An 18-year-old girl is brought to the emergency department because of a 1-day history of severe headache with photophobia and diffuse myalgias. She is a college student and lives in a dormitory in a large urban area. She has not traveled recently. On arrival, she is lethargic. Her temperature is 39.3°C (102.7°F), pulse is 120/min, and blood pressure is 88/58 mm Hg. Examination shows scattered petechiae and ecchymoses on the trunk and lower extremities. There is decreased range of motion of the neck. Cerebrospinal fluid analysis shows a cell count of 1,600/μL (80% neutrophils) and a lactate concentration of 5.1 mmol/L. Which of the following is most likely to have prevented this patient's condition?
AIntravenous vancomycin
BPolysaccharide conjugate vaccine
CErythromycin therapy
DDoxycycline therapy
EToxoid vaccine
An 18-month-old boy presents to the emergency department for malaise. The boy’s parents report worsening fatigue for 3 days with associated irritability and anorexia. The patient’s newborn screening revealed a point mutation in the beta-globin gene but the patient has otherwise been healthy since birth. On physical exam, his temperature is 102.4°F (39.1°C), blood pressure is 78/42 mmHg, pulse is 124/min, and respirations are 32/min. The child is tired-appearing and difficult to soothe. Laboratory testing is performed and reveals the following: Serum: Na+: 137 mEq/L Cl-: 100 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 16 mg/dL Creatinine: 0.9 mg/dL Glucose: 96 mg/dL Leukocyte count: 19,300/mm^3 with normal differential Hemoglobin: 7.8 g/dL Hematocrit: 21% Mean corpuscular volume: 82 um^3 Platelet count: 324,000/mm^3 Reticulocyte index: 3.6% Which of the following is the most likely causative organism for this patient's presentation?
AStreptococcus pneumoniae
BListeria monocytogenes
CHaemophilus influenzae
DNeisseria meningitidis
ESalmonella
A 15-year-old boy is brought to the Emergency department by ambulance from school. He started the day with some body aches and joint pain but then had several episodes of vomiting and started complaining of a terrible headache. The school nurse called for emergency services. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. He is a good student and enjoys sports. At the hospital, his blood pressure is 120/80 mm Hg, heart rate is 105/min, respiratory rate is 21/min, and his temperature is 38.9°C (102.0°F). On physical exam, he appears drowsy with neck stiffness and sensitivity to light. Kernig’s sign is positive. An ophthalmic exam is performed followed by a lumbar puncture. An aliquot of cerebrospinal fluid is sent to microbiology. A gram stain shows gram-negative diplococci. A smear is prepared on blood agar and grows round, smooth, convex colonies with clearly defined edges. Which of the following would identify the described pathogen?
AOxidase-positive and ferments glucose and maltose
BOxidase-positive test and ferments glucose only
CCatalase-negative and oxidase-positive
DNo growth on Thayer-Martin medium
EGrowth in anaerobic conditions
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