A 7-year-old girl is brought to the pediatrician by her parents for red papules over her left thigh and swelling in the right axilla for the past few days. Her parents say that she had a cat bite on her left thigh 2 weeks ago. Her temperature is 38.6°C (101.4°F), pulse is 90/min, and respirations are 22/min. On her physical examination, hepatosplenomegaly is present with a healing area of erythema on her left thigh. Her laboratory studies show: Hemoglobin 12.9 gm/dL Leukocyte count 9,300/mm3 Platelet count 167,000/mm3 ESR 12 mm/hr Which of the following is the most appropriate next step in management?
AAzithromycin as a single agent
BNo treatment is required
CDoxycycline + rifampin
DSurgical excision of the lymph node
ERifampin + azithromycin
A 72-year-old woman comes to the physician because of a 3-day history of redness and swelling of her right leg and fever. She says the leg is very painful and the redness over it has become larger. She appears ill. Her temperature is 39.3°C (102.7°F), pulse is 103/min, and blood pressure is 138/90 mm Hg. Cardiopulmonary examination shows no abnormalities. Examination shows an area of diffuse erythema and swelling over her anterior right lower leg; it is warm and tender to touch. Squeezing of the calf does not elicit tenderness. There is swelling of the right inguinal lymph nodes. Pedal pulses are palpable bilaterally. Which of the following is the strongest predisposing factor for this patient's condition?
ACigarette smoking
BGraves disease
CTinea pedis
DRheumatoid arthritis
EImmobility
A 62-year-old woman presents to the emergency department for evaluation of a spreading skin infection that began from an ulcer on her foot. The patient has type 2 diabetes mellitus that is poorly controlled. On examination, there is redness and erythema to the lower limb with skin breakdown along an extensive portion of the leg. The patient’s tissues separate readily from the fascial plane, prompting a diagnosis of necrotizing fasciitis. What is the exotoxin most likely associated with this patient’s presentation?
AStreptococcal pyogenic exotoxin A
BTSST-1
CDiphtheria toxin
DExfoliative toxin
EStreptococcal pyogenic exotoxin B
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