immediately. There is debate on whether these patients should be managed
surgically with incision and drainage or medically with antibiotics.
(a)Acute mastoiditis usually presents with swelling of the mastoid,
fever, and earache. (b)Peritonsillar abscess typically presents with a fluctu-
ant soft palate mass. (d)ANUG is an infection of the gingival. (e)Pharyngitis
is limited to the oropharynx and should not involve the tissues of the
neck.
181.The answer is d.(Rosen, pp 1928-1937.)This is a typical scenario for
osteomyelitis.Conventional radiography on the day of injury is insensitive
to the detection of osteomyelitis; even 1 week after the injury x-ray diagno-
sis is limited. The most common pathogen in osteomyelitis is S aureus.How-
ever, Pseudomonasis responsible for bone and joint infections in three
settings. First, a puncture wound through a shoe. Pseudomonasdoes not
grow on the puncture object, but rather is associated with the shoe itself and
may be inoculated into the bone as the sharp object passes through the col-
onized shoe into the wound. Second, prosthetic devices implanted for
orthopedic surgery. Third is IV drug use.
(a)Neisseria gonorrhoeaeis the most common organism causing septic
arthritis in individuals under 30 years old. (b)Staphylococcus epidermidisis
not a common organism to cause osteomyelitis. (c)Sporothrix schenckiiis the
causative agent of sporotrichosis or “rose handler’s disease.” (e)Salmonellais
a cause of osteomyelitis in asplenic individuals, such as those with sickle-cell
disease, caused by their lack of ability to fend off encapsulated organisms.
However, the most common causative organism in sickle-cell patients is
S aureus.
182.The answer is e.(Tintinalli, pp 614-615.)The patient has Fournier
gangrene,a polymicrobial necrotizing fasciitis of the perineal subcuta-
neous fascia and male genitalia. Treatment is aggressive fluid resuscitation,
surgical debridement, broad-spectrum antibiotics, and possibly hyperbaric
oxygen therapy. These patients require hospital admission. If not promptly
treated, the overall mortality rate of these patients is approximately 20%.
(a and b)These are polymicrobial infections and antibiotics must
cover gram-negative, gram-positive, and anaerobic bacteria. These patients
may require surgical debridement. IV antibiotic treatment and hospital
admission are recommended as these patients have a relatively high mor-
tality if not adequately and aggressively treated. (c)While these patients
will require pain medications, fluid hydration, IV antibiotics, surgical
Fever Answers 201