A 2-year-old boy presents for a routine checkup. The patient’s mother says that he has been ‘under the weather’ for the past few days. She did not measure his temperature at home but states that he has felt warm. She denies any episodes of diarrhea or vomiting. No significant past medical history or current medications. The patient attends daycare. He is due for a hepatitis A vaccine. The patient was born at term with no prenatal or perinatal complications. The vital signs include: temperature 37.8°C (100.1°F), blood pressure 112/62 mm Hg, pulse 80/min, respiratory rate 18/min, and oxygen saturation 99% on room air. The patient is alert and responsive. The physical exam is unremarkable. Which of the following is the most appropriate next step in the management of this patient?
AOrder a complete blood count
BOrder liver function tests
CStrep rapid antigen detection test
DAdminister the hepatitis A vaccine
EDelay the hepatitis A immunization until next visit
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 67-year-old man presents to the emergency department with confusion. The patient is generally healthy, but his wife noticed him becoming progressively more confused as the day went on. The patient is not currently taking any medications and has no recent falls or trauma. His temperature is 102°F (38.9°C), blood pressure is 126/64 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a confused man who cannot participate in a neurological exam secondary to his confusion. No symptoms are elicited with flexion of the neck and jolt accentuation of headache is negative. Initial laboratory values are unremarkable and the patient's chest radiograph and urinalysis are within normal limits. An initial CT scan of the head is unremarkable. Which of the following is the best next step in management?
ACT angiogram of the head and neck
BVancomycin, ceftriaxone, ampicillin, and dexamethasone
CAcyclovir
DPCR of the cerebrospinal fluid
EMRI of the head
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