Fever
Answers
167.The answer is c.(Rosen, pp 620-621.)Spinal abscessesare most
commonly found in immunocompromised patients, IV drug users,and
theelderly.Signs and symptoms of epidural abscess usually develop over
a week or two and include fever, localized pain, and progressive weakness.
An elevated WBC count is also commonly seen. MRI is the most useful
diagnostic test. Staphylococcus aureusis the most common causative organ-
ism, followed by gram-negative bacilli and tuberculosis bacillus.
(a)A lung abscess is a cavitation of lung parenchyma resulting from local
suppuration and central necrosis. It is often precipitated by aspiration of
oropharyngeal secretions. (b)Inflammatory conditions, including ankylosing
spondylitis, may cause back pain. The key findings in this disease include
gradual onset of morning stiffness improved with exercise in a patient less
than age 40 years. On physical examination, these patients may have limited
back flexion, reduced chest expansion, and sacroiliac joint tenderness, all of
which are nonspecific. Fever and weakness would not be expected. (d)Back
pain may result from vertebral compression fractures. These may be sec-
ondary to trauma or may be atraumatic in a patient with osteoporosis. Osteo-
porotic compression fractures usually involve patients over 70 years or patients
with acquired bone weakness (eg, prolonged steroid use). (e)Metastatic
lesions invade the spinal bone marrow, leading to compression of the spinal
cord. Most common primary tumors include breast, lung, thyroid, kidney,
prostate (BLT with Kosher pickles), as well as lymphoma and multiple
myeloma. Maintain a high level of suspicion for any cancer patient who devel-
ops back pain; these patients must be investigated for spinal metastases.
168.The answer is c.(Filbin, 2006.)The treatment for sepsis has evolved
considerably over the past 10 years. Early recognition and early aggressive
therapy for patients with sepsis have a significant impact on mortality. Dr
Emanuel Rivers et al, brought this issue to the forefront with their landmark
article in the New England Journal of Medicinein 2001, where they instituted
a treatment protocol for patients with septic shock, termed early-goal-
directed therapy (EGDT).EGDT emphasizes early recognition of patients
190