1/25 Rosen's Quiz

Ludwig’s angina is an infection that most typically originates from which previous location?

An 18 year old male patient presents with sore throat, tonsillar exudates, cough, but is afebrile. What is the patient’s Centor Criteria score and would you treat with antibiotics?

A 45-year old female with no past medical history presents to the ER with chief complaint of subjective fever, nasal drainage, and facial pressure. The symptoms have lasted 7-days. Vital signs are HR 85, RR 18, BP 140/90, O2 sat 99%, and T 98.6F (37C). Physical exam reveals a well-appearing female with nasal discharge but is otherwise unremarkable. Pain is worse when leaning forward. Which of the following is the most appropriate management for this patient's condition?

A 46yo male with Type 2 diabetes presents to the ED with right sided sinus pain and pressure for 2 days that has progressed to right sided eye pain and pressure. It is associated with subjective fevers and occasional epistaxis. Vital signs are 39C (102.2F), HR 111, BP 136/74, RR 26, in 4/10 pain. His right eye shows mild periorbital edema with chemosis and there are small black eschars in his right nares and posterior oropharynx. Point of care blood sugar is 300 mg/dL (16.7 mmol/L). What is the most appropriate next step?

A 23-year-old previously healthy female returns to the Emergency Department, her third visit in one week for sore throat. Four days previous she was diagnosed by another physician with likely bacterial pharyngitis and discharged with a course of amoxicillin, which she states she has taken as prescribed. Today, she is endorsing worsening sore throat as well as unilateral neck pain on the right, fevers and difficulty swallowing. Her vitals are BP 105/58, P 115, RR 26 O2Sat 97%, T102F (39C). On physical exam, the patient has intense pharyngeal erythema, tonsillar swelling and exudate as well as mild swelling appreciated to the right side of his neck. Labs are still pending when you get a read from the CT of the neck you ordered that shows a large thrombus of her right internal jugular vein. What bacteria is most likely responsible for the patient's symptoms?

A 35-year old female with a history of HIV and non-compliance with her medications presents to the ER with a chief complaint of cough and fever. Chest radiograph reveals diffuse bilateral infiltrates, and initial ABG is significant for a PaO2 of 65 mmHg on room air. The patient is diagnosed with pneumonia and is started on ceftriaxone and azithromycin, as well as IV trimethoprim/sulfamethoxazole for potential PCP infection. After 12 hours, the patient becomes progressively more hypotensive and requires central venous access and a norepinephrine drip is started. Which of the following treatments is most likely to have prevented this complication?

A 5-year-old is brought the ED in respiratory distress. Vital signs are: HR 130, RR 20, T 102.2F (39C). On physical examination he has subcostal retractions. The patient is also drooling and not tolerating his secretions. He is assuming a tripod position for comfort with his jaw extended forward. He was born in the United States and is up-to-date with his immunizations. What is the most likely organism affecting this patient?

A 48-year-old man is brought in by his wife for fever and malaise. Per his wife, this patient does not have any medical history but he has been drinking daily for the past 5 years. She noted that he has been coughing up dark, jelly-like sputum over the past week with fever. Based on this clinical presentation, what is the MOST likely finding on gram stain preparation?

A 55-year old male with a history of IV drug abuse presents to the Emergency Department with a chief complaint of foul smelling cough as well as fevers and chills for one week. Vital signs on presentation are heart rate 110, blood pressure is 95/60, temperature is 104 degrees F (40 degrees C), and oxygen saturation is 91% on room air. Chest x-ray shows a multi-lobar pneumonia. Which of the following is the most appropriate antibiotic coverage to start in this patient?

A 4-year old female is brought in by her parents for sore throat and difficulty breathing. Vital signs on presentation are: BP 90/50, P 135, RR 30, O2Sat 94%room air, T104F (40C). On physical exam the patient is holding her chin extended and is leaning forward. She is also drooling and the parents report that her voice appears hoarse. On direct examination, the oropharynx appears clear with no erythema or purulent discharge, and the uvula is midline. The remainder of the exam is unremarkable. What is the most appropriate next step in management?

A 45 year old male patient presents to an urgent care center in Los Angeles. He has a chief complaint of cough and myalgias for one week. This morning, he began having streaks of blood in his sputum. Past medical history is noncontributory. Vitals signs are within normal limits, and the patient is afebrile. On physical exam, the patient appears comfortable, in no respiratory distress. Lung sounds are clear to auscultation bilaterally. Which of the following is the most likely diagnosis?

Which of the following infections most typically involves the rapid onset of stridor, severe throat pain, and possible airway compromise requiring intubation?

A 7-year-old child presents to the Emergency Department with rapid onset fever, sore throat, drooling and a muffled voice. Initial vital signs are: HR 130, RR 30, BP 100/60, T 103F (39.4C). Physical exam reveals an ill-appearing child who is sitting upright in the tripod position with active drooling. What is the definitive diagnostic test for this disease?