Infectious Diseases and Sepsis
Core concepts
Understand the definitions and management of sepsis and septic shock, including early recognition, fluid resuscitation, and timely antibiotics. Know the common sources and the approach to fever in the returning traveler and the immunocompromised patient. Recognize the "can't miss" infections: meningitis, necrotizing fasciitis, toxic shock syndrome, and endocarditis.
Understand antimicrobial stewardship principles and the importance of cultures before antibiotics when feasible. Know the isolation precautions for common pathogens and the approach to needlestick exposure and post-exposure prophylaxis. Recognize the clinical features of specific infections such as malaria, dengue, and tuberculosis.
Traps
Questions test whether you delay antibiotics for cultures in a septic patient - do not. Another trap is missing necrotizing fasciitis (pain out of proportion, crepitus, rapid progression) and failing to involve surgery early. Watch for the immunocompromised patient who may not mount a fever.
Worked example / rule of thumb
A patient with fever, hypotension, and lactate of 4 mmol/L: sepsis bundle - fluids, cultures, broad-spectrum antibiotics, and source control. Rule of thumb: "Antibiotics within the hour in septic shock; cultures first only if they do not delay treatment."