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Category: Critical Care Medicine-Infections and Immunologic Disease--->Soft-Tissue, Bone, Joint Infections
Page: 1

Question 1#Print Question

A 32-year-old previously healthy man presents with fevers and hypotension. He was bitten by a dog 4 days ago with deep puncture wounds that required operative closure. He has a history of anaphylaxis to penicillin and cephalosporins and has been receiving trimethoprim-sulfamethoxazole since surgery. Tetanus toxoid was administered and his other immunizations are up to date. On examination, his wound shows evidence of cellulitis.

Which of the following changes to his antibiotic regimen is most appropriate?

A. Change trimethoprim-sulfamethoxazole to levofloxacin
B. Add vancomycin
C. Add clindamycin
D. No change necessary


Question 2#Print Question

A 20-year-old female college student presents with fever and a painful left knee for the last 3 days. She denies any recent trauma and was treated last week for a urinary tract infection. Her vital signs are T 38.8°C, HR 112 beats/min, RR 24 breaths/min, BP 78/42 mm Hg, and O2 saturation 98% on RA. Physical examination reveals a swollen and erythematous knee with decreased range of motion. Joint aspiration demonstrates white blood cell (WBC) 20,000, with 80% neutrophils and calcium pyrophosphate crystals, and no organism are seen on gram stain. In addition to fluid administration, which of the following interventions is most appropriate?

A. No further treatment warranted
B. Administer vancomycin and ceftriaxone
C. Administer intra-articular glucocorticoids
D. Administer indomethacin


Question 3#Print Question

A 55-year-old male with non–insulin-dependent diabetes mellitus presents with lower leg swelling and severe pain. He fell while gardening yesterday and has a laceration on his heel. On examination has a fever of 39.4°C and is mildly confused. He has erythema, edema, and crepitus up to the midcalf. Notable laboratory values are a WBC count of 22,000 cells/mm2 and lactate 3.9.

What is the most appropriate next step in treatment?

A. Perform surgical debridement
B. Administer hyperbaric oxygen therapy
C. Administer intravenous immunoglobulin
D. Administer AB103, a mimetic of the CD28 T-lymphocyte receptor


Question 4#Print Question

A 28-year-old woman is admitted to the ICU with septic shock due to a soft-tissue infection. Three days prior to admission, she fell while riding her bicycle and sustained lacerations to her legs which she self-treated. Within the ICU, she undergoes fluid resuscitation, receives vasopressor support and broad-spectrum antibiotics, and is taken for surgical debridement. Tissue and blood cultures grow Streptococcus pyogenes and antibiotics are narrowed to penicillin and clindamycin. Two days later, she remains febrile, and vasopressor dependent, has a generalized rash, develops acute kidney injury requiring renal replacement therapy as well as elevated transaminases and jaundice. Sensitivity testing shows no antimicrobial resistance and no further organisms.

Which of the following interventions is MOST likely to be beneficial for treatment of this patient?

A. Intravenous immunoglobulin (IVIG) administered for 3 days
B. Hyperbaric oxygen therapy
C. Anti–tumor necrosis factor (TNF) antibody
D. Changing antibiotics to meropenem


Question 5#Print Question

A 61-year-old man presented with fever, malaise, and a blistering red rash 5 days after undergoing a laparoscopic cholecystectomy. Per report, the rash started at his port insertion sites but has progressed and now involves his face, trunk, and extremities. His medical history includes end-stage renal disease on intermittent hemodialysis, hypertension, and diabetes mellitus. Vital signs are T 38.7°C, HR 76 beats/min, BP 150/80 mm Hg, RR 26 breaths/min, and oxygen saturation of 97% on room air. Examination reveals red, blistering, tender skin, warm-to-touch and peels with gentle stroking. The rash is accentuated in the flexor creases. Perioral crusting is present but mucous membranes are spared.

What is the MOST likely etiology of this condition?

A. Systemic infection with circulating endotoxins
B. Drug-induced keratinocyte necrosis
C. Staphylococcal infection proliferating exotoxins
D. Bacterial infection invading the fascia




Category: Critical Care Medicine-Infections and Immunologic Disease--->Soft-Tissue, Bone, Joint Infections
Page: 1 of 1