An 18-year-old female college student is brought to the emergency department by ambulance for a headache and altered mental status. The patient lives with her boyfriend who is with her currently. He states she had not been feeling well for the past day and has vomited several times in the past 12 hours. Lumbar puncture is performed in the emergency room and demonstrates an increased cell count with a neutrophil predominance and gram-negative diplococci on Gram stain. The patient is started on vancomycin and ceftriaxone. Which of the following is the best next step in management?
ATreat boyfriend with rifampin
BAdd ampicillin to treatment regimen
CAdd ampicillin, dexamethasone, and rifampin to treatment regimen
DAdd dexamethasone to treatment regimen
ETreat boyfriend with ceftriaxone and vancomycin
A 22-year-old female is brought to the emergency department by her roommate with a one day history of fever and malaise. She did not feel well after class the previous night and has been in her room since then. She has not been eating or drinking due to severe nausea. Her roommate checked on her one hour ago and was alarmed to find a fever of 102°F (38.9°C). On physical exam temperature is 103°F (40°C), blood pressure is 110/66 mmHg, pulse is 110/min, respirations are 23/min, and pulse oximetry is 98% on room air. She refuses to move her neck and has a rash on her trunk. You perform a lumbar puncture and the CSF analysis is shown below. Appearance: Cloudy Opening pressure: 180 mm H2O WBC count: 150 cells/µL (93% PMN) Glucose level: < 40 mg/dL Protein level: 50 mg/dL Gram stain: gram-negative diplococci Based on this patient's clinical presentation, which of the following should most likely be administered?
ACeftriaxone
BDexamethasone
CRifampin
DAcyclovir
EErythromycin
A 59-year-old woman comes to the emergency department because of a 2-day history of worsening fever, chills, malaise, productive cough, and difficulty breathing. Three days ago, she returned from a trip to South Africa. She has type 2 diabetes mellitus, hypertension, and varicose veins. Her current medications include metformin, lisinopril, and atorvastatin. Her temperature is 39.4°C (102.9°F), pulse is 102/minute, blood pressure is 94/68 mm Hg, and respirations are 31/minute. Pulse oximetry on 2 L of oxygen via nasal cannula shows an oxygen saturation of 91%. Examination reveals decreased breath sounds and dull percussion over the left lung base. The skin is very warm and well-perfused. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11.6 g/dL Leukocyte count 15,400/mm3 platelet count 282,000/mm3 Serum Na+ 144 mEq/L Cl- 104 mEq/L K+ 4.9 mEq/L Creatinine 1.5 mg/dL Blood and urine for cultures are obtained. Intravenous fluid resuscitation is begun. Which of the following is the next best step in management?
AErythromycin
BIntravenous ceftriaxone and azithromycin
CExternal cooling and intravenous acetaminophen
DIntravenous vancomycin and ceftriaxone
ECT of the chest with contrast
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