A 33-year-old man presents to the emergency department complaining of weakness and fatigue. He states that his symptoms have worsened over the past day. He has a past medical history of IV drug abuse and alcoholism and he currently smells of alcohol. His temperature is 102°F (38.9°C), blood pressure is 111/68 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for focal tenderness over the lumbar spine. Initial lab values and blood cultures are drawn and are notable for leukocytosis and an elevated C-reactive protein (CRP). Which of the following is the best treatment for this patient?
ANafcillin
BCeftriaxone
CPiperacillin-tazobactam
DVancomycin
EIbuprofen and warm compresses
A 42-year-old homeless man presents to the emergency department complaining of pain in his right knee and fever. The patient is having difficulty walking and looks visibly uncomfortable. On examination, he is disheveled but his behavior is not erratic. The patient’s right knee is erythematous, edematous, and warm, with evidence of a 3 cm wound that is weeping purulent fluid. The patient has a decreased range of motion secondary to pain and swelling. The wound is cultured and empiric antibiotic therapy is initiated. Four minutes into the patient’s antibiotic therapy, he develops a red, pruritic rash on his face and neck. What is the most likely antibiotic this patient is being treated with?
AGentamicin
BLinezolid
CPenicillin G
DErythromycin
EVancomycin
A 77-year-old woman is brought to the emergency department from her nursing home because she was found down overnight. On presentation she was found to be delirious and was unable to answer questions. Chart review shows that she is allergic to cephalosporins. Her temperature is 102.2°F (39°C), blood pressure is 105/52 mmHg, pulse is 94/min, and respirations are 23/min. Physical exam reveals a productive cough. A metabolic panel is obtained with the following results: Serum: Na+: 135 mEq/L Cl-: 95 mEq/L K+: 4 mEq/L HCO3-: 19 mEq/L BUN: 40 mg/dL Creatinine: 2.5 mg/dL Glucose: 150 mg/dL Based on these findings two different drugs are started empirically. Gram stain on a blood sample is performed showing the presence of gram-positive organisms on all samples. One of the drugs is subsequently stopped. The drug that was most likely stopped has which of the following characteristics?
AResistance conveyed through acetylation
BAssociated with red man syndrome
CSingle-ringed ß-lactam structure
DCauses discolored teeth in children
EAccumulates inside bacteria via O2-dependent uptake
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