Clinical Scenario Worksheet: Infectious Diseases and Neurology

ED patient with high fever and a centrifugal rash of deep, firm, umbilicated pustules in the same stage on face and distal limbs. Which immediate steps are appropriate today?

• Airborne and contact isolation with restricted room access

• Immediate notification of infection prevention and public health

• Routine office viral culture in the hospital lab

• Reference-lab PCR arranged through public health channels

• Broad-spectrum antibiotics as primary therapy

A triage nurse must rapidly distinguish smallpox from varicella in a patient with generalized rash and fever. Which single finding most strongly supports smallpox over varicella?

• Lesions in the same stage of development on each body area

• Trunk-predominant rash with mixed-stage lesions

• Thin-walled 'dew-drop' vesicles on erythematous base

• Absence of prodromal high fever

A hospitalized patient with suspected smallpox requires specimen collection under strict protocols. Which request is least consistent with safety and policy?

• Coordinate with public health for secure chain-of-custody

• Collect in appropriate leak-proof containers with BSL guidance

• Send to local routine lab for same-day viral culture

• Limit staff exposure and document PPE used

Traveler from an endemic region develops asymmetric flaccid paralysis with reduced reflexes and intact sensation. Which diagnostics best support confirmation now?

• Stool RT-PCR and/or viral isolation for poliovirus

• Oropharyngeal swab RT-PCR early in illness

• CSF lymphocytic pleocytosis as a specific confirmatory test

• MRI alone as definitive confirmation

• Paired serology when available, interpreted with timing

Suspected bulbar polio presents with dysphagia, weak cough, and pooling secretions. Which single action is the highest priority this hour?

• Airway protection and readiness for ventilatory support

• Immediate high-dose corticosteroids

• Aggressive diuresis to reduce airway edema

• Delay interventions pending viral culture

A rehab plan is written for non-bulbar paralytic polio with lower-limb weakness.

• Focuses on strengthening lower limbs

• Emphasizes speech therapy

• Targets upper-limb rehabilitation only

• Centers on bulbar muscle recovery

A rehab plan is written for non-bulbar paralytic polio with lower-limb weakness.

Which element is least aligned with evidence-based care?

• Early PT with gentle range-of-motion and contracture prevention

• Energy conservation with pacing and assistive devices

• Prolonged strict bedrest for several weeks

• Swallow screening if bulbar signs emerge

A hospitalized patient with encephalitis is tested for rabies; multiple staff had routine contact using gloves and hand hygiene only. Which follow-up is most appropriate?

• Standard precautions are adequate; evaluate only mucous membrane exposures

• Place entire unit on airborne isolation for 10 days

• Monitor all staff for hydrophobia daily

• Begin universal PEP for all employees

A family refuses HRIG due to cost but will accept vaccine after a severe bat exposure during sleep. Which counseling point is most accurate today?

• HRIG is unnecessary if vaccine is given the same day

• HRIG is indicated for previously unvaccinated persons to neutralize virus at the wound

• HRIG is only for dog bites, not bats

• Vaccine alone provides immediate passive protection

Infant with severe combined immunodeficiency (SCID) awaits HSCT; parents ask about vaccines and precautions. Which single order is least appropriate today?

• Live attenuated MMR at 12 months

• PJP prophylaxis per protocol

• Protective isolation with infection avoidance

• Irradiated/CMV-appropriate blood products