S aureusis the leading cause of osteomyelitis, followed by Streptococcus.In
neonates, group B Streptococcusis a common infecting bacterium of bone
and joint infections, and group A Streptococcusmay be seen in children
3 months to 14 years of age. (e)Infection of the skin or bone following a
cat bite is most likely because of P multocida.
175.The answer is d.(Filbin, 2006.)The basis of sepsis (c)is the pres-
ence of infection and the subsequent physiologic alterations in response to
that infection, namely the activation of the inflammatory cascade. (a)SIRS
is a term used to define this clinical condition, and is considered present if
abnormalities in two of the following four clinical parameters exist: (1) body
temperature, (2) HR, (3) RR, and (4) peripheral leukocyte count. These cri-
teria include body temperature < 36°C (96.8°F) or > 38°C (100.4°F), rather
90 beats per minute, RR > 20 breaths per minute or, on blood gas, a
PaCO 2 less than 32 mm Hg, and WBC count < 4000 cells/mm^3 or > 12,000
cells/mm^3 , or greater than 10% band forms. This patient’s condition is most
consistent with severe sepsis,which is defined as sepsis with acute organ
dysfunction.Some examples of end-organ dysfunction include acute lung
injury, encephalopathy, confusion, progressive coagulopathy caused by
inability to synthesize clotting factors, elevated unconjugated serum biliru-
bin, oliguria, anuria, and systolic and diastolic heart failure. Severe SIRS
(b)is defined as end-organ dysfunction without evidence of infection. Septic
shock(e)is defined as sepsis with persistent hypotension despite fluid
resuscitation and resulting tissue hypoperfusion.
176.The answer is e.(Rosen, pp 977-978.)Ludwig Angina (LA)is a
potentially life-threatening cellulitisof the connective tissue of the floor of
the mouth and neckthat begins in the submandibular space.An infected
or recently extracted tooth is present in most cases. Typically, it is a
polymicrobial infectioninvolving aerobic and anaerobic bacteria of the
mouth. The most commonly isolated organisms include streptococci,
staphylococci, and bacteroides species. The most common physical find-
ings in LA are bilateral submandibular swelling and tongue protrusion or
elevation. A tense edema and brawny induration of the neck above the
hyoid may be present and is described as a “bull neck.” Marked tenderness
to palpation of the neck and subcutaneous emphysema may be noted.
Trismusandfeverare often present, but usually no palpable fluctuance or
cervical lymphadenopathy. The involved teeth may be tender to palpation.
Patients with LA should neverbe left alone as airway impairment can
Fever Answers 197