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ANTHRAX Anthrax can occur in 4 forms, depending on the route of infection: cutaneous, inhalational, gastrointestinal, and injection. Cutaneous anthrax begins as a pruritic papule or vesicle and progresses over 2 to 6 days to an ulcerated lesion with subsequent formation of a central black eschar. The lesion itself is characteristically painless, with surrounding oedema, hyperaemia, and painful regional lymphadenopathy. Patients may have associated fever, lymphangitis, and extensive oedema. Inhalational anthrax is a frequently lethal form of the disease and constitutes a medical emergency. The initial presentation is nonspecific with fever, sweats, non-productive cough, chest pain, headache, myalgia, malaise, nausea, and vomiting, but progresses to the fulminant phase 2 to 5 days later. In some cases, the illness is biphasic with a period of improvement between prodromal symptoms and overwhelming illness. Fulminant manifestations include hypotension, dyspnoea, hypoxia, cyanosis, and shock occurring as a result of haemorrhagic mediastinal lymphadenitis, haemorrhagic pneumonia, haemorrhagic pleural effusions, and toxaemia. A widened mediastinum is the classic finding on imaging of the chest. Chest radiography may also show pleural effusions or infiltrates, both of which may be haemorrhagic in nature. Gastrointestinal tract disease can present as one of 2 distinct clinical syndromes — intestinal or oropharyngeal. Patients with the intestinal form have nausea, anorexia, vomiting, and fever progressing to severe abdominal pain, massive ascites, hematemesis, and bloody diarrhea, related to development of oedema and ulceration of the bowel, primarily the ileum and cecum. Patients with oropharyngeal anthrax may also have dysphagia with posterior oropharyngeal necrotic ulcers, which can be associated with marked, often unilateral neck swelling, regional adenopathy, fever, and sepsis. Injection anthrax has not been reported to date in children. Its primary occurrence has been reported among injecting heroin users; however, smoking and snorting of heroin also have been identified as exposure routes. Systemic illness can result from hematogenous and lymphatic dissemination and can occur with any form of anthrax. Most patients with inhalational, gastrointestinal, and injection anthrax have systemic illness. Anthrax meningitis can occur in any patient with systemic illness regardless of origin; it can also occur in patients lacking any other apparent clinical presentation. The case-fatality rate for patients with appropriately treated cutaneous anthrax is usually less than 1%. Even with antimicrobial treatment and supportive care, the mortality rate for inhalational or gastrointestinal tract disease is between 40% and 45% and approaches 100% for meningitis. Choose the correct statement.
Питання КРОК 1 (медицина) · тест з варіантами та поясненням · Medus
EN: Choose the correct statement.
Варіанти відповідей
Inhalational form of anthrax progresses over less than a week
Chest radiography in case of the inhalational form of anthrax always shows pleural effusions or infiltrates
Inhalational form of anthrax is always lethal
Inhalational form of anthrax always has a period of improvement
Answer options (EN)
Inhalational form of anthrax progresses over less than a week
Chest radiography in case of the inhalational form of anthrax always shows pleural effusions or infiltrates
Inhalational form of anthrax is always lethal
Inhalational form of anthrax always has a period of improvement
Правильна відповідь
Inhalational form of anthrax progresses over less than a week
Пояснення
Інгаляційна форма сибірки має швидкий перебіг - від кількох днів до тижня; часто летальна, але не завжди. Рентгенографія не завжди показує випіт чи інфільтрати на початку; період поліпшення не типовий. Найкоректніше - що захворювання прогресує менше ніж за тиждень.
