A neonate born at 33 weeks is transferred to the NICU after a complicated pregnancy and C-section. A week after being admitted, he developed a fever and became lethargic and minimally responsive to stimuli. A lumbar puncture is performed that reveals the following: Appearance Cloudy Protein 64 mg/dL Glucose 22 mg/dL Pressure 330 mm H20 Cells 295 cells/mm³ (> 90% PMN) A specimen is sent to microbiology and reveals gram-negative rods. Which of the following is the next appropriate step in management?
AMRI scan of the head
BStart the patient on IV ceftriaxone
CProvide supportive measures only
DStart the patient on IV cefotaxime
EStart the patient on oral rifampin
A 6-day-old newborn is brought to the emergency department by his mother due to a high fever that started last night. His mother says that he was born via an uneventful vaginal delivery at home at 38 weeks gestation and was doing fine up until yesterday when he became disinterested in breastfeeding and spit up several times. His temperature is 39.5°C (103.1°F), pulse is 155/min, respirations are 45/min, and O2 sats are 92% on room air. He is lethargic and minimally responsive to stimuli. While on his back, his head is quickly lifted towards his chest which causes his legs to flex. The mother had only a few prenatal care visits and none at the end of the pregnancy. What is the most likely source of this patients infection?
ATick bite
BDuring birth
CInfection from surgery
DContaminated food
EMother’s roommate
A 53-year-old diabetic man with cellulitis of the right lower limb presents to the emergency department because of symptoms of fever and chills. His pulse is 122/min, the blood pressure is 76/50 mm Hg, the respirations are 26/min, and the temperature is 40.0°C (104.0°F). His urine output is < 0.5mL/kg/h. He has warm peripheral extremities. The hemodynamic status of the patient is not improving in spite of the initiation of adequate fluid resuscitation. He is admitted to the hospital. Which of the following is the most likely laboratory profile?
AWBC count: 11,670/mm3; low CVP; blood culture: gram-negative bacteremia; blood lactate level: 0.9 mmol/L
BWBC count: 1234/mm3; high CVP; blood culture: gram-negative bacteremia; blood lactate level: 1.6 mmol/L
CWBC count: 16,670/mm3; low CVP; blood culture: gram-negative bacteremia; blood lactate level: 2.2 mmol/L
DWBC count: 6670/mm3; low CVP; blood culture: gram-positive bacteremia; blood lactate level: 1.1 mmol/L
EWBC count: 8880/mm3; high CVP; blood culture: gram-positive bacteremia; blood lactate level: 2.1 mmol/L
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