosporin first line
200
Unlike its Staphylococcal counterpart, Toxic Shock Syndrome caused by this organism is highly associated with concurrent bacteremia and necrotizing soft tissue infections.
(MUST BE SPECIFIC!!)
What is Streptococcus pyogenes (Group A Strep)?
200
These nocturnal pests are attracted to CO2 and leave erythematous, pruritic macules often arranged in a linear or clustered pattern colloquially known as "breakfast, lunch, and dinner."
What are bed bugs?
200
In a native joint, a synovial fluid white blood cell count greater than this threshold is classically taught as the highly sensitive, definitive cutoff for diagnosing septic arthritis.
What is 50,000 cells/mm³?
200
A patient presents with fever, chills, and an ulcerated skin lesion with massive regional lymphadenopathy (a bubo) after skinning a wild rabbit. You suspect this highly infectious zoonotic disease.
What is tularemia?
200
The first line antibiotic of choice is...
What is NONE
This is ACUTE stasis dermatitis: xerotic, sometimes ulcerated, weepy, and intensly erythematous overlying BILATERAL pretibial regions.
Tx: initial treatment is supportive, Unna boot (zinc oxide) wrap therapy, elevation, compression
300
Pathophysiologically, TSS occurs because bacterial exotoxins act as these—bypassing normal antigen processing to directly cross-link MHC Class II and T-cell receptors, triggering a massive cytokine storm.
What are superantigens?
Normal antigens only activate a tiny fraction <0.1% of T-cells. Superantigens bind outside the normal antigen-binding groove, forcing an interaction with up to 20% of the body's T-cells.
300
This highly contagious, hyperkeratotic variant of a common infestation occurs primarily in elderly or immunocompromised patients and requires treatment with both topical permethrin and oral ivermectin.
What is Crusted (Norwegian) Scabies?
300
Unlike cirrhotic SBP, peritonitis in a peritoneal dialysis patient is diagnosed at this threshold.
What is ascitic WBC count of greater than 100 and 50% PMNs?
300
A patient presents with rapidly progressive hemorrhagic bullae and necrotizing fasciitis of the lower extremities after wading in warm coastal waters or eating raw oysters.
What is Vibrio vulnificans?
300
What is a Kerion?
Tx: Oral antifungal agent - terbinafine, griseofulvin, oral azoles
400
In addition to broad-spectrum bactericidal agents, a specific protein synthesis inhibitor is a mandatory addition to the TSS antibiotic regimen because it directly halts the bacterial production of exotoxins.
Clindamycin is one agent. This is another.
What is Linezolid?
400
Romaña's sign—unilateral, painless periorbital edema—is the classic acute presentation of this parasitic disease transmitted by the feces of it's carrier?
What is Chagas disease (American trypanosomiasis)?
400
Because the presence of a foreign body drastically lowers the threshold for inflammation, acute prosthetic joint infections can be diagnosed with a synovial WBC count as low as this widely tested threshold range.
What is 1,100 to 3,000 cells/mm³?
400
In a patient who survives the initial bite of a Macaque monkey, emergency physicians must prophylax against this specific alphaherpesvirus, which causes a rapidly progressive, frequently fatal encephalomyelitis in humans.
What is herpes B virus (Herpesvirus simiae)?
Rx: valacylovir / acyclovir
If neuro sx: acyclovir or gancyclovir IV
400
DAILY DOUBLE
You might want to perform THIS test to give you THIS diagnosis.
What is Wood's Lamp Fluorescence
Dx: Erythrasma
Bacterial Infection: Corynebacterium
Initial Rx: oral/topical abx (erythromycin, clindamycin, fusidic acid)
500
In severe, refractory Strep TSS where the patient remains persistently hypotensive despite source control and vasopressors, guidelines recommend administering this pooled blood product?
What is IVIG?
500
In immunocompromised patients - particularly those recently started on high-dose corticosteroids - the accelerated auto-infective cycle of this intestinal nematode can cause a fatal hyperinfection syndrome, classically presenting as polymicrobial gram-negative bacteremia or meningitis because the migrating larvae carry enteric gut flora directly through the bowel wall and into the bloodstream.
What is Strongyloides stercoralis?
500
In post-neurosurgical patients, a standard CSF white blood cell count is often unreliable for diagnosing meningitis due to sterile surgical inflammation. Instead, a CSF level of this specific biomarker greater than 4.0 mmol/L is highly specific for a bacterial infection.
What is Lactate?
500
This free-living amoeba, classically contracted by swimming in warm freshwater lakes or using unsterilized tap water in a neti pot, travels rapidly via the olfactory nerve to cause a nearly 100% fatal Primary Amebic Meningoencephalitis.
What is Naegleria fowleri?
500
A 50-year-old Jewish male presents with painful mouth sores for two months, now developing easily ruptured blisters on his chest and trunk.
What is Pemphigus vulgaris
Most patients with pemphigus vulgaris first present with lesions on the mucous membranes such as the mouth and genitals. Blisters usually develop on the skin after a few weeks or months, although in some cases, mucosal lesions may be the only manifestation of the disease.
Tx: moderate to high dose PO/IV steroids, in severe cases steroid sparing immunosuppresives (azathioprine, cyclophosphamide, m mofetil) or DMARD therapy may be utilized.
DIFFERENT FROM BULLOUS PEMPHIGOID
BP
- deeper blisters, tense fluid filled, negative Nikolsky
- older population (> 60 typically)
- autoimmune, sometimes med induce