Chapter·Internal MedicineInfectious diseases (sepsis, endocarditis)

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1

A previously healthy 35-year-old woman is brought into the emergency department after being found unresponsive by her husband. Her husband finds an empty bottle of diazepam tablets in her pocket. She is stuporous. At the hospital, her blood pressure is 90/40 mm Hg, the pulse is 58/min, and the respirations are 6/min. The examination of the pupils shows normal size and reactivity to light. Deep tendon reflexes are 1+ bilaterally. Babinski sign is absent. All 4 extremities are hypotonic. The patient is intubated and taken to the critical care unit for mechanical ventilation and treatment. Regarding the prevention of pneumonia in this patient, which of the following strategies is most likely to achieve this goal?

ANasogastric tube insertion

BDaily evaluation for ventilator weaning

CSubglottic drainage of secretions

DOropharynx and gut antibacterial decontamination

EProne positioning during mechanical ventilation

2

A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for advanced melanoma. The research team decides to conduct a non-randomized study where the novel drug will be offered to patients who are deemed to be at risk for toxicity with the current standard of care immunotherapy, while patients without such risk factors will receive the standard treatment. Which of the following best describes the level of evidence that this study can offer?

ALevel 1

BLevel 3

CLevel 5

DLevel 4

ELevel 2

3

A 37-year-old man with a history of IV drug use presents to the ED with complaints of fevers, chills, and malaise for one week. He admits to recently using IV and intramuscular heroin. Vital signs are as follows: T 40.0 C, HR 120 bpm, BP 110/68 mmHg, RR 14, O2Sat 98%. Examination reveals a new systolic murmur that is loudest at the lower left sternal border. Initial management includes administration of which of the following regimens?

AIV Vancomycin, IV ceftriaxone, IV fluconazole

BIV Vancomycin, IV ceftriaxone

CIV Vancomycin, IV levofloxacin

DIV Vancomycin

EIV Vancomycin, IV gentamicin, PO rifampin

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